We put
quality
first
1
Quality Account
2012-2013
Contents
Part 1: Statement on Quality3
Statement from Chief Executive4
Statement from Responsible Director5
Our definition of Quality6
Introduction – About Us7
Our Services8
Equality, Human Rights and Inclusion10
Strategy and Service Development11
Our Mission, Vision, Values and Goals12
Our Quality Framework13
Part 2: Our Priorities for Quality Improvement
15
How we decided our quality priorities for 2013/14
17
Priority 1: Safety – reducing avoidable pressure ulcers
18
Priority 2: Experience – customer satisfaction
20
Priority 3: Effectiveness – improving outcomes
22
Priority 4: Effectiveness - supporting independence by personalised care
24
Monitoring our progress26
Mid Staffordshire Foundation Trust Public Enquiry
27
Other areas of quality improvement28
Statements of Assurance29
Mandatory Quality Indicators37
Part 3: Review of Quality Performance in 2012/13
41
Progress against Quality & Safety Programme Priorities 2012/13
42
Partnership Trust Performance indicators55
Safety58
Experience63
Effectiveness72
Supporting Staff79
Statements from our Partners83
Statement of Directors’ Responsibilities in respect of the Quality Account
91
Glossary92
2
Part 1
Statement on
quality
3
Statement from Chief Executive
Providing personalised care at the
highest quality, with the best possible
outcomes for users and carers, continues
to be our key priority.
We provide community health and adult social
care services to people living in Staffordshire
and Stoke-on-Trent. Our organisation has a
diverse range of services, a wide geographic and
demographic coverage, and integration between
health and social care that all combine to make it
unique.
Each of our major developments this year has
been driven by one of our core values; we put
quality first.
• On 1 April 2012 when we became an integrated
provider of Adult Social Care Services and
Community Health Services:
• We continued our progress to becoming a
Foundation Trust, giving us new freedoms to
make our own decisions and help us to engage
more with our communities through our
membership,
• We developed our integrated services operating
model, where health and social care will be
provided by integrated teams. In 2013/14 we
will start implementing this model,
• We started work to develop integrated
Children’s services by forming a new Children’s
Directorate,
• We developed and consulted on our Quality
Framework, our key strategic document for
quality. We will continue to involve service
Stuart Poynor
Chief Executive
4
users, partner agencies and staff at every stage
of implementation over the next five years. We
have already engaged with our staff to gather
ideas for improving quality.
We look to the year ahead, establishing our
Model of Care, which forms the basis of our
Clinical Strategy, that supports people to remain
healthier so that fewer people are admitted
to hospital, transforming adult health and
social care services, developing a children’s
directorate, and of forging new relationships
with our commissioners. We have made a
commitment to be an ambassador trust for the
“Personal, Fair & Diverse” campaign. The Mid
Staffordshire Foundation Trust Public Enquiry
recommendations have significant implications
for our Trust, and we will be addressing
these recommendations in detail during the
forthcoming year.
Production of this Quality Account demonstrates
our Board level commitment to quality, reaffirms
our commitment to evidence-based quality
improvement, and explains this to the public.
We know that quality relies, not only on
structures and processes, but primarily on people.
Our appointment of an Ambassador of Cultural
Change – an ally for anyone worried about raising
concerns – reflects our commitment to quality.
Looking back over the past year we cannot fail to
be impressed by the dedication and enthusiasm
our staff have for quality. On behalf of the Board
we are pleased to present this account to you.
Professor Nigel Ratcliffe
Chairman
Statement from Responsible Director
I hereby state that to the best of my
knowledge that the information
contained in the following Quality
Account is accurate.
Siobhan Heafield
Director of Nursing and Quality
Service User Experience
A gentleman who suffers from a number of conditions,
including Chronic Obstructive Pulmonary Disease, heart
problems and diabetes, attended Trust Board to speak of his
experiences.
He informed members that since being in contact with
a community nurse, and having a personalised care plan
developed, his hospital admissions had dramatically reduced
and his health and wellbeing had improved.
The gentleman had nothing but praise for the services that he
had received and told the Board how a smile from his nurse
meant the world to him and that she had ‘brought brightness
into his life’.
5
Our definition of Quality
Quality refers to all our service user and carer requirements; expressed in terms of safety, effectiveness, and
experience; and ultimately focussed on outcomes.
We subscribe to the definition put forth by Lord Darzi as follows:
High quality care is where; service users are in control,
have effective access to treatment or care, are safe, and
where illnesses are not just treated, but prevented1.
Service User Compliment
Received July – 2012 – Community Intervention Team – Bilbrook House:-
“Thanks to the Intermediate Care Team for the wonderful service
provided. All arranged incredibly quickly. Please pass on my
thanks to all the nurses. Everyone was very helpful and efficient. I
have been most impressed with the service provided.”
1. Adapted from High Quality Care For All, Department of Health 2008.
6
About Us
We are one of the largest integrated community
trusts in the country:
• We employ 6,118 staff, including doctors,
dentists, nurses, allied health professionals, social
workers, managers and support staff
• We serve a population of 1.1 million people; in
their homes, in our five community hospitals, and
in six prisons
• Our services cover a geographic area of around
1,012 square miles from the Staffordshire
Moorlands in the North, down to the borders of
the Black Country
• We have an income of £367m
• F rom 1 April 2012 we became an integrated
provider of Adult Social Care Services (older
people, physical disabilities and sensory
impairment) and Community Health Services
About Staffordshire and
Stoke-on-Trent
Staffordshire County is split into eight District and
Borough Councils:
• Cannock Chase
• East Staffordshire
• Lichfield
• Newcastle-under-Lyme
• South Staffordshire
• Stafford
• Staffordshire Moorlands
• Tamworth
Stoke-on-Trent is a Unitary Authority situated
within the boundary of Staffordshire.
In general, high levels of deprivation are apparent
in Stoke-on-Trent and there are also pockets of
deprivation in Newcastle-under-Lyme, Cannock
and Burton. In contrast, further south of the
County, are the more affluent areas of Lichfield
and South Staffordshire2.
2. Based on the Atlas of Deprivation 2010, Office for National Statistics
7
Our Services
Responsibilities for delivery of both clinical and
corporate services are split across six directorates:
• Nursing and Quality
• Operations (with two divisions)
• Transformation
• Medical
• Finance and Resources
• Workforce and Development
Our core services are managed within localities to
maintain a focus of delivery to a specific patient
population.
Range of Services provided by the Partnership Trust
Adults Services
Adult Ability Team
Adult Social Care Services
Assistive Technology
Community Falls Service
Community Matrons
Community Pain Management
Community Rheumatology
Continence Service
Dietetics
District Nursing Service
Health Visitors
Intermediate Care
Intervention Service
Occupational Therapy
Physiotherapy
Podiatry
Rehabilitation
Respiratory Services
Rheumatology
Speech and Language Therapy
Wheelchair and Equipment Services
Children’s Services
Community Children’s Nursing
Children’s Airways Support Team (CAST)
Children’s Occupational Therapy
Dietetics
Health Visitors
Family Nurse Partnership
8
Healthy Kid5
Hospital at Home
Infant Feeding
Newborn Hearing Screening Programme
Paediatric Liaison
Physiotherapy
Safeguarding Children
Speech and Language Therapy
School Health Community Support and
Information Service
School Nursing Service
Specialist Services
Amputee Rehabilitation
Asylum Seeker and Refugee Service
Community Cardiac Rehabilitation / Heart Failure
Cancer Support Team
Continence Service
Dental
Dermatology
Deep Vein Thrombosis Screening
Diabetes Service
Early Supported Community Stroke Team
Health Improvement / Lifestyle
Hearing Aid Battery and Tubing Centre
Homeless Health Service
Immunisation
Learning Disabilities
Long Term Conditions Team
Limb Fitting
Multi Agency Safeguarding Hub (MASH)
Musculoskeletal Service
Night Allocation of Nursing Services
Orthopaedic and Rheumatology Triage
Orthotic Service
Orthopaedic Service
Pulmonary Rehabilitation
Preventative Services
Respiratory Service
Sexual Health Services
Stop Smoking - Time to Quit
Stroke Rehabilitation
Tissue Viability
Adult Weight Management (“Waistlines”)
Walk in Centre / Minor Injuries Unit Services
Community Hospitals
We have five community hospital sites from which the
Partnership Trust delivers a range of community based
services with a total of 340 beds.
Bradwell Hospital
Cheadle Hospital
Leek Hospital
Haywood Hospital
Longton Cottage Hospital
We provide a number of community based clinics from:
Sir Robert Peel Hospital
Samuel Johnson Community Hospital
Patient Experience
A lady who has Churg
Strauss Syndrome spoke to
our Trust Board about the
Expert Patient Programme
that helps people with long
term conditions manage
their day to day life.
She explained that the
course had given her, and
many others, self-confidence
in managing their condition
but that the programme
had now ceased.
The Trust is rolling out
patient empowerment
schemes to develop a
supportive programme
for sufferers of long term
conditions.
Prison Healthcare Services
We also provide health care services within prison
settings.
Her Majesty’s Prison (HMP) Stafford
Her Majesty’s Prison (HMP) Featherstone
Her Majesty’s Prison & Young Offenders Institute
(HMP&YOI) Drake Hall
Her Majesty’s Prison & Young Offenders Institute
(HMP&YOI) Swinfen Hall
Her Majesty’s Young Offenders Institute Brinsford
Her Majesty’s Young Offenders Institute Werrington
9
Equality, Human Rights and Inclusion
The Partnership Trust is committed to ensuring
effective measures are in place to meet our
Vision and Values as well as our legal obligations
in protecting people from discrimination in the
workplace and in wider society3.
• Our Equality and Inclusion strategy was
developed following consultation and
engagement.
• Our Equality Data Analysis identified key
messages and actions to address gaps or
patterns in data collection, service access and
uptake.
• We have worked to align our Equality Delivery
System database with our Care Quality
Commission database and we will begin
populating this over the next year. The Equality
Delivery System is a performance tool which
will support the Trust to monitor and measure
progress on our equality objectives.
• An Equality Analysis has to be completed for
all our policies and strategies, as part of their
development process. This ensures that they are
inclusive, fair, and accessible for all our staff and
service users.
3. See the Equality Act 2010 and the Public Sector Equality Duty
10
Across the Trust there are many activities, which
are part of everyday practices, which support
compliance with the wider equalities agenda.
Examples include patient choice, patient care,
and employment practices, that all promote the
principles of the Human Rights Act 1998.
We have established a Trust wide Integrated
Language and Communication Service which
supports staff to access language, British Sign
Language (BSL) and Lip-speaker interpreters.
The service also provides access to telephone
interpreters and translation of documents upon
request.
This service supports competent communication
between:
• Patients / service users and health professionals
when accessing health and social care,
consultation and engagement events
• Staff when accessing internal training
programmes, consultation and engagement
events
For more information see:
http://www.staffordshireandstokeontrent.
nhs.uk/About-Us/equality-strategy.htm
Strategy and Service Development
To fulfil our Vision, we need to deliver truly integrated, health and
social care.
Our “Better Together” transformation programme
will see the full merger of our adult health and
social care services into fully integrated teams.
Our Partnership Trust Board recognises that
successful delivery of these service developments
What will integrated adult health
and social care teams mean for our
service users?
• A single assessment will identify the health and
social care needs of our service users, improving
their experience of our care.
• A care co-ordinator will manage a person’s care
plan to ensure the right care is provided at the
right time in the right place.
• People with long term conditions will be able to
live more independently
• The use of new technology will improve
productivity levels of our staff.
Other Service Developments
2013/14
We reviewed our Children’s Services last year,
and decided that to provide safe, effective
and proactive services for children and young
people we would establish a Children’s Services
Directorate.
will require significant transformation in culture
and working practices.
Our supporting strategies, such as Estates,
Information Management and Technology, and
Workforce & Organisation Development underpin
our strategic direction.
• There will be fewer delayed discharges and
a shorter length of stay in hospital, whilst
improving patient safety and promoting
independence
The implementation of Integrated Teams is one of
our key service developments which responds to
the findings of our assessment of local population
needs.
We developed our Model of Care for integrated
teams over the last year and we will start
implementing it in 2013/14. Our Model of Care
forms the basis of our clinical strategy
We developed a new management structure for
Children’s Services, to take effect from 1 April 2013.
During 2013/14 we will continue working with
our staff and partner organisations to develop
integrated services and joint working for children.
Service User Experience
A gentleman from Tamworth, who suffers from Parkinson’s
disease, attended our Trust Board to talk about the
excellent services and experiences he was provided with
by the physiotherapy and speech therapist teams.
11
Our Vision, Values and Goals
During the last 12 months we have developed
and refined our vision, values and goals through
engagement and consultation with staff, key
stakeholders and the public.
Figure 1. Our vision, values and strategic goals
Our Vision
We will deliver personalised care of the highest quality, with the best possible outcomes
for users and carers, empowering them to remain independent.
Our Values
We will put quality first. We focus on people. We take responsibility.
Our Strategic Goals
We will provide high quality and safe services which provide an excellent experience and best
possible outcomes.
We will work with partners, users and carers to deliver integrated services simply and
effectively.
Our organisation will develop and deliver sustainable innovative services that support
independence.
Our workforce will be empowered and supported to deliver care in a way that is consistent
with our values.
We will make excellent use of our resources and improve levels of efficiency across our trust.
12
Our Quality Framework
Last year we developed a Quality Framework,
which is our 5-year quality strategy . We have
many strategies and work streams related to
quality – the Quality Framework gives an overall
direction for these strategies.
Effectiveness, and Experience strategies will be
agreed in 2013/14.
The Quality Framework aim is that all service
users receive the highest quality of care,
by ensuring that front line teams are
empowered by the organisation to provide
this. The Framework contains six quality goals
(see figure 2), reflecting the unique makeup of our
Trust.
• Monthly quality reports are received by the
Partnership Trust Board.
• Performance scorecards including key quality
performance indicators are shared on a monthly
basis at Partnership Trust Board and Committee
level.
• Matrons use a quality assurance “Ward to Board”
dashboard, designed to give assurance that what
is discussed at Board level actually happens in
the ward.
• Each month the chair of the Quality Governance
Committee presents the minutes and an update
to the Trust Board.
• Operational divisions review monthly reports on
quality.
• Divisional performance health and social care
quality reviews are conducted across key quality
indicators.
The Quality Framework will be supported by four
key strategies and work streams:
• Safety Strategy
• Effectiveness Strategy
• Experience Strategy
• Quality Assurance Programme
These strategies and work streams detail the
policies, systems and processes that we will
use to achieve our six quality goals. The Safety,
We use our quality information in a variety of
ways:
Figure 2. Our six quality goals
Quality at the
Front Line
Integrating
Quality
Delivering
Excellence
Effective
Outcomes
Assuring
Quality
Service User
Involvement
13
Focus on:
School Nursing
Bev Roberts, our School Nursing Specialist
Practitioner from the Cannock School Nursing
Team, reports:
“To coincide with World Mental Health Day on
10 October 2012 I arranged a multi-agency
event to visit all the high schools in Cannock
and Rugeley. We targeted year eight groups
of students and arranged for the community
youth bus to transport us from school to school
delivering information and to raise awareness of
support services available locally and nationally to
support young people who may be experiencing
mental health difficulties. It was also to raise the
awareness of positive mental health. “Good mental
health is just as important as good physical health”
is the message we wanted to give out during this
week.
We visited six high schools in Cannock and
Rugeley with multi-agency partners from
Staffordshire County Council. The named School
Nurse for each high school also attended.
• We delivered a 20 minute awareness raising
session around: what is mental health, positive
steps to improve our mental health and agencies
who can help.
• We also showed the three minute film from
the Department of Health’s “Time to Change”
programme.
• S tudents then had a chance to explore the local
community youth bus with the youth workers.
• Youngsters had the opportunity to complete
a “foot” of their own positive steps to mental
health.
• We were also able to give each student
information on emotional health and a Child line
guide about keeping safe and who to contact in
times of distress.
We delivered the session to over 900 year eight
students over four days. The week was very
positive and well supported. It was encouraging to
see all the information being well received by the
students who were interested in what we had to
say.
Fairoak and Hagley Park schools continued
the mental health awareness theme in their
assemblies all week.
“These results show that our hard work is taking us in the right direction and
our focus will be on continuing to improve the environment in our hospitals
for the people we serve.”
14
Part 2
Our Priorities
for Quality
Improvement
15
Focus on:
Community
Intervention Services
Joined up Community Health Services are
changing the way we care. People across
Staffordshire are benefitting from a more coordinated approach to all of a person’s health and
care needs.
Following a recent fall that resulted in a fractured
pelvis, a local lady in her 70’s was admitted to
the Haywood Hospital where she experienced
what she described as “excellent care”. Nine days
later she was able to return home, following
close liaison with the hospital and Occupational
Therapists who made sure she had the equipment
she needed to make it possible for her to return
home so early in her recovery.
A Community Intervention Service Nurse and
Occupational Therapist made an assessment
within two hours of her returning home and
then supported with four daily support calls from
the team’s care staff and Rehabilitation Support
Workers.
The team was able to;
• assist with meals and personal care,
• follow rehabilitation goals set by the
physiotherapist and occupational therapist; and
• provide regular nursing monitoring.
Following four weeks of support, she was able to
manage independently within her home again.
She is able to look after her dog, and, although still
reliant on friends and family for shopping has now
almost returned to her previous level of mobility.
“ Following a recent fall that resulted in a fractured pelvis, a local
lady in her 70’s was admitted to the Haywood Hospital where she
experienced what she described as “excellent care.”
16
How we decided our quality priorities
for 2013/14
Our priorities for 2013/14 are based
on existing priorities that need to be
maintained, the views of service users,
carers and families and our staff.
We also considered our performance in
previous years and lessons learned from
incidents and complaints.
To determine the areas that the Partnership Trust
should focus on for 2013/14, we considered:
•C
onsultation feedback from service users,
carers, staff, commissioners, partner agencies
and stakeholders gained whilst developing our
Quality Framework.
•O
ur strategic goals and annual objectives.
•P
riorities in Staffordshire County Council’s latest
local account for 2011/12.
We have also worked alongside the
commissioners of our services to agree the quality
improvements we will deliver as part of the
community health services contract. The Quality
schedule forms part of our contract with our
commissioners for community health services and
includes quality indicators.
After consideration of the priorities in our Quality
Framework, strategic goals, and annual objectives,
our Executive Management Team agreed four
quality priorities for 2013/14.
• All of the priorities are about improving the
safety, effectiveness, and service user experience
of our services.
• Three of the priorities build on the progress
made against last year’s quality account priorities.
Last year, one of our quality priorities was around
developing training packages and pathways for
Dementia. Dementia is a significant challenge for
the NHS and is still important for us. As outlined in
Part 3, we have made significant progress against
this priority, which we feel is now embedded into
our everyday practice.
We will continue work around Dementia,
particularly with regard to training staff.
This year, our choice of priorities reflects
the unique challenges we face as we
continue to implement our plans for
integration.
Table 1: Our four quality priorities for 2013/14
Our Priority
Our Aim
Priority 1:
Safety – reducing avoidable pressure ulcers:
No avoidable grade 2/3/4 pressure ulcers
developed in our care.
Priority 2:
Experience – customer satisfaction
Improve our overall customer satisfaction (Net
promoter score / “Friends and family test”).
Priority 3:
Effectiveness – improving outcomes
Improve the outcomes of our services.
Priority 4:
Effectiveness - supporting independence by
personalised care
Ensure our service users have choice and
control over the shape of health and social
care support we provide.
17
Priority 1:
Safety – reducing avoidable pressure
ulcers
Our aim: no avoidable grade 2/3/4 pressure ulcers developed
in our care.
Pressure ulcers cause patients long term pain and
distress. Nationally, the “Safety Express” and “harm
free care” initiatives are calling on the NHS to build
on its quality and safety processes.
We are open and honest about any harm that
service users experience while in our care. This was
one of the key themes from the Mid Staffordshire
Foundation Trust Public Enquiry. We recognise
that one important aspect of harm free care is the
absence of avoidable pressure ulcers.
As defined by the Department of Health,
“avoidable pressure ulcer” means that the person
receiving care developed a pressure ulcer and the
provider of care did not do one of the following:
• evaluate the person’s clinical condition and
pressure ulcer risk factors;
• plan and implement interventions that are
consistent with the person’s needs and goals, and
recognised standards of practice;
• monitor and evaluate the impact of the
interventions; or
• revise the interventions as appropriate.
4 See “Our Quality Framework”
18
Last year we set up multidisciplinary Tissue
Viability Panels, which:
• r eview serious pressure ulcer incidents
•d
ecide, after thorough investigation, whether the
pressure ulcer was avoidable
• r ecord and disseminate lessons learnt from each
incident.
We will continue our focus on eliminating all
avoidable pressure ulcers for people in our care.
We will also work with partner agencies to provide
training for care homes (residential and nursing) to
reduce the occurrence of pressure damage across
all care settings.
As part of improving our safety culture we want
our staff to increase their reporting of incidents.
We also aim to see the percentage of serious
incidents reducing. Our safety strategy4 will
describe how we will do this.
Table 2: Key safety measures for reducing avoidable Pressure Ulcers
Measures we will report to our
Board
Our current position
2013/14 target
Number of pressure ulcers
reported as grade 3 and 4
pressure ulcers developed in
our care and reported as Serious
Incidents
Last year we reported 146
pressure ulcers reported as grade
3 and 4 pressure ulcers as Serious
Incidents.
Zero grade 2/3/4 avoidable
pressure ulcers developed
in our care
Number of pressure ulcers
reported as avoidable grade 3 /
4 pressure ulcers developed in
our care and reported as Serious
Incidents.
Last year 40 pressure ulcers
grade 3 and 4 were reported
as avoidable, of which 3 were
acquired within the community
hospitals and 37 were acquired in
the Community.
Zero grade 2/3/4 avoidable
pressure ulcers developed
in our care
All pressure ulcers for people in
our care and reported as adverse
incidents
Last year we reported 1,043
incidents related to pressure
ulcers. This includes all incidents
of skin damage that resulted
in ulceration. E.g. diabetic foot
changes. During 2012/13 data
quality checking and processes
were improved to ensure more
refined classification of damage.
Increase in number of
incidents reported and
reduction in the proportion
of serious incidents / all
reported incidents
Other measures we will use to track progress
Total number of adverse incidents
reported (all incidents)
Last year we reported 6,140
incidents.
Quarterly increase in
number of incidents
reported
Percentage of reported incidents
classified as serious incidents 4.6% (281) of all incidents
reported were serious incidents.
Quarterly reduction in
proportion of serious
incidents / all reported
incidents
19
Priority 2:
Experience – customer satisfaction
Our aim: improve our overall customer satisfaction (Net promoter
score / “Friends and family test”)
A key indicator of whether our service users have
experienced high quality care is whether they
would recommend us to their family and friends.
People who received a positive experience of care,
and are willing to recommend the Partnership
Trust to others, are called “promoters”. Our “net
promoter score” measures whether our service
users would, overall, promote us to others.
This simple question– the “friends and family test”
– is now being used across the NHS:
“How likely is it that you would recommend
this service to friends and family?”
We ask this simple question:
We recognise that the “net promoter score” has
some limitations, and has been the subject of
scientific and statistical debate, so we will use
this information to flag areas for further in-depth
analysis.
As we did last year, we will continue to use a
variety of methods to listen to our service users,
including:
• Real-time feedback
• Complaints and compliments
• Surveys and focus groups.
We will listen to our service users to improve the
information we give them. We will support our
staff to provide the best quality of care – one
which they would be happy to recommend to
their friends and families. Our Experience strategy5
will describe how we will do this.
“How likely is it that you would recommend
this service to friends and family?”
20
5. See “Our Quality Framework”
Table 3: Key experience measures for customer satisfaction
Measures we will report to our
Board
Our current position
2013/14 target
Friends and family test (Net
Promoter Score)
Baseline score (as at April
2013) is +74
+84 by end of Q4
Health and social care
compliments received by the
Partnership Trust
1738 compliments received
for 2012/13
Year on year increase in the
number of compliments
received
Percentage of complaints
acknowledged within three
working days
98% (Health)
97% (Social Care)
100% (health)
100% (social care)
Percentage of complaints
responded to within complaints
NHS regulations timescales
100%
100%
Patient Experience Surveys within
Health and Social Care
(New measure)
At least 1000 responses each
month from surveys in Health.
Implementation of comment
cards for community services
where service users don’t wish to
use technological solutions
Baseline TBC
TBC
Number of complaints that were
not responded to within 60 days
(New measure)
0
Other measures we will use to track
progress
21
Priority 3:
Effectiveness – improving outcomes
Our aim: improve the outcomes of our services
We want to provide effective services with positive
outcomes for our service users. We know that
quality improves when our staff focus on the
outcome - “the end result” - for the service user.
To focus on the outcome means to focus on
individual needs and preferences, not simply on
tasks.
The Health and Social Care Act (2012) emphasises
the need to demonstrate quality, not just quantity
of service delivery. Therefore, using outcome
measures is crucial for a safe, effective, efficient and
high quality service.
Some parts of our organisation are fully focussed
on service user outcome measurement and
improvement. Also we are measuring outcomes
by means of the Commissioning for Quality and
Innovation (CQUIN) payment framework. Last year,
we asked our Therapy, Allied Health Professional
and Children’s clinical teams to develop the most
relevant clinical outcome measures for their own
service. This is a two-year initiative, and we want
this good practice be extended across the whole
organisation. Our Effectiveness Strategy6 will
describe how we will do this.
• Managers can judge the effectiveness of the
service as a whole and ensure collection of data
to enable this.
• Practitioners can use outcome measures as part
of their reflection and audit, to confirm whether
their interventions have achieved the desired
outcome.
• Outcome measures are also useful in
assessing the effectiveness of new
interventions.
• Users of services are entitled to know the
effectiveness of the services they use.
• Commissioners can use evidence of
effectiveness in order to justify and prioritise
spending.
“Users of services are entitled to know the
effectiveness of the services they use.”
22
6. See “Our Quality Framework”
Table 4: Key effectiveness measures for improving outcomes
Measures we will report to our Board
Our current position
2013/14 target
Number of teams demonstrating
improvement in their outcome
measures
28 participated teams in 2012/13 are
using outcome measures in practice
and are using them to improve their
services.
Three out of 28 participating teams
can demonstrate improvement in
their outcome measures.
42 teams will be participating
in 2013/14 will have
completed their level for
2013/14 as per the table
below and move to the next
level for 2014/15
2012/13 average was 24.8 days (Target 23 days)
Monthly data not to exceed a
median of 23 days throughout
the whole year
Other measures we will use to track
progress
Average length of stay in
community hospitals
Table 5: Teams participating in outcome measures for 2013/14
Outcome measures: Level
To achieve this level each team must:
Number of teams at this level
at start of 2013/14
1 - Plan to develop evidence based
outcome tools
Services or teams will evidence that
outcome measurement tools are in
use and systems for data capture are
fully established.
18
2a - Plan systems for capturing and
analysing outcome data
Services or teams will evidence that
systems have been developed to
ensure that outcome data is being
systematically collated in a manner
that will allow analysis.
12
2b - Collect 12 months outcome
data.
Services or teams must evidence
that quality outcome data has been
collected and analysed throughout
the year.
9
3 - Plan for improving outcomes.
Services or teams must demonstrate
that outcomes have measurably and
materially improved.
3
23
Priority 4:
Effectiveness - supporting
independence by personalised care
Our aim: ensure our service users have choice and control over the shape
of health and social care support we provide
We want our integrated adult health and social
care teams to focus on giving service users choice
and control over the shape of the support we give
them. We call this “personalisation”.
“Making it Real” is a set of statements from
people who use care and support telling us
what they would expect, see and experience
if personalisation is real and working well in an
organisation.
We want our service users to feel that they agree
with key statements in “Making it Real” e.g. “I have
the information and support I need in order to
remain as independent as possible”. This will help
show how well we are doing in transforming
adult social care through personalisation and
community-based support7.
We have already run 17 workshops across
Staffordshire and Stoke on Trent, and consulted
with various service user groups to find out
their priorities around personalised care. We will
carefully consider all feedback to develop our top
priorities for this year.
We will then run more workshops and consult
with service users later in the year to see how
much improvement we have made.
We have made progress integrating our health
and social care services, and we want to continue
this work. The outcome-focussed statements in
“Making it Real” will help us to keep track of quality.
Our Effectiveness Strategy8 will describe how we
will do this.
“Making it Real” is a set of statements from
people who use care and support telling us
what they would expect, see and experience.
24
7. http://www.thinklocalactpersonal.org.uk/Browse/mir/aboutMIR/faqs/#WhatisMakingitReal
8. See “Our Quality Framework”
Table 6: Key effectiveness measures for supporting independence by personalised care
Measures we will report to our
Board
Our current position
2013/14 target
Service users who agree with key
statements in “Making it Real”
(e.g. “I have the information and
support I need in order to remain
as independent as possible”)
Baseline to be developed
We are aiming to improve on the
baseline. How the improvement
will be measured is yet to be
determined.
Percentage of people who receive
directed support and / or direct
payments
2012/13: 61.6% of eligible
clients (Target 45%)
Achieve 70% by the end of the
year
Percentage of people who feel
that they were supported to make
their own decisions about their
social care and / or services
During March 2013: 95%
(Target: achieve 85% by
March 2013)
Maintain 85% through the
whole year
Proportion of permanent
admissions to residential or
nursing care homes
March 2013: 170.0 per
100,000 population
(Target 150 per 100,000)
150 per 100,000
Other measures we will use to track
progress
25
Monitoring our progress
The Quality Governance Committee is the
principal committee, below the Trust Board,
charged with leading quality. It leads quality in
various ways:
• Promotion of innovation and best practice
• Identification and management of risks to the
quality of care
• Ensuring that required standards are met
• Investigating any sub-standard performance,
ensuring necessary improvements are made.
Figure 3 identifies the group of sub-committees
that report to the Quality Governance Committee.
• The sub-committees all provide assurance
through monthly reporting on effectiveness,
safety and experience of care.
• S afety and Effectiveness Operational Groups
(North and South) report on issues of quality at
a local level and exception report into the Safety
and Effectiveness Sub-Committee.
It is through this governance structure that
priorities are and will continue to be monitored.
During 2013/14 we will review our governance
structures to align with changes to our operational
directorate.
Figure 3. Partnership Trust committee structure as at March 2013
26
Mid Staffordshire Foundation Trust
Public Enquiry
Before the publication of the Mid Staffordshire
Foundation Trust Public Enquiry we were working
on a culture of openness, where staff can feel free
to raise concerns around quality.
The recommendations of the Enquiry have farreaching implications across the Partnership Trust.
We started work in response to the
recommendations from February 2013. In
March 2013 our Trust board considered the
recommendations in detail at a designated halfday board development event.
During 2013/14 the Trust will work to embed the
recommendations into its routine business by:
•R
eviewing work we are already doing in relation
to the recommendations.
•C
onducting a series of staff listening events,
to promote openness around quality of care,
which will feed in to a series of focus groups led
by members of the Trust Board and which will
in turn form the Trust’s response to the Enquiry
recommendations.
• Supporting
the Trust Board to oversee the deep
cultural changes that are the essence of the Mid
Staffordshire Foundation Trust Public Enquiry
recommendations.
•A
ppointing an Ambassador of Cultural Change –
an ally for anyone worried about raising concerns.
• Identifying a lead director for coordinating all
activities relating to the recommendations
Our Executive Management Team will monitor
progress and consider our work programme to
ensure that we fully implement these important
recommendations.
“During 2013/14 the Trust will work to embed
the recommendations into its routine.”
27
Other areas of quality improvement
Our quality priorities are not the only areas of
improvement this year. We will also deliver other
improvements from our:
• Quality Framework implementation plan,
• Supporting strategies for quality,
• Contracts with commissioners,
• Commissioning for Quality and Innovation
Schemes (CQUINS), and our
• Partnership Trust strategic goals.
Our Safety, Effectiveness and Experience
Strategies9 will outline further additional work in
relation to quality.
Service User Experience
A gentleman from Eccleshall, who suffers from
Emphysema /Chronic Obstructive Pulmonary Disorder
did not want to be hospitalised for treatment and
entered the Community Intervention Service. After
seeing a Community Nurse a care plan was put in place
that reduced the number of trips to the clinic and
provided him with a care pack he could use from home.
The gentleman said that this care had made a huge
difference to his quality of life.
28
9 See “our Quality Framework”
Statements of Assurance
Review of services
During 2012/13 Staffordshire and Stoke on Trent
Partnership Trust provided and / or sub-contracted
71 NHS services.
The Staffordshire and Stoke on Trent Partnership
Trust has reviewed all the data available to them
on the quality of care in 71 NHS services.
The income generated by the NHS services
reviewed in 2013/14 represents 100% of the total
income generated from the provision of NHS
services by the Staffordshire and Stoke-on-Trent
Partnership Trust for 2012/13.
Participation in clinical audits and
National Confidential Enquiries
National Clinical Audit
During 2012/13, nine National Clinical Audits and
zero National Confidential Enquiries covered NHS
services that Staffordshire and Stoke on Trent
Partnership Trust provides.
During this period Staffordshire and Stoke on
Trent Partnership Trust participated in 22% (2) of
National Clinical Audits and 100% 10 (0) National
Confidential Enquiries which it was eligible to
participate in
The Trust was not able to participate in seven
National Clinical Audits. Throughout 2012/13 we
have worked to merge our external and in-house
support teams for clinical audit. As part of this
process in September 2012 we served notice on
our external clinical audit support provider. We
have been developing a single clinical audit inhouse support service which took effect from April
2013.
The National Clinical Audits and National
Confidential Enquiries that Staffordshire and Stoke
on Trent Partnership NHS Trust participated in
during 2012/13 are as follows:
The National Clinical Audits and National
Confidential Enquiries that Staffordshire and Stoke
on Trent Partnership Trust participated in, and
for which data collection was completed during
2012/13, are listed below alongside the number
of cases submitted to each audit or enquiry as
a percentage of the number of registered cases
required by the terms of that audit or enquiry.
Table 7: National Clinical Audits and National Confidential Enquiries
Title of Audit
Eligible
Participate
% submitted
Diabetes (Paediatric)
Yes
Yes
100%
National Parkinson’s
Disease Audit (This
was completed in
partnership with Burton
Hospitals NHS Trust,
as the identified care
pathway at the time of
registration was shared)
Yes
Yes
100%
10. No National Confidential Enquiries were applicable to the Partnership Trust.
29
Table 8: Reasons for non-participation in National Clinical Audits
Audit Title
Rationale for non-participation
Adult Asthma
During the audit period, the number of patients identified for this criteria
were small. The decision was made not to participate.
During the audit period, the number of patients identified for this criteria
were small. The decision was made not to participate.
During the audit period, the number of patients identified for this criteria
were small. The decision was made not to participate.
Deadline for registration was missed during period of organisational
change. The Partnership Trust will be participating 2013/14.
Deadline for registration was missed during period of organisational
change.
Deadline for registration was missed during period of organisational
change. The Partnership Trust will be participating in the audit during
2013/14.
During organisational change, participation in this audit was missed.
Based on the national audit, we have undertaken our own audit in order
to compare our findings against the national results.
Fever in Children
Fractured Neck of Femur
Hip Fracture Database
Pain Database (National
Pain Audit)
Stroke National Audit
National Audit of
Dementia
The low participation in National audit was noted
mid-year, and other pieces of work at national
level were undertaken as given below:
• Introduction of a screening process to support
early recognition of Dementia linking work with
local CQUIN programme.
a) N
ational Dementia & Antipsychotic prescribing
audit.
b) National Foot care “Diabetes E” audit (pilot).
As we have a Podiatrist with specific interest
in care of the diabetic foot, we agreed to take
part in the pilot of this national audit.
Local Clinical Audit
The report of one National Clinical Audit report
was reviewed by the provider in 2012/13 and
Staffordshire and Stoke on Trent Partnership NHS
Trust intends to take the following actions to
improve the quality of healthcare provided:
30
The reports of 30 Local Clinical Audits were
reviewed by the provider in 2012/13 and
Staffordshire and Stoke on Trent Partnership NHS
Trust intends to take the following actions to
improve the quality of healthcare provided. See
the sample list on page 9.
Information on Participation in
Clinical Research
The number of service users receiving NHS
services provided or sub contracted by
Staffordshire and Stoke-on-Trent Partnership NHS
Trust in 2012/13 that were recruited during that
period to participate in research approved by a
Research Ethics Committee was 624.
The Partnership Trust has approved 26 studies on
the National Institute of Health Research portfolio
and four non portfolio studies.
Research that the Partnership Trust took part in
included;
• A study to identify whether people who have
GCA (Giant Cell Arteritis) have changes in the
shape of their blood vessels.
• A study to identify genes and to understand
the genetics of Ankylosing Spondylitis better
and develop better ways of diagnosing and
treatment.
• A study to see whether it was possible to
predict whether people will react positively to
methotrexate for the treatment of rheumatoid
arthritis.
• A research project to define needs, costs and
outcomes, for people with long term neurological
conditions.
• Four research projects to monitor the longterm safety of biological agents in patients with
rheumatoid arthritis.
• A project to understand the genetic cause of
Polymyositis and Dermatomyositis to see if it is
possible to design specific drugs for treating the
condition.
• A study was entered with the aim to collect
clinical information and blood samples from
people with arthritic and rheumatic diseases
together with unaffected people.
• A survey to develop a support service for
arthritic patients that require social, emotional or
psychological support.
• A study to identify genes associated with
Systemic Lupus Erythematosus through
comparing lupus sufferers and healthy individuals
by their age, sex and ethnicity.
• A study to see if the use of Rituximab may help
relieve the symptoms associated with Sjögren’s
syndrome.
study investigating genetic and non-genetic
•A
differences to see if it is possible to predict likely
sufferers of pneumonitis.
•A
study to collect data comparing two treatments
in patients with rheumatoid arthritis who are not
responding adequately to their current therapy.
•A
study to see how well BOTOX® works in treating
adults who have experienced a stroke resulting in
spasticity in one of their ankles.
•A
study to identify whether Rituximab therapy or
anti-TNF therapy is more effective in improving
the clinical symptoms, signs, physical function
and health related quality of life of patients with
active rheumatoid arthritis.
•A
study for patients with new onset rheumatoid
arthritis and understanding the reasons for their
delay in GP consultation and then strategies to
reduce this delay.
•A
study to identify better ways to measure
psoriatic arthritis, such as measuring aspects of
quality of life, functioning and disability at work.
•A
study to help predict early non response to anti
TNF and methotrexate combination therapy in
rheumatoid arthritis patients.
•A
research project to develop, design and
conduct a pilot trial comparing occupational
therapy (OT) treatment; OT treatment plus thumb
splint and OT treatment plus placebo splint in
people with thumb base osteoarthritis.
•M
onitoring the safety of treatments for
Ankylosing Spondylitis (AS) patients and to find
out more about how treatments affect the lives of
AS patients in areas like work, driving and general
quality of life.
study to determine whether
•A
Hydroxychloroquine is effective at reducing pain
in hand osteoarthritis.
study to investigate the feasibility of collecting
•A
data in practice using the Patient Reported
Outcome Measure Tool, and to examine aspects
of the tool’s measurement properties.
• The validation of new risk assessment instruments
for use with patients discharged from medium
secure services.
•A
n observational study on the adverse effects of
Maraviroc.
study looking at how people with HIV progress
•A
in relation to blood markers.
31
Table 9: Changes to practice by clinical audit
Title of Audit
Changes to practice
An audit of compliance of
new DVLA guidance for first
diabetic appointments
Think Glucose part of the CQUIN
Leaflet guidance offered to all new insulin
dependent diabetic patients in community based programme and the National
Insulin Passport initiative.
clinics.
An audit of safe drug
administration in HM Prisons
Unique Prisoner identification has to be produced Patient safety, responsive audit
from a reported incident.
for every request for medication.
An audit of nurse lead
Enuresis clinic care to school
age children
Service conforms to NICE guidance. Direct selfreferral by patient or by parent via questionnaire,
resulted in assessment & treatment including use
of bed wetting alarm. 67% of all referrals were via
questionnaire process. 20% of all referrals were
placed on alarm system.
Clinical Effectiveness Monitoring the implementation
of NICE guidance.
Re-audit of patient held
podiatry instrument packs
Patient held instruments were given to patients
fitting criteria, and 81% remembered to bring
these back to clinic each time – sustaining cost
savings for the podiatry service.
Quality, Innovation, Productivity
& Prevention (QIPP)
A review of ward
documentation using Rapid
Improvement Cycles
Template “dummy” set of records kept on each
ward for training to ensure standardised records
used across the ward areas.
Documentation campaign
& rapid improvement cycle
methodology.
An audit of Comfort rounds
in Community Hospital
wards
Changes to prompts in documentation to ensure
variations in comfort rounds are documented e.g.
variations in comfort rounds should not hamper
rehabilitation and independence of the patient.
Documentation Campaign
Use of the Commissioning for Quality
and Innovation (CQUIN) payment
framework
A proportion of Staffordshire and Stoke on Trent
Partnership Trusts income in 2012/13 was conditional on
achieving quality improvement and innovation goals. The
goals were agreed between the Partnership Trust and any
person or body they entered into a contract, agreement
or arrangement with for the provision of NHS services,
through the Commissioning for Quality and Innovation
payment framework.
The Trust achieved 99.95% (by value) of all its CQUIN
initiatives. We partially achieved the Safety Express CQUIN
initiative:
• Target: 95% of patients who are at high risk of pressure
damage will have their pressure ulcer risk reassessed on a
monthly basis. Our achievement in March 2013: 91.5%
• Target: 100% of all patients identified, on assessment, as
being at risk or having pressure damage will be placed
on a SSKIN bundle. Our achievement in March 2013:
89.93%.
32
Links with other quality
initiatives
What is a SSKIN bundle?
The SKIN bundle is an assessment and communication
tool for pressure ulcer prevention covering the following:
• Surface
• Skin inspection
• Keep moving
• Incontinence
• Nutrition
The SSKIN Care Bundle is a powerful tool as it defines and
ties best practices together. The bundle also makes the
actual process of preventing pressure ulcers visible to all.
See www.patientsafetyfirst.nhs.uk
While we did not achieve our target, our progress against
this CQUIN reflects significant quality improvement by our
services during the year.
Further details of the agreed goals for 2012/13 and for the
following 12 month period are available electronically at:
http://www.staffordshireandstokeontrent.nhs.
uk/About-Us/quality-and-innovation.htm
Table 10: CQUINS achievement for 2012/13
2012/2013 CQUINS
Year-end
1.Patient Experience
To obtain the views of patients using a standardised
monitoring framework based on their experiences of using
Trust services. Outcomes used to make improvements in
the care the Trust provides.
2a. Safety Express – data collection Monthly surveying of all appropriate patients to collect
data on four outcomes (pressure ulcers, falls, urinary
tract infection in patients with catheters and Venous
thromboembolism (VTE).)
2b. Roll out of Safety Express –
Community Services
3
To achieve 95% of patients who are “free from new harm” in
Community Hospitals by the end of March 2013.
To achieve 92 % of patients who are “free from new harm”
in Community by the end of March 2013.
Implementation and development of care initiatives for
improving patient outcomes for:.
a) Tissue Viability
b) Falls
c) Venous Thromboembolism Assessment
d) Urinary Catheter Care
3.Dementia
3
To establish clear pathways for patients into various
agencies.
7
3
3
3
3
To provide specialist input into assessment and support
where applicable.
4. Venous leg ulcer
To improve the care provided to patients with venous leg
ulceration.
3
5. Therapy outcome measures
To improve therapy outcomes for patients.
Outcome measures are specific items of data that are
tracked to demonstrate how an intervention is having an
impact and how effective the intervention is, rather than
merely counting number of contacts.
Many teams will use outcome measures to monitor
progress an individual patient makes towards clinical goals,
but it is much less common for teams to analyse outcome
measures across a cohort of similar patients, to identify
those parts of the service that are working well and those
with the most scope for improvement.
3
6.Patient Empowerment/ SelfManagement
Improve the ability of patients to manage their care in
order to reduce future reliance on health services and
reduce the necessity of admission to secondary care.
3
7. Case Management
Prevent avoidable admissions for patients with a long term
condition by improved identification of ‘at risk’ patients and
provision of appropriate interventions.
3
33
Information on the Care Quality
Commission (CQC) registration and
periodic/special reviews Staffordshire and Stoke on Trent Partnership
Trust is required to register with the Care Quality
Commission and its current registration status is
registered without conditions. The Partnership
Trust has no conditions on registration.
The Care Quality Commission has not taken
enforcement action against the Trust during
2012/13.
The registration details are available on the Care
Quality Commission website via the following link
www.cqc.org.uk.
Staffordshire and Stoke on Trent Partnership Trust
has not participated in any special reviews or
investigations by the CQC during the reporting
period.
The CQC has undertaken seven planned and
unannounced inspection visits during 2012/13.
These include the following:
Table 11: Care Quality Commission reviews undertaken in the Partnership Trust
34
Inspection Date/s
Inspection Service / Location
Inspection Outcome
1 August 2012
Adult Social Care – Living
Independently Staffordshire:
Cannock
Compliant with the 5 Standards
inspected.
28/29 August 2012
Her Majesty’s Youth Offender
Institute (HMYOI) Werrington
Compliant with 2 of the 5
Standards inspected.
Inspection in conjunction with
Her Majesty’s Inspectorate of
Prisons (HMIP)
Action required with 3 of the 5
Standards inspected.
(See 4 February 2013 review)
8 October 2012
Adult Social Care – Living
Independently Staffordshire:
Newcastle
Compliant with the 5 Standards
inspected.
9 November 2012
Adult Social Care – Living
Independently Staffordshire:
Stafford
Compliant with the 5 Standards
inspected.
14 November 2012
Adult Social Care – Living
Independently Staffordshire:
East Staffs
Compliant with the 5 Standards
inspected.
4 February 2013
Her Majesty’s Youth Offender
Institute (HMYOI) Werrington
(follow-up desktop review)
Compliant with the 3 Standards
judged as part-compliant in
August 2012.
11/12 March 2013
HMP Drake Hall - Inspection in
conjunction with Her Majesty’s
Inspectorate of Prisons (HMIP)
Compliant with the 5 Standards
inspected.
HMP Werrington inspections
(August 2012 and February 2013)
The following actions were implemented as a
result of the August 2012 inspection:
• Improved quality health promotion information
has now been provided on the wings.
•A
smoking cessation referrals programme has
been put in place for young people.
• The range, quality and cleanliness of equipment
provided in the wing treatment rooms have been
improved.
• F ormal one-to-one clinical supervision has been
strengthened, with clear recording of all sessions.
• The system for handling and responding to
young people’s complaints was made more
effective.
The Care Quality Commission completed a followup desktop review in February 2013 resulting in a
judgement of compliance.
NHS Litigation Authority
The NHS Litigation Authority handles negligence
claims and works to improve risk management
practices in the NHS. The Authority has produced
Risk Management Standards at three different
levels for NHS organisations providing acute,
community or mental health and learning
disability services.
The Partnership Trust is currently at Level 1,
and has been reassessed against the five Risk
Management Standards at the same level on 29 &
30 May 2013.
together to identify and improve data quality and
membership from both health and social care;
• t he Trust has an agreed Data Quality Strategy
in place, with a supplementary action plan to
improve data quality, which is reviewed monthly
by the Data Quality Group;
• t he Trust has established a Data Quality
Confidence Assessment Programme, which will
be introduced in 2013/14. This will be a rolling
programme of data quality audits of different
teams within the Trust, as well as assessments
of the quality of data for all key performance
indicators the Trust publishes within its
performance report to Board;
• Improved management of information to
divisions to enable clinicians to analyse their own
activity data to improve accuracy; and
• S upport and training to teams to address
recording issues and promote the importance of
data quality.
NHS Number
Staffordshire and Stoke on Trent Partnership
Trust submitted records during 2012/13 to the
Secondary Uses Service for inclusion in the
Hospital Episode Statistics which are included in
the latest published data.
The percentage of patients in the published data
which included the patient’s valid NHS number
was:
• 99.9% for admitted patient care
• 99.9% for out patient care
The percentage of patients in the published data
During the year the Partnership Trust has reviewed
the fifty procedural documents required for
assessment purposes; all of were approved for
implementation in advance of the assessment.
Data Quality
Staffordshire and Stoke on Trent Partnership NHS
Trust is taking the following actions to improve
data quality:
•A
Data Quality Group has been established and
meets monthly to discuss data quality issues
across the Trust. The group includes managers,
administrative staff and clinicians working
35
which included the patient’s valid General Medical
Practice Code was:
• 1 00% for admitted patient care
• 9 9.9% for out patient care
Information Governance
Staffordshire and Stoke on Trent Partnership Trust’s
Information Governance Assessment Report score
overall for 2012/13 was 65% and was graded Not
Satisfactory (Red).
The Partnership Trust achieved the minimum
level attainments in 37 out of the 39 toolkit
requirements. The two areas where minimum
level attainments were not achieved were:
• 1 0-112: Information Governance awareness and
mandatory training procedures are in place and
all staff are appropriately trained
• 1 0-309 Business continuity plans are up to date
and tested for all critical information assets (data
processing facilities, communications services
and data) and service - specific measures are in
place
Governance Steering Group which meets monthly
and monitors the action plan to progress the two
requirements not met and to also pro-actively
monitor the continuing improvement of all
requirements of the IG Toolkit relevant to the
Partnership Trust.
Clinical coding error rate
Clinical coding translates the medical terminology
written by clinicians to describe a patient’s
diagnosis and treatment into standard, recognised
codes.
Staffordshire and Stoke on Trent Partnership
Trust was not subject to the Payment by Results
clinical coding audit during 2012/13 by the Audit
Commission.
Although the above statement only applies
to Acute Trusts, all Payment by Results activity
relating to our community hospitals is coded and
audits take place to ensure the clinical coding
reflects the patient’s records. Any invalid codes
are rejected by the Secondary Uses Service and
corrected / resubmitted.
Action plans have been developed and are ongoing for the two requirements that have not
been achieved.
The Partnership Trust has an Information
Service User Experience
A mother who has a daughter
with special needs had
experienced difficulties during
the transition from children’s
services to adult services.
Although happy about the
services that are provided,
she felt there was a lack of
36
continuity and assessments
took too long.
The Trust is undertaking work
with regard to the integrated
model of care that will bring
together the coordination
of care for both children’s
and adult services within the
Partnership Trust.
Mandatory Quality Indicators
The core set of indicators below are part of the
Quality Account mandatory reporting indicators
and are applicable to our Partnership Trust.
Staffordshire and Stoke on Trent Partnership Trust
intends to take the following actions to improve
this percentage, and so the quality of its services,
by:
Readmissions
Staffordshire and Stoke on Trent Partnership Trust
considers that this data is as described for the
following reasons:
•A
s of 30 May 2012, data available on the Health
and Social Care Information Centre (HSIC)
pertains to April 2010 to March 2011. The
Partnership Trust doesn’t feature in this dataset
as the Trust was not established within the April
2010 to March 2011 Financial Year.
•D
ata for 2012/13 was not available from the
Health and Social Care Information Centre as at
29 April 2013.
• Reviewing latest data once available
• Analysis of data and national comparisons and
developing improvements via the Safety and
Effectiveness Operational Groups responsible for
quality in community hospital inpatient services.
Table 12: Mandatory quality indicator for readmissions
Quality Indicator
2011/12
2012/13
National 2012/13
The data made available to the National
Health Service Trust or NHS Foundation Trust
by the Health and Social Care Information
Centre with regard to the percentage of
patients aged— (i) 0 to 14; and (ii) 15 or over,
readmitted to a hospital which forms part of
the trust within 28 days of being discharged
from a hospital which forms part of the Trust
during the reporting period.
No data
available
No data
available
No data
available
37
Staff who would recommend
the Trust as a provider of care
Staffordshire and Stoke on Trent Partnership Trust
considers that this data is as described for the
following reasons:
• 382 out of 838 randomly sampled staff took
part in this survey. This is a response rate of 46%
which is below average for community trusts in
England, and compares with a response rate of
56% in this Trust in the 2011 survey.
• The survey was administered by an external
agency, allowing consistent comparisons of the
experiences of staff across the NHS.
The Partnership Trust requested that all staff
participate in the 2012 staff survey, resulting in an
additional 2090 staff responding.
Staffordshire and Stoke on Trent Partnership Trust
has taken the following actions to improve this
score, and so the quality of its services, by the
following actions:
• The Trust has a staff survey working group
to monitor the corporate action plan that
has been developed. The group consists of
14 representatives from the Trust including
Staff Side, Human Resources, Organisational
Development, Staff Support, Counselling and
Communications.
•A
n annual cycle has been developed which
demonstrates the timescales involved and
the work being developed, implemented and
monitored throughout the year.
• L ocal action planning with the Human Resources
team working with service managers highlights
areas for concern, developing local action plans
within teams.
Table 13: Mandatory quality indicator for staff who would recommend the Trust
Quality Indicator
The data made available
to the National Health
Service Trust or NHS
Foundation Trust by the
Health and Social Care
Information Centre with
regard to the percentage
of staff employed by,
or under contract to,
the Trust during the
reporting period who
would recommend the
Trust as a provider of care
to their family or friends.
38
Staff recommendation of
the Partnership Trust as a
place to work or receive
treatment, on a scale of
1 to 5.
2011/12
2012/13
National 12/13
3.58
3.67
Average: 3.58
Best score:
3.88
Patient safety incidents
A patient safety incident is something which
happens that has an adverse effect on a patient’s
safety. This happening may or may not be linked
to other events. We record and monitor such
incidents to learn from them and prevent them
happening again.
Reporting incidents is considered a good indicator
of the safety culture within an organisation as
it helps staff to identify risks and take action to
reduce them recurring.
Staffordshire and Stoke on Trent Partnership Trust
considers that this data is as described for the
following reasons:
ata available from the Health and Social Care
•D
Information Centre (HSIC) is for the financial year
April 2011 to March 2012.
• L atest available data as of 24 May 2013 is for the
period 1 April 2012 to 30 September 2012.
Staffordshire and Stoke on Trent Partnership Trust
has taken the following actions to improve this
rate, and so the quality of its services, by:
•C
ontinuing training in incident reporting and
safety culture
•R
egular tissue viability panels review Tissue
Viability incidents and share learning from
incidents across the Partnership Trust
•R
eports are made available to operational teams
for local learning from incidents
Table 14: Mandatory quality indicator for patient safety
Quality Indicator
The data made
available to the
National Health
Service trust or
NHS foundation
trust by the Health
and Social Care
Information Centre
with regard to
the number and,
where available,
rate of patient
safety incidents
reported within the
trust during the
reporting period,
and the number
and percentage
of such patient
safety incidents that
resulted in severe
harm or death.
2011/1211
2012/13
National 2012/1312
Rate of patient
safety incidents
1 October 2011 to
31 March 2012 there
were 15.4 Incidents
reported per 1,000
bed days
1 April 2012 to 30
September 2012
there were 34.5
Incidents reported
per 1,000 bed days
Median: 41.1
incidents reported
per 1,000 bed days
Number of safety
incidents that
resulted in severe
harm or death
1 October 2011 to
31 March 2012 were
7 Incidents
1 April 2012 to 30
September 2012
were 17 incidents
Average: 14 per
organisation (267
incidents across 19
organisations)
Percentage of
patient safety
incidents that
result in severe
harm or death
1 October 2011 to
31 March 2012
0.77 %
(7 out of 908
incidents)
1.16 %
(17 out of 1470
incidents)
0.98%
(267 out of 27,122
incidents across 19
organisations)
The National Reporting and Learning System (NRLS) is the world’s most comprehensive database of
patient safety information, to identify and tackle important patient safety issues at their root cause.
We provide data to the NRLS, which allows us to compare our reporting rates with similar organisations.
11. The partnership trust was established on 1 September 2011; data is for part-year only
12. National data: All Primary Care Organisations with Inpatient provision
39
Chart 1: Comparative reporting rate, per 1,000 bed days, for 19 primary care organisations with
inpatient provision.
Chart 2 below details the degree of harm for primary care organisations with inpatient provision.
Chart 2: The degree of harm for primary care organisations with inpatient provision
40
Part 3
Review of Quality
Performance in
2012/13
41
Focus on:
Patient Environment
Action Teams (PEAT)
inspections
The Partnership Trust has achieved five out of
five “excellent” ratings in the PEAT inspections for
2012/13.
PEAT is an annual assessment of inpatient
healthcare sites in England that have more than
ten beds. It is a benchmarking tool to ensure
improvements are made in the non-clinical
aspects of patient care including environment,
food, privacy and dignity. The assessment
results help to highlight areas for improvement
and share best practice across healthcare
organisations in England.
Siobhan Heafield, Director of Nursing and
Quality, thanked staff for all their efforts in
achieving this result. “These results show that
our hard work is taking us in the right direction
and our focus will be on continuing to improve
the environment in our hospitals for the people
we serve. Thanks go to all the community health
services staff who work tirelessly to improve
our community hospitals and make them the
excellent places they are.”
patient representatives. They looked at levels of
cleanliness, aspects of infection control (such as
hand hygiene), the quality of the environment
(such as decoration, maintenance and lighting)
as well as the standard of food offered to
patients.
Following the inspection, each hospital is given a
score out of excellent, good, acceptable, poor or
unacceptable.
All the Partnership Trust’s community hospitals
- Haywood Hospital, Longton Hospital, Leek
Moorlands Hospital, Cheadle Hospital and
Bradwell Hospital have been given a clean
sweep of “excellent” in each area.
Siobhan added: “Patients have the right to be
treated in clean surroundings, with good food
and with respect for their privacy.
“The work we have undertaken in all of our
community hospitals has made a real impact on
the experience that our patients have.”
The PEAT programme assesses all non-clinical
services such as food and privacy and dignity in
hospitals and inpatient units with ten or more
beds.
The inspection team consisted of nurses,
catering and domestic service managers and
“These results show that our hard work is taking
us in the right direction and our focus will be on continuing to
improve the environment in our hospitals for the people we serve.”
42
Progress against Quality & Safety
Programme Priorities 2012/13
Priority 1 – Safety Express initiative
What is Safety Express?
“Safety Express” and “Harm Free Care” are national
work streams that aim to increase safety by
measuring and reducing harm from a patient
perspective. As part of this work the ‘Safety
Thermometer’ measures the number of patients
protected from harm, looking at four key safety
issues:
Goal
We will aim to reduce the level of harm acquired
in our care for every service user
• Pressure ulcers
• Urine Infections & Catheters
• Falls
• Venous Thromboembolism (VTE)
Table 15: Progress against the Safety Express initiative
Aims/Objectives
Progress
Ensure 95% of all
patients will be free
from any new harm
acquired in our
Community services
by the end of March
2013.
By March 2013 we achieved:
Community (District Nursing): 92.59% harm free care
Community (Hospital Ward): 83.39% harm free care
Our overall score in March 2013 was 91.4%
Provide monthly data
that will be collated
through the NHS
Safety Thermometer
initiative.
The Partnership Trust has successfully submitted NHS Safety Thermometer
data for the Community Hospital and Community Nursing services
throughout 2012/13.
43
Table 15: Progress against the Safety Express initiative
Aims/Objectives
Progress
Monitor and report
comparative data
identifying action
plans of service
improvements.
Safety Thermometer information is reported back to teams who monitor their
own progress and make changes to provide safer standards of care. Managers
and specialist services, such as the Infection Control and Tissue Viability
nursing teams, support this process.
Pressure damage remains the highest reported of the four harms with 5.5% of
patients admitted to our care having pressure damage before they came into
Partnership Trust care and 1.7% of patients developing a pressure ulcer whilst
in our care.
• In our community services 4.5% of patients admitted to our care had
pressure damage before they came into Partnership Trust care and 1.7% of
patients developed a pressure ulcer whilst in our care.
• In our community hospitals 12.4% of patients admitted to our care had
pressure damage before they came into Partnership Trust care and 1.4% of
patients developed a pressure ulcer whilst in our care.
Roll out the Safety
Express Improvement
plan to all
Community teams by
2013.
SSKIN bundle (Surface, Skin inspection, Keep moving,
Incontinence, Nutrition & hydration) for pressure ulcer
prevention:
The SSKIN bundle package has been adopted in all five Community Hospitals
and by the Community Nursing service.
An audit at the end of March 2013 showed that almost 90% of people at risk
or with a pressure ulcer have a SSKIN bundle in place; this number has risen
from 29% in November 2012.
The Walsall Pressure Ulcer Risk Assessment tool has been implemented across
all clinical services. This tool helps staff to identify which people are likely
to develop a pressure ulcer and which key factors could contribute to skin
breakdown e.g. diet and fluids, incontinence, ability to move about.
In March 2013 an audit showed that almost 99% of all people seen by the
District Nurses were assessed for pressure ulcer risk.
Catheter Acquired
Urinary Tract Infection
(CAUTI)
People who have a urinary catheter in place are at increased risk of developing
a urinary tract infection (UTI) compared to those that do not have a catheter.
The Catheter Life Chart and patient held Catheter Diary document has been
successfully implemented across the Community Nursing service; with usage
rising from 68% in July to 98% at the end of March 2013.
The catheter diary booklets given to patients with a urinary catheter help them
and their carers to understand how to safely look after the device and reduce
the risk of infection.
44
Chart 3: Safety Thermometer: harm free care achievement 2012/13
Safety Thermometer: Harm Free Care 2012/13
Safety Thermometer: Harm free care 2012/13
100%
95%
90%
85%
80%
75%
70%
65%
60%
55%
Partnership Trust overall
CQUIN Target: 95%
Mar 13
Feb 13
Jan 13
Dec 12
Nov 12
Oct 12
Sep 12
Aug 12
Jul 12
Jun 12
May 12
Apr 12
50%
Service User Compliment
Received September 2012 - Community Stroke Team – Stoneydelph Health Centre:-
“We come to you because we knew you would point us in the right
direction and you explain it in English so that we can understand it.”
45
Priority 2 – Dementia
Why Dementia?
Dementia is a significant challenge for the NHS:
• 25% of beds are occupied by people with
Dementia.
• Dementia sufferers often have longer stays in
hospital than people without Dementia.
• There is often a sense that people with dementia
are ‘in the wrong service’.
By routinely assessing for risk of Dementia we can
ensure our service users get the right care at the
right place and time.
46
Goal
We aim to work with partners to develop and
implement a training package for key staff to
enhance their skills in Dementia Care. To establish
clear pathways for patients into various agencies
to provide specialist input into assessment and
support where applicable.
Table 16: Progress against Dementia
Aims/Objectives
Progress
Develop and implement
Dementia training
programmes for all health/
social care staff.
The training programme for Partnership Trust staff has been rolled
out across all inpatient ward teams and clinical community teams.
Work in collaboration
with partners and various
specialist agents to establish
a programme of screening
and assessment in the
Community.
All NHS organisations in Staffordshire and Stoke on Trent have
worked together to develop and use a standard screening approach
to identify people over the age of 75 years who may have dementia
or other problems affecting their memory.
In 2012/13 there were 573 staff who received training related to
Dementia.
Each person is asked on admission to a ward or on the first home
visit: Have you been more forgetful in the past 12 months, to the
extent that it has significantly affected your daily life?
Where concerns exist, further screening takes place. Patients who
have memory impairment will be referred by the doctor managing
their care to the most appropriate service e.g. Memory Clinic.
Devise and implement a
standardised assessment and
Dementia pathway through
collaborative working with
external partners across
Staffordshire.
A Dementia Screening pathway for the Partnership Trust was agreed
in July 2012. This pathway relates to how people using our services
are screened and where necessary referred for dementia care. The
process was launched in the Community Hospitals with the wider
community teams adopting the pathway in March 2013.
1,731 people have been screened using this process since October
2012, with 34 people being referred to a Memory Clinic during this
time. A further 27 people were referred for other investigation or
support where their memory problems were thought to be related
to another health condition.
Increase the competency
of the workforce through
rotation posts for the dual
training of Registered General
Nurses and Registered
Mental Health Nursing Staff.
A rotational programme between the Partnership Trust and North
Staffordshire Combined Healthcare NHS Trust has been agreed. This
programme will start in the Spring of 2013.
47
Priority 3 – Social Care Integration
What is Social Care Integration?
Over the last few years, GPs, hospitals, health
workers, social care staff and others have
increasingly worked side-by-side, sharing
information and taking a more co-ordinated
approach to the way services are delivered.
Older people and people with long-term health
conditions are especially benefiting from these
changes.
Previously, if someone needed to arrange care
from a district nurse, for example, but also needs
help to bathe or prepare a meal, they might have
two or three different professionals arriving at their
door and asking similar questions before help can
be put in place. With these changes, the process is
becoming much smoother.
The Vision for Social Care (2011) and Think Local
Act Personal (2011) emphasizes a system that
48
helps people to live their lives the way they want
to, supported by the staff who work with them.
The approach aims to:
• Free the frontline from “red tape”.
• Support local organisations to focus on the
quality of care.
• Focus on outcomes achieved for people using
services and their carers.
• Reduce unnecessary focus on targets and service
activity.
Goal
A work programme has been developed to align
working standards and practices, and to integrate
governance arrangements by 2013 in order to
ensure the best possible outcomes are achieved.
Table 17: Progress against social care integration
Aims/Objectives
Progress:
Embed an integrated
quality assurance
framework
which promotes
independence and
allows the person to
be listened to.
The Adult Social Care Quality Sub-committee has produced a legacy document to describe
all work streams during the transition period. This time-limited group has now ceased and
responsibilities have been integrated into corporate functions.
The Quality Framework for the Partnership Trust includes a strategic objective to integrate
quality as a core part of the organisation.
Integration workshops have taken place for health and social care Patient Advice & Liaison
Service (PALS), complaints and service user and carer experience to review processes and
procedures. Targets will be set to improve performance.
Promote ‘self-directed
support’ and direct
budgets enabling
people to live in
Staffordshire to ‘live
their life in their way’.
The proportion of people using social care in receipt of eligible on-going services who receive
self-directed support, and those receiving direct payments, was 61.6%. (Target: 45%)
Ensure client safety
and ‘safeguarding’ are
central to practice.
The Trust continues to provide statutory Adult Safeguarding training, Mental Capacity Act
training and Children’s Safeguarding training, and has dedicated roles for Safeguarding,
Adult Safeguarding Champions are now in post across the Partnership Trust. They have been
provided with a resource folder and receive regular update meetings.
A safeguarding vulnerable adults site has been developed on the Partnership Trust intranet. This
includes useful links, documents and discussion boards for Adult Safeguarding Champions and
Speakers.
The monthly Safeguarding Vulnerable Adults (SVA) Committee includes health and social care
representation and a Non-Executive Director. Action plans from adult protection investigations
are discussed at the SVA meeting and lessons learned disseminated to teams. The SVA
committee reports to Quality Governance Committee, Commissioners and Care Quality
Commission Compliance Inspector.
The Partnership Trust is actively involved with the Multi Agency Safeguarding Hub and the
Staffordshire & Stoke on Trent Adult Safeguarding Partnership. The Trust adopts interagency
procedures and attends the Executive Board and sub groups of the Adult Safeguarding
Partnership.
Ensure Assistive
Technology i.e.
devices that assist
people to improve
/ maintain their
independence, is
central to client
choice.
A Multi Stakeholder Assistive Technology steering group chaired by the Partnership Trust has
been established.
A draft strategy has been produced by Commissioners across Staffordshire and is currently
being considered by the Assistive Technology Steering Group.
Within 2012-13, 16,853 people were in receipt of on-going support through community based
services, around 2000 of these were in receipt of Telecare.
Last year, 96 people with COPD using were using Telehealth in North Staffordshire. In South
Staffordshire joint funding with Social Care led to the deployment of 32 electronic Assistive
Technology units.
Within the Partnership Trust we are seeking to establish an Assistive Technology project that
would further determine the extent of collaboration and understand areas of development that
are likely to gain the most efficiencies and improved outcomes.
49
Priority 4 – Service User Experience
What do we mean by Service User Experience?
It is essential that quality of care is measured at
the level of each service user’s experience. It is
important to involve service users any time we
want to examine or improve quality.
Service user involvement improves satisfaction
and is rewarding for professionals.
Service user, carer and family experience of every
community service will be measured by the
organisation through real time monthly reporting
and validation of both qualitative information and
quantitative metrics.
The Partnership Trust will monitor performance
through Ward to Board assurance of the family
and friends test. The Trust has a baseline target in
50
quarter 1. By the end of quarter 4 the Trust has to
achieve a 10 point improvement.
Operational action plans of service improvement
will be devised from service users’ satisfaction
scores and comments of service improvements.
Feedback to service users, carers and families will
be clearly visible demonstrating every service
user’s satisfaction and levels of improvement.
Goal
We will address top themes that are considered
to have caused concern for service users, carers or
the family’s experience of services during 2012/13.
Table 18: Progress against service user experience
Aims/Objectives
Progress
Monitor our
Customer Service
Excellence (CSE)
Standards through
annual inspections
for the organisation
to be accredited
to the Customer
Service Excellence
Charter Mark.
Stoke on Trent and North Staffordshire Health and Social Care Teams achieved
the Customer Service Excellence Accreditation in May and July 2012.
Capture monthly real
time data through
hand held devices
From 1 September 2012 the Partnership Trust has introduced a standard
method for collecting service user and carer experience data, with 140 teams
using 100 electronic devices for capturing real time data along with five
community hospitals and Outpatients.
South Staffordshire locations received the Customer Service Excellence
Accreditation in December 2012.
The organisation has demonstrated compliance with all 57 Customer Service
Excellence criteria and received the corporate accreditation for Customer
Service Excellence in April 2013.
Surveys have been designed by service users, carers and learning disability
forums and in accordance to the Patient Experience NICE Guidance.
Invite service users,
carers and families
to the Trust Board
to describe their
experience of Health
and Social Care
services
Service users and carers are invited on a monthly basis to Trust Board to talk
about their experiences of our care, along with recommendations of how we
can make service improvements.
Ensure 100% of
service users are
asked to complete a
discharge question
upon discharge from
the Community
Hospital Sites
All service users are asked to complete the “Friends and Family” test on
discharge. In March 2012 the Community Hospitals sites achieved a net
promoter discharge score of +75.
Community
Hospital Service
Managers are asked
to devise action
plans of service
improvements
Roll out the “friends
and family” question
to all Community
Services.
Patient Stories are reported to the User and Carer Forum.
Each ward is provided a report of their “friends and family” test score.
Monthly Patient Experience reports and actions of service improvements are
monitored through the Safety and Effectiveness Operational Group, Quality
Governance Committee and Trust Board.
From the 1 September 2012 this process has been embedded across all
Operational Teams.
From 1 September 2012 the “Friends and Family” question has been
implemented across the Partnership Trust, and is reported monthly by
individual teams.
51
52
Triangulate real
time feedback with
complaints, PALS,
incidents and service
user, carer and
family stories of their
experience of health
and social care
services.
Patient Experience monthly reports incorporate data for PALS, Complaints and
Incidents. The reports identify monthly trends and themes along with lessons
learnt for the Partnership Trust.
Capture and
compare monthly
data reporting to
the Trust Board
and Governance
structures.
Integrated Patient Experience Reports capture and provide monthly
comparative data upon trends and themes which is reported to the Trust
Board and relevant Governance Structures.
Roll out use of
real time service
user experience
questionnaires using
hand held wireless
devices.
From Sept 2012 to March 2013 the Trust has introduced large scale real time
reporting and has received 10,947 user, carer, parent or family members’
surveys for health care services.
Standardise the
Mystery Shopper
Programme for
Health and Social
care services across
the Partnership Trust.
The Mystery Shopper Programme is fully implemented within the North
Staffordshire and Stoke on Trent locations of the Partnership through
Workforce Locality Funding.
Use best practice
from the “Good
Engagement
Practice for the
NHS” to inform and
improve services and
patient experience.
The introduction of the Service User and Carer Forum allows representatives
of staff and service users and carers to receive action plans of service
improvements for the Partnership Trust.
Service users are involved in the Customer Services Excellence steering group
and inspections.
Improve data
collection and
its quality so that
there is a significant
reduction in the
percentage of “not
stated and not
known” categories
recorded across
all the Equality
Characteristics
Real time service user experience reporting captures quality data on
equality characteristics, providing every person with the choice to disclose
information.
Integrated workshops including colleagues from Staffordshire County Council
complaints department have been undertaken to identify ways to streamline
co-existing processes, reduce duplication and improve performance.
Patient Experience data is scrutinised alongside other quality data at our
Quality Governance Committee and by User and Carer representatives at our
User and Carer Forum.
During 2013/14 we will develop social care real-time experience reporting,
along with reporting of experience from our integrated adult health and
social care teams.
The Partnership Trust intends to review roles and use volunteers and
members in 2013/14 to develop it’s mystery shopper programme.
Data on equality characteristics are captured through the complaints audit
tool.
All operational teams capture data on equality characteristics at referral via
the single assessment process.
Develop specific
systems to capture
disability of service
users across all
services
Easy read service user experience surveys have been developed through the
engagement of a service user learning disability forum.
Picture surveys have been introduced across the Partnership Trust.
Carer surveys have been implemented to enable carers, families or advocates
to undertake surveys for service users who are unable to participate.
From the introduction of the Ele-Lite devices the format size of all surveys can
be expanded to large print for users with visual impairments.
Service users / carers can access face-to-face or telephone interviews/
advocacy/translators as required.
Review data
processes and
dashboards already
reporting service
user uptake and
experience to
incorporate the
equality protected
groups.
data on protected
groups.
Review of real time reporting that includes monthly data on protected
groups
Support staff to
increase the quality
of data required at
service level and
at each capture
of service user
experience and
feedback.
Staff are provided with on-going customer service training.
All service user feedback and data results are presented monthly to every
operational team.
Service user and carer experience captures categories recorded across all the
Equality Characteristics.
Reporting completed, each Operational team receives results and monthly
report from 1 Sept 2012
User and Carer Experience monthly reporting is received at the User and
Carer Experience Forum. Participation of the User and Carer Forum consists
of Senior Managers and representation from User and Carer Charitable and
Voluntary organisations
Operational Teams are required to develop action plans of improvement
following the monthly feedback of Users Carers or Parents comments.
The introduction of real time reporting has increased the quality of reporting
through one standardised methodology.
CSE Awareness Training Events completed and will be an on-going process.
Monthly reports to each team from the 1 September 2012.
The service uptake and access across equality groups is reported to Trust
Board. Actions to address gaps in improving data collection feed into relevant
training programmes and service user feedback.
Embed equality
analysis framework
into everyday
decision making
utilising health
intelligence and
service user data
from national and
local sources.
Equality analyses are being undertaken and completed for the Partnership
Trust for all service user and carer experience work programmes.
Anonymous equality data is collected using real time experience data across
the Partnership Trust.
53
Focus on:
Adult Ability team
wins “Best of service”
Pam Bostock is a Consultant Occupational
Therapist, working for our Partnership Trust
in East Staffordshire. She is the team lead for
the Adult Ability Team - a community based
specialist nursing and Neurological Rehabilitation
Service, offering therapeutic interventions and
case management for people with progressive
neurological conditions, supporting people from
diagnosis to end of life.
Pam’s team assess and formulate therapeutic
programmes tailored to the individuals own
goals to give service users the skills they need to
manage their own condition at home and help
them to live their life in the way they choose.
The team includes Occupational Therapists,
Physiotherapists, Parkinson’s disease and Multiple
Sclerosis specialist nurses, an
integrated Support worker
and an administrator with a
counselling background.
of an outcome measure for use with people with
long term neurological conditions.
As well as being cited as an example of best
practice by the Department of Health, the team
was recently presented with one of three ‘Best
of Service’ Awards provided by the Staffordshire
Neurological Alliance. Pam’s has also been
invited to join the Multiple Sclerosis guideline
development group for the National Institute for
Health and Care Excellence (NICE), as well as being
a co-contributor for a national piece of research
into progressive neurological conditions, in
conjunction with a leading university – currently
in application phase.
The team contributed to
two pieces of multi-centred
research in 2012 – an MS
fatigue management
programme and research
analysing the requirements
“ As well as being cited as an example of best practice by the
Department of Health, the team was recently presented with one
of three ‘Best of Service’ Awards provided by the Staffordshire
Neurological Alliance.”
54
Partnership Trust Performance indicators
Overall, performance for the 2012/13
Table 19: Partnership Trust high level performance indicator achievements.
Indicator
2011 / 12
Quality
Account
Percentage of patients seen within
four hours in Minor Injury Units / walk- 99.9%
in centres
Therapies - percentage of patients
treated within 18 weeks from referral
94.0%
to treatment
2012/13
Performance
Commentary
3
99.9%
3
99.9% achieved Against a
target of 95%
7
97.3%
3
97.3% achieved Against a
target of 95%
4.3% achieved Against
a target of 5% (ACFT
Benchmarking position
4.66% )
99.0% achieved Against
a target of 95% (ACFT
Benchmarking position
98.70%)
Percentage of patients that did not
attend their outpatient/community
appointment
4.7%
3
4.3%
3
Percentage of non-admitted patients
meeting the 18 week consultant led
referral to treatment target
97.8%
3
99.0%
3
Percentage of admitted patients
meeting the 18 week consultant led
referral to treatment target
95.3%
3
95.7%
3
95.7% achieved Against a
target of 90%
(previous
target
100%)
7
98.1%
3
98.1% achieved Against a
target of 95%
100%
3
100%
3
100% achieved Against a
target of 100%
Percentage of patients offered a
Genito-Urinary Medicine appointment
to be seen within 48 hours
Percentage patients receiving a
diagnostic scan within six weeks of
referral
Delayed transfers of care (percentage
of occupied bed days)
99.9%
7
3.3%
3
3.3% achieved Against
a target of 3.5% (ACFT
benchmark position 6%)
3
0
3
0 Cases against a target of 0
7
3
11
3
11 Cases against a tolerance
of <= 11
1
(Target:
0)
7
1
3
1 Case against a contractual
tolerance of <= 1
4.9%
Mixed sex accommodation: Single sex
0
number of breaches
Clostridium Difficile (number of
incidents within 1 month) (Hospital
Acquired)- (VSA03)
MRSA Bacteraemia (number of
incidents within 1 month) (Hospital
Acquired) - (VSA01)
55
Table 19: Partnership Trust high level performance indicator achievements.
Indicator
2011 / 12
Quality
Account
MRSA Screening on Admission (%
screened on elective admission)
99.9%
7
99.9%
7
99.9% achieved Against a
target of 100%
MSSA (number of cases) (Hospital
Acquired)
0
3
1
3
1 Case against a tolerance
of << 4
Compliance with CQC Registration
Regulations
Compliant
3
Compliant
3
Full Compliance
Number of Never Events
0
3
0
3
0 Cases against a target of 0
7
97% Social
Care 98%
Health
7
Against a target of 100%
% of complaints acknowledged within
98.8%
72 hours of receipt
SC30 -Time from Referral to
Implementation of all Services
N/A13
SC31 -Carers Receiving Services or
Information Following Assessment as
N/A
a % of all Adults Receiving Community
Based Services
SC20 Older People Still at Home and
Needing no on-going Social Care
N/A14
Services 91 days Following Receipt of
Reablement Services
2B Older People Who Were Still
at Home 91 Days After Discharge
N/A
from Hospital Into Reablement /
Rehabilitation Services
56
2012/13
Performance
Commentary
68% Against a target
of 80%, due to various
pressures15
68%
7
44.5%
3
44.5% against a target of
30%
42.0%
3
42.0% against a target of
42%
87.9%
3
87.9% against a target of
86%
13. The Partnership Trust included Adult Social Care from 1 April 2012
14. The Partnership Trust included Adult Social Care from 1 April 2012
15. D
uring 2012/13 there was an 8% increase in the volume of referrals for an adult social care assessment. The acuity of demand for social
care has increased significantly. A number of high priority safeguarding referrals are being diverted to Partnership Trust from the SCCled adult protection team. Increased demand from hospitals as a result of reducing length of stay.
Table 19: Partnership Trust high level performance indicator achievements.
Indicator
SC10 The Proportion of People Using
Social Care in Receipt of Eligible
on-going Services Who Receive
Self Directed Support, and Those
Receiving Direct Payments
2011 / 12
Quality
Account
N/A
2012/13
Performance
62.5%
Commentary
3
62.5% against a target of
45%
2A Permanent Admissions to
Residential or Nursing Care Homes per N/A
Adult 100,000 Population
170.0
SC40- Projected Number of VA
Referrals per 10,000 Population
N/A
40.1
No Target
SC44 - Compliance with Vulnerable
Adults Quality Standards (quarterly)
N/A
93%
No Target
Q18 - Quality Improvement Survey
Proportion of People Who Feel They
Were Supported to Make Their Own
N/A
Decisions About Their Social Care and/
or Services?
95%
7
3
170.0 against a target of
150.016
against a target of 85%
16 Due to pressures in the health economy, particularly in the North of the Trust. The Partnership Trust is reviewing this area in detail
during 2013/14.
57
Safety
Incident Reporting
The Partnership Trust views incident reporting
as a very positive aid to managing patient safety.
The information we collect allows us to analyse
what and where safety issues may be occurring.
Investigation of incidents allows us to learn
lessons and make changes to reduce the risks of
recurrence.
All staff are actively encouraged to report any
incident that gives them cause for concern. The
Trust is committed to an open and transparent
culture of raising safety concerns to ensure the
safety of people who use our services. This is a key
focus in the training staff receive in relation to risk
management and incident reporting.
Table 21 identifies the top three reported incident
types.
58
1 September
2011 - 31 March 2012
1 April 2012
–
30 September
2012
1 October 2012
–
31 March 2013
Total:
1 April 2012
– 31 March
2013
Table 20: Total number of incidents reported.
Total number of incidents
reported (attributable to the
Partnership Trust)
3431
2948
3192
6140
Total number of serious incidents
111
124
155
279
Serious incidents as a proportion
of all incidents
3.24%
4.21%
4.85%
4.54%
Never events
0
0
0
0
Table 21: Top three reported incident types April 2012 - March 2013.
Adverse Incidents
Total Number Reported
1.Slips/Trips/Falls
1112
2.Pressure Ulcer
1063
3.Clinical Incidents
665
Of the incidents reported 146 pressure ulcers were
reported as a grade 3 or 4 pressure ulcer serious
incident. Following the tissue viability panels 40
were confirmed as avoidable grade 3 or 4 pressure
ulcer acquired within the Partnership Trust care, 3
were acquired in the community hospitals and 37
were within the community. A further 33 serious
incidents were reported in relation to a slip, trip or
fall.
Table 22 below details the percentage of serious
incidents reported in relation to the number of
incidents reported.
Number of adverse
incidents reported
385
Mar-13
Feb-13
Jan-13
Dec-12
Nov-12
Oct-12
Sep-12
Aug-12
Jul-12
Jun-12
Apr-12
May-12
Table 22: Percentage of Serious Incidents
470
513
582
482
516
591
479
480
579
529
534
Number of reported
incidents classified
as serious incidents 23
28
15
26
20
12
16
22
21
38
33
25
Percentage of
reported incidents
classified as serious
incidents 5.97%
5.96%
2.92%
4.47%
4.15%
2.33%
2.71%
4.59%
4.38%
6.56%
6.24%
4.68%
Number of never
events
0
0
0
0
0
0
0
0
0
0
0
0
59
Chart 4: Number of incidents reported per month from April 2012 to March 2013
Number of adverse incidents reported
Service User Compliment
Received July 2012 – Cobridge Community Health Centre (CASH)
“Gratitude for the help and advice offered to me on
my recent visit to CASH. My first query was by phone
and then by appointment. On both occasions, I was
greeted in a warm and friendly manner. The Doctor I
saw introduced themselves and explained my procedure
which put me at ease. Overall, I was treated with a kind
and understanding manner by all staff within the clinic.
I will not hesitate to use the service again. 5 star service!”
60
Serious Incident Reporting
Pressure ulcers and falls were the two highest
reported incident themes during the last year.
• Pressure ulcers: 59% of all Serious Incidents
• Falls: 12% of all Serious Incidents
The Partnership Trust’s service responses and
inputs to these theme areas include:
•Z
ero tolerance pressure ulcer management
action plan
•P
atient Safety (LIPS) Falls Collaborative
programme
These service developments have been
highlighted earlier in Part 2 of the document.
World Health Organisation Surgical
Safety Checklist
The World Health Organisation is the directing and
coordinating authority for health within the United
Nations. It is responsible for providing leadership
on global health matters. The National Patient
Safety Agency recommended that community
services did not need to implement the World
Health Organisation Surgical Safety Checklist.
The Partnership Trust has however adopted the
principles within the relevant services of podiatry
and dentistry.
Central Alerting System
The Partnership Trust uses a national system called
the Central Alerting System for issuing safety
based alerts to all its services and teams.
The Central Alerting System brings together the
Chief Medical Officer’s Public Health Link and the
Safety Alert Broadcast System. It enables alerts
and urgent patient safety specific guidance to be
accessed at any time.
During 2012/13 the Partnership Trust has received
142 alerts, of which 92 required acknowledgement
and addressing within the required time frame. 84
alerts have been acknowledged within the time
frame. Eight alerts were still open at the end of the
year. There were 50 alerts which did not require a
response from the Trust.
Recommendations from Her
Majesty’s Coroner
As a result of an inquest, HM Coroner may require
an organisation to make improvements to its
services, normally within a 56 day timescale. This is
known as a “Rule 43” recommendation.
During the year the Trust received one Rule 43
recommendation. The Coroner raised concerns
that social care staff had failed to assess a service
user’s capacity and to challenge the expectations
of other providers of care in relation to the needs
of the service user, who had refused services and
subsequently died of hypothermia.
The Trust has taken action by working with partner
organisations to develop policy guidance on how
to support individuals who refuse services. The
policy focuses on the Partnership Trust taking
on the co-ordination of an assessment by bring
agencies together (face to face) ensuring that all
partners support the management of a shared
risk management plan when an individual refuses
support, yet is deemed to have mental capacity.
The Trust has responded to the Coroner on the
action taken and confirmed that the policy has
Alerts are received by email direct from the
Central Alerting System. All alerts are checked for
relevance to the organisation through discussion
with a senior manager. Relevant alerts are
cascaded to teams who take necessary actions
and confirm back to the risk team for confirmation
of completion, for the risk team to make a positive
return.
61
been implemented. The Coroner was assured that
the Trust has improved the service and taken the
necessary steps to prevent future deaths.
Infection Control
During 2012-2013 the Partnership Trust had one
case of MRSA bacteraemia which occurred in a
Community Hospital. A bacteraemia is a blood
sample which has been tested and found to be
growing bacteria in such as MRSA. The source
of the bacteraemia isolated in the community
hospital related to a small cannula placed in the
back of a service user’s hand. The service user had
a number of cannula inserted during their stay,
one of which became infected. Additional training
has been given to ward staff to prevent incidents
such as these in the future.
During 2012/13 the Partnership Trust did not
exceed its trajectory for Clostridium Difficile
incidents.
62
In 2013/14 we will work on two specific areas to
support the reduction of serious infections such as
bacteraemias:
•C
hronic wounds related to Diabetic ulcers
•A
review on Central Venous Catheters / Hickman
line management. These are tubes/cannulas
that are inserted to administer medications and
treatments.
Learning lessons
In addition to the progress listed for Priority
1 (Safety Express) previously, these are some
examples of changes to practice following root
cause analysis of incidents:
• We developed a Standardised Risk assessment
tool and root cause analysis tool across the
organisation, combining tools from our
predecessor organisations.
• We standardised our Pressure Ulcer prevention
teaching programme across the organisation.
• We developed a Tissue Viability Wound Care
forum (North Division) and Link nurses (South
Division). Community nurses are involved in
becoming Tissue Viability change champions,
ensuring competencies are regularly reviewed.
• We introduced the Tissue Viability panel, chaired
by the Director of Nursing and Medical Director,
ensuring a Multidisciplinary approach to learning
and sharing lessons from pressure ulcers.
• We developed a standard set of forms for
Pressure Ulcer Prevention using the “SSKIN
bundle” approach, and we use this across the
organisation, in response to an identified
theme from Root Cause Analyses around
record keeping.
• Our tissue viability team, physiotherapy,
dietetics, occupational therapy and
wheelchair services are working together
to develop a business case for a Postural
Management Service.
• We are developing a Pressure Ulcer
documentation booklet and will start
using this in 2013/14.
Experience
Table 23: Compliments, complaints and PALS contacts
Complaints and compliments
The Partnership Trust has received 1738
compliments during 2012/13:
• 1429 for Health
• 309 for Social Care
Compliments
1,738
Complaints about healthcare services
Complaints against social care services
PALS contacts
260
164
1,986
Chart 5: Monthly compliments for the Partnership Trust
Compliments received 2012/13
Compliments received 2012/13
300
Health
250
Social Care
200
150
100
50
Mar 13
Feb 13
Jan 13
Dec 12
Nov 12
Oct 12
Sep 12
Aug 12
Jul 12
Jun 12
May 12
Apr 12
0
Service User Experience
A lady who had surgery to remove a brain tumour spoke of
her treatment at Sir Robert Peel Hospital, Tamworth. The lady
said the support that she and her husband received from the
Stroke Nurse was ‘invaluable’ and she also described the nurse
as her ‘lifeline who had kept them going’.
63
Formal Complaints Performance/ Activity
Chart 6: Complaints Performance Information
80
Formal Complaints received 2012/13
Formal Complaints received 2012/13
70
60
50
40
30
20
NHS
10
0
NHS
Social Care
Social Care
Apr-Jun 2012
64
36
Jul-Sep 2012
58
45
Jan-Mar 2013
68
43
Parliamentary and Health Service
Ombudsman (PHSO) reviews
Local Government Ombudsman
(LGO) reviews
In 2012/13 six complaints were reviewed
by the PHSO.
Last year 14 complaints were referred to
the LGO.
• E leven complaints were immediately closed with
no further actions.
•O
ne complaint was upheld and led to the Trust
paying £668.10 to a Complainant towards the
cost of respite care.
• Two further upheld complaints led to the
Trust paying £200 and £500 for time and
inconvenience of two individual complainants.
Of the six cases the Ombudsman decided to
close four without further action and has to date
upheld one case. In this case the Ombudsman
recommended that the Trust pay a £500 to a
complainant due to loss of health care records. The
Ombudsman had not completed the investigation
for one case which was referred in March 2013.
This case relates to:
• A Legacy complaint (November 2010) relating to
South Staffordshire Primary Care Trust. The PHSO
has requested a copy of the complaint file and
patient records.
64
Oct-Dec 2012
70
40
There was one referral to the Local Government
Ombudsman in March. The complaint relates
to the Adult Social Care Team in Newcastle with
regard to alleged misinformation provided by
staff about care entitlements under national
directives. The Trust is awaiting the outcome of the
investigation.
Health Care Complaints
Performance
In December 2012 the Trust Executive
Management Team made a commitment
to reduce the time taken to respond to
complainants. This new commitment went over
and above the National Complaints Targets
and and meant that our teams would need to
strive to meet investigation deadlines without
renegotiation. Our complainants are kept up to
date with progress regularly.
Of the 260 health care formal complaints, 80%
have been completed in accordance to the Trusts
internal targets, i.e. no extensions to complaint
timescales.
During 2012/13 the Trust was 100% compliant
with National Complaints Targets, with all
complainants updated throughout the complaint
investigation and informed accordingly to
negotiate timescales dependent upon their
individual complaint.
65
Chart 7: Performance Activity for the top five categories received in April 2012 to March 2013
Partnership Trust top 5 complaint themes 2012/13
Partnership Trust top 5 complaint themes 2012/13
Clinical Treatment
24%
Other
30%
Staff Attitude
17%
Access to Services
8%
Appointments
10%
66
Quality of Care
11%
Of the 260 health care formal complaints, 182
complaints have been categorised into the top
five themes for the Trust as identified in the chart
above. The other remaining 78 were individual
cases of concern with no specific identifiable
trends or themes.
Adult Social Care Complaints
Performance
In 2013/14 the Trust will be reviewing the
Complaints and PALS functions to further improve
performance and incorporate recommendations
from the Report of the Mid Staffordshire NHS
Foundation Trust Public Inquiry.
Of the 164 formal complaints for Adult Social
Care, 52% were responded to within the agreed
timescale. This is below the standard expected and
senior colleagues are working together to improve
this performance.
The Trust works together with Staffordshire County
Council under a legal Partnership Agreement to
manage the statutory complaints process for our
Social Care provision.
Chart 8: Partnership Trust Adult Social Care complaint themes 2012/13
Adult Social Care complaint themes for 2012/13
Service User Compliment
Received April 2013 – Haywood Hospital – Rheumatology
“I would just like to thank all the staff at Scotia Day Case
Unit, Haywood hospital for all their help and support at my
5 day treatment package; their professionalism and care
was excellent. In this day and age where the public are so
fast to accuse the NHS for not giving an excellent service
to their patients it made me proud to see this service
achieved great success. I was very apprehensive about my
diagnosis and treatment but the staff put me at ease and
helped me to come to terms with it.”
67
Patients Advice and Liaison Service
(PALS)
Of the 725 contacts relating to the Trust, 688
(95%) were resolved within 24 hours, and 37 (5%)
contacts were escalated to a formal complaint.
During 2012/13 the Trust received 1986 PALS
contacts. Of the 1986, there were 725 PALS
contacts directly relating to the Trust. The
remaining 1261 contacts relate to signposting to
other organisations, information and advice.
Of the 725 PALS contacts which related to our
Trust, 506 were in relation to the top five PALS
categories highlighted in chart 17 below. The
other 219 contacts relate to a diverse range of
categories with no specific trend or theme.
Chart 9: PALS Contacts
Partnership Trust PALS contacts 2012/13
Partnership Trust PALS contacts 2012/13
250
PALS contacts signposting to other organisations, info & advice
PALS contacts related to the Trust
PALS contacts escalated to formal complaints
200
150
100
50
Mar 13
Feb 13
Jan 13
Dec 12
Nov 12
Oct 12
Sep 12
Aug 12
Jul 12
Jun 12
May 12
Apr 12
0
Service User Compliment
Received December 2012 – Minor Injuries Unit Cannock:-
Patient sent note to say a big thank you for the extremely high
standard of care she received when she attended the unit after
a minor car accident in December Kindness much appreciated.
68
Chart 10: Top five PALS Categories
Themes from PALS contacts directly related to the
Partnership Trust 2012/13
Themes from PALS contacts directly related to the
Partnership Trust 2012/13
Access to Services
24%
Other (no specific
theme)
30%
Aids and Appliances /
Equipment
7%
General Information
8%
Appointments
21%
Quality of Care
10%
Trust Wide Net Promoter Score
(NPS)
The Net Promoter Score is a simple measuring
tool which has been endorsed nationally by
Government to enable benchmarking of service
user experience across all NHS Trusts.
It is an adaptation of a customer service tool
used in industry. Successful firms have moved
beyond asking about satisfaction, to tracking
loyalty through a simple question – “would you
recommend this service to a friend or family?” This
is the Net Promoter question.
If you recommend, then you are a promoter. If you
would not, you are a detractor. Good firms expect
to have many more promoters than detractors –
50% or more.
If patients and carers would not recommend
services then staff, wards and the Board will know
there is a problem, and can do something about it.
Organisations need to ask the same question
across different settings in real time so that staff,
boards and wards can understand in real time
where they are failing their patients compared to
the best, and address the issues.
Poor scores tell you that you may have a problem,
not how to solve it. This measure is a simple test
to focus boards and wards minds on acting. This is
why we track performance monthly and publish
the results. Teams who perform poorly in this test
are held to account and supported to improve.
As part of our CQUIN programme we committed
to capture Net Promoter Scores, and introduced
this methodology from 1 July 2012.
A baseline measurement was taken in July 2012
for the Trust as a whole. This was a positive score
of +62.12.
During the period from 1 July 2012 to the 31
March 2013, the Trust captured the experience of
10,947 users, carers, parents or family members.
At the end of the year we had improved our
overall score to +67.30. Our highest peak of
positive experience was +77.62 during January
2013.
69
Figure 4. Partnership Trust overall Net Promoter Score for March 2013
March Net Promoter Score for the Partnership Trust
Monthly Promoter Score = 72.41
Monthly Passive Score = 22.48
Monthly Detractor Score = 5.11
NPS score for March +67.30
Chart 11: The monthly breakdown of the Trust wide Net Promoter Score.
Partnership Trust Net Promoter Score 2012/13
Partnership Trust Net Promoter Score 2012/13
100
90
80
70
60
50
40
30
20
10
70
Mar 13
Feb 13
Jan 13
Dec 12
Nov 12
Oct 12
Sep 12
Aug 12
Jul 12
0
Improving our Net Promoter Score
The Net Promoter score is broken down into
individual teams, which each have a target for
improvement as part of the CQUIN programme.
Our CQUIN target was to achieve a 10 point
improvement in our scores by March 2013,
starting from the baseline in July 2012.
Some improvements we have made include:
• Introducing new menus across the wards and a
monthly meeting with the food services provider.
•D
isplaying therapy timetables within the ward
environments.
• Introducing a standardised approach for
displaying waiting times in outpatient
departments.
• Introducing laminated communication boards
across all the Health Centres.
•P
assing on feedback relating to buildings and car
parking to the relevant commissioners.
• Introduction of early warning triggers for any
negative comments which immediately alert
operational teams.
Individualised monthly reports are sent to the
Chief Operating Officer, Hospital Manager, Service
Managers and Matrons.
Social Care Users Experience
As part of our Partnership Agreement with
Staffordshire County Council, colleagues
undertake monthly surveying of service users.
From December to February 2013 there were 246
questionnaires distributed. The response rate was
29%.
Two Indicators included in these surveys are
particularly valuable for us to monitor. These are
reported monthly as part of our scorecard to
Board along with quarterly reporting as part of the
performance report and data is included below.
This is currently part of a development in our
integrated approach to Service User Experience
and we have started to monitor the data since
December 2012.
Table 24: Partnership Trust Net Promoter Scores for specific areas
Area
July 2012 baseline
March 2013 score
CQUIN target
Community Hospitals Discharge
+46.67
+75.00
+56.67
Community Inpatient Wards
+56.67
+61.48
+66.67
Outpatients
+73.91
+70.46
+83.91
Health Centres
+36.05
+42.48
+46.05
Dec 2012
Jan 2013
Feb 2013
County
83%
89%
95%
North Staffordshire
86%
93%
90%
SW Staffordshire
81%
88%
95%
SE Staffordshire
84%
87%
100%
Table 25: Adult Social Carer Surveys
Do you feel that you were
supported to make your own
decisions about your social care
and/or services? (% ‘Yes)
% responding “Yes”
71
Table 26: Adult Social Carer Surveys
Overall, how satisfied are you with the assessment
and support planning experience with Social
Services?
County
North Staffordshire
SW Staffordshire
SE Staffordshire
The lower ‘overall satisfaction’ for North
Staffordshire is due to a higher proportion of
respondents choosing ’Quite satisfied’ rather than
‘Very satisfied’. The responses did not reveal any
notable trends to explain this dip.
% responding “Very satisfied”
Dec 2012
66%
69%
65%
66%
Jan 2013
66%
58%
74%
65%
Feb 2013
65%
48%
75%
71%
As part of the survey, respondents are asked if
they would like a follow up interview. Feedback
from interviews, as well as additional information
from the surveys, is used to review and improve
services. Staffordshire County Council will be
working with the Partnership Trust during
2013/14 to regularly review results from this ongoing survey.
Effectiveness
What is effectiveness?
Effectiveness is about doing the right thing at the
right time for the right person17 and is concerned
with demonstrating improvements in quality and
performance.
Practice Audit working in the
Partnership Trust
During 2012/13, Practice Audit support was
provided by predecessor service arrangements,
either in house or under the management of a
Service Level Agreement. The requirement to
participate and the level of support available to
staff to undertake audit therefore varied across the
Trust.
With effect from April 2013, the Practice audit
support service is an in-house service and the
support provided by the service level agreement
terminated. The fully in-house service will
be able to provide a quicker and dedicated
response to all staff undertaking audit, as well
as being able to support the Trust requirement
17. Royal College of Nursing (1996) What is Clinical Effectiveness?
72
of mandatoryparticipation in the annual audit
programme.
Since September 2012 there has been service user
group representation on the Practice Audit Group.
Research working in the
Partnership Trust
Research, service evaluation and innovation
activities are essential to a modern, effective
health service. Research activities are a core part of
the NHS.
Most research activity was undertaken at the
Haywood Hospital, Stoke-on-Trent which has
an international reputation for involvement in
rheumatology and musculoskeletal research.
However, there are also research studies being
undertaken in stroke services, community
physiotherapy, sexual health and prisons.
During 2012/13, three staff members took part in
the National Research Internship Scheme as rolled
out through the NHS Midlands and East. This
scheme gave the opportunity for staff members
to have protected time to investigate the local
implementation of NICE Quality Standards. One
of the internees has been invited to present her
work to the NICE Quality Standards Team with the
intention of rolling out the learning nationally.
During 2012/13, the Partnership Trust published its
Research Strategy 2013–18.
Quality Visits in the Partnership
Trust
The Partnership Trust has a Quality Visit
Programme that assesses quality standards and
performance across all health and social care
teams. The Quality Visit is a supportive process and
aims to:
•H
elp front line staff to deliver better care and
safety to our service users.
•H
ighlight and share good practice with the rest
of the organisation.
• Identify areas for improvement.
The Quality Visit programme works in two ways:
•R
outine visits, which are not scheduled because
of prior concerns or events.
•R
esponsive visits, which occur following a ‘trigger
event’ such as a service user complaint or staff
raising a concern.
Quality Visits are conducted similar to that of
national regulators. An area to be reviewed is
given 24 hours prior notice to the visit.
Examples of improvements to service user care
that the Partnership Trust has implemented from
undertaking the quality visit programme are:
• Improved signage for service users to direct to
departments.
•H
eightened awareness of record keeping
on Community Hospital Wards – rapid cycle
improvement audits have been used to continue
to monitor this process.
• L aunch of a Patient documentation project
to review and streamline patient notes in
community hospitals.
• Improved record keeping around
Multidisciplinary Care Team meetings.
• Improvements in safety i.e. disposing of needles
•B
etter cleanliness i.e. high standards of cleaning
enforced coupled with evidence of cleaning.
•M
ore visible ways to provide feedback to the
Partnership Trust.
A series of responsive quality visits took place in as
a result of a complaint at a Community Hospital
which primarily looked at documentation and
included a review of:
•M
edicines management and reconciliation
•P
ain relief
•O
bservation around deterioration
• V TE risk assessment
This responsive review process was carried out
across all community hospital wards within the
Partnership Trust to ensure that these themes
were not evident in other community hospitals.
Quality Circles
Quality Circles are groups of staff specifically
brought together to identify potential
improvements.
• Improvements are based on many small
incremental changes
• Staff are the best people to identify
improvements as they are working with the
processes on a daily basis
• Small improvements are less likely to require
major investment
• Staff take ownership for the quality of their work,
and team working is reinforced.
73
Improvement from Quality Circles
• Development of a standard letter which is sent
from the allocated worker to the service user,
explaining when their care transfers from the
hospital team to the long-term team, including
new contact details.
• Review of the process for agreeing top-ups,
including amending the process so that the
service user signs the top-up form with the social
worker present, rather than sending this by post.
• A quality circle would invite family members to
meet with the management team and talk about
their experience. As a result:
o areas where communication had broken down
were identified
o staff could discuss with the family members
reasonable expectations from social care in
terms of on-going support for a service user
funding their own care.
o adult protection case closure is now more
timely so that families and other relevant parties
are not waiting for outcomes.
o an independent agency is used when selffunding clients need support when planning
their own care, while continuing to adhere to
statutory responsibilities for assessment of need.
• A Quality Circle changed the way duty workers
record referrals so that when service users contact
them, the worker dealing with the query can
quickly find the relevant information and feedback
to the service users the exact status of their referral
• Review and updating of guidance following an
audit around “Recording with Care” to ensure it is
easy for staff to use and understand. Development
and rollout of “Recording with Care” training and
support with partner agencies, to improve the way
staff evidence their work.
Mortality reviews
The review of hospital mortality is recognised as a
method to improve mortality rates, patient safety,
end of life care, promote a process of peer review
and also provide assurance to the public.
Within the Partnership Trust a system of reviewing
all deaths, led by the Medical Director, has been
introduced. In order to embed reviews in practice,
they have become part of hospital ward routine,
being championed by clinicians. These reviews are
discussed as part of the regular multidisciplinary
team meetings on each of the wards. An
74
organisation wide overview of these reviews is
conducted by the Mortality Review Group and
the outcomes reported through the committee
structures to the board to provide assurances of
high quality care that is provided by the Partnership
Trust.
The Partnership Trust has reviewed 15 deaths. The
lessons learnt from these reviews are disseminated
to all wards for implementation across the
Partnership Trust, using internal communication
processes.
Themes identified to date have included a review of
pain evaluation documentation, implementation of
a training programme to ensure monitoring process
is robust, and raising awareness of the content of
the never events list.
NICE working in the Partnership
Trust
The Partnership Trust is committed to
implementing and monitoring all applicable
guidance issued by the NICE, in order to ensure
service users receive the best and most appropriate
care, ensure that NHS resources are not wasted
on inappropriate or ineffective care and to
ensure equity and consistency of care across the
geographical area.
Once applicable guidance is implemented the
Partnership Trust monitors and audits guidance
to ensure that it is being correctly undertaken.
In 2012/2013 the Partnership Trust undertook a
number of audits that included the monitoring of
NICE standards and results. NICE guidance covered
in these audits were:
• CG29 - Pressure ulcers: The management of
pressure ulcers in primary and secondary care
• CG32 - Nutrition support in adults: Oral nutrition
support, enteral tube feeding and parenteral
nutrition
• CG66 - Type 2 diabetes (partially updated by CG87)
• CG123 - Common mental health disorders:
Identification and pathways to care
Throughout these audits there were high levels of
compliance that were identified. Where there was
low compliance found actions to address these
were identified and implemented (see table 27 )
Table 27: NICE guidance audit actions to address low compliance with NICE guidance
Guidance
Area of low compliance
Action to address
CG29
23% (10/44) of patients audited were not assessed for
their level of pressure ulcer risk every three months.
Pressure Ulcer guidelines
re-launched across the
Trust.
21% (9/44) of patients audited did not have a skin
inspection recorded on initial assessment and
thereafter according to level of risk.
21% (9/44) of patients audited did not receive
documented health advice and guidance on the
management of pressure ulcers.
CG32
57% (100/176) of patients audited had evidence that
the Malnutrition Universal Screening Tool (MUST) was
used.
Launch events held at
various venues across the
Trust.
SSKIN bundle
documentation introduced.
Training programme
to support the patient
pathway and completion of
pathway documentation
14% (14/100) of patients audited did not receive the
review of care appropriate to their MUST score.
CG123
20% (1/5) of patients audited with mild to moderate
depression had structured group activities available.
20% (1/5) of patients audited with mild to moderate
obsessive-compulsive disorder (OCD) had access to
group cognitive behavioural therapy (CBT).
Focus placed on the
provision of therapeutic
groups, delivered
in conjunction with
secondary services.
40% (2/5) of patients audited with generalised
anxiety disorder that had not improved after physical
education had access to psycho educational groups.
40% (2/5) of patients audited had no evidence of
the involvement of family and carers during the
assessment or treatment process.
Staff made aware of the
availability of self-help
material and how it can be
accessed.
Staff made aware of local
care pathways including
40% (2/5) of patients audited had no evidence of
primary care, mental health
protocols available to ensure effective communication and learning disability.
with families, carers and other professionals
Protocols and policies, in
regard to involvement of
family and carers reviewed.
75
Patient Group Directions
PGDs are written instructions for the supply and
administration of medicines to groups of patients
who do not need to be individually identified
before presentation for treatment. They do not
therefore lend themselves to patient-focussed
care.
The preferred and main method for patients to
receive medicines is for a prescriber to prescribe
for that patient based on their clinical need.
However, there may be instances where PGDs
are more suited to a certain group of patients.
For example, in situations where clearly defined
instructions for the supply and administration of
medicines can be produced and where there are
volumes of patients who present for treatment
(e.g. vaccines, eye drops before examination etc.).
Quality Impact Assessment of Cost
Improvement Projects
The supply and administration of medicines
under Patient Group Direction should therefore
be reserved for those limited situations where
this offers and advantage to patient care without
compromising patient safety and be consistent
with appropriate professional relationships and
accountability.
Risks associated with every scheme must be
identified in order to assess risks against each of
the elements of quality in order that an informed
decision can be made in relation to acceptance or
mitigation of that risk.
We have a total of 232 PGDs, currently 112 have
been reviewed and reissued and the rest are
currently under review.
Community Nursing – District
Nursing Review
A review of Community District Nursing Service
(DN) was carried out by the Commissioners for
North Staffordshire and those for Stoke-on-Trent.
This review focused on the North Division of the
Partnership Trust.
The review was instigated as GPs and
Commissioners recognised the increase in clinical
activity amongst DN teams particularly as the
number of staff working in the teams had fallen.
The review identified that it was unclear which
people the DN teams should care for as the
service lacked a defined referral criteria.
Key actions from this review include:
•A
n increase in staffing numbers (establishment)
across the service
•R
ecruitment to vacant and new posts
76
• The development of a referral criteria for DN
services
• Identify work currently being carried out by DNs
that could be completed by other professionals
or services
• Exploration of the impact of data collection from
quality improvement schemes on DN services
• The collaboration between community services
and primary care services to introduce Integrated
Local Care Teams across the North Division,
which includes service user involvement.
The Trust is required to deliver cost improvements
year on year. It is critical that the impacts on
Safety, Effectiveness and Patient Experience are
understood before cost improvement projects are
initiated.
In January 2013 we approved a process to Quality
Impact Assess (QIA) each Cost Improvement
Project (CIP) at the development phase, and the
process for on-going monitoring to ensure that
quality is safeguarded.
• Each CIP scheme is owned by a business
lead who is an operational manager. At the
initiation of a scheme they have responsibility for
delivery of the scheme in relation to managing
the delivery of both the financial and quality
elements of the scheme.
• The initial CIP QIA will be reviewed in the
originating Operational Division before full
review by the CIP QIA Panel. The CIP QIA Panel
comprises the Directors of Medicine and Nursing
& Quality, the Professional Leads, corporate
finance manager and other relevant subject
specialists.
• Each stage of the CIP QIA process will be
documented in a specific template, and
the outcome summarised in the overall CIP
template.
• There is a process identified for ensuring
appropriate governance arrangements are in
place to report the quality impact to both the
Quality Governance Committee and the Finance
Investment and Performance Committee.
Professional Leads
Professional Leads are all registered practitioners
(nurse, allied health professional or social worker)
and they ensure professional leadership is in
place for all frontline staff and other parts of the
Partnership Trust. Professional Leads promote,
influence and support:
•A
culture of safety and risk management
•D
elivery of quality services based on best
practice, audit and research
• Innovation and service change
•D
evelopment of policy and maintenance of
professional standards, such as record keeping
• L eading work to embed a culture of
compassionate care
• E fficient use of resources
• Workforce development and planning, including
competencies
Patient Compliment
Received September 2012 Community Stroke Team –
Stoneydelph Health Centre
“We come to you because
we knew you would point us
in the right direction and you
explain it in English so that
we can understand it.”
Professional leads also work closely with partners
to support safe, efficient and effective patientcentred care to achieve the best possible
outcomes.
77
Focus on:
Stoke Speaks Out – Speech
and Language Therapy
“Stoke Speaks Out” is a multi-agency strategy
across Stoke on Trent to tackle high levels of
language delay identified in children across Stoke
on Trent.
The programme grew from research conducted
by speech and language therapists across Sure
Start local programmes from 2002 to 2010.
This revealed a significantly high percentage of
children presented with severe language delay
on entry to nursery- this averaged at around 64%
children were delayed across the City. The National
incidence for speech and language impairment is
8-10% of children.
The programme was set up in 2004 as a joint
Neighbourhood Renewal initiative. There was
originally a core project team but now many of
these roles are embedded into people’s roles
within their own services. The programme remains
one of the City’s five priorities for Early Years and
there is still huge multi-agency commitment.
The programme has seen language improve
across the City from 64% delay in 2002 to 39%
delay in 2010.
For more information visit
www.stokespeaksout.org.uk
Research informs us that these issues left
undetected or unresolved have a huge impact on
children’s life chances and educational outcomes.
Speech, language and communication needs
can result in low self-esteem, poor confidence,
low literacy levels and poor attainment at school.
There is a strong link between youth offending
and speech and language delay.
“The programme has seen language improve across the City
from 64% delay in 2002 to 39% delay in 2010.”
78
Supporting Staff
Leadership Development and Talent
Management
These two key areas form the main work streams
supporting the Organisational Development
Strategy.
We have appointed a Leadership Programme
Manager who will lead a project that will identify
and design a robust leadership programme to
support staff at all levels. The overall aim is to
establish in-house provision that will be led and
provided by executive and senior managers. Key
staff members, including professional leads, will
be offered opportunities to undertake accredited
coaching qualifications and training in delivery of
3600 assessments.
A fair and equitable approach to Talent
Management is being introduced that will
recognise and support staff who can make a
difference to services within the organisation.
This will be supported by the increasing capacity
that is being developed through the Leadership
Programme, to provide coaching and mentoring.
Staff Opinions Survey
We use the results of the annual NHS staff survey
to address any areas for improvement as well
as compare ourselves against other community
trusts.
As a Learning Organisation, we are evaluating the
impact of previous Leadership Programmes as
well as analysing Leadership profiles of staff. This
will ensure that the internal training we develop
fully meets the needs of the workforce to deliver
quality care that empowers both staff
and service users to reach their full
potential.
79
Table 28: Staff opinion survey results
80
National Staff Survey results
Trust
Score
2011
Trust
Score
2012
National
average for
community trusts
in 2012
Overall level of staff engagement
Staff feeling satisfied with the quality of work and patient
care they are able to deliver
Staff agreeing that their role makes a difference to patients
Staff feeling work pressure*
Staff reporting effective team working
Staff working extra hours*
Staff received job relevant training, learning and
development
Staff appraised in last 12 months
Staff having well-structured appraisals in last 12 months
Support from immediate managers
Staff receiving health and safety training in last 12months
Staff suffering work-related stress in last 12 months*
Staff saying hand washing materials are always available
Staff witnessing potentially harmful errors, near misses or
incidents in last month*
Staff reporting errors, near misses or incidents witnessed in
the previous month
Fairness and effectiveness of incident reporting procedures
Staff experiencing physical violence from patients, relatives
or the public in last 12 months*
Staff experiencing physical violence from staff in last 12
months*
Staff experiencing harassment, bullying or abuse from
patients, relatives or the public in last 12 months*
Staff experiencing harassment, bullying or abuse from staff
in last 12 months*
Staff feeling pressure in last three months to attend work
when feeling unwell*
Staff reporting good communication between senior
management and staff
Staff able to contribute towards improvements at work
Overall level of staff satisfaction
Staff that would recommend the Trust as a place to work
or receive treatment
Staff motivation at work
Staff having equality and diversity training in last 12
months
Staff believing the Trust provides equal opportunities for
career progression or promotion
Staff experiencing discrimination at work in last 12
months*
3.76
77%
3.70
76%
3.69
76%
92%
90%
3.14
3.75
68%
85%
91%
3.12
3.82
70%
82%
82%
40%
3.77
73%
28%
68%
21%
96%
38%
3.71
80%
41%
60%
21%
88%
38%
3.70
76%
40%
57%
26%
97%
88%
93%
3.55
3.55
8%
3.54
8%
0%
1%
25%
26%
19%
20%
23%
27%
26%
28%
67%
3.67
3.67
68%
3.65
3.58
68%
3.61
3.58
3.95
48%
3.83
63%
3.82
64%
93%
92%
92%
10%
8%
9%
*A lower score is better for these key findings
3.87
59%
20%
Whilst the Partnership Trust was pleased with the
overall results (see table 28) we recognise the
need to focus on the following areas of service
improvement:
•P
ercentage of staff suffering work-related stress
in last 12 months
•P
ercentage of staff reporting good
communication between senior management
and staff
•Q
uality of the appraisal process
Celebrating Excellence Awards
Each year we recognise and celebrate the
achievements, innovations and dedication of
individuals and teams in helping the Trust to
achieve its vision and values but most importantly
in providing high quality care and services to
the local people of Staffordshire and Stoke on
Trent. The Awards recognise the hard work and
outstanding commitment of individual members
of staff and teams from across the organisation
who deliver excellent standards of service. The
winners in 2012/13 were:
• S pecial Recognition Award: Johanne Tomlinson
(Anxiety Management Lead Nurse, HMP Stafford)
•D
eveloping Excellent Service Award: Trudi
Massey (Rehab Co-ordinator, Trauma)
• Team of the Year Health Award: Oak Ward,
Bradwell Hospital
• Innovation Award: Cannock Adult Community
Nursing Service
• Service User Focus Award: Rowan Robinson &
Alison France (Rehabilitation Officers)
• Improving Efficiency & Reducing Costs Awards:
Steve Ball (Speech & Language Resource
Assistant)
• Team of the Year Social Care: Brighton House
Reablement Home
• Team of the Year Admin/Support Services Award:
Cashiering Team at Haywood Hospital
• Dedication to Service Award: Glenis Elsby
(Health Centre Manager, Shelton Primary Care
Centre)
• Inspirational Leader Award: Sue Garland (Team
Leader , School Nursing Team)
• Outstanding Newcomer Award: Jenna Abell
(Transformation Programme Manager)
For more information, visit http://www.
staffordshireandstokeontrent.nhs.uk/ServiceShowcase/2013-celebrating-excellence-awards.
htm
81
Focus on:
Nursing Standard’s Nurse of
the Year Johanne Tomlinson
Staff Nurse Johanne Tomlinson was nominated
in the 2013 Celebrating Excellence Awards by
her team at HMP Stafford and specifically chosen
to receive the special recognition award by the
Chair and Chief Executive for her outstanding
contribution and dedication to her work with
prisoners experiencing anxiety in custody and for
developing a dedicated service to help prisoners
who are former servicemen.
Johanne has developed and implemented a
service model of care at HMP Stafford for all
prisoners who suffer with anxiety disorders and a
separate model of care “The Ten Point Care Model”
for those prisoners who are ex-forces and suffer
with severe anxiety issues. This was recognised as
good practice in the 2012 HMIP Inspection and
as a result Johanne was chosen to win the overall
Nursing Standard’s Nurse of the Year 2012.
The work that Johanne carries out is unique and
does not take place in any other prisons. During
the last 12 months Johanne has worked endlessly
to promote her work in order to improve the
lives of offenders across the country. Johanne
has met with many high profile visitors both at
HMP Stafford and in London; these have included
Richard Bradshaw, Baroness Masham, Lord
Ramsbottom, and Surgeon Rafaielli. Johanne has
spoken at regional, national and international
conferences
and has been
the guest
of honour at
an Awards
ceremony
with Michael
Spur.
Johanne is passionate about her work and
the immense difference it makes to the life of
prisoners but also the positive impact on their life
after prison, their families and children’s lives and
the community as a whole.
The Staffordshire and Stoke On Trent Partnership
NHS Trust and Johanne’s team at HMP Stafford are
immensely proud of what she has achieved. Not
only is the spot light shining brightly on Johanne,
but also the Prison Service, the Partnership Trust
and Offender Health.
Siobhan Heafield, director of Nursing and Quality,
said: “We are delighted Jo continues to receive the
national recognition for her work and dedication.”
“These results show that our hard work is taking us in the right direction and
our focus will be on continuing to improve the environment in our hospitals
for the people we serve.”
82
Statements from our partners
From 1 to 30 May 2013 we circulated a draft of this
quality account for formal comment to:
• Healthwatch Staffordshire
• Stoke Overview and Scrutiny Committee
• Staffordshire Overview and Scrutiny Committee
• North Staffordshire Clinical Commissioning Group
• Stafford and Surrounds Clinical Commissioning
Group
• East Staffordshire Clinical Commissioning Group
• South East Staffordshire and Seisdon Peninsular
Clinical Commissioning Group
• Stoke-on-Trent Clinical Commissioning Group
• Cannock Chase Clinical Commissioning Group
• Healthwatch Stoke
• Does this account reflect our approach and
priorities for quality?
• Does this account present an honest and
accurate picture of quality, including our areas for
development?
We received many responses and thank all who
took the time to comment on our quality account.
As a result we have made numerous changes to
the document to improve readability and present
clearer information on the quality of our services.
As directed by regulation and national guidance,
this section contains the formal responses from
Healthwatch, Overview and Scrutiny Committees,
and Clinical Commissioning Groups.
In addition, we asked staff, service user groups, and
other partner organisations to comment on the
draft. We asked all who commented to consider:
83
picture but
/13 paints a positive
12
20
r
fo
ce
an
rm
of
Overall perfo
to implementation
rtunity
et of time for referral
d to have the oppo
rg
se
ta
ea
re
pl
ca
is
e
l
e
hir
cia
hir
ds
so
ds
or
e
or
th
aff
rth St
Healthwatch Staff
d furthermore in no
an
Stoke-on-Trent
et
d
m
an
t
e
no
hir
is
ds
s
or
ice
aff
rv
St
t
se
to comment on the
ful to the Trust all
about the assessmen
tion ratings of users
ty Account and grate
ali
fac
tis
Qu
er
sa
st
e
th
Tru
S
NH
ip
d
has deteriorated ov
Partnersh
tatives an
anning experience
pl
althwatch represen
t
He
or
of
pp
g
by
su
ld
tin
d
ee
he
an
e
m
a
.
nc
l evide
estions
for attending
is supports anecdota
rt and answer our qu
Th
po
s.
re
th
aft
on
dr
t
m
e
no
nt
th
t
ce
uld
en
re
g. We wo
members to pres
arly needs addressin
cle
is
Th
h.
e
atc
th
hw
of
alt
He
entation
ress on the implem
ll-received
og
we
pr
en
de
be
pe
s
im
ha
t
to
is
un
acco
wish th
Overall this Quality
ther
el.
e. It is a well put toge
hir
ds
or
aff
integrated care mod
St
h
atc
d
by Healthw
an
s
ion
at
pir
as
ty
ali
record of qu
t Excellence Awards
e view
and comprehensive
tatives expressed th
the report setting ou
en
of
es
ion
pr
ct
re
r
se
ou
al
d
fin
e
ee
Th
e message that
improvements. Ind
s further reinforces th
e respects.
ice
m
rv
so
se
in
t’
on
s
or
ht
sh
lig
elf
ot
its
ld
and Sp
staff are valued.
that the Trust had ‘so
n seriously and that
ke
ta
is
ty
ali
qu
ctations of the Trust
ment
that not all the expe
ent to include a state
ge
m
cu
led
do
ow
e
kn
th
r
ac
fo
e
l
W
fu
of the time but this
It would be help
ed Trust reports such
tices can be met all
lat
ac
re
r
pr
he
or
s
ot
of
ard
t
nd
ex
nt
sta
on
s are in place to
putting it into the co
ance reports. We
dence that measure
nfi
rm
co
rfo
us
pe
es
lar
giv
gu
t
re
en
d
m
rt an
docu
its brief
d to problems.
as the Annual Repo
iance and to respon
count is restricted in
pl
Ac
m
ty
co
ali
ss
Qu
se
e
as
th
at
th
appreciate
tices reflect the
st’s policies and prac
for 2013/14 is
ent
but hope that the Tru
her those be treatm
oosing the priorities
et
ch
r
wh
fo
ion
ale
lat
ion
pu
rat
po
e
Th
e proposals are
needs of the whole
the rationale and th
specific such as
th
n
bo
itio
d
nd
an
ll
co
we
re,
ca
ed
er
et
explain
pleased to
specific such as cath
Staffordshire. We are
such as the forces
h
p
atc
ou
gr
hw
a
alt
to
He
ng
by
ini
d
or perta
supporte
ar’s report has been
learning disabilities
dback against last ye
fee
r
ou
at
th
te
no
d strongly in
community.
feedback has feature
er
us
at
th
in
d
ne
tio
ac
these priorities
s. It is our view that
that the mission
g
itie
tin
ior
ee
pr
e
m
r
th
ou
ing
at
d
lop
se
deve
ess and service
The view was expres
een safety, effectiven
care’ and should be
tw
ed
be
lis
ce
na
lan
rso
ba
pe
od
FE
ad ‘SA
st’s plans
offer a go
statement should re
d to see that the Tru
se
ea
pl
are
e
st.
W
e.
Tru
e
nc
pporting
iority for th
user experie
mework Plan and su
THE overarching pr
inned by a Quality Fra
rp
de
un
are
strate progress
examples to demon
of
ge
quality strategies.
ran
od
go
a
is
There
tly linked to targets/
ec
dir
t
no
t
bu
3
-1
od
2012
out the need for go
ints of the
against priorities for
tives feel strongly ab
owledge the constra
ta
kn
en
ac
es
pr
do
ly
re
e
r
lar
W
.
Ou
cu
ta
rti
da
e pa
not
performance
ration of services. W
that the Account is
ordination and integ
idance and the fact
co
gu
t
un
ed care teams
co
e
rat
Ac
or
eg
ty
m
int
e
ali
g
m
Qu
However, so
implementin
r
rt.
fo
s
po
re
an
pl
ce
e
an
th
t
rm
or
rfo
supp
ove both
designed as a full pe
that these will impr
ore benchmarking
pe
m
ho
of
d
an
ion
ty
lus
un
inc
co
e
e
th
and
across th
rvice, as well
detail about targets
experience of the se
eir
.
th
ion
d
ct
an
se
s
er
ta
us
da
r
e
fo
hance th
in general.
outcomes
health community
data may further en
e
th
on
ct
pa
im
ive
as have a posit
onstrates the
m
de
y
arl
cle
ry
ve
t
ts and hope
The Quality Accoun
s to official documen
actice and
er
pr
us
of
ing
ut
ov
pr
inp
e
im
th
to
st
Tru
We value
ich user
ain some user/carer
commitment of the
ary version will cont
of data sources, of wh
m
ge
m
su
ran
e
a
th
on
at
d
th
se
ba
e
performance
e extensive real tim
features strongly. Th
k
comments.
ac
db
fee
r
re
es
ca
tiv
d
tia
an
her quality ini
ot
th
wi
ng
alo
s
m
of the Quality
reporting mechanis
g that the report
iving the final version
sin
ce
ea
re
pl
to
is
It
ard
.
es
rw
fo
tiv
k
ta
en
We loo
ts made
impressed our repres
actical improvemen
pr
of
n
tio
lec
Account.
se
od
about
contains a go
ments and statistics
te
sta
y,
wa
e
m
sa
e
as a result. In th
well-documented
12/13 priorities are
20
e
th
st
ain
ag
ss
re
prog
provements,
gful examples of im
nin
ea
m
by
up
ed
ganisation
and back
Trust is a listening or
e
th
at
th
e
nc
de
nfi
giving us co
ty seriously.
and does take quali
84
Staffordshire an
d Stoke-on-Trent
Partnership NHS
Account 2012-2
Trust Quality
013
Healthwatch Stokeon-Trent came into
operation on 1st Ap
difficult to provide
ril 2013 and it is th
a comprehensive re
erefore
sp
onse to the Quality
time when this orga
Report for a period
nisation was not in
of
existence.
However, Healthw
atch Stoke-on-Tren
t
w
ish to commend St
Trent Partnership NH
affordshire and Stok
S Trust for the work
e on
done in the year 20
Quality Account.
12/13 as described
in the
Healthwatch Stokeon-Trent looks forw
ard to working clo
Stoke on Trent Partn
sely with Staffordshi
ership NHS Trust to
re and
support the enablem
in influencing the
ent of the patient vo
quality of care prov
ice
ided across all serv
and in supporting
ice areas in the year
the priorities set.
ahead,
85
86
Staffordshire O
verview and Scru
tiny Committee
Staffordshire an
d Stoke on Tren
t Partnership
NHS Trust
Quality Account
- Staffordshire H
ealth
Scrutiny commen
tary
We are directed to
consider whether
a Trust’s Quality
Account is represen
tative and gives co
mprehensive
coverage of their se
rvices and whether
we believe
that there are signi
ficant omissions of
iss
ues of
concern.
There are some sect
ions of information
that the
Trust must include
and some sections
w
here they
can choose what to
include, which is ex
pe
cted
to be locally determ
ined and produced
through
engagement with
stakeholders.
We focused on wha
t we might expect
to see in the
Quality Account, ba
sed on the guidan
ce
that trusts
are given and wha
t we have learned
about the Trust’s
services through he
alth scrutiny activity
in the last
year.
We also considered
how clearly the Tru
st’s draft
Account explains fo
r a public audience
(with
evidence and exam
ples) what they are
do
ing well,
where improvemen
t is needed and wha
t will be the
priorities for the co
ming year.
Our approach has
been to review the
Trust’s draft
Account and make
comments for them
to consider
in finalising the pu
blication. Our com
ments are as
follows.
Statement of Quali
ty. We are pleased
to see a clear
Statement of Quali
ty from the Chief Ex
ecutive and
Chairman. In additio
n we note the state
ment from
the Responsible Di
rector that the Quali
ty
Account
is accurate and has
been signed by th
e
Di
rector of
Nursing and Quality
.
Commentary
We are pleased to
see a clear introdu
ction in respect
of the Trust includi
ng a comprehensiv
e list of services
provided by the Pa
rtnership, and we no
te the Trusts
mission, vision, valu
es and goals are als
o detailed. We
would have liked to
have seen more de
tail of who
was involved in the
development of th
ese.
Priorities. We note
the detail of how th
e Quality
Priorities 2013-14 we
re decided. We wo
uld have
liked to have seen
potentially how th
ese priorities
would be delivered
The way in which pr
ogress will be
monitored and repo
rted to the Board cle
arly outlined
in your structure.
Clear detail is inclu
ded on your particip
ation in clinical
research.
In relation to CQUI
N it is noted that th
e year-end
achievements are
yet to be confirmed
and the level of
income yet to be de
termined.
Review of Qualit
y Performance 20
13-14
Comment in relatio
n to those indicato
rs that have not
been delivered again
st target would be
helpful
Additional comm
ent from Counci
llor Patricia
Rowlands – Chai
r Stafford Boroug
h Council
Health Scrutiny
Committee
I acknowledge rece
ipt of the Quality Ac
count, but on
this occasion I wish
to decline to make
a
comment on
the basis of the relat
ively short timesca
le
in which to
make an informed
response and the lac
k of in-house
resources to advise
on the analysis of he
althcare
organisational acco
unts which are both
te
chnical and
appear to be writte
n for healthcare pr
ofessionals”
87
e-on-Trent CCG
ire CCG and Stok
North Staffordsh
rm SKIN
lopment of a unifo
sure ulcers e.g. deve
es
pr
d scrutiny off
on-Trent CCG
ance action plan an
eler
ok
to
St
ro
d
ze
an
a
G
le,
CC
nd
re
bu
bility Panel.
North Staffordshi
thly at the Tissue Via
e nominated
on
th
m
as
rs
t
ce
en
ul
m
re
te
su
sta
es
t
all pr
and have
are making this join
affordshire &
ented at the Panel
St
es
of
pr
n
re
io
e
ar
vis
rs
Di
ne
rth
io
the No
stigation
Commiss
commissioners for
mmissioners
allenge to the inve
ch
Co
t
e
en
Th
es
st.
pr
Tru
to
S
ty
ni
NH
ership
the opportu
Stoke-on-Trent Partn
ality Account for
Qu
e
th
on
t
en
m
m
findings.
are pleased to co
However:
& East
2012/13.
e the NHS Midlands
Trust did not achiev
he
T
•
d4
an
3
grade 2,
ring process, North
iminate avoidable
ito
‘el
to
on
n
m
tio
ct
bi
ra
nt
am
co
e
nu
d the mbers
ith the
As part of th
December 2012’ an
-Trent CCG meet w
by
on
rs
ece
ul
ok
St
re
d
su
an
es
G
pr
ughout the
Staffordshire CC
ed fairly static thro
and seek assurance
ain
r
m
ito
re
s
on
m
ha
d
to
rte
sis
po
ba
of re
/13 as a
Trust on a monthly
therefore use 2012
Quality Account
ill
e
w
Th
rs
.
ne
ed
io
id
iss
ov
m
pr
s
m
.
rvice
year. Co
ar on year decrease
on the quality of se
these
and wish to see a ye
at are discussed at
k
th
ar
s
ea
hm
ar
nc
e
els
th
be
lev
of
y
er
high
covers man
tients receive safe,
uld have expected
ek to ensure that pa
ommissioners wo
•C
ts and would
di
Au
l
meetings, which se
tional Clinica
Na
in
n
io
at
cip
rti
pa
of
ars; the
high quality care.
lvement in future ye
vo
in
er
gh
hi
e
se
to
expect
applicable audits.
ated in 2 of the 11
cip
rti
pa
3
st
/1
Tru
12
20
proving
ovement in the
Review of
expect to see impr
commitment to im
s
rs
st’
ne
io
Tru
e
iss
th
m
te
om
no
C
•
sessment score.
It is pleasing to
ce Toolkit overall as
an
rn
ve
Go
n
io
at
:
rm
Info
quality, in particular
al time
d the breadth of re
en
m
m
co
rs
ne
io
iss
omm
•C
warning
13/14
feedback, e.g. early
Priorities for 20
ific priorities
patient experience
and the
ts,
en
m
m
welcome the spec
co
rs
e
ne
tiv
io
ga
iss
ne
m
r
m
fo
d
Co
e
pe
lo
Th
ed in this
systems deve
e Trust has highlight
service users e.g.
th
e
th
ch
hi
to
w
te
4
ria
/1
op
13
pr
20
for
ntinued
use of formats ap
areas to target for co
experience
te
er
ria
us
op
ice
pr
rv
ap
se
e
ad
ar
re
all
sy
ning
report;
disability
development of ea
clinical commissio
ment of a learning
t and link with the
ge
en
ga
en
em
e
ov
th
ntinue
pr
h
co
im
ug
to
ro
e
surveys th
te the plan
troduction of pictur
missioners also no
in
m
e
Co
th
.
d
ies
an
rit
ving
m
io
ha
ru
pr
s
fo
e month
service user
over the next twelv
tia
en
m
de
on
rk
wo
surveys.
mmissioners
2012/13.
llaboratively with Co
nificant progress in
co
sig
g
e
in
ad
rk
m
wo
is
st
al
• The Tru
from the extern
S
recommendations
id Staffordshire NH
en set
to implement the
the Report of the M
Project Board has be
to
A
.
se
ng
on
rsi
sp
re
of
Nu
e
rt
ict
Th
pa
str
key
review of Di
recommendations
Inquiry will form a
implementation of
dation Trust Public
e
un
th
Fo
r
ito
ely working
on
,
tiv
m
es
ac
tiv
to
is
ta
up
4. The Trust
nt represen
/1
tie
13
pa
20
rs,
in
ne
e
io
nc
iss
ra
m
su
m
e
our as
which includes Co
her providers in th
from the Trust.
mmissioners and ot
es
co
e
tiv
ta
sid
Trusts
en
ng
es
by
alo
d
pr
re
pe
lo
or
s deve
e
and seni
the CQUIN outcom
y to ensure that plan
of
om
%
on
.95
ec
99
h
is
ed
alt
g
ev
he
in
hi
rn
• The Trust ac
at the Trust
y align and that lea
ioners recognise th
the health econom
iss
ss
m
ro
m
ac
Co
s.
re
su
d
ea
m
d develope
ds & Family Test an
shared.
embraced the Frien
ls into the
ita
sp
Ho
ity
un
m
m
Co
its
knowledge, the
its use beyond the
ling and quality vis
the commissioner’s
nd
of
ha
st
ts
be
ain
e
pl
th
m
To
co
,
.
rt is accurate.
community
ed within this repo
mandatory to do so
ain
as
nt
w
it
co
n
re
io
fo
at
be
s,
rm
fo
es
in
assurance proc
tion and control
e infection preven
th
ed
ev
hi
ac
st
d
an
Tru
s
• The
Difficile case
ber of Clostridium
targets for the num
MRSA cases.
ation’ breaches
Hughes
ixed Sex Accommod
M
g
in
hire CCG at
in
im
‘El
review Dr Dave
o
a
N
•
ok
rto
de
cer, North Staffords
un
rs
Offi
ne
e
io
bl
ta
iss
m
un
m
co
Co
Ac
l
d.
Clinica
have been reporte
e Community
Bradwell & Cheadl
at
ts
en
em
ng
ra
ar
of the
were fully
d all wards visited
an
13
20
ch
ar
M
in
Hospitals
Bartlam
G
of work Dr Andy
compliant.
nt
ou
am
r, Stoke-on-Trent CC
t
an
fic
ni
gnise the sig
l Accountable Office
co
ica
re
in
rs
Cl
ne
io
iss
m
e
bl
• Com
ate avoida
t in place to elimin
that the Trust has pu
88
Stafford and Su
rround CCG and
Ca
nnock Chase CC
Stafford and Surroun
d CCG and Cannoc
k Chase
CCG are making th
is joint statement as
th
e
lead commissione
rs for the South Divis
io
n
of
Staffordshire & Stok
e –on-Trent Partner
ship NHS
Trust. The commiss
ioners are pleased
to have the
opportunity to com
ment on the Quali
ty Account
for 2013/14.
Many of the areas
covered in the Quali
ty Account
document are revie
wed at the month
ly Clinical
Quality Review Mee
tings with the Trust
where
commissioners mee
t with the Trust to
ho
ld them
to account for the
quality and safety of
services,
to agree any actions
for improvement an
d obtain
assurance for curre
nt and prospective
pa
tie
nts who
may have need of
their services.
G
more seamless and
acceptable service
to users.
However whilst th
e Trust has made sig
nificant
progress with patie
nt experience initiat
ives the
commissioners wo
uld want to see a m
or
e robust
system for managin
g complaints which
has been
an issue in the latte
r part of 2012/13 pa
rticularly for
social care services.
The commissioners
note the results of
the staff
survey which high
lights a significant
increase
in staff stress from
the previous year an
d some
related increases in
working extra hour
s
with lower
reporting rates for
errors and incidents.
The Trust
has recognised this
as priority and is wo
rking with
commissioners in th
e South and North
to
address
capacity and work
force issues which
w
ill
be
key to
commissioning inte
ntions for system w
ide solutions
to pressures in the
acute sector.
Having read the qu
ality account we ar
e pleased
to note the improv
ements made in 20
12
/13 in
particular
•C
ommend the wo
rk that the Trust ha
s undertaken
on the reduction of
Priorities for 20
avoidable pressure
13/14
ulcers
which continue to
Th
e commissioners su
be a challenging ta
pport the priorities
rget;
their zero tolerance
for
2013/14 outlined in
approach to this sa
th
e Quality Account
fety
issue and the analy
as
th
es
e are based on impr
tical processes used
ovements identified
to make
improvements whi
through quality an
ch are underpinne
d
sa
fe
ty performance revie
d by the
tissue viability scru
ws
and align with clini
tiny panel.
cal commissioning
pr
• The highly succes
io
rit
ies
.
Co
m
m
issioners particular
sful introduction of
ly welcome the co
the Family
and Friends Test w
nt
in
wo
ued
rk
on Dementia planne
hich complements
d by the Trust and
the
comprehensive rang
th
e
role this will play alo
e of patient experie
ng with the nationa
nce
l initiative to
initiatives develope
im
pr
ov
e
th
e care for dementia
d by the Trust.
and their carers.
• Welcomed the Di
strict Nursing Revie
w
un
de
rtaken To the be
in the North the re
st of the commissio
sults of which will
ner’s knowledge th
be used to
shape and inform
information contain
e
a South review ; in
ed
w
ith
in
the context
this report is accura
of the national revie
te.
w and local comm
issioning
intentions for the im
proving the manag
ement of
chronic disease.
• The unique oppo
Andrew Donald
rtunity being graspe
d by the
Trust as an employ
Accountable Office
er of an adult socia
r
l care
workforce for the
Stafford and Surroun
development of an
ds CCG and Cannoc
in
te
gr
ated
health social care pr
k Chase
CCG
ovision which will
provide a
89
Focus on:
Partnership Trust Community
matron Jane Morton has been
awarded royal recognition for
services to healthcare.
Jane, who has been a community nurse for 18
years, received The Queen’s Nursing Institute
Queen Mother Award for Outstanding Service
for her achievements helping homeless and
vulnerable people in Stoke-On-Trent.
Over the past seven years, Jane has founded
a health care clinic that offers basic medical
treatment helping to reduce the number of
admissions from homeless people into Accident
and Emergency Departments. The royal award
recognises nurses whose contribution to
healthcare has distinguished them from the norm.
Today Jane said; “The Queen’s Nursing Institute
Awards are very prestigious therefore recognition
from such a well-informed organisation is a great
honour.
“I’m particularly grateful because the Queen’s
Nursing Institute supports and encourages
quality community nursing care and nominations
demonstrate recognition from my peers who
compiled the original application”.
received a £75,000 grant for winning the NHS
Innovation Challenge Prize.
The ‘Open Surgery’ clinic operates alongside
a number of charity organisations including
Brighter Futures and has reduced rough sleepers’
admission to hospital by 95%.
Brighter Futures Chief Executive Gill Brown said,
“Jane is a worthy recipient of the award and
an excellent example of the very best modern
nursing.
“Her commitment to partnership working has
improved health outcomes and encouraged
rough sleepers to turn their lives around. “
Jane was joined by Homeless Health team
colleagues Laura Porter and Sue Herman, who
nominated her for the award, at The Queen’s
Nursing Institute presentation in London on 15th
April where award winners were announced
Siobhan Heafield, Director and Nursing and
Quality said; “I am delighted for Jane and thrilled
that her work providing community care to
vulnerable people in Stoke-on-Trent has received
such high praise from The Queen’s Nursing
Institute.”
The win follows a series of accolades for the
Hanley based community matron who recently
“I’m particularly grateful because the Queen’s Nursing Institute
supports and encourages quality community nursing care and
nominations demonstrate recognition from my peers who compiled
the original application”.
90
Statement of Directors’ Responsibilities
in respect of the Quality Account
The directors are required under the Health Act
2009, National Health Service (Quality Accounts)
Regulations 2010 and National Health Service
(Quality Account) Amendment Regulation 2011 to
prepare Quality Accounts for each financial year.
The Department of Health has issued guidance on
the form and content of annual Quality Accounts
(which incorporate the above legal requirements).
In preparing the Quality Account, directors are
required to take steps to satisfy themselves that:
• the Quality Accounts presents a balanced picture
of the Trust’s performance over the period
covered;
• the performance information reported in the
Quality Account is reliable and accurate;
• there are proper internal controls over the
collection and reporting of the measures of
performance included in the Quality Account,
and these controls are subject to review to
confirm that they are working effectively in
practice;
• the data underpinning the measures of
performance reported in the Quality Account is
robust and reliable, conforms to specified data
quality standards and prescribed definitions,
is subject to appropriate scrutiny and review;
and the Quality Account has been prepared
in accordance with Department of Health
guidance.
The directors confirm to the best of their
knowledge and belief they have complied with
the above requirements in preparing the Quality
Account.
By order of the Board
Director of Nursing and Quality - Siobhan Heafield
Chief Executive Officer - Stuart Poynor
Deputy Chief Executive Officer - Geraint Griffiths
Medical Director - Dr Doug Wulff
Director of Workforce and Development Julie Tanner
Director of Finance and Resources Jonathan Tringham
91
Glossary
Assistive Technology
AT (Assistive Technology) can be defined as “any
device which assists a person in retaining or
improving their independence, safety, security and
dignity”. AT could be considered an umbrella term for
a vast range of devices from simple grab-sticks,
to GPS safety-tracking systems.
Board
The role of the Board is to take corporate
responsibility for the organisation’s strategies and
actions. The chair and non-executive directors are
lay people drawn from the local community and
are accountable to the Secretary of State. The Chief
Executive is responsible for ensuring that the board
is empowered to govern the organisation and to
deliver its objectives.
C.dificile
Clostidium dificile (C.dif ). A bacteria living in the gut
that can cause severe diarrhoea.
Care Quality Commission (CQC)
The CQC is the independent regulator of health and
social care in England. It regulates health and adult
social care services, whether provided by the NHS,
local authorities, private companies or voluntary
organisations to make sure that the care that people
receive meets essential standards of quality and
safety. www.cqc.org.uk
Commissioners
Commissioners are responsible for ensuring
adequate services are available for their local
population by assessing needs and purchasing
services. They commission services (including acute
care, primary care and mental healthcare) for the
whole of their population, with a view to improving
their population’s health.
Commissioning for Quality and Innovation
(CQUIN)
A proportion of the Partnership Trust’s income is
conditional on quality and innovation, through
the Commissioning for Quality and Innovation
(CQUIN) payment framework.
Customer Service Excellence
The Customer Service Excellence, (previously the
“Charter Mark”) is a practical tool to support and drive
public services that are more responsive to people’s
needs. www.customerserviceexcellence.uk.com
92
Dementia
‘Dementia’ describes a set of symptoms that include
loss of memory, mood changes, and problems with
communication and reasoning.
Foundation Trust (FT)
NHS Foundation Trusts are not-for-profit, public
benefit corporations. They are part of the NHS and
provide over half of all NHS hospital, mental health
and ambulance services. NHS Foundation Trusts were
created to devolve decision making from central
government to local organisations and communities.
They provide and develop healthcare according to
core NHS principles - free care, based on need and
not ability to pay.
Healthcare
Healthcare includes all forms of healthcare provided
for individuals, whether relating to physical or mental
health, and includes procedures that are similar
to forms of medical or surgical care but are not
provided in connection with a medical condition, for
example cosmetic surgery.
HMCIP: HM Chief Inspector of Prisons (HMCIP)
for England and Wales
HM Chief Inspector of Prisons is independent of the
Prison Service and reports directly to the government
on the treatment of prisoners, the conditions of
prisons in England and Wales and such other matters.
Information Governance
Information Governance provides a framework which
determines the way in which the Partnership Trust
processes and handles information and particularly
how it protects personal and sensitive personal
information relating to patients.
Local Involvement Networks (LINks)
Local Involvement Networks (LINks) are made up
of individuals and community groups which work
together to improve local services. Their job is to find
out what the public like and dislike about local health
and social care. They will then work with the people
who plan and run these services to improve them.
From 1 April 2013, LINks have been replaced by Local
Healthwatch organisations.
Multi-Agency Safeguarding Hub (MASH)
The MASH is partnership where a number of
agencies work together in one place, sharing
information and making collaborative decisions
to help vulnerable people and their families within
Staffordshire and Stoke-on-Trent.
The MASH is a confidential, legally compliant
environment, which means that all material, sensitive
or not, can be revealed to another agency to decide
what approach is needed by frontline staff for the
purposes of safeguarding children and vulnerable
adults.
Further information can be found on the ‘Safeguarding
Children’ Section of our Intranet or visit the
safeguarding board website: http://www.staffsscb.org.
uk/
MRSA
Methicillin-Resistant Staphylococcus aureus, a
bacterium with antibiotic resistance.
MSSA
Methicillin-Sensitive Staphylococcus aureus, a
bacterium which is sensitive to Methicillin.
Staphylococcus aureus is a bacterium that commonly
colonises human skin and mucosa (e.g. inside the
nose) without causing any problems. It can also cause
disease, particularly if there is an opportunity for
the bacteria to enter the body, for example through
broken skin or a medical procedure.
National Institute for Health and Care Excellence
(NICE)
The National Institute for Health and Care Excellence
(NICE) recommends best practice guidelines to
healthcare providers in the NHS. The guidelines make
recommendations on medical treatments, including
drug treatments, in order to reduce the variation in the
availability and quality of treatment. www.nice.org.uk
Never Event
A “Never Event” is a serious occurrence that should
never happen and can be prevented. They are
considered unacceptable and eminently preventable.
Examples include:
•A
surgical procedure carried out on the wrong site
(e.g. wrong knee, wrong eye, wrong patient, wrong
limb, wrong organ)
•D
eath or severe harm as a result of maladministration
of insulin by a health professional.
eath or severe harm as a result of a patient falling
•D
from an unrestricted window.
A full list of Never Events for 2012/13 can be found on
the Department of Health website:
https://www.gov.uk/government/publications/thenever-events-list-2012-to-2013
Overview and Scrutiny Committees
Since January 2003, every local authority with
responsibilities for adult social care (150 in all) has had
the power to scrutinise local health services. Overview
and scrutiny committees take on the role of scrutiny
of the NHS – not just major changes but the ongoing operation and planning of services. They bring
democratic accountability into healthcare decisions
and make the NHS more publicly accountable and
responsive to local communities.
Patient Advice and Liaison Services (PALS)
Patient Advice and Liaison Services have been
introduced in England from 2002 to ensure that the
NHS listens to patients, their relatives, carers and
friends, and answers their questions and resolves their
concerns as quickly as possible.
Patient Safety Incident
A patient safety incident is an event, or something
which happens which has an effect on a patient’s
safety. This happening may or may not be linked
to other events. Staffordshire and Stoke on Trent
Partnership NHS Trust monitor such incidents to learn
from them and prevent them happening again.
Periodic Reviews
Periodic reviews are reviews of health services
carried out by the Care Quality Commission (CQC).
The term ‘review’ refers to an assessment of the
quality of a service or the impact of a range of
commissioned services, using the information that
the CQC holds about them, including the views
of people who use those services. www.cqc.org.
uk/guidanceforprofessionals/healthcare/nhsstaff/
periodicreview2009/10.cfm
Personalisation
Personalisation is a social care approach described
by the Department of Health as meaning that “every
person who receives support, whether provided by
statutory services or funded by themselves, will have
choice and control over the shape of that support in
all care settings”.
Practice Audit
Practice audit (Clinical & Social Care Audit) is a quality
improvement cycle that involves the measurement of
the effectiveness of care against agreed and proven
standards for quality, and then taking action to bring
practice in line with standards so as to improve the
quality of outcomes.
93
Pressure Ulcers / Pressure damage
Pressure Ulcers are also known as pressure sores or
bed sores. They occur when the skin and underlying
tissue become damaged. In very serious cases, the
underlying muscle and bone can be damaged. www.
nhs.uk/conditions/pressure-ulcers
QIPP: Quality, Innovation, Productivity and
Prevention
The Quality, Innovation, Productivity and Prevention
programme is a national Department of Health
strategy involving all NHS staff, patients, clinicians
and the voluntary sector. It aims to improve the
quality and delivery of NHS care while reducing
costs to make £20bn efficiency savings by 2014/15.
These savings will be reinvested to support frontline
services.
Quality Indicators
A quality indicator is an agreed-upon process or
outcome measure that is used to determine the level
of quality achieved.
Research
Clinical research and clinical trials are an everyday
part of the NHS. The people who do research
are mostly the same doctors and other health
professionals who treat people. A clinical trial is a
particular type of research that tests one treatment
against another. It may involve either patients or
people in good health, or both.
Risk Management Systems
These enable staff across the organisation to
identify and report risks to the quality of care. The
organisation is then better able to manage these
risks, focusing on addressing those issues that are
more likely to have a greater adverse impact on
patient experience, safety and effectiveness. An
example of a system would be the Ulysses incident
reporting software that the organisation uses to
monitor risks and incidents.
Root Cause Analysis
Root Cause Analysis is a class of problem solving
methods aimed at identifying the root causes of
problems or events. It is a structured approach that
aims to identify the factors that resulted in a harmful
event, so that future behaviours, actions, inactions
or conditions can be changed to prevent its reoccurrence.
Serious Incident
A “serious incident” requiring investigation is an
incident that occurred in relation to services
provided and care resulting in either, unexpected
94
or avoidable death, serious or permanent physical
or psychological harm, a scenario that prevents
or threatens the organisations ability to provide
healthcare services, allegations of abuse, adverse
media coverage or public concern about the
organisation, or, any of the Never Events on the
national list. See www.npsa.org.uk
Safety Express Initiative
Safety Express is the name of the Department
of Health’s Quality, Innovation, Productivity and
Prevention (QIPP) safe care work stream and aims
to deliver a safer more reliable NHS with improved
outcomes for patients at a significantly lower cost.
Safety Thermometer
The NHS Safety Thermometer is a local improvement
tool for measuring, monitoring and analysing patient
harms and ‘harm free’ care. From July 2012 data
collected using the NHS Safety Thermometer is part
of the Commissioning for Quality and Innovation
(CQUIN) payment programme. For more information
on this national initiative see: http://www.ic.nhs.uk/
services/nhs-safety-thermometer
SSKIN bundle
The SSKIN bundle is an assessment and
communication tool for pressure ulcer prevention
covering the following: Surface, Skin inspection,
Keep moving, Incontinence and Nutrition. See www.
patientsafetyfirst.nhs.uk/
Special Reviews and Studies
Under the Health and Social Care Act (2008), the CQC
are responsible for a programme of special reviews
and studies, which are projects that look at themes
in health and social care. These projects focus on
services, pathways of care or groups of people. The
Partnership Trust study, and learn from, the published
reports to further improve the care we provided to
our patients.
Tissue Viability
Tissue Viability is a specialist area of healthcare
dealing with the treatment and the healing of almost
any type of wound, focusing on wounds which are
difficult to heal. Tissue Viability covers every aspect of
wound care including advice on pain, diet, mobility,
continence, life style choices, and the specialist
equipment which may need to be used.
Venous thromboembolism (VTE)
Venous thromboembolism (VTE) is a condition in
which a blood clot (thrombus) forms in a vein. Blood
flow through the affected vein can be limited by the
clot, and may cause swelling and pain.
If you need this information in a different
language please contact:
This information is available in other formats
Please contact 0800 783 2865 or email quality@ssotp.nhs.uk
95
This report is available on request in other formats,
such as large print, Braille, audio or translated.
Enquiries should be directed to:
Jessie Dickson
Communications Manager
Staffordshire and Stoke on Trent Partnership NHS Trust
Morston House, The Midway
Newcastle-under-Lyme
Staffordshire
ST5 1QG
Telephone: 0845 602 6772 ext. 6519
A copy is also available on our website:
http://www.staffordshireandstokeontrent.nhs.uk/
Quality, people, responsibility
96