Quality Account
2014/15
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Contents
Part 1
Part 1
Our Quality Account 2014/15
Statement on Quality from the Interim
Chief Executive, Josie Spencer
Part 2
Priorities for Improvement and
Statements of Assurance from
the Board
Part 3
Information on the Quality of
Our Services
Annex
Statements from Directors,
Third Parties and Auditors
Josie Spencer
Welcome to Coventry and Warwickshire Partnership NHS Trust’s Quality
Account for the period 1 April 2014 to 31 March 2015. The Quality
Account is an annual report to the public from providers of NHS healthcare
about the quality of services they deliver.
The primary purpose of the Quality Account is to encourage Boards and
leaders of healthcare organisations to assess quality across all of the
healthcare services offered. It allows us, as leaders, clinicians and staff
to demonstrate our commitment to continuous, evidence-based quality
improvement and to explain our progress to the public.
The quality of our services must be the measure by which the Trust is
judged. This Quality Account summarises how we have performed against
the priorities we set ourselves for improving the quality of patient services
in 2014/15. It also outlines the priorities we have set for 2015/16.
Our vision is: “to improve the wellbeing of the people we serve and to
be recognised for always doing the best we can”, and this vision sits at
the heart of all that we do. The Trust Board is accountable for ensuring
that patients receive high quality healthcare. The Trust Board is absolutely
determined to work with staff to nurture a culture that supports and
empowers everyone at the Trust to deliver continuous improvement in
the quality of care we provide.
Front cover image: January 2015 –
Tissue Viability Service nurses campaigned
throughout the year to spread the
word about preventing pressure sores
L to R Nurse Sister Nikki Kavanagh,
Nurse Manager Louise McKeeney,
and Sister Jackie Wells
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High quality care is care that is safe, effective and a positive patient
experience. We will continue to learn from the experiences of others and
will build on the recommendations by stakeholders to the National Health
Service at both a national and local level.
During the past year the Trust identified its own programme of Quality Goals which included:
Quality Goal 1:
Compassion in Action
Quality Goal 2:
Implement a ‘cultural barometer’ including Friends and Family. Test for both patients and staff
Quality Goal 3:
Real Time Patient Experience Outcomes
Quality Goal 4:
Further embed the outcome frameworks at a more granular
Quality Goal 5:
Develop our approach to values based recruitment and appraisal service and IPU level
Quality Goal 6:
Implementation of the Safer Staffing requirements across the Trust
Quality Goal 7:
Continue to develop our Estates elements of our Transformational Programme
Quality Goal 8:
Develop our approach to and begin implementation of our new clinical information system
Quality Goal 9:
Further develop and implement the leadership and people development strategy, with a
particular focus on first-line leadership
Quality Goal 10: ‘VALUE’ based, user focused services
Our progress against these priorities is described in section 1.
The Trust is the major provider of mental health and
learning disability services to the people of Coventry and
Warwickshire. It is also the main provider of community
physical health services to the people of Coventry and
a provider of specialist learning disability services in
Solihull. In June 2014, the Trust refreshed its Five Year
Plan and outlined the ambitious development targets
that build upon the successes of our Transformational
Change Programme (TCP).
The TCP is now in its third year and has so far delivered
significant infrastructure developments, such as:
•The introduction of Community Resource Centres
(CRCs) – hub locations across Coventry and
Warwickshire which support community venues,
“spokes”, in providing a wide range of physical,
mental health and learning disability services from
the heart of the communities the Trust serves
•Integrated Practice Units (IPUs) – which wrap the
provision of services around the patient, ensuring that
patients do not have to navigate complex pathways of
care to receive the treatment they require
•Central Booking Service – providing a single point
of access for all Trust services giving a simplified and
seamless pathway into care
These developments have been instrumental in positioning
the Trust so that it can continue to deliver high quality
patient care and meet the demanding efficiency challenges
expected over the coming year and beyond. They have also
laid the foundations to prepare the Trust for the substantial
change programme that is still required to provide system
wide services in harmony with partner organisations, as
conceptually outlined in the Five Year Forward View.
The Trust has worked extremely hard to implement the
Government’s Safer Staffing initiative. The Trust Director
of Nursing and Quality and the Medical Director have
reviewed Trust inpatient unit staffing levels using the
available national guidance to establish ‘safe’ staffing
levels for all of our inpatient wards. This work is subject
to ongoing review as national staff benchmarks become
available together with more definitive guidance on what
‘safe’ staffing looks like.
We are confident that the Trust is now in a much stronger
position to realise its vision and has developed a clear and
sustainable way forward through its strategic plans. We
recognise that there is still much to be done to ensure
high quality, compassionate services for local people. We
are committed to improving the overall patient experience
and to listening and acting on what our patients and local
people tell us they want from their local services.
I would also like to thank the staff, who continue to do
their best and want to constantly improve our services
for the people we serve. We hope that this Account
will be both helpful and informative for our patients,
services users, carers, staff, commissioners and partner
organisations. I welcome your continuing support and
involvement over the next year, as we continue to work
together to improve the quality of our services to get the
very best outcomes.
The Trust Board is confident that this Account presents
an accurate reflection of quality across Coventry and
Warwickshire Partnership NHS Trust and I can confirm
that to the best of my knowledge the information
contained within it is accurate.
Josie Spencer
Interim Chief Executive
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Part 2
Priorities for Improvement and
Statements of Assurance from the Board
Part 2 is the section in our Quality Account that reflects on the progress of our priorities
from 2014/15 and looks forward and identifies our quality priorities for 2015/16. It also
includes our statements of assurance from the Trust Board.
Quality Priorities Framework
C
Customer Care
The Trust has developed and agreed, in consultation with
its staff, Four Quality Priorities, which are:
• Customer Care
• Achieving Shared and Agreed Outcomes
• Respectful Environments
• Efficiency Through Effectiveness
A
Achieving shared and
agreed outcomes
The Trust Board is committed to promoting a positive
culture enabling continuous improvement of our services
for patients/service users and carers, the public, our staff
and our stakeholders through the setting of specific
Trust Quality Goals.
R
Respectful
environments
E
Efficiency through
effectiveness
National Clinical Director for Mental Health, Geraldine Strathdee,
visited Coventry’s Caludon Centre this year
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Progress against our Quality Goals
in 2014/15
The Goals set for the year 2014/15, and our progress against them, is described below.
C
Customer Care
Quality Goal 1: Compassion in Action
Many professions, departments and external organisations collect, or are
required to collect, data, in order to measure performance and identify
areas for development against specific performance targets. The Trust took
the lead on the development of a Compassionate Practice Education 360
Multi-Source Feedback Tool (MSFT) across the Arden, Hereford and Worcester
Local Education Training Council (ahwLETC). The Tool has been developed to
support the collection of information, enabling rich collaborative feedback
from the perspective of Leaders/Unit Mangers’ own reflections of their area of
practice and from the members of the team, healthcare students and service
users/patients and their family/carers. The Tool supports the identification of
good practice but also key areas where care can be improved and enhanced.
The Tool is accessed via a secure link over the internet. It is completely
automated to simplify the assessment process, and to ensure accuracy and
timeliness of feedback reports. We have kept this as a goal for 2015/16 with
a new action plan in place.
Quality Goal 2: Implement a ‘cultural
barometer’ including Friends and Family
Test for both patients and staff
The Friends and Family Test (FFT) seeks to identify if users of our services or our
staff would recommend those services to their friends and family if they needed
similar care or treatment and over the year. Over the year the Trust implemented
arrangements to capture data from both staff and patients and is taking action
to review the results and respond to the findings (please note patient data is
reported in Quality Goal 3).
For staff, the Friends and Family Test is typically carried out through the use of a
survey. The results for Quarter 4 reveal that overall, 56% (780 Respondents) of
staff would recommend the organisation to friends and family if they needed
care or treatment compared to 55% (1774 Respondents) in Quarter 3.
42% (757 Respondents) of staff would recommend the organisation to friends
and family as a place to work in Quarter 4 which has reduced slightly from
Quarter 3 where we reported 46% (1775 Respondents).
We are taking steps to review and understand these results. We have kept this
as a goal for 2015/16 with a new action plan in place to support embedding
our data capture processes and to take action against the findings.
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A
Achieving shared and
agreed outcomes
Quality Goal 3: Real Time Patient
Experience Outcomes
Friends and Family Test arrangements (with additional questions to support
real time patient experience outcomes) continue to be rolled out and
implemented across services. Services also continue to implement local
patient experience initiatives.
We decided that out Real Time Patient Experience Outcome Goal would
adopt the Friends and Family Test (FFT)for Patients indicator.
The FFT was officially launched nationally in January 2015 marking the official
go – live date for implementation of the survey in Community and Mental
Health settings. This was accompanied by a range of internal and external
communications and also a statutory data return to the Health and Social
Care Information Centre (HSCIC). During 2014/15, the Trust developed
its processes for the roll out of the survey initially in Inpatient areas and
subsequently across all other services and teams which was completed in
preparation for the go-live date.
Implementation of the indicator within the Trust has been completed in line
with national guidance. The Trust developed both a freepost postcard and
electronic ‘App’, with both standard and easy read versions. During quarter 3
all responses were received via postcards whilst testing of the electronic App
was completed.
It is envisaged that a large number of services will implement the App in
preference to the postcards as this enables more efficient input and reporting
of the data. This is in line with the current project plan to expand the methods
by which the survey can be offered and completed and hence maximise
response rates, recognising that this continues to be a developmental piece
of work for the Trust.
From the first reporting quarter a total of 1241 postcard responses were
received. Patients have been asked how likely they were to recommend our
services to family and friends if they needed similar care or treatment. Responses
were received on a six point scale ranging from extremely likely to extremely
unlikely. Service users were also offered the opportunity to provide qualitative
comments to explain the reason for the answers given. The results show that
93% of respondents are likely or extremely likely to recommend our services.
This is an extremely positive result and reflects that the vast majority of our
service users are satisfied with the quality of the care they receive.
We will continue to use this framework to capture important patient feedback
in 2015/16.
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Quality Goal 4: Further embed the outcome
frameworks at a more granular service and
IPU level
The Trust has refocused the way in which it develops and organises services
through its Transformational Change Programme which is designed to deliver
quality services in the most cost effective way. An integral part of this work was
to revisit the Clinical Strategy to enable programmes to align with and focus
on the clinical model we are trying to achieve. The Trust launched its Clinical
Strategy at the Annual General Meeting in September 2014.
The Trust has adopted the VALUE based approach to delivering healthcare as
its principal methodology to drive the clinical strategy and this continues to
be the main driver for supporting clinical development. This is a proven model
developed by the Harvard Business School.
The VALUE based approach places significant emphasis on defining the
outcomes for a patient to be achieved by a care pathway at the outset and
design the delivery of service in a way that best facilitates those outcomes.
The measurement of outcomes and experience are important ways of assessing
quality and efficiency of care and providing the focus for future improvements.
All clinicians are expected to participate in the measurement of outcomes for
their service.
In year services have developed their Outcome Frameworks, which supports
services to understand and plan for the expected outcomes we want patients to
have and experience as a result of the care that we provide. This remains a key
piece of work for us and we have kept this as a goal for 2015/16 with a new
action plan in place.
R
Respectful
environments
Quality Goal 5: Develop our approach to values
based recruitment and appraisal
Values Based Recruitment is an approach to help attract and select students,
trainees and employees, whose personal values and behaviours align with those
of the Trust. The Trust developed its plan and implemented its arrangements for
Values Based Recruitment.
Values Based Recruitment will bring a number of benefits:
•In-depth information for managers regarding new applicants’ suitability
for posts.
•Insight into applicants’ values and behaviours and the extent to which these
‘fit’ with organisation and role.
• It reflects commitment to NHS values and delivery of high quality patient care.
• Applicants gain an understanding of our Trust’s culture.
•By recruiting the right people at the right time it should reduce recruitment
costs long-term.
• It is evidenced to increased retention and enhanced performance in the role.
•This enhanced performance translates to more positive experiences for our
clients/patients.
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Quality Goal 6: Implementation of the
Safer Staffing requirements across the Trust
The Trust has established safe staffing levels within its inpatient settings
and continues to work to ensure that those levels are maintained. The
Trusts reports it progress to Trust Board to ensure that there is appropriate
transparency of its performance.
The Safer Staffing initiative seeks to ensure that an appropriate blend and
number of qualified and non-qualified staff are working in inpatient areas
reflect the number of patients that require care.
The national reporting expectations for this indicator include a monthly
national submission for Secondary Care Mental Health and Specialist Services
Directorates by ward, reflecting the total number of staff planned to be on duty
verses the total number of staff actually on duty in hours. The first monthly
submission took place in June 2014. Currently there are no agreed national
targets for safer staffing and nationally, this element of the programme has
been delayed. In the interim, the Trust has applied a local rating to facilitate
performance monitoring and improvement, with an expectation that as a
minimum, 80% of planned staffing will be achieved on all wards.
On each occasion that staffing has fallen short of the identified minimum the
staffing levels have been reviewed by the clinical leadership team and on each
occasion due to the patient profile and other mitigating actions the staffing
has been considered to be safe.
We have kept this as a goal for 2015/16 with a new action plan in place.
Quality Goal 7: Continue to develop our Estates
elements of our Transformational Programme
A number of Estates programmes of work have been completed and have led
to safer sites for patients to receive care and treatment within and for staff to
deliver quality services.
The quality of the buildings and environment (the estate) within which patients
receive care and Trust staff work is very important to us. This quality goal set out
a number of initiatives that we wanted to deliver in year including:
• Replacing the anti-barricade doors within inpatient areas (in agreed phases).
• Complete fencing work for the low secure areas on the Marston Green Site.
•Establishing Community Resource Centres (CRC) to support the infrastructure
for each locality area to deliver integrated care with dedicated streamlined
administration and management resources thus being more efficient
and effective.
•Revising our arrangements for disposing of our estate to ensure we use the
most efficient and effective method.
The related programmes of work have been completed and have led to safer
sites for patients to receive care and treatment within and for staff to continue
to deliver quality services.
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E
Efficiency through
effectiveness
Quality Goal 8: Develop our approach to and
begin implementation of our new clinical
information system
The Trust completed its business planning arrangements to progress its
planned replacement of a number of its existing patient administration
systems to one system.
The Trust operates and manages a number of different software systems
to capture and record information about patients. Many of these systems
do not work in conjunction with each other and have expensive costs to
continued ongoing delivery.
The Trust completed its business planning arrangements to progress its
planned replacement of a number of its existing patient administration systems
to one system in conjunction with its staff. We have identified the systems that
will be closed and continue to work through the arrangements to migrate data
and information safely.
Quality Goal 9: Further develop and implement
the leadership and people development strategy,
with a particular focus on first-line leadership
The Trust embarked on a training programme across all of its range of staff
in order to up-skill and further support staff to deliver excellent services across
the Trust.
The Trust developed and launched its Leadership Development and Talent
Management Strategy (2014- 2017) at its Public Trust Board in September 2014.
The Trust recognises that attracting, developing, managing and retaining
talented people with the right skills and behaviours is critical to the success of
the Trust and the wider NHS.
The Trust is committed to developing our staff and this programme of work
includes development opportunities that will lead to improvements in existing
knowledge, skills, attitudes and behaviour in our people.
The strategy has been developed to provide a framework for developing our
leaders in the Trust and identify talented individuals who will become senior
leaders in the future.
During the year the Trust developed a comprehensive programme of Leadership
and Management development opportunities which are available to all staff
working in the Trust. In May 2014 the Trust launched its Band 7 Leadership
Development programme, a mandatory programme for all staff employed at
this level in the organisation. It is anticipated that all Band 7 staff will have
completed the programme over the next two years.
The Band 7 programme ‘Value in Leadership’ gives individuals the opportunity
to assess how they work based on their preferences, receive 360 feedback,
understand their roles in managing performance and the programme develops
their skills as coaches through coaching practice and action learning sets.
9
They undertake the Edward Jenner national academic on line programme and
have the opportunity to be part of an Action Learning set over the following
12 months.
We will continue to monitor the success of out strategy and have developed a
plan to assure Board and stakeholders of success.
Quality Goal 10: ‘VALUE’ based,
user focused services
The Trust’s Clinical Strategy, which was launched at the Trust Annual General
Meeting in September 2014, sets out the way in which the Trust has adopted
and will use the VALUE model.
In developing its Clinical Strategy, the Trust has recognised the increasing
necessity to deliver an integrated service with other providers offering health
and social care provision.
The Strategy is intended to deliver over the next 3-5 years and is the focus
of the work of our Transformational Change Programme. The setting of
Trust Board Quality Improvement Goals will be used to articulate the work
programme to be achieved each year and enable the Trust Board and its
stakeholders to be assured of progress.
The delivery of the Strategy over the next 3-5 years remains a key piece of
work for the Trust.
10
Commissioning for Quality and
Innovation (CQUIN) Framework
Our last Quality Account, reflecting the year 2013/14, detailed a number of priorities for 2014/15, which were based
on the Commissioning for Quality and Innovation (CQUIN) framework, and which is designed to promote quality
improvement by linking a proportion of the Trust’s income to the delivery of agreed quality goals. The content of local
schemes is agreed between the Trust and its Clinical Commissioning Group (CCG) commissioners prior to the start of
the financial year, and includes nationally and locally defined CQUIN indicators. In conjunction with our stakeholders
we agreed that we would formally report against the following CQUIN goals for 2014/15.
Friends and Family Test (FFT)
What did we aim to do?
Implement the Patient and Staff FFT as per national guidance and according to the
national timetable.
What did we expect to achieve?
To improve the experience of patients and staff. The FFT will provide timely, granular
feedback from patients and staff about their experience of the Trust.
How well did we do?
The Trust has succeeded in delivering the FFT for patients via a specially-designed
postcard survey, which was rolled out across inpatient areas by the end of Quarter 2,
and to all other areas of the Trust by the end of Quarter 3. An electronic Application
for the survey was developed and tested, to enhance the data collection process.
Meanwhile, all employees were provided with the opportunity to complete the
staff FFT survey in Quarters 1, 2 and 4, and during Q3, were able to complete the
FFT questions via the NHS Staff Survey as per national guidance. The Trust has also
introduced robust processes for submitting the associated national FFT data returns.
Members of our Sexual Health team
11
Improving Physical Healthcare to reduce Premature Mortality
(Cardio metabolic assessment for patients with schizophrenia)
What did we aim to do?
For 2014/15 this CQUIN focuses on all patients with psychoses, including
schizophrenia and bipolar affective disorder, in all types of inpatient beds, intensive
community teams in all sectors including early intervention teams, assertive outreach
and community forensic teams.
This CQUIN will support the Trust to ensure that service users have recorded
comprehensive physical and mental health diagnoses, communicated between
primary care and specialist mental health clinicians and with the service user.
The primary aim is to reduce premature mortality, improve patient safety, patient
experience and quality of life, through shared communications and reconciliation
of treatments. This CQUIN also supports and facilitates closer working relationships
between specialist mental health providers and primary care. It has the capacity to
lead to reductions in length of stay through addressing the impact of untreated
physical morbidity on recovery.
What did we expect to achieve?
The Trust will work with its commissioners and other care services within the local
health economy to agree how best to support services to put in place systematic
arrangements to ensure that their services are routinely undertaking cardio-metabolic
assessments and that, following assessments, treatment arrangements are in place
and communicated with the patient and their family and between clinicians in all
sectors who have responsibility for the patient.
How well did we do?
A patient record sheet was designed and distributed across inpatient areas to ensure
that the cardio metabolic assessments could be closely monitored and followed up
for individual patients where necessary. Equipment and promotional materials were
distributed to wards to facilitate completion of physical assessments and signposting
for interventions. The Trust met all the deadlines for supply of information to the
Royal College of Psychiatrists as required for the audit. Although considerable work
was undertaken to promote the completion of assessments, the final results (due to
be published nationally in Spring 2015) are expected to show that the Trust did not
meet the full level of compliance with the audit.
Target Partially Met
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Leadership and Compassionate Practice – Peer Review of community services
What did we aim to do?
Compassion in Practice (2012) introduced the six fundamental values for nursing
care: Care, Compassion, Competence, Communication, Courage, and Commitment.
Known also as the 6Cs, these values and behaviours form the basis of the
Government’s three-year strategy for delivering Compassionate Care across the
NHS, Public Health and Social Care. Building on the Trust’s existing Early Warning
System (EWS) process, this CQUIN is aimed at developing a Peer Review approach
for Community Services Pathway and Primary Care and Prevention Services which
is based on the 6Cs. The approach will involve undertaking a series of observational
visits (both planned and unplanned) to support the embedding of 6Cs in services
delivered in particular to the frail elderly population of Coventry. This would be
based on the 6C competency framework.
What did we expect to achieve?
Design a peer review model based on 6Cs competency framework.
Undertake peer reviews across services and develop improvement plans
where necessary.
Report the impact from learning and resulting changes to practice
How well did we do?
A programme of Peer Reviews was designed and implemented across Community
Health and Wellbeing services throughout the year. Services selected for review
included both clinic-based and community services, with a focus on services with
a high proportion of frail elderly or vulnerable patients. Following each review,
a service-specific action plan was developed. Common themes arising from the
reviews have been identified and a plan developed to share this learning across
services. The project has received national recognition through the receipt of the
6Cs Live! and Nursing Times “6Cs in Action: Celebrating Excellence” Award.
Members of our volunteer drivers, who help transport people to and from
hospital appointments
13
Looking forward to 2015/16
In consultation with staff in the Trust and other key
stakeholders the Trust has refreshed its Quality Improvement
Goals for the period 2015/16. Of note during this
development stage is the Trust participation in a Task and
Finish Group (TFG) with representatives from the Adult
Social Care and Health Overview and Scrutiny Committee
(Warwickshire), Health and Social Care Scrutiny Board
(Coventry) and representatives from local Healthwatch
groups covering Coventry and Warwickshire. In addition
the Trust works closely with its lead Commissioner,
Coventry and Rugby Clinical Commissioning Group.
Support from the TFG, and the fact that it represents
patients and wider stakeholder and public concerns has
been invaluable in ensuring that the Trust set goals that
were felt important and reflective of patient, Trust, local
health economy and national drivers and requirements.
The Trust has blended a combination of national
requirements, which require local interpretation and
implementation, in amongst locally important issues.
The Trust has identified that in many instances the national
agenda is in tandem with what is felt important to the
local agenda (for example, in respect of the safer staffing
requirements). We have also carried over the theme of
a number of Quality Goals from 2014/15 to 2015/16 to
support continuation of our plans and work.
We will report our progress with our Quality Improvement
Goals through our public Trust Board meeting on a
quarterly basis. The quarterly report will inform if we are
on track with our intended progress. Our Quality Goals
for 2015/16 are as follows:
Trust Quality Improvement Goals
for 2015/16
Quality Improvement Goal One:
Compassion in Action
The promotion of compassionate care and a positive culture
of compassion is an organisational priority and is one of
the Trust’s values. Building on the work begun last year,
the Trust will take the lead on the further development of
the Compassionate Practice Education 360 Multi-Source
Feedback Tool (MSFT) across the Arden, Hereford and
Worcester Local Education Training Council (ahwLETC),
and develop its use in the Trust.
In 2015/16 we will:
•Lead the completion of the Phase 2 pilot of MSFT
across the Arden, Hereford and Worcester health
economy and evaluate its effectiveness.
•Develop and implement the use of the MSFT within
clinical teams across the Trust.
•Explore the use of a targeted subset of statements
within the MSFT for more frequent real-time
feedback on patient (linked to outcome measures)
and staff experience.
14
Quality Improvement Goal Two:
Embed the ‘cultural barometer’
including Friends and Family Test
for both patients and staff
The NHS friends and family test (FFT) is an important
opportunity for patients and for staff to provide feedback
on the Trust’s care and treatment services. The Friends and
Family Test seeks to identify if users of our services or our
staff would recommend those services to their friends and
family if they needed similar care or treatment.
In 2015/16 we will:
•Develop our mechanisms to regular ask staff and
patients if they would recommend our services and
take action in accordance with the findings.
Quality Improvement Goal
Three: Patient Reported
Outcome Measures
Patient Reported Outcome Measures (PROMs) and
Patient Experience Reported measures (PREMS) are
fast becoming a common mechanism for ascertaining
the impact of healthcare on a patient’s health.
Well developed PROMs and PREMS may be used
to understand the impact of a service on patients’
health at the point of the delivery of care, and
to make comparisons between expected and
experienced health outcomes.
In 2015/16 we will:
•We will have identified a selection of PROMs that
are important to our patients develop them to be
central to the delivery of care.
•We will have explored the use of a selection of
Patient Reported Experience Measures that are
important to our patients develop them to be
central to the delivery of care.
Quality Improvement Goal
Four: Outcome Frameworks
Reported as part of the
Integrated Performance
Report (at a local level)
The Trust has developed a suite of Outcome
Frameworks for each Integrated Practice Unit and
reports outcome metrics to the Executive Performance
Group. It is important to consistently review the
nature and type of outcome metrics reported to
ensure that they remain fit for purposes and useful
to patients, clinicians and other stakeholders.
In 2015/16 we will:
•Revise our Outcome Framework and our reported
metrics to ensure robust reporting at service,
directorate and Trust level.
Quality Improvement Goal Five:
Implementation of the Safer Staffing
requirements across the Trust (subject
to national guidance)
Assessing the nursing needs of individual patients is paramount
when making decisions about safe nursing staff requirements.
Assessment of patients’ nursing needs should take into account
individual preferences and the need for holistic care and patient
contact time. This goal will build on the work the Trust has
completed to date in inpatient settings and focus on ensuring
safe staffing levels within community settings in accordance
with national guidance.
In 2015/16 we will:
•Review our arrangements in inpatient settings
following publication of national tools and guidance.
•Establish and implement our arrangements in community
settings in accordance with nationally published guidance.
Quality Improvement Goal Six:
An Integrated Workforce that is
efficient and effective
We will establish a reporting structure that will align
information from ESR, Safer Staffing, NHS Professionals
and eRostering to support integrated workforce planning
and enable the organisation to recruit more effectively.
In 2015/16 we will:
•Establish an Integrated Workforce Group to ensure all key
stakeholders are engaged in a revised workforce strategy.
•Continue to develop and Implement the roll out of key
workforce systems such as e Rostering and the Safer
Staffing module.
Quality Improvement Goal Seven:
Development and Implementation of
our Inclusion Strategy
The Trust believes that being inclusive in our service provision and
fair in our employment practice is integral to providing excellent
customer service and is the backbone of our staff recruitment,
retention and engagement.
In 2015/16 we will:
•Develop, in consultation with stakeholders, our Inclusion Strategy.
•Set out our roadmap for the delivery of our Inclusion Strategy.
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Quality Improvement Goal Eight:
Implement the Clinical
Information System
Quality Improvement Goal
Nine: Implementation of the
Clinical Strategy
The project vision is to provide a single electronic clinical
system that enables seamless, integrated care across the
Trust, by spring 2016. The Trust uses a number of clinical
systems to record clinical care. The new system will contain
a single patient database, accessible across the trust with
up to date patient information. It will ensure that clinical
and administrative tasks are supported to enable effective
patient care across the communities we serve. It will allow
staff timely access to information; and will be accessible
from mobile devices and all locations throughout the trust.
The clinical systems replacement programme will enhance
the capture of, and access to, information. In turn this will
increase the time for direct patient activities and facilitate
delivery of improved patient care.
The Trust developed and published its 5 year Clinical
Strategy in 2014. The strategy recognises the increasing
necessity to deliver an integrated service with other
providers offering health and social care provision.
The strategy is written in the context of delivery within
the Trust, but which will be provided in a way that
pro-actively seeks to create interfaces and to reduce
barriers between providers resulting in seamless holistic
outcomes for the patient.
In 2015/16 we will:
•Continue to develop our plan to implement our new
Clinical Information System and implement year one.
In time the care provided by the Trust will be organised by
clinical pathway which will outline a streamlined consistent
package of care to patients with similar conditions across
the Trust whilst having sufficient flexibility to respond to
variation in individual patient needs or preferences. The
outcomes to be achieved will be specified at the beginning
of the treatment pathway and reviewed at regular intervals.
Wherever possible patients and their carers will be provided
with the information and support to make choices and
manage their own healthcare with the goal of leading an
autonomous and independent a life as they can.
In 2015/16 we will:
•Continue to develop our plan to implement our
Trust Clinical Strategy.
•Undertake further development of the Clinical model
including, refinement of care pathways, Outcomes
frameworks and Effective Team Cultures.
Our Criminal Justice and Liaison staff work closely
with Police in Coventry
16
Quality Improvement Goal Ten:
Delivering the transformational
programme and being a partner
in system change
The Transformational Change Programme aims to realise
our clinical strategy to deliver value based healthcare. It has
two key strands, one is focussed around mobilising and
developing our people (Delivering VALUE using CARE with
Compassion), and the other is focussed around providing
the right infrastructure and systems to enable us to make
the appropriate changes (Enabling Programme).
In 2015/16 we will:
• C
ontinue to take a leadership role in the Better Care
Programme in Coventry leading upon a number of
key work streams.
• W
ork with colleagues across the system to develop our
plans in relation to the Five Year Forward View and the
Dalton Report review initially developing our response
to redesign the urgent care pathway.
Quality Improvement Goal Eleven:
Further develop the clinical
pathways attached to mental
health currencies and payment,
and the costing of them
(subject to national guidance)
The Transformational Change Programme and Clinical
Strategy for Mental Health services have been supported
by the development of clinical pathways that support
currencies associated with national guidance and the
tariff payment system. This Goal will finalise intervention
pathways for mental health services and robustly cost
them so that they inform payment levels in the future.
In 2015/16 we will:
•
Have fully developed intervention pathways for
mental health currencies and implement a process
for understanding clinical variation.
•
Develop full costs for the standard intervention
pathways and use them as the basis for establishing
future payment levels.
Commissioning for Quality and
Innovation (CQUIN) Framework
In addition to Quality Goals the Trust is committed to
deliver a number of Commissioner targets (collectively
known as CQUINS). Commissioner priorities for the new
contract year were agreed through a process of negotiation
involving the Trust, Clinical Commissioning Groups and
Specialist Commissioners Groups.
Suggestions for quality improvement were taken from
all stakeholders, and through open discussion, areas
of commonality and shared priority were agreed. The
rationale for inclusion of each priority was based on links
with national, regional and local quality improvement
programmes. Project teams will take forward specific
actions and documentary evidence will be reported
at regular intervals to demonstrate achievement
against milestones, both internally and externally to
Commissioners. Stakeholders have previously asked the
Trust to only report against a small number of CQUIN
targets for 2015/16 and we have prioritised the following
to be reported within the Quality Account.
17
1. Veterans Mental Health
What did we aim to do?
This is the second year of a two-year ambition to ensure that Ex-Armed Forces
personnel receive access to priority treatment through an enhanced standard care
pathway, tailored for veterans and their carers who have been referred to Secondary
Care Mental Health services.
What did we expect to achieve?
The work programme will build on the advances made in Year 1 by:
• Continuing to embed the enhanced clinical pathway
• R
aising knowledge and awareness among clinicians through appropriate training
and continuation of the Trust’s ‘Champion’s Network’
• W
orking in partnership with veteran service users, veteran’s charities
(Combat Stress, Royal British Legion) and primary care colleagues
How will we know?
Access to the appropriate clinical support will be offered to veterans according to
identified need, to be demonstrated through improved data capture at all entry
points into services. The staff training delivery plan will be monitored and evaluated.
Feedback will be obtained from all stakeholders with a view to improving the
pathway and service-users’ experience of Secondary Care Mental Health services.
2. Attention deficit hyperactivity disorder (ADHD) – Transition
What did we aim to do?
During this second year of the project, the aim is to complete a pilot of the proposed
ADHD Transitions pathway that was ratified across the health economy during
14/15. The pathway will ensure that the complex needs of young people with
ADHD leaving CAMHS are appropriately met through either referral into Secondary
Care Mental Health services, or through discharge to their GP with shared care
arrangements for medication where clinically appropriate.
What did we expect to achieve?
We will implement and test the operational pathway through an agreed monitoring
process. We will also review with key stakeholders the agreed prescribing element
of the pathway, making any revisions where required. We will support GP colleagues
with the new arrangements through provision of advice and reference materials.
How will we know?
The pilot will be evaluated to determine the number of clients who transitioned
under the new pathway and to understand the associated levels of prescribing in
primary and secondary care. We will provide recommendations to commissioners
based on the outcomes from the project, including any gaps in provision, to inform
future commissioning of the service.
18
Statements of Assurance from the
Board relating to the Quality of NHS
services provided here at Coventry and
Warwickshire Partnership NHS Trust
The wording in the following statements is required in the
Department of Health regulations for producing quality
accounts and is included to enable readers to make
comparisons between similar organisations.
• POMH Topic 12b: Prescribing for Personality Disorder
•
POMH Topic 9c: Prescribing for People with a
Learning Disability
•
National Confidential Inquiry into Suicide and Homicide
for People with Mental Illness (NCISH).
Review of Services
The national clinical audits and national confidential
enquiries that the Trust participated in during 2014/15
and for which data collection was collected during
2014/15, are as follows:
During 2014/15 the Trust provided and/or sub-contracted
42 relevant health services. The Trust has reviewed all the
data available to it on the quality of care in 42 of these
relevant health services.
The income generated by the relevant health services
reviewed in 2014/15 represents 93.9% of the total income
generated from the provision of relevant health services by
the Trust for 2014/15.
Participation in Clinical Audits
• E pilepsy 12 (Childhood Epilepsy) (Round 2,
2012 – 2014)
• National Audit of Intermediate Care
• POMH Topic 12b: Prescribing for Personality Disorder
• P OMH Topic 9c: Prescribing for People with a
Learning Disability
•
National Confidential Inquiry into Suicide and Homicide
for People with Mental Illness (NCISH).
During 2014/15 the Trust participated in 100% of the
national clinical audits and national confidential enquiries
which it was eligible to participate in.
The national clinical audits and national confidential
enquiries that the Trust was eligible to participate in during
2014/15 and for which data collection was collected
during 2014/15, are as follows:
The national clinical audits and national confidential
enquiries that the Trust participated in, and for which data
collection was completed during 2014/15, are listed below
alongside the number of cases submitted to each audit or
enquiry as a percentage of the number of registered cases
required by the terms of that audit or enquiry.
• Epilepsy 12 (Childhood Epilepsy) (Round 2, 2012-2014)
• National Audit of Intermediate Care
Eligible audits / confidential enquiries applicable
to the Trust
Eligible to
participate
Participation
in 2014/15?
% of cases submitted 2014/15
Epilepsy 12 (Childhood Epilepsy) (Round 2, 2012/2014)
3
3
100%
National Audit of Intermediate Care 2014
3
3
100 Patient Reported Experience
Measure questionnaires were
distributed. Returns figure not
published by national audit.
POMH Topic 12b: Prescribing for Personality Disorder
3
3
15
POMH Topic 9c: Prescribing for People with a
Learning Disability
3
3
237
National Confidential Inquiry into Suicide and
Homicide for People with Mental Illness (NCISH)
3
3
100%
19
The reports of four national clinical audits were reviewed by the provider in 2014/15 and the Trust intends to take the
following actions to improve the quality of healthcare provided as detailed below.
National audit title
Description of actions following national clinical audit
Epilepsy 12 (Childhood Epilepsy)
(Round 2, 2012/2014)
Since the audit time period the epilepsy nurse post in Coventry has been filled.
National Audit of Schizophrenia
Positive feedback from patients accessing services was received. The clinical audit findings
highlighted good, average and below average performance.
Patient satisfaction was better than the national average. Patients reported that
they would like better access to the epilepsy specialist team and contact with peers.
The Trust plan to develop an after school club for adolescents
Work is being undertaken to embed a process to ensure physical health checks are monitored.
National Audit of Intermediate
Care 2014
Patients accessing the Trust’s intermediate care services reported positive experiences and
rated the service highly.
Work is being undertaken to ensure that internal information systems allow appropriate
activity data to be captured in relation to the intermediate care service.
A patient information leaflet outlining the service provided by the Intermediate Care Team
is being developed to help patient understanding.
The Patient Reported Experience Measure (PREMS) questionnaire will be adapted locally to
enable the Intermediate Care Team to capture patient feedback about their experience of
the service which will be used to inform future service developments.
POMH 12b: Prescribing for People
with a Personality Disorder
No action being taken.
The reports of 54 local clinical audits were reviewed by the Trust in 2014/15. The following have been selected as
examples of how services have used clinical audit to improve the quality of care delivered.
Audit title
Description of actions following clinical audit
Podiatry Service
The re-audit findings highlighted that overall compliance across the podiatry service
has increased for each standard.
Re-audit: Is the advice given to
diabetic patients accessing Podiatry
Services in line with NICE Clinical
Guideline 10?
Community Children’s Nursing (CCN)
Are CCN’s meeting the required
medication administration standards
as defined in the service action plan?
Dental Services
Quality of Peer Assessments
Rating (PAR) scores for completed
orthodontic treatments
Educational sessions have been delivered to staff to re-enforce the need to provide
patients with appropriate information and to document that this has been provided.
Overall the prescription sheets were found to be in line with local guidance
requirements. As a result the service has returned to single nurse visiting for the
routine administration of medicines with the exception of first time visits when a
two person visit will be carried out.
Comparison with 2011/2012 and 2012/2013 results show that the mean reduction of
PAR score continues to be maintained at a high level but that there is a small increase
in the proportion in the ‘worse or no difference’ category. This may be attributable
to the increasing number of complex referrals for treatments that are not suitable for
treatment or not readily undertaken in a general dental practice.
As high standards have been maintained no action was required.
Integrated Sexual Health Services
(ISHS)
Management of sexual assault victims
attending ISHS in Coventry
Medicines Management
Rapid Tranquillisation Audit
20
The clinical audit findings highlighted variances in the documentation of all required
information. History taking and screening were clearly and routinely documented. In
order to ensure important information is routinely discussed and documented and used
to inform decision making an electronic proforma has been developed and is in use.
Medicines Management to continue rapid tranquillisation teaching sessions to
highlight key aspects of the Trust policy.
Participation in Clinical Research – Commitment to research as a driver
for improving the quality of care and patient experience
The number of patients receiving relevant health services
provided or sub-contracted by the Trust in 2014/15 that
were recruited during that period to participate in research
approved by a research ethics committee was 1214.
Research is a key priority for the NHS. The NHS Constitution
(Section 3a) has pledged: “… to give people better access
to the potential benefits of participating in research studies
including clinical trials”. Participation in research offers
potential benefits not only to the patient, but also to the
staff involved, to the Trust, and to the NHS as a whole.
The Trust has made a commitment to include research
engagement in new staff induction training.
The Trust’s participation in clinical research demonstrates its
commitment to improving the quality of care we offer and
to making our contribution to wider health improvement.
Our clinical staff stay abreast of the latest possible treatment
possibilities and active participation in research leads to
successful patient outcomes. Our engagement with clinical
research also demonstrates the Trust’s commitment to
testing and offering the latest medical treatments and
techniques. Over the past year we have recruited to seven
drug intervention trials, and have formally responded to
nine requests for ‘expressions of interest’ from commercial
companies. Two commercial trials are currently running
within Integrated Sexual Health Services.
There were 29 Portfolio and Commercial studies open to
recruitment during 2014/15. The majority of these were
adopted by Mental Health and Integrated Sexual Health
Services and they have recruited to time and target. There
are also studies in set up this year within Learning Disability
and Eating Disorder services. The Trust has seen an increase
in the number of Principal Investigators and in the number
of clinicians supporting research delivery. Over the past
few years there has also been an increase in the number
of clinicians attending specialist training delivered by study
teams. For example, psychological therapists and supervisors
from IAPT services have received training by experts in the
field of Generalised Anxiety Disorder (ToSCA trial), and all
clinicians within the IPUs are scheduled to receive training
as part of a five-year programme to develop, evaluate,
implement and disseminate a user/carer led training
package for mental health professionals to improve user/
carer involvement in care planning.
The Trust has a long standing and effective partnerships
with both the University of Warwick and Coventry
University. Each year a number of collaborative grant
applications and research studies are undertaken,
demonstrating the value that the Trust places on research.
This year we have supported three Research for Patient
Benefit (RfPB) grant applications.
The following is an example of a Research project that
demonstrates how the Trust is using research to improve
the service for people with dementia and their carers.
Improving the experience of dementia and enhancing active life: living well with dementia: The IDEAL study
The IDEAL study is a major five-year longitudinal cohort
study of 1,500 people with dementia and their family carers
throughout the UK to examine how social and psychological
capitals, assets and resources influence the possibility of living
well with dementia. The aim is to identify changes that could
result in improved well-being, life satisfaction and quality
of life. The study is funded under the ESRC/NIHR dementia
initiative and supported by DeNDRoN, NISCHR CRC, SDCRN
and NICRN. It will continue until December 2018.
The project draws together expertise from psychology,
sociology, medicine, public health, economics, social policy,
physiology and statistics to examine in detail what can be
done to ensure that as many people as possible are enabled
to live well with dementia. It is led by Bangor University in
collaboration with Cardiff University, Brunel University, the
London School of Economics, King’s College London, Sussex
University, the Research Institute for the Care of Older People
(RICE), the Alzheimer’s Society and Innovations in Dementia CIC.
Over a two-year period 1500 people with early-stage
dementia, and at least 1000 carers of these individuals,
will be recruited through NHS memory services in all areas
of the UK. All participants will be visited on three occasions
over three years and will be asked to respond to questions
about things that influence their well-being, quality of life
and satisfaction with life. Participants for whom well-being
improves or declines markedly over the first year of the study
will be interviewed in more depth to help explain why these
changes have occurred. The findings from the study will help
to identify what can be done by individuals, communities,
health and social care practitioners, care providers and policymakers to improve the likelihood of living well with dementia.
The study will be the first large-scale study of its kind.
CWPT is currently the 7th highest recruitment site of 26 sites
across the UK.
21
Goals agreed with commissioners
– Use of the CQUIN payment
framework
A proportion of the Trust’s income in 2014/15 was
conditional on achieving quality improvement and innovation
goals agreed between the Trust and any person or body
they entered into a contract, agreement or arrangement
with for the provision of relevant health services, through
the Commissioning for Quality and Innovation payment
framework. Further details of the agreed goals for 2014/15
and for the following 12 month period are available online
at http://www.covwarkpt.nhs.uk/aboutus/CQUINs.
What others say about
the provider:
Statements from the CQC
In addition to the Wave 1 inspection described above
the Care Quality Commission completed nine inspections,
focussing on the Mental Health Act, as part of their
on-going programme of reviews during 2014/15. The CQC
reported some common themes that the Trust is taking
action to resolve.
Data Quality – Statement on
relevance of Data Quality and
our actions to improve our
Data Quality
Good quality information underpins the effective
delivery of patient care and is essential if improvements
in quality of care are to be made. Improving data quality,
which includes the quality of ethnicity and other equality
data, will thus improve patient care and improve value
for money.
The Trust is required to register with the Care Quality
Commission and its current registration status is registered
without conditions.
NHS Number and General Medical
Practice Code Validity*
The Care Quality Commission has taken enforcement
action against the Trust during 2014/15.
The Trust submitted records during 2014/15 to the
Secondary Uses service for inclusion in the Hospital Episode
Statistics which are included in the latest published data.
The percentage of records in the published data:
The Trust has participated in special reviews or
investigations by the Care Quality Commission relating
to the following areas during 2014/15, namely the CQC
Wave 1 Inspection (Pilot). This was undertaken in January
2014 and the final report was received in April 2014.
The CQC identified one Enforcement Action and five
Compliance Actions. The reports were widely shared with
staff, commissioners and other stakeholders to ensure that
the Trust was transparent with the findings and the action
it would take.
The Trust intends to take the following action to address
the conclusions or requirements reported by the CQC:
The Trust has developed an action plan to respond to the
points raised by the CQC.
The Trust has made the following progress by 31st March
2015 in taking such action:
•
The Trust has worked with the CQC and other
stakeholder agencies to support the development of an
action plan and has engaged with the CQC to confirm
and challenge the content and findings of each report. The
enforcement notice was removed on 14th July 2014 by the
CQC. The Trust has completed all of its actions in respect
of the Compliance Actions and notified the CQC of this.
22
Which included the patient’s valid NHS number was:
•
*99.8% for admitted patient care;
•
*99.9% for outpatient care.
•
Not applicable for Accident and Emergency
Which included the patient’s valid General Practitioner
Registration Code was:
•
*99.7% for admitted patient care;
•
*99.6% for outpatient care.
•
Not applicable for Accident and Emergency
Information Governance Toolkit
attainment levels
The Trust Information Governance Assessment Report
overall score for 2014/15 was 71% and was graded Green.
Clinical coding error rate
The Trust was not subject to the Payment by Results
clinical coding audit during the reporting period by
the Audit Commission.
•
Regular data quality subscription reports issued to
staff where there are data quality issues with the data
for key data items such as ethnicity, postcode and
General Practitioner;
Our actions to improve our
Data Quality
•
Using nationally reported benchmarking data from
the Health and Social Care Information Centre to
benchmark our performance on data quality and
identify any issues for resolution;
The Trust will be taking the following actions to improve
data quality
•
Continued compliance with the Information
Governance Toolkit.
•
Continued development of data capture processes and
procedures that are aligned to the patient journey;
Core Quality Indicators
•
Consolidating roles and responsibilities for data capture
along the patient journey;
•
Data quality improvement plans for nationally
flowed datasets;
The Trust is required to provide performance details
against a core set of quality indicators that were part of
a new mandatory reporting requirement in the Quality
Accounts from 2012/13 with the data being supplied
through the Health and Social Care Information Centre
(HSCIC) as follows:
7 Day Follow Up 2014/15
The data made available to the Trust by the HSCIC with regard to the percentage of patients on Care Programme
Approach who were followed up within seven days after discharge from psychiatric inpatient care during the reporting
period demonstrated the following:
Year
Target
Q1
Q2
Q3
Q4
Full Year
National
Average
National Range
2014/2015
95%
98.0%
96.8%
97.8%
98%
97.6%
97.2%
59.5% -100%
2013/2014
95%
99.6%
99.6%
99.1%
97.6%
98.97%
97.3%
77.2% - 100%
2012/2013
95%
98.9%
97.5%
97.3%
98.7%
98.2%
97.6%
0%-100%
Please note: The following local exemptions apply to locally reported data: Patient Choice; Patient moved out of area; Patient transferred to prison;
No mental illness; Not an adult Mental Health patient.
All patients discharged to their place of residence, care
home, residential accommodation, or to non-psychiatric
care must be followed up within seven days of discharge.
Where a patient has been transferred to prison, contact
should be made via the prison in-reach team. The seven
day period should be measured in days not hours and
should start on the day after the discharge.
Exemptions include patients who die within seven days
of discharge; patients where legal precedence has forced
the removal of the patient from the country; and patients
transferred to an NHS psychiatric inpatient ward. All Child
and Adolescent Mental Health Services (CAMHS) patients
are also excluded.
The Trust considers that this data is as described for the
following reasons:
•
This data is reported through local performance
management systems and reviewed at relevant
committees. The indicator is reported monthly to
Trust Board having been reviewed and signed off
by senior managers.
The Trust intends to take the following actions to improve
this percentage, and so the quality of its services, by:
•
Continuing its current success in following up patients
after they have been discharged from psychiatric care.
23
Gatekeeping Admission by Crisis Intervention Teams 2014/15
The data made available to the Trust by the HSCIC with regard to the percentage of admissions to acute wards for
which the Crisis Resolution Home Treatment Team acted as a gatekeeper during the reporting period demonstrated
the following:
Year
Target
Q1
Q2
Q3
Q4
Full Year
National
Average
National Range
2014/2015
95%
99.6%
100%
100%
100%
99.9%
98.1%
33% - 100%
2013/2014
95%
100%
100%
100%
100%
100%
98.3%
0% - 100%
2012/2013
95%
100%
100%
100%
100%
100%
98.3%
90.7% -100%
An admission has been gate-kept by a crisis resolution
team if it has assessed the service user before admission
and was involved in the decision making-process which
resulted in an admission. An assessment should be
recorded if there is direct contact between a member of
the CRHT team and the referred patient, irrespective of
the setting, and an assessment is made. The assessment
may be made via a phone conversation or by any faceto-face contact with the patient. Exemptions include
patients recalled on Community Treatment Order; patients
transferred from another NHS hospital for psychiatric
treatment; internal transfers of service users between
wards in the trust for psychiatry treatment; patients on
leave under Section 17 of the Mental Health Act; and
planned admissions for psychiatric care from specialist
units such as eating disorder units.
The Trust considers that this data is as described for the
following reasons:
•
This data is reported through local performance
management systems and reviewed at relevant
committees. The indicator is reported monthly to
Trust Board having been reviewed and signed off
by senior managers.
The Trust intends to take the following actions to improve
this percentage, and so the quality of its services, by:
•
Ensuring that all admissions to psychiatric wards are
managed through the Crisis Intervention Teams.
•
Continuing to monitor its performance to ensure that
its high standard is maintained.
Admissions with 28 days of discharge 2014/15
The data made available to the Trust by the HSCIC with regard to the percentage of patients re-admitted to the Trust
within 28 days of being discharged demonstrated the following:
Patient Age
2014/15
2013/14
2012/13
2011/12
2010/11
0 to 14
-
-
-
-
0.00
15 or Over
-
-
-
-
0.00
The data is not reported by the HSCIC as this indicator is not applicable to the Trust.
The Trust considers that this data is as described for the
following reasons:
The Trust intends to take the following actions to improve
this score, and so the quality of its services, by:
• The Target does not apply to the Trust.
• No further action.
24
Staff recommending the Trust as a provider of care
The data made available to the Trust by the HSCIC with regard to the percentage of staff employed by, or under contract
to, the Trust during the reporting period who would recommend the Trust as a provider of care to their family or friends
demonstrated the following:
Year
Trust %
National Average for similar trusts
Range of Scores for similar trusts
2014*
55% (1784)
59%
36%-84%
2013
57% (351 respondents)
59%
38% - 85%
2012
60% (407 respondents)
58%
39% - 80%
*The 2014 results reflect responses to the question: “If a friend or relative needed treatment I would be happy with the standard of care provided by
this organisation.”
The Trust considers that this data is as described for the
following reasons:
• T his survey is undertaken independently to the Trust and
in line with national survey requirements.
• C
ontinuing to Implement the Transformational Change
Programme within its services for people with Mental
Health conditions thereby creating more focussed care
for users of this service.
The Trust intends to take the following actions to improve
this percentage, and so the quality of its services, by:
Patient experience of community mental health services
The data made available to the Trust by the Health and Social Care Information Centre (HSCIC) with regard to the Trust’s
“Patient experience of community mental health services” indicator score is shown below. This is to do with the patient’s
experience of contact with a health or social care worker, and demonstrated the following:
Year
Score
National Range (England)
National Average Score (England)
2014*
7.1 (out of 10)
6.7 – 7.8
7.2 (average of the range)
2013*
6.7 (out of 10)
6.2 – 7.4
6.8 (average of the range)
*Please note HSCIC have not published relating to 2014 or 2013 in this format– this data is taken from the Patient Community Mental Health survey 2014 and
2013 and reflects the ‘overall score’ for the survey. Discrete changes in the national survey between 2013 and 2014 may limit a direct comparison.
The Trust considers that this data is as described for the
following reasons:
The Trust intends to take the following actions to improve
this score, and so the quality of its services, by:
•
This survey is undertaken independently to the Trust and
in line with national survey requirements. The results are
consistent other Trusts.
•
Continuing to Implement the Transformational Change
Programme within its services for people with Mental
Health conditions, creating more focussed care for users
of this service.
25
ercentage of patient safety incidents that resulted in severe
P
harm or death
The data made available to the Trust by the HSCIC with regard to the number and, where available, rate of patient safety
incidents reported within the trust during the reporting period, and the number and percentage of such patient safety
incidents that resulted in severe harm or death.
Year/Period
Number of incidents
occurring
Percentage resulting in
severe harm or death
National average percentage National range
resulting in severe
resulting in severe harm
harm or death
or death
Apr 14 to Sep 14
4834 [4914]*
1.4% (n69) [1.5% (n72)]*
1.0%
0% - 6%
*Oct 14 to Mar 15 5234
1.6% (n83)
^
^
*2014/15
10148
1.5% (n155)
^
^
Apr 13 to Sep 13
3183
1.9% (n60)
1.3%
0% - 5.3%
Oct 13 to Mar 14
3089
2.2% (n68)
1.1%
0.2% - 5.3%
2013/14
6272
2.0% (n128)
^
^
* Reflects locally reported data. The locally reported data has been subject to independent external audit.
^ Data not available
The Trust considers that this data is as described for the
following reasons:
The Trust intends to take the following actions to improve
this rate, and so the quality of its services, by:
• Incident reporting data is reported to the Trust
Integrated Performance Committee. Data is reviewed
at all levels of the organisation through the incident
reporting and review system. The National Reporting
Learning System, (NRLS) highlight that recording is
not necessarily consistent across Trusts which make
comparisons difficult.
•
The Trust will continue to take action to address
issues arising out of the reporting of incidents and
will continue to report and review trends and themes
throughout its governance structure.
26
The Trust would also like to take the opportunity to
confirm that it has not reported any ‘Never Events’ in
2014/15, against the Department of Health reportable list.
Part 3
Information on the Quality of
Our Services – Key Achievements
for 2014/2015
Patient and Public Engagement
and Feedback
The Trust continues to implement its Equal Partners
Strategy through a focused action plan. A key element is
the continued development of the Equal Partners Assembly
Steering Group, which is a mixed group of patient and
carer representatives, and Trust staff. The purpose of
the Assembly is to give Patients and Carers a Voice, and
provides a forum for Staff, Patients and Carers working
together, so that mutually agreed decisions can be made
about how things work within the Trust.
The Assembly also offers the opportunity to empower
staff and involve them in Learning from Patients’ and
Carers’ Experiences.
The Trust continues to actively source, film and edit Patient
and Carer Stories and sharing these as part of each public
Trust Board meeting. The Stories demonstrate lessons
learnt from incidents and complaints and highlight peoples
experiences of the services that they receive from the Trust.
Equality and Diversity
The Trust has an Equality and Diversity Strategy and
arrangements in place to:
•
Ensure the services provided by us are appropriate for all
using Trust services regardless of their religion or belief,
race, gender, sexual orientation, disability or age;
The Equality and Diversity professional leads within the
Trust also provide support across the Trust to ensure that:
•
Staff are advised and supported on the wider equality
agenda through training;
•
Interpreting services for Trust users whose first language
is not English, or who have a hearing or speech
impairment are available;
•
The needs of Trust users are met by promoting flexible
staffing from those groups to ensure the needs of the
diverse groups are met;
•
Discrimination from both a staff and Trust user
Perspective is addressed;
•
Staff and Trust users who have experienced harassment,
bullying or verbal abuse because of their religion or
belief, race, gender, sexual orientation, disability or age
are supported;
•
Preventative work is undertaken with these groups,
where there may be a higher incidence of certain
illnesses or diseases.
Key equality and diversity
achievements in 2014/15
can be summarised as:
Equality Impact Assessment (EIA) Process
•
Raise awareness with Trust users from the above groups
so they can access our services;
The EIA process and guidance has been amended,
with guidance notes, flow chart and database of
policies displayed on the intranet.
•
Ensure interpretation services are available when Trust
users attend an appointment;
Equality and Diversity Strategy
•
Ensure that the Equality and Diversity Action Plan is
reviewed annually and this subsequently links in at
Trust Board level.
The Trust is in the process of implementing the Equality
and Diversity strategy. This strategy will have annual
objectives and the Equality Impact Assessment process
will be incorporated within the strategy.
27
Personal, Fair and Diverse Champion
The Trust is supporting a national campaign which is
encouraging NHS staff to become champions for a
personal, fair and diverse NHS.
Buddying Support
We have launched the Buddy Support system for
employees, which is a support service where an impartial
person is available to be contacted by an individual who
believes that they are being bullied or harassed or is being
accused of being a bully or harassing someone.
Awards for 2014/15
Year on year, the Trust has managed to retain the
Disability ‘2-tick’ symbol award and Mindful Employers
award. We have applied to retain the NHS Employer
Partners Status Award.
Training
Dedicated training around equality and diversity,
spirituality, bereavement and loss training delivered
to staff.
Valuing our Patients and Staff
The forums were held across various Trust sites to find out
how staff are feeling and what the barriers they perceive
to be to providing care to patients.
Future Plans and actions for
2015/16:
• T o further embed the Buddy Service. This is a support
service where an impartial person will be available to
be contacted by an individual who believes that s/he is
being bullied or harassed or is being accused of being a
bully and/or harassing someone.
• T o identify equality-related impacts including risks, and
report on how these risks are to be managed through
Board and committee papers.
• T o put in place an Equality and Diversity Strategy so the
Trust is legally compliant in line with the Equality Act
2010. Within this Strategy will be the Trust’s objectives
for 2015.
• T o put in place the Personal, Fair and Diverse
Champions. These are a group of people that will
champion the equality and diversity work to ensure
that the organisation is personal, fair and diverse.
Complaints, Patient Advice and
Liaison Services (PALs)
and Compliments
P utting people at the heart of everything we do, and
working with them as Equal Partners, will ensure that we
develop quality services, based around people’s individual
needs and aspirations, valuing the contributions they can
make. Equal Partnerships will ensure that every voice is
heard, individual choice and wellbeing is promoted, and
people are enabled to have the best possible experience
of our service.
The Trust has identified that complaints have become
more complex and may involve an increasing number of
different organisations (for example other NHS services
and Social Care Services). It is our aim to ensure that each
complaint received, is acted upon in a way that meets the
needs of each individual.
In 2014/15 the Trust received 118 complaints (109 in
2013/14) as demonstrated in the table opposite:
28
Number of complaints
Financial Year
Directorate
Category
2014/15
2013/14
Community Health and Wellbeing
Communication Issues
1
6
Medical Care From Doctor/Consultant
2
5
Nursing Care & Treatment
6
5
Other Direct Care – ie CPN / Case Worker
2
Rights (Of The Patient)
2
2
13
18
Community Health and Wellbeing Total
Corporate
Communication Issues
3
Information
Rights (Of The Patient)
Corporate Total
Integrated Children’s Services
1
Admission/Discharge
1
Communication Issues
4
1
Medical Care From Doctor/Consultant
3
2
Nursing Care & Treatment
2
5
Other Direct Care – Ie CPN / Case Worker
1
2
5
Staff Attitude
1
7
18
Admission/Discharge
1
1
11
11
Information
1
1
Medical Care From Doctor/Consultant
14
9
Nursing Care & Treatment
13
9
Other Direct Care – Ie CPN / Case Worker
15
14
Rights (Of The Patient)
25
13
Staff Attitude
1
2
81
60
Communication Issues
1
Medical Care From Doctor/Consultant
1
Nursing Care & Treatment
3
Other Direct Care – Ie CPN / Case Worker
2
Rights (Of The Patient)
3
Staff Attitude
Grand Total
17
Communication Issues
Secondary Care Mental Health Total
Specialist Services Total
1
Rights (Of The Patient)
Integrated Children’s Services Total
Specialist Services
5
Information
Waiting Lists
Secondary Care Mental Health
2
1
3
1
5
9
118
109
29
The Trust aims to make local complaint handling a positive
experience for those who seek to access the service.
The Trust takes pride in the way in which complaints are
managed as it is important to us that the process, the
decision making and the way in which we communicate
are as straight forward and effective as possible.
handling, and our wish to reassure the public that we
take complaints very seriously. We always ensure that
organisational learning is clearly identified in the response
and that this is supported internally through evidence
being available to assure stakeholders that we have done
what we said that we would do.
The points to be investigated are agreed with the
complainant at the earliest opportunity, and meetings are
offered on either an informal or formal basis. Through
our letter of response, which may involve a number of
different clinical areas and/or other organisations, we aim
to provide various remedies through the issuing of an
appropriate apology and a variety of actions which aim to
redress the issues identified, where appropriate.
The Trust PALs service provides advice, information
and support to patients and carers to help to resolve
issues. This may take the form of signposting to other
services, providing information, for example, of how to
access services, or supporting someone in a ward round,
outpatient appointment or case conference to assist them
in getting their views heard. PALs often provide a speedy
resolution to an issue or concern and for many provides a
better option than making a formal complaint. The table
below shows the number of PALs contacts managed by
The Trust in 2014/15 in comparison to previous years.
All of our complaint responses are signed by our Chief
Executive and reviewed by the Trust Chair, in order to
underpin the organisations approach to complaints
No of PALS contacts
No PALS contacts
No PALS contacts
2014-2015
2013-2014
2012-2013
540
431
424
During the course of the year individual members of
staff, teams and services receive many compliments from
patients wishing to say thank you for the way in which
they or their loved ones have been cared for and treated.
Where complainants have a formal process to follow,
those who compliment tend to do it informally by sending
a letter or card, or verbally and collecting this data across
Number of Compliments received
the Trust is much harder to do. Staff are continually
reminded and encouraged to capture and record evidence
of compliments so that this can be reported but we know
that the data is far from complete. The table below shows
the number of compliments received by The Trust in
2014/15 in comparison to previous years.
2014-2015
2013-2014
2012-2013
646
439
424
Patient Survey
The Trust participated in the nationally mandated National
Community Mental Health Service User Survey which
published its results in 2014. The questionnaire was issued
to 850 people who receive community mental health
services. Responses were received from 252 service
Patient survey
users, which is a higher response rate than the previous
year (233 responses). In the table below Questions
are grouped under the section in which they appear in
the questionnaire (as reported by the Care
Quality Commission).
Patient Response*
Compared with
other trusts^
Health and Social Care Workers
7.7/10
About the same
Organising Care
8.2/10
About the same
Planning Care
7.0/10
About the same
Reviewing Care
7.3/10
About the same
Changes in who people see
5.5/10
About the same
Crisis Care
6.2/10
About the same
Treatments
7.2/10
About the same
Other areas of life
4.4/10
Worse
Overall views and experiences
7.1/10
About the same
30
The Trust has developed an action
plan, which was co-produced with
service users and carers, to address these
issues and updates on progress have been
regularly reported. The mandated survey
is repeated each year and the results will
demonstrate whether the action plans have
been successful.
*For each question in the survey peoples responses are
converted into scores where the best possible score is 10/10.
^ Judgement as reported by the Care Quality Commission
Staff Survey
The Trust took part in the 12th annual NHS Staff Survey in
September 2014. The Trust has a response rated of 48% which
was an increase on 43% who participated the previous year.
Key Findings for which the Trust compared most favourably
with other similar Trusts in England
1.Percentage working extra hours = 67% (national
average 71%)
2.Percentage receiving health and safety training in the
last 12 months = 90% (national average 73%)
3.Percentage having equality and diversity training in the
last 12 months = 79% (national average 67%)
4.Percentage of staff receiving job-relevant training,
learning or development in last 12 months = 82%
(national average = 82%)
5.Percentage of staff feeling satisfied with the quality of
work and patient care they are able to deliver = 76%
(national average 76%)
Key Findings for which the Trust did not compare favourably
with other similar Trusts in England
1.Effective team working = 3.76 (national average 3.84)
2.Percentage of staff feeling pressure in last 3 months
to attend work when feeling unwell = 24% (national
average 20%)
3.Percentage of staff able to contribute towards
improvements at work = 68% (national average 72%)
4.Percentage of staff witnessing potentially harmful errors,
near misses or incidents in last month = 33% (national
average 26%)
5.Staff motivation at work = 3.74 (national average 3.84)
Overall, the Trust has similar scores compared to our 2013.
There was only one Key Finding where we have significantly
improved and one Key Finding where we have significantly
deteriorated as follows:
•
Where staff experience has improved – Percentage of
staff having equality and diversity training in the last 12
months has increased for 71% in 2013 to 79% in 2014.
• W
here staff experience has deteriorated – Staff
motivation at work. Trust Score in 2013 - 3.89, Trust
score in 2014 - 3.74.
The Trust Integrated Workforce Group will be tasked with
focussing on two areas, reported with the Survey for
survey, for improvement. These will be agreed following
our Big Conversations with Staff in April and May 2015 and
reported against in our next Quality Account.
The Trust Board has embarked on a large scale staff
engagement programme of activity within our Equal
Active Partners (EAP) framework. This, we are hopeful, will
support our development and continual improvement of
staff engagement at all levels, showing some additional
improvements in our 2015 staff survey. Our sixth wave
of EAP teams have attracted over 12 teams which are
developing their own mission statements and straplines
to make improvements in their areas, owning and taking
forward action plans locally. Over 80 teams have now
undertaken the EAP model to make improvements. Other
staff engagement activity continues which includes health
and wellness days for staff. Valuing our staff road shows,
social activities such as sports day and quiz night and more
visibility of our senior team through back to the floor and
online content. Our Chief Executive continues to respond to
our “Ask Josie a Question” section on the Intranet. This is
proving to be popular and has already generated a number of
questions from staff. All questions and answers are available
for all to see in “Josie’s Room” on the staff Intranet.
Following on from our 2013 results a number of actions
were undertaken in response to staff feedback at our Big
Conversations. A Buddy service has been established to
support with work based issues. This service has been
communicated widely, with leaflets and posters being
distributed across the organisation.
Working With Stakeholders – The
Quality Account Task and Finish Group
The Trust has been an active participant in a Task and
Finish group with key stakeholders representing Adult
Social Care and Health Overview and Scrutiny Committee
(Warwickshire), Health and Social Care Scrutiny Board
(Coventry), Healthwatch Coventry and Healthwatch
Warwickshire. The aim of the of the Quality Account Task
and Finish Group is to support stakeholders to learn about
and understand the Trust and provide a forum to question
and challenge the delivery of services.
Group members were taken on two tours of Trust services,
one tour focussing on services delivered from our St Michaels
Hospital site in Warwickshire and the other tour focusing on
services delivered from our Manor Site, Nuneaton.
In addition the Group requested that they have the
opportunity to debate the following topics:
• Compassion in Action
• Friends and Family Test
• Staffing Levels
• Being An ‘open, listening and transparent’ Trust
• Management of Dual-Diagnosis Patients
• Managing Transitions Between Services
• Partnership Working
• Complaints management (as part of a health economy
wide forum).
The Trust has welcomed the continued engagement
with this key group and looks forward to sustaining its
involvement in 2015/16.
31
Focus on: Specialist Services
Specialist services provide high quality inpatient and community services to
people with learning disabilities or eating disorders across CWPT. Specialist
assessment and treatment services provide care at both Brooklands and Gosford
unit in Coventry, with secure service also being provided at the Brooklands
site. The Eating Disorder service has 15 inpatient beds at the Aspen centre and
community provision offers domiciliary support. All of the inpatients services are
able to detain people so they can be cared for under the Mental Health Act.
Specialist services also has five community learning disability teams across the Trust
which provide MDT services for people with learning disabilities and there is also
Day care, respite care, domiciliary care staff provide support to people who live in
their own homes in Coventry.
Ken Goss, Consultant Clinical Psychologist
Key achievements in 2014/15
International Work – Coventry
Eating Disorder Service: (CEDS)
Compassion Focused Therapy for
Eating Disorders CFT-E)
CEDS has pioneered development and use of CFT-E over
the past 12 years. This therapy helps patients manage
the thoughts and feelings that they have around eating/
size/shape and the problems that patients with an eating
disorders have with shame and self-criticism. It has been
found to be highly effective in the treatment of eating
disorder patients. Recently the service published an
eight year audit of outcome and published a number of
treatment manuals and book chapters outlining CFT-E.
The growing popularity of this approach has led to the
service to provide supervision and training for a number of
services in the UK, and has attracted wider international
interest. Last year, Dr Goss, Consultant Clinical
Psychologist, presented at international conferences
in the USA, Norway, and the UK. Most recently he has
been invited to Norway to lead the CFT-E arm of the first
Randomised Control Trial comparing it with Cognitive
Behavioural Therapy. Over the next year the service will
publish the first study using CFT-E for patients with low
weight eating disorders and will be leading a multisite
clinical audit of this version of the programme in the UK.
32
Secure Services, Brooklands –
Annual Peer Review
The Medium and Low secure services at Brooklands are
members of the Royal College of Psychiatrist’s Quality
Network for Forensic Mental Health Services. Each year
the service participates in a peer review process, where
representatives from the college and other secure providers
review the medium and low secure units against a
nationally agreed set of standards based on the three
tiers of security (physical, procedural and relational)
The peer review took place on Tuesday 3 March 2015
and this year was the first year that the low secure service
was included. Service users and front line staff were
interviewed; this was an opportunity for them to give their
perspective on living and working within the service.
Overall it was a successful day with very positive feedback
and a useful account of service challenges.
The feedback regarding the Low Secure units indicated
good environments, welcoming staff and good use of the
de-escalation suites, minimising the need for seclusion.
The Medium Secure unit was described as feeling clean
and bright, despite the building work with the staff
making the best of what they had and were continuing to
offer therapeutic activity.
Overall Feedback was that the service users spoke highly
of the staff on all the units and the use of care planning
that puts the service users in control of their own meetings
if they wish. The inspectors reported a positive energy
throughout the services.
Specialist & Assessment Treatment
Peer Reviews
On Tuesday 23 September the Amber Unit at Brooklands
underwent a Learning Disability – Accreditation for
Inpatient Mental Health Services (LD-AIMS) peer review
from the Royal College of Psychiatrists. The review focuses
on a number of standards that the service has to meet in
order to be accredited such as:
•
Safe/therapeutic environment
•
Patient and Carer feedback
•
Timely and purposeful admission
•
Policies and procedures
•
Staff training and development
The verbal feedback at the end of the review was very
positive with patient and carers giving 9/10 for the unit
and the staff. The final report is awaited.
On Thursday 9 October the Jade Unit had its first Quality
Network for Learning Disability (QNLD) peer review. QNLD
is the start of the process towards accreditation under
LD-AIMS. In the verbal feedback the inspection team said
that they were pleased that the LD Standards were used in
the design of the build. They noted:
•
Good user friendly signage
Community Learning
Disability Teams Move Toward
an Integrated Approach
•
The Trust’s Learning Disability community multidisciplinary team based at Enterprise House have
relocated to Civic Centre 2 as part of Coventry City
Council all age disability strategy and to enhance joined
up approach to community LD services across the city.
Shirley House Opens
Shirley House, in Shirley, Solihull, recently renamed
following votes from families, clients and staff (previously
Gilliver Road) is now a 10 bedded respite facility that
caters for adults with a learning disability who experience
life limiting conditions, complex health care needs or
challenging behaviour.
The building is purpose built and divided into three separate
areas where two areas are dedicated for planned respite:
1)A newly refurbished unit that has been specifically
designed for clients that challenge (The Ivies) and
2)A purpose built facility with assistive technology
to support client with complex health care needs
(The Vines).
•
Pre admission assessments were multi professional
We work in a multi-disciplined fashion that compliments
the services we offer and provide. These include a range
of benefits for clients and their families including planned
overnight stays with 24 hour nursing care, day support
/ activities during their stay, a sensory room, specialist
learning disability nursing interventions for known clients
and regular contact with families to ensure their son or
daughter is supported appropriately.
•
That doctors and practice nurses were seen part of
the team, and not separate
The unit has been nominated a Trust Q (Quality) Award for
all the work undertaken.
•
Menu boards and activity boards
•
Outside space and facilities
•
Access to a range of activities off the unit
•
Impressed with the skill and gender mix of staff
•
Impressed that the service was continuing to develop
and was changing culture
•
Liked the care plans in respect of regular view of
observation plans, physical interventions and overall
care plans were individualised
•
They were impressed with the development of the
Integrated Treatment Plans and have taken copies.
33
‘If you listen you will hear us’
Staff from the North Warks Community Learning Disability
Team based at The Loft in Bedworth were at Ropewalk
Shopping Centre in Nuneaton on Friday 11 July 2014 to
promote a resource pack they have put together, entitled
‘If you listen you will hear us’ – aimed at supporting the
care needs of people with Profound and Multiple Learning
Disabilities. Carers and families of people with a Learning
Disability, as well as members of the public, came along
to meet the team and find out more. The team spoke to
50 people and gave out a range of information about the
team and will be following up with some organisations
regarding further work. It was a very positive day with
some great feedback from the general public.
Palliative care for people with
learning disabilities within
Solihull, Coventry and
Warwickshire local network.
A network between Learning Disabilities services and
Palliative Care specialisms has been set up, following the
Palliative Care of People with Learning Disabilities (PCPLD)
Network conference on loss, bereavement and end of life
care. The purpose of the network is to share information
about resources and local activities within Coventry,
Solihull and Warwickshire and to explore the possibility
of forming a local area group.
The aim is to improve the palliative / end of life care
programme for people with learning disability across
Coventry, Solihull and Warwickshire.
GP Resource Packs
The Solihull Health Facilitation Liaison Team developed a
resource pack for the GP practices which was designed to
raise awareness of health issues for people with learning
disabilities. The pack was presented to the Solihull GP’s at
a protected learning time event.
This was also rolled out to GP practices within Coventry
and Warwickshire.
The folder contains information on what a learning
disability is and a screening tool to help determine
if someone has a learning disability. There is advice
about read codes (all GP practices in the area now use
34
standardised read codes) and a practice protocol for
delivering health checks, including an easy read invitation
letter. There is information on the Mental Capacity Act
and consent, tips on communication and signs and
symbols, information on the associated health needs
of people with learning disabilities, epilepsy management
plans and other useful information. The folder includes
information on referring to the Community Adult
Learning Disability Service.
Quality Goals
Specialist Services have reported against its Quality
Goals in year. Members of the Specialist Services Senior
Management Team monitor quality goals at a monthly
meeting which ensures plans are in place to meet all
milestones with Lead AHP responsibility for coordinating
the progress for each of the goals.
Key programmes of work for 2014/15 include:
•
Improved use of patient/service user engagement
and involvement including collecting real time patient
feedback and undertaking the Friends and Family Test
and action planning regarding the analysed results.
•
Development of an Outcomes Framework and use of
agreed outcome measures which include a patient rated
outcome measure. There has been roll out of the agreed
outcome measures in a number of service areas with
plans in place for the remaining services, and training
to staff provided regarding their use.
•
Review the care of individuals with challenging
behaviour and autism to ensure a positive approach.
This has taken account of the work of the Winterbourne
View group and new Government drivers in relation
to the repatriation work in bringing patients close to
home. A Positive Behaviour Support group has been
established and meets bi-monthly to progress awareness
raising and training in these approaches.
Focus on: Integrated Children’s Services
Integrated Children’s Services provides physical health
services, learning disability services and mental health
services to children and young people in a wide variety
of settings appropriate to their needs; including at home,
in schools, children’s centres, outpatient clinics, children’s
respite units and, in some cases, supporting care provided
in acute hospitals. The nature of our services include
universal services (pre-school & school age), targeted
services and specialist services (pre-school and school age).
We work closely with a range of other services, including
GPs, social care, schools, hospitals and third sector
organisations.
We are organised into Integrated Practice Units, which
are multi-professional teams and deliver care through
patient-focused care pathways.
Members of our Child and Adolescent Mental Health Services
(Camhs) team
Key achievements in 2014/15
•
On-going achievement of contractual targets, including
for breastfeeding recording & prevalence and for
Specialist CAMHS waits to 1st appointment;
•
Achievement of significant increases in the numbers
of qualified Health Visitors in response to the national
workforce expansion initiative;
•
Successful Immunisation and Vaccination programmes
that have exceeded national targets and compare
favourably to local comparators;
•
On-going development of enhanced responses to
Domestic Violence & Abuse within Health Visiting;
•
Organised a successful multi-agency Austism
Strategy Day;
•
Significant support to the Multi-Agency Safeguarding
Hub (MASH) to assist early interventions for safeguarding
issues for children;
•
Significant patient experience work, such as 165
responses to a Specialist CAMHS survey to support
the service redesign;
•
Continued development of multi-professional team
working in Integrated Practice Units around the needs
of children;
•
Increased multi-professional care pathways and refining
of those in place;
•
Establishment of a children and young people’s
Assembly is underway;
•
Closer working with Social Care over Looked After
Children, including, co-location of the Looked After
Children’s Co-ordinator with Social Care LAC team
members to improve communication about children
in care;
•
Successful implementation of the Band 5 Health
Visitor Staff Nurse Competency Framework;
•
Involvement in a number of research projects,
including the MILESTONE Project, which is a
transnational research project focused on transitions
in mental health services.
•
Established professional fora for Nursing, Psychological
Services, Allied Health Professionals and Medical staff
and work areas include further enhancing the experience
of student nurses;
35
Examples of the quality of our
services this year:
Jigsaw
Jigsaw is a support and intervention package run jointly
by Speech & Language Therapy, Occupational Therapy
and Community Paediatrics. It is offered to all families of
pre-school children in Coventry, following a diagnosis of
Autistic Spectrum Disorder.
Once diagnosed, families are offered group therapy which
consist of the children receiving 3 x weekly, hands-on play
sessions of 1 ¼ hours duration in conjunction with 3 other
children and their families. The aims are to help families
to learn strategies and activities to support their child’s
communication and development.
Parents are supported through 2 x extra sessions (without
their children present) where information about their
child’s diagnosis and medical concerns or implications
may be discussed with the Community Paediatrician.
Occupational Therapists work with parents to understand
their child’s ‘sensory world’ and includes why they may
struggle with eating certain foods, are constantly on-thego or have difficulty having their hair washed etc. Speech
& Language Therapists dedicate a specific session to the
speech and language problems the children can have
and the support they require. Advice is also given on very
practical issues that are extremely important to families
such as feeding, toileting, self-care skills and sleeping,
to take home to try.
15 families over a six week period receive this service.
Peer learning and support between parents is forged
through other parents joining the sessions and these have
evaluated extremely well with parents telling us they are
“Excellent” and regular evaluation provide feedback such
as: “Thank you for all your support and help while my son
Peter was going through his assessment process and for
showing me many helpful techniques to enable me to get
the best from my son.”
Looked After Children’s Service:
The health of Looked after Children (LAC) is recognised to
be substantially worse than the health of their peers, due
to the impacts of poverty, poor and inconsistent parenting
contributing to attachment issues; emotional, physical /
sexual abuse and neglect. The effects of poor preventative
care, such as lower rates of immunisation and worse
dental health, inadequate care of disability, undiagnosed
36
health disorders and significant behavioural, emotional
and mental health issues are compounded in the young
adolescents and teenagers deemed as being Hard To
Reach (HTR). Their mobility also makes continuity of
care very difficult.
LAC children are required to have regular reviews of their
health. These traditionally have been poorly attended for
many reasons but those who disengage the most, are
adolescents who are deemed as Hard To Reach (HTR).
The LAC team has evolved to wrap health services around
these youngsters, offering a flexible, client centred
approach to assess and meet positive health outcomes
for approximately 800 children annually. Home visits,
flexible evening and weekend appointments, proactively
engaging with children in Residential Children’s Homes,
identification of a named nurse for each home develop
positive therapeutic relationships between service users,
their carers and the LAC nurse; which has led to a more
meaningful assessment and greater focus on achieving
successful health outcomes for the most vulnerable.
The feedback from young people has been extremely
positive. One young person in a Residential Home stated
to another resident who was reluctant to have a health
assessment: “… (LAC Nurse) is lovely, you can tell her
anything and if you tell her something she will get it
sorted. You can tell her anything, I have, and she can help.
She has helped me and even went to sexual health with
me ‘cos I didn’t want to go with staff. She’s alright”
A dedicated monthly ‘one stop shop’ teenage Paediatric
LAC clinic has been set up for the most disengaged
youngsters. This is run jointly by LAC Nurses and involves
other professionals to support young people, including the
Sexual Health outreach nurse and Compass (under 18’s
substance misuse service). The feedback from one young
person stated:
“It was nice that I met you (LAC Nurse) and
you made talking about my health so easy, you
listened to me and I could talk to you and tell you
about my health problem and then you got me
an appointment with (The Paediatrician) and you
were both really nice and sorted it out for me.”
Future plans to help demystify the health assessment
processes by working with care leavers to explore
information for children coming into care, are underway.
Focus on: Secondary Mental Health Care
Secondary Care Mental Health services has moved into
the operational stage of our ambitious five year plan.
We have now developed the Acute Integrated Practice
Unit, consisting of services supporting service users and
their carers while in an acute phase of a person’s illness
and/or receiving high intensive treatment. This Acute IPU
includes Acute Liaison, Age Independent Crisis Resolution/
Home Treatment, Place of Safety, Day Treatment Services
and Inpatient Services, including rehabilitation and clinical
review team.
Phil Marriott and Dan Barnard’s audio ‘Don’t Panic!’ content was
published as a mobile phone app during this year
During 2014/15 we have continued working on the
implementation of the IPU’s expanding on the work started
in 2013/14, and we have now moved to create one age
independent Single Point of Entry all mental health service
across Coventry and Warwickshire who provide triage
referrals and for assessment into the appropriate IPU. Day
Treatment Services became age independent for functional
patients and will offer an alternative to admission for age
independent functional patients, focusing on decreasing
inpatient admissions and facilitating early discharge.
In our inpatient services we have moved for mixed sex
acute admission ward to single sex age independent
treatment wards we continue to have two Psychiatric
Intensive Care Units (PICU) ward with a total of 16 beds,
and dedicated wards for patients with organic disorders
and wards that can provide care for patient with additional
physical complexities.
Key achievements in 2014/15
•
Street Triage: a successful project that has improved
patient care in the community preventing assessments
within Police Cells and unnecessary admission to
hospital using the least restrictive approach to care.
They have also been nominated for a West Midlands
Police Diamond Award.
Our community services have moved from 15 Adult
teams spread across Coventry and Warwickshire,
including Assertive Outreach/Early Intervention,
Community Rehabilitation and five Functional and
Organic Older Adult teams, to a service divided into
distinct localities: South Warwickshire, North Warwickshire
and Coventry. Services in these localities provide age
independent community Integrated Practice Units based
around Care Clusters that provide a range of interventions
linked to patient outcomes.
•
A new Clinical Coordination Centre has also been
developed using technology to support a slicker and
smoother coordination process across all Hospital sites
for admissions and discharges again supporting better
patient experience.
•
The Clinical Review Team were also nominated for a
national award in the Health Service Journal for their
“Bringing People Closer to Home” project, and were
runners up.
•
AMHT and Crisis services have again supported
patients being assessed and treated in the most
appropriate environment and supporting care within
the community again also supporting the least
restrictive approach to care.
•
Within inpatient services, standardisation has been
rolled out and seen a successful project to managing
and supporting patient safety, quality and leadership
with consultants and ward managers joining forces to
achieve better patient outcomes.
37
Focus on: Community Health
and Well Being
Our directorate provides a wide range of physical and
early intervention mental health services in both clinic
and home-based settings. The directorate is diverse in its
workforce ranging from nursing and medical staff to allied
health professionals and mental health specialist staff.
Community Health and Well Being IPUs are:
Living Well: to support and improve quality of life for
patients and prevent future ill health
Rehabilitation and Reablement: to actively promote
independence; empowering individuals to self care,
reach an optimum level of independence and reduce
dependency on services.
Members of our Tissue Viability team, with the React to Red
campaign to help reduce pressure sores
End of Life: to provide a quality and seamless service
in line with patient wishes to support care in the last
weeks of life.
Key achievements in 2014/15
• Our Improved Access to Psychological Therapies (IAPT)
service has implemented robust standardised therapy
modalities to provide consistent care to clients. The
service has also been successful to partake in a national
pilot to provide psychological support to those seeking
employment.
• Our Lifestyle Team was successful in gaining the city
wide contract to deliver and support the national NHS
Health Check screening in Coventry. The NHS health
check screen is a cardio vascular disease risk assessment
which aims to reduce the incidence of coronary heart
disease, kidney, stroke, and diabetic disease and
vascular dementia, within the 40-74 age population,
who have no pre-existing cardio vascular disease. It
aims to identify individuals who may have high risk
factors for CVD issues and provide early treatment
whilst also encouraging lifestyle changes. The uptake of
Health Checks in Coventry has dramatically increased
since CWPT commenced the contract and support
GP practices to deliver Health Checks to their practice
population.
• The directorate was delighted to be awarded first,
second and third place in the Clinical Audit &
Effectiveness Awards with:
• 1
st prize - Integrated Care Plan Audit by Ann Storer,
Community Matron
38
• 2
nd prize - Quality Outcome of Completed
Orthodontic Treatments (PAR Score Audit) by
Steve Gomersall, Clinical Director CDS
• 3
rd prize for Falls Service: Patient Reported
Outcome Measures by Claire Mee, Community
Physiotherapy Lead.
• We held our first Stakeholder event at the Welcome
Centre on 2 October 2014, all Directorate services
were displayed and staff were available to answer
service related questions. Presentations on our IPU
developments were delivered utilising ‘patient experience
stories’. Feedback was obtained from our service users
which was helpful to inform our future developments.
This event provided an excellent opportunity to
showcase our services and to receive valuable feedback
from service users and FT Members on how they would
like to see our services develop in the future.
• Our Tissue Viability Team were partners in the ‘React to
Red Skin campaign’; a pressure ulcer prevention campaign
being promoted in the Coventry and Warwickshire area.
The aim was to educate as many people as possible about
the dangers of pressure ulcers and the simple steps that
can be taken to avoid them. In November the ‘React to
Red Campaign’ received national recognition for its work
in leading engagement with local care homes; publicised
and promoted on the national website for pressure ulcers.
The campaign also received a very positive article in the
Nursing Times on 29 October 2014, which emphasised
the value of partnership approach to skin care and
pressure ulcer prevention.
•
On 1 December 2014, in response to the Urgent Care
pressures across the health economy, CWPT jointly with
partners, launched a Falls Response Service to prevent,
where possible, admission to hospital for patients who
fall. The service provides a seamless pathway 24 hours a
day, seven days a week for West Midlands Ambulance
Service to liaise directly with our Community services.
The rapid access enables crews to leave a patient safely
at home knowing that a specialist nurse will be attending
within hours to undertake a comprehensive assessment.
Patient feedback has been positive and the service has
been able to meet the immediate patient needs as well as
referring to services for the wider holistic areas of health
and social care from assessing within the home. This
is the first stage in the development of a Primary Care
Assessment Unit, to provide a holistic assessment of a
patient’s needs which can include medical, therapy social
support or simply providing equipment to support the
patient to remain in the home.
•
Our Community Neuro-rehabilitation Team began a pilot
in 2014 to support early discharge from secondary care
for patients who have suffered a stroke. The aim is to
facilitate earlier integration back into the community and
their usual place of living and reduce the dependency
on secondary care resources. This work has seen very
positive results and the service has supported a number
of patients to be discharged earlier from the acute
stroke pathway and reduce time within secondary care.
Anecdotal evidence from patients currently supported
suggests the service has been very well received by
patients and their families.
•
Our Stop Smoking in Pregnancy team worked with the
University of Aberdeen to support the ‘Feasibility of using
indoor air quality measurement as a motivational tool to
change smoking habits among pregnant mothers’ study.
The study enabled consenting pregnant women, engaged
in stop smoking service from May 2014, to have the Dylos
DC1700 instrument within their home for between 2-5
days. The instrument was used to measure fine particles in
the home to measure indoor air quality. This highlighted
the impact secondhand smoke was having in the woman’s
home and provided advice to reduce the impact; for
example by having a smoke free home.
•
Over the past year the Directorate has been developing
a bi monthly Patient Focus Group, and attendance has
grown from just one or two service users attending to
now over 10 patients attending each meeting. Staff have
found the experience very positive in both listening to
their positive and negative experiences of the services we
provide, and ensuring patients have the opportunity to
influence what is happening across the directorate.
Local Peer Reviews
To review the quality and safety of the services we provide,
Community Health and Wellbeing have undertaken 16
unannounced Peer Reviews across the Directorate, focusing
on services offering care to our frail, elderly population.
The team conducting the reviews ensure that either GP,
service user representation or both is present.
Following each review a report is developed summarising
the findings from the service against each of the 6C’s.
This is then shared across the directorate via our Safety &
Quality forum. The report utilises incident reporting data,
team performance reports, the risk register, as well as
formal complaints/compliments. Learning from the report
and the impact of implemented changes is measured via
service action plans and action tracker; reported to Trust
Board & the Clinical Commissioning Group.
On the frontline best practice sharing has expedited
positive change and improved patient care by facilitating
reflection amongst our clinicians upon their consultation
styles; facilitating a greater ‘compassion focused’ patient
experience, where this is needed.
These reviews will continue regularly as they have become
invaluable to improving quality and safety of our services
and they are now strongly embedded, supporting our
Directorate and Trust Quality goals.
The reviews have also attracted national attention, voted
winning entry in the Nursing Times 6Cs Live! 6Cs in Action:
Celebrating Excellence Award Competition in March 2015.
Marie Batey, judging panel member and Head of Acute
and Lead for Compassion in Practice said: “This initiative,
with its sophisticated and robust implementation plan
and measurement, has the potential to transform the care
provided to frail elderly patients. It really is an exemplar
for other Trusts and organisations to study and adopt
in their own settings. While the values embodied in the
6Cs are at the core of these peer-to-peer reviews, it is
also encouraging to see partnership working in action with both the Trust and the CCG each playing their role
in ensuring patient care is as good as it can be. I wish
the project future success and encourage other Trusts to
find out more and whether the lessons learnt here have
relevance in their own organisation.”
39
Annex
Statements Provided by Commissioning
Organisations, Healthwatch and Health
Overview and Scrutiny Committees
NHS Coventry and Rugby CCG Commentary
Coventry and Warwickshire Partnership NHS Trust Quality Account 2014/15
HS Coventry and Rugby Clinical Commissioning Group
N
(CRCCG) are pleased to receive and comment on Coventry
and Warwickshire Partnership NHS Trust’s (CWPT) 2014/15
Quality Account. Although the version seen by CRCCG
was in draft form, we have reviewed the mandatory
data elements and can confirm that those included are
consistent with that known to CRCCG.
We have continued to work closely with the Trust during
2014/15 on a number of quality improvements and are
pleased with the level of openness and transparency
which the staff have demonstrated, particularly when
having challenging conversations. This provides a strong
foundation for developing the partnership working
necessary to deliver the integrated services described in
the Five Year Forward Plan.
We have also been impressed by the integrated approach
undertaken between CWPT, the local acute trust and the
local authority to reduce the prevalence of pressure ulcers
particularly in people within care homes or in receipt of
domiciliary care. This innovative work provides a solid basis
for further quality improvements across the system.
Staffing remains a focus both nationally and locally,
particularly with the introduction of safer staffing levels
which the Trust has implemented across in-patients
services in mental health and learning disabilities. The Trust
has been open in sharing the associated challenges of
recruiting appropriately trained staff and we are assured
regarding the steps that they are taking in monitoring
any impact and mitigating any potential risks.
40
Whilst having sufficient staff is important, the capacity
to deliver good quality care does not rely solely on the
number of staff and so the CCG continues to take a keen
interest in both the development of the workforce and
the organisational culture of the Trust. Although the staff
survey demonstrates that there is further work to do,
we recognise the engagement work that the Trust are
doing through their Equal Active Partners Framework and
look forward to learning more about the impact of this
programme. In addition, we value the significant work that
the Trust has done to improve the accurate reporting of
training levels in safeguarding; however, we expect them
to demonstrate sustained achievement against the targets
throughout the coming year.
Improvement work started in 2014 across a number of
services, particularly Child and Adolescent Mental Health
Services (CAMHS) continues and we await with interest the
outcome of further service reviews that form part of our
quality assurance processes.
Finally, the CCG is satisfied that the Trust has delivered all
the necessary improvements identified by their Care Quality
Commission inspection at the start of 2014.
We fully support the quality goals the Trust has identified
for 2015/16 which build on the work that they commenced
in 2014/15.
Joint Statement from Adult Social Care and Health Overview and
Scrutiny Committee (Warwickshire), Health and Social Care Scrutiny
Board (Coventry), Healthwatch Coventry and Healthwatch Warwickshire
Coventry and Warwickshire Partnership Trust (CWPT)
– Quality Account (QA) 2014/15
This response is made on behalf of the QA Task and Finish
Group (TFG) set up by Warwickshire County Council’s Adult
Social Care and Health Overview and Scrutiny Committee,
Coventry City Council, Coventry and Warwickshire
Healthwatch, reflecting the views, input and contributions
of those members.
We have appreciated the commitment of CWPT staff to
engage with us on wider quality assurance issues as well as
working towards a QA that demonstrates to all audiences
what the Trust are doing to improve services in all areas.
We welcome the opportunity to comment on the QA and
look forward to monitoring the progress of the Quality
Goals over the next year.
We have discussed with all NHS Trusts across Coventry and
Warwickshire, the challenges in producing a document
that answers a broad range of conflicting demands and
audiences. We welcome the presentation of this QA,
which is generally easy to read and well-presented but
would like a more comprehensive glossary with full names
for acronyms and less use of ‘jargon’ such as ‘granular
level’ which is misleading.
There is a clear message in the QA about working with
partner organisations, and we welcome the emphasis
on partnership working to achieve system-wide service
improvement, which will benefit CWPT service users.
Reflecting on 2014/15
We welcome the explanation of the CQUINs as well as the
approach to reporting against the agreed Goal CQUINs.
We have been able to consider these outcomes in more
detail, but the QA needs to show the patient journey
in relation to Goals, with a clear outcome to measure
improvement. It is difficult, however, to see this for
remaining Goals and whether the Trust has achieved the
measures of success it identified last year, e.g. last year’s
measure of success for Goal 3 was for each service to use
real time patient feedback, but it is not clear if this is now
in place and what the result/benefit has been.
Goal 9 – Further develop and implement the leadership and
people development strategy. Numbers of staff trained and
topics covered would have been useful.
Looking forward to 2015/16
We recognise that some Priority Goals are national targets
which must be implemented by the Trust, but believe the
QA process should be used for identifying work specific to
improving service/patient quality within a Trust. This works
best when using patient, carer and staff input in developing
Goals and it would be useful to see how this input has
influenced the setting of Goals.
We are pleased to see the QA showing how the Trust
intends to achieve the agreed Goals.
Compassion in Action (Goal One) - We believe there is a lot
of potential for improvement through the MSFT and look
forward to monitoring this over the next year, particularly
the use of real-time feedback.
Patient Report Outcome Measures (Goal Three) –
We welcome the recognition of the importance of listening
to patients as part of the process in making improvements.
We hope that this work will act as a catalyst for the next
phase of patient engagement within the Trust and that by
next year there will be a clear line between what users and
staff have said, actions by the Trust, what difference has
been made and the impact on setting of Goals.
Outcomes Frameworks Reported as part of the Integrated
Performance Report (Goal Four) – “robust reporting at
service, directorate and Trust level” is crucial to improving
quality assurance. Health Scrutiny have identified a number
of areas for improvement in relation to data and reporting
and we welcome this Improvement Goal.
CQUIN Framework – The two CQUINs identified cover
areas that have been identified by Health Scrutiny and
Healthwatch as areas needing improvement, and these are
welcomed. While we have asked for the information on
CQUINs in the main document to be limited, we think it is
good practice to include a full report on CQUIN targets as
an appendix.
Goal 5 – Respectful Environments. A description of the
benefits is provided and it would be useful for readers
to see reported the actions and the measures of success
through a revised appraisal process.
41
Focus On
This section is useful and information setting out Specialist
Services, Integrated Children’s Services, Secondary
Mental Health Care, Community Health and Well Being.
We believe that for many readers, this will be easy to
identify with and understand.
Other comments
Health Scrutiny continues to scrutinise CWPT over areas
of concern including waiting lists in CAMHS. This was
supported by the 2014 WMQRS Peer Review, and we feel
that this Peer Review and the improvements put in place to
address issues raised should have been included in the QA.
We do however, welcome the work that has been done to
assist with the CAMHS Redesign.
We believe that the key issues for the Trust (gathered from
the ongoing work of the TFG and from this document) are:
• Staff recruitment and retention
• Staff morale
• C
hanging ways of working and being a significant
contributor within new local initiatives aimed at
integrated care and simplifying pathways to care across
a range of NHS and social care services
•Implementing plans which are at early or later phases of
development.
Success for the Trust will rely on getting these issues
right, and we believe there needs to be a clear link with
the Goals and peer reviews (leadership), recruitment,
partnership working and safer staffing levels. We look
forward to working with the Trust over the next year to
monitor these areas.
Healthwatch Coventry has had early discussions with the
Trust regarding a review of complaints and PALS delivery,
and have valuable insight through their provision of the
Independent Advocacy Support Service (ICAS) for people
making NHS complaints. We look forward to seeing the
outcome of this as an important area for all Trusts, both
locally and also tying in with a number of significant
national reports and calls to action around complaint
handling. It would benefit from being a Quality Goal.
42
Healthwatch Coventry
Healthwatch Coventry commentary on the Coventry
and Warwickshire Partnership Trust Quality Account
Healthwatch Coventry is the consumer champion for
local health and social care services, working to give local
people and users of services a voice in their NHS and care
services. Local Healthwatch welcomes its role in producing
commentaries on NHS Trusts’ Quality Accounts.
Other Goals would benefit from examples to substantiate
the work, eg Goal 4, an example of an outcomes
framework and how this has improved things; and Goal 7
an example of how safer patient environments have been
provided and where.
The version of the draft quality account Healthwatch
Coventry received to enable us to compose this
commentary was not complete and did not contain
all the data.
There is a rollover of many of the quality goals from
last year’s account. It would be easier for the Trust to
undertake, track and report on fewer priorities.
We have been a member of a task group convened by
Warwickshire County Council Scrutiny Board to meet with
the Trust and discuss progress on last year’s priorities, and
what should be included as priorities this year. We asked
the Trust to focus on fewer priorities with clearer outcomes,
we are not sure that this has been achieved.
Is the document clearly presented for patients/public?
We do not think that the document is clear for patients
and the public. It would benefit from use of plain English
and a much more direct style. Making the glossary more
comprehensive and using the full names to explain
acronyms would help, but there is too much jargon and
management speak for the information to mean anything
to a local resident. Our comments below also show that it
is difficult to understand what work has been carried out
and the outcomes/impact of the work.
The section on Integrated Children’s Services is, however,
very readable and clear and includes quotes from service
users that make it come to life.
Report on last year’s priorities
Unfortunately, the information provided in the Account
does not enable us to see if the Trust has achieved the
measures of success it identified in last year’s document.
For example last year’s measure of success for quality goal
3 was for each service to use real time patient feedback,
but it is not clear if this is now in place and what the result/
benefit has been.
Other trusts append a full report on CQUIN targets to their
Quality Account and we think this is good practice.
Other performance information
We welcome the introduction of the Buddying Support
for employees and trust that the Gatekeeper is as equally
impartial/independent as the Buddy.
Some further explanation/narrative around Severe Harm/
Death would be helpful as reporting of incidents has
increased in the first half 2014-2015 and cases of severe
harm/death have gone up by 9. Yet there were no ‘Never
Events’. Around 33% of staff also reported witnessing
potentially harmful errors.
Trust priorities for the coming year
Some of the priorities are national targets, which must be
implemented by Trust. Quality Accounts can be a useful
process for identifying work specific to improving service
quality within a Trust and work best when utilising patient,
carer and staff input in developing goals.
Some new developments such as the Equal Partners
Assembly are highlighted and therefore there has been
progress on engagement and feedback. However it is not
clear in the report how the views of patients/service users
and feedback received has influenced the setting of
quality goals.
For goal 5: respectful environments. A description of the
benefits is provided rather than a report on actions and the
measures of success identified last year: a revised appraisal
process and implementation of this.
For Goal 9: information on the number of staff trained and
in what topics would be helpful.
43
Statement of Directors Responsibilities
The directors are required under the Health Act 2009
to prepare a Quality Account for each financial year.
The Department of Health has issued guidance on the
form and content of annual Quality Accounts (which
incorporates the legal requirements in the Health
Act 2009 and the National Health Service (Quality
Accounts) Regulations 2010 (as amended by the
National Health Service (Quality Accounts)
Amendment Regulations 2012).
In preparing the Quality Account, directors are required
to take steps to satisfy themselves that:
•
The Quality Account presents a balanced picture of
the Trust’s performance over the period covered;
•
The performance information reported in the Quality
Account is reliable and accurate;
•
There are proper internal controls over the collection
and reporting of the measures of performance
included in the Quality Account, and these controls
are subject to review to confirm that they are working
effectively in practice;
Jagtar Singh
Chair, Coventry and Warwickshire Partnership NHS Trust
Date: 30th June 2015
•
The data underpinning the measures of performance
reported in the Quality Account is robust and reliable,
conforms to specified data quality standards and
prescribed definitions, and is subject to appropriate
scrutiny and review; and
•
The Quality Account has been prepared in accordance
with Department of Health guidance
•
The directors confirm to the best of their knowledge
and belief they have complied with the above
requirements in preparing the Quality Account.
Josie Spencer
Interim Chief Executive, Coventry and Warwickshire
Partnership NHS Trust
Date: 30th June 2015
44
Independent Auditors’ Limited assurance
report to the Directors of Coventry and
Warwickshire Partnership NHS Trust on
the Annual Quality Account
We have been engaged by the Board of Directors of
Coventry and Warwickshire Partnership NHS Trust to
perform an independent assurance engagement in respect
of Coventry and Warwickshire Partnership NHS Trust‘s
Quality Account for the year ended 31 March 2015 (“the
Quality Account”) and specified performance indicators
contained therein.
In accordance with section 8 of the Health Act 2009 (“the
Health Act”) and the National Health Service (Quality
Accounts) Regulations 2010 and subsequent amendments
thereto (the “Regulations”), the Trust is required to prepare
a Quality Account annually.
Specified Indicators
Percentage of patients on Care
Programme Approach (CPA) followed up
within seven days of discharge.
Reported on page 23 of the Quality
Account document.
NHS Quality Accounts Auditor Guidance 2014/15 (the
“Auditor Guidance”), published in March 2015 by
NHS England, sets out the requirements for our limited
assurance work, including the choice of indicators.
Scope and subject matter
The indicators for the year ended 31 March 2015 subject
to limited assurance (the “specified indicators”); marked
with the symbol A in the Quality Account, consist of the
following indicators as mandated by NHS England:
Specified Indicators Criteria
•The indicator is expressed as a the proportion of those patients on Care Programme
Approach (CPA) discharged from inpatient care who are followed up within seven days;
•‘Patients discharged’ includes patients discharged to their place of residence, care
home, residential accommodation, or to non-psychiatric care, or to prison;
• The indicator excludes patients who die within seven days of discharge;
•The indicator excludes patients removed from the country as a result of legal
precedence within seven days of discharge;
•The indicator excludes patients transferred to NHS psychiatric inpatient ward when
discharged from inpatient care;
•The indicator excludes CAMHS (children and adolescent mental health services), i.e.
patients aged under 18;
•Those that are recorded as followed up receive face to face contact or a telephone
conversation (not text or phone messages); and
•The seven day period should be measured in days not hours and should start on the
day after discharge
Percentage of reported patient safety
•The indicator is expressed as a percentage of patient safety incidents reported to the National
incidents resulting in severe harm or death.
Reporting and Learning Service (NRLS) that have resulted in severe harm or death;
Reported on page 26 of the Quality
Account document.
•A patient safety incident is defined as ‘any unintended or unexpected incident(s)
that could or did lead to harm for one of more person(s) receiving NHS funded
healthcare’; and
•The ‘degree of harm’ for patient safety incidents is defined as follows: ‘severe’ – the
patient has been permanently harmed as a result of the incident; and ‘death’ – the
incident has resulted in the death of the patient.
45
Respective responsibilities of Directors and auditors
The Directors are required under the Health Act 2009 to
prepare a Quality Account for each financial year. The
Department of Health has issued guidance on the form and
content of annual Quality Accounts (which incorporates
the legal requirements in the Health Act 2009 and the
Regulations).
In preparing the Quality Account, the Directors are required
to take steps to satisfy themselves that:
•the Quality Account presents a balanced picture of the
Trust’s performance over the period covered;
•the performance information reported in the Quality
Account is reliable and accurate;
•there are proper internal controls over the collection and
reporting of the measures of performance included in the
Quality Account, and these controls are subject to review
to confirm that they are working effectively in practice;
•the data underpinning the measures of performance
reported in the Quality Account is robust and reliable,
conforms to specified data quality standards and
prescribed definitions, and is subject to appropriate
scrutiny and review; and
•the Quality Account has been prepared in accordance
with Department of Health guidance.
The Directors are required to confirm compliance with these
requirements in a statement of directors’ responsibilities
within the Quality Account.
Our responsibility is to form a conclusion, based on limited
assurance procedures, on whether anything has come to our
attention that causes us to believe that:
•the Quality Account has not been prepared in line with
the requirements set out in the Regulations;
•the Quality Account is not consistent in all material
respects with the sources specified in Auditor Guidance,
issued by NHS England in March 2015 and specified
below; and
•the specified indicators in the Quality Account identified
as having been the subject of limited assurance in the
Quality Account have not been prepared in all material
respects in accordance with the Regulations and the six
dimensions of data quality set out in the Auditor Guidance.
We read the Quality Account and conclude whether it is
consistent with the requirements of the Regulations and to
consider the implications for our report if we become aware
of any material omissions.
46
We read the other information contained in the
Quality Account and consider whether it is materially
inconsistent with:
•Board minutes for the financial year, April 2014 and
up to the date of signing this limited assurance report
(the period);
•papers relating to the Quality Account reported to the
Board over the period April 2014 to the date of signing
this limited assurance report;
•feedback from NHS Coventry and Rugby Clinical
Commissioning Group;
•feedback from Local Healthwatch Coventry dated 2/06/2015;
•feedback from Adult Social Care and Health Overview
and Scrutiny Committee (Warwickshire), Health and Social
Care Scrutiny Board (Coventry), Healthwatch Coventry
and Healthwatch Warwickshire;
•the Trust’s complaints report published under regulation
18 of the Local Authority, Social Services and NHS
Complaints (England) Regulations 2009, dated 1 October
2013 – 30 September 2014;
• the latest national patient survey report dated 2014;
• the latest national NHS staff survey dated 2014;
• the Head of Internal Audit’s annual opinion over the
Trust’s control environment dated May 2015;
• the Annual Governance Statement dated 26/05/15; and
•Care Quality Commission Intelligent Monitoring Report
dated November 2014.
We consider the implications for our report if we become
aware of any apparent misstatements or material
inconsistencies with these documents (collectively the
“documents”). Our responsibilities do not extend to any
other information.
This report, including the conclusion, is made solely to
the Board of Directors of Coventry and Warwickshire
Partnership NHS Trust. We permit the disclosure of this
report to enable the Board of Directors to demonstrate
that they have discharged their governance responsibilities
by commissioning an independent assurance report
in connection with the indicators. To the fullest extent
permissible by law, we do not accept or assume
responsibility to anyone other than the Board of Directors
as a body and Coventry and Warwickshire Partnership
NHS Trust for our work or this report save where terms are
expressly agreed and with our prior consent in writing.
We are in compliance with the applicable independence
and competency requirements of the Institute of Chartered
Accountants in England and Wales (“ICAEW”) Code of
Ethics. Our team comprised assurance practitioners and
relevant subject matter experts.
Assurance work performed
We conducted this limited assurance engagement in
accordance with International Standard on Assurance
Engagements 3000 ‘Assurance Engagements other than
Audits or Reviews of Historical Financial Information’ issued
by the International Auditing and Assurance Standards
Board (‘ISAE 3000’) and the Auditor Guidance. Our limited
assurance procedures included:
•reviewing the content of the Quality Account against the
requirements of the Regulations;
•reviewing the Quality Account for consistency against the
documents specified above;
•obtaining an understanding of the design and operation
of the controls in place in relation to the collation and
reporting of the specified indicators, including controls
over third party information (if applicable) and performing
walkthroughs to confirm our understanding;
•based on our understanding, assessing the risks that
the performance against the specified indicators may be
materially misstated and determining the nature, timing
and extent of further procedures;
•making enquiries of relevant management, personnel
and, where relevant, third parties ;
techniques may also vary. Furthermore, the nature and
methods used to determine such information, as well as the
measurement criteria and the precision thereof, may change
over time. It is important to read the Quality Account in the
context of the criteria set out in the Regulations.
The nature, form and content required of Quality Accounts
are determined by the Department of Health. This may
result in the omission of information relevant to other users,
for example for the purpose of comparing the results of
different NHS organisations.
In addition, the scope of our assurance work has not
included governance over quality or non-mandated
indicators which have been determined locally by Coventry
and Warwickshire Partnership NHS Trust.
Conclusion
Based on the results of our procedures, nothing has come
to our attention that causes us to believe that, for the year
ended 31 March 2015:
•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 with the sources specified above; and
•the indicators in the Quality Account subject to limited
assurance have not been prepared in all material respects
in accordance with the Regulations and the six dimensions
of data quality set out in the Auditor Guidance.
•considering significant judgements made by the
management in preparation of the specified indicators;
•performing limited testing, on a selective basis of
evidence supporting the reported performance indicators,
and assessing the related disclosures; and
• reading the documents.
A limited assurance engagement is narrower in scope than a
reasonable assurance engagement. The nature, timing and
extent of procedures for gathering sufficient appropriate
evidence are deliberately limited relative to a reasonable
assurance engagement.
Limitations
Non-financial performance information is subject to more
inherent limitations than financial information, given the
characteristics of the subject matter and the methods used
for determining such information.
The absence of a significant body of established practice
on which to draw allows for the selection of different
but acceptable measurement techniques which can result
in materially different measurements and can impact
comparability. The precision of different measurement
PricewaterhouseCoopers LLP
Cornwall Court
19 Cornwall Street
Birmingham
B3 2DT
Date: 30th June 2015
Note: The maintenance and integrity of the Coventry and
Warwickshire Partnership NHS Trust’s website is the responsibility
of the directors; the work carried out by the assurance providers
does not involve consideration of these matters and, accordingly,
the assurance providers accept no responsibility for any changes
that may have occurred to the reported performance indicators or
criteria since they were initially presented on the website.
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How to provide feedback
Thank you for taking the time to read this Quality Account. We hope that you have found it useful and informative
and would welcome any feedback or suggestions on how we could improve this further for next year, be it either layout, style
or content.
If you would like to make a comment or suggestion then please contact us using any of the methods listed on the back cover
of this publication.
48
Glossary
Care Quality
Commission (CQC)
The CQC is the independent regulator of health and adult social care services in England. It also
protects the interest of people whose rights are restricted under the Mental Health Act.
Clinical Audit
Clinical audit is a systematic process for setting and monitoring standards of clinical care. Guidelines
set out what best clinical practice should be and audit investigates whether best practice is being
carried out and makes recommendations for improvement.
Clinical Coding
Clinical coding is used to translate medical terminology describing a diagnosis and treatment into
standard, recognised codes.
Commissioners
Commissioners have responsibility for assessing the needs of their local population and purchasing
services to meet these needs. They commission services, including acute care, primary care and
mental healthcare) for the whole of their local population with a view to improving their health.
Commissioning
for Quality and
Innovation (CQUIN)
CQUINs are a payment framework that is a compulsory part of the NHS contract. It allows local
health communities to develop local schemes to encourage quality improvement and recognise
innovation by making a proportion of the organisations income conditional on achieving the
locally agreed goals.
Foundation Trust (FT)
A Foundation Trust remains part of the NHS however has greater local accountability and freedom
to manage themselves. Staff and members of the public can join their Boards or become members.
Hospital Episode
Statistics (HES)
HES is a national data source that contains anonymous details of all admissions to a NHS hospital
in England. It also contains anonymous details of all NHS outpatient appointments in England and
is used too plan healthcare, support commissioning, clinical audit and governance and national
policy development.
Information
Governance (IG)
Toolkit
The IG toolkit is an online tool that allows organisations to measure their performance against
information governance standards. The information governance standards encompass legal
requirements, central guidance and best practice in information handling.
Integrated Practice
Unit
Describes the way in which the Trust organises its services.
Healthwatch
Each local authority area has a Healthwatch group which is a network of local people, groups
and organisations from the local community who want to make care services better. The aim of
Healthwatch is to ensure local people have a say in the planning, design, commissioning and
provision of health and social care services.
National Institute of
Health and Clinical
Excellence (NICE)
NICE provides guidance, sets quality standards and manages a national database to improve
people’s health and prevent and treat ill health. It makes recommendations to the NHS on new and
existing medicines, treatments and procedures; treating and caring for people with specific diseases
and conditions and how to improve people’s health and prevent illness and disease.
National Patient
Safety Agency (NPSA)
The NPSA leads and contributes to improved safe patient care by information, supporting an
influencing the health sector. It manages a national safety reported system and received confidential
reports from healthcare staff across England and Wales. These reports are analysed to identify
common risks to patients and look at opportunities to improve patient safety.
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Equality statement
If you require this publication in a different
format or language, please contact our Equality
and Diversity Department on 024 7653 6802,
or write to the address below.
Coventry and Warwickshire Partnership NHS Trust
Headquarters, Wayside House, Wilsons Lane, Coventry CV6 6NY
Tel: 024 7636 2100
Email: enquiries@covwarkpt.nhs.uk
Web: www.covwarkpt.nhs.uk
Twitter: @CWPT_media