2014/15

A Quality Account is an annual report detailing the quality of services that have been provided by an
NHS healthcare provider. The report is made available to the public.
A Quality Account allows us to report on the quality of our services and show our key partners (service users, their families and carers, our working partners, commissioners, our staff and the public) how our services have improved.
SSOTP | Quality Account 2
1 | Part 1: Statement on Quality
2 | Statement from Chairman and Chief Executive
4 | Statement from Responsible Director
5 | Introduction – About Us
6 | Our Services
8 | Raising concerns
10 | Our Strategy and Service Development
12 | Our Quality Framework
Audley and Kidsgrove
Integrated Local Care
Team
“We could not have wished for a more dedicated, caring, skilled and altogether human group of professionals. Our mother felt very comfortable with you all right from the first visit and regarded you all as close friends. I am deeply grateful for the compassion and empathy you all displayed in abundance.”
13 | Part 2: Our Priorities for Quality Improvement
14 | How we decided our Quality Improvement Priorities for 2015/16
15 | Priority 1: Safety – Reduce avoidable harm
17 | Priority 2: Experience – Improve Customer Satisfaction
22 | Priority 3: Effectiveness – improve our outcomes
23 | Priority 4: Effectiveness – support independence by personalised care
26 | Priority 5: Safety – improve our workforce and our safety culture
26 | How we will make improvements
30 | Statements of Assurance
40 | Mandatory Quality Indicators
47 | Part 3: Review of Quality Performance in 2014/15
48 | Progress against our Quality Improvement Priorities 2014/15
71 | Our Performance Indicators
78 | Safety
83 | Experience
95 | Effectiveness
99 | Assuring the Quality of our Services
101 | Supporting our Staff
106 | Divisional Quality Highlights
112 | Statements from our Partners
121 | Statement of Directors’ Responsibilities in respect of the Quality Account
122 | Glossary

Service user experience
- Falls Management
Service based in Seisdon
“Thank you for all the support you have given me on my road to recovery after losing my confidence following my falls; the speedy installation of equipment which has made me feel safer in my own home.”
SSOTP | Quality Account 1

The Quality Account 2014/15 describes how we prioritised safety, effectiveness and service user experience and how we will continue to work to ensure that we improve quality.
It is essential that our service users and their families / carers are confident in the quality of our services. This publication details how we performed against our Quality
Improvement Priorities for 2014/15.
We are continually impressed with the quality work that our teams provide and this report only provides an overview of the work we have done to improve quality in
2014/15.
As with previous years, our achievements in 2014/15 all support our core value of ‘we put quality first’. Some examples of successes this year include:
• We expanded our successful apprenticeship programme developing opportunities in our corporate as well as clinical services.
• We are developing a new research culture in our social care service and have introduced a facilitator role to support this.
• We introduced a new “mystery shopper” service to help improve and influence the way in which our services are delivered in the future
• Our Rheumatology Service at the Haywood Hospital was held up as a national example in providing specialist care outside of hospital by national think tank The King’s Fund.
• We launched a new scheme in partnership with the British Youth Council to create School Nurse
Champions amongst 11 – 16 year olds to boost profile and raise awareness of the services provided by school nurses.
2 | Quality Account
• We became the first community trust to produce real time patient feedback to monitor patient satisfaction and improve quality of care
• In his “Freedom to Speak Up” Review commissioned by the government, Sir Robert Francis QC recommended our unique
Ambassador for Cultural Change role be adopted by every
NHS Trust in the country in order to better support staff and encourage greater openness and transparency in the NHS.
• We became one of 12 trailblazer organisations to join the
NHS England “Sign up to Safety” initiative aimed at reducing harm and saving lives in the NHS.
• We held public engagement events in East and South
Staffordshire to encourage patients, service users and members of the general public to have their say on joined up health and social care and how they can choose and control the type of social care support they receive.
• Four of our Health Visitors have become Fellows of the
Institute of Health Visiting (FiHV), in recognition of their exceptional achievement and leadership for improving health outcomes of children and families.
• A ‘Queens Nurse’ award was given to a nurse in our end of life service.
We are delighted to have had such good engagement from our stakeholders in developing our Quality Improvement Priorities for 2015/16. Stakeholder input is essential for us to continue to provide high quality care for our service users.
As with previous years, this Quality Account is a public record of our Board level commitment to quality and quality improvement.
It is also important that we take the time to thank our staff and celebrate those who go above and beyond what is expected of them. Our annual Celebrating Excellence Awards took place in
March 2015 and profiles on all of the winners are interspersed throughout this Quality Account.
On behalf of the Board we are pleased to present this account to you.
Stuart Poynor
Chief Executive
Professor Nigel Ratcliffe
Chairman
Quality Account | 3

Tina Cookson
Director of Nursing and Quality
A Quality
Account is an annual report detailing the quality of services that have been provided by an NHS healthcare provider. The report is made available to the public.
A Quality Account allows us to report on the quality of our services and show our key partners (service users, their families and carers, our working partners, commissioners, our staff and the public) how our services have improved.
| Quality Account
Quality refers to all our service user and carer requirements; and ultimately focussed on outcomes of care. High Quality care can be defined in three parts; safety, effectiveness, and experience.
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The Staffordshire and Stoke on Trent Partnership NHS Trust is the largest integrated community health and social care trust in the country:
We employ 5,798 staff 1 including doctors, dentists, nurses, allied health professionals, social workers, managers and support staff.
Staffordshire and Stoke on Trent covers a geographic area of around 1,012 square miles from the Staffordshire Moorlands in the North, down to the borders of the Black Country.
This area contains a population of 1.1 million people; and our services are provided in homes, community settings, our five community hospitals, and in six prisons. We provide sexual health services to Telford and Wrekin, Shropshire, Leicester and Leicestershire &
Rutland
We have an income of £372m.
1 Or 4,710.01 Whole Time Equivalent staff. Count as at 31 March 2015.
We provide health services to a wide ranging population across a large geographic area. Across
Staffordshire and Stoke-on-Trent people have differing needs due to age, unemployment levels, deprivation and differing ethnicity across our regions.
As a result of these and numerous other factors, areas within our boundaries have differing health care priorities. This challenges us to ensure that the health care we deliver is not only just a quality service but is also appropriate to our service users.
We have provided a range of sexual health services in nine clinics across Telford & Wrekin and Shropshire since 2013. From January 2014 we also began providing sexual health services to the people of
Leicester, Leicestershire & Rutland.
Quality Account | 5

Adult Ability Team
Advanced Nurse Practitioners
Asylum Seekers and Refuge Services
Cancer Supportive Services
Community Intervention Service
Community Rehabilitation
Community Response Team
Community Stroke
Continence
Dermatology Specialist Nurse (Covering SES Only)
Diabetes Education Programme (DESMOND)
Diabetic Retinopathy
Diabetic Team
Dietetics
Dressing Clinic
Falls and Parkinson’s
Falls Prevention and Osteoporosis
Heart Failure/Cardiac
Homeless Matron
Hospital Discharge
Integrated Local Care Teams (ILCTs) for Health and
Social Care
Intermediate Care Team
Learning Disabilities
Learning Disabilities Nursing
Leg Ulcer Clinic
Living Independently Service
Lymphedema Clinic
Medicines Management Services
MICATs (MSK/Physio)
MICATs (Rheum/Chronic Pain)
Night Allocation Night Services
Occupational Therapy
Out of Hours/Evening Service
Pain Management
Palliative Care
Physiotherapy
Physiotherapy (MICATs)
Physiotherapy and Orthopaedic Medicine Service
(POMs)
Podiatry
Podiatry Nail Surgery (AQP)
Primary Care Orthopaedic Service (PCOS)
Pulmonary Rehabilitation
Rapid Response
Respiratory
Sensory Rehabilitation
Speech and Language Therapy
Stroke Supported Discharge
Tissue Viability Team
Weight Management
Wheelchair Services
Baby Friendly
Childhood Obesity
Children’s Dietetics
Children’s Occupational Therapy
Children’s Physiotherapy
Children’s Podiatry
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Family Nurse Partnership
Family Nursing Partnership
Health Visiting
Hospital @ Home/CAST
Infant Feeding Team
Information and Support Team
Long Term Conditions
Palliative Care
School Nursing
School Nursing Special Schools
School Nursing Vaccines - HPV & MMR
Speech and Language Therapy
Universal Neonatal Hearing
Bradwell Hospital
Cheadle Hospital
Haywood Hospital
Leek Hospital
Longton Cottage Hospital
Amputee Rehabilitation
Deep Vein Thrombosis Screening
Dental
Early Supported Community Stroke Team
End of life care
Health Improvement
Limb Fitting
Minor Injuries Unit
Neuro Rehabilitation and Trauma
Research
Sexual Health Services
Specialist Rheumatology Services
Time to Quit – Smoking Cessation
Walk in Centre
HMP & YOI Drakehall
HMP & YOI Swinfen Hall
HMP Featherstone
HMP Stafford
YOI Brinsford
YOI Werrington
Service user experience
- Cannock Community
Intervention Service
“From the first visit to the very last, every member of the team was delightful and friendly with a warm approach to us. They showed a strong sense of teamwork, each knowing every detail of what was happening in my husband’s case. They were always professional and their knowledge of his condition and skills required for treatment were excellent.”

As an organisation that provides care to vulnerable people, we take any concerns raised by our staff very seriously.
We are committed to supporting any of our staff who are worried about areas of poor practice, attitudes or inappropriate behaviour within our organisation.
• HR processes continue to change and improve in response to feedback from staff.
• We are in the process of developing local 'Champions' to promote cultural change and help their colleagues to raise concerns whilst sharing best practise and positive solutions.
We believe in encouraging openness and transparency in all we do. There will be no negative comeback for individuals who have acted responsibly in highlighting issues that could put the people we care for at risk in any way. We are pleased that our encouraging approach has resulted in more staff contacting our Ambassador for
Cultural Change this year.
The top concerns raised by our staff are:
• We have revised our quality priority 5 to include safety culture as well as safe staffing.
We are also delighted that the Francis Review “Freedom to speak out” included a recommendation that all NHS Trusts must appoint a 'Guardian', based on our
Ambassador for cultural change role.
• Low and / or unsafe staffing levels or poor skill mix
• Service user / staff safety
If our staff feel concerned about any matter they can report it to:
• Poor interpersonal relationships between staff including perceived bullying and harassment.
• Their line manager
• Lack of communication and timeliness of HR processes including recruitment
• Their Professional Lead
• A Staffside or union representative
Work done to improve our services as a result of concerns raised has been varied: • Our Ambassador for Cultural
Change
• We believe that enabling staff to raise concerns means that they are less likely to go off sick.
• Our Raising Concerns helpline
123 1161 ext. 8888
0300
• We have been able to redeploy staff to more appropriate areas in response to staff raising concerns about low staffing levels/skill mix. This has supported staff and ensured safer, quality service delivery.
• Any of our Executive
Directors or members of our Trust Board
We deliver quality and do the very best we can.
We treat people as individuals and take time to respect and understand their point of view.
We take personal ownership of things and see them through.
We focus on finding solutions.
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We will provide high quality and safe services which provide an excellent experience and best possible outcomes
We will work with partners, users and carers to deliver integrated services simply and effectively
Our organisation will develop and deliver sustainable, innovative services that support independence
Our workforce will be empowered and supported to deliver care in a way that is consistent with our values
We will make excellent use of our resources and improve levels of efficiency across our services Quality Account | 9 8 | Quality Account

Our fundamental aim is to move from a traditional, reactive system to one where support is there before a crisis occurs and to be much better at supporting people to remain healthier through targeted intervention and support. Integrated care is the focus of our strategy:
To deliver this model, we will focus on:
• Joint working with our partner organisations
• Building relationships with voluntary, independent and hospice sector organisations
• Putting the emphasis on service users
• Planning services along pathways
• Focussing on Prevention, Early Intervention,
Reablement, and Self Care
To achieve our strategy we are developing a Model of
Care to provide “the right care, in the right setting, at the right time, with the right workforce.” This means we can maximise quality of life and independence of each individual. The
Model has some critical success factors:
• People are treated as close to home as possible
• Early intervention to prevent
• Evaluating and demonstrating the impact of our model
• Transformation of Adult Social Care within our integrated teams
Community Hospital based services are another key part of the Partnership Trust’s service offer.
We know that demand for this service will increase and change both as a result of an ageing population and as a result of the need to reduce demand in an acute setting and increasing care in a community setting.
admission to hospital, residential and nursing care where appropriate
• Using our resources efficiently across our Health and
Social Care economies
We aim to reduce delayed discharges and length of stay whilst improving patient safety and promoting independence.
• Services designed around the individual with simple access, in a consistent manner
As part of the health economy discussions Clinical
Commissioning Groups are reviewing our community
• An entitlement to a single assessment of need and agreed personalised care plan
• Case management for highest need individuals and a named Case Manager responsible for organising care
• Access to a personal health budget where appropriate hospital bed provision. The focus will include step up and down beds, specialist beds and end of life care.
The emphasis as we move forward will be to work in partnership with providers from across the pathway to provide services in the most appropriate setting.
• Access to technology enabled care and minimising duplication of services
We are also looking to explore opportunities to improve
Children’s Services and are scoping how health and social care health outcomes could be improved through
10 | Quality Account partnership working and service redesign.
To develop and deliver sustainable and innovative services the Partnership Trust is seeking to utilise technological improvements to improve service user care and the delivery of productivity targets, as outlined in the Information Management and Technology
Strategy. Through the introduction of smartphones and laptop devices there will be a reduction in requirements of travel by community staff and in the number of appointments needed with service users which will increase productivity.
People with long term conditions (e.g. Diabetes,
Hypertension, Chronic Obstructive Pulmonary Disease) will be supported to manage their condition with the aid of telehealth initiatives which will reduce the need for them to present at A&E or their GP surgery and enable people to live more independently.
The use of Personal Budgets or Direct Payments will be supported which will enable people to arrange and purchase their own care and support should they choose to do so. Self- Directed Support is a key part of achieving our vision to deliver personalised care and empowering people to be independent and able to make choices about how they live their lives. This is endorsed through the implementation of the Care Act
2014.
We are pursuing new business opportunities, such as sexual health and lifestyle services, that can enhance the services we already provide. This brings benefits to our local population and complements our continued provision of joined up services within a reducing financial envelope.
Service user experience -
Physiotherapy department based at Sir Robert Peel Hospital
“In all the years where I have had physiotherapy at several other service providers, I have never had such a comprehensive physiotherapy session where I have felt completely confident in the person conducting the session. I felt that the physiotherapist really understood what was happening to me and offered to help solve my problem without more drugs. I was highly delighted with my physiotherapist and the way which the appointment was managed. He was outstanding.”
Quality Account | 11

Our Quality Framework is our 5-year strategic document for quality. We have many strategies and work streams related to quality – the Quality Framework gives an overall direction for these strategies.
The Quality Framework’s aim is that all service users receive the highest quality of care, by ensuring that frontline teams are empowered by the organisation to provide this.
The Quality Framework is supported by four key strategies and work streams, which provide more detail on how we will improve the quality of our services:
• Safety Strategy
• Effectiveness Strategy
• Experience Strategy
• Quality Assurance Programme
For more information see our website: www.staffordshireandstokeontrent.nhs.uk/About-Us/ quality-framework.htm
• Our Trust Board receives monthly quality reports.
• Performance scorecards including key quality performance indicators are shared on a monthly basis at Trust Board and Committee level.
• Matrons use a quality assurance “Ward to Board” dashboard, designed to give assurance that what is discussed at Board level actually happens in the ward.
• Operational divisions / directorates review monthly reports on quality at their local Safety and
Effectiveness Operational Groups.
Service user experience
- Moorlands Community
Intervention Service
“I am very grateful for the kindness and care I received from you in my home. This wonderful service has helped me to get back to a normal routine and re-establish my independence. I will never forget all the kindness shown to me and I wish you all the very best for the future, in your most valuable work within the community.”
SSOTP Quality Account | 13 12 | Quality Account

• Our existing priorities from 2014/15 that need to be maintained
• National guidance and best practice
• Views from our staff, commissioners, partner agencies and others
• Our vision, strategic goals and objectives
• Emailing stakeholders and inviting them to comment and forward the documents to their colleagues
• Holding consultation sessions that included invitations to Partnership Trust staff, Clinical Commissioning Group leads, partner agencies and Trust members
• Posting the consultation documents on our internet site
• Running webinars and Tweet chats.
The comments from the consultation were considered by our Executive Management Team in March 2015. Our Safety and Effectiveness Subcommittee approved our priorities in April 2015.
A full consultation report, with full details of each quality priority, is available on our internet site at: www.staffordshireandstokeontrent.nhs.uk/About-Us/quality-account.htm
Our aim:
This year, and previous years, we have focussed on reducing avoidable grade 3 and 4 pressure ulcers developed in our care. We will continue this work and will work on reducing the number of serious incident falls developed in our care.
We will continue to run our Tissue Viability and Falls panels to review incidents reported. These panels help us to continually learn and reduce the harm within our care.
We will continue to measure the overall number of incidents reported, and the proportion of serious incidents, as we view this as a measure of our safety culture. We will report this data to our Trust Board.
In 2014/15 NHS England launched Sign up to Safety, and we have joined this campaign 2 .
Sign up to Safety is designed to help realise the ambition of making the NHS the safest healthcare system in the world by creating a system devoted to continuous learning and improvement.
Sign up to Safety aims to deliver harm free care for every patient, every time, everywhere. It champions openness and honesty and supports everyone to improve the safety of patients.
Sign up to Safety’s three year objective is to reduce avoidable harm by 50% and save 6,000 lives across the NHS.
We have developed a Sign up to Safety Improvement plan which shows how we will reduce harm for service users over the next three years with the focus on pressure ulcers and falls.
The core principles of this plan are to put safety first, to ensure we continually learn, be honest, work collaboratively and provide support to individuals.
Service user compliment
- Tamworth’s Community
Intervention Team
“To the caring CIT team, for all your dedication, for being so caring and considerate, for answering all my questions for me, all your lovely smiling faces for being there when needed. Without all of you I would be in hospital, thank you from the bottom of my heart.
2 See www.england.nhs.uk/signuptosafety/whos-signed-up/staff-stoke/
Quality Account | 15
| Quality Account

Measures for 2015/16 Why this is important
Number of avoidable and attributable grade 3 and 4 pressure ulcers developed in our care
Number of serious incident falls reported whilst in our care
2015/16 target
Nationally, the majority of pressure ulcers are understood to be preventable and could be avoided through simple actions by frontline healthcare staff, and by patients and carers.
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Zero grade 3 and 4 avoidable and attributable pressure ulcers developed in our care in community hospitals
Reduce the incidence of avoidable and attributable community grade 3 and 4 pressure ulcers developed in our care, by a minimum of 10% for 2015/16 (with a tolerance of 23 cases maximum in community services during
2015/16.)
Nationally, inpatient falls are understood to be one of the most commonly reported patient safety incidents.
Falls are a major concern for patient safety and a marker of care quality.
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Reduce serious incident falls in all our care settings, by a minimum of 10% for 2015/16
(with a tolerance of 12 cases maximum in our community hospitals and bed-based rehabilitation services)
3 See www.nhsiq.nhs.uk/improvement-programmes/patient-safety/pressure-ulcers.aspx
4 See www.patientsafetyfirst.nhs.uk/Content.aspx?path=/interventions/falls/
Our aim:
We view our overall “Friends and Family Test” as a useful indicator of the overall experience and satisfaction of our services. We also use other survey and involvement methods to uncover the details behind this high-level indicator.
We want our complaints processes to work well, and to provide us with valuable insights to improve our services.
We will continue to use our volunteer-led complaints panel to support us in doing this.
We also want to improve our service user’s experience of personalisation 5 , especially for social care. For example, our service users receive a copy of their care plan, the care plan involves them, and the plan clearly identifies their needs and outcomes to be achieved.
We want to encourage improvements in our services which are identified by our service users and carers.
Linked to one of our Commissioning for Quality and
Innovation (CQUIN) schemes for 2015/16, we have also included an indicator around service user and carer stories.
We know that these stories are a proactive way to improve our service user’s experience of care. We will use these stories, working with our partner agencies to improve whole pathways of care. We will start this work with the care pathway for patients with respiratory conditions.
In 2014/15 we consulted with our service users and carers, and developed four core work programmes for 2015/16.
We will also develop surveys and factsheets to highlight these areas:
• High quality of care
• Giving the right information to our service users and carers
• Decision-making tools
• Ensure that we listen to our service users and carers
5 See also Priority 3.
16 | Quality Account Quality Account | 17

Measures for 2015/16
Friends and Family Test
Health and social care compliments received about
Partnership Trust services
Reporting service user and carer feedback by word clouds
Why this is important
The Friends and Family Test has been in use across many parts of the NHS since October 2013. It is now in use in almost all NHS services. Feedback gathered can be used to stimulate improvement in our services.
2015/16 target
Improve our Trust wide score, so that more than 90% would recommend our services to their friends and family if they needed similar treatment, and less than 5% would not recommend us.
Each Operational Team will be monitored monthly to improve their individual scores.
Monthly recommendations from our service users experience will be incorporated into each Operational Teams actions of improvement.
Feedback gathered can be used to stimulate improvement in our services.
Year on year increase in the number of compliments received
Distilling service user feedback to highlight positive and negative patterns, which can assist our teams to determine improvement opportunities based on themes.
Monthly service user and carer feedback will be introduced from April 2015 through data reported in word clouds. Feedback will be reported monthly and aligned to each teams experience targets.
Our teams will use this information to improve their services.
Friends and family test for carers
Service User experience surveys within health and social care
Number of Complaints that are reviewed by our
Independent Complaints
Review Panel
Feedback gathered can be used to stimulate improvement in our services.
Maintaining a large sample ensures that our teams regularly obtain feedback from service users, and increases confidence in the results.
We will continue our open and honest approach to investigating and responding to complaints.
Improve our Trust wide score, so that more than 90% who would recommend our services to their friends and family if they needed similar treatment, and less than 5% would not recommend us.
Ensure that we receive at least 1300 responses each month from our service users.
Ensure that we receive at least 200 responses each month from our carers.
We will use the feedback to continually improve our health and social care services.
We will introduce an integrated Health and Social Care Survey from April 2015 for
Integrated Local Care Teams.
In 2014/15 the panel reviewed 23 complaints.
Panel to review a minimum of 20 complaints in 2015/16, split across the divisions, including multi-agency complaint responses.
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Measures for 2015/16 Why this is important
Actions taken in response to recommendations by our
Independent Complaints
Review Panel
We will continue our open and honest approach to investigating and responding to complaints.
Publication of complaints and outcomes of investigations and findings of the Independent
Complaints Review Panel
2015/16 target
Implement and demonstrate learning from all recommendations from the panel.
Panel to make an annual report to our Trust
Board.
We will continue our open and honest approach to investigating and responding to complaints.
First report on our website in quarter 1.
Care plan audits: proportion of people receiving a copy of their care plan (social care support planning)
Develop Patient stories
Feedback from service users and carers on the quality of care that they have received from our services.
The ADASS national survey highlighted good practice around copying care plans to service users, compared with our
2014/15 baseline audit
Develop Patient storiesPatient stories can be an important component in understanding what has happened to a patient, in conjunction with their perceptions of the health care they have received.
Patient stories are gathered by interviewing patients directly, face-to-face or by telephone, to gather their insights on the care they have received.
We know that many additional
A&E attendances are related to respiratory conditions. Improving the respiratory pathway will help to reduce unnecessary
A&E admissions to University
Hospitals North Midlands.
In 2014/15 we consulted with our service users and carers; this was a core theme from their feedback.
The baseline audit result for 2014/15 was
55%
Target: increase to 95% by the end of
2015/16
Publish 16 patient stories, associated learning, and improvement actions, in relation to the
North Staffordshire respiratory pathway for
2015/16
Improve our Trust wide monthly score, so that at least 90% of our service users and carers are extremely satisfied with the quality of our services.
Quality Account | 19

Measures for 2015/16 Why this is important
Feedback from service users and carers on whether we provide accurate health and social care information to support their recovery through an episode of ill health or injury.
In 2014/15 we consulted with our service users and carers; this was a core theme from their feedback.
Feedback from service users and carers that they feel involved in decisions regarding their individualised plans of care.
In 2014/15 we consulted with our service users and carers; this was a core theme from their feedback.
Feedback from service users and carers that they feel supported to manage their health or social care needs.
In 2014/15 we consulted with our service users and carers; this was a core theme from their feedback.
2015/16 target
Develop baseline in Q2
Aim for at least 90% of our service users and carers agree that accurate health and social care information to support their recovery through an episode of ill health or injury is provided.
Develop baseline in Q2
Aim for at least 90% of our service users and carers agree that they feel involved in decisions regarding their individualised plans of care.
Develop baseline in Q2
Aim for at least 90% of our service users and carers agree that they feel supported to manage their health or social care needs.
6 See www.england.nhs.uk/ourwork/pe/fft/
7 See http://betterevaluation.org/evaluation-options/wordcloud
8 Subject to agreement with commissioners and pending development of integrated survey methods.
9 In April 2014 the Partnership Trust introduced an independent panel for the review of complaints. Panel volunteers are offered education and training on the complaints process. Reports, with the outcomes of the complaint along with actions of improvement, are shared across the Trust.
10 See https://www.gov.uk/government/publications/nhshospitals-complaints-system-review
11 See https://www.gov.uk/government/publications/nhshospitals-complaints-system-review
12 See https://www.gov.uk/government/publications/nhshospitals-complaints-system-review
13 See www.kingsfund.org.uk/projects/pfcc/patient-stories
14 As part of our CQUIN 2015/16 initiatives, the 16 patient stories along with actions of improvement will be published on our website. We will review all 16 patient stories with our
Commissioners to improve the Staffordshire Respiratory Pathway for our service users.
15 Supplemental to the friends and family test question
Service user compliment -
Rehabilitation Centre at
Samuel Johnson Hospital
“I became more aware of the importance of exercise and posture to aid my Parkinson’s. I found the sessions fun. We were informed without being preached at, and all times treated with patience and respect.”
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Our aim:
We want to provide effective services with positive outcomes for our service users. We know that quality improves when we focus on the outcome – “the end result” – for the service user. To focus on the outcome means to focus on individual needs and preferences, not simply tasks.
Now that many of our therapies teams are routinely measuring and reporting outcomes, we want to use this data to drive improvements in our services.
During 2015/16:
• We will continue our work to expand our use of outcome measures.
• Our teams will focus on using outcome measures in their everyday practice so they can demonstrate improvements for individual service users.
• We will make use of Practice Audit (including clinical and social care audit) as a method for frontline teams to review and improve their outcomes, using their established outcome measures.
• We will roll out the use of the EQ-5D in identified
Community Intervention Services
• We will explore the use of alternative outcome measures for our Integrated Local Care Teams
Measures for 2015/16
Why this is important 2015/16 target
Number of teams demonstrating improvement in their outcome measures
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One of the goals in our quality framework is to provide effective services with good outcomes for our service users.
Focussing on outcomes reflects a whole-systems approach to health and social care. As outlined in our Effectiveness
Strategy, we want our front line teams to have information on the outcomes of their services, and use this to improve their services.
All applicable frontline teams collect and analyse outcome data, and have plans for improving the outcomes of their service.
Applicable teams:
• Allied Health Professional teams
• Multidisciplinary teams (e.g. Falls, Rehabilitation, Pain
Management)
• Children’s clinical teams
• Community Intervention Services
Our aim:
We want our integrated adult health and social care teams to focus on giving service users choice and control over the shape of the support we give them. This is called “personalisation”. Although traditionally a social care concept, we want our health and social care teams to work to have a shared understanding of personalisation 16 .
A recent national personalisation survey tells us “what good looks like” around personalisation 17 . We will expand our work on personalisation, reflecting the priorities in Making It Real 18 .
We also want to offer people up-do-date choices and easily accessible information. We are working with our local authority to develop and promote an e-marketplace. We want to ensure all our people receiving social care can benefit from this service.
We want to promote person-centred care for our service users, so that our staff focus on helping them to be independent. To do this, we will train our staff in person-centred care.
As part of the improvements we are making to social care, we are developing new baselines and targets for our social care indicators in 2015/16. The targets will be agreed in July 2015 with our social care commissioners.
16 See the Social Care Institute for Excellence article on implications of personalisation for NHS staff: www.scie.org.uk/publications/ataglance/ataglance30.asp
17 See “ADASS Personalisation Survey 2014” in the appendix
18 We will continue to work on “Making It Real” in 2015/16, as we have done over the last two years.
Quality Account | 23

Measures for
2015/16
Use of e-marketplaces
Why this is important
The ADASS personalisation survey showed that, nationally, “least progress is recorded on creating e-marketplaces” .
2015/16 target
Work with Staffordshire County
Council to increase use of the e-marketplace for social care
Ensure that all social care staff have information on how to access the e-marketplace, including
Staffordshire Cares
Ensuring our adult social care frontline staff are trained in reablement and personalisation philosophy
Earlier diagnosis, intervention and reablement means that people and their carers are less dependent on intensive services.
Personalisation means building support around the individual and providing people with more choice, control and flexibility in the way they receive care and support – regardless of the setting in which they receive it.
Ensure that key staff in all
Integrated Local Care Teams,
Community Intervention Services, and Living Independently
Staffordshire teams have received person-centred care training
(personalisation)
Proportion of people who feel that they were supported to make their own decisions about their social care and / or services (1b proxy)
We want our service users to be able to manage their own support as much as they wish, so they are in control of what, how and when support is delivered to match their needs
We want our service users to be able to manage their own support as much as they wish, so they are in control of what, how and when support is delivered to match their needs
Maintain at least 85% through the whole year
78%
14
at least
11
Proportion of people who receive self-directed support and / or direct payments (SC10a-c)
We want our service users to be able to manage their own support as much as they wish, so they are in control of what, how and when support is delivered to match their needs
Achieve 80% by the end of the year (self-directed support)
12
Achieve 45% by the end of the year (direct payments) 13
Indicator 1b: Proportion of people using social care that have control over their daily life
(via National annual survey)
19 See www.adass.org.uk/home/
20 Subject to agreement with commissioners, to be reviewed in line with revised models for social care
21 Subject to agreement with commissioners, to be reviewed in line with revised models for social care
22 Subject to agreement with commissioners, to be reviewed in line with revised models for social care
24 | Quality Account Quality Account | 25

Our aim:
In 2014/15, we published monthly shift-by shift staffing levels and two staffing establishment reviews for our community hospitals, in line with national guidance.
15
We have already taken action in 2014/15 to ensure that our wards remain safely staffed, and have started work on determining optimum staffing levels for many of our community services. In 2015/16 we will continue this work, providing clear information for all our teams on safe staffing levels.
We also recognise that safe staffing is a big part of a good safety culture.
We will continue to measure the overall number of incidents reported, and the proportion of serious incidents, as we view this as a measure of our safety culture. We will continue to report this data to our Trust Board.
The Freedom to Speak Up report gives us 20 principles and actions to create the right conditions for a positive safety culture. Our Safety team, Complaints and PALS teams, Service Improvement Team, and our Ambassador for Cultural
Change will work together to continue a positive safety culture during 2015/16. We will enable, empower, and encourage our staff to raise safety concerns.
23 Subject to agreement with commissioners, to be reviewed in line with revised models for social care
24 See www.england.nhs.uk/wp-content/uploads/2013/11/nqb-how-to-guid.pdf
Measures for 2015/16
Publish monthly staffing levels for our community hospital wards, including agreed establishment, safe staffing level in relation to acuity, and actual staffing levels
Publish two acuity staffing establishment reviews, which look at safe staffing levels in community hospitals, during
2015/16
Community staffing levels
(Workforce planning toolkit)
Number of “near misses” reported
Why this is important
This will contribute to improved care for patients by ensuring that effective staffing levels are continually presented, challenged, owned and discussed at Board, commissioning and front line level.
This information shows that we regularly review our plans for safely staffed community hospitals.
Staffing capacity and capability should be discussed at a public Board meeting at least every six months on the basis of a full nursing and midwifery establishment review.
National guidance on staffing levels has not been published yet. This information shows that we are working on developing safe staffing levels for our community services.
To give our service users confidence that staffing levels in community teams are as important to us as hospital staffing.
Safety is everyone’s job; staff on the lookout to improve safety will see and report more incidents and “near misses”. We want all staff to be
“quality inspectors”.
Services that report more “near misses” have a better safety culture.
Total number of adverse incidents reported to the Trust
(all incidents)
Report more incidents and “near misses”. We want all staff to be
“quality inspectors”.
(Aligned to indicator 5.6 in the
2015/16 NHS mandate)
Total number of patient safety incidents, as reported to the National Reporting and
Learning System.
Services that report more “near misses” have a better safety culture.
2015/16 target
Staffing is always at a safe level in relation to shift-by shift service need, taking into account the demand on the service
Reviews will make use of national guidance, professional body guidance and best practice on staffing levels, and will aim to demonstrate appropriate staffing establishment and skill mix, for the provision of safe care
All our teams will be assessed against national guidance and our workforce tool to ensure we have the right staff and skills in place to deliver safe care
Redesign or recruit the workforce against the agreed staffing levels
Complete the competency frameworks, ensuring training needs for each individual team are delivered.
25% increase from 2014/15 baseline during 2015/16
Our ambition is to increase the number of incidents reported by 10%, compared to all incidents reported during 2014/15.
We want to improve our patient safety incident reporting rate to be within the median range of other community trusts with bed-based services.
Quality Account | 27 26 | Quality Account

Measures for 2015/16
Percentage of reported serious incidents applicable to the
Trust
(Aligned to indicator 5.6 in the
2015/16 NHS mandate)
Formally reported safety concerns, as outlined by the
Freedom to Speak Up report.
Why this is important
If a team has an increasing proportion of serious incidents there may be a safety issue. Services that report more incidents, with a low proportion of serious incidents, have a better safety culture.
As recommended by the Freedom to
Speak up report; we want our staff to be able to raise concerns. We will to use this information to improve quality.
Promotes a culture of staff/patients/ carers being able to raise concerns.
Demonstrates that the Trust engages with Staff to take concerns seriously.
2015/16 target
Reduction in proportion of serious incidents from all reported incidents
Publish in our 2015/16 Quality
Account quantitative and qualitative data describing the number of formally reported concerns in addition to incident reports, the action taken in respect of them and feedback on the outcome.
16
Percentage of staff (by staff group and profession) who had an appraisal in the last 12 months
Important process of valuing staff and ensuring that they understand their responsibilities in line with corporate vision and objectives.
90% of all our directly employed staff will have had an appraisal with the last 12 months.
Percentage of staff (by staff group and profession) who have received all statutory and mandatory training within
Trust timescales
A well-trained workforce is critical to quality care.
Develop a robust reporting mechanism for mortality across the trust: Review every death in a community hospital and every unexpected death where we are the lead provider, reviewing systems and processes, and implement changes across the five community hospitals.
A well-trained workforce is critical to quality care.
90% of all our directly employed staff will have received all statutory and mandatory training within Trust timescales
Reporting system implemented and fully compliant by July 2015 at latest.
25 See A promise to learn – a commitment to act, available at https://www.gov.uk/government/uploads/system/uploads/ attachment_data/file/226703/Berwick_Report.pdf
26 Subject to national guidance following the consultation on the implementation of the Freedom to Speak Up report. See https:// www.gov.uk/government/consultations/measures-to-help-staff-speak-out-about-patient-safety
28 | Quality Account
Our focus for this next year is to ensure that staffing levels are in line with the Workforce Planning Toolkit outcomes or as defined by commissioning specifications.
Considerable efforts are being made to recruit and attract
Nurses into our District Nursing, Hospital and Offender
Health Services. This is being undertaken via specific campaigns and additional resources have been brought in to ensure that this is undertaken in a timely manner.
Our Matrons have been involved in a specific initiative to recruit Nurses from Spain and we are working proactively with local universities to promote community/offender health services as a career for newly qualified nurses.
We are reviewing our mentoring and preceptorship programmes to ensure that new staff to the Trust receive the appropriate support and development. We are also reviewing our exit interview process to ensure that we build a robust retention strategy to ensure that staff are not leaving the Trust for adverse reasons.
We want to further empower our operational front line teams to deliver quality. We know that our frontline staff are key to improving the quality of care we provide.
Our Quality Framework 27 and strategies for quality 28 are the main way we will address our quality improvement priorities. Our Nursing and Quality Directorate will support the delivery of these strategies, working closely with several other teams:
• Service Improvement Team
• Workforce Transformation Team
• Healthcheck Team
• Organisational development Team
• Performance Team
• Professional Leads
• Research and Innovation Team
The Quality Governance Committee is the principal committee charged by our Trust board to lead on quality. This committee, and Its Safety and Effectiveness Subcommittee, will regularly review our progress against these priorities.
Also, each of our divisions has a Safety and Effectiveness Operational Group. These groups will review all areas of quality in their own divisions.
27 See our Quality Framework, available on our website here: www.staffordshireandstokeontrent.nhs.uk/Quality%20files/
Quality%20Framework%20final%20v3.5.pdf
28 See our Safety, Effectiveness, and Experience strategies on our website here: www.staffordshireandstokeontrent.nhs.uk/About-Us/quality-framework.htm
Quality Account | 29

During 2014/15 Staffordshire and Stoke on Trent NHS Partnership Trust provided and / or sub- contracted 71 NHS services.
The Staffordshire and Stoke on Trent NHS Partnership Trust has reviewed all the data available to them on the quality of care in 71 NHS services .
The income generated by the NHS services reviewed in 2014/15 represents 100% of the total income generated from the provision of NHS services by the Staffordshire and Stoke- on-Trent Partnership Trust for 2014/15.
During 2014/15, three national clinical audits and one national confidential enquiry covered NHS services that
Staffordshire and Stoke on Trent NHS Partnership Trust provides.
During this period Staffordshire and Stoke on Trent NHS Partnership Trust participated in 100% of National clinical audits and 100% of National confidential enquiries which it was eligible to participate in.
The National clinical audits and National Confidential Enquiries that Staffordshire and Stoke on Trent Partnership NHS
Trust participated in during 2014/15 are as follows:
The National clinical audits and National confidential enquiries that Staffordshire and Stoke on Trent NHS Partnership
Trust participated in, and for which data collection was completed during 2014/15, are listed in the table 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.
Feedback form nine year old sister of a service user - Speech & Language
Therapy Service
“My brother has amazed me with his speech. I am so happy that he is learning step by step. I hope that he improves on this even though he is a bit behind I am proud of him! I am really happy about his reading, thank you for looking after him.”
30 | Quality Account
National Clinical Audits and national confidential enquiries
Audit
National Audit of Intermediate Care
Sentinel Stroke National Audit Programme
(Organisational Data)
Sentinel Stroke National Audit Programme
NCEPOD Sepsis Study
Participation
Yes
Yes
Yes
Yes
No of cases required to be submitted by teams
N/A – data provided was not service user specific
N/A – Data collection due to start
Summer 2015
618
5 (one for each
Community
Hospital)
Cases
Submitted by teams as a percentage of cases required
N/A – data provided was not service user specific
N/A
100%
100%
The Trust is also participating in the following National clinical audits, with data submissions due in
2015/16:
• National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme
• UK Parkinson’s Audit (Previously known as National Parkinson’s Audit)
• National Diabetes Foot Ulcer (Adult)
The report of five national clinical audit reports was reviewed by the provider in 2014/15 and Staffordshire and Stoke on Trent Partnership NHS Trust intends to take the following actions to improve the quality of healthcare provided:
• Adult Community Acquired Pneumonia – no actions applicable
• Emergency Use of Oxygen– no actions applicable
• Paediatric Pneumonia– no actions applicable
• Pulmonary Hypertension– no actions applicable
• UK Parkinson’s Audit– no actions applicable
Quality Account | 31

The reports of 55 local clinical audits were reviewed by the provider in 2014/15 and Staffordshire and Stoke on Trent
Partnership NHS Trust intends to take the following actions to improve the quality of care provided in health and social care delivery.
Table 1: Changes to practice (not exhaustive)
Title of Audit Actions to improve quality of care
Links with other quality initiatives
Falls – Preventing
Falls in Older
People admitted to community hospital
Four standards had over 90% (n=21) compliance with NICE guideline 161 for overall assessment of risk for service users who are prone to falling. A multi-factorial assessment tool was routinely used, and the process was supported by a 95% compliance with documentation about the service user’s history of falling.
A check list for falls risk assessment has been developed and implemented on the hospital wards and forms part of the overall care package.
NICE guidance 161
Improving the quality of inhaler technique for patients with
Chronic Obstructive
Airways Disease
(COPD) on first assessment with community matron service
Audit demonstrated that 88% (n=49) of patients had received inhaler technique training in the last 12 months, in line with NICE guidance.
Improvement to inhaler technique by service users was provided by the implementation of standardised education package supported by user friendly literature. Half of those with poor technique were provided with spacer devices to improve technique further and to maximise the benefit of inhaler medication.
NICE guidance 101
Re-audit of the implementation of the World Health
Organisation (WHO) surgical checklist
(community dentistry)
Monitoring the appropriateness of the use of chaperones for intimate examinations in sexual health services
100% (n=28) compliance was achieved with the WHO surgical checklist, which provides a mechanism to ensure that all appropriate safety checks are undertaken prior to any patient receiving sedation for dental care.
Where staff provide a service in facilities not owned by the Trust, the use of the Trust version of the check list was implemented to ensure full compliance and minimise any risk to patient safety.
95% (n=221) of cases a chaperone was available for intimate examinations. 5% had non-availability recorded and offered another appointment.
Changes to documentation have been made to document the name and role of the chaperone for each occasion, and ensure documentation of patients offered a chaperone but who declined the offer. Increased use of health care assistants to ensure the likelihood of the non-availability of chaperones and the need for patients to be offered another appointment is reduced.
National Patient
Safety Alerts
Patient Experience
32 | Quality Account
Title of Audit Actions to improve quality of care
Links with other quality initiatives
Improving the timeframe for the “Discharge to
Assess” process for
Living Independently in Staffordshire service
The audit showed that care packages were in place within the required timeframe for 82.2% (n=79) of cases.
Improvements in legibility to paper based records by the implementation of electronic (computer) driven documentation.
Review of assessment flow process to remove unnecessary stages
(duplication) and improve the transfer of care experience for patients.
Integrated health and social care service
The number of service users receiving NHS services provided or sub contracted by Staffordshire and Stoke on Trent
Partnership NHS Trust in 2014/15 that were recruited during that period to participate in research approved by a
Research Ethics Committee was 597.
The Partnership Trust has 42 approved studies on the National Institute of Health Research portfolio and 5 non portfolio studies. Over the past year the Research Delivery Unit has made considerable effort to increase the research activity within the trust. The Partnership Trust participation in commercial studies has also grown.
NIHR portfolio studies
Rheumatology
2013/14
32
75%
2014/15
42
64.3%
There has been an increase in staffing levels and temporary staff to support research studies. Secondments from Research facilitators have had a positive effect leading to an increase in recruitment for community studies.
Research that the Partnership Trust took part in included:
Stroke
Community
15.6%
9.4%
14.3%
21.4%
• An interventional study to assess the efficacy of openlabel Tocilizumab as monotherapy or in combination with MTX or other non-biologic DMARDs for
Rheumatoid Arthritis. The Research team achieved the target of 5 patients that had been originally set. A new target to 9 has now set
• The Research delivery unit has been awarded a certificate for being the 2nd unit to research 100 patients within an observational study which observes two cohorts of Ankylosing Spondylitis patients
• A study to investigate if functional strength training can reduce weakness and improve recovery post stroke
• A study investigating neurorehabilitation needs in people with neurological conditions
• An investigation of National Guidance for Measuring Home Furniture and Fittings to Enable User Self-assessment and Successful Fit of Minor Assistive Devices
• A study to evaluate the Accu-Chek insight insulin pump and associated pump devices in routine practice
• A study that investigates to the impact of chronic disease co-morbidity on patients with heart failure
Quality Account | 33

In 2014/15 a proportion of our income – 2.5% of healthcare services commissioned through the standard NHS contract
– was conditional on achieving quality improvement and innovation goals. The goals were agreed between ourselves and our NHS commissioners through the Commissioning for Quality and Innovation (CQUIN) payment framework.
The Trust achieved 68.97% (by value) of all its CQUIN initiatives. Achievement (by value) was less than 100% for the following initiatives:
• 2 Safety Thermometer: 0%
• 4 Raising Concerns: 63%
• 6S partnership for patients: 76%
• 8 Seven Day services: 30%
Further details of the agreed goals for 2014/15 and for the following 12 month period are available electronically at: www.staffordshireandstokeontrent.nhs.uk/About-Us/quality-and-innovation.htm
Table 2: CQUINS achievement for 2014/15
2014/15 Commissioning for Quality and Innovation (CQUIN) schemes
1 Friends and
Family Test
(FFT)
Implementation of staff FFT as per guidance, according to the national timetable.
Early implementation.
Phased expansion.
Achieved 29
Q1

Q2

Q3

Q4

2 Safety
Thermometer
Reduction in the prevalence of pressure ulcers (non-mandatory, commissioners may agree a different improvement goal if pressure ulcer improvement is not appropriate).
Year end:
3 User empowerment
/ Customer
Service
Introduce Customer Service Review Panels which consist of Chairs from
Voluntary Organisations who will become “critical friends” of the Trust.
Meetings will be held monthly for the scrutiny and review of a minimum of 12 complaints by quarter four.
Within this innovation, the Customer Service Review Panel will scrutinise the complaints process and outcomes following the complaint. Monthly actions of improvement will be developed through the model of Plan-Do-Study-Act
(PDSA) cycles.
Q1

Q2

Q3

Q4

2014/15 Commissioning for Quality and Innovation (CQUIN) schemes
4 Raising
Concerns
Achieved 29
Deliver a comprehensive programme of support for Trust staff in order to develop a positive culture for all.
The quality improvements from this programme will be (a) decrease in patient safety/quality issues as staff feel more confident to challenge poor practice and (b) there is clear national evidence that staff who feel happy and valued within the workplace will automatically deliver better quality care.
This will be evidenced via the Patient Family and Friends Test and the annual
Staff Opinion Survey.
Q1 Partial
Q2

Q3

Q4 Partial
5N Mental
Health ILCT
The CQUIN intends to embed a holistic way of working to ensure that both the mental health and physical health of the patient is considered and incorporated into a single holistic care plan as appropriate reflecting the needs of the patient. In order to achieve this the use of the Patient Health
Questionnaire (PHQ) 9 & Generalized Anxiety Disorder (GAD) 7 tools and a locally adapted tool (currently used within primary care) as part of the long term condition patient care assessment will be utilised. Staff within Integrated
Local care Teams (ILCTs) would be up skilled to provide self-help advice or where appropriate discussion with or referral onwards to Improved Access to Psychological Therapies (IAPT) services. Training will be provided by the 2 local IAPT service, North Staffs Wellbeing Service and Healthy Minds (Stoke), and will be cost neutral to the provider. The overall aim is for training to be provided to all ILCT’s. The IAPT service will also provide a named therapist for each ILCT for support and advice.
Q1

Q2

Q3

Q4

6N Seamless and Safe
Handover
This CQUIN aims to support the transfer of patients from the Royal Hospital of
Staffordshire through the LIS “Discharge to Assess” process (D2A) model of care in Q3. The aim of the CQUIN scheme was to increase discharge patient flow through the introduction of D2A safe and seamless handovers from the
Acute Trust.
Q1

Q2

Q3

Q4

5S Outcomes for Local Teams
The purpose of this CQUIN is to incentivise Integrated Local care Teams
(ILCTs) to implement EQ 5D and to use this measure to identify priorities for continuous improvement on an ongoing basis. Integrated teams will be able to analyse outcome measures across a cohort of similar patients to identify those parts of the service that are working well and those with the most scope for improvement. The EQ5D has been identified as the most appropriate outcome measure identified (a pilot has been completed with the
University of Sheffield).
Q1

Q2
Q3



34 | Quality Account Quality Account | 35

2014/15 Commissioning for Quality and Innovation (CQUIN) schemes
6S
Partnership for patients
7S ILCT –
Medication
Safety
The overall aim of this scheme is to support the work taking place by the
Discharge Co-ordinator(s) employed by Staffordshire and Stoke on Trent NHS
Partnership Trust, who is based at Burton Hospital Foundation Trust. The aim of the Discharge Coordinator(s) is to a) support early discharge from hospital, through liaison with community services who deliver support to patients in the community; b) Redirect appropriate patients in ED/AAC to community services.
The NHS Outcomes Framework requires us to focus on a small number of key outcomes that we must measure together. Domain 5 includes an
“improvement area indicator that will cover” incidence of medications errors causing serious harm. This CQUIN will be targeted at Specialist teams as they have comprehensive knowledge of, and access to Medications information.
The focus of the CQUIN will be the use of a suite of tools (Developed by
Central Manchester CCG) that allow the Clinicians to survey appropriate
Patients to collect data on four key Medication safety areas which can result in harm: (Omission, Dehydration / Overload, Antimicrobials, Poly Pharmacy).
8 Seven Day
Services
Critical to the development of a LHE which can respond to seven day demands is the development of clinical and social care services which can support improved communication, navigation, and leadership across all days of the week.
It is expected by supporting a workforce which has the flexibility to provide care over a seven day week, will meet the demands of the LHE and provide a qualitative service supporting patients to achieve their optimum health status in the right place and at the right time, and with no delays.
It is expected that this CQUIN will develop both services and workforce which will support the achievement of the following outcomes; access, coordination and continuity, proactive care, safety.
9 Case
Management of offenders with complex mental health needs
Trust to work towards ensuring that 95% of offenders identified as having a complex mental health need have an identified case manager (including a care plan) and that the case manager is known by the offender and that the offender is able to contact the case manager.
Achieved 29
Q1

Q2

Q3

Partial
Q1

Q2
Q3


Q4

Q1

Q2

Q3
Q4
Q1

Q2
Q3
Q4



10 Introduction of ASQ SE for the Health
Visiting Service
Implementation of a evidenced based assessment tool (ASQ SE) for early identification of social and emotional concerns in children 0-5 by HVs.
This will require the development of a clear criterion for use of the tool, a pathway for referral, and a training programme. It is planned that 60% of the
HV workforce are trained in this tool by the end of March 2015.
Q1

Q2
Q3
Q4



29 DRAFT achievement subject to agreement with commissioners
36 | Quality Account
Staffordshire and Stoke on Trent NHS Partnership Trust is required to register with the Care Quality Commission and its current registration status is registered without conditions. The Partnership Trust has no conditions on registration.
The Care Quality Commission has not taken enforcement action against the Trust during 2014/15.
The registration details are available on the Care Quality Commission website via the following link www.cqc.org.uk
.
Staffordshire and Stoke on Trent NHS Partnership Trust has not participated in any special reviews or investigations by the CQC during the reporting period.
The CQC has undertaken three inspection visits during 2014/15. These include the following:
Table 3: Care Quality Commission inspections undertaken in the Partnership Trust
Date/s Inspection Service / Location Inspection Outcome
30 June & 1July
2014
HMYOI Swinfen Hall – Inspection in conjunction with Her Majesty’s
Inspectorate of Prisons (Health Care)
16 February
2015
The CQC found us fully compliant with eight standards inspected.
5 November
2014
(responsive visit)
District Nursing Teams: (Milehouse,
Kidsgrove, Smallthorne and Trentside)
Haywood Hospital and Bradwell
Hospital
Trust wide, there were four areas for improvement which were identified as ‘must’ or ‘should’ be completed.
The CQC did not give us a rating against any standards for this visit.
HMYOI 30 Brinsford - Inspection in conjunction with Her Majesty’s
Inspectorate of Prisons (Health Care)
As of 29 April 2015, the Report is still awaited.
30 Her Majesty’s Young Offender Institution
Service user compliment -
Haywood Hospital Walk In
Centre
“I had to attend the Walk in Centre today and waited just under the stated time which was no problem. I saw a nurse who put me at ease and with the issue I had, she came up with some creative and comical ways
I could help myself at home. Good experience all round with nice caring staff!”
Quality Account | 37

The Responsive visit by the CQC on 5 November 2014 was to our District Nursing Teams (Milehouse,
Kidsgrove, Smallthorne and Trentside), and community hospitals (Haywood Hospital and Bradwell Hospital).
The CQC undertook the unannounced inspection in response to a number of whistle-blowing letters from staff.
The visit was not a comprehensive inspection and as such, the CQC did not provide ratings on the Trust. The report was published on 19 March 2015.
There were four areas for improvement which were identified as ‘must’ or ‘should’ be completed:
• Review the internal communication arrangements for the Ambassador for Change to ensure transparent lines of communication and staff feel reassured that the role is organisation wide, not part of the management process.
• Review nurse staffing in community adult nursing to ensure patient outcomes are not compromised, especially in those areas where waiting lists are in operation
• Ensure the health check process and outcomes are shared with staff to ensure they are engaged with the process and are aware of progress on staffing issues
• Review the methods currently used for communicating and engaging with staff to ensure there is a mechanism for the trust to monitor and measure the effectiveness.
An action plan has been developed to address these recommendations.
Staffordshire and Stoke on Trent Partnership NHS Trust is taking the following actions to improve data quality;
• Continue to deliver the data quality strategy, and approved data quality work plan for 2015/16
• Assess and score the data quality of those performance indicators identified as high priority.
• Assess the data quality of individual services using data quality questionnaires.
• Implement Trust wide support and training where required around the consistent use of systems and coding.
• Include data quality in staff communication tools to raise the profile and highlight requirements.
• Review and revise the data quality documentation included in the induction pack to bring up-to-date.
• Empower individual staff to take on a data quality role within their team with training and support.
Staffordshire and Stoke on Trent NHS Partnership Trust submitted records during 2014/15 to the Secondary Uses Service
(SUS) for inclusion in the Hospital Episode Statistics which are included in the latest published data.
The percentage of patients in the published SUS data which included the patient’s valid NHS number was:
• 100% for admitted patient care
• 100% for outpatient care
The percentage of patients in the published SUS data which included the patient’s valid General Medical Practice Code was:
• 100% for admitted patient care
• 100% for outpatient care
38 | Quality Account
Staffordshire and Stoke on Trent NHS Partnership Trust’s Information Governance Assessment Report score overall for
2014/15 was 76% and was graded Satisfactory .
We have achieved an overall score of 76 per cent in the Information Governance Toolkit; the overall rating attained was satisfactory with improvement plan. This is a national initiative aimed at improving data security across the NHS and demonstrates that we have systems and policies in place and they have been implemented. The Partnership Trust achieved the minimum level attainments in 38 out of the 39 toolkit requirements with an improvement plan to address the one remaining outstanding training requirement (112).
During 2014/15 we did the following in relation to Information Security and Information Governance:
• Developed a new e-learning training package for staff
• Hosted a Trust wide event promoting information sharing to protect adults
• Took part in a program of cyber security testing to ensure our electronic security controls are robust
• Issued a wide range of communications and guidance materials
• Developed new standards for the management of corporate records
• Held regular meetings of our Information Governance Steering Group
Clinical coding translates the medical terminology written by clinicians to describe a patient’s diagnosis and treatment into standard, recognised codes.
Staffordshire and Stoke on Trent NHS Partnership Trust was not subject to the Payment by Results clinical coding audit during 2014/15 by the Audit Commission.
Service user compliment - School nursing service Dawn Wood based at Biddulph Primary Care
Centre.
“You listened, gave lots of valuable advice and never once judged us. The breakthrough that she has made has been amazing and you don’t realise how much her life as changed and it’s all down to you. Thank you”.
Quality Account | 39

The core set of indicators below are part of the Quality Account mandatory reporting indicators and are applicable to our Partnership Trust.
Staffordshire and Stoke on Trent NHS Partnership Trust considers that this data is as described for the following reasons:
• As of 16 April 2015, latest data available on the Health and Social Care Information Centre (HSIC) pertains to
2011/12.
• The partnership Trust readmission rate is not significantly higher than the England average, after taking the 95% confidence interval into account.
Staffordshire and Stoke on Trent NHS Partnership Trust intends to take the following actions to improve this percentage, and so the quality of its services, by:
• Reviewing latest data once available
• Analysis of data and national comparisons and developing improvements via the Safety and Effectiveness
Operational Groups responsible for quality in community hospital inpatient services.
Chart 1: Comparison of readmission rates for 2011/12
Table 4: Mandatory quality indicator for readmissions
Quality Indicator
The data made available to the
National Health Service Trust or NHS
Foundation Trust by the Health and
Social Care Information Centre with regard to the percentage of patients aged— (i) 0 to 14; and (ii) 15 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.
31
Age
0-15
16+
2009/10
0.00
0.00
2010/11
0.00
2011/12
0.00
Comparator
2011/12
West Midlands region 10.65
(95% confidence:
10.45 to 10.85)
0.00
12.16
(95% confidence:
10.71 to
13.75)
England 11.45
(95% confidence:
11.42 to 11.48)
Table 5: Mandatory quality indicator for staff who would recommend the Trust
Quality Indicator 2011/12 2012/13 2013/14 2014/15
National
14/15
The data made available to the
National Health Service Trust or
NHS 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.
70% 64% 64% 65%
All trusts: 66%
Best 93%
Worst 35%
Community trusts: 70%
Best 83%
Worst 62%
Staffordshire and Stoke on Trent NHS Partnership Trust considers that this data is as described for the following reasons:
• The response rate of 35% is below average 44% response rate for community trusts in England, and compares with a response rate of 46% in the 2013/14 survey.
• The survey was administered by an external agency, allowing consistent comparisons of the experiences of staff across the NHS.
31 2010/11 and 2011/12 data: Numbers of patients too small for meaningful comparisons
40 | Quality Account Quality Account | 41

Staffordshire and Stoke on Trent NHS Partnership Trust has taken the following actions to improve this score, and so the quality of its services, by the following actions: has been mapped to the key performance criteria for Band
7 team leaders (Skills for Health).
The Trust has analysed the feedback from staff and used this information to inform its organisational development strategy. The Organisational Development Strategy has three strategic aims:
This programme will be adapted for other staff groups e.g.
Band 6 operational staff who are taking on leadership and management responsibilities.
To create a culture where individuals are empowered to fulfil their roles and support the Trust’s vision
To develop our leaders to be ambitious, innovative, empowered role models for other staff
Other Organisational Development initiatives include a range of support for teams who need some development.
This includes close working with Service Improvement
Managers to provide timely and well- planned interventions, coaching and designing team development days.
LEADERSHIP DEVELOPMENT AND TALENT MANAGEMENT
To support the continuous improvement of the Partnership
Trust so that it is effective, efficient and delivers quality safe care that meets the needs of the population it serves
There are four key work streams:
The Partnership Approach to Leadership was implemented in April 2014. The first part of the programme, ‘The
Gateway’ workshop is mandatory for all staff in leadership roles and over 700 staff have now attended.
VALUES: We introduced Values-Based Recruitment (VBR), with different options from values based questions within competency-based interviews to full values-based interviews. A ‘How to Guide’ has been produced which includes a bank of values based questions and VBR
Masterclasses are being held during 2015-16 to train staff in the techniques of VBR.
INVOLVEMENT: A Staff Involvement and Engagement
Strategy was signed off by the Trust Board in July 2014.
A range of activities were identified that involve different directorates and teams:
The Gateway introduces this approach which is based on compassionate and appreciative leadership. It includes an overview of key service improvement and business development elements. Attendance at this workshop enables access to other opportunities for Leadership
Development. These include external leadership courses such as those run by the NHS Leadership Academy, an internal 5 day programme for new managers and a schedule of 12 Masterclasses:
• Coaching for Managers
• Courageous Conversations
• 1 Vision quarterly events commenced in March 2014 and provide an opportunity for staff to meet with the Chief Executive and Executive Directors and hear about current Trust work as well as having an opportunity to ask questions and share their ideas.
• Engaging for Success
• Problem Solving
• Leading Upwards
• Technology Enabled care
• Leadership Forums are held quarterly for staff in leadership roles to listen to inspirational external speakers and have internal debate.
• Effective Team Working
• Understanding and supporting your workforce
• Raising Excellence is a campaign to highlight staff who really ‘live the values’. Nominations are received and the Chief Executive then sends personal ‘Thank you’ cards. All staff who receive cards are included in the nominations for the annual staff awards ceremony.
• Values-Based Recruitment
• CQC preparation
• Leadership & Management Essentials ( 5 days)
• Programme management
Staff involvement activities are monitored and implemented via the Organisational Health Group that has cross- directorate membership. Ideas for new activities are initiated from informal ‘Positivity Group’ forums.
TEAM WORKING: The Organisational Development team have designed a programme for operational Team Leaders that is being implemented in April 2015. This programme
A Talent pool has been identified as a result of using a new tool as part of Appraisal. Staff who wish to pursue active Talent Management have opportunities for shadowing, mentoring and internal secondments. This will link to the wider Local Education and Training Council initiative for Talent Management during 2015-16.
42 | Quality Account
Reporting incidents is considered a good indicator of the safety culture within an organisation as it helps staff to identify risks and take action to reduce them recurring.
Staffordshire and Stoke on Trent NHS Partnership Trust considers that this data is as described for the following reasons:
• Latest available data from the Health and Social Care Information Centre is for the period 1 April 2014 to 30
September 2014.
Table 6: Mandatory quality indicator for patient safety
Quality Indicator
1 Oct
2012 to 31
Mar
2013
1 April
2013 to
30
Sept
2013
1 Oct
2013 to 31
Mar
2014
The data made available to the
National Health
Service trust or
NHS foundation trust by the Health and Social Care
Information Centre with regard to 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.
Number of patient safety incidents
Rate of patient safety incidents
Number of safety incidents that resulted in severe harm or death
Percentage of Patient safety incidents that resulted in severe harm or death
1576
37.0 per
1,000 bed days
20 incidents
1.3%
1481
26 per
1,000 bed days
6 incidents
0.4%
1609
28.2 per
1,000 bed days
14 incidents
0.9%
1 April
2014 to 30
Sept
2014
1635
32.44 per
1,000 bed days
National 1
April
2014 to 30
Sept
2014 32
34,036 (all
Community Trusts)
Range: 563 to
3,068
Median: 95.18 incidents reported per 1,000 bed days
Range
33
32.44 to
196.26
15 incidents
0.9%
Average 18.1 incidents per
Community Trust
Range 0 to 90
(344 incidents across 19 Trusts)
1.0% (all
Community Trusts)
(344 out of 34,036 incidents)
Range 0.0% to
3.9% across 19 Trusts
32 National data: All Primary Care Organisations with Inpatient provision
33 Excluding trusts where no rate was published
Quality Account | 43

We provide data to the National Reporting and Learning System (NRLS), which allows us to compare our reporting rates with similar organisations.
A ‘low’ reporting rate should not be interpreted as a ‘safe’ organisation, and may represent under-reporting. Experience in other industries has shown that as an organisation’s reporting culture matures, staff become more likely to report incidents.
A ‘high’ reporting rate should not be interpreted as an ‘unsafe’ organisation, and may actually represent a culture of greater openness.
Chart 1: Comparative reporting rate – incidents per 1,000 bed days (higher is better)
Chart 2: Comparative reporting rate – percentage of incidents resulting in severe harm or death (lower is better)
Chart 1 compares our incident reporting rate to other community trusts. Our reporting rate is 32.44 incidents per 1,000 bed days, the lowest rate when compared to other community Trusts with bed-based services. This information is based on our patient safety incident reporting to the National Reporting and Learning System. We want to increase our patient safety incident reporting rate, so that in 2015/16 we are within the middle 50% of Trusts.
Chart 2 details the degree of harm for community trusts and shows that 0.9% of incidents we reported resulted in severe harm or death. Further detail on our actions to reduce harm is in the Safety section, in Part 3 of this account.
Staffordshire and Stoke on Trent NHS Partnership Trust has taken the following actions to improve this rate, and so the quality of its services, by:
• Mapping the incident reporting system to team level.
• Providing monthly incident reporting training to all staff.
• Sharing the lessons learnt and recommendations following serious incidents to teams through the Safety and
Effectiveness Operational Groups.
We have also:
• Developed a Sign up to Safety Improvement Plan which will raise the awareness of incident reporting.
• Developed a patient safety strategy to create a learning culture within which the safety of patients is translated into everyday practice. This strategy promotes reporting and learning from incidents.
44 | Quality Account Quality Account | 45

46 | Quality Account
Time to Quit
“Extremely happy with the service and much needed support.
I love the fact that you can be visited at home rather than having to make arrangements to go out to an apt”
Haywood Scotia Day
“pleasant atmosphere, clean & tidy environment”
Samuel Johnson
Physiotherapy
“Very pleasant, very warm, very efficient”
Quality Account | 47

Our aim:
We decided to focus this priority on one clear measure – the number of avoidable grade 3 and 4 pressure ulcers developed in our care. Our staff report all grade 3 and 4 pressure ulcers via our incident reporting system, and we will continue to run our Tissue Viability panels to review whether these were avoidable, according to national definitions and guidance.
Chart 3 details avoidable pressure ulcers that were acquired within our Community Hospitals. No avoidable pressure ulcers were acquired in our community hospitals for 2014/15; this demonstrates an improvement to last year.
Year
2013/14
2014/15
Avoidable and attributable pressure ulcers acquired in our community hospitals
4
0
In 2014/15 we aimed for a maximum tolerance of 26 avoidable pressure ulcers in the community. Chart 4 details pressure ulcers acquired whilst in the care of our community services. During 2014/15 there were 34 avoidable pressure ulcers in our care, which is 8 more than our maximum tolerance. A number of these were identified as avoidable pressure damage because the documentation provided limited evidence of high quality care.
Chart 4: Avoidable attributable Community grade 3 or 4 Pressure Ulcers 2014/15
The tissue viability scrutiny panel, which consists of clinicians, commissioners and Directors within the organisation, continues to meet monthly. The panel reviews and challenges root cause analysis reports relating to pressure ulcers. The panel also makes a decision, based on the evidence presented, on:
• whether the pressure ulcer is avoidable or unavoidable
• whether the pressure ulcer is attributable to our services
• whether to close the incident and to identify lessons learnt
• whether letters of expectation or commendation would be appropriate
• what lessons learnt can be reported back to the clinical teams involved
• any further recommendations that can be made
The Tissue Viability Service is delivering mandatory training sessions across the organisation. All new staff members receive training from the Tissue Viability Service on induction regarding wound care documentation, pressure ulcer prevention and leg ulcer management.
The increase in serious incidents reported is a result of an increase in the number of pressure ulcers and ward closures reported during Q3 and Q4. Reducing pressure ulcers remains one of our quality priorities for 2015/16 - See Priority 1.
Stafford Musculoskeletal Service
“I appreciated everyone’s positive attitude to me. Especially, one day when I was really down and depressed, the support that was given to me helped me a lot.
Everyone gave me encouragement at all times.”
48 | Quality Account Quality Account | 49

Table 7: Key safety measures for priority 1
2014/15 target Progress
Number of avoidable grade 3 and
4 pressure ulcers developed in our care :
Aim for Zero grade 3 and 4 avoidable pressure ulcers developed in our care with a tolerance of 26 cases maximum during 2014/15.
For 2014/15 we had no avoidable community hospital pressure ulcers developed in our care
From April 2014 to March 2015 we had 34 avoidable pressure ulcers in community services developed in our care 34
Q4, 2013/14: 1687 incidents
Q1, 2014/15: 1677 incidents
Total number of adverse incidents reported applicable to the
Partnership Trust (all incidents):
Quarterly increase in number of incidents reported
Q2, 2014/15: 1748 incidents
Q3, 2014/15: 1778 incidents
Achieved?

×
×
Percentage of reported incidents applicable to the Partnership Trust classified as serious incidents:
Quarterly reduction in proportion of serious incidents / all reported
Incidents
Q4, 2014/15: 1923 incidents
Q4, 2013/14: 3.44%
Q1, 2014/15: 1.72%
Q2, 2014/15: 2.28%
Q3, 2014/15: 3.93%
Q4, 2014/15: 4.16%


×
×
×


×
34 To be confirmed following Tissue Viability panel in May 2015
50 | Quality Account
The increase in serious incidents reported is a result of an increase in the number of pressure ulcers and ward closures reported during Q3 and Q4. Reducing pressure ulcers remains one of our quality priorities for 2015/16 - See Priority 1.
From April 2014 to January 2015 we had 31 avoidable pressure ulcers in community services developed in our care
Chart 5: Serious incidents 2014/15 by type 35
35 Some data in this chart is pending validation by our Tissue Viability Panel.
Stafford Rehabilitation Team
Clear instructions given, patience and understanding of the problems involved, very convenient.
Quality Account | 51

Our aim:
The Friends and Family Test (FFT) has been introduced nationally across all NHS Community Services in 2014/2015. It enables us to listen to our patients, service users and their carers about their experiences whilst in our care.
Our customer’s experience is calculated by asking one simple question - “How likely are you to recommend this service to friends and family if they needed similar care or treatment?”
A national review of the FFT took place in October 2014, identifying a change in reporting from a plus and a minus Net
Promoter Score (NPS). Therefore, we have changed reporting to introduce the percentage score for those who would recommend the service.
As an early implementer of the FFT, we have introduced this test across all our Health and Social Care Teams.
We have increased the sample size of the FFT to exceed our aim of 1,300 service users per month in accordance to national guidance.
Our aim was to capture the experience of 15,600 service users; we have exceeded this aim by 40% (10,291).
We value our Staffordshire carers who are our key partners in providing care to ill, frail, or disabled relatives contributing an indicative £1.825 billion per year. We captured feedback from
1886 carers using the Friends and Family Test.. The responses from a sample of 1809 carers achieved an average score of
99% stating that they would recommend our services. Our average Carers Net Promoter Score was +81.08.
An average of 97% of service users stated that they would recommend our services. Our Average Net Promoter Score
Trust wide was +70.41.
52 | Quality Account
Table 1: Key experience measures for customer satisfaction
2014/15 target
Friends and Family Test (Net Promoter Score):
Sustain +72.50 for the whole trust
We have achieved an average of
97% of our service users stating that they would recommend our services.
36

Health and Social Care compliments received by the
Partnership Trust:
Year on year increase in the number of compliments received
1738 compliments received for
2012/13 2693 compliments received for 2013/14 2022 compliments received for 2014/15
×
Perscentage of complaints acknowledged within three working days, in accordance with Health and Social
Care complaints regulations:
100% (Health)
100% (Social Care)
100% (Health) 100% (Social Care)
36 see next page

Quality Account | 53

2014/15 target
Percentage of PALs concerns directly associated to services provided by the Partnership Trust resolved in
24 hours or escalated to a formal complaint:
100%
Percentage of complaints responded to within timescales agreed with the complainant, in accordance with Health and Social Care complaints regulations:
100%
100%
100%
Patient Experience Surveys within Health and Social
Care:
Sustain at least 1300 responses each month from surveys in Health.
We have increased our monthly FFT sample size to 1,300 service users per month. We have exceeded our aim by 40% (10,291).
At least 98 surveys sent each month in Social Care for
Integrated Local Care Teams.
In accordance to the Section 75 service level agreement, 98 surveys per month have been distributed to service users who have received
Adult Social Care Services.
Implementation of comment cards for community services in order to expand the methods of collecting service users and carer feedback:
Comment cards available in all places where care is delivered
Monthly reporting of feedback from cards to all
Operational Teams
Number of Complaints that are reviewed by our new
Independent Customer Review Panel:
At least 12 complaints reviewed by the panel in
2014/15
Comment cards have been distributed across all our Health and
Social Care services.
We have received 389 comment cards from March 2014 to April 2015.
In 2014/15 the panel independently reviewed 23 complaints






List of actions taken in response to recommendations by our new Independent Customer Review Panel:
Aim to implement all recommendations from the panel
During 2014/15 the panel agreed
44 actions of which 39 have been completed and closed.
Partial
36 national review has taken place in 2014/2015 of the Friends and Family Test. The Net Promoter Score (NPS) of a plus or minus will no longer be used as a scoring method and so this original target had to be changed in accordance to the national Friends and
Family Tests guidance. From October 2014, the reporting changed to meet 90% of service user who would recommend our service to friends and family.
54 | Quality Account Quality Account | 55

Our aim:
We want to provide effective services with positive outcomes for our service users. We know that quality improves when our staff focus on the outcome - “the end result” - for the service user. To focus on the outcome means to focus on individual needs and preferences, not simply on tasks.
ILCTs found that, after using the EQ5D, they felt it would be beneficial to consider alternative measures to capture service user outcomes for long term conditions.
While the EQ5D is a useful, international validated measure of the quality of life, it should not be considered as a sole measure for service users with chronic long-term conditions. In 2015/16 we will help our front line teams to use other validated outcome measurement tools.
Thirty six out of thirty eight teams are progressing against their action plans for 2014-2015. Two teams have ceased collecting data due to staff shortages (clinical and administration staff) and high clinical demand. The teams have reported that outcomes data is still being collected via paper, though not being entered onto electronic data systems.
Now that many of our therapies teams are routinely measuring and reporting outcomes, we want to use this data to drive improvements in our services.
Our Community Intervention Services will use the EQ-5D measure in 2015/16.
During 2014/15 we also started a project that will lead to our care records being held electronically. Our new electronic records system will collect data for outcome measures in 2016/17. With this new system our teams will be able to report and compare outcomes automatically.
The work on our electronic care records has superseded the outcomes work we were planning to do in 2014/15 for our ILCTs.
Seven of our 33 Integrated Local Care Teams piloted the use of the EQ5D tool. In 2014/15, we looked at using the EQ5D as an outcome measure for all our Integrated
Local Care Teams (ILCTs). During the year, our frontline
For 2015/16 we will make use of Practice Audit (including clinical and social care audit) as a method for frontline teams to review and improve their outcomes, using their established outcome measures. When our new electronic system is available in 2016/17 to the teams they will then use it to provide team level outcome reports.
Sexual Health
Leicester
“Very good, friendly, privacy, confidently, feel safe”
Lichfield
Physiotherapy
“Concerned care makes sure you feel you matter.”
56 | Quality Account
Table 2: Key effectiveness measures for improving outcomes
2014/15 measure and target
Number of teams demonstrating improvement in their outcome measures:
All teams currently developing their outcome measures will have moved to their next level by the end of 2014/15 and will have as a minimum started collecting and analysing outcomes data (level 2a).
Applicable teams:
Allied Health Professional teams
Multidisciplinary teams, e.g. Falls, Rehabilitation,
Pain Management
Children’s clinical teams
Progress
Electronic data collection tools are in development for a number of teams to ensure the data they are collecting can be collated to ensure analysis can take place.
Thirty six out of thirty eight therapies teams are progressing against their action plans for 2014-2015. Two teams have ceased collecting data due to staff shortages (clinical and admin staff) and high clinical demand.
Achieved?

New teams will be participating in the outcome measures programme, and will have as a minimum a plan to develop evidence based outcome tools (level
1). Applicable teams:
Integrated Local Care Teams (ILCTs
Our ILCTs piloted the use of EQ-5D.
Our Community Intervention Services the EQ-5D and will use this measure in
2015/16
Our work on electronic records in 2014/15 and 2015/16 has superseded the work we planned to do for ILCT and specialist services teams for outcome measures.
Specialist Services teams
Developing electronic reporting of routine outcome measures for specialist services will now take place as part of our electronic records project, from 2016/17 onwards.
Introducing the monitoring of outcomes specific to our integrated health and social care teams. (e.g.
EQ5D or other tool)
Develop, and pilot a suite of measures during the year.
For integrated health and social care teams who have identified and implemented Evidence based outcome measures, baseline data collection will commence.
Seven out of our 33 Integrated Local Care
Teams (ILCTs) piloted the use of the EQ5D tool.
We will continue to develop and pilot measures for our Integrated Local Health and Social Care Teams during 2015/16

×

×
Quality Account | 57

Table 3: Outcome measures levels
Outcome measures: Level
1 - Plan to develop evidence based outcome tools: Services or teams will evidence that outcome measurement tools are in use and systems for data capture are fully established.
2a - Plan systems for capturing and analysing outcome data: Services or teams will evidence that systems have been developed to ensure that outcome data is being systematically collated in a manner that will allow analysis.
2b - Collect 12 months outcome data: Services or teams must evidence that quality outcome data has been collected and analysed throughout the year.
3 - Plan for improving outcomes: Services or teams must demonstrate that outcomes have measurably and materially improved.
4 – Ongoing improvement in outcomes : Team has a programme of planned improvements against priorities identified from outcome data and will use future outcome data to monitor effectiveness of planned improvements.
Table 4: Outcome measures levels
Team Outcome measure
North Staffordshire Adult Podiatry
Services practice
Stoke on Trent Adult Podiatry Services
Stafford, Seisdon and Surrounds Adult
Podiatry Services
East Staffordshire Adult Podiatry
Services
Cannock and Rugeley Adult Podiatry
Services
North Paediatric Podiatry services
South Paediatric Podiatry Services
A Visual Analogue Scale – pain and function
(psychometric response scale).
A Visual Analogue Scale – pain and function
(psychometric response scale).
A Visual Analogue Scale – pain and function
(psychometric response scale).
A Visual Analogue Scale – pain and function
(psychometric response scale).
A Visual Analogue Scale – pain and function
(psychometric response scale).
Oxford Foot & Ankle Questionnaire OxAFQ-C (child or parent self-report of health and wellbeing)
Oxford Foot & Ankle Questionnaire OxAFQ-C (child or parent self-report of health and wellbeing)
Palliative Care, Primary Care
Occupational Therapy Team, Stoke on
Trent
Inpatient Occupational Therapy services, Bradwell Hospital
58 | Quality Account
East Kent Outcome System & Binary Individualised
Outcome Measure (goal attainment outcome measure).
East Kent Outcome System & Binary Individualised
Outcome Measure (goal attainment outcome measure).
Reported level
2a
1
1
1
2a
1
1
1
2a
Team Outcome measure
Inpatient Occupational Therapy services Leek Moorland Hospital
Inpatient Occupational Therapy services Cheadle Hospital
Tunstall and West Community
Occupational Therapy Team
Leek, Biddulph and Moorlands
Community Occupational Therapy
Team
Newcastle North and Central
Community Occupational Therapy
Team
Longton and Meir Community
Occupational Therapy Team
Hanley, Bucknall, Bentilee and South
East Community Occupational Therapy
Team
MSK/Rheumatology Occupational
Therapy Team, Haywood Hospital
Speech and Language Therapy –
Southern Division
Paediatric Physiotherapy Service –
Southern Division
Children’s Physiotherapy Service -
Northern Division
East Staffs Community Physiotherapy
Service (Musculoskeletal)
Primary Care Orthopaedic Service in
East Staffs Locality
Dietetic Services – Irritable Bowel
Syndrome
East Kent Outcome System & Binary Individualised
Outcome Measure (goal attainment outcome measure).
East Kent Outcome System & Binary Individualised
Outcome Measure (goal attainment outcome measure).
East Kent Outcome System & Binary Individualised
Outcome Measure (goal attainment outcome measure).
East Kent Outcome System & Binary Individualised
Outcome Measure (goal attainment outcome measure).
East Kent Outcome System & Binary Individualised
Outcome Measure (goal attainment outcome measure).
East Kent Outcome System & Binary Individualised
Outcome Measure (goal attainment outcome measure).
East Kent Outcome System & Binary Individualised
Outcome Measure (goal attainment outcome measure).
East Kent Outcome System (goal attainment outcome measure).
East Kent Outcome System (goal attainment outcome measure).
The Care Aims Model (Malcolmess, 2001, 2005) has been adopted to enable goal attainment outcome measures.
The Care Aims Model (Malcolmess, 2001, 2005) has been adopted to enable goal attainment outcome measures.
EQ5D5L (health status self-reported questionnaire)
EQ5D5L (health status self-reported questionnaire)
IBS Symptom Measurement before and after treatment*
Dietetic Services - Enteral Feeding Goal Attainment Outcome Measure*
Reported level
1
1
1
1
2a
1
1
1
2b
2b
2b
2a
2a
2a
2a
Healthy Kid5 – Southern Division Outcomes Monitor Tool* 2a
Adult Ability Team - Southern Division Individualised data collection sheets* 2a
Quality Account | 59

Team
Stone Rehabilitation Team
Outcome measure
Community Dependency Index (standardised measure of independence in self-care activities),
Berg (performance based measure of balance),
Reported level
2b
2b Stone Rehabilitation Team
Stone Rehabilitation Team Elderly Mobility Scale (validated mobility assessment tool),
Stone Rehabilitation Team EQ5D (health status self-reported questionnaire).
Children’s Occupational Therapy Team
- Northern Division
Northern Division Community
Physiotherapy Musculoskeletal outpatients
– North Staffordshire
Data record sheet*
EQ5D5L (health status self-reported questionnaire).
Stafford and Cannock Falls Service
Tinnetti (standardised assessment tool for gait and balance),
Stafford and Cannock Falls Service Visual Analogue Scale (psychometric response scale),
Stafford and Cannock Falls Service Goal attainment outcome measure.
Adult Speech and Language Therapy
Service - Northern Division
Children’s Speech and Language
Therapy Service - Northern Division
East Kent Outcome System (goal attainment outcome measure).
The Care Aims Model (Malcolmess, 2001,2005) has been adopted to enable the development of the North
Staffordshire Risk Matrix*
Northern Division Community
Physiotherapy Musculoskeletal outpatients
– Stoke
Dietetic Services - Adult Weight
Management - Southern Division
Musculoskeletal Interface Service (MIS)
Seisdon
Stafford and Cannock Orthopaedic and Rheumatology Triage and
Community Physiotherapy Team
(Musculoskeletal)
EQ5D5L (health status self-reported questionnaire).
Data Collection & Reporting Service*
EQ5D5L (health status self-reported questionnaire).
EQ5D5L (health status self-reported questionnaire).
3
3
2b
2b
2a
2b
2b
3
3
3
2b
2b
2b
60 | Quality Account
Team
Stafford and Cannock Orthopaedic and Rheumatology Triage and
Community Physiotherapy Team
(Musculoskeletal)
Stafford and Cannock Orthopaedic and Rheumatology Triage and
Community Physiotherapy Team
(Musculoskeletal)
Stafford and Cannock Orthopaedic and Rheumatology Triage and
Community Physiotherapy Team
(Musculoskeletal)
Stafford and Cannock Orthopaedic and Rheumatology Triage and
Community Physiotherapy Team
(Musculoskeletal)
Stafford and Cannock Orthopaedic and Rheumatology Triage and
Community Physiotherapy Team
(Musculoskeletal)
Stafford and Cannock Orthopaedic and Rheumatology Triage and
Community Physiotherapy Team
(Musculoskeletal)
Osteoporosis and Falls Management
Team (East Staffordshire) - Southern
Division
Osteoporosis and Falls Management
Team (East Staffordshire) - Southern
Division
Osteoporosis and Falls Management
Team (East Staffordshire) - Southern
Division
Osteoporosis and Falls Management
Team (East Staffordshire) - Southern
Division
Falls Management South East Staffs
(Burntwood, Lichfield and Tamworth)
Falls Management South East Staffs
(Burntwood, Lichfield and Tamworth)
Outcome measure
VAS (psychometric response scale).
Neck Disability Index (questionnaire regarding effect of neck pain in everyday functioning).
Shoulder Pain and Disability Index, SPADI & Oxford shoulder score, OSS, (measurement of shoulder pain and disability).
Oswestry Disability Score (outcome measure for low back pain)
Oxford Hip Score (assessment of hip and knee pain and disability).
VISA-A (an index of the severity of Achilles tendinopathy).
Tinnetti falls efficiency scale (measurement of the fear of falling),
Tinnetti balance assessment (standardised assessment tool for gait and balance),
Confidence in maintaining balance scale (Subjective measure of confidence in performing various ambulatory activities)
Visual Analogue Scale – falling (psychometric response scale)
Berg (performance based measure of balance),
Reported level
2b
2b
2b
2b
2b
2b
3
3
3
3
3
Timed up and go, TUAG (measure of general mobility), goal attainment outcome measure*
3
Quality Account | 61

Team Outcome measure
Stroke Rehabilitation Therapy Service,
Sneyd Ward - Northern Division
Stroke Rehabilitation Therapy Service,
Sneyd Ward - Northern Division
Stroke Rehabilitation Therapy Service,
Sneyd Ward - Northern Division
Stroke Rehabilitation Therapy Service,
Sneyd Ward - Northern Division
Stroke Rehabilitation Therapy Service,
Sneyd Ward - Northern Division
Stroke Rehabilitation Therapy Service,
Sneyd Ward - Northern Division
Community Pain Management Service
(Stafford and Cannock)
Community Pain Management Service
(Stafford and Cannock)
Community Pain Management Service
(Stafford and Cannock)
Community Pain Management Service
(Stafford and Cannock)
Community Pain Management Service
(Stafford and Cannock)
Early Supported Discharge Team (East
Staffordshire)
Early Supported Discharge Team (East
Staffordshire)
Early Supported Discharge Team (East
Staffordshire)
Early Supported Discharge Team -
Northern Division
Early Supported Discharge Team -
Northern Division
Berg (performance based measure of balance), Mortricity index (measures motor impairment),
Barthel index (measures a person’s daily functioning specifically the activities of daily living),
Modified Rankin score (measures the degree of disability or dependence in the daily activities of people),
Nottingham dressing assessment (assessment of post stroke dressing ability),
Montreal cognitive assessment (rapid screening instrument for mild cognitive dysfunction),
Hospital anxiety and depression scale (self-assessment scale to detect states of depression, anxiety and emotional distress).
Oswestry Disability Index (outcome measure for low back pain)
Hospital Anxiety and Depression Scale (self-assessment scale to detect states of depression, anxiety and emotional distress),
Pain Self-efficacy Questionnaire, PSEQ, (measures a person’s confidence in performing a range of activities, despite pain)
Tampa Scale of Kinesiophobia (measures the fear of movement)
Pain Coping Strategies Questionnaire (measures pain and pain related disability)
Barthel index (measures a person’s daily functioning specifically the activities of daily living),
Therapy Outcome Measures, TOMS (measure of impairment, activity, participation, wellbeing)
East Kent Outcome System (goal attainment outcome measure).
Barthel index (measures a person’s daily functioning specifically the activities of daily living),
Modified Rankin score (measures the degree of disability or dependence in the daily activities of people)
Reported level
3
3
3
3
3
3
3
2a
2a
2a
2a
4
4
4
4
4
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Team Outcome measure
Early Supported Discharge Team -
Northern Division
Early Supported Discharge Team -
Northern Division
Early Supported Discharge Team -
Northern Division
Community Intervention Services East
Staffs
Intervention Team & Stroke
National Institute of Health Stroke Scale (tool used by healthcare providers to objectively quantify the impairment caused by a stroke).
Nottingham dressing assessment (assessment of post stroke dressing ability)
East Kent Outcome System, EKOS, (goal attainment outcome measure).
Quality of Life monitoring tool
TOMS; Barthel; Rankin; EKOS
Stafford & Cannock Home Oxygen East team also collects MYMOP
ILCT Burntwood
Adult Weight Mngt & Physical Activity
Occupational Therapy West
Health action plans
Lifestyle monitoring outcome tool (Weight, weight loss,
BMI, Physical Activity Levels, Fruit and veg, smoking, alcohol, general health and wellbeing)
Lifestyle monitoring outcome tool
ILCT Trentside
ILCT Rising Brook
EQ5D5L (health status self-reported questionnaire)
EQ5D5L (health status self-reported questionnaire)
ILCT Weeping Cross & Penkridge
ILCT Rugeley
ILCT Cannock
ILCT Hednesford
ILCT Great Wyrley
Specialist Diabetes (South)
Smoking Cessation Team
EQ5D5L (health status self-reported questionnaire)
EQ5D5L (health status self-reported questionnaire)
EQ5D5L (health status self-reported questionnaire)
EQ5D5L (health status self-reported questionnaire)
EQ5D5L (health status self-reported questionnaire)
DESMOND, knowledge pre/post SAKID health outcomes pre/post
Smoking Status with Carbon Monoxide verification
Reported level
4
4
4
1
1
1
2a
3
1
3
2a
2a
2a
2a
2a
1
2a
2a
Quality Account | 63

Team Outcome measure
Long Term Conditions
Universal Neonatal Hearing
Early Supported Discharge Team -
Northern Division
Early Supported Discharge Team -
Northern Division
Early Supported Discharge Team -
Northern Division
Community Intervention Services East
Staffs
Intervention Team & Stroke
HBA1C
Newborn hearing screening programme; including all
NHSP Quality Standards and KPIs
National Institute of Health Stroke Scale (tool used by healthcare providers to objectively quantify the impairment caused by a stroke).
Nottingham dressing assessment (assessment of post stroke dressing ability)
East Kent Outcome System, EKOS, (goal attainment outcome measure).
Quality of Life monitoring tool
TOMS; Barthel; Rankin; EKOS
Stafford & Cannock Home Oxygen East team also collects MYMOP
ILCT Burntwood Health action plans
Adult Weight Management & Physical
Activity
Lifestyle monitoring outcome tool (Weight, weight loss,
BMI, Physical Activity Levels, Fruit and veg, smoking, alcohol, general health and wellbeing)
Occupational Therapy West Lifestyle monitoring outcome tool
ILCT Trentside
ILCT Rising Brook
EQ5D5L (health status self-reported questionnaire)
EQ5D5L (health status self-reported questionnaire)
ILCT Weeping Cross & Penkridge
ILCT Rugeley
EQ5D5L (health status self-reported questionnaire)
EQ5D5L (health status self-reported questionnaire)
ILCT Cannock
ILCT Hednesford
ILCT Great Wyrley
EQ5D5L (health status self-reported questionnaire)
EQ5D5L (health status self-reported questionnaire)
EQ5D5L (health status self-reported questionnaire)
Reported level
2a
3
4
4
4
3
1
2a
2a
2a
2a
2a
2a
2a
1
1
1
2a
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Team
Specialist Diabetes (South)
Smoking Cessation Team
Long Term Conditions
Family Nurse Partnership (FNP)
Universal Neonatal Hearing
Outcome measure
DESMOND, knowledge pre/post SAKID health outcomes pre/post
Smoking Status with Carbon Monoxide verification
HBA1C
Fidelity measures, smoking reduction, alcohol and drug use, breastfeeding, Birth statistics, child health and development, repeat pregnancies, use of contraception, return to education or employment.
Newborn hearing screening programme; including all
NHSP Quality Standards and KPIs
Reported level
1
3
2a
3
3
Bradwell Bennion
“I would recommend this service I was treated like royalty, excellent staff well done”
Cobridge
Sexual Health
“I cannot praise the staff enough for their wonderful, professional and caring attitude. I am a regular visitor here and the staff play a huge part in making my visits far less upsetting than they would be. I have nothing but praise for this service”
Quality Account | 65

Our aim:
We want our integrated adult Health and Social Care teams to focus on giving service users choice and control over the shape of the support we give them. We call this “personalisation”.
“Making it Real” is a set of statements from people who use care and support telling us what they would expect, see and experience if personalisation is real and working well in an organisation.
We have registered on the “Making It Real” national website and published our action plan in response to the key priority statements. Following Staffordshire County Council engagement sessions, the five key priorities were identified:
Table 5: Five Key Making it Real Priorities
Theme Statement
Personal Budgets and self-funding: My money
Workforce: My support staff
I am able to get skilled advice to plan my care and support, and also be given help to understand costs and make best use of the money involved and where I want and need this.
I have access to a pool of people, advice on how to employ them and the opportunity to get advice from my peers
Information & Advice
I have access to easy to understand information about care and support which is consistent, accurate, accessible and up to date
Personal Budgets and self-funding: My money
I know the amount of money available to me for care and support needs, and I can determine how this is used (whether it’s my own money, Direct Payment, or a council managed personal budget)
Personal Budgets and self-funding: My money
I can decide the kind of support I need and when, where and how to receive it
We have developed a “Have your say” website to provide our service users and carers with accurate information. We have developed with our partners and carers the Staffordshire Carer assessment. This will ensure that the assessment process is efficient and designed to assess the service users and carers personalised plan of care.
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Table 6: Key effectiveness measures for supporting independence by personalised care
Measure & Target for 2014/15
Progress Achieved?
Service users who agree with key statements in
“Making it Real” (e.g. “I have the information and support I need in order to remain as independent as possible”):
Complete the first cycle of Making It Real in its entirety during Q1
2014/15, and complete a new cycle.
A cycle of Making It Real Consultation events was held across
Staffordshire during Q2 and Q3 of 2014-2015 based on the five priority statements.
We completed the Making it Real engagement Events across
Staffordshire and advertised the Events in Q2 and Q3. We captured face to face feedback from the people in attendance.
We have feedback from the online making it real Survey and we have amended our making it Real action plan and upload which reflects our Key priorities. We have also included our personalisation
Questions relating to accurate information and being Involved in decision making into our monthly health and Social care surveys.
This enables us to capture feedback and immediately develop actions of improvement
Partial
There was a delay in the completion of the events, which were not completed in Q1 as planned.
Review good practice and actions from other organisations participating in Making It
Real , adapting these for our organisation, as part of our 2014/15 Making It
Real action plan .
We have devised an online survey to capture the feedback from our service users and carers which was completed by the end of
September 2014.
Service User and Carer events have taken place across Staffordshire.
From the engagement sessions, we had very little engagement within Staffordshire.
We have worked with our carers following the Healthwatch Carer
Consultation and engaged with the User and Carer Forum, Local
Carers’ Associations and Staffordshire County Council. We have reviewed our services against the key themes highlighted in the
Health Watch Carer Consultation.
Our five priorities work streams have been implemented to develop the following areas:
A new Staffordshire Carer assessment has been devised taking into account the Making it Real Priorities. This has been developed with other Staffordshire providers along with carer groups. This will be implemented across Staffordshire in Q2 2015.
We have devised accurate information for service users and carers regarding topics relating to Adult Social Care, benefits and Self- help information following the Healthwatch Carer consultation.

Quality Account | 67

Measure & Target for 2014/15
Proportion of people who feel that they were supported to make their own decisions about their Social Care and / or services (1b proxy):
90%
37
Proportion of people who receive self- directed support and / or direct payments
(SC10a-c):
Achieve 70% by the end of the year (self-directed support)
Achieve 50% by the end of the year (direct payments)
Progress
88% against a target of 90%
We have listened to our service users and carers and introduced
Integrated Health and Social Local Care teams.
SC10a (Self-directed support): 70.2% against a target of 80%
SC10b (With a direct payment): 24.1% against a target of 36%
SC10c (PB via direct payment): 34.4% against a target of 45%
Indicator 1b: Proportion of people using Social
Care that have control over their daily life (via national annual survey):
78%
Latest available data is from the 2013/14 survey : 69%
Achieved?
×
×
×
37 This target was revised to 90% from the previously published target of 85%
Our aim:
The National Quality Board’s Safe Staffing ‘How to Guide’ 38 emphasises the need for policies, systems and routine monitoring of shift-to-shift staffing levels. Also, staffing capacity and capability should be discussed at a public Board meeting at least every six months on the basis of a full nursing and midwifery establishment review. This is supported by a national requirement for transparent monthly reporting of ward-by-ward staffing levels.
Measure & Target for 2014/15
Progress
Publish monthly staffing levels for our community wards, including agreed establishment, safe staffing level in relation to acuity, and actual staffing levels:
Staffing is always at a safe level in relation to shift-by shift service need, taking into account the demand on the service.
39
Monthly reporting to Trust Board on Safe
Staffing continues in line with national requirements. Increased demand has placed additional pressures on staffing across the whole health economy. There have been a number of community hospital wards closed for short periods of time due to Influenza and diarrhoea and vomiting
(Norovirus) outbreaks which have affected both patients and staff.
Additional bed capacity was made available during Quarters 3 & 4 in response to the local and national health economy emergency care crisis experienced during the winter months.
Additional staffing capacity was provided through existing staff undertaking additional hours of work, close working with partner organisations and additional provision through staffing agencies.
Achieved?

38 See www.england.nhs.uk/wp-content/uploads/2013/11/nqb-how-to-guid.pdf
39 Details on how this will be reported are to be developed by April 2014
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Measure & Target for 2014/15
Progress
Publish two acuity staffing establishment reviews, which look at safe staffing levels in community hospitals, during 2014/15:
Reviews will make use of national guidance, professional body guidance and best practice on staffing levels, and will aim to demonstrate appropriate staffing establishment and skill mix, for the provision of safe care.
Monthly reporting to Trust Board on Safe
Staffing continues in line with national requirements. Increased demand has placed additional pressures on staffing across the whole health economy. There have been a number of community hospital wards closed for short periods of time due to Influenza and diarrhoea and vomiting (Norovirus) outbreaks which have affected both patients and staff.
Additional bed capacity was made available during Quarters 3 & 4 in response to the local and national health economy emergency care crisis experienced during the winter months. Additional staffing capacity was provided through existing staff undertaking additional hours of work, close working with partner organisations and additional provision through staffing agencies.
Achieved?

40 See www.england.nhs.uk/wp-content/uploads/2013/11/nqb-how-to-guid.pdf
4130 Details on how this will be reported are to be developed by April 2014
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• The time patients stay in hospital for the year is a median average of 17 days against a target of 23 days.
• All annual national 18 week referral to treatment targets have been achieved for consultant-led activity, including admitted (98.2%) and non-admitted patients (98.8%) and incomplete pathways (97.3%). In addition, no patients have waited over 52 weeks for treatment.
• Overall therapies 18 week performance for the year was 97.6% against a 95% target.
• National targets for wait times at Walk-in-Centres/
Minor Injuries Units have being achieved with 99.8% compliance against a 95% target.
• Patients Receiving a Diagnostic Scan within 6 weeks of referral is performing at 99.2% against a target of
>99%.
• The number of patients who did not attend their outpatient/community appointments in the year remains below the target, with a rate of 4.5% compared to the 7.5% contractual target.
• Levels of delayed transfers of care have remained volatile through-out the year with a year-end position of 5.3%. For comparison the Aspiring Community
Foundation Trust (ACFT) benchmark average is 8.9%.
• The Trust’s reablement services continue to meet the target for older people remaining at home 91 days following reablement with performance of 87.8%.
It is encouraging to note that 52.7% of people who are still at home receive no ongoing services and the average duration of reablement episodes is 5.4 weeks.
• The levels of carers receiving an assessment or review have improved and are now rated green with performance of 34.6% against a 30% target.
• 2014/15 long term residential and nursing care admissions are within target and rated green which is a notable improvement compared to the continual underperformance recorded throughout 2013/14.
• The percentage of adult protection cases where the risk of harm has been reduced has performed well throughout the whole year demonstrating 92.1% against an 87% target.
• Social Care clients were satisfied with their overall assessment and support experience in 2014/15.
• The Partnership Trust is compliant with the 95%
Methicillin-Resistant Staphylococcus Aureus (MRSA)
Screening target with performance of 99.9% In addition the organisation is on trajectory to have less than 8 avoidable cases of Clostridium Difficile by year end.
• The Trust has had zero breaches of mixed sex accommodation and zero Never Events, and no outstanding CAS alerts throughout the year.
• Children’s Speech and Language therapy underperformed throughout the year, however there is a notable improvement in the direction of travel.
Improvement plans are in place and work is being carried out jointly with commissioners to address these areas.
• Although year-end data is not yet available 42 the levels of 4 and 12 week smoking quitters in quarter 3 are in excess of targeted levels however there is a noticeable improvement month on month.
• Levels of Social Care clients receiving reviews have again been rated red during the year with 60.6% of community reviews and 52.5% of residential or nursing care clients receiving a review.
• The timeliness of Social Care assessments has also continued to under-perform against the target of
70% performance; 51.3% of people received their assessment within 4 weeks. Improvement plans are in place to address areas of under- performance.
Divisional teams continue to work through the lists of assessment episodes which appear to still be open following referral, in particular, those showing as breaching the four week threshold (SC30a).
• There was one MRSA bacteraemia in October. This is the only instance for the Trust this year. The infection control team have classified this as an unavoidable case.
• The social care survey, percentage of people who feel they were supported to make their own decisions about their care is rated red at 88% against a target of 90%. Analysis shows these percentages are based on very low response and completion rates for the specific question.
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A Waiting List Management Group was set up by the
Board’s Finance, Investment & Performance Committee.
The group is chaired by the Director of Operations, and is committed to deliver improved patient waiting times. Key actions include:
Trust Access and Did Not Attend (DNA) policies has been developed and consulted upon in 2014, both policies have been consulted upon, approved and are being used by
Trust staff.
Work on developing Standard Operating Procedures for all services which manage a waiting list has commenced.
Work continues in this area and is scheduled to be completed during Q1 of 2015/16, ensuring all are in line with national requirements
The development and monitoring of a Trust wide waiting list management delivery plan continues to ensure all recommended actions are taken forward in the correct forums.
The group has implemented an internal intranet site to bring together all intelligence regarding waiting list management needed by Trust staff to manage waiting times.
An internal training model which supports the Trusts access and DNA policies has been developed this will be rolled out early 2015/16.
A review of all patient letters is underway to ensure they are harmonised to local and national policies.
Work continues on the new data warehouse and dashboard to assist services in managing their patient waiting time pathways.
Waiting List Management and Reporting: A plan is in place which has already delivered improvements. Further work will take place on standardising procedures and reporting consistently.
31 Data on smoking quitters (the 12-week quit time) is normally presented three months in arrears
The Trust is working with Clinical Commissioning Groups to manage urgent care flow. In particular to develop alternatives to further avoid admission to acute hospitals.
Transforming social care is essential in the context of demographic and financial pressures. We have an ambitious transformation plan to deliver jointly with
Staffordshire County Council.
Realising the benefits of improved intelligence reporting from the clinical system and embedding a service line management ethos in the organisation to support delivery of efficient and effective services.
42 Data on smoking quitters (the 12-week quit time) is normally presented three months in arrears
Longton
Aynsley
“The hospital and staff provided attentive understanding care at all times. Always pleasant and encouraging. They provided a whole care package, treating the spirit as well as medical and body needs. An excellent caring hospital. A gem in the NHS set up. I feel truly cared for and not just a body in a bed to be processed.”
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Incident reporting is an integral tool in managing patient safety. The information collected through reporting allows us to analyse what, how and where safety issues may be occurring.
Chart 6: Total Number of Incidents reported
Each Serious Incident affects service users and staff. Making sure these are reported effectively and in a timely manner will help the Trust to learn the most from such incidents to improve safety. The Trust has a robust process for making sure that we act on Serious Incidents promptly and that we follow up resulting actions. All Serious incident reports are presented to the relevant Trust Committees or review panels to identify actions and learning themes.
Pressure ulcers, ward closures and slip trips and falls were the most reported serious incident. These serious incident reports go through tissue viability / falls and infection control review panels which identify specific learning and actions that are applicable for the Trust.
Infection control reviews noted that our ward nursing staff recognised norovirus and influenza symptoms quicker than in previous years. We learnt where patients have a history of confusion we should consider placing them in beds nearer nursing stations.
The NHS Safety Thermometer provides a ‘temperature check’ on harm that can help us to measure whether we provide harm free care for our patients. There are four harms that we track every month; Pressure ulcers, falls, catheterassociated urinary tract infections, and Venous Thromboembolisms (blood clots).
• We have consistently provided care with no new harms, better than our 95% target. In March 2015 we reports
97.28% care with no new harms, compared with a national figure of 97.7%
• Our provision of harm free care, which includes harms experienced by patients before they come into our care, has been less than our 95% target. The high proportion of ‘old harms’ experienced by patients before they come into
Partnership Trust care has contributed significantly to this picture.
Chart 7: NHS safety thermometer, no new harms
We encourage our staff to report any incident that gives them cause for concern. We are committed to an open and transparent culture of raising safety concerns to ensure the safety of people who use our services.
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Chart 8: NHS safety thermometer, harm free care
Chart 9: NHS safety thermometer, Integrated Local Care Teams (ILCTs), no new harms
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We use the national Central Alerting System for issuing safety based alerts to our services and teams. The Central
Alerting System issues patient safety alerts, important public health messages and other safety critical information and guidance. We receive alerts by email direct from the Central Alerting System. We send relevant alerts to teams who take necessary actions and confirm this with our risk team.
During 2014/15 we received 160 alerts, of which 129 required acknowledgement and addressing within the required time frame. 128 alerts have been acknowledged and closed within the time frame. A further 1 alert was acknowledged and still open at the end of the year. There were 31 alerts which did not require our response.
HM Coroner may require organisations to make improvements to services within a 56 day timescale as a result of an inquest. This is known as a ‘regulation 28’ report. We did not receive any regulation 28 reports in 2014/15.
We continue to be active partners participating with the work of Staffordshire and Stoke on Trent Adult Safeguarding
Partnership and contribute to the Safeguarding Adult Board and subgroups. Our involvement is essential, as all partner agencies play a significant role in contributing to the adult safeguarding agenda and ensuring that the prevention of abuse and protection of adults at risk from harm is everyone’s business.
We have worked closely with the Safeguarding Board to ensure compliance with the Safeguarding section of the
Care Act 2014, especially in the development of revised Safeguarding Enquiry Procedures and actively supporting the
Safeguarding Adults at Risk process. Further work is being undertaken to support our staff in the application of the Act in practice. As an integrated health and social care provider our staff undertake the majority of adult safeguarding work in Staffordshire and so make a major contribution to the safeguarding of adults at risk.
A network of adult safeguarding champions has been recruited across the organisation since September 2012 to provide support and expertise to front line staff. An afternoon session was provided for Champions in March 2015, which included adult safeguarding case studies to demonstrate application of safeguarding to practice and the improvements in outcomes for vulnerable adults. Further masterclasses are being arranged to cover a wide range of safeguarding topics.
Our Safeguarding Vulnerable Adults Committee monitors all adult Safeguarding incidents reported by our staff on a monthly basis. Regular exception reports are provided by the Safeguarding Vulnerable Adults Committee to the Quality
Governance Committee, Trust Board and to Commissioners.
Infection Prevention and Control is taken very seriously within the Trust, and is an agenda item on all directorate business meetings. We have an Infection Prevention and Control Committee that provides assurance to the Quality
Governance Committee that the Trust is compliant with the 10 criteria within the Hygiene code.
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Infection Prevention and Control is taken very seriously within the Trust, and is an agenda item on all directorate business meetings. We have an Infection Prevention and Control Committee that provides assurance to the Quality
Governance Committee that the Trust is compliant with the 10 criteria within the Hygiene code.
During 2014/15 we identified 10 cases of Clostridium difficle (which is a bacteria that can cause symptoms such as diarrhoea) in our community hospital wards - this number was the same as the previous year. Following each case, a root cause analysis panel is held with the clinicians. The panel discusses the patient’s pathway and identifies risks that may contribute to the infection, improvements required and good practice. The Panel also make a judgment based on the evidence collected and presented as to whether the Clostridium difficile was ‘avoidable’ or ‘unavoidable’; i.e. whether our care resulted in harm to a patient. The root cause analysis panel identified that 8 of the 10 cases of
Clostridium difficile were unavoidable cases.
Learning from the two avoidable cases included:
• The antibiotic prescribing guidelines have been reviewed
• Investment has been approved to increase the number of pharmacy staff, who can support clinicians in their treatment decisions.
For 2014/15 environmental cleanliness standards had improved by 10% in all the wards. Each area was consistently meeting 95% in cleanliness audits, which is important when trying to prevent the spread of organisms such as bacteria and viruses. The hand hygiene practices of our clinical staff have remained consistently high between 95% and 100%.
All Trusts in England have a zero tolerance for Methicillin Resistant Staphylococcus Aureus (MRSA) bacteraemias. One
MRSA bacteraemia was isolated in the Community hospitals in 2014/15. The patient in the Community hospital was treated and recovered well from the bacteraemia. This case was identified as unavoidable.
Infection control training is mandatory for all clinical staff to complete, and more than 85% of staff have attended infection control training. The Team also support education programmes outside of the Trust in the local Universities,
Primary care settings and local Care homes.
We aim to provide our service users a positive experience of care. Our complaints process helps us learn how our services are performing. With this feedback we can understand and make improvements to services.
For 2014/15 we received 351 complaints. All complaints were acknowledged within three working days in line with the
Health and Social Care Complaint regulations.
In 2014/15 a new Customer Services Team structure has been put in place to reflect a culture of listening to staff and complainants seeking to actively understand why complaints are made. The governance framework and methods of reporting to Chief Operating Officers has been reviewed and improved.
We established an Independent Complaints Review Panel in January 2014 – a group made up of a number of voluntary organisations from across Staffordshire and Stoke-on-Trent.
Working independently of the Trust, the Panel brings a degree of external scrutiny and proportionate challenge to how the Trust investigates and manages complaints.
In 2014/15 the Panel reviewed 23 complaints.
The key responsibilities of the Panel are to
• Establish if complaints are managed in line with agreed timeframes and within the Trust’s process
• Are appropriately coordinated and delegated
• That all relevant parties are consulted on the response; actions plans are formalised
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• That evidence is in place to show that lessons learned have been embedded in practice and disseminated across the organisation
• To identify any emerging themes/trends arising from complaints
This approach has provided us with an independent challenge process that will inform improvements to the way in which complaints are investigated and responded to; the findings of which will be published on our website.
During 2014/15, 98 members of staff have undertaken the Investigation Officer training and toolkit (established in
January 2014 with 128 individuals completing the training in total to date).
In 2014/15 five complaints were referred to the PHSO and 11 to the LGO for review.
The Trust has received the final outcome of 8 referrals that are now closed.
Of the 5 Health complaints reviewed by the PHSO, 1 was found to be not upheld.
Of the 11 Adult Social Care complaints reviewed by the LGO, 4 were found to be upheld and 3 not upheld.
As at April 2015 the Trust is awaiting the final outcome of 8 referrals that are currently under review (4 Health and 4
Adult Social Care).
The Trust works in partnership with Staffordshire County Council as part of a legal contractual agreement to manage the statutory complaints process for Adult Social Care services.
From April 2014 to March 2015 the Trust received 148 formal Adult Social Care complaints. The five most comment themes are in the chart below.
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Leek
& Moorlands
Community Matrons
“There are no words to say how thankful I am for the support I receive,… I feel well looked after and know when times get harder I am in safe hands”
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The Trust’s PALS service works with patients, service-users, carers and family members to resolve concerns raised.
The PALS aims to resolve concerns within 24 hours from the first contact providing information about Trust services and signposting to other services in the health and adult social care economy. The Service also advises individuals should they wish to make a formal complaint.
From April 2014 to March 2015 the Trust received 936 PALS contacts through its service.
We view our Friends and Family Test (FFT) score as a useful early warning indicator upon the overall experience and satisfaction of our service users. We triangulate the data to other surveys along with quality indicators to uncover the detail behind this high level-indicator.
Our aim was to sustain and maintain our overall customer experience as measured by the FFT. From April 2014 until
March 2015, we have received a total of 25,891 surveys.
Feedback was received from 24,005 service users and 1,886 carers upon their experience of our services. Our aim was to capture the experience of 15,600 service users; we have exceeded this aim by 40% (10,291).
Of the 24,005 surveys captured from our service users, 21,865 surveys have been collated into our sample for our FFT monthly score.
We have successfully achieved an average score of 97% of our service users recommending our services to their friends and family if they needed similar care or treatment. The average Net Promoter Score (NPS) Trust wide was +70.41.
Chart 11: The old reporting of NPS for the Trust wide FFT for service users in 2014/2015
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Chart 12: The new reporting of percentages for the Trust wide FFT for service users in 2014/2015 Chart 14: The old reporting of NPS for the Trust wide FFT for carers in 2014/2015
Chart 13: The new reporting of percentages for the Trust wide FFT for carers in 2014/2015
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Every month 98 paper surveys are disseminated to Adult Social Care Users and Carers. The current figures represent survey activity between September 2014 and December 2014 due to the data being reported on a three month rolling aggregate.
We have introduced the Integrated Health and Social Care Survey from the 1 April 2015, which will improve the feedback of our service users and carers through real time reporting. Through this survey it is our priority to ensure that 95% of our service users and carers are empowered to make their own decisions regarding their individualised plan of care to manage their condition.
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Chart 15: “Do you feel that you are supported to make your own decisions about your social care and/or services?” (% ‘Yes’)
Chart 16: Overall, how satisfied are you with the assessment and support planning experience with Social Services? (%
‘Yes, at all times’
We use a variety of methods to capture the experience of service users and carers receiving our care. We listen and develop actions of improvements from our service user and carers’ suggestions
We have introduced pre-paid experience comment cards which service users and carers can return by post. Comment cards have been implemented across our community services in all our locations where care is delivered. We have achieved a
13% (389) response rate from March 2014 to April 2015.
In Quarter 4 we developed and implemented children’s ‘monkey’ comment cards designed for children aged four to eight within our Children and Young People Services. The illustrated cards have enabled our children to express their experience of treatment and care through pictures.
Feedback cards have been introduced to signpost users to the website where they can leave feedback. This ensures every team is able to provide feedback through a variety of routes during the process of progressing with wireless feedback.
Patient Stories were captured from our service users and carers on their experience whilst in our care. From each patient story actions of improvement have been developed which include service improvements and redesign of our teams.
The Mystery User and Carer programme has been introduced to capture the anonymised feedback regarding an individual’s care pathway and suggestions of improvement.
The Trust has provided publication through local media along with inviting voluntary and charitable organisations to work in collaboration with health and social care professionals. The main aim of PLACE is to provide validated onsite assessments through the engagement of members of the public. The assessment focuses on a “being open culture” within our environment, on every ward across the five Community Hospitals sites.
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Chart 17: Patient Led Assessment of the Care Environment results for our Community Hospitals in 2014/2015.
From our Service User and carer feedback we have redesigned and implemented the following actions of service improvements within each of our Operational teams.
Our Service Users have said - I would like more information on how to register a death in the community.
We listened - The Trust has listened to the concerns of our Service Users and carers regarding the current available information and its suitability.
We did - Produced a bereavement leaflet following health economy consultation with all external partners and the Coroners. This now provides our Service Users and cares with key information about registering a death in the community.
Our Service Users have said - I would like more information available for me as a carer on aspects of wellbeing, work and being part of the local community
We listened - The Trust has carried out some ‘Making It Real’ events to gather the views of our Service Users and carers.
We did - The Trust has produced a series of fact sheets in collaboration with our partners across the health economy of
Staffordshire.
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Our Service Users have said - I would like to go home from hospital as soon as possible with a personalised care plan which supports my health and social care needs.
We listened - The Trust has gathered feedback patient stories, comments, and service improvements across the health economy of Staffordshire.
We did - The Trust has recruited a number of home care workers. This is to support our Service Users and carers within the community regarding discharge from our health and social care services. The Trust has introduced the “Home First campaign” which ensures that all our staff are being supported to communicate positively as possible with patients, carers and families to help identify how a person care could be provided at “Home First”.
Within our Community Hospitals we are working in collaboration with the University Hospital of North Midlands and we have introduced the ‘Discharge to Assess’ scheme. The introduction of this model is to ensure that Service Users are discharged in a safe and timely manner.
Our Service Users have said - I did not know who to contact out of office hours.
We listened - The Trust has captured your experience in our Patient stories.
We did - The Trust has now ensured all telephone numbers are clearly documented and positioned at the front of the file.
Our Service Users have said - I want to go home, not into respite care.
We listened - The Trust listened to how stressful you had found being in hospital and how you wanted to carry out everyday tasks.
We did - The Trust has designed a rehabilitation programme for the whole family confidence again.
Our Service Users have said - I would like to talk about how I can gain more control over my health and care.
We listened - The Trust invited users to public engagement events to gather comments and service improvements from our Service Users and carers.
We did - The Trust held events in Stafford, Burton and Cannock. The Trust has developed a new Carer Assessment with Staffordshire County Council. The Trust has produced new Service User and carer information for the Staffordshire health economy.
Our Service Users have said - I would like to be treated at home rather than go to hospital.
We listened - The Trust has spoken to our partners across the health economy of Staffordshire to see how we could make this happen.
We did - The Trust has started the “matron in a car” scheme where matrons attend 999 calls. They are able provide care packages which enable people to receive urgent care at home.
Our Service Users have Said - I am not always able to try out assistive technologies.
We listened - The Trust asked users which equipment they would find most useful.
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We did - The Trust now provide a trial box of equipment for our Service Users to sample.
Our Service Users have said - I feel that the waiting times at the sexual health clinics are too long.
We listened - The Trust has gathered comments and service improvements from our Service Users and carers.
Our Children’s services are currently being redesigned and we will be integrating services with our Social Care Services following consultation from our parents across the .
Our Parents have said - I think the comment cards for children to use could be more child friendly.
We listened - The Trust gained consultation across the Staffordshire health economy.
We did - The Trust produced a child friendly ‘Monkey’ comment card for young people between four and eight years.
We continue to use Practice Audit – incorporating clinical audit and social care audit – to improve care for our Service
Users.
We completed 83 local practice audit projects, which covered a wide range of subjects and services from which actions were developed for service user improvement.
During 2014/15 we redesigned and streamlined our Documentation audit to make it more responsive and less time consuming for front line teams which ensures that safe services are provided and maintained.
We also trained 129 front line health and social care staff in the basics of practice audit.
We view NICE guidance as high quality advice on what is effective, good value healthcare. We are committed to comply with all applicable NICE guidance.
We reviewed 140 pieces of NICE guidance published during 2014/15. The table below shows our compliance with the guidance.
Where we are partially compliant with guidance we take action to assess any risks, become compliant, and monitor progress at our Safety and Effectiveness Sub-committee.
Table 8: Compliance with NICE guidance published in 2014/15
NICE Guidance, status at 31 March 2015
Currently assessing relevance to our Trust
(includes 20 pieces of guidance issued in March 2015)
Not relevant to our Trust
Relevant to our Trust, and we are partially compliant with the guidance
Relevant to our Trust, and we are fully compliant with the guidance
Total
48
74
5
13
We encourage our staff to include NICE guidance in their clinical and social care audits. In 2014/15 we conducted seven audits related to NICE guidance. The guidance covered in these audits included:
• CG 138 + QS 15 Patient Experience in Adult NHS care: Improving the experience of care for people
• CG 123 Common Mental Health Disorders: Identification and Pathways to Care
• 29. The prevention and treatment of pressure ulcers
• CG 179- Nutrition
• CG 35 Parkinson’s Disease
• CG 179- Nutrition
• 161 - Falls: assessment and prevention of falls in older people
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Our Mortality Review Group reviews the care that our services have provided in the time immediately preceding a patient’s death. At each meeting the group reviews deaths to assess whether we can improve the quality of our care.
Our Mortality Review Group meets monthly and is currently chaired by the Interim Medical Director.
Chart 18: Number of community hospital deaths per month (2 year comparison)
There was a peak of deaths in February 2015 to the highest recorded:
• Prior to February 2015 we had 298 beds. From February onwards we increased our capacity to 346 beds. For example, we opened 37 beds at Longton Cottage Hospital.
• An increase in palliative deaths was noted in February, related to the opening of our palliative care ward
We have been able to improve our coding of palliative care deaths, with improved information from a data warehouse; we are now able to report more consistently an accurate position for community palliative care deaths.
We are involved with other community trusts (co-ordinated by the Trust Development Authority) to develop community tools and measures in order to ultimately produce community national guidance and standards.
We also plan to ensure all community hospital deaths are reviewed, to look at the quality of care provided and identify any gaps in systems and services provided. (See our Quality Improvement Priority 5 for 2015/16)
During 2014/5 the Research Service was part of the Medical Directorate and the innovation service was part of the
Transformation Team. Significant changes took place in in 2014/15 in relation to Research:
• We became a member of the Clinical Research Network
• We created a Trust wide Research Office and Research Delivery Unit
• Our Transformation Team developed a new service improvement team, with a focussed approach to service improvements
The current focus of our resources and activity is in research delivery and working in partnership with the National
Institute of Health Research and the Clinical Research Networks to deliver an increase in both the number of studies running locally and the number of patients offered the opportunity to participate in clinical research studies.
There is a well-established research active team within Rheumatology based at the Haywood Hospital and a smaller research active element with Stroke and Rehabilitation also based at the Haywood Hospital. There are strong links between Keele Primary Care Sciences Research Institute and Our Musculo-skeletal (MSK) community physiotherapy teams which has enabled widespread participation in MSK research studies, a pathway for practice generated research questions to be studied, and the implementation of research findings.
We will develop a robust strategy for research and innovation in 2015/16.
During 2014/15 we developed an in-house one-day evidence-based practice course. This course helps our staff to find, appraise and act on research evidence.
In 2015/16 we will provide more evidence-based practice training for our staff.
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Prescribing of medicines is the most common therapeutic intervention which takes place in the NHS. Our Medicines
Management Group works to ensure that patients get the medicines they need to effectively manage their condition.
The Group includes nurses, doctors, pharmacists and representatives from other healthcare professions from a range of service areas. Guidelines, governance processes and policies are reviewed and approved by the Group to ensure our service users gain optimal benefit from medicines.
We have a strategy to improve Medicines Optimisation for patients. The Medicines Management team, led by the
Clinical Director of Pharmacy Services, are leading on the delivery of the four key principles of medicines optimisation, as outlined in our Medicines Optimisation Strategy:
• Understanding the patient experience of medicines
• Evidence based choice of medicines
• Making medicines optimisation part of routine practice
• Ensuring medicines are used as safely as possible
Pharmacy services in community hospital are prioritising the development of the clinical role
– rather than a dispensing role – of our pharmacist and Medicines Management Technicians
We support Non-medical prescribers ensuring The Nursing and Midwifery Council, NMC Standards and Health and Care
Professions Council, HCPC Standards of prescribing are maintained.
In 2015/16 our work will include bringing Medicines Safety Issues to the fore and further developing the above and new initiatives.
We use our Quality Visit programme to assess local, national and regulatory quality standards and performance in a safe and consistent manner across all our health and social care teams.
The Quality Visit is a supportive process that aims to help front line staff to deliver better care and safety to our service users, whilst ensuring compliance with our regulators such as the Care Quality Commission. Our visits highlight and share good practice with the rest of the organisation and also identify areas for improvement.
Quality Visits also identified good examples of partnership working with other organisations and seamless integrated working across our health and social care teams.
When visiting a team, reviewers grade their findings by level of concern; low, medium or high and then risk assess the findings against the Trust standard risk assessment matrix to better understand the actual impact on staff and people using our services. This information is agreed with the team leader of each team.
We invited our commissioners and voluntary organisations, such as Healthwatch, to join the quality visit team to ensure that our visits have a level of independent scrutiny.
Themes that have been identified and addressed following
Quality Visits over 2014/15 include:
We conducted 35 Quality Visits to health and social care teams in 2014/15.
• Documentation of care
• Staffing levels and recruitment
In every quality visit, aspects of good practice and learning are shared across the Trust. Examples include:
• IT provision and network speed
• Confidentiality, respect and dignity
• Safety and security of staff
• Estates issues
• The development and learning from quality visits is part of our Band 5 district nursing development programme.
All teams that receive a quality visit agreed an action plan to address the issues found in their area.
• Collaborative working across health and social care teams, for example, sharing referral information across agencies to improve service user experience.
• Good feedback received from our partners organisations regarding our working relationships.
At our divisional business meetings we monitor Quality
Visits and their action plans. Quality Visit outcomes are presented at governance meetings through to the Trust
Board ensuring that exceptions are reported and learning shared.
• We improved privacy and dignity for our service users by relocating a children’s physiotherapy service to more suitable premises.
• We reviewed and then reduced waiting lists for our heart failure and diabetes services in North
Staffordshire.
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Clayton District
Nurses
“Delighted with all the care given to my wife. Thank you”
Haywood Scotia
“The complete support, care and professionalism of all staff which fills me with great confidence and trust in the care I am receiving.”

We assess the impact on service quality of our plans to deliver cost improvements. We call this a Quality Impact
Assessment (QIA). Our Director of Nursing and Quality and Medical Director lead these assessments, and report the outcomes to our Trust Board.
Our 2014/15 cost improvement Programme target was £14.244m and our scheme was initially valued at £14.085m.
• 171 schemes were approved by our Quality Impact Assessment process. However in some cases the actual financial value has proved to be less than the original value by around £2.7m.
• 13 schemes still need to be signed off by the QIA Panel. These schemes were identified at the end of the financial year as part of a review of underspends. The schemes will be rolled forward into our 2015/16 programme.
• 30 schemes have proved to be financially unviable.
• There were a number of schemes where the QIA panel requested additional assurance prior to implementation.
Table 9: Table: Cost Improvement Programme for 2014/15
Quality Impact Assessment complete and approved
Quality Impact Assessment not completed
Scheme withdrawn from programme due to financial viability
Scheme withdrawn from programme due to quality concerns
Total
171
13
30
0
214
Number of schemes
Original scheme value
Costs saved in
2014/15
Full year impact
(savings in future years)
£11,592,894 £7,497,046
£0 £268,019
£2,492,199 £0
£0 £0
£14,085,093 £7,765,065
£8,848,723
£323,573
£0
£0
£9,172,296
The Professional Leadership Team are all registered practitioners (nurses, allied health professionals or social workers) and they ensure professional leadership is in place for all frontline staff and other parts of our Trust.
Some areas where the team have worked with other staff during 2014/15 included:
• 6C’s Challenge Award: An award for clinical, non-clinical and corporate teams to demonstrate how the service they provide aligns to the 6C’s and organisational values. Thirteen applications were made and seven teams received the award.
• Professional Competency Framework and Job Descriptions: The team have worked in partnership with the Transformation team to start the development of a competency framework for all professional bandings underpinned by competency based job descriptions. These projects will ensure that staff will have the right skills to deliver high quality care across our services.
• The Professional Head of Nursing and Professional Head of Allied Health Professions presented at the National ‘The
6Cs are for everyone’ conference in Westminster.
• Recognition of Excellence – Health Visiting: The Professional Lead for Health Visiting and three other of our health visitors, have become Fellows of the Institute of Health Visiting (FiHV).
Valuing the importance of professional supervision we developed an integrated policy and framework for supervision of Health and Social Care professionals. This policy recognises the distinct nature of types of supervision; managerial, professional and clinical. Rather than a purely “management tool”, supervision will now focus on critical reflection, skills and professional development. This focus on professional supervision, encompassing restorative approaches will support and promote professional resilience.
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We are continuing with our project to focus on workforce development for Social Workers and Social Care staff.
We are undertaking a planned approach to our staff development, which will define the required future workforce requirements for Social Work and Social Care, taking into account national, regional and local contexts.
In order to ensure that Social Work and Social Care Staff are kept informed about best practice and as part of developing a research culture. A number of developments have taken place:
• Providing access to Social Work journals via the Trusts library services and NHS Athens.
• Purchasing an online resource CareKnowledge providing further access to journals and regular updates on policy and best practice.
• Supporting a Trust Social Worker to secure a research fellowship (first Social Worker on a NHS Fellowship in the West Midlands).
• Secured funding via NIHR Clinical Research Network
(West Midlands) and appointing a part time Social
Work Research Facilitator.
Since the last survey in 2013 a lot of work has taken place to improve staff experiences at work and this is reflected in some of the positive results for 2014. New Health and
Wellbeing and Employee Engagement and Involvement strategies are in place across the Trust. The focus on the Partnership Approach to Leadership has included a new approach to Appraisal training for managers with feedback tools and techniques designed to enhance the process.
Key Strengths and Improvements since the last survey are:
• Percentage of staff feeling pressure in the last 3 months to attend work when feeling unwell
Areas for improvement include:
• Percentage of staff receiving Appraisal in the last 12 months, which has been impacted by the introduction of Pay Progression
• Access to training, which since February 2105 is available via e-learning
• Improving use of patient feedback to inform service delivery
This year we have done the following:
• Launched new wellbeing pages on the Trust Intranet to signpost staff to wellbeing support services and self-help tools
• Percentage of staff stating their appraisal helped them agree clear objectives for their work
• Launched a new stress awareness self-assessment tool which will signpost staff to wellbeing support
• Percentage of staff left feeling valued by the organisation
• We have mandated stress management courses for line managers in 2014-2015
• Percentage of staff receiving recognition for good work
• Percentage of staff witnessing potentially harmful errors, near misses or incidents in the last month
• Introduced a Gateway to Leadership Training programme for managers and leaders in the
Partnership Trust and introduced a range of targeted master classes
• Percentage of staff who know who senior managers are
• Introduced a “Health check” approach as a way to diagnose the support that teams need and plan appropriate interventions
• Percentage of staff who agreed their manager takes a positive interest in their health and wellbeing
• Introduced a Health and Wellbeing Awareness
Campaign linked to national campaigns such as stress awareness/alcohol awareness
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Table 10: Staff opinion key survey results
National Staff Survey results
Overall level of staff engagement
From 1 (poorly engaged) to 5 (highly engaged)
Staff feeling satisfied with the quality of work and patient care they are able to deliver
Staff agreeing that their role makes a difference to patients
Staff feeling work pressure*
From 1 (low work pressure) to 5 (high work pressure)
Staff reporting effective team working
From 1 (ineffective) to 5 (effective)
Percentage of staff working extra hours*
Staff received job relevant training, learning and development
Staff appraised in last 12 months
Staff having well-structured appraisals in last 12 months
Support from immediate managers
From 1 (unsupportive) to 5 (supportive)
Staff receiving health and safety training in last
12months
Staff suffering work-related stress in last 12 months*
Staff witnessing potentially harmful errors, near misses or incidents in last month*
Staff reporting errors, near misses or incidents witnessed in the previous month
Fairness and effectiveness of incident reporting procedures
From 1 (ineffective / unfair) to 5 (effective / fair)
Staff agreeing that they would feel secure raising concerns about unsafe clinical practice.
Trust
Score
2011
Trust
Score
2012
Trust
Score
2013
Trust
Score
2014
National average for community trusts in
2014
3.76
3.70
3.69
3.70
3.75
77%
92%
3.87
59%
82%
40%
3.77
73%
28%
21%
97%
3.55
76%
90%
3.13
3.76
68%
86%
97%
38%
3.71
79%
42%
21%
87%
3.55
72%
90%
3.21
3.74
72%
84%
93%
35%
3.62
70%
45%
24%
92%
3.46
74%
89%
3.20
3.83
70%
83%
78%
34%
3.80
63%
45%
19%
91%
3.51
70%
75%
90%
3.11
3.83
70%
83%
90%
38%
3.75
76%
41%
23%
91%
3.58
72%
*A lower score is better for these key findings
Quality Account | 103

104
National Staff Survey results
Staff experiencing physical violence from patients, relatives or the public in last 12 months*
Staff experiencing physical violence from staff in last 12 months*
Staff experiencing harassment, bullying or abuse from patients, relatives or the public in last 12 months*
Staff experiencing harassment, bullying or abuse from staff in last 12 months*
Staff feeling pressure in last three months to attend work when feeling unwell*
Staff reporting good communication between senior management and staff
Staff able to contribute towards improvements at work
Overall level of staff satisfaction
From 1 (dissatisfied) to 5 (satisfied)
Staff that would recommend the Trust as a place to work or receive treatment
From 1 (Unlikely) to 5 (Likely)
Staff motivation at work
From 1 (not enthusiastic / absorbed) to 5
(enthusiastic / absorbed)
Staff having equality and diversity training in last
12 months
Staff believing the Trust provides equal opportunities for career progression or promotion
Staff experiencing discrimination at work in last
12 months*
Staff agreeing feedback from patients /service users is used to make informed decisions in their directorate/department
Trust
Score
2011
Trust
Score
2012
Trust
Score
2013
Trust
Score
2014
National average for community trusts in
2014
8% 10% 6% 8%
20%
67%
3.67
3.67
3.95
48%
93%
10%
1%
26%
20%
23%
27%
68%
3.66
3.57
3.83
64%
92%
8%
2%
28%
21%
24%
23%
68%
3.58
3.58
3.84
55%
93%
8%
1%
23%
18%
18%
28%
69%
3.66
3.57
3.82
51%
90%
7%
47%
1%
24%
19%
22%
32%
69%
3.66
3.65
3.87
68%
91%
8%
52%
| Quality Account *A lower score is better for these key findings
Our main focus is on keeping staff well and at work, the health and wellbeing of all our staff and responding to their needs is important to us. Reducing the cost of absence remains a top priority for the Trust. We had a sickness absence rate of 4.98% during 2014/15 and next year we plan to continue reducing the sickness absence figures across the Trust, towards the national target of
4%.
Our work streams for the next year will focus on the delivery of strategic goals to reduce sickness absence by
1%, reduce stress levels in the organisation, improving line manager capability, confidence and competence in supporting wellbeing and improving systems and processes within our Electronic Staff Record.
We will focus on prevention, timely intervention, rehabilitation, tools to help managers deal with attendance, promotion of health and wellbeing, using work as a means to improve health and wellbeing and using the workplace to promote teaching and training, encouraging staff and managers to support staff health and wellbeing.
We are committed to ensuring effective measures are in place to meet our Vision and Values as well as our legal obligations in protecting people from discrimination in the workplace and in wider society.
40
• Our Equality and Inclusion strategy will be reviewed in Summer 2015 following consultation and engagement.
• Our Equality Delivery System, EDS2 implementation and engagement plan supports the Trust to monitor and measure progress on our equality objectives and actions and will result in a formally graded EDS2 with revised actions to move forward as an exemplar Trust.
• An Equality Analysis has to be completed for all our policies and strategies, as part of their development process.
This ensures that they are inclusive, fair, and accessible for all our staff and service users.
• As a Personal Fair and Diverse Ambassador Trust executive team members have visited local groups and discussions on health experience and perception have led to further Trust initiatives such as Trust Board meetings at Community venues i.e. North Staffordshire Afro-Caribbean Association, in May there will be an opportunity for members to visit the Islamic community venue and local Mosque to support our inclusion agenda
Across the Trust there are many activities, which are part of everyday practices, which support compliance with the wider equalities agenda. Examples include patient choice, patient care, and employment practices, that all promote the principles of the Human Rights Act 1998.
A Trust wide Integrated Language and Communication Service supports staff to access language, British Sign Language
(BSL) and Lip-speaker interpreters. The service also provides access to telephone interpreters and translation of documents upon request. This service supports competent communication between:
• Patients / service users and health professionals when accessing Health and Social Care, consultation and engagement events
• Staff when accessing internal training programmes, consultation and engagement events
For more information see: www.staffordshireandstokeontrent.nhs.uk/About- Us/equality-strategy.htm
40 See the Equality Act 2010 and the Public Sector Equality Duty
Quality Account | 105

The North Division provides all the assessment and care services for social care, community nurses and allied health professionals in the community.
The Division also provides the allied health professional services to all community hospitals.
• Occupational Therapy reduced the adult social care waiting times from 37 weeks to 20 weeks in
Newcastle and 33 to 13 weeks in the Moorlands.
• In the North Division, 97% of users reported they would recommend the Trust to friends and family
Over the past 12 months, there have been significant achievements by services in order to improve access for local people.
• Community Nurses and Matrons have exceeded the target for the number of people successfully kept at home rather than attending as an emergency.
• Social Care services have achieved the target to reduce the number of permanent admissions to Residential and Nursing Homes. The target for 2014/15 was 150 per 100,000 and the North Division attained 140 per
100,000.
• The North Division exceeded the target set for Carers assessment / reviews in 2014/15.
• All Consultant-led and Allied Health Professional services were compliant with their respective national and local referral to treatment waiting time targets.
• There was a need to improve the recruitment to
District Nursing service. Two major campaigns of recruitment were undertaken. A three month rolling programme of recruitment is now taking place in order to ensure that an appropriate level of staff are in place to support local people.
• New model of social care with a focus upon prevention.
• Health and Social Care staff working with GPs achieved the target of the number of care plans set with the Clinical Commissioning Groups put in place for complex people who need support.
• We started work on producing an emergency care plan which was used by GPs and ambulance services to further reduce the number of emergency attendances.
• 98% of users felt that all staff members were polite, helpful and courteous and 82% were extremely satisfied with the clinical treatment and quality of care received.
• There was a number of areas where care packages have had to be moved to another provider at short notice. We worked to ensure all services were maintained and safely moved to another provider.
• Implementation of the Care Act.
• Continued recruitment and retention of District Nurses in particular and all other services.
• Ensuring the delivery of a Cost Improvement
Programme whilst maintaining quality of assessment and support.
• The development of relevant Commissioning for
Quality and Innovation (CQUIN) schemes for 2015/16.
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The South Division provides all the assessment and care services for integrated teams of Health and Social care professionals, Enablement and hospital discharge teams
Intermediate Care, Therapies, Long-term Conditions
Services, and Specialist Nurses.
• Continued development of ambulatory clinics in all areas providing care closer to home.
• Focused work with the local Acute Trusts to ensure safe discharges from hospital in South Staffordshire and surrounding areas for our patients.
• Pilot of the community response team in Tamworth –
A matron and a paramedic in a response car attending
999 calls – this has facilitated a non-conveyance rate of 69% instead of the normal 39% for West Midlands
Ambulance Service.
• Launch of the Trusts new supervision policy has provided structured support for all our staff.
• Cannock have a new community intervention service working closely with Walsall Manor Hospital and providing a more responsive service to patients in acute need and a more consistent service to individuals with long term conditions.
• Improved approach to integrated working across
Health and Social Care, this has included participation of Health and Social Care staff in multidisciplinary teams meetings with general practice and joint working where there are safeguarding concerns around care provision of vulnerable adults.
• The Adult Ability Team has been nationally recognised as best practice for services for people with progressive neurological conditions.
• We have also embraced new technology and have all been issued with laptops and phones for remote working to enable us to work flexibly and efficiently reducing travel costs and enabling us to spend more time face to face with patients.
• Key quality challenges have related to numbers of qualified nurses within our District Nursing teams, in particular nurses with the specialist practice District
Nurse qualification. We are targeting recruitment via national and local media and social media to resolve our workforce challenges.
• Continued pressure for timely and appropriate discharge of patients across the health economy has been a challenge for our teams working in this area.
• Service redesign to meet a variety of commissioning intentions across the county for 2014/15 has been challenging for our teams.
• A Single Point of Access for health and social care referrals is being developed to enhance communication integration and ensure simple easy to navigate pathways for our customers.
• Service redesign of our Staffordshire wide diabetic retinopathy screening service will ensure the increasing number of diabetic patients have access to this vital screening.
• Restructuring of services in line with Clinical
Commissioning Group intentions will have a positive impact on services.
• Further improvement of access to ambulatory clinics.
• Continued development of integrated working across health and social care
• Further identification and usage of digital technology to improve patient outcomes and encourage self- care.
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Our community hospitals provide a range of inpatient services incorporating the following specialties:
• Stroke Rehabilitation
• Neuro Rehabilitation and Trauma
• Rheumatology
• General Rehabilitation
• Intermediate Care
• Assessment (for on-going care needs)
• End of Life
During 2014/15 the Community Hospitals saw an improvement in the indicators related to the Safety
Thermometer audits.
“The Purple Bow Scheme” was piloted on Sycamore
Ward for patients at imminent end of life. This has been a successful pilot and has won a National Community
Hospitals Association Award for Innovation. The scheme provides relatives and carers of patients at the end of their life the opportunity to spend as much time together as they require and enables the relatives to agree any special requirements their loved ones or indeed themselves have to support this very difficult and emotional time.
The patients are designated with the “Purple Bow” to demonstrate to ward staff that the patient is at end of life and to be sensitive to the needs of the relatives and carers at this time and provide support as agreed.
Matron tea parties are an initiative that was developed during 2014/15 that not only provided an opportunity to seek patient and relative/carer feedback, but also provided an opportunity to undertake some teaching with patients and their families around some key issues such as nutrition and hydration.
A Buddy Ward scheme was piloted within the Community
Hospitals on Jackfield Ward and the purpose of this scheme was to create closer partnership working with ward teams at the acute Trust to facilitate an improvement in the transfer process for patients between the 2 organisations. This has proved to be very successful in relation to the pathway for fractured neck of femur and other trauma patients. The Trust will be seeking to develop this initiative further in 2015/16.
Further development of a Ward Assurance dashboard has taken place this year (formally known as the “Matron’s dashboard”) – an audit is undertaken on a monthly basis and reviews indicators in a number of areas. For
2015/16 this will now be supported by the internal audit department.
Key challenges for 2015/16 are the continuation of significant urgent care pressures.
The requirement to undertake and respond to bed based capacity will remain a challenge in the context of reviewing service developments, service improvements and transformation.
In addition to this the commissioning landscape is one of a fluctuating state and this is proving difficult to allow for successful planning.
Developments for the coming year will include:
• Dementia strategy in accordance with the Department of Health Dementia challenge for 2020
• Safety ACE programme (linked to the Sign Up to
Safety Initiative)
• Further development of the Mortality Review Group
(led by the Medical Director)
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The Trust provides Sexual Health Services in North & South
Staffordshire, Shropshire, Telford & Wrekin and Leicester,
Leicestershire & Rutland. Our services are commissioned by Local Authorities and are delivered in a range of consultant led hub clinics and nurse led community clinics.
In addition to clinical services we also provide health improvement, prevention and promotion services to address risk taking behaviour, promote sexual health and improve lifestyle.
appointment and walk in sessions.
To ensure that clients who need urgent care are seen promptly we have introduced a range of self-assessment and nurse assessment (triage) in addition to clinical assessments in our clinics so that we can offer timely and appropriate care.
During 2014/15 we have responded to a changing national agenda which has directed that Family Planning and
Genito-urinary services integrate to provide one stop clinics to address changing sexual health. As part of this integration we have been providing a range of education and training opportunities for our staff to equip them to deliver this new service model.
In changing the service, we have extended our clinics so that clients can walk-in (self-refer) to our services. To help to improve access and reduce waiting times we have extended the opening hours to include more evening and weekend sessions and have introduced a range of both
• Continue to develop staff education and training for
Integrated Sexual Health Services.
• Tender for a range of new and renewal contract opportunities
• Further develop prevention and promotion services
• Standardise services approaches throughout the network
• Further market and develop C (Condom) card opportunities
• Review and expand opportunities for further targeted outreach services to ensure the service reaches high risk and vulnerable clients.
We provide health services to six of Her Majesty’s Prisons
(HMP) in Staffordshire. We also manage the Youth
Diversion Programme and the Youth Offending Service in Staffordshire. Our other services include GPs, Mental
Health; Physiotherapy, Podiatry, Stop Smoking and
Screening programmes. We also coordinate and arrange hospital appointments. In addition to these clinical services, we provide health improvement advice and support through our Health Trainer service to promote and improve healthy lifestyles.
other prisons. We also hope to extend this programme further in the coming year by implementing simple telehealth to offenders being released. This will increase the opportunity to improve the skills and techniques that offenders have learned while they have been in prison.
We are also proud of HMYOI 41 Swinfen Hall Healthcare who received the Rainbow Charter that demonstrates compliance equality and diversity standards.
During 2014/15 we have been very proud of our Nurse- led Anxiety Management Programme at HMP Stafford, which has been nationally recognised as best practice. The programme has benefited offenders and has improved their clinical outcomes. It is now being rolled out across
We have responded to a challenging agenda regarding staffing. Several key areas were reviewed and resulted in regular meetings so that recruitment issues could be addressed which has resulted in improved staffing across
Prisons.
41 Her Majesty’s Young Offender Institution
Quality Account | 109

Time to Quit provides stop smoking support to residents of Staffordshire and Stoke on Trent. Support to stop smoking is provided on a one to one basis or where it’s required in groups.
The twelve week programme for anyone aged 12 and over is based on supporting people to stop smoking completely. A combination of behavioural support and medication is used to maximise the likelihood of success.
Stop smoking support is provided through a core team and also by partners and subcontractors such as pharmacies, GP surgeries, NHS trusts and Staffordshire Fire and Rescue Service. This ensures the service has a wide reach throughout the area.
• NICE require 35%-70% of those starting a quit attempt to be smoke-free at four weeks. Time to Quit currently averages 50% who are smoke-free at four weeks.
are smoke-free at four weeks to still be smoke-free at twelve weeks. Time to Quit currently average 60%.
• The team have won the Partnership Trust gold award for the highest client satisfaction score.
We have introduced service user satisfaction surveys in order to get meaningful information for both parties.
This year has seen Time to Quit move to a full electronic client record. The first results of Time to Quit’s record keeping audit shows areas where record keeping is at
100% of the required standard.
• Learning from all feedback to improve the client satisfaction scores received.
• Sharing record keeping best practice to raise the standard of all records to 100% scores.
• Further improving quit rates with education for subcontractors and partners around the follow up of clients throughout their quit attempt.
• Guidance and best practice require 50% of those who
We have restructured our children’s management team to improve and support leadership across all services we have aligned our delivery model to further support the closer working with our partners in both the City Council and
Staffordshire County Council.
Through further expansion our popular Hospital at Home service continues to enable children and their families in the North of the County to avoid hospital admissions and to achieve earlier discharge by providing safe and effective clinical nursing care at home. Over the past year the service has also begun to work directly with GP’s locally within the out of hours service, ensuring that families can have access quickly to specialist paediatric nurses.
The Children’s Airway Support team has combined with the Children’s Community Nursing team to provide an improved level of service to a wider range of patients and in a more effective manner. The team is able to react more quickly to the changing needs of patients and their families. The service is also working in greater partnership with local charitable organisations.
The Family Nurse Partnership has expanded its services to the Newcastle Under Lyme area and now supports many more young parents and their children. The Trust has achieved its target in the national Call to Action campaign designed to increase the numbers of Health Visitors.
2015/16 will see further expansion of both the Children’s
Diabetes team and the Hospital at Home team into the
South of the County.
AHP North Stoke
“Because I felt my condition was understood and I was treated with complete respect”
Stafford
Physiotherapy
“Excellent treatment which matched that from a private sports clinic”
110 | Quality Account Quality Account | 111

During May 2015 we circulated a draft of this quality account for formal comment to:
• Healthwatch Stoke-on-Trent
• Healthwatch Staffordshire
• Stoke Overview and Scrutiny Committee
• Staffordshire Health Scrutiny Committee
• North Staffordshire Clinical Commissioning Group
• Stafford and Surrounds Clinical Commissioning Group
• East Staffordshire Clinical Commissioning Group
• South East Staffordshire and Seisdon Peninsular Clinical Commissioning Group
• Stoke-on-Trent Clinical Commissioning Group
• Cannock Chase Clinical Commissioning Group
• Leicester Clinical Commissioning Groups
• Telford and Shropshire Clinical Commissioning Groups
• NHS England (Shropshire and Staffordshire Area Team; Leicestershire and Lincolnshire Area Team)
In addition, we placed a draft copy of the Quality Account on our Internet site, and asked our staff, service user groups, and other partner organisations to comment on the draft.
As directed by regulation and national guidance, this section contains the formal responses we received from our local
Healthwatch, Overview and Scrutiny Committees, and Clinical Commissioning Groups.
We also thank the staff, service users and partner agencies who responded to our consultation.
The Quality Account was presented and considered by Healthwatch Stoke-on-Trent on 20th May 2015 and, following the presentation from SSOTP and responses to the questions raised, Healthwatch Stoke-on-Trent offers the following comments.
There were a number of references made by patient representatives during the presentation, to the complicated presentation of evidence in the Account which often made it difficult to assess if there had been any progress. Efforts to address this would be appreciated by the public who are the target recipients of this document. A considerable discussion centred around concerns that the Measures for 2015/16 held a significant number of targets that cannot be measured effectively from the way that they are described. Better presentation and clearer targets would assist the
Trust in robust monitoring of performance against targets for reporting next year. It is hoped that this will be addressed in the final version of the report.
We welcome the recognition by the Trust that it is important to provide routes for staff to raise concerns at all levels of the organisation. However, we would prefer to see additional emphasis placed on identifying and implementing solutions so that staff feel that they are being listened to, action is being taken, and feel assured that the risks they identify are mitigated. It is also concerning that the report does not give higher prioritisation to improved staffing levels since this has been such a key issue throughout the year.
There are clearly concerns around the need to reduce avoidable harm (Priority 1) and the focus in the last year on reducing avoidable Grade 3 & 4 pressure ulcers has not produced the results required. Healthwatch Stoke-on-Trent is pleased this remains a priority and hopes that addressing this through improved care and recruitment of district nurses and community staff to bring the Trust up to appropriate staffing levels will be a high priority.
The local health and care economy across Staffordshire and Stoke-on-Trent should be working as one to provide integrated care. The Quality Account provides an ideal opportunity to give a demonstrable message to the public and staff that SSOTP are part of this bigger picture and working with partners to deliver the New Model of Care (North
Staffs & Stoke-on-Trent). It would be helpful to see this better described in the Quality Account to assure the public that providers and commissioners working together are central to delivery of better care.
In conclusion Healthwatch Stoke-on-Trent recognise the pivotal role that SSOTP has to play in the delivery of the community services required to achieve the New Model of Care (Step Up/Step Down) in North Staffs and Stoke on
Trent. Healthwatch hopes that the Trust will focus on ensuring it has optimised its staffing, particularly in recruiting sufficient District Nurses, to provide safe, high quality care in the community, that it works closely with partners to maintain and improve this, that it is able to demonstrate the quality through robust monitoring and review, and that most importantly it listens to patients and their families at all times, to shape, improve and deliver the services they need. We look forward to working with the Trust to support this in the coming year.
Healthwatch Stoke-on-Trent May 2015.
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Healthwatch Staffordshire is pleased to comment on the draft Quality Account for 2014-15 and thanks the Trust representatives for presenting the draft to our volunteers. Over the year under review Healthwatch Staffordshire has contributed to some Trust quality initiatives through our membership of the User Carer Experience Forum and the
Complaints Review Panel as well as participating in the priority setting meeting, in Quality visits and the Annual Awards initiative. We are confident through these mechanisms that the Trust is committed to collecting and acting upon the views of people who use services and their carers.
The Quality Account and the Trust representatives at our meeting set out the achievements for the year under review as well as clearly reporting the challenges. It is pleasing to note that those challenges are built into the actions planned under the priorities for the forthcoming year. The proposed priorities are comprehensive and explicit in their objectives.
We are aware of the large geographical coverage of the Trust and the wide range of services commissioned by a variety of different organisations. At our meeting with Trust representatives we talked about different practices and staffing levels in different parts of the County. For example, capacity of District Nursing provision is very problematic in one area but reported as performing well in another; some areas have or have had specialist condition nurses whilst others may not; the draft Account reports on very poor performance for Health Visiting in another area. We welcome the Trust’s plans to implement a workforce development toolkit for community teams in order to improve planning for the makeup and levels of staff teams, both within and outside ‘normal’ working days and times.
An overriding concern of Healthwatch continues to be the need for better integration of services both within the Trust and between the Trust and other providers. Whilst the New Model of Care is a North Staffordshire and Stoke-on-Trent initiative we believe that the planning and lessons learned to prevent unnecessary hospital attendances and admissions and to support early and effective discharge should be transferable across other districts. We reiterate our concerns that the capacity and effectiveness of community health and social care services are fundamental to the success of the new model. We believe there is still much work to be done in this regard.
We welcome the priority to tackle safety culture and reduce avoidable harm and at our meeting we were reassured by the range of initiatives in place to provide safe care. We are mindful however of the community staffing capacity already noted and the potential impact on safe care if shortfalls are not addressed.
The work which the Trust is carrying out to expand its improving outcomes initiative is well received by Healthwatch and although some teams are behind in their implementation, the numbers of teams which have moved to level 3 and
4 of the scheme is very pleasing. We believe, when fully implemented, this will enable the Trust to improve outcomes for people using services by better understanding its services and enabling benchmarking between teams. This pursuit of quality is further supported by the Trust’s existing benchmarking with other organisations and its participation in clinical audit and research.
We note that there continue to be problems with social care assessments for both users and carers. The effectiveness and timeliness of assessments, setting up packages of care and reviews is the foundation upon which the Trust’s priority of offering choice and control to people will be achieved. Effective care planning along with good quality provision will be essential to achieve good outcomes for those needing support. It is also a key component of the need for better joined up working. We welcome the Trust’s offer to meet with Healthwatch representatives on this theme.
Healthwatch Staffordshire is committed to continuing our work with the Trust to support the effective engagement with people who use services and carers and to ensure that their voices are heard in service planning and reviews.
May 2015
114 | Quality Account
Staffordshire and Stoke on Trent Partnership NHS Trust
We are directed to consider whether a Trust’s Quality Account is representative and gives comprehensive coverage of their services and whether we believe that there are significant omissions of issues of concern.
There are some sections of information that the Trust must include and some sections where they can choose what to include, which is expected to be locally determined and produced through engagement with stakeholders.
We focused on what we might expect to see in the Quality Account, based on the guidance that trusts are given and what we have learned about the Trust’s services through health scrutiny activity in the last year.
We also considered how clearly the Trust’s draft Account explains for a public audience (with evidence and examples) what they are doing well, where improvement is needed and what will be the priorities for the coming year.
Our approach has been to review the Trust’s draft Account and make comments for them to consider in finalising the publication. Our comments are as follows.
PART 1
We are pleased to see a clear Statement from the Chief Executive and Chairman and also note the statement from the
Responsible Director that the Quality Account is accurate and has been signed by the Director of Nursing and Quality.
We appreciate the clear introduction in respect of the Trust including a comprehensive list of services provided by the Partnership, and we note the Trusts mission, vision, values and goals are also detailed. We are pleased to see the inclusion of a comprehensive list of services provided by the Trust. We feel it would have been helpful to put the acronym, ILCT, in full as it is not detailed until later in the document. Also we would have wished to see the services provided at the Community Hospitals detailed in that section.
We also support the inclusion of the Raising Concerns section but wished to see further detail on feedback and outcomes.
We were pleased to see the detail contained within the ‘Our Strategy and Service Development’ and the Quality
Framework link.
PART 2
We support and recognise the consultation undertaken by the Trust to decide the Priorities and the involvement of stakeholders. We would like to see more detail on baselines for these priorities and how they will be monitored going forward. It is felt that some of the measures and targets were not clear or would be difficult to monitor. Also an explanation of EQ-5D would have been appreciated at this point.
The recruitment to the workforce is highlighted but is it felt this should be supported by a priority to retain staff, especially in relation to Community staffing.
We note the Trust provided 71 Services and that the they were all reviewed. We would have liked to have seen more detail of the income received by the Trust from whom and for which services.
In relation to the Clinical Research we note the Trust’s involvement but would have liked more detail on the outcomes from these pieces of work and the benefits to the Trust.
It is noted that the achievement of CQUIN initiative has yet to be completed in the draft. We would hope the amounts of income involved are included. Where non achievement is indicated, detail of the reasons would be beneficial.
The inclusion of CQC registration and the inspections and outcomes is supported.
We would wish to see the outcomes following the action being taken concerning Data Quality.
The inclusion of the Mandatory Quality Indicators is noted.
Quality Account | 115

PART 3
We support the level of detail contained in the review of Quality Performance with the aims and progress being clearly displayed. As previously, where non achievement is indicated, detail of the reasons would be beneficial.
We would have liked to see more detail on Complaints Management and outcomes and how this had led to improvements. We also would have wished to see the outcomes from the ‘Mystery Shopper’ included. The inclusion of more positive and negative comments on the patient feedback would be welcomed to demonstrate a balance of attention and awareness.
Generally would have wished to see more case studies included. It is noted however that within the draft they are detailed at the end with the intention of interspersing them throughout the final version.
We appreciate the ‘Medicines Optimisation’ and queried if returned medicine should also be supported.
Thank you for the opportunity to respond to the organisations quality accounts. Unfortunately, due to the Council holding all out elections this year, the council does not have an Overview and Scrutiny Committee which can consider
Health items during the timescale of your consultation. Under the circumstances, Health Scrutiny is unable to comment on this year’s accounts.
North Staffordshire CCG and Stoke-on-Trent CCG are making this joint statement as the nominated commissioners for the North Division of Staffordshire & Stoke-on-Trent Partnership NHS Trust.
The contract and service specifications with the Trust detail the level and standards of care expected and how these will be measured, monitored, reviewed and performance managed. As part of the contract monitoring process, North
Staffordshire CCG and Stoke-on-Trent CCG meet with the Trust on a monthly basis to monitor and seek assurance on the quality of services provided. Further, a pan Staffordshire meeting takes place on a quarterly basis whereby themed discussions take place. In addition to the contract meetings, the CCGs work closely with Trust and undertake continuous dialogue as issues arise to seek assurance, which is also obtained via quality visits and attendance at Trust internal meetings.
The Quality Account covers many of the areas that are discussed at these meetings, which seek to ensure that patients receive safe, high quality care.
REVIEW OF 2014/15
It is pleasing to note the Trust’s commitment to improving quality as demonstrated by the following achievements:
• Commissioners wish to celebrate the Trusts successes in 2014/15 recognised amongst other achievements by being awarded a National Community Hospitals Associates Award for Innovation for ‘The Purple Bow Scheme’ on
Sycamore Ward at Bradwell Community Hospital and a member of staff receiving a ‘Queen’s Nurse’ Award.
• Commissioners commend the breadth of real time patient experience feedback. The Trust achieves coverage across the whole organisation and has demonstrated a consistently high response rate and positive response, 97% would recommend the Trust, from the use of the Friends & Family Test. Further, the Trust continues to extended it’s
116 | Quality Account methods for collating feedback including the development and implementation of children’s ‘monkey’ comment cards designed for children aged four to eight years.
• The Trust has not reported any avoidable pressure ulcers in Community Hospitals during 2014/15; a reduction from
4 in the previous year.
• The Trust has not reported any ‘Eliminating Mixed Sex Accommodation’ breaches during 2014/15.
However, 2014/15 has not been without its challenges:
• Commissioners are aware of the challenges that the Trust is facing recruiting qualified nurses in particular into
District Nursing Teams reflected in staff feedback and the CQC unannounced inspection reports. We also recognise the importance of listening and responding to staff concerns. Following the closure of Longton Cottage
Community Hospital we undertook four unannounced visits and we are currently in the process of arranging nurse led focus groups for District Nursing to hear from staff, to understand their perspective and gain broader insight into the services.
• The Trust reported 31 avoidable pressure ulcers within Community Services during 2014/15 a slight increase on
2013/14 (29 avoidable pressure ulcers). Whilst this is disappointing Commissioners are assured that investigations are undertaken to a high level, identify lessons and areas for improvement and witness robust internal challenge at the Tissue Viability Scrutiny Panels where we are represented. We are pleased that the reducing avoidable pressure ulcers priority has been extended into 2015/16 and there is a focus on reducing harm from pressure ulcers within the Trust’s Sign up to Safety Improvement plan.
• Whilst it is disappointing that the Trust reported a MRSA bacteraemia the post infection review determined that the case was unavoidable and the Trust achieved a screening rate of 99.9%. The CCGs work closely with the Trust’s
Infection Prevention & Control Team and the Trust is actively engaged with both the local North Staffordshire
Infection Prevention Control Group and the NHS England group.
PRIORITIES FOR 2015/16
The Commissioners welcome the specific priorities for 2015/16 which the Trust has highlighted in this account and developed in consultation via Stakeholder Workshops.
To the best of the commissioner’s knowledge, the information contained within this report is accurate.
Quality Account | 117

INTRODUCTION
Cannock Chase CCG and Stafford and Surrounds CCGs are making this joint statement as the nominated commissioners for the South Division of Staffordshire & Stoke-on-Trent Partnership NHS Trust. The Commissioners were pleased to contribute to the Quality Account for 2014/15
As part of the national contract monitoring process, the CCGs meet with the Trust on a monthly basis at the Clinical
Quality Review Group (CQRM) to assure the maintenance of high quality and safe services to the people of South
Staffordshire. We continue to work very closely with the commissioners in the North of the county to share learning and reinforce good practice across the local health economy; and where appropriate to receive the benefits of developments at scale. This has taken place at quarterly joint CQRMs attended by the North and South commissioners where themed reviews of key quality and safety issues are undertaken such as staffing and pressure ulcers.
For 2015/16 forward joint meetings will now be held on a monthly basis to reflect the increasing collaboration across the CCGs following the dissolution of Mid Staffordshire Hospital Foundation Trust and the development of new service models and pathways within which community services have a critical role; an example is “Stemming The Flow” a community programme for the elderly with Long Term Conditions.
The Quality Account covers many of the areas that are discussed at these meetings, which seek to ensure that patients receive safe, high quality care.
REVIEW OF 2014/15
The South CCGs were pleased to note that during 2014/15:-
• The Trust investment in initiatives for Family and Friends Test in the latest technological equipment which has resulted in consistently high responses rates from both patient and carer surveys.
• The CCGs were pleased with the successful achievement of all of the local 2014-15 CQUINS. These were focused on local priority areas that lead to improving communication between staff and managers, improving response to complaints and delivering better outcomes for patients. These initiatives have now been embedded into everyday operational practice for the trust. This demonstrates a long term commitment to the original plans over three years and justifies the investment made.
• The appointment of an Ambassador for Culture initiative and the CCGs are pleased to note that the Trust is to implement the recommendation from the CQC for this initiative to be more integrated into Trust systems to fully realise the potential.
However the main challenge facing the Trust is that related to workforce issues highlighted in the CQC visit following staff whistleblowing incidents. We recognise that community providers do not have the same access to staffing tools that are available for acute providers and note the good work that the Trust is doing to develop robust tools for safely deploying community staff. These are not fully developed yet and the Trust has struggled to provide us with the level of assurance on workforce in the context of recruitment challenges and other pressures. Over 2015/16 the Trust is working with North and South commissioners to improve the level of workforce assurance required and monitoring any potential quality or safety issues that could arise from this.
118 | Quality Account
The annual staff survey result for recommending the Trust to families and friends appear to reflect this difficulty being below the national average for comparable Trusts and the rate achieved by the Trust 4 years ago.
We were disappointed that Trust’s plans for integrated health and social care teams have not progressed as far as expected however recognise that there have been additional challenges in year. The Trust has assured the CCG that these will be back on track in 2015/16. The CCG will be monitoring this on a monthly basis.
In last year’s quality statement we referred to the work the Trust had undertaken to reduce the number of pressure ulcers which identified those that were attributable to the Trust and those which could have been avoided.
Unfortunately the Trust was not able to maintain the improvement and from October 2014 there has an increase in avoidable pressure ulcers. We are pleased to note that this continues to be a priority for the Trust for 2015/16
PRIORITIES FOR 2015/16
The Commissioners welcome the specific priorities for 2015/16 which the Trust has highlighted in this account. The CCGs note that they are an extension of those priorities identified in 2014/15 and support this continuation in recognition that the priorities require long term commitment and investment to achieve sustainable improvements. The Trust will need to overcome some of the challenges which they experienced in this year particularly that relating to workforce if they are to progress these priorities.
Quality Account | 119

Haywood Scotia
“I have never laughed so much or felt so well cared for in hospital before.
Respected & made to feel part of a family. All aspects of care were excellent. My visitors commented on the lovely atmosphere of the ward & even said they’d like to work here. I can’t praise all of them enough as their standard is what all hospitals should be set by. I leave hospital feeling so grateful to them & thankful for their kindness, positivity & encouragement of my total care every step of the way. I am confident to return home with such wonderful & fond memories of my stay, of which I will be praising to others who may need similar care & treatment. 10/10 thank you so very much”
Cannock Diabetic
Nurses
Lichfield
Physiotherapy
A very pleasant consultation. I was asked lots of questions- I was really well informed about everything about what treatment I will be receiving.
“I was put at ease and treated promptly”
The Directors are required under the Health Act 2009, National Health Service (Quality Accounts) Regulations 2010 and
National Health Service (Quality Account) Amendment Regulation 2011 to prepare Quality Accounts for each financial year.
The Department of Health has issued guidance on the form and content of annual Quality Accounts (which incorporate the above legal requirements).
In preparing the Quality Account, directors are required to take steps to satisfy themselves that:
• the Quality Account presents a balanced picture of the Trust’s performance over the period covered
• the performance information reported in the Quality Account is reliable and accurate
• there are proper internal controls over the collection and reporting of the measures of performance included in the
Quality Account, and these controls are subject to review to confirm that they are working effectively in practice
• the data underpinning the measures of performance reported in the Quality Account is robust and reliable, conform to specified data quality standards and prescribed definitions, is subject to appropriate scrutiny and review; and the
Quality Account has been prepared in accordance with Department of Health guidance
The Directors confirm to the best of their knowledge and belief they have complied with the above requirements in preparing the Quality Account.
By order of the Board
Tina Cookson
Director of Nursing and Quality
Kieron Murphy
Director of Operations
Stuart Poynor
Chief Executive
James Shipman
Medical Director
Jonathan Tringham
Director of Finance and Resources
Geraint Griffiths
Deputy Chief Executive Officer
Julie Tanner
Director of Workforce and
Development
Kieron Murphy
Director of Children’s Services
Quality Account | 121 120 | Quality Account

The 6C’s focus on putting the person being cared for at the heart of the care they are given The 6C’s are Care,
Compassion, Competence, Communication, Courage and
Commitment.
The role of the Board is to take corporate responsibility for the organisation’s strategies and actions. The chair and non-executive directors are lay people drawn from the local community and are accountable to the Secretary of
State. The Chief Executive is responsible for ensuring that the board is empowered to govern the organisation and to deliver its objectives.
The CQC is the independent regulator of Health and Social
Care in England. It regulates health and adult Social Care services, whether provided by the NHS, local authorities, private companies or voluntary organisations to make sure that the care that people receive meets essential standards of quality and safety. www.cqc.org.uk
Commissioners are responsible for ensuring adequate services are available for their local population by assessing needs and purchasing services. They commission services (including acute care, primary care and mental healthcare) for the whole of their population, with a view to improving their population’s health.
Clinical commissioning groups (CCGs) are NHS organisations set up by the Health and Social Care Act
2012 to organise the delivery of NHS services in England.
A proportion of the Partnership Trust’s income is conditional on quality and innovation, through the
Commissioning for Quality and Innovation (CQUIN) payment framework.
This proportion is normally 2.5% of healthcare services commissioned through the standard NHS contract. The goals are agreed between the Trust its NHS commissioners through the Commissioning for Quality and Innovation
(CQUIN) payment framework.
The Direct Payments scheme is a UK Government initiative in the field of Social Services that gives users money directly to pay for their own care, rather than the traditional route of a Local Government Authority providing care for them.
This is a new discharge process, where patients leave hospital as soon as they are medically fit. Their support needs are then assessed at home, rather than in hospital.
A home-based assessment can be more insightful than ward-based assessments, provide a better experience of care, and help to avoid costly extended hospital stays.
The EQ-5D™ is an international standardised evidencebased instrument for use as a measure of health outcome.
Applicable to a wide range of health conditions and treatments, the EQ-5D health questionnaire provides a simple descriptive profile and a single index value for health status
See www.euroqol.org for further information.
Healthcare includes all forms of healthcare provided for individuals, whether relating to physical or mental health, and includes procedures that are similar to forms of medical or surgical care but are not provided in connection with a medical condition, for example cosmetic surgery.
Information Governance provides a framework which determines how we process and handle information and particularly how we protect our service user’s personal and sensitive information.
122 | Quality Account
Health and social care teams merged and working together to improve outcomes for people using services
This describes all local health and social care providers across a specific geography and looks at the geography of people using the services and variations in health outcomes.
Methicillin-Resistant Staphylococcus aureus, a bacterium with antibiotic resistance.
A bacteraemia is identified from a blood sample. The sample identifies that a bacteria is present in the blood in this case the sample was MRSA bacteria
Methicillin-Sensitive Staphylococcus aureus, a bacterium which is sensitive to Methicillin.
Staphylococcus aureus is a bacterium that commonly colonises human skin and mucosa (e.g. inside the nose) without causing any problems. It can also cause disease, particularly if there is an opportunity for the bacteria to enter the body, for example through broken skin or a medical procedure.
The National Institute for Health and Care Excellence
(NICE) recommends best practice guidelines to healthcare providers in the NHS. The guidelines make recommendations on medical treatments, including drug treatments, in order to reduce the variation in the availability and quality of treatment. www.nice.org.uk
The national safety campaign - ‘Sign up to Safety’, was launched in March 2014. Every hospital Trust that chooses to join will commit to a new ambition: to reduce avoidable harm by a half, reduce the costs of harm by one half, and in doing so contribute to saving up to 6,000 lives nationally over the next three years.
A “Never Event” is a serious occurrence that should never happen and can be prevented. They are considered unacceptable and eminently preventable. Examples include:
• A surgical procedure carried out on the wrong site
(e.g. wrong knee, wrong eye, wrong patient, wrong limb, wrong organ)
• Death or severe harm as a result of maladministration of insulin by a health professional.
• Death or severe harm as a result of a patient falling from an unrestricted window. A full list of Never
Events for 2012/13 can be found on the Department of Health website: https://www.gov.uk/government/ publications/the-never-events-list-2012-to-2013
Since January 2003, every local authority with responsibilities for adult Social Care (150 in all) has had the power to scrutinise local health services. Overview and scrutiny committees take on the role of scrutiny of the NHS – not just major changes but the on-going operation and planning of services. They bring democratic accountability into healthcare decisions and make the
NHS more publicly accountable and responsive to local communities.
Patient Advice and Liaison Services have been introduced in England from 2002 to ensure that the NHS listens to patients, their relatives, carers and friends, and answers their questions and resolves their concerns as quickly as possible.
A patient safety incident is an event, or something which happens which has an effect on a patient’s safety. This happening may or may not be linked to other events.
Staffordshire and Stoke on Trent Partnership NHS monitor such incidents to learn from them and prevent them happening again.
Personalisation is a Social Care approach described by the
Department of Health as meaning that “every person who receives support, whether provided by statutory services or funded by themselves, will have choice and control over the shape of that support in all care settings".
Quality Account | 123

Practice audit (Clinical & Social Care Audit) is a quality improvement cycle that involves the measurement of the effectiveness of care against agreed and proven standards for quality, and then taking action to bring practice in line with standards so as to improve the quality of outcomes.
Pressure Ulcers are also known as pressure sores or bed sores. They occur when the skin and underlying tissue become damaged. In very serious cases, the underlying muscle and bone can be damaged. www.nhs.uk/ conditions/pressure-ulcers
A quality indicator is an agreed-upon process or outcome measure that is used to determine the level of quality achieved.
Clinical research and clinical trials are an everyday part of the NHS. The people who do research are mostly the same doctors and other health professionals who treat people.
A clinical trial is a particular type of research that tests one treatment against another. It may involve either patients or people in good health, or both.
These enable staff across the organisation to identify and report risks to the quality of care. The organisation is then better able to manage these risks, focusing on addressing those issues that are more likely to have a greater adverse impact on patient experience, safety and effectiveness.
An example of a system would be the Ulysses incident reporting software that the organisation uses to monitor risks and incidents.
Root Cause Analysis is a class of problem solving methods aimed at identifying the root causes of problems or events. It is a structured approach that aims to identify the factors that resulted in a harmful event, so that future behaviours, actions, inactions or conditions can be changed to prevent its re-occurrence.
If you are eligible for care and/or support from the local authority then you should be closely involved in constructing your care or support plan, based on what you think will best meet your eligible care needs.
A “serious incident” requiring investigation is an incident that occurred in relation to services provided and care resulting in either, unexpected or avoidable death, serious or permanent physical or psychological harm, a scenario that prevents or threatens the organisations ability to provide healthcare services, allegations of abuse, adverse media coverage or public concern about the organisation, or, any of the Never Events on the national list. See www.
npsa.org.uk
The NHS Safety Thermometer is a local improvement tool for measuring, monitoring and analysing patient harms and ‘harm free’ care.
For more information on this national initiative see: www.ic.nhs.uk/services/nhs-safety-thermometer
The SSKIN bundle is an assessment and communication tool for pressure ulcer prevention covering the following:
Surface, Skin inspection, Keep moving, Incontinence and
Nutrition. See www.patientsafetyfirst.nhs.uk/
Tissue Viability is a specialist area of healthcare dealing with the treatment and the healing of almost any type of wound, focusing on wounds which are difficult to heal. Tissue Viability covers every aspect of wound care including advice on pain, diet, mobility, continence, life style choices, and the specialist equipment which may need to be used.
Venous thromboembolism (VTE) is a condition in which a blood clot (thrombus) forms in a vein. Blood flow through the affected vein can be limited by the clot, and may cause swelling and pain.
124 | Quality Account
Please contact 0800 783 2865
Quality Account | 125

126 | Quality Account
Communications Team , Staffordshire and Stoke-on-Trent Partnership NHS
Trust, Morston House, The Midway, Newcastle-under-Lyme, Staffordshire, ST5
1QG
0300 123 1161