Vista Healthcare Independent Hospital
Quality Account 2013/14
2013/14
VISTA HEALTHCARE INDEPENDENT HOSPITAL
QUALITY ACCOUNT
INDEX
Page(s)
3
Statement from CEO
Board Directors
4
Statement from Clinical Directorates
5
Structure of the Report
7
Introduction
8
Overview of Services Provided by Vista Healthcare
10
Priorities for 2014/15
o
Patient Engagement/Experience
12
o
Effectiveness
12
o
Safety
12
o
ASC/LSU Objectives
13
Surveys 2013/14
o
Patient Satisfaction
14
o
Essens
15
o
Safeguarding Following Patient Training
16
o
Food
17
Update on Priorities for 2013/14 & Updates
o
Patient Engagement
18
o
Safety
25
o
Effectiveness
28
Security at Vista Healthcare
30
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Complaints
33
Conclusion and Contact Information
34
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Statement from the CEO
This is my first opportunity to present the Vista Healthcare Annual Quality Accounts. As Chief Executive
Officer I recognise the importance of the Accounts in raising standards in the quality of care and
treatment mine and all other care providers deliver to those entrusted to us. I also see this as a chance
to demonstrate the direction of travel that Vista is showing in achieving its goals and to report and
celebrate success where appropriate.
The year has been less turbulent than those previous as the management team has been more settled
and have started to get to grips with the many challenges that the hospital and sector were presented
with. I am pleased and proud of the attitude and commitment that has been shown by my team in
satisfying many of the priorities set in earlier Accounts and determining new goals for the future.
The external continued scrutiny from the regulator provides the desired operating framework for
service providers; however it’s down to the provider organisation to ensure that all staff are focused on
delivering quality of care. The fundamental of good quality, appropriate and safe care is the placing of
the patient at the centre of that care. Here at Vista we have strived to create a culture that values and
empowers patients, giving them a stake and voice.
This is further supported with staff who also feel valued and heard. Training is in place that ensures staff
are competent to deliver relevant care, supervision is available aimed at continuously improving
practice and the appraisal of staff is undertaken to reflect performance and address staff needs.
As a specialist learning disability service we have focused on empowering patients through the
development of literature that is understandable (easy read) and involvement in producing bespoke
training packages which helps them understand the reason for a number of interventions. As a
consequence of empowering patients and staff, Vista Healthcare can demonstrate how such an
approach influences standards, best practice, partnership working and helps us become a better
listening organisation that puts service users at the heart of everything it does.
I am delighted to present the 2013/14 Quality Accounts as I believe that Vista Healthcare has moved a
long way in achieving the objectives previously set. We continue on our journey happy in the
knowledge that we understand the route and meeting our sign-posted milestones as we go. We are
always mindful of becoming complacent but are aware the process of producing and reviewing these
Accounts keeps us focused on our patients, their care and quality of life.
Doreen McCollin
Chief Executive Officer
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Board Directors
The Board is accountable for the systems of assurance, internal control and risk management and
regularly monitors and reviews these at Board level and through the hospital management team and
sub-committees.
The Chief Executive is ultimately responsible for ensuring that Vista delivers a high quality service for all
of our patients and for the delivery of and compliance with assurance, quality and performance targets.
This responsibility is delegated to the Clinical Directors and Service manager for quality governance,
operational performance and performance targets, and also to the Financial Controller for financial
targets.
The Vista Healthcare Board is actively engaged in reviewing the quality of our service. The Chief
Executive, Chairman and Board Directors take part in regular hospital-wide visits to meet with patients
and staff. Throughout the year teams consisting of the Chief Executive, Directors, Estates & Facilities
and Health & Safety, visit the site to assess the environment. Action plans are developed and
monitored as necessary. Key themes and risks are reported to the Board.
The Board gains assurance on quality through a number of reports including Board visits to wards,
patient complaints, Health & Safety, maintenance, safeguarding, quality and financial reports. In
preparing this quality report the directors have taken steps to satisfy themselves that:
• The content of the quality reports meets with the requirements set out by Vista Healthcare
• The content of the quality report is not inconsistent with internal and external sources of
information, including –
o Board minutes and papers from the period April 2013 to June 2014
o Papers relating to quality reported to the Board over the period April 2013 to June 2014
o Vista Healthcare complaints report
o Essens Report 2013/14
o Vista Healthcare audits
The quality report presents a reflection of Vista Healthcare performance over the period covered; the
performance information reported in the quality Account is reliable and accurate; there are proper
controls over the collection and reporting of the measures of performance included in the report.
There are proper internal controls over the collection and reporting of the measures of
performance included in the Quality Account and these controls are subject to review to
confirm that they’re working effectively in practice.
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Statement from Clinical Directorates
ASC /LR Service 2013/14 and forward into 2014/15
The year 2013/14 saw the formal development of the directorate and identification of key working
ethos within the directorate.
A Clinical Director was formally appointed in February 2014 and we are in the process of appointing a
Directorate Modern Matron/Directorate Manager.
Bed Occupancy increased significantly In 2013/14 perhaps due to improved relationship with
commissioners and better outcomes as reflected in many successful discharges and transitions.
The ASD accreditation process continues to progress and we have now completed all core standards
and will be moving on to the Specialist Standards in 2014/15. The aim will be for the ASC service to gain
full NHS Accreditation in 2015/16.
Although the directorate lost a number of key multi-disciplinary staff, we have now recruited dynamic
and well qualified staff in the OT and SaLT departments. We have also established OT assistant and SaLT
assistant positions to enable hands on implementation of professional guidelines with nursing and care
staff.
The establishment of on-site GP clinics has helped to reduce the problem of access to primary care for
many of our patients that are not able to visit GP Clinics. The directorate has taken full advantage of this
situation to ensure that all patients within our services have required access to all aspects of their
general medical care. This has led to an overall physical health status as reflected in our physical health
index monitoring.
Dr O. Kareem
Clinical Director
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Low Secure and LR Service 2013/14
The introduction of a clinical directorate has allowed the team working in Maple and Watson (low
secure) and Larch (locked rehabilitation, female) to focus more on this forensic group of patients.
The aim of the multidisciplinary team is to reduce risks and increase skills, allowing the patient to safely
progress along their care pathway. Our interventions need to be tailored to the cognitive abilities of our
patients and their ability to benefit from individual or group interventions.
Our forensic focus has allowed us to form positive relationships with local MAPPA and the statutory
agencies, working together to manage risks.
We have good working relationships with NHS England care managers who commission all of our beds
in the low secure units.
In May 2014 we undertook our first peer review in the Royal College of Psychiatrists Quality Network of
Forensic Services. We were pleased with the feedback and will make further improvements through
our action plan.
Dr Lorna Duggan
Clinical Director
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The Structure of the Report
Vista Healthcare Quality Account outlines the targets that have been agreed for the coming year
2014/15. It also summarises the company’s performance and improvements against the quality
priorities and objectives that were set for 2012/13.
We have reported against the priorities, including explanations where we have not met our targets and
how we’re addressing those issues.
We have attempted to work with patients and other stakeholders to establish our priorities for the year
ahead and once again, have detailed our new priorities under the headings Patient Safety, Clinical
Effectiveness and Patient Experience.
We have also provided other information that we consider relevant to the overall quality performance
of the Hospital.
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Introduction
As an organisation, Vista continues to set high standards for delivery of patient care; standards which
include the provision of a safe, effective and inclusive service. 2012/13 was a particularly challenging
year for the organisation as it found maintaining the balance of high quality care within a very tight
financial envelope whilst accepting that there are a number of key areas requiring financial resources to
address them. Vista had not had an up-lift in fee for a number of years whilst accepting that inflation
and other increases in cost meant that it was a very fine balancing act to meet all the necessary targets,
both those that are externally imposed along with the organisation’s own. Notwithstanding this, Vista
took the view that if the people that use our services continue to be the focal point around which
services are designed and delivered, it was necessary to commit financial resources to enhance the lives
and wellbeing of our service users.
The key priorities for 2012/13 clearly set out some exacting targets across broad areas of patient
engagement, safety and effectiveness of service provision/delivery; details of which will be contained
within Vista’s documentations. The imperatives of many of these targets has been; to enhance the
systems, processes and policies to ensure that we are proactive in enhancing the quality of services
delivered to our patients; the maintenance of patient’s, staff’s and the general public’s safety; the
ability to respond in a timely way to incidents, accidents; and also patient’s, care managers,
commissioners and the CQC’s comments.
Key areas that Vista Healthcare had sought to address were the management of medicines; and
empowerment of our patients with the intention of enhancing their involvement in their care and the
running of the hospital, ensuring that information provided to patients was in the format that they
could understand either through the provision of easy-read documentation and the use of language in a
way that the Plain English Society advocates. In respect of patient’s safety, the management of
medicines was considered to be an area worthy of some focused attention through audits and
subsequent training.
Vista Healthcare strives to learn from feedback received from its patients, their families and other
stakeholders. We recognise that all our stakeholders will only accept our assurances from our ability to
demonstrate high levels of patient satisfaction through the provision of a safe, therapeutic and outcome
focused service. Since the last report, there have been a number of changes within the hospital that has
enabled us to develop effective care pathways and enhance our ability to provide true individualised
care with the level of flexibility that is necessary to meet individual needs. These changes have brought
about a number of challenges, which were not unexpected as they mirrored those detailed by change
management theorist.
Over the last 6 months of 2012, we have made significant advances in embedding agreed changes. This
has been verified both by the CQC and the National Development Team for Inclusion (NDTI). We are not
complacent in believing that we have arrived at our destination and firmly believe that there are a
number of other areas that still require change. These areas form part of our Quality Improvement
Priorities for 2013/14.
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We aim to provide services that are safe and to make a positive difference to the lives of everyone we
come into contact with; be it patients, their families, commissioners, care managers or colleagues, as
well as being a good neighbour.
We also identified behaviours which are associated with our Values. They are around Respect, Caring
and Trust.
In 2013/14, the majority of our services were commissioned by NHS England; with other beds being
purchased on behalf of the commissioners of local CCG’s covering an area such as Hampshire, Berkshire,
Surrey, Dorset, Sussex and Wiltshire. One of the great achievements for us has been the ability to
provide services as near to the home communities as possible.
During 2013/14, in order to ensure that Vista’s internal structure is the right shape to deliver clinical and
operational excellence, we conducted a review on how the services are organised. As a result of this,
the hospital was divided into two Directorates; one Low Secure and the other Autistic Spectrum
Condition. This Directorate structure will allow the Hospital to provide a streamlined model with
consistent structures on the roles and responsibilities to improve reporting and align our care delivery
to the needs of the patient group and improve reporting and thus drive quality up.
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Overview of Services
Vista Healthcare Independent Hospital is a registered hospital which provides assessment and
treatment for people who have learning disabilities and/or have mental health problems who present
challenges in relation to their behaviour. The main driver to improve services is the paper – Valuing
People which sets out the national strategic direction for learning disabilities and reflects the objectives
set out in Vista Healthcare’s Quality Agenda.
There are five wards within the hospital that are part of the care pathway encompassing locked and
rehab male ASD, Low Secure male and female and female rehab. In an attempt to reduce the length of
stay within the hospital, there have been discussions with commissioner and case managers on the
merit of the hospital providing personal care and supported living outside of the hospital. This is an
attempt to enhance the care pathway and assist our commissioners and patients to live independent
lives out in the community. This initiative has been warmly welcomed by case managers and
commissioners alike. To that end, a successful variation application was made to the CQC.
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Objectives for 2014/15
Patient Engagement/Experience
1. Increase the number of communication groups running.
2. Develop the patient training portfolio to give service users the opportunity to become
involved in training on a wider range of subjects, including physical health, sexual health,
manual handling, complaints training, safeguarding and recruitment.
3. Take forward service user led audits and encourage suggestions for these at Patient
Assemblies and similar meetings.
4. Encourage service user involvement in attendance at hospital meetings, reporting at CPA,
re-forming the patient social club, attendance at external meetings and attendance at the
15 Steps Challenge.
Effectiveness
1. Improve the patient observation and engagement training to staff and service users up to
90%.
2. To further embed the work of the Clinical Directors.
3. To appoint the Modern Matrons to work in conjunction with the Clinical Directors to ensure
services are safe, effective and patient led.
4. Encourage ward staff to participate in therapeutic groups and take part in supporting
patients with homework and encourage prioritisation of therapy over activities, with staff
supporting patients during therapy sessions.
Safety
1. Deliver training to all patients in women’s and men’s health (as appropriate) to include
personal and sexual health.
2. To embed a pro-active risk management strategy.
3. To formalise the Directors quality walk-around to ensure we learn and use their feedback
and observations meaningfully.
4. Re audit the ligature audit carried out in the 2011/12 year.
5. Increase awareness of dysphagia by re-introducing off site training for the SaLT team and
key staff, accessing appropriate external training for key staff, and increasing the number of
robust mealtime guidelines/care plans/liaison with kitchen staff to maintain patient safety.
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In 2014/15 the ASD/Locked Rehabilitation directorate will focus on the following:
1. Establishing specific service philosophies for the ASD and Rehabilitation services.
2. Strengthening our Directorate Clinical governance processes via regular meetings where quality,
outcomes, effectiveness and safety will be the focus of discussions.
3. Improvement of patients’ safety by ensuring appropriate monitoring of pharmacological,
psychological and physical interventions.
4. Ensuring that all patients that are not detained under the MHA are appropriately assessed for
DoLS in light of recent supreme court judgement.
5. Work closely with commissioners, community teams and families in order to ensure their input,
participation and feedback in to the care that we are providing.
6. Set up a framework of expected outcomes for patients by which we can measure the
effectiveness of our care input.
7. Undertake a ‘Zero Tolerance’ campaign against patient bullying so as to bring peoples minds to
this issue, enlighten them of its significance and enable them to reflect on Practices that may
otherwise not be construed as bullying.
8. Continue to progress the NAS accreditation program in order to achieve full accreditation in
2015/16.
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Surveys
Patient Satisfaction Survey – March 2014
Number of Patients Taking Part in Survey Vs Total Number Available:
The last two patient surveys were conducted using elite tablets with answers displayed using smiley
faces. This increased the patient’s enjoyment of taking part. Respondents for the survey conducted in
March 2014 were considerably less than in previous years and we felt that this reflected the change in
patient population during the 6 months previous; a significant number of new patients had been
admitted and many more were experiencing difficulty with presentation or with communication skills.
Our last survey was redrafted to reflect CQC standards and this worked well. Our next survey will be
adapted further to reflect the needs and patient populations of the two directorates, and we may
conduct the survey using a sample of the patient population rather than the whole of the population so
that those patients with more advanced or reliable communication skills would take part.
Vista remains committed to conducting two patient surveys per year.
Despite the lower response rate, results were overall very positive:
Care and Treatment
80%
Receiving appropriate treatment
70%
Agree with the content of their care plan
85%
Involved in ward rounds
80%
Agree that staff help and motivate them
75%
Agree that they know who their named nurse/key worker is
74%
Agree that they like who supports them on the ward
7%
20%
Not satisfied with the way that their CPAs are run
Did not know what their medication was for
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Patient Privacy & Dignity
12%
Did not know about abuse
90%
Agreed that they did know what abuse was and what to do about it
20%
Did not understand that records were kept about them
45%
Felt that they needed more help managing their money
60%
Would like to have access to online educational opportunities
70%
72%
Would like to have controlled access to email
56%
Happy with the food
Would like to use IT to keep in touch with family and friends and for
recreation
Unmet Need
30%
Did not know their Care Manager
35%
Did not know their Social Worker
ESSENs
The main objective of the EssenCES audit was to evaluate the social and therapeutic atmosphere on
wards for Forensic Patients at Vista Hospital, outlining areas of good practice and areas that may need
improvement. The Essen Climate Evaluation Schema (EssenCES) was administered to forensic patients
and staff members who work with forensic patients to assess the essential traits of the social and
therapeutic atmosphere of the wards. There are marked variations between scores on the EssenCES
questionnaire across the LSU (Watson and Maple ward) and Locked Rehabilitation service (Ash and
Larch ward) at Vista Healthcare.
In order to give all staff the opportunity to complete the questionnaire, copies were left on all wards
and instructions were given as to how they should be completed. Members of the Psychology
department also provided individual guidance as to how the questionnaires should be completed.
Patients completed the questionnaire supported by a member of staff.
Therapeutic Hold
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Patient Safety
Experienced Safety
Improvement Area
•
•
•
Therapeutic hold for patients on Watson Ward.
Experienced safety, in particular for staff on Maple Ward.
Patient cohesion, in particular for patients on Watson Ward.
Patient Survey following Safeguarding Training
March 2013 Vs October 2013
Our first training session was held in Q1 2013; 3 separate training sessions were held and both common
venue training and ward based training was carried out. With the exception of 2 patients who were
unwell, all patients were trained at this time. Further sessions of training have been carried out, again
using a mixture of ward based training and a common venue for group training, and in the year of 56 in
patients we have trained 53 – achieving our 95% target for the year.
Recognising the importance of this we will continue with this programme throughout the year of
2014/15.
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2013/14
Patient understanding of the term "abuse"
Survey
March
2013
Survey
October 2013
81%
83%
Patient understanding of what action to take
Survey
March 2013
Survey
October
2013
Patients who
found training
useful
88%
100%
Patients
who would
like to do
training
again
78%
50%
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Patient Survey - Food Survey
March 2014
In October 2013, Vista started cooking fresh food on site again. It has been 6 months and Vista did a
follow up food survey to see patient response to this change across the hospital.
5 out of 6 wards were involved in the food survey. A rehabilitation ward ASH is out of scope as they do
their own shopping and cooking. Overall 76% patient participates in this survey.
Overall 95% of patients at Vista enjoy their meal, only 2 patients are not happy with all aspects of the
food. Food is such an emotive issue it is difficult to get it right for every person.
It does seem that cooking fresh food on site has been a success with the majority of the patients. Vista
still thinks to improve certain sections after achieving success great response from patients.
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Update on Priorities for 2013/14
Patient Engagement
1. Ensure all elements of care are patient focused and allows for patient input in line with the
recovery principles, the outcome stars and My Shared Pathway.
In this financial year Vista Healthcare reorganised the service into two Clinical Directorates. One
directorate has responsibility for two low secure wards, and one locked rehabilitation ward;
namely Watson, Maple and Larch. The other directorate has responsibility for two ASC wards,
Prandle and Willow, and one locked rehabilitation ward, Ash.
The hospital took the decision to work with My Shared Pathway across the hospital rather than
just on the mandatory low secure service wards. We also have licences for three other recovery
tools, namely, Recovery Star, Life Star, Spectrum Star and the intent is for all patients to be
working with these tools throughout their stay at Vista.
The low secure directorate has fully embedded My Shared Pathway and the use of a recovery
star. We have not had many patients who have come to stay here with a completed My Shared
Pathway portfolio, but there have been one or two. The patients who are admitted into the low
secure service are automatically placed on a My Shared Pathway care plan and they can have as
much involvement in this as they would like. The recovery star chosen to accompany MSP will
be the one most appropriate for the particular patient. In general, Life Star is used on Watson
and Maple, but Recovery and Spectrum Stars are available if a patient is more able or less able
to participate in their care plan writing.
During the reporting year 2013-2014 we received and held a lot of training for MSP and the
Recovery Stars. We built upon the official training we received in September 2012 for Life Star.
Since then, we have trained further staff both on and off the wards.
We have seconded a nurse into an audit role on the low secure directorate service. He is
making sure all patients have their recovery tool of choice in place, as well as taking on the
training of the patients. This has been very interactive and involved patients scoring themselves
on the star chart.
We have renamed the regular Ward Rounds to reflect the commitment to MSP and this patient
centred way of care planning. The meetings are now called “Pathway Meetings” and this has
filtered down to the patients, so this is what they call them too. We have held competitions in
this financial year, one for the best MSP Portfolio, and one for the best quotes regarding
working with MSP to be put onto the website.
We feel we have fully committed to working in a patient centred, patient involving and recovery
focussed manner. Our IT systems have been changed to reflect this new way of working, and
we have changed some of our terminology to help embed this. We now have a “Recovery
Team” rather than an MDT team, and we have “Pathway Meetings” which do help keep
everyone focussed on what the meetings are for. Our CPA Manager has worked with the IT
team to ensure the electronic systems work in the way we want them to and that they capture
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the information in the right way. This has been a huge piece of work over the last two years, but
we are at the stage where we are fully embedded but there might be more work to do on the
implementation of the recovery star tools, especially on the ASC service. This is an important
work in progress. Finally, to check this element of care is patient focussed, we do ask the
patients their views on feeling involved in their care, feeling involved in the writing of their care
plans, the help they receive from staff in understanding their care plans and having copies of
their care plans. This is done at every CPA meeting, and in the twice yearly Patient Satisfaction
Survey.
2. Further increase meaningful engagement (aim for 100%)
As mentioned in previous years Vista has adopted the Low Secure Standard of 25 hours of
meaningful activity per week per patient as a benchmark for good practice across the whole of
the hospital site using the nationally recognised definition of Meaningful Activity – ‘Time spent
doing activities both on your own or with others, which are personal and important to you,
impacts on the way you feel and which drives your treatment and recovery’ – as a means of
identifying and recording meaningful activity offered to patients. In addition the Meaningful
Week component of the CareNotes software is being used to record and analyse the data
regarding patient’s engagement with meaningful activity. The last 3 months of data has been
used as a sample for analysis (i.e. 01/12/13 to 28/02/14).
The analysis of this data shows that Vista Healthcare offered average hours of meaningful
activity in excess of 25 hours per week, with some individual patients offered/engaging with
over 100 hours of meaningful activity per week!
Whilst Vista is pleased with the level of engagement and uptake of the meaningful week, the
hospital is committed to developing the recording system through the introduction of a more
user friendly version of the Meaningful Week system.
3. Increase the number of patient-suggested audits carried out
Vista Healthcare is committed to increasing the patients’ voice and in doing so it was agreed in
the Quality Account 2012/13 that there would be a number of patient suggested audits carried
out. However, within the service it has been quite difficult for the patients to come to suggest
particular areas that they want auditing. The only area that they were particularly keen for this
to happen in the year was food. To this end a food survey was carried out twice during the
reporting year. There was a marked difference in the results from both – as discussed above
this is mainly down to the hospital agreeing or accepting the patients’ suggestion to provide
freshly cooked food on site rather than cook/chill food previously provided.
During 2013/14 an enormous amount of work has been carried out on patient training and less
of audits. The plan for 2014/15 is to provide some training to the patients on audits and what
they are in the hope that more patient led audits will be carried out during the next year.
2013/14 saw the introduction of the 15 Steps Challenge. The 15 Steps Challenge was born out
of a mother’s belief that “I can tell what kind of care my daughter is going to get within 15
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steps of walking on to a ward”. The purpose of the Challenge is to help staff, patients and
others to work together to identify improvements that can be made to enhance the patients
experience. It provides a way of understanding patients’ first impressions more clearly. It also
provides a method for creating positive improvements in the quality of care through identifying
what is working well on wards and what could be improved; therefore, it supports the sharing
of good practice and concentrates on some patient experience improvements.
For this process patients were invited to participate and there were a number of patients who
demonstrated interest and took an active part. Their input was extremely encouraging and
demonstrated that patients do have a key role to play in this area and can contribute
significantly. To this end it has been decided to continue with the 15 step challenge audit in this
area and to invite patients again to take part.
4. Ensure that 95% of patients are trained in Safeguarding
In recognition of the importance of training patients in safeguarding, we planned to hold this on
a quarterly basis, thereby picking up all new patients and providing refresher training for those
patients who want it or are due for it.
Each training session is delivered by a professional patient trainer using an animated interactive
DVD and covers the 6 different areas of abuse, Physical, Sexual, Neglect, Financial, Emotional,
and Discrimination. There are stories for each category; some of the scenarios are interactive
and the patients answer “yes” or “no” using a remote control devise. If they choose the correct
answer the scenario shows resolution, if they choose the incorrect response, the scenario will
remain bad, or even get worse. This has proved to be an excellent method of reinforcing the
message to the patients.
This has been received very well by the patients and the majority of them do appear to
understand the message. Understanding is monitored by means of our twice yearly patient
survey at which time we ask if the patients know what safeguarding is, who they would go to if
they needed help and how useful they find the training.
5. Re audit the patient observation and engagement audit
This audit aims to enhance the quality of care by exploring the service-user’s perception of how
they are managed during observation.
Secondly the audit will aim to establish whether the standard of observation within Vista
Healthcare complies with Vista’s own VHCL005 and NICE guidelines.
Objectives
•
To explore service user’s perception and understanding of observation and engagement
•
To examine service user’s view of being observed
•
To look into service user’s activity programme during observation
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•
To explore service user’s likes for observation
•
To examine service user’s dislikes of observation
•
To put forward recommendations and plan of action to improve areas of concern
•
To highlight areas of poor compliance
Was the reason for being on observation
explained to you?
Were you given any written explanation to
agree and sign your observation level?
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Did you engage with staff whilst on
observation?
Did you have any opportunity to staff about
how you felt whilst on observation?
Did you attend any planned activity whilst
on observation?
In your opinion did you benefit from the
observation experience?
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Patient Like
•
•
•
Feel Safe
Staff engagement improved their presentation
Activity
Patient Dislike
•
•
•
•
•
•
Lack of privacy
No space
No dignity
New staff on observation
Intrusive
Staff chatting / reading newspaper
Conclusion
It is clear that service users have not been involved in the management of their own
observation. To improve the quality of care to meet the standards that have been put in place
by vista Healthcare we have to do more to meet the standards, and improve the necessary
training of staff to improve the quality of care of service users.
6. Ensure patient involvement in the recruitment process for all staff
Patients have been involved in the recruitment of staff on an informal basis for many years. The
patients who had been involved in this process had always enjoyed the experience that this
afforded them, and interviewees had expressed positive comments about their experience too.
During 2012/13 it was agreed that the involvement of patients in the recruitment process
should be formalised. A recruitment drive was held during Q1; posters were put up on the
wards advertising the training and patients were asked to register their interest with either a
member of the ward staff, or with the Patient Experience Manager.
It was felt that 4-6 patients was the right number and those who had expressed an interest
were screened to measure their understanding of the screening and to ensure that there were
no relationship issues within the group.
Training took place over a three week period and training included the use of discussing
scenarios and practice interviewing with a number of volunteer interviewees from the staff,
until they felt confident with the process.
The patients are encouraged to score the responses of the candidates to their questions and
this mark contributes to 25% of the final score allocated to a potential candidate. Each patient
has a selection of questions they can ask different candidates applying for different jobs, and
they mark the score out of 10. The scores are then totalled, and this is sent to Human
Resources to be added to the interview and test scores.
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The patients very much enjoy this process and they report feeling empowered to have a say in
who is offered a job here to work with them. They have come up with some very challenging
questions and of course it is also an opportunity to see how candidates handle this situation.
Candidates report that they feel this process is good for them to go through which makes the
contribution patients are making to the workforce very valuable indeed.
Patients are now involved in the majority of recruitment interviews on site.
During Q4 2014, a further 4 patients were recruited and trained. The success of this training is
evident in that many more patients wish to do the training and wish to make a contribution in
this way; we will offer this training on a quarterly basis until all patients that want to be trained
have been trained.
Safety
1. Improve infection control within all patient environments through training and audits
A major focus through the year 2013/14 was to change of the focus on training for all clinical
and non-clinical staff, all clinical staff attending classroom-based sessions on a annual basis and
non-clinical staff will focus on e-learning. All staff are certificated regardless of the method of
training.
To ensure that the classroom training for clinical staff is robust, the training content has been
revisited and updated. A new presentation has been designed and is in use.
The IPC Lead for the hospital ensures that nurses are given the opportunity to develop their
own skills and knowledge and thereby enhancing their CPD learning, and are encouraged to
access on line training, the latest focus being that on antibiotic resistance.
Further attention has been given to sharps safety in all areas, particularly in response to needlestick injury.
Training on Women’s and Men’s Health will be delivered directly to patients and is planned
going into 2014/15, including personal and sexual health.
All Infection Control policies were updated in June 2013 and planning forward the Occupational
Health nurse is putting together a protocol on vaccinations.
From September 2014 it is planned that a microfiber cleaning system will be trialled for all
clinical areas and this will go hand in hand with the introduction of carpet cleaning training for
all housekeeping staff, by the end of September 2014.
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Infection Control Audit Report 2013/14
Compliance Rates:
Clinical Areas
Clinical Equipment
100%
Clinical Environment
Clinical Practice
Hand Hygeine
100%
93%
90%
Environment
Sharps Management
100%
100%
Waste Management
Decontamination of
Environment
100%
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Most of the planned corrective actions were remedied as a result of a refurbishment
programmes; this involved the moving of some equipment into more appropriate areas and the
supply of new equipment, particularly fridges and freezers.
In addition the following remedies were recommended:
Dishwasher to be cleaned regularly to avoid lime scale build up; pest proof containers to be
purchased; paper towels to be provided in wall mounted dispensers to avoid contamination;
hand hygiene reviewed with staff.
2. Ensure that 100% of staff are trained in Safeguarding
There has been a significant increase in the number of staff who received safeguarding training
during 2013/14 compared to 2012/13. Last year saw just 32% of staff completing their
safeguarding e-learning module and 18% having completed a classroom based safeguarding
session, whereas at the time of writing, 86% of Vista staff had received safeguarding training
within the last twelve months.
Whilst Vista have not achieved the target 100% of staff being trained in safeguarding,
monitoring of the training matrix throughout the last twelve months has seen that at all times
between 80 and 90% of staff have received training in safeguarding. Of the staff who have not
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started, or their training has expired, these were typically due to staff being absent from work
due to sickness or maternity leave.
1
4
11
9
Completed
Expired
In Progress
Not started
86%
Renewal Due
Percentage of Vista staff who have received training in safeguarding within the last year, as at 6 March 2014. (Please note, staff that have not
started/expired/in progress are shown as actual staff numbers and not percentages).
An overall review of training within Vista, which sees a new structure from April 2014, confirms
the commitment Vista have in safeguarding service users from abuse by ensuring staff have
access to necessary training. Whilst “Skills for Health” recommends that staff only require
safeguarding refresher training every three years, because safeguarding is such an important
aspect of the care provided at Vista, our training plan ensures that staff receive an annual
refresher. There is also now a multi-layered approach to safeguarding training. At induction,
staff complete the e-learning module which gives them the basic knowledge around
safeguarding. This is supplemented by a face-to face session within the corporate induction day
which reinforces staff responsibilities and clearly outlines the local arrangements for reporting
and recording safeguarding concerns. Finally, quarterly there is a classroom based session which
has greater focus on the principles of the Mental Capacity Act (2005) within safeguarding by
ensuring the participation and representation of people who lack capacity when responding to
safeguarding concerns, as well as emphasising the importance of service user empowerment.
The Prevent Strategy, which is a cross-government policy and forms a strand of the
government’s counter-terrorism strategy CONTEST, is now being embedded within safeguarding
training at Vista. The safeguarding induction training introduces the concept of Prevent, which is
being followed up further by HealthWrap training.
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3. Re audit the ligature audit carried out in the 2011/12 year
Patient safety is key in the delivery of care provided to patients at Vista Healthcare. As part of
the safety consideration it had been agreed that for the 2013/14 Quality Account a re-audit
would be carried out of the ligature risk however, the general view of the policy group was that
the existing policy procedure and audit tool was not robust enough. To this end the policy
procedure and audit tool were reviewed, and ratified by the clinical governance committee.
The new policy required ward staff to carry out the assessment however, this work had not
been concluded until the fourth quarterly of 2013/14, with plans to complete the audit in
2014/15.
4. Improve the service’s ability to review and learn from incidents, accidents and complaints to
further improve patient safety
The start of 2014 has seen the Clinical Governance structure reviewed and the Patient Safety
Committee refocused to align with the governance changes. The Patient Safety Committee is
the forum where the details of incidents, SIRIs, safeguarding, restraints, medication errors,
AWOLs/absconscions and complaints are discussed in detail, allowing for lessons learned and
themes to be extracted and cascaded to all staff in the organisation through the corporate
Clinical Governance Committee. Accidents take on a similar analysis, but this is carried out
through the Health & Safety Committee.
A significant resource has been concentrated on developing the incident/accident reporting
system (Datix) used at Vista. The structure of this system has been modified to ensure the
information needed for analysis and reporting is captured in an accurate and clear way.
Incident/accident reporting procedures have been reviewed, and incident/accident
management procedures have been formally introduced. The quality of incident management
has been emphasised, and the final sign off for incidents and accidents is delegated to two
members of the Senior Management Team. This will ensure the standards of incident
investigations will be im0proved, as well as the organisation having a high level overview of all
incidents/accidents within the organisation, which will enhance patient safety.
5. Actively involve patients in the risk assessment process through the roll-out of START
The end of 2013 saw the training of core staff in the standardised forensic risk assessment
START (Short-term Assessment of Risk & Treatability). This assessment was chosen because it
incorporates static as well as dynamic risk factors, and provides a structure to communicate
risk-related information accurately and consistently. The clinical team have spent the last few
months embedding this tool within clinical practice, and the next steps will be to look at the
patient involvement in the tool.
Effectiveness
1. Review current clinical outcomes with a view to continual improvement
Unfortunately, progress has been slower than we anticipated in this area and we did not meet
this goal. We now plan to put additional resource into this area to ensure that the data is
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published. The Clinical Audit and Governance Committee will ensure that they oversee and
develop this area of work during 2014/15 and will commence monitoring the data from
individual departments.
2. Working with internal and external stakeholders to further improve the patient’s care pathway
including the provision of packages of care for supported living
Following successful registration with the CQC for the regulated activity of personal care,
January 2014 saw the first service user to be supported in the community by Vista’s Supported
Living Service. There is a strategy in place to develop this service further, particularly focussing
on providing an enhanced supported living service to facilitate a quicker and more robust
discharge from hospital for some of our current service users at Vista.
Previously the development of supported living services has been held back by the lack of
suitable accommodation within the community for service users to taken on a tenancy.
Extensive work has been undertaken within the housing sector and Vista Supported Living
Services have now established some arrangements with social and private landlords, to source
suitable property for service users. This is an important step in being able to improve the
patient’s care pathway out of hospital, and further partnership opportunities within the housing
sector continue to be sought to enable a variety of options to meet individual services user’s
needs.
Ensuring that Vista staff are aware of what the enhanced supported living service can offer
patients in the hospital is an important aspect of developing the care pathway. This ensures
that suitable service users are identified at an earlier stage, with the view to being able to
reduce the length of stay within the hospital. Likewise, ensuring commissioners and care
managers have a good knowledge of this service, to enable an early consideration of a service
user’s suitability for the supported living service as part of the service user’s care pathway.
3. Further enhance the accuracy and efficacy of record keeping through continued improvement of
IT structures especially relating to the Electronic Patient Record system
Carenotes, which is the electronic patient record system used within Vista, has been developed
over the last year to include direct input of patient information into a form, rather than
uploading documents as attachments. This has seen the development of specific electronic
forms (i.e. START, Positive Handling Plans), which ensures the information is readily available
and can be updated easily by clinicians. In ensuring effective auditing of clinical records, a
number of reports have been created, using CareNotes, which can easily draw on the
information in the clinical forms, and allows for monitoring of standards.
This has proven particularly helpful in monitoring documentation that requires periods of
reviews; the reports automatically draw out the records that are not within timescales.
This work will be further developed over the coming year.
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4. Further enhance patient access to high quality and effective physical health care monitoring and
treatment
Physical health and well-being plays an important role in a patient’s care pathway and uses a
person centred approach to identify and monitor physical health needs. The focus is on enabling
and supporting patients to access their own health screening through local services where
possible.
For patients who have difficulty with this, physical health screening is available within the
hospital, ECG screening was introduced during 2013, with nurse led monitoring of COPD and
diabetes. Access to dentistry and an optician is through local services, with patient able to
choose their preference wherever possible. Nurses and SaLT representatives have attended
training for oral health care. Podiatry services are provided within the hospital, where clinical
need is indicated, Foot Care Champions provide basic foot care at a ward level.
The NHS England CQUIN for the year of 2013/14 focussed our minds on physical healthcare
issues and one area to be reviewed was the contract that we had with our local GP service. It
was considered that this arrangement was not fulfilling our needs and a new provider was
sought; the new service started shortly before Christmas and all of our specific needs are being
met. In particular the surgery alternates a male and female doctor for those who have a
preference; the patients have choice of whether to attend surgery at the hospital or at the
general practice and the GPs take full responsibility for the patients’ physical health care needs,
including the ordering of physical health care medication.
In response to the CQUIN objectives we also reviewed the way that we record our physical
healthcare information on our PAS system and the collection of information and production of
reports is now much improved; albeit work continues in this area to not only ensure compliance
with our commissioners but also to ensure that we have robust records of patient care.
Patients have a Healthcare Passport that is available to be taken with them should they need
hospital treatment and also a My Healthcare Plan, that accompanies them to GP
appointments.
Education opportunities, available through the Patient Experience meetings, have included
training in being First Aid competent, with scheduled training on personal care, sexual health
and body image.
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Vista Security
The management team at Vista felt that there was a need for a person with overall responsibility for
security to support the work already carried out by the security nurses on each ward and which would
provide cohesion across the site, and a post was created for a period of secondment, which has now
been made substantive. This post reports into the Clinical Governance Committee. Key areas
undertaken by this role include:
Key Management Project – Key management is a major part of the low secure standards in that they
have to be controlled, issued and are accounted for. One of the challenges of this project was
encouraging staff not to take keys home with them and this has involved the introduction of a key
management process for each of the wards and the Security Co-ordinator in visiting each of the wards
to ensure that staff do not leave the site with their keys. This project is still in its early days and the
change has brought about some staff issues however work will continue to ensure that this project is
successful.
Local Grounds Checks – The grounds of the hospital are walked weekly to ensure that all ward outside
areas and pathways are safe for patients, staff and visitors. Identified issues are raised with the relevant
departments. A formal document in the form of a checklist is used which not only ensures that the
checks are completed but that there is an evidence trail of this task, allowing for a double check that
works have been completed as requested during previous checks.
Liaising with Police Service – Vista has strengthened its relationship with the local neighbourhood
police service and hold quarterly meetings with them to explore ways that the hospital can tap into
their resources such as theft prevention in order to strengthen the security of the hospital. This regular
contact has helped to form stronger relationships, which supports contact in liaising with them over
their response to incidents in which they have become involved at the hospital.
Managing the Alarm System – One of the weaknesses of our alarm system was a that we did not have a
strong relationship with the alarm company and internally we did not have a robust system of
understanding where our alarms were, which were in service, out for repair etc. The Security Coordinator first created n alarm detail collection spreadsheet on which is collated all the information
required to identify where alarms are meant to be, which has improved the recovery of misplaced
alarms much easier. Contact with the alarm system company is now on a regular basis and the service
for the repair and return of broken alarms is much improved.
Weekly checks on ward security books – The Security Coordinator makes weekly checks on each of the
wards to ensure sure they are completing the security books correctly; this includes alarm and key
signing, ward security checks and radio response member book. Any issues raised during these checks
can be attended to, including minor repairs to alarms or radios.
Weekly to bi-weekly support meetings with security nurses – These meetings are used to allow for
outstanding issues to be raised or to update staff on latest information, either local or legislative.
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Organisation and commencing of fire drills – The Security Co-ordinator plays a key role in the
organisation of fire drills including liaison with departments such as maintenance to plan and
commence fire evacuation drills for wards. The Security Co-ordinator is responsible for reviewing how
the procedures went, learning points and recommending improvements to be made.
Security Training and Support of Staff – The Security Co-ordinator attends staff induction and ensures
that new staff are aware of procedures and protocols, how to use alarms, radios etc. He is also involved
in ensuring that all staff are given and wear a security badge and ensures that they are allowed the
relevant accesses.
Organising Security for Patient social events – Vista runs a variety of social events for the patients that
have been very well managed in the past by ward staff however it was felt that the Security Coordinator would assume overall responsibility for managing these events. This involves ensuring that
everybody is assembled where they should be and this is supported by the preparation of venue maps,
ensuring that radios are available for staff so that issues can quickly be communicated, and also liaising
with our neighbours to ensure that they are aware that an event is taking place (this was particularly
important during the Bonfire Night party). He will also update local police services. This involvement is
key in ensuring that all events run smoothly and allow patients and staff to feel safe and to have fun.
Plans for the future include:
•
•
•
•
Production of regular security advice emails and/or newsletter
Production of policies eg Hostage and Incidents at Height
Continued improvement of radio and personal alarm systems
Formal introduction of relational security to the wards
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Complaints
Our robust complaints system enables us to produce reliable and accurate complaints information
however the system has changed so much over past years that we cannot make like for like
comparisons. However, overall we are meeting our target times for responding and the complaints
information is reviewed by Clinical Governance, SMT, the Patient Safety Forum and the Board.
Informal complaints recording is encouraged on the wards as it is recognised that some issues that arise
can be and are dealt with by ward staff within a short space of time. This allows the formal complaints
process to focus on the more serious and complicated concerns that are raised. Regular audits of this
system are made by the Mental Health Act Managers as part of their cycle of audit and also the
Complaints Manager.
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Conclusion
2013/14 has been a particularly challenging year for Vista Healthcare as there were some key
organisational changes that took place, including the appointment of a new CEO and a reorganisation of
the SMT and the Board structures. The new administration considered areas that required significant
reorganisation in order to continue to meet the standards laid down by the regulators, managers and
professionals within the hospital. To this end there has been an overhaul of the policy group, H&S,
security and other governance areas.
The priorities set out in the QA 2013/14 were all sensible and were supported by the new
administration however due to changes n some key personnel some areas were not able to be
addressed. Those areas have been reviewed and where appropriate included in the objectives for
2014/15.
The progress made in the clinical priorities and quality of care has been a joy to observe and to be a part
of. This has seen an enhancement in many therapeutic interventions on patient led initiatives. This all
culminated in a CQC visit in January 2014 and which reflected on the clinical and managerial work that
had gone on in year resulting in Vista Healthcare being fully compliant in all areas inspected.
Vista Healthcare intends to continue in its efforts to improve the patient journey and pathway through
offering opportunities for patients to move through in a considered and structured way from inpatient
to life in the community as appropriate, through a supported living service.
The objectives for 2014/15 have been set without the input of Commissioners and Care Managers,
however it is our intention to share these in year and add to them if requested.
Based on the information contained within the Quality Account, Vista Healthcare confirms that the
Quality Account is not prepared in all material respects in line with the criteria set out in the regulations.
The Quality Account is not consistent in all material respects as specified in the guidance, but there is
nothing that has come to our attention that causes us to believe that we are not compliant for the year
ending 31st March 2014.
Contact
For Further information please contact the following:
Doreen McCollin – Chief Executive Officer/Registered Manager
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