Priory Healthcare
Quality Account 2013-14
PROVIDING QUALITY
INSPIRING INNOVATION
DELIVERING VALUE
Contents
Part 1 Statement from the Chief Executive
03 Statement from the Chief Executive
04 Quality statement from the Director of Corporate Assurance and Chief Nursing Officer
Part 2 Priorities for improvement
05 Summary of progress against 2013-14 Quality Performance Indicators
06 Detailed review of performance against 2013-14 Quality Performance Indicators
10 Priorities for improvement 2014-15
12 Our statements of assurance from the Board
Part 3 Additional information
14 Service user satisfaction – delivering value through clinical excellence
16 Outcomes – the success of our service users
20 Participation in clinical audits
21 The Commissioning for Quality and Innovation (CQUIN) framework
22 Continuous improvement in the delivery of our services
23 Staff opinion
23 Investing in staff, education and training
24 Regulatory compliance
25 Focus sites during 2013-14
25 Improving safety for our service users
Part 4 Appendix
26 Statement of assurance from our lead commissioner
27 Working in partnership with the NHS
28 Statement of Directors' responsibilities in respect of the Quality Account
29 Independent Limited Assurance Report to the Board of Directors of the
Priory Group’s No. 1 Limited on the annual Quality Account
32 Format of this Quality Account
33 Scope of data inclusion
2
Part 1 – Statement from the Chief Executive
Welcome to the latest Priory Group
Healthcare Quality Account. In publishing
an annual set of Quality Accounts for our
Healthcare Division our aim is to be fully
transparent and accountable for the
services we provide. The account provides
a summary of the achievements of our
Healthcare business during 2013-14
and outlines our priorities for further
improvements in the year ahead. Delivering
good care to our service users cannot be
done in isolation and we work in a close
partnership with our staff, service users,
families, Commissioners and Regulators.
In April 2013 we set ourselves ambitious
Quality Improvement Indicators. Of the eight
indicators set, I am proud to say we have
achieved or mostly achieved seven. These
remain our key priorities for the coming year
as we strive for excellence against a backdrop
of ever increasing acuity of our patients and
continued regulatory changes. I am therefore
pleased to outline some of the key highlights:
• 100% Commissioning for Quality and
Innovation (CQUIN) targets achieved for
the year
• 93% of all outcomes were judged to be met
by the Care Quality Commission at their
last inspection
• 97% of service users surveyed in acute
mental health services would recommend
Priory
• 98% of service users felt safe during their stay
• 83% of service users in secure services felt
engaged in their own recovery
• 75% of young people in Child and
Adolescent Mental Health Services
(CAMHS) showed an improvement
in their overall wellbeing
• 100% of service users in our neurorehabilitation service believe they were
well cared for and supported
• 100% of service users in our specialist
autism service felt that they were able to
make suggestions about their own care
• across all 58 registered healthcare sites
nationally not a single service was placed
under any form of embargo throughout
the whole year.
Of course, none of these results are
achievable without the ongoing dedication
and hard work of our staff. Our 2013 staff
survey showed that 89% of Priory Healthcare
employees felt that they were able to
contribute to the success of their team and
81% felt that they were able to do their job
to a standard that they were proud of
compared to the NHS benchmark of 77%.
I was delighted to celebrate our staff
achievements this year with our first ever
Priory Group “PRIDE” awards where staff were
individually recognised for their care, hard
work and achievements in underpinning our
core values of delivering value, providing
quality and inspiring innovation.
Throughout all of this however our absolute
focus remains on service user safety, clinical
effectiveness and the service user experience.
Learning from serious incidents and
complaints is also hugely important to us as
we strive for continued improvement and
excellence in care delivery and outcomes. My
aim is to ensure that the safety and wellbeing
of service users is protected and the highest
quality standards are upheld whilst further
developing integrated care pathways.
I am proud of Priory’s performance over the
last quality year and, to the best of my
knowledge, the information contained in this
report is a true and accurate reflection of the
services and outcomes that we have delivered.
Tom Riall
Chief Executive Officer
June 2014
3
Quality statement from the Director of Corporate
Assurance and Chief Nursing Officer
The Priory Group is focused on delivering
safe, compassionate, effectively regulated
care, that strives for good clinical
outcomes. The focus remains on providing
excellence in mental healthcare across
the communities we serve.
During 2013 the Priory Group benchmarked
itself against all the recommendations from
the Francis inquiry and delivered on a number
of key areas such as encouraging openness
and transparency, focus on safer staffing and
improving the service user experience. The
focus has been to enhance and further raise
care standards.
We continue to invest in our staff through
education and training. In 2013 The Priory
Group launched its Nursing Strategy which
focuses on delivering compassionate care in
a consistent manner. A new competency
framework has been developed to further
drive up professional standards. In addition,
we are offering apprenticeships which include
the Diploma in Health and Social Care to
Healthcare Assistants in some key hospitals.
We are proud to report that 99% of service
users in acute mental health services felt they
were treated with dignity and respect.
Our ultimate objective is to be world class
and a beacon of good practice for other
health and social care providers. In July 2013,
PricewaterhouseCoopers returned
to undertake a further review of our
governance processes:
“We are proud to report that 99% of service users in
acute mental health services felt they were treated
with dignity and respect.”
4
“There have been significant improvements
in the way in which the Group governs for
and manages quality, providing a better
balance of focus across financial, operational
and quality performance.”
“The creation of a Head of Quality
role within each division has
allowed for a much greater degree
of focus on quality and has provided
an improved level of capacity to
manage quality improvement.”
PricewaterhouseCoopers external review
Delivery of high quality care remains the
priority against a backdrop of high acuity and
significant challenge. If at times we fall short
of delivering the high standards that we
expect, we take immediate and robust
remedial action and learn lessons.
There is no room for complacency and we
continue to be passionate about the care
that we deliver. We proactively seek out the
areas for improvement and continue to have
a dedicated arms-length internal inspection
team that proactively highlights areas for
improvement. This assists us in ensuring that
our services continue to be well-led, safe,
effective, caring, responsive and provide good
clinical outcomes. We look ahead to 2014-15
with enthusiasm and focus and continue to
put quality at the heart of everything we do.
Siân Wicks
Director of Corporate Assurance
and Chief Nursing Officer
June 2014
Part 2 – Priorities for improvement
Summary of progress against 2013-14
Quality Performance Indicators
In 2012-13, our Quality Account incorporated the feedback from service users, Priory staff, Commissioners and other
external stakeholders, to identify three priority domains and eight priorities for improvement in 2013 -14 as our Quality
Performance Indicators (QPI’s).
In this section we will summarise our achievement against these priorities. We have used baseline indicators from
the 2012-13 Quality Account where possible to ensure the evaluation of our objectives is as accurate and effective
as possible.
QPI
number
Service and Priority
Domain
Outcome
PRIORY HEALTHCARE DIVISION
1
All service users to have their physical healthcare needs assessed and a plan put in
place to address areas of physical health need
Clinical effectiveness
and service user safety
Mostly achieved
2
Ensure that unmet need is recorded for all service users to assist in the CPA and
discharge planning process
Clinical effectiveness
and service user safety
Mostly achieved
Service user experience
Partially achieved1
Service user experience
Achieved
Service user experience
Achieved
Clinical effectiveness
Achieved
Service user safety
Mostly achieved
Service user experience
Achieved
CHILD AND ADOLESCENT MENTAL HEALTH SERVICES
3
Service users to be more involved and to participate in the planning and review of
safe, sound, and supportive services
EATING DISORDER SERVICES
4
Increase family and carer engagement and wellbeing
SECURE SERVICES
5
Service users to participate in recruitment across all our secure sites
COMPLEX CARE SERVICES
6
Increase service user involvement and engagement in meaningful activity to support
their recovery and rehabilitation
ACUTE MENTAL HEALTH SERVICES
7
Ensure that the service user is signposted to appropriate support services in the event
of a crisis upon discharge from acute services
SECURE SERVICES
8
Increase service user satisfaction in relation to care planning and communication
Table 1: Summary of progress against 2013-14 Quality Performance Indicators
1
The wording of this target
has been amended since
the previous year’s Quality
Account.
5
Detailed review of performance against
2013-14 Quality Performance Indicators
All the Quality Performance Indicators selected in 2013 -14, were new indicators for the Healthcare division and involved
establishing new data collection processes across sites.
Priory Healthcare division
Clinical effectiveness and service user safety
Clinical effectiveness and service user safety
QPI 1: All service users to have their physical healthcare
needs assessed and a plan put in place to address areas
of physical health need.
QPI 2: Ensure that unmet need is recorded for all
service users to assist in the CPA and discharge
planning process.
Target: 90% of service users admitted from September
2013 to have a physical healthcare examination on
admission to assess any physical healthcare needs.1
Target: 95% of CPA minutes and MDT review minutes
to record any unmet need and if there is no unmet need,
that there is a clear statement outlining this.
Measure: Quarterly audit of CareNotes will commence
from September 2013.
Measure: Quarterly audit of CPA minutes and MDT
review minutes will commence from September 2013.
Mostly achieved: While 80% of service users admitted
since September 2013 received a physical healthcare
assessment, month-on-month performance against this
indicator has improved and was at 91% for service users
admitted in March 2014. Data collection processes have
been implemented at all sites to enable central
monitoring of this via the electronic health records and
a monthly scorecard will continue to monitor compliance.
Partially achieved: This QPI was measured from October
2013 and is now fully implemented in all sites. Recording
of unmet needs in March 2014 occurred in 87% of CPA
and MDT meetings.
100
100
90
90
80
80
70
70
60
60
50
50
40
40
30
30
20
20
10
10
0
Sep
Oct
Nov
Dec
Jan
Target
Fig 1. Percentage of service users admitted under CPA
receiving a healthcare assessment
1
The wording of this target has been amended
since the previous year’s Quality Account.
6
Feb
Mar
0
Oct
Nov
Dec
Jan
Feb
Target
Fig 2. Recording of unmet needs in CPA and MDT meetings
Mar
Child and adolescent mental health services
Service user experience
QPI 3: Service users to be more involved and to
participate in the planning and review of safe, sound,
and supportive services.
Target: Service user presence at 90% of clinical
governance meetings.
Measure: Clinical governance minutes to record service
user attendance and sites to submit a quarterly report to
be included in the quarterly service user action plan.
Partially achieved: Young people did not routinely
attend clinical governance meetings at all sites but have
attended community meetings which feed into site
clinical governance meetings.
7
Detailed review of performance against
2013-14 Quality Performance Indicators
Eating disorder services
Service user experience
Secure services
Service user experience
QPI 4: Increase family and carer engagement
and wellbeing.
QPI 5: Service users to participate in recruitment across
all our secure sites.
Target: 90% of families or carers to be offered a Priory
Carer Wellbeing Workbook and to attend a wellbeing
planning meeting.
Target: Service users to be involved in 80% of interviews
for senior clinical posts at their sites.
Measure: Sites to keep a record of the number of
workbooks given out and wellbeing planning
appointments taken up. This indicator was measured
from October 2013.
Achieved: The year-end position was 100% of Eating
Disorder families and carers were provided with a Priory
Carer Wellbeing Workbook. In 2014-15, we will ensure this
is embedded, consistently happens and at least 90% is
achieved. In March 2014 all families or carers of patients
admitted with eating disorders were provided with
a Priory Carer Wellbeing Workbook.
Measure: Audit of appointments within secure services
at site level via the HR electronic records.
Achieved: All senior level posts recruited for secure sites
during Quarter 4 had service users involved in the
interviews. We exceeded the 80% target in five of the last
six months.
100
100
90
90
80
80
70
70
60
60
50
50
40
40
30
30
20
20
10
10
0
Oct
Nov
Dec
Jan
Feb
Target
Fig 3. Percentage of family and carers being given Priory
Carer Wellbeing Workbook
8
Mar
0
Oct
Nov
Dec
Jan
Feb
Mar
Target
Fig 4. Percentage of service users involved in interviews for senior
clinical posts (performance for November was 0%).
Detailed review of performance against
2013-14 Quality Performance Indicators
Complex care services
Clinical effectiveness
Secure services
Service user experience
QPI 6: Increase service user involvement and
engagement in meaningful activity to support their
recovery and rehabilitation.
QPI 8: Increase service user satisfaction in relation to
care planning and communication.
Target: 25 hours of diverse and meaningful activity to be
offered to every service user each week.
Target: Service user satisfaction to increase by 10% from
the 2012-13 baseline of 73%.
Measure: Through the service user satisfaction survey.
Measure: Audit of clinical health records (via CareNotes)
to evidence the offer of activity and the number of hours
taken up by the service user.
Achieved: When audited in January 2014 the average
number of hours of diverse and meaningful activity
offered to patients in complex care services each week
was 30 hours.
Achieved: Service user satisfaction when surveyed in
February 2014 had increased to 82%, from a baseline in
2012-13 of 73%. This is an increase of 12.3% in service
user satisfaction.
Acute mental health services
Service user safety
QPI 7: Ensure that the service user is signposted to
appropriate support services in the event of a crisis
upon discharge from acute services.
Target: 90% of service users to be offered a crisis card
upon discharge.
100
90
80
70
60
Measure: Each hospital to keep a record of the number of
cards offered and the number of times a discussion took
place to explain the purpose of the card.
50
40
30
Mostly achieved: 81% of service users surveyed during
the reporting period confirmed that they had been given
crisis information upon being discharged.
20
10
0
Q1
Q2
Q3
Q4
Target
Fig 5. Percentage of services users being given crisis information
(QPI 7)
9
Priorities for improvement 2014-15
We continually strive to improve both the experience and
outcomes of our service users in order to achieve the
highest standards of care. This includes developing Quality
Performance Indicators (QPIs) across the 3 domains:
• Clinical effectiveness
• Service user safety
• Service user experience
For each of these Quality Performance Indicators we have
established robust monitoring of the processes and
practices for each service line and for the Priory Group
overall. For quality improvement priorities for 2013-14
identified in the 2012-13 report, the previous year’s data
is not included, as this year’s priorities have changed.
We have identified nine priorities for improvement in
2014-15 at a divisional and service level, which are
detailed opposite and on the following page.
Last year we set new ambitious objectives. They require
further embedding as we strive for improvement. In
addition we have introduced the ‘Friends and Family test’
across all our service lines. It is our intention to report the
new test results fully in 2014-2015.
Quality Performance Indicators for the Priory
Healthcare division
QPI One
Domain: Clinical effectiveness & service user safety.
Category: Physical health.
Objective: For all service users to have their physical
health care needs assessed and a plan put in place to
address areas of physical health need.
Target: Newly admitted service users to have a physical
health assessment as part of the admission process and
90% of service users where there are physical health
needs to have a physical health care plan in place.
Measurement Source: Clinical health records
(CareNotes) averaged for the 12 month period.
10
QPI Two
Domain: Clinical effectiveness & service user experience.
Category: Unmet need.
Objective: To ensure that we record unmet need for all
service users. This will assist in the CPA and discharge
planning process.
Target: 95% of CPA minutes and MDT review minutes
to record any unmet need and if there is no unmet need
that there is a clear statement outlining this.
Measurement Source: Care Programme Approach (CPA)
minutes and Multidisciplinary Team (MDT) review minutes
averaged for the 12 month period.
QPI Three
Domain: Service user safety.
Category: Medication errors.
Objective: To improve patient safety by reducing
administration errors.
Target: Reduce the number of errors as a proportion of
the number of reviews undertaken from a divisional
average baseline of 2.35 in March 2014.
Measurement Source: Prescriptions involving
administration errors via Ashton Audits averaged for the
12 month period.
QPI Four
Domain: Clinical effectiveness.
Category: Clinical supervision.
Objective: To ensure hospital nursing teams receive
monthly clinical supervisions.
Target: 90% of hospital nursing and healthcare assistant
staff to receive monthly clinical supervisions.
Measurement Source: Foundations for Growth averaged
for the 12 month period.
Child and adolescent mental health services (CAMHS)
QPI Five
Domain: Service user safety.
Category: Absconsion.
Objective: To reduce actual absconsions.
Target: To further reduce actual absconsions by 10%
from the previous year of 148 actual absconsions.
Measurement Source: To monitor monthly via incident
reporting system and to review the data for actual vs
attempted absconsions.
Priorities for improvement 2014-15
Secure services
QPI Seven
Domain: Service user experience.
Category: Service user involvement.
Objective: For service users to participate in the
recruitment of at least 80% of posts across our
secure services.
Target: Service users to be involved in at least 80%
of the interviews for posts across all secure services.
Measurement Source: HR electronic records.
Audit against secure wide procedure averaged for the
12 month period.
Complex care services
QPI Eight
Domain: Service user experience.
Category: Meaningful activity.
Objective: For increased service user involvement and
engagement in meaningful activity to support their
recovery and rehabilitation.
Target: A minimum of twenty-five hours of diverse and
meaningful activity to be offered to each service user
per week.
Measurement Source: Clinical Health Records
(CareNotes) to evidence the offer of activity and the
number of hours taken.
Acute
Eating disorders
QPI Six
Domain: Service user experience.
Category: Family and carer involvement.
Objective: To increase family and carer engagement and
wellbeing.
Target: Priory Carer Wellbeing Workbook to be offered to
the family and carers of 90% of admissions.
Measurement Source: Each hospital to keep a record of
the number of booklets offered and the number/
percentage taken averaged for the 12 month period.
QPI Nine
Domain: Service user safety.
Category: Crisis cards.
Objective: To ensure the service user upon discharge from
acute services is sign posted to appropriate support
services in the event of a crisis.
Target: For 90% of service users to be offered crisis
information upon discharge.
Measurement Source: Service user survey completed
upon discharge which includes a question about whether
they were offered crisis information averaged for the
12 month period.
11
Our statements of assurance from the Board
This statement serves to offer assurance to the public that Priory Healthcare is performing to essential standards,
providing high quality care, measuring clinical processes and involved in initiatives to improve quality.
Review of Services
During 2013-14 Priory Healthcare provided the following
58 relevant services, comprising:
Healthcare and addictions
Psychiatric care and therapy for a broad range of mental
health disorders including acute mental health
(depression, stress, anxiety etc.), eating disorders, neurodisabilities, complex care and child and adolescent mental
health services (CAMHS) alongside behavioural and
substance addictions.
Secure and step down
Provision of forensic mental healthcare services through
clinically effective, evidence based treatment
programmes for adult service users who require secure
and step down care in a setting that provides physical and
psychological security. Facilities enable both medium and
low secure service users to receive an integrated and
holistic approach to their treatment.
Priory Healthcare has reviewed all the data available
to them on the quality of care in 58 of these relevant
health services.
The income generated by the relevant health services in
2013-14 represents 85% of the total income generated
from the provision of relevant health services by Priory
Healthcare for 2013-14.
Participation in Clinical Audits
During 2013-14, 3 national clinical audits and one
national confidential enquiry covered relevant health
services that Priory Healthcare provides.
Priory participated in the National Confidential Inquiry
into Suicide and Homicide for People with Mental Illness
and the National Patient Safety Agency Suicide
Prevention Audit during this period.
12
During 2013-14 Priory Healthcare participated in no
national clinical audits and 100% of the national
confidential enquiries of the national clinical audits and
the national confidential enquiries it was eligible to
participate in.
The national clinical audits and national confidential
enquiries that Priory Healthcare was eligible to participate
in during 2013-14 are as follows:
• National Confidential Inquiry into Suicide and
Homicide for People with Mental Illness (NCISH)
• National Audit of Psychological Therapies (NAPT)
• Prescribing Observatory for Mental Health (POMH) –
Prescribing in Mental Health Services
The national clinical audits and national confidential
enquiries that Priory Healthcare participated in during
2013-14 are as follows:
• National Confidential Inquiry into Suicide and
Homicide for People with Mental Illness (NCISH)
The national clinical audits and national confidential
enquiries that Priory Healthcare participated in, and for
which data collection was completed during 2013-14, are
listed below 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.
• National Confidential Inquiry into Suicide and
Homicide for People with Mental Illness (NCISH)
93%
The reports of 0 national clinical audits were reviewed by
the provider in 2013-14 and Priory Healthcare intends
to take the following actions to improve the quality of
healthcare provided.
The reports of 6 local clinical audits were reviewed by the
provider in 2013-14 and Priory Healthcare intends to take
the following actions to improve the quality of healthcare
provided:
1. Safeguarding Mandatory audit to ensure compliance
against national standards
Statements from the Care Quality Commission
Priory Healthcare is required to register with the Care
Quality Commission (CQC) in England and its current
registration status is ‘registered’. Priory Healthcare
locations do not have any conditions placed on
their registrations.
Priory Healthcare is also registered with:
2. HR Files Learning from SUI in relation to safe
staff recruitment
3. Infection Control Mandatory audit to ensure
compliance against national standards
4. Risk Assessments, Care Plans, CPA and Observations
Assurance audit to ensure key standard practices are in
place across the division and will act as a triangulation
of the quality walk round results
5. Preventing Suicide National Patient Safety Agency Tool
6. Clinical Supervision To evaluate the new standardised
clinical supervision provided to staff.
Participation in Clinical Research
The number of patients receiving relevant health services
provided or sub-contracted by Priory Healthcare in 201314 that were recruited in that period to participate in
research approved by a research ethics committee was 0.
Goals Agreed with Commissioners –
Use of the CQUIN Payment Framework
A proportion of Priory Healthcare income in 2013-14
was conditional on achieving quality improvement and
innovation goals agreed between Priory Healthcare and
any person or body they entered into a contract,
agreement or arrangement with for the provision of
relevant services, through the Commissioning for Quality
and Innovation payment framework.
Further details of the agreed goals for 2013-14 and for
the following 12 month period are available on request
from amandasellers@priorygroup.com
• Health Inspectorate Wales (HIW)
• Care and Social Services Inspectorate Wales (CSSIW)
• Healthcare Inspectorate Scotland (HIS)
The CQC has taken enforcement action against 1 Priory
Healthcare location during 2013-14. Priory Healthcare
has not participated in any special reviews or
investigations by the CQC during the reporting period.
There was no enforcement action from the Welsh
or Scottish regulators.
Data Quality
Priory Healthcare were not required to submit records
during 2013-14 to the Secondary Uses Service (SUS)
for inclusion in the Hospital Episode Statistics (HES) which
are included in the latest published data.
Information Governance Toolkit
Attainment Levels
Priory Healthcare Information Governance Assessment
Report score overall score for 2013-14 was 69% and was
graded Green.
Clinical Coding Error Rate
Priory Healthcare was not subject to the Payment by
Results clinical coding audit during the reporting period
by the Audit Commission.
“Facilities enable both medium and low
secure service users to receive an integrated
and holistic approach to their treatment.”
13
Part 3 – Additional information
Service user satisfaction –
delivering value through clinical excellence1
By listening to our service users we can drive service development across the Priory Group Healthcare division. Service
users that feel engaged with the care they are receiving and the trust in the health care professionals delivering that
care, have significantly improved outcomes.
care ser
vi
2013
2014
95%
m
Overall satisfaction with the quality of care by service
1
The Quality Performance Indicators in this report
are not governed by standard national definitions.
2
Felt the staff are caring and supportive.
14
g
in
99%
disorder ser
v
2013
2014
neu
d
ea
t
d and ad
chil
o
co
plex
2013
2014
isability se
rv
s
ice
94%
-d
ro
2013
2014
100%
cure services 2
se
s
ice
98%
2013
2014
therapy servic
y
a
es
2013
2014
h
s
ce
iction servic
e
s
d
ad
96%
cent mental
h services
2013
2014
s
le
lt
ea
m
h
ental ealth s
es
vic
er
acut
e
In 2012-13 we noted that service users within our low and medium secure services demonstrated lower levels of
satisfaction within the service than for other areas within the Healthcare division and we took action to address this.
We are delighted to report an increase in service user satisfaction from our secure service users. In particular the Secure
Service Users conference was an especially innovative approach to increasing service user involvement and engagement
which has been evidenced by the increased service user satisfaction.
93%
2013
2014
83%
Highlights from the service user satisfaction survey
by service
Acute mental health services
Day therapy services
97% Would recommend us to a friend
100% Treated with courtesy and respect
99% Treated with dignity and respect
98% We understood their needs and difficulties
98% Felt safe during their stay
97% Felt that therapy was as good as expected
Addiction services
99% Treated with dignity and respect
99%
Staff made them feel welcome
when they arrived
98% Would recommend us to a friend
Eating disorder services
99%
Staff made them feel welcome
when they arrived
Complex care services
95% Feel they are treated with respect at all times
94%
Feel they have the opportunity to join
activities on site and in the community
93% Feel safe within Priory services
Secure services
80% Felt listened to and understood by staff
98% Treated with dignity and respect
81% Have confidence in the ability of the staff
98% Felt safe during their stay
83% Felt engaged in own recovery
Child and adolescent mental health services
94%
Felt their healthcare professionals listened
to and understood their problems
Neuro-disability services
100% Believed they are cared for and supported
Felt they are able to attend service
user meetings
93% The service helped to deal with their problems
100%
91% Satisfied with the services offered to them
94% Felt treated with respect and dignity
15
Outcomes – the success of our service users
One of the central objectives of the Priory Healthcare
division is to enable every service user to be an active
participant in their own recovery process.
Outcomes demonstrate the progression that each service
user has made and are an intrinsic element of every
personalised care pathway. When appropriate, we
regularly feed outcomes back to the individual, alongside
families and carers, as well as those who commission our
services and form an integral part of the individual's wider
care pathway.
Clinical outcomes within acute mental health, addiction
services and eating disorder services use the nationally
recognised Health of the Nation Outcomes Scales
(HoNOS). The HoNOS assessment is undertaken upon
admission and again at discharge (or bi-annually within
our secure services) to ascertain the level of improvement
in a service user’s clinical condition during their
inpatient stay.
16
Within child and adolescent mental health services,
we use the Health of the Nation Outcomes Scales for
Children and Adolescents (HoNOSCA), and the HoNOS
Secure tool is used within our low and medium secure
facilities. All of the HoNOS outcomes quoted that relate
to improvement in overall mental wellbeing refer to
service user outcomes at the point of discharge. Across
the Healthcare division, additional outcome tools may
also be used, according to the nature of each service.
We believe that progress is made in many forms, and
achieving outcomes is relevant to the unique needs of
each service user. This means that we also consider the
social, emotional and physical development of the
individual alongside their clinical progression. For this
reason, we place great emphasis on qualitative outcomes
alongside clinical metrics to reflect the success of our
service users.
Acute mental health services
2013-2014
showed improvement in their
overall mental wellbeing
82%
2013-2014
79%
demonstrated an improvement
at discharge from therapy
Eating disorder services
2012-2013
2013-2014
86%
84%
2012-2013
2013-2014
75%
2013-2014
97%
wholly or partially achieved
their goals
2012-2013
99%
Secure services
2013-2014
65%
2013-2014
76%
2013-2014
61%
77%
showed improvement in
their risk profile
of admissions who had incidents
in the first six months went on to
reduce the number of incidents in
the second six months
2012-2013
63%
2012-2013
64%
80%
showed improvement in their
overall mental wellbeing
91%
2012-2013
77%
Addiction services
2013-2014
showed improvement in their
overall mental wellbeing
2012-2013
2012-2013
gained weight
92%
2013-2014
Complex care
showed improvement in
attitude to diet, shape
and weight
92%
2013-2014
89%
showed improvement in
their overall mental wellbeing
after 7 days
were still abstinent
12 months post discharge
2012-2013
93%
2012-2013
86%
Child and adolescent mental health services
2012-2013
2013-2014
n/a
75%
showed improvement in their
overall mental wellbeing
2012-2013
77%
17
Case Study
Adam* Priory Hospital Ticehurst
Adam was transferred to Priory Hospital Ticehurst under section 3 of the Mental Health Act
with diagnoses of mild learning disability, borderline personality disorder, social phobia, severe
self-harm issues and substance misuse. He was quite ambivalent about his admission to
Ticehurst, stating that he had given up all hope of having a ‘normal’ life. Initially he was
pessimistic about his future and was reluctant to engage and discuss his issues as he felt
he had been let down many times in the past.
On admission, Adam was fully assessed by the multidisciplinary team which consisted of
a psychiatrist, nursing staff, occupational therapist and a psychologist. Over time, Adam started
to attend dialectical behaviour therapy sessions for his self-harm issues and was seen by an
addiction therapist for motivational work and relapse prevention. Furthermore, he found that
talking and being open about his anxiety and low self-esteem helped him to take control of
his negative feelings.
Adam found that the team at Ticehurst respected his views and positively encouraged him
to take ownership of his care and, with some assistance, help to develop his own care plans.
The section 3 was rescinded, Adam enrolled with a local college, achieving a distinction on
a painting and decorating course which he attended without assistance.
Adam has continued to improve and eventually felt comfortable looking for accommodation
within the community with the help and support of the multidisciplinary team, who ensured
that the gradual move back to the community was at a pace that was comfortable for him.
Adam was fully discharged into the community with help from the local Community Mental
Health Team and is now happily settled within local employment.
ADAM IS
NOW SETTLED
WITHIN LOCAL
EMPLOYMENT
.
18
18
ROBERT IS NOW
A MEMBER OF
VARIOUS SOCIAL
GROUPS
.
Case Study
Robert* Priory Egerton Road Neuro-Rehab Centre
Robert was a highly paid and well respected computer analyst until at the age of 29 when, as
a result of Wolff-Parkinson-White Syndrome, he suffered a cardiac arrest and seizure causing
cerebral anoxia.
Initially, Robert was admitted to the Priory Hospital Ticehurst where he underwent a programme of
intense rehabilitation with the multidisciplinary team (MDT). Robert stayed at Ticehurst for 3 years
and learned to cope with his cognitive disabilities before eventually moving to a small residential
home at Priory Egerton Road. Here, Robert lived in the main house with the support of the MDT
who worked with him to develop his memory, improve his social skills and independence which he so
desperately wanted to regain. As part of his programme the MDT instigated a daily log, listing every
activity for that day including the basics such as shaving.
Eventually Robert went back into employment, working part time in Hastings. He was able to visit
his parents, travelling independently, and after three years he moved to the annexe of Egerton Road
preparing him for the next stage of his journey as well as giving him more control.
In time Robert moved into his own home near his parents. The home was also close enough for
the MDT to continue their support with an outreach package tailored to his needs. Robert now lives
independently and is a member of various social groups; he is incredibly thankful to Priory Egerton
Road MDT for supporting his journey to more independent living.
Staff at Egerton Road continued to outreach with Robert within his own home through a gradually
reducing support package.
*Service user’s
names have
been changed
to maintain
confidentiality
19
Participation in clinical audits
In 2013-14, a divisional audit calendar was implemented
that included six large audits in order to ensure divisional
wide assurance and enable benchmarking between sites,
with the opportunity for sites to learn from each other.
The topics were chosen strategically using data from
inspections, serious incidents and national requirements.
Each hospital/care home also chose at least three site
specific audits relevant to them to ensure all their needs
were accounted for. The monthly medicine audits at each
hospital also continue and populate information on a
medicines scorecard that is produced monthly, enabling
issues to be picked up by ward and addressed through the
monthly QPI monitoring processes in place.
Audit Title
Domain
Rationale
1. Safeguarding
Service User (SU) Safety
Compliance against national standards.
2. Recruitment
Staff and SU Safety
Safe staff recruitment.
3. Infection Control
SU Safety and Clinical Effectiveness
Compliance against national standards.
4. Risk Assessments, Care Plans,
Care Programme Approach
and Observations
SU Safety, Clinical Effectiveness and
SU Experience
Assurance audit to ensure key standard practices.
5. Preventing Suicide
SU Safety
National Patient Safety Agency Suicide Prevention Toolkit
6. Clinical Supervision
Staff, SU Safety and
Clinical Effectiveness
To monitor implementation of the new Clinical Supervision
Policy.
7. Mental Health Act
SU Safety and Experience
Compliance with legal requirements and regulatory themes
8. Mental Capacity Act
SU Safety and Experience
Compliance with legal requirements and regulatory themes
Table 2. Divisional Audits
“During 2013-14 we worked with our pharmacy
provider to undertake weekly audit research into our
prescribing systems. The feedback and lessons
learned were shared across the division and
demonstrated a sustained improvement in
medication management. A paper was completed
and this has been submitted to a number of journals
for publication.”
20
The Commissioning for Quality and Innovation (CQUIN)
framework
We are proud to have achieved 100% CQUIN requirements across two schemes and better still the service users have
really benefitted from some of the initiatives introduced.
All Specialised Mental
Health NHS England
contract
Highlights
Outcome
Quality Dashboard
The reports we receive show we are above the national average for percentage of staff up to date
with safeguarding children and adult training. The dashboards confirm our internal monitoring
processes.
Achieved
Optimising Care Pathways
We can now see how people progress through care pathways and the level at which they access
psychological interventions. The full year effect of collecting this data will provide a greater picture
of admission to discharge pathways.
Achieved
Physical Healthcare
A Priory Physical Healthcare Assessment template was developed and rolled out across sites via
CareNotes (electronic patient record).
Achieved
Care Programme Approach
Priory Healthcare Services have been working with our NHS provider partners in secondary care to
maintain positive relationships which ultimately assist service users in jointly planning for their future
and preparing for discharge.
Achieved
Access to literacy and
numeracy
Excellent increase in access to literacy and numeracy; including online education, access to college
courses and inreach tuition for adult courses.
Achieved
Use of technology
Increased use of video and tele-conferencing and exploring a secure mobile solution which will
enable both internal and external remote communication via a computer or tablet.
Secure Only
Achieved
Kent and Medway Commissioning Support Unit (CSU) contract for Priory Complex Care services
Quarter 1 & 2
These CQUINs supported the work we do via our Recovery and Outcomes group promoting and
delivering an ethos of recovery, service user involvement and engagement in meaningful activity.
Achieved
Information about
Medicines
Ensuring we assist our service users to understand the positive effects and potential side effects
of their medication.
Achieved
Care Programme Approach
This is proving to be very useful for commissioners to monitor attendance of care coordinators
at CPA reviews.
Achieved
We undertake regular physical health assessments for people with Long Term Conditions and ensure
that our service users access primary care services and have, as a minimum, an annual health check.
Achieved
Our sites which have high levels of service users with physical health needs have been inputting into
the National Patient Safety Thermometer database.
Achieved
Physical Health
Patient Safety Thermometer
Table 3. CQUINs for Priory Healthcare
21
Continuous improvement in the delivery of our services
Providing a high quality service for both our service users
and those who commission our services is a central
objective for the Priory Healthcare division. As such, we
take all complaints very seriously and utilise this feedback
as part of an overall ethos to drive service development
through continuous improvement.
We use the lessons learned from comments and
complaints to help improve the care that we provide to
our service users. Examples of the improvements made
during 2013-14 include:
• adjusting the content of a number of staff training
modules
• enhancing wi-fi reception at our hospitals
• reviewing menus and catering schedules at a number
of sites.
The majority of complaints that we receive are dealt with
at Stage 1 of the complaints process. This means that the
manager of the service undertakes an investigation into
the concerns that have been raised and provides
a response to the complainant. In the event that the
complainant remains dissatisfied, a further review is
undertaken at Stage 2 of the complaints process by
a senior manager who is independent of the service.
In the event that resolution is not reached at Stage 2 the
complaint can be referred to Stage 3 of the complaints
process. This involves the complaint being reviewed
depending on the service user’s funding arrangements,
by the Independent Sector Complaints Adjudication
Service (ISCAS) or the Parliamentary Health Service
Ombudsman (PHSO).
Commentary on 2013-14 complaints
For 2013-14 we saw a slight reduction in complaints
at Stage Two. However, there were three complaints
at Stage Three, one of which was referred to the
Independent Sector Complaints Adjudication Service
(ISCAS) and the remaining two were referred to the
Parliamentary Health Service Ombudsman (PHSO).
Stage 3 cases (April 2013 – March 2014)
Independent Sector Complaints
Adjudication Service
The complaint referred to ISCAS was partially upheld.
Parliamentary Health Service Ombudsman
Of the two complaints referred to the PHSO, neither
complaint was upheld.
Complaints per 1000
occupied bed days
2013-14
1.41
2012-13
1.32
2011-12
1.45
2010-11
1.40
Table 4. Complaints during 2013-14
2013-14 Stage 2
21
2013-14 Stage 3
3
2012-13 Stage 2
22
Table 5. Complaints at Stage 2 and 3
22
Staff opinion
The annual Staff Engagement Survey is well received by
staff from the Priory Healthcare division, with a response
rate of 73% for the 2014 survey (the highest response
rate in the Group, and the highest response rate since the
survey began in 2009). Where possible, the results of this
survey have been benchmarked against the NHS.
We recognise that, although staff recognition is higher
within the Priory Healthcare division than the NHS
benchmark identified below, it is still an area of focus
for the Group. Our PRIDE Awards, launched in 2013,
recognise our staff’s significant contribution in delivering
value, providing quality and inspiring innovation and
demonstrating leadership.
Theme
Result
2013-14
NHS
Benchmark
Result
2012-13
Feel they are able to
contribute to the success
of their team
89%
Data not
available
89%
Feel they are able to do
their job to a standard
they are personally
pleased with
81%
77%
79%
Would recommend Priory
76%
as a good place to work
54%
74%
Feel they will still be
working for Priory in 12
month’s time
Data not
available
55%
Feel they achieve
56%
recognition for their work
54%
54%
Overall job satisfaction
Data not
available
68%
57%
70%
Table 6. Staff Engagement Survey key findings
Investing in staff, education and training
2013-14
e-learning Modules
2012-13
95%
Safeguarding vulnerable adults
94%
97%
Safeguarding children
99%
98%
Confidentiality and data protection
99%
93%
Infection control
92%
96%
Safe-handling of medicines
97%
97%
Suicide and self-harm
98%
91%
Mental Capacity Act
90%
93%
Deprivation of Liberty
90%
Learning and development
Our staff are key to the quality of care delivered and
service user experience. Foundations for Growth, our
internal e-learning programme for staff, was launched
seven years ago and in 2013-14 alone, the programme
has enabled Healthcare staff to complete 87,759
e-learning modules and 23,047 face to face training
sessions including mandatory training. However, we also
recognise the importance of learning and development
within the wider context of delivering quality and inspiring
innovation within our services. For this reason, significant
investment has been made in continuing professional
development during 2013 -14.
Table 7. Percentage of allocated e-learning modules completed by Priory Healthcare staff during 2013-14
23
Regulatory compliance
The Healthcare division covers England, Scotland and
Wales, and is therefore required to work under the
standards set out by regulators within each respective
area. 50 of our 58 Healthcare sites were inspected by
regulators between 1 April 2013 and 31 March 2014.
These are broken down by regulators as follows:
• Care Quality Commission
42
• Health Inspectorate Scotland
0
• Health Inspectorate Wales
2
• Care and Social Services
Inspectorate Wales
6
Internal inspections
In 2013 every single healthcare site had a full
benchmarking inspection against the relevant outcomes
and standards for all regulators. A programme of rigorous
internal compliance inspection and monitoring continues
across the Group on an ongoing basis, by arms length
specialist inspectors. Internal compliance activity is
now prioritised based on a robust process of Quality
Performance Indicator Review, intelligence monitoring
and risk assessment. Specialist inspection teams comprise
of health and safety and regulatory compliance experts,
and experienced financial auditors. During the period
specialist inspections took place across the Priory
Healthcare division as follows:
•
•
•
•
136 internal regulatory compliance inspection visits
17 fire risk assessments
36 health and safety inspections
46 financial audits.
Care Quality Commission (CQC)
of outcomes inspected at the most recent
93%
regulatory inspections were met
199 outcomes identified in the Essential Standards of
Quality and Safety were reviewed during the most recent
inspections that took place at Priory Healthcare sites
between 1 April 2013 and 31 March 2014. Of these 186
were met and 13 were unmet. Examples of these were
records and care planning. Significant efforts have been
made to move these outcomes to compliance.
Healthcare Inspectorate Scotland (HIS)
of outcomes were judged to
100%
have been met
During the period between 1 April 2013 to 31 March
2014 there were no inspections. The last HIS inspection
occurred on the 3 December 2012 and was fully
compliant across all standards inspected.
Healthcare Inspectorate Wales (HIW)
Two Priory hospitals were inspected by Health
Inspectorate Wales between 1 April 2013 and 31 March
2014 and there were 14 recommendations made relating
to 9 standards. Action plans were immediately
implemented and notification of this sent to the regulator.
Care and Social Services Inspectorate Wales (CSSIW)
of outcomes were judged to
96%
have been met
The Care and Social Services Inspectorate Wales
inspected 22 standards across Priory Healthcare Welsh
sites between 1 April 2013 and 31 March 2014. 21 of the
standards were judged to have been met. One standard
was deemed to have been unmet. This site immediately
addressed the issue relating to staff meetings.
Embargoes and warning notices
There have been no external embargoes in any Priory
Healthcare site during the period. There has been one
regulatory enforcement action, a warning notice, issued
by the CQC at Hayes Grove. An improvement plan was
put in place, which has since been completed. As a result
of this the division has invited the regulator back to the
service for re-inspection as soon as possible, to validate
compliance.
24
• Sites with warning notices
• Sites with imposed embargoes to admission
1
0
Focus sites during 2013-14
When a hospital or care home requires additional support,
this is managed through a formalised framework and the
necessary support put in place for the improvements
to be made. As required by the Duty of Candour, Priory
Healthcare communicates openly and works with
regulators and commissioners, service users, their families
and carers and other external stakeholders for as long
as necessary to ensure full confidence in our service
is restored.
The Priory Hospital Middleton St George
This hospital gained compliance very quickly with the
CQC by March 2013 from the warning notice issued in
January 2013 in relation to staff recruitment. However,
a longer term improvement plan needed to be put in
place to address cultural staff practices and strengthen
safeguarding processes. The site has made considerable
progress and this has been expressed by CQC,
commissioners, service users and other external stakeholders.
The Priory Hospital Southampton
The hospital has worked with commissioners to address
concerns identified. Commissioners have conducted
regular visits and have been pleased with the progress
that has been made. This hospital is no longer a focus site.
The Priory Potters Bar
The CQC found the site to be unmet in relation to
outcomes. A robust recovery plan was put in place with
work ongoing.
The Priory Hemel Hempstead
In March 2013, this hospital was found to be unmet
for outcomes when inspected by the CQC. The report
highlighted poor standards of care and leadership.
A recovery plan was put in place and the site was
re-inspected in August 2013 and found to be fully
compliant. This site is no longer a focus site and in
subsequent evaluation and monitoring six months on,
including feedback from service users and the family,
the hospital has been found to have sustained the
improvements and embedded them in practice.
Improving safety for our
service users
In order to improve processes and practices within our
services, and to ensure our Duty of Candour is met, Priory
Group strives to develop an open and transparent culture
where staff are able to report incidents as they occur.
Since 2012 we have reported all incidents using an
electronic reporting system, which all staff have access
to. Staff are instructed on how to use this within
induction, and an overview is also provided within the
e-learning modules on Safety, Quality and Compliance.
Our staff are encouraged to report all incidents, serious
incidents and near misses in line with a “no-blame” culture
and to help us better understand causes and contributory
factors at an organisational level. We are pleased to see
increased reporting of incidents, since this indicates the
further development of a patient safety culture.
4
During 2013-14 there were no incidents that
would be classified as never events as defined
by NHS England4.
2013-14
2012-13
NHS average
(April 13September 13)
Total number of incidents
reported (per 1000
occupied bed days)
25.4
21.8
28.0
Serious incidents relating to
the death of a service user
0.2%
0.2%
0.9%
Incidents resulting in the
permanent harm of
a service user
0.1%
0.3%
0.4%
Table 8. Incidents reported
NHS England; “The never events list; 2013-14 update” http://www.england.nhs.uk/wp-content/uploads/2013/12/nev-ev-list-1314-clar.pdf
25
Part 4 – Appendix
Statement of assurance from our lead commissioner
This statement is given to the best of my knowledge for
the period 2013-14 in respect of secure services, adult
eating disorder services and child and adolescent mental
health services commissioned by NHS England.
Priory Healthcare has enthusiastically and successfully
implemented the national CQUINs across services, and
has provided commissioners with good evidence to
support the monitoring of achievements each quarter.
Priory Healthcare has been compliant with the
performance reporting cycle and has provided good
quality, timely reporting in relation to the key quality
indicators as defined in the contract.
Commissioner meetings with service users and the
advocacy service at Thornford Park have been supported
and encouraged by Priory, and this has provided
commissioners with invaluable feedback on the quality
of service provision.
The Provider has complied with submissions of serious
incident and safeguarding notifications, related reports
and action plans. This has supported the robust
monitoring of the safety and quality of placements, with
areas of concern identified being addressed promptly.
Priory have responded well to issues in a transparent
manner and are continuing to work with commissioners
to strengthen monitoring and reporting processes and
further develop patient safety. They are continually
working to recruit and train staff with the level of skills
required for the challenges they face.
26
We will work with the provider over the coming year to
ensure robust processes are in place to share learning
across its portfolio of services.
Louise Doughty
Head of Mental Health & Programme of Care Lead
Wessex
NHS England
Working in partnership with the NHS
Within the Priory Healthcare division alone, 85% of our
services are commissioned on behalf of the NHS and
other public bodies throughout the UK. It is therefore
essential to us that our services are delivered in close
collaboration with referring commissioners and other
external care providers to ensure the optimum outcome
for each service user, as part of their overall care pathway.
This means ensuring early visibility of the service user’s
progression throughout each treatment phase relevant to
their individual goals and objectives and, where possible,
developing a stepped care approach to treatment, with
transparent and flexible pricing frameworks.
“The last year has been a period of massive change for commissioners and providers.
The relationship between the two has seldom been so complex and flexibility has been
at the core of the dialogue. In particular areas, notably Tier 4 CAMHS and Adult Eating
Disorders, demand has exceeded supply with consequent very real challenges throughout
the Care Pathway.
As commissioners we have had daily contact with the Priory Group, both at local and
national level. The Group’s national referral process has helped us save time in contacting
units, and daily bulletins on bed availability have become essential to commissioners in
trying to ensure that patients are placed as close to home as possible.
These processes are an essential part of the quality agenda, as access to services takes on
a profile it has seldom had before. Priory continue to demonstrate a customer focus and
when we have asked the Group for help in particularly trying times, they always do their
best to assist.”
Roger Cook
Head of CAMHS and Specialised
Commissioning at West Midlands
Specialised Commissioning
Reporting year 2013-14
“During our unannounced inspection we found
evidence that people who use the services at The
Priory are regularly involved in providing feedback
about the care and support provided. We saw that
the relationship between staff and people who use
the service was open and inclusive and that people
were treated with dignity and respect. We spoke
with 10 members of staff across different
disciplines and all of them were motivated to
give good care. This inspection resulted in no
requirements and two recommendations.”
Susan Brimelow
Chief Inspector, Healthcare Improvement Scotland,
on the Inspection: 3 & 4 December 2012
27
Statement of Directors responsibilities in respect of the
Quality Account
The Directors are required under the Health Act 2009 and the National Health Service (Quality Accounts) Regulations
to prepare quality accounts for each financial year.
Monitor has issued guidance to NHS Foundation Trust boards on the form and content of the annual quality reports
(which incorporate the above legal requirements) and on the arrangements that NHS Foundation Trust boards should
put in place to support the data quality for the preparation of the quality report.
In preparing the Quality Account, Directors are required to take steps to satisfy themselves that:
1. The content of the Quality Account meets the relevant requirements set out in the NHS Foundation Trust Annual
Reporting Manual 2013-14
2. The content of the Quality Account is not inconsistent with internal and external sources of information including:
•
Board minutes and papers for the period April 2013 to June 2014
•
Papers relating to quality reported to the Board over the period April 2013 to June 2014
•
Feedback from commissioners
•
Feedback from external auditing reviews (conducted by PricewaterhouseCoopers)
3. The Quality Account presents a balanced picture of the Priory Healthcare division’s performance over the
period covered
4. The performance information reported in the Quality Account is reliable and accurate
5. 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
6. 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
7. The Quality Account has been prepared in accordance with Monitor’s annual reporting guidance (which incorporates
the Quality Account regulations, published at www.monitor.gov.uk/annualreportingmanual) as well as the standards
to support data quality for the preparation of the Quality Account (available at
www.monitor.gov.uk/annualreportingmanual).
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
June 2014
Mike Jeffries
Chairman
The Priory Group
28
Tom Riall
Chief Executive Officer
The Priory Group
Independent Limited Assurance Report to the Board of
Directors of the Priory Group’s No. 1 Limited on the annual
Quality Account
We have been engaged by the Board of Directors of The
Priory Group No. 1 Limited (the ‘Company’) to perform
an independent assurance engagement in respect the
Company’s Healthcare Quality Account for the year
ended 31 March 2014 (the ‘Quality Report’).
Scope and subject matter
The Company has voluntarily applied certain principles
of the guidance provided by Monitor to NHS Foundation
Trusts (‘Detailed Guidance for External Assurance on
Quality Reports 2013-14’, published 25 February 2014
(the ‘guidance’)), and Annex 2 of the NHS Foundation
Trust Annual Reporting Manual (the ‘ARM’), published
14 March 2014.
These principles have been selected based on those
deemed applicable to the Company and have been set
out in the ‘Format of the Quality Report’ section of the
Appendix to the Quality Report. Monitor’s guidance for
the Quality Report incorporates the requirements set
out in the Department of Health’s Quality Accounts
Regulations and additional reporting requirements set
out by Monitor.
We provide assurance in respect of:
i. the content of the Quality Report, in accordance with
those aspects of the guidance and the ARM relevant
to the Company as determined by management,
as set out in the Appendix to the Quality Report; and
ii. the consistency of the Quality Report with the
documents specified below.
Respective responsibilities of the Directors
and auditors
The Directors are responsible for the content and the
preparation of the Quality Report in accordance with
those principles of the guidance and Annex 2 of the ARM
that are applicable to the Company, as set out in the
Appendix to the Quality Report.
Our responsibility is to form a conclusion, based on limited
assurance procedures, on whether anything has come to
our attention that causes us to believe that:
• the Quality Report does not incorporate the matters
specified in the guidance and Annex 2 to the ARM that
are applicable to the Company; and
• the Quality Report is not consistent in all material
respects with the sources specified below.
We read the Quality Report and consider whether it
addresses the content requirements of the ARM
applicable to the Company, as set out in the Appendix to
the Quality Report, and consider the implications for our
report if we become aware of any material omissions.
We read the other information contained in the Quality
Report and consider whether it is materially inconsistent
with the following documents:
• Board minutes for the period April 2013 to the date
of signing this limited assurance report (the ‘period’);
• papers relating to quality reported to the Board over
the period April 2013 to the date of signing this limited
assurance report;
• feedback from the Commissioners (NHS England)
dated 25 April 2014;
• the Company’s monthly complaints scorecard;
• feedback from other stakeholders incorporated into
the Quality Account (West Midlands Specialised
Commissioning, dated 12 March 2014; and,
Healthcare Improvement Scotland, dated
10 April 2014);
• quarterly patient surveys;
• the annual staff survey; and
• feedback from the Board of Directors.
29
We consider the implications for our report if we become
aware of any apparent misstatements or material
inconsistencies with those documents (collectively, the
‘documents’). Our responsibilities do not extend to any
other information.
A limited assurance engagement is less in scope than a
reasonable assurance engagement. The nature, timing
and extent of procedures for gathering sufficient,
appropriate evidence are deliberately limited relative
to a reasonable assurance engagement.
We are in compliance with the applicable independence
and competency requirements of the Institute of
Chartered Accountants in England and Wales (“ICAEW”)
Code of Ethics. Our team comprised assurance
practitioners and relevant subject matter experts.
Limitation
Non-financial performance information is subject to more
inherent limitations than financial information, given the
characteristics of the subject matter and the methods
used for determining such information.
This limited assurance report, including the conclusion,
has been prepared solely for the Board of Directors of the
Company as a body, to assist the Company in reporting
its quality agenda, performance and activities. We permit
the disclosure of this limited assurance report within the
Quality Report for the year ended 31 March 2014.
The absence of a significant body of established practice
on which to draw allows for the selection of different but
acceptable measurement techniques which can result in
materially different measurements and can impact
comparability. The precision of different measurement
techniques may also vary.
To the fullest extent permitted by law, we do not accept or
assume responsibility to anyone other than the Board of
Directors as a body and the Company for our work or this
report save where terms are expressly agreed and with our
prior consent in writing.
Furthermore, the nature and methods used to determine
such information, as well as the measurement criteria and
the precision thereof, may change over time.
Assurance work performed
We conducted this limited assurance engagement in
accordance with International Standard on Assurance
Engagements 3000 ‘Assurance Engagements other than
Audits or Reviews of Historical Financial Information’
issued by the International Auditing and Assurance
Standards Board (‘ISAE 3000’). Our limited assurance
procedures included:
• making enquiries of relevant management, personnel
and, where relevant, third parties;
• reviewing the content of the Quality Report against the
guidance and content requirements of the ARM that
are relevant to the Company, as set out in the
Appendix to the Quality Report; and
• reading the specified documents and comparing their
consistency with the information included in the
Quality Report.
30
It is important to read the Quality Report in the context
of the content requirements of the guidance and of the
ARM, and the Director’s determination of its applicability
to the Company, as set out in the Appendix to the
Quality Report.
The nature, form and content required of Quality Reports
have been determined by the Company based on
Monitor’s guidance for the purposes of this assurance
engagement. This may result in the omission of
information relevant to other users.
In addition, the scope of our assurance work has not
included governance over quality or performance
indicators included in the Quality Report, which have
been determined locally by the Company.
Basis for qualified conclusion
The ARM requires Part 3 of the Quality Report to include
performance against the relevant indicators and
performance thresholds set out in the Compliance
Framework/Risk Assessment Framework. This has been
included in the Quality Report, except for:
• percentage of patients on Care Programme Approach
who were followed up within 7 days after discharge;
• percentage of admissions to acute wards for which the
Crisis Resolution Home Treatment Team acted as a
gatekeeper during the reporting period;
Qualified conclusion
Based on the results of our procedures, except for the
matters described in the basis for conclusion paragraph,
nothing has come to our attention that causes us to
believe that for the year ended 31 March 2014:
• the Quality Report does not incorporate the matters set
out in the guidance and Annex 2 of the ARM that are
applicable to the company as set out in the Appendix
to the Quality Report;
• the Quality Report is not consistent in all material
respects with the documents specified above.
• percentage of patients readmitted to hospital within
28 days of discharge;
• minimising mental health delayed transfers of care;
• meeting commitment to serve new psychosis cases
by early intervention teams;
• mental health data completeness: identifiers; and,
• mental health data completeness: outcomes for
patients on CPA.
The ARM requires Part 3 of the Quality Report to include
an overview of the quality of care offered by the provider
based on performance in 2013-14 against indicators
selected by the Board in consultation with stakeholders,
with an explanation of the underlying reason(s) for
selection. The Quality Report does not directly provide an
overview in the format prescribed by the guidance, and it
is included in Part 2 instead of Part 3.
PricewaterhouseCoopers LLP
Chartered Accountants
Leeds
Date:
The maintenance and integrity of the Priory Group No. 1 Limited’s
website is the responsibility of the Directors; the work carried out by the
assurance providers does not involve consideration of these matters and,
accordingly, the assurance providers accept no responsibility for any
changes that may have occurred to the reported performance indicators
or criteria since they were initially presented on the website.
31
Format of this Quality Account
This Quality Account has been produced using the NHS Foundation Trust Annual Reporting Manual for 2013-14,
published by Monitor in March 2014, and the The National Health Service (Quality Accounts) Amendment Regulations
2012. We have excluded sections that are not relevant to the Priory Group.
Data items from the NHS Quality Accounts content checklist not included in the Priory Healthcare
division’s 2013-14 Quality Account
The table below documents items which were not reported according to the NHS Quality Accounts content checklist
annex within the NHS Foundation Trust Annual Reporting Manual for 2013-14 because they were not applicable to the
services delivered by the division.
Data guidance item
Rationale for exclusion
Part 2 – Priorities for improvement
For quality improvement priorities for 2013/14 identified in the 2012/13
report, the previous year’s data is not included in the Quality Account
Data not available
A rationale for the selection of the priorities and whether/how the views
of patients, the wider public and staff were taken into account
There was some involvement of staff and service users in developing
the priorities for improvement
Annex 2 – Care Quality Account Indicator
Care Programme Approach (CPA) service users, either receiving
follow-up contact within seven days of discharge or having formal review
within 12 months
Minimising mental health delayed transfers of care
No crisis resolution home treatment service provided by Priory hospitals
Percentage of service users readmitted to a hospital within 28 days of
being discharged
Admissions to inpatient services have access to crisis resolution home
treatment teams
Meeting commitment to serve new psychosis cases by early
intervention teams
No early intervention in psychosis service provided by Priory hospitals
Data completeness: identifiers
No mental health minimum data set submission required for
Priory hospitals
Data completeness: outcomes for service users on CPA
Service user experience of community mental health services
32
Priory hospitals do not provide community mental health services
Scope of data inclusion
The 2013-14 Quality Account provides an overview of the performance of the Priory Healthcare division against
a wide range of internal measures and metrics, relevant to the division itself, or particular services and sites therein.
This data may not represent the entire breadth of services or sites within the Priory Healthcare division; therefore,
this appendix sets out the scope of data inclusion, as well as any relevant considerations (such as the methods by
which samples were selected for analysis).
Some sites were not fully integrated into the Priory Healthcare division’s systems for the entirety of the period and are
therefore not included in all figures, although all sites are reflected in some way across the indicators used in this report.
In this appendix, we will refer to two groups of sites, according to their implementation of the service user management
system CareNotes. These are:
CareNotes sites
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Cefn Carnau
Chadwick Lodge
Cheadle Royal Hospital
Farmfield
Middleton St George Hospital
Priory Hospital Dewsbury
Priory Hospital Keighley
Priory Hospital Market Weighton
Priory Hospital Sturt
Recovery 1st
The Cloisters – Newbury
The Priory Heathfield
The Priory Hemel Hempstead
The Priory Highbank
The Priory Hospital Aberdare
The Priory Hospital Altrincham
The Priory Hospital Brighton and Hove
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
The Priory Hospital Bristol
The Priory Hospital Chelmsford
The Priory Hospital Church Village
The Priory Hospital Glasgow
The Priory Hospital Hayes Grove
The Priory Hospital North London
The Priory Hospital Preston
The Priory Hospital Roehampton
The Priory Hospital Southampton
The Priory Hospital Woking
The Priory Nottingham
The Priory Potters Bar
The Priory St Neots
The Priory Ticehurst House
Thornford Park
Ty Gwyn Hall
Woodbourne Priory Hospital
•
•
•
•
•
•
•
•
Greenhill
Highfields – now part of Craegmoor
Mount Eveswell
Princes Street
Rookery Hove
Rookery Radstock
The Vines
Ty Ffynu
Non-CareNotes sites
•
•
•
•
•
•
•
•
85 Brecon Road
Avalon
Beechley Drive
Brynawel
Caewal Road
Charles House
Egerton Road
Ghyllside
33
All service users to have their physical healthcare
needs and a plan put in place to address areas of
physical health need (p6):
Data sourced from CareNotes sites only. Compliance
was measured through the completion of a Doctor’s
assessment or Physical Health form in the service users’
electronic records. Service users are included where the
following criteria is met:
1. The service user was admitted to our services in the
period from 1 September 2013 to 31 March 2014
inclusive
2. The service user stayed in our services for at least
one night
This data is accurate as at 2 April 2014.
Ensure that the service user is signposted to
appropriate support services in the event of a crisis
upon discharge from acute services (p6):
All relevant sites included. Agreement was measured
through the satisfaction survey, which is offered to all
service users upon discharge. Acute patients are included
where the following criteria is met:
1. The service user was discharged in the period from
1 April 2013 to 31 March 2014 inclusive
2. The service user stayed in our services for at least
one night
3. The service user submitted a paper satisfaction form
having answered at least one question
4. The form was recorded on CareNotes
‘Agreement’ is defined as those people answering “Yes”
to the following question: “Before you left hospital, were
you given information about how to get help in a crisis,
or when urgent help is needed?” Completion rate for the
period is 46%.
34
Increase service user satisfaction in relation to care
planning and communication (p6):
Data sourced from CareNotes sites only. Surveys were
offered to all service users in the participating sites during
the period 24 February to 21 March 2014. Surveys were
included if the following criteria is met:
1. The service user submitted a paper satisfaction form
having answered the relevant question
2. The service user stayed in our services for at least one
night within the period
3. The form was recorded on CareNotes
‘Agreement’ is defined as those people answering
“Strongly Agree” or “Agree” to the following statement:
“The service does a good job of supporting my care
planning and involving me in the process”. Completion
rate for the period was 41%.
All relevant sites were included for the other priorities of
improvement, including non-CareNotes sites.
Continuous improvement in the delivery of our
services (p22):
The Priory Group implemented a new complaint reporting
system on 1 January 2012. Because of the inherent
differences between the previous and new systems, it was
not feasible to combine the data with our 2011-12 data.
Therefore, where we present 2011-12 incident and
complaint data, we have used the period 1 April 2011
to 31 December 2011.
Improving safety for our service users (p25):
All relevant sites included, including non-CareNotes sites.
Incidents which meet all of the following criteria
are included:
1. The incident involves at least one service user as a
participant (incidents involving more than one service
user are counted as one incident)
2. The incident is reported on the Priory Group clinical
governance system
Incidents leading to permanent harm are rated as having
a “high” level of harm (second highest on a five point
scale) and are defined as “any incident that appears to
have resulted in permanent harm to one or more persons.
Serious injury resulting in brain damage, loss of limb or
impaired use”.
35
Priory Group, 80 Hammersmith Road, London, W14 8UD