The Huntercombe Group
Quality Account 2013/2014
CONTENTS PAGE
Part 1 - Statement of Quality from the Board of Directors
Margaret Cudmore, Chief Executive, The Huntercombe Group
4
Paula Smyth, Head of Clinical Standards & Compliance, The
Huntercombe Group
6
The Huntercombe Group – Visions and Values
7
Proud of what we do and Believing in our Values
7
Overview of Services Provided by The Huntercombe Group
8
Child and Adolescent Mental Health Services
8
Eating Disorders
8
Adult Mental Health and Learning Disabilities
8
Acquired Brain Injury & Neurological Services
8
Children and Adolescents with Specialist Needs
9
Addictions
9
NHS Services Provided by The Huntercombe Group
10
Part 2 - Priorities for Improvement and Statements of Assurance
from the Board
Priority One
12
Priority Two
12
Priority Three
12
Priority Four
12
Priority Five
12
Statements Relating to the Quality of NHS Services Provided
14
Review of Services
14
Participation in Clinical Audits
14
Participation in Clinical Research
15
Goals Agreed with Commissioners
15
What others say about The Huntercombe Group
16
Data Quality
16
NHS Number and General Medical Practice Code Validity
16
Clinical Coding
16
1
Contents Continued
Part 3 - How We Have Performed in 2013/2014
Celebrating Success
18
New Initiatives
19
Progress Against Our 2014/2014 Priorities
21
Priority One
21
Priority Two
22
Priority Three
22
Priority Four
23
Priority Five
23
Commissioning for Quality and Innovation (CQIN) Performance
24
Routine Performance Monitoring
26
Regulatory Compliance
26
Complaints
27
Incidents and Reporting
29
Lessons Learnt from Complaints and Incidents
30
Patient Experience and Listening to Others
31
Friends and Family Test Results
31
Patient Satisfaction
32
Carer Survey
35
Feedback from Referrers
38
2
Part 1
Statement on Quality from the
Board of Directors
3
Statement on Quality from the Board of Directors
Margaret Cudmore,
Chief Executive, The Huntercombe Group
It gives me great pleasure to present the 5th Annual Quality Account for The Huntercombe
Group.
The Huntercombe Group is the Specialist Services Division of Four Seasons Health Care and
one of the leading providers of specialist healthcare working in partnership with the NHS and
Local Authorities throughout England and Scotland to provide high quality, safe and effective
care for its patients.
Specialising in Adult Mental Health, Specialist Brain Injury and Child and Adolescent Mental
Health (CAMHS) the Huntercombe Group has gained a reputation for innovation and
creating the right treatment solutions for patients with particularly challenging and complex
needs. We ensure that every individual admitted to our services has the potential to
enhance their prospects for a more fulfilling life.
Every patient at the Huntercombe Group is treated as an individual, with their own very
specific and often complex needs. It is their right to be valued and cared for in a safe,
therapeutic environment whilst receiving the professional, clinical care they require.
This has been another very exciting year for the Huntercombe Group and one that has seen the
group make good progress against last year’s priorities. There have been a number of
challenges in the past year including the implementation of new NHS commissioning
arrangements and increased regulatory scrutiny but working closely with our commissioners
and the CQC and this has helped us look at our systems and to drive forward improvements
with our care delivery. We also recognise it is the hard work and commitment of all our staff
that leads to these improvements in the quality of our services and we are proud of their skills
and dedication.
We are not however complacent and recognise that there are still improvements that can be
made and a number of these have been included in our priorities for 2014 and 2015.
4
This quality account covers all of our services that provide NHS commissioned care across all
specialities. This Quality Account aims to:
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Enhance our accountability to the people who use our services their carers and other
stakeholders of our quality improvement agenda
Enable us to demonstrate what improvements we have made and what we plan to make
Provide information about the quality of our services
Show how we involve and respond to feedback from our service users, carers and
others
Ensure we review our services, decide and demonstrate where we are doing well but
also where improvement is required
It comprises of three sections. Part one are statements from Huntercombe Group Board
Members. Part two outlines our priorities for improvement in the year ahead and mandatory
statements about various aspects of the quality of our services. The final part reviews our
progress against our quality account priorities for 2013/2014 and gives an overview of some of
our key performance indicator.
The report has been produced in accordance with guidance issued by the Department of Health
and will be published both on our website at www.huntercombe.com and also via the NHS
Choices website.
We hope you find this report both interesting and informative and we very much welcome your
feedback and suggestions regarding this quality account. If you would like to comment or if
you require any further information please email: Paula Smyth, Head of Clinical Standards and
Compliance at paula.smyth@huntercombe.com Alternatively please write to Paula Smyth, Head
of Clinical Standards and Compliance, The Huntercombe Group, Tulip House, Craven Court,
Willie Snaith Road, Newmarket, Suffolk CB8 7FA
I will be standing down as Chief Executive during the summer of 2014 handing over to Valerie
Michie who replaces me. It has been a privileged for me to work with such a formidable team of
healthcare professionals for these last 9 years and I have no doubt that they will seek to
achieve even greater success in the years to come the patients best interests.
Margaret Cudmore
Chief Executive
5
Statement on Quality from the Board of Directors
Paula Smyth
Head of Clinical Standards and Compliance
Welcome to the Annual Quality Account for The Huntercombe Group.
This quality account provides us with an opportunity to present to our patients, their carers,
commissioners and the wider public, the progress we have made against our quality priorities
set in 2012/2013, and overview of some of the many successes that we have achieved. The
report also highlights areas where we still need to do more and our priorities for 2014/1015.
At The Huntercombe Group we are committed to the provision of high quality care for all those
who use our services and their families. We recognise that the delivery of good quality, safe
services is dependent upon the commitment, motivation and engagement of all of our staff
along with need to have robust systems and processes in place to continuously monitor and
improve the services we deliver.
With the changing nature of health and social care regulation and individuals at Board level
being increasingly held to account for the quality of care, we continue to strive to demonstrate
what is being done to learn lessons when things go wrong and to ensure that there is a clear
line of sight ‘from Ward to Board’ in relation to our clinical governance processes.
We also recognise that high quality care can only be delivered in an environment where people
are listened to and where people’s views, concerns and complaints are welcomed and embraced
as a way to learn and improve.
We can already see that the year ahead is going to be every bit as challenging as the past year,
if not more, and we have set ourselves a number of ambitious priorities for 2014-15. We look
forward to reporting the outcome of these to you in our next quality account.
Paula Smyth
Head of Clinical Standards and Compliance
6
The Huntercombe Group – Visions and Values
The Huntercombe Group is a Specialist Services Division of Four Seasons Health Care, one of
the largest independent care providers in the UK. Specialising in Adult Mental Health, Specialist
Brain Injury and Child and Adolescent Mental Health Services (CAMHS). The organisation
gained a reputation for innovation and creating the right treatment solutions for patients with
particularly challenging and complex needs. With 55 hospitals and specialist centres across
England and Scotland, we work in partnership with NHS and Local Authorities to provide
innovative, high quality, person-centred health and social care services.
The Huntercombe Group (THG) aims to continuously improve and innovate in the services we
operate and we do this through various joint initiatives and partnerships with the NHS. Every
patient at THG is treated as an individual, with their own very specific and often complex needs.
It is their right to be valued and cared for in a safe, therapeutic environment whilst receiving
the professional, clinical care they require. We aim to ensure that every individual admitted to
our services has the potential to enhance their prospects for a more fulfilling life.
Proud of what we do and Believing in our Values
We are a specialist organisation delivering results though tailored inspirational care for adults
and young people with complex needs; through clinical excellence, quality environments and a
friendly ‘CAN DO’ approach.
We listen, we learn, we empathise, we respect and we care. Insight is fundamental to the way
we shape our services.
We are innovative, creative, dynamic and flexible in our service delivery, our research and
learning, and how we go about our business. Yet in everything we do, we take a measured
approach.
We put those in our care first; they are at the heart of everything we do. We also recognise
the commitment of our staff and stakeholders and the need to continually strengthen our
relationships with our external partners.
We strive for excellence across our whole service, through our clinical expertise and within our
care environments. Through good teamwork, we will always aim higher, are never complacent,
and lead by example.
We are reliable. Ours is a name to be trusted. We deliver results through transparent service
delivery and safety is paramount across all aspects of our business.
We offer accessible and tailored care pathways to meet geographical and specialist needs. We
aim to deliver the best possible value-based healthcare within our customers’ budgets.
Our strength is in our patient-centered focus, ‘CAN DO’ approach and flexibility. We believe in
making a difference to people’s lives through tailored solutions … not only to those in our care,
but to their families, commissioners and beyond.
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Overview of Services Provided by The Huntercombe
Group
Child and Adolescent Mental Health Services
Our CAMHS Tier 4 services are facilitated within our specialist hospitals situated in: Edinburgh,
Stafford, Maidenhead and Norwich, whilst our hospital in Cotswold Spa focuses on delivering a
specialist inpatient and outpatient programme of care for eating disorders. Our tailored
treatment packages for CAMHS are both innovative and flexible, delivered by a highly skilled
team of health care professionals.
Eating Disorders
At our specialist eating disorder hospitals, we provide assessment and treatment for
adolescents and young adults with severe and life threatening eating disorders such as anorexia
nervosa, bulimia nervosa and related disorders. Our hospitals are located in Edinburgh,
Maidenhead and Stafford. We also provide a shorter-stay eating disorder service based in the
Cotswolds for patients requiring less intensive treatment to that provided in our other hospitals.
Between our four hospitals we are able to offer treatment for eating disorders from the age of
11 upwards.
Adult Mental Health and Learning Disabilities
Our Hospitals and Centre’s throughout the UK provide a wide range of specialist treatment for
adults with a range of mental health disorders, learning disabilities and complex needs.
Specialist, patient centred care and treatment is delivered within a variety of settings and levels
of security, from medium/low secure Hospitals to step down services including Community
Hospitals and care homes with nursing and/or residential care. Continuum of care is vital for
patients stepping up or stepping down, and our uniform model of care supports patients
through a structured care pathway. Risk can also be managed efficiently around the patient’s
needs at any point in time.
Acquired Brain Injury & Neurological Services
We offer a broad range of specialist brain injury and neurological services from post-acute
intensive treatments for highly dependent patients through to supported living environments
that enable our clients to consider a return to independent living. Our award winning and
flexible person-centred neuro-rehabilitation services are delivered in centres across England and
Scotland.
8
Children and Adolescents with Specialist Needs
We have two centres that specialise in the treatment and care of children and adolescents with
specialist needs. Our centre, Granville Lodge, in Hartlepool provides specialised care for children
with physical disabilities and delayed learning associated with their disabilities. Whilst our centre
in Stockton, cares for children with a moderate or severe learning disability with or without
associated challenging behaviours and can cater for those with more than one diagnosed
learning disability.
Addictions
We provide detox and rehabilitation treatment in Sunderland, this service caters for both NHS
and private patients. The centre provides highly effective evidence-based interventions in the
treatment of drug and alcohol misuse. Our centre is able to cater for adults with complex needs
including poly-drug use, pregnant drug users, alcohol-related brain disease and mental health
co-morbidity.
9
NHS Services Provided by The Huntercombe Group
The table below outlines the NHS services provided by the group and the percentage of NHS
patients within each service. A majority of the remainder of the services provided by the
Huntercombe Group receive social care funding.
Service Name
Service Type
% of NHS
Patients
The Huntercombe Hospital Maidenhead
Child & Adolescent Mental Health
100%
The Huntercombe Hospital Stafford
Child & Adolescent Mental Health
100%
The Huntercombe Hospital Edinburgh
Child & Adolescent Mental Health
100%
The Huntercombe Hospital Cotswold Spa
Child & Adolescent Mental Health
100%
The Huntercombe Hospital Norwich
Child & Adolescent Mental Health
100%
Blackheath Brain Injury Rehabilitation Unit
Brain Injury & Neurodisability
100%
Frenchay Brain Injury Rehabilitation Unit
Brain Injury & Neurodisability
100%
The Huntercombe Hospital Roehampton
Adult Mental Health & Learning Disability
100%
The Huntercombe Hospital East Yorkshire
Adult Mental Health & Learning Disability
100%
The Huntercombe Centre Sherwood
Adult Mental Health & Learning Disability
100%
James House
Adult Mental Health & Learning Disability
100%
Beech House
Murdostoun Brain Injury Rehabilitation Centre
Adult Mental Health & Learning Disability
Brain Injury & Neurodisability
100%
100%
Cedar House
Adult Mental Health & Learning Disability
100%
Ashley House
Adult Mental Health & Learning Disability
100%
The Huntercombe Centre Derby
Adult Mental Health & Learning Disability
100%
Watcombe Hall
Stocksbridge Brain injury Rehabilitation Centre
Adult Mental Health & Learning Disability
Brain Injury & Neurodisability
100%
83%
The Huntercombe Centre Redbourne
Adult Mental Health & Learning Disability
66%
The Huntercombe Centre Crewe
Brain Injury & Neurodisability
60%
The Huntercombe Centre Sunderland
Addictions
52%
Huntercombe Services Nottingham
Brain Injury & Neurodisability
46%
Abbeymoor Neurodisability Centre
Brain Injury & Neurodisability
44%
The Huntercombe Centre Cambridge
Adult Mental Health & Learning Disability
38%
Murdostoun Neurodisability Centre
Hothfield Brian Injury Rehabilitation &
Neurodisability Centre
Brain Injury & Neurodisability
29%
Brain Injury & Neurodisability
26%
Pathfields Lodge and Greenfields
Adult Mental Health & Learning Disability
25%
The Huntercombe Centre Peterlee
Adult Mental Health & Learning Disability
23%
The Huntercombe Centre Birmingham
Adult Mental Health & Learning Disability
17%
Huntercombe Services Granville Lodge
Children with Special Needs
17%
Stanhope Neurodisability Centre
Brain Injury & Neurodisability
16%
Kings Delph Lodge
Adult Mental Health & Learning Disability
14%
Meadowbrook Neurodisability Centre
Brain Injury & Neurodisability
14%
Portland House
Adult Mental Health & Learning Disability
13%
Huntercombe House Stockton
Children with Special Needs
13%
South Quay Neurodisability Centre
Brain Injury & Neurodisability
11%
Aspley Neurodisability Services
Brain Injury & Neurodisability
8%
Beeton Grange
Adult Mental Health & Learning Disability
5%
The Dell
Adult Mental Health & Learning Disability
4%
The Royd
Adult Mental Health & Learning Disability
4%
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Part 2
Priorities for Improvement and
Statements of Assurance from
the Board
11
Priorities for Improvement and Statements of Assurance from
the Board
The following priorities have been agreed, taking into account the views of staff, feedback that
we have received from those using our services through our service user surveys, audit reports
and commissioner requirements and priorities for 2014/2015.
Priority One
The recruitment and retention of good staff remains a huge challenge for The Huntercombe
Group in ensuring that the Group continues to meet the needs of the individuals to whom we
provide care, the targets set by our commissioners and the modernisation agenda.
The Huntercombe Group needs to employ staff in certain areas and improve how we retain,
lead and support our workforce as well as ensure staffing levels continue to accommodate safe
and effective service delivery.
To achieve this we have identified a number of priorities for 2014/2015:
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Focused recruitment activity and decreased reliance on agency staff
To review our Induction and Supervision Frameworks
Implement a bespoke leadership development programme for senior Nursing Staff in
conjunction with the Royal College of Nursing
Priority Two
Within the Huntercombe Group we recognise that the implementation of an effective risk
strategy and risk framework is key to the delivery of our key objectives and in the development
of a positive learning environment and risk aware culture.
In order to achieve this we will continue to:
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Further develop our Framework for Risk Management Framework and Processes
Continue to embed and strengthen our electronic incident reporting across all Services
including new modules for the management of subject access requests and the
management of alerts
Priority Three
The Huntercombe Group vision of striving for excellence requires a determined and persistent
focus on the effectiveness of the care we provide for patients and the outcomes our services
achieve. Achieving best outcomes requires us to provide care that is safe and care that is
effective. In 2013/2014 we aim to:

Strengthen our clinical audit programme – focussing on priorities as informed by our risk
register.
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Conduct an on-going programme of reviewing our policies and procedures ensuring
these are based on the best practice / research evidence and that they are fit for
purpose.
More effective use of outcome measures to inform us, our patients, the public and our
commissioners about our performance.
To sign up to the Learning Disability Provider Code.
To re-launch our Mindshare research programme for all employees of The Huntercombe
Group and to encourage take-up of academic and clinical research including the
introduction of the Mindshare Foundation Grant which is a modest initiative to
encourage research and alleviate some of the cost barriers associated with research
projects.
Priority Four
To provide welcoming, responsive services that listen and respond to those who use them and
their families and carers and to demonstrate respect, dignity, choice and involvement we will:

Continue to ensure a routine programme of satisfaction surveys across all services to
elicit feedback from those who use our services, the families and carers and those who
refer to us and to act upon their feedback to improve our services and the experiences
of those who use them.

Develop further information for people who use our services and their families based on
the feedback we have received from patients and residents in 2013/2014. This will
include the provision of leaflets, posters and feedback from key meetings across THG.
Information will be provided in a range of accessible formats and will be developed in
conjunction with those who use our services.

Pilot Patient Led Assessments of the Care Environment (PLACE) in a number of services
across THG. PLACE is a new NHS initiate that was launched in 2013 for assessing the
care environment. Place Assessments will provide clear messages for THG directly from
those who use our services about how the environment or services may be improved.
Following evaluation of the success of these pilots we will consider how these can be
rolled out further across the group.
Priority Five
To commence delivery and implementation of the Connect Tech Programme across THG.
Connect Tech is the programme associated with the implementation of the Coldharbour
software suite. Connect Tech comprises of six applications including Care Notes an electronic
patient record, e-compliance an integrated suite of compliance tools, Occupancy Management,
Time and attendance, Enquiry Management and Business Intelligence.
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Statements Relating to the Quality of NHS Services
Provided
Review of Services
During 2013/2014 the Huntercombe Group provided and / or subcontracted 40 NHS Services.
These have been described in Section 1.
The Huntercombe Group has reviewed all the data available to them on the quality of care in
100% of these NHS services.
The income generated by the NHS services reviewed in 2013/2014 represents 100% of the total
income generated from the provision of NHS services by the Huntercombe Group for
2013/2014.
Participation in Clinical Audits
During 2013/2014 five national clinical audits and one national confidential enquiries covered
NHS services that the Huntercombe Group provides.
During that period the Huntercombe Group participated in 0% national clinical audits and 100%
national confidential enquiries of the national clinical audits and national confidential enquiries
which it was eligible to participate in.
The national clinical audits and the national confidential enquiries that the Huntercombe Group
was eligible to participate in during 2013/2014 are as follows:
National Clinical Audits:
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RCPH National Childhood Epilepsy Audit
National Adult Diabetes Audit
National Audit of Psychological Therapies
Prescribing in Mental Health Services (POMH)
National Audit of Schizophrenia
National Confidential Enquiries:

National Confidential Enquiry into suicide and homicide by people with mental illness
The national clinical audits and national confidential enquiries that the Huntercombe Group
participated in, and for which data collection was completed during 2013/2014, 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 or enquiry.
The National Confidential Enquiry into suicide and homicide for people with mental illness
100%.
The Huntercombe Group regularly receives and reviews local clinical audit reports at both unit,
divisional and group level. Each service has a programme of audits that are conducted
throughout the year. Findings of the audits are shared via out integrated governance
framework to ensure that the experience is shared, lessons learned and action plans monitored.
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Participation in Clinical Research
The Huntercombe Group is committed to the improvement of their services and in sharing best
practice to disseminate learning’s throughout the public and independent healthcare sector,
which in turn contributes to patient improvements in the areas of health we work within.
A dedicated area on the Huntercombe website now features all past and current research
projects from across the group and we actively participate in a number of university student
placement schemes across England and Scotland.
We actively encourage the following:
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Academic research ( in partnership with an academic institution or body )
Clinical research ( that is undertaken by a clinician or in partnership with another
institution, partner or body )
Best practice
By sharing original thinking, findings and best practice to better serve patients through the
promotion of self-development and advancement of clinical innovation across our specialist
fields. We do this through journal submissions and publications, our annual clinical conference,
workshops and educational forums with plans to utilise the Huntercombe iEVENTS network.
The number of patients receiving NHS Services provided or sub-contracted by the Huntercombe
Group in 2013/2014 that were recruited during that period to participate in research approved
by a research ethics committee was 0.
Goals Agreed with Commissioners
A proportion of The Huntercombe Group’s income in 2013/2014 was conditional on achieving
quality improvement and innovation goals agreed between the Huntercombe Group and any
person or body they entered into a contract, agreement or arrangement with for the provision
of NHS services, through the Commissioning for Quality and Innovation (CQUIN) payment
framework.
During 2013/2014 the Huntercombe Group met or exceeded all its Commissioning for Quality
and Innovation targets across all relevant service groups and has plans in place to ensure that
we continue to meet all of our CQUIN targets for 2014/2015.
Further details of the agreed goals for 2014/2015 and for the following 12 month period are
available on request by email to brett.cowell@huntercombe.com
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What others say about The Huntercombe Group
The Huntercombe Group is required to register with the Care Quality Commission and has full
registration under the Health & Social Care Act 2008. The group is currently registered in
respect of the following regulated activities:

Assessment of medical treatment for persons detained under the Mental Health Act
1983.

Treatment of disease disorder and or injury.

Diagnostic and screening procedures.

Accommodation for persons requiring nursing or personal care.
The Huntercombe Group has no conditions on its registration.
The Care Quality Commission has taken enforcement against two services the Huntercombe
Group during 2013/2014.
A Warning Notice was received in respect of Regulation 11 (Safeguarding) in one hospital in our
Adult Mental Health & Learning Disability Services and a Notice of Proposal was received by
another. This notice of proposal was challenged by The Huntercombe Group and after working
closely with Commissioners and re-inspection the service now has only minor non-compliance
against 3 outcomes and is awaiting further re-inspection by the CQC.
Data Quality
In its most recent Information Governance Assessment The Huntercombe Group achieved
compliance at Level 2 and was graded Green.
The Huntercombe group was also successful in securing N3 connection to the NHS.
NHS Number and General Medical Practice Code Validity
The Huntercombe Group did not submit records during 2013/2014 to the Secondary Uses
service for inclusion in the Hospital Episode Statistics which are included in the latest published
data.
Clinical Coding
The Huntercombe Group was not subject to the Payment by Results clinical coding audit during
2013/2014 by the Audit Commission.
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Part 3
How We Have Performed in
2013/2014
17
How We Have Performed in 2013/2014
Celebrating Success
Specialist Care Awards
During 2013/2014 the Huntercombe Group celebrated success through the achievement of a
number of coveted national awards and accreditation.
This year Campsie House was a finalist at this year’s Laing & Buisson Independent Specialist
Care Awards. Campsie House specialises in meeting the needs of adults with complex
neurological conditions who have high, medium or low nursing care needs as a result of a
neurological condition or brain injury.
The unit was recognised for its ability to tailor programmes specifically to meet the needs of
each individual to enable them to achieve their personal goals, reduce disability and improve
their quality of life. The judges were impressed that staff had developed a programme to firmly
establish the rights and responsibilities of each individual that depends on the centre’s services.
As a result,
The rights and responsibilities programme has added another layer to the service’s drive to
continue to develop participation and involvement through ‘co-production’. In turn this has
challenged staff and relatives perceptions on how the service should be delivered and has
raised overall awareness within Campsie House of people’s rights to equal opportunity and
citizenship no matter what barriers lay ahead.
Huntington’s Society Accreditation
The Huntercombe Group Linlathen’ s Neurological Care Centre in Dundee allocated 12 beds for
the care and support of people with a diagnosis of Huntington’s disease and over a number of
years has acquired a substantial knowledge and expertise managing this challenging population.
Working closely with the Scottish Huntington’s Association (SHA) an opportunity presented itself
to formally submit a self-assessment of our service to the SHA for consideration as a fully
accredited care facility and specialist provider.
The self-assessment was a rigorous process divided into 4 main sections:

Management systems, staffing and organisation; regulatory compliance,
education/training and staff.

Health and personal care including; care planning, medication management, pain
management, cognitive changes, palliative care, nutrition and hydration, communication
difficulties.

Individual lifestyle; emotional support, independence, privacy and dignity, activities,
cultural and spiritual life, choices and decision making.

Health, safety and physical environment; fire, security and emergencies, housekeeping,
maintenance, infection control, catering.
18
An internal team approach was used to complete and submit the complex self-assessment
documentation for submission to the SHA.
A senior representative team from the SHA visited the centre spending a full day in the unit
observing, talking with the residents and examining/auditing evidence.
Following a full SHA Board meeting, Linlathen successfully met all the expected standards and
was subsequently awarded accreditation as the first such centre in Scotland. Demands for the
service have now increased with the addition of 4 extra beds and further capacity planned to
capture additional demand in the future.
New Initiatives
Health Idol Programmes
Health Idol applies a holistic approach, encouraging patients to take control of all aspects of
their life. The programme has been successful in other hospitals as patients achieve their
weight loss goals and see their self-esteem increase.
Health Idol has officially launched its 4 week programmes at the Huntercombe Hospital
Norwich, Stafford and Maidenhead. The courses cover all aspects of nutrition, lifestyle and
wellbeing for patients as part of their rehabilitation.
Health Idol has delivered comprehensive training to hospital staff and they have now completed
NVQ level 2 training in Fitness Instruction, and exercises and workshops in Nutrition and
Wellbeing. Staff can teach patients to lose weight safely and effectively whilst maintaining their
long term health and wellbeing.
CAMHS Services are also looking to set up Jamie Oliver’s cooking skills programme so that
patients can achieve a Level 1 BTEC in healthy cooking. In addition, Health Idol will continue to
work alongside the team to enhance the current hospital activity to include power walks,
outdoor activity and one-to-one fitness programming. An affiliation with a local college will
support the initiative as it helps to set up Jamie’s Cooking skills programme.
Driving Up Quality Code
The Driving Up Quality Code is a code for providers and commissioners aimed at:





Driving up quality in services for people with learning disabilities that goes beyond
minimum standards.
Creating and building a passion in the learning disability sector to provide high quality,
values-led services
Providing a clear message to the sector and the wider population about what is and
what is not acceptable practice
Promoting a culture of openness and honesty in organisations
Promoting the celebration and sharing of the good work that is already out there.
Within our Adult Mental Health and Learning Disabilities Division we are committed to the code
and our intention to sign up during the first Quarter of 2014/2015.
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In signing up to the Driving Up Quality Code the Adult Mental Health and Intellectual Disability
Division will make a transparent public commitment that it is achieving or working towards the
good practices which are outlined within the code.
We have conducted reflective self assessments both as a division and across our services to
identify where practices are in relation to the five key areas as outlined in the code, what
evidence is in place to demonstrate this and to put in place plans for improvement. We have
prepared corporate statements on behalf of the division in supporting our pledge.
We will progress this work further over the year ahead.
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Progress Against Our 2013/2014 Priorities
In this section of the report we outline our progress against our priorities for 2013/2014 and
our performance against a number of key quality indicators.
Whilst this report indicates that progress has been made in many areas, we are not complacent
and recognise that further work will need to be undertaken in the year ahead.
Last year in addition to seeking to strengthen our Quality Systems and increasing our regulatory
compliance we set ourselves a number of priorities within the following domains:




Safety
Effectiveness
Involvement
Clinical Leadership
Priority One: To continue to strengthen and embed our quality monitoring
systems and improve our regulatory compliance across the Group.
Achievements
To Increase Regulatory
Compliance
Our regulatory compliance has increased significantly quarter by quarter
throughout the year. On the 31st March 2013 a total of 91% of all outcomes
assessed by the CQC at the last inspection across all services were
complaint.
Strengthening our
Integrated Governance
Systems
We have continued to consolidate the implementation of our Integrated
Governance Framework at all levels across the group and improved the flow
of information from Ward to Board.
We have introduced “ Governance Hot Topics” to raise the awareness of all
staff of key governance issues affecting the group, to inform them on the
actions being undertaken, to ask their views and to outline their role in the
process. After each divisional governance meeting we highlight three “hot
topics” for each division and publish these on posters in every site. Where
appropriate feedback is then sought via local governance arrangements and
via surveys conducted via survey monkey.
We have strengthened our H&S arrangements through the introduction of a
cross divisional health and safety committee and have introduced monthly
Health & safety reporting on key indicators through to the Board.
We have restructured and strengthened our Clinical Standards and
Compliance Team with the introduction of Quality Manager roles for each of
our three divisions and through the appointment of a corporate governance
and risk manager. This will allow for a much closer alignment between the
team and operations and will increase the support available.
21
Priority Two: To continue to develop the way we measure and monitor
patient safety and take appropriate actions to ensure that the people who
use our services are not harmed.
Achievements
Strengthening our
Infection Control
Arrangements
We continue to strengthen our infection control arrangements and
monitoring of infection control practices within all our patient environments.
On 1st April 2013 we launched our revised infection control policy manual,
this policy manual provides a standardised approach to Infection Prevention
and Control across all sites within THG and we have also introduced a
standardised reporting framework. All areas have an identified Infection
Prevention and Control Lead through the development and implementation
of standardised audit tool. Our current compliance with our e-learning
compliance is currently 83% across the group and we recognise that further
work is required to ensure compliance with our own statutory and
mandatory standards and to ensure that sites have their own infection
prevention and control lead.
Implementation of DATIX
Risk Management System
We have introduced the DATIX Risk Management System across all services
to enable us to improve the management of all incidents and standardise
the reporting of incidents, complaints and compliments. Although this is
now in use across all services, some initial implantation difficulties have
been identified. We are currently working to address these and to ensure
that the system is used to its full potential.
Priority Three: Clinical Effectiveness is about doing the right thing at the
right time for the person using our services to achieve the right outcome. To
improve clinical effectiveness we will:
Achievements
Promoting Evidence Based
Practice
We have continued to promote evidence based practice, research and
innovation across the Huntercombe Group though arrange of initiatives
including an Annual Clinical Conference, Workshops and Educational Forums
Improving our Care
Documentation
In our Adult Mental Health and Learning Disability Services and our
Acquired Brain injury and neurological care services we have reviewed and
strengthened our care documentation and this is now in the process of
being rolled out across all services. In sites were implementation has
already taken place we are receiving favourable feedback from our
regulators and commissioners.
22
Priority Four: To provide welcoming, responsive services that listen and
respond to those who use them and their families and carers and to
demonstrate respect, dignity, choice and involvement.
Achievements
Objectives to Improve
Patient Involvement
At the beginning of the year each of our hospitals / units has set objectives
to improve the involvement of people who use their services. These have
been monitored via local and divisional governance meetings Initiatives
introduced include patient involvement in staff interviews, implementation
of rights and responsibilities programmes, patients presenting at relatives
open days, patients nominating a staff “Star of the week” for a staff
member who they feel has “made a difference” to them during the
preceding week, the development of local newsletters for patients and
improved mechanisms to feedback to patients actions taken in response to
their feedback and participation in Health Idol programmes.
The Development of
PEARL for Acquired Brain
Injury and Neurological
Services
We have also started to explore the potential to develop a PEARL
Accreditation Programme in our Acquired Brain Injury and Neurological
Services, based on a similar model to the award winning PEARL Dementia
programmes developed by Four Seasons Healthcare. Unfortunately due to
current demands on the PEARL team within this work has been slower than
originally expected but we will continue to explore this area of work over
the forthcoming year.
Responding to Feedback
and Improving Patient
Experience.
A routine programme of satisfaction surveys have been conducted across all
services to illicit feedback from those who use our services, the families and
carers and those who refer to us. An overview of the findings are included
later in this report.
Priority Five: To strengthen clinical leadership and further develop our
professional frameworks to ensure best practice.
Achievements
Development of a
communication and
information portal for our
Registered Nurses
We are currently in the process of developing of a dedicated information
portal for our nurses within the Huntercombe Group. During the last six
months we have undertaken some brief research into how we could better
support nurses through an IT based support structure which provides;
better and faster access to information for nurses in enabling them to fulfil
their role, to provide mentorship and support for fellow nurses regardless of
geographical boundaries, to enable and empower our nursing teams to
share ideas and best practice in a secure and safe forum and to access the
latest nursing news and opportunities for personal development. It is
anticipated that this system will be available in August 2014.
Management Induction
Programmes
We have introduced a new Corporate Induction Programme for all new
managers joining the company; all existing Managers have also attended.
23
Commissioning for Quality and Innovation (CQUIN)
Performance
The Commissioning for Quality Improvement and Innovation (CQUIN) Payment
framework enables commissioners to reward excellence by linking a proportion of the
providers’ income to the achievement of local quality improvement goals.
This year commissioners set CQUIN targets for the following services:




Child and Adolescent Mental Health Services
Secure Services
Locked Rehabilitation Services
Brain Injury Recovery Units
The tables below indicate our performance against the targets set for each service.
CAMHS 2013 /14 CQUIN Performance
Clinical Dashboard
Optimising Pathways
Physical Healthcare
Care Programme Approach
Q1
Q2
Q3
Q4
100% achieved
100% achieved
100% achieved
100% achieved
100% achieved
100% achieved
100% achieved
100% achieved
100% achieved
100% achieved
99% achieved
100% achieved
100% achieved
100% achieved
100% achieved
100% achieved
Low Secure 2013 /14 CQUIN Performance
Q1
Q2
Q3
Q4
100% achieved
100% achieved
100% achieved
100% achieved
100% achieved
100% achieved
100% achieved
100% achieved
100% achieved
100% achieved
100% achieved
100% achieved
Care Programme Approach
100% achieved
100% achieved
100% achieved
100% achieved
Provision of literacy, numeracy,
IT and vocational skills training
100% achieved
100% achieved
100% achieved
100% achieved
Increase in use of
communications technology
100% achieved
100% achieved
100% achieved
100% achieved
Clinical Dashboard
Optimising Pathways
Physical Healthcare
24
Locked Rehabilitation Services 2013 /14 CQUIN Performance
Best practice implementation
Further implementation of
Recovery Planning Tools
Integration with national secure
pathway
Excellence in Locked
Rehabilitation
Transparency for carers,
patients and public on outcomes
and involvement in
improvement
Q1
Q2
Q3
Q4
100% achieved
100% achieved
100% achieved
100% achieved
100% achieved
100% achieved
100% achieved
100% achieved
100% achieved
100% achieved
100% achieved
100% achieved
100% achieved
100% achieved
100% achieved
100% achieved
Q3
Q4
Blackheath BIRU 2013/14 CQUIN Performance
Q1
Q2
Friends and family test
100% achieved
100% achieved
100% achieved 100% achieved
Dementia
100% achieved
84% achieved
84% achieved
100% achieved
NHS Safety Thermometer
100% achieved
0% achieved
0% achieved
100% achieved
100% achieved
100% achieved
100% achieved 100% achieved
100% achieved
100% achieved
100% achieved 100% achieved
VTE Risk Assessment
10% improvement in patient
outcomes
25
Routine Performance Monitoring
Regulatory Compliance
The Huntercombe Group services are regulated by the Care Quality Commission in England,
Health Improvement Scotland, the Care Inspectorate (Scotland) and Ofsted.
The quality of care and compliance with regulation is monitored within the Huntercombe Group
through the Quality Performance Management System.
Reports are reviewed at all local and divisional governance meetings and at every THG Board
Meeting.
At the 31st March 2014, based on the last inspection for each service – The Huntercombe Group
was
• 69 % fully compliant in all inspected outcomes
• 17 % of one or more minor concerns
• 13 % of one or more moderate concern
• 1 % of one or more major concerns.
The graph below outlines THG Performance against all outcomes assessed at the time of the
last inspection on a monthly basis from 1st April 2013 to 31st March 2013
300
250
200
150
Total Outcomes Assessed
Compliant
Minor Concern
100
50
Moderate Concern
Major Concern
0
Green
Compliant – means that people who use services are experiencing the outcomes relating to the
essential standard.
Yellow
Minor concern – means that people who use services are safe but are not always experiencing the
outcomes relating to this essential standard
Amber
Moderate concern – means that people who use services are safe but are not always experiencing
the outcomes relating to this essential standard and there is an impact on their health and wellbeing
because of this.
Red
Major concern – means that people who use services are not experiencing the outcomes relating to
this essential standard and are not protected from unsafe or inappropriate care, treatment and
support.
26
Complaints
High quality care can only be delivered in an environment where people are listened to and
were people’s views, concerns and complaints are welcomed and embraced as a way to learn
and improve.
Within the Huntercombe Group we aim to ensure that all people who use our services have
access to guidance on the procedures for raising a concern or making a complaint.
All sites have access to complaints posters and leaflets and residents and their families are
encouraged to report comments, compliments and complaints on leaflets at each site. Since the
beginning of 2014 all complaints have been recorded on Datix, an online incident/risk
management system. This data is analysed by the Compliance and Clinical Standards Team and
distributed via governance processes.
A ‘benchmarking across services’ report and service individual report is completed to breakdown
all complaints across The Huntercombe Group each Quarter. These reports are shared within
services and provide opportunities for lesson learning and sharing of best practice and lead to
improvements in the complaints process for people who use our services. These are fed back to
patients in the forms of posters and lessons learnt and also fed through the local, regional and
divisional integrated governance processes.
During the last year a vast majority of our complaints were dealt with informally at the point at
which they were received to the satisfaction of the complainant. Where complaints are not able
to be resolved immediately to the satisfaction of the person making the complaint, they are
passed to the Hospital or Home Manager and are then fully investigated in accordance with our
formal complaints procedure. All complaints in writing or at the request of the complainant are
treated as a formal complaint.
The graphs below give details of the number of complaints received by The Huntercombe
Group in 2013 / 2014 and an overview of the nature of the complaint. These results show a
significant increase from reporting in the previous year. This is thought to be in part due to
improved reporting of complaints by staff and though promoting greater awareness of the
complaints procedure to our patients. The findings also demonstrate that a relatively small
number of all complaints are upheld.
During 2014/2015 we will be continuing to implement the feedback module on our Datix
System this will allow us to continue to focus on this key quality indicator and to have greater
visibility of the robustness of the investigation process.
27
Figure 1: Number of Formal Complaints and Overview of the Nature Received by
Division during 2013/2014
Adult Mental Health & Learning Disability Services
Quarter 1
Complaints Received
Complaints Upheld
121
28
Quarter 2
Quarter 3
Quarter 4
69
18
73
18
73
18
40
35
30
Involvement and Information
25
Personalised Care and Treatment
20
Safeguarding and Safety
15
Quality of Staffing
10
Other
5
0
Quarter 1
Quarter 2
Quarter 3
Quarter 4
Acquired Brain Injury & Neurological Services
Complaints Received
Complaints Upheld
Quarter 1
Quarter 2
Quarter 3
Quarter 4
14
4
10
2
15
6
3
1
8
7
6
Involvement and Information
5
Personalised Care and Treatment
4
Safeguarding and Safety
3
Quality of Staffing
2
Other
1
0
Quarter 1
Quarter 2
Quarter 3
Quarter 4
28
Child Adolescent and Mental Health Services
Complaints Received
Complaints Upheld
Quarter 1
Quarter 2
Quarter 3
Quarter 4
42
4
21
3
24
3
19
1
25
20
Involvement and Information
Personalised Care and Treatment
15
Safeguarding and Safety
10
Quality of Staffing
Other
5
0
Quarter 1
Quarter 2
Quarter 3
Quarter 4
Incidents and Reporting
Learning lessons from all incidents including Serious Incidents Requiring Investigation
(previously known as SUI’s) remains a priority for The Huntercombe Group.
We have made progress in maximising opportunities to ensure learning from incidents and
Serious Incidents and to ensure that this information is shared across all services.
In our governance meetings we have had presentation from root cause analysis investigations,
we have also shared learning through the use of our governance ‘Hot Topics’ and through
feedback to our Policy Review Group.
Figure 2: Number of Serious Incidents Requiring Investigation in 2012/2013 by
Division
60
50
40
ADMH&LD
30
BIND
20
CAMHS
10
0
Quarter 1
Quarter 2
Quarter 3
Quarter 4
29
Lessons Learnt from Complaints and Incidents
The Huntercombe Group has processes to report, investigate, monitor and learn from
complaints and Incidents. One of the key aims of this process is to reduce the risk of repeat
both where the original incident or complaint occurred and elsewhere across the group. The
timely and appropriate dissemination of learning following a complaint or incident is core to
achieving this and to ensure that these lessons are embedded in practice.
Over the past 12 months in response to complaints and incidents within the Huntercombe
Group a sample of these are as follows. We have:

Reviewed a number of policies and procedures to make them more explicit this includes
our policies for seclusion, observation and cardiopulmonary resuscitation.

We have increased the provision of information for patients in the form of leaflets and
posters having first consulted them on what they see as the information they would like
to see and would find most helpful.

We have made a number of environment improvements in our hospitals and care
environment.

Staff in a number of units have received further training in medicines management.

Introduced a multi-professional peer review process for any patient who is being care
for in an individual care facility.

Introduced a bespoke Mental Health Act Administration system to provide more robust
monitoring of mental health act administration to reduce the risk of MHA errors and
centralised co-ordination, recruitment and support of our Mental Health Act Hospital
Managers.
30
Patient Experience and Listening to Others
It is clear that the patient experience is an essential part of quality healthcare provision. The
experience of care is important to patients alongside safety and effectiveness. Patients want to
feel informed, involved, listened to and supported so that they can participate and make
meaningful decisions and choices about their care and treatment.
Within the Huntercombe Group we have a number of different mechanisms for feedback from
those who use our services and their families. Patient Forums / Community Meetings are held
in all of our services and we have annual survey programmes in place in our Adult Mental
Health and Brain Injury and Neurological Services. Within our CAMHS services patient’s
questionnaires are completed shortly after admission and on discharge from the service.
Friends and Family Test Results
This year we included within our Adult Mental Health and Learning Disability survey the friends
and family test question.
How likely are you to recommend this service to family or friends if they needed
similar care or treatment ?
Patient Survey 2013 - Adult Mental Health & Learning Disability Services
54%
0%
10%
20%
Extremely likely
30%
Likely
23%
40%
50%
Neither likely or unlikely
60%
Unlikely
10%
70%
80%
Extremely unlikely
9%
90%
1%4%
100%
Don't know
31
How likely are you to recommend this service to family or friends if they
needed similar care or treatment ?
Patient Survey 2013 - Specialist Brain Injury Services
54%
0%
10%
20%
Extremely likely
30%
Likely
23%
40%
50%
60%
Neither likely or unlikely
Unlikely
70%
10%
80%
Extremely unlikely
9% 1%4%
90%
100%
Don't know
Patient Satisfaction
Adult Mental Health & Learning Disability Services
In early 2014 we conducted our annual survey of patients and residents within our Adult Mental
Health and Learning Disability Services. In total 249 patients and residents out of a possible
417 agreed to participate in the survey. Giving a response rate of 60%.
The survey was based on the CUES questionnaire (Carers and Users Expectations of Services),
the NHS Service User Survey and the National Learning Disabilities Survey. The questions were
adapted where requires for adults with a learning disability often residing in secure
environments. The survey was facilitated by advocates from POWHER our contracted
independent advocacy. Where needed, advocates provided communication support to individual
patients to assist them in indicating their preferred responses to individual questions.
The graphs on the following page outlines the percentage of people who stated they were
happy or felt satisfaction in each of the areas covered within the survey. These scores give an
overall percentage for a number of individual questions in each section of the questionnaire.
The results are now being considered by the individual services and actions plans put in place
to address the findings.
32
Figure 4: Patient Survey
120%
100%
80%
60%
2012
2013
2014
40%
20%
0%
*Support for Meaningful Life has only been part of the patient survey since 2014 therefore no
comparisons are available from previous years.
These results indicate an improvement in satisfaction across all areas with exception of
satisfaction with support provided from our staff and we will be reviewing the survey comments
and looking at this further to identify the reasons why and take steps to make improvements.
There was also a very small reduction in satisfaction with food.
Other highlights within the survey findings include:

87% consider the place where they live to be clean.

89% of patients / residents stated they knew who to contact if they wished to raise a
concern about their safety or to make a complaint.

83% of patients / residents felt that staff treated them with dignity and respect

90% of patients / residents felt that they were given prescribed medications when they
needed them (including pain relief).
We will continue to take actions to improve our patients and residents satisfaction in all areas
throughout the year ahead.
33
Child and Adolescent Mental Health Services
Within our CAHMS Services regular surveys of both Patient and Parent Satisfaction have been
undertaken on an on-going basis throughout the year both during treatment and upon
discharge.
Recent findings from the CAMHS satisfaction survey undertaken at Huntercombe Hospital
Maidenhead and Huntercombe Hospital Norwich identified the following:

Overall, 71% of patients across units felt that staff treated them with respect and
dignity (Maidenhead).

81% of patients reported that they have one consultant and one doctor in charge of
their care (Maidenhead).

65% of patients reported that they have an individual therapist (Maidenhead).

100% of patients who responded were happy with the input they received from
therapists (Norwich).

67% of patients who responded to the survey were very happy with their group therapy
(Norwich).

67% of patients said they were very happy with the help they received from the service
with regards to their education (keeping up with school work, taking exams) (Norwich).
Some patients at Norwich who responded to the survey were unhappy about how information
was given to them about the nature of their problems and what to expect in the future and a
number of patients at Maidenhead felt that the physical environment in which there were being
cared for could be improved. As a group we were aware of these issues and are committed to
addressing them.
Acquired Brain Injury & Neurological Services
During July 2013, surveys were distributed to all clients at every Huntercombe Group specialist
brain injury centre to obtain feedback about the service provided by our teams at each centre.
In previous years we combined the survey for clients and relatives, but this year, for the first
time, we issued separate surveys to each group. In light of these changes it makes
comparisons with the previous year’s results more difficult.
In total 392 questionnaires were given to clients for their completion. A total of 170
questionnaires were returned giving a response rate of 43%.
Outlined on the following page is a summary of the results.
34
Service Provided by Acquired Brain Injury & Neurological Services in 2013 Survey
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
* In addition a further 48% stated that they could not recall if they had been offered on admission.
Carer Survey
Brain Injury & Neurodisability Services
In March 2013 a new survey targeting our carers was developed by The Huntercombe Group,
this was sent by post to the next of kin/nearest relative for all patients within our Acquired
Brain Injury and Neurological Services survey.
In total 359 carers were invited to complete the survey, 79 surveys were returned giving a
response rate of 22%
Carers were asked how likely they would be to recommend The Huntercombe Group to
someone in a similar situation to their relative, and a selection of the key results was as follows:
How likely are you to recommend this centre to family or friends if they
needed similar care or treatment to your relative?
43%
0%
10%
20%
39%
30%
Extremely likely
40%
50%
Likely
60%
4%
70%
80%
90%
100%
Neither likely or unlikely
35
How would you rate the quality of care your relative/friend has received so
far?
42%
0%
10%
20%
48%
30%
40%
50%
Excellent
60%
70%
80%
90%
100%
Good
Do you feel your relative is safe and well cared for?
91%
0%
10%
20%
30%
40%
1%
50%
Yes
60%
70%
80%
90%
100%
No
Do you feel your relative/ friend is treated with dignity and respect?
59%
0%
10%
20%
30%
38%
40%
Totally
50%
60%
70%
80%
90%
100%
Most of the time
36
Welcome and Support
Are you made to feel welcome by centre staff when you visit?
94%
0%
10%
20%
30%
40%
Totally
6%
50%
60%
70%
80%
90%
100%
Sometimes
Aspects of the Service That Impressed our Carers
The following are quotes taken from carers survey:
“Staff always find time to make our daughter smile and laugh.” – Elswick Hall
“The relationship between mum and carers is excellent, they interact with her really well and
make her feel part of a community.” – Crewe
“They detailed report received this year was by far the best we have ever had.” –
Hothfield
“The staff are always polite and helpful and the grounds always look nice.” – Murdostoun
“Care is brilliant and staff are very caring.” – Nottingham
“Staff are polite and always happy to answer any questions.” – Peter Gidney
“The centre manager is excellent.” – Frenchay
“I’m impressed with the one to one care provided during the early days of admission.” –
Frenchay
“The staff’s knowledge regarding Brain Injury and their extremely caring nature.” –
Nottingham
“The staff are helpful and nothing is too much trouble.” – Crewe
“Caring friendly staff, willingness to listen and act upon any changes we feel
necessary after discussion.” – Abbeymoor
“The existing centre manager and his approach to patient care.” – Campsie
“Support for family members, also staff retention is high this is of great benefit to
your patients.” – Stocksbridge.
37
Child and Adolescent Mental Health Services
In June 2013 a relatives and carers survey was conducted at Huntercombe Hospital Norwich.
The findings of the survey were generally positive although a couple of areas for improvement
were noted and have been addressed.


Parents expressed difficulties around being able to get through to their relatives via the
main switchboard. In response to this, the switchboard answering message was
reviewed, direct dial numbers were facilitated on the wards and cordless phones placed
on the wards.
CPA’s – Although parents said they were able to input into their relatives CPA, they felt
the reports were distributed too late, leaving them insufficient time to read through the
paperwork prior to the meeting. New processes have been put in place internally to
address this.
Outlined below are some of the positive comments received from the parents of patients at
Norwich.







Reception staff are all excellent, polite and make you feel welcome.
As far as I know my relative receives fabulous care, always happy when she rings or I
ring her. Only thing she says, “I’m unhappy as I’m too far away from my family which
we all agree.
Very friendly and very professional, make it easy to bring up/talk about more difficult
issues.
‘Staff I have had the chance to talk to have been great, can’t fault’
‘Overall we are very pleased with the care our relative has received. Problems have
been addressed and acted upon.’
Skype is a great bonus for us as a family – thank you for providing the service’
‘I would like to thank all the staff for the fantastic care they give X’
Adult Mental Health Services
Our Relatives and Carers survey for Adult Mental Health and Learning Disability Services is
currently underway and a report will be produced soon.
Feedback from Referrers
Each year The Huntercombe Group conducts surveys of its referrers. The aims of the surveys is
to gauge customer perception of The Huntercombe Group as a provider of specialised services,
to determine customer satisfaction across the Group, to better understand the key drivers for
referral and customers’ future needs and to identify strengths and weaknesses.
During 2013/20134 surveys have been undertaken in both our Child and Adolescent Mental
Health Services and our Brain Injury and Neurological Services divisions.
Referrers were asked to rate various aspects of our service. The following graphs show how
each service was scored out of ten against each criteria for both divisions.
38
Figure 5: Aspects of our Service for Acquired Brain Injury and Neurological Services
How would you rate the following aspects of our service …
(a score of 10 = "excellent")
Structure of our case review meetings?
Quality and effectiveness of our communication?
Range of activities available?
Appearance of the centre and its facilities?
2013
Our ability to engage our patients/clients in all aspects…
2012
Effectiveness of our administration and support staff?
Clinical effectiveness of our nursing care staff?
Clinical effectiveness of our therapists?
Clinical effectiveness of our consultants?
Overall clinical effectiveness of our MDT?
Overall quality of service your patients/clients have…
0
1
2
3
4
5
6
7
8
9
10
Figure 5: Aspects of our Service for Child Adolescent and Mental Health Services
How would you rate the following aspects of our service …
(a score of 10 = "excellent")
Structure of our case review meetings?
Quality and effectiveness of our communication?
Range of activities available?
Appearance of the hospital and its facilities?
Involvement in CPA process
Education Provision
Effectiveness of our administration and support…
Clinical effectiveness of our nursing care staff?
Clinical effectiveness of our therapists?
Clinical effectiveness of our consultants?
Overall clinical effectiveness of our MDT?
Overall quality of service your patients have…
0.00 1.00 2.00 3.00 4.00 5.00 6.00 7.00 8.00 9.00 10.00
2013
2012
39
The following comments were made by referrers:
Regular written updates
are very helpful.
The effort and specialist skills
that is very evident in the team
and how they use those skills
to ensure the best outcomes
for the patient.
Over a number of years an
effective partnership approach
including residents and their
families has been developed.
Cotswold Spa have provided an
excellent service and I would
have ticked excellent in all of
the boxes about if my survey
just covered this unit.
The interdisciplinary model of
care and the communication
with professionals as well as
the patient and their family.
The feedback on our patient
under your care was very
good and the staff were very
friendly.
Easy access to any
member of the MDT for
up-to-date information.
Communication and work of
social work and education
staff. Very important bearing
in mind the geographical
location of the Edinburgh
service from the home areas.
Referrers were also asked to highlight aspects of the service they would like to see improved.
These are now being considered by The Huntercombe Group.
We very much welcome your feedback and suggestions regarding this quality account. If you
would like to comment or if you require any further information please email Paula Smyth, Head
of Clinical Standards and Compliance at paula.smyth@huntercombe.com
Alternatively please write to Paula Smyth, Head of Clinical Standards and Compliance, The
Huntercombe Group, Tulip House, Craven Court, Willie Snaith Road, Newmarket, Suffolk CB8
7FA
40