Quality Account
An annual report detailing
the quality of services we
offer to our community
If you would like this information in another
format or language, or would like to provide
feedback about any of our services, please
contact our Patient Experience Service:
Telephone: 0151 514 6311
Freephone: 0800 694 5530
or patient.experience@wirralct.nhs.uk
www.wirralct.nhs.uk
b Introduction
Simon Gilby, Chief Executive
3
b Section 1
Foreword from the Board
4
b Section 2
Performance overview 2014/15
6
b Section 3
Innovation in service delivery
16
b Section 4
Quality assurance of the services we deliver
18
b Section 5
Bringing high quality services closer to home
20
Our values will guide how we will achieve that vision
and face up to the challenges that lie ahead.
b Section 6
Volunteer and membership
24
Health is our passion, with patients at the heart of everything we do
b Section 7
Objectives for 2015/16
26
b Section 8
Statement from Healthwatch Wirral
28
b Section 9
Statement from Wirral Clinical Commissioning Group
29
b Section 10
Statement from Local Authority
30
b Section 11
Our services
31
Our vision is to be the
outstanding provider of
high quality, integrated
care to the communities
we serve.
Exceptional care as standard
Actively supporting each other to do our jobs
Responsive, professional and innovative
Trusted to deliver
Contents
b About
Introduction b
our trust
Who we are
Who we serve
Wirral Community NHS Trust is located in Wirral in
Our Wirral population comprises around 320,000
North West England. We provide high quality
residents across 145,000 households (based on
primary, community and public health services to
projections from the 2011 census).
the population of Wirral and parts of Cheshire and
Liverpool. Registered with the Care Quality
Commission (CQC) without conditions, we play
a key role in the local health and social care
economy as a high performing organisation with
an excellent clinical reputation.
We employ over 1,400 members of staff, 90%
of whom are in patient-facing roles, the majority of
these being employed in our nursing and therapy
There are pronounced extremes in Wirral, with
affluent areas very close to communities
experiencing significant levels of poverty and
deprivation. Variations in life expectancy are
amongst the highest in England.
Just over 5% (16,101) of Wirral’s population classify
themselves as being from a black and ethnic
minority population group.
services. Our workforce represents over 70% of
Wirral has a relatively high older population and a
the costs of the organisation and are our most
relatively low proportion of people in their twenties
important and valued resource.
and thirties compared to England and Wales as a
whole. The older population (aged 65 years and
above) is expected to increase faster than any
other age group over the next decade.
This changing age profile, along with conditions
caused or exacerbated by lifestyle, will place
increased demands on our services in future,
particularly in some nursing services.
This Quality Account reflects our commitment
to providing the best possible standards of
clinical care, shows how we are listening to
patients, staff and partners and how we have
worked with them to deliver services that meet
the needs and expectations of the people
who use them.
During 2014/15 we can share many
examples of where we are providing
excellent clinical care including the
achievement of our Commissioning for
Quality and Innnovations (CQUIN)
schemes and quality objectives in areas
such as pressure ulcer care, access to
integrated and coordinated care teams,
infection prevention and control and
clinical innovation.
In September 2014, the CQC carried
out a comprehensive review of all our
services and we are proud to have
received an overall rating of ‘Good’.
The inspection considered how safe,
caring, effective, responsive and well led
our services were and we continue to
be registered with the CQC with no
conditions.
Our quality governance assurance
framework was inspected during 2014
by Monitor, the NHS financial watchdog.
The results of this review were also
very positive.
The findings of the Francis Report
following the events at Mid Staffordshire
hospital continue to drive our ambition to
continuously improve quality across all of
our services. We have led the way this
year in developing a ‘Right Staffing’
project which helps us to make certain
that the right staff with the right skills are
available at the right time and in the right
place for our patients.
We have aimed high again in setting
challenging quality goals for 2015/16.
These include a continued focus on
effective wound care and prevention of
pressure ulcers. We are committed to our
patient safety and leadership walkrounds,
a process by which executive and nonexecutive directors meet with staff and
patients to find out how it is for them.
We are determined to achieve financial
stability and recognise that quality is both
a clinical and business priority for us as we
move into more difficult financial times.
Our ambition to achieve foundation trust
status during 2015/16 will support this, as
will the commitment and dedication of our
staff as we work to ensure our services are
as efficient as possible.
On behalf of the Trust Board, I would
like to thank all of our staff who have
contributed to what has been a
successful year improving quality across
all services on a daily basis and for the
care they take in doing the very best for
each and every person they meet.
I confirm on behalf of the Trust Board
that, to the best of my knowledge and
belief, the information contained in this
Quality Account is accurate and
represents our performance in 2014/15
and our priorities for continuously
improving quality in 2015/16.
Simon Gilby
Chief Executive
3
b Section 1 Foreword from the Board
Quality Account 2014 - 2015
The Quality Account
aims to provide
assurance to
our patients,
commissioners and
the local population
that our services
are safe, effective,
caring, responsive
and well-led.
Our priorities for 2015/16 are set out in this report
and have been developed in partnership with patients,
members, healthwatch and our commissioners.
They are aligned with the NHS constitution and aim
to meet the expectations of the populations we serve.
Our priorities for 2015/16 - we will:
• identify and support people with dementia
• reduce avoidable admissions to hospital
• integrate therapy services
• reduce avoidable grade 3 and 4 pressure ulcers
acquired during care
• achieve 4.0% staff sickness levels or below
• achieve foundation trust status during 2015/16
4
5
b Section 2
Performance overview 2014 - 2015
Quality Account 2014 - 2015
routes eg e-mail, feedback cards,
telephone and via the trust website.
During 2014/15 there were no referrals to
the Parliamentary and Health Service
Ombudsman in relation to our trust.
b Increase the number of
completed patient experience
questionnaires from all
clinical services by 10%
All clinical services use the patient
experience questionnaire to learn from
feedback provided by patients, families
and carers. The questionnaire also
collects information about who is using
the service so that we have a better
understanding of people’s needs
associated with different groups of
patients.
Our patients and
communities
Section 2 sets out our objectives for 2014/15 and details how well
we did against each one.
b Meet the milestones of
right staffing
During 2014/15 we have made great
progress in establishing the right levels of
staffing across many of our services and
have met all our project milestones.
b 95% of staff feel confident
and able to raise concerns
about patient safety and
effectiveness of care
Our regular programme of patient safety
& leadership walkrounds gives staff and
patients the opportunity to talk directly
with members of the Trust Board about a
6
range of topics, especially patient safety
and how services may be improved.
We are delighted that almost all of our
staff tell us that they feel able to raise any
concerns that they might have. This is
consistent with our open and honest
culture that encourages the reporting of
any incidents and near misses to promote
learning and improvement.
b 95% of complaints and
concerns responded to in
three days
There were 79 written complaints received
in 2014/15 compared with 40 written
complaints received in 2013/14.
100% of complaints and concerns were
acknowledged within three working
days. Complaint themes include aspects
of clinical care, communication and
attitude.
Improvements resulting from
complaints include:
• recruitment of additional staff to the
podiatry service
• implementation of a Community Health
Care Project Lead and Support
Practitioner working closely with the
community nursing teams
Patient concerns and complaints are
received by the trust through a variety of
As a trust we have increased the
participation of patients, families and
carers and achieved an increase greater
than 10% in completing patient
experience questionnaires.
To improve feedback we have developed
patient experience feedback
questionnaires especially for children and
young people and people who have a
disability due to brain injury and have
installed feedback kiosks in our GP Out
of Hours and Walk-in centre services.
Customer care training is also available
for all staff.
b Friends and family score
of 80% or more
The NHS friends and family test is a
simple feedback tool which asks the
question:
How likely are you to recommend our
service to friends and family if they
needed similar care or treatment?
Response options range between
‘extremely likely – extremely unlikely’
and people can leave anonymous
comments too.
The trust has adopted the friends and
family test ahead of national guidance
and consistently scored above 88% when
patients are asked if they would
recommend our services to friends
and family.
b Staff confident to raise
concerns about patient
safety and fraud
In the last 12 months, 678 concerns
raised via the Raising Concerns Policy
have been investigated.
Awareness raising with staff on how to
raise a concern has taken place through
the weekly staff bulletin, posters and
StaffZone (the trust’s staff intranet).
All formal concerns raised are monitored
through the Education and Workforce
Committee in relation to patient safety
and fraud matters.
b Additional safety
information
Serious Untoward Incidents (SUIs)
Serious incidents requiring investigation
in healthcare are rare, but when they do
occur the trust has processes in place to
respond quickly, protecting patients by
ensuring a robust investigation is carried
out. This provides an opportunity for the
trust to learn from all serious incidents,
minimising the risk of the incident
happening again.
In 2014/15 we had approximately
1.1 million patient contacts across our
core services. During this time 1,780
patient safety incidents were reported.
Learning from all incidents has been
used to develop new policies, procedures
and training to support staff to deliver
safe care.
Never Events
Never events are serious, largely
preventable patient safety incidents that
should not occur if the available
preventative measures have been
implemented.
We had one never event during 2014/15.
The incident was a wrong tooth extraction
which was disclosed immediately to
the patient and a full apology provided.
A thorough investigation has taken place
and learning has improved and
strengthened processes to prevent a
recurrence of this type of incident.
During 2013/14 we reported 11 SUIs,
and during 2014/15 we reported 19 SUIs.
We have worked closely with our
commissioners over the last year to
ensure we report all suspected and actual
serious incidents within a maximum of 48
hours from the time the incident is known.
As a result, there has been an increase
in reporting which is not directly
comparable to the previous annual
reporting. Enhanced reporting processes
fully supports the trust’s continuing
commitment to embed an open, honest,
transparent culture of learning from
experience, ensuring patients are
protected from harm whilst receiving
care from our clinical services.
All SUIs are fully investigated and shared
with our commissioners. Learning themes
are reviewed and shared across the trust
to prevent them from reoccurring.
We report all patient safety incidents to
NHS England via the national reporting
and learning system.
7
b Section 2
Performance overview 2014 - 2015
Quality Account 2014 - 2015
support staff to provide outstanding
care for patients
• Quality Standard for Constipation in
Children and Young People, was
launched and we updated our care
pathway to ensure children are
assessed, offered treatment and
referred on appropriately
• new Metastatic Spinal Cord
Compression guidelines have been
implemented
• we used this new guidance to update
our leg ulcer care policy and training
for our nurses
• our minor injuries handbook for head
injuries have been updated for clinical
staff to ensure patients are managed
safely and effectively
We are planning to launch a new
update for clinical staff in 2015 to
highlight best practice standards
across all our services.
b 60 Frontline Focus visits
completed
Our services
8
b Access to integrated and
coordinated care team
b 95% clinical audits
completed
Integrated and coordinated care teams
include both health and social care
professionals working together so people
have just one referral and assessment.
Individuals will benefit from a single key
contact who is aware of their current
treatment history and needs.
Clinical audit supports healthcare staff to
continually improve quality of care as
patient safety is a key priority. 100% of
clinical audits were completed.
• Community Nursing identified the need
for new technology to improve
assessments to help guide treatment
options for patients with leg ulcers
The key quality outcomes included:
• Continence Service highlighted the
need for more enuresis alarms as first
line choice of treatment for children
with nocturnal enuresis
Access to the service can be via
various professional routes:
• Wheelchair Service continues to
improve care for patients using
wheelchairs to reduce the risk of
developing pressure ulcers
b National Institute of Clinical
Excellence (NICE) standards
implemented
GP, Department of Adult Social Services,
secondary care, voluntary agency,
domiciliary care agency, patient and
carer’s self-referral.
• personalised care plan audit showed
100% of records evidenced care
planning was in place and partnership
working with the patient and carer
Key achievements include:
• development of a new IT system to
track all new guidance, ensuring we
Frontline Focus visits enable the trust to
review the quality of care provided to
patients, and helps staff to solve quality
and patient safety related problems. They
provide assurance to the Trust Board that
the care our patients receive is compliant
with the Essential Standards of Quality
and Safety from the (CQC). This is
achieved by an Advanced Practitioner
working alongside a staff member for part
of their working day.
What has been achieved:
• patient information leaflets have been
developed to support patients whilst
receiving care and services
• the privacy and dignity of patients
receiving care had been assured
• trust documentation has been updated
to ensure patients have all the
information they need to make
informed decisions
For 2015/16 a new framework is being
developed to evidence on-going
compliance with the new Care Quality
Commission (CQC) fundamental
standards. This reflects the changes from
our care regulator; the CQC. A broader
more detailed observation will be
undertaken by a team of staff looking at
all aspects of care.
b 95% harm free care
We use the national NHS Safety
Thermometer standards to measure
patient harm in relation to:
•falls
• urinary tract infections in patients with
catheters
• pressure ulcers
• venous thromboembolism
(blood clots)
‘‘
During 2014/15 we achieved 96%.
Have found the
service and help
and advice I was
given was very
comprehensive
and all the staff
are very caring.
Cardiac Rehabilitation
’’
9
b Section 2
Performance overview 2014 - 2015
Our people
b 95% of staff to have annual
appraisal and development
plan
We achieved 100% of staff having an
appraisal and development plan during
2014/15. We aim to review guidance for
managers and ensure specific,
measurable, attainable, relevant,
timebound (SMART) objectives are
set for staff within the appraisal window
of May – July.
10
b Implement staff friends
and family test
We have conducted the staff friends and
family test in each of the first three
quarters of the year, once as part of the
national NHS staff survey.
We ranked top of all community trusts for
the percentage of staff who would
recommend their trust to friends or family
for care or treatment. For the percentage
Quality Account 2014 - 2015
b 95% staff to attend
corporate and local induction
b Decrease in staff sickness
rates to 4.2%
We achieved 90% of staff attending
corporate and 96% local induction.
For 2015/16 this objective has been
reviewed with the development of the
‘Onboarding’ process. New starters will
complete their corporate induction online
prior to starting and then undertake local
induction with their manager within four
weeks of their start date.
In 2014/15 the sickness rate for the
organisation was 4.9%.
b 95% staff to attend core
mandatory training
95% of staff completed their core
mandatory training 2014/2015.
Developments:
of staff who would recommend their trust
as a place to work, we were in the top five
community trusts in the country.
In both cases our
results were significantly
higher than the national,
local or community
trust average.
• we will be introducing new Conflict
Resolution elearning training for our
non clinical staff to support their health
and wellbeing in the workplace
• we will be revising our clinical core
training to ensure we deliver
exceptional care to our patients – with
specific consideration for those who
may be vulnerable in the community
such as patients with learning
disabilities or dementia
We have seen a reduction in sickness
absence The Managing Attendance Policy
has been revised to include additional
guidance for managers and signposting
for support for staff. Absence rates are
monitored by the Education and Workforce
Committee with identified actions being
reviewed to assess effectiveness.
b 75% eligible staff to
receive flu vaccination
Influenza can be a serious illness.
To protect our staff and patients we offer
all our staff the opportunity to have a free
flu vaccine. Our 2014 Staff Flu Campaign
was extremely successful, and we saw an
overall increase of 16.6% staff uptake
compared to 2013.
We were the top performing community
trust with 71.6% of our eligible workforce
vaccinated. This considerably exceeds
the national figure of 54.9% of frontline
staff vaccinated and to other community
trusts.
‘‘
Wonderful,
happy,
pleasant
and
courteous
staff!
Community Dental
’’
11
b Section 2
Performance overview 2014 - 2015
Quality Account 2014 - 2015
‘‘
I cannot praise all the
staff high enough for
their professional care
to all patients of rehab
thank you one and all.
Wheelchair Service
Our sustainability
b 95% staff to complete
Information Governance
training
During 2014/15, 96% of our staff completed
online information governance training.
This includes how we ensure patient
information is managed safely and
securely and is appropriately shared when
necessary as part of the patient clinical
care pathway.
12
b Achieve level 2 on IG
toolkit
b Implement practice
development partnership
Of the 39 standards assessed, 38 are
applicable to us and we achieved level 2,
the required level, in all. In addition, we
achieved level 3 in nine (24%) standards
compared to five (13%) in 2013/14.
We have developed a practice
development partnership working
collaboratively with the University of
Chester and our clinical services.
Current research projects include:
• understanding what helps patients make
decisions about their end of life care
• exploring patients’ individual
experiences of two layer and four layer
bandaging systems for leg ulcer care;
comparing patient outcomes and
informing future decisions regarding
care and treatments
b Establish funding stream
for innovation and research
We are committed to active innovation
and research across the trust,
continuously improving clinical services
and patient outcomes.
In 2014/15 we developed an innovation
fund open to all staff to apply for grants
of up to £5000 to implement clinical
innovations within their service area.
Each applicant must demonstrate how
their ideas meet the following criteria:
• improve care for patients
• improve responsiveness for patient
care
• improve patient safety
’’
• improve how services for patients are
well-led
• improve the effectiveness of patient
services
Our clinical forum review each
submission and awards funding
following a presentation delivered
by the clinical teams.
Successful applications include:
• implementing pressure mapping,
within the Wheelchair Service to
support patient education and
pressure ulcer prevention
• introducing a two layer compression
bandaging system across the
Community Nursing Service to
promote patient comfort whilst
improving compliance with leg ulcer
treatments. This was supported by
purchasing additional Dopplex
machines, to assist nursing staff with
their clinical assessments
b Implement continuous
quality improvement
programme
We have trained 110 staff since
April 2014 on effective ways to make
quality improvements, sharing new
ways of working and learning from
patient’s feedback.
To make further improvements in care
over 2015/16 we will:
• carry out a minimum of four innovation
projects via a clinical innovation fund
• encourage clinical teams to share
their local quality improvements with
all services so we can learn from
each other
• provide opportunities for all staff to
attend quality improvement workshops
13
b Section 2
Performance overview 2014 - 2015
Quality Account 2014 - 2015
• information on patient experience
• a patient story
• an improvement story describing what
the trust has learnt and what
improvements they are making
compassion and support for those with
dementia and their carers.
communication channel that helps to
shape the organisational culture.
Leadership
These are a few of the things that staff have
influenced or been directly involved in:
We are currently finalising our reports with
NHS England prior to publication.
We support our leaders with management
development programmes and we link
with the NHS Leadership Academy for our
nationally recognised leadership courses.
b Caring - Hello my name is…
Feedback from healthcare students
In our recent Care Quality Commission
inspection report, our staff were
recognised as being compassionate and
caring. For us this was great feedback
and a welcome reminder to our excellent
staff that they do a great job every day.
In 2014/15 we have provided learning
opportunities for many students, medical,
nursing , speech & language therapy,
dietitians, podiatry and health visiting
students. We invite students to share
their learning experiences through
feedback.
b Well-led - successful
tenders
Performance
overview
b Safe - Right Staffing
Our Right Staffing project is central to our
ambition to deliver safe, caring and
effective services. We have excellent staff
who care deeply and we recognise that
in order to support them to do the best
job they can do, we need the right staff in
the right place at the right time with the
right skills.
The right staffing project has helped us to
work out how many community nurses we
need to deliver safe, caring services to
our housebound population. In addition,
our walk-in centres are now able to
provide the right level of staffing every
day based on the number of people
14
we estimate might need the service on
that day.
We plan to continue this work until we are
satisfied that we understand what staff
and skills are required in all our services.
b Responsive - open and
honest care and duty of
candour
We are committed to delivering care that
is open, honest and transparent. In
2014/15 the contractual duty of candour
and NHS England’s Open and Honest
Care programme were introduced.
The new contractual duty of candour
means that we inform patients, family
members and carers when they are
involved in a patient safety incident that
results in moderate or severe harm or
death. All incidents will be investigated
and feedback on lessons learned offered
to patients and their families.
The ‘open and honest care’ programme
supports trusts to publish monthly data
on their public websites about key areas
of healthcare quality, including:
• harm free care information
• information on healthcare associated
infections
• pressure ulcers
• falls causing moderate or greater harm
• information on staff experience
Building on this feedback the trust is now
involved in the ‘hello my name is...’
campaign. This is a national campaign
started by Dr Kate Granger, a cancer
sufferer and clinician. Kate noticed that
during her own treatment, not all health
workers, including doctors and nurses
introduced themselves to her.
She suggested that this simple
introduction is first rung on the ladder to
providing compassionate care and often
getting the simple things right, means
the more complex things will follow
more easily and naturally.’
b Effective - learning and
development / workforce
development
In 2014/15, we supported 95 staff to
access academic modules at local
universities to enable them to respond to
the needs of services and the patients
they care for. In addition to areas relating
to prescribing and clinical examination
examples of other modules are:
During 2014/15, we have successfully
bid for some key services. This is a
demonstration of the confidence our
commissioners have in the quality of
the services we provide.
Our new services include the 0-19 Health
and Wellbeing Service. This brings
together all preventative, public health
services for children and young people
into one single service. Health visitors,
school nurses, nurses and health trainers
will work alongside our valued partners in
Home-Start, Brook and Barnardo’s to
ensure that children have easy access
to high quality health services.
b Staff Council
• tissue viability for care of wounds
The Staff Council meet regularly with
members of the board to discuss matters
that affect staff at work. Following staff
council elections in 2014/15 there is
improved representation of trust services
and it continues to be a valuable
We are delivering dementia awareness
training for all clinical staff to ensure we
can provide outstanding care,
• dialogue with the board regarding the
experiences of front line staff
• reintroducing the staff retirement
course
• supported the promotion of the ‘hello
my name is…’ campaign with staff
• supported staff awards scheme
• contributed to the plans for CQC visits
in September 2014
b Staff awards
The trust held its third annual ‘For You
Thank You’ Staff Awards in February
2015. Held to celebrate and recognise the
exceptional work of staff from across
the trust, nearly 70 nominations were
received for individuals and teams
across the eight categories.
This year the trust launched its Patient
Choice Award which generated a huge
response from the public. Members of
Staff Council and public members of the
trust were involved in the judging process
and the event was well received by
everyone who was involved.
We will also be delivering our outstanding
Specialised Dental Service across
Cheshire West, Chester and Wirral from
April 2015. Previously known as
Community Dental, this new service
provides specialised dentistry to children
and adults which cannot be provided by
a general dental practitioner.
• supporting patients with long term
conditions
• safeguarding vulnerable group
• articulating staff concerns at times of
reorganisation and relocation
The winner of our Patient Choice Award, Niamh
McTague pictured with Councillor Steve Foulkes,
Mayor of Wirral.
15
b Section 3
Innovation in service delivery
Quality Account 2014 - 2015
trust will be developed during 2015/16, to
ensure that we achieve our research
ambitions.
b Continuous Quality
improvement Programme
Innovation in
service delivery
b Ideas scheme, innovation
fund, research programme
2014. Staff can view all the ideas online
and see how they are progressing.
The trust recognises that participation in
research and working innovatively
provides multiple benefits across the
organisation and health and social care
economy.
Through advances made, the trust
contributes to the delivery of high
quality care, with improved outcomes
for patients.
In addition to the development of a
clinical innovation fund, we set up an
ideas scheme encouraging staff to share
their ideas with the trust’s senior
management team for consideration.
We have received over 50 new ideas
since its launch on StaffZone in October
16
Research priorities
Our current research priorities, based on
NHS England guidance include:
• research into clinical interventions and
innovations that have the greatest
impact on outcomes
The trust is currently working with the
National Institute for Health Research
Local Clinical Research Network and
Academic Health Science Network.
A framework to support the expansion of
research and innovation throughout the
• health visiting and family nurse
partnership support
• infant feeding support
• school nursing and immunisations
We have implemented the following
quality improvements to enhance care for
patients:
• work with primary and secondary
schools on nutrition, oral health and
contraception
• speech and language therapists are
using new assessments to help
support patients who have difficulties
swallowing safely - early results show a
significant improvement in nutrition,
well-being and extra support for carers
• weight management support for
children, young people and their
families
• our night nursing service is providing
additional training for nursing
auxiliaries to support nursing care
for palliative patients
• personal, informative, tailored advice
and support
• community nursing have been using
new ways to care for patients with leg
ulcers which help healing and reduce
risk of infection occurring
• drop-in support
• targeted work around drugs, alcohol
and smoking
• support for young carers
Clients receive a free lifestyle assessment
with a health trainer to look at what
support they could benefit from. They are
then signposted to the appropriate
sessions which may include; a box fit
session; attendance at the wellness gym,
cook yourself slim; chair based exercise
or a stop smoking group session. People
who are giving up smoking can also
attend the Breathewell, Singwell group
focused particularly on those with chronic
obstructive pulmonary disease.
Livewell have an allotment where people
can meet weekly and tend to the
vegetable and flower plot. All the
vegetables grown there can be taken
home and used to cook healthy meals
using the recipes provided.
• emotional health and wellbeing
support
• more patients are being cared for in
their own homes including those who
need more specialised care from
nurses when they require antibiotics
b Service examples –
Livewell
• supporting the NHS as a good place
for both commercial and noncommercial research
• the establishment of clear links with
clinical leaders across all professions,
with academia, industry, and with
non-clinical researchers in health and
social care
The 0-19 Health and Wellbeing Service
includes:
b Service examples – 0-19
Health and Wellbeing Service
The new service, delivered by the trust
and our partners Barnardo’s, Brook and
Home-Start Wirral, will help improve the
current and future health and wellbeing of
children and young people, help reduce
health inequalities, respond to local need
and provide universal and targeted
support as required.
The Livewell service offers a
comprehensive free programme
supporting local people to make positive
lifestyle changes.
The programme looks to encourage
people to:
‘‘
Great communication
and follow up, very
understanding and
compassionate.
• get more active
• eat healthier
• quit smoking
• lose weight
• relax and unwind
Wheelchair
Health
Visiting
Service
’’
17
b Section 4
Quality assurance of the services we offer
Quality Account 2014 - 2015
• Community Nursing identified the need
for new technology to improve
assessments to help guide treatment
options for patients with leg ulcers
• Continence Service highlighted the
need for more enuresis alarms as first
line choice of treatment for children
with nocturnal enuresis
• following an audit of standards on the
prevention of patient falls, a new
patient information leaflet on falls
prevention was produced
b Infection Prevention and
Control
We strive to provide services that meet
the infection prevention and control needs
of our patients. We undertook a
programme of audits which included
clinical procedures, hand hygiene and
the cleanliness of the premises where we
provide treatment. This enables us to see
how well we are doing against national
best practice standards and our internal
policies and procedures. Our aim is to
ensure consistent standards of infection
prevention and control and enable
continuous quality improvement.
Internal assurance
b Frontline Focus
In 2014/15 we undertook 60 Frontline
Focus visits which enable the trust to
review quality care provided to patients.
• disinfection of stethoscopes and blood
pressure monitoring equipment
between each patient consultation.
These visits have resulted in
improvements in:
Overall many services consistently met all
standards of quality and safety.
• provision of patient support
information
• patient privacy in clinic areas
Following the quality assurance visits
we were able to raise awareness of the:
• hand hygiene in home visiting services
18
b Clinical audit
Clinical audit supports healthcare staff
to continually improve quality of care
as patient safety is a key priority for the
organisation. Our objective was to
complete 95% of clinical audits, we have
completed 100%.
b Mersey Internal Audit
Agency
Throughout 2014/15 WCT worked with the
Mersey Internal Audit Agency (MIAA) to
test out how good our governance
processes are. MIAA gave us a rating of
significant assurance following a quality
health check and recognised the value
and assurance provided by our right
staffing project.
b Revalidation
Revalidation is required by all nurses to
ensure that they remain fit to practice.
A new process is due to be tested by the
Nursing and Midwifery Council during
2015 and we have developed staff
appraisals to ensure that nursing staff are
able to provide the right kind of evidence
to support this.
Are you a nurse?
Make sure you know about revalidation!
Revalidation is a process that all nurses and midwives
will need to engage with to demonstrate that they
practise safely and effectively throughout their career.
All nurses and midwives are currently required to renew their registration
every three years. Revalidation will strengthen the renewal process by
introducing new requirements that focus on:
• up-to-date practice and professional development
•reflectionontheprofessionalstandardsofpracticeandbehaviouras
set out in the Code, and
• engagement in professional discussions with other registered nurses
or midwives
Make sure you know your renewal date and how you can prepare for
revalidation by visiting www.nmc.org.uk
b Safeguarding audit
Every year we are required to audit our
safeguarding processes. This year we
have focused on this important area of
work and are due to achieve all key
indicators during 2015/16. In particular we
have reviewed safeguarding training and
supervision opportunities for staff.
The key quality outcomes included:
• Wheelchair Service continues to
improve care for patients using
wheelchairs to reduce the risk of
developing pressure ulcers
RevalidationRollerBanner.indd 1
29/04/2015 11:35:40
• personalised care plan audit showed
100% of records evidenced care
planning was in place and partnership
working with the patient and carer
19
b Section 4
Quality assurance of the services we offer
Quality Account 2014 - 2015
standards for providers, which
incorporates the provision of a safe and
secure environment for patients, staff and
visitors and to protecting NHS property
and assets. It is the responsibility of the
organisation as a whole to ensure it
meets the required standards.
In July 2014 our compliance with these
standards was reviewed by NHS Protect
as part of the quality assurance
programme. The review considered
findings from an earlier inspection
conducted in October 2013. This review
graded the trust’s response to these
standards utilising a red, amber and
green rating. Overall the trust has been
rated as ‘Green’ for security management
with compliance evidenced in 29 of the
30 assessed standards.
b Trust Development Authority
with the TDA during 2014/15 to achieve
our ambition of becoming a foundation
trust. In March 2015 the TDA referred us
to Monitor for our final review and we aim
to become one of the first community
foundation trusts by September 2015.
This will provide us with more financial
flexibility and enable us to be more
innovative in our development of services.
The Trust Development Authority (TDA) is
the NHS body that supports aspiring NHS
foundation trusts. We have worked closely
‘‘
We appreciate
very much the
kind and efficient
treatment we
External assurance
b Care Quality Commission
The CQC regulates all health and adult
social care services in England. Through
inspections and information monitoring,
it ensures that essential common quality
standards are met. We are registered with
the CQC without exceptions.
In September 2014, we were inspected
by the CQC under their new inspection
framework. We were visited by 30
inspectors who spent time with all our
services for one week.
20
We are proud to have achieved a ‘Good’
rating across all areas. Our staff were
recognised as being caring, compassionate
and safe. Services were congratulated for
being effective and responsive to patient
needs and the organisation as a whole was
found to be well-led.
b Monitor Review
During the summer of 2014 our quality
governance arrangements were also
inspected by Monitor, the NHS financial
regulator. We were found to have good
quality governance arrangements in place.
receive and are
very thankful.
b Information Governance
In 2014/15 the trust maintained level 2
compliance with the national information
governance toolkit requirements.
b NHS Protect Audit
Providers of NHS services must put in
place and maintain appropriate counter
fraud and security management
arrangements. Those arrangements are
governed by a body called NHS Protect.
Podiatry
’’
NHS Protect has developed a national
strategy and a series of security
21
b Section 5
Bringing high quality services closer to home
Quality Account 2014 - 2015
b Integration
The challenge continues to grow as
Wirral’s health and social care system
faces further financial pressure moving
into 2015/16. The demand for services is
increasing as our population gets older
and more individuals experience complex
long term health conditions.
We have released a lot of efficiency
savings over the past few years, but we
now recognise that radical transformation
across all health and care organisations
is the only way that we will make the
saving required to deliver high quality
health and care support to the population
of Wirral in the future. The joint strategy
which supports this is Vision 2018.
b Vision 2018
Local leaders are working in partnership
to develop and implement the Vision 2018
strategy. This is aimed at providing better
outcomes for the people of Wirral through
integrated services which are run
efficiently and achieve high standards
of care.
We continue to support the
local NHS to reduce hospital
admissions and support early
discharge by providing high
quality, specialist services in
the community.
22
The programme also aims to work with
Wirral residents, empowering them to
manage their own health and wellbeing
needs through appropriate, accessible
information, use of technology, preventative
support and shared decision making.
b Integrated Care
Coordination Teams
professionals who are already involved in
the patient’s care.
This is a community based service aimed
at improving and coordinating care for
adults with a health and social care need
within the community.
The team’s assessment will consider
patient’s needs under a broad range of
headings eg mobility.
The aim of the Integrated Care
Coordination Teams (ICCT) is to provide
an integrated, responsive stepped
approach for both planned and
unplanned care at home which is both
person centred and responsive to an
individual’s health and social needs.
b Integrated Discharge Team
The development of the Integrated
Discharge Team underpins the health
economy objectives to improve quality,
productivity and prevention by using
whole system solutions and promoting
person centred approaches.
b Continuing healthcare
Continuing healthcare is a package of
care that is arranged and funded solely
by the NHS for individuals who are not in
hospital but have complex, ongoing
healthcare needs.
These needs are then given a weighting
marked priority, severe, high, moderate,
low or no needs.
If a patient has at least one priority need,
or severe needs in at least two areas, they
could be eligible for NHS continuing
healthcare. Patients may also be eligible
if they have a severe need in one area
plus a number of other needs, or a
number of high or moderate needs,
depending on their nature, intensity,
complexity or unpredictability.
In all cases, the overall need, and
interactions between needs, will be
taken into account, together with
evidence from risk assessments, in
deciding whether NHS continuing
healthcare should be provided.
The assessment takes into account the
patients views and the views of carers
they may have.
Assessments for continuing healthcare
are undertaken by a ‘multi-disciplinary’
team of health or social care
‘‘
As a family we have used the walk-in centre a
number of times and could not fault the service
received at any time. Staff are always friendly
and explain information to you. Brilliant facility.
Eastham Walk-in centre
’’
23
b Section 6
Volunteers and membership
Quality Account 2014 - 2015
b Work placements
In 2014/15 the trust provided 20
placements for students in year 12 and
13 during a three week period in June
and July and supported more throughout
the year.
Students enjoyed their placements and
found them valuable in helping identify
future careers, whilst staff have found it
very rewarding to take part.
“I could not have asked
for a more exciting,
enjoyable and invaluable
work experience than my
week with the Programme
Management Office”
“…many thanks for giving
me the opportunity to
show a school placement
what our trust is about”
We were delighted that our work
placement programme was included in
Health Education England’s Widening
Participation Directory of Best Practice
this year.
b Preparing for our Council
of Governors
As part of applying to become an NHS
foundation trust we are preparing to form
a Council of Governors. Foundation
trusts have more freedom to plan and
invest in services for the benefit of their
local population. Governors are elected
by public and staff members and
appointed by partner organisations. As a
group they represent the interests of local
people. The trust board becomes
accountable to them for its performance.
Once we enter the last stage of our
foundation trust application process we
will call elections for public and staff
governors. During 2014/15 we have been
informing people about what governors
do and the election process. We want as
many enthusiastic and committed people
as possible to stand for election.
We will support our new governors with
an induction and development
programme, making sure they have the
information and training they need to be
able to fulfil their new duties. We will
provide on-going support to our
governors. They will meet regularly to
make sure the trust is performing well and
planning to meet people’s needs.
Volunteers and
membership
b Members
Members are at the heart of our trust.
Being a member means finding out about
what’s going on and having the chance to
influence the development of your
community NHS trust. We have over
5,000 public members and all of our
permanent staff are members too.
Members engage with trust in many ways
and in the past year we have established
member involvement in groups such as
the Community Equality Panel, Medicines
Management Group and Practice
Research Steering Group.
24
In the coming year we plan to establish
a Patient Experience Group with trust
members and we expect, most
importantly, that all members get the
chance to vote for the people they
want to represent them in our Council
of Governors.
b Volunteers
We have continued to develop new
volunteer placements across the trust.
We now have volunteers in teams and
services including our Breastfeeding
Support Group and Speech &
Language Therapy.
We continue to work closely with our
allied charities: the League of Friends
and Wirral HeartBeat. Last year we
helped the League of Friends improve
the process by which trust services may
apply for funding and saw a massive
increase in the number of requests.
These were for items that aren’t paid for
from core NHS funding but enhance the
work of our teams.
This year the requests included a
demonstration skeleton and other items
of kit for physiotherapy and equipment
to support singing classes for the
Livewell service.
25
b Section 7
Objectives for 2015 - 2016
Quality Account 2014 - 2015
Our Vision:
To be the outstanding provider of high quality, integrated care to the communities we serve.
Our quality statements:
Our patients:
Our people:
Our services:
Our sustainability:
We protect people from
avoidable harm
We value and listen to
our staff
We deliver clinical
excellence
We are a sustainable
organisation
We will identify and provide
appropriate care for all patients aged
75 diagnosed with dementia following
an episode of emergency unplanned
care.
We will ensure that 95% of staff
complete mandatory training during
2015/16.
We will identify the best model(s) for
effectively managing the single point
of access with the aim of reducing
avoidable admissions to acute care.
95% of staff will have their Appraisal
May – July 2015.
We will reduce avoidable grade 3 & 4
pressure ulcers acquired during our
care.
95% of patients will be seen within 30
minutes for initial assessment within
our walk in centres.
We will achieve a friends and family
test score of 85%.
We will achieve 4.0% staff sickness
levels or below.
We will increase the percentage of
staff who would recommend Wirral
Community NHS Trust as a place to
work / receive treatment as measured
by the NHS national survey.
We will develop and implement a
Wirral wide integrated therapies
pathway to expedite safe, timely
discharge and prevent avoidable
admission to hospital care.
We will achieve foundation trust
status during 2015/16.
We will reduce the proportion of
avoidable emergency admissions to
hospital by working in partnership to
plan safe out of hospital care.
We will support a minimum of four
innovation projects via our clinical
innovation fund.
All clinical staff in our 0-19 service will
receive safeguarding supervision in
accordance with the Safeguarding
Supervision Policy.
We will improve the rating achieved
within our Information Governance
Toolkit submission year on year.
We will use staff ideas to help us
reduce waste and become more
cost effective.
We will ensure that daily nursing
staffing levels and skill mix against
assessed patient acuity levels are
maintained at 95% of the required
fill rate.
Underpinning Governance and Assurance
26
27
b Section 8
Supporting statement from Healthwatch Wirral
Supporting statement from
Healthwatch Wirral
Healthwatch Wirral (HW) would like to
thank Wirral Community NHS Trust for the
opportunity to comment on the Quality
Account for 2014/15. The HW Quality
Account sub group met on 14th May
2015 to compile this response.
• the trust has exceeded its target in
completed clinical audits
Priorities for 2015/16
• the trust achieved a ‘Good’ rating in
their CQC inspection
The 6 priorities were noted and HW would
welcome more detail particularly in the
integrated therapy services and how they
would benefit patients.
HW looks forward to receiving the quarterly
reviews on progress against these
priorities.
Review of Performance in 2014/15
It was positive to note that:
• the trust is using their right staffing
project to enable them to work out how
many community nurses are needed to
deliver a safe, caring service to the
housebound population. In addition, the
trust can now determinate the right level
of staffing in walk in centres based on
the number of people they estimate
might need the service each day. HW
acknowledges that the trust has made
great progress in establishing the right
levels of staffing across many of the
services and have met all of the project
milestones but would welcome further
detail about the milestones achieved
and the timescale of the project.
• 95% of staff felt confident about raising
concerns, which is consistent with an
open and honest culture
• there was decrease to 4.2% in sickness
absence during the year
• the trust have consistently scored more
than 88% in the Friends and Family Test
when patients are asked whether they
would recommend the service to family
and friends
• the number of completed patient
experience questionnaires have
increased and a questionnaire for
children, young people and people who
have a disability has been developed
28
• the harm free care target has been
exceeded
• the Continuous Quality Improvement
Programme has been implemented
HW would welcome more information on
the Integrated and Coordinated Care
teams. Also, of interest would be the
impact on reducing avoidable admissions
to hospital along with details of outcome
measures that the trust will monitor
against.
ulcers, identifying the need for new
technology to improve assessments and
treatment options for patients with leg
ulcers and the production of a patient
information leaflet on falls prevention.
Other measures of internal assurance were
noted including audits on Safeguarding,
Infection control and the Mersey Internal
Audit Agency (MIAA) which tests how
good the trust governance processes are.
The trust were given a rating of significant
assurance from MIAA.
HW look forward to receiving reviews on
these audits and the achievement of key
indicators.
The trust should be congratulated on
achieving 100% of staff having an annual
appraisal and development plan, including
supporting staff to access academic
modules. The trust is also delivering
dementia awareness training.
Quality assurance -external
HW were pleased to note the trust’s
successful bid for some key services and
look forward to hearing how these are
progressing.
Overall, the Quality Account was positive,
however, HW had concerns about the
increase of significant untoward incidents
reported and in particular the reporting of 1
Never Event. HW would recommend that
the trust should continue using a robust
learning process which includes Root
Cause Analysis.
The trusts Quality Statements were noted
and HW looks forward to receiving reviews
on their progress.
Quality assurance -internal
The Frontline Focus visits were noted
which have resulted in improvements in
the provision of patient support information
and patient privacy in clinic areas.
HW would welcome the opportunity to
participate in future visits.
It was pleasing to note that the trust had
exceeded their objective to complete 95%
of clinical audits which resulted in key
quality outcomes. These included
improving care for wheelchair users to
reduce the risk of developing pressure
The Care Quality Commission inspected
the trust in September 2014 and HW were
pleased to note that the trust were
awarded a ‘Good’ rating and that staff
were recognised as being caring.
HW has enjoyed working alongside the
community trust as it recognises the value
in our relationship and has utilised the
functions, duties and powers of HW to
provide challenge and assurances. HW
appreciates the opportunity to comment
on the report as a “critical friend” and we
look forward to working with the trust to
support the implementation of the Quality
Account and strategic plans.
Statement from Clinical Commissioning Group
Section 9 b
Supporting statement
from Wirral Clinical
Commissioning Group
As lead commissioner Wirral CCG is
committed to commissioning high quality
services from Wirral Community NHS
Trust. We take very seriously our
responsibility to ensure that patients’
needs are met by the provision of safe,
high quality services and that the views
and expectations of patients and the
public are listened and acted upon
This account reflects quality performance
in 2014/15 and clearly sets out the
direction regarding quality for the 2015/16.
We acknowledge and congratulate the
community trust on their achievements
over the past year in achieving the
objectives set and the rating of ‘good’
following the comprehensive review of all
services by the Care Quality Commission
in September 2014.
Our patients and communities:
We note that there has been a ‘never
event’ reported in 2014/15. This was due
to wrong site surgery. A root cause
analysis has been undertaken to identify
causal factors and lessons learnt. The
trust is to be commended on being an
earlier implementer of the Friends and
Family test ahead of national guidance
and for consistently scoring above 88%
for the services delivered.
Our services:
We commend the trust on the use
different ways to gain insight into the
quality of care that is being delivered by
practitioners. This includes the front line
focus visits to services. We acknowledge
the work the trust has undertaken in
relation to pressure ulcers and in view of
this have achieved 96% against the NHS
safety thermometer standards of harm
free care.
Our people:
In order to deliver high quality services,
the induction and training of staff is of
paramount importance. Whilst we
acknowledge the achievement in local
induction for staff, improvement needs to
be made in relation to attendance at
corporate induction. This was not
achieved in 2013/14.
It is noted that the staff sickness levels
are at 4.9% which is higher than the
national average and an increase in last
year. We acknowledge the increase in
flu vaccination and performance
benchmarked against other comparable
organisations; however the local target set
has not been achieved. We acknowledge
that the trust will strive to improve this in
2015/16 and this will be monitored by the
CCG throughout the contracting year.
Looking forward in 2015/16, the CCG is
reassured that the priorities for improving
quality that have been identified by the
trust are priorities for the CCG including:
• Identify and support people with
dementias
• Reduce avoidable admission to
hospital
• Integration of therapy service
• Reduce avoidable grade 3 and 4
pressure ulcers acquired during care
• Achieve 4.0% staff
We believe that this quality account gives
a high profile to continuous quality
improvements in Wirral Community NHS
Trust and the monitoring of the priorities
for 2015/16. Wirral Clinical Commissioning
Group looks forward to continuing to work
in partnership with the Trust to assure the
quality of services commissioned over the
forthcoming year.
Pete Naylor
Wirral CCG
Karen Prior
Healthwatch Wirral Manager
On behalf of Healthwatch Wirral
29
b Section 10 Statement from Local Authority
Our services b
Statement of support Wirral Council
The Families and Wellbeing Policy and
Performance Committee undertake the
health scrutiny function at Wirral Council.
The Committee has established a Panel of
Members (the Health and Care
Performance Panel) to undertake on-going
scrutiny of performance issues relating to
the health and care sector. Members of the
Panel met on 12th May 2015 to consider
the draft Quality Account and received a
verbal presentation on the contents of the
document. Members would like to thank
Wirral Community NHS Trust for the
opportunity to comment on the Quality
Account 2014/15. Panel Members look
forward to working in partnership with the
trust during the forthcoming year.
Members provide the following comments:
above 88% when patients are asked if they
would recommend the trust’s services to
friends and family. This outcome is
welcomed by Members and demonstrates
the quality of services provided by the
trust.
Overview
Our people
Members acknowledge the excellent
performance of the trust as measured
against the targets for 2014/15. The
performance of the trust was confirmed
during the year by the overall rating of
‘Good’ being achieved following the
comprehensive review carried out by
the Care Quality Commission (CQC) in
September 2014.
Staff Friends and Family Test
The Members welcome the layout of the
Quality Account and the clarity with which
the information was presented to them.
Members also support the priorities
selected for improvement for 2015/16.
Section 2 Performance Overview
2014/15
2014/15 resulted in an increase in the
number of reported Serious Untoward
Incidents ( to 19). However, it is
acknowledged that this is partly explained
by the trust aiming to more openly report
incidents and encourage such reporting.
The trust’s approach of “staff being
supported; not blamed” is to be
applauded.
It is very welcome that Wirral Community
NHS Trust ranked top of all community
trusts for the percentage of staff who
would recommend their trust to friends or
family for care or treatment. In addition, the
trust was ranked in the top 5 community
trusts in the country for the percentage of
staff who would recommend their trust as
a place to work.
While recognising the trust’s reputation as
a good employer, Members have noted
the potential national issue regarding the
recruitment of community nurses and will
be interested in monitoring progress in
2015/16.
Our patients and communities
Concerns raised by staff
Annual staff appraisal and development
plans
In the context of the Francis Report and
other national reports, it is important to
note that almost all staff feel confident and
able to raise concerns about patient safety
and effectiveness of care. This is
reassuring and is a comment upon the
culture which the Trust actively tries to
engender.
Members note the high priority which the
Trust clearly places on staff and their
training. Achieving 100% of all staff having
an appraisal and development plan is
noteworthy.
Friends and Family Test
Against a target score of 80%, the trust has
reported that it has consistently scored
30
Serious Untoward Incidents / Never
Events
Our sustainability
Funding stream for innovation and
research
During 2014/15, the trust developed an
innovation fund open to all staff to apply
for grants of up to £5000 to implement
clinical innovations within the service area.
It is also noted that the continuation and
expansion of the scheme is identified as a
priority for 2015/16. This approach to the
empowerment of front-line staff is
welcomed by Members.
Section 5 Bringing high quality
services closer to home
With regards to future planning, the
emphasis and commitment placed on
service integration and the Vision 2018
programme is welcomed by Members.
Section 7 Objectives for 2015/16
In general, Members support the priorities
selected for improvement for 2015/16. In
particular, the increased emphasis towards
reducing avoidable grade 3 and 4
pressure ulcers acquired during care is
welcomed.
In the response to last year’s Quality
Account, Members welcomed the work
that was being developed by the trust to
support care homes to develop improved
care for residents, in particular with regard
to pressure ulcers. Members trust that this
initiative will continue.
I hope that these comments are useful.
Councillor Moira McLaughlin
Chair, Health and Care Performance
Panel and
Deputy Chair, Families and Wellbeing
Policy & Performance Committee
b 0 - 19 Health and Wellbeing Service
b Ophthalmology (eye care)
b 24 Hour Community Nursing Service
b Palliative Care (specialised care for serious illness)
b Centralised Booking
b Parkinson’s Disease
b Community Discharge and Liaison
b Phlebotomy (blood tests)
b Rehabilitation at Home Service
b Physiotherapy & Rehabilitation
b Continence
b Podiatry (foot care)
b Deep Vein Thrombosis (blood clots)
b Sexual Health Wirral
b GP Out Of Hours
b Single Point of Access (referral service)
b GP Practices
b Specialised Dental Services
b Heart Support
b Speech & Language Therapy
b Infant Feeding
b Tissue Viability (skin care)
b Livewell Programme (healthy lifestyles)
b Walk-in Centres (Eastham, Wallasey and the All Day
b Health Centre at Arrowe Park)
b Minor Injuries Unit
b Nutrition & Dietetics
b Wheelchair Service
Support Services
Infection Prevention & Control, Quality & Governance and Safeguarding.
Communications & Marketing, Estates Management, Finance, Human Resources, Business Intelligence and
Information Technology.
Staff sickness rates
Members note that, although the target for
staff sickness in 2014/15 was 4.2%, the
actual rate for the trust was 4.9%. However,
it is also noted that a more difficult target
of 4.0% has been adopted for 2015/16.
31