Contents
Section 1
Section 2
Section 3
Goal 1
Goal 2
Page
1.1
Introduction to Quality Account
4
1.2
Statement of Directors
5
1.3
Foreword from the Chief Executive
6
1.4
About our Services, Our Mission, Vision
and Values
10
1.5
Executive Summary
12
Our Quality Priorities
2.1
Achievements 2013/2014
28
2.2
Priorities for Improvement Areas
30
2.3
Governance Statement
31
2.4
Our Quality Priorities
34
2.5
Quality Aspirations and Goals
39
Our Progress
3.1
Performance 2013/2014
42
3.2
CQUINs
43
3.3
A year on from Francis
44
3.4 Introduction to progress of Quality Goals
Measurable year on year improvement in
every area of patient safety in community
services.
Safe Care Deliverables
45
Infection Prevention and Control
49
Harm Free Care
53
Pressure Ulcer Prevention and Management
55
Venous Thrombo-embolism
58
Falls Prevention and Reduction
59
Patient Safety Walkabouts
62
Safeguarding
64
Early Warning Trigger Tool
68
Safe Medicines Management
To improve outcomes by developing
integrated care pathways ensuring the right
care, right place, right person, right time.
Transfer of Care
69
Improving End of Life Care
75
Page 2 of 153
47
73
Morbidity and Mortality
78
Acute Pain
80
Dementia
82
Children & Young People
85
National Institute for Health & Care Excellence
Measurable year on year improvement in
patient experience, engagement and
satisfaction.
Improving Patient Feedback
91
Improving Nutrition and Hydration
97
CNO Caring with compassion strategy
100
Improving Health and Wellbeing
102
Promoting a culture of accountability and
openness.
Information Governance
107
Clinical Audit
110
Research
115
Serious Incidents
117
Understanding Claims
119
Care Quality Commission
121
Improving delivery, capacity and capability
in all areas.
Improving Clinical Education and Standards
124
Workforce
127
Transformation
132
Summary of Responses
135
Appendix A
Progress on Francis
142
Appendix B
CQUINs schedule
148
Appendix C
Audit Examples
149
Goal 3
Goal 4
Goal 5
Page 3 of 153
93
SECTION 1
1.1 What is a Quality Account?
Quality Accounts are annual reports that all providers of NHS services in England have a
statutory duty to produce to the public about the quality of services they deliver and their
plans for improvement.
The purpose of the Quality Account:



Public accountability is increased and quality improved within NHS organisations so
that the public can hold providers to account for the quality of services they deliver.
Patient and cares can make informed choices about their providers of healthcare.
Boards of providers review their performance over the previous year, identify areas for
improvement, and publish that information, along with a commitment to you about how
those improvements will be made and monitored over the next year.
The three important quality improvement areas:



Patient safety
Clinical effectiveness (how well the care provided works)
Patient experience (how patients experience the care they receive)
Some of the information in a Quality Account is mandatory but most is decided by patients
and staff. This Quality Account contains information about the quality of our services, the
improvements we have made during 2013/14 and sets out our key priorities for next year.
This report includes the comments of our external stakeholders on how well they think we
are doing including:



Clinical Commissioning Groups
Kent County Council
Healthwatch Kent
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1.2 2013/14 Statement of Director Responsibilities in Respect to the Quality Report
The Trust’s Directors are required under the Health Act 2009 and the National Health
Service (Quality Accounts) Regulations 2010 to prepare Quality Accounts for each
financial year. National guidance has been issued on the form and content of annual
quality accounts (which incorporate the above legal requirements) and on the
arrangements that Boards should put in place to support the data quality for the
preparation of the Quality Account.
In preparing the Quality Account, directors are required to take steps to satisfy themselves
that the content of the Quality Account meets the requirements set out.
The content of the Quality Account is not inconsistent with internal and external sources of
information including:














Board minutes and papers for the period April 2013 to March 2014
Papers relating to quality reported to the Quality Committee over the period April 2013
to March 2014
Feedback from commissioners – May 2014
The Trust’s complaints reports 2013/14
The national staff survey 2013/ 2014
CQC quality and risk profile 2013/14
Feedback from governors
Feedback from Healthwatch organisations – May 2014
The national patient survey 2013
The head of internal audit‘s opinion over the trust’s control environment dated 2013/14
The performance information reported in the Quality Account is reliable and accurate
There are proper internal controls over the collection and reporting of the measures of
performance included in the Quality Account, and these controls are subject to review
to confirm that they are working effectively in practice
The data underpinning the measures of performance reported in the Quality Account is
robust and reliable, conforms to specified data quality standards and prescribed
definitions, is subject to appropriate scrutiny and review; and the Quality Account has
been prepared in accordance with 2013/14 reporting guidance (which incorporates the
Quality Accounts regulations)
The Directors confirm to the best of their knowledge and belief they have complied with
the above requirements in preparing the Quality Account.
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1.3 Foreword from the Chief Executive
Welcome to our third Quality Account from Kent Community Health NHS Trust (KCHT).
This publication describes just how seriously we consider quality and safety issues and
how we continually work to improve care to patients and families. We want to make users
confident of the quality of our services and we aim to continue to deliver the very best
healthcare to people in the community and closer to home.
The quality account is one of the most important documents that we publish each year and
sets out the priority areas that we need to focus on. These have been identified by
patients, staff and partner organisations. By comparing ourselves with other organisations
we can identify areas where we can further improve and consistently deliver high
standards of care. This includes communication with our patients, relatives,
commissioners and partner organisations. We also need to ensure that our staff have the
right skills and competences; we are able to contribute to plans and have the right capacity
to fulfil our role within the health and social care system.
Care regulations have been amended and are reflected in this account. To ensure that the
Trust responds to central changes we closely follow Department of Health requirements
and respond positively to the recommendations in national publications, as well as
listening and responding to what our staff, patients and commissioners say.
In this document we outline the progress that we made in 2013/14 and areas where we
need to improve further.
This year we have developed our Quality Strategy which clearly sets out the four quality
aspirations which we will be aspiring to achieve, underpinned by a well-led, open culture.
1.
2.
3.
4.
Equal partnerships between patients, their families and the delivery of KCHT
services which respect individual needs and values and demonstrates care,
compassion, continuity and shared decision-making.
There will be no avoidable injury or harm to people who receive KCHT services
and a safe, clean environment will be provided at all times
Treatment, interventions, support and services will be appropriate and
effective, provided at the right time, by the right person with the right skills and
wasteful and harmful variation in care will be eradicated.
A culture of transparency and openness through learning, sharing and
innovation. This will be a cornerstone in driving and sustaining excellent care,
through robust governance, leadership and accountability at all levels.
Underpinning the quality aspirations will be the priorities for improvement in 2014/15 which
were agreed following discussions with our patients, staff, shadow governors, Trust
members and partners and reflect what was important to them. The quality goals for
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2014/15 focus on the three pillars of patient safety, clinical effectiveness and patient
experience and the continued need to develop our staff and our culture.
We recognise how important it is for us to continue to build on our partnerships with our
commissioners and GP colleagues, all providers, the county and district councils, the
voluntary sector and our communities in order to make a real difference to people’s lives
and experience of the wider health economy.
We work closely with the people who use our services and their carers and families. With
their involvement and that of our Trust shadow governors and members and voluntary
groups we are working together to improve services.
This year has seen many improvements in the Trust including new models of care which
have resulted in the restructuring of most of our teams. It has been a challenging time for
staff but they have worked hard to implement initiatives which are designed to improve
quality and you will find many examples detailed in case studies in this Quality Account.
Our work with our partners to deliver integrated care pathways and to achieve the best
possible outcomes for patients has been recognised by the Department of Health which
chose Kent as one of fourteen pioneers in the country to take forward the integration of
health and social care.
The Trust has made favourable progress during the past 12 months, although we still need
to continue to make improvements. There is more work to be done in reducing patient
harms, such as pressure ulcers and medication errors; we need to improve recruitment
and retention of staff, staff competencies, mandatory training and staff morale. It is also
critical that patients, their families and members of staff at whatever level they work,
should feel confident to raise concerns within a safe environment and that something will
happen as a result. It is the most basic ingredient of our duty of care. We will spend more
time talking with staff, through organised listening events, informal walkabouts and team
meetings to support a more open culture.
It is critical that we focus on the culture of the organisation and ensure that it is founded on
the Chief Nursing officer 6Cs; care, compassion, courage, communication, competence
and commitment. It has been a key priority for 2013/14 and will be a high priority for next
year to ensure that we encourage a culture within the Trust where everybody feels able to
provide first class care every time, for every patient and their family.
We want to continue to be open and to learn when things go wrong and ensure that all
staff have the required competence to deliver what is expected by patients and their
families. We need to ensure good communication and treat everybody with compassion
and with a commitment to always do the best that we can.
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The Trust has a clear vision and value-based framework to ensure that strong leadership,
at all levels, remains key to realising our vision. There is a continued emphasis on
leadership and management at every level of the organisation. We also recognise the
need for a culture that permeates every level of the organisation. We want to recruit and
retain the highest quality of staff and invest in their continued development, so they can
reinforce the standards and commitment to quality patient care. We recognise there is still
further work to do and we will continue to build our standards and value base supported by
robust appraisals.
Turnover has remained a key issue but this has been expected in a year of transition and
change. We will monitor this closely and take action to address any particular areas of
concern. We have focused on reducing the number of days lost to sickness absence this
year as we see this as an important way to improve quality of life and reduce costs. It will
continue to be a focus of activity next year.
We continue to reduce further the numbers of hospital acquired infections. In 2013/14 we
had the lowest numbers of Clostridium difficile ever. However, recognising that one is too
many, we continue to scrutinise every case to ensure learning to prevent these infections.
We also had a major focus on reducing the number of pressure ulcers and we have
increased the number of teams with reduced incidents of pressure ulcers. We still have
teams that need to improve and unfortunately this meant that we exceeded our trajectory.
The Director of Nursing and Quality continues to work with clinical teams to understand the
causes and put in measures to do all we can to drive down incidences.
2014/15 is going to be an extremely challenging but also exciting year for the Trust. We
are committed to improving patient and staff experience in all aspects of our performance.
We will be assessed by the Care Quality Commission in June 2014. The assessment will
focus on whether our services are safe, effective, caring, responsive and well-led.
In 2014/2015, the cost improvement programme will be a challenge. We are confident our
quality and transformation plans will enable us to reduce costs and to continue to deliver
effective and efficient services to meet current and future demands. Our progress against
the quality goals in 2014/15 will be monitored by the Board and reported through our
governance systems, especially the Quality Committee which reviews information and
performance of local teams through to the board on a monthly basis.
I want to take this opportunity to thank all our staff for continually striving to improve the
care that they deliver; staff and service users for providing valuable feedback on our
services as well as colleagues for their continued partnership working.
Page 8 of 153
Declaration
The Chief Executive should be the accountable officer for the Trust and that responsibility
includes accountability for clinical governance and hence the quality and safety of care
delivered by the Trust. The information in this Quality Account is provided from our data
management and our quality improvement systems and to the best of my knowledge is
accurate and provides a true reflection of our organisation.
Marion Dinwoodie
Chief Executive
Page 9 of 153
1.4 About our Services
Kent Community Health NHS Trust is one of the largest providers of NHS care in patients’
homes and the community in England.
We provide care for patients in their own homes and in other locations, including GP
surgeries, nursing homes, health clinics, community hospitals, minor injury units and
children’s centres.
Our 5,400 strong workforce includes doctors, community nurses, dieticians, health visitors,
dentists, podiatrists, occupational therapists, physiotherapists, family therapists, clinical
psychologists, speech and language therapists, radiographers, pharmacists, health
trainers, health improvement specialists and many more.
Our services are commissioned by clinical commissioning groups, local authorities and
NHS England, mostly in Kent, but also in neighbouring areas.
The Trust provides services for children and adults to support them to stay healthy,
manage their long-term health conditions, help them avoid going into hospital and, when
they have needed to be in hospital, help them to get home quickly.
Advice and support for children’s emotional and physical health and wellbeing is available
from a range of services, including health visitors, by attending one of the Trust’s parenting
support groups in children’s centres or from our school-based nurses.
Our health and wellbeing services support people to make positive lifestyle choices. Help
is available to increase exercise, eat healthily, quit smoking and assist with wider health
and social needs. Sexual health services encourage safe sex and provide contraception,
family planning and treatment.
If people do become ill and need treatment, there are seven minor injury units across Kent,
which treat a range of minor illnesses and injuries. We also provide emergency and
specialist dental treatment, wheelchairs and other specialist equipment.
A range of specialist services, including physiotherapy, podiatry, orthopaedics and chronic
pain are provided in the community so that people can get treatment close to home.
Nursing and therapy teams provide care in people’s homes and help in managing longterm conditions, so they don’t have to go into hospital unnecessarily.
We have a rapid response service 24-hours-a day, seven-days-a-week where experienced
nurses, following a request from a GP or other health professional, assess a patient’s
needs within two hours and put a package of care in place to enable the patient to stay at
home rather than go to hospital.
Page 10 of 153
More complex care for people, who otherwise would have needed to go into hospital,
called step-up care, is also provided in the county’s 12 community hospitals. If people do
need in-patient care in an acute hospital, for example while recovering from an illness, our
staff support people to get back home by providing rehabilitation at home and in
community hospitals.
We provide specialist care in the community, for example for seriously ill children or
rehabilitation following a serious illness or injury and provide care for disabled children and
adults. For more information about the Trust’s full range of services please visit our
website www.kentcht.nhs.uk or contact us using the information on the back of this report.
Our Mission, Vision and Values
Our mission is to provide high-quality, value for money community-based services to
prevent people from becoming unwell, to avoid people going into hospital or to leave
earlier and to provide support closer to home.
Kent Community Health NHS Trust’s vision is to be the provider of choice by delivering
excellent care and improving the health of our communities. We will achieve this through
these five core values:
 Caring with compassion
 Listening, responding and empowering
 Leading through partnerships
 Learning, sharing and innovating
 Striving for excellence.
Our Strategic Goals





Preventing people from becoming unwell and dying prematurely by improving the
health of the population through universal targeted services.
Enhancing the quality of life for people with long-term conditions by providing
integrated services to enable them to manage their condition and maintain their health
Helping people recover from periods of ill health or following injury through the
provision of responsive community services.
Ensuring that people have a positive experience of care and improved health outcomes
by delivering excellent healthcare.
Ensuring people receive safe care through best practice.
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1.5 Executive Summary
This is our third Quality Account as Kent Community Health NHS Trust. It details our
achievements against the key areas of quality improvement set for 2013/14 and where we
need to make further improvements.
In the last twelve months the Trust has made good progress in delivering high quality care,
however there is more work to be done in 2014/2015. Our staff have worked hard to
reduce harm to our patients and have received training in a range of topics that support
safe, person-centred care.
We have implemented the Quality Strategy and held a range of staff engagement events.
Preparation for CQC visits was undertaken through a programme of visits and along with
an Early Warning Trigger Tool, has helped to identify further areas for improvement.
Care strategies for dementia, end of life care and acute pain have been developed and
awareness of issues important to patients, carers and staff have been raised.
We still need to continue to make improvements in areas such as pressure ulcers, wound
management and medication errors, we need to improve recruitment and retention of staff,
staff competencies, mandatory training and staff morale.
It is also critical that patients, their families and members of staff at whatever level they
work, should feel confident to raise concerns within a safe environment and that something
will happen as a result. It is the most basic ingredient of our duty of care.
We will spend more time talking with staff, through organised listening events, informal
walkabouts and team meetings to support a more open culture.
It is critical that we focus on the culture of the organisation and ensure that it is founded on
the Compassion in Care Strategy. This has been a key priority for 2013/14 and will be a
high priority for next year to ensure that we encourage a culture within the Trust where
everybody feels able to provide first class care every time, for every patient and their
families.
Performance and progress in 2013/14 against each goal will be summarised. The key
improvement areas for 2014/15 are detailed in the main report.
Page 12 of 153
Goal 1: Measurable year on year improvement in every area of patient safety in
Community Services
Quality
Goal 1
2013/14
HCAI
Infection
control
Overall
Performance
against
Goals
Improvements
required
33%
Reduction
C Diff on
2013/14
Target
Achieved
40%
Zero MRSA
2013/14
Hand
IPC
CAUTIs
MRSA
Hygiene Mandatory and UTIs
Screening
Compliance Training
50%
100%
95%
95%
reduction
Not fully
achieved
99%
1 case
82%
73.6%
Achieved
Good progress has been made achieving a 40% reduction in C.diff and a 50% reduction in
CAUTIs and UTIs. There was one case of MRSA bacterium attributable to KCHT this year
and MRSA screening compliance was below 100% for 3 months.
Overall there are areas where we have not performed as well this year with Hand Hygiene
and Infection Prevention training below the compliance target. Our PLACE results were
low compared to the National average. The Trust recognises these are priority areas and
there are improvement actions in place to ensure patient safety.
Cleanliness
Food and Hydration
Privacy, Dignity
and Wellbeing
Condition and
Appearance
National Results
95.74%
84.98%
88.87%
88.75%
KCHT Results
88.94%
86.05%
81.78%
77.89%
Quality Goal 1
2013/14
Harm Free Care
Overall
Performance
against Goals
Achieved
Target to Achieve
National 95% HFC
Target to Achieve
95% New Harms
Achieved
98%
We have performed very well in the delivery of harm free care and have been above the
national and regional average consistently throughout the year. We have seen a 2.5%
reduction in harms compared to the 2012/13 position.
Quality Goal 1
2013/14
Falls
Performance
10% Reduction in all
against
Falls
Aims/Objectives
Achieved
7%
10% Reduction in
Falls with Harms
14%
Reduction in
Falls Leading to
Fractures
42.85%
Falls have reduced considerably and in the community hospitals there has been a
significant reduction in falls with harm. We have seen a 42.85% reduction in the number of
falls resulting in a fracture. There was an average of 6.85 falls per 1000 occupied bed days
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(OBD) for 2013/14 which compares favourably against the national benchmark of 8.6 falls
per 1000 OBD for community hospitals (NRLS benchmarking data 2010).
Performance
Zero Avoidable
Quality Goal 1
Grade 3 AND 4
against
2013/14
Aims/Objectives Pressure Ulcers
Pressure Ulcer
Prevention
and
Management
Improvements
required
57
Reduction in
Pressure Ulcers
by 20% of Poor
Performing Areas
81% of Teams
Achieved Zero
Aspirant
Foundation
Trust
Benchmark
20.9
KCHT
Average
Monthly
Attributable
Avoidable
12.7
There has an overall reduction in the numbers of pressure ulcers within KCHT. However
the zero avoidable grade 3 and 4 pressure ulcers target was not met.
81% of teams (including Long Term Services, intermediate care, podiatry and community
hospitals) achieved zero.
7% of teams had one pressure ulcer and sustained
improvement and 12% had two or more. Work has begun in teams where there have been
avoidable pressure ulcers and we will continue to ensure quality improvements are
sustained.
Good practice has been identified; actions taken in response included an easy access
guide to the prevention and management of pressure ulcers; leaflets for formal and
informal carers on prevention of pressure damage; eLearning for Waterlow (risk
assessment tool) and implementation of the Quality Nurse Indicators. A strengthened
Tissue Viability Team is now in place and will be led by a Nurse Consultant.
The reduction of pressure ulcers remains a high priority for the Trust and we proactively
develop initiatives to raise awareness of risks and to prevent harm.
Quality Goal 1
2013/14
Performance
against Aims/Objectives
100% of VTE Assessment
Completed within 24 hours
VTE
Achieved
97%
Our average compliance for the assessment of venous thrombo-embolism risk (VTE)
within 24 hours of admission was 97% and we will continue to aim for 100%. All staff have
been trained and competency assessed and no patient has suffered a VTE under our
care.
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Quality Goal 1
2013/14
Performance
against
Aims/Objectives
Review Patient Safety
Walkabouts
Patient Safety Walkabouts
Achieved
Achieved
A refreshed programme of Patient Safety Walkabouts took place in 2013/14 and a pre-visit
survey was developed. Since July 2013, 324 surveys had been completed which resulted
in a 54% increase in feedback by staff. Key results highlighted 5 action areas:
communication, service development, IT, quality and safety and risk management. These
visits have led to changes and raised awareness of the importance of the right equipment,
insulin administration and team communication.
Quality Goal 1
2013/14
Safeguarding
Adults,
Children and
MCA/DoLs
Performance
against
Aims/Objectives
Improvements
required
Decrease in the
Number of
Cases
Implicating
KCHT
Safeguarding
Concerns
To Improve on To Improve on
To Improve
Safeguarding Safeguarding
on MCA
Children
Adults
Training
Training
Training
Position 80%
Position 80%
Position 79%
Target 85%
Target is 85%
Target 85%
49
89%
80%
89%
Work continues in partnership with Kent Social Care services; in the last 12 months there
has been a steady increase in the number of children subject to a Child Protection Plan.
This upward trend is due to a number of factors, the application of the multi-agency
thresholds and statutory assessments and continued application of the Common
Assessment Framework by our staff.
255 adult protection alerts were raised by KCHT and the numbers of cases where our
services were implicated has risen. Nine of these were confirmed. To ensure patients
under our care do not sustain harm, lessons learned have been cascaded.
Awareness of the Mental Capacity Act and Deprivation of Liberty Safeguards has
increased through a variety of initiatives to support frontline staff. This is a key priority
area.
Safeguarding training compliance was a focus for improvement in 2013/14 and although
we have made progress the adult safeguarding training compliance figure has not been
achieved. Continued efforts will be made to improve compliance.
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Quality Goal 1
2013/14
Safe Medicines
Management
Performance
against
Aims/Objectives
Improvements required
Improve Medication National Target
Improve
Incident Reporting Flu Vaccinations Optimisation of
on 2012/13 Figures
75%
Medicines by 20%
16% increase
49%
Not achieved
Good progress has been made; safe medicine incident reports have increased by 16%.
Of these incidents 87% did not result in any harm; 11% were low harm incidents and 1%
were moderate harm. These predominantly related to administration errors and missed
doses. A detailed action plan has been developed to help eradicate errors and prevent
harm.
KCHT had a successful staff flu vaccination programme with an increase in take up from
17% in 2012/13 to 49%, although significant progress was made we did not meet the
national target.
Performance against the agreed metric for 2013/14 to improve optimisation of medicines
by 20% was not achieved. The Trust has developed a medicines optimisation strategy
which has 6 overarching objectives and includes measurable key performance indictors to
ensure progress can be monitored in 2014/15.
Quality Goal 1
2013/14
Early Warning Trigger Tool
Performance
against
Aims/Objectives
Implement the Early
Warning Trigger Tool
across all services
Achieved
Achieved
An early warning trigger tool has been developed to identify teams where quality
performance is deviating from expected standards and to enable help and support to be
targeted, to provide a level of assurance of quality throughout the implementation of
change and service redesign. This has been implemented across all services. The tool has
highlighted various areas where there have been concerns in some teams and rapid
support has been provided.
Further work is required on the early warning trigger tool and the indicators need to be
refined following its implementation and review.
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Goal 2: To improve outcomes by developing integrated care pathways ensuring
the right care, right place, right person, right time.
Quality Goal 2
2013/14
Transfer of Care
Improve Incident
Improving Transfer of Reporting System
Performance
Care by developing
to Support
Discharge Passport
against
care pathways in four
Analysis of
Aims/Objectives
areas
Transfer of Care
Incidents
Improvements Not fully achieved baseline
Achieved
Not achieved
required
work is in place
Transfer of care is an area where patients and carers would like to see improvements. Our
transfer of care policy has been implemented across all services. We have improved the
reporting system which is enabling us to monitor and analyse such incidents in more
detail.
Work continues with other providers to develop integrated care pathways and improve the
transition pathway for children moving into adult services. Progress has been made and
we will continue to build on what we have achieved.
There were 697 transfers of care incidents from external providers of which 46% were
related to pressure ulcers and 25% were related to admission, transfer and discharge
issues. Internally, the majority of transfer of care incidents involved medication. We will be
prioritising this area during 2014/15 to ensure we improve the transfer of care process for
patients, carers and staff.
Quality Goal 2
2013/14
End of Life
Performance
against
Aims/Objectives
Achieved
Develop an End of Life
Strategy
Achieved
To w ork with our
h ospice
c olleagues
Achieved
90% of Patients
Die in their
Preferred Place
Achieved
We have made significant progress in End of Life and developed an End of Life Strategy
with key stakeholders including patients, carers, the public, our staff and Hospice
colleagues for both adults and children. The focus is on ensuring our workforce has the
skills and competency required to deliver safe effective care.
The significant national review of the Liverpool Care Pathway has resulted in the phasing
out of the LCP and a greater emphasis on the development of individualised care plans for
each patient.
Policies and procedures have been updated throughout the year.
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Quality Goal 2
2013/14
NICE
Performance
against
Aims/Objectives
Achieved
Technological
Appraisals to be 100%
Compliant
Achieved
Twenty-eight quality standards were issued for 2013/14 of which 22 were relevant to our
services along with 30 guidelines. A group has been set up with key stakeholders to
receive, review and agree actions; this group includes patient and public representatives.
Quality Goal 2
2013/14
Acute Pain
Performance
against
Aims/Objectives
Achieved
Pain Audit
Achieved
In response to patient feedback effective management of acute pain was identified as a
developmental goal for 2013/14. A pain audit highlighted that in 94% of cases a holistic
assessment was undertaken within 24 hours of first contact. An assessment of pain was
included and evidence showed that previous effective pain management was discussed
with patients. Medicines management teams have developed training packages for staff
and we now have a pharmacist on call 24 hours a day over 365 days to support and
advise staff on the management of pain.
Quality Goal 2
2013/14
Dementia
Performance
against
Aims/Objectives
Dementia Strategy
Achieved
Achieved
Dementia
Awareness Training
Across All
Community
Hospitals
Achieved
Ensuring that we address the needs of the growing number of people with Dementia was a
developmental goal and we have made excellent progress this year. We have developed a
Dementia Strategy and an associated care pathway. Dementia Support Nurses led by a
Nurse Consultant have delivered training and raised awareness with staff from a wide
range of services and disciplines across the Trust. Staff attending training sessions fed
back that they felt confident in recognising the early signs of dementia and how to
communicate with a person with dementia.
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Quality Goal 2
2013/14
Children and
Young People
Increase the
Number of Families
Performance
Offer of Universal
Benefitting from
Services across
against
Family Nurse
Kent
Aims/Objectives
Partnership
Programme
Successful expansion
100% achieved
Roll out the Early
Intervention and
Prevention Models
Achieved
There has been considerable progress made within Children and Young People’s
services. The Trust has received further investment for expansion of the Family Nurse
Partnership programme to provide intensive early parenting support for 250 teen parents.
Health Visiting services have achieved a 100% offer of universal services and these are
now Health Visiting Lead roles for domestic abuse and perinatal mental health, supporting
over 200 families with children under 5 experiencing domestic abuse. The Active Baby
programme supporting cognitive development and positive parenting has been rolled out
across the teams and early years’ settings.
Our School Nursing teams were the best performing in the SE Coast region achieving high
uptakes of immunisations and growth measurement, and winning national recognition for a
multi-agency toilet training project.
Children’s integrated therapy services have extended into East Sussex and implemented
regular assessment clinics for all disciplines to meet referral targets; urgent referrals are
now allocated and seen within two weeks of referral.
Quality Goal 2
2013/14
Morbidity and Mortality
Performance
against Aims/Objectives
Achieved
Strengthen Morbidity and
Mortality in Community
Hospitals
Achieved
Progress has continued throughout the year and following a review of end of life care More
Care Less Pathway (2013) and the Francis report, a procedure to review all deaths within
the 12 community hospitals is in place. 90% of deaths related to patients who were
admitted for end of life care and 10% were patients whose death was unexpected. No
cause for concern was found in their care and treatment. Key findings from the reviews
have been included into on-going action plans.
Audits of The Deteriorating Patient Policy and Resuscitation were completed. As a
consequence a review of the competency-based training on Basic Life Support, was
completed resulting in the inclusion of management of the deteriorating patient, team
communication and revision of the National Early Warning Score (NEWS) competency
framework. Further work is required to ensure the audit recommendations and actions are
embedded into practice to safeguard patients.
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Goal 3: Measurable year on year improvement in patient experience, engagement
and satisfaction.
Quality Goal 3
2013/14
Performance
against
Aims/Objectives
20% of Patients
undertake Friends
and Family
Scores and
Achieve a Result
of +80 per month
on the Net
Promoter Score
Over 95% Patient
Satisfaction in all
Service Areas
using Meridian
Surveys and at
least 15% Coverage
Achieved
B
Achieved
Improving
patient feedback
Stakeholder
Engagement
Increase by 15%
Achieved
The Trust captures patient feedback in real-time using iPads with ‘Meridian’ software.
Feedback is consistently positive with around 1 complaint for every 10,000 patient
contacts. The number of complaints increased to 362 compared to 301 in 2012/13 in
common with other Kent trusts. This may reflect increased publicity about how to
complain as we encourage people to give their feedback so that we can learn from it and
improve patient experience. Learning from complaints has inspired changes to several
referral, appointment and communication processes.
The Trust’s overall patient experience score this year is 95% and we can be assured that
overall most patients have a positive experience. We are one of the first trusts to introduce
the NHS Friends and Family Test. KCHT’s overall score is positive and above the
benchmark for aspirant Community Foundation Trusts
The Trust has also made significant progress in actively engaging with stakeholders and
exceeded the targets for 2013/14.
Quality Goal 3
2013/14
Improve Nutrition
and Hydration
Performance against
Aims/Objectives
Implement Nursing
Indicators in 100%
of Community
Hospitals including
Nutrition and
Hydration and Pain
Indicators
Achieved
Achieved
Evaluate and Action the
Results of the Hydrant
Project
Achieved
The Trust has an on-going commitment to ensuring patients receive the best nutritional
support and has established a Nutrition and Hydration Group with a comprehensive action
plan in place. In 2013/2014 we took part in a Department of Health pilot project that
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demonstrated that a multi-disciplinary approach is needed to support hydration and has
led to a variety of initiatives being implemented. A range of Nutrition and Hydration
resources are available. Admission questionnaires now identify inpatient choices and new
menus and drinks have been introduced across the community hospitals.
Quality Goal 3
2013/14
Caring with compassion
Performance against
Aims/Objectives
Achieved
Implement the Six
Areas of the Chief
Nursing Officer
Caring and
Compassion Strategy
Achieved
KCHT Definition of
Compassionate Care
Achieved
The Trust held a series of engagement events with patient, carers, public and staff to
define a KCHT definition of compassionate care which was launched at our 1 st Class care
Conference which was attended by the Chief Nursing Officer of England.
Implementation of the Caring with Compassion Strategy is underway and a robust action
plan is in place.
Quality Goal 3
2013/14
Improve Health and
Wellbeing
Performance against
Aims/Objectives
Achieved
95% of Patients
Asked about
Smoking as Part
of their
Assessment
Achieved
90% Offered Referral to
Stop Smoking Services
Achieved
Healthy weight is vital for long-term health and wellbeing and can prevent long-term
conditions such as hypertension, heart disease, type 2 diabetes and certain types of
cancer. During 2013/2014 32,000 people had health checks with the Trust’s Health
Checks Team who collaborated with GPs, pharmacies and other providers.
The Stop Smoking service received on average 92% patient satisfaction and has reviewed
its service model. The team has strengthened its links with Kent and Medway NHS and
Social Care Partnership Trust, which has agreed to become smoke free next year.
The Health Trainer service saw over 4,800 new self-referring clients, achieving excellent
outcomes with 73% of all goals set being fully or partly achieved. In partnership with
schools, pharmacies, community centres and GPs in areas of greatest need, the Healthy
Weight team delivered specific programmes for adults with a high body mass index,
families and children, providing practical help.
KCHT’s integrated sexual health services enabled service users to access all the services
they need in one visit with implementation of a Hub and Spoke model in 35 sites across
Kent and Medway. Staff have undergone training to develop new competencies to allow
them to work across the breadth of the service. Service developments include using social
media to encourage patient participation.
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Goal 4:
Promoting a culture of accountability and openness.
Quality Goal 4
2013/14
Care Quality Commission
Performance against
Aims/Objectives
Achieved
Maintain Registration of 34
Locations without Conditions
Achieved
KCHT is required to maintain registration with the Care Quality Commission (CQC) and
has 34 locations registered.
The CQC has not taken any enforcement action against us in 2013/14.
We have not participated in any special reviews or investigations by the CQC during this
reporting period.
We continue to be registered with the CQC without conditions.
The Trust has a robust assurance process that requires services and subject matter
experts (in areas such as safeguarding, medicines, consent, learning and development
and equality and diversity) to self-assess compliance against the CQC’s 16 Quality and
Safety Outcomes.
The Trust’s mock CQC inspection tools have been re-designed and are now based on the
CQC’s new five domains – Caring, Effective, Responsive, Well-led and Safe. Training and
awareness material is being developed to raise awareness amongst staff.
The Trust will be inspected by the CQC in June 2014.
Quality Goal 4
2013/14
Serious
Incidents
Performance
against
Aims/Objectives
Achieved
Improve Incident
Implement in Full
Reporting across the the “Being Open”
Organisation By 10%
Policy in All
Incidents
7.6%
Achieved
Reduce the Number
OF Serious Incidents
Reduction of 5
In 2013/14 the Trust had total of 79 SIs compared to the 82 reported in the previous year.
The largest proportion related to pressure ulcers and there have been information
governance and falls serious incidents.
The Trust has maintained 100% compliance with the national targets for the completion of
SI investigations.
The Trust has had no Never Events.
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The Being Open policy and the principles of transparency and candour are embedded into
the serious incident investigation process.
A plan of action to ensure the organisation learns lessons from all incidents/near
misses/complaints and claims to improve patient experience and patient/staff safety for the
future is in place and is a key quality priority for 2014/15.
Claims
During the year 2013/14 the Trust had seven clinical claims. In one case we admitted the
care given was not of an acceptable standard. To ensure consistently high standards of
care, the clinical service held a ‘back to basics’ training day and shared the lessons
learned throughout the Trust. Five clinical claims are still being investigated.
We also had four non-clinical claims made against us in this period. One claim was
repudiated and the other three are still being investigated.
Inquests
Reports on Action to Prevent Future Deaths (PFDs) place the Coroner under a statutory
duty to issue a report to any person or organisation where, in the opinion of the Coroner,
action should be taken to prevent future deaths.
The Trust has received one such report in 2013/14. The report related to communication
between healthcare providers and the holistic training of district nurses. Actions have been
taken to mitigate risks in the future and lessons learned have been shared across the trust.
Data Quality
Effective delivery of patient care relies on good quality information and is essential if
improvements in the quality of care are to be made. The Information Quality Improvement
Group is driving the implementation of the Data Quality Policy, ensuring standard
operating procedures and best practice is followed, data quality audits are reviewed and
action plans monitored.
Information Governance
KCHT’s Information Governance Assessment Report’s overall score for 2013/14 was 81%
and was graded satisfactory and green exceeding the previous year’s score by 6%. All
requirements have met the minimum level 2 compliance and the IGTA is rated as
“Satisfactory”. The work plan for 2014/15 will include continued auditing of compliance.
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Audit
During 2013/14 KCHT participated in 100% of the national audits which it was eligible to
participate in. For 2013/14 there were no national confidential enquiries that KCHT was
eligible to participate in. However, for 2014/15 there are already 3 national confidential
enquiries that are relevant to KCHT. These include Lower Limb Amputation, Mortality
Review and Sepsis.
The Falls and Bone Health in Older People and the National Audit of Treatment & Care of
HIV infected inpatients are the two national audits that were reviewed by KCHT in 2013/14
and actions to improve the quality of healthcare will be taken.
For a clinical audit to be recorded as complete by the Trust every single action identified
from the audit must be implemented. At the end of 2013/14 350 actions designed to
improve the quality of care for our patients had been implemented. There were many
areas of good practice and positive outcomes for patients.
Outcomes for patients and staff are now included against all recommendations in an action
plan. This encourages auditors to focus on the audit output rather than the process of
action planning and managing change so there is a clear understanding of how each
action from the audit will improve care for our patients.
The audit programme for 2014/15 was approved by the Clinical Audit Group on 20 th March
2014 and consists of 160 clinical audits.
Research and Development
During 2013/14 Kent Community Health NHS Trust has participated in 45 research
studies, 19 of these are classified by the National Institute of Health Research as portfolio
studies. Portfolio studies are high quality clinical research studies that are eligible for
support from the National Institute of Health Research Clinical Research Network in
England.
There was 36 clinical staff at KCHT participating in the Research Ethics Committee during
2013/14. Links have been strengthened between Research and Clinical Audit in order to
contribute to increased clinical effectiveness within KCHT.
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Goal 5:
Improving delivery capacity and capability in all areas.
Quality Goal 2
2013/14
CEST
Performance
against
Aims/Objectives
Achieved
Mentorship Updates
Compliance 85%
Achieved
Implement Person Centered Care
Planning in at least 50% of
Services
To continue to improve
The delivery of consistently high quality care requires an educated, skilled, competent
workforce working to evidence-based practice standards. Significant progress has been
made and a Clinical Competency Framework developed where the core domain includes
holistic assessment, person-centred care planning/goal setting, record keeping and
safeguarding.
A clinical induction programme has been developed and focuses on standards,
competencies and practice outcomes.
Action learning sets enabling time reflection, sharing experiences, learning and networking
are incorporated in the Trust’s preceptorship programme.
In light of the Cavendish review the Trust has reviewed the Health Care Support Worker
Programme and developed an associated strategy and career progression framework for
implementation in 2014.
There has been an increased focus on the quality assurance of education and training and
on improving the quality and delivery of training sessions.
In 2012/13 the compliance figure for mentorship updates was below target. It has been
successfully achieved for this year.
Across the organisation the level of access to clinical supervision has been variable. A
review of the policy resulted in a revised framework for staff.
The Trust has successfully developed a Post Graduate Certificate in Community Health in
partnership with the University of Kent which will deliver essential education flexibly and at
a standard equal to Higher Education Institutes.
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Performance
Quality Goal 5
against
2013/14
Aims/Objectives
Workforce
Improvements
required
Mandatory
Training
85% Compliance
in all 10 areas
Reduction in
Sickness
Absence to
3.75%
Fire and Moving and
Handling Training
did not Meet the
Target
4.25 %
Reduction in
Average
Recruitment
Timescales from
10.5 weeks
Achieved
7.6 weeks
Staff Survey
Results
2 % lower than
National Average
Training is a key priority for the organisation and fundamental to high quality care. Our
mandatory training compliance figure is 85%, eight of the ten areas of training have
achieved the target, however Fire training and Moving and Handling training did not meet
the target. Where compliance is below 85% teams are being targeted to discuss why
compliance is not being achieved and to find alternative ways of providing training.
Recruitment and retention is a key focus for the Trust to increase our permanent workforce
and reduce the amount of temporary staff. The Trust is recruiting staff more quickly and
strong relationships with local Universities will enable us to recruit and support newly
qualified clinicians.
We are currently exploring the option of overseas recruitment and Return to Practice to
support those areas with the most difficulties in recruiting staff.
A variety of initiatives and incentives have been implemented to attract new staff into
KCHT and to support retention of existing staff.
The Trust has developed a framework for managers (The KCHT Manager) aligned to
KCHT values and outstanding leadership and management behaviours. The Trust
recognises good leadership is fundamental to the delivery of quality care.
The 2013 staff survey results were disappointing in some areas but demonstrated that
73% of staff feel satisfied with the quality of work and patient care they are able to deliver
which is 2% lower than the national 2013 average for community trusts. Directorates have
developed action plans to address any issues raised.
The Trust concerns regarding workforce and morale are a key quality priority for 2014/15.
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Transformation
The Transformation Team is driving forward service improvement and partnership work to
support the Trust in securing quality, clinical and financial sustainability. Highlights of this
work in 2013/14 were:



The development of the intermediate care model, which supports people to avoid
admission to an acute hospital by providing urgent support, either at home or in a
community inpatient unit;
A new model of more intensive support in the community;
The implementation of the productive community services programme in 220 teams
and the e-rostering system to ensure safe levels of staffing.
The Kent Health and Social Care Integration Programme were recognised as one of
fourteen Integration Pioneers by the Department of Health in 2013.
Throughout the year the Trust has shared its integration work with other organisations
around the UK, and presented at major national conferences.
In summary, following the progress and areas for improvement identified through this
quality account, the Trust will continue to achieve the five overarching quality goals and
there will be six key focus areas for quality improvement which are:






Improving staff morale and recruitment/retention;
Learning from mistakes to improve safety;
Improving the implementation of the Mental Capacity Act;
Reducing the number of medication errors;
Wound medicine
Continue to develop integrated pathways.
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SECTION 2 – OUR QUALITY PRIORITIES
2.1
Achievements in 2013/14
Harm Free Care Safety Thermometer
We have surveyed 37,835 patients, achieving the Safety Thermometer target of 95% harm free
care and a 2.5% reduction in all harms, above the National and Regional benchmarks.
Falls
14% reduction in attributable falls for community hospital inpatients
31% reduction in falls resulting in harm and 43% reduction in severe harm falls
KCHT hosted a successful Falls Conference that was highlighted in a national journal.
Our award-winning Colours Reducing Falls programme is helping to identify people at risk of
falling in hospital.
Pressure Ulcers
81% of teams have achieved zero attributable-avoidable grade 3 and 4 pressure ulcers.
Never Events
No never events.
Health Visiting and School Nursing
Increased the number of Health Visitors by 12% to 243.71 in 2013-2014
Implementation of the Active Baby provided “champion” training to 550 health visitors, children’s
centre and early year’s staff
85% children in the original pilot area are reported as “starting school ready to learn” compared to
25% four years ago.
The Clean and Dry initiative to improve toilet training has won national recognition, media and
conference coverage.
Post Graduate Certificate in Community Health
Designed in partnership between the Trust and the University of Kent
Focuses on clinical education and assurance of competent practice.
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End of Life and Dementia
Appointed a Dementia Nurse Consultant and a Nurse Consultant for End of Life Care.
Developed a Dementia Strategy for KCHT.
Developed and implemented the End of Life Strategy and pathway in partnership with key
stakeholders.
Pain
A chronic knee pain programme developed in Kent was praised by the National Institute for
Health and Care Excellence.
“A Step into Placement”
An evaluation of a student’s placement based on the 15 step initiative commended by the Nursing
and Midwifery Council in January 2014.
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2.2 Priorities for Improvement Areas
Improving staff morale and recruitment and retention (safety, effectiveness
patient experience)
Staff morale and the delivery of safe, high quality care are well documented. Staff survey
results show there are areas where staff morale is below average and needs to improve.
Learning from mistakes to improve safety
To stay effective, innovate and address care issues organisations must learn rapidly to avoid
mistakes recurring and build sustainability. The Trust needs to strengthen the methods and
scale of organisational learning and this will underpin all of the key quality improvements for
2014/15.
Improve implementation of the Mental Capacity Act (MCA 2007)
We must do more to ensure that staff understand the Act, its application and what it means
for the care and treatment of people.
Reduce the number of medication errors and increase optimisation of
medicines
We know that KCHT has had a number of medication incidents in 2013/14 that have caused
harm to patients and therefore it is a priority to improve and reduce this avoidable harm.
Wound Medicine
Last year we committed to eliminating avoidable category 3 and 4 pressure ulcers. We must
continue to strive to reach this goal.
Continue to develop Integrated Care pathways and ways of working
CQUINS for 2014/15 are focused on diabetes, chronic obstructive pulmonary disease, heart
failure and fragility pathways. KCHT has begun this work and needs to continue it in the
coming year.
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2.3 Governance Statement
Significant Issues
Our Annual Governance Statement for 2012/13 highlighted four significant issues. The first
was a loss of patient records during archiving, the second was poor maintenance of the
Trust’s hydrotherapy pools, the third was related to the prevalence of pressure ulcers and
the fourth concerned a delay in the identification of a deteriorating patient.
Clear action plans have been developed and implemented as a result of these issues.
Training on the treatment of deteriorating patients is available to staff and is being rolled
out to relevant services. Pressure ulcers remain an issue in some localities but there has
been a marked improvement in reporting and in the prevention of grade three and four
ulcers.
The Information Governance team provide support to any team that relocates and the
Trust has a clear policy relating to archiving records. Eighty seven per cent of all staff
(calculated including those on maternity and sick leave) have received mandatory
Information Governance training.
For the year 2013/14 the following significant issues have been identified:
Significant Issue Description: Remedial Action Taken and Plans for Mitigation:
The Trust was issued with a
Prevention of Future Death
Report following a Coroner’s
inquest in December 2013
relating to the death of a patient
in December 2011. The report
was critical of communications
between the Trust and out of
hours GP services and training
of district nurses in relation to
symptoms of bleeding.
The Trust has worked with the out of hours provider
concerned to ensure that they have multiple
communications options for the relevant service 24 hours a
day.
The Clinical Education and Standards Team was set up in
May 2013. It is led by the deputy Director of Nursing and
Quality and aims to support staff in providing high quality
care.
Since the inquest, the nurses in the team that were
responsible for the deceased’s care have received clinical
supervision from their manager and the head of service.
This included the delivery of injections and anticoagulants.
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Significant Issue Description: Remedial Action Taken and Plans for Mitigation:
In November 2013 the HSE
conducted
an
investigation
following an incident at Sheppey
Community Hospital where a
patient fell from his bed due to a
problem with the bed rails.
Fortunately the patient did not
suffer any significant injuries and
returned to the ward that same
evening and was discharged as
was planned prior to the incident.
As a result of their findings, the HSE issued an
Improvement Notice on 4 December 2013 requiring a full
review of the following:






The suitability of bed rails and their compatibility with
mattresses
Assurance that all bed rail dimensions meet current
British Standards
Staff were appropriately trained in the assessment, use
and checking of bed rails
A system of planned preventative maintenance for all
bed rails
Written procedures for assessment of bed rail
requirements against the needs of the patient
Evidence of management checks, monitoring and
review of bed rail safety
An action plan to address the issues has been developed
and is overseen by the Adults Directorate Quality Group. A
formal response has been sent to the HSE describing the
actions that the Trust is taking as a result of the incident.
While clear progress has been
made in the year with regard to
pressure ulcers, concern still
exists in some areas either due
to delays of reporting incidents or
in relation to prevalence in
specific geographical areas.
Each pressure ulcer occurrence is subject to an immediate
and in depth root cause analysis with an action plan which
includes wider dissemination of lessons learnt. These
action plans are reviewed by the Director of Nursing and
Quality and the Director of Operations, Adults. There is an
overarching Trust action plan and Pressure Ulcer Project
Board in place led by the Director of Nursing and Quality.
The Board oversees progress and trends in this area which
are reported at all formal and informal meetings. During the
year, specific actions taken have included tendering and
awarding a new contract for the provision of pressure
relieving
mattresses;
developing
closer
working
relationships with nursing homes, improving patient
information; targeting training being provided to teams
regarding reporting and management action taken where
appropriate.
A number of services across the
Trust are suffering from high
vacancies and turnover. This in
turn exposes the Trust to the risk
that safety and quality of care
may be compromised.
The Trust has been working to reduce vacancy levels in the
affected services and localities. Human Resources provide
specific support to managers struggling to recruit. Targeted
recruitment campaigns are run in areas where normal
procedures are not filling vacancies. The Trust also has a
programme to support nurses who wish to return to
practice.
All staff complete an exit questionnaire when they leave the
Trust in order to understand why people leave. The Trust
has a workforce in which a significant proportion of staff are
approaching retirement age, and changes to service
provision may lead to staff leaving as a result.
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Significant Issue Description: Remedial Action Taken and Plans for Mitigation:
Some indicators show that staff
morale is low in some areas of
the Trust. This includes the
annual staff survey and feedback
from
internal
engagement
programmes.
The Trust is not achieving the
expected targets in relation to
the completion of statutory and
mandatory training.
The Trust has a communications and engagement strategy
and associated action plan. Actions that the Trust has
taken to address staff morale include:

Working with staff to discuss our vision and values

Enhanced engagement programme to listen to staff
views and demonstrate subsequent actions

Developing a consistent framework for appraisals
supported by a clear description of the behaviours we
expect from staff and managers.

The first cohort of managers is going through the
KCHT manager programme

An organisational-wide staff awards scheme which is
growing in momentum and new quarterly awards to
reward good patient feedback.

New structures that support greater team working and
a new auditable structure for team meetings and the
cascade of communications.

A task and finish group addressing the burden of
paperwork and reporting required from front-line staff
so they have more time to devote to patients
Significant action has been taken in year to address these
areas and although progress is noted, this has not been
sufficient.
Action being taken includes:

On-going review of mandatory training requirements

Expanded methods to deliver training including elearning, out of hours training and targeted training
delivered at convenient locations

Increases in number of trainers available

Data cleansing and data quality assessments.
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2.4 Our Quality Priorities for 2014/15
KCHT has chosen 6 priority areas for improvement which have been identified against our
overall performance for 2013/14.
These also reflect feedback received from key stakeholders, are underpinned by the
strategic objectives and link to our quality aspirations and quality goals. All link to the three
elements of quality – Patient Safety, Clinical Effectiveness and Patient Experience
1.
Improving Staff Morale and Recruitment and Retention (Safety, Effectiveness
Patient Experience)
Why is this a priority?
Links to:
Quality Aspirations 3 & 4,
Quality Goals 2,4,5
The Trust recognises that it is important that as an employer we are providing a positive
experience for staff and that staff are proud to work with us. We know that the relationship
between staff morale and the delivery of safe, high quality care is well documented. The
results from the staff survey demonstrate that there are areas where we are below
average and we need to improve. We also know that we need to reduce the level of
vacancies and increase staff retention as well as implementing the national
recommendations regarding safer staffing. We are also committed to ensuring that we
have the right staff, with the right skills, in the right place with the right competencies and
this requires further effort.
Developing capability and capacity to deliver:










Implement the recruitment and retention strategy and workforce plan
Overseas recruitment campaign.
Increase the number of staff undergoing the community nursing qualification.
Increased focus on leadership and management training, to recognise that high quality
leadership training needs to be supported at all levels.
Implement a new bank system to support temporary staffing.
Organisational refocus to ensure that the human resources teams are appropriately
aligned to support the operational teams.
Promote improved engagement with the staff health and wellbeing strategy.
Implement performance related pay progression alongside the Values into Action
Framework. Continue to link performance (including our values) to pay for the rest of
the organisation.
Education services available to staff to ensure evidenced-based practice including elearning solutions.
Roll out the competency frameworks across the organisation.
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


2.
Reduce sickness absence to below 3.75%.
absence.
Improve staff engagement.
Appraisal rates to be above 85%.
There will be a focus on short term
Learning from Mistakes to Improve Safety (Safety)
Why is this a priority?
Links to:
Quality Aspirations 2, 4
Quality Goals 4, 5
A learning organisation not only values and encourages learning from its own experiences,
but looks beyond itself for lessons and avoids complacency. This is one of the key
elements identified in improving safety management, leadership and safety culture. The
Trust recognises that it needs to work in an environment of rapid and accelerating change,
growing public expectations, increasing demands, expanding workloads and continued
resource constraints. To stay effective and innovate and address care issues
organisations must learn rapidly and build sustainability.
The Trust understands the importance of a culture where staff see the need to report any
incident affecting patients, the staff or the environment. By investigating each incident, the
lessons learned from such investigations can be communicated widely and
recommendations implemented swiftly. The Trust acknowledges that for some incidents
the organisation has been a passive learner, where lessons are identified but not put into
practice, rather than learning actively, where those lessons are embedded into an
organisation’s culture and practices.
Developing capability and capacity to deliver:







For nursing posts encompass the 6cs approach as laid out by the chief nursing officer.
Setting a refreshed culture for the organisation (Values into Action Framework).
Improved clinical supervision.
Continue with “being open”- communicating honestly and openly with patients and their
families when things go wrong.
Fair blame - we need to continue to ensure that staff are confident in the fairness of the
system in order to further develop a culture whereby incidents are routinely reported
and investigated.
Continue with “Schwartz rounds.”
Continue to share best practice and support staff.
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3.
Improve Implementation of the Mental Capacity Act (MCA 2007) (Patient
Experience, Safety)
Why is this a priority?
Links to:
Quality Aspirations 1,2
Quality Goals 2,3,4,5
The Mental Capacity Act is a very important mechanism for protecting the rights of people
who do not have the ability (mental capacity) to make certain decisions for
themselves. Understanding the Mental Capacity Act and the way it is applied is critical to
good quality, safe care. Similar to the national picture, we know that within KCHT we have
varied compliance with training and with understanding and application of the Mental
Capacity Act and Deprivation of Liberties safeguards. We must therefore do more to
ensure that staff understand the Act and its application and what it means for the care and
treatment of people.
Developing capability and capacity to deliver:






4.
A dedicated MCA lead has been recruited. The safeguarding teams have had MCA
strengthened in their roles and responsibilities.
Standardise MCA assessment and documentation in all areas of the Trust to prevent
variation in practice.
Increase compliance with MCA training and the number of staff trained in level 3 MCA
Implement the MCA actions identified by internal audit.
Improve the education and training of temporary staff in MCA awareness .
Ensure that staff who have completed MCA training have competencies signed off and
assessed.
Reduce the Number of Medication Errors and Increase Optimisation of
Medicines (Safety, Effectiveness and Patient Experience)
Why is this a priority?
Links to:
Quality Aspirations 2,3
Quality Goals 1,2,4
Medicines play a crucial role in maintaining health, preventing illness, managing chronic
conditions and curing disease and are a valuable resource in the NHS. It is crucial that
patients get the best quality outcomes from medicines. However, the evidence shows that
up to 50% of patients do not take their medicines as intended. We waste over £300 million
worth of medicines a year and safety data indicates we could do better at preventing
avoidable harm from prescribed medication. Effective medicines optimisation is essential
to solving this. We also know that KCHT has had a number of medication incidents in
Page 36 of 153
2013/14 that have caused harm to patients and therefore it is a priority to improve and
reduce this avoidable harm.
Developing capability and capacity to deliver:





5.
Implement the medicines optimisation strategy 6 key goals and objectives for 2014/5.
Improve the support for staff through the Medicines information service and pharmacy
support in Community Hospitals.
Increase reporting and learning from medication incidents.
Minimise dosing errors and omitted dosage using a peer review process.
Increase information to patients on administration of medicines.
Wound Medicine (Effectiveness, Patient Experience)
Why is this a priority?
Links to:
Quality Aspirations 1,2,3
Quality Goals 1,2,3,4,5
The integrity of skin is vital to patients’ physical and psychological health and it is
something that is taken for granted until it is damaged. A holistic approach means a
relationship, between the patient, the wound and the treatment. The aim of wound
management is to provide the optimum environment for the natural healing process to
occur. The challenges of wound management suggest that clinical governance, pain
management from wounds and improving quality of life through effective wound care are
intricately linked. In the past wound management has not always been well managed. As
the management of patients’ wounds comprises 60% of the community nurses workload it
is essential that we ensure the effectiveness of our care to improve patient experience.
Equally last year we committed to eliminating avoidable grade 3 and grade 4 pressure
ulcers. Therefore we must continue to reach this goal as a priority this year.
Developing capability and capacity to deliver:







Expand tissue viability team resource.
Ensure all staff are trained and competent in wound care
Increase and ensure compliance with the first choice dressing list
Continue the campaign on nutrition and hydration to aid healing.
Implement the wound medicine project and the integrated care pathways for wound
care
Deliver a specific wound medicine module for wound medicine in conjunction with the
University of Kent.
Work with industry and international partners on best practice.
Page 37 of 153
6.
Continue to Develop Integrated Care pathways and Ways of Working (Safety,
Effectiveness and Patient Experience)
Why is this a priority?
Links to:
Quality Aspirations 1,3
Quality Goals 2,3,5
Integration is about the management and delivery of health services so that clients receive
a continuum of preventative and curative services according to their needs, over time and
across different levels of the health system, to provide good quality care. Nationally we
recognise that often the patient’s journey has too many steps and that we need to ensure
that it is as seamless as possible and that the patient receives the right care, at the right
time, from the right person, particularly in supporting long-term conditions. This means
working in close collaboration with partner organisations. CQUINs for 2014/15 are
focussed on Diabetes, Chronic Obstructive Pulmonary Disease, Heart Failure and fragility
pathways. KCHT began this work in a number of areas in 2013/14 and needs to continue
to develop this work in the coming year, is key to supporting and maintaining people’s
health and wellbeing closer to home and working as part of the wider health economy in
reducing the burden on secondary care.
Developing capability and capacity to deliver (safety, effectiveness and patient
experience)







Develop new models of care and patient pathways in 4 key areas
Implement the End of Life Care Strategy and Dementia Strategy.
Improved utilisation of community beds.
Improve discharge skill and competencies to support timely discharge and transfers
Continue with the Rapid Response Scheme in North Kent to support prevention of
hospital admissions.
Increase health and wellbeing support in localities.
Increase intravenous support in the community to allow care closer to home.
How will we monitor and report our improvements?
Each improvement priority and goal will have an underlying improvement action plan with
key metrics, performance and quality indicators and outcome measures. These will be
monitored and reported to the Trust Quality Committee and the Trust’s Board, through the
relevant committees and based on benchmarking against other provider services, as
detailed in the quality aspirations dashboard (section 2.4).
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2.5 Quality Aspirations Dashboard
Quality Aspirations and Goals - 2014/2015
1.Equal partnerships between
patients, their families and the
delivery of KCHT services which
respect individual needs and values
and demonstrate care, compassion,
continuity and shared decisionmaking
2.There will be no injury or harm to
people who receive KCHT services and
a safe, clean environment will be
provided at all time
3. Treatment , interventions, support
and services will be appropriate and
effective, provided at the right time,
by the right person with the right
skills, wasteful and harmful variation
in care will be eradicated
4. A culture of transparency and
openness through learning, sharing and
innovation. This will be a cornerstone
in driving and sustaining excellent care
through governance , leadership and
accountability at all levels
Goal 1 – Patient Safety
Measurable year on year
improvement in every area of
patient safety in community
services
Goal 2 – Clinical Effectiveness
To improve outcomes by
developing integrated care
pathways ensuring the right
care, right place, right person,
right time
Goal 3 – Patient Experience
Measurable year on year
improvements in patient
experience, engagement and
satisfaction
Goal 4 – Links in with Goal
1, 2 & 3
Promoting a culture of
accountability and openness
Goal 5 – Links in with Goal 1,
2&3
Improving delivery, capacity
and capability in all areas
Reduction in catheter
associated urinary tract
infections in the community by
10% of the baseline
(established during qtr2 )
Improve transfer of care by
developing care pathways in
four area- Diabetes, COPD,
Heart Failure, End of Life care
and Frail elderly
15% of patients undertake
friend and family scores and
achieve a result of + 75 per
month on the NET Promoter
Score
Decrease the numbers of
cases implicating KCHT in
safeguarding concerns
against the 2013/14 baseline
70% of all clinical staff across
all services to be assessed on
core competencies
Falls prevention and reduction
by 10% and 10% reduction in
falls with harm.
SBAR to be rolled out across
all services for transfer of care
by qtr 4 2015
Over 95% patient
satisfaction in all service
areas using Meridian surveys
and at least 50% coverage
Improve recruitment and
retention process and
decrease vacancies to less
than 4 %
Implementation of safer
nursing staffing tool in
community hospitals
Page 39 of 153
Goal 1 – Patient Safety
Measurable year on year
improvement in every area of
patient safety in community
services
Goal 2 – Clinical Effectiveness
To improve outcomes by
developing integrated care
pathways ensuring the right
care, right place, right person,
right time
Goal 3 – Patient Experience
Measurable year on year
improvements in patient
experience, engagement and
satisfaction
Goal 4 – Links in with Goal
1, 2 & 3
Promoting a culture of
accountability and openness
Goal 5 – Links in with Goal 1,
2&3
Improving delivery, capacity
and capability in all areas
Reduction in all attributable
avoidable and unavoidable
Pressure Ulcers by 20%,
trajectories to be set for each
locality
10% reduction in transfer of
care issues internally
Implement person centred
care planning in 50% of
services
Improve incident reporting
across the organisation by
10%
Mandatory training
compliance at 85% across the
organisation
50% reduction in attributable
avoidable grade 3 & 4 pressure
ulcers set against 2013/14
numbers
95% of medications to be
reconciled within 24 hours –
community hospitals
Embed the six areas of the
CNO Caring and compassion
strategy
Embed the See something
Say something campaign
(whistleblowing) - measure
through responses
10% reduction in agency use
Safety thermometer 20 %
reduction in new harm
pressure ulcers and 5 %
reduction in old harm pressure
ulcers
95% of medications to be
reconciled within 24 hours –
community hospitals
Develop and implement
nurse indicators across
children and young person’s
services
Strengthen morbidity and
mortality reporting in
community hospitals
Ensure that every service
redesign and cost
improvement plan is quality
impact assessed
Deliver 95% harm free care
Reduction in medication
20 % of patients feedback on
errors causing harm by 15% on their experience in relation
2013/14 baseline
to wound care
Reduction in serious
incidents by 50%
Increase the number of health
visitors to 342 by March 2015.
Implement an early warning
trigger tool at team level across
all services
100 % of VTE assessments to
be completed within 24 hours
of admission
Reduction in complaints
implicating clinical care by
10% from 13/14
Reduction in sickness absence
to 3.75%
Implement end of life
strategy goals
Page 40 of 153
Goal 1 – Patient Safety
Measurable year on year
improvement in every area of
patient safety in community
services
Goal 2 – Clinical Effectiveness
To improve outcomes by
developing integrated care
pathways ensuring the right
care, right place, right person,
right time
Goal 3 – Patient Experience
Measurable year on year
improvements in patient
experience, engagement and
satisfaction
Goal 4 – Links in with Goal
1, 2 & 3
Promoting a culture of
accountability and openness
Goal 5 – Links in with Goal 1,
2&3
Improving delivery, capacity
and capability in all areas
Reduce the length of stay to 21
days in community hospitals
85% compliance with MCA
training across the
organisation and 70 % of
clinical staff competency
assessed
Implement dementia
strategy goals
Reduction in coroners
inquests implicating KCHT
Trust wide appraisal for all
staff at 85%
Early implementation of the
medication safety thermometer
To establish a baseline for
healing rates
Implement “clean and dry”
to all school nurses
85% compliance with DoLs
training and 85%
community hospital
matrons, junior matrons and
clinical sisters will have been
competency assessed
To implement the agreed
standard for clinical and
managerial supervision. 95%
of staff will be receiving
supervision by end of 2015.
Increase the uptake of staff flu
vaccination by 20%
Introduce situation,
background, action and
recommendation as a
communication handover
tool.
Implementation of the
Family and Friends Test for
staff
Reduce agency staffing by 10%
Reduce turnover to less than
10%
Increase PLACE scores to
achieve national best practice
in all areas, where estate allows
Develop a discharge passport
for transfers of care
Variances to be below 3%
Improve compliance to agreed
benchmarks for all statutory
and mandatory training
Page 41 of 153
Section 3 - Progress against 2013/14 priorities
3.1 KCHT Performance Measures
Over 3,700 patients
identified as having
Chlamydia
following screening
and offered
treatment
Over
119,000 patients
have been treated
at our MIUs and
WIC, 320 a day on
average, 7 days a
week
Over 6,000
patients
supported to quit
smoking
New referrals
were seen within
18 weeks in our
consultant-led
services in
97.4% of cases
All Cost
Improvement
Plans were
Quality Impact
Assessed
Nearly 500,000
patient contacts
were for planned
therapy in a clinic
setting
Over 3,200
patients were
admitted to
Community
Hospitals
More then
Care was
provided by over
3,600 staff from
many professions
3 million
patient contacts
were provided in
the community
16,500
new born babies
were seen by our
Health Visitors
The median length
of stay in our
Community
Hospitals was
23.2 days
Over
1.6 million
More than
of our patient contacts
were provided in the
patients’ own place
of residence
Health Checks
have been carried
out across Kent
We significantly
exceeded the
50% data
quality target
for Referral to
Treatment
Page 42 of 153
30,000
Our C-difficile
reduction target
was met for
2013/14, reducing
from 11 to 8 cases.
3.2 Commissioning for Quality and Innovation
Statement
Commissioning for Quality and Innovation
A proportion of Kent Community NHS Health Trust’s income in 2013/14 was conditional on
achieving quality improvement and innovation (CQUIN) goals agreed with NHS Kent and
Medway through the CQUIN of all CQUIN goals for 2013/14 93% was achieved.
Further details of the agreed goals and performance against those goals for 2013/14 and
2014/15 are available in our performance reports to the Board on our website
www.kentcht.nhs.uk See Appendix B
The CQUIN framework aims to ensure that there is a shift in quality within the NHS and
stretch targets are set. This means that payments are made to providers upon the
achievement of the nationally and locally agreed quality goals.
CQUIN was 2.5% of applicable contracts, namely CCG contracts, totalling £3,678k of
which we achieved £3,415k (93%).
CQUINS for 2014/15 are focused on diabetes, chronic obstructive pulmonary disease,
heart failure and fragility pathways. KCHT has begun this work and needs to continue in
the coming year.
Page 43 of 153
3.3 A year on from Francis
Our progress on Francis
The Francis report was published in February 2013 and had 290 recommendations for
action across the NHS – both locally and nationally.
The Trust conducted its initial assessment against the Francis report in February 2013 and
subsequently self-assessed against additional reviews and have added any
recommendations to the Francis action plan.
These are listed below:
 Patients First and Foremost: Government’s initial response to the Francis report March 2013
 Health Education England Mandate – April 2013
 Children and Young People’s Forum – May 2013
 Cavendish review of Health Care Assistants – July 2013
 Review of the Liverpool Care Pathway – July 2013
 Keogh review of mortality/morbidity – July 2013
 Berwick report – August 2013
 After Francis: Making a Difference – September 2013
 Clwyd Hart review of complaints – October 2013
 Keogh review of urgent care – November 2013
 National Quality Board Safer Staffing Levels guidance – November 2013
 Hard Truths: Government response to Francis – January 2014
The actions for KCHT have been themed as follows:
 Creating the right culture
 Putting the Patient first
 Fundamental Standards of Behaviour
 Accountability of Directors
 Performance Management and Oversight
 Patient, Public and Local Scrutiny
 Effective Complaints Handling
 Openness, Transparency and Candour
 Nursing
 Leadership
 Caring for Older People
 Information
Progress has been made in all areas throughout 2013-14 and future plans are in place for
2014/15. (A summary of progress is in Appendix A).
Page 44 of 153
3.4 Progress of Quality Goals
The following section of the report provides more detail on the achievements of the
individual goals, as summarised in the executive summary, against each of the five overall
goals. There are a variety of subject areas underneath each goal which support delivery
and attainment. Each subject area will provide an update on progress made during
2013/14 and will highlight the priority areas for continual improvement for 2014/15.
Goal 1
Measurable year on year improvement in every area of patient safety in community
services. This section includes a variety of key subject areas which support the Trust in
achieving the overarching goal, with the primary focus on Patient Safety and Reduction of
Harms to ensure safe care.
Goal 2
To improve outcomes by developing integrated care pathways ensuring the right care,
right place, right person, right time. Within this section the key subject areas are End of
Life, Dementia, NICE, Children and Young People and Transfer of Care, all of which are
fundamental in achieving this goal.
Goal 3
Measurable year on year improvement in patient experience, engagement and satisfaction
– This is important for the Trust to ensure we are delivering services that are patient
centred. The subjects which support the Trust in achieving this goal are Patient Feedback,
Complaints, Nutrition and Hydration, Caring with Compassion and Health and Wellbeing.
Goal 4
Promoting a culture of accountability and openness. This is a high priority for the Trust to
ensure we are transparent and a learning organisation. The subject areas which contribute
to this goal are Serious Incidents, Claims, CQC, Information Governance, Clinical Audit
and Research.
Goal 5
Improving delivery, capacity and capability in all areas. This is fundamental to ensuring
safe, effective delivery of high quality care and providing a good experience for people
who use KCHT services. The main subject areas which support this goal are Clinical
Education, Workforce and Transformation.
Page 45 of 153
Each of these goals link to the NHS Outcome frameworks five domains and KCHT
strategic objectives and are aligned to the three key elements of quality – patient safety,
patient experience and clinical effectiveness.
Page 46 of 153
Goal 1: Measurable year on year improvement in every area of patient safety in
community services.
Safe Care Deliverables
Mandatory Statement – Safe Care
When compared to 2012/13 the overall number of incidents has reduced in 2013/14, but
the rate of incidents remain consistent against activity. We want to do better and will
continue to strive to reduce incidents of harm.
The Trust’s rate of patient safety incidents is 1 per 1,000 patient contacts and of this 0.2%
resulted in severe harm or death, which is a reduction compared with 0.3% in 2012/13.
The reduction in severe harms is due to the significant reduction in the number of falls in
this level of harm.
KCHT reports all attributable patient safety incidents to the NRLS (National Reporting and
Learning System). This data is shared with other organisations, such as the HSCIC
(Health and Social Care Information Centre). A summary of the data reported to the NRLS
during 2013/14 is shown below.
To provide context, the rate of incidents per 1000 patient contacts is detailed in the table
below.
Number of
incidents
Per 1000
contacts
Percentage
None (No harm to patient(s)
1612
0.5979
40.0%
Low (Minimal harm - patient(s) required
extra observation or minor treatment)
1552
0.5756
38.5%
Moderate (Short term harm - patient(s)
required further treatment, or procedure)
859
0.3186
21.3%
Severe (Permanent or long term harm)
6
0.0022
0.1%
Death (Caused by the Patient Incident)
1
0.0004
<0.1%
4030
1.4947
100%
2013/14
Total
Page 47 of 153
A patient death occurred during an influenza outbreak and a full root cause analysis
investigation has been undertaken. Following the investigation it was not possible to
confirm whether or not the patient’s death was related to the flu, however lessons learnt
have been shared throughout the organisation.
When compared to 2012/13, the number of incidents has increased from 3744 to 4030 (an
increase of 8%) due to a drive to improve incident reporting. The level of harm has
reduced.
The table below shows the 2012/13 incident figures
2012/13
Attributable Patient Incidents
Pressure ulcers (number of
forms)
Falls
SafeMed
Severe Harm
Death Harm
Total Severe and Death
Apr
328
May
366
Jun
324
Jul
321
Aug
372
Sep
278
Oct
282
Nov
288
Dec
265
Jan
308
Feb
280
Mar TOTAL
3744
332
137
155
121
113
137
90
90
88
90
108
100
101
1330
62
64
73
61
71
63
72
51
50
79
59
70
775
59
42
57
68
73
51
46
50
42
39
40
53
620
1
0
0
0
1
0
2
2
1
0
0
3
10
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
1
0
2
2
1
0
0
3
10
2865
227
264
264
224
254
227
230
259
254
198
241
222
Patient contacts (1000s)
1.3
1.4
1.4
1.2
1.4
1.5
1.2
1.2
1.1
1.0
1.6
1.2
1.5
Incident Rate per 1000 patient
contacts
0.3%
0.3
0.0
0.0
0.0
0.3
0.0
0.7
0.7
0.4
0.0
0.0
0.9
% of Severe and Death
Incidents
*There is a slight variance to the data reported in the 2012/13 Quality Account. The main difference occurs within the Safe Medicines
figures which have been corrected following audit. Other variations are due to incidents being reported after the 2012/13 Quality
Account was produced
The table below shows the 2013/14 incident figures
2013/14
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Total
Attributable Patient Incidents
314
317
359
359
324
341
360
317
284
357
328
370
4030
Pressure ulcers (number of
forms)
109
110
109
102
74
95
133
106
85
104
111
117
1255
Falls
55
64
66
77
37
67
56
47
53
74
61
67
724
*SafeMed
45
48
63
62
85
75
58
62
62
65
61
56
742
Severe Harm
1
0
1
1
0
1
1
0
0
1
0
0
6
Death Harm
0
0
0
0
0
0
0
0
0
0
1
0
1
Total Severe and Death
1
0
1
1
0
1
1
0
0
1
1
0
7
Patient contacts (1000)
228
242
234
251
205
226
250
239
199
223
188
213
2483
Incident Rate per 1000
patient contacts
% of Severe and Death
Incidents
1.4
1.3
1.5
1.4
1.6
1.5
1.4
1.3
1.4
1.6
1.7
1.7
1.6
0.3
0
0.3
0.3
0
0.3
0.3
0
0
0.3
0.3
0
0.2%
We will to strive to improve and reduce the number of harm incidents and build upon the
improvements we have made during 2013/14, as detailed in our key priorities.
Page 48 of 153
Goal 1: Measurable year on year improvement in every area of patient safety in
community services.
Infection Prevention and Control
Reduction in Health Care Associate Infections
The Quality Goal 2013/14: No one to contract MRSA in any of our community
hospitals and to reduce Clostridium Difficle by 33%.
How did we perform in 2013/14?
Our plan was to improve our performance by 33% of C difficile (C.diff) incidents.
Target
2013/14
33%
reduction
Achieved
40%
In 2012/13 there were 14 cases which reduced to 8 cases in 2013/14. The Trusts’ rate of
c.diff infection decreased from 15.1 per 100,000 bed days in 2012/13 to 9.1 cases per
100,000 occupied bed days in 2013/14 which compares favourably against neighbouring
Acute Trust rates (published data rate to November 2013):
Local acute Trust rates for comparison:
 Dartford and Gravesham 10.09 per 100,000 occupied bed days
 EKHUFT 16 per 100,000 occupied bed days
 Maidstone and Tonbridge Wells – 18.63 per 100,000 occupied bed days
 Medway Maritime 8.2 per 100,000 occupied bed days
A root cause analysis (RCA) is completed for all incidents of Clostridium difficile to
understand the contributory factors and that lessons learned are clarified and
implemented. Of 8 cases, only one was deemed to be avoidable and new policies and
procedures for contractors have been improved.
Antimicrobial Stewardship – (UK Five Year Antimicrobial Resistance Strategy 2013–
2018) is a key contributor to reducing C difficle and the Trust has undertaken a gap
analysis to ensure that all best practice is followed. The Trust has further strengthened
efforts on appropriate prescribing to aid reduction in cases of Clostridium difficile and
antimicrobial resistance and will continue to audit year on year.
Methicillin Resistant Staphylococcus Aureus (MRSA) –
Target
2013/14
Zero
Not achieved
1 case
Page 49 of 153
One MRSA bacteraemia (blood stream infection) was attributed to the Trust in April 2013.
A full root cause analysis was carried out and as a result further screening and skin
cleansing was implemented.
MRSA Screening is carried out on all patients who are admitted to community hospitals
from home to reduce the risk of spreading infection.
Target
2013/14
100%
Not fully achieved
99%
Three patients that should have been screened were not which led to an overall
achievement of 99%. As a result improvements were made in the orientation and induction
programme for agency staff.


Escherichia coli - There have been zero cases of E. coli blood stream infection within
KCHT
There were eight outbreaks of norovirus in five of the community hospitals which
reflected norovirus in the community and there was one outbreak of influenza. These
were all well managed and contained.
Issues of isolation and ward layout that make isolation of patients difficult are being
addressed with the estates team and commissioners.
The influenza outbreak RCA identified lessons to be learned and these are being
implemented to reduce further risks
One patient died during this outbreak. This was reported as an SI and a full root cause
analysis investigation was completed. It was not possible to confirm whether or not the
patient’s death was related to the flu, however lessons learned have been shared
throughout the organisation.
Infection Prevention and Control Training
Hand hygiene is the single most important measure in reducing the spread of infection and
is a priority for KCHT.
Overall compliance Hand Hygiene 82% Clinical staff compliance: 82.5%
Target
2013/14
85%
Not achieved
82%
Overall compliance IPC Mandatory training 73.6% Clinical staff compliance: 65%
Target
2013/14
85%
Not achieved
74 %
Page 50 of 153
The target of 85% reflects staff on maternity leave, career breaks or vacant posts.
The Director of Infection Prevention and Control wrote to all non-compliant staff in
September 2013 to directly address non-compliance. A review of the training programmes
and targeting teams with poor performance is a priority for the next year. The Infection
Prevention and Control team aims to achieve full compliance by August 2014.
Hospital Acquired Catheter Associated Urinary Tract infections (CAUTIs) and
Urinary Tract Infections (UTIs)
Target
2013/14
50%
reduction
Achieved
The plan for 13/14 was to reduce CAUTIs and UTIs. There was a significant decrease of
CAUTIs by 50%, this rate has been sustained but there has been no further decrease in
the last year. The reported cases remain significantly low averaging 3.5 per month. For
UTIs there was a 15% overall reduction.
Patient Led Assessment of the Care Environment (PLACE). These visits replaced the
Patient Environment Action Team (PEAT) inspections. The assessment covers privacy
and dignity, wellbeing, food, cleanliness and general maintenance of all areas of
community hospitals where care is delivered. Visits are conducted by a team of 50%
patient representatives and 50% of Trust staff. The overall scores are shown in the table
below.
National
Results
KCHT
results
Cleanliness
Food and
Hydration
Privacy, Dignity
and Wellbeing
Condition and
appearance
95.74%
84.98%
88.87%
88.75%
88.94%
86.05%
81.78%
77.89%
The Trust performed in the lower quartile nationally and is very disappointed with the
results. Whilst some issues relate to the age and condition of the estate, which is being
addressed by the landlords, The Trust has taken actions to improve the performance of
cleanliness, food and nutrition by introducing new menus and a specific campaign on
nutrition and hydration. The Trust has introduced changes to some of the ward
configuration and estates and is confident that these will be reflected in future
assessments:
Management of Healthcare Waste - updated Waste guidance issued by the Department
of Health: HTM 07-01 Safe Management of Healthcare Waste was reviewed against
Page 51 of 153
KCHT standards and practice and KCHT has been found to be fully compliant with the
guidance.
No waste generated by healthcare workers will be left within a patient’s home without their
consent.
Goals for 2014/2015:







Reduce Clostridium Difficile to no more than 7 cases.
Catheter Acquired Urinary Tract Infections and Urinary Tract Infections to reduce by a
further 10%.
Ensure 100% compliance with MRSA screening.
Increase the percentage scores on the PLACE audit to at least the national average.
Ensure full compliance with hand hygiene and improve compliance with infection
prevention training.
Increase the percentage uptake of staff flu vaccinations.
The following case study highlights one of the achievements for 2013/14.
Case studies
‘C Diff green card rolled out to protect patients’
Page 52 of 153
Goal 1: Measurable year on year improvement in every area of patient safety in
community services.
Harm Free Care
Delivering harm free care is important to KCHT as we do not want to cause harm to any
patient or their family. The Trust wants to improve quality and engage staff in thinking
about how they can help reduce harms even further.
How did we perform 2013/14?
We have successfully increased the percentage of Harm Free Care (HFC) above the
national average for 2013/14 and exceeded the KCHT benchmark.
The safety
thermometer that measures harm free care focuses on four harms:




Falls
Preventable pressure ulcers
Venous thrombo-embolism (VTE)
Catheter acquired infections (CAUTI)
The graphs below show our position against last year and the national benchmark.
37,835 patients were surveyed for the year, an increase of 18.7% compared to 2012/13
with a 2.5% reduction in harms for 2013/14, which is above the National and Regional
benchmarks.
KCHT Patients Surveyed
KCHT Position Average
National Position Average
Regional Position Average
2013-14
37835
95.42
93.04
93.70
Page 53 of 153
2012-13 % Variance
31874
↑18.70%
92.92
↑2.50%
92.61
0.42%
91.59
2.11%
The main category of harm remains new and old pressure ulcers even though there has
been a reduction in both for 2013/14. There is on-going work to reduce pressure ulcers,
(covered in another section of the report. In addition the Trust is working collaboratively
with CCGs, Acute Trusts and social care to have a whole systems approach to the
reduction of harms. The table below shows the improvement of each individual harm in
comparison to last year.
Harm
Total Old PU
Total New PU
Total Falls with Harm
Total New VTE
Total Catheter & NEW UTI
Total Catheter & OLD UTI
2012-13
2013-14
4.38
1.33
0.57
0.37
0.31
0.23
3.31
0.72
0.25
0.08
0.15
0.13
Workshops with clinical staff have focused on reinforcing the importance of teams using
their safety thermometer results to inform quality improvements and reduce harms.
Goals for 2014/2015:




To be an early implementer of the new national medication safety thermometer tool.
To maintain and improve 95% and above Harm Free Care for new harms.
To reduce the number of new harm pressure ulcers by 20%.
To reduce the number of old pressure ulcers by 5% by working in partnership across
the whole system.
Page 54 of 153
Goal 1: Measurable year on year improvement in every area of patient safety in
community services.
Pressure Ulcer Prevention and Management
Zero attributable and avoidable pressure ulcers
The development of pressure damage has a profoundly negative effect on all aspects of a
person’s life and is very distressing for patients, carers and their families.
The reduction of pressure ulcer incidents has been a key priority for the Trust and a key
goal for staff.
How did we perform in 2013/14?
2013/14
Progress
Inherited
Pressure
Ulcers (Non
attributable
Pressure Ulcers
attributable to
KCHT
Aspirant
Foundation Trust
Benchmark
Monthly average
of attributable
avoidable 20.9
Pressure
Ulcers
2% ↓
7.2 % ↓
KCHT position
12.7
The results for this year have seen some positive improvements but we have much more
work to do. The number of pressure ulcers which KCHT inherited from other care
providers has reduced by 2% which reflects the overall priority across the whole health
economy. The number of attributable avoidable and unavoidable pressure ulcers grade 2,
3 and 4 has reduced by 7.21 % compared to 2012/13, as shown in the graph below.
250
2012/13 Yes (Attributable)
200
150
2013/14 Yes (Attributable)
100
2012/13 Yes (Attributable)
Average
50
0
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
2013/14 Yes (Attributable)
Average
The number of attributable avoidable grade 2, 3 and 4 pressure ulcers reported on
average per month was 12.7 which compares favourably against the Aspirant Community
Page 55 of 153
Foundation Trust benchmark of 20.9 per month (Feb 2014 publication) however as a Trust
it is our priority to reduce all avoidable pressure ulcers.
Eighty-one per cent of the total of 144 teams achieved zero Grade 3 and 4 pressure ulcers
in community hospital wards, short-term and long-term services). 7% of teams had one
avoidable grade 3& 4 pressure ulcer and 12% of teams had two or more. These teams will
be subjected to an intensive support programme to ensure lessons are learned and
embedded into practice. Work has already begun in many of these teams to ensure
quality improvements are sustained.
Root cause analysis investigations are completed on pressure ulcers classified as serious
incidents, so we can understand why it has happened and learn the lessons.
We have completed a detailed analysis of attributable avoidable and unavoidable pressure
ulcers across all services. There has been targeted support including holistic assessment,
caseload management support, accountability sessions, tissue viability training,
competency assessments and the implementation of nurse indicators in teams where
there have been two or more attributable avoidable grade 3& 4 pressure ulcers. A sample
of teams who had achieved zero avoidable pressure ulcers were visited which highlighted
areas of best practice that have been factored into the pressure ulcer standard.
A repeat audit was completed on compliance with the pressure ulcer standard for
attributable unavoidable pressure ulcers which had been classified as all interventions in
place and non-concordant.
It highlighted evidence of good practice including clear evidence of shared care between
podiatry, nursing and patient choices. In non-concordant patients there was evidence of
negotiation and risk assessments.
Page 56 of 153
Although the audit highlighted some good practice there is still work to do to improve
practice. In response to the findings the following actions were implemented:







A top tips handbook for the prevention and management of pressure ulcers.
A leaflet on the prevention of pressure damage for formal and informal carers
developed in partnership with them. Partnership working will aim to address the
shared care issues associated with pressure damage.
A high profile campaign on the reduction of pressure ulcers, including screensavers on
all computers.
Developing an eLearning tool for Waterlow (risk assessment tool).
Holistic assessment training has been developed.
Nurse indicators and standards.
A nurse consultant for tissue viability will be employed and the tissue viability team has
been strengthened.
Goals for 2014/2015:
Work has continued with other providers and clinical commissioning groups to address the
issues. A CQUIN for 2014/15 has been designed to support the wider health economy
focus on the reduction of pressure ulcers:




To identify further learning from teams who have achieved zero avoidable grade 3 and
4 pressure ulcers.
Reduction in unavoidable pressure ulcers “all interventions in place” and “nonconcordant” by 20%.
20% reduction in avoidable grade 2 pressure ulcers.
50% reduction grade 3 and 4 pressure ulcers aiming for zero.
Page 57 of 153
Goal 1: Measurable year on year improvement in every area of patient safety in
community services.
Venous Thrombo-embolism ( VTE)
All patients admitted into community hospitals should have a venous thrombo-embolism
risk assessment completed within 24 hours to see if they are at risk of developing a blood
clot. Preventative treatment using daily injections helps to dramatically reduce the risk.
We had no preventable VTE events or deaths in 2013/2014 and on average the Trust is
achieving 97% compliance. Work continues to ensure processes are robust to ensure all
patients are assessed within 24 hours to achieve 100% of the target.
Target
Progress
100%
97% not achieved
All established qualified staff have been trained and competency assessed.
programme for new staff is in place and part of their induction.
VTE
Screenings
Target
Actual
(2013-14)
Actual
(2012-13)
A rolling
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
95%
95%
96%
98%
95%
95%
98%
100%
98.00%
98%
96%
100%
90%
98%
96%
95%
96%
96%
99%
Goals for 2014/2015:





100% of assessments to be completed within 24 hours.
Revision of the VTE assessment tool to improve evidence of decision-making.
Patient information leaflet to be given to all patients at the time of assessment.
All patients at risk of VTE are to have a care plan in place.
A rapid cycle audit will take place to ensure all recommendations are embedded.
Page 58 of 153
Goal 1: Measurable year on year improvement in every area of patient safety in
community services.
Falls Prevention and Reduction by 10% and 10% reduction in falls resulting in falls
with harm
Falls can happen at any age but are more common when we get older. The cause of falls
includes many factors and reducing the risk of falls requires thorough assessment and
planning.
How did we do in 2013/14?
The KCHT falls rate is variable and influenced by a combination of factors. Services aim
to achieve a balance between promoting independent mobility through rehabilitation and
the on-going risk of falls.
Target
2013/14
10% reduction in falls
7%
We have seen a 7% reduction in all falls reported this year compared to the 2012/13
figures.
There has been a 14% decrease in the number of inpatient falls in community hospitals in
2013/14. The table below clearly demonstrates improvements against the 2012/13
position.
Target
2013/14
10% reduction in
Community Hospital
falls
Achieved
14%
KCHT achieved an average of 6.85 falls per 1000 Occupied Bed Days (OBD) for 2013/14.
This figure compares favourably against the national benchmark of 8.6 falls per 1,000
OBD for community hospitals (NRLS benchmarking data 2010).
Service transformation within community hospitals to reduce the number of falls has led to
a decrease in overall terms by 31.41% and a 42.85% reduction in fractures compared to
last year (as seen in the chart overleaf). We will continue to strive for further reductions in
both of these areas in the next year.
Page 59 of 153
From January 2014 the podiatry service joined a national falls research programme
sponsored by the University of York, the REFORM study (Reducing Falls with Orthoses
and a multifaceted podiatry intervention).
Goals for 2014/2015:
This year KCHT will trial “The Canadian Safer Home Tool” using two pilot sites in East and
West Kent. The tool is internationally validated and will provide an assessment of falls
risks in the domiciliary setting. In addition KCHT will:








Reduce the number of falls by a further 10%.
Reduce the number of falls with harm by a further 10%.
Review comfort rounds and the use of the quality risk indicators tool in relation to falls.
Undertake observational audits in all community hospitals to determine any key triggers
for falls.
Increase medications reviews to help support a reduction in falls.
Focus awareness on medication starting with fall awareness week in June.
Focus support interventions on people with dementia.
Review the environment in all wards, such as signage.
Page 60 of 153
Case study
‘June gets a greenbelt’
An innovative new wristband scheme which has cut falls at the Livingstone hospital by 50
per cent is to be rolled out across Kent.
Colours Reducing Falls is an award-winning programme where all patients are assessed by
the physiotherapy team, which decides how much help they need and what their risk of
falling might be. They are given a red, yellow or green wrist band to alert other staff.
Senior Physiotherapist Sam Gohir at the Livingstone Hospital in Dartford said, “We trialed
this programme two years ago as a simple way of making sure all staff in our hospital knew
the needs of every patient. It allows us to take into account all the factors that might affect a
patient’s fall risk, such as if they have dementia, mobility issues or a lack of confidence.
“It has worked fantastically well and in the first six months, the number of falls at the
Livingstone had reduced by 50 per cent.”
June Gildea, 75, from Gravesend, suffered a fall at her home and fractured her hip. She
said: "The staff have been really supportive and it has encouraged me to work hard and do
my exercises and move up to the green band. I felt like I had won a medal when they
promoted me! It has given me the confidence to know I will be ok when it’s time to go home.”
Now the team behind the scheme has been recognised by the Community Hospitals
Association (CHA) for the effective and simple way they have improved patient care.
The system has been so successful that it has also been launched on the Sapphire Unit at
Gravesham Community Hospital and will be rolled out across all community hospitals run by
Kent Community Health NHS Trust.
Page 61 of 153
Goal 1: Measurable year on year improvement in every area of patient safety in
community services.
Patient Safety Walkabouts (PSW)
In 2013/14, 43 Patient Safety Walkabouts (PSW) took place. Patient Safety Walkabouts
are weekly visits to a team by a member of the executive and non-executive team to
discuss and engage with staff on areas of patient safety. As part of the visit and in order to
be as inclusive as possible a pre-visit survey is sent to teams prior to the walkabout, so
that staff who may not be able to attend the walkabout can give their views on safety,
quality, effectiveness, innovation and aspiration.
The survey results highlighted the following top 5 action areas:

Communication: This was a recurrent issue related to ensuring that there is adequate
and regular communication from team leaders/managers addressing policy changes,
Lessons Learned, the Trust core brief and staff concerns around service
redesign/restructuring and relocation. Actions were resolved for example by arranging
executive visits, reinstating team meetings and strengthening and changing the
engagement and communication plan.

Service development: These actions covered a range of issues which included the
desire to understand best practice in comparable teams; the potential for development
of support roles such as dietetic assistants or phlebotomists; marketing services and
identifying or rectifying gaps or inequity in service provision. As a result a number of
support roles have been introduced. Best practice is being used to support good
practice, such as pressure ulcers and a review of staffing has taken place.

IT: Information technology actions mitigated frequent concerns around implementation
and training for Community Information System (CIS), adequate IT access in
integrated teams and issues pertaining to out of hours systems and out of base
connection problems. These are being addressed as part of the overall implementation
of the system as they are highlighted.

Quality and safety: Issues highlighted included a variety of issues such as
confidentiality in public waiting areas, understanding and using performance data with
teams to support improvement, raising awareness of the Francis report, and escalating
concerns around gaps in provision, practice or awareness. A number of interventions
have been put in place, for example changes in awaiting areas, escalation frameworks
and locality-based scorecards.
Page 62 of 153

Risk management: Issues raised by staff involved staff risk management such as
moving and handling, conflict resolution, lone working risks, adequate staffing levels
and raising awareness of team risk registers. Considerable work has been
undertaken including in the areas identified, safety reviews have been undertaken
and support has been given to teams on risk registers.
The visits have enabled staff to voice their concerns and raise issues that pertain to
practice. This supports the culture of openness as recommended by Francis. Actions that
have supported patient care include raised awareness of requisitioning the right
equipment, highlighting issues around Insulin administration in the community and
improving board to floor communication.
Goals for 2014/2015:




A revised quality and safety visit programme to encompass more staff and less
bureaucracy.
Increased visibility of the Executive and Board through executive road shows
Improved communication with all teams, by improving communication channels and
methods
Continue to address issues raised by staff at the walkabout in timely manner
Page 63 of 153
Goal 1: Measurable year on year improvement in every area of patient safety in
community services.
Safeguarding
Decrease the number of safeguarding cases implicating KCHT in safeguarding
concerns
The Trust recognises its responsibility to prevent abuse of adults and children who are at
risk. Safeguarding is a fundamental part of patient safety and healthcare professionals
have a key role in identification of safeguarding concerns and responding appropriately to
them.
Safeguarding Children
We have continued to work closely with our partners in Kent Social Care services, to
ensure staff, understand the multi-agency thresholds that have been developed to help
them identify and manage safeguarding and child protection concerns. A multi-agency
review of Kent and Medway Threshold Criteria for Children in Need was completed in
2013, to evidence that existing arrangements to safeguard and protect the most vulnerable
children living or visiting the counties reflect their needs.
In the last 12 months there has been a steady increase in the number of children made
subject to a Child Protection Plan (CPP). This upward trend is due to a number of factors,
including:



improvements made by KCHT practitioners in applying the multi-agency child-inneed thresholds and statutory assessment framework for child protection
the continued application of the Common Assessment Framework (CAF), by KCHT
practitioners.
the Kent Safeguarding Children’s Board redefined its strategic objectives to state
that all children who were identified at risk of significant harm should be made
subject to CPP proceedings, which resulted in a review of such cases against the
afore-mentioned thresholds
Safeguarding Adults
During 2013/14, KCHT raised 226 Adult Protection (AP) alerts involving other agencies,
carers compared to 255 alerts raised in the previous 12 months. In the same period 65
Adult Protection alerts were raised against KCHT, either by another agency (9), or KCHT
itself (56). The details of the cases raised against KCHT services were as follows:
Page 64 of 153
Types of abuse Number of Adult
Protection alerts
Neglect
53 (29 pressure ulcers)
Financial
1
Physical
8
Sexual
3
Outcomes of alerts raised against KCHT
The 65 Adult protection alerts for 2013/14 is a significant increase in activity compared to
the 49 alerts raised during 2012/13. This increased reporting reflects the continued
awareness that our frontline services have as to their safeguarding responsibilities and
what constitutes a safeguarding concern. This is borne out by the increase in the number
of practitioners contacting our internal SG service, for advice and/or to share concerns.



Closed - abuse confirmed
14
Closed - abuse discounted
27
Closed – insufficient evidence
4
Cases still open/under
investigation by KCC
20
8/14 confirmed abuse cases were classified as a Serious Incident Requiring
Investigation (SI),
7/9 were investigated under the category of neglect
1/9 was investigated under sexual abuse.
Root Cause Analysis (RCA) investigation findings are used to formulate a robust action
plan to ensure organisational learning is embedded; learning is shared through the
Lessons Learnt Newsletter and included in training programmes to prevent such an
incident happening again.
The key learning opportunities and outcomes from the cases investigated through the SI
process, included

The need to improve shared care arrangements with care home staff
Page 65 of 153






The need for staff to have a better understanding of safeguarding policy and
procedure, to support earlier identification of concerns and timely liaison with KCHT
Safeguarding services and KCC
Review of staffing levels and handover arrangements, to support the provision of
safe care
The need to seek specialist advice, at an earlier stage in the patients care, to
support the early identification, escalation and management of complex needs
A review of staff competencies, to ensure the application of learning to practice and
patients will be cared for by trained and experienced staff
The need to access safeguarding training, to ensure that the patient’s best interest
is at the heart of care being provided
The need to have robust contract monitoring arrangements in place, that will
immediately highlight possible delays in equipment delivery and mitigate associated
risks of harm
Mental Capacity Act/Deprivation of Liberty Safeguards (MCA/DoLS)
Last year, each of the Community Hospitals was allocated a named Safeguarding
practitioner from the Safeguarding Team.
During core hours our Safeguarding service provides same day telephone advice
regarding any urgent MCA/DoLS issues/concerns and has regular presence at ward
rounds and multi-disciplinary meetings. This input from the Safeguarding service has
increased associated frontline teams’ awareness of MCA, increased safeguarding
consultations, reporting of MCA concerns and consideration of DoLS applications. There
are MCA link nurses, to provide local leadership around MCA and to act as a first line
resource to their colleagues.
Last year our Community Hospitals had 1 DoLS application authorised by the Supervisory
Body.
The achievements from this initiative include:  Increased sign-off of MCA competencies for band 6/7/8 practitioners
 MCA prompt cards.
 Bespoke MCA training sessions provided
 Best interest meetings taking place at the request of KCHT staff.
 Safeguarding Operational Manual published
Alignment of designated Safeguarding Specialist Practitioners to each community
hospital - Work will continue into next year, to support the MCA link nurses to consolidate
their role, ensuring that they are confident in undertaking regular case review. This will
provide the Trust with assurance that care plans, records and patient care reflects the
principles of the MCA.
Page 66 of 153
Improve Safeguarding training compliance – remains a key priority and a rolling
programme of Safeguarding training sessions is made available to staff across the Trust
practitioners have been reminded of their professional responsibilities to safeguard and
protect vulnerable adults and children. The table below shows the overall training
compliance.
Safeguarding Training – target 85%
12/13
13/14
80%
89%
Safeguarding children training
79%
80%
Safeguarding adults training
80%
89%
Mental Capacity Act (MCA) Training
To address the remaining (overall and module specific) compliance gaps:
Safeguarding and Mental Capacity Act training packages, included e-learning (which has
been endorsed by the Department of Health) have been made available and will support
face to face sessions to ensure compliance.
Goals for 2014/2015:





Ensuring that all staff are compliant with safeguarding/MCA and DoLS training and that
KCHT’s target is reached and maintained.
Reducing the number of cases of avoidable harm remains a priority for KCHT in
2014/15
Supporting MCA link nurses to consolidate their role within Community Hospitals
Achieve and maintain corporate compliance for all safeguarding training and ensure
robust action plans are in place and delivered against by each service that continues to
show non-compliance. 85% of community hospital band 6 and 7 practitioners to have
their competency assessed for DoLS
Review our MCA training to embed MCA into Consent and Safeguarding Children
training.
Page 67 of 153
Goal 1: Measurable year on year improvement in every area of patient safety in
community services.
Early Warning Trigger Tool ( EWTT)
An Early Warning Trigger Tool (EWTT) has been developed to identify teams where
quality performance is deviating from expected standards and to enable help and support
to be targeted to provide a level of assurance of quality throughout the implementation of
change and service redesign.
The EWTT has been rolled out across all services at locality level and has been in place
since October 2013.
Patient safety and ensuring patients suffer no harm is a key priority for the trust and this
tool helps to identify areas where safety maybe compromised through a range of indictors.
There are pockets of teams where we have had concerns during the year and rapid
support, guidance, training, competency assessments, review, recommendations and
actions of systems and processes and resource management has been provided.
The outcomes of intensive support has improved the delivery of quality care and reduced
harm to patients, improved patient and staff experience.
There are some key areas where there could be potential risks and action plans are in
place and on-going monitoring through the EWTT and a variety of assurance metrics
The thresholds of tolerance have been set with clear actions stipulated at each level for
the service / hospital. Clear action plans are put in place whenever there is a breach in
standards.
Goals for 2014/2015:
Further work is required on the EWTT and the indictors need to be refined following
its implementation and our learning.


To develop team-level reporting, as the aggregated score at locality level is
masking team level sensitivity.
Develop the escalation framework and rapid response support framework to
support teams identified in need of improvement.
Page 68 of 153
Goal 1: Measurable year on year improvement in every area of patient safety in
community services.
Delivering Safe Medicine Management
Making sure patients get the right medicines at the right time is important to us, whether at
home or in hospital, to keep patients safe in our care. Data indicates that incorrect
administration of medicines results in 10-20% of hospital admissions.
There has been a 16% increase in attributable safe medicine incidents reported in
2013/14 compared to 2012/13. This is largely due to increase reporting of medication
incidents within KCHT which is positive as previously not all areas reported consistently.
The table below shows 87% of these incidents did not result in harm to patients. The low
and moderate harms are predominately related to administration errors and missed doses
of medication which are unacceptable for patients. There is an organisational action plan
in place to address the root causes of these incidents. This is a priority area for
improvement for 2014/15.
2013/14
None
Low
Moderate Severe Death
Level of harm by percentage
88%
11%
1%
0%
0%
Level of harm by numbers
649
85
8
0
0
Performance against the agreed metric for 2013/14 to improve optimisation of medicines
by 20% was not achieved. The Trust has developed a medicine optimisation strategy
which has 6 overarching objectives and includes measurable key performance indictors to
ensure progress can be monitored in 2014/15.
Medicines Management undertook a number of actions to improve the management of
medicines which included:




Development of community medicines management administration documentation
and a Paediatric palliative care chart has been developed in collaboration with local
and tertiary paediatric palliative care providers to help improve the management of
medicines for patients.
Improved medicine training so that staff understand the impact of medicines on
patients
Pharmacy has worked with the University of Kent to develop an injectable medicine
a module as part of the Postgraduate Certificate in Community Health Care.
KCHT is compliant with the NHS England patient safety requirements (formally
NPSA) and has introduced the new syringe drivers that will improve patient safety
Page 69 of 153




In September 2013 KCHT became the first community health trust to have a
medicines information service registered and accredited with United Kingdom
Medicines Information. This service helps staff to discuss patient medicines and
issues with a pharmacist to ensure best use.
An external audit of systems and processes associated with the management of
controlled drugs provided significant assurance.
A successful staff flu vaccination programme was led by the Medicines
management team which resulted in a doubling of uptake amongst KCHT front-line
staff by using innovate ideas. Unfortunately whilst the Trust made a significant
improvement from 17% in 2012/13 to 49 % in 2013/14 we, it did not meet the
national target of 75% but was short listed for a national NHS Employers award, for
the innovative approaches used.
The first pre-registration pharmacy technician to be trained in Community services
registered with the General Pharmaceutical Council and a second student began
training in January 2014.
A number of areas of risk associated with the management of medicines have been
identified through audit, incident reporting and medicines information enquiries and actions
put in place to address them.




Patients missing doses or receiving drugs at the wrong frequency, this is being
addressed on an individual basis and is part of an organisational action plan to
eliminate these errors.
Agency staff do not always have sufficient skills to administer medicines safely.
This has been addressed through contracts with the agencies and on line training
packages
Wards/services being non-compliant with medicines policies, following each service
audit, individual service action plans are put in place to address the issues
identified.
The annual omitted dose audit showed that actions that have been implemented
during the previous twelve months have led to a reduction in omitted doses; work
to implement additional actions both in inpatient and domiciliary settings to further
reduce the occurrence of omitted doses. All incidents that have resulted in any
harm to patients however minor have been investigated and actions taken to
prevent similar incidents with the result that levels of harm from medicines is low.
The Patient Experience
Policies for the use of patients own medication and self-administration have been updated
and work to promote self-administration in community hospitals has taken place. Patients
have been supported in domiciliary settings to enable correct use of medicines and
prevent hospital admissions as part of different locality projects with much success.
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Goals for 2014/15:
The Trust has developed a medicines optimisation strategy with the following objectives to
be implemented in 14/15, which will support the areas identified as risk.
Objective 1: Strategic, Risk and Governance
KCHT will make medicines optimisation an integral part of the Trust’s medicines strategy,
systems, working practices and culture at all levels.
Objective 2: Safe Use of Medicines
KCHT will have systems, processes and practices designed and in place to prevent or
reduce the risk to patients from medicines.
Objective 3: Effective Choice of Medicines and Patient Outcomes
KCHT will have systems and processes in place to deliver good clinical outcomes through
effective medicines optimisation supported by robust local decision making.
Objective 4: The Patient Experience
KCHT will involve patients (and carers) in the decisions made about their medicines and
support them to take medicines as intended.
Objective 5: Environment for Medicines Optimisation
KCHT will continually work towards improving health environments that support optimal
use of medicines and secure the best outcomes for patients.
Objective 6: Workforce for Medicines Optimisation
KCHT will have in place workforce planning, development and education and training to
support the optimal use of medicines to ensure that services are delivered by competent
and well trained staff.
All of the overarching objectives are supported by detailed actions underpinning the
strategy.
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SUMMARY
Goal 1: Measurable year on year improvement in every area of patient safety in
community services
The summary of performance against goal 1 has overall been very positive with many
targets achieved and progress has been made in reducing harms to patients. However,
the Trust still has a significant amount of work to do to sustain and continue to improve
patient safety. Infection prevention and safeguarding adults training, PLACE results,
medicine errors and reduction in attributable pressure ulcers are the key areas requiring
improvements to ensure patients are not harmed.
The goals and measures for 2014/15 within goal 1 will ensure there are improvements in
these areas to minimise risk to patients and improvements made are sustained and
embedded into practice.
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Goal 2: To improve outcomes by developing integrated care pathways ensuring
the right care, right place, right person, right time
Transfer of Care
Transfer of Care is an area patient and carers would like to see improvements and is a key
priority for the organisation.
During 2013/2014 a total of 697 transfers of care incidents occurred from external
providers to KCHT. 46% of these were related to pressure ulcers and 25% were related to
admission, transfer and discharge issues. Work continues with health economy partners to
identify barriers to safe transfers of care and implement solutions such as a new Transfer
of Care form for reporting concerns. Whilst the reporting has been robust, we have not
achieved all the aspirations that were set for this year. The graph below shows the
transfer of care issues.
The internal transfer of care incidents related to:
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28% Safe Medicine Incidents
20% Access, Appointment, Admission, Transfer, Discharge
16% Pressure Ulcers
16% Treatment, Procedure
7% Patient Information
13% Other
A review of the incident reporting system took place to improve data capture of transfer of
care issues.
Since June there were 143 transfers of care issues involving KCHT services .The main
issue internally is communication and a new communication tool is to be used to improve
internal and external communication and will be rolled out during 2014.
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A review of incidents citing communication as a contributory factor reveals that the main
issues are delays or failures in referral process to community teams. This can result in
missed visits, omissions of medications, pressure area / ulcer deterioration and delays in
following up of vulnerable patients. These areas are being addressed by the introduction
of a caseload management tool, a quality risk indicator and enhanced pharmacy support in
addition to the actions in the pressure ulcer action plan.
Goals for 2014/2015:
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Further Transfer of Care audit 2014/15 against the policy
Complete implementation of Situation Background Action Recommendation
(SBAR) communication model for handover across all services.
20% Reduction of attributable transfer of care issues internally.
Improve data capture to enable focus on quality improvements.
Work with external partners to reduce the number of transfer of care issues that
impact on patients.
Develop a patient held discharge passport.
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Goal 2: To improve outcomes by developing integrated care pathways ensuring
the right care, right place, right person, right time
Improving End of Life Care
90% of patients die in their preferred place
Target
90% patients died in Achieved
their preferred place
The Trust is committed to improving and embedding best practice in all areas of end of life
care for patients and relatives/carers. The Trust appointed a Nurse Consultant for End of
Life Care in June 2013 to lead the development and implementation of an end of life
strategy to improve the care to patients and their families. The strategy has been
developed with key stakeholders including patients; carers; staff; the public and hospice
colleagues. On a national level it has been an important year for end of life care following
the review of the Liverpool Care Pathway (LCP). The review undertaken resulted in the
pathway being phased out with focus now on staff assessing patients and creating an
individualised care plan.
An audit was undertaken to identify the scope of the gaps in best practice, compliance with
LCP and a baseline on which to focus improvement actions and develop a response to the
removal of the LCP.
Information on the decisions regarding reassessment and actions taken indicates that
decisions to continue treatments or not were not always preceded by an assessment.
A key strand of the strategy is to focus on ensuring that the workforce has the skills and
competencies required to appropriately care for this vulnerable group of patients. Related
competency assessments to match the skills required to provide safe, effective care have
been developed and approved for implementation.
The education and training programmes have been reviewed to enable our workforce to
have the skills they require:
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For all new staff who provide clinical care to patients so that they have the fundamental
skills to care for patients who may be at end of life or have long-term conditions and
health issues that may make them consider their wishes for the future
On how to care for patients to ensure they have appropriate medication to keep them
comfortable at end of life
To help staff have the difficult conversations about dying with individuals and families
To enable our staff to discuss ‘Do not Resuscitate’ and to be able to work with the lead
clinicians to complete the appropriate documents to allow for a Natural death.
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The Trust has worked in partnership with colleagues at the University of Kent and
Canterbury Christchurch University (CCU) to develop and deliver education and training
on end of life care to nurses and doctors across the county. The Trust secured funding to
develop an online training programme to support the public and health and social care
staff to gain understanding and insight into Advance Care Planning. The Trust has
benefited from collaboration with local Hospices including Demelza House and the CHYPs
team for North Kent to help individuals including children plan for their future.
Policies and procedures have been updated and new policies developed to ensure staff
have the appropriate best guidance for end of life care. This includes a policy for care after
death, ‘do not resuscitate orders’, and another focussing on verification of death.
Regular forums have been established to allow colleagues from the local Hospices, third
sector providers (such as Marie Curie and Macmillan) and commissioners for end of life
care to discuss issues and areas for improvement. The aim is for the various stakeholders
to work together to make sure patients are getting the right care and future developments
meet the needs of the whole community. The Trust has already started using an electronic
system such as the ‘Share my Care’ record which identifies patients’ wishes at end of life
across local health providers.
The community nursing staff have also been involved in a research project to help better
understand carers’ needs for those caring for a family member or friend at end of life. The
National study is led by the University of Manchester and aims to improve the support
carers receive at end of life.
In Dartford and Gravesham, staff have been involved in a project known as “Planning for
Change”, a case management pilot to help identify those who are nearing the end of life to
help support them and get appropriate care and plans in place.
In West Kent, staff have been working to develop a rapid response service which aims to
support patients including those nearing the end of their life to enable them to be cared for
at home.
Goals for 2014/2015:
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Improve written information and communication on support at end of life;
Implementing the strategy to improve the experience for patients and those close to
them (End of Life Strategy available)
Take forward the work already underway to make sure our staff have the appropriate
training and the right skills to provide the right care
Listen to patients and their relatives and increase the opportunities for them to
feedback to us
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Review more data and information to ensure we provide high quality care. We will do
this via our new community information system
Improve ways of involving and assessing carers needs
Improve discussions and documentation on patients preferences and choices including
spiritual and religious needs
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Goal 2: To improve outcomes by developing integrated care pathways
ensuring the right care, right place, right person, right time
Morbidity and Mortality
Following the review of end of life care, More Care Less Pathway (2013) and the Francis
report, we instigated a procedure to review all deaths within the 12 community hospitals to
identify any areas of concern and to learn lessons to improve care and treatment. There
were 52 deaths in community hospitals. 90% of these were patients admitted for end of life
care, the other 10% were patients who were still undergoing active rehabilitation and the
death was unexpected, but no cause for concern was found in any of the cases
Key findings from the reviews for 2014 highlighted the following:
•
•
•
•
•
•
Senior staff are committed to making sure staff are supported to manage care of
patients at end of life
The majority of the care provided was supportive and staff felt they had enabled
patients to achieve a ‘good death’
KCHT currently has a lack of information for patients and relatives regarding Do Not
Resuscitate Orders and end of life care planning
Staff need to develop skills to recognise changes which suggest a patient is in their last
days of life
Lack of communication with families and updating on progress or change in symptoms
Transfer of care into community hospital beds for end of life care could be improved.
Work has continued throughout the year to assure that the implementation of The
Deteriorating Patient Policy is embedded into practice and audit has been undertaken with
a further audit on Resuscitation scenarios. Both these audits highlighted key issues
including:
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discussions regarding DNA CPR decisions need to be documented in the patient
records (using the MCA framework is the patient lacks capacity);
staff competence in completing the National Early Warning Score (NEWS);
actions taken when a patient’s condition deteriorates needs to be clearly
documented and evaluated;
poor team communication in resuscitation event.
Detailed action plans are in place and a review of the competency based training on Basic
Life Support which includes recognition of the deteriorating patient. This has resulted in
revision and further development of the training to incorporate management and of a
deteriorating patient and team communication. The competency assessment framework
has been reviewed for NEWS.
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Further work is required to ensure the audit recommendations and actions are embedded
into practice to safeguard the patients.
Goals for 2014/15:
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Implementation of End of Life training which includes recognising when a patient’s
at end of life and competency assessments for clinical staff
Developing information leaflets for patients and relatives on end of life care planning
and Do Not Resuscitate Orders
To work in partnership with our commissioners and other health and social care
providers to improve transfer of care
To continue to review mortality and morbidity
To implement standard mortality rate reviews in all community hospitals.
Revised competency based training for basic life support (BLS) will be included in
clinical induction
All community clinical staff to have completed training and competency by March
2015 target 85% compliance
Revised BLS incorporating management and recognition of the deteriorating,
patient, communication, National Early Warning Score and escalation and
associated competencies to be rolled out.
All clinical staff in Community Hospitals to have completed the revised BLS training
and to be assessed as competent to achieve the 85% target by March 2015.
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Goal 2: To improve outcomes by developing integrated care pathways ensuring
the right care, right place, right person, right time
Acute Pain
Key National guidance recommends ensuring people feel supported to manage their
condition and improve functional ability for people with Long Term Conditions and ensure
people have a positive experience of care.
Last year patient feedback identified that acute pain was an area that they wished the
Trust to focus on. As a result the Trust concentrated on a pain audit to understand how
pain was managed with patients.
The pain audit showed 94% of patients received a holistic assessment within 24 hours of
the first contact including pain assessment. 53% of the patients reviewed had an initial
assessment that included what had worked well in the past in managing their pain.
In 40% of patients, pain intensity was assessed using numerical scales. In 19% of patients
this was not assessed at all which identified a key area that required improvement. The
patient's preference for managing their pain was recorded in 43% of patients’ records. A
communication aid was required for 3% of patients (those that had learning disabilities) to
help assess their pain and its use and was recorded in the patients case notes. 83% of
records showed that a patient's plan of care had been developed and discussed with the
patient and/or their carer and agreed.
An end of life audit undertaken this year showed that in 100 patients, 97% had appropriate
pain relief prescribed.
Children’s services were also audited on pain assessment and treatment. 67% of the
children had a learning disability. 75% of those reviewed had a holistic assessment with
pain assessed at the initial contact. In 50% of cases a pain assessment tool was used. Of
these 50% of the assessments used the FACE tool whilst 33% used a numbers scale. In
100% of the case notes reviewed the risks and benefits of treatment had been discussed
with the child/young person and/or parent as well as possible alternatives for treatment. An
action plan is in place following the audit to address the issues highlighted.
We now have a pharmacist on call 24 hours a day, 365 days a year for advice if required
regarding medication which includes guidance on appropriate pain management for
patients.
Extensive training on syringe drivers and new equipment purchased to ensure patients at
end of life have access to appropriate pain treatment.
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The medicines management team has developed training packages using on line training
and blended learning to train staff in use of medication.
Goals for 2014/2015:
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Progress a task and finish group to take a lead on pain management and
assessment.
Develop a practice standard for pain
Identify and implement suitable assessment tools and pain scoring charts that can
be utilised as the basis for effective pain management. The tools will be suitable for
children and those with disabilities including blind people and those with dementia.
Develop a training package on assessing and managing acute and chronic pain
20% improvement in audit results especially in assessment of pain.
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Goal 2: To improve outcomes by developing integrated care pathways ensuring
the right care, right place, right person, right time
Dementia
The number of patients diagnosed with dementia is increasing, so ensuring that they
receive appropriate care is important.
In August 2013 the Trust appointed a Nurse Consultant for Dementia jointly with the
University of Greenwich. In addition she leads the Dementia Cluster within the Centre of
Positive Ageing at the university. The Nurse Consultant successfully acquired a place on
the first HE KSS / BSMS Primary Care Dementia Fellowship Programme led by Professor
Sube Banerjee with the development of collaborative working across KSS which is exciting
for the Trust.
A Dementia Strategy for KCHT has been developed through a Dementia Steering Group
and consultation at the First Class Care Conference (2013) and includes clinical
representation across KCHT’s workforce and the third sector such as Dementia UK and
patients/users.
A Dementia Care Pathway has been developed, an electronic resource for staff to use to
support patients and their families/carers affected by dementia.
Dementia awareness across the 12 community hospitals has been addressed through the
implementation of the Butterfly Scheme, the development of dementia champions and
dementia awareness training for all patient-facing staff.
The Butterfly Scheme includes a symbol of a butterfly which can be attached to patient
notes, or by their bedside, for patients with a possible diagnosis of dementia, to highlight
this to all staff, while maintaining a level of confidentiality. The symbol of the butterfly will
remind staff to use the REACH approach in communication: 
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Remind the patient what has led to this moment
Explain what is about to happen
Arrange the bedside area to make sense and be assessable to the patient
Check well-being, especially cleanliness and hydration
History must always be verified
Dementia awareness training has initially focused on community hospital staff, now this is
completed the training will be adapted and delivered to community nursing staff.
Following the completion of the training, staff voluntarily completed a dementia awareness
questionnaire, with 521 responses. Staff attending training sessions feel confident in
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recognising the early signs of dementia and how to communicate with a person with
dementia.
Case study
Film stars and fish tanks for Edenbridge hospital
With black and white film star pictures on the wall, you’d be forgiven for not realising
you had stepped inside Edenbridge and District War Memorial Hospital.
But the new look and feel is all thanks to a new initiative by Kent Community Health
NHS Trust to provide a friendlier environment for patients with dementia to
recuperate in.
The day room has been overhauled to create a calm and relaxing atmosphere for
patients, encouraging them to socialise and become more independent.
Other improvements include open seating areas so patients can chat to each other
more easily, improved access to books, magazines, television, music and
information leaflets, a fish tank, better access to tea and coffee which they can help
themselves to and black and white pictures of classic film stars on the main corridor
walls.
Rachel Daykin, Clinical Support Nurse Dementia Care, has been leading the
changes with the hospital team and has also been involved in training all staff who
come into contact with patients with dementia, including cooks, cleaners and
porters.
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She said: “It’s really fantastic to see the changes that have been made at
Edenbridge hospital. Before the improvements, the day room looked very dull and
dark and it was completely uninviting for patients. It was like a boardroom!
“It’s really important we provide a relaxing and supportive environment for our
patients and I know the changes have extended beyond the day room onto the ward.
This is really positive for all our patients, but especially those who have dementia as
it can be really frightening and isolating having to spend time in a hospital in
unfamiliar surroundings. The black and white pictures are my favourite feature; they
encourage people to reminisce and provide them with something familiar to talk
about.”
June Simmons, 70, from Tunbridge Wells, has been a patient at Edenbridge hospital
for two weeks. She started to feel very short of breath in December last year and by
the time she was admitted to Pembury Hospital she could no longer walk. She was
diagnosed with arrhythmia and offered the chance to go to Edenbridge for
rehabilitation before returning home.
She said: “I came here for rehab after staying at Pembury Hospital and they have
done a marvellous job helping me to walk again. As soon as I could walk with the
frame they brought me into the day room to have dinner. It’s a lovely space to come
and relax and chat.
“I am agoraphobic so don’t go out much at home and I will really miss all the friendly
chats in this room. I have made some really nice friends, felt 100 per cent supported
and don’t want to go home!”
Goals for 2014/2015:
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Focus on community staff to complete dementia awareness training with a pre- and
post-audit dementia knowledge questionnaire.
Continued support of community hospital staff to maintain development of the
Butterfly Scheme and implementation of intermediate dementia training for clinical
staff.
Further development of the Dementia Care Pathway with information to support
practitioners, and people living with dementia and their carers/families.
Easy access to relevant information and the creation of a blog regarding dementia.
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Goal 2: To improve outcomes by developing integrated care pathways ensuring
the right care, right place, right person, right time
Children and Young People
The Trust provides services for children and adults to support them to stay healthy,
manage their long-term health conditions, help them avoid going into hospital and, when
they have needed to be in hospital, help them to get home quickly.
We deliver Children’s integrated therapy services outside of Kent in East Sussex. There is
a large geographical spread of services, including areas of urban deprivation, and sparsely
populated rural communities. We offer a range of hub and spoke service provision from
clinics, as well as offering home and school based community visits – to ensure we see
the child and family in a setting that is best suited to their clinical and social needs, and
delivers care closer to home and school.
Waiting List Initiative East Sussex Children’s Integrated Therapy Service
In April 2013, KCHT took responsibility for the delivery of Children’s Integrated Therapy
services in East Sussex. At the point of transfer to KCHT, there were 851 children found
to be on waiting lists to see Occupational Therapy, Physiotherapy and Speech and
Language Therapy. Some children had been waiting for nearly two years for an
appointment. In discussion with commissioners, we agreed to carry out a waiting list
initiative to clear all waits within nine months. This not only assessed children, but offered
them a further three follow-up therapy appointments to complete therapy and discharge or
to start therapy and, if required, transfer the child to the new service for on-going care. The
waiting list initiative was successfully completed at the end of September 2013.
A new system has been established to screen, prioritise and allocate all referrals to the
service from 1 April 2013. New regular assessment clinics for all disciplines have been
established to meet the target for assessment within 18 weeks of referral. In addition, any
urgent referrals are now allocated and seen within two weeks of referral.
Family Nurse Partnership
This is a licensed researched based national programme specifically targeted to First Time
parents aged 19 and under having their first baby.
Each programme has 4 nurses working with up to 25 young parents each, in a researched,
strength based parenting programme which can make a real difference to these young
parents and the outcomes for their babies.
The research base shows that where the Family Nurses can engage young people the
outcomes it achieves are healthier pregnancies, better long term health and social
outcomes such as reduced smoking, increased breast feeding, reduced substance use,
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reduced post natal depression and achieves healthier relationships for the parents. Many
engage in education or employment following the birth of their babies. For their babies
there are reduced hospital admissions, reduced A&E and GP attendances, better
immunisation, and greater safety in the home, greater school readiness and school
attendance and in America where the programme has been in place for 30 years the
children achieve better education attainment, more likely to find employment and reduce
criminality.
Many of these young parents have been school refusers and are Looked after Children
and frequently do not engage with services.
Our first team of 4 nurses and 1 Supervisor was established in January 2012 and within 12
months they had engaged 96 families onto the programme and achieved higher that
national average engagement and retention rates with the young parents. Our first family
will graduate from the programme later this month.
Our licence to recruit up to another 100 families with an additional 4 nurses from January
2013 has commenced the fastest national expansion to the programme.
We currently have 157 parents on the programme. Currently the service is provided in the
following districts Swale, Thanet, Maidstone, Tonbridge and Malling which have the
highest rates for young parents across the county.
We have recently been granted further license for 1 supervisor and an additional 75
families which will expand the team by 3 Family Nurses, recruitment of the appropriate
families will commence in Jan 2015 due to the licensing and training requirements for the
team. Districts where the service will be expanded into are currently being negotiated with
commissioners and the National FNP team.
Universal Services
The Children’s Universal Service includes Health Visiting, Family Nurse Partnership,
School Nursing and Children in Care Nurses.
The Trust now has 253.87 Health Visitors [HV] in post compared to 217 in 2012/13 and
there are currently 106 students in training, they have the support of specialist mentors
and their Practice Teacher which provides a ‘team around the student‘ model of delivery.
This approach has been recognised and complimented at the recent NMC inspection with
one of our partner HEIs. The students will qualify in September 14 and January 15, we
intend offering all our students full time employment within the Trust.
In the past year we have worked with the local universities to provide a variety of bespoke
‘return to practice’ courses with 8 Health Visitors completing and joining the team we
have also been successful in attracting a further 15 qualified Health Visitors from out of
area.
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We recognise that having so many newly qualified staff, that it is even more important that
we retain our experienced health visitors to provide support both to clients and
staff. Therefore we have developed lead roles in areas such as domestic abuse and
perinatal mental health which provides intense early support for families and early referral
to safeguarding.
The Domestic Abuse leads have been supporting over 200 families with children under 5
who are experiencing Domestic Abuse.
By 2015 the increase in Health Visitors will ensure that all families in Kent are offered all
the elements of the Universal Healthy Child programme, which will include an antenatal
support visit to all parents, a new birth visit, a postnatal mental health assessment, a one
year and two and half year development check. The needs of the children and families will
be assessed and monitored and any additional support will be provided by the team or if
required an onward referral made. Using initiatives such as Active Baby, the service will
aim to help all children have a smooth transition from early year into school years.
Active Baby - It is acknowledged that the start of life is a crucial time for children and
parents, in laying the foundations of good health and wellbeing in later years. A child’s
early experience and environment influences their brain development during these early
years, when warm, positive parenting helps create a strong foundation for the
future. Active baby promotes cognitive development through movement and positive
parenting through interaction. This work has highlighted a growing issue of children
arriving at school ill prepared to learn. This includes issues such as poor toilet
control. Health Visitors and School Nurses have responded to these issues by developing
a programme to support children and families. All health visitors will be trained to promote
‘active baby’ and all children centre and early year’s staff will be trained in this approach.
Our lead Health Visitor Active Learner has now provided “champion” training to health
visitors, children’s centres and some early years settings a total of over 550 staff across
these settings in Kent have been trained to offer families these crucial messages for their
baby’s development. 85% children in the original pilot area are reported by teachers as
“starting school ready to learn” as opposed to a figure of around 25% four years ago.
Children in Care Specialist Nurse
The nurses provide all children in care with a review health assessment; they monitor the
health status of children and young people and help them to identify any health issues that
may exist. They work with the children and if appropriate the carers, to develop health care
plans that will highlight any issues, they make recommendations and if required referrals
to other health services, these plans are then monitored and reviewed as appropriate.
The following is just some of the feedback from the client experience:
“I was impressed with the service and the care and attention my children received”
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“The Nurse was very friendly and polite”
“The Nurse was funny and fun”
“The Nurse was very kind and didn’t make me feel insecure about my weight”
“The Nurse understood what I had to say even though some things were hard to talk
about, she listened and understood”
Agreed goals for 2014/15:
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Further expansion of Family Nurse Partnership programme to increase to maximize
capacity for 250 parents by March 2015.
Increase Health Visitors to 342.2 by March 2015.
Further develop the health visiting lead roles for CONI, Infant Feeding and
Safeguarding
Health visitor active learner training will continue to increase the training to 1000
staff
School Nursing
In School Nursing there are currently 106 students and the team has increased the
Practice Teacher capacity to 33. We have developed an innovative Specialist Mentor and
Team around the Practice Teacher model of delivery. This approach has been recognised
and complimented at the recent NMC inspection with one of our partner HEIs.
Clean and Dry was one of two Early Implementer Site Projects focussed on transition from
early years to school. School nurses and Health Visitors identified that a large number of
children in the Dover/Deal area were starting school in nappies, not having been toilet
trained. ‘Clean and Dry’ is a multi-agency approach to supporting parents in toilet
training. The project won national recognition and media coverage, with staff presenting at
DH conferences nationwide. In addition HPV vaccinations in Kent school totalled 95.5%.
Average uptake for all 3 vaccines was 87%, higher than the England average. KCHT
school nursing teams were the best performing in the SE Coast region.
National Child Measurement Programme (NCMP) uptake academic year 2012/13 – KCHT
school nursing teams achieved over 90% uptake in both Year 6 and Year 7, exceeding the
target.
In recognition of the important role school nurses have to play in the delivery of the
Healthy Child Programme, KCC commissioners invested in an additional 4 whole time
equivalent all year round SCPHN (school nursing) for the West of Kent.
2013 School Nursing Conference was held with Viv Bennett, Director of Nursing at the DH
and Public Health England as the Key Note speaker.
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Clean and Dry
Clean, Dry and Ready for School is a new initiative by Kent Community Health NHS
Trust.
School nurses and health visitors are working with nurseries and primary schools to
identify children who need help with toilet training before starting school and those
not yet clean and dry at school.
The pilot initially involved KCHT working with two nurseries attached to two schools
– Warden House Primary School in Deal, Bright Sparks Preschool in Deal and
Shatterlocks Infants School and Nursery in Dover. It’s been so successful it’s now
being rolled out across Kent.
School Nurse Practice Teacher Chris Beer said: “We had lots of contact from
schools saying they were seeing a rising number of children starting school who
were still wearing nappies and children who were not staying clean and dry during
the day.
“We looked at 18 schools and found 24 children who were not toilet trained. While
the odd accident is acceptable, we want to make sure children and parents are
supported so children are clean and dry before they start school and therefore ready
to learn.”
One of the main problems can be that children are not drinking enough fluid during
the day. “What we hope is that by working with children who are struggling early on
in nursery, we can support them so by the time they get to school they will be clean
and dry and can concentrate on learning.”
The team is also looking at how through children's centres, it can reach those
children who do not attend nurseries, by holding coffee mornings when they start
schools to meet with parents.
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Goals for 2014/15
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Expand the existing Immunisation Team
Introduce a Band 5 Development programme to support recruitment onto SCPHN
programme and retention of staff
Roll-out ‘Clean and Dry’ training to all School Nurses to support transition from early
years to school
Develop a transition pathway from Year 6 to Year 7
Develop an integrated School Nursing/Healthy Schools framework for the delivery
of HCP.
Expand the delivery of the initial assessments core service across KCHT
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Goal 2: To improve outcomes by developing integrated care pathways ensuring
the right care, right place, right person, right time
National Institute for Health and Care Excellence (NICE)
Compliance with Assessments
KCHT receives information from NICE for distribution, assessment and implementation
across the organisation which sets out best practice standards.
The organisation receives the following on a monthly basis from NICE:
•
•
•
•
•
Interventional procedures (relate mostly to surgical procedures)
Technological appraisals (these mainly relate to new medicines and must be acted on
by law)
Medical technologies (relating to medical equipment) and diagnostics
Clinical guidelines (these usually contain many recommendations)
Quality standards (these mainly relate to the priorities to be focussed on in the clinical
guidelines).
The Care Quality Commission (CQC), in its document, A New Start, June 2013, advised
that it will monitor and assess standards of quality, will work with NICE to ensure these
align with the NICE Quality Standards and provide a comprehensive spectrum of
standards, as recommended by Robert Francis. 28 quality standards were issued in
2013/14. Of these, 22 were relevant to KCHT and standards of practice have been
reviewed against the standards.
Goals for 2014/2015:
•
To implement commissioned standards as identified by NICE
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SUMMARY
Goal 2: To improve outcomes by developing integrated care pathways ensuring the
right care, right place, right person, right time
The Trust has made significant progress this year on End of Life and Dementia with
strategies in place. Baseline work has been completed to continue to build upon for next
year.
Children and Young people’s services have performed extremely well across all initiatives
to ensure positive health outcomes.
Transfer of care is an area where we will need to strengthen to ensure all transfers are
safe and transition from children’s to adult services are seamless.
Recognition and management of the deteriorating patient is a key area where the trust has
to continue to focus on next year.
All areas have key goals to meet throughout 2014/15 to ensure sustainability of quality and
patient outcomes.
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Goal 3: Measurable year on year improvement in patient experience, engagement
and satisfaction
Improving Patient Feedback
The Trust takes patient experience and complaints very seriously and works hard to act on
that feedback to make improvements for all patients.
We are using 230 iPads with ‘Meridian’ software to capture patient feedback in real-time in
people’s homes and at clinics and community hospitals. Feedback is consistently positive.
We receive around 1 complaint for every 10,000 patient contacts.
KCHT receives relatively few complaints relative to patient contacts; however, the overall
number of complaints has increased during 2013/14 to 362 compared to 301 in
2012/13. This trend is in common with other NHS trusts in Kent and may also reflect
increased publicity about how to complain. The trust encourages people to give their
feedback, whether it is good or bad, so that we can learn from it and improve the patient
experience. The number of complaints varies across localities.
289 of the 362 complaints for 2013/14 were reported in the KO41 an annual return to the
Department of Health and required some form of investigation to resolve. There have been
four complaints reported where the patient has suffered harm and these have been raised
as serious incidents and full root cause analysis investigations have been completed.
Learning from complaints has resulted in a variety of service improvements and changes
to improve our patients experience such as:





Improvements to appointment systems in community paediatrics.
Intermediate Care Therapy services have been extended to seven days a week in
some localities.
Promotion of local referral numbers / point of contact for community nursing.
Service user involvement in Dental services.
Podiatry provided a facility for patients to leave voicemail when reception was not
staffed.
Whilst the main subject continues to be clinical treatment, there has been an increase in
complaints about waiting times either for assessment or follow-up appointments relating to
a number of services, but in particular to Children’s Speech and Language Therapy in
some areas, Podiatry across Kent and Dental services in prisons. A deep dive report was
presented to the Trust’s Quality Committee and the improvement plan was
approved. Complaints about waiting times have reduced since October 2013, and
therefore it is likely that the actions are proving effective.
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The number of complaints per service needs to be viewed in the context of the number of
patient contacts. For example, in January 2014 Community Nursing services in Kent had
one complaint per 4,286 contacts whereas Dental had one per 2,008 contacts.
Patient Experience - The Trust’s overall patient experience score for April 2013 to March
2014 is 95% based on 57,362 surveys.
Overall patient experience is very positive, and the amount of patient feedback collected
each quarter is now more than the Trust collected on a yearly basis in 2011/12. Therefore
we can be assured that overall most patients have a positive experience.
There has been an improvement in patients reporting they feel involved in decisions about
their care and treatment compared with 2012/13.
A variety of actions from patient experience feedback have been implemented

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In Livingstone Community Hospital a privacy room for patient discussions and private
matters has been provided.
Eye masks/pads have been provided for patients who have difficulty sleeping.
At Whitstable and Tankerton Community Hospital a HCA now has one shift per week
dedicated to doing activities with patients on Friends Ward.
At Tonbridge Community Hospital a second phone has been provided to take incoming
calls and more activities are taking place at the weekend.
At Faversham Cottage Hospital volunteers are now coming in at supper time to assist
patients.
In Adult Musculoskeletal Physiotherapy a room is now available to hold sensitive
conversations.
In Community Orthopaedic and Chronic Pain ICATS texts are being sent to patients
advising them of appointments booked
an additional Podiatrist has now been recruited
School nurses now request a private room to be available after school Chlamydia
assemblies and information is now available to signpost young people to other venues
where testing can be provided.
Sexual Health has a choice of walk-in slots as well as booked appointments.
Friends and Family Test
We are one of the first Community Services Trust’s in the country to introduce the NHS
Friends and Family Test which is included in all KCHTs services surveys. Patient’s clients
are asked if based on their experience today, would they recommend the service to their
friends and family. The scores are calculated based on a range of answers.
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The maximum score is +100 and the minimum is -100. KCHTs had an overall score of
+77, which is positive and is above the benchmark of +75 for aspirant Community
Foundation Trusts (ACFT) recorded up to February 2014. We will strive to continue to
improve our score during 2014/2015.
Area
Trust-wide
FFT
Score
Total
Responses
+77
15,688
Extremely
Likely
Likely
12,320
2,948
Neither
Likely or
Unlikely
Unlikely
203
51
Extremely Don't
Unlikely
Know
51
115
Stakeholder Engagement
The Trust has made significant progress in actively engaging with stakeholders and has
exceeded the targets for 2013/14.
Target
Increase members
on patient
engagement
network by 20%
Increase membership to reflect the
local population
Increase
groups/reps on
a further 10
services
Recruited 2,673 new members in total.
Achieved by 55%
Increased members who are listed as
working class or non-working by 134.
Increased male members by 556.
Achieved
increase to 13
Increased members aged 22 and over
by 1,626.
The Trust engages with stakeholders in a number of ways, and generally receives very
positive feedback about the quality of care and positive attitude of our staff. This includes:


An on-going programme of attendance at voluntary and community sector events and
forums, with information stands, and as guest speakers. Examples of the 77 events
attended in 2013/14 include the Nepalese community event in Ashford, Kent County
Show, launch of the information service in Dartford, Dartford Elders Forum, Gravesham
Over 50s Forum, Ethnic Minority Independence Council forum meetings and
community event in Canterbury, Roma event in Dover, Little Forest Children’s Centre in
Tunbridge Wells, Fibromyalgia group in Swale and Tunbridge Wells, and Tunbridge
Wells Access Group.
A Patient Engagement Network with 130 members, 32 of who are involved in attending
the Trust’s committees and working groups as patient/public reps. Others sit on
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




interview panels; take part in PLACE visits; and assist the patient information team to
develop user-friendly patient information.
Work with the District Partnership Groups (people with learning disabilities) to develop
Easy Read information, including patient leaflets, posters and an Easy Read version of
the Trust’s quarterly Community Health magazine.
A Patient Experience Committee which oversees all our patient experience and public
engagement. This has places for 14 patient/public representatives.
We have a Memorandum of Understanding with Healthwatch Kent. We have attended
a training session with their prospective volunteers to talk about KCHT and NHS, and
Healthwatch have two places on our Patient Experience Committee.
We have met all but one of the CCG Board Lay Members, and attended one of their lay
members meetings at the invitation of the South Kent Coast Lay Member.
Within Children’s Therapy services in Kent and East Sussex, we will be expanding
current levels of parental engagement and feedback through use of parent and carer
forums for disabled children or those with long term conditions.
We co-ordinate a quarterly forum of patient and public engagement leads from NHS Trusts
across Kent. CCG Board Lay Members and Healthwatch are invited to attend these
meetings.
Goals for 2014/2015:
 Improve patient experience in services that are not reaching the Trust’s target
 Support services to make changes as a result of patient feedback including complaints
and ensure that changes impact positively on “protected groups.”
 Ensure all services have clear and accessible patient information both online and
printed, e.g. community hospital booklet, patients in community.
 Support services to improve information to patients and carers about further support
available.
 To continue to improve KCHT Friends and Family Test score.
 To improve engagement with hard to reach groups.
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Goal 3: Measurable year on year improvement in patient experience, engagement
and satisfaction
Improve Nutrition and Hydration
Malnutrition continues to affect over 3 million people in the UK with approximately 1.3
million being over the age of 65. The Trust has an on-going commitment to ensuring
patients receive the best nutritional support and risks associated with malnutrition are
identified and acted upon.
The Trust has an established Nutrition and Hydration Group which has a comprehensive
action plan in place that includes:







A malnutrition universal screening tool to risk score for malnutrition.
Nutrition policies.
Admission questionnaire for patients and their carers to support personalised care
planning.
Nutritional resources available for nursing staff to leave with patients.
Dietetic referral system for all community hospitals.
Hydration focus for community hospitals – a standard of seven daily drinks are offered
to our patients as well as the water jugs.
A Nutrition and Hydration Nursing handbook for all nurses. This holds first line actions
for staff to take in the prevention of malnutrition and dehydration.
The Hydrant is a hands free hydration system which the Trust trialled as part of our
commitment to improving hydration.
The overall awareness of the importance of hydration amongst staff has increased. It has
shown that a multidisciplinary approach is needed to support hydration. The project has led to
a variety of initiates being implemented.
Ensure that every patient has a nutritional care plan specific to their needs – ongoing action to increase awareness and knowledge regarding patients’ nutritional needs
and personalised care plan. Nutrition training modules are currently being rolled out. The
aim is to establish 100% compliance of identified staff to be trained in Nutrition and
Hydration by the end of 2014.
New menus
As part of the campaign new menus have been introduced and these include:


Seasonal menus – and easy to read menu booklets.
24 hour / 7days week hot meal availability.
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
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New crockery and mats (to support Dementia friendly initiatives).
Wider range of snacks and drinks available in snack cupboards.
Wider range of puree and modified consistency diet options.
Afternoon tea with homemade cake daily.
Cooked breakfast at weekends.
The menus have been assured by the Dieticians and Speech and Language therapists for
nutritional quality and safety.
Other Activities
Nutrition and Hydration Week
Nutrition and Hydration is essential to patient care and in 2014/15, our new campaign was
launched with tea parties across the Trust during this year’s worldwide Nutrition and
Hydration week 17 – 23 March 2014.
The aim of the Nutrition and Hydration Week 2014 was to:




Raise awareness and improve understanding of the vital importance of good nutrition
and hydration.
Illustrate how people can improve their quality of life by making changes to eating and
drinking habits.
Show staff the preventative role they can play in reducing malnutrition-related illnesses.
This event launched our Nutrition and Hydration 2014 yearlong campaign. The event
was a success for patients and staff.
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Goals for 2014/2015:
Aims for 2014/15 are to achieve the following outcomes:

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
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1000 KCHT nursing and allied health professionals to have attended face to face
nutrition and hydration training by March 2015.
50% of Health Care Assistants to have accessed face to face nutrition and hydration
training by March 2015.
Nutrition and Hydration information to be available in community hospitals discharge
packs by August 2014.
Ensure all community hospitals are using coloured crockery/coloured mats and offering
finger foods for patients with dementia by October 2014.
Audit hydration practices in community hospitals by January 2015
Audit the completion of MUST (assessment of nutritional status), referrals to dieticians
and nutritional care plans by March 2015.
Case study
‘Importance of nutrition and hydration highlighted across hospitals’
Community hospital staff across Kent pulled out all the stops to dress up as traditional
tea maids and serve patients drinks, homemade cakes, and fruit to highlight how
important the right food and drink is to recovery.
The event, led by manager Tiffany Maxted and our Nutrition and Dietetics Service, was
organised to celebrate this year’s Nutrition and Hydration week in March 2014.
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Goal 3: Measurable year on year improvement in patient experience, engagement
and satisfaction
Implement the six areas of the CNO Caring with Compassion strategy
The implementation of the Caring with Compassion strategy was launched with a series of
engagement events with patients, carers and staff to define ‘compassionate care’ for Kent.
The level of involvement was extremely high and the final definition was launched at the 1st
Class Care Conference in November 2013 which was attended by the Chief Nursing
Officer of England and the Chief Executive Officer of the Patient Association.
KCHT definition for Compassionate Care:
“Hear my story, respect me, be kind, acknowledge my wishes, respond and
understand my needs and care like you mean it, because you do.”
KCHT has made 2 DVDs highlighting compassionate care, and supported further
development of “Sit and See™” tool with the author to ensure it met the needs of a
community trust. It is an observational tool which aims to capture the quality of interaction
between patients and staff as Positive, Passive or Poor.
A robust action plan has been developed to support the implementation of the strategy
including:

Care – integrated care pathways.

Compassion – align 15 Steps, Dignity and Respect standard, PLACE inspection.

Courage – “Seen Something, Say Something” campaign encouraging staff to raise
concerns.

Competence – development of competency framework and role profiles; developing
community nursing tools to support competency and safe staffing and part of a project
with the University of Kent in developing a shared purpose framework and community
nursing tool.

Communication – introduction of SBAR (Situation, Background, Assessment,
Recommendation) as the Trust communication tool for staff.

Commitment – the development of professional practice standards clarifying
expectation for staff in relation to specific areas of practice; introduction of values
based recruitment.
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Goals for 2014/2015:

Roll out the observational “Sit and See™ tool” in practice and evaluate the findings in
community hospitals by end of quarter two.

Continue to support national and local developments in staffing competencies for
community nursing by March 15.

Further develop the competency frameworks across all areas of the Trust by March 15.

Develop a culture where everybody feels able to deliver first class care through the
implementation of the culture change plan.

Communication that is focused on the patient and their family - this will be measured
through patient questionnaires.

Treat everybody with compassion with a commitment to do the best we can - this will
be measured through patient experience, staff survey and appraisal.
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Goal 3: Measurable year on year improvement in patient experience, engagement
and satisfaction
Improving Health and Wellbeing
The Health Checks Team has given health checks to 32,000 people (34% uptake of
invitations sent) and is aiming to achieve a minimum of 50% of NHS Health Checks from
the invited population next year.
The team worked closely with GPs, pharmacies and other providers to ensure the invites
were sent in a staggered way to prevent any long waiting times, all clients received an
appointment within 4 weeks of a request. The team received positive comments on the
service by their clients.
The NHS Health Check programme aims to help prevent heart disease, stroke, diabetes,
kidney disease and certain types of dementia. Everyone between the ages of 40 and 74,
who has not already been diagnosed with one of these conditions or have certain risk
factors, will be invited (once every five years) to have a check to assess their risk of heart
disease, stroke, kidney disease and diabetes and will be given support and advice to help
them reduce or manage that risk.
The Stop Smoking service has received an average of 92% positive patient experience
this year. The team has reviewed its service model and has linked in to the health trainer
service for on-going behavioural support to prevent relapse and more targeted work in
areas such as mental health. The team has strengthened their links with Kent and Medway
Partnership Trust which has agreed to become smoke free next year. There are only two
mental health trusts in the country which are smoke free.
Target 2013/14
95% of patient
asked about
smoking as part of
their assessment
90 % of patient
asked were offered
a referral to stop
smoking services
Achieved
Achieved
The Health Trainer Service has seen over 4,800 new self-referring clients this year.
Clients have been achieving excellent outcomes with 73% of all goals set being fully or
partly achieved. The service sign posted clients for additional support for weight
management, stop smoking, increasing physical activity and social care support such as
housing, benefits and education. Clients have reported over 98% satisfaction with the
service.
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Healthy Weight - The Healthy Weight team deliver specific programmes for families,
young children and adults with a body mass index (BMI ) from 25 – 40+. The team will
also coordinate the delivery of community schemes including East Kent Health Walks, an
Exercise Referral Scheme and Fresh Start, a community weight management programme.
Working in partnership with schools, pharmacies, community centres and GPs we provide
sensible, practical help and advice to anyone wanting to change to a healthier lifestyle.
We specialise in assisting the most vulnerable populations in the areas of greatest need.
There is significant evidence that being a healthy weight is vital for long term health and
wellbeing and can prevent long term conditions such as hypertension, heart disease, type
2 diabetes and certain types of cancer.
We have good engagement with over 90% client satisfaction and we work with our
external providers who deliver services on behalf of KCHT to conduct patient satisfaction
and experience feedback to enhance our services further.
Self-Management - KCHT has developed a Self-Management Steering Group which is
progressing well and has developed the “Making every contact count strategy” which sets
ten priorities to improve pathways, develop easy referral processes, enhance training
provision to staff, to provide holistic support and strengthen services for self-management
to promote independence.
Sexual Health - integrated sexual health services allows service users to access all the
services they need in one visit and implementation of a Hub and Spoke model is
underway. There are 35 different sites across Kent and Medway and over 100 clinical
sessions per week.
Screening supports Public Health targets to increase the early diagnosis of HIV and
increase diagnosis of Chlamydia.
Staff have developed new competencies to allow them to work across the breadth of the
service.
Feedback from patients shows that they appreciate the services being on one site, which
was in response to the negative comments regarding waiting times. The service is also
aiming to increase patient participation through social media including Twitter and
Facebook.
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Case study
Tilly happy to be in the spotlight after help from Healthy Weight Team
Chirpy teenager Tilly Penn used to refuse to pose for family
snaps – now she’s thrilled with her professional portfolio photos
for a London acting agency and is feeling fit, healthy and
fabulous – with help from the Healthy Weight Team at Kent
Community Health NHS Trust. “I was never the skinniest girl
in the class,” smiles 13-year-old Tilly, who lives with her
mum Nina in Dover. “But I’d always loved PE until a couple
of accidents put me out of action and the weight started to
creep up.”
In a series of unfortunate events, two years ago Tilly broke her arm and then
suffered a fractured leg the following year. “Basically in years seven and eight at
school I couldn’t take part in PE or do any exercise at all,” said the One Direction
fanatic and Dover Grammar School student. “But I met the Healthy Weight Team at
a school sports open day and was told about Ready Steady Go. I thought, ‘I could
give that a go’.”
Mum Nina works for P&O ferries at Dover docks and was the first to admit that the
family had got into some bad habits when it came to mealtimes. “Because of my
shift work I often opted for takeaways or ready meals for me and Tilly. We both
wanted to be motivated to stay healthy, that’s where Ready Steady Go came in.”
Tilly and Nina started the programme in January 2013 at a local school. “It was
really good fun,” said Tilly. “I was worried at first but I met some really nice people
and we made lots of friends.”
Ready Steady Go is a free, fun course, which covers healthy eating, being more
active and changing family routines to encourage the whole family to take steps
towards a healthier future.
“The programme showed us that cooking from scratch didn’t have to be hard work,
we just needed to plan ahead and be a bit more organised,” says Nina. “Now I
watch the portion sizes and we always eat together at the table. It’s made a real
difference.”
“I’ve got loads more energy now,” says Tilly. “I eat breakfast every day and I usually
walk to school. I’ve even improved my grades.” Tilly also gets out and about in
Dover harbour twice a week to take part in a rowing club, which she loves. “I’ve
been going for five weeks and I really enjoy the exercise and the fresh air. I’m glad
we did Ready Steady Go and I’d recommend it to any family that wants to be
healthier.”
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Goals for 2014/2015:
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

Increase target numbers of smokers successfully quitting by developing and
implementing a new Stop Smoking model with commissioners. The focus will be on
behaviour change and harm reduction as well as quitting.
Develop and implement Every Contact Counts strategy.
Enhance health improvement services for mental health clients addressing the
recommendations within “Closing the Gap.”
Implement electronic records for all services including Sexual Health.
To continue to access the target population at risk of chlamydia to screen and treat.
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SUMMARY
Goal 3: Measurable year on year improvement in patient experience, engagement
and satisfaction
Overall the Trust has made positive progress against this goal with complaints increasing
which is positive and resulting in changes in practice. Patient experience is very positive
and achieved the target with Friends and Family Test results comparing positively against
Aspirant Foundation Trust. Trust stakeholder engagement has increased considerably.
Nutrition and hydration is fundamental to quality care and steady progress has been made
and continued work is planned for 2014/15. All health and wellbeing initiatives have
demonstrated achievements. The Caring with Compassion strategy is being implemented
and progress continues.
Goals for 2014/15 all aim to ensure we improve on the good work we have achieved and
clearly demonstrate we are listening to our key stakeholders.
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Goal 4: Promoting a culture of accountability and openness
Information Governance
Data Quality Statement
Effective delivery of patient care relies on good quality information and is essential if
improvements in quality of care are to be made. Historically the quality of data captured by
services working in a community setting has been poor due to a lack of investment in
information systems.
Background and Requirements
The Trust has a number of statutory responsibilities relating to the collection and reporting
of information. These range from the requirement to complete a number of national returns,
to the need to collect specific data sets for various services that the Trust provides. There
are also a number of local contractual requirements such as the need to supply a number of
local commissioning data sets commissioners on a monthly basis covering the activities of
many services the Trust provides. The Trust is also required to accurately report levels of
activity and performance against a number of key performance indicators and as well as
reporting achievement against the national and local CQUINs and reenablement schemes.
The Trust is also required to provide accurate information internally to support clinical and
business decision making.
KCHT is taking the following actions to improve data quality:

Assurance Policy: KCHT has a Data Quality Policy in place which is intended to raise
the profile of data quality and the subsequent information derived from it within the
Trust. Basic principles outlining the roles and responsibilities of staff the need to have a
robust data quality audits and governance arrangements for monitoring the policy
implementation.

Governance: The Information Quality Improvement Group (IQIG) meets on a quarterly
basis and has a membership which includes all ‘key’ information system leads,
Information Governance and Information Technology teams. The focus of the group to
drive the implementation of the data quality policy, ensure standard operating
procedures and best practice are followed and to review data quality audits and
associated action plans.
The Information Quality Assurance Group (IQAG) oversees improvements in data
quality and completeness to provide assurance to internal and external stakeholders.

Action Plans: There are various action plans in place that aim to improve data quality
relating to the Trust’s corporate and clinical systems. These range from system specific
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plans put in place following audits, to higher level plans covering local or national data
sets / data standards.

Monitoring: Internally data quality action plans are monitored via the IQIG and the IQAG.
The Trust’s commissioners also monitor a ‘Data Quality Improvement Plan’ which forms
part of the contract.

Reporting: The data quality and completeness indicators included in Monitor’s
Compliance Framework have been incorporated into the Trust’s Integrated Performance
Report. In addition, data quality star ratings have been added to this report along with a
number of data quality indicators to raise the visibility of data quality within the
organisation.
KCHT currently has no single, centralised, integrated patient records system in place.
Implementation of a new Community Information System (CIS) will address many of the data
quality issues within the Trust, as the system has been configured to comply with all relevant
data standards. The system will be fully implemented during 2014/15.
NHS Number and General Medical Practice Code Validity
Statement
Kent Community Health NHS Trust submitted records during April 2013 to March 2014 to
the Secondary Uses Service (SUS) for inclusion in the Hospital Episode Statistics which
are included in the latest published data.
The percentage of records in the published data which included the patient’s valid NHS
number was 99.8% for admitted patient care.
The percentage of records in the published data which included the patient’s valid
General Medical Practice Code was 100% for admitted patient care.
It should be highlighted that data are currently only submitted to SUS for ten of the twelve
Community Hospitals which KCHT has responsibility for. The Trust will be deploying a
new system to all twelve hospitals during 2014/15 which will enable SUS to be collected
and submitted.
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Payment by Results
Statement
KCHT has not been subject to the Payment by Results clinical coding audit during the
reporting period 2013/14.
Additional Statements
During 2013-2014 the Kent Community Health NHS Trust provided and/or sub-contracted
62 relevant health services.
The Kent Community Health NHS Trust has reviewed all the data available to them on the
quality of care in of these 62 relevant health services. All services are subject to a contract.
The income generated by the relevant health services reviewed in 2013-2014 represents
c.94% per cent of the total income generated from the provision of relevant health
services.
Information Governance
Statement
KCHT Information Governance Assessment Report overall score for 2013/14 was 81%
and was graded satisfactory and green.
Kent Community Health NHS Trust has shown significant improvement in the Information
Governance Toolkit Assessment (IGTA) for the period 2013/14. The compliance score
submitted for 2013/14 is 81%, exceeding the previous year’s score by 6%.
All requirements have met the minimum level 2 compliance, and the IGTA is rated as
“satisfactory”. The work plan for 2014/15 will include continued auditing of compliance.
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Goal 4: Promoting a culture of accountability and openness
Clinical Audit
By the start of each financial year KCHT has agreed an appropriate planned programme
clinical audit activity designed to assess our performance against local and national
standards of care.
Statement
During 2013/14 two national clinical audits covered NHS services that KCHT provided.
During that period KCHT participated in 100% of the national clinical audits it was eligible to
participate in.
The national clinical audits KCHT is eligible to participate in during 2013/14 were as follows:

National Epilepsy Audit – this did not relate to core business of the Trust and
therefore no eligible patients were identified. However, we will re-evaluate our
applicability of this audit in 2014/15. to the Trust.

Sentinel Stroke National Audit Programme
For 2013/14 there were no national confidential enquiries that KCHT was eligible to
participate in. However, for 2014/15 there are already 3 national confidential enquiries that
are relevant to KCHT. These include:
1. Lower Limb Amputation – organisational survey
2. Mortality Review
3. Sepsis – organisational survey
The reports of two national clinical audits were reviewed by KCHT in 2013/14 and KCHT
intends to take the following actions to improve the quality of healthcare provided.
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National Clinical
Audit Title
Findings/outcomes
Falls and bone
health in older
people

Falls screening tool 1 to be incorporated into the new electronic
community information system to ensure all patients receive
relevant falls assessment

The screening tool will be on the staff intranet for easy staff access
in the interim

Online training is available through the staff intranet for community
hospitals staff and has been added to the training needs analysis
under essential to role

Falls awareness training is being introduced for all clinical staff
within KCHT

A patient leaflet and booklet to provide advice about falls
prevention has been developed.

The outcome for patient will be improved screening, risk
assessment and tailored care package.

KCHT has proposed an annual inpatient HIV audit is undertaken
with the acute trust. However, KCHT do not manage HIV inpatient
services.

In line with other providers, and good practice, HIV inpatients are
jointly managed under the care of an HIV consultant with an
admitting Consultant. Complex inpatients are transferred to a
tertiary HIV centre in line with locally agreed pathways. The
outcome is that the testing for HIV is now more widely promoted
through a variety of training methods and community events
resulting in earlier detection and treatment.
National audit of
Treatment & Care
of HIV infected
inpatients
EFFECTIVNESS OF THE LOCAL AUDIT PROGRAMME
In order for a clinical audit to be recorded as complete by the Trust every single action
identified from the audit must be implemented. At the end of 2013/14 350 actions
designed to improve the quality of care for our patients had been implemented as a result
of clinical audit. Examples of actions undertaken or planned include:




Ensure that key data requirements for record keeping are incorporated as mandatory
fields in our new Community Information System.
Musculoskeletal Physiotherapy to introduce a Whiplash Assessment Form.
Community Orthopaedics to introduce waiting list system to monitor follow ups after
MRI and confirm the serious pathology pathway.
Mandatory workshops have been introduced for all staff required to monitor Telehealth
to ensure staff competency and capability and to ensure that we continue to deliver
high quality care to our patients.
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





Redesign consent audit instrument to reflect patient impact and assurance in line with
CQC Outcome 2 Standards testing design to ensure reliability and clarity in use.
Implementation of a monitoring system for wards incorporating review of hydration
practices through the nurse indicators.
The Fresh Start Programme will be monitored to ensure adherence to inclusion criteria
to ensure that all clients with a BMI in excess of 35 are referred to dietetics. This will
improve the criteria pathway and ensure the relevant service meets the clients’ needs.
Datix incident reporting to record being open for all patient safety incidents.
Increase the awareness and use of Antimicrobial Guidance.
Improve clinical coding to better capture all post exposure prophylaxis consultations.
Areas of good practice and positive outcomes for patients identified by local clinical
audit include:




Documentation audit highlighted that staff are aware of and able to apply the principles
of good record keeping taking into account information governance and relevant
professional standards.
Whiplash Audit showed that there are very positive treatment outcomes for patients
suffering from whiplash following treatment by Musculoskeletal Physiotherapy.
Management of MRI referrals in Community Orthopaedics Audit demonstrated that
regular review of referral criteria has been undertaken to ensure appropriateness of
referrals.
Telehealth re-audit confirmed that Kent Community Health Trust is seen as a national
leader in relation to Telehealth. We have hosted many other organisations to visit and
review our systems and processes. We were one of the first organisations to develop
protocols and policies to support the monitoring for patients using Telehealth –
therefore the implications of this audit will be felt Trust wide and we must ensure our
st





monitoring processes are robust and 1 class.
Consent audit demonstrated positive results in terms of patients receiving information
regarding their care, treatment and support options and information on the benefits and
risks.
Hydration in Community Hospitals Audit led to the introduction of nutrition and
hydration prompts. These are used to identify patients’ needs on admission to the
ward and support individualised care planning.
Fresh Start Audit showed that 99% of clients on the Fresh Start Programme achieved
their weight loss/maintenance goals.
Being Open Audit demonstrated that 95% of staff are aware of the principles of Being
Open.
Audit to Identify Appropriate Prescribing for patients with Bacterial Infections
demonstrated that there is excellent awareness of the associated risk with the
concurrent use of stomach acid suppressants and antimicrobials amongst prescribers
and staff.
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
Re-audit of HIV Post Exposure Prophylaxis demonstrated that there has been a
significant improvement of the appropriate prescribing of post exposure prophylaxis
from 69% in 2009 to 90% in 2013.
OTHER ACHIEVEMENTS FOR CLINICAL AUDIT





KPI’s were introduced around number of due audit recommendations implemented (set
at >=80% to receive green RAG rating). Trust position at end of financial year was
85%.
Outcomes for patients and staff are now included against all recommendations in an
action plan.
The Clinical Audit Group and Department have enjoyed the continued support and
input of 2 patient representatives.
Strategic Clinical Audit Co-ordinator now Chairs South East Clinical Effectiveness
Network (SECEN) and feeds into the National Quality Improvement Clinical Audit
Network which helps to drive the national clinical audit agenda.
Through Chairing SECEN the Strategic Clinical Audit Co-ordinator was involved in
presenting at the Healthcare Quality Improvement Annual National Conference. In
addition, a poster was also presented at this national conference on the KCHT Clinical
Audit Action Plan Monitoring Process.
CONCLUSION

Where concerns are identified in relation to individual audits by the Clinical Audit
Department but are not addressed by recommendations formulated by the project lead,
this will be escalated to the appropriate directorate group responsible for clinical
audit. Where issues remain outstanding these are escalated to the Medical Director
and the Clinical Audit Group.

Outcomes for patients and staff are now included against all recommendations in an
action plan. This encourages auditors to focus on the on the audit output rather than
the process of action planning and managing change i.e. there is a clear understanding
of how each action from the audit will improve care for our patients.
AUDIT PROGRAMME 2014/15
The audit programme for 2014/15 was approved by the Clinical Audit Group on 20 th March
2014 and consists of 160 clinical audits. Forward Planning sessions were held by the
Clinical Audit Department and Head of Risk Management with Directorates in order to
ensure that the programme for 2014/15 was systematically prioritised by using the HQIP 4step prioritisation model as outlined below:
Priority 1 – External “must do” audits e.g. national audits, CQUIN audits, audits of NICE
Guidance or other national priority areas.
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Priority 2 – Internal “must do” audits e.g. audits focussed on risk and quality issues
identified from a number of sources such as clinical governance, risk registers and
complaints data.
Priority 3 – Directorate Priorities
Priority 4 – Clinician Interest
This ensures that the KCHT Clinical Audit Programme for 2014/15 reflects relevant
national priorities and is informed by local quality and risk issues.
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Goal 4: Promoting a culture of accountability and openness
Research and Development
Research and Development Account for 2013/14
Participation in clinical research demonstrates Kent Community Health NHS Trust
commitment to improving the quality of care we offer and to making our contribution to
wider health improvement. Our clinical staff stay abreast of the latest possible treatment
possibilities and active participation in research leads to successful patient outcomes.
During 2013/14 Kent Community Health NHS Trust has participated in 45 research
studies, 19 of these are classified by the National Institute of Health Research as portfolio
studies. Portfolio studies are high quality clinical research studies that are eligible for
support from the National Institute of Health Research Clinical Research Network in
England.
Statement
Kent Community Health NHS Trust has become involved in 7 new portfolio research
projects during 2013/14. Total patient recruitment for portfolio studies for participation in
research approved by a research ethics committee for this period is 149.
Statement
The portfolio studies cited above the number of patients receiving NHS services provided
or sub-contracted by Kent Community Health NHS Trust in 2013/14 that were recruited
during that period to participate in research approved by a research ethics committee was
52.
The improvement in patient health outcomes demonstrates that a commitment to clinical
research leads to better treatments for patients.
There was 36 clinical staff at Kent Community Health NHS Trust participating in research
approved by a Research Ethics Committee during 2013/14.
In the last three years, no publications have resulted from our involvement in NIHR
research. However, KCHT has a commitment to transparency and a desire to improve
patient outcomes and experience across the NHS and we will be encouraging our
researchers to publish relevant findings in the future.
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In 2013/14 links have been strengthened between Research and Clinical Audit in order to
contribute to increased clinical effectiveness within KCHT.
Goals for 2014/15:
For 2014/15 we have increased the resources for research within KCHT including the
recent recruitment of an experienced Senior Research Nurse who will help to deliver on
our research priorities action plan which is focussed on the following 3 areas:



Review of existing arrangements to embed robust research structures within KCHT.
Establishment/re-establishment of links within and without KCHT to ensure stakeholder
engagement.
Raising the profile of research and ensuring lessons learnt approach to research
findings.
Our engagement with clinical research demonstrates Kent Community Health NHS Trusts
commitment to testing and offering the latest medical treatments and techniques.
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Goal 4: Promoting a culture of accountability and openness
Serious Incidents
The Trust remains committed to reducing the levels of preventable harms and developing
the Trust as a learning organisation where staff feel empowered to openly discuss
incidents and learn lessons. The Trust has focused on strengthening these values and
being explicit about the behaviours required to embed this into the Trusts culture.
In 2013/14 the Trust had total of 79 serious incidents compared to the 82 reported in the
previous year. The largest proportion relate to pressure ulcers. The Trust has maintained
100% compliance with the national targets for the completion of SI investigations. The
Trust has had no never events.
Root Cause Analysis (RCA)
KCHT embedded the Being Open policy and the principles of transparency and candour
into the Serious Incident investigation process. Every Serious Incident is investigated
using RCA process to ascertain the possible reasons leading to a Serious Incident.
Patients and their relatives/carers are advised of the incident and involved in the
investigation and clarification is attained on the level of involvement and feedback the
patient and their relatives/carers wish to have.
This year the drive has been to increase staff participation in the investigation process and
learning for students and staff within all disciplines. Heads of Service are expected to
complete 72 hour Report to encourage immediate action and learning in response to the
incident.
The highest prevalence of Serious Incidents are:
 Pressure ulcers 57%
 Information Governance (IG) 14%
 Falls 11%
The classification of an Information Governance Incident has been expanded and it was
expected this would increase the overall number of Information Governance Serious
Incidents. Compared to 2012/13 there were five fewer pressure ulcer Serious Incidents
reported in 2013/14.
Lessons Learnt
The serious incident team have developed a plan of action to ensure the organisation
learns lessons from all incidents/near misses/complaints and claims to improve patient
experience and patient/staff safety for future.
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The emphasis for every incident is to establish what has happened and not who is to
blame. At times, the investigation may uncover actions from an individual which require
further action and investigation to establish more details. This is always carried out in
collaboration with the operational teams and the employee relations team.
The lessons learnt newsletter is published quarterly and weekly information and learning is
shared through the communication bulletin.
Below are some of the recommendations and actions that have arisen from the
investigations:
Pressure Ulcer Serious Incidents
 Handover processes must be robust Staff should put equipment provision/delays on
the incident reporting
 Staff should refer to specialists for expert help
 All wounds to be photographed at the time of discovery
Falls
 Holistic assessments and reassessments must be completed relating to patients at risk
of falls and when patients are re-referred or if the patient’s condition changes.
 All equipment should be checked on every shift to make sure it is working correctly.
 Consent must be gained from patients for the use of sensor mats.
Information Governance
 Person identifiable information should not be kept at a non-KCHT site.
 Staff must always follow the safe haven fax procedure
 The pre-programmed fax number facility must be used to store the fax number for
frequently used numbers.
 Staff must ensure they only transport the minimum amount of information needed to
complete the visit and ensure that it is transported and stored in accordance with the
Records Management Policy.
Goals for 2014/2015:
 No never events.
 Embedding learning from incidents.
 Twenty per cent reduction in reported SIs Incidents due to an intended reduction in
pressure ulcers.
 Serious Incidents as a rate per occupied bed days/contacts will be reported
quarterly to the Quality Committee and Trust Board to allow benchmarking with
other similar providers.
 The Serious Incidents Team will engage with staff at focus groups to identify
innovative methods of sharing lessons learned.
 The Being Open Policy will be audited.
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Goal 4: Promoting a culture of accountability and openness
Understanding Claims
During the year 2013/14 the Trust had seven clinical claims. In one case we have admitted
the care given was not of an acceptable standard. To ensure consistently high standards
of care, the clinical service held a ‘back to basics’ training day and shared the lessons
learnt throughout the Trust. Five clinical claims are still being investigated.
We also had four non-clinical claims made against us in this period. One claim was
repudiated and the other three are still being investigated.
Inquests:
‘Rule 43’ reports have been replaced with ‘Reports on Action to Prevent Future Deaths’
(PFDs).
PFDs place the Coroner under a statutory duty to issue a report to any person or
organisation where, in the opinion of the Coroner, action should be taken to prevent future
deaths.
These reports can be issued before or during the inquest. It is important that the Trust fully
and swiftly investigates the circumstances of any deaths, identifies any action that can be
undertaken to reduce future deaths and puts in place a plan to carry out the actions. The
Trust has received one such report in 2013/14. The report related to communication
between healthcare providers and the holistic training of district nurses. The Coroner’s
specific concerns were:


The out of hours GP service (OOH GPs) had difficulties in contacting the district
nursing service and the Coroner considered that improved methods of both oral and
written communication between OOH GPs and the district nurses must be put in place.
The training of district nurses must now include that a patient should be examined if
symptoms of bleeding have been reported.
In our response, we explained that subsequent to the incident the relevant Head of Service
had provided to the OOH GPs full 24 hour contact details for her team. These details were
published by the OOH GPs on their intranet and were circulated to relevant staff. A KCHT
representative also attends the OOH GPs clinical governance meetings.
Clinical Education and Standards Team (CEST) has begun rolling out a programme of
training in holistic care and all community nurses will undergo this training.
In addition, the Trust has introduced new patient documentation which will support this
process (The Health and Social Care Record: Bi-Overview Booklet). This documentation
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has been developed in partnership with Kent County Council and has been designed to
allow our clinicians to document a full assessment of the clinical needs of each patient. All
staff who is expected to use Bi-Overview has received appropriate training on the
documentation.
Goals for 2014/2015:


More involvement in training of staff, including clinical record keeping, statement writing
and court skills in order to assist staff generally.
To reduce the number of coroners cases implicating KCHT.
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Goal 4: Promoting a culture of accountability and openness
Care Quality Commission
Statement
KCHT is required to maintain registration with CQC and has 34 locations registered.
We continue to be registered with the Care Quality Commission without conditions.
A condition of registration can be imposed upon a provider where there is evidence that
they are not compliant, to limit or restrict what they can do. The CQC has not taken any
enforcement action against us in 2013/14
We have not participated in any special reviews or investigations by the CQC during this
reporting period.
The Trust has a robust assurance process that requires services and subject matter
experts (in areas such as safeguarding, medicines, consent, learning and development
and equality and diversity) to self-assess compliance against the CQC’s 16 Quality and
Safety Outcomes.
Improvements September to December 2013
During this quarter work began within the Standards Assurance Team to consider the
recent, significant changes to the CQC’s inspection model.
The key lines of enquiry used during inspections of acute Trusts have been reviewed (a
community trust model has not yet been published) and an organisational level selfassessment undertaken so that indications of gaps could be identified.
The Trust’s mock CQC inspection tools have been re-designed and are now based on the
CQC’s new five domains – Caring, Effective, Responsive, Well-led and Safe. Training and
awareness material is being developed to raise awareness amongst staff.
The Trust will be inspected by the CQC during 2014.
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CQC inspections
The CQC inspected two of our services this year and the results are shown below:
Outcome
Outcome 1 Respecting and
involving people who use
services
Outcome 4 Care and welfare of
people who use services
Outcome 7 Safeguarding
Edenbridge Hospital
22.04.13
Hawkhurst Hospital
07.06.13
Compliant
Compliant
Compliant
Compliant
Outcome 13 Staffing
Outcome 14: Supporting
workers
Outcome 16: Assessing and
monitoring the quality of
services
Outcome 21: Records
Compliant
Compliant
Compliant
Compliant
Compliant
The CQC’s Quality and Risk Profile (QRP) for the Trust is updated by the CQC nine times
each year. Each new version is reviewed to ensure any areas of concern have been
addressed. The data available to the CQC to populate the QRP has increased since last
year.
The majority of items on the QRP are either positive (70 items) or neutral (144 items).
These data items relate to areas such as positive comments from CQC reviews and
inspections, Information Governance Toolkit results, Food Standards Agency ratings,
positive staff survey results, our responses to safety alerts from the Medicines and
Healthcare products Regulatory Agency (MHRA), and positive comments left by patients
on NHS Choices.
There are currently 39 negative data items within the QRP. The main themes of these
negative items are: 13 relate to issues identified during CQC review/inspection, 13 relate
to negative comments left on NHS Choices or the CQC's web form and 6 relate to Staff
Survey results and actions have been taken to address these negative items.
Goals for 2014/15:
The Trust will be inspected by CQC in June 2014 and aims to achieve “good” to
“outstanding” rating.
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SUMMARY
Goal 4: Promoting a culture of accountability and openness
The overall summary for this goal shows good progress with many targets achieved. We
have had no never events however the number of serious incidents has not sufficiently
reduced which is a concern for the trust. Ensuring lessons learnt are being embedded into
practice is a priority for the Trust to minimise the risk to patients and avoidable harm.
The trust received one “Report on Action to Prevent Future Deaths’ issued by the coroner
which is unacceptable and work will continue to ensure these lessons are embedded to
protect patients.
All goals for 2014/15 are set to ensure improvements will be made.
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Goal 5: Improving delivery capacity and capability in all areas
Clinical Education and Standards
Clinical Education and Standards
The delivery of consistently high quality care requires an educated, skilled, competent
workforce to evidence based practice standards. The trust is committed to the
development of the workforce and has developed strong partnerships with Higher
Education Institution (HEI) providers and clinical experts to develop a robust education and
workforce development programme.
Competency Framework - The Clinical Education and Standards Team (CEST) has been
developing the Clinical Competency Framework with Clinical Operations. The aim of the
framework is to reflect the professional standards, clinical competencies and the practice
outcomes expected of staff members from bands 2-7. Each role profile makes explicit to
staff their personal responsibilities in patient care. The core domain includes holistic
assessment, care planning/goal setting, record keeping and safeguarding. For staff in
band 6 and 7 roles the profiles include clinical leadership and management competencies
to ensure that quality of services are monitored and measured locally by the teams. The
role profile details the competency requirements, development opportunities and the
assessment process to meet the standards required for high quality care.
The framework will be supported by a robust education and training programme which will
include:
The framework will provide the structure to support staff to prepare the necessary
evidence required for Revalidation that is to be introduced to non-medical professionals
starting with nursing in 2015. It will provide assurance to the organisation that staff have
clarity of role, competencies and behaviours. The framework has been aligned to the
Values into Action framework and will detail the behaviours that will be required to each
domain. The framework has also been mapped to CQC, Nursing & Midwifery Council
(NMC) and National Occupational Standards.
Clinical Induction Programme – in 2014 the trust will introduce the programme which will
establish the competency framework with staff on commencing with the trust. It will focus
on the standards, competencies and practice outcomes for the high risk areas such as:




Holistic Assessment and Person Centred Care Planning/Goal Setting.
Pressure Ulcer prevention and management; and general wound management and 1 st
Choice Dressings.
Diabetes management.
Falls prevention.
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Preceptorship Programme – Newly qualified staff need a period of support and
supervision through the transition period. The trust has a programme in place which
provides staff with education and training but more importantly dedicated Action Learning
sets which enable them to have time for reflection, sharing experiences and learning and
networking.
Health Care Support Worker Programme (HCSW) – the Trust has a long standing
history of delivering HCSW programmes in nursing and Allied Healthcare Professionals
(AHPs). In 2013 the Francis Report recommended that a review be undertaken of HCSW
education and the Cavendish Review followed. The Trust programmes have been
reviewed against the Cavendish Report (2013) and the regional Health Care Support
Worker Career Progression Strategy. The Trust has developed a Health Care Support
Worker strategy and career progression framework for implementation in 2014. The
revised programme has strengthened the education and competencies relating to the high
risk areas of practice.
Quality Improvement Development Programme
In 2013 the first cohort of nursing delegates commenced a Quality Improvement
Development Programme and completed Quality Improvement Projects. The aim of the
programme is to provide mentoring to staff in clinical leadership roles to lead and manage
change and make improvements within their area of practice.
Validation
In August 2012 it was agreed that all learning opportunities in KCHT should be
standardised to ensure the provision and expectation of 1st Class clinical education every
time to ensure: 





Lessons learnt from incidents and complaints are incorporated in to training
programmes.
Focus is placed on competency assessment in practice.
Clarity on the patient outcomes measures that the training will impact upon
That training is fit for purpose.
Standardisation in relation to templates.
Application of appropriate teaching methods.
There has been an increased focus on the quality assurance of education and training and
on improving the quality and delivery of training sessions. The next phase of this quality
assurance process will focus on the impact the training has on clinical practices. The
quality assurance model will link in with the clinical competencies to help drive standards
up even further. An evaluation of the outcomes will be provided on a quarterly basis
through 2014/15.
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CEST has also developed an assurance visit tool to ensure that students, preceptees and
other learners have the support and the environment that promotes learning.
Mentorship – the NMC mandate that registrants who supervise teach and assess
students undertake an annual Mentor update. During this year the non-compliance has
been rectified with compliance over 85%. Across KCHT allied health professionals have a
high level of compliance. In recognition of NMC best practice AHPs have agreed to work to
the same standard and work is underway to incorporate roles equivalent to Mentors onto
the register.
The NMC completed a quality placement assessment in January for Canterbury Christ
Church University and February for University of Greenwich and no immediate concerns
were identified.
Clinical Supervision – Clinical supervision is a relationship based clinical education that
brings practitioners and skilled trained supervisors and/or peers together to reflect on
practice. Supervision aims to identify solutions to problems, improve practice and increase
understanding of professional issues. Across the organisation the level of access to
Clinical Supervision has been variable and sometimes undervalued by staff. Work has
been undertaken to review the policy, the models in place across the Trust and develop a
revised framework for staff.
Post Graduate Certificate in Community Health in partnership with the University of
Kent– The development of this model focused on high priority areas of clinical practice,
designed in response to gaps in clinical education and assurance related to competent
practice which correlates directly to patient outcomes.
The Trust will be able to deliver essential education flexibly and at a standard equal to
Higher Education Institutes. The delivered programme is focused on work based learning
and the application of Trust values and objectives. Rewards staff with academic credits
without additional attendance at educational institutions. It will also support the desire to
increase innovation and research activity.
Goals for 2014/2015:
 Ninety-five per cent of all clinical staff to have individual competency role profiles with
relevant assessment tools.
 NMC Mentors to maintain compliance at 85%.
 Development of career pathways for unregistered workforce through the strategy.
 75% of newly appointed unregistered clinical support workers will be on a career
development pathway by March 2015.
 Increase of 25 Non-Medical Prescribers within Long Term Conditions by March 2015.
 Implementing Post Graduate Certificate in Community Health Care in partnership
with University of Kent by September 2014.
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Goal 5 - Improving delivery capacity and capability in all areas
Workforce
KCHT strives to be a high performing sustainable organisation, delivering safe quality
services to our patients. Our staff are the critical factor in achieving this. We therefore
need our staff to perform at the highest level possible at all times.
Trust wide appraisal compliance was 82% which fell below our target of 95%. Work
continues to improve this compliance figure. Appraisals are key to ensuring staff
understand their role and objectives for the forthcoming year with support identified to help
them achieve these. This year the Trust has linked performance to pay for Bands 7 and
above with a view to rolling this out to all staff by April 2015. Staff are rated against their
compliance with mandatory training, performance against objectives, the achievement of
their personal development plan and an assessment of behaviours against our Values.
The focus of this framework is to create a high performing organisation with equal
opportunity for all staff to reach the higher performance categories.
Training
Is a key priority for the organisation and fundamental to high quality care. Our mandatory
training compliance figure is 85% and some areas have seen a considerable improvement
on attaining this target compared to 2012/13.
12/13 Year End
13/14 Year End
Training - Mandatory - Induction
99.00%
100.00%
Training - Mandatory - Information Governance
88.00%
87.00%
Training - Mandatory - Fire - Community Hosp.
77.00%
75.00%
Training - Mandatory - Fire - Non Community Hosp.
91.00%
88.00%
Training - Mandatory - Moving and Handling: Client
78.00%
79.00%
Training - Mandatory - Moving and Handling: Object
90.00%
94.00%
Training - Mandatory - Health & Safety
95.00%
97.00%
Training - Mandatory - Equality & Diversity
86.00%
91.00%
Training - Mandatory - Safeguarding Adults Basic
94.00%
97.00%
Mandatory Training: MCA Basic Awareness
99.00%
100.00%
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Services below 85% and are being targeted to discuss the reasons as to why compliance
is not being achieved and identifying alternative ways of providing training updates.
Our aim is to be compliant in all areas of mandatory training by June 2015.
Recruitment and Retention
A key focus has been to increase our permanent workforce and reduce the amount of
temporary staff. An action plan is in place to ensure values are aligned to those of KCHT.
The Trust is recruiting staff quicker having reduced our average recruitment timescales
from 10.5 weeks (November 2013) to 7.6 weeks (March 2014). Retention of staff
continues to be a challenge and preceptorship programme and close working relationships
with local Universities will enable us to recruit and support newly qualified clinicians.
New staff are surveyed after their first six weeks in post. This data will help us review our
induction period.
Our workforce of the future needs to be responsive and flexible to rapid and constant
change. We are introducing a model for potential recruits to rate themselves against our
Values prior to application. We are currently exploring the option of overseas recruitment
and Return to Practice to support those areas with the most difficulties in recruiting staff.
Leadership
Good leadership is key for our staff and many of our existing managers have already taken
part in extensive management development programmes. KCHT wants to assess the
current capability and future potential of leaders and managers and to use this information
to understand how they can improve their Management capability to inform succession
planning activities.
A framework for managers (The KCHT Manager) has been developed in which the Trust
Values are described in terms of outstanding leadership and management behaviours. All
managers will go through a diagnostic against this framework using a questionnaire
aligned to these behaviours which will inform targeted development.
Staff Survey
A full census for the 2013 staff survey was undertaken which meant that 5054 staff were
issued with a self-completion questionnaire.
The 2013 staff survey demonstrated that 73% of staff feel satisfied with the quality of work
and patient care they are able to deliver which is 2% lower than the national 2013 average
for community trusts. Within that score are the following results:
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


Seventy-one per cent feel they are able to do their job to a standard they are personally
pleased with;
Eighty-two per cent are satisfied with the quality of care they give to patients/service
users;
Sixty-four per cent feel they are able to deliver the care they aspire to.
Each of these scores is below the 2013 benchmark and was targeted for action in
Operational Directorate action plans following the 2012 survey.
Eighty-nine per cent (89%) of staff agree that their role makes a difference to patients and
69% feel they are able to contribute to improvements at work.
There are clear areas that require improvement and the Organisation Development
Business Partners (ODBP’s) are working with their directorates to develop action plans to
address any issues raised.
The aim of the actions is to create an environment where staff:








Feel that high quality is recognised.
Understand the context in which they work including commissioning expectations.
Are engaged by their line managers in shaping the services and solutions to address
the challenges they face.
Recognise their personal responsibilities and are held to account by the whole team.
Help staff recognise the impact their role has on patients.
Help staff understand the environment in which they deliver care, the scope of the
service they are commissioned to deliver, and provide positive recognition for teams
and individuals delivering an excellent service.
Create a culture where incidents reported match the results of the staff survey so that
incidents can be investigated and dealt with at the time they occur.
Create an environment where staff and managers understand their responsibilities
under the Attendance Management Policy, and managers are confident in supporting
absence and managing performance.
There are varieties of actions to be taken, some of which are:


Implementation of ‘Talking Points’ to improve trust, openness and accountability within
teams.
Local staff engagement sessions (targeting hard to reach staff) run by ADs and CSDs
to cover:
o Service achievements
o Commissioning intentions and challenges
o Requesting feedback and ideas from staff
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What are they doing to address the challenges eg recruitment, service changes?



Develop an understanding in clinicians of their leadership and management
responsibilities through the implementation of a first line management programme.
Continue the emphasis on high quality appraisals through the audit of Band 7.
Recognise high quality work through awards, articles in magazines, weekly bulletins
and positive media stories.
Improving Morale
Our staff engagement score in the 2013 staff survey has increased slightly to 3.69,
although it remains below the national average score of 3.71. Sickness absence
(including stress) rate has reduced although along with our level of turnover and retention
of staff remain key concerns and an element of our workforce strategy.
The Trust’s Staff Engagement Strategy has a number of strands:

A very visible “we are listening” campaign to continue to listen and make changes in
response to staff feedback. We need to continue to find ways to celebrate success and
recognise staff achievements.

Support for managers to engage well with their teams and support them through
organisational change this includes the KCHT Manager diagnostic described above
and further management development training including training for managers in
having difficult conversations, resolving disagreements and holding others to account.
Engagement has improved with managers and operational managers have been going
back to the front-line and experiencing the challenges faced by staff.

Staff Friends and Family Survey has been rolled out across the Trust. The survey will
be carried out quarterly and along with other measures such as turnover rates, will
provide a useful measure of how staff view our service and the Trust as a place for
treatment and to work.
Equality Delivery System
We have significantly increased the visibility of Staff Networks and introduced a new Staff
Disability Network. Communication between the Networks and senior management teams
has improved with an identified member of the Executive team at each network. All
networks work much closer together to share common themes and ideas and have
developed simplified ways to allow for quicker responses to feedback and requests. The
Disability Network has developed a Health and Well Being passport for staff to help the
conversations with managers on reasonable adjustments.
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Our website aims to improve our image towards diversity and we are discussing
recruitment strategies with our Networks to support on-going improvements to our
recruitment processes.
This year we have simplified our Equality analysis with workshops to help our staff
understand the value of understanding the equality impact of the work they do.
Goals for 2014/2015:
We need to recruit more staff, develop staff, retain skilled staff and keep those in
employment at work by:




Linking performance to pay for the rest of our organisation by April 2015.
Improving our staff survey results through the implementation of our Staff engagement
strategy using the results of our Friends and Family test for staff.
Continue to focus on reducing our vacancy rate through a planned approach to
recruitment and retention.
Reducing sickness absence with a focus on short term absence.
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Goal 5: Improving delivery capacity and capability in all areas
Transformation
The Transformation Team is driving forward service improvement and partnership work to
support the Trust in securing quality, clinical and financial sustainability. This work forms
the Trust’s Transformation Framework, known as ‘The Human Touch’ which is a
framework to transform:





Models and pathways of care, so that care is integrated around the patient.
The times and places where we deliver care, so that it is 24/7, close as possible to
home and make best use of technology.
Our people, so that we have a culture of continual service improvement.
Our clinical systems, so that we use technology to support services to be safer and
more efficient.
Our partnerships, so that we tackle the challenges and opportunities facing health
and social care together, making the best use of all our resources.
Highlights of this work in 2013/14 include:
Developing the intermediate care model which supports people to avoid admission to
an acute hospital by providing urgent support either at home or in a community inpatient
unit. It also supports early discharge from an acute hospital for rehabilitation, at home or
for a short rehabilitative stay in a community Hospital.
In 2013/14 a new model of more intensive support in the community was developed
including:






Expanding the therapy services to a 24/7 model.
Reducing length of stay to 18 days.
Enhancing the health and well-being support and social activities available.
Increasing the use of advanced nursing skills such as IV therapy closer to home.
Implementing the productive community services programme across 220 teams.
Implementing the e rostering system to ensure safe levels of staffing.
Transforming our partnerships: Integration Pioneer
The Kent Health and Social Care Integration Programme was recognised as one of
fourteen Integration Pioneers by the Department of Health in 2013. With the Trust’s
partners at Kent County Council and Kent and Medway Partnership Trust, the Adult
Operations Directorate, corporate teams and transformation team has continued to drive
forward the main mechanisms for integration:
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



Risk stratification to identify high risk patients.
Integrated teams across all CCG localities.
Multi-disciplinary teams (MDTs) meetings, led by either the GP or Community
Matron and involving all partners take place regularly.
Health and social care co-ordinators support the co-ordination of Local referral units
are being established to provide a single, co-ordinated point of access.
Throughout the year the Trust has shared its integration work with other organisations
around the UK, and presented at major national conferences.
Goals for 2014/2015:

Transforming our models of care: Support services to undertake service redesign to
increase quality, patient experience and productivity, including Musco Skeletal
services, intensive intermediate care, long-term conditions, and self-management
services.

Transforming the times and places where we give care: Supporting the
development of a service led strategy through mapping opportunities for services to
work collaboratively in community based buildings.

Transforming our people: Develop and implement transformation skills package to
improve skills of staff in undertaking service redesign and project management.

Transforming our clinical support systems: Complete implementation of e-rostering
by March 2015.
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SUMMARY
Goal 5: Improving delivery capacity and capability in all areas
Progress has been made with the development of a Trust wide clinical competency
framework.
However, overall performance against this goal has not progressed as well as we would
have wanted. Compliance with mandatory training in two areas was not achieved.
Recruitment and retention continues to be an area of concern, along with staff morale and
these issues will be a key priority for 2014/15 to ensure that this goal is met.
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SUMMARY OF RESPONSES
From: Alison Smith [mailto:Alison.Smith@eastsussex.gov.uk]
Sent: 15 May 2014 17:06
To: Clive Tracey
Cc: Thomas Jo (NHS HASTINGS AND ROTHER CCG)
Subject: Feedback on th Quality Account
Hi Clive,
Thank you for sharing this with me and I have now had a chance to review the document and consider the
content.
I am responding on behalf of the 3 East Sussex CCGs and the Local Authority as the joint commissioner and
the lead for your contract for the provision of the childrens integrated therapy services (2013) and
paediatric equipment (since 1 April2014)
The document talks about the quality goals and I am pleased that in this section the Trust wishes to build
on partnerships with commissioners and GPs and that you will aim to deliver integrated care pathways
working with partners.
The 6 priorities for improvement are areas that commissioners would want to see included and see services
deliver. It would have been nice to see some reference to children and CITs here and include the
importance of delivering services closer to home/school etc. I would have also liked to see some reference
in the document to the geographical spread of you services and how you acknowledge some difference
between areas by working in slightly different ways to reflect this.
In the section on Quality Aspirations and Goals 2014/15, would it be possible to include CITs here e.g
around patient experience and engagement with parent /carer forums.
A piece on CITS in the Children and young people section pages 86-88 would have been helpful too
especially as you did so well on achieving the waiting list challenge!
I hope these comments are helpful
Best wishes
alison
Alison Smith
Strategic Lead for health for Children and Maternity-East Sussex
01273 335109
mobile-07801 838590
E1C, County Hall,St Anne's Crescent,
Lewes,East Sussex BN7 1UE
Page 135 of 153
Healthwatch Kent response to the Quality Account for Kent Community Health Trust
As the independent champion for the views of patients and social care users in Kent we have read the
Quality Accounts with great interest.
Our role is to help patients and the public to get the best out of their local health and social care services
and the Quality Account report is a key tool for enabling the public to understand how their services are
being improved. With this in mind, we enlisted members of the public and Healthwatch staff and
volunteers to read, digest and comment on your Quality Account to ensure we have a full and balanced
commentary which represents the view of the public.
On reading the Accounts, our initial feedback is that the accounts are very lengthy and not written in plain
English making this hard for the general public to read, understand and digest. This is not a problem unique
to the Community Health Trust as we have seen similar issues with all the Quality Accounts from Kent
providers. For future reports we would like to work with you, and other providers, to ensure the reports
are accessible and understandable for a wider audience. For this year, a list of acronyms would help.
The report references on a number of occasions, engagement with the public and patients and it clearly
demonstrates that the Trust is very patient focused. We have also found this to be the case in our dealing
with the Trust over the past year.
We would like to hear more detail about how you are reaching seldom heard communities and we would
be happy to help you to develop ideas for the year ahead as this is such a vital part of your work. The
report clearly states the achievements made and the areas for improvement.
Healthwatch Kent has signed a Memorandum of Understanding with Kent Community Health Trust and we
have found them to be extremely welcoming and supportive of the work that Healthwatch does. The Trust
is always looking for new ways to engage with and listen to the public.
In summary, we would like to see more detail about how you involve patients and the public from all
seldom heard communities in decisions about the provision, development and quality of the services you
provide. We hope to continue and develop our relationship with the Trust to ensure we can help you with
this.
Healthwatch Kent May 2014
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PROGRESS ON FRANCIS
APPENDIX A
Theme
Progress
Creating the Right Culture




Plan for Future
Schwartz rounds have commenced – these sessions are led
by the Director of Nursing and Quality. Staff are asked to
focus on how they felt during an event (rather than focussing
on what happened) and are an evidence based method of
supporting staff to examine and reflect about an experience.
Staff engagement metrics have been identified which give the
leaders within the organisation a ‘barometer’ of how the staff
feel. This is used as one measurement in an Early Warning
Trigger Tool which guides the Board to where there may be
risks to quality and safety and act to remedy a situation as it
emerges rather than wait for an incident to occur.
The Executive Team has embarked on several approaches
to staff engagement throughout the year – the Director of
Nursing and Quality met with staff across all localities to
present the findings of the Francis report to them, outline the
KCHT strategy to embed the learning and give them an
opportunity to ask questions and raise concerns.
The Medical Director has introduced monthly Clinical
Governance Review meetings. This is a forum for clinical
staff to share complex case studies with their peers and
challenge each other in a safe environment. Clinical audit
results are presented at this forum to increase learning and
encourage peer review.
Page 142 of 153



A ‘You Said We Did’ section will be developed on Staff zone
to give staff a response to suggestions they make to the
Executive Team.
The Executive Team are hosting a series of road shows
across the Region to give staff an opportunity to ask
questions and give suggestions.
The Nursing and Quality team are planning an update on the
Trusts response to Francis and presenting this at team
meetings to ensure that staff feel involved in the action plan
and can feel part of it.
Theme
Progress
Putting the Patient first








Plan for Future
The Named Nurse System is in use at every community
hospital to ensure patients and relatives have a named
professional to discuss their care with.
The NHS Constitution has been widely publicised and
referred to across KCHT. Every member of staff received a
letter from the Director of Human Resources highlighting their
responsibilities.
KCHT has embraced and embedded the 6 Cs – Care,
Compassion, Communication, Courage, Competence and
Commitment – which was introduced by the Chief Nursing
Officer for England. This was celebrated at the Nursing and
Quality Conference which the CNO attended as the guest of
honour.
KCHT has publicised the #hellomynameis campaign to all
staff and tested staff response and patient response through
feedback questionnaires. Both staff and patients have
responded positively to this
Patient stories have been widely used for all staff groups to
ensure all staff have a patient focus no matter what their role
or function is.
The range of clinical education has increased to allow staff to
develop their skill set and deliver high quality patient care.
A set of core competencies have been identified for each role
within the organisation. This will ensure that the patient
receives care from competent staff.
The Trust is compliant with the National Quality Board
staffing guidance
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





A Named Professional system is to be implemented in the
community setting – in some cases this may be the GP or
Social Worker
The Trust will work towards every person with a long-term
condition being offered a personalised care plan – to be
agreed with their lead clinician – by April 2015
National guidance is expected to be introduced to reduce
malnutrition in older people. The Trust will adopt this.
The Trust will continue to develop a multi-disciplinary, multiorganisational diabetes pathway to improve patient
experience
The Trust will further develop the dementia friendly care
environment
The Trust will await the NICE guidance on safe staffing levels
and implement this where applicable.
Theme
Progress
Fundamental Standards of
Behaviour




Accountability of Directors





Performance Management
and Oversight




Plan for Future
All contractors providing outsourced services have had
contracts and codes of behaviour reviewed to ensure that
patient safety and quality is included to embed KCHT values
and expectations.
The Marsden Manual of clinical procedures has been made
available to all staff to ensure evidenced based, up-to-date
procedures and guidance is used for patient care.
The clinical audit programme has examined adherence to
quality standards and clinical procedures e.g. Intra-venous
drug administration.
A portfolio of practice standards is under development and
will be added to as new standards are developed
The KCHT Board complies with the NHS Healthy Board
guidance
The Trust has committed to Staff Engagement
The Trust has appointed shadow Governors from both public
and staff groups.
The Board are committed to the CQC’s Fundamental
Standards
The Trust has continued to embrace the Foundation Trust
process
Job Descriptions have been reviewed and altered to ensure
line management structures show accountability
The National Quality Board has introduced Quality
Surveillance Groups which are attended by commissioners,
regulatory bodies and NHS England to hold providers to
account
All staff are subject to competency assessments
Performance related Pay Progression for Band 7 and above
has been introduced from 1 April 2014
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

When policies/ procedures are reviewed in KCHT, guidance
or advice from professional bodies e.g. NMC, GMC will be
included where appropriate.
Healthcare assistants (HCA) to develop a code of conduct

Continue to adhere to the Fit and Proper Persons guidance
for application of Board members and Executives.

The Performance related Pay Progression for all staff grades
will commence in April 2015
Theme
Progress
Patient, Public and Local
Scrutiny



Effective
Handling
Complaints




Openness, Transparency
and Candour





Plan for Future
The Trust has embraced patient involvement at committee
level e.g. Medicines Management
The Patient engagement group is a successful long standing
group
The Trust use Internal audit to provide objective scrutiny
A gap analysis of the Clwyd Hart recommendations was
undertaken and actions taken to reach compliance
The Chief Executive has sight of all complaints
The Customer Care Strategy was refreshed this year.
There is clinical involvement in complaints whenever possible
The Being Open policy has been refreshed to take into
account new National recommendations
All staff are asked about Being Open when reporting any
incident
The Being Open audit shows 100% compliance with Being
Open in the Serious Incident process
Lessons to be Learned are included on the public website
The Trust has introduced a confidential telephone line for
staff who wish to whistle blow – ‘Seen Something Say
Something’
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


The Director of Nursing and Quality has commissioned
internal audit to complete an audit of the Francis action plan
A patient representative is being recruited for the Quality
Committee
The Trust will increase the involvement from Staff and Public
Governor’s throughout 2014/15.

A sample of patients will be asked for feedback about how
their complaint was handled to scrutinise satisfaction with the
service after completion.

The Duty of Candour responsibilities will continue to be
reviewed as National guidance is published.
Theme
Progress
Nursing





Leadership




Plan for Future
There has been collaboration with a local university to deliver
post graduate education within KCHT
Health Care Assistants are given the opportunity to gain an
NVQ certificate.
Staff have an opportunity for Health Visiting qualification
Band 6 Clinical sisters in Community Hospitals are
supernumery
An Enhanced Rapid Response service provides staff with an
opportunity to extend their clinical skills
KCHT has developed a Manager programme of education.
The first cohort of managers have positively evaluated the
programme
The Trust has commissioned a bespoke toolkit for managers
to build trust within their teams. This is called Talking points
The NHS Leadership Academy courses are promoted to
relevant staff
The Trust has continued to use the influencer strategy to
embrace change.
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
The Trust are collaborating to give staff an opportunity to gain
a Diploma in Community Nursing

The Trust will continue to promote the National and local
leadership opportunities and support staff into leadership
positions through effective appraisal.
Theme
Progress
Caring for Older People





Plan for Future
A Care of the Dying pathway and End of Life strategy have
been agreed
A Nurse Consultant specialising in Dementia has led a
steering group to improve the experience of patients with
dementia in the Trust.
The Medical Director is chairing a whole systems diabetes
strategy group to develop a multi-organisational diabetes
pathway
The Trust has won an award for the Community Geriatrician
programme which is part of the programme of work to
improve the specialist care for older people.
The success of the falls reduction strategy has continued
throughout the year
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
The Deputy Director of Nursing is collaborating with a local
university to develop a specialist course in caring for the
older person
APPENDIX B
CQUIN DASHBOARD
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Appendix C
AUDIT EXAMPLES FOR OTHER SECTIONS OF THE QUALITY ACCOUNTS
Examples of audits that map to the Quality Account Reports sections are included below:
Pressure Ulcers
The Management of Pressure Ulcers Audit
Audit Purpose/
Background
Outcomes/ Findings
This audit was undertaken to
gain assurance that best
practice guidance relating to
pressure ulcers and Band 7
responsibilities is being
followed and evidenced
through documentation.






Furthermore to identify
where current practice in
assessment, care planning,
delivery and recording can
improve and provide
assurance to Board and
external stakeholders.



The aim of the audit was to
reduce avoidable patient
harm through prevention,
early assessment and risk
reduction.


81% of the reported pressure ulcers were unavoidable
100% of Pressure ulcer risk assessments were completed.
90% Holistic assessment of the patient was completed on initial
visit
95% MUST nutritional screening undertaken at initial visit.
Malnutrition Universal Screening Tool (MUST)
85% of patients/carers were given documented evidence of
pressure ulcer information highlighting the risks and benefits
66% of patients had been holistically reassessed/reviewed 4
weekly or more frequently if their condition had changed or
deteriorated.
71% of equipment was regularly monitored for its effectiveness,
in line with the care plan ensuring it continues to reduce risk of
pressure damage and meet the patient’s needs
90% of patients had an individualised comprehensive wound
care plan which had been agreed with the patient.
Updated Framework document now includes a section for signoff by Head of Service review, when appropriate
Audit findings shared with Heads of Service for discussion with
Team Leaders and staff including the need to document care
and action taken
Rapid cycle audit undertaken to evidence where improvements
have been made.
Page 149 of 153
Pressure Ulcers Re-Audit
CG29: NICE guidance on pressure ulcer management
Audit Purpose / Background
Findings/Outcomes
A recommendation from the pressure
ulcer validation audit reported in June
2012 was to repeat a pressure ulcer
validation based on the audit
methodology, to review the
implementation of the changes
recommended and provide
assurance.
Assurance was provided with regard to the decisions the
Team Leaders were making/reporting. The validation audit
agreed with 100% of the decisions ‘that the pressure ulcers
were unavoidable.’
Following the Pressure Ulcer Audit
reported December 2012, one of the
objectives was to undertake a rapid
cycle audit of records of patients at
risk of developing pressure ulcers,
reviewing standards not fully met in
this original audit
 The conclusions that 78% were unavoidable, due to ‘all
preventative measures being in place’ and 21% were
unavoidable, due to ‘the patient having capacity but
was non concordant.’
This is an improvement to the results found in the previous
validation audit reported September 2012 where 77% of
the pressure ulcer decisions were validated as accurate
compared to the re-audit where there was 100%.
A handbook of Top Tips in Prevention and Management of
Pressure Ulcers for all clinical staff has been developed to
further aid understanding.
Falls Audit and Falls CQUIN audit
CG21: NICE Clinical Guidance on Falls (CG21) (replaced by CG161)
Audit Purpose / Background
Findings/Outcomes
KCHT seeks to identify those adults
at risk of falling and at time of audit
were using Falls Screening Tool 1 as
part of the admissions procedure. If
the screening tool indicates an
increased risk of falls then advice or
referral to an appropriate service for
further assessment can be given.
Assessments should identify the risk
factors for falls and osteoporosis and
offer appropriate interventions to
reduce the risk of falling. The audit
was undertaken to ensure that all
patients of 65 or older are
appropriately screened and treated or
referred on as appropriate.



Falls CQUIN audit- P/049/13 the CQUIN compliance
was met as shown:
o 99% of patients aged 65 and over were
assessed for the risk of falling at first
assessment – Standard 95%
o 97% of those at risk of falling were referred for
further assessment or support or had a full falls
care plan in place – Standard 90%
Availability of the falls prevention leaflets has been
increased
The falls screening tool 1 questions are now included in
the Functional Analysis of the Care Environment
(FACE) documentation.
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Nutrition and Hydration
Puree Diets in Community Hospitals P/077/12
Audit Purpose/
Background
Outcomes/ Findings
The Dysphagia Diet in
Community Hospital audit was
undertaken to gain assurance
that texture modified diets for
dysphagia patients were
prepared to the standards
described in the dysphagia diet
food texture descriptors
developed by the National
Patient Safety Agency.

The aim was to reduce the risk
of harm through aspiration by
ensuring that texture modified
diets provided to patients:



Are the correct consistency.
Decrease the number of
patients inappropriately
started on texture modified
diets.
Identify the best model of
food provision.







162 patients were audited, with 14% found to be on a
modified diet or enteral feed.
All those started on this diet due to swallowing difficulties
had been assessed by the Speech and Language
Therapist.
There was a lack of up to date training in dysphagia; a
training package is now under development by Speech and
Language Therapy
25 thick pureed meals across nine hospitals were audited
against the Dysphagia Diet Food Texture Descriptors.
Four meals failed the standards. Hotel services are to
introduce regular spot check monitoring of pureed and soft
meals. 100% of meals should meet the standards listed
Little detail was recorded on the meal systems in use at the
different sites.
Insufficient information was provided on fork mashable
meals, further audit is recommended.
Outcome was the introduction of new equipment for
producing puree diets. This has standardised pureed meal
preparation.
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Hydration in Community Hospitals
Audit Purpose/
Background
Outcomes/ Findings
The Hydration in Community
Hospitals audit was undertaken
to ensure that best practice in
hydration for community
hospital patients was being
followed. The audit aimed to:



Ensure adequate fluids are
being provided
Ensure care plans and
systems are in place for
those at risk
Ensure accurate
documentation of hydration
needs



The number of hot drinks offered daily varies
representing a historical difference in catering systems
and guidance between east and west Kent. The policy is
being revised to ensure standardisation with the
recommendation for at least eight hot drink rounds of
200ml to be offered daily and water jugs to be changed
at least twice daily.
The assessment and documentation of hydration needs
was hugely variable between the different wards and
there was no standard format to this assessment.
Standard assessment for hydration risk has been
developed and implemented on community hospital
wards
Nutrition and hydration practice to be monitored on ward
monthly and reported to the Community Nutrition
Steering Group
Health Visiting and Safeguarding
Antenatal / Postnatal Communication and Risk Assessment Audit –I/001/11
Audit Purpose / Background
Findings/Outcomes
This audit was commissioned from a
serious case review learning
implementation and monitoring
group. The purpose of the audit was
to ensure that the Antenatal /
Postnatal Communication and Risk
Assessment guidance implemented
in January 2011 was being followed
by Midwives, Health Visitors and GPs
in East Kent. This was an interface
audit between East Kent Hospitals
and Kent Community Health NHS
Trust as there was insufficient
capacity (within PCT) for GP’s to take
part in the audit.




This audit provided clear evidence that Midwives are
using the communication tool (Concern and
Vulnerability form) effectively and copies are being
sent in accordance with the Protocol.
Midwives now have the up to date contact address for
each of the six Health Visiting Districts
A notification form had not been completed by the
Health Visitor and sent to the GP in 23 cases. The
form has been re-launched to Health Visitors in all six
districts
Daily allocation of new births has been introduced to
increase the number of visits being undertaken within
14 days of the birth
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End of Life Care
QS13: NICE Quality Standard on end of life care for adults
Audit Purpose / Background
Findings/Outcomes
This audit was undertaken:




To ensure that all palliative care
patients who are at the end of

life and their families or carers,
have their care, treatment and
support needs met by being
given a high standard of
appropriate care.
To ensure that end of life care
follows nationally recognised

standards of best practice and
to verify that patients died in
their preferred place of care

where possible.
To provide evidence for the end
of life quality goal for the
Quality Accounts.
24% of patients are not included on a GP palliative care
register. Potential risk has been communicated to Clinical
Commissioning Group’s.
The majority of patients (89%) were involved in deciding
their end of life care plan. The audit demonstrates that in
a minority of cases improvements could be made in
assessing a patient’s capacity to understand explanations
and communicating with the patients regarding their end of
life care. A patient carer survey will be developed to
ensure involvement in discussions.
98% of patients (who were able to understand) were fully
aware of their diagnosis and that they were believed to be
in the dying phase.
In the community hospitals 29% of carers were given
verbal and written information on the support available to
them and in the community 12% were given verbal and
written information. Appropriate information leaflets for
patients/relatives have been developed.
OTHER CLINICAL AUDIT EXAMPLES
Medical Devices Survey
Survey Purpose / Background
Findings/Outcomes
The Medical Devices Survey was
undertaken to ensure compliance with
Medicines and Healthcare Products
Regulatory Agency (MHRA) guidelines and
to provide assurance against Care Quality
Commission’s Registration Standard,
Outcome 11, safety, availability and
suitability of equipment. This is the second
consecutive year that the survey has been
undertaken Trust wide to ensure that the
Medical Devices policy is understood and
followed by all staff where appropriate. The
purpose of the survey was to assess and
minimise the risk for both staff and patients
who use and prescribe medical devices.
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68% of staff correctly identified the symbol that
is used to identify a medical device can only be
used once.
88% of staff got the definition of a single use
device correct
Training was provided in 67% of cases if staff
prescribe medical devices, while it was provided
in 76% of cases if staff use medical devices
The Single Use Poster will be distributed to all
Services.
The Medical Devices Manager will deliver the
Single Use presentation at directorate meetings
The process for reporting a fault and or repair
will be clearly written in the Medical Devices
Policy.
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