Annual Report 2014/15
Quality Account
Statement on Quality from the
Chief Executive
Welcome to our Quality Account for 2014/15. This is our
report to the public about the quality of the services we
provide. It summarises our challenges and achievements
from the last year, and sets out our performance in
achieving the three selected priorities from 2014/15 as
well as other key quality improvement measures.
I would like to take this opportunity to thank all of the
staff in the Trust for their hard work, dedication and
commitment. We have a number of initiatives that
recognise the efforts of staff, including our annual Staff
Awards evening where we celebrate those who have
truly gone above and beyond for their patients, services
or colleagues, while our monthly Living the Values award
goes to those who really demonstrate our Trust values.
We see the continual investment and development of our
staff and building strong leadership as key to the delivery
of quality care for patients.
Our teams made some significant quality achievements
during 2014/15, for example:
• The number of avoidable pressure ulcers has steadily
reduced.
• The care for people with dementia and their carers in
the community hospital wards has improved.
• We have a better understanding of young people’s
experiences of our sexual health services.
• We were a finalist in ‘The most improved flu fighter
campaign’ at a national ceremony after getting over 50%
of staff vaccinated over the winter.
• Our Individual Placement and Support (IPS) Mental
Health Employment service underwent an external
review accredited through the Centre of Mental Health.
The service has been classed as ‘Exemplary’, the highest
rating possible.
Our Trust
• Established 1st July 2011
•O
ffering a diverse range of community services
from over 125 sites
• 354 inpatient beds
• 129 Mental health beds
22
• We were shortlisted in three categories in this year’s
National Health Service Journal awards - the health
sector’s version of the Oscars. Professor Jo Smith, Clinical
Psychologist, was shortlisted in the Clinical Leader of the
Year category.
• We were highly commended by Health Education West
Midlands in the Apprenticeship Recognition Awards.
• The contribution of our staff who mentor University of
Worcester students was recognised with several awards
for outstanding mentorship.
• The Trust’s Team Leader Development Programme won
a West Midlands Gold Quality Award.
• Our new Holt Ward for people who have acute mental
health needs was opened by Worcester MP Robin Walker
at the end of June 2014.
• Healthcare acquired infections remained very low with
cases of Clostridium difficile falling to their lowest level
with only 3 cases during 2014/15.
• We dedicated February as our ‘Self-Help, not Self-Harm’
awareness month to help raise awareness about why
people resort to harming themselves and how families
and friends can help someone cope better and more
safely with worries, pressures or anxieties.
In this Quality Account we have tried to produce an
honest and open picture of how we measure quality,
what the measures tell us, and then what we do about
it. As well as describing our successes we also present
examples of where we could do better, with the aim of
giving a balanced account. We welcome any feedback on
the report.
I believe to the best of my knowledge and belief the
information in this document is accurate.
Sarah Dugan
Chief Executive
• 195 community hospital beds
• 30 respite beds
• (2 inpatient units in prisons)
• Employ 3924 staff
•In the region of 26,000 contacts with patients each
week
Our Clinical Strategy for 2015-2019 intended outcomes for
patients
• Support people to live healthy lives
• Promote independence and support people with health care
needs and/or disabilities to live well
• Support people to recover following an episode of ill health or
injury
• Ensure our patients and carers always have a positive
experience of our services
• Always provide safe and harm free care
Statement on Director’s
Responsibilities
There are proper internal controls over the collection and
reporting of indicators and the data underpinning the
indicators is robust and reliable.
Introduction to the
Quality Account
Our Quality Account is an annual report to the public
about the quality of the services our Trust delivers. The
aim of the Quality Account is to enhance the Trust’s
accountability to the public and its commissioners
(purchasers of healthcare) on both the achievements
made to improving the quality of services for our local
communities as well as being very clear about where
further improvement is required.
The Quality Account is both retrospective and forward
looking. A single definition of quality for the NHS was
first set out in High Quality Care for All setting out three
dimensions to quality, all three of which must be present
in order to provide a high quality service:
Clinical effectiveness – quality care is care which is
delivered according to the best evidence as to what is
clinically effective in improving an individual’s health
outcomes
Safety – quality care is care which is delivered to avoid
all avoidable harm and risks to the individual’s safety;
and
Patient experience – quality care is care which
aims to give patients as positive an experience as
possible, including being treated according to what
that individual wants or needs, and with compassion,
dignity and respect
This Quality Account describes the quality of the Trust’s
services so that the public, patients and anyone with an
interest in healthcare will be able to understand:
Where the Trust is doing well
Where improvements in service quality are needed and
how we have prioritised these
How the Trust Board has reviewed our challenges in
improving the quality of care during the year and what
we have prioritised for 2015/16.
We review how we performed against our Quality
Account priorities from last year:
Reducing avoidable pressure ulcers
Improving care for people who have dementia
Evaluating and improving care for young people in
sexual health services
Looking ahead and we have defined three
Quality Account priorities for taking forward
in 2015/16:
d
ementia training for staff
p
hysical health care checks for mental
health inpatients
to promote an open learning culture in
order to reduce the level of harm arising
from some incidents.
We describe these in more detail further on in the
account. Firstly however, we would like to describe the
wider perspective of quality monitoring in the NHS with
the aim of giving some context and background to the
Quality Account.
23
Annual Report 2014/15
Bewdley, Worcestershire
Monitoring Quality in
the NHS
The many changes in the NHS in recent years, together
with an increased focus on quality, means that there is a
complex landscape to navigate for understanding who
is responsible for checking and monitoring the quality
of care. Even people who work in the NHS every day
find it difficult to keep up with the changes. The roles of
different organisations can sometimes overlap. Below
is short summary of the national bodies, their roles in
terms of monitoring quality and how these partners
have engaged with the Trust over the last year. More
information on the structure of the wider NHS is available
at www.england.nhs.uk/wp-content/uploads/2014/06/
simple-nhs-guide.pdf or on the Trust’s website.
Monitor
Monitor assesses NHS trusts for NHS foundation trust
status and ensures that NHS foundation trusts are wellled from both a quality and finance perspective and are
financially robust. Worcestershire Health and Care NHS
Trust is aiming to become a foundation trust.
Monitor’s Quality Governance Framework was
introduced in 2010 in response to the lessons learned
from the failings at Mid Staffordshire NHS Foundation
Trust. Assessing trusts against this Framework tests
24
whether effective arrangements are in place in the Trust
to continuously monitor and improve the quality of
health care provided. Areas that are highlighted through
the process as requiring further work then addressed.
Monitor visited us in the autumn of 2014 to undertake
preliminary quality governance check. Overall the visit
went very well and we have implemented some changes
that we think will improve our governance framework
such as:
We have strengthened the way we assess and review
risks in the organisation
We have changed the structure of the committee that
oversees quality and safety to enable it to take a more
strategic approach, and also to ensure key messages
are identified and rapidly reported to board
We are putting measures in place that will give
transparent assurance about the quality of the data we
use.
The changes are being overseen for their effectiveness
by the Trust board in readiness for further assessment by
Monitor.
The Trust Development Authority (TDA)
The Trust Development Authority (TDA) is responsible
for ensuring that non-foundation trusts develop the
capability to achieve independent foundation trust
status. The Trust has been working with the TDA during
2014/15 in preparing for our application for foundation
status. The TDA monitors quality indicators in the
Trust and holds monthly meetings with us to review
performance.
to Monitor.
The TDA looks at nationally published indicators, quality
indicators and information from, for example, complaints
and incidents to assess the overall level of risk the Trust
is carrying. The TDA calculate a score for this. So far we
are one of only a handful of Community and Mental
Health Trusts to have been rated as ‘Green’ (meaning on
track) against all relevant targets relating to safety and
performance by the TDA.
Further information about the outcome of the CQC’s
inspection of our services is set out further on this
account.
The Care Quality Commission (CQC)
The Care Quality Commission (CQC) is the independent
regulator for quality in health and social care in England.
It registers and inspects hospitals, care homes, GP
surgeries, dental practices and other healthcare services.
If services are not meeting standards of quality and
safety, the CQC has powers to issue warnings, restrict the
service, issue a fixed penalty notice, suspend or cancel
registration, or prosecute the provider.
The CQC have undertaken a number of inspections in the
Trust over the last year and in January 2015 undertook a
major inspection across a number of our services under
the Chief Inspector of Hospitals programme. The CQC
assess whether our services are safe, effective, caring,
responsive and well-led. The outcome of the Chief
Inspectors inspection, will determine whether we are
able to go forward with our foundation trust application
Healthwatch
Healthwatch is an independent consumer champion –
giving the public, patients and users of health and social
care services in Worcestershire a voice. Healthwatch finds
out what people thinks about services and what can be
improved – from a patient or service user’s point of view.
The organisation visits services to gather view of the
people who use them, and can signpost people to the
right information and advice.
More information about Worcestershire’s Healthwatch
can be found at www.healthwatchworcestershire.co.uk
Department of Health
The government’s Department of Health provides
strategic leadership for the NHS and social care in
England. To ensure that the taxpayer (to whom the
government is accountable) has a say in how NHS
money is spent, a mandate is published yearly to provide
ambitions and directions for NHS England. NHS England
has a duty to achieve the ambitions that are set out in the
Mandate and is held to account by the Secretary of State
for Health to do so.
25
Annual Report 2014/15
Commissioners and
Providers
The day-to-day operational running of the NHS is split
into two major functions:
commissioners – identify the need for and then
buying services for patients.
providers – NHS services are delivered by a number of
different organisations called providers. Worcestershire
Health and Care NHS Trust is a provider.
Commissioners and providers agree contracts that
set out which services are to be provided. There are a
number of quality key performance indicators (KPIs)
within the contracts that the commissioners monitor
in order to assure themselves that the service they
have bought is providing a good quality service.
Worcestershire Health and Care NHS Trust meets
with its commissioners every month to review the
quality of the provision of services and agree actions.
The commissioners also undertake announced and
unannounced inspections during the year to see for
themselves how well the services are doing against the
quality elements of the contract. Further information
about this year’s inspections by the our commissioners is
presented further on in the account.
NHS England
The day-to-day running of the NHS is determined by
NHS England. It also has responsibility for directly
commissioning some services such as GP provision,
offender healthcare and health services for the armed
forces.
Some of NHS England’s responsibilities are delegated
more locally through regional teams.
NHS England also allocates funding to CCGs (see below)
and local authorities, which commission services locally
for patients.
26
Clinical Commissioning Groups (CCGs)
Clinical Commissioning Groups (CCGs) are made up
of local GP practices and have a team of people who
organise the buying of services. CCGs commission
hospital care, community health services, mental health
and learning disability services. Worcestershire currently
has 3 CCGs who commission many of the services
provided by the Worcestershire Health and Care NHS
Trust.
CCGs are supported in their work by a number of
organisations at national, regional and local level to help
them in their decision making such as Commissioning
Support Units (CSUs), Strategic Clinical Networks and
Clinical Senates.
Working Together
The Trust works together with all of our partners,
regulators, commissioners and other care providers to
ensure the care, safety and welfare of people who use
our services, and those of other providers, is at the heart
of everything we do.
For example, the Trust is part of a partnership across
West Mercia areas involving the police, local authorities,
charities and other NHS bodies who are working
together to improve mental health care for people
in a crisis. All partners signed up to a Mental Health
Crisis Concordant in December 2014 that includes a
commitment to work together to improve the system of
care and support so people in crisis because of a mental
health condition are kept safe and get the support they
need – whatever the circumstances, and from whichever
service they turn to first.
A local Mental Health Governance Board has been
established to ensure consistent standards are delivered
by partners.
Worcestershire Health
and Care NHS Trust
provides a wide range
of community and
mental health services.
Community Care (average 16,546 recorded
patient contacts per week)
ommunity Health Services such as District Nursing
C
Community Hospitals and
Older Adult Mental Health Services
Adult Mental Health (average 2,941
recorded patient contacts per week)
Inpatients
wards including a Psychiatric Intensive Care
Unit
Community Mental Health Teams
Primary Care Mental Health
Specialisms – e.g. perinatal, eating disorders
Learning Disability Services (average 331
recorded contacts per week)
espite Units
R
Community teams
Children’s Services (average 3043 recorded
patient contacts per week)
ommunity Paediatrics
C
Community Services e.g. Health Visiting and School
Health Nursing
Child Development Centres
Children and Adolescent Mental Health Services
(CAMHS)
Specialist Primary Care Services (average
3,694 recorded contacts per week)
S pecialist Dental Services
Sexual Health Services
Offender Health Care
27
Annual Report 2014/15
Some Examples of
Achievements and Work
in Progress from 2014/15
Adult Mental Health and Learning Disability
Services
Key achievements: Royal College of Psychiatry
(RCPsych) accreditation of all areas, mainly at excellent.
International recognition for Early Intervention Psychosis.
Successful transfer of Learning Disability services from
Local Authority to Trust Management in October 2014.
Work in progress: Review of least restrictive practice
underway. Working with partners to address the gap
around services for people with Autism/ Aspergers.
Community Hospitals
Key achievements: Reduced length of stay for patients
who come into the hospitals.
Work in progress: Delayed Transfers of Care and social
care impact/Bed occupancy during winter.
Older Adult Mental Health Services
Key achievements: Winner of national dementia
innovation award for Early Intervention Dementia service
Work in progress: Review of managing increased
demand for services for patients with dementia,
particularly in inpatient settings.
Children, Young People and Families Services
- CAMHs
Key achievements: Redesign of services to improve our
responsiveness
Work in progress: Supporting increased GP
understanding of CAMHs.
Specialist Primary Care
Key achievements: HMP Oakwood re-inspected by the
CQC and now fully compliant.
Work in progress: Recruiting enough staff to fill
vacancies.
Self Help not Self Harm
We dedicated February as our Self-Help, not Self-Harm
awareness month, which was in response to recent
figures showing a 40% rise in the number of local
children, aged ten to 14, who have admitted to selfharming over the last three years.
As part of this awareness month, we launched a social
media campaign to raise awareness of self-harm where
people wrote on their wrists something they do to
positively cope with adversity.
We also held an event in Worcester which saw our Child
and Adolescent Mental Health Service (CAMHS) deliver
a presentation to help better understand why children
resort to harming themselves and how families, teachers
and friends can help a young person cope better and
more safely with worries, pressures or anxieties.
With over 50 selfies, 50 articles in the media, including
the national press, and over 150 people attending the
event, the campaign was a huge success.
Early Intervention Team
At the end of January the North Worcestershire Early
Intervention Team based at New Brook hosted a visit
from four Nigerian mental health professionals.
The visitors were very keen to learn about how the Early
Intervention Service works in England and what support
this offers service users and carers. The visitors explained
that in Nigeria, community mental health nursing is still
developing and they wanted to learn about the service
so that they could gain new ideas to develop a similar
service in Nigeria.
Responsibility
for Quality in
Worcestershire Health
and Care NHS Trust
Our frontline staff work within a framework of
professional registration, codes of conduct and Trust
policies which set out individual personal accountability
for the quality and safety of care provided to patients.
However, ultimately, our Trust Board has the final and
definitive responsibility for the success or failure in the
quality of care provided by the Trust. This responsibility
is made workable through governance arrangements,
devolving responsibilities to the operating levels in the
organisation. These arrangements are referred to as
Quality Governance.
Trust Board meetings focus on quality – the detailed
board reports from the Director of Quality (Executive
Nurse) are available at http://www.hacw.nhs.uk/ourboard/board-agendas-minutes-and-meeting-dates
These reports give more detail about the information we
provide in this account.
Whilst individuals and clinical teams at the frontline
have personal responsibility for delivering quality care,
the board drives forward quality governance systems
that enable clinicians and clinical teams to work at
their best. Our systems make sure all staff understand
the requirement to measure and monitor quality – to
celebrate successes and to address any issues quickly and
effectively. The processes and systems we use support
staff in being able to do their best, promote innovation
and encourage ambitious thinking.
The board’s sub-committee structure underpins the
delivery and governance of the organisation – in
particular the Quality and Safety Committee. The
Committee has revised its scope during 2014/15 to
deliver a greater emphasis on strategic business –
focusing on the bigger picture. A new sub-committee
has been established – the Clinical Governance subcommittee – to concentrate on more detailed quality
reports. Early indications are that these new governance
arrangements allow for a greater degree of scrutiny to
team level each month and enhance shared awareness of
safety and risk management.
Good quality governance means that the Trust
consistently:
identifies
and shares good practice, quality
improvement and innovation;
shares
learning from improvement actions from when
things have not gone well;
irects resources and support to areas that are not
d
reaching expected standards and targets;
as clarity and openness in measuring and sharing
h
performance;
invites challenge from stakeholders, in particular
patients, carers, staff and commissioners;
celebrates and shares successes.
Each of the Service Delivery Units have established
quality governance arrangements, whereby quality of
care is measured and reviewed, with shared learning and
improvements being taken forward. The Service Delivery
Units report into the Clinical Governance Sub-committee,
with key issues and risks escalated to the Quality and
Safety Committee and Board.
It was eye opening to see how mental health care varies
across the world, and it was also very encouraging to
meet people who are keen to change the negativity
attached to mental health and develop new mental
health systems.
28
29
Annual Report 2014/15
Measuring Quality in
the Trust
acquired infections.
Harm free care – the figures from this are taken from our
monthly ‘safety thermometer audits’.
The right information needs to be gathered, interpreted
correctly, and fed back to staff at the front line to sustain
and improve quality. This area of work is regularly revised
in the Trust as new and improved systems are procured,
and metrics are reviewed for efficacy and relevance.
Dashboards
A monthly performance report provides us with
measures on a large number of key indicators.
Below is our quality dashboard, setting out measures
that specifically relate to quality. The dashboard is
updated every month throughout the year and helps us
to see if any sudden changes occur, and where we need
to improve.
Any amber or red rated indicators have an associated
recovery plan – setting out specific actions to be taken
to bring the indicator up to green. The recovery plans are
often long term projects, as many factors are involved in
improving some of the indicators.
This year we divided the dashboard measures into the
CQC domains:
Safe Services
MRSA and Closridium difficile (C diff ) are health care
Effective Services
The NICE and clinical audit indicators tell us whether
these key issues in measuring clinical effectiveness in our
services are running to plan.
The Care Programme Approach indicator tells us about
an aspect of the quality of care for people who are cared
for by some of our mental health services.
Caring Services
The Friends and Family Test was introduced across all
services in January 2015. The complaints indicators tell
us whether we are responding in a timely manner to
complaints and how many we are receiving each month.
Well-led Services
The staffing indicators give us a snapshot view of
appraisals and sickness – staffing indicators that can be
very reflective of the quality of care being delivered to
patients.
Responsive Services
This tells us if we are acting quickly enough on safety
information and whether we are meeting people’s needs
in a timely way.
Quality Dashboard 2014/15
ARE
SERVICES
SAFE? Performance
Target
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
0
0
0
0
0
0
0
0
0
0
0
0
0
≤9
0
0
0
1
2
0
0
0
0
0
0
3YTD
% of Patients
who are harm
free - Pressure
Ulcers
95%
92.7%
92.6%
94.4%
93.0%
93.7%
94.3%
93.9%
94.5%
95.1%
94.5%
94.9%
95.3%
% of Patients
who are harm
free - Falls
95%
99.8%
99.8%
99.7%
99.8%
99.9%
99.2%
99.9%
99.8%
99.7%
98.4%
99.5%
99.8%
MRSA Bacteraemia Rates
C-Diff Rates
% of Patients
who are harm
free - Venous
Thromboembolism
95%
99.9%
99.8%
99.9%
99.8%
99.9%
97.1%
99.6%
99.8%
99.9%
99.8%
100%
99.9%
Number
of serious
incidents in a
month
No Target
12
26
25
28
18
26
16
27
26
17
16
22
30
ARE
SERVICES
EFFECTIVE? Performance
Target
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
% of NICE
Compliance
assessments
completed and
returned within
timescale
90%
100%
100%
98%
99%
96%
97%
98%
100%
100%
97%
97%
93%
% of Clinical
audits that are
running to plan
95%
100%
91%
93%
96%
93%
92%
91%
78%
97%
100%
90%
93%
Patients
on Care
Programme
Approach
Discharged
from MH
Inpatient
Care who are
Followed-Up
within 7 Days
95%
100%
98.0%
98.0%
96.9%
100%
100%
100%
97.8%
98.2%
98.1%
100%
100%
Patients on
Care Programme
Approach for
at least 12
Months who
had a CPA
Review in at
least the last
12 months
95%
97.9%
96.5%
96.9%
97.2%
97.2%
98.2%
98.1%
98.3%
98.1%
98.1%
97.5%
97.8%
ARE
SERVICES
CARING? Performance
Target
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Friends and
Family Test
(FFT)
95%
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
94%
84%
94%
92%
Number of
complaints
received
relating to staff
attitude or
behavior
No Target
2
4
2
0
1
3
5
1
3
2
6
3
% of complaints
responded to
within policy
guidelines
reported
two months
retrospectively
to allow 25
working days
to pass
95%
100%
100%
97%
95%
100%
100%
100%
100%
100%
100%
100%
100%
% of
complaints
responded to
within policy
guidelines per
month
95%
100%
100%
97%
95%
100%
100%
100%
100%
100%
100%
100%
100%
Number of
complaints in a
month
No Target
23
35
30
41
47
39
37
36
23
25
37
29
95%
87.8%
87.0%
87.0%
87.5%
89.7%
88.8%
89.5%
89.4%
90.2%
89.5%
89.5%
31
90.1%
** % of
patients with
a valid ethnic
status
Annual Report 2014/15
ARE
SERVICES
WELL LED?
Performance
Target
Apr
% staff with
completed
appraisals
over previous
12 months
100%
92.3%
Rolling 12
months sickness absence
rate
<3.40%
4.52%
4.51%
4.44%
4.44%
4.44%
4.42%
4.38%
4.33%
4.32%
4.32%
4.37%
4.40%
% uptake of
mandatory
training over
previous 12
months
95%
90.9%
90.7%
89.7%
91.5%
90.7%
90.0%
88.5%
90.1%
90.9%
91.6%
93.5%
92.2%
Infection
control
training
uptake
95%
92.7%
91.2%
90.7%
92.1%
91.9%
91.2%
87.5%
91.4%
91.4%
96.7%
93.3%
92.6%
Performance
Target
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
ARE
SERVICES
RESPONSIVE? May
93.8%
Jun
93.7%
Jul
91.8%
Aug
92.6%
Sep
92.8%
Oct
93.3%
Nov
93.0%
Dec
93.4%
Jan
92.1%
Feb
91.9%
Mar
91.8%
% reporting of
incidents on
Ulysses within
48 hours
90%
83.8%
82.3%
82.9%
86.8%
86.3%
83.8%
86.3%
86.4%
85.7%
82.3%
84.4%
88.5%
% response of
Safety Alerts
within set
timeframe
90%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
100%
MIU time to
treatment
(minutes)
60
10
11
13
12
9
10
9
8
8
9
10
12
Sexual HealthGUM Clinical
Patient offered
within 48
hours of initial
contact
90%
100%
100%
100%
99.9%
99.9%
99.7%
99.9%
100%
98.8%
100%
100%
100%
Maximum time
of 18 weeks
from point
of referral to
treatment in
aggregate non admitted
95%
99.3%
95.1%
100%
99.1%
98.4%
97.2%
97.6%
98.1%
99.4%
99.2%
97%
99.3%
Patient Safety Walkabouts
The Trust has an annual programme of ‘Patient Safety
Walkabouts’ that promotes a culture whereby our senior
leaders not only ‘talk the talk’ but to also ‘walk the walk’.
The walkabouts ensure that members of the Trust Board
are informed first hand regarding the safety concerns of
frontline staff. Both Board members and staff involved in
the walkabouts have fed back that they find them very
helpful. Issues that are raised through the walkabouts
include matters that staff feel they need help in resolving,
such as estates issues, but also achievements of teams
that visibly demonstrate the values of the Trust. It was
through the feedback from staff in the patient safety
walkabouts that the Trust’s incident reporting was
changed to a more user-friendly system.
of the prisoners can be best addressed.
• Care Quality Commission (CQC) patient surveys
• Analysis of compliments, complaints, Patient Advice and
Liaison Service (PALS) enquiries and comments on NHS
Choices
• Our website page http://www.hacw.nhs.uk/ourservices/patient-experience/
Overall the feedback we have receive from the patient
experience work across a range of services is very
positive. The results are fed back to the team/department
and are also fed back to patients/service users - for
example by posters in waiting rooms. We undertake
many local patient surveys, for example to find out what
people think about changes that have been made, or to
gather more information about a service if the quality
indicators on our dashboards are showing there may be
an issue.
Feedback from Patients and
People Who Use our Services
An example of how one local patient
experience survey was started
The Trust recognises that measuring and acting upon
patient what patients tell us is a key driver of quality
and service improvement. We welcome and encourage
all feedback, whether positive or negative to help us to
continually improve our services.
A child at Chadsgrove school in Bromsgrove was asked if
they liked physiotherapy. When the response was ‘no’, she
was asked why she hadn’t said anything? She responded
“Because no one asked! “
The Trust has a programme of activities to gain feedback
which includes:
• The Friends and Family Test – would you recommend
this service?
• Local patient surveys – these are tailored to the
particular services. For example Focus Groups at Long
Lartin in July 2014 highlighted the differing needs of
the ageing population within the prison. Further work is
underway with the prisoners to explore how the needs
This prompted a project to take place to ask for feedback
from children, parents, teachers and teaching assistants.
An action plan is in the process of being developed from
the feedback received – including training sessions for
teaching assistants and teachers in how to support the
physiotherapy team and better support the physical
needs of the children during school. Our patient
experience team will also be attending parents evenings
to gain further feedback from parents.
RAG Rating:
Below Target
Performance rating above 90% or within 5%
On Target
Data not available
Target not required
32
33
Annual Report 2014/15
Friends and Family Test
The Friends and Family Test (FFT), provides a simple
headline metric which, when combined with follow-up
questions, can drive improvement. The test is based on a
simple question “How likely are you to recommend our
service to friends and family if they needed similar care
or treatment?” with answers on a scale of extremely likely
to extremely unlikely.
“An excellent service that provides what is needed. Well
done.”
“We now house ECT presence at our weekly community
team meeting and this is a huge improvement in
communication.“
“The ECT always respond quickly; should use this service
more.“
The Trust has an online library of FFT resources for staff/
patients to use. This can be viewed at: http://www.hacw.
nhs.uk/our-services/patient-experience/friends-andfamily-test/fft-library/.
Patient Experience of Community Mental Health Services
Each year a survey of people aged 18 and over accessing
community mental health services is conducted and
collated by the Care Quality Commission.
We are utilising the skills of volunteers in encouraging
patients to take part in the survey in an aim to boost the
number of responses.
The 2014 survey was substantially redeveloped to reflect
changes in policy, best practice and patterns of service.
The CQC state that this means that results from the 2014
survey are not comparable with the results of previous
surveys. The CQC state that the results provided by this
year’s survey will be considered as a baseline to measure
improvement against in subsequent years.
An overall average of 91% of patients who took part in
the FFT survey were either extremely likely or likely to
recommend our services. When asked to give the reason
for the scoring, many people cited the positive and
caring nature of our clinical staff.
GPs Feedback About the Trust’s Enhanced
Care Teams
The South Worcestershire CCG conducted a survey of GPs
across the county to hear their views on the Enhanced
Care service. The service was set up two years ago to
provide high quality rehabilitation, recovery, treatment
and care services to older adults with the overall aim of
avoiding unnecessary hospital admission, facilitating
timely discharge from hospital and promoting the
recovery of older adults with severe and enduring mental
health needs.
After what has been a challenging start, the feedback we
received includes some very positive comments as well
as some areas for improvements. Some of the comments
were:
The Trust had 288 respondents to the 2014 survey
which was a response rate of 34% compared with 29%
nationally.
40% of respondents were aged 66 and older.
In all sections of the survey the Trust achieved an average
result overall.
The Trust performed strongly against other Trusts on the
following questions:
ere you involved as much as you wanted to be in
W
agreeing what care you will receive?
Does this agreement on what care you will receive take
your personal circumstances into account?
Were you involved as much as you wanted to be in
deciding what treatments or therapies to use?
“Very useful service for helping people at home or
planning respite care”
The results for the following questions were worse than
for most other Trusts.
Did you feel that decisions were made together by you
and the person you saw during this discussion?
What impact has this had on the care you receive?
“The service has made an extraordinary difference to
our ability to provide greater support for appropriate
community care of our very ill, frail and isolated patients.”
The score for this question may be linked to a number of
medical staff retiring in close succession in the south of
the county. We are able to suggest this link as there was a
34
rise in complaints from service users about this issue.
o you know who to contact out of office hours if you
D
have a crisis?
This question applies only to those patients and services
users who are on the Care Programme Approach (CPA).
Again the score for this is lower than would have been
expected and actions have been implemented to
improve this score, such as ensuring staff provide out of
hours crisis contact details within care plans.
Complaints and
Compliments
During the year 2014/2015 the Patient Relations Team
have actively worked with all of our teams to ensure that
patients who use our services are able to contact the
Patient Relations Team should they need to. This work
has ensured that a greater number of patients, their
families and carers have known how to contact us. Our
interactive “contact us” page on the website has also
been changed as a result of a complaint. There has been
a 40% increase in the total number of contacts to the
team compared to the previous year, 2013/14.
In June 2014 our Complaints Policy was reviewed and
updated in accordance with the “Principles for Remedy”
which is published by the Parliamentary and Health
Service Ombudsman. Our aim is to provide fair, open and
honest responses to complaints and we are guided by
the principles of:
• Getting it right
• Being customer focused
• Being open and accountable
• Acting fairly and proportionately
• Putting things right
• Seeking continuous improvement
Trust policy is to respond to written complaints
within 25 working days. Performance against this
standard is measured and reported every month on
the Trust’s quality dashboard. The average response
35
Annual Report 2014/15
time to complaints during 2014/15 was 15 days, with
the exception of those complaints which required
an extension to the 25 working day timescale. All of
our complaints are available to see on our website
– with names and any personal details removed for
confidentiality reasons.
We received 402 complaints in 2014-15 compared to 284
in the previous year. We have been actively promoting
our complaints service during the year as we see any
feedback, good or bad, as an opportunity to learn and
improve. All of our upheld complaints result in an action
plan so that these can be shared by the services in their
team meetings, and more widely through governance
meetings and trust-wide publications.
2013/14
2014/15
Number of complaints
284
402
Number of professional
enquiries
66
119
PALS Enquiries
525
708
We try to identify any themes or trends from what our
patients, their families and carers have shared with us.
Due to the diversity of the services that we provide
this can be a challenge as issues tend to be ‘one-offs’,
however where a trend is identified, action is taken to
prevent any reoccurrence. We know from reviewing
all of the complaints that the route cause often stems
from a lack of communication with patients and carers,
or communication that has been ineffective. We closely
track complaints to identify if there is a repeated issue
within one team or with a particular member of staff but
there is very rarely any evidence of this. Each complaint
has a learning plan implemented which would include
customer service training if communication has been
identified as an issue in the complaint.
Some examples of actions taken and lessons learned
from complaints during 2014/15 include:
Complaint: Patient had attended their appointment
and had pressed the door bells outside the building. The
patient identified that these were not functional and
advised that patients did not realise this. As a result of
36
the complaint, access arrangements have been made
much clearer.
We work in partnership with our suppliers and other
trusts if a complaint relates to services that we do not
provide. For example, concerns were raised in relation to
problems caused by the time prescriptions were received
from the pharmacy supplier in one of the prisons. As a
result we held discussions with the pharmacy supplier
which led to an improved pharmacy service for patients.
Complaint: A phlebotomist attempted to take blood
from the incorrect patient at a residential home. Action
was taken to ensure that all staff who are not familiar
with the patients in a residential home will be escorted to
the room by a member of staff in the home who verbally
identifies the patient.
Complaint: A concern was raised regarding the lack of
regular physiotherapy due to members of staff being
unavailable. As a result, the Team established a robust
system to help them to prioritise their caseload when
colleagues are absent from work due to sickness. The
Team also reviewed their communication processes to
ensure delays are minimised.
On the rare occasions that a complainant remains
dissatisfied with the response to their complaint
they always have the right to refer their case to the
Parliamentary and Health Service Ombudsman (PHSO) to
request a review of their complaint and care.
During 2014/2015 6 complainants asked for their case
to be reviewed by the PHSO. Of these cases 3 have been
closed, 2 with no further action being required. One case
has requested that we provide a further apology to the
complainant. One case which was referred to the PHSO
in 2013/2014 has been reviewed and the PHSO have
reported a service failure and therefore a number of
actions will be taken.
Looking forward to 2015/16 we are undertaking further
work with complaints that have been re-opened to gain
a greater understanding of why the issues were not
fully resolved or addressed in the original investigation
and response. The aim is to learn how we can further
improve the quality and content of our responses.
Compliments and Gifts
Over the last 12 months we have seen a rise in the
positive feedback we have received from patients or their
families. This feedback is really important for us to see
where things have gone well in our services and is always
appreciated by the staff involved, as we know that it may
not be an easy time for our patients or family. All of our
compliments are put onto the Trust’s website and we
have a rolling ‘ticker’ running across the top of the staff
pages with real examples of compliments people have
given us.
4778 recorded compliments were received during the
year 2014/2015 compared to 2463 in 2013/14.
Some examples of compliments received include:
T hank you all very much for being such kind and
wonderful people and for helping me in my first steps
towards recovery. Keep being fantastic.
I t was lovely to be treated by such lovely staff. The
receptionist made me feel at ease straight away with
her friendly personality. The nurse and dentist were
fantastic, very professional and made me feel so at
ease.
T hank you again for everything you’ve done for us as
a family, you’ve given us the support and back up we
were reaching out for, we are all so very grateful.
J ust a little note to say a huge thank you for all the care
you showed mum and us, her family during her stay
with you. It was comforting to us as a family to know
she was being cared for by people she liked, who could
always put a smile on her face. Thank you for making
her last weeks happy ones.
I just wanted to write and thank you all so very much
for supporting us and looking after our son so well. You
fitted into our lives with ease, often putting up with my
difficult requests. You were always professional and at
the same time human. We miss your visits, but know
you are offering the same wonderful care to other boys
and girls who need you. Eternally grateful.
Patient Advice and Liaison
Service(PALS)/Professional
Enquiries
Our PALs and Professional Enquiry contacts have also
increased over the last 12 months. The majority of cases
are resolved within five working days. Our average
response time is 3 days.
Some examples of our PALs queries are listed below:
A gentleman enquired about further support he could
provide to his wife who has dementia.
A member of the public contacted the team to ask how
to access Cognitive Behavioural Therapy.
A patient had been discharged from an Acute Hospital
following a stroke and the family member enquired
about support available for them.
There were also 119 professional enquiries received,
compared to 66 in the previous year. These enquiries
include contacts from Members of Parliament, General
Practitioners and Solicitors. We aim to respond to these
queries within 10 working days.
37
Annual Report 2014/15
Our Team of Staff
The most powerful tool that we have in achieving our
goals and objectives are our staff. The Trust employs over
3,900 people and as part of our on-going commitment
to enhancing staff health and wellbeing, we carry out
a series of staff engagement initiatives and surveys.
We then develop action plans that are based on the
outcomes and share details with all staff through our
regular communication channels.
During the past 12 months we have increased our
methods of communication, involvement and
engagement with staff which include:
monthly Team Brief which is cascaded by managers,
A
via team meetings, across the whole organisation.
A weekly update, every Friday, from the Chief Executive
which provides staff with information as to what is
happening within the Trust, patient stories, the events
that they can attend, seminars, workshops and forums
they can engage in.
Staff are actively encouraged to contribute to the
content of Team Brief and are invited to put questions
to the Trust’s communications team or directly to the
Chief Executive.
A monthly “Living the Values Award” whereby staff
can nominate colleagues who have gone over and
above their role, living up to the Trust’s values and
demonstrating star qualities.
A series of ‘Focus Cards’ reminding staff about a variety
of issues such as clinical recording keeping standards,
how to raise concerns at work, consent to treatment.
NHS Staff Survey
The NHS Staff Survey is recognised as an important way
of ensuring that the views of staff working in the NHS
inform local improvements. After the results of the 2013
National NHS Staff Survey it was agreed that a series
of Focus Groups would be established to give all staff
the opportunity to attend and provide feedback on
their experiences of working for the Trust. The aim was
to understand what works well, what is not working
well and areas where the trust could seek to introduce
improvements.
Staff were given the opportunity to comment on a
number of broad themes as well as being able to
38
comment on any aspect of their role and working for the
Trust.
The Focus Groups were held at a number of different
sites including the Prisons. All staff were invited through
the Chief Executive’s Weekly Update to volunteer to
attend one of the sessions. The dates/times and venues
were also publicised on the intranet and in Team Brief.
Managers were also asked to nominate a number of
representatives from their Teams to ensure that all SDUs/
Departments across the Trust had the opportunity to
attend and feedback.
All areas of the Trust were represented at some point
during the sessions. Staff who attended the Focus Groups
felt they were very useful and they are now carried out
on a six monthly basis.
Staff Awards
Our Staff Achievement Awards ceremony was held on
the night of Thursday 2nd October 2014 at The Bank
House Hotel near Worcester. The evening was a great
success and was attended by over 100 people. There
were over 200 nominations this year for the 13 awards.
they were with the volunteers who were stationed at key
sites wearing bright blue sashes emblazoned with ‘Here
to Help’. Our volunteers are a fantastic band of men and
women, of all ages and from all walks of life who freely
give of their time to support the Trust’s work.
One of the Trust’s Physiotherapist Team Leaders, Gordon
Smith and his colleague from the Heart of England
Foundation Trust, Nicola Ferdinand, had their work
published in the International Journal of Therapy and
Rehabilitation in November 2014 (Vol 21, no 11). The
study compared the perceptions of physiotherapists and
podiatrists in the treatment of plantar fasciitis (heel pain).
The publication of Gordon’s work is just one example
of our staff’s commitment to working with colleagues
towards delivering best practice, evidence-based care to
patients.
Feedback from Trainee Doctors
The Trust’s Medical Education department is now
routinely collecting feedback from trainee doctors at
the end of each placement. This data is analysed against
regionally and nationally collected data to identify any
trends. The general trend from the data continues to
indicate that trainees are having a positive experience at
the Trust, would recommend it to their fellow trainees as
a place to work and that they would be happy to have
friends and family treated by the services provided.
Staff appraisals
We have continued to focus our efforts on ensuring all
staff have a meaningful and productive appraisal every
year. During 2014/15 over 92% of staff had an appraisal
– this performance indicator is included on the Quality
Dashboard. The quality of appraisals is crucial, and the
appraisal paperwork was changed last year to include
the Trust’s vision and values. All staff are asked to identify
how they evidence the Trust’s values through their
own behaviours at work and are set clear objectives for
the coming year. Appraisal also requires staff and their
managers to identify individual areas for development.
On Tuesday February 10th 2015 we held the first of a
series of our new Valued events for staff. There were
a range of stalls and information to support staff and
presentations from staff and guests on ‘looking after
yourself and your colleagues’ physical and mental health
and wellbeing.
Examples of some the awards are:
Mental Health Inpatient Services for Team of the Year
Tenbury Community Hospital for the Patient Choice
Award
Malvern District Nurses for the Living the Values Award
Facilities Housekeeping Team for the SMART Award
The Offender Health Care team at HMP Oakwood for
the Special Recognition Award
The Trust is also supported by a number of volunteers
who come in to carry out a range of roles, from running
clubs or exercise classes to tendering to our gardens
and other outside spaces. The ‘Volunteer of the Year’
award seeks to reward the outstanding contribution of
a volunteer whose dedication really makes a different
to staff and/or patients and was won this year by David
Freeman. Well done David and thank you to you and all
our volunteers for your commitment and contribution to
the Trust’s work.
Thank you also to the volunteers who helped with the
Trust’s Chief Inspector of Hospitals CQC inspection in
January 2015. The CQC highlighted to us how impressed
39
Annual Report 2014/15
Safe Staffing
The ‘Safer Nursing Care Tool’ (SNCT) has been approved
for use by NICE and is designed to be used every 6
months over 20 working days in inpatient wards. We
used this approach for the 4th time between January
12th and February 6th 2015.
The tool provides a recommended nursing establishment
in whole time equivalents (WTE) taking into account bed
occupancy levels and patient dependency set against
the current budgeted establishment.
We have previously adjusted some ward establishments
as a result of using the SNCT to ensure that nurse staffing
levels meet the recommended measures of;
2 registered nurses on duty per shift * exceptions apply
to small wards/units
One registered nurse for every 8 patients
A process has been established ahead of any
adjustments to ward establishments to ensure that
results from the SNCT are discussed in the context of
professional judgement. This process involves interviews
with the ward manager, matron and service lead in
conjunction with the Deputy Director of Nursing and a
finance representative.
We have found that the most frequent reason for
staffing shortages continues to be short notice sickness
or temporary staff not turning up for their shifts and
inability to fill shifts.
The predominant reason for staffing levels to be above
the planned level is the need to have additional nurses
to meet closer observations of patients reflecting the
numbers of patients on both our mental health and
community hospital wards requiring more intensive
nurse observations, to either manage prevention of falls
or patient behavioural issues that could breach patient
safety.
We have an electronic system that records staffing levels
so that senior nurses can see at a glance if there are
issues. Real time staffing levels are also displayed at the
entrance to all of our wards.
Staff have been actively encouraged to report any
staffing levels issues onto our incident reporting system.
40
We have seen a rise over the last year in these types of
incidents being reported.
Annual Workforce Review
In its response to the Francis report, the Government
made clear the expectation that all NHS Trust
Boards should receive assurance that staffing levels
are appropriate to deliver safe care. However their
recommendations were broader than simply expecting
the use of accredited safe staffing tools; and underlined
the expectation that Boards receive an annual update
on the workforce capacity and competency of all clinical
teams. As a result in the last 12 months all clinical
services have conducted a workforce review. These
focused on the clinical quality and safety of services
taking in to consideration workforce capacity, skills,
benchmarking and adherence to national/local guidance
where available. The results of the review are being
compared to other data we hold to ascertain actions for
taking forward in 2015/16.
Staff Induction and Training
In 2014/15, 510 new employees attended the one day
Worcestershire Health & Care Trust Induction as their
first day of employment. This includes trust volunteers.
The induction day includes a welcome from our Chief
Executive, Sarah Dugan and an overview of the services
and structures within the Trust. All new staff receive an
induction booklet which gives information on a variety
of subjects that can help staff in their new posts.
There are eight mandatory training courses that all staff
within the Trust must complete.
Influenza Vaccination for staff
The Trust’s latest flu campaign over 2014/15,
encouraging our members of staff to get the flu jab, has
been shortlisted for a national award. The Flu Fighter
awards are run by NHS Employers and we have been
shortlisted in the ‘most improved flu campaign’ category.
The campaign, which ran over the autumn and winter,
helped boost the numbers of staff vaccinated from 37%
in 2013/14 to over 50% in 2014/15.
Our Continuing
Response to the Francis
Enquiry
Robert Francis QC led a public inquiry into the failings
at Mid Staffordshire NHS Foundation Trust. The inquiry
identified many reasons for why things went so wrong
and the report made 290 recommendations. At the heart
of these was a need to develop: a culture of openness
and transparency; a system of accountability for all; a
system promoting clinical leadership and an emphasis on
always putting patients first. www.midstaffspublicinquiry.
com
In February 2015 Robert Francis released a follow-up
report called “Freedom to Speak Up”. It makes a number
of recommendations for all NHS Trusts to adopt. In the
main these focus on developing and maintaining an
open and transparent culture within Trusts where staff
feel supported and confident to raise any issues.
We held a public event in October 2014 where progress
against our Francis Action Plan was presented. Attendees
then gave their views on what they perceived to be the
current status of each area. The action plan was updated
accordingly and has now been revised to take into
account the ‘Freedom to Speak Up’ recommendations.
Here are just some of the changes we have made as a
result of the Trust’s Francis Action Plan:
alues based recruitment is now in place for every
V
vacancy advertised.
Appraisal process includes assessment of behaviours in
terms of Trust values.
Staff awards have been introduced to recognise those
staff who clearly demonstrate ‘living the values’.
Screens are now in place on wards displaying staffing
levels and associated safety data for that clinical area.
This information is available in real time to senior
managers along with regular staffing levels reports to
Board.
Staff now use the incident reporting system to report
any staffing level incidents. These are directly reported
to the Director of Quality, Deputy Director of Nursing
and Medical Director to ensure appropriate actions
have been taken.
Staffing levels have been made available to public via
the Trust website and NHS Choices.
Our ‘Whistleblowing’ policy has been replaced by a
Raising Concerns policy, which makes it easier and less
daunting for staff to raise concerns.
Extensive, well-evaluated training programmes for
team leaders are in place.
Staff Friends and Family Test schedule and pulse
surveys undertaken for ‘temperature checks’ with
associated action plans.
Extensive, well-evaluated training programmes for
team leaders is in place.
A strategic approach to co-production is in place
which identifies a number of actions aimed at ensuring
patients and carers are involved at every level and are
equal partners in care.
Our Youth Board helps ensure Children and Family
services are child and young person friendly.
Duty of Candour policy in place with an associated
training plan.
Evidence of improved safety culture – increased
percentage of low or no harm incidents.
41
Annual Report 2014/15
External Visits and
Inspections
The Care Quality Commission and our commissioners
undertake visits to a variety of Trust services throughout
the year to spend time with patients and staff and
gather information to assure them that our services are
safe and well managed. These visits and inspection can
be announced (i.e. where the Trust is notified of them
beforehand) or unannounced.
The visits and inspections bring increased benefits to the
Trust, and help to provide assurance on the continuous
improvement in the quality and safety of our services.
Following an external inspection the visiting body will
produce a report and action plans are implemented
in relation to any recommendations arising from the
visit. In January 2015 the Trust underwent a major CQC
inspection. The outcome of the inspection provides an
overall rating for the Trust’s services. The CQC published
the final reports in June 2015 and concluded that while
many areas were Good, there were some which Require
Improvement. The Trust also published the reports and
its action plan which can be found at www.hacw.nhs.uk/
CIHreport
The following report presents a summary of all of the
inspections undertaken to clinical services in the Trust
from April 2014 to March 2015 arranged by Service
Delivery Unit.
General Themes:
• None of the assurance visits during the year have
resulted in an unknown serious risk being detected.
• Where follow up visits have taken place, the
implementation of action plans were checked and were
noted to have been implemented. This was particularly
evident in the reports from HMP Oakwood and
Churchview inspections.
• Extremely positive feedback was received from
inspectors about our staff in all of the SDUs and can be
seen as evidence of the outstanding commitment to
high quality care by our staff.
Themes by SDU:
Specialist Primary Care
Offender Health – Although there are some
recommendations from the combined reports, the
42
overall theme is that actions implemented following
previous visits and inspections have led to improvements
in all 3 prisons. The offender healthcare staff in particular
were praised for their commitment and caring approach.
The re-inspection of HMP Oakwood in December 2014
produced a very positive report.
Sexual Health Services – Although this CQC inspection
focussed on the registration arrangements for Arrowside,
the CQC team gave extremely positive feedback about
the overall service and suggested one of our consultants
could assist the CQC in an advisory capacity.
Adult Mental Health – largely very positive reports,
again highlighting the commitment of staff and
their caring approach. Findings regarding clinical
documentation and record keeping are variable between
care settings, with some areas identified as having good
practice, whilst others needed improvement. The SDU
have actions in place to address this with standardised
documentation being introduced. Some delays in estates
requests being actioned were flagged in two of the
inspections.
Learning Disability – very positive assurance visit
reports received regarding both Osborne Court and
Churchview. Interactions between staff and people
who use the service were observed to be “natural and
service users clearly have positive relationships with their
support staff”. It was noted that staff understand incident
reporting and know how to report incidents. Actions
from a previous inspection of Churchview had been
successfully implemented.
Community Care – there is a theme regarding
communication between in-patient services (both
community hospital and acute trust wards) and the
community teams, particularly across some patient
pathways. The establishment of the Patient Flow Centre
and the countywide work around this project will address
many of the issues raised. The inspections highlighted
the very positive feedback from patients and their
families and carers regarding the staff in the services.
Children’s Services – the inspection of Ludlow Road was
very positive. The inspectors highlighted that staff were
observed responding confidently and promptly to the
needs and wishes of the children they were supporting.
The reports from the inspections of the walk-in centres
were succinct and did not require any action plans to be
implemented.
Key to table
U – Unannounced visit
A – Announced visit
CCG – Clinical Commissioning Group
CQC – Care Quality Commission
LAT – Local Area Team
HMIP – Her Majesty’s Inspector of Prisons
ICU – Integrated Commissioning Unit
Date
Organisation
6th May 2014
CQC
14th May 2014
Announced/
Focus of visit
Services visited
U
Offender Healthcare
HMP Oakwood
LAT
A
Offender Healthcare
HMP Long Lartin
26th June 2014
ICU
A
Quality Assurance visit
Osborne Court
27th June 2014
CQC
A
MHA monitoring
Harvington ward
27th June 2014
CQC
U
MHA monitoring
Cromwell House
14th-15th July 2014
CQC
A
Offender healthcare
HMP Hewell
17th July 2014
ICU
A
Quality Assurance
Churchview
17th July 2014
CCG
A
Quality Assurance
Malvern Integrated Team and
Specialist Nursing – IV Therapy
Team -
13th August 2014
ICU
A
Quality Assurance
New Haven
13th August 2014
LAT
A
Offender Healthcare
HMP Hewell
27th-28th August
2014
TDA
A
Infection Prevention and
Control
9th September 2014
CCG
A
Quality Assurance
11th September
2014
ICU
U
Quality Assurance
Holt ward
11th September
2014
ICU
A
Quality Assurance
Athelon ward
Unannounced
New Haven
Malvern Community Hospital
Holt Ward
POWCH, Integrated
Community Hub, New Haven,
MIU
43
Annual Report 2014/15
17th September
2014
CCG
26th September
2014
CQC
30th September
2014
A
Mental Health Act CQC Visits
Medical GP Cover service
specification
Evesham Izod ward, and
Pershore Hospital
A
MHA monitoring
Hadley Unit
ICU
A
Quality Assurance
Ludlow Road
8th October 2014
ICU
U
Quality Assurance
Hillcrest ward
8th October 2014
ICU
A
Quality Assurance
Harvington ward
14th October 2014
LAT
A
Offender Health
HMP Oakwood
14th October 2014
ICU
A
Quality Assurance
20th October 2014
ICU
A
Quality Assurance
20th-31st October
2014
HMIP
U
Offender Health
29th October 2014
CQC
U
Registration check
Arrowside
November 2014
Monitor
A
Quality Governance
Trustwide review of
governance
Improving the care for people with Dementia
and their carers
a
19th November 2014 CCG
U
Medical GP Cover service
specification
Tenbury Hospital
Understanding and Improving Young People’s
Experiences of Sexual Health Services
a
24th November 2014 ICU
A
Quality Assurance
Cromwell House
1st-5th December
2014
CQC/HMIP
A
Quality Assurance visit
HMP Oakwood
19th-24th January
2015
CQC
A
Quality Assurance
Over 90 services visited
28th January 2015
CCG
U
Quality Assurance
Hospital @ Home /Allied
Healthcare
5th February 2015
CQC
A
Offender Health
HMP Hewell
5th February 2015
ICU
A
Quality Assurance
Keith Winter House
44
Talking Walk-ins at children’s
centres – SALT: Buttercup,
Worcester
Talking Walk-ins at children’s
centres – SALT: Riversides,
Bewdley
The following locations were visited by the CQC during
2014/15 specifically to monitor our compliance with the
Mental Health Act:
Cromwell House, Adult Recovery Ward, Worcester
Harvington Ward, Adult Acute Ward, Kidderminster
Hadley, Psychiatric Intensive Care Unit, Worcester
All of these visits have been unannounced (97% of all of
CQC Mental Health Act monitoring visits nationally take
place on an unannounced basis).
Common areas of interest to the inspectors were care
planning, capacity and consent to treatment and the
provision of rights information to patients. Different
findings on these themes have been made, but there was
no single cause identified. Where relevant, actions have
been undertaken by the Trust in relation to these.
The CQC noted that patients in all areas inspected
were positive in their general comments about ward
staff. Comments made by patients and recorded by the
CQC include “I’ve enjoyed my time here. The care and
treatment is very good”, “They keep me safe at all times;
they never hold grudges” and “They treat me with proper
respect and dignity; they are just cool”.
The formal findings following the CQC’s Chief Inspector
of Hospitals visit which took place in January 2015 are
awaited.
2014/15 Quality Account Priorities
For last year’s Quality Account we set three priorities for improvement. The progress of these is summarised ‘at a
glance’ in the table below.
HMP Long Lartin
Objective
Achieved
Getting There
Behind
Schedule
a
Preventing Avoidable Pressure Ulcers
Priority 1: Preventing Avoidable Pressure Ulcers (carried forward from 2013/14)
A pressure ulcer is an area of damage to the skin and the underlying tissue, usually over a bony area of the body.
Pressure ulcers range in severity from skin discolouration to severe open wounds.
Pressure ulcers cause patients long term pain and distress
Pressure ulcers can mean longer stays in hospital
Avoidable pressure ulcers are widely seen as a key indicator of the quality of nursing care.
Avoidable Pressure Ulcer: “Avoidable” means that the person receiving care developed a pressure ulcer and the
provider of care did not do one of the following: evaluate the person’s clinical condition and pressure ulcer risk factors;
plan and implement interventions that are consistent with the persons needs and goals, and recognised standards of
practice; monitor and evaluate the impact of the interventions; or revise the interventions as appropriate.”
Unavoidable Pressure Ulcer: “Unavoidable” means that the person receiving care developed a pressure ulcer even
though the provider of the care had evaluated the person’s clinical condition and pressure ulcer risk factors; planned
and implemented interventions that are consistent with the persons needs and goals; and recognised standards of
practice; monitored and evaluated the impact of the interventions; and revised the approaches as appropriate; or the
individual person refused to adhere to prevention strategies in spite of education of the consequences of
non-adherence”.
45
Annual Report 2014/15
How did we do?
While we recognise that we will always have a challenge to reduce pressure ulcers in the community as patients
are not in our care 24 hours a day, the great care our teams provide to patients mean that the number of avoidable
pressure ulcers has reduced during 2014/15.
Between August 2014 and March 2015 the percentage of avoidable pressure ulcers has reduced month on month (see
graph below).
This trend can be explained by a number of changes in the way staff look after patients, including staff undertaking
an investigation when a pressure ulcer has occurred, thus learning directly from their own care, a sharing of lessons
via serious incidents forums as well as greater provision of education and support to staff.
All investigations are reviewed in detail by the Director of Quality (Executive Nurse) and the Medical Director who
have adopted strict criteria in arriving at a conclusion in in relation to whether the ulcer could have been avoided.
The vast majority of pressure ulcers judged as being avoidable were due to the correct paper work such as risk
assessments and care plans not being completed in a timely manner.
Sometimes, for numerous reasons, patients do not take the advice of the nursing teams with regard to, for example,
the use of pressure relief equipment. We have therefore introduced a form that we ask patients to sign, which
acknowledges the advice that has been given in how to avoid pressure ulcers, but that the patient has chosen not to
follow the advice. This has helped us to further understand patient’s reasons for not wanting to follow advice.
What did we measure?
Result at end of March 2015
Percentage of avoidable grade 3 and 4 pressure ulcers
The percentage of avoidable
pressure ulcers has decreased by
21.8%
The table below sets out the number of Grade 3 and 4 pressure ulcers investigated through Route Cause Analysis
(RCA) investigations between April 2014 and March 2015, setting out the number deemed as avoidable or
unavoidable.
No. of
Avoidable
Pressure Ulcers
Apr
14
May
14
Jun
14
Jul
14
Aug
14
Sep
14
Oct
14
Nov
14
Dec
14
Jan
15
Feb
15
Mar
15
TOTAL
5
13
9
6
3
7
4
3
7
3
3
2
65
No. of
Unavoidable
Pressure Ulcers
2
Investigation
in Progress
0
0
0
0
0
0
0
0
0
0
3
8
11
Total No. of
Grade 3 & 4
Pressure Ulcers
7
19
10
14
11
15
7
14
14
8
8
12
139
46
6
1
8
8
8
3
11
7
5
2
2
63
How will we keep moving forward with our ambition
to eliminate avoidable pressure ulcers?
We will continue to ensure people admitted to our
services are assessed for the risk of developing pressure
ulcers. The paperwork that evidences this assessment
will be tracked by our nursing metrics audits. We
will continue to support practice improvement and
awareness raising across our services and the wider
health economy.
We are continuing to implement our training
schedule, and we are working with our partners across
Worcestershire to ensure there is a joined up approach
to fulfilling our ambition of no avoidable pressure ulcers
happening to any patients.
Priority 2: Improving the care for people with
Dementia and their carers
Dementia is caused when the brain is damaged by
diseases, such as Alzheimer’s disease or a series of
strokes. Alzheimer’s disease is the most common cause
of dementia but not all dementia is due to Alzheimer’s.
The specific symptoms that someone with dementia
experiences will depend on the parts of the brain that are
damaged and the disease that is causing the dementia.
Symptoms of Dementia may include memory loss and
difficulties with thinking, problem-solving or language.
These changes are often small to start with, but for
someone with dementia they have become severe
enough to affect daily life. A person with dementia may
also experience changes in their mood or behaviour.
Dementia Care Mapping
Dementia Care Mapping (DCM) has been recommended
by the National Institute for Health and Clinical
Excellence as a method for improving care practice
for people with dementia. DCM is an observational
method used to evaluate the experience of people with
dementia.
Specially trained staff observe and record care from the
patient’s point of view over a 6 hour period. The data
is then analysed and is fed back to staff as a means of
changing and improving the patients’
During 2014/15 we will implemented Dementia Care
Mapping in the Community Hospitals.
What measures did we use?
We undertook two carer surveys, one at the beginning
of the year and then one towards the end of the year
when the Dementia Care Mapping actions had been
implemented. We compared the results to measure
whether the actions have resulted in an improved
experience for people with dementia and their carers.
How did we do?
We have undertaken our mapping in line with all of the
requirements laid out in the principles of Dementia Care
Mapping (DCM) . This involves a rather complicated
analysis of raw data taking into account both individual
and total ward population activity and well-being. To
enable staff to work with the results we have focused on
the information collected and the practicalities in how
this relates to the quality of care we provide.
47
Annual Report 2014/15
It was vital that we communicated with staff about the
quality of their interactions with patients, individually
or on the ward as a whole. Staff behaviours have an
intrinsic effect on patients well-being and behaviours.
This is important for all client groups but especially in
dementia care where the patient’s cogitative ability is
affected. We are pleased to note very positive examples
of engagement with patients which have made a positive
difference to their well-being.
The vast majority of the actions arising out of the DCM
exercise apply to all patient care. It should be noted
that the auditors found very positive examples of kind,
patient person centred approaches on the community
hospital wards.
Some of the actions that have been taken as a result
of the DCM exercise which have improved care for
dementia patients are:
ll staff will have dementia awareness/ person centred
A
care training (this to be taken forward in next year’s
Quality Account priorities)
Staff reflection in shift handovers has been encouraged
regarding effective person centred communicationthe do’s and don’ts for each patient’s needs
Staff more minded to engage with the patient at each
and every intervention or task around the patient, and
to look for signs they may need like contact.
Better location of dementia friendly signs (picture and
words)
Televisions placed in accessible areas and channels and
volume checked in line with patients in close proximity
Small seating arrangements that can facilitate
conversations in bays for staff to write up notes and
provide a base and patients to get together at other
times
Ensure photographs, paintings etc. placed on walls or
bedside cabinets are line of view of patients as there
was. Pictures can make such a difference to patients.
Priority 3: Understanding and Improving
Young People’s Experiences of Sexual Health
Services
All young people, including those aged under 16, are
entitled to confidential sexual health and contraceptive
advice and treatment. Access to confidential sexual
health services, both in schools and in the community, is
one of the ways in which young people can be supported
to stay safe.
48
Why did we focus on young person’s experiences?
We recognise that meeting the particular needs of young
people is a key component in ensuring our services are
effective.
We wanted to include a priority in the accounts that
would tell us more about the services we provide for
young people. The Youth Board were asked for their
views and the attitude of workers in sexual health
services came out as one of the things young people
think is important.
How were we going to achieve this goal?
The Department of Health has the ‘ You’re Welcome’
quality criteria which lays out principles to help health
services become young people friendly. ‘You’re Welcome’
can increase health workers skills in working effectively,
appropriately and sensitively with young people. Our
Sexual Health services have been working with the
‘You’re Welcome’ criteria for some time so we want to
know what young people think of our services.
What Measures did we use?
We asked young people through a survey about their
views. The results are as follows:
Gender of people who responded–
Female: 87.2%
Male: 12.8%
session, did you have a choice about:
Yes
No
N/A
Where you wanted to be seen? (if clinic takes place in ONE location, select
N/A)
Who by?
Who you wanted there with you?
41%
16%
43%
26%
83%
47%
6%
27%
11%
How many people you wanted there with you?
72%
13%
16%
Being seen on your own, if you wanted to?
Booking an appointment convenient to you? (if a drop in service, chose N/A)
Your consultation and treatment i.e. were you given the chance to have a say
about your consultation and treatment?
Were you told that you could attend sessions without a parent or carer?
83%
50%
5%
9%
12%
41%
79%
7%
13%
66%
12%
22%
Staff Members –
Yes
No
N/A
Were clear about what they can or can’t do?
96%
2%
2%
Met your needs?
99%
0%
1%
Were friendly and helpful?
100%
0%
0%
Confidentiality –
Age of people who responded
12 – 13 years
14 – 15 years
16 – 18 years
19 – 21 years
Yes
No
Don’t know
85%
11%
4%
Was the information easy
99%
to understand?
1%
1%
Did staff ask your
permission to share
information where
necessary?
13%
13%
0.7%
23.9%
46.4%
29.0%
Did staff talk to you
about confidentiality?
74%
When you attended your appointment or a drop in
49
Annual Report 2014/15
Information about services
Yes
No
N/A
Was your appointment place
confidential?
91%
2%
8%
Did you feel safe in the building?
96%
1%
3%
Did you feel the reception was
welcoming?
95%
1%
4%
Was the waiting area comfortable?
91%
5%
4%
Was the appointment place easy to get to
80%
if you were on public transport?
4%
16%
Were there enough activities you could
do e.g. reading while you were waiting?
80%
11%
9%
Was the venue suitable, if you had a
disability?
52%
5%
43%
Your views and feedback –
Yes
Were you asked about your
41%
experience as a service user?
Were you asked to comment whether
47%
the service met your needs?
Did you have a chance to say positive
things about the service or to make a 64%
complaint?
No
N/A
44%
15%
39%
14%
21%
14%
Healthy Eating and weight
Management
34%
33%
34%
Long term health needs
33%
32%
36%
Substance Misuse (i.e. drugs and
alcohol)
30%
31%
39%
Mental Health or emotional health
and psychological well-being concerns
30%
33%
37%
How likely are you to recommend our service to friends and family if they needed similar care
or treatment? (1 = most likely and 5 = least likely)
1 (VERY LIKELY)
80.9%
2
9.2%
3
3.1%
4
3.8%
4 (LEAST LIKELY)
3.1%
Were you given information about other health issues (if applicable) such as –
Smoking
50
Yes
No
N/A
36%
29%
35%
51
Annual Report 2014/15
Review of 2014/15
Patient Safety – Incident Reporting
It is widely recognised that organisations that promote incident reporting create a safety culture amongst all
disciplines of staff to learn, share lessons and implement solutions to prevent harm (NPSA Seven Steps to Patient
Safety, 2004). We have been actively encouraging staff to report all incidents and near misses through our webbased system. We analyse the data and put it into a format so that teams can use it to identify any themes or trends,
or whether there is evidence of any sudden change. This can help us identify where resources should be directed
towards.
Very detailed reports about incidents are provided to our governance committees and Trust board in order that there
is a shared understanding of where our risks lie, and to track whether the measures that are being implemented to
minimise those risks are effective.
Some incidents are classed as ‘serious incidents’. Over 80% of serious incidents reported in the Trust are grade 3 and
4 pressure ulcers – both avoidable and unavoidable. A great deal of resource is directed at finding the cause of such
incidents in the trust, and ensuring any lessons learned from them is shared and acted upon.
One of the key aims of the serious incident reporting and learning process is to reduce the risk of recurrence, both
where the original incident occurred and elsewhere in the NHS. The timely and appropriate dissemination of learning
following a serious incident is core to achieving this and to ensure that these lessons are embedded in practice. In
the Trust we share learning through a variety of means and have a dedicated web page on the staff intranet that is
updated each month. It is evident from the analysis of themes that the majority of incidents identify issues related to
documentation, training / education and lack of knowledge of policy or procedure. Each of these issues are addressed
through detailed and specific actions plans.
Data from incident reports is presented in a number of different ways – including statistical process control (SPC)
charts. Graphs are selected to encourage the analysis of trends and to identify when a change in relation to the
historical position is likely to be ‘real’ or statistically significant.
We also measure the degree of harm that has happened as a result of the incident. The overall aim is to increase
the number of incidents reported, and increase the proportion of those that are near misses or result in no harm.
In the three months of 2014/15, the percentage of patient safety incidents resulting in no or low harm was 94%, an
improvement from the 85.7% average for 2014/15.
In the Staff Survey 2014 results, one of our most improved scores was staff reporting that the trust shares learning
from incidents.
Medicines Management
Medicines are the most common intervention in healthcare. The Trust encourages the reporting of medication
incidents and ‘near misses’. Making sure that patients get the right medicines at the right time is really important to us
to keep patients safe in our care, whether they are inpatients in hospital or living in their own homes.
The Trust’s medicines management team works closely with healthcare professionals across the organisation to
ensure patient safety and quality care with respect to medicines use. Any trends are examined to understand whether
we need to change written policies or procedures or to adapt the training that staff receive. This means that we
take active steps to ensure that our patients benefit from the medicines given to them with the aim that none are
subjected to serious medication error.
Example of learning from incidents
It was identified that there had been a number of errors relating to the administration of insulin injections in the community
teams. A small group was set up to look into the causes of the errors and what could be done to prevent such incidents
occurring again in future. This led to a pilot of healthcare assistants, after receiving training, administering the insulin
injections to patients with ‘stable’ diabetes. Evaluation of the pilot from staff and patients has been very positive and the
number of incidents has reduced. The pilot is therefore being carefully rolled out with continued monitoring.
52
Staff within Worcestershire Health and Care NHS Trust will continue to be encouraged to actively report all
medication related safety incidents, via media such as the pharmacy team newsletter and Medication Safety
Bulletins. Awareness during 2015/16 will focus on omitted medications.
53
Annual Report 2014/15
Falls Prevention
Encouraging patients to mobilise and maintain independence is a key objective of many of our services. This means
that on occasion some patients may fall. However, this has to be managed in an appropriate way and the risk of injury
from a fall avoided. Where injuries occur due to a fall detailed investigations take place to identify the cause.
We use the data from incident reports to try and identify where most falls occur, and why. For example we looked
at whether more falls were happening at a particular time of day in the in-patient units, or whether there was any
difference at the weekend.
No. of Slip, Trip, Falls
reported as Serious Incidents
Q1
Q2
Q3
Q4
TOTAL
2013-14
4
6
6
3
19
2014-15
3
2
4
2
11
The Trust is committed to continuing to implement the falls prevention work to ensure we keep all patients as safe as
possible.
NHS Safety Thermometer
Most falls are reported as resulting in low or no harm to the patient – although it is recognised that any fall can leave
someone feeling shaken.
The Safety Thermometer is a point prevalence study of patients on one day a month, every month. It enables the
calculation of the proportion of patients who received harm free care on that day. Harm free care is defined as the
number of patients in whom all of the following harms are absent:
A Pressure ulcer of any category 2, 3, or 4, acquired anywhere;
A fall which resulted in any degree of harm within the previous 72 hours in a care setting;
A Venous thromboembolism (VTE) of any type acquired whilst under our care; and
Treatment for Urinary Tract Infection (UTI) in patients with an indwelling urethral urinary catheter.
Between April 4014 and March 2015 information on a total of 14,915 patients has been included in our Safety
Thermometer calculations. 13,918 of these patients (93.3%) were reported as receiving overall harm free care. This
figure counts patients where the harm has occurred outside of the trust’s services (old harms). 98.07 % were reported
as being harm free when focusing on harms that only occurred within the Trust (new harms).
Graph showing the percentage of harm free care across the Trust 2014-2015
We track how many patients are ‘repeat fallers’ which could indicate that falls prevention measures are not being
effectively implemented – although often patients that repeatedly have had all appropriate measures put in place and
are simply at very high risk.
During 2014/15 there has been a 42% reduction in serious incident related falls in the trust. Due to a change in
reporting criteria for serious incidents, this year we were required to report and investigate all inpatient fractures
resulting in moderate and severe harm to the patient. Prior to this, in 2013-14 we were only reporting severe harm i.e.
patients with fractured neck of femur. The decrease in the number of serious incidents is therefore even more or an
achievement on the part of the clinical teams.
54
The most significant harm occurring in the Trust relates to pressure ulcers. It is important to note however that the
Safety Thermometer does not measure whether pressure ulcers were avoidable or not.
55
Annual Report 2014/15
Infection Prevention and Control
Actively minimising healthcare associated infections is a
priority in the Trust. We are committed to ensuring that
the risk of infections is kept to an absolute minimum.
During 2014/15 we maintained an excellent performance
on the prevention and control of infection across our
services.
A total of three cases of Clostridium difficile were
reported in 2014/2015 at year end against a trajectory
of 9 post 48 hour cases (all were assessed by the
commissioners and ourselves as unavoidable). No MRSA
bacteraemias were identified during 2014/2015.
Within the Trust it is widely acknowledged that infection
prevention and control is everyone’s responsibility; this is
in addition to the Infection Prevention and Control team
who provide specific advice and guidance to staff.
implementation of the Care Act Guidance in relation to
safeguarding adults
Making changes to training and reporting processes to
ensure Care Act compliance
Supporting structure changes to both the Safeguarding
Adult and Safeguarding Children Boards
Engaging and collaborating with partner organisations
in the development of a Multi Agency Safeguarding
Hub
Supporting staff with training, supervision and
reflection on safeguarding cases.
Worcestershire Health and Care Trust
response to NHS Trusts’ reports relating to
Savile
A task and finish group was set up in January 2015 to
provide assurance that robust and appropriate policies
and procedures were in place and to identify gaps were
further work is required. There is a degree of assurance
already evidence and some on-going work to update
policies where necessary and implement a new a policy
to manage media, celebrities and other such visitors to
the Trust.
The PLACE team carried out the formal inspections
during 2014/15 and we are very pleased to have
maintained good or excellent standards across our sites.
The Trust maintains its approach of zero tolerance of
the abuse of children and adults with care and support
needs.
Safeguarding
Never Events
Activity continues in the Trust to ensure that children
and adults with care and support needs that come into
contact with the services in the Trust are safeguarded.
The Integrated Safeguarding Team along with the
Safeguarding Working Groups have continued to embed
learning from safeguarding audits and reviews in all
aspects of the Trust’s work as the organisation continues
to develop a learning culture.
Never Events are defined by the Department of Health as
‘serious, largely preventable safety incidents that should
not occur if the available preventative measures have
been implemented by healthcare providers’. Fifteen of
the list of twenty five never events are relevant to the
Trust. There have been no occurrences of Never Events in
the Trust during 2014/15.
56
Commissioning for Quality and Innovation (CQUIN) schemes require Trusts to improve quality and innovation by
discussing, agreeing and monitoring quality indicators with its commissioners. When the quality improvement goals
and indicators are achieved, the Trust earns a financial payment.
The indicators set out in the table below were set for 2014/15 and present our performance.
We fully met all of our CQUIN targets apart from sub-indicators in three of the schemes. Some of the reasons for
not meeting these targets stem from a lack of shared understanding of definitions between commissioners and the
Trust. We do however recognise there were failings on our part in relation to a lack of a sufficiently robust process for
signing off the CQUIN reports.
We learnt from this and have now implemented a stronger process for 2015/16, including more effective action
planning for the each CQUIN, and checks to detect possible problems at an earlier stage.
The Trust commenced work in October 2014 to
identify any issues raised in respect of findings and
recommendations from inquiries within NHS Trusts.
Across the Trust there have been a number of initiatives
to reduce infection during the year:
Ensuring staff attend appropriate training – the uptake
of infection control training by year end is at nearly
90%
Promoting hand hygiene and undertaking audits
An infection control charter for both patient, service
users, visitors and staff.
Key activities during 2014/15 were:
Learning from Multi Agency Adult and Children’s
Serious Case Reviews
Ensuring that staff continue to be aware and can
identify risks related to child sexual exploitation
Reviewing the processes for managing children and
young people at risk of suicide
Preparation with the Safeguarding Adult Board for the
Our 2014/15 CQUIN Performance
Central Alerting System
The Central Alerting System is a means of alerting
health and social care providers to the important
safety information from a number of different sources.
The actions required as a result of the alerts can be
minor or involve significant change. During 2014/15 all
alerts received were responded to within the required
timeframe.
Service Included in CQUIN
CQUIN
Scheme
Older
Adult
Mental
Health
Tissue
Viability
15%
reduction
Pressure
Ulcers
Friends and
Family Test 
for staff
Friends and
Family Test 
for Patients
Patient
Flow in
community
care
Patient
Flow in
Psychiatric
Intensive
Care Unit
Dementia
Care
Tissue
Viability
Community
Care
Adult
Mental
Health
Children,
Young
Primary
People
Care
and
Families
Learning Offender
Disability Health

Some
CQUIN
indicators
met
not fully
fully
met






















57
Annual Report 2014/15
Service Included in CQUIN
CQUIN
Scheme
Hydration
Care
Older
Adult
Mental
Health

Physical
health for

patients
with schizophrenia
Communication with
GPs – care
planning
approach

Community
Care
Adult
Mental
Health
Children,
Young
Primary
People
Care
and
Families
Health
Some
indicators
not fully
met








Quality Account Priorities for 2015/16
Performance in the Quality Account priorities will be
monitored by the Trust’s Quality and Safety Committee,
and will be reported to Trust Board in the Director of
Quality’s board report.

Health
checks for
prisoners
aged over
50
58
Offender

Health
Action
Plans for
people with
a Learning
Disabilities
Breast
Feeding
uptake
– Health
Visiting
Learning
Disability
CQUIN
met
fully
Looking Forward Things we want to do
better in 2015/16
PRIORITY ONE – 75% OF FRONTLINE STAFF
WILL RECEIVE DEMENTIA AWARENESSS
TRAINING BY THE END OF 2015/16.
Our Early Intervention in Dementia team delivered a
presentation at Worcestershire County Council’s Health,
Overview and Scrutiny committee in March 2015 on how
we can help people live well with Dementia.
The Trust’s Clinical Director for Older Adult Mental
Health Dr Bernie Coope said about 8,500 people in
Worcestershire – 3.4% of the entire population – are
currently living with Dementia, about half of whom are
older than 85 and 450 of whom are younger than 65. He
stressed the importance of early diagnosis and the need
for healthcare organisations to work together to help
people live well with Dementia.
As part of our ongoing work to continuously improve
care for people with dementia and their carers, we will
prioritise training 75% of our frontline staff in dementia
awareness.
How will achievement be measured?


We will track how many eligible staff have completed the
training each month.
PRORITY TWO – 90% OF MENTAL HEALTH
INPATIENTS WILL HAVE A PHYSICAL HEALTH
CHECK OF BLOOD PRESSURE, PULSE, BMI
AND BLOOD SUGARS WITHIN 2 DAYS OF
ADMISSION.
Physical health and mental health are inextricably linked
and we know that more action is needed to improve the
physical health of people with mental health problems.
Poor mental health is associated with an increased risk
of diseases such as cardiovascular disease, cancer and
diabetes.
We have therefore prioritised carrying out physical health
checks on patients on the adult mental health wards.
How will achievement be measured?
We will undertake audits to see how many patients have
their physical health checks recorded in the clinical notes.
PRIORITY THREE – To promote an open
learning culture in order to reduce
the level of harm arising from some
incidents.
A high level of reporting for errors, accidents and near
misses is a measure of a good safety culture that is
transparent and willing to learn and improve to prevent
recurrences. Over time we want to see an increase in the
number of incidents being reported with fewer serious
incidents and more that are reported as low or no harm
incidents.
How will achievement be measured?
We will measure the level of harm for each incident every
month, and will track the percentage of low and no harm
incidents.
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Annual Report 2014/15
CQUINS for 2015/16
The following CQUINS have been agreed with our
commissioners for 2015/16. Each of the CQUINs has
a number of sub-indicators. We are committed to
delivering these quality improvements and will be
reporting on our progress with each of them to Trust
Board and our commissioners during the year.
Dementia
and Delirium – Find, Assess, Investigate,
Refer and Inform
Dementia & Delirium Staff Training
Supporting Carers of people with Dementia
educing the proportion of avoidable emergency
R
admissions to hospital
T issue Viability (Pressure Ulcer Prevention-Rising staff
Awareness)
eveloping a method of capturing the capacity within
D
Enhanced Care Teams (ECT) that can be utilized by the
patient Flow Centre to Improve the quality of transfer
of care for patients by co-ordinating care in the right
place at the right time
I mprove the utilisation of white board functions to
improve patient flow within community hospitals and
ensuring information is kept up to date on each shift in
hours and Out of Hours
2014/15 Quality Account Technical Section –
Mandatory Statements
The following section contains the mandatory statements common to all Quality Accounts as required by the
regulations set out by the Department of Health.
Review of services
During 2014/15 the Worcestershire Health and Care Trust provided and/or sub contracted 5 NHS services.
ommunity Care
C
Adult Mental Health and Learning Disabilities
Children, Young People and Families
Specialist Primary Care
The Worcestershire Health and Care NHS Trust has reviewed all the data available to them on the quality of care in five
of these NHS services.
The income generated by the NHS services reviewed in 2014/15 represents 100 per cent of the total income
generated from the provision of NHS services by the Worcestershire Health and Care NHS Trust for 2014/15.
Participation in clinical audits
NICE
NICE is the National Institute for Health and Care Excellence. NICE provides national guidance and advice to improve
health and social care. It achieves this by producing evidence-based guidance and advice for health, public health and
social care practitioners. More information is available at www.nice.org.uk
The Trust assesses all clinical guidance published by NICE to see whether it is relevant to the services our organisation
provides.
I mproving the timely transfer of care for patients
to other providers, through the use of the Trusted
Assessor Model
Small things make a difference – patient experience
Learning Disability Community Outcome Measures
ental Health: Improving Physical Healthcare for
M
Patients with Severe Mental Illness
Mental Health Discharge Planning
Memtal Health Restraint Reduction
Health Visiting – sharing information
Offender Health – Mental Health First Aid
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Annual Report 2014/15
Audit
Participation in clinical audits
Notes
Subject of audit
During 2014/15 seven national clinical audits and one national confidential enquiry
covered NHS services that Worcestershire Health and Care NHS Trust provides.
During that period Worcestershire Health and Care NHS Trust participated in 86%
*(6/7) national clinical audits and 100% national confidential enquiries of the
national clinical audits and national confidential enquiries which it was eligible to
participate in.
Table 2: national audit reports
*(6/7): The Trust did not
participate in the National Audit
of Intermediate Care. There was
a subscription fee payable by
the commissioners, which was
not met.
Standard where audit
identified need for
improvement
Actions that have been
put in place since audit
POMH-UK Topic 14a:
Prescribing for substance
misuse: alcohol
detoxification
Cohort too small to draw
conclusions from. The
Trust is not commissioned
to deliver a detox service.
Findings were however
presented to consultant
psychiatrists for discussion,
as well as being shared
with the wider SDU.
POMH-UK Topic 12b:
Prescribing for people with
a personality disorder
Currently being considered
by the SDUs.
The national clinical audits and national confidential enquiries that Worcestershire
Health and Care NHS Trust was eligible to participate in during 2014/15 are as
follows:
POMH-UK Topic 14a: Prescribing for substance misuse: alcohol detoxification
POMH-UK Topic 12b: Prescribing for people with a personality disorder
POMH-UK Topic 10c: Prescribing antipsychotics for children and adolescents
POMH-UK Topic 9c: Antipsychotic prescribing in people with a learning disability
National audit of anogenital herpes management
National Diabetes Foot Audit
National Audit of Intermediate Care
National Confidential Inquiry into Suicide and Homicide by people with Mental
Illness (NCISH)
The national clinical audits and national confidential enquiries that Worcestershire See table on page 67
Health and Care NHS Trust participated in, and for which data collection was
completed during the period are listed below alongside the number of cases
submitted to each audit or enquiry as a percentage of the number of registered
cases required by the terms of that audit or enquiry.
The reports of 4 national clinical audits were reviewed by the provider in 2014/15 and
Worcestershire Health and Care NHS Trust intends to take the following actions to
improve the quality of healthcare provided
See table on page 68
The reports of 56 local clinical audits were reviewed by the provider in 2014/15 and
Worcestershire Health and Care NHS Trust intends to take the following actions to
improve the quality of healthcare provided.
See table on page 68
Please note, this is a sample
only to give an idea of the
spread of audit work across the
services.
Outcome
POMH-UK Topic 10c:
Prescribing antipsychotics
for children and
adolescents
A review of therapeutic
response and side effects of
antipsychotic medication
should be documented at
least once every 6 months.
This review should include
tests/measures of weight/
BMI, blood pressure,
glucose/HbA1c, lipids and
assessment for the presence of extrapyramidal side
effects (derived from NICE
CG155 recommendation
1.3.18).
Discussed with individual
doctors who were not
using the template.
National audit of
anogenital herpes
management
n/a
n/a
Template in place and
works well when used.
Consultant contacted
POMH audit team to
establish why they are
requesting 6 monthly
reviews of bloods when
national recommendations
are for 12 monthly.
Participation in clinical research
The number of patients receiving NHS services provided or sub-contracted by Worcestershire Health and Care NHS Trust in 2014/15 that were recruited during that period
to participate in research approved by a research ethics committee was 30 (as of 16
March 2015).
62
National Institute of Health
Research portfolio studies only.
National audit board have
stated that they are unable
to produce local results
therefore not possible to
develop a local action plan.
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Annual Report 2014/15
Table 3: local audit reports
Subject of audit
Standard where audit identified need for
improvement
Actions that have been put in place since
audit
Re-audit of current
admission clerking
practices by medical staff
on Harvington Ward.
Driving advice discussed or ‘non-driver’
documented at admission.
Results at re-audit indicate improvement
from 6% to 55% compliance. Ward to trial
‘Admission Record’.
Pharmacological
management of
Generalised Anxiety
Disorder.
All standards met.
No further action required.
Re-audit on record keeping All records should have;
Findings were presented and discussed at
the Team Business and Quality meeting.
standards at Rowan House. Ethnicity and next of kin details
Name, ID Number, and page number on all
pages
Entry of time of all contacts using 24 hour
clock
List of abbreviation and their expansion
Appropriate filing of documents.
Re-Audit of Physical Health
Monitoring for Adult
Inpatients on The Hadley
Unit.
All patients should have a thorough
history including Past and Current Medical
Problems including relevant treatments,
Family History and Medications and
Systems Review.
All female patients should be asked about
recent breast and cervical screening and
if they examine their breasts regularly for
lumps.
Some improvements seen at re-audit.
Ward continues using the Physical Health
Assessment form for recording the
examination findings.
Audit of Physical health
monitoring in Early
Intervention.
Patients’ physical health (weight, blood
pressure, waist Circumference, BMI,
ECG, glucose/HbA1C, lipids & prolactin)
should be monitored annually, including
documentation of smoking habits.
Individual action plans were formed for
each patient who had various physical
measurements missing. This document
was available for case managers to view
on the ‘M’ drive to clarify exactly what
needed to be followed up for each
patient.
Case Managers were informed how to
request ECGs and this information was
placed on the ‘M’ drive and emailed
around.
Audit of Driving
Documentation in Early
Intervention Team – South.
Driving status should be known for each
patient in the Early Intervention Team.
Audit of Driving Documentation in Early
Intervention Team – South.
Action points from the audit were
communicated via an email for staff
members that were not in attendance
at the meeting where the findings were
discussed, and also to act as a memory
prompt.
Audit of guidelines for
Healthcare Support
Workers (School Health)
Audiology Screening in
Schools.
All standards met.
No further action required.
Audit of NICE compliance
of Hepatitis C testing
and offer of Hepatitis
B Vaccination (Sexual
Health).
All standards met.
No further action required.
Goals agreed with Commissioners
Adult Mental Health Audit
Bundle (Inpatient).
72 hour assessments to be completed on
time.
Ensuring that prior to discharge the team
has carried out a joint CPA review or
evidenced as to why this is not applicable.
Feedback has been given at the SDU
Quality meeting, and mailshots sent to all
AMH staff via the ‘Note From Governance’
posters for managers to discuss at their
team meetings.
Adult Mental Health Audit
Bundle (Community).
All patient records are to contain a risk assessment.
Staff are to evidence that patients have
had the opportunity to sign and have a
copy of their care plan.
Staff are to fully complete the needs assessment document and evidence rationale for areas that are not applicable.
Feedback has been given at the SDU
Quality meeting, and mailshots sent to all
AMH staff via the ‘Note From Governance’
posters for managers to discuss at their
team meetings.
64
A proportion of Worcestershire Health and Care NHS Trust income in 2014/15 was conditional on achieving quality
improvement and innovation goals agreed between Worcestershire Health and Care NHS Trust and any person or
body they entered into a contract, agreement or arrangement with for the provision of NHS services, through the
Commissioning for Quality and Innovation payment framework.
Further details of the agreed goals for 2014/15 and for the following 12 month period are available electronically at
www.hacw.nhs.uk
Statements for the CQC
Worcestershire Health and Care NHS Trust is required to register with the Care Quality Commission and its current
registration status is registered. Worcestershire Health and Care NHS Trust has no conditions imposed on its
registration.
Worcestershire Health and Care NHS Trust has not participated in any special reviews or investigations under section
48 of the Health and Social Care Act 2008 by the CQC during 2014/15.
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Annual Report 2014/15
Secondary Uses Service
Worcestershire Health and Care NHS Trust submitted
records during 2014/15 to the Secondary Uses Service
for inclusion in the Hospital Episode Statistics which are
included in the latest published data.
The percentage of records in the published data which
included the patient’s valid NHS Number was:
99.92% for admitted patient care
99.95% for outpatient care
The percentage of records in the published data which
included the patient’s valid general medical practice was:
99.91% for admitted patient care
99.70% for outpatient care
Data Quality
Worcestershire Health and Care NHS Trust will be taking
the following actions to improve data quality.
During 2014/15 a Data Quality Improvement Group
was set up. The group meets every two months and has
annual work programme, which is monitored by the
Audit Committee. This initiative strengthens the steps
being taken in improving data quality.
The purpose of the Group is to:
Identify barriers and obstacles to the use of data and
information by the Trust to facilitate greater efficiency
and effectiveness in the delivery of care, and to
implement plans to remove those barriers;
Provide assurance that the systems and processes to
support data capture across the Trust are robust and
that the information contained within the reports that
are presented to the Board and Committees is accurate;
Address any issues regarding data quality that arise
from external scrutiny of Trust information (e.g. Care
Quality Commission, Trust Development Authority,
commissioners and other stakeholders)
Ensure the implementation of the recommendations
from annual Internal Audit Report into Data Quality
and any other external assessments of data quality that
may take place;
Identify specific areas of concern with regard to data
quality and determine the approach to rectify these
shortfalls;
Ensure consistency of data collection and reporting
between the SDUs;
Identify the nature of information, both in terms of
the style of presentation, the mode and frequency of
66
delivery, that is required by front-line teams to support
more effective and efficient service delivery.
Develop and deliver an annual workplan that will be
formally approved by the Audit Committee.
Care Record to allow real-time tracing.
Distributing
weekly validation reports to show the attendances in each MIU where the NHS number is unknown.
Finally, publishing the above validation report through our own systems to allow MIU staff access to the lists on a
daily basis.
Ethnic Coding
Completeness has improved significantly, and is currently over 97%. This work will continue throughout 2015/16.
Throughout 2014/15 monthly validation sheets were
distributed to services to show the detail of patients who
received care during the previous month and whose
ethnicity has not been recorded in the relevant PAS. The
services were tasked with retrospectively updating the
source system with the patient’s ethnic category code.
Clinical coding error rate
SDU levels of ethnic coding completeness have been
reported to the Finance & Performance Committee on a
monthly basis. Reported levels have increased from 83%
in April, and remained at between 89% and 90% for the
rest of the year.
The requirements of Information Governance are central to the way we operate to ensure all data we collect is held
safety and securely.
For 2015/16 reports are being developed to expand the
validation exercise to include the coding completeness
of those patients currently on a caseload, and those with
future appointments booked.
Inpatient Primary Diagnosis
The Trust currently does not employ its own clinical
coding staff. Therefore, a service level agreement is in
place with Worcestershire Acute Hospitals NHS Trust to
support the coding of our community hospital inpatient
stays. Mental Health coding is undertaken by the ward
clerks and is quite a specialised area.
An exercise will be undertaken to review the advantages
and disadvantages of employing our own clinical coders.
NHS Number
We stated 2014/15 with low levels of NHS number
completeness within the Minor Injury Unit (MIU) Patient
Administration System. Unfortunately, there isn’t the
functionality to validate NHS Numbers against the
information held on the National Spine.
To counter this, a series of approaches were implemented
during the year, such as:
Completing mass (batch) tracing of NHS Numbers held
on the National Spine, and feeding the results back to
MIU admin staff to enter into our system.
Providing MIU admin staff with access to the Summary
Worcestershire Health and Care NHS Trust was not subject to the payment by results clinical coding audit during
2014/15.
Information Governance Assessment Report
The Trust achieved an Information Governance Toolkit score of 81% and were graded ‘satisfactory’, which is the
highest grade achievable. There were no Information Governance Serious Incidents requiring investigation reported
for 2014-15.
Mandated Indicators
Care Programme Approach (CPA) follow up contact within seven days of discharge from hospital.
The Trust’s performance in this area is measured on a quarterly basis as part of the Trust Development Authority’s
Accountability Framework indicators. In order to achieve the highest level of compliance in this area (“Performing”)
the Trust must achieve 95% of inpatients on CPA followed up within seven days of discharge from hospital.
The Trust is pleased to report that a level of ‘Performing’ was consistently achieved, with scores over 97%, for each
quarter in 2014/15. The quarterly scores are shown in Table 1 below.
Percentage of people on CPA followed up within 7 days of discharge from hospital.
Clinical coding error rate
Performance
Threshold
95% or over
Actual Quarterly Performance 2014/15
Quarter 1
98.9%
Quarter 2
99.5%
Quarter 3
98.8%
Quarter 4
100.0%
Minimising Delayed Transfers of Care
Measuring delayed transfers of care forms part of the Trust Development Authority’s Accountability Framework, and
helps the Trust to assess the impact of community-based care in facilitating timely discharge from hospitals.
People should receive the right care in the right place at the right time and we must ensure that people move on
from the hospital environment once they are safe to transfer.
The indicator seeks to encourage organisations to work in partnership to minimise the number of patients remaining
in hospital settings who are ready for discharge.
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Annual Report 2014/15
The definition is as follows: “the number of patients (acute and non-acute, aged 18 and over) whose transfer of care
was delayed, expressed as a percentage of the number of consultant and non-consultant led occupied beds.”
In order to achieve the highest level of compliance in this area (“Performing”) the Trust must keep delayed transfers of
care to 7.5% or less during each quarter.
Table 2 shows the Trust’s position for 2014/15. The Trust reports that a level of ‘Performing’ was not achieved in the
final three quarters of the financial year.
We routinely monitor our performance in this area across all services and where performance consistently falls
below target we implement recovery plans that are monitored by the Trust Board. We actively work with our partner
organisations to minimise any delays.
Percentage delayed transfers of care.
Percentage of patients readmitted to hospital within 28 days of being discharged.
Measuring the percentage of patients who were readmitted to hospital as an emergency within 28 days of being
discharged provides information to help us monitor success in avoiding (or reducing to a minimum) readmissions
following discharge from hospital.
The following table shows the quarterly percentage of all inpatient admissions that were readmitted in an emergency
within 28 days of the previous discharge during 2014/15.
Quarter 1
Quarter 2
Quarter 3
Quarter 4
Ages 0-14
0.0%
0.0%
0.0%
0.0%
Ages 15 +
3.9%
4.4%
3.2%
2.4%
Patient experience of community mental health services.
Performance
Threshold
Actual Quarterly Performance 2014/15
Quarter 1
7.5% or less
Quarter 2
6.6%
Quarter 3
8.6%
Quarter 4
8.1%
8.7%
The number of admissions to the Trust’s mental health acute wards that were gate kept by the Assessment and Home
Treatment Teams
When service user admissions are assessed (“gate kept”) by their local Assessment and Home Treatment Team, service
users have the opportunity to be treated in their own home. Wherever possible we offer service users the choice
to be supported in their own home as an alternative to hospital admission. This is recognised as best practice and
monitored by the Trust Development Authority’s Accountability Framework.
The method for calculating performance is as follows: “the number of admissions to the Trust’s acute wards (excluding
internal transfers between wards, patients recalled from community treatment orders, and patients on leave under
Section 17 of the Mental Health Act) that were gate kept by the Assessment and Home Treatment team prior to
admission. An admission has been ‘gate kept’ if the team assessed the service user before admission and involved
them in the decision making process that resulted in the hospital admission. This is expressed as a percentage of total
admissions to the Trust’s acute mental health wards.”
In order to achieve the highest level of compliance (“Performing”) the Trust must ensure that 95% of admissions to
acute mental health wards were gate kept by the Assessment and Home Treatment Teams.
The 2014/15 performance is shown in Table 3. The Trust is pleased to report that a level of ‘Performing’ was consistently
achieved, with scores over 97%, for each quarter in 2014/15.
Percentage of admissions to mental health acute wards that were gate kept.
Performance
Threshold
Actual Quarterly Performance 2014/15
Quarter 1
Quarter 2
Quarter 3
Quarter 4
7.5% or over
98.1%
99.3%
98.4%
97.5%
68
To improve the quality of services that the Trust delivers, it is important to understand what people think about their
care and treatment. One way of doing this is by asking people who have recently used our services to tell us about
their experiences.
To assist with this, each year a survey of people aged 18 and over accessing community mental health services is
conducted and collated each year by the Care Quality Commission.
398 responses were received from staff that took part in the 2014 survey (random sample of 850 were sent
questionnaires) - a response rate of 49% which is above average for mental health/learning disability trusts in England
and compares with a response rate of 50% for the Trust in the 2013 survey.
An excerpt of the survey results, specifically covering the patient’s experience of contact with a health or social care
worker, are shown in the table below. The full report has been published by the CQC and is available on their website.
Patient experience of contact with a health or social care worker:
(score out of 10)
Compared with the
national response,
we scored:
Listening: for the person or people seen most recently was listening
carefully to them.
8.2
About the same
Time: for being given enough time to discuss their needs and treatment
7.6
About the same
Agreeing care: for having agreed what care and services they will
receive
5.8
About the same
Trust’s 2014 score.
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Annual Report 2014/15
Worcestershire Health
and Care NHS Trust
Quality Account 2015
Involvement in planning care: for those who have agreed what care
and services they will receive, being involved as much as they
would like in agreeing this
7.8
About the same
Personal circumstances: for those who have agreed what care and
services they will receive, that this agreement takes into account
their personal circumstances
8.0
About the same
Comments by the Worcestershire Health
Overview and Scrutiny Committee – April
2015
Contact: for feeling that they have seen mental health services often
enough for their needs in the last 12 months
6.9
About the same
Worcestershire Health Overview and Scrutiny Committee
(HOSC) has considered a number of issues over the last
year through regular informal meetings and committee
meetings, including:
Respect and dignity: for feeling that they were treated with respect
and dignity by NHS mental health services
Overall view of mental health services: for feeling that overall they
had a good experience
8.3
6.9
About the same
About the same
Figures taken from the CQC website: http://www.cqc.org.uk/provider/R1A/survey/6
Patient Safety Incidents
The table below sets out the level of harm from incidents reporting during 2014/15.
LEVELS OF HARM
NO. OF INCIDENTS
No Harm
4847
Low Harm
4308
Moderate Harm
469
Severe Harm
80
Death (NRLS Reportable)
26
Death (Non-NRLS Reportable)
52
Near Miss
713
TOTAL INCIDENTS 2014/2015
10495
The number of patient safety incidents that resulted in severe harm or death was 158 (1.51%).
Examples of Patient Safety Incidents that result in severe harm are grade 4 pressure ulcers (both avoidable and
unavoidable) and falls where the patient sustains a fracture. All such incidents undergo a thorough investigation to
establish the root cause of the incident, and in many instances nothing could have been done to prevent the incident.
Well Connected
Patient flow
Urgent care
Mental health provision and proposals
Mental health liaison
the mental wellbeing and suicide prevention strategy
the five year Health and Care strategy
Tenbury Wells minor injuries unit
Community Services redesign
The HOSC also contributed to the Care Quality
Commission Chief Inspector’s inspection of the Trust.
Overall Worcestershire HOSC considers that the Quality
Account is a fair reflection of the services provided by
the Trust. It is an accessible and balanced document,
though members asked for the Quality Dashboard
indicators to be defined and for the 2015/16 priority on
reducing severe incidents to be more clearly explained. It
is not clear how public and patients have been involved
in its development, although the HOSC has found
that for most service changes – e.g. Tenbury MIU - the
Trust’s consultation with patients and pubic has been
appropriate. The Trust’s Quality Assurance mechanisms
are explained and appear appropriate.
The HOSC notes the progress made against the three
Quality Account priorities for 2014/15. The drop in
avoidable ulcers is good news but members would like to
see further detail on how Dementia care has improved.
The changes in Learning Disability services are noted, but
this is an area that scrutiny will continue to monitor.
In terms of the 2015/16 priorities, the HOSC welcomes
the opportunity to comment on them and the early
sight of the draft QA. We are pleased with the continuing
focus on dementia awareness and understanding, and
would like to stress this is not just needed by nursing
staff. Members would also highlight the importance of
services for all frail elderly patients, not just those with
dementia.
The HOSC agrees with the areas highlighted for
improvement and has no concerns about the plans.
The HOSC noted the increasing number of complaints,
but felt this might be attributed to an increasing
awareness of how to complain. Members were keen to
see an analysis of any trends emerging from complaints
and PALS enquiries.
Members welcome the QA’s focus on prison healthcare
and the compliance of the service with standards.
The reduction in waiting times for CAMHS has been
welcomed, but members note the need for more Tier 4
beds.
Delayed transfers of care have been a particular concern
across the health economy in Worcestershire and the
HOSC has started to look at patient flow. In relation to
community hospital capacity, members welcome the
proposals in south Worcestershire to create a core offer
for community hospitals.
In relation to community based mental health crisis
services, the HOSC had reservations about the changes
to the mental health liaison service and, whilst
acknowledging that all statutory responsibilities were
met, would like to see an evaluation of the impact of the
changes.
One issue which is not covered in the Quality Account
is the development of stroke community rehabilitation
services. HOSC members have raised their concerns
with commissioners as to how service equity can be
established and financed across the county without
penalising provision in South Worcestershire.
Where a death is recorded on the system, this is where a patient who is known to our services dies unexpectedly –
this does not mean that the death was preventable. Large scale investigations are undertaken in such instances to
establish if the care provided in our services was safe and appropriate, and whether there was anything that could
have been done to prevent the death.
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Annual Report 2014/15
CCGs Response to Worcestershire Health and
Care Trust Quality Account 2014/15
The response detailed below is a collective response
from the three Clinical Commissioning Groups in
Worcestershire- NHS South Worcestershire CCG, NHS
Wyre Forest CCG and NHS Redditch and Bromsgrove
CCG.
All three CCGs welcome the opportunity to comment on
the 2014/15 Quality Account for Worcestershire Health
and Care Trust.
From the information provided within this document
and the Quality Monitoring processes the Clinical
Commissioning Groups have in place, we believe this
Quality Account provides a representative and balanced
perspective of the quality of healthcare provided by the
Trust.
The sustained performance against the majority of
clinical indicators, as monitored through the Clinical
Quality Review process is recognised and commended.
Particular improvements noted with Infection Rates
(C-diff rates), harm free falls and Pressure Ulcers.
The Trust should be commended on their progress
against the three priority areas that were set for 2014/15.
The CCGs acknowledge the Trusts actions, efforts
and interventions to reduce the number of avoidable
Pressure Ulcers for patients in their care. However,
maintaining progress and further improvements in this
area will require sustained efforts, staff training and
continued quality monitoring.
Improvements in the quality of care for people with
Dementia and their Carers, especially for those people
within In-patient settings has been noted and recognised
as an area of good practice. The on-going focus for
2105/16 with dementia / person centred awareness
training is welcomed.
At the beginning of 2014 some of the sub-indicators for
CQUIN goals were not fully met, and since then the CCGs
can confirm that the Trust have improved their internal
processes creating greater focus and action planning of
each CQUIN, coupled with improved report checks prior
to submission to CCGs.
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The trust has an established robust process of Incident
reporting and Learning from Incidents. Over the last year
there has been a significant improvement with Incident
reporting within the trust and an increase in the number
of incidents which resulted in no or low harm. The CCGs
are pleased to note in the priorities for 2015/16 the
continued commitment of the Trust to strive to reduce
harm to patients and to continue to learn and prevent
re-occurrences.
A paragraph within the Incident Reporting section
relating to Serious Incidents reported within Mental
Health services would have been helpful to demonstrate
the trends in reporting and lessons learned.
The CCGs note the section within the document relating
to National and Local Audits undertaken, however, the
section lacks an introductory narrative and the column
relating to the actions that have been put in place since
the audit provides limited assurance of continued quality
improvement.
The CCG has taken the opportunity to check the accuracy
of the data presented in the document in relation to
locally commissioned services and believes it to be a
factual account.
In Summary, the CCGs believe the Quality Account is a
balanced and accurate record of the organisations key
quality challenges and improvements during 2104/15
and support the identified Quality Account priorities for
2015/16.
On behalf of NHS Redditch and Bromsgrove,
South Worcestershire and Wyre Forest Clinical
commissioning groups (CCGs).
Changes Made to the Quality Account after receipt of
the statements
We would like to thank our partners for submitting their
statements in relation to the Quality Account. Some
of the issues raised by stakeholders will be covered
in the Annual Report. The Quality Account forms part
of the annual report. Other suggested changes will
be incorporated into the 2015/16 Quality Account to
improve the overall presentation of information.
Healthwatch Worcestershire Response to the
Worcestershire Health and Care NHS Trust
Quality Accounts 2014-2015
One of Healthwatch Worcestershire’s principle roles as
the champion for those who use publicly funded health
and care services in the county is to use the experiences
of patients, carers and the public to influence how NHS
organisations such as Worcestershire Health and Care
NHS Trust provide services.
Nationally, the NHS 5 Year Forward View which was
published by the Chief Executive of NHS England in
October 2014 commits the NHS to engaging with
patients and the public to ensure their views shape the
design and delivery of health and care services. Whilst
locally, Worcestershire Health and Care NHS Trust, as
a partner in the county’s ‘Well Connected Programme’
which aims to integrate health and care services, has
committed to place the views of patients, service users
and carers at the heart of service design and delivery.
Therefore Healthwatch Worcestershire has commented
on the Quality Accounts of the Worcestershire Health and
Care NHS Trust for the period 2014/15 in that context.
The process of involving patients, service users and carers
in the design and delivery of their services is called ‘CoProduction’
Do the priorities of the provider reflect the priorities
of the population?
The Quality Account does not explain to what extent
the three priorities for the next year have been set by
patients or the public; or if they have been involved
in any engagement or discussion about setting these
priorities.
Whilst Healthwatch Worcestershire supports the Trust’s
aim to make improvements in the three areas chosen.
In particular ensuring mental health in patients receive
physical health checks. Feedback given to us over
the last year suggests that a priority area for patients
and the public is access to mental health services,
particularly in a crisis and the reduction of waiting
times to access CAMHS.
One of the Key Achievements reported for the year
is for CAMHS – ‘the redesign of services to improve
our responsiveness’. We would welcome further
information about what this involved and how the
success has been evaluated with users of the service.
atient survey of Community Mental Health Services
P
– feedback given to Healthwatch Worcestershire
supports the findings that there is improvement
required to ensure service users know who to
contact out of hours in a crisis. We would like further
information about what the actions are that have been
implemented and the improvements recorded, as our
feedback would suggest this is still an ongoing issue.
Healthwatch Worcestershire would support the
identified need to record ethnic status and using this
information to identify potential barriers for Black,
Asian and Minority Ethnic groups to accessing services.
This is an area Healthwatch Worcestershire is currently
working on as an identified business priority.
The Quality Account does demonstrate that measures
such as the Friends and Family Test and other surveys
have been carried out in order to gain feedback from
those using services. Co-Production is also mentioned.
However we would like to see Co-Production being a
major theme running through the whole document.
We would also welcome further information about
more on-going engagement and user led reviews of
services, such as any patient forums used. The Youth
Board is mentioned, however their work over the last
year is not described.
We are pleased that work has been carried out to
increase awareness and use of the ways service
users and patients are able to provide feedback. Also
that changes that are made as a result of this are
communicated back, for example through posters in
waiting rooms. Healthwatch Worcestershire has been
talking with different groups, including those with a
learning disability about the importance of providing
information about giving feedback in different formats.
We hope this is something that will be available across
Trust services.
Are there any important issues missed?
Feedback gained to the Quality Account through our
Reference and Engagement Group raises concerns
that priorities identified do not include or impact upon
young people. There is also concern that the needs
of hard to reach groups, in particular those who are
homeless, in relation to accessing early intervention
and mental health support have not been included.
Information is included about the number of
complaints, other feedback received and survey
responses. There are some examples of positive feedback
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Annual Report 2014/15
and issues where changes have been made. However we
feel there could be further information about some of the
issues that were raised through complaints and surveys
carried out and where further improvements are still
required.
It might be helpful to include the details of the service
failure which was upheld by the Parliamentary and
Health Services Ombudsman.
Has the provider demonstrated that they have
involved patients and the public in the production of
the Quality Accounts?
Apart from the inclusion of quotes of feedback from
patients and the results of surveys, it is not clear if
patients or the public were involved in producing the
Quality Account.
Healthwatch Worcestershire would welcome the
chance to give feedback at an earlier stage of the
process of writing the Quality Account in future, as
this may provide more opportunity for feedback to be
incorporated.
Is the Quality Account clearly presented for patients
and the public?
Creating a colour print version of the Quality Account
set out in this way helps to make it easier to look
through and identify different sections.
It is helpful to have explanations about commissioners
and providers and the way in which the Trust is
monitored and regulated.
There are a lot of figures and use of abbreviations,
jargon and complex terminology which can be difficult
to understand. More explanation and clearly laid out
actions needed and improvements demonstrated
would be helpful.
It is a very long document, in small print. It would be
useful to think about making this available in different
formats, such as Easy Read. At present many of the
patients and users of Trust services would not be able
to access the information in its current format.
Worcestershire Healthwatch.
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Statement of directors’ responsibilities in
respect of the Quality Account
The directors are required under the Health Act 2009
to prepare a Quality Account for each financial year.
The Department of Health has issued guidance on the
form and content of annual Quality Accounts (which
incorporates the legal requirements in the Health Act
2009 and the National Health Service (Quality Accounts)
Regulations 2010 (as amended by the National Health
Service (Quality Accounts) Amendment Regulations
2011).
In preparing the Quality Account, directors are required
to take steps to satisfy themselves that:
The 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,
conforms to specified data quality standards and
prescribed definitions, and 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
25 June 2015 ________________________________
Chair
25 June 2015
_________________________________
Chief Executive
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Annual Report 2014/15
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