Quality Account 2012-2013
Suffolk Community Healthcare
Quality Account 2012 - 2013
EXECUTIVE SUMMARY
The quality account is an annual report for the public
from the healthcare provider about the quality of
services that it delivers. It is intended to assure
commissioners, patients and the public that the provider
is regularly scrutinising its services and concentrating on
those that need the most attention.
The report outlines how well we are doing against
national and local targets, where we need to improve
the quality of services, and priorities for the coming
year. Suffolk Community Healthcare (SCH) seeks to
transform community health services to better support
the increasingly complex needs of an ageing population.
Our vision is to deliver a service that treats every patient
as an individual, providing them with the highest quality
clinical treatment, and treating them with dignity,
respect and genuine care. We will do this by:
•
Providing improved accessibility to services across
Suffolk for patients
•
Embedding the concept of ‘no decision about me,
without me’ across SCH
•
Increasing patient engagement, education and
ownership of community health services.
•
Patient Safety – the Safety Thermometer tool has
successfully been used to improve performance
on the major four harms in patient care
•
Clinical Effectiveness –Speech and Language
Therapy has been introduced for people with
dementia
•
Clinical Effectiveness - the assessment of children’s
continuing care has been enhanced
•
Patient Experience – there has been an
improvement in the effectiveness, quality, safety
and patient experience of discharges from acute
hospitals
The quality improvement priorities for 2013/2014
are as follows:
This report covers the six month period from the
creation of SCH in October 2012 to 31 March 2013.
Although this has been a time of transition, as new
providers and systems have been introduced, staff have
ensured that the quality of services has continued to
improve.
•
Patient Safety (Community) - To continue to
work to redesign the structure and function of
the Community Health Teams and Community
Intervention Service.
•
Patient Safety (Community Hospitals) -To improve
the recognition and management of the unwell
patient in community hospital settings through
training and embedding a consistent approach
within all units.
•
Clinical Effectiveness - To redesign the Falls
Pathway – so that both falls prevention and falls
and fragility fracture prevention continue to be a
priority within SCH.
•
Patient Experience - To improve patient and carer
experience by enhancing service user engagement
and support for carers.
Along with a wide range of service improvements, good
progress has been made on all of the priorities set for
2012-2013:
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Suffolk Community Healthcare
Quality Account 2012 - 2013
Contents
Part 1 - Introductions.................................................................................................................................... 4
Introduction from Patrick Birchall, Chief Executive Officer, Suffolk Community Healthcare....................4
Suffolk Community Healthcare Quality Account 2012/2013.................................................................... 6
Introduction to Clinical Services within Suffolk Community Healthcare................................................... 7
Our Delivery Strategy................................................................................................................................ 8
Serco’s Governing Principles..................................................................................................................... 9
Part 2A Looking Forward: Our Priorities for Quality Improvement 2013/2014........................................... 10
Engaging with Patients............................................................................................................................ 10
Patient Representatives.......................................................................................................................... 10
Bringing Excellence to Care..................................................................................................................... 11
Our Vision and Values............................................................................................................................. 11
Priorities for Improvement in 2013/2014............................................................................................... 12
Part 2B: How We Manage Quality Improvements....................................................................................... 19
Quality and Safety................................................................................................................................... 19
Reviewing the Quality of Our Services.................................................................................................... 19
Excellence in Clinical Care and Outcomes Through Clinical Audit........................................................... 19
Policies and Procedures.......................................................................................................................... 21
Commissioning for Quality and Innovation (CQUIN) 2012/13................................................................ 21
Commissioning for Quality and Innovation (CQUIN) 2013/14................................................................ 24
Reviewing the Quality of Our Services.................................................................................................... 25
How Our Regulator the Care Quality Commission (CQC) Views Our Services........................................ 25
Quality and Safety................................................................................................................................... 26
Part 3: Looking Back: Our Care Quality Achievements in 2012/2013......................................................... 28
Suffolk Community Healthcare Priorities for 2012/2013........................................................................ 28
Clinical Effectiveness - Introduction........................................................................................................ 41
Patient Experience.................................................................................................................................. 46
Workforce Development in 2012/2013.................................................................................................. 55
Organisational Development in 2013-2014............................................................................................ 57
Communications and Staff Engagement in 2012/2013........................................................................... 58
Closing Statement from Patrick Birchall, Chief Executive Officer............................................................ 59
ANNEX Statements from Organisations and Committees....................................................................... 60
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Suffolk Community Healthcare
Quality Account 2012 - 2013
PART 1 - INTRODUCTIONS
Introduction from Patrick Birchall,
Chief Executive Officer,
Suffolk Community Healthcare
All providers of NHS services, no matter how large or
small, or what services they provide, should be striving
to achieve high quality care for all. Quality of care is
about four key principles: the clinical effectiveness of
the treatments and interventions we offer, the safety of
those receiving, working in or visiting our services, the
experience of those using or supporting those who use
our services, and the accessibility of our services for
patients. At Suffolk Community Healthcare we strive to
ensure that the care we deliver is in line with these key
principles of quality and provided in such a way that
results in a positive experience for our patients.
I am therefore immensely proud to present the first
Pat Birchall, Chief Executive Officer
Quality Account for Suffolk Community Healthcare
of Suffolk Community Healthcare
(SCH) for 2012-2013. In October 2012 as part of the
NHS Government reforms, Serco took over responsibility for delivering NHS community health
services in Suffolk, separating the existing community health services from the commissioning
organisation, NHS Suffolk. Working in partnership with South Essex Partnership University NHS
Foundation Trust (SEPT) and Community Dental Services CIC Bedford (CDS) together we have
formed one of the first private and public agreements in the country to deliver community
healthcare services under the name of Suffolk Community Healthcare (SCH). We consider this
to be a unique opportunity that will provide this partnership greater freedom to shape our
services in response to the needs of our patients and to improve services locally while still
being part of the NHS.
We are required by law to produce an annual Quality Account, enabling us to be transparent
and accountable for the quality of service we provide. As a newly established organisation
the report will cover the first six months since Suffolk Community Healthcare was officially
formed 1st October 2012 – 30th April 2013. The Quality Account provides us with an excellent
opportunity to share with you the importance of quality by highlighting our achievements over
the past year and setting the priorities for the coming year in areas where improvements need
to be made. We hope that once you have read this report you will see that although a new
provider in the delivery of community health services, Serco is committed to ensuring services
continue to be delivered to the highest standard of care achievable.
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Suffolk Community Healthcare
Quality Account 2012 - 2013
You will be aware that the formation of any new organisation incurs periods of major change
and uncertainty. However, despite this, the commitment of our staff to providing high quality
care to patients on a daily basis whilst transformation of our services has taken place is to be
commended. This commitment will continue to be fundamental as we move forward to realise
our aspirations within our key stated aims of transforming community health services through:
Providing improved accessibility to services across Suffolk for patients
Embedding the concept of ‘no decision about me, without me’ across the organisation
Increasing patient engagement, education and ownership of community health services.
Suffolk Community Healthcare is very conscious of the financial restraints that providers of NHS
services will be facing over the coming years and the importance of safeguarding quality of
care. The essence of how we approach this will be through the transformation and redesign of
our services to ensure the highest possible value from the resources allocated to the providers
of NHS services. Improving the efficiency and effectiveness of our services will allow Suffolk
Community Healthcare to realise its ambition in “Releasing time to care” for the recipients of
our services. The Quality Account will describe in greater detail how we have started to deliver
our key aims but also importantly outline how moving forward through our transformation
model quality must remain our guiding principle. A principle brought to the forefront of all our
minds with the publication of the Francis Inquiry Report in relation to the care provided by
Mid Staffordshire NHS Foundation Trust. As an organisation we have reviewed the outcomes
of this report to ensure that we learn from the lessons and details of the inquiry and that the
recommendations identified become part of our quality improvement programme.
In conclusion understanding the health needs of all of the communities we serve will be the
key to getting decisions right as we move forward. One of our main priorities for 2013 will be
engaging with our local communities to work with us, not only in telling us about their personal
experiences of SCH staff and services but also how we can continue to improve services by
taking account of what really matters to patients and their carers.
I hope you find the Quality Account interesting and informative and we look forward to
receiving your feedback which will allow us to continue to improve the content and future
format of this report.
On behalf of the Leadership Team it gives us great pleasure to introduce our first Quality
Account for the period October 1st 2012 – April 30th 2013. I can confirm that to the best of
my knowledge and belief the information contained in the Quality Account sets out a true and
accurate representation of our performance and achievements in 2012-2013 and demonstrates
our commitment to quality improvement.
Patrick Birchall
Chief Executive Officer
Suffolk Community Healthcare
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Suffolk Community Healthcare
Quality Account 2012 - 2013
SUFFOLK COMMUNITY HEALTHCARE
QUALITY ACCOUNT 2012/2013
What are Quality Accounts and why are they important?
At Suffolk Community Healthcare we are committed to improving the quality of services we
provide to our patients. Our Quality Account is our annual report of:
•
How well we are doing against targets we are set by the Department of Health, our local
primary care trust (PCT) NHS Suffolk, and those we set ourselves as an organisation
•
Where we need to improve the quality of the services we provide
•
Our priorities for the coming year.
Want to know more?
If you would like more information about our Quality Account, or to find out more about our
services, please contact Christian Jenner (details below).
Tell us what you think
We would like to hear your views on our Quality Account. Please contact Christian Jenner by
telephone on 01284 718259, or by email at christian.jenner@suffolkpct.nhs.uk.
Need this document in a different format?
The Quality Account is available in large print and other languages on request. Please contact
Christian Jenner by telephone on 01284 718259, or email Christian.jenner@suffolkpct.nhs.uk..
A warm welcome at the Minor Injuries Unit in Felixstowe
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Quality Account 2012 - 2013
Introduction to Clinical Services within Suffolk Community Healthcare
In April 2012 the contract for providing Suffolk Community Healthcare services was awarded to Serco. In October 2012 staff
transferred to a new organisation, Suffolk Community Healthcare. As a result this quality account will only reflect the period
from which the new organisation started from the 1st October 2012 to the 31st March 2013.
The new organisation comprises of Serco, SEPT (South Essex Partnership University NHS Foundation Trust) and Community
Dental Services (CDS), each responsible for the provision of one or more services, as shown in the table below:
Service
Organisation Responsible for Services
Inpatient Units
Serco
Adult Community Health Services
Serco
Admission Prevention Services
Serco
Specialist Nursing Services
Serco
Dermatology Service
Serco
Minor Injuries Unit
Serco
Continence Services
Serco
Community Equipment Services
Serco
Wheelchair Services
Serco
Community Dental Services
Community Dental Services (CDS)
Podiatry
South Essex Partnership Trust (SEPT)
Foot and Ankle Surgery
South Essex Partnership Trust (SEPT)
Adult Speech & Language Therapy Services
South Essex Partnership Trust (SEPT)
Community Paediatric Services
South Essex Partnership Trust (SEPT)
This Quality Report will focus mainly on
services provided by Serco, and where
appropriate it will make reference to services
which are delivered by others.
The clinical services which are provided
directly by Serco relate mainly to Adult
Services. This includes four community
hospital inpatient units in Aldeburgh,
Felixstowe, Ipswich and Newmarket, as well
as some commissioned beds in Eye and
Sudbury. The delivery of services across
Map of Suffolk
Suffolk Community Healthcare (SCH) is
provided by a range of professionals which
includes district nurses, physiotherapists, occupational therapists, generic workers and healthcare assistants. As well
as, community matrons and specialist nursing which includes neurology, Parkinson’s, epilepsy, falls and fractures,
heart failure, cardiac rehabilitation, dermatology and pulmonary rehabilitation. SCH also provides other services
which include admission prevention, a minor injuries unit in Felixstowe, continence services, community equipment
(independent living) and wheelchair service. The map below shows the geographical area covered in Suffolk.
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Suffolk Community Healthcare
Quality Account 2012 - 2013
Our Delivery Strategy
Our commitments to patients and carers are to:
Suffolk Community Healthcare’s delivery strategy is to
provide an integrated delivery model with a single point
of access supported by the new Care Co-ordination
Centre (CCC) working with Community Health Teams
(CHTs) based across Suffolk. As far as possible, all care
should be given by CHTs who are empowered and own
the care they deliver. The exception to this is the
care provided by Specialist Clinical Services. These
services will also be synchronised through the Care
Co-ordination Centre.
1) Provide improved accessibility to services across
Suffolk for patients by;
Through better organisation and improved management
of clinician time we will increase capacity within the
system and improve the quality of patient care. By
placing the patient at the heart of holistic and truly
integrated care pathways, tailored to individual needs,
Suffolk Community Healthcare will improve patient
and carer experiences and outcomes. Our staff will be
empowered to provide the right care, in the right place,
at the right time in partnership with colleagues from the
wider health and social care sector.
•
Simplifying the current service and clearly
communicating what the services are;
•
Providing a single point of access through our CCC
for patients and carers;
•
Revising our service delivery and clinic hours to
meet the needs of patients, carers children
and families;
•
Promoting our services and providing education
around the benefits of services and technologies
to patients; and
•
Addressing the rural needs of Suffolk patients
through mobile clinics, multi-disciplinary LDTs
(local delivery teams), collaborative working with
the voluntary and community sector.
2) Embed the concept of ‘no decision about me, without
me’ across the organisation by;
•
Establishing a named Care Lead to work with
patients and carers to design and implement
care plans, taking ownership for the timely and
appropriate delivery of care;
•
Using new technologies such as mobile devices to
engage patients in their care and decisions being
made about them;
•
Enhancing customer service training for all staff
to improve the interaction between clinicians
and patients.
3) Increase patient engagement, education and
ownership of community health services by;
Offering compassionate care is a priority for all SCH staff
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•
Increasing the numbers of proactive feedback
channels for patients and conducting regular
customer surveys and point of care surveying
through the CCC
•
Implementing the Patient Partnership model,
which enables patients to come together at a
local level to take decisions on the care provided
to them and how it can be improved. The Patient
Partnership will also become an advocacy
mechanism for new ways of working such as the
use of new assistive technologies
•
Publishing transparently how we are performing
and also the outcomes of any formal evaluations
undertaken on our services.
Suffolk Community Healthcare
Quality Account 2012 - 2013
Serco’s Governing Principles
There are four governing principles which are the behaviours expected throughout the organisation. We must
all live by the governing principles in our dealings with colleagues, patients, suppliers, partners, shareholders and
communities. The governing principles are:
Foster an entrepreneurial culture
We are passionate about building innovative and successful
Serco businesses. We succeed by encouraging and generating
new ideas. We trust our people to deliver. We embrace change
and, by taking measured risks, encourage creative thinking.
Enable our people to excel
Our success comes from our commitment and energy to go
the extra mile. We are responsible to each other and can
expect support when we need it most. We expect our people
to achieve more by recognising and harnessing the power of
individuals. We value people for their knowledge, and ideas
and potential to contribute.
Deliver our promises
We do what we say we will do to meet expectations. We only
promise what we can deliver. If we make mistakes we put them
right. We are clear about what we need to achieve and we
expect to make a fair profit.
Build trust and respect
We build respect by operating in a safe, socially responsible,
consistent and honest manner. We never compromise on safety
and we always operate in an ethical and responsible manner. We listen. In doing so, we treat others as we would wish to
be treated ourselves and challenge when we see something is
wrong. We integrate with our communities.
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Quality Account 2012 - 2013
PART 2A LOOKING FORWARD: OUR PRIORITIES FOR QUALITY
IMPROVEMENT 2013/2014
Suffolk Community Healthcare continually captures information throughout the year about the quality of the services
it provides and the risks to service users. Through our quality management framework we regularly monitor, assess
and evaluate all of our services. Integral to the routine monitoring of clinical audit, quality measurement and
staff feedback are the views of patients and carers, information that we consider to be extremely important when
considering future delivery of service and quality improvement.
Engaging with Patients and Patient Representatives
We strongly believe in the importance of establishing meaningful dialogue with patients, patient representatives
and carers to help us deliver our quality improvement plans for the coming year. Whilst we still need to develop this
further to cover the full range of diverse services we offer, this year we have made significant progress in engaging in
discussion and debate with a number of patients and their representatives.
A wide range of meetings and public engagement events have taken place since October 2012 which are listed below.
Stakeholder & Public Engagement Meetings/Events During 2012-2013
PIPS
St Nicholas Hospice
SOVA
St Elizabeth Hospice
Suffolk Acre
Ipswich and East CCG
Age UK
West CCG
Headway
Local Medical Council
Suffolk Carers
A range of GP Practices across Suffolk
Suffolk Link (now replaced by Health Watch)
Ipswich Hospital Trust
Patient Partnership Groups
West Suffolk Foundation Trust Hospital
Suffolk County Council
Cambridge University Foundation Trust Hospitals
Health Scrutiny Committee
Norfolk & Suffolk Foundation Trust
Harmoni (out of hours services)
NHS Cambridgeshire
Marie Curie
Nine Public Engagement Events across Suffolk
Through these meetings and engagement events SCH
has been able to share its vision and proposals, and to
use the learning from the feedback to inform future
developments. In the year ahead SCH will continue to
meet with organisations such as Healthwatch Suffolk and
the Health Scrutiny Committee to discuss patient and
carer feedback, review findings and together consider
recommendations, priorities and improvements to
take forward.
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One of our CQUIN (Commissioning for Quality and
Innovation payment framework) goals for the year ahead
will be to continue to build upon patient experience
though the development of patient stories and patient
opinions. This is as well as exploring how best to
progress the outcome of our benchmark survey and the
general collection of patient experience.
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Suffolk Community Healthcare
Quality Account 2012 - 2013
Bringing Excellence to Care Through Our
Vision and Values
All these sessions and initiatives help us to cross-check
what patients and their representatives are saying with
other sources of feedback such as surveys, what the
Clinical Commissioning Groups and NHS Suffolk tell us,
contact through the Patient Advice and Liaison Service
(PALS), and through analysis of trends in complaints
and incidents. We are then are able to map these
to the organisation’s strategic objectives for quality
and safety and the operational objectives that the
clinical directorate will be making that focus on greater
efficiency and productivity. From all of this collective
intelligence our quality development plans for 20132014 are formed.
Suffolk Community Healthcare remains committed to
quality improvement being at the heart of everything
we do as we move forward working together as a new
community provider organisation.
Throughout the transition process SCH has worked to
maintain effective governance across the organisation.
Maintaining and improving quality during the transition
has been critical to enable the new organisation to
meet some of the greatest challenges in delivering NHS
services, as we strive to improve quality whilst reducing
cost by improving productivity and redesigning services
wherever possible. The scale of the challenge means
that throughout the time of transition and beyond,
quality must remain our guiding principle and focus.
In the year ahead SCH will continue the development
of it communication engagement processes with all
stakeholders which will encompass the following:
•
An engagement website/portal that enables
stakeholders to access information on
developments in the delivery of community
services and engagement activities, and
opportunity for SCH to receive any feedback
•
A monthly electronic newsletter – this is the
key regular flow of information that ensures
everybody knows what we are doing.
•
Training/coaching for a small team of locality
based staff so they are able to attend a range of
local meetings (e.g. voluntary group meetings,
patient group meetings) to present SCH latest
developments and to capture stakeholder views.
•
A number of drop-in “open day” events around
the county to enable stakeholders to meet with
staff and hear first-hand about the plans and
proposed developments.
•
A range of small focus group discussions used
to capture feedback for SCH and the Clinical
Commissioning Groups.
Suffolk Community Healthcare will ensure that
quality improvement continues. This will be through
implementation of strategic quality objectives identified
within its future plans and key clinical quality priorities
featured in this quality account grouped under the three
quality dimension headings:
•
Patient Safety
•
Clinical Effectiveness
•
Patient Experience
Our resounding strategic quality objective is to ensure that:
“SCH will provide safe and high quality services which result in a positive patient experience”
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Suffolk Community Healthcare
Quality Account 2012 - 2013
Priorities for Improvement in 2013/2014
As in last year’s Quality Account we have grouped our
priorities and plans under the three quality dimension
headings. We feel they reflect what we think we still
need to achieve. This is based on assessment of our
performance in 2012/2013, the further improvements
we want to take forward and feedback from patients
and stakeholders.
PRIORITY ONE: Patient Safety - Community Hospitals
To improve the recognition and management of the
unwell patient in a community hospital setting.
PRIORITY TWO: Clinical Effectiveness
To redesign the Falls Pathway – so that both falls
prevention and falls and fragility fracture prevention
continue to be a priority within SCH. A key focus will be
the management of falls and fragility fracture prevention
in the year ahead
PRIORITY ONE: Patient Safety - Community
To maintain our safety focus by continuing work to
redesign the structure and function of the Community
Health Teams and Community Intervention Service. This
will focus on areas identified as CQUIN goals such as to
improve discharge planning and the development of
self-management for patients.
PRIORITY THREE: Patient Experience
To improve patient and carer experience by focusing on
the CQUIN goals which relate to enhancing service user
engagement and support for carers.
CQUIN is defined as the Commissioning for Quality and
Innovation payment framework. The CQUIN framework
rewards excellence by linking a proportion of income to
the achievement of local quality improvement projects.
Enjoying the sunshine in Felixstowe Community Hospital garden
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Suffolk Community Healthcare
Quality Account 2012 - 2013
PRIORITY ONE: PATIENT SAFETY - COMMUNITY
Changes we are making to the Community Health Teams
We are making a range of changes to the Community
Health Teams to improve the quality and responsiveness
of our services for the patients we serve. Some of these
changes are detailed here whilst others will follow later
in within this report.
To maintain our safety focus by continuing work to
redesign the structure and function of the Community
Health Teams and the Community Intervention Service.
This will focus on areas identified as CQUIN goals such as
to improve discharge planning and the development of
self-management for patients.
Improving the way we work with GP colleagues
Each CHT is working closely with a cluster of GPs to
improve communication and the co-ordination of
patient care. We are developing a way of identifying
those patients who are at a high risk of becoming
unwell so that we can together with the GP, the patients
and their carers agree a care plan that will help us to
prevent a crisis occurring.
Redesigning Community Health Services
We are part way through an ambitious programme of
major change with our Community Health Teams (CHT).
These changes will improve the way we work and care
for our patients. They are centred on four key
principles to:
•
Make it easier and simpler for patients to
understand and get the help when needed
•
Enable clinical staff to spend more time caring for
patients
•
Wherever possible provide a joined up service
with other partner organisations
•
Improve the patient experience.
Introducing a Single Number and Referral point
The Care Co-ordination Centre (CCC) will be a single
point of access for services and a management referral
centre for all community services provided by SCH.
There is now one single telephone number to contact
the CCC. The number is in use 24 hours a day for anyone
wishing to contact a service, instead of having to leave
message on an answerphone. The Care Co-ordination
Centre also has a centralised administration function.
The centre will take on most of the administration tasks
that the clinician previously had to do such as, booking
appointments and registering new patients on the
computer system.
There are now fifteen Community Health Teams which
are geographically located and work with a cluster of
GP practices. These teams of professionals provide
healthcare to patients either in their own homes, in
clinics, health centres or other local facilities. Each
team comprises of nurses, occupational therapists,
physiotherapists and support workers. Which are
supported by the countywide community
equipment service.
Increasing the time staff spend with patients through
mobile working
We are investing in improving the IT infrastructure,
the result of which will be that every member of
staff will have been issued with a laptop and have
received training. This initiative is a technology
improvement which when fully functional will enable
nurses, therapists and generic workers to document
assessments; plan care; and record treatments and
other information, at the time they are undertaking
it ‘in real time’ without the need to duplicate this in
paper format and then electronically and reducing time
spent returning to the office to put information onto the
computer. This will make more time available to spend
on direct patient care.
SCH also has a newly formed Community Intervention
Service (CIS). This service is made up of two teams,
one for the east of the county and one for the west.
Each team consists of nurses and support workers and
provides healthcare 24 hours per day. This service
provides an ‘urgent response’ to patients in their own
homes, who have become suddenly unwell and as an
alternative to hospital admission. This service also
works in the emergency departments at the acute
hospitals helping to facilitate timely discharge of patients
where it is safe to do so.
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Suffolk Community Healthcare
Quality Account 2012 - 2013
Changes we are making to the Community
Intervention Service (CIS)
•
Community Health Teams have been re-organised
around GP practices
Joining up Services
•
New team leader and management structures are
in place
•
Attendance at GP team meetings to discuss
complex patients is in place
•
All staff in CHTs have been issued with a laptop
computer and received training
•
The Care Co-ordination Centre is in operation
•
The Community Intervention Service teams have
been developed
•
The discharge planning functions in the acute
hospitals have been planned and piloted
•
The introduction of the enhanced Geriatric
Assessment Clinics has been planned and
recruitment is underway.
We are joining up all of our services that provide
admission prevention and urgent care into a single unit,
with one team in the east and one in the west. This
means that it will be less confusing and will ensure
a seamless service so that patient care can be coordinated throughout the 24 hour period.
Improving Discharge Planning
We are bringing our discharge planning services into
the Community Intervention Service. The teams which
are based at the acute hospital, but will work differently
focusing on the ‘front door’ of the hospital identifying
those patients who are already receiving care from our
community teams. This will mean that we are able
to help to get those patients out of the hospital as
quickly as possible and home with the support of our
community teams.
Patient Feedback: “Every member of the team
carried out their care to a very high standard and
were particularly kind, encouraging and cheerful.
What a brilliant team you have and we are very
grateful for all you’ve done”
Developing Enhanced Geriatric Assessment
Community Clinics
What do we want to achieve in 2013/ 2014?
We are working with our social care, mental health,
acute hospital and GP colleagues to develop community
clinics where elderly people can be seen quickly and
receive assessment, treatment and advice to help
prevent a hospital admission. These clinics will be run by
a nurse consultant/practitioner with therapists, mental
health nurse and social worker input as necessary.
The clinics will also be supported by medical advice
from a Community Geriatrician. The clinics will provide
an alternative to hospital for GPs and will be held in
locations across the west of the county.
We are committed to building on the changes and
initiatives we have already began. Our goal will be to
complete the service re-design and introduce new ways
of improving and co-ordinating care around the patient.
Wherever possible we will take the opportunity to work
more closely with our social care colleagues to avoid
’gaps and duplication’ for patients.
We intend to do this by:
How did we perform in 2012/ 2013?
Since the commencement of the new contract in
October 2012 we have strived to implement many
changes whilst remaining focussed on maintaining safe
patient care. We have continued to see more patients
and have seen an increase in the complexity of patient
needs. We have prevented many avoidable hospital
admissions by supporting patients at home.
Trialling joint health and social care assessments
at our care co-ordination centre
•
Implementing our care lead training programme
•
Commencing the enhanced geriatric
assessment clinics
•
Completing the changes to the discharge
planning teams.
New Initiatives will be to:
•
We have made good progress in our service re-design
areas mentioned above in the following ways:
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Introduce a new operational performance
management framework across all teams. This
will enable Team Leaders to better understand
and manage the demands on their service. This
Suffolk Community Healthcare
Quality Account 2012 - 2013
will improve the way teams are able to respond to
patient needs, and increase the amount of time
that staff spend face to face with patients.
•
Develop an assistant practitioner role as part of
the CHTs. This will mean that more of the patient’s
needs can be met by one person, therefore
reducing the number of different staff that the
patient has to see.
•
Change core hours of work moving from 9am-5pm
to 8am-8pm. This will mean that more patients
will be able to be seen at a time convenient for
them. This will also support the co-ordination of
discharges from hospitals that occur late in
the afternoon.
•
A Care Coordination Centre analyst at work
PRIORITY ONE: PATIENT SAFETY –
COMMUNITY HOSPITALS
To improve the recognition and management of the
unwell patient in a community hospital setting.
Explore the opportunities for telehealth and
telemedicine to avoid hospital admission.
Older people admitted to community hospitals are
often highly dependent patients suffering from a range
different chronic conditions. The management of patient
deterioration within this cohort of patients can often be
difficult to recognise and treat, particularly in units that
are nurse led. The CQUIN goal proposes to develop a
clinical early warning system appropriate to community
hospital patients that enhances the awareness and
management when a patient is becoming unwell.
How did we perform in 2012/2013?
This is a new quality improvement for 2013-2014 so
it has not been measured before. However, SCH is
committed to embedding a consistent approach into all
inpatient units so that staff are better able to recognise
and manage the unwell patient.
Care Coordination Centre colleagues discuss a referral
How will we monitor progress?
There will be a designated clinical lead who will be
responsible for monitoring the progress of achieving the
CQUIN goals.
What do we want to achieve in 2013/2014
We aim to:
Progress will be monitored through the:
•
New management structures that will have
weekly local team meetings and monthly progress
reporting to the Head of Operations (HOS).
•
The Local Area Managers will update the
Leadership Team.
•
Relevant governance groups will monitor and
review progress against the implementation plans.
•
Active seeking of patient engagement and
feedback through patient partnership forums.
•
Results of ongoing patient satisfaction survey
using the family and friends test.
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15
•
Implement a standardised approach to identify
signs of when a patient becomes unwell. In order
to signal potential deterioration to staff and
supports effective clinical decision making, so that
appropriate referrals are made
•
Monitor the number of patients with early
warning indicators documentation and care plan
in place
•
Ensure identified staff receive appropriate training
in the use of key tools to support early warning
indicators
•
To monitor the patient experience and potential
reduction in length of stay.
Suffolk Community Healthcare
Quality Account 2012 - 2013
How will we monitor progress?
How did we perform in 2012/2013?
This CQUIN goal will be led and monitored by a
designated clinical lead within a monthly progress
reporting framework.
•
Local Area Manager Group and the Modern
Matron Forum
During the last year the Falls Co-ordinators, Osteoporosis
Nurse Specialist and Fall and Fracture Liaison Specialist
Nurses have continued to work tirelessly to ensure that
falls prevention is ‘everybody’s business’, this targeted
work has been to patients, staff, carers, GPs, practice
nurses and other stakeholders. More detail follows later
in the section which looks back on our achievements.
•
Monthly progress reporting to the Head of
Operations (HOS)
What do we want to achieve in 2013/2014
•
HOS will update the Leadership Team
•
Relevant governance groups that will monitor and
review progress against the implementation plans.
Progress will be monitored through the:
The management of falls and fragility fracture
prevention has been set as a CQUIN goal for the year
head. This will target all eligible patients over 65
years on the caseload of all Community Health Teams
(CHTs), so that they have a fall and fragility fracture
risk assessment and a care plan implemented where
indicated. The falls prevention work already started
within the inpatient units will continue to evolve.
PRIORITY 2: CLINICAL EFFECTIVENESS
To redesign the Falls Pathway – so that both falls
prevention and falls and fragility fracture prevention
continue to be a priority within SCH. A key focus will be
the management of falls and fragility fracture prevention
in the year head.
The CQUIN goal will improve the availability of falls and
fracture prevention by extending the current level of risk
assessment activity which will be offered to all people
who are on the CHTs caseload. As a result the CHTs will
undertake the following activities:
Falls and fragility fractures have a major impact on
the quality of life, health and healthcare costs. Risk
factors for falls should be minimised for patients within
community hospitals and for patients within their own
homes where health professionals are in attendance. By
reducing the incidence of falls and fragility fractures the
benefits will not only be for patients, but also for the
wider health economy such as reduction in the number
of ambulance call outs, hospital admissions and hospital
length of stay.
The management of falls prevention and fragility
fracture risk is a key component of the service SCH
provide to people, but the incidence and referral for
management of falls continues to increase.
•
Co-ordination and completion of a stage 2 falls
and fragility fracture checklist for medium to
low risk patients within 2 weeks and for high risk
patients within 72hours
•
Record the lying and standing blood pressure for
all patients as part of the stage 2 checklist which
will also be recorded on to SystmOne
•
A falls care plan started or onward referral
(whichever is indicated) within two weeks of an
initial assessment
•
Notification of risk and outcome to patient’s GP to
support completion of primary care risk register.
How will we monitor progress?
There will be a designated clinical lead for this
CQUIN who will be responsible for monitoring of the
achievement against this CQUIN goal. Progress will
be monitored through our data collection systems.
The Falls Co-ordinators will be instrumental in
supporting the CHTs in working to deliver this
important quality improvement.
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Suffolk Community Healthcare
Quality Account 2012 - 2013
PRIORITY 3: PATIENT EXPERIENCE
What do we want to achieve in 2013/2014
To improve patient and carer experience by focusing on
the CQUIN goals which relate to enhancing service user
engagement and support for carers.
We plan to deliver these CQUIN goals through:
•
Family Carer Engagement
•
This CQUIN goal is to improve family carer and patient
experience through a multi-agency approach. There
are approx. 90,000 family carers known to the system
in Suffolk within the Suffolk population. It is believed
that a number of avoidable admissions take place
through family carer crisis. There is a paucity of data
on the impact of family carers on the health system.
This overarching CQUIN for carer involvement/support
includes the mandated CQUIN for carers of people
with dementia.
•
•
•
How will we monitor progress?
There will be a designated clinical lead who will be
responsible for going monitoring of the achievement
against these CQUIN goals. Progress will be monitored
through the:
Friends and Family Test
There is a clear need to ensure that listening to patient
feedback is prioritised and acted upon. We recognise
that the Friends and Family Test is a single, headline
metric which cannot replace more local, information
that provides insight into operational issues. We plan
to build upon our benchmark survey and general
collection of patient experience, so that we improve
staff and service user engagement to collect real time
feedback from patients. This will provide intelligence
to fully understand the patient experience and to drive
continuous improvement.
•
•
•
•
•
Implementation of each project
Results of ongoing family carer satisfaction survey
using the family and friends test
Results of quarterly audit of carers of people
with dementia
Final project reports
Plans for continued family carer engagement
and support.
Other Service Improvements
How did we perform in 2012/2013?
There are other service improvements planned for the
year ahead which will contribute to improving patient
experience such as the:
During the last year we have worked to improve patient
experience with the implementation of the friends
and family test across key service areas which will be
rolled out across all areas in the year ahead. Suffolk
Community Healthcare also commissioned an in depth
study into the experience of patients using its services in
community hospitals, clinics and home care settings and
the result can be found later on when looking back on
our achievements.
Community Cancer Nurse Specialist Pilot
The community cancer nurse specialist pilot is a new
initiative for Suffolk Community Healthcare. The number
of people surviving cancer is growing with better
treatment outcomes. The support patients receive
once they have completed their acute phase of cancer
treatment has been well documented. It is known
that patients feel vulnerable, abandoned and unable
to pick up the treads of their previous life. Finances,
Patient Feedback: “I would recommend the
service as I feel stay has been treated
with respect and dignity.”
NHS
The appointment of senior clinical leadership for
family carers, (targeting people caring for patients
with dementia).
The identification of a carer’s link for each
inpatient unit.
Continuing to identify dementia leads and
champions across the hospitals
Co-production of a family carers’ information pack
with third sector(voluntary organisations) and
statutory sector
Implementation of an agreed method for
collecting real time patient feedback such as
patient discovery interview, and patient voices.
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Suffolk Community Healthcare
Quality Account 2012 - 2013
relationships, general health are all affected by the cancer journey
and patients require support and the tools to self-manage and
resume their everyday life.
SCH has successfully bid for funds to pilot community cancer
nurse specialists to support patients during their cancer journey
and once they have completed their treatment and are in
remission. These posts will compliment current services including
Marie Curie, hospice at home, acute care cancer nurse specialists,
and community nurses. Within the pilot there will be three
community cancer nurse specialists and two support roles which
will be based over three local areas, Sudbury, Woodbridge and
Ipswich. Each nurse will have responsibility for a group of GP
practices and will provide care to that cohort of patients. The pilot
will be closely monitored and evaluated by the University of East
Anglia and the results presented to local Clinical Commissioning
Groups for consideration to commission this model within all GP
practices. The pilot will start on the 1st August 2013 and will be
run over two years.
The outcomes for the pilot are:
•
•
•
Our hospitals achieve excellent scores on patient environment
To improve the outcome for the patient after
cancer treatment
To improve self-management for patients
To reduce the contact required in acute organisations and GP practices.
The benefits for SCH are:
•
To increase the knowledge and skills of the community nurses in caring for patients who have survived
cancer, but require our support in managing symptoms
•
To increase the knowledge and skill in cancer treatments and symptom control for the community staff.
The Care Lead Role
Suffolk Community Healthcare (SCH) is committed to improving the experience of our patients and ensuring that our
services meet the requirements of the future health needs of the communities we serve. By placing the patient at the
heart of holistic and truly integrated care pathways, tailored to individual needs, SCH will improve patient and carer
experiences and outcomes. All patients will have a named care lead to embed the concept of ‘no decision about me,
without me.’
The purpose of the care lead will be to:
•
•
Work across all agencies to agree the best care pathway for the patient and carer
Support a model of prevention rather than intervention
•
Promote self-management by building confidence, and developing understanding of patients’ strengths, goals,
and aspirations as well as their needs and difficulties.
The overarching benefit is we get it right first time, improving patient experience and reducing inefficiencies in our
own system. Training for the care lead role is planned to start in June 2013.
NHS
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Suffolk Community Healthcare
Quality Account 2012 - 2013
PART 2B: HOW WE MANAGE QUALITY IMPROVEMENTS
Quality and Safety
This section provides information to demonstrate that the organisation is performing to essential standards, that we
measure our clinical processes and performance and are involved in national projects to monitor quality.
Reviewing the Quality of Our Services
Excellence in Clinical Care and Outcomes
Through Clinical Audit
In the previous six months of 2012/13 Suffolk
Community Healthcare has provided 40 services
organised across mainly adult services. We have
reviewed all the data available to us on the quality of
care in these NHS services.
Participation in national clinical audit
During 2012/2013 there were no national clinical
audits for which SCH were eligible and appropriate to
community services.
The organisation has a robust performance management
framework in place utilising a quality report. This
is reviewed from the senior to frontline staff and
contains indicators of quality covering patient safety,
clinical effectiveness and patient experience. These
are reviewed monthly by the Leadership Team and
presented to the Serco Health Board where appropriate.
In this way we believe we systematically improve the
quality of our services.
Local and Mandatory Audit
Between October 2012 and March 2013 Suffolk
Community Healthcare reviewed the reports of 65 local
and mandatory clinical audits; this has included two
multiagency requests. Each audit was reviewed within
the organisation’s quality and governance system.
Development of action plans were encouraged when
standards were not met to help improve the quality of
healthcare provided.
The Leadership Team, Compliance Committee; Finance
and Performance Committee and the Quality and
Safety Assurance Committee receive and review regular
assurance and progress reports.
The findings were then shared throughout the
organisation via quarterly and annual reports, the audit
champion representatives, Take Care Take Note monthly
bulletins and the intranet.
Table 1 - Examples of Clinical Audits in 2012/2013
Audit Topic
Explanation of what the audit was examining
and what the general aims were
Actions to improve the quality of healthcare
Essential Steps: Prevention of spread
of infection care
bundles
The aim of the audit is to improve hand hygiene
and to heighten staff awareness of the ‘5 Moments for Hand Hygiene’, the audit includes:
Hand Hygiene
Aseptic Technique
Use of Personal Protective Equipment
Safe Disposal of Sharps
Infection control to continue with training of the
required hand washing technique
Cold Chain Audit
To ensure that the cold chain is maintained and
the monitoring of fridges in each clinic are adhered to according to the policy
All staff providing vaccination are to undergo cold
chain training.
Designated person and deputy to be appointed to
monitoring and take responsibility of auditing of vaccination fridge temperature.
Cold chain policy developed and circulated to all staff
plus the annual DOH vaccine specific guidance.
Essential Steps –
Urinary Catheter
Care and Supra-pubic Catheter Care
To examine the competency of the clinician in
line with the standards of care outlined within
the Urinary Catheter guideline.
The nights bags are single use (best practice), however patients prefer to wear drainable bags. Audit
question to make exceptions to benefit the patient
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Quality Account 2012 - 2013
Clinical audit is good for our services –
embedding audit for excellence
Infection Control has gone back to basics looking at the
technique and via training and Link Nurses has once
again raised the profile of hand hygiene.
Clinical audit is a quality assurance and improvement
method, enabling staff to measure and evaluate
outcomes of care in a systematic manner. In 2012/2013
there has been a drive to further embed audit activity
at clinical service level so that it meets local needs
and specialist services. Relevant clinical audit helps
staff to achieve their ambition to deliver continuous
improvement in patient care.
Environmental Management Decontamination of Patient Equipment and
Clinic and Ward Environment Audits.
The Environmental Management Audit measures a
range of infection prevention and control practices. SCH
have in place a Decontamination Policy to identify the
principles, responsibilities and methods associated with
cleaning and decontamination of equipment and
the environment.
This year we have:
•
Merged the Audit Subgroup with the Clinical
Policy group, the aim of the two groups coming
together was to address both audit and policies
during one meeting, ensuring the relevant
members of the group could provide their
expertise when policies were presented as a new
or review document
•
Used the intranet with open transparency with
all services to enable them to view their own
and other service results and actions. In order to
encourage staff to take ownership of their own
audits, recommendations and actions
•
Continued to review and develop the clinical
audit plan.
The aim of the audit was to help reduce the spread of
infection and healthcare associated infections. The
audit provides an overview of performance against the
Decontamination Policy, and has highlighted areas that
require improvement and areas of good practice.
The inpatient units included the therapy section whilst
undertaking their decontamination of patient equipment
audit and identified the water from the splint baths were
not being drained or cleaned daily by therapists. This
was addressed immediately and therapists are ensuring
splint baths are drained and cleaned daily when in use,
preventing any potential contamination.
How has audit helped improve our clinical
practice?
How has audit improved our patient
experience
Essential Steps – Hand Hygiene: Aseptic
Technique, PPE and Sharps.
Through on-going audits in areas such as hand hygiene,
aseptic technique and environment audit, the learning
from these contributes to ensuring patient receive the
best quality service possible, which in turn improves the
overall patient experience.
Hand hygiene is identified as one of four risk elements
within Essential Steps to be measured through a local
audit programme. The risk elements of the care process
are based upon ‘Saving Lives’ (DH 2005) and ‘Prevention
of Healthcare Associated Infection in Primary and
Community Care’ (NICE 2003). The aim of the audit is to
improve hand hygiene and to heighten staff awareness
of the ‘5 Moments for Hand Hygiene’, the audit is an
observed one and includes:
•
Hand Hygiene
•
Aseptic Technique
•
Use of Personal Protective Equipment
•
Safe Disposal of Sharps.
NHS
What do we want to achieve in 2013/14?
•
Service leads to be held accountable for all clinical
audits to meet deadlines
•
Follow up with action plans
•
Identify audit requirements within policies.
Raise awareness with staff to understand the importance
of clinical audit and how audit can assist in improving
patient care and the service they offer.
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Quality Account 2012 - 2013
Policies and Procedures
updating and rationalising the SCH intranet to ensure
tighter version control of documents and
clearer signposting.
This year there we have had an in-depth review of all
SCH documentation including policies, procedures,
protocols and medicines management procedures. This
has been done with assistance from external agencies/
organisations and our partners.
Policy and audit work streams are obviously very closely
linked and in response to this we trialled a merger of
the Clinical Policy and Clinical Audit groups to try to
streamline and dovetail this work. Although the close
links were useful the meeting proved rather too large
and unwieldy so we are now returning to two
separate groups.
A thorough review of policies has been conducted
and a programme of timely review and updating is in
progress and ongoing. We have also been reviewing
the processes and pathways around policy research,
development, consultation and ratification and
assurance to ensure our policies are evidence based and
in line with current clinical practice.
All this work will continue next year with the
restructuring of the organisation, the Clinical
Governance and Audit Departments.
Commissioning for Quality and Innovation
(CQUIN) 2012/13
The basis of this review has been an updating of our
“Policy for Policies” and policy template. In future
policies will be in the form of a succinct and brief
over-arching policy with an underlying local standard
procedure which can be readily updated and adapted to
suit all parts of the service/ organisation.
A proportion of Suffolk Community Healthcare income
in 2012/2013 was conditional on achieving quality
improvement and innovation goals agreed between
Suffolk Community Health and NHS Suffolk through the
Commissioning for Quality and Innovation payment
framework (CQUIN). The CQUIN framework rewards
excellence by linking a proportion of income to the
achievement of local quality improvement projects.
The table below shows the agreed CQUIN targets and
outcomes upto 31st March 2013. Summaries of our
achievements in last year’s CQUIN projects are also
highlighted in this section.
Another important aspect is to ensure that new
SCH documents are disseminated throughout the
organisation and that we receive assurance from
clinicians that they are aware of and have read
these. We are developing an electronic database,
in consultation with clinicians. As part of this it is
important that busy clinicians are able to quickly and
easily access these documents when required so we are
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Quality Account 2012 - 2013
Table 2 - CQUIN Goals for 2012/2013
NHS
CQUIN
Description of Indicator
Threshold for payment
1
Improvement in the identification and
management of patients at risk of
venous thromboembolism (VTE) for all
community services
To achieve 98% by the end of quarter 4
2
To have real time systems in place to
monitor patient experience including
the NPS
To show 3% improvement on baseline survey
3
Dementia screening
90% of patients aged over 75 who are admitted to an in-patient unit will be screened
4
NHS Safety Thermometer
A safety thermometer survey for all relevant
patients must be completed each month
5
Every Contact Counts
Every team will have staff trained to deliver
‘making every contact count’
6
Discharge Summaries
100% of discharge summaries will be sent
within 1 day
7
Hypertension project
Monitor and measure the number of community patient contacts where blood pressure
is recorded and where clinically appropriate
reported to GPs
8
EAU consultant service with Admission
Prevention Service support
To demonstrate improvement by quarter 4
9i
Care for children with complex health
needs, to promote admission avoidance and support early discharge from
the acute trusts
Develop and document integrated pathways
and design a case for change
9ii
Children’s continuing care training –
outcome measures
To develop packages of care indicating level of
need in line with NHSS thresholds
22
Status
Partially (96%)
Partially
Suffolk Community Healthcare
Quality Account 2012 - 2013
CQUIN Goal 1- Venous Thromboembolism –
focusing on patient safety, reducing harm
CQUIN Goal 2: To have systems in place to
monitor patient experience including the NPS
(Net Promoter Score):
Venous Thromboembolism (VTE) is a blood clot that
forms within a blood vessel and in the worst cases can
be fatal. Clots usually develop in the deep veins of the
leg, known as a deep vein thrombus or DVT. A piece of
the clot can break off and travel to the lungs – this is
called a pulmonary embolism or PE.
We want to ensure that all our patients have the best
possible experience of care. The Friends and Family Test
is a way of gathering feedback about patient experience
and driving improvement in our services. We asked all
patients that were admitted to our inpatient units the
following question:
VTE has always been a major risk for patients, especially
after surgery, or if they are immobile – for example after
a hip replacement operation. Familiar risk factors such
as being overweight and smoking increase the chance of
a patient developing a clot, and people recovering from
fractures or lower limb problems are also at risk.
‘How likely is it that you would recommend this service
to friends and family?’
The results are analysed to produce a net promoter
score (NPS) and to see if any action is required. The
average NPS for the twelve months from April 2012 to
March 2013 was 72 out of 100.
There is a national drive to reduce the incidence of
DVT, which started in the acute hospitals, and has
included the development of a national risk assessment
tool. Suffolk Community Healthcare, which runs four
community hospitals, is the first community provider
in the eastern region to have taken on a contractual
commitment to use this tool as part of our work to
reduce VTE.
All patients that gave comments left positive
comments about the care and experience they
received in our inpatient units. Feedback from
patients include:
Over the past year, we have been developing a
programme to tackle the risk of VTE for patients being
cared for in our community hospital inpatient units.
When people are admitted from the acute hospitals,
for further care and rehabilitation, we ensure a VTE risk
assessment has been done and attached to their chart.
Patients will continue with the same prophylaxis as
necessary meaning they receive the appropriate drugs
and wear compression garments such as stockings.
If patients are admitted to our unit from their home,
we will carry out our own risk assessment. Their
assessments will be reviewed and updated if necessary
by our doctors while they are in our care.
“I found the staff very considerate and helpful
in all aspects of their job and respect for their
patients in their care. Thank you for your
consideration.”
“Very impressed with the physiotherapy
service and treatment and the occupational
therapists.”
“I have received excellent care and attention
from all the staff whilst here. They do an
excellent job. The food was very good. I am
very grateful for all help I needed.”
“Wonderful, caring staff, who were always
there when I needed them, lovely food and
room very comfortable.”
Since these moves were introduced they have become
firmly embedded in the care we offer everyone who
is admitted to our inpatient units. For the 12 months
from April 2012 to March 2013 an average of 99.33% of
patients were screened for VTE.
NHS
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Quality Account 2012 - 2013
Commissioning for Quality and Innovation
(CQUIN) 2013/14
existing and new support networks. Through this
support to carers of people living with dementia
will be improved.
The CQUIN projects agreed for the coming year are
outlined below:
• We will continue to acknowledge the value and
importance of listening to and acting on patients’
experiences in order to improve the quality of
our services. In addition to the existing methods
of gathering information will be inclusion of
‘real time’ information collection; using iPads
and gathering ‘richer’ information from patients
through in-depth interviews. These interviews
will help to improve staff engagement and will
challenge assumptions and perceptions about
what we think the patient or family member feels
and needs.
•
We will promote good practice by monitoring
patient safety in the areas of pressure ulcers
and falls and will link any occurrences with an
improvement plan for each community hospital.
•
An earlier CQUIN identified that there is a high
incidence of pressure ulcers in residential care
homes and in people’s own homes. We will
address this by targeting training to care homes
and family carers and will monitor the effect this
has on future incidence.
•
We will adopt a standardised approach across the
community hospitals to support effective clinical
decision making and information to support
onward referral.
•
We will continue to carry out dementia screening
for inpatients over the age of 75. This will ensure
patients at risk are referred on for specialist
assessment and support.
•
We will provide a third year of training to staff,
delivered by our dementia specialist. This will
complement the training already provided in
order to further enhance knowledge and skill in
this area of increasing need.
•
NHS
To further support the above, we will engage with
other health and care providers in order to avoid
unnecessary duplication and provide a ‘joined up’
multi agency approach for patients and carers.
Views of carers will be actively sought and any
improvements identified will be acted upon. Staff
will be made aware of ‘signposting’ routes to
24
•
We will improve the experience of people with
cognitive impairment and dementia in our
community hospitals and in their own homes, by
enabling staff to adopt a cognitive rehabilitation
approach. This aims at maintaining optimal
orientation, communication, self-care, stimulation
and safety.
•
Due to the increasing incidence of falls and
resultant fractures, we will improve the availability
of falls and fracture prevention measures in the
homes of patients known to our services. Risk
assessments will be carried out, risks reduced
and care plans written with the patient
where indicated.
•
Along with other healthcare providers, we will
equip staff with the knowledge and skills in order
to be able to empower patients with long term
conditions to self-manage their condition. This will
aim at patients becoming active partners in their
treatment, rather than passive recipients.
•
To support the increasing incidence of cancer we
will initiate a pilot project where three community
cancer nurses and two assistant practitioners
will work across Suffolk to provide patients
with practical advice, information and support,
personalised care planning and supported
self-management.
•
We will proactively work with the acute hospitals
by providing information on thrombosis that
develops in the community after an acute
hospital stay. This will help to identify where
improvements can be made to reduce hospital
acquired thrombosis in the future.
•
We will contribute to the national priority of
improving discharge arrangements from acute
hospitals. Measures will be put in place to
improve efficiencies in the patient’s acute hospital
stay and reduce the need for re-admission. We
will achieve this by working in a more integrated
way with the acute hospitals.
Suffolk Community Healthcare
Quality Account 2012 - 2013
Reviewing the Quality of Our Services
How Our Regulator the Care Quality
Commission (CQC) Views Our Services
The Care Quality Commission (CQC) is the independent
regulator of health and social care in England. Suffolk
Community Healthcare is registered with the CQC.
Our current registration status is: “registered with no
conditions”. As an organisation we are required to
register compliance against the 16 essential standards of
quality and safety for the following regulated activities:
•
Treatment of disease, disorder or injury
•
Nursing care
•
Diagnostic and screening procedures
•
Surgical procedures.
Dr Emily Knapp, Dr Amy Schiller from CDS receiving the QIDS
As a private organisation we are required to ensure that
local managers are held accountable for ensuring that
the CQC standards and outcomes are embedded into
everyday practice. This is through the five Local Area
Managers for Suffolk who are the designated responsible
registered manager for their locality and will be held to
account by the CQC.
certificate from Helen Pailthorpe and Peter Bateman BDA.
Community Dental Services Community
Interest Company (CDS)
As a result of the formation of the new organisation
on the 1st October 2012 the Suffolk Community Dental
Services was transferred to the Community Dental
Services Community Interest Company (CDS), which is a
staff owned social enterprise. During the first 6 months
CDS has continued to provide dental care from all 11
clinics, delivering the level of service commissioned.
During the last year Suffolk Community Healthcare has
not received any unannounced inspection from the
CQC to any of it services. However, in anticipation of the
Care Quality Commission’s visits to assure compliance
against registration expectations, throughout the year,
clinical services across the organisation have been
introduced to that potential experience and undergone
‘mock inspections’.
In October 2012 CDS became the first community
dental service in the UK to achieve the ‘Quality in
Dental Services’ (QIDS) award, a quality assurance mark.
This reflects an enormous amount of hard work by all
members of staff and a commitment to maintaining
these standards moving forward.
The four community hospitals and the Minor Injury Unit
were visited by external assessors, whilst each community
service and team underwent an inspection by governance
team members. The findings of the reviews against CQC
outcomes resulted in the development of both local
and corporate action plans. The organisation has
continued to monitor the implementation of the action
plans through regular review meetings and feedback
up to the Leadership Team. There is a bi-monthly news
bulletin for sharing CQC updates, identifying strengths
and learning opportunities which is circulated for staff
to maintain an awareness of developments and ongoing
programme of regular assessment visits with all teams
throughout the year.
NHS
To help monitor the quality of the service provided CDS
has undertaken quarterly patient surveys, with very
favourable results.
Patient feedback included:
“The dentist and assistant who dealt with our
daughter were outstanding. They kept her
calm, informed and happy. Thank you.”
25
Suffolk Community Healthcare
Quality Account 2012 - 2013
As a result of the patient and carer feedback received
we are reviewing our processes for dealing with
appointment waiting times in order to ensure that the
patient journey is managed as effectively as possible.
their own data without the aid of others, such as the
Area Team. SCH has attended and actively contributed
to regular regional data quality forums at the East of
England Strategic Health Authority including several
information sharing meetings where we had a leading
role in helping other community providers adapt their
systems in order to report datasets.
CDS is registered with CQC and at the beginning of 2012;
the CQC completed an inspection visit to the Healthy
Living Centre at Thetford. CDS in the regulated
activities of:•
Diagnostic and screening procedures;
•
Treatment of disease, disorder or injury; and
•
Surgical procedures.
SCH has worked with its partners, such as SEPT, to share
good practice in data provision and ensure that there
is a consistent and standardised approach to the data
stored on SystmOne. The move to using SystmOne as
the clinical record for patients will only improve the data
quality as clinicians will only need to access one system
to record activity and clinical details. The outcome of the inspection was that CDS was judged
to meet the standards in:
•
Respecting and involving people who use services;
•
Care and welfare of people who use services;
•
Cleanliness and infection control;
•
Requirements relating to workers; and
•
Complaints.
Generally SCH has continued to set high standards on
data quality, SCH has never dropped below 99% for
the inclusion of NHS numbers within the Outpatient
and Inpatient datasets, this is a key marker in national
reports (Table 3 and Table 4). Suffolk Community
Healthcare 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. SCH was not subject to payment by
results, so the clinical coding audit was not applicable
during this period.
The volume of referrals to the service has been
increasing. To help with the management of this and
to aid better customer service, CDS has now centralised
the management of referrals, allowing a better and
more responsive service for patients. In addition, CDS is
introducing a networked dental computer system across
all its clinics which will include the appointments system.
This will allow appointment queries to be managed at a
number of locations, particularly of benefit patients and
where there are part-time clinics.
Table 3 - Valid NHS Numbers
NHS Number % Valid for Suffolk community Healthcare
(NHM)
Quality and Safety
SCH % Valid
National % Valid
Inpatients
100.00%
99.1 %
Outpatients
99.9%
99.3%
A&E
99.5%
95.1%
Table 4 - Registered GP Practices
Data Quality
Registered GP Practice % Valid for Suffolk community
Healthcare (NHM)
Work started at the beginning of 2012 to prepare SCH
in providing a full and complete set for the Community
Information Dataset (CIDS), a nationally mandated
requirement by March 2014, and has continued
throughout the last 6 months. Good progress has been
made, as several services now report their 18 week
referral to treatment compliancy through the SystmOne
( IT system) functionality. This means that it is easy for
the services to run reports within their unit and check
NHS
CDS
26
CDS
SCH % Valid
National % Valid
Inpatients
100.00%
99.9 %
Outpatients
100.00%
99.9%
A&E
100.00%
99.7%
Suffolk Community Healthcare
Quality Account 2012 - 2013
Information governance toolkit
attainment levels
We now have in place the SCH Information Governance
steering group with an agreed framework and action
plan to enable the organisation to provide evidence
for the NHS IG Tool Kit within the Department of
Health. This is how the organisation will work towards
compliance during the next three months.
Information governance (IG) provides a framework
which determines the way in which organisations
process and handles information. Suffolk Community
Healthcare (SCH) is now working to achieve compliance,
within the NHS IG Toolkit, as a private organisation
under its own name, where previously this was with
NHS Suffolk.
Information governance should not be seen in isolation
but as an integral part of our work, ensuring that we
meet legal requirements while supporting business
improvement and continuity. The framework ensures
that information is:
SCH is committed to ensuring that we manage all of the
information we hold and process in an efficient, effective
and secure manner. This will be achieved through
the application of robust information governance
policies and procedures in accordance with information
management legislation and Department of Health
(DH) guidelines, supported by training and awareness
activities for staff.
•
Held securely and confidentially
•
Obtained fairly and lawfully
•
Recorded accurately and reliably
•
Used effectively and ethically
•
Shared appropriately and legally
Two therapists at Felixstowe Community Hospital keeping patient records up to date
NHS
27
Suffolk Community Healthcare
Quality Account 2012 - 2013
PART 3: LOOKING BACK: OUR CARE QUALITY ACHIEVEMENTS IN
2012/2013
Suffolk Community Healthcare Priorities for 2012/2013
At its meeting in April 2012 the Board of Suffolk Community Healthcare agreed its priority areas for improvement
of the quality of clinical services for the year 2012/2013. The Board decided to consider the quality of services in
the domains recommended by the White Paper “High Quality Care for All”. This defines a quality service as being
safe, clinically effective and patient-centred. Though SCH has transferred to Serco we continue to work towards and
monitor these objectives.
The agreed aims were:
PRIORITY 1: Patient Safety
To maintain our safety focus by continuing to work with
the Safety Thermometer Tool (collating data on patients
who develop pressure ulcers, blood clots, urinary tract
infections and falls whilst in our care) and to use this
information to inform our improvement plans
PRIORITY 2: Clinical Effectiveness
To provide Speech and Language Therapy (SALT) services
for people with dementia; and to increase access to
paediatric SALT services
PRIORITY 3: Clinical Effectiveness
To enhance the assessment of children’s continuing care
and improve the experience of families in need of this
support across Suffolk
PRIORITY 4: Patient Experience
To improve the effectiveness, quality, safety and patient
experience of discharges from acute hospitals to the
community; including working more closely with
community teams to facilitate discharge from
community hospitals
Achievements against the above priorities will be discussed in the following pages together with a
description of the methods used (metrics) to measure quality performance across the organisation.
Included are examples of developments within our services, where both clinical and support
functions have helped improve the quality of care that we have provided during the past year.
NHS
28
Suffolk Community Healthcare
Quality Account 2012 - 2013
Patient Safety
further examples of achievements in areas such as
safeguarding, infection control and falls prevention.
Keeping patients safe is the highest priority for Suffolk
Community Healthcare. It is important not only
that services are as safe as they can be, but that we
demonstrate this to ourselves, our partners, our patients
and carers and to the public.
We encourage all staff to report any untoward events
as part of our open and honest culture and aim to
promote shared learning. The National Patient Safety
Agency (NPSA) supports high levels of incident reporting
as being viewed as positive, since those organisations
having an open culture are more likely to have the
processes in place to learn from these events. The
following indicators are the measures the organisation
has chosen to reflect patient safety across SCH.
The section which follows highlights the indicators
for patient safety across SCH. It will review the
achievements against the patient safety priority set for
2012/2013. The narrative which follows will provide
Table 5 – Indicators for Patient Safety
Indicator
Target
Number
Oct 12- March 13
Number of MRSA Bacteraemia cases
0
0
2
0
0
6
Number of CDiff cases occurring 72 hours post admission
into inpatient facilities
Number of inpatient falls resulting in severe harm or
death
Number of pressure ulcers (Grade 2 and above) developing 72 hours following admission into SCH care
Inpatient
13
Community
83
Number of medication incidents
31
No Harm
26
Low harm
3
Moderate harm
2
Severe harm
0
Death
0
The number of Serious Incidents requiring investigation
20
Percentage of Serious Incidents that have a 45 day report
completed within 45 days
Number of incidents that would previously have been
NPSA reportable
Number of incidents that would previously not have been
NPSA reportable
Total number of incidents
NHS
95
100%
430
1009
1439
29
Suffolk Community Healthcare
Quality Account 2012 - 2013
The complexities of modern healthcare mean that
things may occasionally go wrong despite our having
the relevant processes and procedures in place. Suffolk
Community Healthcare follows appropriate policies in
order to identify any failings or weaknesses and then
ensure that investigation and learning from incidents or
complaints takes place.
•
Determine what happened
•
Determine why it happened
•
Decide on what to do to reduce the likelihood that
it will happen again.
Our reporting framework has been developed to ensure
that agreed actions and lessons learnt from incidents,
RCA’s, complaints and claims are disseminated across
the organisation. A summary report covering all key
elements is presented to the Compliance Committee
enabling organisational wide sharing.
Clinical services report any patient safety incidents to
our Risk and Patient Safety team, who review and assess
both the details and the impact of the incident as well as
the severity of the issues, identified thereby making sure
that the correct level of investigation is undertaken and
the potential learning shared across the organisation
Learning from various sources, including incidents as
mentioned above, is reported to all staff throughout the
organisation using our Take Care - Take Note news sheet.
All Serious Incidents are required to have a Root
Cause Analysis investigation undertaken. A Root Cause
Analysis (RCA) investigation, put simply, encourages the
question “Why?” to be asked. It allows us to identify
the significant issues and causes behind an incident that
may have happened helping us to understand the root
cause/s of the problem. The reason behind the problem
can often prompt further questions: the real key being
to avoid assumptions and to encourage staff to ‘drill
down’ to the real root cause. RCA uses a specific set
of steps with associated tools to help find the primary
cause of the problem so that we can:
In addition each directorate produces a risk register
which is reviewed on a monthly basis. The highest risks
are discussed and agreed by the Compliance Committee
and then included within the organisational risk register
which is reported to the Leadership team.
A risk register is a management tool that enables the
organisation to understand its risks. It holds not only
risk information but also the control measures and
actions needed to reduce these risks. Risks are identified
through a number of sources including incidents,
complaints, audit reports and risk assessments.
A treatment room ready to receive patients who need care
NHS
30
Suffolk Community Healthcare
Quality Account 2012 - 2013
Patient Safety Achievements in 2012/2013
How did we perform in 2012/ 2013?
The use of the Safety Thermometer Tool has continued
through this year. The tool been through several
revisions in order to improve the quality of data
obtained. Engagement with the process by frontline
teams has been extremely positive and the increased
awareness generated by this audit has had a positive
impact on patient safety. Data submission has been
maintained at 100% for the entire year.
Patient Safety 2012/2013 Priority 1
We said we would maintain our safety focus by
continuing to work with the Safety Thermometer Tool
(collating data on patients who develop pressure ulcers,
blood clots, urinary tract infections and falls while
in our care) and use this information to inform our
improvement plans:
The NHS Safety Thermometer
The principles of harm free care are now part of the
ethos of daily care within our community hospitals
and community teams. Safety Thermometer data
has enabled identification of areas of risk and training
has been provided in line within regional initiatives to
reduce all four harms with particular focus this year
around the reduction of avoidable pressure ulcers.
Whilst pressure ulcers were not eliminated completely
the increased awareness and holistic working resulted
in a significant reduction in the number of higher grade
pressure ulcers within our care.
The NHS Safety Thermometer provides a ‘temperature
check’ on harm and can be used with other measures of
harm to measure local and system progress.
Safety Thermometer is a national initiative to monitor
the major four main harms in patient care which are:
•
Catheter Acquired Infections
•
Pressure Ulcers
•
Venous Thromboembolism
•
Falls
•
It was developed as a point of care survey tool
which aims to ensure the NHS provides
harm-free care.
We have been working with other acute and community
health agencies and with social care to try to reduce
harms and this work will be extended in the coming
year. Data has been shared between organisations
both locally, regionally and nationally in order to ensure
streamlining of initiatives and sharing good practice.
All harms are related
All these harms are related, and require us to provide
a holistic assessment encompassing our basic needs
for good health. If a patient is not eating well or taking
enough fluids they may feel dizzy when they stand and
they are more at risk of falling. If a urinary catheter
is not draining well because a patient is not drinking
enough water this can put them at risk of developing an
infection. Lack of food can make an individual lethargic
and less motivated to move, increasing the risk of VTE.
If they spend more time in bed, pressure ulcers
could develop.
What do we want to achieve in 2013/ 2014?
1. Use Safety Thermometer data to produce local reports
for individual teams to enable monthly real-time data
and proactive patient care
2. Roll out of further training programmes to enable
continued reduction of pressure ulcers
3. Focus on reduction of falls for patients within our
community hospitals and in their own homes via training
and streamlining of equipment services
We have to make sure that in trying to ensure that
a patient does not receive one harm, it is not at the
expense of the patient suffering another. If a patient is at
risk of falling we must encourage them to mobilise safely
rather than stay in bed or a chair as they would then be
at greater risk of a urinary tract infection or
an embolism.
NHS
As Pressure Ulcer reduction remains a national priority
the following section reviews achievements by SCH
against this key area.
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Suffolk Community Healthcare
Quality Account 2012 - 2013
Example - Pressure Ulcers
resulted in a significant reduction in the numbers of
pressure ulcers.
What is a pressure ulcer? - A pressure ulcer is damage
that occurs on the skin and underlying tissue. A pressure
ulcer can be caused by pressure, sheer, friction or a
combination of these three things.
•
•
•
We participated in the pressure ulcer collaborative
programme with teams from acute and community
services throughout the region and the Safety Cross
Programme for 2013/14 was developed and introduced
as a result of this.
Pressure – the weight of the body pressing down
on the skin
Friction – rubbing of the skin
Sheer – layers of the skin are forced to slide over
one another when sliding down or up the
bed/chair.
What do we want to achieve in 2013/ 2014?
Roll out the Safety Cross. The Safety Cross has a number
of key aims. The data collected can be used to:
Pressure ulcers can develop in any patient but are
more likely in the elderly, people who are obese or
malnourished or have skin/continence problems or
underlying conditions. The first sign that a pressure
ulcer is developing is usually discoloured skin, which if
untreated could lead to an open wound. Pressure ulcers
are graded one to four depending on their severity (four
being the most severe).
•
•
•
•
How did we perform in 2012/ 2013?
•
Pressure Ulcer reduction remains under close scrutiny
and we have been engaged with a variety of local,
regional and national initiatives.
•
The Midlands and East Pressure Ulcer Ambition to
eliminate all grade 2,3, and 4 pressure ulcers by the end
of 2012 provided a focus for the work of our frontline
teams and amongst frontline teams and whilst the
ambition was not achieved the increased awareness
•
Raise awareness within the team and others
regarding, for example, how many pressure ulcers
are acquired in each care area
Improve patient safety
Promote good practice (i.e. look at how many
days have gone by without a new pressure ulcer/
fall with harm occurring)
Provide real time incidence data, as data is
collected daily
Link the data to each team’s improvement aim
and also that of the organisation
Continue to collect Safety Thermometer Data and
share the results within the teams to link with
Safety Cross data to help improve care and reduce
the number of pressure ulcers
Recruit a Tissue Viability Nurse so that good
practice and lessons learned from Incident data
are shared throughout the organisation.
A nurse treating a patient with leg problems
NHS
32
Suffolk Community Healthcare
Quality Account 2012 - 2013
How will we monitor progress?
together with Mental Capacity training and Deprivation
of Liberties training facilitating an integrated approach
to these sensitive areas of clinical practice.
The Safety Thermometer will continue to be monitored
through our data collection systems as elements have
been defined as CQUIN goals for the year ahead. It will
be reviewed by our risk management team and reported
to our governance groups to ensure that its profile
remains high from the frontline up to the
Leadership Team.
The safeguarding team work closely with representatives
from other sectors of the community to ensure we
address safeguarding in an integrated approach –
communicating and liaising as appropriate to ensure the
safety of our vulnerable clients.
Case Study: Mrs X, a 39 year old lady, was referred
with a history of a venous leg ulcer. She attended
the leg ulcer management clinic weekly. Where
she was assessed and treated with compression
bandaging and as a result her leg ulcer was healed
a week before she was due to go on holiday
abroad which she was thrilled about.
We are active participants of the Local Safeguarding
board – which is undergoing transformation as it mirrors
the statutory format of Children Safeguarding boards
with the appointment of an external chairperson.
SCH has a Safeguarding Vulnerable Adults action plan in
place monitored through the SCH Safeguarding Group.
Key priorities for the coming year are:
Patient Feedback:
“Many thanks for enabling me to be able to
go on holiday without bandages, to have the
freedom of wearing clothes without having to
cover up my leg and particularly being able to
swim”
Patient safety 2012/2013 Other Achievements
Other examples of patient safety work we have
undertaken this year are explained below.
Development of a safeguarding adults training
pathway to mirror that of children’s safeguarding
•
Development of a clinical supervision model –
building on the group supervision model adopted
this year
•
Development of a safeguarding champions role
•
Continued development of partnership working
with SEPT and CDS staff.
Safeguarding children
SCH is highly committed to ensuring staff are properly
trained and supported at an appropriate level to protect
and safeguard children from abuse. During this year this
support has continued to be provided by the Named
Nurse Safeguarding Children service via the Suffolk County
Council following their transfer from community health
services to the local authority in 2011. Training for all
new staff is supported by the named nurses at induction
and all staff adhere to a training matrix according to the
safeguarding guidance published by the Royal Colleges.
Various training methods are used, including eLearning
and more focused multi-agency training.
Safeguarding vulnerable people
Suffolk Community Healthcare is committed to ensuring
that all adult patients are protected and safeguarded
from abuse in line with National Standards. We work
predominantly with adults and older patients with
complex health needs and have a duty to safeguard
vulnerable clients to act on any concerns and to ensure
the situation is appropriately assessed and investigated.
To achieve this, our safeguarding adults training is
mandatory for all staff, achieving 86.9% compliance
as of April 2013. Annual staff training is through an
eLearning programme but bespoke training programmes
are developed through the Named Professional for
Safeguarding working directly with clinical teams
to address concerns and situations specific to their
particular service area. Most recently our Dementia
Lead for SCH has incorporated safeguarding awareness,
NHS
•
The compliance rate for safeguarding level 1 training is
83.6% as of April 2013.
Following responsibility for SCH services transferring
to Serco as of 1st October 2013 and in discussion
with SEPT and CDS, SCH have agreed to enhance their
named nurse children’s service provision through the
33
Suffolk Community Healthcare
Quality Account 2012 - 2013
employment of a children’s safeguarding position within
the organisation. This role will work closely with the
named nurse for adult safeguarding and together will
provide an integrated service to the staff within SCH.
committed to preventing and controlling health care
associated infections (HCAI) as we do not accept that
avoidable HCAIs are an inevitable part of health care.
What is Methicillin Resistant Staphylococcus Aureus-MRSA?
Key priorities for the coming year are:
•
Continue to roll out of safeguarding palette
•
Consideration of implementation of Systm1 into
clinical areas that require Clinical Viewer – to
enable communication across all providers
•
To support the development of the MultiAgency Safeguarding Hub in Suffolk
•
Continue to build on established clinical
supervision systems
•
Continue to build relationships with our
partnership organisations (SEPT and CDS) in
maintaining robust safeguarding governance
processes across the partnership.
It is estimated that 3% of people carry MRSA harmlessly on their
skin, but for hospital and patients within the community the risk of
infection may be increased due to wounds or invasive treatments
which make them more vulnerable. Serious MRSA infections may
result in MRSA blood stream infections.
What is Clostridium difficile- C-diff?
C-diff is a common cause of hospital acquired diarrhoea. It is bacteria
that are harmlessly present in the bowel of 3% of healthy adults and
up to 30% of elderly patients. When certain antibiotics disturb the
balance of bacteria in the gut, C-diff can multiply rapidly and produce
toxins which cause diarrhoea and illness.
Last year we had an ambitious target of zero MRSA
bacteraemia cases within our four community hospitals
– we are delighted to report that we have achieved
this annual target for the third year in succession.
We will continue to strive to reduce further this the
C diff infection limit, which has been set at three for
2013/2014. In 2012/2013, with a threshold of no more
than four, we reported four cases, one more than the
previous year.
Infection Prevention and Control
We said we would reduce the number of healthcare
acquired infections:
Suffolk Community Healthcare has a zero tolerance
approach to preventable infections, the most wellknown being Methicillin Resistant Staphylococcus
Aureus (MRSA) and Clostridium difficile (C-diff). We are
Table 6 - C-diff cases attributable to Suffolk Community Healthcare
C diff cases March 2008 to March 2013
9
8
No of cumulative cases
7
6
5
4
3
2
1
0
2008/2009
NHS
2009/2010
2010/2011
34
2011/2012
2012/2013
Suffolk Community Healthcare
Quality Account 2012 - 2013
While the additional case was disappointing, we remained within our target set. In addition to the SCH Infection
Prevention and Control Plan, a specific C diff Remedial Action Plan was implemented and monitored rigorously by our
commissioners between July and January 2013, to ensure all lessons were fully implemented to reduce further cases
in 2013/2014.
What has worked well in reducing the number of healthcare acquired infections?
Our infection control annual plan aims to continually reduce healthcare acquired infections (HCAIs) by
implementing, sustaining and improving practice across the whole organisation internally and working
collaboratively with external partners.
Our staff generally observe good hand washing practice and have encouraged patients to do so to. In addition
we know that our cleaning standards have improved. As can be seen below that our PEAT (Patient Environment
Assessment Team) scores this year were outstanding, with only one area not receiving an excellent score from the
external assessment.
Table 7 - Patient Environment Assessment Team (PEAT) scores for 2012/13
Site Name
Environment
Score
Food Score
Privacy & Dignity
Score
NEWMARKET COMMUNITY HOSPITAL
5 Excellent
5 Excellent
5 Excellent
BLUEBIRD LODGE, IPSWICH
4 Good
5 Excellent
5 Excellent
ALDEBURGH HOSPITAL
5 Excellent
5 Excellent
5 Excellent
FELIXSTOWE HOSPITAL
5 Excellent
5 Excellent
5 Excellent
It should be noted that the existing PEAT programme is
being replaced this year by a new Patient-Led inspection
regime (PLACE).
Other achievements against the 2012/2013 Annual
Improvement Plan
We have learnt a lot by examining each of four C-diff
cases in detail. A root cause analysis (an in-depth review
of care to identify any variance from best practice) was
carried out for each C-diff case, enabling staff to monitor
trends, identify the actual cause of the infection and
implement or reinforce changes in practice. Each case
was reviewed at a root cause analysis meeting with the
Infection Control Team.
Ensuring antibiotic formulary adhered to, hold GP
provider services to account and GPs follow local
NHSS prescribing guidelines
•
Reasons for antibiotic prescribing and
recommended date to stop antibiotic not
always visible.
•
Strict adherence and understanding of sampling
and isolation of patients.
NHS
MRSA Screening – 100% achieved for
rehabilitation patients as well as for Foot and
Ankle patients (surgery to Foot and Ankle by
Podiatric Surgeons).
•
System in place to ensure the reason for
prescribing an antibiotic is recorded along with a
recommended date to stop the antibiotic
•
Antibiotic audit was undertaken and results were
shared with staff and other partners
Audit data analysis demonstrated consistently high
compliance with hand hygiene compliance, aseptic
technique and use of personal protective equipment. To
ensure that those working on a one-to-one basis were
monitored for compliance with hand hygiene, patients
were asked about staff compliance with hand hygiene in
their patient satisfaction survey questionnaire.
Our analysis suggests key learning points:
•
•
35
Suffolk Community Healthcare
Quality Account 2012 - 2013
Outbreaks of Norovirus
infection were reported in
all inpatient units this year;
they were successfully
managed and following
root cause analysis,
learning put into place
as a result of the lessons
identified. Resources for
management of suspected
infectious diarrhoea
outbreak were produced
and shared widely to
ensure continued best
practice was in place.
Information board at a community hospital emphasising
infection control
The training programme was reviewed and a blended
approach was taken to ensure ‘getting the basics right’
and bespoke sessions were highly regarded by all staff.
Continuous improvement was demonstrated by
the overall increase in uptake of 25% over a 15
month period.
SCH Podiatry, Foot and
Ankle and Community
Paediatric Services were
transferred to the management of SEPT from October
2013, and a dependent infection control service has
continued to be provided to the staff by the Infection
Control Lead from SCH.
Keeping infection out of
our clinics and hospitals is
a priority
A point prevalence study had been undertaken for
urinary catheters and the results were shared widely
to discourage the unnecessary use of urinary catheters
without a rationale, in order to reduce catheter
associated infections, which placed patients at higher
risk of systemic infection.
Infection control services are no longer provided to
Community Dental Services since October 2012, as they
moved to an independent status.
Figure 1- SCH Infection Control Training Compliance
SCH Infection Control Training Compliance
100
90
80
70
%
60
50
Target 100% (95% prior to Oct 2012)
40
30
20
10
0
2011
NHS
2012
2013
36
2014
Suffolk Community Healthcare
Quality Account 2012 - 2013
Flu immunisation programme for staff aimed to increase rates by 10% each year. The data in bar chart below
demonstrates that uptake rates have improved year on year.
Figure 2 - Flu Immunisation Uptake
IMMFORM data -Staff Flu Uptake
70
60
50
40
30
20
10
0
2010/11
2011/12
2012/13
%
To ensure local ownership of this key agenda, 27 Infection Control Links were trained to assist with the
implementation of infection control agenda and succession planning.
Further improvement areas for 2013/2014
Ensure the governance processes for infection
prevention and control are reviewed and enhanced
following the transition into the new organisation and
the transfer of some services to SEPT in October 2012.
Further improvement proposals are
•
Review training programme to address
competency, and skill sets focusing on practical
skills in asepsis.
•
Review and align Policies.
•
Agree standards for cleaning and an effective
system in place for sharing progress of
achievements in cleaning standards of all sites.
•
Implement surveillance system for HCAI in the
Community.
•
Enhance decontamination process and structures.
•
Stretch the Staff Flu uptakes by 10%.
•
Stretch Infection Control Training uptake to 100%.
NHS
37
•
Support innovations and long-term projects such
as the involvement of patient representatives/
volunteers in hand hygiene, environmental audits
and PLACE.
•
Continue to address catheter associated urinary
tract infection rates – by decreasing the number
of patients who are given catheters and reducing
the length of time catheters are in place we aim to
reduce this type of infection.
•
Influence and enhance antibiotic prescribing
by GPs.
•
Influence and collaborate with Estates and
Facilities to ensure infection control aspects in
buildings are managed; KPIs are in all contracts
and SLAs in line with requirements of the
Hygiene Code.
•
Continue to work with all staff and partners to
ensure compliance with CQC Essential Standards
requirements.
Suffolk Community Healthcare
Quality Account 2012 - 2013
Falls Prevention
inpatient units and receive an injury as a result. We will
continue to make reducing inpatient falls a priority over
the next year to improve results.
Falling is the most frequent and serious type of injury for
anyone over the age of 65 years of age. Helping people
at risk to avoid falling is a major focus for SCH. This year
our falls team has been developing a falls care pathway,
including care plans and providing training to health and
care professionals.
Working in Partnership
Suffolk Community Healthcare (SCH) continues to
make falls and fracture prevention a priority in its
delivery of community health services. It is working in
partnership with other organisations such as ambulance
services, primary care, acute hospitals, local authority
organisations, private & voluntary organisations, and
commercial industries to prevent falls and falls-related
injuries. One such example is the work SCH does in care
homes across Suffolk, the Falls Prevention Co-Ordinators
and Osteoporosis Nurse Specialist provide level one
falls and bone health training for all professionals within
organisations. Also a range of education and information
sessions are also provided for residents in care homes,
lunch clubs, church groups, and other voluntary sector
organisations; so that individuals are empowered to take
care and responsibility for their own health; and seek
help and advice from professionals as necessary.
A fall can destroy a person’s confidence, increase their
isolation and reduce their independence. The aftereffects of even minor falls can be catastrophic for an
older person’s physical and mental health. Falls can also
result in fractures – most commonly of the wrist and hip.
People with weak bones, as a result of osteoporosis, are
at particular risk of sustaining a fracture.
Anyone can help to reduce their likelihood of falling by
exercising, eating and drinking properly, being aware
of trip hazards at home and outside, wearing proper
footwear and having the right glasses, kept clean.
Unfortunately this year we have not achieved a
reduction in the number of patients who fall within our
Inpatient Units.
Although falls rates remain high, SCH continues to work to improve the care it provides in inpatient units so that
the number of falls and falls-related injuries are prevented or reduced. SCH has a falls care pathway in place where
patients who are at risk of falls and fractures are identified on admission so the appropriate care commences quickly
in order to give patients the best possible chance of recovery and avoiding further or future falls.
Figure 3 - Number of Falls and Falls-related Variables for In-patient Units
Table 2 - Inpatient Falls - April 2012 - March 2013
60
57
50
50
44
Frequency
40
39
40
39
32
37
30
29
30
32
32
23
20
20
13
14
14
15
14
13
12
8
7
Number of Falls Resulting in Harm
23
22
15
13
19
Total Number of Falls
Number of Patients Who Fell
26
23
10
38
37
34
17
13
7
0
Apr-12 May-12 Jun-12
Jul-12
Aug-12 Sep-12
Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13
Month
NHS
38
Suffolk Community Healthcare
Quality Account 2012 - 2013
Help for People Falling
Generic workers trained in the OTAGO programme
work offer help and support. OTAGO is an evidence
based falls prevention programme of balance and
strengthening exercises.
The Community Health Teams runs a programme to
help people who have fallen or have a fear of falling.
Once referred to our services, patients are given
physiotherapy, occupational therapy and medical review
at our falls clinic or at home.
As well as exercise, the group offers comradeship and
encourages people to take more control over their
health. Aged from the late 60s to early 90s, for all of
them the goal is the same – to reduce their risk of falling
and build their confidence. At the end of the 12-week
course, patients are advised to keep exercising and are
helped to attend a group in the community.
If they are likely to benefit, the patient will be invited
to join our weekly balance group, and follow a home
exercise programme. The format has been changed to
reflect the evidence base for balance exercise, the needs
of the patients and the skill mix of staff. The exercises
mirror functional activities people carry out at home.
Case Study – Day and Treatment Team
Mrs C who is 77 years old suffers from Guillain Barre Syndrome. She was referred to the Day and Treatment
team for rehabilitation because her mobility and balance was very poor, and she was unable to stand or
walk. Her goal was to be able to stand and eventually walk.
The Day and Treatment team devised a treatment plan that included home visits, home exercise, and
lots and lots of one to one circuit exercises - increasing in intensity and making it harder as she started
to improve. The family even changed the dining room and made it into a little gym which helped in her
rehabilitation.
Mrs C is now getting stronger and stronger each day, swimming twice a week, walking with two crutches,
going shopping with husband, and even escorting daughter who is visiting from Australia to go sight-seeing
and shopping. Here is a quote from Mrs C:
“Thank you for all your help and encouragement. It has been really good for me. I feel that I have
come on a lot in the past few months, especially walking up the ramp at the leisure centre with
one rail and one crutch!”
What did we achieve in 2012/2013?
What do we want to achieve in 2013/2014?
•
The Falls and Fracture Policy has been completed
•
•
Monthly inpatient Royal College of Physicians FallSafe audit commenced
To cascade the CQUIN goal and to support staff to
deliver its requirements
•
Increase in assistive technology equipment for all
inpatient units
To consistently implement intentional rounding in
all the inpatient units
•
To purchase more assistive technology for
inpatient units
•
To continue to work (in the East) with the
Consultant from Specialist Falls Service to provide
interface geriatrician cover in community hospitals
and possibly for all community healthcare teams
•
To utilise the interface geriatrician (once recruited
in the West) to support the falls pathway
•
•
Assistive technology training for key staff
•
A Suffolk-wide Falls Champion Conference
•
A physiotherapy team successfully started a
‘better balance group’
•
Falls Champions have been identified and are
working in all inpatient units.
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39
Suffolk Community Healthcare
Quality Account 2012 - 2013
•
To work to integrate the better balance group for
inpatients with dementia exercises
•
To standardise OTAGO exercise for the Community
Health Teams
•
To continue to work on the pilot project (in the
West) with Age UK to employ a ‘falls prevention
exercise co-ordinator’ who will develop a database
resource so that patients can be informed of local
exercise classes so they can continue exercising
after they have been discharged from SCH.
The IFFLS service ensures that all fragility fracture
patients over the age of 75 years receive a falls screen
and osteoporosis assessment within primary care,
working to agreed clinical pathways. Integrating the
IFFLS within primary and secondary care ensures that
the service has been designed to ensure individual
patients receive a targeted assessment with appropriate
treatment and intervention.
Since Oct 2012 the two specialist nurses have
successfully established the following which has firmly
embedded an integrated approach.
Falls and Fragility Fracture Liaison Service (IFFLS)
Last year saw the development of an integrated falls and
fragility fracture pathway across the health, social and
voluntary care sectors in West Suffolk. The aim was to
identify, assess and refer people at risk of osteoporosis,
and at risk of falling. The implementation of this
initiative has been led by two integrated falls & fracture
liaison specialist nurses who worked with all West
Suffolk GP practices to develop their falls and fragility
fracture service and support joined-up working across
the care sector. The falls prevention co-ordinators
continue to work alongside local healthcare teams to
offer assessment and advice for complex fallers, work
with the inpatient units and support training.
During 2012 the initial focus for primary care was on
pro-actively case-finding for the over 75 year old fallers,
to establish falls registers within the 25 GP practices and
to offer those on the register an initial falls screen as
used within Suffolk Community Healthcare. During a 4
months period the following was achieved:
•
Falls and Fracture Clinical pathways were designed
and agreed
•
24,000 over 75yr olds were screened using the
Stage 1 Falls Screen
•
70 Practice Nurses were trained to competently
deliver the Stage 2 assessment
•
Training packs to support learning and onward
referrals were produced.
•
The two specialists nurses assessed all
housebound and 24 hour care establishments’
residents identified on the falls registers, a
total of 433 people.
NHS
•
Patient identification
•
Establishment of clinical pathways
•
Long-term compliance with medication
•
Communication and integration across acute,
community and Primary Care.
•
In the year ahead the two specialist nurses will
work with Community Healthcare Teams and
Specialist Services:
•
To enhance the falls and fracture assessment skills
of CHT staff
•
To provide Osteoporosis training for the CHTs
•
To embed Stage 2 Falls and Fracture Guide within
the community assessment template, supported
by the new IT infrastructure.
In the East of Suffolk there is a Community Osteoporosis
Service led by an Osteoporosis Nurse Specialist. The
service follows up all the patients of 75yrs and over
who attend Ipswich Hospital with a fragility fracture.
Referrals are also accepted from the CHTs, GPs and
other healthcare professionals. In the last year the East
of Suffolk has seen a 30% reduction in fractures. In the
year ahead the service will continue to:
40
•
Implement the falls and osteoporosis pathway
•
Ensure that all patients have a fracture risk
assessment and life style advice
•
Ensure that patients at risk receive calcium and
vitamin D supplements
•
Offer all patients at risk exercise/balance classes
•
Support the CHTs where needed.
Suffolk Community Healthcare
Quality Account 2012 - 2013
Clinical Effectiveness - Introduction
Clinical effectiveness is described as having the right
person (a suitably qualified professional) doing:
•
the right thing (evidence based practice)
•
in the right way (skills and competence)
•
at the right time (providing treatment/services
when the patient needs them)
•
in the right place (location of treatment/services)
•
with the right result (clinical effectiveness/
maximising health gains)
Clinical effectiveness is thinking critically about what you
do, questioning whether it is having the desired result,
and making a change to practice. It is based on evidence
of what is effective in order to improve patient care
and experience. This can happen at Leadership Team,
directorate, department, team, or individual level.
Rehabilitation session with a physiotherapist in a hospital gym
hours of referral, and we also responded to 9550 (out
of 9892) within 72 hours (Table 8). This enables primary
care providers to provide a timely response to patients
that need an urgent intervention, preventing them
becoming an admission to an acute hospital. This is a
good outcome both for the NHS and, most importantly,
the patient, keeping them at home in familiar
surroundings.
We collect and monitor a wide range of detailed data
about how our services are performing. This means we
can identify areas of good performance and maintain
high standards, and importantly we can see if there
are any problems, and take improvement actions. We
use these reports within our committees and Board
meetings, alongside other information to ensure we
have a good understanding about the services
patients receive.
The Delayed Transfers of Care are high for the 6 month
period. However, only a third (33.3%) of these are
attributable to the NHS, whilst the remaining two thirds
(66.7%) are attributable to Social Care. Of the patients
delayed in SCH care only seven were delayed due to a
lack of completion of an NHS continuing care assessment
or equipment. SCH continues to work hard to improve
its discharge planning processes to reduce future delays
for patients in our care.
The next section summarises a relevant sub-set of the
more than 100 key performance indicators reported by
SCH. Followed by a review of the clinical effectiveness
achievements for two of the key prioritises for
2012/2013; as well as an example from our
current services.
In the Minor Injuries unit in Felixstowe only one patient
was not discharged/transferred within 4 hours out of
2667 patients seen. The national target is 98% and SCH
excelled with 99.96%.
The importance of community services in supporting
patients outside of the acute setting has been very
prominent in the news recently. The continued increase
in demand for community services both in the clinic
and home setting is likely to remain a challenge in the
coming year.
On the next page you will find a summary of the key
performance indicators we use to monitor the monthly
performance of our services from 1 October 2012 to
31 March 2013.
During the 6 month period SCH has continue to meet its
target for response times by the community teams. SCH
has responded to 3060 patients (out of 3206) within 4
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Quality Account 2012 - 2013
Table 8 - Summary of Performance Indicators
Summary Performance Indicators
Notes
Face to Face Activity
Oct - Mar
2012/13
Planned
Activity
Al l Servi ces
228,573
Local Health Community Team Response Times to new
referrals
4 hours
72 hours
18 weeks
254,825
6 mth Actual
Al l Servi ces
≤33
53
Data Completeness
Target
100%
Month 12
100%
Target
100%
Month 12
100%
Compliant
15
Non Compliant
0
Compliant
4
Non Compliant
0
Compliant
2
Non Compliant
0
Target
≥98%
Month 12
100%
Target
≤6%
Month 12
1.80%
Estimated Discharge Date
Pledge 2 - 18wk RTT for non
cons led services
Number of Servi ces
18 Week RTT
Number of Servi ces
Diagnostics
Audi ol ogy
Minor Injuries Unit (MIU)
Pa ti ents s een wi thi n 4hrs
DNAs
Al l Servi ces
Length of Stay
Avera ge Length of Sta y
Month 12
25.8
Ta rget i s +- 10% of pl a nned a cti vi ty.
SCH ha s been very bus y i n 2012/13
a nd over-performed i n a cti vi ty.
Over the 6 month peri od SCH
res ponded to a tota l of 3060
pa ti ents wi thi n 4hrs (out of 3206)
a nd we a l s o res ponded to 9550
pa ti ents wi thi n 72hrs (out of 9892).
95.5%
96.5%
99.7%
6 mth Target
Al l Servi ces
26,252
Average over 6
mths
Delayed Transfer of Care
(DTOC)
NHS Number for Outpa ti ents
NHS
Target
≥95%
≥95%
≥95%
Oct - Mar 2012/13 Over/(Under)
Actual Activity
Activity
* refer to a dja cent text
Thi s i s where i npa ti ents di s cha rges
ha ve been del a yed, thi s del a y ca n
be due to NHS or Soci a l ca re
rea s ons . Onl y 7 of thes e del a yed
tra ns fers were due to NHS
a s s es s ment, communi ty equi pment
or domi ci l i a ry pa cka ges , 38 were
due to s oci a l ca re del a ys .
Us i ng NHS numbers mi ni mi zes
errors i n medi ci ne ma na gement,
trea tments etc
No SCH non-cons ul ta nt l ed s ervi ces
ha d wa i ts of over 18weeks for
Referra l to Trea tment (RTT).
Al l SCH cons ul ta nt l ed s ervi ces ha d
wa i ts of l es s tha n 18 week from
referra l to trea tment.
There i s a 6 week referra l to tes t
ta rget for di a gnos ti c s ervi ces .
A l ow Di d Not Attend ra te i ndi ca tes
a n a cti vel y ma na ged a ppoi ntment
s chedul e. DNAs a re a wa s te of ti me
a nd res ources .
Oct-Mar 2012/13
Average
26.3
42
Suffolk Community Healthcare
Quality Account 2012 - 2013
The six month period from October 2012 to March 2013 includes the winter period which often places excessive
demand upon both the acute and community services. However, through this period the average length of stay in our
inpatient units was 26 days and this was as a result of staff working hard to ensure timely discharge for patients.
Figure 4 - Length of Stay in Inpatient Units
Clinical Effectiveness Achievements in
2012/2013
proved possible to fully develop this area of the service
this year. However, through further discussions with the
commissioners, and through our CQUIN framework, we
expect agreement on a care pathway for the next year.
The provision of this element of the service would offer
patients the following:
Clinical Effectiveness 2012/2013 Priority 2
This section and the next provide a review of the
achievements against two of the priorities in 2012/2013
related to clinical effectiveness from services which are
now managed by SEPT.
We said we would provide Speech and Language
Therapy (SLT) services for people with dementia:
There is a drive nationally, regionally and locally to
improve the delivery of healthcare to people with
dementia. Speech and Language Therapy (SLT) has a key
role to play in delivering these services. Research tells
us that about two-thirds of people in nursing homes
diagnosed with dementia will encounter some degree of
swallowing difficulty. A key part of our work is to make
sure that people with dysphagia (difficulty swallowing)
are diagnosed and assessed as soon as possible, in
order to help them eat and drink as safely as possible.
We are working very hard to ensure that our therapists
can provide intervention in the community, as well as
in acute hospitals to achieve this. Whilst the benefits
of SLT input to the treatment and care of people with
dementia remain undisputed, it has unfortunately not
NHS
•
Improved health and wellbeing including
preserving oral intake (eating and drinking)
allowing people to remain at home for longer
•
Patients will be able to express their choice for
future dysphagia management during the end
stages of their condition
•
Allow patients to be seen across the county much
earlier and more routinely for assessment and
management of swallowing problems
•
Patients will be able to access communication
therapy – supporting maintenance of
communication function for longer and help the
carers to develop new communication
•
Facilitation methods and techniques.
What have we achieved in 2012/2013?
Our current service provision supports a single
assessment/advice session with community patients
referred for a swallow assessment due to eating and
drinking difficulties. There is currently no provision
43
Suffolk Community Healthcare
Quality Account 2012 - 2013
for assessment or advice relating to communication
impairment associated with this disorder. Working
together with commissioners and through our CQUIN
framework we will be able to support investment into
the service to extend the current service provision.
•
Practitioner visits to other teams/sites of
excellence across the Eastern Region to help
identify areas of best practice and to inform
local development.
•
Establishment of a local clinical/assessor network
(across the various agencies contributing to
continuing care assessment). This has led to
peer review of assessment outcomes and more
consistent approaches to assessment across
agencies; as well as providing a valuable support
network for clinical staff.
•
Continued input to the commissioning review
panel in Suffolk and contribution to guidance
being developed locally for Suffolk.
•
Operational policy has been drafted and is
awaiting agreement whilst we work with the
new Children’ Complex Care Manager within the
Clinical Commissioning Groups locally to agree the
commissioning framework for continuing care
in Suffolk.
•
A parent information leaflet has been drafted to
help inform families of what to expect during the
process - families have now been engaged in the
development of this to help understand what
they need to help them through the assessment
journey. To this end we have completed an
exercise to contact parents to collect their views
of the pathway and are currently reviewing the
outcomes of this to help inform the format and
content of our information resources.
Forward into 2013/2014 and beyond
•
Specialist assessment of dysphagia
•
Assessment of capacity to consent to treatment
and care
•
Provision of specific programmes to maximise
function and maintain function in later life
•
Train relevant SCH staff, mainly nurses, working
in the inpatient units and CHTs to recognise the
problem and refer patients to the SLT service
•
Train others to manage communication
and dysphagia
•
As with all our services, we aim to offer joined-up
care and this work will be linked to our dementia
care pathway
•
Reduce stress and burden on caregivers by
providing specific management strategies for
people with dementia
•
Specialist input to inform decision making around
non-oral feeding.
The Adult SLT team is working to align practice and
staffing across the county to increase flexibility
for patient care where required. Recent staffing
reorganisation has provided the service with the
opportunity to streamline and is beginning to offer the
benefits of broader support mechanisms in terms of
economies of scale.
Whilst we had intended to deliver training to our staff to
further improve the skills in assessment in this area, our
work in the last year has indicated that formal training
in this area is not readily available to access. Although
formal training is not available from external sources,
the project has enabled us to develop a training package
locally which we will offer to our staff and partners once
the final commissioning framework is known.
Clinical Effectiveness 2012/2013 Priority 3
We said we would: enhance the assessment of children’s
continuing care and improve the experience of families
in need of this support across Suffolk:
Forward into 2013/2014 and beyond
Across the SEPT Community Paediatric Services in
Suffolk we have a number of quality initiatives and
service developments planned as part of our ongoing
cycle of continuous improvement. An example of some
of the more significant areas being:
What have we achieved in 2012/2013?
The Children’s Community Nursing Team Lead and
the Short Break Nursing Co-ordinator have led on this
priority area during the last year. They have developed
a plan, with milestones for achievement throughout the
year, which has been monitored on a quarterly basis.
Key areas of work and associated success in this area
have been:
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44
Suffolk Community Healthcare
Quality Account 2012 - 2013
•
Leading on the development of a multi-agency,
integrated Communication Strategy for Suffolk.
This will target services for Children and Young
People with Speech, Communication and
Language Needs and the needs of children
experiencing problems in this area. Our aim is
to facilitate the development of this Strategy
to improve outcomes for children and focus on
new ways of working to meet the continued high
demand for support in Suffolk.
•
Continuing the work of the Suffolk Children’s
Integrated Palliative Care Network (currently
chaired and coordinated by SEPT with active
multi-agency involvement) and reinvigorating the
group with refocused priorities and action plans
to look at emergency care plans, transition and
parent/child engagement across the network. We
will also actively engage with our CCG colleagues
to focus commissioning intentions in this area,
translating the National Agenda of “Together for
Short Lives” with the Regional work completed in
the Children’s Palliative Care Network into
local actions.
•
Reviewing our paediatric therapy teams in order
to explore opportunities for further integration,
innovation and transformation and developing
further opportunities for integration within clinical
pathways along with partner agencies.
•
Developing a local estates strategy which will
include review of our current core sites for service
delivery; with a view to exploring opportunities
for new sites for delivery or ways of working to
support our most complex children.
•
Working with our colleagues in Norfolk and
Suffolk Foundation NHS Trust CAMHS services to
jointly develop services to support children with
autism where there are currently identified gaps
in service provision.
•
Examples of our services
Specialist Services – Pulmonary Rehabilitation
Programme
A pulmonary rehabilitation (PR) is defined as “…………..
an interdisciplinary programme of care for patients
with chronic respiratory impairment that is individually
tailored and designed to optimise each patient’s physical
and social performance and autonomy. Programmes
comprise individualised exercise programmes and
education”. PR should be a core component of the
overall management of patients diagnosed with
COPD which can result in disabling breathlessness.
By providing individually tailored physical exercise
training, self -management advice and multi-disciplinary
education, the aim is to reduce symptoms, improve daily
function and activity leading to best achievable level of
independent living. The course is often demanding both
in terms of time, physical and psychosocial investment.
Therefore motivation to engage in the rehabilitation
programme is to be encouraged.
Local Context
The Suffolk Pulmonary Rehabilitation Programme is
now provided by SCH. A team consisting of a clinical
lead, qualified physiotherapists and PR assistances was
developed, with more staff being recruited and trained
as the service evolves. Developments included the
PR assessment tools, the programme, sourcing local
venues across Suffolk and identifying speakers for the
educational component of the programme. Referrals are
accepted from a broad range of healthcare professionals
for patients with a confirmed diagnosis of COPD.
The Course
The pulmonary rehabilitation programme is a group
Reviewing and developing services for Looked
After Children and those undergoing Adoption
in partnership with our local authority and
commissioning colleagues.
sessions for around 10 people and runs as twice weekly
sessions for up to 6 weeks. Each session lasts for up
to 2 hours and each session consists of an individually
tailored exercise programme and an education
component aimed at improving the understanding
of living with COPD. Each exercise programme is
monitored and progressed at every patient contact. A
final assessment, incorporating all previously recorded
outcome measures is undertaken with a review
assessment 3 months later.
As you will have read from 1st October 2012, these
services became part of SEPT – a copy of their Quality
Account for 2012/13 can be found on the SEPT website –
www.sept.nhs.uk.
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45
Suffolk Community Healthcare
Quality Account 2012 - 2013
Patient Experience
Making sure our patients have a good experience while
they are in our care, in whatever setting, is a priority for
all our staff. Our goal is to provide safe, effective and
appropriate care with dignity and respect, and to do that
we make sure that we listen to what our patients and
their families think about our services.
The next section focuses on key aspects of patient
experience which include complaints, compliments,
patient surveys and the outcome of an in-depth patient
experience study commissioned by SCH. This is
followed by a review of our achievements against the
patient experience priority for 2012/2013, as well as
other achievements.
The Pulmonary Rehabilitation Programme in action
People are encouraged to continue exercising long
after they have completed a PR programme. To support
this, people are encouraged to stay in contact with
each other, join a local gym or exercise class (exercise
professionals are included in our list of educational
speakers, discount costs are available) and to join a local
British Lung Foundation (BLF) breathe easy group.
Our Patient Experience Group, senior staff from across
SCH, meet regularly to assess all the information we
have from patients: complaints, compliments and
surveys. This group also looks at national and regional
strategies to improve patient experience, and works with
organisations such as Age UK to learn about concerns
reported by their client groups.
The improvements in peoples exercise tolerance/
activities of daily living are often something beyond
which they ever thought they could achieve. This is
borne out by the outcomes of the final assessments,
verbal and written feedback
The trend for the number of complaints for the six
months documented in this report is in line with the
total number of complaints received in the previous
complete financial year. We continue to take every
complaint extremely seriously and ensure there is timely
and thorough investigation. Where change is needed
it will be introduced as soon as possible, and we make
sure that learning is shared across the organisation as
well as in the team involved. The aim is to prevent the
incident from happening again, and to improve our care
as a result.
Case Study: Mrs X was an 84 year old lady,
following treatment for an exacerbation of
her COPD, she was referred to the pulmonary
rehabilitation programme. As part of the
programme Mrs X was taught specific exercises to
help improve her lung muscles and confidence and
she achieve her goal. This was to go up and down
the stairs three times a day. She is now able to
visit other premises where she is not reliant on a
lift and she has joined the local gym.
The number of recorded compliments continues
to increase, for the 6 month period there were 254
compliments, which has in part been driven by an
increased effort to encourage services to promote the
positive work they are performing (Table 9 & Figure 5).
Patient Feedback: “The Pulmonary Rehab
has been excellent for me. I am much more
confident in myself, and staff have been
brilliant”
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Quality Account 2012 - 2013
Table 9 - Complaints & Compliments Summary
2009/2010
2010/2011
2011/2012
1/10/12 to 31/3/12
Total Compliments
316
314
433
254*
Total SCH Complaints
92
42
22
11*
% of Responses within 25 days
84%
95%
100%
100%
Request for review by NHS Suffolk
3
2
2
0
Referral to Ombudsman
1
0
1
1
Adult East
Not collected
Not collected
9
5*
Adult West
Not collected
Not collected
8
6*
Community Paediatric Services
Not collected
Not collected
3
0*
Wheelchair Services/Community
Equipment Services
Not collected
Not collected
2
0*
Complaints by directorate
* Results are for ½ year only.
Figure 5 - Complaints and Compliments Trends
Complaints & Compliments trends
100
90
80
70
60
Complaints
50
Compliments
40
30
20
10
Ap
r-0
Ju 8
n0
Au 8
g08
Oc
t-0
De 8
c0
Fe 8
b0
Ap 9
r-0
Ju 9
n0
Au 9
g09
Oc
t-0
De 9
c0
Fe 9
b1
Ap 0
r-1
Ju 0
n1
Au 0
g10
Oc
t-1
De 0
c1
Fe 0
b1
Ap 1
r-1
Ju 1
n1
Au 1
g11
Oc
t-1
De 1
c1
Fe 1
b1
Ap 2
r-1
Ju 2
n1
Au 2
g12
Oc
t-1
De 2
c1
Fe 2
b13
0
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Quality Account 2012 - 2013
Compliment and Complaint Management
about services, including taking part in the “Listening”
forums organised by NHS Suffolk. These events bring
together local people and representatives of services in
the county, especially those who represent hard to reach
groups. SCH staff work with them to listen to and record
concerns about healthcare in the community, and as far
as possible, address them.
All the compliments we receive are also collated, and the
staff involved acknowledged and thanked. A monthly
selection is posted on our intranet site and highlighted
in our newsletter. We guard against complacency, and
have a rolling programme of patient surveys across our
services to find out more, as shown in Table 10. While
they are overwhelmingly positive, the surveys pick up
issues about which we need to be aware.
Whenever SCH receives a complaint there is a robust
process in place to manage it which includes a though
investigation, timely feedback to the patient and/
or family carer and most importantly any learning is
cascaded throughout the organisation.
We work with a number of organisations from a range
of sectors to listen to what our community has to say
Table 10 - Patient Survey Indicators
Comparison of annual results
2009-2010
results
2010-2011
results
2011-2012
results
1/10/12 to
31/3/13
Yes, all the time to Q6 (Did the member of staff treat
you with respect, dignity and in privacy?)
93%
95%
97%
87%*
Yes, completely to Q8 (Did you get answers to your
important questions?)
85%
85%
89%
93%*
Yes, completely to Q9 (Did staff explain reasons for
treatment or action in a way you understood?)
Not collected
87%
87%
87%*
Yes, definitely to Q10 (Were you involved as much as
you wanted in decisions about treatment?)
Not collected
80%
83%
87%*
Composite score
Not collected
87%
89%
88%*
Yes to Q12 (Would you recommend this service?)
Not collected
99%
99%
98%*
Total number of patients responding/month (average)
Not collected
206
170
109*
Number of patients surveyed/month (average)
Not collected
641
343
207*
Total number of patient episodes/month (average)
Not collected
14934
7657
5474*
% of patients surveyed/month (average)
Not collected
4.28%
5%
3.8%*
* Results are for ½ year only.
The results for the patient experience scores from the six months detailed in this report have shown some
improvement in the scores relating to how SCH staff interact verbally with their patients e.g. explaining reasons for
treatment and providing answers to important questions. There was also a decrease in the total number of patient
episodes per month due to the transfer of services to other providers.
NHS
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Suffolk Community Healthcare
Quality Account 2012 - 2013
The Net Promoter Friends and Family Scores
The NPS is calculated by asking service users to indicate
against a range of answers whether they would
recommend the service to their friends and family. The
range of answers are broken down into 3 groups, namely
a promoter, passive or detractor response and from the
percentage returns in each category a ratio or score is
calculated. The NPS can run from +100 to -100, with a
positive score indicating a higher proportion of service
users who would recommend the service.
One of the CQUIN targets for the financial year 2012/13
was to collect and report on the net promoter score
(NPS). This is also sometimes referred to as the friends
and family score and is a government initiative that allows
patients and members of the public to easily compare
the standard of service provision across providers. The
services initially involved within Suffolk Community
Healthcare are the four inpatient units although it will be
rolled out to all other community services over the next
few months.
The charts below illustrate that overall there were
positive scores from the service users’ responses
(Table 11 and Figure 6).
Table 11 - Net Promoter or Friends and Family Scores
Net Promoter Score (Oct’12-Mar’13) For the Inpatient Units
October
November
December
January
February
March
YTD 12/13
ACH
86
89
67
38
60
80
+73
BBL
No return
75
53
No return
79
80
+74
FCH
No return
No return
42
100
100
86
+78
NCH
0
70
90
73
-13
100
+60
Monthly
NPS
+46
+77
+59
+68
+66
+83
+72
Figure 6 - Overall SCH Monthly & Year to Date Net Promoter Scores
Overall SCH Monthly & YTD NPS (12/13)
100
80
80
60
60
40
40
20
20
NHS
NPS score
(YTD)
NPS
12
/1
3
YT
D
h
M
ar
c
Fe
br
ua
ry
Ja
nu
ar
y
ec
em
be
r
D
ov
em
be
r
N
-20
0
ct
ob
er
0
O
NPS
100
-20
-40
-40
-60
-60
-80
-80
-100
-100
49
NPS score
(month)
Suffolk Community Healthcare
Quality Account 2012 - 2013
Patient Experience Study
At the end of 2012, Suffolk Community Healthcare commissioned an in depth study into the experience of patients
using its services in Community Hospitals, Clinics and Home Care settings. Initially 26 45 minute telephone interviews
were conducted, followed by 10 interviews with patients in our community hospitals. A survey question set was then
developed from the findings of the interviews and in discussion with Suffolk Link and Suffolk Family Carers. In March
2013 a postal survey was sent out to 3,683 patients and carers who had used the service in the last six months. 1,267
completed surveys were received, a response rate of 34%.
Patients and carers were initially asked the Friends and Family test question ‘How likely would you be to recommend
the service to family or friends if they needed similar care or treatment’. The overall resulting score of 65 tells us that
70% of patients would be ‘Extremely Likely’ to recommend the service, with 5% saying they would be Neither likely
nor unlikely, Unlikely or Extremely Unlikely to recommend. Patients most often
gave caring, kind, considerate and helpful staff as their reason
for recommendation.
This result was backed up by the strongly positive ratings given across a
number of areas, with 99% of home/clinic patients agreeing that staff are
always friendly/polite, 97% of patients agreeing that staff always explain the
procedure/treatment and 94% agreeing that staff made them feel comfortable
about asking questions.
Areas where the results suggested most scope for improvement and focus
were around information, communication and co-ordination of care. For
example, information about access to support groups, making written information accessible and keeping patients
informed about length of time they may need to wait for an appointment scored slightly less well. For some patients,
co-ordination between services and between different staff that they may see
could be improved.
The study has provided the team with an in depth view of patient and carer
experience across the range of the services provided.
Many areas of strength, where patients have reported excellent levels of care
have been identified but the report also identifies some areas where the team
will focus improvements over the year ahead.
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Suffolk Community Healthcare
Quality Account 2012 - 2013
Summary Results – Home/Clinic Setting Patients
Home/Clinic patients
Home/Clinic Patients
Continuity of care (and in particular
non-clinical care) received least
positivity
Staff well rated (positively impacting
on perceptions of care)
Quantitatively, there was no real
negativity towards the appointment
system
Communication levels were good
Home/Clinic Patients - Detail



?
?
?
NHS
Flexibility: ability to receive services such as OT’s and physiotherapy at home is highly
appreciated by patients and felt to be a real benefit for them – some of whom struggle to
make appointments at hospitals which are often at a good distance from home and often
require a taxi and therefore become expensive
Staff delivering Home/ Clinic Setting services scored very highly on aspects such as
being friendly, explaining procedures, being respectful of individual needs with 96% of
patients having confidence in them
94% of patients agreed that they were involved as much as they wanted to be in
decisions about their treatment and 93% felt that their care plan was explained in a way
they could understand
Awareness of and referral to aftercare support services is sporadic – some patients
talked of being armed with information and support about the possible services they could
rely on for support while others felt very much in the dark about this and often relied on
word of mouth to find out about important services that they are eligible for
Scores were lowest (66% agreeing) for patients being told how to access emotional
support if they needed it. 84% agreed that they were given advice on general health
and well being and 82% agreed that extra support with day to day activities was made
available
Carers scored lower than patients on all aspects of the survey, with only 76%
agreeing that they were kept informed about changes to the patient’s care plan, and 45%
agreeing that they were told how to access emotional support if they needed it
51
Suffolk Community Healthcare
Quality Account 2012 - 2013
Summary Results – Community Hospital Patients
Community Hospitals
Community Hospitals
Excellent Physical Comfort/
Environment ratings
Lack of staff/ staff contact a concern
Staff well rated
Information not easily understandable
Clinical Care good
Community Hospitals - Detail




?
?
?
?
NHS
Staff at in-patient facilities such as Ipswich, Newmarket and Bluebird hospital were consistently
described as professional and attentive
The level of care provided was generally felt to be very good and staff were often described as
caring, friendly individuals
The majority of patients felt confident they would receive the necessary support to get out of,
and into bed as well as washed and cleaned which meant patients felt respected
The physical environment was felt to be very good and consequently patients were generally
very comfortable - some did not want to go home!
Satisfaction with food was high with and ample serving sizes, an appetising menu and patients
appreciated the menu system where they could order in advance
Understaffing was highlighted as a problem causing regular strain on the routine support
lnformation - some patients were disappointed with basic leaflets and would have appreciated
a more personal touch, talking through health concerns physio exercises etc. Furthermore,
some leaflets were inaccessible - text or pictures too small and not fit for purpose
Some patients felt that they did not receive enough information about treatment plans and
expected discharge – with too little discussion about their situation with doctors or specialists.
Others reported that information such as telephone numbers for aftercare support services was
not correct
Finally some patients found themselves discharged from hospital without clear instructions
regarding their aftercare - given medication (such as injections) without instructions or
guidance how to administer them which left them feeling nervous
52
Suffolk Community Healthcare
Quality Account 2012 - 2013
Patient Experience Achievements in
2012/2013
This resulted in 421 patients being assessed during a
three month period. Of these 195 were transferred to a
‘winter pressure bed’ within nursing homes. 34% were
from A&E or the assessment wards, and can therefore
be identified as admission prevention, 61.5% were
on an in-patient ward and transferred as a supported
discharge, and the remaining 4.5% had refused ACS
transitional care or were awaiting care start dates if
privately funded.
Patient Experience 2012/2013 Priority 4
We said we would improve the effectiveness, quality,
safety and patient experience of discharges from acute
hospitals to the community; working more closely
with community teams to facilitate discharge from
community hospitals:
Patient pathways were examined and the usual process
for community beds streamlined with increased
understanding and communication, and designated
therapists at the ‘front door and assessment wards.’
The dedicated IDPT staff member for ‘winter beds’
also attended the daily bed meeting, and escalation
meetings with senior acute hospital managers where
specific patients were identified and discussed prior to
assessment. This ‘in reaching’ at a high level enabled
joint working to ensure appropriate patients were
included. Robust initial assessment and accurate goal
setting, along with comprehensive referral criteria,
improved patient flow and also reduced length of stay
within the winter beds. Of the 195 patients transferred
to a winter bed only 16 were re-admitted to hospital due
either due to deterioration in condition or an unforeseen
medical occurrence.
Improving Discharge Planning
In May 2012 it was identified that ‘simple’ discharges,
which were being hand written and faxed direct to
community teams from ward staff within Ipswich
hospital, were causing some issues. As a result the
integrated discharge planning team (IDPT) took over the
processing of all referrals, which proved very successful,
reducing risk, improving communication with the
community teams and providing a better understanding
of discharge data. Alongside this a new system was
introduced to deal with addressing incident reporting
within Ipswich hospital. This also influenced other
initiatives such as a ‘check list’ for the ward staff to work
through when referring to community services, which is
now on every ward computer.
The concept of the discharge planning ‘link nurse’ was
expanded in June 2012 to also include community
bed facilities with attendance at the weekly MDT
meeting within the community hospitals inpatient and
commissioned bed facilities. This again has improved
communication and allowed feedback and dialogue
between acute and community staff via the link nurse
who was also able to follow patients throughout their
journey from acute hospital to the rehabilitation facility.
‘Link nurses’ were also established within specialties,
such as palliative care, tissue viability, stroke, dementia
and provision of equipment.
Feedback from all involved including NHS Suffolk,
Nursing homes, Ipswich Hospital and IDPT stated that
“Engagement and joint working from all involved
resulting in an overall massive improvement from
last year”
How did we perform in 2012/2013?
The winter bed initiative 2012/13 provided the
opportunity for IDPT staff to look at assessment
and transfer of patients from the acute setting to
beds commissioned within nursing homes and trial
alternative systems and procedures, this work built upon
other initiatives to look at how we assess and gather
information prior to patient transfer or referral.
NHS
•
Increased joint working with both acute and
community colleagues
•
Robust risk management procedures at ward level
•
Trialling of new ways of working with regard to
referral to winter beds.
Once patients and families understood the ‘Winter beds
scheme’ they were very positive with many patients
asking to return in the future if the need arose, although
no formal feedback was ascertained there were no
patient complaints and informal feedback
was complimentary.
53
Suffolk Community Healthcare
Quality Account 2012 - 2013
What do we want to achieve in 2013/ 2014?
•
Continue work on more efficient referral
processes to ensure community staff receive
timely and appropriate information
•
Continue work on improving the quality and
process of transfer from acute hospital to
community bed based services
•
Continue to strengthen partnerships across acute,
community, social care and voluntary sectors to
work together to make improve the quality
of discharges
•
Continue the implementation of an in-reach
model to the acute hospital in order that
discharges are proactively managed
•
Improve the co-ordination and management of
community beds
•
Continue to integrate work across admission
prevention and supported discharge elements
of the CIS.
People with dementia and their families often tell us
they are fearful of seeking a diagnosis. Yet a timely
diagnosis opens the door to support, treatment and
information that people would otherwise not have
access to. While there is no cure at present, the right
treatment and support can help slow the progression
and improve the situation for people with dementia
and their carers.
How will we monitor our progress in 2013/2014?
A tool for people with dementia receiving professional care
We recognise that there are still improvements to be
made and during the coming year, we will continue to
monitor progress through the:
•
Robust CQUIN monitoring process
•
Good communication with key stakeholders
•
Regular progress meetings
•
Clinical quality and safety assurance committee
•
Monitoring of relevant data such as readmission
rates, waiting times and patient and carer
experience feedback.
Suffolk Community Healthcare has undertaken
considerable work during the past year to further
advance the priority of improving the patient and carer
experience for people living with dementia.
Examples include:
Patient Experience 2012/2013 Other Achievements
Another example of the patient experience work we
have undertaken this year is explained below.
•
A workforce development programme for all
staff challenging traditional ways of thinking and
promoting good practice.
•
Improving the environment in the Community
Hospitals to ensure they are more dementia
friendly.
•
Working with local Museums to provide materials
and input from their staff in cognitive stimulation
sessions at community hospitals.
•
Supporting Dementia Champions who contribute
towards transforming the quality of care for
people with dementia.
•
Setting up a comprehensive website on Dementia
Care. This has a wealth of information on assistive
technology, adapted living environments,
information from other organisations, innovations
and research.
•
Adopting tools and techniques which have been
shown nationally to improve communications
between patient, families and staff.
Dementia Care
Suffolk has a relatively elderly age profile with 19% of
the population aged 65 and over, compared to 16.5% in
England. 65s-84s are projected to increase in number by
92,400 and age 85 and over by 28,800 by 2031. This is
an increase of 67% and 148% respectively. In Suffolk, it
is estimated there are 5,500 people with dementia who
are not diagnosed.
NHS
54
Suffolk Community Healthcare
Quality Account 2012 - 2013
Key priorities for next year include:
are encouraged to participate in organised activities
and initiatives. Health and Wellbeing Champions
introduce initiatives to their teams that encourage
healthy eating and lifestyle and develop a good
approach to work/life balance.
There is still more to be done to ensure there is
continuous improvement for the patient and carer
experience for people living with dementia, this
will include:
•
Events have included:
Continuing a cultural change towards involving
patients, and those closest them, as partners
in care.
•
Working in partnership with other organisations
to avoid unnecessary admissions to hospital and
ensure that when admission is necessary it is as
short as possible.
•
Offering a holistic rehabilitation programme that
brings about improved memory, orientation,
changes in behaviour and increased levels of
involvement in day to day living tasks.
•
Adaptations and assistive technologies to improve
patient safety, independence, privacy and dignity
in hospital and peoples’ own homes.
•
Donations distributed to local hospitals, children’s
hospice and a homeless family hostel
•
Pedometer challenges with teams counting steps
over 4 days
•
Relaxation sessions
•
Staff flu vaccinations
•
A 10 mile sponsored walk around Felixstowe
•
A sponsored bike ride from Ipswich Hospital to
Bury St Edmunds
•
Table-tennis sessions.
SCH won the NHS East of England’s Summer of Fun
Competition. Trusts were challenged to keep weekly
activity diaries recording half hourly periods of a
diversity of sport and everyday events such as dog
walking, gardening and reading. Recognising the
importance of mental health, and today’s stressful
workplace, the prize money was used to help fund
‘developing personal resilience’ workshops for staff.
A development programme to facilitate a more
knowledgeable, confident and competent
workforce addressing the needs of people with
dementia and cognitive impairment
Patient Feedback: “What a wonderful hospital
to attend, all the staff were very friendly, helpful,
understanding, reassuring and thoughtful. No one
could wish for any better treatment anywhere.
I felt so well looked after throughout my visit. A
really big thank you to all the staff for their care,
treatment and kindness”
A £50 book token was provided by the Workforce
Development group to present to the winner of
a random draw of Summer of Fun competition
participants. The book token was won by a staff
member of SEPT.
Workforce Development in 2012/2013
Developing the Skills Needed for the
Workforce of the Future
Health and Wellbeing Update
SCH is committed to the personal development of its
workforce to enable them to excel in their chosen career
for the organisation, for their self-fulfilment and to
ensure excellent care for the people of Suffolk.
This year, Suffolk Community Healthcare has worked
towards reaching the standards of Staying Healthy at
Work accreditation known as “aSHaWd”. Once all the
requirements are achieved SCH will receive an aSHaWd
certificate demonstrating that we are an organisation
prioritising the health and wellbeing of our staff. Staff performance is reviewed annually through a robust
personal development review process when skills
development needs are assessed. This is supported
by substantial mandatory and continued professional
development programmes to meet personal
Utilising the SCH website and training staff to become
team workplace health and wellbeing champions, staff
NHS
•
55
Suffolk Community Healthcare
Quality Account 2012 - 2013
development needs and to ensure our staff are equipped
to provide safe first-class health care for patients. The
programmes include mandatory information and clinical
skills updates, Apprenticeships, Foundation Degrees,
Diplomas, Degrees and Masters Qualifications.
for school leavers and for those requiring placements
prior to being accepted on to undergraduate University
programmes.
Our Future Workforce
Over 150 student placements have been made
available for nursing and therapy students to provide
practical experience in support of academic study whilst
working towards a professional qualification at partner
Universities.
Offering Pre-registration Nursing or Therapy Student
Placements
SCH is equally committed to attracting new staff to
ensure the employment of high calibre clinicians and
health professionals to provide a workforce of excellence
to care for the people of Suffolk in a rapidly changing
health environment. To do this essential links with the
public and local schools have been maintained by:
Providing Apprenticeships
Suffolk Community Healthcare has continued to provide
staff with apprenticeship training leading to nationallyrecognised qualifications. During the year seven
employed staff and one non-employed young apprentice
began their apprenticeships. Six of these are working
towards Health and Social Care apprenticeships and one
towards Business Administration apprenticeships. The
organisation looks for ways to provide apprenticeship
placements for young people and Newmarket Hospital
has recently created a temporary position of Ward
Clerk to support a young apprentice to achieve an
Apprenticeship in Business Administration whilst gaining
valuable work experience.
Attending School Careers Fairs
SCH continues to attend careers fairs within schools and
colleges in Suffolk whenever the opportunity arises. This
gives the opportunity to provide detailed information
and discuss employment possibilities directly with those
interested in a career in the health sector
Offering Work Experience Placements
A significant number of work experience placements
have been provided on request within many services
across the organisation meeting requests, e.g. Day and
Treatment Service, In-patient Community Hospitals,
District Nursing. All placements provide opportunities
for our visitors to experience life within busy health
teams in areas across Suffolk, working with nurses,
physiotherapists and other healthcare professionals.
Many placements are provided for those of school age,
SCH’s apprentice numbers have contributed to an
overall NHS Suffolk total of 119 apprenticeships against
a target number of 91. SCH is committed to providing
apprenticeship training as appropriate for staff.
One young apprentice who worked as a non-employed Apprentice
Administrator in our Workforce Development Department has now secured
a permanent position with Serco in the new Care Co-ordination Centre:
“I applied for an apprentice position in May 2011 and was offered a young
apprenticeship post as an Administrator in the training department. During
my time with them I have learned how to carry out basic administration,
understand and use the training database, take phone call and e-mail
queries from staff about training and many other skills. In September 2012
I was offered a temporary contract in the same department. When SCH
transferred to Serco I was offered a job in the Care Co-ordination Centre
where I am now enjoying working”.
Nikita Wicks, former apprentice now full-time staff member
NHS
56
Suffolk Community Healthcare
Quality Account 2012 - 2013
Future Plans
Leadership Development
The transfer of services and staff to the new organisation
has prompted a significant restructure of services and
jobs roles. To ensure staff are equipped to perform to
their best ability an organisation-wide training needs
analysis is being designed and tailored to individual
roles. This will help to inform a robust targeted training
programme to ensure all staff possess the appropriate
skills to provide first-class clinical care for the population
of Suffolk.
We have already implemented a new Personal
Development Review system linked to the NHS
Leadership Framework and Serco H3 Leadership Model.
Both link to the values and guiding principles of SCH. A
consistent approach to leadership development will take
effect over 2013, including coaching, 360 appraisals,
delivering team building and training to support having
difficult conversations. We also continue to have a
commitment to the local Suffolk Leadership Academy.
Leadership Development will be a significant priority,
providing staff with the development and understanding
they need to take the organisation forward whilst
embracing new technologies and ways of working.
Management Development
Ongoing training will be provided to line managers,
some of which are new in post, to development general
management skills in subjects such as managing
sickness absence and performance management, staff
engagement and communication. The roll out of *MyHR
also means that managers will need to change the way
they work to be more self-sufficient using on line tools
and remote access to HR advice.
SCH will continue to have close links with other NHS
bodies including the Norfolk and Suffolk Workforce
Partnership Group which will provide continuous
professional development funding to support training
for all staff.
SCH will continue to provide student placements in
conjunction with our partner universities to ensure that
clinical students preparing to join our workforce have
the benefit of excellent practical experience within
clinical teams alongside our qualified staff.
Staff Engagement
We have always been interested in the views of staff,
and engagement with staff is a priority for the new
Leadership Team. Staff roadshows throughout the
consultation period proved very effective and we are
keen to maintain the same level of engagement. The
new Team Brief will ensure a consistent message reaches
all staff via line managers. Leadership Team visits to
staff meetings will improve two way communication at
the front line and getting back to the floor will open up
opportunities for senior managers to undertake a day in
the life of
Work will be undertaken to develop links with Higher
Education Institutions to attract newly qualified staff
straight from education, ensuring SCH attracts the best
clinicians into its workforce.
Serco *MyHR will provide specialist recruitment advice
for staff on all aspects of recruitment to ensure a
seamless recruitment experience.
(*MyHR- Serco service centre for HR and recruitment
plus an internet based tool.)
Health and Wellbeing
Organisational Development in 2013-2014
We have a strong focus on Health and Wellbeing, and
in 2013 we will re-launch initiatives as part of staff
engagement and in line with Serco priorities. We
continue to train champions and will be looking to
use this network to support the achievement
of accreditation.
SCH has been through a major restructure that
has changed the way all staff work. The focus for
organisational development going forward will be
to embed these changes through leadership and
management development, the roll out of *MyHR,
staff engagement and re-launch of our health and
well-being initiatives.
NHS
57
Suffolk Community Healthcare
Quality Account 2012 - 2013
Communications and Staff Engagement in
2012/2013
to be communicated and embedded. We made sure
that we provided support as different processes for the
dozens of actions that support healthcare provision from
the payroll to stock ordering were introduced.
As with any organisation, our greatest asset is our staff.
Serco employs about 950 people (the remaining 400 SCH
staff are now employed by SEPT and CDS), working in a
wide variety of roles and in varying settings across the
whole of Suffolk.
We launched a staff consultation on 31 October 2012,
which laid out the plans for the workforce and changes
in working practices, such as the setting up of the
Community Health Teams and the introduction of the
Care Co-ordination Centre. Bringing in these changes,
aimed at improving our services, meant that some posts
would be relocated, fundamentally changed, or in some
cases would no longer exist. There was a commitment
that no frontline staff would be made redundant, and
every effort was made to find a good outcome for all our
people, whatever their roles.
Preparing staff for fundamental organisational change
has been part of our work for a number of years.
From March 2012, when Serco was announced as the
preferred bidder for our services, we made every effort
to keep staff up to date every step of the way, and to
support them in making their voices heard.
With the transition to Serco in October 2012, it
was more important than ever to keep our people
fully informed and able to have their say about the
transformation of our services. Facing change brought
challenges for everyone, so it was important that we
did all we could to maintain morale and make sure that
providing excellent patient care remained our primary
focus. Thanks to the commitment and dedication of
our staff, and the skills of team leads and managers,
this was largely accomplished. However, this has been
a challenging time for all our people. There are things
that we could have done better, but we are taking those
lessons on board for the future.
By the end of April 2013 the reorganisation was virtually
complete, and fewer posts than originally anticipated
were lost from our structures. A number of staff, in
managerial or support roles, have chosen to take
redundancy or leave the organisation, and we have done
our best to support them through that process.
Our challenge now is to embed the changes and
efficiencies planned in the transformation, and deliver
the improvements in our services that we have promised
to our patients and our staff. As well as our familiar
routes, we now have access to the expertise and
resources of Serco, including the Our World intranet
portal which supports Serco people worldwide.
Our routes for staff engagement include our intranet,
regular newsletters and updates, letters, emails;
and face to face contact at road shows or in team
meetings and one to ones. We received and answered
a thousand queries from a dedicated staff consultation
email address.
We are setting up virtual engagement forums and
collaboration rooms which, with mobile working, will
help us keep in touch with all our SCH colleagues.
Through our leadership structure, we are committed to
building on the relationships that exist within our teams
and creating a “one team” spirit across SCH.
As well as the overarching plans for improvement that
are changing the way our people work and deliver our
services, there were many smaller changes that had
NHS
58
Suffolk Community Healthcare
Quality Account 2012 - 2013
Closing Statement from Patrick Birchall, Chief Executive Officer.
I am extremely privileged to have been able to present the quality achievements of Suffolk
Community Healthcare during 2012-2013, along with our priorities for the year ahead. Despite
it being a time of transition for our staff, they have continued to work tirelessly to deliver a
quality service to our patients and to strive for continuous improvement, which, I believe, has
been reflected within this report.
Thank you for taking the time to read this Quality Report, which I hope you have enjoyed. I
would welcome feedback on its content and format, and any ideas you may have as to how we
might improve the report in future years.
If you have any questions or comments about this Quality report please contact:
Christian Jenner (Communications Officer)
Email at: christian.jenner@suffolkpct.nhs.uk
Telephone on 01284 718259
Receiving treatment from the Pulmonary Rehabilitation Team
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ANNEX
Statements from Organisations and Committees
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Ipswich & East Suffolk Clinical Comissioning Group
West Suffolk Clinical Commissioning Group
Rushbrook House
Paper Mill Lane
Bramford
Ipswich
IP8 4DE
QUALITY ACCOUNTS
Ipswich and East Suffolk Clinical Commissioning Group and West Suffolk Clinical Commissioning
Group, as the commissioning organisations for Suffolk Community Healthcare, confirm that the
organisation has consulted and invited comment regarding the Quality Account for 2012/2013.
This has occurred within the agreed timeframe and the CCGs’ are satisfied that the Quality
Account incorporates all the mandated elements required.
The CCGs’ have reviewed the Quality Account data to assess reliability and validity and to the
best of our knowledge consider that the data is accurate. The information contained within
the Quality Account is reflective of both the challenges and achievements within the Trust over
the previous 12 month period. The priorities identified within the account for the year ahead
reflect and support local priorities.
Ipswich and East Suffolk Clinical Commissioning Group and West Suffolk Clinical Commissioning
Group, are currently working with clinicians and managers from Suffolk Community Healthcare
and with local service users to continue to improve services to ensure quality, safety, clinical
effectiveness and good patient/care experience is delivered across the organisation.
This Quality Account demonstrates the commitment of the Trust to improve services. The
Clinical Commissioning Groups endorse the publication of this account.
13 June 2013
www.westsuffolkcommissioning.co.uk • www.ipswichandeastsuffolkccg.nhs.uk
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Date: 21 May 2013
Enquiries to: Theresa Harden
Tel: 01473 260855
Email: Theresa.harden@suffolk.gov.uk
For the attention of:
Mary Heffernan
Head of Adult Services, Operational Lead Suffolk Community Healthcare
Stow Lodge Centre
Chilton Way
Stowmarket
IP14 1SZ
Dear Mary
Quality Account 2013
Please find below a statement for this year’s Quality Account, which was agreed by the Chairman
and Vice-Chairman on behalf of the Suffolk Health Scrutiny Committee, prior to the county council
elections which took place on 2 May:Due to the County Council elections this year, the Suffolk Health Scrutiny Committee was unable
to meet to discuss the content of this year’s Quality Accounts during the timescales set by the
Department of Health. In previous years, the Committee has not commented individually on providers
Quality Accounts, as it has taken the view that it would be appropriate for Suffolk LINk to consider the
documents and comment accordingly. The Committee is aware that the dedicated Quality Accounts
Working Group established by Suffolk LINk has continued its work on Quality Accounts for 2012/13
and will be providing its views to the Healthwatch Board for formal ratification and submission to
Suffolk providers.
The Committee has, in the main, been happy with the engagement of local healthcare providers in the
work of the Committee over the past year, and is keen that these relationships continue to develop
to ensure the best possible health services for the people of Suffolk. Consideration will be given to
discussions with providers about how they are performing against their agreed targets, and potential
scrutiny issues raised, when the Committee reconvenes in summer 2013. Yours sincerely
Theresa Harden
Business Manager (Democratic Services)
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