Quality Account 2011 - 12

providing services we would be happy for our families to use

“The service that has been offered to me has been a life saver and I mean that literally. It provided me with support, information understanding. Comments from service users in 2011 -12

contentspart 1 Table of contents 1 Quality - Chief executive’s view and declaration of Quality Account accuracy 3 Summary of Quality Account 5 What is the purpose of the Quality Account? 5 Why these areas? 5 Our key achievements in relation to quality in 2011-12 Our priorities for 2012-13 Mandatory statements 8 Statement of director’s responsibilities in respect of the Quality Account 8

part 2 Who was involved in setting priorities for 2012-13? 9 How did we collect these priorities? 9 How did we shortlist? 9 Our priorities for 2012-13 10 Service user safety 10 Service user safety priority 1 10 Service user safety priority 2 10 Clinical effectiveness 11 Clinical effectiveness priority 1 11 Clinical effectiveness priority 2 11 Service user experience 12 Service user experience priority 1 12 Service user experience priority 2 12

mandatory statements How NAViGO monitors quality and performance? 13 Participation in clinical audits 13 Participation in clinical research 15 Goals agreed with funders of services 16 Care Quality Commission registration 16

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part 3 How we performed on quality last year – 2011-12 18 Performance on Quality Account priorities for 2011-12 19 Achievements across the service in 2011-12 22 Rharian Fields 22 Improving Access to Psychological Therapies (IAPT) for people with Chronic Obstructive Pulmonary Disease (COPD) 23 Improving quality in physical healthcare in community mental health services 24 Forensic service 24 Memory service accreditation 25 Staff survey 26 National performance reporting requirements 27 Employment and accommodation in North East Lincolnshire 27 Health of the Nation Outcome Scales (HoNOS) 28 Improving Access to Psychological Therapies (IAPT) 29

glossary of key terms 30

statements from other organisations about the Quality Account Link 32 Service User and Carer Forum 33 North East Lincolnshire Care Trust Plus 34 Local authority scrutiny committee 35

mandatory statements continued Data quality 16 Information governance 17 Our performance on information governance toolkit 17 Clinical coding 17

“If this service was not there, I don’t think I would be able to get better, in fact, I know that I wouldn’t.” Comments from service users in 2011 -12

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part 1quality: chief executive’s view and declaration of Quality Account accuracy

NAViGO Community Interest Company is a not for profit organisation that emerged from the NHS in April 2011 to run all local mental health and associated services in North East Lincolnshire. We have all the services you would expect of a mental health provider including acute facilities, but also specialist services such as systemic family therapy, highly developed employment and training services running our own and other peoples ancillary services (catering, cleaning, maintenance, etc.) creating jobs and training for people with mental health problems, eating disorders and many more. We designed the services in conjunction with people who use them and as such many are bespoke. Our mission is simple, to provide services that we would be happy for our own families to use and we are on our way to achieving this, already 75 per cent of our staff said if a friend or relative needed treatment they would be happy with the standard of care in any of the services provided by NAViGO, compared to only 59 per cent in other services nationally. However, we will continue to strive to increase this result and

want every single member of our staff to provide the standard of service they would as if they were treating a member of their family. This Quality Account illustrates how we place quality at the heart of our organisation, delivering award winning services in partnership with our local community. We believe strongly that by working in partnership with our members we can reflect a journey towards a life lived with purpose and meaning; this is our testament to the quality of services we provide. As an organisation we are truly unique. We have a voting membership giving service users and carers equal rights to staff. We continually strive to provide quality services in partnership with the people who know our services best, our staff, our service users and carers. Partnerships are crucial to NAViGO’s success, both locally and internationally. Over the last year NAViGO has established a partnership with an institution based in Macedonia, to help support staff development and training while also hoping to improve

the physical surrounding for the service users. A number of staff from the institution, which provides care to a whole range of people of all ages with both learning difficulties and mental health problems, visited NAViGO services for four weeks to receive training and to experience how services are provided here in the UK and members of NAViGO staff have subsequently visited Macedonia. Fundraising has also been undertaken for the institution with a number of staff involved in various events including a skydive. NAViGO also has strong links with the Caribbean islands of Antigua and Barbuda, providing regular RESPECT training for nursing staff, police, prison and emergency services. RESPECT training is now an integral part of The Antigua and Barbuda Mental Health Training Partnership which encompasses NAViGO, IAS (UK), Antigua and Barbuda Ministry of Health, Brian Hoser, The National Mental Health Association of Antigua and Barbuda and the North East Lincolnshire Mental Health Service User and Carer Independent Forum.

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Closer to home, NAViGO is heavily involved with many local organisations in the health and social care sector and beyond. A number of partner organisations sit on the Membership Board which governs the organisation including the Independent Service User and Carer Forum, North East Lincolnshire Council, LiNK, En-gage, Alzheimer’s, Rethink, Mind and Artlandish.

As you will see throughout this report, services are also being developed with other health care organisations including locally based social enterprise Care Plus and the local general hospital, Diana, Princess of Wales. Against a background of national service cuts, by working smarter, reducing waste, ensuring everyone relates directly to those who use the services and are therefore more efficient, having less managers and bureaucracy, we have managed (in our first year as a social enterprise) to not only save significant sums of money required of us, but also generate surplus money to reinvest back into our services,

creating accommodation for vulnerable people as voted for by our members and developing new specialist services such as Rharian Fields, our new dedicated inpatient user eating disorder service, the first of its kind for North East Lincolnshire.

We have also managed to secure funding to further develop different parts of our services. As part of a pathfinder programme, £427,000 of funding has been awarded to NAViGO by the Department of Health. This has enabled the expansion of local forensic mental health services to provide an expert panel to the magistrates court and more assertive follow up for signposted offenders. Open Minds have also secured a £200,000 grant from the Burdett Trust for Nursing (The Empowerment Programme) to develop integrated pathways for the assessment and treatment of depression and anxiety in people with severe COPD.

We are national top scorers for many indicators thanks to

the innovative design of not just our physical buildings, but the ways in which our services work fluidly around them and have won numerous awards over the last year including being named over all winners of The Guardian Public Service Awards as well as receiving the Employee Ownership Rising Star Award and the Best Public Sector Employee-Led Mutual Organisation (ELMO) Award at The Philip Baxendale Awards. In conclusion, we will keep trying to be more flexible and changing the way we do things to create reinvestment each year, giving our members a real voice in the development of our local services and creating a service which is truly part of the local community.

Kevin Bond Chief executive

In accordance with the NHS (Quality Accounts) Amendment Regulations 2011 No. 269, I hereby state that to the best of my knowledge the information in this document is accurate.

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summary of Quality Account

what is the purpose of the Quality Account?

The purpose of the Quality Account is to: • Evidence to the public the quality of service NAViGO delivers

• Show measureable quality improvement in identified areas and discuss plans to further improve quality

• Involve and respond to service user feedback. The three areas of priority we have chosen to focus on are:- • Service user safety – Ensuring service users do not come to harm whilst in our care

• Clinical effectiveness - Applying the best knowledge, derived from research, clinical experience and preferences of service users to ensure we achieve the best outcomes for our service users • Service user experience - Listening to and acting on service users views in order that we provide the best service and experience possible.

why these areas?

Service user safety, clinical effectiveness and service user experience were the three categories Lord Darzi used in his review of the NHS in 2008, “High Quality Care for All”. Lord Darzi felt that keeping service users safe, providing them with an effective service to produce the best outcomes, and acting on their feedback, would ultimately lead to health services focusing on quality rather than speed of delivering the service. In this way health services would be led by service users and not by government targets. This vision fits with NAViGO’s vision of providing services we would be happy for our families to use.

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our key achievements in relation to quality in 2011-12

NAViGO has achieved the majority of its performance targets in 2011-12. These include targets set by regulators such as the Care Quality Commission and the Department of Health. Particularly pleasing performance has been achieved in relation to the percentage of service users in paid employment and settled accommodation where NAViGO was one of the top five performing providers of mental health services nationally.

Services across NAViGO have been developed following feedback from service users and carers and the results of clinical research. For example, the community mental health service ran a successful pilot late in 2011 aimed at supporting people with severe mental health problems in managing the physical health concerns often associated with mental ill-health. Service user feedback was really positive and the outcome of the pilot showed a significant number of people whom the mental health services worked with, did

actually have either known physical illness or in many cases (including one case of acute appendicitis) unknown health complaints which we were able to treat really quickly in partnership with the G.P’s. The wellbeing service is now being rolled out across case supervision services on the back of this successful pilot. NAViGO has won several prestigious awards which reflect the quality of services it delivers including being named overall winners of The Guardian Public Service Awards as well as receiving the Employee Ownership Rising Star Award and the Best Public Sector Employee-Led Mutual Organisation (ELMO) Award at The Philip Baxendale Awards. Progress has been made against some of the priorities set for improving quality locally in last year’s Quality Account. NAViGO significantly increased the number of service users with recorded Health of the Nation Outcome Assessments (HoNOS). HoNOS is an outcome measure which is used in the clustering process known as Payment by

Results (PbR).

Service users are allocated to care clusters using the mental health clustering tool based upon HoNOS (how the service user is feeling in last two weeks) and alongside service user history which in turn supports care planning and enables Mental Health Payment by Results (MH PbR). The clustering tool supports providers and funders of services in measuring health and social care outcomes in mental health without the need to collect additional data.

Participation in national clinical audits was also achieved with NAViGO partaking in two national audits between March 2011 and April 2012, the national dementia audit and the national schizophrenia audit. A local audit programme and audit committee was also established.

Priorities which were set in the previous year’s Quality Account and required further work were carried over into the priorities for 2012-13 which are listed in part 2 of the Quality Account.

“One of the most imaginative and inspirational ideas in our public services. Involving people in the service they are using gives them a truly meaningful stake in it and in this case helps set them firmly on the road to recovery.” David Brindle, The Guardian’s public services editor

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service user safety priority 1 Any service user safety incidents reported on Datix rated as having major/catastrophic consequences should have a documented root cause analysis and associated action plan discussed and monitored at the clinical governance committee. service user safety priority 2

Review the North East Lincolnshire strategy for suicide prevention and work in partnership with other organisations (predominately public bodies) in refining the strategy to ensure it helps guide local practitioners in achieving better outcomes for people in crisis. The strategy will include suicide awareness training for staff and a review of current procedure, to support staff in recognising the signs of suicidal thinking and ultimately prevent suicide from occurring. clinical effectiveness priority 1

Audit the current care and treatment of service users with a dual diagnosis of drug and alcohol and mental health problems against National Institute for Clinical Excellence (NICE) guidelines to establish the effectiveness of current treatment where care is shared between NAViGO and other agencies. Recommend improvements to include policy review and action plans. clinical effectiveness priority 2 To measure how many people with Dementia have treatment at home as opposed to hospital during 2012-13 and to use this as a target for working towards more treatment delivered at home in subsequent years. To supplement this data with service user and carer surveys to determine whether treatment at home provides a more positive experience and better outcomes for the service user.

service user experience priority 1 As per priority set in 2010-11, to monitor waiting times for people needing a crisis team assessment to ensure 97% of referrals are seen within 4 hours and 85% of referrals are seen within 2 hours. service user experience priority 2

To produce monthly monitoring of time taken to assess and start treatment for people referring to Open Minds, to ensure 95% of referrals are assessed within 10 days and, following assessment, the service user’s wait to start their choice of treatment is reduced.

After thorough consultation with our service users, members and staff, the following priorities for quality improvement have been identified. These priorities will be NAViGO’s focus in improving service user safety, the effectiveness of its services and service user experience between April 2012 and March 2013. Priorities were chosen after analysing data including waiting times, complaints, feedback from the service user and carer forum and service user surveys, and incidents and accidents. The shortlist of priorities was developed based on the ethos of NAViGO – providing services we would be happy for our families to use. Following presentation of the potential priorities at the Service User and Carer’s Forum, quality improvement priorities reached the shortlist where there were trends in both the qualitative and quantitative data. For example, data from the electronic service user record showed service users were sometimes waiting long periods for a follow up appointment for one to one therapy at Open Minds. Feedback from the Service User and Carer’s Forum, local service user surveys and complaints indicated this was also an area of concern for service users and carers.

our priorities for 2012-13

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mandatory statements

statement of director’s responsibilities in respect of the Quality Account

The directors are required under the Health Act 2009, National Health Service (Quality Accounts) Regulations 2010 and National Health Service (Quality Account) Amendment Regulation 2011 to prepare Quality Accounts for each financial year. The Department of Health has issued guidance on the form and content of annual Quality Accounts (which incorporate the above legal requirements).

In preparing the Quality Account, directors are required to take steps to satisfy themselves that:

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

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

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

• The data underpinning the measures of performance reported in the Quality Account is robust and reliable, conforms to specified data quality standards and prescribed definitions, is subject to appropriate scrutiny and review; and

• The Quality Account has been prepared in accordance with Department of Health guidance.

The directors confirm to the best of their knowledge and belief they have complied with the above requirements in preparing the Quality Account.

By order of the Board

Kevin Bond Barry Flintoft Simon Beeton chief executive director of operations director of finance

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part 2

who was involved in setting priorities for 2012-13?

NAViGO’s priorities for quality improvement for the financial year April 2012 to March 2013 were identified in conjunction with service users and carers, NAViGO’s main funder of services, North East Lincolnshire Care Trust Plus, and NAViGO members of staff.

how did we collect these priorities?NAViGO is a social enterprise, it is owned by the staff and run by community and staff members. Community members are service users, carers or people in the local area with a genuine interest in mental health. The membership sits on the Board as non-executives and helps set priorities, plan and monitor if processes are working. Members are part of every committee and issues of quality are always discussed. The Quality Account helps focus this process and activity into an annual plan. The process for identifying priorities began with a review of our performance in the previous financial year (April 2011 to March 2012). This included an evaluation of priorities featured in last year’s Quality Account to establish whether further work was needed in these areas or whether enough work had been done to justify retiring these priorities, whilst continuing to monitor them through regular internal performance reporting.

Performance Indicators set nationally for mental health providers by the Care Quality Commission and the Department of Health were examined to ascertain whether NAViGO was performing below target or had a downward trend in results which would necessitate the need for identifying them as a priority for improvement. Staff meetings involving representation from the Service User and Carer’s Forum discussed potential quality improvement priorities based on the results of the previous financial year performance review alongside a range of qualitative and quantitative data. This data featured complaints, service user safety incidents and accidents, local service user surveys, feedback from the Service User and Carer’s Forum and Commissioning for Quality and Innovation (CQUIN) indicators set by NAViGO’s main commissioner, North East Lincolnshire Care Trust Plus.

The shortlist of priorities was developed based on the ethos of NAViGO: providing services we would be happy for our families to use. Following presentation of the potential priorities at the Service User and Carer’s Forum, quality improvement priorities reached the shortlist where there were trends in both the qualitative and quantitative data. For example, data from the electronic service user record showed service users were sometimes waiting long periods for a follow up appointment for one to one therapy at Open Minds. Feedback from the Service User and Carer’s Forum, local service user surveys and complaints indicated this was also an area of concern for service users and carers.

how did we shortlist?

“I’m sure we wouldn’t have made anywhere near the same progresswithout your input. Yet again, I can only praise highly your work, and the difference it really makes to my work in such circumstances, and to the benefit of those motivated patients I’ve referred to you.”Dr J Laughton, GP

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our priorities for 2012-13

NAViGO felt it was important to categorise its quality improvement priorities under the headings of service user safety, clinical effectiveness and service user experience in order to align them to the government paper, High Quality Care for All, which uses the same headings. It was hoped this would give added clarity to NAViGO’s priorities and enable comparison between NAViGO and other providers of health and social care services.

“I was listened to and treated with respect.” Comments from service users in 2011 -12

service user safety

Ensuring service users come to no harm whilst receiving services is paramount to NAViGO delivering on its vision of providing services we would be happy for our families to use. In 2010-11 NAViGO adopted the Datix incident, accident and risk management system to support a positive culture in relation to reporting incidents, accidents and near misses which could hurt service users. As 2010-11 was the year Datix was launched in NAViGO the priority for quality improvement

relating to service user safety was: To ensure all errors/near misses/incidents that could hurt staff/service users are reported on the service user safety database ‘Datix’ and that lessons are learnt. A review of the data recorded on the Datix system shows that the number of reported service user safety related incidents increased. Despite the National Patient Safety Agency (NPSA) indicating that high reporting organisations

typically have a positive approach to incident reporting and are keen to learn lessons, NAViGO felt there was further work to be done around learning lessons and preventing similar incidents from re-occurring. Weekly review of the quality and detail of reported incidents did not show thorough action planning or root cause analysis which is needed in order for lessons to be learned. With this in mind, it was decided that the priority for 2012-13 would be:

Any service user safety incidents reported on Datix rated as having major/catastrophic consequences should have a documented root cause analysis and associated action plan discussed and monitored at the Clinical Governance Committee.

service user safety priority 1 service user safety priority 2

Review the North East Lincolnshire strategy for suicide prevention and work in partnership with other organisations (predominately public bodies) in refining the strategy to ensure it helps guide local practitioners in achieving better outcomes for people in crisis. The strategy will include suicide awareness training for staff and a review of current procedure, to support staff in recognising the signs of suicidal thinking and ultimately prevent suicide from occurring.

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clinical effectiveness

Ensuring the services we provide are as effective as they can be is a significant part of what NAViGO believes should define quality.In 2010-11 NAViGO identified an area for improvement in the effectiveness of its services being the treatment of service users with both mental health and learning disabilities. At the time there were no documented local guidelines

which set out the best and most effective treatment for these service users. NAViGO’s main funder of services identified this as a quality improvement and set milestones for delivery and implementation of the guidelines in NAViGO’s contract. Guidelines have now been produced for service users with both mental health and learning disabilities.

Further work needs to be focused around the care and treatment of other service users who have a dual diagnosis, specifically those who abuse drugs and alcohol and have mental health problems. Serious incidents have occurred in relation to these service users where the care is shared between NAViGO and other agencies and the need for information sharing is vital.

Audit the current care and treatment of service users with a dual diagnosis of drug and alcohol and mental health problems against National Institute for Clinical Excellence (NICE) guidelines to establish the effectiveness of current treatment where care is shared between NAViGO and other agencies. Recommend improvements to include policy review and action plans. Care for people with Dementia is changing to include more choice for service users and carers about whether they prefer to be treated at home rather than in hospital. A local priority for NAViGO and its main funder of services, North East Lincolnshire Care Trust Plus, is to be able to offer this choice of treatment options and to measure their effectiveness both in terms of how much treatment at home may add to stability and positive outcomes for the service user and to measure the extent it adds to improved experience for the family or carer.

clinical effectiveness priority 1 clinical effectiveness priority 2

To measure how many people with Dementia have treatment at home as opposed to hospital during 2012-13 and to use this as a target for working towards more treatment delivered at home in subsequent years. To supplement this data with service user and carer surveys to determine whether treatment at home provides a more positive experience and better outcomes for the service user.

“I was in relapse and the care and the compassion, care and humanity I received helped me through an overwhelmingly difficult time.” Comments from service users in 2011 -12

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service user experience

The heart of what NAViGO does is providing positive experience and outcomes for service users and carers. The importance NAViGO puts on service users and carers to drive the quality of its services is significant and can be proven by the influence of its service user and carer forum, its membership or shareholders, which has a high service user representation, and its commitment to providing

employment and training opportunities for its service users within its Tukes enterprise. The following priorities have been identified from the service user and service user forum, complaints and local service user surveys. Although waiting times had improved for service users needing a crisis assessment, from 89% of referrals seen within 4 hours in 2010-11 to

93% of referrals seen within 4 hours in 2011-12, NAViGO felt it should be aiming to see at least 97% of people within the 4 hour waiting time target in the NAViGO contract. It was also deemed high priority to ensure that the majority of these referrals were seen within the first 2 hours. In 2011-12 80% of referrals were seen within a two hour period. This percentage needs to rise to at least 85%.

As per priority set in 2010-11, to monitor waiting times for people needing a crisis team assessment to ensure 97% of referrals are seen within 4 hours and 85% of referrals are seen within 2 hours.

Our open access facility for service users with mild to moderate mental health problems, Open Minds, has been extremely popular with people in North East Lincolnshire. The demand for accessing services such as cognitive behavioural therapy (CBT) and stress management groups without a referral from a general practitioner has been so high that unfortunately it has resulted in a delay in people starting treatment, where their choice of treatment is in high demand.

All service users are assessed within 10 days which is the beginning of their therapy. Following assessment they are offered a choice of treatment which could include exercise, stress control, or psychological intervention. Depending on the treatment the service user chooses, there may be a delay in starting treatment based on the demand for that particular therapy at the time. Feedback from service users has suggested that whilst their overall experience of the service has been excellent, fewer delays in starting treatment for some therapies would make their experience better still. Open Minds is constantly reviewing ways service users can access the service in order to improve service user experience.

service user experience priority 1 service user experience priority 2

To produce monthly monitoring of time taken to assess and start treatment for people referring to Open Minds, to ensure 95% of referrals are assessed within 10 days and, following assessment, the service user’s wait to start their choice of treatment is reduced.

“After building up the courage to enter open minds, I found it easy to return and the staff very approachable and friendly. The fact that the service is there is a reassurance in itself. It reminds you you’re not alone and many people are going through similar difficulties as yourself.” Comments from service users in 2011 -12

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mandatory statement

The following sections are mandated for inclusion in all Quality Accounts. This is to enable the public to compare NAViGO with other providers of health and social care.

how NAViGO monitors quality and performanceNAViGO’s performance team produces data from the service user administration system (Maracis) to inform progress against national performance indicators set by the Care Quality Commission, the Department of Health and the Local Authority.

Performance is also monitored locally against priorities set in contracts with funders of services, namely North East Lincolnshire Care Trust Plus. All performance indicators are monitored at least monthly using a traffic light system (green for on or above target, amber for slightly below target and red for well below target). Data is broken down into service areas and discussed at monthly meetings with service leads. Any issues are passed down to operational staff and action plans for improvement are agreed. Any constant under-performance is escalated to the director of operations and the Local Board. The Local Board and the main service funder receive a performance report including a summary of exceptions where targets have not been met every quarter.

Any data quality issues within the service user administration system are identified on a daily basis using internal reports. This includes missing data where it is a vital part of the service user’s record, such as the National Health Service number (NHS number). NHS numbers are traced using an electronic system which ensures health records are linked to the correct service user.

participation in clinical auditsClinical audit provides a way to review and reflect on current practice to assess whether a healthcare provider is doing what it should be doing according to national and local guidance.Clinical audit is important because its aim is to continuously improve the quality of care provided to service users.

National confidential enquiries collect data on adverse events to identify shortfalls and improve future clinical care; they also highlight short falls/failures in service organisation. In 2011-12 there were no national confidential enquiries Mental Health Trusts were required to report on as part of the Quality Account.

During 2011/12, NAViGO Health and Social Care Community Interest Company (CIC) participated in 1 (one) national clinical audit and 0 (zero) national confidential enquiries studies, out of 2 (two) national clinical audits and national confidential enquiries which it was eligible to participate in. This was in addition to NAViGO’s local clinical audit programme and a national audit not applicable to the Quality Account.

The national clinical audit that NAViGO participated in and for which data collection was completed during 2011/12 is listed in the table below, alongside the number of cases submitted as a percentage of the number of registered cases required by the terms of that audit.

national audits applicable to Quality Account

participation (yes/no)

percentage (%) of required cases submitted

prescribing in mental health services

no not applicable

national audit of schizophrenia

yes 100

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A number of local audits were also carried out during 2011-12 and monitored via the NAViGO Clinical Audit Committee. Some of these completed audits are depicted in the table below. local audits completed in 2011-12

numbers partaking in the audit

actions agreed

Named Worker Audit 20 1. Implement advisory recommendations to improve documentation within case notes

Audit of NICE Guid-ance for Obsessive Compulsive Disorder (OCD)

26 1. Educate doctors about the use of clomipramine in OCD and the current recommendations of NICE for the treatment of severe OCD

2. Disseminate information on OCD from Royal College of Psychiatry to service users and their families with extra note about local support groups and local service provision

3. Medical staff use standardised and validated scale to diagnose OCD and its severity for example Yale-Brown

4. Educate medical staff about specialist OCD MDT service

5. Highlight to staff the criteria that NICE guidelines expect to be documented and the findings of OCD audit

Re-audit of Care Programme Approach (CPA) records

130 1. To scan all signed care plans into Maracis

2. To identify carers in adult acute services which are currently not consistently collecting this information

3. Adult services to monitor in supervision with each practitioner carers have been identified and offered assessments

4. All care plans to be typed within the electronic record

5. To scan all consent to treatment forms into Maracis

6. All services to monitor in supervision with practitioners using missing data report. Performance to be reviewed at service and organisational level at the Board and infrastructure meetings

Audit of NHS Litigation Authority (LA) Record Keeping Standards

130 1. To scan all consent to treatment forms into Maracis to allow for further audit on standard 11 during 2012

2. Training to be provided for all clinical staff on NHSLA record keeping standards. To particularly highlight the requirements of dating, timing and signing errors in written entries in the paper-light file and the need to not use ditto marks and abbreviations even with commonly used terminology such as CPA, HoNOS, ECG

3. All documentation generated by NAViGO practitioners should be typed

4. To amend CPA paperwork to include prompts for Adverse Reactions

Baseline clinical audit of the usage of clozapine for service users with refractory schizophrenia

20 1. To write Local Policy

2. Improve documentation/ training at CPD Meetings

3. Re-audit with larger sample size

4. To organise the service of family interventions

5. To develop CBT work for psychosis and obtain Royal Society of Psychiatrist leaflet

6. Advocacy service referral or involvement 14

participation in clinical research

Clinical research involves gathering information to help us understand the best treatments, medication or procedures for service users. It also enables new treatments and medications to be developed.

The number of service users receiving NHS services provided by NAViGO in 2011/12 that were recruited during that period to participate in research approved by a research ethics committee was two hundred and six. Eight carers were also recruited to participate in one of the research studies.

Participation in clinical research demonstrates NAViGO’s commitment to improving the quality of care we offer and to making our contribution to wider health improvement. Our clinical staff stay abreast of the latest possible treatment options and active participation in research leads to successful service user outcomes.

NAViGO was involved in conducting nine clinical research studies in mental health during 2011/12 and there were twenty clinical staff participating in research approved by a research ethics committee during this period.

Also, in the last three years, twenty six publications have resulted from our involvement in research, which shows our commitment to transparency and desire to improve service user outcomes and experience across the NHS.

One of the key areas of research within NAViGO is the on-going research study by Professor Ann Mortimer, M.D. and Dr Colin Robertson, Ph.D into Transcranial Magnetic Stimulation (TMS) to treat chronic depression.

Our research study using Transcranial Magnetic Stimulation (TMS) to treat chronic depression, uses a special technique called Electroencephalogram (EEG) guided TMS that identifies for each person their brainwave patterns that are strongly associated with their depression. We can then use these patterns as target areas to treat with TMS. In general the treatment success of chronic depression is not very good, however our research results provides very good evidence that six out of ten people show significant life changing experiences with this treatment. We are continuing to recruit to this study to provide further evidence of the significant effects of our EEG guided treatment.

The purpose of our research is to provide the evidence base to establish a treatment service. We have good evidence that our novel EEG guided TMS is personalised to each service user, as it identifies the key target areas for treatment. It is free from any serious side effects, is safe and non-invasive as there is nothing to ingest, in contrast to drugs which have can have many side effects and have to be taken on a continuous basis. The treatment is time limited as each session lasts typically no more than three quarters of an hour: the overall course completed within one month can be cost effective. Furthermore, our results show the effects are durable. That is, people continue to improve even after the treatment course is completed. Building on this we have expanded our research to include schizophrenia, and in the near future gain ethical approval for a research programme that will have the capability to offer TMS across a wide range of conditions to include anxiety, obsessive compulsive disorder (OCD) and Post Traumatic Stress Disorder (PTSD).

“I never thought this would be possible but the team have made a great improvement to the client’s outlook by 100% and it has been a great benefit to him and his family.” Comments from service users in 2011 -12

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goals agreed with funders of services

Primary care trusts hold the NHS budget for their area and decide how it is spent on hospitals and other health services. This is known as ‘commissioning’. North East Lincolnshire Care Trust Plus is the main funder of services at NAViGO. They set us targets based on quality and innovation.

A proportion of NAViGO’s income in 2011/12 was conditional on achieving quality improvement and innovation goals agreed

between NAViGO and any person or body they entered into a contract, agreement or arrangement with for the provision of NHS services, through the Commissioning for Quality and Innovation payment framework (CQUIN).

Further details of the agreed goals for 2011/12 and for the following 12-month period are available electronically on the NAViGO website: www.navigocare.co.uk

Care Quality Commission registration

The Care Quality Commission regulates and inspects health organisations. If it is satisfied the organisation provides good, safe care, it registers the organisation.

NAViGO Health and Social Care is required to register with the Care Quality Commission (CQC) and its current registration status is registered. The Care Quality Commission has

not taken enforcement action against NAViGO Health and Social Care during 2011/12.

The Trust has worked hard in achieving all standards of care to a satisfactory level at its last inspection in September 2011 and continues to work to improve quality of services provided and to provide assurance to the Board.

data quality

Part of NAViGO’s commitment to providing quality services is to ensure it keeps accurate, complete and up to date records. Data quality measures include whether service users’ NHS numbers were present in their health records.

NAViGO submitted records during 2011/12 to the Secondary Uses Service for inclusion in the Hospital Episode Statistics which are included in the latest published data*.

The percentage of records in the published data, which included the service user’s valid NHS number was:

• 99.8% for admitted service users care; •100% for outpatient care

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

• 100% for admitted service users care; • 100% for outpatient care

*Latest published data February 2012

These results are well above the national average.

NAViGO will be taking the following actions to improve data quality. Please refer to the section on “How NAViGO monitors quality and performance” on page 13.

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information governance

Information Governance ensures necessary safeguards for, and appropriate use of, service user and personal information.

The director accountable for managing service user information and ensuring service user confidentiality is also known as the Caldicott Guardian. NAViGO’s Caldicott Guardian is Dr Barry Flintoft, Director of Operations.

As a new organisation, NAViGO is utilising the skills of North East Lincolnshire Care Trust Plus through a service level agreement which covers information governance and security. NAViGO’s information governance framework has been developed in partnership with the Care Trust Plus’ Information Governance and security manager.

We continue to take our duty to protect personal information and confidentiality very seriously and are committed to taking all reasonable measures to do so, both for electronic information and paper records.

At Trust Board level, our director of finance is accountable for managing the service level agreement with North East Lincolnshire Care Trust Plus which covers all information assets and any associated risks and incidents. Our Caldicott guardian is responsible for the management of service user information and service user confidentiality. Information Governance and information risks are managed and controlled via the Information Governance

toolkit submissions and the clinical governance committee. There is regular reporting to NAViGO’s clinical governance committee on how it is performing against the standards set in the Information Governance toolkit.

The toolkit and supporting evidence focuses on:

• The formal assignment of responsibilities to named individuals or groups

• Documented policies subject to formal review, approval and dissemination

• Checks and measures of staff understanding, and compliance with policies and processes.

our performance on information governance toolkit

Our information governance assessment report overall score for 2011/12 was 60% and was graded ‘not satisfactory’. As a new organisation, this was the first time we had been assessed against the Information Governance Toolkit and we expect to see an improved performance next year.

Although we have many of the required systems in place, we lost points because we did not always have enough documentary

evidence of this. We are working to address this before next year’s assessment. A full action plan, approved by NHS Connecting for Health, to meet the required documentary evidence has been put in place and actions have been allocated to members of the NAViGO Management team. Actions include dates for achievement and a process for monitoring the action plan is in place through monthly NAViGO clinical governance committee meetings.

clinical coding

Clinical codes are a way of recording service user diagnosis and treatment.

NAViGO Health and Social Care was not subject to the Payment by Results clinical coding audit during 2011/12 by the Audit Commission.

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part 3

how we performed on quality last year – 2011-12

Part 3 of the Quality Account evaluates NAViGO’s overall performance in 2011-12. This includes a review of whether or not we have achieved the priorities set in the previous year’s Quality Account, which may carry forward to the coming year’s priorities in part 2 should they not be fully achieved.

We then talk about what we have achieved in the last year, which we feel will contribute to improved quality for our service users.

Lastly we summarise our achievements in relation to national reporting requirements set by regulatory bodies such as the Department of Health, and the Care Quality Commission. This should allow comparison between NAViGO’s performance measures, which link to quality, and other providers of mental health services who are required to report on the same performance measures.

“The community mental health team that I have at this time are one of the best I have had in the past 10 years.” Comments from service users in 2011 -12

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theme objective actions achieved outcome achieved?service user safety To ensure all errors/

near misses/ incidents that could hurt staff/service users are reported on the service user safety database ‘Datix’ and that lessons are learnt

‘Datix’ risk management system implemented and incidents logged on a daily basis.Lessons learned and root cause analysis to be improved in the coming year

Priority for 2012-13 to be: Any ser-vice user safety incidents reported on Datix rated as having major/catastrophic consequences should have a documented root cause analysis and associated action plan discussed and monitored at the Clinical Governance Committee

To reduce the number of service users from being Absent Without Leave (AWOL)

Researched best practice on reporting instances of AWOL from other mental health providers. Ensured all services users at risk of absconding are monitored by two members of staff whilst outside in smoking areas

Number of service users AWOL as reported nationally reduced. Continue to monitor via monthly internal reports using the ‘Datix’ risk management system

Physical violence from service users/ their relatives or members ofthe public

‘Datix’ risk management system implemented and incidents logged on a daily basis. RESPECT techniques utilised

Decreased percentage of staff (14% in 2011-12 as opposed to 19% in 2010-11) experiencing physical violence from service users.Utilise de-briefing sessions as frequently as possible where physical violence against staff occurs and link these sessions with RESPECT methods to identify where lessons could be learned

performance on Quality Account priorities for 2011-12

The following performance review of last financial year (March 2011 to April 2012) will summarise NAViGO’s performance against the quality priorities set in the previous year using a traffic light rating system. Green meaning we fully achieved our objectives, amber meaning we almost achieved objectives but recognise there is still work to do, and red meaning there is significant work still to do to realise our objectives.

service user safety

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theme objective actions achieved outcome achieved?clinical effectiveness

Improve the coverage of Health of the Nation Outcome Scores (HONOS), ensuring all eligible service users have a HoNOS Payment by Results (PbR) Care Cluster recorded on the clinical service user administration system - Maracis

PbR training completed for all clinical staff. Awareness of PbR in staff meetings

95% of service users had a PbR cluster recorded by December 2011 which meets national and local targets

Participation in the national audit programme

Clinical Audit committee established to monitor local and national audits. Two national audits undertaken out of three applicable to mental health providers

Continue to enhance audit programme and quality of audit action planning. Monitor internally at Clinical Audit committee

Care for service users with dual diagnosis

Guidelines have now been produced for service users with both mental health and learning disabilities

Further extend to dual diagnosis for mental health and drug and alcohol abuse. Priority for 2012-13 to be: Audit the current care and treatment of service users with a dual diagnosis of drug and alcohol and mental health problems against National Institute for Clinical Excellence (NICE) guidelines, to establish the effectiveness of current treatment where care is shared between NAViGO and other agencies. Recommend improvements to include policy review and action plans

clinical effectiveness

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theme objective actions achieved outcome achieved?service user experience

Service user experience of waiting times in crisis (Harrison House)

Waiting times improved for service users requesting crisis assessment from 89% of referrals seen within 4 hours in 2010-11 to 93% of referrals seen within 4 hours in 2011-12

Continue to improve performance in this area and set further targets for 2012-13. Priority for 2012-13: To monitor waiting times for people requesting assessment by the crisis team to ensure 97% of referrals are seen within 4 hours and 80% of referrals are seen within 1 hour

Service user experience in Outpatient Department

New processes in place to check service user information prior to attending appointments.Service user satisfaction survey concluded service users much happier with their overall experience of being seen in outpatients

Continue to monitor service user satisfaction internally via local service user surveys and put any subsequent actions for improvement in place

CQC community mental health survey 2010

Survey carried out. Actions for improvement identified and allocated to senior members of staff for implementation

Compare results from 2011 survey (currently in progress) to 2010 results to assess whether improvements have been made. Monitor actions internally

service user experience

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achievements across the service in 2011-12

NAViGO has had a busy first year. Along with the prestigious awards won, detailed in the chief executive’s summary in part 1, many more developments have been made to a service which is flourishing, guided by what its members and service users want.

“I feel like someone is holding my hand and after fighting this eating disorder on my own for the last three years it is a good thing. I don’t feel that I am on my own anymore.” Comments from service users in 2011 -12

Rharian Fields

Rharian Fields is home to the specialist eating disorder team. This service allows people who may have conditions such as Anorexia and Bulimia to be cared for and treated by a dedicated team, in a purpose built environment within the region rather than having to travel long distances for treatment. Although NAViGO already provides an outpatient eating disorder service, this new service will allow for the team to apply even more innovative practice and to keep at the forefront of national service, building on the current outpatient programme, to provide

group therapy, day care and a re-feeding service as well as a dedicated, discreet in-service user unit. The dedicated eating disorder team consists of a psychiatrist, nurses, social workers, psychologists, therapists and a nutritionist all of whom have received specialist training in the assessment and management of eating disorders both in the UK and at an international level. The service is recognised on the national list of providers and has already obtained a service contract with Northern Lincolnshire and Goole NHS Foundation Trust.

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Open Minds

Open Minds provides the talking therapies (IAPT) service for people with common mental health problems in North East Lincolnshire and was recently awarded a £200,000 grant for service development from the Burdett Trust for Nursing (The Empowerment Programme).

In line with government guidance and strategy around the benefits of extending talking therapies to people with physical long term conditions, the grant will be used over two years to develop integrated pathways for the assessment and treatment of depression and anxiety in people with severe COPD.

Evidence shows that COPD is the second most common cause of emergency admission to hospital and that up to 67% of people with COPD experience depression, anxiety and panic attacks. This psychological co-morbidity can increase the number of hospital admissions and reduce quality of life for people with COPD.

However, treatment of depression, anxiety and panic using Cognitive Behavioural Therapy (CBT) can reduce hospital admissions and improve mental and physical health and quality of life.

This innovative service development will bring together the provision of talking therapies (CBT) with existing COPD services at Hope Street Clinic and Diana Princess of Wales hospital. Professionals from each organisation will work together in partnership to provide integrated pathways between the hospital wards, Hope

Street Clinic and Open Minds; providing the right care in the right place at the right time. Two dedicated Psychological Therapists and a Data Analyst have been recruited in order to develop the service. The service will offer assessment and treatment for people that have been admitted to hospital with severe COPD or have been referred to Hope Street (and have had several admissions to hospital). Sessions will take place on the respiratory wards before people are discharged from hospital and will also take place at Hope Street or in people’s homes. Referrals will be taken from June 2012 and during May 2012; people that have COPD and have been admitted to hospital most frequently will be contacted and offered an assessment.

The service will monitor and measure reductions in hospital admissions, bed days and Accident and Emergency (A&E) attendances. Improvements in physical health and outcomes for Pulmonary Rehabilitation (PR) programmes will also be measured as well as improvements in depression, anxiety and panic and quality of life. Service user involvement has also been crucial in the development of the project and feedback from service users will be collected and used to make improvements throughout the project.

Results providing evidence of the benefits of the service will be used at the end of the two years to submit a proposal to the GP Commissioning Consortium (GPCC) for funding to continue and develop the service to include people with less severe COPD.

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improving quality in physical healthcare in community mental health services

The community mental health service ran a successful pilot late in 2011 aimed at supporting people with severe mental health problems in managing the physical health concerns often associated with mental ill-health. The idea behind the project was to test the notion that there is actually a higher occurrence of certain physical illness such as diabetes, coronary heart disease, high cholesterol, and breathing related problems amongst other things, and where there were problems discovered, look at ways for us to help more quickly or intervene as required to stop them becoming worse. To do this the mental health team ran a regular wellbeing clinic over a 3 month period in Weelsby View Health Centre and invited 80 people from the team’s caseload to take part, and of these 40 people responded and were seen in a wellbeing clinic appointment. They were offered blood tests, and routine observations such as Blood Pressure, urine tests, and other health related screening which are not usually routinely provided by a mental health service.

Where there were physical health concerns detected, the service users were then in most cases referred through to the G.P quickly for treatment choices. There were also a large range of information leaflets provided upon request informing of different self-help techniques from self-examination, healthy eating and caffeine intake, through to smoking cessation and sexual health as well as numerous other subjects. We could also advise of where to go for help with certain needs or of what services could be considered by the team. Service user feedback was really positive and the outcome of the pilot showed a significant number people whom the mental health services worked with, did actually have either known physical illness or in many cases (including one case of acute appendicitis) unknown health complaints which we were able to treat really quickly in partnership with the G.P’s. The wellbeing service is now being rolled out across case supervision services on the back of this successful pilot.

forensic service investment

As part of a pathfinder programme, £427,000 of funding has been awarded to NAViGO by the Department of Health enabling the expansion of local forensic mental health services to provide an expert panel to the magistrates court and more assertive follow up for signposted offenders.

This is a multi-agency development and NAViGO will be working together with the Humberside Probation Trust, the Drug Intervention Programme (DiP) and the combined Grimsby courts to provide a professional, multi-agency, rapid response panel to assess individuals where magistrates have expressed concern over their mental health.

The panel will consist of a forensic practitioner, an offender manager and a DiP worker who will provide an assessment and written report back to the court within a three to four hour timeframe, significantly speeding up court outcomes and reducing the normal delays associated with remands/adjournments.To be chosen as one of only 20 pathfinder sites

from over 200 schemes in the country is a real achievement for NAViGO and testament to the excellent work undertaken by the forensic mental health team.

The funding is part of a wider initiative announced by Paul Burstow, minister of state for care services, which will see £19.4 million spent nationally on the development of new and expanded diversion services in 2012/13.

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memory service accreditation

The Memory Services National Accreditation Programme works with services to assure and improve the quality of memory services for people with memory problems / dementia and their carers. It engages staff in a comprehensive process of review, through which good practice and high quality care are recognised, and services are supported to identify and address areas for improvement.

Accreditation assures staff, service users and carers, funders of services and regulators of the quality of the service being provided. NAViGO went through a rigorous assessment process which involved reviewing service user, staff and carer feedback and auditing its own practices against the accreditation standards.

An independent team of people, including clinicians and a service user/carer, then visited NAVIGO to assess the results of its findings and to discuss best practice.

NAViGO was delighted to have achieved an accreditation status of ‘excellent’, the top category possible to achieve. This means that NAViGO achieved the majority of standards to a high level and is now a recommended provider of Memory Services approved by the Memory Services National Accreditation Programme for at least two years. NAViGO is able to demonstrate that it meets national guidelines and standards, such as the NICE Quality Standard for Dementia.

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staff survey

As a provider of NHS services, NAViGO is required to undertake a yearly staff survey. The survey results form part of the monitoring required by CQC and is also used by the Department of Health. 2011-12 saw NAViGO undertake its first staff survey as a standalone organisation with some impressive results. The response rate was unprecedented and at 79 per cent NAViGO had the highest return rate of all social enterprises within the UK.

Given NAViGO’s mission statement is to deliver services we would be happy for our family to use, it was pleasing to see already 75 per cent

of respondents said that if a friend or relative needed treatment they would be happy with the standard of care provided by NAViGO. 79 per cent also felt that care of service users is NAViGO’s top priority, an increase of 10 per on last year and higher than the national average of 66 per cent.

The majority of the results showed improvements however there were areas identified which will be examined in more detail.

NAViGO is developing an action plan based on the results as it is important to continue to improve engagement of staff and embed the finding is employees working lives.

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we hear you loud and clear

we are in the national top ten

for responsesNHS staff survey 2011

72 % response rate... our best ever

national performance reporting requirements employment and accommodation in North East LincolnshireBeing in sustainable employment and long-term settled accommodation are key factors in reducing the likelihood and impact of social exclusion for at-risk adults. It can have positive effects on health and well-being. This is why the Government set targets for Mental Health providers under a Public Service Agreement which strives to improve employment and accommodation prospects for people on the Care Programme Approach.

The Mental Health Minimum Data Set is the vehicle which monitors the number of service users on the Care Programme Approach (CPA)

in settled accommodation and employment and informs the results of the Department of Health Performance Framework.

NAViGO is particularly proud to be in the top 5 performing mental health providers in the country when it comes to securing settled accommodation and employment opportunities for its service users.

The trend graphs below show NAViGO’s progress against the national England average performance from March 2009 to September 2011 which is the latest available published data.

*Q1 2011-12 uses internal data due to issues with the released MHMDS for the quarter.

“My housing is in the right location, very central to my needs. I have been very happy content and settled where I am. I always get a phone call and continue to support us, very friendly team.” Comments from service users in 2011 -12

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Health of the Nation Outcome Scales (HoNOS)

HoNOS is an outcome measure which is used in the clustering process known as Payment by Results (PbR). Service users are allocated to Care Clusters using the mental health clustering tool based upon HoNOS (how the service user is feeling in last two weeks) and alongside service user history which in turn supports care planning and enables Mental Health Payment by Results (MH PbR). The clustering tool supports providers and funders of services in measuring health and social care outcomes in mental health without the need to collect additional data. It will also form the basis for NAViGO’s contract and

how it will be paid from 2013-14. Rather than issuing a block payment for services provided, funders of services will calculate the cost of providing services based upon the level of need historically which will be calculated by a fixed cost per cluster and the number of service users in those clusters.

NAViGO has worked hard to implement HoNOS and Payment by Results. The trend graph below based upon the data submitted to the Mental Health Minimum Dataset shows that as at December 2011 almost 95% of service users have had a HoNOS assessment recorded on Maracis.

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Improving Access to Psychological Therapies (IAPT)

Open Minds, part of NAViGO, provides the talking therapies (IAPT) service for people with common mental health problems in North East Lincolnshire. Part of the national reporting requirements for IAPT services are the IAPT Key Performance Indicators (KPI). NAViGO is proud to be amongst the top performing providers of IAPT services nationally in relation to these indicators, which demonstrate how positive its outcomes for service users have been in 2011-12.

The table below shows the latest data

published by the Information Centre as at September 2011. NAViGO is performing in the top quarter of IAPT providers nationally. The data shows that almost 60% of people receiving treatment from NAViGO’s IAPT service, Open Minds, are recovering from their mental health problem compared with 44% on average nationally. 12% of people accessing the service who were on benefits and sick pay have been assisted back into work, which is almost double the national average percentage at just 6.6%.

“Superb personal service. My one to one counsellor was excellent and I felt she could relate totally to how I felt and help me to address my feelings and thoughts. Thank you so much for your help and support when I needed it most” Comments from service users in 2011 -12

IAPT KPI NAViGO England Average

Quartile BenchmarkPosition

Proportion of referrals who have enteredtreatment

91.20% 60.10% Top 8

People who have entered treatment as a proportion of people with anxiety and depression

3.10% 2.10% Top 25

Proportion of people moving to recovery

59.70% 43.90% Top 14

Proportion of service users moving off sick pay and benefits

12.29% 6.60% Top 11

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glossary of key terms

Care Quality Commission (CQC)

The CQC regulates all health and adult social care services in England, including those provided by the NHS, local authorities, private companies or voluntary organisations. It also protects the interests of people detained under the Mental Health Act. Carer

A carer is someone who looks after their relatives or friends on an unpaid, voluntary basis often in place of paid care worker.

Cognitive behavioural therapy (CBT)

This is an approach to treatment that involves working with people to help them change their emotions, thoughts and behaviour. A person’s personal beliefs are addressed in order to understand and change behaviour.

Commissioning for Quality and Innovation (CQUIN)

The CQUIN payment framework enables the people who fund services (commissioners) to reward excellence, by linking a proportion of English healthcare providers’ income to the achievement of local quality improvement goals.

Crisis team

The crisis home treatment service works directly with people who are experiencing a severe mental health crisis and need immediate and more intensive care and treatment, mostly at home.

Department of Health (DoH)

The DoH provides leadership for public health, the NHS and social care in England. Its purpose is to improve England’s health and well-being and in doing so achieve better health, better care, and better value for all.

Dual diagnosis

This refers to two or more disorders affecting one person, for example, mental illness and learning disability. It is also used for people who have a mental health problem and also misuse substances, such as illegal drugs, legal drugs or alcohol.

Electronic service user record

Details of a service user’s current health and history held on a computer.

Forensic Mental Health Services

Specialist services for people with mental health problems, who have been arrested, are on remand or have been to court and found guilty of a crime.

High Quality Care for All

A national report published on 30 June 2008, resulting from a year-long review of the NHS, led by health minister and surgeon Lord Darzi. High Quality Care for All sets out the government’s

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approach to health policy, focusing on quality outcomes for service users rather than the speed of delivering the service. It encompasses three key areas for measuring quality: service user outcomes and experiences and clinical outcomes which come under the headings of ‘service user safety’, ‘service user experience’ and ‘clinical effectiveness’. National Institute for Clinical Excellence (NICE)

It provides clinical staff and the public in England and Wales with guidance on current treatments. NICE is an independent organisation that provides national guidance and standards on the promotion of good health and the prevention and treatment of ill health.

National Patient Safety Agency (NPSA)

The NPSA leads and contributes to improved, safe service user care by informing, supporting and influencing the health sector.

NHS Connecting for Health

NHS Connecting for Health (NHS CFH) maintains and develops the NHS national IT services.

Non-executive

An individual who sits on the business board. They have the same powers and responsibilities as directors but are not involved in the day to day running of services.

Open Minds

Open Minds provides care and support for people age 16+ who are experiencing common mental health problems, such as stress, depression and anxiety.

Root cause analysis

Root Cause Analysis is a way of investigating the key reason why an incident occurred, to ensure lessons are learned to prevent similar occurrences. Incidents investigated using root cause analysis are often serious and may involve harm to a service user.

Service user

A service user is someone who uses health services and may also be referred to as: service user or client.

Service User and Carer’s Forum

The Forum is for mental health service users and carers in North East Lincolnshire to have a say in the planning, development and monitoring of local mental health services.

Social enterprise

A social enterprise is a business whose goals are mainly social, and whose profits are put back into its services or the community.

Systemic Family Therapy

Family therapy can help support families through communications problems and other issues to help improve the family environment.

Tukes

Tukes provides training, skills development and work experience in real working environments for people with mental health problems and others.

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statements from other organisations about the Quality Account

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North East Lincolnshire Local Involvement Network (LINk)

13/06/2012 Dear Kevin Bond, RE: NAViGO Quality Accounts NEL LINk Response North East Lincolnshire Local Involvement Network (LINk) appreciates being involved in the NAViGO Quality Accounts. Our LINk members were given the opportunity to feedback on the draft. North East Lincolnshire Local Involvement Network (LINk) has had ample opportunity to verify the commitments given in this Quality Account to partnership working through joint working and the attendance of the NAViGO Chief Executive at general meeting to explain the ethos and operation of the organisation to our members. Additionally, a representative from our Governing Body members has been given the opportunity to serve on the Membership Board.

The Quality Account is straightforward and appears to be accurate. We would particularly commend the robust methodology employed for deciding upon the priorities for the coming year, and the clear and honest reporting of performance for 2011-12. NAViGO is to be congratulated on its scoring against the national benchmarks and this reinforces the view of the LINk that the organisation provides high quality mental health services.

Yours sincerely, Ian McDonald, LINk Chair

North East Lincolnshire Local Involvement Network (LINk) Hosted by VANEL at: 14 Town Hall Street, GRIMSBY, DN31 1HN

Tel: 01472 315437

Mobile: 07930 101 907

Fax: 01472 231122

Email: link@vanel.org.uk

www.nellink.org.uk

NE Lincs Mental Health Service User and Carer Independent Forum

THE FORUM IS AN INDEPENDENT SERVICE USER & CARER INITIATIVE PROMOTING SERVICE USER & CARER INVOLVEMENT North East Lincolnshire Mental Health (Service User & Carer) Independent Forum Incorporated Charity Registered in England & Wales 1093511 Company Limited by Guarantee Number 4450913 Registered Office Hadley Ridge North End, Goxhill, North Lincolnshire DN19 7JX

NE Lincs Mental Health Service User and Carer Independent Forum

Postal address c/o 14 Town Hall Street, Grimsby DN31 1HN Tel/ (01472) 233312 Email:info@ nelforum.org.uk

Independent Forum members welcomed the opportunity to comment on the draft Quality Account for 2011 – 2012. This document was discussed at the weekly Forum meeting on 13th June 2012 after it had been available for members to consider for the previous two weeks. Members were pleased to see that the feedback from earlier consultation about priorities for the coming year had been incorporated into the plan, underlining the value which NAViGO places on service user and carer input in the process of planning, developing and monitoring services. This commitment to the involvement of service users and carers was further demonstrated in 2011 -2012 by the establishment of Community Membership as an integral part of the management of the company, with Community Representatives having equal status as Staff Representatives on the management boards. Independent Forum members felt that NAViGO should be proud of the developments in services which had taken place over the last year and which were highlighted in the report. The achievements were particularly commendable given the huge change experienced during the transition to a Community Interest Company. They noted the reference to the success of the pilot of the wellbeing service and were pleased to see a more holistic approach being taken. The tendency to treat mental illness in isolation and to attribute physical symptoms to the mental illness has long been an irritation to service users. This is one example of the benefits of co- location and the development of closer relationships with GP practices. Members were also pleased to see the continuing development of TMS, looking forward to the day when a treatment service can be established. With regard to performance on Quality Account priorities for 2011 – 2012 Independent Forum members acknowledge the improvements that have been made in the service user experience and note the intention to set further targets for these areas in 2012 – 2013 as well as additional priority objectives. This approach demonstrates an intention of continuous improvement. In terms of the priority areas for 2012-2013 Independent Forum members had the opportunity to contribute to the shortlist and agreed that the areas selected had been those which had been raised by them over the last year as a cause for concern. In publishing these priority areas for the coming year members felt that their feedback and contribution to the development of services was valued. Overall, members felt that the document was well laid out, with clear information, gave an accurate summary of the service provision over the last year and the requirements for 2012-2013. The inclusion of a glossary and explanations of terms within the body of the text (eg payment by results) were useful additions.

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North East Lincolnshire Care Trust Plus

Commissioner’s statement

The North East Lincolnshire Care Trust Plus (CTP) Board are pleased to comment on and approve the Quality Accounts for NAViGO for 11/12.

We recognise as commissioners that 2011/12 has been another challenging year for NAViGO with the first year as a social enterprise and the changes to the CTP, as well as the implementation of a new mental health commissioning strategy. These accounts reflect on the year 2011/12, which was the first year that NAVIGO operated as a social enterprise.

The CTP has always been committed to ensuring that services are of the safest and highest quality. We congratulate all staff for their contribution to the achievements over the past year and their on-going work to improve the quality of services. There will always be challenges to meet and both commissioners and providers will strive for the highest quality in all care provided, putting patients at the heart of everything we do. 2012/13 will remain challenging and we have agreed the priorities of improvement together, in order that we can have a balanced view focusing on successes whilst highlighting areas for continued development and improvement within 2012/13.

Over the last two years, we have developed a model of care for services valuing people working alongside the person, their families and carers to support enablement and inclusion, and we have worked with NAViGO to implement this service model. We have also worked closely with community members, your representatives, to ensure we focus on those things which mean the most to people and listen to your views of the care you received - changing this when necessary and always seeking to improve.

As a result we have focused a large proportion of our time on quality, looking at the things that really matter to our community – safe services, high levels of customer satisfaction, and improved clinical outcomes.

We are pleased to have witnessed the on-going commitment and enthusiasm and energy for delivering a high quality service to the public and we are sure this will be reflected in the further development and implementation of the quality frame and improvement in outcomes for the local community.

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North East Lincolnshire Council

Municipal Offices, Town Hall Square, Grimsby, North East Lincolnshire, DN31 1HU

Deputy Chief Executive Liz Jones

21 June 2012 To whom it may concern, Re: Quality Account - NAViGO Health and Social Care Community Interest Company On behalf of the North East Lincolnshire Health, Housing and Wellbeing scrutiny panel, thank you for providing an opportunity to comment on the quality account for NAViGO Health and Social Care Community Interest Company. The document gave a good overview of the achievements and performance of the past year and details of the priorities moving forward. Priorities – The quality account indicates that there has been wide consultation with stakeholders to set the priorities and having community members on the board emphasises that NAViGO is community led. Positive outcomes – It is encouraging to see that good performance has been achieved in relation to the percentage of service users in paid employment and settled accommodation, as this has a big impact on wellbeing. Performance – It would be useful to have a little more information to explain why the objective – care for service users with dual diagnosis - had not been achieved in 2011/12. Presentation – Although the document is quite lengthy, it is well laid out and easy to follow. The traffic light rating system used in the performance review section makes it clear to see whether the objectives were achieved or not in 2011/12. Research – It is pleasing to see NAViGO’s commitment to improving the quality of care they offer which is demonstrated through the participation in clinical research. The scrutiny panel would welcome NAViGO to attend a future panel meeting to see the progress being made towards the priorities outlined in the quality account, and how this is contributing to the achievement of the following two outcomes in North East Lincolnshire Council's Council Plan for 2012/15: All children and young people grow up healthy, emotionally secure and confident The mental health and wellbeing of all people is improved, especially those in the most deprived

communities

It would also be a good opportunity to have earlier engagement in the development of the quality account for 2013/14. Yours faithfully Cllr Elliott Chair of the Health, Housing and Wellbeing Scrutiny Panel North East Lincolnshire Council 35

Arabic ةيفيك نع راسفتسالل وأ ةقيثولا هذهل ىرخا ةخسن ىلع لوصحلل لاصتالا ءاجرلا ةقيثولل يرخا غيص دوجو ةيناكما ىلع لوصحلا459 302 (01472) يلاتلا مقرلاب

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Latvian Lai iegūtu šā dokumenta papildu eksemplārus vai uzzinātu par citu formātu pieejamību, lūdzu, zvaniet pa tālr. (01472) 302 459

Lithuanian Norėdami gauti šio dokumento kopijas arba paklausti dėl kitų formatų skambinkite telefonu 01472 625800

Polish W celu otrzymania kolejnych kopi niniejszego dokumentu, lub w celu zapytania o dostępności innych formatów dokumentu, należy dzwonić pod następujący numer telefonu(01472) 302 459

Russian Чтобы получить дополнительные копии настоящего документа или узнать о других возможных форматах, пожалуйста, позвоните по телефону (01472) 302 459

Slovenian Naročilo dodatnih izvodov tega dokumenta ali povpraševanje po drugih formatih nam lahko posredujete po telefonu(01472) 302 459

If you require this leaflet in another format please ask an English speaking relative to contact PALS on (01472) 302 459.

Copies of this Quality Account can be obtained from our website http://www.navigocare.co.uk/index.php?id=providing-quality-services and the NHS Choices website http://www.nhs.uk

Printed copies can be obtained by contacting:

The performance team on (01472) 252366 extension 265.

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