Welcome to 2gether NHS
Foundation Trust’s Quality
Report for 2012/13.
The purpose of a Quality Report
is to ensure Trust Boards focus on
quality improvement as a core
function of the organisation.
In this section
3
Statement on Quality from the
Chief Executive
5
Looking ahead to 2013/14
9
Statements relating to the
Quality of the NHS services
provided
17
Looking Back: A review of
Quality in 2012/13
39
Statements from our Partners
on the Quality Report
45
Statement of Directors’
Responsibilities in respect of
the Quality Report
49
Independent Auditor’s Report to
the Council of Governors on the
Quality Report
Part 1. Statement on Quality from the Chief Executive
Introduction
Quality Initiatives 2012/13
Quality Initiatives 2013/14
3
3
3
Part 2a. Looking ahead to 2013/14
Priorities for Improvement 2013/14
5
Part 2b. Statements relating to the Quality of NHS Services Provided
Review of Services
Participation in Clinical Audits and National Confidential Enquiries
Participation in Clinical Research
Use of the CQUIN payment framework
Statements from the Care Quality Commission
Quality of Data
9
10
11
12
15
16
Part 3. Looking Back: A Review of Quality in 2011/12
Priorities for Improvement 2012/13
Domain 1: Preventing people from dying prematurely
Domain 2: Enhancing quality of life for people with long-term conditions
Domain 3: Helping people to recover from episodes of ill health or following injury
Domain 4: Ensuring people have a positive experience of care
Domain 5: Treating and caring for people in a safe environment and protecting them from avoidable harm
Summary Report on Quality Measures for 2012/13
Monitor Indicators and Thresholds for 2012/13
Quality Indicators for 2012/13
Community Survey 2012
Staff Survey 2012
PEAT Assessment Results 2011/12
17
18
18
20
22
27
31
33
33
36
37
38
Annex 1. Statements from our Partners on the Quality Account
Gloucestershire Health, Community and Care Overview and Scrutiny Committee
Herefordshire Health, Community and Care Overview and Scrutiny Committee
Gloucestershire Local Involvement Network
Healthwatch Herefordshire
Gloucestershire Clinical Comissioning Group
Herefordshire Clinical Comissioning Group
The Royal College of Psychiatrists
39
39
40
41
42
43
43
Annex 2. Statement of Directors’ Responsibilities in respect of the Quality Report
45
Annex 3. Glossary
46
Annex 4. How to contact us
2
Other Comments, Concerns, Complaints and Compliments
Alternative Formats
48
48
Independent Auditor’s Report to the Council of Governors on the Quality Report
49
Part 1. Statement on Quality from the Chief Executive
Against a backdrop initially of uncertainty and
subsequently of knowledge that we would cease being the
preferred provider, our practitioners maintained high
standards of provision throughout the year delivering some
of the best outcomes across the South West of England.
From December onwards practitioners worked extremely
hard to continue to deliver services and ensure a safe
transfer of care to the new provider. This was achieved
and we ceased service provision from the end of March
2013.
Quality Initiatives 2013/14
Introduction
Once again on behalf of the Board and all colleagues
within 2gether NHS Foundation Trust it is my pleasure to
present our annual Quality Report. As always, this report
is a combination of the collective efforts of many clinical
and managerial colleagues across the Trust.
Our Quality Report last year identified 24 goals and 34
targets across the five domains of quality as detailed in the
2012/13 NHS Operating Framework and NHS Outcomes
Framework. Following feedback from service users,
carers, our commissioners and LINks, we have
streamlined our objectives for 2013/14 into 11 goals and
12 targets.
In part 2 of this report you will find those detailed goals and
targets - these are the further improvements we have
planned for 2013/14. In part 3 you will read how we did
against the plans we set out to achieve in our Quality
Report last year.
Quality Initiatives 2012/13
Whilst 2012/13 has been a challenging year, our frontline
staff backed by our support services have once again
continued to deliver improvements in the quality of
services we provide.
Significant progress was made on the 24 goals and 34
targets we set ourselves, with 24 targets achieved.
Progress on the ten targets which were not fully achieved
is detailed within the report.
We have been privileged to have had the opportunity to
provide the full range of a prison Healthcare service into
HMP Gloucester. Our team of dedicated and skilled
practitioners were acknowledged during a Care Quality
Commission (CQC) visit to the prison for their excellent
work. HMP Gloucester was one of the seven prisons
chosen for closure under the reconfiguration plans by the
Ministry of Justice and the service provision ceased at the
end of the 2012/13 financial year.
In June 2012, Gloucestershire Substance Misuse Services
were tendered by commissioners. We were unsuccessful
at tender and service contracts were awarded to Turning
Point.
This theme of continuous improvements will continue into
2013/14 and is supported by further investment in our
inpatient units and our community bases. It will also be
evident in the ongoing professional development and
increased number of permanent staff working within our
working age adult inpatient services.
As we commence 2013/14, our focus is clear: to work ever
closer with service users, carers, commissioners and staff
to understand the quality indicators that matter most to
them. As a provider organisation we only exist to serve
service users and carers.
They are experts by experience and throughout the year,
much of our learning and subsequent improvements have
come from their involvement in service planning and
evaluation. We are indebted to their continued support.
"Health outcomes matter to patients and the
public. Measuring and publishing information on
health outcomes are important for encouraging
improvements in quality".
During 2013/14 we will implement ways to help make sure
that our adult service users have the opportunity to
describe the impact of the interventions they received by
completing nationally recognised outcome measures.
This will help us to continually understand, from their
perspective, the usefulness of the interventions provided
and enable us to make any necessary adjustments.
It is essential that when individual’s access services that
they are as safe as possible. We will build upon the
learning from our involvement in the South of England
Improving Safety in Mental Health Programme to
implement change using reliable improvement
technologies.
The Francis Report and the failings at Winterbourne View
have raised question of confidence in the overall care and
support system.
Every health and social care practitioner, every manager
and every Board member must think carefully about the
recommendations that have emerged from the lessons
from both of these reports to ensure that they have
confidence in the local services they provide and access.
3
Our clinical leadership is leading our organisational
self-reflection and action planning to ensure that we can
give everyone confidence, that locally, we have a culture
that is conducive to ensure the quality of care we provide
and that if concerns arise, that there are effective methods
of raising these and that they are acted upon.
Our clinicians are highly qualified and experienced. They
are trained to critically appraise and utilise emerging
evidence on effectiveness, to adopt and adapt best
practice and to personalise what they do for the unique
circumstances of the individual they are supporting with
care and compassion. These attributes will be pivotal in
embracing the changes ahead of us effectively.
Following the introduction of a Carers Charter in 2011, this
year service users and clinicians collaborated together to
develop our Service User Charter.
The charter was launched on World Mental Health Day in
October and together with our Carers Charter is a
statement of the positive intent to place service users and
carers at the centre of everything we do, on every
occasion.
Overall, the primary goal to which we aspire is to ensure
that individuals in our care are safe, obtain the best
possible outcomes and when in receipt of services have
the experience that we would all wish for a member of our
family.
As we have stated in previous years our name is a
statement of intent; to work together with others.
Throughout the year we have benefited from feedback,
collaborative discussions, suggestions and challenges
from our partners in commissioning, LiNks and shadow
Healthwatch as well as other provider organisation
colleagues.
We are proud to be a part of the NHS. We are also proud
that as a Public Interest Corporation we are a membership
organisation. Our 7,000 members elect a Council of
Governors who play a vital role in ensuring our
accountability and connectivity to our local communities in
which we serve.
We are indebted to our Governors who have given freely
of their time energy and skills to assure themselves on
behalf of our communities that the quality of services
provided is of an appropriate standard.
In the coming year, the Trust Board will continue to focus
our energy and expertise on ensuring that we consistently
deliver and improve the services we provide. This is what
our service users and carers deserve; this is what we will
work with them and our commissioners to achieve.
Shaun Clee
Chief Executive
2
gether NHS Foundation Trust
4
Part 2a. Looking ahead to 2013/14
This section of the report looks ahead to our priorities for
quality improvement in 2013/14. We have developed our
quality priorities for improvement against the five quality
areas described in the NHS Outcomes Framework
2013/14.
These areas sit under the three key dimensions of
effectiveness; user experience and safety and have been
approved by the Trust Board following discussions with our
key stakeholders. We are aiming to improve outcomes for
service users through these actions being mindful that a
key national priority is:
“Health outcomes matter to patients and the public.
Measuring and publishing information on health outcomes
are important for encouraging improvements in quality”
NHS Outcomes Framework 2013/14
Following feedback from service users, carers, our
commissioners and LINks, we have streamlined our
objectives for 2013/14 into 11 goals and 12 targets.
Outcomes will be measured and monitored with the period
of time varying from monthly, quarterly or annually
depending what we are measuring and how often the data
is collected.
How we prioritised our quality improvement
initiatives
The quality improvements in each area were chosen by
considering the requirements and recommendations from
the following sources:
Documents/Organisations:
• NHS Commissioning Board (Everyone Counts: Planning
for Patients 2013/14)
• The Francis Inquiry (February 2013)
• Care Quality Commission (via the Quality Risk Profile
and CQC Compliance Reviews at our sites)
• Department of Health, with specific reference to ‘No
health, without mental health (2011)
• Internal inspections
• Monitor
• King’s Fund report on Quality Accounts
• National Institute for Health & Care Excellence
publications including their quality standards
We strongly value working in partnership and have had
feedback on our services during 2012/13 which has
informed our choice of quality improvement initiatives for
this coming year. The feedback and contributions have
come from:
• Gloucestershire Local Involvement Network (LINk)
• Herefordshire Local Involvement Network (LINk)
• Gloucestershire Health, Community and Care Overview
and Scrutiny Committee (HCCOSC) and Council
colleagues
• Herefordshire Overview and Scrutiny Committee and
Council colleagues
• NHS Gloucestershire and the shadow Clinical
Commissioning Group
• NHS Herefordshire and the shadow Clinical
Commissioning Group
• Internal audits
• South West Mental Health Patient Safety Improvement
Programme
• Trust’s Service Experience Committee (comprising of
service users and carers)
• Trust’s Governors
• Trust clinicians and managers
The proposed quality initiatives were then considered and
agreed by the Governance Committee, which is a
sub-committee of the Board and has clinical and
managerial representation from across the Trust and is
chaired by a Non-Executive Director. This Committee
meets formally monthly to consider information relating to
quality across all of the services we provide.
The priorities for improvement are applicable for services
in both Gloucestershire and Herefordshire unless
specified, and where they are different it is a reflection of
the different quality priorities in each county.
5
Progress on the implementation of each of the quality
improvement areas will continue to be reported to the Trust
Board every quarter. This information will also be shared
with our major stakeholders.
These targets represent a small sample of the large
number of quality initiatives which are undertaken, but are
areas which will potentially have a significant impact on
safety and quality.
In terms of wider initiatives, the Trust remains an active
participant in the South of England Patient Safety
Improvement Programme for mental health providers and
has challenging CQUIN targets in both counties.
The Trust has also reviewed the recommendations from
the Francis Report into the Mid Staffordshire Trust and
identified areas where we have good assurance and
issues we plan to focus on for further work.
A group of senior clinicians has met to draw up a plan of
actions and areas of work and these will be communicated
to staff in a series of road shows which will also provide an
opportunity for staff to give feedback and make their own
suggestions.
This alongside our service experience work will hopefully
make the organisation more aware of what it is like to work
in the Trust or to receive services.
Domain 1: Preventing people from dying prematurely
Ensuring that premature death in people with serious mental illness and learning difficulties is reduced remains a key
priority; we will carry out the following activities:
Goal
Target
Drivers
Minimise the risk of
suicide of people who use
our services
1.1
Reduce the numbers of deaths relating to
identified risk factors of people in contact with
services when compared data from previous
years.
National strategy of zero
tolerance of preventable harm
Gloucestershire Suicide
Prevention Strategy and Action
Plan
Herefordshire Public Health
Report
6
Ensure we follow people
up when they leave our
inpatient units within 48
hours to reduce risk of
harm.
1.2
95% of adults will be followed up by our
services within 48 hours of discharge from
psychiatric inpatient care
Improve the physical
health of patients with
mental health problems
1.3
70% of community patients with a serious
mental illness will have had an annual physical
health check
(This is a local target. The national target is
that 95% CPA service users receive follow up
within 7 days)
Local and national priorities
Our local target of 95% was
not met consistently during
2012-13
People with schizophrenia and
bipolar disorder die on average
25 years earlier than the general
population largely because of
physical health problems.
Domain 2: Enhancing quality of life for people with long term conditions
We will continue to focus on outcomes that are important to those living with long-term conditions. The way we will carry
out this objective will be to focus improvements upon the following:
Goal
Target
Drivers
Improve the experience of
people with dementia in
Gloucestershire and
Herefordshire
2.1
Improved access to dementia services for
Black & Ethnic minority communities through
training an agreed number of staff. 70% of an
identified group of registered staff will receive
this training. (Gloucestershire).
Prime Minister’s Dementia
Challenge (2012) - enhancing
the quality of life for people
with dementia.
2.2
Ensure appropriate and timely reviews of
prescribed antipsychotic medication for people
with dementia living in a care home through
three monthly reviews, providing demonstrable
evidence of improvement during Quarter 4.
(Herefordshire)
People will feedback to us
whether the service they
have received has
improved their quality of
life.
2.3
90% of adults in contact with services will
describe the impact of interventions on their
discharge through the completion of nationally
recognised outcome measures
Children and Young
Peoples Services will use
mechanisms to gain
feedback on whether the
service has improved
their quality of life.
2.4
Report on improved outcomes of those who
use the service
Improve the effectiveness of
interventions offered by the
Trust
Implementation of the new
National Children’s Improving
Access to Psychological
Therapy
Local priority for Herefordshire
to improve services
Domain 3: Helping people to recover from episodes of ill health or following injury
Central to the service we provide is achieving the best possible outcomes for people who develop treatable conditions.
Specifically, we need to help people recover from illness or injury and prevent conditions from becoming more serious.
Actions that will be taken to support this objective include:
Goal
Target
Drivers
Ensure appropriate
access to psychiatric
inpatient care
3.1
95% of people will be seen by the Crisis and
Home Treatment Team prior to admission, to
ensure appropriate access to inpatients
services.
Department of Health
Outcomes Framework - key
measure on appropriate
access
7
Domain 4: Ensuring people have a positive experience of care
Quality of care includes the quality of caring. This means how personal care is provided; the compassion, dignity and
respect with which service users are treated, and the extent to which they are given the level of comfort, information and
support they require.
The Trust is implementing the 6Cs (National Nursing Strategy 2012) throughout the organisation. In our quarterly reports
we will report on our development work in this area as well as focusing upon equality and diversity work and partnership
working with voluntary agencies in both counties.
Goal
Target
Improve service user
experience
4.1
Undertake local surveys of both community
and inpatient services by asking the following
questions and improve on our 2012/13 scores.
• Did you have enough time to discuss your
condition, treatment and care? (72%)
• Did you find talking with a member of your
care team helpful? (49%)
• Did we involve your family and carers as
much as you would like? (50%)
• Has your mental health care service helped
you start achieving your treatment goals?
(54%)
Improve carer experience
4.2
Ensure that 100% of carers are offered
assessments
Drivers
We have identified these
questions as they were areas
where we achieved a lower
score in the 2012/13 national
Community Patient Survey
Implementation of Trust’s
Carers Charter
Domain 5: Treating and caring for people in a safe environment and protecting them from avoidable harm
Protecting service users from further harm whilst they are in our care is a fundamental requirement. We seek to ensure a
safe environment for service users, staff and everyone else that comes into contact with us. We will achieve this by the
following:
Goal
Target
Drivers
Minimise the risk of harm
to people who use our
services
5.1
To reduce the number of serious incidents as
a proportion of patients on the trust’s caseload
to an annual average of 0.2 incidents per 1000
caseload.
National driver of zero
tolerance of preventable harm
for people who use NHS
services
(Patient harm serious incidents are reported
nationally e.g. pressure ulcers, severe selfharm incidents )
NHS Safety Programme
Ensure the safety of
patients detained under
the Mental Health Act
8
5.2
Reduce the number of patients who are absent
without leave from inpatient units who are
formally detained by 50%. Baseline to be
established and confirmed in Quarter 1 2013
NHS Safety Programme
Part 2b. Statements relating to the Quality of NHS Services Provided
The following section includes responses to a nationally defined set of statements which are common across all Quality
Reports. The statements provide assurance that we are providing services according to national standards, measuring
and monitoring the quality of care we provide and are participating in and learning from
national projects.
Review of
Services
The purpose of this section of the report is to ensure we
have considered the quality of care across all our services
which we undertake through comprehensive reports on all
services to the Governance Committee (a sub-committee
of the Board).
During 2012/2013, the 2gether NHS Foundation Trust
provided and/or sub-contracted the following NHS
services:
Gloucestershire
Our services are delivered through multidisciplinary and
specialist teams. They are:
• One stop teams providing care to adults with mental
health problems and those with a learning disability
• Primary Mental Health Care services
• Specialist services including Early Intervention, Crisis
Resolution and Home Treatment, Assertive Outreach,
Managing Memory, *Prison healthcare, *Substance
Misuse and Children and Young People Services
• Inpatient care
• Improving Access to Psychological Therapies
*Following the closure of HMP Gloucester, the Prison
Healthcare service ceased to be a service that we
provided from 31 March 2013. Also the Substance Misuse
Services were transferred to Turning Point from 1 April
2013 following a tendering process by NHS
Gloucestershire.
Herefordshire
We provide a comprehensive range of integrated mental
health and social care services across the county. Our
services include:
• Children and Adolescent Mental Health care
• Specialist services including Early Intervention, Assertive
Outreach and Crisis Resolution and Home Treatment
and Substance Misuse Services
• Inpatient care
• Improving Access to Psychological Therapies
South Gloucestershire
During 2012/13, we provided Improving Access to
Psychological Therapies services until October 2012.
gether NHS Foundation Trust has reviewed all the data
available to them on the quality of care in all of these NHS
services through a systematic plan of quality reporting and
assurance that is considered by the Trust’s Governance
Committee and the Board.
2
The income generated by the NHS services reviewed in
2012/13 represents 94.9% of the total income generated
from the provision of NHS services by the 2gether NHS
Foundation Trust for 2011/12.
Participation in Clinical Audits and National
Confidential Enquiries
During 2012/13, two national clinical audits and four
national confidential enquiries covered NHS services that
2
gether NHS Foundation Trust provides.
During that period, 2gether NHS Foundation Trust
participated in 50% national clinical audits and 100%
confidential enquiries of the national clinical audits and
national confidential enquiries which we were eligible to
participate in.
• providing care to adults with mental health problems in
Recovery Teams and Older People’s teams
9
The national clinical audits and national confidential enquiries that 2gether NHS Foundation Trust was eligible and
participated in during 2012/13 are as follows:
National Clinical Audits
Clinical Audits
Participated - Yes/No
National Audit of
Psychological Therapies
Yes
Prescribing Observatory
for Mental Health
No
Reason for no participation
Voluntary involvement. The Trust was
not a member in 2012-2013
membership period
National Confidential Enquiries
National Confidential Enquiries
Participated - Yes/No
Confidential Enquiry into
Maternal and Child Health
Yes
National Confidential Inquiry
into Suicide and Homicide by
People with Mental Illness
Yes
Sudden Unexplained Death of
Psychiatric Inpatients Study
Yes
Confidential Inquiry into the
Premature Deaths of People
with a Learning Disability
Yes
Reason for no participation
The national clinical audits and national confidential enquiries that 2gether NHS Foundation Trust participated in, and for
which data collection was completed during 2012/13 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.
Clinical Audits
No of cases requested
No of cases submitted
All
Not known
Confidential Enquiry into
Maternal and Child Health
Not
Available
Not
Available
Not Available
National Confidential Inquiry into
into Suicide and Homicide by
People with Mental Illness
Not
Available
Not
Available
98.45%
Sudden Unexplained Death of
Psychiatric Inpatients Study
Not
Available
Not
Available
98.31%
Confidential Inquiry into the
Premature Deaths of People
with a Learning Disability
Not
Available
Not
Available
Not Available
National Audit of Psychological
Therapies
% cases submitted
Report not available.
Confidential Enquiries
The report for the National Audit of Psychological Therapies has not yet been issued and will be available in October 2013.
10
The participation in these national audits and enquiries
demonstrates that as an organisation we want to learn and
benchmark our care against other providers to the benefit
of the people who use our services. As a result of
participating in the national audits we are:
Participation in Clinical Research
• Ensuring an increased focus on the physical health of
people diagnosed with schizophrenia
• Reviewing how more people can access psychological
therapy services through our Improving Access to
Psychological Therapy service
• Providing maternal mental health services according to
agreed countywide pathways of care
Throughout the last twelve months, we have continued to
support the recruitment of service users and staff into
research approved by an NHS research ethics committee.
During 2012/13 the Trust took part in the audit of
schizophrenia lead nationally by Rethink. The Trust also
participated in the first round of the National Audit of
Schizophrenia in autumn 2011, the final report of which
was published in April 2012. 2gether NHS Foundation Trust
is already enlisted to take part in the second round of this
audit due to take place during 2013/14.
Clinical audits of our services
Within our services there is a high level of clinical
participation in local clinical audits, demonstrating our
commitment to quality across the organisation. All clinically
led local audits are reported to the Governance Committee
in summary form to ensure that actions are taken forward
and learning is shared widely.
During 2012/13, 83 local clinical audits were completed
within the Trust. During this process we internally identified
581 recommendations to further improve our practice as
part of our commitment to continuous improvement. A
further 17 audits were commenced during 2012/13 and are
due to be completed early in 2013/14.
An extract from one of our internal audits regarding
compliance with the Falls Care Pathway (written
incorporating the NICE guidance CG21) identified the
following:
All inpatients in older people services and learning
disability services over the age of 40 were included in the
audit. In total 45 inpatients were identified and of the 16
criteria the following scores were identified:
•
•
•
•
6 (38%) scored 95-100% compliance
2 (13%) scored 90-94% compliance
7 (43%) scored 80-89% compliance
1 (6%) scored 70-79% compliance
Overall score 91% Compliance
The audit showed that the Falls risk assessment is
routinely covered on admission or as part of the Trust initial
assessment and all those assessed as being at risk are
being referred for physiotherapy treatment.
The areas which scored lower included:
• Osteoporosis risk
• Visual impairment
• Home hazard assessment
From the audit findings, recommendations were made to
further improve quality and patient experience within this
area.
It is important that we report on our participation in
research reflecting our commitment to continuously
improve the quality of services that we provide.
During 2012/13, there were 242 people recruited (data
from the Western Comprehensive Local Research Network
- WCLRN). The number has decreased from last year (315
recruits) reflecting that there are less recruiting studies on
the National Institute for Health Research (NIHR) portfolio,
and greater competition.
The Trust currently has a total of 62 registered and
approved studies in Gloucestershire which includes a mix
of clinical and commercial trials, confidential inquiries,
service evaluations and student research. Of these
studies, 40 were clinical research based in mental health
or dementia during 2012/13, with the addition of 22 service
evaluation or student research projects initiated and
co-ordinated by Trust staff or students.
We continue to participate in research that fits with the
Trust core values, which means we are focusing closely on
research studies that align with our continuing
commitment to improving the quality of care we offer and
to making our contribution to wider health improvement.
Service change within Herefordshire has meant that active
research did not take place during 2012-13 but
preparations were made to ensure that research activity
can begin during 2013-14.
Research Sponsors
At the close of 2012/13, we have 28 approved NIHR
studies recruiting or active in Gloucestershire. Of these,
17 studies are sponsored by Universities, seven sponsors
are from the pharmaceutical industry, two are other NHS
Trusts and two are charitable organisations such as the
Medical Research Council.
This highlights the need for NHS organisations, such as
ours, to build strong academic links with those Universities
who are research active in mental health in order to help
build links for site selection.
Examples of the breadth of our research portfolio of activity
are listed below.
Mental Health
• ECHO: Expert Carers Helping Others – a randomised
controlled trial of a carer intervention for those with an
eating disorder
• N-Alive Pilot: NALoxone InVEstigation Prison-based
Naloxone-on-release pilot randomised controlled
prevention trial: to demonstrate feasibility by recruiting
first tenth of 56,000 participants needed to quantify
reduction in drugs-related deaths soon after release
• DPIM Polymorphisms in Mental Illness: investigating
genetic factors involved in schizophrenia, bipolar
disorder, alcoholism and autism and exploring possible
treatment options
11
• National Confidential Inquiry into Suicide and Homicide
by People with Mental Illness
• Confidential Inquiry into premature deaths of people with
learning disabilities
• REFOCUS randomised controlled trial: Developing a
recovery focus in mental health services in England
• OASIS: Seroquel XL hospital-event monitoring study
• Victims of homicide with mental illness
• National study of suicide by prisoners
• Liberty, equality, capacity: the impact of the Deprivation
of Liberty
Dementias and Neurodegenerative Disease
• A large randomised assessment of the relative cost
effectiveness of classes of drugs for Parkinson’s
• Brains for Dementia Research
We continue to receive support funding from the WCLRN
via the Research and Development Consortium for
Gloucestershire to provide a research infrastructure within
the Trust.
Use of the Commissioning for Quality & Innovation
(CQUIN) framework
The national contractual use of CQUINs is to support the
essential focus upon quality improvement in the provision
of services and incentivise this through specific quality
payments.
A proportion of 2gether NHS Foundation Trust’s income in
2012/13 was conditional on achieving quality improvement
and innovation goals agreed between 2gether NHS
Foundation Trust and NHS Gloucestershire, NHS
Herefordshire and NHS South West Specialised
Commissioning Group (for the provision of low secure
mental health NHS services).
• GERAS: Observational Study of costs and resource use
of Alzheimer’s disease in Europe
• PD Rehab – Parkinson Disease
2012/13 CQUIN Goals
Gloucestershire
12
Goal Name
Description
Goal
weighting
Expected
value
Quality
Domain
Venous thrombo –
embolism (VTE)
Reduce avoidable death, disability &
chronic ill health from VTE
5.00%
£91,100
Safety
Patient Experience
Improve responsiveness to the personal
needs of patients (Patient Experience)
19.00%
£346,180
Patient
Experience
NHS Safety
Thermometer
Improve data collection on pressure
ulcers, falls, urinary tract infection in
those with a catheter & VTE
5.00%
£91,100
Safety
Telehealth and
Telecare
Promote use of this technology to help
people live more independently at home
10.00%
£182,220
Effectiveness
Maternal Mental
Health
Provide a pathway and staff training to
better help expectant mothers who are
experiencing mental ill health
14.00%
£255,080
Effectiveness
Out of County
Placements
To ensure systems are in place that will
allow people to be treated as close to
their support networks as possible
3.00%
£54,660
Effectiveness
Medicines
management
Falls
Make plans to encourage generic
prescribing within Primary care
Reduce falls within inpatient settings
22.00%
£400,840
Effectiveness
10.00%
£182,220
Safety
Learning Disability
Outcomes
Develop a tool that captures how
interventions result in improvements for
the individual or LD population
12.00%
£218,640
Patient
Experience
Herefordshire
Goal Name
Description
Goal
weighting
Expected
value
Quality
Domain
VTE Risk Assessment
(Prevention)
To reduce avoidable death, disability
and chronic ill health from venous
thromboembolism (VTE)
5.00%
£17,783
Safety
NHS Safety
Thermometer
Improve data collection onpressure
ulcers, falls, urinary tract infection in
those with a catheter & VTE
5.00%
£17,783
Safety
Improve responsiveness
to the personal needs
of patients
Improve responsiveness to the
personal needs of patients
(Patient Experience)
18.00%
£64,019
Patient
Experience
Making Every Contact
Count
Making every patient contact count
through systematic healthy lifestyle
advice delivered through frontline staff
12.00%
£42,680
Effectiveness
Pain
Assessment
Implementation of a community and
inpatient (Cantilupe) pain assessment
tool to improve local assessment
30.00%
£106,699
Effectiveness
Recovery
Star
To pilot the implementation of
recovery star clients of agreed teams
15.00%
£53,349
Effectiveness
Prevention of
suicide
Implementation of the NPSA community
patient suicide prevention through
toolkits
15.00%
£53,349
Safety
Goal Name
Description
Goal
weighting
Expected
value
Quality
Domain
Minimum Take
Dashboard
Aimed at ensuring that implementation
and routine use of the required clinical
dashboards
25%
£9,801
Efficiency
Shared pathway
and recovery and
outcomes
Introduce and implement a recovery
and outcomes based approach to the
care pathway, demonstrating recovery
orientated practice
25%
£9,801
Patient
Experience
Implementing a
standard secure
pathway
Introduce and monitor key milestones
on the patient pathway to make it
efficient and reduce length of stay
25%
£9,801
Efficiency
Secure forensic
care pathway
feasibility project
Implement, review and feedback on
MHCT clustering, 5 Care pathway
indicators, and reporting feasibility
within a clear reporting structure
25%
£9,801
Innovation
Low Secure Services
The total combined potential value of the income conditional on reaching the targets within the CQUINs during 2012-13
was £2,301,000 of which £2,290,000 has actually been achieved. This is different to the figure provided in the final
account due to due the year end figure being agreed by commissioners at the end of Quarter 4 2012-13.
In 2011-12 the total potential value of the income conditional on reaching the targets within the CQUINs was £1,321,000
of which £1,306,500 was achieved.
13
2013/14 CQUIN Goals
2013/14
CQUIN Goals
CQUIN goals for 2013/14 have been agreed with Gloucestershire and Herefordshire Clinical Commissioning Groups and
the National Commissioning Board (for the provision of low secure mental health NHS services). These include:
Digital First Initiatives - an innovation which aims to avoid unnecessary face to face appointments
Increased use of Telecare/Telehealth Technologies - using technologies to help people live independently
Use of NHS Safety Thermometer - a tool to promote, measure and monitor harm free care
Patient experience - improving the experience that service users have from our services
Effective Communication between Secondary and Primary Health - improved communication between GPs and
specialist services
Increased use of Recovery Star - tool for promoting service users recovery
CAMHS Outcome measure - understanding what helps children and young people best
Increased use of LD Outcomes measure - understanding what helps people with a learning disability best
Responsiveness to carers of inpatients - making sure that we are listening to and working with carers
Carers for people with dementia - making sure that we are listening to and working with carers
VTE Monitoring and assessing - a tool to promote, measure and monitor harm free care
Encourage use of generic prescribing in Primary Care - working with GPs to promote good use of medicines
Physical health of people with mental health problems - promoting annual physical health checks
Increased access for BME to community services - ensuring that equality of access to our services is available to
the whole community
Payment by Results - promoting efficiency, patient choice and best practice
Suicide prevention training - providing staff with skills to help support people experiencing suicidal crisis
Regular review of elderly patients being prescribed antipsychotic medication - ensuring appropriate use of
medicines
Low secure care pathway - ensuring the best outcomes for people in our forensic services
Provision of Literacy and Numeracy in Low secure unit - improving reading and simple arithmetic
14
Statements from the Care Quality Commission
The Care Quality Commission (CQC) is the independent
regulator of health and adult social care services in
England. From April 2010, all NHS Trusts have been
legally required to register with the CQC. Registration is
the licence to operate and to be registered, providers must,
by law, demonstrate compliance with the requirements of
the CQC (Registration) Regulations 2009.
The inspection found that people using this service were
treated people with respect, provided with safe care and
food and drink to meet their individual needs and
safeguarded from harm.
Comments from patients to the CQC inspectors included:
“I feel involved in my care and know my rights”
gether NHS Foundation Trust is registered with the CQC
with no conditions. This means that the Trust has
continued to demonstrate compliance with the regulations
and we are registered to provide the following regulated
activities:
The inspection found that the recording of care was not
compliant with the CQC standards and that this was
having a minor impact on patients using the service.
• Assessment or medical treatment to persons detained
under the Mental Health act 1983
• Diagnostic and screening procedures
• Treatment of disease, disorder or injury
A series of actions were taken and following a review by
the CQC of information provided to them by the Trust, the
service was judged in February 2013 as being fully
compliant.
The locations from which the Trust is registered to provide
these regulated activities are confirmed on the CQC
website www.cqc.org.uk.
Review of Westridge Assessment and Treatment Unit
2
The CQC has not taken enforcement action against
gether NHS Foundation Trust during 2012/13; however
compliance actions were required following one of their
inspections during this time period.
2
The Trust continues to receive monthly Quality Risk
Profiles from the CQC. The Quality Risk Profile published
on 4 April 2013 declares no risk to compliance with any of
the 16 essential standard outcome areas for quality and
safety above a ‘High Yellow rating’.
This is on a scale that increases risk from Low/High red to
Low/High Yellow to Low/High Amber to Low/High Red. Low
Green being the lowest risk rating and High Red being the
highest risk rating.
The CQC has monitored the Trust’s compliance with its
standards by undertaking the following inspections of
services during 2012/13:
Review of HMP Gloucester- Prison Healthcare
A CQC Inspection of the healthcare provision within the
prison took place on 9-12 July 2012, as part of a wider
inspection by HMP Inspectorate of HMP Gloucester.
The inspection found that the service was compliant in the
areas reviewed which included treating people with
respect, the provision of safe care which is co-ordinated,
appropriately trained and supervised staff with quality
monitoring systems in place.
During the inspection prisoners spoken with expressed a
high level of satisfaction with the health services offered.
One person commented:
“They’ve really helped me a lot”.
Charlton Lane Centre
A CQC inspection of Charlton Lane Centre took place on
22 August 2012 as part of the national themed CQC
inspections on dignity and nutrition. Charlton Lane
provides inpatient care to people with mental health
problems as well as physical health problems.
“Staff always maintain my privacy and dignity”
An unannounced CQC inspection of this in patient service
for people with a learning disability took place on 18
December 2012.
The inspection found that people using this service were
provided with safe care in appropriate environments, were
safeguarded from harm, with appropriate levels of staff on
duty and quality monitoring systems in place.
Relatives told the inspection team that they were happy
with the service provided, the skills of the staff and they felt
informed and included in the care of those using the
service.
Mental Health Act monitoring
The CQC undertake regular reviews of the use of the
Mental Health Act within Trust services – The Mental
Health Act Commissioner has visited all of our inpatient
services in Gloucestershire and Herefordshire and has
forwarded to the Trust reports detailing their findings.
We have investigated the points raised within the reports
and responded to the CQC detailing the actions that have
been put in place to correct those issues.
All visit reports made by the Commissioner and the Trust
responses are scrutinised initially by the Director of
Service Delivery and then by the Trusts Mental Health Act
Scrutiny Committee.
Changes in service registration with Care Quality
Commission for 2013/14
The CQC have been formally informed of the closure of
Her Majesty’s Prison – Gloucester, and that the Substance
Misuse Services in Gloucestershire were transferred to
Turning Point from 1 April 2013 following a tendering
process by NHS Gloucestershire.
The Trust’s Certificate of Registration with CQC has been
updated in relation to the locations from which services are
provided.
15
Quality of Data
Statement on relevance of Data Quality and actions to improve Data Quality
Good quality data underpins the effective provision of care and treatment and is essential to enabling improvements in
care.
gether NHS Foundation Trust submitted records during 2012/13 to the Secondary Uses Service for inclusion in the
Hospital Episode Statistics which are included in the latest published data.
2
The percentage of records in the published data which included:
• the patient’s valid NHS number was: 99.8% for admitted patient care (99.1% national); and 99.9% for outpatient care
(99% national)
• the patient’s valid General Practitioner Registration Code was:100% for admitted patient care (99.9%); and 99.9% for
outpatient care (99.3% national)
gether NHS Foundation Trust has taken the following actions to improve data quality building on its existing clinical data
quality arrangements:
2
• Putting in place new data quality processes resulting in one report covering all services which is held on a shared
system so managers can view information by service, team or clinician
• Significant increase in the completeness of data capture over and above what has already been achieved throughout
2012/13
• Setting up a new Clinical Information Reference Committee to support the already established RiO (mental health
electronic record) Group to continue the review of data quality
Information Governance Toolkit
Ensuring that patient data is held securely is essential, as such the Trust complies with the NHS requirements on
Information Governance and assesses itself annually against the national standards set out in the Information
Governance Toolkit which is available on the Health & Social Care Information Centre website:
http://systems.hscic.gov.uk/infogov
gether NHS Foundation Trust Information Governance Toolkit Assessment Report overall score for 2011/12 was 83%
and was graded green (satisfactory). For the 2012/13 version of the Information Governance Toolkit Foundation Trusts
were again required to achieve a minimum of Level 2 for each of the 45 indicators.
2
At time of submission on 31 March 2013, of the 45 key indicators:
• 22 were at level 3
• 22 were at level 2
• 1 was deemed not relevant to us
This produced an overall score of 83%, which is rated green (satisfactory)
The Trust’s efforts will remain focussed on maintaining the current level of compliance during 2013/14 and ensuring that
the relevant evidence is up to date and reflective of best practice as currently understood, and that good information
governance is promoted and embedded in the Trust through the work of the Information Governance and Health Records
Committee, the IG Advisory Committee and Trust managers and staff.
Clinical Coding Error Rate
gether NHS Foundation Trust was not subject to the Payment by Results clinical coding audit during 2012/2013 by the
Audit Commission.
2
16
Part 3. Looking Back: A Review of Quality in 2012/13
A Review of
Quality in
2012/13
The 2012/13 quality priorities were agreed in May 2012
and published in the Quality Report, and are accessed
through the following link:
http://www.nhs.uk/Services/Trusts/Overview/DefaultVie
w.aspx?id=2769
The quality priorities were grouped under five broad areas
of quality improvements. This section of the report outlines
the achievements and progress made in each of the five
areas against what we said we would do. It also outlines
key service developments which have positively impacted
on the care we provide.
Significant progress was made on the 24 goals and 34
targets we set ourselves, with 24 targets achieved. The
report describes the progress made on the 10 targets that
we did not achieve or partially achieved relating to:
1. Smoking cessation referrals in Gloucestershire (1.3)
2. Implementation of an IAPT service for HMP Gloucester
(2.5)
3. Ensuring improved access to IAPT in Herefordshire
(2.6)
4. At least 95% of adult Care Programme Approach (CPA)
service users receiving follow-up contact within 48
hours of discharge from psychiatric inpatient care (3.1)
5. Internal service satisfaction survey results (4.1)
6. Achievement of AIMS accreditation in Herefordshire
inpatient services (4.4)
7. Reduction in serious harm from falls by 50% (between
2010-13)
8. Zero unexpected deaths in inpatient units. (5.3)
9. Information being made available from a crisis team to
an inpatient unit within 4 hours of admission. (5.4)
10.Service users being discharged with relevant
information ( 5.5)
Since the start of the Commissioning for Quality and
Innovation (CQUIN) scheme commenced, 2gether NHS
Foundation Trust has worked proactively with its
commissioners to ensure that the targets that were being
set had a positive benefit for users of its service.
It is important to us that we use this scheme to aid quality
improvements and that it fits into our commitment to
constantly strive to improve quality overall.
In January 2011, NICE (now The National Institute for
Health and Care Excellence) released Quality Standard 14
which is focused on service user experience in adult
mental health. In this standard they stated that high-quality
care should be clinically effective, safe and be provided in
a way that ensures the service user has the best possible
experience of care from the NHS.
“The way the staff are here makes it feel more
equal, from the patient point of view. They make
you feel equal, they don’t talk down to you”.
This quality standard describes markers of high
quality, cost-effective care that, when delivered collectively,
should contribute to improving the effectiveness, safety
and experience of care for service users in the following
ways:
• enhancing quality of life for people with long-term
conditions
• ensuring that people have a positive experience of care
• treating and caring for people in a safe environment and
protecting them from avoidable harm
• enhancing quality of life for people with care and support
needs
• ensuring that people have a positive experience of care
and support
• safeguarding adults whose circumstances make them
vulnerable and protecting them from avoidable harm
This standard has had a direct impact on what CQUINs
were agreed and how we delivered them.
17
Domain 1: Preventing people from dying prematurely
In 2012/13 we committed to continue our quality work in reducing the risk of premature death in people with serious mental
illness and learning difficulties. We set ourselves three goals with five associated targets, and achieved four targets within
this domain.
1.1 Suicide Prevention
We aimed to minimise the risk of suicide amongst those with mental disorders through a systematic implementation of
sound risk management principles and set ourselves a specific target.
Target
Year End Achievement
To use the National Patient Safety Agency (NPSA) National
Suicide Prevention Toolkit for all inpatient units in
Herefordshire and Gloucestershire monthly on a sample of
patients records.*
It is positive to report that the toolkit audit took
place in all teams as per the plan and this enabled
staff to ensure all patient risk factors are taken
account of and learning within in teams
* This target relates to Wotton Lawn Hospital and Stonebow
Unit
To use the NPSA Community Suicide Prevention Toolkit
quarterly to audit Crisis & Recovery Teams in Gloucestershire
and Herefordshire suicide prevention work
1.2 Promoting healthier lifestyles
We wanted to provide more positive health interventions
for our service users relating to smoking and drinking and
quality improvements have taken place:
Staff in Herefordshire and Gloucestershire have
undertaken specific Making Every Contact Count training.
162 staff have been trained at Level 1 and 114 at Level 2
in Herefordshire. This has increased the total number of
referrals that have been made to stop smoking services
this year to:
Improving the health of prisoners has been a key objective
through accessible primary and mental health services.
This has been measured against 32 national prison
indicators and at the end of the year before the prison
closed the healthcare service was meeting all the
indicators.
Comments from individuals under our care to CQC
inspectors at HMP Gloucester included:
• Gloucestershire: 146 against a target of 170 (Not
achieved. This target relates to service users in the
community. In 2013/14 emphasis will be placed on
smoking cessation as part of the physical health check)
• Herefordshire: 71 against a target of 62
"There's no problem with the staff, they are very
efficient and sort things out quickly."
"They let you speak and I feel like they listen to
my opinions."
Domain 2: Enhancing quality of life for people with long-term conditions
We continue to be aware that people who have a mental illness or a learning disability need support to live with their
long-term condition and we wanted to make more quality improvements to our service that would assist in this area. In
this domain, we set ourselves four goals with seven associated targets, and achieved five of the targets.
2.1 Improving services for people with dementia (Gloucestershire)
We wanted to improve dementia services within Gloucestershire by providing appropriate assessments of need and
ensuring that people were able to access the appropriate services for them.
Staff in Gloucestershire have undertaken specific Telehealth and Telecare training. This will help them to be aware of the
benefits of Telecare and Telehealth services and promote the use of this technology to help people live more independently at home. The technology includes personal alarms and health monitoring devices.
• Gloucestershire staff trained: 105 against a target of 83
18
2.2 Improving services for people with dementia
(Herefordshire)
In Herefordshire, reflecting local priorities, we wanted to
ensure that service users with a diagnosis of dementia
received a thorough pain assessment on admission to
hospital and in community teams. Throughout the year we
have developed the tool, trained staff and have now
embedded it into practice in such a way that all appropriate
people are now assessed in this way on admission.
2.3 Improve services for people with a learning disability in
Gloucestershire
We were concerned that there has been an absence of a
tool that that accurately captures how interventions from
the Learning Disability (LD) service result in improvements
for the individual or population of people using learning
disability services. We therefore have worked
collaboratively to develop and implement one during the
course of this year.
Throughout this year we have worked collaboratively and
developed a Health Equality framework outcome tool,
trained staff, piloted the tool and it has been launched
nationally. The scores from within our Trust are showing
positive outcomes across all five health equality
2.5 Improve access to psychological therapy services for
the wider populations in Gloucestershire
In line with principles outlined in ‘No health, without mental
health’ (2011), we wanted to make sure that as many
people as possible were able to access and benefit from
our Improving Access to Psychological Therapies (IAPT)
services in Gloucestershire and Herefordshire. Access and
recovery rates have improved throughout the year.
We also wanted to establish and implement a children’s
Improving Access to Psychological Therapies (IAPT)
service in Gloucestershire as part of a national pilot.
determinant areas with further analysis made possible by
the developing electronic data capture tool. Overall a net
positive 24% change in the impact of the evidence based
determinants of health inequalities was achieved across
the sample.
2.4 Improve access to services for adults in Gloucestershire
To ensure ease of access to our services we wanted to
establish and implement a Contact Centre and monitor the
benefits for service users and those referring to the
service.
The Gloucestershire Contact Centre commenced in May
2012 providing a referral management function for the
North Locality initially. The West Locality commenced
using the service on the 16 July 2012 and the South
Locality service commenced in September. The Contact
Centre is continuing to review how systems can be
improved and has recently provided access for GP queries
related to medication with access to the on call Consultant
rota. The service has been positively received evidenced
by increased use of the service by GP colleagues.
The Contact Centre is now also receiving referrals for the
Crisis Teams between 9am-5pm.
Our IAPT trainees have now completed their course at
Reading University, and work is taking place to ensure
participation and feedback from children on this. The
service is currently developing routine outcome monitoring
and developing a Cognitive Behaviour Therapy (CBT)
pathway.
Prior to HMP Gloucester closing on March 31 2013, we
had also progressed our plans to implement an IAPT
service for prisoners within the prison and the service had
commenced. With the closure of the prison the target could
not, therefore, be realised.
Target
Year End Achievement (cumulative)
To ensure that people in Gloucestershire have
improved access to our Improving Access to
Psychological Therapies (IAPT) Service
Q1 Referrals - 1148
Q2 Referrals - 2640
Q3 Referrals - 4402
Q4 Referrals - 6415
2.6 Improve access to psychological therapy services for
the wider populations in Herefordshire
In line with ‘No health, without mental health’ (2011) we
wanted to make sure that as many people as possible
were able to access and benefit from our IAPT services in
Herefordshire. At the end of March 2013 there had been
943 new cases accepted against a target of 950 so the
target was narrowly missed, but nevertheless not
achieved.
There were also 599 successful completions of therapy
against a target of 600; likewise, whilst this was a marginal
deficit, the overall target was not achieved. Progress
against targets for 2013/14 will be reviewed monthly by the
Trust’s Delivery Committee to maintain a dedicated focus
throughout the year.
Target
Year End Achievement (cumulative)
To ensure that people in Herefordshire have
improved access to Herefordshire IAPT
Q1 Referrals - 270
Q2 Referrals - 503
Q3 Referrals - 657
Q4 Referrals - 943
19
Domain 3: Helping people to recover from episodes of ill health or following injury
We continue to strive to provide a service that is achieving the best possible outcomes for people who develop treatable
conditions. Specifically, in 2012/13 we wanted to help people recover from illness or injury and prevent conditions from
becoming more serious. In this domain, we set ourselves seven goals with eight associated targets, and achieved seven
of the targets.
3.1 In order to try to ensure safety of people discharged from our services, we wanted to follow them up within as short
space of time as possible, exceeding the set national timescales
Target
Year End Achievement
At least 95% of adult Care Programme Approach
(CPA) receiving follow-up contact within 48 hours
of discharge from psychiatric inpatient care.
We did not achieve this target during 2012/13 so we will
be keeping it as a key target for 2013/14
. In April 2013 we
will introduce pre discharge planning forms which will
identify who is responsible for completing the 48 hour
follow up, and have produced guidance for staff for
recording this. This target will be monitored monthly via
the Countywide Delivery Committee.
Gloucestershire
Gloucestershire
Target (95%)
Year end (89%)
89%
Herefordshire
Herefordshire
Target (95%)
Year end (70%)
70%
This relates to our stretch target of follow up within 48 hours. We have consistently achieved the national target in
ensuring that 95% of people on CPA received follow up within 7 days of discharge.
3.2 To ensure effective and responsive services for people with a first episode of psychosis, we wanted to put mechanisms
in place that checked people with a first episode of psychosis were being treated by the appropriate teams
Target
New psychosis cases will be served by early
intervention teams*
Target (95%)
Year End Achievement
Gloucestershire
Year end (100%)
100%
Herefordshire
Year end (100%)
100%
* Measure defined by Department of Health national standards
20
4
3.3 To ensure appropriate admission to psychiatric inpatient care, we wanted to put mechanisms in place that checked
people were consistently being assessed by our Crisis and Home Resolution Treatment Teams, prior to any potential
admission (excludes those with organic illnesses).
Target
Year End Achievement
At least 95% of service users admitted to
psychiatric inpatient care who had access to
crisis resolution home treatment teams*
Gloucestershire
Target (95%)
Year end (100%)
98.6%
Herefordshire
Year end (100%)
100%
3.4 Recognising the need to ensure inpatients are transferred from hospital beds swiftly when they are fit to leave hospital;
we wanted to measure how long we were taking to discharge patients when they are ready to be discharged.
Target
Year End Achievement
Less than 7.5% of inpatient bed days will be a
delayed transfer of care when they are ready to
leave hospital.*
Gloucestershire (1%)
Target <7.5%
1%
<7.5%
0%
2.5%
5%
7.5%
10%
0%
2.5%
5%
7.5%
10%
7.5%
10%
Herefordshire (0.5%)
0.5%
0%
2.5%
5%
3.5 Develop effective recovery services within Herefordshire
The Recovery Star is a recognised client centred tool that
is used nationally to assist with the recovery process for
individuals. We wanted to start using this measure in
Herefordshire, with an added intention to continue to build
its use in the future.
As the days went by I started doing things like going to
The Recovery Star is a
recognised client centred
tool that is used nationally
to assist with the recovery
process for individuals.
college, attending the gym, cooking, going out for walks,
going on day trips and, the best of all, I went on holiday.
Our target was for 90% of an agreed sample of
service users within Herefordshire to have an assessment
completed. At the end of Quarter 4, 100% of the sample
size were reported as having had an assessment and
re-assessment.
21
3.6 Reduce waiting times for children and young people within Gloucestershire
Target
Year End Achievement
95% of non-urgent tier 3 cases will be seen
within eight weeks
(children and young people’s services).
Target (95%)
Current (97%)
97%
3.7 Reduce waiting times for children and young people within Gloucestershire
The specialist service continues to engage with children and young people experiencing greater levels of acutity and we
continue to ensure we achieve a rapid response. We have received positive feedback from those who use this service and
our partners on this.
Target
Year End Achievement
95% of children referred for crisis home treatment
will receive support within 24 hours
Target (95%)
Current (97%)
97%
3.8 Improve the experience of expectant mothers in need of mental health support in Gloucestershire, through staff training
We recognised the need to develop a maternal mental health pathway in Gloucestershire, and train staff in this area in
order to provide a better service to expectant mothers who were in need of mental health support. After developing and
implementing an operational policy and pathway, a training programme was developed and will continue to be offered to
staff. This year:
• Gloucestershire staff trained: 108 against a target of 102
Domain 4: Ensuring people have a positive experience of care
Quality of care includes the quality of caring reflecting the introduction of the national
Nursing Strategy ‘Compassion in Practice – the 6Cs (December 2012) which the Trust
has adopted at Board level and across all professions.
For us, we are ensuring our commitment to the 6Cs, through the Trust’s Service User
and Carer Charters as well as considering what we learn from the Francis Inquiry.
As part of this work, it is essential that we gain feedback from those who use our
services and we have increased this focus during 2012/13.
In this domain, we set ourselves five goals with seven associated targets, and achieved
five of the targets with a partial achievement of a further one.
22
4.1 Gain feedback from service users to determine satisfaction levels with the care they are receiving, in order to change
the service where appropriate
We realise the absolute importance and validity in gaining
feedback from people who use our services. Overall this
year we have gained feedback on discharge of 196
patients and 526 community patients.
Below are a series of results from questions that have
been asked of people who use our services in both
Gloucestershire and Herefordshire each quarter, these are
set against national targets. We chose these questions, as
the national survey of mental health patients in 2011
demonstrated that we were not meeting people’s needs in
these areas, and we wanted to know if the actions we had
taken had made a difference.
We did not meet our own targets in some instances but
responses exceeded the national average scores in the
majority of questions. Seeking feedback from service users
remains a high priority with a further satisfaction survey
being a quality target for 2013-14.
Whilst the same questions have been used for both
Gloucestershire and Herefordshire, there were different
targets set in both counties.
The questions were as follows:
1. Crisis Care - Do you have the number of someone in
mental health service that you can call out of office hours?
2. Care Reviews -Were you given a chance to express
your views during your Care Review meeting?
3. Medication Explanation - Was your medication
explained to you?
4. Feeling Safe - Did you feel safe in our care?
5. Recommending Services - How likely is it that you
would recommend this service to friends and family?
Inpatient Results
Target
Year End Achievement
Crisis Care
Gloucestershire 51%
(reflecting the national average 51%)
Gloucestershire Inpatient 88%
88%
51%
Herefordshire 70%
Herefordshire Inpatient 85%
70%
85%
Care Reviews
Gloucestershire 70%
(reflecting the national average 70%)
Gloucestershire Inpatient 91%
91%
70%
Herefordshire Inpatient 100%
Herefordshire 90%
100%
90%
Gloucestershire Inpatient 94%
Medication Explanation
Gloucestershire & Herefordshire 68%
(reflecting the national average)
94%
Herefordshire Inpatient 92%
68%
92%
Feeling Safe
Gloucestershire Inpatient 94%
Gloucestershire & Herefordshire 90%
(reflecting the national average)
90%
94%
Herefordshire Inpatient 100%
100%
23
Target
Year End Achievement
Recommending Services
The target was set to increase scores from
Quarter 1 scores
Gloucestershire 27%
27%
Gloucestershire Inpatient 25%
25%
51%
Herefordshire 25%
Herefordshire Inpatient 77%
25%
77%
Community Results
Target
Year End Achievement
Crisis Care
Gloucestershire 51%
(reflecting the national average 51%)
Gloucestershire Inpatient 79%
79%
51%
Herefordshire 70%
Herefordshire Inpatient 64%
70%
64%
Care Reviews
Gloucestershire 70%
(reflecting the national average 70%)
Gloucestershire Inpatient 93%
93%
70%
Herefordshire Inpatient 89%
Herefordshire 90%
90%
89%
Gloucestershire Inpatient 96%
Medication Explanation
Gloucestershire & Herefordshire 68%
(reflecting the national average)
96%
Herefordshire Inpatient 98%
68%
98%
Feeling Safe
Gloucestershire Inpatient 99%
Gloucestershire & Herefordshire 90%
(reflecting the national average)
90%
99%
Herefordshire Inpatient 96%
96%
24
Target
Year End Achievement
Recommending Services
The target was set to increase scores from
Quarter 1 scores
Gloucestershire 46%
Gloucestershire Inpatient 45%
45%
46%
Herefordshire 45%
Herefordshire Inpatient 45%
45%
It is seen that the key target we did not achieve relates to
“recommending services”. We will survey a larger sample
of service users during 2013/14 and will use iPads to
gather this information in real time, thereby providing early
feedback to the teams of how the service is viewed by
those who use it.
This will provide a powerful message to all staff and help to
culturally embed the principles of both the Carer’s Charter
and the Service User Charter.
“The launch of The Carers Charter is the first step in
acknowledging the role of Carers. It establishes important
principles for guiding clinicians as they work with family
and friends of the patients they are treating”.
4.2 Promote dignity in care
To promote the dignity of people who use our services, we
wanted to sign up to national care campaigns.
After holding a workshop on the Kissing it Better initiative in
February 2012, staff who attended made pledges to make
small changes to improve services. These are being
followed up and mentors have been allocated to help
implement the changes.
As stated above we have embraced the national Nursing
Vision ‘Compassion in Practice – the 6Cs (December
2012) commonly called the 6Cs.
These are Care, Compassion, Commitment, Competence,
Courage and Communication.
This vision has been adopted across all the clinical
disciplines of health and social care professionals and also
across all corporate functions.
“Mental health professionals all have a duty to support
people on their recovery journeys and can do so by
developing values and attitudes that support personal
recovery.”
The Trust has developed a pledge site where staff can
pledge their commitment to deliver care and interact with
other staff in line with the principles outlined in the 6Cs.
45%
Staff who pledge are being issued with a 6Cs pledge
badge as a visible declaration of their commitment to the
6Cs.
4.3 Ensure compliance with the national NHS “Equality
Delivery System” covering all nine protected characteristics
gether NHS Foundation Trust believes passionately in the
equality of the services that it delivers and, to promote this,
has four equality objectives in the business plan and the
work on translating these objectives into local actions is
overseen by the Trust’s Diversity Steering Group.
2
Objective 1
In addition to a data validation exercise commencing in
Herefordshire, the same exercise was carried out and
completed for Substance Misuse Services. A review of
progress will be undertaken early in next year to ensure
further actions are taken forward.
Objective 2
Our Five Steps to Wellbeing programme has been
delivered to members of the Asian and Bengali
communities. Sessions were arranged with partner
organisations and delivered through interpreters. The
delivery of this programme has enabled some of the
participants to access support and interventions offered
through Let’s Talk, our Improving Access to Psychological
Therapies (IAPT) service, which they historically would not
have accessed allowing them to receive the right support
at the right time.
Objective 3
Service user and carer participants took part in the
recruitment and selection process for the Director of
Finance, Director of Organisational Development and for
two non-executive director roles. Feedback from
participants was that they enjoyed the process, felt
involved and included and that their views were taken into
account.
Objective 4
Six managers have been trained to deliver 360 degree
appraisal as part of supporting managers undertaking the
development programme, and those considering
placements on the programme for 2013 – 2014.
25
4.4 Provision of high quality inpatient services
To ensure we are providing high quality inpatient services,
we participate in the Royal College of Psychiatry
accreditation process for inpatient services known as AIMS
in both Gloucestershire and Herefordshire.
Gloucestershire has now received full AIMS accreditation
for all of its inpatient services. Herefordshire did not
achieve this target within the year but are well on their way
to completing this rigorous, time consuming but worthwhile
evaluation.
To achieve accreditation additional psychology input will
need to be secured, and there is an associated action plan
in place to gather the necessary evidence to demonstrate
that all criteria are fully met. The target for 2013/14 is to
apply for accreditation in three months as along as the
psychology appointment is made.
4.5 Improve service user experience
Service users are rightly at the centre of everything that we
do. One of the ways that we wanted to ensure and support
this was to have a Service Users Charter which all Trust
employees would sign up to.
The Service User Charter was successfully launched on
World Mental Health Day 10 October 2012. The Charter
was endorsed by the Trust Board on the 24 September
2012.
Additional awareness raising leaflets to encourage
complaints when people are dissatisfied with or concerned
about their care have been developed.
The number of clients seen by 2gether services in 2012-13
is reported as 26,168 .Taking the complaint number figure
of 147 this represents complaints from less that 0.6% of
the population served. This is the same percentage figure
of complaints that were reported in last year’s Complaints
Annual Report. Whilst more complaints were recorded last
year (n=178) the organisation reported more people using
services last year also.
During 2012-13 five complaints were referred to the
Parliamentary Health Services Ombudsman which is one
more than in the previous two years. None of the cases
referred this year were upheld.
Figure 1 - Number of complaints by quarter year over a
five year period
200
180
160
“I have received excellent support from my
employment specialist where I feel without her, I would
be very poorly. Always there for me even though she is
extremely busy.”
41
37
100
80
21
60
8
15
13
40
20
0
15
2008/09
20
16
2009/10
2010/11
Work has been carried out to raise awareness of the
complaints process through increased publicity in clinical
areas, public forums and on the Trust’s website.
39
49
2011/12
39
2012/13
This number does not include numbers of people seen by the Improving
Access to Psychological Therapies Service (IAPT) now was it
represented in the 2011-12 complaints report.
2
It should be noted that the figures quoted in 2011-12 report were an
estimate as the electronic records system (RiO) had not been
implemented in Herefordshire services at that time.
The Service Experience Team continues to develop
systematic ways of recording and reporting learning from
complaints and other service experience feedback. The
following are examples of the learning from complaints that
have occurred during 2012/13.
You Said
In previous years illustrated in Figure 1 - i.e. before April
2011. 2gether NHS Foundation Trust was not providing
services to Herefordshire or HMP Gloucester Prison
service.
47
Jan - Mar
Oct - Dec
Jul - Sep
Apr - Jun
1
We committed to develop a Volunteers Pathway during
2012/13 to help service users in their on-going recovery
A total of 147 complaints were made to the Trust between
April 2012 and the end of March 2013. This represents a
17% fall in number from the previous year (see Figure 1)
when service provision was at a comparable rate.
33
26
28
Clinical Treatment
Complaints
30
23
4.6 Improve service user experience
This strategy has been drafted, consulted upon and it is
planned that it will be agreed at by the Board in late Spring
of 2013.
26
36
120
The presentation of the Service User Charter has now
been integrated into staff induction. All managers and staff
have been informed of this and the Service User Charter is
displayed in over 49 clinical areas in the Trust.
The charter has been translated into five different
languages and an easy read version is also available.
39
140
“It is not helpful to change medication without
a full explanation to patient and family.”
We Did
A message has been sent to staff that there is a
need to communicate with patients and wherever
possible with families when medication change is
recommended.
You Said
• Work with new partner organisations including
Healthwatch to respond to, take action to rectify
situations where indicated and learn feedback
“Sometimes staff interaction with patients and
carers is perceived as rude and uncaring.”
We Did
We have launched our Service User Charter in all
clinical teams which sets out the expectations of
providing a positive service experience.
The Service Experience Team will continue to work
towards improving the service it provides by managing
performance and capturing organisational learning from
complaints. In 2012/13 the emphasis on a holistic
approach to service experience will continue to:
• Learn from the Francis Report and integrate learning into
the Trust’s Complaints Policy and clinical practice
• Continue to review the complaints process and
procedure and to facilitate improvements in service
users’ experience across the organisation in partnership
with operational services
• Report information about the protected characteristics of
people who complain about our services in order to
better understand the equality of our approach and to
fulfil the Equality Delivery Scheme requirements
• Refine the system of capturing how satisfied people who
complain are with the response they have received from
the Service Experience Team of the Trust
• Continue to triangulate complaints with concerns,
comments and compliments received to gain rich
information about potential areas of risk to address and
to document in the quarterly Service Experience Reports
• Implement a system for learning from complaints across
the organisation
Domain 5: Treating and caring for people in a safe environment and protecting them from avoidable harm
Protecting service users from further harm whilst they are in our care is a fundamental requirement. We seek to ensure
we assess the safety of those who use our services as well as providing a safe environment for service users, staff and
everyone else that comes into contact with us. In this domain, we set ourselves five goals with seven associated targets,
and fully achieved three targets, with a partial completion of a further one.
5.1 Minimising the risk of venous thromboembolism (VTE)
In order to minimise risk and prevent service users coming to harm within our services we set out to ensure that Venous
Thromboembolism (VTE) was assessed as a potential danger, on admission, and was dealt with swiftly and appropriately
if found to be a concern.
Target
Year End Achievement
Gloucestershire
Gloucestershire
Assessment Target (90%)
Assessment Current (96%)
90%
Treatment Target (90%)
96%
Treatment Current (100%)
90%
90%
100%
Herefordshire
Herefordshire
Assessment Target (98%)
Assessment Current (100%)
100%
98%
Treatment Target (98%)
Treatment Current (100%)
90%
98%
90%
100%
27
5.2 Minimise the risk of harm to inpatients
Our aim was to reduce serious harm from falls by 50%
between 2010-2013. This target has not been achieved.
From 2010, we have aimed to reduce serious harm from
falls by 50% and within Gloucestershire this has been
exceeded with an improvement of 66%. From 2011, the
organisation expanded and Herefordshire services joined
the Trust. The acquisition of new services means that the
overall organisational aim has not yet been fully achieved
as the roll out of the programme is at different stages of
implementation; however a 33% improvement is reported
and we are looking to achieve the overall organisational
aim of a 50% reduction by March 2014
To assist with this we will look to test ward floor mapping
and magnetic falls risk indicators for the patient status
whiteboards at the Stonebow Unit in Hereford, we will
measure the days between falls in Herefordshire as we do
in Gloucestershire and we will set up learning events
between Willow Ward at Charlton Lane Hospital and
Cantilupe Ward at Stonebow Unit as the inpatient group is
very similar, and shared learning will be sensitive to service
user need.
Since the end of January 2011, 2gether NHS Foundation
Trust has been involved in the NHS South West Quality
and Safety Improvement Programme for Mental Health.
The Trust is part of a group of seven mental health NHS
Trusts in the South West of England who are working
together to deliver the Patient Safety Programme. The
overall aim of the programme is to reduce avoidable harm
to inpatients whilst in our care, by making improvements in
the way we work, and thereby improving the patients’
experience of what is provided.
One of the work streams is on patient, family, and carer
communication, as part of this work we had an initiative to
ensure that when people are discharged from our services
that they had a clear care plan, an updated risk
assessment and management plan, summary of key
information and a medication list.
5.3 Minimise the risk of harm to inpatients
We wanted this to happen 95% of the time. The numbers
of service users discharged with all this information has not
yet been audited so we did not achieve the specific target;
however we have tested initiatives to provide discharge
information as outlined below.
Our aim was to have no unexpected deaths in our inpatient
units.
Wotton Lawn Hospital continues to pilot user friendly
information for service users which includes the following:
Sadly there was one unexpected inpatient death and
therefore this target has not been achieved. The serious
incident was fully investigated and reviewed by the
Strategic Health Authority and the learning cascaded
across our Trust and others in the South West area.
To minimise the risk of access to ligatures, Kingsholm and
Abbey Wards at Wotton Lawn Hospital completed second
phase ligature works programmes during 2012/13, works
are underway on Dean Ward and Priory Ward has ligature
work scheduled for autumn 2013. It has been confirmed
that 2gether will become responsible for the estate in
Herefordshire in 2013, and a programme of estates work is
underway at the Stonebow Unit.
A Ligature Policy was approved during 2012 and requires a
detailed annual audit of all acute inpatient units to be
undertaken by senior clinicians in conjunction with estates,
health and safety colleagues and service users who are
experts by experience. The results and recommendations
from the annual ligature audit will be monitored via the
Governance Committee.
5.4 Minimise the risk of harm to inpatients
Our aim was to ensure that where the crisis team are
supporting a known service user and an admission to an
inpatient unit was needed, in 95% of admissions,
information would be passed from the crisis team to the
ward within four hours.
We had hoped that this information could be captured from
the electronic health records system (RiO) at the end of the
year to see if there had been an improvement but we did
not identify a mechanism to extract this data, therefore the
target was not achieved.
During 2013/14 our Clinical Systems Team will work
closely with clinical colleagues to see if a solution to
document this can be realised and subsequently audited.
28
5.5 Implementation of the South West Patient Safety
Improvement Programme (Discharge Information)
• a paper questionnaire was introduced in October 2012
and given out to service users on discharge. These are
returned to the ward and the ward manager collates the
information. This stays with each ward for them to learn
the feedback and plan the next steps as appropriate. A
file is kept including this information
• credit card size cards were available to give to patients
on discharge for a three month period, with the 48 hour
follow up appointment on and the details of the relevant
crisis service, according to locality. These are currently
out of print but being revised to extend the scope of their
use beyond Wotton Lawn Hospital. The revised cards will
be reintroduced in 2013/14
• a letter being given to the patient from pharmacy on
discharge with their current medication
• a copy of information being sent to the GP within 48
hours of discharge
From April 2013, iPads will be reintroduced to all wards
and these will also be used to capture information the
experience of patients during their inpatient stay, the other
discharge information will continue to be provided.
5.6 Monitor and report the numbers of serious incidents for
the purpose of improving safety of services
Serious incidents requiring investigation are incidents
which occurred in relation to NHS funded services and
care resulting in unexpected or avoidable death, or serious
harm to service users, staff, visitors or members of the
public.
Reducing the numbers of these incidents remains a high
priority for the Trust and as such it reports and investigates
all incidents which occur, monitors trends and makes
recommendations to improve care wherever possible.
Numbers of serious incidents reported by the Trust have decreased this year; which is, in part, an indication of the
vigilance of our staff in maintaining the safety of service users.
Figure 1 below shows the absolute number of serious incidents reported by the Trust over a five year period.
Number of serious incidents
Serious incident rate per 1000 caseload
70
11
60
50
14
40
4
6
20
7
12
23
15
7
10
0
10
6
30
2008/09
18
13
8
2009/10
2010/11
Q4
Q3
Q2
Q1
20
9
13
15
19
2011/12
0.70
0.60
0.50
0.40
0.30
0.20
0.10
0.00
12
2011/12
2012/13
Figure 1
2012/13
Figure 2
It is possible to attribute the increase in reported serious incidents seen from 2011/12 to the Trust expanding its scope
from that time to include the provision of mental health services in Herefordshire and prison healthcare in Gloucestershire.
The rate of serious incidents per 1000 service users on the Trust caseload has been calculated as shown in Figure 2
above.
The most frequently reported serious incidents are suspected suicide, and attempted suicide, this is seen clearly in Figure
3. It is really positive that the numbers of patients in contact with mental health services who died by suicide decreased
from 27 in 2011/12 (including two deaths in custody) to 18 in 2012/13 (including two deaths in custody).
Initiatives such as the implementation of both the inpatient and community suicide prevention toolkit continue to improve
staff awareness of issues associated with suicide.
Serious incidents by type 2012-13
Declassified - 2
ECT incident - 1
Serious assault - 3
Infection control ward closure - 3
Natural cause death - 1
Grade 3 pressure ulcer - 4
Police intervention - 1
Absconding - 1
Arson - 2
Suspected suicide
(including deaths in
custody) - 18
Falls leading to fracture - 4
Deliberate self harm - 4
Attempted suicide 12
Unexpected death - 2
Accidental death - 2
Figure 3
29
Two independent investigation reports were published
during 2012/13. These were commissioned by the
Strategic Health Authority (SHA) following homicides
committed by service users who were under the care of the
trust at the time of the incidents, these are as follows:
1. The Independent Investigation into the Care and
Treatment of Mr A (the incident occurred in 2008)
2. The Independent Investigation into the Care and
Treatment of Mr C (the incident occurred in 2010)
Both reports were critical of aspects of the care provided
and elements of the Trust’s internal investigation
processes at the time, and made recommendations in key
areas as follows:
•
•
•
•
•
•
•
•
•
•
•
Clinical risk assessment and management
Care Programme Approach
Substance misuse
Safeguarding
Medication and treatment
Carers
Communications
Serious Incident Procedures
Clinical supervision
Joint working with the police and
Governance and management issues
The Trust developed detailed action plans in response to
these, and had already made many changes to systems
and practice in the years between the tragic events
occurring and publication of the reports.
The NHS safety thermometer
continues to be used every
month for all service users in
older person and learning
disability units.
30
There have been no Department of Health defined Never
Events within the Trust during 2012-13. Never Events are
serious, largely preventable patient safety incidents that
should not occur if the available preventative measures
have been implemented. The full list of reportable Never
Events can be seen at:
www.gov.uk/government/news/never-eventslist-update-for-2012-13
5.7 Promote service user safety
We were required to implement the NHS Safety
Thermometer (which required the monthly submission of
data on pressure ulcers, falls, urinary tract infection in
those with a catheter and VTE) and pilot the Mental Health
Safety Thermometer (which had different harm indicators
including violence and aggression).
The NHS safety thermometer continues to be used every
month for all service users in older person and learning
disability units, which we report to the Department of
Health (DH) Information Centre. As a provider of mental
health and learning disability services, the data general
reflects low incidences of harm with the exception of falls
which we are already tackling.
We have been involved in the piloting of a mental health
safety thermometer. This will be reviewed nationally and a
decision made as to whether this will be rolled out.
Summary Report on Quality Measures for 2012/2013
The following are the quality measures that have been mentioned previously under the 5 main areas which had specific
targets.
Domain 1: Preventing people from dying prematurely
2011-2012
Actual
2012-2013
Target
2012-2013
Actual
1
Compliance with suicide prevention toolkit in
Gloucestershire
100%
100%
100%
2
Compliance with suicide prevention toolkit in
Herefordshire
100%
100%
100%
3
Increase in recorded referrals to GSAS
Gloucester
179
>170
146
4
Increase in recorded referrals to GSAS
Herefordshire.
Staff receiving MECC training - Herefordshire
-
>62
71
>175
276
Compliance with prison indicators
-
=32
32
2011-2012
Actual
2012-2013
Target
2012-2013
Actual
-
>83
105
100%
>95%
100%
5
Domain 2: Enhancing quality of life for people with
long-term conditions
6
Staff receiving Telecare training – Gloucester
7
Assessment of inpatients for pain and distress in
Herefordshire
8
Develop a learning disability outcome tool
-
-
Achieved
9
Establish and implement the Contact Centre
-
-
Achieved
10
Establish a Children’s IAPT in Gloucester
-
-
On target
11
Ensure improved access to IAPT in Herefordshire
-
>950
943
12
Implement an IAPT service for HMP Gloucester
-
-
Not achieved due to
prison closure
2011-2012
Actual
2012-2013
Target
2012-2013
Actual
-
>95%
>95%
89%
70%
127%
114%
>95%
>95%
100%
100%
99%
>95%
>95%
Q4 98%
Q4 100%
Q4 98.8%
Domain 3: Helping people to recover from episodes of
ill health or following injury
13
14
15
Adult CPA receiving follow-up within 48 hours of
discharge – stretch target
Gloucestershire
Herefordshire
Serving new psychosis cases by early
intervention teams
Gloucestershire
Herefordshire
Access to crisis resolution/home treatment
services
Gloucestershire
Herefordshire
(combined year-end)
31
16
Delayed Transfer of Care
Gloucestershire
Herefordshire
(combined)
17
Recovery Star - Herefordshire
18
4.2%
≤ 7.5%
≤ 7.5%
≤ 7.5%
1%
0.5%
0.9%
-
>90%
100%
Non-urgent tier 3 cases will be seen within
eight weeks (children and young people’s
services)
95%
97%
19
Children referred for crisis home treatment will
receive support within 24 hours
95%
97%
20
Staff receiving MMH training - Gloucestershire
>102
108
2011-2012
Actual
2012-2013
Target
2012-2013
Actual
-
≤ Q1 Score
≤ Q1 Score
≤ Q1 Score
≤ Q1 Score
Partially achieved
Partially achieved
Achieved
Partially achieved
-
-
Achieved
-
-
Achieved
Achieve AIMS accreditation – all older peoples
inpatient services Gloucestershire
-
-
Achieved
Achieve AIMS accreditation – all inpatient
services Herefordshire
-
-
Not achieved
Finalise and implement the Service Users
Charter
-
-
Achieved
Develop a Volunteers Pathway
-
-
On target
Domain 4: Ensuring people have a positive experience of care
21
Internal service level results from surveys
Gloucestershire Inpatient
Gloucestershire Community
Herefordshire Inpatient
Herefordshire Community
22
Sign up to National Care Campaign
23
Ensure compliance with the national NHS
“Equality Delivery System”
24
25
26
27
Domain 5: Treating and caring for people in a safe
environment and protecting them from avoidable harm
28
32
2011-2012
Actual
2012-2013
Target
2012-2013
Actual
VTE screening for all adult admissions
Gloucestershire
Herefordshire
100%
90%
98%
96%
100%
VTE prophylaxis for adult admissions at risk
Gloucestershire
Herefordshire
100%
90%
98%
100%
100%
<50%
<50%
33%
29
Reduce serious harm from falls by 50%
(between 2010-13)
30
Zero unexpected deaths in inpatient units
0
0
1
31
Information available from a crisis team to an
inpatient unit within four hours
-
95%
Not measured
32
Service users discharged with relevant information
-
95%
Pilot developed
Partially achieved
33
Develop and monitor a serious incidents rate
-
-
Achieved
34
Implement the NHS Safety Thermometer
-
-
Achieved
Monitor Indicators and Thresholds for 2012/2013
The following table shows the 10 metrics that are monitored during 2011/12. These are the indicators and thresholds from
Monitor and follow the standard Department of Health national definitions.
Please note that some are also the Trust Quality targets as shown in the previous table, though some may have more
stretching targets than Monitor require as a threshold.
2010-2011
Actual
2011-2012
Actual
National
Threshold
2012-2013
Actual
1
Clostridium Difficile objective
0
0
0
1
2
MRSA bacteraemia objective
0
0
0
0
3
Seven day CPA follow-up after discharge
100%
100%
95%
98.6%
4
CPA formal review within 12 months
100%
96.6%
95%
95.1%
5
Delayed transfer of care
5.9%
4.2%
≤7.5%
0.9%
6
Access to Crisis resolution/home treatment
services
97%
99%
90%
98.8%
7
Serving new psychosis cases by early
intervention teams
130%
G127%
H114%
95%
100%
8
MHMDS data completeness: identifiers
99%
99.5%
99%
99.7%
9
MHMDS data completeness: CPA outcomes
50%+
86.9%
50%
79.7%
10
Learning Disability – six criteria
6 at level 4
6
6 at level 4
6
Quality Indicators 2012 -2013
There are a number of mandated Quality Indicators which
organisations providing mental health services are required
to report on, and these are detailed below.
The comparisons with the national average and both the
lowest and highest performing trusts are benchmarked
against other mental health service providers.
1. Percentage of patients on CPA who were followed up
within seven days after discharge from psychiatric inpatient
care
gether NHS Foundation Trust considers that this data is as
described for the following reasons:
2
that service users are more vulnerable and at higher risk
during this time
• In recognition of this awareness there is a local stretch
target of follow up within 48 hours of discharge from
inpatient care
gether NHS Foundation Trust has taken the following
action to improve this percentage, and so the quality of its
services by:
2
• Keeping its local stretch target of follow up within 48
hours as a key quality target for 2013-14
• The Trust performs well against this indicator as staff
work hard to provide timely follow up as they are aware
Quarter 1
2012-13
Quarter 2
2012-13
Quarter 3
2012-13
Quarter 4
2012-13
100%
100%
99.6%
99.1%
National Average
97.5%
97.3%
97.6%
97.3%
Lowest Trust
94.9%
89.9%
92.5%
93.6%
Highest Trust
100%
100%
100%
100%
2
gether NHS Foundation Trust
33
2. Proportion of admissions to psychiatric inpatient care
that were gate kept by Crisis Teams
gether NHS Foundation Trust considers that this data is as
described for the following reasons:
2
• Whilst the Trust performs well against this indicator, we
are a small organisation with a small number of beds;
staff respond to individual service user need and help to
support them at home wherever possible unless
admission is clearly indicated
• During 2012, crisis teams also gate kept admissions to
older people’s services beds within Gloucestershire
gether NHS Foundation Trust has taken the following
action to improve this percentage, and so the quality of its
services, by:
2
• Ensuring that all teams are aware that they must involve
crisis teams at the point of admission even when a
service user is transferred from other mental health or
general hospitals
• Ensuring that the all admitting consultants are aware that
they have to admit via the crisis teams to beds within
older people’s service beds
• On some occasions individuals have been admitted
directly from other hospital beds if they have been
returned from out of county
Quarter 1
2012-13
Quarter 2
2012-13
Quarter 3
2012-13
Quarter 4
2012-13
97.9%
99.4%
97.7%
98.8%
97.8%
98%
98.4%
98.6%
Lowest Trust
83%
84.4%
90.7%
20%
Highest Trust
100%
100%
100%
100%
2
gether NHS Foundation Trust
National Average
3. 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
gether NHS Foundation Trust considers that this data is as
described for the following reasons:
2
• The Trust has been through a significant period of
change in the preceding 12 months, services have been
reconfigured, and staff are working in new ways
• The new ways of working continue to be embedded and
staff may not, as yet, have seen the benefits for service
users, however the feedback directly from service users
and carers suggests that the benefits are being felt
gether NHS Foundation Trust has taken the following
action to improve this score, and so the quality of its
services, by:
2
• Holding focus groups with staff to understand their
concerns and agree actions which staff members, their
managers, and senior managers within the Trust can
take to make a positive difference
• Sharing positive feedback from service users and carers
with staff, for example feedback from stakeholder events
where service users can carers assessed the Trust
progress on the outcomes described in the Trust’s
Equality Delivery System (Goals 1 and 2 which relate to
patient care)
• Involving staff in responding to the Francis report though
local workshops
• Holding staff engagement events
NHS Staff Survey
2011
NHS Staff Survey
2012
3.36
3.20
National Median Score
3.42
3.54
Lowest Trust Score
3.07
3.06
Highest Trust Score
3.94
4.06
2
34
gether NHS Foundation Trust Score
4. “Patient experience of community mental health
services” indicator score with regard to a patient’s experience of contact with a health or social care worker during
the reporting period
gether NHS Foundation Trust has taken the following
action to improve this score, and so the quality of its
services, by:
2
• Scrutinising the 2012 data for both Herefordshire and
Gloucestershire further and noting some differences in
where developments appear to be needed. This has
formed an action plan which was completed
collaboratively in September 2012 and cascaded for
implementation across operational services through
Locality Directors and Service Experience Leads
gether NHS Foundation Trust considers that this data is as
described for the following reasons:
2
• We are aware that the survey results for 2011 and 2012
do not compare like with like. This is because the 2011
2
gether survey did not include the Herefordshire
population. This matter needs to be considered when
making conclusions from the numerical data supplied
NHS Community Mental
Health Survey 2011
NHS Community Mental
Health Survey 2012
8.7
8.4
National Average Score
not available
not available
Lowest Score
not available
8.2
Highest Score
not available
9.1
2
gether NHS Foundation Trust Score
5. The number and 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
• The Trust is in the highest 25% of reporters and it is
believed that organisations that report more incidents
usually have a better and more effective safety culture
• There is limited national guidance in assigning
categories of harm for mental health providers
gether NHS Foundation Trust considers that this data is as
described for the following reasons:
2
• If staff reporting an incident do not include all required
information, there can be delays in uploading incidents to
the NRLS
• Not all of the Trust’s reported incidents meet the criteria
for uploading to the National Reporting and Learning
Systems (NRLS), for example, whilst the trust documents
all deaths by natural causes within its risk management
system it only uploads those in which natural causes are
not suspected. All deaths by suspected suicide are
reported in line with the revised CQC guidance effective
from 1 April 2012
gether NHS Foundation Trust has taken the following
action to improve this rate, and so the quality of its
services, by:
2
• Strengthening local guidance to staff regarding data
completeness, reporting deadlines and timeliness of
upload
• NRLS data is published 6 months in arrears; therefore
data below for severe harm and death will not
correspond with the serious incident information shown
in section 5.6 of the Quality Report
• Including additional local guidance within the Trust’s
Incident Reporting Policy to assist staff in classifying
categories of harm
October 2011 - March 2012
April 2012 - September 2012
Number
Rate
Severe
Death
Number
Rate
Severe
Death
1268
34.6
0/0%
3/0.2%
1503
36.79
2/0.1%
4/0.3%
105,228
19.9
110,360
23.8
Lowest Trust
44
0
0/0%
0/0%
22
0
0/0%
0/0%
Highest Trust
6080
86.89
69/2.3%
53/0.9%
6903
70.29
316/8.9%
78/2.6%
gether NHS
Foundation Trust
2
National
496/0.5% 806/0.8%
831/0.8% 916/0.8%
* Rate is the number of incidents reported per 1000 bed days.
35
This year is the first time that this indicator has been
required to be included within the Quality Report alongside
comparative data provided, where possible, from the
Health and Social Care Information Centre.
The National Reporting and Learning Service (NRLS) was
established in 2003. The system enables patient safety
incident reports to be submitted to a national database on
a voluntary basis designed to promote learning.
It is mandatory for NHS Trusts in England to report all
serious patient safety incidents to the Care Quality
Commission (CQC) as part of the Care Quality
Commission registration process.
As there is not a nationally established and regulated
approach to reporting and categorising patient safety
incidents, different Trusts may choose to apply different
approaches and guidance to reporting, categorisation and
validation of patient safety incidents.
The approach taken to determine the classification of each
incident, such as those ‘resulting in severe harm or death’,
will often rely on clinical judgement. This judgement may,
acceptably, differ between professionals.
In addition, the classification of the impact of an incident
may be subject to a potentially lengthy investigation which
may result in the classification being changed.
To avoid duplication of reporting, all incidents resulting in
death or severe harm should be reported to the NRLS who
then report them to the Care Quality Commission. Although
it is not mandatory, it is common practice for NHS Trusts to
report patient safety incidents under the NRLS’s voluntary
arrangements.
This change may not be reported externally and the data
held by a Trust may not be the same as that held by the
NRLS. Therefore, it may be difficult to explain the differences between the data reported by the Trusts as this may
not be comparable.
Community Survey 2012
During 2012, the CQC published the results of an independent survey taken in 2012 that tested the experience of our
community service users, comparing the results with most other mental health trusts.
The results for Gloucestershire and Herefordshire were:
Our Score (out of 10)
Compared with other Mental
Health Trusts
Health & Social Care Workers
8.4
About the same
Medications
7.5
About the same
Talking Therapies
6.1
Worse
Care Co-ordinator
8.3
About the same
Care Plan
6.9
About the same
Care Review
7.4
About the same
Day to Day Living
5.6
About the same
Crisis Care
5.9
About the same
Overall
6.5
About the same
Questions about:
The survey received replies from 273 of our service users out of 850 who were asked to participate, which represents a
response rate of 33% compared with an average for all mental health trusts of 32%. Full details of this survey can be
found on the CQC website www.cqc.org.uk.
Overall, these results state that we are mainly within the expected range for mental health trusts in all areas, except for
one. It is clear we have more to do to improve the experience of people using our services. We have an action plan in
place to address this and will monitoring feedback through our local surveys throughout the coming year. We anticipate
that the additional actions and initiatives identified earlier in the report will result in further improvements in these scores
next year.
36
Staff Survey 2012
Staff Survey
2012
Every year, the Department of Health conducts a national
NHS staff survey. The survey is used to gauge how well
our staff believe that we treat them and provide good
management as described in the staff pledges of the NHS
Constitution. The 2012 results were released in March
2013.
This year there were 28 Key Findings in the survey
compared with 38 the previous year. Of those 28, seven
key findings cannot be compared with the previous year’s
results because of changes to the format of the survey
questions so that comparisons with the 2011 results were
not possible for seven key results, leaving 21 for
comparative purposes.
Of the 21 results which can be compared, staff said that
that there was no change in many areas and consequently
results were consistent for 15 of the key findings when
compared with the previous year. However results are
worse than other like-type Trusts.
For a further five key findings, results were not as good as
the previous year, and one was better.
When compared with like-type Trusts in the 28 key areas
we were:
•
•
•
•
Better than average in 3 areas (8)
Average in 7 (10)
Worse than average in 7 (9)
In the lowest 20% in 11 (6)
The previous year’s figures are shown in brackets.
For the second year running our survey also included staff
in our Herefordshire services. However the response rate
overall was lower with only 48% of staff in the random
sample returning their questionnaire compared with 60%
the previous year.
The comparison with last year shows that in many areas
we are roughly the same, but it is clear that other Trusts
have improved relative to us.
The five key findings for which the Trust compares most
favourably with other mental health/learning disability
Trusts in England were:
• Working extra hours
• Staff witnessing potentially harmful errors, near misses
or incidents in last month
• Support from immediate managers
• Staff experiencing physical violence from patients,
relatives or the public in last 12 months
• Feeling pressure in last three months to attend work
when feeling unwell
The five key findings for which the Trust compares least
favourably with other mental health/learning disability trusts
in England were:
• Good communication between senior management and
staff
• Motivation at work
• Staff receiving job relevant training, learning or
development in last 12 months
• Recommendation of the Trust as a place to work or
receive treatment
• Having equality and diversity training in last 12 months
The above five key findings are included in the eleven key
findings where the Trust is in the bottom 20% for like type
Trusts. The other six key findings in this category are:
• Staff feeling satisfied with the quality of work and patient
care they can deliver
• Agreeing that their role makes a difference to patients
• Work pressure felt by staff
• Having well-structured appraisals in the last 12 months
• Experiencing work related stress in the last 12 months
• Able to contribute to improvements at work
37
Whilst the results of the 2012 survey were disappointing,
they were not wholly unexpected in the context of the
significant change which services and staff have
experienced in the preceding 12 months.
The Trust has therefore been pro-active in starting a staff
engagement programme which will be co-ordinated and
overseen by a Workforce and Organisational Development
Committee. This committee will report to the Trust Board
Executive Committee and will oversee four work streams
of ‘Training’; ‘Culture’; ‘Workforce’ and ‘Staff Engagement’.
The Trust Board has approved a set of recommendations
which will enable the Trust to respond to the results of the
2012 survey. Three key findings have been set at the
priorities, these are ‘stress at work’; ‘communication with
senior managers’ and ‘recommendation of the Trust as a
place to work and receive treatment’.
In respect of these key findings, work has commenced
through the running of focus groups led by staff for staff to
understand experiences, to enable individuals to identify
actions they can take to make a difference, what managers
can do and how organisational issues can be addressed.
Specific actions have already been identified such as a
comprehensive review of the appraisal process to
streamline the documentation and ensure the process is
meaningful for staff and managers; reviewing and revising
the Trust’s recognition programme to include local or more
frequent recognition where staff are making a difference to
our service users and carers; holding health and wellbeing
days for staff; revising and re-publicising our Dignity at
Work scheme encouraging staff to seek support and
advice on issues at work; and improving course booking
processes to ensure staff can more easily book training
and supporting managers to release staff.
Staff will be asked to participate in both structured
conversations and anonymous online surveys on the topics
above. Specifically, we will seek ideas from staff on how
we can make further improvements in the care we are
commissioned to provide and how we can make our Trust
a better place to work.
The Trust will actively work with Staff Side representatives
who are committed to improving the working environment
and all feedback will be fed into our new Staff
Engagement Committee. We will continue to ask
managers what additional support they need and we are
planning an additional leadership and development
programme for the Autumn.
Further details can be found in the Annual Staff Survey
section of our Annual Report and Accounts 2012/13.
PEAT Assessment Results 2012/13
Every year, our locations are assessed for the quality of the environment, food, and for privacy and dignity. These are
known as Patient Environment Action Team (PEAT) assessments. The table below gives a summary of their findings for
the eight main inpatient premises during the year.
This is the last publication of PEAT results in their current form; following a Government announcement in July 2012 that a
new inspection programme will be developed for launch in April 2013.
Weighted
Environment
Score
Overall
Food Score
Overall
Privacy &
Dignity Score
Charlton Lane
4 Good
5 Excellent
5 Excellent
Wotton Lawn
4 Good
4 Good
5 Excellent
Laurel House
4 Good
5 Excellent
5 Excellent
Honeybourne, Cheltenham
4 Good
4 Good
5 Excellent
Hollybrook
4 Good
5 Excellent
5 Excellent
Westridge
4 Good
5 Excellent
5 Excellent
BranchLea Cross, Cheltenham
4 Good
5 Excellent
5 Excellent
Stonebow Unit
4 Good
5 Excellent
5 Excellent
Site Name
38
Annex 1. Statements from our Partners on the Quality Account
We have taken the opportunity of sharing our Quality Account progress and development with many of our partners
throughout the year, including the Board of Governors. We are very grateful for the time they have taken to provide
helpful comments and suggestions in its content and layout.
We have already taken the opportunity to include many of their very useful suggestions and recommendations in the final
version of this document. Responses from those partners who have made formal written responses are given below.
Gloucestershire Health, Community and Care Overview and Scrutiny Committee
Comments on the 2gether NHS Foundation Trust
Quality Report 2012/13
The Health, Community and Care Overview and Scrutiny Committee (HCCOSC) welcome the opportunity to
comment on the 2gether NHS Foundation Trust’s Quality Account 2012/13.
The committee has developed a good working relationship with the 2gether NHS Foundation Trust; and appreciates
the open manner in which Trust representatives attend committee meetings. I hope that this will continue into the
new council and the new Health and Care Overview and Scrutiny Committee.
The Quality Account shows that a lot of work has been undertaken by the Trust during 2012/13; and demonstrates
the Trust’s commitment to its service users and their carers.
The Winterbourne View and Francis Reports have raised serious concerns regarding the care of patients and
damaged people’s confidence in the care system. It is good to see that the Trust has taken forward the issues and
lessons discussed into its work planning and leadership team.
However, following on from my comments on the structure of the 2011/12 Quality Account, I must again comment
that this document is not easily accessible, and suggest that the Trust considers the presentation of this report such
that it is more easily understandable.
I would like to thank Shaun Clee, Trish Jay and Jane Melton for attending our meetings and answering our
questions in a helpful and informative manner.
Cllr Stephen McMillan
Chairman
Herefordshire Health, Community and Care Overview and Scrutiny Committee
Comments on the 2gether NHS Foundation Trust
Quality Report 2012/13
The Health and Social Care Overview and Scrutiny Committee have created a good working relationship with
2
gether NHS Foundation Trust over the past year. In light of the Francis report and the significant changes to the
health care system, it is imperative that this relationship continues to develop and grow.
We are now working in a world where transparency and openness is of even more importance than ever. The
Committee would like to thank 2gether for their openness and transparency in their reports and in meetings
attended.
Though the Committee has no specific points to make reference this year’s Quality Accounts, the Committee are
changing the way in which they view and comment on Quality Accounts. Later this year the Committee shall invite
key stakeholders to a briefing on the content of Quality Reports, recurring themes and areas of improvement. This
will then allow the Committee to make a comprehensive and informed response for 2013/2014.
It would be of great benefit if the Committee could receive the Quality Reports well within time next year to allow
Members to give sufficient scrutiny of the document.
I would like to thank Shaun Clee and Colin Merker for their attendance at the Health and Social Care Overview and
Scrutiny Committee.
Councillor Jeremy Millar,
Chair of Health and Social Care Overview and Scrutiny Committee
39
Gloucestershire Local Involvement Network (LINk)
Comments on the 2gether NHS Foundation Trust
DRAFT Quality Account 2013
Gloucestershire LINk welcomes the opportunity to comment on the draft 2gether NHS Foundation Trust’s 2013
Quality Account. The following comments have been compiled by a group of LINk members.
This early draft of the Quality Account does not include a large amount of qualitative data or the CEO’s statement,
which makes the comments rather limited.
LINk has been aware that there have been improvements in the mental health services for residents of
Gloucestershire and feel that the draft does not sufficiently emphasise where the Trust is providing an excellent
service and also where improvements have been made.
It would be helpful to highlight the transitions/changes which have taken place during this report period. For
example, the prison closed in mid-February resulting in incomplete data-sets relating to the effort put into this area
of work.
As this is a document that is available to the public it might be better if there was an explanation of the ‘Fair
Horizons’ model of care or Care Programme approach so that the public can understand the different parts of the
mental health services in the county. An example of this is found in the statement that the implementation of a
contact centre will improve the service without explaining how this helps.
There is a lack of qualitative information which is disappointing especially in relation to this particular area of health.
More qualitative evidence would bring the report ‘alive’. Some explanation of how certain issues, such as the
number of falls, are being tackled and how positive results have been achieved would be useful.
A more consistent approach in the presentation of data would be welcome particularly where data for
Gloucestershire and Herefordshire are seen side by side.
We would also suggest that specific percentages be used to give a more accurate reflection of the Trust’s efforts
into service improvement, especially as achievements have mostly met and exceeded targets.
There is a disappointing lack of understanding of Equality Diversity System (EDS) as baselines do not appear to
have been set. Moreover, it is not obvious how partnership with other services has improved this engagement with
the community.
We would very much welcome the establishment and implementation of a Children’s IAPT in Gloucestershire as
this was a clear gap in the CYP services provided.
We were delighted to see that the inpatient wards for Older Peoples’ services in Gloucestershire had gained
accreditation with national standards.
The development of the Service User Charter has enabled patients to understand the ethos of the organisation.
It is disappointing that only 48% of staff taking part in the random sample returned their questionnaire compared
with 60% in the previous year and that one of the key findings that compare least favourably with other Mental
Health/Learning Disability Trusts was the ‘motivation at work’ which is reflected in these scores.
Unfortunately, the cessation of the LINks on March 31 makes it impossible to do more than make these brief
comments which may not be relevant on the completed document.
Barbara Marshall
Chair of Gloucestershire LINk
28 March 2013
40
Healthwatch - Herefordshire
Comments 2012-13 Quality Account for
2
gether NHS Foundation Trust
1. Thank you for the opportunity to comment on the Quality Account. You will be aware that Healthwatch
Herefordshire came into being on the 1 April; therefore this response is built on information derived from or collated
by the Herefordshire LINk. Healthwatch Herefordshire looks forward to receiving the Quality Account for 2013/14
and making a fuller contribution as we will have data to compare with this Account and knowledge gained during
this coming year.
1.1 We would like to acknowledge the work that the Trust has done to build the relationship with partners in
Herefordshire to secure better quality services. Attendance at and the reports given to the LINk during the year
were well received. The co-ordination of activity with partners to support service users and their carers enabled a
clearer understanding of the roles of each organisation and where there were potential gaps in services or the
quality was not as it should be.
1.2 This work is not reflected in the Account and would have been an opportunity to demonstrate that the Trust is
committed to support the work of others as part of driving up quality. An area identified as a gap in service was the
need to listen to Carers concerns about deterioration in the mental health of the person they care for. A report
produced jointly by the LINk and Herefordshire Carers Support and subsequent explorations had identified that
some carers of people with enduring conditions didn’t know where to contact or felt they had not been listened to,
and this had resulted in a crisis incident. We note in the CQUINS section of the Account that this is an area to be
monitored and will be of continuing concern. Other parts of the Account refer to crisis care for the service user,
showing positive results, maybe cross referencing of some standards would be helpful.
1.3 Participation in clinical research is cited as low in Herefordshire for this period due to service changes; however,
we understand that involvement with research has been low in Herefordshire for some time, according to
information from the PCRN. With a rural scattered population and transport challenges it is important for
Herefordshire people to be offered the same opportunities to engage with research as people in other areas such
as Gloucestershire and for this to be facilitated appropriately.
1.4 One aspect not commented upon but with a bearing on one of the CQUIN goals, namely to ‘improve
responsiveness to the personal needs of patients’, is initial access to mental health care and support and possibly
identification of needs at the first point of access. Recent feedback to Healthwatch indicates that there is a
perception that mental healthcare and support is diminishing within the voluntary sector and needs to be picked up
by statutory services. In the meantime increasing numbers of people do not know where to go for support and help.
Therefore, access to the mental health services pathway may be an area to monitor for the future.
1.5 The Account gives a good record of the quality ‘tool box’, the impact on the longer term benefits to people using
the services and their families is less clear and we hope that Healthwatch will have a role in ensuring this is
embedded as the goal for us all.
Paul Bates
Interim Chair
Herefordshire Healthwatch
02/05/2013
41
Gloucestershire Clinical Commissioning Group
Statement for Quality Account
2
gether NHS Foundation Trust 2012/13
Gloucestershire Clinical Commissioning Group (CCG), on behalf of its predecessor NHS Gloucestershire, has
taken the opportunity to review the Quality Account prepared by 2gether NHS Foundation Trust (2gether) for
2012/13.
We are pleased that 2gether has been working alongside NHS Gloucestershire and the shadow CCG during
2012/13 to maintain and further improve the quality of commissioned services.
gether have engaged with the development of initiatives such as the Map of Medicine and Your Health, Your Care
strategy– our shared vision for the future. They have also demonstrated further improvement of the safety,
effectiveness and patient experience of services particularly in relation to the successful development of an
appropriate Outcome Measure for Learning Disability services and reduction in the number of patient falls within
inpatient environments in Gloucestershire.
2
The CCG very much welcome 2gether’s focus on patient experience and quality of care, which demonstrates a joint
commitment to delivering high quality compassionate care. We look forward to developing a whole health and
social care community clinical programme approach towards commissioning and delivering services, with a strong
emphasis on clinical leadership and engagement. Integrated care will be delivered according to agreed pathways
and standards, with strong user and carer involvement being evident from prevention to end of life.
There are robust arrangements in place with 2gether to agree, monitor and review the quality of services. The
Clinical Quality Review Group continues to meet bi-monthly and brings together GPs, senior clinicians and
managers from both 2gether and Gloucestershire CCG. We have received assurance throughout the year from
2
gether in relation to key quality issues, both where quality and safety has improved, and where it fell below
expectations, remedial plans put in place and learning shared wherever possible.
It is the view of the CCG that the Quality Account produced by 2gether does not in general reflect a balanced view
of some of the services provided by the Trust. Whilst acknowledging the excellent outcomes delivered by 2gether,
the Account would provide a more rounded view of services if the areas for improvement were more clearly
identified. For example in respect of children and young people’s services (CYPS) the targets indicated in the report
show successful year end outcomes, 95% of non-urgent tier 3 cases will be seen within 8 weeks (CYPS) achieving
97%, however the target for Non-urgent tier 3 cases will be treated within 8 weeks (CYPS) achieved a year end
performance of 74%, and did not achieve the target and was not reported in the account. The CCG are aware of
the efforts to improve this target but feel as a public document it would be more transparent to clearly highlights
areas for improvement and describe actions to improve these services.
It was disappointing to see the results of the staff survey indicating the Trust's score was in the lowest 20% when
compared with Trusts of a similar type, and a decrease in staff recommendation of the Trust as a place to work or
receive treatment which was also in the lowest 20%. The CCG welcome the initiatives described in the report to
address these concerns and will be working with 2gether over the next few months to ensure improvement in these
key areas.
The priorities for 2013/14 have been developed in partnership and Gloucestershire CCG endorse the proposals set
out in the Quality Account. The Francis report and the failings at Winterbourne View underline the importance of
honesty; transparency and engaging with stakeholders and the CCG are committed to working with 2gether to
ensure they are in a strong position to manage both present and future challenges. The CCG will work with 2gether
to deliver best value effective care for the people of Gloucestershire. Upholding these values ensures that the
population of Gloucestershire will maintain trust and confidence in these core NHS services.
Gloucestershire CCG can confirm that we consider that the Quality Account contains accurate information in
relation to the quality of services that 2gether NHS Foundation Trust provides to the residents of Gloucestershire.
Marion Andrews-Evans
Executive Nurse and Quality Lead
NHS Gloucestershire Clinical Commissioning Group
42
Herefordshire Clinical Commissioning Group
Statement for Quality Account 2012/13
2
gether NHS Foundation Trust
Our ref:
Ask for: David Farnsworth
Tel: 01432 260618
Email: david.farnsworth@herefordshireccg.nhs.uk
Herefordshire Clinical Commissioning Group (CCG) is pleased to receive 2gether NHS Foundation Trust quality
account for 2012/13 which provides an overview of the quality of services during the period, and sets out priorities
for the forthcoming year.
Following a review of the information presented, coupled with commissioner led reviews of quality across all
providers, the CCG is satisfied with the accuracy of the report. This recognises the Trust commitment to quality and
demonstrates further development which mirrors the aspirations of commissioners.
The CCG appreciates the renewed focus to improve the physical health of patients with mental health problems,
alongside the commitment to reduction in suicide within the service user group. Furthermore, the focus on
improving patient experience is welcomed which mirrors wider national learning which increasingly values the voice
of service users.
Herefordshire CCG has set out a quality framework which includes assurance visits and regular quality review
meetings between provider and commissioners to scrutinise and challenge quality. We look forward to continuing
this work during the coming year to ensure the delivery of high quality, high performing and safe services for the
residents of Herefordshire.
Yours sincerely,
David Farnsworth
Executive Lead Nurse
Herefordshire CCG
The Royal College of Psychiatrists
Statement of Participation in National Quality Improvement Projects
managed by The Royal College of Psychiatrists’ Centre for Quality Improvement
Participation
by Trust
National
Participation
3 ECT Clinics
93 ECT Clinics
Working age adults wards
4 wards
165 wards
Psychiatric intensive care units (PICU)
1 PICU
34 PICUs
Older people mental health wards
3 wards
57 wards
Inpatient learning disability units
2 units
36 units
Inpatient rehabilitation units
0 units
36 units
2 services
61 services
0 teams
43 teams
April 1 2012 – March 31 2013
CCQI Programme
Service accreditation programmes
ECT clinics
Memory services
Psychiatric liaison teams
43
Participation
by Trust
National
Participation
0 units
91 units
2 teams
45 teams
0 communities
83 communities
Low secure forensic mental health services
0 services
66 services
Medium secure forensic mental health services
0 services
64 services
0 units
15 units
April 1 2012 – March 31 2013
CCQI Programme
Service quality improvement networks
Inpatient child and adolescent units
Child and adolescent community MH teams
Therapeutic communities
Perinatal mental health inpatient units
The Royal College of Psychiatrists
Statement of Participation in the Prescribing Observatory for Mental Health (POMH)
2
gether NHS Foundation Trust was not a member of POMH in 2012/13
April 1 2012 – March 31 2013
POMH Topic
Number of patients enrolled
by Trust
Number of patients
enrolled nationally
Prescribing antipsychotics for dementia (Topic 11a)
0
TBC
Assessment of the side effects of depot antipsychotics
(Topic 6c)
0
TBC
Monitoring of patients prescribed lithium (Topic 7c)
0
TBC
Prescribing antipsychotics for children & adolescents
(Topic 10b)
0
TBC
The Royal College of Psychiatrists
Statement of Participation in the National Audit of Psychological Therapies
April 1 2012 – March 31 2013
2
Number of teams enrolled
by Trust
gether NHS Foundation Trust
1
Number of teams
enrolled nationally
TBC
Trust Contacts for National Quality Improvement Projects
CCQI Programme
Name
Email
ECT Clinic - Gloucestershire
Dr Jim Laidlaw
jim.laidlaw@glos.nhs.uk
Working age adults wards
Dr Tiffany Earle
tiffany.earle@glos.nhs.uk
Psychiatric intensive care units (PICU)
Caroline Driscoll
caroline.driscoll@glos.nhs.uk
Older people mental health wards
Sally Simmonds
sally.simmonds@herefordpct.nhs.uk
Inpatient learning disability units
Tim Coupland
tim.coupland@glos.nhs.uk
Inpatient rehabilitation units
Sarah Bennion
sarah.bennion@herefordpct.nhs.uk
Mathew Page
mathew.page@glos.nhs.uk
Service Quality Improvement Networks
Children & Young Peoples Services
44
Annex 2. Statement of Directors’ Responsibilities in respect of
the Quality Report
The directors are required under the Health Act 2009 and the National Health Service Quality Accounts Regulations 2010
as amended to prepare Quality Accounts for each financial year.
Monitor has issued guidance to NHS foundation trust boards on the form and content of annual Quality Reports (which
incorporate the above legal requirements) and on the arrangements that foundation trust boards should put in place to
support the data quality for the preparation of the quality report.
In preparing the Quality Report, directors are required to take steps to satisfy themselves that:
• the content of the Quality Report meets the requirements set out in the NHS Foundation Trust Annual Reporting Manual
2012/13;
• the content of the Quality Report is not inconsistent with internal and external sources of information including:
o
o
o
o
o
o
o
o
o
o
o
o
Board minutes and papers for the period April 2012 to May 2013
Papers relating to Quality reported to the Board over the period April 2012 to May 2013
Feedback from the Gloucestershire commissioners dated May 2013
Feedback from the Herefordshire commissioners dated May 2013
Feedback from Governors dated April 2013
Feedback from Herefordshire Healthwatch dated 2 May 2013
Feedback from Gloucestershire LINk dated 28 March 2013
The Trust’s complaints report published under regulation 18 of the Local Authority Social Services and NHS
Complaints Regulations 2009, dated April 2013;
The 2012 national patient survey
The 2012 national staff survey
The Head of Internal Audit’s annual opinion over the trust’s control environment dated May 2013
CQC quality and risk profiles dated April 2012 to March 2013
• the Quality Report presents a balanced picture of the NHS foundation trust’s performance over the period covered;
• the performance information reported in the Quality Report is reliable and accurate;
• there are proper internal controls over the collection and reporting of the measures of performance included in the
Quality Report, 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 Report is robust and reliable, conforms to
specified data quality standards and prescribed definitions, is subject to appropriate scrutiny and review; and the Quality
Report has been prepared in accordance with Monitor’s annual reporting guidance - which incorporates the Quality
Accounts regulations - (published at www.monitor-nhsft.gov.uk/annualreportingmanual) as well as the standards to
support data quality for the preparation of the Quality Report available at
www.monitornhsft.gov.uk/annualreportingmanual.
The directors confirm to the best of their knowledge and belief they have complied with the above requirements in
preparing the Quality Report.
By order of the Board
NB: sign and date in any colour ink except black
Date: 28 May 2013
Chair
Date: 28 May 2013
Chief Executive
45
Annex 3. Glossary
AIMS
National accreditation for Inpatient Mental Health Services process led by
the Royal College of Psychiatrists. It is a standards-based accreditation
process for adult inpatient mental health services that encourages
organisations to identify and prioritise problems and sets achievable
targets for change.
CAMHS
Child and Adolescent Mental Health Services
CBT
Cognitive Behavioural Therapy
Clinical Commissioning Group
CCG
CPA
Care Programme Approach: a system of delivering community service to
those with mental illness
CQC
Care Quality Commission – the Government body that regulates the quality
of services from all providers of NHS care
CQUIN
Commissioning for Quality & Innovation: this is a way of incentivising NHS
organisations by making part of their payments dependent on achieving
specific quality goals and targets
CRA
The Community Reinforcement Approach (CRA) is a comprehensive
behavioural programme for treating substance-abuse problems
Essence of Care Screening
Essence of Care Screening is a method of assessing the risks associated
with the condition of a service user so that the most appropriate treatment
can be determined
2
gether NHS Trust’s programme to reengineer their services more around
their service user’s individual needs in a one-stop shop approach rather
than being looked after by many different teams. This will provide much
enhanced quality of care
Fair Horizons
46
Green Light Mental Health Toolkit
A self-audit set of 39 indicators that was initially instigated by the
Healthcare Commission (previous regulator to CQC) to measure the quality
of the health services provided to people with learning disabilities
GRiP
Gloucestershire Recovery in Psychosis (GRiP) is 2gether’s specialist early
intervention team working with people aged 14-35 who have first episode
psychosis
GSAS
Gloucestershire Smoking Advice Service
HCCOSC
Health, Community and Care Overview and Scrutiny Committee
HoNOS
Health of the Nation Outcome Scales – this is the most widely used routine
measure of clinical outcome used by English mental health services.
IAPT
Improving Access to Psychological Therapies
Information Governance (IG) Toolkit
The IG Toolkit is an online system that allows NHS organisations and
partners to assess themselves against a list of 45 Department of Health
Information Governance policies and standards
The King’s Fund
The King’s Fund is a charity that seeks to understand how the health
service in England can be improved
KUF
The National Knowledge and Understanding Framework on Personality
Disorder is a national framework to support people to work more effectively
with personality disorder
LINk
Local Involvement Networks (LINks) are groups made up of individuals and
community groups, such as faith groups and residents’ associations,
working together to improve health and social care services
LIPS
The Leading Improvement in Patient Safety programme (LIPS) is
concerned with building capacity and capability within hospital teams to
improve patient safety
MECC
Making Every Contact Count is about using every opportunity to talk to
individuals about improving their health and wellbeing
Memory Assessment Service
Memory assessment services offer a responsive service to aid the early
identification of dementia, and include a full range of assessment,
diagnostic, therapeutic and rehabilitation services ensuring an integrated
approach to the care of people with dementia and the support of their
carers, in partnership with local healthcare, social care and voluntary
organisations
MHMDS
The Mental Health Minimum Data Set is a series of key personal
information that should be recorded on the records of every service user
Monitor
Monitor is the independent regulator of NHS foundation trusts.They are
independent of central government and directly accountable to Parliament
MRSA
Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterium
responsible for several difficult-to-treat infections in humans. It is also
called multidrug-resistant
NHS
The National Health Service refers to one or more of the four publicly
funded healthcare systems within the United Kingdom. The systems are
primarily funded through general taxation rather than requiring private
insurance payments. The services provide a comprehensive range of
health services, the vast majority of which are free at the point of use for
residents of the United Kingdom
NICE
The National Institute for Health and Care Excellence (previously National
Institute for Health and Clinical Excellence) is an independent organisation
responsible for providing national guidance on promoting good health and
preventing and treating ill health
NIHR
The National Institute for Health Research supports a health research
system in which the NHS supports outstanding individuals, working in
world class facilities, conducting leading edge research focused on the
needs of patients and the public
Tier 3 Children’s Services
Services which offer a comprehensive assessment and treatment service
based on a skill mix drawn from professionals from the range of disciplines
and therapeutic backgrounds (such as the local Children and Young
Peoples Service in Gloucestershire and CAMHS in Herefordshire)
NPSA
The National Patient Safety Agency is a body that leads and contributes to
improved, safe patient care by informing, supporting and influencing the
health sector
NTA
The National Treatment Association for Substance Misuse is a special NHS
health authority established to improve the availability, capacity and
effectiveness of drug treatment in England
PCT
The Primary Care Trust, which oversees the operations of providers of
NHS care. The PCTs responsible for 2gether NHS Foundation Trust are
NHS Gloucestershire and NHS Herefordshire.
PEAT assessments
Patient Environment Action Team assessments are assessments carried
out by the NPSA into the quality of the environment, food, and privacy and
dignity in every inpatient location
PICU
POMH-UK
Psychiatric Intensive Care Unit
QRP
The Quality and Risk Profile is a monthly compilation by the CQC of all the
evidence about a Trust they have in order to judge the level of risk that the
Trust carries to fulfil its obligations of care
RiO
This is the name of the electronic system for recording service user care
notes and related information within 2gether NHS Foundation Trust. In a
major exercise, it has been implemented across almost all the Trust’s
areas of operation during 2010
Safety Thermometers
These are national tools for measuring patient safety. The general Safety
Thermometer was introduced for all NHS providers in April 2012. They are
required to submit monthly data returns to the NHS Information Centre.
The Mental Health Safety Thermometer is still in development
SHA
Strategic Health Authority
SIRI
Serious Incident Requiring Investigation, previously known as a “Serious
Untoward Incident”. A serious incident is essentially an incident that
occurred resulting in serious harm, avoidable death, abuse or serious
damage to the reputation of the Trust or NHS. In the context of the Quality
Report, we use the standard definition of a Serious Incident given by the
NPSA
The national Prescribing Observatory for Mental Health is a body that helps
specialist mental health Trusts and healthcare organisations improve their
prescribing practice
47
Service Users Charter
A set of pledges made by 2gether staff about the way in which we will work
with people who use our services
Step 2 IAPT
These interventions include guided self-help (booklets and worksheets)
computerised CBT, employment advice, signposting to other services,
books on prescription, lifestyle support and group work
Step 3 IAPT
The Step 3 service will work with people who have been assessed at Step
2, may have undertaken Step 2 interventions or whose needs require more
complex interventions possibly on an individual basis, which will provided
by High Intensity Therapists
VTE
Venous thromboembolism is a potentially fatal condition caused when a
blood clot (thrombus) forms in a vein. In certain circumstances it is known
as Deep Vein Thrombosis
Annex 4. How to Contact Us
If you have any questions or comments concerning the contents of this report or have any other questions about the Trust
and how it operates, please write to:
Mr Shaun Clee
Chief Executive Officer
2
gether NHS Foundation Trust
Rikenel
Montpellier
Gloucester
GL1 1LY
Or email: shaun.clee@glos.nhs.uk
Alternatively, you may telephone on 01452 894000 or fax on 01452 894001.
Other Comments, Concerns, Complaints and Compliments
Your views and suggestions are important us. They help us to improve the services we provide.
You can give us feedback about our services by:
• Speaking to a member of staff directly
• Telephoning us on 01452 894673
• Completing our Online Feedback Form at www.2gether.nhs.uk
• Completing our Comment, Concern, Complaint, Compliment Leaflet, available from any of our Trust sites or from our
website www.2gether.nhs.uk
• Using one of the feedback screens at selected Trust sites
• Contacting Patient Advice and Liaison Service (PALS) on 0800 0151 548
• Writing to the appropriate service manager or the Trust’s Chief Executive
Alternative Formats
If you would like a copy of this report in large print, Braille, audio cassette tape or another language, please telephone us
on 01452 894000 or fax on 01452 894001.
48
Independent Auditor’s Report to the Council of Governors of 2gether NHS
Foundation Trust on the Quality Report
We have been engaged by the Council of Governors of
2
gether NHS Foundation Trust to perform an independent
assurance engagement in respect of 2gether NHS
Foundation Trust’s Quality Report for the year ended 31
March 2013 (the “Quality Report”) and certain performance
indicators contained therein.
This report, including the conclusion, has been prepared
solely for the Council of Governors of 2gether NHS
Foundation Trust as a body, to assist the Council of
Governors in reporting 2gether NHS Foundation Trust’s
quality agenda, performance and activities.
We permit the disclosure of this report within the Annual
Report for the year ended 31 March 2013, to enable the
Council of Governors to demonstrate they have discharged
their governance responsibilities by commissioning an
independent assurance report in connection with the
indicators.
To the fullest extent permitted by law, we do not accept or
assume responsibility to anyone other than the Council of
Governors as a body and 2gether NHS Foundation Trust
for our work or this report save where terms are expressly
agreed and with our prior consent in writing.
Scope and subject matter
The indicators for the year ended 31 March 2013 subject to
limited assurance consist of the national priority indicators
as mandated by Monitor:
• Delayed Transfers of Care
• Access to Crisis Resolution Teams
We refer to these national priority indicators collectively as
the “indicators”.
Respective responsibilities of the Directors and auditors
The Directors are responsible for the content and the
preparation of the Quality Report in accordance with the
criteria set out in the NHS Foundation Trust Annual
Reporting Manual issued by Monitor.
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 Report is not prepared in all material respects
in line with the criteria set out in the NHS Foundation
Trust Annual Reporting Manual;
• the Quality Report is not consistent in all material
respects with the following sources:
• Board minutes for the period April 2012 to March
2013;
• Feedback from Commissioners dated May 2013;
• Feedback from local Healthwatch organisations dated
May 2013;
• The Trust’s 2012/13 complaints report published
under regulation 18 of the Local Authority Social
Services and NHS Complaints Regulations 2009;
• The Mental Health Patient Survey report 2012;
• The National Staff Survey results 2012;
49
• Care Quality Commission quality and risk profiles
dated March 2012 – September 2012 and October
2012 – March 2013;
• The Head of Internal Audit’s annual opinion over the
Trust’s control environment for the year ending
31/03/2013; and
• Other papers relating to Quality reported to the Board
from April 2012 to March 2013.
• The indicators in the Quality Report identified as
having been the subject of limited assurance in the
Quality Report are not reasonably stated in all
material respects in accordance with the NHS
Foundation Trust Annual Reporting Manual and the six
dimensions of data quality set out in the Detailed
Guidance for External Assurance on Quality Reports.
We read the Quality Report and consider whether it
addresses the content requirements of the NHS
Foundation Trust Annual Reporting Manual, and consider
the implications for our report if we become aware of any
material omissions.
We read the other information contained in the Quality
Report and consider whether it is materially inconsistent
with the documents specified within the detailed guidance.
We consider the implications for our report if we become
aware of any apparent misstatements or material
inconsistencies with those documents (collectively the
“documents”). Our responsibilities do not extend to any
other information.
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 (Revised) – “Assurance Engagements
other than Audits or Reviews of Historical Financial
Information” issued by the International Auditing and
Assurance Standards Board (“ISAE 3000”). Our limited
assurance procedures included:
• Evaluating the design and implementation of the key
processes and controls for managing and reporting the
indicators.
• Making enquiries of management
• Testing key management controls
• Limited testing, on a selective basis, of the data used to
calculate the indicator back to supporting documentation
• Comparing the content requirements of the NHS
Foundation Trust Annual Reporting Manual to the
categories reported in the Quality Report.
• Reading the documents
A limited assurance engagement is smaller in scope than a
reasonable assurance engagement. The nature, timing and
extend of procedures for gathering sufficient appropriate
evidence are deliberately limited relative to a reasonable
assurance engagement.
Conclusion
Limitations
• the Quality Report is not prepared in all material respects
in line with the criteria set out in the NHS Foundation
Trust Annual Reporting Manual;
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
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
Report in the context of the criteria set out in the NHS
Foundation Trust Annual Reporting manual.
The scope of our assurance work has not included
governance over quality or non-mandated indicators which
have been determined locally by 2gether NHS Foundation
Trust.
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 2013:
• the Quality Report is not consistent in all material
respects with the sources specified in the Detailed
Guidance for External Assurance on Quality Reports;
and
• the indicators in the Quality Report subject to limited
assurance have not been reasonably stated in all
material respects in accordance with the NHS
Foundation Trust Annual Reporting Manual.
Deloitte LLP
Chartered Accountants
Bristol Office
28 May 2013
50