Quality Account
2014/15
Excellent care at the heart of the community
Quality Account 2014/15
Page 2 of 73
Summary
In the report entitled the Five Year Forward View published in October 2014, the chief executive
of NHS England Simon Stevens described how and why the NHS needs to change, what this
change might involve and how we can achieve it. He reaffirmed the core values and
achievements of the NHS, and acknowledged that new technology and advances in medicine
offer new opportunities. However, he argued that the NHS must evolve to meet the challenges
of; more and more people living longer and with complex long-term and care health needs; the
need to support people to lead healthier lives; and the demands of providing health and care
support when the public finances are constrained.
As Simon Stevens said as he started his new job with NHS England in April 2014, “An ageing
population with more chronic health conditions, but with new opportunities to live as
independently as possible, means we’re going to have to radically transform how care is
delivered outside hospitals.” His assessment reflects what we know about people’s
preferences. If they are unwell, people generally want to be cared for in or near their own
homes, close to family and friends and the things with which they are familiar. They prefer not
to go to hospital if this can be avoided, and if they need a hospital stay, they want support to
return to home as quickly as possible.
In fact around 90 per cent of people’s contact with the NHS is in the community, either with
primary care – for example their GP or local pharmacy – or with services run by community
organisations like us - Sussex Community NHS Trust (SCT).
This is why we speak in our vision about excellent care at the heart of the community.
SCT is the main provider of community health and care across Brighton & Hove and West
Sussex. Our teams deliver essential medical, nursing and therapeutic care to over 8,000
adults, children and young people a day, including some of the most vulnerable people in our
communities across the age range. At all times, we prioritise quality and compassion. Our aim
is to support people to manage and adjust to changes in their health to enable them to live
healthy, independently lives.
With quality as our top priority, we care for most people in their own homes or as close to home
as possible in our community hospitals, or in the clinics and centres we work from. We put the
people we care for at the centre of everything we do, wrap care around them and work closely
with GPs, hospital trusts, local authority social care partners and voluntary organisations to
ensure people get the support they need.
To do this work we employ around 4,500 staff. Most of them are expert clinicians (doctors,
dentists, nurses and therapists), and they get great support from specialists in areas such as
governance, education and training, medicines management, information technology, human
resources, finance, facilities and estates.
Amongst our teams, we have:
•
Health visitors working with families with young children.
•
School nurses caring for the school-age population.
•
Specialist doctors, nurses and therapists looking after children, young people and adults
with complex health needs, mobility problems and long-term health conditions.
•
Multidisciplinary community teams caring for the frail elderly.
•
Specialist clinicians caring for people at the end of their lives.
Quality Account 2014/15
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Our strategic goals
To deliver our vision of excellent care at the heart of the community we have three strategic
goals:
•
We will provide excellent care every time to reinforce wellbeing and independence.
•
Working with our partners, we will personalise services for the individual.
•
We will be a strong and sustainable business, grounded in our communities and led by
excellent staff.
To guide our work, our core values and behaviours are now very much part of our culture, so
the people we care for and our other stakeholders know what to expect from us:
•
compassionate care – caring for people in ways we would want for our loved ones.
•
working together – as a team forging strong links with the people we care for, the wider
public and our health and care partners, so we can rise to the challenges we face
together.
•
achieving ambitions – for our users, for our staff, for our teams, for our organisation.
•
delivering excellence – because the people we care for and our partners deserve nothing
less.
Around 1.1 million people live in the area we serve in Brighton & Hove and West Sussex. It is
very likely that most of them will encounter our services in some way at some time: as a patient,
a carer, relative, neighbour or friend of a patient, or through a link with one of our staff members
or volunteers.
Every GP practice in England is now part of a Clinical Commissioning Group (CCG). CCGs
commission (plan and buy) the majority of health services, including emergency care, elective
hospital care, maternity services, and community and mental health services for patients. The
CCGs in our area are:
•
NHS Coastal West Sussex CCG, covering Arun, Adur, Bognor Regis, Chanctonbury,
Chichester, and Worthing, and including 56 GP surgeries and more than 482,100
residents.
•
NHS Horsham and Mid Sussex CCG, covering Burgess Hill, East Grinstead, Haywards
Heath, Horsham and the surrounding area, and including 23 GP practices and
approximately 225,000 residents.
•
NHS Crawley CCG, covering Crawley and the surrounding area, and including 13 GP
practices and approximately 120,000 residents.
•
NHS Brighton & Hove CCG, covering the city and including 47 GP practices and
approximately 300,000 residents.
We also provide services to people living outside of these areas, including in East Sussex.
Quality Account 2014/15
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Contents
Introduction
6
Part 1 - Chief Executive and Chair Statement
7
Part 2 - Looking Ahead
8
2.1
Our Priorities for Quality Improvement in 2015/16
8
2.2
Priorities for Improvement 2015/16
8
2.3
Statements of Assurance from the Board
10
2.4
Clinical Audit and Confidential Enquiries
2.4.1
Trust-Wide Audits
2.4.2
Local Clinical Audits
10
12
13
2.5
Participation in Research
16
2.6
NICE Guidance
21
2.7
Commissioning for Quality and Innovation (CQUIN) Framework
21
2.8
Statements from the CQC
23
2.9
Data Quality
23
2.10
NHS Number and General Medical Practice Code Validity
27
2.11
Information Governance Toolkit Attainment Levels
27
2.12
Clinical Coding Error Rate
27
2.13
Incidents and Patient Safety
27
2.14
Non-Patient Safety
30
2.15
Environmental Impact
30
2.16
Estates
32
2.16.1
Building a Healthier Sussex
32
2.16.2
Modernising our estate around our service needs
32
2.16.3
Redevelopment of Brighton General Hospital
33
2.16.4
A unique partnership between SCT and Capita
33
2.17
Organisational Culture
34
2.18
Staffing Levels
34
2.19
Becoming an NHS Foundation Trust
34
2.20
Working with Patient Representatives
36
2.20.1
Healthwatch
36
2.20.2
Local authority scrutiny committees
36
2.20.3
Engagement with the voluntary & community sector
37
2.20.4
Engaging for change
37
Quality Account 2014/15
Part 3 Looking Back
Page 5 of 73
38
3.1
How we did last year
38
3.2
A Review of our Priorities for Quality Improvement in 2013/14
39
3.3
Additional Achievements in 2013/14
44
3.4
Clinical Quality Half Days
49
3.5
Complaints
49
3.6
Compliments
51
3.7
Equality & Diversity
52
3.8
Volunteers
52
3.9
Safe Care
53
3.10
Patient Centred Care
56
3.11
Staff Care
57
Part 4 Statements of Assurance
4.1
The Board
61
61
Part 5 Who did we involve?
62
Part 6 Statements provided by stakeholders
62
6.1
Brighton & Hove City Council’s Health and Wellbeing
Overview and Scrutiny Committee
62
6.2
Commissioners
63
6.3
Healthwatch Brighton and Hove
65
6.4
Healthwatch West Sussex
66
6.5
West Sussex County Council Health & Adult Social Care Select C’ttee 69
Part 7 Conclusion
70
Part 8 Glossary of terms
71
Part 9 Feedback
73
Quality Account 2014/15
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Introduction
A Quality Account is an annual report to the public by a provider of health and care services
about the quality of care they deliver. All NHS health and care bodies are required to publish
their Quality Account each year, and we embrace this requirement as an important way to
report to you - the people we serve - on our work and on our progress against our quality
improvement priorities.
The Department of Health (DH) provides guidance on what a Quality Account is for and how to
produce it. The DH says that the account should seek to:
•
Encourage our board of directors and leaders to assess quality across all of the services
we provide.
•
Demonstrate our commitment to continuous, evidence-based quality improvement.
•
Explain our progress to the public we serve.
We have a strong commitment to be open and accountable – for example by reporting on key
activities at the board meeting in public each month and in the annual Quality Account. By
being open in this way we offer for scrutiny debate and reflection, our approach to quality and
our performance in key measurable areas - things like patient safety, the effectiveness of
treatments and what patients say about their experiences of care.
Our staff work hard to provide the very best quality of service, whatever their role. We’re
pleased that in their inspection of our work in December 2014, the Care Quality Commission
(CQC) inspectors said: “All the staff we saw and spoke with demonstrated commitment to the
delivery of safe, effective and caring treatment…We observed staff responding to patients, their
families and carers with kindness in a compassionate and professional manner.”
Delivering quality care like this is an on-going process and like all organisations, we aim to
continually update and adapt our plans and priorities to reflect our own progress and the needs
and wants of the people we serve - from our patients, their families and carers - through to our
health and care commissioners.
The Quality Account looks both backward and forward - showing how we did over the year just
gone and where we plan to go in the year ahead. This enables us to reflect on progress against
our priorities from previous years, show where we are doing well and where we can make
improvements. It allows us to look forward, explaining our quality improvement priorities for the
coming year, and how we will achieve and measure these. These are annual reports, so we
want you to see continuity and progress over time.
In short, our Quality Account is a way to provide assurance to you about our commitment to
quality and our performance against our goals. We try to ensure our account is accurate,
balanced and fair, and we ask our partners to comment how far we have achieved this. We
include their feedback at the back of the report.
We publish our Quality Account via the NHS Choices website and our own website. Copies are
also available in different formats and in different community languages on request.
Quality Account 2014/15
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Part 1 - Chief Executive and Chair Statement
We are delighted to open our Quality Account for
2014/15 with the Care Quality Commission’s
assessment of the quality of our services. The
Chief Inspector of Hospital’s team visited Sussex
Community NHS Trust in December 2014 and in
March 2015. We received the inspector’s final
report in March, which not only rates our services
as “good” overall, but also confirms that our end of
life care is “outstanding”. The NHS Trust
Sue Sjuve
Development Authority (NHS TDA) said “It is one of Paula Head
Chief
Executive
Chair
the best inspections that we have seen in NHS
trusts in the South” and we hope that it confirms
your own view of the safe, compassionate,
responsive, caring and well-led services we provide. This is all due to our excellent staff who
work very hard, very thoughtfully, very skilfully and very professionally, to deliver care to the 1.1
million people who live in the area we serve.
The inspection report paves the way for SCT to continue the journey to become an NHS
Foundation Trust and justifies the confidence placed in us by our commissioners and partners.
This has been a very challenging year for the Trust and for the local health and care system
within which it operates. The Trust has worked with its health and social care partners to
alleviate the pressure on acute hospitals, to wrap care around individuals and families and to
manage public money and resources to maintain high quality care and a good experience for
those who use our services.
The coming year will see further improvements in quality through continuing transformation in
the way that we deliver our community-based services. High quality patient care continues to
be at the centre of all we do. Our major challenges this year will be the further improvement of
quality whilst we deliver our recurrent cost improvement programme in an environment of
constrained funding. Our Transformation Programme will enable us to do this and to keep
people well and independent in their homes, and cared for in the community.
We will ensure that patients continue to be our primary consideration. We will continue to listen
to our patients and staff, encouraging openness and honesty, and will monitor our performance
carefully. Our approach to transformation and further improvements to quality will ensure that
the care our patients receive from primary care, social care, and other health service providers
is co-ordinated with the aim of providing a seamless experience.
We hope you will agree that our Quality Account provides many examples of where we already
provide high quality care. We are confident that during 2015/16, our staff and volunteers will
work together with our patients, partners and commissioners to ensure continuous improvement
across all services.
On behalf of the Trust board, we thank everyone who has contributed to what has been a very
challenging, but successful year improving quality across all services. This account highlights
the pride and commitment of our staff throughout the organisation to delivering excellent care at
every opportunity for the people who use our services.
We confirm, on behalf of the Trust board that to the best of our knowledge and belief, the
information contained in this Quality Account is accurate and represents our performance in
2014/15, together with our priorities for 2015/16.
Quality Account 2014/15
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Part 2 - Looking Ahead
2.1
Our Priorities for Quality Improvement in 2015/16
To make certain our care is excellent we must ensure that we provide the three elements that
denote high quality care in every encounter we have with our patients. These three elements
are: safety, clinical effectiveness and patient experience and all three elements are embedded
in our Clinical Care Strategy and our Quality Account and form the basis of our adult integrated
care and support, children’s integrated care and support, specialist community and wellbeing
organisational design.
The priorities we have set for the coming year are organised around these three core elements
of quality.
2.2
Priorities for Improvement 2015/16
Following national evidence and local data collection, e.g. from incidents, complaints, staff,
stakeholder and service feedback, together with national and locally agreed CQUINs and the
quality improvement objectives within Trust’s Clinical Care Strategy, the following priorities for
improvement have been agreed.
Safe Care
Improvement
Priority Area
Expected Outcomes
How will we do it?
Infection
Prevention &
Control (IP&C)
There will be no
incidents of preventable
transmission of
healthcare acquired
infections (HCAIs).
Maintain the framework for Infection Prevention
and Control with a view to constant improvement.
Hand hygiene audits will be fully implemented in
the community.
Medicines –
missed doses
(A missed
medication
dose is where it
is unclear if a
patient received
the medication
or not because
the medication
administration
chart has not
been signed.)
There will be a reduction
in the number of missed
medication doses within
the adult inpatient
wards.
All wards will establish a Medication Action Group
and identify a local lead.
Each Group will produce an action plan.
Medication administration will be discussed and
monitored monthly.
The Medicines Management team will collect data
to provide a monthly Medication Safety
Thermometer to indicate progress.
The Medicines Management team will conduct an
annual Missed Doses Audit to assess
achievement.
Pressure
Damage
There will be a
reduction in the
occurrence of pressure
damage due to a lapse
in our care.
Every patient will have a holistic assessment and
will be screened for their risk of developing
pressure damage.
Those patients deemed ‘at risk’ will have a
pressure damage prevention care plan.
A care plan for carers will be provided to support
care staff.
Quality Account 2014/15
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Effective Care
Improvement
Priority Area
Expected Outcomes
How will we do it?
Quality
Improvement
Metrics for
Specialist
Services
To extrapolate and
interrogate data
regarding specialist
services, specifically
diabetes care, and leg
ulcers.
Review current metrics and develop appropriate
metrics to monitor progress and demonstrate
improvement.
Falls
To further reduce the
Each bedded unit to set individual targets for
percentage of patients in reducing the number of falls and develop local
our care who fall.
action plans.
The Falls Prevention Steering group will identify
and implement additional tools to reduce the
number of falls for patients with dementia and will
monitor and report on progress.
An annual audit of compliance with national falls
prevention initiatives will be undertaken to indicate
achievement of expected outcomes.
Compassionate
care
To improve care and
compassion in practice.
Implement the ‘Sit and See’ Observational Tool
within community services, adding ‘Hello my name
is …’ as an introduction.
Develop and implement documentation, such as
‘Knowing me..’ to enable personalised care in
bedded units for people with specific needs, such
as dementia.
Patient Centred Care
Improvement
Priority Area
Expected Outcomes
How will we do it?
Missed/deferred The number of
visits
complaints received
from patients regarding
missed visits will be
significantly reduced.
Written information will be provided to all patients
on the community nursing ‘live’ case list giving
information of what to do in the event of a missed
visit.
Develop and implement an improved process for
informing patients of changes to planned visits.
Missed visits will be reported and reviewed at
Senior Management Team meetings.
Written information will be provided to all patients
on admission to community services regarding
service visits and contact information.
Complaints
Evaluate the newly implemented complaints
process.
To commence monitoring initial response times
and the time taken to respond to complaints.
Improve the response
times for handling of
complaints, and
recording compliments.
Quality Account 2014/15
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Complaints
cont.
To reduce the number of All staff to have access to Customer Care training,
complaints citing staff
with those teams identified as having a high
attitude.
incidence of complaints citing staff attitude
targeted to attend.
Safeguarding
Adults
90% of all staff will have
attended Safeguarding
Adults training by the
end of the year.
Safeguarding training will be revised and
expanded to include support services previously
not included.
Nutrition &
Hydration
Improve patient nutrition
and hydration in bedded
units.
Develop a strategy based on the Hospital Food
Standards report on food and drink in NHS
hospitals 1.
Develop an action plan for delivery through the
multidisciplinary Nutrition & Hydration Forum and
monitor progress.
Establish feedback to identify achievement of
outcomes.
Additional quality improvement goals are included in the trust-wide Quality Improvement Plan
available on our website.
2.3
Statements of Assurance from the Board
During 2014 to 2015, Sussex Community NHS Trust provided and/ or sub-contracted over 90
NHS services. We deliver our services to people in their own homes, in clinics or as inpatients
across Brighton & Hove and West Sussex. Our bedded units are at Arundel & District
Community Hospital, Bognor Regis War Memorial Hospital, Crawley Hospital, Horsham
Hospital, the Kleinwort Centre in Haywards Heath, Midhurst Community Hospital, Salvington
Lodge in Worthing and Zachary Merton Community Hospital in Rustington. We also provide
services from GP premises, schools and community facilities.
SCT has reviewed all the data available to them on the quality of care in all of these NHS
services. The income generated by the NHS services reviewed in 2014/15 represents 83.2 per
cent of the total income generated from the provision of NHS services by SCT for 2014/15.
2.4
Clinical Audit and Confidential Enquiries
During 2014/15, four national clinical audits and one national confidential enquiry covered NHS
services that SCT provides. During that period, the Trust participated in 100% of national
clinical audits and 100% of national confidential enquiries of the national clinical audits and
national confidential enquiries in which it was eligible to participate.
The national clinical audits and national confidential enquiries that SCT was eligible to
participate in during 2014/15 are as follows:
1
•
National Clinical Audit for Rheumatoid and Early Inflammatory Arthritis.
•
Sentinel Stroke National Audit Programme (SSNAP).
•
Chronic Obstructive Pulmonary Disease (COPD) Audit.
•
National Audit of Intermediate Care (NAIC).
•
Sepsis Study - National Confidential Enquiry into Patient Outcome and Death
(NCEPOD).
The Hospital Food Standards Panel’s report on standards for food and drink in NHS hospitals, Department of Health, August 2014
Quality Account 2014/15
Page 11 of 73
The national clinical audits and national confidential enquiries that SCT participated in, and for
which data collection was completed during 2014/15, are listed below, alongside the number of
cases submitted to each audit or enquiry, as a percentage of the number of registered cases
required by the terms of that audit or enquiry.
National Clinical Audit / Confidential Enquiries
Participation
% Cases
Submitted
Rheumatoid and Early Inflammatory Arthritis Audit (British
Society for Rheumatology)
16
100%
SSNAP (Royal College of Physicians)
351
100%
Chronic Obstructive Pulmonary Disease (COPD) Audit (Royal
College of Physicians)
Data
collection is
in progress
Submission
due July 2015
NAIC (NHS Benchmarking Network)
350
100%
Sepsis Study – Organisational Questionnaires (NCEPOD)
8
100%
The reports of two national clinical audits were reviewed by the Trust in 2014/15 and SCT
intends to take the following actions to improve the quality of healthcare provided. The reports
for the remaining two national clinical audits will be reviewed following their publication.
National Clinical Audit Reports
Outcomes and actions
Rheumatoid and Early Inflammatory
Arthritis Audit (British Society for
Rheumatology)
The report was reviewed and no actions were
identified.
NAIC (NHS Benchmarking Network)
The national report and local benchmarking
information have been received and are under
review.
SSNAP (Royal College of Physicians)
The report will be reviewed following publication in
December 2015.
COPD Audit (Royal College of Physicians) The report will be reviewed following publication in
February 2016.
During 2014/15, SCT participated in four optional national clinical audits considered relevant to
local clinical practice, resulting in the following outcomes and actions:
National Clinical
Audit
Outcomes and actions
Back Pain
Although compliance with evidence-based guidelines on back pain
Management Re-audit management exceeded the benchmark, the service is raising
performance further by:
Faculty of
Occupational Medicine • being proactive in taking appropriate actions when identifying the
psychological risk factors of long-term disability and inability to work;
• offering further training to the team to identify psychological risk
factors.
Quality Account 2014/15
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National Re-audit of
In most categories, results exceeded the national benchmark. Where
Record Keeping
the benchmark was not met:
Faculty of
• clinicians will be reminded that any alternations or corrections in
Occupational Medicine
records must be countersigned and dated as per Nursing and
Midwifery Council (NMC) Guidance on Record Keeping;
• staff will be reminded that use of abbreviations must be
understandable. Where clarity is required, clinicians will write the
word in full at least once in the entry with the abbreviation in
brackets.
In most categories, results exceeded the national benchmark. Where
MoHawk
(Management of
the benchmark was not met:
Health at work and
• all clients referred to the service will be seen within 10 working days;
knowledge) Re-audit
• all reports will be sent out within two working days of a client being
Faculty of
seen;
Occupational Medicine
• all clients referred for lower back pain to be assessed for the
psychological risk factors of long-term disability and inability to work.
National Audit of
Unstageable /
Ungradeable Pressure
Ulcers
Tissue Viability Society
Data on 6 patients was submitted. The results will be shared at the
European Wound Management Association (EWMA) conference in
May 2015. The Trust will review the results to identify potential
actions.
2.4.1 Trust-Wide Audits
During 2014/15, SCT completed ten trust-wide clinical audits considered relevant to local
clinical practice resulting in the following outcomes and actions:
Audit title
Outcomes and actions
Management of
Medical Devices audit
programme
The management of medical devices is monitored by each service
using self-audit, to check compliance with the medical devices policy.
Results of these self-audits are compiled centrally on a biannual basis.
The next report is due at the end of 2015/16.
Omitted doses reaudit.
Six wards showed an improvement and five wards showed an
increase in the number of omitted doses compared to the 2013/14
audit. Results informed a list of recommendations and action plan for
Matrons and Ward Managers to achieve to ensure a further reduction
in omitted doses.
Antimicrobial re-audit
Results showed an improvement indicating that antimicrobial
prescribing is following approved guidelines and good practice. A
short list of recommendations for improvement is in place and a reaudit is planned in 2015/16.
Prescription chart reaudit
The results showed an improvement in most areas of the Trust;
however, some areas require further work. Recommendations and an
action plan are in place and aim to be completed by July 2015.
Controlled drugs (CD)
training re-audit
The number of staff trained rose to 85%. Recommendations have
been agreed and actions put in place to increase training compliance
to by a further 10% during 2015/16.
Quality Account 2014/15
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CD reconciliation and
receipts audit
Results demonstrated an improvement in CD reconciliation compared
to a previous report by an external auditor. It also showed the
procedure for CD receipts is not followed consistently. An action plan
is in place for Ward Managers to complete.
Infection Prevention
and Control
Environmental Audit
programme
123 environmental audits were carried out with 98 (80%) achieving full
compliance. Actions taken as a result of the audit include: new
cleanable shelving for linen cupboards, new vinyl flooring,
standardisation and purchase of commodes, leak testing of wheelchair
cushion covers, compliant hand hygiene sinks, new bedside lockers,
standardisation of products to improve decontamination and improved
sharps management.
Heath Records Audits
programme
Each service is required to audit their health records once every two
years using set standards that have been compiled with reference to
nationally agreed standards. 95% of services have completed their
audits and each team will have used their findings to populate an
action plan.
Do Not Attempt
Cardiovascular
Pulmonary
Resuscitation
(DNACPR) Audit
All adult inpatient wards undertook a spot audit of current inpatients
according to nationally agreed criteria. In all but two cases, the
DNACPR orders satisfied the criteria. The GPs concerned were
notified that they had not completed the DNACPR orders correctly and
the orders were corrected immediately.
Monitoring the
implementation of the
Trust’s Pressure
Damage Prevention
Operational Framework
The audit identified a transition towards a harm prevention approach
with standards of assessment, care intervention and evaluation
scoring highly. Areas to be improved include care-planning standards,
consideration of self-care options, standards of record keeping and
handover and communication.
2.4.2 Local Clinical Audits
76 local clinical audits were undertaken in 2014/15, of which 30% were re-audits. 51 audits
were complete by year-end. The reports of 39 local clinical audits were reviewed in 2014/15
and SCT intends to take the following actions to improve the quality of healthcare provided:
Audit title
Outcomes and actions
Continence Pad Usage Staff were found to be using the assessment tool correctly; however,
– Inpatient wards
weaknesses in the assessment tool itself were identified. The tool is
being revised to ensure all patient needs are identified.
Static Commode Use – Inpatient wards discussed the results and agreed a standard way of
Inpatient wards
identifying which patients are most suitable to use a static commode
and stand to experience the greatest benefits from using one.
Audit of
implementation of
NICE Stroke guidance
(CG162) – Community
Nero Rehab Team
(CNRT)
The audit found the majority of guidance was met. To increase
compliance with guidance on intensity of therapy visits provided, the
team will audit the number of patients who could benefit from more
therapy visits to provide the best chance for neurological recovery
following stroke. The findings will inform a service review.
Clinical screening audit The findings prompted implementation of a Standard Operating
– Community Rapid
Procedure to ensure consistency with all assessments, including the
Response Service
admission and assessment criteria and discharge standards for the
Quality Account 2014/15
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Audit title
Outcomes and actions
service. Malnutrition Universal Screening Tool (MUST) and Waterlow
assessments to be completed during all initial screenings. Pressure
damage care plans will be created when MUST/Waterlow
assessments are carried out and targeted training will be offered to
staff on how to complete MUST and Waterlow assessments.
Audit of completed
initial assessment
forms to assess
whether depression
and anxiety screening
is undertaken – CNRT
To increase the proportion of newly referred patients being screened
for anxiety and depression at the first point of care, staff will complete
the screening tools during initial assessments. By doing so, the
provision of earlier and therefore more effective neuropsychological
interventions is increased, which in turn may also improve a patient’s
engagement with other aspects of their rehabilitation following a
neurological event.
Steroid Injection Audit
– Musculoskeletal
service
The audit results showed that steroid injection therapy continues to be
an effective method for treating musculoskeletal conditions and is
safe whilst guidelines and protocols are followed.
Audit into the use of
acupuncture –
Physiotherapy service
Results indicated the number of patients a physiotherapist needs to
treat with acupuncture each year to remain competent requires
agreement, together with the minimum amount of time a patient is
asked to rest following treatment, prior to leaving the department.
Audit of patient notes
to check all patients
receive an annual
review of pulses,
monofilament and
medication – podiatry
service
The findings were reported at a team meeting in August 2014. It was
agreed that the annual review completion rate was unsatisfactory. It
was also agreed that different coloured sheets would be used to
prompt clinicians to update the records as required.
Audit of the number of
5 year olds not
routinely receiving a
hearing screen
following a request for
written parental
consent – Paediatric
audiology
The audit indicated approximately 10% of 5 year olds across Brighton
& Hove do not receive a hearing screening due to unreturned consent
forms. Additionally, approximately 2% of parents declined the
screening. These results were obtained whilst a single consent form
was used for both hearing and vision screening. Separate consent
forms have now been introduced.
Audit of local
standards regarding
treating children with
dyspraxia – Children’s
Speech and Language
Therapy Service
(SaLT)
This audit highlighted areas where compliance standards were not
met for this client group. This included staff knowledge and training
and access to assessment resources. Recommendations were made
to improve standards in these areas, and a re-audit is planned in
September 2015 following implementation of the action plan. The
action plan includes:
SLT manager to identify Specialist SLTs for Motor Speech Disorders.
Specialist SLTs to provide training/work-shops at team
forums/professional study days.
Two new Diagnostic Evaluation of Articulation &Phonology to be
purchased so there are at least 3 in the service.
Red flag markers added to case-history form and modified form used
in all new files.
Quality Account 2014/15
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Audit title
Outcomes and actions
An audit of the doses
of prescribed
domperidone – Chailey
Heritage Clinical
Services
Domperidone is associated with a small increased risk of potentially
life-threatening effects on the heart. Electronic medication notes were
audited against new guidance from the Neonatal and Paediatric
Pharmacists Group. Following results of the audit, the lead
Consultant will consider reducing prescribed doses, accounting for
patients’ pre-existing cardiac diseases and other medications. This
will be evaluated at each individual’s health review and will reduce the
possible risks associated with higher than recommended doses of
domperidone being prescribed.
Re-audit of the
Safeguarding
assessment tool for
young people –
Contraception and
Sexual Health Clinic
Key actions:
• The current assessment tool should be used for all young people
under 18 who attend the service.
• Referral pathways should be clearly recorded and individual
assessments updated at each attendance.
• When creating electronic patient records the assessment tool
should form the basis of an under 18’s assessment, and should
include assessing vulnerabilities and risk of child sexual
exploitation in sexual health services.
Re-audit of Alcohol
Key actions:
Screening Practice
Circulate audit findings to all clinical staff in the service.
using the Fast Alcohol Amend screening tool proforma to:
Screening Tool (FAST)
• include an alcohol unit assessment;
– Contraception and
• include a ‘not applicable’ response to the FAST question;
Sexual Health Clinic
• record if patient information leaflets and referrals have been
accepted or declined.
Carry out refresher training to address FAST screening and the
changes on the proforma.
Audit of timeliness of
vascular assessment
and surgical
intervention –
Abdominal Aortic
Aneurysm (AAA)
Screening Service
Key actions:
• Centralise all referrals via a Vascular Nurse Specialist and/or
Vascular Multidisciplinary Team Co-ordinator.
• Ensure all Sussex AAA Screening referrals are distributed equally
to vascular surgeons.
• Establish an audit trail for every referral with dialogue about
comments/reasons for any delays in either vascular assessment
and/or surgical intervention.
Audit of effectiveness
& family compliance
with the use of
kinesiotaping to
improve function of
children with cerebral
palsy
The audit found that kinesiotaping can play a role in the management
of mild neurological disorders and should be considered as a
treatment option, where families are able to manage taping at home
once taught. The treatment will be embedded within the splinting
pathway in children’s therapy services.
During 2014/15 to support and encourage clinical audit activity, eight ‘Introduction to Clinical
Audit’ workshops were provided to staff of various clinical backgrounds. This increased
engagement with clinical audit activity will be supported through a new model for planning and
Quality Account 2014/15
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monitoring audit to reduce administrative overheads and by implementing a rotation of audits for
teams to complete each calendar month. The calendared audits will be influenced by real time
learning from incidents, complaints, patient feedback and other priorities. This process ensures
high standards of clinical audit are undertaken in line with emerging divisional priorities, as well
as facilitating effective sharing of learning and outcomes from audit.
SCT’s internal auditor TIAA reviewed the effectiveness of the Trust’s clinical audit process,
assessing the Trust’s clinical audit methodology, structure, performance and culture. TIAA’s
report found ‘reasonable assurance’ with a single recommendation that all relevant clinical
governance groups consider adding clinical audit as a standing agenda item. This action will be
led by the Trust’s Medical Director.
2.5
Participation in Research
The number of patients receiving relevant health services provided or sub-contracted by SCT in
2014/15 that were recruited during that period to participate in research approved by a research
ethics committee was 567 into 10 studies. In addition, 1033 clinical staff and health
professionals were recruited to 5 studies that had been approved by a research ethics
committee during this period, making a total recruitment of 1600 participants to 14 studies.
Please note health service research studies often involve patients, carers and clinical staff,
study numbers are therefore not mutually exclusive.
Figure 1: Participant recruitment by clinical
7
12
62
124
Cancer
Tissue Viability
Diabetes
355
Palliative Care
Neurological conditions
Children's Rehabilitation
1005
Infection
Health Service
34
1
Opportunities for our patients, carers and clinical staff to participate in research and improve
clinical services and treatments have steadily increased over the past five years. Our research
activity has grown in both the number of studies and participants, and the complexity of the
research work undertaken, notably intervention studies evaluating treatments or service reconfigurations.
Quality Account 2014/15
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Types of studies and clinical areas
Our clinical research studies involved adult services (10 studies) and children’s services (3
studies) in the clinical areas of: palliative care, tissue viability, neurology, diabetes, cancer and
children rehabilitation (Figure 1, above).
Our research studies comprised five intervention studies evaluating treatment or service
reconfigurations and 9 observational studies (Table 1, open studies 2014-2015). Our staff (Dr
Catherine Evans, Dr Will Farr and Dr Liz Bryant) led three nationally funded research studies as
chief investigators.
The evaluation studies involved clinical services in:
•
Palliative care comprising a service reconfiguration for frail older people with nonmalignant conditions (OPTCare Elderly - Optimising palliative care for older people in
community settings); and a psychological intervention for patients with depression
(CanTalk).
• Cancer services evaluating a psychological intervention for patients with anxiety and
depression (Getting Down to Coping).
• Tissue viability services in our inpatient rehabilitation settings to improve assessment and
equipment to prevent and treat pressure area damage (Pressure2).
• Children’s services comprising rehabilitation interventions for children with cerebral palsy
to improve: mobility and bone density for children with (Petra Bike Study); and the
effectiveness of virtual reality exercise for children with ambulatory cerebral palsy (Wii Fit
and Ambulant Cerebral Palsy Feasibility Study).
Our observational work involved increasingly complex studies with participation in multi-site
national studies (Table 1). For example, a national study on measuring complexity and service
outcomes in palliative care (C-Change); and a national study looking at what is important for
quality of life for people living with neurological disorders (TONIC). We achieved the highest
recruitment across the multiple NHS sites involved in these two national studies.
Outputs and impact of our research work and activity
Our increasing participation in clinical research is contributing to improving clinical effectiveness
in the Trust and building research capacity and infrastructure to support clinical and health
service research. Improving clinical effectiveness is a national priority – both implementing
research evidence into clinical practice to improve patient outcomes and for clinical staff to stay
abreast of advancements in treatments; and increase opportunities for patients/carers to
participate in research to improve the quality and effectiveness of treatments and services. For
example:
•
Participation as a study site for an international study Pressure Ulcer Risk Assessment
Framework (PURAF) on the assessment of risk to pressure area damage led to revision
of the Trust’s processes of assessing risk to pressure area damage and implementation
of the study’s findings ( http://etheses.whiterose.ac.uk/7570/ )
•
Work led by Dr Diane Sellers at Chailey Heritage Children Services and funded by the
NIHR to develop a classification tool for eating and drinking ability for children with
cerebral palsy (EDACS) is used nationally and internationally with translations into 15
languages http://www.sussexcommunity.nhs.uk/getinvolved/eating_drinking_classification.htm
Our increasing research activity is enabling us to build our research capacity with a growing
number of staff leading research studies as chief investigators, as co-applicants on research
Quality Account 2014/15
Page 18 of 73
grants, and as site principle investigators leading the implementation of our research studies.
This growth is reflected in increasing publications – both as a lead or co-author, conference
presentations and awards of esteem in research (table 2). Our dissemination demonstrates our
commitment to improving patient outcomes and experiences across health and social care
locally, regionally and nationally.
The National Institute for Health Research (NIHR) (or their partners) are the main funders of our
work (13 studies, see Table 1).
Table 1: Open research studies 2014-2015
*Indicates own account studies led by Trust staff or hosted by the Trust
Research Studies actively recruiting or in active follow up locally
Portfolio studies - funded and supported by the National Institute for Health Research
Adult Services
Title
Chief Investigator &
affiliation
Funder
Optimising palliative care for older people
in community settings: development and
evaluation of a new short term integrated
service.
*Dr Catherine Evans,
SCT & King’s College
London
NIHR Research for
Patient Benefit
Getting down to Coping
*Dr S Faithfull,
University of Surrey
NIHR Research for
Patient Benefit grant
Can Talk: the clinical and cost
effectiveness of CBT plus treatment of
depression in advanced cancer: a
randomised controlled trial.
Dr Mark Serfaty,
University College
London
NIHR Health Technology
Assessment Programme
Pressure Relieving Support Surfaces: A
Randomised Evaluation 2
Professor Jane Nixon,
University of Leeds
NIHR Health Technology
Assessment Programme
Validity and Reliability of Integrated
Palliative Care Outcome Scale (IPOS)
Dr Fliss Murtagh,
King’s College London
NIHR Programme Grant
Trajectories of Outcome in Neurological
Conditions
Professor Caroline
Young, Walton Centre
NHS FT
Motor Neurone Disease
Association
Chronic Fatigue Syndrome in the NHS:
Outcomes after treatment by Specialist
Services
Dr Simon Collin,
University of Bristol
NIHR Postdoctoral
Research Fellowship
Comprehensive Geriatric Assessment,
How best to deliver comprehensive
geriatric assessment (CGA) in a costeffective way
Dr Sasha Shepard,
University of Oxford
NIHR Health Service &
Delivery Research
Programme
DARE: Diabetic Alliance for Research in
England
Professor Andrew
Hattersley, University
of Exeter
Wellcome Trust
Quality Account 2014/15
Themis: A Multi-site evaluation of
hospital-based Independent Domestic
Violence Advisor services
Page 19 of 73
Dr Kelly Buckley, Coordinated Action
Against Domestic
Abuse
Henry Smith Charity, The
OAK Philanthropy Ltd
Sigrid Rausing Trust
Children, Wellbeing & Reablement IAPT Services
Wii Fit and Ambulant Cerebral Palsy
Feasibility Study
*Dr Will Farr, SCT
NIHR Research for
Patient Benefit grant
The introduction of Petra running-bikes to
encourage and facilitate weight-bearing
exercise for children with cerebral palsy
who are unable to walk independently: a
pilot study.
*Dr Donna Cowan,
SCT CHCS
SPARKS (The Children's
Medical Charity)
Diagnostic test accuracy of a modified
screening questionnaire and home pulse
oximetry parameters in the diagnosis of
obstructive sleep apnoea in children with
Down Syndrome.
Dr Catherine Hill,
Southampton
University Hospitals
NHS Trust
Action Medical Research
TraCCS - Transforming community health
services for children and young people
who are ill: a quasi-experimental
evaluation.
Professor Gillian
Parker, University of
York
NIHR Health Service and
Delivery Research
Programme
Non-NIHR portfolio studies (not funded or supported by NIHR e.g. NHS England or
charity-funded studies)
Adult Services
Culture of Care Barometer
Professor Anne Marie
Rafferty, KCL
NHS England
Children, Wellbeing & Reablement IAPT Services
An Epidemiological ASD Study and
Establishing a Research Database.
Dr Jeremy Parr,
Newcastle University
Autistica
Table 2: Outputs by clinical research staff from Sussex Community NHS Trust
Articles published peer reviewed journals
Title
Authors and year
Journal publication
Place and Cause of Death in
Centenarians: A Population-Based
Observational Study in England, 2001
to 2010
Evans, C J, Y Ho, et
al. (2014)
PLOS Medicine 11(6):
e1001653
Development and reliability of a system to Sellers, D, Mandy, A,
Developmental Medicine
classify the eating and drinking ability of
Pennington, L,
& Child Neurology. 56 (3)
people with cerebral palsy.
Hankins, M and Morris, 245–251
C (2014)
A systematic review of ordinal scales
used to classify the eating and drinking
abilities of individuals with cerebral palsy
Sellers, D, Pennington, Developmental Medicine
L, Mandy, A and
& Child Neurology. 56 (4)
Morris, C (2014)
313-322
Quality Account 2014/15
Page 20 of 73
Recent advances in assistive technology
and engineering (RAATE) – a UK
perspective
Cowan, D and Judge S Disability &
(2014)
Rehabilitation: Assistive
Technology. 9 (1) 31- 32
The Concept of a Toolbox of Outcome
Measures for Children with Cerebral
Palsy: Why, What and How to use?"
Wright, V and A
Majnemer (2014)
Journal of Child
Neurology 29(8): 10551065
Can a six-week exercise intervention
improve gross motor function for nonambulant children with cerebral palsy? A
pilot randomised controlled trial
Bryant, E, Pountney,
T, and Williams, H
(2013)
Clinical Rehabilitation. 27
(2) 150-159
Factors associated with quality of life in
active childhood epilepsy: A populationbased study.
Reilly C, P Atkinson, et
al. (2015)
Journal of European
Paediatric Neurology
Society: 1-6. Published
online 7.1.15
Parent- and Teacher-Reported
Symptoms of ADHD in School-Aged
Children With Active Epilepsy: A
Population-Based Study.
Reilly, C, P Atkinson,
et al. (2014)
Journal of Attention
Disorders. Published
online 21.11.14
Screening for mental health disorders
inactive childhood epilepsy: Populationbased data.
Reilly, C, P Atkinson,
et al. (2014)
Epilepsy Research.
108(10): 1917-1926
Academic achievement in school-aged
children with active epilepsy: A
population-based study.
Reilly, C, P Atkinson,
et al. (2014)
Epilepsia: 55(12): 19101917
Pathological Demand Avoidance in a
population-based cohort of children with
epilepsy: Four case studies.
Reilly, C, P Atkinson,
et al. (2014)
Research in
Developmental
Disabilities 35(12): 32363244
Neurobehavioural Comorbidities in
Children with Active Epilepsy: A
Population-Based Study.
Reilly, C, P Atkinson,
et al. (2014)
Pediatrics Official Journal
of the American Academy
of Pediatrics 133(6):
e1586-93
Electronic Assistive Technology.
Cowan D, Rogers J,
Najafi L, Panthi F,
Wade W, Lievesley R,
Adam T and Long D
(2014)
In: Taktak A, Ganney P,
Long D and White P eds.
Clinical Engineering: a
handbook for clinical &
biomedical engineers.
Academic Press, pp.359388
Mechanical and Electromechanical
Devices.
Cowan D, Smith M,
Gardiner V, Horwood
P, Morris C, Holsgrove
T, Mayhew T, Long D
& Hillman M (2014)
In: Taktak A, Ganney P,
Long D and White P eds.
Clinical Engineering: a
handbook for clinical &
biomedical engineers.
Academic Press, pp.407432
Books or book contributions
Quality Account 2014/15
Page 21 of 73
Published conference abstracts
The clinical use of functional classification Killian L, Bryant E &
systems for children and young people
Sellers D (2014)
with cerebral palsy.
Developmental Medicine
& Child Neurology (Vol
56), Supplement s4, p32.
Abstract presented at the
European Academy of
Childhood Disability,
Vienna, July2014
To what extent are risk factors for
osteoporosis and fracture measured and
recorded among children with severe and
complex disabilities: an audit
McGill K, Bryant E,
Walker-Bone K (2014)
Osteoporosis
International 25 (s6)
s684-s685. Abstract
presented at the National
Osteoporosis
Conference, Birmingham,
Dec 2014
Paul Polani Award to encourage research
and innovation in the field of Paediatric
Neurodisability
Dr D Sellers, March
2015
British Academy of
Childhood Disability &
Royal College of
Paediatrics & Child
Health
NIHR Research and Development
Leadership Programme, Ashridge
Business School
Ms L Southby & Dr C J
Evans
NIHR Leadership
Programme for
Research, Development
& Innovation
NIHR Leadership programme for senior
clinical academics
Dr C J Evans
NIHR Leadership
Programme
NIHR Clinical Lectureship; a joint post
between Sussex Community NHS Trust
and Kings College London, working in
Palliative Care
Dr C J Evans, March
2011-February 2015
HEE/NIHR Integrated
Clinical Academic
Training Programme for
non-medical healthcare
professions
Esteem Awards
2.6
NICE Guidance
In 2014/15, SCT identified 21 Clinical Guidelines issued by the National Institute for Health &
Care Excellence (NICE) as Directly Applicable. SCT has a robust policy and process for the
dissemination, review, implementation and monitoring of applicable NICE guidance and use of
the guidance to assess practice. The Trust wide Clinical Governance Group and the Services’
Clinical Governance Groups oversee and monitor NICE Guidance.
2.7
Commissioning for Quality and Innovation (CQUIN) Framework
Each year, a proportion of the money SCT receives (our income) is paid only if we achieve
quality improvement and innovation goals that have been agreed between SCT and any other
person or organisation they have a contract, an agreement or arrangement with to provide NHS
services. This happens through the CQUIN payment framework.
Quality Account 2014/15
Page 22 of 73
2014/15
There were seven CQUIN indicators at 2.5% of the contract value in 2014/15. Two of the
CQUINs were nationally mandated and the others were locally agreed.
Nationally mandated
• Family and Friends Test.
• Safety Thermometer.
Locally agreed
• Seven day working.
• Proactive Care.
• Frailty.
• Immunisations School Aged children.
• AAA screening.
2015/16
For 2015/16, CQUINs continue to attract 2.5% of contract value. There are two national
schemes with the others agreed locally:
Nationally mandated
• Dementia.
• Admissions Avoidance through the development of schemes on the community.
Locally agreed
• Transition plans for young people with disabilities or complex health needs moving to
adult health services.
• Implementation of EKOS goal setting tool for children’s speech and language therapy.
• Mental health screening.
• Frailty (second year of the two year scheme).
• Improve uptake of AAA screening where this is identified as low in the health equity audit
report.
• Improved handover between maternity and health visiting services.
• CHIS: Improvements in monitoring, recalling, scheduling and record keeping for Hep B
vaccinations.
We are continuing to discuss with commissioners their proposals for schemes associated with
end of life care and proactive care.
Quality Account 2014/15
2.8
Page 23 of 73
Statements from the CQC
SCT is required to register with the Care Quality Commission. The Trust has 10 registered
locations and is registered to carry out the following regulated activities:
•
Nursing care
•
Family planning services
•
Treatment of disease, disorder or injury
•
Surgical procedures
•
Diagnostic and screening procedures
The Trust was inspected in December 2014 under the Chief Inspector of Hospitals regime. The
CQC inspected four groups of services: Community health inpatient services, Community health
services for adults, Community health services for children young people and families and End
of life care. The inspection focused on the five key questions:
•
Are services safe?
•
Are services effective?
•
Are services caring?
•
Are services responsive?
•
Are services well led?
The Trust was rated as “good” in all the areas and achieved an overall rating of ‘Good’.
The Trust undertakes proactive internal ‘Assurance Reviews’ to self-assess its service user,
visitor and staff safety; clinical effectiveness; and service user experience against the CQC
outcomes. Any areas identified for improvements are followed up ensuring remedial actions are
completed.
2.9
Data Quality
The table below details the actions Sussex Community NHS Trust is taking to improve data
quality. Key to this is the implementation of a new clinical information system, which is in the
process of being deployed throughout the Trust. The new system enables staff to record
accurate, timely and complete data against the patient record. As part of this deployment, the
Trust is piloting a mobile working solution to community-based staff, significantly improving data
quality by enabling data to be recorded at the point of patient contact.
2013-2015 Core Data Quality Strategy actions
Action
Achieved? Anticipated
Outcomes
Progress
Data quality is best
when it is captured
directly by the person
who performs the
activity, at the time the
activity takes place.
On target
Work on raising awareness of
data quality via management
awareness days, intranet, user
groups and data quality
reports. A mobile working
solution is being piloted to
enable data to be collected in
real time.
All staff will have an
awareness of the
importance of data
quality and the tools to
support record data
accurately at the point
it is created.
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It is of paramount
importance that all
data collected is of
appropriate quality in
dimensions, which
include accuracy,
integrity and
freshness.
On target
Clear guidance to
support staff on
accurate data
collection at the Trust
moving towards
compliance with the
Community
Information Data Set
(CIDS) & Children and
Young People’s Health
Services (CYPHS)
This is a fundamental aspect
of training in the new clinical
system and continues
throughout the system roll out.
All data that is
collected must be high
quality and focused, to
ensure it is being used
as effectively as
possible.
On target
A ‘baseline’ review of
current data use and
system analysis is
required.
Review of current data use
and system analysis has been
included as part of planned
deployment of new system.
Staff can usually
improve data quality in
their normal work, for
example by reducing
input delays and
checking at the point it
is created.
On target
A trajectory of
improved data quality
in all teams will be
agreed through our
Business Planning
Process.
Data quality indicators have
been incorporated in
performance dashboards,
allowing services to monitor
accuracy and completeness of
data. Services are routinely
asked to provide narrative
indicating how they are
working to improve data
quality, increasing
understanding and ownership.
Staff training in any
data collection.
On target
A full training
programme to support
the implementation of
the Trust’s Data
Quality Strategy in
place.
Experienced trainers have
been recruited and detailed
training is provided to each
service deployed, training is
tailored for each service and
staff role.
Data quality reports are
developed against each
deployment to ensure that
users have understood their
training and prevent bad habits
from forming.
System changes must
be communicated in
an effective and timely
manner to ensure
those collecting data
are as informed as
possible.
Yes
The Trust will devise
and document a robust
change control
process in a new
policy.
A change advisory board
meets weekly to discuss and
approve any system changes.
All clinical changes are
directed to the clinical
information assurance group
for ratification.
Quality Account 2014/15
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*Quality Indicator 19
SCT
rate
National
average
Best performing
Community Trust
Worst performing
Community Trust
The percentage of patients
readmitted to a hospital which
forms part of the Trust within
28 days of being discharged
from a hospital which forms
part of the Trust during the
reporting period; aged:
(i) 0 to 15; and
(ii) 16 or over.
*We are unable to report our performance against Quality Indicator 19 as current data is
unavailable from the Health & Social Care Information Centre (HSCIC).
Quality Indicator 21
SCT
rate
National
average
Best performing
Community Trust
Worst performing
Community Trust
70%
83%
Cambridgeshire
Community
Services NHS Trust
62%
Liverpool
Community Health
NHS Trust
2012
2013
2014
67%
68%
72%
The percentage of staff
72%
employed by, or under contract
to, the Trust during the
reporting period who would
recommend the Trust as a
provider of care to their family
or friends.
SCT considers that this data is as described for the following reasons. The data has been
supplied by an external organisation following strict protocols and downloaded from the HSCIC.
SCT intends to take the following actions to improve this score, and so the quality of its services;
continue to work to engage staff in the leadership of the Trust to create a culture of excellence
and pride in the organisation. This includes engaging staff on our staff survey results and raising
awareness of how the Trust is responding, development of our leadership strategy, and
promotion of support mechanisms to help staff be effective at work, e.g. flexible working
opportunities.
Quality Indicator 25
Number of
patient safety
incidents
reported
SCT
rate Oct
13 - Mar
14
SCT
rate Apr
14 - Sep
14
National
Average
Oct 13 Mar 14
National
Average
Apr 14 Sep 14
Highest
National
Oct 13 Mar 14
Highest
National
Apr 14 Sep 14
Lowest
National
Oct 13 Mar 14
Lowest
National
Apr 14 Sep 14
2,292
2,085
1,991
1,963
4,058
3,068
883
873
Quality Account 2014/15
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% Rate of patient 101.4
safety incidents
reported (per
1,000 bed days)
110.73
98.5*
95.57**
206.3*
196.26** 30.7*
32.44**
Number of
incidents that
resulted in
severe harm or
death
7
8
24*
19**
139*
90**
1*
0**
% Rate of
incidents that
resulted in
severe harm or
death (per 1,000
bed days)
0.3
0.4
1.15*
0.84**
5.3*
3.9**
0.1*
0**
Note: The NHS Patient Safety Division recognise that a high level of patient safety incidents
reported can be a useful indicator of an open and transparent organisation.
* Based on 15 Community Trusts submitting data over the same reporting period.
** Based on 11 Community Trusts submitting data over the same reporting period.
SCT considers that this data is as described for the following reasons: the data has been
extracted from information supplied by the National Reporting and Learning System (NRLS)
following strict protocols and downloaded from the HSCIC.
The Trust has taken the following actions to improve this indicator and so the quality of its
services, by implementing the following initiatives as part of the Trust Quality Improvement Plan
2014-15;
Management of Pressure Damage Incidents
There has been an improvement in the number of pressure damage incidents reported, with a
14% reduction in 2014-15, due to the preventative work undertaken over the last year including;
• Implementation of pressure damage prevention framework.
• Changing ethos that pressure damage is everybody’s business.
• Implementing Purpose T risk assessment tool.
• Design of pressure damage prevention flowchart and toolkit to realign Trust documents to
support the process.
• Improved reporting / data quality including.
• Improved process for reporting ‘unstageable’ to prevent double reporting.
There has been an improvement in the number of slips, trips and falls, with a 12% reduction in
2014-15, due to the preventative work undertaken over the last year including;
• Patients are identified as at risk or not at risk of falls on admission via the falls bundle &
appropriate care planning is commenced.
• If a patient falls this is identified on a falls safety cross and an incident form is completed.
This is also reflected at handover and by the patient status board above the patient’s bed
so that all staff are aware of the fall.
• A running total of falls is kept for each patient and this is handed over each shift, including
what the falls triggers are.
• Consideration is given to cohort nursing in bays for multiple patients who are at risk and
Quality Account 2014/15
Page 27 of 73
extra staff are provided to maintain safety.
• Use of falls prevention equipment such as sensor pads and alarms.
The Trust will continue to improve incidents which result in harm, through the development of the
Quality Improvement Plan and the Sign up to Safety Improvement initiative.
2.10 NHS Number and General Medical Practice Code Validity
SCT 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 that included the patient’s valid NHS number
was:
2010/11
2011/12
2012/13
2013/14
2014/15
For admitted patient care
98.5%
99.9%
100%
99.9%
100%
For outpatient care
99.8%
99%
99.4%
99.6%
99.8%
For accident & emergency care
95.3%
99.2%
99.4%
99.2%
99.3%
The percentage of records in the published data included the patient’s valid General Medical
Practice Code was:
2010/11
2011/12
2012/13
2013/14
2014/15
For admitted patient care
99.9%
99.7%
99.4%
98.2%
99.3%
For outpatient care
99.9%
99.7%
99.8%
99.8%
99.3%
For accident & emergency care
100%
100%
100%
100%
100%
2.11 Information Governance Toolkit Attainment Levels
SCT’s Information Governance Assessment Report overall score for 2014/15 was 75% and was
graded green - meaning our rating was satisfactory. This score was an increase from the
2013/14 score and shows an improvement in our information governance compliance. The
assessment has been audited and the Trust has been given substantial assurance.
Reaching an improved rating of 75% demonstrates the Trust has appropriate processes in
place to maintain the protection and confidentiality of its patient information and that it adheres
to data protection legislation and good record keeping practice. The Trust has a Senior
Information Risk Owner and a Caldicott Guardian who are engaged with information
governance and the protection of patient information. In 2015/2016, the Trust will work to
improve its information governance scores further and best practice.
2.12 Clinical Coding Error Rate
SCT was not subject to the Payment by Results clinical coding audit during 2014/15 by the
Audit Commission.
2.13 Incidents and Patient Safety
SCT continues to use an incident reporting system called ‘Safeguard’ which enables staff to
report any incident or near miss they have witnessed or become aware of. Safeguard also
allows the Trust to monitor reporting themes and trends, and to ensure incidents are rapidly
responded to. The data warehouse also extracts data from Safeguard to contribute to the
Trust’s comprehensive performance reporting.
Quality Account 2014/15
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During 2014/15, 6525 incidents were reported, representing a 3% decrease compared with
2013/14, as shown in the chart below.
The three most frequently reported categories of incidents in 2014/15 remain the same as those
reported in 2013/14 and were:
•
Pressure Damage (including pressure damage originating in another organisation);
•
Slips, trips and falls; and
•
Medication Errors (including medication errors originating in another organisation).
The Trust plans to implement a new incident reporting system ‘Datix’ over the forthcoming year,
to continue to improve incident reporting and data quality.
All NHS Trusts in England are required to report patient safety incidents every week to the
National Reporting and Learning Service (NRLS) in order to promote learning. The Trust has
continued to meet its responsibility to send incidents relating to patient safety, which is used for
comparative bench marking. The target for this indicator is to be below the national average for
the percentage of incidents that resulted in severe harm or death; based on comparative
2013/14 data, the Trust has achieved this.
The Trust considers that this data is as described for the following reasons:
•
The approach taken to determine the classification of each incident, such as those
‘resulting in severe harm or death’ will often rely on clinical judgement. This judgement
may acceptably, differ between health professionals.
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•
In addition, the classification of the impact of an incident may be subject to a lengthy
investigation, which may result in the classification being changed. This change may not
be reported, so the data held by a Trust may differ to that held by NRLS.
•
SCT’s board regularly reviews patient safety incident reports for themes and trends.
All Community NHS
Trusts
Sussex Community NHS Trust
2013/14
Number of
Incidents
2013/14
% of
Incidents
Degree of
Harm
2014/15
Number
of
Incidents
% of
Incidents
Number
of
Incidents
% of
incidents
Not yet
assessed
3
0.05
55
1
16351
49
No Harm
2662
51
2073
43
1822
35.5
Low
2162
42
2204
46
4762
4.3
Moderate
340
7
384
8
317
1
Severe
16
0.3
20
0.4
68
0.2
Death
4
0.07
39
0.8
Near Miss
16
0.3
55
1
Total
5203
100
4830
100
The above patient incidents and near misses have been bench-marked against National
Community Trust incidents reported from 1st April 2013 to 31st March 2014.
During the year 2014/15, the Trust reported 4830 patient incidents, representing a 7% decrease
when compared to 2013/14.
During 2014/15 the Trust has revised the way in which it records against ‘death’ to include any
unexpected death of a patient who has had involvement with one or more SCT service. This
has resulted in an increase in the number of deaths reported; however, the outcome of those
deaths requiring investigation, or a Coroner’s inquest did not conclude the causes of death to be
attributed to the Trust.
Whilst the number of incidents reported overall has reduced, the majority (89%) were scored as
‘No’ or ‘Low’ Harm. During 2014/15, the process for incident reporting and harm scoring was
revised. As an unexpected consequence, the number of incidents ‘yet to be assessed’
increased, and the process has been amended to prevent this from reoccurring. There is no
correlation of data to suggest any specific reasons for the increase in severe incidents.
The Trust will be implementing the following actions to reduce the level of incidents resulting in
harm to patients:
•
Actively encouraging incident reporting to increase improvement actions and
organisational learning.
•
Revising the role of the Patient Safety Leads to Quality and Patient Safety Improvement
Nurses to enable them to work clinically and embed lessons identified from incidents,
serious incidents and complaints.
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•
Continue to work with the Kent, Surrey and Sussex Patient Safety Collaborative on
identified work streams.
•
Continue to enable service level ownership and monitoring of incidents and patient safety
through the clinical governance structure.
•
Continued to undertake Falls Assessments and falls prevention work in our bedded
inpatient areas.
•
Continue to deliver against the Pressure Damage Prevention Framework.
•
Implement the incident reporting system ‘Datix’ to improve incident reporting and data
quality.
2.14 Non-Patient Safety
SCT internally reports non-patient incidents and near misses, which are monitored by the
Health and Safety Group, chaired by the Chief Nurse. During the year 2014/15, the Trust
reported 4830 patient incidents, representing a 13% increase when compared to 2013/14.
Non Patient Incidents
and Non Patient Near
Miss Incidents
Degree of Harm
Sussex Community NHS Trust
2013/14
2014/15
Number of
Incidents
% of
Incidents
2
0.1
16
0.9
No Harm
934
62
1027
61
Minor
487
33
549
32
Moderate
67
4
69
4
Severe
0
0
4
0.2
Catastrophic
0
0
1
0.05
Near Miss
7
0.4
29
1.7
1497
100
1695
100
Not yet assessed
Total
Number of
Incidents
% of
incidents
Of the non-patient incidents, 9 were reportable under RIDDOR, (the Reporting of Injuries,
Diseases and Dangerous Occurrences Regulations) a decrease from 2013/14 when 12
incidents were reported.
2.15 Environmental Impact
In 2010, SCT adopted its first Board-approved Sustainable Development Management Plan
(SDMP). Nicknamed “15 by 15”, the SDMP set a trajectory to reduce all key environmental
impacts from Trust operations (including, most significantly absolute CO2 emissions) by 15% by
2015, along with a zero waste to landfill commitment. The purpose was simple – to
demonstrate the benefits of taking action to become more environmentally sustainable and lay
the foundations for a more ambitious and longer-term sustainability strategy.
In 2014, our Board approved a new and more holistic sustainable healthcare strategy, Care
Without Carbon (CWC) – an innovative approach to delivering health services that care for both
people and the environment. The strategy is aimed at addressing one of our core strategic
objectives - to be a strong, sustainable business, grounded in our communities and led by
Quality Account 2014/15
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excellent staff, and it has been designed to dovetail into all major Trust strategic and operational
initiatives.
CWC sets challenging sustainability targets for 2020, with a long-term aspiration to become the
first carbon neutral healthcare NHS provider in the UK. It identifies seven different areas for
action - including buildings, journeys, procurement and health & wellbeing. In this way, its focus
is on integrating sustainability across Trust operations, providing benefits to staff and patients,
as well as substantial cost savings and reduced emissions.
Since 2010, we have achieved* the following:
Buildings
Reduced our carbon footprint by 985 tonnes (15.7%), meaning we have met our
15 by 15 target a year early.
Procurement
Recycled 62% of our non-healthcare waste, with zero non-healthcare waste
going to landfill. Also introduced offensive waste stream, meeting our 35%
target.
Journeys
Cut our vehicle emissions by 9.8% by introducing cleaner commercial vehicles,
including our first electric courier vehicle and are progressively capping engine
emissions through our lease car scheme.
Buildings
Improved the efficiency of our buildings, with a 14.5% increase in energy
efficiency (kgCO2e/m2) and 40.8% increase in water efficiency (m3/m2). This
was achieved through the introduction of energy efficient and renewable energy
technology; improving space utilisation; and introducing water efficiency and
leak detection schemes.
Journeys
Worked through our Business Travel Plan to introduce our first electric bike to
the fleet alongside our first zero emission pool car, taking our low emission fleet
vehicles up to 16. We have also continued to develop our well-utilised Travel
Bureau to support managers and their staff reduce travel time and costs.
Culture
Launched a new staff engagement campaign, Dare to Care, in February 2015
to promote Care Without Carbon and encourage grass-roots action in support of
its goals. Dare to Care invites staff to take a simple ‘Dare’ (or pledge) that
benefits them and the environment, incentivised by a supplier-sponsored
quarterly prize draw. Staff sign up through our new website
www.carewithoutcarbon.org with the campaign being continually updated
throughout the year.
Wellbeing
Drawn together the sustainability and workforce wellbeing agendas through our
Dare to Care campaign. Each Dare has been selected because it supports
CWC’s three core goals: enhancing care quality, improving resource efficiency
and maximising productivity.
Procurement
Further developed collaborative projects with key suppliers to reduce the
environmental impacts of products/services used by the Trust.
Adaptation
Started work on a Climate Change Adaptation Plan for the Trust. Initial work
has focussed on identifying how the Trust will be impacted by our changing
climate, with increased extreme weather events (such as floods and heat
waves) and increased temperatures predicted. Impacts on Trust buildings and
on patients were considered, for example the potential increase in both heat
and flood-related illness/death. We look forward to working with clinical teams
to develop this further this year.
Quality Account 2014/15
Pioneering
Page 32 of 73
Won the national Institute of Healthcare Engineering and Estate Management
(IHEEM) Sustainable Achievement Award in 2014, as well as being runner up
for the Energy Saving Trust’s Fleet Heroes awards with commendation for
reducing business mileage by almost a million miles.
Nominated for the NHS Sustainability Awards for Behaviour Change, HR and
Clinical.
Presented on Care Without Carbon at an NHS England sustainable practice
event in 2014 as well as several others throughout the year. We are also taking
a lead role in facilitating a South East sustainability best practice network this
year at the request of NHS England.
*Achievements listed are based on validated 2013/14 data, or 2014/15 input for qualitative
achievements.
2.16 Estates
2.16.1 Building a Healthier Sussex
Our estates and facilities are key to supporting our vision of delivering effective care at the heart
of the community. As a community Trust with more than 4,400 staff, covering more than 800
square miles, accommodation is a key issue for us. We currently operate from 300 locations,
including 60 main sites and there is huge variation in the age and quality of the buildings we
work in and from where we deliver our services. SCT inherited many of these sites from a
number of different organisations in 2010.
Our five-year estates strategy looks at how to improve the quality of our accommodation,
support our clinical services strategy, be more efficient with the space we use, improve options
for flexible working and at the same time save money. We have recently reviewed and
refreshed our estates strategy for 2015 – 2020 in order to:
•
Ensure that all our plans for our estate are clinically led.
•
Align with service transformation programmes to improve the capacity and resilience of
our services in a financially constrained context.
•
Coordinate with commitments to invest in information technology, particularly the rollout
of SystmOne to support paper-less working, and enable more agile and productive
working to improve patient services and staff working lives.
Please see the estates strategy on our website www.sussexcommunity.nhs.uk/trustreports
2.16.2 Modernising our estate around our service needs
The estates strategy sets out a number of principles for modernising the estate, from which
some specifics can be determined. These include:
•
Administrative/ community health services hubs to support resilient teams. The majority
of services we provide are in patients own homes, or in other premises such as GP
surgeries. We are organising our services to support inter-disciplinary and interorganisational teams with the capacity to respond to need in the community. A ‘hub’ is a
central administrative space where staff can base themselves. Hubs are not locations to
which patients would expect to have to go. We aim to have six hubs in key geographical
areas. Those already in place include: Brighton General Hospital (Brighton & Hove
area), The Quadrant, Lancing Business Park (Lancing and Shoreham area), Southfield
House (Worthing area), Southgate House (Chichester and Bognor area), although we
plan to relocate to better quality office facilities in Chichester in mid-2015.
Quality Account 2014/15
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•
Further hubs are required for Mid Sussex and for the Crawley/Horsham area. The exact
requirements will be worked up in the current year, as the exact model will vary
dependent on local geography and commissioners requirements. Nevertheless, the
principle of establishing administrative hubs distinct from clinical facilities will apply.
•
Improved integration and co-location of services. We are working closely with our local
authority partners (Brighton & Hove City, and West Sussex County Councils in particular)
to co-locate teams around care groups. Increasingly, teams such as health visitors are
located with other children’s services provided jointly with partners in shared facilities
such as children’s centres.
•
We are supporting patients with a greater level of acuity in the community and are
working with commissioners and partners to deliver new patient pathways. This has
implications for our estate, e.g. in the need for increased high quality clinical
accommodation and diagnostics. To support a new musculo-skeletal (MSK) service we
are improving facilities at Crawley and Horsham Hospitals as well as Hove Polyclinic to
provide high quality diagnostic and treatment facilities around the service need.
2.16.3 Redevelopment of Brighton General Hospital
Our largest and oldest facility is Brighton General Hospital. Dating from the 1860s the facility
was originally built as a Poor Law Institution (workhouse) and has undergone many changes of
use. It no longer provides inpatient services, but accommodates a range of clinical,
administrative and support functions. The buildings are no longer suited to today’s needs with
the result that the facility overall is approximately 50% under-utilised. Initial feasibility has
established that it would be possible to procure a new clinical facility built to modern standards,
relocate other services in offices and other accommodation elsewhere in a way that can save
costs and potentially release land for much needed housing development in the city.
Drawing on the expertise of our partners Capita, we will be working up a more detailed master
plan and proposal with a view to securing a business case for major changes to the Brighton
General Hospital site over the next 5 years.
2.16.4 A unique partnership between SCT and Capita
Our strategic goals are clear, but the means of achieving these are not straightforward.
Following the production of a business case in 2013, approved by both SCT and Capita, the two
organisations entered into a 5-year strategic partnering agreement that commenced in April
2014. SCT staff who provided the management and administration function within the estates
team were transferred to Capita at this time. This partnership enables:
•
Continued delivery of an excellent estates and facilities service to the Trust.
•
Delivery of estates transformation and improvement of asset utilisation.
•
Accelerated opportunities such as the redevelopment of the Brighton and Hove site.
•
Commercialisation of the estates and facilities function.
•
Robust assurance to ensure that all Trust accommodation is CQC and infection control
compliant.
•
Alignment of estates related investment with associated investment in information
technology to implement agile working and deliver greater productivity overall.
•
Source alternative funding mechanisms to support strategic property development.
•
Ability to supplement existing skills via the capabilities of the wider Capita structure.
Quality Account 2014/15
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2.17 Organisational Culture
Culture has a significant impact on staff satisfaction, which in turn has an impact on the care
delivered. SCT seeks to ensure that our organisational culture supports staff in the delivery of
excellent care.
Building on the internal cultural inquiry (SCT, 2013), we have developed and embedded a
values and behaviours pledge, and used our values explicitly in recruitment and appraisal. We
have continued to offer a range of leadership development opportunities including an annual
leadership conference, which in 2014 focussed on culture.
SCT piloted the Culture of Care barometer tool in 2013 with King’s College London. In addition
to testing the tool, it was helpful to see the results of the pilot, which triangulated with what our
staff survey results had told us. Developing a tool such as this gives recognition of the
importance of positive culture to the delivery of quality services and patient care. Feedback
from the pilot found the tool particularly useful within teams or groups of staff as a way of
breaking down barriers, challenges and problems distinct to a particular area. SCT will be
suggesting it is used when supporting teams, or as a “before” and “after” measure for teams
undergoing change. Culture is being addressed in a wider context by the organisation, for
example, in work relating to the staff survey action plan, organisational values, reward and
recognition and staff engagement.
2.18 Staffing Levels
SCT is engaged in a number of activities around recruitment and retention of staff including
recruitment campaigns, an international recruitment exercise, reviewing how we market
ourselves for recruitment purposes, and streamlining our recruitment processes. The Trust has
also reviewed its temporary staffing arrangements and is introducing a new system through a
master vendor contract, which aims to reduce bank and agency staff costs.
Recruitment drives taken forward during 2014/15 included:
•
National media campaigns online and in print, attendance at recruitment fairs attracting
candidates from all parts of the UK.
•
Recruitment from Italy, Spain and Portugal.
•
Local media and banner advertising.
•
Introduction of a ‘recommend a nurse scheme’ providing incentives for Trust staff to
introduce new colleagues to the organisation.
•
Progress made on a review of how temporary staff are engaged to increase the supply of
skilled, safe and trained agency and bank workers while being able to control costs more
effectively.
In the period from 1st April 2014 to 31st January 2015, SCT recruited just under 750 new staff,
which included 176 registered nurses, 85 allied health professionals and 22 doctors or dentists,
and 197 clinical support staff.
There is a significant amount of activity taking place to ensure we have investigated every
avenue to attract staff. The Trust Workforce & Development Group will review the Recruitment
& Resourcing Plan on a bi-monthly basis to consider what activities the Trust should continue to
invest in, or alternative methods to attract applicants.
2.19 Becoming an NHS Foundation Trust
The NHS Trust Development Authority (NTDA) continues to fully support the Trust on our
journey to becoming an independent NHS Foundation Trust (FT) in 2015/16. Following a
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successful board to board with the NTDA in June 2014 and a “Good” rating from the Care
Quality Commission (CQC) Inspection in December 2014, the Trust is placed in the highest
category (A1) for onward approval to Monitor.
In June 2014, senior Trust leaders met with officials from the NTDA. We had the opportunity to
describe the Trust’s progress to date and articulate the Trust’s new 5-year strategic plan to
improve the quality of patient care we provide and deliver a sustainable model of care to deliver
benefits across the wider local health economy system and improve individual patient care and
experience.
The NTDA continued to recognise the significant progress that was being made by the Trust
and this was echoed by positive statements of support from our commissioners and partners in
the NHS and local government across Brighton & Hove and West Sussex.
The introduction of a revised Care Quality Commission (CQC) inspection regime in 2014, as a
result of the Robert Francis Report, necessitated a delay in the Trust’s FT planning timelines as
a “Good” inspection result or better, became a prerequisite for approval to the Monitor stage.
The Trust welcomed the opportunity for an independent assessment of our quality standards
and was very pleased with the overall “Good” grading received across all 5 domains (Safe,
Caring, Responsive, Effective and Well-Led). The Trust was particularly proud of the
“Outstanding” grading received in the End of Life Care Responsive domain.
Having received a “Good” rating in March 2015, the next steps include a final board to board
with the NTDA in June 2015 and then handover to Monitor later in 2015 for several months of
detailed scrutiny, before Monitor can recommend FT status. Therefore, as a result of the CQC
inspection requirements the final approval to become an FT may be delayed into 2016.
FTs were established to devolve decision-making power from central government to local
organisations and communities. FTs are not directed by the government and are accountable
to local communities. This means that they have greater freedom to determine, (with their
governors and members (see below)), their own strategy and the way services are run. FTs
also have more financial independence than NHS Trusts, and can use this to improve services
for patients and service users. FTs are not-for-profit, public-benefit corporations. Public-benefit
corporations are different from other public authorities, such as local councils, in that they have
membership.
We strongly believe that being an FT will help us to:
•
Improve patient care.
•
Be more open and accountable.
•
Strengthen our links with local people.
•
Build on the work we have already done to make our services more sensitive to the
needs of patients.
Many people feel a strong sense of connection to the NHS and to NHS service providers. The
principles behind FTs build on this sense of connection and ownership. FTs have a duty to
engage with their communities and encourage local people to become members of the
organisation. They must also take steps to ensure their membership is representative of the
communities they serve.
Anyone who lives in the areas we serve, works for the Trust, or has been a patient or service
user, can become a member of the FT. This gives staff and local people a real stake in the
future of their community services and means you can have a say in how the Trust is run.
•
Call us on 01273 242127
•
Visit our website www.sussexcommunity.nhs.uk/ft
Quality Account 2014/15
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•
Email us sc-tr.sctmembership@nhs.net
•
Write to us FREEPOST RSXG XTCJ BBBT, Foundation Trust Membership Office,
Brighton General Hospital, Elm Grove, Brighton, BN2 3EW.
•
Complete the feedback form on the final page of this document.
By March 2015, we had recruited over 4,200 public members and are on course to achieve our
5,000 public members target by the end of 2015 and encourage as many local people to join.
2.20 Working with Patient Representatives
Our engagement strategy adopted by the Trust board in April 2014 shows how we will work to
ensure the patient’s voice is at the heart of every decision we make.
To help us achieve this goal we engage with a range of representative bodies that speak on
behalf of the people we serve, from groups that are set up with statutory powers to hold health
and care providers to account (Healthwatch, scrutiny committees) through to community and
voluntary sector organisations (VCS) that reflect the views of local people.
2.20.1 Healthwatch
Healthwatch England is the national consumer champion in health and care. It has significant
statutory powers to ensure the voice of the consumer is strengthened and heard by those who
commission, deliver and regulate health and care services.
Healthwatch England works across a broad range of organisations from local and specialist
partners to national health and care bodies and the government. It seeks views from all
sections of the community, and has close ties with the many organisations that represent the
public, both at a local and national level.
Healthwatch England supports local Healthwatch bodies across the country. We work closely
with our two local Healthwatch organisations in Brighton & Hove and West Sussex, and are
committed to develop and strengthen our relationship, as below:
•
People from Healthwatch attend our regular meetings with patient representatives hosted by
our chair, Sue Sjuve, and our Patient Experience Group, chaired by our Chief Nurse, Susan
Marshall.
•
We welcome Healthwatch to our events, such as our annual general meeting and meetings
of the Trust board in public.
•
We engage with Healthwatch about our plans for strategic and service development.
•
We send weekly updates about our work and regular news items about the Trust for
inclusion in Healthwatch communications.
•
We share Healthwatch news updates with our staff.
•
Healthwatch representatives attend our Patient Experience Group.
•
We respond in an open and timely manner to Healthwatch requests for information about
our work and performance.
2.20.2 Local authority scrutiny committees
We have equally strong relationships with our two health and overview scrutiny committees –
West Sussex Health & Adult Social Care Select Committee (HASC) and Brighton & Hove
Health & Wellbeing Overview Scrutiny Committee (HWOSC).
These bodies are made up of locally elected councillors and have the power to hold NHS
organisations to account for the quality of their services. We speak with both bodies regularly
Quality Account 2014/15
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about our plans for strategic and service development and regularly attend their meetings in
public to offer presentations about our work.
2.20.3 Engagement with the voluntary & community sector
We engage with community and voluntary sector organisations (VCS) that reflect the views of
our local communities, maintaining details to identify and segment VCS groups in our area.
We manage a programme in which our leaders attend and present at VCS meetings, using
these opportunities to explore our vision, strategic goals and plans and secure support for our
work. In this engagement work we:
•
Engage proactively with groups that speak on behalf of health and care users or reflect
broader interests within the area we serve.
•
Seek engagement opportunities with groups that speak on behalf of our more
marginalised communities (e.g. disabled people, people from the black and minority
ethnic communities).
2.20.4 Engaging for change
The ambitions of the NHS nationally and locally – and our vision of excellent care at the heart of
the community – require change in the ways care is delivered. Engagement with all our
stakeholders with regard to the development of change and the ways change is implemented is
the central purpose and point of our engagement strategy.
We follow good practice and statutory requirements to ensure engagement with regard to
change are timely, purposeful and meaningful. We will work to deliver engagement in
collaboration with statutory and VCS partners, building upon existing structures and
relationships. We use the full range of engagement processes and methodologies – including
formal public consultation where appropriate - following careful assessment of the issues and
the needs and circumstances of the stakeholders most directly affected.
All this will help allay concerns, give reassurance, build support for change and improve the
decision-making process. Ultimately, it will support us to realise our vision of excellent care at
the heart of the community, and put the voice of the people we serve at the heart of every
decision we take.
Quality Account 2014/15
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Part 3 - Looking Back
3.1
How we did last year
The objectives of this Quality Account align with the inspection model applied to community
health and care providers like SCT by the independent regulator of health and social care in
England, the Care Quality Commission (CQC).
The CQC inspects the quality of work delivered by health and care providers and publishes a
rating to describe this quality. To do this the CQC looks for evidence that services are safe,
effective, caring, responsive and well led. On the basis of the CQC inspection carried out in
December 2014, England’s chief inspector of hospitals:
•
Rated the overall quality of services we provide as Good.
•
Rated our end of life care as Outstanding for how it responds to people’s needs.
•
Rated some elements in the safe domain for our inpatient care services require
improvement, including medicines’ management (missed doses), training in the care of
people with dementia, record keeping and care planning.
The inspectors looked at the quality of care in four of our main services areas: community
health services for adults; community health services for children & young people; end of life
care and community inpatient care.
In the process they found:
•
Good practice to ensure safe and responsive care, and some exceptional and innovative
practice.
•
Caring staff who consistently provide good care.
•
Clear leadership, a positive culture and good engagement.
•
Partnership working that protects vulnerable people from abuse.
•
Staff who feel valued and supported by their managers, supervisors and the Trust board.
As part of the CQC’s recommendations, the inspectors advised us to:
•
Take new steps to boost recruitment and improve staffing levels.
•
Work with our partners to improve the quality of parts of the estate we work from.
•
Review the rollout of IT systems that support patient care.
We will work hard to maintain the momentum that helped us achieve a “Good” rating and helps
show the people we serve that our services are safe, effective, caring, responsive and well led.
We will build on our strengths and address with extra clarity and energy the inspectors’
recommendations for improvement. The process is already well underway.
In this Quality Account, you will see much more information about our progress against our
quality goals, and about those areas where we know improvement is needed.
Quality Account 2014/15
3.2
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A Review of our Priorities for Quality Improvement in 2013/14
How did we perform against the priorities for 2013/14 as listed in last year’s Quality Account?
Safe Care
Improvement Expected
Priority
Outcome
What we said we’d do
How did we do?
Falls
To reduce
the number
of patients
who fall
whilst in our
care by
10%.

Extend the Falls Bundle
work, benchmark
community hospitals
audit data; review the
community assessment
for falls risk and review
compliance with
updated NICE
Guidance.
We have exceeded the
target we set ourselves by
reducing the number of Falls
within Community Hospitals
by 12%. We have also
reduced the percentage of
falls resulting in moderate
harm.
Medication
Incidents
For the
number of
medication
incidents
reported to
plateau, or
continue to
increase
demonstrati
ng an open
culture of
reporting by
staff.


Encourage reporting
through internal
mandatory training
courses for staff.
Discuss, shared learning
& improvements made
locally from medication
incidents & throughout
the Trust’s governance
structure.
Communicate with staff
using the Trust’s
communication
channels.
601 medication incidents
have been reported from 1st
April to 31st March 2015,
compared to 726 medication
incidents reported in the
same period last year.
For the
proportion
(%) of
medication
incidents
assessed as
causing
harm to be
lower than
the previous
year.

Review medication
incidents at
organisational level;
identify learning &
improvements via the
Trust’s Medicines Safety
& Governance Group.
Produce medication
incident reports every 6
months.
Continue to improve the
Trust’s incident reporting
The proportion (%) of
medication incidents
assessed as causing harm
was 16 % compared to 23%
in the same period last year
meaning the target has been
achieved. This is a positive
trend as this means fewer
medication incidents caused
harm to patients in 2014/15
compared to the previous
year.
The number of reported
medication incidents has
decreased. The target of
plateauing or increasing the
number of medication
incidents reported for 2014/15
has not been achieved. It is
worth noting that a number of
the incidents reported do not
relate to SCT care and
delivery, but originated from
outside SCT and reported by
SCT.
Quality Account 2014/15
Page 40 of 73
system and to review,
audit and improve
medicines processes
and training.
Healthcare
Acquired
Infection
(HCAI)
For there to
be no
incidents of
preventable
transmission
of HCAIs.


Undertake mandatory
training by all clinical
staff.

Undertake hand hygiene
audits.

Develop a C.difficile
reduction action.

Share learning from
incidents investigated.
No incidents of preventable
transmission of HCAIs have
occurred in 2014/15.
Statutory training is offered
to all clinical staff. Hand
hygiene practical training is
offered in all bedded units.
Hand hygiene audits are
undertaken regularly
throughout the year in all
bedded units and gradually
increasing in community
teams.
C.diff reduction action plan
has been revised and
improved.
Never Events
For there to
be no ‘Never
Events’.

Through continuous staff
training, appraisals, staff
safety awareness,
newsletters and regular
patient safety messages
cascaded through team
talk – SCT’s team
briefing system.
There have been no ‘Never
Events’ reported.
VTE
For no inpatient in the
care of SCT
services to
develop a
Venous
Thromboem
bolism
(VTE).

A VTE risk assessment
completed on admission
for all in-patients, as
appropriate.
For in-patients at risk of
developing a VTE to
receive the appropriate
prophylaxis.
Undertake a root cause
analysis investigation
(RCA) will be conducted
where any VTE occurs in
SCT in-patient care.
To date, no in-patients have
been diagnosed with a VTE
due to a lapse in our care
since April 2014.
VTE risk assessment forms
are being completed in all
inpatient units.


Prophylaxis is provided for all
inpatients at risk of
developing a VTE according
to NICE guidelines.
Where a VTE occurs in SCT
care, a root cause analysis
will be conducted.
Quality Account 2014/15
Page 41 of 73
Effective Care
Improvement Expected
Priority
Outcome
Mortality
Reviews
Pressure
Damage
Pressure
Damage
What we said we’d do
How did we do?
Front line clinical staff have
tested new mortality review
forms and feedback has
been collated. The form,
together with an explanation
of why the data is being
collected is available to all
staff on the Pulse.
The first mortality review
meeting was delayed due to
the roll out of the new forms,
together with staff training
taking longer than expected.
The meetings commenced in
February 2015.
A thorough
review of all
patients who
die within
our care will
take place,
including a
new
quarterly
multidisciplinary
mortality
review
meeting.

Introduce new patient
death review forms to all
teams.

Introduce quarterly
mortality review
meetings.
For there to
be a
reduction in
the number
of cases of
pressure
damage.

Develop and implement
an operation framework
for the prevention of
pressure damage.
Undertake an audit
against the framework to
ensure zero tolerance of
preventable pressure
damage.
There has been a 14%
reduction in the number of
pressure damage incidents
reported in 2014/15.
The professional framework
has been implemented across
all adult services.
The framework’s
implementation was audited
during June 2014 and the
Trust continues to report
reduced pressure damage.
For staff to
be equipped
with the
necessary
skills to
enable them
to prevent/
manage
pressure
damage
effectively.


For 85% of relevant staff
to have undertaken
pressure damage
prevention training.
During April 14 – March 15,
407 staff accessed formal
wound care/pressure damage
prevention training. Capturing
localised training numbers
centrally to support robust
Trust reporting remains a
challenge.
Pressure damage prevention
training is provided through a
suite of delivery options
including: mandatory training
day, multidisciplinary training
sessions, bespoke team
sessions, the Preceptorship
programme and online elearning and Bite-size
modules.
The new Purpose T risk

Quality Account 2014/15
Page 42 of 73
assessment tool has been
adopted by the Trust and is
incorporated into all training
as appropriate.
The risk team have delivered
training regarding pressure
damage incident reporting
resulting in a significant
reduction in inappropriate
reporting and an increase in
the quality of pressure
damage reporting.
A ‘top ten tips’ programme
has been developed and will
be delivered to all new staff
joining the Trust during
mandatory induction and
included on statutory training
days from January 2015.
Patient Centred Care
Improvement Expected
Priority
Outcome
What we said we’d do
How did we do?
Care Plan
Every
patient
identified as
being at risk
of pressure
damage will
have a
patient
centred
pressure
damage
prevention
care plan

Audit against the
operation framework for
the prevention of
pressure damage.
The Trust has moved
significantly forward on
ensuring individualised
prevention care plans are in
place for those patients at risk
of developing pressure
damage. The audit found at
least 97% of patients had an
appropriate holistic
assessment on admission,
which included identification
of their individual risk of
pressure damage occurring.
86% had specific pressure
damage prevention care
plans as a result of their
assessment.
Friends and
Family Test
(FFT)
Patient
feedback
gained, and
acted upon,
using the
national
FFT.

Roll out the FFT across
further services,
according to national
guidance.
The FFT rollout has been
achieved in line with national
guidance and early
implementation as defined by
the national FFT CQUIN.
We achieved the aim of 20%
of services/activity by 1st
October 2014 with the
remaining 80% of services by
1st January 2015.
Quality Account 2014/15
Patient
Advice &
Liaison
Service
(PALS)
For patients
and families
to be able to
meet with an
independent
liaison
officer.
Page 43 of 73

We will provide PALS
surgeries at key Trust
sites in line with the
recommendations of
both the Clywd and Hart
Review and Patients
Association Peer
Review.
PALS surgeries commenced
as planned in September
2014 and we held two
surgeries in our community
hospitals in Crawley and
Horsham. The attendance
was disappointing, although
PALS staff actively visited inpatients to gain feedback and
ensure they were aware of
the service. Feedback
received was all positive.
PALS are considering
alternative options to capture
community-based services
and how the PALS service
can work with colleagues in
partner organisations such as
Healthwatch by July 2015.
We are continuing to explore
our options to provide
surgeries at various sites and
considering our advertising
methods.
Quality Account 2014/15
3.3
Page 44 of 73
Additional Achievements in 2013/14
April 2014
Proud to Care
Our Brighton & Hove community neurological
rehabilitation team (pictured right) won the team
communication award at the Sussex and Surrey Proud
to Care Awards.
The team was recognised for their drive to improve the
ways they communicate with people and obtain
patient feedback.
Strengthening our leaders
We hosted the first of our quarterly Leadership Exchange sessions to give our leaders the
chance to meet together and with members of the executive leadership team to share ideas and
explore some of the big items on our agenda. We’re continuing the programme into 2015/16
and staff say they find the sessions positive, energetic and uplifting!
May 2014
Welcome to Horsham
We hosted a visit by councillors from Horsham District Council to meet our community, nursing
and therapy teams at Horsham Hospital and learn more about our support for people in the
community with long term conditions, including young children and their families, and the frail
elderly. At least two councillors were so impressed they went on to register to become public
members of our NHS Foundation Trust.
June 2014
Sue Eckstein leadership award
At our leadership conference we presented the inaugural Sue
Eckstein leadership award to family nurse supervisor Suzy
Portway. Sue Eckstein was an accomplished academic and writer
who died in November 2013. Her experience of NHS care and her
work on clinical ethics at the Brighton and Sussex Medical School
led her to consider what good care looks like – insights she shared
with us at our leadership conference in 2013, and at our Annual
General Meeting in 2011.
The Sue Eckstein award acknowledges Sue and her support for
our work – especially our rehabilitation services and the Brighton &
Hove palliative care partnership. It celebrates how leadership
commitment and enthusiasm plays such a critical role in enhancing
the quality of care, and helps embed the values and qualities Sue
felt so passionate about. Sue’s husband Alistair Burtt was able to
join us to present the award to our first winner, Suzy Portway, as
seen in the photo.
Quality Account 2014/15
Page 45 of 73
Good for kids
Our Rainbow nursery at Crawley Hospital received a ‘Good’ rating from Ofsted. The inspector
praised staff for the good relationships they have with the children and noted that children play
and learn in a safe and secure environment. At the same time, our Hilltop nursery in Brighton
achieved the Healthy Choice award for the second time. This is given to early years settings
that meet all the conditions set for healthy eating, and is a joint scheme by Food Safety Team,
Brighton & Hove Food Partnership and Brighton and Hove CCG.
July 2014
Wedding guests
With help from local chaplain Rev. Steve Lomas, our staff at
Arundel Hospital arranged a wedding blessing so one of our
patients could be part of his grandson’s wedding celebrations.
He passed away soon after, but the groom and bride have said
how important the event was to him and their family: “We are so
thankful to the hospital for their hard work. Everything worked
out perfectly and it was great our grandfather was part of our
wedding blessing”.
Spreading good practice
Zoe Faulkner, breastfeeding peer support coordinator for Brighton & Hove, spoke to fellow
practitioners around the world about the achievements of our Brighton & Hove breastfeeding
team as part of an online international conference iLactation.
Our Sussex specialist community public health nurse/health visitor education practice teachers
reached the final of the Community Practitioners’ and Health Visitors Association awards to
celebrate efforts to improve the lives of children and families.
September 2014
Sign up to Safety
To help promote an open culture in which staff put patient safety and wellbeing first and have
the confidence to express concerns, we registered for the national Sign up to Safety campaign
designed to promote the ambition to make the NHS the safest healthcare system in the world.
A good PLACE
The quality of the care environment at our community hospitals compares favourably with the
best, as confirmed by the patient-led assessment of the care environment (PLACE) report
published by the Health and Social Care Information Centre (HSCIC). PLACE requires selfassessment by a team of reviewers from external partners and members of the public to ensure
independent scrutiny and objectivity. They review a range of non-clinical areas that reflect
public concerns, including cleanliness (including bathrooms, furniture, fixtures & fittings), food
& hydration (including choice, taste, temperature & availability), privacy, dignity & wellbeing
(including changing & waiting facilities, single sex facilities, telephone access & appropriate
patient clothing) and condition & maintenance (including decoration, signage, car-parking).
A top employer
We were delighted to secure a place in the Health Service Journal’s (HSJ) Best Places to Work
list of the top 100 health and care employers in England. This success reflects the positive
feedback staff offered in the confidential NHS staff survey.
Quality Account 2014/15
Page 46 of 73
How we do it
Our West Sussex family nurse partnership (FNP) team hosted a visit by Kate Billingham CBE,
the international ambassador for FNP at the University of Colorado and three health ministers
from Norway, where they are preparing to launch their own FNP programme and were keen to
see how we do it.
October 2014
Winners again
We won the Institute of Healthcare Engineering and Estate Management’s national sustainable
achievement award for our Care Without Carbon strategy. This recognises our use of
innovative technology and sustainable practices, together with our unique approach to
sustainability across key areas. And it’s not the first time our efforts to reduce our
environmental impact have enjoyed national recognition - in 2011 we received the HSJ’s good
corporate citizenship award.
But I’m not unwell!
One of our proactive care team leads, physiotherapist Nick Seecharan, presented an evaluation
of our proactive care work at Physiotherapy UK’s national conference. His presentation ‘But I’m
not unwell! Changing the conversation’ shared experiences of multidisciplinary team working
and implications for physiotherapists working with patients with long-term conditions.
Embedding our values
Our children’s community nursing service
included an award ceremony in their annual
awayday to recognise colleagues in four
categories reflecting our values:
compassionate care, working together,
achieving ambitions, delivering excellence.
There were 40 powerful nominations, and
the winners are shown right.
November 2014
Time to Talk
Our award winning talking therapies service Time to Talk introduced self-referral for people in
the Mid Sussex area thanks to the support of our local clinical commissioners. Subject to the
progress, we plan to introduce the self-referral option across West Sussex. Time to Talk offers
a range of support including guided self-help via the phone or face-to-face, group courses,
cognitive behavioural therapy (CBT) and counselling. To promote the service we secured
coverage in the local media, produced and distributed a leaflet and uploaded a promotional
video to YouTube. You can see this by visiting You Tube and searching for Time to Talk West
Sussex.
December 2014
They’re all winners!
Our Sussex rehabilitation centre team were runners-up at the Limbless Association prosthetics
and orthotics award 2014, with Clare Johnson placed as runner-up in the best prosthetist
category. This achievement reflects as well the work of our colleagues at Ottobock who provide
us with both orthotic and prosthetic services.
Quality Account 2014/15
Page 47 of 73
Our Midhurst Macmillan specialist palliative care service was commended at the national
Quality in Care (QiC) oncology awards 2014 in the end of life care and bereavement category.
Our OneCall OneTeam service won the Kent, Surrey and Sussex (KSS) Leadership
Collaborative award for outstanding collaborative leadership.
Our nurseries manager Cara Mitchell was runner-up in the inspirational leader category at the
KSS Leadership Collaborative.
January 2015
Winners again
We won two awards: 1) most improved community provider; and 2) enhancing innovation
through collaboration at the celebration of innovation and improvement organised by the Kent
Surrey Sussex academic health science network (KSS AHSN). Our success was based on our
DocoboWeb project in Coastal West Sussex, which involved our community matrons working
with local nursing/residential care homes to use online technologies to manage risk and reduce
avoidable interventions and admissions. The results are impressive - a 75 per cent reduction in
hospital admissions compared with a year earlier, with nearly half of the residents in the pilot not
needing an admission.
Picture this
BTEC Art and Design
students at Collyer’s
College crossed the road
to Horsham Hospital to
display their artwork at our
Horizon Unit in an initiative
arranged between ward
manager Dawn Fincham
and Sharon Rolfe, subject
leader at Collyer’s. The
students’ artwork work will
remain on display until the end of 2015. The Horizon unit offers intermediate care and
rehabilitation, especially for elderly patients recuperating after serious illness or surgery. The
art display really helps to cheer up the ward and promotes interaction between the young
people and our generally older patients.
Hello, my name is…
Patient safety is at the heart of our commitment to an open culture, and is reinforced by our
commitment to compassionate care. For these reasons we’re pleased to support the hello my
name is… campaign pioneered by Dr Kate Granger, a hospital consultant from Yorkshire who
works in elderly care. Dr Granger has terminal cancer, and is motivated by her experience as a
patient and how she feels when staff don’t introduce themselves to her. She tells of the
difference it makes when people begin with something as simple as ‘hello my name is’, helping
her feel like a person, rather than a patient.
Time to Talk – again!
Our talking therapies service in Mid Sussex Time to Talk was listed by NHS England as a
national good practice site, which means we’ll work with our local commissioners to offer insight
to other health and care communities on how to best deliver the national improving access to
psychological therapies (IAPT) programme. NHS England said we rank alongside ‘high
performing, world class services’.
Quality Account 2014/15
Page 48 of 73
Best for breastfeeding
Thanks largely to the hard work of our breastfeeding support team and health visitors, Brighton
& Hove recorded England’s highest rate of exclusive breastfeeding at 6-8 weeks of age. Our
success builds upon the hard work of the midwives at Brighton & Sussex University Hospitals
NHS Trust and of a network of dedicated volunteers, all working together to give local mothers
the best possible chance of successfully breastfeeding their babies.
Palliative Care
The Cicely Saunders Institute in London praised our Brighton & Hove community palliative care
team for their support for a research study to help demonstrate the impact palliative care can
make. Working with colleagues from Martlets Hospice and the Royal Sussex County Hospital’s
palliative care team, we were the first site to reach the study’s recruitment target.
February 2015
Staff survey success
Given the link between staff engagement and quality of care, we’re pleased that our staff
responded more positively than the national average in 25 of the 29 key findings in the 2014
NHS staff survey published this month. Our staff engagement and staff satisfaction measures
went up again and are significantly above the national average. We can show improvement
across all the survey's key findings, and we perform better than average for 15/17 of key
themes highlighted by the Francis report into failures of care at Stafford Hospital.
However, our staff are more likely than average to feel under pressure and to experience
bullying, harassment or abuse from patients' relatives or the public. Too many report working
extra hours - 72 per cent, the same as the national rate. And our score for staff experiencing
stress is similarly too high, although it has come down since 2013, and is below average.
These are all areas we’re taking steps to address. In total nearly 1,700 staff responded.
Dare to Care begins
Our staff have taken up our Dare to Care challenge as part of our aim to deliver services that
care for the environment as well as people. We are asking them to sign up to a challenge to
help reduce waste and carbon emissions - anything from printing double sided, switching off
lights or taking the bus to work instead of driving. Dare to Care is part of SCT’s sustainable
healthcare strategy called Care Without Carbon. It provides a way to cut costs, improve the
wellbeing of staff and patients and helps to reduce waste and emissions.
March 2015
NHS sustainability awards
We achieved three places in the national NHS sustainability awards shortlist to celebrate the
work of health and care organisations to promote sustainable practice - an area where we've
already built a national reputation, having won a HSJ Good Corporate Citizenship prize in 2011
and other recent awards.
Quality Account 2014/15
3.4
Page 49 of 73
Clinical Quality Half Days
SCT’s board and clinical executive committee have given ALL teams the opportunity to meet
together to look at quality improvement ideas, by setting aside four clinical quality half days
during which teams have the freedom to stop all non-urgent work and instead meet together to
discuss ideas and agree their own plans to improve the quality of care/experience they provide
to the people they care for. It's their opportunity to review what they currently do and how they
can continuously improve and the team’s themselves decide the agenda for these sessions as
they are best placed to know the most important quality issues for their colleagues and patients.
The first day took place on Tuesday, 4 November 2014 and some examples that teams shared
to improve practice are listed below:
• How making use of our library resources can help support and develop clinical teams.
• The Falls team worked together to deliver a consistent approach and share best practice.
• Children’s physiotherapy – ways to provide a better service – responding to demand and
feedback.
• Marketing and communications team – internal communication channels – staff survey.
• Reducing the risk of catheter encrustation.
• Catheter cocktail.
• Community Citrus Clear.
The second day took place on Wednesday, 11 February 2015 and some examples that teams
shared to improve practice are listed below:
• The Horsham Community Nursing team looked at how they could personalise care plans,
reviewed how they worked and standardised their triage process to optimise how they
worked.
• The Intermediate Primary Care teams in Brighton & Hove reviewed the pressure damage
information available and undertook training on how to use the new Pressure Ulcer Risk
Assessment – Purpose T form.
The next half days will take place on Thursday 4 June and Tuesday 17 November. Urgent care
services will continue to run during these times.
3.5
Complaints
All NHS Trusts are required to follow the NHS Complaints Regulations, which the Trust has
continued to meet during 2014/15.
In 2014/15, SCT received 245 formal complaints, representing an increase of 20%, compared to
204 in 2013/14. In addition, 25 complaints were resolved outside of the formal complaints
process. These involved complainants who did not wish to access the formal complaints
process, but made their complaint verbally, and were happy with the resolution achieved within
1 working day. They are recorded by the Trust for monitoring purposes, but are not recordable
under the Complaints Regulations; however they help to form part of our overall complaints
data.
Whilst the number of complaints reported in 2014/15 has increased by 20% from 2013/14, when
benchmarked against the increase in activity from 2014/15, complaints have actually only
increased by 0.001%.
Quality Account 2014/15
Page 50 of 73
Of the 245 complaints received, these can be broken down into the following complaint types:
•
172 low/medium risk complaints
•
73 complex complaints (categorised as complaints that involve more than one
organisation and/or have involvement with a recordable Serious Incident or a
Safeguarding Alert).
3.5.1 Categories of Complaint
The three most frequent complaints received are in relation to:
•
Access to appointments / waiting times (Clinical Provision)
•
Staff Attitude (Communication)
•
Nursing Care (Clinical Provision)
3.5.2 Closed Complaints
At the time of reporting, of the 245 low/medium and complex complaints received in 2014/15,
185 were resolved with the following outcomes.
3.5.3 Lessons identified from Complaints/Patient Advice & Liaison Service contacts
All complaints are investigated to establish their cause and to identify actions and learning to
reduce, where possible, the likelihood of a re-occurrence. All complaint investigations and
responses are approved by the Head of Service, Deputy Chief Operating Officer and Chief
Executive.
Quality Account 2014/15
Page 51 of 73
The actions below are some examples of changes made as a result of feedback through our
complaints and PALS contacts:
• A Community nursing service have increased the triage of incoming new referrals and
enhanced initial assessments re accessing services outside the home environment.
• Community Short Term Services have increased opportunities for family members to be
involved in therapy and exercise sessions, where patients consent.
• “OneCall One Team” have revised their email handling system to ensure all actions
relating to a referral have been completed.
• A process change has been initiated for the use of a computerised system for
paediatricians and their administration staff to record all outstanding results and requests
for information.
• Community Hospitals will include comfort-rounding training on the induction of new staff.
• Volunteers at a Community Hospital will be trained to answer the telephone to reduce the
time callers are waiting.
Lessons identified from complaints are communicated across the Trust in a number of different
ways to maximise the opportunity for all relevant staff to benefit, including:
• Immediate changes to practice implemented in the relevant service.
• Locality governance meetings and cascade of information and knowledge from these
meetings to relevant teams.
• Promotion of lessons identified including themes, through information pages on the Trust
intranet, clinical governance newsletters and the Trust’s weekly update newsletter.
Patient stories in relation to complaints are also presented at the every board meeting.
3.6
Compliments
SCT records compliments, received through letters and cards of thanks on a centralised
database, and shares them across the Trust.
The Trust received 2540 compliments in 2014/15 compared with 2165 in 2013/14. The ratio is
currently 9.4 compliments to every complaint received.
Some examples of compliments received are:
“My care and treatment is as first class as any in the country, first class. I cannot think of any
part of my care that is not 1st class. The nurses are friendly and on time when required.
Overall a marvellous and caring service. God bless them all!" Chichester south proactive care
team.
Quality Account 2014/15
Page 52 of 73
“Just a little note to say "Thank you!" (We) are really grateful. You have such a talent with
young children and I admire you and really want just to let you know how much we appreciate
the opportunity to do the Earlybird course. Thank you again, there is something very special
about you!” Children’s Speech and Language Therapy.
3.7
Equality & Diversity
SCT is committed to a vision of excellent care that always includes equality. Over the past
year, an ambition for equality and human rights - of ‘equitable care at the heart of all our
communities’ for patients, carers, service-users and workers has been developed.
During 2014/15, we have promoted this ambition through the setting of standards in a new
Equality and Human Rights Policy and analysis tool and through developing leadership:
• Briefing executives on current performance.
• Facilitating a seminar for non-executive directors on equitable decision-making.
• Engaging senior clinical, operational and community leaders and other external
stakeholders through our ‘Valuing all Voices’ programme.
• Increasing staff equality and diversity training compliance by 10% through new face-toface training and a workbook.
The Trust has also won a bid to pilot a regional leadership development programme called
‘Awakening Inclusive Leadership’ which will continue to promote our ambition and strengthen
the capability of our leaders to deliver it.
To sustain progress, the Trust has refreshed its Equality and Diversity Group of senior leaders
and is currently engaging stakeholders through a series of community and leadership events to
update our strategy to address evidence of inequitable service quality and health and
employment outcomes. The results of this will be published on the Trust’s website in 2015/16.
The Trust is proud to have retained its status as a ‘Two Ticks’ disability positive employer during
2014/15. We are committed to employing, retaining and developing the abilities of disabled
staff. During this year, the Trust has supported the development of a disabled staff network to
promote leadership and accessible workplaces.
3.8
Volunteers
Volunteers play an invaluable role in SCT and we ensure they are fully supported, supervised
and developed in order to enhance service delivery and patient experience.
Voluntary Services sits within the Public Health Department. Our Volunteering Steering Group
oversees the work of volunteers throughout the organisation in the Brighton & Hove, Coastal
and North localities working in conjunction with the Expert Patient Programme, Sussex
Snowdrop Trust and Community Macmillan Volunteer Managers. The group ensures best
practice in the engagement and support of volunteers and aims to reduce obstacles and
increase opportunities in order to make volunteering in SCT inclusive and accessible for all. A
new database management system is now fully embedded to ensure governance procedures
throughout the Trust for volunteers are robust.
In 2014/15, the service has delivered volunteer specific statutory training to 420 volunteers and
we are in the process of developing a refresher-training booklet. Our new and updated policy
has been ratified and we are working closely with clinicians to ensure it is embedded within
services and to strengthen our volunteer workforce within our bedded units and community
services.
Quality Account 2014/15
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In 2014, we delivered a successful project called iConnect4Life that was about enabling
housebound and socially isolated patients to get on-line and access the internet with the help of
buddy volunteers. Further roll out of this project is expected in 2015.
Voluntary Services Data is also being collected to identify the demographics of our volunteer
workforce; once this is complete, the service can work towards developing a strategy, which will
fit within SCT’s clinical strategy. We will also be looking to develop how we work with our
partners in the contribution volunteers have in supporting health improvement. SCT has
committed to delivering a three yearly Trust-wide thank you event and a yearly recognition
award for volunteers.
3.9
Safe Care
3.9.1 Serious Incidents and Incident Reporting
SCT is required to report all Serious Incidents (SIs) to the Clinical Commissioning Group (CCG)
in line with the NHS England ‘Serious Incident Framework’. The Trust remains compliant with
this obligation, and has consistently met the timeframes for submission of Serious Incident
Reports to the CCG’s Serious Incident Scrutiny Panel.
In 2014/15, 45 SIs were raised, six were downgraded by the CCG, leaving 39 SI’s. This is an
increase from the previous year where 30 SI’s were reported.
The most frequently reported Serious Incident categories of incidents in 2014/15 were:
•
Slips, Trips and Falls (resulting in a fracture) and;
•
Pressure Damage.
Quality Account 2014/15
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Those reported under ‘other’ include a software failure (1), delayed treatment (2) and a
communication failure (2). Since 2013/14, the number of ‘pressure damage’ incidents reported
as a SI has reduced by 15 incidents, whilst ‘slips, trips and falls’ have increased by 11 incidents.
All SIs are investigated to establish their root cause and contributory factors and to identify
actions and learning to reduce, where possible, the likelihood of a re-occurrence. All SI Reports
are scrutinised and approved by the Trust’s Serious Incident Review Group to ensure
consistency, identify trends and themes and enable trust wide improvement from lessons
identified.
The role of the Patient Safety Leads has been revised to Quality and Patient Safety
Improvement Nurses to enable them to work clinically with services to identify themes and
embed lessons identified from incidents.
Lessons learned from SIs are communicated across the Trust in a number of different ways to
maximise the opportunity for all relevant staff to benefit, including:
• Immediate changes to practice implemented in the relevant service.
• Locality governance meetings and cascade of information and knowledge from these
meetings to relevant teams.
• Promotion of lessons identified including themes, through information pages on the Trust
intranet, clinical governance newsletters and the Trust’s weekly update newsletter.
Patient stories in relation to Serious Incidents are also presented at the board bi-annually.
3.9.2 Healthcare Associated Infections (HCAIs)
In 2014/15, our Infection Prevention and Control (IP&C) Team were involved with Post Infection
Reviews (PIR) for three patients who had Methicillin-resistant Staphylococcus aureus (MRSA)
blood stream infections. No lapses in the quality of care provided by SCT were identified and
none of these infections were apportioned to SCT’s target.
During 2014/15, our IP&C team led on the Root Cause Analysis (RCA) of 10 patients who were
identified as having Clostridium difficile (C. diff.) infection whilst in our bedded units. Due to the
timing of the specimens, nine of these patients were apportioned to SCT.
Following investigation one case was identified as being associated with a lapse in care. This
was due to an error in the prescribing antibiotics by our GP colleagues. Training has now been
provided to prevent this from occurring again. .
NHS England has issued new guidance for 2015/16 and our RCA procedures have been
updated to take this into account. Cases will only be apportioned to the target if lapses in SCT
care are identified.
IP&C have a C.diff reduction plan in progress and have continued to work closely with other
members of the local health economy towards reducing the occurrence of this disease.
Quality Account 2014/15
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3.9.3 Central Alert System
The Department of Health (DH) Central Alert System (CAS) is designed to rapidly disseminate
important safety and device alerts to nominated leads in NHS Trusts in a consistent and
streamlined way for onward transmission to those who need to take action. Trusts are required
to acknowledge receipt of each alert and respond as relevant within specified timescales.
2012/13
2013/14
2014/15
115
233
158
Acknowledged within 2 working days
110 (96%)
231 (99%)
157 (99%)
Found to be applicable to SCT
46 (40%)
41 (17%)
11 (7%)
Applicable alert responses within prescribed
timescales
43 (94%)
39 (95%)
11 (100%)
Total number of alerts received
It was expected that NHS England would implement a revised system in late 2014, which would
enable stronger correlation between incidents reported through NPSA and NRLS, Alerts and
Serious Incidents and improve feedback through the introduction of national networks via CAS.
During 2014 SCT participated in further scoping exercises for this system, however the system
is yet to be implemented.
3.9.4 Never Events
There have been no ‘Never Events’ during the reporting period. Never events are serious
medical errors or adverse events that should never happen to a patient.
3.9.5 Safeguarding
Everybody has the right to be safe no matter who they are, or what their circumstances.
Safeguarding is everyone’s concern and is the basis of safe and effective care. All staff
(including volunteers) within SCT have a responsibility to keep children, young people and
adults safe and to promote their wellbeing and this process starts with safe recruitment
processes.
Safeguarding is about the protection of harm by abuse and/or neglect. Safety from harm and
exploitation is a basic need, being and feeling unsafe undermines our relationships and selfbelief. Safeguarding is a range of activities aimed at upholding children’s and adults right to be
safe. This is important as some children, young people and adults are unable to protect
themselves because of their age, environment, situation, or circumstances.
All staff access mandatory basic training in both safeguarding children and adults and for those
working in specific areas, higher levels of training is provided. The framework for all
safeguarding children training is aligned to the intercollegiate document (RCPCH, 2014) and
meets this quality standard. There is currently no equivalent for safeguarding adults.
The Trust has policies and procedures, which are updated to reflect good practice, current
guidance and are based on evidence. These support the Multi-Agency Sussex procedures for
safeguarding children and adults.
Last year the Trust commissioned an external review on Safeguarding across children and
adults and the 22 recommendations were accepted by the Trust Board and are being
implemented. The Trust has secured additional resources and a Head of Safeguarding has
been recruited.
Quality Account 2014/15
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There is an internal structure of delivery groups in both the adult and children’s & specialist
services divisions, reporting to a Steering Committee, chaired by the Chief Nurse. The Chief
Nurse has Board accountability for safeguarding children and adults.
SCT is represented at the Safeguarding Adults and Children’s Boards in both Brighton & Hove
and West Sussex, ensuring there is a multi-agency response to keeping adults protected from
abuse and neglect.
Specialist staff have been offered specific training on the Mental Capacity Act and the
Deprivation of Liberty Safeguards ensuring they can assess the capacity of patients and clients.
The Trust upholds the principles of the Act - that every adult has the right to make their own
decisions and must be assumed to have capacity to do so, unless it is proved otherwise.
During the year, the Trust has prepared for the changes the Care Act 2014 has made to making
safeguarding personal and to ensure the patient/client is informed and outcomes are identified.
The Trust has participated in the multiagency audit and an internal service audit to ensure
quality of service and provision.
The safeguarding teams in Brighton & Hove and West Sussex have named and specialist
nurses in Children Safeguarding. Both teams work closely with children’s services, police, third
sector and others to work effectively to respond to neglect and abuse. To ensure their
effectiveness, there is a programme of single agency and multi-agency audits and case file
reviews and these are reported to the Trust Safeguarding Steering Committee.
Learning from all child deaths is important to ensure that any preventable factors can be
identified. The Trust has dedicated staff in Brighton & Hove and West Sussex who assist and
support staff in collating information for the Child Death Review Panels.
3.10 Patient Centred Care
Throughout the year, our services collected patient feedback using different methods including
via the Friends and Family Test, surveys and one-to-one interviews. Feedback and actions
taken in response to issues raised are reported to the Trust’s Patient Experience Group,
examples include:
Team
Issue
Outcome
Salvington Lodge –
Inpatient ward
A call bell was found on the
floor by a relative.
An investigation found the bell was
prone to falling on the floor. This was
resolved by attaching a clip to the bell
so it could be clipped on to bed sheets.
Salvington Lodge –
Inpatient ward
Noise from call bells at
night.
Call bells now have a lower tone at
night.
Chichester
Community Nursing
Team
One patient asked whether
they could be assessed for
their diabetes rather than
solely having insulin
administered.
The team addressed this by
commencing with in house diabetes
sessions and with an evening event
looking at the whole person approach
to patients with diabetes, i.e. their
personal goals, implications for their
eyes, feet, etc.
Children’s Speech
and Language
Therapy – Brighton
Team
A child was seen by a
number of different
therapists over the period of
time he was supported by
the service.
Actions were taken with recruitment
and absence to minimise the changes
of staff covering a particular caseload.
Quality Account 2014/15
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3.10.1 Patient Advice & Liaison Service (PALS)
In line with the Robert Francis Report and the Clywd and Hart Complaints Review, the Trust
recognises the importance of a dedicated Patient Advice and Liaison Service (PALS) and has
made the service more accessible to patients and their families. The Trust has introduced
locally held PALS surgeries at our services in Crawley and Horsham. Healthwatch, in both
Brighton & Hove and West Sussex have expressed interest in attending future West Sussex
events.
During 2014/15, PALS received 1019 contacts, representing an increase of 21%, compared
with 839 in 2013/14. Of these contacts, 456 were signposted to other organisations and
services. The PALS officer has also attended meetings with complainants to support and act as
an advocate.
SCT’s PALS service runs alongside the complaints process and ensures that when a serious
issue is identified, it can be escalated quickly via the complaints route. As an internal resource,
the PALS officer has specialist knowledge, skills and relationships with Trust services, which
ensure our patients, and their families/carers receive an effective and responsive service.
3.10.2 Friends & Family Test
In July 2014, NHS England published guidance on how the Friends and Family Test (FFT)
should be implemented in community trusts. The test asks patients a simple question: “How
likely are you to recommend our service to your friends and family if they needed similar care or
treatment?” In line with NHS England’s guidance, FFT was rolled out to all clinical services
prior to January 2015. FFT has been well received by patients with the Trust receiving
approximately 2500 responses a month. To enable staff to be able to respond more quickly to
patient comments left via FFT, options for using touchscreen tablets to conduct FFT in real time
are being explored in 2015/16.
3.10.3 Overarching Patient Experience Plan
In 2014/15, the SCT created an Overarching Patient Experience Plan (OPEP) to consolidate
patient experience work from a number of sources including the Patient Experience Strategy,
the Trust Development Authority’s Patient Experience Development Framework and actions
arising from analysis of complaints and incidents. The Patient Experience Group focuses on
monitoring the progress of the OPEP.
3.11 Staff Care
3.11.1 Staff Communications
To strengthen staff engagement, we continue to improve the ways we communicate with staff,
and promote good dialogue between staff and the senior team.
• We launched our new intranet, ensuring all relevant content is included.
• We deliver a monthly team briefing system to carry messages from the executive
leadership team to frontline staff, encourage discussion in teams and generate feedback.
• We send out a weekly message from our chief executive to all staff, linking what’s going
on within the Trust and locally to the bigger national picture.
• We publish our staff magazine and employee of the month scheme, showcasing best
practice and recognising achievement.
• Members of the board and executive leadership get out across the Trust visiting services.
Quality Account 2014/15
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• We are running surveys and other audit measures to evaluate the effectiveness of our
internal communication channels.
3.11.2 Staff Experience
The annual NHS staff survey provides an insight into staff views on the organisation and their
experience of working within it. The survey is a key measure of staff engagement and
wellbeing, which directly correlates with patient outcomes and experience and is essential to the
provision of high quality services. When compared to previous years, the results can prove a
useful tool in measuring progress and aiding our continuous improvement.
In 2014, we were required to survey a random sample of 850 staff and our response rate was
51%. In addition to the mandatory sample, we opted to survey all 4,000 eligible staff. In total,
1691 staff responded (including the 419 sample respondents), a response rate of 42.33%. This
is 1% less than in 2013.
Following a steady increase in scores over previous years, the Trust has stabilised and there
are not many areas showing a significant change from last year. This means that,overall, we
have maintained the improvements made in previous years and on the whole, the Trust is still
scoring better than our comparator group. However, there are still areas of concern that need
attention.
What we did
Promotion of staff health
• Produced “Steps to health and wellbeing” handbook for all staff.
• Produced a mindfulness CD for all staff.
• Stress training for managers.
• Reviewed the No-smoking policy and the promotion of stop smoking services.
• Promoted a Workstation Exercise video.
Violence and Aggression from patients, relatives and members of the public
• Increased the Security Management Team.
• Rolling out the ‘Skyguard’ lone working devices to teams who have identified that they have
a need for them.
Staffing levels
• Staffing templates have been reviewed in some services in accordance with safer staffing
guidance.
• The Trust-wide bank has been further developed to enhance the provision of internal
temporary workers and robust agency arrangements.
• The productive team have supported teams to work smarter and release time to care using
LEAN methodology.
Supervision and appraisal
• We have maintained high levels of participation in supervision and increased the proportion
of teams demonstrating 100% compliance, which is now over 80%.
• Developed the Staff Performance Management Framework, which will reinforce behaviours
in accordance with Trust values.
• Appraisal rates have been rising and reached 89% in December 2014.
Culture
• My behaviours and values pledge launched.
• Piloted Culture of Care Barometer.
Quality Account 2014/15
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• Over 100 staff have participated in the Transformation Development Programme to develop
skills in achieving small and large-scale change.
Core training
• Improvement in uptake of the training delivered through the statutory training day.
• Rolling attendance rates rose from 43% in April 2013, to 64% in December 2013 and 78% in
2014.
Where we are now?
The Trust has managed to maintain the positive set of scores from last year. All the Key
Findings are as good as or better than last year.
When compared with other community trusts, SCT is doing particularly well. We score better
than other organisations on 22 out of the 27 Key Findings and are worse on only two. Where
our scores are worse, we are not far from the average. As a result of this, our Staff
Engagement Score continues to improve year on year and remains above the average for other
community trusts.
3.11.3 The Transformation Plan
SCT’s Board approved the Trust’s 5-year transformation plan in June 2014. It describes how
we will achieve our vision of excellent care at the heart of the community, building on the many
good things about our services, while recognising that we cannot achieve our strategy and meet
future challenges without change.
Many of the transformation programmes and projects involve working with partners such as
GPs, Social Services, acute hospitals and other NHS Trusts. The transformation plan is
delivered through an agreed programme of work, overseen by the Trust Transformation Board,
chaired by the Chief Executive.
In order to ensure changes - particularly cost improvement plans - do not have a negative
impact on quality, they are assessed through a formal Quality Impact Assessment (QIA)
process and must be approved by the Trust’s Medical Director and Chief Nurse.
The 2015/16 transformation programme is in development, but is likely to include the following
major transformation projects:
•
Rolling out a new clinical IT system (SystmOne) that will facilitate safety, quality and
efficiency improvements.
•
Reviewing and better aligning our rapid response, intermediate care, specialist and
community nursing services to enable best, efficient and consistent service to patients.
•
Improving the way we provide administrative support to our clinical services to provide
better, more efficient services to patients and clinicians.
•
Reviewing and redesigning our children’s and families services to provide bettercoordinated care following the change of commissioners.
It will also include smaller front-line, clinically led, service-level improvement projects, using the
skills of the 100 members of staff who have been trained as transformation leads and
facilitators.
Transformation Development Programme
114 staff volunteered for an opportunity to be trained in improvement methodology, change
management, leadership skills and project management processes. These improvement leads
and facilitators have developed the skills to support small-scale local change, or to lead larger
scale projects and changes.
Quality Account 2014/15
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The programme has ensured there is a critical mass of staff using a common range of tools and
techniques that will help to embed an attitude of continuous improvement and innovative culture
into the organisation. The programme has evaluated well and plans are well under way to
spread the skills and techniques more widely within the organisation during 2015/16.
Productive Team
The Productive team support services to capture data to help them improve the quality of their
services and release time to care through the introduction of efficient working processes.
Focus during 2014 has been on the development of toolkits, support in skills development and
developing new ways of working. The teams input was invaluable in the preparations for the
Care Quality Commission inspection at the end of 2014 and the plan is to develop these skills in
the transformation facilitators to maximise the benefit across the Trust.
Quality Account 2014/15
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4 Statements of Assurance
4.1
The Board
Statement by a senior employee in respect of the Quality Account
The directors are required under the Health Act 2009 to prepare a Quality Account for each
financial year. The Department of Health has issued guidance on the form and content of
annual Quality Accounts (in line with requirements set out in Quality Accounts legislation).
In preparing their Quality account, directors should take steps to assure themselves that:
• The Quality Account presents a balanced picture of the Trust’s performance over the
reporting period.
• The performance information reported in the Quality Account is reliable and accurate.
• There are proper internal controls over the collection and reporting of the measures of
performance included in the Quality Account, and these controls are subject to review to
confirm they are working effectively in practice.
• The data underpinning the measure of performance reported in the Quality Account is
robust and reliable, conforms to specified data quality standards and prescribed
definitions, and is subject to appropriate scrutiny and review.
• The Quality Account has been prepared in accordance with any Department of Health
guidance.
The directors confirm to the best of their knowledge and belief that they have complied with the
above requirements in preparing the Quality Account.
By order of the Board
2nd June 2015
Paula Head
Chief Executive, Sussex Community NHS Trust
2nd June 2015
Quality Account 2014/15
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5 Who did we involve?
Clinicians, managers and support staff have all been invited to contribute to the 2014/15 Quality
Account, identifying their priorities for improvement for 2015/16.
Stakeholders who were invited to be involved in the development of the Quality Account
include:
• Brighton & Sussex University Hospitals
• Sussex Partnership NHS Foundation Trust
• NHS Coastal West Sussex CCG
• NHS Crawley, Horsham and Mid Sussex CCG
• Brighton & Hove CCG
• South East Coast Ambulance Service
• Healthwatch, Brighton & Hove
• Healthwatch, West Sussex
• Our staff
• Service users (via our Patient Experience Group)
All our Commissioners, Brighton & Hove City Council and West Sussex County Council via their
respective Health & Wellbeing Overview & Scrutiny Committee (HWOSC) and Health & Adult
Social Care Select Committee (HASCS), Healthwatch Brighton & Hove and Healthwatch West
Sussex have all been asked to comment via separate letters. These responses can be read
below.
6
Statements provided by Stakeholders
6.1
Brighton & Hove City Council’s Health and Wellbeing Overview and
Scrutiny Committee
The statement from Councillor Sven Rufus, Chair, HWOSC was sent via email to SCT on 28
May 2015:
Brighton & Hove City Council’s Health and Wellbeing Overview and Scrutiny Committee
(HWOSC) appreciates the high quality work that Sussex Community NHS Trust (SCT) carries
out for the residents of Brighton and Hove, and for the wider Sussex region.
SCT is always willing to come to the scrutiny committee with proposals for changes in service
provision and they are happy to listen to suggestions that members make.
The Trust acts in a way that keeps the needs of residents at the heart of their services. They
provide many useful community services for Sussex residents.
HWOSC members were very pleased to note that their services have recently been recognised
as ‘good’ by the Care Quality Commission.
Councillor Sven Rufus, Chair, HWOSC
Quality Account 2014/15
6.2
Page 63 of 73
Commissioners
Amendment to previous letter - sent on 19 May 2015
Attn: Paula Head
Chief Executive Officer
Sussex Community NHS Trust
Sent Electronically
Lower Ground Floor
Crawley Hospital
West Green Drive
Crawley
West Sussex
RH11 7DH
Tel: 01293 600300 (ext. 4255)
Email: hsccg.contactushorshamandmidsussexccg@nhs.net
14 May 2015
Dear Paula
Sussex Community NHS Trust – Quality Account
The CCGs; Brighton and Hove, Crawley, Horsham and Mid-Sussex, High Weald Lewes
Havens, Eastbourne, Hailsham and Seaford, Hastings and Rother and Coastal West Sussex,
would like to congratulate the Trust on its CQC report and the good standard of care delivered
over the past year. The approval to move to Foundation status is noted and the current work
underway in addressing care will build upon the foundations of a good CQC report and TDA
support.
The Quality Account appears to meet the requirements of the Department of Health Guidance
and has clearly outlined quality developments over the year 2014/15 and ambitions going
forward.
The CCGs agree that priorities for improvement in the Quality Account meet the key issues
arising from Quality Reviews with the Trust over the past year, notably the missed and deferred
visits which have been cause for concern, and the falls and pressure damage work. The CCGs
welcome the work on organisational culture and its links to the staff survey action plan. The
staff recruitment and retention work is welcome however, the need to recruit to Community
Nursing posts remain a concern and the CCGs look forward to working with the Trust and
health system in addressing these needs.
It is pleasing to note the work with Partners and local authority Safeguarding Committees,
Healthwatch and the voluntary sector. The 5 year forward view challenges Organisations to
change the way they deliver services, and makes partnership working essential to enable
innovative changes to take place.
The CQC mentioned areas for improvement. The work to boost recruitment and improve
staffing levels is welcomed, also the need to review the rollout of IT systems is particularly
welcome given the issues which have arisen with the implementation of new Child Health
immunisation System.
Quality Account 2014/15
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Work to improve the quality of the Estate is welcome as it impacts upon the delivery of patient
care, and makes it more difficult for staff to deliver improved services. The CCGs note the
emphasis upon continuous improvement for clinical care and agree that areas outlined in the
report align with CCGs findings from monitoring and review meetings throughout the year.
There are areas for improvement as outlined but the CCGs believe that the Trust have
realistically identified where improvement is needed. The recent CQC review did not uncover
any surprises in this repsect and as a Trust you appear to be taking the necessary steps to
ensure these improvements take place.
The Trust transformation plan Quality impact assessment process is commendable and it would
be helpful to have mention of at least one instance where the process prevented a development
deemed unhelpful to patient care or experience.
A mention of lessons learned from System Implementation for Child health records
immunisations would be helpful and how these lessons will improve other care plan
implementations in the future.
A fuller description of the challenges in recruiting to Community Teams and how the Trust is
addressing these challenges would be helpful.
The CCGs note the good work on being an International Study site for work with Children with
cereberal palsy led by Dr Diane Sellis.
The CCGs commend the Trust on its improvements over the past year and look forward to
working in partnership to address the challenges outlined in the Quality Account.
Yours sincerely
Mona Walker
Head of Quality/Chief Nurse
Crawley Clinical Commissioning Group
Horsham and Mid Sussex Clinical Commissioning Group
Quality Account 2014/15
6.3
Page 65 of 73
Healthwatch Brighton and Hove
Sussex Community Trust Quality Account Response
At a time when we are moving towards a more community oriented model of care, Sussex
Community Trust plays a key role in ensuring that the people of Brighton and Hove receive
services that are safe and of high quality. We would like to congratulate the trust on their recent
Care Quality Commission inspection, particularly around the ‘outstanding’ rating for End of Life
Care in our area. We would also like to commend the trust for their timely implementation of the
Friends and Family Test. Other local trusts have found it beneficial to move to an electronic
system of gathering data for the test, and we support Sussex Community Trust’s interest in
pursuing this.
Appointments
Our own primary data confirms that the topics of ‘access to appointments’, ‘staff attitude’, and
‘nursing care’ are the three most common complaints for the trust, and are important areas for
improvement in 2015/2016. Healthwatch Brighton and Hove has been monitoring missed and
deferred home visits in our area, and supports this as a key priority for improvement going
forward. We would like to offer our support in terms of proofing and promoting any written
information explaining what people should do if their appointment is delayed or missed. We
would also like to offer our support in ensuring that patients are at the heart of redesigning the
systems in place for informing them when there are changes to planned visits.
Care and Compassion
We also support the inclusion of the ‘Sit and See’ observational tool as a way to measure care
and compassion in community health settings, along with the other measures indicated this
area. Healthwatch Enter and View Volunteers have recently been trained in ‘Sit and See’
observation, and our in-house trainer will pass this training on to additional volunteers in 2015.
Healthwatch Brighton and Hove would like to open a conversation with Sussex Community
Trust about how we can work together to observe and improve compassionate care together.
Brighton General Hospital
Brighton General Hospital is, as the Quality Account presents, an aged building which is now
largely unsuitable for clinical care. We welcome the provision of a new building, and the
feasibility work which has already taken place. We would like to be kept up to date on how
patient experience will be built in to this ongoing process in the future, particularly with regard to
designing new spaces, looking at locations, and opportunities for patient voice to be heard.
Healthwatch Brighton and Hove and Sussex Community Trust have built a positive working
relationship, which we would like to maintain and develop over the next financial year. Quality
and safety can only improve where the voices of patients are listened to, and we will continue to
ensure this happens in 2015/2016.
Quality Account 2014/15
6.4
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Healthwatch West Sussex
Working to make sure the consumer’s voice is always heard and helps
shape the provision of health and social care services in West Sussex
Quality Account comment
Sussex Community NHS Trust 2014/15
Introduction
As the independent champion for health and social care for patients across West Sussex
Healthwatch (HWWSx) are pleased to be invited to comment on Sussex Community NHS Trust
(SCT) draft Quality Account (QA) for 2014-15.
The Trust’s draft QA 2014-15 clearly demonstrates a willingness to be open and transparent
under the Duty of Candour.
SCT delivers a wide diversity of services, working in both acute and community settings. We are
pleased to see some evidence of cross agency working and would encourage further
commitment to partnership working in order to ensure a seamless services for patients.
We note that the Care Quality Commission (CQC) has awarded a “Good” rating generally to the
Trust with some areas reported as “Outstanding”. The CQC particularly mentioned the excellent
attitude of staff to patients and carers. However, they did identify a need to improve medicines
management, training in the care of dementia patients, record keeping and care planning,
therefore, we are delighted to see these issues addressed in the priorities for 2015/16.
HWWSx welcomes the inclusion of Additional Achievements 2013/14 which demonstrates some
notable successes both nationally and locally and underpins the Trust’s commitment to patients,
their family and carers at the centre of care.
Given the national concern over the quality of End of Life care we are pleased see that the Trust
are proposing to implement a number of improvements in care of the dying in both inpatient and
community care.
Our commentary reflects the content of the Trust’s draft QA 2014/15 and draws from patient
experience as recorded in our Client Relationship Management database system.
HWWSx received both positive and negative comments from patients mostly concerning
Bognor Regis War Memorial Hospital.
In summary
Positive
• We are pleased to say that the majority of patients who contacted us reported a good
experience at the hospital in the treatment they received and especially noted the caring
and considerate attitude of staff.
Negative
• We received a concerning report of inappropriate discharge where friends and family had
to intervene to ensure services were in placement before the patient returned home.
• A concern was raised that there is a problem with the wheelchair service for disabled
children with special needs in the north of the county.
Further anonymised details can be supplied if required.
Quality Account 2014/15
Page 67 of 73
Safety
Reported improvement 2014/15
HWWSx welcome the reduction in hospital acquired infections and pressure damage by specific
training being offered to widely across the Trust.
A plan to improve access to services addresses a number of issues which have been reported
to us.
The recruitment of a Head of Safeguarding is to be welcomed.
Priorities for 2015/16
We were pleased to note the introduction of IP&C C Diff reduction plan and a plan to reduce the
incidence of pressure sores. This will be of particular benefit to the elderly residents of West
Sussex.
As the CQC raised the issue of inappropriate medicines management we note the Trust aims to
reduce the number of incidents in this area. We trust that this action will also reduce the number
of serious incidents. Serious incidents and near misses are a source of learning and we
welcome the Trust’s renewed focus on disseminating this learning to staff. We would wish to
see evidence of this included in the Quality Account 2015/16.
We have been made aware of national concern around stroke and therefore are pleased to see
the Trust is introducing SSNAP standards.
Effectiveness
Reported improvement 2014/15
As above we welcome the Introduction of the Purpose T risk assessment tool for pressure sores
and its use continued in 2015/16.
We commend the Trust in working towards transparency around the increase of complaints,
evidencing learning from them and actions taken accordingly.
Priorities for 2015/16
We welcome the priority of a seamless care pathway between primary and secondary care as it
will address some of the issues reported to us. Planned review of alignment of rapid response,
intermediate care specialist and community nursing services are further welcomed.
Data quality and accuracy of coding are a major issues for all healthcare providers. We are
pleased to note that the Trust is reviewing these areas. The roll out of a new clinical IT system
will support data capture and analysis across the Trust to improve quality and efficiency of
service. We hope to see evidence of this improvement in the QA 2015/16.
The Trust is to be commended in recruiting a falls champion which it is hoped will reduce the
incidence of fractured neck of femur.
Patient experience
Reported improvement 2014/15
As the independent patient’s voice we commend the Trust in its efforts to hear directly from
patients, their families and carers and offer more information on their services through the
Valuing All Voices programme, Awakening Inclusion leadership, retaining the Two Ticks
disability positive employer, improved access to PALS. We note the priority placed on improved
response to complaints and overarching Patient Experience Plan analysis of complaints and
incidents. We would wish to see continued evidence of improvements made as a result of
patient feedback in the 2015/16 QA.
Quality Account 2014/15
Page 68 of 73
Priorities for 2015/16
HWWSx very much welcome the inclusion in the QA of increased patient feedback through
focus groups and a Customer Care programme to support the philosophy of patients at the
heart of care. The development of Cultural Champions will assist staff and ensure that
individuals with protected characteristics receive equal access. The introduction of an Equality
and Diversity team which will be responsible for publishing the results of stakeholder events is
commendable.
The proposed priorities of reducing missed visits through revised appointment system
addresses complaints received by HWWSx.
Poor nutrition is often referred to as part of overall unacceptable quality of care in the elderly
and therefore we commend the Trust for addressing this.
Safeguarding of children and adults in healthcare situation is of paramount importance to
HWWSx so we are pleased to see a focus on this area throughout the Trust.
Conclusions from the service user perspective
As an independent organisation representing the patient their family and carers viewing
evidence of service improvement is of primary importance to us.
HWWSx commends the Trust for their stated aim of putting the patient at the heart of their care.
A commitment to high quality, safe and compassionate care with a view to continuous
improvement is welcomed together with the introduction of Sit and See to enable personalised
care.
We congratulate the Trust on the improvements achieved as identified in the QA 2014-15 report
but would wish to see a more outcomes focused approach in the future with clear evidence of
actions taken as a result of serious incidents, complaints and meaningful patient engagement.
We welcome the Trust’s commitment to working in partnership with Social Services, primary
and acute care. We recognise and commend in particular the improvement in Health Visiting
services but would wish to see further evidence of improvement and focus on children and
family services.
It is noted that the Trust plan to implement a review of the Transformation and Development
Programme for staff which promotes and supports an organisational culture of compassion and
supports staff values and behaviours. However, the QA priorities for 2015/16 does not mention
any review of staffing levels and skill mix which has been a concern raised with us in the past.
HWWSx looks forward to continuing to work with the Trust in an open, transparent and mutually
respectful relationship with support continuous improvement in the delivery of healthcare for all
patients
Quality Account 2014/15
6.5
Page 69 of 73
West Sussex County Council Health & Adult Social Care Select C’ttee
Mrs Margaret Evans
County Hall
Chairman
West Street
Health & Adult Social Care Select Committee
Chichester
West Sussex
033022-22551
PO19 1RQ
e-mail address:
Margaret.evans@westsussex.gov.uk
website: www.westsussex.gov.uk
If calling please ask for
Suzanne Thompson
19 May 2015
Janet Parfitt
Quality Improvement Lead, Clinical Quality Division
Sussex Community NHS Trust
SENT VIA E-MAIL
Dear Janet
2014-15 Quality Account
Thank you for offering the Health & Adult Social Care Select Committee (HASC) the opportunity
to comment on Sussex Community NHS Trust’s (SCT) Quality Account for 2014-15.
We welcome the strategic goals to deliver excellent care at the heart of the community through
the core values and behaviours of compassionate care, working together, achieving ambitions
and delivering excellence.
HASC congratulates the Trust on its ‘Good’ overall Care Quality Commission inspection result
and will work with the Trust if any substantial changes to services arise from the continuing
transformation programme.
Yours sincerely
Mrs Margaret Evans
Chairman, Health & Adult Social Care Select Committee
c.c.
Dr James Walsh, Mrs Ann Rapnik, Mr Bryan Turner
Quality Account 2014/15
7
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Conclusion
SCT’s Quality Account 2014/15 documents our quality improvement priorities for the next year
and reports on how we did against those priorities we set ourselves last year. The process has
been inclusive and illustrates that improving the quality of care we give is not the responsibility
of one person, or service; it is a collective responsibility – part of the culture of our Trust.
This Quality Account has been prepared in accordance with the Department of Health’s Quality
Account Toolkit, first published in December 2010 and available electronically at
www.dh.gov.uk/publications .
Quality Account 2014/15
8
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Glossary of terms
Term
Description
Assurance
Providing information or evidence to show that something is
working as it should, for instance the required level of care, or
meeting legal requirements.
Care Quality
Commission - CQC
The independent health & social care regulator for England.
Clinical Audit
A process used to improve the quality of care. This is done by
reviewing the care given against explicit criteria. Analysis of the
results is then used to highlight any gaps. An action plan can then
be put in place to address those gaps and then a re-audit takes
place to review whether those actions have worked to plug the
gaps identified. A clinical audit can also highlight good practice,
which can then be shared across SCT.
Clinical Coding
Instead of writing out long medical terms that describe a patient's
complaint, problem, diagnosis, treatment or reason for seeking
medical attention, each has its own unique clinical code to make it
easier to store electronically and measure.
Clinical Commissioning
Groups - CCGs
Groups of GPs who are responsible for designing local health
services in England.
Clinical Effectiveness
Is the clinical intervention used doing what it is supposed to? Does
it work?
Clinical Governance
Clinical governance is a systematic approach to maintaining and
improving the quality of patient care within the NHS.
Clostridium Difficile - C.
difficile
A contagious bacterial infection, which can sometimes reproduce
rapidly – especially in older people who are being treated with antibiotics – and causes potentially serious diarrhoea.
Commissioning
The process of buying health and care services to meet the needs
of the population. It also includes checking how they are provided
to make sure they are value for money.
Commissioning for
Quality and Innovation CQUIN
A payment framework, which commissioners use to reward
excellence, by linking a proportion of the Trust’s income, to its
achieving set local quality improvement goals.
Community Information
Dataset - CIDS
CIDS makes locally and nationally comparable data available on
community services. This helps commissioners to make decisions
on the provision of services.
Data Warehouse
In computing, a Data Warehouse is a database used for collecting,
and storing data so it can be used for reporting and analysis.
Department of Health DH
A UK government department responsible for government policy for
health and social care matters and for the National Health Service
(NHS) in England.
EKOS
East Kent Outcomes System
Quality Account 2014/15
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Falls Bundle
A bundle of interventions that when used helps to reduce falls and
related injuries.
Healthwatch
Healthwatch England is the independent consumer champion for
health and social care in England. It ensures the overall views and
experiences of people who use health and social care services are
heard and taken seriously at a local and national level.
Improving Access to
Psychological
Therapies (IAPT)
A national programme including Time to Talk.
Information Governance A system that allows NHS organisations and partners to measure
Toolkit
themselves against Department of Health Information Governance
policies and standards.
Intranet
An intranet is a computer network that uses Internet technology to
share information between employees within an organisation.
SCT’s Intranet system is called the Pulse.
Malnutrition Universal
Screening Tool - MUST
MUST is a five-step screening tool used to identify adults who are
malnourished, at risk of malnutrition, or obese. It also includes
guidelines, which can be used to develop a care plan to manage
the problem.
Methicillin-Resistant
Staphylococcus Aureus
- MRSA
Staphylococcus aureus (Staph) is a type of bacteria that is
commonly found on the skin and in the noses of healthy people.
Some Staph bacteria are easily treatable, while others are not.
Staph bacteria that are resistant to the antibiotic methicillin are
known as Methicillin-resistant Staphylococcus aureus or MRSA.
Metrics
Measures, usually statistical, used to assess any sort of
performance such as financial, quality of care, waiting times, etc.
National Institute For
Health Research - NIHR
A government body that coordinates and funds research for the
NHS in England.
National Institute for
Health & Care
Excellence - NICE
An independent organisation responsible for providing national
guidance on promoting good health, and on preventing and treating
ill health.
National Patient Safety
Agency - NPSA
Leads and contributes to improved and safe patient care by
informing, supporting and influencing organisations and people
working in the health sector.
National Reporting and
Learning System NRLS
An NHS national reporting system, which collects data and reports
on patient safety incidents. This information is used to develop
tools and guidance to help improve patient safety.
Patient Advice &
Liaison Service - PALS
A service providing a contact point for patients, their relatives,
carers and friends where they can ask questions about their local
healthcare services.
Productive Series
Programme
A set of practical tools, such as patient experience surveys,
developed by the NHS Institute for Innovation & Improvement, to
help NHS services redesign and streamline the way they work.
Productive Ward
A ward based element of the Productive Series.
The Pulse
The Trust’s intranet for staff.
Quality Account 2014/15
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Feedback
We would very much like to know what you think about our Quality Account this year. Please
use this form to let us know what you think about this report and what you would like us to
include in next year’s.
1. Who are you?
Patient, family
member or
carer
Member
of staff
Other
(please
specify)
2. What did you like about this report?
3. What could we improve?
4. What would you like us to include in next year’s report?
5. Are there any other comments you would like to make?
6. Sussex Community NHS Trust is applying to become a Foundation Trust. Are you
interested in becoming a member? If so, please provide your name and address below.
Thank you for taking the time to read this report and give us your comments.
Please post this form to:
Paula Head
Chief Executive
Sussex Community NHS Trust
J Block, Brighton General Hospital
Elm Grove, Brighton
East Sussex
BN2 3EW
You can also contact us via social media using:
• twitter.com/nhs_sct
• facebook.com/sussexcommunitynhs