Quality Account
2012–2013
EXCELLENT CARE AT THE
HEART OF THE COMMUNITY
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QUALITY ACCOUNT 2012/2013
Contents
of our Quality Account 2012/13
PART 1
PART 2 (continued)
Overview
Our priorities for improvement and statements
relating to the quality of the services we provide
 Statement from our Chief
Executive & Chair
3
Statements of assurance from our board:
 Information Governance Toolkit
attainment level
 Clinical coding error rate
 Incidents and patient safety
PART 2
PART 3
Our priorities for improvement and statements
relating to the quality of the services we provide
 Looking back at 2012/13
4
2013/14 improvement priorities:
 Patient safety
 Clinical effectiveness
 Patient experience
6
6
7
Statements of assurance from our board:




16
16
16
Review of services
8
Participation in clinical audits
8
Participation in clinical research 12
Use of the Commissioning for Quality
and Innovation framework
13
 Statements from the Care Quality
Commission
14
 Data quality
14
 NHS Number and General Medical
Practice Code validity
15
How we performed
 Service user, staff and visitor safety
17
 Improving clinical effectiveness
 Patient/Carer experience
22
33
Who we involved in our Quality Account:
 Our stakeholders
 Stakeholder statements
46
47
PART 4
Useful information
 Glossary
 Feedback form
56
58
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QUALITY ACCOUNT 2012/2013
Statement
from our Chief Executive & Chair
We are pleased to present our Quality Account for 2012/13
Our vision is excellent care at the heart of the community and our Board has set out how we will accomplish this in our
Clinical Care Strategy which aims to provide fully integrated, effective, quality health and social care within or as close to the
patient’s home as possible. This will lead to avoidance of hospital admissions and provide efficient, fully supported
discharges for those admitted to hospital. To achieve quality care we will:
 Develop and improve the three pillars of good quality care – safety, experience and effectiveness
 Ensure that the three pillars of good quality care are embedded within the work of every service in the Trust
 Use clinical governance as a tool for improving quality of care by every member of clinical staff in the Trust.
This Quality Account provides us with the opportunity to present to our patients and their carers, our partner organisations,
stakeholders and the wider public, the progress we have made against the quality priorities we set out in our 2011/12
Quality Account (page 4), to show where we have done well against standards of quality and to recognise where we need to
improve. We also set out our quality priorities for 2013/14 (page 6).
This has been a challenging year for the NHS and we are proud of the improvements we have made in the quality of our
services and our contribution to the local health economy, but we recognise that there is room for significant improvement.
Our key priority is to provide high quality, safe care. In response to the report into Mid Staffordshire NHS Foundation Trust
by Robert Francis QC, we have established a working group which has begun planning for and implementing those
recommendations which are relevant to our organisation. In addition, where we consider
actions in response to financial pressures, we always assess any possible impact of those
actions on the quality of our services to ensure no decisions we make are to the detriment of
our patients.
We are pleased to report we have met 91% of the priorities we set ourselves this year, and are
making good progress against others. This year we have also achieved a number of external
standards including:
 Achievement of the NHS Litigation Authority Risk Management Standards Level 1
 Maintaining our CQC registration with no conditions and all inspected standards met
 Achievement of the Information Governance Toolkit Level 2 – looking after your data
 Improved staff survey results in relation to awareness of senior staff and increased job
performance satisfaction levels.
Paula Head
Chief Executive
We are working towards registration as a Foundation Trust, because achieving this will demonstrate that we consistently
meet high quality and financial management standards, and because being a Foundation Trust will allow us to be more
responsive to the needs of our local service users. We would encourage you to get involved and
join us as members – for more information on this see page 45.
This Quality Account has been prepared in accordance with the NHS (Quality Accounts)
Regulations 2010 and on behalf of the Trust Board we can confirm that, to the best of our
knowledge, the information in this document is accurate.
We have asked a number of external organisations to review and comment on our Quality
Account. These organisations and a summary of the comments are provided from page 46.
We really hope you find our Quality Account a useful and informative document and very much
welcome any comments you have – you can contact us via: paulahead@nhs.net or
susan.sjuve@nhs.net
Sue Sjuve
Chair
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QUALITY ACCOUNT 2012/2013
Our improvement
priorities
for 2012/13 and the future
Patient safety, clinical effectiveness and patient experience
Sussex Community NHS Trust (SCT) believes 3 core elements comprise quality:
 Patient Safety – we need to ensure we work to the highest clinical standards to reduce, avoid and
stop avoidable harm to patients wherever possible
 Clinical Effectiveness – we should improve our understanding of treatment options and success
rate from different treatments for different conditions including clinical measures, possible
complications of treatments and measures of clinical improvement
 Patient Experience – we want to know what patients think about our services and respond to their
views to improve the quality of what we do in the services we provide.
Our 2012/13 priorities were framed around these elements of quality, and were laid out in last year’s
Quality Account. The tables below demonstrate our progress against achieving those priorities:
Patient Safety
Priority for Improvement
Achieved?
 = Yes
X = No
▲ = Nearly
Outcome
Reducing Serious Incident (SI) reporting
time periods to allow us to learn promptly
when things go wrong.

We closed 98.53% of SIs within agreed reported
periods compared with 87.5% during 2011/12.
Reducing Healthcare Associated Infections
(HCAI) for Methicillin-resistant
Staphylococcus aureus (MRSA) and
Clostridium difficile (C. difficile).

We reported the same number of cases of MRSA as
in 2011/12, and we reported 3 fewer cases of C.
Difficile than in 2011/12.
Early Years Speech & Language Therapy (SALT)
The Early Years SALT team produced a leaflet about speech, language and communication to be handed
out to newly pregnant mothers by midwives. This joined up approach to healthcare providers gives
pregnant mothers a multitude of information including which kind of buggy is best for speech and
language development, what the benefits are of a parent facing buggy, whether a parent should use a
dummy for their baby, as well as feeding and oral development.
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QUALITY ACCOUNT 2012/2013
Clinical Effectiveness
Priority for Improvement
Achieved?
 = Yes
X = No
▲ = Nearly
Outcome
Prevention of Venous Thromboembolism
(VTE) in our hospitalised patients via risk
assessment.
Reduction of preventable pressure
damage acquired by patients in our care.

98% of our inpatients were risk assessed for
developing VTE.
X
Rates of preventable pressure damage increased
during 2012/13 so we are retaining this priority for
2013/14.
Reduction in harm caused by preventable
medication errors.

During 2012/13 the percentage of reported
medication errors resulting in minor and moderate
harm was lower than in 2011/12. There was also an
increase in reporting of medication errors resulting
in no harm, indicating growth of an open reporting
culture.
Reduction in the number of preventable
falls experienced by patients in our care.

The Falls Bundle was implemented across all
inpatient areas and resulted in a reduction in
preventable falls. Our success in this area is
discussed on page 24.
Ensuring our patients’ nutritional and
dietetic needs are promptly assessed.

We maintained our high nutritional assessment
rates in our inpatient units and we have
significantly increased assessment rates carried out
by our community nursing teams.
Improved catheter care given by our
community nurses to provide more timely
care and reduce emergency admissions.

Our Bladder & Bowel service has worked with
community nurses to help patients manage their
needs and recatheterisations in a planned way
through the use of individualised treatment plans.
This reduces avoidable emergency admissions.
Patient Experience
Priority for Improvement
Achieved?
 = Yes
X = No
▲ = Nearly
Outcome
Implementation of a Patient Experience
Strategy.

Maintaining a 100% uptake within clinical
teams of undertaking patient experience
surveys/feedback.
▲
The Patient Experience Strategy was developed
through the Patient Experience Sub-committee and
the final 5 year strategy was approved in April
2013.
90% of clinical teams undertook patient experience
surveys/feedback.
Volunteer Strategy Implementation.
▲
Implementation is planned for late 2013.
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QUALITY ACCOUNT 2012/2013
Priorities for 2013/14
This year’s priorities are also organised around Patient Safety, Clinical Effectiveness and Patient Experience.
Patient Safety
Improvement
Priority Area
Understanding the
implications for the
Trust from the Francis
Report into failings at
Mid Staffordshire NHS
Foundation Trust.
How we’ll do it
Implementation of four prioritised
Francis Report themes, detailed in
our Francis Report Outcomes
Group’s (FROG) action plan:
1.
2.
3.
4.
Serious Incidents (SIs).
‘No harm’ incidents.
Putting patients first
Fundamental standards of
behaviour
Openness, transparency and
candour
Leadership
Ensuring all SI action plans are
followed through and completed.
Ensuring all incident action plans are
followed through.
Expected Outcomes
Completed service diagnostic across all services.
Evidence of assurance against the
recommendations or demonstrable
improvements in place which meet an agreed
standard.
Completion of an organisational cultural inquiry
with actions in the first year completed to create
the desired Trust culture.
Implementation of the recommendations from
the four prioritised themes.
Reduction of SIs with repeat root causes.
Increase the ratio of ‘no harm’ incidents to severe
harm incidents.
Implementation of our harm free
care strategy.
Clinical Effectiveness
Improvement
Priority Area
How we’ll do it
Expected Outcomes
Pressure damage
healing.
Monitoring and sharing best practice via the Trust’s
Pressure Damage Prevention Strategy Group, weekly Safety
Express monitoring, enhanced education and training for
staff, new pressure damage prevention strategy and
protocols, improved reporting, analysis and feedback to
staff. Zero tolerance of pressure damage.
The Trust’s Professional Forums will lead NICE guidance
implementation.
20% improvement in
pressure damage healing
against the May 2013
Trust baseline.
NICE guidance.
100% of relevant NICE
guidance implemented.
Family Nurse Partnership (FNP) – West Sussex
The FNP is an intensive, structured and early preventative programme for first time teenage parents
from early pregnancy to when their child is 2 years old. Their first annual review took place in November
2012 with the FNP National Unit, lead commissioners, senior managers, key partners, and most
importantly, young parents. They were highly commended by the Department of Health: “The team is
performing incredibly well. To have full caseloads, good levels of fidelity, good outcomes, learnt and
developed methods of programme delivery to this extent after just one year is an incredible achievement.
The supervisor and nurses have undoubtedly worked and continue to work exceptionally hard to achieve
and maintain this.” (Dr Dulcie MCBride, Service Development Lead, FNP National Unit, Dec 2012)
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QUALITY ACCOUNT 2012/2013
Patient Experience
Improvement
Priority Area
End of life.
How we’ll do it
Promotion of Advance Care Planning.
Development of the Palliative Care Partnership in Brighton
& Hove.
End of life.
Pressure damage
acquisition.
Learning disabilities.
Implementation of our End of Life Care strategy.
Build on current good practice in the North locality of SCT in
relation to community nursing services.
Monitoring and sharing best practice via the Trust’s
Pressure Damage Prevention Strategy Group, weekly Safety
Express monitoring, enhanced education and training for
staff, new pressure damage prevention strategy and
protocols, improved reporting, analysis and feedback to
staff. Zero tolerance of pressure damage.
Implementing a robust system to identify patients using our
services who have learning disabilities.
Development of more easy read documents and leaflets.
Expected Outcomes
80% of patients dying in
their Preferred Place of
Care (PPC) against the
2012/13 baseline of 70%.
Establish a baseline by
September 2013 of the
number of people dying in
their PPC, and improving
on this by 10% within the
year.
Improvement in pressure
damage incidence
amongst our patients,
achieving 20% below the
national baseline for
comparable Trusts.
Achievement of 6 criteria
related to meeting the
needs of patients with
learning disabilities.
Raising staff awareness of people with learning disabilities
and their needs, and how to make services as accessible as
possible.
Friends and Family Test.
Patient survey.
Increased representation of people with learning
disabilities, and increased patient experience collection
from services users with learning disabilities.
All specified areas undertaking the Friends and Family Test
as per national guidance.
All areas undertaking a minimum of an annual patient
survey to gauge patient and user satisfaction and feedback.
Achievement of
Commissioning for
Quality & Innovation
(CQUIN) goal – 10%
increase in our Net
Promoter score at year
end vs. April 2013.
20% improvement in
positive responses in all
services against the April
2013 baseline.
Increased Recycling & Reduced Landfill Waste
We have committed to get to zero general waste to landfill by 2015. During 2012 we established a new
Trust-wide waste management contract with SITA UK. Through this we have introduced dry mixed
recycling across our Trust’s facilities. This boosted our recycling rate to almost 60% (we recycled
around 260 tonnes of waste last year), with an aspiration to achieve an 85% recycling rate by 2015.
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QUALITY ACCOUNT 2012/2013
Statements of assurance
from the board
Review of services
During 2012/13 SCT provided and/or sub-contracted over 90 relevant health services. Our services are
delivered to people in their own homes, in clinics or as inpatients across Brighton & Hove and West Sussex.
Our community hospitals are Arundel & District Community Hospital, Bognor War Memorial Hospital,
Crawley Hospital, Horsham Hospital, the Kleinwort Centre, Midhurst Community Hospital, Salvington Lodge
and Zachery Merton Community Hospital. We also provide services from GP premises, schools and
community facilities.
SCT has reviewed all the data available to them on the
quality of care in all of these NHS health services.
The income generated by the NHS services reviewed in
2012/13 represents 80.29% per cent of the total income
generated from the provision of NHS services by SCT for
2012/13.
Participation in clinical audits
During 2012/13, 3 national clinical audits and 0 national
confidential enquiries covered relevant health services
that SCT provides.
Solar Panels at Brighton General
Hospital
During autumn 2012 we installed a 50kW
solar panel system at Brighton General
Hospital (the largest system in Brighton &
Hove). This enables us to generate our own
zero-carbon electricity and save money.
During the first five months of operation the
system saved over 9 tonnes of CO₂.
During that period SCT participated in 100% of national
clinical audits of the national clinical audits it was
eligible to participate in.
The national clinical audits that SCT participated in
during 2012/13 are as follows:
 The National Pain Audit
 National Parkinson's Audit
 Psychological Therapies Audit.
The national clinical audits that SCT participated in, and for which data collection was completed during
2012/13, are listed below alongside the number of cases submitted to each audit or enquiry as a
percentage of the number of registered cases required by the terms of that audit or enquiry.
National Clinical Audit
Participation
% Cases Submitted
The National Pain Audit
100 cases
100%
National Parkinson's Audit
10 cases
100%
3,598 cases
100%
Psychological Therapies Audit
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The report of 1 national clinical audit was reviewed by the provider in 2012/13 and SCT intends to take the
following actions to improve the quality of healthcare provided:
 During spring 2013 two members of staff attended the National Pain Audit’s presentation of its
findings. It is anticipated that during 2013 it will produce adapted care pathways on a national level
for adaptation at local service level. The staff will feedback their learning to their wider team to
identify any immediate actions. Once the pathway recommendations are published they will be
reviewed by the Trust and actions agreed.
The local, organisational and national reports resulting from the Psychological Therapies Audit are due to
be published by The Royal College of Psychiatrists in October 2013. Once published the report will be
reviewed by the Trust and actions agreed.
The national report resulting from the National Parkinson’s Audit is due to be published by Parkinson’s UK
by summer 2013. Once published the report will be reviewed by the Trust and actions agreed.
Additionally, during 2012/13 SCT participated in a further national clinical audit that did not appear on the
Healthcare Quality Improvement Partnership (HQIP) list - the Internal Review of Cancer Measures defined
by the National Cancer Network Audit. This was part of an external review by the Sussex Cancer Network
along with other palliative care teams. The Trust is in the process of identifying actions arising from the
audit.
Other audits
Health Records Audits – Examples of good practice highlighted:
 Records that were well written
 Completion of care plans, with factual and appropriate use of language
 The use of accurate and up to date data.
Key learning points identified:
 Abbreviations may only be used in the patient record if they are from the approved lists as
specified by the Trust health records standards.
 All received reports should be dated and signed to signify they have been read and evaluated
before filing.
Key actions put in place by community teams:
 Awareness of audit results and record management standards to be raised through team meetings,
training and supervision
 Changes have been made to practice by teams to improve standards, e.g. reports read and signed
on arrival, abbreviation lists added to notes or no abbreviations used.
As part of the Medical Devices and Decontamination Policy, all inpatient bedded areas are required to
complete a mattress audit; all areas completed this audit during 2012/13. Additionally, medical devices
audits were completed by our Rheumatology, Adult Physiotherapy and Special Care Dental services.
The Trust identified 3 Medicines Management Audits as priority audits in 2012/13; Completion of
Controlled Drugs Training Audit; Omitted Dosages Audit; Anti-microbial Audit. As a result of the Antimicrobial Audit the Trust has developed a new Anti-microbial Pharmacist post.
The Infection Prevention & Control Team has a programme of annual audits that include the Environmental
Audit and Essential Steps Audits. During 2012/13, 96 Environmental Audits were completed and 72 (75%) of
these were marked as fully compliant. Actions taken as a result of the audits include; a portable sink being
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QUALITY ACCOUNT 2012/2013
sourced to mitigate risk; study day being arranged; fridge
thermometers purchased and local procedure for recording
temperature and dating and labelling of food and replacement
of hand washing sinks.
Local clinical audits
The reports of 61 local clinical audits were reviewed by the
provider in 2012/13 and SCT intends to take the following
actions to improve the quality of healthcare provided:
Leg Ulcer Audit (Coastal):
The audit found that not all who had leg ulcers had their cause
identified, and not all staff were photographing wounds or
completing leg ulcer assessments.
Morley Street, Brighton
Surgery 5 – a new surgery which
incorporates a decontamination room
is currently being built on the ground
floor, School Clinic, Morley Street. The
surgery is being built to enable the
dental service to attend to the needs of
wheelchair patients without the need
to transfer to a dental chair and mobile
bariatric patients. A wheelchair
platform will be available which
enables the patient to remain in their
wheelchair while undergoing treatment
and the platform also includes a
bariatric bench for patients who are
unable to sit in a standard dental chair
due to weight restrictions. The surgery
will also be completely ambidextrous
for the clinical staff.
Actions include:
 Increasing the number of cameras within community
teams
 Developing clear guidelines for staff on managing
photography
 Rolling out a programme of wound care boards in
conjunction with tissue viability nurses and community
teams, ensuring leg ulcer assessments are completed
 Ensure all patients have an identified leg ulcer aetiology
 Ensure all patients with leg ulcers have a photograph of their wound with clear reviews
 Ensure all patients with leg ulcers have a leg ulcer assessment completed.
Community Short Term Services (CSTS) – Northwick Park Dependency Scores (NPDS) Audit:
NPDS is a fully validated tool that can be used to assess dependency of patients on nursing staff in a
rehabilitation setting. The tool covers Basic Care Needs (e.g. washing, dressing, eating and drinking) and
Special Nursing Needs that cover care activities normally undertaken by a qualified nurse or a carer (e.g.
open wound care, tracheostomy or psychological support).
The audit was conducted on a single day in March 2013 across all community short term bedded units in
Brighton & Hove. A total of 60 patients were assessed. This audit concluded that acuity levels of this
snapshot evaluation are low and dependency scores have risen slightly but not significantly since 2011
therefore there are no actions.
DiabetesE Audit:
DiabetesE is a web based, self assessment, diabetes care performance improvement tool. It measures and
benchmarks the performance of all aspects of a system of diabetes care and actively encourages
continuous improvement to meet and surpass the National Institute for Health & Care Excellence (NICE)
Quality Standard for Diabetes in Adults. Actions include:
 The care pathway for the management of people with diabetes should include explicit guidance on
coordinating care with other specialties e.g. kidney, foot, obstetric, ophthalmic, cardiovascular,
care of the elderly teams
 There should be support and engagement from a senior executive within your organisation to
improve the diabetes service
 The specialist diabetes team should provide clinical management advice to practice based
commissioning groups on commissioning diabetes services
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QUALITY ACCOUNT 2012/2013


The care pathway for the management of people with diabetes should take into account the needs
of hard to reach groups, for example those in secure estates, travellers, refugees, asylum seekers
etc.
People with diabetes under the care of the specialist diabetes team should have access to 24 hour
per day emergency telephone contact.
Contraception & Sexual Health (CASH) Service
To audit the cost effective use of contraceptive pills to provide effective 'bridging' contraception until the
preferred method can be started. Different types of medications were considered in terms of safety and
cost. Actions include:
 Prescribing cost savings identified
 Memo to clinicians with guidance for identifying the safest, most acceptable and cost-effective
bridging option for patients waiting for a preferred method.
Wheelchair service stock audit (Worthing)
All equipment allocated at the Worthing wheelchair service for a named client must be clearly labelled with
the client’s name, and action required e.g. ‘Wheelchair Therapist Clinic’, and the date the item was placed
on the shelf. The purpose of the audit was to ensure the standard was being met. 145 items were checked
and approximately one third of items were incorrectly labelled. Actions include:
 Approximately £5,000 of allocated equipment was returned to free stock. Approximately two thirds
of this was reallocated to other clients within 48 hours
 During the wheelchair service team meeting all staff were advised of the outcome of the audit and
the requirement to uphold the standard
 Implementation of a periodic review of allocated equipment
 Implementation of an annual stock take and audit.
The above outcomes are a sample arising from local clinical audits we conducted during 2012/13. Planning
clinical audits for 2013/14 is under way and in next year’s Quality Account we will also report on the
number of re-audits conducted.
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QUALITY ACCOUNT 2012/2013
Participation in clinical research
The number of patients receiving health services provided or sub-contracted by SCT in 2012/13 that were
recruited during that period to participate in research approved by a research ethics committee was 132
across 10 studies. 527 carers were recruited across 5 studies and 30 health care professionals were
recruited across 5 studies supported by the Trust, bringing the total recruitment to 689 across 16 studies; a
significant increase in recruitment overall from the previous year.
Of the 10 studies where patients were recruited, 9 were National Institute for Health Research (NIHR)
Portfolio studies, 4 involved Children’s Services and 6 involved Adult Services. The studies involved various
clinical specialties.
Studies conducted in our Adult Services focused on patients using services providing care for diabetes,
pressure damage, musculoskeletal arm pain, continence management and Parkinson’s disease. One NIHR
Portfolio and one non-NIHR Portfolio study conducted in Children’s Services focused on childhood epilepsy.
The remaining two NIHR Portfolio studies looked at aspects of care for individuals with Cerebral Palsy (CP).
A three year NIHR Research for Patient Benefit (RfPB) funded study to develop an Eating and Drinking
Ability Classification System (EDACS) for individuals
with CP was completed in March 2013. The
development and testing of the new measurement
tool involved the recruitment of 238 expert
participants from the UK and around the world,
including individuals with CP and their parents.
Requests for permission to use EDACS in research
and clinical practice have been received, together
with requests to translate EDACS into Dutch,
Norwegian, Hebrew and Portuguese. The Chief
Investigator is planning future studies using EDACS
to explore the stability of eating and drinking
ability over time and the relationship of eating and
drinking ability with nutritional adequacy and
respiratory health for individuals with CP.
By far the majority of participants recruited to
studies during this period were parents and carers
of patients receiving our services. Five studies
were conducted, 4 NIHR Portfolio and 1 non-NIHR
Portfolio, involving clinical specialties from
Children’s and Adult Services. One NIHR Portfolio
study conducted in Children’s Services focused on
the eating and drinking abilities of children with
cerebral palsy. The non-NIHR Portfolio study
looked at the experience of parents learning
physiotherapy techniques as trainers for their
children.
In Adult Services, one of the two NIHR Portfolio studies conducted involved patients with Parkinson’s
disease and their carers. The study compares the DNA sequences and protein levels of different genes and
proteins thought to be involved in neurodegenerative disorders. The second study is a 3 year NIHR RfPB
funded phased study. In Phase 1 recently bereaved carers were surveyed about end of life care. The
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findings will inform how best to develop new short term palliative care services for frail older people in
community settings. Phase 2 will involve the development and evaluation of the feasibility of the new
service.
Participation in research demonstrates the Trust’s commitment to improving the quality of care and
contributing to wider health improvements. Our clinical staff stay abreast of the latest treatment
possibilities and active participation in research leads to successful outcomes.
Use of the Commissioning for Quality and Innovation (CQUIN)
framework
A proportion of SCT income in 2012/13 was conditional on achieving quality improvement and innovation
goals agreed between SCT and any person or body with whom they entered into a contract, agreement or
arrangement for the provision of NHS services, through the CQUIN payment framework. The agreed CQUIN
payment was 2.5% of the contract value.
The goals included:
 Enhanced detection and prevention of VTE in inpatients – This will reduce the risk of patients
experiencing a blood clot occurring inside a blood vessel
 Two inpatient surveys through the Productive Ward programme which incorporate questions
known to be important to patients and where past data indicated that significant room for
improvement exists across England
 Ensuring emergency inpatients aged 75 and over are screened for dementia and given assessments
as required. Dementia is a significant challenge for the NHS (25% of beds are occupied by people
with dementia) and half of those admitted to hospital with dementia have never been diagnosed
prior to admission
 The detailed and timely collection of data for use in the NHS Safety Thermometer, which is an
improvement tool for measuring, monitoring and analysing patient harms and 'harm free' care.
Patients were subsequently monitored for pressure ulcers, falls, urinary tract infections (UTIs) in
patients with catheters and VTE. The Safety Thermometer allows nationally consistent data to be
collected and published as well as facilitating local improvement activity
 In December 2011 the Department of Health (DH) described a number of high impact actions of
which the Trust has participated in 3. The first, Child in a Chair in a Day, has led to our Wheelchair
Service reviewing its referral to supply pathways, while investing in additional standard wheelchairs
to ensure children receive wheelchairs promptly. The second and third actions, 3 Million Lives and
Digital by Default, have led to the Trust working with healthcare solutions provider Docobo to
implement Telehealth via email, concentrating mainly on suitable patients who access our Heart
Failure, Diabetes, and Chronic Obstructive Pulmonary Disease (COPD) services.
We achieved the majority of our goals. However, we still have further work to do on some areas including
supporting clinicians in our Heart Failure service to demonstrate quality pathway management using
information technology.
Further details of the agreed goals for 2012/13 and for the following 12 month period are available
electronically at http://www.sussexcommunity.nhs.uk/cquin.htm.
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Statements from the Care Quality Commission (CQC)
SCT is required to register with the CQC and its current registration status is ‘registered with no conditions’.
The CQC has not taken enforcement action against SCT during 2012/13.
SCT has not participated in any special reviews or investigations by the CQC during the reporting period.
During 2012/13, one Review of Compliance report was published for Trust locations registered with the
CQC. The location was subject to an unannounced inspection and was assessed as compliant with all 16
CQC Core Outcomes.
The Trust also undertakes proactive internal ‘Assurance Reviews’ to self-assess its service user, visitor and
staff safety, clinical effectiveness and service user experience against the CQC outcomes. Any areas
identified for improvements are followed-up ensuring remedial actions are completed.
Data quality
2012/13 data quality actions review
Action
Implementation of the Performance Management
Framework. This includes an intranet based
reporting system (known as Scholar) to provide an
integrated board report with detailed information
on finance, staff records, governance and clinical
systems.
Achieved?
 = Yes
X = No
▲ = Nearly

Outcomes
Implemented with ongoing
development.
New reports will be created for the board and
services with a number of Key Performance
Indicators (KPIs).

A KPI dashboard report has been
implemented in Scholar.
New data collection methods for services not able
to record the data directly onto our clinical
systems.

Completed. An email based
solution was introduced.
Review and reconfiguration of relevant IT systems,
in preparation for Community Information Dataset
(CIDS).

Completed.
Further development of the Trust Data Warehouse
(Scholar) to provide a central repository for
corporate and clinical information, enabling more
efficient performance and data quality reporting.

Amalgamation of data sources
and development of Scholar
reports.
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QUALITY ACCOUNT 2012/2013
SCT is taking the following actions to improve data quality:
2013-2015 Core Data Quality Strategy actions
Action
Anticipated outcomes
Data quality is best when it is captured directly by
the person who performs the activity, at the time
the activity takes place.
All staff will have an awareness of the importance
of data quality and the tools to support record data
accurately at the point it is created.
It is of paramount importance that all data
collected is of appropriate quality in dimensions
which include accuracy, integrity and freshness.
Staff will be given clear guidance to support
accurate data collection, at the appropriate level of
detail, and the Trust will move towards compliance
with the CIDS requirements.
All data that is collected must be high quality and
focused, to ensure it is being used as effectively as
possible.
A ‘baseline’ review of current data use and system
analysis, drawing together information from our
Health Records Group, our Information Asset
Management Steering Group and our Performance
Analysis team. This will enable us to develop a
robust mapping of information flows.
Staff can usually improve data quality in their
normal work, for example by reducing input delays
and checking at the point it is created.
A trajectory of improved data quality in all teams
will be agreed through our Business Planning
Process.
Staff should be trained in using any data collection
system by a person deemed suitably qualified by
the Trust.
A full training programme to support the
implementation of the Trust’s Data Quality
Strategy.
System changes must be communicated in an
effective and timely manner to ensure those
collecting data are as informed as possible.
The Trust will devise and document a robust
change control process in a new policy.
NHS Number and General Medical Practice Code validity
SCT submitted records during 2012/13 to the Secondary Uses service for inclusion in the Hospital Episode
Statistics which are included in the latest published data. The percentage of records in the published data:
– which included the patient’s valid NHS number was:
100% for admitted patient care;
99.4% for outpatient care; and
99.4% for accident and emergency care.
– which included the patient’s valid General Medical Practice Code was:
98.8% for admitted patient care;
99.7% for outpatient care; and
100% for accident and emergency care.
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QUALITY ACCOUNT 2012/2013
Information Governance Toolkit attainment level
The SCT Information Governance Assessment Report overall score for 2012/13 was 70% and was graded
green. The score for 2011/12 was 59%, which shows a significant improvement in our Information
Governance compliance.
Reaching an improved rating of 70% demonstrates the Trust has robust processes to maintain protection
and confidentiality of its patient information and that it adheres to data protection legislation and good
record keeping practice.
The Trust has a Senior Information Risk Owner and Caldicott Guardian who are engaged with information
governance and the protection of patient information. In 2013/2014, the Trust will work to further improve
its score, provide additional training and awareness across the Trust and fully embed the information asset
management programme of work.
Clinical coding error rate
SCT was not subject to the Payment by Results clinical coding audit during 2012/13 by the Audit
Commission.
Incidents and patient safety
All primary care
organisations with
inpatient provision
SCT
Financial Year 2011/2012
Financial Year 2011/2012
Degree of
harm
Incidents
% of
Incidents
Incidents
% of
Incidents
No Harm
Low
Moderate
Severe
Death
Total
22,199
13,829
5,932
306
55
42,321
52.75%
32.50%
13.90%
0.70%
0.15%
100.00%
1,152
1,086
259
16
4
2,517
45.80%
43.15%
10.25%
0.65%
0.15%
100.00%
Provisional for Financial
Year 2012/2013
Incidents
% of
incidents
1,621
1,113
241
10
0
2,986
54.40%
37.30%
8%
0.30%
0
100.00%
SCT considers that this data is as described for the following reasons:
 All patient safety data is sent to the NPSA via the National Reporting and Learning System (NRLS)
 This data has been supplied by the NPSA
 Patient safety incident reports are monitored daily by SCT’s Risk Team for collation and to respond
to as required
 Patient safety incidents reports are regularly reviewed by SCT’s board for themes and trends.
SCT has taken the following actions to improve these percentages, and so the quality of its services, by:
 Appointing four Patient Safety Leads (discussed on page 18)
 Implementation of the Falls Bundle in our bedded inpatient areas (discussed on page 24)
 Continued delivery against our Pressure Damage Prevention Strategy (discussed on page 29).
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QUALITY ACCOUNT 2012/2013
Review of quality
performance
Service user, staff and visitor safety
Serious Incidents (SIs) and incident reporting
The Trust uses an incident reporting system called ‘Safeguard’ to
enable staff to quickly and simply report any incident or near miss
they have witnessed. Safeguard also allows the Trust to monitor
reporting themes and trends, and to ensure incidents are rapidly
responded to.
During 2012/13 a total of 5,823 incidents were reported, which
represents a 21.67% (4,786) increase compared with 2011/12.
This increase was for a number of reasons:
 Staff have developed experience and confidence using the electronic reporting process
 Themes and learning from incidents are now regularly shared and discussed in clinical teams across
all our services, raising the profile of incident reporting
 An open reporting culture has developed where staff are more likely to report incidents and
understand their obligation to do so.
The Trust sends
all incident
reports relating to
patient safety to
the NPSA via the
National
Reporting and
Learning System
(NRLS). The NPSA
compares this
information with
other Trusts,
finding that SCT
reports an
average number
of patient safety
incidents for its
size.
A chart which shows incident reporting activity during 2012/13:
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QUALITY ACCOUNT 2012/2013
Frequently reported incidents
The most frequently reported areas of incident involve falls, medication errors and pressure damage.
Graph to show the top 3 most frequently reported areas of incident:
Pressure damage (also referred to as pressure ulcers, pressure sores or bed sores) is graded according to
severity from 1 to 4. During 2012/13 the Trust took several steps to reduce pressure damage including:
 Introduction of seven new training packages for relevant teams
 Acquisition of an e-learning package to facilitate further training
 Clinical staff meetings in each of our localities to identify ways to further improve the prevention
and management of pressure damage.
More detail on our:
1. progress reducing pressure damage can be found on page 29.
2. progress reducing falls in our bedded inpatient areas can be found on page 24.
3. approach to monitoring medication errors can be found on page 22.
The Trust has an established process to ensure incident investigations are proportionate to their assessed
seriousness or potential consequences. Our incident investigations are designed to examine processes and
find system failings, so actions can be identified to reduce future incidents.
Serious Incidents (SIs)
In 2012/13 84 SIs were reported: - 48 occurred in patients’ homes, 5 occurred in residential homes and 31
occurred in hospitals or clinics. The most common reported SIs related to pressure damage, falls and
infection control issues. All SIs are investigated to establish their root cause and to identify actions and
learning to reduce, where possible, the likelihood of their recurrence.
During 2012/13 the Trust recruited four Patient Safety Leads to investigate all SIs. Appointment of the
Patient Safety Leads has allowed the Trust to foster internal expertise in identifying the root causes and
themes of SIs, as well as providing consistency within investigations, reporting and learning from SIs.
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QUALITY ACCOUNT 2012/2013
The Trust facilitates learning from each SI in three main ways so that:
1. Services affected by SIs make immediate changes to practice
2. Lessons identified from the root causes of an SI are shared across teams
3. Learning from SIs becomes a key component of clinical governance and our quality strategy.
A chart which shows our SIs broken down by category:
Healthcare Associated Infections (HCAIs)
In 2012/13 2 of our patients were reported as having a Methicillin-resistant Staphylococcus aureus (MRSA)
bloodstream infection (BSI) in our bedded units, which is 1 more than our agreed target. This compares
with 2011/12 where 2 of our patients were also reported as having MRSA BSIs. Both cases in 2012/13
occurred at Crawley hospital on Viking and Caravelle wards, although the cases were not related. One case
was unavoidable, however the other was potentially avoidable and as a result the Trust learned lessons
surrounding urinary care by introducing mandatory urinary catheter care training and revising our Urinary
Catheter Policy. The national target for MRSA BSIs from April 2013 has been set to zero avoidable MRSA
infections. We will report on our progress against this target in our 2013/14 Quality Account.
In 2012/13 8 of our patients were reported as having a Clostridium difficile (C. difficile) infection (CDI) in our
bedded units. 1 case was in Brighton & Hove and 7 cases were in West Sussex. This number was lower than
our target of 12 cases, and this is also an improvement on the 11 cases reported in 2011/12. In line with
national guidance the Trust also updated its C. difficile Infection Procedure. All cases were resolved without
serious harm.
Additionally, the Trust has recruited a new Antimicrobial Pharmacist to commence post in April 2013 to
improve antimicrobial prescribing across our services and further reduce CDIs and other HCAIs.
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A chart which shows the number of cumulative cases of MRSA against our target in 2012/13:
A chart which shows the number of cumulative cases of C. difficile against our target in 2012/13:
Page 20 of 58
QUALITY ACCOUNT 2012/2013
Central Alert System (CAS)
The DH’s Central Alerts System (CAS) has been designed to rapidly disseminate important safety and device
alerts to nominated leads in NHS Trusts in a consistent and streamlined way for onward transmission to
those who need to take action. A detailed action plan is created for any alert applicable to the Trust and a
lead is identified to progress work.
During 2012/13 115 alerts were received from CAS of which:
 95.7% (110) were acknowledged within two working days
 40% (46) were found to be applicable to the Trust
 93.5% (43) of applicable alerts were actioned within prescribed timescales.
During 2012/13 the Trust reviewed its alert response process resulting in improvements to the central
administration of alerts. This led to an increase in alerts acknowledged within two working days (93% in
2011/12). These improvements will be built on in 2013/14 to raise our alert acknowledgment performance
and to ensure actions taken when alerts are received are reported to CAS in a timely manner.
Never Events
The Department of Health has identified a range of 25 patient safety incidents which are largely
preventable and should not occur if the relevant preventative measures are put in place. These are known
as “Never Events”. The Trust did not report any Never Event incidents during the period 2012/13.
Safeguarding adults at risk (SAR)
2012/13 Safeguarding priority areas
Priority for Improvement
Developing strategies to improve staff awareness of
SAR
Achieved?
 = Yes
X = No
▲ = Nearly

Outcome
Increased training levels have
lead to staff raising more
alerts.
The committee now meets
quarterly and is chaired by the
Chief Nurse.
Establishing and embedding the Trust’s SAR
Committee to monitor clinical areas for improvements
in practice

Incorporating Prevent Strategy into relevant practice
areas
Aligning the work of our SAR Practitioners with
existing Brighton & Hove and West Sussex Council
services to enhance multiagency working

Completed.

Completed.
During 2012/13 SCT continued to support the SAR process in Brighton & Hove and West Sussex. The Trust
received over 100 requests to provide Health Investigating Officer support. SCT also participates in a
multiagency audit of safeguarding investigations. This audit process allows scrutiny of safeguarding
investigations to ensure robust processes have been followed to ensure that the welfare of those at risk is
safeguarded.
During 2013/14 we will focus on developing and implementing a Trust Safeguarding Adults Strategy,
development of a Trust wide SAR training strategy and closer integration of clinical metrics and SAR activity.
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QUALITY ACCOUNT 2012/2013
Improving clinical effectiveness
Medication
Almost all services across the Trust use medicines. The main
focus of improving medicines management continues to be
working towards standardisation of our medicine management
processes and as this work has moved forward the focus is
shifting towards improving and increasing medicines
management standards.
For example in 2012/13 the Trust signed up as a development
site for using the Royal Pharmaceutical Society (RPS)
‘Professional Standards for Hospital Pharmacy Services’ issued in
July 2012. These standards are challenging, aspirational and
consist of broad frameworks that support the Trust to
continuously improve to deliver high quality patient care. A selfassessment has been undertaken against these standards and an
improvement action plan is in place.
A ‘Learning from incidents’ newsletter is circulated to staff to
communicate learning from medication incidents within the
Trust or from relevant medication incidents highlighted
nationally.
Standardisation of Medicines Management Documentation
Completed 2012/13
Planned for 2013/14
Community Nursing Medication Instruction Charts
Implemented Trust wide
Ongoing review.
Chailey Heritage Clinical Services Medication Chart
Medication charts were reviewed and it was agreed Ongoing review.
to design a new medication chart. A new Medication
Chart was designed, piloted and implemented
Adult inpatient Medication Prescription and Administration Chart
A revised chart is under development which will
include a VTE risk assessment algorithm
Printing and implementation of the new chart
including staff training to support its use.
Patient’s Medication Record Chart
This chart was introduced with guidance for use
A patient information leaflet for adult inpatients to
encourage them to ask for information about their
medicines.
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QUALITY ACCOUNT 2012/2013
Audits
Completed 2012/13
Planned for 2013/14
All completed audits have actions plans in place to make further improvements.









Antimicrobial prescribing
Omitted doses and refrigerated medicines (adult inpatient units)
Refrigerator storage of Human Papilloma Virus (HPV) vaccines by
school nurses (regular self-audits)
Training in standard operating procedure for controlled drugs (adult
inpatient units)
Patient held medicine information card (adult inpatient units)
Non-medical prescribing ‘intent to prescribe’.
Pilot audit – using ‘green bags’ for transfer of medicines
Patient Group Directions – local audits
Medicines reconciliation of medicines on admission by pharmacy staff
(adult inpatient units).
Follow-up on action plans
Re-audit where further
improvement or assurance
is required
To complete the medicines
management audit
programme for 2013/14.
Medicines Management Reviews of adult inpatient units
Completed 2012/13
Planned for 2013/14
Follow-up medicines management reviews to ensure
the actions from the 2011/12 reviews had been
addressed. 91% of the actions were either completed
or in the process of being completed.
The medicines management team will work with
the adult inpatient units to complete the remaining
actions. The medicines management reviews will
be repeated in 2014/15.
Safe and secure handling of medicines
Completed 2012/13
Planned for 2013/14
Safe and secure handling of medicines workshops
95% of registered healthcare professionals completed
Safe & Secure handling of medicines workshops in
2012/13 compared with 69% in 2011/12.
Review the Safe & Secure handling of medicines
workshop.
Safe and secure handling of medicines assessments
A self-assessment form was circulated to all clinics
and departments where medicines are stored to
check that these are stored and handled in
accordance with the Medicines Policy.
Follow-up on action plans.
Competency assessment for medicines administration
A community nursing competency assessment
framework for medicines administration assessment
was issued. A pilot was undertaken.
Increase the number of community nurses who
have completed the competency assessments.
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QUALITY ACCOUNT 2012/2013
Falls and Fractures
The Falls Bundle is based on the Royal College of Physicians Falls
Bundle (2011). It looks at many areas including whether patients
have appropriate footwear, their lying and standing blood
pressure, their falls history and fear of falling, checks on fracture
risk, review of medications being taken and an assessment of
cognition to identify risk factors which can be mitigated.
During 2012/13 the Falls Bundle was implemented across all Trust
inpatient units. The Falls Bundle Steering Group reviewed the
documentation twice in that period in response to learning made
from use. The implementation of the Falls Bundle was
accompanied by falls awareness training and education about the
documentation that is used within our inpatient units. Compared
to 2011/12, the number of falls has reduced across inpatient areas.
The steering group is in the process of developing a Falls
Workbook as an educational tool that will be mandatory for all
staff within our bedded units. Online training and a workbook
approach enables learning to be overseen by matrons, ward
managers and therapy leads.
During 2013/14 the steering group will look at how The Butterfly
Scheme and Intentional Rounding (discussed on pages 30 and 40
respectively) can support us to continue to reduce the risk of falls.
New weekly clinic
Working with our falls team, the
clinical
medication
review
pharmacy service established a
weekly clinic providing advice on
lifestyle changes and medication
reviews
for
patients
with
suspected postural hypotension
(when a person’s blood pressure
drops significantly when they
stand up) who may be at risk of
falls. The new clinic allows the
patient to see a nurse and a
pharmacist during the same
appointment. As a result waiting
times for the falls clinic have
reduced from five months to three
weeks and more than £75,000 has
already been saved by preventing
hospital admissions and making
prescribing savings.
A chart which shows the number and impact of inpatient falls during 2012/13:
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QUALITY ACCOUNT 2012/2013
Nutrition and Dietetics
Ensuring our inpatients in bedded units are hydrated and have access to good nutrition is a priority;
therefore all patients staying in our bedded units have a nutritional assessment. Inpatient units are
required to undertake a Malnutrition Universal Screening Tool (MUST) assessment on all patients within 48
hours of admission. The tool leads to recommendations which form part of each patient’s individual care
plan.
During 2012/13 inpatient assessments were on average completed 89% of the time, exceeding our
historical 2010/11 CQUIN target of 85%. During 2013/14 our board will monitor our progress toward
achieving a target of 100%.
A chart which shows the percentage of MUST assessments completed within target timeframes:
Liverpool Care Pathway (LCP)
The LCP assists practitioners in delivering best care by following the principles of caring for dying patients.
In June 2012 the Marie Curie Palliative Care Institute Liverpool confirmed our LCP was compliant with their
template. The key to using the pathway effectively is ensuring our staff have the training, communication
skills and confidence in delivering end of life care. Our End of Life Care Team support staff by offering
training in workshops. The Trust will respond to any changes recommended following the national review
of the LCP, which is expected late 2013.
Advance Care Planning
An Advance Care Plan (ACP) gives people the opportunity to discuss their wishes and preferences in
relation to future care. Although it is a voluntary process, it is important everyone is given the opportunity
to make an ACP. The benefits include empowering people to have a choice in where and how they would
like to be cared for at end of life.
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QUALITY ACCOUNT 2012/2013
EoLC in Dementia
The EoLC Team worked with the
Dementia Specialist Nurses to deliver
specific training to care for people
with dementia who are moving into
the last phase of their disease
progression. Following the success of
this collaborative approach more
integrated training is planned for
2013/14.
The EoLC coordinators have worked in collaboration across 5
organisations in West Sussex to develop a standardised ACP. It
is available on our website: www.sussexcommunity.nhs.uk/acp
The EoLC Coordinators continue to offer training to SCT nurses,
GPs and care homes.
In the 2013/14 Quality Account we will report on the number
of eligible patients offered an ACP and the number who
completed one. We will also report on the number of people
who completed an ACP who died at their preferred place of
care (PPC).
Gold Standards Framework (GSF)
The GSF is a nationally recognised and accredited education programme designed to support care for
patients nearing the end of life, and is delivered by non-specialist nurses and carers. It is concerned with
helping people to live well until the end of life.
The GSF has been proven to improve the quality, co-ordination and organisation of care in primary care,
care homes and acute hospitals. This enables more patients to receive the type of care they want, in their
preferred place, with greater cost efficiency through reduced hospitalisation.
Care Project
Following funding from the national end of life programme the Trust has been offering a “Spiritual Care”
service to those living in Chichester and surrounding areas.
Data collected from the Liverpool Care Pathway (LCP) revealed those dying from non-cancer conditions in
the community had very little or no “spiritual care” provision. The project followed on from a similar
initiative using a befriending team working alongside chaplaincy
within St Richard’s Hospital and was shown to be immensely
EoLC Coordinator Team
beneficial.
In 2012 our EoLC Coordinator Team
were given Regional Centre status
14 hand-picked volunteers underwent training and the project
by the National GSF Community
has been identified nationally as an example of good practice.
Interest Company (CIC), the first
NHS organisation to achieve this.
Being a Regional Centre enables the
team to deliver the GSF programme
to care homes across Kent, Surrey
and Sussex. During 2012/13 our
EoLC Coordinators ran a successful
Gold
Standards
Framework
programme with 24 nursing homes
predominantly in Sussex. This offers
training and support to deliver
better end of life care and raise the
standards for people who are cared
for. Another programme will be
running in 2013/14.
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QUALITY ACCOUNT 2012/2013
Midhurst Macmillan Service
During 2012/13 the Midhurst Macmillan Service continued to help over 80% of its patients to die in their
Preferred Place of Care (PPC), which for the majority of people is their own home. The team also worked to
continue preventing hospital admissions by providing clinical interventions to people at home.
The team is one of five pilot sites involved in a King’s Fund project relating to models of care coordination
for people with chronic and medically complex illnesses, which can be applied in different contexts and
care settings. The report on this is due in 2013. We are also participating in 2 research projects:
 A 3 year funded study in 3 phases, the first of which involved surveying bereaved carers about end
of life care. The findings will inform how best to develop new short term palliative care services for
frail older people in community settings.
 ‘Can Talk’ study led by University College London, is a randomised control trial looking at the
clinical and cost effectiveness of cognitive behavioural therapy plus treatment as usual for
treatment of depression in advanced cancer.
The Midhurst Macmillan Service is working with the South East Coast Ambulance Service NHS Foundation
Trust (SECAmb) on their Intelligence Based Information System (IBIS) and holds regular teaching and
education sessions for local community nursing teams, GPs and nursing home staff. The service has also
worked with other specialist palliative care providers on Sage and Thyme’s communications skills training.
A chart which shows the number of people cared for by the Midhurst Macmillan Service during 2012/13
who died in their PPC:
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QUALITY ACCOUNT 2012/2013
Brighton & Hove – Community Palliative Care Team (CPCT)
During 2012 a review of the community based palliative and EoLC in Brighton & Hove was undertaken by
the Brighton & Hove Clinical Commissioning Group (CCG). The aims of the review were to:
 Review the patient journey through existing services
 Provide a seamless end of life pathway in line with best practice and available finance
 Reduce inappropriate accident and emergency, and hospital admissions
 Integrate the needs of patients living with dementia into end of life services
 Achieve a 10% efficiency saving through adopting the new model.
As a result of the review, the CPCT formed a partnership with the Hospice at Home Team based at the
Martlets Hospice, which is known as The Palliative Care Partnership (PCP). The PCP will provide: 7 day a week visiting service and 24/7 specialist consultant telephone advice for professionals
 Access to wider support services for palliative and end of life care patients, irrespective of
diagnosis, including pre- and post- bereavement support, welfare benefits advice, spiritual care,
social worker, creative therapies, complementary therapies, and volunteer visiting services
 Specialist holistic assessments
 Improved communication and continuity of care through use of a shared Electronic Patient Record
system (Crosscare).
It is anticipated PCP outcomes will:
 Increase numbers of expected deaths in their PPC and reduce inappropriate hospital admissions
 Increase numbers of patients with a palliative diagnosis, other than cancer, being cared for at
home/in their PPC
 Increase numbers of patients dying from a life-limiting illness spending their last weeks of life in
their PPC
 Decrease numbers of patients dying in hospital if it is not their PPC
 Improve equity of access to support and information services for palliative and end of life care
patients and their families
 Improve coordination of care and partnership working across organisational boundaries.
A chart which shows the CPCT helped over 71% of its patients die in their PPC during 2012/13:
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QUALITY ACCOUNT 2012/2013
Pressure damage
During 2012/13 we focused on our Pressure Damage Prevention Strategy, prioritising staff training to:
 Identify people who are at risk from developing pressure damage
 Implementing strategies to prevent pressure damage occurring
 Recognise and grade pressure damage once it has occurred.
A Pressure Damage Prevention Strategy Group has been developed and chaired by the Chief Nurse along
with weekly Safety Express meetings with the Deputy Chief Nurse. The aim of both of these is to have clear
senior clinical leadership together with support to share best practice, identify issues and propose
resolutions across the Trust.
Examples of some resolutions include providing our community nursing teams with digital cameras so
wounds can be photographed and emailed to a Tissue Viability Specialist nurse for an expedient expert
overview and advice on treatment; “Bite Size” training packages have also been developed to enable staff
to keep themselves up to date on a regular basis and can be used at team meetings so staff can learn
together.
At present when pressure damage is identified (as represented in the following two charts) it is not
centrally recorded if it is preventable or not. We are introducing a new bespoke database to capture this
information during 2013/14.
A chart which shows the number of instances of pressure damage acquired while under our care, graded
by severity:
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QUALITY ACCOUNT 2012/2013
A chart which shows the number of instances of pressure damage acquired outside of our care, graded
by severity:
The Butterfly Scheme
During 2012/13 we began to implement
the Butterfly Scheme across our inpatient
wards to help us improve the ways we
care for people with dementia.
The Butterfly Scheme helps increase
hospital staff awareness that a patient’s
memory is permanently affected by
dementia.
It provides a simple, practical strategy to provide these patients
with the most effective and appropriate care, reducing their
stress levels and increasing their safety and well-being.
Staff who interact with dementia patients are taught to offer
them a 5-point targeted response. To support implementation
of the scheme we have identified Dementia Champions at each
of our inpatient units to drive forward the change and ensure
we work to the highest standards.
In 2013/14 we will continue to implement the scheme in the
remainder of our inpatient areas.
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QUALITY ACCOUNT 2012/2013
National Institute for Health & Care Excellence (NICE) guidance
In 2012/13 NICE released 102 pieces of clinical guidance of which 11 were categorised as directly applicable
to the Trust. SCT has a robust policy and process for the dissemination, review, implementation and
monitoring of applicable NICE guidance. The NICE guidance process is overseen by the Trust’s Clinical
Effectiveness sub-committee.
Local implementation of NICE guidance is reviewed by services through the Clinical Audit process.
Delayed transfers of care / Discharge planning
Building on our 2011/12 achievements, in 2012/13 SCT further reduced the number of bed days lost due to
delayed transfers of care.
This has principally been achieved by working more closely with colleagues across all sectors and
developing our patient goal planning processes. For example, at Midhurst Community Hospital a single GP
sees all patients every day for a week and handover to the GP covering the next week at a multidisciplinary
meeting attended by both GPs.
Staff at Arundel & District Community Hospital and Zachery Merton Community Hospital have also
reviewed their MDT meeting to ensure their discharge planning is as effective and proactive as possible.
A chart which shows then number of average (weekly) bed days lost due to delayed transfers of care:
Praise for our Community Neurological Rehabilitation Team (CNRT)
We are proud our north locality CNRT team was proclaimed best community organisation at this year’s
West Sussex County Times community awards programme. The team was established in April 2012 to
provide a specialist neuro-rehabilitation service to patients in the Horsham, Crawley and Mid Sussex
who have had a stroke or have progressive neurological illnesses.
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QUALITY ACCOUNT 2012/2013
Catheter care / Urinary Tract Infections (UTIs)
In 2012 patients in Brighton & Hove who had an indwelling urinary catheter but no other nursing needs had
their care transferred to the Bladder & Bowel Service, as part of a redesign of the service. The service now
provides catheter care management for this group of patients, managing their needs and recatheterisations
in a planned way through use of individualised treatment plans as well as preventing unplanned visits,
whenever possible.
Other patients with urinary catheters within Brighton & Hove whose care is managed by other community
clinicians are also managed on a short term basis if their catheters are problematic. This helps prevent
unnecessary admissions to accident and emergency.
As part of the ongoing commitment to reduce the number of urinary catheters, the Brighton & Hove team
assesses patients to ascertain if they are suitable for a planned trial without a catheter. If this trial should
fail they are offered to be taught intermittent self-catheterisation rather than be recatheterised.
The Bladder & Bowel service also has North and South teams in West Sussex who provide advice regarding
urinary catheters and promote the use of the pathways to aid the planned management of catheters,
preventing unnecessary admissions to accident and emergency.
Throughout 2012/2013 our service continued to provide an extensive urinary catheterisation and
catheterisation update education programme for registered clinicians which was open both to Trust based
and external practitioners. During 2013/14 the Bladder & Bowel Service will continue to try to prevent
unnecessary admissions into accident and emergency, through encouragement of patient and carer
education plus an extensive education programme for clinicians.
Paediatric physiotherapy
Our Paediatric Physiotherapy service continues to run their successful and innovative physiotherapy
advice drop-in clinics for parents of young children, using local Children & Family Centres. These are
held weekly in both the Horsham and Crawley districts. This enables parents with concerns over more
minor issues such as plagiocephaly, intoeing gait, flat feet and baby and toddler motor skills (e.g.
delays in weight bearing, sitting and walking) to see a member of the physiotherapy team in a childfriendly, non-threatening environment close to their home, and with a choice of times and venues.
Over a sample of two months, 29 children were seen in 5 clinics, with 36% being concerned with their
child’s motor development, 32% seeking advice on foot, knee and hip issues (such as uneven leg
creases, flat feet and intoeing gait) and 23% seen for concerns with head posture (head turning
preference, plagiocephaly and torticollis). Following referral by their Health Visiting team or GP they
can be seen quickly and given reassurance and advice, and if necessary ongoing intervention will be
arranged. Over the last year the team identified a case of child with late Developmental Dysplasia of
the Hip (DDH), a child with cerebral palsy and saw several babies with infantile torticollis. This allowed
for early interventions and better outcomes for the children and their families.
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Patient/Carer and staff experience
Patient/Carer experience
Across the year our services collected
patient feedback using different
methods e.g. postal surveys, one-toone interviews, user groups. Survey
results and actions taken in direct
response to issues raised are reported
through the Trust’s Quality Committee,
for example:
 Horsham
Hospital
Minor
Injuries Unit: Improvements to
the waiting area and piloting of
a revised triage assessment
system
 Children’s Speech & Language
Therapy: Improved patient information leaflets and introduction of parent focus groups
 Integrated Primary Care Teams, Brighton & Hove: Use of the Productive Community module of the
Productive Series to help improve capacity.
The CQUIN for patient experience feedback for 2012/13 focussed on SCT’s inpatient units. This was in the
form of a survey of all patients discharged in June 2012 and January 2013 using the same set of questions
for comparison of progress/improvement. The Trust met its CQUIN target.
We redesigned the Trust website and it is now possible for visitors to access information on how to submit
compliments, comments, concerns and complaints. There is an online form to leave feedback and also
information on how to ‘Get involved’, such as taking part in surveys or research opportunities.
Friends and Family Test
Between January and March 2013 the Trust piloted the Friends
and Family test (which asks ‘How likely are you to recommend
our ward / department to friends and family if they needed
similar care or treatment?’) across 3 inpatient wards at
Crawley Hospital. Patients answering the question are also
asked to explain why they gave the score they did. From 1st
April 2013 we implemented the Friends and Family Test across
our Urgent Treatment Centre, Minor Injuries Units and all our
adult inpatient units.
Wound care teams
Our wound care teams work with
patients in their own homes as part
of our Integrated Primary Care
service in Brighton & Hove. Skilled
nurses lead on decision-making with
regard to wound care, and ensure
accurate diagnosis and effective care
planning improving outcomes and
the patient’s experience.
Patient Experience Sub-committee
Reporting into our Quality Committee, the Patient Experience
Sub-committee has a broad membership of stakeholders including public and patient representatives,
clinical and managerial staff, Communications staff and a Non-executive Director. The committee is chaired
by the Chief Nurse.
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Patient Experience Strategy
In 2012/13 a key piece of the group’s work was the continued development of a Patient Experience
Strategy. The strategy embodies the Trust’s drive to put patients at the centre of service delivery and
include their views and opinions in developing new services.
The Patient Experience Sub-committee will focus on taking the strategy forward over the next five years
including achieving improved participation of minority and disadvantaged groups. In 2012/13 networking
continues with gypsies and travellers in Brighton & Hove, the Black Minority and Ethnic (BME) Partnership
and the Crawley Ethnic Partnership.
Staff experience
The annual NHS staff survey provides an insight into staff views on the organisation and their experience of
working within it. The survey is a key measure of staff engagement and wellbeing which is essential to the
provision of high quality services. When compared to previous years, the results can prove a useful tool in
measuring progress and aiding our continuous improvement.
In 2012 we were required to survey a random sample of 850 staff and our response rate was 53%, the same
rate as 2011 and average for community Trusts. In addition to the mandatory sample we opted to survey all
4,000 eligible staff. In total we received 1,460 responses.
In 2011 the Trust had been broadly average in comparison to other community Trusts. While there were
some very positive improvements, particularly around appraisal rates, there were also disappointments,
particularly in questions relating to stress and work pressure with many respondents expressing concern
about change, and the continuity of organisational understanding of their services.
What we did
Following analysis of the 2011 survey results, a Workforce Wellbeing Group developed a staff wellbeing
action plan. As a result we:
 Reduced recruitment timescales by up to 35 days
 Increased the appraisal rate to an average of 75% over the year, peaking at 81% in January 2013
 Implemented an employee of the month scheme
 Improved communication to staff by introduction of team briefing, a weekly message from the
Chief Executive and improvements to the internet and intranet
 Introduced a programme of policy review
 Ran wellbeing sessions at a number of sites to raise awareness of health matters, including stress
 Improved access to counselling services.
Where we are now
Overall the 2012 survey shows clear improvement in many areas compared to 2011 and we compare very
favourably against other community Trusts. Our score for overall staff engagement has improved and the
number of staff recommending the Trust as a place to work or receive treatment has also increased.
An analysis of individual questions in the survey shows some large improvements. For example, staff who
feel able to do their job to a standard they are personally pleased with has increased from 55% to 75% and
those being clear about whom senior managers are increased from 66% to 83%. However, the lowest score
is for senior managers acting on feedback at 30%.
Our number of positive scores has roughly doubled since 2011 and the number of negative scores has
reduced by around 60%, a significant improvement. However, staff suffering work related stress has
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increased from 32% to 41% (although not inconsistent with comparator organisations) and more staff need
to have their health and safety training (down from 82% to 76%).
What will we do about this?
Stress will be a key focus of future
actions. A recent Health & Safety
Executive stress indicator report
identifies that the organisational
factors that contribute to high stress
levels have improved a little. It may
be the case that levels of resilience
and/or the impact of external
stresses, such as economic factors
are having an increased effect on
staff in the workplace. Stress is the
largest single cause of absence and
an investment in supporting staff to
improve their resilience may be
essential. This will need to take place
alongside further development of
the organisational culture through our human resources and organisation development strategy, and with
continued support and development of leaders.
Health and safety training is being addressed through a review of the delivery of annual Statutory training.
Overall, the staff survey information is valuable in providing evidence to support the development of our
plans and strategies, but we will also build on our existing Workforce Wellbeing action plan by breaking
down the survey results into service area in order that each service can develop their own local plans and
identify good and poor practice, targeting areas of concern and sharing learning.
Staff sickness
A chart which shows our rate of staff sickness across 2012/13:
Despite our focus on addressing
sickness absence and our target
to reduce the rate, our staff
sickness rose from 4% to 5.41%
during the 12 month period to
February 2013.
We will set our target at 4% for
the coming year and continue
with our Health & Wellbeing
group to address issues.
Progress towards this target will
be regularly reviewed by the
board.
Appraisals
We continued from the previous year in maintaining our focus on increasing appraisal rates and have seen
steady progress throughout the year, slightly exceeding our 80% target for staff having received an
appraisal to 81% in January 2013.
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Use of agency
staff
A chart which shows our rate of staff sickness across 2012/13:
In 2011/12 we reduced
our spending on agency
staff to 3.06% of our pay
bill, compared to 4% the
previous year. In
2012/13 we set
ourselves a target of
reducing it to 3%. As can
be seen from the chart,
this has been exceeded
in the summer months,
possibly as a result of
covering annual leave.
In 2013/14 staffing
establishments will be
set at a level to cover
annual leave so
increased agency staff
usage should not occur for this reason.
The Productive Series
The Productive Series supports teams to redesign and streamline the way they work. This helps achieve
significant and lasting improvements – predominantly in the extra time they give to patients, as well as
improving the quality of care delivered whilst reducing costs.
SCT continues to support the implementation of the Productive Community Services (PCS) and Productive
Ward (PW) programmes as a means to achieving the DH’s ambition for all NHS patients to be receiving
“Productive Care” by 2014. The initial 2 year project plan for PCS has been extended for a further year until
March 2014.
The tables below summarise achievements the series brought about last year and our plans for the future:
Productive Leader (PL): Releasing time to lead
Completed 2012/13
Planned for 2013/14
7 senior leader teams completed PL.
Productive principles will be encouraged and the
tools and templates will be available to staff to use.
An evaluation of the PL was undertaken.
Improvements were reported in email management,
working relationships between PAs and senior
leaders and meetings management.
Productive Programme team to use PL
methodologies to support frontline teams and their
leaders and administrators.
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Productive Community Services (PCS): Releasing time to care
Completed 2012/13
Planned for 2013/14
79 out of 141 teams from Adult and Children’s
services commenced the programme.
Continued delivery of the PCS is planned to involve
all community teams by 2014.
Creation of an Improvement Officer role to provide
intensive support to teams.
To prioritise PCS delivery for teams who are best
positioned to participate, as well as teams
requesting specific PCS facilitation.
Evidence of sustainable improvements were
observed and captured at team level, including:
a) Patient Safety & Reliability
1. New standard procedures for use of non-sterile
gloves and decontamination wipes.
a) Programme facilitators to align SCT approved
safety tools to PCS.
2. Participating teams have used Patient Status at
a Glance boards for improved management of
patients identified at risk.
b) Patient Experience
Participating teams have used tools from the
Patient Perspective module to develop local
Welcome and Involvement packs.
b) To work with our Marketing & Communications
team to ensure Welcome and Involvement packs
meet Trust branding requirements. To facilitate
participating teams to align feedback from
Patient Perspective activities with data on
complaints and compliments.
c) Staff Health & Wellbeing
Productive programmes team have designed
and piloted a questionnaire for capturing the
impact of PCS on staff health and wellbeing.
c) To inform our delivery of PCS we will roll out a
questionnaire.
d) Productivity
Participating teams have improved use of office
space and filing systems, and improved
organisation of their electronic folders and
clinical store rooms. Teams keep before and
after photos which they use to set team
standards and audit further improvements.
d) To work with our Performance Analysis team to
identify a way of recording data centrally and
generating aggregate reports.
Bognor physiotherapists run Brighton Marathon
A team of seven physiotherapists ran in 2012’s Brighton Marathon in aid of Breast Cancer Care. To help
with their fundraising efforts, the team held a cake sale in the physiotherapy department at Bognor War
Memorial Hospital.
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Productive Ward (PW): Releasing time to care
Completed 2012/13
Planned for 2013/14
SCT received training from the NHS Institute in the
use of the Productive Community Hospital toolkit.
The Minor Injury Unit at Horsham Hospital and the
Urgent Treatment Centre at Crawley Hospital are
now using the modules to review their services. The
therapies department at Crawley Hospital has also
started using the toolkit.
All sites to follow the same Productive Ward
questionnaire timetable for the year. This will allow
for benchmarking and a more focused sharing of
good practice.
All wards now receive a report monthly showing
results from questionnaires and audits undertaken
as part of Productive Wards, to know how they are
doing and to identify any improvements needed.
This year the programme will continue to develop
the multidisciplinary approach to modules,
encouraging involvement of staff from all disciplines
in the improvement to services at ward level.
As part of the meals module, Salvington Lodge
introduced the use of “dignity crockery” for patients
with dementia. Other sites are now reviewing the
use of this in their areas.
Continue to embed standards and competencies in
relation to individual modules. Past experience has
demonstrated these contribute to fostering
consistent and reliable care.
Crawley Hospital staff developed a night time
module using the Productive approach. This enabled
the team to look at the night experience from a
patient and staff perspective. Output has included
the development of a night time standard and a
review of the patient care documentation. This
module has now been commenced by 3 other sites.
To roll out the night time module to all relevant
community inpatient wards.
Patient Advice & Liaison Service (PALS)
PALS provides an easy access service for patients, carers and relatives to answer questions and resolve
concerns as quickly as possible.
The service provides information about the NHS complaints procedure and how to get independent help in
making a complaint, and helps improve the quality of care and experiences of patients by ensuring staff
who manage services are made aware of any issues raised.
A dedicated resource for handling PALS issues has enabled a more robust recording process. All PALS
enquiries are recorded and monthly reports showing trends are provided to Assistant Directors, Executive
Directors and services.
In 2012/13 PALS received 479 enquiries in relation to SCT services, and 175 enquiries in relation to other
providers. This represents a 34.85% increase in enquires compared with 2011/12, which is a result of a
robust campaign to promote the service.
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Complaints
In 2012/13 the Trust received a total of 237 complaints, compared to 235 in 2011/12.




64% of complaints were closed in line with the Trust’s policy of 45 working days
The remaining complaints were closed outside of this timescale in consultation with complainants.
These complaints took longer to close due to their complex nature, where a multi-agency response
was required or where the issue was being investigated under another process, such as an incident
or safeguarding investigation
At the time of writing 182 of the 237 complaints received in 2012/13 were closed, of which 50%
(91) were not upheld, 26.4% (48) were partially upheld and 23.6% (43) were upheld.
Key complaint themes were shared with service users via our Patient Experience Sub-committee.
A chart which shows the 5 largest categories of complaint received in 2012/13:
Examples of actions taken as a result of learning from complaints include:
 New disabled parking bays created at Brighton General Hospital
 New guidelines for a Healthy Child Clinic to ensure an Early Years Visitor/Community Nursery Nurse
is available in the clinic every week to support parents and families
 The Admission Avoidance Team has produced an ‘Introduction to the Team’ leaflet which is
provided to new patients
 The National Early Warning Score (NEWS) is being implemented in our in-patient units.
During the reporting period 10 complaints were referred to the Parliamentary Health Service Ombudsman
(PHSO), one of which resulted in an ongoing investigation.
The Complaints team has the following priorities for 2013/14:
 To produce a toolkit for services to assist in the management of complaints. This will include the
recommendations from the report into Mid Staffordshire NHS Foundation Trust.
 To review the complaints training programme to ensure it is relevant to roles and responsibilities of
different groups of staff.
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Compliments
The total number of compliments recorded for 2012/13 is 1,797. This figure is 23.4% higher than last year
as services have been encouraged to use Trust’s central recording mechanism. Work will continue
throughout 2013/14 to ensure all services consistently record their compliments.
Equality and Diversity
The Trust’s Equality and Diversity Board has agreed the following objectives for 2012-2016 as required by
the Equality Act 2010:
 Improve patient engagement with Seldom Heard Groups in order to reduce health inequalities
 Establish widely available and corporately well-managed accessibility to services sensitive to
patient needs
 Meet annual targets for the completion of mandatory equality, diversity and human rights staff
training, appropriate to their role
 Ensure leaders understand their role in the context of delivering against the Equality Act 2010.
To increase staff training levels, an Equality and Diversity workbook is being developed to provide a flexible
training option and to augment existing e-learning and group training opportunities.
Intentional Rounding
Intentional Rounding is a structured process where nurses and allied health professionals can carry out
regular checks with patients at set intervals - typically every 1-2 hours. During these checks they carry out
scheduled or required tasks. This in turn enables staff to organise their priorities and care planning,
therefore following the productive model of releasing more time for direct patient care.
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As well as the fundamentals of
nurse/patient interaction, communication
and maintaining privacy and dignity,
rounding focuses on six core elements:
 Pain
 Anxiety
 Nutrition and hydration
 Continence
 Risk of falling
 Pressure ulcer prevention.
Intentional rounding has been implemented
in all SCT community hospitals.
Outcomes include:
 Patient experience reports have improved
 Call bell usage and response times are improved
 Ward leadership is visible, accessible and established, nurses are aware of their roles and
accountability. The ward photo board details the nurses on duty for the day’s shift.
 Staff report they enjoy a more organised patient focused work schedule.
Proactive care
Staff working in Littlehampton, Bognor and Chichester community nursing and therapy teams are working
as part of the new Proactive Care Teams alongside health and social care colleagues from primary care,
West Sussex County Council and Sussex Partnership NHS Foundation Trust.
Patients benefit from joint health and social care interventions co-designed with patients and carers to
meet today’s care needs, and to plan for future needs. Many of these patients have more than one longterm condition and are at risk of going into hospital. Proactive Care keeps them at home whenever it is safe
to do so, which is what most patients indicate they want. Proactive care also ensures patients have greater
control over decision making about their care, ensures the minimum number of assessments and creates a
single shared care plan.
Staff benefit as they are able to talk directly with colleagues from other sectors, share concerns and plans
and coordinate the number of visits each professional does. The result is a happier, well motivated and
more professionally fulfilled workforce. Previous barriers to good partnership working have now been
greatly reduced or eradicated altogether.
By the end of 2013 there will be complete coverage of the Coastal area with another 8 teams to add to the
5 already working. We are introducing a tool to identify people ‘at risk’, many of whom will not be known
to community services. This identification process will enable assessments to be completed,
care/rehabilitation plans to be put in place and contingencies worked out efficiently and quickly. There will
also be a programme of work to ensure that as many patients, where it is clinically safe to do so, will
receive training to develop skills to manage their own conditions, supported with equipment where
appropriate.
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Volunteers
Volunteers play an invaluable role in SCT and we ensure they are fully supported, supervised and
developed in order to enhance service delivery and patient experience.
Our Volunteering Steering Group, formed during 2012/13, oversees the work of volunteers throughout the
organisation in services such as the Expert Patient Programme, Snow Drop Trust, Community Macmillan,
Milk Infant Feeding Team,
and Learning Disabilities
Health Facilitation Team.
The group will look at best
practice in the engagement
and support of volunteers,
and will aim to reduce
obstacles and increase
opportunities in order to
make volunteering in SCT
inclusive and accessible for
all. A new database
management system has
also been launched which
will hold records of all our
volunteers throughout the
Trust.
The volunteer strategy and
action plan provides a basis
for a professional
volunteer programme
which will enable
Volunteer Managers and Trust staff to work in partnership identifying suitable roles and ensuring
volunteers are not used as a replacement for a paid post.
Our relationship with Local Involvement Networks (LINk)
LINks were set up by the Local Government and Public Involvement in Health Act 2007 to give individuals
and voluntary and community groups the chance to review the performance of health and social care
providers, comment on the provision of local services and influence the decisions of commissioning bodies.
During the past year we have built on our commitment to work closely with the West Sussex LINk and
Brighton & Hove LINk and welcome their input as ‘critical friends’. We value their interests in our work and
their honest and robust comments on our performance – ultimately the quality of care we provide to our
patients.
Relationships have been managed proactively both by LINks and via our marketing and communications
team. Our relationships have been enhanced by the strong informal relationships that have been
established with our chair, other board members and representatives of our LINks. For example, following
feedback from our LINks representatives our chair, executive director of operations and marketing and
stakeholder engagement manager meet together after each board meeting to discuss items that LINks
would like to talk about.
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As part of our relationship:
 LINk members regularly attended meetings of our board in public, and their contributions to our
board discussions were welcomed.
 We met with the LINks after each board meeting to discuss items of interest with time for
questions.
 LINks members attended internal meetings, including the Trust planning group and our patient
experience steering group.
 We invited LINks to events, such as our annual general meeting.
 We sent regular news items to each LINk for their mailings to their members i.e. a new service
development.
 We included LINks in our weekly chief executive message and sent them copies of our staff
magazine Trust Talk.
 We advised the LINks about our organisational development, service change and improvement,
and encouraged their comments e.g. our Worthing wheelchair consultation.
 We supported LINks in patient satisfaction surveys e.g. we helped to facilitate a survey with
patients who received treatment for a leg ulcer from our tissue viability service.
 We sought advice, guidance and support from our LINks with regard to public engagement.
 We attended LINk meetings and participated at LINk events to explain who we are and what we do
e.g. Brighton & Hove LINk steering group meeting and their farewell event.
Moving forward – Healthwatch England and Local Healthwatch
In July 2010, the government announced plans to set up Healthwatch England. Under these changes, LINks
became local Healthwatch organisations from 1st April 2013.
Healthwatch England is the new, independent consumer champion for health and social care in England.
Their job is similar to the LINks – to argue for the consumer interest of all those who use health and social
care services. Their role is to give a national voice to the key issues that affect people who use health and
care services. They will use evidence based on real experiences to highlight national issues and trends and
raise these at the highest levels. They will actively seek views from all sections of the community – not just
from those who shout the loudest, but especially from those who sometimes struggle to be heard.
Local Healthwatch organisations will:
 Have the power to enter and view services
 Influence how services are set up and commissioned by having a seat on the local health and
wellbeing board
 Produce reports which influence the way services are designed and delivered
 Want to be involved in any service change
 Provide information, advice and support about local services
 Pass information and recommendations to Healthwatch England and the CQC
 Are commissioned to provide a separate advocacy service.
We are working closely with our new local Healthwatch organisations to build new relationships and build
on the extensive work undertaken in partnership with our previous LINks organisations.
We will be consulting with Local Healthwatch in the very near future with regards to our public consultation
and plan to become an NHS Foundation Trust as well as future changes to services.
We thank all LINks representatives for their support over the past few years.
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The Francis Report
Robert Francis QC chaired a public inquiry into the ‘appalling suffering of patients’ at the Mid Staffordshire
NHS Foundation Trust between 2005 and 2008. He was asked by the government to consider:
 Why the healthcare system did not detect the problems and take action sooner?
 What are the lessons for the NHS as a whole?
His view is that the NHS should be able to deliver an acceptable level of care, but that we cannot assume it
always does. He concludes we need a fundamental culture change across the NHS to ensure such events
cannot happen again. This requires a relentless focus on the patient’s interests and protecting patients
from poor care.
In publishing his report, Francis calls upon:
 Every healthcare organisation to review and act upon his recommendations.
 All NHS staff to play their part in support of change.
What SCT is doing
Each of us, on an individual and team level, is using what Francis tells us to review practice in our own
areas. We are doing this by:
 Understanding what Francis recommends
 Thinking about what stops delivery of the best possible patient care
 Reflecting on all aspects of our patients’ healthcare experiences
 Recognising where improvements could be made and by being bold enough to be part of the
solution.
Alongside this approach, since February 2013 the Trust has been running a series of open workshops for
staff from across the Trust to:
 Establish the Trust’s own baseline against the recommendations
 Prioritise themes from the report to focus on first
 Engage staff in describing the Trust’s cultures and
 Ensure we understand our strengths and weaknesses and take action to improve where we need
to.
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Becoming an NHS Foundation Trust (FT)
We have been given the green light to move forward to the next
stage of preparations to become an independent NHS
Foundation Trust (FT) in 2014 by the NHS Trust Development
Authority (NTDA).
Senior Trust leaders met with officials from the NTDA who gave
us the opportunity to describe the Trust’s progress over 2012/13
to improve the quality of patient care, spend money wisely and
strengthen governance arrangements.
The NTDA’s recognition of this progress follows the positive
statements of support the Trust has received in recent months
from commissioners and partners in the NHS and local
government across Brighton & Hove and West Sussex.
Electric Vehicle Charging
Point
We are aiming to implement the
first publicly available electric
vehicle charging point at Brighton
General Hospital, with support
from Brighton & Hove City Council.
We will ensure that the electricity
used to charge electric vehicles is
from a low or zero carbon source,
e.g. solar panels. This will form part
of our efforts to decarbonise our
own fleet but we also see this as an
important community engagement
initiative.
FTs were set up to devolve decision making power from central
government to local organisations and communities. FTs are not
directed by the government, so have greater freedom to decide,
with their governors and members (see below), their own
strategy and the way services are run. FTs have more financial
independence than NHS trusts, and can use this to improve services for patients and service users. FTs are
not-for-profit, public-benefit corporations. A public benefit corporation is a body set up by the state to
perform public benefit. Public-benefit corporations are different from other public authorities (such as local
councils) in that they have a membership.
We believe that being a FT will help us to:
 Improve patient care
 Be more open and accountable
 Strengthen our links with local people
 Build on the work we have already done to make our services more sensitive to the needs of
patients.
Many people feel a strong sense of connection to the NHS and NHS service providers. The principles behind
FTs build on this sense of connection and ownership. FTs have a duty to engage with their communities and
encourage local people to become members of the organisation. They have to take steps to ensure that
their membership is representative of the communities they serve.
Anyone who lives in the area we serve, works for the Trust, or has been a patient or service user, can
become a member of the FT. This gives staff and local people a real stake in the future of their community
services. If you’d like to know more about becoming a member please email: sc-tr.sctmembership@nhs.net
or complete our feedback form on page 58.
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Who we involved in our
Quality Account
From living room to boardroom
Our stakeholders
Clinicians, managers and support staff have all been invited to contribute to the 2012/13 Quality Account,
identifying their priorities for improvement for 2013/14.
Stakeholders who have been involved in the development of the Quality Account include:
 Our staff
 Service users (via our Patient Experience Sub-committee)
 Commissioners who have been asked to comment via letter
 Brighton & Hove City Council and West Sussex County Council who have been asked to comment
via letters to their respective Health & Wellbeing Overview & Scrutiny Committee (HWOSC) and
Health & Adult Social Care Select Committee (HASCS)
 Healthwatch Brighton & Hove and Healthwatch West Sussex have been asked to comment via
separate letters.
All the stakeholders listed above were also given opportunities to contribute to and comment on the
development and content of this report, and their statements follow.
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Clinical Commissioning Groups
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Healthwatch Brighton & Hove
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Healthwatch West Sussex
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Health & Adult Social Care Select Committee
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Useful information
From living room to boardroom
Glossary
Term
Description
Assurance
Providing information or evidence to demonstrate that something is working as it should,
such as the required level of care, or meeting legal requirements.
The independent health and social care regulator for England.
Care Quality
Commission
CQC
Clinical Audit
Clinical Coding
Clinical Commissioning
Groups
CCGs
Clinical Effectiveness
Clinical Governance
Clostridium Difficile
C. difficile
Commissioning
Commissioning for
Quality and Innovation
CQUIN
Community
Information Dataset
CIDS
Data Warehouse
Department of Health
DH
Falls Bundle
Gold Standards
Framework
Grade 3 or 4 Pressure
Damage
Healthwatch
Information
Governance Toolkit
A quality improvement process that seeks to improve patient care and outcomes through
systematic review of care against explicit criteria and the implementation of change.
The translation of medical terminology as written by the clinician to describe a patient's
complaint, problem, diagnosis, treatment or reason for seeking medical attention, into a
coded format.
Groups of GPs who are responsible for designing local health services In England.
The extent to which specific clinical interventions do what they are intended to do.
A system through which NHS organisations are accountable for continuously improving the
quality of their services and ensuring high standards of care.
A bacterial infection.
The process of ensuring health and care services are provided effectively and meet the needs
of the population. Activities include assessing population needs, buying products and
services and monitoring the provision of those services.
A payment framework which enables commissioners to reward excellence by linking a
proportion of English healthcare providers' income to the achievement of local quality
improvement goals.
CIDS makes locally and nationally comparable data available on community services to help
commissioners make decisions on the provision of services.
In computing, a Data Warehouse is a database used for reporting and analysis.
A department of the UK government responsible for government policy for health and social
care matters and for the National Health Service (NHS) in England.
A bundle of interventions that support the reduction of falls and related injuries.
The Gold Standards Framework is a model that enables good practice to be available to all
people nearing the end of their lives, irrespective of diagnosis.
Pressure damage (previously often referred to as a ‘bed sore’ or ‘pressure sore’) is a localised
area of damage to the skin and/or underlying tissues. A Grade 3 is full thickness skin loss and
Grade 4 is extensive destruction, tissue damage to muscle, bone, or supporting structures
with or without full thickness skin loss
Healthwatch England is the independent consumer champion for health and social care in
England, ensuring overall views and experiences of people who use health and social care
services are heard and taken seriously at a local and national level.
A system which allows NHS organisations and partners to assess themselves against
Department of Health Information Governance policies and standards.
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QUALITY ACCOUNT 2012/2013
Term
Description
Intranet
An Intranet is a computer network that uses Internet technology to share information
amongst employees within an organisation. The Trust’s Intranet system is called The PULSE.
The King's Fund is an independent charity working to improve health and health care in
England.
The LCP is a set of guidelines for looking after people in the final days or hours of their life.
King’s Fund, the
Liverpool Care
Pathway
LCP
Malnutrition Universal
Screening Tool
MUST
Methicillin-Resistant
Staphylococcus Aureus
MRSA
Metrics
National Institute For
Health Research
NIHR
National Institute for
Health & Care
Excellence
NICE
National Patient
Safety Agency
NPSA
National Reporting
and Learning System
NRLS
Patient Advice &
Liaison Service
PALS
Primary Care Trust
PCT
Productive Series
Programme
Productive Ward
Safety Express
Senior Information
Risk Owner
SIRO
South East Coast
Ambulance Service
NHS Foundation Trust
SECAmb
Sussex Community
NHS Trust
SCT
MUST is a five-step screening tool to identify adults, who are malnourished, at risk of
malnutrition or obese. It also includes management guidelines which can be used to develop
a care plan.
A bacterial infection.
Measures, usually statistical, used to assess any sort of performance such as financial, quality
of care, waiting times, etc.
A government body that coordinates and funds research for the NHS in England.
An independent organisation responsible for providing national guidance on promoting good
health and preventing and treating ill health.
Leads and contributes to improved, safe patient care by informing, supporting and
influencing organisations and people working in the health sector.
An NHS national reporting system, in England and Wales, to report on patient safety
incidents. This information is used to develop tools and guidance to help improve patient
safety.
A service providing a contact point for patients, their relatives, carers and friends to ask
questions about their local healthcare services.
A PCT was an NHS organisation responsible for improving the health of local people,
developing services provided by local GPs and their teams (called primary care) and making
sure other appropriate health services were in place to meet local people’s needs. PCTs have
been replaced by CCGs.
A set of practical tools, such as patient experience surveys, developed by the NHS Institute
for Innovation & Improvement, to help NHS services redesign and streamline the way they
work.
Ward based element of the Productive Series.
Safety Express is a ‘call to action’ for NHS staff who want to see a safer more reliable NHS
with improved outcomes at significantly lower cost.
The SIRO is an Executive Director of the Trust who takes ownership of the Trust’s information
risk policy, and acts as advocate for information risk on the board.
SECAmb responds to 999 calls from the public, urgent calls from healthcare professionals in
Kent and Sussex, and provides non-emergency patient transport services (pre-booked
patient journeys to and from healthcare facilities).
SCT is the main provider of NHS community health services across West Sussex and Brighton
& Hove. SCT provides a wide range of medical, nursing and therapeutic care to over 8,000
people a day. SCT works to help people plan, manage and adapt to changes in their health, to
prevent avoidable admission to hospital and to minimise hospital stay.
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QUALITY ACCOUNT 2012/2013
Quality Account feedback form
We would very much welcome your feedback on what you think about our Quality Account. Please use this
form to let us know your thoughts and whether you would like us to include anything else in next year’s
report.
1. Who are you?
Patient, family
member or carer
Member of
staff
Other (please
specify)
2. What did you like about this report?
3. What could we improve?
4. What would you like us to include in next year’s report?
5. Are there any other comments you would like to make?
6. Sussex Community NHS Trust is applying to become a Foundation Trust. Are you interested in
becoming a member? If so please provide your name and address below.
Thank you for taking the time to read this report and give us your comments.
Please post the form to:
Paula Head
Chief Executive
Sussex Community NHS Trust
A1 East, Brighton General Hospital
Elm Grove, Brighton
East Sussex
BN2 3EW
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