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Quality Account 2018-19

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Contents

Section 1 – Introduction

Chairmans Statement 3

Our Vision and Values 4

Our approach to quality 5

Section 2 – Quality and Effectiveness

Care Quality Commission (CQC) 6

CQUINS 6

Staff Survey 7

Clinical and Service Audits 9

Incident Reporting 9

Outcomes 10

Section 3 – Service User Experience

Complaints 11

Friends and Family Test 11

Quality of Care 11

Section 4 – Quality Priorities for the next year 2019/20 12

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Section 1 – Introduction

Chairman’s Statement

When, in 2006, a group of 10 GPs and practice managers met and decided to found what soon became Novus Health, our aim was to provide services that were of high quality and more readily available than those which were offered from secondary care at that time. We were committed to ensuring that the clinical and managerial personnel we worked with and the systems we introduced were of high quality.

Over the last 12 years I am pleased to say that we have maintained these aims and, from a very small beginning, have built a provider organisation which has the principles of safety, effectiveness and a positive patient experience at its forefront.

We are committed to a programme of monitoring outcomes, both in terms of compliance with processes which we have introduced to ensure safety, and also in terms of patient satisfaction.

The results of such monitoring are regularly reviewed by our management team and the board. We actively consider all comments made by patients and staff, aiming for constant improvement in our services and to eliminate, where possible, any issues which may adversely affect patients’ experience or outcomes.

We are fortunate to have a dedicated team of staff who go to great lengths to deliver on our program of quality and effectiveness. In return we take steps to support them in their personal training in development and have systems in place to monitor staff views and respond to any concerns.

Having chaired Novus Health since 2006, I firmly believe that our governance objectives and overall strategy have enabled us to provide services which are valued by referrers, commissioners and patients. This is a long-term commitment which, I hope, will allow us to maintain these high standards in the future.

Martin Shutkever Chairman Novus Health

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Our Vision and Values

The statements below identify the Vison, Values, Aims and Priorities for the organisation for the next two years. These statements are underpinned by detailed operational plans that will support the transformation of the organisation and development of the range of services provided locally. Our Vision – identifies our future ambition and how we desire to be recognised Our values – should be embedded in everything we do and every patient contact Our Aims – outline the our purpose and intentions Our Priorities – identify the elements of our organisation that are the most important

Vision and Values

Our Vision Our Values

“To be recognised for our commitment to improving health care services for the local community, developing our range of locally accessed services and excelling in quality, safety and patient experience”

Woking together for patients

Respect and dignity

Commitment to quality of care

Compassion

Improving lives

Everyone counts

Strategic Aims

Improving the safety and clinical quality of our services

Improving the experience for the patients, carers and families that we treat.

Developing the range of services we provide and developing the integration of services between primary and secondary care.

Delivering services closer to people’s homes, with continually improved access to treatment times.

Developing our organisation and workforce.

Improving the financial stability of the organisation.

Key Priorities

Quality

Delivering safe, harm free care focusing on evidence based pathways, supervision and board level clinical leadership.

Developing, maintaining and deploying clinical staff, who are competent, empowered and promote the core values of the organisation.

Delivering personalised, responsive and compassionate care in partnership with patients and families, commissioners and other healthcare providers in appropriate environments safeguarding the most vulnerable.

Operational

Developing a robust organisational infrastructure that supports continuous improvement, can respond to new challenges and become a leading enabler within the local health economy.

Exceeding all key NHS Constitution and commissioned standards and deliverables, including access and quality outcomes.

Developing our range of community services that are available to the local population, delivered by local clinicians, closer to people’s homes, which are integrated with primary and secondary care provision.

Financial Improving our financial stability and generating funds to re-invest in our services.

Equality

Develop a more diverse workforce and promote an inclusive culture, equality of opportunity for all staff and the behaviours and capabilities required to regulate proportionately, fairly and free from bias

Ensure that the way we operate, our rules and the decisions we make are proportionate, fair and free from bias.

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We will Excel by:

Delivering on our promises.

Making it personal.

Putting in the extra effort to succeed.

Taking your healthcare seriously.

Making it timely. The Excel principles underpin the organisations drive to build confidence and satisfaction. They are fundamental to ensuring that staff know the performance that they are expected to deliver and that they deliver a quality service.

Our approach to Quality

Quality is the foundation for all decision making and actions undertaken by Novus Health Ltd. We

have clear objectives to ensure the delivery of safe and effective care. This is evidenced by the

‘golden’ thread of quality woven throughout the delivery plan. The provision of high quality care is

measured against the Care Quality Commission (CQC) domains:

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Section 2 – Quality and Effectiveness

Care Quality Commission (CQC)

Our last inspection was on the 8th February 2014, it was a routine inspection and the following

standards were published:

CQUINs

The Commissioning for Quality and Innovation (CQUINs) was introduced in 2009 to make a

proportion of healthcare providers’ income conditional on demonstrating improvements in quality

and innovation in specified areas of patient care. The key aim of the CQUIN framework is to secure

improvements in the quality of services and better outcomes for patients. Following approval from

NHS Wakefield CCG the Novus Health Ltd initiated 7 improvement projects, the table below

identifies the planned activity and achievement.

Topic Activity Status

Ensure eRS entry is updated reflecting current service requirements AchievedProvide TRISH with regular, structured service information on access, delivery, innovation

and operational issues that may affect patient choice.Achieved

Development of an Audiology Referral Support Pilot proposal to reduce unnecessary ENT

referrals and deliver activity through a different resource model reducing the costs of

service deliveryAchieved

Continue Telephone Assessment pilot on East of District Achieved

Develop and implement new model for Trinity Medical Centre which includes clinical triage

of all referrals, model to include GP, Nurse triage, care navigator and self referral processAchieved

Introduction of ‘clinical leads’ within community service, enhanced mentoring and support,

introduction of peer review for onward IPT’sAchieved

Introduction of e-consultation within S1 for referrers to get advice prior to referral Not Achieved

Develop CTS pathway for CCG to consider for the replacement of the current Minor Hand

Surgery serviceAchieved

Development of Templates within S1 consultation process to record compliance with CCG

Commissioning Policy and EVB RecommendationsAchieved

Develop opportunities to redesign the General and Vascular service pathway to re-integrate

with MYHTNot Achieved

Service specific Patient Participation Event AchievedIntroduction of QuickSIV Test – enabling an assessment of an individual ears base ability to

process speechAchieved

Move entire hearing aid range to the GN Resound C-Series – a wifi enabled more modern

device with enhanced functionsAchieved

Implement hearing rehabilitation instructional videos C2Hear on NH website and create

hard copies to send to patients that requestAchieved

System Recovery – Engagement

with Referral Support project

System Recovery - Community

Physiotherapy Service

Transformation – Phase 2

System Recovery – Pathway

redesign

Adult Hearing Loss – Service

Transformation and Patient

Engagement

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Staff Survey

The NHS Staff Survey is an important source of information about what it is like to work in the health

service in England. The NHS Staff Survey results are utilised by organisations to support local

improvements in staff experience and wellbeing and are also examined by external organisations

such as the CQC and NHS Improvement.

This is the first time a full staff Survey was completed at Novus Health, we received 31 responses

from 45 surveys sent our – a very pleasing 69% response rate, this is a mixture of clinical and non-

clinical staff members.

The following key elements have reflect the priorities for Novus Health Ltd:

Do the following statements apply to you and your job?

Topic Activity Status

Identify the criteria/ measures to be used in the outcome framework Achieved

Identify the information/ recording requirements necessary to support criteria at 1 AchievedAlter clinical system template/ coding and recording requirements to capture necessary

informationAchieved

Develop ‘Outcome Framework Report and embed in the Clinical and Operational Review

meetingAchieved

Review current LocSSIP’s Achieved

Development of theatre standards and inclusion in LocSSIP’s Achieved

Identification of clinical risk matrix and development of response protocols Achieved

Re-issue new LocSSIP ‘Manual’ which includes enhanced content requirements Achieved

Develop Consultant clinics in the community service – bring consultants out of MYHT to

improve governance and oversight of GPwSI’s, improve access to expertise for patients and

reduce wait times

Achieved

Conduct a clinical Structure and location review for current service – to develop a

centralised Hub with more limited spoke delivery modelAchieved

Introduce nurse led cryotherapy and minor operations clinics Achieved

Develop governance and clinical model to enable community based roaccutane prescribing Not Achieved

Community Dermatology Service

transformation

Develop and implement ‘Outcomes

Framework’ that sits across all services

Review and development of Local

Safety Standards for Invasive

Procedures for all surgical services

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To what extent do you agree/disagree with the following?

Are you aware of how to raise concerns about unsafe clinical practice?

To what extent do you agree with the following statements about unsafe clinical practice?

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Q25. To what extent do these statements reflect your view of your organisation as a whole?

Clinical and Service Audits

During the year a number of planned and reactive audits have been completed, the outcomes of

these audits inform the cycle of continuous improvement, they are presented and discussed at the

Clinical and Operational Review Committee and summarised at Board.

Examples of areas of improvement:

Title Outcome

Infection Control – Bare below the elbow And Hand Hygiene

100% Compliance

Low Risk BCC excision 90% Diagnostic agreement on histology 97% complete excision margin

Documentation Audit – Care pathways 100% compliance – on re-audit

Local Safety Standard for Invasive Procedures – 7 Sequential Steps

100% Compliance

Incident Reporting

At Novus Health Ltd is committed to the safety of our patients, relatives and staff. Over the year our

staff reported 35 incidents and issues, which allow us to investigate, learn and improve our service

delivery. There were no serious incidents, injuries or never events.

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Outcomes

As part of the 2018/19 Quality Improvement Plan Novus Health Ltd developed and implemented an

outcomes framework that captures operational, clinical, Patient and Clinician reported outcomes

and allows the organisation to assess the effectiveness of the services we provide.

The table below demonstrates some of the indicators we are utilising, this reporting is now

embedded into our governance and clinical review processes and used to continuously improve

quality, outcomes and the patient experience.

In addition, our patient feedback process captures the patient reported symptom improvement as a

results of the treatment they have received at Novus Health Ltd.

Minor Hand

Surgery

Cataract Surgery

General Surgery

Vascular Surgery

Dermatology Audiology Wakefield

Audiology North

Kirklees Physiotherapy

96% 97% 91% 100% 93% 93% 96% 65%

Service Pathway point YTD

2

42

97.17%

84.32%

88.55%

Followup 58

1:0.7

Minor Procedure - Surgical phase 0

2

5

SOS apointments Number of patients self referring for urgent review

0

2

Excision margins within tolerance 99%

Diagnostic agreement (predicted against histology) 86%

0

10

43

0

0

0

1:0.9

0

0

0

1

3

Routine post surgical followup/ review 32

01:0.7

FA:FUP Ratio 1:2.8

DNA Rate 8.0%

Clinic Utilisation 87.0%

100 % ; Fully resolved 18.2%

75-99%; Good improvement reported 50.1%

75-30% ; Moderate improvement reported / able to better self manage 15.0%

30- 0 %; Minimal improvement / change in symptoms 15.4%

Ceased to Attend / Did Not Attend 20.9%

Referred to Other Speciality. 4.5%

Routinely wearing hearing aid Yes 89.52%

Aids comfortable Yes 86.68%

Confident fitting hering aid Yes 91.15%

Able to change hearing aid batery Yes 95.49%

Able to clean hearing aid Yes 87.03%

Because of the hearing aid, hearing has improved Yes 84.21%

Can now hear satisfactorily more of the time Yes 80.63%

General Surgery 4/7 day review

Post Operative Wound Infections

Post operative complications

Low Risk BCC

Followup

No interopertive complications

Cancelled Operations - On day of surgery by surgeon - transferred to MYHT

4/7 day review

No interopeartive complications

Post operative complications 4/7 day review

12 week reviewMHS

Outpatient pathway

General Dermatology

FA:FUP Ratio

Consultant Followup appointment - as a result of post surgical contra-indication

Surgical site healing (fully)

Night symptoms improved

Post operative wound Infections

8-10 Week Review

Consultant Followup appointment - as a result of post surgical contra-indication

Surgical Phase

FA:FUP RatioFollowup

Routine post surgical followup/ review

Post Operative Wound Infections

Post operative complications

4/7 day reviewPost Operative Wound Infections

Symptom improvement

Post operative complications

Outcome FrameworkElement

Consultant Followup appointment - as a result of post surgical contra-indicationFA:FUP Ratio

Vascular Surgery

Surgical Phase

Interopertive complications

Cancelled Operations - On day of surgery - health related

Cancelled Operations - On day of surgery by surgeon - transferred to MYHT/ other

4/7 day reviewPost Operative Wound Infections

Post operative complications

Followup

Physiotherapy

Audiology

Clinician Assessed Improvement

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Section 3 - Service User Experience

Complaints

As a learning organisation, complaints are a vital source of information shared across our services to

inform and improve what we do, we actively encourage all types of feedback and have introduced a

new category to our complaints management system of ‘concerns’ which are in essence informal

negative feedback which helps to give a measure of lower level issues and what can be done to

improve the patient experience.

During the year we received:

Formal Complaints 2

Informal Complaints/ Concerns 76

Friends and Family Test

We actively promote a culture of continuous improvement and encourage service users to feed back

there experience. It is therefore pleasing that the average response was 94% of respondents stated

they would be likely to recommend Novus Health. The table below identifies the responses by

individual Service.

Percentage of patients likely to recommend our service’s to friend and family

Minor Hand

Surgery

Cataract Surgery

General Surgery

Vascular Surgery

Dermatology Hearing

Loss Wakefield

Hearing Loss

North Kirklees

Community Physiotherapy

99% 100% 100% 100% 99% 97% 99% 85%

Quality of Care

The Patient Feedback questionnaires also enable reporting of our patient’s assessment of the quality

of care they receive, whether they were involved in the decision making and were they treated with

Dignity and respect.

Overall - Quality of Care (Excellent, Very Good and Good)

96%

Individual Service - Quality of Care (Excellent, Very Good and Good)

Minor Hand Surgery

Cataract Surgery

General Surgery

Vascular Surgery

Dermatology Hearing Loss

Wakefield

Hearing Loss North

Kirklees

Community Physiotherapy

99% 99% 100% 100% 99% 99% 99% 91%

Yes No

Were you treated with dignity and respect? 99% 1%

Were you involved in decisions about your care? 98% 2%

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Section 4 - Quality Priorities for the next year (2019/20)

Quality is the foundation for all decision making and actions undertaken. Novus Health has a clear

objective to ensure the delivery of safe and effective care. This is evidenced by the ‘golden’ thread of

quality woven throughout the delivery plan.

Priority 1 – Increase staffs knowledge of incident reporting processes and why they should be

encouraged to be used.

Priority 2 – Improve the Adult hearing loss patient’s functional outcomes

Priority 3 – Improve Physiotherapy patient’s symptom improvement scores.

Priority 4 – improve the clinical and operational audit program across services.