Quality Account 2013/14
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Summary
Sussex Community NHS Trust (SCT) is the main provider of community NHS healthcare across
Brighton & Hove and West Sussex, and the largest community healthcare provider in the South
of England strategic health authority that stretches from Cornwall to Kent.
Our expert teams provide essential medical, nursing and therapeutic care to adults, children
and families in clinics, in their own homes, or as inpatients in our Community Hospitals. From
our health visitors looking after new born babies to our community practitioners (nurses and
therapists) caring for the frail elderly, we look after some of the most vulnerable people in our
communities.
Around 1 million people live in the area we serve, and it is very likely that most of them will
come into contact with our services in some way: as a patient, a carer or relative of a patient, or
through a link with one of our staff members or volunteers. In this way what we do helps form
the bedrock of the NHS, and we provide care that truly spans from ‘cradle to grave’.
How we did last year:
 83% of our services conducted a patient experience survey.
 We received 204 complaints and 2,165 compliments.
 We retained our status as a ‘Two Ticks’ disability employer during 2013/14.
 Our Midhurst Macmillan specialist palliative care service was cited by NHS England as
an example of transformational practice.
 A palliative care partnership in Brighton & Hove was established bringing together our
specialist palliative care team in the city and the Martlets Hospice.
 Our physiotherapy teams in Crawley and Horsham have established a new service with
our local Clinical Commissioning Groups (CCGs), called the Functional Restoration
Programme (FRP), helping people with chronic pain.
 Over the past year our Falls Prevention team has worked with more than 50 care homes
in Brighton & Hove to support and train staff to prevent falls amongst their residents.
 A new Employee Assistance Programme has been put in place, which provides
counselling and a range of advice services for staff, available 24:7.
 We promoted NHS Health Checks to staff and made them readily available through our
Prevention Assessment team.
 We maintained high levels of participation in supervision and increased the proportion of
teams demonstrating 100% compliance.
 We reviewed ourselves against the recommendations of the Francis Report with an
action plan presented to, and being monitored by, the Quality Committee.
 We continued our progress to achieving NHS Foundation Trust status.
Things we would like to do better next year:
 Reduce the number of incidents resulting in harm to patients.
 Reduce the incidence (still further) of all avoidable pressure damage.
 Improve pressure damage rates.
 Increase the number of services conducting a patient experience survey.
 Reduce the numbers of staff reporting they experienced feeling unwell due to stress.
 Reduce the numbers of staff experiencing bullying, harassment and abuse from patients,
relatives or the public.
 Reduce the rate of staff sickness absence.
Quality Account 2013/14
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About the Trust
Sussex Community NHS Trust (SCT) became an NHS Trust in October 2010 and plans to
achieve NHS Foundation Trust status in 2015. We work to meet the diverse needs of our
population of around 1 million people across West Sussex and Brighton & Hove, providing high
quality medical, nursing and therapeutic care to up to 8,000 patients a day. We have around
4,400 staff and we are one of the largest community NHS Trusts in the country. We have a
unique ability to provide care in our patient’s own homes and this puts us in a strong position to
prevent ill health, and work with our patients, their carers, other providers and commissioners to
develop innovative and responsive services that truly meet the health and social care needs of
our local population and beyond.
What the Trust stands for
Our vision is to deliver ‘Excellent care at the heart of the community’. To deliver this vision we
have three strategic objectives:
 We will provide excellent, compassionate care to people in or close to their homes so
that they can lead healthy and independent lives.
 Our services will be shaped by our users, partners and staff and personalised for the
individual and their specific circumstances.
 We will be a socially responsible, strong and sustainable business led by excellent staff.
Our patients can expect to be cared for by staff who embrace our core values: compassionate
care, working together, achieving ambitions and delivering excellence. Our partners can be
confident in our performance and in our commitment to develop services, consult and involve
them in how we grow and be business-like in our relationships with them.
The goals within this Quality Account align with the new CQC inspection model for Community
Providers, which is that we are providing services that are safe, effective, caring, responsive
and well led.
The Trust serves the populations of the West Sussex and Brighton & Hove commissioning
localities, which comprise:
 *Coastal West Sussex CCG, covering Adur, Arun, Chanctonbury, Chichester, Regis, and
Worthing, 54 GP surgeries and more than 482,100 patients.
 *Mid Sussex & Horsham CCG, covering Burgess Hill, East Grinstead, Haywards Heath,
Horsham and the surrounding area, 23 GP practices and approximately 225,000
patients.
 *Crawley CCG, covering Crawley and the surrounding area, 13 GP practices and more
than 120,000 patients.
 *Brighton & Hove CCG, 47 GP practices and approximately 300,000 patients.
Patients and service users outside of these areas, including East Sussex, also use our services.
*Information taken from CCG’s websites, accessed 26 June 2014.
Quality Account 2013/14
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Contents
Summary
2
Contents
4
Introduction
6
Part 1 - Chief Executive and Chair Statement
7
Part 2 - Looking Ahead
9
2.1
Priorities for Improvement 2014/15
11
2.2
Statements of Assurance from the Board
13
2.3
Clinical Audit and Confidential Enquiries
13
2.4
Trust-Wide Audits
14
2.5
Local Clinical Audits
15
2.6
Participation in Research
18
2.7
Commissioning for Quality and Innovation (CQUIN) Framework
19
2.8
Statements from the CQC
19
2.9
Data Quality
20
2.10
NHS Number and General Medical Practice Code Validity
22
2.11
Information Governance Toolkit Attainment Levels
22
2.12
Clinical Coding Error Rate
22
2.13
Incidents and Patient Safety
22
2.14
Environmental Impact
24
2.15
Estates
24
2.16
The Robert Francis Inquiry
26
2.17
Cultural Enquiry
26
2.18
Staffing Levels
26
2.19
Becoming an NHS Foundation Trust
27
2.20
Working with Patient Representatives
28
Part 3 - Looking Back
30
3.1
A Review of our Priorities for Quality Improvement in 2012/13
30
3.2
Additional Achievements in 2013/14
35
3.3
Complaints
36
3.4
Compliments
38
3.5
Equality & Diversity
38
3.6
Volunteers
38
Quality Account 2013/14
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3.7
Safe Care
39
3.8
Patient Centred Care
43
3.9
Staff Care
45
4
Who did we involve?
47
5
Statements provided by stakeholders
48
6
Conclusion
53
7
Glossary of Terms
54
8
Feedback
58
Quality Account 2013/14
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Introduction
What is a Quality Account?
At the heart of all we do is our commitment to
provide high quality personalised patient care
that meets the needs and expectations of
some of the most vulnerable people in our
communities.
Our Quality Account provides you with details
of how we will achieve this commitment this
year and how far we have fulfilled our
achievements set last year.
We publish our Quality Account every year
and make this available to the public via the
NHS Choices website and our own website.
Copies are also available in different formats
and in different community languages on
request.
Our Quality Account 2013/14 seeks to assure
our commissioners, patients and the public
we serve that we are regularly scrutinising all
our services, concentrating on those that
need the most attention.
Quality Accounts are both backward and
forward-looking - they state where we are,
and where we plan to go. They enable us to
reflect on progress against the priorities we
set in previous year’s accounts, and provide information regarding the quality of our services,
explaining both what we are doing well and where improvement is needed.
Importantly, they also enable us to look forward, explaining what we have identified as our
priorities for improvement over the coming year, and how we will achieve and measure these.
As Quality Accounts are annual reports, you should expect to see continuity between our
accounts as time progresses.
We want you to be confident that our Quality Account is accurate, balanced and fair. So we
have asked our partners to comment on how far we have achieved this and include their
feedback at the back of the report.
We welcome your comments on what you read and on any other aspect of our work. In
particular, please feel free to challenge us if you think we don’t measure up to the standards we
set ourselves.
Quality Account 2013/14
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Part 1 - Chief Executive and Chair Statement
Our commitment to deliver quality care in line with
our vision of excellent care at the heart of the
community is driven by the simple fact that it’s the
right thing to do. We do this within a tough and
fast-moving environment where we face evergrowing demand for our services and ever-greater
pressure on the finances.
We do this as well within the context of a debate
that talks increasingly about change, innovation
Paula Head
Sue Sjuve
and transformation. As Simon Stevens said as he
Chief Executive
Chair
started his new job as the chief executive of NHS
England in April 2014, “An ageing population with
more chronic health conditions, but with new opportunities to live as independently as possible,
means we’re going to have to radically transform how care is delivered outside hospitals.”
This is why we are working in ever closer partnership with our social care partners, Brighton &
Hove City Council and West Sussex County Council. It is our intention that people who use our
services should not be aware of where our provision ends and someone else’s starts – they
should just feel well cared for and supported.
We provide a full list of our services via the services tab on the homepage of our website at
www.sussexcommunity.nhs.uk/.
Excellent care is at the heart of everything we do, and in April 2014 we are registered with the
Care Quality Commission (CQC) without conditions. In October 2013, the CQC carried out an
unannounced inspection at our Kleinwort Centre in Haywards Heath and assessed us as
demonstrating compliance in all areas.
Over the past year, we have achieved much that demonstrates our commitment to high quality,
safe care. This includes a full response to the Francis Report, with good progress against our
action plans, and the achievement of our quality objectives in areas such as Proactive Care,
End of Life Care and Infection, Prevention and Control.
We have been working hard to further our understanding of how patients experience our
services, and in addition to the patient stories and feedback that we hear at our monthly board
meetings, we have:
 Introduced the friends and family test to all our bedded units and urgent care centres.
 Revised and re-launched our director insight and visibility visits where members of the
Trust board visit services and talk with patients and carers about their experiences.
 Continued with the development of patient involvement in some of our board committees,
such as the Charitable Funds Committee and the Patient Experience Group.
 Made improvements to referral pathways and patient information as the result of the
patient experience work
As well as reviewing our achievements over the last year, this account sets out our priorities for
improving patient experience, staff experience and collaborating with other providers to ensure
the continued delivery of high quality care during 2014/15.
We hope you will agree that our Quality Account provides many examples of where we are
already providing high quality care. We are confident that during 2014/15, our staff and
volunteers will work together with our patients, partners and commissioners to ensure
continuous improvement across all services.
Quality Account 2013/14
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On behalf of the trust board, we would like to thank everyone who has contributed to what has
been a successful year improving quality across all services. This account highlights the pride
and commitment of our staff throughout the organisation to delivering excellent care at every
care encounter for the people who use our services.
We confirm, on behalf of the trust board that to the best of our knowledge and belief, the
information contained in this Quality Account is accurate and represents our performance in
2013/14, together with our priorities for 2014/15.
Quality Account 2013/14
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Part 2 - Looking Ahead
Our Priorities for Quality Improvement in 2014/15
To make certain our care is excellent we must
ensure that the three themes of quality care
are provided in every encounter we have with
our patients. The three themes are safe care,
effective care and patient-centred care.
These three quality themes are embedded in
our Clinical Care Strategy and our Quality
Account and form the basis of our adult
integrated care and support, children’s
integrated care and support, specialist
community and wellbeing organisational
design.
The priorities we have set for the future year
are organised around these three core
elements of quality:
Safe Care
We subscribe to the outcomes of the Berwick
review (2013) into improving patient safety:
 Place the quality of patient care,
especially patient safety, above all
other aims.
 Engage, empower, and hear patients
and carers at all times.
 Foster whole-heartedly the growth and
development of all staff, including their
ability and support to improve the
processes in which they work.
 Embrace transparency unequivocally and everywhere, in the service of accountability,
trust and the growth of knowledge.
Effective Care
We are committed to improving our understanding of treatment options and success rates,
including possible complications of treatments and measures of clinical improvement.
We have systems and processes in place to ensure compliance with NICE guidelines and to
identify and incorporate into practice the latest technological and research advances in patient
care. Our framework includes the sign-off of each piece of guidance by the Medical Director.
This process ensures applicability of the guideline and allows us to identify a lead to facilitate
the effective implementation of new guidelines and guidance into clinical practice.
Implementation is overseen through regular reporting to the clinical effectiveness committee.
We are developing our extensive research programme to include innovation alongside our work
on technological advances in community care (reported as the 7th most successful community
trust research programme in England, Guardian, July 2013). We will develop a community
research institute in partnership with local universities and teaching hospitals.
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Our clinical governance framework includes the trust-wide clinical governance group, our
medicines safety & governance group, our research, development and innovations group and
service level clinical governance groups. The local clinical governance groups ensure
implementation of clinical effectiveness priorities.
We carry out robust internal governance assessments across the Trust. We will also continue
to work through a number of channels with patients and carers, commissioners and the public in
order to assure them of the quality of our services and to demonstrate our progress in securing
clinical improvements.
Patient Centred Care
SCT measures the success of patient-centred care through assessing patient and carer
experience. We expect our patients and carers to receive high quality care and be treated with
dignity and respect during every care experience.
Our patients are at the heart of all we do and we ensure that their voice informs all practice from
both individual patient interactions to strategic decisions of the Trust board.
We will involve our patients in their care on many different levels. In each interaction with
patients, we will ensure that their ideas and expectations are heard and acted upon. At service
level, we will involve patients in the future direction of the service via patient participation groups
and consultations. We will involve patients at Trust level through their attendance at board
meetings and their involvement as members of our future foundation trust.
We receive compliments and complaints from service users. We want to be proactive and seek
out how patients feel about the service we are delivering and work on their responses to
improve the quality of care they receive.
Patient feedback will influence the way we develop services. It will help us identify services that
require support and development and areas where we need to improve. Patient feedback will
also be used to identify areas of good practice and acknowledge the efforts of staff who deliver
excellent patient care.
We firmly believe that our patients should receive the ‘6 C’s’ when being cared for by our staff
as described in the national Compassion in Practice programme. The 6 C’s are:
 Care
 Compassion
 Competence
 Communication
 Courage
 Commitment
We have decided to include a 7th ‘C’ for consistency of care across our services.
These elements also reflect the new CQC inspection model for community services, which aims
to ensure any care provided is safe, effective, caring, responsive and well led.
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2.1
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Priorities for Improvement 2014/15
Following national evidence and local data collection, e.g. from incidents, complaints, staff,
stakeholders and service feedback, the following quality improvement priorities have been
agreed.
Safe Care
Improvement
Priority Area
Expected Outcomes
How will we do it?
Falls
To reduce the number of Extending the Falls Bundle work; benchmarking
patients who fall whilst in community hospitals audit data; review of
our care by 10%.
community assessment for falls risk and review
of compliance with updated NICE Guidance.
Medication
Incidents
For the number of
medication incidents
reported to plateau, or
continue to increase
demonstrating an open
culture of reporting by
staff.
For the proportion (%) of
medication incidents
assessed as causing
harm to be lower than
the previous year.
Encourage reporting through internal mandatory
training courses for staff.
Discuss, shared learning & improvements made
locally from medication incidents & throughout
the Trust’s governance structure.
Communicate with staff using the Trust’s
communication channels.
Review medication incidents at organisational
level; identify learning & improvements via the
Trust’s Medicines Safety & Governance Group.
Produce medication incident reports every 6
months.
Continue to improve the Trust’s incident
reporting system and to review, audit and
improve medicines processes and training.
HCAI
For there to be no
incidents of preventable
transmission of
healthcare acquired
infections (HCAIs).
Mandatory training undertaken by all clinical
staff.
Hand hygiene audits undertaken.
Any incidents investigated and the learning
shared.
A C.difficile reduction action plan is in place.
Never Events
For there to be no
‘Never Events’.
Through continuous staff training, appraisals,
staff safety awareness, newsletters and regular
patient safety messages cascaded through team
talk – SCT’s team briefing system.
VTE
For no in-patient in the
care of SCT services to
develop a Venous
Thromboembolism
(VTE).
A VTE risk assessment will be completed on
admission for all in-patients, as appropriate.
In-patients at risk of developing a VTE will
receive the appropriate prophylaxis.
A root cause analysis investigation (RCA) will be
conducted where any VTE occurs in SCT inpatient care.
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Effective Care
Improvement
Priority Area
Expected Outcomes
How will we do it?
Mortality
Reviews
A thorough review of all
patients who die within
our care will take place,
including a new
quarterly multidisciplinary mortality
review meeting.
The introduction of new patient death review
forms to all teams.
New quarterly mortality review meetings
introduced.
Pressure
Damage
For there to be a
reduction in the number
of cases of pressure
damage.
Develop and implement an operation framework
for the prevention of pressure damage.
An audit against the framework will be
undertaken.
Zero tolerance of preventable pressure damage.
Pressure
Damage
For staff to be equipped
with the necessary skills
to enable them to
prevent/manage
pressure damage
effectively.
For 85% of relevant staff to have undertaken
pressure damage prevention training.
Patient Centred Care
Improvement
Priority Area
Expected Outcomes
How will we do it?
Care Plan
Every patient identified
as being at risk of
pressure damage will
have a patient centred
pressure damage
prevention care plan
An audit against the operation framework for the
prevention of pressure damage will be
undertaken.
Friends and
Family Test
Patient feedback gained, Roll out of Friends and Family Test across
and acted upon, using
further services, according to national guidance.
the national Friends and
Family Test.
Patient Advice
& Liaison
Service (PALS)
For patients and families
to be able to meet with
an independent liaison
officer.
We will provide PALS surgeries at key Trust
sites in line with the recommendations of both
the Clywd and Hart Review and Patients
Association Peer Review.
Other Trust quality priorities and goals are set out in detail in the Trust’s Clinical Care Strategy
available on the Trust’s website, under Trust Reports.
Quality Account 2013/14
2.2
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Statements of Assurance from the Board
During 2013/14, Sussex Community NHS Trust provided and/ or sub-contracted over 90 NHS
services. We deliver our services to people in their own homes, in clinics or as inpatients
across Brighton & Hove and West Sussex. Our bedded units are at Arundel & District
Community Hospital, Bognor Regis War Memorial Hospital, Crawley Hospital, Horsham
Hospital, the Kleinwort Centre in Haywards Heath, Midhurst Community Hospital, Salvington
Lodge in Worthing and Zachary Merton Community Hospital in Rustington. We also provide
services from GP premises, schools and community facilities.
SCT has reviewed all the data available to them on the quality of care in all of these NHS
services. The income generated by the NHS services reviewed in 2013/14 represents 82.4%
per cent of the total income generated from the provision of NHS services by SCT for 2013/14.
2.3
Clinical Audit and Confidential Enquiries
During 2013/14, two national clinical audits and no national confidential enquiries covered NHS
services that Sussex Community NHS Trust provides. SCT participated in 100% of national
clinical audits, which it was eligible to participate in.
The 2 national clinical audits that SCT was eligible to participate in during 2013/14 were:
 Rheumatoid and Early Onset Inflammatory Arthritis.
 Sentinel Stroke National Audit Programme (SSNAP).
The national clinical audits that SCT participated in, and for which data collection was
completed during 2013/14, are listed below alongside the number of cases submitted to each
audit as a percentage of the number of registered cases required by the terms of that audit.
National Clinical Audit
Participation
% Cases Submitted
Rheumatoid and Early Onset Inflammatory Arthritis
(British Society for Rheumatology)
13 cases
100%
SSNAP (Royal College of Physicians)
46 cases
63%**
** The Trust was unable to participate in the first cohort of data capture due to a delay in capturing data
from other participants.
The report from the Rheumatoid and Early Onset Inflammatory Arthritis Audit is due for
publication in June 2015 and the report from the Sentinel Stroke National Audit Programme
(SSNAP) Audit is due for publication in May 2015. Once published, both reports will be
reviewed by the Trust and actions agreed.
Additionally during 2013/14 SCT participated in four further national clinical audits that did not
appear on the Healthcare Quality Improvement Partnership (HQIP) list, but were considered
relevant to local clinical practice.
National Clinical
Audit
National Body
Outcomes/Actions
Depression and Long
Term Sickness
Faculty of Occupational
Medicine
Report still to be published.
National Health and
Wellbeing audit
Faculty of Occupational
Medicine
Targets and benchmarks were
exceeded. Results showed that the
Quality Account 2013/14
(HWDU) (re-audit)
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Trust is looking at all elements of
health and wellbeing, including
secondary diagnosis.
MoHawk
(Management of
Health at work and
knowledge)
Faculty of Occupational
Medicine
(SEQOHS, or Safe Effective
Quality Occupational Health
Service accreditation)
Targets and benchmarks were
exceeded. No further action
required by the service.
National Audit of
Intermediate Care
NHS Benchmarking Network
The Trust is in the process of
identifying actions arising from the
audit.
2.4
Trust-Wide Audits
Management of Medical Devices
To comply with the Medical Devices and Decontamination Policy and the Care Quality
Commission’s Standards of Quality and Safety, all services within the Trust using medical
devices have to complete a management of medical devices audit, which checks compliance
with medical devices standards regarding procurement, inventory and maintenance, training,
risk management, records and storage of medical devices. In 2013/14, 82% of services
completed and returned a medical devices audit. Audit completion helped embed the reviewing
of staff competencies as part of the annual appraisal process.
Medicines Management
The Trust identified three medicines management audits as priority audits in 2013/14: omitted
doses audit, antimicrobial audit and the prescription chart audit.
The omitted doses audit found that 10 units/ wards from 13 showed an improvement (decrease)
in the number of omitted doses. Results informed a list of recommendations and an action plan
for Matrons to follow to ensure numbers of omitted doses reduce further.
The antimicrobial audit results showed an improvement on 2012 results, indicating that
antimicrobial prescribing is following approved guidelines and good practice. Areas for
improvement were the recording of allergies and prescribing of antimicrobials where urinary
tract infections were present. A list of recommendations and an action plan is in place and a reaudit will take place next year.
South Coast Audit conducted a management of controlled drugs audit on wards in SCT bedded
units and found ‘adequate assurance’. Actions were identified around the daily reconciliation,
receipt, ordering, security and pharmacy checks on controlled drugs. A further audit has been
agreed following the implementation of actions.
Infection Prevention & Control
There is a programme of annual infection prevention & control audits, including the
environmental audit and essential steps audits. During 2013/14, 85 environmental audits were
completed, of which 75 (88%) were fully compliant. Actions taken as a result of the audits
include: hand cream made available for staff in the out patients office, hydrotherapy policy
completed and implemented, application made to League of Friends for replacement chairs,
standardisation of products to improve decontamination, new hand hygiene sink agreed and
wall mounted apron holders ordered.
Quality Account 2013/14
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Monthly Essential Steps audits are also completed for hand hygiene, urinary catheter insertion
and urinary catheter on-going care
2.5
Local Clinical Audits
A total of 86 local clinical audits were undertaken by the provider in 2013/14 and SCT intends to
take the following actions to improve the quality of healthcare provided.
Title
Action to be Taken
Deep Vein Thrombosis (DVT) Following the first audit the Trust established a two level Wells
score form. A re-audit carried out three months later showed a
96% adherence to the standard, which was a significant
improvement.
Venous Thrombo Embollism
(VTE)
Continue to risk assess patients attending the Urgent Treatment
Centre ensuring they receive VTE prophylaxis as appropriate,
according to the NICE guideline.
Medical Gas Cylinders
All units now have compliant gas cylinder docking stations in
place and an agreed number of cylinders per ward.
Transfer of Care
Improvements made in the quality of notes of patients
transferred from an acute trust to Crawley Hospital. A re-audit
was undertaken and whilst some areas had improved, there
were further improvements that could be made. SCT will
continue to liaise with the other trust to improve the transfer of
records process.
RCN Benchmarking
Actions include a review of current bed occupancy, the use of
temporary staff to cover vacancies or to provide one to one care
to meet an individual patient’s needs, review of trained nurse
cover overnight, agreement to increase staffing levels in some
areas and / or the hours worked by senior clinical staff.
Resuscitation
Results showed that all in-patient units have the required
equipment (as stated in the policy). All managers of all units will
continue to undertake weekly checks to ensure continued
adherence to the standards.
NICE public health guidance
for the workplace’
Audit highlighted areas of good practice, which included:
 carrying out a three month Occupational Health (OH)
pilot to measure the date of sick leave commencement to
the date of referral to OH;
 analysing sickness data by equality and occupational
measures;
 completing/developing plans and strategy regarding
obesity;
 board reviewing health and wellbeing data alongside
sickness absence data;
 having a senior champion for health and wellbeing;
 engaging staff in developing and planning health
programmes;
Quality Account 2013/14
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
monitoring all programmes by diversity characteristics
and adjusting delivery to them.
These areas for improvement will now be taken forward by
various services.
Catheter
Actions identified from the audit are to:
 develop links with urology to gain a greater
understanding of why catheters are being inserted;
 work with urology and acute wards to improve
information on discharge;
 increase the number of patients that are being trialled
without catheter in the community to reduce patients with
long term catheters;
 increase training in the locality to improve staff
knowledge;
 identify staff weekly who can shadow urology nurse to
increase skills and knowledge on catheter care;
 increase staff knowledge on managing difficult catheters
through staff working closely with urology.
Dental Sedation Consent
Results showed that all patients/parents had given consent for
sedation, however in future it would be good practice to always
document this on the electronic patient notes system. The
treatment to be carried out should be agreed during the consent
process and documented both on the electronic patient notes
system and on the consent form. The side effects of inhalation
sedation should also be discussed and documented on the
consent form.
Dental Attendance
Recommendations made:
 review referral criteria and systems of referral;
 review the way Special Care Dentistry offers care to the
different groups of patients referred to the service;
 set up and trial a drop in dental service offering
emergency and ad hoc one off occasional treatments for
these patients;
 review the way first appointments for new patients are
offered;
 re-audit once changes have been made.
Radiographs
Recommendations are that clinicians must actively ensure that
radiographs are used to achieve optimal standards of diagnosis
and patient care, and that disease is not missed.
NICE Guidance ‘When to
suspect child maltreatment’
Actions are in place to address the following areas:
 training has been set up to cover staff who require it;
 changes are being made to the statutory training day to
ensure named professionals are covered;
 the guidance has been incorporated into level 1 and level
2 training;
Quality Account 2013/14
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
the guidance is available to all staff via a direct link on the
SCT Intranet.
Vaccine porter temperature
logs
The results show there is good compliance with completing
temperature logs.
AAA Surveillance data
transfer to GP
Laptops to be sourced so that data and ultrasound images can
be stored electronically on a central, national database and
transported in a timely manner.
Physiotherapy
This audit demonstrated the effectiveness of local steroid
injections; that a suitably qualified Extended Scope
Physiotherapy Practitioner is managing musculoskeletal
problems safely and effectively and that patients were
prevented from unnecessarily joining an orthopaedic waiting list,
achieving reductions in orthopaedic waiting times. Cost savings
were also demonstrated. Use to be continued.
Amputation
This joint audit between Brighton & Sussex University Hospital
(BSUH) and SCT has led to the development of prosthetic
service training sessions for BSUH staff and the creation of joint
SCT/BSUH clinics to serve patients better.
Quality Account 2013/14
2.6
Page 18 of 58
Participation in Research
The number of patients receiving relevant health services provided or sub-contracted by Sussex
Community NHS Trust in 2013/14 that were recruited during that period to participate in
research approved by a research ethics committee was 328 into 15 studies. In addition, 85
clinical staff and health professionals were recruited to 4 studies that had been approved by a
research ethics committee during this period, making a total recruitment of 413 participants to
19 studies.
The Trust offers patients the opportunity to be involved in research that has a direct relevance
to them, and staff to contribute to improving the care and treatments they provide.
Of the 19 studies conducted in the Trust, 18 were National Institute for Health Research (NIHR)
Portfolio studies. Six were conducted in services for children and 12 in adult services. Studies
in adult services looked at aspects of pressure care, models of better care for patients with comorbidities and for those receiving end of life care. Patients with musculoskeletal arm pain,
diabetes and cancer were also invited to take part in studies related to their treatments. Studies
taking place in children’s services involved patients with ADHD and Cerebral Palsy.
Trust staff took on the role of Chief Investigator for 2 studies this year following successful
funding applications to NIHR Research for Patient Benefit (RfPB) and Sparks, a children’s
medical charity.
In the last three years, our staff have also authored or co-authored 13 publications arising from
our involvement in NIHR research. This demonstrates our commitment to transparency and our
desire to improve patient outcomes and experience across the NHS. Participation in research
is key to improving the quality of care and contributing to wider health improvements and by
actively participating in research SCT clinical staff are able to stay abreast of the latest
treatment possibilities
Studies currently being undertaken

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The introduction of Petra running-bikes to encourage and facilitate weight-bearing
exercise for children with cerebral palsy who are unable to walk independently: a pilot
study.
The effects of night positioning on sleep, postural deformity and pain in children and
young people with cerebral palsy - an exploratory study.
Establishing best practice when assessing and supporting children with complex
neurological disabilities using eye gaze devices.
Maintained physical activity and physiotherapy in the management of distal arm pain .
Narratives of health and illness for Health-talk on-line.
Integration and continuity in Primary Care: polyclinics and alternatives.
Diabetes Alliance Research in England (formerly the Exeter Research Alliance) (DARE) .
Establishing and Implementing Best Practice to Reduce Unplanned Admissions in those
aged 85+ through System Change (ESCAPE 85+).
Optimising palliative care for older people in community settings: development and
evaluation of a new short term integrated service (phases 1b and 2).
Pressure Relieving Support Surfaces: A Randomised Evaluation 2 .
Experience of Pain in PM (PEMS) study.
National guidance for measuring home furniture and fittings to enable user selfassessment and successful fit of minor assistive devices-stage 3.
Quality Account 2013/14
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Helping people with aphasia have better conversations: which therapy works best and for
who?
Eye Movement Desensitization and Reprocessing (EMDR) therapy: A Study Exploring
Clients’ Relationship Style and the Therapeutic Alliance Between Clients and Therapists .
Transforming community health services for children and young people who are ill: a
quasi-experimental evaluation.
Can Talk - the clinical and cost effectiveness of CBT plus treatment as usual for the
treatment of depression in advanced cancer.
Diagnostic test accuracy of a modified screening questionnaire and home pulse oximetry
parameters in the diagnosis of obstructive sleep apnoea in children with Down syndrome.
ADHD and You.
An epidemiological Autistic Spectrum Disorder (ASD) study and establishing a research
database.
Participation in research demonstrates the Trust’s commitment to improving the quality of care
and contributing to wider health improvements. Our clinical staff are able to stay abreast of the
latest treatment possibilities and active participation in research leads to successful outcomes.
2.7
Commissioning for Quality and Innovation (CQUIN) Framework
Each year, a proportion of the money SCT receives (our income) is paid only if we achieve
quality improvement and innovation goals that have been agreed between SCT and any other
person or organisation they have a contract, an agreement or arrangement with to provide NHS
services. This happens through the CQUIN payment framework.
The agreed proportion of SCT income for 2013/14 was 2.5% of the contract value. Further
details of the agreed goals for last year and for the following 12-month period are available
electronically at http://www.sussexcommunity.nhs.uk/cquin.htm.
2.8
Statements from the CQC
Sussex Community NHS Trust is required to register with the Care Quality Commission and its
current registration status is ‘registered with no conditions’. The CQC has not taken
enforcement action against SCT during 2013/14.
SCT has not participated in any special reviews or investigations by the CQC during the
reporting period.
During 2013/14, one Review of Compliance report was published for Trust locations registered
with the CQC (Kleinwort Hospital). This location was subject to an unannounced inspection and
was assessed as compliant with all outcomes assessed.
The Trust also undertakes proactive internal ‘Assurance Reviews’ to self-assess its service
user, visitor and staff safety, clinical effectiveness and service user experience against the CQC
outcomes. Any areas identified for improvements are followed up ensuring remedial actions are
completed.
Quality Account 2013/14
2.9
Page 20 of 58
Data Quality
The table below details the actions Sussex Community NHS Trust is taking to improve data
quality. Key to this is the implementation of a new clinical information system, which is in the
process of being deployed throughout the Trust. The new system will enable staff to record
accurate, timely and complete data against the patient record. In addition, the Trust has plans
to introduce a mobile working solution to community-based staff, which will have a significant
impact on improving data quality by enabling data to be recorded at the point of patient contact.
2013-2015 Core Data Quality Strategy actions
Action
Achieved? Anticipated
Outcomes
Progress
Data quality is
best when it is
captured directly
by the person
who performs
the activity, at
the time the
activity takes
place.
On target
All staff will have an
awareness of the
importance of data
quality and the tools to
support record data
accurately at the point
it is created.
Work on raising awareness of data
quality via management awareness
days, intranet, user groups and
data quality reports. A mobile
working solution is being piloted to
enable data to be collected in real
time.
It is of
paramount
importance that
On target
Clear guidance to
support staff on
accurate data
This is a fundamental aspect of
training in the new clinical system
and will continue throughout the
Quality Account 2013/14
all data collected
is of appropriate
quality in
dimensions,
which include
accuracy,
integrity and
freshness.
Page 21 of 58
collection at the Trust
moving towards
compliance with the
Community Information
Data Set (CIDS)
requirements.
system roll out.
On target
A ‘baseline’ review of
current data use and
system analysis is
required.
Review of current data use and
system analysis underway
enabling us to develop information
flow maps.
Staff can usually On target
improve data
quality in their
normal work, for
example by
reducing input
delays and
checking at the
point it is created.
A trajectory of
improved data quality
in all teams will be
agreed through our
Business Planning
Process.
A pilot data quality dashboard has
been successfully trialled; this will
be rolled out to all services and will
show data quality improvements
and targets.
Staff training in
any data
collection.
On target
A full training
programme to support
the implementation of
the Trust’s Data Quality
Strategy in place.
Experienced trainers have been
recruited and detailed training is
provided to each service deployed,
training is tailored for each service
and staff role.
System changes
must be
communicated in
an effective and
timely manner to
ensure those
collecting data
are as informed
as possible.
Yes
The Trust will devise
and document a robust
change control process
in a new policy.
A change advisory board has been
set up and meets weekly to
discuss and approve any system
changes. All clinical changes are
directed to the clinical information
assurance group for ratification.
All data that is
collected must
be high quality
and focused, to
ensure it is being
used as
effectively as
possible.
Quality Account 2013/14
Page 22 of 58
2.10 NHS Number and General Medical Practice Code Validity
Sussex Community NHS Trust submitted records during 2013/14 to the Secondary Uses
service for inclusion in the Hospital Episode Statistics, which are included in the latest published
data.
The percentage of records in the published data that included the patient’s valid NHS number
was:
2010/11
2011/12
2012/13
2013/14
For admitted patient care
98.5%
99.9%
100%
99.9%
For outpatient care
99.8%
99%
99.4%
99.6%
For accident & emergency care
95.3%
99.2%
99.4%
99.2%
The percentage of records in the published data included the patient’s valid General Medical
Practice Code was:
2010/11
2011/12
2012/13
2013/14
For admitted patient care
99.9%
99.7%
99.4%
98.2%
For outpatient care
99.9%
99.7%
99.8%
99.8%
For accident & emergency care
100%
100%
100%
100%
2.11 Information Governance Toolkit Attainment Levels
Sussex Community NHS Trust’s Information Governance Assessment Report overall score for
2013/14 was 74% and was graded green - meaning our rating was satisfactory. This score was
an increase from the 2012/13 score and shows a significant improvement in our information
governance compliance.
Reaching an improved rating of 74% demonstrates the Trust has the processes to maintain the
protection and confidentiality of its patient information and that it adheres to data protection
legislation and good record keeping practice.
The Trust has a Senior Information Risk Owner and a Caldicott Guardian who are engaged with
information governance and the protection of patient information. In 2014/2015, the Trust will
work to improve its information governance scores and best practice further.
2.12 Clinical Coding Error Rate
SCT was not subject to the Payment by Results clinical coding audit during 2013/14 by the
Audit Commission.
2.13 Incidents and Patient Safety
All NHS Trusts in England are required to report patient safety incidents every week to the
National Reporting and Learning Service (NRLS) in order to promote learning. This indicator
covers patient safety incident reports for all incidents including those that resulted in severe
harm or death. The target for this indicator is to be below the national average for the
percentage of incidents that resulted in severe harm or death, which the Trust has achieved.
SCT considers that this data is as described for the following reasons:
Quality Account 2013/14
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The approach taken to determine the classification of each incident, such as those
‘resulting in severe harm or death’ will often rely on clinical judgement. This judgement
may acceptably, differ between health professionals.
In addition, the classification of the impact of an incident may be subject to a lengthy
investigation, which may result in the classification being changed. This change may not
be reported so the data held by a trust may differ to that held by NRLS.
Patient safety incident reports are monitored daily by SCT’s Risk Team for collation and
response as required
SCT’s board regularly reviews patient safety incident reports for themes and trends.
All Community NHS Trusts
Sussex Community NHS Trust
2012/13
Number of
Incidents
2012/13
% of
Incidents
Degree of
Harm
2013/14
Number
% of
Number
% of
of
Incidents
of
incidents
Incidents
Incidents
Not yet
assessed
16
0.27%
138
2%
26,254
45.74%
No Harm
3514
60.1%
3474
52%
21,616
37.66%
Low
1913
32.7%
2607
39%
9,005
15.70%
Moderate
334
5.7%
415
6%
412
0.72%
Severe
12
0.21%
17
0.75%
104
0.18%
Death
0
0
5
0.5%
Near
Miss
58
0.99%
23
1%
Total
5,847
100.00%
6,679
100.00%
57,391
100.00%
All 5 incidents recorded as a degree of harm of ‘death’ were reported because an unexpected
death of a patient who had involvement with one or more SCT services occurred. In no
instances was the death attributed to care provided by SCT.
SCT has taken the following actions to reduce the level of incidents resulting in harm to
patients:
 Actively encouraging incident reporting to increase improvement actions and
organisational learning.
 Our Patient Safety Leads have progressed their role to include monitoring identified
improvement actions and supporting shared learning across the Trust.
 Revised operational structure facilitating ownership of patient safety improvements.
 Continued delivery of the Falls Bundle in our bedded inpatient areas.
 Continued delivery against our Pressure Damage Prevention Framework.
 Delivery against a medications improvement plan.
Quality Account 2013/14
Page 24 of 58
2.14 Environmental Impact
Sussex Community NHS Trust’s sustainability journey began when it was formed in 2010. The
Trust Board approved our first Sustainable Development Management Plan (SDMP) in July of
that year. Nicknamed “15 by 15”, the SDMP aims to reduce key environmental impacts by 15%
between 2010 and 2015 and achieving zero general waste to landfill. The purpose was simple
– to demonstrate the benefits of taking action to become more environmentally sustainable and
lay the foundations for a more ambitious and longer-term sustainability strategy.
Since 2010, we have:
 Reduced our carbon footprint of 609 tonnes (10.7%), meaning we are well on course to
meet our 15 by 15 target.
 Recycled almost 60% of our general waste by weight, with the remainder being sent for
energy recovery, meaning we have achieved our zero general waste to landfill objective.
 Cut our vehicle emissions by 12.5% by introducing cleaner commercial vehicles,
including our first electric courier vehicle, and are progressively capping engine
emissions through our lease car scheme.
 Improved our energy efficiency (kgCO2e/m2) by 6.3% and our water efficiency (m3/m2)
by 34.8% through the introduction of energy efficient and renewable energy technology,
improving space utilisation and water efficiency and leak detection schemes.
 Created a comprehensive Business Travel Plan for the Trust aimed at reducing solo car
occupancy and promoting more sustainable and healthy travel modes and established a
unique Travel Bureau to support managers and their staff reduce travel time and costs.
 Developed a team of enthusiastic Carbon Champions to help deliver sustainability and
carbon reduction initiatives through staff engagement, with those staff making the most
telling contribution being recognised in annual staff awards.
 Initiated collaborative projects with our major suppliers to reduce the environmental
impacts of our supply chain.
In January 2014, our Board approved a new sustainable healthcare strategy, which sets out a
range of principles and actions aimed at addressing one of our strategic objectives, which is to
be a socially responsible, strong and sustainable business. The strategy is entitled “Care
Without Carbon”, reflecting our commitment to decarbonise our operations and become a more
economically, environmentally and socially sustainable business.
2.15 Estates
Accommodating our future
As a community trust with more than 4,400 staff, covering more than 800 square miles,
accommodation is a key issue for us. We currently operate from 300 locations, including 60
main sites and there is huge variation in the age and quality of the buildings we work in and
from where we deliver our services. SCT inherited many of these sites from a number of
different organisations in 2010.
Our five-year estates strategy looks at how to improve the quality of our accommodation, be
more efficient with the space we use, improve options for flexible working and at the same time
save money. View our estates strategy on our website www.sussexcommunity.nhs.uk under
Trust Reports.
Quality Account 2013/14
Page 25 of 58
Hub and spoke
Part of our plan is to introduce a ‘hub and spoke’ model, which we have already started to bring
in with support from our clinical teams and our new strategic partner, Capita. A ‘hub’ is a central
administrative space where staff can base themselves. Hubs are not locations to which patients
would expect to have to go. We aim to have six hubs in key geographical areas.
Linking to each hub will be a series of ‘spokes’, such as a health centre or GP surgery, where
staff are based and can access support and resources at the hub nearest to them. Our spoke
sites will ensure we maintain local, neighbourhood access to our services in smaller rural towns
and villages.
We have already identified four of our six main hubs:
 Brighton General Hospital (Brighton and Hove area)
 The Quadrant, Lancing Business Park (Lancing and Shoreham area)
 Southfield House (Worthing area)
 Southgate House (Chichester and Bognor area)
Further hubs will be identified for the Haywards Heath and Burgess Hill area and the Crawley
and Horsham area.
In addition to our administrative hubs and spokes, we are looking to improve our clinical
accommodation across the trust and are working closely with services to do this.
Our estates strategy is not just about buildings, but more about how we use our space to our
best advantage to strengthen team working and to make the most of technology to support us.
Quality Account 2013/14
Page 26 of 58
2.16 The Robert Francis Inquiry
In November 2013, the government published a full response to the public inquiry led by Robert
Francis QC into the events at Mid Staffordshire NHS Foundation Trust, “Hard Truths: the
journey to putting patients first”.
The five main areas covered by the recommendations are:
 Compassion and Care
 Values and Standards
 Openness and Transparency
 Leadership
 Information
SCT reviewed itself against the recommendations and an action plan was developed for areas
where it was felt improvements could be made. This is monitored by the Quality Committee and
progress reported to the Trust Board.
2.17 Cultural Enquiry
Culture has a significant impact on staff satisfaction, which in turn has an impact on the care
delivered. SCT seeks to ensure that our organisational culture supports staff in the delivery of
excellent care. An internal cultural inquiry took place as part of the organisational response to
the Francis report (2013). This sought to obtain staff views on the four priorities identified by the
Francis Report Outcomes Group (FROG). The inquiry found a wide range of views. Variances
could not be linked to particular professions, services or geographical areas. Some of the
themes that emerged were; staff commitment to the delivery of excellent care, the pivotal role of
line management, and the importance of support to raise concerns, and complexities involved in
working across organisations. Actions are being taken forward involving staff at all levels,
including a clear articulation of the Trust values and associated behaviours.
2.18 Staffing Levels
The Trust has agreed to invest significant resources to enhance staffing numbers and ratios
within some of our bedded units. The ratio of registered staff to unregistered staff will be
boosted to 65% & 35% respectively. A large recruitment drive is planned shortly to minimise
the use of agency staff and reduce reliance of bank staff.
Quality Account 2013/14
Page 27 of 58
2.19 Becoming an NHS Foundation Trust
The NHS Trust Development Authority (NTDA) continues to support our plan to become an
independent NHS Foundation Trust (FT) in 2015. In November 2013, senior Trust leaders met
with officials from the NTDA. We had the opportunity to describe the Trust’s progress in
2013/14 and to show how the Trust’s 5-year strategic plan will improve the quality of patient
care we provide and will deliver a sustainable model of care, both of which will deliver benefits
across the wider local health economy system.
The NTDA recognised the significant progress made by the Trust and this followed the positive
statements of support the Trust received from our commissioners and partners in the NHS and
local government across Brighton & Hove and West Sussex.
The Care Quality Commission (CQC) has recently introduced a new inspection model for all
care providers. All NHS Trusts must now undergo this new inspection, before proceeding
further with their FT applications. SCT is underway with its preparation for this new CQC
inspection, which will be held later in 2014. Following a successful inspection, the Trust is
planning to complete the NTDA FT assessment phase in 2014, before being assessed by
Monitor and authorised as an FT in 2015.
FTs were set up to devolve decision-making power from central government to local
organisations and communities. FTs are not directed by the government and are accountable
to local communities. This means that they have greater freedom to determine, (with their
governors and members (see below), their own strategy and the way services are run. FTs also
have more financial independence than NHS Trusts, and can use this to improve services for
patients and service users. FTs are not-for-profit, public-benefit corporations. Public-benefit
corporations are different from other public authorities, such as local councils, in that they have
membership.
Quality Account 2013/14
Page 28 of 58
We strongly believe that being an FT will help us to:
 Improve patient care.
 Be more open and accountable.
 Strengthen our links with local people.
 Build on the work we have already done to make our services more sensitive to the
needs of patients.
Many people feel a strong sense of connection to the NHS and to NHS service providers. The
principles behind FTs build on this sense of connection and ownership. FTs have a duty to
engage with their communities and encourage local people to become members of the
organisation. They must also take steps to ensure their membership is representative of the
communities they serve.
Anyone who lives in the areas we serve, works for the Trust, or has been a patient or service
user, can become a member of the FT. This gives staff and local people a real stake in the
future of their community services and means you can have a say in how the Trust is run.
 Call us on 01273 242127
 Visit our website www.sussexcommunity.nhs.uk/ft
 Email us sc-tr.sctmembership@nhs.net
 Write to us FREEPOST RSXG XTCJ BBBT, Foundation Trust Membership Office,
Brighton General Hospital, Elm Grove, Brighton, BN2 3EW.
 Complete the feedback form on the final page of this document.
By March 2014, we had recruited just over 4,000 public members and are on course to achieve
our 5,000 public members target by 2015 and encourage as many local people to join.
2.20 Working with Patient Representatives
Healthwatch
Healthwatch England is the new, independent consumer champion for health and social care in
England. Its job is similar to its predecessor LINks (local involvement networks) – to ensure the
voice of the consumer is strengthened and heard by the people that commission, deliver and
regulate health and care services.
Healthwatch England works across a broad range of organisations from local and specialist
partners to national health and care bodies and the government. It actively seeks views from all
sections of the community, and has close ties with the many organisations that represent them,
both at a local and national level.
Healthwatch England also supports the range of local Healthwatch bodies across the country.
As a Trust, we work closely with our two local Healthwatch bodies in West Sussex and Brighton
& Hove, welcoming their input as ‘critical friends’ as part of our on-going relationship:
 People from Healthwatch attend our regular meetings with patient representatives hosted
by our chair, Sue Sjuve.
 We supported the launch of Healthwatch West Sussex, and used the event as an
opportunity to talk with members of the public and patients.
 We attended the launch of Healthwatch Brighton & Hove along with the city’s mayor and
other key stakeholders.
 We welcome Healthwatch to our events, such as our annual general meeting and
meetings of the Trust board in public.
Quality Account 2013/14
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Page 29 of 58
We consulted Healthwatch about our plans to become an NHS Foundation Trust and
obtained their support and our plans around service development.
We send regular news items about the Trust for inclusion in their communications.
We engage with Healthwatch about service changes, and sought their comments with
regard to our Bognor Regis podiatry service, and our Brighton & Hove special care dental
service and community early years speech and language therapy service.
Healthwatch representatives attend our Patient Experience Group.
Scrutiny Committees
We have equally strong relationships with our two health and overview scrutiny committees –
West Sussex Health and Adult Social Care Select Committee (HASC) and Brighton & Hove
Health and Wellbeing Overview Scrutiny Committee (HWOSC). These bodies are made up of
locally elected councillors and have the power to hold NHS organisations to account for the
quality of their services.
We have spoken to West Sussex HASC on many occasions and delivered presentations about
our work including proactive care. We inputted into a themed focus on A&E highlighting the
work we do across our services to avoid unnecessary admissions to hospital, and formed part
of the wider discussions and consultation on the review of short break services for children with
complex needs.
We have spoken to Brighton & Hove HWOSC about patients outcomes from our integrated
primary care teams and our palliative care partnership (a partnership with the Martlets), raising
the positive impact they are having on people who we care for and the cost savings we are
making for the local health economy.
Quality Account 2013/14
Page 30 of 58
Part 3 - Looking Back
3.1
A Review of our Priorities for Quality Improvement in 2012/13
How did we perform against the priorities for 2012/13 as listed in last year’s Quality Account?
Patient Safety
Improvement
Priority
Expected
Outcome
What we said we’d
do
How did we do?
Understanding
the implications
for the Trust
from the
Francis Report
into failings at
Mid
Staffordshire
NHS
Foundation
Trust.
Complete service
diagnostic across
all services and
evidence of
assurance
against the
recommendations
of the report.
Implement four
prioritised Francis
Report themes,
detailed in our Francis
Report Outcomes
Group’s (FROG) action
plan:
1. Putting patients
first.
2. Fundamental
standards of
behaviour.
3. Openness,
transparency and
candour.
4. Leadership.
Cultural inquiry undertaken.
Values and associated
behaviours developed and
circulated throughout the
organisation.
Values based recruitment
commenced.
Management skills day and
leadership programmes in
place.
Probation periods introduced
for newly appointed staff.
Signed up to the Nursing
Times Speak out Safely
Campaign.1
Increase in staffing levels
agreed.
Strengthened leadership.
Internal assurance visits.
Patient stories at the trust
board.
Serious
Incidents (SIs).
Reduction of SIs
where they
present with a
repeated root
cause.
Ensuring all SI action
plans are followed
through and
completed.
During 2012/13, 86 Serious
Incidents were reported and
in 2013/14, 45 Serious
Incidents were reported,
representing a reduction of
41.
Incidents, actions & lessons
learnt have been regular
agenda items at the SCT
Pressure Damage Strategy
Group, Falls Group,
safeguarding, and infection
control forums, to share
learning and agree further
actions for improvement.
Established Trust-wide action
plan overseen by Serious
1
http://www.nursingtimes.net/opinion/speak-out-safely/#
Quality Account 2013/14
Page 31 of 58
Incident Review Group
(SIRG).
Board /Quality Committee
have undertaken focussed
review of individual
investigations & outcomes for
assurance that lessons learnt
have been adequately
embedded.
Clinical governance
newsletter is used to alert
staff to lessons learnt and
actions taken.
Patient Safety Lead (PSL)
‘stand’ at various Trust day
events to promote learning.
PSLs supporting clinical teams
with safety initiatives such as
audit, protocol development,
etc.
‘No harm’
incidents.
Increase the ratio
of ‘no harm’
incidents to
severe harm
incidents.
Ensuring all incident
action plans are
followed through.
Implementation of our
harm free care
strategy.
In 2012/13, the ratio was
224:1 and in 2013/14, the
ratio was 204:1, indicating a
reduction in the ratio of no
harm incidents to severe
harm incidents. This could
be due to better reporting as
the number of incidents
reported rose and the
number of severe harm rose.
Same as above, plus revised
operational structure enabling
shorter communication lines
to improve learning.
This will be a significant part
of the Trust’s quality
improvement priorities for
2014/15.
Clinical Effectiveness
Improvement
Priority
Expected
Outcome
What we said we’d
do
How did we do?
Pressure
damage
healing.
20% improvement
in pressure
damage healing
against the May
2013 Trust
baseline.
Monitoring and sharing
best practice via the
Trust’s Pressure
Damage Prevention
Strategy Group,
weekly monitoring,
enhanced education
and training for staff,
It has proved impossible to
quantify an improvement in
pressure damage healing.
This is due mainly to the
establishment of a robust
method of measuring and
recording pressure healing
rates taking longer than
Quality Account 2013/14
NICE
guidance.
100% of relevant
NICE guidance
implemented.
Page 32 of 58
new pressure damage
prevention strategy
and protocols,
improved reporting,
analysis and feedback
to staff. Zero tolerance
of avoidable pressure
damage.
expected.
This remains a priority for
2014/15 to embed the
prevention strategy and start
to recognise a reduction.
The Trust’s
Professional Forums
will lead NICE
guidance
implementation.
53% of directly applicable
guidance has been fully
implemented.
We are partially compliant with
33% of directly applicable
guidance – this guidance is
predominantly that which
requires joint implementation
with our partner organisations,
and we are working closely
with colleagues to progress
this.
We are currently implementing
the remaining 14% of directly
applicable guidance.
Patient Experience
Improvement
Priority
Expected
Outcome
What we said we’d
do
How did we do?
End of life.
80% of patients
dying in their
Preferred Place of
Care (PPC)
against the
2012/13 baseline
of 70%.
Promotion of Advance
Care Planning.
Development of the
Palliative Care
Partnership in Brighton
& Hove.
Implementation of the
End of Life Care
strategy.
84% of patients seen by the
Midhurst Macmillan Service
died in their preferred place of
death during 2013/14.
The target set for patients
seen by CPCT in B&H dying in
their PPC was 65%, which
was exceeded. 77.5% of
patients seen by the team in
B&H died in their PPC.
100% of patients seen by the
Community Palliative Care
Team were given the
opportunity to engage in
Advance Care Planning
(ACP).
End of life.
Establish a
baseline by
September 2013
of the number of
people dying in
their PPC, and
improving on this
Build on current good
practice in the North
locality of SCT in
relation to community
nursing services.
At the end of September 2013,
the number of people dying in
their PPC was 77.03%. From
October 2013 to March 2014,
this number had increased to
82.94%. This represents an
improvement of 7.67%, so
Quality Account 2013/14
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by 10% within the
year.
whilst slightly short of the 10%
target, is still a significant
achievement.
Pressure
damage
acquisition.
Improvement in
pressure damage
incidence
amongst our
patients,
achieving 20%
below the national
baseline for
comparable
Trusts.
Monitoring and sharing
best practice via the
Trust’s Pressure
Damage Prevention
Strategy Group,
weekly Safety Express
monitoring, enhanced
education and training
for staff, new pressure
damage prevention
strategy and protocols,
improved reporting,
analysis and feedback
to staff. Zero tolerance
of pressure damage.
It has not been possible to
measure this target as the
national baseline currently
does not exist.
This remains a priority for
2014/15 as the numbers of
people with pressure damage
being reported by SCT has
increased this year, due in
part to improved reporting
mechanisms, but also due to
an increase in activity and the
complexity of people receiving
our care.
Learning
disabilities.
Achievement of 6
criteria related to
meeting the
needs of patients
with learning
disabilities.
Implementing a robust
system to identify
patients using our
services who have
learning disabilities.
There is now the ability to add
a flag on SystemOne, the
patient administration system
The Learning Disabilities
Health Facilitation team are
now using this flagging system
All staff are required to have
completed Equality and
Diversity Training.
Development of more
easy read documents
and leaflets.
‘Easy Read’ treatment options
available via link on intranet
(Pulse) for all staff.
PALS leaflet available in ‘Easy
Read’ format.
Appointment letters being
created on the patient
administration system.
Raising staff
awareness of people
with learning
disabilities and their
needs, and how to
make services as
accessible as possible.
The Learning Disability Health
Facilitation team regularly
deliver a ½ day ‘Learning
Disability Awareness’ to all
operational / clinical areas.
Increased
representation of
people with learning
disabilities, and
increased patient
experience collection
from services users
A ‘reading group’ service has
been developed to provide
feedback of accessibility of
services for patients with
Learning Disabilities.
A patient story of service
experience, either in person at
Quality Account 2013/14
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with learning
disabilities.
the Board or by 1:1 NonExecutive time with a patient
with Learning Disabilities is
currently being arranged.
Provide suitable
support for family
carers who support
patients with learning
disabilities.
A ‘supporting carers’ protocol
and network for the
organisations’ carers has been
developed and includes those
who support patients with
Learning Disabilities.
All staff who have regular
contact with patients with
Learning Disabilities and their
carers are aware of the
support available from the
Carers Wellbeing service.
Friends and
Family Test.
Achievement of
Commissioning
for Quality &
Innovation
(CQUIN) goal –
10% increase in
our Net Promoter
score at year-end
vs. April 2013.
All specified areas
undertaking the
Friends and Family
Test as per national
guidance.
This target was not met. All
specified areas undertook the
Friends and Family Test as
per national guidance and our
average Net Promoter Score
(NPS) in March 2014 was 81
vs. 84 in April 2013. The test
was new in 2013/14 and SCT,
like other providers, found that
increases in response rates
reduced the average NPS
scores; SCT’s response rates
increased substantially from
11.8% to 18.3% over 2013/14.
All areas specified in national
guidance are participating in
the Friends & Family Test.
Patient survey.
20% improvement
in positive
responses in all
services against
the April 2013
baseline.
All areas undertaking a
minimum of an annual
patient survey to
gauge patient and user
satisfaction and
feedback.
It is not known if there was a
20% improvement in positive
responses. Due to
fundamental differences in
approaches to surveying
patients across the Trust, it
was impossible to draw
comparisons between different
surveys. In response, a
standardised Patient
Experience Survey has been
devised for use across our
adult services. This
standardised survey is being
rolled out to relevant services
in 2014/15.
Quality Account 2013/14
3.2
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Additional Achievements in 2013/14
3.2.1 One Call Team
In the past month, 84% of all referral calls were answered in less than two minutes. This
compares with just over 60% at the same time last year. Our Rapid Assessment Intervention
Team (RAIT) referrals are also increasing. In the past month, 560 patients have been referred
to our RAIT team (with 87% being seen on the same day of referral) compared to 332 at the
same time last year.
Find out more about our One Call and Rapid Assessment Intervention Team (RAIT) on our
website.
3.2.2 Proactive Care Team
Proactive care teams help reduce hospital admissions
Our proactive care teams have greatly increased the numbers of patients who have
personalised care plans (or ‘contingency plans’) in place within five days of being referred to the
team. Numbers have risen from 27% in September 2013 to 83% in December 2013.
As a direct result of this South East Coast Ambulance Service (SECAmb) have reported fewer
admissions to hospital of those patients who have contingency plans in place.
3.2.3 New Physiotherapy Service
New physiotherapy service for patients with chronic pain
Our physiotherapy teams in Crawley and Horsham have established a new service with our
local Clinical Commissioning Groups (CCGs), called the Functional Restoration Programme
(FRP). The FRP is designed to help people with chronic pain. It is not suitable for everyone
and it is specifically targeted at people with non-specific, psycho-social related pain. The first
courses started in Crawley and Horsham in March 2014.
For further information see our physiotherapy service information page.
3.2.4 Reducing the Risk of Falls in Brighton & Hove
Our teams working to reduce the risk of falls amongst elderly and vulnerable people in Brighton
& Hove were amongst winners at the Trust’s annual staff award ceremony.
Find out more on our website about our work with more than 50 care homes in Brighton & Hove
to train staff to prevent falls amongst their residents and our work with SECAmb, which has
seen a 50% reduction in the number of people taken to A&E who have suffered a fall.
3.2.5 CNRT (Brighton & Hove) win Proud to Care Award
Our Brighton & Hove based community neurological rehabilitation team (CNRT) won an award
at the end of March at the Sussex and Surrey Proud to Care Awards. The CNRT team secured
the 'team communication award', and were recognised for their drive to improve the way they
communicate with service users and how they provide information about their service and
obtain patient feedback.
Find out more about the CNRT’s award win on our website.
Quality Account 2013/14
3.3
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Complaints
In 2013/14, the Trust received a total of 204 complaints. This compared to 237 in 2012/13, a
drop of 33 complaints.
The 204 complaints we received can be broken down into the following complaint types:
 173 standard complaints.
 31 complex complaints (categorised as complaints that involve more than one
organisation and/or have involvement with a recordable Serious Incident or a
Safeguarding Alert).
In addition, the Trust resolved 27 complaints outside of the formal complaints process. These
involve complainants who do not wish to access the formal complaints process, make their
complaint verbally, and are happy with the resolution achieved within 1 working day. They are
recorded by the Trust for monitoring purposes, but are not recordable under the Complaints
Regulations, however they help to form part of our overall complaints data.
3.3.1 Categories of Complaint
Chart showing the
category of complaints.
3.3.2 Closed Complaints
At the time of reporting, of the 204 complaints received in 2013/14, 148 were resolved.
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3.3.3 Resolution of Complaints
At the time of reporting, 148 complaints have been resolved with the following outcomes, as
indicated below:
Chart 2 shows the
outcome of the closed
complaints.
An upheld complaint is where, after investigation, errors were found and learning identified. If a
complaint is not upheld, it means that after investigation no errors were identified.
The Trust is committed to ensuring that all communication with complainants is open, honest
and sincere. All complainants are offered the option of meeting with staff to discuss their
complaint/concern.
Learning from Complaints and Patient Advice & Liaison Service (PALS) contacts
The actions services have taken as a result of learning from complaints and PALS include:
 An improved telephone system within the Phlebotomy team enabling the service to
manage calls in a timely manner. An additional administrator recruited to assist with the
increased volume of calls.
 Improved knowledge of wound drain management systems enabling a wider staff team to
provide this type of care.
 The Community Palliative Care Team has developed a leaflet for both patients and
health professionals to clarify the referral criteria to their service.
 A review of documentation shared with GPs when patients are taken on the Community
Nurse caseload has provided clearer information with care planning.
 Implementation of a Discharge Summary sheet provided to GP practice nurses when a
patient is discharged from Community Care has helped to improve the transition of care
for patients.
 A photo board has been erected displaying key staff on the Horizon Unit at Horsham
Hospital. This gives patients the opportunity to identify who to speak with when requiring
specific information.
 A new referral logging system for the Bladder and Bowel service has been created to
reduce duplicated referrals and provide a ‘live referral’ source.
 The Bladder and Bowel service now send follow up letters when patients fail to contact
the service to arrange their visit.
Quality Account 2013/14
3.4
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Compliments
The Trust received 2,165 compliments in 2013/14 compared with 1797 in 2012/13. The ratio is
currently 11 compliments to every complaint received.
3.5
Equality & Diversity
The Trust’s Equality and Diversity Board agreed the following objectives for 2012-2016 as
required by the Equality Act 2010:
 Improve patient engagement with Seldom Heard Groups in order to reduce health
inequalities.
 Establish widely available and corporately well-managed accessibility to services
sensitive to patient needs.
 Meet annual targets for the completion of mandatory equality, diversity and human rights
staff training, appropriate to their role.
 Ensure leaders understand their role in the context of delivering against the Equality Act
2010.
To increase staff training levels, an Equality and Diversity workbook is being developed to
provide a flexible training option and to augment existing e-learning and group training
opportunities.
SCT is proud to retain its status as a ‘Two Ticks’ disability employer during 2013/14. This
means we are positive about disabled people and have committed to employing, retaining and
developing the abilities of disabled staff. We have made commitments regarding recruitment,
training, retention, consultation and disability awareness.
In 2014, the Trust is collaborating with Brighton & Hove City Council and other local NHS bodies
to manage tenders for Communication Support Services, which include overseas spoken
language interpretation, British Sign Language and lip speaking, bilingual advocacy, telephone
interpreting and written translation. The tender will ensure service users receive the best
possible service and providers receive the best possible value.
3.6
Volunteers
Volunteers play an invaluable role in SCT and we ensure they are fully supported, supervised
and developed in order to enhance service delivery and patient experience.
Our Volunteering Steering Group oversees the work of volunteers throughout the organisation
in the North, Brighton & Hove and Coastal localities working in conjunction with the Expert
Patient Programme, Sussex Snowdrop Trust and Community Macmillan Volunteer Managers.
The group ensures best practice in the engagement and support of volunteers, and aims to
reduce obstacles and increase opportunities in order to make volunteering in SCT inclusive and
accessible for all. A new database management system is now fully embedded to ensure
governance procedures throughout the Trust for volunteers are complete.
In 2013, we held a very successful garden party for over 200 volunteers in recognition for the
outstanding contribution that they make for SCT and at which the Chief Nurse gave out long
service awards. The Volunteering Steering Group will continue to work closely with clinicians to
further identify and carry out strengthening, improving and innovating service delivery in order to
improve patient experience.
Quality Account 2013/14
3.7
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Safe Care
3.7.1 Serious Incidents and Incident Reporting
The Trust continues to use an incident reporting system called ‘Safeguard’ which enables staff
to report quickly and simply, any incident or near miss they have witnessed. Safeguard also
allows the Trust to monitor reporting themes and trends, and to ensure incidents are rapidly
responded to. The data warehouse also extracts data from Safeguard to contribute to the
Trust’s comprehensive performance reporting.
During 2013/14, 6,679 incidents were reported, representing a 14.4% increase compared with
2012/13 and maintaining a year on year increase in reporting. This culture of increased
reporting reflects:
 The continued positive experience and confidence of staff in the use of the reporting
process.
 The high profile of incident reporting through themes and learning being regularly shared
and discussed in clinical teams across all services.
 An open reporting culture encouraging staff to understand their obligation to report
incidents.
The Trust has continued to meet its responsibility to send incidents relating to patient safety to
the National Patient Safety Association (NPSA) via the National Reporting and Learning System
(NRLS). When the NPSA compares this information with other Trusts, SCT reports an average
number of patient safety incidents for its size.
The chart below shows the incident reporting activity in the Trust during 2013/14.
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3.7.2 Frequently Reported Incidents
The chart below shows the three most frequently reported category of incidents in 2013/14:
pressure damage, slips, trips & falls and medication errors.
Whilst the level of reported medication errors has remained relatively static, slips, trips and falls
has shown a reduction from 20% to 16% reflecting the positive impact of the health and safety
management system and associated auditing, and operation of the falls bundle in managing
patient falls.
3.7.3 Serious Incidents
In 2013/14, 30 Serious Incidents (SIs) were reported, a reduction on the 84 reported during the
previous year. Of these, 23 related to pressure damage, followed by 3 falls, 2 sudden
unexpected deaths and 2 infection control issues. All SIs were investigated to establish their
root cause and to identify actions and learning to reduce, where possible, the likelihood of a reoccurrence.
The Patient Safety Leads recruited during 2012/13 have developed their expertise in incident
investigation, identifying themes and working with services and teams to implement
improvements in clinical practice reflecting the learning from these investigations. Reporting of
investigation findings through the Serious Incident Review Group has increased consistency,
shared learning and wider communication to other services.
Lessons learned from SIs are communicated across the Trust in a number of different ways to
maximize the opportunity for all relevant staff to benefit, including:

Immediate changes to practice implemented in the relevant service.

Locality governance meetings and cascade of information and knowledge from these
meetings to relevant teams.

Promotion of lessons learned, including themes, through information pages on the Trust
intranet, clinical governance newsletter and the Trust’s weekly update newsletter.
3.7.4 Healthcare Associated Infections (HCAIs)
In 2013/14 our team were involved with Post Infection Reviews (PIR) for four patients who had
Methicillin-resistant Staphylococcus aureus (MRSA) blood stream infections. The PIR process
is new from April 2013. None of these cases were identified as attributable to Sussex
Community NHS Trust as they were cared for by several organisations. However, we
contributed to the collection of information and formulating the learning.
Quality Account 2013/14
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During 2013/14, ten patients were identified as having Clostridium difficile (C. diff.) infection
whilst in our bedded units. Two of these cases came to us from other organisations within 72
hours of admission, in a further two cases the patients had repeat specimens sent to the
laboratory and so they were counted as new episodes of infection. Of the remaining six
patients, all but one were considered unavoidable. For the avoidable case. the prescribing of
antibiotics had been for 7 days instead of 5 which is not in line with our current antibiotic
prescribing guidelines. Information and training has been provided for the prescriber.
There has, however been a local rise in the number of cases, as a result of which SCT have put
a C.diff reduction action plan in place and will continue to work with colleagues across the
health economy to reduce the infection.
One patient experienced an E. Coli blood stream infection whilst in Crawley Hospital. An
investigation was completed which showed SCT staff had followed protocols correctly.
3.7.5 Central Alert System
The Department of Health (DH) Central Alert System (CAS) is designed to rapidly disseminate
important safety and device alerts to nominated leads in NHS Trusts in a consistent and
streamlined way for onward transmission to those who need to take action. A detailed plan is
created for any alert applicable to the Trust and a lead identified to progress work. Trusts are
required to acknowledge receipt of each alert and respond as relevant within specified
timescales.
2012/13
2013/14
Total number of alerts received
115
233
Acknowledged within 2 working days
110 (96%)
231 (99%)
Found to be applicable to SCT
46 (40%)
41 (17%)
Applicable alert responses within prescribed timescales
43 (94%)
39 (95%)
During 2013, NHS England and the Medicines and Healthcare Products Regulatory Agency
(MHRA) who manage the CAS system on behalf of the DH invited the views of interested
stakeholders to inform their planned review of the process and its IT capabilities. SCT
participated in this consultation process. The objective is to maintain what is good while
incorporating improvements through a revised system due to be implemented in late 2014. The
new system will include stronger correlation between incidents reported through the NPSA and
NRLS, Alerts and SIs, and improved feedback through the introduction of national networks
through CAS.
3.7.6 Never Events
There have been no ‘Never Events’ during the reporting period.
3.7.7 Safeguarding Adults
As last year, SCT once again participated in the multiagency audit of safeguarding
investigations, during which various agencies investigations are scrutinised to ensure robust
processes have been followed ensuring the welfare of those at risk is safeguarded.
Up until the end of March 2014, the majority of the Safeguarding Adults at Risk Team were
commissioned by the CCGs to undertake investigations and support practice in Care Homes.
This resource has now transferred back to the CCGs and in order to strengthen safeguarding
adults at risk for SCT, a dedicated team is being recruited.
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As planned SCT developed a three-year Safeguarding Adults strategy (2013-16) focusing on
the DH’s six key principles of safeguarding:
 Empowerment
 Protection
 Prevention
 Proportionality
 Partnership
 Accountability
The Chief Nurse leads the strategy, which includes a three-year training strategy for
safeguarding adults, mental capacity and Deprivation of Liberty Safeguards.
3.7.8 Safeguarding Children
The safety and welfare of children and young people is of paramount consideration for SCT and
its staff. All Trust staff (clinical and non-clinical) are responsible for the safety and well-being of
children and young people. SCT is committed to developing a culture in which the day to day
working practice of staff promotes the safety and well-being of children and young people. The
trust supports a zero tolerance policy towards acts of abuse and seeks to maintain good
systems for effective identification of child maltreatment. SCT ensures staff are aware of their
responsibilities and know who to access for support, guidance and referral.
The Trust has two safeguarding children teams, which are aligned with three Clinical
Commissioning Groups (CCGs) and two Local Safeguarding Children Boards (LSCB). Based
on historical arrangements, Chailey Heritage Clinical Services are aligned with Brighton and
Hove locality Safeguarding Children team. These overall arrangements enable robust, effective
support, development and advice to be provided to all staff across the organisation.
Safeguarding children supervision is organised to work as part of these arrangements, they are
underpinned by safeguarding children supervision procedures.
A Children Act Section 11 audit is undertaken every two years to provide an overview,
assurance and inform action planning for the Trust, LSCBs and CCGs. The Section 11 audit
has been completed this year and signed off by SCT’s Chief Nurse. It has been submitted to
the Brighton & Hove LSCB and West Sussex LSCBs. The majority of the standards audited are
RAG rated green, demonstrating SCT compliance with national requirements. Current
amber/red RAG ratings are in relation to staff development with regard to preventing Child
Sexual Exploitation and understanding e-safety risks for children and young people. An action
plan is in place to address the amber/red areas and this is monitored at the Trust-wide
Safeguarding Children Group.
Staff training and development is informed by a training needs analysis and a safeguarding
children learning and development strategy. This means an annual safeguarding children
programme is in place providing opportunities for all levels of development to be achieved, i.e.
levels 1-5 as outlined in the intercollegiate document, ‘Safeguarding Children and Young
People: roles and competences for health care staff’.
Trust-wide and locality safeguarding children audits are undertaken to inform both the
organisation and both LSCBs. The focus for this year has been on auditing against NICE CG89
guidance – ‘when to suspect child maltreatment’, safeguarding children supervision audits and
regular case file audits are also completed for both LSCBs. Internal management
reviews/serious case reviews have been undertaken in both LSCBs. The key learning points
from these have been shared with relevant staff groups and associated action plans have been
completed.
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The organisation strives to achieve robust
multi-agency collaboration in all safeguarding
children matters. In the coming year
continued development of Multiagency
Agency Safeguarding Hubs (MASH) in both
Brighton & Hove and West Sussex will
support this commitment. As will continued
multi-agency training opportunities, such as
involving the police in staff development days
for health visitors and school nurses in West
Sussex.
The Chief Nurse holds overall accountability
for both of the organisation's safeguarding
children teams and for identification of
organisational safeguarding children priorities
and how these are addressed.
3.8
Patient Centred Care
Throughout the year, our services collected
patient feedback using different methods, e.g.
postal surveys, one-to-one interviews and
user groups. Survey results and actions
taken in response to issues raised are
reported to the Trust’s Patient Experience
Group, for example:
 Time to Talk, a talking therapies
service in West Sussex: the introduction of additional live supervision to enhance therapy
outcomes.
 Contraception & Sexual Health, Brighton: clearer information given to service users on
arrival about waiting times.
 Children’s Speech & Language Therapy Service, Brighton & Hove: the introduction of
strategies to increase parent involvement including:
o offering opportunities for parents to observe a therapy session, if appropriate, at
school or as part of a home visit;
o agreeing how to feedback to parents following a direct contact with a child in
school;
o offering parents more specific ideas of home activities, particularly during school
holidays;
o ensuring speech and language therapists have opportunities to meet teaching
assistants supporting children to ensure everyone is clear about speech, language
and communication objectives.
3.8.1 Patient Advice & Liaison Service (PALS)
The PALS service provides patients, relatives, carers and service users with an immediate
resolution for non-serious issues. It also provides information on how to access the formal
complaints process.
We received 547 PALS enquiries during 2013/2014, which represents a 14% increase
compared to 2012/2013. Trends for this year show ‘Appointments’ and ‘Communication’ to be
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the highest categories of contact. Common enquiries relate to waiting times for appointments
and requests for contact details of services.
The PALS service also signposted 301 enquiries in relation to other local NHS Trusts. This is a
significant increase of 75% compared with 2012/2013. To help mitigate the number of enquiries
we receive relating to other Trusts, we will be adding contact details of other PALS services in
the area onto our external website.
Currently, our PALS service is contactable by phone and email. In 2014/15 we will also be
providing PALS surgeries at key Trust sites. This will enable patients and families to meet face
to face with an independent liaison officer and is in line with the recommendations of both the
Clywd and Hart Review and Patients Association Peer Review.
3.8.2 Friends & Family Test
NHS England introduced the Friends and Family Test (FFT) in 2013. Patients who use
participating services are asked a simple question: How likely are you to recommend our
ward/service to friends and family if they needed similar care or treatment? All SCT inpatient
units, the Urgent Treatment Centre in Crawley and both Minor Injury Units in Horsham and
Bognor Regis are involved.
FFT aims to be a simple test of patient experience to identify what is working well and what can
be improved. To facilitate this, comments from patients are distributed directly to frontline staff
where the impact can be made. To support staff feeding back to patients the improvements
they have made, a tool for creating a poster has been developed for use in clinics and wards in
the style of ‘You said.. we did’.
3.8.3 Patient Experience Survey
In spring 2014, a standardised patient experience survey was piloted in 14 adult services. The
goal of the standardised survey is to uniformly capture patient experience across many teams
and services so their experiences can be analysed and compared in a systematic way. The
pilot and supporting toolkit has been well received by participating services and a full rollout to
all adult services will take place in 2014/15.
3.8.4 Patient Experience Group
Reporting into our Trust-Wide Clinical Governance Group, the Patient Experience Group has a
broad membership of stakeholders, including public and patient representatives, Healthwatch
representatives, clinical and managerial staff, patient experience staff, communications staff
and a non-executive director. The Associate Medical Director for Clinical Quality chairs the
group.
3.8.5 Patient Experience Strategy
In 2013/14 a key piece of the Patient Experience Group’s work was the continued development
of a Patient Experience Strategy. The strategy embodies the Trust’s drive to put patients at the
centre of service delivery and include their views and opinions in developing new services. The
Patient Experience Group focuses on taking the strategy forward over the next four years
including achieving improved participation of minority and disadvantaged groups.
3.8.6 Board Stories
SCT recognises the importance of the views of patients and their relatives and actively
encourages them to make their voices heard. One of the ways we do this is at Board meetings.
Each one starts with a patient, or a relative of a patient, describing what their involvement with
Quality Account 2013/14
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the Trust has been, and giving details of where things could be improved in the future, as well
as sharing what worked well.
The Board uses this key information to see what lessons can be learned in relation to not only a
particular unit or service, but also whether there are lessons that need to be learned on a Trust–
wide basis. The patients who attend board meetings to share their stories have had both
positive and negative experiences as we can learn from both, i.e. the positive experiences
enable us to spread the good work across the Trust and the negative comments focus our
attentions on where we can improve.
3.9
Staff Care
3.9.1 Staff Communications
To strengthen staff engagement, we continue to improve the ways we communicate with staff,
and promote good dialogue between staff and the senior team.
 We launched our new intranet, ensuring all relevant content is included.
 We deliver a monthly team briefing system to carry messages from the executive
leadership team to frontline staff, encourage discussion in teams and generate feedback.
 We send out a weekly message from our chief executive to all staff, linking what’s going
on within the Trust and locally to the bigger national picture.
 We publish our staff magazine and employee of the month scheme, showcasing best
practice and recognising achievement.
 Members of the board and executive leadership get out across the Trust visiting services.
 We are running surveys and other audit measures to evaluate the effectiveness of our
internal communication channels.
3.9.2 Staff Experience
The annual NHS staff survey provides an insight into staff views on the organisation and their
experience of working within it. The survey is a key measure of staff engagement and
wellbeing, which directly correlates with patient outcomes and experience and is essential to the
provision of high quality services. When compared to previous years, the results can prove a
useful tool in measuring progress and aiding our continuous improvement.
In 2013, we were required to survey a random sample of 850 staff and our response rate was
51%. In addition to the mandatory sample, we opted to survey all 4,000 eligible staff. In total,
we received 1,718 responses (43%) - an increase of 258 responses (38%) since 2012.
There were major increases in some scoring areas last year such as appraisal, recommending
the Trust as a place to work or receive treatment and overall job satisfaction. There were some
areas for improvement including an increase in the numbers of staff reporting they experienced
feeling unwell due to stress and reduced numbers of staff receiving Health and Safety training.
What we did


Appraisal – we continued to support services to improve the uptake and quality of
appraisals. Appraisal rates have been rising and reached 86% in December 2013.
Statutory training has been completely revised. There has been an improvement in the
uptake of training delivered through the statutory training day (which includes Health &
Safety training). Rolling attendance rates rose from 43% in April 2013, to 74% in March
2014.
Quality Account 2013/14
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Stress - new Employee Assistance Program has been put in place. This provides
counselling and a range of advice services available to staff 24:7. This is a significant
enhancement to our previous offering for a lower cost.
Occupational health provides stress training for managers. They have engaged a
psychologist to enhance their range of services to staff, and resources to assist with the
self-management and reduction of stress, anxiety and depression have been publicised.
Health and Lifestyle - we have promoted NHS Health Checks to staff and made them
readily available through our Prevention Assessment team.
Incidents of violence and aggression - contact is made with all staff who report an
incident to ensure appropriate support and follow up. There has been an increase in the
issuing of behavioural contracts as a result of reporting incidents of violence and
aggression.
Supervision - we have maintained high levels of participation in supervision and
increased the proportion of teams demonstrating 100% compliance.
Where we are now?
The Trust has been on a journey of improving scores since its inception and has seen many
clear improvements in scores, both year on year and in comparison with other organisations.
All Key Findings scores are as good, or better than last year, no scores have declined. In
comparison to other community trusts we have nearly doubled the number of scores that are
better than other trusts and reduced the number that are worse to 4. Where our scores are
worse, we are not far from the average.
3.9.3 The Productive Series
The Productive Series involves the delivery of structured modules for quality improvement. The
programmes are designed for a range of settings and suitable for implementation by any team
delivering health care. The programmes provide enabling frameworks to empower staff to drive
improvements in efficiency and productivity and release more time to care.
During the last year staff have achieved a significant amount using the Productive Series, with
several teams winning awards as a result (see section 3.1). During 2014/15 the Trust will
continue to use audit tools to assess compliance with agreed standards of care, celebrate good
practice and identify areas for further improvement. The Productive Series team plan to use
the modules and other improvement methodologies to refocus on supporting service level
improvement and organisational transformation programmes, together with supporting services
to develop new ways of working in community hubs.
Quality Account 2013/14
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Who did we involve?
Clinicians, managers and support staff have all been invited to contribute to the 2013/14 Quality
Account, identifying their priorities for improvement for 2014/15.
Stakeholders who have been involved in the development of the Quality Account include:
 Our staff
 Service users (via our Patient Experience Group)
 Commissioners who have been asked to comment via letter
 Brighton & Hove City Council and West Sussex County Council who have been asked to
comment via letters to their respective Health & Wellbeing Overview & Scrutiny
Committee (HWOSC) and Health & Adult Social Care Select Committee (HASCS)
 Healthwatch Brighton & Hove and Healthwatch West Sussex have been asked to
comment via separate letters.
All the stakeholders listed above were also given opportunities to contribute to and comment on
the development and content of this report, and their statements follow.
Quality Account 2013/14
5
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Statements provided by Stakeholders
Please note, on receipt of the constructive feedback from our stakeholders, some of the
anomalies regarding data inconsistencies and further explanations have been addressed.
5.1
Commissioners
Sussex Community NHS Trust
Response to 2013/14 Quality Account
NHS Crawley, Horsham and Mid Sussex, Brighton & Hove and Coastal West Sussex CCGs
have reviewed the Quality Account and are agreed that the document meets the Department of
Health national Guidance on Quality Account reporting. The format and content of the report
includes the key headings and references necessary for Patient Safety information,
Commissioner Scrutiny and Regulator Standards
Priorities for 2013/14
As one of the largest NHS Community trusts in the country considerable strides have been
made in many areas, notably the Employee Assistance Programme to help staff deal with
workplace stress, and the focus upon improving care to patients by reducing falls and skin
pressure damage.
The NHS Staff Survey highlighted employee stress as a major contributor to Trust sickness
rates. The Employee Assistance Programme would therefore, benefit from a joint focus on the
linkages between employee satisfaction, overtime rates, bank and agency usage, appraisals
and mandatory training, and the impact of the nurse to patient ratio reviews. This work also
feeds into the staff Friends and Family Test scheduled for later this year.
The Quality Account gives an explanation of the benefits IT and data collection brings not only
to patients, but also to staff in their daily work. This IT facility could also be used to promote
remote working, and an explanation of how this could work in practice would be welcome.
An outline of the Specialist/Advanced skills necessary to meet new service requirements would
better highlight the considerable work underway in this respect. It could also be used to
demonstrate to the public and staff the partnership working underway with Primary/Social
Care/Private Sector.
Additionally the internal Francis report review has enabled the Trust to identify gaps and create
an improvement plan. The review of all deaths which occur in care is particularly welcome, and
would be even more robust if done in partnership with the wider Multidisciplinary team and
Primary Care. This could form an important future marker for the Older People’s Frailty
Pathway. The focus upon developing a Community Research Institute demonstrates a will to
improve and advance care with underpinning evidence.
The CCGs whilst acknowledging the progress made are aware that the Trust faces specific
challenges in some key priority areas, namely the further reduction in patient falls and Pressure
Damage. To further reduce Pressure Damage and Health Care Acquired Infection requires
better working with partners in the health care system in line with CQUIN requirements.
The CCGs have some specific comments to make on the presentation of data in the document.
The Patient Safety incident numbers would appear to relate to May 2014. This was previously
Quality Account 2013/14
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raised at a Quality meeting with the Trust. The cut-off point should relate to March 2014.
Additionally the totals for the degree of harm would appear to differ from the numbers on the top
of page 33.
It is understood that the Trust has now instigated a new incident reporting system whereby all
types of pressure damage occurring inside and outside of SCT care are reported. This has
resulted in an increase in numbers as these figures were not previously captured. It is
acknowledged however that this openness and transparency from the Trust positively promotes
the collaborative working with other providers, ensures the Trust is able to focus on the
elements that are within their control and enables triangulation of the wider picture.
NHS Guidance letter for 2013/14 (9/1/14) requires the Trust to include the readmission rates
within 28 days for patients 15 years and over.
On page 29 under Patient survey results it would be helpful to have a fuller explanation as to
why the target against the baseline has not been met. Also at 3.1.1 on the same page regarding
the One Call Team, it would be helpful to have the % seen on the same day of referral to show
improvement.
It was felt that a sentence explaining the changes to the Safeguarding Adults Team and the
planned restructure for 2014/15 would be helpful in setting the scene for older people’s
protection.
The issue of Learning Disability clients in the Dental service would benefit from a fuller
explanation of how consent is obtained in these circumstances, and how people without
capacity are managed.
The Trust in line with other organisations has challenges with data quality and capture;
especially it would appear in the North of the county. The CCGs look forward to improvements
arising from the implementation of the new Data System
It would also be helpful to have consistent Equality and Diversity data available, in recognition of
the diverse population served.
Priorities for 2014/15
The priorities for 2014/15 appear to be appropriate, and are in line with the areas where further
progress is required.
Conclusion
The trust has made good progress in many areas against its priorities for 2013/14.
The challenges over the coming year are to build upon the progress to date, whilst accelerating
the necessary changes. The Partnership Working with the Acute Sector, Primary and Social
Care, and Commissioners will be crucial as many of the issues are outside the sole control of
the Community Trust. The transformation of services whilst keeping a diverse and widely
dispersed workforce motivated and energised, poses particular challenges for the Board and
senior management. The investment in Staff welfare is a welcome recognition of this need.
The collection of feedback from patients in the many environments in which care takes place, can
be difficult, however the efforts to collect and act upon views is noted. The CCGs look forward
to reviewing over the coming year the more detailed work with the Friends and Family Test.
The Community Trust is making progress and if sustained will be in a good position to attain
Foundation Trust status in 2015. The CCGs look forward to working closely with the Trust in this
respect.
Victoria Daley
Head of Quality/Chief Nurse
29th May 2014
Quality Account 2013/14
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Healthwatch Brighton and Hove
Healthwatch Brighton and Hove Response to
Sussex Community NHS Trust (SCT) Quality Account
Sussex Community Trust had a good working relationship with our predecessors, the LINk and
has proactively consulted with Healthwatch Brighton and Hove. We look forward to working
more closely with the Trust in 2014.
“Find out more here on our website about our work with more than 50 care homes in Brighton &
Hove to train staff to prevent falls amongst their residents and our work with SECAmb, which
has seen a 50% reduction in the number of people taken to A&E who have suffered a fall.
Target: “To reduce the number of patients who fall whilst in our care by 10%.”
Healthwatch Brighton and Hove commends the Trust for the work they have done on falls
prevention and would like to see other innovative ways utilised to reduce falls in the community.
We broadly support the reduction of agency staff as a more sustainable and consistent
experience for patients, and a more financially stable and resource efficient direction for the
organisation. The majority of the negative information we receive about SCT is around nonattendance or lateness of community nurses, we would hope that more regular staff may
improve this.
A number of additional concerns raised have been about the bladder and bowel service,
particularly in relation to catheter care. For this reason we wholly endorse the actions related to
the catheter audit around increased training and knowledge.
Many people appreciate face-to-face advice and support at difficult times, and for this reason
the creation of PALS surgeries (by the Trust) where patients can resolve issues in the manner
are a positive step. We look forward to some collaborative work in this area.
“For the proportion (%) of medication incidents assessed as causing harm to be lower than the
previous year.”
Healthwatch Brighton and Hove would have liked SCT to have included a percentage target to
reducing medication incidents.
Quality Account 2013/14
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Healthwatch West Sussex
Horsham Advice Centre
Lower Tanbridge Way,
Horsham, RH12 1PJ
0300 012 0122
27th May 2014
Comment from Healthwatch West Sussex on Sussex Community NHS Trust
Quality Account (QA) 2013/14
As the consumer champion for health and social care consumers across the county,
Healthwatch West Sussex welcomes the emphasis given in the Chief Executive & Chair’s
statement to the centrality of patient experience in assessments of Trust performance.
From the consumer perspective we have obvious concerns over the almost two-thirds increase
in total number of incidents over the year as reported in Section 2.13 (and apparent data
inconsistencies with section 3.6.1), and in particular the rise in those resulting in Death and
Severe Harm. We will follow with keen interest the impact of actions taken to counter rising
incident levels in next year’s QA. We welcome implementation of the Friends & family Test
mentioned in the Patient Experience section of the table in section 3.1 though the inconclusive
reporting on the Patient Survey outcome was disappointing (p.29).
The Complaints analysis section is welcome leading as it hopefully does to a better
understanding of service deficiencies and gaps. We commend the list of remedial actions
implemented arising from the complaints process and PALS contacts (p.31). Additional clarity
offered to the public on which services are managed by which local Trusts will hopefully reduce
the number of significant numbers of misdirected PALS enquiries.
The Trust has engaged well with Healthwatch West Sussex over PLACE audits and recognised
the value of engaging with independent patient assessors on subsequent follow up discussions.
The Trust Chair has also communicated proactively with us on issues of patient care. With this
in mind, we are disappointed at the lack of engagement with the Trust on the QA prioritisation
and criteria selection process and hope this will be improved next year. In addition, we have
evidence through PPGs that there is a need for better communication with primary care
services in West Sussex on the part of the Trust, having been perceived as moving its Health
Visitors from Health Centres without sufficient consultation.
Whilst acknowledging the difficulties of compiling a draft QA from its various sources, as a
vehicle for public information and health literacy, this draft could be made easier for lay readers
to follow, for example by utilising tables and graphics depicting trends and comparative data (eg
relating to Patient Experience in Section 3) facilitating easier interpretation for the reader.
Healthwatch West Sussex looks forward to continuation in improvement in its relationship with
the Trust and jointly reviewing performance from the patient and public perspective.
Frances Russell,
Chair of the Board, Healthwatch West Sussex
Quality Account 2013/14
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West Sussex County Council Health & Adult Social Care Select C’ttee
Mrs Margaret Evans
Chairman
Health & Adult Social Care Select Committee
033022-22532
e-mail address:
Margaret.evans@westsussex.gov.uk
website: www.westsussex.gov.uk
County Hall
West Street
Chichester
West Sussex
PO19 1RQ
30 May 2014
SENT VIA E-MAIL
Dear Janet
2013-14 Quality Account
Thank you for offering the Health & Adult Social Care Select Committee (HASC) the opportunity
to comment on Sussex Community NHS Trust’s (SCT) Quality Account for 2013-14.
Overall, we do not necessarily find the Quality Account format very “user friendly” – but
understand that you are following national requirements. Quality Accounts tend to be too long
and too detailed to provide the kind of information that is readily digestible by the public and laypeople. However, Sussex Community Trust’s Quality Account is a very clear, easy-to-read
document. It provides a good summary of how the Trust has performed your plans for the
future – and your overall vision and what the Trust stands for.
We welcome the focus on quality in your priorities for 2014-15 and your emphasis on safe,
effective, patient-centred and consistent care. You have set yourself a number of challenging
targets, but would like to have seen some reference to improved discharge planning and
support for carers, as these are issues of concern to the HASC and in which SCT has a key role
to play. You have shown strong performance against your priorities for 2013-14, whilst
recognising areas for improvement, such as pressure damage. We do not underestimate the
scale of the challenges facing community health services, and congratulate you on the
additional achievements outlined, particularly Proactive Care (which HASC will be reviewing
again in early 2015).
Finally, a priority for the future must be ensuring safe, high quality services that are sustainable
and deliverable for the future. This is not something you can achieve in isolation – it will require
the whole health and social care system to work together to meet the challenges of increasing
demand, pressure on services and financial constraints.
We welcome the continued open dialogue and liaison arrangements between SCT and the
HASC, and look forward to working with you in 2014-15.
Yours sincerely
Mrs Margaret Evans
Chairman, Health & Adult Social Care Select Committee
c.c. Dr James Walsh, Mrs Ann Rapnik, Mr Bryan Turner
Quality Account 2013/14
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Conclusion
Sussex Community NHS Trust’s Quality Account 2013/14 documents our quality improvement
priorities for the next year and reports on how we did against those priorities we set ourselves
last year. The process has been inclusive and illustrates that improving the quality of care we
give is not the responsibility of one person, or service; it is a collective responsibility – part of the
culture of our trust – part of the DNA that makes up the NHS.
This Quality Account has been prepared in accordance with the Department of Health’s Quality
Account Toolkit, first published in December 2010 and available electronically at
http://www.dh.gov.uk/publications.
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Glossary of terms
Term
Description
Assurance
Providing information or evidence to show that something
is working as it should, for instance the required level of
care, or meeting legal requirements.
Care Quality Commission
- CQC
The independent health and social care regulator for
England.
Clinical Audit
A process used to improve the quality of care. This is done
by reviewing the care given against explicit criteria.
Analysing the results is then used to highlight any gaps.
An action plan can then be put in place to address those
gaps and then a re-audit takes place to review whether
those actions have worked to plug the gaps identified.
A clinical audit can also highlight good practice, which can
then be shared across SCT.
Clinical Coding
Instead of writing out long medical terms that describe a
patient's complaint, problem, diagnosis, treatment or
reason for seeking medical attention, each has its own
unique clinical code to make it easier to store electronically
and measure.
Clinical Commissioning Groups
- CCGs
Groups of GPs who are responsible for designing local
health services In England.
Clinical Effectiveness
Is the clinical intervention used doing what it is supposed
to? Does it work?
Clinical Governance
Clinical governance is a systematic approach to
maintaining and improving the quality of patient care within
the NHS.
Clostridium Difficile
- C. difficile
A contagious bacterial infection, which can sometimes
reproduce rapidly – especially in older people who are
being treated with anti-biotics – and causes potentially
serious diarrhoea.
Commissioning
The process of buying health and care services to meet the
needs of the population. It also includes checking how
they are provided to make sure they are value for money.
Community Equipment Service
- CES
SCT, in conjunction with West Sussex County Council
manages a community equipment service (CES) to support
patients in the community and the current contract to
supply and deliver that equipment is with NRS Healthcare.
Commissioning for Quality and
Innovation
- CQUIN
A payment framework, which commissioners use to reward
excellence, by linking a proportion of the Trust’s income, to
its achieving set local quality improvement goals.
Quality Account 2013/14
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Community Information Dataset
- CIDS
CIDS makes locally and nationally comparable data
available on community services. This helps
commissioners to make decisions on the provision of
services.
Data Warehouse
In computing, a Data Warehouse is a database used for
collecting, and storing data so it can be used for reporting
and analysis.
Department of Health
- DH
A UK government department responsible for government
policy for health and social care matters and for the
National Health Service (NHS) in England.
Falls Bundle
A bundle of interventions that when used helps to reduce
falls and related injuries.
Gold Standards Framework
The Gold Standards Framework is a model used so that all
people nearing the end of their lives, (regardless of their
diagnosis) can expect good practice to be available to
them.
Grade 3 or 4 Pressure Damage
Pressure damage (previously often referred to as a ‘bed
sore’ or ‘pressure sore’) is a localised area of damage to
the skin and/or underlying tissues. Damage is measure by
grading it – grade 3 is full thickness skin loss and grade 4
is extensive destruction, tissue damage to muscle, bone, or
supporting structures with or without full thickness skin
loss.
Healthwatch
Healthwatch England is the independent consumer
champion for health and social care in England. It ensures
the overall views and experiences of people who use
health and social care services are heard and taken
seriously at a local and national level.
Information Governance Toolkit
A system that allows NHS organisations and partners to
measure themselves against Department of Health
Information Governance policies and standards.
Intranet
An Intranet is a computer network that uses Internet
technology to share information between employees within
an organisation. SCT’s Intranet system is called The
PULSE.
King’s Fund, the
The King's Fund is an independent charity working to
improve health and health care in England.
Malnutrition Universal
Screening Tool
- MUST
MUST is a five-step screening tool used to identify adults
who are malnourished, at risk of malnutrition or obese. It
also includes guidelines, which can be used to develop a
care plan to manage the problem.
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Methicillin-Resistant
Staphylococcus Aureus
- MRSA
Staphylococcus aureus (Staph) is a type of bacteria that is
commonly found on the skin and in the noses of healthy
people. Some Staph bacteria are easily treatable, while
others are not. Staph bacteria that are resistant to the
antibiotic methicillin are known as Methicillin-resistant
Staphylococcus aureus or MRSA.
Metrics
Measures, usually statistical, used to assess any sort of
performance such as financial, quality of care, waiting
times, etc.
National Institute For Health
Research
- NIHR
A government body that coordinates and funds research
for the NHS in England.
National Institute for Health &
Care Excellence
- NICE
An independent organisation responsible for providing
national guidance on promoting good health, and on
preventing and treating ill health.
National Patient Safety Agency
- NPSA
Leads and contributes to improved and safe patient care by
informing, supporting and influencing organisations and
people working in the health sector.
National Reporting and
Learning System
- NRLS
An NHS national reporting system, which collects data and
reports on patient safety incidents. This information is
used to develop tools and guidance to help improve patient
safety.
NRS
SCT, in conjunction with West Sussex County Council
manages a community equipment service to support
patients in the community and the current contract to
supply and deliver that equipment is with NRS Healthcare.
Patient Advice & Liaison
Service
- PALS
A service providing a contact point for patients, their
relatives, carers and friends where they can ask questions
about their local healthcare services.
Primary Care Trust
- PCT
A PCT was an NHS organisation responsible for improving
the health of local people, developing services provided by
local GPs and their teams (called primary care) and making
sure other appropriate health services were in place to
meet local people’s needs. PCTs have been replaced by
CCGs.
Productive Series Programme
A set of practical tools, such as patient experience surveys,
developed by the NHS Institute for Innovation &
Improvement, to help NHS services redesign and
streamline the way they work.
Productive Ward
A ward based element of the Productive Series.
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Safety Express
Safety Express is a ‘call to action’ for NHS staff who want
to see a safer more reliable NHS with improved outcomes,
at a significantly lower cost.
Senior Information Risk Owner
- SIRO
The SIRO is an Executive Director of the Trust who takes
ownership of the Trust’s information risk policy, and acts as
advocate for information risk on the board.
South East Coast Ambulance
Service NHS Foundation Trust
- SECAmb
SECAmb responds to 999 emergency calls from the public,
and urgent calls from healthcare professionals in Kent and
Sussex. It also provides non-emergency patient transport
services (pre-booked patient journeys to and from
healthcare facilities).
Sussex Community NHS Trust
- SCT
SCT is the main provider of NHS community health
services across West Sussex and Brighton & Hove. SCT
provides a wide range of medical, nursing and therapeutic
care to over 8,000 people a day. SCT works to help
people plan, manage and adapt to changes in their health,
to prevent avoidable admission to hospital and to minimise
hospital stay.
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Feedback
We would very much like to know what you think about our Quality Account this year. Please
use this form to let us know what you think about this report and what you would like us to
include in next year’s.
1. Who are you?
Patient, family
member or
carer
Member
of staff
Other
(please
specify)
2. What did you like about this report?
3. What could we improve?
4. What would you like us to include in next year’s report?
5. Are there any other comments you would like to make?
6. Sussex Community NHS Trust is applying to become an NHS Foundation Trust. Are
you interested in becoming a member? If so, please provide your name and address
below.
Thank you for taking the time to read this report and give us your comments.
Please post this form to:
Paula Head
Chief Executive
Sussex Community NHS Trust
J Block, Brighton General Hospital
Elm Grove, Brighton
East Sussex
BN2 3EW
You can also contact us via social media using:
 twitter.com/nhs_sct
 facebook.com/sussexcommunitynhs