Quality Account
2013-14
Contents
Part 1
Introductions
5
Statement from the Chief Executive
What is a Quality Account?
Our approach to improving quality
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Part 2
2014-15 Priorities
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Our quality priorities for improvement during 2014-15
Priority 1: Patient Safety – Having the right staff in the right place at the right time,
with the right skills
Priority 2: Patient Safety – Dementia
Priority 3: Clinical Effectiveness – Discharge Planning
Priority 4: Clinical Effectiveness – To undertake a review of patient pathways from
acute to community hospitals
Priority 5: Patient Experience – Continuations of Compassion in Practice (6 C’s)
Other areas of quality improvement for 2014-15
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Part 3
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Review of 2013-14 achievements
Priority 1: Patient Safety – Pressure Ulcers
Priority 2: Patient Safety – Dementia Care
Priority 3: Clinical Effectiveness – Discharge Planning
Priority 4: Clinical Effectiveness – Mental Capacity Awareness
Priority 5: Patient Experience – 6 C’s
The East Cornwall Integrated Respiratory Team
Parkinson’s Disease Service
Safety Thermometer
Blood Transfusion Management
Patient Experience
Complaints and Compliments
Nutrition and Hydration
Frailty
SystemOne
PCH Dental Ltd
PLACE
Clinical Research
Urodynamic Investigation Service
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Contents
Bladder and Bowel Specialist Services – Adults & Children
Resuscitation Team
Newquay Community Hospital Re-design
Serious Incidents
4 R’s
Health and Safety
Innovations and developments
• Femmeze®
• Koala Cable Project
• Newquay Pathfinder
Statutory Statements concerning quality of services
• Care Quality Commission
• Maintaining Essential Standards for Registration with CQC
• NHSLA Assessment
• Eliminating Mixed Sex Accommodation (EMSA)
• Audit Participation
• Data Quality
• Information Governance
• Clinical Coding Error Rate
• Research
• Goals agreed with Commissioners
Our Services
Part 4
Isles of Scilly
Focus on the Isles of Scilly
Our Services on the Isles of Scilly
Part 5
What others say about us
Cornwall Overview and Scrutiny Committee
Isles of Scilly Overview and Scrutiny Committee
NHS Kernow
Healthwatch Cornwall
Healthwatch Isles of Scilly
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Contents
Part 6
Statement of Assurance
Statement of Assurance
Glossary
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Part 1
Introductions
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Peninsula Community Health | Quality Account 2013-14
Part 1
Statement from the Chief Executive
I am pleased to present the third Peninsula Community Health Quality
Account; it is my first Account since becoming Chief Executive in July last
year. My commitment as Chief Executive as I begin my first full year with PCH,
is to ensure that we are an organisation that is relentless in our pursuit of
patient interests. Exceeding the expectations of our patients and the
communities that we serve must always be what drives us.
This Account reviews what has been achieved in 2013-14 and describes our
priorities for improvement for 2014-15. I hope it provides interesting and useful
information to our commissioners, partners, staff, and most of all, to our
patients and the wider community.
Our priorities for improving patient safety, clinical effectiveness and the patient
experience of our services in 2014-15 are set out in Part Two of our Quality
Account. Part Three demonstrates our progress in the priority quality
improvement areas identified in our 2013-14 Quality Account. In producing this
Quality Account we have taken into account the following specific sources of
information:
•
•
•
•
Patient and public surveys including the Friends and Family Test
Responses from staff and stakeholders to the draft priorities for 2014-15
Monthly performance reports to the Board
Reports from key functions such as infection prevention and control,
health, safety and risk, incident management, information governance
and safeguarding
• Monthly reports from the localities
• Reports from our internal auditors
2013-14 has seen Peninsula Community Health grow in prominence as the
leading local provider for community health services, delivering exemplary
outcomes for patients and service users across Cornwall and Isles of Scilly.
The past year has seen us further develop improved systems and processes
to ensure that care we provide is of an excellent standard and meets the
expectations of patients and service users.
We will continue to work closely with our health and social care partners,
voluntary sector and patient representatives to identify quality improvement
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Peninsula Community Health | Quality Account 2013-14
Part 1
Statement from the Chief Executive
priorities for the population we serve. An example of this is the Newquay
Pathfinder Project. The project aim was to improve integrated working
between health, social care and voluntary services, to reduce the risk of
inappropriate hospital admissions for patients with multiple long-term
conditions. I am very proud of the team and their achievements which were
recognised by receiving a National award for the long-term conditions at the
Health Service Journal Awards in November 2013.
Our staff continue to work tirelessly to provide the highest quality of care
throughout Cornwall and the Isles of Scilly and I am proud that we employ
such dedicated, hardworking and compassionate individuals, who seek to
improve the lives of patients, service users, families and carers at every
opportunity.
The forthcoming year brings challenges to PCH, not least in relation to the
requirement for financial sustainability and the increasing costs associated
with healthcare. As an organisation we are committed to ensuring that these
continuing issues do not impact negatively on frontline service delivery or the
excellent quality care, patients and service users have come to expect from
PCH.
PCH has considered the 290 recommendations in the Francis Report and also
the government’s response in the Hard Truths document. The safety and wellbeing of our patients is paramount to us and so is our commitment to ensure
we have the right staff, with the right skills providing the right care in the
right place. We have held staff engagement sessions to ensure we work
together on implementing the recommendations from these important reports.
Our key achievements in 2013-14 include:
• No MRSA bacteremias
• No breaches in Mixed Sex Accommodation
• A reduction in patients length of stay in hospital by an average of 7 days
on the previous year, ensuring patients are cared for in the most
appropriate environment and reducing delays
• We have maintained CQC registration without condition
• Formation of PCH Dental Ltd
• Implementation of the values of the 6 C’s
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Peninsula Community Health | Quality Account 2013-14
Part 1
Statement from the Chief Executive
• Reduction in grade 3 and 4 pressure ulcers
• Improved ward environment for patients who have dementia
• Commenced roll out of a new computerised patient record across
community services
• Pioneer Status - We are delighted that out of the 99
UK bids, Cornwall is one of 14 areas chosen from across England to be
awarded Pioneer Status. Pioneer Status will give us additional support
to develop integrated or 'joined up' health and social care services.
Integrated services enable the individual to move easily from one service
to another; only telling their story once to anyone involved in their
care regardless of who they work for; knowing who is supporting them
and why.
• The £1million Department of Health funded NHS Patient Feedback
Challenge was launched in March 2012. The programme has developed
and spread good and innovative practice for using patient feedback to
improve healthcare services. The Kinda Magic was a PCH project which
focussed on real time patient feedback and looking at ways to capture
patient experiences particularly of those patients who may find it difficult
I would like to thank all of the staff who have contributed to this Quality
Account. I would like to confirm that this Account has been reviewed and the
content agreed by the Peninsula Community Health Board.
To the best of my knowledge the information shared in this Quality Account is
reliable, accurate and represents a true picture of our performance during
2013-14.
Steve Jenkin
Chief Executive
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What is a quality account
This is our third published Quality Account and it follows the format and content laid out in the
Department of Health Guidance 2010-11, where relevant to independent providers of
community health services.
The Quality Account provides a structure for us to report on the three key elements of the
quality of care that a person using our services receives, as illustrated in the figure below.
Our approach to improving quality
We are pleased with our achievements to date but are far from complacent. We
are determined to make continuous improvements to our service. We recognise
that high quality services can only be delivered by motivated, skilled and
engaged staff and that we need to continue to support them to deliver improved
quality of service. Staff involvement is a key principle of the social enterprise
model and as such we have well developed staff and clinical forums to ensure
the voice of the workforce is heard. This is essential to maintain and improve
quality. We have a rigorous process of internal performance management and
assurance of service quality, in all our services, across the area we serve.
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Part 2
2014-15 Priorities
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Peninsula Community Health | Quality Account 2013-14
Part 2
Our quality priorities for improvement 2014-15
In determining our quality priorities for 2014-15 we are continuing to strive to
make tangible improvements to the care of our patients. This is set within the
context of delivering care in community hospitals and in the community,
avoiding unnecessary hospital visits and admissions. This is an important
element of improving the quality of patient care.
It is critical that we focus also on the culture of the organisation and ensure
that this is founded on the values of the 6 C’s – Care, Compassion, Courage,
Communication, Competence and Commitment. As the Director of Nursing
and Professional Practice this will be my priority for the year ahead – to
ensure, engage, empower and encourage a culture where everyone feels able
to provide the highest standards of care, every time, for every patient.
I want us to be an organisation which has the courage to be open when
things go wrong and to have the competence to deliver what is expected and
needed from us.
We need to ensure communication that is truly and fully focused on the
needs of the patients using our services and their family and carers, and that
we have the compassion to always be present in the moment for the people
we care for and work with.
I want us to have the commitment to always give our best, and most
importantly, to be a caring organisation that always provides quality care
closer to you.
This is my pledge to you.
Helen Newson
Director of Nursing and
Professional Practice
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Our quality priorities for improvement 2014-15
To shape the areas that Peninsula Community Health should focus on for quality
improvement in 2014-15, we have sought the views of our patients, staff and stakeholders in
a number of ways, including:
•
•
•
An analysis of themes from complaints received, incidents reported and concerns
raised through our Patient Advice & Liaison Service (PALS) during 2013-14
Feedback from stakeholders and staff to our draft priorities
Discussion with our staff in teams, committees and engagement events
After careful consideration of the main themes emerging from the feedback and linked to the
national and local objectives, we have agreed the five key priorities for 2014-15
 Patient Safety:
 Patient Safety:
 Clinical Effectiveness:
 Clinical Effectiveness:
 Patient Experience:
Priority
Having the right staff in the right place at the right
time, with the right skills
Dementia
Discharge Planning
To undertake a review of patient pathways from
acute to community hospitals
Continuations of Compassion in Practice (6 C’s)
 for 2014-15: Patient Safety
Having the right staff in the right place at the right time, with the right skills
Having the right staff in the right place at the right time, with the right skills is a
fundamental element to the delivery of safe, high quality care for our patients.
What are we going to do?
Plan and implement the recommendations
How?
Steering group in place and action plan developed
By when:
Key recommendations will be met throughout 2014-15, but
certain elements will require a longer term plan to ensure
sustainability
Project lead:
Trish Cooper, Deputy Director of Nursing and Professional
Practice
Board Sponsor:
Helen Newson, Director of Nursing and Professional
Practice
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Peninsula Community Health | Quality Account 2013-14
Our quality priorities for improvement 2014-15
Nursing and care staff, working as part of wider multidisciplinary teams, play a critical role in
securing high quality care and excellent outcomes for patients. There are established and
evidenced links between patient outcomes and whether healthcare organisations have the
right people, with the right skills, in the right place at the right time.
Compassion in Practice emphasises the importance of getting this right, and the publication of
the report for the Mid-Staffordshire NHS Foundation Trust Public Inquiry, and other reviews by
Professor Sir Bruce Keogh into 14 trusts with elevated mortality rates, Don Berwick’s review
into patient safety, and the Cavendish review into the role of healthcare assistants and
support workers, also highlighted the risks to patients of not taking this issue seriously.
The National Quality Board and the Chief Nursing Officer (England) have set out the
expectations of NHS Providers and Commissioners in respect of nursing and care staffing
capacity and capability. During 2013-14 PCH has commenced the work to meet the
expectations, not only because it is a requirement, but also because it is the right thing to
do.
Priority
 for 2014-15: Patient Safety
Dementia
What are we going to do?
Build on the work already commenced and implemented in
2013-14. Also, this year we will be introducing the Kinda
Magic Project, where we will start to implement patient
experience metrics with patients and their carers
How?
Steering group in place and action plan developed
By when:
We will begin to pilot patient experience metrics in the next
6 months and the information gathered will help us to focus
on new areas of improvement
Project Lead:
Sue Greenwood, Dementia Lead
Board Sponsor:
Helen Newson, Director of Nursing and Professional
Practice
We want to continue to raise the standards of knowledge and skills in staff, being able to
proactively deal with patients that become acutely distressed and confused on our wards.
We aim to provide education to enable staff to increase their skills and feel confident in the
way they manage and de-escalate situations.
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Our quality priorities for improvement 2014-15
Priority
 for 2014-15: Clinical Effectiveness
Discharge Planning
To further improve effective discharge planning to reduce length of stay and to
ensure patients and carers are informed and involved in all stages of the process,
leading to reduction in readmission rates to acute and community hospitals.
What are we going to do?
Build on the work already commenced and implemented
in 2013-14.
How?
There is a programme board in place which monitors the
actions and outcomes.
By when:
March 2014
Project Lead:
Trish Cooper, Deputy
Professional Practice
Board Sponsor:
Helen Newson Director of Nursing and Professional
Practice
Director
of
Nursing
and
We also want to concentrate on the time of day discharges occur. At PCH we do not
discharge patients overnight, but do appear to discharge more people in the afternoon, we
want to understand the reasons for this and ensure we are arranging discharges in line with
what is right for the patient. Previous work undertaken by the Department of Health has
indicated that hospitals should be discharging more patients in the morning; this helps
people to settle in at home, and identify any issues earlier in the day which can then be
resolved more swiftly and prevent people from being readmitted, because their discharge
home has not gone well. We want to work more with our voluntary organisations to ensure
patients have all the support they need when they go home.
All hospitals participate in the community hospital working group where new operational
procedures are developed. Previously we collected information on historical times of day of
discharge, but this year we will be monitoring this on a daily basis and developing patient
experience metrics to allow us to check if patients are happy with their discharge and what
we can do better.
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Our quality priorities for improvement 2014-15
Priority
 for 2014-15: Clinical Effectiveness
To undertake a review of patient pathways from acute to community hospitals
What are we going to do?
Work with our health and social care partners to develop
pathways for specific conditions.
How?
Working with partners, audit review
By when:
March 2014
Project Lead:
Nicky Harvey, Intermediate Care Lead
Board Sponsor:
Helen Newson Director of Nursing and Professional
Practice
We will ensure that PCH continues its commitment as a key partner in the urgent care
programme in Cornwall & Isles of Scilly by supporting the management of more patients in
the community and reducing the need for hospital admissions. Smoothing the pathway of
patients from the acute hospitals to community hospitals helps to achieve care provision in
the right place in a timely way. In 2014-15 PCH will be commissioning an extensive
independent audit of how community hospital beds are utilised. We hope this will inform our
work on pathways across acute and community settings.
Priority
 for 2014-15: Patient Experience
Continuations of Compassion in Practice (6 C’s)
To ensure patients are treated with respect and dignity.
What are we going to do?
Update our Whistleblowing Policy; ensure we adopt all the
elements of the Duty of Candour, continued staff
engagement and assessing all complaints and
safeguarding alerts in line with the 6 C’s
How?
As you will see on page 30 PCH has already embraced
the 6 C’s, we have held a staff workshop, Board seminar,
shared information on our website and have an
organisational action plan which is being led by our clinical
leaders.
By when:
March 2014
Project Lead:
Community Hospital Matrons
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Our quality priorities for improvement 2014-15
Board Sponsor:
Helen Newson Director of Nursing and Professional
Practice
Compassion in Practice sets out the shared purpose for nursing and care staff to deliver
high quality, compassionate care and to achieve excellent health and wellbeing outcomes.
The three-year strategy is built on the enduring values that underpin care wherever it takes
place; to allow each nurse and care worker to deliver the high quality care that patients
expect and that nurses and care staff want to deliver. The strategy centres on core values
and behaviours, recognised by patients and carers alike, which are encapsulated in the 6
C’s: Care, Compassion, Competence, Communication, Courage and Commitment. Each of
these key concepts has been defined through extensive consultation with patients, nurses
and care staff.
Next steps
•
To develop a website page for patients to publicise the work being undertaken.
•
To develop a website for staff so they can sign up to the 6 C’s. To source and fund 6
C’s badges for staff.
•
To continue to nurture the buzz generated by the workshop and to arrange another
workshop day to develop some of the ideas further.
•
Further workshops will be held to monitor progress and develop the ideas further.
Our five priorities for improvement for 2014-15 are
not the only areas of quality enhancement planned
for 2014-15. We will also deliver the quality
improvements outlined in our contract and CQUINs
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Part 3
Review of 2013-14
achievements
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Peninsula Community Health | Quality Account 2013-14
Part 3
Review of 2013-14 Quality performance
Outlined in this section is a review of our quality performance
against the priorities set in the 2012-13 Quality Account.
Priority  for 2013-14: Patient Safety
Introduction
Pressure ulcer prevalence is the total number of patients with pressure damage over a
period of a month. This is calculated on the number of pressure ulcers, not the number of
patients. Incidence is an indicator of the extent to which pressure ulceration is occurring
within a specific environment. Pressure Ulcer Incidents are reported via the Datix Incident
Reporting System by practitioners within Peninsula Community Health (PCH) following the
detection of a pressure ulcer. The information in the following report is provided via the
Datix system.
Incidence allows for the investigation of:
• Quality of care provided to prevent pressure damage.
• The impact of educational initiatives aimed at reducing the number of pressure
ulcers occurring
• The need for equipment to relieve pressure
Ward Mangers/Team Leaders are responsible for ensuring all pressure ulcers from Grade
1-4 are entered via the Datix system. Data is then analysed by the tissue viability service.
The information required to be reported by staff needs to include:
1. Site of pressure damage
2. Stage of pressure damage
3. Whether the patient was admitted to our care with pressure damage and site
of admission
Examination of these criteria focuses upon the number of ulcers rather than the number of
patients and some patients may have had more than one pressure ulcer. The Tissue
Viability staff review the incident and compare with the Safety Thermometer information to
ascertain if there is an increasing incidence or trend within a particular team.
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Review of 2013-14 Quality performance
Grade 2 Pressure Ulcers
The number of patients developing Grade 2 pressure ulcers whilst in community hospitals
in PCH has had a sharp decrease over the last three months of 2013 (January-March
2014). Since the introduction of the Pressure Ulcer Reduction group in May 2013 there
was an initial increase as reporting improved, however as initiatives have been introduced
and become embedded, there has been a steady decrease in Grade 2-4 pressure ulcers,
with no grade 3 and 4 pressure ulcers reported as developing during February and March
2014 in Community Hospitals.
Grade 2 pressure ulcer acquired in the patients’ own home and in Residential homes with
PCH care reduced steadily during April-September 2013 increased during OctoberNovember 2013, and has started to decline in January-March 2014. Incidence of pressure
ulcers within the District Nursing service is presently being validated via the Tissue Viability
team. There is evidence to suggest that not all teams are reporting via the Datix Incident
Reporting System. This is being addressed by targeted training within teams and individual
staff. Grade 3 and 4 pressure ulcers have remained consistent.
The majority of pressure ulcers are occurring in the patients’ own home, with a large
number still occurring in Residential Homes. At this time domiciliary care agencies involved
with patients living in their homes are not recording pressure ulcer damage on an incident
reporting system which can be seen by health staff.
It is important to recognise the hard work that teams have undertaken in implementing the
recommendations of the pressure ulcer reduction group. There has been a 50% reduction
of grade 2 pressure ulcers and there has been a 60% in grade 3-4 pressure ulcers in the
community. In community hospitals there has also been a 60% reduction in grade 1-2
pressure ulcers. There were 5 grade 3-4 pressure ulcers at the beginning of 2013-14, with
0 at the year end.
Our future work for 2014-15 to continue to reduce the incidence of
pressure ulcers includes:
1. Implementation of PERSUE check list in all community teams.
2. Implementation of review of all patients if frailty 5 or above.
3. Implementation of SKIN bundles to all District Nurse Teams, Residential Homes and
Care Agencies
4. Implementation of Red flag recording at nurse handover
5. Review of manual handling techniques to avoid patients from acquiring pressure
damage due to shearing injuries
6. Review of patients who are at risk of heel damage to develop a multidisciplinary
pathway
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Peninsula Community Health | Quality Account 2013-14
Review of 2013-14 Quality performance
Priority  for 2013-14: Patient Safety
Protect the quality of care and dignity of patients with dementia
Developing a Dementia Friendly Organisation
One of our biggest achievements was to be successfully awarded a grant of over half a
million pounds from the Prime Minister’s Dementia Challenge to invest in our community
hospitals environments to make them more dementia friendly. This project was originally
developed in conjunction with the local acute provider – Royal Cornwall Hospitals Trust and
integrates the care pathway for patients with a consistent approach to colour coding doors
and Wayfinding both between acute/community hospitals but also across the health service
within Cornwall.
The environmental improvements were also developed in accordance with feedback from a
number of forums, these included: RCHT, Alzheimer’s Society, dementia champions and
the Local Dementia Leadership Group (people living with dementia).
As people with dementia comprise an ever-growing proportion of people using health
services, it is essential that health environments are tailored to their needs. An unsuitable
care environment can have a significant negative impact on someone with dementia. But
the solutions are often surprisingly simple.
How care environments affect people with dementia
Being admitted to hospital is a potentially frightening experience that can cause agitation,
disorientation and distress in any patient. For someone with dementia, this anxiety is often
increased by unfamiliar surroundings and the heightened sensory challenges associated
with a busy hospital ward or department.
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Review of 2013-14 Quality performance
Someone with dementia may:
•
•
•
•
•
•
•
•
•
be confused and agitated in unfamiliar environments
become restless and distracted in environments that are visually over stimulating or
where there is competing visual information, such as highly patterned wallpaper or
too many notices or signs
have difficulty seeing handrails, toilet seats or doors, or the food on their plate, if
these are the same colour as the background
avoid stepping on shadows or coloured strips on flooring, because they may look like
a change of level
resist walking on shiny flooring because it looks wet or slippery
misinterpret reflections in mirrors, windows and shiny surfaces
have difficulty hearing or understanding conversations if there is competing
background noise – for example, from a television
have a reduced tolerance for sound and feel anxious in situations with unfamiliar or
loud noises
feel curious and want to walk around
The detrimental effect of hospital stays on the independence of people with dementia is
well documented (Alzheimer’s Society 2009), and there is widespread awareness of the
problem. Many patients lose their independence during a period in hospital if they are
unable to continue with their daily activities. As a result, they may not be able to return
home when the acute episode of care is completed. This can be devastating, both for them
and their families (Alzheimer’s Society 2009).
An exciting and innovating programme of work has been undertaken throughout 2013/14
within Peninsula Community Health, which has led to significant improvements to the
environments of our hospital wards and departments. The basis for these changes and
aims of the project were, to follow principles of the Kings Fund – Developing Supportive
Design for people with dementia
The work undertaken has included:
The covering of patient related doors with a coloured acrovyn which has changed the
environment for the better with colour which we know benefits a number of patients,
including those with dementia. The addition of sign posting further adds benefits including
dignity, confidence for those in unfamiliar surroundings.
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Peninsula Community Health | Quality Account 2013-14
Review of 2013-14 Quality performance
We have really looked to de-clutter all ward and department areas, and introduced a
reception and/or multi professional base to enable patients and visitors to clearly identify a
point where they obtain help and support. This has been undertaken by clear colour coding
with supporting signage.
Projecting signs have been put into place above toilets to sign post patients as well as
where Matron/Sister’s offices are located. Signage on all doors clearly identifies if it is a
staff only area or what room it is i.e. side room and number, bay name/no, toilet
male/female, day room, visiting times clearly displayed as well as ‘protected meal times’ to
ensure that time can be spent assisting patients where this is necessary.
Wayfinding to areas, like toilets and day rooms, where it is not obvious, helps patients
become more independent. Calendar clocks have been displayed to provide both time and
date for orientation.
Toilet seats will be provided in a colour to make them stand out and increase continence
and dignity for patients.
Directional signage increases the independence of patients which promotes better privacy
and dignity by increasing patient confidence in locating where they need to go for things like
toilets, bathrooms, day rooms, Matron/sisters, reception. This in turn can reduce the stress
a patient feels when they are in unfamiliar surroundings.
In working through the project with RCHT, the colours of doors and signage ensures
consistency for patients moving from the acute to community hospitals.
As we near the completion of our work it’s important to say that initial feedback from our
patient’s carers and staff has been overwhelmingly positive. A fuller evaluation of the
impact will be completed over the next 12 months.
Dementia Champions
We now have 65 active dementia champions spread across the organisation which is a
testament to our staff’s commitment to want to provide quality services to all of the people
we care for. Our dementia champions work in many of our multi professional teams across
Cornwall and the Isles of Scilly promoting the care of people with dementia. They have
passion, commitment and enthusiasm to ensure that people with dementia are supported
and provided with the best care.
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Peninsula Community Health | Quality Account 2013-14
Review of 2013-14 Quality performance
Dementia work improvements
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Review of 2013-14 Quality performance
Knowing the Person
In February 2014 we held a workshop for staff working across health and social care and
the independent sector to introduce person centred approaches to care. Named “knowing
the person” means exactly that. It encouraged staff to get to know the people who we
provide care for, and introduced the concept on One Page Profiles. Personalisation is a
genuinely responsive approach that delivers what people want, in the way they want it, by
people they want to receive it from. Personalisation builds upon person centered care, with
an increased focus on choice and control for the individual. At its heart, personalisation is
about observing, listening and understanding what makes a person tick, what gives them
hope, enjoyment and meaning in their everyday life, and then tailoring care and support to
help them either attain or retain these. Personalisation starts with the person: knowing who
they are, what matters to them and how they want to be supported. A one page profile
therefore is the foundation of personalisation. A one page profile describes what people
value about someone, what is individual about them, what is important to them and how
best to support them. It reflects the balance between what is important to the person and
how we can ensure they stay as healthy, safe and well as possible. We know that patients
frequently have to tell their story. A one-page profile is a description of who the person is on
one page. It describes what matters to them, so that the patient is known as an individual,
and how to support each patient well, from their perspective. This helps not only patients
only telling their story once, but knowing them as people, not just patients. The day was a
real success and sets a firm foundation for us to build on as we progress in becoming a
person centred organisation.
Person-Centered Practices and Health and Wellbeing in Cornwall and
Isles of Scilly Workshop
The purpose of this day which is being held in June 2014 is to introduce and explore how
specific person-centered practices can support health and well-being in Cornwall, and to
think together about possible next steps. It will be led by Helen Sanderson and Jo Harvey,
from Helen Sanderson Associates who will be sharing the work they are leading in
hospitals and community settings in the Midlands and the North West, where they are
introducing one-page profiles and a new patient experience.
Dementia Care Best Practice
Funded by NHS Kernow, six PCH staff have just attended a two day course to become
facilitators in Best Practice in Dementia Care with Stirling University and the RCN. From
September, we will be taking 50 support staff through a six month work based course, on
successful completion they will be awarded a City and Guilds qualification in Best Practice
in Dementia Care, this is a very exciting development and is aimed at focusing on our
health care, administrative, therapy support staff. Staff will be fully supported by the six
facilitators through the use of Action Learning Sets across Cornwall and the Isles of Scilly.
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Screening for Dementia
We have also introduced active screening for all patients over 75 for Dementia and Delirium
in all our community hospitals.
Interactive Digital Reminiscence Therapy Units
We have introduced two interactive activity devices that encourage the health and
wellbeing of people with dementia, providing an interactive programme of activities that
promotes thoughtfulness and conversations.
Using touch screens, the simple and easy to use programmes comprise of several simple,
engaging games and thousands of digital media content items, drawing upon carefully
selected photographs, T.V. shows, music and film clips from the 1930’s onwards. All of
which have been specifically chosen for people with cognitive impairment, encouraging
them to reminisce and share their memories. This further supports the work our dementia
champions are progressing every day within Peninsula Community Health.
Dementia Awards
In 2012 we introduced an award across the organisation, in recognition of our staff’s
continuing commitment to provide the highest quality of care to the community we serve.
The teams completed an educational workbook based on essential dementia awareness
and person centred approaches.
It’s great to be able to report that the vast majority of our services have reached a Gold
Standard Award for Dementia Awareness. These awards were celebrated at our Annual
General Meeting in 2013. A number of our Dementia Champions are now progressing to
the Platinum award by completing a level 3 workbook in Dementia Care.
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Review of 2013-14 Quality performance
Priority  for 2013-14: Clinical Effectiveness
Aim: to improve effective discharge planning to reduce length of stay and to ensure
patients and carers are informed and involved in all stages of the process, leading to
reduction in readmission rates
During 2013-14 a great deal of work was undertaken to improve discharge planning within
PCH community hospitals. We have worked extensively with our partners to improve
discharge pathways for patients and a good example of this was our participation in Fall to
Green in November 2013.
Fall to Green commenced on 27th November for one week. There was an enhanced focus
on improving patient flow, ensuring that patients were in the right place for their care, with
no unnecessary delays. Health and social care partners across Cornwall participated.
Clinical staff were released from non-essential tasks to focus on their clinical duties and
non-clinical staff worked with the ward staff as Ward Liaison Officers and offered objective
feedback and support.
Outcomes were:
•
•
•
•
•
•
•
Onward Care team facilitated over 100 discharges from RCHT
Onward care team facilitated over 20 discharges from Plymouth Hospitals.
Commenced live delays information for community hospitals
Live inpatient los (length of stay) for community hospitals
Improved patient experience/Five question discharge questionnaire
Nursing/residential home status available daily
Monitoring morning discharges – at least five a day
A number of the ideas which were tested during this week and which were successful in
improving the quality of patient discharge have been adopted.
The summary below shows some of the work that has been undertaken following Fall to
Green and also by renewed focus and commitment by our staff:
•
•
•
Demarcation between Early Intervention Service community and the development of
the Onward Care Team at Royal Cornwall Hospital to support discharges/transfers
from RCHT
Nurse and Case Co-ordinator on duty at weekends in RCHT and take part of acute
and community weekend communications
A member of the team in Onward Care at RCHT starts work earlier weekdays
(0730hrs) to support morning transfers
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•
•
•
•
•
•
•
•
•
•
•
•
•
•
Facilitating week on week normalisation of weekend transfers and discharges from
both acute and community hospitals
Acute GPs now have attended all Community Hospitals Multi-disciplinary team
meetings to ensure standardisation and quality of meetings.
Admission criteria developed for community hospitals(Stage 1)
Falmouth Medical Cover pilot commenced in early 2014.
Progress Chasers employed in all Community hospitals. These staff members
assist nursing staff with arranging discharges for patients
Discharge documentation reviewed.
Reluctant Discharge policy review.
Onward Care Teams structure review.
New ways of working with volunteers.
Piloting follow up telephone call to patients after discharge.
Reviewing in patient therapy assessment.
Implementation of Swiftplus across West/Central community hospitals. This is a
ward view IT system which allows staff to manage their patients discharge and gives
a realtime view of ward movements
Sitrep (Situation Report) now has live length of stay for each ward. The sitrep is a
twice daily report from all our community hospitals which is circulated to all partners
and includes information on bedstate, admissions and discharges.
Weekday daily conference call with all community wards to progress chase and a
daily call at the weekends with on-call managers/director, onward care team and
RCHT manager to maintain discharges across CHs and complex
transfers/discharges from RCHT
As can be seen from the chart below, all of this work has led to a reduction in patient length
of stay in community hospitals. In April 2013 the average length of stay was 27.7 days and
by March 2014 this has reduced to 21.27 days
PCH is committed to continuing to improve the quality of discharge planning and to ensure
that patients are not delayed and receive their care in the place that is most appropriate. A
continued focus will remain within 2014/15.
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Priority  for 2013-14: Clinical Effectiveness
Safeguarding the needs of vulnerable adults
To safeguard and meet the needs of patients with severe cognitive impairment we
need to improve the way our staff assess and record Mental Capacity and
determination of Best Interest.
Ensuring our patients are safe and able to live free from abuse remains our constant priority
and we strive to ensure that our staff are equipped to recognise and challenge the signs of
abuse and take appropriate steps to safeguard children, young people and vulnerable
adults.
The Safeguarding unit set up in 2012 is working well with the service covered during
periods of leave so that all PCH staff have access to advice and support. The Unit
monitors, supports and provides safeguarding training, reviewing the content of training and
education in order to ensure that it is current and continues to reflect legislation.
The named nurse receives an average 3 calls a day from staff seeking advice and support.
These do not always result in a Safeguarding alert. This totals over 700 calls per year.
Communication and relationships with external agencies has greatly improved with
increased multi-agency working. Attendance at strategic and Safeguarding meetings has
improved resulting in opportunities for shared learning. Reports required by Adult Care
Support & Wellbeing for Safeguarding meetings are now checked by the Named Nurse to
ensure they contain the required information and are in the correct format.
We have worked closely with ACS&W and our staff to improve and streamline process and
we are now seeing a more robust working relationship between the agencies, especially
around triage and thresholds for entry into the Safeguarding Process.
The Procedure for reporting safeguarding concerns has been clarified and communicated
to all staff. Initially there was an increase in alerts made by PCH staff suggesting that
awareness of safeguarding procedures had increased. Now we are starting to see a
reduction in alerts but an increase in reported safeguarding concerns and ability for staff to
seek advice and implement localised safeguarding measures. This indicates that staff are
recognising and acting on what they see and what they hear.
The Named Nurse for Safeguarding has used every opportunity to raise awareness and
educate staff. When staff ring for advice or are approached for a report/information the
opportunity is taken to share knowledge and learning, in order to improve knowledge,
awareness and accountability. This has resulted in more staff seeking advice and
telephone calls have increased considerably.
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Although awareness is greater, we need to continue with work regarding staff assessment
and recording of Mental Capacity and determination of Best Interest. Due to a recent
national legal case, which may change the levels of referrals we make, a programme of
training requirements for all staff will be developed in the next year to ensure all staff have
access to and attend the relevant course, as appropriate. There are also plans to develop a
network of safeguarding/ champions across PCH in each service or ward/team area.
As part of their review of providers in 2013-14, the Care Quality Commission visited all
registered locations within PCH and found staff to be knowledgeable regarding safeguarding
procedures and consistently knew where to seek advice and what to do if they had a
concern.
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Priority  for 2013-14: Patient Experience
Following on from the Mid Staffs and other high profile cases of neglect and poor care in
health services, emerging issues have highlighted that no organisation can afford to be
complacent and think that the shocking examples of poor care could never happen here.
In response to the emerging problems, the Chief Nursing Officer and Director of Nursing at
the Department of Health published a vision for nursing and commenced an engagement
process to develop it. A key part of the engagement process was ensuring the strategy
addressed equality issues under the Equality Act 2010, considering it from the point of view
of both the people receiving the care and those giving it.
At the heart of this vision were 6 fundamental values (6 C’s):
Care. Care is our core business and that of our organisation and the care we deliver helps
the individual person and improves the health of the whole community. Caring defines us
and our work. People receiving care expect it to be right for them, consistently, throughout
every stage of their life.
Compassion. Compassion is how care is given through relationships based on
empathy, respect and dignity – it can also be described as intelligent kindness and is
central to how people perceive their care.
Competence. Competence means all those in caring roles must have the ability to
understand an individual’s health and social needs and the expertise, clinical and technical
knowledge to deliver effective care and treatments based on research and evidence.
Communication. Communication is central to successful caring relationships and to
effective team working. Listening is as important as what we say and do and essential for
“no decision about me without me”. Communication is the key to a good workplace with
benefits for those in our care and staff alike.
Courage. Courage enables us to do the right thing for the people we care for, to speak up
when we have concerns and to have the personal strength and vision to innovate and to
embrace new ways of working.
Commitment. A commitment to our patients and populations is a cornerstone of what we
do. We need to build on our commitment to improve the care and experience of our
patients, to take action to make this vision and strategy a reality for all and meet the health,
care and support challenges ahead. (DOH 2012)
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The responses sent a clear message that has shaped the final vision and strategy. They
were:
•
•
•
•
•
•
•
•
•
•
Making the 6 C’s part of everything we do
Change delivered by frontline staff
Leadership at every level
Training and Development of all staff reflecting the 6 C’s
Creating the right culture
Communicating our vision
Doing this collaboratively with others
Supporting staff health and wellbeing
Shared decision making and communications with patients and the people we
support
Releasing time to care and reducing bureaucracy
National implementation plans have been developed for six action areas where effort can
be concentrated and create an impact for patients and people we support:
•
•
•
•
•
•
Helping people to stay independent, maximising well-being and improving health
outcomes
Working with people to provide a positive experience of care
Delivering high quality care and measuring impact
Building and strengthening leadership
Ensuring we have the right staff, with the right skills in the right place.
Supporting staff experience
PCH Working Group
A working group was developed to engage staff and plan implementation of the 6 C’s
ensuring that representation included staff from the front line in deciding how to implement
the 6 C’s across PCH. Staff are more likely to become engaged in the concept if they are
fully involved rather than being told they have to do something.
Workshops
A successful professional, exciting and well attended workshop was held in October 2013,
organised to promote the concept of 6 C’s and explore and gather ideas and thoughts on
how PCH could implement the actions,
The objectives of the workshop were:
•
•
•
•
To formulate an implementation strategy for the 6 C’s across PCH
To promote the 6 C’s across the Trust
To involve all staff groups in embracing the 6 C’s throughout PCH
To enable the development of communication and working relationships across PCH
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•
•
To form 6 work streams reflecting the Action Areas
To publicise and celebrate what we do well.
The overallaim of the day was to spark a debate encouraging frank and honest discussion
as to how PCH can use the 6 C’s to improve care for our patients and support our staff.
Some large scale projects were suggested but also many small actions that can be done
immediately to make big changes.
Immediate actions were identified that can be implemented across the organisation easily,
as well as larger, perhaps longer term projects that will need work to develop and
commitment from the board to implement.
Overall there is a feeling of positivity about implementation of the 6 C’s that we need to
nurture and take forward. All comments and suggestions from the workshop formed the
basis of an action plan which was publicised across PCH.
Challenges
The workshop highlighted that PCH is already doing much of the actions identified in the
Chief Nurse’s vision and has some very dedicated and enthusiastic staff that daily do an
excellent job. The challenge is to maintain and spread that positivity and engage staff in
any change process.
We should celebrate the positives as well as work to improve the negatives. The challenge
will be to embed a culture of consequences for inappropriate actions without bullying or
blame and positive reinforcement of compassionate care.
The 6 C’s is discussed at a range of forums including Matron’s meetings.The PCH Board
remain updated and committed to the 6 C’s.
The information from the workshop and full details of the 6 C’s was shared at the October
2013, PCH Annual General Meeting.
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Examples of Quality performance of services in 2013-14
The East Cornwall Integrated Respiratory Team
Background
The East Cornwall Integrated Community Respiratory Team (ICRT) was commissioned in
late 2012 and became operational on 04/02/2013. The team consists of a full time clinical
specialist physiotherapist, whose role is combined with Team Leadership of the team.
Specialist Respiratory Nursing, Occupational Therapy (OT), Speech and Language Therapy
(SALT) and Physiotherapy Support Worker are the other posts contained within the team.
The team was commissioned to improve the management of patients with respiratory
conditions, specifically Chronic Obstructive Pulmonary Disease (COPD) for adults in East
Cornwall.
Objectives
Initial objectives for the team were:
1. To increase capacity for Pulmonary Rehabilitation in East Cornwall to meet national
guidance – Impress 2011.
2. Reduction of non-elective hospital admissions for patients with COPD and other
respiratory related illness.
3. To work closely with other teams, including GP’s, the Community Matron Service
and Acute Care at Home Service to provide a seamless service for patients with
chronic respiratory disease and help them stay well and at home.
Progress
Both capacity and access to pulmonary rehabilitation in this area of Cornwall has improved
very significantly. Groups now run in Liskeard, Lewannick, Saltash and Torpoint and the
team are looking at venues in Looe. Clinical outcomes demonstrate significant
improvements in aerobic fitness and reduced levels of anxiety and depression.
Patient feedback from the groups:
•
85% of attendees felt the programme definitely was of benefit and 15% felt that it
was of benefit to some extent.
•
54% of patients felt that they were definitely confident to continue exercising.
•
68% of patients felt more confident to recognise breathing difficulties and how to
manage them.
•
81% of patients felt that they had definitely been given enough support to continue
with an active lifestyle.
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Comments from patients
•
•
•
•
•
‘I found the group most helpful in a social context and the information and exercises a
great help. The staff were excellent and would happily attend similar events in the
future.’
‘I look forward to coming to the group every week. I look forward to meeting new
people. Could the course be extended for a longer period of time. It’s good to get out
of the home.’
‘I appreciate the NHS offering this service. I felt looked after and that I have benefited.’
‘I have found the support group an enormous help. I feel in control of my breathing and
how to pace myself. The team have been excellent – very patient and friendly. I
cannot praise them enough.’
‘I pace myself but I can do it. My family are amazed. They know how good it’s been for
me.’
Data provided by NHS Kernow demonstrates a reduction in hospital admissions for the year
Feb 2013 – Feb 2014. Numerous case studies demonstrate effective and inspiring inter team
working.
Parkinsons Disease Services
Joint Parkinson's/Therapy Project
Aim: To reduce Parkinson’s Hospital admissions by development of a pathway that
identifies the reasons why people with Parkinson’s acutely deteriorate
A Parkinson's Strategy Group has been formed to discuss reduction of hospital admissions
and to improve hospital care. This group comprises representation from Peninsula
Community Health, Royal Cornwall Hospital Trust (RCHT), NHS Kernow & the voluntary
sector.
Baseline information is being gathered to look at how many and where patients with
Parkinson’s disease are being admitted when they become unwell. Also, all incident data
linked to missed doses of Parkinson’s medication is being collated. It will be this group’s role
to analyse all of this information and identify required actions for improvement.
A care plan has been put together for community hospital use and will be adapted for care
home use. This care plan will include a number of triggers for staff to consider when writing
the full care plan with the patient and their carer.
Work in conjunction with the South West Strategic Clinical Network (SWAFT) is underway in
terms of linking with SWASFT to reduce hospital admissions.
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Examples of Quality performance of services in 2013-14
Safety Thermometer
The NHS Safety Thermometer is a national improvement tool, to assist in reducing harm to
patients. The NHS Safety Thermometer was intended to be a local improvement tool for
measuring, monitoring and analysing patient harms and ‘harm free’ care.
The tool measures four high-volume patient safety issues (pressure ulcers, falls resulting in
harm, urinary infection in patients with a catheter and treatment for venous
thromboembolism).
It was first adopted as a National CQUIN and introduced nationally from April 2012. In this
second year of safety thermometer recording the CQUIN for Peninsula Community Health
was split into 3 different elements.
•
•
•
The first element was based on successfully implementing the safety thermometer
across all services that did not collect in 2012-13. This was mainly therapy services
plus a further specialist nursing team.
The second element was based on continued collection of safety thermometer data
between April and October for those services that collected in 2012-13.
The final element was based on an improvement in the prevalence of pressure
ulcers between October and March compared to a baseline set as the median value
for the period April to September 2013.
The safety thermometer process involves recording against the four harms one day a
month on the same day across the entire organisation. All patients in an inpatient area on
the survey day are included, as well as everyone seen in the community on that day or
seen by one of the therapy teams in the community.
N.B. Patients seen in groups or outpatient clinics are not currently included in the safety
thermometer process.
Locally it was agreed that to meet the requirement of the 2013-14 CQUIN PCH would be
required to implement the safety thermometer in all therapy teams by September 2013, in
addition to continued collection in the inpatient wards and community teams
Within the therapy teams a phased approach was taken with some teams commencing in
August and all teams collecting no later than October.
In total 17273 patients have been surveyed. Of these 15660 have suffered no harm
89.44%. A number of these were harms acquired before being admitted to PCH care (for
example patients who were admitted with a pressure ulcer).
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When looking at those with new harms only, acquired since coming under PCH care, 16628
suffered no harm (96.27%).
Whilst the safety thermometer is not primarily a benchmarking tool it is worth looking at the
national safety thermometer harm levels to ensure PCH is not significantly different to the
national picture.
When looking at all organisations and all settings the overall harm free care percentage for the
year to date at 93.11% is higher than PCH at 90.66% and the new harm free care percentage
slightly higher at 97.19% compared to PCH at 96.27%
When comparing PCH wards to all community hospital wards we compare slightly better, with
86.99% and 97.47% all harm free and new harm free respectively compared to all community
hospital wards of 89.25% and 96.39%
The following charts show PCH performance against the 4 harm measures for all services
combined i.e. inpatient wards, community services and therapy services.
Pressure
Ulcers
Falls
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Patients with an indwelling catheter being treated for a UTI
VTE
All Harm Free Care
39
New Harm Free Care
Peninsula Community Health | Quality Account 2013-14
Examples of Quality performance of services in 2013-14
Blood Transfusion Management
PCH staff administered approximately 800 units of blood across the county in 2013-14.
Most of these were 2 unit transfusions. Patients are transfused as inpatients or day
patients in all the community hospitals except Fowey and Poltair; The Acute Care at Home
team transfuse patients at home in the mid and west of the County. To comply with NPSA
SPN14 ‘Right Patient-Right Blood’ staff are required to complete transfusion training, face
to face and online.
Competency assessment is on a two yearly cycle. Compliance from PCH nursing staff has
dropped to an overall 60%, due in part to new staff starting. Staff are assessed by the ward
based transfusion assessors who in turn are assessed by the Transfusion Practitioner. In
areas where there are blood fridges, staff also complete fridge monitoring competencies to
comply with BSQR and MHRA requirements. Each assessor has an action plan in place for
completion of assessments to improve compliance.
The low levels of incidents demonstrate the benefits of training and assessment. There has
been a 50% reduction in transfusion incidents in year 2013-14. The following table
illustrates the year on year reduction in incidents.
In 2013-14 there were 53 reported incidents. 62% were errors/omissions in monitoring the
blood fridges and not directly related to transfusions. 50% of these blood fridge errors
involved failure to sign the form completed at end of the week. There will be a focus in the
next year on reducing these incidents. Overall 1.75% of transfusions involved a minor error
in documentation, a considerable reduction on previous years.
Any incident involving the wrong blood transfused; special requirements not met;
unnecessary or inappropriate transfusions; handling and storage errors resulting in unsafe
transfusion of products and Right blood Right patient administration errors must be reported
nationally to SHOT (Serious Hazards of Transfusion). In 2013-14 only one incident was
reported to SHOT. This involved a cold chain error and no patient suffered harm as a result.
Derriford and RCHT are both introducing electronic blood tracking into the community and
work has been undertaken to ensure that staff are prepared and aware of the coming
changes.
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Examples of Quality performance of services in 2013-14
Patient Experience
Last year saw a national shift in scope and volume of patient experience feedback with the
implementation of the Friends and Family Test (FFT) for acute inpatients and Emergency
Department attendees. Although not a national requirement for community care service
providers, PCH took the initiative, along with other community providers in the south of
England, and implemented it for community hospital inpatients and Minor Injury Unit (MIU)
attendees.
Feedback from the FFT has worked well in supplementing our existing Patient Experience
Metrics process which continues to provide excellent in-depth feedback information from
inpatients. The Kinda Magic project is in its final stages and its toolkit will be launched
nationally in Autumn 2014.
Actions taken in response to feedback received are, wherever possible, swift as our
processes are designed to provide teams with the information as quickly as possible after it
is received.
Friends and Family Test
All patients aged 16 and over are offered the opportunity to answer the question ‘How likely
are you to recommend our ward [MIU] to your family and friends if they needed similar care
or treatment?’ at or within 48 hours of discharge. The possible response options are:
• Extremely likely
• Likely
• Neither likely nor unlikely
• Unlikely
• Extremely unlikely
• Don’t know
The responses are converted into a score, based on ‘Net Promoter Score’ methodology,
where the proportion of combined negative or indifferent responses is subtracted from the
proportion of those who are ‘extremely likely’ to recommend the service. There is a possible
score range of –100 to +100. Patients can reply on a response card with a freepost
address, or online via the PCH website using the ward/MIU identifier.
In its first year, the FFT has yielded 6719 responses from adult patients discharged from
PCH wards or MIUs. Of these, 6184 (92%) patients also wrote a comment giving a reason
for the rating they had given. This means that the information gathered is of value: whether
patients say they would be extremely likely or extremely unlikely (or anything in between) to
recommend the service, there is generally a reason given. Staff can therefore use this
information to make improvements where necessary, but as the vast majority of comments
are very positive, it is also very rewarding for staff to read this.
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Achieving a response rate of 15% by March 2014 was the Patient Experience CQUIN target
for PCH for 2013-2014. The response rate climbed steadily during the year starting at
6.95% in April and reaching 12.45% in February. Additional efforts and interventions were
made during March to finally secure a response rate of 15.33% for year end.
Response rates for inpatients are subject to greater variation, particularly at individual ward
level, due to the much lower numbers of admissions and discharges compared to MIU
attendees. Increased response rates from inpatients were achieved when the responsibility
for the distribution of the cards was given to the Ward Clerk or Ward Housekeeper. These
staff members have assumed ownership of the process and try very hard to collect the
cards prior to the patients leaving as we know that many discharged patients are not able to
get to a post box and cannot respond online. Achieving an increased response rate from
MIUs has proved more challenging but nevertheless there is a slow but steady increase.
To date, the overwhelming number of patients respond ‘extremely likely’ to the FFT
question and most of the rest respond ‘likely’. Negative responses or indifferent responses
are received from only around 5 or 6 patients each month. This means that the overall
scores for PCH are extremely high and have ranged from 88 to 93.
Negative comments are always escalated ahead of the monthly report to the relevant
Matron. This ensures that if any action is required it can be taken promptly. Of the few
negative comments received each month it is not uncommon for waiting times in MIU, and
lack of X-ray in MIU to feature. Negative comments attributable to poor staff attitude are
always followed up and if the staff member is identifiable this is dealt with in supervision and
1:1 sessions with the Ward/MIU Manager and/or Matron.
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Comments naming individual staff members are anonymised in reports but sent in full to the
Matron to share with the staff member. As most comments are very praiseworthy it is very
positive feedback for individual staff.
Main learning points from the Friends and Family Test:
•
Patients do not appreciate long MIU waiting times when they see nursing staff (rather
than receptionists) booking patients in and doing other administrative duties.
•
Kindness and empathy, a professional approach, good information and reassurance
are frequently mentioned and so highly appreciated that patients often rate the
service highly even when they have had to wait.
•
People attending MIUs do not like giving their personal details in earshot of other
patients.
Examples of actions taken in response to FFT feedback
•
After a number of comments about the MIU being very cold at one hospital the
heating systems were checked and found to be faulty. The faults were all corrected.
•
In response to a comment about the X-ray being closed for a lengthy period at
lunchtime, the Matron reviewed the closing time with staff so that it isn’t closed for
too long over meal breaks.
•
A comment reporting an instance of poor staff attitude led to a discussion at the ward
team meeting about mindfulness of comments made and how they are perceived.
•
Several comments about lack of WiFi facilities for inpatients have been escalated to
the IT Manager. Work is now underway to provide WiFi facilities to inpatients.
Patient Experience Metrics
We are now in our 4th year of collecting Patient Experience Metrics from patients in our
community hospitals. It is evident that this is now a well embedded process and that staff
really value it and take ownership of the feedback they receive, acting on it where
necessary.
Our ‘metrics’ or ‘indicators’ are a set of questions we ask patients during unannounced ward
visits. ‘We’ are a team of non-clinical managers or members of our training team who visit
wards and talk to patients. We ask them the questions that help us obtain our regular
quantitative metrics, but we also have a conversation around their answers and capture
their comments. We report this information back to the Ward Manager and Matron. This
information helps us to understand why patients give the answers they do. This is the
qualitative information that helps us to target our actions most effectively. Depending on
how many patients are able to participate, up to 10 patients per ward (and sometimes
relatives) are interviewed.
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Reporting back patient views and actual comments is extremely powerful. Often this
feedback is very positive and encouraging to staff, and when there is negative feedback this
motivates immediate attention to issues that arise.
Consistent good results – responses to questions about
• patients’ perceptions of cleanliness of their environment
• confidence in staff hand hygiene
• patients saying they have enough to eat and drink
• receiving enough help to eat meals
• mixed sex accommodation
• staff attention to pain relief
• privacy
• staff being available to talk about worries and concerns
• treated with respect and dignity
Areas for improvement
Food
Whilst the majority of patients say that the food is ‘very good’, there continues to be a
number of patients who say they don’t like it very much. Often this is due to their lack of
appetite and sometimes comes down to individual taste but is nevertheless taken seriously.
Throughout last year, the Nutrition and Hydration Steering Group worked to develop a set of
wide ranging and innovative recommendations to not only improve perceived patient
satisfaction of food, but to improve nutrition and hydration of patients generally. The
recommendations are due to be launched during the next three months.
Promptness of call bell being answered
This is a very important indicator and is helping to inform current work around safe and
evidenced based staffing levels.
Patients reporting staff have talked to them about discharge from hospital
Of all the metrics this one has been the most challenging and has only reached the amber
threshold (80%) twice, scoring 81% in August and 80% in November 2013. However it is
notable that there has been an approximate 20% improvement from scores from the mid
50s up to the mid 70s over the last 2 years, being helped considerably by the work to
improve patient flow and reduce length of hospital stay.
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Peninsula Community Health | Quality Account 2013-14
Examples of Quality performance of services in 2013-14
‘Kinda Magic’
The Kinda Magic project has continued into another year. This project had been successful
in being selected to be part of the NHS Institute Patient Feedback Challenge. The expert
panel recognised the strengths and value of PCH’s methodology of collecting quality patient
experience metrics and asked us to ‘spread’ this process to other areas of the NHS.
‘Kinda Magic’ had 2 main aims or ‘phases’:
• Phase 1 – the spread and ‘adoption’ of the principles of the PCH process of
collecting patient experience metrics to other specialities and to other organisations
• Phase 2 – the spread and ‘adaptation’ of the tools and process to groups of patients
usually excluded, those with communicative and cognitive impairment such as
dementia, aphasia and learning disability
With Phase 1 completed last year, work with our spread partners has continued on Phase
2. Tools to obtain patient experience feedback from patients with communicative and
cognitive impairment have been developed and trialled and are now in the final testing
phase. Together with our partners, Royal Cornwall Hospitals Trust, Cornwall Partnership
Foundation Trust and Coventry and Warwickshire Partnership Trust we are planning to
launch these county-wide during the summer, and nationally during the autumn.
In June 2013 we presented Kinda Magic at a Masterclass to all 7 Health Boards in Wales
and we have been contacted for information by other interested organisations across
England.
Kinda Magic was also a finalist in the national Patient Experience Network Awards in
February 2014.
Complaints and Compliments
PCH welcomes comments and suggestions about any aspect of our services. We equally
value any concerns or complaints to be raised with us in order to ensure we improve the
services we provide.
During 2013-14 we received a total of 140 complaints across a range of community services,
raising a variety of issues as well as some common themes, contrasting with 120 for year
2012-13. Thirteen of these complaints were passed with consent to another organisation to
investigate or were withdrawn or not taken forward by the complainant. The remaining 127
complaints were about PCH services and were followed through the complaints procedure.
These complaints were made in a variety of ways, by telephone, in writing, by email, face to
face or passed to the department by a member of staff.
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Peninsula Community Health | Quality Account 2013-14
Examples of Quality performance of services in 2013-14
A total of 248 PALS contacts were received during 2013-14, these range from simple
signposting and information giving to concerns around community service delivery. 295
PALS contact were recorded for the previous year 2012-13. Some concerns raised may be
serious concerns that the complainant does not wish to be responded to in a formal way,
these concerns would be investigated by the organisation formally to ensure that lessons
can be learnt from experience. The following chart compares the number of cases received
against the previous year as follows:
PALS and
Complaints
2012-13 &
2013-14
The following charts shows the number of complaints and PALS contacts received in each
month of 2012-13
PALS and
Complaints by
Month 2013-14
PALS and
Complaints
received 2012-13
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Peninsula Community Health | Quality Account 2013-14
Examples of Quality performance of services in 2013-14
We place an emphasis on resolving complaints and PALS concerns as quickly and
effectively as possible, and in a way that is both proportionate and agreed with the
complainant. The investigation of individual complaints identifies actions to be taken to
reduce the risk of the complaint recurring. Work is on-going across PCH to ensure that
learning from individual complaints is spread across the organisation. Where any part of a
complaint is upheld, the complainant always receives an apology.
98% of all complaints received were acknowledged within 3 working days.
There have been in the current year difficulties in compliance with responses being sent to
the complainant within agreed timescales. Remedial action has been taken and the
backlog of complaints, which reached 64 complaints in the first 6 months of 2013-14 has
now been cleared. In January-March 2014 there were 5 complaints that remained open
after 25 working days, two of these had scheduled Local resolution meetings planned at the
complainant’s convenience. The remaining three had had a longer timeframe agreed with
the complainant; usually this is due to mutli-agency complexity around individual concerns.
Ombudsman
The Parliamentary and Health Service Ombudsman has responsibility for the second stage
of the NHS Complaints Procedure. There were two referrals made during this year. One
was made regarding dental treatment, which the Ombudsman decided that expenses
should be paid. The other related to complex care for a community patient where the
organisation was recognised to have no case to answer. The number of cases that are
taken up for investigation by the Ombudsman following review is likely to increase as their
working practices have changed and they are reviewing more cases and not only looking at
process but also outcome.
ICAS
ICAS is a free, independent and confidential service available to anyone who wishes to
make a complaint about their NHS care. This statutory service was launched in 2003 and
provides a national advocacy service delivered to agreed quality standards. The
organisation has recently been restructured to reflect the concentration on health issues.
IHCAS advocates support complainants in making complaints, and assist them to think
about what they would like to achieve from their complaint, such as an apology, an
explanation or an improvement to NHS services. All complainants who contact the
Complaints & PALS Department are given information about their local IHCAS office. Two
complaints were made through ICAS during this year.
No complaints were made based specifically on issues of Equality or Diversity. All
complainants are advised that they should never be discriminated against if they make a
complaint, and to let us know immediately if they believe this has happened to them.
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Peninsula Community Health | Quality Account 2013-14
Examples of Quality performance of services in 2013-14
Patient Advice and Liaison Service (PALS)
The Patient Advice and Liaison Service (PALS) was introduced by the Department of
Health in 2002 to provide advice and support to users of local health services. The PALS
service is predominantly telephone based, although an increasing amount of people are
using the website or email to contact PALS. Enquirers raise a wide range of issues; some
are simple requests for information and others are more complex, requiring a number of
calls and sometimes mediation meetings. The service is available to any member of the
public, patients, carers, relatives and staff.
The seven national standards for PALS are being used to develop a framework in which to
work. This will ensure PCH meets the criteria for the core standards. The seven national
standards are:
• The PALS service is identifiable and accessible to the community served by the
•
•
•
•
•
•
organisation;
PALS will be seamless across health and social care;
PALS will be sensitive and provide a confidential service that meets individual needs;
PALS will have systems that make their findings known as part of routine monitoring,
in order to facilitate change;
PALS enables people to access information about services provided by the
organisation, and information about health and social care issues;
PALS plays a key role in bringing about culture change in the NHS placing patients
at the heart of service planning and delivery;
PALS will actively seek the views of service users, carers and the public to ensure
services are effective.
An integral part of the PALS function is to work alongside other NHS organisations, acting
as a liaison between the patients and the service. Calls relating to other providers are
passed to the PALS services of those organisations, or advice is given about how they can
be contacted.
PALS received a total of 248 contacts during 2013-14.
Translation and Interpretation Services
PALS organises translation and interpretation services which provide face-to-face
interpreters and translation of literature for patients receiving our services. This is arranged
through Jobline Staffing, Language Line or Cornwall Deaf Association. 54 requests were
made during 2013-14, compared with 62 in the previous year. These requests were
predominantly for physiotherapy and dental appointments.
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Peninsula Community Health | Quality Account 2013-14
Examples of Quality performance of services in 2013-14
Positive Feedback
Although complaints and concerns are formally monitored, it should not be forgotten that
these are far outweighed by the number of plaudits received. There are many patients who
are very happy with the services provided by the organisation and who appreciate the
professional and caring treatment they receive from staff. An array of praise is regularly
received by staff in a variety of settings, including numerous cards, flowers, biscuits and
chocolates as a mark of thanks for the care staff have provided to patients.
Nutrition and Hydration
Nutrition and Hydration Group
PCH continues to have a successful and highly motivated Nutrition and Hydration Group
which meets regularly and includes representatives from nursing staff, hotel services,
therapists and patient feedback via the monthly metrics report. Within 2013-14, the priority
of the group was to raise awareness about the importance of the ‘protected mealtimes
service’ (PMS) and to set agreed standards across all PCH hospitals. To this end, the
group held several workshops to gain feedback from a wide range of frontline staff. From
the feedback, they produced a poster now on display at ward entrances informing all staff
and visitors of the PMS. A new PMS protocol has been drafted and awaiting approval.
Additional training and education will be provided where considered necessary.
Hydration
PCH are committed to raising standards in basic hydration care and in 2012 created a
unique secondment nursing role titled ‘Hydration Lead Nurse’ (HLN). The long term aim of
the post is to achieve sustainable improved outcomes of care across health and social
care, thereby reducing acute admissions associated with dehydration such as urine
infections, falls, pressure ulcers, and most critically acute kidney injury.
The HLN has developed simple, cost effective measures to improve patient safety and
quality of care. This includes the creation of a new assessment tool to identify ‘reliance on
a carer to drink’ as there is currently no national validated tool; new drinking equipment
and improved systems and processes for monitoring all drinks. The first proof of concept
tests carried out in five of PCH community hospitals have produced very positive feedback
from patients and staff alike; further trials are now planned.
Approximately 45% of elderly people admitted to hospital are thought to be already
suffering with dehydration and, as such, the HLN is forging close links with colleagues in
NHS Kernow, acute hospitals, care homes and the domiciliary care sector. This unique
nursing role has attracted national interest and the HLN has recently been invited to work
with a newly established dehydration steering group within NHS England and is also an
active member of the All Parliamentary Hydration Forum.
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Peninsula Community Health | Quality Account 2013-14
Examples of Quality performance of services in 2013-14
Frailty
In August 2013 the Helen Lyndon, PCH Nurse Consultant for Older People began working
with NHS England on developing some guidance for the implementation of an integrated
care pathway for frail older people. A steering group of clinicians was established across
the South of England and a guidance document produced. If frail older people are
supported in living independently and understanding their long-term conditions, and
educated to manage them effectively, they are less likely to reach crisis, require urgent care
support and hospital admission. It is also now well established that frail older people suffer
avoidable harm within a busy hospital setting and that the majority of care across the
pathway could be provided closer to or at home. The guidance document summarises the
evidence of the effects of an integrated pathway of care for older people, suggests
standards and interventions across the pathway and demonstrates how a pathway can be
commissioned effectively using levers and incentives across providers.
The guidance although initially produced for the South region has been adopted as national
NHS
England
Guidance
and
can
be
found
on
the
website
at:
http://www.england.nhs.uk/ourwork/pe/safe-care/ and is called ‘Safe, Compassionate Care
for Frail Older People Using an Integrated Care Pathway’.
The nurse consultant has now been invited by NHS England to work nationally to embed
the guidance within commissioning and provider organisations across the country. She has
been seconded to NHS England for one year from April 2014 to fulfil this role.
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Peninsula Community Health | Quality Account 2013-14
Examples of Quality performance of services in 2013-14
SystemOne
SystemOne is now live!
Following Board approval, PCH has signed a contract with The Phoenix Partnership to
implement the new electronic patient’s record system to all Community based staff. Phase
one is underway. Our Countywide Podiatry Service and Community Nursing Teams based
at Camborne, Redruth, Helston, Hayle, Falmouth, and Penzance are all now using
SystmOne. Further phases will follow throughout 2014-15.
Dentistry – PCH Dental Ltd.
PCH Dental Ltd has been providing quality care for all patients across Cornwall and
the Isles of Scilly
During 2013-14 PCH Dental Ltd has treated over 25,000 patients who do not have their own
dentist and/or require emergency dentistry across Cornwall and Isles of Scilly. The company
plays a major role in emergency care across Cornwall by providing approximately 600
sessions of emergency evenings and weekend dental care open to all members of the
public.
A patient survey carried out during the year showed that 99% of patients said that they were
extremely likely or likely to recommend PCH Dental services to friends and family if they
needed similar care or treatment.
PCH Dental also continues to provide specialist care for adults and children with a physical
disability, learning difficulties, psychiatric or complex medical needs. During 2013-14 PCH
Dental treated approximately 4,000 such patients using specialist skills such as sedation
techniques and general anaesthesia.
Overall PCH Dental completed over just over 40,000 patient appointments across
emergency and routine care, special care, orthodontics and oral surgery.
During 2013-14 PCH Dental has also embarked on a pilot study to promote oral health and
reduce tooth decay in young children. Over the longer term, evidence suggests that this will
help produce a reduction in the number of children (currently just fewer than 1000 p.a.) in
Cornwall and Isles of Scilly who are referred to PCH Dental for extraction of decayed teeth
under general anaesthesia.
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Peninsula Community Health | Quality Account 2013-14
Examples of Quality performance of services in 2013-14
Patient-Led Assessments of the Care Environment
(PLACE)
Patient-Led Assessments of the Care Environment (PLACE) are a self-assessment of a
range of non-clinical services which contribute to the environment in which healthcare is
delivered, within all organisations constituting healthcare sectors in England. The NHS
constitution establishes a number of principles and values of the NHS in England, and
include:
• Putting the patient first;
• Actively encouraging feedback from the public, patients and staff to help improve
services;
• Striving to get the basics of quality of care right;
• A commitment to ensure that services are provided in a clean and safe environment
that is fit for purpose.
The inspection process changed this year following the Prime Minister’s call for new patientled inspections of the hospital environment.
These PLACE assessments were introduced in April, 2013 to replace the Patient
Environment Action Team (PEAT) undertaken from 2000-2012 inclusive. PCH undertook
this process as a trial within 2013, to establish a baseline moving forward into 2014.
During 2013-14 PLACE were completed for PCH and all data/scores submitted to Health
and Social Care Information Centre ( HSCIC )
The inspections are a benchmarking tool to ensure improvements are made in the four nonclinical aspects of patient care:
• Cleanliness
• Building and Estates
• Food and Hydration
• Privacy and Dignity.
Figure 1 overleaf plots PCH scores for 2013, against the national statistics for the same
period. On completion, the national statistics identified marginal errors within their
application and data collection. The learning from this was carried through to the
assessments for 2014.
There will be no further definition of these results - the former 'rating' of Excellent/Good/
Acceptable/Poor/Unacceptable no longer applies. There is no Pass or Fail mark in this
process.
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Peninsula Community Health | Quality Account 2013-14
Examples of Quality performance of services in 2013-14
National Statistics
Number of assessments undertaken
Totals
1.359
PCH Experimental Statistics
Number of assessments
undertaken
Cleanliness
83.90%
Condition, Appearance and
Maintenance
86.49%
86.03%
National average scores
Cleanliness
Condition, Appearance and
Maintenance
95.75%
Privacy, Dignity and Wellbeing
88.90%
Privacy, Dignity and Wellbeing
Food and Hydration
85.41%
Food and Hydration
88.78%
Totals
14
85.10%
There are number of considerations which need to be applied, when reviewing the PCH
statistical results.
The cleanliness levels are closely monitored at all PCH hospitals with findings being
reported directly into the Infection Prevention Control Committee (IPC). This process has
demonstrated that the scoring across all aspects is continually improving. Hotel Services,
Infection Control and the Health and Safety teams are continuing to work closely to apply
legislative applications and to address any issues as they arise.
In relation to the condition, appearance and maintenance of the PCH leased premises
Poltair and the refurbishment of Stratton were included in the 2013 assessments to provide
accuracy to the PCH baseline. Progress is on-going through the Estates, Performance,
Operational Group (EPOG) as to the management of the backlog maintenance across all
units. It is important to note that much of the estate is old and requires substantial backlog
maintenance.
With regard to the Privacy Dignity and Wellbeing result, this score incorporates a number of
other areas of the assessment in addition to those in the Ward. Work being undertaken by
the Dementia lead will contribute to an overall improvement in this area moving forward.
Innovation work around hydration and the on-going monitoring of the quality, nutritional and
taste of the food within the units by Hotel Services will ensure continued improvement to the
patient’s wellbeing. New initiatives such as the fruit plate will again improve performance
on this element.
Progress is being monitored in relation to the project and the roll out programme for 2014
by the Patient Environment Action Group (PEAG).
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Peninsula Community Health | Quality Account 2013-14
Examples of Quality performance of services in 2013-14
Clinical Research –
“Postural Management in subacute complex stroke: The effects of a
standing program on neuromuscular impairment and function”.
The Lanyon Ward Stroke Specialist Physiotherapist based on the Rehabilitation Unit at
Camborne Redruth Community Hospital applied and was awarded a place on the Clinical
Academic Training Programme internship, run by NHS Health Education South West
receiving a £10,000 bursary to support their clinical research/academic career.
The aim of this research is to investigate whether a standing frame programme provides
benefits such as stretching contracted muscles, decreasing spasticity, preventing
osteopenia, strengthening muscles, improving bladder and bowel function and relieving
pressure areas to stroke patient. The act of standing may also have psychological benefits.
This internship will provide the opportunity to experience working in a clinical research
environment and undertake formal research training.
The Stroke Specialist will be able
maintain a clinical role whilst undertaking research in their own clinical environment:
On completion of the research, the Stroke Specialist will write up their work for publication
and using patient and public involvement, prepare a proposal for a fully funded PhD with
academic support from Plymouth University.
This is a fantastic and exciting opportunity which will contribute to existing evidence-base
for people with stroke and may result in a change in practice locally, even nationally, both in
the inpatient stroke rehabilitation setting as well longer-term community based stroke
rehabilitation. It may also have other positive impacts such as reducing carer burden and
reduce the need for packages of care.
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Examples of Quality performance of services in 2013-14
Urodynamic Investigation Service
Introduction
Urodynamic investigation is a diagnostic investigation and involves the assessment of lower
urinary tract function. The service is delivered to female patients from across Cornwall and
Isles of Scilly at the Camborne & Redruth Community Hospital and is led by the Bladder
and Bowel Specialist Nurse Consultant.
For 2013-14, a total of 354 patients were seen for urodynamic investigations and a
questionnaire was given to the majority of them. Ninety-seven questionnaires were
returned, giving a 27% response rate. Overall, the survey responses from the patients
demonstrate a high level of satisfaction with the service.
Aims of service
•
•
•
•
•
•
To deliver high quality urodynamic investigations
Participate in education (CPD) to increase knowledge and skill
Take action to preserve and maximise privacy and dignity
Comply with clinical care pathways (e.g. Map of Medicine)
Demonstrate a compassionate, kind and caring attitude
Monitor quality through clinical audit, taking into account comments through patient
experience questionnaires and complaints
Improvements
Following results of previous surveys, improvements based on the findings have been
implemented. This includes ensuring that all patients are provided with contact details in
case of any concern following the investigation or query about the results. The results have
improved thus: 70% (2010), 79% (2012/13) to 100% (2013-14).
Conclusion
Patients undergoing urodynamic investigations are highly satisfied, rating the service as
mostly excellent. Since last year’s survey patient contact details have been improved,
should they have any post-investigation concern or query. Important to note, less patients
(n=2 / 2%) experienced a urinary tract infection within a week of the investigation compared
to the previous survey (n=4 / 6%). A Cochrane systematic review identified that up to 28%
patients undergoing urodynamic investigations may experience symptomatic urinary tract
infection (Foon et al 2012). A repeat patient experience survey will be conducted for 201415.
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Peninsula Community Health | Quality Account 2013-14
Examples of Quality performance of services in 2013-14
Bladder and Bowel Specialist Service – Adults
Introduction
The purpose of this survey was to demonstrate the patient experience for adults when
accessing the service for regular clinics (not diagnostic investigations) across the county
and covers the period June-December 2013. Currently there are 12 hospital sites for the
clinic delivery (with multiple clinics on differing days). A new patient consultation is 45
minutes and a follow-up is 20 minutes.
The county-wide service provides:
• Access to assessment, treatment and evaluation for a range of bladder and bowel
continence problems; as well as diagnostic investigations to resolve symptoms
wherever this is achievable with a clear focus on the basic right to continence.
• Leadership across the local health community and educational support to embed best
practice values and standards in continence care beyond the reach of the team of three
clinicians.
• Promotion of dignity at every opportunity for patients with bladder and bowel continence
issues, ensuring that they are listened to and that they receive safe and effective quality
care.
Conclusion
Overall, our patients have responded that their experience is very positive when receiving
treatment from the service. However, there are areas for learning and improvement. i.e. the
team will discuss provision of information about treatment planning. Furthermore, the
offering of chaperoning needs to improve. There will also be consideration on altering the
question to clarify when a chaperone should be offered.
Next Stage
Findings of the report are to be submitted to the PCH Executive team; discussed at the
service monthly team meeting and filed with our service performance evidence.
Bladder and Bowel Specialist Service – Children
Introduction
The survey was to demonstrate the patient experience for children and young people when
accessing the service for regular clinics (not diagnostic investigations) across the county
for the period June to December 2013. Currently there are 12 hospital sites for the clinic
delivery (with multiple clinics on differing days). A new patient consultation is 45 minutes
and a follow-up is 20 minutes.
Engaging the patient and families
The clinicians give the questionnaire to patients at the end of a consultation; at discharge;
or opportunistically when there is something we want to capture (a particularly good or not
so good experience). A total of 41 children and young people questionnaires were returned
between June and December 2013.
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Examples of Quality performance of services in 2013-14
Conclusion
Overall, our patients have responded that their experience is very positive when receiving
treatment from the service. There are areas for learning and improvement e.g. the right to
choose or decline treatment and also medication side-effects. An unsurprising key feature
that has emerged is the concern from some parents about the delay in receiving a follow-up
appointment, for which the service received a poor rating from one family. Recruitment of a
Band 6 children’s nurse is currently being planned.
Resuscitation Team
Service Improvement during 2013-14
Publication of Allow Natural Death (AND) patient /relative information leaflets and posters.
The Team are currently piloting a new and improved Early Warning Score (MEWs)
observation charts on two community sites with a view to further
PCH wide
implementation.
Education and Training
The Team have maintained and updated on professional development courses:
• AIM (Acute Illness Management)
• ROS (Recognition Of the Sick patient)
• RC(UK) ILS (Immediate Life Support)
• Medical Emergencies in Dentistry
• RC(UK) PILS (Paediatric Immediate Life Support)
The Resuscitation Officers (RO) have undertaken additional EPLS instructor training during
2013/14. This has resulted in 1 fully qualified EPLS instructor and 1 Instructor candidate
which allows for the continued delivery of PILS training. The RO’s have updated the online
assessment to facilitate the administration of named drugs by qualified nurses, in line with
Patient Group Directives (PGDs).
Emergency equipment
During 2013-14 an Emergency Equipment Audit identified the need for an additional crash
trolley in Falmouth Hospital. This action has been completed. An alert was raised
identifying a fault with selected serial numbers of MRx defibrillators. This has been followed
up and resolved. The resuscitation team review all relevant medical device alerts and PCH
remains 100% compliant with Medical Device alerts.
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Peninsula Community Health | Quality Account 2013-14
Improvement Works
Newquay Community Hospital
The following work took place during 2013-14:
• Refurbishment of a new and enhanced Minor Injury Unit, increasing capacity and
security for the unit, staff and patient’s.
• Refurbishment of the new Outpatient Unit and Main Reception with increasing
capacity. This has allowed integrated working with SERCO with their receptionists
operating the OCEANO system for MIU patients allowing for extended opening times
of the reception area from 08.30-21.00hrs.
• Within the inpatient areas, dementia ‘all about me’ boards were initially trialled at
Newquay and now rolled out county wide. They are a visual reminder to all staff to be
able to engage with specific personal needs of the patients i.e how the patient likes
their tea/coffee, what food and drink dislikes they have, who is important to them. This
has resulted in enhancing the patient’s stay and experience
• The hospital now serves a cooked breakfast three times a week and offers fruit plates
between lunch and tea. This has proved immensely popular and the friends and family
feedback forms often indicate this as being a highlight of the day for patients. A short
film reflecting the change in the nutritional and hydration provision has been made.
• New roof on the main building to replace the old roof that leaked and was broken. This
is about nearing completion and has enhanced to appearance of the hospital.
• New signage displayed and colour coded doors fitted as part of the Dementia Project
• Accreditation for gold standard framework to help patients in the last year of their lives
to meet specific needs
Serious Incident’s (SI’s)
Any Serious Incident is reported on the Strategic Executive Information System
(STEIS) system and logged by an administrator. Nominated investigators undertake a Root
Cause Analysis (RCA) to look at learning’s from the incident and make recommendations for
implementation.
The final internal investigation report should also include a clearly time-framed action plan that
will be monitored by NHS Kernow to ensure all actions are completed and that any problems
or root causes identified have been resolved through the action plan.
All Serious Incident’s reported by PCH are monitored and reviewed by the Clinical Quality and
Safety Risk sub Committee attended by Locality Managers, Directors, Non-Executive
Directors and relevant Managers.
The sub-committee note the content of the report, approve its content and agree its
dissemination to nominated individuals, committees and groups so that the learning and
recommendations and embedded across the organisation. The sub-committee will also
monitor and require updates on how the actions are being implemented. During 2013-14 PCH
reported 96 SI’s. This number includes 76 grade 3 and 16 grade 4 pressure ulcers.
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Peninsula Community Health | Quality Account 2013-14
Improvement Works
How to ensure the right people, with the right skills, are
in the right place at the right time – 4 R’s
Introduction
The Francis Report highlighted individual and organisational failings within the NHS and the
need for a review of how high quality, compassionate care is provided.
To support healthcare organisations the 4 R’s guidance was developed by the Chief
Nursing Officer for England working with the National Quality Board. 10 expectations are
set out in The 4 R’s, which will guide and support PCH to review their care staffing ratios,
capacity and capability to ensure it is of a high quality and produces the best possible
outcome for our patients.
Working Group
A working group lead by the Director of Nursing and Professional Practice was developed
supported by a multi-disciplinary membership to review the 10 expectations:
Expectations
Accountability and Responsibility
Expectation 1 – Boards taken full responsibility for the quality of care provided to patients,
and as a key determinant of quality, take full and collective responsibility for nursing, care
staffing capacity and capability
Expectation 2 – Processes are in place to enable staffing establishments to be met on a
shift to shift basis.
Evidence Based Making
Expectation 3 – Evidence based tools are used to inform nursing and care staffing,
capacity and capability
Supporting and Fostering a Professional Environment
Expectation 4 – Clinical and managerial leaders foster a culture of professionalism and
responsiveness, where staff feel able to raised concerns.
Expectation 5 – A multi-professional approach is taken when setting nursing and care
staffing establishing.
Expectation 6 – Nurses and care staff have sufficient time to fulfil responsibilities that are
additional to their direct caring duties.
Expectation 7 – Boards receive monthly updates on workforce information, and staffing
capacity and capability is discussed at a public board meeting at least every 6 months on
the basis of a full nursing establishment review.
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Peninsula Community Health | Quality Account 2013-14
Improvement Works
Expectation 8 – NHS providers clearly display information about the nurses and care staff
present on each ward, clinical setting, departmental or service on each shift.
Expectation 9 – Providers of NHS services take an active role in securing staff in line with
their working requirements.
Expectation 10 – Commissioners actively seek assurances that the right people, with the
right skills, are in the right place at the right time within the providers with whom they
contract.
Action Plan
Version 1 of The 4 R’s Action plan was developed for each expectation; designed to form a
framework for PCH to work within to support implementation.
The action plan outlined proposed actions underpinned by each of the 10 expectations
focussing on a range of topics, progress, a named executive and a management lead with
anticipated completion timescales. The action plan was presented and well received at the
PCH March Board.
A range of key actions underway at year end includes:
•
•
•
•
•
•
•
•
•
•
•
•
•
A full review of community hospital wards nursing skill mix has been undertaken and
presented to PCH Board
Introduction and roll of SystmOne in community teams
Implementing the 6 C’s workshops
Planning programme of ‘Working Differently’ study days
Use of staffing analysis tool to review the community nursing staff established and
skill mix
Development of Recruitment and Retention Strategy
Board involvement and taking responsibility for the quality of care to patient
Develop Escalation Polices and Contingency Plans for managing nursing skill mix
Review and relaunch of E-Rostering Management policy/guidelines
Working group to review Whistleblowing Policy/Clinical Supervision Policy
Safety thermometer to be fully embedded at local level by Locality Managers/
Matrons
Managers to allocate and monitoring mandatory training and cpd flexibility without
depleting minimum staffing levels when producing rosters
Commenced inpatient acuity tool on all community hospital wards
Expectation 8, To meet this ‘My Doctor/My Nurse’ Inpatient whiteboard had been printed,
provided and fitted above all community hospital inpatient beds and ‘Staffing Requirement’
board displayed in Wards, MIU’s, OPD’s and physiotherapy reception areas outlining the
number of staff on duty and also how many should be on duty. This action was completed
within the end of year deadline. Version 2 of the 4 R’s Action plan is currently being drafted
in preparation for presenting to PCH Board.
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Peninsula Community Health | Quality Account 2013-14
Improvement Works
Health and Safety
During 2013-14 the Health and Safety (H&S) team have been involved in several pieces of
work which will improve quality within PCH community hospitals.
Water Safety Management Group
The Water Safety Management group has become a pivotal meeting in making decisions
on water safety. This group’s work has been so successful that Cornwall Partnership
Foundation Trust (CFT) asked to join the group to work jointly in partnership, sharing ideas
and processes countywide, particularly as we share so many premises with CFT staff.
The group has excellent attendance including a Microbiologist, Infection Prevention Control
representatives and expertise from the Cornwall Healthcare Estates and Support Services
(CHESS). This group will continue to support the improvement of water quality within our
units.
Medical Gas Advisory Group
The H&S team arranged a county wide programme of practical hands on medical gas
training for hospital staff in the summer of 2013. This training was delivered by the named
Authorising Engineer. This training will now be rolled out as a ‘Train the Trainer’ programme
to ensure that any new staff who are involved in changing cylinders, manifolds etc. receive
the appropriate level of training. These training sessions enhances the level of competency
of our staff responsible for the management of medical gases and ensures that both bottled
and piped gas is always available for our patients. Medical gas issues are well managed in
the organisation and the Medical Gas Advisory Group now meets three times a year.
Fire Safety Operational Group
A key function of this group is to ensure the provision of suitable fire safety equipment in our
community hospitals. During 2013-14 fire evacuation equipment (Albac mats and / or Evac
chairs) were provided where appropriate within our hospital sites. User training has been
delivered to link training staff for cascade to hospital staff. If ever an evacuation situation
arises, this equipment will assist in moving patients with reduced mobility out of the building.
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Peninsula Community Health | Quality Account 2013-14
Innovations and Developments
We are passionate about learning from each other and support all of our
staff to innovate - so that we can develop and understand our business
better together.
The secret to nurturing successful innovation in the workplace is not
waiting until an idea is perfect - but encouraging the discussion of early
ideas and imagination - so that they can be shared and helped to get off
the ground. This page is a place where we are raising our ideas, sharing
any developments that our teams have been involved with and also
valuing any lessons learnt from things that didn't go so well.
Femmeze®, a simple solution to self-managing prolapse
Women are commonly concerned about a heavy, dragging feeling in their genital area that
can be caused by vaginal prolapse. There are different types of prolapse, such as bulging
of the front wall of the vagina (cystocele), descent of the womb (uterus) or bulging of the
back wall (rectocele).
If the back wall is prolapsed, this can distort the position of the rectum (this holds the stool
until ready to be passed) and therefore there may be difficulty in passing stool or a feeling
that it hasn’t emptied properly. To cope with this, some women will resort to using their
fingers to apply pressure to the structures to aid passing their stool.
We have developed a new product to help women with this inconvenient and uncomfortable
problem. Essentially, the product replaces the need to use fingers and is a simple design to
help reposition the prolapse temporarily so that stool is passed more easily. The product
can be reused following simple washing instructions. For women where surgical repair of
their prolapse is not an option or they are waiting for surgery, this may be a useful way of
managing it. By introducing this new product we hope to offer women a simple solution to
self-managing prolapse in a novel way.
Sharon Eustice
Nurse Consultant
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Peninsula Community Health | Quality Account 2013-14
Innovations and Developments
The Koala Cable Project
Patients in hospital often need a variety of equipment around their bed. However, because
there are no cable-management facilities built in to beds, cables can drag on the floor and
become contaminated.
The problem then occurs when the cable is handled or it touches beds and equipment,
causing serious infection prevention and health and safety issues. This is not a new
problem and is well known amongst health professionals, but until now has been
unresolved. The Koala Cable project was started to deliver a solution to poor cable
management and therefore reduce the risks around infection and health and safety.
With input from nursing and ward teams, Margaret West began to explore ideas on how to
tackle the problem. Initial ideas included velcro straps, metal clips and hooks, magnet
hooks and sucker hooks. After a design and development process with outside agencies, a
prototype of the Koala cable was put through testing in a ward Trial at St Austell Community
Hospital, with extensive input from health and safety and clinical professionals.
After the initial trial, the prototype was reviewed by the Ward Team. Generally the feedback
was excellent although the review did lead to some design refinements. The next prototype
incorporated thinner heads to pass in between bed rails, stronger magnets to give a better
hold and a longer length.
The next step in the process will involve trials across other community hospitals in Cornwall
and liaison with the NHS supply chain so that ultimately the solution can be developed out
to be shared across the NHS.
Margaret West
Matron, St Austell and Fowey
Community Hospital
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Peninsula Community Health | Quality Account 2013-14
Innovations and Developments
Newquay Pathfinder Project
In June 2012 a case finding exercise was carried out which identified 100 people over the
age of 50 with multiple long term conditions that had significant risk of being admitted
inappropriately to hospital.
Age UK National put in place investment to support two skilled workers to work within the
Newquay District Nurse Team, The project aim was to improve integration between health
and social care services and the voluntary sector to reduce the risk of inappropriate hospital
admissions for older people.
The team achieved this by co-ordinating and signposting the right volunteer service to the
individual, helping to promote self-care and self-management.
For District nursing the project aimed to manage the demand for health related services by
main streaming prevention at a local level so that older people receive better care closer to
home.
To date 130 people have received support and the results are showing a positive impact.
Early results showed a 26% improvement in people’s mental well-being, a 27% reduction in
hospital admissions and a 95% satisfaction rate among the care team related to integrated
working.
The project has increased staff morale - in knowing we are doing something more
meaningful for our patients and wrapping more support around the team. In a time where
demand for community nursing is increasing and resources are limited the Pathfinder is a
creative approach to changing the culture from being task orientated back to being focused
about individuals, on their goals.
Newquay Pathfinder achieved a National Award for Managing long Term Conditions
Category at the Health Service Journal awards (HSJ) in November 2013. The judges
described the Pathfinder 'as the best thing they had seen' providing joined up care across
the NHS and social services.
Lucy Clement
District Nurse Locality Team
Leader
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Peninsula Community Health | Quality Account 2013-14
Statutory Statements concerning quality of services
This section contains statutory statements concerning the
quality of services provided by PCH. These are common to all
NHS provider organisations’ Quality Accounts and can be used
to compare us with other organisations.
During 2013-14 PCH provided and/or sub-contracted 36 NHS
services. The income generated by the NHS services reviewed
in 2013-14 represents 100% of the total income generated from
the provisions of NHS services by PCH for 2013-14.
PCH works from over 100 locations throughout Cornwall and
Isles of Scilly, including 14 community hospitals. PCH reviewed
all the data in regard to these services monthly.
Since May 2013, PCH has a subsidiary company – PCH Dental
Ltd providing NHS commissioned dental services throughout
Devon and Cornwall.
Care Quality Commission
In 2013-14 PCH continued to be registered with the CQC to provide regulated activities at 19
locations. Post 1st May 2013 and the formation of PCH Dental Ltd, this has reduced to 16
locations.
During 2013-14 the CQC visited all PCH registered locations, as part of their scheduled
inspections programme. All of these visits were unannounced and were not as a result of
any concerns raised.
Overall the visits were and the feedback was very positive. PCH was found to be compliant
on all Essential Standards.
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Peninsula Community Health | Quality Account 2013-14
Statutory Statements concerning quality of services
Maintaining Essential Standards for Registration
with the Care Quality Commission
PCH is required to register with the Care Quality Commission and its current registration status
is without condition. The Care Quality Commission has not taken any enforcement action
against PCH during 2013-14
PCH has not participated in special reviews or investigations by the Care Quality Commission
as at 31st March 2014.
NHSLA Assessment
There was no formal assessment for general NHSLA standards during 2013-14.
Eliminating Mixed Sex Accommodation (EMSA)
PCH has remained 100% compliant with eliminating mixed sex accommodation during 201314.
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Peninsula Community Health | Quality Account 2013-14
Statutory Statements concerning quality of services
Audit Participation
Clinical audit is a systematic process of improving the quality of patient care by looking
closely at current practice, evaluating the quality of care provided to patients based on best
practice and nationally set clinical standards, modifying it where necessary and evaluating
the outcome.
The main aim of clinical audit is to provide assurances that the clinical services are meeting
the needs of service users and at the same time providing internal assurance that staff are
following best practice based on research evidence.
PCH is committed to improve the quality and outcomes of patient care by establishing a
culture where high quality clinical audit can be sustained. The 2013-14 Audit Plan
incorporated a programme of over 40 clinical audits in addition to a record keeping audit of
all services in addition to any national clinical audits which the organisation was eligible to
participate in.
National Clinical Audit Participation
Although it is not mandatory for community services to undertake national clinical audits it is
good practice.
During the period April 2013 to March 2014, only one national clinical audit and zero
national confidential enquiries were relevant to NHS services that PCH provides.
During that period, PCH participated in 100% of the national clinical audits and 100% (zero
eligible and therefore zero participated in) national confidential enquiries of the national
clinical audits and national confidential enquiries which it was eligible to participate in.
The national clinical audits and national confidential enquiries that PCH was eligible to
participate in during 2013-14 are as follows:
•
National Audit of Intermediate Care
The national clinical audits and national confidential enquiries that PCH participated in
during 2013-14 are therefore as follows:
•
Intermediate Care Audit
The national clinical audits and national confidential enquiries that PCH participated in, and
for which data collection was completed during 2013-14 are listed alongside the number of
cases submitted to each audit or enquiry as a percentage of the number of registered
cases required by the terms of that audit or enquiry.
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Statutory Statements concerning quality of services
Number of cases
submitted
Intermediate Care
N/A
Number of cases submitted
as a percentage of eligible
cases
No individual patient records
audited as part of this audit. It
was an audit of activity and
costs etc
Improving services through participation in national audits
The reports of 1 national clinical audit were reviewed by PCH in the period April 2013 to
March 2014 and PCH intends to take or has taken the following actions to improve the quality
of healthcare provided
National Audit
Intermediate Care
Actions planned/taken
•
Data collected and submitted. Report currently being
evaluated
Local Audit Participation
Clinical audit is supported by the Governance team. All local clinical audits are reported to
and monitored by the Clinical Quality and Safety. Reports are reviewed and action plans for
quality improvement are monitored by this committee. In addition reports are also scrutinised
by the Audit Committee.
The reports of a number of local clinical audits were reviewed in the period April 2013 to
March 2014 and PCH intends to take or has taken the following actions to improve the quality
of healthcare provided for those audits listed.
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Peninsula Community Health | Quality Account 2013-14
Statutory Statements concerning quality of services
Local Audit
Actions planned/taken
Record keeping audit
•
A comprehensive record keeping audit was undertaken of all
services. Of the 23 standards audited, 21 had improved from
the previous year’s audit results. Specific areas for improvement
were identified for each service and are the subject of individual
service action plans to be communicated via service team
meetings. A re-audit in the next 12 months will monitor the
effectiveness of the action plans in maintaining and improving
record keeping quality
Antibiotic Audit
•
Share results of audit with the individual community
hospitals, prescribers, antimicrobial lead pharmacist
RCHT, Serco, Tissue Viability Lead and Infection
Control Lead.
Monitor antibiotic stocklists and adjust to reflect any
updates to guidelines. Ensure stock lists are available
on wards to prescribers.
Feedback to prescribers where documentation of
indication and course length/review date are omitted.
Compare results across community hospitals
represented at the South West Provider Pharmacist
Leads meeting.
Provide information on antibiotic prescribing guidelines
to all prescribers working in/for Peninsula Community
Health
Train nursing staff to access microbiology results and
request antibiotic review
Training for prescribers on antibiotic guidelines
•
•
•
•
•
•
Blood Glucose Meter Audit
•
•
•
•
•
Diabetic Hypoboxes audit
•
•
•
73
All test strip vials to have the discard date of 6 months from
opening written on the vial
All Quality Control (QC) bottles to have discard date of 3
months from opening written on the bottles
QC to be followed as per policy
All staff to ensure that the meter and box is cleaned according
to local policy
All areas need to be able to identify where their meters are and
have a record of when they are sent to repair and returned
New guidelines provided and education of staff undertaken
All nurses to complete the safe management of hypoglcyaemia
e-learning
All wards to complete hypo audit forms
Peninsula Community Health | Quality Account 2013-14
Statutory Statements concerning quality of services
Local Audit
Actions planned/taken
Speech & Language
therapy hypophonia
treatment audit
Long term conditions audit
•
Audit complete. Results currently being analysed following which
final report with recommendations and actions to be completed.
•
Occupational Therapy
Service
Audit of casework and
working practices
•
User satisfaction with all areas of Community Nurse support
improved from 2012-13. Focus of action plan to maintain current
standards.
In order to ensure that the service user is directed to the most
appropriate service to meet their needs in the most timely way,
referrals for bathing and simple equipment are now directed to
Adult Health, Care and Wellbeing.
The ‘Seating Review Group’, a multi disciplinary group of
clinicians with an interest in seating/postural issues, has been
reconvened.
Standard Operating Procedure on delayed/missed doses updated
Training provided on drug chart completion to prescribers and
nursing staff
Policy for safe ordering, prescribing and administration of drugs to
be reviewed
Day unit/ ward clerks to request notes as soon as transfusion
booked. If GP referral (Acute Care at Home) must have patient
profile with reason for transfusion documented.
Haemoglobin (HB) result to be requested when transfusion
booked and documented in nursing notes. If necessary they can
be looked up online. If no Hb then reason for transfusion to be
questioned.
Transfusion Practitioner to send email to all registered nurses to
remind them of the policy requirements
Transfusion assessors to reinforce the message and check
patient medical notes post transfusion in their clinical areas.
•
Clinical Prescribing Audit
•
•
•
Blood transfusion Audit
•
•
•
•
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Peninsula Community Health | Quality Account 2013-14
Statutory Statements concerning quality of services
Data Quality
Good data quality is an indicator that an organisation has robust systems and methods for
capturing accurate information about their patients. PCH submitted records during April 2013
– March 2014 to the Secondary User Service (SUS) for inclusion in the Hospital Episode
Statistics which are included in the latest published data. These are one of the
measurements that the Care Quality Commission use to monitor our on-going compliance.
As per the SUS Data Quality Dashboard April 2013- February 2014:
NHS number compliance:
Inpatient = 99.8%
Outpatient = 99.9%
Minor Injury Units = 95.9%
GP Practice compliance:
Inpatient = 100%
Outpatient = 100%
Minor Injury Unit = 99.6%
There is a late data entry issue which is being monitored monthly with performance reviews
and local action plans have been initiated. SystmOne (new clinical IT solution) is currently
being installed across all PCH community services, and this will improve any late data entry
delays as the system will be used real-time.
Information Governance
PCH has declared compliance with Level 2 of the Information Governance Toolkit for 2013-
Clinical Coding Error Rate
PCH was not subject to a Payment by Results clinical coding audit during 2013-14.
Research
In 2013-14 PCH continues to be a research partner working closely with the research team
based within the local acute organisation. PCH is informed, and approval sought, for any
research taking place with, or near to the services we provide.
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Statutory Statements concerning quality of services
Goals agreed with Commissioners
CQUIN – A proportion of Peninsula Community Health income in 2013-14 was conditional
on achieving quality improvement and innovation goals agreed between Peninsula
Community Health and our commissioners NHS Kernow. These were met apart from the
Safety Thermometer CQUIN which was partially met.
The CQUINs for 2013-14 were:
Goal
Number
Goal Name
Description of Goal
1
National: Patient
Experience
Implementation of the Friends and Family Test in inpatient wards
2
National: Safety
thermometer
Improvement against the NHS Safety Thermometer - (excluding VTE),
particularly pressure sores
Local:
Whole System
CQUIN Unscheduled Care
Local: Innovation Bedstock
Local: Hospital
Discharge
3
4
5
Whole System Multi-agency integrated unscheduled care plan
Increase flow and volume of patients through PCH CIC community
beds.
Improve Internal Hospital Discharge Process
The CQUINs for 2014-15 are in the final stages of agreement with NHS Kernow and they
are:
Goal
Number
Goal Name
Description of Goal
Implementation of the Friends and Family Test to all areas. Full
delivery of the nationally set milestones and to start to analyse the
qualitative data collected
Improvement in NHS Safety Thermometer – pertaining to pressure
ulcers
To continue with the Dementia internal programme. To support the
Dementia lead with the continued roll out of the University of Stirling
staff training programme
1
National: Patient
Experience
2
National: Safety
thermometer
3
National: Dementia
4
Local: Living Well
Optimising patient flow
5
Local: Living Well
Establishment of Community Frailty Virtual Ward Team and Toolkits
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Peninsula Community Health | Quality Account 2013-14
Our Services
Over 40,000
appointments were
undertaken by
Peninsula Community
Health's Dentists
732,630 patients
were seen by
services provided
by PCH
There have been
4,402 inpatients
in our Community
Hospitals in
2013/14
Physiotherapists
carried out a total
of 91,132 outpatient
appointments
Community nurses
undertook
301,246 patient
visits
91,037 patients
were seen in our
Minor Injury Units
77
PCH employs
2104 people
Peninsula Community Health | Quality Account 2013-14
Part 4
Isles of Scilly
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Peninsula Community Health | Quality Account 2013-14
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Peninsula Community Health | Quality Account 2013-14
Part 4
Isles of Scilly
Focus on the Isles of Scilly
PCH provides hospital and community nursing & therapy services on the Isles of Scilly.
St Mary’s Hospital is still viewed by the I.O.S community as the first point of contact for all
aspects of health related issues. We continue to provide in- patient care for a broad variety
of conditions and age groups, however, our client profile is predominately the frail elderly
with complex & chronic health conditions.
We continue to provide initial care and stabilisation of patients with acute and serious
health problems prior to transferring them to the mainland for on-going care. St Mary’s MIU
department is open 24 hours a day. Patient group Directives for MIU medication now
includes antibiotics for specific problems. All Registered Nurses were able to attend the
training brought to St Mary’s Hospital by Ros Palmer (Community Pharmacist Advisor).
St Mary’s Hospital remains the first point of contact for out of hours GP calls, which are
triaged by the Registered Nurse on-duty.
Near patient testing equipment has been installed in at the hospital and this assists in some
diagnosis procedures.
Performance Highlights
In the last 12 months, we have seen the following for St Mary’s Hospital:
•
•
•
•
•
•
•
•
•
•
•
Continued high performance in risk assessing and providing preventative treatment
for venous thrombo-emboli
Continued high performance in medicines reconciliation
Considerable effort by the staff to enable clients and/or their relatives to complete
Family and Friends feed-back forms. Although response rates remain below the
target of 15%- the responses received have been excellent.
Monthly Safety Thermometer audits all undertaken
Patient Dependency audits all undertaken
PLACE Inspection April 2014,over-all impression very good
Healthwatch Isles of Scilly survey into I.O.S Health and Social Care services
identified how valued PCH services are within the Isles, with the majority of the
feedback being excellent or very good.
Nursing and Patient Experience Metrics all undertaken.
Maintaining Essential Standards for Registration with the Care Quality Commission.
St Mary’s Hospital found to be fully compliant when visited unannounced by CQC.
St Mary’s Hospital took part in Fall to Green (Nov-Dec 2013)
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Peninsula Community Health | Quality Account 2013-14
Isles of Scilly
•
•
•
Dementia Champion in place and she will take forward the work on dementia workbooks with all Healthcare Assistants from September 2014
In conjunction with Truro College, we have been able to take forward Health and
Social Care Diploma training for a newly appointed Healthcare Assistant. This has
supported the enabling local people to apply for vacant posts.
More in-patient procedures such as the administration of Intravenous.
Immunoglobulin and Ferinject, which previously required the patient to attend RCHT
now being undertaken at St Mary’s Hospital within agreed protocols.
How safe was healthcare on the Isles of Scilly in 2013-14
•
•
•
•
•
100% of inpatients received thrombo-emboli risk assessment and treatment
43 Recorded Datix Incidents between April 1st 2013- March 31st 2014- Broad range
of incidents. Main ones are as follows.
 Slips, Trips & Falls: 13 recorded incidents- 2 minor harm, remainder nil harm.
 Blood Transfusion related incidents: 12 recorded incidents- none involved patient
transfusions. All incidents related to either transport of transfusion product to
Isles, Blood fridge calibration and 2 regarding documentation. New checking
procedures are now in place.
 Pressure ulcer: 3 reported incidents. 2 were identified on admission to Hospital.
 Medication 3 incidents: None involving administration to patients. 2 were
transport to Isles related and one was a miscount, which was rechecked and
rectified.
100% inpatients at St Mary’s received Medicines reconciliation, reducing the risk of
medication errors and improving patient outcomes.
Use of teleconferencing for some out-patients has not been as successful as hoped.
Further work on this area is required in 2014-15.
In 2013 the STEPS re-ablement training programme was brought to the Isles and
PCH nursing staff attended the training, with the Adult Social Care team. Work still
needs to be done to embed re-ablement into discharge planning and on-going home
care packages.
Isles of Scilly Community Services provided by PCH
•
•
The permanent Community Registered Nurse retired from her post in December
2013. Registered Nurses based in St Mary’s Hospital are now rostered to work in the
community. This ensures the continuity of care between hospital in-patients and
community patients. One PCH patient-centred care plan follows the patient, whether
they are an inpatient in St Mary’s Hospital or community client.
Hospital/Community Matron (one role) commenced monthly reviews, with GPs of
client’s living with Long-term-conditions, using Personalised Care Planning.
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Peninsula Community Health | Quality Account 2013-14
Isles of Scilly
•
•
•
•
•
Community Rehab Assistance attended work experience with the West Cornwall
Early Intervention Service and evaluation of learning experience will identify
opportunities for I.O.S EIS to be considered.
Associate Therapy Practitioner (ATP) continues to provide a broad range of therapy
interventions, including Falls Preventions, Steady On-Groups and one-to-one patient
therapy interventions. Fortnightly visits to the Islands from the West Cornwall
Therapy team have ensured continuity of community therapy services, assessment
& evaluation of therapy plans and supervision for ATP.
Cardiac Rehab Registered Nurse post (4 hours a week) commenced in March 2014
and proving to be an excellent addition to PCH Community Rehab services.
Supervision for local role provided within established PCH Cardiac services to
ensure safe practice.
Acute Care at Home- for clients requiring I.V anti-biotics now offered within their own
home. All procedures undertaken within PCH protocols.
24/7 End-of-Life Care continues to be provided by PCH Community Nurses,
ensuring patient choice and holistic patent centred care.
Impacts to PCH service delivery on the Isles of Scilly
•
We have found difficulties in appointing to registered nurse vacancies due to varying
reasons including: lack of affordable accommodation
 Poor winter transport
A workforce strategy is being developed.
•
•
The discontinuation of the helicopter passenger service in 2012 continues to impact
on service delivery. The Isle’s sole transport provider have reduced the times of their
schedule flights, which means staff are finding it difficult to attend training/up-dates
on the mainland in a day trip. Teleconferencing for meetings and training are being
sourced,
Need for suitable sustainable solution for long-term care requirements on the Isles of
Scilly.
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Peninsula Community Health | Quality Account 2013-14
Our Services on the Isles of Scilly
Throughout 2013-14, St
Mary’s
Hospital on the Isles of
Scilly had a
total of 187 inpatients
In 2013-14, District
Nurses on the
Isles of Scilly undertook
3,564 patient visits
Throughout 2013-14,
there were 4,152
patient contacts made
with services provided by
In 2013-14, 2,000
appointments
Peninsula Community
Health on
the Isles of Scilly
were undertaken by
Dentists on the
Isles of Scilly
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Peninsula Community Health | Quality Account 2013-14
Part 5
What others say
about us
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Peninsula Community Health | Quality Account 2013-14
What others say about us
Cornwall Overview and Scrutiny Committee
Cornwall Council’s Health and Social Care Scrutiny Committee agreed to comment on the
Quality Account 2013 -2014 of Peninsula Community Health (PCH). All references in this
commentary relate to the period 1 April 2013 to the date of this statement.
Peninsula Community Health has engaged with the Committee and regularly attends
meetings. The Committee believes that the Quality Account is a good reflection of the
services provided by the organisation, and provides comprehensive coverage of the
provider’s services. They wish to congratulate PCH on the ease of the understanding of the
document.
The appointment of a Hydration Lead Nurse and the actions taken in this area were
welcomed by Members, and they wish this work to continue to be a high priority for PCH.
Lengths of stay and discharge times have been of concern to the Committee and the
information that there has been improvement in these areas is welcomed. The aim to
increase the numbers of people safely discharged by lunch is one that the Committee will
be keen to monitor over the next year.
The Committee looks forward to working in partnership with Peninsula Community Health in
2014-15.
Isles of Scilly Overview and Scrutiny Committee
The Council of the Isles of Scilly welcomes the opportunity to contribute to the Quality
Accounts.
We would like to see further development of the integration of health and social care
services on the islands. We are glad to see progress in engagement with PCH on how to
maximise all the available resources on the islands, especially the Community Hospital, to
provide seamless service provision.
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What others say about us
NHS Kernow
Kernow Clinical Commissioning Group (KCCG) welcomes the opportunity to comment on
the 2013/14 Quality Account for Peninsula Community Health CIC (PCH). We would like to
acknowledge the efforts made by the provider to deliver a wide range of quality
improvements in 2013/14.
The Quality Account covers a wide range of indicators and KCCG notes the progress made
against several key quality indicators including; maintaining zero MRSA breaches and
controlling C. Diff within target, no breaches of mixed sex accommodation, and a reduction
in the average length of stay for patients. PCH’s innovative work to improve the care for
patients with dementia also deserves recognition.
The CCG is particularly keen to recognise the work carried out by PCH in response to the
Francis Report’s recommendations. The roll-out of the 6 C’s and pro-active work carried
out in community hospitals responding to the “right staff, right skills, right care and right
place” recommendations has provided additional assurances to the commissioners.
We are also happy to highlight the work carried out by PCH teams in the community to help
develop innovative projects such as the Newquay Pathfinder and the on-going integrated
working through the Living Well project which has helped Cornwall achieve Pioneer Status.
With regard to providing a balanced view the CCG would note that PCH partially achieved
the Safety Thermometer CQUIN. However the improved performance in the last three
months of 2013/14 has provided some assurances given the improvements made in
recording incidents. Performance against the rest of the CQUINs has been positive,
particularly with regard to the Friends and Family Test, and patient flow.
We are pleased to see that the priorities chosen for 2014/15 broadly align with those of
KCCG and we look forward to working with PCH over the next year to achieve more
efficient integrated pathways across health and social care and continuing to delivering high
quality services for our patients.
Healthwatch Cornwall
Healthwatch Cornwall was pleased to read the Quality Account for Peninsula Community
Health (PCH) 2013/14 and note the areas of focus chosen by the organisation, both for last
year and this.
The work to develop a dementia friendly organisation to improve the experience and
orientation for people admitted with dementia, together with the use of Dementia
Champions, alongside other partners in health, is a commendable move.
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Peninsula Community Health | Quality Account 2013-14
What others say about us
The work to know patients as individuals- “knowing the person”- and the focus on Person
Centred Practice is an area in which this organisation is pioneering and sharing good
practice with the community, which is impressive. The substantial reported reduction in the
incidence of pressure ulcers both in the community and in hospital is also worthy of note.
There is a real feel that the patient voice is a priority here. The issues identified for
continued quality improvement with discharge planning, with the intention that more
patients will be discharged in the morning, is welcomed.
Healthwatch Cornwall is extremely pleased to note that no patients were discharged at
night last year. Discharge continues to be an area of public dissatisfaction generally and
Healthwatch Cornwall is involved in a national inquiry with Healthwatch England to look at
this issue. Good practice stories such as this can help inform other areas of the country.
PCH has committed to updating its Whistleblowing Policy to reflect the Duty of Candour
that care organisations should be adopting in order to prevent institutional poor practice,
and as part of this is giving a higher focus to patients’ complaints.
Healthwatch Cornwall rarely receives complaints about this service and it has an open
route to ensuring any information received is attended to. Healthwatch Cornwall has started
to develop a relationship with PCH that is based on candour and it looks forward to working
more closely with them in future.
Healthwatch Isles of Scilly
Healthwatch Isles of Scilly is pleased to have the opportunity to comment on the Peninsula
Community Health Quality Report 2014. It is very pleasing to see, for the second time, a
section devoted the islands. Our ‘numbers’ are often lost in data which covers Cornwall and
the Isles of Scilly so this provides useful perspective as well as information about services
which is of particular interest to our community. The arrangements for providing procedures
at St Marys Hospital which would otherwise involve a trip to the mainland are most
welcome and we hope these can be increased further.
As noted in the report our own community survey yielded very positive feedback about PCH
services on-island.
Healthwatch supports the principle of integrated health and social care and the
development of ‘joined up services’ through Pioneer. We undertook some local staff and
community engagement which we reported back to the IOS Health and Wellbeing Board
Planning and Delivery Group. There were some very strong, positive, messages about how
this can be achieved and the commitment required from all providers. Peninsula
Community Health will have a pivotal role in this.
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Part 6
Statement of
Assurance
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Statement of Assurance from the Board
Statement of Directors Responsibilities in Respect of the
Quality Account
The Directors are required under the Health Act 2009 to prepare a Quality Account for each
financial year. The Department of Health has issued guidance on the form and content of
annual Quality Accounts (which incorporates the legal requirements in the Health Act 2009
and the National Health Service (Quality Reports) Regulations 2010 (as amended by the
National Heath Service (Quality Accounts) Amendments Regulations 2011).
In preparing the Quality Account, directors are required to take steps to satisfy themselves
that:
• The Quality Account presents a balanced picture of the organisations performance over
the period covered
• The performance information reported in the Quality Account is reliable and accurate
• There are proper internal controls over the collection and reporting of the measures of
performance included in the Quality Account, and these controls are subject to review to
confirm that they are working effectively in practice
• The data underpinning the measures of performance reported in the Quality Account is
robust and reliable, conforms to specified data quality standards and prescribed
definitions, and is subject to appropriate scrutiny and review; and
• The Quality Account has been prepared in accordance with Department of Health
guidance
The directors confirm to the best of their knowledge and belief they have complied with the
above requirements in preparing the Quality Account.
By order of the Board
Michael Williams
Chairman
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Steve Jenkin
Chief Executive
Peninsula Community Health | Quality Account 2013-14
Glossary
Glossary
Board of Peninsula Community Health CIC
The Board is accountable for setting the
strategic direction of the organisation,
monitoring performance against objectives,
ensuring high standards of corporate
governance and helping to promote links
between the organisation and the community.
The Board has 10 members and includes the
Chairman, Chief Executive, four Executive
Directors and four Non-Executive Directors
Care Quality Commission
The Care Quality Commission (CQC) is the
independent regulator of health and social
care in England. It replaced the Healthcare
Commission, Mental Health Act Commission
and the Commission for Social Care
Inspection in April 2009. The CQC regulates
health and adult social care services provided
by the NHS, local authorities, independent
healthcare
providers
and
voluntary
organisations. Visit: www.cqc.org.uk
Clinical Audit
Clinical audit measures the quality of care and
services against agreed standards and
suggests or makes improvements where
necessary
Commissioners of services
These are organisations that buy services on
behalf of people living in a defined
geographical area.
They may purchase
services for the population as a whole, or for
individuals who need specific care, treatment
and support.
Healthcare services are
commissioned by primary care trusts. Social
services are commissioned by local authorities
Commissioning for Quality and Innovation A report into the future of the NHS, entitles
(CQUIN)
‘High Quality Care for All’ 2008, included a
commitment to make a proportion of providers’
income conditional on quality and innovation.
This is achieved through the Commissioning
for Quality and Innovation (CQUIN) payment
framework. Visit www.dh.gov.uk
Complaint
This is an expression of dissatisfaction that
can relate to any aspect of a person’s care,
treatment or support. It can be expressed
orally, through gestures or in writing.
Department of Health
The Department of health is the department of
the UK government responsible for policies on
health, social care and the NHS (England
only).
Dignity
Dignity is concerned with how people feel,
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think and behave in relation to the worth and
value that they place on themselves and
others. To treat someone with dignity is to
respect them as a valued person, taking into
account their individual views and beliefs.
Discharge
The point at which a patient leaves hospital to
return home; or is transferred to another
service: or the provision of a service is formally
concluded.
Hospital Episode Statistics (HES)
This is a data warehouse containing a vast
amount of information on the NHS, including
details on all admissions to NHS provider
hospitals and outpatient appointments in
England. HES is an authoritative sourced
used for healthcare analysis by the NHS,
government and many other organisations.
Information Governance
Information Governance is concerned with the
structures, policies and practices in place to
ensure the confidentiality and security of
health and social care service records.
NHS Kernow
NHS Kernow is the clinical commissioning
group for Cornwall and the Isles of Scilly. The
Group is formed of 69 local practices who are
themselves formed into locality groups. NHS
Kernow principal work is to buy health services
on behalf of local people.
Healthwatch Cornwall and Healthwatch Isles Healthwatch Cornwall and Healthwatch Isles
of Scilly
of Scilly are the people’s champion of health
and social care in the county. It listens to the
experiences people have of local, publicly
funded care, whether good or bad, and uses
this evidence to help inform and influence the
commissioners and providers of services. It
needs you to help make positive changes for
the better where necessary.
National Confidential Enquiry into patient NCEPOD is an independent body concerned
Outcome and Death - NCEPOD
with maintaining and improving standards of
medical and surgical care. It does this by
reviewing the management of patients and
undertaking confidential surveys and research,
which are then published for the public’s
benefit.
National Institute for Health and Clinical NICE
is an independent organisation
Excellence - NICE
responsible for providing national guidance on
promoting good health and preventing and
treating ill health
NHS Number
This is the national unique patient identifier
that makes it possible to share patient
information across the whole of the NHS,
safely, efficiently and accurately.
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Overview and Scrutiny Committees (OSC)
Patient
PLACE
Privacy and dignity
Providers
VTE – Venous- Thromboembolism
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Since January 2003, all local authorities with
responsibilities for social care have had the
power to review and report on local health
services. Overview and Scrutiny Committees
have taken on this role, and have been
instrumental in helping to plan services and
bring about change. They bring democratic
accountability into healthcare decision-making
and make the NHS more responsive to local
communities.
This is a person who receives health or social
care through a regulated activity. Patients are
defined ‘service users’ in the Health and Social
Care Act 2008.
PLACE is an annual inspection of inpatient
facilities at healthcare sites across England
with more than 10 beds. PLACE is selfassessed and inspects standards including
food, cleanliness, infection control and patient
environment.
The scheme was initially
established in 2000 and called PEATs at the
time.
To respect someone’s privacy involves
recognising when they would like to be alone
(or with family or friends), and showing
sensitivity to their wishes for a private
conversation and preventing others from
looking or listening in. To treat someone with
dignity is to respect them as a valued person,
taking into account their individual views and
beliefs.
Providers are the organisations that provide
NHS services, for example NHS trusts,
community interest companies, voluntary
sector organisations.
A venous thrombosis is a blood clot
(thrombus)
that
forms
within
a vein. Thrombosis is a medical term for a
blood clot occurring inside a blood vessel. A
classical venous thrombosis is deep vein
thrombosis (DVT), which can break off
(embolize),
and
become
a
lifethreatening pulmonary embolism (PE). The
conditions of DVT and PE are referred to
collectively
with
the
term
venous
thromboembolism
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