Quality Accounts
For
Northern Pathways
2013/14
Contents
PART ONE ............................................................................................................................. 3
Statements ............................................................................................................................. 3
Statement on Quality from the Chair of the Northern Pathways Board................................... 3
Overview of services .............................................................................................................. 5
PART TWO ............................................................................................................................ 6
Priorities for improvement 2014/15 ......................................................................................... 6
Specialised Services Quality Dashboards .............................................................................. 6
PART THREE ......................................................................................................................... 7
Quality Review Performance 2013/14 .................................................................................... 7
1. Review of Priorities 2013/14 ............................................................................................... 7
2. Review of Quality................................................................................................................ 8
3. What Others Say About Us .............................................................................................. 14
4. Glossary ........................................................................................................................... 17
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PART ONE
Statements
Statement on Quality from the Chair of the Northern Pathways Board
Garrow House in York is a 12 bedded high support service for women stepping down from
secure care. The service was developed by Northern Pathways, which is a joint venture
between Turning Point and The Retreat. The service was developed in response to national
high level policy guidance, including Women's Mental Health: into the Mainstream (2002)
and the subsequent Implementation Guidance (2003), a regional strategy document,
Forensic Services for Women a Strategy Document 2004-2008 and was informed by a
strategic review of population need and service provision and a detailed service user
involvement project. The result is a high quality service for women that enhances the care
pathway for women in secure care. The service opened in January 2009 and 2013/14 was
its fifth full year of operation.
As an established service and an established company, we have continued to develop and
refine robust structures and systems to define, monitor and assess quality. These have
included:
 Northern Pathways Board and quarterly Northern Pathways Governance Committee
including all key parties to monitor business and clinical governance.
 Monthly Risk Management Group.
 Turning Point‟s internal quality assurance tool (IQAT) mapped to the Care Quality
Commission (CQC) Independent Hospital standards.
 Development of Women‟s involvement systems including continued employment of an
Involvement Worker, weekly community meetings, weekly involvement group, one to
one women‟s sessions, monthly women‟s governance meetings, representation from
the women on the Governance Group and Committee, the Department of Health
(DoH) monitoring meetings, attendance at the steering group, the service models
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

workshop and all away days and partners‟ workshops. Also a representative attends
the Recovery & Outcomes Meetings (formerly the Regional Involvement Strategy) and
project groups.
Increased partnership working with Leeds and York Partnership Foundation Trust
(LYPFT) to ensure an appropriate mix of clinical input and operational management.
Commitment from all staff and women to ensure involvement and quality ethos.
During its fifth year, Garrow House has worked hard to maintain and develop a high quality
service and we are very pleased with the results. In 2013/2014 the service achieved all the
innovation goals agreed between Northern Pathways and the regional commissioners for the
provision of NHS services, through the Commissioning for Quality and Improvement
payments framework (CQUINS) and achieved all available incentive payments. Robust
involvement systems are in place which means that the women within the service are
actively involved in all aspects of their care and service delivery. This continues to result in
high levels of satisfaction and development of a service which the women consistently state
is meeting their needs. There has been a continual rolling quality action plan managed by
the Operations Manager and reported to the Northern Pathways Governance Committee,
which has covered all areas identified, where quality improvement has been required.
We feel that there has been a proactive approach to quality assurance and that staff,
alongside service users have worked hard to identify areas where improvement is required
and have taken the relevant actions to ensure that all areas are resolved and improved.
Quality improvement is an on-going priority for the service and it is always top of the agenda.
On behalf of Northern Pathways, I affirm my commitment to providing high quality services
and confirm that, to the best of my knowledge, the content of this report is accurate.
Andy James
Chair Northern Pathways
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Overview of services
Northern Pathways is a unique partnership between two well-respected third sector
organisations. The partnership combines the national infrastructure of Turning Point, a large
health and social care organisation with over 25 years‟ experience in mental health, with The
Retreat, a long established York-based mental health provider working with the NHS to
provide mental health care for people with complex needs.
Garrow House is designed to support women making the difficult transition from secure
services back into the community, building independence and life skills while focusing on
long term recovery. Registered as an independent hospital, Garrow House caters for women
with a range of diagnoses including mental illness, personality disorder and mild learning
disability, for a maximum stay of three years.
During 2013/14 Northern Pathways provided one NHS service, namely Garrow House.
Northern Pathways has reviewed all the data available to them on the quality of care in the
one NHS service.
The income generated by the NHS services reviewed in 2013/14 represents 100% of the
total income generated from the provision of the NHS services by Northern Pathways for
2013/14.
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PART TWO
Priorities for improvement 2014/15
Continuing to improve our services is an essential corner stone of Northern Pathways‟
values. The priorities for next year reflect the CQUINS going forward and include two
mandatory ones, two Personality Disorder ones, completion of the quality dashboard and
one chosen as a development opportunity for Garrow House.
Priority
Friends and
Family Test (FFT)
Mandatory
Implementation of FFT as per guidance, according to the
national timetable
Improving
Mandatory
Physical
Healthcare to
reduce premature
mortality in people
with severe mental
illness
Developing
MH19 -Tier
Outcomes
4
Personality
Disorder
1. Cardio metabolic assessment for patients with
schizophrenia
Specialised
MH22
Services
Quality
Dashboards
This indicator is aimed at ensuring that Providers embed
and routinely use the required clinical dashboards
developed during 2013/14 for specialised services.
Access
Assessment
MH18 -Tier
4
Personality
Disorder
This CQUIN enables providers to get a better
understanding of the pathways into a Tier 4 service.
Having an agreed assessment framework will support
clinicians developing a consistently applied assessment
of needs for people accessing Tier 4 Services.
Collaborative Risk
Assessments Education
Provision of
literacy,
numeracy, IT and
vocational skills
training (2013/14)
MH5
The provision of an education training package for
patients and qualified staff around collaborative risk
assessment and management.
To improve access to the range of literacy, numeracy IT
and vocational skills available to service users.
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Voluntary
2. Communication with General Practitioners
This CQUIN enables providers to get a better
understanding of the effectiveness of the treatments
interventions, improve the quality of care and the service
user‟s experience. Outcome measurements can guide
treatment decisions, and enable clinicians to provide
patient centred care.
PART THREE
Quality Review Performance 2013/14
1. Review of Priorities 2013/14
One of the most important aims for the service must be to look back and objectively review
our performance and position throughout 2013/14. The priorities we identified over the last
financial year have been listed as below and updates given on the progress made.
Priority 1
To optimise length of stay in order that service users are not within specialised
mental health services for longer (or shorter periods) than is clinically appropriate.
Specialised mental health services form part of those services recognised as low volume
and high cost. As such minimal reductions in length of stay can realise significant savings.
Working to improve the total pathway would also enhance the service user‟s experience and
in many cases ensure that the service user can be cared for in the least restrictive care
environment possible.
Outcome at Year End
The service has worked together to ensure that all known stakeholders are involved in the
communications regarding the women‟s journey so that timely and effective planning can be
made to ensure a more streamlined experience as the woman continues her recovery.
Priority 2
To improve the physical health and wellbeing of all patients, as an integral part of
their overall treatment and rehabilitation plan. To ensure patients are supported to attain
and retain good physical health and wellbeing and receive equivalent healthcare screening
and interventions to those offered in the community. Hospitals must have an overarching
clear policy of ensuring health and wellbeing of all patients and staff.
Outcome at Year End
The physical health CQUIN has enabled the service to provide additional health screening to
enable the women to make informed choices regarding their on-going physical health e.g.
knowing their „heart‟ age in relation to their actual age. Spin-off projects include the provision
of daily physical recreational and sporting opportunities, which are discussed and agreed
with the women on a monthly basis, to ensure that their needs and preferences are being
met.
Priority 3
To develop a baseline audit and an action plan to ensure the care programme
approach (CPA) process is effective and appropriately identifies unmet need. The CPA
meeting provides the interface between specialised and CCG commissioned services. This
CQUIN allows service users and commissioners to be assured that the CPA meetings will be
evaluated by the provider organisations. This is to ensure that each CPA is assessed by the
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clinical team to make sure that the meeting was effective, able to plan for the care of the
service user and that attendance from all statutory parties, in the care pathway, enabled
effective plans to be developed. If the meeting was not effective then that will be reported to
the provider and the commissioners identifying the reasons why not, with an action plan set
against the provider for all actions under their control/not under the provider‟s control.
Outcome at Year End
This CQUIN provided the basis upon which to analyse potential barriers to a woman moving
on and whether she has any unmet needs. The focus during CPA addresses the causes for
a woman remaining in the service and addresses what would need to be achieved to allow
her to move on. Additional work undertaken and related to this CQUIN is the woman‟s
development around the MDT paperwork and ensuring that their contribution to the
discussions is effective and based upon their CPA goals.
Priority 4
To continually improve the women’s experiences at Garrow House, ensuring that this
aim is permanently on the agenda. To understand the processes within the service from
the women‟s perspective and seek to improve, through wide consultation and participation,
all decision making processes.
Outcome at Year End
This initiative remains high on the agenda at Garrow House and the Involvement CoOrdinator works with the women in all aspects of the service provision ensuring that their
views are being represented. This enables the women to participate effectively and
meaningfully in, for example, interviews for staff of all grades, representation on the Northern
Pathways Governance Board, supporting women with roles as „experts of receiving services‟
in the CQC, the Department of Health and the Royal College of Nursing.
2. Review of Quality
Goals Agreed with Commissioners - CQUINS
A proportion of Northern Pathways‟ income in 2013/14 was conditional on achieving quality
improvement and innovation goals agreed between Northern Pathways and the regional
commissioners for the provision of NHS services, through the Commissioning for Quality and
Improvement payments framework. Garrow House has accomplished 100% of the CQUIN
targets for 2013/14.
Patient Safety
Through the quarterly Governance Committee patient safety has been assessed. An
analysis of all incidents is undertaken monthly through the service governance and this
group reports to the quarterly Governance Committee. To date, the service has been a high
incident reporting service and the Committee wished to analyse the type of incidents and
trends to determine any improvements to service delivery.
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Incidents and Accidents – Incident Severity
This table demonstrates a decrease of moderate incidents from April 2013, which may
account for an increase in low incidents in this time period.
Incidents and Accidents – by highest five
GH Total Incidents
35
Self harm
30
Aggressive/ Challenging
Behaviour
Medication
25
Accidents
20
15
10
5
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Mar-14
Feb-14
Jan-14
Dec-13
Nov-13
Oct-13
Sep-13
Aug-13
Jul-13
Jun-13
May-13
Apr-13
Mar-13
Feb-13
Jan-13
Dec-12
Nov-12
Oct-12
Sep-12
Aug-12
Jul-12
Jun-12
May-12
Apr-12
0
This year has seen an overall decrease in incidents at Garrow House, with spikes of activity
in August 2013 and December 2013. There has been a decline in self- harm and aggressive/
challenging behaviour again with peaks in September 2013 (self-harm) and December 2013
(aggressive/ challenging behaviour). These peaks relate to one woman who had a period of
difficulties in her family dynamics and a general increase in incidents over the Christmas
period.
Clinical Effectiveness
Outcomes
To enable us to evidence that the women are able to move forward significantly in their
recovery, we utilise a number of outcome measures within the service. Recovery Star and
HoNOS data are collected using the Symptom Checklist- 90 (HCR-20). The data from
routine risk assessments (HCR-20 and START) is also recorded as an outcome measure.
All women have an initial Recovery Star within 2 weeks of admission to the service and
thereafter complete a self-assessment, with a staff member, quarterly, to evidence their
recovery journey. The results of these are entered into our Client Information Management
(CIM) system. The following graph shows the average recovery star scores for individuals in
the Garrow House at the end of March 2014.
1: Managing Mental Health
2: Self Care
3: Living Skills
4: Social Networks
5: Work
6: Relationships
7: Addictive Behaviour
8: Responsibilities
9: Respect and Self Esteem
10: Trust and Hope
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Complaints, comments and compliments
One measure of quality around patient experience used by Northern Pathways is the
analysis of the complaints, comments and compliments made by the service users.
Garrow House received one formal written complaint in 2013/14. Any complaints are
addressed informally and at the earliest opportunity as the first step, however a complaints
procedure is in place, should the complaint escalate. There have been 24 recorded
compliments, and these are some of the compliments received at Garrow House during this
year.
 Card - To all the women at Garrow House. Thank you for all your support. I just want
to wish you all the best. Thank you for your help and advice. Good luck in everything
you do.
 One of the Women complimented Project Worker SG and Social Worker JR on
helping her find suitable accommodation to move on to and for attending a meeting to
support her when meeting somebody who was assessing her.
 Occupational Therapist HW complimented one of the Women on getting a property to
move into in the Community. She then in turn complimented Social Worker JR for
assisting her with this.
 Card - Thank you very much for all you have done for me whilst at Garrow.
 Card - Thank you so much for having me. You have made my placement with you so
enjoyable and have all taught me so much.
 One of the Women thanked Project Worker SG for her ongoing work and support with
locating housing.
 One of the Women complimented all the Women and staff for their ongoing support
during a difficult time
 One of the Women complimented OT HW for taking her to view her new flat
 One of the Women complimented and thanked Support Worker BC on helping her
and supporting her whilst on Home Leave
 One of the Women complimented the Domestic Staff on their hard work
Staffing
Starters and Leavers
5
Starters 13-14
Starters & Leavers
Leavers 13-14
4
Starters Prev.
Yr
3
2
1
0
Apr
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May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Additional spend has reduced since December, and is less than 10% of payroll. Most of the
spend is on staff overtime.
The average lost working days per FTE remains low and January was the first recording of
long term sick for this period.
Women’s Experience
The Women have been involved in a number of workshops:
1. Self-catering and getting feedback about how this was working and any areas that
could be improved.
2. Equality and Diversity and stopping hate crimes.
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3. Chain Analyses to ensure that the Women were aware of what these are used for,
when they would be used and how they worked. Women also gave feedback on how
this process could be improved.
External
Two of our Women recently attended the i4i Regional meeting where discussions amongst
Service Users and staff were held on what work the Regional Involvement Leads would
focus on and how they could best be involved both regionally and within individual services.
Another of our Women continues working with the Department of Health and the CQC. She
has also recently been successful in gaining work with the Royal College of Nursing.
Internal
We have a Woman as a Service User representative at our monthly Recovery and
Outcomes meetings. At present the Women have chosen not to have a representative
attending the Policy meetings, instead preferring the Involvement Coordinator to attend and
then offer feedback to the Women.
The weekly Involvement Group is now up and running, with the Women continuing to be
supported to be involved with various procedures in the house and how they could become
more involved within the service. During this group the Women have recently reviewed the
House Rules, being involved in changing the Women‟s MDT sheets, reviewing the
Community Meeting agenda, and we have also looked at re-designing the Women‟s Guide
to Garrow House. In the future we plan to have one of the Women attending the Monthly and
Quarterly Governance meetings as a Service User representative for Garrow House.
Staff and Women at Garrow House took part in a Dreams and Stories workshop. The idea
behind the day was to look at what the service does well, what the service could do better
and how the service might achieve its goals. The day was also attended by Turning Point
Area Operations Manager (Gaye Flounders) and the Area Development Manager/Mental
Health Business Unit Involvement Lead (Julie Virgin).
“I enjoyed spending the day with Garrow House staff and women, hearing about the
positives and challenges around running a successful service for Women with high support
needs. It was good to hear honest feedback from both staff and the women about how
Garrow House could be improved but also to hear positives about the service, especially the
Women who have built more independent lives” Julie Virgin (Turning Point Area
Development Manager)
There have been recent interviews for Support Worker posts and one of the Women
participated in these interviews. One of the Women also attended and participated in
interviews for the Social Worker role which were held in Rotherham.
The first edition of The Garrow Times was produced with a collection of interviews, reports,
jokes and information. The editorial team is made up of both staff and women at the House.
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3. What Others Say About Us
CQC statement
Garrow House, Northern Pathways is required to register with the Care Quality Commission
and its current registration status is registered. CQC undertook two inspections during
2013/14 and Garrow House was fully compliant The CQC has not taken any enforcement
action against Northern Pathways during 2013/14.
Here are some of the of CQC comments from an inspection made in March 2014.
Comments from the women were all positive. We heard “It‟s really helped
me being here”. “Everything is great”.
We visited on a day when the women were each having a review of progress of their
„recovery star‟. The recovery star is part of the shared pathway and links into the
multi-disciplinary team. Progress is discussed and updated scores mutually agreed.
Staff told us that if there is a difference of opinion which cannot be resolved, the
woman‟s views are recorded on the plan. Staff told us the plans travel with the women
if they are transferred to another hospital.
We reviewed a selection of the electronic case notes. We found in all cases very
detailed care plans are in place with evidence of the women‟s involvement and
participation clearly recorded. We saw that copies of care plans are held by the
women. We found the MHA admission documents in the files we reviewed to be in
order with all the processes recorded appropriately. Staff told us “we have an
excellent service from the MHA office”.
Women’s Statements
Garrow is a nice calm homely atmosphere but I think it would
benefit from having additional staff. I also think it would be good if
we had step down flats to prepare us for the community somewhere
in the Retreat grounds. This would be good as we could benefit from
consistent familiar support whilst re-integrating into the
community
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I have never lived anywhere like Garrow House before. The first thing
I noticed was that there were no high fences and that felt lovely and
more like a home. I have had more freedom to go out to the shops, I’ve
been to the pub to watch football and to a live game. I am able to visit
my daughter and build a relationship with my baby
granddaughter.
The freedom and independence I have found at Garrow have been
very liberating and there is one thing I will say and that is that in
some way we are all a happy, if not dysfunctional , family. One
thing (on the negative side) is that there is not always enough
staff. In general, I find Garrow an empowering and inspiring
service.
Commissioner Statement
Garrow House has had a continued period of stability over this last year. The involvement of
women and the experience of women who have been placed in Garrow House continues to
be of a high standard. However, the service is still experiencing difficulties maintaining the
partnership involved in Northern Pathways cited previously and the partnership will have to
focus on ensuring that these difficulties to do not begin to have an impact on the ability of the
service to maintain the previously achieved high standards. The biggest challenge for the
service going into the next 12 months will be adjusting to the new commissioning
arrangements. The service will need to embrace a new specification and straddle the difficult
gap between the women‟s forensic and Tier Four Personality Disorder pathways.
Mick Burns
Senior Commissioning Manager
Secure and Specialist Mental Health Commissioning
NHS England South Yorkshire & Bassettlaw
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Healthwatch Statement
Thank you for giving Healthwatch York the opportunity to comment on your Quality Account
for 2013/14. We found the Account to be well presented and it very clearly demonstrates the
organisation‟s commitment to providing high quality services.
We particularly welcome the establishment of the weekly Involvement Group. Supporting
women to be more involved within the service will contribute to the homely and positive
atmosphere already established at Garrow House.
It was pleasing to see that statements from women who are or have been service users are
included again. This really helps to paint a picture of what it‟s like to live at Garrow House.
We look forward to any opportunities for working with Garrow House over the coming year.
Carol Pack
Information Officer, Healthwatch York
15 Priory Street York YO1 6ET
01904 621133
www.healthwatchyork.co.uk
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4. Glossary
CCG
Clinical
Commissioning
Group
Is a statutory NHS organisation, representing groupings of GP
Practices, that are, from April 2013, responsible for designing local
health services In England. They will do this by commissioning (or
buying) healthcare services. There are 211 CCGs in England.
CQC
Care Quality
Commission
The independent regulator of health and social care in England. It
regulates health and adult social care services, whether provided by
the NHS, local authorities, private companies or voluntary
organisations.
CQUIN
Commissioning
for Quality and
Innovation
Measures which determine whether we achieve quality goals or an
element of the quality goal. These achievements are on the basis of
which CQUIN payments are made.
HoNOS
Health of the
Nation Outcome
Scale
A widely used routine clinical outcome measure used by English
mental health services.
A group of different types of clinicians who work together as a team.
MDT
Multidisciplinary
Team
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For more information on Garrow House or to give feedback on
these accounts please visit our website on
http://www.northernpathways.co.uk/ and complete a contact
form.
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