First Community Health & Care
Quality Account
2013/14
Page 1 | Quality Account 2013-14
Contents
Our Vision, Mission & Values
About First Community Health & Care
Part 1: Introduction from our Managing Director
Part 2: Our Priorities for improvement
Priority 1 - Patient Safety
Priority 2 - Clinical Effectiveness
Priority 3 - Patient Experience
Statutory Statements of Assurance
Part 3: A review of the quality of our services
from 1st April 2013 - 31st March 2014
Stakeholder Statements
Glossary
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Our Vision, Mission & Values
Our vision is...
‘To be recognised, respected and trusted by patients, carers, professionals
and staff as the best provider and innovator of integrated community services.’
Our mission is to...
Services for our
community
Enable people to maximise their health and well being potential
Meet and exceed quality and safety requirements
Prevent unnecessary hospital admissions and facilitate hospital discharge
Deliver integrated services with a single point of access
Business
Capability
Infrastructure
(valuing our staff)
Be customer focused at all levels within the organisation (commissioner and patient)
Develop our business skills that allow FCH&C to respond to and shape market opportunities and threats in
line with our vision and values
Become the employer of choice
Develop IT systems and infrastructure that maximise service productivity and patient outcomes
Use our estate efficiently and ensure a welcoming environment for patients and staff
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Values - How will we behave?
We will...
Care about you
We will be
Caring
Conscientious
Sensitive
Empathetic
Approachable
Provide a seamless service
Where we can we will ensure
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Patient choice
Integrated services
Timely services
Continuity of care
Be business focused
We will ensure
Our customers are valued
We are skilled in business
We offer bespoke care
We are productive and efficient
Our staff will be
Well trained and knowledgeable
Using the best care and treatments available
Professional and helpful
Compassionate, caring and kind
Supported to develop their potential
Page 5 | Quality Account 2013-14
About
Our Quality Account 2013-14
What is a Quality Account and why do we
produce one?
What does our Quality Account include?
Our Quality Account is divided into three sections:
How have we involved stakeholders
in our Quality Account?
Each year all providers of NHS healthcare are
required to produce a Quality Account to
inform the public about the quality of the
services they provide. It follows a set structure
to enable direct comparison with other
provider organisations.
Why we produce this annual account
Part 1 gives a statement of quality from our Managing Director
with an introduction and overview of who we are and what we do.
• where we can make improvements in the
quality of the services we provide
We welcome the views of our
stakeholders in the development of
our account and have consulted with
a broad range of stakeholders,
including our commissioners,
Healthwatch and our Community
Forum asking them to tell us what is
important to them, their thoughts on
how we presented our information
last year and what they would like
to be included in our account going
forward.
The priorities, both looking back and looking forward, reflect the
three domains of quality (see glossary) to ensure a balanced view
of the services we provide: patient safety, clinical effectiveness and
patient experience.
In Part 2 we look at our priorities for improvement in the quality of
our services. We start by looking back at each of the three priorities
we set last year, reviewing our progress and outlining our plans for
It enables us to share with the public and other future development.
stakeholders:
We then look forward, setting three new priorities for improvement
for the coming year.
• what we are doing well
• how we have involved our service users and
other stakeholders in evaluation of the quality
of our services and determining our priorities
for improvement over the next 12 months
We then provide statutory statements of assurance which relate to
the quality of the services we have provided in the period 1st April
• how we have performed against our priorities 2013 to 31st March 2014. The content is common to all NHS
providers, allowing direct comparison across organisations.
for improvement as set out in our last Quality
Account. For each of these priorities we will
tell you if we have delivered them and how we Part 3 gives us an opportunity to review the quality and
know this. If we have not delivered any we will performance of our services using these three domains of quality.
We also include a section on staff experience as we recognise the
tell you why not and what we will be doing in
impact this has on the quality of the services we provide.
the future to address this.
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Our published Quality Accounts are
also available for public scrutiny on
our website at:
http://firstcommunitysurrey.com/
who_we_are
Glossary of terms: This year we
have included a glossary of terms
(page 49) which explains some of
the terminology used.
PART 1: Introduction
About FCH&C: Who are we and what do we do?
First Community Health & Care (FCH&C) is a not-for-profit social enterprise , providing community healthcare
services since October 2011 to people living in east Surrey and parts of West Sussex. Just like GPs, First Community
Health & Care remains part of the NHS family and will continue to deliver NHS services with the community interest
ethos, where our patients and clients are at the centre of everything we do.
Community Nursing
Provide a broad range of specialist nursing
interventions and care mainly in the home setting.
Nurse Advisors for Care Homes
Provide support, advice and facilitate training to care
home staff.
Heart Failure Service
Provide specialist assessment and support to
promote self-management for people with heart
failure.
Respiratory Team
A multi-disciplinary team providing care for patients
with certain types of respiratory disease.
Specialist Nurses
We have specialist nurses providing care for people
with skin conditions for both children and adults
(Dermatology) and Multiple Sclerosis. We also have
specialist nurses who advise and manage the
prevention of infection and wound care.
Rapid Response
A nursing and therapy service facilitating patient
discharges from hospital and can respond within two
hours to patients in the community to prevent
unnecessary hospital admission.
Audiology
Provide specialist assessment and diagnosis for people with
hearing loss and balance problems and provide appropriate
support such as digital hearing aids and specialist advice.
Nutrition & Dietetics
Provide a service in the community for children and adults.
Occupational Therapy
Provides a holistic assessment of how an illness or disability
affects an individual’s daily life and helps the individual
overcome these.
Physiotherapy
Provide specialist assessment and treatment for a wide range of
mobility problems including recovery after illness or injury e.g.
heart attack, fractures, joint replacements and sports injuries.
Speech and Language Therapy
Provide specialist assessment and advice to both patients and
carers for speech, language, communication and/or swallowing
difficulty.
0-19 Universal Children Services
Health Visitors, School Nurses, Staff Nurses, Community Nursery
Nurses and Admin Support Workers working together with
children and young people and their families, offering advice
and information to support their health, development and
well-being.
Rapid Assessment Clinic
A GP, community nurse or ambulance crew may refer patients
here for assessment, investigations (such as blood tests and
X-rays) and treatments to prevent them being sent to an
Emergency Department of a main hospital or needing a spell in
hospital for treatment such as a blood transfusion.
Podiatry
Formerly known as chiropody, podiatrists assess and treat a range of
foot problems.
Orthotics
Assess patients who have a weakness or deformity in a part of the
body as a result of a long term condition to see if provision of an
orthotic appliance e.g. splints, braces, callipers would help improve
mobility and support the affected area.
Neurological Rehab Team
Consists of a range of therapists with specialist rehabilitation skills to
assist people with neurological conditions (e.g. Stroke, Brain
Injury, Multiple Sclerosis) to maximise their independence
particularly after a hospital admission.
Caterham Dene Ward
A 28 bedded inpatient ward for people aged 18 years and over
requiring a period of rehabilitation after illness, injury or for certain
conditions. Admission to the ward reduces the pressure on acute
hospital beds, ensures that such patients receive the most
appropriate care and enables them to return home after a period of
assessment and treatment provided by a close-working
multi-disciplinary team.
Integrated Care & Assessment Treatment Service (ICATS)
Provide assessment and diagnosis of joint and muscle injury or
conditions such as arthritis, back pain and other joint problems.
Minor Injuries Unit
For people aged 18 years or over with minor injuries that cannot be
managed by the GP or practice nurse.
Page 7 | Quality Account 2013-14
Introduction
From our Managing Director
It gives me great pleasure to introduce First Community Health and Care’s
Quality Account for the period 1st April 2013 to 31st March 2014 sharing
our achievements over the past year and our plans for improvement during
2014/15.
We are a not-for-profit social enterprise and, as such, our staff are invited to
become shareholders. Being a shareholder is intended as a symbol of
commitment to patients’ services, giving staff a say as to how to develop our
services in the best interests of the community. We currently have 403 staff and
274 (68%) are shareholders (as at 31st March 2014).
Over the past year we have strived to provide the highest quality services for
our community and ensure our patients and service users remain at the centre
of what we do. Our quality account contains many examples of how we have
done this and how we will continue to do this in the year ahead.
This year we have extended our services which you can read about on pages
21-24 . This reflects the commitment of our staff and the continual evaluation of
the services we provide in response to our community’s needs. For example, we
have worked with Parkinson’s Disease UK (a charity) and patient and carer
representatives during the recruitment process for a specialist post to support
people in the community with Parkinson’s Disease, aligning this post with the
Community Neurological Rehabilitation Team.
We have been working hard to improve how we listen to and understand the
experiences of our service users. To achieve this we are working in partnership
with ‘iWantGreatCare’, a company who provide the most detailed, accurate and
timely monitoring of patient experience. This gives us real time feedback and
enables our patients to tell us what is important to them. We discuss and act on
this at all levels within the Organisation including at Board level to ensure we
are listening and responding. You can read more about this on pages 12 and 41.
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Philip Greenhill
Managing Director
We are also undertaking “Board walks” at our local community hospital
enabling us, as Board members, to talk to our patients as they use our
services in order to understand and respond to what they tell us. I would
like to take this opportunity to thank our patients and service users, on
behalf of all the staff at First Community Health & Care, for their time in
giving us their views and sharing their experiences.
During 2013 we have seen the publication of The Francis Report,
detailing serious failings in quality of care and patient safety. The
report details 290 recommendations, for all NHS trusts, commissioners
and external regulators to ensure similar failings in care and safety are
not repeated. Our Chief Nurse has worked closely with all of our staff to
consider and act upon these recommendations to improve safety. We
developed a “plan on a page” to ensure quality and safety are central to
what we do. This plan is centred around improving patient and service
user experience and feedback, creating a caring and open culture,
providing individualised care and strengthening our clinical leadership.
To safeguard and promote our service users’ safety, we have continued
to use the NHS Safety Thermometer to benchmark our local
information with national data, ensuring we perform in line with or
above the national average. Analysis of our incident data has enabled us
to work on reducing the incidence of pressure ulcers and reduce the risk
of our patients falling in our hospital ward.
To ensure we are clinically effective we have developed our clinical audit
policy and strategy, refining our reporting framework. Our third
‘Celebrating Quality Improvement’ day welcomed over 100 of our staff,
including Board members, all celebrating and sharing examples of
quality improvement. Our process of ensuring our services implement,
or are compliant with, guidance on best practice as set out by the
National Institute for Health and Care Excellence (NICE) has seen
developments such as raising awareness of Osteoporosis and timely
changes to our Rapid Assessment Clinic Deep Vein Thrombosis pathway
to ensure patient care reflects best practice.
We run our social enterprise with our patients and service users at the
heart of what we do. Our staff and patients help steer our social
enterprise to ensure that we serve our community in the best way. To
this effect we have a Council of Governors, a group of staff elected by
their peers to stand office for a period of two years, and a Community
Forum, established in April 2013, which provides a forum for engaging
with our local community. We reinvest our profits through the Council
of Governors’ Community Development Fund which supports our core
purpose as a social enterprise to add social value back into the heart of
our community (see glossary).
Our Quality Account for the period 1st April 2013 to 31st March
2014 highlights further achievements that continue to
demonstrate our commitment to the provision of high quality care.
On behalf of the Board I would like to take this opportunity to
thank all of our staff whose commitment and professionalism
enables us to provide high quality services and continually improve
the quality of care we provide.
In accordance with the NHS (Quality Accounts) Amendment
Regulations 2011 No 269:
“I hereby state that to the best of my knowledge the
information in this document is accurate”.
Philip Greenhill
Managing Director
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PART 2: Our Priorities for Improvement
Looking back… What we said we would do last year…
In our last account we chose three priorities for improvement, one in each of the three domains – patient safety, clinical
effectiveness and patient experience. We will review our progress against each of these priorities before outlining our priorities
for the coming year.
Priority 1 Update 2012-13
Patient Safety
“To improve patient safety we will identify all patients within our Clinical Commissioning Group area with a urinary catheter. We will create a catheter
register and ensure we are providing the right care, in the right place, at the right time.”
We wanted to create a catheter register to help us to ensure that patients are on the correct care pathway and that they are receiving the right care.
However, since setting this priority, there have been developments in the local health economy which have affected the way in which the priority has been
delivered. Our local acute hospital has developed a patient-held Catheter Passport which we are in the process of adopting for use within our services. This
allows for all services involved with the patient to have the most up-to-date information, thus providing the most appropriate care. This proactive
management will empower patients and help to reduce the risk of catheter associated problems. Catheter registers continue to be maintained at team
level enabling practitioners to monitor the number of patients on their caseload with a catheter, and to plan and implement individualised packages of
care.
We continue to raise awareness on the prevalence of catheters through the monthly ‘Safety Thermometer’ point prevalence surveys. This is a monthly
national survey that looks at the ‘harms’ to patients in relation to catheter associated infections. We report our information each month to the national
Health & Social Care Information Centre. The results are available to the public and commissioners via the Quality Observatory website:
http://www.qualityobservatory.nhs.uk/.
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Priority 2 Update 2012-13
Clinical Effectiveness
“To develop our clinical effectiveness we will support all registered clinical staff (Nurses and Allied Health Professionals) to access clinical supervision
(a formal way to maintain and improve quality care through protected time for reflection and learning) in their preferred format, time and place from
a menu of options.”
First Community Health & Care are committed to the provision of clinical supervision for all our clinical staff. Clinical supervision plays a key role in supporting and
empowering our staff to achieve their potential and thus provide the highest quality of care. All of our registered clinical staff are supported to access clinical
supervision in their preferred format, time and place. For example, at the end of March 2014, 131 of our 247 registered clinical staff were accessing group-facilitated clinical supervision. The remainder were accessing other options from our clinical supervision menu.
In May 2012 First Community Health & Care introduced new guidelines, providing a framework for the implementation and maintenance of an innovative
approach to clinical supervision. This framework offers a range of options for staff to participate in clinical supervision that accommodates variations in work
settings and individual learning needs. Whilst priority for clinical supervision has been given to registered staff - nurses and therapists – we currently include
community nursery nurses and associate practitioners and plan to extend provision to non-registered staff across all clinical services.
A review was carried out in May 2013 using an online survey tool to find out how the new clinical supervision guidelines and menu of options are working for all
clinical staff and identify any training/development needs. It was reassuring to find that staff found clinical supervision supportive and gave them protected time
to reflect on their practice.
What we said we’d do in 2012-14
What we’ve done…
“We will undertake an annual survey of clinical supervision practice within FCH&C and use these results, and We have reviewed our guidelines and menu of options in November 2013; the survey findings also
the recommendations in the Francis Report (2013)*, to inform, review and update our guidelines and menu informed the content and frequency of training for staff and managers.
of options.”
“We will monitor the effectiveness of clinical supervision and clinicians’ commitment to their chosen option.” We have completed our annual survey and the results have been shared with staff.
“We will provide workshops to enable new and existing staff to use clinical supervision effectively.”
We have delivered 15 workshops, attended by 118 out of 330 (36%) clinical staff since July 2012.
“We will train group facilitators, provide protected time to facilitate groups and support them through
updates, facilitator supervision and the appraisal process.”
We have trained nine new facilitators in September/October 2013 and offered an annual update/
development day for existing facilitators in April 2013. This means we will be able to offer seven
staff a place in a clinical supervision group for each facilitator who takes on a group.
“Our Chief Nurse will champion clinical supervision throughout the organisation.”
The Chief Nurse has had budget-holding responsibility for clinical supervision since April 2013 and
secured funding for the new facilitator and ‘train the trainer’ training in September/October 2013.
“We will provide quarterly progress reports to the Clinical Quality and Effectiveness Group.”
We have continued with this.
“We will raise the profile of clinical supervision with our Self-Managed Business Teams.” (see page 44)
We have done this through quarterly reporting at the Clinical Quality and Effectiveness Group and
presentations at the Senior Team Meeting.
“We will complete the learning and development process by embedding learning from clinical supervision
into appraisal.”
We have introduced new appraisal documentation and training with prompts for managers to ask
staff about their clinical supervision activity i.e. group attendance/other activities completed and
resultant learning.
* The Mid Staffordhsire NHS Foundation Trust Public Inquiry Final Report 2013
http://www.midstaffspublicinquiry.com
Page 11 | Quality Account 2013-14
What next?
We will continue to review our guidelines at least annually to ensure they remain fit for purpose and reflect local need and national best practice and
ensure recurring learning themes from group supervision inform clinical practice and management. We will explore further options for non-registered
staff. Our facilitators will continue with annual development days and facilitator supervision groups for their support and development. Our Chief Nurse
will continue to champion clinical supervision and quarterly reporting will continue.
Priority 3 Update 2012-13
Patient Experience
“To improve our patient experience feedback we will use the Friends and Family Test
(Net Promoter Score) process to collect and analyse user feedback.”
The national Friends & Family Test was launched in April 2013 by NHS England. They have an extensive rollout plan which started with the Friends and
Family question “Would you recommend this service to your family and friends if they needed similar care or treatment” being asked in acute hospital
wards and A&E departments. We have developed the Friends and Family question with ‘iWantGreatCare’ (iWGC) which is now being piloted in our
community services ahead of the mandate in December 2014. First Community Health & Care have worked in partnership with iWGC as a pilot in the
community to roll out the Friends and Family Test (FFT) since April 2013. We started by asking the initial FFT question about our Minor Injuries Unit (MIU),
Rapid Assessment Clinic (RAC) and Community Hospital Ward. Our results in this pilot stage were extremely positive. For example, when compared with
three other similar MIU environments, also using an iWGC methodology, First Community Health & Care received the highest Net Promoter Score (NPS) in
the February 2014 reporting month (see chart adjacent).
We plan to use the FFT across all our community services from April 2014.
We have worked with iWGC to expand our original question, to include three core questions looking at
quality of care and experience, and three service specific questions. We use this feedback to inform
comparative benchmarking across our services.
We no longer use patient satisfaction surveys as the data from FFT has enabled a more detailed level of
reporting. We use feedback to triangulate against other quality metrics including patient compliments,
complaints, incidents and performance indicators to give our patients a chance to be heard. This can act
as an early warning signal of a potential reduction in quality so we can respond in a timely fashion.
In December 2014, we shared our learning with other organisations as part of the iWGC national
symposium for patient experience to help others implement FFT in the community setting.
Page 12 | Quality Account 2013-14
What we said we’d do in 2012-14
What we’ve done
“We will design our Friends and Family Test question and process for collecting patient feedback
for both the inpatient ward and Minor Injury Unit at Caterham Dene Hospital for use from 1st April
2013.”
We have rolled this out in April 2013. Results are displayed in the department and on our website. We
have now included all adult services.
“We will work with a company called ‘IWantGreatCare’ (iWGC) who will collect and collate our patient
feedback forms and send us back monthly reports and use the information to create a five star
rating.”
We are working with iWGC who receive our feedback forms and analyse the data to create our
reports.
“We will ask the patient for their age and gender.”
We are asking patients for their age and gender
“We will ask every patient (or their carer) the following question:
We have expanded this question as part of our roll out to include three core questions and three
service specific questions.
How likely are you to recommend our ward/service to friends and family if they needed similar care or
treatment?
- Extremely likely
- Likely
- Neither likely nor unlikely
- Unlikely
- Extremely unlikely.”
“We will give patients (or their carers) an opportunity to use a free space to make comments about
their care by asking the following question:
We have used this information to good effect, helping us to understand patient experience and
improve the care environment.
What was good about your care, and what could be improved?”
“The results will be available to patients and the public and we will respond to them.”
We use a number of channels to monitor patient feedback and publish our FFT results including
‘Patient Opinion’, NHS Choices, Twitter and ‘iWantGreatCare’. We display the results on our public
facing notice boards at Caterham Dene Hospital and have a ‘You Said, We Did’ section on our website.
“We will implement a monthly employee survey to help us to establish the ‘cultural health’ of all of
our staff. This will include a question to enable us to identify the number of staff employed by First
Community Health & Care who would recommend our organisation as a provider of care to their
family and friends.”
Please see staff experience section on page 44.
What next?
We will continue to collect patient FFT and feedback and use the information
to make continual improvements to our services and compare quality across
our services. We will ask for additional information to comply with the
Equality Act 2010. We will use the themes from feedback to monitor what
questions we will ask in the future. We will have more ‘You Said, We Did’ boards
in public facing areas and clinics.
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Looking forward
Identifying our priorities for 2014 - 15
This forward looking section of our report shows our plans for quality
improvement and why we have chosen these priorities. It demonstrates how we will
develop our quality improvement capacity and capability to deliver these priorities.
We put together a list of possible priorities by considering our performance over
the past year and national/ regional priorities.
We considered how we would be able to measure these possible priorities by
considering what measurements and data collection was already in place.
The list was then arranged under the headings of the three domains of quality:
patient safety, clinical effectiveness, and patient experience with the ambition of
having one priority under each domain.
The list was discussed and consulted on internally through our service leads to
ensure staff engagement.
To ensure our priorities for the coming year match those of our patients, carers and
partners we also went through a process of external consultation inviting
contributions from a range of stakeholders including our Community Forum and
HealthWatch Surrey.
The final selection was made by the Board after reviewing their feedback. Each
priority has been allocated to a responsible Board member to ensure commitment
at Board level to these quality improvements.
Page 14 | Quality Account 2013-14
PRIORITY 1Patient Safety
“We will measure medication error and harm from error identifying the proportion of patients that
are ‘harm free’ on a given day each month on Caterham Dene Ward.”
How will we measure this? Data will be collected on
Why have we chosen this? In response to incident
one day each month to provide a baseline to direct improvement
efforts and then to measure improvement over time. This will
enable the ward to understand the burden of medication error and
harm and connect frontline teams to the issues of medication error
and harm, enabling immediate improvements to patient care.
reports, and in recognition of the National Patient Safety Agency
(NPSA) documentation and Care Quality Commission Outcome 9*,
it was decided to complete a quarterly missed and omitted dose
audit for 2013-14. There has been no improvement in recorded
missed and omitted doses, despite changes in practice. We have
undertaken extensive analysis as to why this is and have found that
there is some overlap between the use of drug charts patients are
admitted with and starting new drug charts for use on the ward.
This would indicate that doses are not being missed or omitted but
rather that there is a recording discrepancy. We have therefore
initiated start date and time on each new drug chart and will be
reviewing this action against data from the Medication Safety
Thermometer.
How will we achieve this? We will use the Medication
Safety Thermometer tool on the national website at:
http://www.safetythermometer.nhs.uk/. This is a national tool with
a three step process that measures medication error and harm
from error through medication review, detailed review of high risk
patients and appropriate response.
Further to these actions we will also implement the Medication
Safety Thermometer. This focuses on medication reconciliation,
allergy status, medication omission, and identifying harm from high
risk medicines in line with Domain 5 of the NHS Outcomes
Framework.
*The Care Quality Commission (CQC) Essential Standards (2010) Outcome 9: Management
of Medicines states that “People should be given medicines they need, when they need
them and in a safe way.”
What we will do & when
April
2014
Start
collecting
data
May
Collect
data
June
Collect
data
July
Collect
data
August
Collect
data
September
Review data.
Action plan
for
improvement
October
Collect
data
November
Collect
data
December
Collect
data
January
Collect
data
February
Collect
data
March
Review data.
Action plan
for
improvement
2015
Page 15 | Quality Account 2013-14
PRIORITY 2
Clinical Effectiveness
“We will have a transition contact with 85% of children in year 7.’
Why have we chosen this? A transition contact is an
interaction between a school nurse and children moving from primary
to secondary education. It is about introducing the year 7 group and
their parents to the school nurse team to ensure young people have
access to health advice and information and parents know how to raise
concerns and how to support their child. It is part of the Healthy Child
Programme which is a best practice guide to the services we deliver.
Transition between primary and secondary school, and the way schools
work with other agencies to manage transition, can influence children’s
future school careers and the climate and culture of the whole school
community*. A report published by the Youth Council, in which
children in Surrey were well represented, demonstrated children did
not know who their school nurse was and what they did.
How will we measure this? Contacts - We will review
the number of referrals into our service to see if they increase.
Attendance data – We will find out how many children are absent
from the assemblies we attend so we can ascertain if we have met
our target of contact with 85% of children.
How will we achieve this? We will attend assemblies
and give out information to all children in year 7 at the schools in
our area regarding the role of the school nurse.
A transition visit will:
• increase children’s and their parents’ awareness of the health
services available to them
• introduce them to their school nursing service
• support young people and their parents to access health advice
• improve emotional and physical well being
• impact on adolescent health choices and the reduction in risk taking
behaviour.
Page 16 | Quality Account 2013-14
*TaMHS, Extended Services and Young Minds (No Date) The Transition from Primary to Secondary School
How an understanding of mental health and emotional wellbeing can help children, schools and families
http://www.youngminds.org.uk/assets/00001303/Transitionfromprimarytosecondary.pdf
PRIORITY 3
Patient Experience
“We will increase our stakeholder engagement in clinical audit.”
Why have we chosen this? Clinical audit is defined as
“a quality improvement cycle that involves measurement of the
effectiveness of healthcare against agreed and proven standards for
high quality, and taking action to bring practice in line with these
standards so as to improve the quality of care and health
outcomes.” As a community interest company, we want to involve
our patients / service users and the public in clinical audit. Patients
and carers have a unique view of the services we provide and
may assess the quality of the care they receive in different ways
to healthcare professionals. We are committed to the principle of
involving patients/carers in the clinical audit process. We want to
increase this involvement from asking patients their views through
surveys to involving them in the clinical audit process and
identification of our annual audit priorities.
Our clinical audit strategy 2013-2016 operational action plan
includes the following objective:
‘To increase service user involvement in clinical audit and other
quality improvement activities across FCH&C – moving from
consultation (asking service user views and using these views to
inform decision-making) to collaboration (active on-going partnership
with service users) over the three year period of the strategy.’
How will we measure this?
Audit of clinical audit - In 2013 we carried out an audit of the clinical audit
process so we have existing data to benchmark our improvement.
Clinical audit data – We have redesigned our audit reporting template and
database so we can capture and measure this.
How will we achieve this?
• Implementation of the clinical audit strategy 2013-2016 operational action
plan.
• Implementation of our ‘In Your Shoes’ patient / service user involvement
strategy.
• Consultation regarding audit priorities with our commissioners (East Surrey
Clinical Commissioning Group & Surrey County Council), Community Forum,
Healthwatch Surrey, etc.
• Invite stakeholders to annual ‘Quality Improvement Day’ (page 30-32).
• Monitoring / recording patient /user involvement in clinical audit at individual
and business unit level and looking at ways in which we can increase it further.
• Implementation of “You said…we did” feedback across all services, via
noticeboards and our website.
• Ultimately we will work towards enabling carer or service user led audits.
HQIP (2001) How to use this book. IN: Burgess, R (ed) NEW Principles
of Best Practice in Clinical Audit Oxted: Radcliffe Publishing
Page 17 | Quality Account 2013-14
Statutory Statements of Assurance
The statutory statements in this part of our Quality Account relate to the quality of the
service we have provided in the period 1st April 2013 to 31st March 2014. The content is
common to all providers allowing comparison across organisations.
Review of Services
All of our services continuously provide,
maintain and evaluate evidence of the
quality and safety of care they provide to
maintain their Care Quality Commission
(CQC) registration under the Essential
Standards of Quality and Safety. This
evidence is critiqued and analysed by the
Board as part of our internal governance
structure.
The Board have undertaken nine ‘Board
walks’ on Caterham Dene Ward since
June 2013. These visits by members of
the Board were unannounced in order
to enable real time analysis of progress
against the CQC standards, including
patient safety, cleanliness and
record-keeping.
Participation in Confidential Enquiries
First Community Health & Care was not
required to participate in any
confidential enquiries during this
reporting period.
Page 18 | Quality Account 2013-14
National audit
During the reporting period we have not
identified any relevant national audits to
participate in. We have considered both
the national audits for Quality Accounts
and National Clinical Audit and Patient
Outcomes Programme. We have not
been asked by a national audit provider
to participate in a national audit.
During the reporting period there were
no national confidential enquiries that
covered NHS services provided by First
Community Health & Care.
Research
The number of patients receiving NHS
services provided or sub-contracted by
First Community Health & Care in the
reporting period that were recruited
during that period to participate in
research approved by a research ethics
committee was zero.
In our last quality account we reported
on a research study, conducted by one of
our student health visitors, using
grounded theory methodology. In brief
the study, entitled: ‘Exploring the
Perspectives of South Asian Clients
regarding the Health Visiting Service’,
found that South Asian clients
distinguish between health and
parenting advice, being more likely to
accept health advice from their health
visitor and more likely to accept
parenting advice from their family.
Because there had been no previous
research in this area within health
visiting these are regarded as “new
findings” and offer important insights
into how South Asians perceive the
service. This will be used to inform the
local health visiting service, providing
practitioners with a better understanding
of how best to improve the experience
of South Asian clients who access this
service. The author is hoping to publish
these findings in a national journal
during 2014.
Goals agreed with our commissioners
(CQUINs)
A proportion of First Community Health &
Care’s income from 1st April 2013 to 31st
March 2014 was conditional on achieving
quality improvement and innovation goals
agreed between FCH&C and our
commissioners for the provision of NHS
services, through the Commissioning for
Quality and Innovation (CQUIN) payment
framework. This equated to 2.5% of our
contract value with the East Surrey Clinical
Commissioning Group. Three of the four
targets have been achieved successfully.
The fourth was affected by issues outside of
our control.
The four areas are in relation to delivery
of the Safety Thermometer monitoring;
education provided by the Tissue Viability
Service; service provision by the Nurse
Advisors for Care Homes; and the service
delivery and outcomes of the proactive
care community matrons.
The Safety Thermometer Survey is a
national point prevalence survey
conducted on a prescribed day in the
month and is a national CQUIN. The CQUIN
targets were set for FCH&C for 2013/14
with an emphasis on data collection and
monthly reporting to the Quality
Observatory on prevalence of harms.
FCH&C maintains 100% participation in
the Safety Thermometer survey for eligible
services.
Care Quality Commission (CQC)
First Community Health & Care is registered
with the Care Quality Commission, the
regulatory body for health and social care.
First Community Health & Care have no
conditions on registration. The Care Quality
Commission has not taken enforcement
action against First Community Health &
Care during the period 1st April 2013 to
31st March 2014. First Community Health &
Care has not participated in any special
reviews or investigations by the CQC
during the reporting period.
In January 2013 we developed a booklet to
give to all staff as a guide to the Care
Quality Commission Standards.
Throughout 2013 the CQC registered
manager and clinical governance
administration manager attended all team
meetings and ran drop-in sessions to issue
the booklets ensuring all staff groups were
covered. The booklets are also routinely
issued at staff induction sessions. All staff
now have access to a booklet.
The booklets have been used successfully
as prompts for key learning and clinical
teams are encouraged to have CQC
standards as a standing item on their team
meeting agenda as a prompt for discussion
and a reminder of key pathways, contact
details and protocols. Staff who have been
involved with CQC inspection visits have
said that the booklet was an extremely
useful tool to understand and demystify
the requirements of CQC registration.
CQC carried out a routine, unannounced
inspection of Caterham Dene Hospital on
6th March 2014. The following standards
were inspected:
• Care and welfare of people who use
services
• Meeting nutritional needs
• Cleanliness and infection control
• Staffing
• Assessing and monitoring the quality of
service provision
All aspects of these standards were met.
The personal care and treatment records of
people who use the service were looked at
and the inspectors observed how
people were being cared for at each stage
of their treatment and care. They also
talked to service users and staff and
reviewed the information provided to them
by First Community. During the inspection
they visited the ward, Minor Injuries Unit
and spoke to staff from the Rapid
Assessment Clinic.
The report states that patients spoke
positively about the care and treatment
they received:
Page 19 | Quality Account 2013-14
“Staff are attentive and always there when
you need them”
“The staff are always so helpful if you want
anything”
Patients stated that they were involved in
the planning of their care and that staff
were “professional” and “friendly”.
During the previous CQC inspection of
Caterham Dene on 25th March 2013, the
inspectors identified issues with the care
records. In response to this an action plan
was developed as outlined in our last
account. This action plan has been
implemented and was signed off by CQC at
their visit on 6th March 2014. The
inspectors recognised that a lot of work
had been undertaken to improve the care
records and felt that the patients’ needs
were fully assessed. Care plans were
developed with the patient and were
accessible to both staff and the relevant
patient. There was good evidence that
patients had been fully involved in
developing their care plan as well as being
involved in helping to determine what
support or treatment they needed.
The full report is available on the CQC
website at:
http://www.cqc.org.uk/directory/1-298932083
Page 20 | Quality Account 2013-14
Data Quality
At First Community Health & Care, we see
data quality as everybody’s responsibility.
Such an approach helps us ensure high
standards in data quality are maintained
throughout the organisation.
We believe excellent data quality builds the
foundations for the delivery of quality care,
good patient experience and
cost-effective services. It also assists with
clinical decision-making. We continue
to monitor information such as incident
reports, complaints, compliments, activity
data and data quality within our IT system.
This enables us to see how our services are
performing in their entirety, to identify risks
and take any necessary actions.
We also use our data to ensure we provide
services which represent good value for
money and best patient care. We use RiO,
a safe and secure electronic patient record
system which connects to the Spine – the
secure database of key information about
a patient’s health and care which forms the
core of the NHS Care Records Service.
Some examples of what our data tells us
for the period 1st April 2013 to 31st March
2014:
• Rapid Response & Falls Service saw
11,064 first-time appointments
• Caterham Dene Ward had 381 admissions
and discharged 375 patients, 209 were
back to their usual place of residence
• Our Minor Injury Unit (MIU) saw 5,175
patients
• Our Rapid Assessment Clinic (RAC) saw
1,373 first-time appointments and 609
follow-up appointments including ongoing treatment patients
• Health visiting teams saw 10,552 first
time appointments and 23,656 follow-up
appointments.
NHS Number and General Medical
Practice Code Validity
First Community Health & Care have
submitted records to the Secondary User
Service for inclusion in the Hospital Episode
Statistics for the period1st April 2013 to
31st March 2014. We will be compiling our
2012/13 data for submission shortly.
Clinical coding error rate
First Community Health & Care was not
subject to the Payment by Results clinical
coding audit from 1st April 2013 to 31st
March 2014 by the Audit Commission.
Information Governance Toolkit
attainment level
The First Community Health & Care
Information Governance Assessment
Report overall score for 2013/14 was 69%
and graded as satisfactory (green).
PART 3: A review of the quality and performance of our services
New services for 2013/14
Caterham Dene Minor Injuries Unit Extended Hours
The Minor Injuries Unit at our Community Hospital, Caterham Dene, extended its opening hours in February 2014. The Minor Injuries Unit is now open from
9.00am - 8.00pm, 365 days a year.
Managing Director, Philip Greenhill said:
“Our hugely popular Minor Injuries Unit is a safe and convenient alternative to A&E for minor injuries. Our MIU currently sees 70 – 100 patients per week and
we consistently receive excellent patient feedback results via the national Friends and Family Test. There is no need to book an appointment, and we have
limited free parking on site. With the centre being open for longer hours, this will only serve the needs of our population better.”
Dr Joe McGilligan, GP and East Surrey Clinical Commissioning Group Chair said:
“Extended opening hours for the popular Minor Injuries Unit in Caterham is excellent news for local people.
With the service now open 9am - 8pm, 7 days a week, working people will find accessing the service much
easier.
It is important that patients access the right service for the right illness, often people go to A&E because
they are worried and unsure of where else to go. The Minor Injuries Unit provides convenient treatment for
sprains, strains and minor burns, so there is no need to go to A&E.”
Page 21 | Quality Account 2013-14
Some feedback from users taken from website reviews
in February 2014:
“Very attentive, informative,
professional & friendly from
beginning to end. NHS at its most
very best, excellent model for
other walk in hospitals.”
“Being seen by a medical professional on the day and at the
time I needed treatment for a minor injury was amazing.
After completing a short questionnaire, I waited about 10
minutes before I was seen by the nurse who was courteous,
informative, friendly and treated me in a professional manner.
I would not have gone to A&E for treatment as it was not an
emergency but, as it was the weekend, I was not able to get an
appointment at my doctors. I was very grateful to have the
option of receiving treatment at the Minor Injuries Unit and
would recommend it to family and friends.”
Page 22 | Quality Account 2013-14
“Not long to wait for x-ray,
fantastic care by
radiographer & nurse Philip
was fantastic. I cannot thank
you enough for the care you
gave to my mother.”
“Very fast, very professional.
Open on a Sunday.
Excellent”
New Health Visitor/School Nurse Role
In July 2013, a new role was created within the 0-19 Service for a Health Visitor/School Nurse for homeless children, young people and families in
recognition of the complex health needs of the vulnerable families living in our community. The remit of the role is to achieve the best possible health
outcomes for clients living in guesthouse, hostel and refuge accommodation through delivery of health care and advice, advocacy, multi-agency working
and support for practitioners within the FCH&C 0-19 service.
This service enables families in very disadvantaged situations to receive a detailed health needs assessment that informs timely and client-led health
interventions and support, enabling them to engage with other services. The service is supported by an experienced Community Staff Nurse and is
currently working with 45 families. We will evaluate service user experience via the ‘iWantGreatCare’ process during 2014.
Increasing expertise within the Rapid
Response Service
We appointed an Associate Practitioner at the end of 2012. She is successfully progressing patients
with their exercise programmes and is running the seated exercise class within our rehabilitation
unit alongside the physiotherapist.
A physiotherapist from the Rapid Response service is attending an Independent Prescribing course.
This will benefit the patient and the Team, as the patient can receive a prescription immediately
rather than waiting for a GP or a nurse from the Team to visit the patient. This also means that the
patient will not need to repeat their symptoms to another health professional.
Page 23 | Quality Account 2013-14
Better Balance Exercise Class
In response to the National Audit of Falls and Bone Health (2012), a Better Balance Exercise Class was
set up in June 2013 as a joint initiative between FCH&C and the YMCA at Redhill adding social value
to the health and wellbeing of residents in the Reigate and Redhill area. This is a very exciting project
which aims to help people reduce their risk of falls, feel more confident in carrying out their daily
tasks and prevent any unnecessary admissions to hospital. In November 2013, we conducted an
audit to review the effectiveness of the Better Balance Exercise Class and found there was a relatively
high drop-out rate, mainly for health reasons. We therefore introduced these classes as a rolling
programme to ensure that patients did not have to wait for weeks for another class to start and so
the number of participants remained high throughout the eight week programme. A total of 41
people have attended and benefitted from the classes since June 2013.
Our plan going forward:
•
Feedback from participants indicates that,
for the majority, this programme has been
successful in meeting its expected
outcomes:
“Excellent class”
“The whole classes have been excellent,
including the staff”
“I have improved with all of my exercises
and feel better for having done them”
The Associate Practitioner will be completing the postural stability instructor’s course. This will
provide time for other staff to see more patients with complex needs and means there are more
people trained to take the class.
“So far so good, thank you for your
patience”
• To promote the Better Balance Exercise Class to other healthcare professionals to increase referral
“All the staff were very friendly, and
informative. It’s a pity that more people
don’t avail themselves of all the help that is
available”
rates and maintain a good level of participants.
Increased community bed capacity
During the reporting period the Rapid Response Team increased its community bed capacity by 110% (from 10 to 21 beds). This will help to facilitate early
hospital discharge for patients with complex health and social care needs, giving the patient a longer period of time to rehabilitate and/or for health
professionals to identify any on-going care needs. The team has built up pathways and processes within four nursing homes to ensure a smooth transition of
care from the hospital to the patient’s discharge home or to a permanent residential or nursing home.
As this was a new cohort of patients for Rapid Response with patients requiring complex health and social care interventions, specific staff training needs
around end of life care, mental health and dementia were identified. The Community Matrons have delivered one training session on end of life care,
attended by nine members (25%) of the Rapid Response Team and other sessions are planned to ensure all practitioners are aware of current best practice in
these areas. Five members of staff from FCH&C also completed a four day Dementia Care Mapping course. The aim is to provide further training in the use of
this mapping tool to improve care of patients with dementia across First Community.
Page 24 | Quality Account 2013-14
Review of our services
We will now provide an overview of some of our quality improvements for the period 1st
April 2013 to 31st March 2014.
Patient Safety
Safeguarding adults
• FCH&C now has a dedicated Adult Safeguarding Lead in post to provide advice and support to staff relating to Adult Safeguarding matters. This post
reports directly to the Executive Lead for Safeguarding, the Clinical Operations Director.
•
All staff within the organisation attend Adult Safeguarding training on induction and are required to attend an update every three years. A spot check in
December 2013 revealed that 84% of all staff were compliant with training. This is higher than the 80% threshold accepted by the CQC at their inspection
visit in March 2013.
• There were no Deprivation of Liberty Safeguards applications at Caterham Dene ward during the year.
• Over the last year we have developed FCH&C Adult Safeguarding operational guidance which includes escalation flow charts to provide clear guidance
on information sharing and reporting, and Mental Capacity Act assessment guidance, in line with Surrey Multi-agency Safeguarding Adults policies. Two
launch events were held in October 2013 to raise awareness of adult safeguarding matters.
• We work in collaboration with our health and social care partners by representation on the Surrey Safeguarding Adults Board (SSAB) and Social Services
Safeguarding Adults Group
• At our hospital ward and community clinics we display leaflets and posters to promote our service users’ awareness of safeguarding and signpost them
where to get help.
Page 25 | Quality Account 2013-14
Safeguarding children
In the reporting period, 85% of staff in the Children’s 0-19 Service, have completed Level 3 Safeguarding Children training. A further 8% of staff joined the
organisation in September 2013 and are completing modules working towards Level 3. There are three levels of Safeguarding Children training that move
from basic awareness to advanced training for practitioners who require in depth training. All FCH&C staff receive Level 1 training as part of their induction,
but registered practitioners who are required to hold a safeguarding caseload can only do so once they have completed training at Level 3. Staff who have
not completed the multi-agency training do not carry a safeguarding caseload. All staff who have previously completed this training and who hold a
safeguarding caseload have received their annual update during the reporting period.
We have continued to ensure support for our 0-19 staff with a safeguarding caseload by increasing the number of staff trained to provide safeguarding
supervision; an additional three members of staff trained as safeguarding supervisors in the reporting period with plans to train further staff during 2014.
All registered staff continue to receive safeguarding supervision every three months.
We collect monthly performance data with regard to safeguarding which enables us to assess the quality of our health visiting service and informs our
service redesign. For example, if we have a high number of young parents (under 18s) we can tailor services to meet their needs. This data also ensures
that the health professionals carrying a safeguarding caseload receive the appropriate levels of supervision and support. For example, we have increased
the number of nursery nurses supporting teams who carry a high safeguarding caseload, enabling them to provide packages of care to the most
vulnerable families. This might include support with behavioural issues, parenting or healthy eating on a budget.
Medicines Management
In March 2014 we implemented our new Medicine Policy after an extensive review by the FCH&C Lead Pharmacist, and consultation with front-line staff and
senior management. This gives our clinicians clear working guidelines to ensure the safe management of medicine.
As part of the Medicine Policy governance requirement, a quarterly Medicine Incident Report is presented to the Clinical Quality and Effectiveness Group.
Medicine administration incidents at Caterham Dene Hospital ward are the most frequently reported incidents each quarter. An analysis of these incidents
together with the annual Drug Chart Audit reported a number of missed and omitted doses (see glossary definition). This has been taken in consideration
when agreeing priority 1 going forward for 2014-15 (see Part 2, page 15).
Page 26 | Quality Account 2013-14
Safety Thermometer
The NHS Safety Thermometer is a point prevalence survey to allow teams to measure ‘harm’ and the percentage of patients that receive ‘harm free’ (see
glossary for definitions) care in relation to pressure ulcers, falls, urinary tract infections in patients with urethral catheters (UTIs) and venous
thromboembolism. We report on this monthly and feedback to our teams. We have compared our data with the national picture as a method of
benchmarking our results and have provided our 2013/14 quarterly data for comparison in the table below:
Criteria measured
(each out of 100%)
Harm Free
Pressure Ulcers All
Pressure Ulcers New
Catheters with UTIs
New Harms
Q1 2013 - 2014
FCH&C
National
92%
92%
7%
5%
2%
1%
1%
1%
3%
3%
Q2 2013 - 2014
FCH&C
National
94%
93%
4%
5%
1%
1%
1%
1%
3%
3%
Q3 2013 - 2014
FCH&C
National
97%
94%
3%
5%
0%
1%
0%
1%
1%
3%
Q4 2013 - 2014
FCH&C
National
97%
94%
2%
5%
0%
1%
0%
1%
2%
3%
We have used this tool to help us measure our performance in other areas, in
particular the completion of nutrition screening to identify people at risk of
malnutrition. Malnutrition occurs when the food a person eats does not give
them the nutrients they need to maintain good health or when someone does
not eat enough food (sub-nutrition).
We screen our patients for risk of malnutrition or undernourishment using the
Malnutrition Universal Screening Tool (MUST).
The chart adjacent shows the percentage of patients who have had a MUST
assessment on a certain day each month. We are working to increase these levels
both to improve the way in which we collect and analyse the data and to
understand if those patients without a MUST assessment require one.
Page 27 | Quality Account 2013-14
Incident Reporting
Adverse incidents (something that was not expected to happen) will occur within any organisation and when they do it is important to ensure that what
happened is documented and shared with the aim of preventing, or reducing the likelihood of a recurrence. In some circumstances the incident will be a
“near miss” or “good catch” which means that an adverse event would have happened but action was taken to prevent it.
Over the last year 599 incidents have been reported, an increase of 45 from the previous year. We have completed Root Cause Analysis (see glossary) on all
grade 3 and 4 pressure ulcers.
During the period 1st April 2013 to 31st March 2014 we had a total of 18 Serious Incidents (3% of the total incidents reported) – 13 concerned the
acquisition or deterioration of pressure ulcers, three were in relation to falls resulting in a fracture and two were safeguarding concerns.
Reducing the risk of patients falling in our hospital ward
An analysis of reported falls incidents took place in 2013 which resulted in the implementation of an action plan to reduce patient falls and harm. This
included training for staff in assisting patients to mobilise and transfer safely; the implementation of a robust system for communicating every patient’s
moving and handling precautions; relaying the day room to maximise the space for safe mobility; and the provision of slipper socks. Falls prevention has
been given a high profile on the ward and during Falls Prevention Week the ward hosted an event for patients, relatives, carers and staff to promote falls
prevention, inviting speakers from FCH&C Falls Prevention Team, Telecare and Caterham Dene Physiotherapy department who undertook interactive
sessions with those who attended.
Page 28 | Quality Account 2013-14
Infection Prevention and Control
• Infection rates – During the reporting period, there were no cases of MRSA bacteraemia or Clostridium difficile.
• MRSA screening – Patients within our community hospital are screened on admission and re-screened four weeks following admission. During the
reporting period, we completed this screening with 100% of our patients.
• Infection Prevention and Control updates – Annual updates on infection prevention and control are offered to staff either as face to face sessions or
e-learning modules. A spot check during the reporting period showed 89% compliance with mandatory training.
• Hand hygiene audit – At our community hospital we observe our staff washing their hands to ensure they are doing this properly. During the reporting
period 100% of staff observed washed their hands correctly. All community based healthcare teams undertake a peer review of their hand hygiene
technique at least annually. Some results from this are:
– Our Rapid Response team achieved 100% correct hand washing technique in November 2013
– The in-patient therapists at Caterham Dene achieved 100% in July 2013.
• National Standards of Cleanliness – Cleanliness within our community hospital is audited monthly using the standard 49 point audit form*, providing
a useful indicator of cleanliness standards. At one point during the reporting period, a fall in standards was identified, quickly enabling the
organisation to work with the cleaning contractor to raise standards to an acceptable level.
*http://www.dhsspsni.gov.uk/environmental_cleanliness_standards_in_hsc_acute_hospital_facilities.pdf
Page 29 | Quality Account 2013-14
Clinical Effectiveness
Annual Quality Improvement Day
Every year we host a Quality Improvement Day where we invite our Business Units
to showcase their quality improvement work. All members of the organisation are
invited including the Board. This year all Business Units took the opportunity to do
this, producing posters detailing their work. We also heard from individual
clinicians about quality improvement and clinical audit work they had undertaken.
We were privileged to welcome representatives from both The National Institute
for Health and Care Excellence and the Healthcare Quality Improvement
Partnership (HQIP). The representative from HQIP later wrote a blog about the day,
an extract of which can be seen below:
“Over the course of three sessions we saw 14
varied and interesting presentations, with
clinical audits alongside other quality
improvement projects, with a dozen or so
exhibition stands attracting interest in the breaks.
The ongoing success of the event has seen an
increase in quality improvement activity amongst
the nurses, therapists and other clinicians in the
organisation with … a corresponding increase in
the quality of the projects, the confidence of those
who carry them out and the improvements to
services they deliver.”
Page 30 | Quality Account 2013-14
We have included a summary of some of the presentations in the tables below.
Project title
Aim of the project
Identifying the Speech and
Language Therapy (SALT) needs
of children under 5 in order to
develop a menu of options /
appropriate support to meet these
needs.
• To reduce SALT referrals and
inappropriate referrals (present
waiting list is 6-9 months for
assessment)
Description
A survey of staff and parents who
have accessed SALT.
• Explore parents’ expectations that
child will receive assessment and
therapy
Emergency catheter call
outs for the Evening & Night
Service 2013
Aim of the project
• To enable the service to
identify whether a catheter
change is required.
• To indicate whether we are all
carrying out best and
consistent practice.
• To help identify areas where
training is required to enhance
our practice.
• To help identify problematic
catheters that require review.
Actions / Future plans
• Families to gain information
about local SALT services and
processes
Next steps:
• Reduction in inappropriate
referrals to SALT
• Staff focus group
• Stakeholder Engagement (SALT)
• Families and staff to have a
greater understanding of SAL
development leading to a more
realistic expectation of SAL in the
under 5s. In turn would reduce
overall number of referrals.
• Equip parents with up to date
information and advice to support
their child’s speech and language
development.
Project title
Results
Description
We recorded data on all
unplanned catheter visits as
these visits are due to patients
experiencing problems with
their catheters which we want
to avoid by individualising care.
• Service user focus group
Results
Actions / Future plans
There were 109 patients with catheters on our
caseload, 21 supra-pubic, 56 urethral and 32 not
documented.
• For 29% (n=32) of these catheters we had not stated
in the records of care whether the catheter was
urethral or supra-pubic (through the tummy into the
bladder).
• We will make changes to
our documentation to
ensure we record all
relevant details.
• We will adopt the catheter
passport to ensure
continuity of care.
• We will ensure all our staff
maintain their competence
to care for our patients with
catheters through formal
assessment against agreed
• We have reduced the use of catheter maintenance
competencies for catheter
solutions in the management of catheter problems
from 27% in 2012 to 20% in 2013. This is good, as there care.
is limited evidence to support the use of catheter
• We will undertake a further
maintenance solutions to manage blocked or
review of the use of catheter
bypassing catheters.
maintenance solutions.
• The average time it takes to care for our patients who
have problems with their catheters is 28 minutes.
• We also had not recorded the reason some of our
patients had a catheter, this is important to enable us
to review if our patients still require a catheter.
Page 31 | Quality Account 2013-14
Project title
Aim of the project
Antibiotic Prescribing: Drug Charts • Assess and monitor antibiotic
at Caterham Dene Hospital Ward.
prescribing against local
guidelines.
Description
Results
A snapshot audit of all available
drug recording charts available on
a specific day.
Overall, antibiotic usage was in line
with the local primary care
guidance or local acute trust
guidance where appropriate.
• Review the implementation of
the 2012 action plans.
Other clinical audit work
During 2013 a booklet for clinicians “How to undertake a clinical audit” was developed. These were
distributed at the Annual Quality Improvement Day and are given to new clinical staff at
induction.
Clinical Audit Policy and Strategy
This year we have also developed and launched a new clinical audit policy and strategy. We have
refined our reporting processes to enable sharing of clinical audit activity, including plans, results
and action plans.
Community Nursing
All our District Nurses have completed a supported programme on clinical audit which has
involved them planning an audit. We now have a clinical audit group in District Nursing.
Dietetics
The dietetic department will revisit the MUST audit for inpatients as a priority in the 2014/15 audit
timetable.
Audiology
Following a medical records audit to support the UKAS accreditation process, a review of the
documentation of the follow-up pathway has been completed to identify any shortfall in
documentation. New standard operating procedures have been written and implemented and
re-audit indicates a significant improvement with 95% compliance.
Page 32 | Quality Account 2013-14
Actions / Future plans
We will continue to monitor this
to ensure our practice remains
safe and in line with best practice
guidance.
NICE
A policy has been developed to provide
guidance for staff in First Community Health &
Care with regard to the dissemination,
implementation and monitoring of NICE
guidance. It describes how FCH&C will
disseminate knowledge about new NICE guidance
and the process for assessing whether FCH&C
services are compliant with the
recommendations.
“Thanks for the FRAX osteoporotic risk The changes include the development of a
scores. They are useful. Please keep them patient information leaflet and improved
assessment documentation.
coming.”
DVT pathway
The DVT (Deep Vein Thrombosis) pathway at the
Rapid Access Clinic (RAC) now reflects the NICE
clinical guideline ‘Venous thromboembolic
diseases: diagnosis of deep vein thrombosis’
http://guidance.nice.org.uk/CG144.
Documentation used in the RAC has been
A clear process to respond effectively to NICE
updated and ratified via FCH&C’s Clinical Practice
guidance brings benefits to patients ensuring that Group. This piece of work was presented at the
the care provided is both clinically and cost
audit day, evidencing improvements these
effective. It helps the organisation to meet
changes have made.
standards set by the Care Quality Commission
(CQC). The process supports the organisation’s
Deep Vein Thrombosis is a condition in which a
governance framework and provides assurance to blood clot forms in a vein, particularly the deep
the Board.
veins of the leg. The thrombus (clot) can dislodge
Some examples of work undertaken within
FCH&C during the reporting period, with regard
to specific NICE guidance follows.
Raising awareness of osteoporosis
The NICE clinical guideline ‘Osteoporosis fragility
fracture’ www.guidance.nice.org.uk/CG146
recommends the use of the FRAX® tool (see
glossary). During 2013 we introduced the use of
this online tool within the Falls Service and with
the Community Matrons. We have begun to trial
this within other community services in 2014 and
will audit its effectiveness in identifying which
patients require bone protection or further
investigation. The introduction of the FRAX® tool
has received a positive response from GPs:
and travel in the blood to the pulmonary arteries
causing a fatal pulmonary embolism. A non-fatal
clot can result in long term illness, venous
ulceration, or post thrombotic limb, which can
have a significant effect on quality of life. In
2010/2011, 56,000 people were diagnosed with
blood clots.
Our Rapid Assessment Clinic accepts referrals
from GPs for patients suspected of having a deep
vein thrombosis. The publication of NICE CG144
enabled us to audit our service against criteria
and standards of best practice. From this we were
able to adapt and change our pathway to enable
us to provide our patients with the highest quality
service which is both safe and effective, as
evidenced by the clinical audit process.
In October 2013 we collected data after these
changes had been introduced to ensure they had
had the desired effect of meeting the criteria and
standards set out by NICE CG144. We looked at all
patients attending the RAC in September
suspected of a DVT - a total of 19 patients.
Here are some of the results:
• 100% of patients were assessed using
the two level DVT Wells Score, the
assessment tool recommended by NICE
• 100% of patients with a ‘likely’ Wells
Score (meaning they have risk
factors and signs of a DVT) were offered
a proximal leg vein ultrasound scan to
confirm or rule out the diagnosis (only
two patients had a ‘likely’ Wells Score).
• Of these two patients only one had
their scan within 24 hours of being
assessed; however both patients
received the recommended treatment
(an interim 24 hour dose of parenteral
anti-coagulant e.g. Enoxaparin) whilst
they waited for their scan.
Page 33 | Quality Account 2013-14
Productive Community Services
Productive Community Services is an organisation-wide change programme
which helps front line staff improve quality and productivity.
It aims to:
•
•
•
•
•
Increase patient-facing contact time
0-19 Service - Planning Your Workload
The 0-19 Service plotted their daily travel data and looked at the routes
covered, with a view to possibly reducing travelling time in future. From
mapping a day-in-the-life travel snapshot the team have divided their
caseload geographically. There has been a reduction in mileage and a
more cohesive approach to caseload management as shown below.
Comparison of 0-19 Team mileage for 2012 - 2013
Reduce inefficient work practices
Improve the quality and safety of care
Revitalise the workforce
Put staff at the forefront of redesigning their services
FCH&C are using this framework as an enabler, aligning modules to the needs
and priorities of our services to ensure we provide the best quality care for all our
patients. An example of our work is detailed on the right.
Enhancing Quality Initiative
Enhancing Quality (EQ) is an innovative clinician-led quality improvement programme launched in January 2010 across Kent, Surrey and Sussex.
By clinicians analysing where to intervene for greatest quality improvement, EQ aims to improve patient outcomes and reduce variation in care, every
patient, every time. The programme is evidence-based and data-driven, providing the opportunity to benchmark our patients’ outcomes with other
organisations across the three domains of quality: clinical effectiveness, patient safety and patient experience. Out of six work-streams, managing heart
failure in the community was the only one relevant to First Community Health & Care.
Our Heart Failure Team has successfully managed 207 patients with heart failure since joining the EQ initiative in October 2011 and have exceeded all
targets set by EQ for our local area to February 2014 (see chart on following page).
Page 34 | Quality Account 2013-14
The above chart demonstrates how we have achieved and exceeded our targets. For example we have achieved 98.0% effectiveness at managing ACE
inhibitor and ARB medication which exceeds our EQ target of 93.4%. We have also achieved 95.6% effectiveness at managing our patient beta blocker
medication, which exceeds our target of 89.6%. The Management Complete Quality Score (CQS) and Actual Care Score (ACS) targets relate to the number
of patients receiving the optimal medication for their condition. This improves the patient’s heart function and lessens their symptoms associated with
heart failure e.g. shortness of breath, ankle swelling and fatigue.
ACE Inhibitor
An ACE inhibitor (or angiotensin-converting-enzyme inhibitor) is a medicine used primarily for the treatment of hypertension (elevated blood pressure) and congestive heart failure (CHF)
Angiotensin II
Angiotensin II receptor antagonists, also known as angiotensin receptor blockers (ARBs), are medicines that are often used to treat high blood pressure.
Beta Blockers
Beta-blockers (also known as beta-adrenoceptor blocking agents) are medications used to treat several conditions, by reducing the workload of the heart soas to put it under less strain.
Management Actual Score
Management Actual Score (ACS) is the percentage of people titrated on the medications who have not reached the maximum recommended dose of 10mg but have reached the maximum that they can tolerate.
Management Complete Quality Score (CQS)
Management Complete Quality Scores (CQS) is the number of patients who have reached the maximum target amount of 10mg of ACE (Ramipril) and beta blocker (Bisoprolol).
Page 35 | Quality Account 2013-14
Patient Experience
Complaints & Compliments
We have received a total of 23 complaints between 1st April 2013 and 31st March 2014. Four of these complaints related to incidents where Surrey &
Sussex Healthcare were the lead organisation (see chart below).
As a result of these complaints:
• The Podiatry and Physiotherapy Departments have
reorganised their administration teams to ensure integrated
working which allows greater flexibility. This has improved
scheduling of podiatry patients to maximise clinic
appointments and also improved telephone access to the
departments.
• The menu choices and availability of vegetarian meals for
Caterham Dene Ward patients have been reviewed. An
appropriate escalation process has been implemented to
enable immediate action to be taken to deal with patient
concerns about the food choices provided.
Our complaints policy states we will acknowledge all complaints within two working
days. In the reporting period, 96% of complaints were acknowledged within two working
days. The 4% not acknowledged relates to one complaint received within the
organisation. Initially this was considered to be a complaint about a partnership
organisation, however, it was later agreed that FCH&C would investigate the complaint
and respond on behalf of both organisations.
Page 36 | Quality Account 2013-14
All teams receive compliments not only verbally but also by
way of ‘thank you’ cards, e-mails, and letters. For this period
the teams received 86 written compliments and 89 gifts.
Teams also receive feedback through the Friends and Family
Test.
UNICEF Baby Friendly Initiative
In October 2013 the health visiting teams (health
visitors, staff nurses and community nursery nurses) at First
Community Health & Care achieved outstanding results as
part of the Stage 2 assessment of UNICEF’s and the World
Health Organisation’s ‘Baby Friendly Initiative’ (for more
information go to: http://www.unicef.org.uk/babyfriendly/).
Health visiting teams at First Community were evaluated
against a set of criteria which demonstrate high
standards of care for all families. First Community achieved
100% in all criteria, with the exception of one result of
98%*. This is an outstanding result, only achieved by one
other organisation nationally, exceeding the national
standard of 80% to pass this stage.
Many mothers stop breastfeeding earlier than they want
to. The initiative ensures that health visiting teams can help
mothers (and just as importantly - their partners) overcome
the inevitable difficulties and challenges that many
experience in the early days, weeks and months of
parenthood to carry on breastfeeding for as long as they
wish to.
The UNICEF assessor stated in the report “First Community presents
an extremely positive approach to breastfeeding. The level
of knowledge and understanding combined with emotional
sensitivity and insight demonstrated by staff interviewed was
exceptional and both assessors were greatly impressed by the
findings.’’
Baby Cafés are a relaxed, friendly place to drop in for support and advice for breastfeeding
mothers. This year (2013-14) we have seen an 8% increase in the number of visitors to the
Baby Cafés (1,525 as compared with 1,412 in 2012-2013). Some of the feedback received
from Mums during 2013-14:
“Having a safe environment to get used to public feeding has boosted my confidence.”
“Always hoped I would be able to breastfeed. The Baby Café provided good advice in a
friendly environment.”
“I breast-fed my baby for longer than I originally thought. This is down to the support I have
received from the Baby Café and the friendships.”
We have seen a 3% increase in the number of
infants receiving breast milk at 6-8 weeks in east
Surrey (from 57% in Quarter 3 2012-2013 to 60%
Quarter 3 2013-2014).
First Community Health & Care also works with local
partners including Children’s Centres, the National
Childbirth Trust, Mum2Mum peer supporters and Tandridge
Education Partnership to offer three Baby Cafés in the area.
First Community will continue to work towards Stage 3 of the Baby Friendly Initiative to
become a fully accredited organisation in November 2014.
*Results related to one ‘unsure’ response to criterion 7: HV and support staff who gave an
adequate explanation of how they would determine that a baby was receiving enough breast-milk.
Page 37 | Quality Account 2013-14
Health Visitor Call to Action
The health visiting service is based on high quality , evidence-based
services delivered through effective partnerships with Children’s Centres,
GPs and other key early years providers through a four tiered model (see
glossary).
The key aim of the Health Visitor (HV) Call to Action is to
improve services and health outcomes in the early years for
children, families and local communities, through
expanding and strengthening health visiting services and
promoting learning and good practice.
For FCH&C, this means an increase of 10.3 whole time equivalent (WTE)
health visitors by March 2015. In March 2012 FCH&C employed 19.8WTE
health visitors. At the end of March 2014 we have achieved an increase of
44% with a total of 28.44WTE health visitors now in post. Since
September 2013 we have been achieving above the agreed trajectory
and remain on track to achieve a 50% increase in our health visitor
numbers overall by 2015.
Page 38 | Quality Account 2013-14
The increase in the number of health visitors within the service has had a
positive impact on the delivery of our services for families with children under
the age of five years. One of the most significant impacts has been seen in the
area of the new birth contact. The requirement to contact the mother
following the birth of the baby dates back to the 1946 National Health Service
Act. The national Healthy Child Programme recommends that this contact
results in a face-to-face review (home visit) by the health visitor, ideally within
10-14 days following the birth. The chart below shows the increase in the
number of new birth contacts completed within 14 days since the increase in
health visitor numbers.
New birth visit made on or before 14 days after birth
New birth visit made after 14 days after birth
“The start of life is a crucial time for children and parents.
Good, well resourced health visiting services can help
ensure that families have a positive start, working in
partnership with GPs, maternity and other health services,
Sure Start Children’s Centres and other early years services.
That is why the Coalition Government has made the
challenging commitment to an extra 4,200 health visitors
by 2015.”
(DH 2011)
Quality improvements in the Audiology Service
In February 2014 the FCH&C Audiology Service was accredited by the United Kingdom
Accreditation Service for adult assessment and rehabilitation and complex assessment and
rehabilitation. It is currently the only community service in the UK to be accredited for
complex assessment, the twelfth service overall and the second non-acute trust service. The
assessment required a formal submission and a three day assessment process with inspectors
spending time in the department as well as speaking to staff and patients. There are five
mandatory actions that have to be completed prior to the 2nd May 2014 which will be
reviewed internally through the Clinical Quality and Effectiveness Group.
Prior to moving to a cost per case tariff contract on the 1st September 2013, the FCH&C
Audiology Service was in breach of the 18 week ‘referral to treatment time’ national target
(see glossary). This resulted in long waits of over a year for hearing aid provision from date
of referral. Since the change of contract, FCH&C has successfully reduced wait times through
funding additional capacity in the form of clinics to target the backlog. Wait times from
referral to assessment and provision of a hearing aid has reduced from 54 weeks
pre-September 2013 to just three weeks at the end of March 2014, well within the 18 week
target. This means that people with hearing loss now receive a timely service.
Dignity and respect in our Rapid Access Clinic
In our last quality account we told you about how we had used the Essence of Care (2010) to consider the dignity of our patients attending the clinic. This
is a national benchmarking tool addressing the fundamental aspects of care, dignity forming one aspect of this.
We have now completed the actions for improvement and have:
•
purchased blinds to cover an opaque window to increase privacy
•
installed signage so staff can recognise when a room is ‘engaged’
•
put a keypad on the room where we keep our medical records in a locked cabinet in order to protect the confidentiality of these records of care.
We will be repeating this benchmarking process during 2014.
Page 39 | Quality Account 2013-14
Conversation Partnership Scheme
In our last account we wrote about a pilot project for training volunteers to work with
isolated people with communication difficulties. In collaboration with the Tandridge
Befriending Scheme the Conversation Partner Scheme aims to train volunteers to
support people living with communication disability who would benefit from
befriending in the community. Funding was identified to continue this scheme for
another year. Another group of eight volunteers (making a total of 16) have been
trained by the FCH&C Speech and Language Therapy (SLT) team. For various reasons
five of these volunteers are no longer able to visit, leaving 11 active volunteers. Ongoing support is being provided to the volunteers at Tandridge Befriending Service
by a process of supervision meetings and individual support to volunteers as needed.
Twelve people, who themselves have communication difficulties as a result of stroke,
have also been trained to act as conversation partner volunteers and expert patients
in the scheme. There have been a total of 21 referrals into the scheme and 16 of these
have been matched with a volunteer conversation partner.
Going forward, the FCH&C Speech and Language Therapy department will be working closely with Connect (the communication disability charity), who have been
awarded lottery funding to support conversation partner schemes throughout the
country.
Those receiving visits said:
“Helps you get up because you are expecting a visit”
“Gives you confidence”
“I am now happy to order a beer or a coffee”
Page 40 | Quality Account 2013-14
This has been a very positive scheme for
both people with communication
difficulties and for the volunteers
themselves. Our evaluation of the
service indicated that:
• Volunteers felt more confident, enjoyed
the visits, had a better understanding of
stroke and aphasia and were well
supported by SLT
• People with aphasia looked forward to
the visits, and enjoyed the wide range of
topics, the chance to chat, and the
company
Volunteers said:
“Finding a way to help”
“I’ve gained a friend”
“We always managed to find the words”
“We enjoy our time together and are still finding new
areas of conversation”
Patient Satisfaction Surveys, the Friends & Family Test
and ‘iWantGreatCare’
Community Neuro-Rehabilitation Team (CNRT)
The CNRT have been using ‘iWantGreatCare’ as the vehicle for patient feedback since October
2013. There was some specific feedback in December 2013 (two comments out of a total of five
responses) relating to an area of improvement around involving patients more in their care
planning and agreeing/providing them with clear rehabilitation goals. As a result of this
feedback the team has designed a ‘goal sheet’ which enables patients to set and agree goals
with the health professional. Patients keep a copy of this. These goals are reviewed in
multi-disciplinary meetings and with patients on a weekly basis with changes documented to
show progress and agreement. The sheets are signed off at the end of the treatment period with
the patient. These will be audited as part of the bi-annual record-keeping audit.
Caterham Dene Ward
Patient experience is of primary importance and all service user feedback is used to improve services.
All service users are given a copy of the Friends and Family Test (FFT) questionnaire on discharge. The
results are collated externally every month and provide scores in a number of areas including dignity,
patient involvement, information, staff, cleanliness, trust and the help received by patients. Scores have
remained consistently high.
All comments are analysed and where appropriate any negative comments and suggestions are acted
upon. For example, in response to patient comments regarding difficulty in attracting the staff attention when in the day room, a new call bell system is to be fitted which includes the provision of patient
held call bells which are worn around the neck or on the wrist so that patients can call for a member of
staff when they are away from their bed space.
Comments have included:
‘Staff nurses very polite, nothing was too much trouble’
‘A great experience – built me up ready for home’
‘Lovely caring staff’
‘Visitors always made welcome’
‘The staff nurses, physios, OT were all wonderful and helpful’
The survey results are made available to staff and the survey results are a standing item at team
meetings.
Page 41 | Quality Account 2013-14
Clinic in a Box
‘Clinic in a Box’ is a mobile clinic led by school nurses offering sexual health and
relationship advice to young people, weekly during term time. ‘Clinic in a Box’ is
currently provided in two secondary schools within the east Surrey locality. During
2014/15 we plan to offer this service to the remaining five secondary schools in the
locality, subject to their agreement.
During 2013 the ‘Clinic in a Box’ service saw a 23% increase in attendance
compared with 2012 and an overall increase of 240% compared with 2011 when it
was first introduced (see chart adjacent). The three months from January to March
2014 continue to show an upward trend in attendance with an increase in levels of
satisfaction with the service.
Young people attending ‘Clinic in a Box’ are asked to complete an evaluation questionnaire at each contact. Accessibility, appropriateness and
confidentiality of the service continue to be highly valued by all attendees. In the reporting period more than 99% of total responses across all criteria
(compared to 93% in our previous account) were either ‘strongly agree’ (92%) or ‘agree’ (7%). The only ‘disagree’ response was in response to the statement:
“I would recommend this service to members of my family”. This was due to a concern from the young person that recommending the service indicated they
had personal experience of the service which might, therefore, compromise the confidentiality of their consultation (see chart below).
We continue to monitor and review the content and process of
evaluation against the ‘You’re Welcome’ criteria and Friends and
Family Test Question to ensure the service meets the needs of
all young people attending the schools where ‘Clinic in a Box’ is
delivered. The 0-19 Service, together with ‘iWantGreatCare’, have
developed a unique tool designed to enable young people to
provide us with feedback on their ‘Clinic in a Box’ experience. This
will be introduced during 2014 and, with the use of mobile IT
devices, will ensure that user feedback is captured in real time.
Page 42 | Quality Account 2013-14
Staff Experience
Council of Governors
Our Council of Governors (CoG) is an elected group of staff who represent shareholder staff and their views. They meet on alternate months and act on
behalf of staff members as a link to the Board and help make decisions in the best interests of our patients and the organisation.
KEY ACHIEVEMENTS 2013-2014
We have….
…developed a much clearer vision of our role and function within the
Company Articles as a staff voice in the maintenance of FCH&C
Community Interest Company’s principles and responsibilities as a
transparent and genuine Social Enterprise.
…reappointed two Non-Executive Directors and the Chairman and
contributed toward the Organisational Development Plan.
…developed and implemented a new meeting structure to enable CoG to
function independently of the Board.
…developed the process for the application and allocation of the
Community Development Fund, as part of FCH&C’s Community Interest
Strategy, to help our community and add social value, donating approx.
£20,000 to community groups, including Age Concern and St Catherine’s
Hospice.
…attended and promoted FCH+C events reinforcing our commitment to
add social value to our organisation, including attendance at the
Community Forum and AGM.
…given presentations about the role of CoG at the AGM and at six staff
engagement sessions throughout 2013-14, to encourage an increase in the
number of shareholders.
PRIORITIES 2014-2015
We will….
…continue to be a staff voice at Board level.
…recruit to any vacant CoG seats, to ensure that all staff group views are
represented.
…consider opportunities to add social value to our community for the year
and to fully implement the process for the application and allocation of the
Community Development Fund.
…continue to attend and promote FCH+C events including our
Community Forum to enable us to network with our community and other
stakeholders.
…plan and attend staff engagement sessions and the AGM to enable us
to engage with staff about the company’s social mission and Community
Interest Strategy and increase the number of staff shareholders and our
collective staff voice.
Page 43 | Quality Account 2013-14
Staff Survey (‘iWantGreatCare’)
The Friends and Family Test is mandated for NHS staff from April 2014. First Community Health & Care started the staff survey questions in January 2014.
We have had two pilot months of reporting since this time. We send out our survey for two weeks of each month electronically.
In January 2014, our first month of surveying, 13% of staff completed and returned the survey. (The national benchmark is predicted to be set at 15%
although this figure is still to be set in guidance and has not yet been released). Feedback was widely positive and we have produced a monthly feedback
blog: “You Said, We’re Listening, We’re Doing” to summarise the comments. Feedback from staff indicated that monthly surveys were too often. We are
going to continue with the FFT for staff on a quarterly basis from April 2014 as suggested by the NHS England guidance.
Developing our leaders
Self-Managed Business Team (SMBT) Programme
We have continued to develop our leaders by implementing the SMBT programme to support Business Partners in their evolving role leading their
Self-Managed Business Teams. Self-Managed Business Teams are semi-autonomous teams whose members determine, plan and manage services,
empowering clinical teams to adopt delegated responsibility for financial management, performance, quality assurance and operational management. As
a part of this programme the following progress has been made this year:
• A Decision Making Rights Framework has been agreed clarifying responsibility at business partner, executive and Board levels
• Business Plans have been developed for each business unit outlining existing services and key areas for development over the next 18 months
• An innovation form has been cascaded allowing ideas from the ground to be implemented where practical and commercially viable
• A Leadership Development Training programme has been delivered to support Business Partner development
• A Competency Framework has been implemented allowing Business Partners to identify their areas for individual development and support
• A draft SMBT Dashboard has been worked up allowing business partners and their teams to have real time information about their services and
performance
This programme has been supported by a dedicated Programme Manager with members of the Executive Team leading individual work-streams. A
monthly meeting with both Business Partners and the Extended Management Team has been prioritised to ensure the progress of this work.
Page 44 | Quality Account 2013-14
Queen’s Nurse Award
The title of Queen’s Nurse (QN)* is open to community nurses, with more than three years’ experience, who want
to demonstrate their commitment to patient-centred values and continually improving practice. Achieving the
Queen’s Nurse title enables practitioners to join a growing network of like-minded nurses, marking the
beginning of a process of learning and leadership. Managers and patients provide feedback about applicants,
which is assessed along with their application. Two members of staff received this award in April 2013 and a third
member of staff is currently going through the application process.
Supporting our staff
Institute of Health Visiting
In March 2014 the 0-19 Service invested in corporate membership of the Institute of Health Visiting (iHV) for all
health visitors, including students, employed by FCH&C.
The Institute of Health Visiting was launched on the 28th November 2012 to promote excellence in health visiting
practice to benefit all children, families and communities. The iHV “supports the development of universally high
quality health visiting practice so that health visitors can effectively respond to the health needs of all children,
families and communities enabling them to achieve their optimum level of health, thereby reducing health
inequalities.” (http://ihv.org.uk/)
Glenda Vella & Carol Hedger, QNI
Appraisal
We recognise the importance of developing our staff through regular
appraisal. We have been reliant on manually counting the number of staff
who have had an appraisal and have recognised the need to improve
our systems. This year we have worked on new appraisal documentation,
started to roll out a training programme for appraisals for both the
appraiser and appraisee, which will take full effect during 2014, and
implemented an electronic process to record appraisal dates. This includes
monitoring personal development plans to enable training needs analysis.
We will also introduce a more planned approach to appraisals with all
appraisals being undertaken where possible in the first quarter of the
financial year.
*http://www.qni.org.uk/for_patients/queens_nurses_2
Page 45 | Quality Account 2013-14
STATEMENT FROM HEALTHWATCH SURREY
“As the independent champion for the views of patients and social care users in Surrey Healthwatch Surrey is
pleased to comment on the 2013/2014 Quality Account of First Community Health and Care.
First Community Health and Care is thanked for working openly with Healthwatch Surrey to improve the
quality of services for people who have had a stroke following Healthwatch’s Stroke Pathway Report.
Healthwatch commends the extension of the MIU opening hours at Caterham Dene and Audiology reduced
waiting times, people tell us that such access to services is important to them and a good experience.
Healthwatch recognises that measuring success can be challenging but would like to stress how important it
will be to show this in the 2014/2015 Quality Accounts.
Healthwatch supports the continued prioritisation of staff clinical supervision to improve clinical
effectiveness.
Just one question, how could more people benefit from the balance class?”
Jane Shipp
Healthwatch Surrey
13th June 2014
Page 46 | Quality Account 2013-14
We would like to thank Healthwatch Surrey for their
statement. We will be reviewing the promotion of the
balance class over the coming year.
STATEMENT FROM EAST SURREY CLINICAL COMMISSIONING GROUP
The initial response from East Surrey Clinical Commissioning Group was received on 24th June 2014 and, as a result, we have made the amendments
detailed below:
Our Managing Director added to his statement on page 8
“For example, we have worked with Parkinson’s Disease UK (a charity) and patient and carer representatives during the recruitment process for a specialist post to
support people in the community with Parkinson’s Disease, aligning this post with the Community Neurological Rehabilitation Team.”
Our Managing Director added to his statement on page 8
“During 2013 we have seen the publication of The Francis Report, detailing serious failings in quality of care and patient safety. The report details 290 recommendations, for all NHS trusts, commissioners and external regulators to ensure similar failings in care and safety are not repeated. Our Chief Nurse has worked
closely with all of our staff to consider and act upon these recommendations to improve safety. We developed a “plan on a page” to ensure quality and safety are
central to what we do. This plan is centred around improving patient and service user experience and feedback, creating a caring and open culture, providing
individualised care and strengthening our clinical leadership.”
Our Managing Director added to his statement on page 9
“We reinvest our profits through the Council of Governors’ Community Development Fund which supports our core purpose as a social enterprise to add social
value back into the heart of our community (see glossary).”
We have added two sentences on page 10
“We wanted to create a catheter register to help us to ensure that patients are on the correct care pathway and that they are receiving the right care.”
“This proactive management will empower patients and help to reduce the risk of catheter associated problems.”
We have added a sentence to page11
“All of our registered clinical staff are supported to access clinical supervision in their preferred format, time and place. For example, at the end of March 2014, 131
of our 247 registered clinical staff were accessing group-facilitated clinical supervision. The remainder were accessing other options from our clinical supervision
menu.”
We have added a timeline to page 15
We have added a sentence to page 17
“Ultimately we will work towards enabling carer or service user led audits.”
Page 47 | Quality Account 2013-14
STATEMENT FROM EAST SURREY CLINICAL COMMISSIONING GROUP
We would like to thank East Surrey CCG for their
statement. We look forward to working collaboratively
over the coming year.
Page 48 | Quality Account 2013-14
GLOSSARY
18 weeks
There are currently 18-week ‘referral to treatment time’ (FTT) targets in England (introduced in 2009). FTT refers to the waiting time between a GP referral and treatment,
which, in the case of audiology, is usually hearing aids. These figures relate to people who have been referred by their GP direct to audiology (direct access patients).
They do not include people who go to ENT (ear, nose and throat department) first, or people who already have hearing aids who are waiting for further treatment or
support, such as digital upgrades or the second issue of a hearing aid. Within the overall 18 week target there is a six week diagnostic (primary pathway) target which
refers to the time from referral to initial assessment (hearing test). The term ‘people with hearing loss’ refers to people who are deaf, deafened and hard of hearing.
Baby Friendly Initiative (BFI)
The Baby Friendly Initiative is a worldwide programme developed by UNICEF and WHO to ensure that health care organisations are able to offer the highest standards of
care for pregnant women and breastfeeding mothers and babies. The Initiative ensures that all health professionals are trained to offer the best possible advice and
support to breastfeeding mothers so that their babies can have the very best start in life.
Care Quality Commission (CQC)
The CQC is the regulator for all health and social care services in England, ensuring that the Government standards or rules about care are met. From April 2009, every
NHS healthcare provider must be registered with the CQC.
Clinical audit
Clinical audit measures the quality of care and services against agreed standards and suggests or makes improvements where necessary.
Clinical Coding Error Rate
Clinical coding translates the medical terminology written by clinicians to describe a patient’s diagnosis and treatment into standard, recognised codes. The accuracy of
this coding is a fundamental indicator of the accuracy of patient records.
Commissioning for Quality and Innovation (CQUIN) payment framework
The CQUIN payment framework enables commissioners to reward excellence, by linking a proportion of NHS providers’ income to the achievement of local quality
improvement goals.
Community Interest Company
A Community Interest Company (CIC) is a special type of limited company which exists to benefit the community rather than private shareholders.
Deprivation of Liberty Safeguards
The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes and hospitals are looked after in
a way that does not inappropriately restrict their freedom. The safeguards should ensure that a care home or hospital only deprives someone of their liberty in a safe and
correct way, and that this is only done when it is in the best interests of the person and there is no other way to look after them.
Page 49 | Quality Account 2013-14
Harm Free Care
For more information go to http://harmfreecare.org/wp-content/uploads/DH%20ST%20Guidance%2025%205%2012.pdf
High Quality Care for All
High Quality Care for All (June 2008) set the vision for Quality to be at the heart of everything the NHS does, and defined quality as centred around three domains:
patient safety, clinical effectiveness and patient experience.
Information Governance Toolkit attainment level
The Information Quality and Records Management attainment levels assessed within the Information Governance Toolkit provide an overall measure of the quality of
data systems, standards and processes within an organisation.
National Institute for Health and Care Excellence (NICE)
NICE is an independent organisation responsible for providing national guidance on promoting good health and preventing and treating ill health. Visit:
www.nice.org.uk
National Patient Safety Agency (NPSA)
The NPSA leads and contributes to improved, safe patient care by informing, supporting and influencing the health sector. It aims to reduce risks to patients receiving
NHS care and improve safety. Visit: www.npsa.nhs.uk
Net Promoter Score (NPS)
Net Promoter Score (NPS) measures the loyalty that exists between a provider and a consumer. The provider can be a company, employer or any other entity. The
provider is the entity that is asking the questions on the NPS survey. The consumer is the customer, employee, or respondent to an NPS survey.
NHS Number and General Medical Practice Code Validity
The patient NHS number is the key identifier for patient records. Improving the quality of NHS number data has a direct impact on clinical safety.
Omitted Medicine
An omitted medicine is the failure to prescribe a drug in a timely manner; it is also the failure to administer a dose when the next dose is due or, in the case of once only
doses (stat doses), failure to administer a drug within two hours of the time the dose is due. A delayed medicine is when the administration of the drug is two hours or
more after the time the dose is due (definitions as set out in the FCH&C Omitted and Delayed Medicines Guidelines, 2014).
Participation in Confidential Enquiries
Confidential Enquiries are special enquiries that seek to improve health and health care by collecting evidence on aspects of care, identifying any shortfalls in this, and
disseminating recommendations based on these findings. They include the Confidential Enquiry into Maternal Deaths and Child Health (CEMACH), Confidential
Enquiries into Stillbirths and Deaths in Infancy (CESDI), the National Confidential Enquiry into Patient Outcome and Death, and the National Confidential Inquiry into
Suicide and Homicide by People with Mental Illness.
Root Cause Analysis
Root cause analysis (RCA) is a method of problem solving that tries to identify the root causes of faults or problems. A root cause is a cause that once removed from the
problem fault sequence, prvents the final undesirable event from recurring.
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Social Enterprise
The Government defines social enterprises as “businesses with primarily social objectives whose surpluses are principally reinvested for that purpose in the business
or in the community, rather than being driven by the need to maximise profit for shareholders and owners.” As with all businesses, they compete to deliver goods and
services. The difference is that social and environmental purposes are at the very heart of what they do, and the profits they make are reinvested towards achieving those
purposes.
The DVT Wells Score
The DVT Wells Score uses 10 criteria to calculate the probability or risk of a deep vein thrombosis (DVT).
The FRAX tool
The FRAX tool has been developed by the World Health Organisation (WHO) to evaluate fracture risk of patients. It is based on individual patient models that integrate
the risks associated with clinical risk factors as well as bone mineral density (BMD) at the femur neck.
The Health Visitor Improvement Plan
The Health Visitor Improvement Plan 2011-2015 outlines four different levels (tiers) of service based on assessment of the needs of the child and family:
1. Community Service: A range of services offered to all families in a community that reflect the needs of the community.
2. Universal Services: provided for all families with children aged 0-5, for example, immunisations, health and development reviews, drop-in health clinics and a range of
community services and resources.
3. Universal Plus Services: offered to families with children aged 0-5 with specific issues, for example, postnatal depression, sleep issues, weaning or any other concerns
about parenting.
4. Universal Partnership Plus Services: Health visitor teams, working together with a range of local services, provide on-going support to families with children aged 0-5
with complex needs.
The Mid Staffordhsire NHS Foundation Trust Public Inquiry Final Report 2013
On 9 June 2010 the Secretary of State for Health, Andrew Lansley MP, announced a full public inquiry into the role of the commissioning, supervisory and regulatory
bodies in the monitoring of Mid Staffordshire Foundation NHS Trust.
The Inquiry was established under the Inquiries Act 2005 and is chaired by Robert Francis QC, who made recommendations to the Secretary of State based on the
lessons learnt from Mid Staffordshire. It builds on the work of his earlier independent inquiry into the care provided by Mid Staffordshire NHS Foundation Trust between
January 2005 and March 2009. Click on link for further information http://www.midstaffspublicinquiry.com.
UNICEF
United Nations Children’s Fund (formerly United Nations International Children’s Emergency Fund). UNICEF UK is a registered charity raising funds and awareness to
support UNICEF’s work to protect child rights worldwide, in accordance with the UN Convention on the Rights of the Child (CRC). UNICEF UK also runs programmes in
schools, hospitals and with local authorities in the UK.
WHO
The World Health Organisation is the directing and coordinating authority for health within the United Nations system. It is responsible for providing
leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical
support to countries and monitoring and assessing health trends.
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Our Vision is...
“ To be recognised, respected
and trusted by patients, carers,
professionals and staff as the best
provider and innovator
of integrated community services.”
Further Information/Feedback
If you would like to find out more about our services, please visit our website at:
http://firstcommunitysurrey.com
If you would like this information in another format or language, or would like to provide feedback about this
account or any of our services, please contact:
Communications Team
First Community Health & Care
2nd Floor, Forum House
41-51 Brighton Road
Redhill
Surrey
RH1 6YS
© First Community Health & Care 2014
Page 52 | Quality Account 2013-14
t: @1stchatter
w: www.firstcommunitysurrey.com
t: 01737 775450
e: fchcenquiries@firstcommunitysurrey.com