Quality Account
2014/15
Bridgewater Quality Account 2014/15
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Bridgewater Quality Account 2014/15
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Contents
Page
Part 1 - Statement on Quality from the Chief Executive
Statement on Quality by Chief Executive
5
A bit more about us.....
7
Part 2 - Priorities for Improvement and Statements of Assurance from the Board
Review of Progress against 2014/15 Priorities for Improvement
8
Priorities for Improvement in 2015/16
12
Statements of Assurance from the Board
14
Reporting against Core Indicators page 19
Part 3 - Review of Quality Performance
Quality of Services in 2014/15
25
Trust Quality Measures
25
Patient Experience28
Patient Story28
Patient Survey and Friends and Family Test Results
29
Patient Partners29
Patient Advice and Liaison Service
30
Complaints31
Staff Engagement, Health & Wellbeing
32
Staff Engagement32
NHS Staff Survey 2014
33
Staff Health & Wellbeing
34
Performance Development Reviews
35
Staff Turnover35
Responsible Officer Compliance
36
Education & Professional Development
36
Mandatory Training36
Continuing Professional Development
36
Competence Frameworks37
Pre-Registration37
Forward Planning37
Leadership Programme and the Bridgewater Quality Improvement 38
Programme Library Strategy
38
Equality, Diversity and Inclusion
39
Delivering Same Sex Accommodation
40
Incident reporting40
Never events44
Central Alert System
45
Pressure Ulcers45
Workforce Planning46
Coroner’s Cases46
Bridgewater Quality Account 2014/15
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Contents
Page
Infection Prevention and Control
47
Safeguarding53
National Institute for Health and Care Excellence
54
Clinical Audit56
Research59
Care Quality Commission
59
St Helens Clinical Commissioning GroupReview of Newton Hospital 60
Medicines Management61
Information Governance64
Emergency Preparedness, Resilience and Response
65
Partnership Working65
Service Improvements70
Listening into Action
76
Developing our Organisational Culture
77
Quality, Innovation, Productivity and Prevention
78
Clinical Strategies79
Strategy Days79
Quality Seminars80
Health Improvement Programmes
80
Midwifery81
Community Dental82
Walk in Centres
83
Out of Hours
83
Waiting Times84
Foundation Trust Application
87
Monitor Regulation87
Council of Governors
88
Monitoring the Quality of Services across Bridgewater
88
Quality Impact Assessment Process
89
Actions taken to address Francis Report Recommendations
89
Actions taken to address Freedom to Speak up Recommendations
89
Sign up to Safety
89
Open and Honest Care
89
NHS Safety Thermometer
90
Internal Audit91
Stakeholder Involvement in the Development of our Quality Account
93
Appendices
Appendix A – Children’s Immunisations for Quality Account
102
Appendix B – Statement of Directors’ Responsibilities
103
Appendix C – Auditors Report
104
Bridgewater Quality Account 2014/15
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Statement on Quality
by Chief Executive
I am delighted to write this Statement on Quality for our 2014/15 Quality Account.
This has been a very positive year as the organisation became one of the first two community
trusts to be awarded Foundation Trust status. This was a momentous occasion and marked
the achievement of one of our strategic objectives. I would like to once again take this
opportunity to thank all the staff for their hard work and dedication to delivering high quality
patient care, without whom this would not have been possible. This account covers the entire
financial year.
I want all colleagues to be involved in developing and implementing the plans we have; this
is why we embarked on the Listening into Action programme. The Big Conversations were
an opportunity for staff to talk to me about what they felt the biggest blockers to great patient
care were, and what actions we should take to overcome or fix them. Staff were not backward
in coming forward, with a lot of lively and passionate discussion at each event. We have been
able to make some “quick wins” to address the concerns raised by staff. For example:
• A text messaging reminder service for patients has been implemented across MSK/
CATS to assist in reducing the number of unutilised treatment slots as a result of
patients not turning up for their appointment
• The introduction of teleconferencing facilities Trust-wide to enable staff to do their jobs
properly, help them manage their time more effectively, and reduce the amount of
miles they are expected to travel. Each directorate now has its own teleconferencing
line for all staff to use.
Bridgewater Quality Account 2014/15
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We take patient feedback seriously and each month a Patient Story is presented to the
Board. These stories portray a very strong message about the care we provide and we
always strive to make improvements when that care is not as we would like it to be. The Trust
receives relatively few complaints. However, any areas for improvement are taken very
seriously by the Board, managers and all our staff and we endeavour constantly to improve
the quality of care we deliver.
It is very pleasing to note that 99% of our patients expressed their overall satisfaction with
their care and treatment which is up from 98% at the end of March 2014.
As Chief Executive I am confident that the Trust provides a high quality service and that this
Quality Account demonstrates this. To the best of my knowledge the information in this
account is accurate and fairly reflects the quality of the care we deliver.
Colin Scales
Bridgewater Quality Account 2014/15
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A bit more about us…
Bridgewater provides high quality community and specialist services to 855,848 people
covering:
• Runcorn & Widnes (Halton)
• St Helens
•Warrington
• Wigan Borough
• Community Dental (provides services in all of the above areas plus Bolton, Tameside,
Trafford, Glossop, Stockport and Western Cheshire)
The majority of our services are delivered in patients’ homes or at locations close to where
they live, such as clinics, health centres, GP practices, community centres and schools.
As a provider of both mainstream and specialist care our role is to focus on providing cost
effective NHS care by keeping people out of hospital and supporting vulnerable people
throughout their lives.
As a dedicated provider of community services our strategy is to bring more care closer to
home – this means providing a wider range of services in community settings to keep people
healthier for longer and developing more specialist services to support people to live
independently at home.
We employ 3,400 staff and have an income of £140 million which comes from our
commissioners; including Clinical Commissioning Groups (CCGs), NHS England and Local
Authorities.
• NHS Warrington CCG represents 26 GP practices, acting on behalf of over 212,901
patients living in Warrington
• NHS Halton CCG represents 17 GP practices, acting on behalf of over 125,892
patients living in Halton
• NHS St Helens CCG represents 37 GP practices, acting on behalf of over 194,758
patients living in St Helens
• NHS Wigan CCG represents 65 GP practices, acting on behalf of over 322,297
patients living in Wigan
On an average day we care for:
•
•
•
•
•
Approximately 9500 patients
409 people in our walk-in centres
27 people in our community hospital (Newton)
2190 supported by our district nurses
290 people in our community dental services
Bridgewater Quality Account 2014/15
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Review of Progress against 2014/15 Priorities for
Improvement
Quality Improvement
priorities in 2014/15
Measures of
success
Update and Assurance
Outcome
Ensuring we are safe
Open and Honest Care –
Improve the accuracy of
pressure ulcer reporting.
Safer Staffing: appropriate levels
and skills of staff to
ensure quality of care and patient
safety. Develop a
standardised caseload
weighting tool that is
understood and used
consistently across all district
nursing teams and boroughs.
Effective reporting will identify the
need for redeployment or
additional resources.
Monthly pressure
audit reports
Quarterly dashboard produced and monitored by
QMG.
Met
Incident reports for
pressure ulcers
Reported monthly in the Integrated Performance
Report (IPR) and nationally for Open and Honest
Care on NHS Choices.
Met
National publication
of our pressure
ulcer numbers
Reported monthly in the IPR and nationally for Open
and Honest Care on NHS Choices.
Met
Quarterly safer
staffing and caseload
weighting reports
Safer staffing reports produced monthly and
submitted to Board.
Met
Monitoring of
Caseload weighting
Standards agreed and peer audit in progress.
Met
Measure the impact
using standardised
clinical assessment
tools alongside
parental
questionnaires
Integrated Research Application System ethics was
granted.
The Eczema Expert pilot was delayed by 3-6 months
due to issues relating to whether all the contents
in the box are included in the Greater Manchester
formulary/available without prescription.
Increase in the
number of Patient
Partners involved with
service redesigns
There were 170 patient partners at the end of 2013/14.
There were 195 patient partners at the end of 2014/15.
Met
Maintain or improve
the overall patient
experience score
At the end of 2013/14 98% of patients expressed
overall satisfaction with their care and treatment.
At the end of 2014/15 99% of patients expressed
overall satisfaction with their care and treatment.
Met
Increased
understanding about
what is most
important to those who
use our children and
young people services
A parent reported outcomes and experience measure
has been developed and will be routinely
implemented in Warrington Borough from April
2015 to provide both assurance and feedback for
services to inform continuous improvement.
Met
Ensuring we are effective
To develop an innovative,
evidence based, self-care
approach to the treatment of atopic
eczema in children.
Not Met
Ensuring we are caring
Improving patient experience and
involvement.
Understand more about the
emotional and functional outcomes
of care for children and young
people through direct family
engagement techniques. We are
interviewing families and will be
developing a feedback tool which
Bridgewater Quality Account 2014/15
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Review of Progress against 2014/15 Priorities for
Improvement (continued)
Quality Improvement
priorities in 2014/15
Measures of
success
Update and Assurance
Outcome
can capture and report on the
question ‘what difference did we
make?’ in relation to functional and
emotional outcomes.
Engagement with patients with
disabilities and their carers to
work collaboratively with them
to improve patient experience for
patients with disabilities within
community dental services.
Increased
understanding
about what is
most important to
patients with
disabilities and
their carers who
use our
community dental
services
Measures of success have been achieved in that we have
found out what is important for our patients and acted on
it. However this work needs to be on-going and it is now
embedded in what we do routinely.
Met
Ensuring we are responsive
New birth visit
contacts by
health visitors
Warrington: (2013/14 – 48.3%) 2014/15 – 49.6%£
Wigan: (2013/14 – 39.4%) 2014/15 – 37.9%
Halton: (2013/14 – 27.99%) 2014/15 – 34.58% £
St Helens: (2013/14 – 30.85%) 2014/15 – 42.77%£
Partially
6-8 week breast
feeding rates
Warrington: (2013/14 – 36.6%) 2014/15 – 37.3%£
Wigan: (2013/14 – 31.2%) 2014/15 – 28.4%
Halton: (2013/14 – 21.71%) 2014/15 – 20.72%
St Helens: (2013/14 – 21.79%) 2014/15 – 21.01%
Partially
3 month breast
feeding rates
(development
target)
The 3 month breast feeding rates are not currently collated.
The current emphasis is on improving the initial and 6-8 week
breast feeding rates.
Not Met
IV therapy delivered in Warrington, Halton, St Helens and
Knowsley.
Early supported discharges (ESDs)
Q1 Early discharges = 107
Q2 Early discharges = 123
Q3 Early discharges = 110
Q4 Early discharges = 133
PART (Paediatric Acute Response Team) have also facilitated
5 ESDs since the service commenced in May 2014.
Met
Number of
hospital
admissions
avoided
IV therapy delivered in Warrington, Halton, St Helens and
Knowsley .
Number of admissions avoided
Q1 Admissions avoided = 82
Q2 Admissions avoided = 93
Q3 Admissions avoided = 97
Q4 Admissions avoided = 121
Met
Nationally agreed
health check
requirements will
be implemented
All patients received into custody are requested to attend an
annual health check.
Met
To implement a comprehensive
annual health check across all
three prison sites for offenders who
have a learning disability.
£
£
£
Developing out of hospital services Reduced length of
to deliver intravenous therapy (IV) stay in hospital
in the community.
£
To improve the current breast
feeding rates across the
boroughs we serve by giving new
mothers the opportunity to sign up
to the Flo initiative which provides
them with on-going support and
motivational texts whilst they are
breast feeding.
Bridgewater Quality Account 2014/15
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Review of Progress against 2014/15 Priorities for
Improvement (continued)
Quality Improvement
priorities in 2014/15
Measures of
success
Number of annual health
checks carried out
To ensure processes are in
place to provide on-ward
referral, sign-posting and
advice to patients identified as
potentially having dementia,
and their carers, within our
community nursing and
in-patient services.
Update and Assurance
Audit completed and all the required health checks have
been carried out as required.
Outcome
Met
Questions from the Six
6CIT contained within all community nursing
Item Cognitive
assessment documentation across Bridgewater.
Impairment Tool (6CIT)
(nationally recognised
cognitive impairment test)
to be incorporated into
initial screening
assessment to ensure all
patients are screened
Met
Devise borough
specific information packs
regarding local services
to support patients and
carers
E-directory of services and voluntary agencies available
by borough to support patients and carers developed on
intranet.
Resource links are available as part of the training.
Met
Develop a passion for
supporting people
with dementia by
identifying and utilising
“dementia champions” to
lead the project
Dementia champions identified at service level within
community nursing. There are between 2-4 champions
in each borough.
Dementia friend identified within in-patient services.
The champions are a resource for staff if required.
The dementia friendly training has now been
superseded by the e-learning.
Met
Develop tiered levels
of dementia awareness
by working with learning
and development to
establish a baseline
of work-force current
training and awareness
levels and establish a
training needs analysis
and training plan, as
appropriate
Dementia training is on the community nursing
workforce training needs analysis and levels of training
are monitored by the Learning and Development Team.
Bridgewater dementia training figures returned to NHS
North West are Q1 = 585, Q2 = 226, Q3 = 392 and
Q4 178 Total = 1381
Met
Our risk descriptions will
be the same as
our incident
descriptions
Risk management training delivered on a monthly basis
which has more accurately identified patient safety
incidents. All incident cause groups (used for aggregate
reporting) have been re-described during 2014/15 but
implemented in April 2015 with the risk types being
updated in line with these during April 2015.
Not Met
More accurately
documented risk
assessments and
consequently a potential
reduction in harm caused
Risk management training delivered on a monthly basis.
Met
Ensuring we are well-led
Prevent the risk of future
incidents by improving the
way in which we monitor risks
by more closely aligning our
risk and incident data.
Bridgewater Quality Account 2014/15
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The priorities for 2014/15 have been monitored throughout the year. As we move into
2015/16 the Trust will ensure that these areas continue to be monitored as part of the
Trust quality monitoring processes. The three areas not completed will continue to be
monitored and reported on in next year’s account.
Quality Improvement
To develop an innovative evidence base,
self-care approach to the treatment of
atopic eczema in children
Prevent the risk of future incidents by
improving the way in which we monitor
risks by more closely aligning our risk
and incident data
To improve the current breast feeding
rates across the boroughs we serve by
giving new mothers the opportunity
to sign up to the Flo initiative which
provides them with on-going support and
motivational texts whilst they are breast
feeding
Outcome
Comment
Not Met
This development will continue into
2015/16 and the Trust is working
partnership with the Clinical
Commissioning Group to develop the way
forward for the benefit of the children.
Not Met
This was not completed by the end of
2014/15. The new incident cause groups
will be in place from April 2015/16.
Partially Met
In light of the 2014/15 data we are
working with the commissioners to
develop enhanced service specifications
for infant feeding.
Bridgewater Quality Account 2014/15
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Priorities for Improvement in 2015/16
During 2015/16 the Trust is committed to further develop the culture in line with our mission:
to improve local health and promote wellbeing in the communities with serve.
As we start 2015/16 the Trust is entering a new exciting phase of its journey and the existing
Quality Strategy will be reviewed and refreshed to meet the changing environment of
community care in line with the Five Year Forward Plan, and national initiatives that have
identified improvement in quality of care and the developments in the organisational
structure. The new Quality Strategy will cover the next three years. The Board will review and
approve this new strategy in August 2015.
To continue our quality journey we will build on the positive culture where quality of care can
develop. The Trust will ensure through our revised strategy that we:
• Have clearly aligned goals and objectives at every level
• Identify shared values and behaviours across the Trust
• Provide a learning and improvement environment
This strategy will be further developed and defined during 2015/16 in consultation with
patients, governors and partner organisations. The Trust will have an implementation plan for
our Quality Strategy. The Quality and Safety Committee will receive quarterly reports on the
implementation of this plan via the Quality Management Group. Our progress on delivering
the priorities will be reported in next year’s Quality Account.
Quality Priority 1 - Sign up to Safety
‘Sign up to Safety’ aims to deliver harm free care for every patient, every time, everywhere. It
champions openness and honesty and supports everyone to improve the safety of patients.
We have developed our patient safety improvement plan for 2015/16 based on the ‘Sign up
to Safety’ actions and we have committed to the following five ‘Sign up to Safety’ pledges:
1. Putting safety first: commit to reduce avoidable harm in the NHS by half and make public
the goals and plans developed locally
2. Continually learn: make our organisation more resilient to risks, by acting on patient
feedback and by constantly measuring and monitoring how safe our services are
3. Being honest: be transparent with people about our progress to tackle patient
safety issues and support staff to be candid with patients and their families if something
goes wrong
4. Collaborating: take a lead role in supporting local collaborative learning so that
improvements are made across all of the local services that patients use
5. Being supportive: help our people understand why things go wrong and how to put them
right. Give them the time and support to improve and celebrate the progress
Bridgewater Quality Account 2014/15
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Quality Priority 2 - Improvement in the handling of serious and untoward incidents
Following publication of NHS England’s revised framework for the handling of serious and
untoward incidents, the Risk Team and Senior Managers agreed a programme of work for
2015/16. This programme of work will assist in the implementation of the new framework and
address the:
• Late submission of Root Cause Analysis (RCA) documents during 2014/15
• Quality of data on the Strategic Executive Information System (STEIS)
• Internal quality control of the “sign off “ of completed SUI investigations
The programme of work has been discussed with each of our Clinical Commissioning
Groups.
Quality Priority 3 – NHS Safety Thermometer improvements in care
The Trust performs well against aspects of the NHS Safety Thermometer in comparison to
other NHS community services. Nevertheless, we strive to continuously improve care against
these key areas. During 2015/16, we will further develop clinical delivery and training in the
following areas:
• Pressure ulcer management:
• To continue the reporting of the pressure ulcer monitoring tool and analysis of the
data
• To reduce the incidents of avoidable pressure ulcers in line with the new national
framework
• To continue to work in partnership with local health providers to improve the health
economy pathway
• Falls management in in-patient bed areas:
• To roll out the FallSafe programme to all in-patient and intermediate care units
• To monitor the effectiveness of the programme and reduction in the number of
falls incidents
• Undertake regular audits on falls during the 2015/16
• Medication safety:
• Robust monitoring of omitted or late doses of medication by improved incident
reporting, ensuring lessons learnt are embed into practice and policy and training
put in place
• Increase the reporting of medication near misses in order to identify lessons learnt
and thus reduce medication incidents
• Improve the uniformity of medication incident data reported via the Trusts
electronic incident reporting system in order to improve the analysis of incidents
Quality Priority 4 - Newton Hospital Vision and Strategy
Following a review by the CQC and St Helens CCG, the Trust is developing a vision and
strategy working in liaison with the CCG; due for presentation at the Trust Board in Quarter 2.
Bridgewater Quality Account 2014/15
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How were they chosen?
Patient safety is a top priority for the Trust. We have signed up to the ‘Sign up to Safety’
initiative, which is designed to help realise the ambition of making the NHS the safest
healthcare system in the world.
Quality priorities 2 and 3 have been identified following discussions with a range of staff at a
Management Away Day and they are in line with our top three reported incidents. The Clinical
Commissioning Groups (CCGs) have identified these areas as priorities.
With respect to quality priority 4, the Trust is working with St Helens CCG to determine the
strategic direction of Newton Hospital with the aim of improving patient pathways and
partnership working with the wider health economy.
Statements of Assurance from the Board
Review of Services
During 2014/15 Bridgewater Community Healthcare NHS Foundation Trust provided and/or
sub-contracted 129 relevant health services.
Bridgewater Community Healthcare NHS Foundation Trust has reviewed all the data available
to them on the quality of care in 100% of these relevant health services.
The income generated by the relevant health services reviewed in 2014/15 represents 93.5%
of the total income generated from the provision of relevant health services by Bridgewater
Community Healthcare NHS Foundation Trust for 2014/15.
Audit
During 2014/15, one national clinical audit and one national confidential enquiry covered
relevant health services that Bridgewater Community Healthcare NHS Foundation Trust
provides.
During that period Bridgewater Community Healthcare NHS Foundation Trust participated in
100% national clinical audits and 100% national confidential enquires of the national clinical
audits and national confidential enquires it was eligible to participate in.
The national clinical audits and national confidential enquires that Bridgewater Community
Healthcare NHS Foundation Trust was eligible to participate in during 2014/15 are as follows:
Title
The National Audit of Intermediate Care
The National Confidential Enquiry – Sepsis Study
organisational questionnaire
Audit Requirements
Services distributed a service user questionnaire. This
phase of the audit did not require cases to be submitted
This study was an organisational questionnaire and did not
require cases to be submitted
No national clinical audit reports published during 2014/15 were relevant to the services that
Bridgewater Community Healthcare NHS Foundation Trust provides and therefore none were
eligible to be reviewed.
Bridgewater Quality Account 2014/15
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The reports of 30 local clinical audits were reviewed by the provider in 2014/15 and
Bridgewater Community Healthcare NHS Foundation Trust intends to take the following
actions to improve the quality of healthcare provided:
Title of Audit
Audit of Catheter Care (joint audit with
Wrightington, Wigan and Leigh NHS
Foundation Trust)
Key Findings
11 standards in the audit. 8/11
achieved compliance levels of 80% or
more.
The remaining 3 standards that
achieved less than 80% are:
1. samples followed up within 3 days
2. wound swab if signs of infection
3. supra-pubic catheters not to be
changed in first 6 weeks
Actions
Improve use of standard forms such
as CCP11 (care plan form) to ensure
comprehensive documentation and
prompts.
Minor redesign of catheter passport
as suggested by patient feedback.
Re-audit with clarification around two
questions that results indicate may
have been misinterpreted by auditors.
The patient feedback aspect of the audit
supports the audit findings except that
the patient health records show 80% of
patients were given catheter
passports, whereas patient feedback
figure is 50%. This difference may
be due to the fact that not all patients
returned the questionnaire.
Audit of In-patient Falls Prevention
(Newton Community Hospital)
Falls and fall-related injuries are a
common and serious problem for older
people. People aged 65 and older have
the highest risk of falling, with 30% of
people older than 65 and 50% of
people older than 80 falling at least
once a year.(NICE 2013)
Patient health records were assessed
using NICE standards for inpatient
falls:
• 100% of patients had a falls
assessment within 6 hours of
admission
• All patients had an agreed care
plan that had been reviewed.
However only 40% were
multifactorial with timescales
• 88% of patient and their carers
received verbal advice on the ward
on falls prevention techniques
• 79% of patients received further
verbal advice before discharge on
falls prevention strategies
Audit results reflect a lot of
improvement work undertaken prior
to audit; however the audit has shown
some areas for improvement.
The RCP FallSafe initiative with
pathway and care bundles is being
adapted and will be launched within
the next 6 months across all
bed-based services provided by
Bridgewater. This will provide a more
robust process for both patients and
staff.
A further audit will be undertaken 3
months after implementation of
FallSafe to ensure that all NICE
standards have been achieved.
Bridgewater Quality Account 2014/15
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Title of Audit
Key Findings
Actions
• Only 1 person had evidence of
being offered and referred to a
falls prevention service
• Only 19% of patients had a lying
and standing blood pressure taken
(local & RCN standard)
• 81% had a home assessment
documented in the notes. Patient
feedback showed this to be 100%
Further patient feedback:
• 100% of patient said they were
treated with dignity and respect at
all times
• All patients rated the care as very
good or excellent
Out of the 30 audits, 19 have action plans for development and 11 achieved the standards of
care. It should be noted that a good clinical audit programme will focus on areas identified
for potential improvement. This means that most of the topics being audited for the first time
are expected to have action plans for improvement. A portion of the clinical audit programme
will consist of re-audits that have been through cycles of improvements and been re-audited
until standards are met. Some examples of audits that have met the standards are:
Title of Audit
Key Findings
Audit of assessment of dementia at Significant improvements from initial audit as shown below.
Newton Community Hospital
(cycle 2)
100% assessed using evidence based tool (6CIT), of these 84% within 6 hours
of admission. An increase of 61% from previous audit. The service added the
recording the time of the 6CIT assessment which provided the
evidence that 84% were being assessed within 6 hours. The previous audit
highlighted that the time was not recorded and there was only evidence of
‘assessment within 6 hours’ in 39% of cases.
91% of patients had the outcome of the 6CIT assessment acted upon. In the
previous audit this was 80%.
The initial audit findings showed that only 17% had information regarding the
assessment contained within the GP letter, within this audit cycle this had
increased to 96%.
This re-audit shows that standards audited are now all within an acceptable
level.
Audit of Insulin Safety in Community
Nursing
This audit was piloted in the Wigan borough and then repeated across all areas
of Bridgewater. As the clinical standards of care were met, there is no need to
re-audit but on-going monitoring will be undertaken through incident reporting.
There were four parts to this audit. Three parts were undertaken during a home
visit to administer insulin to patients.
Bridgewater Quality Account 2014/15
16
Title of Audit
Key Findings
The fourth part related to staff training.
1. Nurses were observed: all patients were noted to have their blood glucose
checked or were known to be stable prior to the administration of the
insulin. All staff were observed administering the insulin in a safe manner.
2. Patient health records were audited which showed that all patients had an
insulin care plan. All prescription sheets met record keeping standards for:
- Dose in units (not abbreviated)
-Frequency
- Drug name
- Batch and expiry
3. The patient was asked whether they had been offered or taught to
administer the insulin, either self-administer or a family member/carer.
The patient was also asked whether it was easy enough to get insulin
medication from their own GP.
-
-
In 16% of patients, it is not known whether they had been taught or offered
self -monitoring or self -administration skills. The auditor either did not ask
the patient or did not complete the audit form properly during the visit.
A small number of patients (6%) said that it was not easy enough to get
insulin medication; they blamed the pharmacy or their own GP.
4. 47% of staff said they had not received training on insulin. The largest
number of staff saying they had received training was at Wigan (62%),
and the lowest at Halton (4%). The disparity of training is a known issue
across the service and is already under review.
Participation in Clinical Research
The number of patients receiving relevant health services provided or subcontracted by
Bridgewater Community Healthcare NHS Foundation Trust in 2014/15 that were recruited
during that period to participate in research approved by a research ethics committee was 87.
Goals agreed with Commissioners - Use of the Commissioning
for Quality and Innovation (CQUIN) Payment Framework
A proportion of Bridgewater Community Healthcare NHS Foundation Trust income in 2014/15
was conditional on achieving quality improvement and innovation goals agreed between
Bridgewater Community Healthcare NHS Foundation Trust and any person or body they
entered into a contract, agreement or arrangement with for the provision of relevant health
services, through the CQUIN payment framework.
The Trust developed Commissioning for Quality and Innovation schemes with each of the
four main boroughs, Halton, St Helens, Warrington and Wigan Clinical Commissioning Group
payment framework. Targets were also agreed separately with Specialised Commissioning
for our Offender Heath services.
The framework aims to embed quality within commissioner-provider discussions and to
create a culture of continuous quality improvement, with goals that are agreed as part of
annual contracts.
Bridgewater Quality Account 2014/15
17
Further details regarding the agreed goals for 2014/15 and for the following 12 month period
is available electronically at www.bridgewater.nhs.uk/aboutus/foi/cquin/
During 2014/15 the Trust attracted 2.5% of our contract value as CQUIN payments. The total
payment available within the CQUIN framework during the period was £2907k.
The monetary total for the associated payment in 2013/14 was £2948k.
What others say about the Provider - Statements from the CQC
Bridgewater Community Healthcare NHS Foundation Trust is required to register with the
Care Quality Commission and its current registration status is full and unconditional
registration.
The Care Quality Commission has not taken enforcement action against Bridgewater
Community Healthcare NHS Foundation Trust during 2014/15.
Bridgewater Community Healthcare NHS Foundation Trust has not participated in any special
reviews or investigations by the CQC during the reporting period.
NHS Number and General Medical Practice Code Validity
Bridgewater Community Healthcare NHS Foundation 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:
• 99.9% for outpatient care
• 98.5% for accident and emergency care
The percentage of records in the published data which included the patient’s valid General
Medical Practice code was:
• 97.4% for outpatient care
• 98.5% for accident and emergency care
Information Governance Toolkit Attainment Levels
The Information Governance Toolkit (IGT) provides an overall measure of the data quality
systems, standards and processes. The score a trust receives is therefore indicative of how
well that trust has followed guidance and good practice. An audit was conducted by
Mersey Internal Audit Agency (MIAA) during January/February 2015 to evaluate and validate
the Trust’s self-assessed scores. The final report from MIAA granted the Trust ‘significant
assurance’.
Bridgewater Community Healthcare NHS Foundation Trust Information Governance
Assessment Report overall score for 2014/15 was 66% and was graded green and validated
as satisfactory.
Bridgewater Quality Account 2014/15
18
Clinical Coding Error Rate
Bridgewater Community Healthcare NHS Foundation Trust was not subject to the payment by
results clinical coding audit during 2014/15 by the Audit Commission.
Statement on Relevance of Data Quality and your actions to
improve your Data Quality
Bridgewater Community Healthcare NHS Foundation Trust will be taking the following action
to improve data quality.
The Trust recognises the need to ensure that all Trust and clinical decisions are based on
sound data and has a number of controls in place to support the process of ensuring high
quality data.
The Trust has used MIAA to audit performance reporting since May 2011. The overall
objective of the audits is to provide assurance that the Trust has an effective processcontrolled system for performance reporting.
The Trust has implemented its data consistency programme that aims to ensure a consistent
One Bridgewater approach to recording data across all its boroughs.
A data consistency implementation group is chaired by the Medical Director, who oversees
data consistency progress aligned with service redesign and SystmOne roll-out across the
Trust.
Reporting against Core Indicators
Since 2012/13, NHS Foundation Trusts have been required to report performance against a
core set of indicators. Bridgewater Community Healthcare NHS Foundation Trust is able to
provide data related to the following relevant indicators.
Core Indicator
The percentage of patients aged 16 or
over, that were readmitted to a hospital
which forms part of the Trust within
28 days of being discharged from a
hospital which forms part of the Trust
during the reporting.
2014/15
2%
2013/14
0.3%
There were 343 discharges and 7
readmissions within 28 days
There were 367 discharges and 1
readmission within 28 days
NB – The above figures relate to Newton Community Hospital which is an intermediate care
facility and only admits patients aged 18 or over. Therefore, direct comparison with the
national comparative data below is not possible.
The National average for Emergency 28 day Readmissions for patients over 16 years of age
for the 2011/12 reporting period (latest available data) is 11.08% and the North West average
is 13.02%.
Bridgewater Quality Account 2014/15
19
Bridgewater Community Healthcare NHS Foundation Trust considers that this data is as
described for the following reasons;
Days to readmission back into Newton Community
Hospital
16
1
5
1
23
4
22
Reason
1 x Fall
Reduced mobility
Chest infection
Patient unable to cope at home
Chest Pain
Reduced Mobility
Reduced Mobility
Bridgewater Community Healthcare NHS Foundation Trust has taken the following actions to
improve this number, and so the quality of its services, by:
• Continuation of the two week Outreach Service to provide support to patients in their
own homes
• Commencement of daily Multidisciplinary (MDT) Team Planning Meetings
• Commencement of three x weekly MDT ward rounds
• Commencement of local team analysis of readmissions to enable learning and
improvement
Core Indicator
% of staff that would
recommend the Trust
to friends and family in
need of treatment. (Q12d
NHS Staff Survey)
% of staff that would
recommend the Trust to
friends and family as a
place to work.
(Q12c NHS Staff Survey)
Bridgewater
2013
Bridgewater
2014
National
Average for
Community
Trusts
Highest
Community
Trust
Lowest
Community
Trust
65%
70%
70%
83%
62%
47%
49%
53%
73%
41%
The Bridgewater Community Healthcare NHS Foundation Trust considers that this data is as
described for the following reasons:
• There have been major organisational changes affecting staff during 2013 and 2014.
It is recognised that change of this nature and scale can affect staff morale and their
perceptions of the organisation. Work has been on-going during 2014 to try to
improve this and there has been a slight improvement in the score to reflect this.
Bridgewater Quality Account 2014/15
20
The Bridgewater Community Healthcare NHS Foundation Trust intends to take the
following actions to improve this score, and so the quality of its services by:
• Recognising that there is a slight improvement in this result and continuing to work
towards improving this score by proactively monitoring the staff survey action plans
that will be developed with staff involvement and focusing on the results of the
quarterly family and friends survey results.
• Various initiatives have been put into place to work further on staff engagement and
these include: updating the intranet site, Director Walkabouts, Professional Forums,
Chief Executives Blog, Team Brief and Trust Bulletin, Star of the Month, Annual Staff
Awards and “you said, we did…..are doing” cascades.
Core Indicator
Percentage of patients who were
admitted to hospital (Newton Hospital
only) and who were risk assessed for
venous thromboembolism during the
reporting period.
VTE Screening Performance
Bridgewater Average Full Year
National Average All Trust
(April 2014 - Jan 2015)
Greater Area Manchester Team
(April 2014 - Jan 2015)
Community Trust All
(April 2014 - Jan 2015)
2014/15
2013/14
98.75%
99.46%
Average % of VTE
Patients Screened
99.64%
Lowest Performance %
Highest Performance %
94.40%
100%
96.09%
87.42%
100%
96.17%
93.68%
100%
98.53%
95.14%
100%
(NB – the data in the above table from UNIFY2 relates to both Newton Hospital and our
intermediate care service in Padgate House. Therefore a direct comparison is not possible.
The table has been added to provide indicative data regarding the national average and the
highest and lowest scores for this core indicator).
Bridgewater Community Healthcare NHS Foundation Trust considers that this data is as
described for the following reasons;
• Four patients were not risk assessed;
• Three patients were readmitted into the acute hospital within 24 hours
• One patient died within 24 hours of admission.
Bridgewater Quality Account 2014/15
21
Bridgewater Community Healthcare NHS Foundation Trust has taken the following actions to
improve this percentage, and so the quality of its services, by ensuring that all patients are
risk assessed and appropriate actions/treatment for all patients within 24 hours of admission
are completed where their length of stay is longer than 24 hours.
Core Indicator
The number and, where available,
rate of patient safety incidents
reported within the trust during
2014/15, and the number and
percentage of such patient safety
incidents that resulted in severe
harm or death
The number and, where
available, rate of patient
safety incidents reported
within the trust during
2014/15
The number and
percentage of such
patient safety incidents
that resulted in severe
harm or death
2014/15
3963 incidents reported
of which 1323 (33%) were
submitted to the NRLS as
patient safety incidents
2013/14
4655 incidents reported
of which 1088 (23%) were
submitted to the NRLS as
patient safety incidents
There were 24 incidents
resulting in severe harm
or death, 13 (0.98%) of
which met the criteria for a
patient safety incident
There were 16 incidents
resulting in severe harm
or death, 7 (0.64%) of
which met the criteria for a
patient safety incident
Please see additional information provided in the incident reporting section of this account
regarding the national average, highest and lowest comparative figures from the National
Reporting and Learning Service (NRLS).
The Trust considers that this data is as described for the following reasons, compared to
2013/14: • Incident reporting volumes have decreased by 716 (15%) due to a correction in the
reporting of non-patient safety incidents during 2014/15, please see the Incident
Reporting section for further detail
• The volume of patient safety incidents has increased by 151 (13%) due to closer scrutiny
and more accurate reporting, of these,
• The ratio of No Harm incidents (near miss, insignificant outcomes) increased by
195 (49%) through better recording
• There was an increase of 26 (48%) serious untoward incidents identified
The Trust has maintained or initiated the following actions to improve the collection and
accuracy of this data and indicators, and so the quality of its services, by:
• Increased staff training in root cause analysis documentation and techniques, incident
management and risk assessment
• Routine scrutiny of incidents on a daily and weekly basis by the risk team and senior
clinicians that increases data quality and accuracy
• Increasing the timeliness of risk and incident reported to the Quality Management Group
to discuss and agree service change
• Improving internal incident reports for the re-structured clinical directorates
Bridgewater Quality Account 2014/15
22
Monitor Compliance / Monitor Risk Assessment Framework
Due to Bridgewater achieving Foundation Trust status on 1st November 2014, the on-going
Trust Development Agency Oversight self-certification and monthly declarations ceased in
September 2014.
Monitor expects NHS Foundation Trusts to establish and effectively implement systems and
processes to ensure that they can meet national standards for access to health care services.
Monitor incorporated performance against a number of these standards in their assessment
of the overall governance of Bridgewater going forward as a Foundation Trust.
Performance against the relevant indicators and performance thresholds is set out on next
page.
Bridgewater Quality Account 2014/15
23
Access
90%
95%
92%
95%
85%
94%
96%
93%
12
N/A
50%
50%
50%
Maximum time 18 weeks from point of referral to
treatment in aggregate - admitted
Maximum time 18 weeks from point of referral to
treatment in aggregate - non - admitted
Maximum time 18 weeks from point of referral to
treatment in aggregate - patient on an incomplete
pathway
A&E maximum waiting time of four hours from
arrival to admission/transfer/discharge
All cancers: 62 day wait for first treatment from
urgent GP referral for suspected cancer
All cancers: 31 day wait for a second or
subsequent treatment, comprising: Surgery
All cancers: 31 day wait from diagnosis to first
treatment
Cancer: two weeks wait from referral to date
first seen, comprising all urgent referrals
(cancer suspected)
Clostridium (C) difficile - meeting the
C. difficile objective
Certification against compliance regarding access
to health care for people with a learning disability
Data completeness: community services,
comprising: Referral to treatment information
Data completeness: community services,
after comprising Referral information
Data completeness: community services, comprising:
Treatment activity information
2
3
4
5
6
7
8
14
18
19
Threshold or
target YTD
1
Access and Outcomes Metrics 2014/15
(per Risk Assessment framework)
Scoring
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
Achieved
Achieved
Achieved
Achieved
Achieved
Achieved
Not Met
Achieved
Achieved
Achieved
Achieved
Achieved
Not
relevant
Current Month
Achieved
/Not Met
99.16%
94.34%
100.00%
Achieved
0.0
100.00%
100.00%
100.00%
100.00%
99.93%
98.20%
98.40%
Apr-14
99.19%
94.40%
100.00%
Achieved
0.0
100.00%
91.00%
100.00%
100.00%
99.89%
97.10%
95.50%
May-14
99.21%
94.96%
100.00%
Achieved
0.0
99.15%
100.00%
100.00%
100.00%
99.71%
99.80%
98.00%
Jun-14
99.24%
95.04%
100.00%
Achieved
0.0
97.16%
100.00%
100.00%
100.00%
99.79%
99.50%
98.70%
Jul-14
99.17%
95.22%
100.00%
Achieved
0.0
99.17%
100.00%
100.00%
100.00%
99.96%
98.60%
99.00%
Aug-14
99.23%
95.53%
100.00%
Achieved
0.0
100.00%
100.00%
100.00%
100.00%
99.91%
98.90%
97.20%
Sep-14
99.24%
95.54%
100.00%
Achieved
0.0
100.00%
100.00%
100.00%
100.00%
99.86%
98.30%
98.20%
Oct-14
*Where the Trust fails any one month during the quarter, the Trust is required to enter the lowest monthly figure (not the average) and the target is failed.
Outcomes
Bridgewater Quality Account 2014/15
24
99.20%
95.05%
100.00%
Achieved
1.0
100.00%
100.00%
100.00%
100.00%
99.90%
98.40%
95.90%
Nov-14
99.16%
94.89%
100.00%
Achieved
0.0
100.00%
100.00%
100.00%
100.00%
99.32%
94.90%
95.90%
Dec-14
99.23%
95.24%
100.00%
Achieved
1.0
100.00%
100.00%
100.00%
100.00%
99.88%
97.70%
95.40%
Jan-15
99.19%
94.99%
100.00%
Achieved
0.0
100.00%
100.00%
100.00%
100.00%
99.95%
99.10%
93.70%
Feb-15
99.23%
95.41%
100.00%
Achieved
0.0
100.00%
100.00%
100.00%
100.00%
99.83%
99.40%
98.70%
Mar-15
Quality of Services in 2014/15
Trust Quality Measures
During 2014/15 the following Quality Measures were agreed.
The measures were chosen to reflect patient safety, patient experience and clinical
effectiveness, and to demonstrate the quality of care provided by a broad range of our
services.
£
38%
33%
34%
£
80
54
57
£
45%
34%
51%
2
4
2
£
Number of pressure
ulcers which developed
whilst patients were under
our care
Change
2014/15 full 2013/14 full 2012/13 full
compared to
year position year position year position
previous year
£
Indicator to be
measured
0
0
3
Number of serious untoward incidents (SUIs)
Number of reported cases
of Clostridium difficile
Number of reported cases
of MRSA
Ratio of patient falls
(in-patient facilities)
Percentage of patient
facing staff that have been
vaccinated against flu
£
Proportion of incidents
with outcome of “No
Harm “
£
5%
3%
3%
ALW £
Warrington£
Halton &
St Helens£
Dental£
Total£
60%
48%
45%
56%
46%
36%
51%
59%
58%
47%
53%
36%
45%
32%
52%
Comments
V olume of reported
incidents decreased
overall, and the %
ratio of these types of
incidents increased by
comparison
The volume of
reported SUIs
increased by 26 (48%)
with a significant
increase in nonpressure ulcer SUIs i.e.
information governance
breaches and falls
Reported patient
safety incidents
increased by 2%,and
“No Harm” (near miss,
insignificant) outcomes
increased by 11%
NB – the figures
published in last year’s
account included minor
harm
For further
information please see
Clostridium difficile
section
T he overall number
of reported incidents
decreased, and the
ratio of falls increased
by 2%
National average across
all trusts - 54.9%
A vaccination and
immunisation lead post
is to be appointed to
lead the delivery of and
operationally manage
the flu immunisation
programme
Bridgewater Quality Account 2014/15
25
Indicator to be measured
Change
compared to
previous year
2014/15 full
2013/14 full 2012/13 full
year
year position year position
position
Staff who would
recommend our services to
friends and family
£
3.55
3.48
(reported last
year as 3.47)
3.58
Percentage of patients
indicating they had a good
overall
experience
£
99%
98%
Figure not
collected in
2012/13
Number of complaints
£
91
88
125
Warrington£
97%
95%
97%
ALW £
87%
86%
Halton
81%
Not
available
St Helens
95%
End of life – Percentage
of patients being cared for
in their Preferred Place of
Care (PPC)
Bridgewater Quality Account 2014/15
26
Comments
T he minimum score is
1 and the
maximum score is 5.
For further
information please see
section on
Statutory Quality
Indicators and
Statements
For further
information please
refer to patient survey
and Friends and
Family Test results
sections of this
account
shton Leigh Wigan
A
data on PPC was not
routinely collated prior
to 13/14.
During 2013/14 Halton
& St Helens jointly
monitored whether
a PPC assessment
had been completed
(93.5%).
During 2014/15 a
standardised approach
has been introduced
to monitoring clinical
standards in end of
life care delivery in
all boroughs. Within
Halton and St Helens
this process has been
introduced from
September 2014 and
we are working
towards embedding
this within teams to
ensure the quality
of the data. During
2015/16 we will begin
to evaluate the data to
highlight areas we can
develop and improve.
Indicator to be measured
Percentage of
immunisations delivered
on schedule for children
reaching their 2nd birthday
Change
compared to
previous year
2014/15 full
2013/14 full 2012/13 full
year
year position year position
position
Please see appendix A
Diphtheria
Tetanus
Whooping cough
polio
Hib
Meningitis C
Pneumococcal
MMR
Percentage of admitted
patients that have been risk
assessed for VTE (Newton
Hospital)
98.75%
99.46%
Figures not
collected in
2012/13
£
Number of patients
re-entering the service
within 30 days (Newton
Hospital only)
£
Comments
7
1
Figures not
collected in
2012/13
Four patients were not
risk assessed;
• three patients
were readmitted
into the acute
hospital within 24
hours
• one patient died
within 24 hours
of admission.
Of the 7 patients
readmitted within
28 days to Newton
1 patient had a fall,
2 had a decline in
medical condition, 1
not coping at home
and 3 patients mobility
deteriorated further
following discharge.
They were readmitted
back into Newton
Community Hospital
which avoided
admission into an
acute hospital bed
Bridgewater Quality Account 2014/15
27
Patient Experience
The Trust recognises that eliciting, measuring and acting upon patient feedback is a key
driver of quality and service improvement. The Trust has a Patient Charter outlining what
people should expect from Bridgewater services and who to contact if they do not meet
those standards. The Trust uses a range of methods to seek patient feedback including the
use of patient stories, patient surveys, which include the Friends and Family question and
the use of Patient Partners, as a way of involving the people who actually use the services.
All feedback is closely monitored with any lessons learned identified and cascaded across
the organisation.
Patient Story
A patient story is presented to the Board each month. This is a compelling way of illustrating
the patient’s experience and enables the Board to gain a meaningful understanding of how
people feel about using our services.
Lessons learned from each story are identified and action plans are developed and
monitored monthly to ensure that quality and service experience issues are acted on and
lessons learned across the whole Trust.
Some examples of patient stories during the year include:
• Adult Continence Service
How the service supported a patient to use a range of products and equipment which
fitted-in with their life style and has given them confidence when on holidays abroad, using
trains, and going to the theatre.
• Adult Learning Disability Service
How the service supported a patient living alone with a history of diabetes, no social care
provision and who had not attended for a check-up at his GP surgery for over 3 years. Patient
was unable to read letters from healthcare providers and therefore was not able to access
appropriate services. The service supported him to identify and understand his needs and
ensured information was accessible in easy read/pictorial letters.
• Health Visiting Service
How a mother was involved in the service as a Parent Partner to share her experience of the
service in order to ensure the service was continually improving and meeting the needs of
patients.
• Augmentative and Alternative Communication Network
A remarkable story about a patient with cerebral palsy, who helped develop a communication
tool to enable them to communicate.
The patient uses Alternative and Augmentative Communication (A.A.C.) and would like to be
a role model for new users and anxious parents.
Bridgewater Quality Account 2014/15
28
Patient Survey and Friends and Family Test Result
Bridgewater has developed a ‘Talk to Us…’ form to seek patient feedback. This includes the
Friends and Family Test (FFT), which became mandatory for all Community Trusts from
January 2015, as well as a number of questions which aim to ascertain how people feel
about accessing Bridgewater services.
The FFT 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.
Although the FFT only became mandatory for all Trusts from January 2015, this has been
implemented across Bridgewater since 2013 and during the year, a total of 22,613 people
responded to the FFT question. The way the FFT is reported has changed during the year
and the results are now shown as a percentage of people who would recommend the service
and those who would not. The results from October 2014, when the new system of analysing
the results was introduced, are shown below.
Borough/Service
Dental Services
Halton
St Helens
Warrington
Wigan
Number of
Responses
493
1526
1371
819
1997
Quarter 3
Would
Recommend
99%
97%
97%
98%
96%
Would NOT
Recommend
1.1%
0.5%
1%
0.5%
0.4%
Number of
Responses
454
1226
2482
1342
3506
Quarter 4
Would
Recommend
99%
98%
96%
98%
96%
Would NOT
Recommend
0.5%
0.6%
0.3%
0.3%
0.8%
The survey results from the follow up questions show that 24,820 people have responded to
the questionnaires since April 2014 and 99% have expressed overall satisfaction with their
care and treatment.
Patient Partners
Patient Partners is a Bridgewater initiative to showcase how to actively involve patients and
carers to work with staff to identify areas for improvement in quality of care and service
delivery.
Over 190 Patient Partners are actively involved in working with the services to identify and
implement service improvements. The services working with Patient Partners include:
• Adult Speech and Language Therapy (Halton).
• Changes include the development of a ‘Loud treatment group’ to be set up to
support intensive, evidence based therapy for speech difficulties for people with
Parkinson’s Disease.
• Dermatology (Wigan)
• Eczema Expert - Patient Partners within focus groups supported the development
of a Top Tips sheet for emollient and steroid use within the Eczema Expert pack
and continue to provide feedback to support development.
Bridgewater Quality Account 2014/15
29
• Heart Failure Nurse Specialist Healthy Heart Service (Halton and St Helens)
• Capturing patient stories on their journey through the service, including ease of
access to the service, the quality of the information provided and what we could
do to improve the service.
• School Health (Warrington)
• Capturing the views of children and young people who have asthma, about their
experiences and how the services could help them understand and manage their
condition.
Patient Advice and Liaison Service
We recognise that when people have issues or concerns with our services we should aim to
resolve these as quickly as possible. Bridgewater provides a single free phone number for
people to contact for advice and information or to help resolve their issues and
concerns.
During 2014/15 we received 1440 contacts across Bridgewater, as summarised below.
Corporate
Dental
Halton
St Helens
Warrington
Wigan
Willaston
Total
Quarter 1
2
11
48
50
94
151
0
356
Quarter 2
0
12
64
46
95
164
1
382
Quarter 3
3
8
48
45
95
122
0
321
Quarter 4
4
14
56
50
101
153
3
381
Total
9
45
216
191
385
590
4
1440
Around 51% of the contacts were requests for advice and information, including signposting
to other organisations.
Almost 49% of the contacts resulted in the department liaising between the enquirer and the
service to resolve issues and concerns. Examples of the issues raised include appointment
delay/cancellation and staff attitudes.
Only 8 of the 1440 contacts went on to become formal complaints.
Bridgewater Quality Account 2014/15
30
Complaints
We aim to learn from complaints as part of improving our patients’ experience.
During 2014/15 we received 91 complaints compared to 88 during the previous year. These
are summarised on a Borough/Service basis below:
Number of
Complaints
Dental
Halton
St Helens
Warrington
Wigan
Willaston
Total
5
19
18
21
25
3
91
The complaints were divided across a range of issues. The themes are summarised in the
table below:
Theme of complaint
Number
Aspects of clinical treatment
62
Attitude of staff
13
Aids and appliances, equipment, premises
5
Appointments, delay/cancellation (outpatient)
4
Failure to follow agreed procedures
4
Admissions, discharge and transfer arrangements
2
Patients’ privacy and dignity
1
Total
91
Every complaint received is investigated to understand fully what has happened and to seek
out the lessons that can be learned. All lessons learned are discussed with the service leads
at the lessons learned group and cascaded via Team Brief.
Some examples of lessons learned include:
•
•
Ear Care Service – All ear care patients to be provided with written information
outlining potential side effects. This will be recorded on SystmOne when the
information leaflet has been posted with appointment.
Walk-in Centre (WIC) – a concern was raised as to whether it is normal policy to
refuse treatment based on the fact the night had been busy, the conduct of the nurse
who saw the child and the notes that were put on her clinical records.
• Closing procedure for WIC to be reviewed to ensure it supports the decision
making process for patients attending at the end of the day.
• Customer Care training initiated for all patient facing staff.
• Dental Services – Following a complaint about staff attitude and the lack of care and
treatment received from a particular dentist in one of our community dental services.
• E-learning package purchased from the National Autistic Society to enable dental
staff to understand the effects of autism in dental health and treatment.
• The package will be shared with the Learning and Development Team to be
accessible to all services.
Bridgewater Quality Account 2014/15
31
Staff Engagement, Health & Wellbeing
Our key priorities for 2014/15 were to:
•
•
•
•
•
•
Improve on the national NHS Staff Survey results
Improve the national NHS Staff Survey ‘Engagement‘ score
Improve the national NHS Staff Survey score for Staff recommending the Trust as a place to work and receive treatment
Increase the Personal Development Review rate (Staff appraisal)
Reduce sickness absence rates against a Trust target of 3.78%
Achieve Trust target of a rolling 8% for staff turnover.
Staff Engagement
The Trust promotes effective employee engagement to create a motivated and valued
workforce which ultimately leads to better patient care and service experience. Engagement,
consultation and ensuring effective communications with our staff is of paramount
importance. During the past 12 months we have continued to improved our methods of
communication, involvement and engagement with staff to enable them to understand the
aims and objectives of the Trust, its mission, vision and values.
The key performance indicators have helped the Trust to measure, and will continue to help
measure the quality of staff experience. Data relating to workforce indicators are reported to
the Trust Board as are the annual national NHS staff survey results.
We enjoy effective partnership working with our Trade Unions and Staff-side colleagues and
believe this is critical to our success.
We have various information and communication channels, engagement systems,
programmes and initiatives which include, but are not limited to:
• A monthly Team Brief cascade led by the Chief Executive and Executive Team. The
Brief is cascaded by managers across the whole organisation within seven days
• A weekly Trust Bulletin 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 able to contribute to the content of the
Bulletin, put questions to the Trust’s communications team and partake in research
programmes and promote the good work of their services as per its regular ‘Spotlight
on Services’ feature
• A “Star of the Month 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. Awards are presented by the Chief Executive and publicised in the
Bridgewater Bulletin, Trust Intranet and website
• Trust wide Staff Awards were held in March 2015. There were six Awards categories:
• Clinical Employee of the Year
• Non-Clinical Employee of the Year
• Team of the Year
• Outstanding Contribution to Innovation
• Patient Choice Award – nominated by our Patients/Members
• Chairman’s Award for Lifetime Achievement
Bridgewater Quality Account 2014/15
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• The Chief Executive’s Blog is featured in the Trust Bulletin and also accessible to staff
via the Trust’s Intranet
• The Trust Intranet keeps staff updated with current information on the organisation;
what is happening within the Trust, its services, organisational change, developments,
initiatives, innovation and improvements
• Director Walk-abouts enable staff to meet members the executive team to discuss the
quality of services they delivery and listen to their views, ideas and what it is like to
work for the Trust
• Professional Forums, which are made up of clinical staff, include presentations and
workshops on national, regional and local issues and initiatives, best practice and
networking opportunities
• The Productive Community Services Programme enables staff to share their
experiences of service improvements and developments. Staff have and are adjusting
to new ways of working. Staff who have undergone modules have reported much
improved working environments, increased face-to-face contact time with patients
and less time spent on administration tasks due to system and process
improvements, enabling more time to deliver patient care.
NHS Staff Survey 2014
Working with staff to understand key messages from the staff survey
The Trust takes part in the national annual NHS staff survey. As well as providing us with
feedback on how we are doing and how staff are feeling in relation to 29 ‘Key Findings’, we
are provided with a national ‘staff engagement’ score. Our 2014 score slightly improved in
comparison to 2013 from 3.61 to 3.67. The scoring system is a scale of 1 to 5 with 1 being
‘strongly disagree’ and 5 ‘strongly agree’.
The overall indicator of staff engagement is calculated using the following ‘Key Findings’
questions:
• KF22: Staff ability to contribute towards improvement in work
• KF24: Staff recommendation of the Trust as a place to work or receive treatment
• KF25: Staff motivation at work
To ensure that we continue to listen to our staff and acknowledge the important feedback we
get from our survey, we develop action plans to inform us of our key priorities and areas for
further developments and continuous improvements. The action plan is and will continue to
be managed through formal management meetings where performance reviews take place.
Action plans and progress against the same are shared with our Staff-side colleagues at our
partnership working groups.
As part of our response to the staff survey to enable staff to see how we are responding to
their feedback, we have developed the “Listening to You” approach…”You said, we did…
are doing” cascades. Year on year we ensure that we measure the changes identified in the
staff survey as it provides a structured, evidence based way for us to engage with staff and
respond to their feedback. We have also introduced ‘Chris’ Clinic’ which gives direct access
to the Trust’s Director of People, Planning and Development on a weekly basis, enabling an
opportunity for staff to ask questions or raise issues on an individual basis.
Bridgewater Quality Account 2014/15
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We have a quarterly staff friends and family test which is focussed on areas of the national
staff survey, enabling us to monitor our progress throughout the year.
The staff survey results provide us with our top five and bottom five ranking scores:
Top 5 Ranking Scores - The five areas for which the Trust compares most favourably with
other Community Trusts in England are:
• KF17: Percentage of staff experiencing physical violence from staff in last 12 months
• KF27: Percentage of staff believing the trust provides equal opportunities for career
progression or promotion
• KF19: Percentage of staff experiencing harassment, bullying or abuse from staff in last
12 months
• KF16: Percentage of staff experiencing physical violence from patients, relatives or the
public in the last 12 months
• KF12: Percentage of staff witnessing potentially harmful errors, near misses or
incidents in last month.
Bottom 5 Ranking Scores - The five areas for which the Trust compares least favourably with
other Community Trusts in England are:
• KF2: Percentage of staff agreeing that their role makes a difference to patients
• KF29: Percentage of staff agreeing that feedback from patients / service users is used
to make informed decisions in their directorate / department
• KF8: Percentage of staff having well-structured appraisals in last 12 months
• KF21: Percentage of staff reporting good communication between senior
management and staff
• KF15: Percentage of staff agreeing that they would feel secure raising concerns about
unsafe clinical practice
Although we saw a deterioration in 11 of our ‘Key Findings’ in comparison to the 2013 with
the exception of KF7: Percentage of staff appraised in the last 12 months, staff survey
results were not statistically significant. There has also been an improvement in scores on
16 of the Key Findings from 2013 to 2014. None of the scores in which there has been an
improvement are statistically significant. This was welcoming for the Trust in light of the major
organisational changes affecting staff. Improving on the staff survey results will remain a key
priority through our action plans and focus groups.
Staff Health & Wellbeing
We continue in our commitment to reduce sickness absence through effective management
and support from Occupational Health and the Trust’s Human Resources team. A healthy
motivated workforce is integral to achieving better care for our patients. We have an
occupational health service which provides staff with:
• Telephone and face to face counselling services
• Physiotherapy services
• Occupational health referral and assessment services, including speedy referrals for
mental health and muscular-skeletal disorders.
Bridgewater Quality Account 2014/15
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Our Occupational Health Service provides us with information that helps us identify areas of
staff health and wellbeing that may require more attention, such as issues of personal and
workplace stress. The introduction of online occupational health referrals has enabled more
timely referrals and feedback on medical assessments / opinions.
The Trust recognises that any adverse impact on staff that affects their ability to function at
their best in the workplace needs active steps to provide support and take a preventative
stance where possible. The Trust will be recruiting a member of staff to support the
managing and handling of staff health and wellbeing.
The Trust’s sickness absence target is 3.78%. The absence rate at the end of March 2015
was 5.68% in comparison to 4.90% at the end of March 2014.
Management are provided with monthly absence reports which enable them to monitor
absence in line with the Trust’s policies and procedures. Absence rates are monitored
monthly by the Trust Board.
Personal Development Reviews (PDRs)
We continue to provide opportunities for our staff to develop via a ‘values’ driven personal
development review to ensure they can continue to meet the needs of our aims, objectives
and patients.
The Trust’s focus on PDRs has been captured within the 2014 NHS Staff Survey in which 85%
of respondents confirmed that they had been appraised in the last 12 months. This is the
survey’s ‘Key Findings’ for which the Trust has had a significant reduction since 2013 when
94% of staff confirmed they had been appraised.
Directorate
Percentage of Staff Compliance
Adult Services
96.99%
Children’s Services
91.32%
Corporate Service
49.66%
Specialist Services
96.71%
BRIDGEWATER
91.15%
Concerted efforts will be focused into ensuring that staff have an annual PDR. Managers
now complete and return monthly compliance reports which enable senior managers to
review PDR take up, compliance and non-compliance by way of individual staff members
within their Teams. To ensure PDRs are meaningful, we will be focussing on improving our
bottom five ranking staff survey scores.
Staff Turnover
The rolling staff turnover for the Trust as at 31 March 2015 was 14.07%. This is above the
Trust target of 8% however during a time of organisational change and continuing cost
improvement programmes this is not necessarily unexpected or a cause for concern. Work
is on-going around staff engagement and any particular issues should be identified during
this stream of work.
Bridgewater Quality Account 2014/15
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Responsible Officer Compliance
The introduction of Medical Revalidation in December 2012 has reinforced the
interdependent responsibilities of healthcare organisations and individual professionals
around patient safety and good medical practice. Medical revalidation has placed new
statutory duties on organisations and individuals, to ensure that doctors are practising in well
structured, managed and governed systems.
Through utilising PREM IT electronic appraisal system, Bridgewater is supporting the
evaluation of our doctors’ fitness to practise in a fair and consistent way. Currently we are
100% compliant with our appraisals returns. The next step is to establish a reporting process
that will not only evidence our compliance, but also provide assurance at Board Level that
our medical professionals are operating safely and providing good medical care.
Education & Professional Development
The primary aim of the Education and Professional Development (EPD) Service is to support
all health care staff within Bridgewater to have up to date, evidence based knowledge, skills
and abilities in order to ensure that they can provide safe, effective and compassionate care.
Mandatory Training
During 2014/15 substantial work has been undertaken to review the mandatory training and
induction programmes. This has involved consideration of a new eLearning platform and
alignment to national and local agendas.
Continuing Professional Development
Continuing Professional Development (CPD) is fundamental to the advancement of all staff
and is the mechanism through which high quality care is identified and maintained (DH
2014). The EPD service has continued to support all staff to further develop their knowledge,
skills, practical experience and competencies. This is achieved by completion of an annual
Training Needs Analysis which is based on both individual learning and development needs,
identified through Personal Development Review, and the Commissioned Service delivery.
This ensures that staff have the right skills to deliver a high quality service to meet the
identified needs of the population they serve. In 2014/15 training has been provided on a
variety of topics including:
• Clinical skills
• Coaching and Mentoring
• Communication and Difficult Conversations
• Leadership and Management
• Record Keeping
In addition, we continue to support and fund staff to attend external learning and
development opportunities and to access academic modules on a wide range of subjects for
example:
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• Advanced Clinical Skills
• Apprenticeship frameworks, vocational qualifications and cadet programmes
• Public Health
• Prevention and Early Intervention
•Research
Educational Governance and internal Quality Assurance processes are in place and aligned
to the Education Outcomes Framework (DH 2013). This guarantees continual improvement
of the training provided and that it matches the expectations of the public, staff, employers,
healthcare professional bodies and, if appropriate, statutory requirements.
Competence Frameworks
A Competence Development Group was established in early 2014 to support the
development of competence frameworks for all grades of patient facing staff. These are
currently being piloted within several of our services and will be evaluated prior to Trust wide
implementation. This will support continuous assessment and on-going development of staff
and provide assurance on the skills, competence, attitudes and behaviours of our staff.
The Trust has also taken an active role as a member of the North West Steering Group in the
development and testing of the Care Certificate Framework; in response to the
recommendations of the 2013 Cavendish Report. The Care Certificate covers 15 standards
that set out the learning outcomes, competences and standards of behaviour expected of
all healthcare support workers to ensure that they are caring, compassionate and provide
quality care. As a result of the feedback received from the Trusts involved in the development
and testing, the Care Certificate was formally launched in April 2015 and is currently being
implemented by all health and social care organisations in England.
Pre-Registration
The development of future healthcare professionals is at the very heart of our education and
professional development offer. A dedicated team of practice education facilitators work in
partnership with our clinical staff and services and with our partner universities to ensure the
maintenance of high quality educational placements and positive learning experiences. The
team also supports practice education through the on-going development and maintenance
of our qualified mentors and educators. The Trust is able to offer students the opportunity
to undertake placements in a diverse range of clinical services and in integrated health and
social care settings. This prepares our future practitioners to respond to the needs of our
current and future population as health and social care continues to transform and develop.
Forward Planning
In 2015/16, we will continue to develop the Professional Development Support Framework to
underpin education provision with a particular focus on revalidation to include accountability,
clinical supervision and action learning sets. In addition, we plan to further affirm our
commitment to the development of our future workforce through wider access to work
experience programmes and through the development of placements to support
undergraduate medical students.
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Leadership Programme and the Bridgewater Quality Improvement Programme
Bridgewater’s Quality Improvement Programme has been established to support the culture
of continual improvement within the Trust. Bridgewater has worked in close collaboration with
the Advancing Quality Alliance (AQuA) to research, design and deliver a bespoke
improvement course. Course participants focus on improving clinical outcomes for our
patients through increasing capability and flexibility within the workforce.
The first cohort of band 6-8 staff commenced in January 2014, the second programme
commenced in September 2014 and the third programme is due to commence in May 2015.
The style of learning is interactive and uses the knowledge and expertise of the course
participants throughout the three modules, which cover an introduction to quality
improvement and quality improvement tools, an introduction to Lean and the human
dimensions of change.
The tools and techniques used throughout include the latest principles from both industry
and healthcare.
The modules are designed to equip participants with transferable knowledge and to be able
to share their learning within the workplace.
The course requires completion of a work based project and examples of the projects are
included below:
• How we best utilise the skills of therapy assistants (redesign of role to increase
capacity and skill mix capability in the team).
• Speech and Language Therapy – social marketing – understand the needs of local
schools and what will improve our relationships.
• FallSafe programme with ward staff to reduce incidence of inappropriate falls for bed
based services.
• Review inappropriate referrals with integrated community discharge planning team,
collaboration between community and acute trust.
• Review and redesign role of health care assistant to become more involved in the
care of patients at the Walk in Centres.
Library Strategy
Bridgewater Library and Knowledge Service (LKS) has continued to develop in line with its
strategic plans for 2012-15. As a result we scored 87% in the 2014-15 annual quality
assurance process (LQAF), which measures NHS libraries’ performance nationally. This is a
further improvement on previous scores and brings us in line with other Trusts in the
Northwest.
In February 2015, a new national strategy for NHS Library and Knowledge Services was
published. Entitled “Knowledge for Healthcare: a framework for NHS library and knowledge
services in England 2015 – 2020”, the national strategy sets out the strategic intentions for all
Bridgewater Quality Account 2014/15
38
NHS library services up to 2020. The Bridgewater LKS response has been to revise and
update our local strategy in line with national expectations. The Bridgewater strategy for
2015-18 focusses on the consolidation of achievements to-date and ensures that LKS
services are equally available to Bridgewater staff irrespective of their location. As a
community trust with a wide geographic spread, we rely heavily on information technology to
deliver evidence in electronic form. In 2014-15, Bridgewater staff and students logged in to
databases 1571 times using OpenAthens authentication. This is an increase from 785
accesses in 2013-14.
Equality, Diversity and Inclusion
The reduction of health inequalities is a fundamental part of the framework within which all
NHS organisations operate. The Health and Social Care Act 2012, the NHS Constitution, the
NHS Outcomes Framework and the Five Year Forward View all set out the commitment to
reduce health inequalities and improve healthy life expectancy. The first two CQC
Fundamental Standards, (Person Centred Care and Dignity and Respect), also reiterate the
commitment nationally to provide a healthcare service that is equitable in access and
outcomes for all members of our society. These national strategies, the Equality Act 2010 and
the Human Rights Act 1998 provide the legal framework within which the Trust operates its
equality governance.
In order to demonstrate compliance with the Equality Act the Trust uses the national NHS
Equality Delivery System (EDS2) to assess and grade performance on 18 outcomes across
four goals – two patient centred and two staff and management centred. Using the
information gathered in the completion of the annual Public Sector Equality Duty report, the
EDS2 process and the equality analysis of services the Trust determines actions for the
coming year(s).
At Board level, responsibility for equality diversity and inclusion sits with the Director of
People, Planning and Development. The Head of Health Inequalities and Inclusion ensures
that the Trust is meeting its legal responsibilities and provides strategic direction in relation to
equality and health inclusion. The Equality and Human Rights Project Officer works with
services to provide guidance and support on equality and diversity issues. The Trust’s
Equality Statement sets out the commitment to equality and inclusion and is supported by
an Equality and Health Inequalities Action Plan. Board assurance on the fulfilment of equality
goals and objectives is provided by the Quality and Safety Committee who review the actions
of the Health Inequalities and Inclusion Team and report on a six monthly basis. In addition,
regular updates are provided to the Trust’s commissioners by the team.
The Trust has a network of over 100 personal fair diverse champions who receive regular
updates to cascade to their staff; updates in the last year have included child sexual
exploitation, autism friendly Christmas and stroke awareness.
As a health care provider the Trust requires all services to have a completed an equality
analysis.
The Health Inequalities and Inclusion Team plans for 2015/16 include the signing of British
Deaf Association BSL Charter, the production of reasonable adjustments guidance for Trust
staff, the production of religion and belief guidance for staff, the start of a rolling programme
of access audits of Trust services, a review of language interpretation and translation
Bridgewater Quality Account 2014/15
39
provision, further awareness raising through the personal fair diverse Trust champions and
submission to Stonewall Workplace Equality Index. In addition the Trust will be reporting on
the key indicators in the new NHS Workforce Race Equality Standard.
Detailed Trust equality information such as our Public Sector Equality Duty reports, our EDS
(and EDS2) grading results and service equality analysis are published on our website
http://www.bridgewater.nhs.uk
Delivering Same Sex Accommodation (DSSA) (Halton,
St Helens and Warrington Boroughs)
Newton Hospital
Every patient has the right to receive high quality care that is safe, effective and respects their
privacy and dignity. Newton Community Hospital (our only inpatient facility) is committed to
providing every patient with same sex accommodation as it helps to safeguard their privacy
and dignity when they are often at their most vulnerable. Other than in exceptional
circumstances, patients admitted to Newton Community Hospital can expect to find the
following standards for the provision of same sex accommodation:
• the room where their bed is will only have patients of the same sex
• the toilet and bathroom will be just for one gender and will be close to the bed area
• patients may share some communal space, such as day rooms or dining rooms
Occasionally, it may not be possible to care for patients in a same sex environment, e.g. in
the case of an emergency or specialist care situation. The clinical (medical) need will take
priority over keeping the patient apart from other patients of the opposite sex.
We can confirm for the period of April 2014 until March 2015 there were no breaches to the
same sex accommodation.
Padgate House
Padgate House is a 35 bedded intermediate care unit based in Warrington. The building is
owned and managed by Warrington Borough Council. The Trust is responsible for the
provision of clinical services. The home has 35 single bedded rooms which are not en-suite.
This ensures that patients never share a bedded area. The building has 14 bathrooms which
are shared by all residents meaning that males and females will share the same facilities
however there are clear engaged signs on doors and doors are lockable from the inside to
maintain patient privacy. Staff are able to unlock doors from the outside should the need
arise to ensure patient safety and were necessary staff will accompany and assist patients
whilst using bathrooms. As Padgate House is not a hospital they are not considered to
breach under the mixed sex accommodation requirements for use of communal bathroom
facilities.
Incident Reporting
The Trust utilised the web-based Ulysses Safeguard Risk Management System for reporting
all actual incidents and near misses, where clinical service delivery or patient safety may
have been compromised.
Bridgewater Quality Account 2014/15
40
There was a decrease in 2014/15 reporting compared to 2013/14 due to more accurate
reporting and changes in service structures during 2014/15. Increasing accuracy of
incident reporting is a positive indication of an open and honest culture that encourages staff
to report incidents.
1400
2013/14
2014/15
1278
1200
1131
1013
1000
1143
1041
1127
993
916
800
600
400
200
0
Quarter 1
Commissioning Borough
ALW
Quarter 3
Quarter 2
Quarter 4
2013/14
2014/15
1304
1173
-131
8
+8
Cheshire*
Variance
-10%
Halton
829
766
-63
-8%
St Helens
1234
1031
-203
-16%
Trafford
30
1
-29
-97%
Warrington
930
761
-169
-18%
Prisons (NHS England)
85
80
-5
-6%
Dental (NHS England)
233
134
-99
-42%
Corporate
34
9
-25
-74%
4679
3963
-716
-15%
Total
*Cheshire Commissioners came online with the introduction of the Willaston Primary Care
Service in July 2014.
Due to weekly and monthly incident data reviews by senior clinicians and managers,
introduced during 2013/14 and maintained during 2014/15, the quality and accuracy of data
has continued to improve during 2014/15. Along with daily checks undertaken by members
of the risk team, this process also ensures that any serious incidents are identified early and
escalated as quickly as possible for management attention.
The ‘Care Indicator Tool for Pressure Ulcers’ demonstrated quarterly improvements in
pressure ulcer management by clinicians and continues to be utilised during 2014/15 to the
benefit of patient outcomes. The added value of this data resulted in improved investigations
and identified gaps for service change, notably, the frequency of review of patient’s pressure
ulcers.
Bridgewater Quality Account 2014/15
41
There were 13 (0.98%) patient safety incidents reported that resulted in major or catastrophic
outcomes. Staff reported 3963 incidents during 2014/15, 1323 (33%) of which were
categorised as incidents or near misses effecting patient safety. These are submitted to the
National Reporting and Learning Service (NRLS), from which the CQC nationally monitors all
Trusts’ patient safety incidents. The following table represents the number of patient safety
incidents reported to the NRLS by level of actual impact.
Patient Safety Incidents by
Actual Impact
2013/14**
2014/15
2014/15
Near Miss
114
10%
203
15%
+89
+6%
Insignificant
285
24%
391
30%
+106
+5%
Minor
636
54%
546
41%
-90
-13%
Moderate
128
11%
170
13%
+42
+2%
Major
5
0.43%
4
0.30%
-1
-0.12%
Catastrophic
4
0.34%
9
0.68%
+5
+0.34%
1172
1323
+151
**Compared to the 2013/14 Quality Account, the incident data has increased due to
retrospective data input and update after data was extracted for that report
Patient Safety Incidents by Actual Levels of impact
Minor, 609, 56.0%
Moderate, 114, 10.5%
Catastropic, 3, 0.3%
Other, 7, 0.6%
Near Miss (no harm), 97, 8.9%
Major, 4, 0.4%
Insignificant, (no harm) 261, 24.0%
Although the overall volume of reported incidents (3963) has decreased compared to last
year by 716 (15%), the volume of patient safety incidents (1323) increased by 151 (13%)
compared to 2013/14. An increasing volume of reported patient safety incidents and more
serious incidents offers assurance that staff continue to honestly and openly report issues
relevant to the safety of patients and where increased actual harm has occurred. The ratio
of ‘No Harm’ patient safety incidents increased by 195 (49%); near misses and insignificant
outcomes each increased by 89 (6%) and 106 (5%) respectively compared to 2013/14.
Bridgewater Quality Account 2014/15
42
14/15 Qtr 4
14/15 Qtr 4
14/15 Qtr 3
14/15 Qtr 2
14/15 Qtr 1
13/14 Qtr 4
13/14 Qtr 3
13/14 Qtr 2
0
13/14 Qtr 1
200
14/15 Qtr 3
400
14/15 Qtr 2
600
14/15 Qtr 1
800
13/14 Qtr 4
1000
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0
13/14 Qtr 3
1400
1200
13/14 Qtr 2
Non-PSI
PSI
13/14 Qtr 1
Non-PSI
PSI
The Children and Family Services Directorate confirmed that, compared to 2013/14, the
reduction in reported incidents confirms a correction in reporting more accurately rather than
any reporting downturn.
Similarly, in the previous division-based structure, services in the ALW division reported high
numbers of demand and capacity concerns via the incident reporting system rather than
incidents that directly impacted on service delivery or patient care. The managers have now
documented these issues on the Operational Risk Register and are monitoring these directly
with clinical managers. A number of actions have been put in place to address these
concerns:
• Procurement of capacity planning tool in ALW Health Visiting and School Nursing
services with the involvement of staff
• Involvement of teams in service planning via the clinical reference groups
• Profession-specific leadership as a result of the ALW operational management and
team restructure
• Improved timescales for completion of vacancy control forms so staff can see the
recruitment process progressing
• Team leader and professional meetings set up to improve communication and aid
solution focused thinking
All incidents were routinely investigated and, in some cases, these may have been escalated
into a full root cause analysis based on a consistent national methodology. The Trust
maintained a pool of over 40 staff (clinical and non-clinical) specifically trained in root cause
analysis techniques thus ensuring that incidents are thoroughly investigated and lessons are
learned to prevent recurrence.
Bridgewater Quality Account 2014/15
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Patient Safety Incidents reported to the National
Reporting and Learning Service (NRLS) April
2014 to September 2014 by NRLS Degree of
Harm
Ave from similar
organisations*
Reported from similar
organisations
Total
%
N
%
Lowest
Highest
None
327
45%
929
52%
230
1492
Low
296
27%
618
34%
94
1585
Moderate
96
41%
227
13%
87
537
Severe
3
0.41%
15
0.82%
0
89
Death
7
0.96%
3
0.19%
0
15
729
1792
* National figures obtained from the NRLS April 2015 report. Please note that:
• The averages include Bridgewater data,
• This national data covers patient safety incidents reported from April 14 to September
2014 (October 14 to March 2015 data is available later in 2015), however,
• The NRLS advises that not all organisations apply the national coding of Degree of
Harm in a consistent way, which can make comparison of harm profiles of
organisations difficult, also
• Most other providers are not solely Community Trusts as Bridgewater is i.e. they have
some mental health or acute functions; as a result, of the 19 Trusts that the NRLS has
compared Bridgewater to, there is only one other Community Trust with a service
profile similar to Bridgewater and against which the Trust remains comparable
The following initiatives were undertaken during 2014/15 to improve our management of
incidents:
• Automated weekly incident reports to senior managers every Monday morning of the
previous seven days incident details to identify any concerns
• An increased pool of trained root cause analysis investigators during the final quarter
• Automatic notification of all pressure ulcers to all the tissue viability nurses
immediately on submission
• Improving rates of pressure ulcer photographs attached electronically to incidents in
order that the tissue viability nurses can provide early advice remotely.
Never Events
Never events are serious, largely preventable patient safety incidents that may result in death
or permanent harm, that should not occur if the available preventative measures have been
implemented. The Department of Health reviews a list of these each year and there are 25
different events that all Trusts continually monitor. If they occur, we are required to report
directly to the Care Quality Commission and our commissioners. There were no such events
occurring during 2014/15.
Bridgewater Quality Account 2014/15
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Central Alert System
Using incident data from across England, the NHS develops national initiatives and training
programmes to reduce incidents and encourage safer practice. Alerts are released through
a single “Central Alerting System” (CAS) to NHS organisations which are then required to
indicate their compliance with these safe practice alerts. They cover urgent regional or
national matters concerning faulty medical devices, medication, estates issues and other
patient safety issues. The Trust received 101 clinical alerts, and 59 non-clinical alerts, which
were then cascaded to each directorate and onto service leads to assess the action required
for each alert. All alerts relevant to patient safety in the community sector were assessed
within the required timescales and action plans for improvement put in place where they were
applicable to community healthcare.
At the end of 2014/15 the Trust was assessing the relevance of three alerts to meet any
recommendations within the expected completion dates set later in 2015/16.
Pressure Ulcers
Pressure ulcers can range from redness of the skin, to a small graze to a cavity. All patients
with pressure ulcers are regularly reviewed to identify where, how and why they developed.
In particular any pressure ulcer that develops or deteriorates whilst in our care has to be
investigated to identify the cause and any areas where we could have improved our care.
More serious pressure ulcers are reported to the GP, commissioners and the NHS Area
Teams. The Trust is then monitored to ensure that we have identified the reasons for the
development of pressure ulcers and any actions we need to undertake to improve future
care.
A system for reporting all pressure ulcers is in place. During 2014/15 a total of 1153 pressure
ulcer incidents were reported by staff of which 716 (62%) developed before our involvement
in their care, 437 (38%) developed or deteriorated whilst the patient was under the care of
the Trust. The Trust actively encourages all reported incidents and near misses are shared
with patients and their relatives/carers. However, where an incident carries an impact score
of 3 (moderate) or above sharing this information is now compulsory and this Trust monitors
adherence to this through its Quality Management Group.
Many patients who develop or experience a deterioration to an existing pressure ulcer may
have infrequent visits from district nursing, for example four times a year. Therefore, it is
important that we work closely with patients and their carers to support them to care for their
pressure areas. We have developed a patient information leaflet on what good pressure
relief looks like, demonstrating pressure relieving techniques and provision of pressure
relieving equipment where appropriate. District nurses actively encourage and rely on
feedback from patients and their carers regarding any changes to the patient’s condition that
requires a district nurse to check.
A training programme is delivered by our tissue viability team to all staff. This includes both
taught sessions and workbooks for staff to complete. Within each team there are dedicated
link nurses, who are registered nurses with additional training. Link nurses are then
responsible for supporting staff to complete their competence in pressure ulcer care. Link
nurses then act as a point of contact for any further guidance needed in relation to specific
patients working closely with the tissue viability nurse’s when required.
Bridgewater Quality Account 2014/15
45
The Trust also has a pressure ulcer working group which monitors the pressure ulcer action
plan, which was developed to ensure all the right organisational systems and processes were
in place to support staff who were caring for patients with pressure ulcers or who were at risk
of developing them. The information leaflet and training programme came out of this work.
Building on this work from last year we have now implemented a process to monitor our
performance against the new processes and national standards. Achievement against
the standards can be evaluated at team, neighbourhood or borough level and is reported
quarterly to our Quality Management Group. In the event the standard has not been fully
achieved, an individual or team performance plan is developed to guide the necessary
improvements.
Workforce Planning – Staff in the right place at the right time
with the right skills
Through the delivery of the Trust’s service transformation and cost improvement
programmes, we have become much better at understanding what patients and the public
want and need. It is important that we have a workforce that is flexible, mobile and is being
continually developed around patient need.
Managers undertake workforce planning in line with an agreed model.
From April 2014, we have been required nationally to publish our staffing levels set within the
guidance and context of ‘Safer Staffing Levels’. As a Community Trust we only have to report
Safe Staffing for our Community Hospital inpatient unit. This information has been submitted
monthly and in 2014/15 the Board have received monthly reports. The information is also
shared on NHS Choices and our web site.
http://www.bridgewater.nhs.uk/saferstaffing/
Coroner’s Cases
The Trust received a Regulation 28 ‘prevention of future deaths’ report in December 2014
following the inquest into the death of an infant in April 2014. The death occurred the
morning after he had been seen and examined by the GP Out of Hours Service in Warrington.
The coroner raised four matters of concern with the Trust and stated that ‘there is a very clear
training need identified here in relation to the appreciation of this type of occurrence with very
young children’.
The Trust has addressed the concerns raised in the report and has responded to the
Coroner and the patient’s family in a timely manner. The Chief Executive met with the
Coroner to investigate how we as a trust can assist the Coroner’s Office with processes to
ensure we are always able to represent our view and to assure both him and the family of the
actions we have taken within the Trust.
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46
Infection Prevention and Control
Safe, effective and systematic infection prevention and control measures are an important
component in health care. The prevention of infection is the primary goal when providing care
to patients and to ensure risk is reduced to healthcare staff. Much has been done to reduce
the risks of healthcare associated infections (HCAIs) in both the hospital and community over
the past years, and it is therefore essential that Bridgewater continues to ensure ‘infection
prevention’ continues to be seen as a priority.
Hygiene Code
The Trust is responsible for meeting the standards within Hygiene Code (Health and Social
Care Act 2008). We therefore believe that we are able to assure the Care Quality Commission
(CQC) that we can supply evidence of best practice which indicates how we are maintaining
a reduction in HCAI’s and supporting measures to improve environmental hygiene.
Dental health care and practice is monitored by ensuring care is managed against the
standards within the ‘HTM01-05: Decontamination in Primary Care Dental Practices
Guidance’.
As a Trust, we continue to support a philosophy of a ‘zero tolerance’ to avoidable HCAI. In
the past year to help us achieve this we have:
• Continued a programme of peer audit of hand hygiene in all staff with face to face
hands on contact.
• Achieved a second year with no MRSA bacteraemia infections
• Assisted in the reduction of avoidable Clostridium difficile infections
• Continued to provide education, audit and training regarding ‘Essential Steps to Safe
Clean Care’, the national programme of healthcare practice which helps staff to work
in a systematic manner to prevent infection. In particular using ‘Aseptic Non Touch
Technique’ (ANTT), for high risk procedures
• Worked across the health economy sharing best practice in infection prevention.
• Had a small improvement in staff flu vaccine uptake, but realise more needs to be
done
• Undertaken a programme of quality walk-round visits
• Responded to the risks from suspected Ebola infection.
Infection, Prevention and Control Team
At the beginning of 2014, the Infection, Prevention and Control (IPC) Team divided into two
distinct teams to ensure that clear lines of accountability were distinguished between the
commissioner and provider roles. The commissioner role is not covered in this report. The
Trust IPC team structure and lines of accountability can be seen below. The IPC service
reports directly to the Executive Nurse who is the Director of Infection, Prevention and
Control.
Two full-time IPC nurses are currently managing the provider service and a decision to
employ a third nurse is currently under review. The Trust IPC team has the responsibility for
providing advice, training and on-going support on infection, prevention and control to all
directorates and their services as well as other partner agencies, i.e. intermediate care
facilities jointly managed/utilised by the Trust.
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47
IPC Structure and Lines of Communication/Accountability
Trust Board
Executive Nurse/Director of Governance
Quality and
Safety
Committee
Director of Infection, Prevention and Control
(DIPC)
Infection, Prevention and Control Lead Nurse
(band 8b)
General Managers and
Services
Infection, Prevention and Control Infection,
Prevention and Control (band 7)
IPC Nurse (vacant)
Infection, Prevention and Control Programme of Work
The annual Infection, Prevention and Control Programme of Work is developed and
monitored throughout the year. The work programme has a primary focus on policy
development, education and training, which outlines the structures required to share
information across the Trust from the Chief Executive to staff in the community and vice
versa.
All actions set within the work programme are developed to support the Trust in providing
evidence of meeting the criteria within the Health and Social care Act 2008. The last year has
been a challenging year for the IPC team, with a change to their management structure and
having to meet new priorities such as managing the staff flu programme and responding to
the Ebola outbreak. This is also the first year that the two infection prevention control nurses
have been responsible for supporting the management of IPC across the whole footprint,
which is extensive. Whilst most actions set were met, some goals were not, due to increasing
workload and changes to roles, these were:
• Ensuring there is a Trust wide Infection, Prevention and Control Group
• IPC Team to provide face-to-face update sessions to all teams
It is expected that both of these actions will remain in the 2015/16 plan and will be met as a
priority.
Internal Reporting Arrangements
The Quality and Safety Committee, that provides assurance to the Board, receives a quarterly
report and verbal update from the Lead Nurse infection, prevention and control and the
Director of Infection, Prevention and Control (DIPC).The Trust’s compliance against the
Health and Social Care Act, and key actions to meet best practice are noted at this
committee. This group has been made aware of the challenges encountered by the IPC team
and of the recommendations requested by the IPC team to support an effective service.
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48
Reporting to Clinical Commissioning Groups
The Trust reports its compliance against the Health and Social Care Act to a number of
Clinical Commissioning Groups. Again the annual programme of infection, prevention and
control is the basis of this reporting mechanism, and any findings from outbreaks or single
cases of infection are discussed at this group. Action plans are scrutinised and clear dates
for response and completion of actions are set out.
Healthcare Associated Infection (HCAI)
The risk of obtaining a HCAI will always be a concern for patients receiving treatment across
the NHS. We have worked closely with our commissioners to monitor HCAI, and where a
lapse in care is thought to have occurred during the care we have provided, a full root cause
analysis (RCA) is always undertaken. At present we as a Trust participate in the national
mandatory surveillance programme for MRSA and Clostridium difficile infection. The diagram
below indicates infections attributed to the Trust.
HCAI Bridgewater Community Healthcare NHS
Foundation Trust 2014-15
1
March 15
February 15
January 15
December 14
November 14
October 14
September 14
August 14
July 14
June 14
May 14
April 14
0
Number of cases
of Community
acquired MRSA
cases attributed to
Bridgewater within
month
Number of cases
of Community
acquired C. difficile
cases attributed to
Bridgewater within
month
Methicillin Resistant Staphylococcus Aureus (MRSA)
The Infection Prevention and Control Team review all notifications of MRSA bacteraemia
(blood poisoning) infection, using a recognised Post Infection Review (PIR) tool. This helps
to fully investigate the patient’s journey, exploring the key contacts patients have had with
health care staff and their practices. No MRSA bacteraemia cases were attributed to the Trust
during 2014/15, this is the second year a nil return has been submitted and indicates a
continued effort by Trust staff to prevent infection MRSA bacteraemia in practice.
To ensure the Trust maintains a continued zero MRSA bacteraemia, staff are audited and
provide evidence of good hand hygiene in practice, undertake infection prevention
precautions such as aseptic technique and are supported by the infection, prevention and
control team.
Bridgewater Quality Account 2014/15
49
Clostridium Difficile
Clostridium difficile (also known as ‘ C. difficile’ or ‘C. diff’) is a bacterium that can be found in
people’s intestines (their digestive tract or gut). It causes either diarrhoea (mild to severe) or
in some cases a life-threatening inflammation of the intestines. A person can become
infected with Clostridium difficile if he/she ingests the bacterium and this can be made worse
if they have taken a number of antibiotics which can disturb the normal bacteria in their gut.
The most effective way we can reduce Clostridium difficile infection is to reduce antibiotic
prescribing where possible, target infections with specific antibiotics, and ensure that when
antibiotics are prescribed, the full course is taken by patients. Good hand hygiene with soap
and water and environmental hygiene are also key in the fight against this infection.
As a community trust we do not have a target for reduction of Clostridium difficile but we are
expected to support acute trusts and commissioning organisations in meeting their goals.
Only one of the four Clinical Commissioning Groups we work with have set a threshold (see
the table below).
Clinical Commissioning Group
Ashton, Leigh and Wigan
Warrington
Threshold
Actual
No threshold set
0
4
0
Halton
No threshold set
0
St Helens
No threshold set
2
Over 2014/15, a number of cases of Clostridium difficile infection were investigated and two
of these were attributed to the Trust (please note that ‘attributed to the Trust’ signifies in these
cases that some care we provided could be improved rather than the Trust being directly
responsible for the infection). These two cases of Clostridium difficile infection had been
admitted to the Trust inpatient facilities and commenced with diarrhoea soon after admission.
The cases could have been avoided if use of aperients (laxatives) had been reviewed and in
the second case all staff involved had noted that this was a relapse of an earlier Clostridium
Difficile infection, rather than a new case and the patient treated accordingly. Learning from
these two cases have been noted and action plans completed to reduce future risk to
patients.
Ebola
All NHS Trust were asked to ensure that they have robust systems in place to educate the
public and healthcare staff in the management of patients suspected as having this infection.
For the Trust this has meant reviewing where patients are most likely to attend for advice, and
this we believed would be our out of hours services and walk in centres. The IPC team
distributed posters and information provided by Public Health England, ensuring this
information was visible as people attend our premises. Education sessions were then
provided by the IPC team to ensure staff were aware of the latest guidance and of how to
manage suspected cases, ensuring these staff were aware of key contacts. We have not
been involved in the management of any confirmed cases. The Trust IPC team will continue to
address any staff educational and support needs until the outbreak is declared over.
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50
Outbreaks
Outbreaks of infection usually occur when people and patients come together. The Trust is
responsible for two inpatient facilities and we encountered a number of diarrhoea and
vomiting infections during the winter months, affecting both residents and staff. This seems
to have reflected the levels of diarrheal infection in the community at large which have caused
problems for our hospitals. The outbreaks were all found to be due to norovirus infection.
This is a particularly virulent (contagious) infection, which spreads easily between staff and
patients as it can be spread via both the bowel when suffering diarrhoea and aerosols from
the mouth when those affected vomit. During outbreaks of this kind it is important is to keep
patients hydrated and comfortable, maintain strict adherence to hand hygiene and other
infection, prevention and control practices, ensure staff stay away from work whilst affected,
close to admissions until the outbreak is declared over and to undertake a thorough
environmental ‘deep clean’ before reopening. These outbreaks have tested our practices,
policies and procedures and we have reviewed these in the light of the findings. Action plans
were set to ensure lessons were learned and these actions have been implemented to reduce
the risk of further outbreaks and to help us better manage those we cannot avoid.
Environmental Cleanliness
Infection control audits are undertaken in a cross section of clinics at least annually and
following each audit an action plan is written with recommendations for implementation.
Overall the audits indicate that the majority of our clinics demonstrate very good compliance
with national standards and satisfaction with our clinical services. Where issues were found
action plans were set to improve standards, often the issues were regarding clutter and
helping staff to manage their environment better. All of our cleaning contractors meet the
national cleaning standards and use a colour coding system to reduce the risk of cross
contamination and infection.
Quality walk-rounds
Patient safety walk-rounds were historically a way of ensuring that executives were informed
first hand, regarding the safety concerns of frontline staff. They are also a way of
demonstrating visible commitment by listening to and supporting staff when issues of safety
are raised.
Over the past year quality walk-rounds have been undertaken across the Trust footprint
involving a number of our adult, children and complex services. The process allows us the
opportunity to speak to staff and service users and for them to speak directly to senior staff.
Each visiting team includes a senior manager, non-executive directors (NEDs), IPC nurses,
estates and a patient representative. Each team member has a crib sheet of quality based
questions which help collect data on the service provided, highlight the successes and where
action is needed to improve the care we give. Any actions highlighted from the visits are fed
back to the executive team, staff groups and services to improve future practice. The process
has proved popular with our NEDs and patient representatives but requires review to ensure
that appropriate administration and support when organising the visits is in place. A key
element of the walk-rounds is to ensure that areas for improvement are identified and actions
set to improve care provided. These actions can be checked to ensure they have been
completed in the next round of quality visits.
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51
Influenza Vaccination for staff
The Trust’s Lead Nurse for Infection, Prevention and Control along with colleagues from
communications ran a staff influenza campaign between September 2014 and February 2015
to encourage the take-up of the seasonal flu vaccine among staff and in particular frontline
staff.
The objectives of the 2014/15 seasonal flu campaign were:
• To meet the Department of Health, Public England target of 75% of frontline staff
employed by Bridgewater being immunised against seasonal flu
• To inform all staff employed by Bridgewater of the list of locations, times and dates
where they can have a free flu vaccination
• To inform all staff employed by Bridgewater about the benefits of having a flu
vaccination and address any questions they may have.
To meet these objectives a flu plan was devised and was structured to ensure that key
members of staff including those at director level, were aware that key to the success of this
programme was their individual and collective involvement. Over 100 staff vaccination
sessions were undertaken in clinics, at team meetings and ‘drop ins’, to ensure staff had
better access. A staff questionnaire was completed and this indicated that 71% believed that
there were enough flu sessions. Recommendations to improve uptake for 2015/16 are given
at the end of this section, however as it has now been widely reported that the vaccine this
year was not as effective to the strain that was circulating, fears are that this many have an
effect on flu uptake across the NHS.
The Trust campaign was run from the first week of September 2014 until the end of February
2015. In total 53% (n=1240) of frontline staff across Bridgewater were vaccinated during this
period. This is an increase of 8% on the previous Bridgewater 2013/14 flu season. Results by
service and borough can be seen below. Over 386 corporate non-clinical staff were also
vaccinated and whilst these staff are not counted in the official frontline figures, the Trust
supports them as they often encourage their clinical colleagues to be vaccinated.
Flu vaccine uptake by directorate
Total frontline staff
Total vaccinated
%
Adult
1153
614
53
Children
711
422
59
Specialist
483
204
42
Total
2347
1240
53%
Flu vaccine uptake by Borough
%
Ashton, Leigh & Wigan
60
Halton
45
St Helens
47
Warrington
48
To improve flu uptake in the coming year the IPC team have highlighted a number of issues.
An improvement plan will be in place and monitored through directorate and quality
management groups.
Bridgewater Quality Account 2014/15
52
Safeguarding
The Trust has systems in place to ensure that patients and the public are safe. Safeguarding
assurance is provided through the Safeguarding Assurance Group which reports to the
Quality and Safety Committee of the Trust. The Safeguarding Assurance Group monitors
training, incidents, risks and supports the partnership working in relation to safeguarding
children and vulnerable adults. The group provides challenge to internal and external
processes and is chaired by the Trust executive lead for safeguarding. A recent audit by
Mersey Internal Audit showed that the systems and processes in place provided significant
assurance that people are safe in our care.
Safeguarding assurance is also provided to commissioners through the safeguarding audit
tool which is completed annually with quarterly reviews of performance by the
commissioners.
The Trust is represented on each of the local safeguarding boards and the staff involved in
safeguarding issues have good working relationships with local authorities, social services,
police and safeguarding teams. Multi Agency Safeguarding Hubs are providing integrated
safeguarding teams, promoting information sharing, shared assessments and targeted
delivery of services to families and young people.
The Trust follows national statutory guidance and local recommended practice for
safeguarding.
Safeguarding children and vulnerable adults is the key focus for our service.
The Safeguarding service provides:
• Advice, support, and training for Trust staff and external agencies
• Services for children in care – ensuring their health needs are identified and health
care plans are monitored
• Clinical and safeguarding supervision for staff within the Trust to provide support,
management and education to practitioners to improve practice for safeguarding
children and adults.
The organisation participates in multi-agency safeguarding inspections working with services
within local authority boundaries e.g. St Helens, Halton, Warrington, Wigan and Trafford. A
recent Ofsted inspection in Halton recommended that Care Leavers were aware of their right
to access health information about themselves and to be provide with a “health Passport”. All
Care Leavers are currently provided with this information before they leave care. The outcome
of a recent Ofsted inspection in Warrington is awaited.
In the last year the Trust has participated in several Serious Case Reviews for children, local
case reviews for adults and domestic homicide reviews; these are all on-going and the
learning from the reviews has been used to inform best practice in the organisation and in
partnership working.
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53
Some of the learning which has been implemented into practice includes:
• A guideline for bruising and physical injuries in children has been developed and
communicated
• Improved communication processes in district nursing services; daily handover
process
• Shared risk assessments for non-concordant care
• Assessment of self-neglect
• Promotion and awareness raising of the escalation policy across partner agencies
• Multi-agency case file audits to recognise the impact of services working together to
affect change and improve outcomes for children
• Improved information sharing with GP practices and flagging of vulnerable children on
the computer records has been achieved
• We have reviewed Out of Hours GP information sharing processes and are
developing standard operating procedures for sharing of information with the
universal caseload holder when a child attends the OOH GP service on three
separate occasions in a given period (six months for pre-school children and 12
months for school age children)
• We have implemented safeguarding supervision for the Out of Hours GP service
• We have developed more robust IT processes with the acute Trust for the sharing of
information when children attend the emergency department or are discharged from
hospital
• The voice of the child is being heard, recorded and acted upon on a more consistent
basis
The Looked after Children service has now been incorporated into the Safeguarding Children
Team across all boroughs. Developments in this area have resulted in improved attendance
of children and young people for initial and review health assessments. Health needs are
being addressed sooner with an expectation of better health outcomes for children. Care
leaver passports have been developed to provide young people with a summary of their
health since birth, incorporating immunisations dates and relevant family history. Guidance is
given to educate young people regarding access to health care i.e. GP, dentist, sexual health
services.
National Institute for Health and Care Excellence (NICE)
Every month NICE publishes guidance that sets the standards for high quality healthcare and
encourages healthy living.
The Trust is committed to continually improving the quality of our services and the health of
our patients. By adopting a robust approach to implementing NICE guidelines service users
can be assured that their care and treatment is safe, up to date, and evidence based.
All newly published NICE guidance is distributed to services throughout the Trust to ensure
that services are compliant with NICE recommendations. Services evaluate each piece of
guidance and determine whether it is relevant to their service and if so, the service is required
to undertake a baseline assessment to state whether they are fully compliant, partially
compliant or non-compliant.
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54
Services are given four weeks to undertake baseline assessments following publication of
guidance and a further four weeks if compliance is partial and an action plan needs to be
developed. Partial compliance means that there is one or more recommendation that the
service is not adhering to at present. This is to be expected in relation to newly published
NICE guidance. However, an action plan must be devised in order to bring the service into
full compliance.
In the year April 2014 to March 2015, NICE published 109 pieces of guidance, excluding
NICE Quality Standards, most of which related to care provided in acute hospitals. There
were 23 pieces of guidance applicable to services that the Trust provides. We were fully
compliant with 11 and action plans were put in place to bring us into full compliance with the
remaining 12.
Total applicable to Trust
services
23
Fully compliant
Partially compliant with action plan
to bring into full compliance
Not compliant
11
12
0
Compliance with NICE guidance is reported through the Quality and Safety Committee of the
Trust Board. Clinical audits of NICE guidance are included in the annual clinical audit plan.
Below is an example of an audit that was completed to check compliance with NICE
guidance.
Audit of Nocturnal Enuresis (NICE CG 111 “Nocturnal Enuresis: the management of
bedwetting in children and young people.”
The audit was undertaken in the Children Continence Service provided in the Halton and St
Helens area. It revealed good practice in comparison to NICE recommendations but
highlighted a couple of areas where improvements could be made. In particular, standard 1
– see table below. All 21 items had to be documented for the standard to be met and in 59%
of cases, they were all there. The service is moving paper health records to an
electronic patient record and has reviewed the electronic system to ensure that all of these
assessment questions are included. This will act as a prompt to ensure that specific
questions are not omitted. A further audit will be undertaken in 2015 to ensure that this
compliance percentage has improved as anticipated.
Compliance
1
2
3
4
5
6
Assessment and Investigation – this standard contained 21 individual items relating to
bedwetting history, daytime symptoms and toileting patterns. If even one of these 21
items was omitted, the standard was recorded as not met.
The clinician should assess whether the child or young person has any comorbidities or
there are other factors to consider
An alarm should be offered as the first-line treatment to children or young
people with bedwetting.
The response to an alarm should be assessed by 4 weeks.
Alarm treatment should be continued in children or young people with bedwetting who
are showing signs of response until a minimum of 2 weeks’ uninterrupted dry nights has
been achieved.
The appropriateness of continuing with alarm treatment should be assessed if complete
dryness is not achieved after 3 months.
59%
94%
82%
100%
100%
100%
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55
NICE Quality Standards
NICE Quality Standards are a different type of publication to be used by providers and
commissioners in the design and delivery of services. NICE Quality Standards are to be used
to engender quality improvements and, unlike other NICE guidance, are not for compliance
purposes.
A two pronged approach was implemented from 2014/15 so that the Trust can keep up with
new Quality Standards published each month while at the same time address NICE Quality
Standards that had previously been published.
By the end of March 2015, there were a total of 83 NICE Quality Standards. 73% of these are
applicable to care provided by one or more of our services. A phased prioritised approach
is underway to gather evidence against each one, so that plans for improvement to service
delivery can be made.
Clinical Audit
Clinical audit is a quality improvement process that seeks to improve patient care. This
means the care that patients receive is reviewed against standards which are proven to be
best practice (evidence based care). This is carefully evaluated and where required, changes
are made to improve care.
We believe that it is our responsibility to provide our patients with good quality, safe and
effective care in order to achieve the best outcomes.
We need to identify areas that can be improved and address those as a matter of priority.
The clinical audit plan is presented to and overseen by the Quality and Safety Committee.
Progress is reported on a quarterly basis and includes key findings from individual audit
projects along with the main priorities in the associated action plans.
Topics included in the clinical audit plan are identified from:
• National priorities for example an NHS England national audit or NICE guidelines
• Local priorities, for example an incident report, a patient complaint or a concern from
any other source.
• Commissioner priorities.
The example below is an audit which reflected one of our commissioner’s priorities.
Audit of Efficacy of the Growth and Nutrition Service
The Child Growth and Nutrition Service is a specialist nurse led clinic for obese children,
established in St Helens in 2004. It was expanded to cover the Halton area in 2011. Children
aged 4-16 years who meet the referral criteria are eligible to attend. The aim of children’s
weight management, for the majority of children, is to maintain their weight whilst they
continue to grow in height until their height and weight is in proportion and their BMI is within
the healthy range. In extreme obesity or once a child reaches puberty the aim would be a
small weight loss of 0.5-1kg per month until their height and weight is in proportion and their
BMI is within the healthy range.
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The standards used to measure the care are contained within:
• NICE 43 (2006) - Obesity: Guidance on the prevention, identification, assessment and
management of overweight and obesity in adults and children
• SIGN 115 (2010) - Management of Obesity
• Bridgewater clinical guidance: Child Growth and Nutrition Service for Clinically Obese
School Age Children (4-16 years) (2011), HStHCL284. Last updated 2014
The service has undertaken clinical audit over several years previous to this final one. Earlier
cycles of audit have focussed on whether the service met the needs of the families referred,
behaviour change and effect on BMI. Later audits focussed on clinical care, specifically the
identification and management of obesity related co-morbidities. Over all of the cycles of
audit, the percentage of children in the extreme obese category has reduced from 13.33% to
1.11%.
The results as detailed in the table below show 100% compliance with 10 out of 11
standards. One out of the five elements in Standard 9 does not achieve 100% and that is
the urine sample tested for the presence of glucose and protein. Patients were being asked
to bring a urine sample to clinic. In the cases where the test was not done, it is noted that a
specimen was not provided. The service has already changed practice and now asks for the
urine specimen to be provided in clinic rather than brought along to clinic.
At the review appointment the BMI score improved or was maintained in 63% of children.
Reasons were documented in relation to the remaining 37% such as not achieving the
required exercise levels, family situations such as holidays, family breakdown, emotional
difficulties, comfort eating. These reasons illustrate some of the challenges the service must
address and the range of support needed by families and children.
In addition to the information provided in the table below, parents and children were asked
via questionnaire for their feedback which shows that:
• 93% of parents reported attending the clinic helps to support the family with behaviour
change
• 100% of parents reported having an agreed action plan with realistic goals. A number
of parents said they did not have a written copy but would have liked one. In
response to this, the service is now offering a written action plan whilst in clinic. This
will result in improved communication with parents and children thereby ensuring
patient safety and patient involvement in care
• 93% of parents reported that their child was involved in decisions about their care
• Children were asked how they felt about more exercise, changes in diet and attending
clinic. They were also asked what changes they had made. Their feedback shows
that they are making the recommended changes although they are not always happy
to do so
• When asked 86% of the children said if a friend needed the same kind of help they
should come to this clinic. The remaining 14% of the children said maybe.
Bridgewater Quality Account 2014/15
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1
2
3
Standard
Referral criteria must be met in all cases (includes aged 4-16 and BMI ≥98th Centile)
On receipt of referral an appointment is to be offered within 8 weeks from referral
At initial assessment an holistic assessment which will include:
• Birth history
• Past medical history
• Current medical concerns
• Medication
• Allergies
• Immunisation status
• Environmental factors and Social and family factors
• Assess family history of obesity and comorbidities
100%
97%
93%
4
Medical Examination
• Height weight and calculation of BMI
• Waist measurement and abdominal girth
• Respiratory, cardiac, abdominal examinations
• Pubertal development, signs of acanthosis nigricans, hirsuitism or cushings syndrome
• Signs and symptoms suggestive of type 2 diabetes
• Routine urinalysis
92%
5
If clinically indicated, children should be signposted to Tier 2/3 Primary Mental Health Service as
required for appropriate support. Emotional and wellbeing assessment done via strengths,
difficulties and short moods and feelings questionnaire.
100%
6
“Physical activity levels” should be discussed with child and parent and documented within the
patient record.
100%
7
“Dietary intake” was discussed with child and parent and documented within notes
100%
8
All children to have an agreed care plan with achievable goals and timescales with letter of
discussion sent to parent, GP, school nurse and any other professional.
100%
9
Clinical investigations
• Urine sample tested for the presence of glucose and protein
• Children are referred to the paediatric day unit /phlebotomy for a fasting serum glucose
level if they present with any of the following:
- a family history of Type 2 diabetes or maternal gestational diabetes
- acanthosis nigricans
- BMI >99.6th centile
• Children are referred to the paediatric day unit/phlebotomy for a fasting lipid profile if
they present with any of the following:
- a family history of dyslipidemia
- a family history of ischaemic heart disease
- BMI >99.6th centile
• Children are referred to the paediatric day unit for a glucose tolerance test if the child
presented with appearance of Acanthosis Nigricans
• Thyroid function (TSH) will be checked if the child is short for height and there is a
family history of auto-immune disorder e.g. coeliac disease, hypothyroidism or type 1
diabetes
88%
10
All children must be seen within 6 to 12 months following the first assessment and reviewed
100%
11
All children discharged from services are to have at least one of the following:
• BMI<98th Centile
• Parent/ child choice
• Child reached 16th birthday and will transfer over to adult pathway
• Transferred out of area
• Non-attendance at clinic following one DNA unless the staff member is aware of
any exceptional mitigating circumstances or following two consecutive cancelled
appointments
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100%
Research
During 2014/15, The Trust has expanded its research portfolio and is now participating in
dental research and studies relating to prison healthcare. In addition, eligible Trust patients
have been able to participate in a number of important national studies into areas such as
rehabilitation following stroke, autism and ADHD, heart failure in older patients, and a Down’s
Syndrome feeding study.
The Trust has received recognition from the Health Services Journal and National Institute for
Health Research (NIHR) for the contribution we have made to promote clinical research in the
Trust; one important aspect of which is providing our patients with opportunities to participate
in research. To this end, the Trust has participated in the Department of Health’s ‘OK to Ask’
about clinical research and international clinical trials campaigns.
Bridgewater clinicians continue to use research evidence to inform their clinical practice.
The number of research active staff continues to increase, via assisting the identification and
recruitment of patients into studies, initiating research, and registering for higher research
degrees, such as doctorates or NIHR Clinical Masters in Research. During 2014/15, Trust
staff have also published their work in books and journals, and presented at conferences.
Examples of this research has considered screening for cardiovascular risk factors in
patients with psoriasis, implementing NICE guidelines for childhood eczema, and
incorporating Yoga into physiotherapy practice as an extension of therapeutic exercise.
Care Quality Commission – Essential Standards for Patient
Safety and Quality
Throughout 2014/15 the Trust has continued to declare full compliance with the essential
standards and remains registered, without conditions, with the CQC.
Quarterly reports on compliance across the Trust have been submitted to both the Quality
Management Group and the Quality and Safety Committee.
To facilitate the reporting of compliance from service level up to the above committees we
have continued to utilise our CQC Monitoring Framework. This framework sets out the
expectation that our clinical services are accountable and responsible for monitoring and
reporting compliance with the essential standards. Compliance is reported up through the
directorate management structures and where necessary appropriate actions are undertaken
to address any identified areas for improvement.
In order to check compliance at service level we have continued to carry out our own internal
CQC Service Reviews. During 2014/15 there were 24 reviews undertaken. The review
panels consist of a member of the governance team and a service manager. The panel
discuss compliance against all the outcomes with the relevant clinical manager. The reviews
take approximately 2.5 hours and whilst they cannot be seen as “deep dives” into each
service they do facilitate an increased awareness of “what good looks like”. Following a
review, the service is provided with an action plan identifying areas for improvement. All the
action plans are monitored within the relevant directorate structure and via the quarterly
reports through to completion.
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Care Quality Commission Inspections
In February 2014 the Trust was the first community health service to be inspected in the North
as part of the Wave 1 pilot inspections of NHS community health providers.
Overall, the CQC inspection found that the Trust provided safe and effective community
health services which were well-led with a clear focus on quality. However, the regulator
found some weaknesses in risk and quality reporting and action taken following the
identification of risks at Newton Community Hospital.
The final CQC inspection report published on 17th April 2014 included one compliance
action as follows:
Regulation 10 HSCA 2008 (Regulated Activities)
Regulations 2010 Assessing and monitoring the quality of service provision.
The provider has not protected people by means of an effective operation of systems
to identify, assess and manage risks relating to the health, welfare and safety of service
users at Newton Community Hospital.
Regulation 10(1)(b) and 10(2)(c)(i)
As expected, the report also identified some specific areas where we needed to make
improvements to systems and processes. An action plan was submitted to CQC to address
CQC’s Areas for Improvement (“Must do’s, Should do’s and Could do’s”). This action plan
was monitored by both the Quality Management Group and the Quality and Safety
Committee to ensure all the required actions were undertaken.
CQC identified two “must do’s”;
• Develop effective reporting mechanisms to ensure that the board are fully sighted on
activity and performance at Newton Community Hospital.
• As a result a Quality Dashboard was developed which is submitted as part of the
Integrated Performance Report to the Quality and Safety Committee.
• Develop effective systems to identify, assess and manage of risks at Newton
Community Hospital.
• All Newton Hospital specific risks are recorded on Ulysses (the organisations
electronic risk management system) and discussed with staff at the weekly
multidisciplinary team meetings.
The Trust declared compliance against the above compliance action in March 2015.
St Helens Clinical Commissioning Group Review of Newton
Hospital
The CQC inspection of the Trust in February 2014 found some gaps in risk and quality
reporting at Newton Community Hospital. Consequently, St Helens Clinical Commissioning
Group (CCG) made a request to carry out an inspection visit of the inpatient ward at Newton
to provide them with assurance that any issues identified by the CQC had been addressed.
The visit took place on the 5th November 2014. The inspection team included several
members of the CCG along with two Healthwatch representatives.
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All the members of the team were provided with information prior to the visit so that they
could spend the time on the ward with patients and staff.
The ward was busy but the team found the staff very accommodating, friendly and
welcoming. The patients that the inspectors spoke to were very positive about the quality of
their care and the team saw staff treating patients with compassion, dignity and respect.
Areas for improvement included the need to develop the environment to be more dementia
friendly and to make patient documentation simpler and clearer, both of which are being
taken forward. As a result of the visit the ward team are now producing a vision for Newton
Hospital which will identify goals for the ward team to achieve which will be monitored by the
Bridgewater executive board and at the St Helens quality meeting with the CCG.
Medicines Management
Incidents
The Bridgewater Medicines Management Team continues to work closely with healthcare
professionals to ensure patient safety and quality care with respect to medicines use. The
Trust supports an open culture encouraging the reporting of medication incidents and also
interventions made to avoid possible errors.
The detailed review and analysis of reported medication incidents is a fundamental aspect
of the work of the Medicines Management Team, supported by the Risk Management Team.
Following an initial detailed analysis and classification of incidents, by the Medication
Incident Panel, incidents are discussed at the Medicines Management Groups (both internal
Bridgewater meetings and interface meetings involving pharmacist representatives from the
local CCGs) and the Quality Management Group to identify themes and review the lessons
learned measures put in place to minimise incidents.
In 2014/15, 250 medication related incidents were reported by the Trust staff including 28
involving controlled drugs. They include ‘third party’ incidents which Bridgewater staff
identified but originated from other healthcare providers e.g. hospitals, community
pharmacies, GPs, care agencies or individuals. The reporting of these third party incidents
demonstrates continued vigilance by Bridgewater staff regarding the safety of medicines
within the community.
The graphs below summarise the total medication incidents and the controlled drug
incidents reported by severity, respectively.
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Medication Incidents by Month and Severity
30
u
25
20
15
u
s
s
s
u
u
u
s
February 15
January 15
October 14
September 14
August 14
July 14
June 14
s
s
March 15
s
u
s
u
s
s
u
u
December 14
u
s
November 14
u
May 14
5
0
u
u
April 14
10
s
(0) Near Miss
(1) No Harm
(2) Minor
(3) Moderate
Total
Controlled Drug Incidents by Month and Severity
7
6
(3) Moderate
(2) Minor
(1) No Harm
(0) Near Miss
5
4
3
March 15
February 15
January 15
December 14
November 14
October 14
September 14
August 14
July 14
June 14
May 14
1
0
April 14
2
Third party incidents and administration of medications are the main types of incident
reported. It is well known that medication issues are most frequent when a patient moves
from one place of care to another and often due to lack of communication e.g. breakdown in
communication on transfer of patients between organisations. The Trust’s Medicine
Management team has established closer links in 2014/15 with local trusts to report relevant
third party incidents for appropriate investigation and to facilitate lessons learnt being shared
across the health economy.
As a result of the medicines management review of medication incidents the Trust is able to
review procedures and policies to ensure any changes are implemented. Incidents are dealt
with on a case by case basis with staff involved undergoing a review and assessment of their
practice using the medicines competency framework.
Non-Medical Prescribing
A Non-Medical Prescriber (NMP) is a registered healthcare professional who has specialist
knowledge and skills and who has undertaken additional training to become a qualified
prescriber. The Trust currently has ~450 non-medical prescribers who work to ensure
patients have timely and appropriate access to medication and have individualised evidence
based care.
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The North West Non-Medical Prescribing Leads Network commission an annual audit and
NHS healthcare organisations across the north west are invited to take part in this regional
clinician’s online audit for non-medical prescribers. The standards set for this audit were
developed at the inception of the audit in 2009 and were linked to the Care Quality
Commission Outcome 9 (Medicines Management) and 16 (Assessing and monitoring the
quality of service provision). The main aims of taking part in the audit are to provide a source
of evidence that helps to identify areas requiring improvement and to demonstrate the
importance of having prescribers who can deliver care where and when it is needed thus
enabling them to complete the episode of care.
Within Bridgewater, 51% of non-medical prescribers took part in the 2014 on-line clinician’s
audit. Participants were asked to complete each audit as soon as possible after seeing a
patient (consultation).
229 (51%) non-medical prescribers took part in the audit compared with 26% in 2012 (there
was no audit in 2013 due to updating of the audit tool and national organisational changes).
The following information indicated how non-medical prescribers are key in the delivery of
care at the point of contact:
• 38% contacts prevented a GP surgery appointment
• 26% contacts prevented a GP home visit
• 10% prevented follow up to another healthcare professional
• 6% prevented re-admission
• 5% prevented attendance at A&E
• 4% prevented of new referral to another healthcare professional
• 3% prevented of admission (hospital or hospice)
• 2% prevented of walk in centre visit
• 2% prevented of follow up by consultant (or team)
• 1% prevented of visit to minor injuries centre
• 1% prevented of new referral to consultant.
The results of the audit have been shared with all of the prescribers and individuals have
access to their own prescribing report to allow them to review any areas of their prescribing
practice where improvement can be made.
The impact/outcome of consultation results highlight the value of non-medical prescribing in
practice within Bridgewater and for their patients. This approach enables health
professionals and patients to utilise their time more effectively and reduce the number of
appointments patients may otherwise need to attend.
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Information Governance
The Trust understands our service users provide their personal information to us on the
understanding we will treat it confidentially and keep it secure.
Information governance (IG) provides a framework to bring together all the legal rules,
guidance and best practice that apply to the handling of information, allowing:
•
•
•
•
•
Implementation of central advice and guidance
Compliance with the law
Year on year improvement plans
Best practices in handling and dealing with information
Safeguards for, and appropriate use of, patient, staff and business information.
The Trust has an on-going, rolling IG assurance programme, dealing with all aspects of
confidentiality, integrity and the security of information. As a core part of this, IG training is
mandatory for all staff, which ensures that everyone is aware of their responsibility for
managing information in the correct way.
The Trust has carried out significant work in developing an overarching IG agenda. This
incorporates the Quality and Safety Committee which has responsibility for overseeing IG
at a strategic level with the Information Governance Subgroup assigned responsibility at an
operational level.
In 2014 the Trust had three data breaches, including loss of patient identifiable data.
Security of patient and staff information is considered to be of paramount importance to the
Trust. The three data breaches were thoroughly investigated and as a result of the
investigations, processes and procedures were reviewed, and all staff were asked to
undertake the ‘Secure Transfer of Personal Data’ eLearning module. Lessons learned
following the investigation were communicated to all staff via monthly Team Briefs and staff
meetings. The data breaches were reported to the Information Commissioners Office (ICO)
via the Information Governance Toolkit, as ‘Serious Incidents Requiring Investigation’ (SIRI).
The Information Commissioner’s Office (ICO) conducted a thorough investigation into all
three incidents and was satisfied that the Trust had taken the necessary measures to
minimise the risk of any further data breaches, and concluded that the three incidents did not
meet the criteria set out in their Data Protection Regulatory Action Policy necessitating further
action.
In 2014, the Health and Social Care Information Centre (HSCIC) set up a Caldicott2
Implementation Monitoring Group (CIMG) team in response to Dame Fiona Caldicott’s review
and the Government report, Information: To Share or Not to Share in 2013. The Trust fully
supports the CIMG to ensure the recommendations in the report are acted upon by
submitting an assurance report to the CIMG on a quarterly basis.
The Trust is proactive in information sharing for care purposes with the local health economy
across the entire Bridgewater patch. The Trust has in place documented protocols to ensure
information sharing has a secure legal basis, is ethical and secure and most importantly, staff
involved in the process of information sharing understand the process and are confident in
ensuring all sharing is in the best interests of the patient.
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Emergency Preparedness, Resilience and Response (EPRR)
As a provider of NHS-funded healthcare, the Trust has defined roles and responsibilities
under the Civil Contingencies Act 2004, the Health & Social Care Act 2012, NHS England
Emergency Planning Framework 2013, NHS England Core Standards for EPRR 2014 and
other associated guidance.
All NHS-funded organisations must identify a Board-level Accountable Emergency Officer
(AEO) who is responsible for ensuring they comply with legal and policy EPRR requirements.
The Trust’s AEO is the Chief Operating Officer, who is supported in discharging these duties
by the Head of EPRR.
We have an Emergency Planning Steering Group to coordinate and oversee the EPRR
function and ensure that we have major incident, business continuity and other emergency
plans which are regularly reviewed and tested. This group also monitors the action plans we
have in place to address any areas for development which have been identified.
For further information relating to EPRR please see the 2014/15 Annual Report.
Partnership Working
Health and Wellbeing Boards
The Trust is delighted that we are invited to attend the Health and Wellbeing Boards in each
of the towns we serve.
This is not universally the case in England, but it is extremely helpful for providers to be
present when Health and Wellbeing Boards are setting priorities for their populations and to
be able to contribute to their conversations about what is feasible, what is desirable and how
best to work together to achieve their aims.
Each borough has asked for a local as well as a “global” breakdown of our quality
performance reports and we discuss quality at a borough–level with each CCG quality lead
regularly, throughout the year.
Work with Halton’s Children Trust Partnership
Bridgewater have been working with local council colleagues in the Halton Borough to
develop a more joined up service for families, children and young people who have more
complex needs that require services from a number of agencies.
A time limited working group, including parents, children centres, family support, early years
schools, Common Assessment Framework support and health services was set up to look
at what would be best for Halton families’, children and young people. A service manager
from the Bridgewater children’s services team led the redesign work. The result has been
the creation of three newly organised 0-19 early intervention teams, which started to work
together in September 2014. The service is available to children, young people and families
in Halton. This is the first step towards integration of health, education and social care teams.
Development continues to be led by the Children Trust Partnership to make sure that services
are easy to access and delivered in a way that helps children, young people and families.
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Warrington Children’s Community Respiratory Team (CCresT)
During 2014/15, Bridgewater and Warrington and Halton Hospitals Trust collaborated to
develop a new service to help the youngsters of Warrington who are troubled by recurrent
wheeze or diagnosed with asthma.
CCResT, which opened its doors in April 2015, aims to keep care close to home, reduce the
number of interactions with secondary care and improve self-management of the condition.
Through detailed assessment and a personalised education plan, these children will be
enabled to lead as normal a life as possible and reduce the number of exacerbations of their
disease.
Assessment and education will be delivered by staff experienced in the care of respiratory
disease, having previously delivered a similar service based at Warrington Hospital. The care
will be provided by both paediatric respiratory nurses and physiotherapists who are
passionate in delivering high quality care.
Following a detailed initial assessment, further consultations will be offered to evaluate the
impact of changes in care. Once improvement has been confirmed the children will be
referred back to their GP for further review and management. In certain circumstances
CCResT will be able to refer directly onto paediatric consultants if this is felt to be necessary.
Warrington GP Extended Hours Service
“Access, demand and capacity” is one of the ten priority areas established by the GP
membership for the Warrington CCG Primary Care Strategy. As part of the Prime Minister
Challenge Fund (PMCF) initiative, Warrington Health Plus Community Interest Company
(CIC) is working in partnership with Bridgewater to establish a service that helps meet this
priority. In November 2014, together we successfully established the GP Extended Hours
Service, as a pilot from our Bath St Health and Wellbeing Centre. This pilot provides access
to GP appointments outside core practice hours, seven days a week.
Through this pilot we have learnt how best to work with GP practices on providing a
non-urgent appointment service, particularly the process that allows a safe and effective
patient journey. Through this work, we have identified demand and capacity issues that every
GP practice is facing in core hours, as many patients are requesting same day
appointments. As a result, Bridgewater is currently working in partnership with Warrington
Health Plus team to support the implementation of the second stage of this project, which
will address the demand for same day GP appointments.
Wigan District Nurse Liaison Team
The District Nurse Liaison team are based within Wigan Hospital. The role of the team is to
aid in providing a seamless discharge from hospital to their own homes or future home (e.g.
care homes etc). This is carried out by attending the wards on a daily basis and discussing
referrals into the community with the ward staff and assisting in liaising with the district
nursing teams when planning discharges.
The nurses are experienced former community nurses with a wealth of knowledge and
experience and provide education and links to the ward staff thus facilitating efficient
discharges.
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Care Home Support Team
The Warrington Care Home Support Team work in partnership with care home managers,
other professionals from within Bridgewater, GPs, colleagues from Warrington Hospital, and
social services.
The team undertake rapid specialist assessment of patients within residential and nursing
homes that have acute/unstable conditions who are referred to the team as an alternative to
a GP visit or hospital admission. They also make recommendations for the nursing
management of patients in care homes ensuring best practice and a high standard of
nursing care is delivered. This involves communicating with patients, relatives, agencies and
the multidisciplinary team, regarding patient care and acting as an advocate for individual
management of patients.
To ensure care plans are met and patients have access to specialist services they work as
part of the multidisciplinary team, working with other healthcare professionals and Social
Services as required.
The team also provide education and support to staff within the care homes to enable them
to provide quality care to the care home patients.
The team raise any concerns with the safeguarding team and attend relevant safeguarding/
best interest meetings alongside partners in social care.
One of the care home support team is a Care Home Discharge Facilitator based in
Warrington Hospital. They review those clients that have been admitted to hospital to
ensure that discharge planning is commenced appropriately, avoiding delays to the
discharge. They will also assist in arranging any specific equipment or training if the client’s
needs have changed during the hospital stay to ensure they can safely return home.
Introduction of the Northwest Ambulance Service (NWAS) Pathfinder Service (Wigan)
As part of a successful winter pressures bid, Leigh Walk-In Centre (WIC) introduced the
NWAS pathfinder service in November 2014. The introduction of a doctor within the service
has aided A&E avoidance schemes and provided an alternative destination for NWAS staff to
bring their patients. During February 2015 Leigh WIC were able to divert 53 out of 54 patients
(98%) referred to them by NWAS away from A&E.
In addition, referral rates to A&E from Leigh WIC have reduced; in October 2014 Leigh saw
3437 patients and referred 147 (4.2%) to A&E. In January 2015 they saw 3490 patients and
referred only 86 (2.40%). The rate of referral has remained 2.2 - 2.4% since November 2014.
Intravenous (IV) Therapy Teams (Warrington, St Helens, Halton and Knowsley)
IV Therapy Teams provide acute care, previously only available in a hospital setting in
patients own homes and local clinics.
The benefits of a community IV Therapy service according to Chapman et al (2011) include:
•
Admission avoidance and reduced length of stay in hospital (with resulting
increases in inpatient capacity and significant cost savings compared with inpatient
care)
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•
•
Reduction in risk of healthcare-associated infection
Improved patient choice and satisfaction.
The service actively in-reaches into local acute trust wards to promote the service and help
identify patients suitable for home treatment which facilitates discharge.
The service has no waiting lists, first visit community doses can be administered the same
day once the referral document is received. Once the patient returns home and contacts the
team, a venous access device can be inserted and the first community dose can be
administered within the comfort of the patients own home.
Initially, when the IV service was set up the majority of referrals were received from an acute
setting. Medically stable patients were referred to the service and their lengths of stay as an
inpatient reduced. Conditions treated include osteomyelitis, infected joints, endocarditis,
abscesses and meningitis etc.
However, as the service has grown an increasing number of patients are being referred
directly to the service by their GP, community matron and outpatient clinic settings. This
avoids a hospital admission. Conditions treated include skin and soft tissue infections,
bronchiectasis, urinary tract infections, acute dehydration and hyperemesis gravidarum etc.
Patient feedback on the IV Therapy Service:
• “The service was invaluable to my husband and without it he would not have realised
his final wish to spend his last days at home”
• “This service is great, without it I would have had to stay in hospital for two weeks
solely for intravenous antibiotics. All the staff I have met have been very professional
and pleasant”
• “I didn’t have to go the hospital. I had the treatment in the warmth and comfort of my
own home”.
Specialist Community Rehabilitation Service Hub and Spoke Model
Historically, in Cheshire and Merseyside, patients with complex rehabilitation needs requiring
community rehabilitation following discharge from a specialist unit or acute trust, experienced
prolonged waiting times for community generic or neurological therapy services, as well as
significant variations in access and quality of care. Limited provision impacted on patients’
clinical outcomes resulting in longer term recovery, reduced opportunity for independence
and increasing potential for readmissions to acute hospital.
Following the implementation of the Cheshire and Merseyside Major Trauma Collaborative,
a rehabilitation pathway was developed to address the increased demand for rehabilitation
requiring a specialist multidisciplinary approach across inpatient, outpatient and community
services.
Bridgewater Community Specialist Rehabilitation Services (BCSRS) are managed as part of
a co-ordinated whole system model of care which includes the following levels of specialist
rehabilitation services and partner organisations:
• Hub Hyper Acute Rehabilitation Unit and Complex Rehabilitation Unit (The Walton
Centre Foundation Trust);
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•
•
•
•
•
•
The Phoenix Specialist Rehabilitation Spoke Unit (The Royal Liverpool and
Broadgreen NHS Hospital Trust);
Elyn Lodge Specialist Spoke Rehabilitation Unit (St Helens and Knowsley NHS
Hospital Foundation Trust);
Oak Vale Extended Specialist Rehabilitation Unit (Health and Social Care
Partnerships);
Community Specialist Rehabilitation Services (Bridgewater NHS Foundation Trust,
Merseycare NHS Trust
Liverpool Neuro.
The service is commissioned for patients with highly complex rehabilitation needs who
require specialist multidisciplinary intervention following traumatic injury and illness within
their own homes for a period of up to 12 months. Whilst the service was commissioned in
April 2013, the team has evolved to reflect the needs of the patient group. The
multidisciplinary team includes occupational therapists, physiotherapists, neuropsychology
and clinical psychology, rehabilitation assistants and a case manager.
The team focuses on individual goals for the patient which extend beyond activities of daily
living. They encompass returning to work, education and management of social and leisure
time.
This pathway is unique. No other national pathway encompasses a number of providers
who focus on delivering seamless care and rehabilitation from the acute episode through
intensive rehabilitation in the hub/spoke inpatient units through to extended and community
rehabilitation.
Implementation of Community Care Plans in Halton and St Helens
In Halton and St Helens there were two new CQUINs for community nursing this year. An
integrated care one for long term conditions for patients under 65 and a frailty CQUIN for
patients over 75.
They have resulted in the services working closely with the North West Ambulance service on
the development and implementation of community care plans, for those patients who
frequently call emergency services in crisis situations.
Individualised care plans have been developed with the patients and carers detailing the
patient’s condition, what changes to look out for, and rescue steps if the patient needs help.
The care plans are also shared with GPs. The aim of the care plans is to prevent the patient
being transported to hospital during crisis situations. The care plans are uploaded onto an
electronic system so services can access the information and a copy is left with the patient
ensuring the ambulance service has all the necessary information and a rescue plan when
they are called out.
Traditional care planning no longer meets the needs of complex patients. The community
matron team have developed self-care plans for patients with long term conditions and all
the patients are involved in identifying their needs and developing their care plan. The “I”
statement enables the patient, carers and clinicians to detail what aspects of the plan they
can do and what aspects require support from others. The I care plans have resulted in clear
understanding for patients of the care that will be provided and it provides them with control
over their health and well-being.
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Patient survey results have shown that patients are showing an increase in confidence in
managing their own care.
Service Improvements (including new or significantly revised services)
New Urgent Care Centre
During 2014/15 Bridgewater has been working very closely with other local healthcare
providers and commissioners to improve urgent care services offered in the Widnes area.
As a result of this collaboration the new Widnes NHS Urgent Care Centre (UCC) will open in
late summer 2015 in the Health Care Resource Centre, Oaks Place Widnes and will be open
7am – 10pm, 365 days of the year. UCCs are community-based primary care facilities which
provide access to urgent care for a local population. The aims of the UCC include making
care easier to access closer to home and helping people avoid making unnecessary visits
to A&E. There will be increased numbers of doctors, nurses and other practitioners working
within the UCC and they will have access to X-ray, ultrasound and other diagnostic services;
enabling them to treat a wider range of conditions and injuries in an effective and timely
manner and meet the needs of our population.
Work to reduce falls in Newton Hospital
In the last twelve months Newton Hospital in-patient unit has been working hard to support
patients who are assessed as being high risk of having a fall.
The ward has undertaken weekly audits for the past eight months and established that 96%
of patients have been assessed as high risk of falls.
Patients are admitted to the ward often due to falling in the community or following
orthopaedic surgery following a fall, the aim of the ward is to maximise patient’s
independence and functional ability so that where possible patients can return safely to their
own homes.
In the past twelve months the ward has reviewed practice and implemented the following to
support falls prevention;
•
•
•
•
•
•
•
•
•
•
Offering patients falls prevention slipper socks
Purchasing falls monitors
Where possible placing patients who are high risk of falls in a more visible area
Weekly audits of falls assessment forms
Increase staffing when patient demand requires it
Development of patient information leaflets
Daily multidisciplinary meetings which discusses every patient on the ward
Three times a week multidisciplinary ward rounds
Undertaken a priority audit assessing falls prevention processes against NICE
Guidance
Currently participating in developing ‘FallSafe’ Care bundles which provides falls
prevention and management guidance approved by the Royal College of Physicians
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The chart below demonstrates the number of falls over the past twelve months on the ward.
This shows there has been an overall reduction.
NB this data includes all falls activity including near misses and lowering to the floor.
16
u
14
12
u
10
8
6
u
u
u
u
u
u
u
u
u
March 15
February 15
January 15
December 14
November 14
October 14
September 14
August 14
July 14
June 14
u
May 14
2
0
u
April 14
4
Day
Night
Linear (Day)
Linear (Night)
Willaston GP Practice
On 1st July 2014, Bridgewater took over the management of the Willaston Surgery in Wirral.
Willaston has a well-established team and offers a full range of primary care services.
Since July 2014, it has been our objective to maintain and strengthen the team and the work
they do. This can be evidenced with the continued high levels of satisfaction outlined in the
bi-annual GP patient survey.
From the outset we have committed to exploring ways of working more closely with the team
to help them deal with their workload and respond to changing patient needs. For example,
the practice has introduced an early visiting service, with the aim to undertake home visits
in the morning and if possible avoid hospital admissions. If a hospital admission is required,
there is a better chance of an earlier discharge.
Building on the well-respected patient participation group, Bridgewater has continued with
the ongoing positive patient engagement via the patient participation group.
This involves continually seeking their views on the delivery of the services offered to the
patients of Willaston. This commenced with a village meet and greet on 1st August 2014
at which the senior Bridgewater team met with local people and their representatives. This
proved to be a positive event, providing the opportunity for patients to ask questions of
Bridgewater. This commitment has continued with well attended patient participation group
meetings that take place every six months.
Speech & Language Therapy in Halton
The Speech and Language Therapy (SLT) Department in Halton have been actively involved
in seeking feedback from their service users, and using this feedback to improve service
delivery. They have developed a series of pathways which illustrate how this is achieved.
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The main streams of feedback sought include:
1. Service specific feedback received following discharge from the service. This is
sought from service users and/or their carers/staff depending on who has been
involved in setting and achieving the goals for intervention
2.Randomised telephone feedback for service users on active caseloads
3. Verbal feedback obtained on a voluntary basis from service users, carers and other
professionals. “Verbal” is a term loosely applied in this context, as feedback is
accepted that has been communicated effectively via any means of communication
4. Focus group feedback – Service users and patient partners are invited to comment
on aspects of service delivery to inform change
5. GP/referrer feedback – feedback is sought alongside reports to seek feedback on
our input and how we have communicated the outcome of our intervention.
Feedback received is documented by staff and in accordance with the feedback codes
(which relate to diagnosis and type of SLT input received).
The number sent compared to the number received is monitored to ascertain how
representative the feedback is of caseloads and to inform whether further changes to
methods of collection for feedback are indicated.
Every month, feedback is shared with the team at the team meeting.
The SLT manager and/or the therapist:
• Generates an action plan in response to the feedback
• Shares feedback and any action plans with the Customer Care Team
The SLT team are open to any feedback on service delivery or suggested changes to be
made at all times. When spontaneous feedback is shared, the recipient informs the person
giving feedback that this will be shared with the team and action plans made accordingly as
appropriate.
Focus groups are arranged in order to involve service users in consideration of any service
delivery issues or changes.
Feedback received is used to improve service delivery, and is recorded and processed as for
all other feedback received.
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The Continence Service in Wigan won a National Award The Wigan Continence Care Service, provided jointly by Bridgewater in partnership with
Wrightington, Wigan and Leigh NHS Foundation Trust (WWL), received the Continence Care
Team award at the inaugural National Continence Care Awards in London. The service
received the award for being “a multi-professional continence team which effectively delivers
improvements in the patient experience and quality of life”.
St Helens Health Improvement Team launches “It’s Time to Talk…”
In May 2014, the Health Improvement Team St Helens launched “it’s Time to Talk…”
campaign in St Helens.
As part of the Healthy in St Helens event, the team offered information and tips on how the
public can start a conversation with a friend, relative, colleague or neighbour. The campaign
links closely with the national Time to Change campaign, which aims to end mental health
discrimination. Since its launch in 2007, evidence shows that there has been significant
improvement in public attitudes towards mental health.
As part of the launch, the team encouraged people to make a pledge to do something small,
but meaningful for a friend whether it was a walk, a call, a text or a chat over a cuppa.
HSJ Awards Winner: Managing Long Term Conditions
The Integrated Neighbourhood teams in Wigan won the ‘Managing Long Term Conditions’
award at the national HSJ Awards 2014 in London.
The awards are the largest celebration of healthcare excellence in the UK, highlighting the
most innovative and successful people and projects in the sector.
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The creation of Wigan’s integrated neighbourhood teams has helped create more than 1,000
case management plans for the highest risk patients at Wigan’s practices since April 2013.
This has contributed significantly to a 43% drop in A&E visits and a fall of 48% in emergency
admissions. Outpatient attendance was also down by 17% by January 2014.
A standard operating procedure, dedicated clinical facilitators and admin support,
investment in new technology, patient meetings to agree care goals, and the overall simplicity
of the system were other measures behind the success.
After a review by esteemed judging panels, made up of senior and influential figures from
the health sector, Bridgewater won in recognition of its outstanding work. The judges said
“The winner is providing system change driving whole person care - a step by step approach
which is engaging along the way”.
Supporting Patients and their Families at the End of Life
Healthcare organisations across Wigan and Leigh worked together to ensure that care for
people approaching the end of life continued to be focused on meeting individual needs and
wishes in line with the Priorities of Care as outlined in the document “One Chance to get it
Right: Improving people’s experiences of care in the last few days and hours of life”.
The Priorities of Care supersede the Liverpool Care Pathway and maintain a focus on
continuing to provide compassionate care while moving away from protocols and processes.
The priorities recognise that personalised end of life care plans should be created and
communication with patients and those close to them is fundamental.
The partnership of organisations across Wigan Borough were committed to applying the five
Priorities of Care in order to ensure high quality end of life care is delivered in every
healthcare setting - hospitals, the community and hospices.
A rolling programme of education and training was implemented to ensure understanding
and full use of the priorities across the borough.
In order to meet the five priorities a plan of care was developed for those approaching the
end of life and agreed with each patient and those close to them.
Special Educational Needs and Disabilities Agenda
As a result of the Children and Families Act 2014 parents should now have a stronger voice
in determining how their children’s special needs are addressed. Our services have been
working more closely with our colleagues in the borough councils to develop child friendly
Education Health and Care Plans. This is leading services to work closely together in a
different way. In order to best meet the needs of children and families who access our
services we need to ensure we have all the skills required for working in new and integrated
ways. To do this we are reviewing all our skill mix and redesigning our services to meet the
needs of the population going forward.
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Warrington Communication Project is Commissioned on a Permanent Basis
The Children and Family Services Directorate was delighted when a needs analysis project,
focusing on the communication needs of vulnerable children with communication disorders
and autism or learning disabilities, was so successful that it has been commissioned on a
permanent basis in secondary schools in Warrington.
Paediatric speech and language therapy staff worked with teaching staff in five secondary
schools with students with autism and learning difficulties. Teaching staff were coached to
deliver specialist social skills support for these vulnerable young people. Views on outcomes
from parents and schools were extremely positive with adults saying that:
• Students talk to each other more and have fewer fallouts. There is less need for staff
interventions to sort out problems at break and lunch times.
• Students are forming more successful relationships with pupils within the mainstream
school.
• Some students are more integrated into classes and need less support. Two pupils
who had significant social interaction difficulties are now almost independent in class
and are developing mainstream friendship groups.
• Mainstream subject teachers have commented that these students are more active
learners and that their classroom behaviour is more appropriate than some of their
peers.
• They participate more in class discussions.
• One school introduced the ‘Going for Gold’ reward scheme. This rewards
achievement against their goals and around positive learning behaviour. The students
in the project are among the higher achievers for this award within their mainstream
year groups.
• Academic improvements in English are a result of improved oral language skills.
Teaching staff have been able to take the young people out on community visits, which is
unlikely to have happened before the project. In all cases staff and the public have
commented on their social skills. Students could ask for information and hold a brief and
appropriate conversation with staff at the local leisure centre, the library etc.
As a result of the success of the project it has now been offered to these schools on a
permanent basis.
Paediatric Continence Service gains Makaton accreditation
The Paediatric Continence Service in Halton and St Helens gained Makaton accreditation
and are now a certified member of the ‘Makaton friendly Scheme’. This was awarded in
recognition of the team’s efforts during the intensive training and on-going assessment of
four modules by a Makaton examiner, to ensure that people, including children, feel welcome
and able to use our services.
Makaton is a language programme using signs and symbols to help people communicate.
Makaton can take away frustration of struggling to be understood and enables individuals to
connect with other people and the world around them.
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The Family Nurse Partnership
The Family Nurse Partnership (FNP) is a free and voluntary programme for first time
expectant mothers who are under 20 years of age. The FNP has been established in Wigan
since 2011. In 2014 it was expanded to include Halton and St Helens boroughs. The
programme was signed off by the FNP National Unit and began to work with young
families from November 2014. The Warrington team was established in February 2015 and
was signed off by the FNP National Unit in March 2015.
The FNP offers intensive and structured home visiting, delivered by specially trained nurses
from early pregnancy until the child is two years old.
We know from research that a healthy pregnancy gives babies the best possible start in
life. A mothers and fathers relationship with their baby right from their start is crucial for their
future health and happiness.
The specially trained family nurse will help parents understand about pregnancy and how
mothers can care well for themselves and their babies.
Information provided will support parents to make decisions which
• Increase the chances of mums having a healthy pregnancy
• Help them to manage their labour
• Improve their child’s development
• Build a positive relationship with their baby and other people
• Help parents plan for their future
• Enable parents to make healthy lifestyle choices
• Enable parents to achieve their aspirations (such as finding a job or returning to
education)
We have received some very positive feedback from families;
Mum
• “I’m more independent and prepared for being a mum”
• “Family Nurse Partnership made the difficult times easier. I can put my child first but
still do things for myself in the future”
Dad
• “can’t wait to get stuck in, this is really helping us to develop as parents, step by step”
Gran
• “it must be working, I can see she’s changed so much”
Listening into Action (LiA)
Listening into Action (LiA) is a new and innovative way of working, aimed at:
•
•
•
Removing barriers that get in the way of providing the best care to patients and their
families
Improving the patient experience
Enabling out frontline teams to do their jobs more effectively
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Bridgewater staff know what needs to be done to improve our services, and LiA puts them at
the centre of change – using their knowledge, ideas and experience to make changes that
have a big impact.
Bridgewater’s LiA journey started in October 2014 with the Pulse Check staff survey,
designed to assess staff motivation and engagement. The results highlighted the need to
improve staff morale, so work began on the Chief Executive’s “Big Conversation” events.
Nearly 400 staff contributed to the eight events held across the boroughs and through the
intranet page.
Staff were asked to feedback on what gets in the way of them delivering the very best care
for our patients, and what changes they think would make the biggest impact. All
suggestions were documented and key themes emerged, including IT, morale and culture,
and recruitment.
A number of “quick wins” were also highlighted and acted upon, including the introduction
of teleconferencing phone lines, WiFi access at Newton Hospital, and a dedicated phone-in
session with the Director for People, Planning and Development.
The LiA Sponsor Group identified 13 key themes, and oversaw the creation of new dedicated
staff-led working groups. These groups have spread the LiA ethos throughout Bridgewater
by holding “smaller conversations” within their teams, striving to make improvements to their
work stream through to the “Pass it On” events in June 2015. Bridgewater’s Chief Executive
will continue to chair the bi-weekly Sponsor Group Meetings.
Developing our Organisational Culture
Over the past year the Trust has made a commitment to achieve a culture change across
the organisation. This is to create a culture that truly engages with and empowers our staff to
enable them to provide the highest standard of care for patients, service users and an
environment that promotes a culture of wellbeing for staff.
A series of workshops have been held with all levels of staff during the year to shape the
culture framework for the Trust. The framework will be launched in 2015/16.
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Quality, Innovation, Productivity and Prevention (QIPP)
QIPP is an approach to how services can be delivered against a backdrop of increasing
pressure on NHS budgets nationally. The QIPP approach is that through reviewing how we
currently deliver services we can find new and innovative ways of delivering a better service
at a lower cost. QIPP is also about identifying new services that will improve quality and
outcomes for patients but save money elsewhere in the NHS. This means that more money
can be spent in the community, keeping people more independent in their own homes.
Last year we described our planning for a new fracture liaison service (FLS) in Wigan. This
went live on 1st April 2014 and is already demonstrating a significant impact on the care we
provide for patients. The following table shows the performance at the end of March 2015:
Quality Standards
Performance 2014/15
1. 90% of referrals are seen within 6 weeks
96.2%
2. 100% of referrals are seen within 18 weeks
100%
3. 100% of referrals are made to the FLS within 7 days of being
seen (originating provider dependant)
100%
4. 100% of patients are followed up for medication optimisation
within one month of being assessed by the service
100%
5. 100% of patients are followed up for medication optimisation
within 12 months of being assessed by the service
Not yet available
The service has received 1347 referrals and completed 1081 contacts during the year, the
majority of whom had been referred from fracture clinic. Patients are prescribed a bone
sparing drug called bisphosphonate which helps to strengthen bone density and so prevent
fractures and lifestyle advice. The fewer the number of fractures the less demand there is on
A&E, emergency theatres and medical beds, demonstrating how an initiative in the
community improves outcomes for patients and reduces demand for hospital care.
Bridgewater also led a whole system initiative in Wigan called Integrated Neighbourhood
Teams or INTs. These are multidisciplinary teams in the community (Bridgewater,
Wrightington Wigan and Leigh, 5 Boroughs Partnership Trust, Wigan Council) who meet with
GPs to discuss and agree care plans for patients who have been frequently admitted to
hospital. By meeting in this way and sharing information, the patient’s care can be better
co-ordinated and they can be supported to remain independent in their own home. As with
the fracture liaison service patient outcomes and experience has improved as well as
creating an overall reduction in demand for hospital services. In November 2014, Integrated
Neighbourhood Teams won the prestigious HSJ Award for managing long term conditions.
During the last year Bridgewater has been working together with health and social care
partners in Wigan to develop an integrated Community Nursing and Therapies (ICNT) service
which will radically change the way services are delivered. Based around locality integrated
hubs, services will be co-located (children’s, health improvement, mental health, social care,
community and long term conditions management). The re-designed service will improve the
management of both higher risk patients (the INTs will be core to the new delivery model) but
also focus on patients who have a lower risk score to support self-management and
independence.
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Clinical Strategies
The Clinical Services Strategies set out the intentions for the delivery and development of
services over the next five years. They include what we do, why and how to ensure that our
services are in the strongest position to deliver high quality care and promote health and
wellbeing in our communities.
Internally, the Trust’s mission, core values and quality strategy were integral to the development
of the clinical strategies and support delivery of the ambitions set out in the strategies.
Externally, national and local policy guidance and commissioning intentions along with
professional and expert group guidance also informed our thinking.
The insight our frontline staff have into their work underlines the importance of their role in
clinical service development and innovation. They have the advantage of being able to
combine their practical experience of delivering services with national, professional, clinical and
policy guidance and locally determined requirements from our commissioners. The Trust has
responded strongly to staff involvement in the co-production of strategies via a range of quality
seminars held with front line staff.
Examples of the positive impact of our strategy on our population can be found throughout this
document.
Strategy Days
Two strategy days were held in 2014/15 to enable the senior management team and clinical
leaders to focus on the Trusts strategy particularly considering the five year forward view,
commissioning intentions of the CCGs and meeting the future needs of the borough
populations.
The strategy day in December 2014 focused on the five year forward view and taking stock of
where we were at that point in time Borough by Borough. The strengths, weaknesses,
opportunities and threats were mapped for each health economy. This gave the opportunity for
the challenges below to be considered specific to each boroughs local needs and context.
Workshops were held to look at some key challenges for us and to consider:
• How we may become a multi-specialty community provider
• What our role is in urgent and emergency care
• What our primary care strategy should be
Following discussion next steps and plans were agreed for each of the work groups.
The strategy day held in March 2015 was an opportunity to look at the progress of the LiA,
culture and quality improvement work programmes across the Trust, the potential barriers and
what could be done to remove them. There was opportunity to revisit the work undertaken at
the December strategy day looking at the “Five Year Forward View” and forming multi-speciality
providers and at the Trusts “Living by Our Mission” strategy and how to make it a reality .
The senior management team then looked at the challenges falling out of the discussions
above and how we could meet them by doing things differently.
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Quality Seminars
The Trust held three Quality Seminars in 2014/15. The aim of the seminars was to encourage
staff to think differently about how they work and by doing things differently continually
improve the quality of care provided.
The first seminar was held in May 2014 and an external speaker Steve Head gave a very
engaging presentation centred around everyone making a 1% difference. Staff considered
what a gold standard service would look like and then what small things they could all do to
improve the quality of care they deliver.
They were asked to consider what they could stop doing that was not adding value to the
service, patients or helping colleagues and then what could they start doing that would.
They were asked to consider how they would deliver these changes and what the milestones
would be to success.
There were some excellent suggestions from staff and each member of staff made a pledge
to make one change that would improve the quality of care they provide and agreed to
review these pledges in three months’ time. The objective was to ensure that the outcome of
the seminar were real practical changes that made a positive difference to patient care and
experience.
All the quality seminars focused on considering existing practice, processes and systems
and challenging the way we currently provide care to encourage staff to think how they could
implement both immediate small practical changes and innovative transformation to improve
quality.
Health Improvement Programmes
Throughout 2014/15, Bridgewater has provided a comprehensive range of Health
Improvement services in ALW, Halton and St Helens. These services are provided by teams
which have diverse and specialist skills, and they work in close partnership with local
communities, voluntary and third sector organisations. The teams have a remit to enable
clients to improve their own health. Using motivational interviewing techniques, the health
improvement teams support clients to stop smoking, adopt healthier eating, reduce their
alcohol intake and engage more in their local community. Clients can self-refer to the services
but they are often signposted by other health professionals such as GPs, practice nurses,
Health Care Assistants and Bridgewater partners. The pathway through the service may be
directly attributed to a health check.
The services are delivered in many venues across the boroughs including GP surgeries, LIFT
buildings, libraries, Job Centres, community centres and workplaces ensuring easy access
for service users.
Examples of how these teams improve individual health are highlighted in the ‘Be clear on
cancer’ work streams (where awareness is raised about risks of developing cancer and how
to access services and support as soon as possible if people have signs and symptoms)
and weight management work streams (where teams support people to lose weight through
improved choices about diet, exercise and cooking, as well as working on motivation and
self-esteem). The teams work in novel ways to reach out to local communities – one example
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being a drama workshop to improve awareness of mental health issues is St Helens College.
Through drama, students were made aware of their own emotions and feelings, and how to
seek support without stigma. Feedback from students included comments that ‘It made me
realise I had felt like that’ and ‘It made me want help others’. The success of the project was
far reaching, such that consideration is being given to roll this out to local schools.
Midwifery (Halton)
Halton Midwifery Service continues to be the only midwifery service nationally based within
a community trust. The service delivers the full remit of pregnancy and postnatal care and a
home birth facility. In the past year we have booked 1,576 women for care during their
pregnancy, cared for approximately 1,600 women and their babies in the postnatal period.
There were 12 successful planned home births and the service responded and provided care
to 10 un-booked home births. The service provides care 365 days per year and has an on
call facility from 5pm-9am also across 365 days.
The pilot of the digital pens and electronic women held records finished in March and the
system went live in April 2014. All women booking with the service now have their personal,
clinical and midwifery information stored within a bespoke system which links with SystmOne.
There have been some teething problems which are addressed as they arise but overall the
system has been beneficial to the service, the woman, and the capture of clinical data across
the maternity episode.
Postnatally, babies details and clinical care is also recorded electronically which adds to the
capture of quality data available for the baby from birth which can be shared with other health
professionals providing continuing care e.g. health visitors and form the basis of a lifelong
medical record for the child in question.
Alongside the internal maternity dashboard, April 2014 saw the introduction of the external
Clinical Commissioning Group ‘maternity dashboard’ into the service. The purpose of both
dashboards is to monitor clinical effectiveness, safe staffing and patient experience across
the service. Data is inputted monthly and RAG rated (red, amber, and green) so that trends
can be monitored and action plans produced. There are plans to amalgamate both
dashboards in the forthcoming year and a change will be made to the smoking data with all
women who smoke being referred to the smoking cessation service rather than the present
opt in referral. This is in line with the forthcoming care bundle for reducing stillbirths nationally.
User feedback is collected using the ‘friends and family’ criteria at the antenatal and
postnatal touch points. A service specific user questionnaire was distributed in June 2014
and we received 399 completed questionnaires over a four week period from 500 distributed.
Women were asked to answer 13 questions including two demographic questions and were
asked for comments at the end of the questionnaire.
99.74% of respondents felt:
• They had continuity of care
• The information given was delivered in a professional manner
• They had a chance to ask questions and
• That their questions were addressed satisfactorily.
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Comments such as ‘found all staff helpful and approachable’ and ‘very good professional
care very impressed’ were warmly received by the staff. The exercise will be repeated again
in June 2015.
Local Supervising Midwifery Report (Halton and St Helens Division)
The annual Local Supervising Audit was carried out in October 2014 and once again all the
standards were met. There were some recommendations from the visit which have been
incorporated into an action plan which is reviewed at the six weekly supervisor of midwife
meetings and both the plan and the progress will be presented at the next audit visit in
November 2015.
Alongside the trust mandatory training, midwives must complete specific midwifery updates
on a yearly basis and this training is delivered within the service with input from transfusion
services and midwifery lectures at Edge Hill. A bespoke community based emergency skills
and drills package is accessed annually by each midwife within the service to maintain
competency in emergency situations.
Community Dental
The Community Dental Service (CDS) in Bridgewater is commissioned to provide a range of
dental care in Greater Manchester, Merseyside and Cheshire as well as some public health
activity in conjunction with a number of local authorities. The key performance indicator
dictates that 95% of referrals to the service are seen within 20 working days. The service
continues to meet this target.
One of the key roles of the CDS is to provide dental care for people with severe disabilities.
Over the past year the CDS has prioritised gaining feedback from patients with disabilities
and their carers in order to provide a dental service which meets their specific needs. The
CDS now has a member of staff who has volunteered to be a ‘Disability Champion’ in each
area. They are tasked with making contact with local disability groups to seek their views on
what the ideal dental service for people with disabilities should look like.
As a result of the information gained by the Disability Champions sensory toys have been
purchased for children to play with in the waiting room and projectors to project images onto
the ceiling to distract patients during treatment. Large changing mats are now available in all
dental clinics for patients who require them.
Feedback from carers of patients with autism has resulted in staff accessing an e-learning
package from the National Autistic Society and a presentation about the effects of autism on
dental health and dental care is being rolled out to all staff. Visual communication aids have
been developed to assist communication between patients who have autism and the dental
staff.
Feedback from dental network staff revealed they needed more training on general aspects
of disability. Training sessions on person centred care for people with disabilities are now
being rolled out to dental staff.
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Walk-in Centres
The Department of Health‘s (DH) Operating Framework sets out the national clinical quality
indicators for Accident and Emergency Departments (A&E) including walk-in centres.
The Trust has three walk-in centres in Leigh, St Helens and Widnes which provide treatments
for minor ailments.
Walk In Centre
Indicator
Target
BW
Leigh
St Helens
Widnes
Percentage of patients seen in less than 4
hours
<=95%
99.77%
99.56%
99.91%
99.76%
Time to treatment decision (median value)
<=60 mins
00:19:34
00:19:26
00:20:44
00:18:02
Unplanned re-attendance %
<=5%
0.2%
0.7%
0.0%
0.1%
Left without being seen %
<=5%
0.7%
0.3%
0.7%
1.1%
The Trust and three centres have achieved their targets throughout 2014/15.
Out of Hours
The Out of Hours Services provide medical assistance by offering telephone advice from
GPs and from nurses along with face to face consultations either at home or in a primary
care centre. The Trust has two Out of Hours services, one in Wigan and one in Warrington.
From 1st January 2005, all providers of GP Out of Hours (OOH) Services are required to
comply with the National Quality Requirements (NQR) first published in October 2004.
The services report quality standards dependent on their agreed service specification and
performance.
This year’s data shows an improvement in compliance for both services.
It should be noted, that due to the low numbers reported in some quality requirements
individual breaches can make a significant difference to compliance levels.
Actions are in place to further strengthen performance and create greater resilience within
the service. The service is constantly reviewing and amending the service model to better
meet demand performance and quality to improve the patient experience.
Out of Hours Services are required to be compliant against a set of national targets. The
Trust has gradually improved its performance against the targets throughout 2014/15,
however the cumulative position is described in the table below:
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Quality Requirements description
QR01 Regularly reporting of Quality Standards
QR02 Clinical details sent before 8;00
QR03 Patients with defined needs
QR4
Clinical Audit complete
QR5
Patient Experience
QR8a
Engaged Calls
QR8b Abandoned Calls
Targets
Wigan
Warrington
Compliant
Compliant
Compliant
100%
97.91%
96.18%
Compliant
N/A
Compliant
100%
N/A
100%
1%
N/A
Compliant
0.10%
N/A
0.00%
5%
N/A
2.30%
QR8c
Answered with 50 seconds
100%
N/A
94.76%
QR9a
Emergency Care Requiring Ambulance
100%
N/A
100%
100%
N/A
89.83%
100%
N/A
90.28%
QR12a PCC Emergency Appointment within 60 minutes
100%
100%
100%
QR12b PCC Urgent appointment within 120 minutes
100%
93.02%
91.38%
QR12c PCC Routine appointment within 360 minutes
100%
99.42%
98.43%
QR12a Visit Emergency appointment within 60 minutes
100%
N/A
90.00%
QR12b Visit Urgent appointment within 120 minutes
100%
89.51%
88.59%
QR12c Visit Routine appointment within 360 minutes
100%
97.85%
96.26%
QR12a Telephone Emergency appointment within 60 minutes
100%
98.80%
N/A
QR12b Telephone Urgent appointment within 120 minutes
100%
99.41%
N/A
QR12c Telephone Routine appointment within 360 minutes
100%
99.94%
N/A
Compliant
Compliant
Compliant
QR9b Urgent Care requiring call within 20 minutes
QR9c
Routine Care requiring call within 60 minutes
QR13 Interpretation Services within 15 minutes of initial contact
Compliant
Non Compliant
Partially Compliant
Not applicable
Waiting Times
The Trust monitors and reports on the length of time between a patient’s referral to one of our
services and when the treatment is received by the patient.
Waiting Times - Consultant Led Services
Consultant-led services are those where a consultant retains overall responsibility for the
clinical care of the patient.
The completed Referral to Treatment (RTT) pathway is a true indicator of the length of time
between referral and the start of treatment.
Bridgewater Quality Account 2014/15
84
Bridgewater Consultant-led Services
Referral to Treatment Times
April 2014 to March 2015
Number of waiters
1000
900
800
700
600
500
400
300
200
100
0
Apr-14 May-14 Jun-14 Jul-14
Aug-13 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar15
< 11 weeks
11-17 weeks
> 18 weeks
At the end of 2014/15 the Trust had a total of 782 patients waiting for consultant-led services.
Waiting Times - All Services
The Trust measures the time that has elapsed between receipt of referral to the start of
treatment and applies the national target of 18 weeks to all its services. Below are patient
waiting times reported at the end of each month for all Bridgewater services (2014/15).
All Bridgewater Services with Waiting Lists
Waiting Times April 2014 to March 2015
Number of waiters
14000
12000
10000
8000
6000
4000
2000
0
Apr-14 May-14
Jun-14 Jul-14
< 11 weeks
Aug-14 Sep-14 Oct-14
11 - 17 weeks
Nov-14 Dec-14
> 18 weeks
Jan-15 Feb-15 Mar15
At the end of 2014/15 the Trust had a total of 10,769 patients waiting for all services. Of these
9,827 (91.25%) were waiting under 11 weeks.
Bridgewater Quality Account 2014/15
85
Cancer Services
The Trust delivers community based cancer services to patients living in the Warrington area
which is commissioned by Warrington CCG.
The table below demonstrates that the Trust has been meeting and overachieving against the
Referral to Treatment and cancer targets throughout 2014/15
Waiting Times
All cancers: 31-day wait for second or subsequent treatment (Surgery)
All Cancers: 62-day wait for first treatment (From urgent GP referral to
treatment)
All cancers: 31-day wait (From diagnosis to first treatment)
All cancers: 2 weeks wait from referrals to date first seen
Thresholds
94%
Full Year 14/15
100.00%
Achieved?
P
85%
98.65%
P
96%
93%
98.36%
99.52%
P
P
Compliance against Targets
Referral To Treatment time is the length of time between a patient’s referral to one of our
services to the start of their treatment.
The NHS Constitution gives patients the right to:
• Start your consultant led treatment within a maximum of 18 weeks from referral for
non-urgent conditions
• The Trust also aspires to meeting the 18 week pledge for all other services
• Be seen by a cancer specialist within a maximum of two weeks from GP referral for
urgent referrals where cancer is suspected
• Start your AHP led treatment within a maximum of 18 weeks from referral for
non-urgent conditions.
The Trust achieved all its quarterly monitored national targets for waiting times during
2014/15.
Performance against Referral to Treatment (RTT) waiting time targets
As part of the national requirements the Trust is required to report on the length of time
between referral to a Consultant-Led service and the start of treatment being received. The
following table demonstrates our compliance against the 18 week RTT target of 95% for
completed pathways.
Consultant-Led Services
Referral To Treatment
(completed pathways)
Referral to treatment 18 week compliance (95th percentile) Full year
Referral to treatment 18 week compliance (% under 18 weeks) Full year
Thresholds
Full Year 14/15
Achieved?
<18.3
95%
15.83
97.0%
P
Within 2014/15 the Trust met and exceeded the 95% threshold set.
Bridgewater Quality Account 2014/15
86
Foundation Trust Application
The Trust has now completed Monitor’s foundation trust (FT) application process. Following
the findings of the Care Quality Commission’s (CQC) inspection carried out in February 2014,
the Trust was able to progress to the final stage of the FT application process, and
re-engaged with Monitor in June 2014.
During this final stage, Monitor’s assessment team visited the Trust to conduct on-site
interviews with the Board of Directors, clinical staff, our Governors and partner agencies.
Following this rigorous process, the Trust Board met with Monitor’s Board in London on 9th
September 2014 and on 1st November, Bridgewater was one of the first two community
trusts to be awarded an FT licence.
Monitor Regulation
Now that the Trust has attained FT status, it is subject to the routine annual planning and
reporting requirements set out by Monitor, as part of their on-going regulation of foundation
trusts.
Each year, Monitor sets out the annual planning and reporting cycle that details the actions
and submissions that the Trust must make to maintain its FT licence. The required
submissions include detailed information on finance and activity, contracts and performance,
and a comprehensive operational plan that sets out the Trusts intentions for the coming
financial year.
Performance against the Risk Assessment Framework is set out below.
Risk Assessment
Framework 2014/15
Q1
Q2
Q3
Q4
n/a
n/a
4
4
n/a
n/a
Green
Green
Continuity of Service Rating
Governance Rating
Continuity of Service Rating score of 4 - Monitor will generally take no action beyond
continuing to monitor the licence holder.
Governance Rating of Green – No governance concern is evident or where Monitor are not
currently undertaking a formal investigation.
Bridgewater Quality Account 2014/15
87
Council of Governors
The Trust has a Council of Governors which consists of both elected and appointed
governors. Throughout this first year of operation as a foundation trust, the Council of
Governors’ role has been developing. Governors have provided a valuable input to quality
visits to a number of services this year, bringing their ‘lay’ perspective to bear in improving
service delivery. They have undertaken considerable outreach to local communities,
increasing the membership and promoting the work of the Trust. More formally, the
governors were engaged in the stakeholders sessions as part of the appointment of a new
Chief Executive Officer, and have commenced the process of recruiting new non-executive
directors.
The Trust was already operating a Council of Governors in shadow form, following elections
in September 2013, in preparation for becoming a foundation trust. Following authorisation,
formal Council of Governor meetings were held in November 2014, December 2014 and
March 2015.
The Council of Governors comprises a total of 33 Governor seats, of which 18 are elected
Public Governors, nine are elected Staff Governors and six are appointed Partner Governors.
The Council is chaired by the Trust’s Chairman and the Lead Governor.
Monitoring the Quality of Services across Bridgewater
Board and Sub-Committees
The Board and Sub-Committee structure of the Trust is illustrated below.
Audit
Committee
Investment
Committee
Quality and
Safety
Committee
BOARD
Trust
Effieciency
Assurance
Committee
Nominations
and
Renumerations
Local
Negotiating
Committee
During 2014/15 the Quality Management Group, as a sub-group of the Quality and Safety
Committee (QSC), was established as an operational group to facilitate discussion on all
quality related issues e.g. incidents, risks, CQC compliance, new national initiatives e.g. Sign
up to Safety and presentations from the directorates regarding key service delivery and
staffing priorities. This group includes key senior managers to ensure that any identified
barriers to the provision of quality care are addressed in a timely manner and escalated to
the QSC as appropriate. This group has enabled the Trust to proactively manage and
challenge the quality agenda.
Bridgewater Quality Account 2014/15
88
Quality Impact Assessment Process
Quality Impact Assessments (QIA) are carried out to review all cost improvement programme
(CIP) schemes, to ensure there are no negative impacts to the quality of services.
The QIA panel has been established to oversee the Trust’s QIA process. It provides
assurance that there is a robust QIA process for all CIP schemes. It reports internally to both
the Quality and Safety Committee quarterly and the Trust Efficiency Assurance Committee
(TEAC) on a monthly basis and externally to the Clinical Commissioning Groups.
Action taken to Address Francis Report Recommendations
The Trust undertook an assessment of the 290 recommendations in the Francis 2 report
which were then categorised into 26 objectives for the Trust in 2014/15. The Trust has
monitored this action plan with regular updates to the Board and the four Clinical
Commissioning Groups. This is now normal business of the Trust and the Quality Strategy
will provide further framework to embed quality into the Trust culture.
Action taken to Address Freedom to Speak Up Recommendations
The Trust has undertaken a gap analysis against the Freedom to Speak Up – Review of
whistleblowing in the NHS, which during 2015/16 will be developed into an action plan and
will be monitored by the Quality and Safety Committee.
Sign up to Safety
Sign up to Safety is designed to help realise the ambition of making the NHS the safest
healthcare system in the world by creating a system devoted to continuous learning and
improvement. This ambition is bigger than any individual or organisation and achieving it
requires us all to unite behind this common purpose. We need to give patients confidence
that we are doing all we can to ensure that the care they receive will be safe and effective at
all times.
Sign up to Safety aims to deliver harm free care for every patient, every time, everywhere. It
champions openness and honesty and supports everyone to improve the safety of patients.
Patient safety is a top priority at Bridgewater Community Healthcare Foundation Trust. We
have signed up to the ‘Sign up to Safety’ initiative, which is designed to help realise the
ambition of making the NHS the safest healthcare system in the world. We have developed
our patient safety improvement plan for 2015/16 based on the Sign up to Safety actions and
we have committed to the five Sign up to Safety pledges (please see Priorities for
Improvement in 2015/16 section for further details).
Open and Honest Care (previously known as the
Transparency Project)
From April 2014 the Trust was the only Community Trust to publish Open and Honest data.
The data published relates to pressure ulcer data as collected as part of the NHS Safety
Thermometer. We also publish data relating to staff and patient experience, including patient
stories submitted to the Board and lessons learnt by the Trust. It is envisaged that it will
Bridgewater Quality Account 2014/15
89
support patient choice, enhance staff knowledge and lead to changes in both clinical
practice and organisational culture which is seen as fundamental to good patient care.
The Trust has worked with the national team to further develop the work and look at how
further areas of care can be reported on.
NHS Safety Thermometer
The NHS Safety Thermometer is a national improvement tool for measuring, monitoring
and analysing patient care and “harm free” care. It provides a quick and simple method for
surveying patient harms and analysing results so that we can measure and monitor local
improvement and harm free care over time.
The Trust has been compliant with submission of this data during 2014/15.
Bridgewater Sample Size
This table illustrates the size of the population that contributed to the point prevalence
monthly monitoring.
Bridgewater
Sample Size
March April May
-14
-14 -14
June
-14
Jul
-14
Aug
-14
Sep
-14
Oct
-14
Nov
-14
Dec
-14
Jan
-15
Feb
-15
Mar
-15
1025 940 981 1197 951 970 1134 1044 981 1085 966 1050 964
Percentage of Harms (New)
This table demonstrates that for 11 months of 2014/15, the Trust reported a below national
average position for new harm caused by the Trust during a patient’s episode of care.
Percentage
of harms
(New)
Mar
-14
Apr
-14
May
-14
Jun
-14
Jul
-14
Aug
-14
Sep
-14
Oct
-14
Nov
-14
Dec
-14
Jan
-15
Feb
-15
Mar
-15
National
2.57%
2.53%
2.51%
2.46%
2.34%
2.47%
2.42%
2.42%
2.32%
2.26%
2.40%
2.36%
2.32%
Bridgewater
Community
NHS
Foundation
TrustTrust
3.02%
2.02%
1.12%
2.34%
0.95%
1.96%
1.94%
1.15%
1.73%
2.12%
1.66%
1.81%
1.04%
Percentage of Harm Free
This table demonstrates that for 12 months of 2014/15, the Trust reported an above national
average position for patients who had received harm free care during their episode of care.
Percentage
of harms
(New)
Mar
-14
Apr
-14
May
-14
Jun
-14
Jul
-14
Aug
-14
Sep
-14
Oct
-14
Nov
-14
Dec
-14
Jan
-15
Feb
-15
Mar
-15
National
93.62%
93.56%
93.50%
93.59%
93.82%
93.66%
93.72%
93.87%
93.88%
94.07%
93.82%
93.72%
93.96%
Bridgewater
Community
NHS
Foundation
TrustTrust
94.44%
95.21%
96.02%
95.82%
96.42%
94.95%
95.41%
96.46%
95.11%
96.13%
94.51%
94.95%
95.02%
Bridgewater Quality Account 2014/15
90
Internal Audit
During the past year our internal auditors (Mersey Internal Audit Agency) have undertaken a
series of reviews of various aspects of services. Below is a table indicating the reviews
undertaken and the assurance levels given.
High Assurance - Some low impact control weaknesses found which, if addressed would
improve overall control. However, these weaknesses do not affect key controls and are
unlikely to impair the achievement of the objectives of the system.
Significant Assurance - There are some weaknesses in the design and/or operation of
controls which could impair the achievement of the objectives of the system, function or
process. However, either their impact would be minimal or they would be unlikely to occur.
Limited Assurance - There are weaknesses in the design and / or operation of controls
which could have a significant impact on the achievement of the key system, function or
process objectives but should not have a significant impact on the achievement of
organisational objectives.
REVIEW TITLE
ASSURANCE LEVEL
Emergency Preparedness Review
Objective: To review and evaluate the arrangements in place within the Trust in relation to
Emergency Preparedness systems and procedures.
Significant
General Ledger
Objective: The financial ledger records all financial transactions of the organisation and
ensures their completeness and integrity, with the aim of providing the basic data from which
management accounts, financial accounts and statutory returns can be prepared.
Significant
Income & Debtors
Objective: All income due to the organisation is properly identified, collected and accounted
for under management control and management receives timely and adequate information to
control this.
Significant
Non Pay Expenditure
Objective: All goods and services are ordered promptly by authorised officers, are available
when required are of an appropriate quality, and the correct payment is made to the
correct payee at the most appropriate time and is properly accounted for in the organisation’s
records. Significant
Treasury Management
Objective: Ensuring that the financial stability of the organisation is attained and then
constantly monitored and maintained to enable the organisation to meet its business plan.
Significant
SystmOne & IG Governance Arrangements
Objective: To provide an opinion on the adequacy of the governance framework implemented
around the SystmOne application with reference to the best practice standards such as the
NHS Information Governance Toolkit.
Significant
Recruitment Processes Follow Up
Objective: To provide an update against the position reported to the April 2014 Audit
Committee meeting on the progress of recommendations made in respect of the 2013/14
review of Recruitment Processes.
Significant
Serious Untoward Incidents (SUIs) Follow Up
Objective: To provide an update on the progress of implementation of recommendations
made in the 2013/14 SUI review and provide an analysis of the level of agreement with the
recommendations made. Significant
Bridgewater Quality Account 2014/15
91
REVIEW TITLE
ASSURANCE LEVEL
New Domain Review
Objective: To provide an opinion on the design, effectiveness and coverage of the
arrangements in place to protect and manage the new Microsoft Domain and the system, data
and user resources under its control. Significant
Information Governance (IG) Toolkit
Objective: To provide an opinion on the adequacy of policies, systems and operational
activities to complete, approve and submit the IG Toolkit scores. We also provided an opinion
on the validity of the scores based on the evidence available.
Significant
Safeguarding Follow Up Review
Objective: To provide an update against the position reported to the February 2015 Audit
Committee meeting on the progress of recommendations made in respect of the 2014/15
review of Safeguarding. Significant
Telephony (VOIP) Review
Objective: To provide an assessment of the effectiveness of the control framework being
exercised by management over the telephone systems and highlight improvements where
appropriate. Limited
Safeguarding Review (Superseded by Follow Up)
Objective: To The overall objective of the review was to assess the systems and processes in
place across the organisation to ensure compliance with safeguarding statutory requirements
and guidance.
Limited
Data Consistency Phase I Review
Objective: To ensure that the Trust has robust systems and processes in place for collecting
and recording activity data to support the complete and accurate reporting of activity data to
Trust Board in accordance with national definitions and requirements. Limited
Network Infrastructure Review
Objective: To provide an assessment of the risks associated with the adequacy and
effectiveness of the network infrastructure (such as distributed cabling, switches, routers,
firewalls and monitoring tools) and associated control framework, that provides responsive
and resilient connectivity between users, key systems and data storage across the Trust’s
managed estate as well as external connections.
Limited
Financial Systems Technical Security Review
Objective: To provide an assessment on the effectiveness of the technical security control
framework being exercised by management over Financial Systems including Excel
spreadsheets created in-house and highlighting opportunities for improvement, where
appropriate.
Limited
School Nursing Service Review
Objective: To provide an opinion on the controls and systems in place at a local level, focusing upon the School Nursing Service.
Limited
20 Working Day Dental Target
Objective: To ensure there are adequate systems and controls in place to deliver the 20 day
dental target.
Limited
Specialised Services Governance Arrangements Review
Objective: To provide assurance that the governance arrangements in place and operating
within the Specialised Services directorate are in line with the Trust’s accountability
framework.
ESR (HR / Payroll) Review
Objective: To provide an assessment of the effectiveness of the systems of control operating
at the Trust to ensure that only employees of the organisation are paid, and only for work that
they perform on behalf of the organisation.
Bridgewater Quality Account 2014/15
92
Limited
Limited
Detailed action plans have been developed in response to all recommendations from the
MIAA reports, regardless of the overall level of assurance, and will be monitored by the Audit
Committee and the Quality and Safety Committee with follow up visits planned by MIAA
during 2015/16 to receive updates and assurance that these have been addressed.
The Audit Committee was in receipt of full reports and progress reports on all of the audits
and recommendations during 2014/15.
Stakeholder Involvement in the Development of our Quality Account
Opportunity to Shape the Content of our Quality Account
Prior to our quality account being drafted our Chief Executive wrote to our Clinical
Commissioning Group’s and Local Authorities requesting their input into the content of the
account. A number of suggestions were received regarding content and our 2015/16 quality
improvement priorities which have been addressed during the development of the account.
Stakeholder feedback
We sent out our draft Quality Account to our stakeholders inviting them to comment on
whether or not they considered the document to be accurate in relation to services provided.
All of the responses have been included in our account.
Wigan
Healthwatch Wigan Stakeholder Feedback
Healthwatch Wigan (HWW) welcome this Quality Account for 2014/15 and would like to
congratulate the Trust and all the staff at Bridgewater on becoming one of only two
Community Trusts to achieve Foundation status. HWW would also like to acknowledge the
hard work of staff at all levels of the Trust in maintaining and, in many areas, improving the
services delivered to the people of Wigan.
HWW recognises the work done by the Board in the past year to improve staff engagement
and improve staff morale and we look forward to seeing this work continuing to enable further
improvement to the services being delivered by Bridgewater. HWW would like to encourage
the Trust to continue to use ‘Patient Stories’ as a way of illustrating the patient experience
to the Board but would like to see a negative story used occasionally, one where perhaps
services were not up to the standards required by the Trust. We feel that these will help the
Board to understand the patient experience even better.
HWW would like to see included in the 1st Priority a statement about the Trust having a ’no
blame culture’ in order for staff to feel able to report all incidents and admit mistakes
regardless of fault and to learn from them.
HWW would like to see some explanation in the report of some of the results recorded e.g.:
• Why the Breast feeding rates at 6-8 weeks have fallen
Bridgewater Quality Account 2014/15
93
•
•
Why the take up of Personal Development Reviews amongst Corporate Staff was only 50%
Whilst HWW recognises the work the Trust is doing to stop patients going to A&E by the introduction of the Northwest Ambulance Service (NWAS) Pathfinder Service which has diverted patients to the Leigh Walk-in Centre, we would like to see a breakdown of patient outcomes when using the Out of Hours Service in Wigan.
HWW would like to see a report included in the account about the work, if any, the Trust is
doing with the Voluntary Sector in Wigan to enhance the patient experience.
Finally HWW would like to congratulate the Wigan Continence Care Service on receiving the
Continence Care Team award at the inaugural National Continence Care Awards in London
and the Wigan District Nurse Liaison Team on the work they are doing to improve the
‘discharge experience’ for patients at the Royal Albert Edward Infirmary.
Martin Broom
Director, Healthwatch Wigan
Bridgewater Quality Account 2014/15
94
Wigan Borough Clinical Commissioning Group Response to Bridgewater
Community Healthcare NHS Foundation Trust Quality Account 2014/2015
Wigan Borough Clinical Commissioning Group (the CCG) appreciates the opportunity to
comment on the Annual Quality Account for Bridgewater Community Healthcare NHS
Foundation Trust.
Firstly the CCG would like to congratulate the Trust on being one of the first two NHS
Community Trusts to have been awarded Foundation Trust status. The CCG also
welcomes and recognises the progress that the Trust has made in respect of their
2014/2015 quality priorities.
Notable successes have included for example; the work undertaken on developing the
‘Open and Honest Care’ programme with Patient Stories presented to the Trust Board on
a monthly basis and the related work to improve the accuracy of Pressure Ulcer reporting
across the Trust. The CCG also recognises the improvement in the Patient Experience
scores from 98% at the end of 2013/2014 to 99% at 2014/2015. However there are areas
where further improvement is required; and the CCG requests that the Trust seeks to
improve its governance arrangements in relation to the investigation and learning from
Serious Incidents (SIs). In addition the Trust should also actively seek to improve their
reporting of Patient Safety Incidents (PSIs) with no or low harm as a consequence to the
National Reporting and Learning System (NHS NRLS). This will assist to provide
assurance that the Trust is a learning organisation.
The quality priorities for 2015/2016 inclusive of engagement with; the National Campaign
‘Sign up to Safety’ and the NHS Safety Thermometer Improvements in Care will assist to
shape and support the future improvements to improve the quality, safety and experience
of the care provided by the Trust services.
The CCG will also support the Trust to deliver safer, effective and caring healthcare
through the agreed Commissioning for Quality and Innovation (CQUIN) Schemes for
2015/2016 to incentivise quality improvements for example; in Frail Elderly Care; Out of
Hours Antibiotic Stewardship and Patient Safety.
The CCG looks forward to continuing to work with the Trust during the coming year, to
build on the progress made and to provide continued support to the planned initiatives that
will seek to improve the quality of care and outcomes for the resident population of the
Wigan Borough.
Dr Tim Dalton, Chairman, Wigan Borough Clinical Commissioning Group
May 2015
Bridgewater Quality Account 2014/15
95
Bridgewater Quality Account 2014/15
96
Kate Fallon
Chief Executive
Bridgewater Community Healthcare NHS Trust
Bevan House
Smithy Brook Road
Pemberton
Wigan, WN3 6PR
Our Ref
EST
If you telephone Emma Sutton-Thompson
please ask for
Your ref
th
Date
20 May 2015
E-mail address
Emma.Sutton-Thompson
@halton.gov.uk
Dear Kate,
Our Ref
EST
Kate Fallon
Quality
Accounts 2015
Chief Executive
If you telephone Emma Sutton-Thompson
Bridgewater Community Healthcare NHS Trust please ask for
Further to receiving a copy of your draft Quality Accounts
and the Joint Quality Accounts
Bevan House
event held on 13th May that your colleague Dot Keates
attended
to present a summary of
Your ref
Smithy
Brook
Road
your
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I am writing with the Health Policy and Performance
Board
th
PembertonThe Health Policy and Performance Board
20 May
Dateparticularly noted
comments.
the2015
following key
Wigan, WN3 6PR
areas:
E-mail address Emma.Sutton-Thompson
@halton.gov.uk
During the year 2014/15 the Trust identified a number of priorities to be achieved during
this year. The Board were pleased to note that the majority of the targets for this year
were achieved which is extremely good. The three areas that were not achieved, have
Dearput
Kate,
been
against the priorities for this year and the Board look forward to also seeing
improvements in these quality areas.
Quality Accounts 2015
The Board noted that the staff survey on recommending the Trust as a place to work or
Further
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“you said, we did” cascades.
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this
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were achieved which is extremely good. The three areas that were not achieved, have
been put against the priorities for this year and the Board look forward to also seeing
improvements
these quality
areas.noted that the Trust aims to deliver harm free care
 ‘Sign up toinSafety’
– the Board
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year. The Board understand that the large organisational changes that have taken place
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will affect people’s morale and perceptions, and hopefully this will improve over time. The
interested to see a reduction in avoidable pressure ulcers in the coming year.
Board are pleased to see the action plan that has been implemented to make
improvements
in this area, in particular the professionals forum, monthly team brief and
Communities
Directorate
“you
said,
we
did”
cascades.
Runcorn Town Hall, Heath
Road, Runcorn, Cheshire WA7 5TD
The Board note that the
priorities for next year were all centred around safety and felt that
Tel: 0151 907 8300
other areas to be considered were effectiveness and lessons learnt.
The Board are pleased to note the additional Improvement Priorities for 2015 – 2016:
The Board would like to thank Bridgewater Community Healthcare NHS Trust for the
opportunity to comment on these Quality Accounts.
 ‘Sign up to Safety’ – the Board noted that the Trust aims to deliver harm free care
for every patient, every time, everywhere and to champion openness and honesty
Yours sincerely,
to improve the safety of patients.
 Improvement in the handling of serious and untoward incidents
Councillor Joan Lowe
Communities Directorate
Chair,
Health Policy and Performance Board
Runcorn Town Hall, Heath Road, Runcorn, Cheshire WA7 5TD
Tel: 0151 907 8300
Bridgewater Quality Account 2014/15
97
Esther Kirby
Director of Nursing and Quality
Bridgewater Community NHS Foundation Trust
28th May 2015
Re: QA Bridgewater 14-15 JS
Dear Esther
First Floor
Runcorn Town Hall
Heath Road
Many thanks for the submission of the Quality Account for 2014-2015 and for the presentation
to
Runcorn
local stakeholders on 13th May 2015. This letter provides the response from NHS Halton Clinical
Cheshire
Commissioning Group to the Quality Account 2014-2015.
WA7 5TD
Re Quality Account 2014-2015
NHS Halton CCG understands the pressures and challenges for trust and the local
health
economy
Tel:
01928
593479
in the last year and would like to congratulate and thanks the Trust for the level
of
partnership
www.haltonccg.nhs.uk
working and support with NHS Halton CCG in this year in relation to the Urgent Care centre
developments. We also note the excellent collaborative work with your staff and managers in relation
to the review
Esther
Kirby of community nursing services in Halton and the support given by both your staff and
the localofmanager
theQuality
development of a new specification for these services for 2015-2016. The
Director
Nursing in
and
work
has
enabled
a
high
levelFoundation
of engagement
Bridgewater Community NHS
Trustwith your staff locally and has without doubt enabled
greater integration across the health economy in particular with General Practice and Local authority
social care.
28th May 2015
As you are aware NHS Halton CCG worked closely during 2014-2015 with the co commissioners
NHS
StBridgewater
Helen CCG 14-15
for Contracting
and Quality arrangements through which all indicators and
Re:
QA
JS
First Floor
CQUINs schemes were reviewed and monitored. The arrangements for 2015/2016Runcorn
contractTown
year Hall
will
be slightly
links
Dear
Estherdifferent with Halton leading on its own contract but we will continue to have close
Heath
Road
with other commissioners of your services in an effort to standardise expectations and ways of
Runcorn
workings.
year the
trust has made excellent progress in the delivery of quality improvements
Re
Quality This
Account
2014-2015
Cheshire
with some excellent work in relation to improvements in pressure ulcer prevention and management
WA7 5TD
whichthanks
are now
fully embedded
the trust.
Many
forbeing
the submission
of theinQuality
Account for 2014-2015 and for the presentation to
Clinical
local stakeholders on 13th May 2015. This letter provides the response from NHS Halton
Tel: 01928
593479
NHS Halton CCG
would
to congratulate
trust on the hard work of its staff
and their
Commissioning
Group
to like
the Quality
Accountthe
2014-2015.
www.haltonccg.nhs.uk
commitment to the care of the people of Halton. In this year we have seen significant improvements
in integrated
care to
frail elderlythe
patients,
those
with
long termfor
conditions
witheconomy
complex
NHS
Halton CCG
understands
pressures
and
challenges
trust andand
the children
local health
inneeds
the last
year are
andlooked
would after
like tothrough
congratulate
and thanks
the Trust The
for the
level of from
partnership
or who
local CQUIN
programmes.
outcomes
these
working
and support
withexcellent
NHS Halton
CCGstaff
in this
year
in relation
Urgent
Care centre in care
programmes
has been
and your
have
worked
hard to
to the
deliver
the improvements
developments.
We also notefor
thepatients
excellent
collaborative work with your staff and managers in relation
planning and management
locally.
to the review of community nursing services in Halton and the support given by both your staff and
the local manager in the development of a new specification for these services for 2015-2016. The
work
enabled
high level
engagementthe
with
your staff locally
and has without
doubt enabled
NHShas
Halton
CCG awould
like toofcongratulate
organisation
on achievement
of foundation
trust
greater
integration
thewe
health
economy
particular
with General
Practice and Local authority
status the
processacross
for which
understand
is in
both
challenging
and robust.
social care.
As
youHalton
are aware
Halton the
CCG
worked closely
during 2014-2015
with the
cobut
commissioners
NHS
CCGNHS
recognises
challenges
for all providers
in the coming
year
we look forward
NHS
St Helen
for Contracting
and Quality
arrangements
through
which all
and and
to working
withCCG
the Trust
during 2015-2016
to deliver
continued
improvement
in indicators
service quality
CQUINs
schemes were
reviewed
and
monitored.
Theasarrangements
for 2015/2016
contract
year
will
patient experience
and also
on the
partnership
work
we move forward
with our One
Halton
model
be
of slightly
service different
delivery. with Halton leading on its own contract but we will continue to have close links
with other commissioners of your services in an effort to standardise expectations and ways of
workings.
This year the trust has made excellent progress in the delivery of quality improvements
Yours sincerely
with some excellent work in relation to improvements in pressure ulcer prevention and management
which are now being fully embedded in the trust.
NHS Halton CCG would like to congratulate the trust on the hard work of its staff and their
commitment to the care of the people of Halton. In this year we have seen significant improvements
in integrated care to frail elderly patients, those with long term conditions and children with complex
Jan Snoddon
Chief Nurse/Quality Lead
NHS Halton CCG
Email jan.snoddon@haltonccg.nhs.uk
Bridgewater Quality Account 2014/15
98
Public Health Comments on Quality Accounts – May 2015
Bridgewater

Breastfeeding- More needs to be done across Halton to improve breastfeeding rates.
It was disappointing to note that the 6-8 week breastfeeding rates had got worse
since the previous year. However, it is encouraging to note that the Trust will continue
to focus on this issue over the coming year.

Dementia- Good to see that dementia targets for 14/15 were met.

Encouraging to note that falls management will form part of Quality Priority 3 for
2015/16. Halton has identified reducing the number of falls in the over 65s as part of
its Health and Wellbeing Strategy given the high rates of falls locally.

Health Inequalities and Inclusion Team- It is encouraging to note that the trust is
continuing to work on the issue of health inequalities locally. Given the increasing
health inequalities issue it is important to ensure that we continue to monitor services
to ensure they are accessible to all.

Encouraged to note the work that continues within the trust on Healthcare Acquired
Infections and the positive results this has achieved. It is also positive to note the
work that is continuing on outbreak control and steps that have been taken by the
Trust on Ebola.

Influenza vaccination for staff- it was disappointing to see that Halton had the lowest
vaccine uptake across Trust areas (45%). This is some way off the recommended
target of 75% set by the Department of Health. It would be good to see improvement
strategies in place to address this.

NICE Guidance Compliance- The report notes that in 2014/15, 25 pieces of NICE
guidance were published, however, the Trust is only fully compliant on 13. We do
however accept that action plans are in place to increase full compliance in all areas.

Audit of Growth and Nutrition Service- Whilst it is encouraging to note the decrease in
the number of children in the extreme obese category, the results show the need to
continue to focus on this important area, especially since Halton suffers from
particularly challenging rates of childhood obesity.

Childhood Immunisations- Whilst it is encouraging to see that vaccine uptake remains
high in Halton, there has been a slight reduction in a number of areas. Most of these
are very small, however, MMR uptake in 2014/15 has reduced by 2.5% from the
previous year. Whilst this still represents a modest reduction, it is still an area that
needs to be monitored to ensure it does not decrease further. Similarly, the uptake for
the Pneumococcal booster also reduced by 2.2% since last year.
Public and Environmental Health Department
Policy & Resources Directorate
Runcorn Town Hall, Heath Road, Runcorn, Cheshire, WA7 5TD
www.halton.gov.uk
Bridgewater Quality Account 2014/15
99
Esther Kirby
Executive Nurse
Bridgewater Community Healthcare NHS Trust
Bevan House,
17 Beecham Court,
Smithy Brook Road,
Pemberton,
Wigan.
WN3 6PR.
Dear Esther
 01925 843636
Re:
Quality
Account
2014-2015
Please
Ask
For: John
Wharton
Arpley House
110 Birchwood Boulevard
E-mail: john.wharton@warringtonccg.nhs.uk
25 843636
Many thanks for the submission of the Quality Account for 2014-2015, Arpley
and forHouse
the
Ask For: John Wharton
presentation to local stakeholders and the Local Area Team. This letter provides the Birchwood
response
from Warrington CCG to your Quality Account.
john.wharton@warringtonccg.nhs.uk
Warrington
th
WA3 7QH
Date:
26
May
2015
The account affirms the work that is being carried out by the trust and which is regularly
th
6 May 2015
Arp
110 Birchwood
Arp
B
W
www.warringtonc
discussed through the mechanisms which we have in place; www.warringtonccg.nhs.uk
contract monitoring, the
established strong focus on quality and the rigorous SUI process are all contributory factors to
ensure that both commissioner and provider are working collaboratively to improve care and
agree appropriate actions and monitoring when the patient experience has not been to the
Esther we
Kirby
standard
all aspire too. I believe that these forums continue to build on our relationship
and
cemented
our united approach to delivering high standards of health care to the local
Executive Nurse
population.
Bridgewater Community Healthcare NHS Trust
Kirby
Bevan House,
ve Nurse
Warrington
CCG welcomes the work delivered by the Trust in relation to improving patient
care
for the localNHS
population
and wishes to continue the healthy relationship that we have for
Beecham
Court,
water Community17
Healthcare
Trust
future planning of health care delivery. We also wish to congratulate you for the impressive
Smithy
Brook
Road,
House,
work
which
you have
carried out, particularly the intravenous therapy service which has
Pemberton,
impacted
on reducing the length of stay and avoiding admissions for Warrington residents.
cham Court,
The
CCG acknowledges the work undertaken to reduce pressure ulcers the year end position
Wigan.
Brook Road,
of 38% is an increase on the last two years, although it’s difficult to see what is attributable to
WN3 6PR.
rton,
Warrington
and understand the true impact of the work that has taken place this last year.
PR.
sther
uality Account
Warrington CCG also share your disappointment at not meeting your improvement target
regarding the prevention of the risk of future incidents, however acknowledges that this work
Dear
Esther
will
continue
and be built upon in your quality priorities for 2015/2016.
Warrington
CCG Account
welcomes the
feedback which you received from your Care Quality
Re: Quality
2014-2015
Clinical Chief Officer : Dr Andrew Davies MB ChB
Commission (CQC) and are pleased to see the trust declared compliance against the
identified compliance action. The inclusion of your planned Quality Priorities for 2015/16,
Many thanks
the and
submission
QualitytheAccount
2014-2015,
2014-2015
particularly
r sign up for
to safety
the continued of
focusthe
on improving
handling offor
serious
and
untoward incidents
is also
most welcome. and the Local Area Team. This letter provides
presentation
to local
stakeholders
and
the re
Warrington
CCG
to we
your
Quality
Account.
thanks for the Ifrom
submission
of the
Quality
forto 2014-2015,
for the
conclude by informing
you that
are Account
looking forward
working with the and
Trust throughout
ation to local stakeholders
andto the
Local
This
the
response
2015/16, helping
improve
the Area
quality Team.
and delivery
of letter
servicesprovides
for the local
population
and
ensuring
that
the
provider
is
working
towards
delivering
the
three
key
domains
of
the
CCG’S
affirms the work that is being carried out by the trust and which is re
arrington CCG toThe
youraccount
Quality Account.
quality strategy safety, effectiveness and experience remain at the heart of health care
discussed
through
the mechanisms which we have in place; contract monitorin
provision.
focus
on quality
rigorous
SUI process
are all contributory fac
count affirms theestablished
work that strong
is being
carried
out byand
thethe
trust
and which
is regularly
I
believe
that
this
is
an
accurate
and
honest
account
of
your
organisation
and
wish
to
that bothwhich
commissioner
are working
collaboratively
to improve ca
ed through the ensure
mechanisms
we haveand
in provider
place; contract
monitoring,
the
congratulate you on your work.
appropriate
when
the patientfactors
experience
has not been
shed strong focusagree
on quality
and the actions
rigorousand
SUImonitoring
process are
all contributory
to
standard
we
all
aspire
too.
I
believe
that
these
forums
continue
to
build
on our relat
that both commissioner and provider are working collaboratively to improve care and
Yours
sincerely
andand
cemented
our when
unitedthe
approach
deliveringhas
high
of health care to th
appropriate actions
monitoring
patient to
experience
notstandards
been to the
population.
d we all aspire too.
I believe that these forums continue to build on our relationship
mented our united approach to delivering high standards of health care to the local
Warrington CCG welcomes the work delivered by the Trust in relation to improving
ion.
care for the local population and wishes to continue the healthy relationship that we h
future
planning
of health by
care
also to
wish
to congratulate
gton CCG welcomes
the
work delivered
thedelivery.
Trust in We
relation
improving
patient you for the imp
John
Wharton
Chief
Nurse
&
Quality
Lead
work and
which
you to
have
carried
particularly
the intravenous
service whi
r the local population
wishes
continue
theout,
healthy
relationship
that we havetherapy
for
Warrington Clinical Commissioning Group
impacted
on
reducing
the
length
of
stay
and
avoiding
admissions
for
Warrington
res
planning of health care delivery. We also wish to congratulate you for the impressive
The CCG
acknowledges
the work
undertaken
to reduce
pressure
which you 100
have carried
out,
particularly the
intravenous
therapy
service
which ulcers
has the year end p
Bridgewater Quality Account 2014/15
of 38%
is an
increase
the lastadmissions
two years, for
although
it’s difficult
to see what is attribut
ed on reducing the
length
of stay
and on
avoiding
Warrington
residents.
and understand
the true
impactulcers
of thethe
work
that
hasposition
taken place this last ye
CG acknowledgesWarrington
the work undertaken
to reduce
pressure
year
end
is an increase on the last two years, although it’s difficult to see what is attributable to
T: 01744 624265
F: 01744 624188
Our Ref:
SC/JB / SC1211
2 June 2015
St Helens Chamber
Salisbury Street
Off Chalon Way
St Helens
WA10 1FY
Emailed: colin.scales@bridgewater.nhs.uk
Colin Scales
Chief Executive T: 01744 624265
St Helens Chamber
Bridgewater Community Healthcare NHS Foundation Trust
Salisbury Street
Bevan House F: 01744 624188
Off Chalon Way
17 Beecham Court
Our Ref:
SC/JB / SC1211
St Helens
Smithy Brook Road
St Helens Chamber
T: 01744
624265 WN3 6PR
Wigan
WA10 1FY
F: 01744 624188
2 June 2015 Salisbury Street
Off Chalon Way
Dear Colin
Emailed: colin.scales@bridgewater.nhs.uk
Our Ref:
SC/JB / SC1211
St Helens
Bridgewater Quality Accounts. WA10 1FY
Colin Scales
2 June 2015
Chief Quality
Executive
Following the recent
Accounts
presentation,
which unfortunately I was unable to
Emailed:
colin.scales@bridgewater.nhs.uk
Bridgewater
Community
Healthcare
NHS
Trust
attend, the following
observations
/ comments
were made
by Foundation
Sarah O’Brien
which I would like
Bevan
House
to formally feedback
to yourselves.
The presentation a good presentation, open and honest.
Colin Scales
Chief Executive
17 Beecham Court
Bridgewater
Community
Healthcare
NHS
Foundation
1. We
were pleased
toBrook
note
that
you had Trust
included Newton Hospital as a Quality priority for
Smithy
Road
Bevan House
2015-16 andWigan
look forward toWN3
working
with them on this.
6PR
17 Beecham Court
Smithy2.Brook
Road priority 2 for 2015-16 is relating to improvement in management of serious
Quality
Wigan
WN3 6PRDear Colin
Dear Colin
incidents. We recognise that Bridgewater have already made a lot of improvements this
year and would
like to see more
emphasis
in 2015-16 on learning lessons.
Bridgewater
Quality
Accounts.
3. AllQuality
3 quality
priorities for 2015-16 are very safety focused and it would be good to see
Bridgewater
Accounts.
Following the recent Quality Accounts presentation, which unfortunately I was unable to
some plans relating to experience and effectiveness.
attend, the following observations / comments were made by Sarah O’Brien which I would like
Following the recent Quality Accounts presentation, which unfortunately I was unable to
totoformally
feedback
to yourselves.
The
presentation
a good presentation, open and honest.
Listening
action/ comments
work
you have
a commenced
is excellent.
attend,4.the The
following
observations
were made
by Sarah O’Brien
which I would like
to formally feedback to yourselves. The presentation a good presentation, open and honest.
1.
1. back
Wethat
were
to note that
you
had out
included
Hospital
as a Quality priority for
5. Joe Banat fed
the pleased
work Bridgewater
have
carried
to dateNewton
to improve
access
2015-16
lookthis
forward
tobeHospital
working
with
them
on this.
We were
pleased
to note
that
you and
hadand
included
Newton
as
a Quality
priority
for
to Open
Minds
and
outcomes
should
included
in
the
quality
account.
2015-16 and look forward to working with them on this.
6. We suggested
could
have2 been
a bit more
included toin improvement
the document inabout
2. there
Quality
priority
for 2015-16
is relating
management of serious
2. Qualitysafeguarding
priority 2 forand
2015-16
is and
relating
toBridgewater
improvement
incarrying
management
of serious
staffing
what
outhave
in these
areasmade a lot of improvements this
incidents.
We
recognise
thatare
Bridgewater
already
incidents. We recognise that Bridgewater have already made a lot of improvements this
year
and
would
like
to
see
more
emphasis
in
2015-16
on learning lessons.
year and would like to see more emphasis in 2015-16 on learning lessons.
Yours sincerely,
3.forAll
3 quality
priorities
2015-16
very
and it would be good to see
3. All 3 quality priorities
2015-16
are very
safety for
focused
and itare
would
besafety
good tofocused
see
some plans relating to experience
and effectiveness.
some plans
relating to experience and effectiveness.
4. The Listening to action
have a commenced
is excellent.
4. work
Theyou
Listening
to action work
you have a commenced is excellent.
5. Joe Banat fed back that the work Bridgewater have carried out to date to improve access
5. Joe Banat
back
the work
to Open Minds and outcomes
and thisfed
should
bethat
included
in the Bridgewater
quality account.have carried out to date to improve access
to Open Minds and outcomes and this should be included in the quality account.
6. We suggested there could have been a bit more included in the document about
safeguarding and staffing
and what
Bridgewater
arecould
carryinghave
out in been
these areas
6. We
suggested
there
a bit more included in the document about
Cox safeguarding and staffing and what Bridgewater are carrying out in these areas
Clinical Chief Executive
Yours sincerely,
NHS St Helens CCG
cc
S O’Brien
L Spooner
Dr Stephen
Yours sincerely,
Working in partnership with
and
Dr Stephen Cox
Clinical Chief Executive
NHS St Helens CCG
Dr Stephen Cox
cc
S O’Brien
L Spooner Clinical Chief Executive
NHS St Helens CCG
cc
S O’Brien and
Working in partnership with
L Spooner
Working in partnership with
Bridgewaterand
Quality Account 2014/15
101
Appendix A
Children’s Immunisations for Quality Account
Bridgewater
Percentage of
immunisations
delivered on
schedule for
children reaching their
2nd birthday
Primary
13/14
14/15
Diphtheria
97.8%
97.7%
Tetanus
97.8%
97.7%
Pertussis (Whooping Cough)
97.8%
97.7%
Polio
97.8%
97.7%
Haemophilus Influenzae B
97.8%
97.4%
Meningitis C
97.6%
98.3%
Pneumococcal Booster
95.8%
94.7%
MMR
95.6%
94.2%
Primary
13/14
14/15
Diphtheria
97.6%
97.8%
Tetanus
97.6%
97.8%
Pertussis (Whooping Cough)
97.6%
97.8%
Polio
97.6%
97.8%
Haemophilus Influenzae B
97.6%
97.7%
Meningitis C
98.1%
98.3%
Pneumococcal Booster
95.6%
95.3%
MMR
95.3%
94.5%
Ashton, Leigh and Wigan
Percentage of
immunisations
delivered on
schedule for
children reaching their 2nd
birthday
Bridgewater Quality Account 2014/15
102
Appendix A (continued)
Children’s Immunisations for Quality Account
Halton and St. Helens
Percentage of
immunisations
delivered on
schedule for
children reaching their 2nd
birthday
Primary
13/14
14/15
Diphtheria
97.7%
97.4%
Tetanus
97.7%
97.4%
Pertussis (Whooping Cough)
97.7%
97.4%
Polio
97.7%
97.4%
Haemophilus Influenzae B
97.7%
96.8%
Meningitis C
96.9%
98.9%
Pneumococcal Booster
96.5%
94.3%
MMR
96.3%
93.8%
Primary
13/14
14/15
Diphtheria
98.3%
98.1%
Tetanus
98.3%
98.1%
Pertussis (Whooping Cough)
98.3%
98.1%
Polio
98.3%
97.9%
Haemophilus Influenzae B
98.2%
97.9%
Meningitis C
97.9%
97.5%
Pneumococcal Booster
95.1%
94.7%
MMR
94.8%
94.4%
Warrington
Percentage of
immunisations
delivered on
schedule for
children reaching their 2nd
birthday
Statement of Directors’ Responsibilities
The directors are required under the Health Act 2009 and the National Health Service (Quality
Accounts) Regulations to prepare Quality Accounts for each financial year.
Monitor has issued guidance to NHS foundation trust boards on the form and content of
annual quality reports (which incorporate the above legal requirements) and on the
arrangements that NHS foundation trust boards should put in place to support the data
quality for the preparation of the quality report.
Bridgewater Quality Account 2014/15
103
In preparing the Quality Report, directors are required to take steps to satisfy themselves that:
• The content of the Quality Report meets the requirements set out in the NHS
Foundation Trust Annual Reporting Manual 2014/15 and supporting guidance
• The content of the Quality Report is not inconsistent with internal and external sources
of information including:
• Board minutes and papers for the period April 2014 to May 2015
• Papers relating to Quality reported to the board over the period April 2014 to May
2015
• Feedback from commissioners dated May 2015
• Feedback from governors dated May 2015
• Feedback from local Healthwatch organisations dated May 2015
• Feedback from Overview and Scrutiny Committee dated May 2015
• The trust’s complaints report published under regulation 18 of the Local Authority
Social Services and NHS Complaints Regulations 2009.
• The national patient survey – not applicable to community healthcare providers
• The national staff survey 24/02/2015
• The Head of Internal Audit’s annual opinion over the trust’s control environment
dated March 2015
• CQC Intelligent Monitoring Report – not applicable to community healthcare
providers
• The Quality Report presents a balanced picture of the NHS foundation trust’s
performance over the period covered
• The performance information reported in the Quality Report is reliable and accurate
• There are proper internal controls over the collection and reporting of the measures of
performance included in the Quality Report, 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 Report is
robust and reliable, conforms to specified data quality standards and prescribed
definitions, is subject to appropriate scrutiny and review and
• The Quality Report has been prepared in accordance with Monitor’s annual reporting
guidance (which incorporates the Quality Accounts regulations)
(published at www.monitor.gov.uk/annualreportingmanual) as well as the standards to
support data quality for the preparation of the Quality Report
(available at www.monitor.gov.uk/annualreportingmanual).
The directors confirm to the best of their knowledge and belief they have complied with the
above requirements in preparing the Quality Report.
By order of the board
29/5/15
..............................Date.............................................................Chairman
29/5/15
..............................Date.............................................................Chief
Executive
Bridgewater Quality Account 2014/15
104
Bridgewater Quality Account 2014/15
105
Bridgewater Quality Account 2014/15
106
Bridgewater Quality Account 2014/15
107
Bridgewater Quality Account 2014/15
108
Bridgewater Community Healthcare
NHS Foundation Trust
Bevan House
17 Beecham Court
Smithy Brook Road
Wigan
WN3 6PR
Tel: 01942 482630 | Fax 01942 482662
Email: enquiries@bridgewater.nhs.uk | www.bridgewater.nhs.uk
www.facebook.com/BridgewaterNHS
www.twitter.com/Bridgewater_NHS
Bridgewater Quality Account 2014/15
109