Quality Account
2013 — 2014
Chief Executive Summary and Quality Statement
Contents
3
Chief Executive Summary
33
What our regulators
say about us
Chief Executive
Summary
5
How we did in 2013/14
35
Our priorities for 2014/15
The Quality Account is an annual report
for the public which shows how NHS
organisations are providing quality
services for their patients. This is the
fifth year Liverpool Community Health
(LCH) NHS Trust has published their
account.
In addition to a Quality Account the
organisation also produces an Annual Report.
The report covers all aspects of what we do,
progress that we have made with delivering
our services, and details of our annual financial
accounts.
The report can be found at
www.liverpoolcommunityhealth.nhs.
uk/who-we-are/publications.htm
A Year of Change and Challenges
12
Review of Quality
in 2013/14
40
This has been an extremely challenging
year for the Trust and for our staff. The Care
Quality Commission inspection reports and
subsequent warning notices were extremely
disappointing and difficult for the organisation.
What our Commissioners
and Healthwatch say
about us
However, this has led to a period of reflection
and positive change which will see a
transformation of our services that will be led
by our staff and our partners.
24
Assurances on Quality of
LCH Services Provided in
2013/14
03 | Quality Account 2013–14
Chief Executive Summary and Quality Statement
My role will be to help support the Trust, and
our dedicated staff, to get back on track in
delivering the best care and services to the
communities we serve. I have been warmly
welcomed in the few weeks I have been in LCH
and I respect the honesty and commitment the
staff have all demonstrated during a period of
change.
We exist to provide the best possible care
to the local communities and we are now
working to change the way we will deliver
those services to ensure they are seamlessly
entwined with local GP and primary care and
supporting our local hospitals.
The Trust places great importance on the
experiences of our patients and service
users when they receive care, and we will
continue to demonstrate our commitment
to this by strengthening our processes to
involve our patients and service users. We
remain committed to improving our patient
experiences and recognise that we need to
support staff to make further improvements
to ensure patients remain at the heart of
everything we do.
We are continuing to build strong links with
our partners across health and social care.
In particular we are working to meet the
requirements our new commissioners seek of
us to ensure we deliver services that place the
patient at the centre and are driven by health
outcomes. To achieve this we will continue to
build meaningful and productive relationships
with our commissioners and partners.
How we did in 2013/2014
I am really proud of the integrity, commitment
and dedication of our talented staff. Every
member of staff in this organisation makes a
valuable contribution to the quality of care that
is delivered every day.
Their commitment to continuous improvement
and ensuring that quality patient centred
care is at the heart of everything we do is
exemplary.
I would like to thank our staff for their
continued commitment, positive approach
and professionalism especially in the face of
change. The next 12 months now promise to
be an exciting and challenging time for us, as
we continue to develop and improve.
Sue Page, CBE
Interim Chief Executive
Liverpool Community Health NHS Trust
Quality Account 2013–14 | 04
How we did in
2013/14
All NHS organisations continually
identify areas where improvements in
quality can be made. Improvements
may be identified from local, regional
and national influence – for example a
local improvement may be a change
as a result of patient feedback and
nationally there may be a change in
result of a major report such as the
Mid Staffordshire Hospital review. Some
improvements can be implemented
quickly, others need a real focus and
project support together with front
line staff leading the improvement. At
the end of each year, the list of large
scale improvements are reviewed
and prioritised – these then form our
priorities for the next year..
05 | Quality Account 2013–14
The following were identified as our priorities
for 2013/14, page 35 identifies the priorities for
2014/15.
Dementia
We recognise our role with dementia care and
played an active part in the 2013 ‘Year of Action
on Dementia’. Strong alliances have been
formed with all organisations across the city.
We work closely with Clinical Commissioning
Groups (CCG) in Liverpool, Sefton, West
Lancashire and surrounding areas to further
develop our role in delivering patient-centred
care that:
●identifies people with dementia through
screening
●improving outcomes for people with
dementia
●provide support for carers and family
members
●is provided by staff who are trained to
support patients with dementia
Our work on dementia is aligned to the
national strategy and in addition to this, next
year we will review and align our strategy
to those of our local commissioners, Sefton,
Liverpool CCGs and local authority.
We work with colleagues in Liverpool John
Moores University and Merseycare as part of
the ‘Mi’ (More independence) project. This is a
Government-funded technology initiative that
is being piloted across four UK regions and
Liverpool has been chosen as one of the pilot
areas. We aim to ensure that new technology
and other innovations are used effectively to
support those affected and their carers, and
that such developments become a routine part
of the services we provide.
We are committed to supporting the most
elderly and frail members of our community,
and are using technology such as telecare and
telehealth solutions. More information about
telehealth can be viewed on page 23.
You can read more about the work LCH is
doing as part of the Liverpool Dementia Action
Alliance here:
www.dementiaaction.org.uk/
members_and_action_plans/
1380-liverpool_community_health_
nhs_trust
Safer Care: Harm Free Care
LCH continues its commitment to providing
safe care for our patients and as part of this we
continue with our programme around “Harm
Free Care”.
Using a number of national and local tools and
techniques (e.g. Safety Thermometer, Patient
Stories to the Board, Incident Reporting) we
are able to identify emerging themes, and
this supports us in the early implementation
of improvements to help minimise or even
prevent harm to patients.
We will continue to work in partnership with
patients and carers to provide information to
enable individuals to make informed choices
about their care options. We also continue to
support people to remain independent through
the promotion of self-care where appropriate.
Quality Account 2013–14 | 06
Francis Report
Compassion in Practice
The Francis II Report (Mid Staffs) in 201213 triggered an important change in the
NHS with regard to its approach to patient
safety, and care and compassion in the NHS.
LCH reviewed its services, practices and
performance against the recommendations
from the Francis Report, and developed
programmes of improvement to enhance
the safety and overall quality of the care we
provide. There has also been greater focus on
securing meaningful feedback from patients
and carers to help us measure and effectively
respond to patient experience.
Compassion in Practice is the three year vision
and strategy for nursing, midwifery and care
staff established by the Chief Nurse for the
NHS. The strategy is built upon a number
of values – the 6 Cs – care, compassion,
competence, communication, courage and
commitment. The values of this strategy have
been incorporated into ‘We are LCH’ staff road
shows, our Integrated Clinical and Quality
Strategy, recruitment practices, and staff
training and leadership programmes.
Subsequent reports (such as Berwick, Keogh
and Cavendish) highlighted similar challenges,
and the need for stronger clinical leadership.
Based on the key issues identified in all of
these reports, LCH developed an overarching
improvement programme, supported by
detailed action planning. The aim of this
programme is to enhance the overall quality
of the care we provide, strengthen clinical
leadership, and promote staff engagement and
wellbeing.
Whilst we had already implemented many of
the recommendations, such as patient stories
to the Board and a focus on ‘Harm Free Care’
(such as pressure ulcers and falls), we also
identified the opportunity for further important
changes, including:
●An improved system for feeding back key
learning to staff
●Wider engagement and development of
staff to help and support them to make
changes to their services through the
Listening into Action Programme (LiA)
●Access to training programmes such as
Management and Leadership Essentials
and Fit for the Future – these can be found
in “Our priorities for 2014/2015” section
07 | Quality Account 2013–14
Service Improvement
LCH is committed to on-going service
development and to ensure the services that
are delivered are based on quality. In the
current economic climate, all health care
providers are challenged to deliver high
quality care at the same time as achieving
cost improvement savings through improving
productivity, efficiency and effectiveness.
A range of service improvement projects have
been delivered across the organisation using
service improvement techniques based on
‘Lean’ methodologies. Lean is a way to provide
value to patients in a resourceful way, without
wasting any money.
Projects during 2013/14 ranged from large
scale Improvement Workshops to mapping
services to ensure that they are working in the
most effective way.
Within Bed-based Intermediate Care, work has
been carried out to standardise and improve:
●Documentation
●Communication
●Discharge processes
●Safety around falls and pressure ulcers
How we did in 2013/2014
Commissioning for Quality and
Innovation (CQUIN)
CQUINs are based on national best practice or
local priorities which support and encourage
improvement and innovation. A proportion
of LCH income in 2013-14 was allocated to
the achievement of quality improvement and
innovation goals that were agreed between
LCH and Clinical Commissioning Groups for
the provision of NHS services.
Further details of the agreed goals for 201314 and for the following 12 month period are
available electronically at
www.institute.nhs.uk/world_class_
commissioning/pct_portal/cquin.html
Using Technology to give staff more
time to care
Many of our staff provide care in patient’s
homes and the local community. The use of
technology enables them to have more direct
contact time with patients to provide care and
treatment. In 2013, all front line clinical staff
were provided with a tablet device, such as an
iPad, so they can access internet resources and
specialist information (e.g. National Institute
for Health and Clinical Effectiveness (NICE),
British National Formulary). In addition to this,
staff ability to access and input directly onto
clinical records was piloted and roll out will
continue throughout 2014/15.
The following CQUIN goals applied to both our
Liverpool and Sefton Services.
Family and Friends Test
The Friends and Family Test (FFT) is a national
CQUIN indicator which applies to all NHS
hospitals and community providers. The
CQUIN has 3 elements to it:
1. Response rates: achievement against
national Q4 requirement of 20%.
2.Net promoter score: Score against
positive and negative responses to the
question “How likely is it that you would
recommend our service to family or
friends?”
3.Patient Feedback: review of any feedback
to support improvements in care
Further information about FFT can be viewed
on page 20.
Quality Account 2013–14 | 08
Safety Thermometer:
All NHS hospitals and community providers
have this as a CQUIN. The NHS Safety
Thermometer (ST) is an improvement tool for
measuring, monitoring and analysing patient
harms (Pressure Ulcers, Falls, Urinary Tract
Infections for those patients with an indwelling
catheter, Venous Thromboembolism – type
of Deep Vein Thrombosis). LCH collect and
analyses data on a monthly basis to support
improvements in care to reduce the four harms
identified above.
Dementia:
Again the Dementia CQUIN applies to all NHS
hospitals and community providers and has a
number of elements to the goal:
1.Completion of a national assessment tool
used to support identification of dementia
2.Referral onwards if dementia is suspected
3.Survey of carers
Patient Safety – Francis report:
This CQUIN relates to implementation of
the action plan which our organisation has
developed in response to the review of the
Mid Staffordshire hospital. Our organisation,
along with all NHS organisations has a duty to
review the recommendations and implement
improvements where necessary.
Integrated Care and Virtual Ward:
Integrated Care/Virtual Ward provides coordinated Health and Social Care for patients
who are at high risk of emergency admission
to hospital – such as those with long term
conditions and frail or vulnerable older people.
To support these patients Multidisciplinary
Team Meetings are held between GPs and
community service teams to discuss how the
healthcare professionals can support patients
in the best way.
09 | Quality Account 2013–14
EMIS: Electronic system to support
patient records:
The EMIS (Egton Medical Information System)
is an electronic patient record system which is
widely used by GPs and Community Care in
the UK. The use of EMIS by LCH helps speed
up important exchange of information to
improve patient care. In order to achieve the
CQUIN goal LCH must ensure that the roll out
plan for the system is being followed.
Breastfeeding:
There were two elements to this CQUIN.
1. Support improvement in breast feeding
rates at 6-8 weeks post birth
2. Survey of mothers to find out how they
are feeding their babies and whether they
have the right support from healthcare
professionals
The following CQUIN goals applied to Sefton
Services only.
VTE - Venous thromboembolism:
A VTE is a collective term for both ‘deep vein
thrombosis’ (DVT) and ‘pulmonary embolism’
(PE). The CQUIN goal is to make sure that at
least 95% of patients who are admitted to our
bed based Intermediate Care unit (Ward 35
at Aintree Hospital) have been assessed to
identify whether they are at risk of a VTE. If a
patient is identified as at risk then appropriate
actions are put into place to help prevent the
VTE from occurring.
How we did in 2013/2014
CQUIN Achievement:
Public Health
One of our bed based Intermediate Care units
is located in Ward 35 at Aintree Hospital. The
ward admits:
Our commissioners are currently reviewing
the information we have sent them to confirm
CQUIN achievement, however from LCH’s
perspective we have met all of the CQUIN
indicators aside from the following:
●GP referrals for patients who are too
unwell to stay at home but not quite ill
enough to go into an acute hospital (step
up)
●Patients from Aintree hospital who are not
quite ready to go home (step down)
Dementia – referral onwards: LCH identified
occasions when we would not automatically
refer a patient to a specialist. We are working
with commissioners to agree a list of these
occasions.
Public Health is about helping people to
stay healthy and focuses on wellbeing and
prevention rather than treatment of disease.
It is also about understanding the health
needs of local populations, addressing these
and any health inequalities. Research has
shown that good health is fundamental to
leading a healthy and productive lifestyle.
Examples of how we provide this include
providing health and well-being services in
local communities, such as ‘Walk for Health’, to
more individualised targeted information and
signposting such as smoking cessation. We
also work closely with other partners to tackle
wider public health issues.
Ward 35 – Step up/Step down and
Length of stay:
The CQUIN focuses on the ratio of patients
who are stepped up against those that are
stepped down and also how long the patient
stays on the ward (length of stay).
Ward 35 – Step up/Step down and Length of
stay: We recognised from an early point that
we would not meet this indicator due to an
increase in the complexity of patients who
were being admitted.
Quality Account 2013–14 | 10
A major achievement for LCH during 2013 was
the extension of our Royal Society of Public
Health (RSPH) – Health & Wellbeing status
until 2016. This award commends “LCH’s
commitment to public health at a corporate
level and the clear commitment to develop its
workforce”.
11 | Quality Account 2013–14
This year has seen the Public Health Strategy
Team working with colleagues to:
●Reduce patient Did Not Attend (DNA) rates
●Provide LCH staff with the necessary
skills and information to deliver health
prevention messages; this is called the
“Every Contact Counts” programme
●Achieve a 71% Flu jab uptake for our staff
●Target specific services such as our
treatment rooms and children’s services
to deliver and record health chats. In the
first six months of 13/14, our Children’s
Division reported 45,869 separate pieces of
health advice being provided
70%
OF
STAFF
VACCINATED
AGAINST FLU
Review of Quality in 2013/2014
Quality Domain
Safety
MRSA screening for all relevant admissions
Number of reported MRSA
Assessment of patients on admission for C Diff risk
Number of reported C Diff
Review of Quality in
2013/14
Key national and local quality measures
and quality activity within LCH
The table shows our achievements against the
target sets both nationally and internally:
2012/132013/14Target
Intermediate Care
Intermediate Care
99.3%98.1%100%
110
Intermediate Care
99.3%98.4%100%
Intermediate Care
0
1
100% Isolation 100%
Isolation of patients with known or suspected C Diff
within 4 hours
Infection Prevention & Control: Compliance with HCAI
Framework
Never Events
Intermediate Care
Serious Untoward Incidents
(SUI)
Pressure Ulcers Community Acquired Grade 3
Pressure Ulcers Community Acquired Grade 4
Falls
Organisation wide
Effectiveness
Completeness of Breastfeeding Status at 6-8 weeks
Child Measurement Programme
Quality Account 2013–14 | 12
Service
Organisation wide
Organisation wide
Adults
Adults
Intermediate Care
100%
CompliantComplaintCompliance
against the
framework
01
3237
301620
452
303148213
Children’s
95.7%
Organisation wide
Reception
Reception 90%
= 98%
- 98.1%
Year 6 = 90.6% Year 6 = 93.3% 923774769
Chlamydia Positivity Rates
Primary Care and Public Health
NICE Guidance & Appraisals
Cellulitis Pathway – Bed Days Saved
Adults
13 | Quality Account 2013–14
0 95.5% 95%
1195762 Review of Quality in 2013/2014
Quality Domain
Vaccinations
Tetanus, Polio, Pertussis, Haemophilus influenza type b
at 1 year (DTaP/IPV/Hib)
Measles, Mumps & Rubella at 2 years (MMR1)
Haemophilus influenza type b, Meningitis C at 2 years
(Hib/Men C)
Pneumococcal booster at 2 years (PCV)
Measles, Mumps and Rubella at 5 years (MMR2)
Pre School Booster (PSB)
Human Papillomavirus (HPV) at 12-13 years (girls) – three doses
Service
2012/132013/14Target
Children’s
95.9%94.8%95%
Children’s
95.5%94.0%95%
Children’s
95.3%93.8%95%
Children’s
95.8%94.2%95%
Children’s
91.8%91.1%95%
Children’s
92.5%91% 90%
Children’s
90%
Results will
be available
in September
2014
Patient Experience
Same Sex Accommodation Intermediate Care
Breaches
PLACE (Patient Led Assessment Intermediate Care
of the Care Environment)
95%
Methicillin-resistant Staphylococcus
Aureus (MRSA) & Clostridium Difficile
(C.Diff) and Health Care Acquired
Infection Framework (HCAI)
Our aim is to prevent harm by assuring that
we are doing all we can to provide clean and
infection free environments for our patients
and the public.
LCH follows national standards for infection
control, such as the Health and Social Care Act
2008 (Hygiene Code), and have a dedicated
Infection Prevention and Control Team who
support the organisation to meet these
standards.
More information about the above can be
viewed in the Assurances of Quality section on
page 24.
000
National
Average
• Cleanliness
Results will
be available
in September
2014
99%
• Condition, Appearance, Maintenance
92%
89%
• Privacy, Dignity, Wellbeing
81%
89%
• Food and Hydration
91%
85%
96%
Complaints
Organisation wide
183140-
Walk-in-Centres Waiting Times (treated within 4 hours)
AHP Incomplete Pathways
Adults & Children’s
99.98%100% 95%
Adults
9918 weeks
Equality Delivery System (EDS)
Organisation wide
AchievedAchievedAchievement
of goals
The following outlines more detail about some of the quality measures and activities included in
the table above.
Quality Account 2013–14 | 14
Never Events
A Never Event is a serious, largely preventable
patient safety incident (e.g. wrong site
surgery), that should not occur if the right
processes are in place. Should a Never Event
occur, a process called Root Cause Analysis is
undertaken to identify the cause of the event
and develop an action plan to address the
gap(s) identified in the system.
The Trust has declared 1 never event during
2013/14, which was an extraction of a wrong
tooth. The lessons learnt from this are:
Serious Untoward Incidents (SUI)
A SUI, in broad terms is something out of the
ordinary or unexpected with the potential to
cause harm to patients or the public. A SUI
involves one or more of the following:
●Avoidable serious injury or death
●Never event not resulting in severe harm
or death
●Serious damage to NHS property, e.g. fire,
criminal activity
●Major health risk, e.g. outbreak of
infection
●Large scale theft or fraud or where major
litigation is expected
The organisation has had 37 SUIs in the last
year, the majority related to Pressure Ulcers.
All SUI’s are fully investigated, themes
reviewed and actions put into place to prevent
incidents from reoccurring. Some of the
actions and lessons learnt are listed below:
Pressure Ulcer Care
●An aggregated review of avoidable
pressure ulcers has been undertaken to
identify root causes and themes
●An action plan will be developed for 14/15
to help further reduce future incidences of
pressure ulcers
●We continue to work in close collaboration
with our commissioners and other local
providers of care
Medical Device Error
●To be more vigilant with dental treatment
plans and any discrepancies to be
highlighted and reviewed immediately
prior to the start of the treatment by the
Dentist
●This information has been disseminated
across the Dental Directorate via a Clinical
Improvement Notice (CIN) summarising
the case to all dentists
15 | Quality Account 2013–14
●All phlebotomists are now aware of their
responsibilities in checking expiry dates
prior to taking samples
●System and process now in place with
a daily expiry check list now attached to
phlebotomy trolleys
●Trolley checks undertaken and
documented
Review of Quality in 2013/2014
Information Governance Breach
●Changes to LCH postal processes
●Communication to all staff to remind them
of their own Information Governance
responsibilities
Medication Error - Vaccines
●LCH Cold Chain Policy has been reviewed
and includes; the logging of all vaccinations
stored in individual fridges; Incident
reporting process
●Review of contract with fridge service and
repair provider
●Organisational “Lessons Learnt” event
took place with internal and external
stakeholders
Falls
In 2013/2014 a falls prevention project was
introduced within bed-based Intermediate
Care. This was based upon the FallSafe Project
conducted by the Royal College of Physicians.
The project supported reducing the risk of a
patient falling by managing risks that have
been highlighted during assessment. New Care
Plans and documentation were introduced with
training delivered to staff on the reporting of
incidences and risk assessments/management.
Breast Feeding
Research demonstrates that coronary heart
disease, cancers and childhood obesity, could
be reduced by increasing breastfeeding rates.
LCH is working with other partners to improve
the numbers of mothers’ breastfeeding
following the birth of their child, and
continuation of breastfeeding as their child
gets older.
An important factor in achieving this is to
achieve the adoption of the UNICEF Baby
Friendly Initiative Standards (BFI). The Sefton
service was awarded full BFI accreditation
in March 2014, and is currently working to
adopt newly introduced BFI standards. The
Liverpool service is currently working towards
full accreditation. The date for external UNICEF
assessment of the services provided by LCH
and its partner organisations in Liverpool
will be determined by an audit of mothers’
experiences of breastfeeding support in
February 2015.
There is also a CQUIN relating to
breastfeeding. Please see 9 for further
information.
National Child Measurement
Programme
The National Child Measurement Programme
(NCMP) involves the collection of the height
and weight of Reception and Year Six children.
This allows the identification of children who
may have a potential risk to their health related
to their weight, and in turn supports the offer
of targeted support for those families. Upon
launch of this national programme concerns
were received from parents about the wording
of the nationally produced letters. In response
to this LCH adapted the letters.
This programme links into our public health
work of preventing longer term ill health in
children.
National Institute for Health and Clinical
Excellence (NICE) Guidance and
Appraisals
The National Institute for Clinical Excellence
(NICE) supports healthcare professionals to
ensure that the care they provide is of the
best possible quality and offers the best value
for money. NICE provide independent and
evidence-based guidance on the most effective
ways to prevent, diagnose and treat disease
and ill health, reducing inequalities and
variation.
A working group and reporting routes to
the Board have been established where
all available guidance is reviewed for its
applicability to our services. We will also be
using NICE guidance as the main focus for
our clinical audit programme for 2014-15, and
continue to develop collaborative partnership
working with other trusts to ensure that whole
pathways are covered.
responds flexibly and proactively to disease
prevention and outbreak management. We
deliver extensive programmes of vaccinations
and immunisations and work in close
collaboration with our partners to achieve this.
Cellulitis Pathway
One of the pieces of NICE guidance applicable
to LCH relates to Cellulitis (infection of the
skin). As part of our innovative work we have
collaborated with specialists from a number of
areas in order to join up and standardise the
Cellulitis Pathway. For patients, this supports a
seamless journey of care, to and from hospital
and home.
Where a patient requires intravenous
antibiotics (through a drip) for cellulitis, this
is delivered in the community setting by our
Intravenous Therapy Team (IVT). During 201314 the team received 254 referrals for Cellulitis,
providing treatment that might otherwise have
had to be delivered in hospital.
254
REFERRALS FOR
CELLULITIS
Vaccinations and Immunisations
For some diseases such as measles, mumps,
rubella and flu, prevention is through
vaccination and immunisation programmes.
The aim of vaccination and immunisation is
to protect individuals from illness, and ensure
there are enough members of the public
protected to prevent disease outbreaks. LCH
Flu Campaign
The staff seasonal flu campaign is backed by
the Department of Health, NHS Employers and
the social partnership forum, ‘Flu Fighters‘, to
protect patients from the flu virus.
The NHS already faces challenges around
maintaining its workforce during times of
increased sickness, so it is also vital to reduce
the potential impact of flu on staffing levels to
protect the delivery of patient care.
This year’s seasonal staff flu campaign has
been extremely successful with 70% of
frontline staff being vaccinated. LCH were
nominated, shortlisted, and finalists for the Flu
Fighter award for the ‘best flu team’ nationally.
Merseyside Trusts were
amongst the highest
performing NHS
organisations in the country
for immunising frontline
healthcare workers and
patients with the seasonal
flu vaccination.
G
etting the free annual staff
flu jab made Zoran feel like
a superhero!
Zoran Blackie, Business Planning Manager.
3831.LCH_FluA4_v1.indd 1
Quality Account 2013–14 | 16
17 | Quality Account 2013–14
18/09/2013 12:03
Review of Quality in 2013/2014
LCH continues to develop and work towards
achievement of goal 3. Work to date has been:
Equality and Diversity
The Equality Delivery System (EDS)
Equality and Diversity for Liverpool
Community Health is about promoting health
equalities for all groups and communities in
the region, by identifying and overcoming
barriers to access and inclusion across the
range of health services and practices.
EDS measures how successful we are in
providing equal access to healthcare services,
quality and outcomes to the diverse population
that we serve. There are four main goals to
EDS. Those goals are:
For our communities, this means a service
that is fair, flexible, engaged and responsive to
cultural, physical or social difference.
Our vision is to be a champion and leader
in promoting diversity, managing diversity
and challenging discrimination. Diversity
implies that we not only acknowledge people’s
differences, whether they are visible or nonvisible, but also recognise and make best use
of the strengths and benefits that come with
diversity in general, and a diverse workforce in
particular.
1. Better Health Outcomes for All
2. Improved Patient Access and Experience
3. Empowered, engaged and included staff
4. Inclusive leadership at all levels
We were assessed by both Liverpool and
Sefton Healthwatch organisations who agreed
that we had met our target and improved
sufficiently to be graded as “Achieving” across
goals 1, 2 and 4 which are related to service
delivery.
●Move over to new NHS Jobs system and
process for recruitment
●Recruitment drives to encourage people
to work for our organisation
●More custom made approach to training
and development i.e. variety of ways
which training/education is delivered;
condensing training; enabling staff to
choose training to support their roles
●Campaign to support zero tolerance
approach to bullying and harassment
●Reviewed varying policies to support staff
such as flexible working; sickness absence
●Acted upon recommendations made as
result of staff feedback
●Feedback over 2013/14 through both
our staff surveys and the CQC has
demonstrated that staff have not felt
supported at work. Many actions are
now underway to improve this including
ensuring robust clinical leadership is in
place; access to timely clinical supervision
and embarking on the national
Listening into Action approach to staff
empowerment and engagement. We will
monitor ourselves on this very important
goal to see how we have improved by
next year
Stonewall
Stonewall is a national
lobbying group that
promotes inclusive
workplaces for lesbian,
gay and bisexual people.
LCH was successful in gaining a place in the
Stonewall Top 100 Workplace Equality Index
moving up an impressive 20 places from 86th
to 66th. Stonewall also gave LCH’s “Pride
in Health” LGBT (lesbian, gay, bisexual and
transgender) staff network a “Star Performer”
award. This was awarded in recognition of
Pride in Health’s innovations and for the impact
the network group has had on the culture of
participating Trusts and also the contributions it
has made to events such as Liverpool Pride and
IDAHO (International Day Against Homophobia).
We were also commended on the joint working
that “Pride in Health” has done with other Staff
Networks and its dedication to supporting staff
in the workplace who experience discrimination
or need advice.
LCH came 4th in Stonewall’s national Healthcare
Equality Index which is a benchmarking
exercise for the NHS on sexual orientation
equality in service delivery. It recognises the
work that we have done to make our patient
facing areas and communications more
inclusive and for the excellent engagement
work that our Armistead Service has undertaken
with the lesbian, gay and bisexual communities
on a range of public health issues.
Training and Development
It is mandatory for all LCH staff to undertake
regular Equality and Diversity training. Last
year we added Deaf Awareness, Transgender
Awareness and Cultural Competency to
our training. Our Trust Board also received
bespoke sessions in leadership of the equality
and diversity agenda.
Quality Account 2013–14 | 18
19 | Quality Account 2013–14
How we did in 2013/2014
Patient Involvement and Feedback
District Nursing Surveys
See page 30 for the results of our patient
experience surveys from 2013/2014.
We recognise that it is difficult for patients
who are being cared for in their own home to
provide feedback in an anonymous way. Since
2012 we have asked Healthwatch to conduct
surveys, and analyse and produce a report
on our District Nursing services. The findings
and recommendations form the basis for an
improvement programme as part of a cycle of
continuous service development.
Friends and Family Test
The National Friends and Family Test (FFT) is
a single question survey which asks patients
whether they would “recommend the NHS
service they have received to friends and
family” who need similar treatment or care.
Through including the question in our patient
surveys, LCH implemented FFT ahead of the
national schedule across our services and
Intermediate Care wards.
Mystery Shopping
One area highlighted in the last District
Nursing survey related to how patients
contacted staff by telephone. This prompted
LCH to look further into this and a number of
mystery shoppers were recruited and trained
from our Trust Public Membership (now
up to 7000 members). A telephone survey
has recently been completed and a mystery
shopping exercise for our drop-in services
is planned. The results of the survey can be
found at:
The diagram below shows the various ways
that we capture feedback for FFT. The data is
analysed and regularly reported to patients,
staff and managers. The results provide a
benchmark for patient satisfaction allowing us
to identify where service improvements are
needed. In 2013/14 93.8% of patients reported
that they would recommend our services to
their friends and family.
Patient Stories
ELECTRONIC
APP
WEBSITE
‘RATE
OUR SERVICE”
PAPER BASED
SURVEYS
NET PROMOTER
SCORE
?
VOICE
MESSAGING
SMS
TEXTS
PATIENT
EXPERIENCE
VOLUNTEERS
The aim of patient stories is to learn and
continuously improve the quality of the
services that we deliver. Over the last year,
the Board have heard from a diverse range of
patients with both challenging and positive
stories of their experience. Each Trust Board
meeting starts with a patient explaining
their experiences of using our services.
And each story is followed up by actions
and a commitment to inform future service
improvements.
POSTCARDS
Quality Account 2013–14 | 20
www.liverpoolcommunityhealth.nhs.
uk/Downloads/Patient-Experience/
Mystery-Shopping-Report.pdf
Patient Involvement
LCH are accountable to our patients, carers and
the wider public. As such, we seek to involve
them in the development and evaluation
of the healthcare services we provide. Our
patient involvement model (below) has been
designed to ensure that communication is
linked from the top of the organisation to the
communities that we serve. At the hub are
our members who we have recruited on our
journey to become a Community Foundation
Trust. Our members act as a virtual patient
council. Members have a choice in what areas
they would like to get involved with, along with
a choice of how and when they would like to
be involved.
21 | Quality Account 2013–14
LEARNING &
SHARING
(PATIENT STORIES)
TASK &
FINISH GROUPS
PATIENT
EXPERIENCE GROUP
(WITH PATIENT
PARTICIPATING)
PLACE
INSPECTORS (V)
INFORMATION
MEMBERSHIP
READERS
PANEL
MYSTERY
SHOPPERS
FOCUS
GROUPS
SURVEYS
Valuing our staff
At LCH, our staff are our greatest asset. The
contribution that each person can make has
a real impact on ensuring that we continue
to deliver high quality care for our patients
and local populations. Listening to staff and
giving them the opportunity to feed back their
experience is central to our values.
Below are some of the engagement activities
we have in place for our staff:
●Staff Forums
●Annual Staff Survey
●We are LCH Roadshows
●Twitter! Staff on Twitter were encouraged
to let LCH know what makes them proud
by using #weareLCH
●Campaigns ranging from Health and
Wellbeing to Whistleblowing to actively
engaging and encouraging staff
participation and support.
●Listening into Action
●Clinical Summit
●Clinical Reference Groups
How we did in 2013/2014
We have been hearing how important
recognition is to help build pride in the
organisation and the work that staff do celebrating success and sharing best practice
across teams. We also heard some great
examples of how this is being done and how it
could be improved across LCH.
Innovation & Technology
To continue to deliver high quality care, we aim
to ensure that patients are kept safe, have a
positive experience of the services they receive
and are treated by staff who deliver best
practice in care. The use of technology will
help support this aspiration through providing
continuity of care between professionals,
straightforward access to our services, and the
promotion of independence and self care for
patients.
Remote delivery of Speech and Language
Therapy for Children
Promote Health and Wellbeing to socially
excluded patients
It was identified that for some patients,
accessing healthcare can interfere with their
lifestyle and education. Following a successful
pilot using Skype, it is planned to provide
consultation services for paediatric speech
and language therapy as part of normal
practice. This will mean that the patient and
their family can be at home with a computer
or smart phone and can have a video call with
a specialist using Skype. The benefits of this
include reduced travelling for families, and it
reduces the need to take time out of education
and employment to attend appointments.
A pilot project used technology via the
television set has been trailed in the homes
of several patients. This connects patients
to family, friends, and health workers and
provides social interaction media like exercises
and amusing past TV clip favourites to
promote health and well-being.
To aid a speedy, confidential and efficient
registration and booking-in service, a self
check- in facility has been used for our new
Liverpool City Centre Integrated Walk-In and
Sexual Health service.
More independence (Mi) Health
Mi Health allows people with
long term conditions (heart
failure, Chronic obstructive
pulmonary disease (COPD),
diabetes) to monitor their own
health using a small, easy to
use piece of equipment that
works through a patient’s own TV or a tablet/
personal computer in their own home.
Below are some examples of the projects we
implemented in 2013-14.
Mobile Clinical Recording
During 2013-14 approxinately1600 front line
clinical workers were provided with tablet
devices to enable mobile working to view
and update information at the point of care.
Having access to the patients clinical record
ensures that the clinician has access to clear,
legible and up-to-date information to facilitate
well informed clinical decision making. Staff
can also access useful sources of information
to share with patients to promote health and
well-being and use the device to obtain FFT
feedback from patients.
Kiosks and self check-in in sexual health
eRedbook
The eRedbook is an initiative led by the Royal
College of Paediatrics and Child Health; it is an
electronic personal child health record that is
parent-owned with the purpose of encouraging
parents to take an active responsibility for the
health of their child.
Quality Account 2013–14 | 22
Patients monitor their vital signs such as blood
pressure, pulse, weight, oxygen levels or blood
sugar levels, as well as completing simple
questions about their health and watching
videos that show them how they can improve
management of their condition. Measurements
and answers are monitored daily in LCH’s
Telehealth hub by healthcare professionals
who are able to give the right support and
advice when needed. Patients are able to take
more control, and live more independently
and safely at home, whilst the likelihood of
needing emergency hospital admission and/or
treatment is reduced. Patient experience has
increased and health outcomes have improved.
23 | Quality Account 2013–14
Clinical Recording system
LCH are rolling out EMIS (Egton Medical
Information System) for most of our services.
EMIS is an electronic patient record system
which is widely used by GPs and Community
Care in the UK. The use of EMIS by LCH
will help speed up important exchange of
information to improve patient care.
LCH continues to work closely with EMIS to
develop a fit for purpose community health
record, however this development is long and
challenging. There are over 1300 staff using
EMIS within LCH. Services are able to share
key information with each other and with
primary care (GPs).
Assurances on Quality of NHS Services Provided in 2013/14
Assurances on
Quality of NHS
Services Provided in
2013/14
During 2013/14 LCH provided and/or
subcontracted 77 NHS services. LCH
has reviewed all the data available to
them on the quality of care in all 77
of these NHS services. The number
of services has reduced from 90 in
2012/13 to 77 in 2013/14. This is
due to LCH ceasing to provide some
services and due to reclassification of
service categories.
Foundation Trust
In 2013-14 we undertook a number of
assessments as part of our foundation trust
application, including reviews of our quality
and governance and an inspection under
CQC’s new Chief Inspector of Hospitals regime.
The findings of these reviews and the CQC
inspections have highlighted that as a trust,
we need to embrace and embed new ways
of working before we are ready to become
a Foundation Trust. Whilst this remains an
ambition of LCH we are committed first and
foremost to making the changes required;
working with staff, patients and the health
community to ensure our services are clinically
led and managed for the benefit of our
patients.
NHS Trust Development Authority
(TDA)
The NHS TDA oversees all NHS Trusts to
support and govern them through their
journey to become sustainable, independent
organisations. The Trust is working closely
with the TDA on delivery of our improvement
plans.
Monitor regulates health services in England
and is responsible for authorising all
foundation trust applications. As part of all
FT assessments, Monitor reviews the quality
governance arrangements of aspirant trusts;
LCH participated in a quality governance
review with Monitor between January and
March 2014.
Monitor reviewed over 700 pieces of evidence
and spoke to over 50 staff, including Board
members and health professionals, through
service visits, focus groups and one to one
meetings. The findings demonstrated that
more work needs to be done to ensure quality
drives the trust’s strategy and to make our
governance structures and processes more
robust. In 14/15, we will be completely
refreshing our Integrated Clinical and Quality
Strategy, and making improvements to our
governance processes to ensure they support
staff to deliver high quality care.
The income generated by the
NHS services reviewed in 2013/14
represents 100% of the total income
generated from the provision of NHS
services by LCH in 2013/14.
Quality Account 2013–14 | 24
Monitor Quality Governance
25 | Quality Account 2013–14
Assurances on Quality of NHS Services Provided in 2013/14
Board Governance Assurance
Framework (BGAF)
The Board undertakes regular self-assessments
against the Department of Health’s BGAF to
provide assurance that the Board:
●Has the right knowledge and skills
●Continuously develops these skills
●Engages effectively with its stakeholders
To support this, the Board were independently
assessed against the BGAF by an external
independent consultancy agency (KPMG); they
noted that improvements had been made since
the previous assessment in 2012. They made
further recommendations including gaining
staff feedback on how the trust approaches
lessons learnt and improving engagement
with members and stakeholders, which will be
taken forward in 2014-15.
Care Quality Commission (CQC)
Chief Inspector of Hospitals
CQC are changing the way they inspect
services. As part of our foundation trust
application, LCH participated in this new
style inspection in May 2014. The inspection
involves CQC inspectors, clinicians and
patients who are ‘experts by experience’
making announced and unannounced visits
to LCH services to determine if they are safe,
effective, caring, responsive and well-led.
Participation in Clinical Audits
LCH is committed to improving the quality
of our services and regularly reviews clinical
practice against locally and nationally agreed
standards – this is known as clinical audit.
National Clinical Audits
National Audits are considered as to their
applicability to our services. During 2013-14,
there were no National Audits and national
confidential enquiries that were applicable to
community services.
For 2014-15 LCH have registered their interest
in participating in the National Clinical Audit
for Intermediate Care.
Participation in Local Clinical Audits
Each year we set an annual clinical audit plan
as part of our commitment to continually
improve the quality of our services. This is
through a structured programme of audit
projects that review clinical practice against
local and national best practice standards – this
is known as Clinical Audit.
The Clinical Audit 2013-14 Plan set out an
overview of the planned activity for the
year. This included a focus on re-audit and
continued clinical audit to include:
●Organisational requirements
●Organisational-wide audit
●Local Clinical Audit plans for all Services
During 13/14 LCH planned to undertake 132
clinical audits and as of May 14, 95 % of these
have been completed with 100% of the actions
due delivered. The other 5% of clinical audits
of our services are still on-going. The reports
of the 132 local clinical audits were reviewed
by LCH in 2013/14 and LCH intends to take the
following actions to improve the quality of
health care provided.
Quality Account 2013–14 | 26
Sefton District Nursing Wound Assessment Audit
2013/14
●South Sefton District Nursing Service now
has the support of the Skin Service and
Professional Development Mentor Team;
they have proven to be invaluable as a
resource of knowledge and experience
Liverpool Community Health Discharge Planning
Service & Complex Discharge Planning at The
Walton Neurosciences NHS Trust
●Increased use of I.T. / electronic record
keeping supporting handover of
information between services which has
benefitted the patient journey
●A clearer, joined up referral process
across regions will reduce delays in
patient care
Baby Friendly Initiative (BFI) Infant feeding:
Bottle feeding Audit 2013/14
●The audit has provided evidence to
share with partner organisations so
that improvements can be made to the
services we jointly provide
●Mothers do not always remember all
the safe sleep information about the
risks of smoking, alcohol, and drugs.
This has indicated the need to work with
Safeguarding nurses and Care of Next
Infant coordinators to look at the present
procedures and make improvements
based on the current research
27 | Quality Account 2013–14
Participation in Clinical Research
The number of patients receiving NHS
services, provided by/or sub-contracted by
LCH in 2013/14, that were recruited during
that period to participate in research approved
by a research ethics committee was zero
although the Trust is strengthening its position
in encouraging and supporting the active
recruitment of patients into portfolio research
studies.
As a community trust, we want to ensure that
our staff and patients have every opportunity
to be involved in research to support their
own aspirations and wishes, and to support
the organisation in its aspirations to improve
our overall organisational health. There has
been a significant increase in research activity
this year, with a total of 15 projects approved
in comparison to 8 in 2012/13, demonstrating
an increase of 87.5% in research activity.
The increase in activity is due to increased
awareness amongst staff in the trust,
who receive support to establish research
activity in their area of work and through
our collaboration with other partners. This
supports the development and expansion
of our research portfolio and allows us to
maximise the benefits of our position with
huge numbers of patient contacts each year.
We also undertake extensive networking and
presentation of our research work at local,
regional and national events.
It is the organisation’s aim to lead on the
National Institute for Health Research’s
research for Speech and Language Services
during 2014/15.
Assurances on Quality of NHS Services Provided in 2013/14
Most complaints received during 2013/14
related to the clinical care of patients (38/27%).
This is a 51% reduction on the number
received about clinical care in 2012/13.
Subject of complaint Communication between staff and patients/
carers/relatives was the second highest
receiving 29 complaints. However, this is a
reduction on the 30 complaints received the
year before.
The third highest category with 23 complaints
was staff attitude, but again we observed a
48% reduction from the year before.
As a Trust we have taken a number of actions
to improve patient experience within these
three main areas.
Comments, compliments
and complaints
Customer service and patient experience are
definitive indicators in measuring the quality of
services we provide. As such, we know we can
learn from every comment, compliment and
complaint received.
Over the last 12 months our staff delivered
over 2 million patient contacts and we
received:
●31 concerns
●140 formal complaints
●738 PALS queries
●1124 compliments
As part of complaints management, key
themes are identified which inform lessons
learnt and training and development for staff
as part of on-going service improvement. We
offer each complainant the opportunity to
meet with the relevant manager to discuss
their concerns in full. This is offered at both the
acknowledgment and response stage. Upon
completion, all written responses are reviewed
by both the Medical Director and the Director
of Nursing before being signed off by the
Chief Executive (or Deputy Chief Executive).
For the coming year we will be providing
further feedback regarding responses and the
outcomes of complaints to staff.
The average time to respond to a complaint
is less than 20 working days compared to
23 days in 2012/13. LCH are committed to
providing complete and timely responses to
complainants and will continue to work at
improving our response rate further, whilst
not compromising on either the level of
investigation or the quality of the replies.
●Staff groups have undergone bespoke
customer services training
●Teams are encouraged to discuss
anonymised complaints during their
meetings to determine if anything could
or should have been done differently
●If a patient story to the Board originated
from a complaint, representatives from
divisions attend the Board meeting with
complainants to hear first-hand of their
often very negative experiences
Each complaint is seen as an opportunity to
learn and is investigated fully by the relevant
service manager. Action plans are produced by
the service and are monitored by the Customer
Service Department.
LCH is a learning organisation, we see
complaints and concerns as an important way
to improve our performance.
Quality Account 2013–14 | 28
29 | Quality Account 2013–14
2013/14
1 - Admissions, discharge and transfer
arrangements 7
2 - Aids and appliances, equipment, premises
(including access) 9
3 - Appointments, delay / cancellation
(outpatient) 9
4 - Appointments, delay / cancellation
(inpatient) 1
5 - Length of time waiting for a response, or
to be seen: NHS Direct 0
6 - Length of time waiting for a response, or
to be seen: Walk in centres 0
7 - Attitude of staff 28
8 - All aspects of clinical treatment 38
9 - Communication / information to patients
(written and oral) 29
10 - Consent to treatment 0
11 - Complaints handling 1
12 - Patients privacy and dignity 3
13 - Patients property and expenses 3
14 - CCG commissioning (including waiting
lists) 1
15 - Independent sector services
commissioned by CCGs 0
16 - Independent sector services
commissioned by trusts 0
17 - Personal records (including medical and /
or complaints) 2
18 - Failure to follow agreed procedures 2
19 - Patient's status, discrimination (e.g.
racial, gender, age) 0
20 - Mortuary and post mortem arrangements 0
21 - Transport (ambulances and other) 0
22 - Policy and commercial decisions of trusts 0
23 - Code of openness - complaints 0
24 - Hotel services (including food) 0
25 - Other 7
TOTAL 140
Assurances on Quality of NHS Services Provided in 2013/14
Patient Experience Surveys 2013-14
Positive patient experience is important. We
strive to ensure patients receive services that
they value. All of our services take part in a 2
year rolling programme for Patient Experience.
Each Service completes a Patient Experience
survey every other year to meet contract
requirements unless they are considered to
be a priority service (have a high turnover
of patients/ high numbers of incidents or
complaints/ Commissioning requirement), in
which case they do a survey each year. The
overall percentage of satisfaction for 2013/14
is currently 98%, this is an accumulation of
patients / carers who scored our services either
Good, Very Good or Excellent.
National Quality Board –
Core Quality Indicators
Domain 4 – Ensuring that people have
a positive experience of Care
The Department of Health and Monitor (the
regulator of health services in England) are in
the process of developing an Annual Reporting
Manual for NHS Foundation Organisations.
This manual will contain a core set of quality
indicators which foundation trusts will have
to report on as part of their Quality Accounts.
The Quality Indicators which are relative to our
organisation are identified in the table below.
Capturing patient feedback provides
valuable information on the quality of the
services we provide and to inform future
service improvement plans. In 2013-14 LCH
Intermediate Care Wards undertook patient
surveys, which included 5 questions required
by our commissioner.
NHS Outcome
Framework Domain
Indicator
Domain 4: Ensuring that
people have a positive
experience of care
Responsiveness to inpatients’ personal needs
Domain 5: Treating and
caring for people in a safe
environment and protecting
them from avoidable harm
Percentage of admitted patients risk-assessed
for Venous Thromboembolism
Percentage of staff who would recommend the
provider to friends or family needing care
Rate of C. difficile
Rate of patient safety incidents and percentage
resulting in severe harm or death
The survey showed that
●78% of respondents were welcomed,
introduced to people on the ward and
given information about their stay on
arrival
●83% of respondents were given enough
time to discuss their condition, worries
and fears with healthcare professionals
●71% of respondents felt that staff clearly
explained the purpose of any medication
and side effects in a way that could be
understood
●92% of respondents felt that staff took
family or home situations into account
when planning their discharge from
hospital
●74% of respondents were told who to
contact if they were worried about their
condition or treatment after they had left
hospital
An action plan will be developed to improve
the quality of experience for patients.
Domain 5 - Treating and caring for
people in a safe environment and
protecting them from avoidable harm:
As part of the plan to combat and reduce
Healthcare Acquired Infections (HCAI)
the Infection Prevention & Control Team
introduced a number of initiatives on LCH
Intermediate Care Wards, including:
Quality Account 2013–14 | 30
● A robust surveillance system to monitor
infection risks of indwelling devices and
prevent health care acquired infections.
● Isolate all patients on suspicion of
infectious diarrhoea within 4 hours.
● Monitoring and reporting of staff
compliance with hand hygiene procedures
including bare below the elbow policy.
● Auditing practice to ensure that standards
are being met
31 | Quality Account 2013–14
Data Quality Team
As an organisation, access to accurate,
timely data and information is important to
inform decision making, risk management
and service improvement. As a trust we use
data in many ways; to measure performance,
monitor outcomes, identify emerging risks,
and to ensure we provide value for money.
The use of data also provides information on
the demographics of our local populations
who access our services for example, age and
ethnicity.
As part of our continual service improvement,
Liverpool Community Health will be taking the
following actions to improve data quality.
●Right First Time Campaign - raising the
awareness of the importance of recording
correct information in patients’ electronic
and paper records
●Educate new staff about Data Quality
before they are given access to systems
●Ensure that all training materials include
data quality standards in accordance with
the Information Governance Toolkit
What our regulators say about LCH
Assurances on Quality of NHS Services Provided in 2013/14
NHS Number
Every person has a unique NHS Number. The
use of the NHS Number aids the reduction of
clinical risk to patients. Using the NHS Number
makes it possible to share patient information
safely, efficiently and accurately across NHS
organisations. There are national standards set
out and LCH continue to monitor and strive to
improve our NHS Number compliance in line
with the National NHS Number Standard.
NHS Number completeness for three major
systems
Patient
Administration
System
National All patients seen in
Target
2013/14 that have an
NHS Number
EMIS Web
98%
99.9%
CCH2000/
HSW
98%
99.8%
iPM
98%
99.5%
These figures were obtained from the SUS
Data Quality Dashboard, Health and Social
Care Information Centre.
Clinical Coding error rate
LCH was not subject to the Payment by Results
clinical coding audit during 2013/2014 by the
Audit Commission.
National Requirements
The Community Information Data Set (CIDS)
is a national dataset. All organisations that
provide Community Services must collect and
submit CIDS to their local Data Management
Information Centre (DMIC). LCH routinely
submits CIDS and we are currently awaiting
further instructions from the Health & Social
Care Information Centre (HSCIC) to provide
this data nationally.
What our regulators
say about LCH
Statement from the
Care Quality Commission
LCH is required to register with the Care
Quality Commission (CQC) and its current
registration status is registered with concerns.
LCH submitted records during 2013/14 to the
Secondary Uses service for inclusion in the
Hospital Episode Statistics, which are included
in the latest published data.
The CQC has taken enforcement action against
LCH during 2013/14. These enforcement
actions relate to:
The percentage of records in the published
data which included the patient’s valid NHS
number was:
●Assessing and monitoring the quality of
services
●Supporting staff
●100% for admitted patient care
●98.7% for accident and emergency care/
Walk In Centre
The enforcement actions placed on LCH
followed unannounced visits in November
and December 2013 to a small number of
our services, including Ward 35 (managed by
LCH) based at Aintree University Hospitals
NHS Foundation Trust, Community Equipment
and Disability Advisory Service (CEDAS) and
District Nursing.
The percentage of records in the published
data which included the patient’s valid General
Medical Practice Code was:
●100% for admitted patient care
●99.9% for accident and emergency care/
Walk In Centre
In light of their findings, CQC informed the
trust that action is required to demonstrate
that compliance is achieved in the two areas
identified by April 2014.
Quality Account 2013–14 | 32
33 | Quality Account 2013–14
LCH has taken the following action to address
the conclusions and requirements reported by
the CQC:
●Improved ways in which staff can raise
issues and concerns – we have revised
our Whistleblowing Policy, produced a
simple flowchart to support staff who
wish to raise an issue and are now using
Public Concern at Work to provide an
independent whistleblowing line for staff
●Changed our processes for reporting
and acting on incidents - to ensure we
increase our learning from them and
continue to share this learning with others
●Improved medicines management in
our intermediate care wards, to ensure
processes for self-medication and
transcribing are robust and followed by
all staff
●Changed the complaints process to invite
patients to a meeting to discuss their
complaint at the beginning and end of the
investigation process
What our regulators say about LCH
●Improved mandatory training and
appraisal rates and plans to increase
the number of staff accessing clinical
supervision
LCH has not participated in special reviews or
investigations by the CQC during 2013/14. We
have however participated in the following
unannounced inspections: Her Majesty’s
Prison (HMP) Liverpool, Wards 9 and 11
at Broadgreen Hospital, District Nursing,
Community Equipment and Disability Advisory
Service (CEDAS), and Ward 35 in 2013/14.
More information about CQC visits to LCH can
be viewed on the LCH Internet and the CQC
website.
Other Regulators
The NHS Litigation Authority (NHSLA) handles
claims made against NHS organisations and
works to improve risk management practices
in the NHS.
All NHS organisations in England can apply
to be members of these schemes. Members
pay an annual contribution (premium) to
the relevant schemes, which is similar to
insurance.
As part of this, all members of these schemes
are subject to an assessment, based on 3 levels
of compliance.
The NHSLA has confirmed that LCH is currently
meeting Level One.
Information Governance Toolkit
Attainment Levels
Information Governance ensures necessary
safeguards for, and appropriate use of, patient
and personal information.
Our Priorities for 2014/15
The Information Governance Toolkit is a
performance tool produced by the Department
of Health (DH). It draws together legal rules
and central guidance presenting them as a set
of information governance requirements.
What are the Information Governance
requirements?
There are different sets of information
governance requirements for different
organisational types. However, all
organisations have to assess themselves
against requirements for:
●Management structures and
responsibilities (e.g. assigning
responsibility for carrying out the IG
assessment, providing staff training)
●Confidentiality and data protection
●Information security
The purpose of the assessment is to enable
organisations to measure their compliance
against the law and central guidance and to
see whether information is handled correctly
and protected from unauthorised access, loss,
damage and destruction.
There are 3 levels to the IG Toolkit, 1, 2 and 3.
Satisfactory with the IG Toolkit equates to LCH
meeting ALL 39 requirements at Level 2.
Not Satisfactory
Not evidenced Attainment
Level 2 on all requirements
Satisfactory with
Not evidenced Attainment
Improvement Plan Level 2 on all requirements but
improvement actions provided
Satisfactory
Evidenced Attainment Level 2
or above on all requirements
LCH Information Governance Assessment
Report score overall score for 2013-14 was
70% and was graded Satisfactory (GREEN) for
Level 2.
Quality Account 2013–14 | 34
Our Priorities for
2014/15
Clinical Excellence
Listening into Action (LIA):
In support of on-going personal and
professional development of our staff in
ensuring they have the requisite skills
and competencies to fulfil their roles, an
overarching action plan has been developed.
This plan also supports the implementation
of recommendations and guidance from
important NHS Reviews (Francis, Keogh,
Berwick and Cavendish) undertaken last year.
Listening into Action allows clinicians and
staff delivering our services to identify where
changes are needed and to identify what
support is needed for them to make the
changes. Benefits from these changes are
linked to patient and staff experience, the wider
population across Liverpool and Sefton, and
help to improve the working lives of LCH staff.
In line with the above, over the last six months
we have reviewed our programmes of work
and identified the following key programmes:
●Listening into Action (LIA)
●Open and Honest Care
●Leadership Programme / Band 6
Development Programme
●Other HCA / Band 5 nursing
programmes
These are on-going programmes of work and
brief narrative below provides highlights from
those programmes.
35 | Quality Account 2013–14
There have been a number of approaches to
attain staff views on what needs to change
and the improvements identified. LCH has
identified key areas of improvement which
will support the organisation as a whole, and
has also identified 10 front line teams who will
take forward changes in their own services.
Updates about this programme can be found
via the following link:
lch-internet.nhs.sitekit.net/
Downloads/newsletters/lia/Index.html
Our Priorities for 2014/15
Two date three pilot cohorts of staff have been
through the programme, and these staff are
helping to shape the final programme.
Other staff development opportunities
Distiller, Ambassador and Clinical Supervision:
The Trust has invested in training and
development for Health Care Assistants (HCA’s)
and Band 5/6 nursing, to ensure that training
translates into day to day practice to improve
care and staff engagement.
For HCAs it offers the chance to explore
development opportunities that include
becoming assistant practitioners, undertaking
nurse training, or simply developing within
their current role.
Open and Honest Care: Driving
Improvements
The NHS Nursing Strategy “Compassion in
Practice” requires NHS services to become
more transparent and consistent in publishing
safety, effectiveness and experience data, with
the overall aim of driving improvements in
practice. Later this year, LCH will commence
publication of the information identified above
via its Internet Site.
www.liverpoolcommunityhealth.nhs.
uk
Student Ambassador Programme:
Clinical Leadership
Within LCH there is clinical leadership in
place from front line to Board level. Clinical
leadership and accountability underpins the
drive for continual improvement of quality
and safety outcomes for patients and local
populations. As part of our commitment to
staff in the delivery of our Integrated Clinical
and Quality Strategy, staff have access to
a wide range of training and development
opportunities to equip them with the skills,
knowledge and competencies to undertake
leadership roles.
Band 6 Nurse Development Programme:
An opportunity was provided for twelve of
our band 5 nurses to develop their band 6
skills and become caseload holders. The
programme has elements of in-house learning,
assessment, and University accreditation. Staff
are supported in their development by Mentors
during the programme. Recent evaluation of
the programme was extremely positive from
the staff who participated.
Leadership Programme:
The following are some of the leadership
development opportunities in the Trust; both
these programmes focus on developing our
leaders of the future whilst at the same time
enabling them to improve the quality of service
delivery in their respective areas as part of the
programmes:
Quality Account 2013–14 | 36
A number of staff roadshows were undertaken
during 2013/14, feedback from staff was the
re-introduction of the Leadership Programme
and from this, Enabling the Extraordinary was
developed. The programme provides learning
that encompasses a mix of traditional and new
types of learning to meet all learning styles
and offers participants the opportunity to tailor
the programme to their learning needs in a
flexible way.
37 | Quality Account 2013–14
This programme supports nursing students
who work with the LCH Practice Education
Facilitators to ensure that LCH is providing
the right opportunities for students. The
Ambassadors also network to share good
practice and lessons leant across the
organisations and the student nursing
population.
Our Priorities for 2014/15
Clinical Supervision:
There is a need within LCH to draw on good
practice both internally and externally to
support an ethos of Clinical Supervision;
however it is acknowledged that “one size
does not fit all”. We have established a multi disciplinary working group who have reviewed
the existing Clinical Supervision and found that
it needs refining to meet the needs of our staff.
The Trust is currently developing a revised
Clinical Supervision Policy which will
incorporate health care assistants’ roles, nonclinicians as well as Registered Nurses and
Allied Health Professionals. Once approved the
multi-disciplinary working group will oversee
the implementation, training and promotion of
the policy
Below provides two approaches of how clinical
supervision is being applied to practice.
Externally facilitated sessions were held for
Band 5s and HCAs, whereby staff were able
to test current methods/tools for clinical
supervision to support their role development.
This in turn has enabled staff to test and
apply these methods within their own area of
practice.
As part of the Health Visitor re-energising /
development programme, the Trust has
invested in restorative supervision. This is a
process that has been developed and aligned
to the Solihull Approach which is delivered in
Children’s services. It is a form of supervision
which has been designed to support
professionals to reduce stress and burn out.
The Trust has trained 20 health visitors in
this model and once they have completed
all the competencies restorative supervision
will be rolled out. This is to complement a
range of clinical supervision that is currently
offered to registered nurses and Allied Health
Professionals.
Quality Account 2013–14 | 38
Integrated Care: Health and Social Care
Services
In Liverpool, LCH are working towards
developing a Section 75 (s.75) Partnership
Agreement with Liverpool City Council (LCC).
The purpose of this Partnership Agreement is
to establish a framework within which LCH and
LCC can create partnership procedures, terms,
conditions and pooled budgets (as appropriate)
to enable integrated service delivery. The
overall aim of all of the partnership work is to
improve health and wellbeing, raise levels of
self care and independence, and reduce health
and care inequalities for people in Liverpool.
39 | Quality Account 2013–14
For each area where working in partnership
is deemed to be of significant benefit for the
local population, a schedule will be developed
which will sit underneath he partnership
agreement. It is expected that this will include
the joint delivery of care and support services
to older people (including the reablement
pathway and utilisation of the LCC 24/7 Hubs),
integrated health and wellbeing approaches,
and localised integrated health and social care
services to be designed by and provided for
individuals closer to their homes in localities
and neighbourhoods.
The benefits of partnership working are
expected to increase continuity of care for
people as they move between services, and
promote enhanced communication between
professionals and other care providers.
What our commissioners and Healthwatch say about us
An example of a particular point that could
benefit from this suggested greater level of
detail is regarding the patient feedback that the
Trust obtained relating to its Intermediate Care
service. The Quality Account shows that there
is room to significantly improve that service
and it states that an action plan to improve
the quality of experience for patients will be
developed; however, no further detail is given.
What our
commissioners and
Healthwatch say
about us:
Statement from Liverpool and Sefton
Clinical Commissioning Groups
A joint statement is being provided by
Liverpool and Sefton Clinical Commissioning
Groups. At date of publishing this account
statements have not been received however
will be displayed via a link on the internet site
alongside the quality account.
Statement from Liverpool Healthwatch
Healthwatch Liverpool welcomes this
opportunity to comment on the Quality
Account 2013/14 of Liverpool Community
Health NHS Trust (LCH).In the opinion of
Healthwatch Liverpool this Quality Account
does provide enough information about
LCH be of use to the public in getting a basic
understanding of the quality of the service.
It is refreshing to observe that this Quality
Account clearly acknowledges the challenges
that the Trust has faced in this year in terms of
its performance as measured by some aspects
of an inspection report compiled by the Care
Quality Commission (CQC). Healthwatch
Liverpool is also pleased to note that this
Explicitly linking such issues into a
systematically illustrated patient experience
and quality improvement system would help
demonstrate to the public that the Trust has
the means to make the desired improvements
happen. To accommodate this in future the
section on Patient Involvement and Feedback
might benefit from being expanded.
acknowledgement by the Chief Executive goes
along with an explicit statement of the value
the Trust is now putting on the experience of
patients and service users. Importantly there
is also a stated commitment to strengthen
processes to involve patients and service
users. These are all relevant considerations
in forming the basis upon which significant
quality improvements can be made by the
Trust.
Despite there still being room for
improvements, in this Quality Account the
Trust does show that it is taking positive steps
to engage patients, service users and the
public. Healthwatch Liverpool welcomes this
and intends to play an active role in engaging
with the Trust throughout the coming year
to ensure that there is adequate independent
local scrutiny and that the patients’ voice is
continuously strengthened at LCH.
The priorities identified within the Quality
Account rightly identify Listening into Action
and Open and Honest Care amongst their
number. Healthwatch Liverpool views the
effective development, implementation and
monitoring of action plans stemming from
these priorities as crucial for progressing the
associated aims. The Quality Account does
supply some narrative about both the Learning
into Action Priority and Open and Honest Care,
which this is useful, however, in future Quality
Accounts it might also be helpful to see the
inclusion of a little more detail about specific
aims and the reporting structure up to the
Board that will ensure progress towards these
aims.
Quality Account 2013–14 | 40
41 | Quality Account 2013–14
Statement from Sefton Healthwatch
Sefton Healthwatch were unable to provide a
statement due to timescales.
Quality Account 2013–14 | 42
43 | Quality Account 2013–14
Trust Headquarters
Liverpool Community Health NHS Trust,
2nd Floor Liverpool Innovation Park,
Digital Way, Liverpool
L7 9NJ
0151 295 3000
www.liverpoolcommunityhealth.nhs.uk
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© Liverpool Community Health NHS Trust 2014
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