2012/13
VISTA HEALTHCARE INDEPENDENT HOSPITAL
QUALITY ACCOUNT
Vista Healthcare Independent Hospital
Quality Account 2012/13
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QUALITY ACCOUNT
2012/13
INDEX
Statement from CEO
Page 3
Board Directors
Page 5
Statement from the Medical Director
Page 6
Priorities for 2013/14
Page 8
Introduction
Page 9
Overview of Services Provided by Vista Healthcare
Page 10
Priorities for 2012/13 & Updates
Page 11 - 31
Patient Engagement – Page 11
Safety – Page 14
Effectiveness – Page 26
Infection Control Information for Patients
Page 32
Conclusion and Contact Information
Page 34
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Statement from the CEO
This is my second year of presenting Vista Healthcare Annual Quality Accounts and it has been a
turbulent but interesting one, not only for Vista but for healthcare providers across both the public
and independent sectors. The fallout from Winterbourne View continues to affect learning disability
providers particularly in relation to how independent healthcare is being scrutinised.
There can be no excuse for the abuses suffered by the patients at Winterbourne View; however, if
we only move patients into the community without dealing with the fundamental causes of the
abuse we will be reacting to another debacle, this time in the community. The failures at
Winterbourne and subsequent reports have illustrated that organisations must be culturally
competent to deliver the highest standard of care and treatment for the most vulnerable people in
our communities.
While continued scrutiny from the regulator gives the necessary independent review of service
provision, it is for provider organisations to ensure that all staff are focused on delivering quality
care by creating a culture that values and empowers patients and staff. To do this there needs to be
a system whereby managers are continually seen (high profile), training is in place that ensures staff
are competent to deliver care that is needed, supervision is available aimed at continuously
improving practice and the appraisal of staff is undertaken to reflect performance and address staff
needs. During this year we at Vista have adopted such an approach which is reflected in the values
and behaviours we expect from our staff and while we are on a journey we are seeing a positive
response from both patients and staff which has been reflected in our most recent patient survey,
CQC and National Development Team for Inclusion’s (NDTi) audits and reports.
Winterbourne has now been compounded by the failings of Mid Staffordshire (Francis Report) which
has demonstrated some fundamental issues for both clinicians and the organisation. The inquiry
into the organisation found that patients were routinely neglected as management became
preoccupied with cost cutting, targets and processes losing sight of the fundamental responsibility to
provide safe care. This is the consequence of money taking precedent over care through the annual
erosion and pressure on budgets. We are cognisant of such an impact on our organisation and
where we can no longer absorb any further deflationary settlement without impacting on the quality
of care, we have asked to meet with commissioners to agree, in the spirit of partnership, how we
can together meet these challenges as the status quo is often not an option.
As a specialist learning disability service we have focused on empowering patients through the
development of literature that is understandable (easy read) and involvement in producing bespoke
training packages which helps them understand the reason for a number of interventions. As a
consequence of empowering patients and staff, Vista Healthcare can demonstrate how such an
approach influences standards, best practice, partnership working and helps us become a better
listening organisation that puts service users at the heart of everything it does.
In 2011/12 Quality Accounts, Vista Healthcare provided a commitment to deliver high quality
services as a matter of course, but also a commitment to a number of priority areas for
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improvement. This report provides details of Vista Healthcare’s achievements in those areas. It also
provides a description of the quality initiatives for 2013/14. The report also details how the
organisation has worked to embed the CQC standards in everyday practice and how the
requirements have been met.
There are other areas which Vista Healthcare is proud to describe; these include CQUIN
achievements, environmental improvements and the work with commissioners and case managers
in an attempt to include them in partnership working. More recently we have been reviewed by the
NDTi who took on board and applied the outcomes surrounding the post Winterbourne review.
I am delighted to present the 2012/13 Quality Accounts as I believe that Vista Healthcare has moved
a long way in achieving the objectives set for 2012/13 and as I said above, we are on a journey, but
I’m happy to acknowledge some of our achievements without becoming complacent and therefore, I
anticipate 2013/14 to be another challenging year, not least of all because we will have another year
of austerity.
Ian McComiskie
CEO
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Board Directors
In preparing this Quality Account (QA) the directors have taken steps to satisfy themselves that:

The content of the quality report meets the requirements set out by Vista Healthcare
The content of the QA is not inconsistent with internal and external sources of information.
The QA presents a reflection of Vista Healthcare performance over the period covered; the
performance information reported in the Quality Account is reliable and accurate; there are proper
controls over the collection and reporting of the measures of performance included in the report.
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Statement from the Medical Director
As Medical Director I feel privileged to be asked to provide a report for Vista’s Quality account.
Over the past two years we have faced a number of significant challenges which has resulted in a
change agenda with the drive for quality at its heart. From the report provided herein, I can confirm
that we have strived to achieve Vista’s corporate aims and objectives as far as possible.
We set out with a challenging programme of improvements with patients at the forefront of what
we do.
The Winterbourne and the Francis reports have enabled us to learn from the recommendations and
we have established a robust clinical, quality driven patient safety protocol which will form the
nucleus of our developing services.
It has been a challenging and eventful year to be working as part of a very proactive team, both
within management and care delivery, which is primarily focussed on improving the quality of
clinical care we provide to the patients admitted to Vista Hospital.
Vista is fortunate to have a very robust Medical, Nursing and Specialist Multi-Disciplinary Clinical
team, which is committed, strong and is empowering. Each team, is led by a Consultant Psychiatrist
(Responsible Clinician) with the support of management, and are engaged as partners within a
quality driven Clinical Governance Group.
As part of Clinical Governance, the Medical Directorate leads the Clinical Effectiveness strategy,
within which Clinical Audit lies and there is now a well-established Clinical Audit committee which is
actively overseeing all the audits conducted within Vista.
As part of quality and adherence to standards, Vista has a dedicated Mental Health Legislation
Committee under the Medical Directorate, overseeing the application of the Mental Health Act and
the Mental Capacity Act (including DoLS).
One of the achievements pertaining to quality and safety is the establishment of regular ward
governance meetings, empowering our staff to focus on service developments and requirements,
including supporting the group to highlight service deficiencies to senior management for quick
actions.
The Medical team believe in evidence based treatment and care and this is driven through the teams
and the various national and RCPsych guidelines are followed. All the clinicians have been appraised
and are in the process of being revalidated by the GMC.
Liaison with the community teams, care managers and commissioners has improved a great deal,
allowing us to have established communications to enable a successful pathway of care delivery for
the patients. This is further enhanced at care level through an improved CPA process.
We know we can do more to keep the momentum. We are striving to maintain a culture within the
organisation continuing to empower and assist our staff to place the patient at the centre of
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everything we do. The scrutiny of external agencies like the CQC, NDTi & Commissioners has helped
us undertake this and a route map will be established to continue these activities.
We are looking forward to continue our work as a team. We are aware that the key to success is
working to empower our patients and a bottom up approach, from a dedicated staff group. In
addition, the patients receiving the service and their views will be pivotal in bringing about positive
changes and we will concentrate on harnessing this over the next year to make positive and quality
driven changes and improvement to care.
This Quality Account will enable all stakeholders, from the evidence provided, to see for themselves
the activities of the organisation and as the Medical Director, I am satisfied with the content and
endorse the same. My sincere thanks to the Clinical Team as a whole and the Management Team
who have enabled us to progress further and continue with this journey.
Dr Sivanathan Manjubhashini MBBS. DPM. FRCPsych. DMSW (Psych)
Medical Director/Consultant Psychiatrist
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Priorities for 2013/14
Patient Engagement
1. Ensure all elements of care are patient focused and allows for patient input in line with the
recovery principles, the outcome stars and My Shared Pathway
2. Further increase meaningful engagement (aim for 100%)
3. Increase the number of patient-suggested audits carried out
4. Ensure that 95% of patients are trained in Safeguarding
5. Re audit the patient observation and engagement audit
6. Ensure patient involvement in the recruitment process for all staff
Safety
1. Improve infection control within all patient environments through training and audits
2. Ensure that 100% of staff are trained in Safeguarding
3. Re audit the ligature audit carried out in the 2011/12 year
4. Improve the service’s ability to review and learn from incidents, accidents and complaints to
further improve patient safety
5. Actively involve patients in the risk assessment process through the roll-out of START
Effectiveness
1. Review current clinical outcomes with a view to continual improvement
2. Working with internal and external stakeholders to further improve the patient’s care
pathway including the provision of packages of care for supported living
3. Further enhance the accuracy and efficacy of record keeping through continued
improvement of IT structures especially relating to the Electronic Patient Record system
4. Further enhance patient’s access to high quality and effective physical health care
monitoring and treatment
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Introduction
As an organisation, Vista continues to set high standards for delivery of patient care; standards
which include the provision of a safe, effective and inclusive service. 2012/13 was a particularly
challenging year for the organisation as it found maintaining the balance of high quality care within a
very tight financial envelope whilst accepting that there are a number of key areas requiring financial
resources to address them. Vista had not had an up-lift in fee for a number of years whilst accepting
that inflation and other increases in cost meant that it was a very fine balancing act to meet all the
necessary targets, both those that are externally imposed along with the organisation’s own.
Notwithstanding this, Vista took the view that if the people that use our services continue to be the
focal point around which services are designed and delivered, it was necessary to commit financial
resources to enhance the lives and wellbeing of our service users.
The key priorities for 2012/13 clearly set out some exacting targets across broad areas of patient
engagement, safety and effectiveness of service provision/delivery; details of which will be
contained within Vista’s documentations. The imperatives of many of these targets has been; to
enhance the systems, processes and policies to ensure that we are proactive in enhancing the
quality of services delivered to our patients; the maintenance of patient’s, staff’s and the general
public’s safety; the ability to respond in a timely way to incidents, accidents; and also patient’s, care
managers, commissioners and the CQC’s comments.
Key areas that Vista Healthcare had sought to address were the management of medicines; and
empowerment of our patients with the intention of enhancing their involvement in their care and
the running of the hospital, ensuring that information provided to patients was in the format that
they could understand either through the provision of easy-read documentation and the use of
language in a way that the Plain English Society advocates. In respect of patient’s safety, the
management of medicines was considered to be an area worthy of some focused attention through
audits and subsequent training.
Vista Healthcare strives to learn from feedback received from its patients, their families and other
stakeholders. We recognise that all our stakeholders will only accept our assurances from our ability
to demonstrate high levels of patient satisfaction through the provision of a safe, therapeutic and
outcome focused service. Since the last report, there have been a number of changes within the
hospital that has enabled us to develop effective care pathways and enhance our ability to provide
true individualised care with the level of flexibility that is necessary to meet individual needs. These
changes have brought about a number of challenges, which were not unexpected as they mirrored
those detailed by change management theorist.
Over the last 6 months of 2012, we have made significant advances in embedding agreed changes.
This has been verified both by the CQC and the NDTi. We are not complacent in believing that we
have arrived at our destination and firmly believe that there are a number of other areas that still
require change. These areas form part of our Quality Improvement Priorities for 2013/14.
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Overview of Services Provided by Vista Healthcare
Vista Healthcare Independent Hospital is a registered hospital which provides assessment and
treatment for people who have learning disabilities and/or have mental health problems who
present challenges in relation to their behaviour. The main driver to improve services is the paper –
Valuing People which sets out the national strategic direction for learning disabilities and reflects the
objectives set out in ‘Our Health, Our Care, Our Say’.
There are five wards within the hospital that are part of the care pathway encompassing locked and
rehab male ASD, Low Secure male and female and female rehab. In an attempt to reduce the length
of stay within the hospital, there have been discussions with commissioners and case managers on
the merit of the hospital providing personal care and supported living outside of the hospital. This is
an attempt to enhance the care pathway and assist our commissioners and patients to live
independent lives out in the community. This initiative has been warmly welcomed by case
managers and commissioners alike. To that end, a successful variation application was made to the
CQC.
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Priorities for 2012/13
Patient Engagement 2013/2013:
1. To encourage the use of the recovery principles by using and achieving 90% compliance of
engagement with Recovery Star
The hospital is heavily promoting the use of recovery tools for patients since being involved
in the Pilot Study for My Shared Pathway (MSP). MSP is now up and running within the Low
Secure Service, and it seemed obvious to include the ASD service in a recovery led initiative.
To achieve this training will be provided to all staff and patients in various ‘Stars’ including
the Life, Spectrum and Recovery. This also provides the opportunity to strengthen the
training for My Shared Pathway with patients.
The use of the Recovery Star as part of the Outcome Star family will be used in conjunction
with Life Star and Spectrum Star as appropriate to Patient need. Now that the initial MSP
work has been completed the ‘Stars’ will be used as an additional recovery tool to
consolidate the four MSP questions and to enable patients to ‘see’ where they are on the
recovery pathway and plan their individual recovery with the Recovery Team. Training will
be written and presented on the Outcome Star and how they are used as tools for discussion
as to a patient’s needs and recovery pathway development. The information gathered from
the Stars can if necessary be ‘mapped’ onto the Outcomes of MSP to show a unified
approach in the Recovery Principles used at Vista. To record compliance of engagement a
spread sheet record will be produced to track those attending training on the recovery
principles and their transfer to the working environment, and similar recording will take
place to track all the patients showing which Star they are being supported with in their
Recovery and evidence of success. The training and tracking will take place in Q1 and Q2.
2. Ensure all elements of care are patient focused and allow for patient input in line with the
recovery principles
100% completion of the Individual and Team scoring using My Shared Pathway – Outcomes,
Plans and Progress has been achieved. The next step in ensuring that all elements of care are
patient focused and are reflected in the eight Outcomes of MSP will be the use of two
scoring outcomes to drive the care plans for recovery. It is hoped to achieve this by
encouraging patients to discuss with their Primary Nurse the scoring outcomes to identify
areas where opinions differ and establish why and what work needs to be done to bring the
scoring closer together; or to look at where scoring is the same and plan how the patient can
move their skills forward. Once this discussion has taken place the patient will be
encouraged to discuss this information at their Recovery Team Meeting.
Each of the eight Outcomes has a clinician lead who will work with patient and Primary
Nurses in consultation with the Team to write care plans to address the needs identified by
patients. To further ensure patient understanding and to support their decisions in areas of
further development the use of an appropriate Outcome Star e.g. Life Star, Recovery
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Star may also be used as a supporting tool to document and record patients’ extant status,
aspirations, how they can be supported in achieving them and to record achievement.
3. Further increase meaningful engagement (aim for 100%)
Vista has adopted the Low Secure Standard of 25 hours of meaningful activity per week per
patient as a benchmark for good practice across the whole of the hospital site using the
nationally recognised definition of Meaningful Activity – ‘Time spent doing activities both on
your own or with others, which are personal and important to you, impacts on the way you
feel and which drives your treatment and recovery’ – as a means of identifying and
recording meaningful activity offered to patients. In addition the Meaningful Week
component of the CareNotes software is being used to record and analyse the data
regarding patient’s engagement with meaningful activity. The information is collated and
analysed on a monthly basis as part of the Clinical Governance Meeting.
The most recent figures (03/04/2013) show that overall the hospital is meeting the required
25 hours of meaningful activity per week per patient. In some instances (Ash, Maple) the
amount of activity offered is almost double the requirement. Prandle is the only ward where
the average hours of activity offered do not meet the required 25 hours per week (20.11).
However, this is a significant rise from the last recorded figures for Prandle (11.31).
Individual data shows that all LSU wards are consistently offering all patients at least 25
hours of meaningful activity per week. Within the ASD service that is a marked difference
with only 33% of Prandle patients recorded as being offered 25 hours of activity and 75% of
Willow. Recent changes in the recording and gathering of data (i.e. data now includes
activities that were offered and declined as opposed to solely activities that took place)
suggest that our aim of 100% compliance to the standard across the whole hospital should
be achieved in the next few months.
4. Provide high quality new information for patients relatives and carers
This is on-going and will continually evolve. The entrance halls of wards and other buildings
will be made friendlier with clocks, literature, pens etc. All information will be developed in
line with marketing and business plans, and in as Easy Read format as is necessary to
maintain branding. A short survey with Carers/Parents was carried out and discovered that
the majority of them would like to receive a copy of the patient’s newsletter too. Staff
dedicated to the Patient Newsletter has been enhanced.
Work identifying and securing Patient Information Areas on the wards is being finalised. The
old boards are going to be relocated in the entrance halls and will hold all visitor
information. Any information that is needed for patients will follow the agreed branding
format and all information so far produced is on the general area of the electronic
communication system for all staff to access.
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5. Continue to carry out patient-focused audits as appropriate
The Patient Satisfaction Survey for March 2013 is complete with findings and
recommendations for the future imminent. This survey will be repeated in September and
hopefully further progress will have been made. The introduction of applications allowing
the capture of more information on ward based handheld devices from patients and possibly
even carers, and staff if appropriate, is planned in the near future.
6. Ensure that 95% of patients are trained in Safeguarding
This has been achieved with the extant cohort of patients but the turnover of patients
affects rolling achievement. Further training in safeguarding (abuse) is going to be held in
May/June 2013 and will become part of the annual programme. The Patient Satisfaction
Survey records many responses on this item with reporting they would like to do this
training again as they found it very helpful and informative.
Along with safeguarding training, there are plans for other patient training e.g. recruitment,
committee meetings, patient representative, buddy training, complaints, and possibly fire
awareness and safety.
7. Ensure that 95 % of patients are trained in Recovery Star Principles
When patient training on all the stars commences, the patients will have a good grasp and
understanding of all the stars and of My Shared Pathway. We have been able to “map” the
scores and colours of Recovery Star onto My Shared Pathway so these tools can be used
interchangeably. This will enable the hospital to choose the most appropriate recovery tool
for the patient and therefore ensure a more positive outcome. The completion of this
training will be a Q2 goal.
8. Ensure that all wards have weekly community meetings
Ward meetings had been taking place regularly but taking varying formats and with differing
focus. Staff have worked hard in bringing these closer to expectations. The meetings occur
weekly with the overriding focus on how the wards function as communities; however the
formats still reflect the ward purpose and environment. Patient participation remains the
driver for the meetings.
9. Ensure that there is a monthly hospital wide patient meeting (patients assembly)
Staff have tried a number of variations in assembling patients with a view to maximising the
benefits derived but because of a number of practicalities it was decided to revert to holding
the big Patient Assembly every month. The patients do enjoy coming to this meeting, and it
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is an opportunity for them to air their grievances but also to see what is happening on other
wards. This is an important part of the process for patients and the opportunity for them to
socialise and mingle in this way is vital; and is an opportunity to share information.
10. Re audit the patient observation and engagement audit
The re-audit of patient observation and engagement has not been achieved within the life of
this Account. This objective will be rolled forward to the next year.
Safety 2012/13:
1. To improve medicine management processes through audits and training
The processes for the management of medicines have been audited over the year resulting
in discernible improvement. There have been a number of teaching sessions and medication
assessment sessions for all newly recruited Registered Nurses. Audits have been carried out
by Ward Managers and the Pharmacist with any irregularities addressed immediately.
With training and staff awareness sessions the year has seen a big improvement in drug
errors and staff demonstrating more awareness about the need to manage medication
storage and administration more responsibly. Staff have also been more willing to
acknowledge mistakes and take responsibility for their actions.
The chart above does demonstrate that further work is required to bring the errors down to
zero as no drug errors are acceptable.
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2. Improve infection control within all patient environments through training and audits
3. Improve the ward atmosphere through conducting EssenCES surveys and make changes as
appropriate in response to the findings
Executive Summary
The main objective of the present audit was to evaluate the social and therapeutic atmosphere
on wards for Low Secure Patients at Vista Hospital, outlining areas of good practice and areas
that may need improvement. The Essen Climate Evaluation Schema (EssenCES) was
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administered to Low Secure patients and staff members who work with Low Secure patients to
assess the essential traits of the social and therapeutic atmosphere of the wards. There are
marked variations between scores on the EssenCES questionnaire across the three Low Secure
wards at Vista Healthcare.
Patients and staff on Watson ward rank the three dimensions of the EssenCES questionnaire in
the same order; therapeutic hold highest, followed by experienced safety and then patient
cohesion. Patients and staff on Ash ward are also in agreement, ranking therapeutic hold
highest, followed by patient cohesion and experienced safety ranked last. In contrast to Watson
and Ash wards, there are fewer consensuses between the staff and patients on Maple ward.
Although both rank therapeutic hold highest, patients then ranked patient cohesion second
followed by experienced safety. In contrast staff working on Maple ward ranked experienced
safety second followed by patient cohesion. The scores highlight an improvement in the
presence of the three dimensions for almost all patients and staff from the three wards. For
both staff and patients on Ash ward and patients on Maple ward experienced safety was
highlighted as an area that could benefit from being built upon. For both patients and staff on
Watson ward as well as the staff on Maple ward, patient cohesion was identified as an area that
may benefit from being built upon. It may be beneficial to the continued improvement of the
three wards for the ward managers and the recovery team to look at these results and develop
action plans to help continue to improve the therapeutic atmosphere on Watson, Ash and Maple
ward.
Background
The Essen Climate Evaluation scale is a 15 item questionnaire originally developed for assessing
characteristics of the social and therapeutic atmospheres of forensic psychiatric wards. The data
from the questionnaire is used to derive measure of 3 separate aspects if the social and
therapeutic atmospheres of the ward:
o Patients cohesion and mutual support
o Experienced safety
o Therapeutic hold
It is important to recognise that a positive therapeutic atmosphere has been shown to be
associated with improved patient outcomes, positive staff performance and morale and a
number of measures of both patient and staff “satisfaction”.
The EssenCES tool has now been completed on 2 occasions during 2012 with the most recent
study being completed in February/March 2012. The purpose of this exercise has been to make
a comprehensive assessment of the therapeutic atmosphere within the hospital.
Since the last audit, changes have also been made to the training for positive handling
techniques and restraint. All permanent staff are required to attend team teach training and as
there has been an increase in permanent staff on the three wards more trained staff are working
on each shift. All staff have now been trained in these techniques and are undergoing refresher
training when needed. Staff are also trained in using advanced techniques. Improvements to the
training and the consistency of techniques utilised by the permanent staff may have influenced
staff and patients perceptions of experienced safety on the three wards.
Objectives
The main objective of the present audit was to evaluate the social and therapeutic atmosphere
on wards for Low Secure Patients at Vista Hospital, outlining areas of good practice and areas
that may need improvement. It also provides an opportunity to identify any differences in
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patient and staff’s perspectives since the last EssenCES audit was completed (July 2011), as well
as areas that continue to need improvement. The aim of the present findings is to be able to
provide a guide to an action plan to further build upon the therapeutic atmosphere on wards
and in turn to improve the environment in which therapeutic treatments can be provided for the
Low Secure patients at Vista Healthcare.
Results
Watson Ward
Figure 1 displays the mean score for each of the three dimensions of the EssenCES questionnaire
for both the staff and patients on Watson Ward. It can be seen that there is a general consensus
between the staff and patients with regards to the three dimensions. Therapeutic hold is rated
the highest with a mean of 16.3 for the staff and 13.1 for the patients. This suggests that
patients on average agree ‘quite a lot’ with the statements reflecting the presence of
therapeutic hold on Watson ward, and in comparison, on average staff agree ‘very much’ with
statements reflecting the presence of therapeutic hold on the ward. Experienced safety is rated
second highest, with a total mean of 11.2 for staff and 11.1 for patients. The scores reflect that
the patients and staff are in very close agreement that on average they agree ‘somewhat’ with
the statements representing a lack of perceived safety on Watson ward. It should be noted that
scores for the Experienced Safety questions are reversed during analysis, resulting in a higher
score representing a higher perception of experienced safety. Patient Cohesion was rated third
with a total mean of 10.5 for staff and 10 for patients. The scores reflect that both patients and
staff on average agree ‘somewhat’ with the statements representing the presence of patient
cohesion on Watson Ward.
Figure 1. Overall mean score for each dimension of the EssenCES questionnaire for both staff and patients on Watson
Watson Ward
Ward.
20
18
16
14
12
10
8
6
4
2
0
Patients' Cohesion
Experienced
Safety
Staff Mean
Therapeutic Hold
Patient Mean
The standard deviation scores between individual’s totals for each of the three dimensions
were also calculated. With regards to Watson Ward there seems to be much more variation
in responses for the patients (standard deviations for the three scales ranged from 4 - 4.7)
with the largest variation seen in the Patient Cohesion questions. The standard deviation
scores for Watson ward staff ranged from 2.7 - 3.7 thus reflecting a smaller variation in their
individual scores. The largest standard deviation was seen in the Therapeutic Hold questions.
Ash Ward
Figure 2 highlights the total mean scores for the three dimensions on the EssenCES
questionnaire for both the patients and staff on Ash ward. Similar to Watson ward, there is a
general consensus between both the patients and staff on Ash ward according to how the
three dimensions were ranked. However, greater discrepancy was observed between staff
and patient responses on Ash ward as compared to Watson ward which is reflected in the
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total mean scores. Similarly to Watson ward, Therapeutic Hold is ranked highest with a total
mean of 17.2 for staff and 15.5 for patients. This reflects that on average the patients agree
‘quite a lot’ with the statements representing the presence of therapeutic hold on the ward.
In comparison staff, on average, agree ‘very much’ with the statements looking at the
presence of therapeutic hold on the ward. Patient Cohesion is ranked second with a total
mean of 13.7 for the patients and 12.1 for staff. This highlights that both staff and patients
on average agree ‘quite a lot’ with the statements representing the presence of Patient
Cohesion on Ash ward. Experienced Safety is ranked last for Ash ward with a total mean of
11.6 for staff and 10 for patients. Again both staff and patients on average agree ‘somewhat’
with the statements that reflect a lack of perceived safety on the ward. It should be noted
that scores for the Experienced Safety questions are reversed during analysis, resulting in a
higher score representing a higher perception of experienced safety.
Figure 2. Overall mean score for each dimension of the EssenCES questionnaire for both staff and patients on Ash Ward.
20
18
16
14
12
10
8
6
4
2
0
Patients' Cohesion
Experienced
Safety
Staff Mean
Therapeutic Hold
Patient Mean
Standard deviations for both staff and patients on Ash ward were also calculated. It
highlighted that there was a large variation in the answers given by the patients on ash with
the standard deviation ranging from 4.7 – 6.3. The largest variation was seen with the
Patient Cohesion questions. A possible reason for such results is that at the time the
questionnaires were completed a patient on Ash was going through an unsettled period
which had led to a lot of disruption on the ward. For the staff working on Ash ward the
standard deviation scores are quite high ranging from 3.5 – 4.9. Again the highest standard
deviation was seen for the Patient Cohesion questions which may reflect the unsettled
period of a particular patient and how staff perceived this to be affecting other patients on
Ash ward.
Maple Ward
Figure 3 represents the total mean scores for the three dimensions of the EssenCES
questionnaire for both the patients and the staff working on Maple ward. Therapeutic Hold
was ranked highest for both the patients and staff on Maple ward, although there was a
large difference between the two total means. With a total mean of 17.5 staff on average
agree ‘very much’ with the statements representing therapeutic hold on the ward. In
contrast with a total mean of 13.2 on average the patients on Maple ward agree ‘somewhat’
with the statements representing therapeutic hold on the ward.
The patients then ranked Patient Cohesion second highest with a total mean of 12.3,
suggesting that on average the patients agree ‘quite a lot’ with the statements representing
the presence of Patient Cohesion on Maple ward. Ranked last was Experienced Safety. The
patients on Maple ward had a total mean of 11.5 which reflects that on average the patients
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feel that they agree ‘somewhat’ with the statements representing a lack of perceived safety
on the wards. It should be noted that scores for the Experienced Safety questions are
reversed during analysis, resulting in a higher score representing a higher perception of
experienced safety.
In contrast, the staff working on Maple ward ranked Experienced Safety second highest with
a total mean of 12.7. This suggests that on average the staff feel that they agree ‘little’ with
the statements representing a lack of perceived safety on Maple ward. Again it should be
noted that scores for the Experienced Safety questions are reversed during analysis,
resulting in a higher score representing a higher perception of experienced safety. Patient
Cohesion was ranked third with a total mean of 11.2 which suggests that on average the
staff agree ‘somewhat’ with the statements representing the presence of patient cohesion
on Maple ward.
Figure 3. Overall mean score for each dimension of the EssenCES questionnaire for both staff and patients on Maple Ward.
20
18
16
14
12
10
8
6
4
2
0
Patients' Cohesion Experienced Safety
Staff Mean
Therapeutic Hold
Patient Mean
The standard deviations for the patients on Maple ward range from 5.6 - 8.2 which highlight
a large variation in individual responses to the three dimensions. However, the sample size
for the patients was small due to the size of the ward, and so consequently a higher
standard deviation may be seen as outliers will be more influential over the standard
deviation. The standard deviation scores for staff on Maple ward range from 1.9 – 4.3, with
Therapeutic Hold having the smallest variation in individual answers (SD: 1.9). This indicates
that there is higher consensus amongst staff regarding the presence of therapeutic hold on
Maple ward than staff working on Ash and Watson ward.
Discussion
For all three wards both patients and staff indicate that therapeutic hold is the most
established dimension across the wards, suggesting that for most patients and staff the
climate is perceived as supportive for the patients and their therapeutic needs on Watson,
Ash and Maple ward. Recent changes made to the use of the Vista bank staff has resulted in
wards employing more permanent staff. It is possible that by decreasing the use of bank
staff and thus increasing the number of regular staff on the three wards, patients and staff
are able to build rapport which in turn leads to a more supportive environment as patients
may feel they can approach familiar staff for support.
During the period the survey was being carried out on Ash ward, one patient was particularly
unsettled which resulted in some disruption to the ward. This may have had an impact on
the perceived safety responses on Ash ward as well as the patient cohesion responses for
both patients and staff.
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Comparison to EssenCES audit July 2011
The previous EssenCES audit completed in July 2011 was carried out on three wards, which
included two male wards Watson and Ash, and a female ward; Maple.
In the previous audit the patients and staff on Watson ward ranked the three dimensions in
the same order; therapeutic hold highest, followed by patient cohesion and then
experienced safety. In the current results a general consensus remains amongst the patients
and staff, however experienced safety is ranked second followed by patient cohesion. In
comparison to the previous audit the means scores for staff on Watson ward have increased
for all three dimensions, and have decreased for patients on the dimensions of patient
cohesion and therapeutic hold (although this difference is small). It appears that for staff
working on Watson ward the therapeutic atmosphere has improved, but patient responses
across the three areas have remained relatively stable.
The present audit highlights an overall increase in scores for patients on Ash ward across the
three dimensions, highlighting an improvement in the therapeutic environment since the
previous audit. For staff working on Ash ward there is an increase in mean scores for the
dimensions therapeutic hold and patient Cohesion but a slight decrease for experienced
safety. This result may be due to the unpredictability of a particular patient currently on Ash
ward who was going through an unsettled period at the time the survey was carried out.
Similarly to the previous audit there is a general consensus amongst the patients and staff
on Ash ward when ranking the three dimensions, however, the current results show that
therapeutic hold received the highest means, followed by patient cohesion and then
experienced safety whereas the previous audit highlighted experienced safety second
followed by patient cohesion.
Similar to the differences observed amongst staff and patients in the audit completed in
2011 there was also less consensus amongst patients and staff on Maple ward during the
current audit, with the three dimensions being ranked differently. However, for both
patients and staff there has been a large increase in the mean scores for all three
dimensions since the previous audit, highlighting that there has been an improvement in the
therapeutic atmosphere over the past 18 months. Similarly to the previous audit,
therapeutic hold was ranked highest for patients and staff on Maple ward. However, in
comparison to the previous results patients’ ranked patient cohesion second followed by
experienced safety and staff ranked experienced safety second followed by patient
cohesion.
Conclusions
Similar to the previous audit completed in July 2011 there are variations between the scores
on the EssenCES questionnaire across the three wards at Vista Healthcare. Although there
are differences in the mean totals for each of the three dimensions for all wards, the staff
and patients on Watson ward are in agreement with the ranking of the dimensions;
therapeutic hold highest, followed by experienced safety and then patient cohesion.
Patients and staff on Ash ward also rank each of the three dimensions in the same order
with therapeutic hold ranked highest followed by patient cohesion and then experienced
safety. Similarly to the previous audit there was less agreement amongst the patients and
staff on Maple ward compared to Watson and Ash ward. Both patients and staff ranked
therapeutic hold highest, patients then ranked patient cohesion second followed by
experienced safety. In contrast the staff ranked experienced safety above patient cohesion.
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Overall the present results highlight an increase in scores across the three dimensions of the
EssenCES questionnaire which suggests improvements have been made to the therapeutic
environments on Watson, Ash and Maple ward for both staff and patients. It is possible that
more regular staff and consistent approaches to behaviour management including all
permanent staff being trained in an approach to effectively manage incidents have
contributed to the improvement in scores.
Recommendations
In order to continue building on the perceived safety of the three wards it is recommended
that team teach training continues for all staff working in the hospital and for refresher
training to take place when needed. It is hoped that regular training in positive handling will
allow the staff to continue feeling confident when faced with challenging situations on the
wards. Given the increase in experienced safety scores across the three wards it may be
beneficial to compare the number of incidents that took place at the time of the previous
audit (July 2011) and the current audit to see whether the number of incidents has changed
or whether it is the staff’s perception of safety on the three wards that has changed. This
comparison may give a better understanding of what has influenced the experienced safety
scores.
Patient cohesion is something that can continue to be built upon in order to create a more
supportive atmosphere on the three wards. It may be beneficial for the wards to actively
engage in activities that can take place as a ward, as a way to boost morale and improve the
support amongst patients. For Watson ward this may be harder to achieve as the ward is
larger and it is more likely that the patients form smaller friendship groups and engage in
activities within these. However, activities that take place on the ward such as quiz and
games nights, cultural awareness days as well as group activities like rambling clubs could
help improve the patient cohesion scores for larger wards.
Given that the findings of the current audit highlight variations across the three wards it may
be beneficial for the ward managers in collaboration with the recovery team to discuss the
findings from the report. This will allow the chance to look at where further improvements
can be made, in order to develop individual action plans for improving the current
therapeutic environments on the three wards.
4. Further training of staff to Advanced level of Team Teach
A range of more intensive physical techniques that build on the Intermediate course. It
focuses more on the elements of fights, attacks with weapons and where considered
necessary, ground holds, known as Ground Floor Recovery.
The physical techniques provide a gradual, graded system of response commensurate with
the situation, task and individuals involved, allowing for phasing up or down as dictated to
by the circumstances at the time. The use of force must be reasonable, proportionate and
necessary.
There is an emphasis on appropriate and targeted verbal and non-verbal communication.
The aim is for the person to calm sufficiently so that staff can return the physical control and
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help find a better way. A calm approach with staff using (Communication, Awareness
/Assessment Listening/Looking and Making Safe skills) is expected at all times when
managing such situations.
Staff numbers: Where there is time and sufficient resources the emphasis should be on the
involvement of at least two members of staff when such crisis situations occur. However, for
Ground Floor Recovery, a minimum of THREE staff is considered necessary (two for holds,
one to act as ‘Critical friend’. At least ONE of the staff involved in a ground hold recovery
MUST have a First Aid qualification and ideally the situation should be overseen by a medical
doctor (if longer than 15 minutes, IS A REQUIREMENT)
Where possible, the expectation is that course members will exhaust all behavioural
management strategies before they physically intervene. Where and when there is time, the
physical interventions should be viewed as a "last resort option" for staff. All physical
techniques should be endorsed in policy and supported by Recovery Team’s endorsement of
Positive Handling Plans
5. Ensure that 100% of staff are trained in Safeguarding
Safeguarding of vulnerable adults is an aspect of care that protects people who are often
vulnerable, and often without family support. Those at Vista are 18 and above and have
learning difficulties or some form of mental illness. Support for vulnerable adults comprises
protection from abuse and other services that make their lives comfortable.
Vista Healthcare is committed to enforcing policies and guidelines that support and
empower vulnerable adults. These policies ensure that the safety of vulnerable people is
paramount. It is the aim of this audit to explore the standards that have been set in the
practice and guidelines of SOVA and find out if compliance with the standards is being met.
Where practices have not been met, recommendations and a plan of action is proposed.
The objectives of this audit are to investigate among staff:
 An understanding of what safeguarding adults involves
 The likelihood of reporting a safeguarding issue
 Awareness of correct procedures for reporting safeguarding issues
 Whether feedback of SOVA incidents is communicated properly to nurses
 Level of confidence in reporting safeguarding issues
 An awareness of timescales for reporting to SOVA
 Is SOVA training in place
 Have Staff access to Vista’s SOVA practices and guidelines
 SOVA guidelines have been approved by Vista’s Board, Clinical Governance
Committee and the Executive Management team
 Vista has Practice and Procedure guidelines in line with SOVA policies
100% of staff understand what safeguarding is.
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
In the short scenario, 87% of respondents believed it was a safeguarding issue,
whilst the other 13% did not agree
 70% could report SOVA procedures. The other 30% were not so sure
 97% of staff are aware of Vista’s polices and guidelines and 80% could access them
on their computers , 73% are aware that Vista’s SOVA policies are approved by
Vista’s Board and CEO
 90% of participants have had mandatory SOVA training 10% have had no training at
all
 A provision has been put in place for all staff to complete their Safeguarding E
Learning by 15th May 2013. All employee E-learning accounts have been updated to
ensure they have been assigned the module.
 Managers are responsible for ensuring that the staff have the opportunity to
compete this at the training centre or time and computer access is made available
during their working hours.
 Each manager has access to their team’s E Learning account to monitor and review
their staffs’ progress.
Currently, 32% of staff have completed the E learning module within the last 12 months.
The training manager will send a weekly report to the managers with the percentage of
staff that have completed their E Learning to monitor the progress.
New employees will be assigned the Safeguarding module which should be completed
within 4 weeks from their start date.
18% of staff have attended classroom training in the last 12 months. A rolling
programme to capture new staff and annual refresher training will continue as part of
the training plan.
E learning / classroom training will be completed annually to ensure continuity of
training.
Safeguarding is included as part of the monthly induction and staff are given a copy of
the policy and reporting procedures.
WHAT ACTION TO TAKE AFTER A
SOVA RELATED INCIDENT HAS
OCCURED
DO YOU KNOW WHAT
SAFEGUARDING IS?
3%
YES
97%
NO
30%
NO
YES
70%
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DOES VISTA HAVE A PRACTICE
AND PROCEDURE GUIDELINES
IN LINE WITH SOVA POLICIES?
YES
SOVA GUIDELINES ARE
APPROVED BY VISTA'S
BOARD
NO
23%
3%
YES
4%
NO
NOT SURE
73%
97%
ARE YOU AWARE OF
SOVA POLICIES AND…
COMPLETION OF
SAFEGUARDING
TRAINING
17%
YES
3%
10%
NO
80%
YES
NO
NOT SURE
90%
THERE IS A SYSTEM IN PLACE FOR
RECORDING INCIDENTS AND
CONCERNS IN RELATION TO
VULNERABLE ADULTS
YES
NO
7%
93%
DO YOU OFTEN GET
FEEDBACK FROM REPORTED
SOVA INCIDENTS?
YES
NO
NOT SURE
10%
50%
40%
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DO STAFF HAVE MANDATORY
AWARENESS SESSIONS IN
PROTECTION OF VULNERABLE
ADULTS
Yes
No
Not Sure
4%3%
93%
TIMESCALE TO REPORT SOVA
CONCERNS
NO NOT SURE
0%
3%
YES
97%
6. Re audit the ligature audit carried out in the 2011/12 year
Patient safety is of the highest priority for Vista Healthcare and as such, the hospital has
adopted a clear approach to managing all identified risk. With respect to ligature risk, the
preventing suicide toolkit (MPSA 2003) recommended at least annual audits in patient
areas for ligature risk and robust plans to be put in place to manage likely ligature points.
This was reiterated by The National Suicide Prevention Strategy for England (Annual
Progress Report NIHME 2004). Vista Healthcare has chosen to work in line with legislative
guidance and best practice principles to ensure that this area of risk is minimised. In carrying
out ligature audits, our aim is to provide patients with a safe environment in which they can
receive care. Whilst agreeing in year that this re-audit needs to be done, it was imperative
that various systems and processes be addressed prior to the audit being carried out. As a
result of which, the ligature policy has been reviewed and refined to better provide guidance
to staff, to ensure that there is a standardised and structured approach to ligature risk
management. This has impacted on the organisations ability to complete the audit in year;
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however, work is currently underway for the completion of this work. The audit results will
therefore be reported in the 2013/14 Quality Accounts.
Effectiveness 2012/13:
1. Further develop the Recovery approach; embed the Recovery Star within My Shared
Pathway and the CPA process
2. Review current clinical outcomes with a view to continual improvement
3. Working with internal and external stakeholders to further improve the patient care
pathway
4. Improve consistency of clinical systems
With regards to ensuring the consistency of the clinical systems, a number of audits have
been undertaken to gauge staff’s understanding and execution of various tasks. One of the
areas that have been looked at is an audit of the Mental Health Act Section 58 (consent to
treatment). In line with legislation and best practice, Vista Healthcare supports the fact that
all patients who are detained under a section of the Mental Health Act 1983 revised 2007
and require treatment need to be consulted about the proposed treatment. For consent to
be valid, patients must be competent and must be able to make informed decisions. S/he
must also be able to communicate that decision. In order to do this, s/he must have
sufficient information to make this decision. The responsibility lies with the responsible
clinician to explain the diagnosis or condition and possible side effects associated with the
treatment. Consent can be invalidated if patients are compelled or lack capacity to consent.
According to the Mental Capacity Act 2005, it should always be assumed that a patient has
capacity until proven otherwise. The Mental Health Act 1983 stipulates that detained
patients can be administered medication for their mental illness/disorder without their
consent for three months from the start of their treatment. However, after this period,
consultation, negotiation or agreement for treatment needs to be sought. Under English
Common Law, all mentally competent adults have a right to give or withhold consent to any
medical treatment. It is important to note that this policy is up-held, even to the detriment
of the detained person’s health therefore it is imperative that consent is “informed
consent”. Informed consent means that the patient is assessed by a competent professional
and the patient understands the decision making in relation to their treatment. The patient
must be given information about her/his own condition, the possible side effects and the
effects of planned treatment. It also ensures that the patient makes choices out of her/his
own volition and without undue pressure and has also agreed to the treatment in question.
To administer treatment without informed and continuing consent may constitute assault
and trespass against the person. Part 4 of S.58 gives legal powers for the treatment of
mental disorder without the patient’s consent. On the other hand, if a patient does not give
consent, or withholds consent, then a second opinion is requested. The patient will then be
seen and assessed by a Second Opinion Appointed Doctor (SOAD). It was therefore decided
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with this in mind that the audit should be conducted to measure compliance to the MHA
1983. The audit also looked at the policies and procedures in place at Vista Healthcare
relating to consent to treatment and that they are adhered to.
5. Raise the standard of record keeping with others through improvement of our IT
structures by enhancing the Electronic Patient Record system
There have been a number of issues impacting on the organisations ability to improve the
standards of record keeping. Firstly, the hardware has required updating in order to enable
all staff to easily access the Electronic Patient Records (EPR). Secondly, there have been
awareness sessions for all new staff on the EPR. However, for a number of the existing staff,
it was obvious that further training was required, not only on the understanding the full
capacity of the system, but also in terms of making objective entries on the system. This
training has been rolled out and some modification made to the actual system. Thirdly, it has
been apparent that the system has greater capacity than the organisation was aware of. To
that end, a new IT Manager was recruited expertise on the system. Since his arrival, there
have been a number of modifications resulting in improved functionality and a more coordinated approach to the management of patient records. This has seen an in ease of use
for the clinical staff, thus minimising the time spent on the system and also enabling staff to
access patient records in a more systematic way.
Work has also been carried out on ensuring that the MDT is working much more cohesively
and that each discipline is delivering on their area of expertise in order to improve the
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patient’s experience and involvement within their care planning. Within the nursing team,
an audit was carried out in care planning. Care planning is a very important part of nursing
care. It facilitates nursing process and provides a record of the care provided by the Multidisciplinary team in conjunction with the patient. One of the key aspects of the audit was to
focus on the fact that the patient owns the care plan and is able to decide who has access to
it.
Within the hospital, care planning is managed by browser/EPR system, CareNotes.
CareNotes acts as a container for the patient information system documentation. According
to the Mental Health Commission, a care plan is a “documented set of goals developed,
regularly reviewed and updated by the resident’s multi-disciplinary team so far as
practicable in consultant with each resident”. The treatments provided to patients are
varied, therefore, a care plan expressed in writing is needed to support the MDT and provide
the necessary care to a patient. The care planning process ensures that everyone in the MDT
knows their obligation to the patient’s treatment as to when to administer it, how and why.
Essentially, the care planning process is a patient centred one. A key requirement to the care
planning process is the inclusion of the patient as the key driver of the care planning
process. The care plan therefore, belongs to the patient. Vista Healthcare has taken a view
that the burden is on the MDT to ensure that patient views are properly represented in all
decision making when the patient lacks capacity or is unable to represent or express their
own views at any given time. The aim of the audit was to determine that patient’s MDT
notes in particular care plans, are being recorded in accordance with Vista Healthcare
Records Policy and that records captured are accurate, up-to-date, regularly evaluated and
that the documentation is consistent across all wards. The outcome of this would be to
identify areas of record keeping that need improvement and where compliance with record
keeping is lacking across the wards.
28
0
20
0
Standards
Standards
29
Are care plans updated to show new…
40
Are incidents/accidents reorded in the care plan?
60
Patients involved with care plan discussion
100
Care plans updated to show new interventions
100
Record of communication with MDT
120
All patient needs identified
120
Evidence care plans evaluated regularly
80
Percentage Compiance
Maple Ward
Risk assessments up to date
Care plans up to date
Are care plans updated to show new…
Are incidents/accidents reorded in the care…
Patients involved with care plan discussion
Care plans updated to show new interventions
Record of communication with MDT
All patient needs identified
Evidence care plans evaluated regularly
Risk assessments up to date
Care plans up to date
Percentage Compliance
2012/13
VISTA HEALTHCARE INDEPENDENT HOSPITAL
QUALITY ACCOUNT
Willow Ward
80
60
40
20
20
20
0
0
40
STANDARDS
STANDARDS
30
Are care plans updated to show new…
60
Are incidents/accidents reorded in the care plan?
80
Patients involved with care plan discussion
80
Care plans updated to show new interventions
100
Record of communication with MDT
100
All patient needs identified
120
Edidence care plans viewed regularly
120
% COMPLIANCE
PRANDLE WARD
Risk assessments up to date
Care plans up to date
Are care plans updated to show new…
Are incidents/accidents reorded in the care plan?
Patients involved with care plan discussion
Care plans updated to show new interventions
Record of communication with MDT
All patient needs identified
Evidence care plans evaluated regularly
Risk assessments up to date
Care plans up to date
% COMPLIANCE
2012/13
VISTA HEALTHCARE INDEPENDENT HOSPITAL
QUALITY ACCOUNT
WATSON WARD
60
40
31
Standards
0
Are care plans updated to show new…
Are incidents/accidents reorded in the care plan?
Patients involved with care plan discussion
Care plans updated to show new interventions
Record of communication with MDT
All patient needs identified
Evidence care plans evaluated regularly
Risk assessments up to date
Care plans up to date
Percentage Compliance
2012/13
VISTA HEALTHCARE INDEPENDENT HOSPITAL
QUALITY ACCOUNT
Ash Ward
120
100
80
60
40
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VISTA HEALTHCARE INDEPENDENT HOSPITAL
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2012/13
Infection Control Information for Patients
Ash Ward
Duration:
From:
25.01.13
To:
01.03.2013
Group Description
The Food Safety Awareness group is designed to be a fun way of developing
communication and interaction skills whilst also raising awareness of the
importance of food hygiene and safety.
Individual’s Aims



Awareness of self and others
Enhancing attention, listening eye-contact and turn-taking skills
Increasing understanding by using routines, pictures, objects, spoken
words and music.
Session 1

Easy read information regarding what food safety is

Hazards to food safety – cleaning products, physical objects, bacteria/germs, animals

Food Poisoning – what is it?
-

Symptoms of food poisoning
Identifying hazards from a picture
Session 2

Recap of Week 1

Easy read information regarding hand washing

Use of glitter box for hand washing

Personal Hygiene (spreading germs) – hand washing


Jewellery

Cuts – blue plaster

Hair, clothes

Illness
Two case studies of people with poor personal hygiene. What is wrong? What should they
be doing?
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Session 3

Recap of week 2

How are germs spread – coughing, sneezing, animals, not washing hands, dirty utensils,
stacking fridge, chopping boards (cross contamination). Discussion regarding how to stop
spreading germs – washing hands, PPE, cleaning.

Fridge/freezer temperatures – is this the correct temperature?

Stacking fridge – putting food in the correct place

Coloured chopping board activity – what food belongs to which chopping board (coloured
card)
Session 4

Quiz
An MRSA Policy was completed and we now have long and a short version.
When all the patient information was placed on the Patient Information Boards on the wards, copies
of the policy were placed in the leaflet holders. Copies of these leaflets are also available in General
area of the electronic document system (G Drive) for ward staff to have access to in order to print
more copies if necessary.
Further work on hand washing was commissioned and completed resulting in a Hand Washing
poster and booklet. The poster comes in two versions, one with Makaton symbols and one without,
in order to be ward appropriate. These are also placed on the G drive for common access. The
poster and booklet are also in the Patient Information Areas.
The hand washing booklet covers “Why do I wash my hands”, “when do I wash my hands” and “how
do I wash my hands”. More or different leaflets and posters can/will be produced as necessary.
Consideration has been given to a video and this will be produced when time and resources permit.
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Conclusion
Vista Healthcare continues to operate within a challenging sector. The evidence set out in this
Quality Account demonstrates that Vista recognises and takes its responsibilities seriously in
meeting these challenges whilst remaining focussed on the quality of patient experience.
Through conflicting priorities it has not been possible to meet all the objectives set out for this
period of reporting. This can be taken as underachievement but should be seen as reflecting the
reality of managing complex services in difficult times whilst rightfully seeking to maintain and
improve quality. These objectives do not disappear or are forgotten but will be rolled forward and
reported on in subsequent accounts. In meeting many of its targets and objectives Vista Healthcare
has improved the safety of patients through improvement to systems and the revision of good
practices. Notwithstanding the achievements of Vista Healthcare during 2012/13, the focus will
remain on improving quality for the patients in the areas of safety, patient engagement and
effectiveness.
With the compliance and compilation of each Quality Account Vista managers develop knowledge,
skills and understanding required to see continuous improvement in the standards of care
demanded by increasingly aware service users. The 2012/13 QA is further evidence of the
commitment of Vista Healthcare and its staff to meeting its responsibilities as a patient focused care
provider delivering as high a quality of care that can be provided in given circumstance.
Patients and other stakeholders now have evidence demonstrating that all patients are included and
influence the care they receive and the environment in which it is delivered.
Contact
For Further information please contact the following:
Dr Manjubhashini – Medical Director
Doreen McCollin – Chief Operating Officer/Registered Manager
34