nhs north somerset community services quality accounts 2010/11 · hospital by an integrated team of...

NHS North Somerset Community Services

Quality Accounts

2010/11

Contents Part 1 Statement of Quality from the Chief Executive

Page

North Somerset Explained 3

Statement from Stephen Harrison 5

Statement from Penny Brown 5

Part 2 Priorities for Improvement

Page

Priority 1 – Improve Patient Experience 7

Priority 2 – Improve Patient Safety 8

Priority 3 – Provide Clinically Effective Services 10

Statements of Assurance 14

Part 3 Review of our Quality Performance in 2010/2011

Page

Review of our Quality Performance in 2010/2011 25

Patient Experience 26

Patient Safety 31

Clinical Effectiveness 37

Additional Quality Improvements in North Somerset 42

Statements from third parties 42

Part One North Somerset Community Services Explained North Somerset covers an area over 145 square miles. It serves a very diverse population ranging from communities in the wealthy suburbs on the outskirts of Bristol, to rural villages and the communities of popular seaside towns. The PCT area shares its boundaries with North Somerset Council and works with a diversity of health care providers, ranging from small, local hospitals to the large, high profile acute and teaching Trusts of Bristol. Community Services are delivered from a range of localities, including Clevedon Community Hospital, Weston General Hospital, and a number of community bases including GP practices. The healthcare locations throughout the area are highlighted on the map below; We provide a total of 25 services in our core area, including community nursing and therapies, children’s services and learning disabilities. We deliver a number of specialist services including diabetes nurses and a service that works across Bristol and South Gloucestershire supporting patients with Lymphoedema (swelling caused by impairment to the lymph system). We also have a community hospital in Clevedon where we have 18 beds and are able to provide rehabilitation and respite. A range of outpatient services are also delivered on that site including a community endoscopy service.

Statement by our Trust Chair - Stephen Harrison

This report describes the quality account for services provided by North Somerset Community Services. Members of the public, patients and others will be able to use the report to understand new clinical developments and plans for further enhancement of services in the future. Some exciting clinical innovations have been introduced this year in North Somerset; the introduction of community wards has meant more patients can be cared for outside of hospital by an integrated team of nurses and therapist with strong links with social services. Community staff have also fully engaged in the Quality Improvement Patient Safety Programme co-ordinated by the Strategic Health Authority. This is a programme that helps the health community work together to enhance clinical care for patients. Areas of focus are those patients who are at risk of falling, vulnerable to pressure ulcers or infection. These are just two examples of the excellent work being achieved. In 2011/12 NHS North Somerset Community Services are separating from the Primary Care Trust and becoming a social enterprise, with focus on integrated working. This attention to ‘seamless working’ across North Somerset is perhaps the most important way in which we can improve the clinical quality, where there is a culture of continuous improvement based on partnership with staff, patients and other stakeholders. In closing I would like to extend my appreciation to all staff within North Somerset Community Services for their hard work last year and their commitment to innovation and improvement in services for the population of North Somerset.

Statement by our Chief Executive designate I am pleased to present the Quality Accounts for NHS North Somerset Community Services and take the opportunity to describe to a wide local audience the story of how we have provided the best possible care and treatment for all our service users and carers in 2010/11. This account aims to give an honest picture of Quality in the organisation in the past year. Part 1 contains the brief statements required to introduce the account and confirm the accuracy of the information contain within. Part 2 explains the priorities for Quality in the coming year and covers the information prescribed by law. Part 3 describes how the North Somerset Community Services performed in 2010/11, combining the hard data, wider descriptions of Quality through the year, and what some service users have said. This is the first North Somerset Community Services Quality Account which marks an important step in demonstrating our commitment to delivering safe, high quality care and services to the population of North Somerset. We recognise the importance of this in the light of our full separation from NHS North Somerset to becoming a social enterprise, and will continue to strive to improve the quality of our services year on year. This will take effect from 1st October 2011. Our strategy to date has mirrored that of NHS North Somerset, with four principal objectives:

• Identifying the health needs of their local populations and responding to diversity;

• Developing plans for health improvement

• Working as part of Local Strategic Partnerships to ensure co-ordination of planning and community engagement, integration of service delivery and input to the wider government agenda including Modernising Social Services, Sure Start, Community Safety, Quality Protects, Youth Offending Teams and Regeneration Initiatives;

• Leading in the development of the local health strategy to implement national priorities and to meet local health needs and to deliver this strategy by both providing and commissioning services from primary care practitioners and NHS Trusts.

We have aimed to ensure all our services “Make it right for you” – this embraces making it right for our patient, our staff and our stakeholders. We have a firm commitment to work towards seamless services with our partner agencies, integrating them wherever possible, and over the year have further built on the integration of services between ourselves and North Somerset Council for both Adults and Children.

We have embarked on a huge organisational change programme, developing community teams, which started in November 2010. We have brought together our community nursing and therapy services into community teams, to deliver joined up care to the patient. Within the team there is a community ward element where patients with the highest need are supported more intensively. We believe this will further aid seamless, integrated services and will improve the quality of services we can offer to our patients. This has necessitated further education and training for front line staff to maximise the capabilities and competency of the workforce, and we have built a robust education and training strategy to support this. We have introduced a new Community Information system, RIO, which enables clinicians to have a full understanding of the other practitioners involved in the care of our patients. As this rolls out fully, it will further enhance the quality of the service we provide. We are committed to working as efficiently as possible, and have adhered strongly to the principles of high quality, safety, and value when redesigning services. We have started a whole system service improvement programme, based on productive techniques and lean methodology, and have full clinical involvement through training key staff in service redesign techniques. With the financial challenges that are facing all organisations, it is vital that we continue to find better and improved ways to deliver our services more effectively. Quality will remain our absolute priority, and we will continue to improve our services at the same time as improving value for money. Statement by Chief Executive designate In accordance with the NHS (Quality Accounts) regulations 2010 No. 279, I hereby state that to the best of my knowledge the information in this document is accurate. Signed

Chief Executive designate Date: 30th June 2011

North Somerset Community Services Team at the NHS Leadership Challenge

Part Two

Priorities for Improvement and statements of assurance from the Board 2.1 Priorities for Improvement for 2011/2012 As we move towards a social enterprise, we are committed to further improving the quality of the services we provide for the population of North Somerset. Our three main priorities are;

Priority 1: Maintain and improve the experience of our patients

Priority 2: To improve patient safety

Priority 3: To provide clinically effective services, that we are able to demonstrate deliver the outcomes our service users expect

Priority 1: Maintain and improve the experience of our patients Gathering patient experience feedback on the services we provide is the first step in our journey to provide effective care. The information we gather and then analyse, will contribute to the day to day management of our services and our strategic intentions. As a social enterprise our governance structures will inform all stakeholders of our patients’ feedback. The Board of Directors will ensure that this information is gathered and acted upon and they will be held to account for this by the Council of Governors. We are currently part of the NHS North Somerset patient experience strategy; however we will create our own strategy as part of the successful development of a social enterprise. This strategy will place quality at the heart of everything we do and have a significant impact the services we provide. It will achieve this by setting out how we will listen and respond to patient and carers feedback. To enable this to happen we will provide a range of functions that will inform and enable service improvement.

• Complaints Management

• Patient Advice and Liaison Service (PALS)

• Dedicated feedback channels through a range of measures such as Patient surveys, patient experience audits, stakeholder group feedback

• Dedicated incident reporting system

We recognise and value liaising closely with the community in which we work to ensure the services we develop are based on local needs. Therefore, as part of our new structure as a separate organisation we will develop a Community forum. This forum will be open to service users, carers and volunteers and will meet on a regular basis, with an open meeting held at least annually to assist us in understanding the perspective of Service Users. As part of this commitment, we will ensure that the Community Forum will elect a member to serve on the Council of Governors. This will give them the opportunity to influence the organisation as the Council of Governors will have the authority to;

• Promote and encourage participation in the Company’s affairs; • Strive to ensure that the relevant interests of the community ( including service users,

carers, staff, the voluntary sector organisations and the local authorities) served by the CIC are appropriately represented;

• Appoint the Chair and Non Executive Directors; • Delegate powers to identified lead within the organisation where decisions need to be

made; • Approve major transactions, for example major financial decisions; • Change the constitution. Priority 2: To improve patient safety In North Somerset we continue to strive to deliver services that are safe and effective. We recognise that in order to deliver improvements for our patients we need to review the model of care and develop information to support the requirement for service design and highlight the intended benefits. We are developing ways of instigating a systematic approach to reviewing what we do. One of the systems we have used and will continue to apply is highlighted below;

As providers of community services, we are closely engaged with the Quality and Patient Safety Improvement Programme in the South West. Using the PDSA (Plan, Do, Study, Act) model, we have targeted areas where service re-design and the development of

reliable data will improve the safety for patients. During 2011/2012 identified workstreams will be further developed with key outcome measures and data requirements agreed and captured. We will pilot the programmes within 2 care homes in the region. The programmes we will be implementing throughout 2011/2012 are;

Infection Prevention and Control

Aim: To reduce the amount of catheter infections

• Number of urinary Catheters in situ

• Number of patients with a urinary catheter being treated for a Urinary Tract Infection (UTI) arising from a current inpatient stay

• Percent compliance with a urinary catheter insertion bundle

• Percent compliance with urinary catheter ongoing care management bundle

Venous ThromboEmbolism (VTE)

Aim: All patients to be assessed for VTE on admission and after 24 hours. If needed, VTE prophylaxis prescribed and administered

• Number of patients who have developed a Venous Thromboembolism (Deep Vein Thrombosis or Pulmonary Embolism) in hospital only

Falls

Aim: To reduce or eliminate patient falls

• Number of falls resulting in harm

• Days between falls resulting in harm-only to be used when falls become a rare event

• Percent compliance with falls risk assessment and identification

• Percent compliance with comfort/rounds

Pressure Ulcers

Aim: To reduce or eliminate the risk of patients developing pressure ulcers

• Number of pressure ulcers newly acquired on your unit

• Days between pressure ulcers newly acquired on your unit

• Percent compliance with SKIN bundle

Rescue and recognition of the deteriorating patient -

Aim: To recognise and act upon deterioration in health of patients within the community.

• Percent compliance using the Daily Safety Briefing

• Patients with observations complete

• Trigger patients receiving appropriate response

Leadership

• Number of walk arounds completed

• Actionable items identified during walk arounds completed

Medicines Management

• Patients with medication reconciliation performed and documented within 24 hours of admission

• Patients with medicines reconciliation performed and documented on discharge

• Selected drug adverse event rate

We have involved clinicians from all professions and services to support this programme, along with the audit and performance teams to ensure we are able to collate data and evidence the outcomes and benefits for the patients.

We are aiming to achieve the following outcomes by 2014 by implementing the programme in our services;

Pressure ulcers (grade III,IV) 80% reduction in hospital setting

Pressure ulcers (grade III,IV) 30% reduction in community setting

Manage deteriorating patient

95% of patients to have observations and early warning score to highlight potential issues

Manage deteriorating patient 95% of patients assessed as deteriorating receive an appropriate response

VTE

95% of patients assessed to be at risk of venous thromboembolism receive appropriate prophylaxis

Catheter Associated Urinary tract infection Reduce by 50%

Falls Serious injury from falls reduced by 50%

Medicines Management 95% of patients have a medication reconciliation within 24 hours of admission

Priority 3: To provide clinically effective services, which we are able to demonstrate and will deliver the outcomes our service users expect Community Teams In 2010/2011 Community Services were commissioned to develop a structure to deliver seamless services for patients, reducing unnecessary admission to acute trusts and providing care in patients homes. In 2011/2012 we will be completing the implementation of the community team model throughout our region, bringing together nursing and therapy services. Each of these teams will be based around 3 GP practices, to ensure closer communication about the patients we will be caring for. Within the community team there will be a community ward element that steps up the intensity of service if the patient becomes unwell and commission social care on a short term basis when it is required to support the patient at home. We recognise to provide effective services that support patients in the community we need to ensure we are able to deliver the right service with the right person, in the right place, at the right time. We believe that the Community Teams will give us the ability to meet this challenge. The purpose of this service re-design is to improve the outcomes we expect by;

• Reducing emergency hospital admissions and bed days

• Reducing NHS costs

• Improving patient experience

The model of care is represented:

Community

Ward

Community

Ward

Community

Ward

Multidisciplinary Community Wards meeting patients health & social care needs

Community

Ward

Community

Ward

Community

Ward

Acute

Care

Urgent Care

Clinical specialities

Community

Ward

Clevedon

Hosptial

LInks

GPs

GWAS

Social Care

Strategic

Partners

We have linked with the Nuffield Trust to support us in gathering of evidence we require to validate the outcomes. We will be evaluating these in a number of ways, for example;

• Prevention of Admission;

To establish the effectiveness of this intervention, patients admitted to a virtual ward will have to be compared with a control group containing patients of similar characteristics living in areas without a community ward. Both quantitative and qualitative information will be needed to provide a complete picture. This would include quantitative data such as;

• Number of patients referred

• Route of referral

• Admission decision (including referral/access to other services if not admitted to the ward)

• Location of admission (e.g. own home, nursing home)

• Patient demographics (age, sex, postcode, living arrangements)

• Patient conditions (primary and secondary diagnosis using ICD10 codes)

• Care provided (staff, procedures, medication, equipment)

• Average length of stay

• Discharge location

• Ward occupancy We will collate this data using information gathered from within our Electronic Patient Record (RiO) and also from the intelligence accessed through sources such as Dr. Foster or the Primary care data Resource (PCDR) tool, which identifies patients who are at risk of hospital admission. We will be collecting qualitative data such as;

• Patient acceptability and perceived benefits

• Professional acceptability and perceived benefits

• Opportunity costs

• Communication and team working

• Management & IT issues

• Level of awareness

• Effectiveness of referral processes

• Perceived under / overprovision of services

• Issues of equity

We will gather this information from a range of sources such as patients experience questionnaires, complaints and compliments, feedback from the Community Forum and by the development of focus groups as we implement evaluation. Our data will be used to provide monthly performance figures for the Commissioners and will be reported using our balanced scorecard. During 2011/2012 we will fully implement a capacity management tool which has been benchmarked on a snapshot audit in February 2011. We have used this information to further develop the model to take into account how unwell the patients are, and reflect this in the capacity of the community team to safely and effectively manage the care of the person in their own home. By implementing an organisational wide management system to our service delivery, we will ensure that patients will be seen when they need to be, by developing an organisation wide approach to service delivery, with professionals in the community teams providing support to other areas when that is required. By implementing this model across our community teams we will improve care for the patient, communication with the GP and Hospital and build on our links with our social care partners. Our vision is a health system working in partnership for the benefit of the patient and their community, as illustrated below;

CommunityUrgent

care

Elective

care

•Organising care around

care packages including

social care

•Clear entry to the system

•Clinical leadership and

operational management

built around patient journey

System

management

Vision of the Care System

Clevedon Community Hospital

We will be working throughout the next year on the development of a new community hospital. The illustrations above indicate the possibilities for the new build. The site chosen is where a supermarket was previously trading, and is ideally sited with excellent transport links for the community to be able to access the facility. The new hospital is planned to be completed in 2012 with 24 beds and access to a range of outpatient services and diagnostics as indicated below;

• Inpatients (24 single en-suite bedrooms)

• Minor Injuries Unit (MIU) open from 7am to 9pm,

• Outpatient (OP) Clinics

• Diagnostics (including x-ray and ultrasound scanning)

• Rehabilitation Therapies

• Resource Centre

• Out of Hours (OOH) GP service Some areas that will not be available in the new Community Hospital and these are highlighted below;

• No admissions will be accepted from emergency/blue light ambulances;

• No walk-in services users will be accepted apart from in the Minor Injuries Unit and Out of Hours

The Community Hospital will support an overall population of approximately 120,000 people covering the northern part of North Somerset. This includes the three main settlements of Portishead, Nailsea and Clevedon. The remainder are rural parishes and villages scattered within the area. There will be the opportunity to review the figures based on the potential change predicted in the population in North Somerset. The benefits of building a new hospital are highlighted in the table below.

2.2 Statements of Assurance relating to the quality of services provided Review of Services During 2010/11 North Somerset community services provided 25 NHS services. North Somerset Community Services has reviewed all the data available to them on the quality of care for all of these services. The income generated by the NHS services reviewed in 2010/11 represents 100% of the total income generated from the provision of NHS services by North Somerset Community Services for 2010/11. Data relating to performance for all services is collated and is used to populate a scorecard. The scorecard is presented on a regular basis to commissioners, the Community Services Committee and the Community Services Governance and Risk Committee. Using the scorecard approach managers and clinicians regularly review service related data and action plans can be proactively developed and implemented where areas of concern become apparent. Incident data is reviewed on a monthly basis by the Governance, Quality and Risk Group and the Community Services Committee any trends highlighted are investigated further. A total of 831 incidents were reported during 2010/11. 53% of these were patient related incidents. 42% of incidents reported were completed by the District Nursing Teams. An illustration of the reports we prepare for the board and staff is shown below;

Total Incidents received 2010/11 01.04.10 to 31.03.11

Staff related

Incident, 191

Trust related

Incident, 26

Incident related to

the Public, 3

Non Patient related

Incident, 169

Patient related

Incident, 442

Total Incidents received 2010/11 ( 01.04.10 to 31.03.11)

Other, 84

Treatment or

Procedure, 3

Security, 41

Access, Admission,

Transfer, Discharge,

88

Abusive, Violent,

Disruptive or Self

Harming Behaviour, 37

Accident that may

result in personal

injury, 109

Assessment, 5

Consent,

Confidentiality or

Communication, 24

Patient Information, 31

Infrastructure or

Resources, 122Medical Device, 33

Medication, 36

Implementation of Care

or Ongoing Monitoring

or Review, 218

We can further interpret the data to highlight where there are trends, areas of high reporting and produce reports tailored to specific services. This gives us the opportunity to further scrutinise areas and take all appropriate action. Quality Improvement Plan for 2011/2012 for Incidents We will continue to build on the learning from the use of a comprehensive reporting process. Our plans for 2011/2012 are;

• To introduce the online reporting, improving access for staff to further encourage ease of reporting incidents and provision of prompt feedback.

• To further develop the comprehensive training package for all staff, ensuring all are aware of the importance and value of incident reporting.

• To produce an integrated scorecard showing performance and incident data.

As we move into a Social Enterprise we will ensure data is reviewed by the Board of the new organisation. We are also planning to introduce quality reviews to support senior staff shadowing front line clinicians to gain knowledge and understanding of clinical concerns as issues. Participation in Clinical Audits During 2010/11 we have not participated in any national audits but have been involved in strategic audits such as:

- Pressure Ulcer - Stroke

We have been engaged with partners in a range of audits within our clinical teams. The information we have been collating and analysing link to a range of different areas, both in the direct delivery of services, but also highlighting the range of support for staff. These are highlighted in the section below.

Palliative Care Audit 11/11/10

This audit was carried out in response to the Marie Curie Delivering Choice initiative which is currently being undertaken in North Somerset and Somerset. The aim of this initiative is to enable the provision of the support, expertise and information to allow the individual to die peacefully in the place of their choice. In order to achieve the most effective way to deliver care, a coordination centre was planned to be developed in the autumn of 2010. An initial audit was required to benchmark the time spent in direct patient care for those on the palliative pathway. A snapshot audit was carried out on any one day during the week commencing 26th April 2010, and completed by all 13 community nurse teams (including the Community Matrons) in North Somerset PCT. The aim of the snapshot was to have a feel for the amount of time and the proportion of the working day community nurses currently spend responding to the needs of palliative patients and the impact of end of life care on the teams.

ENTIR

E 7

ENTIR

E 6

ENTIR

E 5

SOUTH

7

SOUTH

6

SOUTH

5

NORTH

7

NORTH

6

NORTH

5

TIME DIRECT CARE

TRAVEL ENTIRE PCT

CO-ORDINATION OF CARE ENTIRE PCT

70

225

9590

0 0

300

0 0

747

0 0

315

00

432

00

415480

725

335

0

265

80

480460

0

100

200

300

400

500

600

700

800

MINUTES

CLINICAL EFFECTIVENESS AUDIT

TIME DIRECT CARE TRAVEL ENTIRE PCT CO-ORDINATION OF CARE ENTIRE PCT

This has been further broken down into the different nurse roles to evidence who would be more involved in the delivery of palliative care in the community; Time spent on direct care by nursing teams In total, 1620 minutes were spent in End of life care Band 7 – Community Matrons spent a total of 415 minutes on direct care – 25% of the total Band 6 – District Nursing Sisters spent a total of 480 minutes – 30% of the total Band 5 – Community Nurses spent a total of 725 minutes – 45% of the total

Quality Improvement Plan for 2011/2012 The Marie Curie delivering choice programme will be evaluated in 2011/2012. As part of the evaluation, this audit will be completed using the same methodology. We will then be able to evidence the effect on the clinical services from the development of the end of life coordination centre. There have been no national confidential enquiries relevant to North Somerset Community Services during this period. Our plan for 2011/12 is to identify and arrange participation in relevant national clinical audits to benchmark the quality of our clinical services and we will also ensure participation in National Confidential Enquiries. Over the next twelve months we will be reviewing how we will be able to participate in national audits for conditions our staff manage. For example;

• Childhood epilepsy

• Diabetes in children and adults

• Chronic Obstructive Pulmonary Disease

• Falls and non-hip fractures

• Hip fracture. Reviewing reports of Local Clinical Audits Local clinical audits relating to records and documentation and patient experience are completed as mandatory each year. During 2010/11 all services completed these audits and they were reviewed by Commissioners at contract meetings on a quarterly basis. The service managers and clinicians review the audit results to ensure action plans are fed into their annual work plan. In 2011/12 we will implement additional local service specific audits to further evidence the quality of the services provided. Clinicians and Services Leads have highlighted the following topics as preferred audit subjects: 1. Decontamination Audit for Clevedon Community Hospital 2. Single Sex Accommodation 3. Audit of Complaints and Compliments

Research Participation in clinical research Getting Out of the House National Research Project The number of patients receiving NHS Services provided by North Somerset Community Services in 2010/11 that were recruited during that period to participate in research approved by a research ethics committee was 19. The Occupational therapy service is participating in a Multi-Centre Randomised Control Trial of rehabilitation aimed at improving outdoor mobility for people after stroke. The Getting Out of the House Study is being led by the University of Nottingham and funded by a research grant provided by The National Institute of Health Research. BACKGROUND TO THE STUDY Getting out of the house after a stroke is important for various reasons but many people cannot get out of the house as much as they would like. It is not just about improving physical mobility but improving confidence, motivation and self-belief. A pilot study was carried out in Nottingham in 2005 where 176 stroke survivors were recruited and provided with verbal and written information about local transport and mobility issues. Half the people then received the targeted outdoor mobility therapy. The study showed that the therapy had a positive effect on getting out of the house. However for the therapy to become routine clinical care across the country the study has to be scaled up using several different areas and several different therapists. There are now 15 sites across the country and will include 506 people who want to get out of the house more often.

Priorities agreed with Commissioners

In 2010/2011 North Somerset Community Services met all the quality priorities required by NHS North Somerset. A proportion of our income in 2010/11 was conditional on achieving quality improvement and innovation goals (CQUIN) agreed between North Somerset Community Services and NHS North Somerset. This was included in the contract for the provision of NHS services through their Commissioning for Quality and Innovation Framework.

CQUIN Performance RAG Rating

100% of patients are VTE risk assessment using the national tool

100% Green

100% of patients who are identified as requiring appropriate VTE prophylaxis receive it

100% Green

Improve responsiveness to the personal needs of patients – five set questions were asked on the survey and the responses will set a baseline for comparison measurement during 2001/12

100% of services asked patients these questions 100% of services completed a patient survey

Green

Clevedon Hospital – measure number of pressure ulcers – grade 2 and above acquired whilst on caseload and report via incident reporting

Achieved Green

CQUIN Performance RAG Rating

District Nursing – measure number of pressure ulcers – grade 2 and above acquired whilst on caseload and report via incident reporting

Achieved Green

‘Recruit’ and train an agreed number of designated service champions to improve the care for people with dementia

Achieved Green

Undertaking of agreed championing activities to agreed specifications and timescales

Achieved Green

In 2011/2012, we will continue to work with our staff to ensure that the targets we have agreed within our contract will be achieved. Performance against national requirements Within our contract for 2010/2011, we were required to deliver safe and effective services that also met national requirements for the community services. We have achieved an excellent level meeting these targets and will continue to ensure we remain focused on the provision of services that continue to meet these requirements.

1.1.1 Methicillin-resistant Staphylococcus Aureus (MRSA) - Number of acquired Infections (Bacteraemia)

Target Performance RAG Rating

Number of MRSA Bacteraemia Acquired Infections

0 Green

1.1.2 Rates of Clostridium Difficile (Cdiff)


Number of Cdiff Acquired Infections 2 Green

1.1.3 Breaches of Mixed Sex Accommodation in line with Delivering Single Sex Accommodation


No single sex accommodation breaches 0 Green

1.1.4 Referral to Treatment – Patients seen within 18 weeks for non-admitted pathways


For patient referred for specialist physiotherapy - 95% in 8 weeks (except where assessment cannot be completed during this time due to patient choice or where patients require investigations e.g. MRI, Nerve Conduction study)

99% Green

For patients referred for non-specialist physiotherapy – 95% of percentage of patients seen within 13 weeks

100% Green

1.1.5 Supporting Measures – Number of Diagnostic Waits >6 weeks


100% of patients seen within 6 weeks 100% Green

1.1.6 < 4 hour wait in A&E (Minor Injury Unit)


98% of patients seen within 4 hours 100% Green

Performance against our contract The Community Contract contained 106 Key Performance Indicators (KPI’s) with targets set against them and 104 Key Performance Indicators which were benchmarked to provide information for target setting for 2011/12.

Number of Targeted KPI’s

Number of Targeted KPI’s Achieved

Number of Targeted KPI’s Not Achieved

% of KPI’s Achieved Overall

106 82* 23* 77%

*awaiting confirmation of the final outturn for expenditure on wound care

Only two KPIs were not fully completed:

• Community Occupational Therapy 95% urgent patients seen within10 days of referral target ( relating to staffing shortages in the team – this is now resolved and in Quarter 4 the service is now achieving the KPI)

• Community Physiotherapy non face to face contact target (see below). For 2011/2012, we have worked closely with our commissioners to review the performance and the indicators that were used last year. We have developed our learning to ensure we are able to agree targets that are achievable, and focus on the delivery of effective clinical care for patients. An example of the application of this is that the non face to face contact target has been removed from the performance framework for community physiotherapy, as it was recognised that the service is most effective when seeing patients face to face. Patient environment action team (PEAT) As required by the Community Contract we completed an assessment led by PEAT. The result this year shows an improved outcome following action plans instigated after the review in 2009/2010. This year our scores were:

Site Name Environment

Score Food Score

Privacy & Dignity Score

Clevedon Hospital Good Good Good

Last year our scores were:

Site Name Environment

Score Food Score

Privacy & Dignity Score

Clevedon Hospital Good Excellent Acceptable

We are delighted with the improved score on privacy and dignity. The food score has between ‘good’ and ‘excellent’ in the last few years and will be reviewed again based on the information from last year to see where we may improve. The hospital manager will continue to monitor quality to maintain high standards and ensure further improvement.

What others say Regulation with the Care Quality Commission

The provider arm of NHS North Somerset has “full registration status without conditions” with the Care Quality Commission. It is registered to provide three regulated activities – Treatment of disease, disorder or injury Diagnostic and screening procedures. Nursing care. These are in two registered locations – Clevedon Hospital and East End Court (provider services HQ).

There have been no enforcement measures carried out by the CQC in the last year.

NHS North Somerset Community Services has not participated in any special reviews or investigations by the Care Quality Commission during this reporting period.

Quality and Risk profile

“The quality and risk profile tool produced by the Care Quality Commission gathers together key information about the organisation. It enables the CQC compliance inspector to assess where any risks may lie in relation to the regulated activities the Trust carries out”.

CQC staff survey

Staff Survey 2010 - Community Services Highlights The findings of the NHS Staff Survey 2010 have been structured around the four pledges in the NHS Staff Constitution which was published in January 2009 plus two additional themes. The response rate was 60% and the findings were structured around 38 key findings. Staff Pledge 1 – To provide all staff with clear roles, responsibilities and rewarding jobs 33% of community services staff reporting that they were dissatisfied with the quality of work and patient care they are able to deliver and was a theme that was reported in the previous two years’ surveys. Health visitors, in particular were a group who reported negatively to this finding with 76% reporting dissatisfaction in this area and was significantly above the Trust average of 65%. It is anticipated that staff’s perception around the quality of work and patient care will improve with the introduction of community wards and the increased funding for the SPHN service. 92% of Health Visitors, 89% of Community Nurses and 76% AHPs are still reporting that they are working additional hours compared with the Trust average of 65% and managers need to be proactive about monitoring this situation via day to day supervision and 1:1s and being alert to situations where working additional hours could lead to sickness absence.

Staff Pledge 2 – to provide all staff with personal development, access to appropriate jobs and line management support to succeed. There is a marked improvement in the number of completed staff appraisals with 82% of community services staff reporting that they had received an appraisal in the last 12 months. 71% of staff reporting that they had already received job relevant training identified in the appraisal with 29% saying it was too early to say. Staff Pledge 3 – To provide support and opportunities for staff to maintain their health, well-being and safety. The areas of work related injury and work related stress were highlighted as areas for improvement and the results remain unchanged from last year. 24% of staff working at Clevedon Hospital, 25% of District Nurses and 24% of Specialist Public Health Nursing reported that they are suffered work related injury compared with a Trust average of 13%. The reported incidents of injury accidents do not support the findings of the survey and indicate an under-reporting of injury incidents/accidents. The Community Groups reporting that they had suffered from work related stress above the Trust average of 32% were District Nursing (35%), Specialist Public Health Nursing (39%) and Specialist Services (38%). The Health and Safety Manager has offered further stress management training and the Associate Director of Organisational Change is running two “Happiness” workshops. The Improving Working Lives Group has financially sponsored Mindfulness Sessions and more recently a number of Pilates sessions, both of which have been well supported. A new policy reference document entitled Health and Well-being has been introduced signposting staff to relevant policies and help. In October 2010, an Employee Assistance Scheme was launched to offer timely, quality counselling sessions as well as an interactive website to help staff manage life’s planned and unplanned events. It is anticipated that staff will benefit from the scheme during the forthcoming organisational changes. Staff Pledge 4 – To engage staff in decisions that affect them, the services they provide and empower them to put forward ways to deliver better and safer services This area was not so strongly reported on in community services as it was in Commissioning. 53% of Community staff agreed that they were consulted about changes that affect them. 20% neither agreed nor disagreed and 27% disagreed or strongly disagreed. 50% of staff agreed that senior managers encourage staff to suggest new ideas for improving services with 30% neither agreed nor disagreed and 20% disagreed or strongly disagreed. This result probably reflects the organisational changes that community services staff are experiencing. Additional Theme – Staff Satisfaction 19% of Community staff reported an intention to look for a new job in a different organisation in the next 12 months although, in this period of national and organisation change, this result is not unexpected. This result was better than Commissioning (27%). Additional Theme – Equality and Diversity 58% of Community staff reporting receiving Equality and Diversity Training (Trust average 63% and National average 48%) although 11% of Community staff reported experiencing bullying, harassment or abuse from a manager or colleague which is an average result across PCTs nationally.

Data quality Secondary Uses Service Due to the historical organisational relationship, North Bristol Trust submits records on behalf of North Somerset Community Services to the Secondary Uses Service. The data is included in the hospital episode statistics in the latest published data. The percentage of records in the published data which included the patient’s valid NHS number was:

100% for admitted patient

100% for out patient care

89% for the Minor Injuries Unit (MIU) - for the 11% where this was not recorded the identifier on the electronic record was.

The percentage of records in the published data which included the patient’s valid General Medical Practice Code was:

100% for admitted patient care

100% for out patient care

100% for Minor Injuries Unit Information Governance Toolkit attainment levels North Somerset Community Services Information Governance Assessment Report score overall score for 2010/11 was 77%. The following statement was submitted for Community services by the Information Governance team in North Somerset.

In 2010, NHS North Somerset undertook and completed its annual assessment that enabled it to assure Connecting for Health that it was meeting the requirements as set out in the following workstreams, that allowed it to safeguard information:

• Information Governance Management

• Confidentiality and Data Protection Assurance

• Information Security Assurance

• Clinical Information Assurance

• Secondary Use Assurance

• Corporate Information Assurance The organisation submitted a score of 77% in the above standards, which enabled it to fully comply with the required levels. The scoring process was between 0 and 3, with Connecting for Health stating that the minimum required standard is a level 2. NHS North Somerset achieved this across the board. Due to the expansive review to the requirements undertaken by Connecting for Health, comparison with last year’s score would not reflect the improvements made by NHS North Somerset during the assessment timeframe.

Clinical coding error rate North Somerset Community Services was not subject to the payment by results clinical coding audit during 2010/11 by the Audit Commission.

Part Three

Review of our Quality Performance in 2010/2011 This is a review of North Somerset Community Services performance over the past year. The information relates to community nursing and therapies, Learning Disabilities, Children and Young People’s Services, and Clevedon Community Hospital. We have worked with staff and users to agree our Mission and Values;

Mission Statement We aim to provide first class health care services within the community, delivering effective outcomes with people through collaboration education and innovation. Values We value and respect people We act honestly and fairly We listen and learn We support and develop our staff We work hard to continually deliver quality and value for money

In 2010/2011 our key objectives were;

� To improve quality and the patients experience � To ensure our workforce are the best they can be to deliver effective community

services � To meet our contractual obligations

To highlight the quality of service provided within that framework, we have linked them to the key headings of patient experience, patient safety and clinical effectiveness.

“I have my confidence again. (Home Oxygen Patient)

3.1 Patient Experience

3.1.1 Dignity in Care As a result of a national audit, a Dignity in Care Group was established by Community Services. They have developed some key principles to ensure that all professionals delivering care are aware of their role and commitment to ensure that all service users are treated with the dignity that they would expect. Our policy states that it is our intention to ensure dignity in care is extended to all adults receiving health and social care services irrespective of the setting and service provided, thereby including all vulnerable and hard to reach groups. The ten point dignity challenge we have adopted is a clear statement of what people can expect from a service that respects dignity. In North Somerset we aspire to all those providing care to adopt that challenge as individual organisations and as partners in the local health and social care community. Ten point dignity challenge

Zero tolerance of all forms of abuse

Support people with the same respect you would want for yourself or a member of your family

Treat each person as an individual by offering a personalised service

Enable people to maintain the maximum possible level of independence, choice and control

Listen and support people to express their needs and wants

Respect people’s right to privacy

Ensure people feel able to complain without fear of retribution

Engage with family members and care givers as care partners

Assist people to maintain confidence and a positive self esteem

Act to alleviate people’s loneliness and isolation

Each service has nominated a champion within the team, and it is their responsibility to ensure information is effectively cascaded. Service managers will review the data presented from complaints and patient experience audits to monitor any areas that may require action, or investigation. Quality Improvement Plan for 2011/2012 We will further develop the initial work the group has completed. For example;

• We will be developing a People Strategy within the organisation ensuring that services are able to access data reflecting patient experience.

• We will build on the learning from the existing clinical champions

• We will work closely with the Community Forum to learn more about the views of the local community.

Over the last year we have introduced the End of Life Coordination Centre in partnership with Marie Curie. For people who are coming to the end of their lives, the team ensures there is a care plan in place, equipment is ordered as soon as required and arranges overnight care to support the carers and patient. We have been able to more effectively manage services to support people to die in the place of their choice.

To date there has been a 10% reduction in deaths in hospital

3.2.2 Recording patient experience During 2010/11 all 25 Community Services teams completed a Patient Satisfaction Audit. Following the development of the audit programme, each service was allocated a 3 month period in which to ask their patients/services users what they thought of the service provided by our staff. This audit formed part of the mandatory audit programme and contained 4 questions relevant to all services which relate directly to the delivery of the Contract held with NHS North Somerset and service leads were asked to select additional service related questions from a pre written list. Questionnaires were sent to a minimum of 25% of the case load at the time of the audit and the results were to be displayed as a report. A total of 3059 questionnaires were sent out to patients who had been seen in our services. Of those, 1143 were returned, giving a response rate of 37%.

These reports were reviewed by the Lead Commissioners for each service and feedback given. The results for all services have been collated below, with the totals reflecting the percentage number of ‘yes’ replies we recorded.

Q1 Did you feel involved in decisions about your treatment or care?

Q2 If you had worries or fears, was a member of staff available to you to discuss them?

Q3 Was there sufficient privacy when you were being examined or treated?

Q4 Were you or your family given information about who to contact if you were worried about your condition or treatment?

Quality improvement plan for 2011/2012 The mandatory patient experience audit programme will run in the same way as 2010/11, with the addition of 4 new services:

� Community Wards –Tyntesfield, Weston North � End of Life Care � Continuing Health Care � Single Point of Access

The number of questions to be asked has reduced to a maximum of 15, to include 8 mandatory questions. The reason for this change is because last year it was felt the questionnaires were too long, some included up to 30 questions. It is anticipated that this change will also improve the return rate. Some changes to the wording of the questions will take place in order to include our learning disabilities clients.

“ Thank you for the help you have given me and my family. (DARRT Patient) 3.2.3 Customer services Information on complaints and compliments received about Community Services has been collated by the Patient Advice and Liaison Service (PALS) provided by NHS North Somerset, and within the internal audit structure. Complaints We receive information on a complaint with a timeline in which we will have to respond to the complainant, and whether we are the lead or have provided part of the service related to the complaint. For example, a service user or their carer may have concerns about all services that have been involved in the care, not just Community Services.

Once concerns about the quality of treatment provided are received, the service involved is required to make a response made to the complainant within an agreed timeframe. There is an internal review looking at the issues that are raised and any potential services changes that are highlighted as a result. The service managers are required to produce an action plan with a timeline for implementation, and an agreed date for a further reflection and learning from any new practices that have been developed. The information on complaints is reported on a monthly basis by service and is presented on a Community Services dashboard to the contract and performance meeting and the Community Services Committee.

We received a total of 15 complaints across all the services we provide. Compliments We collate the compliments we receive within the organisation. The information on compliments is reported on a monthly basis by service and is also included on the dashboard. The compliments we received by category are illustrated below.

We received a total of 184 compliments for our services in 2010/2011.

Quality Improvement Plan 2011/2012 In 2011/2012 we will be developing and implementing a People’s Strategy which will;

• Develop and implement a complaints and compliments process within our own organisation, with a clear performance framework

• Ensure complaints and compliments are collated and shared across the operational services

• Share action plans developed as a result of a complaint across all services, ensuring learning is cascaded and captured.

3.2.4 Eliminating mixed sex accommodation. We have successfully maintained single sex accommodation throughout the last year. We have also completed the necessary compliance to ensure that we have confirmed our continuing commitment to this target. This is available on the NHS North Somerset website (www.northsomerset.nhs.uk) but is also reproduced below;

A patient information leaflet was required by the Community Matrons to tell patients what they could expect from the service. In order to make the information accessible, they asked for support from their patients. The resulting document was developed and written by one of those patients, and read many more. The feedback from use in the community has been extremely positive. Below is an extract;

“Matrons will make sure you understand how your medicines help you and can prescribe or arrange new medicines if needed. In addition, they will make sure your views are listened to and that your care is designed around your needs. That way you can be confident that you are in control of your health and care”

North Somerset Provider Services is pleased to confirm that we are compliant with the Government’s requirement to eliminate mixed-sex accommodation, except when it is in the patient’s overall best interest, or reflects their personal choice. We have the necessary facilities, resources and culture to ensure that patients who are admitted to our hospital will only share the room where they sleep with members of the same sex, and same-sex toilets and bathrooms will be close to their bed area. Sharing with members of the opposite sex will only happen when

• Clinically necessary; for example where patients need a safe haven bed to prevent admission to an acute hospital; whilst this is highly improbable we would not turn away patients in need of our services but make special arrangements for interim provision.

• Patients actively choose to share; for instance a mixed sex couple wishing to share a double room.

Quality Improvement Plan 2011/2012 We will continue to deliver the service as we have committed to do so in the above compliance. Any failure to meet these requirements will be reported immediately to the commissioners and Board.

3.2 Patient safety Throughout the year we have focused on key work streams where we recognise there is a need to develop our understanding in order to improve the quality of the services that we provide. We have involved key clinicians, working together to share knowledge and experience in these different areas. 3.2.1 Management of Pressure Ulcers The management of pressure ulcers is an area we have concentrated on in the last year. The purpose of this scrutiny is to promote the safe management of patients in the community. Definition: a) Number of pressure ulcers inherited from acute care and seen at Clevedon Community Hospital and by community nursing services

b) Number of pressure ulcers acquired whilst being seen by community nursing services

Data Source: A Point prevalence snapshot audit of pressure ulcers managed by the

District Nursing Service (DNS) which took place on May 24th 2010. This audit has highlighted that within the District Nursing Service 91 patients were being treated with pressure ulcers on that day resulting in a prevalence of 5% of the total caseload numbers.

Before admission to DNS caseload - 60 – 66% (24% from Acute Care) After admission to DN caseload - 31 – 34% Rationale: National prevalence is unclear as methods of collecting data vary greatly,

however Narzarko (2005) suggest that prevalence ranges between 5% and 32% across different settings.

NHS South West has agreed the need to triangulate several of its existing safety and quality governance processes (including performance, finance, patient safety and workforce) to strengthen the assurance of providers operating plans in relation to workforce change and patient safety NHS North Somerset Community Services has been selected to test the 10 self-evaluation questions in order to determine whether or not they provide a useful basis to undertake a self evaluation and resultant action plan to compliment the Trust’s existing governance arrangements. This approach will be rolled out to other Trusts once feedback has been received.

Progress: The number of pressure ulcers inherited from acute care showed a 10% reduction from the prevalence audit carried out previously in Jan 2010. There was a 2% increase in the number acquired on the caseload. This led to a more qualitative audit being undertaken in October 10 looking at the assessment process and care planned. An action plan has been formulated using the information obtained from both these audits.

During 2011/2012, we will be implementing the learning from the action plan to reduce the incident of pressure ulcers acquired on our caseloads.

Following the engagement with this workstream, a group of clinicians entered the NHS South West Leadership Challenge. Their entry was presenting a tool to ensure community staff are able to fully assess for any of the risk factors leading to development of a pressure sore; This is shown below; Pressure needs PROMPT action

R – Red? Report / Refer it O – Oral Intake – adequate? M – Moisture Levels - P – Posture – manage it T – TAKE THE PRESSURE OFF

Managing the Deteriorating Patient It is important to be able to identify early those patients who may be at risk of becoming more unwell and therefore require extra support. Over the last year, we have implemented a number of different systems within our community hospital to change the care of patients as soon as it is required. Definition: Number of patients who are assessed using the early warnings system in Clevedon Community Hospital. Data Source: As from Monday 11th April 2011, all patients are now assessed using the Community Services Early Warning System (EWS). This has been developed from the experience of local hospitals and forms part of the observation chart. To date 15 patients have been managed using the system. Rationale: The EWS has been implemented as part of the safer patient initiative; the aim of this programme is to detect any changes in the patient’s vital signs and to act upon the changes. Progress: Although still in the early stages of the programme, initial signs are positive, Staff have engaged fully with the new charts and are encouraged and empowered by the support offered by using EWS.

Infection Control As part of our performance targets we monitor closely the infection rates at our community hospital. This information is highlighted below. Definition: Number of recorded cases of MRSA and C.diff inherited from or acquired in Clevedon Community Hospital. Data Source: This data is collected on a monthly basis as part of our agreed data capture for the commissioners. All patients admitted to CCH are routinely screened for MRSA. There have been no incidences of acquired or imported bacteraemias throughout the year. However, Clevedon Community Hospital had one case of acquired C-Diff and no cases of acquired MRSA. There were 13 confirmed cases of imported MRSA. Rationale: The reason for such low rates of acquired infections is down to the diligence of the staff and the leadership of the senior team. Regular auditing of IC compliance is performed routinely. Progress: Infection prevention and control is taken very seriously at CCH, as the low rates of infections prove. We are not complacent and are always striving to improve. We have CQUINS targets to reach which we are confident we can achieve.

Safeguarding our patients In order to support fully the patients and service users, we maintain a process of training and development in the key areas of safeguarding adults and children Safe guarding Adults Definition: Ensure that effective systems are in place and that staff are appropriately trained and supported to safe guard and promote the welfare of vulnerable adults. Data Source: Training needs analysis using MLE and CPD in line. The local authority provides the training and collects the data which is reported on quarterly. Rationale: To ensure that staff are competent and capable to assess and deliver services and to raise awareness and minimise the risk of abuse taking place. Progress: The new training contract commissioned form the local authority has recently been redesigned. E Learning is available to all new starters and as a refresher course. Level 1 For all non clinical and clinical staff every 3 years. Clinical staff have to do a refresher E learning course annually. Level 2 is for staff that undertakes investigations. Train the Trainer course is for staff that will be delivering training. Update sessions to inform staff of lessons learnt at serious case reviews. Team supervision sessions to discuss cases and any new developments.

Safeguarding Children Definition: Ensure that effective systems are in place and that staff are appropriately trained and supported to satisfy their statutory requirement relating to Section 11 (Children Act 2004) to safeguard and promote the welfare of children. Data Source: Training needs analysis across organisation using MLE and CPD online (Local Authority training tracking system). Rationale: To ensure that staff were commensurate and compliant with safeguarding children competencies in line with Working Together to Safeguard Children (2010) and the Intercollegiate Document (2010). Progress: Level One: the requirement for compliance with this level is that all staff will complete the e-learning package within 6 weeks of employment. This needs to be refreshed every 3 years. Current levels indicate that 80% of staff have completed this training within the required time frame. Data is tracked via MLE (Managed Learning Environment).

Level Two: This was highlighted as an area for review. An intensive package of training has been put in place. Those staff at Band 6 and above within clinical adult led services have been targeted for this level of training. Currently 61% of this group have attended. Training will now be available on a rolling programme. Data is logged onto MLE with an expectation that the training will be refreshed every three years. Level Three: this applies to all staff who work directly with children and families. Data obtained indicates that 100% of staff have accessed this level of training or specialist training e.g. domestic abuse, substance misuse within the past three years. Work is ongoing to maintain and improve these levels. Additional work is planned to ensure that staff working with children are kept updated at least yearly via professional forums.

Falls at Clevedon Community Hospital It is important that we understand fully what may be the causes of falls in our community hospital. We have instigated a full process reviewing where and when a fall happens, and how we introduce changes to improve safety of the patient in our care. Definition: Number of falls reported within Clevedon Community Hospital. Thematic analysis of falls incident forms from April 2010 to March 2011. Thirty five incident reports were collected during they year, all the incident reports are directly related to patients falls. The break down of geographical areas are as follows (Chart 1).

Geographical areas - falls (chart 1)

27

6

1 1

0

5

10

15

20

25

30

Ward Bathroom Corridor Dayroom

Area

The year’s falls have been analysed including, what day of the week the falls occurred (Chart 2). Thursdays, Fridays and Saturdays were the days when most falls occurred, totalling 8 per day.

Falls per day of the week (chart 2)

0

2

4

6

8

10S

unda

y

Monda

y

Tuesd

ay

Wednesda

y

Thurs

day

Frida

y

Satu

rda

y

The analysis of falls per month is detailed below (Chart 3).

Falls per month (chart 3)

0

1

2

3

4

5

6

7

Apr-

10

May-1

0

Jun-1

0

Jul-10

Aug-1

0

Sep-1

0

Oct-

10

Nov-1

0

Dec-1

0

Jan-1

1

Feb-1

1

Mar-

11

Clevedon Community Hospital (CCH) admitted 224 patients (GP, Rehabilitation, Safe Haven and day cases) last year, a total of 35 incidents were recorded, which equates to 15.6% of the patients had one or more incident forms submitted. It is notable, that last year we had at least one patient, who fell on a number of occasions, this patient’s falls contributes significantly to the 15.6%. Staff at CCH work hard to reduce the number of patients falling, however, as we provide a rehabilitation service there will invertible be a small number of patients who fall.

Our aim next year is to reduce the number of falls and we intend to do this by:-

• Introducing a multidisciplinary falls assessment

• Identifying and managing patient who are deemed at risk of falling (via falls assessment)

• Continuing to ensure environmental falls hazards are minimized, i.e. de-cluttering wards and generally keeping the hospital tidy

• Working in partnership with experts, i.e. Consultant, GP’s, therapists and nurses

• Quality Improvement and Service Plan, this is a regional plan working in conjunction with the Institute Of Health and Innovation (IHI) to formulate a specific work stream to assess and manage falls with in CCH. The plan is to use PDSA cycles to trial a full falls assessment as against a PACT falls assessment to determine the most appropriate for CCH. Consider the colour coding of walking aids with a RAG/Name tag to determine level of support required to mobilise. Also considering use of Intentional Rounding for patients most at risk, this is a checklist carried out by staff at timed intervals to reduce key risks to falling. Also maintain links with QPSIP Falls team to share knowledge and progress via conference calls.

South West Hospitals Standards in Dementia Care audit implementing work. This audit will help assess and eliminate falls risks for dementia patients, i.e. shadows, poor lighting, good visible signage etc.

3.3 Clinical effectiveness Within our organisation we have a service improvement team, working with clinicians to improve the services they provide for the benefits of patients. We are committed to the provision of services with quality as its organising principle through a period of expected significant financial challenge. A number of initiatives have taken place during 2010/2011 which will be built on and further developed during 2011/2012.

3.3.1 Productive Community Services

“Thank you for the wonderful service I have received since leaving

hospital (Clevedon Community Team Patient)

Productive Community Services (PCS) is part of the NHS Institute productive programme. It puts staff at the forefront of redesigning services with the aims of:

• Increasing patient facing time

• Reducing waste

• Reduce inefficient work practices

• Improve the quality and safety of care

PCS was launched in March 2010 with the following services:

• Rapid Response & Rehabilitation

• Bladder & Bowel Service

• Occupational Therapy

• District Nursing Portishead

• District Nursing Weston

• District Nursing Worle

• The Musculo-skeletal Interface and physiotherapy service Initially services concentrated on the working environment to ensure it contributes positively to the care delivered, as opposed to hindering it, making things easy to find, understand, use and manage consistently. As a result of PCS a number of improvements were realised including:

• Reduction in expenditure on stock & equipment - using a systematic approach to reorganise store cupboards, nursing bags and stock carried in staff cars

• Standardised “grab bags” introduced in Rapid Response & Rehab team ensuring that staff are able to quickly access all the equipment required when seeing a patient in their own home

• Using lean problem solving approach the Bladder & Bowel service implemented a number of actions to reduce the Did Not Attend rates in the service from 30% in April 2010 to below 10% by March 2011

• Administration processes were streamlined across the musculoskeletal physiotherapy and triage service, improving cross cover and reducing admin costs.

• Standardised bags introduced within District Nursing team to ensure all staff are able to access what they will need when caring for a patient in their own home.

Plan for 2011/2012 Due to the introduction of Community Wards the PCS programme has been relaunched with the focus on Community Wards to ensure that effective and efficient working practices are in place.

3.3.2 Education & Training

� Training in Lean Principles During 2009/10 fourteen staff within NHS North Somerset Community Services attended Lean Practitioner training. A further 10 staff attended Lean Awareness training. The aim of the training is to equip staff with the knowledge and skills to carry out quality and service improvements within their own services and for staff to recognise the importance of making every intervention and action count, to get the best for patients and the best for the cost of each intervention. This encourages staff to really consider how to get value from their time and the systems they use to improve patient outcomes. A number of service improvements were made following the Lean Practitioner training including streamlining the Essence of Care processes, streamlining performance reporting process. The knowledge and skills gained during 2010/11 will be built on and developed this year through our Productivity & Efficiency programme.

� Project Management A total of fourteen staff attended Essentials of Project Management training in 2010/11to equip with the knowledge and skills to apply project management principles to service improvement and change management within their own services.

� Organising for Quality During 2010/11 6 staff are participating in the NHS Institute Organising for Quality programme. The emphasis of the programme is to develop knowledge and skills around quality and service improvements and will enable staff to demonstrate the outcome of our interventions and services. We will do this by measurement for improvement, linked with other measures such as clinical audit, clinical governance to improve services and demonstrate our outcomes. As part of the course staff are carrying out small projects within their area which have included;

• Use of Safe Haven beds

• Reviewing caseloads

• Response times

• Single point of access

Plan for 2011/2012

• We will continuing to embed the Productive Community services programme across all teams, ensuring we are able to evidence the efficiency of our services and improved quality.

• We will be assessing the outputs of the quality programme and cascading the learning.

3.3.3 Service Improvements

A number of service improvements have taken place during 2010/11. Examples of these are shown below.

• Introduction of centralised system for ordering on-line wound care products During 2009/10 a centralised on-line system for ordering wound care products was rolled out across community services. Alongside this a wound care formulary was introduced to ensure wound care was standardised across community services and products used were evidence based and cost-effective. A wound care formulary was also introduced across nursing and residential homes. During 2011/12 we are planning to roll the centralised system for ordering on-line wound care products. 3.3.4 Care Homes Training Programme In conjunction with the University of the West of England a number of our staff and services have been involved in an on-going training programme for care home and residential staff. Our staff have delivered sessions on a variety of topics including wound care, managing long term conditions and services available within the community to support care and residential home staff managing residents. Our staff have also visited care homes with a large number of hospital admissions to offer the home support, advice and signposting to services to prevent hospital admission.

Quality Improvement Plans for 2011/2012 Productivity & Efficiency Programme We are introducing a Productivity & Efficiency programme to pull together a number of quality and service improvement workstreams. Examples of these include:

• System redesign & flexible working

• Information quality & mobile working solutions

• Training & development

• Capacity management Each workstream will have a project lead and clinical lead and a project plan detailing key workstreams and milestones. We are planning to work with services to achieve the aims of each workstream and to develop staff skills in service and quality improvements. By doing so will help to achieve a culture of continuous quality and service improvement across the organisation.

“This has been an excellent service and a great help to my comfort.

(Lymphoedema Service user) 3.3.5 Improving outcomes for patients with lower limb pressure ulcers The close working relationship between the podiatry service and the tissue viability specialist has led to the introduction of a new service, and an enhancement to the existing podiatry service. We are now offering a treatment option called Versajet, a non-invasive process that will remove infected material from the ulcer, promoting healing and repair. This is available for patients for whom the standard conservative treatment options have not been effective. The podiatry team have also developed skills in providing soft casts for patients with heel ulcers. This will reduce the pressure on the area, by applying a cast that is made to measure for the patients and is adaptable to their needs.

“ I have been in excruciating pain for over a year….now I can walk a

little way with no pain” (Podiatry Patient)

Improved Access to clinical services Definition: Improved access to all services via Single Point of Access (SPA). Data Source: Numbers of Professionals referring to Community Nursing & Community Occupational Therapy through the Single Point of Access (an integrated service with Local Authority). Rationale: The purpose of the Single Point of Access (SPA) is to provide improved access to adult health and social care community services. The establishment of a Single Point of Access including the co-location of multi-disciplinary health and social care teams enables it to play a key role in providing an integrated community care model. The objectives of the SPA are as follows:

• To improve access to services for both professionals and the public

• To promote early recognition and resolution of service needs

• To maximise the % of skilled Professional resource available for complex cases

• To enable information to be collected once, in line with the agenda for single assessment

• To minimise unnecessary administration by community services professional staff

• To maximise use of technology and electronic referral and case management systems, rather than paper

Progress: All referrals for Community Nursing and Occupational Therapy in the South of the region are coming via SPA. This allows for a number of cases to be closed within SPA, without having to be referred on to the Community Teams. We are introducing physiotherapists to the team following the success of the occupational therapists so referrals for this service can come via SPA.

“ I have been feeling very much on my own with my problem, it’s nice to know of someone I can contact and talk. (Home Oxygen Patient)

Healthcare for All A very successful stakeholder event was arranged by the Learning Disability team that was used as a forum for reviewing our progress against the standards required for Healthcare for All. This was the third self assessment and involved service users, carers, stakeholders and staff. This showed what a significant improvement has been made to supporting people’s health since the first self assessment two years ago, with most measures now being scored green (compared with the majority being red two years ago) This includes better identification of people with learning disabilities by GP’s with the majority of practices now providing an annual health check. There is better access to healthcare which is more responsive to meet people’s individual needs.

3.4 Additional Quality Improvements in North Somerset 3.4.1 North Somerset Community Partnership As a result of the Government NHS White Paper ‘Equity and Excellence; Liberating the NHS’, that sets out the commitment that there will be a change in the structure for provider services to ensure that they are truly separate from the Commissioner functions. Therefore we have been developing a new organisational form. We took into account the views of our staff and stakeholders who told us that they wanted to have a community service that represented our population. Over the last year we have been working towards becoming a social enterprise, a business that is set up for the benefit of the community and will reinvest any surplus into the service or for the benefit of the local population. This will become fully operational as North Community Partnership on October 1st 2011. This will be an opportunity to build on our learning and develop services based around the needs of the community. We feel this will benefit patients, staff and all our stakeholders to improve health and well being.

3.5 Statements from third parties 3.5.1 Statement from NHS North Somerset Board The Board discussed the North Somerset Community Services Quality Account in May 2011 and with some minor amendments, they agreed to ratify the report and confirmed they were satisfied the areas below had been followed:-

• The Quality Accounts presents a balanced picture of the Trust’s performance over the period covered;

• The performance information reported in the Quality Account is reliable and accurate;

• There are proper internal controls over the collection and reporting of the measures of performance included in the Quality Account, and these controls are subject to review to confirm that they are working effectively in practice;

• The data underpinning the measures of performance reported in the Quality Account is robust and reliable, conforms to specified data quality standards and prescribed definitions, is subject to appropriate scrutiny and review; and the Quality Account has been prepared in accordance with Department of Health guidance

3.5.2 Response from North Somerset Local Involvement Network North Somerset LINk appreciates the opportunity to comment on this Quality Account. The LINk supports and has been activity involved with contributing to the process for North Somerset Community Services to move to a Social Enterprise. We believe this move will provide a framework that will be beneficial both to patients and staff. Community Services will be playing an increasingly important role as more care is moved closer to and delivered in a patient’s home. There are and will be challenges and this will demand more staff, patient and public involvement. We believe there is a determination within Community Services to promote and pursue these issues in the interests of a quality service for patients.

We note ‘the driver’ for the change to ‘Community Wards’ is described in the priority order as:

• reducing emergency hospital admissions and bed days

• reducing NHS costs

• improving patient experience and that Community Services 2010/11 objectives are:

• to improve quality and the patients experience

• to ensure our workforce are the best they can be to deliver effective community services

• to meet our contractual obligations We understand the current economic situation and agree that changes must include value for money but would highlight the importance of prioritising ‘improving patient experience’ (as shown in Community Services objectives) as the long-term beneficial way forward. The LINk supports Community Wards and would like to see the objectives for these service changes reflecting the objectives for Community Services giving priority to improving quality and patient’s experience. This report shows good levels of care for patients and we are pleased to note that identified concerns in relation to staff well-being are being addressed with appropriate training and support. The LINk would welcome the opportunity for continued dialogue and involvement with Community Services in the future. 3.5.3 Response from North Somerset Health and Overview Scrutiny Panel We would like to thank these parties for taking the time to comment on our first Quality Account. We will use the comments made to help us develop the structure and content of our Quality Account in future years. 3.5.4 Response from Commissioner Thank you for inviting us to comment upon your Quality Accounts for 2010 - 11. We welcome the identification of your key priority areas to include:

- Maintain and improve the experience of patients - Improve patient safety - Provide clinically effective services which deliver outcomes patients expect

The above are all key areas of work identified in the last year to improve quality and patient safety provision in North Somerset Community Services and reflect the discussions and areas of involvement the commissioners have been engaged in over the last year.

In 2010 - 11 North Somerset Community Services has demonstrated strong performance in a number of areas including implementation of VTE assessments for all patients in line with the national target, maintaining requirements under ‘Elimination of Mixed Sex Accommodation’ and in achieving zero incidence of hospital acquired MRSA bacteraemias. The service has also improved patient experience in a number of ways to include adoption of the Ten point Dignity Challenge, patient surveys in all 25 service teams and in responding to patient feedback. Throughout 2010 -11 Community Services have embarked on a longer improvement journey, taking part in national initiatives such as Productive Community Services, regional initiatives such as the Quality and Patient Safety Programme and more local initiatives such as setting up and delivery of training to local care homes to improve care they can provide to patients with long term conditions. These are clear indicators of improving quality and a further programme for quality improvement for 2011 -12 is set out. We note the need to provide a greater emphasis on both clinical effectiveness measures such as NICE and best practice guidance, and in the use of clinical audit. We will continue to work together with Community Services to both support and monitor this. The PCT and Community Services have worked closely together during 2010/11 to resolve any performance issues that arose and Commissioners did not issue any performance notices. Detailed contract monitoring processes are in place for 2011/12 which will benefit from increased electronic data collection and improved presentation of data. Individual service specifications include an improved focus on service continuity during staff absence and service staff will complete their work to understand and manage their service capacity to maximum effect. Community Services achieved all of their CQUIN goals, except one which the commissioners withdrew due to unavoidable recruitment delays. Learning emerging from the CQUIN schemes has been useful in setting both realistic measures and in ensuring data systems are sufficiently developed to deliver baselines early in the year where this has been agreed. CQUIN schemes for 2011 – 12 will further reflect this learning. Throughout the year Community Services has engaged with commissioners both within the formal contract and quality monitoring processes, but also in delivery of the wider health and social care agenda to include safeguarding arrangements for adults and children. There are a number of key themes underpinning the priority areas for the forthcoming year and we look forward to an increased programme of patients, carers and families’ involvement in the delivery of these areas, particularly in planning care and providing more acute care for patients within Community Wards. The document itself was clear in presenting the content, however it would be helpful next year to clearly articulate data collection which is retrospective or is planned for the forthcoming contract year. We feel that this could be further developed in 2011 -12 with the engagement of the planned patient involvement group ‘Community Forum’ in exploring particular areas of interest for the local population, and in further developing an easy to read format.

nhs north somerset community services quality accounts 2010/11 · hospital by an integrated team of...

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