1

SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

This Quality Account (QA) is an annual report about the quality of services delivered by
Suffolk Community Healthcare. It helps assure commissioners, patients and the public that
SCH is regularly scrutinising its services and concentrating on those that need the most attention.
The QA outlines how well we are doing against national and local targets, where we need to improve the quality of services and our priorities for the coming year.
There are major challenges ahead – an ageing population with complex health needs, reducing budgets and a planned reconfiguration of the health system in Suffolk. Suffolk Community
Healthcare (SCH) is meeting these challenges by transforming community health services and looking for new ways to provide a higher quality, joined-up yet more efficient service – not easy on reducing budgets. Delivering high quality, safe care is our first priority and overrides any other.
We focus on treating each patient as an individual, helping join up their care and giving them the service closest to what they want within available resources.
WHERE WE ARE NOW
We are halfway through a three year contract.
After a challenging start we are now meeting
95% of our contracted key performance indicators (KPIs) set by our customers the
Suffolk Care Commissioning Groups (CCGs).
Patient feedback shows high levels of patient satisfaction – 81 compared to the NHS average of 70. We are making progress in transforming services, having reshaped the community health teams and introduced a single point of phone referral to access any SCH services - the CCC.
This is open 24/7 and takes over 13,000 calls a month, 95% answered within 30 seconds. This year we also received excellent reports from the Care Quality Commission (CQC) on all of our community hospitals and minor injuries unit at Felixstowe. The morale, engagement, recruitment and retention rates of our staff are also starting to improve and we continue building on this progress.
Good progress has been made on all of the QA priorities set for 2013-2014:
PRIORITY 1 - PATIENT SAFETY
■ 1a) redesigned structure and function of our community health teams (CHTs) and community intervention service (CIS)
■ Changes fully embedded – now, 15 CHTs link and coordinate with professionals across the health and social care sector
(eg GPs, social workers)
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

■ Introduced the care lead role - all patients will have a single named worker to help join up their health and social care across all agencies
■ All ‘admission avoidance’ staff joined together into the community intervention service (CIS) to help reduce admissions to acute hospitals and ‘smooth out’ care around discharge or admission
■ 1b) Improve recognition and management of unwell patients in our community hospitals.
Work in this area continues in 2014/15.
■ Introduced the NEWS early warning system to help spot and action signs that patients are unwell or deteriorating
■ Introduced ‘GULP’ assessment and various checklists to help patients stay hydrated
PRIORITY 2 - CLINICAL EFFECTIVENESS
■ We carried out a range of improvements to increase clinical effectiveness. For example
■ Redesigning the falls pathway, introducing screening for falls risk of over 65s as part of general assessments. We routinely screened 5047 people who attended our services for risk of falls.
■ New equipment to support high risk patients avoid falls. The average number of falls in our inpatient units is falling.
■ ‘Intentional rounding’ in hospitals - a process where nurses carry out regular checks on patients at set intervals
PRIORITY 3 – PATIENT EXPERIENCE
■ We focussed on improve user engagement and supporting carers
■ Appointed patient experience manager to ensure patient experience becomes
‘everyones business’ in SCH.
■ Introduced better, more comprehensive patient surveys. 97% of patients would now recommend our services, 95% of patients agreed their treatment/care plan was clearly explained and 93% felt they were well-involved in their care decisions.
4 SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

IN 2014/15 OUR QA PRIORITY AREAS
ARE:
Patient safety: Improving the community equipment service (CES)
Clinical effectiveness: Introduc a comprehensive monitoring system called ‘the balanced scorecard’ to ensure that quality is understood and measured and areas for improvement identified and owned.
Patient experience: Further work to listen to patients’ voices, expand the depth and reach of how we collect and measure patient experiences to improve services.
Improve staff engagement further as this clearly impacts on patient experience.
There are many other quality initiatives within our organisation beyond these three QA priorities as we have a comprehensive commitment to quality. We are very pleased that our customers and stakeholders in their attached letters, acknowledge the improvements and focus on quality that we have within SCH.
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 5

1:1 CEO’S STATEMENT
1:2 INTRODUCTION TO SUFFOLK COMMUNITY HEALTHCARE
1:3 PUTTING QUALITY FIRST
1:4 HIGHLIGHTS FROM 2013/14
1:5 FEATURED SERVICE – COMMUNITY CANCER TEAM
2:1 OUR PRIORITIES FOR QUALITY IMPROVEMENT IN 2014/15
2:2 OTHER IMPROVEMENTS WE PLAN TO DELIVER
2:3 STATEMENTS OF ASSURANCE – REVIEW OF SERVICE
2:31 PARTICIPATION IN CLINICAL AUDITS AND NATIONAL CONFIDENTIAL ENQUIRIES
2:32 COMMISSIONING FOR QUALITY AND INNOVATION
2:33 CARE QUALITY COMMISSION AND SPECIALIST REVIEWS
2:34 DATA QUALITY
2:35 INFORMATION GOVERNANCE
2:4 FEATURED SERVICE – ADULT SPEECH AND LANGUAGE THERAPY
35
44
48
52
55
59
61
64
11
15
18
29
32
3:1 PROGRESS AGAINST QUALITY IMPROVEMENT PRIORITIES
PRIORITY ONE – PATIENT SAFETY
1A: TO MAINTAIN OUR SAFETY FOCUS BY CONTINUING TO REDESIGN THE
STRUCTURE AND FUNCTION OF THE COMMUNITY HEALTH TEAMS
AND COMMUNITY INTERVENTION SERVICE
1B: COMMUNITY HOSPITALS: TO IMPROVE THE RECOGNITION AND
MANAGEMENT OF THE UNWELL PATIENT IN A COMMUNITY HOSPITAL SETTING
71
71
71
82
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

PRIORITY TWO – CLINICAL EFFECTIVENESS
TO REDESIGN THE FALLS PATHWAY SO THAT BOTH FALLS PREVENTION AND
FALLS AND FRAGILITY FRACTURE PREVENTION CONTINUE TO BE
A PRIORITY WITHIN SCH
88
88
PRIORITY THREE – PATIENT EXPERIENCE 95
TO CONTINUE TO IMPROVE THE QUALITY OF PATIENT AND CARER EXPERIENCE
BY IMPROVING SERVICE USER ENGAGEMENT AND SUPPORT FOR CARERS
3:2 SUMMARY PERFORMANCE INDICATORS 102
3:3 LEARNING FROM INCIDENTS AND COMPLAINTS
3:4 SAFEGUARDING VULNERABLE ADULTS AND CHILDREN
3:5 INFECTION CONTROL
3:6 NHS SAFETY THERMOMETER AND NHS SAFETY CROSS
3:7 WORKFORCE
108
121
124
130
136
GLOSSARY 147
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

WHAT ARE QUALITY ACCOUNTS AND
WHY ARE THEY IMPORTANT?
At Suffolk Community Healthcare we constantly strive to improve the quality of services we provide to our patients. The Quality Account is our annual report of:
■ How well we are doing against targets set by the Department of Health, our Clinical
Commissioning Groups (CCGs), and set ourselves.
■ Where we need to improve the quality of the services we provide
■ Our priorities for the coming year.
WANT TO KNOW MORE OR TELL US
WHAT YOU THINK
We love to hear your views and are happy to give you extra information that you need.
Please contact Christian Jenner
T: 01284 718 259
E: christian.jenner@suffolkch.nhs.uk
NEED THIS DOCUMENT IN A DIFFERENT
FORMAT?
The Quality Account is available in large print and other languages and formats on request. Please contact Christian Jenner by telephone on 01284
718259, or email christian.jenner@suffolkch.
nhs.uk.
STRUCTURE OF THE REPORT
The report outlines the quality improvements the Suffolk Community Healthcare Board has agreed for 2014/2015. It also summarises the organisation’s performance and improvements against the quality priorities and objectives we set ourselves for the year 2013/2014.
We have reported against the priorities, including explaining any that we have not met and how we are addressing any issues.
Throughout the year we worked with stakeholders and staff to establish the priorities for the coming year and address the challenges we faced throughout 2013/2014. Our new priorities are detailed under the headings patient safety; clinical effectiveness and patient experience. We explain how we decide on our priorities and how we measure performance against them.
Finally, we provide information to review that is relevant to the quality of our services and include statements from Healthwatch, Health Scrutiny
Committee and the Clinical Commissioning
Groups submitted in response to this Quality
Account.
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SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 9

10 SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

Hello and welcome to our Quality Account for
2013/14. This document is the equivalent of an annual report, but rather than focus on numbers and performance, it is primarily concerned with quality and safety.
In October 2012 Serco entered into a partnership with other providers and, working with existing staff, began delivering NHS community health services in Suffolk as SCH.
The original partnership was between Serco,
South Essex Partnership University Foundation
Trust (SEPT) and Community Dental Services
(CIC) Bedford (CDS). This year we extended this partnership to include Bromley Community
Healthcare. Bromley is advising and supporting
SCH, particularly around our clinical operations for Adult Community Services.
We are now around halfway through the threeyear contract. High quality, safe care remains our very first priority. We are building an innovative, well-shaped organisation that is fit for the challenges facing healthcare in the future.
Services, morale and processes are all improving and we are delivering or surpassing 95% of our performance targets set by the CCGs. More importantly, feedback shows patients are highly satisfied with the care they receive from SCH.
Our four community hospitals: Aldeburgh,
Newmarket, Bluebird Lodge, Felixstowe and the minor injuries unit all received excellent reports from the Care Quality Commission, a clear indication of quality.
We are also facing some enormous challenges, many of which are common across the NHS.
In the light of the Francis Report on the failings at Mid Staffordshire Hospital, we all know we cannot be complacent. We all have a responsibility - our staff, our management, our commissioners, our regulators, our politicians
- to ensure quality and safety are our guiding principles and nothing makes us lose sight of this.
We also know we need to deliver quality care on a far smaller budget than before. We need to do this for more patients, as the size of our elderly population grows. Taken together, these challenges represent no small task. But our team, at all levels of SCH, is committed to working together to address them.
Another challenge and opportunity we will face in the coming year is around the redesign of the health system in Suffolk. The CCGs are embarking on a radical new service reconfiguration with integrated, joined-up services between emergency, urgent and community services at the heart of the plan. SCH is already working towards integration within our own services, for example, the single point of access we provide to patients and clinicians through our care coordination centre (CCC). We want to ensure services are personalised and joined up and as
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 11

close to what the patient wants and needs as possible within the resources available. We don’t yet know what shape community services will take within the redesign. However, we do know that our staff will continue to provide the service in one form or another and our patients will continue to receive it. We will therefore support and engage in the process and ensure our staff and patients have an opportunity to contribute.
I want to take this opportunity to thank our staff at SCH and partners across Suffolk. The tasks we have going forward are not going to be easy, but if we keep the patient at the heart of everything we do I believe we will build a higher quality and sustainable health service for the people of
Suffolk.
I am pleased to confirm that the Board of
Directors has reviewed the 2013/14 Quality
Account and confirms that it is an accurate and balanced reflection of our performance. We hope that this Quality Account provides you with a clear picture of how important quality improvement and patient safety are to everyone at SCH.
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I am honoured to write this introduction as Serco’s new Group Chief Executive and I share Abi
Tierney’s pride in the difference we are making for local people. Suffolk Community Healthcare has aligned its vision and values with Serco’s: being passionate about building innovative and successful businesses; having the commitment and energy to go the extra mile; doing what we say we will do to meet expectations; and building trust and respect by operating in a safe, socially responsible, consistent and honest manner.
We were commissioned to transform community health services in Suffolk on behalf of the NHS and it’s true to say we have faced a number of challenges. Not least in forming a new organisation with people moving from the
NHS to Serco, at the same time as introducing new technology and IT systems to bring about the kind of transformation that we all want to achieve.
Having said that, I’m delighted to see that we have made some significant improvements. You will read more about them in this report, but I would particularly like to highlight the fact that 99% of patients would recommend our service to family and friends if they needed similar treatment.
Our community health teams are meeting all their targets for response times, and formal compliments about our services outnumbered complaints by more than four to one at the end of March.
Finally, I would like to thank our two local clinical commissioning groups, local authorities, our partners and local people and organisations for their feedback and support, all of which has helped us to improve and, I am sure, will help us improve further in future.
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 13

Directors’ Statement of Responsibilities: Suffolk
Community Healthcare Board of Directors is required under the Health Act 2009 to prepare
Quality Accounts 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, the National Health Service
(Quality Accounts) 2010 and the National
Health Service (Quality Accounts) Amendment
Regulations 2011.
The Quality Account has been prepared in accordance with the Department of Health guidance and presents a balanced picture of the organisation’s performance over the period covered. The performance reported in the
Quality Account is reliable and accurate.
There are proper internal controls over the collection and reporting of the measures of performance in the Quality Account and these controls are subject to review to ensure they are working effectively in practice.
The data underpinning the measures of performance reported in the Quality account is robust and reliable and conforms to specified data quality standards and prescribed definitions and is subject to appropriate scrutiny and review.
Directors’ Declaration: We can confirm that to the best of our knowledge and belief the information contained in the Quality Account is accurate and represents our performance in 2013/2014 and our commitment to quality improvement.
ABIGAIL TIERNEY
GAYNOR FERRARI
ANDREW HARDMAN
DAWN GODBOLD
PAMELLA CHAPPELL
DR AMIT SETHI
STEPHANIE MURRAY
PETER FORRESTER
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Our vision for Suffolk Community Healthcare, a partnership between Serco, SEPT (South Essex
Partnership University NHS Foundation Trust) and Community Dental Services (CDS), is to provide high quality accessible and responsive community adult and children’s services in people’s homes and their community through an integrated model of care.
ORGANISATION OF CLINICAL SERVICES:
1. SERCO: Adult Community Services: service delivery by a range of professionals which includes district nurses, physiotherapists, occupational therapists, generic workers and healthcare assistants.
They work in integrated Community Health
Teams arranged around a cluster of GP practices and working in a coterminous way with social care, managed within four localities. Community Health Teams work alongside community matrons, community cancer nurses, specialist nursing (neurology,
Parkinson’s, epilepsy), falls and fractures, heart failure, cardiac rehabilitation, and dermatology services. SERCO also provides other services which include admission prevention (Community Intervention
Service), pulmonary rehabilitation (chronic obstructive pulmonary disease – COPD) service, a minor injuries unit in Felixstowe, continence team, community equipment
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14
(independent living) and wheelchair service.
Our services includes inpatient facilities in four community hospitals in Aldeburgh,
Felixstowe, Ipswich and Newmarket plus
NHS-funded nursing home beds in Eye and
Sudbury.
2. SERCO: Care Co-ordination centre – is a single point of referrals for GPs, hospitals, other statutory and voluntary organisations and patients and carers, 24 hours a day, 365 days a year.
3. SEPT: provides community paediatric services, podiatry, foot and ankle surgery and adult speech and language therapy.
4. Community Dental Service (CIC)
Bedford: provides a full range of dental care to both adults and children with special needs and those from marginalised and vulnerable groups. The service sees phobic/anxious patients on referral from general dental practice and elsewhere for treatment under both inhalation and intravenous sedation and under general anaesthesia at West Suffolk
Hospital. It has an oral health promotion & education team The service operates from
10 clinics across Suffolk.
CDS also carries out dental screening of primary school children in schools in the most deprived areas informing parents of untreated dental disease and signposting to dental services. It also carries out national epidemiology programmes with the data used for national dental health surveys.
15

Eye
Haverhill
Aldeburgh
Sudbury
Hadleigh
Felixstowe
Woodbridge
THE MAP ABOVE SHOWS THE
GEOGRAPHICAL AREA COVERED
IN SUFFOLK.

SUFFOLK COMMUNITY HEALTHCARE IN
SUMMARY:
■ Delivers community based services to people of all ages across Suffolk
■ Provides services to West Suffolk CCG,
Ipswich and East Suffolk CCG, Ipswich
Hospital, West Suffolk Foundation Trust,
South Norfolk CCG, East Coast Community
Healthcare, Cambridge University Hospital
Foundation Trust (Addenbrookes Hospital),
Cambridge and Peterborough CCG, Suffolk
County Council
■ Serves an estimated population of 650,000 people in Suffolk, with the exception of the
Waveney area
■ Delivers services in a variety of settings including people’s own homes, care homes, community hospital in patient units and clinics, day centres, 31 schools, GP surgeries and health centres
■ With our partners SEPT and CDS, we employ around 1,400 staff, including nurses, healthcare assistants, physiotherapists, occupational therapists, specialist clinicians, generic workers, healthcare assistants, technicians, administrators and support staff
■ Has a range of corporate functions to support clinical excellence, including finance, performance, quality and risk management and workforce development
■ Our income in 2013 was £56,935,654.
£56,935,654
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 17

Our patients are at the centre of care following the concept of “no decision about me, without me”
Engaged, competent and confident workforce
Commitment to best practice to improve outcomes.
Providing the right care, from the right clinician at the right time and in the right place.
Integrated teams working in partnership with the wider health and social care sector.
High quality care is all about ensuring that those who require our services receive the right care, when they need it, delivered with care and compassion by the most appropriate person.
Quality is much more than a word or a set of action plans, it is about how we as an organisation and individuals within that organisation live by our values and our behaviours. Inextricably linked with quality, as an organisation we believe that where these are aligned, patients will receive high quality care with better outcomes, a better experience and for our staff better job satisfaction and a sense of wellbeing.
The Mid Staffordshire NHS Trust public inquiry highlighted for us all the importance of keeping our patients and the quality of care we provide at the heart of everything we do. We have continued to focus upon the findings and recommendations of the inquiry and on delivering high quality patient-centred care with caring, compassionate staff. The recommendations are on many different levels from changing clinical practice to a new focus on more effective leadership and changes throughout our systems. We recognise that changes take time – some actions need longterm planning, while others can be more easily achieved.
We have done lots of work throughout 2013 and
2014 to develop a quality culture that listens – an culture where the Board actively works to create a positive emotional environment, valuing staff, promoting their health and wellbeing and supporting them to cope with the demands of their work.
18 SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

However as a Board, we realise we have not always got this right – facing specific challenges in the latter part of 2012 and 2013. We know that
Boards must demonstrate that they appreciate the contribution made by staff and by so doing influence the quality of care their staff deliver.
During 2013/2014 we have introduced new ways to engage with staff and thank and recognise individuals and teams. We have introduced back to the floor days with senior leaders meeting teams at least twice each month to understand teams’ key issues and achievements. An annual staff survey helps us understand how employees feel about the organisation and we are acting on what we learn. These are just a few of the initiatives we have introduced, but we know we still have some way to go. That is why we have made staff engagement one of our quality priorities for 2014/2015. (See page 33).
In the summer of 2013 Suffolk GP Dr Amit
Sethi was appointed as our medical director to support the focus on quality in patient care and improve links and partnerships with the medical profession. He spends much of his time engaging with and listening to GPs across Suffolk. A new GP engagement strategy was launched in February and 34 of 66 practices accepted an invitation for
Amit and other clinical staff to visit their practice team meetings. We have also improved our links with the CCGs and other key stakeholders.
This increasing visibility and openness is having a significant positive impact on our relationships both with GPs and other partners, and can only have a positive impact on patient experience.
With other senior staff, Amit is closely involved with informing the current system redesign with the CCGs. Other work led by the medical director includes:
■ Caldicott Guardian for SCH - including working with the CCG in ensuring practitioners in community and medical services can share electronic patient records (via SystmOne) while protecting the confidentiality of patient data.
■ Assessing the types and scale of noncommissioned work SCH undertakes
- this ensures patients do not fall between the gaps in services for which SCH is not commissioned to deliver. SCH carries out this work presently because patient care is our first priority, over financial reward. Joined up and comprehensive commissioning will hopefully end these anomalies and create a fairer, clearer system that is ultimately better for patients.
■ Developing the Quality Initiative Project
- to demonstrate how the work of our skilled workforce not only improves lives but also saves the health economy money and supports primary care and acute trusts. We are working with the National Association of
Primary Care to deliver this research within the next year.
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 19

HOW DO WE MONITOR QUALITY?
We want to be one of the highest achieving community organisations in the country. To understand how well (or not) we may be doing and assess our performance we monitor a number of “indicators” (aspects of a service that can be measured). Examples include the number of patients waiting for a particular treatment or the number of complaints or compliments a service may have had. Measuring such indicators demonstrates how efficient the organisation is in using its resources and how effective it is in achieving the best patient outcomes.
Indicators are measured daily, monthly and quarterly. Some data are compared nationally so that we may learn from, and share good practice with, other organisations.
Information is collected and presented in a number of different ways allowing:
■ The Board to scrutinise the quality of services, and have an accurate, timely and balanced picture of performance including patient, clinical, regulatory, staffing and financial perspectives
■ Trend analysis of specific indicators
■ Comparisons with other organisations
(known as benchmarking).
Various committees monitor information and we feedback to services so they can review and improve continuously.
20 SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

HOW DO WE MONITOR QUALITY - EXAMPLES
MIU ATTENDANCES
800
700
600
500
400
300
200
100
MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB
LENGTH OF STAY (OVER THE LAST 6 MONTHS)
5 10
Number of Days
15 20 25 30
OCT
SEP
NOV
DEC
FEB
JAN

SUFFOLK COMMUNITY HEALTHCARE GOVERNANCE FRAMEWORK

DRIVING QUALITY THROUGH
ACCOUNTABILITY
SCH has a well-established quality framework structure to ensure accountability through its committee and management structures and support quality. The Clinical Quality and
Safety Assurance Committee and Compliance
Committee oversee all aspects of quality ensuring responsible officers are held to account for their relevant areas.
The main subgroups for monitoring quality are the Medicines Management Group (chaired by the Medical Director), Patient Experience Group,
Safeguarding Group and Infection Control Group
(chaired by the Director of Nursing, Therapies
& Governance). There is also representation from SEPT and CDS on a number of the groups to ensure quality is monitored throughout the
SCH partnership. Each committee receives structured reports from teams and individuals for monitoring and assurance purposes.
MANAGEMENT STRUCTURE
Each locality is managed by an area manager, supported by nursing and therapy professionals.
Together they are accountable for quality within the operational management structure. This is an area of development for this year (see page
39). Indicators of performance and quality (the
‘balanced scorecard’) are now in place so teams have information at their fingertips about their area of practice. This allows teams to identify where things are progressing well and where improvement required.
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 23

COMMUNITY HEALTH TEAM
BALANCED SCORECARD
T = Target (%) A = Actual S = Score
The balanced scorecard is being developed for non-clinical teams too, and the SCH leadership team. Quality should be the driving force of any health organisation. The balanced scorecards provide accountability and focus to drive continuous quality improvement across SCH.
Quality
Q1 Service users who rated the service as top
Q2 GP FFT score
Q3 EW TT score
Q4 Record Keeping
Audits
Q5 Students Placed
Q6 Mentors in Place
Q7 FFT Score
Q8 FFT Surveys
Completed
T
100
100
10
Y
90
10
A S
Compliance
C1 Annual Budget (£K)
C2 Annual Budget (FTE)
C3 Annual Activity
Baseline (contacts)
T
C4
C5 Incidents
C6 Serious Incidents 0
C7 Mandatory Training 100
C8 Complaints (completed within timeframe)
100
C9 Complaints Concluded
(number)
C10 Staff Appraisals
Complete
100
C11 SI Outstanding Action
Plans
0
A S

Productivity
P1 Patients who do not attend appointments
P2 Patients who do not attend appointments
P3 Appointments cancelled by the service
P4 Appointments cancelled by the service
T
5
5
2
2
P5 Activity Performance
(contacts)
0
P6 Activity Performance
(contacts) - YTD
16.104
A S
P7 Response times targets Red - 4 hours -
P8 Response times targets Red - 4 hours -
P9 Response times targets Amber - 72 hours
P10 Response times targets Amber - 72 hours
P11 Response times targets Green - 18 weeks
P12 Response times targets Green - 18 weeks
P13 Vacancies
P14 Sickness Absence
95
95
95
95
95
95
3
Finance
F1 Efficiency
F2 Agency Spend YTD
F3 Agency Spend In Month
T A S
5
F4 Financial Performance
Variance - YTD (£K)
F5 Financial Performance
Variance - In Month
F6 P2P Heatmap

LEADERSHIP TEAM BALANCED SCORECARD
BSC Q1
BSC Q2
Quality & Safety
Good News Stories
Vacancies
Number of Stories
% of agreed establishment vacant at end of month
BSC Q3 Friends and Family Scores
BSC Q4 Friends and Family
Response
BSC Q5 Complaints
Response Rate
Number of complaints received
BSC Q6 Complaints Completed on Time
% of complaints responded to in (standard time)
BSC Q7 Compliments Number of Compliments received
Number of SUIs reported BSC Q8 Serious Untoward
Incidents
BSC Q9 Clinical Audit Programme % of planned Clinical Audit completed (Cumulative)
BSC Q10 Service Improvements % of total Service
Improvement Plans completed
BSC Q11 Customer Insight Insight Survey a) Net
Promoter b) Response Rate
BSC Q12 Stakeholder Meetings
BSC Q13 Outcomes of Service
Plans
BSC Q14 CQC Compliance
BSC Q15 Risks
BSC Q16 RIDDORS
?CRM
% of total Service
Improvement Plans completed
% of compliance of all inspected domains
Number of identified risks moving from Amber to Red
Number reported
Workforce
Team
FFT
FFT
Monthly
Compliance
Team
Weekly
Compliance
Team
Monthly
Compliance
Team
Monthly
Compliance
Team
Weekly
Governance
Team
Quarterly
LAMs Quarterly
Insight
Results
?CRM
LAMs
Governance
Team
SLT
6 Monthly
Monthly
Governance
Team

LEADERSHIP TEAM BALANCED
SCORECARD
Critically we recognise that ensuring quality throughout the organisation is more than holding regular Board and committee meetings and scrutinising data. It is about actively seeking opportunities to hear the voice and experiences of staff, patients and the public. This is a lesson we learnt through 2013/14, with a higher than acceptable percentage of staff reporting that they have felt disengaged from the senior management of the organisation.
That is why all leadership team members have made the commitment to step out of the board room and engage directly with our frontline staff, gaining first-hand knowledge of the staff and patient experience in giving and receiving care.
Leadership team members attend a minimum of two team meetings per month, with the medical and nursing directors working clinically with staff in the community and leaders also visit teams as they work to see the issues they face and their commitment to quality first-hand. We are set to re-launch leadership “quality walkabouts” to make sure we make real differences, using what we learn from observing and listening to staff.
DRIVING QUALITY THROUGH
LISTENING TO WHAT YOU TELL US
There are many ways that the views and the public are heard:
■ Surveys – postal and telephone
■ Letters of thanks
■ Complaints
■ Feedback from the CCG through their PALS service and through other communication channels: MPs, local groups
■ Patient and carer interviews.
All of this information is reviewed and used to improve where required. Through 2013/2104 we realise that we have had specific challenges with some areas of our services, especially the community equipment service (CES). We have listened to the concerns about this service and are working hard to improve . We know we have further to go and this is why for 2014/2015 we have made CES a focus for quality improvement
(see page 34).
(Excerpt from a patient complaint)
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 27

COMMUNICATIONS AND ENGAGEMENT
DURING 2013/14
The re-engagement of our staff, our patients and carers and our stakeholders has been of critical importance in the last year and it remains so.
Following transfer to SERCO the introduction of new systems, procedures and structure meant communications didn’t receive enough attention and staff engagement and morale suffered. Our new Chief Executive, Dr Abi Tierney joined us in
February 2014 and in this short time has brought a renewed focus on better communications, engagement – and listening.
In the autumn of 2013 SCH set up and delivered listening events throughout Suffolk, giving staff, patients and stakeholders the opportunity to meet our leadership and give their views. This was an important step, and the start of a major programme of work.
EXTERNAL ACTIVITY
In December 2013 our medical director Dr Amit
Sethi began a concerted engagement programme with GPs, with face to face meetings across
Suffolk. We are progressing with visits to every
GP practice to give open and honest account of our activity and listen to any comments or concerns to build relationships and join up our services. The plan now is to encourage wider team involvement in engaging with GPs to develop positive relationships and improve our shared goal of excellence in healthcare.
We are working with our community teams to ensure regular visits and meetings with GP surgeries.
We also attended the eight CCG locality meetings to meet with the local medical council, chief executive officer and chair and we introduced a stakeholder e-newsletter called SCH Update. To receive a copy email gaynor.ferrari@suffolkch.
nhs.uk.
We are also launching our new website to explain our services and achievements so that customers and patients have confidence and knowledge about how to access our services.
INTERNAL COMMUNICATIONS
We have introduced new channels for internal communications. Our chief executive sends a weekly email to all staff with an open and honest account of the decisions and discussions taken by the leadership team (the Board).
In March we began piloting an audio show which staff can hear over the telephone. Our show, named by staff as Suffolk Punch, contains news and views from colleagues all over SCH and is one small part of re-engagement with our team.
28 SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

■ Maintaining compliance with the 16 essential standards of care assessed by the Care
Quality Commission: One non-compliance was noted around the quality and content of patient records completed (CQC Outcome
21) at Bluebird Lodge. This has now been reassessed as compliant.
■ Patient Experience - Friends and Family test: This survey helps patients and their relatives or carers to comment on the care and treatment received in order to improve services. It was introduced in 2013 and asks patients if they would recommend healthcare services to friends or family if they needed similar care or treatment. The overall test score for SCH in 2013/2014 was
80 – exceeding the national average score for NHS trusts of 71. Our minor injuries unit service has consistently scored 100 for five out of the last six months of the survey.
SCH Score for 2013/14 - 80
Average Score for NHS Trusts - 71
■ Patient Safety - Falls: In 2013 inpatient falls at one of our community hospitals increased by
20% in three-months. A detailed review of the falls data during December identified that a significant number of falls occurred during the late shift up to midnight. Immediate action included the additional support of a health care support worker between 5pm and midnight and a review of the ratio of registered staff numbers. In February 2014 a decrease of 60% in patient falls was recorded in the same hospital. A fantastic improvement and one we continue to maintain.
60% decrease
■ Clinical Effectiveness - Community Hospitals:
Average length of stay in our community hospitals reduced from 27 days in 2011 to
23.7 days in March 2014. This means people are going home sooner and we can support other partners in the health system by looking after more patients.
23.7 days
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 29

■ Patient Experience - Continence Service:
We have increased the time nurses can spend with patients by introducing mobile technology and electronic scheduling.
■ Patient Experience - Care Co-ordination
Centre (CCC): Our CCC in Ipswich is open
24/7 and provides a single point of access for all referrers (access for referrers before
Serco joined SCH was not 24/7).
open 24/7
■ Patient safety - Safeguarding: Since December
2013 99% of staff are trained in safeguarding for both adults and children.
■ Service Performance targets: we have improved and have reached 100% for some indicators:
■ Continence re-assessments within 6 weeks
■ Epilepsy non-urgent contact within 10 days
■ Dermatology routine referrals seen within 8 weeks
■ Adult speech and language therapy new referrals triaged within 5 days, and high priority patients seen within 10 days.
99%
30
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

In March 2014 a total of 124 KPIs met their target.
Community Health Teams response times: performance against this indicator continues to be excellent. We are measured against twohour, four-hour and 72-hour response times to referrals. In March 2014 performance was as follows: two-hour 100%, four-hours 99%,
72-hours 98%.
100%
99%
98%
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 31

COMMUNITY CANCER NURSE SERVICE
The community cancer nurse specialist pilot is a new initiative for Suffolk Community Healthcare.
The number of people surviving cancer is growing with better treatment and outcomes.
Good support once patients have completed their acute phase of treatment is crucial. Patients feel vulnerable, abandoned and unable to pick up the threads of their previous life. Finances, relationships, general health are all affected by the cancer journey and patients require support and the tools to self-manage and resume their everyday life.
SCH successfully bid for funds to pilot community cancer nurse specialists to support patients during their cancer journey and after completing their treatment and are in remission. The pilot began on the 1st August 2013 and runs over two years.
The objectives of the pilot are:
■ Improve the outcome for the patient after cancer treatment
■ Improve self-management for patients
■ Reduce the contact required in acute organisations and GP practices.
In the first two months we developed the team, referral pathways, wrote patient information leaflets, care plans and triage guidelines. This was done as a whole team across Suffolk to ensure consistency.
The teams began contacting patients in October
2013 and now have a caseload of over 160 patients across Suffolk. Developing partnerships - working with acute and community organisations, hospices, the volunteer sector and social care - is key to success and an ongoing theme to promote the service.
The team accepts referrals for anyone who has a diagnosis of cancer at any time on their cancer pathway from diagnosis to recovery. It also includes many patients who are palliative but who are not in a terminal phase yet. The team also actively assists a number of carers to enable them to support their family member or friends with cancer.
32 SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

Mr R was sadly terminally ill with prostate cancer that had spread to his bones. His wish was to die at home with his family. He had poor mobility due to his illness. Initial assessment showed that his wife was struggling to care for him while previously declining outside help. The team listened to patient and family regarding their concerns:
■ Care package arranged for two people to care for him four times a day
■ Equipment to aid carers included slide sheet, handling belt, hoist (referrals made to OT and physiotherapy)
■ Continuing care funding form completed and duly granted
■ Liaised with GP when needs changed e.g pain, nausea etc
■ Liaised with palliative nurse specialist from hospice
■ Referred to Marie Curie for overnight support
■ Weekly and daily support visits sometimes twice a day as changes occurred
■ Finally set up syringe driver to administer end of life medication and support whole family through dying process
■ Mr R was able to have his dying wishes to be at home with his large family

34 SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

HOW DO WE DECIDE ON OUR PRIORITIES
FOR NEXT YEAR?
Throughout 2013/2014 there has been much discussion with our stakeholders, staff and patients about the performance of our services.
We have developed our quality priorities for
2014/2015 based on their feedback. The Board has considered the proposals developed and agreed the priorities set out below. These priorities span the three domains of quality: patient safety, clinical effectiveness and patient experience.
Progress against our priorities will be measured and monitored through the monthly balanced scorecards. The balanced scorecard supports staff to be more involved in measuring their performance and monitoring progress against targets. We will also review at our governance committees and provide exception reports to the Executive Board.
We have tried to make our quality account accessible and easy to read. If you are interested in being involved in the development of our quality account in the future please contact
Christian Jenner by telephone on 01284 718259, or email christian.jenner@suffolkch.nhs.uk
QUALITY IMPROVEMENT PRIORITIES
2014/2015
1. Patient Safety: To improve the quality of the service of our Community Equipment
Service
2. Clinical Effectiveness: To introduce a comprehensive approach to monitoring services to ensure that quality is understood, measured, reported and owned by our clinical services (Balanced Scorecard)
3. Patient Experience:
■ To improve staff engagement within SCH as this impacts on patient experience
■ To improve patient experience - actively listen to the patient voice and act upon recommendations to improve our services.
The table on the following page summarises our quality improvement priorities for
2014/2015.
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 35

PRIORITY QUALITY INDICATORS 2014/2015
PATIENT SAFETY TO IMPROVE THE QUALITY OF OUR COMMUNITY EQUIPMENT
SERVICE
WHY IS THIS A PRIORITY?
The Community Equipment Service (CES) provides equipment across Suffolk as well as
Great Yarmouth and Waveney.
The service operates from three main stores in Ipswich, Bury St Edmunds and Ellough and supports 67 satellite stores across the county.
Service Targets
■ Within 4 hours: For End of Life patients
(24/hour 7 day per week service).
■ Next working day: For urgent delivery of equipment. This is a Monday to Friday only service with order cut-off at 1530hrs each working day.
■ Within 2 working days: This is a Monday to Friday only service with order cut-off at 1530hrs each working day.
■ Within 7 working days: This is a Monday to Friday only service with order cut-off at 1530hrs each working day.
■ The current service makes provision for collections of equipment with a normal service level of 10 working days – by exception within 3 working days.
■ In 2013 - 2014 we faced significant challenges in meeting all of the above service targets. This caused complaints about delays in receiving equipment and impact and delay on hospital discharges.
WHERE ARE WE NOW?
In March 2014 our performance against each target is:
■ 4 hours=89.28%
■ Next working day=91.63%
■ 2 days=97.07%
■ 7 day=88.27%:
Other concerns raised:
■ Data ambiguity in reporting of service targets. This was caused by inconsistent application of prioritisation codes against the above targets by referrers
■ Incorrect use of the service targets resulted in excess of 2500 “urgent” requests per month which do not relate to critical end of life – 4 hour response or critical next working day delivery. The ordering process channelled clinicians to refer in this way so we have changed it.
■ On occasions the delivery time against the service targets is exceeded despite best efforts to achieve performance.
Following these concerns the CCG has put a remedial action plan in place to address performance.
A full review of the service has been completed and recommendations to address these key issues and improve the service performance and consequent quality impact has been developed.

WHAT ARE OUR PLANS FOR 2014/15?
Delivery of the action plan should address performance/quality issues:
Redesign the order form to ensure clinicians’ requests for equipment delivery are made against clinical need (mirrored against the service targets, rather than urgent vs non urgent) thus ensuring the service delivers equipment to all patients in an appropriate timescale
Ensuring focus on clinical prioritisation by all referrers will improve patient experience as all patients will get equipment within an acceptable expected timeframe.
To refine the delivery process and include with it the ability to record:
Not at home
Incorrect assessment
Incorrect contact details
Patient choice
These criteria will provide a more detailed analysis of the reasons for delayed deliveries and mitigate unnecessary delays in future.
Weekly performance analysis reports - reviewed by the service lead and responsible director. Performance monitored through appropriate governance group and reported to the Board by exception.
Unique bar coding of non-maintainable core stock items has been removed. This is already reducing the administrative burden for both clinicians and CES staff and simplifying the booking in and out of equipment from depots and satellite stores
The time saved will be invested in improving stock management at satellite stores together with the delivery and collection of equipment against clinical need.

PRIORITY QUALITY INDICATORS 2014/2015
CLINICAL EFFECTIVENESS TO INTRODUCE A COMPREHENSIVE APPROACH TO
MONITORING SERVICES TO ENSURE THAT QUALITY IS UNDERSTOOD, MEASURED,
REPORTED AND OWNED BY OUR CLINICAL SERVICES (BALANCED SCORECARD)
WHY IS THIS A PRIORITY?
Placing quality at the heart of operational delivery.
Suffolk Community Healthcare is introducing the ‘balanced scorecard’ - a comprehensive approach to monitoring services to ensure that quality is understood, measured and reported on at all levels of the organisation.
Four quadrants, ‘Quality’, ‘Productivity’,
‘Finance’ and ‘Compliance’ will be measured against a range of agreed targets, on a monthly cycle (and published).
All community health teams, community hospitals and specialist services will include balanced scorecards. These will be discussed monthly at team meetings so that all staff have oversight and ownership of their performance.
A recommendation of the Francis report
(following Mid Staffordshire inquiry) is developing accountability throughout all layers of the organisation for the quality and safety of care delivered to patients. (See page 13 for example of balanced scorecard).
WHERE ARE WE NOW?
The majority of the information that will appear on the balanced scorecard is available and used at a high level within SCH ( for example community contract performance monitoring). The information is gathered from many sources and not easily available nor used at a local level.
Previously quality was reviewed in parallel with performance and not as an integral part of the performance regime.

WHAT ARE OUR PLANS FOR 2014/15?
Aim for 2014/15 is to establish local team balanced scorecards. The balanced scorecard will give us more detailed information about how we are doing and will highlight areas we need to improve, support learning across teams and provide a key development tool.
Fundamentally the balanced scorecard places quality measures at the heart of performance monitoring giving this area equity alongside productivity and financial performance and building on the recommendations of the
Francis Report.
Once established, balanced scorecards will be monitored monthly for each team with an overarching ‘dashboard’ balanced scorecard for whole service overview of all of the services we provide to patients.
Review to take place at the leadership team level, at local area manager level and an individual team level. Individual staff balanced scorecards on their own performance will highlight good practice and areas for development.
We anticipate that the content of the scorecards will evolve over the year as the teams become more used to them and as other measures for assuring quality are suggested. We will actively encourage the input of staff to help shape and develop the scorecards content.

PRIORITY QUALITY INDICATORS 2014/2015
PATIENT EXPERIENCE
WHY IS THIS A PRIORITY?
A key indicator of whether our patients have experienced “high quality care” is if they would recommend us to their family and carers. This is called the “Friends and
Family” Test (FFT).
People who are willing to recommend us are called promoters – our net promoter score
(NPS) is the overall measure.
This simple question in “the Friends and
Family test” is used across the NHS:
Within SCH we use FFT in our community hospitals and MIU successfully and want to increase the numbers participating in other services including community health teams, specialist nursing & therapy services and across Community Equipment Service and Wheelchair Service. This is a focus for
2014/2015.
It is not easy to encourage responses from often very frail and vulnerable patients.
The NPS has some limitations so we will also build on this year’s “patient voices” work carried out in the community hospitals – where a sample of patients and carers were interviewed to gain a greater quality and depth of information.
This enables us to look at our services and view them from the patient and carer perspective – a view we can often miss.
WHERE ARE WE NOW?
In March 2014 NPS for 2013/2014 was 80
– exceeding the national average for NHS trusts of 71.
Our MIU service consistently scored 100 for five of the last six months.
Community health teams and specialist teams consistently score above 70. However response rate is low (to consider statistically significant) at 100-150 responses per quarter.
We will improve this in 2014/2015 by reviewing how we collect patient experience information.
We have worked with community hospitals to support staff to interview patients and carers to gain a more qualitative insight into their views of the services they receive.
This proved exceptionally positive – small changes made a great difference to patients’ overall experience. Eg: Not filling water jugs so full so that patients can lift them independently and drink when they want to.
We will build on this work next year.

WHAT ARE OUR PLANS FOR 2014/15?
In 2014/2015 we are reviewing how we collect patient experience surveys and information.
We will explore whether working in partnership with other organisations
(Healthwatch, voluntary organisations etc.) may help.
We aim to increase the FFT response rate to:
Community hospitals – 30% of discharged patients
MIU – 20% of discharged patients
Community Health Teams – 18% of discharged patients
Wheelchair and Community Equipment
Services – 20% of patients referred.
We will listen to the patient voice through interviews/discussion within community health teams, Wheelchair Service and
Community Equipment Service and build on work begun in community hospitals.
Ensure the patient voice heard right through to Board level:
Relaunch the Leadership Team walkabouts
Ensure that each Board meeting begins with a patient story-through invitation to patients and carers or services.

PRIORITY QUALITY INDICATORS 2014/2015
PATIENT EXPERIENCE (2) - STAFF ENGAGEMENT
WHY IS THIS A PRIORITY?
Staff engagement is fundamental to high quality services. There is a strong link between staff that feel valued, happy at work, respected and supported and the quality of service they provide.
Francis clearly states that greater trust needs to be built between management and front line staff.
In SCH we recognise that, due to a number of challenges during 2013/2014 –this trust was damaged and that staff felt senior management were not listening to them.
Staff voiced disquiet through external sources such as CCG, GPs, unions, incident forms and complaints. Following our internal SERCO staff survey in October
2013 it was evident that change needed to happen.
We have a target for September 2014 of a
25% improvement in staff engagement. We have an engagement and communications plan in place to meet this challenge and create a more stable, happier workforce.
WHERE ARE WE NOW?
From January 2014 a new Chief Executive joined – who clearly recognises the value of placing staff at the heart of everything we do.
Within three months SCH has established:
■ A weekly CEO update – informing staff of what has been discussed at leadership team meetings
■ A fortnightly radio show – that showcases service developments, recognises staff achievement and brings different members of the leadership team to talk to staff about their aspirations, concerns, priorities
■ Senior management attendance at team meetings and more senior visibility
■ Each service area has developed an action plan focusing upon staff engagement and involvement within their teams
■ Development of clinical champion groups: infection control, SystmOne
(our electronic patient record system), new ‘ways of working’ champions – staff groups that lead and recommend service developments.
However, we recognise that this is only the beginning.

WHAT ARE OUR PLANS FOR 2014/15?
Staff engagement and satisfaction to be monitored at intervals through the Serco
‘Viewpoint’ staff survey.
Each manager has developed an engagement action plan based on staff feedback and the survey.
Plans include:
In May 2014 new reward and recognition scheme launched, developed in line with
Serco’s governing principles and the 6 C’s of
Nursing to adequately reward our staff for going above and beyond the call of duty in their roles, (a regular occurrence).
Launch staff campaign called Fix/100 to identify and fix 100 issues that affect staff’s working lives. We have gathered almost 100 already and have started the fixes.
Developing an employee communication forum (ECF) to improve communication across SCH. We also have a JSF (Joint Staff
Forum to meet regularly with our unions.
Improve staff survey score to recommend as a place to work or receive treatment.
■ Reduction in staff turnover
■ Increase in responses to the viewpoint survey in addition to the increase in staff engagement score
■ Increase in staff survey score particularly around “Trust in Leadership” question.

1.
Commissioning for Quality and Innovation
Framework (CQUIN) 2014/15
CQUINs (Commissioning for Quality and
Innovation) are projects agreed between the commissioners (who buy our services) and the healthcare provider. The projects are set up to improve quality standards in key areas.
Every year SCH and the East and West
CCGs agree quality improvement and innovation goals and a proportion of
Suffolk Community Healthcare income in
2013/2014 was conditional on achieving through the CQUIN framework.
Our CQUIN priorities for the coming year are:
■ Friends & Family Test: Increase the reach of the FFT (as detailed earlier) throughout all services and begin a staff FFT to give our staff the same opportunity to provide feedback.
■ Integrated working: Work with other providers to explore where we can better integrate to improve patient experience.
Look at sharing information, workforce developments, and patient information.
■ Patient voices: We will continue to acknowledge the value and importance of listening to and acting on patients’ experiences in order to improve the quality of our services. We will collect ‘real time’ information (as we did last year) and apply this to community health teams.
■ Dementia: Further enhance our service for patients with dementia as well as a physical condition by allocating each patient a
‘dementia link practitioner’ to help them and their carer through the patient journey as well as offering valuable advice and signposting to other key services.
44 SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

■ Harm free care: We will promote good practice by monitoring patient safety in the areas of pressure ulcers and falls and link with other local providers to identify where we can reduce harm across the healthcare system.
Review and evaluate the pressure relieving equipment in our central store and make recommendations for future procurement.
We will also ensure our practice falls policy reflects the most evidence base and implement changes.
■ Seven-day working: Identify where SCH can provide an enhanced response to patient needs in order to contribute to a seven-day service, in line with the recommendations of
Sir Bruce Keogh’s report.
2.
Involvement with our partners in quality improvements across the health and social care system.
West Suffolk and Ipswich and East Suffolk
CCGs are planning to redesign health services system wide as part of their five- year strategic plan for Suffolk. The project has three work streams: urgent care; health and independence and efficient hospitals and SCH managers and frontline clinicians are involved and working closely with other organisations in Suffolk’s health system. The redesign hopes to:
■ Join up services around patients to make care as seamless as possible when different organisations are involved
■ Identify in a planned way people who may need support and help
■ Help people to live well as independently as possible
■ Ensure people get help swiftly and easily if they have urgent care needs.
This builds on SCH’s work on developing the care lead role and geographically located multi-disciplinary teams working in partnership with other providers.
3.
Learning from complaints, incidents and patient and carer feedback.
4.
Awareness and acknowledgement of national and regulatory frameworks and guidelines e.g. Francis, Keogh and Berwick reports and NICE Guidance regarding safer staffing levels.
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 45

SAFER STAFFING LEVELS
In 2013 and 2014, as part of continual service improvement and in response to the Francis,
Keogh and Berwick reports, SCH has been reviewing nurse staffing levels in our inpatient units and how assurance can be gained that these are set and maintained appropriately. The national response to these reports is driven by the National Quality Board which states:
46 SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

The review in SCH takes into account this evidence:
■ The RCN ‘basically safe care’ skill mix and staffing ratios
■ The RCN/Safe Staffing Alliance 1:8 registered nurse ratios (now to include NICE recommendations May 2014)
■ Triangulation of ‘nurse-sensitive indicators’ including the impacts on patient experience
■ Literature review and benchmarking where possible and scrutiny by senior nursing and operational staff.
A range of recommendations will be taken to the executive board for agreement.
Comments from patients
In addition to proposals around staff numbers, we are ensuring that members of the public can see if daily staff numbers on the ward match expectations or not. This information is collated and reported to the Director of Nursing and the
Board. As we move through the year we will develop further our assurances around staffing and how this information is shared in the public domain.
National efforts have concentrated on developing guidance and recommendations for acute and community inpatient settings. SCH has also undertaken a review of staffing models within the community and benchmarked against both national numbers and other community providers. This is being used to inform recruitment and workforce planning processes.
There have been challenges to recruitment over the past year (nationally and in SCH) and the organisation has authorised an increase in the use of temporary staff both internally (bank) and externally (agency) staff. This enables SCH to deliver safe, high quality care while also increasing effort and resources in the recruitment process.
We have seen an increase in recruitment and corresponding reduction in the use of temporary staff.
Safe staffing not just in terms of numbers but also skill mix, competencies and training, remain a priority for SCH and will remain a focus for the coming year.
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 47

During 2013/2014 Suffolk Community Healthcare has provided or subcontracted 40 NHS services.
SCH has reviewed all of the data available on the quality of care of in 40 services.
The income generated by the 40 NHS services reviewed in 2013/2014 represents 100% of the total income generated from the provision of
NHS services for Suffolk Community Healthcare for 2013/2014.
During 2013/14 there were two national clinical audits for which SCH were eligible and appropriate to community services. These were the PLACE (Patient Led Assessment of Care
Environment) and Safety Thermometer audits.
Type of Audit Eligible Participate
% submitted
Safety
Thermometer
Yes Yes 100%
PLACE Yes Yes 100%
LOCAL AND MANDATORY AUDIT
Between April 2013 and March 2014 Suffolk
Community Healthcare reviewed the reports in excess of 100 local, national and mandatory clinical audits. Each audit was reviewed within the organisation’s quality and governance system.
Action plans were requested where standards were not met to help improve the quality of healthcare provided by the service.
The findings were shared throughout the organisation via quarterly and annual reports, the
Audit Champions Forum, Take Care Take Note monthly bulletins and SCH intranet.
As in previous years, the mandatory audit plan for
2013/14 is a live working document. This ensures the plan is reviewed and updated throughout the year in line with benchmarking audits, incidents, new policies and changes in service provision.
The audits undertaken included mandatory, infection control and safety audits. Records of all results are held by the clinical effectiveness and audit department within the clinical governance team. A clinical effectiveness and audit officer joined in March 2014.
48 SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

The following audits were carried out in 2013/2014.
Key: √ participated in audit X did not take part in audit
Audits
Hard
Hygiene
Medicines
Management
(Drug chart)
Community
Hospitals
Community
Teams
√
√
Not
Appropriate
Not
Appropriate
SEPT
Podiatry
(Foot &
Ankle)
Monthly
Actions to improve the quality of healthcare
√
Not
Appropriate
Audit tools being reviewed. Continue with training to improve compliance
Remedial actions to improve practice following any identified errors.
Nursing staff reminded to sign for all drugs administered or write the appropriate code for non-administration; read and sign to state “read and understood” and that they would comply with safe & secure handling of medicines policy. Nursing staff and doctors reminded to complete allergy status
Antibiotic audit
Medicines
Management
IV Lines VIP scores
Record
Keeping
Safety Cross
Wrist Band
√
√
√
√
√
√
Not
Appropriate
Not
Appropriate
√
X
Not
Appropriate
Not
Appropriate
Not
Appropriate
Not
Appropriate
Not
Appropriate
Not
Appropriate
Not
Appropriate
Ward meeting notes evidence the above, which overall improved practice and the results within the organisation.
Improved patient safety in relation to antibiotic prescribing
Remedial actions taken to improve practice following any identified errors
Action taken to enable effective capture of relevant data
Transformation from paper to electronic records required a review of the audit tool to capture both types of data. Audit to recommence with launch of new tool in June 2014
Audit completed daily and displayed in all in-patient units for staff & public to view.
Staff can take immediate action on any issues relating to pressure ulcers or falls.
Action taken owing to incident, carried out on a monthly basis to substantiate practice improvement

The following audits were carried out in 2013/2014.
Key: √ taken part in audit X did not take part in audit
Audits
Ward
Environment*
Decontamination of Clinical
Equipment
(including commodes)
CD’s - Stock
Control of CD
Cupboards &
Procedures for
CD Destruction
Community
Hospitals
Community
Teams
SEPT
Podiatry
(Foot &
Ankle)
Quarterly
√
Not
Appropriate
Not
Appropriate
√
√
Not
Appropriate
Not
Appropriate
Not
Appropriate
Not
Appropriate
Annual / Bi-Annual
Mattress
Urinary
Catheter Care*
Food & Nutrition
Cold Chain
(Flu vaccine)
√
√
√
√
Not
Appropriate
Not
Appropriate
Not
Appropriate
√
Actions to improve the quality of healthcare
To be carried out by the facilities team
Consultation with teams to develop bespoke audit tools for individual teams to be re-launched during
2014/15.
Remedial actions taken to improve practice following any identified errors and re-audit carried out for 3 months until 100% compliant.
Not
Appropriate
Not
Appropriate
Not
Appropriate
Mattresses identified by audit as substandard were marked and replaced
Being monitored on a monthly basis improved patient care
Data captured through Patient survey and PLACE audits. Issues addressed where raised
New vaccination transport packs obtained to ensure maintenance of cold chain

WHAT DO WE WANT TO ACHIEVE IN
2014/15?
A more relevant and responsive clinical audit service.
Clinical audit is about engaging with staff and encouragement to participate in mandatory clinical audit AND initiate audits through their own interests.
An experienced clinical auditor is engaged in raising staff awareness in the importance of clinical audit, to improve the patient experience, patient safety and working practices.
Escalation process in place to ensure action plans completed within agreed timeframe.
Every audit tool to have an action plan template.
Terms of Reference (TOR) are planned for each audit to explain the audit’s objectives, rationale, method, sample (teams and possible numbers of returns expected), resources required, time management and expected timetable. Improved communication of the annual audit schedule.
Clinical audit compliance incorporated in clinical teams’ balanced scorecard to improve awareness and ownership.
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 51

CQUINs (Commissioning for Quality and
Innovation) are projects agreed between the commissioners (who buy our services) and our organisation. The projects are set up to improve quality standards in key areas.
The table to the right shows the agreed CQUIN targets and outcomes up to 31 March 2014.
Summaries of our achievements in last year’s
CQUIN projects are also highlighted.
52 SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

CQUIN ACHIEVEMENT 2013/14
CQUIN
1
Description of Indicator
Use ‘patient voices’ methodology to collect meaningful information from patients, to improve services
2
3
4
5
6
Threshold for Payment
Show evidence of patient interviews, demonstrate resulting actions taken.
To use the NHS Safety Thermometer
‘safety cross’ to monitor where and when patients have had harm caused by a fall or a pressure ulcer
Inpatient units to achieve their ‘harmfree days’ trajectory.
3 out of 4 inpatient units exceeded their trajectory.
Dementia screening / clinical leadership / supporting carers
Improve the prevention of venous thrombolytic embolism (VTE) in hospitals
Improving discharge
90% of patients aged over 75 admitted to an in-patient unit to be screened for dementia.
SCH has a named clinical lead.
SCH to co-operate with the acute hospitals and contribute to their investigations to improve the prevention of VTE.
Pressure ulcers and the care home interface
SCH is to work with the acute hospitals to improve the process for getting patients home. This includes methods of communication and tools to identify when community services should be involved.
This work is ongoing.
Reduce the number of pressure ulcers that occur in care homes by providing quality training and information.
7
8
9
Recognising and managing the unwell patient
Introduce tools that enable staff to identify the deteriorating patient.
All staff to be trained in using the new tools.
Hip fractures
Self-management
95% of patients over 65, referred to SCH therapy services, to be routinely assessed for their risk of falls and offered appropriate intervention.
Identified staff to be trained to better support and motivate patients in selfmanagement of their long-term conditions.
Status
√
√
√
√
√
√
√
√
√
10
Dementia Create an online dementia resource for
SCH staff and develop the skills of the dementia champions in supporting patients with dementia and staff awareness.
√

EXAMPLES OF CQUIN ACHIEVEMENTS
This CQUIN identified staff groups for training in the art of teaching selfmanagement of long term conditions.
Identified staff were trained to better support patients, improving their ability to manage their care, thus reducing future reliance on health services and admission to hospital.
Our population is changing, people are living longer, and with one or more longterm conditions. Different skills are required to motivate and give patients the confidence and knowledge to manage their long-term conditions.
The course was highly valued by the staff involved, all said that they would recommend it to colleagues. Building on the success of this year’s CQUIN,
SCH is looking at continuing this training opportunity for a second year, and expanding it to our social care colleagues.
Whilst our patient surveys offer an important barometer of the quality of our services, it does not allow us to collect detailed information and understand some of the small nuances of a patient’s experience that can enhance the care we deliver. To address this, during 2013/14, we ran a project to capture patients’ stories. Based upon the ‘experience-based design’ methodology developed by the
NHS Institute, we focused on conducting in depth, one-to-one interviews with patients at our four community hospitals.
These interviews allowed us to gain a deeper understanding of the experience of our patients and give staff the patients’ view of the service we provide.
The insight from these interviews was used to highlight areas of good practice as well as areas for improvement, with the modern matrons taking responsibility to ensure these happened. Some of the improvements include:
■ Improved patient information documentation
■ A review of our volunteer recruitment process to increase the number of volunteers we have supporting patients with social activities in our hospitals;
■ Improved communication with patients and their families about discharge arrangements.

The Care Quality Commission (CQC) is the independent regulator of health and social care in England. Suffolk Community Healthcare is registered with the CQC. Our current registration status is: “registered with no conditions”. As an organisation we are required to register compliance against the 16 essential standards of quality and safety for the following regulated activities:
■ Treatment of disease, disorder or injury
■ Personal care
■ Surgical procedures
As a private organisation we must ensure that an appropriate registered manager is in place and held accountable for ensuring that the CQC standards and outcomes are followed in everyday practice. Our Chief Executive, Dr Abi Tierney, is our registered manager. There is a strong management framework in place to ensure the
CQC standards are embedded across SCH. The registration details are available on the Care
Quality Commission Website via the following link: www.cqc.org.uk
During 2013/2014 SCH received five unannounced inspections from the CQC. Visits were made to the four community hospitals,
Felixstowe Minor Injury Unit and community teams based at Newmarket Hospital and Stow
Lodge Centre.
The inspection reports are available on the CQC public website and SCH registration is currently registered without conditions.
Standards were fully met in all but one outcome assessed during the inspection process. The inspection found non-compliance with outcome
21 - quality of records - at Bluebird Lodge inpatient unit. The subsequent local action plan to address the CQC’s recommendation has been approved by the CQC and full compliance achieved.
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 55

CQC OUTCOMES ASSESSED IN 2013/14
Outcome Title of outcome
Aldeburgh
Hospital
Bluebird
Lodge
Felixstowe
Hospital /
MIU
Newmarket
Hospital
1
2
4
6
7
8
11
14
16
17
Respecting and involving people who use services
Consent to care and treatment
Care and welfare of people who use services
Cooperating with other providers
Safeguarding people who use services from abuse
Cleanliness and infection control
Safety, availability and suitability of equipment
Supporting workers
Assessing and monitoring the quality of service provision
Complaints
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
21 Records √
√
X
(assessed as complaint
April 2014)
Stow
Lodge
√
√
√
√
√

EXCERPT OF BLUE BIRD LODGE ACTION PLAN TO ADDRESS NON-COMPLIANCE
RE OUTCOME 21 – RECORDS
Examples of areas identified for development
Examples of actions achieved Monitoring / evidence
Clinical documentation reviewed to support accurate and fit for purpose documentation.
Revision of clinical documentation and care plans ensures information appropriately and fully recorded.
Guideline written to ensure standardisation and consistency of Intentional Rounding* process.
Improvement in documentation recognised during reassessments.
Complete and continuous records of patients’ needs and treatment available in one place.
All care plans now within patients’ rooms.
Weekly audit monitors compliance and quality of documentation.
Complete and accurate records kept in order to support reliable decision making and the review of patients’ needs.
Daily review of care plans
New patient admissions undergo multi-disciplinary team care review and planning.
Care plans clearly document identified patient needs and how they are being addressed.
Intentional rounding process to be reviewed.
Care plans written in a manner that identify actions needed to promote independence/or actions required to support the patient.
Mental capacity assessment and associated care plans to be completed to support people in their management of dementia.
Therapy and support staff now engage with process.
Better understanding as to the use of care plans and their role in assuring good care.
Audit of documentation and staff engagement.
Included in regular audit programme.
Dementia lead supported integration of assessment into daily care planning and training provided.
Dementia Care Knowledge
Gateway established on intranet providing easy access to a toolkit and guidance in its use.
Mental capacity training completed by all staff
Ward staff member trained as
Dementia Link Practitioner and in the use of the toolkit.
Intentional Rounding involves health professionals carrying out regular checks with individual patients at set intervals.

CCG QUALITY IMPROVEMENT VISITS
Quality Improvement Visits are also undertaken by the CCGs. In 2013/2014 visits were made to the inpatient services at Aldeburgh, Newmarket and Bluebird Lodge; the Community Equipment
Service (CES); and Care Co-ordination
Centre (CCC.) Recommendations from those inspections are monitored through the CCG quality subgroup.
The visit to the CES identified actions to address in a number of areas related to performance of service targets and response times (discussed in priorities for quality improvement in 2014/2015 above) and infection control procedures. An action plan is in place to address both areas with significant progress made. This continues to be monitored through the contractual monitoring process with the CCG.
In October 2013 the CCGs commissioned an external quality review of Suffolk Community
Healthcare. At the December 2013 CCG executive public meetings a summary of the
Quality Review and subsequent actions implemented were discussed. Both Executive
Boards agreed that, despite areas for improvement, Suffolk Community Healthcare continued to provide high quality and safe services. The report can be found at http:// www.westsuffolkccg.nhs.uk/wp-content/ uploads/2014/01/WSCCG_Serco_QR.pdf
58
INTERNAL QUALITY ASSURANCE
INSPECTIONS
All clinical services including the CES and CCC have undergone internal Quality Assurance
Visits to support their preparedness for external inspection. Quality and governance team members led the assessments using tools based on CQC expectations. Noted within the reports were comments including:
Identified areas for improvement are supported by the quality and governance department.
Governance links support local area management and their teams, who will help promote and support best practice and the improvements required to assure compliance. Each team is developing local CQC evidence folders to include responses to action plans, incidents, audits etc.
This process is also supported by SEPT, with all services having a local portfolio containing the essential standards of quality and safety with a self-assessment of compliance. All services are audited annually by the trust compliance team.
An risk-rated action plan is in place for any areas where improvement is needed. A system of internal and external assurance mapping
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

is in place that mirrors that used by the CQC
(information is collated from a range of sources both internally and externally and from the CQC quality and risk profile).
There have been 17 internal CQC spot checks completed across services in Suffolk during
2013/14. Of the 17 spot checks completed, eight identified no actions. For the others, action plans were implemented to ensure full compliance was maintained. There are currently no actions arising from any spot checks completed in 2013/14 that have passed their deadline for implementation.
High quality information underpins effective and safe patient care and is key to improvements in quality of care. SCH continues work towards providing a Community Information Data Set
(CIDS), a nationally mandated requirement, though the timescale of this work has been extended nationally to April 2015. Good progress has been made and SCH is now awaiting the national agreement of some data definitions to complete the set-up of our reports.
In 2013/14 there was a change in the level of data that could be provided to the CCGs, as opposed to the primary care trusts (the previous commissioners). From April 2013/14 CCGs were not allowed to receive patient identifiable data so, at short notice, SCH had to annonomise
(making sure patients’ personal details were hidden) our reports to send to the CCGs, whilst they set up a new reporting pathway via the data services for commissioners regional office
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14
(DSCRO). Once the CCGs had set up the reporting pathway we amended our reports to provide the required data.
SCH has continued to upload Suffolk outpatient data, inpatient and minor injuries unit data to
Secondary User Services for inclusion in hospital episode statistics (HES). We are extending this practice to all commissioners in 2014/15 to make the proof of activity for patients registered to
GPs outside Suffolk more visible and to ensure
SCH can invoice for the activity it carries out.
SCH is consistently above the national average for data quality in NHS number and GP practice for all three commissioning datasets. SCH is not subject to ‘payment by results’ so the clinical coding audit is not applicable during this period.
59

NHS NUMBER AND PRACTICE CODE
VALIDITY COMPLIANCE
NHS VALIDITY
NHS Numbers % Valid for
Suffolk Community Healthcare (NHM)
CDS SCH % Valid National %
Valid
Inpatients
Outpatients
A&E
100.0%
100.0%
99.4%
99.1%
00.3%
95.8%
GP PRACTICE VALIDITY
GP Practice % Valid for
Suffolk Community Healthcare (NHM)
CDS SCH % Valid National %
Valid
Inpatients
Outpatients
A&E
98.9%
99.9%
99.2%
99.9%
99.9%
99.1%
SCH wants the data and information used by our services to be of the highest accuracy and quality.
In 2013/2014 we established a programme to ensure timely, accurate, transparent and comprehensive capture of data and information from patient referral to reporting operational and contractual performance. The programme has ensured:
60
■ Efficient, consistent and auditable data capture, processing, interpretation and reporting
■ That all processes are robust, risk assessed, documented and frequently monitored
Compliance with relevant regulatory and best practice policies and procedures and also contractual requirements
■ Reduction of risk of data errors and inappropriate data changes.
Data used by SCH is primarily held in a primary clinical record in a computer programme called
SystmOne and data are collected by the clinical staff treating the patient. These data are extracted from the system to allow us to monitor the quality of care and report on SCH performance against targets set as part of our contract with the Suffolk CCGs.
During the year we have established regular audits of the use of SystmOne and how our staff are using the system to record the work they do with patients. This has led to improved quality and accuracy of data (confirmed by external audits carried out by the National Audit Office and Templar Executives – a specialist company in the field of cyber security). These audits have confirmed that SCH processes are robust.
We have also agreed to report monthly on where data have been changed to reflect changes clinicians make to records of the care they provide. Each month we report to the CCGs how many data corrections have occurred and for what clinical reason data. SCH staff record
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

(on average) 40,000 activities a month and occasionally need to modify/update the clinical record. When this is done it is confirmed as appropriate by a manger.
40,000
In addition we regularly audit the timeliness of our staff recording activity to ensure that clinical records are entered into SystmOne as soon as possible to support the care we provide to them.
The information governance quality and records management attainment levels assessed within the Information Governance Toolkit provide an overall measure of the quality of data systems, standards and processes within an organisation.
The information governance toolkit is available on the Connecting for Health website: www.
ig.connectingforhealth.nhs.uk.
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 61

REPORT RESULTS
ORGANISATION WHICH THIS ASSESSMENT COVERS
SUFFOLK COMMUNITY HEALTHCARE
Information Governance Management
Assessment Level
0
Level
1
Level
2
Level
3
Not
Relevant
Total
Req’ts
Overall
Score
Initial
Grade
Current
Grade
Reason for
Change of
Grade
Version 11
2013 - 2014
0 0 3 2 0 5 80% S S n/a
Confidentiality and Data Protection Assurance
Assessment Level
0
Level
1
Level
2
Level
3
Not
Relevant
Total
Req’ts
Overall
Score
Initial
Grade
Current
Grade
Reason for
Change of
Grade
Version 11
2013 - 2014
0 0 7 1 1 9 70% S S n/a
Information Security Assurance
Assessment Level
0
Level
1
Level
2
Level
3
Not
Relevant
Total
Req’ts
Overall
Score
Initial
Grade
Current
Grade
Reason for
Change of
Grade
Version 11
2013 - 2014
0 0 14 0 1 15 66% S S n/a
Clinical Information Assurance
Assessment Level
0
Level
1
Level
2
Level
3
Not
Relevant
Total
Req’ts
Overall
Score
Initial
Grade
Current
Grade
Reason for
Change of
Grade
Version 11
2013 - 2014
0 0 3 2 0 5 80% S S n/a

Secondary Use Assurance
Assessment Level
0
Level
1
Level
2
Level
3
Not
Relevant
Total
Req’ts
Overall
Score
Initial
Grade
Current
Grade
Reason for
Change of
Grade
Version 11
2013 - 2014
0 0 2 0 0 2 66% S S n/a
Corporate Information Assurance
Assessment Level
0
Level
1
Level
2
Level
3
Not
Relevant
Total
Req’ts
Overall
Score
Initial
Grade
Current
Grade
Reason for
Change of
Grade
Version 11
2013 - 2014
0 0 3 0 0 3 66% S S n/a
Overall
Assessment Level
0
Level
1
Level
2
Level
3
Not
Relevant
Total
Req’ts
Overall
Score
Initial
Grade
Current
Grade
Reason for
Change of
Grade
Version 11
2013 - 2014
0 0 32 5 2 39 71% S S n/a
GRADE
NS - Not satisfactory - not achieved Attainment Level 2 or above on all requirements (Version 8 or after)
S - Satisfactory - Achieved Attainment Level 2 or above on all requirements (Version 8 or after)

A new service initiative called the Bury St
Edmunds Aphasia Café is in place, introduced by a clinical specialist from the adult speech and language therapy west team. It’s for people who have long-term communication difficulties after a stroke (aphasia) who are approaching discharge from therapy. The café provides a highly supportive environment to enable people living with aphasia to re-engage with their community and practice/develop their new communication skills. Patients told us they were less lonely, had a chance to talk with and learn from others with similar problems; and developed new friendships. The clinical specialist had a research poster describing the benefits of this new service initiative accepted at the East of England Stroke
Forum:
64 SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

66
1A: TO MAINTAIN OUR SAFETY FOCUS BY
CONTINUING TO REDESIGN THE
STRUCTURE AND FUNCTION OF THE
COMMUNITY HEALTH TEAMS AND
COMMUNITY INTERVENTION SERVICE
1B: COMMUNITY HOSPITALS: TO IMPROVE
THE RECOGNITION AND MANAGEMENT
OF THE UNWELL PATIENT IN A
COMMUNITY HOSPITAL SETTING
TO REDESIGN THE FALLS PATHWAY SO THAT
BOTH FALLS PREVENTION AND FALLS AND
FRAGILITY FRACTURE PREVENTION CONTINUE
TO BE A PRIORITY WITHIN SCH
TO CONTINUE TO IMPROVE THE QUALITY
OF PATIENT AND CARER EXPERIENCE BY
IMPROVING SERVICE USER ENGAGEMENT AND
SUPPORT FOR CARERS
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

2013/2014 was a year of differing perspectives.
The early part of 2013 saw concerns raised about recruitment, staff engagement, challenges with mobile technology and the implementation of the Care Coordination Centre. We also faced a loss of trust in our abilities to deliver on the promises made when Serco won the tender to provide the service.
However, despite the challenges, patients and carers continued to report high levels of satisfaction with the quality of services they received. Our net promoter score for the year is 80 for the organisation – a score that exceeds the national average of 71.
Central to the delivery of high quality care is the hard work and dedication of our staff. Earlier in the year, affected by the fast pace of change within the organisation, many reported a sense of being disengaged from the senior management team with lack of involvement and influence over the changes being implemented. In the latter part of the year we have worked hard to address this imbalance and we are confident that progress is being made - evident from a recent staff survey undertaken which has shown a 95% response rate. Receiving prompt feedback from our staff is important to our success and we will ensure we will keep this dialogue going to ensure continued improvement.
We have addressed the concerns our staff raised about some central processes by simplifying systems, and we have created new roles to co-ordinate these activities. This means that our staff now have simpler processes to follow and are not spending large amounts of time on administrative tasks.
In addition we have undertaken a review of our staffing levels against our original target operating model (TOM). This included benchmarking against Bromley Healthcare (a community provider of healthcare and a social enterprise) and agreeing average activity levels for clinicians.
This will determine what staffing levels need to be.
RECENT ACHIEVEMENTS INCLUDE:
■ 99% of patients surveyed in April would recommend our service to family and friends if they required similar treatment – 100% in community hospitals (Friends and Family Test respondents)
99%
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 67

■ Achieving 95% of KPIs – compliance with contractual targets continues to improve every month
■ Community teams are meeting all their targets for response times
■ 100% of patients at Felixstowe Minor Injury
Unit treated within four-hour target
■ 100% of audiology tests performed within six weeks
■ Average length of hospital stay dropped again in March to 23.69 days from 24.1, even though that month had the biggest flow through of patients ever
■ 98.1% of all Care Coordination Centre calls answered within 30 seconds (target 95%)
Calls answered within 30 seconds 98.1%
Target - 95%
■ Complaints are low (six across all services for
March) and positive feedback is much higher
– 22 formal compliments
■ Community Equipment Service expected to meet all KPIs by June 2014
■ 95% response rate to latest staff survey.
68
FOCUS ON OUR CARE COORDINATION
CENTRE – AN IMPROVING SERVICE
The Care Coordination Centre (CCC) operates
24 hours a day 365 days a year. It is a single point of access for services and a referral centre for our services. There is one telephone number to contact the CCC, which can also receive referrals by fax and email.
The CCC started work in February 2013 with four members of staff covering one locality:
Felixstowe. Numbers of telephone calls to the centre at the start were very low with about 40 faxed referrals received every day.
On 1 May 2013 the operational hours of the
CCC changed to provide a 365 day service between the hours of 9am and 4pm, and on 15
July 2013 it became a 24 hour a day, 365 days a year service, receiving over 10, 000 calls and
5000 faxes a month. With extended hours came further services, including the continence service, which saw 34% a rise in its productivity in the first month of the CCC managing their referrals and appointments schedule.
The introduction of this service has not been without problems or challenges. Failure to consistently achieve service targets, including percentage of calls answered within 30 seconds, relationships between clinical staff and call analysts, and some process and system issues.
With the support of the CCG we have worked extremely hard to overcome these difficulties and improve the quality of the service we deliver. In
April 2014 we met the target for the percentage of calls answered within 30 seconds for the 4th
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

consecutive month, and we are handling about
13,000 calls a month.
The CCC has broader functions, including patient satisfaction surveys, incident record management, administrative projects and signposting for a variety of contacts. We continue to identify and review functions that the centre can undertake, including referral management for the remaining specialist services provided by
SCH and enhanced appointment scheduling for all CHTs.
We will improve the quality of information captured and communicated to the CHTs, reducing wasted clinical time in processing inaccurate referrals and thus increasing time spent with patients. We receive an increasing amount of positive feedback:
Patient’s relative, Feb 2014
Patient’s relative, Feb 2014
March 2014
GP
CONTACT THE CCC ON 0300 123 2425
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 69

VOLUMES RECEIVED INTO THE CCC FROM APRIL 2013 THROUGH TO APRIL 2014
2000 4000 6000 8000
4000
4594 APR 2013
6351 MAY
4074
7290 JUN
4400
5398
4884
4741
5380
4933
4737
5384
4797
5387
5209
10000 12000 14000
10219 JUL
11153 AUG
11179 SEPT
12112 OCT
11407 NOV
11625 DEC
12620 JAN 2014
12136 FEB
12989 MAR
12320 APR
CALLS ANSWERED
FAX RECEIVED

TO MAINTAIN OUR SAFETY FOCUS
BY CONTINUING TO REDESIGN THE
STRUCTURE AND FUNCTION OF THE
COMMUNITY HEALTH TEAMS AND
COMMUNITY INTERVENTION SERVICE
(CIS).
Integral to quality of care is to ensure that services are joined up and responsive at the point of need.
With patients living longer and the rise in longterm conditions, people need treatment and care from a wide range of different professionals such as nurse, therapist, GP or social worker. By joining up services patients only have to tell their story once in order to get the help they require and all important information is shared.
The changes to the community health team
(CHT) structures are now firmly embedded.
The 15 CHTs work closely with their identified
GP practices and through a neighbourhood team approach also link with social workers, mental health colleagues and the voluntary and charity sector. We are part of regular multidisciplinary team (MDT) meetings with all these colleagues where we discuss patients with complex needs
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 and agree plans to support them in managing their conditions.
The 15 CHTs now have strong links with primary care colleagues (eg GPs).
In 2013/14 we began a programme of practice visits and attendances at locality meetings.
Thirteen GP practices were visited by community health team leads, local area managers and the medical director in the first quarter of the year. These visits provided an opportunity to introduce the team lead and local area manager, and to raise any concerns or queries.
The common themes arising from the visits were visibility of the community health team at a practice level, phlebotomy, staffing and staff morale. We are improving the visibility of the community health teams through these visits and our clinical staff continue to link frequently with practices to deliver patient care. Practices have noted recently that improvements in staffing and staff morale are becoming increasingly apparent.
Also several comments have been made about the efficacy and high levels of service delivered by the Care Coordination Centre.
71

“The meeting had a very welcoming atmosphere and the GPs and practice manager were interested in the update we gave them about the latest developments in SCH. The practice welcomed the attendance by the SCH community nurses at multi-disciplinary meetings. They suggested including our therapists, which we will swiftly arrange.
The practice had high praise for the community nursing team and felt they all communicate well in the best interests of their patients. The practice team made positive comments about the CCC, the help they have received from the call analysts when making referrals, and how useful it is to have a 24/7 service.”
Each primary care visit is followed up with a letter confirming agreed actions and providing feedback on any queries that could not be answered on the day. These letters are copied to the CCG to keep them updated.
Visits to a further 15 practices are planned in
2014/15 with remaining practices having visits arranged, the only exception being practices which declined a visit.
These planned visits are in addition to the engagement with GPs through MDT meetings and day to day contact with frontline community nurses and therapists.
THE CARE LEAD ROLE
During 2013 and the first part of 2014 senior staff from the CHTs were able to complete the Care
Lead Programme. The care lead role aims to:
■ Work across all health and social care agencies to agree the best care pathway for the patient and carer
■ Support a model of prevention rather than intervention
■ Promote self-management by building confidence, and developing understanding of patients’ strengths, goals, and aspirations as well as their needs and difficulties.
Further work is now being done with the clinical teams to embed the principles of care leadership into our model of healthcare delivery. All patients will have a named care lead to help them access holistic and integrated care. Support will be tailored to meet their needs and will improve the experience patients and their carers have of community healthcare -and ultimately improve patient outcomes.
72 SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

“Over the last year we have built on the concept of neighbourhood networks in our communities. This involves a ground-up approach starting with sessions concentrating on bringing professionals providing care in a particular area together.
“Change is a never ending process in both the health and social care arena and if we are going to meet people’s needs in the future we will need to continue to evolve and innovate. However change can sometimes disrupt relationships between professionals, groups, and services. These networks of relationships are hugely valuable in the community supporting our most vulnerable people. It is these that the neighbourhood network project aims to build on.
The local area managers in the east of the county are meeting regularly with their counter part in Adult Community
Services. More importantly frontline staff are planning lunchtime sessions which will give opportunity for joint learning and relationship building. For example
Felixstowe have a deprivation of liberty safeguards (DoLS)/Mental Capacity
Act learning lunch in Felixstowe in June and several learning lunches have been arranged around the topic of dementia.”
Locality Area Manager
COMMUNITY INTERVENTION SERVICE:
All teams responsible for admission avoidance and discharge planning are now joined into one team – the Community Intervention Service
(CIS) . This avoids duplication and gaps, helps to prevent patients being ‘handed over’ from one part of the service to the next and smooths the transfer of care when patients are admitted to, or discharged from acute hospital.
Some of the changes we have made to these services are described below in more detail.
IMPROVING DISCHARGE PLANNING:
In discharge planning at Ipswich Hospital we simplified the referral process to improve the quality and quantity of information received. In
2014/15 we will introduce an electronic referral process to streamline referrals. At West Suffolk
Hospital the discharge planning team outreach to our community beds at Newmarket Hospital and Hazell Court in Sudbury. This has helped to simplify transfer arrangements so patient care is better co-ordinated.
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 73

THE COMMUNITY INTERVENTION
SERVICE (CIS) IN EAST SUFFOLK
Three clinical nurse specialists joined CIS in June
2013 to take on initial referrals from GPs and
Emergency Assessment Unit (EAU) consultants for patients who are more acutely ill, providing assessment, plan of care, treatment plan, monitoring, observation and evaluation. CIS clinicians are working in the Care Coordination
Centre, and senior nursing staff are available for the call analysts taking referrals, to provide expert advice and triage.
The CIS is represented at the Admission
Prevention Network (APN) meeting in the east every month. This is attended by the CCG,
East Anglia Ambulance Service, Adult Social
Care, Harmoni (out of hours provider), Ipswich
Hospital and voluntary groups including the Red
Cross, Suffolk Family Carers and Age UK Suffolk.
This gives us an opportunity to discuss projects and changes to improve services and reduce admissions.
We have enhanced the skills range of the CIS by including physiotherapists and occupational therapists in the team. This means that patients can access expert care from these professions to enable them to remain independent and avoid admissions.
SCH is working with Ipswich and East
CCG on a review of the community matron role. It is being carried out by the public health team and aims to ensure that the people of east Suffolk are getting the maximum benefit from these very experienced and skilled professionals.
Whilst we wait for the outcome of that review, our medical director Dr Amit
Sethi is leading a project to trial a new operating model for the community matrons in Ipswich and East Suffolk.
This work is being developed by the community matrons themselves with the aim of developing more formal links with named lead GPs.
74 SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

DEVELOPING COMPREHENSIVE
GERIATRIC ASSESSMENT IN WEST
SUFFOLK
Delivery of the community-based Comprehensive
Geriatric Assessment (CGA) in West Suffolk has been achieved by refocusing the role of the community matrons as advanced practitioners and linking them to the Interface Geriatrician
(Medical Consultant) in the West Suffolk
Hospital (WSH). An increase in staffing and clearer focus enabled us to deliver CGA within a multidisciplinary team setting. This gives greater continuity of care for the most vulnerable and complex patients in our community enabling the early identification of complex patients in the acute hospitals and the early involvement of community teams to support their discharge.
CGA started as a pilot in the Sudbury area in
February 2014 and will roll out across the west in the coming months. The appointment of a nurse consultant means we can deliver better coordinated care at times of crisis and develop links to other parts of the CIS.
The development of an assistant practitioner role will enable the advanced practitioners to focus their skills on assessment and case management.
A patient was referred to the advanced nurse practitioner by their GP at their practice multidisciplinary team meeting.
The nurse was able to arrange with the hospital geriatrician for urgent assessment and investigations. The patient attended West Suffolk Hospital the following day, had a comprehensive assessment and investigations and a joint treatment plan agreed and implemented by the community nurse. The patient remained at home on an appropriate course of treatment. Prior to the service being in place the patient would have been admitted to hospital to have the assessment and investigations undertaken.
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 75

SUB-ACUTE CARE
In the winter of 2013/14 we worked with the
WSH to develop the sub-acute clinically stable project. This service embraces the ethos of integrated working through a seamless transfer of care out of hospital to care provided by our CIS with some staff seconded from the acute hospital to CIS, to bolster the service and improve links between the two organisations.
With the aim of improving quality of care, it focuses on those patients identified as suitable for sub-acute care (ie clinically stable but medically unfit and at low risk of deterioration).
This means that patients can return to their own homes earlier, whilst still receiving the benefits of care traditionally provided in hospital. The main aims of the sub-acute clinically stable project are shorter length of stay, improved flow across the health and social care systems, structured governance, improved patient experience, reduced readmission rates.
Since the project began we can demonstrate stronger integrated working, a significant reduction in length of stay in hospital, improved governance structure. We have ensured that patients are cared for in the best environment for them and to date the project has saved more than 464 bed days.
The sub-acute model of care is fully funded until mid-2014. We hope the success of the first few months will grow and develop and the service will become embedded within the culture of integrated work and sustained longer term.
In 2014/15 we aim to improve the data collected about the service, increase the number of patients who benefit and increase capacity to deliver sub-acute services in the community.
We believe that this will lead to a truly embedded integrated system and cultural acceptance of a whole service approach to patient centred care.
What is a PICC Line? A PICC line is a peripherally inserted central catheter. It is a long small flexible tube, inserted through a vein, usually in the upper arm and advanced until it sits in a larger vein in the chest near to the heart to give intravenous access and administer medications.
Last year it took 6 days, from doctor referral, to insert the PICC line, waiting time is now just 1-2 days. The delay was caused by a lack of staff trained in PICC insertion. We employed an extra nurse so the PICC nurse can work exclusively on
PICC.
The service has transformed care to this patient group, mitigated risks and educated staff through structured integrated governance and regular clinical review.
76 SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

A patient presented at A&E and was diagnosed with a diabetic foot ulcer which would require intravenous antibiotic therapy. She was referred to the subacute team who assessed and liaised with the community nurses. They were able to make arrangements for the lady to receive this treatment at home the same day. She was discharged within four hours and seen the next day by community nurses and was able to return to work within a week.
Without the service she would have been an inpatient for up to 10-12 weeks.
UPDATE ON INTRODUCING A SINGLE
NUMBER AND REFERRAL POINT
The Care Coordination Centre is now firmly established and takes referrals for all 15 community health teams and the Community
Intervention Service. During the day nurses from the CIS are based at the centre, meaning that patients and referrers have direct access to a nurse if required. We have worked hard so clinicians work closely with call analysts. We are identifying the full range of functions the centre can provide, and are piloting centralised triage and appointment scheduling to further simplify the process and release time to care for patients.
Feedback from patients and referrers on the
CCC is very positive.
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 77

HOW DID WE PERFORM AGAINST OUR
PRIORITIES IN 2013/14?
■ Completed the service redesign of the community health teams
■ Strengthened and improved the way we work with social care colleagues to enhance the neighbourhood model and reduce the overlap for patients between ourselves and social care
■ Joint health and social care assessment at the care co-ordination centre is in operation, so information is only provided once, and a patient can receive both health and social care support from one referral
■ 63 staff from community health teams completed the care lead training. The training will improve the way our staff co-ordinate patient care
■ Enhanced geriatric assessment clinics have begun and the Older Persons Assessment
Team is in place. The discharge planning teams are now part of CIS and work closely with both acute hospitals in planning safe and timely discharge of patients, as detailed in the above section
■ Embedded an operational management framework across all teams to help teams problem solve and take steps to improve efficiency
■ Assistant practitioner roles introduced within the teams. We continue to review the full potential of these roles
■ Following discussion with staff we are changing core hours of work to 8am to 6pm as staff felt that this would more appropriately meet patient need whilst maintaining safe levels of staffing.
WHAT DO WE WANT TO ACHIEVE IN
2014/15?
■ Implement a balanced scorecard across all teams to ensure quality information is reviewed alongside finance and performance data, and corrective action can be taken. This will also help to identify areas of excellent practice that we would want to share across the organisation
■ Roll out Comprehensive Geriatric Assessment across Suffolk
■ Continue and embed the medically fit and sub-acute projects in west Suffolk, and ideally to roll this out to the east of the county
■ Establish and agree a staffing model for our community teams that is based on competencies and patient need as well as activity levels
■ Agee and publish our staffing levels and data for optimal staffing levels for our hospitals and our community teams
78 SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

■ Continue to improve performance on response times and waiting times for services
■ Implement a second interface geriatrician role in the east of the county
■ Continue to contribute to the redesign of services around patients and across organisations working in a collaborative way focused on patient Improve the way we work with staff at all levels to involve frontline staff in the design and delivery of services to ensure they are clinically led
■ Develop the skills of our junior staff
HOW WILL WE MEASURE THIS?
■ Using the balanced scorecards to monitor performance at team and organisation level, the scorecard will provide a complete and easy to understand data set for team leads
■ Continue to monitor patient feedback and numbers of admissions to the acute hospital.
We would expect to see patients feeling better supported and more able to be independent in their own homes
■ Evaluation of the sub-acute model and the comprehensive geriatrician schemes will be completed by the CCG, we hope that they will continue and will be moved to a community-based model in the future rather than an acute hospital based model
■ Staffing levels will be calculated using a quality and activity based modelling process compliance with these will then be monitored using an electronic rostering system. Staffing levels will be monitored at leadership team and board level.
■ The interface geriatrician role is monitored via a steering group. Data is collected and reviewed, which includes patient experience, clinical outcomes and effectiveness of interventions, admissions avoided, efficacy of medication regimes and some patients are followed up via their GP or in an outpatient clinic
■ Redesigning services is part of a five - year plan, progress will be monitored through programme boards and local user involvement including the third sector and voluntary organisations
■ We will measure our staff involvement as part of our staff engagement programme.
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 79

INCREASING THE TIME STAFF SPEND
WITH PATIENTS THROUGH MOBILE
WORKING
Mobile working for clinicians is a key aspect for the future of the NHS, delivering services in the patients’ home effectively and efficiently.
Solutions are needed more than ever to enable clinicians to have access to the information they need at the point of care enabling patients to be involved in their healthcare choices with information available to support their care needs. Across the NHS, evaluation of the impact of mobile technology used by clinicians in the community can be significant. The technology has supported:
■ Increases in the number of patient visits per day
■ Increase in the amount of time spent with patients
■ Patients reported improved experience
■ Patients reported increased peace of mind and reduced anxieties
■ Clinicians reported significantly less wasted time between patient appointments
The importance of capturing accurate and realtime data at the point of care has been a key requirement within healthcare organisations for many years. SCH has recognised this and has already rolled out mobile solutions to across our services in the community. There have been benefits reported by clinical staff but this has not been universal. Generally the technology has not been user-friendly; a combination of connectivity issues and some lack of technical competence and confidence of clinicians in using devices has reduced expected benefits.
SCH continues to seek a solution which will deliver the benefits for both patients and clinicians. We are informed by our strategy to:
■ Support the transformation of community health services
■ Put the patient at the centre of care
■ Make the patient’s home the focus for care
■ Ensure that any technology provided to clinical staff is easy to use, efficient and reliable and usable without the need for technical knowledge
■ Training and support must be available to staff who are using mobile technology.
80 SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

We have invested in improving the IT infrastructure, the result of which will be that every member of staff has been issued with a laptop and has received training. In our search to find an appropriate solution we have been part of a national pilot evaluation of a new application which has been very successful with one of our specialist clinical teams.
During the evaluation period the “new” technology was very well received by clinicians and considered a vast improvement on the previous solution. Based on the success of the pilot evaluation we will roll out this new mobile solution during the summer and autumn of 2014.
We are ensuring that all staff receive appropriate support and we will be monitoring the benefits for patients and staff.
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 81

COMMUNITY HOSPITALS: TO IMPROVE
THE RECOGNITION AND MANAGEMENT
OF THE UNWELL PATIENT IN A
COMMUNITY HOSPITAL SETTING.
Older people admitted to community hospitals are often highly dependent and have a range of different chronic conditions. The management of deterioration in older patients can often be difficult to recognise and treat. This quality improvement aimed to develop a clinical early warning system appropriate to community hospital patients that enhances the awareness and management when a patient is becoming unwell.
HOW DID WE ACHIEVE AGAINST OUR
PRIORITIES IN 2013-2014?
Throughout the year we have been working to improve the recognition of the unwell and deteriorating patient in our community hospitals.
This has involved three areas of work:
1.
The identification of an appropriate early warning trigger tool
The tool needed a clear link to actions rather than just leaving staff with a high scoring patient. The tool needed to be relevant to community settings rather than an acute provider able to call on highly skilled support very quickly.
Having reviewed several options we realised that the national early warning score (NEWS) was appropriate and had all the aspects we identified for success.
2. The implementation of a hydration bundle;
■ One key aspect involved in patients’ deterioration is hydration.
■ Within a rehabilitation setting insisting on very close monitoring (recording input and output) of all our patients is not appropriate. We also felt it was unfair to ask staff to identify at risk patients without a structure to work with. To ensure staff were looking at every patient’s hydration needs and risks we introduced the GULP assessment. (See next page for definition)
■ Within our services it is important to maintain patient independence as much as possible. We are also very focused on patients returning to their home and resuming their normal patterns of living.
Because of this we adapted a tool for patients to monitor their own hydration status. This, in conjunction with an ‘am
I hydrated’ chart used in each inpatient unit, supports patients taking control of their own health.
82 SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

3.
Develop a communication tool;
■ As found in our review of early warning tools it is important to help staff understand what to do when a patient is identified as being at risk. In the community this usually means contacting someone who is at some distance away. This communication is taking place at a time of great stress and a framework helps staff ensure that what is needed is delivered.
■ We reviewed several structures and settled on the SBAR framework. This structure has been extensively tested, is concise and can be operationally used in many different formats.
Senior nursing staff within our four community hospitals are now trained to deliver these items and make them operational.
WHAT DO WE WANT TO ACHIEVE IN
2014/2015?
This quality initiative has not been fully realised in
2013/2014. We underestimated the time taken to consider appropriate tools and develop the training programme. For 2014/2015 we shall coordinate across our community hospitals to ensure delivery of the programme is on track and prioritised within the other quality improvement and compliance work.
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 83

GULP DEHYDRATION RISK SCREENING TOOL ASSESSMENT
PATIENT NAME: NHS NO: D.O.B
DATE / TIME
Gauge 24 hour fluid intake
Intake greater than 1600ml – 0
Unable to assess intake or
Intake between 1200 and 1600ml – 1
Intake less than 1200ml – 2
Urine colour (use urine colour chart)
Urine colour 1-3 – 0
Unable to assess urine colour – 1
Urine colour score 4 -8 - 2
Look for signs, symptoms and risk factors for dehydration
No signs of dehydration – 0
If any of the below reported: - 1
Repeated UTI’s
Frequent falls
Postural hypotension
Dizziness or light-headedness
Dry mouth, lips or eyes
Taking diuretics
Open or weeping wound
Hyperglycaemia
If any of the below reported: - 1
Drowsiness
Low blood pressure
Weak pulse
Sunken eyes
Increased confusion or sudden change in mental state
Diarrhoea and/or vomiting
Fever
PLAN Low risk = total score 0 Medium risk = total score 1-3 High risk = total score 4+
High/Medium/Low risk care plan to be followed (max = 7)
TOTAL SCORE
SIGNATURE
INITIALS
Care Plan – Low risk of harm from dehydration
Encourage service user to continue with current fluid intake
Place “Keeping Hydrated” leaflet in folder
Care Plan – Medium risk of harm from dehydration
Encourage service user to increase frequency or size of drinks – using “Keeping
Hydrated” leaflet for ideas
Ask patient to self-monitor urine colour and aim for urine colour
1-3
Care Plan – High risk of harm from dehydration
Ensure patient takes extra 4 x
250ml drinks per day (in addition to usual fluids and foods) by:
Encouraging extra 250ml drinks at red flag times
Discussing “Keeping
Hydrated” leaflet with patient and/or family and carers

AM I HYDRATED? URINE COLOUR CHART
1 2 3 4
This urine colour chart is a simple tool you can use to assess if you are drinking enough fluids throughout the day to stay hydrated.
If your urine matches the colours numbered 1,
2, or 3 you are hydrated.
If your urine matches the colours numbered 4 through 8 you are dehydrated and need to drink for more fluid.
BE AWARE!
If you are taking single vitamin supplements or a multivitamin supplement, some of the vitamins in the supplements can change the colour of your urine for a few hours, making it bright yellow or discoloured.
Drinking fizzy drinks and drinks with Caffeine will not effectively rehydrate you.
You should aim to drink at least 1.6 – 2 litres
(2.8 – 3.5 pints), around 8 glasses, of fluid per day to stay hydrated. Drinking sufficient amounts can contribute towards staying fit and healthy. Signs of dehydration can include: a dry mouth or lips, thirst, tiredness, headache, dry and loose skin, and dark coloured or strong smelling urine.
GOOD LEVELS OF HYDRATION IN
OLDER PEOPLE CAN HELP PREVENT OR
AID THE TREATMENT OF:
■ Pressure Ulcers
■ Low Blood Pressure
■ Urinary Infections
■ Constipation
■ Confusion
■ Falls
5 6 7 8
HYDRATION CHECKLIST
■ Do you feel thirsty? You may be already suffering from mild-moderate dehydration; thirst is often a late response to dehydration
■ Checking the colour of your urine is an easy way to assess your own hydration status: use the pee chart to score your urine 1-8 to see if you need to drink more.
■ Aging and illness can alter thirst response: as you get older, you may not feel thirsty when you become dehydrated. This is also common in people who have had a stroke or suffer from dementia.
■ Keep a close eye on your hydration status, especially in warmer conditions: during summer months when the weather is hot, or inside the home when central heating is on, the fluid you lose through sweating will be much higher.
■ You will sweat more if you are active: try drinking at 10-15 minute intervals during exercise to prevent dehydration.
■ If suffering from vomiting or diarrhoea, you need to replace the fluid lost to prevent dehydration. Oral re-hydration salts are available at your chemist.
■ If suffering from constipation, drinking more fluid will help soften stools and make them easier to pass.
■ Don’t worry about urinating during the night: try increasing your fluid intake earlier in the day. Aim to have a minimum of 600ml
(1.1 pints) of fluid before lunchtime.

TOP TIPS FOR HEALTHY HYDRATION
■ Try drinking fresh cool water: fruit juice, milk, tea and coffee can also be taken. Opt for water, drinks that are sugar-free or skimmed milk if you have diabetes or you are trying to lose weight.
■ Around 20% of our daily intake of fluid is contained within our food: if you find it difficult to increase the amount you drink, try opting for foods high in moisture such as fruits and vegetables as these are up to 90% water.
■ Semi-liquid foods count towards total fluid intake: try soups, sauces, jellies, ice lollies and ice cream to increase fluid intake further. Chose sugar-free alternatives if you are diabetic or trying to lose weight.
■ Nourishing drinks can also help increase calorie intake: try making milkshakes, smoothies or hot chocolate made with full cream or fortified milk, especially if you are not eating well and need to maintain your weight.
■ Avoid large amounts of caffeine and alcohol: these can make you pass more urine and increase your risk of dehydration. Consume no more than 4 caffeine containing drinks per day. If you chose to drink alcohol, do so within line of current government guidance.
■ Try drinking in between meals or after eating: avoid filling up on fluids before eating.
■ Try to fit your fluid intake around your daily routine: for example try having a full glass of water with medication(s), a glass of fruit juice after breakfast, a cup of tea midmorning, squash after lunch, a smoothie or milkshake mid-afternoon, a cup of coffee after your evening meal, a glass of milk after supper, and a hot chocolate drink before bedtime.
■ Tap water is safe to drink: filtering water will freshen the taste slightly however leaving water to stand can have the same affect.
Adding some ice or chilling water will help to remove any chlorine taste
Based on Water UK: Wise up on water! Review November
2012
Produced in conjunction with the Nutrition & Dietetic team at Bedford Hospital

SBAR REPORT TO PHYSICIAN ABOUT A CRITICAL SITUATION
S
B
A
R
SITUATION
I am calling about <patient name and location>
The patient’s code status is <code status>
The problem I am calling about is...
I have just assessed the patient personally:
Vital signs are: Blood pressure __ / __ Pulse __ Respiration __ and temperature __
I am concerned about the:
Blood pressure because it is __ over 200 or __ less than 100 __ or 30mmHg below usual.
Pulse because it is __ over 140 or __ less than 50.
Respiration because it is __ less than 5 or __ over 40.
Temperature because it is __ less than 96 or __ over 104.
BACKGROUND
The patient’s mental status is:
Alert and oriented to person place and time.
Confused and cooperative or non-cooperative
Agitated or combative
Lethargic but conversant and able to swallow
Stuporous and not talking clearly and possibly not able to swallow
Comatose. Eyes closed. Not responding to situation.
The skin is: Warm and dry, Pale, Mottled, Diaphoretic, Extremities are cold, Extremities are warm
The patient is not or is on oxygen.
The patient has been on __ (l/mm) or (%) oxygen for __ minutes (hours)
The oximeter is reading __ %
The oximeter does not detect a good pulse and is giving erratic readings.
ASSESSMENT
This is what I think the problem is: <say what you think is the problem>
The problem seems to be cardiac, infection, neurologic, respiratory...
I am not sure what the problem is but the patient is deteriorating.
The patient seems to be unstable and may get worse, we need to do something.
RECOMMENDATION
I suggest or request that you: <say what you think is the problem> transfer the patient to critical care come to see the patient at this time
Talk to the patient or family about code status
Ask the on-call family practice resident to see the patient now.
Ask for a consultant to see the patient now.
Are any tests needed:
Do you need any tests like CXR, ABG, EKG, CBC, or BMP? Others?
If the change in treatment is ordered then ask:
How often do you want vital signs?
How long to you expect this problem will last?
If the patient does not get better when would you want us to call again?
This SBAR tool was developed by Kaiser Permanente. Please feel free to use and reproduce these materials in the spirit of patient safety, and please retain this footer in the spirit of appropriate recognition.

To redesign the Falls Pathway – so that both falls prevention and falls and fragility fracture prevention continue to be a priority within SCH.
A key focus will be the management of falls and fragility fracture prevention in the year ahead.
We know that falls and falls-related injuries impact significantly on the quality of life for patients and their families. SCH is wants to make falls and fracture prevention everyone’s business.
HOW DID WE PERFORM IN 2013/2014?
We redesigned our clinical assessment tool so that every patient over 65 years old, who was referred to our community therapists, was routinely screened for their risk of falling. At initial assessment, patients said whether they had fallen in the last year and were asked about the frequency, context and characteristics of the fall(s). Even if patients had not fallen in the last year, the holistic assessment enabled our clinicians to assess for falls risk and ensure preventative action.
■ From June 2012 to March 2013 we routinely screened 5,047 people who attended our services for risk of falls.
■ From June 2012 to March 2013 we referred
587 people who were routinely screened for risk of falls on to their GP because of their blood pressure.
■ We funded 13 staff to complete Otago training – a type of exercise training used in rehabilitation to prevent falls.
■ In 2013/2014 we continued focussing our efforts on reducing falls and falls-related injuries in our community hospitals. We introduced a process called ‘intentional rounding’. The rounding helps our staff to organise the ward workload and ensure that all patients receive attention regularly. We provided additional equipment such as high/ low beds, and sensor mats for our most atrisk patients
Providing harm-free care continues to be the focus for all our staff and is kept on the agenda of the modern matrons’ meeting. We continue providing falls and bone health training for our inpatient staff.
SCH is introducing new roles into our community services to support the falls pathway. One of these roles is the Interface Geriatrician (IG). The
IG is a key role that can provide a consultant review for our patients, while they are in our care. Another role that is being developed is that of the falls champions.
88 SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

For those most at risk, we continue to provide one to one care. This has seen reductions in number of falls not only for the patient being supervised, but for other patients in the same area too. We have increased the level of activity for patients such as playing board games so that patients socialise more which helps prevent isolation and falls.
We looked in detail at the times in which patients were falling and were able to identify key periods where it may be beneficial to have additional staff. The average number of falls across our inpatient units was 38 per month for the first nine months of the year. By putting in additional staff the average number of falls for the last three months of the year fell to 29 per month.
Intentional rounding is a structured process where nurses on wards in acute and community hospitals and care home staff carry out regular checks with individual patients at set intervals, typically hourly. During these checks, they carry out scheduled or required tasks.
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 89

INPATIENT FALLS APRIL 2013 - MARCH 2014
10 20 30 40
27
29 APR 2013
14
41 MAY
25
9
20
24 JUN
9
33 JUL
25
13
39 AUG
29
12
50
46 SEP
31
13
41 OCT
23
10
9
39
22
22
25 DEC
23
27 JAN 2014
9
23 FEB
16
8
25
14
TOTAL NUMBERS FALLS
38 MAR
NO OF INDIVIDUAL
PATIENTS
60 70
67 NOV
80
NO INPATIENT FALLS
RESULTING IN HARM

WHAT DO WE WANT TO ACHIEVE IN
2014/2015?
SCH is working in partnership with the CCGs and other stakeholder organisations to further improve the falls pathway across the whole health and social care system. We will continue to be part of this redesign work and to deliver falls and fracture prevention and rehabilitation.
■ The harm-free CQUIN helps us identify ways in which we can continue to reduce the number of fallers in our inpatient community hospitals, and to reduce the harm that they suffer
■ The new role of the Interface Geriatrician offers comprehensive medical assessment and medication review to people that have fallen, that are known to our community services
■ Falls and bone health training for our staff, and how it is delivered, is being reviewed and updated
■ The role of the falls champions will be developed to ensure that expert advice and practical tips are available routinely to our inpatient units
■ Develop a digital platform for SCH staff to access useful information and guidance related to falls.
HOW WILL WE MONITOR PROGRESS?
The SCH Falls Working Group monitors progress and ensures that falls is part of our core business.
There will be a designated clinical lead for the
CQUIN who will be responsible for monitoring of the achievement against this CQUIN goal.
Progress will be monitored through our data collection systems. The Falls Prevention
Co-ordinators will be instrumental in supporting the CHTs in working to deliver this important quality improvement.
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 91

Mr D is a 71 year old male, referred to an inpatient unit for rehabilitation by the acute hospital, following a stroke which left him with significant left-sided weakness. He had poor sitting balance and was unable to stand without assistance of two staff and the use of standing equipment. He required a significant amount of help to assist with all activities of daily living.
The nursing and therapy team devised a joint interprofessional care plan with Mr D’s involvement, setting short and long-term goals. He participated and engaged fully with his treatment and his family were actively encouraged and participated in his rehabilitation. Mr D attended therapy exercise groups and participated in therapy most days in the gym. His therapy focused on sitting balance and weight transference and progressed to independent standing, transferring and mobilising with a quad stick with assistance.
Mr D returned home, where a therapist found that Mr D and his family are following therapy care plans. He is now mobile around his home with minimal support. Mr D continues to receive therapy at home from the community teams to progress his mobility and upper limb function.

West Suffolk Integrated Falls &
Fracture Liaison Service (WSIFFLS)
UPDATE OF ACHIEVEMENTS FOR
2013/2014
As prioritised by the West Suffolk CCG as part of their commitment to reduce hospital admissions and improve quality of life for older people, two integrated falls and fracture liaison specialist nurses (IFFLS) were appointed to assist with the development of an integrated service working between primary, secondary and community services.
The WS IFFLS ensures that all fragility fracture patients over the age of 75 (excluding high trauma and road traffic accident victims) receive a falls screen and osteoporosis assessment within primary care working to agreed clinical pathways.
Integrating the WS IFFLS within primary and secondary care ensures that individual patients receive a targeted assessment with appropriate treatment and intervention.
The WS IFFLS specialist nurses have successfully established the following which firmly embeds an integrated approach.
1.
Patient identification
2.
Establishment of clinical pathways
3.
Ensuring patients are compliant with osteoporosis medication long term
4.
Ensuring communication and integration across acute, community and primary care
DURING THE PAST YEAR THE WSIFFLS
SPECIALIST NURSES HAVE WORKED
WITH COLLEAGUES TO ADDRESS
AND DEVELOP:
1.
Joint working with the CHTs and for patients that have been discharged to them requiring rehabilitation to enhance staff’s falls and fracture assessment skills. These links have worked well and the teams now identify patients with previous fractures and refer to the WSIFFLS for a bone health assessment
2.
Embedding the Stage 2 Falls and Fracture
Guide within the community assessment and ensuring evidence of on-going clinical intervention
3.
Ongoing work with the GP practices around falls and osteoporosis. The specialist nurses have presented at ‘Learning Lunches’ coordinated by the WSCCG, are booked to attend planned primary care locality meetings and are supporting established primary care
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 93

MDT meetings where fragility fracture patients can be discussed
4.
The specialist nurses continue to support a growing National Osteoporosis Society
(NOS) support group and attend each meeting to offer clinical support and advice
5.
During the latter part of 2013, integrated working between secondary care and primary care has established a pathway to offer SC
Denosumab treatments in the community so that patients with complex needs can have osteoporosis treatments within their own home. This is almost complete.
6.
Work continues with Age UK to support and guide the development of their falls prevention exercise co-ordinator whose aim is to increase the provision of Otago falls prevention exercises in the community.
THE FUTURE:
■ To maintain the service and continue to assess all patients aged over 50 who have sustained a fragility fracture
■ To support the WSCCG to embed further falls and fragility fracture work within primary care
■ To support SCH in delivering a structured approach to falls and fracture prevention training for clinicians
■ To work with the NOS to establish some educational programmes for patients newly diagnosed with osteoporosis
■ To support further business case development for continued funding, to build on and develop further the falls prevention exercise co-ordinator role.
94 SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

TO CONTINUE IMPROVING THE
QUALITY OF PATIENT AND CARER
EXPERIENCE BY IMPROVING SERVICE
USER ENGAGEMENT AND SUPPORT
FOR CARERS.
Providing the best possible experience to our patients continues to be a central priority for
Suffolk Community Healthcare and to make sure we do this we listen to what our patients and their families think about our services.
HOW DID WE PERFORM IN 2013/2014?
The appointment of a Patient Experience
Manager has improved engagement with clinical and non-clinical teams in developing the patient experience agenda, ensuring patient experience is
“everybody’s business” and that we all contribute to ensuring patients, families and carers receive a quality service. Our Patient Experience Group, comprised of senior staff from across SCH, meets regularly to assess all the feedback we receive from patients – via complaints, compliments and surveys. A representative from Healthwatch
Suffolk has recently joined this group to provide external scrutiny to our patient experience work.
The following section summarises the key areas of our patient experience work during 2013/14
PATIENT SURVEYS
The past year has seen the beginning of the roll-out of a new, more comprehensive, patient survey. Whilst the majority of our surveys have been purely paper based, during 2013/14 we piloted a system of telephone surveys to provide patients with the opportunity to talk to someone directly about their experience with us.
Each survey is tailored to the different services we provide with questions covering the following areas:
■ The Friends and Family Test (FFT)
■ Information and involvement – evaluating how well patients have been involved in decisions about their care and the information provided by our staff
■ Health, wellbeing and support – evaluating the impact our service has had on patients’ health and wellbeing
■ Staff – evaluating the skills, knowledge and behaviours of our staff from a patient’s perspective.
The results from these surveys provide SCH with a key insight into the quality of our services.
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 95

SUMMARY OF RESULTS FROM THE PATIENT SURVEYS
97% 95% 93%
1639 patients would recommend our service to family and friends
1572 patients agreed that their treatment/care plan was explained in a way they could understand
1541 patients agreed that they were involved as much as they wanted to be in decisions about their care/treatment
780
Patients agreed that they felt the care/ treatment they have been given has had a positive effect on their wellbeing
90% 86%
746
Patients agreed that they feel that the care/ treatment they have been given has helped them better manage their condition
97% 1598 Patients agreed that have complete confidence in the staff treating/caring for them
96%
94%
1571 Patients agreed that staff made them feel comfortable about asking important questions
828 Patients agreed that the staff made them feel that they really cared about them and their condition
163 Patients rated the service they had received from the
Care Coordination Centre as ‘good’ or above
87%

FRIENDS AND FAMILY TEST (FFT)
The FFT is a single question, which asks patients whether they would recommend the NHS service they have received to friends and family who need similar treatment or care. The score is calculated using the proportion of patients who would be extremely likely to recommend the service minus those who would be unlikely or extremely likely to recommend. The score can run from -100 to +100 with a positive score indicating a higher proportion of service users who would recommend the service. Initially introduced to acute health services in 2013, the test is due to become mandated to community health services by the end of 2014.
The FFT question has been rolled out to a majority of our services during 2013/14 and forms a central part of our patient surveys. The table below shows the test scores across our key service areas during 2013/14.
COMMUNITY HOSPITALS
Q1 +71
Q2 +67
Q3 +69
Q4 +70
Year +69
MIU FELIXSTOWE
Q1 +88
Q2 +89
Q3 +90
Q4 +93
Year +90
COMMUNITY HEALTH TEAMS
Q1
Q2
Q3 +73
Q4 +81
Year +77
SERVICES PROVIDED TO PATIENTS
WITH A LONG TERM CONDITION
Q1 +71
Q2 +77
Q3 +69
Q4 +85
Year +76
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 97

We have already made significant progress introducing Friends and Family Test across our services. We will continue this work across the following areas:
■ Roll out of the FFT to our staff
■ Rolling out the FFT to all of our services
■ Increasing the response rate to the FFT question in our community hospitals and minor injuries unit
■ Working to reduce to the number of negative responses in our community hospitals and minor injuries unit.
OUR AMBITIONS FOR 2014/15
The continuous improvement of patient and carer experience and to build upon the work we have carried out in 2013/14. As such, our patient experience work will focus on the following workstreams during 2014/15:
PATIENT VOICES – COMMUNITY BASED
SERVICES
Building on the innovative and successful work we carried out in our community hospitals, we will be rolling out our patient voices work across our community and specialist services during
2013/4.
The majority of the patients seen in their own homes are elderly, increasingly very elderly and often housebound. This can make it difficult for them to represent themselves at public forums
98 and engagement groups and reluctant to take part in telephone surveys or complete survey forms. Our Patient Voices work during 2014/15 will seek to capture the views of these patients to drive forward improvements within these services.
SOUTH ESSEX PARTNERSHIP
UNIVERSITY FOUNDATION TRUST
(SEPT) SERVICES
In Quarter 1 of 2013/14, SEPT introduced a new, unified patient survey, drawing together the NHS
Friends and Family Test and a further series of questions around key areas we identified with people who use our services. Surveys are coded so that feedback can be provided at team level; teams now receive scores and comments via the
FFT as well as additional scores against the areas that matter to our patients.
The score for 2013/14 for SCH services in SEPT was 71. As the FFT was only rolled out in Suffolk in 2013/14, there is no score from 2012/13 against which to benchmark progress.
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

PATIENT FRIENDS AND FAMILY TEST OVERALL SCORE AND AVERAGE SCORE 2013/14
Locality/
Service
Suffolk
Community
Health Services
Friends and Family Test
Score 2012/13
Max = 100
Friends and Family Test
Score 2013/14
Max = 100
Average score given by respondents 2013/14
Max = 10
Not applicable as not undertaken in 2012/13
71 9.0
NUMBER OF RESPONSES AND PROPORTION FOR EACH SCORE (10-0) FOR 2013/14
Locality/
Service
Score
Suffolk
Community
Health Services
Number of responses
2013/14
N/A
888
Percentage of respondents selecting each score 2013/14
10 = most likely to recommend service
1 = least likely to recooment service
10 9 8 7 6 5 4 3 2 1
61 17 12 4 1 1 0 0 0 1
10 9 8 7
61% 17% 12% 4%
0
3
6 5 4 3
1% 1% 0% 0%
2 1
0% 1%
0
3%
Percentage of respondents selecting each score
2013/14
10 = most likely to recommend service
1 = least likely to recommend service

DEMENTIA CARE
The number of people with dementia in Suffolk is expected to rise by 33% to approximately 14,400 by 2021. There are around 6,000 undiagnosed people living with dementia in Suffolk. On the one hand people affected by the condition tell us they are fearful of seeking a diagnosis. Yet on the other hand a timely diagnosis opens the door to treatment, information and support to enable patients and those closest to them to maintain independence, wellbeing and choice for as long as is possible.
Suffolk Community Healthcare has undertaken considerable work in the past year to further advance the priority of improving the patient and carer experience for people living with dementia.
Keeping up to date with best practice: to ensure new techniques, technologies and tools are promoted throughout the organisation and beyond.
Workforce development opportunities that focus on person-centred care, adapting living environments and working in partnership with others to ensure patients and their carers get connected to the right services and people.
Ninety-five per cent of our staff have undergone training in dementia care to ensure our clinical, admin and facilities services reflect a whole team approach to patients and those closet to them.
Adapting inpatient units to reflect more dementia friendly environments by easing decisionmaking, reducing agitation, distress, encouraging independence, social interaction and safety,
100 screening, assessing and referring inpatients for, timely, clinical cognitive assessment for those with dementia like symptoms.
Reviewing the patient’s psychotropic medication with GP and/or specialist.
Carrying out carers feedback surveys to improve patient experience.
Assessment for assistive technologies on a needs lead basis to ensure safety and comfort whilst maintaining freedom of movement and choice.
WHAT DO WE WANT TO ACHIEVE IN
2014/2015?
The increasing number of patients with complex physical and cognitive disabilities can be better supported to live in the community if offered more help to maximising independence, success and productivity.
Dementia care: maximising enablement, success and productivity SCH’s new pilot programme for
April 14 to March 15 enables us to train staff to support over 400 patients and carers to access a range of services to help with physical and memory problems.
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

PRACTICAL EXAMPLES OF OUR
DEMENTIA SUPPORT
CAN THE COLOUR OF A PLATE REALLY
HELP PATIENTS WITH DEMENTIA TO
EAT AND DRINK MORE?
SUFFOLK COMMUNITY HEALTHCARE
BELIEVES SO
Research shows that bold coloured crockery helps patients to eat and drink more. The striking colours provide a frame to help the patients eat and drink by increasing the contrast between food, drink and the crockery. Patients can see the food more clearly, resulting in eating more and feeling more confident about eating thus improving nutrition, dignity and socialisation.
An important part of our “small makes the biggest difference” dementia care ethos we have bought new crockery for our inpatient units and encourage all the housekeeping staff to look at others ways the dining areas can be improved to support people with Dementia with eating and drinking.
Putting this on a patient’s door helped her remember her shopping list. She had been walking to the shop, going home again to get her list and finding herself too tired to return to the shop. This meant she was not buying food. This label not only helped her to stay independent but also prompted the family to develop other signs as she became more forgetful. Her grandchildren began to feel much more involved in helping her because they could make the signs once they knew the colours to use and text size that was most helpful.
Signs were put in this patient’s living room and kitchen where she frequently fell over when she forgot to use her walking stick. It is has helped her to remember her walking stick and has reduced her falls.
We have also bought large clocks for our community hospitals giving all patients access to day, date and time.
The feedback from patients, relatives and staff has been overwhelming.
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 101

Together with our quality improvement priorities
SCH has continued to collect, monitor, and report as appropriate, numerous quality indicators across the organisation. Close monitoring of this information means we have a good understanding of any issues that occur and timely action can be taken to correct any variances. It also helps us to identify areas of good practice that can be shared across the organisation and where individual staff have performed well.
The following table includes a small number of some of our key performance indicators that are measured on a regular basis.
102 SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

SUMMARY PERFORMANCE INDICATORS
Face to Face
Activity
All Services
Apr - Mar
2013/14 Planned
Activity
Oct - Mar 2013/14
Actual Activity
510,770 487,521
Over/(Under)
Activity
(23,249)
Local Health Community Team - Response Times to new referrals
2 hours
4 hours
72 hours
18 weeks
Target
100%
>95%
>95%
>95%
Delayed Transfer of Care (DTOC)
All Services
Pledge 2 - 18wk RTT for non cons led services
NHS Number of Outpatients
Percentage
-4.6%
Mar - 14
100%
99.3%
98.0%
97.7%
12 mth Target
<79%
Compliant
100%
12 mth Actual
120
Non Compliant
100%
18 Week RTT
Number of Services
Diagnostics
Audiology
Minor Injuries Unit (MIU)
Patients seen within 4hrs
DNAs
All Services
Length of Stay
Average Length of Stay
Compliant
15
Compliant
2
Target
>98%
Target
<6%
Month 12
23.7
Non Compliant
0
Non Compliant
0
2013/14
100%
Month 12
1.86%
2013/14 Average
24.6

OUTPATIENT CARE IN THE CHTS
SCH has a key role in the local health economy bridging the gap between secondary care in hospitals and primary care in the GP surgeries.
Our community healthcare teams have three main response time targets. These targets require a response from our services within either two hours, four hours or 72 hours and over 72 hours
(but within 18 weeks). These response times ensure we provide the required care at the right time and in the right setting, i.e the patient’s home. During 2013/14 the response rates to these targets appeared to decrease (87.61% for four hour and 87.09% for 72 hour), meaning the reports appeared to show that SCH was failing the required target of 95% of referrals being responded to within the correct timeframe.
Investigation showed that several factors, rather than actual service delivery, were adversely affecting the reporting: the reorganisation of the teams in March-May, the introduction of the CCC, network coverage and the reporting system itself. After several months of working on these issues response times have significantly improved and are now above 97% again.
PATIENT CARE IN OUR SPECIALIST
SERVICES
In 2013/14 SCH received 8,792 referrals to our consultant led and non-consultant led specialist services. SCH treated 8,283 (94.2%) of these patients within 18 weeks of referral and 5.7%
(503 patients) of our patients chose a later appointment, leaving only 7 (0.01%) patients out of the 8,792 referrals that were treated outside the 18-week target.
104
INPATIENT CARE IN OUR COMMUNITY
HOSPITALS
Our length of stay (LoS) in our community hospitals and commissioned beds has reduced by 2.2 days in the last 12 months from 26.3 to
24.1 days despite an increase in delayed transfers of care (DToC). In 2013/14 122 patients were identified as medically fit but unable to transfer out of our beds due to delays. 57% (70) of our
DToCs are attributable to social care delays and only 9% (11 patients) of the total number of delays were due to patients awaiting NHS assessments, domiciliary packages or community equipment, which are provided by SCH. All other delays were not within SCH’s control or are dependent on other organisations. SCH is continuing to work on improving discharge planning processes, both internally and with other organisations including working with
Ipswich Hospital Trust on a new direction of choice policy for patients.
MINOR INJURIES UNIT
At the Minor Injuries Unit in Felixstowe all 5,874
(100%) patients were discharged or transferred within four hours of arrival. The national target for MIU and A & E departments is 98% and SCH has continued to excel in providing timely care
100% of the time in 2013/14.
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

ADMISSIONS TO THE COMMUNITY HOSPITALS (OVER THE LAST 6 MONTHS)
20
Number of Admissions
40 60 80 100 120
OCT 2013
NOV
DEC
JAN 2014
FEB
MAR
LENGTH OF STAY (OVER THE LAST 6 MONTHS)
5 10
Number of Days
15 20 25 30
OCT
SEP
NOV
DEC
FEB
JAN
500
400
300
MIU ATTENDANCES
800
700
600
200
100
MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB

SEPT SERVICES – SUMMARY OF
PERFORMANCE INDICATORS
A number of performance and quality indicators are monitored by Serco on a monthly basis for the services provided by SEPT. This enables timely identification of areas of good practice as well as any performance requiring improvement.
Actions are agreed where necessary to ensure that services continue to be of the highest quality.
Excellent progress has been made this year in terms of performance against quality indicators, including:
■ The 85% target for 97% of respondents to patient surveys rating the service as “good or better” has been consistently met, with
97.5% of responders allocating these ratings in Q3 and Q4.
■ A new patient survey has been introduced for
Suffolk services (as part of a Trust-wide roll out of a unified patient survey). The results for Suffolk services are excellent and those for Q4 are as follows (see separate section above on FFT results):
■ There has been excellent performance against indicators relating to care planning and discharge summaries
■ 18 week from referral to treatment targets have been met consistently
■ 100% of staff have completed training relating to safeguarding
■ All complaints have been responded to within agreed timescales
■ There have been no ‘never events’ / serious incidents and a small number of patient safety related incidents, all of which have resulted in either low or no harm
■ SEPT received excellent results from the
NHS national Staff Survey in 2013.
106 SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

Q4 - 371 RESPONSES (AVERAGE SCORE OUT OF 10)
WERE YOU LISTENED TO?
DID YOU UNDERSTAND WHAT WAS SAID?
WERE THE STAFF KIND AND CARING?
DID YOU HAVE CONFIDENCE IN THE STAFF?
WERE YOU TREATED WITH DIGNITY AND RESPECT?
WERE YOU GIVEN ENOUGH INFO?
WERE YOU HAPPY WITH APPT TIMINGS?
WAS THE CLINICAL SETTING COMFORTABLE?
WAS THE CLINICAL SETTING CLEAN?
9.4
9.1
9.6
9.7
9.0
9.3
9.3
9.4
9.6

PATIENT SAFETY
The National Patient Safety Alert System
(NPSAS) supports and promotes high levels of incident reporting as being viewed as a positive organisational indicator of good practice, since those with an open culture are more likely to have established processes to learn from these events.
policy has been promoted across all services and has become established as good practice to ensure the organisation meets its obligation to service users, carers, relatives and the public by being open and honest about any mistakes that are made in the way we care for and treat our service users.
The following indicators are the measures the organisation has chosen to reflect patient safety across SCH.
Keeping patients safe remains the highest priority for Suffolk Community Healthcare. It is important not only that services are as safe as they can be, but that we demonstrate and share this amongst ourselves, our partners, our patients and carers and the general public.
The following section highlights the indicators for patient safety across SCH. It will review the achievements against the patient safety priority set for 2013/2014 and compares with the six- month period reported last year.
We encourage all staff to report any untoward events as part of our open and honest culture and aim to embed shared learning. Our being open
108 SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

INDICATORS FOR PATIENT SAFETY
Indicator
Number of mrsa bacteraemia cases
Number of c diff cases occuring 72 hours after admission into inpatient facilities
Number of inpatient falls resulting in severe harm or death
Number of pressure ulcers (grade 2 and above) developing 72 hours after admission into sch care
Inpatient
Community
Number of medication incidents
No harm
Low harm
Moderate harm
Severe harm
Death
The number of serious incidents requiring investigation
Number of incidents that would previously have been nrls (national reporting & learning system) reportable
Number of incidents that would previously not have been nrls reportable
Total number of incidents
Target
2013/14
0
3
0
1
0
48
4
30
120
54
0
33
944
3137
4081
Total
2013/14
0
6
5
93
Compared to last year

The complexities of modern healthcare mean that things may occasionally go wrong despite our having the relevant processes and procedures in place. Suffolk Community Healthcare follows appropriate policies in order to identify any failings or weaknesses and then ensure that investigation and learning from incidents or complaints takes place. Incident reporting was promoted during the organisational developments over the past year and the increase in number of events reported reflected staff highlighting both clinical and non-clinical issues that were recognised during the transformation of community care working and through increased staff awareness in reporting and sharing concerns from both within and outside the organisation such as safeguarding.
The risk and patient safety team review all clinical incidents and assess both the details and the impact of the incident as well as the significance and severity of the issues identified. With the support of local management this ensures that the correct level of investigation is undertaken, action completed and learning shared across the organisation.
All Serious Incidents (SIs) are required to have a Root Cause Analysis (RCA) investigation undertaken. An RCA investigation encourages the question “Why?” to be asked and learning opportunities to be identified. It allows us to identify the key issues and causes behind an untoward event that may have occurred, enabling us to understand the root cause/s of the problem. The cause of a problem may often prompt further questions, the real key being to avoid assumptions and to encourage staff to ‘drill
110 down’ to the real root cause. RCA uses a specific set of steps with associated tools to help find the primary cause of the problem so that we can:
■ Determine what happened
■ Decide on what to do to reduce the likelihood that it will happen again.
Our reporting framework has been developed to ensure that agreed actions and lessons learnt from incidents, RCAs, complaints and claims are disseminated across the organisation. A summary report of key elements is presented to the
Compliance Committee enabling organisational wide sharing and learning is reflected in the monthly Take Care Take Note bulletin and summarised learning reports.
All staff throughout the organisation receive
Take Care Take Note which includes relevant national patient safety updates. In addition each service area produces a risk register which is reviewed on a monthly basis. A risk register is a management tool that enables the organisation to understand its current significant risks. It holds not only risk information but also the control measures and local actions needed to reduce these risks. Risks are identified through a number of sources including incidents, complaints, audit reports and risk assessments.
All incidents are reviewed and further investigated as appropriate. Details are forwarded to senior managers and discussed within governance meetings. The highest risks are considered and agreed by the Compliance Committee and included in the organisational risk register. This
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

in turn is reported to, and reviewed by, the
Leadership Team.
SERIOUS INCIDENTS
The following table identifies the SIs reported between April 2013- March 2014.
5 10 15
Pressure Ulcers Grade 3 and 4
20 25
Inpatient Fall Resulting in Harm
Infection Control
Medication
Unexplained Death
RCAs inevitably result in actions for changing practice or recognising where excellent care and clinical judgment has taken place. Some examples of these actions are as follows:
■ Patients declining pressure ulcer equipment and advice resulting in a pressure ulcer: An extensive flow chart was developed which supported staff in exploring every avenue to ensure the patient had every opportunity to engage with our care. This resulted in a reduction of non-concordant incidents and increased the awareness and knowledge of staff.
■ There is a significant increase in referrals for drug administration which can see teams having up to 15 patients at a time requiring daily visits. This has led to visits being omitted and drug doses missed. Following an RCA, the team in question put up a drug administration notice board and all visits are listed and checked daily to ensure the visits are allocated and the drug regime remains correct. This action has been replicated by several teams across our services.
■ The RCA of inpatient falls demonstrated the challenges faced by clinical staff in supporting patients admitted on multiple medication such as those being treated for Parkinson’s disease and also those with dementia. The increasing numbers of complex patients admitted to our care have stimulated analysis of inpatient workforce and developments with medical cover support in the units which has offered greater continuity and best care.
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 111

NEVER EVENTS
Never Events are serious, largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented. Never Event incidents identified by the Department of Health in the publication
The never events list: 2013/14 update include clearly defined processes and procedures to follow to ensure these incidents should never happen. SCH’s local review and identification of potential risks, and the subsequent assurance that preventative measures area in place for those applicable to our services, has ensured that no Never Events have occurred locally during
2013/14.
MEDICATION INCIDENTS
Reported medication incidents include both those errors and/or administration omissions by SCH staff but also situations where patients received into our care may have unclear prescriptions or stock to enable nursing staff to maintain the care required. Those incidents resulting in moderate’ harm to the patient included two controlled drug and two insulin events. All were investigated and where further support and training was required this was provided. Controlled drug events involved six of the 15 low harm events but included where prescriptions may have been unclear, supply of medication delayed, stock count discrepancies as well as administration and documentation errors. Learning from these events has been captured and cascaded to clinical teams via the risk management Take Care Take
Note bulletin.
112 SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

MEDICATION INCIDENTS BY SEVERITY OF PATIENT HARM
2 4 6
Number of Reported Incidents
8 10 12
APR
MAY
14 16 18
JUN
JUL
OCT
AUG
SEP
NOV
DEC
JAN
FEB
MAR
NO HARM
LOW HARM
MODERATE HARM

NATIONAL SAFETY ALERTS
Warnings distributed by the Department of Health’s Clinical Alerting System include concerns regarding specific medical devices, medications, estates issues and Chief Medical
Officer concerns that require local review and action if appropriate. All responses have been submitted to the DofH within the required time scales following the completion of appropriate local actions. The National Patient Safety service will from 2014 monitor organisations’ compliance against these publications.
COMPLAINTS AND COMPLIMENTS
COMPLAINTS
Complaints are an important part of the learning and improving cycle. SCH recognises the need to ensure all concerns and complaints are properly investigated and responded to promptly, with action taken swiftly to bring about improvements where necessary.
During 2013/14, we received 65 formal complaints compared with 25 received during the previous year. The table and graph below show the formal complaints received by month during 2013/14 compared with the previous year.
This increase in formal complaints also resulted in an increase in the number of responses that were responded to outside of the 25 working day limit.
Where change is identified following the investigation into a complaint, we make sure this is implemented as swiftly as possible and that
114 any learning is shared across the organisation where necessary. For example, toward the end of 2013 we received a significant number of complaints about the service provided by our contractor responsible for wheelchair repairs.
Our patient experience manager worked closely with the contractors’ senior staff to ensure the improvements that were required as a result of these complaints. Although the formal complaints about this service has reduced, we are not complacent>In partnership with
Healthwatch Suffolk we will be undertaking a survey of patients who have used the repair service to ensure these actions have improved the experience for patients.
We have worked hard to improve the way we manage the complaints we receive. Our priority for the first part of 2014/15 will be the completion of a thorough review of our complaints procedure, using the standards for good complaints handling developed by the
Patients Association as a benchmark. This will help us to ensure our complaints process works effectively for patients and carers.
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

FORMAL COMPLAINTS RECEIVED PER MONTH - 2013/14
2013/14
2012/13
2011/12
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Total
3 0 6 1 4 7 5 11 8 6 8 6 65
3
3
3
3
1
0
2
1
2
1
3
2
2
1
0
1
1
2
1
2
3
4
4
2
25
22
TOTAL FORMAL COMPLAINTS RECEIVED BY MONTH - YEAR ON YEAR COMPARISON
1 2 3 4 5 6 7 8 9 10 11
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
JAN
FEB
MAR
2012/2013
2013/2014

COMPLAINTS BY SERVICE AREA - 2013/14
2 4 6 8
CIS
Community Equipment Service
SEPT - Podiatry
SEPT - Paediatrics
CCC
Continence
MIU - Felixstowe
Phlebotomy
10 12 14 16 18 20
Community Health Team
Wheelchair Service
Community Hospital - Inpatient
COMPLAINTS BY SUBJECT - 2013/14
2 4 6 8 10 12 14 16 18 20
Aids and appliances, equipment, premises (including access)
All aspects of clinical treatment
Attitude of staff
Appointments, delay/cancellation (outpatient)
Communication / information to patients (written and oral)
Admissions, discharge and transfer arrangements
Patients property and expenses

Wheelchair Service
Examples of learning from complaints received:
■ To improve the community hospital discharge process so patients and families are more actively engaged in the process (this arose from a complaint that although the patient was well enough to be discharged, the family felt they had not been involved with the process and were unaware of the aftercare plan nor was there family information available.)
■ Increasing support to patients who require help at mealtimes in the community hospitals (this arose from a complaint from a family member who stated that she found the patient’s meal untouched on several occasions)
■ Improving the way new referrals are managed and monitored by each CHT (a theme following implementation of mobile working and lack of knowledge and competence with working with new processes and systems).
■ Improving the experience for patients who use the wheelchair repair service, including providing training to call centre staff to improve the way calls are handled; putting clear processes in place that mean patients are kept regularly updated with regards to their repair when this involves the ordering of a new/replacement part. This was a common theme from a number of wheelchair complaints.
COMPLIMENTS
We received a total of 263 compliments during
2013/14. All compliments are collated and a selection is posted on our staff intranet site.
We understand the importance of recognising outstanding care delivered by our staff and we will be developing a more formalised staff recognition scheme during the coming year.
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 117

“Staff were very good, if I had any questions they were there to answer. The staff were also very supportive when I was crying and emotional.”
“The pace of my recovery has accelerated because of the outstanding support I have had and continue to have from the Suffolk
Community Healthcare staff. “
“Many thanks for all you have done to support Dad and us… he has been very content whilst in your care.”
“Thank you, you are all wonderful.
So kind, compassionate and caring.
Nobody could expect you to do more. Thank you for your endless patience and caring.”
“We thought the care and staff were absolutely amazing. All the staff were happy with a lovely attitude towards our mum – very positive.”
“Thank you so much for the lovely way you have looked after [patient] these past few months. You have been great.”
“A thank you does not seem enough for all you have done for me.”
“Thank you for all your kindness.
You have really made my way of life more easy and comfortable.”
“I wanted to thank you for all the help and guidance you had shown mum. She was very fond of you and enjoyed seeing you at her appointments.”
“I am writing to express my gratitude to the Community Stoma
Nurse Team from Ipswich… Your team were a great comfort and support to me at a time when I most needed help. I just wish to say a huge thank you to them and let you know at Serco and their NHS managers what a brilliant team of nurses you have working for you.”

“Staff were all very helpful and if I asked them a question they would try to answer it.”
“Just a quick note to say thank you for doing such a splendid job in looking after my mother whom was with you for a few weeks in
December and January. Your care was of a very high standard and she was always treated with dignity and respect.”
“In my 3 visits I was attended to by
3 different nurses. Each nurse was professional, thorough, attentive and caring. From reception to treatment was a pleasant experience every time.”
“I am writing to thank you for all your care, attention and understanding with regard to my mother over the past few weeks.
Both my mother and I were highly impressed by your professional attitude to everything. In addition, your kindness and patience made the whole situation so much easier to deal with. You are a credit to your profession and to the NHS.”
“The support we received from the staff was super.”
“For a long period of time you have cared for my husband who sadly died last Saturday… I would just like to say how grateful I am for all the care and attention you gave him… He always looked forward to your visits.”
“At a time when I was recovering from an emergency operation, your team were a great comfort and support to me at a time when
I needed help. I just wish to say a huge thank you to them and let you know what a brilliant team of nurses you have working for you.”
“I just wanted to say a very sincere
‘thank you’ for all the help you gave my mother before she died.
The care you gave her and me in helping me to look after her was so very much appreciated. It was so important to Mum that she remained at home and I wouldn’t have been able to do that without your help. The service you provide is vital – you do an excellent job!”

SEPT SERVICES
COMPLAINTS:
A total of five complaints were received for services in Suffolk during 2013/14. This constitutes 0.04 complaints per 1,000 patient contacts. One remains open at year end but is within timescale.
The complaints received related to the following services:
■ Speech and language therapy
■ Child and family psychological therapies
■ Podiatry
■ Podiatric surgery
■ Paediatrician
Of the four closed complaints, all were responded to within agreed timescales. Two were partially upheld and two were not upheld.
LEARNING / ACTIONS TAKEN AS A
RESULT OF COMPLAINTS:
Two actions were recorded as arising from complaints during this period:
■ The paediatric team are working with commissioners and Child and Adolescent
Mental Health Services (CAMHS) to support the development of a pathway to support children and young people above the age of
11. The investigator reflected that there are a number of gaps in commissioned pathways for psychology for children and young people in special schools - this has been proactively raised with commissioners recently and is currently under discussion.
■ In response to concerns about delays in podiatry appointments and notification, some temporary administrative and clinical cover has been put in place and more support is currently being arranged.
COMPLIMENTS:
A total of 266 compliments were received during
2013/14 (an increase from 71 in 2012/13). This constitutes 2.03 compliments per 1,000 contacts.
120 SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

VULNERABLE PEOPLE
Suffolk Community Healthcare wants all adult patients protected and safeguarded from abuse and/or neglect in line with national standards. To achieve this:
SCH ensures all staff are offered basic awareness training in safeguarding adults. The training is offered via face to face workshops and/or eLearning and where necessary one to one mentoring.
99% of staff have completed training.
The named safeguarding lead works alongside clinicians to ensure the organisation acts on any concerns to ensure situations of concern are appropriately assessed and investigated.
SCH works in partnership with the county council’s Adult Community Services and our colleagues in other health care environments to ensure we reflect an integrated approach by communicating and liaising as appropriate to contribute to the safety of vulnerable people. We are active participants of the local Safeguarding
Board, regional safeguarding forum and the countywide health subgroup.
SCH has a safeguarding vulnerable adults action plan in place monitored through the SCH
Safeguarding Steering Group.
KEY PRIORITY FOR THE COMING YEAR
■ To audit SCH safeguarding policies, procedures, structures and safeguarding pathways to ensure we can identify our strengths and areas for development around implementing the Health and Social Care Act
2012. An important piece of legislation which will provide a clear framework to protect vulnerable adults at risk of abuse or neglect.
Quote from staff member
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 121

SAFEGUARDING CHILDREN
Safeguarding children has been very much in the public eye over the past 12 months with several high profile cases. SCH has kept abreast of these national changes to ensure our policies and procedures are appropriate to safeguard the children and young people that come into contact with our services. Locally SCH continues to work in partnership with other agencies and has remained an active member of the Local
Safeguarding Children Board over the past year.
The requirement of organisations to have robust processes was clearly outlined by Lord Laming’s review into Child Protection Procedures (2009) and the Care Quality Commission report reviewing Safeguarding within the NHS (2009).
The Care Quality Commission requires health organisations to take reasonable steps to ensure that commissioned services are compliant with healthcare standards relating to arrangements to
Safeguard and promote the welfare of children across the following areas:
Arrangements have been made to safeguard children under Section 11 of the Children Act
2004 having regard to Statutory Guidance on making arrangements to safeguard and promote the welfare of children under section 11 of the
Children Act 2004
Works with partners to protect children and participate in reviews as set out in
Working Together to Safeguard Children (HM
Government, 2006)
Agreed systems, standards and protocols are in place about sharing information about a child and their family both within the organisation and with outside agencies, having regard to statutory guidance on making arrangements to safeguard and promote the welfare of children under section 11 of the Children Act 2004.
SCH is highly committed to ensuring staff are properly trained and supported at an appropriate level to protect and safeguard children from abuse.
During this year this support was provided up until June 2013 by the named nurse safeguarding children service via Suffolk County Council. With
SCH services transferring to a new provider partnership in October 2012 SCH agreed to enhance their named nurse children’s service provision through the employment of a children’s safeguarding position within the organisation.
This was not filled and the safeguarding children team from Ipswich Hospital are now providing a service level agreement until September 2015 for safeguarding children.
The safeguarding children team are working closely with the named nurse for adult safeguarding and together provide an integrated service to SCH staff.
Training of staff is a major part of the team’s work and the CQC requires that all SCH staff are trained in safeguarding children according to the ‘Safeguarding Children and Young people: roles and competences for health care staff,
Intercollegiate document’ (RCPCH 2010). This guidance identifies six levels of competence.
122 SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

The compliance rate for safeguarding level 1/2 training is 99.3% as of April 2014.
The compliance rate for safeguarding level 3:
SEPT: The staff have achieved 100% compliance
COMMUNITY DENTAL SERVICE
Following update training in May 2013, 34 out of 36 clinical staff who need level 3 training are compliant. The next update is in May 2014 which will involve all staff who require this training.
Compliance is 94% for this group but will again be 100% in May 2014.
MINOR INJURIES UNIT
Out of 12 clinical staff who need level 3 training, all six have attended at least one Level 3 training session within the 12 month period. Compliance is 100% for this group of staff.
LOOKED AFTER CHILDREN
A new model to enable timely and appropriate responses within the Looked After Children
Pathway is in the final stages of agreement with the Suffolk CCGs. The model will see a medically led, nurse-initiated entrant into care health screening pathway being introduced.
KEY PRIORITIES FOR THE COMING
YEAR ARE:
■ To support the development of the Multi-
Agency Safeguarding Hub in Suffolk
■ Continue to build on established clinical supervision systems
■ Continue to build relationships with our partnership organisations (SEPT and CDS) in maintaining robust safeguarding governance processes across the partnership
■ Safeguarding children audits to continue as per annual audit plan
■ Continue with safeguarding children work plan
■ Ensure the LSCB recommendations prevalent to health are cascaded to clinical leads
■ The Section 11 self-assessment audit will be completed for the CCGs in April
■ In preparation for the CQC unannounced inspection to review the services for looked after children and safeguarding evidence will be collated and shared with the designated safeguarding children professionals
■ Safeguarding children and lac dashboard will be populated quarterly from April 2014.
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 123

INFECTION PREVENTION AND
CONTROL
We said we would reduce the number of healthcare acquired infections:
Suffolk Community Healthcare has during
2013/14 maintained its zero tolerance approach to preventable infections. We remain committed to preventing and controlling health care associated infections (HCAI) as we do not accept that avoidable HCAIs are an inevitable part of health care.
Of the two most recognised HCAIs we have had mixed results this year. We have continued to ensure our Methicillin Resistant Staphylococcus
Aureus (MRSA) bacteraemia cases remain at zero cases within all four of our community hospitals, this is the fourth successive year we have achieved this target.
A greater challenge was the target of no more than three Clostridium difficile (C.diff) cases for
2013/14. In this respect we had to report six cases. All of these cases have been thoroughly investigated using RCA methodologies and the key learning points have been implemented to prevent as far as possible these infections from occurring. The target for SCH in 2014/15 is to have no more than four cases.
In all of these cases the environment and staff hygiene practices were found not to be an issue and as such there was no evidence of transmission from the either staff or the environment between patients. In all cases the cause was identified as being as a result of antibiotic treatments, and as such much of our efforts to prevent this infection are focused on the close monitoring of these treatments.
It is estimated that 3% of people carry
MRSA harmlessly on their skin, but for hospital and patients within the community the risk of infection may be increased due to wounds or invasive treatments which make them more vulnerable. Serious MRSA infections may result in MRSA blood stream infections.
C-diff is a common cause of hospital acquired diarrhoea. It is bacteria that are harmlessly present in the bowel of 3% of healthy adults and up to 30% of elderly patients. When certain antibiotics disturb the balance of bacteria in the gut, C-diff can multiply rapidly and produce toxins which cause diarrhoea and illness.
124 SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

C-DIFF CASES REPORTED WITHIN SUFFOLK COMMUNITY HEALTHCARE
1 2 3 4
Number of Cases
5 6 7 8 9 10
2008/09
2011/12
2012/13
2010/11
2009/10
2013/14
PATIENT LED ASSESSMENT OF THE CARE ENVIRONMENT (PLACE) SCORES FOR 2013/14
Hospital
Aldeburgh
Bluebird Lodge
Felixstowe
Newmarket
Cleanliness
(including hand hygiene)
100%
91.30%
96.41%
89.66%
Food
92.25%
87.44%
84.66%
72.33%
Privacy, Dignity and Wellbeing
88.89%
80.65%
87.80%
70.29%
Condition,
Appearance and
Maintenance
89.66%
79.10%
89.25%
72.04%

The additional cases are disappointing, especially as we had successfully implemented the remedial action plan and underwent a programme of rigorous monitoring by our commissioners.
However, we have redoubled our efforts to prevent these infections primarily through the introduction of the audit of each antibiotic prescribing episode in our community hospitals, and as such are confident that the target for
2014/15 will be achieved.
WHAT HAS WORKED WELL IN
PREVENTING HEALTHCARE
ASSOCIATED INFECTIONS?
Our organisation operates a ‘ward to board’ approach to preventing infections, with all staff being aware of their responsibilities and required practices with regard to infection prevention.
The organisation regularly tests these through a programme of both internal and external audit of practice and environment. The results of these audits are routinely fed through the organisation to ensure shared learning between departments and to provide a measure of assurance to the management Board on the current standards within the organisation.
The current infection prevention audits that occur within SCH are:
■ The 5 Moments of Hand Hygiene
■ Hand hygiene practice surveys of patients
■ Catheter care
■ Isolation practices
126
■ Antibiotic prescribing
■ Environmental hygiene
■ Equipment decontamination.
In 2013 the former Patient Environment
Assessment Team (PEAT) process changed to a
Patient Led Assessment of the Care Environment
(PLACE). Our community hospitals were audited against the PLACE standards in 2013 the results of which are summarised below.
The Care Quality Commission has visited all of our community hospitals in 2013 and the following comments have been made on their website:
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

Felixstowe
Aldeburgh
Newmarket:
ACHIEVEMENTS AGAINST THE 2013/2014
ANNUAL IMPROVEMENT PLAN
■ Our hand hygiene results have been consistently high
■ Implementation of all key learning from RCA
■ Implementation of an environmental hygiene monthly monitoring programme across all sites
■ The relaunch of the infection prevention and control link worker network so that all locations have access to onsite training & audit functions for infection control
■ MRSA Screening – 100% achieved for rehabilitation patients as well as for foot and ankle surgery patients
■ Greater control of antibiotic prescribing practices through the introduction of a more in depth audit process
■ The introduction of a catheter care audit programme.
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 127

INFECTION PREVENTION AND
CONTROL TRAINING
As an organisation we have continued to place great emphasis on the delivery of suitable training for all of our staff. In the year 2013/14 the delivery options have changed to allow all staff to access training in a manner that better suites their learning styles. In addition to this our commissioners have set a target for 2014/15 of having 95% of all our staff trained, our own target remains 100%. We will be delivering 47 face to face training sessions as well as providing an e-learning option for staff.
The link workers will also deliver practical hand hygiene sessions for all of the staff in their areas of work.
128
THE NUMBER OF STAFF TRAINED IN
INFECTION PREVENTION & CONTROL
2013/14
PERCENTAGE OF STAFF TRAINED
2013/14
Totals
78% 80% 82% 84% 86% 88% 90% 92%
Q1
Q3
Q2
Q5
Q4
Q = Quarter
DEPENDENT SERVICES
SCH has continued to provide the infection prevention and control service to the SEPT podiatry, foot and ankle and community paediatric services under the dependent services agreement. This has involved the provision of advice, policy and site audits.
A similar service has been recommenced in the
Year 2013/14 for the Community Dental Service.
These services will continue to be provided during 2014/15.
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

Q1
INFECTION PREVENTION
IMPROVEMENTS FOR 2014/15
SCH intends to complete the following improvements during the year 2014/15:
■ Increase the percentage of staff trained in infection control knowledge and practice to
95%
■ To achieve month on month improvements in the standards of environmental hygiene in all of our facilities to 95%
■ To improve hand hygiene to 100% in all areas
■ To have no more than four C.diff infections
■ To improve antibiotic prescribing standards to 95% in each episode
■ Improve on last year’s PLACE results
■ To implement the asepsis competency assessment process
■ Achieve a 65% uptake of flu vaccinations by staff
■ Continue to improve our collaboration with other healthcare providers to enhance the ability of the ability of whole health economy to reduce infections.

The use of the Safety Thermometer Tool has continued through this year. The ongoing monitoring and awareness generated by this audit continues to have a positive impact on patient safety.
The NHS Safety Thermometer provides a ‘temperature check’ on harm and can be used with other measures of harm to measure local and system progress. It was developed as a point of care survey tool which aims to ensure the NHS provides harm-free care.
Safety Thermometer is a national initiative to monitor the four potential major harms in patient care which are:
■ Catheter acquired infections
■ Pressure ulcers
■ Venous thromboembolism
■ Falls
Safety Thermometer data, when examined against incident reporting information, has enabled identification of areas of risk and training has been provided in line within regional initiatives to reduce all four harms with particular focus this year around the reduction of avoidable pressure ulcers.
The principles of harm-free care are now part of the ethos of daily care within our community hospitals and community teams.
PRESSURE ULCERS
Whilst pressure ulcers were not eliminated completely the increased awareness and holistic working resulted in a significant reduction in the number of higher grade pressure ulcers within our care.
The figure to the left represents the grade 2 pressure ulcers that occurred whist in our care.
We have consistently maintained a low level in all our community services
130 SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

GRADE 2 PRESSURE ULCERS THAT HAVE OCCURED WHILST IN THE CARE OF SCH.
2 4 6 8 10 12
MAY 2013
JUN 2013
JUL 2013
AUG 2013
SEP 2013
OCT 2013
NOV 2013
DEC 2013
JAN 2014
FEB 2014
MAR 2014
PRESSURE ULCERS OCCURING IN OUR
CARE IN-PATIENT GRADE 2 AVOIDABLE
PRESSURE ULCERS OCCURING IN
OUR CARE IN-PATIENT GRADE 2
UNAVOIDABLE
PRESSURE ULCERS OCCURING IN OUR
CARE COMMUNITY GRADE 2 AVOIDABLE
PRESSURE ULCERS OCCURING IN
OUR CARE COMMUNITY GRADE 2
UNAVOIDABLE

WE HAVE ACHIEVED THIS REDUCTION
THROUGH A RANGE OF ACTIVITIES
INCLUDING:
■ Pressure ulcer prevention training to all levels of clinical staff across all professions
■ Reviewed and include innovative pressure relieving equipment such as silicone pads applied directly to the skin to prevent shearing and relieve pressure
■ Encourage joint working across our professionals to review and manage complex patients with high risks of pressure ulcers.
Our work with other acute and community health agencies, in both the public and private sectors and with social care to try to reduce harms has been extended during the year.
Our data revealed that many of the patients with pressure ulcers that our staff were being asked to care for developed their pressure ulcers within the care home sector.
We designed a pressure ulcer prevention programme and delivered training within care homes to enable continued reduction of pressure ulcers
HOW THE TRAINING WAS PROVIDED
FOR CARE HOMES
■ Training delivered both within our own venues and directly in care homes around
Suffolk
■ Gave the opportunity for staff across organisations to discuss issues relating to patient cooperation, equipment and encourage closer working relations
■ Training packages sent to care homes to enable them to deliver their own training with the same information
■ To enable new staff received the principles of pressure ulcer prevention, it was important homes had the resources to enable them to maintain a basic level of pressure ulcer prevention in-house
■ The training was based on the principles of pressure ulcer prevention identified as part of an drive within the whole Eastern Region; the Pressure Ulcer Ambition which aimed to eliminate pressure ulcers completely and was known as the SSKIN initiative which focussed on the following:
132 SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

WHAT HAS BEEN ACHIEVED?
■ In total all 73 homes in east Suffolk and 45 homes in west Suffolk received mailshots and had follow up phone calls to disseminate the training programme
■ The training package came about as a result of the training initiatives over the year, feedback from the staff who attended, and the fact that we were unable to deliver training to all the care homes in Suffolk
■ It enabled care homes to deliver now and in the future, their own in-house training
■ It is in an electronic format to enable it to be emailed to the homes concerned. A DVD and supporting literature have also been produced, with support from industry, for distribution via the Suffolk wide care home networks
■ Pressure ulcer prevention industry representatives have agreed to develop the training packs and distribute to all residential homes in Suffolk
■ This will supplement the information already distributed to all homes which will enable them to deliver the principles of the programme.
kin inspection: Check it isn’t discoloured or sore
urface: Make sure you’re on a supportive surface
eep moving: Change your position often
ncontinence: Keep clean and dry
utrition: Eat healthily
THE NHS SAFETY CROSS AUDIT
The Safety Cross is an audit tool used to record the number of days between falls and pressure ulcers occurring in clinical areas.
It was implemented within our four community hospitals.
There are two elements to safety crosses; one records community hospital acquired pressure ulcers and one records falls with harm
Safety crosses were completed daily and displayed in all in-patient units for staff and public to view; this showed the number of consecutive harm-free days for falls and pressure ulcers for each month.
This alerted to staff in “real time” to allow for immediate action on any issues.
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 133

INPATIENT UNIT SAFETY CROSS REPORT
TEAM:
KEY:
PRESSURE ULCERS (L)
1 2
MONTH:
3
FALLS
4 5 6
7 8 9 10 11
13
19
14
20
15
21
16
22
17
23
25
28
26
29
31
27
30
12
18
24
ONLY RECORD FALLS THAT RESULT IN HARM

PATIENT SAFETY BENEFITS OF
THE SAFETY CROSS
■ Ongoing increased awareness enabling earlier implementation of preventative measures.
■ Ongoing use of the Safety Cross as a method of engaging frontline staff and improving patient safety and well-being.
HOW WILL WE MONITOR PROGRESS?
■ The Safety Thermometer and Safety Cross will continue to be monitored through our data collection systems as elements have been carried forward into CQUIN goals for the year ahead.
■ Close triangulation between audit and incident reporting data from our risk management team with upward reporting to our governance groups will ensure that its profile remains high from the frontline up to the Leadership Team.
■ National plans to roll out these two tools to cover other areas of clinical practice are under development and will be implemented locally.
WHAT DO WE WANT TO ACHIEVE
IN 2014/ 2015?
Roll out of further training programmes to enable continued reduction of pressure ulcers, falls and other patient harms.
As Pressure ulcer and falls reduction remains a national priority SCH will:
■ Continue to collect Safety Thermometer data and share the results within the teams to help improve care and reduce the number of pressure ulcers and falls
■ Utilise tissue viability and falls prevention expertise within the organisation so that good practice and lessons learned from incident and audit data relating to these aspects of patient safety are shared throughout the organisation.
■ Implement further national patient safety initiatives as required for other areas of patient safety.
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 135

HEALTH AND WELLBEING UPDATE
Suffolk Community Healthcare has maintained its impetus to help staff develop healthy habits in the workplace. Working with Serco has provided further opportunities to develop health and wellbeing champions. Champions now link each month with all Serco’s other health contracts across the UK, sharing information on healthy living, physical activity, disease and illness prevention, mental health awareness and healthy recipe sharing they can then disseminate within their teams.
More champions are undergoing ‘Looking after
Me’ training, giving them a good awareness of their physical, mental and emotional wellbeing.
This equips them to help themselves and their colleagues to develop healthier lifestyles.
Staff are encouraged to participate in organised activities and initiatives. Health and Wellbeing
Champions introduce various initiatives to their teams that encourage healthy eating and lifestyle and develop a good approach to work-life balance. Such initiatives include:
■ The dementia awareness programme
■ Cancer Awareness Month in April
■ Physical activity challenges
■ The Serco walking club
■ Table tennis tournament
We are also looking into launching further initiatives in the coming months with the support of our Health Champions across SCH.
LEADERSHIP DEVELOPMENT
We launched an Operational Management
Framework for team leaders to provide them with regular performance information and an escalation process designed to maximise the time available to spend with patients and remove potential barriers to work completion.
In addition, Serco has recently signed a partnership with Bromley Healthcare, an employee-owned social enterprise, which has run community health services in Bromley since it spun out of the NHS in 2011. This new partnership uses the expertise and skills of both organisations to improve care for patients, while delivering best value for the NHS. Bromley Healthcare is also working closely with the senior and wider leadership teams to develop leadership capability and provide ongoing support to some of the challenges on the contract.
DEVELOPING THE SKILLS NEEDED
FOR THE WORKFORCE OF THE FUTURE
The personal development of our workforce is important to enable them to excel in their chosen career for the organisation, for their selffulfilment and to ensure excellent care for the people of Suffolk.
136 SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

Staff take part in the personal development review annual process when skills development needs are assessed. Both mandatory and continued professional development programmes are provided each year to meet organisational and personal development needs to ensure our staff are equipped to provide safe first-class health care for patients. The programmes provided include a wide range of mandatory topics and clinical skills updates, apprenticeships, foundation degrees, diplomas, degrees and masters qualifications.
Training is delivered within higher education institutions, on site or with out of region training providers.
PRE-QUALIFIED WORKFORCE
SCH continues to develop its pre-qualified staff to provide an excellent service to staff and patients whilst providing support for the qualified workforce. Job roles within this group include essential clinical and non-clinical roles including administration, catering, cleaning, generic workers and assistant practitioners.
Employed apprenticeship qualifications are made available to all pre-qualified staff to give them the opportunity to earn a qualification demonstrating their competence in their current role.
ASSISTANT PRACTITIONERS
In January 2014 six assistant practitioners enrolled on a two-year course to achieve a foundation degree. This is equivalent to the first year of nurse or therapy degree training should the student choose to pursue that path in the future.
RECRUITMENT
SCH recognises the need to ensure sufficient staff are being trained to replace those leaving due to either natural turnover or retirement. With this in mind and due to a predicted significant retirement rate in the near future it is anticipated that a cohort of nurses will embark on a one-year district nurse training programme in September
2014. SCH is also working with Ipswich Hospital to encourage returners through the return to practice route.
We are equally committed to attracting new staff to ensure the employment of high calibre clinicians and health professionals to provide a workforce of excellence to care n a rapidly changing health environment. To do this essential links with the public and local schools continue to be maintained. Additionally, the recruitment team are exploring other means
For difficult to recruit roles such as Bands 5 and 6 nurses, District Nurses and other senior clinician posts, the possibility of international recruitment is currently being considered.
BAND 5 STAFF NURSE DEVELOPMENT
As we sometimes experience difficulties recruiting senior nurses with the right levels of skills and qualifications, we are creating community staff nurse development posts.
These provide a pathway for our band 5 nurses to develop their leadership skills in preparation for further specialist training and also support the retention of our band 5 nursing staff. These posts will be for one year and will be rotational,
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 137

during which staff will be expected to complete modules which will contribute to their specialist training and also provide additional support for the band 6 district nurse within their team.
ATTENDING SCHOOL CAREERS FAIRS
We continue to attend careers fairs at local schools and colleges whenever the opportunity arises. This gives the opportunity to provide detailed information and discuss employment possibilities directly with those interested in a career in the health sector.
OFFERING WORK
EXPERIENCE PLACEMENTS
We regularly receive requests for work experience placements. These are wellsupported by our staff who recognise the value of encouraging new interest into the organisations.
All placements provide opportunities for our visitors to experience life within busy health teams in areas across Suffolk, working with nurses, physiotherapists and other healthcare professionals. Many placements are provided for those of school age, for school leavers and for those requiring placements prior to being accepted on to undergraduate university programmes.
OFFERING PRE-REGISTRATION
NURSING OR THERAPY
STUDENT PLACEMENTS
Numerous placements have been made available for nursing and therapy students to provide practical experience in support of academic
138 study whilst working towards a professional qualification at partner universities. The quality of student placements is closely monitored by the Norfolk and Suffolk Workforce Partnership through the Placement Quality Framework annual process.
APPRENTICESHIPS
During a period of significant organisational change SCH has continued to offer a number of apprenticeship placements to provide job opportunities wherever possible to those showing interest in health sector employment.
The organisation values the enthusiasm and significant contribution apprentices make to the workplace whilst working through their apprenticeship qualification. Apprentices are encouraged to apply for jobs in the organisation when their apprenticeship is drawing to a close.
FUTURE PLANS
Following the transfer of services in October
2012 the organisation is constantly re-assessing its organisational structure and job roles to provide the best possible service to patients.
SCH will continue to have close links with other
NHS bodies including the Norfolk and Suffolk
Workforce Partnership Group which will provide continuous professional development funding to support training for all staff.
The workforce department will work wisely with available funding to provide essential training to support job roles in the future.
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

Recognising the importance of excellent and inspired leadership, leadership development continues to be a significant priority to provide staff with the skills needed to take the organisation forward. A leadership training programme is being developed for 2015.
SCH will continue to provide high quality student placements in conjunction with our partner universities to ensure that clinical students preparing to join our workforce have the benefit of excellent practical experience within clinical teams alongside our qualified staff.
Work will be undertaken to develop links with
Higher Education Institutions to attract newly qualified staff straight from education, ensuring
SCH attracts the best clinicians into its workforce.
ORGANISATIONAL DEVELOPMENT
IN 2014-2015
WORKFORCE PLANNING
AND DEVELOPMENT
SCH is participating in a cross-organisational workforce transformation project to utilise professionals and services across health, social care and voluntary services to reduce the demand on medical and registered nursing staff with reduction in demand for services along with increased planned admission and timely and planned discharge.
CLINICAL SUPPORT
Following an administration review clinical teams are being provided with an appropriate level of administration support to assist with administrative tasks thereby reserving more of clinician time for patients.
LEADERSHIP DEVELOPMENT
Further developments to the Personal
Development Review process are planned to make the Personal Development Plans easier for staff to complete. Personal Development
Reviews are essential for all staff to ensure they understand the link between their job role and the objectives of the organisation, to consider their future career and to establish training needs to ensure job performance.
HEALTH AND WELLBEING
We will continue to focus on the improved health and wellbeing of our staff in 2014 and will encourage our staff to partake in the various events and initiatives to come. Promotion of health and wellbeing schemes will take place later this year, such as
■ Unum Lifeworks promotional presentations
■ Bike to work scheme
■ Gym discounts and Simply Health (insurance) discount
■ Further disease and illness awareness e.g. stroke, diabetes, heathy heart.
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 139

PRACTICE DEVELOPMENT FACILITATOR
With the commencement of the new Practice
Development Facilitator last May, SCH has seen many changes within pre-registration education and staff development.
The role has been developed around the
Performance Quality Assurance Framework
(PQAF), and its investment with our key stakeholders, patients, staff and students. Three main themes have been acknowledged: preregistration education, staff development, and further development of the service. The current role is successful and has had a great impact on the service. However it is nursing focussed so we will be creating a similar, therapy focussed, post.
Some of the highlights, from the role, from the last year, within each theme, are as follows:
PRE-REGISTRATION EDUCATION
■ New allocation process for nursing students
■ Increased ‘active’ nursing mentors and the development of a new ‘database
■ Increased support for student nurses and nursing mentors, including a new link lecturer structure
■ Development of a new feedback system for nursing students and mentors
■ Closer links and stronger relationships built with the local university and health education.
STAFF DEVELOPMENT
■ Inter-professional development strategies identified
■ Develop ‘n-house training and development programmes for all staff, including a yearly rolling programme for wound care
■ Define and introduce a new system for clinical supervision, including training for supervisors
■ Respond to the changing environment of our patient’s requirements for care, and provide training locally to teams that need to meet the needs of those patients
■ Meet key performance indicators around training for Verification of Expected Death.
FURTHER DEVELOPMENT
■ Enhanced attendance at local careers conventions and gained the tools required to meet the needs
■ Increased involvement in the recruitment process for both pre and post-registered staff
■ Development of own knowledge and skills to ensure a quality service is delivered.
■ The introduction of the new therapy practice development facilitator brings exciting times for both SCH, and stakeholders.
140 SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

FOCUS ON QUALITY CARE: PARKINSON’S
DISEASE REHABILITATION GROUP
CASE STUDY ON QUALITY
This group is preparing to celebrate its third anniversary by completing a clinical audit to establish the effectiveness of the service. The
12-week rehabilitation program, held at the
Disability Resource Centre in Bury St Edmunds, is provided by the Bury community therapy team for people with Parkinson’s disease (PD).
The main goal of the group is to improve the overall function and safety of patients diagnosed with PD using exercise, education, daily activities training and strategy practice. Participants learn how to live well with the disease, how to increase/ maintain maximum levels of independence at home, how to deal with different symptoms, and learn few techniques and strategies to improve balance and mobility.
The group was established in April 2011 to support this nationally under-serviced population and it continues to provide support and therapy across the locality. Unlike other similar classes, ours is unique as it builds its basis on the research expertise of staff working within the team, which is coupled by extensive clinical experience, offering this superior advantage of linking evidence to practice. The group continues to use existing facilities, equipment and staff to provide high quality care for people with PD without extra burden on the NHS by ensuring optimum use of available resources. The group has been widely recognised by staff as reflected by the diversity of referrals sent from specialist nurses,
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 consultants, GPs, and community therapists, which again stresses the impact of the group on reducing community services utilisation. The group has been networking with similar groups and other interested staff in Ipswich, Aldeburgh, and Sudbury, promoting transfer of clinical expertise and service development ideas, trustwide as well as with other organisations.
Preliminary results of the clinical audit showed a significant improvement in gait freezing, balance and gait scores, 10-metre walk test scores as well as improved falls efficacy scale scores, which highlights the impact of the group in improving balance and walking, as well as reducing falls risk in people with Parkinson’s disease. Patients perceived the service as a very valuable tool that aids them to function more efficiently and support them to cope with problems that arise as the disease progresses. On completion of the programme, patients were given feedback and evaluation forms to complete. Comments included:
141

I hope you have found useful information within our QA and that it helps increase your understanding about the services we offer and our focus on quality. Our QA is admittedly long and comprehensive; this is a symptom of the huge amount of work we are doing in SCH to improve our services, put the patient at the centre of care and make SCH a more efficient and sustainable organisation. What a hard yet fulfilling year it has been! I thank our stakeholders and customers for their input in this quality account and their engagement with us in the past year. Finally can I once again thank every single person who works in our fantastic team at SCH.
Our improving organisation would be nothing without your focus on high standards and quality and dedication to our patients in Suffolk.
DR ABI TIERNEY
CEO
SUFFOLK COMMUNITY HEALTHCARE
If you have any questions or comments about this Quality report please contact:
CHRISTIAN JENNER
(COMMUNICATIONS OFFICER)
Email at: christian.jenner@suffolkch.nhs.uk.
Telephone on 01284 718259.
142 SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

Suffolk County Council
Endeavour House
8 Russell Road
Ipswich
Suffolk IP1 2BX
30 May 2014
The Suffolk Health Scrutiny Committee appreciates the opportunity to comment on this year’s Quality
Accounts.
This year, the Suffolk Health and Wellbeing Board has agreed that Quality Accounts should be referred to the Health Scrutiny Committee for discussion and oversight.
In light of the Francis Report, the Committee is clear that accountability in the NHS is not just about publishing data. This needs to be linked to mechanisms that bring a reality check to make sure that patients’ experiences are properly reflected. The Committee believes that quality improvement should be an ongoing cycle.
The Health Scrutiny Committee has, in the main, been content with the engagement of local healthcare providers in the work of the Committee over the past year, and is keen that these relationships should continue, with a view to ensuring the best possible health services for the people of Suffolk.
Theresa Harden
Business Manager
Democratic Services
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 143

144
Ipswich & East Clinical Commissioning Group
West Suffolk Clinical Commissioning Group
QUALITY ACCOUNTS
Ipswich and East Suffolk Clinical Commissioning Group and West Suffolk Clinical
Commissioning Group, as the commissioning organisations for Suffolk Community
Healthcare (Serco), confirm that the Trust has consulted and invited comment regarding the
Quality Account for 2013/2014. This has occurred within the agreed timeframe and the
CCGs are satisfied that the Quality Account incorporates all the mandated elements required.
The CCGs have reviewed the Quality Account data to assess reliability and validity and to the best of our knowledge consider that the data is accurate. The information contained within the Quality Account is reflective of both the challenges and achievements within the
Trust over the previous 12 month period. The priorities identified within the account for the year ahead reflect and support local priorities.
Ipswich and East Suffolk Clinical Commissioning Group and West Suffolk Clinical
Commissioning Group, are currently working with clinicians and manager from the Trust and with local service users to continue to improve services to ensure quality, safety, clinical effectiveness and good patient/care experience is delivered across the organisation.
This Quality Account demonstrates the commitment of the Trust to improve services. The
Clinical Commissioning Groups endorse the publication of this account.
Barbara McLean
Chief Nursing Officer
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

Pamela Chappell
Eighty-Six
86 Sandy Hill Lane
Ipswich
IP3 0NA
June 2014 13 th
Dear Pam,
Healthwatch Suffolk response to the Suffolk Community Healthcare Quality
Account 2013/14
Healthwatch Suffolk thanks Suffolk Community Healthcare for the opportunity to comment on its Quality Account for the year 2013/14.
Our working group has considered your draft document and produced a response statement (enclosed) for inclusion in the appendix of the published report.
If you have any questions about Healthwatch Suffolk or this response please do not hesitate to contact Michael Ogden on 01449 703949 or by email to michael.ogden@healthwatchsuffolk.co.uk
.
Healthwatch Suffolk looks forward to working with Suffolk Community Healthcare in the year ahead and to hearing of progress made to improve services and outcomes for patients and service users in Suffolk.
Yours sincerely
Annie Topping
Chief Executive
Enc.
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14 145
Unit 12&13 Norfolk House, Williamsport Way, Needham Market,
Suffolk, IP6 8RW (01449 703949)

Healthwatch Suffolk response to the Suffolk Community Healthcare Quality
Account 2013/14
It is clear that Suffolk Community Healthcare are taking steps to improve its engagement with patients and demonstrate that it is listening. We have been holding regular discussions with relevant staff within Suffolk Community
Healthcare around how it can improve communication with regard to feedback about its services and actions taken in response. In particular, we are very pleased that it has been possible to develop an ambition to establish an independent patient and carer forum that will scrutinise its performance and contribute to future service improvement and developments.
Healthwatch Suffolk is also very pleased to be attending meetings of the Suffolk
Community Healthcare Patient Experience Group as the only external body at this stage. This important seat will enable us to ensure that patient feedback is heard where it matters, and this demonstrates to us that Suffolk Community Healthcare are seeking to work in a manner that caters for the views of its service users.
The Quality Account of Suffolk Community Healthcare is an interesting document, however we would have liked an opportunity to discuss the format and content of this report before the final draft was presented. Furthermore we feel it noteworthy that we were not granted 30 days in which to respond to the document and will expect that this is addressed in future.
The working group for Healthwatch Suffolk have found the document very lengthy and consider that it is lacking in features that will make it accessible and easy to read for all members of the public. It is our belief that the report would benefit from having far greater use of tables and charts. We hope that the progress that
Suffolk Community Healthcare have undoubtedly made over the past year will be reflected in next year’s quality account, which would benefit from dialogue at an early stage.
Healthwatch Suffolk looks forward to seeing Suffolk Community Healthcare achieve its goals for the coming year and is eager to work with the Trust in helping it to achieve those goals.
146 SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14
Unit 12&13 Norfolk House, Williamsport Way, Needham Market,
Suffolk, IP6 8RW (01449 703949)

GLOSSARY
86 SCH headquarters – 86 Sandy
Hill Lane, Ipswich
A
A&E
ACH
ACS
ADHD
AHP
APS
ASD
B
BDA
BBL
BSE
C
CAMHS
CCC
CCG
CCNT
C-DIFF
CDS
Accident and Emergency
Aldeburgh Community Hospital
Adult and Community Services
Attention Deficit Hyperactivity
Disorder
Allied Health Professional
Admission Prevention Service
(now Community Intervention
Service)
Autistic Spectrum Disorder
British Dental Association
Bluebird Lodge
Bury St Edmunds
Child and Adolescent Mental
Health Services
Care Co-ordination Centre
Clinical Commissioning Group
Children’s Community Nursing
Team
Clostridium Difficile
Community Dental Service
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14
CG
CGA
CEO
CES
CHT
CIDS
CIS
CM
COPD
CPN
CPS
CQC
CQUIN
Caldicott Guardian
Comprehensive Geriatric
Assessment
Chief Executive Officer
Community Equipment Service
Community Health Team
Community Intervention Data
Set
Community Intervention Service
Community Matron
Chronic Obstructive Pulmonary
Disease
Community Psychiatric Nurse
Community Paediatric Services
Care Quality Commission
Commissioning for Quality and
Innovation
D
D&T
DN
DH/DOH Department of Health
DRC
DVT
Day and Treatment Team
District Nurse
Disability Resource Centre
Deep Vein Thrombosis
E
EAU
ED
EIT
Emergency Admission Unit
Emergency Department
Early Intervention Team
147

H
HCA
HCAI
HCW
HCSW
HES
HR
HSC
HSE
I
IC
IHT
IT/IMT
IV
F
FCH
FFLS
FOI
G
GP
GW
Felixstowe Community Hospital
Falls and Fractures Liaison
Service
Freedom of Information
General Practitioner
Generic Worker
Health Care Assistant
Health Care Associated
Infections
Health Care Worker
Health Care Support Worker
Hospital Episode Statistics
Human Resources
Health Scrutiny Committee
Health and Safety Executive
Infection Control
Ipswich Hospital Trust
Information Technology/
Information Management and
Technology
Intravenous
J
JSF
K
KPI
L
LA
LAM
LHCT
Joint Staff Forum
Key Performance Indicator
Local Authority
Local Area Manager
Local Healthcare Teams (now
Community Health Teams)
M
MDT
MIU
MM
MND
MRSA
Multidisciplinary team
Minor Injuries Unit
Modern Matron
Motor Neurone Disease
Methicillin-Resistant
Staphylococcus Aureus
N
NAO
NCGC
National Audit Office
National Clinical Guideline
Centre
NCH
NHS
Newmarket Community
Hospital
National Health Service
NHS CFH NHS Connecting for Health
148 SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14

NICE
NMC
NPSA
NSFT
O
OH
OT
P
PALS
PLACE
PN
PU
PPI
PT
Q
QIPP
R
RAG
RCA
RCN
National Institute for Health and
Clinical Excellence
Nursing and Midwifery Council
National Patient Safety Agency
Norfolk and Suffolk Foundation
Trust (Mental Health)
Occupational Health
Occupational Therapist
Patient Advice and Liaison
Service
Patient-Led Assessments of the
Care Environment*
*(formerly PEAT Patient
Environment Action Team)
Practice Nurse
Pressure Ulcer
Patient and Public Involvement
Physiotherapist
Quality, Innovation, Productivity and Prevention
Red, Amber, Green reporting
Root Cause Analysis
Royal College of Nursing
SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14
RCP
RCGP
Royal College of Physicians
Royal College of General
Practitioners
RGN Registered General Nurse
RIDDOR Reporting of Injuries, Diseases and Dangerous Occurrences
RMN
RN
RTT
Regulations
Registered Mental Nurse
Registered Nurse
Referral to Treatment
S
SALT
SCC
SCH
SEPT
SHA
SI
SITREP
SLC
SMOC
Speech and Language Therapy
Suffolk County Council
Suffolk Community Healthcare
South Essex University
Partnership Trust
Strategic Health Authority
Significant/Serious Incident
Situation Report
Stow Lodge Centre
Senior Manager on Call
T
THA
TOM
TOR
TUPE
Therapy Assistant
Target Operating Model
Terms of Reference
Transfer of Undertaking
(Protection of Employment)
Regulations
149

U
UTI
V
VTE
W
WSH
Urinary Tract Infection
Venous Thromboembolism
West Suffolk Hospital
150 SUFFOLK COMMUNITY HEALTHCARE QUALITY ACCOUNT 2013/14