Accessible Responsive Quality Caring Ethical Commitment

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Birmingham Community Healthcare NHS Trust
Quality Account
2014-15
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Contents
Part 1 - About Birmingham Community Healthcare NHS Trust.................... 1
Part 2 - Our quality priorities and statements of assurance...................... 19
Part 3 - Review of quality performance....................................................... 59
Part 4 - Annexes............................................................................................119
Part 1 - About Birmingham Community
Healthcare NHS Trust
Statement of quality from the Chief Executive....................................................2
A summary of successes and developments in 2014-15......................................4
About our services..................................................................................................5
Message from the Chair........................................................................................11
Putting quality first...............................................................................................13
Equality and diversity...........................................................................................14
Patient safety walkabouts....................................................................................15
New partnership with South Birmingham GPs..................................................16
Awards and recognition.......................................................................................17
1
Statement of quality from the
Chief Executive
This marks the fifth Quality Account for the Trust and it gives me great pleasure to
report on the successes and achievements that we have had over the past year. Our
vision is to achieve better care and healthier communities and, throughout this Quality
Account, we outline our commitment to continual improvement in service provision
and to be transparent and accountable to patients, the public, commissioners,
partners and others stakeholders.
The Quality Account is a vital and valuable snapshot into the quality of care that we provide
here at Birmingham Community Healthcare NHS Trust. This is an opportunity to tell you about
progress against the goals we set ourselves last year and what our priorities will be for improving
services for the coming year. We have asked our patients, staff, the public, partners, staff and
other stakeholders to give us their opinion as to what we need to improve, and we continue to
reflect on their views alongside the recommendations from external reports, in our priorities
going forward.
The primary purpose of our Quality Account is to allow clinicians and staff to demonstrate their
commitment to continuous quality improvement and to explain the Trust’s progress to the public.
We are able to demonstrate that the Trust’s quality ethos is stronger than ever, responding to the
needs of our patients and being accountable to all our stakeholders. The development of our new
dental hospital and our dementia friendly unit, are examples of our pledge to work closely with
our partners in order to provide excellent care and treatment with the highest quality healthcare
services for all the communities we serve in accessible locations that offer fitting environments for
modern healthcare.
We have made excellent progress on our quality priorities 2014-15, particularly the patient safety
programme, this year seeing a further increase in our harmFREE care and the further development
of our clinical reporting dashboards for staff. Our aim is to develop this work further through our
quality priorities that have been selected for 2015-16.
The Care Quality Commission (CQC) inspection that was carried out in June 2014 proved
thoroughly positive for us. We were rated as ‘good’ in all categories, with inspectors also noting
how patients and carers praised our staff for their ‘caring and compassionate nature’. Where the
CQC have recommended improvements, we have started work to implement the changes.
continued...
2
Better Care: Healthier Communities
We are proud of what we have achieved this year and this is a great credit and testament to all
staff who work at the Trust, for their ongoing commitment to putting the patient at the very heart
of everything we do. Throughout this year’s report, we are able to provide you with examples of
where we have invested in our staff to ensure that we have the right people, with the right skills,
in the right place at the right time and that we work to support and engage with our staff to
ultimately improve the quality of the services we provide.
During 2014-15, the Trust has continued to provide monthly information on quality and
performance as part of the Board reports, with detailed reports on our quality priorities.
This is supported by the Board hearing directly from patients. These reports are available
on the Trust website www.bhamcommunity.nhs.uk and they include information about our
responses to complaints and patient satisfaction survey results and other measures covering
each of the three domains of quality: patient safety, clinical effectiveness and patient experience.
An ‘easy read’ version of this Quality Account is available on the same website.
It is our intention that this document is as informative as possible, and we welcome receiving your
feedback, which will assist us in improving the content and format of future Quality Accounts.
On behalf of the Trust Board, I can confirm that, to the best of my knowledge and belief, the
information contained in the Quality Account is accurate and represents our performance in
2014-15 and our commitment to quality improvement.
Tracy Taylor, Chief Executive,
Birmingham Community
Healthcare NHS Trust
3
A summary of successes and developments
in 2014-15...
We have consistently
maintained 95 per cent
HarmFREE Care showing
improvement for the
past two years.
The opening of our
18-bed dementia friendly
unit has created an
environment sensitive
to the needs of people
with dementia.
Between April
and June, over
70 per cent of discharged
patients / carers took part in
the Friends and Family Test
(FFT) survey (national
guidance states this
should be a minimum
of 25 per cent).
An overall compliance
rate of 99.88 per cent was
achieved for patients who
received a risk assessment for
venous thromboembolism
during 2014-15.
The Trust received a CQC
rating of ‘outstanding’ in
the ‘caring’ domain for
our end-of-life services.
...and areas where we can improve
• The Trust failed to meet the zero tolerance target for Meticillin-Resistant Staphylococcus
Aureusis (MRSA) new bacteraemia and had three cases during 2014-2015.
• Preventing harm from falls is a key priority - with 26 patients suffering injury resulting
from a fall, we failed to meet our target of a maximum of 22 such incidents.
• During the period 2014-15, the Trust had one ‘never event’ - this was an incorrect tooth
extraction at Birmingham Dental Hospital due to human error.
• Despite significant effort we were unable to meet the challenging target of restricting
staff absence to under 3.9 per cent.
• BCHC has fallen below the national average for three out of the four patient led
assessment on care environment (PLACE) reviews.
4
About our services
Birmingham Community Healthcare (BCHC) NHS Trust provides high quality accessible
and responsive community and specialist NHS services across Birmingham and the
West Midlands and employs 4,820 staff (established budgeted posts - March 2015).
BCHC is committed to delivering better care to help create healthier communities. Across over
100 different clinical services and dedicated support functions, staff are working to help improve
the lives of people across Birmingham and the West Midlands.
What we do
Although the term ‘community services’ in
the context of the NHS is not always well
understood, it covers a very broad range of
services. For example, many people will be
aware of our community nursing service,
which is often known as the district nursing
service, and of our health visiting services.
The community services that we provide fall into
two categories - core community services that
we provide to the to the 1.1 million population of
Birmingham, and Specialist Community Services
which we provide to the city of Birmingham and
to the wider West Midlands Region including
Warwickshire, Staffordshire, Worcestershire,
Shropshire and Herefordshire, serving a
population of 5.5 million people.
These services include specialist rehabilitation
and an integrated teaching Dental Hospital
that provides undergraduate teaching and
postgraduate dental training, secondary and
tertiary specialist dental care. More than 100
different healthcare services are provided by the
organisation. Each year BCHC’s staff have more
than two million contacts with patients and
other service users.
5
Our core community services are provided to a
broad range of people within the communities
we serve, from the newborn to the elderly,
and are delivered in a wide range of locations.
The majority of services, such as community
nursing and health visiting, are delivered in the
patient’s own home, while others are delivered
in inpatient settings such as community hospitals
or intermediate care units. We also deliver
services in GP practices, health centres and child
development centres across the city.
A key focus for the NHS in Birmingham is to
reduce avoidable hospital attendances and
maintain an individual’s independence in their
normal place of residence. When hospital care is
needed, the aim is to make the stay as short as
safely possible. As the only dedicated community
service provider in Birmingham, the Trust is in the
vanguard of efforts to support the shift of focus
of care provision into the community.
This is a very brief explanation of what is a very
complex and diverse service portfolio.
BCHC comprises three clinical divisions
providing services to patients:
The Children and Families Division brings
together all the specialist community services for
children and young people across Birmingham and
offers a co-ordinated approach for child healthcare,
as well as delivering the universal children’s services
of health visiting, mainstream school nursing and
the paediatric eye-screening service.
The Adults and Community Division provides
a range of services for the local communities
within Birmingham including community-based
urgent care and hospital admission avoidance,
district nursing, community podiatry and
physiotherapy to specialist services for older
people. The division also operates two
community hospitals, enhanced recovery
centres and a palliative care facility.
The Specialist Division comprises:
Birmingham Dental Hospital (BDH), in
partnership with the University of Birmingham
School of Dentistry, provides a range of dental
services for people in the West Midlands, training
and development of the dental workforce and an
extensive research programme.
Combined Community Dental Services
provides a range of specialist dental services across
Birmingham, Dudley, Sandwell and Walsall.
Specialist Rehabilitation Services provides a
range of services across the West Midlands for
adults with long-term neurological conditions and
children and adults with limb amputations.
Learning Disability Services provides specialist
health services for people with learning disabilities
across the city of Birmingham.
6
Where our services are provided
The clinical services are supported by a range of corporate functions, such as human
resources, finance, performance, governance and risk management.
A dedicated patient experience team liaises with service users and their representatives.
Staffordshire
Shropshire
East and North
Birmingham
Worcestershire
Warwickshire
Herefordshire
Central and West
Birmingham
South
Birmingham
Key
Service
Coverage
Population
Community Services for children and adults
and Specialist Services for people with
learning disabilities
Birmingham
1.1 million
Birmingham
and Sandwell
1.4 million
School Nursing
Community Dental Services
Specialist Rehabilitation Services and
Birmingham Dental Hospital
7
Birmingham,
Sandwell, Dudley 2 million
and Walsall
West Midlands
5.5 million
Our Values
BCHC is a values-driven organisation. Our six values
are central to what we stand for and believe in.
Accessible
We will provide a range of services that reach out into the
community and meet individual need where everyone counts;
celebrating diversity and valuing difference.
Responsive
We will listen and work with our service users and partners
to meet needs and improve health and wellbeing. We will
encourage innovation and excellence, celebrating success
and learn from experiences.
Quality
We will provide safe, effective personalised care to the highest
standard, providing information to support service users and
their carers to make informed choices.
Caring
We will deliver our services with respect, compassion and
understanding, where people are valued and we will act in
their best interest.
Ethical
Promoting a culture of dignity and respect we will make
morally sound, fair and honest decisions and be openly
accountable. We will commit to investing wisely whilst
being socially and environmentally responsible.
Commitment
Through our actions and commitment we will strive to make
a positive difference to people’s lives. We will value our staff,
the commitment and contributions they make.
8
A strong vision
We deliver person-centred healthcare. Our ambition is to achieve ‘Better Care and
Healthier Communities’.
We have six strategic objectives:
People: To have a skilled, innovative workforce, who are compassionate and caring, where staff
are empowered to take action, and where customer service and clinical leadership are at the
heart of our services.
Purpose: To transform and deliver high quality, efficient, integrated services that enable the best
possible outcomes.
Partnership: To develop effective partnerships working with our stakeholders to provide
integrated care and break down the barriers internally and externally to maximise the benefits of
expertise in the organisation.
Promotion: To promote community services and the Trust, listen to and communicate clearly and
effectively with all our stakeholders and members.
Price: To secure our future through effective contractual terms supported by robust costing and
information systems to meet all our statutory duties and financial targets.
Place: To deliver services in the most appropriate location, supported by an efficient estate and
effective informatics infrastructure.
9
Directors’ Declaration
The Trust directors are now required to satisfy the new Fit and Proper Persons
and Duty of Candour regulations as part of a government directive.
Introduced at the end of last year as part of the Government’s fundamental standards,
the Fit and Proper Person Check and Duty Of Candour requirements help ensure that providers
have robust systems in place, to be open and honest when things go wrong and to hold directors
to account when care fails people.
The Trust’s self-assessment shows that BCHC has
sufficient policies, safeguards and processes in place in
most areas, with a small number of actions to ensure
full compliance.
We can confirm that to the best of our knowledge
and belief the information contained in this Quality
Account is accurate and represents our performance in
2014-15 and our commitment to quality improvement.
Peter Axon
Finance Director
Andy Harrison
Chief Operating
Officer
Beverly Ingram
Director of Nursing
and Therapies
Shokat Akbar
Commercial and
Marketing Director
(left organisation
January 2015)
Tracy Taylor
Chief Executive
Joanne Thurston
Director of
Compliance
and Assurance
Andy Wakeman
Medical Director
10
Message from the Chair
I am very proud to say again that quality continues to be at the heart of what we do
and remains a significant focus and commitment of the Board. This Quality Account
provides an opportunity not only to showcase the excellent work of the staff of
Birmingham Community Healthcare NHS Trust as we continue to improve our services
across the city, but I hope that it also gives an opportunity to demonstrate our
commitment to making improvements and learning lessons.
Understanding the healthcare needs of all of the communities that we serve is key to getting
decisions right as we move forward in an environment that continues to have financial and other
challenges. We have continued to build a strong public membership which is truly representative
of those communities and the recruitment and development of our Shadow Governors has
complemented this. So, we now have a well-established Shadow Council of Governors and its
main sub-committee - the Patient Experience Forum - is active in supporting the gathering of
views, feedback and ideas from our public representatives. We also continue to have our excellent,
dedicated Patient Experience Team, which works with our clinical staff in ensuring that the views
and needs of our patients, carers and members are reflected in the way we provide services and
that they remain a central part of our continuous improvement efforts.
I hope that you find the Quality Account interesting and informative. If you would like to comment
on any part of it, details of how you can do that are included at the back of the document.
We would be delighted to hear from you.
Tom Storrow, Chair,
Birmingham Community
Healthcare NHS Trust
11
Foundation Trust
Aiming to be a Foundation Trust
The Trust Board remains fully committed to becoming licensed as a Foundation Trust and we have
continued to work with our assessment team from Monitor, the Trust Development Authority and
the Care Quality Commission in order to achieve this. The Board of Directors regularly monitors
quality, activity and financial performance, receiving reports in these areas at each meeting, and
approves the signing of a self-certification of performance and a declaration of compliance with
Monitor’s license conditions at each meeting.
Governors’ messages
Dr Peter Mayer - Lead Governor
The Council of Governors plays an important role in the governance of the
Trust. Acting as the voice and representative of the groups that elected them.
I was elected to represent South Birmingham as a Public Governor to ensure
that the Trust is pursuing policies for its members, patients and service users to
provide the best services possible for their particular needs.
The Governors come from all walks of life; some from professional
backgrounds, some from other service providers and some with patient and
carer experience. I was a Hospital Older Persons and Stroke Specialist employed
in Birmingham by both acute and community trusts.
We are now working with the Board to achieve Foundation Trust status and
we are proud to be part of a Trust that, despite the economic climate, delivers
great services, learns from its patients and public and learns from complaints to
continuously improve what it delivers.
As Lead Governor, my role is to work with the Trust and the regulator to
make sure any governance problems identified are dealt with, and to support
succession planning and the appointment of all Board Non-Executive Directors.
Frances Young - Governor and Chair of Patient Experience Forum
As Chair of the Patient Experience Forum, I am pleased to be able to report
that it is now functioning as an important interface between patient interest
groups and those leading the Trust’s quality assurance processes. Quarter by
quarter, the forum receives and debates the Patient Experience report, and is
given presentations on key developments in areas such as patient information,
dementia care, pressure ulcer prevention or the performance of particular services
(e.g. the wheelchair service). The forum is also consulted about the determination
of quality priorities for the future and the preparation of this Quality Account.
It provides an opportunity for Governors to interact with members, and as a
sub-committee of the Council of Governors, is potentially a route by which the
public can influence the Council’s work. All level 3 members are invited to attend.
12
Putting quality first
Beverly Ingram - Director of Nursing and Therapies
High quality healthcare is about services and people who are committed to
excellence with the aim to provide as positive an experience for the patient as
possible. When we strive for high quality care, we must do this for everyone and
ensure that the patient and their needs are central: this is the most important
contribution we all make. Putting the patient at the heart the patient at the heart
of all that we do means that we aim for our services to be designed and delivered
around the needs of people who access care. Accounting for quality means that
we aspire to work together for patient and with patients (and their families and
loved ones) by providing care that is respectful, dignified and compassionate.
Colin Graham - Head of Clinical Governance
High quality care can only be delivered if all the elements of the Trust work
together. For BCHC it is about all staff in the Trust considering they can
make things better for each and every patient. It is the healthcare assistant
who takes time to talk to a patient about how she would cope at home:
it is the physiotherapist who spends a few extra minutes to ensure the patient
understands what treatment they would have and what that might achieve:
it is the district nurse who rings to ensure the equipment order is delivered
and then rings the carer to ensure it has arrived: it is the technician who spends
time sourcing a new prosthesis that would better suit a client’s need. The
Quality Account is one way in which this Trust demonstrates its commitment
to patients in Birmingham and beyond, to deliver the best care that we can for
each of them, and support our population to live as healthier communities.
Examples of Trust Board level assurance on quality
Board Level Assurance
Quality Account
Annual Quality Account provides an overview of the delivery of quality for
the previous 12 months, and the quality priorities for the following year.
Integrated Performance
Report
Both national and local quality metrics are reviewed on a
monthly basis. Update on the quality priorities and top risks to quality.
Board Assurance Framework Trust strategic risks are reviewed quarterly.
Ward to Board
Patients are invited to share their stories at the Board.
Indicators of essential care are also reviewed.
Patient safety walkabouts
Executive and non-executive teams actively engage with patients, service users
and staff by visiting the wards and clinical areas fortnightly.
CQC compliance update
Assessments are undertaken to review and ensure ongoing compliance.
Quality Governance
and Risk Committee
Trust Board sub-committee which reports monthly on quality
and risk issues.
Quality impact assessment
Assessment carried out on all strategic intentions and cost improvement
programmes.
Further details and examples of how the Trust Board is assured that quality is measured,
monitored and improved can be found throughout the Quality Account.
13
Celia Furnival - Senior Independent Non-Executive and Chair of
Quality Governance and Risk Committee
The Board continues to focus on maintaining and improving the provision
of quality of care for all our patients. The Quality Accounts demonstrate
that our clinical teams and Allied Health Professionals continue to meet the
challenges of the high expectations made of them on a daily basis, and we
are proud that they deliver our core values of care and commitment to the
community we serve.
John Craggs - Non-Executive Director for Quality
The Board receives comprehensive and detailed information providing Directors
with a clear picture of progress against our quality goals and demonstrates
where we need to improve to ensure we can reach the high standards we
set for our organisation.
Clinical quality is the cornerstone of the Board’s strategic vision and I am
delighted our Quality Account portrays that vision with such clarity.
Equality and diversity
ion
Pressure ulcer prevent
Talking leafletsntion
Think......
S S K I N
the information
professional can access
The patient/carer or health
ed number, they will
e by calling the associat
in the relevant languag
will be charged
d information. The call
then be played the translate
.
for approximately 2 minutes
lasts
and
rate
local
at the
.......... English
0121 696 4670..............
.......... Punjabi
0121 696 4671..............
.......... Urdu
0121 696 4672..............
.......... Bengali
0121 696 4673..............
.......... Gujarati
0121 696 4674..............
.......... Arabic
0121 696 4675..............
.......... Romanian
...........
4676...
696
0121
.......... Chinese
0121 696 4677..............
.......... Somali
0121 696 4678..............
.......... Polish
0121 696 4679..............
ity Healthcare
Birmingham Commun
NHS Trust
43565 23rd June 2014
ulcer preve
Translating pressure
ages
into different langu
466 5107 Ref:
Dental Hospital Tel: 0121
For example, we have
developed ‘Talking Leaflets’
where patients or carers
can access information
on specific topics in the
relevant language by calling
a number, where they
will hear the translated
information.
Graphic Design, Birmingham
BCHC aligns its services to meet the needs of all
patient groups in the population served in line
with national priorities and local commissioning
requirements which should recognise any health
inequalities that require targeted effort.
Goal 2 - Improved patient access
and experience
We aim to improve access to our services and
the experience for people who have protected
characteristics. The Trust continues to seek
feedback from patients on services provided and
we make necessary changes so that our services
are easily accessible.
Clinical Photography and
‘Protected characteristics’ are a set of nine
characteristics protected by law. It is a criminal
offence to be discriminated against because
of any one of them. These are: age, disability
including learning disability, ethnicity, religion
or belief, sexual orientation, sex, gender
reassignment, pregnancy and maternity,
marriage and civil partnership.
EDS2 has two patient-facing goals:
Goal 1 - Better health outcomes for all
BCHC works with commissioners, staff, patients
and other stakeholders to tackle the wider
issues of health inequality, particularly for those
groups that share protected characteristics.
Design & print enquiries:
BCHC continues to demonstrate full
commitment to the pursuit of equality,
diversity and human rights acts through
the Equality Delivery System (EDS2)
to ensure equality lies at the heart of
our values, processes and behaviours.
People have a right to high quality
services, irrespective of who they are,
where they live, or health status.
14
Patient safety walkabouts
Patient safety walkabouts have been a
feature of the organisation for a number of
years. They are a proactive way of ensuring
discussion between Trust Board Executive
and Non-Executive Directors and frontline
staff. They provide a great opportunity to
have a meaningful and structured dialogue
and they enhance the specific focus on
patient safety and patient experience.
The key aims are to:
• demonstrate top level commitment to
patient safety and clinical engagement
• provide a further line of communication
about patient safety among our staff,
executives and managers
• provide opportunities for senior executives to
learn about patient safety and experiences of
frontline teams
• encourage a culture of reporting of clinical
issues, errors and near misses
• establish and support local solutions to
minimise risk
• share good practice and innovations.
Patient safety walkabouts ensure that executives
are informed first-hand regarding the safety
concerns of frontline staff and that they visibly
demonstrate this commitment in listening to
and supporting staff when issues are raised.
An annual programme is drawn up every
year and a record of the visit takes place
with any actions noted and followed up.
Any areas of good practice or significant
concerns are reflected in the Quality Report
which is presented to the Trust Quality
Governance and Risk Committee.
A small sample of the issues identified and some of the actions taken:
Staff said…
The temporary relocation of
some staff has not given much
notice for informing families.
We did…
Clinical lead and Nursing
and Therapies
lead to discuss and addr
ess with
estates team to ensure
families are
given adequate notice
before any
moves take place in th
e future.
Staff said…
Improvements need to be
made to aspects of some
clinical environments.
We did…
Clinical teams are now involved
in the redesign of clinical spaces
as part of any refurbishment.
15
Staff said…
The personal development and
educational opportunities for nurses
in specialist teams need to improv
e.
We did…
Head of Clinical Education
and Professional Development
working with teams to explore
educational opportunities specific
to their learning needs.
Staff said…
Despite changes to open plan office
accommodation and the provision
of privacy screens, the current
arrangements are not suitable.
We did…
Resolved by estates tea
m with a partition
and door being put in
place, all risks
mitigated and team rep
ort a high level
of satisfaction with the
outcome.
New partnership with South
Birmingham GPs
BCHC continues to play a strong and developing role within the local health economy,
alongside commissioners and other statutory and non-statutory health and social
care providers.
Tracy Taylor, Chief Executive, said:
We are proving our ability to adapt to a
changing landscape within healthcare, both
nationally and locally, particularly in line with
the aspirations contained within NHS England’s
‘Five Year Forward View’. This demonstrates our
commitment to developing new models of care
with our partners and key stakeholders that will
deliver care in a more integrated and seamless
way to enable our populations to access the
appropriate support to meet their needs.
A number of exciting developments are
already beginning to emerge in primary care,
for example in South Birmingham through
the Prime Minister’s Challenge Fund and
in West Birmingham through Vitality being
supported as a multispecialty community
provider ‘vanguard site’. We are a key partner in
these developments which provides us with a
fantastic opportunity to work much closer with
General Practice to transform the way
we provide our services for the benefit
of the local populations.
At the same time we are actively working to
create other similar partnerships across our
geographical area. Different models will suit
different communities.
The Complete Care initiative is another example
of great innovation, developing integrated
services to fit modern needs. Complete Care
(part of the Healthy Villages initiative) brings
together health and social care provision across
both statutory and third sector organisations,
to offer a joined-up service for older adults.
The programme has won approval locally from
patients, as well as nationally from authoritative
organisations such as NHS Providers, NHS
Confederation, the King’s Fund and Health
Service Journal.
A number of exciting developments are already
beginning to emerge in primary care.....we are a key
partner in these developments which provides us
with a fantastic opportunity to work much closer with
General Practice to transform the way we provide our
services for the benefit of the local populations.
16
Awards and recognition
National recognition for armed forces support
BCHC has earned prestigious national recognition of the Trust’s work to support the
armed forces community in Birmingham and the wider West Midlands.
The Trust was awarded the coveted silver award from SaBRE - a national Ministry of Defence
initiative to support Britain’s reservists and employers.
SaBRE aims to help employers understand the role of reservists and raise awareness of the skills
that reservists develop through their engagement with the armed forces.
The Silver Award, signed by Secretary of State for Defence and Chief of the Defence Staff Michael
Fallon MP, is provided to organisations in recognition of their commitment to support the armed
forces, veterans and the families of former service personnel.
Healthy Villages director named as ‘top innovator’
The Healthy Villages initiative received further national recognition
with programme director Sam German named among the 50 top
innovators by Health Service Journal (HSJ).
The magazine published a supplement featuring 50 people in healthcare who
‘are already showing the creativity and imagination necessary to transform the
health service for the 21st century, by introducing new ways of working, policies
and technology at their workplaces and beyond’. Sam was particularly praised by
the judges for ‘putting older people at the centre of health and wellbeing’.
Healthy Villages focuses on integration and joined-up care; preventing health
issues arising; and promoting individual and community wellbeing. Sam said:
The essence of Healthy Villages is about working together in partnerships and being
open to innovation. It is hugely encouraging that what we are doing in Birmingham
to address the health challenges of the future is being recognised nationally.
17
NHS Leadership Recognition Awards
The Trust won ‘NHS Board/Governing Body of the Year’ in the regional NHS Leadership
Recognition Awards.
The Board was recognised for its ‘effective, inspiring leadership for the organisation and its 5,000
staff; inspiring staff to share total commitment to its clear vision of achieving better care and
healthier communities; ensuring patient safety and quality are at the heart of everything’.
Chairman Tom Storrow said:
The award recognises how much the Trust has achieved in meeting clinical, quality
and financial targets whilst delivering more than two million patient interactions
each year. Our Board has a regular presence at the frontline to support patient safety,
and helps ensure we build a strong, values-based, patient focused organisation.
CIPR Awards
Trust’s communications activity
was recognised in the regional
Chartered Institute of Public
Relations (CIPR) awards.
Chief Executive Tracy Taylor’s monthly staff
vodcast won ‘Silver’ in the ‘Best Internal
Communications Campaign’ category.
The Healthy Villages programme and
the parental alcohol awareness campaign
‘Who’s in Charge?’ were finalists.
Nursing Times
The Trust’s Head of Safeguarding Children, Clare Edwards, won the prestigious
national accolade of ‘Nurse Leader of the Year’ at the Nursing Times Awards.
Clare impressed judges with her tireless work on behalf of children across the city
and her influential role in strengthening multi-agency collaboration.
Health Service Journal Awards
The Healthy Villages won a ‘highly commended’ runners-up award in the category for ‘Improving
Partnerships between Health and Local Government’. Judges praised the ‘scale of vision and
huge potential for the community’.
Our other finalists were: the Children’s Palliative Care Team in the ‘Compassionate Patient Care’
category; Clare Edwards, Head of Safeguarding Children, in ‘Clinical Leader of the Year’
and Tracy Taylor in ‘Chief Executive of the Year’.
18
Part 2 - Our quality priorities
and statements of assurance
Looking forward - our priorities for quality improvement 2015-16.............. 20
Looking back - review of our priorities for quality improvement 2014-15...... 25
Statements of assurance from the Board of Directors................................... 37
Participation in clinical audits.......................................................................... 38
19
Looking forward...
We have worked with patients, members of the public, staff and other NHS and local
authority partners to make sure that our priorities address their thoughts, concerns
and aspirations for community healthcare.
Linking in closely with our strategic priorities, our quality priorities serve as areas of key focus
across BCHC. The Board approved our quality priorities for the year ahead, 2015-16, after
extensive consultation with a range of stakeholder groups including the Clinical Forum,
Patient Experience Forum, Governors, members (level 2 and 3) and staff.
The priorities are clinically driven and support the three quality domains:
Patient Safety, Clinical Effectiveness and Patient Experience.
How we chose our quality priorities for 2015-16
The Trust agreed to consult widely on
our quality priorities for the coming year
2015-16 with our internal and external
stakeholders. The project lead for the
Quality Account worked closely with
the Patient Experience Team during the
consultation process.
Consultation took place from November 2014
through to the end of March 2015 and allowed
feedback to be sent via a number of methods,
including an online survey and discussion
forums and sessions.
Stakeholders were asked to suggest quality
priorities and over 100 responses were
obtained. Feedback from the consultation was
collated and analysed with particular reflection
on local and national priorities.
Consultation included the following:
• Patient Experience Forum
• Members of the public
• Governors and a selection of level 2
and 3 members
• Clinical Forum members
• Management Board
• Clinical Divisions.
As part of our process for reviewing and
proposing the quality priorities for 2015-16,
our internal stakeholders reflected on:
• the consultation feedback from internal
and external stakeholders
• our past performance against quality
indicators
• our performance against quality priorities
2014-15
• our risks on the assurance framework.
The Trust Quality Governance and Risk
Committee and the Board further discussed and
finally agreed the quality priorities for 2015-16.
All feedback from the consultation was
reviewed via the appropriate governance forums
so we were able to follow up on some of the
suggestions that had been made. The following
Board quality priorities have been selected and
signed off for 2015-16. More details can be
found from page 21 onwards, where progress
against these will be reported on and detailed
within the Quality Account for 2015-16.
20
Our priorities for quality improvement 2015-16
Quality priority 1 - patient safety programme
Rationale: To continue to implement the Patient Safety Programme,
including infection prevention and control, is a clinical priority for
2015-16. The programme will deliver the six objectives that will help
us to achieve our ambition of the elimination of preventable harm for
patients. Working together with the clinical teams, clinical specialists,
listening to feedback from patients, carers and their families and
wider collaboration with other services will help us to continuously
improve patient safety and make an impact on HarmFREE Care. Key to
our work programme is working with patients and carers, promoting
transparency, promoting a patient safety culture that does not blame
and shame but encourages learning and this fits with the national
Sign up to Safety campaign.
u
Tr
e
s t m t o Ca r
e
Birmingham Community Healthcare
NHS Trust
Pat
i e nt S a fe t
y
The five safety pledges are:
1. Put safety first - commit to reduce avoidable harm in the NHS by
half and make public our locally developed goals and plans.
2. Continually learn - make our organisation more resilient to risks,
by acting on the feedback from patients and staff and by constantly
measuring and monitoring how safe our services are.
3. Honesty - be transparent with people about our progress to tackle patient safety issues and
support staff to be candid with patients and their families if something goes wrong.
4. Collaborate - take a lead role in supporting local collaborative learning, so that
improvements are made across all of the local services that patients use.
5. Support - help people understand why things go wrong and how to put them right.
Give staff the time and support to improve and celebrate progress.
Lead: Julie Jones, Patient Safety Lead
Quality measure: The Patient Safety Programme 2015-16 has been developed and agreed at
Clinical Governance Committee in February 2015, and will be monitored through the Safety
Express Group, reporting on a quarterly basis to Clinical Governance Committee.
Qualitative goal: To continue with the Patient Safety Programme including infection prevention
and control and align to the ‘Sign up to Safety’ five pledges.
Quantitative measure - reported monthly on the Trust Board Scorecard:
1.(NHS Safety Thermometer) To maintain 95 per cent or more patients experiencing HarmFREE
Care as a percentage of the number of patients surveyed on the sample day
2.Reduce the number of falls with severe injury or death
3.Reduce falls with harm per 1000 OBDs
4.Reduce grade 3 or 4 avoidable pressure ulcers (Inpatients and community)
5.To reduce the number of avoidable 48 hour Clostridium difficile (C.diff) toxin positive cases
attributable to BCHC
6.To reduce the number of Meticillin-resistant Staphylococcus aureus (MRSA) new bacteraemia
7.To achieve less than 5.4 per cent of deaths compared to all discharges (excluding end of
life care).
21
Quality priority 2 - safe staffing to enhance care
Lead: Beverly Ingram, Director of Nursing and Therapies and Lisa Eden,
Associate Director of Therapies
Quality measure: This priority will be monitored at the Safe Staffing Board, with a quarterly
report to Quality, Governance and Risk Committee, and monthly via the Board indicators.
Qualitative goals:
• To implement the Safe Care electronic system
• To realise the benefits of the safer staffing objectives and use relevant workforce indicators
as a way to improve knowledge and benefit frontline care
• To fully implement and ensure monitoring of safe staffing within the divisions
• To ensure revalidation for nurses is implemented in line with national time frames
• To ensure that there is a focus on “releasing time to care” within frontline teams.
Quantitative measure – reported monthly on the Trust Board Scorecard:
1.To achieve 90 per cent or more safe staffing fill rates within inpatient nursing teams
2.To achieve 90 per cent or more of staff appraised (12 month rolling average)
3.To achieve less than 4.33 per cent sickness absence levels by the end of March 2016
4.To achieve 85 per cent or more staff having completed their mandatory training (non-contractual)
5.To adhere to the key deliverables within the NMC revalidation for nurses process.
Quality priority 3 - enhancing patient experience
Lead: Alison Last, Associate Director for Patient Experience
Quality measure: This outcome will be monitored through monthly updates and a quarterly
report to Clinical Governance Committee as part of the Patient Experience Programme for
2015-16. The overall aim is to ensure the overall experience of patients and carers is positive
and consistent across all Trust services.
Qualitative goals:
• To continue to listen and seek views from service users to improve the quality of our services
• Develop and implement the Patient Experience dashboard for staff to have access to data in a
timely way
• Move to recording and reporting the new Friends and Family Test (as opposed to the former NPS)
• Undertake at least one full patient story for each division each month and utilise patient stories
to measure and improve services
• Present information on changes made as a result of patient feedback through ‘you said, we did’
boards in all relevant Trust premises and on the Trust website.
Quantitative measure:
1.Maintain a Trust-wide Friends and Family Test Score of 85 or more
22
Quality priority 4 - patient outcomes
Lead: Colin Graham, Head of Clinical Governance and Divisional Clinical Directors
Quality measure: The patient outcome goals were agreed at Clinical Effectiveness Committee in
April and monitored on a monthly basis with quarterly reports to Clinical Governance Committee.
The work around Patient Outcomes has been supported by the publication of proposed
community service measures by the Foundation Trust Network/Aspirant Foundation Trust Group
which will provide some additional indicators and offer an opportunity to benchmark against other
comparable Trusts.
Qualitative goals:
• Continue to collect those outcomes where we now have a baseline
• Improve collection where the recording is variable or incomplete
• Improve the merit of what is collected to indicate improvement and allow for meaningful
comparison
• Develop a timetable and format for collating and presenting clinical outcomes data within
the divisions
• Extend the number of services which are collecting and publishing data
• To ensure outcomes are recorded on and can be collated from RiO
• To begin collecting a narrative outcome indicating what the patient can do, that they
couldn’t achieve before the treatment
• Benchmarking BCHC outcomes with other comparable Trusts.
Quantitative measure:
1.Increase the number of services reporting clinical outcomes by 100 per cent.
23
Quality priority 5 - improving assessments
and care planning
Lead: Frances Clarke, Associate Director of Nursing
Quality measure: This outcome will be monitored quarterly at Clinical Governance Committee
Qualitative goals:
• To implement revised inpatient clinical documentation, including standardised care plans
• To fully implement the revised inpatient clinical documentation by June 2015
• To provide support for clincial services in order to successfully migrate assessment and care
plans onto RiO
• To embed the remaining recommendations from the Care Quality Commission (CQC)
quality visit regarding clinical documentation.
Quantitative goals:
1.To increase the number of patients having holistic assessments and evidence of patient
involvement and engagement in their care plan – 95 per cent compliance monitored through
Essential Care Indicators (ECIs)
2.85 per cent patient facing staff to undertake appropriate dementia training by April 2016
(as outlined by Health Education West Midlands target/Competence Framework and part
of the Strategy to become a Dementia Friendly Trust)
3.Increase to 85 per cent the number of nurses who have completed the assessment and care
planning skills update by March 2016.
Quality priority 6 - information technology to
improve patient care
Lead: Andy Wakeman, Medical Director and Vicky Arnold,
Associate Director of Informatics
Quality measure: Monitored through the Information Board
Qualitative goals:
1.Implementation of RiO to Inpatient Services by end of June 2015
2.Working with Service Birmingham to enable wireless access to BCHC network in local authority
buildings, e.g. schools, by end of September 2015
3.Pilot bi-directional sharing of information with 3 GP practices (covering EMIS, TPP and Vision
GP systems) by end of December 2015.
All Trust desktop and mobile devices to be in a Windows 7 environment by the end of
March 2016.
24
Looking back...
Review of our quality priorities
for 2014-15
Continuous implementation of the patient
safety programme
u
Tr
e
s t m t o Ca r
e
Criterion
To continue to work towards making our care safer and
strive towards our ambition of HarmFREE Care through
continuing to use the NHS Safety Thermometer with other
sources of patient safety information and Safety Express.
Goal:
The implementation of Safety Express and
embedding the NHS Safety Thermometer,
as a measurement tool has worked well
again this year as one of the Trust’s patient
safety objectives and a clinical priority.
The Trust’s ambition of delivering 95 per cent
HarmFREE Care measured by the NHS Safety
Thermometer has been achieved throughout
the year. Safety Express is about the front line
staff delivering care and keeping their patients
free of harm with support from the clinical
specialists. The aim is to eliminate avoidable
harm in patients from four common conditions
and protect patients from:
• pressure ulcers
• harm from falls
Birmingham Community Healthcare
NHS Trust
Pat
i e nt S a fe t
y
• urinary tract infections in patients with
a catheter
• new venous thromboembolism (blood clots).
We said that we would measure and monitor
the delivery of this objective using the CQUIN
goal and achieve 94.7 per cent HarmFREE Care.
Graph 1 below, illustrate that the Trust has
achieved this and has continuously maintained
95 per cent HarmFREE Care for all patient
harms. Graph 2 illustrates new patient harms,
i.e. patients experiencing a harm whilst
we are caring for them and in March 2015
we reached 99.27 per cent HarmFREE Care.
This information is collected once a month
as a snapshot in time; nevertheless, it does
represent an improvement over the year.
All patient harms - HarmFREE Care
Apr
May
Jun
Jul
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Mar
4 harms
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
3 harms
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
2 harms
0%
0.1%
0.1%
0%
0%
0%
0%
0%
0.%
0%
0%
0%
3.5%
3.2%
3.4%
3.2%
3.5%
1 harms
3.4% 3.9% 3.3%
3.3% 2.9% 3.5%
3.1%
HarmFREE 96.6% 96% 96.6% 96.5% 96.8% 96.6% 96.8% 96.5% 96.7% 97% 96.5% 96.99%
25
New patient harms - HarmFREE Care
Apr
May
Jun
Jul
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Mar
4 harms
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
3 harms
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
2 harms
0%
0.1%
0.1%
0%
0%
0%
0%
0%
0%
0%
0%
0%
1 harms
1.3%
1.6%
1.2% 1.0% 1.2%
1.2%
1.2%
1.1%
1.7%
0.8%
1.4%
0.73%
HarmFREE 98.7% 98.4% 98.8% 99% 98.8% 98.8% 98.8% 98.9% 98.3% 99.1% 98.6% 99.27%
2014-15
Trust wide
Adults and Community
Patients in own home
Inpatients
Prison
Rehabilitation - INRU
Learning Disabilities (patients over 65)
Children and Families Division
HarmFREE Care Number sampled %HarmFREE Care
27400
26272
22520
3403
349
264
32
627
28364
27216
23271
3596
349
271
32
629
96.60
96.53
96.77
94.63
100.00
97.42
100.00
99.68
The table shows the sample size for 2014-15 and then split by divisions. The percentage of
HarmFREE Care is the prevalence and is measured on a set day every month. The overall Trust
achievement is 96.60 per cent HarmFREE.
The CQUIN only required the Learning Disability Services to sample patients over 65, and for the
Children and Families Division the sample is restricted to the community nursing teams and the
inpatient respite beds. Although not a CQUIN for 2015-16 the requirements to complete the NHS
Classic Safety Thermometer remain the same. The NHS Safety Thermometer programme manager
helps the teams to ensure that we achieve 100 per cent compliance and this year the Trust has
sampled 28,364 patients and 27,400 were free of the four harms.
Trustwide HarmFREE Care
% HarmFREE Care
2012-13
2013-14
2014-15
94.85
95.27
96.60
26
The Trust is continuing with this concept to strive towards our ambition of HarmFREE Care in 2015-16
and it continues to be one of the quality priorities for 2015-16. This fits well with the work of
Professor Don Berwick, (Institute of Health Improvement) and the recommendations for improving
patient safety, including: engaging with patients and carers, promoting transparency, continuing
to create a culture of lifelong learning and promoting a patient safety culture that does not blame
and shame. Interventions that have driven the improvement and helped us to achieve this success
making a difference to patients this year include:
• Dietetics revised the Malnutrition Universal Screening Tool (MUST), used by the community
nursing teams and the inpatients to ensure that malnutrition is managed well. This has an effect
on the wellbeing of the patients and all of the patient harms
• The medicines management team have reviewed practice for delayed and omitted doses of
medicines which pose a threat to the wellbeing of patients and should be avoided whenever
possible. This has formed a part of the patient safety improvement work
• The Patient Safety Programme Manager has worked with the clinical teams to drive forward
a number of key changes, as follows:
- Purchased more slippers and anti-slip socks for Willow House and the Sheldon Unit.
These initiatives ensure patients are able to mobilise at the earliest opportunity
27
Patient safety booklet
A clinical handbook was launched to give
doctors, nurses and pharmacists instant
access to clinical guidelines for key patient
safety concerns.
succinct clinical guidelines for
key patient safety concerns.
After a review of the patient safety global
trigger tool showed ward staff would benefit
from access to essential clinical information
at the patient’s bedside, plans were made to
develop a concise, easy-to-use handbook for
doctors, nurses and pharmacists in inpatient
areas. Including content from a wide range of
sources, the handbook is designed to provide
easy access to key information to guide clinical
practice at the patient’s bedside.
The content has been prioritised according to
top patient safety issues, including learning
from serious incidents and root cause analyses
plus themes from trigger tool reviews and
specialist team input. There is also information
on compliance with key national patient safety
legislation and policy.
The clinical handbook has been issued to
doctors, nurses and pharmacists in all adult
inpatient areas.
- An audit of the ward environment that has helped us to create a safer environment for our
patients with less clutter, improved lighting, and signage to remind patients where to find
their call bell/alarm and what it looks like. We have called it “Don’t fall, call”
- The therapists worked with patients on an exercise programme “Put Pep into your step”
and they are following this up with a strength and balance exercise programme
- Low level beds and beds with sensor alarms have been purchased and to ensure that they
are used for the correct patients, the trust has guidance on the “Right bed, right patient
- Chair sensors have also been purchased for Willow House and Ward 9, to alert staff when
patients mobilise by themselves without asking for help. Thus, acting as a trigger for both
patient and staff.
• Pressure ulcers are the trusts greatest burden of harm. Led by the tissue viability specialists
with the harms nurses, pressure ulcer champions have been working with the clinical teams
to reduce harm from pressure ulcers. This has been very successful. Improvements have been
made in pressure ulcer prevalence measured by the NHS Safety Thermometer and pressure ulcer
incidents. The nursing teams have been working with patients on concordance as we recognise
that discussing treatment with patients and their carers is key to delivering HarmFREE Care.
• The Venous Thromboembolism (VTE) Reference Group, chaired by adult and community division
clinical director Dr Goodman has led a comprehensive programme of work this year with the
VTE Policy being updated to take account of the learning from RCA investigations of VTEs.
28
Measurement for improvement
Providing teams with good quality data, monitoring and surveillance and encouraging teams to
access their patient safety data were important patient safety objects for 2014-15 and will continue
to be part of the plan for 2015-16. Progress has been made this year evidenced through the use
and accessibility of the electronic dashboard and the Early Warning Alerts (EWA) raised across the
services. These are followed up by the clinical teams with supportive surgeries. The process has
been developed this year to be systematically produced from the Clinical Reporting Dashboard as
the illustrated example below shows.
The advantage is that every clinical team can obtain detailed information to assist them with
surgeries which are helpful discussions held with their team and manager. The Early Warning
Alert (EWA) process has helped teams to use their data in a supportive way to continually learn,
consistently monitoring at team level to improve patient safety.
Patient safety training for 2014-15 measured by the availability of Root Cause Analysis
(RCA) training and further development of training around the four harms.
Training for the clinical teams has continued to be identified during 2014-15 with further education
and learning to support the delivery of HarmFREE Care. We said that this would be measured with
evidence of additional RCA training and further development of training around the four harms
and this has happened, as follows:
• A review of the Root Cause Analysis (RCA) training process commenced this year and included
revisions to the RCA tools and templates, the setting up of a serious incident assurance process
and greater focus on promoting a positive and transparent safety culture;
• Improved education and learning for staff with classroom sessions for VTE (blood clots) raising
staff awareness to support policy
• A falls event held in October launched the revised patient safety training for falls delivered by
the Patient Safety Programme Manager with partners Age UK. The event re-emphasised the
focus on falls prevention and ideas to share practice in a multidisciplinary way. The training,
delivered to the staff on their wards and units for learning disabilities, rehabilitation services
and the adults community services, was designed to be bespoke and support specific needs
of staff and their groups of patients. Interactive sessions discussing care plans, risk assessments,
falls interventions, the importance of reporting incidents and post falls reviews were included.
29
Trigger Tool case note reviews within the adults and community division
is strengthened during 2014-15
The Trust has made continuous improvements to mortality surveillance and the management of
patient deterioration, in response to Sir Bruce Keogh’s mortality review and the expectations of the
NHS Trust Development Authority (NHS TDA). During 2014-15 the case note review process, using
Trigger Tool methodology, has been further developed and used to review all patient deaths and
when patients are transferred in an emergency to another hospital. The review process has also
been strengthened and patient deaths are judged on their preventability.
The work is evidenced through the Mortality and Deteriorating Patients Group, chaired by the
Trusts Medical Director and co-chaired by Dr Sutton, Consultant Geriatrician who has led learning
and change in response to the findings taken from the reviews. Some examples are:
• Feedback from the reviews provided to the clinicians either via a newsletter and summary
reports helps to share good practice and learning.
• The clinicians said that they would like better access to simple guidelines on top patient safety
topics to support their every day clinical practice. A pocket sized Clinical Handbook is now in
use that gives clinicians easy access to key clinical information to guide practice at the patient’s
bedside. The next step is to develop a Clinical App to be used trust wide.
• Quantitative mortality data is assured with qualitative case note review every month.
• Key themes have been identified and clinically led groups established to improve clinical practice
for diabetes, sepsis, hospital acquired pneumonia (HAP), patient deterioration and supportive
care including escalation and the ceiling of care.
• A Trigger Tool action group is established to improve shared learning when things go wrong
and also for staff to feel supported to feedback candidly any concerns relating to patient safety
so patient safety issues can be tackled together.
30
Safe staffing
Rationale: There are established and evidenced links between patient outcomes and whether
organisations have the right people, with the right skills, in the right place at the right time.
Criterion
Goal:
1.Board to take full responsibility for the quality of care provided to patients,
and as a key determinant of quality.
2.Board to take full and collective responsibility for nursing and care staffing
capacity and capability and receive monthly updates on workforce information.
3.Safe staffing data will be available to the public, and staffing capacity and capability
at least every six months on the basis of a full nursing establishment review.
4.Programme of work developed and implemented across the divisions.
Achievements
BCHC has responded to the national guidance on safe staffing set out in How to ensure the right
people with the right skills are in the right place at the right time (DH 2013) by completing two audits
of nursing staffing levels in bedded units in 2014-15. These audits considered the dependency of
patients, using an approved national tool, and reviewing the numbers of nursing posts accordingly.
Information is collected every month on the planned versus actual numbers of registered and
unregistered nurses on each ward, on each shift, each day. This information forms the basis of an
internal report to the Trust Board as part of the monthly quality report and is also available for public
view on the Trust Website. Information on daily staffing levels are displayed at the entrance to each
ward and unit.
In the short term, any shortfall is managed by the use of temporary staff and a formal escalation
process. There are systems in place for monitoring the utilisation of registered staff in the Trust, this
is led by the matrons. This system identifies areas of under-and over-utilisation of registered and
unregistered staff. If an area is identified as having lower than expected numbers of staff, immediate
action is taken. The area concerned will be monitored daily three times at each shift handover by
senior staff within the division. These areas are escalated within the division to the Divisional Director,
Clinical Director and to the Director of Nursing. The on-call manager is informed and they will actively
monitor the situation out of hours.
Matrons will consider a number of factors to optimise safe staffing including:
• the ratio of permanent staff to bank or agency staff
• the number of permanent unregistered staff on the ward
• the dependency of the patients, the number of patients on the ward
• the level of staffing on other wards.
Staff are moved or there is a reallocation of bank/agency staff, which provides stability for patients
and staff. Additional administrative support is identified to support the clinical staff to enable them to
focus on the delivery of safe clinical care. All actions and decisions are communicated regularly to the
senior team throughout the period of time that the area is considered a risk.
A co-ordinated recruitment strategy is underway to increase numbers of registered nurses available
for bedded units in order to more easily achieve safe staffing levels.
If you would like further information about staffing in our inpatient facilities please use the
following link: http://www.bhamcommunity.nhs.uk/about-us/corporate-information/safe-staffing/
31
Measuring clinical outcomes
Clinical outcomes are agreed, measurable
changes in health or quality of life that
result from our care. Constant review of
clinical outcomes establishes standards
against which to continuously improve all
aspects of clinical practice.
Many of BCHC services already collect clinical
outcome data for each patient designed to
measure improvements to health/condition
cross an episode of care working collaboratively
with the client. The development of electronic
processes for collating these results and looking
at them in a systematic way will enable review
of the outcomes data as a whole and would be
advantageous for clinicians to review their care
provision, teams to compare against their peers
and services in terms of evidencing quality of
care delivered.
A number of services are using outcomes
scores to provide a baseline and measure the
improvement for the patient. The collation of
written records has required the use of audit,
the future aim is the transfer of data onto RIO
to facilitate easier more frequent outcome data
collection for all patients.
Achievements
Below are a sample of teams, who have
collected clinical outcomes data during 2014-15.
Examples:
• Moor Green Outpatient Brain Injury Unit
use a Goal Attainment Scaling (GAS) and
Post Acute Rehabilitation Measure (PARM)
for patients with acquired brain injury. The
collective GAS scores showed that the service
is setting goals at about the correct level for
their clients. The PARM measures activities of
daily living and are completed by the family/
carer. The team are working on ways of
improving the return of PARMs at the end of
each patient’s rehabilitation.
• Paediatric Community Physiotherapy team
have recorded up to three smart goals for
children receiving a package of care (POC).
The outcome is measured on the objectives
of the POC to ensure the child is working
towards a change that will have a positive
effect on their lives. Data was collected by
auditing a sample of the records and showed
improvements for many of the patients. in
recording prevented the development of a
more complete picture.
• Dietetics use a model based on the British
Dietetics Associations recommended outcome
model. Examples of the outcomes included
required weight gain/loss, improved hydration
and improved tolerance to feed. A review
of the data has shown where positive
improvements have been made, and the
importance of consistent coding of results.
• Orthodontics departments for both
Birmingham Dental Hospital and Combined
Community Dental Services use a Peer
Assessment Review (PAR) score pre and
post treatment to show improvement in the
patient dentition. Both services score well
above the national standard of 70 per cent of
patients showing an improvement (CQUIN).
• The use of the Vanderbilt diagnostic
rating scale looking for improvements in
patients being treated for Attention Deficit
Hyperactivity Disorder, measuring against six
domains over a period of one-three years.
• Intrathecal Baclofen (ITB) therapy is given
to patients who have severe spasticity
(muscle stiffness and spasm). The Specialist
Rehabilitation Service give each patient four
main goals and 93 per cent of the goals were
fully or partially achieved.
The outcome reports have been presented at
local service level, the Trust Clinical Effectiveness
Committee and at the Trust Clinical Effectiveness
day. Feedback to staff is key to consistently
improving patient care/ treatment outcomes.
The duration of treatment has presented a
challenge for those services caring for patients
over extended periods of 2 or more years.
32
Care planning
Rationale:
No decisions about me
Assessment and care planning
is a fundamental part of patient
without me
care that ensures a patient’s
physical, mental, social, cultural,
spiritual and personal needs are evaluated and a prescription of care is
developed to address those needs. The process may be undertaken by
a single professional group or involve a number of disciplines relevant to
the patient’s needs. Patients with dementia or who are at the end of life
may have specific requirements over and above the standard process.
One in six
and
people aged 80 and
ntia
over have deme year
60,000 deaths a
butable
are directly attri .
to dementia
s
Dementia key fact
y
(Alzheimer’s Societ
Dec 2014)
Criterion
1. To improve the standard of assessment and care planning across the
Trust with a particular focus on end-of-life and dementia care
2. Opening of the new Dementia Friendly Unit.
Goal:
Achievements:
• A total of 1,860 patients were screened for dementia, of whom 515 (27 per cent) were referred
back to their GP for further investigation.
Care planning update 2014-15: achievements
• New assessment documentation and care plans were developed in conjunction with nursing
and therapy staff. Training in comprehensive patient assessment was delivered to nursing staff
• A revised supportive care plan was developed and implemented for all patients identified as
end of life
• The Willows dementia-friendly unit at West Heath Hospital opened in July 2014.
Focus story - remembering to care
Caring nurses have turned back time to
help elderly inpatients feel right at home
during their stay.
The ward 5 team at Moseley Hall Hospital has
recreated a 1960s-style living room in a communal relaxation
area as part of efforts to give extra support to people with
dementia and enhance all patients’ experience of care.
The ‘reminiscence therapy room’ is designed to create a
‘home from home’ experience for people in a care environment, improving day-to-day quality of life,
particularly for people with dementia.
The team’s aim is to give people compassionate, personalised care so they are comfortable,
well looked after and also have stimulation and therapeutic support that offers the best prospects
for recovery and continued independence.
The reminiscence area has been a big hit with the patients. Some use it for some quiet time on their
own, other times it has provided an opportunity for socialising. They are looking at involving our
volunteer helpers to use it for some group sessions.
33
Enhancing patient experience
Rationale:
It is important that we listen and seek the views from service users to support continuous
monitoring and to improve the quality of our services. This supported the organisation and
commissioners to obtain an insight to the service users experience and use this data to identify
issues and help make the necessary improvements.
Criterion
Goal:
1.
2.
3.
4.
Deliver ICARE patient experience training and reflection programme.
Develop further channels for patients to provide feedback.
Embed engagement and involvement across the trust.
Develop capacity to deliver service improvements based on the findings
of patient feedback.
Achievements:
• ICARE training continues to be delivered via induction, team level training and 1:1 coaching
sessions and the Trust 6Cs development programme. The patient experience app has been
developed and the process of making it available to the public is under way. iPads are in regular
use across the Trust.
• Patient feedback postcards are widely available across the Trust and are being well utilised by
patients. Friends and Family Test response/feedback boxes have been placed on reception desks
to encourage patients to return completed feedback.
• Patient experience feedback including measurements of satisfaction relating to the delivery,
timeliness, access and quality of service forms part of reports within divisional governance
framework and also in Trust-wide committees, Confirm and Challenge and Governance
Network. Triangulation with other data takes place through Trust governance network and also
in divisional meetings.
• Service improvements and ‘you said, we did’ are reported through Patient Experience reports in
divisions and Trust-wide and displayed in patient areas.
The Learning Disabilities, Patient Experience Network (PEN) received the award for Partnership at
the Spring Staff ViP awards. Through hard work and commitment the PEN worked closely with
external agencies to provide a successful health event for people with Learning Disabilities and
their carers. All who attended gave positive feedback and gained new information about
BCHC Learning Disability services and
external organisations.
Service users and carers awareness of
PEN have increased through the reaching
out project and work continues to
further increase awareness across all of
Birmingham and BME groups to reflect
the diversity of the city.
34
Information technology
Criterion
Goal:
To continue to support clinical divisions as we roll-out mobile technology
(implementation of the RiO programme) and electronic patient records so that
our clinicians can utilise technology and information to transform their services
and the care they provide.
Achievements:
Following the deployment of over 2,000 laptop devices to community-based clinical staff in the
financial year 2013-14, clinical services started to go live with a new electronic patient record system
(RiO) in April 2014. The system, when fully optimised, will reduce the need for clinicians to travel to
and from the office as they can access patient records remotely using this new technology.
Clinicians are also able to access and share more comprehensive, real-time patient information
enabling less time being spent on administration and more time with patients. In addition
to having administrative capabilities, the system incorporates functionality to capture clinical
information as required throughout community. The system is also the building block to enable
better sharing of information with partner organisations such as GPs.
35
Focus story the tissue
viability
team - RiO
RiO is the electronic patient
record system that allows staff to
access patient records whenever
and wherever they need to. As a
community based city-wide service,
tissue viability is
one of the many
services that are
reaping the benefits of
Tissue viability’s RiO experience:
the new online system,
The good points:
which can be accessed
via mobile devices.
Sharing across disciplines






The team of nurses
Increased visibility and accessibility of patient notes
and support nurses
travel across the city
Improved communication
to assess patients with
Better continuity of care for patients
complex wounds.
This service is provided
Allows for better use of time when patients miss appointments
in patients’ own
Reduces travel time
homes, in residential
and nursing homes,
The sticking points:
in clinics and in
inpatient services.
Reliability of mobile devices - i.e. connectivity
The team works
closely with other
clinicians including
district nurses, care home staff and specialist teams such as the lymphoedema team, to manage
wounds and educate staff, carers and patients on wound prevention.

The bulk of the team’s work involves assessing patients who have, or may be at risk of developing,
a complex wound, and subsequently reporting back on the assessment, providing advice and
support to the person responsible for that patient’s care. As well as speeding up communication,
using RiO on a mobile device is proving to be a time-saver in preparing for clinical appointments
and managing any unexpected changes to their schedule.
David Harries, tissue viability nurse said: “It’s definitely saving time at the ‘front end’ of
appointments as you don’t need to keep coming back to base to print out notes. If patients don’t
attend their scheduled appointment or are running late, we can go on RiO or write a patient letter
on the hop, which we couldn’t do before.”
36
Statements of assurance from the
Board of Directors
This section contains statutory statements concerning the quality of services provided by
Birmingham Community Healthcare NHS Trust. These are common to all trust Quality Accounts
and can be used to compare us with other organisations. Our Board is ultimately responsible
for the delivery and quality of services delivered throughout the organisation. It is therefore also
responsible for the accuracy of information that is presented within our Quality Account.
Review of services
During 2014-15, Birmingham Community Healthcare NHS Trust provided and/or sub-contracted
131 NHS services.
The Trust has reviewed all the data available to them on the quality of care in all of these relevant
health services.
The income generated by the NHS services reviewed in 2014-15 represents 100 per cent of
the total income generated from the provision of the relevant health services by Birmingham
Community Healthcare NHS Trust for 2014-15.
Focus story - dental service learning from audit
The Birmingham Dental Hospital’s Clinical Effectiveness Group hosted a dental services
audit presentation morning in July 2014 in order to support communicating, learning
and celebrating the success of audits undertaken within its services. The morning
was well attended by dental staff from Birmingham Dental Hospital and Combined
Community Dental Service, alongside representation from the Clinical Governance Department
and members of the Specialist Division.
The morning began with a welcome from Kevin Fairbrother, Clinical Lead and Consultant in
Restorative Dentistry, who is Chair of the Dental Hospital Clinical Effectiveness Group. The guest
speaker, Colin Graham, Head of Clinical Governance for
the Trust, spoke about why clinical audit is so important
and the support which is available for audit.
The day was then dedicated to staff presenting their
audits. Feedback from the event has been extremely
positive and has confirmed that a dedicated event
publicising completed audits, sharing best practice,
improving staff awareness of the value of clinical audit
and celebrating achievements has been successful and
well received.
37
Participation in clinical audits
During 2014-15 six national clinical audits and two national confidential enquiries
covered NHS services that Birmingham Community Healthcare NHS Trust provides.
During that period Birmingham Community Healthcare NHS Trust participated in 100 per cent
of the national clinical audits and 100 per cent of the national confidential enquiries of the
national clinical audits and national confidential enquiries which it was eligible to participate in.
The national clinical audits and national confidential enquiries that Birmingham Community
Healthcare NHS Trust was eligible to participate in during 2014-15 are as follows:
National Audits
• Sentinel Stroke National Audit Programme (SSNAP)
• Royal College of Paediatrics and Child Health (RCPCH) Epilepsy12 National Audit (BCHC
contributes to the data collection required for this audit as part of the contribution made
by Birmingham acute Trusts)
• DAHNO Head and Neck Oncology Audit (BCHC contributes a small number of data items to
this audit as part of the cases submitted by University Hospital Birmingham Foundation Trust).
• Royal College of Physicians National COPD Audit (Pulmonary Rehabilitation Element)
• National Diabetes Audit (Footcare element)
• National Intermediate Care audit
• National Confidential Enquiry into Patient Outcome and Death (NCEPOD) Lower Limb
Amputations (Organisational questionnaire only required)
• NCEPOD Sepsis (Organisational questionnaire only required)
The national clinical audits and national confidential enquiries that Birmingham Community
Healthcare NHS Trust participated in during 2014-15 are as follows:
• Sentinel Stroke National Audit Programme (SSNAP), includes Stroke Improvement National
Audit Programme (SINAP)
• Royal College of Paediatrics and Child Health (RCPCH) Epilepsy12 National Audit (BCHC
contributes to the data collection required for this audit as part of the contribution made by
Birmingham acute Trusts)
• DAHNO Head and Neck Oncology (BCHC contributes a small number of data items to this
audit as part of the cases submitted by University Hospital Birmingham Foundation Trust.)
• Royal College of Physicians National COPD Audit (Pulmonary Rehabilitation Element)
• National Diabetes Audit - Footcare element
• National Intermediate Care audit
• NCEPOD Lower Limb Amputations (Organisational Questionnaire)
• NCEPOD Sepsis (Organisational Questionnaire)
38
The national clinical audits and national confidential enquiries that Birmingham Community
Healthcare NHS Trust participated in, and for which data collection was completed during
2014-15, are listed below alongside the number of cases submitted to each audit or enquiry
as a percentage of the number of registered cases required by the terms of that audit or enquiry.
* per cent - Number of cases submitted by BCHC expressed as a % of the number of registered
cases required by the terms of the audit or enquiry.
Audit Title
Acute coronary syndrome or Acute myocardial infarction (MINAP)
Adherence to British Society for Clinical Neurophysiology (BSCN) and
Association of Neurophysiological Scientists (ANS) Standards for Ulnar
Neuropathy at Elbow (UNE) testing
Adult community acquired pneumonia
Bowel Cancer (NBOCAP)
Cardiac Rhythm Management (CRM)
Case Mix Programme (CMP)
Chronic Kidney Disease in Primary Care
Congenital Heart Disease (Paediatric Cardiac Surgery) (CHD)
Coronary angioplasty (PCI)
Diabetes (Adult), includes National Diabetes Inpatient Audit (NADIA)
diabetes care in pregnancy, diabetes footcare 1
Diabetes (Paediatric) (NPDA)
Elective Surgery (National PROMs Programme)
Epilepsy 12 audit (Childhood Epilepsy) 2
Falls and Fragility Fractures Audit Programme (FFFAP)
Fitting Child (care in emergency departments)
Head and neck oncology (DAHNO) 3
Inflammatory bowel disease (IBD) programme
Lung Cancer (NLCA)
Maternal, Newborn and Infant Clinical Outcome Review Programme
(MBRRACE-UK)
Participated
No
No
*%
No
No
No
No
No
No
No
Yes
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
No
No
Yes
No
No
Yes
No
No
No
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
Medical and surgical clinical outcome review programme:
National confidential enquiry into patient outcome and death 4
Mental Health (care in emergency departments)
Mental health clinical outcome review programme: National
Confidential Inquiry into Suicide and Homicide for people with Mental
Illness (NCISH)
National Adult Cardiac Surgery Audit
National Audit of Dementia (care in general hospitals)
National Audit of Intermediate Care
National Cardiac Arrest Audit (NCAA)
Yes
N/A
No
No
N/A
N/A
No
No
Yes
No
N/A
N/A
66%
N/A
Yes
N/A
National Chronic Obstructive Pulmonary Disease (COPD)
Audit Programme 5
39
N/A
N/A
Audit Title
Participated
*%
National Comparative Audit of Blood Transfusion programme
No
N/A
National emergency laparotomy audit (NELA)
No
N/A
National Heart Failure Audit
No
N/A
National Joint Registry (NJR)
No
N/A
National Vascular Registry
No
N/A
Neonatal intensive and special care (NNAP)
No
N/A
Non-invasive ventilation - adults
No
N/A
Oesophago-gastric cancer (NAOGC)
No
N/A
Older people (care in emergency departments)
No
N/A
Ophthalmology (TBC)
No
N/A
Paediatric intensive care (PICANet)
No
N/A
Pleural procedure
No
N/A
Prescribing Observatory for Mental Health (POMH)
No
N/A
Prostate Cancer
No
N/A
Pulmonary hypertension (Pulmonary Hypertension Audit)
No
N/A
Renal replacement therapy (Renal Registry)
No
N/A
Rheumatoid and early inflammatory arthritis
No
N/A
Sentinel Stroke National Audit Programme (SSNAP) 6
Yes
N/A
Severe trauma (Trauma Audit & Research Network, TARN)
No
N/A
Specialist Rehabilitation for Patients with Complex Needs (TBC)
No
N/A
The reports of 14 national clinical audits were reviewed by the provider in 2014-15 and
Birmingham Community Healthcare NHS Trust intends to take the following actions to improve
the quality of healthcare provided. Actioned are outlined in the tables overleaf.
Please also note these include a number of reports relating to National Confidential Enquiries
(NCEPODS) which have been reviewed by the committee for shared learning opportunities during
2014-15.
1. BCHC submitted patient level data in 2014-15, no ascertainment rate set for community Trusts.
2. Ascertainment rate would apply to participating acute Trust, please see corresponding Quality Account for Heart of
England Foundation Trust for this information.
3. Ascertainment rate would apply to participating acute Trust, please see corresponding Trust Quality Account for
University Hospital Birmingham NHS Trust for this information.
4. BCHC participated in the organisational questionnaire element of those NCEPODs relevant to BCHC services,
the patient level data collection element of the studies were not applicable to BCHC services therefore no case
ascertainment rate required from BCHC services.
5. National COPD audit – Pulmonary Rehab workstream data collection taking place until July 15 therefore
ascertainment rate not available at date of publication of Quality Account.
6. No formal ascertainment rate set for community Trusts. BCHC has met the requirement for 20 cases per quarter in
2014-15 to receive a site specific report for this audit.
40
Audit
Royal College of Paediatrics and Child Health (RCPH) National Childhood
Epilepsy 12 audit update requested from Indu Anand
BCHC contributed a number of cases to this audit during 2014-15 as part of the
submission by local acute Trusts therefore results are reported at acute Trust level.
BCHC’s designated lead for this audit has reviewed the report and key findings
in conjunction with leads from partner acute organisations.
BCHC has taken the following actions:
Action
taken
• Completed an audit to identify those paediatricians who have accredited
expertise in epilepsies with a view to developing this resource within our services.
• Supported opportunities for integrated care pathway development and
partnership working.
• Developed an audit of our community services during 2014-15 using audit
standards derived from those included in the national Childhood Epilepsy audit.
Data collection has been completed and the audit report is expected to be ready
by July 2015.
Audit
Action
taken
National adult diabetes audit
We are working closely with our GP colleagues in Sandwell and West Birmingham
CCG and the National Diabetes Audit report has been shared with the Sandwell
and West Birmingham CCG Diabetes steering group to assist them in reviewing
their diabetes care pathways.
We intend to:
• Share the report with GPs and practice nurses in the Diabetes Local Enhanced
Service (LES) Journal Club and subsequent diabetes updates meeting to provide
an opportunity to reflect on the findings.
Audit
Head and neck oncology
• The report has been shared and reviewed by the Oral Medicine Audit Lead at
Birmingham Dental Hospital.
Action
taken
• Birmingham Dental Hospital monitors the two week target for seeing Rapid
Access cancer patients for first appointments after referral as part of their care
pathway. Results have shown that this target is consistently met and this is
reported to the Birmingham Dental Hospital’s Clinical Effectiveness Group.
• We intend to share the report with the Consultant in Restorative Dentistry who
is a member of the Multi-Disciplinary Team at University Hospital Birmingham
to provide an opportunity to reflect on the findings.
41
Audit
National enquiry into suicides and homicides
• The report was presented at the Trust-wide Clinical Effectiveness Committee.
• Learning disabilities service training needs identified and STORM training is
provided specific to role.
Action
taken
• Key recommendations have been reviewed and considered as part of the
development of the Trust’s Suicide Prevention Policy.
• The Trust has identified need to identify a number of ligature light rooms.
• Suicide prevention leaflet has been developed for BCHC to raise awareness
for staff.
Audit
Sentinel Stroke National Audit Programme (SSNAP), includes SINAP
(BCHC contributes as a partner to UHB)
The National Sentinel Stroke Audit has now been superseded by the Sentinel
Stroke National Audit Programme (SSNAP) in acute hospital settings. All services
admitting patients with stroke are required to complete a minimum data set for
all patients. The core data set includes acute care, in patient rehabilitation, early
supported discharge, community follow up and six month reviews.
BCHC registered Ward 8, Moseley Hall Hospital as a participating service in
January 2014.
Action
taken
• To date, approximately 60 patients have been entered into the national
database.
• BCHC received its first site-specific report in Dec 2014.
• An action plan arising from the results is under development and will address
specific clinical issues such as access to therapy, assessment of continence,
mood and cognition.
• Future aim is to register all services at BCHC who provide stroke care,
and input into the audit.
Audit
NCEPOD lower limb amputations
Action
taken
• The report has been shared with the services involved in completing the
organisational return for the service and a self-assessment has been undertaken
against key recommendations by Specialist Rehabilitation Service which will
inform any further actions to be identified.
Audit
NCEPOD on the right track
Action
taken
• Further to review of the key recommendations in the report the Trust has
reviewed existing arrangements in place for the care of children and adults
who have a tracheostomy.
• A policy has been developed and approved for the care of adult patients who
have a tracheostomy. This policy ensures that patients with a tracheostomy outside
of the acute hospital setting receive safe, effective and evidence based care.
42
Local clinical audits
The reports of 180 local clinical audits were
reviewed by the provider in 2014-15 and
Birmingham Community Healthcare NHS Trust
intends to take the following actions to improve
the quality of healthcare provided.
Progress against the action plans for local audits
will be monitored through the divisional governance
arrangements or through corporate workstreams.
Please note a number of local clinical audits for
the 2014-15 reporting period had data collection
which spanned Q4 (Jan - March 2015) and Q1
of the 2015-16 reporting period (April - June 2015).
The Trust anticipates the reports associated with
these audits will be completed during Q1 2015-16
following data verification and analysis.
Podiatry consent audit
This was a re-audit conducted in Adult and
Community Divisions Podiatry Service to ensure that
the correct patient consent forms were being used
and completed prior to completion of minor toe
nail surgery.
The audit supports the service to provide assurance
in relation to CQC Outcome 2: Consent by
demonstrating that the DH consent form 3 is being
used across the service, prior to surgery.
A baseline audit was completed and a number
of actions taken to promote awareness of the
importance of ensuring consent forms were fully
completed including:
• Sharing the results with team leaders
• Redesign of the consent form, distributed to nail
surgery centres February 2014
• All staff reminded at team meetings (minuted)
of the importance of ensuring
the consent forms are completed in full for
each patient prior to undertaking a minor
toe nail procedure.
A re-audit was completed in 2014-15 assessing
64 forms from three different teams, and results
were compared to the baseline audit conducted
in 2013-14.
Overall there was a 25 per cent increase in
compliance, with a compliance score of
91 per cent reported in 2014-15 compared to
66 per cent reported in the 2013-14 baseline audit.
Team leaders will continue to encourage staff to
ensure the consent forms are completed in full and
recommendations include a re-audit in 2015-16 to
see if the improved percentage compliance scores
are maintained.
Falls audit
The audit aimed to examine falls reported from
Ward 9 against the falls classification developed
by Hanger CF et al (2014), and identify any
risk factors.
Results showed that multiple falls were common
amongst patients, some often as a result of recovery
from previous falls. Approximately 20 per cent
of falls resulted in temporary harm and there
were no permanent harms caused by the falls.
75 per cent of falls occurred near the bedside or
bathroom area, in the absence of a staff member.
Recommendations from the audit enforced good
practice within the ward and led to the set up of
a multidisciplinary falls project group. The group
will review the Trust falls risk assessment and
prevention documentation, educate staff on fall
prevention, encourage use of sensor technology
on beds, chairs, and in bathrooms, and modify
the environment to reduce harm from falls.
Specialist rehabilitation record keeping
divisional and corporate audits
The Specialist Rehabilitation Service has reported
marked improvement in percentage compliance
score in both the divisional and corporate audits
for 2014-15 when compared to baseline results in
2013-14.
A compliance score of 87 per cent was reported
for the Divisional audit in 2014-15, a 22 per cent
increase compared to the 65 per cent reported for
2013-14.
The Specialist Rehabilitation service has
undertaken significant work to raise the profile of
clinical record keeping requirements by providing
training for staff and monitoring compliance by
undertaking a number of local spot checks and
are to be commended for their efforts and the
impact this has had.
Examples of further audits completed in 2014-15 are included in the Quality Account and will also be
detailed in the Trust’s clinical audit annual report (anticipated completion date July 2015).
To request a copy of the report please contact clinical.audit@bhamcommunity.nhs.uk
43
Research and Innovation
Birmingham Community Healthcare
NHS Trust is a research active Trust.
The Trust delivers research studies,
meets researchers to assist research
delivery and recruits participants.
In 2014-15 the Trust undertook 21 portfolio
studies*, one participant identification centre
studies, 7 tissue bank studies, 9 student
service evaluations and 10 non portfolio
studies. The number of patients receiving NHS
services provided by Birmingham Community
Healthcare NHS Trust in 2014-15 that were
recruited during that period to participate in
portfolio research approved by
a research ethics committee
*‘Portfolio
was 386.
studies’ refers
Changes to the
to the projects
research governance
opted
funded by or ad
process
by the National
h
lt
In the last 12 months,
Institute of Hea
)
several changes have
Research (NIHR
been made to the
through open
competition.
research governance
process. On the 1st January
2015 the Health Research
Authority (HRA) became a
non-departmental public body to create a
single framework for research across the UK.
These changes will have an impact on our
organisation but until they are implemented
throughout 2015 the impact is unclear. The
Government wishes to see a dramatic and
sustained improvement in the performance
of providers of NHS services in initiating and
delivering clinical research. As a result, several
new key performance indicators have also
been added to the research process with
high level objectives and a 70-day benchmark
measure i.e. 70 days from the receipt of a valid
research application to the first recruit into the
research study.
There have also been national changes to the
structure of the Clinical Research Networks
and we will continue to forge strong
relationships with the relevant divisions
for our trust.
Research welcomes innovation
The team welcomed the arrival of a Clinical
Scientist whose role includes contributing to
the European Regional Development Funded
project called Creative Digital Healthcare
Solutions which finds digital solutions to
healthcare challenges within the organisation.
The team have been involved with the Healthy
Village initiative and will develop an open door
for local small to medium enterprises (SMEs)
to enhance digital enablement. Another
initiative was a campaign which invited
staff to contact us with general healthcare
challenges to be presented to SME’s.
Continued development of the
research strategy
Following a joint review of the research
strategy with the Trust Board the team are
updating the research strategy with a view to
significantly increasing recruitment in line with
clinical priorities.
Research hubs
Two new monthly research groups have been
set up in the area of Children and Families and
Learning Disabilities. A third research forum
has been established with the Rehabilitation
44
centre and the University of Birmingham that
meets three or four times a year. The last event
was hosted at Moseley Hall Hospital with two
presentations from the University and a panel
discussion entitled: Research is a distraction
from the clinician’s duty of care to the patient.
• The preloading study supporting smoking
cessation had a difficult start but several
measures were put in place including
training nurses to contribute to recruitment.
This study has now closed and has
surpassed its recruitment target.
These three new research hubs have helped to
raise awareness and commitment to research
Next steps...
Support of research students
The Research and Innovation team actively
assisted one NIHR PhD applicant to find
appropriate academic supervisors and
supported him successfully through the
application process. Four MRes masters’
degree students were also successful with their
applications to the University of Birmingham
to complete either full/part time courses
with funding available to backfill their BCHC
posts. Successful applicants were speech and
language therapists and physiotherapists.
Research spotlight
Here are some examples of studies that are
ongoing within the Trust:
• The Londowns study is looking at
how parts of the brain work in patients
with Down syndrome with observations
for links with dementia. This research is
ongoing and currently recruiting individuals.
• The INSPIRE study (Influence of Successful
Periodontal Intervention on Renal and
Vascular Systems in patients with Chronic
Kidney Disease: a pilot interventional
randomised controlled trial) is a dental study
to investigate how gum disease affects
the general health of patients with kidney
disease.
• The drooling reduction intervention
study (A single blind study comparing the
efficacy of Glycopyrronium and Hyoscine
on drooling in children with neurodisability)
is comparing two types of medication for
children with conditions such as cerebral
palsy who experience problematic drooling.
45
The research and innovation team are
committed to the continued growth and
development of research, the next steps
within the strategy are:
1.considering the changes from the HRA establish suitable procedures and processes
2.maintain good high level objectives and
70 day benchmark metrics
3.develop relationships with local SME’s
for future innovation
4.consolidate and strengthen our
research governance
5.develop a structured approach to be able
to take advantage of relevant research and
innovation funding possibilities.
Commissioning for Quality and Innovation (CQUIN):
2014-15
What are CQUINs?
CQUINs projects are agreed between the Trust and Commissioners (who buy our services)
on a yearly basis and comprise 2.5 per cent of the contractual value. The projects are set to
improve quality standards in key areas.
A proportion of Birmingham Community Healthcare NHS Trust’s income in 2014-15 was conditional
on achieving quality improvement and innovation goals agreed between the Trust and any person
or body they entered into a contract, agreement or arrangement with for the provision of relevant
health services, through the Commissioning for Quality and Innovation payment framework.
Further details of the agreed goals for 2014-15 and for the following 12 month period are
available electronically at www.bhamcommunity.nhs.uk/about-us/news/publications/cquin/ or by
calling 0121 466 7267.
National CQUINs
1.Staff friends and family test (FFT)
• Adults and Communities
• Specialist Children and Families services
• Dental Hospital
Why was this selected as a priority?
The staff FFT was developed by NHS England and
a working group made up of representatives from
provider trusts, staff side representatives and NHS
Employers. Draft guidance was circulated across
the NHS in December 2013 and views were
sought from academic experts working in the
field of staff engagement. Research has shown
a relationship between staff engagement and
individual and organisational outcome measures,
such as staff absenteeism and turnover, patient
satisfaction and mortality; and safety measures,
including infection rates. The more engaged
staff members are, the better the outcomes
for patients and the organisation generally.
It is therefore important that we strengthen
the staff voice, as well as the patient voice.
Our goal
All NHS organisations providing acute,
community, ambulance and mental health
services are required to implement the staff FFT
between 1 April and 30 June 2014. Respecting
equality and diversity are core NHS values.
The development of the policies and
processes are based on the desire to eliminate
discrimination, harassment and victimisation; to
advance equality of opportunity; and to foster
good relations between all staff groups. The
Dental Hospital had a specific goal to improve
their score in the annual staff survey.
What did we achieve?
The survey was rolled out in line with
national guidance, the staff FFT was widely
communicated across BCHC and the survey
delivered by email. The staff engagement ‘Think
Tank’ provided a forum for discussions about FFT
results and future delivery methods. Comparisons
of the two FFT questions can be made against
the same questions which feature in the annual
NHS staff survey; comparisons of percentages in
this way show a desirable trend.
46
2. Patients friends and family test
• Adults and Communities
• Specialist Children and Families services
• Dental Hospital
• Learning Disabilities service
Why was this selected as a priority?
What did we achieve?
To create a culture where all patients expect to be
given the opportunity to feedback and NHS staff
value and act upon patient needs and wishes.
The Patient Experience Team has conformed
with the FFT roll out timeline and all data
was submitted to UNIFY within the defined
submission groups, as per the guidance.
Between April and June 620 patients/carers
took part in the survey equalling 73.2 per cent
of discharged patients (national guidance states
this should be a minimum of 25 per cent).
Our goal
To expand the use of FFT in more of our
services to ensure that all patient groups have
the opportunity to provide feedback. To gather
the responses and ensure that staff that provide
care are provided with this information, in a
simple format, in near real time and identify
areas where improvements can be made so
practical action can be taken.
The Friend and Family Test has been successfully
rolled out across the different services in line
with the CQUIN requirements.
3. Dementia and delirium
• Adults and Communities
Why was this selected as a priority?
To incentivise the identification of patients
with dementia and delirium, alone and in
combination alongside their other medical
conditions, to prompt appropriate referral and
follow up after they leave hospital and to ensure
that hospitals deliver high quality care to people
with dementia and support their carers.
Our goals
• 90 per cent of appropriate in-patients asked
the dementia case finding question, having
further diagnostic assessment if appropriate
and then being referred via local pathway if
appropriate.
• To introduce a delirium screening tool and
by Q4 screen 90 per cent of appropriate
in-patients for delirium upon admission
• Have a named lead clinician for dementia
and appropriate competence assessment
for staff in line with Health Education
West Midlands framework
47
• Ensuring carers of people with
dementia feel supported by
undertaking a self assessment
as per the Carers Triangle document and
by implementing two initiatives by the end
of the year.
What did we achieve?
The dementia screening compliance was
maintained at >90 per cent throughout the
year. The delirium screening tool was introduced
in June, with the screening compliance targets
being achieved for Q2 and Q3, but the Q4
target of 90 per cent was not met.
A Clinical Lead for dementia has been working
closely with staff to promote basic awareness
and enhanced dementia training alongside
the dementia agenda as a whole and the trust
has continued working towards the Health
Education England training targets. The Triangle
of Care assessment tool was undertaken and
two initiatives put into place to improve the
support offered to carers of BCHC inpatients.
4. NHS Safety Thermometer: Continue the programme, develop a tool to measure days
between harm and engage with other healthcare providers in order to raise awareness of
and to provide training on how to prevent Pressure Ulcers.
• Adults and Communities
• Specialist Children and Families services
• Specialist Rehabilitation Inpatient Unit
Why was this selected as a priority?
BCHC are a clear positive outlier on the
national NHS Safety Thermometer compared
to other similar organisations. One element of
this CQUIN is to incentivise BCHC to continue
to use the NHS Safety Thermometer to keep
HarmFREE Care high on the agenda for all
staff. Another element requires the data for
Adults and Communities to be disaggregated in
order to improve patient care; a ‘days between
harm’ methodology will focus on teams where
patients are on average experiencing ‘harms’
on a more regular basis and try to improve this.
The third element is to develop and improve
on a whole system collaborative approach to
reduce the development of pressure ulcers.
Our goals
1.To refine methodology for collecting all
grade 3 and 4 pressure ulcers, broken down
by adults and community team, showing the
days between harm. Data to be presented
as all grade 3 and 4 pressure ulcers and all
avoidable grade 3 and 4 pressure ulcers.
2.BCHC to develop contacts from each
healthcare setting and scope the intended
outcomes for the year. BCHC to engage with
BSC CCG in order to ensure relevant and
required support is provided.
3.For the inpatient neuro-rehabilitation unit
to maintain a median zero pressure ulcers
recorded on the NHS Safety Thermometer.
What did we achieve?
A GEL dashboard to meet the requirements
was developed with full access to Datix. Training
sessions provided for managers to address
residential homes and care agencies implicated
in avoidable or avoidable but not attributable PU
development. The target for INRU was acheived.
48
Local CQUINs
Birmingham Dental Hospital CQUIN schemes:
Continuation of the Restorative Dentistry, Oral Medicine,
Paediatric Dentistry, Orthodontics and Special Care
Dentistry managed clinical networks (MCNs)
Continuation of the managed
clinical networks
Why was this selected
as a priority?
The managed clinical
networks and the local
professional network for
Dentistry are integral to the development
of clinically led commissioning as set out
by NHS England within its operating model
securing excellence in the commissioning
of NHS Dentistry.
Our goal
To increase engagement with Black
Country practitioners and support
clinicians to actively engage within local
professional networks for Dentistry across
the West Midlands.
What did we achieve?
Specific objectives for 2014-15 for each
network were achieved.
Recording PAR (peer
assessment rating) scores/
assessment of PAR score reduction
Why was this selected as a priority?
The PAR index, is a quality assurance tool which
enables the objective assessment of orthodontic
treatment outcomes. It can be used to calculate
the degree of improvement of orthodontic
cases using start and finish plaster casts of the
teeth. PAR scores are required to demonstrate
improvement.
Our goals
95 per cent of cases undergoing orthodontic
treatment have a pre-treatment PAR score
and post-treatment PAR score measured by
a calibrated scorer.
Of those cases treated by consultant orthodontists
(excluding patients with cleft lip and/or palate,
orthognathic surgery and severe oligodontia cases)
75 per cent should exhibit a reduction in PAR
score greater than 70 per cent, with 3 per cent, or
fewer, cases having a reduction in PAR lower than
30 per cent.
What did we achieve?
The goals were achieved.
49
Rehabilitation service CQUIN schemes:
Prosthetics - access to MDT assessment and recording of outcomes
Why was this selected as a priority?
To improve patient access to the prosthetics multi-disciplinary team (MDT)
assessment and to facilitate ongoing improvement of outcomes for patients
requiring prosthetics.
Our goals
Targets to achieve
• 90 per cent of referrals assessed by Prosthetics Multi-Disciplinary Team within six weeks
• 90 per cent of all prosthetics patients have outcome measures recorded.
What did we achieve?
Quarterly progress reports detail the current business process, training needs and performance
statistics. Referral pathway and data collection work led to the targets achieved.
Learning disabilities service CQUIN schemes:
Partnership working between BCHC community teams and inpatient assessment
and treatment service providers and community based social care providers
Why was this selected as a priority?
The Joint Commissioning Team (JCT) and BCHC share a common strategy to reduce
reliance on inpatient services delivered through improved community based services
supporting people in their own homes.
Our goals
• To work with assessment and treatment service providers to develop a pathway and protocol
for information sharing upon admission, discharge planning, and decision making meetings
that will occur throughout all admissions to inpatient providers. Once the protocol is complete
BCHC will collect data based on defined metrics to inform the bed management process and
to evaluate the success of the new model.
• To work with key social care provider to develop protocols and standards for supporting social
care services providing support for people with learning disabilities and challenging behaviour.
Once the protocols and standards are complete, collect and report data based on defined
metrics and to evaluate the success.
What did we achieve?
All quarterly reports were submitted meeting the requirements of the CQUIN. At the end of the
year an evaluation was carried out of the implementation of the pathways and data collected to
inform service improvement and redefinition of the metrics where appropriate.
50
Adults and Communities and Specialist Children
and Families services CQUIN schemes:
Demonstrating improvement through organisational learning
Why was this selected as a priority?
This CQUIN is in response to the essence of recommendations from the
Francis, Keogh and Berwick Reports e.g. Berwick recommendation No.1
“The NHS should continually and forever reduce patient harm by embracing
wholeheartedly an ethic of learning”. The CQUIN enables the Trust to demonstrate
that it is a learning organisation and that improvements are made as a result of learning.
Our goals
1. To identify an agreed number of priority areas for improvement across the organisation
drawn as a minimum from the integrated learning for:
•
incidents
•
serious incidents
•
complaints and other patient experience data
•
staff experience data
•
executive team walkabouts
•
CQC visit outcomes
•
other relevant data e.g. audit reports, care rounds.
(Improvement themes and number of improvements to be agreed with Commissioners)
2. Implementation of agreed improvements based on these priority areas and further review
of themes/trends emerging from integrated learning.
What did we achieve?
Quarterly reports provided details
of the progress made on the project
deliverables that were agreed as
the plan for this CQUIN, as well
as a comprehensive summary of
integrated learning from the 12
month reporting period of 2014-15.
The final report provided evidence
of implementation of improvements
made in line with action plans,
evidence of Board level review of
the report and evidence of ongoing
significant engagement with staff,
as per the milestone requirements.
51
Learning from safeguarding concerns
Why was this selected as a priority?
There is a need to ensure safeguarding practices support the needs of
vulnerable children and adults. Therefore this CQUIN is aimed at ensuring that
providers continue to embed safeguarding into practice, implement lessons
learnt following a safeguarding event, reflect on practice and ensure that the voice
of the child/adult is heard.
Our goal
Quarterly reports provided details of the progress made on the project deliverables that
were agreed as the plan for this CQUIN, as well as a comprehensive summary of integrated
learning from the 12 month reporting period of 2014-15. The final report provided evidence of
implementation of improvements made in line with action plans, evidence of Board level review
of the report and evidence of ongoing significant engagement with staff, as per the milestone
requirements.
What did we achieve?
The CQUIN has been very successful, achieving all the milestones. Over the year, concerns from
14 children and 14 adults were captured and studied with actions completed for each one as
appropriate. An overall action plan was updated throughout the year and lessons learnt from
the stories were disseminated to staff across BCHC.
Improving frontline care
Why was this selected as a priority?
The Cavendish report highlighted that ‘healthcare assistants (HCAs) make up
around a third of the caring workforce in hospitals, but research suggests that
they now spend more time than nurses at the bedside. If the NHS wants to
improve patient care, it should see healthcare assistants as a critical, strategic resource. Yet many
HCAs feel undervalued and overlooked’. The CQUIN therefore aims to address these findings and
not only develop the skills of current/future HCAs but also ensure that they feel valued
and supported.
Our goal
To improve engagement with HCAs by creating an HCA forum as well as developing a core
training package to enhance and develop existing skills. The CQUIN requires senior engagement
with this staff group and evidence of actions taken in response to issues raised.
What did we achieve?
An interactive forum for healthcare assistants to explore the below 6Cs was successfully set up in
Q1 and well attended across the year with the content evolving in line with the feedback from the
attendees to suit their needs and enable them to feel supported.
• Care and compassion - patient and client experience
• Competence - exploring skills required to do your job well
• Communication - effective tools for communication in your personal and professional life
• Courage and commitment - having the courage and commitment to do your job well.
52
Adults and Communities services CQUIN schemes:
Falls
Why was this selected as a
priority?
To enable the Trust to pursue all
routes to reduce the risk of falls in
patients entering its facilities for care.
Our goals
• Carry out an environmental audit as environment
and correct use of equipment has an impact on
the risk of falls and injury. Develop and implement
an action plan in line with initial findings and
re-audit to demonstrate improvement
• Identify and target frequent fallers and ensure
that their falls prevention plan meets their
needs to prevent harm from falls and leads to a
reduction in repeat fallers over time
Discharge planning
Why was this
selected as a priority?
To incentivise
improvements in the
discharge process from
inpatient beds with a focus on improving
patient experience and safety.
Our goal
To increase the percentage of patients
who are discharged from their inpatient
bed before 1pm to 70 per cent by Q4.
What did we achieve?
Following analysis of baseline data from
the previous year, quarterly targets were
set. The Q2 target was met, Q3 was
not but the final target of 70 per cent
was achieved.
• Provide an effective rehabilitation training
programme for patients including an exercise
programme to improve muscle strength, gait and
balance, mobility, activities in order to support
patients post discharge
• Perform a simple but effective medication-related
falls risk assessment for 80 per cent of inpatients.
What did we achieve?
• A comprehensive falls environment audit was
undertaken in Q1 and action plans for each unit
put into place to make improvements where
necessary. All requirements were achieved
• An electronic database was put into place to
capture all patients falls by time of day, location,
weekday and to identify patients who fell two
times or more within a 30 day period. The Q3
target was achieved but Q4 was not
• A small scale pilot was set up with patient groups
was set up using a training DVD, occupational
therapists and physiotherapists to develop and
undertake the training programme for patients
within the units/wards, to include an exercise
programme to improve strength, gait and balance
and mobility. All milestones were met
• All targets for completing a medication-related
falls risk assessment were met.
53
What the CQC said about BCHC
BCHC is required to register with the CQC which is the regulatory body for ensuring
the Trust meets the appropriate standards of care. The Trust is currently registered with
the CQC and its current registration status is unconditional meaning that there are no
restrictions placed on the Trust in the provision of its services. The CQC has not taken
enforcement action against BCHC during 2014-15. BCHC has not participated in any
special reviews or investigations by the CQC during 2014-15.
Services Inspected during 2014-15:
HMP Birmingham (April 2014)
In June 2014 CQC undertook a comprehensive
review of BCHC services. The inspection was
as part of the second pilot phase of the new
inspection process being introducing for
community health services.
Adult Long Term Conditions
Children’s and Family Services (community)
Children’s and Family Services Edgewood Road
Respite Care Unit
Inpatient Services
Moseley Hall Hospital
West Heath Hospital
Norman Power Centre
Community Unit 29
Perry Tree Centre
Community Unit 27
End of Life Services
Sheldon Unit (Adults)
End of Life Services in the community
for children
Learning Disability Services
Elliot lodge
Sayer House
Kingswood Drive
Hobmoor Bungalows
Dental Services
BDH
Community
Summary of findings from the CQC report published 30 September 2014.
CQC have introduced ratings as an important element of their new approach to inspection and
regulation. Their ratings will always be based on a combination of what they find at inspection,
what people tell them, their Intelligent Monitoring data and local information from the provider
and other organisations. They award us on a four-point scale: outstanding; good; requires
improvement; or inadequate.
Overall rating for community health services at BCHC
Good
Are services caring?
Good
Are services safe?
Good
Are services responsive?
Good
Are services effective?
Good
Are services well led?
Good
The Trust was also delighted to receive a rating of outstanding in the caring domain for
our end-of-life services. The CQC said:
“We judged this domain to be outstanding for end of life care. The level of compassionate and
dignified care was excellent. Staff were emotionally aware displaying a high level of communication
skills to support patients and relatives to a high degree. Staff undertook support roles which may not
at first glance seem part of their role. For example writing to one parent’s employer to inform them
of their child’s illness. Carers having the ability to stay overnight on the Sheldon Unit and having
access to open visiting and free parking was greatly appreciated by carers”.
54
Responding to CQC
BCHC is proud of its rating as ‘good’ however the CQC did identify (two) areas where
the Trust required improvement
1. Are community health services for children, young people and families responsive
to people’s needs? Requires Improvement
CQC said
Some services failed to meet the
18 week referral to treatment
time pathway and children did
not receive timely intervention;
most notably the occupational
therapy and speech and
language therapy services.
The Associate Director for Children and Families
Division, Sue Marsh said:
High levels of demand and other factors meant that
waiting times for clinic appointments had become
unacceptably long. A series of initiatives has been
implemented since 2012 to bear down on waiting times
including locum therapists. We have now recruited over
to 25 fixed term posts to increase capacity.
2. Are Community health inpatient services effective? Requires Improvement
CQC said
Staff uptake of mandatory training
was below the Trust’s target.
Our response
As detailed on page 60, the Trust has exceeded
its target for mandatory training.
CQC said
Our response
We found that most staff had
received little or no training
in stroke care and national
guidance in stroke rehabilitation
was not always followed.
The Trust devised a rolling training programme.
The first of the training events took place in Sept 2014
which was well attended. Further events are scheduled
throughout 2015. Attendance at this training will be will
be monitored at the divisional performance meetings.
CQC said
Our response
People’s care and treatment was not always being planned
and delivered in line with evidence based guidelines.
Care plans were not consistently personalised or holistic
to enable people to maximise their health and well-being.
Not all patients were able to describe what their care was
and how it was being delivered to meet their needs.
The Trust has invested in the
provision of access to Oxford Online
via the Trust intranet, enabling
clinicians with easy access to
evidence based guidance alongside
the Trust Policies and Procedures.
Response from Tracy Taylor, Chief Executive
Trust was were particularly pleased to be rated outstanding in the caring domain for our end of
life care. Our teams work tirelessly to ensure the care and comfort for our end-of-life patients.
Staff are innovative in their approach and will routinely go the extra mile to meet the needs of
patients and their families. This rating is well deserved and I know the staff will continue to
model outstanding care.
55
You said...we did
Family and Friends Test (NET Promoter Score)
The Net Promoter Score (NPS) was introduced in 2012/13. It involves asking patients how
likely they would be to recommend the service to their family and friends. The percentage
detractor is subtracted from the percentage of promoters, and this figure is reported as the
Net Promoter Score.
Although we do regard this test as an additional way of measuring the experience of our patients
rather than a measure in isolation, it has proved particularly useful in that it also allows patients to
make comments that we can then utilise to make improvements.
In 2015/16 national guidance is changing and as a result we will be reporting a simpler Friends and
Family Test which reports the percentage of patients who reported that they would be extremely
or very likely to recommend the service to a loved one.
You said…
be
Parents suggested that they should
mme
provided with a physiotherapy progra
ment
when they attend their child’s appoint
We did…
Parents will be given an
opportunity
to go through the prog
ramme
during the appointment
s
You said…
what
Young people wanted to be asked
their strengths and difficulties are
We did…
In the initial assessment form a pro
mpt
to ask what the concerns of the
child are, has been added
You said…
Parents that are not present during
the
appointment should be sent a copy
We did…
will be
Parents that cannot attend a copy
es
hom
ir
provided and sent to the
You said…
Questionnaire used by the special sch
ool
nurses to be redesigned to take into
account the varying levels
of understanding
We did…
Pictures have been incorporated into
the questionnaire for the younger
children using the service
You said…
Parents wanted a private space in
which to talk with the Health Visitors
at the Baby Clinic
We did…
ms
Baby clinic moved into smaller roo
ate
priv
e
sibl
pos
for privacy. If this is not
ic.
clin
in
ma
corners are created in the
56
Data quality
Birmingham Community Healthcare NHS
Trust will be taking the following actions
to improve data quality:
BCHC has created a comprehensive data quality
improvement programme directed and assured
by the Information Board (IB).
The IB is continuing the work of the former
Data Quality Programme Board, which formed
to take a strategic view of data quality issues
throughout the Trust and to ensure data
is robust, of an adequate and acceptable
standard, whilst enhancing the approach with
focus on the business applications of our data.
The data quality assurance model focuses
on a number of local key performance
indicators which are monitored and approved
by the subcommittee of the IB (Technical
Advisory Group) and reported on a monthly
balanced scorecard.
The overall objective of the IB is to oversee
data quality initiatives for the Trust and provide
a platform for critical information services.
It will improve data quality by working with
stakeholders to ensure data is accurate,
complete, and timely and fit for the purpose
of which it is collected and used.
To achieve this, the Trust will:
• incorporate Trust information into a single
platform and source, to enable a centrally
available and standardised suite
of information reports.
• control, manage and monitor the data
quality risk register
• facilitate a culture of continuous
improvement in data quality
• continually match the data quality risks
against the Trust strategy.
Information Governance (IG) toolkit attainment level
Information governance is the way by
which the NHS handles all organisational
information, but particularly personal and
sensitive information about patients
and employees.
It allows organisations and individuals to ensure
that personal information is dealt with legally,
There had been some incidents
reported where patient
records have been lost whilst
in transit between services.
ethically, confidentially, securely, efficiently
and effectively, in order to deliver the best
possible care.
Birmingham Community Healthcare NHS Trust
Information Governance Assessment Report
overall score for 2014-2015 was 70 per cent
and was graded green.
The new ‘Track and Trace’ systems are
being implemented across the Trust. We are
able to track movements of patient records.
This has improved tracking the location of
records and helped with the booking in
and out of patient records process.
Clinical coding error rate
Clinical coding is the translation of medical terminology as written by the clinician to
describe a patient’s complaint, problem, diagnosis, treatment or reason for seeking
medical attention, into a coded format’ which is nationally and internationally recognised.
‘BCHC was not subject to the Payment by Results clinical coding audit during 2014-15 by the
Audit Commission’.
57
NHS number and general
medical practice
code validity
Health records play an
important role in modern
To find
healthcare. The primary
out your NHS
function of healthcare
number contact
records is to record
important clinical
your GP surgery
to
m
e
th
information which may
and ask
.
p
u
it
need
to be accessed by
k
loo
the healthcare professionals
involved in providing care.
To improve access to healthcare records, the use
of the NHS number has been encouraged during
the year. Everyone registered with the NHS in
England has their own unique NHS number. Using
it to identify a patient correctly is an important
step towards improving safety and efficiency of
healthcare.
Birmingham Community Healthcare NHS Trust submitted records during
2014-15 to the Secondary Uses service for inclusion in the Hospital
Episode Statistics which are included in the latest published data.
The percentage of records in the published data:
• which included the patient’s valid NHS number was:
99.78 per cent for admitted patient care
99.11 per cent for out patient care
• which included the patient’s valid General Medical Practice
Code was:
To protect
u
your privacy yo
show
may be asked to
ng licence
a passport, drivi
roof
or some other p
u are
of identity. If yo
a GP you
registered with
e an
will already hav
NHS Number.
98.76 per cent for admitted patient care
98.04 per cent for outpatient care.
If you know
er or
your NHS numb
ment
have it on a docu
help
or letter you can
to find your
healthcare staff
sily and
records more ea
ly with
share them safe
ho are
other people w
caring for you.
58
Part 3 - Review of quality performance
Review of quality in clinical services............................................................... 60
National indicators............................................................................................ 62
Staff Engagement Think Tank.......................................................................... 70
Essential care indicators (ECIs)......................................................................... 78
Customer service............................................................................................... 81
Complaints......................................................................................................... 82
Partnership working......................................................................................... 83
NHS Change Day............................................................................................... 87
Patient-led assessments of the care environment (PLACE)............................ 90
Infection prevention and control (IPC)............................................................ 93
Improving, learning, sharing............................................................................ 99
Compassion in practice - 6Cs.......................................................................... 101
Snapshots from services about quality improvements during 2014-15......... 103
59
Review of quality in clinical services
Target data scorecard
Annual
target
Month 12
position
Meticillin-Resistant Staphylococcus Aureusis (MRSA) new bactereamia
0
3
Clostridium difficile avoidable cases
15
0
Falls resulting in severe injury or death
22
26
Grade 3 or 4 avoidable pressure ulcers Community (cumulative)
38
41
Grade 3 or 4 avoidable pressure ulcer Inpatients (cumulative)
0
9
N/A
433
0
1
Patient NHS Safety Thermometer (HarmFREE Care)
95%
97.0%
Essential Care Indicators - Inpatients (aggregated measure)
95%
98.0%
Essential Care Indicators - Community (aggregated measure)
95%
96.3%
Venous Thromboembolism (VTE) risk assessment on admission
95%
100%
Number of complaints acknowledged within three days
100%
100%
% complaints responded to within ≤ six months or as agreed
100%
100%
Net Promoter Score (NPS)
65%
66%
Customer experience - patient surveys completed in all areas in
past 12 months
100%
100%
Number of complaints
N/A
225
% staff appraised (within 12 months)
90%
86.8%
20
20
3.90%
4.91%
Safe staffing
90%
108.7%
Mandatory training (contractual)
85%
90.2%
Mandatory training (non-contractual)
85%
89.0%
Indicator
Number of Serious Incidents
Number of Never Events
Medical revalidation
% sickness absence (one month in arrears) (recovery)
Further details around the full range of indicators reported to the Board through the
Trust Quality and Performance scorecard can be found on our Trust website via the
following link www.bhamcommunity.nhs.uk/
60
Improving sickness absence levels
David Holmes - Director of Human Resources
Sickness absence has remained a focus for the Board throughout the year
in order to minimise the impact on colleagues and patients when staff are
unable to come to work. Inspite of significant effort and energy we have been
unable to meet the challenging target of 3.9 per cent absence rate. Whilst
good progress was made in the first part of the year the Trust performance
deteriorated in the middle winter months, however the sickness absence rate
at March 2015 was 4.91 per cent compared to the end of year rate for 2014
of 5.08 per cent.
It was recognised in the latter part of the year that there was little evidence of sustained
improvement and a four point high level action plan was approved by the Trust Board.
The plan focussed on the supportive intervention of line management, the full implementation of
the new Occupational Health Service, the Organisational Development and Health and Wellbeing
programme and the development of revised policy.
It is planned that continuation of the existing sickness absence management programme combined
with the high level actions will address the long term challenges of sickness absence.
Reducing patient falls
Emma Pickering - Patient Safety Manager
We ended the financial year with 26 “falls resulting in severe injury or death”
this was higher than our projected number of 22. Falls remains one of our
key priorities and we will continue to focus our efforts and demonstrate our
commitment to reducing falls through 2015-16 as part of our patient safety
programme that has been chosen as one of our quality priorities 2015-16:
Some of our actions going forward into 2015-16 include:
• guidance being piloted on safe staffing for falls and implementing enhanced staffing
• embedding a multidisciplinary falls education and learning programme that is mandated for
clinical staff with enhanced sessions to develop patient safety ambassadors to coach teams on
falls risk reduction strategies and preventable harm
• raising dementia awareness and highlight the link with falls.
Reducing MRSA cases
The Trust failed to meet the zero tolerance for MRSA bacteraemia and had three cases during
2014-2015. All cases have been reviewed and action plans submitted to the commissioners,
which continue to be monitored through divisional infection control meeting and overseen by
the Infection Prevention and Control Committee. A theme identified from route cause analysis is
related to the prescribing of antimicrobials. The Trust has employed an antimicrobial pharmacist
who will work closely with the Infection Prevention and Control team to formulate and deliver
robust educational plans and antimicrobial audits in 2015-2016.
61
National indicators
Where comparative data provided by Health and Social Care Information Centre (HSCIC)
is not received by the time the Quality Account goes to print, the data will be published
on the BCHC website as soon as it becomes available.
Clostridium difficile (C.diff)
Indicator: The rate per 100,000 bed days of trust apportioned cases of C. difficile infection
that have occurred within the Trust amongst patients aged two or over during 2014-15
(1st April 2014-31st March 2015).
C.diff rate per 100,000 bed days
The Trust recorded 15 cases of Clostridium
Difficile infections (CDI) in 2014-2015.
1.8
1.6
1.62
Root cause analyses have been completed
1.4
for all of the cases, and reports reviewed by
1.2
1.22
1
the commissioners. All reviewed cases have
1.04
1.02
0.8
been identified as unavoidable, meaning the
0.6
Trust could not have prevented the cases.
0.4
There remains one case outstanding and
0.2
reviewed is due to take place by
0
2011-12 2012-13 2013-14 2014-15
commissioners in May 2015.
Birmingham Community Healthcare NHS Trust
considers that this data is as described for the following reasons: Data is received from specimen
laboratories directly. This data is also checked through a national database by commissioners
monthly.
Birmingham Community Healthcare NHS Trust has taken the following actions to improve this
number, and so the quality of its services, by:
Actions taken by the Trust to reduce the number of cases for the coming year:
• Since December 2014 all new cases of CDI which occur on a ward are supported with an
enhanced CDI audit, completed by the IPC team weekly until a unit achieves a pass of 95 per cent
or above for three consecutive weeks. This ensures that good practice is embedded into the unit
and provides greater quality and assurance of control of infection to the unit.
• CDI specific training conducted on all ward areas in December 2014
• Monthly commode audits completed by IPCT with ad hoc training for staff on units to ensure that
they are aware of correct procedures for decontamination.
• If a unit does not meet the standards for the CDI audit for two weeks in a row a request is made
for a ward representative and matron to attend the audit. A self directed learning pack is also sent
to the unit for clinical staff to utilise to enhance their learning regarding clostridium difficile.
62
Venous thromboembolism (VTE)
Venous thromboembolism (VTE) forms part
of the work program for patient safety,
one of the Trust’s quality priorities. Deaths
from hospital acquired blood clots are
preventable and for this reason all patients
admitted to hospital should be assessed
for their risk of developing blood clots
and if necessary protection in the form
of prophylactic treatment provided.
The VTE programme of work, under the
clinical guidance of Dr Martin Goodman and
Patient Safety Lead Julie Jones gained further
momentum this year. The commissioning of
a VTE ‘task and finish’ group chaired by Dr
Goodman and supported by the prevention of
harms team, culminated in the ratification of a
new VTE policy with supplementary appendices
and resources to help support and guide staff.
A useful additional Trust intranet page was
The graph illustrates the improvements made to
BCHC’s VTE prevention program which is in place developed to improve staff access to these useful
to reduce the number of deaths caused by blood resources and training related information.
clots acquired in hospital.
Extensive consultation before and during the
work programme has enabled the learning from
Root Cause Analysis (RCA) investigations of VTEs
Compliance with VTE risk assessment
(blood clots) to be woven into the fabric of the
100.00
clinical guidance now provided. This shapes a
2012-13
2013-14 robust and useful suite of documentation that
95.00
2014-15 supports prevention and management of VTE
related preventable patient harm.
90.00
85.00
Feb
March
Jan
Dec
Nov
Oct
Sept
July
August
June
May
75.00
April
80.00
Birmingham Community Healthcare NHS Trust
considers that this data is as described for the
following reasons:
• Venous thromboembolism (VTE) data is
available, measured and monitored monthly
using the NHS Safety Thermometer,
monitoring the percentage of patients who
were admitted to BCHC bedded areas. An
overall compliance rate of 99.88 per cent
was achieved for patients who received a risk
assessment for venous thromboembolism
during 2014-15.
Birmingham Community Healthcare NHS Trust
has taken the following actions to improve this
percentage, and so the quality of its services,
by the following:
The training needs analysis now in place reflects
the need for staff training accessibility to be both
electronic and classroom based, with focus on
improving awareness and reflecting the Trust
policy. The Trust VTE risk assessment tool has
been updated to reflect clarification of Trust
and National standards, with plans for electronic
replication within the year to complement the
movement towards singular, electronic clinical
record keeping.
The VTE RCA tool has been included in
the Trust revision of tools and templates to
support standardisation of the investigation
and assurance process of serious incidents; this
further promotes a transparent safety culture in
regards to VTE and ensures lessons are learned.
Forums for feedback to clinicians on performance
and compliance with Trust standards and
conveyance of lessons learned to include good
practice include committee meetings, audit,
Data reporting dashboards and regular
newsletter articles within Trust newsletters.
BCHC continues to place a high priority on VTE risk assessment
as shown by our achievement of a 99.88 per cent screening
compliance rate. Dr Martin Goodman - Lead Consultant Geriatrician
63
Incomplete pathways
Indicator: Percentage of incomplete pathways within 18 weeks for patients on incomplete
pathways at the end of the period.
This indicator shows the percentage of patients who were unable to complete their care pathway
within the 18 weeks target. Birmingham Community Healthcare NHS Trust considers that this
data is as described for the following reasons:
• all referral to treatment (RTT) data is fully validated prior to submission by service lines
• use of Service Standard Operating Procedures.
18 week pathway consultant led services (incomplete pathways)
Percent
100
95
90
Ap
ril
20
14
M
ay
20
14
Ju
ne
20
14
Ju
ly
20
14
Au
g
20
14
Se
pt
20
14
O
ct
20
14
No
v
20
14
De
c
20
14
Ja
n
20
15
Fe
b
20
15
M
ar
20
15
85
Date
Apr
2014
May
2014
Jun
2014
Jul
2014
Aug
2014
Sep
2014
Oct
2014
Nov
2014
Dec
2014
Jan
2015
Feb
2015
Mar
2015
Per cent %
2014-15 96.03 96.06 96.52 96.73 94.65 94.65 95.61 92.49 97.22 97.51 98.53 98.18
2013-14 98.18 97.45 96.81 97.13 95.53 95.36 96.30 96.63 96
94.94 96.67 96.51
Target
92
92
92
92
92
92
92
92
92
92
92
92
Birmingham Community Healthcare NHS Trust has taken the following actions to improve
this indicator, and so the quality of its services, by
•
•
•
•
•
weekly RTT teleconference
daily RTT update reports
development and implantation of Trust Patient Access Policy
establishment of RTT working group
monthly service validation and sign off
This indicator is monitored monthly on the Trust Scorecard report.
64
Cancer waits
Indicator: Maximum waiting time of 62 days from urgent GP referral to first treatment for
all cancers.
The application of the National Cancer Waiting Times Monitoring Dataset Specification is defined
by a range of scenarios, which cover all or part of the patient pathway within the waiting times
periods (two week, 31 day and 62 day). BCHC monitors a maximum two-week wait from an
urgent GP referral for suspected cancer to date first seen by a specialist for all suspected cancers.
Cancer referrals are received only by the Birmingham Dental Hospital and so the indicator applies
only in this division and 100 per cent compliance has been achieved for 2014-15.
Birmingham Community Healthcare NHS Trust considers that this data is as described for the
following reasons as it is nationally standardised data which allows us to draw comparisons
against the NHS as a whole.
10
8
6
4
2
0
Ap
ril
20
14
M
ay
20
14
Ju
ne
20
14
Ju
ly
20
14
Au
g
20
14
Se
pt
20
14
O
ct
20
1
No 4
v
20
14
De
c
20
14
Ja
n
20
15
Fe
b
20
15
M
ar
20
15
Number of referrals
Cancer waits - referral to first appointment
Date
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
2014-15
3
4
7
6
2
3
6
8
3
5
2
5
2013-14
5
6
8
6
2
2
4
6
1
8
2
4
Birmingham Community Healthcare NHS Trust has taken the following actions to improve this
indicator, and so the quality of its services, by:
• Managing waiting list with patient tracking lists
• Ensuring capacity is available for all oncology patients in a timely manner
• Weekly RTT teleconference
• Daily RTT update reports
• Development and implementation of Trust Patient Access Policy
• Establishment of RTT working Group
• Monthly Service validation and sign-off
This indicator is monitored monthly on the Trust Scorecard report.
65
Care programme approach
Indicator: The percentage of patients on care programme approach who were followed up
within seven days after discharge from psychiatric in-patient care during the reporting period.
BCHC has maintained 100 per cent compliance on 7 day follow-up of individuals discharged
from hospital. Compliance has been maintained by partnership working with providers and
commissioners. This ensures that BCHC are fully involved with the pre-discharge process and
can be proactive in planning follow-up, which leads to both quality for patients and compliance
internally and externally.
% of patients followed up
within seven days of discharge
2012-13
2013-14
2014-15
100
100
100
Birmingham Community Healthcare NHS Trust considers that this data is as described as clinical
records evidence this with documented records of visits and meetings.
Readmission
Indicator: The percentage of patients aged:
(i) 0 to 15 and
(ii) 16 or over
Readmitted to a hospital which forms part of the trust within 28 days of being discharged from a
hospital which forms part of the trust during the reporting period.
Discharges
2014-15
Emergency Readmits
2014-15
Per cent
<=15
989
0
0.00%
16+
5538
304
5.49%
Birmingham Community Healthcare NHS Trust considers that this data is as described for the
following reasons:
• The data is sourced and processed from a nationally defined clinical data system and has been
internally verified.
Birmingham Community Healthcare NHS Trust intends to take the following actions to improve
this percentage and so the quality of its services, by producing regular reports to monitor
compliance to support service improvement.
66
Staff survey
Staff survey response rates
2013-14
Response rate
2014-15
BCHC
National
average
BCHC
National
average
53%
45%
48%
42%
BCHC improvement/
deterioration
-5%
Our 2014 response rate compares favourably with
response rates nationally recorded at 42 per cent
and the Quality Health average response rate which
is 41 per cent.
Each year NHS organisations invite staff to complete an annual staff survey.
Last year BCHC produced an action plan based on the results. Here are some
of the key improvements in response to the 2013 staff survey.
• Staff personal development review (PDR) is now values-based linked to the staff charter and
leader’s code. Consultation on amendments took place at the Think Tank (for more information
see page 70).
• Enabling teams through delivery of the ‘empowering teams through coaching’ programme;
so far 11 teams have taken part from across the organisation.
• Improved infection, prevention and control with the introduction of practical hand-washing
sessions with a greater focus on inpatient training and community nursing hand-washing packs.
• Embedded the staff charter and leaders code across BCHC with reference to it in PDR
paperwork, induction and many other less formalised development opportunities.
The numbers of staff required to complete a survey depends on the size of the organisation.
The 12th annual national survey of NHS staff was launched in September 2014 at an event open
to all staff helping to raise awareness of the benefits the survey brings and an opportunity to share
activity linked to previous years’ staff survey results.
As in 2013, in 2014 BCHC conducted a sample survey of 804 staff randomly selected across the
organisation. The survey was sent to a random sample of employees up to a maximum of 850
staff per Trust. The Trust had 388 responses returned (48 per cent) from a sample size of 804.
A decrease of 5 per cent compared to 2013.
In summary, the Trust saw an improvement in 39 of the 92 responses (42 per cent),
45 (49 per cent) have declined and 8 (9 per cent) have stayed the same.
67
Top 5 Scores
Improved
2013 2014 + -
Declined
2013 2014 + -
39% 48% 8%
Agreed that organisation
1 informs staff about incidents
Staff/colleagues reported 94% 84% -10%
1 error that could hurt staff/
patients/service users
Agreed training helped
2 to stay up-to-date with
professional requirements
Satisfied with freedom
2 to choose own method
of working
73% 80% 7%
Staff have had an appraisal/ 82% 88% 6%
review in the last 12 months
Agreed that training helped 63% 68% 6%
4 to do job more effectively
3
Agreed that organisation
encourages staff to report
5
errors, near misses or
incidents
86% 91% 5%
72% 62% -10%
49% 44% -8%
Staff often/always
enthusiastic about the job
78% 71% -7%
Agreed that team
4 members have a shared
set of objectives
82% 75% -6%
Appraisal helped agree
clear objectives
3
5
Indicator:
The data made available to the NHS trust or foundation trust by the Health and Social Care
Information Centre with regard to the percentage of staff employed by, or under contract to,
the Trust during the reporting period who would recommend the Trust as a provider of care
to their family or friends.
Birmingham Community Healthcare NHS Trust considers that this data is as described for
the following reasons: the data available is collected from the 2014 staff survey and provided
by Quality Health.
The national staff survey report published by the Department of Health shows scores against
28 key findings. Key finding 24 (KF24) is known as the ‘friends and family test’; the wording
being ‘staff recommend the Trust as a place to work or receive treatment’.
The national score for key finding 24 (as a number where 1 is worst and 5 is best):
KF24: Staff recommendation of the Trust as a place to work
or receive treatment (Questions 12a, 12c-d)
BCHC in 2013
Average (median) for
community trusts 2014
BCHC in 2014
3.55
3.6
3.65
3.7
Key finding 24 is calculated using results from the four questions shown in the chart below.
The breakdown of the results for each question are as follows.
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12d
How likely are you to recommend the
Trust to friends and family if they needed
care or treatment?
12c
How likely are you to recommend the Trust
to friends and family as a place to work?
12b
My organisation acts on concerns raised by
patients/service users.
12a
Question
Key finding 24
Care of patients/service users is my
organisation’s top priority.
0%
20%
40%
Average (median) for community trusts
surveyed by Quality Health
BCHC in 2014
BCHC in 2013
BCHC in 2012
60%
80%
The BCHC Trust intends to take the following actions to improve these scores.
Key points that will be taken forward as actions into 2015-16:
• Managing and understanding work-related stress - effectively supporting people who have
felt unwell due to work-related stress, understanding that stress is a very individual thing and
exploring different ways to ensure resilience for staff
• Effective communications - having a clear message for the staff on how the Trust is moving
forward, improving services for patients, dealing with legacy issues and communicating the
strategic plan to staff continually through multiple channels and continuously repeated to get
the message through. Making the Trust easy to recommend as a place to work
• Patient safety/patient feedback - keeping a focus on clinical safety and developing the
relationship between patient feedback and information provided to staff about that feedback
• Valuing staff - demonstrating how valued staff are in delivering the services through regular
and meaningful feedback, ensuring individuals know that their role is important and they are
appreciated, through their PDRs and beyond and engage with them to develop good ideas
for service development encouraging team objectives and staff ability to make suggestions.
All the key points link to the bottom four ranked scores.
69
Join the journey...
Staff Engagement Think Tank
What is it?
The Engagement Think Tank is a developing initiative,
aiming to create an inclusive, creative space where all
BCHC staff members can come together to explore,
shape and develop engagement strategies and wider
developments across the Trust.
Bringing together people from a variety of services,
roles and settings, the Think Tank also offers a great
forum for individuals to ‘bring and share’ resources,
network, collectively problem-solve, and seek
feedback and future involvement of others in
work developments.
The meetings are scheduled in advance so colleagues
can plan their attendance, and are based at various
locations across BCHC.
So what is discussed and what has happened?
Within facilitated conversations, attendees have had the
opportunity to explore, find out more and influence a number
of topics and initiatives within the organisation.
I learnt a lot from
listening to what
people had to say from
across the clinical
divisions and supporting
corporate services.
Organisational campaigns
such as Flu Jab; Raising
Concerns; NHS Change
Day; ‘Valuing You’ Health
and Wellbeing have been
influenced by the feedback
from the Think Tank meetings.
The Think Tank has
been beneficial both
as a learning forum to
aid my understanding
of developments, and
also to allow me as a
clinician to participate
in developments.
Staff opinions have been collated to identify themes and
suggestions on topics such as mobile working, safe staffing
and management of change. These have then been shared
to influence wider Trust projects and committees.
It has been a useful forum for staff to find out more and
comment on Trust practices, strategies and policies some
of which have included the personal development reviews,
Quality Account sessions, Education and Learning Strategy,
Health and Wellbeing issues; Service Transformation,
organisational learning, Staff Survey, Communication
and Data Visualisation Programme.
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Risk management - incidents
An incident is any event which has given rise to actual harm or injury or damage to/
loss of property. This definition includes patient or client injury, fire, theft, vandalism,
assault and employee accident. It also includes incidents resulting from negligent acts,
deliberate or unforeseen.
Reported incidents
All incident data correct at 11:20hrs 16/04/2015
Incident by incident type
Total 2014-15 Total 2013-14 Total 2012-13
Confidentiality, data and information governance
263
255
233
Fire safety
39
53
31
Infrastructure
358
251
194
Medication, medical gas, medication delivery system
675
673
548
Patient incident
5334
5623
5192
Security
308
270
258
Staff, visitor, contractor incident
1436
1509
1482
Total
8413
8634
7938
Top 3 incidents
Incident by
incident type
Patient incident
Staff, visitor,
contractor incident
Medication,
medical gas,
medication
delivery system
Top 3 categories
2013-14
total
2014-15
total
Slips, trips and falls
1578
1964
Care delivery (including pressure ulcers)
2112
1439
Admission, transfer, discharge, access to services
357
384
Violence, abuse, assault
611
458
Staffing injuries
328
406
Contact injury
109
119
Administration
280
341
Did not
appear in
the top 3
80
94
71
Storage/medication
Prescribing
The top three patient incident categories are similar to what they were in 2013-14, but there has
been a small reduction in the number of incidents categorised as:
• care delivery
• violence, abuse and assault
• prescribing.
71
Serious incidents
A serious incident (SI) is:
• an accident or incident is when a patient, member of staff (including those working in the
community), or a member of the public (including contractors) suffers serious injury, major
permanent harm, or unexpected death (or the risk of death or serious injury) on either premises
where healthcare is provided, or whilst in receipt of healthcare
• any event where actions of health service staff are likely to cause significant public concern
• any event that might seriously impact upon the delivery of services and/or which is likely to
produce significant legal, media or other interest and which, if not properly managed, may result
in loss of the Trust’s reputation or assets
• damage or loss to property by fire, flood, theft or negligent, deliberate or unforeseen act.
A total of 433 SIs were reported, of which 65 were subsequently reclassified as not being SIs,
leaving an overall total of 368. Of these, 314 related to the development of pressure ulcers.
Incident type
Birmingham
Adults and
Dental
Community
Hospital
Division
Services
Children
Learning
and
Disability
Families
Services
Division
Rehabilitation
Total
Services
Absconsion of patient
0
0
0
1
0
1
Accident whilst in hospital
1
0
0
0
0
1
Allegation against HC
non-professional
2
0
0
1
0
3
Allegation against HC
professional
2
0
0
0
0
2
Allegation against HC
professional (fraud)
0
1
0
0
0
1
Allegation of abuse
2
0
0
1
0
3
Assault by inpatient
(in receipt)
1
0
0
0
0
1
Child serious injury
0
0
1
0
0
1
Confidential Information
leak
1
0
0
0
0
1
Dentistry
0
3
0
0
0
3
229
0
2
1
0
232
Grade 3 > 4 pressure ulcer
1
0
0
0
0
1
Grade 4 pressure ulcer
81
0
0
0
0
81
MRSA bacteraemia
3
0
0
0
0
3
Other
1
0
1
0
1
3
Slips, trips and falls
24
0
0
0
2
26
Suicide by outpatient (not
in receipt)
1
0
0
0
0
1
Unexpected death
(general)
1
0
0
0
0
1
Ward closure
3
0
0
0
0
3
353
4
4
4
3
368
Grade 3 pressure ulcer
Total
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Never events
Never events are serious, largely preventable patient safety incidents that should not
occur if the available preventative measures have been implemented by healthcare
providers. During the period 2014-15, the Trust has had one never event - this was an
incorrect tooth extraction at BDH. This incident was due to human error and there are
contributory factors that are being addressed.
Indicator: The number and, where available, rate of patient safety incidents reported within the
Trust during the reporting period, and the number and percentage of such patient safety incidents
that resulted in severe harm or death.
96 incidents were categorised as ‘severe/death’. Of the remaining 86 ‘severe’ incidents, 41 were
not attributable to the Trust.
Year
Total Incidents
Severe/death
%
2012-13
7938
71
1.4
2013-14
8634
91
1.05
2014-15
8413
96
1.14
Birmingham Community Healthcare NHS Trust considers that this data is as described because the
Trust has a single incident reporting system (Datix) which can be accessed by all staff. Each incident
is assigned a ‘handler’ who manages the incident to ensure that all information is accurate.
The Trust has introduced a number of mechanisms to ensure that the quality of its services remains
high and that we learn form incidents. It is important, however, to emphasise that incident
reporting is encouraged to ensure that the Trust is open and transparent.
The Trust has appointed a Trust Risk Manager whose role is to ensure that organisational learning
is embedded throughout the organisation. In relation to pressure ulcer incidents, the key themes,
trends and changes in practice are shared through the Trust Pressure Ulcer Reference Group,
which meets monthly and is attended by the Trust Risk Manager. In relation to slips, trips and falls
incidents, the key themes, trends and changes in practice are shared through the Falls Clinical Sub
Group, which is also attended by the Trust Risk Manager.
The introduction of the Trust newsletter ‘Compass’ has proven to be popular and is cascaded to
all staff on a monthly bases (details covered elsewhere). Furthermore, following a successful pilot,
a weekly SI RCA assurance meeting is held which discusses the incident and ensures that key
learning is identified and changes in practice implemented. The Adults and Community Division
has introduced a number of new Standard Operating Procedures which include procedures for
when patients transfer between district nursing areas.
Bringing direction to practice
In April 2014, the Risk Management Team
launched its monthly newsletter, ‘Compass’. The
aim of the newsletter was to cascade the sharing
of lessons learned, to share solutions to address
root causes which may be relevant to other
teams and services and to share good practice
which reduces the potential impact of incidents.
73
The newsletter has been produced every month
and as well as highlighting specific areas of work,
it has also identified key themes and changes in
practice. Incidents, risks and feedback from the
serious incident RCA assurance process have also
been included each month.
Input has been encouraged from teams and
services and a number have submitted articles
for inclusion.
New Root Cause Analysis (RCA) assurance meeting
A Root Cause Analysis is completed for all serious incidents
(SIs) to ensure that lessons are identified and changes in
practice are made where relevant to prevent reoccurrence.
During the reporting period, the Trust piloted a serious incident (SI)
RCA assurance meeting, which took place on a weekly basis.
The aims of the meeting included:
• agree the contents of the RCA
• improve practice by acting on learning (developing best practice)
• ensure active engagement of clinicians in the assurance and
learning process
• ensure that organisational learning is identified and shared through
themed reports.
96 per cent of staff
felt that the process
should continue
91 per cent of staff
said they had learned
from the other RCAs
presented and would
share the learning
with their team
87 per cent of
staff responded
that it was of
value to stay for
the whole meeting
Initially, the 12 week pilot assured RCAs relating to SIs for pressure
ulcers, patient falls which result in serious injury and healthcare
acquired infections.
One of the primary drivers was to reduce the workload associated
with the RCA process for frontline staff, but to ensure that they
would also derive the maximum benefit from the process.
96 per cent of staff
felt that new process
has strengthened the
engagement between
Board/Senior Managers
and frontline staff
An evaluation of the pilot revealed the following:
• Good understanding on what other teams are doing for pressure area care
• Through learning from other RCAs and disseminating this to team members, clinical practice
will be updated
• By reflecting on how issues were dealt with and how they could have been improved in the future
• Highlights the importance of accurate thorough documentation.
As a result of the positive feedback, it was decided that the process should continue and be
expanded to include all SIs within the Trust.
74
Learning from incidents and risks
In February 2015, The Risk
Management Team held
an event with the theme
‘Learning from Incidents
and Risks - Bringing
Direction to Practice’.
Using case studies and the
experiences of frontline
staff, the aim of the day
was to highlight how BCHC
has reflected on incidents
and risks and introduced
changes in practice to
ensure that we continue to
provide high quality care.
The event was attended by
over 70 frontline staff and
presentations were given on a
number of aspects including
medication incidents, falls incidents and challenging behaviour. Other areas covered included the
Serious Incident Root Cause Analysis assurance meeting, the concept of ‘Learn, Share and Apply
and an overview of the Commissioner role from the BSCCCG Senior Safety and Quality Manager.
The event was well received, with staff making
a number of positive comments about how
they learnt from the day and understood the
need to include risk management as part of
their work.
The BSCCCG Senior Safety and Quality
Manager explained, “I found the event an
engaging, informative and powerful event.
It was impressive how frontline staff from
BCHC were fully committed to the concept
of organisational learning. In my opinion
the event must be seen as a complete
success. I look forward to seeing how BCHC
facilitate future sessions and continue to
develop this concept.“
Based on the positive feedback, it is intended
that the event will take place every year to
ensure that the learning continues to be
shared across the organisation.
75
Organisational learning (CQUIN)
• Lessons that are learnt are shared across BCHC. Improvements are not confined to specific
teams/specialities, but are shared across the Trust. This is shared and used as discussion points
during team meetings and for the divisional newsletters.
• A monthly newsletter ‘Compass’, highlights lessons learned, changes in practice and
identifies key themes.
• The aim is that focus on organisational learning will continue post 2014-15 and become
‘second nature’.
• There is now a resource on the Trust intranet entitled ‘Organisational Learning’. This covers
key areas including risk, incidents, Governance and wider learning as well as innovative ideas
and good practice. This enables staff to look at Organisational Learning that has already been
highlighted as well as enabling them to add to the information contained within the portal.
• Continued development of technology to assist organisational learning. Technology is being
utilised to make learning easy for staff across the Trust and across team.
• The Trust already has a growing Yammer community. It is intended that the Risk Management
Team ‘host’ an Organisational Learning Group where staff can post updates, top tips and
learning. Through the Yammer community, staff can cascade information and learning which
they think needs to be shared across the Trust.
• All data sources are considered when reviewing quality. All quality data is given equal
consideration and attention when reviewing services that are delivered.
• Through triangulation of data, including risks, incidents, complaints, claims, customer service
feedback, NHS Safety Thermometer etc, a more holistic picture is developed to highlight and
improve quality. The Trust Risk Manager attends a number of related meetings to ensure that
learning is shared Trust wide.
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Focus story - case study: missed doses
audit project
Local audits observed an increase in missed doses by regular staff; therefore
this audit was a priority for Ward 9, Inpatient Neurological Rehabilitation Unit (INRU),
in regards to patient safety and wellbeing. The completed audit compared the number
of missed doses by regular staff against missed doses by temporary staff.
Several key issues were identified:
• More missed doses reported for regular staff compared to temporary agency staff
• Majority of missed doses occurred during the 6am, 6pm and 8pm (out-of-hours) drug rounds
• Staff often did not escalate missed doses routinely or on the day as there were no
clear guidelines
• Red “do not disturb” tabards worn by drug round nurses were not effective in
reducing disruptions
• Pattern in terms of missed doses of Enoxaparin at 6pm.
This audit has led to:
• The implementation of the “guidelines for management of staff who have made a medication
error” to escalate missed doses by regular staff
• Missed doses by temporary staff will be reported to the Trust Bank Lead
• Notices promoting nurses to check they have signed for all medication and/or used omission
codes accordingly’ displayed on drug trolley
• New notices will be displayed on drug trolleys to ensure disturbances are reduced
• Weekly missed doses audits where results and action plan discussed with the nursing teams
• Medical teams being reminded to avoid prescribing medication on out-of-hours drugs
rounds unless absolutely necessary
• The creation of missed doses pack for regular trained nurses
• The creation of escalation flow chart to facilitate prompt missed doses identification
and action.
How did taking these actions contribute to better patient care and improved
use of resources?
• Overall number of missed doses decreased on the ward in particular by regular nurses
• Patients safety and quality of care improved
• Staff are more vigilant and clear about escalation protocols and Trust requirements
under the guidelines
• Staff experience fewer interruptions during drug rounds.
77
Essential care indicators (ECIs)
The ECIs are a set of metrics for assessing the quality of care plan and assessment tools
used to manage fundamentals of care. They were initially developed as nursing metrics in
Blackpool and Fylde NHS Trust and have been adapted by BCHC for use in adult inpatient
units, district nursing teams and bedded units and community teams for people
with learning disabilities.
The metric reports form a key part of the monthly quality reporting for the Board and are also fed
back to teams and operational managers for rapid improvement. The metrics are collected monthly
and are used as one of the early warning signs to tell us where teams need more support or
further assessment of standards. The Trust has a dashboard tool for reporting the ECI results and
available on our internal website for staff to access.
Adult bedded units
Patient observations
95% target
98% achieved
Falls assessment
95% target
98.25% achieved
Tissue viability
95% target
97.75% achieved
Nutritional criteria
95% target
97% achieved
Medicines management
95% target
96% achieved
Environment
95% target
98.5% achieved
Patient observations
95% target
90.25% achieved
Pain management
95% target
97.6% achieved
Falls assessment
95% target
96% achieved
Tissue viability
95% target
97.8% achieved
Wound management
95% target
96% achieved
Nutritional criteria
95% target
96% achieved
Medicines management
95% target
98% achieved
Safety
95% target
96.8% achieved
Communication
95% target
96.75% achieved
District nursing teams
Learning Disability Services - inpatients
78
Medicine management
95% target
99.6% achieved
Promotion of health
95% target
97% achieved
Nutritional criteria
95% target
96.4% achieved
Tissue viability
95% target
94.7% achieved
Environment
95% target
99.8% achieved
Patient observations
95% target
93.5% achieved
Falls
95% target
96% achieved
Mental health
95% target
99.25% achieved
Safety
95% target
92.8% achieved
Communication
95% target
94.3% achieved
Medicine management
95% target
94% achieved
Promotion of health
95% target
87.4% achieved
Mental health
95% target
82.4% achieved
Nutrition
95% target
86.25% achieved
Tissue viability
95% target
86% achieved
Falls
95% target
90% achieved
HONOS
95% target
91% achieved
Learning Disability Services - community
In 2014-15 we have reported on the following trends and initiatives for the ECIs:
• adult bedded units showed a steady improvement in compliance across the year with
good levels of compliance achieved for the majority of units across all the standards
• as a result of this continued achievement of the standards, new, stretching standards
have been developed for use in adult bedded units in 2015-16
• district nursing teams showed a steady improvement in compliance across the year with
good levels of compliance achieved for the majority of units across all the standards
• the criteria for patient observations falls below the required standard for the 2014-15.
This indicator requires a full set of observations to be carried out over the first three visits
including analysis of a urine sample. Feedback from staff shows that patients in their own
homes are not always able to provide a sample and this has resulted in a lower level of
compliance for this standard
79
• the learning disabilities inpatient units achieved an overall rating of green for all essential care
indicators apart from tissue viability and patient observations. Additional training and support
has been given to the relevant staff in these areas
• the community teams have been undertaking ECIs since February 2014 and overall the
teams have improved their scores over this period. However there remains scope for further
improvement in all indicators and there is a plan in place to improve the standards. As the
teams move into multidisciplinary hubs from April 2015, the ECIs will be reviewed.
Focus story - improving ECI scores
Staff at Perry Trees Unit faced a dilemma when ECI scores consistently fell short of
the expected target. Documentation and timely risk assessment review was identified
as an area that required more improvement.
With the many and varied risk assessment tools used, a piece of work started to
focus on how they might resolve the issues that staff were experiencing. Work was
undertaken over a three month period to embed a new regime and to reinforce the how to
complete, when to complete and why the risk assessments are required. The potential benefits
to patient safety were also reinforced.
Clinical subject leads were invited to supplement existing training where required and staff were
further supported with a ward specific fact sheet. This included the outcomes of previous ECIs
and RCAs so that they were able to see the themes and links to documentation and affirmed
the importance of wards following the new routine for completion of risk assessments
and documentation.
After embedding the new routine, significant improvements have been seen monthly to
ECI audit scores, peaking in June at 98.7 per cent... a truly remarkable result!
80
Customer service
Customer service
(formerly known as Patient Advice and Liaison Service - PALS)
The customer service team supports BCHC in improving services for patients. It provides
confidential impartial advice and support to patients and staff, helping to sort out concerns or
queries people have about their care and treatment. The team also help enquirers navigate the
services provided by the Trust and signpost them to appropriate points of contact within the Trust.
The customer service team is part of the wider patient experience team for the Trust.
Contact customer service team:
Telephone: Freephone 0800 917 2855
Text: 07540 702 477
Email: contact.bchc@nhs.net
You can write to us at: Moseley Hall Hospital, Alcester Road, Moseley, Birmingham, B13 8JLA
Service
Number of enquiries
(including compliments
logged by customer
services team)
Number excluding
compliments
None BCHC services
214
214
Other BCHC
191
191
• Birmingham Dental Hospital
382
345
• Combined Community Dental Services
27
25
• Learning Disability Services
55
16
• Rehabilitation Services
167
122
Adults and Community Division
1787
1758
Children and Families Division
410
342
3233
2841
Specialist Division
Total
Responding to our callers: an example
The podiatry service previously had many callers unable to get through to an antiquated
phone system at their old (temporary) offices. They moved location in December 2014 to new
centralised office facilities with an up-to-date telephone system, and are now able to handle
many more calls per hour. This has greatly reduced complaints to customer services about
difficulties getting through.
81
Complaints
Top five complaints
1.Manner and attitude
2.Poor standard of care
3.No explanation re. treatment
Division
4.Access to services/staff
5.No response to contact/messages
not passed on
Total
Number of Number of complaints shown
as rate per 10,000 contacts
activity
complaints
(2014/2015) (2014-15)
2014-15
2013-14
Specialist Division total
341,634
86
2.5
-
• Birmingham Dental Hospital
147,498
53
4
2
• Combined Community
Dental Services
65,687
7
1
1
• Learning Disability Services
78,033
5
1
1
• Rehabilitation Services
50,416
21
4
3
Children and Families Division
465,320
35
1
1
1,161,027
103
1
1
Corporate
-
1
-
-
Trust total
1,967,981
225
1
1
Adults and Community
Division
Actions and lessons learned from complaints
1. Manner and attitude:
Feedback received regarding patient over
hearing a conversation un-related to work
during treatment
Action: All dental nurses will be reminded
that discussion of personal matters, between
colleagues and during treatment, is not
acceptable, and performance in this area
will be monitored by the Senior Dental Nurse.
Action: Staff now know to document all
conversations with the family, specifying the
family member spoken to and details of any
actions agreed.
Patient’s expectations of the unit not met due to
lack of information about the unit before their
transfer from an local acute Trust
Action: A unit information leaflet is now
available for patients at the local acute Trust.
2. Poor standard of care:
Patient felt care was impersonal and
inconsistent due to lack of continuity
in staff visiting the patient
Action: The T card system now includes a
named nurse and caseload holder to ensure
continuity of care for patients.
4. Access to services/staff:
A bedded unit – family members unable to
contact the unit by phone due to reception desk
not staffed owing to a vacancy
Action: vacancy has been filled.
3. No explanation re. treatment:
Family members felt they were not informed of
changes in their relatives condition due to poor
documentation of conversations with the family
5. No response to contact/messages not
passed on:
Staff have been reminded of the importance
of responding to patients telephone calls within
48 hours.
82
Partnership working
BCHC recognises the value and importance of partnerships in the delivery and support
of healthcare to patients and actively works with other statutory and non-statutory
providers to offer a co-ordinated response to meeting the needs of our service users.
This includes having co-ordinated working arrangements and interdependencies with our partners
and having clear lines of accountability for quality of services. You can find more examples of
partnership working throughout this section of the Quality Account.
‘IMADgination’ sensory room
Colleagues at Queen Elizabeth Hospital Birmingham (QEHB) have created a fitting
tribute to BCHC specialist services clinical director Dr Imad Soryal, after naming a
specially-designed sensory room after him.
The ‘IMADgination’ sensory room, which recently opened in the hospital’s outpatient’s
department, is designed to provide stimulation for patients with learning difficulties as they wait
for clinic appointments. Fitted with specialist equipment, including an interactive colour changing
bubble tube, a mirror ball, a fibre optics machine and several projectors, the room will help calm,
intrigue and stimulate patients.
In addition to his role as a clinical director with BCHC, Dr Soryal is a neurologist, with a particular
interest in epilepsy. A lot of the patients he sees have a learning disability.
He said: “This room is the culmination of a team effort initiated and completed by the outpatient
team. The venture was particularly appreciated by families of patients because we named each
piece of specialist equipment after patients who died as a result of epilepsy.”
Dr Soryal (centre) with colleagues from
83
the QEHB
Complete Care
Complete Care is a new approach to
health and wellbeing, which is part of the
Birmingham wide Healthy Villages project.
Healthy Villages is a new programme
supporting communities to remain well for
longer. Faced with growing financial and
demographic pressures, partners such as
Birmingham City Council and other third
sector groups have come together to plan a
new way forwards; to make health and social
care systems more proactive in their approach
to wellbeing and prevention. If prevention is
better than cure, then health and social care
should focus more on maintaining wellbeing in
communities - before people need services.
their local community that can improve their
health and wellbeing.
Dr William Bird, Chief Executive of Intelligent
Health said “When examining cause of death,
it could be assumed that obesity or high blood
pressure are the main culprits. Actually, research
suggests that inactivity is as important a risk as
smoking 20 cigarettes a day.”
Complete Care can help people regain a sense
of purpose, and encourage service users to
take steps which can have a positive impact on
their lives. Befriending charities give their time
for someone who doesn’t see many people
Janet James, a district nurse in Balsall Heath,
said: “Complete Care joins up health, social care throughout the week. Complete Care can
and wellbeing services that can help to improve help to prevent social
isolation and reduce
the lives of the communities we serve”.
avoidable hospital
Service users are asked a range of questions
admissions. It can also
which help to build up a picture about their
encourage communities
individual circumstances. This allows us to
to take greater ownership
understand more about their needs, and how
for their own self-care.
we can connect them to additional services in
Focus story - Brian’s journey
”Brian is a 79-year-old from Balsall Heath who recently signed up to the Complete Care
approach, supported by Janet and her team.
Sense of community
Brian’s journey to Complete Care actually begins back in the late 1970s, when he and his
late wife moved to Balsall Heath. Brian said: “I remember back then Balsall Heath was very diverse
and it didn’t matter where you were from, there was a strong sense of community. We’ve lost
much of that now.” Brian and his wife enjoyed a good life in Balsall Heath and volunteered with a
local forum looking after the flowerbeds in the street, which are still blooming today. “When my
wife died two years ago I was in bits. I owe Janet a lot because she was very kind to me during
that difficult time.”
Reducing isolation
Brian has a wide range of long-term conditions which mean he isn’t able to get out very much.
Janet said: “Part of the work I do involves helping to treat some of Brian’s conditions.
This could be explaining in more detail something about his medication.” Brian added: “Even if
someone just came and had a cup of tea with me that would be great. I miss my wife terribly so
the company is just as important as the health part.”
84
Trust clinical effectiveness day 2015
Birmingham Community Healthcare NHS Trust (BCHC)
held its annual clinical effectiveness day to showcase the
impact and accessibility of clinical audit across the Trust.
Learned so much
The event, at Birmingham City’s St Andrew’s stadium, had the theme ‘partnership working’
and was designed to highlight the importance of forging strong internal and external
relationships to ensure clinical audit supports services to achieve the best possible clinical
outcomes for each individual.
Dedication
was rewarded
and celebrated
BCHC Head of Child Safeguarding Clare Edwards and Birmingham
City Council’s Assistant Director of Children Services (Front Door
and MASH) Howard Woolfenden gave an insight into work to better
support children and families across Birmingham.
Delegates heard how multi-agency audits, with BCHC participation,
represent a key part of this work stream.
Tracy Ruthven and Stephen Ashmore of the Clinical Audit Support
Centre offered a lively and engaging presentation while the audit and service evaluation
competitions were an opportunity to recognise real change in practice.
Prizes were awarded to Pankaj Taneja, Birmingham Dental Hospital,
Karen Bamford and Margaret Roche representing BCHC’s Learning
Disability Adult Speech and Language Therapy Service, and Peter Taylor,
accepting on behalf of Amanda Cadge Head of Adult and Communities
Podiatry Service.
Very informative
Clinical Audit and Effectiveness Lead Tracy Millar said: “Clinical audit
can be a bit of a dry topic so we tried to bring the subject alive,
make it accessible and show it’s something we can all get involved in
for the benefit of each service and to strengthen the key partnership
between ourselves as healthcare providers and patients and carers.”
Director of Children Services
Birmingham City Council’s Assistant
olfenden
(Front Door and MASH) Howard Wo
85
Great for
networking
Working collaborative with WMQRS
West Midlands Quality Review Service (WMQRS) was set up
as a collaborative venture by NHS organisations in the
West Midlands to help improve the quality of health services
by developing evidence based quality standards, carrying out
peer reviews; benchmarking against these standards and
providing development and learning for all involved.
BCHC has signed up to this collaborative working arrangement in order to improve quality and
has been actively involved for several years. BCHC staff have been involved in the development of
quality standards and have participated as peer reviewers reviewing services and pathways in other
organisations. The Director of Nursing and Therapies is the Trust’s WMQRS Lead is also an active
member of the WMQRS Board.
BCHC has continued to engage with WMQRS during 2014-15 as part of the wider
health economy to ensure that we continue to:
• work with other health economies
• receive comparative information on the quality of services and share good practice
• contribute to the development of quality standards
• target joint priority areas
• encourage development and learning for all involved.
Plans for the 2015-16:
A programme of work for the coming year has been agreed and there are already reviews
scheduled. They are:
• Chronic pain review.
• Transfer from Acute Hospital Care and Intermediate Care (two reviews planned).
All reviews will be reported in the next Quality Account.
86
What is NHS Change Day?
NHS Change Day is a grassroots movement
of hundreds of thousands of health and care
workers, patients, carers, volunteers and
members of the public.
NHS Change Day records and encourages the
great changes that are being made within
health and care with the premise that if each
of us makes one small change, together we
can change how the world works! Anyone
can make a change for the better. Anyone can
make a change to improve health and care and
Change Day supports innovative campaigns and
ideas by building connections and communities
of support.
For NHS Change Day in BCHC we
supported colleagues to ‘Changeover’
We encouraged staff members across BCHC
to ’changeover’ and shadow colleagues from
a service they were interested to find out
more about.
The purpose was to increase engagement
within the organisation, encourage better
understanding and raise awareness across
services; which in turn it was felt would have
a positive impact on staff in delivering their
own job role.
I was asked if I would like to take part in the Trust’s ‘changeover’ day, so I took the
opportunity to do something completely different and spend time in a clinical setting
with the health visitors at Bloomsbury Health Centre.
Health visitors work with families giving support and advice until the child’s fifth birthday and I had
the pleasure of spending the morning in a baby/child drop-in session. It was a totally fascinating
session seeing the diverse role that the health visitors plays and the real benefit that parents and
children get from the interaction with staff and other parents.
The real benefit for me of being involved in this type of event is it gives you the opportunity to
see the challenges the staff face and take on board their comments and work with them to make
a real difference to patient care. As a consequence, my team are reviewing and redesigning some
of the clinical settings to enhance the clinical provision and patient environment.
Gareth Hughes, Estates
and Facilities Director
Birmingham Community
Healthcare NHS Trust
87
Denise Bolger,
Head of Equality
and Organisational
Development
Community staff nurse Claire
Beresford spent the day with the
Hodge Hill school nurses, to see if
it could be her next career move.
I am interested in moving into school
nursing so I was keen to get a feel for
the job.
I was greeted by a very friendly team
and invited to sit in on an allocation
meeting where all of the incoming work is
distributed amongst the staff. This meant
that I could see the type of referrals made
to the team.
I went out with one of the school nurses
to talk to a parent in her home. Her little
boy was at school so this gave the nurse
the opportunity to talk to her about not
only her son’s needs, but also her own.
Her son is being assessed for learning
difficulties and the family are having
a very challenging time at the moment.
After the home visit, we went to a primary
school to observe a young diabetic child to
ensure he was eating his meal. We stayed
at the same school to deliver a puberty
education talk to a class of year 6 children.
It was great to get involved and to have
interaction with young people and has
left me feeling very positive about a move
into school nursing - I am keeping my eyes
peeled for posts advertised.
Birmingham Community
Healthcare NHS Trust
As part of the NHS Changeover Day initiative for
2015, I went along to spend the day with colleagues
in our rehab service and what a wonderful and
humbling experience it was. Colleagues who are
working there are nothing short of amazing, they are
the epitome of compassionate, patient-centred care.
From the prosthetics service team meeting at Oak
Tree Lane Centre with Sharon Osborne, that started
my day, through to observing clinics and a brain
fatigue support group and going onto a ward later
in the afternoon at Moseley Hall Hospital, it was
clear to me that all of the therapists, nurses and
specialists I met with were so focused on making
sure the patient had the best possible care available
and showed such kindness and consideration of all
their needs and their carers needs, I felt moved to
tears on a number of occasions.
Managing the expectations of patients is so critical
to this service and dealing with the hopes and
dreams of people who have suffered such terrible
misfortune and heartbreak with such empathy and
care is commendable and exactly what this Trust
is all about. I came away with a better deeper
understanding and a deeper respect for clinical
colleagues, which can only benefit me in my role
when I’m putting together strategies to support
their health and wellbeing in the future.
do
share
inspire
Claire Beresford,
Community staff nurse
Birmingham Community
Healthcare NHS Trust
88
Supporting our Armed Forces Community
Current estimates put the veteran population
(excluding dependants) in Birmingham at
approximately 117,000.
In partnership with other NHS providers and
commissioners, local government, the voluntary
sector and the third sector, the project aims to:
The Trust has embarked upon a new
project to support the Armed Forces
Community. The Armed Forces Community
healthcare project team aim to support
ex-service personnel, veterans and their
families during their transition from the
Armed Forces into civilian life, ensuring
that they are not held at a disadvantage
as a result of service and have access to
healthcare services that meet their needs
now and in the future.
Work already undertaken by other NHS Trusts
to assess the health needs of the Armed Forces
Community suggests that the values, behaviours
and beliefs of this community often result in a
reluctance to engage in health and social care
until there is a crisis. However, early intervention
is much needed, with depression, anxiety; alcohol
misuse and post-traumatic stress disorder (PTSD)
alongside musculoskeletal and hearing issues
being known and often of increased prevalence
amongst the Armed Forces Community.
The project is being led by Armed Forces
Community healthcare project manager Scott
Thornton. Scott said: “Service in the armed
forces is quite different from other occupations.
In fulfilling their duty, servicemen are subject
to uncertainty and danger whilst at home and
on operations. Ex-servicemen and their families
make many sacrifices to protect and serve the
people of our country”.
The Armed Forces Community is made up of
serving members of the armed forces, reservists,
veterans and their respective families.
• Provide training and education to medical
professionals and support workers to
recognise where and when additional
support is required and the services
available to the armed forces community.
• Build effective partnerships with external
organisations under a unified vision to
provide effective and timely support and
a seamless transition between services.
• Provide a single point of contact for staff at
BCHC and the armed forces community in
relation to the services we provide.
• Encourage Trust staff to become reservists
(previously known as the Territorial Army)
and support staff who are reservists at BCHC.
Key facts:
When compared to the general population:
• younger veterans have higher rates of
musculoskeletal and mental health conditions
• middle aged veterans have higher rates
of circulatory and respiratory problems
• older veterans have higher rates of
ear complaints
• there are increased proportions of aged
16-24 and 25-34 year olds leaving the
armed forces, whose health needs are
currently under-researched but generally
known to differ
• the proportion of veterans aged 85 years
and over is projected to increase
• early service leavers (with less than four
years of service) are known to find the
transition process challenging and rarely
engage with healthcare services
• there are increased risks of suicide
among young, male veterans.
89
Patient-led assessments of the care
environment (PLACE)
PLACE is a self-assessment of a range of non-clinical services which contribute to the
environment in which healthcare is delivered in the both the NHS and independent/
private healthcare sector in England. Participation is voluntary.
The PLACE programme focuses on the areas which patients say matter. By encouraging and
facilitating greater involvement of patients, the public and other bodies, with an interest in
healthcare to assess us in equal partnership with our staff, we are able to both identify how we
are currently performing against a range of criteria and identify how our services may be improved
for the future. The PLACE programme deliberately stretches standards to drive improvement.
The assessment process includes a review of various elements:
•
•
•
•
•
•
•
•
•
•
cleanliness
a well maintained, tidy environment in good condition
facilities that support privacy and dignity
locks on toilet and bathroom doors
secure storage of personal possessions
right temperature in the care environment
bedside curtains, which are long and wide enough to create a private space
single sex wards/facilities, but single rooms were not high on the list
clean linen
a good choice of tasty hot or cold food and receiving what meals they have
ordered, being able to get a drink of cold water at all times.
This year, the assessment team varied from site to site as different patient representatives were
used as their participation is voluntary. On all sites, the patient representatives made up at least
50 per cent of the team.
Overall comparison with other Community Trusts - PLACE 2014
Appearance, condition and maintenance
Privacy and dignity
Food
Cleanliness
0
Other Trusts
Other Trusts
10
20
30 40
BCHC
50
60
70
80
90
100
National Average
In terms of the comparisons with other Community Trusts, a significant number of our
bedded units are located in buildings belonging to partner organisations and we do
not have direct control over some aspects of the estate e.g. parking facilities at the
Intermediate Care Units.
90
Results 2014
The PLACE assessments for Birmingham Community Healthcare NHS Trust, Adults and
Community Division ran from February 2014 to May 2014. The table below shows
the high-level scores for each site assessed and the corresponding national average scores.
BCHC site
Date of
assessment
Cleanliness
National average %
97.25%
Food and
hydration*
88.79%
Privacy,
dignity and
wellbeing*
Appearance,
condition and
maintenance
87.73%
91.97%
Sheldon Unit
20.05.14
98.28
96.90
80.95
83.90
West Heath Hospital
16.05.14
90.88
90.58
76.36
88.31
Moseley Hall Hospital
24.03.14
94.33
93.01
90.25
79.66
Norman Power
26.02.14
82.50
84.52
84.72
76.67
Riverside
20.02.14
100
91.90
90.00
89.83
Perry Tree
11.03.14
81.46
74.74
75.42
48.36
Ann Marie Howes
29.04.14
99.56
95.28
90.00
94.07
28.03.14
97.84
90.30
64.42
89.36
07.05.14
95.69
91.41
73.00
87.50
92.64
90.27
81.64
81.72
CU29 Heartlands
Hospital
CU27 Good Hope
Hospital
BCHC average %
* Due to changes in the assessment methodology and scoring, the 2014 results for Food and
Hydration and Privacy Dignity and Wellbeing are not considered to be directly comparable with 2013
Action taken following the PLACE 2014 assessments
The actions we have taken now are:
• A multidisciplinary team conduct monthly audits of a selection our sites. The team consists
of an estates and facilities representative, matron and infection prevention control nurse.
They look at all aspects of the environment including maintenance, decoration and cleanliness.
Verbal feedback is given on the day on inspection and an action plan is produced and circulated
within three working days of the visit to the clinical team leader who takes ownership to ensure
the actions are completed.
• With effect from the 1st April 2015 the facilities services centralised under the corporate
umbrella of estates and facilities which underpins and supports the clinical services.
Delivering their services in secure, safe and clean environments whilst providing a nutritious
meal service. Our aim is to demonstrate improvements year on year.
• Dignity champions have been identified in the majority of teams, and the Dignity Champion
Network meets regularly to promote best practice. A new ‘dignity’ DVD has been produced as
part of the work of the dignity champions, to share learning and staff experiences with the aim
of improving how our patients feel about privacy, dignity and wellbeing in BCHC.
91
Our response to Ebola
Ebola virus disease (EVD) is a rare, but severe
infection in humans and non-human primates.
It is caused by the Ebola virus, a filovirus that
was first recognised in 1976 has caused sporadic
outbreaks since in several African countries.
The EVD has attracted a lot of media attention
this during 2014. It is thought to have originated
from West Africa where there have been the
worst affected by this outbreak. In December
2014, the first imported case of Ebola was
confirmed in the UK from a nurse who had
travelled to Glasgow from Sierra Leone.
EVD is of particular public health
importance because it can spread
within a healthcare setting; has a high
case-fatality rate; is difficult to recognise
and detect rapidly and there is no
effective treatment. Environmental
conditions in the UK do not support
the natural reservoirs or vectors of this
virus, and all recorded cases of EVD in
the UK have been acquired abroad with
the exception of one laboratory worker
who sustained a needle stick injury.
The disease is not airborne, like
influenza and very close direct contact
with an infected person is required
for the virus to be passed to another
person. The main routes of transmission
of infection are direct contact (through
broken skin or mucous membrane)
with blood or body fluids, and
indirect contact with environments
contaminated with splashes or droplets
of blood or body fluids. Although a
case has now been confirmed in the
UK, experts believe it is highly unlikely
that the disease will spread.
Birmingham Community Healthcare
NHS Trust has well-established and
practiced infection control procedures
for dealing with infectious disease.
The trust works closely with clinical
teams to ensure that the robust
processes in place are followed
within the organisation to protect
staff and patients should any cases
of Ebola be identified.
Actions taken
• policy currently under development in line
with national recommendations from Public
Health England
• emergency planning team consulted with the teams
identified as ‘high risk’. Staff in these teams have
been provided with appropriate personal protective
equipment and cleaning products. Training
regarding the use of the equipment is on going and
involves fit test training to ensure staff are correctly
using approved face masks in line with the Health
and Safety Executive (HSE) guidelines
• follow up training for mask fit testing for staff
dealing with patients with all high risk respiratory
illness has been completed
• the production of a video for staff to demonstrate
donning and doffing of the equipment. Completed
April 2015
• trust wide communication with actions to be
undertaken should a patient present with symptoms
• packs have been developed for the on call teams
with advice and actions needed for such cases
• action cards have been developed and sent to teams
identified as high risk
• continuous review of the Public Health England
guidance is ongoing in addition to liaison with the
local teams, Clinical Commission Groups and other
NHS Trusts.
92
Infection prevention and control (IPC)
The Trust undertook a detailed
improvement programme in partnership
with the NHS Trust Development Agency
this year. This work included:
• restructuring of the infection prevention
and control team (IPCT) and strengthening
leadership with the appointment of a nurse
consultant in October 2014
• significantly strengthened working
arrangements for the infection prevention
and control committee with a clear director
of infection prevention and control (DIPC).
Leadership and formal deputy DIPC
arrangements have been established
and are now through the nurse consultant
• enhanced infection prevention and control
audit programme includes the use of the
Lewisham hand hygiene audit methodology.
The hand hygiene training programme has
also been strengthened
• implementation of a new estates and facilities
centralised cleaning strategy with unified
leadership and accountability
• board ownership strengthened with
non-executive director role.
All identified short term actions have now
been completed, together with developing
and delivering consistent documentation and
updating relevant infection prevention and
control policies.
The key medium term action of coordinated
centralised arrangements for cleaning has also
been delivered and progress continues to be
made with negotiating a new Service Level
Agreement for microbiologist support from a
local acute trust.
BCHC received a very favourable outcome from
its CQC review in late 2014.
Hand washing
Hand decontamination is a
fundamental principle in preventing
the spread of healthcare associated
infections; in fact ‘hand washing’ is
the single most effective measure to
prevent cross infection.
Month compliance score
October 2014
84%
November 2014
88%
December 2014
89%
January 2015
95%
February 2015
87%
A new hand hygiene audit (the Lewisham tool) has been implemented
March 2015
94%
across the Trust’s inpatient areas and the compliance score has been
agreed at 85 per cent. The audit involved the IPCT observing practice
in each inpatient area and replaced a self assessment tool. The advantage of this approach is
that the IPCT can provide real time feedback and/or ad hoc training to staff if non compliance is
observed directly to those involved. The team has conducted a series of road shows throughout
the Trust for staff, patients and visitors to highlight the importance of hand washing using correct
techniques. These actions have improved the compliance within the Trust from 84 per cent in
October 2014 to 94 per cent in March 2015.
93
Collaborative working
BCHC has been working closely with
Public Health England and emergency
planning colleagues to ensure that the
trust has a robust policy and processes
in place to prevent the spread of high
risk respiratory illnesses including viral
haemorrhagic fever. This has included
enhanced staff training and delivery of
equipment needed for respiratory illness.
Infection
prevention and
control assistants
This is a new role for the Trust, these
staff are part of the IPCT and work
closely with clinical staff visiting each
inpatient area weekly to assist with
ensuring a sustainable approach
helping with audits and ensuring
staff understand how IPC relates to
their area. They support staff with
audits of practice and provide ad
hoc training if needs is identified.
Infection prevention
link practitioners
BCHC has a thriving infection prevention link
practitioners multidisciplinary group who
continue to be an excellent resource to staff
in their departments. These staff also assist in
auditing, surveillance, monitoring and inform the
IPCT of any issues throughout the Trust. Meeting
are help quarterly for these staff which involved
education and peer support. The annual four day
course continues to evaluate well and will be run
again next year. The IPCT will also be arranging
an annual study day for all staff to run during
the Infection Prevention and Control Week in
October 2015.
Training
Mandatory training and update sessions have been revised
to incorporate theoretical teaching including practical
elements to the session to engage staff and allow them
to translate the theory into theory practice. Other bespoke
teaching sessions have been arranged for all levels of
staff including cleaning staff, dental staff, health visitors,
podiatrists etc. BCHC have developed options for staff to
access training to include a workbook and on-line training
to provide a variety of training options for staff to complete.
Audits
Audits have been completed in line with the
annual audit programme. The IPCT audit clinical
areas using nationally recognised tools to enable
bench marking against other departments and
organisations. The main themes highlighted in
the audits undertaken are related to cleanliness.
IPCT have continued to develop the cleanliness
audit process within the Adults and Community
Division. The facilities team undertake monthly
national cleaning standard audits (includes 49
elements), from November 2014 these have
been completed in conjunction with the IPCT,
matrons and clinical staff. This process ensures
that all teams are aware of the results and
prompt action can be taken to address any
identified gaps. The IPCT are currently using
an iPad learning package from the Clinell team
(Cleanliness product provider), which is to be
used on the wards
from May 2015
to educate staff
on the principles
of cleaning and
decontamination.
Month compliance score
October 2014
91%
November 2014
93%
December 2014
93%
January 2015
94%
The compliance
February 2015
97%
score for these
audits is 95 per
March 2015
96%
cent and we have
seen a rise in the
compliance scores, with has resulted in full
compliance from February 2015.
The IPCT carry out monthly commode audits in
the inpatient areas in addition to the cleanliness
audit to ensure that equipment if fit for
purpose. If concerns are highlighted then the
team are able to provide on the spot training to
support staff.
94
Delivering excellent customer service
Customer Service Excellence (CSE) aims to bring professional, highlevel customer service concepts into common currency with frontline public services by offering a unique improvement tool to help
those delivering public services put their customers at the core of
what they do.
BCHC retained the prestigious CSE accreditation in 2014 following further
external assessment. The assessor commented:
Working towards accreditation for the
CSE Standard across the Trust has served
to support that BCHC are continually
looking to achieve total consistency in
working practices across a large and
diverse organisation, that best practices
are shared and demonstrate that the
organisation is customer centric. This
application is representative of the
combined BCHC Trust and the outcome
is a well-deserved recognition that the
Trust merits corporate accreditation
across the board.’
The assessor identified four areas of
best practice (‘compliance plus’):
• The corporate commitment to
putting the customer at the heart
of service delivery and leaders in our organisation
actively support this and advocate for customers– evidenced by the Customer Service Policy,
Organisational Development Strategy and staff engagement opportunities including the
‘Think Tank’
• We can demonstrate our commitment to developing and delivering customer focused services
through our recruitment, training and development policies for staff – evidenced by the
Organisational Development Strategy and Values Toolkit
• We have made arrangements with other providers and partners to offer and supply
co-ordinated services, and these arrangements have demonstrable benefits for our customers evidenced by and strong joint working arrangements across the board in all areas
of the Trust including ‘Your Healthy Villages’
• We identify individual customer needs at the first point of contact with us and ensure that an
appropriate person who can address the reason for contact deals with the customer - evidenced
by the Customer Service Policy and Single Points of Access (SPA).
Further development has been identified, particularly in how we monitor customer service
standards and this will be a focus for the coming year.
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Developing our workforce
In addition to statutory and mandatory training requirements, staff training needs are identified
and discussed in a number of ways including Personal Development Reviews, supervision and
team meetings. Each person will have a personal development plan that could include a number
of learning activities such as undertaking accredited training qualifications and programmes,
e-learning, coaching and mentoring, work shadowing, skills update days, attendance at
conferences and
involvement in projects.
We work closely with
a range of external
training providers such
as local colleges and
universities, specialist
training consultants and
with experts from within
the Trust to ensure that
any training is relevant
and of high quality. We
also have our own inhouse accredited training
centre which enables us
to deliver a number of
qualifications from within
the Trust.
Newly qualified dental nurses
Investors in People (IiP)
IiP is a management framework
established by the UK government to
help organisations get the best from their
people. Their prestigious accreditation is
recognised across the world as a mark of
excellence. The Trust is currently at silver
level for IiP. The rating was awarded in
April 2014.
In the past 12 months the staff Think Tank has
been launched to provide an inclusive, creative
space where all BCHC staff members can
come together to explore, shape and develop
engagement strategies and wider developments
across the Trust.
A new IiP framework is being piloted in 2015,
including three themes of Leading, Supporting
and Improving, to reflect the latest workplace
trends. The Trust is partnering with gold
accredited employers to seek out best practice
and adapt it. An employee has been seconded
from Service Transformation to lead the
Trust into a state of readiness for the next IiP
assessment in 2016.
A Values in Practice (ViP) programme is
currently run all year round to give staff, service
users and the public the opportunity to say an
extra “thank you” whenever they have received
outstanding care or service from a member
of staff, team or volunteers for the Trust.
Categories include: Accessible, Responsive,
Commitment, Caring, Quality and Innovation,
Ethical and Partnership.
96
Safeguarding children
The past 12 months has seen development
and recognition of quality in partnership
working for the safeguarding
children team.
The theme of partnership is always key to
safeguarding and the team have worked to
strengthen their links with all clinical teams,
services and divisions offering support,
supervision and training according to a predetermined schedule and on a bespoke
basis. The safeguarding support programme
developed for newly qualified health visitors
has evaluated and been invaluable learning
for team practice moving forward. Our group
safeguarding supervision sessions have been
extended to offer any BCHC practitioners
working with children or families the
opportunity to come and learn from
other practitioners in joint reflection on
safeguarding practice.
The quality of safeguarding practice and
governance has been recognised by the
independent chair of the Birmingham
Safeguarding Children Board on a recent
inspection and monitoring visit and was
testament to the hard work of those who
focus so much effort on the safety of children
and families.
Partnership working has also been recognised
in the development of the Birmingham Multi
Agency Safeguarding Hub (MASH). Following
several years when the city was judged by
Ofsted to have an inadequate response to
children in need of protection and a poor
record of partnership working, Birmingham
Children Services, West Midlands Police and
BCHC safeguarding children team have worked
together to build an integrated safeguarding
hub (MASH). Working in partnership, the
timely response and information sharing that is
necessary to assess the risk of significant harm
to children is carried out and actioned. The first
six months saw 13,000 children referred and a
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26 per cent increase in child protection
assessments as the MASH was seen to
stimulate confidence in the professional
community resulting in significant increases
in referral of children at significant risk of
harm. This has returned the city to a level that
compares statistically with our neighbours
reviewing concerns related to child abuse,
domestic abuse impacting on children and
child sexual exploitation.
During this highly demanding time the team’s
partnership achievements have been formally
recognised with individual and team ViP awards
by the Trust and the national Nursing Times
Nurse Leader of the Year Award 2014 for the
Head of Service.
Moya Sutton Head of Safeguarding for NHS
England visited MASH in February and wrote
saying: “The MASH pathway and team were
outstanding, …I will be spreading the word
around the country about such best practice…”
2015-2016 will see BCHC staff working in
partnership to further develop the whole system
for supporting children across the city ensuring
that children get the right service at the right
time whatever their level of need.
Safeguarding adults
Where are we now?
In 2014 the safeguarding adults team continued
to build on its ‘Why MCA?’ campaign to raise
awareness and understanding of the Mental
Capacity Act (MCA). The 2014 promotion
focussed on developing quality, easy-read
information in a variety of formats, and sought
to evaluate the effectiveness of the programme
by repeating the 2013 MCA audit.
Easy-read MCA information
The team designed credit-card sized leaflets
for all clinicians in the Trust to use. The cards
fit easily into the Trust’s ID holders to provide
an easy reminder to staff of when a patient
should have a capacity assessment and how
capacity is assessed.
Mental Capacity Assessment:
Why M
ental
C
apacity
A
ct
© created by Clinical Illustration Birmingham Dental Hospital
Safeguarding Adults:
0121 466 7118
• Assume capacity, test if patient’s ability to think
might be compromised.
• Help the patient to make the decision.
• An unwise decision is not a reason to question
capacity.
• If someone lacks capacity, make a best interest
decision.
• Best interest decision should be the least
restrictive action possible.
Produced by Clinical Photography and Graphic Design Tel: 0121 466 5107 Ref: 43935 11.02.15
The team contributed to the patient safety wallet
- a pocket-sized book containing easy remove
and replace information cards for inpatient staff.
In addition to more detailed notes on assessing
mental capacity, these also demystify the rules
regarding the Deprivation of Liberty Safeguards
(DoLS) following the introduction of the Acid Test.
Repeat of 2013 MCA Audit
• The overall understanding by staff of the
application of the MCA had increased
from last year
• The objective of DoLS is that patients lacking
capacity are kept at the centre of their care
and are looked after in a way that does
not inappropriately restrict their freedom.
85.7 per cent of the 2014 respondents felt
that DoLS had improved patients’ care is
a very positive result and an increase from
47.1 per cent.
Conclusion
Safeguarding Adults
Informed Decision-Making
Patient has capacity to make the decision
if they can:
1. Understand the information and
2. Retain the information and
3. Weigh up the information and
4. Communicate their decision by any means.
Results of note:
The audit was a opportunity to look
at current practice in terms of awareness of
the MCA, DoLS and safeguarding process.
It gave services the opportunity for action or
support to aid better understanding/awareness.
The auditors remain impressed by the level of
commitment by staff who were aware that many
patients receiving care present with complex
needs with co-morbidities, in many instances
physical and psychological. The presentation of
patients with complex needs links to using the
processes of safeguarding, MCA and DoLS so
that dignified care is delivered.
Actions
1.Continued access to training for safeguarding,
In 2013, the team audited inpatient teams to
the MCA and DoLS via e-learning for BCHC
establish staff members’ understanding of the
clinical staff
MCA and DoLS, and highlight areas that required
2.Bespoke training to address updates or
more training. Following a targeted, bespoke
specific service needs to continue to be
training regime the audit was repeated.
available for inpatient units/community
Service redesigns have meant that some
teams as needed
areas were no longer available to audit.
3.Support to build confidence in the
Where possible, this was a like-for-like process.
completion of Trust capacity documents
A total of 15 areas were audited in 2013,
in line with Policy, use of ‘show and tell’
and 14 areas in 2014.
initiative to be encouraged.
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Improving, learning, sharing
Neurological rehabilitation unit case study (Ward 9)
The inpatient neurological rehabilitation
unit (INRU) at Moseley Hall Hospital
provides specialist assessment and intensive
rehabilitation for people with disabilities
resulting from neurological conditions.
The majority of patients admitted have suffered
head injuries, strokes or other forms of brain
injury. This unit works alongside West Midlands
Rehabilitation Centre (WMRC) and is part of the
Specialist Services Division.
The past few years have been extremely
challenging for the unit, this was mainly due to
staff shortages and management changes. The
INRU has implemented a number of initiatives
to help the team maintain focus on improving
care quality during a challenging period.
During 2014-15, the ward developed and
implemented a detailed improvement plan,
focussing on four key quality priorities:
• caring for patients with challenging
behaviour
• maintaining a ‘productive’ ward
• joint learning opportunities for nursing staff
• leadership.
We are especially proud of the improvements
they have made in some main priority areas:
Challenging behaviour
Due to the nature of their rehabilitation
needs, it is common for INRU patients to
exhibit challenging behaviour. Led by Clinical
Psychologist Andrew Brennan, the team has
been working hard to establish a psychosocial
model of care to better meet the needs of
such individuals. A highly flexible approach
is key, particularly in style and content of
communication when challenging behaviour
is displayed.
99
Andrew said: “We’ve been working hard to
make sure that the environment, as well as the
staff team, is right to avoid confusion when
people are disorientated. Every room now has
a different colour, so people can be better
orientated. The ward has large electronic
clocks with the date on them, to further help
keep people orientated to the time and date.
“These are all fairly major challenges for a
medical ward to bring in and it has taken quite
a lot of time and co-ordination with the team
to do that.”
Estimates of aggression occurring at some
stage of post-TBI range from 10-90 per cent.
A need was identified through reviews of risk
and DATIX for a rapid and accessible training
for staff on management of aggression for ABI
inpatients. A DVD has now been developed
for staff entitled Dilemmas. The viewer chose
between helpful and unhelpful approaches
based on the scenario given.
Dilemmas had specific aims.
• the DVD is short, no more than 30 minutes
(typical break-time length on hospital wards)
• the DVD aimed to inform of low arousal
approaches and provide attribution training
for staff on post acquired brain injury
aggression.
The productive ward
INRU matron Katie Pugh has implemented
the national ‘productive ward’ initiative,
set out in the NHS Institute for Innovation
and Improvement. A productive ward is
about improving day-to-day processes and
environment to enable nurses and therapists to
spend more time with the patients.
Improving, learning, sharing
A weekly joint ward meeting has been
introduced, enabling the team to take
ownership of their performance, discuss
improvement ideas together and celebrate
successes. All audit and patient satisfaction
survey results are displayed on ‘patient
safety boards’, as well as the unit’s record on
preventing pressure sores, falls and other types
of harm.
Focussing on productivity gains through
practical improvements to ward organisation,
significant benefits have been derived from a
series of exercises to make it easier to access
clinical supplies and monitor stock levels.
We work very closely as an integrated
multidisciplinary team. With our
healthcare assistants in particular, we
want to give them a good insight
into the whole ward and the different
teams that they might meet.
Joint learning for nursing staff
The team has introduced a new training
programme for all nurses and nursing
assistants, with the key aim of making sure
the right people are in the right posts and the
right number of colleagues have the up-todate specialist skills necessary to work
with this patient group.
practised in that particular skill, promoting a
culture of shared learning and peer support.
Ward sister Katie Keenan said the unit is
working hard to cultivate a ‘whole team’ ethos.
“We work very closely as an integrated
multidisciplinary team. With our healthcare
assistants in particular, we want to give them
a good insight into the whole ward and the
different teams that they might meet. So they
now have a two-week training programme
where they spend time with a wide range
of other healthcare professionals, such as
physiotherapists, occupational therapists,
speech and language therapists and dietitians
so that they have a good overview of the
various roles involved in patient care.”
Leadership
The nursing staff have created smaller teams,
each led by a ward sister, supported by the
ward matron. This allows the ward sisters to
each manage a smaller group of staff enabling
them to complete personal development
reviews, monitor mandatory training
participation and manage issue
around attendance.
It also enables all the ward staff to have a clear
and accessible point of senior contact should
they have a problem or require direction.
And with a higher proportion of
the patients admitted only recently
discharged from intensive care, the
team is highly aware of the need to
acquire and maintain up-to-date skills
and knowledge of acute care delivery.
Two ‘competency pathways’ were
developed, one for registered nurses
and another for healthcare assistants,
with team members’ competencies
assessed by a colleague already
100
Compassion in practice - 6Cs
Compassion in practice is a three-year vision aimed at building a culture
of compassionate care for nursing, midwifery and care staff. It is based
around six values:
• care
• communication
• compassion
• competence
• courage
• commitment
The vision aims to embed these values, known as ‘the 6Cs’, in all nursing,
midwifery and care-giving settings throughout the NHS and social care to improve care for patients.
•
•
•
•
•
making the 6Cs an integral part of the Trust induction and patient experience programme
aligning the Trust Values to the 6Cs
values based recruitment
development of training DVD for students and staff
development of ‘leadership lite’ for staff to meet the most compassionate staff to undertake
modelling of how to remain compassionate when challenged by conflicting demands
• Customer Service Excellence award which measures how staff communicate with each other
and with patients and the customer experience
• use of cultural temperature check to review and monitor how staff are feeling.
Focus story - 6Cs in practice
Trust bank healthcare assistant Abdul works regularly on one of the inpatient
neurological rehabilitation wards. Abdul worked in the Trust learning disabilities service
for many years before service redesign led to him taking on a new challenge. There is
no doubt the years spent working with adults with learning disabilities will have helped
Abdul develop a warm and encouraging approach when working with patients and carers, and
a can-do attitude where nothing appears too much trouble. Abdul soon settled into his new
speciality and patients and carers started to comment on his caring and compassionate manner.
Recently for the ward fete we decided to present staff awards. The categories included a patient
choice award and Abdul was named for this very special award. Comments inculded “good
bloke”, “he is always smiling” and “he is so helpful and friendly”.
A further example is when two former patients and carers were asked about their experience
of their inpatient stay on the ward, they made a point of saying how Abdul in particular
made a positive difference to their stay. Abdul
demonstrates all of the 6Cs, and he was
courageous in changing his field of practice after
many decades in one speciality and developed
competency in his new role.
Abdul is a true example of how staff across BCHC
embodies the values of the Trust and each of the
6Cs.
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Same sex accommodation
Birmingham Community Healthcare NHS Trust is committed to providing
every patient with same sex accommodation because it helps to safeguard
their privacy and dignity when they are often at their most vulnerable.
BCHC is pleased to confirm that we are compliant with the government’s requirement
to eliminate mixed-sex accommodation, except when it is in the patient’s overall best interest, or
reflects their personal choice. Every patient has the right to receive high quality care that is safe,
effective and respects their privacy and dignity. We have the necessary facilities, resources and culture
to ensure that patients who are admitted to our hospitals will only share the room where they sleep
with members of the same sex, and same-sex toilets and bathrooms will be close to their bed area.
Sharing with members of the opposite sex will only happen when clinically necessary (for example,
where patients need specialist equipment such as in the provision of specialist bathrooms which
cannot be designated as single sex), or when patients actively choose to share.
This achievement is regularly monitored and if our care should fall short of the required standard,
we will report it. We have also set up an audit mechanism to make sure that we do not misclassify
any of our reports. There were no breaches of the standards in 2014-15. The review of compliance
forms part of our annual audit programme and each bedded unit has had an assessment following
the template developed by the NHS Institute for Innovation and Improvement. This audit has
confirmed overall compliance and there were no breaches of the standards in 2014-15.
102
Snapshots from services about quality
improvements during 2014-15
Heel pressure sores - Ann Marie Howes
The clinical team at one of Birmingham
Community Healthcare’s inpatient units has
achieved significant success in preventing
pressure sores after exploring the causes of
three very similar cases.
“So we introduced a regime of the patients
sitting with the good foot up in a ‘Repose’ foot
protector - a kind of inflated protective boot that
cushions the areas that have experienced the
pressure.
Clinical colleagues noticed that three patients
admitted to the Ann Marie Howes Centre in
close succession to recover from left hip fractures
each developed pressure sores on their
right heels. The team carried out a root cause
analysis and found the wounds resulted from the
patients’ understandable tendency to favour their
‘good side’ when they start to walk again. This
was also the case a sitting position.
Ann explained the team introduced a new
resting regime to help patients recover
following periods of mobilisation, elevating their
‘good foot’ in an inflated protective boot while
they are seated.
Clinical nurse leader Anne Homer said: “We had
three ladies recovering from left hip fractures
very close together and they all developed
pressure ulcers on their opposite heels.
A root cause analysis showed us this was
because when they first mobilise with the
physiotherapists, they put their best foot
forward, as the saying goes. As a result, all the
pressure goes through that foot.
Prevention of harm nurse Fiona Adair said:
“The team was already successful at preventing
pressure ulcers
through systematic
use of risk
assessment and
skin inspection,
with emphasis on
early recognition
and appropriate
intervention at any
clinical signs of
pressure.
There will always be local variance in pressure ulcer occurrences due to the variety of factors
involved. As the NHS Safety Thermometer data shows, we can celebrate the achievement of
pressure ulcer free moments and explore good practice, while careful to avoid the implication
that teams reporting pressure ulcers are failing. The Trust and health care professionals focus
on pressure ulcer prevention and treatment, plus an emphasis on accurate and reflective
documentation.
Plans for the coming year include:
• Prevention of Harms Nurse; targeting clinical areas with PU coaching and action planning.
• Projected proactive support to bedded units, utilising of an existing tissue viability support nurse
with inpatient experience.
• Extra staff training on the updated European Pressure Ulcer Advisory Panel grading categories.
• On-going direct clinical support to staff from tissue viability team, including mandatory referral
to the team of all grade 3, 4 and ‘unstagable’ pressure ulcers.
CLINICAL effectiveness
103
PATIENTsafety
Prison dentistry boost
The Dental Service at HM Prison Birmingham is provided by a very small, but committed and
enthusiastic team from the BCHC Community Dental Service. Prison dentistry can be challenging
as many patients within the prison have poor oral health and a healthy diet and access to good
toothbrushes and toothpaste can be a low priority. Remaining motivated in such circumstances can
be hard, but this year the See Me team from Birmingham and Solihull Mental Health Foundation
NHS Trust (who co-ordinate service user feedback) in HMP Birmingham have obtained some very
positive personal stories. This has given the team a huge boost and renewed their energy and
sense of purpose.
I went to the dentist and had my
tooth extracted. The dentist was
excellent and I never felt any pain
what so ever. I would like to thank
the dental assistant for all of her
help and advice. She made me
feel at ease. The team made my
appointment a pleasant experience.
Each time I have seen the dentist
they have been brilliant. They are
always pleasant and do a great
job under difficult circumstances.
I spoke to the healthcare rep on C wing.
I told him my back teeth were giving me a
lot of pain and I needed to see the dentist
as soon as possible. I was fed up with
sitting in my cell in agony. I needed to be
seen urgently so I could on go on a waiting
list. The healthcare rep spoke to the senior
officer on the wing that rang the dentist
and they fitted me in for an appointment
straight away. They did a great job and
I was feeling better in no time. I was really
happy because the healthcare rep, the
officer and the dentist worked together to
sort out my problem. The dental service is
flexible if they know someone is in pain.
I cannot thank them enough.
I was in a great deal of pain myself
a few weeks ago with my teeth.
I spoke to the senior wing officer
and he managed to get me an
appointment on the same day
to see the dentist. They took my
wisdom teeth out. I would like to
say a big ‘thank you’ to the dentist
and dental service. I know they are
under pressure to see people but
they managed to see me and get
me sorted which I appreciate.
PATIENTexperience
104
Holistic patient support in life changing circumstances
The Trust’s patient information service is
one of a kind - a unique service that offers
advice, support and information to patients,
carers and staff that have experienced a
life-changing injury or event.
When someone experiences a trauma such
as a brain injury or loss of a limb, their life
changes forever. Our clinical services are
there to meet the medical needs of patients,
but just as important are the more practical
‘lifestyle’ needs. This is where patient advice
and information officers Cecelin Johnson,
Joan Walker-Fearon and Sarah Pedley come in.
and families - so they have acquired specialist
knowledge of the services they represent.
“However, every phone call has its unique
complexities,” said Joan, whose background
includes working at the Citizen’s Advice Bureau,
“so we never really know what to expect.
“Sometimes it feels like we’re detectives piecing
a mystery together! People who get in touch
are often in a distressed state and may not
know or have all the information we need.”
As the children and families representative,
Sarah works with parents whose children have
been recently diagnosed with a life-changing
Cecelin said: “If patients are in our care for an
condition. She said: “It can be an incredibly
extended period due to a trauma, they worry
difficult job. Given people’s circumstances,
about paying the
we have to be
bills, returning to
sensitive, striking
Taking a holistic approach requires
work, and how
a fine balance
the team to have an encyclopaedic
they will manage
between being
at home once they
supportive, without
knowledge of employment rights,
are discharged.
over-promising.”
finance,
benefits,
the
housing
system
Our job is to help
“It’s important that
and more besides.
patients with these
our team, and the
issues so that they
clinical staff, are
Each member of the team is assigned
can concentrate
realistic about what
to a different division...so they
on getting better.
support we can
have
acquired
specialist
knowledge
“Often it is not
offer. We are not
just one issue, it is
always able to get
of the services they represent.
one issue linked to
them the benefits
a range of other
they thought they
issues. That’s why our service takes a holistic
were entitled to or the re-housing application
approach, working closely with multidisciplinary we placed for them may take longer than
clinical teams to support the ‘whole person’
they expect, so we have to manage people’s
so that they can maintain quality of life when
expectations.
they return home.”
Cecelin, who previously worked in a homeless
Taking a holistic approach requires the team
to have an encyclopaedic knowledge of
employment rights, finance, benefits, the
housing system and more besides. Each
member of the team is assigned to a different
division - Cecelin to specialist services, Joan to
adults and community and Sarah to children
105
shelter for a housing association, added:
“But it is lovely when we are able to exceed
expectations. When we hear that a patient is
delighted with their newly-adapted home or
that they are off on holiday for the first time in
years thanks to a charity donation we applied
for, it makes all the hard work worthwhile.”
Focus story - Stephen’s Story
Stephen Hemmings is 47 years old. He lives in Kingswinsford with his
wife and two grown-up daughters.
“In 2008, whilst on a flight to my holiday home, I had an A-type dissection of my
aorta. Following an emergency landing in Exeter and 11 hours of surgery, I had an
above the knee amputation of my left leg due to surgical complications.
“The next twelve months of rehabilitation were a very difficult chapter in both mine and my
family’s life. Even now, many years on, it can be difficult to accept the life changes, which is why
I felt compelled to share my story. My treatment from most areas of the medical profession was
outstanding, none more so than the patient information service. Even during my recovery in
hospital, I had a visit from Cecelin Johnson who was able to take away concerns my family and I
had regarding help we may need in the future - things I had never had to consider before.
“Once I was capable of visiting West Midlands Rehabilitation Centre, Cecelin was able to help in
the detail regarding my welfare benefits and entitlement. I was also given advice on employment
rights due to issues that had arisen while attempting to return to work – all this help gave clearer
direction and peace of mind. I am now leading a very normal and positive life, and have been
able to continue a successful career as a company director, in large part, due to the help, care
and compassion showing by the patient information service and all who work at West Midlands
Rehabilitation Centre.”
Stephen with daughters Abi and Bet
h and
wife Jacqui.
CLINICAL effectiveness
PATIENTexperience
106
Cooking with your kids
‘Cooking with your kids’ is part of Food Net in schools
initiative and offers parents and children the opportunity
to cook and learn together, whilst having fun. It is a
five week course delivered by fully trained food health
advisors in primary schools in Birmingham. The families
are given opportunities to cook, whilst also benefiting
from nutrition education on topics such as how to increase
their families’ fruit and vegetable intake, reduce fat and
sugar and how to eat a balanced diet.
I have changed a lot of
things that I used to buy
that contain high levels of
sugar. I have reduced using
lots of oil in my cooking.
‘Cooking with your kids’ started in April 2011. It was developed following feedback from parents
attending Food Net’s adult-only cook and taste programmes that they wanted their children
to participate so that they too could be educated and motivated to cook and eat healthily.
Since then the number of courses and the number of families attending has more than tripled.
This is a big, big
change to our diet.
Cooking with your kids
973
Number of courses run
Number of attendees
475
432
245
35
73
2011-12
2012-13
Families provide really positive feedback about their Cooking with
your Kids experience and course retention is high. More than
80 per cent of families completed cooking courses in 2014-15.
Families report that they really enjoy the course and that it has
a positive impact on their and their family’s eating behaviours.
66
2013-14
145
2014-15
I’ve learnt that cooking
with my daughter
can be fun and that
eating healthier is
also quicker and tastier.
Food Net’s cooking courses measure changes in families eating
behaviours. Between April 2014 and March 2015, adults and children completing cooking courses
reported an average increase in their fruit and vegetable intake of more than 1 portion. This is really
beneficial because it is well documented that increasing fruit and vegetable consumption lowers the
risk of serious health problems, such as heart disease, stroke, type 2 diabetes and obesity. Families
also report an overall reduction in the consumption of takeaways and fizzy drinks and an increase in
the parent’s confidence to cook with their child.
PATIENTexperience
107
Investing in quality, improving diagnosis
Accurate diagnosis is the cornerstone of
responsive, person-centred healthcare,
enabling clinicians to offer bespoke
treatment precisely targeting
individual needs.
BCHC’s citywide podiatry service has invested
in state-of-the-art pressure management
diagnostic equipment to assess exactly where
patients’ feet are most susceptible to problems.
The plantar system provides an on-screen visual
representation of the amount of pressure a
patient experiences across the sole of the feet
as they walk, enabling podiatrists to diagnose
the root cause of problems and design bespoke
devices to ‘offload’ that pressure.
Once the detailed diagnosis is available, the
podiatrist can prescribe highly individualised
treatment, selecting from a range of orthotics
including pads, insoles and arch supports.
Clinical Specialist Lead Podiatrist Pete Taylor
said: “Having this additional diagnostic ability is
particularly valuable for people who are prone
to ulceration or have musculoskeletal problems
with their feet. We can ask patients to walk
across the pressure mat a few times and tailor
the orthotics according to each successive
assessment”.
Musculoskeletal Podiatrist Victoria Horsfall
added: “Having this technology gives us a
lot of assurance that we can provide the
optimal care for each patient on a highly
individualised basis.”
As a security guard for over a decade, I work a 12-hour night
shift and I’m on my feet for a lot of that time on patrol. Because I’m
diabetic, I have regular check-ups with the nurse at my GP practice and
she referred me because she noticed there was hard skin on my soles.
I have to say the care has been excellent – you get an appointment
when you want it, you’re never kept waiting; and the care
they take to assess exactly what you need is first class.
CLINICAL effectiveness
PATIENTexperience
108
District nurse teams praised for pressure ulcer prevention
It is estimated that nearly half a million people in the UK will develop at least one
pressure ulcer in any given year.
Often associated with another health issue, people over 70 years old are among those at risk, as they
have less supple skin and are more likely to have mobility problems.
Pressure ulcers are a constant concern when caring
for people with conditions that make it difficult for
them to move, especially if they are confined to
lying in a bed or sitting for long periods.
That’s why, for all BCHC staff caring for people
at home and in our inpatient facilities, preventing
pressure sores is a top care quality priority.
A wide range of resources has been made
available to clinical teams to help them provide
safe, pressure-ulcer free care and significant
progress has been made - in 2014-15, nearly
half of our 38 district nursing teams and over
70 per cent of our inpatient units went through
the entire year without recording a single instance of a patient who had developed an avoidable
pressure ulcer in their care.
Pressure ulcer nurse Tabitha Lloyd said: “There have been a lot of changes to our district nursing
teams in the last few years, with several teams merging, an ageing population and more complex
care being delivered in the community and inpatient units.
“What is extremely pleasing about this is that so many staff have taken ownership of pressure ulcer
management as part of a real commitment to focussing on excellent patient-centred care.
“All staff have worked incredibly hard to improve and deserve huge credit for the teamwork
that has brought about significant reductions in avoidable pressure ulcers.”
Roll of honour: 100 per cent free of avoidable pressure-ulcers in the teams below:
District nurse teams:
Inpatient units/wards:
Bloomsbury
Selly Oak
Ann Marie Howes
Harborne
Small Heath
Perry Tree
Harvey Rd
Soho/Heathfield
Norman Power
Highgate
Summerfield
Sheldon Unit
Kings Heath
Washwood Heath
Leyhill
Weoley Castle
Moseley Hall Hospital
Wards 4, 5, 7, 8, 9
Lordswood
West Heath
West Heath Hospital Ward 14
Richmond
Woodgate Valley
Willow House
PATIENTsafety
109
Focus story - assessment unit success
Giving people personalised care in their own homes is at the heart of
Birmingham Community Healthcare’s approach to service delivery.
It’s what most people would prefer, given the choice. But around one in every
three acute hospital beds is now occupied by a patient admitted to hospital
unnecessarily; people who could have been safely treated elsewhere.
Meanwhile, delayed discharges from hospital have
increased by nearly 20 per cent.
A new inpatient facility launched by BCHC aims to
meet these challenges by providing quick same-day
assessment of patients in a community hospital as a
direct alternative to acute care.
Birmingham grandmother Christine Buchanan has
chronic breathing difficulties and receives domiciliary
care at her home co-ordinated by an integrated
multidisciplinary team of nurses and therapists and a
clinical case manager to co-ordinate her care needs.
But when she suffered sudden unexplained chest
flutters, case manager Beverly Marriott referred her
straight to the new community medical assessment unit, based at Moseley Hall Hospital, for tests.
“I never want to go into hospital but last year I was in Good Hope three times - four or five days
each time,” said the 59-year-old.
“I knew something felt wrong and the thought of having to go into hospital again just made me
more anxious. So when Bev suggested this alternative, where I could have the tests I needed but
not have to stay overnight, I agreed straight away.”
Bev Marriott said: “Christine had a fast heart rate so we discussed the option of going into the
community medical assessment unit. As a practitioner, the unit is a great option if you have a
patient whose condition needs prompt assessment but who doesn’t have an identified medical
need to go into an acute hospital. Our single point of access co-ordinating urgent and non-urgent
care across the city is getting busier and busier but they were very helpful and patient transport
arrived within a couple of hours”.
Christine said her experience met all her expectations of compassionate, personalised care.
“When you first arrive at a hospital, you’re a bit unsure about what’s happening. But a nurse
came along, gave me a cup of tea, and explained what would happen. I had a full ‘service’ - blood
pressure, temperature, oxygen levels and I was home by teatime. I know from experience that if I’d
gone to A&E, I’d have been there much longer and may well have ended up getting admitted.”
The checks Chris needed were all done by advanced nurse practitioners. That’s the great strength
of the unit because it provides an environment where all that assessment can be done and the
patient can be stabilised. If they’re well
enough, they can be home that day,
For professionals:
reassured and safe.
The community medical assessment unit (CMAU)
provides half a day’s inpatient stay for up to 30 patients
a week.
Professionals can refer patients to the CMAU via BCHC’s
single point of access on 0300 555 1919 (option 2).
PATIENTexperience
110
Better care for tube-fed patients
The Birmingham community nutrition
nursing specialist team have worked
closely with other local Trusts and have
been instrumental in highlighting the
incidence and implementing prevention
strategies for Buried Bumper Syndrome
(BBS) in adults who receive their nutrition
via percutaneous endoscopic gastrostomy
(PEG) tubes, commonly known as a feeding
tube A PEG is a way of introducing food,
medicines and fluids directly into the
stomach by passing a thin tube through
the skin and into the stomach.
BBS is an uncommon but significant complication
of PEG tubes.
Buried bumper syndrome occurs when the inner
disc of the PEG buries into the stomach wall
between the stomach wall and the skin.
This can result in leakage from the insertion
site which causes skin problems, difficulty in
administering feed, water and medication.
This can lead to unplanned hospital admissions,
with patients sometimes needing a second tube
to be placed.
Working collaboratively with Sandwell and
West Birmingham Hospitals (SWBH) NHS Trust,
the Community Nutrition Nurse team undertook
a case analysis of 58 confirmed BBS cases from
2009-2013. Information was obtained from the
Acute Trusts in Birmingham who use the same
type of PEG tube and was compared to numbers
obtained from a neighbouring Trust who use
a PEG tube of different design who had no
incidence of BBS over the same period.
As a result of this case analysis, SWBH NHS Trust
has now changed their practice by changing
the type of PEG tube they use. Linda Ditchburn,
Specialist Nutrition Nurse is sharing good practice
by lobbying other acute Trusts who place PEGs
to also change. A management plan has been
put in place for patients identified with BBS
and they are fast-tracked to City Hospital,
when appropriate, for endoscopic assessment.
BBS can be avoided in the majority
of cases. Work is underway
to raise awareness of this,
particularly in nursing homes/care
environments where we have the
highest incidence.
Linda says “BBS can be avoided in the majority
of cases. Work is underway to raise awareness
of this, particularly in nursing homes/care
environments where we have the highest
incidence”.
All cases identified in community settings are
reported to the safeguarding adult team and at
the Continuing Health Care group meetings.
The Medical and Health Regulatory Agency
are also informed and are currently tasking
the PEG manufacturers to investigate the
documented concerns.
Typical incidence had previously been reported
as 0.9-3 per cent where in Birmingham it
was found to be 4.8-5.8 per cent. This is due
to be published in the Journal of Frontline
Gastroenterology in 2015.
PATIENTsafety
111
CLINICAL effectiveness
Health Visitor Implementation Plan update
On 31 March 2015 the Health Visitor Implementation Plan drew to a close, having achieved the
target of increasing from a start point in 2011 of 131 to 270. This was achieved through the service
working with Birmingham University, BCHC professional development and our commissioners, to
train over 190 students and launch new resources and continuing professional development for
the existing health visitors to deliver the new service offer based on the healthy child programme.
Average health visitor caseloads have halved, providing more time for health visitors to work with
families to promote secure infant parent attachment and safe healthy parenting.
Focus story - Greet is great!
Greet health visiting team
Greet health visiting team have
gone though a challenging period of
transformation over the past two years.
Despite some tough times Greet has
become an engaged, happy and productive
team, evolving into an exemplar of internal
innovation and staff development within
the trust. It has become a place newly
qualified staff never want to leave.
“The workload was simply unmanageable and
staff often passed each other like ships in the
night – it was clear we had to all step back and
work together on solutions. The situation was
not helped by people working in silos, high staff
turnover and stress levels creating too much
tension within the team” says Zarida.
“We focussed upon enablers first and
foremost, putting in place processes and
tools to make workloads more manageable,
innovating from within the team to meet
everybody’s needs.” This included workload
redistribution, streamlining of operations,
enhancing transparency of practice, allocating
time to nurture skills in new students and
fostering a culture of open and honest internal
communication between staff.
“One of the key changes we made was
planning in regular ‘shutdown days’ - days with
no patient visits where we could concentrate on
getting patient files up to date.”
The team also share the task of managing
allocations, to make the workload fairer and
give everyone the opportunity to develop and
improve the process.
The results have been transformational and the
impacts have helped foster a resilient team spirit
at Greet. The staff have become motivated by
more meaningful engagement with patients.
There is also an added sense of sustainability
with students being supported in a more
effective way.
Zarida noted “the team have taken the time
to value each other and utilise each other’s
strengths which has resulted in more team gettogethers, inside and outside of work”. Clinical
Team Leader Julie Millward added “we are in
it together and I believe that is what makes us
strong. I believe we care about our colleagues
and try to look after each other.”
112
New dementia friendly facility opens
The Trust’s new dementia friendly care
facility, located at West Heath Hospital,
opened its doors to patients in July 2014.
Willow House is a dedicated 18-bed ward,
using national best practice and design to
create an environment sensitive to the needs of
people with dementia. It has been supported by
a Department of Health grant of £1m.
BCHC Chief Operating Officer Andy Harrison
said: “We are delighted that this unit has now
opened to patients. “More than a third of the
people we care for in our inpatient units have
a dementia-related diagnosis on top of their
primary reason for being admitted. Many people
with dementia find it stressful to be admitted
to an inpatient facility and may suffer a loss of
confidence and independence as a result.”
The new facility has been created within an
existing ward, refurbished to include features
such as an enclosed garden, colour coding,
dementia friendly signage, memory boards and
symbols to help patients navigate and enjoy
their environment. Willow House is a modern,
fit-for-purpose facility within which patients can
receive excellent, dedicated care and increased
support from our staff and their carers and
family members.
113
Actions going forward
We are working towards the implementation
of the Birmingham and Solihull Dementia
Strategy and have developed an action plan,
monitored by a Dementia Steering group,
chaired by the Director of Operations.
This includes a Trust-wide project to raise
awareness of the specific needs of people with
dementia, improve inpatient environments and
enhance patient and carer experience. As part
of our on-going work we have implemented
a screening tool to aid early identification,
diagnosis and intervention; are developing
guidance on the appropriate management of
symptoms, person centred care, and supporting
patients with dementia and their carers.
The action plan aims to achieve the following
key outcomes:
• early identification and onwards referral for
diagnosis for all patients with dementia, or
suspected dementia, via primary care services
• improved support and information services
for patients and carers to include signposting
to outside agencies
• improved person centered care planning,
including advanced care planning
• availability of training for all frontline staff
to improve patient care and experience
• environmental changes to make inpatient
areas dementia-friendly using the Kings Fund
Enhancing the Healing Environment principles
• monitoring the use of anti-psychotic
medication and implementation of
appropriate national guidelines
• improvement in end of life care for patients
with dementia and monitoring of the uptake
of the supportive care pathway for this group
• promote the dementia friends initiative
across the Trust
Achievement of these actions and the
outcomes will be monitored via the
dementia steering group.
Challenges
• ensuring that dementia remains a high
priority within competing demands
• the challenge of working across multiple
sites across the city and beyond
• the allocation of resources to deliver the
environmental changes required to make the
organisation dementia-friendly - particularly
in the inpatient service which may require
decanting of wards to achieve the changes
• ensuring that the programme of education
can be delivered across the organisation
• providing additional support such as
activities/reminiscence therapy to provide a
stimulating environment may need dedicated
activity co-ordinators or volunteers.
Lord Mayor of Birmingham Councillor Shafique Shah ceremonially plants a dwarf mountain pine tree in the
Willow House gardens as part of celebrations to mark the unit’s opening.
114
Focus story - a parent’s perspective
Due to the unfortunate decline
in our daughter’s health, we
have recently been referred
to the children’s community
palliative care team.
As a family we were quite apprehensive about
having nursing staff coming in to our home.
Our daughter’s condition is Ullrichs Congenital
Muscular Dystrophy and we have always had
medical professionals involved in managing our
daughter’s needs, but her needs were always
assessed in the hospital and we managed her
care ourselves in the home.
With the rapid decline in her health and her
reliance on Bi-level Positive Airway Pressure
(BIPAP), we were feeling very emotionally
vulnerable. After the first visit from a member
of the community palliative care team, we
quickly realised that we had no reason to be
hesitant. All the team members have been
wonderful. They have been sensitive to the
family’s religious, spiritual and emotional needs
as well as a valuable resource of information
and assistance.
We now know we can call the team day or
night and we will speak to a member of the
team that has knowledge about our daughter’s
medical needs. No job is too big or small and
they go above and beyond in their efforts to
help us manage difficult situations.
It is not just our daughter’s medical needs
that the team have helped manage, through
discussions with our other daughter they have
established her areas of interest and organised
activities that she will also enjoy.
With the team’s assistance and advice our
daughter gets to do things she enjoys and we
get to see our daughter smile. That is priceless
to us as parents. We genuinely do not know
how we would manage without them. Over
a short period of time the team have become
members of the family.
They deserve recognition.
From a grateful parent
With the team’s assistance
and advice our daughter
gets to do things she
enjoys and we get to
see our daughter smile.
That is priceless to us as
parents. We genuinely do
not know how we would
manage without them.
Over a short period of time
the team have become
members of the family.
PATIENTexperience
115
Children’s community nursing palliative care team
The Birmingham children’s community
nursing palliative care team is a small team
covering a large city with diverse needs
and complex health care. The philosophy
is to promote the best quality of life for
every child and family that is cared for,
families are offered choice of flexibility
in their child’s care. The team are able to
facilitate an end of life discharge in the
acute setting in just a few hours.
The current children’s community nursing
caseload is over 1,200 children and young
people, 200 of whom are on the palliative
caseload. Many more children and young
people we care for have life limiting/life
threatening conditions Birmingham has the
highest national rate of children with life limiting
or life threatening conditions at 16 per 10,000
(the big study 2013).
A children’s community care indicator tool has
recently been developed. This enables the team
to monitor the quality of care that is given.
Six areas are monitored; these include the
deteriorating child, symptom control charts
and advance care planning. The service
achieved 100 per cent HarmFREE Care in all
teams during its pilot.
The service provides a visiting 24/7 on call
service to all families when a child/young person
is in the end stages of their life. Telephone
advice is also available to all of families on the
caseload where support can be accessed out of
hours. The service has a number of non-medical
prescribers that actively prescribe medication
enabling the nursing team to lead on symptom
control management in the community.
Siblings’ needs are always considered holistically,
they have their own unique journey. Support is
offered and families are signposted to various
agencies as required. Symptom control charts
are regularly completed to enable any changes
or deterioration of a child’s condition to be
identified early. Parallel planning is essential
for families; the ethos of the service is plan for
the worst, but hope for the best. The most
vulnerable children have a “just can’t wait”
box in the home, which contains anticipation
prescriptions and medications which enables
any presenting symptom to be treated without
delay. There are two respite carers in the team
that offer a limited amount of respite to some
of our families enabling parents to have a much
needed break.
They were there from
the beginning up
until the very end and
I am so grateful for
the support they gave
all the way through
his little life and after.
(parent of a bereaved child)
The team offers bereavement support following
the death of a child which is led by the
individual needs of the family. All children and
young people are supported to die in their place
of choice and the service is tailored to meet the
individual needs of the family. The service offers
nurse verification of death where children are
receiving end of life care at home. This ensures
that the time shortly after a child’s death is
dealt with in the most sensitive manner by
nurses that know the family well.
All bereaved families are given a memory box
from the service and are sent cards on the
anniversary of their child’s death and birthday.
Its important that families recognise that staff
are always available for support even after the
death of their child.
116
Focus story - end of the line for New Street
construction workers’ tobacco habit
Construction workers at a
flagship development in
the centre of Birmingham are laying the
foundations of healthier lifestyles thanks
to a groundbreaking partnership with the
citywide stop smoking service.
Stop smoking advisors are holding weekly
lunchtime clinics in the city headquarters of
Mace, lead contractor on the Birmingham
Gateway Project, which comprises the
redeveloped New Street station and the
new Grand Central shopping destination.
Onsite Occupational Health Nurse Allison Rose,
of Duradiamond Healthcare, says that with up to
1,000 workers from more than 30 contractors
onsite during peak activity, the project
represents an excellent opportunity to provide
the extended support would-be quitters need.
“It’s quite unusual to have occupational health
onsite in the construction industry but Mace
decided to offer that service on this project
simply because of the number of people
involved,” Allison explained.
“I’m here to offer treatment for any minor
health and medical issues that crop up but it’s
a great opportunity to offer preventative advice
and support to promote healthier lifestyles.
I was the smoking cessation manager when
I was a GP practice nurse so I know the
potential if you can get the right messages to
the right people at the right time and place.
“When I first started here, I saw the number
of people who smoke was quite high, which is
fairly typical in the construction industry.
So I did a survey and found that about 29 per
cent of people onsite at any time were smokers.
I contacted the Birmingham stop smoking
service and they came along to a health seminar
and had quite a lot of interest. So we teamed
up for the Stoptober campaign and the weekly
clinics followed on from that.”
117
By the end of
January, the number
of people who had
accessed the service
was approaching
100 and well over half had managed to
stay tobacco-free for at least four weeks the accepted minimum to deem a quit
attempt successful.
Mace Logistics Manager Mark Akhurst managed
to kick a 20-a-day habit with the help of the
Stoptober campaign and has stayed ‘quit’
since.“Smoking has been part of the culture of
the workplace in the construction industry,” he
said. “I smoked about 20 a day for years and had
no intention of giving up - you associate it with
your break-time and it’s difficult to break that
habit. But when the support is there regularly
at work and you see more and more of your
workmates giving it a go, it works very well.”
Stop Smoking Service Manager Carol Carter
said: “Giving up smoking is not easy for anyone
but it can be particularly difficult if your friends
and workmates smoke. We know that the
right professional help and support at the right
time can make a huge difference, in fact it can
make you around four times more likely to stop
than with will power alone. “We’re delighted
that this partnership with Mace has proved so
successful and would urge other employers to
get in touch with us if they are interested in
providing a similar service for their staff.”
For friendly advice and support on how
to quit, call the Birmingham stop smoking
team on 0800 052 5855 free or text ‘QUIT’
to 80800.
p Smoking
L-R Gurjinder Doulay, Birmingham Sto
rker,
service community engagement wo
er and
Mark Akhurst, Mace Logistics Manag
lth Nurse of
Allison Rose, onsite Occupational Hea
Duradiamond Healthcare.
New era dawns for dental hospital and school
patients and practitioners and a world class
learning and research environment for more
than 600 students and trainees.
The first construction at Pebble Mill since the
BBC TV studios were closed in 2004, the dental
hospital and school represents the most high
profile new development in the Edgbaston
Medical Quarter - home to more than 60 per
cent of Birmingham’s healthcare economy.
The new Birmingham Dental Hospital and
School of Dentistry at Pebble Mill is to
open its doors to staff, students and the
public in autumn 2015.
After more than a decade of planning, the
£50 million development is set to replace the
current city centre building at St Chad’s Circus,
now over 50 years old and increasingly costly
to maintain.
The eye-catching four-storey structure offers
state-of-the-art dental healthcare facilities for
The first dental hospital in Birmingham - then
called the Birmingham Dental Dispensary opened in 1858, with the teaching of dentistry
starting in 1880. The new building is the
hospital and school’s seventh home during the
decades since, reflecting changing needs and
greater demand as a reputation for first class
dental healthcare and education has grown.
For more information visit:
www.bhamcommunity.nhs.uk/dentalhospital
118
Part 4 - Annexes
Annex 1 - statements from external bodies/organisations......................... 121
Annex 2 - statement of Directors’ responsibilities ...................................... 125
Annex 3 - independent audit statement....................................................... 126
Glossary........................................................................................................... 127
Membership application BCHC NHS Trust..................................................... 128
Acknowledgements........................................................................................ 130
119
Assurance process
In order to assure themselves that the information presented is accurate, and that the
services described and the priorities for improvement are representative, our Board
designated the Director of Nursing and Therapies to lead the process of developing the
Quality Account.
Progress was reported to a number of executive-led committees before final approval from the
Board. The Director of Nursing and Therapies also ensured through the Clinical Quality Assurance
Programme Manager that staff and patients had an opportunity to consult around the key quality
priorities for the Quality Account. The organisation’s executive committees were pivotal in setting
the quality priorities. In addition to this, other stakeholders provided an objective view around the
content of this Quality Account. This Quality Account has been consulted internally with a wide
range of corporate and service level leads and staff through our committee structures, through the
Trust’s Patient Experience Forum, with Healthwatch, Birmingham Health and Social Care Overview
and Scrutiny Committee, our Commissioners and our Quality Accounts Editorial Group. The Quality
Governance and Risk Committee, Management Board and the Trust Board were provided with an
opportunity to review the Quality Account before the final version was agreed, thus ensuring as far
as possible that the information is accurate.
120
Annex 1 - statements from external
bodies/organisations
Comment from Healthwatch Birmingham regarding the Birmingham Community
Healthcare Trust Quality Account 2014-15.
15 May 2015
Thank you for providing us with a copy of your latest Quality Account Information for 2014-15.
We are delighted to make a contribution, feeding back our comments from our review of this
report against your current priorities.
Firstly, we pay full regard to your plans for improvement around your core indicators. Healthwatch
Birmingham is keen to work with the Trust in meeting your quality priorities. Our engagement
with the public has allowed us to better understand the need of listening to the public using this
to influence our strategic thinking. We believe this also reinforces the importance of collaborative
working by providing information to all providers that reflect public interest.
We agree with your rationale for moving forward with the full involvement of patient led services
understanding that, staff, the public, commissioners, partners and stakeholders all play apart in
standardising service delivery. We equally believe that working in partnership is the key to the
success of the trust; ultimately improving quality standards.
We wish to comment on three of your priority areas for 2014-15.
Quality priority 1
Continuous Implementation of Patient safety Programme
We note that your top three incident levels are still marginally high, although there has been
a small reduction in incidents shown in this year’s figures. We also note the totality of serious
incidents is reduced by 15 per cent, highlighting Grade 3 Pressure sores as the highest category
currently under this. Having reviewed your risk management data, we are concerned that existing
levels fail to address appropriate and sufficient safeguards. However, we are pleased to see in place
a number of mechanisms including organisational learning to support the framework of change.
One of your goals under your 2014-2015 CQUIN goals is to redefine Grade 3 and 4 pressure sores.
This further supports your safeguarding model for improvement and will inevitable eliminate risk
levels. We look forward to seeing further changes in this area.
Quality priority 4
Care planning
We consider the approach of assessment and care planning critical to meeting the well-being of
patients. We too endorse your values on being responsive, caring and fully understanding that a
‘No decision about me’ approach should always enshrine the governance of good practice. Point 1
of your qualitative goal demonstrates your commitment to address this.
121
We are happy that patients have been screened for dementia and referred back to their GP’s
for further investigation, this information sits well with the National Audits BCHC have recently
participated in. We trust that the care planning aspect will be integral and a key feature to
monitoring the provision of services, we are happy that action has been taken in this regard.
Quality priority 5
Enhancing patient experience
We fully support the trust’s priority to engage, listen, consult and use this a way to further improve
services. Our service delivery model focuses on the delivery and promotion of patient experience,
our plans for 2015-16 is to carry out independent assessments of your services in order to work
further advance this work and remit.
We equally note that one of your key priorities around quality is your proposed plans for
partnership working with the CCG GP’s and promoting public engagements. Your report suggests
that the trust will look to work and support continuous monitoring by using data to identify issues.
Healthwatch Birmingham prides itself greatly in fulfilling the voice of the public as an independent
body and fully supports the trusts move to producing patient satisfaction. Healthwatch
Birmingham is currently completing GP Survey for Birmingham, to address positive impact in the
similar manner. The Survey has commenced in December 2014, we have spoken to over 200
patients in the last four months paying full regard to patient experience which continues to be a
key theme; as for us quality is driven by the need to continuously meet and assess patients’ needs.
We congratulate BCHC for your recent success of winning Board of the year, National recognition
for Armed Services Support, NHS Leadership Recognition Awards and your various accolades
highlighting success in a number of areas. All of these are testament to your ongoing commitment
and innovative proposals towards building services to meet quality standards. We acknowledge
your efforts in shaping future health services for the betterment of services provided within your
trust and the wider community.
Thank you for giving us the opportunity to review the Trust’s Quality Account.
Yours sincerely,
Candy
Candy Perry
Interim Director, Healthwatch Birmingham
Birmingham Health and Socialcare Overview Scrutiny Committee
‘The Birmingham HOSC has indicated that it is not in a position to provide a statement
on the 2014-15 draft Quality Report’.
122
Statement for Quality Account 2014/15 - Birmingham Community Healthcare NHS Trust
The information provided within this account
presents a balanced report of the healthcare
services that BCHC provides. The range of
services described and priorities for improvement
are representative based on the information that
is available to us. The report demonstrates the
A draft copy of the Quality Account was received progress made within the Trust. It identifies what
by BSC CCG on the 17th April and the statement the organisation has done well, where further
improvement is required and what actions are
has been developed from the information
presented to date. Feedback on the draft account needed to achieve these goals and the priorities
set for 2015/16.
has also been received from Birmingham Cross
It was positive to read that the Trust is working
City CCG, NHS West Midlands and the Joint
towards aligning their patient safety programme
Commissioning Team.
to the ‘Sign Up to Safety’ initiative. The Trust
faced some challenge throughout the year to
deliver an effective Infection prevention and
The report demonstrates the
Control programme, including meeting standards
progress made within the Trust.
of cleanliness within some of the in-patient areas.
The CCG will continue to work with the Trust to
It identifies what the organisation
improve the quality of this service. We welcome
has done well, where further
the focus on continual review of safe staffing to
improvement is required and what
enhance care and support better outcomes for
actions are needed to achieve
patients. We will continue to work with the Trust
these goals and the priorities set
to support achievement of these goals.
Birmingham South Central Clinical
Commissioning Group (BSC CCG), as
coordinating commissioner for Birmingham
Community Healthcare NHS Trust (BCHC),
welcomes the opportunity to provide this
statement for their 2014/15 Quality Account.
for 2015/16.
We have reviewed the content of the Quality
Account and confirm that it complies with the
prescribed information, format and content that
are set out in the Quality Accounts legislation
(namely the Health Act 2009 and the National
Health Service (Quality Accounts) Regulations
2010 (SI 2010/279), as amended by the National
Health Service (Quality Accounts) Amendment
Regulations 2012 (SI2012/3081).
123
The staff survey indicated that there were
some improvements, for example in training
and incident awareness. There was recognition
that there is still further work to do in ensuring
that staff feel valued and receive effective
communication around the strategic vision for
the Trust. With reference to the anticipated
increase in community workload over the
next twelve months; it would be helpful to
understand the Trust strategy to ensure the
delivery of high quality community services.
We welcome the focus on continual review of safe staffing
to enhance care and support better outcomes for patients.
We will continue to work with
the Trust to support achievement of these goals.
The Trust has continued to make progress with
the patient safety programme throughout the
year. They have focused on ‘harm free care’
that includes the reduction of pressure ulcers
in community hospitals and intermediate care
units. An area to be commended is the bespoke
project which aims to reduce the number of
falls and falls with harm. The CCG will continue
to monitor progress with the patient safety
programme and the ‘Sign Up to Safety’ initiative
throughout the coming year through the CCG
Clinical Quality Review Group (CQRG).
We have made some specific comments to
the Trust in relation to their report which we
hope will be considered as part of the final
account. These include the Trust response to
Winterborne with regard to ‘Transforming
Care’ and its application to Continuing Health
Care. In addition, it would be helpful to include
further analysis of patient incidents and patient
experience data including actions implemented
as a result of learning and patient complaints.
Inclusion of supporting narrative relating to the
PLACE data and additional workforce data and
analysis would benefit the report. Further clarity
on the Essential Care Indicators for Learning
Disability Services should be included.
Through this quality account and the
ongoing quality assurance process, BCHC
have demonstrated their commitment to
continually improve the quality of services
provided. As coordinating commissioner,
we look forward to continuing to work in
partnership with the Trust and supporting
them to deliver these quality priorities.
Dr Raj Ramachandram
Chair - Birmingham South Central
Clinical Commissioning Group Quality
and Safety Committee
Through this quality account
and the ongoing quality
assurance process, BCHC
have demonstrated their
commitment to continually
improve the quality of
services provided.
124
Annex 2 – statement of Directors’
responsibilities
The directors are required under the Health Act 2009 to prepare a Quality Account for each
financial year. The Department of Health has issued guidance on the form and content of
annual Quality Accounts (which incorporates the legal requirements in the Health Act 2009
and the National Health Service (Quality Accounts) Regulations 2010 (as amended by the
National Health Service (Quality Accounts) Amendment Regulations 2011).
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 in the Department of
Health Quality Accounts toolkit 201-11 and
supporting guidance
• 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 2014 to March 2015
• papers relating to Quality reported to
the board over the period April 2014
to March 2015
• feedback from commissioners dated 20/05/15
• feedback from local Healthwatch
organisation dated 15/05/2015
• feedback from Overview and Scrutiny
Committee dated 20/05/2015
• the Quality Accounts presents a balanced
picture of the trust’s performance over the
period covered
• the performance information reported in the
Quality Report is reliable and accurate
• there are proper internal controls over the
collection and reporting of the measures of
performance included in the Quality 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 directors confirm to the best of their
knowledge and belief they have complied
with the above requirements in preparing
the Quality Report.
• the 2014 national staff survey
By order of the Board
Date
28.05.2015
Chairman
Date
28.05.2015
Chief Executive
Sign and date in any colour except black
125
Annex 3 – independent audit statement
As part of the programme of audit work for 2015/16 agreed by the Audit Committee, Internal Audit
was requested to undertake a review to provide assurance and to constitute a dry run, in relation to
the Trust’s arrangements for preparing its 2014/15 Quality Account in compliance with requirements
which would potentially apply in the future under Foundation Trust status.
Monitor sets out a range of requirements and guidance regarding Quality Accounts and external
assurance on these, including:
• Detailed Requirements for Quality Reports 2014/15
• Audit Code for NHS Foundation Trusts
• 2014/15 Detailed guidance for external assurance on quality reports
This review noted that the Trust has produced a Quality Account document that is on the whole
consistent with relevant guidance.
The processes followed by the Trust to compile, review and approve its Quality Account document
were found to be systematic and logical. A plan and timetable for the completion of the Quality
Account was established and formal monitoring, review and feedback arrangements were facilitated
through relevant committees and ultimately the Board.
Whilst no detailed data quality testing was undertaken during our review, a sample of indicators
reported within the Quality Account document was reviewed to ensure consistency of reporting to
the Trust’s committees and Board and that reasonable processes were in place to capture data in a
complete, timely and accurate manner. The indicators considered were:
• 18 week referral to treatment (RTT) incomplete pathways
• Cancer waits
• Patient incidents
We highlighted no significant concerns, whilst noting that we have carried out and reported separately
a detailed review on 18 week RTT data quality as mandated by the Trust Development Authority.
126
Glossary
CQC
Care Quality Commission
The independent regulator of health and social care in England
C.diff
Clostridium difficile
An infection causing diarrhoea
ECI
Essential Care Indicator
A set of metrics for assessing the quality of care plan and assessment tools used to
manage fundamentals of care
MUST
Malnutrition universal screening tool
A national tool used to identify if people are at risk of malnutrition
MRSA
Meticillin-resistant Staphylococcus aureus
An infection caused by a bacteria which is resistant to most penicillin based antibiotics
NHSLA
National Health service Litigation Authority
Handles negligence claims made against NHS organisations
NICE
National Institute for Health and Care Excellence
The National Institute for Health and Care Excellence (NICE) provides national
guidance and advice to improve health and social care.
RIO
An electronic patient record system being introduced by the Trust
Baseline
The initial collection of data which serves as a basis for comparison with the data
collected later
Benchmark
A way of improving ourselves by measuring where we are against other similar
services/organisations
Clinical coding
Nationally and internationally understood codes to describe a patient’s complaint,
diagnosis and treatment. Clinical coding assists in the recording of patient data
Commissioners
Commissioners are the people responsible for buying services from us for our
patients and service users
Healthwatch
A network of local people and groups that work to improve health and social
care services
Health and
Social care
Overview Scrutiny
Committee
Oversees health and social care issues in Birmingham
Pathways
A recommended route or map of care to particular illnesses
Pressure Ulcer
A localised injury to the skin and/or underlying tissue, as a result of pressure.
They are graded according to severity, with grade 1 being the least severe and
grade 4 the most severe
Quality Indicators
These are a set of metrics used to measure quality
NHS Safety
Thermometer
A quick and simple method for surveying patients and harmfree care
Venous
thromboembolism A blood clot that develops in a vein
(VTE)
127
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Birmingham Community Healthcare
NHS Trust
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The information you provide will also help us to ensure our membership is representative of
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The minimum age to become a member is 16 years. If you are younger than this and wish
to be involved, please email
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NHS Trust
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129
Acknowledgements
We would like to thank Clinical Photography and Graphic Design and all members of staff, public
members and users of our services who have contributed towards this Quality Account.
Quality Accounts Editorial Group consisted of:
Rebecca Coghlan
Compliance and Assurance Manager
Adam Dandy
Public Engagement Lead/Acting Head of Interpreting
David Disley-Jones
Communications Manager
Lisa Eden
Associate Director of Therapies
Colin Graham
Head of Clinical Governance (Chair)
Carol Herbert
Clinical Quality Assurance Programme Manager (Project Lead)
Alison Last
Associate Director of Patient Experience
Maria Lynch
Clinical Governance Administrator
Anne Pemberton
Advice and Information Service Lead
Christopher Vaughan
Public Member Representative
Angie Villers
Head of Compliance and Assurance
Frances Young
Chair of Patient Experience Forum and Governor
130
How to provide feedback
If you would like to provide feedback on the Quality Accounts you can do this by:
131
Tel
0121 466 7069
Email
clinical.governance@bhamcommunity.nhs.uk
Address
Quality Accounts, Clinical Governance Department
3 Priestley Wharf
20 Holt Street
Birmingham Science Park
Aston
Birmingham, B7 4BN
If you would like to request a copy of this document in an
alternative format, or have any other queries about its content,
please contact the Birmingham Community Healthcare NHS Trust
Communications team at:
Communications team:
3 Priestley Wharf
20 Holt Street
Birmingham Science Park
Aston
Birmingham, B7 4BN
Tel: 0121 466 7281
Email info@bhamcommunity.nhs.uk
Or follow us on Twitter @bhamcommunity
The report is also available at www.bhamcommunity.nhs.uk
Or you can speak to a Patient Experience Officer in our Customer
Services team on tel: 0800 917 2855
132
Accessible Responsive Quality Caring Ethical Commitment
Ethical Quality Caring Accessible Commitment Responsive
Responsive Caring Ethical Accessible Quality Commitment
Commitment Accessible Caring Ethical Responsive Quality
Quality Commitment Caring Ethical Accessible Responsive
Caring Commitment Accessible Quality Responsive Ethical
Accessible Responsive Quality Caring Ethical Commitment
Ethical Quality Caring Accessible Commitment Responsive
Responsive Caring Ethical Accessible Quality Commitment
Commitment Accessible Caring Ethical Responsive Quality
Quality Commitment Caring Ethical Accessible Responsive
Caring Responsive Accessible Quality Commitment Ethical
Accessible Responsive Quality Caring Ethical Commitment
Ethical Quality Caring Accessible Commitment Responsive
Responsive Caring Ethical Accessible Quality Commitment
Commitment Accessible Caring Ethical Responsive Quality
Quality Commitment Caring Ethical Accessible Responsive
Caring
Responsive
Accessible
Commitment
Ethical
Accessible
Responsive
QualityQuality
Caring Ethical
Commitment
Birmingham Community Healthcare
NHS Trust
Design and print enquiries: Clinical Photography and Graphic Design Tel: 0121 466 5107 Reference: 44151 June.2015
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