Barchester Healthcare’s
Independent Hospital Services
Quality Account
2014–2015
www.barchestermentalhealth.com
Barchester Healthcare’s Independent Hospital Services, Quality Account 2014–2015
Introduction
Barchester Healthcare is pleased to report back on the 2013 to 2014 Quality
Account from our independent hospital services, and to set new targets
for 2014 to 2015. This document provides a basis for all stakeholders
involved with our hospitals to look back over and reflect upon the quality
improvements we have made over the past year, and to plan actions for the
improvements we have set ourselves going forward into next year.
I want to ensure that Barchester delivers the very best in quality care. Our
independent hospital’s Quality Account for 2013 to 2014 was an important
contribution to positive change. Though we did not meet all our targets we
made significant progress in all areas – and we are increasingly focused on
what we need to do to achieve targets in the future: we know where more
work is needed and what kind of approach we need to take to make sure
targets are delivered upon. Much of the value of a Quality Account is the
help they offer services in measuring progress objectively, identifying
problems, thinking through and planning new approaches. They are
iterative, too, which is to say that we get better at them as we repeat and
review the processes involved over time.
Moving forward to the Quality Account for 2014 to 2015, we have identified
five areas of improvement that we believe will improve quality within our
services, based on discussions with the individuals we support, their
families and carers, our staff and other stakeholders as well as on
Department of Health guidance.
It is not always easy to involve stakeholders. Some of the people we offer
services to do not find it easy to communicate, for example. Some of the
health professionals who commission those services struggle to find the
time to be involved with the Quality Account planning process. For 2014 to
2015 one of the challenges we have set ourselves is to increase stakeholder
involvement by taking advantage of meetings with commissioners and
medical personnel to discuss Quality Accounts rather than expecting
attendance at formal Quality Review panels, though these will continue.
We are committed to open and transparent working practices, reporting on
what we do, and on where we need to improve. Quality is always evolving,
responding to changes in values, expectations and perceptions. We are
committed to measuring and reviewing our planned outcomes regularly, to
adapting them wherever necessary, and ensuring that the service given to
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Barchester Healthcare’s Independent Hospital Services, Quality Account 2014–2015
the individuals we support, staff and other stakeholders is based on best
practice. As a result, planning for improvements on the basis of working
with a Quality Account is a useful and natural approach for our organisation.
I can confirm that the content of this report has been reviewed by the
Barchester Operations Board in June 2014 and to the best of our
knowledge the information contained in it is accurate.
I would like to take this opportunity to thank all those involved in providing
feedback, ideas or actions for our Quality Account. This includes the
individuals we support, relatives, friends, our staff and internal and
external stakeholders, particularly commissioners and visiting care
professionals. Without their input the progress we have made towards our
aims and objectives would not have been possible.
Willie MacDiarmid
Chief Executive Officer, Barchester Healthcare
Barchester Healthcare’s Independent Hospital Services, Quality Account 2014–2015
Statement of Accuracy of our Quality Account
Directors of organisations providing hospital services have an obligation
under the 2009 Health Act, National Health Service (Quality Accounts)
Regulations 2010 and the National Health Service (Quality Accounts)
Amendment Regulation 2011 to prepare a Quality Account for each
financial year. Guidance has been issued by the Department of Health
setting out these legal requirements.
In that context we need to formally record that over the period covered by
the Quality Account for 2013 to 2014 Barchester Healthcare provided NHS
mental health services within its seven independent hospital sites. 100% of the
total income generated by these services was procured through Barchester
providing care and treatment to those in need on behalf of the NHS.
Monitoring and reporting progress
The Barchester Board sub-committee for Quality and Clinical Governance
Committee meets every month. It regularly reviews the quality and risk profiles
covering all service provision, including mental health service provision.
The committee identifies any areas of care practice that need improvement.
It links with the Hospital Quality and Governance Committee to make sure that
action plans are put in place to improve service delivery and maintain safety.
The committee also reviews reports on progress and challenges to these
action plans.
As Barchester’s Director of Quality and Clinical Governance I am responsible
for its link to the sub-board Quality and Clinical Governance group. The
Hospital Quality and Governance Committee is the key body for driving
quality improvements across all our independent hospitals. Our meetings
are quarterly and there are a number of sub work groups to the main
committee, which drive forward quality and governance projects in between
the national committee meetings.
Barchester Healthcare’s Independent Hospital Services, Quality Account 2014–2015
We have introduced early warning systems to monitor for increases in the
use of anti-psychotic medication and increases in the use of restraint. We
review data to look for patterns that alert us to a change in patient status.
Our strategy is based on national policy initiatives, internal regulatory
compliance and Quality Account priorities. Our committee reviews and
plans its performance to meet the requirements of NHS commissioning
bodies. Plans are to some extent shaped by Commissioning for Quality and
Innovation (CQUIN) standards and its agreed priorities.
Barchester’s independent hospitals work hard to continually improve patient
experience through monthly clinical governance meetings, patient forums,
input from clinical review teams and quality improvement initiatives. As
with Barchester’s corporate clinical governance more generally, local
governance committees are made up by multi-disciplinary representatives.
Throughout 2013 to 2014 the Independent Hospitals ran monthly clinical
audits as part of quality checks based on our Quality Account.
We have seven independent hospitals based primarily in the north of England.
They are: Arbour Lodge in Stockport, Billingham Grange in Billingham, Castle Care
Village in Hull, Forest Hospital in Mansfield, Jasmine Court in Waltham Abbey,
Hazeldene Unit at South View in Billingham and Windermere House in Hull.
Our hospital services are commissioned by the NHS and we work closely
with our commissioners to deliver local services for people with mental
health needs that provide a care pathway into the community. We have
collaborative partnerships with NHS mental health foundation trusts who
we in turn commission through a service level agreement contract for the
provision of psychiatry and other clinical services into our hospitals.
We value our shared working relationships with our partners in the NHS
and appreciate the contribution that accurate reporting through our Quality
Account makes to it, and to the quality of the services we offer.
Over the last two years we have redeveloped our hospital clinical governance
reporting metrics and Key Performance Indicators to ensure that we are collecting
relevant and accurate data that can drive practice and quality development.
We have introduced new reporting metrics for the hospital services.
Examples include:
• risk registers for the use of physical intervention
• monitoring and reporting against the use of anti-psychotics,
and psychotropic medications.
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Trish Morris-Thompson
Director of Quality and Clinical Governance
On behalf of Barchester Healthcare
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Barchester Healthcare’s Independent Hospital Services, Quality Account 2014–2015
Part One
How we performed last year (2013 to 2014)
This section of the Quality Account for Barchester's independent hospitals
reviews our performance over the last year, running from March 2013 to
March 2014 but reported on in June, following Department of Health
guidelines. Overall, we worked hard to meet the targets we set ourselves.
Comparing the 2014–2015 Quality Account to its predecessors shows that
we have met more targets, that we are better focused on the issues and that
our reporting has improved. There is still progress to be made, however:
Quality Account meetings need to become part of our routines and to be
linked informally to all meetings with commissioners and medical staff,
Quality Groups need to establish themselves as forces for change and our
reporting and monitoring must become more focused. Nonetheless, for
2013 to 2014 our hospitals achieved their goals.
The Department of Health’s Quality Account guidance required that we identify
at least three priorities for improvement from the Department of Health’s ‘No
Health without Mental Health’ initiative. This encompasses a list of priority
areas for improvement, which for 2013 to 2014 involved working towards:
• Good mental health
• Recovery
• Positive experience of care
• Reduction in avoidable harm
• Reduction in stigma
The hospital group also believe that goals, action planning and targets
should take account of coming legislation on the Duty of Candour and of
CQC’s ‘five questions’, which give the basis to their fundamental principles.
We used these principles as the starting point for consultations with the
people we support, relatives, staff and other stakeholders, the independent
hospitals’ Managers Forum and Barchester’s Mental Health Clinical
Governance Group. The consultations resulted in targets for improvement
and associated aims set out over the remainder of this section.
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“I go out with staff all the time.
It’s the best place ever.”
Barchester Healthcare’s Independent Hospital Services, Quality Account 2014–2015
Based on the Department of Health’s ‘No Health without Mental
Health’ initiative, priority 2: Recovery:
1. To develop Barchester Recovery Star models for older people living
with dementia and dementia with challenging behaviours and for
younger people with mental health needs.
Barchester Healthcare’s Independent Hospital Services, Quality Account 2014–2015
Based on the Department of Health’s ‘No Health without Mental
Health’ initiative, priorities 3 and 4: Positive experience of care and
Reduction in avoidable harm:
2. Develop Risk Models at all hospitals, using models currently used
in the hospital services with links to NHS Mental Health Hospital
Trusts (e.g. GRIST, FACE and TARA).
To achieve this we agreed we would:
• Form a subcommittee working group
• Involve service users and carers through Quality Review Panels
• Review best practice and develop models specific to each group
• Approve models through the Hospital Clinical Governance Quality Committee
• Review the effectiveness of the new models with service users, carers and
other stakeholders through Quality Review Panels reporting back to the
Hospital Clinical Governance Quality Committee
To achieve this we agreed we would:
• Pilot GRIST at Windermere and Castle Care Village
• Pilot FACE at Billingham Grange and South View
• Pilot TARA at Forest Hospital and Arbour Lodge
• Pilot Sainsbury Model at Jasmine Court
• Review the effectiveness of the new models with service users and relatives
where appropriate
Our targets:
Our targets:
• By six months we would develop outcome models for people living with
dementia with challenging behaviours and for younger people with
mental health needs
• By three months models would be piloted in hospitals as above
• By nine months we would pilot the outcome models
• By six months models would be fully operational
• By twelve months models would be reviewed with stakeholders
through Quality Review Panels
• By twelve months outcome models would be fully operational
• By twelve months we would plan review of outcome models
Did we achieve our target?
A working group was formed and work was commenced, involving review
and quality review panels, reporting to the Hospital Clinical Governance
Committee. The idea of utilising a universal electronic tool was impractical,
as the model is a poor fit for people living with dementia; there are also
licensing cost problems. Each hospital is using established and appropriate
models. It was agreed that hospitals will work towards a research project on
core elements and validation for variants over 2014 to 2015.
Did we achieve our target?
Pilot projects were carried out and appropriate models were selected
(GRIST and Sainsbury), though there are some problems with divergent
commissioning requirements for the individuals we support from different
geographical areas. All homes have risk models in place, reviewed with
service users where appropriate. It was agreed that hospitals will look at
proactively providing information to commissioners based on improved
electronic data collection rather than simply responding to requests.
This target was met.
This target was met.
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Barchester Healthcare’s Independent Hospital Services, Quality Account 2014–2015
Based on the Department of Health’s ‘No Health without Mental
Health’ initiative, priority 4: Prevention of avoidable harm:
3. To accredit all methods of physical intervention.
To achieve this we agreed we would:
• Apply for accreditation of General Services Association and National
Association for Psychological and Physical Intervention training
Barchester Healthcare’s Independent Hospital Services, Quality Account 2014–2015
Based on the Patient Inclusion and Involvement Strategy and the
Department of Health’s ‘No Health without Mental Health’ initiative,
priority 3: Positive experience of care:
4. To develop one user-led customer satisfaction and feedback survey
that can be used universally across all hospital services, ensuring that
alternative formats exist for all methods of communication.
To achieve this we agreed we would:
Our targets:
• Accredit General Services Association and National Association for
Psychological and Physical Intervention within three months
• Report back on accreditation to all Quality Review Panels within six months
• Form a subcommittee working group
• Involve service users and carers through Quality Action Planning
groups and Quality Review Panels
• Develop a customer satisfaction and feedback survey
Did we achieve our target?
• Evolve strategies for survey use involving alternatives to speech
This target was partially achieved and will be fully achieved over
2015–2015. Reporting processes will be improved over 2014 to 2015.
• Review the effectiveness of the new survey for service users, carers and
other stakeholders through Quality Review Panels reporting back to
the Hospital Clinical Governance Quality Committee
This target was met.
Our targets:
• By six months we would develop an agreed customer satisfaction survey
• By nine months we would pilot the satisfaction survey
“I am involved in decisions regarding
my relative every step of the way.”
• By twelve months the survey would be fully operational
Did we achieve our target?
A format has been approved through the agreed channels, including easyread, pictorial and audio versions. Its early version was piloted in two
hospitals. The various formats are awaiting circulation and further testing.
This target was met.
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Barchester Healthcare’s Independent Hospital Services, Quality Account 2014–2015
Based on the Experts by Experience initiative and the Department of
Health’s ‘No Health without Mental Health’ initiative, priorities 3 and
5: Positive experience of care and Reduction in stigma:
Barchester Healthcare’s Independent Hospital Services, Quality Account 2014–2015
Based on the Department of Health’s ‘No Health without Mental
Health’ initiative, priority 3: Positive experience of care:
5. Develop an Experts by Experience programme, based on real
inclusion and designed to involve Experts in business planning and
design and delivery of services, to be piloted at two hospitals.
6. Introduce a training package for staff, which will facilitate a better
understanding of personal needs, culture and diversity, linked to the
introduction of Equalities Impact Assessments for all policies and all
major service changes.
To achieve this we agreed we would:
To achieve this we agreed we would:
• Establish a project group in two hospitals to deliver Experts by
Experience, involving all stakeholders through Quality Action Groups
and Quality Review Panels
• Agree an Equalities Impact Assessment format
• Agree and develop a series of half-day workshops on Experts by
Experience for users of services (including potential Experts), staff,
relatives and carers (including potential Experts), and managers
• Review progress with all stakeholders through Quality Review Panels
• Implement pilot Expert by Experience schemes at two hospitals
Our targets:
• By six months we would develop an Experts by Experience project group
and appropriate half day workshops
• By nine months we would deliver the half-day workshops
• By twelve months pilot schemes would be established in two hospitals
Did we achieve our target?
Project groups met and work on half-day workshops begun. This target lost
momentum as the result of a number of management changes. Progress
will be reviewed and alternatives considered, including an inter-hospital
patient council.
This target was partially met.
• Agree a training package with Barchester Business School, incorporating
training on Equalities Impact Assessments
• Review the training packages with all stakeholders through Quality
Review Panels
• Deliver the agreed training packages
• Review the effectiveness of the training packages with Quality Review Panels
Our targets:
• By three months we would develop an Equalities Impact Assessment format
• By six months we would develop and agree a diversity training package
incorporating training on Equalities Impact Assessments
• By nine months we would deliver a diversity training package
incorporating training on Equalities Impact Assessments
• By twelve months we would review and evaluate the effectiveness of
our diversity training and Equalities Impact Assessment
Did we achieve our target?
An Equalities Impact Assessment format was agreed and is in use for our
Quality Account. A diversity training package has been agreed and tested.
It was well received by staff in its test site and has been the subject of
presentation and review at the Hospital Clinical Governance Committee.
Roll out across all sites is planned.
This target was met.
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Barchester Healthcare’s Independent Hospital Services, Quality Account 2014–2015
Part Two
Identified priorities for clinical improvements
in 2014–2015
Based on the Department of Health’s ‘No Health without Mental
Health’ initiative, priority 3: Positive experience of care:
1. To improve review of data and Quality Account planning for the
Hospital Quality and Clinical Governance Committee.
To achieve this we agreed that:
• All hospitals will send clinical governance data to the responsible
Regional Director two weeks prior to the Hospital Quality and Clinical
Governance Committee meeting
• The Regional Director will circulate a digest version of the data,
matching it to relevant policy and regulatory initiatives and picking
out important areas for service improvement for discussion, review and
action planning
Our targets:
• Establish a pattern of data management and digest format within six months
• Establish at least two action points identified by the Hospital Quality and
Clinical Governance Committee meeting and agreed by Quality Review
Panels within nine months
• Demonstrate service improvements or change towards service
improvements within 12 months
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Barchester Healthcare’s Independent Hospital Services, Quality Account 2014–2015
Barchester Healthcare’s Independent Hospital Services, Quality Account 2014–2015
Based on the Department of Health’s ‘No Health without Mental
Health’ initiative, priority 2: Recovery:
Based on the Department of Health’s ‘No Health without Mental
Health’ initiative, priority 4: Reduction in avoidable harm:
2. To establish a reporting framework on relevant data that involves
commissioners and drives forward recovery wherever appropriate.
3. To improve review of data based on physical restraint, formulating
a strategy for reduction and improving response in each hospital.
To achieve this we agreed we would:
To achieve this we agreed we would:
• Form a sub-committee and agree a core report for commissioners on
recovery statistics and information, with explanatory narratives
where required
• Form a sub-committee to agree new methods of recording restraint,
utilising a grading system’
• Ask individual hospitals to agree additional information specific to
commissioner requirements with the sub-committee
• Individual hospitals to review information produced (with
commissioners if possible) and link to recovery-based action planning
Our targets:
• To produce an agreed core report for commissioners with ‘bolt-on’
information required by commissioners for particular hospitals within
three months
• To review recovery statistics (with commissioners if possible) and to
agree revised recovery plans for individuals who require it within
six months
• Identifying a set of outcome-based benchmarks within 12 months
• To agree methods of recording that improve clarity and transparency and
have a narrative explanatory element
• Ensure that the Regional Director is aware of training records on
restraint for all staff members at each hospital individually
• Ensure the Regional Director can review all incidents, request
multi-disciplinary meetings and increase numbers of staff with
formally accredited restraint training
Our targets:
• Agree a new method of incident recording including grading, with clarity,
transparency and relevant narrative within three months
• Ensure all serious untoward incidents (SUI)s are reviewed by the
Regional Director, beginning after three months and ongoing
• Facilitate multi-disciplinary meetings and action planning for incidents
that require it after three months and ongoing
“Through informed choice,
individuals can access the therapies
and activities they feel benefit them.”
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• Increase the numbers of staff with accredited restraint training within
12 months
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Barchester Healthcare’s Independent Hospital Services, Quality Account 2014–2015
Barchester Healthcare’s Independent Hospital Services, Quality Account 2014–2015
Based on the Department of Health’s ‘No Health without Mental
Health’ initiative, priority 4: Reduction in avoidable harm:
Based on the Department of Health’s ‘No Health without Mental
Health’ initiative, priority 3: Positive experience of care:
4. To improve screening for physical health, review and
improve well-being.
5. To broaden the experience and training of Mental Health Act
Administrators, improving and strengthening services to and
relationships with service users.
To achieve this we agreed we would:
• Form a sub-committee and agree a format for physical health reviews
• Review the physical health of all the individuals we support who do not
refuse consent
• Based on physical health reviews, agree action plans for the individuals
we support to increase well-being
Our targets:
To achieve this we agreed we would:
• Review the training records of all Mental Health Act Administrators
• Agree training plans with all Mental Health Act administrators, working
towards acquiring the Certificate of Mental Health Law and Practice
• Agree ongoing supervision with all Mental Health Act Administrators
incorporating reviews of training progress
• An agreed format for physical health reviews after three months
• Facilitate the formation of a group meeting for peer support for all
Mental Health Act Administrators
• Have systems in place to support all individuals with regard to physical
health and to promote their well-being
• Agree a resource section to be placed on the intranet for Mental Health
Act Administrators and deliver it through the peer group meeting
Our targets:
• All Mental Health Act Administrators training records reviewed after
three months and training plans agreed
• At least 70% of Mental Health Act Administrators to be awarded the
Certificate of Mental Health Law within the specified training period
“The staff are all wonderful. They show
particular love and attention and nothing
is ever too much trouble.”
• All Mental Health Act Administrators to have regular supervision
incorporating review of training progress after three months and ongoing
• At least three monthly peer group meetings to take place for Mental
Health Act Administrators, commencing after three months
• An agreed resource section to be placed on the intranet after six months
• Robustness of reporting mechanisms to be improved and discussed with
the individuals we support and at Quality Review meetings within 12 months.
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Barchester Healthcare’s Independent Hospital Services, Quality Account 2014–2015
Part Three
About Barchester Healthcare – Funding, Registration,
Research, Staffing and Commissioner’s Comments
Funding: Barchester Healthcare provides services to almost 11,000 people
in over 200 service sites. Our commissioners are the individuals we
support, who fund their choices through personal budgets, private income
or resources provided by local authorities, Clinical Commissioning Groups
and the NHS Commissioning Board.
Our overall health income fluctuates on a daily basis because most of it
comes through individual nursing or continuing healthcare funding. In
developing this account we have specifically reviewed the Quality Accounts
of our seven independent hospitals, reporting back as a composite. Their
income represents approximately 3% of the total income for Barchester
generated from the provision of NHS services over 2013 to 2014.
Over the course of 2013 to 2014 we have met requirements for being an
approved provider for 'locked and unlocked' rehabilitation services for
Yorkshire and Humber strategic health authority, which included an
1
element of Commissioning for Quality and Innovation (CQUIN) payment .
Patients in our hospitals are funded through individual contracts. Some
commissioners have set broad targets to be achieved in relation to CQUIN,
which is now part of the standard mental health contract.
Barchester Healthcare was not subject to the Payment by Results clinical
coding audit during 2013 to 2014.
Registration: Barchester Healthcare is licensed by Monitor, the health
service regulator with particular responsibility for patient welfare, value for
money and financial oversight.
Barchester Healthcare is required to register with the Care Quality
Commission (CQC). The range of services Barchester provides is subject to
different registration for different regulated activities. For our independent
hospitals our current registration status is in respect of: ‘Regulated Activity:
Accommodation for persons who require nursing or personal care’ and
‘Regulated Activity: Assessment or medical treatment for persons detained
under the Mental Health Act 1983’. This covers assessment and treatment
of disease, disorder or injury; diagnostic and screening procedures.
1
‘The Commissioning for Quality and Innovation (CQUIN) payment framework enables commissioners
to reward excellence by linking a proportion of providers’ income to the achievement of local quality
improvement goals.’, Department of Health website, 2008, http://www.dh.gov.uk
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Barchester Healthcare’s Independent Hospital Services, Quality Account 2014–2015
Barchester Healthcare’s Independent Hospital Services, Quality Account 2014–2015
Barchester Healthcare has not participated in any special reviews or
investigations by CQC during the reporting period.
CQC have issued no warning notices of action against Barchester
Healthcare’s independent hospital during 2013 to 2014.
Research: We are a pilot site for the 'Think Local, Act Personal' initiative.
We have participated in national audit work, though not directly connected
to delivery of mental health hospital services.
Barchester Healthcare did not submit records during 2013 to 2014 to the
Secondary Uses service for inclusion in the Hospital Episode Statistics.
Staffing: Barchester Healthcare’s excellent service quality was recognised
by our short listing for ‘The Health Investor Award for Best Residential
Care Provider’ in 2014.
Barchester Healthcare featured in ‘The Sunday Times Top 25 Best Companies
to work for’ for 2014, the only care organisation to feature in this list.
The list is based on confidentially researched employee feedback.
“The management and staff are
wonderful and they have sorted
all of the concerns I had.”
Barchester Healthcare would like to thank everyone who
has contributed to this Quality Account.
We look forward to working with all stakeholders over
the coming year to deliver the improvements to which we
are committed.
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