Accessible Responsive Quality Caring Ethical Commitment
advertisement
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 Quality Account 2014-15 If you would like this document in another format including audio, large print, Braille or translated, please contact Communication Team on: 0121 466 7281 If If you you would would like like this this document document in in another another format format including including audio, audio, large large print, print, If you would like this document in another format including audio, large Braille or translated, please contact Communication Team on: 0121 466 7281 Braille or translated, contact Communication Team on: 0121 466print, 7281 Arabic If you you would would like this this please document in another another format including including audio, large print, If like document in format audio, large print, Braille or translated, please contact Communication Team on: 0121 466 7281 If you would like this document in another format including audio, large print, If you would like this،٬ﻮﺻﺗﻲ document inﻰanother format including audio, large print, Braille or ﻠﺑﺔﻐ ،٬ﻛﺒﻴﯿﺮﺓة ﺑﺄﺣﺮﻑف ﺷﺮﻳﯾﻂ ﻲﻓﻚﻠﻋ ﻟﺫذ ﺑﻤﺎ ﺃأﺧﺮﻯى ﻮﺑﺳﻴﯿﻠﺔ ﻮﻟﺍاﺛﻴﯿﻘﺔ ﻫﮬﮪھﺬﻩه ﺗﺮﻳﯾﺪ ﻛﺖﻨ ﺇإﺫذﺍا Braille or translated, please contact Communication Team on: 0121 466 7281 Arabic Braille or translated, please contact Communication Team on: 0121 466 7281 Arabic please contact Communication translated, Team on: 0121 466 7281 ............................ ﻧﺮﺟﻮ ﺃأﻥن ﺗﺘﺼﻞ ﺑـ،٬ﺑﺮﻳﯾﻞ ﻭوﺃأ ﻣﺘﺮﺔﻤﺟ Arabic ﻠﺑﺔﻐ ،٬ﻛﺒﻴﯿﺮﺓة ﺑﺄﺣﺮﻑف ،٬ﻮﺻﺗﻲ ﺷﺮﻳﯾﻂ ﻰ ﻲﻓﻚﻠﻋ ﻟﺫذ ﺑﻤﺎ ﺃأﺧﺮﻯى ﻮﺑﺳﻴﯿﻠﺔ ﻠﺑﺔﻐ ،٬ﻛﺒﻴﯿﺮﺓة ﺑﺄﺣﺮﻑف ،٬ﻮﺻﺗﻲ ﺷﺮﻳﯾﻂ ﻰ ﻲﻓﻚﻠﻋ ﻟﺫذ ﺑﻤﺎ ﺃأﺧﺮﻯى ﻮﻟﺍاﺛﻴﯿﻘﺔ ﻮﺑﺳﻴﯿﻠﺔ ﻫﮬﮪھﺬﻩه ﻮﻟﺍاﺛﻴﯿﻘﺔ ﺗﺮﻳﯾﺪ ﻫﮬﮪھﺬﻩه ﻛﺖﻨ ﺗﺮﻳﯾﺪ ﺇإﺫذﺍا ﻛﺖﻨ ﺇإﺫذﺍا Arabic Bengali Arabic ﻠﺑﺔﻐ،٬ ﺑﺄﺣﺮﻑف ﻛﺒﻴﯿﺮﺓة،٬ﺷﺮﻳﯾﻂ ﻮﺻﺗﻲ ﻰ ﻲﻓﻚﻠﻋ ﻟﺫذ ﺑﻤﺎ ﺃأﺧﺮﻯى ﻮﺑﺳﻴﯿﻠﺔ ﻮﻟﺍاﺛﻴﯿﻘﺔ ﻫﮬﮪھﺬﻩه ﺗﺮﻳﯾﺪ ﻛﺖﻨ ﺇإﺫذﺍا Arabic ............................ ﺗﺘﺼﻞ ﺑـﺑـ ﺃأﻥن ﻧﺮﺟﻮ ،٬ﻣﺘﺮﺔﻤﺟ ﻭوﺃأ ............................ ﺗﺘﺼﻞ ﻮﻟﺍاﺛﻴﯿﻘﺔﺃأﻥن ﻫﮬﮪھﺬﻩه ﻧﺮﺟﻮ ،٬ﻣﺘﺮﺔﻤﺟ ﺑﺮﻳﯾﻞ ﻭوﺃأ ﺑﺮﻳﯾﻞ ﻠﺑﺔﻐ ،٬ﻛﺒﻴﯿﺮﺓة ﺑﺄﺣﺮﻑف ،٬ﻮﺻﺗﻲ ﺷﺮﻳﯾﻂ ﻰ ﻲﻓﻚﻠﻋ ﻟﺫذ ﺑﻤﺎ ﺃأﺧﺮﻯى ﻮﺑﺳﻴﯿﻠﺔ ﺗﺮﻳﯾﺪ ﻛﺖﻨ ﺇإﺫذﺍا ............................ ﺗﺘﺼﻞ ﺑـ ﻫﮬﮪھﺬﻩه ﻧﺮﺟﻮ ،٬ﻣﺘﺮﺔﻤﺟ ﺑﺮﻳﯾﻞ ﻭوﺃأ Bengali ﻠﺑﺔﻐ ،٬ ﺑﺄﺣﺮﻑف ﻛﺒﻴﯿﺮﺓة،٬ﺷﺮﻳﯾﻂ ﻮﺻﺗﻲ ﻰ0121 ﻲﻓﻚﻠﻋ466 ﺑﻤﺎ ﻟﺫذ ﺃأﺧﺮﻯى ﻮﻟﺍاﺛﻴﯿﻘﺔﺃأﻥنﻮﺑﺳﻴﯿﻠﺔ ﻛﺖﻨ ﺗﺮﻳﯾﺪ ﺇإﺫذﺍا Bengali ............................ 7281 ﻧﺮﺟﻮ ﺃأﻥن ﺗﺘﺼﻞ ﺑـ،٬ﺑﺮﻳﯾﻞ ﻭوﺃأ ﻣﺘﺮﺔﻤﺟ Bengali ............................ ﻧﺮﺟﻮ ﺃأﻥن ﺗﺘﺼﻞ ﺑـ،٬ﺑﺮﻳﯾﻞ ﻭوﺃأ ﻣﺘﺮﺔﻤﺟ Bengali Bengali Bengali French Si vous souhaitez que ce document soit présenté sous un autre format, par French 0121 gros 466 7281 French cassette audio, exemple, caractères, Braille ou traduit dans une autre Si vous souhaitez que ce document soit French Si vous souhaitez que ce document soit présenté présenté sous sous un un autre autre format, format, par par langue, veuillez contacter ………………… French French Si vous souhaitez que ce document soit présenté sous un autre format, par exemple, cassette audio, gros caractères, Braille ou traduit dans une autre French exemple, cassette que audio, caractères, Braille ou traduit dansformat, une autre Si vous vous souhaitez souhaitez ce gros document soit présenté présenté sous un autre autre par Si que ce document soit sous un format, par langue, veuillez contacter ………………… exemple, cassette audio, caractères, Braille ou traduit dansformat, une autre Si vous souhaitez que ce gros document soit présenté sous un autre par langue, veuillez contacter ………………… Gujurati exemple, cassette audio, gros caractères, Braille ou traduit dans une autre langue, veuillez contacter ………………… exemple, cassette audio, gros caractères, Braille ou traduit dans une autre langue, veuillez veuillez contacter contacter 0121 ………………… langue, ………………… 466 7281 Gujurati langue, Gujurativeuillez contacter ………………… Gujurati Gujurati Gujurati Gujurati Mandarin 0121 466 7281 Mandarin Mandarin Mandarin Mandarin Mandarin Mandarin 0121 466 7281 Polish Aby otrzymać dokument w innej postaci, np. jako nagranie audio, brajlem, Polish Polish dużą czcionką lub jego tłumaczenie, prosimy o kontakt pod numerem Aby otrzymać dokument Polish Aby otrzymać dokument w w innej innej postaci, postaci, np. np. jako jako nagranie nagranie audio, audio, brajlem, brajlem, ………………… Polish Polish Aby otrzymać dokument w innej postaci, np. jako nagranie audio, brajlem, dużą czcionką lub jego tłumaczenie, prosimy o kontakt pod numerem Polish dużą czcionkądokument lub jego tłumaczenie, prosimy o kontakt podaudio, numerem Aby otrzymać otrzymać w innej innej postaci, postaci, np. jako jako nagranie brajlem, Aby dokument w np. nagranie audio, brajlem, ………………… dużąotrzymać czcionką lub jego tłumaczenie, prosimy o kontakt podaudio, numerem 0121 466 7281 dokument Aby w innej postaci, np. jako nagranie brajlem, ………………… Punjabi dużą czcionką czcionką lub lub jego jego tłumaczenie, tłumaczenie, prosimy prosimy o o kontakt kontakt pod pod numerem numerem dużą ………………… dużą czcionką lub jego tłumaczenie, prosimy o kontakt pod numerem ………………… ………………… Punjabi ………………… Punjabi Punjabi Punjabi Punjabi Punjabi 0121 466 7281 Somali Russian Haddii aad jeclaan laheyd dukumentigan oo qaab kale ah sida qaab maqal, Если вы хотите получить этотmid документ в другом формате, far waaweyn, farta Braille ama la soo turjumeyba ah, fadlanвключая la soo xiriir Russian Russian аудиозапись, в печати шрифтом Брайля или крупным шрифтом, а также ………………… 0121 466 7281 Если вы хотите получить этот документ в другом формате, включая Russian Если вы хотите получить этот документ в другом формате, включая в переводе на ваш язык, просим обращаться к Russian Somali Russian Если вы хотите получить этот документ вили другом формате, включая аудиозапись, в шрифтом Брайля крупным шрифтом, а Russian аудиозапись, в печати печати шрифтом Брайляв или крупным шрифтом, а также также .............................................................................. Urdu Если вы хотите получить этот документ другом формате, включая Haddii aad jeclaan laheyd dukumentigan oo qaab kale ah sida qaab maqal, в переводе на ваш язык, просим обращаться к аудиозапись, в печати шрифтом Брайля или крупным шрифтом, а также Если вы хотите получить этот документ в другом формате, включая в переводе навваш язык, просим Брайля обращаться к аудиозапись, печати шрифтом или крупным крупным шрифтом, а также также аудиозапись, вваш печати шрифтом или шрифтом, а far waaweyn,на farta Braille ama mid Брайля la soo turjumeyba ah, fadlan la soo xiriir в переводе язык, просим обращаться к .............................................................................. аудиозапись, вваш печати шрифтом Брайля или крупным шрифтом, а также .............................................................................. в переводе на язык, просим обращаться к в переводе на ваш язык, просим обращаться к ………………… .............................................................................. в переводе на ваш язык, просим обращаться к 0121 466 7281 .............................................................................. .............................................................................. .............................................................................. Urdu 0121 466 7281 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. 68 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. 70 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 72 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. 76 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. 95 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 97 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. 98 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. 101 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 ! Birmingham Community Healthcare NHS Trust Membership application page 1 Please fill in your details below to become a member of Birmingham Community Healthcare NHS Trust. We are collecting information to ensure we contact you in the best way for you. The information you provide will also help us to ensure our membership is representative of the communities we serve. The minimum age to become a member is 16 years. If you are younger than this and wish to be involved, please email ft@bhamcommunity.nhs.uk Contact details (please use CAPITAL LETTERS) Fields marked with * are mandatory. Title First name* Last name* Date of birth* Gender (please tick) Male Female Address* Postcode* Telephone (home) Telephone (mobile) Email How would you describe your ethnic origin? (please tick as appropriate) White/British Black or Black British/African White/Irish Black or Black British/Any other Black background White/Other Mixed White/Black African Asian or Asian British/Pakistani Mixed White/Black Caribbean Asian or Asian British/Indian Mixed White and Asian Asian or Asian British/Bangladeshi Mixed Any other mixed background Asian or Asian British/Any other Asian background Chinese Black or black British/Caribbean Any other ethnic group (please specify) How would you prefer to be contacted? (please tick as appropriate) ! Email Post Telephone [continued over the page] 128 Birmingham Community Healthcare NHS Trust Membership application page 2 Do you have a disability? (please tick as appropriate) No Yes (please give details of any special requirement below): How would you like to be involved at the current time? (please tick as appropriate) Level 1 membership (limited involvement) Receive information and keep up to date Level 2 membership (active involvement) Participate in surveys and attend meetings Level 3 membership (full involvement) Get involved with an interest in becoming a governor Did a staff member recommend that you become a member? Yes: (please give their name and job title in the space provided below): No: (please specify other in the space provided below): Please tick here if you do NOT want your name and constituency to be available to the public through the Foundation Trust Register of Members. The data you supply will be used only to contact you about the Trust, membership or other related issues and will be stored in accordance with the Data Protection Act. Please see our website at www.bhamcommunity.nhs.uk/ft for more details. I apply to become a member of Birmingham Community Healthcare NHS Trust and agree to the processing of my information: Signature......................................................................................... Date......................... Please return completed forms to: Freepost RSUJ-TESZ-BHSH Membership Birmingham Community Healthcare NHS Trust 3 Priestley Wharf, 20 Holt Street, Birmingham B7 4BN 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
