Quality Report
2014/15
Delivering high quality care
cornwallfoundationtrust.nhs.uk
Phil Confue, Chief Executive
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Statement on quality from the
Chief Executive
The Trust aims to deliver excellent clinical
outcomes within a caring, compassionate
and safe environment. During 2014, staff
from across the Trust met to comprehensively
review and clarify feedback received from
staff, Governors, Board of Directors, patients
and stakeholders on our Vision and Values.
Following consultation our vision and values
were agreed as:
‘’Delivering High Quality CARE’’
C - Compassionate Services
A - Achieving High Standards
R - Respecting Individuals
E - Empowering people
Our Visions and Values are the golden thread
by which we deliver high quality care. The
Trust’s top focus is Quality. We are committed
to providing the highest quality services for
the patients and carers who come into contact
with the Trust. For this to occur it is essential
that we listen to our patients, staff and key
stakeholders, and take their advice on how we
can not only meet but also exceed their and our
expectations.
In October 2014, the Care Quality Commission
introduced a new way of inspecting Trusts
to demonstrate to members of the public
how safe, caring, effective, responsive and
well led services are. These inspections will
include greater involvement of the public
and other stakeholders. In response to this
change the Trust has reviewed its own internal
arrangements to demonstrate and assure
ourselves that the care we deliver is of a high
quality.
This internal review has cumulated in the
development of the Trust’s three year
Quality Strategy of which the Quality Report
is an integral part. Our Quality Strategy
demonstrates our over-arching principles of
delivery and identifies three quality ambitions
applicable across the Trust’s operational Service
Lines. These three ambitions are:
A positive patient experience. We want to
understand the patient experience by listening
and responding to feedback. This means letting
people know what has happened as a result of
their feedback. We want to work with people to
help us to co-produce and deliver high quality
services that meet their needs.
In the last year we have worked with patients to
develop further the use of our patient surveys
(Meridian) by involving them in the design, by
discussing the results with other patients and
asking patients to complete on-line surveys.
This has resulted in us having a wealth of data
which we can use to improve our services. The
national implementation of the Friends and
Family Test demonstrates to the public, through
NHS Choices, patients’ views of the Trust. This
will contribute further to our understanding of
what high quality care looks and feels like from
the perspective of the patient or carer.
Deliver safe care. We are committed to
delivering a safe healthcare system within the
resources available and reducing the level of
harm experienced by our patients over the next
three years. We will do this by building on
our culture and reinforcing the principle that
patient safety is everyone’s business.
Our incident reporting has demonstrated
improvements this year and reflects our aim to
be a high reporter of incidents and near misses
in order to learn and make improvements to
systems. We have publically committed to
supporting the Sign-Up to Safety Pledges and
have developed a safety improvement plan for
the next 3 years building on our existing Patient
Safety Strategy (2013 – 2016).
We have responded to Positive and Proactive
Care: reducing the need for restrictive
interventions (Department of Health). We have
reviewed our definitions of harm in order that
our staff are informed and we are progressing
the implementation of the “Safe Wards”
initiative.
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Clinical Effectiveness. Through the continued
application of clinical effectiveness we will
be able to demonstrate delivery of high
quality care through implementing a range of
initiatives. These include analysis and review
of incidents involving restraint, seclusion and
those that fall under the category of disruptive,
aggressive behavior. We will empower, and
support, people to achieve their personal health
outcomes. Our services will have defined
clinical outcomes based on evidence based
guidance and practice for example guidelines
from the National Institute for Health and Care
Excellence (NICE) guidelines.
We have further developed a number of
research projects, working in conjunction with
the Academic Health Science Network and the
University of Exeter. The work will impact on
the delivery of psychological interventions for a
wide range of people and improve accessibility.
These ambitions, and our developments in the
last year, are supported through our leadership
and safety culture; engaging and empowering
our workforce; clinical engagement and
underpinning governance arrangements.
Over the last year we have been furthering all
these ambitions and want to progress to ensure
we are the provider of choice for both our
patients and our Commissioners.
impact the reliability or accuracy of the data
reported. These include:
•
ata is derived from a large number of
D
different systems and processes. Only some
of these are subject to external assurance,
or included in internal audits programme of
work each year.
•
ata is collected by a large number of
D
teams across the trust alongside their
main responsibilities, which may lead to
differences in how policies are applied or
interpreted. In many cases, data reported
reflects clinical judgement about individual
cases, where another clinician might have
reasonably have classified a case differently.
•
ational data definitions do not necessarily
N
cover all circumstances, and local
interpretations may differ.
•
ata collection practices and data
D
definitions are evolving, which may lead
to differences over time, both within and
between years. The volume of data means
that, where changes are made, it is usually
not practical to reanalyse historic data.
The Trust and its Board have sought to take all
reasonable steps and exercise appropriate due
diligence to ensure the accuracy of the data
reported, but recognises that it is nonetheless
subject to the inherent limitations noted above.
Following these steps, to my knowledge, the
information in the document is accurate.
In addition to our Quality Strategy, we have also
implemented the recommendations resulting
from the second Francis Report on the Mid
Staffordshire Hospital and our Directors have
all undergone the “Fit and Proper Persons
test”. Being open when things happen is a key
requirement of Francis’s recommendations and
to ensure this, we have implemented the Duty
of Candour requirements.
Finally, I would like to thank our stakeholders
for their contribution to this report, in
particular our Governors and local Healthwatch
organisations, as well as the commissioners of
our services. Each provides valuable insights
into our organisation and helps us reflect on,
and address, the views of patients.
Phil Confue, Chief Executive
I am pleased to present this Quality Report to
you and I believe it to be fair and balanced
report on the quality of care within the Trust.
There are a number of inherent limitations in
the preparation of Quality Account which may
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Priorities for improvement and
statements of assurance from the board
Quality improvement
priorities in 2014/15
Children and young people’s
service line
Priority 1: Patient experience in
children’s services
To monitor and improve the experience of
children, young people and their families who
are either referred to the Care Management
Centre or contact us for information to ensure
that it is patient-centred and is a positive
experience.
Why was this a priority?
The central Care Management Centre processes
all referrals to children’s services and has been
designed to provide a consistent, equitable
and reliable process for all referrals, and
enquiries, to children’s services from across the
county. This facilitates a timely and appropriate
response to all referrers, or enquiries,
identifying a pathway of care and ensuring that
patients experience a positive response that is
centred on their requirements.
How did we perform in 2014/15?
In 2014/15 the Trust committed to design a
process to capture the experience of those
professionals, agencies, children, families or
carers who were either making a referral to the
Care Management Centre or who made contact
with an enquiry.
In order to check progress against this priority we set the following performance indicators:
Indicator
Develop a survey to be completed by children,
families and referrers
Demonstrate how feedback has influenced
the service provided by the Care Management
Centre with quarterly updates presented to the
Children’s Trust Board.
Work with the independent sector to develop
an innovative process to further engage with
patients
Ensure this is based on 100 returned completed
surveys
Progress
Surveys have been developed for specific clinics.
These surveys are for completion by children,
families or referrers.
A quality circle audit is conducted with the
results influencing staffing and skill mix.
The service line has improved service user
participation by working with the shadow
Youth Board. Funding has been sought
through Improving Access to Psychological
Therapies (IAPT) to allow joint working between
parenting participation groups at the Council
and the young people shadow board in order
to inform the development of services. Part of
this work also relates to sending a message from
young people to all new clients
The views of young people have influenced the
development of job descriptions.
100 completed surveys have been received and
actions taken particularly in relation to feedback
mechanisms to the referrer. As a result of the
feedback the Autistic Spectrum Disorder (ASD)
Team has now introduced a regular updating
system for clients on the waiting list.
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Functional community service
line
Priority 2: Patient experience in
community mental health services
To develop a programme of workshops for
carers of people who use the Trust’s services.
Why was this a priority?
The involvement and participation of carers is
very often a key factor in supporting patients’
treatment and recovery. It is incumbent on
the Trust to ensure that we identify the carers
for any of our patients, carry out bespoke
assessments of their needs and, when needed,
facilitate them to receive the correct level
of support. However, many carers report
that in the early stages of their contact with
mental health services it can feel a bewildering
and confusing system that they struggle to
understand.
How did we perform in 2014/15?
In 2014/15 the Trust committed to create,
and implement, a programme of carers’
workshops across the county to be delivered
through the Trust Resource Centres. These
workshops enable carers to develop a greater
understanding of the issues around mental
health and the treatment and services available
to offer support. The programme is based
on the implementation model that was used
in 2013/14 for the successful introduction of
Recovery Workshops which are available in all
Resource Centres.
Complex care and dementia
service line
Priority 3: Clinical effectiveness
in complex care and dementia
services
To ensure carers of people with dementia are
offered an assessment of their emotional,
psychological and social needs and, if accepted,
receive tailored interventions identified by a
care plan to address those needs.
Why was this a priority? For the fourth year the Complex care and
dementia service line linked its quality priority
to the National Institute for Health and Care
Excellence (NICE) Dementia Standards. The
expectation that carers of people who receive
their care through the Care Programme
Approach (CPA) have their needs assessed
and a care plan put in place to meet those
needs is also set out in the National Service
Framework (NSF) for Mental Health. A review
of patient records and the opportunity to listen
to the voices of carers highlighted the need
to enhance the experience of carers of people
who receive support from the Complex care and
dementia service line.
In order to check progress against this priority we set the following performance indicators:
Indicator
Develop a carers’ training programme with a
pilot site to commence in June 2014.
Ensure two further sites commence the carers’
Training programme in September 2014.
Ensure an additional two sites commence the
carers’ training programme in December 2014.
Ensure the carers’ training programme is
accessible from 100% of the Trust’s resource
centres by the end of the 2014/15 financial year.
Progress
As part of our wider social care role the Trust
launched, and delivered, a highly successful
programme of carers’ workshops which are
delivered from our Resource Centres.
This target was met by September 2014 with the
programme running in Roswyth Resource Centre
in Newquay and Boundervean Resource Centre
in Camborne.
This target was met by December 2014 with the
programme running in Trelil Court Resource
Centre in Bodmin and Anchor Resource Centre in
Falmouth.
Currently the programme runs in all 10 Resource
Centres across the county resulting in carers
being offered the opportunity to understand
how to support someone with mental health
needs, time to reflect on their own needs as a
carer and to create their own support plan. The
programme is currently being reviewed and
updated in line with the Care Act.
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How did we perform in 2014/15? In 2014, the Trust committed to introduce
the checklist developed by the Mental Health
Foundation. This is an easy to use assessment
which enables staff to assess the needs of
dementia carers and evaluate the benefits
services have provided. In addition Primary Care
Dementia Practitioners committed to work with
local general practices (GPs) to provide support
for increasing the number of carers on the
carers’ register.
In order to check progress against this priority we set the following performance indicators:
Indicator
Introduce, implement and monitor use of the
carers’ checklist, in one of the complex care and
dementia community teams, with the result of
tailored care plans being developed for carers
and therapeutic interventions provided.
Monitor the effectiveness of the tool through
clinical audit and carer feedback.
If successful in effectiveness and efficiency, the
tool will be adopted for mainstream use across
the complex care and dementia service line.
If the tool is not found to be effective an
alternative will be sought.
Consideration will be given to how the tool
can be adapted to meet the needs of carers
of people receiving community mental health
services.
Functional inpatient service
line
Priority 4: Clinical effectiveness in
inpatient mental health services
To continue the 2013/14 priority of ‘on-going
monitoring of delivery of the care pathway for
people with a personality disorder’. This will
allow the inpatient mental health service line
to embed the changes made and continue to
monitor this as a focused piece of work.
Why was this a priority? Improvement in this area is expected to enable
the Trust to deliver more timely care and
Progress
A pilot was undertaken in the Camel and
Valency community teams and completed by 31
March 2015. The outcome of the pilot was that
both carers and staff did not find the checklist
tool helpful. Tailored care plans have been
developed with carers but not as a result of the
use of the checklist.
Questionnaires were completed by staff to
monitor the effectiveness of the tool.
As the tool was not considered effective it was
not adopted for mainstream use across the
service line.
Feedback obtained indicates that the use of
the tool is not an effective alternative and,
therefore, a further meeting will be held
to develop a CD to complement the carers’
assessment.
As described above a meeting will be held to
discuss the development of a Mindfulness CD to
complement the carers’ assessment and ensure
that the assessment is useful to both carers and
clinicians.
treatment that supports the patient both in
hospital and during transition out of hospital
whilst minimising the length of stay in line
with the National Institute for Health and Care
Excellence (NICE) Guidelines.
How did we perform in 2014/15?
In 2014 the Trust committed to develop a
clear referral policy and associated guidance
document to help improve access to specialist
personality disorder services to provide
consultation and assessment. To support
the introduction the Trust also committed to
provide structured staff training in personality
disorder awareness, recognition, models of
understanding and brief interventions.
In order to check progress against this priority we set the following performance indicators:
Indicator
Target 95% of referrals to the personality
disorder services seen within three days of
admission.
Monitor key points on the pathway.
Continue training in personality disorder
awareness and compliancy targets against this
Progress
60% of patients were referred to the personality
disorder services within three days of admission.
Of those who were not referred within 3 days
many were awaiting a definitive diagnosis which
was not possible to determine within three
days of admission due to the complexity of the
patient presentation.
An audit was conducted on the Inpatient
Personality Disorder Pathway in March 2015 to
monitor key points along the pathway.
As at 31 March 2015 83% of eligible staff have
completed training.
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Learning disability service line
Why was this a priority?
Priority 5: Clinical effectiveness in
learning disability services
To implement a communications
charter.
The speech and language therapy team in
the learning disability service took the lead in
developing a multi-agency communications
charter which was launched in October 2013.
The main function of the charter is to help local
businesses and organisations to communicate
with people who have a learning disability or a
communication difficulty.
How did we perform in 2014/15?
The Trust committed to train adult learning
disability staff in the use of the communication
charter and to monitor key improvements and
outcomes within the service line.
In order to check progress against this priority we set the following performance indicators:
Indicator
95% of all adult learning disability staff have
undergone training in using the communication
charter by March 2015.
Monitor key improvements/outcomes in
communication within the learning disability service
line.
Progress
Communication training is provided to staff which
includes understanding the barriers to communication
and the use of a range of communication tools such as
keyword signing, making information easier to read
and the understanding and the use of visual resources.
100% of staff received the basic 3 introductory units.
In addition, the Trust has trained over 150
communication leaders in residential and day settings
across Cornwall. They are provided with skills and
resources to support the individual communication
needs of the people they work with as identified by
the speech and language therapist. Other tools will
help them to improve their general communication
environment. As a result of the above we are seeing
settings becoming more positive signing and total
communication environments. This is releasing
Speech and Language Therapist time to focus on
those clients with the most complex and challenging
communication needs.
Over the past year the Trust has developed a range of
wider access events that help staff and service users
further develop, and use, their communication skills in
a community setting. These include:
• Monthly “Intensive Interaction cafés” to
support work with those who have no formal
communication system.
• Regular ‘Appy talk’ sessions where people can
share and develop their use of technology – for
example Apps on iPads and tablets, and we
are raising money to purchase an ‘eye-gaze
technology system’ so that clients with severe
physical disabilities can access computer and
communication opportunities.
• Visual resources workshops where people can
get support to create their own Communication
Passport, visual timetable etc.
• An increasing number of settings are running
“singing and signing” sessions to develop the
signing skills of service users and staff, some of
which have led to performances at the Hall for
Cornwall and Lemon Quay.
• A monthly newsletter is circulated to all
communication leaders to share ideas and good
practice within their settings, including a “sign of
the week”.
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Future priorities for quality
improvement 2015/16
Each of our five service lines has identified a
quality priority for the 2015/16 financial year.
The priorities cover the domains of safety,
clinical effectiveness and patient experience
and are linked closely to our Quality Ambitions
for the next three years. We initially asked
our members for ideas about future priorities,
through our membership letter. Unfortunately
the responses received were not sufficient
to enable the Trust to develop any specific
priorities for the service lines. This resulted in
service lines presenting a number of options to
our Governors for discussion and agreement.
In October 2014, the Quality and Membership
Committee of our Council of Governors
chose the priorities listed below. These were
recommended to the full Council of Governors
and the Board of Directors who approved the
priorities in December 2014 and January 2015
respectively.
The progress of each quality improvement
priority will be reported to service line Quality
Assurance Groups, the Board of Directors'
Quality and Governance Committee and the
Executive Directors' Performance Improvement
Monitoring Meetings (PIMMs). Each of these
meetings meets on a monthly basis.
Children and young people’s
service line
Priority 1: Experiences of children,
young people and their families of
the safeguarding process
Why is this a priority?
We have collected feedback from children
and young people previously but have not
specifically focussed on children who experience
the safeguarding process. We are committed to
understanding their experiences and using this
insight to improve how we practice to improve
delivery of care to this vulnerable group.
What actions are we planning to
improve our performance?
•
•
end of quarter 1 (June 2015)
ilot the survey in quarter 2 (September
P
2015)
Refine the survey and re-run in quarters 3
and 4 (October 2015 until March 2016)
How will improvement be
measured and monitored? In order to check our progress against this
quality priority, we will:
•
•
F rom the areas we identify in the feedback,
improve our practice and seek feedback on
satisfaction/experience of our services to test
the effectiveness of any changes.
Review, at least, 20 completed surveys in
order to inform practice and capture any
demonstrable changes made using a “You
said, we did” approach. The target group is
small which reflects the numbers of children
who experience this pathway.
Functional community service
line
Priority 2: Working with primary
care we will improve the physical
health levels in community
patients with schizophrenia to
reduce avoidable premature
deaths
Why is this a priority? People with severe mental illnesses are
likely to die 15-20 years earlier than those
without. They are 2-3 times more likely to
develop type 2 diabetes; twice as likely to die
from heart disease; and are 70% more likely
to smoke. They also may have difficulties
accessing physical healthcare and engaging
in preventative programmes such as smoking
cessation and exercise.
It is essential that we work with the wider
health system to ensure that individuals with
schizophrenia do not fall through gaps in
meeting their physical health needs and that we
are supporting them to access other services.
We will:
• Co-produce, with young people, an on line
survey to explore their experiences by the
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What actions are we planning to
improve our performance?
We will:
• Work with primary care to develop, and
agree, a shared protocol regarding physical
checks and a programme in relation to
physical health (taking into account physical
health indicators from the national audit of
schizophrenia) by the end of quarter one
(June 2015).
• Improve the communication between the
Trust and General Practitioners for patients
with specific high risk factors and develop
physical health specific care plans.
• Pilot this programme in one integrated
community mental health team (iCMHT)
in quarter two (September 2015). Prior to
the pilot we will establish a baseline from a
sample of 50% of the caseload to ascertain
the level of physical health checks for
patients with a diagnosis of schizophrenia.
• Following evaluation of the pilot we will
extend the learning approach to all iCMHTs
by March 2016.
How will improvement be
measured and monitored? In order to check our progress against this
quality priority, we will: •
udit 100 patient records in our pilot group,
A
by the end of quarter four (March 2016) to
identify and confirm:
– A
n increase in the number of annual
health checks within the pilot group.
– E
vidence of effective communication
with the patients General Practitioner
around high risk factors.
– E
vidence physical health specific care
plans which include support to access
services and interventions.
•
vidence a change in our position in the
E
National Audit of Schizophrenia from our
current ranking aspiring to be in the top
25% of participating organisations.
Complex care and dementia
service line
Priority 3: Working with patients
and their carers’, we will use our
7-step Formulation Framework
to identify effective engagement
opportunities within a plan of
care for patients with behaviours
that challenge those around them.
Why is this a priority? It is increasingly recognised that challenging
behaviour in patients with dementia is often
an attempt at communicating an ‘unmet need’.
Challenging behaviour is often complex; a
response to both visible and internal triggers.
By using our framework for understanding
the cause of a person’s challenging behaviour,
we can put in place processes to deliver
effective interventions and reduce the use of
pharmacological interventions. This reduces
levels of challenging behaviours; supports
successful discharge and reduces readmissions.
The Complex care and dementia service line
has invested significant energy in developing
evidence based Formulation Framework
to assess, plan, implement and review care
provided to people living with dementia whose
distressed behaviour challenges their care givers.
Currently the assessment, planning and review
mechanisms are well identified. However, the
individually tailored engagement approaches
that are used require refinement. The use of
the Formulation Framework will identify a
range of approaches for the individual in the
form of an engagement programme that will be
identified in a traffic light care plan.
What actions are we planning to
improve our performance?
We will:
•
ake a measure using the neuropsychiatric
T
inventory, (NPI)* tool working
collaboratively with patients and carers
both pre, and post, formulation to track the
effectiveness of our care plans.
NPI is a questionnaire, which uses
*
information from carers of people with
dementia. It is designed to describe the
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“behavioural and psychological symptoms”,
experienced by people with dementia.
Mental health practitioners will use this
information to identify the severity of any
symptoms and to monitor the effect of
treatment.
•
Individualise engagement programmes,
identified through a traffic light care plan,
that will be available for all people receiving
care through the Formulation Framework by
the end of quarter 3 (December 2015).
How will improvement be
measured and monitored? In order to check our progress against this
quality priority, we will:
•
udit, and review, those patients who have
A
been identified within the cohort and check
care plans to demonstrate the use of the
Traffic light and NPI tool.
Functional inpatient
service line
Priority 4: We will improve our
workforce’s understanding of
how we effectively use enhanced
observations to plan care and
improve patient safety.
Why is this a priority? A reoccurring theme resulting from serious
incidents has been that through the
improvement of our delivery of enhanced
observations we can improve care, safety and
patient experience.
What actions are we planning to
improve our performance?
We will:
•
rovide face to face policy updates for all
P
staff on acute wards, (Perran, Carbis and
Fletcher) with competency checks.
•
evelop care plan templates, (where
D
appropriate), to guide staff to include a
rationale for observations and criteria for
reduction of observations.
•
Implement daily observation reviews,
undertaken by our registered nurses, to
ensure that observations are appropriate
and relevant.
•
o-produce, with our patients, written
C
information which explains and describes
enhanced observations for those who
experience them. The information will be
modified after listening to feedback thereby
improving patient experience.
How will improvement be
measured and monitored? In order to check our progress against this
quality priority, we will:
•
•
•
•
nsure 100% of new starters will be assessed
E
using a competency framework within three
weeks of commencement on the ward.
Provide refresher training on enhanced
observations to all other staff by the end of
quarter 3 (December 2015).
Audit a sample of care plans, where
someone has been on enhanced
observations, to review their effectiveness
(Sample to be at least 25 care plans).
Audit daily observation reviews to achieve
95% compliance by the end of quarter three
(December 2015).
Learning disability service line
Priority 5: We will embed the
use of the Health Equalities
Framework (HEF) across the
learning disability service to
reduce health inequalities
that contribute to poor health
outcomes.
Why is this a priority? People with learning disabilities have poorer
health than their non-disabled peers. These
differences in health states are, to an extent,
avoidable and as such represent health
inequalities.
By using the HEF we are able to monitor the
degree and impact of exposure on people with
learning disabilities to acknowledge, evidenced
based determinants of health inequalities in a
range of settings including health and social
care.
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The HEF will:
• Be used with our learning disability
service users to create a profile that is
not dependent on the complexity of a
person’s needs, their specific conditions, or
presentations, but rather on the systems
around them. This ensures that their needs
and long term conditions are appropriately
identified and responded to and that
individuals are receiving the right support.
• Inform the profiles in formulations and
action plans. We will review HEF scores
at key milestones and on discharge to
understand what is working well for a
service user with learning disabilities and
where there may be gaps that lead to health
inequalities.
• Identify, across our services, trends and
themes that are impacting on groups of
service users and will enable us to use this
information to influence the commissioning
of health and social care services.
How will improvement be
measured and monitored?
In order to check our progress against this
quality priority, we will:
•
aintain a database of HEF profiles on the
M
RiO health records.
•
eliver three training sessions within
D
2015/16 with participants feedback
reflecting: increased awareness and
confidence to use the framework.
•
udit a sample of clinical records to
A
identify where a HEF has been applied and
determine whether the outcomes have
been reflected in care plans. The audit will
also include determining whether effective
communication with GPs and Social Services
has taken place.
What actions are we planning to
improve our performance?
We will:
•
ake the HEF electronically available to
M
families and carers who will also be able to
use the tool to have discussions, and reach
agreement, on the best course of action
with an individual.
•
evelop, and deliver, three HEF awareness
D
training sessions in 2015/16 to residential
settings in order to improve the awareness
of the determinants of health inequalities.
•
nsure that 100% of new referrals to the
E
Learning Disability adult community teams
will have an initial HEF scoring within three
months of referral.
•
nsure that 100% of service users will have a
E
HEF score at review and discharge.
•
S ummarise and share HEF profiles with
the service users’ General Practitioners
(GPs) and copy them into subsequent
formulation summaries and action plans.
Where appropriate the HEF summary will
be shared with service users’ primary care
liaison nurses and social workers so that
key determinants that can be delivered, or
provided, elsewhere are visible.
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Review of Quality Performance in
2014/15
Overview of quality: children
and young people’s service
line
In 2014/15 the service line’s key focus was
the development of the Care Management
Centre (CMC). This development was linked
to the service line’s quality priority to develop
a structured survey in order to measure the
quality and experience of the referral process.
This survey informed the service line on how
to improve referrals and those associated
administrative processes that support frontline
staff. The development of the CMC also
supported the implementation of electronic
health records (KITS RiO). This is now fully
embedded within teams. Adjustments to the
reporting structure were also made as a result
of positive staff feedback. The new records
allow the Trust, and the commissioners, to have
a more detailed overview of care delivery and
resultant improvement in data quality.
The Child and Adolescent Mental Health
(CAMHS) teams responded to increasing
demands on their service by instigating a
central screening process to review each referral
directing it to the most appropriate team or
professional. This is part of the new process and
included a review of the eligibility criteria for
specialist CAMHS. This has resulted in a more
consistent approach to the management of the
mental health needs of young people.
During the year the health visitors’ focus
changed, they are now required to deliver core
reviews at a number of development key stages
during the first two years of a child’s life. This
includes an antenatal assessment which reviews
the mother’s mental health; a new birth visit,
and a developmental review of the baby at
three, twelve and twenty four months.
During the past year the children’s service line
co-produced, with Cornwall Local Authority,
a plan for integrated services for children and
young people. The first phase was the launch
of The Early Help Strategy in spring 2014. Three
areas were chosen for initial development.
These were:
•
n Early Help Hub which will enable all
A
enquiries and referrals for children’s services,
in both the Trust and the Local Authority,
to be triaged and directed to the most
appropriate service.
•
he joint development of services to meet
T
the emotional health and well-being needs
of young people.
•
he development of joint services for
T
children with disabilities.
Due to staff changes on the Isles of Scilly an
opportunity arose to review the delivery of
young people’s mental health service on the
Islands. This resulted in the establishment of
a Child and Adolescent Mental Health Service
(CAMHS) worker, instead of the previous
Primary Mental Health Worker post, who has
clear links to the islands’ school
Our three Short Break units across the county
were inspected by Ofsted during 2014. These
units were all awarded the status of ‘good’ with
regard to the respite services provided to very
vulnerable young children.
The speech and language therapy teams
developed a telephone ‘help line’ to assist other
professionals with advice and guidance on the
early management of children with speech
and language difficulties. This resulted in a
decrease in inappropriate referrals to speech
and language services.
In January 2015 the Care Quality Commission
inspected the services commissioned by NHS
Kernow and NHS England in relation to
safeguarding children. The final report will be
published during 2015/16 however, the trust
received positive feedback from the inspectors
about the care delivery to those children under
safeguarding arrangements.
Alison Cook, Associate Director
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Overview of quality:
Functional community service
line
2014/15 was a period of enhancement and
change for the service line. The service line
built on the work undertaken, during the last
few years, to further embed the commitment
to provide high quality services. One of our
key ongoing projects was to increase the
amount and quality of psychological therapy
provided. During the period of the project 12
new Cognitive Analytic Therapists qualified. In
addition we trained staff across the county to
undertake Emotional Coping Skills. This has
resulted in the formation of groups across the
county to deliver these skills. To support this
further we introduced a training programme
to enhance the skills of our clinical staff in a
range of psychological approaches. This has
helped our staff to offer varying psychological
interventions to service users.
In May 2014 the service line amalgamated a
number of teams to integrate staff across 6
locality areas. Within these teams we created
specialist sub-teams to deliver personalised
treatment and care. This resulted in service
users receiving interventions by staff with the
right skills, in the right place and the right time.
Over the latter part of 2014/15 we worked with
our wider health and social care community
partners in providing extensions to currently
provided services. The psychiatric liaison
service has played a key part in supporting the
emergency department at the Royal Cornwall
Hospitals NHS Trust by offering extended
opening hours which has resulted in prompt
assessment and onward treatment for those
patients presenting in mental health crisis. In
addition our peri-natal mental health service
has provided education to colleagues within
both Health Visiting and Midwifery services to
help promote the needs of expectant mothers
with mental health concerns.
As part of our wider social care role we
launched and delivered a highly successful
programme of carers’ workshops delivered from
our Resource Centres. This project expanded
to 10 sites across the county resulting in carers,
from Cornwall and the Isles of Scilly, being
offered the opportunity to understand how to
support someone with mental health needs,
have the time to reflect on their own needs as a
carer and to create their own support plan.
We have also seen the re-building and opening
of a new supported living facility in Bodmin
which provides 8 more self-contained flats to
enable our service users to build the skills for
independent living.
Following feedback from our patients, and
themes generated from serious incidents, we
have responded to concerns raised particularly
in relation to staff absence which we know
impacts on the patient’s perception of our
service. This has resulted in the development
of a protocol to ensure that we keep in regular
contact with patients.
As a result of feedback from our patients from
the National Community Mental Health Survey,
and also the feedback from the use of the
Trust’s patient experience tool, Meridian, we
have seen our overall patient satisfaction rating
rise from an average 65% in 2013 to 83% in
2014.
Colin Quick, Associate Director
Overview of quality: Complex
care and dementia service line
The service line continues to focus on learning
from incidents. During the first part of the
year the focus has been on slips, trips and falls
and minimising the risk of harm. The data
analysis was reassuring, in that whilst a large
number of falls were reported, the impact for
the vast majority of patients resulted in low
harm or no harm. This work continues to be
supported by the Trust’s falls lead through the
review of high risk patients and supporting the
implementation of personalised care plans to
reduce risk of injury.
Over the latter part of the year, the focus
has been specifically on the management of
disruptive and aggressive behaviour. Links
have been established with Devon Partnership
NHS Trust to share ideas, peer review and
best practice initiatives. The Newcastle model
traffic light system has been implemented on
Garner Ward, providing a complete formulation
framework for each patient; producing a
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patient passport aligned to a traffic light system.
This promotes meaningful occupation and an
in-depth understanding into the triggers that
may exacerbate behaviour and psychological
symptoms of dementia. The approach supports
safe and effective care and treatment planning.
Garner Ward’s preceptor Nurse attended the
Institute of Health Improvement (IHI) patient
safety training programme in February 2015
and will be supporting the working group
specifically around disruptive and aggressive
behaviour.
Tamar Memory Assessment Service has received
the highest level of recognition by the Memory
Services National Accreditation Programme
(MSNAP). The Service has been rated as
Excellent, receiving ratification from the Royal
College of Psychiatrists’ Special Committee for
Professional Practice and Ethics (SCPPE).
The Memory Assessment Service continues to
deliver a responsive service with assessments for
people referred within 28 days managing the
increase in referrals of individuals who do not
receive a diagnosis following assessment. The
current dementia diagnosis rate is 57% with
a national target of 67% by 2016. This places
increased pressure and a risk of misdiagnosis
due to earlier referral on the service. As a result
of a review in November 2014, the Memory
Assessment Service commenced a pilot of a
screening approach to manage the increased
demands.
Coombe team have set up a West educational
meeting which supports clinicians in the delivery
of evidence based and quality interventions
through case discussion and peer review. The
forum meets quarterly throughout the year and
is well received by clinicians countywide.
We have also implemented the use of life story
books within the Community teams, following
a trial within the dementia inpatient unit.
This supports personalised care and targeted
treatment interventions across the care pathway
from early contact with Primary Care Dementia
Practitioners (PCDPs) to end of life supporting
carers across the pathway to support patients.
The Nurse Consultant has developed guidance
for staff on how to use a range of personal
narrative tools including the life story books.
Practitioners advise family carers and patients
on the merits of completing a life story record
as an engaging and enjoyable activity; which
produces a valuable resource to support care if
needed in the future.
We have also supported ‘winter pressures’ with
the provision of additional resource to the acute
hospital and until the end of March 2015. The
resource has included 2 days a week cover at
West Cornwall Hospital supporting complex care
and dementia patients, an additional 2 days
of medical cover and 4 days of a clinical nurse
specialist working alongside the onward care
team. This has resulted in increased support
for our patients undergoing acute physical
healthcare problems.
We continue to provide Primary Care Dementia
Practitioners within primary care for people
with dementia providing a consistent standard
of support for patients newly diagnosed with
dementia by a named clinician – a key aspiration
of ‘Forward View’ NHS England 2014. The PCDP
service continues to routinely attend memory
cafes across the county, providing support and
signposting for people with dementia and their
carers.
On the Isles of Scilly we have looked, together
with key health and social care professionals, at
how we provide care and treatment. We now
have a senior member of staff who provides
a service for the island with the support of
the multi-disciplinary team based at Bolitho
in Penzance. Within the multiple roles of the
practitioner is an ability to work with care
home staff and individuals on the island, using
a formulation and person centered approach,
to support people who experience behaviours
that challenge care givers. The practitioner
also has other tools to draw on to support
individuals. Dementia Awareness and training
is also a key area that the practitioner covers.
This role provides a clear communication link
between the Island and mainland services.
When the need is identified resources, such
as Occupational Therapy, can be delivered
on Islands. The Consultant continues to visit
patients on the island and liaises with the GP’s
regarding care and treatment.
In 2014, we have particularly focused time and
resources on stakeholder engagement. ‘Your
Say Days’ have been facilitated across the
county, allowing teams to show case practice
locally within their areas. This has enabled local
GP leads and locally based organisations, as
well as carers and people receiving services, to
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attend and learn about the work we do. It has
also allowed us to listen to their views.
peer reviewed by the Low Secure Peer Review
Network.
The first ‘Tea and Talk’ support group for carers
and families of patients on Garner ward took
place in September 2014. These sessions are
facilitated jointly with CRCC and offer carers
and families the opportunity to discuss in a peer
group their experiences of living with a person
with dementia and give feedback on services
provided by the Trust.
Our Electro Convulsive Therapy (ECT) Service has
once again been awarded ‘excellent’ under ECT
Accreditation Service.
This year the service line has found the face to
face events hugely informative allowing the
receipt of feedback from carers and families in
order to further improve our services.
Alison Morris, Service Line Manager
Overview of quality:
Functional inpatient service
line
Our investment into front-line staff has
continued in 2014/15 and currently our
employed number of registered nurses within
the service line is at the highest number for
some time. Medical staffing has been increased
with the appointment of a full-time Consultant
for our Psychiatric Intensive Care Unit with the
support of a speciality doctor.
The refurbishment of Longreach House
has been completed, with its re-opening in
December 2014. The environment has been
much improved for both patients and staff.
There is now a clear distinction between two
wards, but still with the ability to flex staff in
between. Both wards have new names: Perran
and Carbis.
There has been continued development
of a number of initiatives to improve the
physical health care of our inpatients, centred
on our specialist nursing provision. These
include, safety initiatives to further revise our
medication charts; procedure to complete
feedback loop to prescribers; improvements in
transfers between hospitals; improvements on
discharge letters; the Multi-disciplinary Team
format and documentation; and procedures
around documentation for section 17 leave.
In terms of supporting our staff, we have
developed a supervision passport to enable
staff to capture all instances of ‘ad hoc’
supervision. This will allow improved discussion
at formal supervision sessions and will help staff
towards collating information required for the
introduction of Nurse Revalidation in 2016.
Both hospital sites have received inspections
from the Care Quality Commission (CQC) in
relation to the Mental Health Act during
2014/15. The Trust was found to be compliant
with all of the standards inspected, with only
minor improvements being required.
We have also concentrated on improving the
outcome of incidents and learning from them.
This improvement has been possible with the
support of the Trust’s Governance Team and has
enabled staff to understand the themes and
reflect on how to improve safety in our clinical
areas.
Mike Marshall, Interim Associate
Director
We have increased the psychology provision
over the last year, with a dedicated Psychologist
being appointed to Longreach House. This
means we now have dedicated psychology
provision in all of our inpatient units enabling
us to provide psychological support and
intervention for both our patients and staff.
Fettle Ward (Bodmin Hospital site) has recently
achieved their Accreditation of Inpatient Mental
Health Services (AIMS) in February 2015. In
addition, Bowman Ward has recently been
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Overview of quality: Learning
disability service line
We have had considerable successes over the
past 12 months and these continue to develop.
We are currently in the process of redesigning
the delivery of Adult Learning Disability services
and this has allowed clinicians to engage in
the development of clinical pathways and
processes to support effective treatment and
management of a wide spectrum of clinical
needs. Whilst this has had a significant impact
other areas of work have continued.
The clinical care pathways relating to dementia;
behaviours that challenge; people with
profound and multiple learning disabilities
are now embedded within our daily working
practices. These pathways have been developed
based on best practice guidance and aim to
raise the quality of the assessment process and
improve client experience. Pathway meetings
occur on a monthly basis in the East and West
service bases to review clinical cases on each of
the pathways.
As part of the planned redesign a
comprehensive nursing needs assessment
has been developed to ensure all service
users referred to the service have a holistic
assessment that identifies health needs resulting
in an appropriate specialist assessment and
intervention. The Health Equalities Framework
(HEF) has been piloted for an identified group
and will underpin the work of the service line as
it moves forward. The use of HEF will support
personalised approaches and measurement of
outcomes in the service referral and assessment
processes.
The Learning Disability Communication Charter
was launched in October 2013. This utilises a
range of communication tools such as keyword
signing and making information easier to
read. As there are between 50 -90% of the
Learning Disability population of Cornwall
with communication difficulties, the Service
line has focused on implementing the Charter
by training our staff in a range of these tools
they can use with their patients. In addition, we
have trained over 150 communication leaders
in residential and day settings across Cornwall.
They have been provided with skills and
resources to support individual communication
needs of the people they work with as
identified by the speech and language therapist.
As a result we are seeing more settings aligning
themselves with a positive signing and total
communication environment. This has released
speech and language therapist time to focus
on those clients with the most complex and
challenging communication needs.
Over the past year we have developed a range
of wider access events that help staff and
service users further develop and use their
communication skills in a community setting.
These have included:
•
onthly “Intensive Interaction cafés” to
M
support work with those who have no
formal communication system.
•
egular ‘Appy talk’ session where people
R
can share and develop their use of
technology – for example Apps on iPads
and tablets, and we are raising money
to purchase an ‘eye-gaze technology
system’ so that clients with severe physical
disabilities can access the computer and
communication opportunities
•
isual resources workshops where people
V
can get support to create their own
Communication Passport, visual timetable
etc.
•
n increasing number of settings are
A
running “singing and signing” sessions to
develop the signing skills of service users
and staff, some of which have led to
performances at the Hall for Cornwall and
Lemon Quay.
•
monthly newsletter is circulated to all
A
communication leaders to share ideas and
good practice within their settings, including
a “sign of the week”.
We are currently running a pilot project where
we are supporting final year speech and
language therapy students to help to embed
the charter and improve the communication
environment in a number of day settings.
The dietician from the Learning Disability
Service has been working with the Health
Promotion service and Cornwall Health
and Making Partnerships (CHAMPs) Team
to deliver training to a range of support
workers and carers for people with learning
disabilities. Although the number of people
with a learning disability having an annual
health check is increasing, there is evidence
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that this often does not result in changes to
their health or health behaviours. The training
focused on using a better understanding of
Mental Capacity assessment, best interest
decisions and ‘behaviour change’ techniques to
empower support workers and carers to develop
and implement health action plans. The
training was well received and will continue to
be supported by the learning disability service
line.
Prior to 2014 the Learning Disability Service Line
had informal links with the General Practices.
Building on the model developed in mental
health services of Link Meetings, clinicians from
the learning disability service have now met
with a number of practices. Regular meetings
are planned over the forthcoming year and
attention will be focused on those practices
with a significant number of people with
learning disabilities on their patient list.
In February 2014 a full-day Research and Audit
conference (funded by income generated by
Learning Disability research) was held for staff.
This led to a 100% increase in multidisciplinary
audit involvement in the following 9 months.
In 2015, we are holding 3 smaller audit
seminars (on Clinical Supervision, dementia and
behaviours that challenge) to share knowledge
and plan audit activity within the service line.
This enables us to evidence the quality of the
work we do and benchmark our services against
best practice guidance.
The Learning Disability Service has successfully
recruited the first 2 participants in the UK to
an International trial for people with Down’s
syndrome.
Tony Wolke, Service Manager
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Performance against local quality
performance indicators 2014/15
Local indicators
Indicators were identified in three key areas, these are; clinical effectiveness, patient experience and
patient safety.
The following tables detail the Trust’s performance over previous years. All data is derived from the
Trust’s data monitoring system and the Trust’s Meridian Survey tool.
In October 2013 our Governors discussed our local quality indicators for the future following a
membership survey. The rationale for each of these was:
• Clinical effectiveness – to demonstrate to governors and commissioners the position of access
targets
• Patient safety – the indicators in 2014/15 were chosen as a result of incidents and the ambition of
the Trust to learn from these
• Patient experience – the Governors wished to see the usage of the Trust’s bespoke survey system
increase across all the services lines. In addition during a Care Quality Commission thematic
review in 2013 it was suggested that we pilot feedback on the completed resolution meetings and
complaints.
Clinical Effectiveness – local quality performance indicators 2014/15
Indicator % Adult mental health
patients seen with 28 days % Children’s mental health patients seen within 28 days
(core service)
% Learning Disability
patients seen within 28 days
2014/15
97%
(enhanced indicator)
78%
(enhanced indicator)
2013/14
99%
2012/13*
100%
2011/12*
100%
88%**
92%
93%
98%
(enhanced indicator)
98%**
100%
98%
*Data as recorded at the end of March for each financial year
** With improved performance reporting in 2013/14, the Trust began reporting this local quality performance indicator on a cumulative basis.
Patient Experience – local quality performance indicators 2014/15
Indicator
2014/15
2013/14
To increase the number of patients surveyed by 20% in each service line, using our bespoke survey
system (Meridian) based on 2013/14 data (enhanced indicator)
Children’s service line
1849
135
(95.51%)
(92.63%)
Community service line
1386
692
(79.68%)
(74.61%)
Complex Care and Dementia service line
826
202
(95%)
(93.24%)
Functional Inpatient service line
556
335
(77.43%) (76.33%)
Learning Disability service line
175
146
(92.49%)
(86.49%)To
set up and receive feedback from 25% of all completed resolution
7
NA
meetings/complaints via the ‘postcard’ method (new indicator)**
(64.14%) ** The ‘postcard’ approach to obtaining feedback from completed resolution meetings was trialled
during 2014/15. However, a limited number of ‘postcards’ were returned. This has resulted in the
Patient Experience Team consider, with patients and carers, the introduction of a new approach during
2015/16.
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Patient Safety – local quality performance indicators 2014/15
Indicator 100% of patients who are at risk of falls have a MFRAT (Multifactoral
risk assessment tool) assessment completed (new indicator)
To reduce the number of medication incidents (missed dose) by 25%
based on 2013/14 incident numbers (enhanced indicator)
To reduce the number of absences without leave (AWOL) by 10%
based on 2013/14 reported incidents (new indicator)
2014/15
100%
2013/14
NA
N/A*
N/A*
75
55
*During 2014/15 the Trust made a decision to widen this indicator in order to increase the potential for
improvement to patient safety and experience. The indicator was, therefore, expanded to monitor the
level of harm experienced as a result of medication incidents. This has meant that the focus has been
on increasing the number of no harm incidents and decreasing the number of incidents that resulted
in harm.
Medication Incidents – No harm
Children’s and Young Persons
Complex Care and Dementia
Functional Community
Functional Inpatient
Learning Disabilities
2014/15
27
55
23
204
7
2013/14
18
50
18
193
2
Medication Incidents – Low/Moderate/Severe
Children’s and Young Persons
Complex Care and Dementia
Functional Community
Functional Inpatient
Learning Disabilities
2014/15
2
4
6
10
4
2013/14
8
17
15
69
2
Changes for 2015/16
In October 2014, our full Council of Governors discussed our local quality indicator set for the future.
A final set of indicators was presented and approved at the December 2014 Council of Governors’
meeting and the January 2015 Board of Directors’ meeting. The table below details the local quality
indicators which the Trust will be monitoring in 2015/16. The indicators are aligned to existing Trust
priorities.
ThemeIndicators 2015/16
Patient Safety100% of patients who are identified as being at risk of falls, on Garner Ward,
have a MFRAT (Multifactoral Fall Risk Assessment Tool) assessment completed.
To reduce the number of medication incidents leading to harm (low or above)
without a reduction in the number of incidents reported in 2014/15
To maintain the number of absences without leave (AWOL) resulting in
moderate harm or above at zero (enhanced indicator). Patient Experience
To develop methodology to demonstrate changes in practice through patient
[New for 2015/16]
experience (utilising Meridian) You said – We did. (new indicator)
To develop a mechanism to synthesise the collection of all forms of patient
experience data to enable holistic thematic reviews (new indicator).
To develop a new survey for 2015/16 within the Children’s Learning Disability
Service. This will be a bespoke survey using easy read language and recognised
signs to gather evidence on speak and sign within the Children’s Learning
Disability Service. The survey will be developed ensuring patient involvement
and consultation. This survey will be piloted initially to 10 children.
Clinical Effectiveness 100% Adult mental health patients seen within 28 days.
100% Children’s mental health patients assessed within 28 days.
100% Learning disability patients seen within 28 days.
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Mandatory quality indicator set
With effect from 2012/13 it became mandatory for all trusts to report against a core set of indicators in
various domains within the NHS Outcomes Framework. The Trust’s performance against the relevant
indicators is set out in the following tables, each representing an NHS Outcomes Framework Domain.
The data in the following tables has been made available to the Trust by the Health and Social Care
Information Centre (https://indicators.ic.nhs.uk/webview/) enabling comparison with national data.
The ‘reporting period’ available from the Health and Social Care Information Centre varies across the
indicators.
Domain – Preventing people from dying prematurely and Enhancing quality of life for people with
long term conditions:
Indicator: Percentage of patients on care programme approach who were followed up within seven
days after discharge from psychiatric inpatient care during the reporting period.
Reporting periodTrust performance National average Lowest nationally Highest nationally
97.2%
93.1%
100%
Quarter 4 – 2014/15 98%
Quarter 3 – 2014/15 96.8%
97.3%
90%
100%
Quarter 2 – 2014/15 100%
97.3%
91.5%
100%
Quarter 1 – 2014/15 98.89%
97%
93%
100%
Quarter 4 – 2013/14 100%
97%
93%
100%
The Trust considers that this data is as described for the following reasons: follow up within seven
days after discharge from hospital is an important part of the care delivery and contributes to
reducing the number of deaths by suicide as it reduces risk and social exclusion. During 2014/15 a
small number of patients chose not to engage with the process which has led to the slight decrease in
performance over the last two quarters but performance remains above the national average.
The Trust has taken the following actions to improve this indicator and so the quality of its services;
Daily updates are provided to teams and the indicator is monitored at senior level committees.
Domain – Helping people to recover from episodes of ill health or following injury
Indicator: The percentage of patients aged 0-15 and 16 or over readmitted to a hospital which forms
part of the Trust within 28 days of being discharged from a hospital which forms part of the trust
during the reporting period
Reporting periodTrust performance National average Lowest nationally Highest nationally
Quarter 4 – 2014/15 Data is not available to support this indicator. Please see explanation below.
Quarter 3 – 2014/15
Quarter 2 – 2014/15
Quarter 1 – 2014/15
The Trust considers that this data is as described for the following reasons:
The Health and Social Care Information Centre (HSCIC) has advised that unfortunately the publication
of data for emergency readmissions to hospital within 28 days of discharge indicators has been
delayed this year while the HSCIC brings the production in-house from an external contractor. The
methodology and specifications are under review which will have an impact on when they will be
published. It is highly unlikely that they will be published this year.
The Trust has taken the following actions to improve this: NA. However, the admission of patients
under the age of 18 years is not routinely undertaken.
Domain – Enhancing the quality of life for people with long term conditions:
Indicator: Percentage of admissions to acute wards for which the crisis resolution home treatment
team acted as gatekeeper during the reporting period
Reporting periodTrust performance National average Lowest nationally Highest nationally
Quarter 4 – 2014/15 98%
98.1%
59.5%
100%
Quarter 3 – 2014/15 100%
97.8%
73%
100%
Quarter 2 – 2014/15 100%
98.5%
93.6%
100%
Quarter 1 – 2014/15 100%
98%
33.3%
100%
Quarter 4 – 2013/14 99%
98%
75%
100%
The Trust considers that this data is as described for the following reasons: the home treatment team
ensure referrals for inpatient care are managed consistently and inappropriate admissions are avoided.
The Trust has taken the following actions to improve this: This indicator continues to be monitored
by the Board of Directors’ Performance, Finance and Investment Committee.
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Domain – Ensuring people have a positive experience of care
Indicator: Percentage of staff who would recommend the Trust as a provider of care to their family
or friends
Reporting periodTrust performance National average (mental health trusts)
58%
60%
2014
2013
49%
59%
2012
53%
60%
2011
50%
58%
The Trust considers that this data is as described for the following reasons: this data is derived from
a national survey. The Trust has taken the following actions to improve this percentage and so the
quality of its services: An action plan arising from the 2014 Staff Survey has been developed with staffside representatives and the Trust’s clinical service lines. The action plan was presented to the Trust’s
Board of Directors’ meeting in March 2015. Further information is detailed later in this report under
‘Our Staff and the National Staff Survey 2014’.
Domain – Ensuring people have a positive experience of care
Indicator: Patient experience of community mental health services indicator score with regard to a
patient’s experience of contact with a health or social care worker during the reporting period
Reporting periodOverall Trust
National Community mental health overall patient
performance
experience score
2014*
Data is not available to support this indicator. Please see explanation below.
*Due to redevelopment of the 2014 community mental health survey, the scores for 2014-15 are not
comparable with previous years.
Reporting periodTrust performance National position
2013
70.5
74.1
2012
73.5*
Not available
*Health and Social Care Information Centre adjusted figure
The Trust considers this data is as described for the following reasons: The information is national
data, however, it should be noted that due to redevelopment of the 2014 community mental health
survey, the scores for 2014-15 are not comparable with previous years. In addition the Health and
Social Care Information Centre (HSCIC) has advised that unfortunately the publication of data for this
indicator has been delayed this year while the HSCIC brings the production in-house from an external
contractor. The methodology and specifications are under review which will have an impact on when
they will be published.
The questions encompass a number of areas of importance to patients when they experience care.
The results provide a useful indicator of areas for improvement. Further information on the results
of our community mental health survey 2014 is detailed under the patient experience section of this
report.
The Trust intends to take the following actions to improve this indicator: An action plan arising from
the 2014 Community Mental Health Survey has been developed. The action plan was presented to
the Trust’s Board of Directors’ meeting in January 2015. Further information is detailed later in this
report.
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Domain – Treating and caring for people in a safe environment and protecting them from avoidable harm:
Indicator: The number and, where available, rate of patient safety incidents reported within the
Trust during the reporting period and the number and percentage of such patient safety incidents
that resulted in severe harm or death
Reporting period
safety
April 2014 – Sept 2014
Oct 13 – March 2014
April 2013 – Sept 2013
Oct 2012 – March 2013
April 2012 – Sept 2012
Oct 2011 – March 2012
Number of patient Rate of incidents Number of patient
safety incidents
per 1000 bed days safety incidents
resulting in severe
harm or death
1027
32.82
13
16
1013
26.71
401
18.7
8
405
15.8
7
719
28
14
625
22
9
% of patient
incidents resulting
in severe harm
or death
1.3%
1.6%
1.9%
1.7%
1.9%
1.4%
The Trust considers that this data is as described for the following reasons: the Trust supports openness,
trust, continuous learning and service improvement. The Trust has an open culture. Organisations that
report more incidents usually have a better and more effective safety culture. During 2014/15 the Trust
has continued to focus on supporting staff to report and manage incidents and has been working with
the National Reporting and Learning Service (NRLS) to develop and define harm ratings that are more
applicable to a mental health setting
The NRLS was established in 2003. The system enables patient safety incident reports to be submitted
to a national database designed to promote learning. It is mandatory for NHS trusts in England to
report all serious patient safety incidents to the Care Quality Commission as part of the Care Quality
Commission registration process. To avoid duplication of reporting, all incidents resulting in death or
severe harm should be reported to the NRLS who then report them to the Care Quality Commission.
As there is not a nationally established and regulated approach to reporting and categorising patient
safety incidents, different trusts may choose to apply different approaches and guidance to reporting,
categorisation and validation of patient safety incidents. 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 professionals. In addition, the
classification of the impact of an incident may be subject to a potentially lengthy investigation which
may result in the classification being changed. This change may not be reported externally and the
data held by a Trust may not be the same as that held by the NRLS. Therefore, it may be difficult to
explain the differences between the data reported by the Trust as this may not be comparable.
The Trust has taken, and continues to take, the following actions to improve this score and so the
quality of its services:
•
•
•
Developing harm rating examples for use in the Trust
articipating in national events with the NRLS to develop harm ratings more applicable to a mental
P
health setting
Categorising incidents in order to support learning
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Our performance against key national priorities 2014/15
Target
100% enhanced Care Programme
Approach (CPA) patients comprising either:
• Receiving follow-up contact within
seven days of discharge
95%
• Having formal review within
12 months
95%
Minimising mental health delayed transfers
<=7.5%
of care
Admissions to inpatient services had access
to Crisis Resolution Home Treatment Teams
95%
Meeting commitment to serve new
95%
psychosis cases by Early Intervention Teams
97%
Data completeness identifiers
Data completeness: outcomes for patients
on CPA
50%
n/a
Certification against compliance with
requirements regarding access to health
care for people with a learning disability
Data Completeness: Community Services:
• Referral to treatment information
50%
• Referral information
50%
• Treatment activity information
50%
Patient Experience
Our vision is to deliver high quality care for
our patients, their carers and families. While
we know, and accept, we don’t always get it
right, our on-going development of our Patient
Experience Strategy is pivotal in maintaining a
cycle of continual listening, learning and service
improvement; working together with our
patients and partners in care. This will ensure
that feedback from experience is routinely
captured and put to effective use.
Many national reports, namely the report
into the findings from the Mid Staffordshire
Inquiry and the consequent report of “Putting
Patients in the Picture”, highlights the needs
for organisations to ensure that concerns and
complaints are dealt with in a timely manner
and that patients can see that their views have
been incorporated into service improvements
for the future.
Therefore, the Patient Experience Team (PET)
supports patients, carers and members of the
public to access information; receive prompt
resolution of concerns and complaints and
gathers feedback from stakeholders, users of
Trust services and their carers.
In the 2014 calendar year, the Trust
registered 129 complaints, which represents
2014/15 Performance
Q1
Q2
Q3
Q4
2014/152014/152014/152014/15
98.89%
100%
97%
98%
96.11%
96%
95.7%
94%
0.72%
0%
0.09%
0%
100%
100%
100%
98%
168%
99.71%
139%
99.64%
151%
99.61%
146%
99.67%
80.74%
76.54%
72.18%
69%
100%
100%
89.98%
100%
100%
88.41%
100%
100%
95.7%
100%
100%
94%
an increase of 18.5% on the 2013 calendar
year (108 registered complaints). In the same
period, 22 local resolution meetings were held
to quickly address the concerns highlighted by
complainants.
During 2014 a total of 533 PALS cases were
recorded, which represents a 5% increase in
contacts compared to 2013 (508 PALS Contacts).
The Trust is required to demonstrate how it
has learnt from complaints and implemented
improvements to services as a result. All
complaints are recorded by the relevant clinical
service line and are analysed and discussed at
this level. In addition the Board of Directors’
Quality and Governance Committee receives a
seminar report from each of its clinical service
lines twice a year, which includes discussion
relating to complaints, PALS, concerns,
compliments and the associated learning.
The Board of Directors received the Trust’s
2014 Complaints and PALS Annual Report in
February 2015. This detailed the activity and
corresponding thematic analysis of complaints,
PALS enquiries; use of interpretation services
and compliments for the year. In year the work
undertaken by the PET is monitored by the
Board of Directors’ Quality and Governance
Committee which provides assurance to the
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Board of Directors that concerns are analysed
and acted upon.
In addition the Patient Experience Team
coordinates patient feedback. This is obtained
through electronic surveys known “Meridian”.
This is a web-based solution and, therefore,
provides accessibility and ease of use for service
users across the Trust. We utilise the rich
feedback from these surveys in a variety of ways
but ultimately to inform service development
and improvement.
Further information on complaints is provided
in the Trust’s Annual Report 2014 – PALS/
complaints which is available for download
from: www.cornwallfoundationtrust.nhs.uk.
National Patient Surveys 2014
Annual national surveys provide detailed
feedback as well as enabling us to benchmark
our position against other Trusts. Valuable
feedback, derived from our surveys, has helped,
and continues to help, us improve existing
services and develop new services.
In 2014/15 the Trust participated in two national
surveys related to community mental health
services and inpatient mental health services.
The results of the national patient surveys
provide the Trust with valuable feedback from
patients about patient experience of services.
Both surveys were reviewed by the Board of
Directors and action plans were drawn up to
address the concerns raised by patients.
As a Trust we were pleased to note that the
2014 Community Services Users Survey showed
an overall improvement in the satisfaction level
of people who use the Trust’s services when
compared to the previous survey. This change
has been partly achieved through the dedication
of staff when providing care and through the
involvement of individuals who use our services
in service changes and improvements.
The Trust intends to build on these results
during 2015 and improve on some of the areas
in which the Trust scored below the national
Community
2014Threshold for
Mental Health Survey The Trust
Highest Scoring
Top four ranking scores
20% of all Trusts
Knows how to contact
99%
98%
person in charge of
organising their care (Q10)
Definitely, or to some extent, 85%
86%
felt that they were listened
to carefully (Q5)
Always or sometimes treated 83%
86%
with respect and
dignity (Q43)
Told who is in charge of
82%
82%
organising their care and
services (Q8)
Lowest for
2013
Lowest ScoringThe Trust
20% of all Trusts
96%
The 2014
survey has seen
a complete
81%
revision of
the questions
and therefore
82%
meaningful
comparison with
previous years is
71%
not possible
Community
2014Threshold for
Mental Health Survey The Trust
Highest Scoring
Bottom four ranking scores
20% of all Trusts
Definitely or to some extent 34%
47%
given advice about finding
or keeping work (Q34)
Definitely, or to some extent, 37%
41%
given information about
getting support from people
who have the same
needs (Q38)
50%
Definitely, or to some extent, 41%
supported in taking part in
a local activity (Q36)
Definitely, or to some extent, 44%
49%
given advice about finances
or benefits (Q33)
services (Q8)
Lowest for
2013
Lowest ScoringThe Trust
20% of all Trusts
34%
The 2014
survey has seen
a complete
32%
revision of
the questions
and therefore
meaningful
comparison with
38%
previous years is
not possible
38%
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Inpatient 2014Threshold for Lowest for
Highest
2013
Mental Health Survey The Trust
Highest Scoring Lowest ScoringTrust ScoreThe Trust
Top four ranking scores
20% of
20% of
all Trusts
all Trusts
Made to feel welcome 96%
90%
76%
96%
82%
on arrival by staff (Q1)
Did not share a
97%
97%
89%
100%
90%
sleeping area with the
opposite sex (Q4)
75%
67%
86%
76%
Given enough notice 86%
of discharge from
hospital (Q39)
80%
73%
95%
74%
Discharge not delayed 78%
for any reason (Q40)
Inpatient
2014Threshold for
Mental Health Survey The Trust
Highest Scoring
Bottom four ranking scores
20% of all Trusts
Staff definitely knew about 22%
42%
previous care received (Q2)
Told completely about the
17%
42%
side effects of the
medication (Q25)
9%
40%
Enough activities available
all of the time on
weekdays (Q31)
Enough activities available
13%
30%
all of the time in evenings
and on weekends (Q32)
The inpatient mental health survey placed the
Trust in the top 20% of similar trusts nationally
for 15 out of 39 areas surveyed compared to16
in 2013.
There were four areas where the Trust
performed less well – as highlighted in the table
above. During the year, the In-patient Service
line introduced a number of bespoke surveys in
order to explore key areas of patient experience
in hospital. The results highlighted in the
national survey reflect the feedback generated
through Meridian, and has resulted in the
employment of Activity Coordinators on both
in-patient sites.
Friends and Family Test –
Patient
The Friends and Family test allows patients
to feedback on services provided by Cornwall
Partnership NHS Foundation Trust. The services
sit across two areas namely Mental Health
and Community. The Trust introduced the key
questions from 30 September 2014, but formal
reporting via UNIFY (a national reporting
mechanism that links with NHS Choices)
commenced on a monthly basis in January 2015.
Lowest for
2013
Lowest ScoringThe Trust
20% of all Trusts
19%
39%
19%
23%
21%
17%
12%
17%
The questions are prescribed by NHS England
but are also adapted to meet the needs of
various patient groups (for example in-patient
mental health and children’s), however the stem
of the questions are:
1. How
likely are you to recommend our
ward/service/team to friends and family
if they needed similar care or treatment?
Rating from extremely likely to don’t
know.
2. Thinking
about your answer to Question
1, would you like to tell us the main
reason for your answer today? Free text
These questions are asked at prescribed times,
dependent on each individual service, and were
agreed through consultation with those services
as defined in the guidance “The Friends and
Family Test” (July 2014 Gateway reference No.
01787).
This will result in an expanding wealth of
information which can support learning, and
service change, over the coming months.
These results are reported monthly to Board
as part of the Patient Experience, Quality and
Safety Report.
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Our staff and the National
Staff Survey 2014
The national staff survey results show that
in 2014 that 92% of staff had received an
appraisal. The maintenance of this achievement
is monitored through the Board of Directors’
performance committee. In the latter part of
2014 the Trust co-produced, with staff, our new
appraisal documentation which encompasses
the Trust’s newly developed vision and values.
The 2014 national staff survey was conducted
during September to December 2014. The
survey was based on the ‘basic mandatory
sample’ and ‘core question set’ and a total 750
staff were sent questionnaires. This year we
trailed a multi-mode survey, which was paper
and email surveys.
A total of 276 (373 staff participated in 2013)
Trust staff took part in the survey; with a
response rate of 36.8 % (50% in 2013; 54% in
2012 response rate).
The full survey findings are structured around
four of the seven pledges to staff in the NHS
Constitution plus two additional themes as
follows : Staff Pledge 1: - To provide all staff with clear
roles and responsibilities and rewarding jobs for
teams and individuals that make a difference
to patients, their families and carers and
communities.
Staff Pledge 2: - To provide all staff with
personal development, access to appropriate
education and training for their jobs and line
management support to enable them to fulfill
their potential
Staff Pledge 3: - To provide support and
opportunities for staff to maintain their health,
wellbeing and safety.
Staff Pledge 4: - To engage staff in decisions
that affect them and the services they
provide, individually, through representative
organisations and through local partnership
working arrangements. All staff will be
empowered to put forward ways to deliver
better and safer services for patients and their
families.
Additional themes provided were:
• Staff satisfaction
• Equality and Diversity
• Patient Experience measures
An overall indicator of staff engagement is also
provided.
(It should be noted that the NHS pledges were
amended in 2013, however the report provided
to the Trust has been structured around 4
pledges which have been maintained since
2009.)
As in previous years, there are two types of key
findings:
• Percentage scores, i.e. percentage of staff
giving a particular response to one or a
series of survey questions.
• Scale summary scores, calculated by
converting staff responses to particular
questions into scores. For each of these
scale summary scores, the minimum score is
always 1 and the maximum score is 5.
Largest changes since 2013
Survey
The questions where there have been significant
improvements are:
• % of staff experiencing harassment, bullying
or abuse from patients, relatives or the
public in the last 12 months
• % of staff experiencing physical violence
from staff in the last 12 months
• % of staff having equality and diversity
training in the last 12 months
nly 1 question has shown deterioration of
O
note that is:
• Staff motivation at work
The Trust recognises that while the survey
highlights areas where the Trust is doing well
and compares favourably with other Trusts,
some of the findings of the 2014 national staff
survey results are disappointing and show
recurring issues of concern to staff.
The Trust will continue to work in partnership
with staff and staff representatives to ensure
action is taken to address the issues raised by
staff in the 2014 national survey to achieve the
required changes.
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In addition to the national survey, the Trust has
implemented the Staff Friends and Family Test.
This has been sent to all staff on email as per
the national requirement in Quarters 1, 2 and
4. From this feedback a number of areas have
been developed namely:
•
S taff Experience Group – to feedback
issues from Service Lines and corporate
departments
•
S taff involvement in the development of the
Trust values and behaviours
•
“Celebrating good practice” road shows
•
stablishment of an Annual Nursing
E
Conference
A detailed action plan, with an emphasis on
partnership working to improve communication
and staff satisfaction and motivation at work,
has been developed. In addition, the action
plan has considered the results and comments
generated from the previous Quarters 1, 2, and
4 Staff Friends and Family test.
In addition to seeking views through the
national staff survey, the Trust surveys staff on a
quarterly basis. The findings of the local surveys
are presented to the Board of Directors’ Quality
and Governance Committee.
In regards to staff engagement and in addition
to the above the following are ways in which
CFT seeks to hear and listen to staff views and
feedback actions taken:
• Executive Patient Safety walk rounds
• Chief Executive Officer appointments at
main sites – your chance to meet the most
senior manager
•
•
S trategic Leadership days for differing
groups of staff
Staff involvement in Service Re-design
The key priorities in 2015, will be building
on the Vision and Values work. In addition,
a staff Health and Well-being Group is being
established to look at ways to improve staff’s
working lives and make CFT an employer of
choice in Cornwall.
Overall Indicator of Staff
Engagement
This overall indicator of staff engagement has
been calculated using the questions that make
up Key Findings 22, 24 and 25. The possible
scores range from 1 to 5 with 1 indicating that
staff are poorly engaged and 5 indicating that
staff are highly engaged.
These Key Findings relate to the following
aspects of staff engagement:
•
S taff members’ perceived ability to
contribute to improvements at work.
•
S taff willingness to recommend the trust as
a place to work or receive treatment.
•
xtent to which staff feel motivated and
E
engaged with their work.
The Trust score for 2014 was 3.60 (0.1 decrease
from 2013), this is benchmarked against the
2014 average for Mental Health and Learning
Disability (MH/LD) Trusts as 3.72 (2013 = 3.71).
Table 1 below shows how the Trust compares with other MH/LD Trusts on each of the sub-dimensions
of staff engagement and whether there has been a change since the 2012 survey.
Change since 2013 Survey
Overall staff engagement
Staff ability to contribute toward
improvements at work
Staff recommendation of
the Trust as a place to work
or receive treatment
Staff motivation at work
No change
No change
Ranking compared to other
MH/LD Trusts
Lowest (worst) 20%
Average
No change
Lowest (worst) 20%
Decrease
Lowest (worst) 20%
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Where are we doing well?
The survey highlighted 5 key findings where
the Trust compares most favourably with other
MH/LD Trusts in England. In the table below a
Question
2014
Score
0%
(3%)*
% of staff experiencing physical
violence from staff in last 12 months
(lower score +ve)
% of staff feeling pressure in last
15%
3 months to attend work when feeling (20%)*
unwell
% of staff receiving health and safety
15%
training in last 12 months
(20%)*
(higher score +ve)
26%
% of staff experiencing harassment,
bullying or abuse from patients,
(29%)*
relatives or the public in the last
12 months (lower score +ve)
% of staff experiencing physical
13%
violence from patients, relatives or
(18%)
the public in the last 12 months
(lower score +ve)
comparison is presented between the top 5 in
2013 and top 5 categories in 2014 for CFT. As
indicated only one question remains constant in
each year.
Question
Effective team working
2013
Score
3.99
(3.83)*
% of staff feeling pressure in last
16%
3 months to attend work when feeling (22%)*
unwell
% of staff experiencing harassment,
16%
bullying or abuse from staff in last
(20%)*
12 months
95%
% of staff appraised in the last
12 months
(87%)*
% of staff reporting errors, near misses 95%
or incidents witnessed in the last month (92%)
(* figure in brackets gives the national 2014 average for MH/LD Trusts)
Where are we not doing well?
The survey highlighted 5 key findings where
the Trust compares least favourably with other
Question
2014
Score
66%
(76%)*
% of staff feeling satisfied with the
quality of work and patient care they
are able to delivery.
Staff reporting good communication
27%
between senior management and staff. (30%)*
Staff recommendation of the Trust as
3.36
a place to work or received treatment (3.57)*
(higher score +ve)
MH/LD Trusts in England. In the table below is
a comparison on those questions in 2013 and
bottom 5 categories in 2014 for CFT.
Question
2013
Score
68%
(77%)*
% of staff feeling satisfied with the
quality of work and patient care they
are able to delivery.
Staff reporting good communication
26%
between senior management and staff. (31%)*
Staff recommendation of the Trust as
3.4
a place to work or received treatment (3.55)*
(* figures in brackets gives national 2014 average for mental health/learning disability Trusts)
An action plan has been agreed by Trust Board
in March 2014 and the key actions to be taken
are:
• Increase the communication with senior
managers – “knowing who we are” which
includes a photo gallery of the Trust Board
in all locations.
• Improving the health and well-being of
staff. This builds our Health and Well-being
Strategy by forming a staff group to look
at ways in which we can utilise schemes to
improve our staff lives for example, cycle to
work scheme.
•
•
eward and recognition plans – focus on
R
how we can reward and praise staff for
good work.
Education and training – by working
with managers to understand the specific
professional requirements of the operational
service lines and by realigning clinical
training so we work around the clinical area,
thereby making training personalised for
our staff.
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Statements relating to the quality
of NHS services provided
Statements of assurance from
the Trust Board
During 2014/15 Cornwall Partnership NHS
Foundation Trust provided and/or subcontracted five relevant health services
• mental health inpatient services;
• community mental health services;
• community and inpatient complex care and
dementia services;
• children’s services, including community,
mental health and learning disability
services;
• community services for adults with a
learning disability.
The Trust has reviewed all the data available
to it on the quality of care in all of these NHS
services.
The income generated by the relevant health
services reviewed in 2014/15 represents 100% of
the total income generated from the provision
of relevant health services by the Trust for
2014/15.
Review of data on quality
of care
The Trust has systems and processes in place to
regularly review data on the quality of its care
across the three dimensions of patient safety,
clinical effectiveness and patient experience.
Quality and Experience Report is received by the
Board of Directors at every meeting.
The outcomes of serious incident investigations
are reviewed by the Board of Directors’
Quality and Governance Committee to ensure
actions are followed through and changes
implemented.
Each clinical service line lead delivers monthly
quality and performance reports to the
performance information monitoring meeting
(PIMMs).
Participation in clinical audits
and national inquiries
During 2014/15 2 national clinical audits and 3
national confidential enquiries covered relevant
health services that the Trust provides.
During that period the Trust participated in
100% of the national clinical audits and all
the national confidential enquiries of the
national clinical audits and national confidential
enquiries which it was eligible to participate in.
The Trust also participated in the national
confidential inquiries into sudden unexplained
death.
National Clinical Audits
The Trust is structured into five clinical service
lines, each of which is responsible for delivering
a broad area of NHS services. Each clinical
service line has a governance committee. This
committee regularly receives and reviews data
on the quality of the service line’s clinical care.
The national clinical audits and national
confidential enquiries that the Trust was eligible
to participate in during 2014/15 are as follows:
• Prescribing Observatory for Mental Health
(POMH);
• National Audit of Schizophrenia CQUIN
• National Confidential Inquiry into Suicide
and Homicide
• Sudden unexplained deaths in psychiatric
inpatients
The Board of Directors receives Trust-wide
reports covering a range of data which
includes the results of patient experience
surveys including reports from Healthwatch,
safeguarding, CQC outcomes, results of
clinical audits, complaints/compliments,
incidents, medicines management, infection
control, clinical risks, legal claims, staff
training compliance and target performance
information. In addition a Patient Safety,
The national clinical audits and national
confidential enquiries that the Trust participated
in during 2014/15 are as follows:
• Prescribing Observatory for Mental Health
(POMH);
• National Audit of Schizophrenia CQUIN
• National Confidential Inquiry into Suicide
and Homicide
• Sudden unexplained deaths in psychiatric
inpatients
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The national clinical audits and national
confidential enquiries that the Trust participated
in, and for which data collection was completed
during 2014/15, are listed below alongside
the number of cased submitted to each audit
or enquiry as a percentage of the number of
registered cases required by the terms of that
audit or enquiry
Prescribing Observatory for Mental Health
Clinical AuditCases
No of cases %Comment
requiredsubmitted
Topic 9c: Use of anti-psychotic
-
23
n/a Target number not set by audit
medication for people with a
learning disability
Topic 12b: Prescribing for people -
0
n/a Decision not to participate on
with a personality disorder
this round.
Topic 14a: Prescribing for
-
0
n/a No longer core business fo
substance misuse – alcohol
CFT
detoxification
National Audit of schizophrenia CQUIN
National Audit of Schizophrenia
63
63
100% Original sample was planned
- inpatients
be 100, but fewer inpatients
to
in target dates due to
Longreach hospital closure.
InquiryCases
National confidential inquiry
into: Suicide
Homicide
14
0
No of cases %Comment
submitted
14
100% The National Confidential
Inquiry investigates suicides and
homicides which have occurred
0
in each area once a verdict
has been reached. These
figures refer to the incidents
investigated in the year
National Confidential Inquiry
into Sudden Unexplained
Death (SUDS)
2
2
100% Examines deaths of psychiatric
inpatients which were sudden
and unexplained
The reports of 2 national clinical audits were reviewed by the provider in 2014/15 and the Trust intends
to take the following actions to improve the quality of healthcare provided:
National clinical audits – published
National Audit of Schizophrenia round 2 (NAS2)
was published on 10th October 2014
Prescribing Observatory for Mental Health topic
10c: Use of anti-psychotic medication in CAMHS
Local clinical audits completed
in 2014/15
The reports of 122 local clinical audits were
reviewed by the Trust in 2014/15 the Trust
intends to take the actions detailed below to
improve the quality of healthcare provided:
Recommendations and action plans to address
the findings of each audit are developed by the
relevant clinical service line in order to further
Comment
NAS2 presented to the Trust’s Quality and
Governance Committee in October 2014. An
action plan was developed and presented to the
Trust’s Quality and Governance Committee in
January 2015 and to Board in March 2015.
The published clinical audit was presented to the
Trust’s Quality and Governance Committee in
September 2014 and an action plan developed.
improve the quality of healthcare we provide.
Details are available on request from Dr Ellen
Wilkinson, Medical Director at ellen.wilkinson@
nhs.net. The delivery of the actions is
monitored through the Operational Governance
Structure. The Board of Directors’ Quality and
Governance Committee receives a quarterly
clinical audit report detailing outcomes from all
clinical audits undertaken within the previous
quarter.
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Completed Approved Audits
Complex care and dementia service line
Number TitleCompletion Date
511
Re-audit of Antibiotic Prescribing for Inpatients
20/01/2014
513
Infection Prevention and Control (IPC) – Implementation of Practice
02/05/2014
(incorporating Inoculation injury, Safe management of Laundry/
Linen, Personal Protective Equipment, Dress Code and Hand Hygiene)
514
IPC – Environment (incorporating mattress audit)
02/05/2014
570
Evaluation of the Effectiveness of Personal Safety Training
20/10/2014
571
Decision making process and recording of Do not attempt
resuscitation (DNAR) status of patients on Garner Ward
598
Controlled Drug Standards Quarterly Audits
599
Audit of medication storage (6 monthly)
11/12/2014
602
Audit of omitted medicines on Garner ward
27/10/2014
603
Medicines reconciliation on admission (Adult Functional.
26/11/2014
Inpatients & Complex Care ad Dementia)
605
Medicines reconciliation on admission (Adult Functional. Inpatients
19/12/2013
& Complex Care ad Dementia)
627
Memory Assessment Service – case note audit
14/04/2014
631
Audit of Admissions to Inpatient Dementia Unit
28/01/2015
638
Medical Devices - Self assessment
02/05/2014
662/650
The identification of fixed ligature points within Cornwall
04/04/2014
Partnership NHS Foundation Trust inpatient environments Garner Ward
657
National Early Warning System (NEWS)
07/05/2014
Prescribing of Cognitive Enhancers - Assessment of compliance
03/06/2014
693
against NICE Guidelines
707
Counter Fraud Local Proactive Exercise - Review of Medicines
05/01/2015
Management FP10
Health & Safety - Slips, Trips and Falls
09/01/2015
720
721
Health & Safety - Working at Height
09/01/2015
647
Garner Ward Nutrition and Speech and Language Therapy (SLT) Audit 12/03/2015
648
An evaluation of Moving and Handling Equipment, Servicing and
25/02/2015
Training - Garner. Now includes Therapeutic equipment
655
Mental Health Act Review
12/03/2015
Audit of Covert Administration of Medication on Garner Ward
19/02/2015
728
732
Anitbiotic Prescribing on Inpatient wards
26/02/2015
735
Recording of drug allergies and adverse drug reactions
09/03/2015
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Children and young people’s service line
Number TitleCompletion Date
513
IPC - Implementation/Practice
02/05/2014
535
Moving & Handling equipment, servicing and training- short breaks
19/12/2013
556
Family Nurse Partnership sample safeguarding records Audit
19/12/2013
570
Evaluation of the effectiveness of personal Safety Training
20/10/2014
573
Kerrier Child and adolescent mental health service (CAMHS)
05/11/2014
Family therapy Service Evaluation
587/ 664 Lone Worker Audit – Children’s Services
02/05/2014
599
Quarterly audit of medication storage
11/12/2014
611
Management of depressive disorder in St Austell Specialist CAMHS
01/12/2014
612
Audit of Adherence to the Trust’s Toy policy
15/01/2014
619
Audit of Cleanliness and Safety of Equipment - Health Visitors
20/03/2014
620
Pre Common Assessment Framework (CAF) & Care Plan Audit –
09/05/2014
Health Visitors
625
Health Audit: Identification of unmet health needs using asset
15/01/2014
assessment
634
CAMHS Paper-light File Audit
19/12/2013
649
Moving & Handling/Equipment Audit
25/02/2015
654
Record Keeping Audit - Special Parenting Services
07/04/114
675
Audit of CAMHS ADHD Pilot
02/03/2015
678
Audit of Cleanliness and Safety of Equipment - School Nurses
24/04/2014
680
Pre-live Children’s Care Management Centre
30/11/2013
686
Autism Spectrum Disorder Assessment Team – Service Evaluation
first six months
692
FP10 Prescription Forms Storage
08/09/2014
Family Nurse Practitioners Record Keeping audit
10/10/2014
696
699
Emergency Procedures - Telephone Audit
12/12/2014
701
Kits Rio Safeguarding electronic Records
21/10/2014
School Nurse Pre Caf, safeguarding1 and Care plan Audit
26/02/2015
702
704
Case Formulation Audit
17/11/2014
Counter Fraud Local Proactive Exercise - Review of Medicines
05/01/2015
707
Management FP10
720
Health & Safety - Slips, Trips and Falls
09/01/2015
Health & Safety - Working at Height
09/01/2015
721
Functional community service line
Number TitleCompletion Date
513
IPC – Implementation/Practice
02/05/2014
541
MINDFULNESS - A qualitative audit of the experiences of service
11/11/2014
users of mindfulness practice (Eating Disorders Service)
570
Evaluation of the Effectiveness of Personal Safety Training
20/10/2014
610
Audit of last 10 medication changes – data sheet offered or not.
30/06/2014
632
HoNOS Audit in the Functional Community Mental Health Teams - 03/02/2014
Do patients get better ?
637
Health & Safety - Water Systems Management - Control of Legionella 12/05/
& Pseudomonas
638
Medical Devices - Self Assessment
02/05/2014
664
Health & Safety - Lone Working
01/03/2014
665
Security Management - Violence and Aggression 01/03/2014
666
Health & Safety - First Aid
01/03/2014
707
Counter Fraud Local Proactive Exercise - Review of Medicines
05/01/2015
Management FP10
713
Criminal Justice Liaison & Diversion Service
16/09/2014
718
Patients on the Care Programme Approach: Communication with
17/10/2014
GP’s – CQUIN
720
Health & Safety - Slips, Trips and Falls
09/01/2015
721
Health & Safety - Working at Height
09/01/2015
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Functional community service line
Number TitleCompletion Date
513
IPC – Implementation/Practice
02/05/2014
541
MINDFULNESS - A qualitative audit of the experiences of service
11/11/2014
users of mindfulness practice (Eating Disorders Service)
570
Evaluation of the Effectiveness of Personal Safety Training
20/10/2014
610
Audit of last 10 medication changes – data sheet offered or not.
30/06/2014
632
HoNOS Audit in the Functional Community Mental Health Teams - 03/02/2014
Do patients get better ?
637
Health & Safety - Water Systems Management - Control of Legionella 12/05/
& Pseudomonas
638
Medical Devices - Self Assessment
02/05/2014
664
Health & Safety - Lone Working
01/03/2014
665
Security Management - Violence and Aggression 01/03/2014
666
Health & Safety - First Aid
01/03/2014
707
Counter Fraud Local Proactive Exercise - Review of Medicines
05/01/2015
Management FP10
713
Criminal Justice Liaison & Diversion Service
16/09/2014
718
Patients on the Care Programme Approach: Communication with
17/10/2014
GP’s – CQUIN
720
Health & Safety - Slips, Trips and Falls
09/01/2015
721
Health & Safety - Working at Height
09/01/2015
Completed Audits for Approval
Number TitleCompletion Date
Quarterly audit of medication storage
599
681
Audit to assess CFT Adherence to the Clinical Risk Assessment &
12/03/2015
Risk Management Policy for High Risk Clients
739
Forensic Clinic Audit
11/12/2014
Functional inpatient service line
Number TitleCompletion Date
IPC - Implementation/Practice
02/05/2014
513
514
IPC - Environment incorporating mattress audit
02/05/2014
538
Inpatient Nursing staff knowledge of patient information leaflets
Feb-14
570
Evaluation of the effectiveness of personal Safety Training
20/10/2014
576
Impact of Fettle House upon the admissions and accommodation
28/04/2014
of patients
598
Controlled Drugs Quarterly Audit (Inpatient incl. Home Treatment
24/04/2014
Team and Children’s Services)
616
MRSA Screening of inpatients
02/05/2014
635
CQUIN Functional Inpatients 4B
28/04/2014
636
CQUIN Bowman Inpatient Ward: Improving Physical Healthcare and
16/04/2014
Wellbeing of patients 2012/14
638
Medical Devices - Self assessment
02/05/2014
645
Preventing Falls in older people admitted to hospital
31/03/2015
657
National Early Warning System (NEWS)
07/05/2014
662
Identification of Fixed Ligature Points within Inpatient Environments 04/04/2014
664
Health & Safety - Lone Working
01/03/2014
665
Security Management - Violence & Aggression
01/03/2014
666
Health & Safety - First Aid
01/03/2014
713
Criminal Justice Liaison & Diversion Service
01/09/2014
671
HoNOS Scores on Fletcher Ward
07/05/2014
720
Health & Safety - Slips, Trips and Falls
09/01/2015
721
Health & Safety - Working at Height
09/01/2015
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599
603
649
667
689
728
732
734
735
736
737
740
Six month audits of medication storage
Medicines reconciliation on admission
Moving & Handling (Fletcher/Bay/Fettle)
Mental Health Act Review
Environmental Audit
Audit of Covert Administration of Medication on Garner Ward
Antibiotic Prescribing on Inpatient wards
Discharge on Benzodiazepines
Recording of drug allergies and adverse Drug reactions
Rio Quality of Record Keeping Audit
Allergy Recording on Discharge Prescription on Fletcher
Health & Safety – Control of Substances Hazardous to Health (COSHH)
11/12/2014
26/11/2014
25/02/2015
12/03/2015
07/04/2015
25/02/2015
26/02/2015
26/02/2015
09/03/2015
12/03/2015
09/03/2015
09/03/2015
Learning disability service line
Number TitleCompletion Date
513
IPC - Implementation/Practice
02/05/2014
514
IPC – Environment
02/05/2014
528
Impact of autism diagnostic observation schedule training on 22/04/2014
linicians practice (pre & post training questionnaires)
568
Three year review of Eligibility referrals
11/04/2014
593
Annual Health Checks of LD Patients on psychotropic medication
27/01/2015
(re-audit)
621
Developing a care pathway for service users with a profound and
08/08/2014
multiple Learning Disabilities (East Team)
Medical Devices - Self Assessment
02/05/2014
638
646
Retrospective Audit of Emergency Midazolam use as a reflector of
12/11/2014
seizure control
679
Learning Disabilities Service Records Audit
682
Learning Disabilities Conference Evaluation
04/08/2014
700
Challenging Behaviour
19/11/2014
705
Audit of Intensive Support Team Caseload - Autism QS 51
18/11/2014
707
Counter Fraud Local Proactive Exercise – Review of Medicines
05/01/2015
Management FP10
712
Application of Unified Approach Guidelines in relation to people
01/10/2014
with a Learning Disability who are at risk of receiving abusive or
restrictive practices
715
Application of Unified Approach Guidelines in relation to people
08/10/2014
with Learning Disabilities who are at risk of receiving abusive or
restrictive practices
720
Health & Safety - Slips, Trips and Falls
09/01/2015
721
Health & Safety - Working at Height
09/01/2015
723
A re-audit of dementia training undertaken by Learning Disability
Health staff from October 2013 to October 2014
23/01/2015
726
P-File Audit
20/01/2015
Participation in Clinical
Research
The Trust remains committed to supporting
research in biological, psychological and social
treatments for people with severe mental
illness, dementia and a learning disability. As a
Trust we are collaborating with several major
university departments, the pharmaceutical
industry and major charities.
The Trust has a dedicated research team which
continues to grow and expand, enhancing
the amount of clinical research the Trust is
involved in. This year has been the first year
we have participated in clinical trials involving
investigational medicinal products with people
diagnosed with Downs syndrome and dementia.
Cornwall Partnership NHS Foundation Trust
is the first in the UK to recruit to time and to
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target for the Downs syndrome industry study
which is a great and exciting achievement. Over
the last two years we have grown the research
portfolio for those with dementia and their
carers and are now collaborating with the acute
trust to enable more people with a diagnosis of
dementia to be involved in research. The aim of
the research team is to introduce and integrate
research as part of clinical practice and this is
now being achieved in many areas and with the
help of a standard operating procedure. The
aim for the forthcoming year is to engage with
the children’s service and to commence studies
in this area.
The success of local research projects in the
areas of epilepsy and mental health continue
with more funding being negotiated from
industry to continue to grow this portfolio.
Another exciting development is that two nonmedical staff, one from a nursing background
and the other from a psychology background,
have successfully gained funding for PhD
projects with the Universities of Plymouth and
Exeter.
Goals agreed with
commissioners - CQUINs
A proportion of the Trust’s income in 2014/15
was conditional upon achieving quality
improvement and innovation goals agreed
between the Trust and any person or body
they entered into a contract, agreement or
arrangement with for the provision of relevant
health services, through the Commissioning
for Quality and Innovation (CQUIN) payment
framework.
Further details of the agreed goals for 2014/15
and for the following 12 month period are
available from the Foundation Trust Secretary
and are reported in the Trust Board papers at
www.cornwallfoundationtrust.nhs.uk
In 2014/15 the Trust agreed a wide range of
quality indicators to underpin CQUIN payments
as detailed in the following tables.
We have also sponsored several local studies
which are not on the NIHR portfolio, including
a major collaboration with the Mood Disorder
Unit at the University of Exeter.
We anticipate that by the end of the 20142015 financial year we will have recruited
approximately 173 patients to NIHR funded
research projects. This represents 1-2% of all
patients under the care of CFT.
The number of patients receiving relevant
health services provided or sub-contracted by
the Trust in 2014/15 that were recruited during
that period to participate in research approved
by a research ethics committee was 145 patients
recruited as part of the National Institute of
Health Research.
More information can be found on our website
cornwallfoundationtrust.nhs.uk.
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Contract
1 KCCG Children’s
DoV
2 KCCG Children’s
DoV
3 KCCG Children’s
DoV
4 KCCG Children’s
DoV
Area for improvement
Friends and Family Test – Implementation of staff FFT
Friends and Family Test –
early implementation
Friends and Family Test –
Phased expansion
Referrer Satisfaction system and
survey
5 KCCG MH/ LD
Friends and family test –
implementation of staff FTT
Indicator 1a, 1b and 1c
Early Implementation
Phased expansion
Physical Health Care CQUIN/
Cardio metabolic assessment for
patients with schizophrenia
Communication with General
Practitioners
Pilot Mental Health NHS Safety
Thermometer
Health Equality Framework
6 KCCG MH/LD
7 KCCG MH/LD
8 KCCG MH/ LD
9 KCCG MH/LD
10 KCCG MH/ LD
11 KCCG MH/ LD
12 KCCG MH/ LD
13 KCCG MH/ LD
14 KCCG MH/ LD
RationalePerformance
National CQUIN
Achieved
National CQUIN
Achieved
National CQUIN
Achieved
The Trust will ask a number
of questions to inform
satisfaction levels
National CQUIN
Achieved
National CQUIN
National CQUIN
National CQUIN
Achieved
Achieved
Partially Achieved
National CQUIN
Achieved
Variation on national
CQUIN
The HEF enables services to
demonstrate the impact of
interventions on individuals.
Individual outcomes can also
be collated to demonstrate
impact on priorities for the
population.
Primary Care Dementia
To provide Countywide
Practitioner 6 month Extension provision of the function of
primary care based dementia
practitioners to provide
continuity of care and case
management of people.
Referrer Satisfaction system and The Children’s Service
survey
continues to develop the Care
Management Centre which will
provide referrers with a single
point of access to all children’s
services. To enable the Trust to
understand the perception of
service access and delivery the
referrer experience will ask a
number of questions that
inform satisfaction levels.
Section 117 ReviewThere are a number of
individuals within Cornwall
and the Isles of Scilly who are
eligible for aftercare under
Section 117 MHA 1983. It is,
therefore, a legal requirement
to ensure that there is a robust
overall strategy and this is
underpinned with clear
operational procedures.
Physical Healthcare
National CQUIN
15 NHS England
Bowman Contract
16 NHS England
Friends and family Test
National CQUIB
Bowman Contract Phased expansion
17 NHS Englan
SCG DashboardAs part of quality assurance
Bowman Contract
for commissioners that
specialised services are safe
and effective for patients
Achieved
Achieved
Achieved
Achieved
Achieved
Achieved
Partially Achieved
Achieved
Achieved
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18 NHS England
Low/Med Secure - Collaborative Currently very few users of
Achieved
Bowman Contract Riskforensic services are actively
involved in their risk
assessment and developing
their risk management plan.
The Department of Health
‘Best Practice in Managing
Risk Guidelines 2007’ advises
that a collaborative approach
involving service users should
be used in the risk assessment
process. My Shared Pathway
(a previous Secure Service
CQUIN) promotes collaborative
approaches to a service user’s
care and treatment provided
by secure services. Furthermore,
ecovery approaches emphasise
that risk management should
be built on the recognition of
the service user’s strengths
and should emphasise recovery,
and this is more likely to be
achieved using a collaborative
approach.
19 NHS England
Low/Med Secure - Supporting
The CQUIN requires providers Achieved
Bowman Contract Carer Involvementto develop a strategy to
engage and maintain
relationships with carers where
a service user has identified
this as a choice.
20 NHS England
Health Visiting Ages & Stages
The Public Health Outcomes
Achieved
Children’s ContractFramework indicator 2.5
relating to school readiness
will require the implementation
of the ages and stages assessment at the two year developmental review. Providers do not
currently use this tool and need
to effectively plan for its full
implementation. This will
include updating policies,
ensuring staff are competent
in its use, ensuring availability
of appropriate resources,
ensuring data systems are in
place to record the information
identified in 4.2.1 of the
national Health Visitor
Specification for 14/15.
21 NHS England
Health Visiting Increasing
The national services
Achieved
Children’s Contract accessibility
specification for HV identifies
at minimum greater flexibility
between 8-8 on weekdays to
access HV services.
22 NHS England
Migrant Workers
Health Visiting services need to Achieved
Children’s Contract
effectively engage and meet
the needs of all children and
families in their geographical
area of responsibility whether
they are permanently settled
or more transient.
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In 2014/15, income equal to 2.5% of the
value of our main contract, which covers most
of our NHS services, was conditional upon
achieving CQUIN goals agreed with our host
commissioner, NHS Cornwall and Isles of Scilly.
We anticipate achieving 95% of our CQUIN
related goals for 2014/15. With this level
of performance achievement we anticipate
payment of £1.6 million, subject to
commissioner agreement, from a maximum
potential payment of £1.7 million for mental
health, learning disability and children’s CQUIN
goals.
Statements from the Care
Quality Commission (CQC)
The Care Quality Commission (CQC) is the
organisation that regulates and inspects health
and social care services in England. All NHS
organisations are required to be registered with
the CQC in order to provide services and are
required to maintain specified standards of care
in order to retain their registration.
As part of its role the CQC is required to monitor
the quality of services provided across the NHS
and to take action where standards fall short
of the essential standards. Their assessment of
quality is based on a range of diverse sources
of external information about each trust
which is regularly updated and reviewed. This
is in addition to their own observations and
announced and unannounced inspections.
The Cornwall Partnership NHS Foundation Trust
is required to register with the Care Quality
Commission and its current registration status
is unconditional. The Care Quality Commission
has not taken enforcement action against
the Trust during 2014/15. Routine visits were
undertaken by the Mental Health Act Inspector
during 2014/15.
The Trust has not participated in any special
reviews or investigations by the CQC during the
reporting period.
OFSTED
The Trust’s three children’s short break houses
– Gwyn Dowr, Layland and Roston – are all
registered with OFSTED (Office for Standards
in Education, Children’s Services and Skills).
OFSTED undertakes regular inspections of
these premises. Inspections are carried out
under the Care Standards Act 2000 to assess the
effectiveness of the service and to consider how
well they comply with the relevant regulations
and meet the national minimum standards.
In 2014 all three children’s short break houses
were inspected by OFSTED.
Name
Date of
Grading obtained
of Home
Last Inspection for full inspection
Gwyn Dowr 16.12.14
Good
Layland13.11.14 Good
Roston09.12.14 Good
All recommendations following inspections
are addressed with robust action plans. The
following extract details comments made during
the above inspections.
Gwyn Dowr
•
•
•
•
•
•
oung people enjoy and benefit from their
Y
regular visits
Children and young people receive good
quality care and attention
An individualised and child centred
approach is evident
Young people are kept safe and secure
when they stay
Staff demonstrate a good approach to
enabling young people appropriate freedom
to develop independence while ensuring
their safety
Supervision arrangements will be enhanced
Layland
•
•
•
•
•
•
•
•
•
hildren and young people enjoy their short
C
breaks in this home.
Children receive good quality care and
benefit from the opportunities afforded to
them
A high priority is placed on ensuring young
people are safe and staff are vigilant at
ensuring their welfare
Staff have a good understanding of young
people’s individual needs and these are
supported by detailed care plans
Families are kept up to date with what
happens during young people’s visits.
Staff reflect and learn from any issues or
concerns raised
Staff are child focused and this positively
benefits young people.
Staff are reviewing the current system of
overnight monitoring of children
A development plan for the home is under
construction
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•
•
rofessional and legal practice updates will
P
be developed for staff
Supervision arrangements will be enhanced
Roston
•
•
•
•
•
•
•
•
hildren benefit from good quality care and
C
the support of knowledgeable and caring
staff
The care provided is child-focused, meets
children’s complex needs and promotes their
well being
Activities are purposeful, varied and
rewarding
Children are safe and enabled to enjoy
a range of opportunities and positive
experiences
Staff have an excellent understanding of
children’s diversity and provide professional,
well informed and personalised support
Children’s contributions to the home are
valued
The procedure for managing comments and
complaints will be revised
Supervision arrangements will be enhanced
Data quality statements
Data quality
The accuracy and completeness of the data
used by the Trust to report quality of care and
value for money is of utmost importance and
is seen as an integral part of improving clinical
effectiveness. Clinical activity needs to be
recorded accurately for a number of reasons
including the following:
• It helps us to measure our care against
others
• To reduce delays
• To inform ‘Service Line Management’ which
is the way we track value for money and
financial efficiency.
Improving data quality
The Trust will be taking the following action to
improve data quality:
The Trust continues to focus on the
development of an electronic clinical record
system. Access to live clinical information
by all of the Trust’s clinicians whether they
provide community based or hospital services
has enabled staff to focus on improving clinical
outcomes.
The electronic patient record system known as
RiO, has been implemented across the majority
of the Trust services. In 2014/15 a local version
of RiO was developed by the Trust to provide an
electronic record for its Children’s Service Line.
In 2014/15 the Trust invested in improving its
automated performance reporting systems.
This has enabled improvements in data quality,
where quality assurance via validation is tested
automatically. Development of team level data
provides a data improvement tool to improve
care.
A planned upgrade to Rio during 2015 will
improve conditional logic and hence improve
data quality.
NHS number and general
medical practice code validity
The Trust submitted records during 2014/15 to
the Secondary Uses Service for inclusion in the
Hospital Episode Statistics which are included in
the latest published data.
Alan, Psychological Therapist
The percentage of records in the published
data for admitted patient care which included
the patient’s valid NHS number was 100%. The
percentage of records which included patient’s
valid General Practitioner Registration Code was
99.4% for admitted patient care.
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Information governance
toolkit attainment levels
The Trust’s Information Governance Assessment
Report overall score for 2014/15 was 79% and
was graded as satisfactory.
Information Governance Management
Assessment
Version 12 (2014-2015)
StageOverall Score
Latest
93%
Self-assessed Grade
Satisfactory
Confidentiality and Data Protection Assurance
Assessment
Version 12 (2014-2015)
StageOverall Score
Latest
87%
Self-assessed Grade
Satisfactory
Clinical Information Assurance
Assessment
Version 12 (2014-2015)
StageOverall Score
Latest
86%
Self-assessed Grade
Satisfactory
Secondary Use Assurance
Assessment
Version 12 (2014-2015)
StageOverall Score
Latest
75%
Self-assessed Grade
Satisfactory
Corporate Information Assurance
Assessment
Version 12 (2014-2015)
StageOverall Score
Latest
77%
Self-assessed Grade
Satisfactory
StageOverall Score
Latest
79%
Self-assessed Grade
Satisfactory
Overall
Assessment
Version 12 (2014-2015)
More information on the information
governance toolkit is available from:
www.igt.connectingforhealth.nhs.uk/about.aspx
Clinical coding error rate
The Trust was not subject to the Payment
by Results clinical coding audit during the
reporting period by the Audit Commission.
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Annex 1: Statements from key
stakeholders
Statement from Kernow
Clinical Commissioning Group
for Cornwall Partnership NHS
Foundation Trust Quality
Account 2014/15
Kernow Clinical Commissioning Group is pleased
to have the opportunity to comment on the
Quality Account 2014/15 for the Cornwall
Partnership NHS Foundation Trust (CFT), and
welcomes the approach the Trust has shown in
developing and setting out its plans for quality
improvement. There are routine processes in
place with CFT to agree, monitor and review the
quality of services throughout the year covering
the key quality domains of safety, effectiveness
and experience of care.
The Quality Account presents an overview of a
wide range of quality improvement work being
undertaken. We are particularly pleased to see
the Board’s aim to delivering excellent clinical
outcomes within a caring, compassionate and
safe environment. With the ambition to deliver
your quality strategy overarching principles
across the Trust’s operational Service Lines of:• A positive patient experience
• Delivery of safe care
• Clinical effectiveness
The report presents a fair reflection of progress
in 2014/15 and we can confirm the information
presented in the Quality Account appears to
provide a balanced account which is accurate
and fairly interpreted, from the data collected.
In terms of the performance against the 2014/15
CQUIN goals were achieved in full.
of indicators to indicate the timeliness of the
service;
•
Increase in psychology training during
2014/15, and would like the quality
outcomes be identified in 2016 of the
additional training;
•
Increased capacity in Psychology and during
2016 would like to see evidence of the
quality improvements that should arise from
this additional capacity;
•
he innovation of communication methods
T
such as the photo board, and would be keen
to understand the staff feedback with this
change in methodology;
•
S ignificant achievements in Safeguarding
Adults this is not clearly reflected within
the report with a separate section for
Safeguarding Adults. We note that patient
safety is a prominent theme throughout the
report;
•
Innovative work with the independent
sector to further engage with patients
the report reflects that there has been an
improvement in services. It would good to
understand the scope of the service and the
baseline data, to support the development
of the quality indicators in 2016 ;
•
raining within the Learning disability
T
service line was introduced for improved
communication methods, it would be to
identify the quality achievement during
2016;
•
hat priority 2 was a CQUIN during 2014/15
T
and continues to be during 2015/2016
monitoring of this CQUIN with the CCG to
clearly identify the quality improvements;
•
he success of the Health Equalities
T
Framework has been piloted for an
identified group of patients and the CQUIN
was completed;
We note the positive improvements Cornwall
Partnership NHS Foundation Trust has made in:
•
•
he refurbishment of the Longreach unit
T
to provide a modern facility significantly
improving the environmental experience for
patients,
he increased use of the Personality Disorder
T
service; we would like to see development
Kernow CCG looks forward to working with
the Trust throughout the year to deliver high
quality services to patients, especially:
•
o ensure that within the Quality Accounts
T
there is an identified section for prevention
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of infection at all, not even hand hygiene
or medical devices. Unfortunately audit
lists alone do not provide the level of
assurance that a description of findings and
subsequent improvements would give, so
the CCG would like to see this addressed in
2016;
•
•
atient Safety & Patient Experience, and in
P
particular recognition of the importance
of reviewing patients placed out of county
for acute care to ensure that patient
is repatriated in an appropriate timely
safe manner thereby improving the care
pathway.
o support the development of plan
T
to provide seven days services, in the
urgent and emergency areas in particular
attention being paid to increasing weekend
discharges and providing support in the
home to avoid admissions; KCCG would
like to see continued strong links with
this and the System Resilience Group and
representation to the weekly System wide
Senior Operations Group to support the 7
day services across all organisations.
• Improving the quality of care through joint
working between primary and mental
health care clinicians on developing
patient pathways; Improving the quality
of care through plans to improve health
and wellbeing of its staff, particularly with
strengthening communication and support
across clinical teams and management.
We are pleased to see that the priorities chosen
for 2014/15 are evidence based and have been
identified with key stakeholder involvement.
Kernow CCG recognises the work undertaken in
the following areas and would wish the Trust to
continue to focus on these areas although not
specifically identified as a priority:
•
•
e would like to support the development
W
of the performance data in all areas that
are contained within the quality accounts to
include comparison with the previous year
to demonstrate the quality improvements;
o positively note that CFT’s staff survey
T
did show some areas where they compare
favourably with other Trusts, there were
some findings of the 2014 staff survey
results were disappointing and show
recurring issues of concern to the staff. We
would like to see the development quality
improvement plans to resolve these issues
for staff.
•
e would welcome the opportunity to
W
work with CFT on any recommendations
and required actions resulting from the
Care Quality Commission service review for
looked after children and child protection
arrangements (January 2015)and including
the most recent visit that took place (April
2015).
Cornwall Council: Health and
Adults Overview and Scrutiny
Committee
Cornwall Council’s Health and Social Care
Scrutiny Committee agreed to comment
on the Quality Account 2014 – 2015 of
Cornwall Partnership NHS Foundation Trust.
All references in this commentary relate to
the period 1 April 2014 to the date of this
statement.
Cornwall Partnership NHS Foundation Trust
has engaged with the Committee, have good
channels of communications and regularly
attend meetings. It believes that the
Quality Account is a good reflection of the
services provided by the Trust, and provides
comprehensive coverage of the provider’s
services.
The Committee is pleased that the Trust has
successfully increased stakeholder engagement
and that the results of the Community User
Survey showed an increased level of satisfaction.
Hopefully this will continues in 2015 with the
priorities identified.
Priority 2, regarding the physical health of
patients with schizophrenia, is of interest to the
Committee and will look to see how this aspect
progresses.
Cornwall Council’s Health and Social Care
Scrutiny Committee continues to monitor
actions being taken in relation to Child and
Adolescent Mental Health Services (CAMHS) of
which Cornwall Partnership NHS Foundation
Trust is one of the providers.
The Committee looks forward to working in
partnership with the Trust in 2015-16.
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Council of Isles of Scilly:
Health Overview and Scrutiny
Committee
We are heartened by the progress made by the
Trust. We are glad to see the development made
in the development of a mental health pathway. We are pleased to note the establishment of a
primary mental health worker with clear links
to the Five Islands School. The improvements
to self reporting and openness are also worth
noting.
We are glad to see the Trust’s commitment to
working with partners and other trusts and we
would welcome the opportunity to see how we
can maximise all the available health and care
resources on the islands to provide seamless and
integrated service provision.
Healthwatch Cornwall
Response to Cornwall
Partnership NHS Foundation
Trust Quality Account 2014/15
Review of priorities 2014/15:
This year Healthwatch Cornwall (HC) has
continued to develop its relationship with
Cornwall Partnership NHS Foundation Trust
(CFT) as a critical friend. A system is in place to
enable HC to provide feedback to the Trust in
a timely manner, and in turn CFT is open about
issues and restrictions it has. Mental Health is
the most frequently commented on health issue
that HC hears about and most feedback relates
to patients that access community mental health
services such as Community Psychiatric Nurses
(CPN) and BeMe, rather than inpatient services.
HC is keen to explore patient engagement
opportunities further with CFT in the coming
year, developing the focussed, collaborative
outreach completed in Spring 2015.
During the past 12 months, CFT has worked to
improve children and young people’s mental
health services in Cornwall and this has been
clearly evident through media attention,
reduced negative feedback received by HC and
a positive report coming from the Care Quality
Commission. HC still has concerns about the
amount of children that are cared for out-of-
county and would have liked to have seen an
action or update on this current situation within
the Quality Account.
HC has received a large amount of patient
feedback relating to access to community
mental health services. As mentioned on page
15 of the Quality Account in regards to staffing
absences, HC has received supporting evidence
on this issue. HC has heard from numerous
patients that they are struggling with their
mental health condition and this is not helped
when their CPN has been on sick leave. HC
has had one feedback comment that states a
patient is currently being supported by a third
CPN as the previous two are on sick leave.
The newly created specialist sub-teams that
will deliver personalised treatment and care
should mean that the service user will receive
intervention by staff with the right skills, in
the right place and at the right time. HC
feedback would challenge this statement. HC
has received plenty of feedback about patients’
difficulties of being able to speak to somebody
at the other end of the phone when they are
needing support. They report waiting for a call
back from an appropriate person and never
receiving it and staff talking about their own
issues rather than focussing on the service user.
These feedback comments relate to Bolitho
House and Trevillis House.
HC is glad to see the importance the Trust
places on the Primary Care Dementia
Practitioners (PCDP). HC has received positive
feedback about the service PCDP provide in
the community and are happy to see that
it will continue to be funded past January
2015. HC was aware of the poor provision of
service provided by the PCDP in North Cornwall
due to staff shortage, which contradicts the
information given on page 16. The feedback
HC received indicated that dementia patients
in that area were not in receipt of continuity of
care, which patients in other areas of the county
did. HC hopes that now funding has been
agreed for an extension of the contract that
they will be able to recruit suitable staff.
Do the priorities of the provider reflect
the priorities of the local population?
HC is disappointed to see that priorities
for 2015/16 have not come from patient
engagement but rather services lines producing
their own priorities. The five priorities that
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have been chosen do put the focus more on
the patient, unlike the previous year with
more of a focus on the carer of the patient.
All five priorities have a sharp focus and HC
will be interested to see how these priorities
progress over the next year. As an independent
body, HC would be happy to participate in the
Trust’s work to help it achieve its ambition and
improve services.
Healthwatch Cornwall CIC,
Mansion House,
Princess Street,
Truro,
Cornwall, TR1 2RF
Website: www.healthwatchcornwall.co.uk
Email: enquiries@healthwatchcornwall.co.uk
Information and advice line: 0800 0381 281
Registered Company Number: 8399730
Healthwatch Isles of Scilly
Response to Cornwall
Partnership NHS Foundation
Trust Quality Account 2014/15
We are pleased to comment on this Quality
Account and to have had the opportunity
to discuss it with Sharon Linter of Cornwall
Partnership NHS Foundation Trust.
Children’s services
Historically, we were told that the referral
pathway from IOS, specifically CAMHS and
Autism Spectrum Disorder diagnosis, did
not work well. The introduction of the Care
Management Centre and a part time primary
mental health worker post for IOS will have
made an improvement. We are pleased that
the primary mental health post will be at a
higher tier in 2015/16. We note that other
initiatives are more Cornwall centred and would
like to know more about engagement activity
undertaken in the islands and also how the
planned Early Help Hub to be established with
Cornwall Council will benefit individuals and
services in the Isles of Scilly.
Community mental health services
Historically and ongoing, our feedback about
mental health services in Isles of Scilly is that
there is poor support for chronic conditions
such as anxiety and depression. Increased
provision of psychological therapies, along with
Emotional Coping Skills groups and support
for carers are welcome, but we are not sure
if or how these are delivered in Isles of Scilly.
However, we have had positive feedback about
BeMe.
We are pleased to see that the Trust is working
with the University of Exeter to develop tools
for delivery of psychological interventions and
hope that this will improve access from remote
areas. Regarding patients who present in crisis,
the Council on the Isles of Scilly and other
services have worked with Cornwall Partnership
NHS Foundation Trust to review and develop
protocols around intervention, and safe care
and transfer of patients. This doesn’t feature in
the Quality Account but will be of major benefit
to individual in crisis.
Complex care and dementia
service
We understand that the Primary Care Dementia
Practitioner visiting service is well embedded in
the local multidisciplinary team, and provides
valuable support to individuals and staff.
Improvements to the delivery of interventions
to tackle challenging behaviour, and support
care givers, are welcome and we hope that
sufficient time and resources are available in the
current services.
Do the priorities of the provider
reflect the priorities of the local
population?
We know from feedback that access to
psychological therapies and safe care of
individuals experiencing mental health crisis are
important to people, as is timely intervention
and support for children with additional needs.
These are not reflected in the priorities for
2015/16 but we note plans for sustained delivery
and improvement elsewhere in the Quality
Account.
Priority 3: effective intervention regarding
challenging behaviour in patients with
dementia may well help to address some
difficulties faced by patients and care givers.
Support for people living with dementia, and
their carers, is a challenge for both individuals
and services.
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Priority 5: use of the Health Inequalities
Framework across the learning disability service
would complement local initiatives to improve
general health and wellbeing in the population.
We receive relatively little direct feedback
about services provided by the Trust but have
systems for passing it on, and good contact lines
so we can address issues as they arise. We are
currently undertaking a household community
survey and look forward to discussing the
larger amount of feedback this will generate.
We have always found Cornwall Partnership
NHS Foundation Trust responsive and willing
to engage with us and look forward to future
collaboration.
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Annex 2: Statement of Directors’
Responsibilities for the quality report
The directors are required under the Health Act
2009 and the National Health Service (Quality
Accounts) Regulations to prepare Quality
Accounts for each financial year.
Monitor has issued guidance to NHS foundation
trust boards on the form and content of annual
quality reports (which incorporate the above
legal requirements) and on the arrangements
that NHS foundation trust boards should put
in place to support the data quality for the
preparation of the quality report.
In preparing the Quality Report, directors are
required to take steps to satisfy themselves that:
• thecontentoftheQualityReportmeetsthe
requirements set out in the NHS Foundation
Trust Annual Reporting Manual 2014/15 and
supporting guidance;
• thecontentoftheQualityReportisnot
inconsistent with internal and external
sources of information including:
• Boardminutesandpapersfortheperiod
April 2014 to May 2015
• papersrelatingtoqualityreportedto
the Board over the period April 2014 to
May 2015
• papersrelatingtoqualityreportedto
the Board over the period April 2014 to
May 2015
• feedbackfromNHSKernowClinical
Commissioning Group dated 22 May 2015
• feedbackfromCouncilofIslesofScilly:
Health Overview and Scrutiny Committee
dated May 2015
• feedbackfromGovernorsdated16April
2015
• feedbackfromHealthWatchCornwall
dated May 2015
• feedbackfromHealthWatchIslesofScilly
dated May 2015
• feedbackfromCornwallCouncil:Health
and Adults Overview and Scrutiny
Committee dated May 2015
Vicky Wood, Chair
•
t he Trust’s complaints report published
under regulation 18 of the Local
Authority Social Services and NHS
Complaints Regulations 2009, dated 24
February 2015.
• the 2014 national community mental
health survey
• the 2014 national inpatient mental
health survey;
• the 2014 national staff survey;
• the Head of Internal Audit’s annual
opinion over the Trust’s control
environment dated 20 May 2015
• CQC Intelligent Monitoring Report dated
November 2014.
• the Quality Report presents a balanced
picture of the NHS Foundation Trust’s
performance over the period covered;
• the performance information reported in
the Quality Report is reliable and accurate;
• there are proper internal controls over the
collection and reporting of the measures of
performance included in the Quality Report,
and these controls are subject to review to
confirm that they are working effectively in
practice;
• the data underpinning the measures of
performance reported in the Quality Report
is robust and reliable, conforms to specified
data quality standards and prescribed
definitions, is subject to appropriate scrutiny
and review; and
• the Quality Report has been prepared in
accordance with Monitor’s annual reporting
guidance (which incorporates the Quality
Accounts regulations) (published at www.
monitor.gov.uk/annualreportingmanual)
as well as the standards to support data
quality for the preparation of the Quality
Report. (available at www.monitor.gov.uk/
annualreportingmanual)
The directors confirm to the best of their
knowledge and belief they have complied
with the above requirements in preparing the
Quality Report.
Phillip Confue, Chief Executive
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Aleson, Complex Care and Dementia Community Psychiatric Nurse
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Annex 3: 2014/15 limited
assurance report on the content
of the quality reports and
mandated performance indicators
Independent auditor’s report
to the Council of Governors
of Cornwall Partnership NHS
Foundation Trust on the
Quality Report
We have been engaged by the Council of
Governors of Cornwall Partnership NHS
Foundation Trust to perform an independent
assurance engagement in respect of Cornwall
Partnership NHS Foundation Trust’s quality
report for the year ended 31 March 2015 (the
‘Quality Report’) and certain performance
indicators contained therein.
This report, including the conclusion, has been
prepared solely for the Council of Governors
of Cornwall Partnership NHS Foundation Trust
as a body, to assist the Council of Governors in
reporting Cornwall Partnership NHS Foundation
Trust’s quality agenda, performance and
activities. We permit the disclosure of this
report within the Annual Report for the year
ended 31 March 2015, to enable the Council
of Governors to demonstrate they have
discharged their governance responsibilities by
commissioning an independent assurance report
in connection with the indicators. To the fullest
extent permitted by law, we do not accept or
assume responsibility to anyone other than the
Council of Governors as a body and Cornwall
Partnership NHS Foundation Trust for our work
or this report, except where terms are expressly
agreed and with our prior consent in writing.
Scope and subject matter
The indicators for the year ended 31 March
2015 subject to limited assurance consist of the
national priority indicators as mandated by
Monitor:
• 100% enhanced Care Programme Approach
patients receive follow-up contact with in
seven days of discharge; and
•
dmissions to inpatient services had access
A
to crisis resolution home treatment teams
We refer to these national priority indicators
collectively as the ‘indicators’.
Respective responsibilities of
the directors and auditors
The directors are responsible for the content
and the preparation of the quality report in
accordance with the criteria set out in the ‘NHS
foundation trust annual reporting manual’
issued by Monitor.
Our responsibility is to form a conclusion, based
on limited assurance procedures, on whether
anything has come to our attention that causes
us to believe that:
• the quality report is not prepared in all
material respects in line with the criteria
set out in the ‘NHS foundation trust annual
reporting manual’;
•
t he quality report is not consistent in all
material respects with the sources specified
in the NHS Foundation Trust Annual
Reporting Manual; and
•
t he indicators in the quality report identified
as having been the subject of limited
assurance in the quality report are not
reasonably stated in all material respects
in accordance with the ‘NHS foundation
trust annual reporting manual’ and the six
dimensions of data quality set out in the
‘Detailed guidance for external assurance on
quality reports’.
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We read the quality report and consider
whether it addresses the content requirements
of the ‘NHS foundation trust annual reporting
manual’, and consider the implications for our
report if we become aware of any material
omissions.
We read the other information contained in
the quality report and consider whether it is
materially inconsistent with:
• board minutes for the period April 2014 to
May 2015;
• papers relating to quality reported to the
board over the period April 2014 to May
2015;
• feedback from Commissioners, dated May
2015
• feedback from governors, dated 16 April
2015;
• feedback from local HealthWatch
organisations, dated May 2015;
• feedback from Overview and Scrutiny
Committee, dated May 2015;
• the trust’s complaints report published
under regulation 18 of the Local Authority
Social Services and NHS Complaints
Regulations 2009, dated 24 February 2015
• the latest national patient survey, dated
September 2014
• the latest national staff survey, dated
November 2014;
• Care Quality Commission Intelligent
Monitoring Report dated November 2014;
• the Head of Internal Audit’s annual opinion
over the trust’s control environment dated
May 2015; and
• any other information included in our
review.
We consider the implications for our report
if we become aware of any apparent
misstatements or material inconsistencies with
those documents (collectively the ‘documents’).
Our responsibilities do not extend to any other
information.
We are in compliance with the applicable
independence and competency requirements
of the Institute of Chartered Accountants in
England and Wales (ICAEW) Code of Ethics. Our
team comprised assurance practitioners and
relevant subject matter experts.
Assurance work performed
We conducted this limited assurance
engagement in accordance with International
Standard on Assurance Engagements 3000
(Revised) - ‘Assurance Engagements other
than Audits or Reviews of Historical Financial
Information’ issued by the International
Auditing and Assurance Standards Board
(‘ISAE 3000’). Our limited assurance procedures
included:
• evaluating the design and implementation
of the key processes and controls for
managing and reporting the indicators;
• making enquiries of management;
• testing key management controls;
• imited testing, on a selective basis, of the
data used to calculate the indicator back to
supporting documentation;
• comparing the content requirements of
the ‘NHS foundation trust annual reporting
manual’ to the categories reported in the
quality report; and
• reading the documents.
A limited assurance engagement is smaller in
scope than a reasonable assurance engagement.
The nature, timing and extent of procedures
for gathering sufficient appropriate evidence
are deliberately limited relative to a reasonable
assurance engagement.
Limitations
Non-financial performance information is
subject to more inherent limitations than
financial information, given the characteristics
of the subject matter and the methods used for
determining such information.
The absence of a significant body of
established practice on which to draw allows
for the selection of different, but acceptable
measurement techniques which can result in
materially different measurements and can
affect comparability. The precision of different
measurement techniques may also vary.
Furthermore, the nature and methods used
to determine such information, as well as the
measurement criteria and the precision of these
criteria, may change over time. It is important
to read the quality report in the context of the
criteria set out in the ‘NHS foundation trust
annual reporting manual’.
The scope of our assurance work has not
included testing of indicators other than
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the two selected mandated indicators, or
consideration of quality governance.
Conclusion
Based on the results of our procedures, nothing
has come to our attention that causes us to
believe that, for the year ended 31 March 2015:
• the quality report is not prepared in all
material respects in line with the criteria
set out in the ‘NHS foundation trust annual
reporting manual’;
• the quality report is not consistent in all
material respects with the sources specified
in ‘Detailed Guidance for External Assurance
on Quality Reports; and
• the indicators in the quality report subject to
limited assurance have not been reasonably
stated in all material respects in accordance
with the ‘NHS foundation trust annual
reporting manual’.
Deloitte LLP
Chartered Accountants Cardiff
26 May 2015
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GLOSSARY
TermExplanation
Absence without leave (AWOL)
A person who is absent without official leave
being granted.
Academic Health Science NetworkA body to align education, clinical research,
informatics, innovation, training and education
and healthcare delivery.
Accreditation of inpatient mental health services AIMS is a standards-based accreditation
(AIMS)programme designed to improve the quality of
care in inpatient mental health wards.
Acute
Of sudden onset.
Annual health check
A yearly check of aspects of someone’s health
and a chance to talk.
Board of DirectorsThe Board of Directors is responsible for the
day-to-day management of the Trust and is
accountable for the operational delivery of
services, targets and performance, as well as the
definition and implementation of strategy and
policy.
Care quality commissionIndependent regulator of health and adult social
care in England.
Care management centreA team which receives and administers all
referrals to the children and young people’s
service.
Care pathwayAn integrated care pathway is a multidisciplinary
outline of anticipated care, placed in an
appropriate timeframe, to help a patient with
a specific condition or set of symptoms move
progressively through a clinical experience to
positive outcomes.
Care programme approachA way that services are assessed, planned,
co-ordinated and reviewed for someone with
mental health problems or a range of related
complex needs.
Carer registerAn electronic, or paper based, system to record
people who care for others.
Celebrating good practice road showAn internal process to share learning and
showcase work.
Child and adolescent mental health service
Specialist NHS children and young people’s
(CAMHS)mental health services.
Clinical effectivenessA framework for linking research,
implementation and evaluation in clinical
practice.
Cognitive analytical therapyA collaborative programme of looking at
the way someone thinks, feels and acts; a
programme which is tailored to individual needs
and to manageable goals for change.
Communication charterA framework to help local businesses and
organisations to communicate with people who
have a learning disability or a communication
difficulty.
Communication passportThe charter is a set of principles that should
guide communication in any service provided for
people with learning disabilities. It is hoped that
services will adopt these principles as their basis
for communication.
Cornwall health and making partnerships
A team of people who help to make sure that
(CHAMPS)people with a learning disability in Cornwall and
Isles of Scilly get equal access to health services.
Council of governorsThe Council of Governors is made up of
elected patients, public, staff and partner
representatives.
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Crisis resolution
team based in the community to provide quick
A
access to assess patients experiencing a mental
health crisis.
Delayed transfers of careA Delayed Transfer of Care is experienced by an
inpatient in a hospital, who is ready to move on
to the next stage of care but is prevented from
doing so for one or more reasons.
Duty of CandourCandour is defined in Robert Francis’ report as:
‘The volunteering of all relevant information
to persons who have or may have been harmed
by the provision of services, whether or not the
information has been requested and whether or
not a complaint or a report about that provision
has been made.’
Early help strategyA document developed to outline the multiagency approach for delivering Early Help to
children and young people.
Early intervention teamsA group of healthcare staff who aim to help
people to understand psychosis and reduce the
chance of it happening again.
Electro convulsive therapy (ECT)Electro-Convulsive Therapy (ECT) can be provided
as a treatment for a depressive illness, mania,
catatonia and occasionally schizophrenia. In
Cornwall, ECT is most commonly used to treat
severe depression, and usually when other
treatments have failed.
Emotional coping skillsA way of reducing symptoms by addressing
feelings.
Fit and Proper person testA test to determine whether a person is suitable
to hold a senior role within the organisation.
Formulation frameworkAn approach to assess, plan, implement and
review care provided to people living with
dementia whose distressed behaviour challenges
their care givers.
A report published in relation to the concerns
Francis report
raised about Mid Staffordshire NHS Trust.
Friends and Family TestA method to seek feedback on the care and
treatment provided.
GovernorAn NHS foundation trust governor holds
foundation trust’s non-executive directors to
account for the performance of the board and
represents the interests of members and the
public.
Harm ratingsIncidents within health care which result in
harm to an individual are allocated gradings to
indicate the level of harm experienced.
Health and social care information centre (HSCIC)A national provider of high-quality information,
data and IT systems for health and social care.
HealthwatchAn independent consumer champion that
gathers and represents the views of the public
about health and social care services in England.
Health equalities frameworkAn outcomes framework based on the
determinants of health inequalities, provides a
way for all specialist learning disability services
to agree and measure outcomes with people
with learning disabilities.
Home treatment teamProvides a high level of support to people over
the age of 16 in mental health crisis or relapse in
their own home.
Improving access to psychological therapiesA service offering interventions approved by
the National Institute of Health and Clinical
Excellence (NICE) for treating people with
depression and anxiety disorders.
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Inpatient mental health serviceFacilities which provide a safe environment for
assessment and treatment, of people over the
age of 18 with a mental health condition.
Integrated community mental health teamProvide one-to-one, individualised support that
may take the form of visits to a person’s home or
at a community setting such as a GP surgery.
Intensive interaction cafesA practical approach to interacting with people
with severe or profound and multiple learning
disabilities and/or autism.
Institute for health improvementIHI is a nonprofit organization focused on
motivating and building the will for change,
partnering with patients and health care
professionals to test new models of care, and
ensuring the broadest adoption of best practices
and effective innovations.
International trial for people with Down’s syndrome Research trial.
Low secure unitIntensive rehabilitation unit for forensic (involved
with the courts) and non forensic patients.
Low secure peer review networkA review by another unit as described above.
Memory assessment serviceFacilities across the county which provide
assessment, diagnosis, initial treatment and
the provision of information and support
where there is a concern that someone may be
developing dementia.
Meridian survey toolA company which specialises in developing
questions to be used in a survey to understand a
person’s experience.
MindfulnessMindfulness is a way of paying attention to
the present moment, using techniques like
meditation, breathing and yoga.
Multi disciplinary team (MDT)Members from different healthcare professions
with specialised skills and expertise.
Multifactoral fall risk assessment toolA validated tool to assess a patient’s risk of failing
National community mental health surveyA survey of people who use community mental
health services.
National Institute for Health and Care ExcellenceAn executive non-departmental public body
of the Department of Health in the United
Kingdom.
National service framework for mental healthNational Service Frameworks provide a
systematic approach on which to tackle the
agenda of improving standards and quality
across health care sectors”.
Neuropsychiatric inventorya questionnaire, which uses information from
carers of people with dementia. It is designed
to describe the “behavioural and psychological
symptoms”, experienced by people with
dementia. Mental health practitioners will
use this information to identify the severity
of any symptoms and to monitor the effect of
treatment.
Newcastle modelAn approach to managing challenging behaviour
in patients with dementia.
Information from the National Health Service on
NHS Choices
conditions, treatments, local services and healthy
living.
NHS EnglandEstablished on 1 October 2012 as an executive
non-departmental public body. Also known as
The NHS Commissioning Board (NHS CB).
NHS KernowNHS Kernow is the clinical commissioning group
for Cornwall and the Isles of Scilly. The Group is
formed of 69 local practices who are themselves
formed into locality groups which have been
involved in local commissioning for many years.
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NHS outcomes frameworkSets out the outcomes and corresponding
indicators used to hold NHS England to account
for improvements in health outcomes.
OfstedOfsted is the Office for Standards in Education,
Children’s Services and Skills. It inspects and
regulates services that care for children and
young people, and services providing education
and skills for learners of all ages. Ofsted is a nonministerial department.
Patient experienceThe person’s perception of the care and
treatment experienced.
Patient experience teamA team of people whose aim is to monitor and
improve patient experience.
Patient safetyThe process by which an organisation makes
patient care safer.
Patient safety walk roundAn Executive led visit, to a team or ward, giving
staff, patients and families the opportunity to
identify safety issues with the aim to improve them.
Peri natal mental health serviceThe Peri natal mental health service specialises
in the assessment, diagnosis and short term
treatment of women affected by a moderate to
severe mental health illness in the preconception,
antenatal and postnatal period.
Personality disorder serviceA multidisciplinary team of therapists who
provide assessment and treatment interventions
for clients age 18 and over who either have
a diagnosis of personality disorder or have
difficulties that are suggestive of such a
diagnosis.
PharmacologicalThe science of drugs, including their composition,
uses, and effects.
Postcard methodAn approach, using a postcard, to obtain
feedback.
Psychological therapyForms of treatment which involve talking to a
trained therapist in order to help you overcome
your difficulties. PreceptorAn expert or specialist, such as a physician, who
gives practical experience and training to a
student, especially of medicine or nursing.
Primary careDay to day health care given by a health care
provider ie a doctor.
Primary care dementia practitionerIndividuals whose main purpose of their role is
to support people who have dementia and their
families.
Quality ambitionsSee Quality Strategy.
Quality strategyA document which outlines our commitment to
provide high quality care.
Resource centreA facility which offers support to service users
and families in community settings to promote
recovery through social inclusion and community
participation.
Safe wardsA model introduced to help to improve the
environment on mental health wards.
SchizophreniaSchizophrenia is a long-term mental health
condition that causes a range of different
psychological symptoms.
Service redesignAn activity of planning and organising people,
infrastructure, communication and material
components of a service in order to improve
its quality and the interaction between service
provider and customers.
Short break unitProvides respite to families who have a child with
a learning disability and physical health needs.
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Sign up to SafetySign up to Safety is designed to help realise
the ambition of making the NHS the safest
healthcare system in the world by creating a
system devoted to continuous learning and
improvement.
Staff experience groupA regular opportunity for staff to meet and
discuss their experiences of working within the
Trust.
Strategic leadership dayA regular event in the organisation to share
information.
Supervision passportA written document on which to record formal
and informal supervision dates.
Tea and talkAn informal meeting of patients, carers and staff
to share experiences.
UnifyAn information portal.
Winter pressuresA seasonal increase in demand for health services
Your say daysAn opportunity to listen to the thoughts of
patients, members of the public and others who
want to talk about the services of the Trust.
Youth boardA group of young people who help to develop
services.
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Sharon, Speech and Language Therapy Technician: participating
in the development of the Trust’s new values
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