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Quality Account 2014/15!
You & Your Care www.bdct.nhs.uk
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Contents Part 1: Statement on quality from Chief Executive 1 Introduction page 4
2 Signed declaration page 5
3 Stakeholder involvement page 7
Part 2: Statements of assurance from the Trust Board
4 Review of services page 9
5 Care Quality Commission registration status page 9
6 Participation in clinical audits page 12
7 Research and innovation page 19
8 Commissioning for Quality and Innovation (CQUIN) indicators page 21
9 Data quality page 23
Part 3: Review of Quality Performance 2014/15 10 Trust quality priorities page 25
11 Mandated indicators page 26
12 Local Indicators page 27
12a Clinical effectiveness page 28
12b Patient safety page 35
12c Patient experience page 37
13 Quality and safety page 39
14 Our staff page 44
15 Complaints and compliments page 51
16 Safeguarding page 55
17 Infection prevention and control page 58
18 Patient environment page 58
19 Mental Health Community Survey 2014 result page 62
20 Patient Involvement page 65
21 Risk and Incident management page 69
Part 4: Priorities for Quality Improvement for 2015/16 22 Quality priorities page 74
23 Commissioning for Quality and Innovation indicators page 76
24 Quality priorities; concluding points page 77
Part 5: Statements received from our stakeholders Commissioners page 78
Appendices
Appendix 1 PLACE Local Improvement Plan page 86 Appendix 2 Comprehensive list of services provided 2014/2015 page 87 Appendix 3 Independent Auditor’s Report page 88 Appendix 4 How to contact us page 91 Appendix 5 Glossary of terms page 92
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Part 1: Statement on Quality from the Chief Executive
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Part 1: Statement on Quality from the Chief Executive
1. INTRODUCTION I am pleased to introduce Bradford District Care NHS Foundation Trust’s (BDCFT) 2014/15 Quality Account which demonstrates our quality performance over the last year and sets out our commitment to continue to improve the quality of services that we deliver throughout 2015/16.
The Quality Account is a public document that we publish every year to demonstrate our commitment to delivering excellent services.
In our last Quality Account we included more narrative and patient stories (in addition to measures and numbers) to describe how we have been doing. We have developed this element further this year and we hope you will enjoy reading some of the real examples of how our services have made a difference.
This year has been a particularly important one for the Trust as we continued our journey toward achieving Foundation Trust status. We became a Foundation Trust on 1st May 2015. To achieve this success the Trust has been subject to intense external scrutiny of our quality governance arrangements. Our achievement stands as testament, to the dedication of every member of staff, to provide the highest possible standards of care to everyone who uses our services.
In June 2014 we were one of the first mental health and community trusts to be inspected under the Care Quality Commission’s new, more rigorous, inspection regime and were proud to receive an overall rating of ‘Good’ for the quality of our services. You will see more about this review in the body of the quality account.
In addition to our positive Care Quality Commission inspection outcome, we have continued to deliver against the quality priorities that we committed to for 2014/15 in order to support our commitment to providing safe and effective services which result in a positive experience for patients and service users.
There are some areas in this Quality Account where we have achieved what we set out to do and others where we have not done so well; we continue to work hard to make improvements and to monitor and report on our progress in an open and honest way. You can read more about the detail of our achievements and where we need to do better within the Quality Account.
As I have mentioned, our staff are central to the delivery of high quality, safe and clinically effective
care and it is encouraging to see our great performance in the annual NHS Staff Survey. There remain some areas for improvement and encouraging staff pride in the quality of Trust services is an area we intend to focus on during 2015/16.
In last year’s Quality Account we mentioned the on-going work we were undertaking in response to the report into the public inquiry, led by Robert Francis QC, into failings at Mid-Staffordshire NHS Foundation Trust. Over the last two years we have completed the range of actions we set out to achieve and these are now embedded in the day-to-day workings of the Trust.
We have an excellent record of involving service users, carers and their families in the business of the Trust. During 2014/15 we have been implementing further improvements to the way we involve people based on the outcomes of an external review commissioned by the Trust. We have also introduced the Family and Friends Test during the last year to ensure that we are gathering pertinent information for patients, service users and staff across the Trust. We feel sure that these revised structures and approaches will support further quality improvements during 2015/16.
Through our stakeholder engagement this year we have gathered a range of ideas and themes to support the development of our quality goals for 2015/16. In delivering against these goals we will:
• Continue to deliver against a set of ‘stretch targets’ that really challenge us in terms of delivering excellence
• Continue to develop ways of reporting on outcomes rather than (or as well as) numbers
• Continue to work with service users and carers to further improve the quality of the services we deliver.
We look forward to working with our commissioners who have identified clear priorities for 2015/16, based on assessment of needs of the local population. We will develop quality services in partnership with commissioners to meet their objectives of improving health outcomes and reducing health inequalities.
I believe that, through our relentless focus on improving quality, we are now well on our way to achieving our vision of becoming one of the country’s leading providers of integrated community health services. We commit to publish the Quality Account in June 2015 on our website www.bdct.nhs.uk.
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2. DECLARATION
The Trust Board is confident that this Quality Account presents an accurate reflection of quality across Bradford District Care Trust.
As Chief Executive of Bradford District Care Trust I can confirm that, to the best of my knowledge, the information within this document is accurate.
Simon Large Chief Executive, Bradford District Care NHS Foundation Trust
Did you know?
• BDCT has 526 ‘likes’ on Facebook and 1,305 followers on Twitter*.
• We engage service users and carers in measuring the quality of services throughout the year.
• We employ 2,950 members of staff. • We have 9,397 members. *Figures as of 09/06/15
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OUR VISION Our vision is:
To provide the best possible care for the people of Bradford, Airedale, Wharfedale and Craven and to be recognised as one of the country’s leading providers of integrated community health care services. We have four key aims to help deliver this vision illustrated through our Vision Wheel.
• To provide a top quality service • To achieve excellence in patient experience • To ensure great relationships between the Trust, its staff and stakeholders • To deliver excellent value for money
The Trust’s vision wheel shows how our vision, aims and values are translated into powerful statements describing improved benefits and outcomes for patients, service users and carers.
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The Trust continues to uphold a clear set of values which underpin the delivery of the Trust Vision and have a clear link to the values of the NHS as enshrined in the NHS Constitution (March 2013). These values support a commitment to promote:
• Respect • Openness
• Improvement • Excellence
• Working together
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3. STAKEHOLDER INVOLVEMENT
Engaging with the people who use our services is a continuous process; service users and stakeholders are involved in a number of projects and groups to influence and drive change and quality improvement.
In previous years we have held an annual workshop, inviting a range of key partners work with us in identifying the priorities for the coming year. Although this workshop was well attended we found that this was not the best way to achieve significant service user representation.
This year we sought feedback and comments via an electronic survey from:
• Commissioners • Our staff• Our members
• Our service users and carers • Voluntary sector and partner organisations • Our Trust board
In addition to the survey we also held an event solely for service users and service user representatives to enable us to obtain their views. Adverse weather, on the day, affected attendance so to supplement the feedback from this session a number of existing service user groups were approached to provide comments on our priorities for 2015/16.
The following diagram illustrates our engagement approach:
The purpose of the survey and the engagement we have undertaken was to:
• Source views from key partners and service users about the improvements that were most important to them
• Discuss with service users the purpose of the Quality Account and identify what they would like to be included within the document
The priorities and goals identified can be found in Part 4 of this document.
We would like to thank everyone who has talked with us throughout the year. The formal comments from Healthwatch and provided last year have also helped to shape this account.
Working Together
Our Trust
Board
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Health Overview &
Scrutiny Committee
Our Staff
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Healthwatch
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Voluntary Sector / partner
organisations
Commissioners
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Service Users
and Carers
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Members
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Part 2: Statements of Assurance from the Trust Board
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Part 2: Statements of Assurance from the Trust Board
4. REVIEW OF SERVICES During 2014/15 Bradford District Care Trust provided 63 NHS services in the following areas:
• Mental Health services • Learning Disability Services • Community Services • Dental Services
A full list of services can be found in appendix 2
Bradford District Care Trust has reviewed all the data available to it on the quality of care in all 63 of these services.
The income generated by the NHS services reviewed in 2014/15 represents 100% of the total income generated from the provision of NHS services by the Bradford District Care Trust for 2014/15.
A review of our services appears in part three of this document. This gives an overview of how we are doing against the quality indicators that have been set by us and our stakeholders.
5. CARE QUALITY COMMISSION REGISTRATION STATUS Bradford District Care Trust is required to register with the Care Quality Commission and its current registration status is fully registered. Bradford District Care Trust has no conditions on registration. The Care Quality Commission has not taken enforcement action against Bradford District Care Trust during 2014/15. Bradford District Care Trust has participated in one routine inspection undertaken by the CQC during 2014/15; this was a full inspection of our services during June 2014 conducted using the new Chief Inspector of Hospitals process. All services provided by us (with the exception of substance misuse services and dental services which are inspected separately) were included in the inspection including all wards and a sample of each of the community services provided. In summary the services inspected were:
Mental health / learning disability services
Adult admission wards
Psychiatric Intensive Care Unit and Health Based Place of Safety
Low secure services
Adult community mental health services (including crisis services)
Learning Disability services
Services for older people
Child and adolescent mental health services
Community health services
Children, young people and families: Health visiting, school nursing, looked after children, family nurse partnership
End of Life care
Adults with Long term conditions: District nursing, community matrons and specialist services (e.g. podiatry, speech & language therapy, continence services).
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Bradford District Care Trust was pleased to be awarded a rating of GOOD overall, each CQC ‘domain’ was separately rated and the following table summarises our ratings:
Good practice
The CQC identified good practice across the trust; here are some examples of what they said about our services:
End of life services had employed two palliative care liaison workers who accompanied patients from ethnic backgrounds and their carers through their end of life journey providing emotional support and identifying a holistic and culturally appropriate care package. A female, bilingual health support worker was also available for female patients to discuss personal health issues.
In child and adolescent mental health services, as part of ‘agile working’, staff were provided with equipment such as tablets and video links. This enabled them to work from multiple locations and gave them better and more regular contact with young people and their families.
The family nurse partnership (FNP) team included several areas of good practice… For example, the FNP pro-actively engaged people in the FNP board, held celebration events and regularly shared complex and detailed case studies with people’s involvement. This helped to develop learning and understanding for the rest of the team.
The trust had positive examples of inter-agency working and developing services beyond national guidelines. For example, the Bradford families first (troubled families) pilot initiative, which is largely a social care and police- led initiative, included a dedicated health team who were based in the same location (Flockton House) as other families first teams. This meant troubled families received health support that they may not have received if the initiative had not included a directly-funded health component.
In community health services for adults, patients who received care and treatment for long-term conditions told us that staff communicated well with their GP and other professionals. They gave examples of how community staff had referred them to other services, support and advice groups or had arranged other professionals to carry out assessment visits.
In adult mental health community based services, the service user development worker role was seen as an outstanding example of engaging with people that used the service. People that have had experience of using services and recovered from their individual mental health needs were employed to support people and lead on developing services through engagement.
The intensive home treatment teams were involved with people prior to their discharge from inpatient wards and with people requiring intensive home treatment follow up. Staff from the respective teams linked into inpatient multi- disciplinary and discharge planning meetings. This meant people’s transition back into the community was well coordinated and not unnecessarily delayed.
In learning disability services we saw several examples of good practice in relation to health screening and facilitation at Waddiloves Health Centre. For example, we saw the use of a screening tool that had been developed specifically for people who had Down’s syndrome.
Services for older people had successfully integrated the Chief Nursing Officer’s 6Cs of nursing (care, compassion, competence, communication, courage and commitment) into the delivery of care on Ward 24. The 6Cs had been clearly explained to staff in the context of the care environment. This meant that they could be implemented effectively, which benefitted people and their carers.
Long stay/forensic/rehabilitation services used 'my shared care pathway', which is a recovery and outcomes-based approach to care. The care plans we saw were well documented and described how people’s needs were being met at each stage of their care. people using psychiatric intensive care unit received the right care at the right time, and had regular reviews.
People were able to receive care from other specialist health professionals when needed, and their preferences were taken into account. There were links with other internal and external agencies, which helped people move between services from
Safe Effective Caring Responsive Well led OVERALL RATING
Requires
Improvement
Good
Good
Good
Good
GOOD
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referral, to admission and discharge. Complaints were taken seriously, investigated, responded to and lessons learnt.
In the acute admission wards staff worked well as a multidisciplinary team and took a ‘person-centred’ approach. There was a range of treatment approaches available to meet people’s needs. Staff
were well trained and had good access to training and development opportunities. The acute admission wards were effective in providing safe care and treatment. The staff knew about potential risks to people’s health and safety, and how to respond to them and manage them. Incidents were reported and investigated and lessons were learnt and shared to prevent them happening again.
Areas for improvement Two ‘must do’ or compliance actions were identified by the CQC these related to:
a) further embedding the continuing care medical model and
b) making some improvements to our Health Based Places of Safety environments
Bradford District Care Trust took the following action to address conclusions or requirements reported by the CQC:
We have developed action plans for each of the ‘must do’ actions (continuing care medical model and Health Based Places of Safety environments); progress on implementation is summarised below.
We have developed and implemented an action plan for each of the eleven core services inspected; examples of some of the actions taken are outlined below.
We have developed a further set of actions in agreement with key partners (including commissioners) to ensure that we work together to deal with some of the wider issues such as addressing the requirements of the crisis care concordat through the Mental Health Partnership Board; this plan is monitored by the Service
Development Group which includes membership external to the Trust.
Bradford District Care Trust has made the following progress by the 31st March 2015 in taking such action:
The action plan relating to the Health Based Places of Safety has, already, been fully implemented and progress against the plan relating to the continuing care medical model is progressing in line with agreed timescales and is being reported to Board in April 2015.
The action plans relating to ‘should do’ recommendations have been monitored via the Quality and Safety Committee; the majority of actions are due for completion by June 2015.
Examples of actions taken to date include improvements to:
• the way the lone working policy is implemented • learning lessons from medication errors • the quality of record keeping • the reduction of delays in referral systems
The full CQC Report can be found here http://www.cqc.org.uk/provider/TAD
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6. PARTICIPATION IN CLINICAL AUDITS Bradford District Care Trust Audit Programme
We undertake a full programme of clinical audit which is reported to our Board through the Quality and Safety Committee. We believe that a good audit programme supports clinicians, managers, service users, carers, the community and commissioners to understand how we are doing in line with recommended quality standards. It also provides information we can use to improve quality if any gaps are found. Our clinical audit processes were, themselves, subject to an internal audit in 2013/14. We received a rating of significant assurance.
Our audit activity for 2014/15 included:
1. National audits
2. CQUIN audits
3. Commissioner audits
4. Local audits
National Clinical Audits
During 2014/15, data collection for 3 national clinical audits covered NHS services that BDCT provides. During that period BDCT participated in 100% of the national clinical audits and 99% of national confidential enquiries which it was eligible to participate in. The national clinical audits and national confidential enquires that BDCT was eligible to participate in during 2014/15 are as follows:
National Clinical Audits:
Prescribing Observatory for Mental Health (POMH-UK)
• Prescribing for substance misuse: alcohol detoxification • Prescribing for people with personality disorder • Antipsychotic prescribing in people with a learning disability
National confidential inquiries:
• Suicide and homicide by people with mental illness
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Participation
The number of cases submitted for each audit is included in the table below, along with a percentage of the number of required cases for that audit, if specified and the overall percentage compliance.
Table 1
Name of clinical audit Number of cases submitted
% of required cases as specified in the guidance
Overall Compliance
Prescribing for substance misuse: alcohol detoxification
23 cases Not applicable* 74%
Prescribing for people with personality disorder 72 cases Not applicable* 66%
Antipsychotic prescribing in people with a learning disability
94 cases Not applicable* Results published nationally July 2015
* Not applicable: There was not a minimum requirement for the number of cases that should be submitted for the audit.
It is not possible to provide any detailed information for national confidential enquiries as the questionnaires are sent directly to the consultants who then reply to the researchers.
The report for the following national clinical audit was conducted in 2013/14 and reviewed by the provider in 2014/15.
Table 2
Audit title Actions to be taken
Prescribing antipsychotics for children and adolescents
1. Attend the RiO Development Group to explore how the electronic system may be able to support / remind clinicians in ensuring appropriate tests are carried out.
2. Liaise with the newly formed Physical Health / Wellbeing Clinics to determine if CAMHS can utilise the services of the clinics to support with testing / screening.
National clinical audit results enable us to benchmark our performance against other participating Trusts. Upon receipt of a national clinical audit report, an internal assurance rating process is applied to the findings which means determining an assurance rating level for each of the criteria audited and then an overall assurance level for the audit itself.
The lead for a clinical audit is responsible for sharing the results with the appropriate locality governance group or senior manager and national clinical audit results are also presented to the Medical Staff Audit Group (MSAG) where doctors discuss the findings. This ensures for local learning and action plans are developed to improve. The delivery of the action plans is monitored through locality and professional governance groups and the Clinical Audit Steering Group.
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Commissioning for Quality and Innovation (CQUIN) audits
There was a requirement to complete the following two audits within the CQUIN schedule.
Table 3
Audit Title Date submitted
CQUIN 3.1: Cardio Metabolic Assessment for Patients with Schizophrenia
Results submitted to Royal College of Psychiatrist in January 2015. Reported on by NHS England in March 2015.
CQUIN 3.2: Communication with General Practitioners
Reports submitted in quarter 2 and quarter 4
CQUIN 3.1 focused on the screening of cardio metabolic parameters and appropriate interventions for inpatients. Evidence suggests that people who experience serious mental illness (SMI) are at risk of dying up to 25 years younger than the general population; the main cause being cardiovascular disease, endocrine disorder and respiratory failure. Evidence also suggests that these individuals receive a lesser standard of health promotion and physical health care. Rates of obesity and type 2 diabetes in adults with psychosis or schizophrenia are higher than those of the general population. Rates of tobacco smoking are also high in people with psychosis or schizophrenia. Increased smoking is responsible for most of the excess mortality in people with SMI and quitting smoking is the single most important lifestyle change that can be made to improve health and life expectancy in this group. Offering combined healthy eating and physical activity programmes and help to stop smoking can reduce these rates and improve physical and mental health. The audit included a sample of patients with a diagnosis of schizophrenia, schizo-affective disorder, bipolar disorder or a drug induced psychosis. Services were required to collect evidence that patients were screened for Smoking Status, Lifestyle, Body Mass Index, Blood Pressure, Glucose Regulation and Blood Lipids and where clinically indicated they were provided with or referred onwards to other services for interventions. BDCT achieved an overall compliance of 26%. The results have only recently been published therefore any actions are yet to be agreed.
CQUIN 3.2 focused on the communication of information to a patient’s GP following discharge from inpatient care. This indicator aim was to reduce premature mortality, improve patient safety, patient experience and quality of life, through shared communications and reconciliation of treatments. There was an audit of e-discharge documentation to determine if information relating to a patients diagnosis, medication and physical health needs had been shared with the patients GP following discharge from an inpatient ward. In quarter two, BDCT achieved an overall compliance of 47.9%. The areas of weaker compliance included the communication of mental and physical health diagnoses, including ICD 10 codes, and monitoring requirements of prescribed medication. The report was reviewed by the provider and the following actions were taken to improve the quality of healthcare provided:
Table 4
Audit title Actions to be taken
CQUIN 3.2 (Quarter 2)
1. Roll out of the electronic discharge process to all inpatient wards 2. Amendments to electronic discharge documentation to ensure it is fully
supportive of the information requirements for GPs 3. Communication to all medical staff informing them of the electronic
discharge information requirements. 4. Electronic discharge training to all relevant clinical staff in all clinical
areas where it is in use.
The audit was repeated in quarter four and we had an overall compliance of 51.8%. As the results have only recently become available, actions are yet to be agreed.
The CQUINS for 2015/16 have recently been published and improving physical health of patients with severe mental illness is again a national priority. The focus will, again, be on cardio metabolic assessment and treatment for patients with psychoses and communication with general practitioners.
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Commissioner requested audits
In addition to audits completed as part of the CQUIN initiative (above), the following audits were agreed with and reported to local Clinical Commissioning Groups as a part of the quality monitoring process for the Trust:
Table 5
Audit Title Date submitted Results (Overall compliance)
Care Programme Approach (CPA) CPA focuses on ensuring that patients with complex needs and / or multi agency involvement are managed appropriately through care planning.
Reports submitted in quarter 2 and quarter 4
Quarter 2: 79%
Quarter 4: 91
Section 117 Aftercare Section 117 aftercare ensures that patients’ who have been detained in hospital under Sections 3, 37, 45a, 47 and 48 receive appropriate aftercare
Reports submitted in quarter 2 and quarter 4.
Quarter 2: 86%
Quarter 4: 82%
NICE Physical Health Checks A baseline physical health check should be carried out for patients initiated on antipsychotic medication. The results of the check should be communicated to the patients GP.
Reports submitted in quarter 2 and quarter 4.
Quarter 2: 60%
Quarter 4: 74%
District Nursing Care Plans Patients on the district nursing case load should have an individual completed care plan setting out the patients goals
Report submitted in quarter 4 Quarter 4: 86%
The reports for three of the above commissioner audits were reviewed by the provider in 2014/15 and BDCT took the following actions to improve the quality of healthcare provided between quarter 2 and quarter 4.
Table 6
Audit title Actions to be taken
Care Programme Approach (CPA)
1. Results and trends to be included in CPA Care Co-ordinator training as evidence of current practice.
2. Produce service level reports and heads of service to agree local action 3. Local actions to include a focus on Carers and CPA reviews and the
distribution of information to attendees 4. Re-design the audit to meet the changing needs of services
Section 117 Aftercare
1. MHA and CPA training will continue to reinforce: a) the importance of aligning Section 117 review with other key review
triggers such as CPA b) that the start date for Section 117 entitlement is recorded in all cases
2. Operational managers discuss these result at both operational and local governance meetings.
3. Operational managers to agree ways to improve completion rates across services.
Baseline Physical Health Checks for Patients Initiated on Antipsychotics and Communication of results with GPs
1. Mental Health Physical Review template to be used to record all physical health assessments.
2. Patients requiring baseline physical health checks and further monitoring checks to be referred to the newly set up Physical Health / Wellbeing Clinics.
3. A robust system in place to ensure the sharing of physical health results between secondary care and the GP.
4. Review of the Antipsychotic Shared Care and Physical Health Monitoring Recommendations.
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Local audits
Internally Driven Projects (Local Clinical Audit)
It is recognised that much of the clinical audit activity in NHS trusts will involve individual healthcare professionals and service managers evaluating aspects of care that they themselves have selected as being important to them and/or their team and this is classified as local clinical audit.
BDCT expects each service type to participate in at least 2 clinical audits per year and particular risk or quality issues may inform the topics they select.
Included in the tables below is a summary of the number of active local clinical audits and action plans arising from such during the period 01/04/2014 to 31/03/2015. This includes contract audits from previous years where action plans are still being implemented but not those in the 2014/15 contract.
Table 7: Local Active Clinical Audits
Registered but Not Started
In Progress Completed Discontinued Total
Adult Mental Health 0 4 0 2 6
Adult Services Community 0 0 2 1 3
Allied Health Professionals 0 6 0 0 6
CAMHS 1 3 1 0 5
Children and Family Services 1 5 2 2 10
Community Dental Services 0 2 2 0 4
Learning Disabilities 0 1 0 2 3
Low Secure Services 0 4 1 0 5
Older People 0 1 0 1 2
Substance Misuse 2 3 0 0 5
Trust wide 0 11 6 1 18
Total 4 40 14 9 67
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Table 8: Action Plans Following Local Clinical Audits
Service Action Plan Delivery Status
Action Plan Not Required
Awaiting Action Plan
Ongoing Implemented Discontinued Total
Adult Mental Health 0 1 1 3 0 5
Adult Services Community 0 0 2 1 0 3
Allied Health Professionals 0 0 0 1 0 1
CAMHS 0 0 1 1 0 2
Children and Family Services 0 0 0 5 0 5
Community Dental Services 0 0 0 3 0 3
Learning Disabilities 1 0 1 1 0 3
Low Secure Services 0 0 0 1 0 1
Older People 0 0 0 0 0 0
Substance Misuse 0 0 0 0 0 0
Trust-Wide 1 1 0 11 1 14
Total 2 2 5 27 1 37
EXAMPLES OF LOCAL CLINICAL AUDITS COMPLETED IN 2014/15
Mental Health Clinical Audit (Local): Re-Audit of Involvement of Fathers and Men in CAMHS (Audit ID: 14/15 0540)
This re-audit was conducted in July 2014 and was a repeat of an audit conducted in 2012. An action plan was developed in 2012 and requirements including reminders to staff about the importance of involving both parents where possible, reminders to staff about information recording requirements, training clinicians to enter appropriate information onto RiO and adaptions to consent forms. The re-audit highlighted that CAMHS clinicians continue to show evidence of involving fathers, if appropriate, when working with children and young people in the service. There is a recognised improvement in the number of cases where genograms or family histories are completed and there is an improvement in the number of cases where a father
or male carer is involved. Clinicians do consider the role of fathers in the lives of children and young people; if the father / significant male did not attend an appointment; the reasons for this were usually recorded. There were only a small number of cases where there were no reasons clearly recorded why they did not attend. The audit highlighted that documentation of consent remains inconsistent and had been completed in less than 50% of cases; and a more consistent approach is required. An action plan has been developed to address some of the poorer areas of compliance. It is intended that some of the recording requirements i.e. consent and parent / carer details forms, will be incorporated into RiO 7.
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Community Services Clinical Audit (Local): Well Child Pathway Re-audit (Audit ID:14/14-0521)
This is a re-audit of an audit conducted in 2012/13. Unfortunately the re-audit does not provide direct comparative outcomes as the Health Visiting record keeping has transferred from a manual to an electronic format. The re-audit reviews the delivery of core contacts, as measured by the outcomes from the Health Visiting Well Child Quality Service Standards and Guidance for Practice (Bradford District Care Trust, September 2011). The Core Contacts are defined in the service standards as part of the core universal programme which is offered to families with a pre-school child. The audit measured actual contacts recorded as having been completed, rather than contacts offered. The results demonstrate that 86% of core contacts were delivered within scope i.e. agreed timescales. Qualitative results demonstrate that 73% of contacts undertaken included subject areas recommended within the Well Child Pathway. Out of
scope interventions occasionally reflect the wishes of service users i.e. where an appointment is refused within timescales offered. It was also recognised that antenatal contacts will be offered as a universal contact in the future, therefore moving away from eligible groups only, which should improve reporting options. The audit highlighted a number of areas for consideration. One is that the teams should receive, or be able to run, regular reports to monitor progress and performance against the Well Child standards. Secondly, since antenatal contacts are to be made a universal offer, the scope to better report on activity directly relating to this contact will improve. Regular reports will be developed and shared with teams.
The report for the following local clinical audit was reviewed by the provider in 2014/15 and BDCT intends to take the following actions to improve the quality of healthcare provided.
Table 9 Audit title Action to be taken
Audit 521- Well Child Pathway 1. Health visiting teams will receive, or be able to run, regular reports to monitor progress and performance against the Well Child standards.
2. The scope to better report on antenatal contact activity will improve.
Service user and carer involvement in audit
Our Clinical Audit Department continues to support and develop service user and carer involvement in audit.
This includes:
• Working with and supporting the Partners in Audit Network (PiAN); a service user and carer audit network.
• Delivering clinical audit training to service users and carers. • Service user and carer representation at our Clinical Audit Steering Group. • Service user/carer clinical audit / service evaluation activity led and carried out by the PiAN.
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7. RESEARCH AND INNOVATION Taking part in clinical research shows our commitment to improving the quality of care we offer. It also makes sure we are contributing to wider health improvements. Research helps our clinical staff stay at the cutting edge of treatment possibilities, which can lead to even better patient outcomes.
Over the past year, our investment in research, together with Yorkshire and Humber Local Clinical Research Network funding, has resulted in continued progress in achieving and exceeding the goals of our research strategy. The aim is to develop our ability and reputation to deliver excellent applied health research, with the potential to improve the health and well-being of the people we serve.
Research governance
We have made real improvements to how we look at applications and grant NHS permission to conduct research in our Trust. Over the last year we have granted NHS permission to 13 commercial and non-commercial studies; all within the revised 15 day national target.
Recruitment of people into research
The number of patients receiving NHS services provided or sub-contracted by Bradford District Care Trust in 2014/15 that were recruited during that period to participate in research approved by a research ethics committee was 237.
We continue to broaden the research projects we are involved in, recruiting to 44 research projects in total.
Staff involvement in research
Around 50 members of staff have registered as actively taking part in research projects as either investigators or local collaborators. A further nine members of staff have taken part as research participants.
We have a teaching programme in place for staff from all professional backgrounds called ‘Evidence to Practice’. In addition, access to training courses involved in research delivery (such as Good Clinical Practice) and study design is provided and interested staff are encouraged to attend. In total 34 staff have attended such training this year.
In addition weekly ‘Translating Research into Practice’ fora are provided for staff. Here, research findings are used to inform best practice. 250 clinical staff have attended these sessions this year.
Public Patient Involvement (PPI) in research
Currently, we have three successful PPI work streams:
i) PPI Research Action Group (PPI RAG). This is a strategic group tasked with delivering the action plan in our PPI in Research Strategy http://www.bdct.nhs.uk/rd/ which was developed by a group of service users in 2013/14.
ii) DIAMONDS. This is a stakeholder group contributing to the development of new research into the treatment of diabetes in people with mental health problems. http://www.diabetesppi.nihr.ac.uk/Invitation-for-Patients-and-Carers
iii) Young Persons Research Involvement Group. We have just received a small funding award to set up this new group. We have launched two ‘research awareness’ sessions and these will be followed by a specially designed research training programme aimed specifically at young people.
Research collaborations
We continue to develop research collaborations with a number of NHS and academic institutions. These include the Universities of Bradford, York and Leeds and the Bradford Institute for Health Research. These have already led to several collaborative grant applications and active research projects. We are a key partner in a major regional collaboration between the NHS and academic institutions called CLAHRC (Collaboration for Leadership in Applied Health Research and Care), leading work streams in the mental health co-morbidities theme.
Posts: Currently a full-time Research Fellow for Culture and Mental Health has been appointed by the Trust and a part-time Senior Research Fellow works between our Trust and the University of Leeds. These posts have supported the development of research projects that will benefit the people of Bradford and Airedale in line with our priorities.
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Research grant applications
Eight grant applications for national funding have been submitted over the last year, in which our staff have been either lead applicants or co-applicants. Currently five research grants have been secured by staff members.
Publications
In 2014 our staff were involved in 14 publications.
Examples of these are:
• Design of an international multicentre trial of group schema therapy for borderline personality disorder.
• Charles Bonnet syndrome and cognitive impairment: a systematic review.
• Developing and implementing a fluoride varnish programme for young children in Bradford, UK.
• A project to Improve links between paediatric liaison nurses and school nurses.
• Interventions for preventing delirium in older people in institutional long-term care.
• Systematic computerised cardiovascular health screening for people with severe mental illness.
• Developing a web-based intervention to increase motivation to change and encourage uptake of specialist face-to-face treatment by hospital inpatients: Change Drinking.
• A study of factors that influence the number of visits following traumatic dental injuries.
• Our work in clinical research shows our commitment to testing, and offering the latest medical treatments and techniques.
Examples of Learning Achieved
Our clinicians have developed research skills in most aspects of the research process, including assessing capacity and consent, trial design and outcomes measurement. They have also gained skills relevant to their clinical practice. For example:
• The PiTStop (Stop Delirium) project helped to develop skills in the assessment of delirium, delirium prevention and working with care homes. The PROMS studies: (Patient Reported Outcome Measures) helped to further the understanding and use of objective outcome measures for people with mental health problems.
• The group schema therapy trial developed skills in delivering group therapy for personality disorder.
• Cultural adaptation studies promoted engagement and compassion for diverse cultural groups.
• A study of Positive Behaviour Support for adults with Learning Disability provided opportunities to learn alternative behavioural management skills.
Impact on services
Examples of studies impacting on service practice:
• A recent study on physical health screening in severe mental illness has contributed to the implementation of a screening template on the electronic patient record system in GP practices in Bradford.
• The review of liaison psychiatry in primary care has informed a pilot of a Primary Care Wellbeing service for physical and mental health co morbidity.
• The review of Faith Adapted Cognitive Behavioural Therapy is going to inform service planning.
• The PiTStop project: has led to the development of a delirium intervention programme which is being rolled out to a further six care homes (in addition to the seven in the trial).
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8. COMMISSIONING FOR QUALITY AND INNOVATION (CQUIN) 2014/15 A CQUIN scheme is a locally agreed package of quality improvement goals and targets, to support improvements in the quality of services. The total value of the 2014/15 CQUIN scheme to the Trust was £2.5 million, which was 2.5% of the value of services commissioned through the NHS Standard Contract.
Indicators within these schemes are based on local and national priorities, support new, improved patterns of care and address the three quality domains of quality:
• Patient safety • Clinical effectiveness • Patient experience
In 2014/15 there were three nationally mandated CQUINs which related to our services:
i. Friends and Family Test
ii. NHS Safety Thermometer Test
iii. Improving physical healthcare to reduce premature mortality in people with Severe Mental Illness http://www.england.nhs.uk/wp-content/uploads/2014/02/sc-cquin-guid.pdf
Benefits of these schemes include:
• Consistent method for collecting feedback from service users, patients and carers to be utilised in service development
• Additional resource invested to understand the themes and trends of occurrence of pressure ulcers, in order to identify areas requiring improvement. Teams and care homes have then received additional support and training to minimalise the number of patients developing pressure ulcers
• Inpatients receiving physical health assessments as part of their care plan and results shared with GP in a timely and consistent manner across all specialisms
In addition to the three schemes above, we agreed a further four CQUIN schemes for mental health, learning disabilities and community services with our local Clinical Commissioning Groups and a further five with NHS England which commissioned our low secure and health visiting services .
The Clinical Commissioning Group schemes were:
1. Liaison Psychiatry a. Time to assessment in A&E b. Time to assessment on Older people’s
wards c. Liaison psychiatry training
2. Integrated community team approaches to proactive continuity of care
a. Increased management of lower risk patients
b. Care plans c. Patient satisfaction
3. Integrated working between acute and community care
a. Integrated discharge co-ordination reducing emergency readmissions into Airedale General Hospital
b. Reducing emergency admissions Bradford Teaching Hospitals
c. 24-hour community nursing response 4. Child and Adolescent Mental Health Services
(CAMHS) transition for young people moving on from CAMHS into adult services.
Benefits of these schemes included:
• The production of an electronic training package ‘Mental Health Awareness’ aimed at non- mental health care professionals. This has been implemented by Bradford Teaching Hospitals and Airedale General Hospital and shared with other external colleagues as part of the West Yorkshire training forum. The purpose of the training package is to ensure that all participants increase their awareness of common mental health problems and illnesses, the treatments required and how to access local services.
• All service users who transitioned from CAMHS were asked for feedback relating to their experiences and actions have been taken in response to the feedback received. In partnership with Barnado’s an ‘app’ is being
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developed for young people to access information about transitioning to other servicers. Transitions leaflets have been produced in response to the request for more information about where services are based and the choices young people have about their care
• 95% of patients referred to us from the older peoples wards of acute hospitals have been seen by a member of our Acute Liaison Team within 24 working hours.
• 95% of patients referred from A&E have been seen by a member of our A&E Liaison Team within 2 working hours.
• The integrated care plans that have been implemented for the Multi-Disciplinary teams have been audited by the commissioners to ensure consistent and effective use.
• Patients from the Integrated Care Teams, whose lead practitioner was a member of our staff, were asked to complete a survey about the care they had received. The results showed over 90% responding positively to each question.
• We were successful in delivering 71% of the targets agreed with the CCG’s
The NHS England schemes were
1. Collaborative risk assessments (low secure)
2. Supporting Carer involvement (low secure)
3. Needs formulation at transition (low secure)
4. Quality Dashboard (low secure)
5. Building Community Capacity (health visiting)
Benefits included:
• Service users are now actively involved in their risk assessment and developing their own risk management plan
• We have implemented a framework to ensure service users are encouraged to identify key and meaningful family members, and that they are involved in their care and recovery plan. This ensures that they are involved in the care planning of the service user, should they choose to be
• All service users now receive information within seven days of admission detailing how the service might best meet their current and future needs. This is to try to reduce any worries a service user may have about what is going to happen to them whilst they are within our care.
• We implemented eight groups during 2014/15 to provide advice to families within the local community with pre-school children. Attendance at the groups has been varied but on the whole they were well received.
• We were successful in delivering 96% of the targets agreed with NHS England.
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9. DATA QUALITY We are committed to making sure that the data we use to deliver effective patient care is accurate and used in the same way across the whole Trust. Improving the quality of the data we use improves patient care.
We currently have three key electronic clinical record systems: • RiO (mental health and learning disability services) • SystmOne (community services) • R4 (salaried dental services)
Improving Data Quality
Bradford District Care Trust will be taking the following actions to improve data quality:
• Working towards integration of clinical systems. • Provision of read only primary care record to
mental health and dental services. • All BDCT staff undertake annual Information
Governance training which includes a focus on data quality, completeness and accuracy
• Delivering ongoing training and information to staff about our clinical systems
• Making sure we have strong processes in place to manage data quality within services.
• Seeking assurances from inside our organisation and from outside agencies on our ability to maintain high quality data.
• Improved automated reporting and alerts to support our clinicians to improve data quality.
• Consolidate the recent upgrade to Rio version 7 which will include greater system front end validation which will minimise user input issues.
• Continued working with clinical and administration teams to assist where data quality issues have been identified.
• Joint working with Commissioner to enhance data quality
NHS number and general medical practice code validity
Bradford District Care Trust submitted records (obtained from RiO) during 2014/15 to the Secondary Uses Service for inclusion in the Hospital Episode Statistics which are included in the latest published data. The percentage of records in the published data which included the patient’s valid NHS number (for the period April 2014 to November 2014) was:
• 99.6% for admitted patient care • 100.0% for outpatient care
Bradford District Care Trust (community and dental services) did not submit records during 2014/15 to the Secondary Uses Service for inclusion in the
Hospital Episode Statistics which are included in the latest published data.
The percentage of records in the published data which included the patients valid general medical practice code was:
• 99.1% for admitted patient care • 99.9% for outpatient care
Information governance toolkit
In order to be compliant with the toolkit in 2014/15, a minimum score of 2 in all 45 criteria must be achieved. The trust achieved 10 requirements at level 2 and 34 at level 3; this is a substantial improvement on 13/14.
Clinical Coding Error Rate
Bradford District Care Trust’s services were not subject to the Payment by Results clinical coding audit during 2014/15 by the Audit Commission. As part of the Information Governance toolkit a diagnoses coding audit was undertaken (ICD10 coding audit). The 2014/15 audit resulted in a score on 95% on Primary Diagnoses and 87% on Secondary Diagnosis. This improvement was as a result of the implementation of an improvement plan.
High Quality Information
We continue with our commitment to excellence of data quality standards. We have or plan to meet the requirements for the following datasets:
• Child and adolescent mental health services (CAMHs) dataset
• Community information dataset • Improving access to psychological therapies
dataset • Mental health & learning disabilities dataset • Children and young people’s health dataset • National drug treatment monitoring system
dataset
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Part 3: Review of Quality Performance 2014/15
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Part 3: Review of Quality Performance 2014/15
10. TRUST QUALITY PRIORITIES In our 2013/14 Quality Account we identified our priority areas for 2014/15 which were developed in response to consultation with key stakeholders, including our stakeholder involvement event held in January 2014.
In sections 11 and 12 of this document you will see the mandated and locally agreed numerical indicators and how we performed against them.
We also committed to give more information regarding those areas that our stakeholders wanted know more about, we have used stories and real examples to demonstrate what we are doing in these areas which are listed below:
• Impact of using agency staff – see page 34
• Minimising use of restraint – see page 74
• Learning from incidents – see page 73
• Compliance with the National Cleanliness Audit Programme – see page 62
• Use of carers assessment – see page 39
• Access to advocacy services – see page – 39
• Use of service user and carer feedback within individual appraisals – see page 39
• Providing a single point of access – see page 40
• Learning from best practice – see page 32
• Meeting the needs of people on the Autism spectrum – see page 33
• Importance of good record keeping – see page 18
• Processes for discharge and transition – see page 18, 31
• Staff wellbeing – see page 47, 49
• Addressing physical health needs in Mental Health and Learning Disabilities services – see page 34
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11. MANDATED INDICATORS In guidance published January 2013, providers were asked to include relevant mandated indicators in the Quality Account. The source of the data has been identified as The Health and Social Care Information Centre (HSCIC) .The mandated indicators relevant to the Trust are: Table 10
Mandated Indicators
Agreed improvement target / Benchmark
BDCT as per HSCIC 2013/14
BDCT as per HSCIC 2014/15
% of patients on Care Programme Approach who were followed up within 7 days after discharge
Monitor target 95%
97.6%
98.6%
Highest scoring Trust England Average 97.3%
100% 100%
Lowest scoring Trust 77.2% 90.0%
% of admissions to acute wards for which the Crisis Resolution Home Treatment Team acted as a gatekeeper
95% Monitor target 100% 100%
Highest scoring Trust England Average
97.8%
100% 100%
Lowest scoring Trust 85.5% 73%
% of staff who would recommend the trust as a provider of care to their family or friends. National Average
59%
61% 64%
Highest scoring Trust 84% 84%
Lowest scoring Trust 38% 36%
“Patient experience of community mental health services” indicator score with regard to a patient’s experience of contact with a health or social care worker National Average
85.8% 2013/14
86%
Data not yet published
Highest scoring Trust 90.9%
Lowest scoring Trust 80.9%
The number and rate of patient safety incidents reported within the trust and the number and percentage of such patient safety incidents that resulted in severe harm or death.
All MH Organisations
Severe: 0.30%
Death: 0.70%
0.71% Severe Incidents
0.85% Death
incidents
0.50% Severe Incidents
0.40% Death
incidents
Best score – Severe incidents 0% incidents 0% incidents
Best score – Death 0% incidents 0% incidents
Worst score – Severe incidents 1.81% incidents 2.9% incidents
Worst score - Death 4.49% incident 3.0% incidents
Source: Health and Social Care Information Centre (HSCIC)
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Bradford District Care Trust considers that this data is as described for the following reasons:
• 5 of the 15 mandated indicators apply to BDCT (table 10) • Although the guidance states that indicator – ‘patients readmitted to a hospital within 28 days of being
discharged from a hospital’ relates to all trusts, no data is published for mental health services on the HSCIC website, therefore this indicator has not been included in table 10.
• Of the mandated indicators with data published the Trust has improved its performance for all four of them
• Of the mandated indicators with data published the Trust has met the targets of 3 out of four of them • We have consistently met the 95% target for % of patients on Care Programme Approach who were
followed up within 7 days after discharge throughout the year. • We have continued to meet the 95% target for % of admissions to acute wards for which the Crisis
Resolution Home Treatment Team acted as gatekeeper
12. LOCAL INDICATORS In summary for 2014/15 we monitored 29 local indicators. These were reported on a quarterly basis to the Quality and Safety Committee and Trust Board received a summary update. The majority of these indicators were set a ‘stretch target’, an aspirational target that is set at a level that ensures the organisation is challenged to deliver.
Locality based working
Bradford District Care Trust uses a locality based model of working; our services are based around Clinical Commissioning Group (CCG) boundaries and connected into General Practitioner (GP) practices. This means our staff are more connected to local populations and their healthcare (both physical and mental health) needs. The three localities that work in this way are as follows:
• Airedale Wharfedale and Craven Locality • Bradford District Locality • Bradford City Locality
The Trust also has two further localities as follows:
• Acute Care Services; including the ‘acute’ wards at Airedale Hospital and Lynfield Mount Hospital plus community based services such as the First Response Service, the Intensive Home Treatment Team and the Accident and Emergency Liaison Service.
• Specialist In Patient Services; including low secure services, learning disabilities assessment & treatment unit, in patient services for older people and psychological therapy services.
Sections 12a to 12c of this account show our performance against the 29 local indicators, and provide examples of the work we have been progressing in relation to the following areas:
• Clinical Effectiveness • Patient Safety • Patient Experience
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12a. CLINICAL EFFECTIVENESS
Health Passport for young people leaving care The Looked After Children’s Health Team provides a statutory health assessment service to all Looked After Children within the Bradford District. There are also over 500 Care Leavers within our District who are aged between 16 – 21 years. These young people have experience of the care system and often present with complex and traumatic histories. They are typically challenging to engage with. In order to meet their health needs the BDCT LAC Health Team employs a Care Leavers Nurse (Liz Gilmartin).
Liz has been able to establish positive therapeutic relationships with a whole group of Care Leavers who are also members of the Children in Care Council. The Children in Care Council have actively engaged in a piece of project work to design a health passport and implement the use of health passports across the District.
Over a number of weeks the young people in the Children in Care Council have offered their time, enthusiasm and insights into the content and design of the health passport. This has often involved them reflecting on and being open about their own experiences and needs as a young person within the care system. They have worked together with Liz to produce a dynamic document that contains all their relevant health information. This is of vital importance to young people with a history of being in care who do not have the same family and support networks to rely on.
The health passport allows the young people to own and retain their own health information and respect the sensitivity of this information, it encourages them to take ownership of their health needs independently and focuses their commitment and contribution to the Care Leavers Health Assessment process.
The Health Passport has now been designed and printed. Young people are now receiving their health passports as part of their health assessment with the Care Leavers Nurse. The group is committed to improving the quality of the health passport and are providing written / verbal feedback to refine, shape and further improve the health passport.!
So far young people have told us:
“It’s very nice (the health passport). It’s an easy and tidy way to keep all your health information together.”
“I love it! (the health passport).”
“It’s awesome!”
“I didn’t even know half of the stuff in it (the health passport).”
“This will really help the doctors who will look at it and be able to help me.”
“It’s eye catching!”
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Table 11
CLINICAL EFFECTIVENESS QUARTER 4 2014 / 2015
Indicator Target District City AWC Spec Acute Trust Position
3a Improving physical healthcare to reduce premature mortality in people with Severe Mental Illness
CQUIN Not applicable to these localities 26% 90% target not achieved
3b Quality Assurance of Care Plans CQUIN Anonymised data / not available by locality P
3c Admissions to acute wards for which CRHTT acted as a gate keeper
95.0% Not applicable to these localities 99.5% 209/210
99.5% 209/210
3d Improving the experience of transition between CAMHS and adult MH services
CQUIN Anonymised data / not available by locality P
3e CPA reviewed within the last 12 months 100.0%* 97.1%
750/772 95.6%
328/343 97.4%
538/552 82.6% 19/23
83.3% 10/12
96.5% 1645/1703
3f CPA reviewed within the last 6 months 80.0%* 79.7%
616/772 72.0%
247/343 63.2%
349/552 52.1% 12/23
83.3% 10/12
72.4% 1234/1703
3g In-date Cluster / Clients Clustered 95.0%* 80%
2377/2968 74.8%
930/1242 85.3%
1262/1478 82%
564/687 88.3%
265/300 79.5%
4556/5728
3h In-date Cluster / Clients in scope 95.0%* 77%
2377/3084 72.7%
930/1279 83.3%
1262/1515 81.5%
564/692 87.7%
265/302 76.7%
4566/5933
*stretch targets
The eight local clinical effectiveness indicators above (table 11) have been reported internally on a monthly basis to monitor in year progress:
• 8 of our local indicators in the 2014/15 Quality Account look at how effective our services and care have been. Of the 8 targets, 3 were met
• of the indicators 3 relate to the successful delivery of CQUINs (see section 8 for more detail) of which we successfully achieved 2 (3b and 3d)
• The targets for indicators 3e-3h were intentionally set as high aspirational targets in order to stretch our performance
• By breaking the data down by locality it highlights the better performing areas who can share best practice to others.
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Learning from best practice – Translating Research into Practice Seminars (TRIPS) TRIPS are a unique way of communicating evidence based practice to all staff. Every week a different member of staff acts as guest presenter and gives a talk on a subject they have researched as part of their job or studies. Angus Sturrock, Clinical Studies Officer and Programme Lead for TRIPS, said: “TRIPS is an innovative forum where staff can get together and educate each other on best practice. We’ve also used the sessions to get together and discuss current issues in nursing.”
The subjects covered are many and varied. Angus explained: “The weekly format allows for many subjects to be tackled which aren’t currently offered as part of standard training. There’s something different every time, and I think that’s part of the appeal of TRIPS.
Recently we’ve heard talks about the benefits of music therapy, violence reduction, cultural awareness in mental health services and addressing service users continence needs.”!
A range of staff have used TRIPS to share their knowledge, the sessions are a good opportunity for students who need to present as part of their studies, to develop their presentation skills as well as sharing their latest findings.
Dr Andy McElligott, Medical Director who also has lead responsibility for Research and Development across the Trust, said: “As healthcare professionals we know that using the latest research enables us to provide the best possible care for the people who use our services. The fact that our colleagues are delivering TRIPS weekly provides us all with the perfect opportunity to join a shared learning experience and keep ourselves at the cutting edge of evidence based practice.”
Our staff had the following to say:
“As a service that has contact with people who use any of the Trust’s services we feel it is important to take any opportunity to learn more about a subject which will help us in the future. We always try to have a member of the team attend every TRIPS, they then come back and share the learning with the rest of the team.” – Val Convery, Pals Officer
“I enjoyed sharing my latest research about young people who self-harm. There was a great discussion, the time flew by!” – Tony Collins, CAMHs nurse
“I have enjoyed the sessions I have attended, which have provided a fabulous snapshot of the fantastic work being carried out by staff across the organisation. It is a good forum for sharing innovative practice and discussing topical issues.” – Olwyn Lidster, Clinical Lead Mental Health
“I enjoy sharing my knowledge of gender identity disorder, along with the discussion that the presentation generated following. Everyone listened well and had opportunity to discuss their views.” – Jennifer Clague, Staff nurse
“The session I attended today was helpful in understanding more about Transgender. The presenter was excellent in how she gave an understanding of Transgender.” – Adrian Sta Maria, Health Assistant
Tony Collins shares his research.
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Meeting the needs of people on the Autism spectrum Young people with Autism launch new guide for professionals.
Autism can often be misunderstood, but thanks to a new toolkit developed by young people we now have a very real insight into the condition. ‘Autism from a Young Person’s Perspective’ includes first hand examples, case studies, drawings and poetry to help people to understand what Autism is, how people with Autism feel and believe society feel about them, how to offer appropriate support and how people want to be supported and treated.
It was created by young people who access our Child and Adolescence Mental Health. Services. They attended a summer project jointly hosted by our Trust and Barnardo’s Healthy Minds Participation Service. At weekly workshops, young people with Autism put down on paper, how they would like to be understood and supported by adults.
One of the young people involved said: “I take things literally. What is said is what is really meant and I follow all rules told to me. A door said ‘Keep Closed’ on it. I could not open the door at all because the sign told me not to, so I stood there for ages not being able to go through it.”
Autistic people focus in on details therefore you have to be specific in your language. Say what you mean and do not use sarcasm, metaphors, similes’ that may confuse them.
Another young person added: “When you talk to me I take what you say literally. Do not use sarcasm with me.”
For those who didn’t want to say their views out loud they were provided with the tools to create artwork to include in the toolkit (some also feature on this page).
Catherine Wright, Occupational Therapist helped to facilitate one of the workshops, she said: “It’s important that people understand what it’s like to be a young person living with autism and I think we achieved this with the toolkit. There’s very little written about Autism by young people. This powerful tool helps to give people confidence by giving young people a voice. It also helps us as professionals create a quality service by being more informed.”
The toolkit is aimed at health and educational professionals and also parents and carers of young people.
Dave Benn, Barnardo’s Children’s Service Manager said: “The toolkit offers practical information about understanding of Autism from a young person’s perspective. There are 12 top tips for professionals in relation to making services more inclusive for young people and advice and support for professionals which is based on young people’s direct experience of services.”
It also contains a useful resource list of services, containing an overview of the services and contact details for professionals to access.
To receive a copy of ‘Autism from a young person’s perspective’ please contact [email protected]
#"!
Addressing physical health needs in Mental Health and learning disability services
Making a Difference for Community Mental Health Community Mental Health is getting a boost thanks to our new Advanced Nurse Practitioners. Here, Neil Buckingham and the team tell us how. What’s the role of the team?
We focus on the physical and mental health needs of service users. We’re here to help streamline the service, meet needs more quickly and improve service user experience.
So how are you doing that?
Our job has many sides to it. We support consultants with their case loads. This involves frequently reviewing their case loads. It may mean we can transfer a service user’s care to ours to complete short term work and medication reviews.
We offer patients who may previously have been placed on the consultant’s case load assessments to make sure their care is coordinated at the right level. This has the potential to improve access times in the service and may mean a person can be discharged much quicker.
We’re doing lots of work with GPs around appropriate handovers when we discharge service users back into their care because this was something that they’d asked for reassurance about.
As well as the mental health support we also carry out physical health screening and refer to other specialist health providers if necessary. As part of the Calderdale Competency* we are focusing on the future training needs of staff to meet physical health needs of service users.
So, better patient care?
Yes, definitely. Assessing case loads frees up consultant time to work more closely with those identified as in greatest need and ensures they have more flexibility to work as clinical experts in their area.
We’re qualified prescribers and so meet service users at our nurse led clinics. This means if a person needs to start or change their medication we can often do this in a very short period of time.
The physical health checks have the potential to reduce inequalities that exist for mental health service users. You could say we offer a ‘one stop shop’ for both physical and mental health assessments.
What feedback have you had?
The service began in October 2013, and we’ve been working closely with local professionals to understand the needs of local people. One consultant described our work as a ‘fresh pair of eyes’.
Overall we’ve had a positive reaction from service users. From RiO** we know a lot about them before we meet, so they don’t have to repeat their story, which people appreciate. What also helps is that we’re flexible; we’ve been out to homes and seen people in clinics. The fact that we offer regular contact and that they can call us if they need us is reassuring to people.
* A transformational tool used to improve the way people work. It aims to provide a clear and systematic method of reviewing skill mix roles and service design to ensure safe and effective patient centred care. First developed and implemented by Calderdale and Huddersfield NHS Foundation Trust.
**The clinical record system for mental health services.
Neil Buckingham
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Dental services tailored to meet the needs of individuals
The salaried (community) dental service provides clinical care for patients unable to access care from a family dentist and deliver a range of by community based oral health improvement programmes.
The dental health of young children living in Bradford is amongst the worst in the country and poor oral health has a number of impacts on general health. Dental disease is largely preventable and during 2014-15, the service further developed the delivery of oral health interventions and advice into the Integrated Care Pathway at Children Centres. This has provided an opportunity for preschool children who do not seek dental care from a family dentist to have access to preventive advice and the application of fluoride varnish an evidence based intervention.
‘Looked after’ children tend to have poorer health and wellbeing than their peers; the dental service has developed a pathway with the looked after children’s team to ensure access to timely dental care. A number of presentations on paediatric dental neglect have been delivered to increase awareness and promote interagency working.
Obese patients are a high risk group for tooth decay due to diets which are high in refined sugars. In addition obese patients may have other health issues which can affect their dental health, making provision of dental care in local dental practices challenging. This is further compounded by patients only seeking dental care when they are in pain. The service provides dental care for patients who may be medically compromised and whose weight exceeds that for a conventional dental chair.
A significant proportion of the population suffer from dental anxiety and for those with extreme anxiety receiving dental care in general dental practice is impossible. To address this, the service has provided dental care with intravenous sedation as an alternative to providing care with general anaesthesia. A further development has included the training of a dental nurse to deliver cognitive behavioural therapy now supports the dental team. Evaluation of the service has shown that the patient’s anxiety score is lowered significantly following CBT and may avoid the need for care with intravenous sedation. In the long term by developing coping strategies patients will be able to access routine dental care in general dental practice.
Developments in community nursing services
The Bradford services have been working proactively with commissioners to review the community nursing services which include District Nursing, community matrons and case managers. This has involved a working group which has met monthly to discuss the ongoing issues within the service, including agreeing a new service specification and vision for the service.
The community nursing service has worked closely with GP practices, social care and the Voluntary Community Sector (VCS) to ensure there is a wider integrated community team (ICT) which provides services according to local community need across the district, aligned to GP practice communities. This helps to ensure that patients are getting the right service, at the right time, as close to home as possible.
During 2014 / 15 we have worked closely with care homes to establish robust pressure ulcer prevention training and support.
In the Aire Wharfe Craven area specifically, we have agreed a new integrated community nursing specification working closely with acute colleagues and commissioners we will be consulting with staff on providing a core district nursing service which includes extended hours. In addition we have implemented a primary catheterisation policy aimed at patients in residential and nursing home settings. The purpose of this approach is to prevent unnecessary admissions to hospital for patients who are in urinary retention, but where hospital admission would cause unnecessary distress or an unfavourable outcome. The pathway is shared with primary care practitioners and supports joint decision making with the patient and carers. A trial without catheter procedure has been developed alongside this pathway to enable community staff to remove catheters as required. Staff have been trained in aspects of this care via the continence service, and additional equipment provided in ‘grab bags’ to enable a fast response to requests.
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Early supported discharge project in collaboration with Bradford Teaching Hospitals Foundation Trust (BTHFT).
This project took place as part of patient safety week. The purpose of the work was to ensure that a robust patient flow was maintained between hospital and community services, with key partners such as community nursing services within BDCFT and social services taking part in the exercise. This approach involved a case manager and district nurse supporting the BTHFT in managing the patient flow and educating the ward staff on the services that are provided within the community. A head of service and service manager attended the daily executive ward round which involved questioning both medical and nursing staff on their perceived difficulties in maintaining patient flow and ensuring that patients are discharged in a timely manner. The approach was very successful and BDCT continue to provide a case manager and staff nurse within the community to support ward staff in expediting discharge when appropriate and ensuring that patient flow is maintained. This has now developed into a collaborative approach to care, building strong relationships with both acute and primary care providers and ensuring that early discharge is provided in a supportive and safe way.
Families First; working in partnership
Families’ first has been a 2 year initiative involving police, probation, LA and ourselves, we are one of the few partnerships in the country which had a health component to the initiative. The approach involved working with families who were not engaging with any service including the education system, health or general practitioners. There Department of Health have shown an interest in this work and we were visited by the national team who have praised the collaborative working involved. There are numerous case studies published locally on families stories on how they have engaged positively with services through this initiative, from their children engaging and attending school, to visiting GP’s to gain support with mental health issues. There has also been a positive outcome in terms of families engaging with our dental services and going on to register with a dentist to maintain their oral hygiene.
WY-FI:
BDCFT has been actively involved in supporting the local and regional West Yorkshire-Finding Independence (WY-FI) to improve the lives and wellbeing of people with the most entrenched multiple and complex needs who don’t engage in services, revolve in and out of services or are excluded from services.
People will be assessed as having at least 3 of the 4 complex needs of problematic substance misuse, homelessness, mental ill health and/or re-offending behaviour. We estimate 1,455 people out of the 2,445 people in West Yorkshire who experience 3 or more of these needs in do not receive some or all of the services that they require. The programme is designed to support 1050 beneficiaries over its 6 year term.
Over the next 6 years the WY-FI project plan will deliver improvements to the service user journey by enabling integrated working between services and agencies including:
Improved Service User Outcomes – service users have control over their support plans and are more engaged in the design, delivery and management of services
Service Delivery - more effective and efficient through organisations collaborating and sharing information about themselves and about service users
Commissioning - of services is increasingly integrated, cross agency and more focused on outcomes and impact, which looks at the service user journey rather than individual episodes in the journey
Policy Change - is effected to improve opportunities for people with multiple needs to engage positively in society, benefit from mainstream services and to improve positive perceptions of this marginalised group
The project will deliver a standard service and delivery model across the West Yorkshire area joining services together, developing joint care plans and influencing future models of commissioning. The project will co-ordinate services but there is no new service delivery elements to the model unless identified and funded through the Innovation Fund.
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12b. PATIENT SAFETY
That’s Good Practice! We were pleased to add another award to the trophy cabinet this year when we won ‘excellence in care planning policy and practice statements’ at the Care Coordination Association Good Practice Awards. The national award was for training developed by Jane Spooner, Mental Capacity Act Lead and Julie Laslett, Care Planning Approach/ Clinical Risk Trainer. The training accompanies the Trust’s Advance Decision and Advance Statement information book for service users, carers and health and social care professionals.
Julie said: “We were extremely surprised to find out that we’d won. We’ve been delivering the training for around six months. It gives all staff an opportunity to enhance their professional development. We share good practice around service users’ needs in a supportive forum. We’ve received excellent feedback, particularly from community staff.”
Table 12
SAFETY – Year end position 2014 / 2015
Indicator Target District City AWC Spec Acute Trust Position
1a
Reduction in the prevalence of pressure ulcers
1.8%
4.7% 1.9% 2.3% 0% 0% 3.9%
As a rolling median average (5 months) 4.2% 3.0% 2.3% 0% 0% 3.6%
1b CPA follow up 7 days after discharge 100%* 100%
13/13 100% 11/11
100% 21/21
100% 6/6
98.2% 108/110
98.5% 204/207
1c CPA follow up 3 days after discharge 88.0%* 46.1%
6/13 36.3% 4/11
57.1% 12/21
66.6% 4/6
71.8% 79/110
68.0% 141/207
1di Number of incidents (excluding near misses) By locality as a % of Trust position
n/a 1206 15.6%
509 6.59%
477 6.17%
5357 69.33% 7726
1dii Number of Patient Safety Incidents only By locality as a % of Trust position
n/a 812 22.94%
253 7.17%
245 6.92%
2185 61.74% 3539
1diii
Number of Patient Safety Incidents with a severity of Major or Catastrophic By locality as a % of Trust position
n/a 12 37.5%
6 18.75%
8 25%
6 18.75% 32
1e Compliance with the National Cleanliness Audit Programme 100%* 92.2% 94.2% 95.2% 95.5% 93.9%
1f Risk registers: Actions in place against risk 100%* 80.0% 100% 100% 91.7% 100% 92.8%
1g Risk registers: reviews undertaken in date 100%* 80.0% 64.0% 58.3% 83.3% 90.0% 72.8%
1h Safety Thermometer outcomes; harm free care (BDCT services) includes pressure ulcers
100%* 98.0% 100.0% 99.0% 97.3% 98.5%
*stretch targets
#&!
The ten local safety indicators above (table 12) have been reported internally on a monthly basis to monitor in year progress:
• 10 of our local indicators in the 2014/15 Quality Account looked at the safety or our service users • The targets for indicators 1b,1c,1e-1h were intentionally set as high aspirational targets in order to stretch
our performance • Indicators 1di/ii/iii highlight that although we are a high reporting Trust for incidents, the number that relate
to patients safety are 45.8%, and of those 3,539 incidents less than 1% resulted in severe harm or death. • The target for indicator 1a is to reduce the prevalence of pressure ulcers to 1.8% over a consecutive 5
month period. We acknowledged that this was going to be a difficult target to achieve, at the beginning of the year, as we were already one of the better performing trusts in 2013/14
Impact of using agency staff SAFER STAFFING
We now have safer staffing boards on display at our 13 in-patient wards at Lynfield Mount. Hospital and the Airedale Centre for Mental Health. These show service users, staff and visitors the planned and actual numbers of staff (registered nurses, clinical support workers) on shift each day, who is in charge and if they feel as though the ward is safely staffed. Every month our staffing levels are published on the Trust website and on NHS Choices.
Cathy Woffendin, Deputy Director of Nursing and Specialist Services, said: “Patient safety is very important to us. We already have measures in place to make sure that our wards are safely staffed. The safer staffing boards will help us to quickly identify staffing issues facing our in-patient teams and will mean we can respond to these more efficiently.”
Safer staffing boards became a national requirement in April 2014 and are part of the NHS response to the Francis Inquiry.
Whilst safer staffing is not currently a national reporting requirement within community services the Trust has implemented a rolling programme to
report safer staffing figures to the Board. This commenced in January 2015 with Family Nurse Practitioners, and has since rolled out to Early Intervention in Psychosis, Assertive Outreach Team, Health Visitors, School Nursing and Special Needs school nursing. It is planned that by December 2015 the following community services will also be added:
• Community Matrons • CMHT • CAMHS • District Nurses
#'!
12c. PATIENT EXPERIENCE
Patients say ‘yes’ to Care Trust Patients using Bradford District Care Trust’s services are giving positive feedback through the Friends and Family Test (FFT). The community and mental health provider launched the FFT in November 2014 and has seen over 400 patients answer a simple question about the care they have received.
87% of patients said that they would recommend the Care Trust to friends or family if they needed similar care or treatment.
Tracey Corner, Friends and Family Test Lead at the Care Trust, said: “Thank you to everybody who has taken the time to respond to FFT. Every comment we receive is looked at in detail and given back to the appropriate team to help improve patient experience.
“88% of the comments we have received are all positive. A lot relate to staff’s positive attitude, with people commenting on the support they have been given. Our staff spend a lot of time making sure that the patient and their carer is at the heart of what we do through customer care training and embracing the NHS England’s compassionate care programme.”
Staff at the Care Trust are using a number of ways to ask the question. This includes providing patients with a hand held device at the end of their appointment to ‘tap in’ their answer, or handing patients a card with a web address so that they can complete at a later date.
Responding to the FFT question is simple, free, voluntary and anonymous. Care will not be affected in any way.
The FFT is the biggest collection of patient views. It is already being used in NHS acute in-patient, maternity, A&E departments and GP Practices. All mental health and community services across the country joined the Care Trust in asking the question on 1 January 2015.
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Table 13
PATIENT EXPERIENCE – Year end position 2014 / 2015
Indicator Target District City AWC Spec Acute Trust Position
2a Friends & Family test (staff) – implementation CQUIN Locality split not available P
2b Friends & Family test (patients) – implementation CQUIN Locality split not available P
2c
Community MH experience of contact with a health or social care worker. % of service users whose experience was positive
73.0% Anonymised data / not available by locality 70.0%
2d % of carers offered a carers assessment 65.0%* 44.7%
492/1101 68.8%
190/276 47.0%
237/504 64.7%
101/156 67.9%
131/193 47.0%
813/1731
2e
Mental Health Act; detained patients whose section was not allowed to lapse
100%* Not applicable to these localities 98.8% 98.8%
2f Mental Health Act; patients detained legally 100%* Not applicable to these localities 99.5% 99.5%
2gi PLACE assessment – Privacy, dignity, well being 100%*
Not applicable to these localities
91.95% 91.95%
2gii PLACE assessment – Cleanliness 100%* 98.39% 98.39%
2giii PLACE assessment - Food 100%* 97.58% 97.58%
2giv PLACE assessment – Appearance & Maintenance
100%* 96.67% 96.67%
2h Patient satisfaction survey / feedback following an integrated team approach
CQUIN Anonymised data / not available by locality P
*stretch targets
The eleven local patient experience indicators above (table 13) have been reported internally on a monthly basis to monitor in year progress:
• Eleven of our local indicators in the 2014/15 Quality Account looked at the experience of our patients • Three of the indicators are CQUINs, and we can successfully report that the requirements for them all
have been achieved • The targets for indicators 2d-2giv were intentionally set as high aspirational targets in order to stretch our
performance • We have again scored very highly on the assessments of our food, cleanliness etc. • We are disappointed with the lack of progress made during the year regarding the reporting of carers
assessments but it continues to be a priority and look forward to seeing the impact of the work by the Carers Lead
#)!
Use of Carers Assessment and indicator 2d During 2014/15 a fulltime Carers Lead has been appointed to champion carers in the organisation. Part of this new role is to strengthen Carers in Action work, building up networks with external organisations, e.g. Barnados , Carers Resource and Making Space.
Recognising that our past performance has not been as good as we would have liked and inaccurate recording of data, systems have been upgraded to simplify data capture. Teams now receive regular reports on their performance to ensure they can monitor their own progress.
Access to Advocacy BDCT works with Bradford and Airedale Mental Health Advocacy Group (BAMHAG). BAMHAG are a voluntary organisation who provide independent advocacy for service users with Mental Health needs. BAMHAG help service users say what they want, secure their rights, represent their interests and obtain the services they need.
A BAMHAG representative is available on our inpatient sites or can be accessed via service user groups.
If you want to know more about BAMHAG http://www.bamhag.org.uk/c/about-bamhag
$+!
Use of service user and carer feedback within individual appraisals Can you C me?’ is a new tool exclusive to our Trust which you will start to see and hear more about in the coming months. Here, Kerry Bennett, Quality Health & Innovation Lead, tells us more. How well do you think you are demonstrating the 6Cs in the workplace? The Nurse Development team is currently developing a tool to further support staff, service users, students and partners in service provision to demonstrate how all staff are displaying compassion in practice in whatever role they undertake within the Trust. Following on from the great success of embedding an understanding of the 6C’s throughout all service areas and the recruitment of our Care Maker trust ambassadors, the ‘Can you C me?’ tool aims to continue this momentum. The tool will offer support for all staff to evidence how their individual or team practice demonstrates these behaviours and values of the 6C’s in everything they do. The ‘Can you C me?’ concept can be displayed in all service areas to welcome discussion around the 6C’s and Compassion in Practice. The poster format has been translated into the five most frequently used languages in Bradford and Airedale; Urdu, Slovak, Bengali, Polish and Punjabi, to ensure that this tool supports an inclusive approach as we recognise culture significantly impacts on an individual’s experience of compassionate care.
The tool also provides staff with an opportunity to receive third party feedback that can be reflected upon within individual appraisal, Revalidation or discussed at wider service or team forums to share best practice and support service improvement.
Debbie Cromack, Practice Learning Facilitator, explained: “We often hear in national reports that NHS staff sometimes feel undervalued. ‘Can you C me’ is a simple and flexible feedback tool that gives us all an opportunity to get personal recognition for what we do. The 6Cs are not just for Care Makers to champion.
It doesn’t matter if you’re a nurse, housekeeper, administrator or physiotherapist we should all behave this way, so we can all get feedback.”
Our next step is to firmly link in this tool at Trust Induction, Appraisal, Revalidation and forthcoming Culture Conversations.
Please visit the Connect Compassion in Practice page for further information on how to use this tool in your service area and professional reflection.? The 6Cs are the values behind Compassion in Practice; the three year vision and strategy for NHS nursing, midwifery and care staff in England launched in 2012. We’ve taken the 6Cs one step further and are applying the values throughout the workplace, not just in practice.
Contact: Kerry Bennett, [email protected]
$*!
Providing a single point of access In February, we launched our new mental health service called First Response. Connections caught up with Sarah Deacon, Clinical Lead, to find out more about the service and what it means for you. What is First Response?
The service provides support, quickly to people of all ages experiencing a mental health crisis, regardless of their current involvement with mental health services.
So how does this work?
We have a single telephone number, available 24 hours a day, 7 days a week.
Anyone can call our number, whether it’s the person experiencing the crisis, or a concerned family member, friend or carer.
What happens when they call?
A Telecoach will answer the call. They are experienced in talking to people in distress and can quickly assess the individual’s needs.
Sometimes, the Telecoach will be able to offer guidance to help the caller manage the situation and their feelings. They’ll also have information on hand about local health, social and voluntary services that can help at a later date. Our Telecoaches can make appointments or referrals for this.
If the Telecoach decides that the caller needs urgent care, they’ll ask for the support of a First Responder.
Who is a First Responder?
Our First Responders are mental health nurses and social workers.
They will visit the individual wherever they are at their time of crisis. For example: at home, the town centre, or at a police station, at whatever time of the day. Some of the team can prescribe medication.
First Responders provide the best possible action for the individual at the time. They aim to keep people at home with support, where they feel most comfortable, and will work with the individual on a crisis management plan.
If someone is extremely unwell, they may recommend an admission to hospital.
Depending on the information they’ve received from the telecoach, the First Responder may request the support of our emergency services colleagues at the visit.
“I honestly think if a service like First Response had been around 30 years ago, my family would not be in the position it is today.” Find out how First Response will make a difference for service users and carers, read Chris’ story at http://ow.ly/Hf47k
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How is this different to our other services such as Intensive Home Treatment?
Our current services are all planned around people we know access our mental health services, and people who have ‘crisis plans.’
If someone was experiencing a crisis for the first time, they’d probably go to Accident & Emergency, or make a call to the Police. First Response will hopefully fill this gap, which can be a very distressing time.
We will work very closely with colleagues from existing acute care pathway services including Home Treatment and In-patient Wards.
So what can staff do?
Unfortunately, we never know when a crisis will happen. For many people their first experience of mental ill health is a crisis. We want people to feel reassured that trained professionals are just a phone call away.
The best thing you can do is know that the service is available, and recommend it to service users, family and friends. Patient information cards are available, if you’d find these helpful with your conversations you can request copies by emailing [email protected]
Staff who have close contact with service users may recognise signs that someone is experiencing a crisis, if you can’t encourage the individual to make the call to First Response themselves, please do it for them.
It doesn’t matter if you work in mental health, community or corporate services, we can all get the message out that First Response is only a phone call away if needed.
First Response: 01274 221181 The service is for anyone living in Bradford, Airedale, Wharfedale and Craven. They do not have to have used any of our services before to access it.
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13. QUALITY & SAFETY In addition to monitoring our key quality performance indicators, we have a robust process in place to manage the quality and safety agenda across the Trust.
The Quality and Safety Committee oversees and seeks assurance on a range of quality and safety issues and supports quality developments and improvements.
These issues are captured in our Quality and Safety Framework (see table below) which is used at all levels in the Trust to ensure that all of the key elements of safety are being addressed. The Quality and Safety Framework also links the Care Quality Commission requirements, which supports the Trust in ensuring that we are meeting the required standards.
Table 14
Further detail in relation to some of the elements of the Quality & Safety Framework is provided in Part 2 of this document and in the following sections (13 – 20).
SUMMARY OF THE BDCT QUALITY & SAFETY FRAMEWORK
Personal Effective Safe
Service user & carer involvement (including consent)
Clinical Audit Safeguarding adults & children
Service user and carer experience including complaints, compliments, feedback
Research & Development Incident reporting including alerts
Equality, diversity & human rights National Institute for Health and Care Excellence guidance
Risk management
Care Planning / Care Programme Approach
Staff training & development
Serious Incident reviews
Medicines management Premises & equipment
Working with other providers
Infection Prevention
Standing Item: ' Service changes; impact on quality'
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14. OUR STAFF STAFF SURVEY
Staff satisfaction and engagement are key to delivering high quality, values-based care and are directly associated with patient experience and outcomes. Staff are our key resource, the engagement, satisfaction and health and wellbeing of the workforce are critical to optimal performance and enabling achievement of our vision and strategic objectives. The staff survey is a key means of providing workforce assurance and highlighting areas for improvement actions.
The annual staff survey, conducted every year between September and December, is an important way of measuring staff satisfaction and is a requirement of all NHS organisations.
Research studies have demonstrated a direct correlation between staff satisfaction and patient experience and outcomes. The staff engagement score from the survey forms a key element of the CQC’s measures linked to registration and provides a source of workforce assurance.
Results
The Trust is in the top 20% of organisations for seven out of twenty nine key findings, better than average for nine key findings, average for six key findings, worse than average for five key findings and in the worst 20% of similar organisations for two key findings.
These results are based on a 47% response rate which is above the national average for mental health / learning disabilities trusts which was 44%. The Trust’s response rate is the same as the response rate for 2013. For 2014 a census was used rather than a sample so all staff employed by the Trust had the opportunity to complete the questionnaire of which 1,246 staff did so.
Areas of strong performance
The results of the 2014 survey show that the Trust has performed particularly well in the areas of errors and incidents and violence and harassment. With regards to errors and incidents all four key findings are in the best 20% of Trusts. These are: 23% of staff reported witnessing potentially harmful errors, near misses and incidents (lower score better), 94% of staff reported errors, near misses or incidents witnessed in the last month (higher score better), a score of 3.68 for fairness and effectiveness of incident reporting procedures and 76% of staff agreeing that they would feel secure raising concerns about unsafe clinical practice.
In the area of violence and harassment two key findings are in the best 20% of Trusts relating to 11% of staff experiencing physical violence from patients, relatives, or the public in the last 12 months (lower score better), 24% staff experiencing harassment, bullying or abuse from patients, relatives or the public in the last 12 months (lower score better). In this area a key finding which scored better than average was 2% staff experiencing physical violence from staff in the last 12 months.
In relation to staff engagement the overall score has remained the same as 2013 as being better than average. The three key findings that make up the engagement score show that the Trust is better than average for two of them: staff recommendation of the trust as a place to work or receive treatment (an increase to 3.63 compared to 3.58 in 2013) and staff motivation at work (a slight decrease from 3.91 in 2013 to 3.90). The other key finding: staff ability to contribute towards improvements at work received an average score and has decreased from 76% in 2013 to 72%.
The greatest improvements since 2013 are in two key findings: the percentage of staff experiencing discrimination at work which has decreased from 15% in 2013 to 11% - an improvement of 4% which demonstrates significant progress from worse than average in 2013 to better than average in 2014. The other key finding is the percentage of staff receiving health and safety training in the last 12 months an increase from 76% which was average in 2013 to 83% in 2014 which has scored better than average. Other key findings which have also scored better than average and where the scores have remained the same or improved are the percentage of staff agreeing that their role makes a difference to patients (90% compared to 89% in 2013), work pressure felt by staff (3.00 compared to 3.05 in 2013 – lower score better), having well structured appraisals (43% which is the same as 2013) and reporting good communication between senior management and staff (35% compared to 31% in 2013).
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Areas for improvement
In relation to key findings, the area of equality and diversity is one in which the Trust has scored worse than average for the key finding of believing that the trust provides equal opportunities for career progression or promotion (a decrease from 88% in 2013 to 84% in 2014) and has scored in the worst 20% for staff having equality and diversity training in the last 12 months although the figure has improved from 44% in 2013 to 49% in 2014. (The Trust provides such training currently on a three yearly cycle).
Although the key finding around line manager support has remained at worse than average the score has improved from 3.74 in 2013 to 3.78. This increase compares well against other similar Trusts as nationally there has been a decrease in this area (4.07 in 2013 to 3.81 in 2014).
The percentage of staff feeling satisfied with the quality of work and patient care they are able to deliver has slightly decreased from 76% in 2013 to 75% and remains worse than average although it is only 1% below the average score nationally for mental health / learning disability trusts.
In relation to staff receiving job-relevant training, learning or development in the last 12 months this has slightly decreased from 82% in 2013 to 81% and remains worse than average.
The percentage of staff suffering work-related stress in the last 12 months still remains worse than average and has very slightly improved from 46% in 2013 to 45%.
Staff feeling pressure to attend work when feeling unwell remains in the worst 20% of similar trusts although there has been an improvement from 29% in 2013 to 24% (lower score better). In relation to the individual questions that make up this key finding – 61% of staff had put themselves under pressure to attend work compared to 73% in 2013 and a national average of 66% (so the trust performs better than the national average for this particular question), 29% of staff had felt pressure from their manager to come to work, compared to 30% in 2013 and a national average of 23%, 21% of staff had felt pressure from their colleagues to come to work compared to 22% in 2013 and a national average of 19%. So the elements of this key finding that bring the trust’s performance into the worst 20% of similar trusts links to feeling pressure from managers and colleagues.
The following table summarises the key findings and how we have performed in comparison with other similar trusts:
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Table 15
BDCT 2014
Average score for MH/LD Trusts
Ranking against other MH/LD Trusts 2014
Rating
1 % of staff feeling satisfied with the quality of work and patient care they are able to deliver 75 76 Below (worse than) average
2 % of staff agreeing that their role makes a difference to patients 90 89 Above (better than) average
3 Work pressure felt by staff (lower score better) 3.05 3.07 Below (better than) average
4 Staff agreeing that they work in an effective team (higher score the better) 3.81 3.84 Average
5 % of staff working extra hours 64 71 Lowest (best) 20%
6 % of staff receiving job- relevant training, learning or development in the last 12 months 81 82 Below (worse than) average
7 % of staff appraised in the last 12 months 89 88 Average
8 % of staff having a well-structured appraisal in the last 12 months 43 41 Above (better than) average
9 Support from immediate managers (higher score better) 3.78 3.81 Below (worse than) average
10 % of staff receiving health and safety training in the last 12 months 83 73 Above (better than) average
11 % of staff suffering work related stress in the last 12 months 45 42 Above (worse than) average
12 % of staff witnessing potentially harmful errors, near misses or accidents 23 26 Lowest (best) 20%
13 % of staff reporting potentially harmful errors, near misses or accidents 94 92 Highest (best) 20%
14 Fairness and effectiveness of procedures for reporting errors, near misses or incidents (higher score better)
3.68 3.52 Highest (best) 20%
15 % of staff agreeing they would feel secure raising concerns about unsafe clinical practice 76 69 Highest (best) 20%
16 % of staff experiencing physical violence from patients/ relatives in the last 12 months 11 18 Lowest (best) 20%
17 % of staff experiencing physical violence from other staff in the last 12 months 2 3 Below (better than) average
18 % of staff experiencing harassment or bullying or abuse from patients / relatives in the last 12 months -
24 29 Lowest (best) 20%
19 % of staff experiencing harassment or bullying or abuse from other staff in the last 12 months 20 21 Average
20 % feeling pressure in last 3 months to attend work when feeling unwell 24 20 Highest (worst) 20%
21 % of staff reporting good communication between senior management and staff 35 30 Above (better than) average
22 % of staff able to contribute towards improvements at work 72 72 Average
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BDCT 2014
Average score for MH/LD Trusts
Ranking against other MH/LD Trusts 2014
Rating
23 Staff job satisfaction (higher score better) 3.68 3.67 Average
24 Staff that would recommend the Trust as a place to work or receive treatment (higher the score the better)
3.63 3.57 Above (better than) average
25 Staff motivation at work (higher the score the better) 3.90 3.84 Above (better than) average
26 % of staff having equality and diversity training in the last 12 months 49 67 Lowest (worst) 20%
27 % of staff believing the Trust provides equal opportunities for career progression or promotion
84 86 Below (worse than) average
28 % experiencing discrimination in work in last 12 months 11 12 Below (better than) average
29 % of staff agreeing that feedback from patients/service users is used to make informed decisions in their directorate/department
54 53 Average
Staff Engagement Score 3.76 3.72 Above (better than average)
Key
Better than average or best 20%
Average
Worse than average or worst 20%
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Proposed areas for corporate action:
It is clear from the survey results that there are many high scoring areas and also improvements that the Trust can be proud of. However the survey also provides important feedback on areas that the organisation needs to pay attention to if it is to look after the health and well being of its workforce and thereby its patients.
In light of the feedback from staff it is proposed that corporately the Trust continues to focus on development interventions to address the following issues:
Workplace stress and wellbeing
It is important that stress is addressed at both an individual and organisational level. Although there have been some small improvements since last year in the key findings which relate to workplace stress and wellbeing it is still a priority area for the Trust. The Trust currently provides a wide range of support and interventions to individuals and teams who are experiencing work related stress.
These include a range of courses including building resilience, stress awareness, managing stress for managers, problem solving, self-care courses, online resources, wellbeing@work, team facilitation, Employee Assistance Programme including counselling, stress risk assessments, and Employee Health and Wellbeing. The Robertson Cooper Psychological Resilience sessions will continue to be delivered.
The Employee Health and Wellbeing service will be delivered in-house from 1st June, 2015. It is anticipated that the service will be able to provide more pro-active health and wellbeing services as a result of this arrangement. In addition to the physiotherapists currently working within the service an occupational therapist has been recruited who will shortly be commencing employment and will work with staff who are experiencing stress, anxiety and depression.
The Trust has also trained seven staff in the Mental Health First Aider course. These staff will provide initial support to staff experiencing mental health problems and listen and signpost them to further help and support.
Equality and diversity
Although there has been significant improvement in staff experiencing discrimination at work since the 2013 results, the trust providing equal opportunities for career progression or promotion remains worse
than average. It is proposed that this area should be covered at a focus group for staff as well as ensuring implementation of actions identified from the career progression action plan. The Staff Networks will continue to be engaged in developing the action plan which supports the BME Diversity in Employment strategy.
During this next year equality and diversity training will be linked to a calendar of key events and dates such as LGB history month and specific religious festivals which along with the introduction of e-learning should see a further improvement in the uptake of equality and diversity training.
Management, leadership and team leader development
It is recognised that managers have a crucial role to play in leading and supporting staff particularly through complex change projects and uncertainty. This remains a priority area as managers have a significant influence on how staff feel at work. A full evaluation will take place of the current ‘Engaging Leaders’ programme to establish the impact of the learning and behaviour change and as indicated the second cohort will launch in the autumn of 2015.
NHS Employers have recently sponsored training for one employee from each NHS organisation to be trained to deliver programmes to managers, one being ‘Creating a mentally healthy workplace’ and the other focused on the impact that managers’ behaviours have on their staff. Both programmes will be launched shortly. As described earlier there a wide range of management and team leader modules and programmes that managers are able to access.
Reporting of physical violence, harassment bullying and abuse at work
The responses to the staff survey questions about reporting physical violence and reporting harassment, bullying or abuse after experiencing an incident have deteriorated since 2013. In 2013 91% of staff who had experienced an incident of physical violence had reported it but in 2014 this has decreased to 84%. In 2013 62% of staff had who had experienced an incident of harassment, bullying or abuse had reported it but this had decreased to 54% in 2014. An extensive communications campaign is planned to highlight the importance of reporting incidents of physical violence, harassment, bullying and abuse.
The results of the full staff survey can be found at www.nhsstaffsurveys.com
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Staff wellbeing; an example of how we support our staff
Do you work with Computers? Yes? Then it’s time to make sure you’re working safely. If you work in an office, at a desk, use a computer/ laptop you can help to keep yourself comfortable and well by sitting in the right position and arranging your desk correctly.
Health and safety at work is vital and is the law. Everyone who works at the Trust and uses a computer for continuous spells of an hour or more, daily, should complete a Display Screen Equipment (DSE) assessment. This helps make sure your workstation is safely set up to suit your individual needs.
Paul Challenger, Health and Safety Officer, said: “DSE assessments help to provide a safe, comfortable way of working. Sitting with an incorrect posture can give you longer term damage to your back, neck and other areas. The assessment helps identify any ‘problem areas’ and recommends any adjustments that need to be made.”
You can carry out the assessment yourself using our DSE Assessment Template. You can also contact one of our 45 DSE Champions, trained to carry out DSE assessments with staff within their own teams (with permission of line managers). All this can be found on the Health and Safety pages of Connect.
Mohammed Sheraz-Ul Islam, Administration Team Manager at Single Point of Access, said: “The DSE champion training has been invaluable. We are now able to support staff, identify needs and make reasonable adjustments in good time. For example,
as a result of the DSE champion training, we have identified that several staff required adjustable chairs to ensure they are safe, comfortable and working correctly to Health Safety Executive standards.”
As you turn on your computer/ laptop remember to assess how you are sitting and the space around you. Make the right adjustments needed. If you change offices/ desks, hot desk or work from home, again re-assess and adjust. Just because it’s not ‘your desk’ doesn’t mean you can’t alter the set up to make it suitable for you.
Examples of training and development initiatives in 2014 / 2015
Equality and diversity Over the last year the general equality and diversity training has been reviewed and updated. In addition bespoke and targeted training has been delivered to staff in front-line services around trans equality and gypsy and traveller communities. The current equality and diversity e-learning package will be reviewed and trans awareness e-learning training has recently been launched. During this next year equality and diversity training will be linked to a calendar of key events and dates such as LGB history month and specific religious festivals.
AS a result of an extensive piece of research in the area of equal opportunities for career progression or promotion the Trust recently launched its career progression programme ‘Moving Forwards’ for BME staff at Bands 5 and 6 which is being delivered by a range of internal and external providers with the aim of equipping staff with a range of skills in order to progress in their careers.
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Management, leadership and team leader development Managers have a crucial role to play in leading and supporting staff, particularly through complex change projects and uncertainty. The launch of the Trust’s leadership programme in November 2014 – Engaging Leaders – has enabled a large cohort of managers to undertake leadership development and to build culture change throughout the Trust. A second cohort will be launched in the autumn of 2015.
Delivering the Masterclass programme to General Practitioners
We recognise the role GPs play in providing a quality healthcare service to local people. We also recognise how difficult it is to diagnose and manage certain health conditions in a 10 minute appointment slot. Consequently, we have been running a series of continuing professional development (CPD) validated Masterclasses designed to help GPs overcome these challenges. These sessions also give GPs opportunities to network with other GPs and to learn about best practice taking place elsewhere.
The Masterclass programme focuses on those areas which GPs have told us they find the most useful. The programme we delivered in 2014/15 was as follows:
• Supporting Patients who Self Harm (April 2014)
• Dementia (June 2014)
• Autism (September 2014)
• Sexual Abuse (November 2014)
Further sessions are planned around:
• Adult ADHD (April 2015)
• Physical Health and Wellbeing Clinics, Preventing Premature Death for People who Experience Serious
Mental Illness (June 2015)
• Stammering (September 2015)
• Intensive Therapy for Personality Disorders (October 2015)
• Advanced Care Planning (November 2015)
• Understanding and Treating Trauma/PTSD (January 2016)
• Eating Disorders (March 2016)
• Diagnosis and Management of Autistic Spectrum Conditions (May 2016)
Since the Masterclasses were first launched, attendance at the events continues to increase and we have received excellent feedback about the value of these events.
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15. COMPLAINTS AND COMPLIMENTS We want to work with any individual who has a complaint in a fair, open and honest way. If problems are found, we share any lessons learnt across the whole organisation.
Our complaints process helps us to clearly set out a person’s issues, and to review where we might improve our services as a result of any investigation and learning. At the end of the complaints process, we ask the complainant to tell us how they think we handled their complaint. Where any further actions are required, these are progressed by the service managers involved.
During 2014/15, we received 102 complaints, compared to 80 complaints in 2013/14.
Table 16
2012/13 2013/14 2014/15
Total number of formal complaints 84 80 102
Responses within timescales agreed with complainant 100% 96.25% 100%*
Total number of compliments 199 473 464
*this is an estimated figure as there are 29 complaints yet to be responded to. It is anticipated that these will be responded to in the timescales agreed with the complainant.
We take complaints very seriously and use them as a way of improving services. Service users and carers are encouraged to let staff know if they are unhappy with a service they have received. They are advised of their right to make a formal complaint.
People who are dissatisfied with our response have the right to ask the Parliamentary and Health Service Ombudsman (PHSO) to look again at their complaint.
In 2014/15 the Trust is aware of four complaints that were referred to the PHSO. The case files were shared with the Ombudsman for investigation. Two of the complaints were fully investigated and not upheld. The Trust are waiting for the PHSO to inform the Trust if they will be fully investigating one case. The Trust is awaiting the outcome of a complaint which has been jointly investigated by the PHSO and Local Government Ombudsman (LGO).
%"!
Some complaints covered a number of different parts. Table 17 shows a breakdown of the issues received during the year:
Table 17
40
28
18
16 14
14
12
9
7
6
6
6
5 4
4 3 3 3 3 3 3
Breakdown of the issues raised during 2014/15
Attitude of Staff
Lack of Support
Other
Medication
Information
Nursing Care
Discharge Arrangements
Medical Care (Doctor)
Breach of Confidentiality by Staff
Customer Services
Medical Care (Dentist)
Waiting for Appointment / Length of Waiting List
Patient's Privacy & Dignity
Failure to follow Procedures
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Service improvements
During the year we have continued to look again at its services in light of complaints received. Several improvements have been made as a result. These include:
Attitude of Staff
Attitude of staff has featured highly, particularly within in-patient areas. The in-patient services developed a Customer Service Tool made specifically with their service in mind in inconjunction with Leeds University. This training has reached 211 staff so far. Barbara’s Story and Hello My Name Is is also being rolled out within in-patients. This is also an organisational pledge in conjunction with NHS Change day which was held on 11 March 2015.
This year our Trust’s NHS Change Day action is to support and fully embrace the #hellomynameis campaign. We are encouraging all staff to use the #hellomynameis introduction. The campaign is simple – reminding staff to go back to basics and introduce themselves with #hellomynameis. Feedback from patients across the country shows how vital this is to them, saying that the smallest things make the biggest difference. All trust screensavers now display this key message and the launch was supported by the communications team tweeting staff’s pledges of support.
• The Trust has already started to embrace the #hellomynameis campaign as part of the Compassion in Practice agenda and Caremaker initiative. Our Admin Hubs and Single Point of Access team all answer calls with the "hellomynameis" introduction.
• Following a complaint about the administration of insulin in a nursing home we identified the following actions:
• In collaboration with our Chief Pharmacist, an e-learning tool for medicines management was developed that all qualified district nursing staff will be required to undertake.
• Amending the induction package for newly employed/qualified district nursing staff to incorporate medicines management and insulin administration; and
• The documentation for the administration of insulin has been revised and an insulin only administration sheet devised and will be implemented in the near future.
An inpatient complaint investigation identified a requirement for a written procedure on how the level of information sharing is documented and communicated to staff delivering patient care.
A complaint regarding contacting the District Nursing Team via the Single Point of Access (SPA) has identified the following actions:
• All calls where signposting is provided to be recorded in the patient record and on a workflow management system
• Procedures are in place that instruct SPA Call Handlers on how to respond when a patient is waiting for a GP visit to be updated to include appropriate advice that should be given to the caller
• Information generated by a call to SPA regarding district nursing (e.g. referrals and advice) to have a consistent storage method for ‘in hours’ and ‘out of hours’ services
• Investigations to be undertaken regarding the feasibility of the IT systems flagging up repeat calls from the same telephone number
Compliments
The number of compliments received by our services has steadily decreased slightly compared to last year. Below are a few examples received during 2014/15:
• ‘The support of your very professional staff helped us through a difficult time. We would also like to thank you for making a concerted effort to listen to us and understanding our challenges without judgement but with much more understanding. Your support made all the difference to us’
• ‘I have never had the pleasure before, of meeting such a kind, considerate and professional group of people and I shall be eternally grateful to you all for your kindness and understanding’
• ‘This should show you what remarkable people you are, the love you bring with you knows no bounds, the care and help you gave us all helped me and mine get through a very difficult time....’
• ‘My leg care has been very good.... the staff have done for me the very best in all ways.’
• A service user called into the team office to say how helpful and supportive her care co-ordinator had been, and how with his support she obtained good qualifications from school and is now looking into nurse training.
• ‘You have been outstanding in your support and time with both X and X. It has made a difference to X to have you there and I am not sure your care can be surpassed. You have such a lovely manner, combined with a highly professional and very competent expertise in all you do.’
• ‘your thoughtfulness and dedication is deeply appreciated in assisting X in his needs. through
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the good and bad times you have all been brilliant both with X and us, his family.’
Improvements to Complaints Processes
During 2014 a small team reviewed the Trust’s complaints systems, drawing upon Appreciative Inquiry (AI) approaches. The aim of the group was to review the current processes to enhance the complaints system. The review focused on:
• Consistency across different parts of the Trust/Departments in the management of complaints/concerns/compliments;
• Capacity for investigations and the benefits of swift local resolution;
• Engagement from managers in resolving complaints; and
• Systems and support for complainants and staff.
Changes to be implemented
Following the AI review there were a number of changes identified to be implemented during 2015 and there is a steering group with responsibility for this. The changes are:
1. All concerns and complaints will be allocated a case handler.
The Complaints Department and PALS Department will merge and all concerns and complaints will come into one point of contact. Each complaint will be allocated a case handler (one of the team members) and their role will be a point of contact for the complainants and managers. The name of the department is under review and will be launched in 2015/16.
2. Face to Face meetings and appreciation as general principles
There was a commitment to building in elements of face to face meetings at any stage of a complaint process, whether this is a formal complaint or a concern. The process identified that complainants are more likely to be satisfied with the outcome where they have met with the managers responsible for the team/service. Meetings with complainants will be encouraged and where required, supported and facilitated by the complaint handler or investigator.
3. Support for the person complained about (and other colleagues)
A need for support to be provided for staff members subject to complaints was identified. A leaflet will be produced to provide staff with information on what to expect. A Peer Support Network will be established to offer 1:1 support for staff who have been complained about or who are involved in a complaint.
Expected outcomes/improvements
As a result of implementing the above it is expected that the following improvements will be seen:
• Increased complainant satisfaction at the end of the complaints process.
• A more streamlined process • Improved learning from concerns and complaints • Reduced costs to the Trust • Whilst we have an open and transparent
process already in place, this would increase the involvement of complainants and will strengthen what is already offered.
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16. SAFEGUARDING
Safeguarding adults and children continues to be busy, challenging and complex work. Professionals working within the field are under more government, media and public scrutiny than ever before.
Each and every day front-line practitioners are involved in making complex decisions to try to ensure adults and children are effectively safeguarded. The Safeguarding team continuously work on systems, processes, procedures and training to ensure they are as robust as possible in supporting all our staff in this demanding area of work.
The 2014 Care Act heralds a new way of working in adult safeguarding both in terms of statutory duties and the development of practice. A key aim is to make safeguarding personal. This means working closely with the adult concerned, finding out ‘what being safe means to ...(him/her) and how that can be best achieved (Care Act 2014)The team’s aim is to ensure that our service users lead as risk-free and fulfilled lives as possible.
Our Safeguarding Adults and Children Team provides a high quality, evidence-based service which supports all staff members in safeguarding the health and welfare of children and adults, with particular regard to protecting them from harm.
The Safeguarding Team is a highly innovative, progressive, unique team who provide quality assurance to the organisation and are immensely valued by staff.
Staff quotes:
Our Safeguarding Adults & Children Team works hard to make sure that all our staff understand their wider responsibility: ‘safeguarding is everyone’s business’. This supports everyone to practice competently and confidently. Effective safeguarding also involves working in partnership with service users, their families and other organisations. ‘
Our Safeguarding Adults & Children Policies & Procedures provide a framework for the safe and effective protection of adults and children and offers real guidance for community and mental health staff. The Safeguarding Team regularly reviews and updates its training packages. Included within the training are lessons learnt and good practices from local and national serious case reviews. Courses are delivered at the different levels required for staff and content includes additional mental health material.
Excellent training,
supportive supervision.
Gives me confidence
to make decisions.
Clear advice and
guidance.!
Great to have someone to talk to at the end of
the phone!
Fantastic leadership.
%&!
Child Protection
Our Safeguarding Children Team (Child Protection) includes:
• Providing support and advice on a day to day basis, • A formal programme of safeguarding supervision, • Developing and updating of safeguarding policies • On-going up to date training programmes.
Looked After Children’s / Youth Offending / Care Leavers Health Teams
Our Looked After Children Health Team aims to identify health needs and improve outcomes for looked after children. They provide health assessments and specialist support to children and young people in the care system and those leaving care. They make sure that, where necessary, children and young people are referred on for any specialist care. They work closely with social care services, foster carers and the staff of residential care homes for children and provide public health advice and information.
Youth Offending Team nurses assess the health of those young people referred to them through the criminal justice system. They work closely with the young people and their parents/carers to improve their health and wellbeing. They undertake comprehensive health assessments and refer as necessary for specialist care and treatment.
Our dedicated Leaving Care Nurses support the young people who are preparing to leave care with their health needs, through this potentially difficult transition to independent living and adulthood. A recent development has been a Health Passport for young people which is a personal document containing their health details. It was developed in conjunction with the Children In Care Council and has been entered for awards.
Adult Protection
Our Safeguarding Adult Lead and Named Nurse work closely with Bradford Metropolitan Council’s Adult Protection Unit. This work includes monitoring referrals, establishing trends and developing and delivering training based on the latest evidence and best practice. Managing domestic abuse and the training of staff continues to be a successful joint venture, which includes Safeguarding Adult Leads and the Children’s Named Nurses and practitioners.
We continue to work closely with the local authority and other partner organisations on the implementation of West Yorkshire Safeguarding Adults Procedures. The Trust has seen this as an opportunity to develop practice and support staff in key safeguarding roles . A new pool of employees has been identified who will act as Safeguarding Coordinators and Investigating Officers . Specialist training commissioned by the Safeguarding Adults Board will give these specialists a thorough grounding in safeguarding practice. Continued practice development is to be promoted through supervision groups within the Trust.
The Safeguarding Team is currently making preparations with the Local Authority for the changes required by The Care Act 2014. Staff are being encouraged to include more information on alerts about the views and wishes of the adult at risk, consistent with the ‘Making Safeguarding Personal’ agenda.
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Organisational Learning
We have a Safeguarding Forum which meets every two months. This is chaired by our Deputy Chief Executive/Director of Nursing. It includes Named professionals as well as Heads of Service who are responsible for adult and children’s mental health in-patient and community, children and families, community dental health and safeguarding services. Areas of responsibility include making sure systems and arrangements are in place to monitor and review practice to provide effective safeguarding processes and to identify, mitigate and manage risk.
In October 2014, a successful multi-agency safeguarding week of events was held to raise the profile of safeguarding adults and children. Staff attended from across the Bradford Metropolitan District and included representatives from health, education, social care, police and the voluntary sector. The Safeguarding Team worked together to run special events covering a variety of topics throughout the week.
September 2014 saw the Safeguarding Adults and Children team present a healthcare stand at the Trust’s Annual General Meeting for the first time. A lot of people stopped and had a chat and it was a great way to showcase the work the Team does and to promote the ‘Safeguarding is everyone’s business’ message.
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17. INFECTION PREVENTION AND CONTROL Zero tolerance of healthcare associated infections (HCAIs) remains a high priority for us and we continue to maintain compliance with the Health and Social Care Act 2010 and other national standards in relation to cleanliness and infection prevention and control. This involves an education, audit and monitoring programme to prevent HCAIs.
We make sure our infection prevention and control policies are followed in order to provide a safe environment for everyone. The risk of acquiring an infection whilst in our care remains extremely low. We have had no cases of MRSA bacteraemia or clostridium difficile this year. We undertake weekly proactive monitoring of all inpatients which helps us to identify outbreaks early and enables prompt implementation of precautions.
We have had both planned and unannounced audits and inspections to our mental health, learning disability and community services to check our policies and procedures are being upheld. We use the Department of Health’s Quality Improvement Tools, to check how well we are doing against standards, policies and procedures and to suggest improvements.
The quality of the environment links to good patient experience and also safety, particularly in relation to HCAIs. To make sure standards are met our Hotel Services team do monthly cleanliness audits, following national cleanliness guidelines. This allows for consistent monitoring of all standards. Areas have consistently scored 87% and above, which is the minimum pass rate.
We are committed to making sure all our staff receive regular infection prevention and control mandatory training. We want staff to have the knowledge to prevent and manage the spread of infection and, most importantly, improve patient safety and their own. For 2014/15 our target for infection prevention training was 80% and this was exceeded at 82.8% at year end.
We have worked throughout the year to raise awareness of the importance of staff members having the flu jab and this year we are the top mental health Trust in England, with 76.4% of our front line staff having the flu jab.
18 PATIENT ENVIRONMENT Patient-Led Assessments of the Care Environment (PLACE)
NHS England and the Department of Health recommend that all hospitals, hospices and independent treatment centres providing NHS- funded care undertake an annual assessment of the quality of non-clinical services and condition of their buildings. These assessments are referred to as patient-led assessments of the care environment (PLACE). They look at:
• How clean the environments are; • The condition – inside and outside – of the
building(s), fixtures and fittings; • How well the building meets the needs of those
who use it, for example through signs and car parking facilities;
• The quality and availability of food and drinks; and
• How well the environment protects people’s privacy and dignity.
PLACE audits were undertaken in in-patient areas in May 2014. As the table shows, we had excellent scores from our audit which resulted in our organisation being ranked 8th out of 287 healthcare organisations.
PLACE teams consist of patient and staff assessors; at least 50% of the team being patients and/or members of the public. Patient assessors make recommendations for improvement during their visits and these recommendations are used to develop a Local Improvement Plan; the Plan is available on the Trust’s internet site. Recommendations for improvements during the 2014-15 assessments included:
• Aesthetic improvements to courtyard spaces; • Review of the Lynfield Mount Hospital rest room
space for people detained under Section 136 of the Mental Health Act.
• Redecoration and floor covering replacement in identified areas and;
• Signage improvements.
The PLACE assessment recommendations are progressed and monitored throughout the year by the Patient Environment Group.
PLACE information is used by a range of public bodies such as the Care Quality Commission, NHS England, the Department of Health, local clinical commissioning groups and local Healthwatch. All the results are published by the Health and Social Care Information Centre and are made publicly available.
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Table 18 - Our PLACE-14 scores were above the national average in the 4 domains of PLACE:
PLACE DOMAIN NATIONAL AVERAGE % TRUST RATING %
Cleanliness Reception Corridors, lifts & stairwells Ward areas Patient equipment Hand hygiene
97.25 98.39 P
Food & Hydration Menu cycle; Choice & availability; Quality & quantity (portion size); Temperature; Presentation; Service & support; Beverages
88.79 97.58 P
Privacy, Dignity and Wellbeing Sleeping accommodation; Toilets & bathrooms; Privacy; Confidentiality; Modesty, dignity and respect; Social spaces Women only day areas; Activity areas (indoor).
87.73 91.95 P
Condition Appearance and Maintenance Signage Building maintenance & appearance Grounds appearance, maintenance & tidiness Internal decoration Internal fixtures & fittings Furniture
91.97 96.67 P
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Cleanliness Audits
The provision of a clean and safe healthcare environment remains a key priority for all healthcare organizations. It provides one of the key elements for effective infection prevention and control, and also promotes patient confidence and demonstrates the existence of a positive safety culture.
Cleanliness audits are carried out in all of our patient areas. The target is for each area to achieve an audit score of 87% or higher. The following chart shows our cleanliness audit scores for 2014/15. All areas achieved the 87% target.
Table 19
Area Performance BDCT In-patient: for monits made between: 01/04/2014 and 01/04/2015
Block No. of Monits No. of Checks %
Ashbrook 12 2496 93.27
Assessment & Treatment Centre 12 2428 95.76
Baildon Ward 12 2579 94.57
Bracken Ward 11 2525 95.80
Clover Ward 12 2462 96.51
Duchy Court 1 217 95.85
Fern Ward 12 2378 96.17
Heather Ward 12 2424 94.84
Ilkley Ward 12 2656 94.16
LMH Op, Helios, Psychotherapy 12 2797 91.13
Maplebeck 13 2807 91.66
Moors Suite 12 2289 93.32
Oakburn 12 2473 89.28
Step Forward Centre 12 2867 95.15
Thornton Ward 12 2481 93.43
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Hospital Food
Bradford District Care Trust Food Services Team provides a fresh cook-eat food service at two sites to mental health and elderly mental health patients on 12 in-patient ward areas 365 days per year. We also provide a service to the on-site children’s day nursery and staff restaurant through the week.
The team provides approximately 292,300 meals per year from two production kitchens. In excess of 40 Table d'hôte and a la carte meal choices are available every lunch and evening meal time to each and every patient.
All outcomes relating to our food service provision are monitored and reviewed though the directorate and department performance dashboard including:
• Annual PLACE audit scores • Compliance with care Quality Commission (CQC) requirements • Mealtime Service Audit Scores • External Auditor food hygiene ratings • Environmental Health Food Hygiene Ratings
Our PLACE scores for food show that there was only one NHS organisation with a higher score and that Trust has catering services provided by an independent contractor. Therefore we are proud to be the number one in-house NHS caterer across England and Wales with an overall food and hydration score of 97.58%.
Environmental Health Ratings
Our Environment Health scores have retained 5 out of 5 with the Food Standards Agency Food Hygiene rating scheme.
How we are making a difference: Patient Menu Review Within the past 12 months we have had a full review of our in-patient menu on offer within the 12 ward areas following a nutritional analysis of the menu conducted by the Chair of the Mental Health Group of the British Dietetic Association. We sought to make the menu a visually appealing as possible whilst fulfilling the criteria within the Hospital Food Standards Panel report and PLACE requirements.
The outcome of the review has led to the following changes:
• Menu content is patient and dietician-led. Favourite meal choices form the core of the menu. • Full picture menu now available. Own photographs taken of meals to ensure what the patient sees in the
menu is what the patient actually gets. This includes garnishes and side dishes. • Curved corners and binding method adopted to ensure zero self harm risk. • Menu references NHS Choices healthy eating tips and Eatwell Plate. • Equality impact assessment to ensure religious and cultural needs are catered for along with the option of
individually catered menus for special dietary needs. • 24 hour choices incorporated.
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19. MENTAL HEALTH COMMUNITY SURVEY 2014 RESULTS
The 2014 survey involved service users who used services from 51 Mental Health Trusts and Community Healthcare Providers with mental health functions this year. More than 13,500 service users responded to the survey nationally.
Service users aged 18 and over were eligible for the survey if they were receiving specialist care or treatment for a mental health condition, including those who receive care under the ‘Care Programme Approach’ and had been seen by the Trust between 1 September 2013 and 30 November 2013.
Our report shows 238 service users completed and returned surveys from a sample of 850. This equates to a 29% response rate, a slight increase on last year.
The 2014 survey has seen a complete revision of the questions and therefore means that comparisons with previous years are not possible.
The table below shows how we performed in relation to other mental health trusts; the following points are of note:
• Where it appears that question numbers are missing this is because the ‘missing’ questions were about background information rather than opinions about services and were therefore not included in this section of our report
• The red plus sign indicates where we were rated as being in the lowest 20% of trusts
Table 20
2014 Mental Health Community Survey Management Report
Question % fo
r thi
s Tr
ust
Thre
shol
d fo
r Lo
wes
t Sco
ring
20%
of A
ll Tr
usts
Thre
shol
d fo
r Lo
wes
t Sco
ring
20%
of A
ll Tr
usts
Scor
ed %
in L
owes
t 20
% o
f Tru
sts
Q03 Definitely or to some extent seen often enough for their needs. 63% 60% 67%
Q05 Definitely or to some extent felt that they were listened to carefully. 84% 81% 86%
Q06 Definitely or to some extent given enough time to discuss their needs and treatment. 79% 76% 80%
Q07 Definitely or to some extent understood how mental health needs affect other areas of life. 75% 70% 75%
Q08 Told who is in charge of organising their care and services. 77% 71% 82%
Q10 Knows how to contact person in charge of organising care. 96% 96% 98%
Q11 Care and services organised very well or quite well. 85% 81% 85%
Q12 Definitely or to some extent agreed what care will be received. 61% 57% 64%
Q13 Definitely or to some extent involved as much as wanted to be in agreeing what care will be received. 75% 72% 78%
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2014 Mental Health Community Survey Management Report
Question % fo
r thi
s Tr
ust
Thre
shol
d fo
r Lo
wes
t Sco
ring
20%
of A
ll Tr
usts
Thre
shol
d fo
r Lo
wes
t Sco
ring
20%
of A
ll Tr
usts
Scor
ed %
in L
owes
t 20
% o
f Tru
sts
Q14 Definitely or to some extent agreed that care takes into account personal circumstances. 77% 75% 80%
Q15 In the last 12 months had formal meeting to discuss care. 72% 69% 77%
Q16 Definitely or to some extent involved as much as wanted to be in discussing how care is working? 78% 74% 80%
Q17 Definitely or to some extent felt that decisions were made together. 76% 75% 80%
Q20 Knows who was in charge of organising care while change was taking place. 45% 48% 61% +
Q21 In crisis knows who to contact out of office hours. 61% 61% 74%
Q23 Definitely or to some extent got the help from out of hours team. 72% 58% 67%
Q25 Definitely or to some extent involved as much as wanted to be in decisions about medicines received. 67% 67% 73% +
Q27 Definitely or to some extent given understandable information about prescribed medicines. 67% 67% 73% +
Q29 Medicines have been reviewed in the last year. 76% 74% 82%
Q31 Definitely or to some extent involved in deciding treatments or therapies to use. 75% 71% 75%
Q32 Definitely or to some extent given advice with finding support for physical health needs. 55% 45% 55%
Q33 Definitely or to some extent given advice about finances or benefits. 49% 38% 55%
Q34 Definitely or to some extent given advice about finding or keeping work. 46% 34% 47%
Q35 Definitely or to some extent given advice about finding or keeping accommodation. 55% 41% 52%
Q36 Definitely or to some extent supported in taking part in a local activity. 56% 38% 50%
Q37 Definitely or to some extent involved a family member or someone close to them. 66% 65% 73%
Q38 Definitely or to some extent given information about getting support from people who have the same needs. 41% 32% 41%
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2014 Mental Health Community Survey Management Report
Question % fo
r thi
s Tr
ust
Thre
shol
d fo
r Lo
wes
t Sco
ring
20%
of A
ll Tr
usts
Thre
shol
d fo
r Lo
wes
t Sco
ring
20%
of A
ll Tr
usts
Scor
ed %
in L
owes
t 20
% o
f Tru
sts
Q39 Always or sometimes understand what is important to users. 64% 60% 65%
Q40 NHS MH Services always or sometimes help with what is important. 62% 57% 64%
Q41 NHS MH Services always or sometimes helps users feel hopeful about things that are important. 62% 57% 64%
Q42 Users rating of their experience as Good or Very Good (6-10). 69% 60% 71%
Q43 Always or sometimes treated with respect and dignity. 82% 82% 86%
An action plan has been developed to focus work on the areas for improvement highlighted in the report and examples of actions that have been or are being taken are as follows:
• Ensuring that a copy of up-to-date Care Plan is provided to the service user and/or carer. • Ensuring that a Crisis Plan is completed for each individual with details regarding First response (24/7)
crisis support. • Publicising the First Response contact telephone number across all trust services. • Ensuring Care programme approach (CPA) is being used to review care and clarify the care co-ordinator
or other professionals involved. • Ensure promotion of independent advocacy services. • Promoting access to pharmacy’s user-friendly information on medicines and side effects.
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20. PATIENT INVOLVEMENT BDCT is committed to ensuring that patient experience and involvement is integral to the way in which the Trust operates.
In March 2014 an external report undertaken by Leeds Metropolitan University set out recommendations for the structure and planning of patient, public and carer involvement within the organisation. We have made significant progress during 2014/15 in achieving those recommendations. To facilitate improvements and provide greater assurance a review of reporting structures and governance arrangements has been undertaken.
The new structure has been developed as the You and Your Care Involvement Structure and has been led by Nicola Lees, Deputy Chief Exec/Director of Nursing as chair of the Strategic Reference Group. Reporting to this group, four sub-groups were identified to lead work on the key areas outlined by the report. These are:
• You & Your Care User Involvement Group • You & Your Care Patient Experience Group • You & Your Care Carers & Volunteers Group • You & Your Care External Relationships Group
An integrated approach to user involvement, membership development and volunteer engagement has been developed through the newly formed patient and public involvement structure with a clearly defined work plan. The work of the above groups, together with the Trust Wide Involvement Group (TWIG) has been driven by this. Progress against the priorities has been monitored via the Strategic Reference Group.
You and Your Care Strategic Reference Group
In order to effectively involve service users and carers in the work of the organisation the patient experience and involvement team has been restructured. This has facilitated the opportunity to have a dedicated Involvement Lead and Carer Lead to reflect the commitment of the organisation to having a coherent strategic approach to engagement across all aspects of our services. This includes:
• An action plan produced by the You & Your Care Strategic Reference Group outlining key priorities for the Trust to bring about a whole system culture change, increasing respect and listening to service user and carer feedback to improve the quality of services offered by the Trust.
• Work is continuing to develop a robust process for understanding the role of service users and carers in the organisation. The new reporting and governance structure has enhanced communication and the ability to share information with a wider audience of service users and carers
• A Quality Account Event was held 29th January 2015 to engage with service users and carers in agreeing quality priorities for 2015/16.
• The Trust is working with Healthwatch and there have been ‘enter and view’ visits to help identify issues and good practice within services.
You & Your Care User Involvement Group
The Trust has set itself challenging minimum standards for patient, public and carer involvement across the organisation. Key priorities for the next 6-12 months include:
• Review the Trust’s understanding of involvement • Work with the Centre for Mental Health to secure employment • Work with partners to offer people personal health budgets
To achieve a good level of engagement and involvement requires a concerted effort and commitment from all staff within service areas, and a level of understanding that enables them to motivate their patients or service users.
The work of the group includes:
• The patient experience and involvement team have conducted a scoping exercise to understand which services are involving service users/patient and carers.
• Working with the Centre for Mental Health to implement Individual Placement and Support approach (IPS). Centre for Mental Health staff (Regional Trainer and Team Leader) in post 2nd February 2015. Working closely with other agencies eg Department for Work and Pensions, Local Authority and third sector partners to ensure
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a joined up approach. Target for 60 mental health service users to gain paid employment over the next 18 months.
• Within the personalisation agenda the social care element is already in place for mental health service users but work is ongoing with the Local Authority to improve uptake. Personal health budgets are theoretically available to service users with long term conditions from 1st April 2015. A Clinical Commissioning Group-led Personalised Commissioning Group has been established which we attend and early discussions are taking place in relation to regional pilot of joint health and social care personal budgets.
You & Your Care Patient Experience Group
Patient experience has been a key priority for the Trust. The implementation of Friends and Family Test (FFT) has provided an opportunity to review systems and strengthen patient experience structures. Key priorities for the next 6-12 months include:
• Roll out FFT • Establish service user panels • Benchmark organisational culture around patient experience
FFT has been implemented across the organisation and we can now confidently identify all teams who offer opportunities to gather FFT data. Work to date includes:
• Gathering of patient experience feedback has been strengthened by the commissioning of I Want Great Care to collect and collate FFT data.
• Reporting structures have been agreed to analyse and report trends and themes in the narrative generated by the FFT data and provide opportunities to develop services in a coordinated and responsive manner based on service user feedback.
• The FFT indicators are a % score of how likely patients are to recommend our services to friends and family. This is reported to Board on a monthly basis
• Service user panels are being set up to engage service users and carers. The first one was held on 12th March 2015 in the Aire, Wharfe and Craven locality and will be used as a pilot to assess what works well.
You & Your Care Carers & Volunteers Group
The value of volunteers and carers has been recognised within the Trust. Work is ongoing to develop this more fully. Key priorities for the next 6-12 months include:
• Develop culture & processes around volunteering • Support the transition of carers to Carers Resource • Develop a standard for carer engagement
The NHS Carer Strategy 2014-2016 has recently been published and has been reviewed to identify gaps in practice. A benchmarking exercise has identified the gaps and led to the development of an action plan to standardise carer involvement in the organisation. Work of the group to date includes:
• Continuing to raise the profile of carers in the organisation. The carers lead is working to establish positive relationships with local carer groups to improve engagement.
• A strategy is being developed to support education for staff around carer issues and a base line audit of staff knowledge and awareness around carer issues is planned with the aim of developing a training package for staff.
• Work is ongoing between the Volunteering Lead and service managers to clarify volunteering opportunities in the organisation.
• Policy still being developed due to review of recruitment process and non-inclusion of support for staff to volunteer as identified by the group
• A new Volunteer Coordinator role has been identified to work across all areas of the Trust
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You & Your Care External Relationships Group
The External Relationships Group has three key objectives for the next 6-12 months:
• Produce a membership strategy inclusive of engagement for local people • Increase participation with key stakeholders • Undertake mapping work with GP’s
Work to date includes:
• Approval of communications strategy template for the work stream • Further work being undertaken on membership strategy now that Governors are in post • Qualitative and quantitative survey to be undertaken with the third sector – preparatory work to be done during
next quarter
Trust Wide Involvement Group (TWIG)
The restructuring of the reporting and governance structure for patient experience and involvement has strengthened the requirement for ensuring Involvement is embedded in everything the Trust does. The structure includes service user and carer involvement groups, ensuring robust mechanisms for the sharing of information on the ground with service users and carers. The need to have named Involvement and Carer Leads within each service area is imperative to meeting these requirements and shows the commitment of services. TWIG will act as the mechanism for sharing information with these key staff and other service user and carer forums.
• TWIG has been reviewed and plans to move forward into 2015 with a new structure encompassing service involvement leads and service users / carers in partnership.
• The group has also reviewed reporting structures for service user groups within the organisation and identified representation from these groups to sit on TWIG.
There has been a lot of work to improve communication with internal and external service user and carer groups as we try to establish closer links with groups to ensure diverse views are gathered.
Friends and Family Test (FFT)
The Friends & Family Test is a national requirement set out by NHS England to gain real-time feedback on patient experience. This was successfully launched at Bradford District Care Trust in November 2014.
The use of an independent company across all services promotes inclusivity and aims to capture the full diverse characteristics of the local population.
The introduction of the test has been positively received by staff and has provided a systematic basis from which to build a robust process for gathering, monitoring and identifying actions. Real time monitoring of the narrative by the patient experience and involvement team means that local staff will be able to inform service users and carers of actions in a timely manner. The Trust will also be able to monitor themes and trends to spot areas of concern requiring further investigation and work. More importantly positive feedback can also be celebrated as a positive indicator of patient experience.
To date the Trust has around 700 responses and is rated 4.5 out of 5. Analysis of the comments left shows that 90% are positive. Samples of these are available on the Trust Website. Any negative comments are shared with teams for the opportunity to respond and make changes if possible or explain why not.
Conclusions
The initiatives highlighted in last year’s report continue to go from strength to strength these include:
• Patient stories are shared at every Trust board meeting. Community reporting has been slow to be established but work continues to develop in this area
• The 15 steps challenge and board walk rounds are a popular and rich source of information. Service users and carers are encouraged to participate in the 15 step challenges.
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• The Carer DVD has been used to provide bespoke training to nursing staff . Work is underway to try and utilise this in a more robust manner with regular training on carer issues for all clinical staff.
The Trust has worked hard to strengthen the engagement and involvement of service users and carers. Some examples include:
• Development of a service user group in podiatry • PLACE visits in estates • Service user and carer involvement in recruitment of staff for the First Response Team • Service user and carer involvement in the development of the Daisy Hill project • Benchmarking involvement and engagement using a national tool which will be used to develop a
comprehensive document of patient experience and involvement work in the Trust
You Said, We Did
Summary Scores over date range
Average 5 star 4.67
Review Count 316
% Likely to Recommend 88.5%
% Unlikely to Recommend 3.82%
% Likely to Recommend
“The waiting room could do with a revamp, maybe some music playing? Currently it is quite isolating and depressing.”
“The waiting room could do with a revamp,
You said:
We did: We did:
“We are looking into music in the waiting room and hope to use some charitable funds to improve it.”
“Within the ward have to use plastic cutlery to eat any food.”
“Within the ward have
You said:
We did: We did:
“Please be assured that the use of plastic cutlery was a temporary measure whilst new cutlery was being ordered. Metal cutlery is now available to all in-patients.”
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21. RISK AND INCIDENT MANAGEMENT Robust risk management is a cornerstone of safety and the Trust has a strategy and processes in place to support services in achieving a sound, healthy balance between innovation, opportunity and risk.
The Trust has an electronic risk register system which enables all teams in the Trust to access a locally owned and managed risk register. All staff are given the opportunity to contribute to their local risk registers. Proactive risk identification assessment is actively encouraged and embraced as good practice across all services.
Risk registers are reviewed thoroughly across the services and by management to ensure there are no surprises and to keep the risk registers live and dynamic. We have made a number of improvements to this process over the last year and will continue to develop the way in which we manage risks over the coming year.
Patient safety is one of our highest priorities and we aim to reduce all avoidable harm; it is our duty to protect patients and staff and to actively learn lessons from patient safety incidents and serious incidents (SIs).
Figure 1 is taken from the latest National Patient Safety Agency National Reporting and Learning Service (NRLS) data report published April 2015, this reports on patient safety incidents from April to September 2014.
Figure 1: Comparative reporting rate, per 1,000 bed days
Patient safety information, in the form of incident reports, is a vital part of what is required for patient protection as cited in the Mid Staffordshire Inquiry report.
We are proud that we have a reporting culture that has seen us in the top quartile of organisations reporting since the start of the NRLS publication in March 2009 and that our reporting levels continue to increase gradually year on year.
Figures 2 show the increasing numbers of incidents reported from 2012-2015 by the level of harm. Over the last 3 years our incident reporting has increased by over 1000 reports and approximately 35%
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Figure 2
We constantly endeavour to reduce our levels of harm through learning, improvement initiatives and proactive risk assessment. Figure 3 shows that although the number of incidents reported has increased the percentage of harm against minor, moderate, major and catastrophic levels has reduced from 2013 to 2015. Over 63% of our incidents resulted in no harm at all. The reduction in harm is a trend we aim to maintain.
Figure 3
The Trust benefits from an electronic incident reporting system which is available to all staff. Every time an incident is reported it is immediately and automatically allocated to an incident manager who has responsibility to review and validate the incident within 72 hours.
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Improvements to our incident management system include:
• to monitor our duty of candour compliance the report has been re-designed to capture this information accurately which will enable management reports to be produced from the system
• each member of staff automatically receives feedback on the incident they have reported • lessons learned can be added to the report by the incident manager which will help identify trends and
patterns for shared learning.
Learning from incidents
Learning lessons allows us to understand the causes of the incidents and to take the appropriate action to avoid reoccurrence. Lessons learned from incidents are an invaluable source of information to activate improvement actions. As an example increasing numbers of medication related incidents prompted a review of insulin prescribing and administration. The review resulted in the improvement of communication processes between community services and the hospitals and patient medication regimes were reviewed and revised to improve the patient experience and outcomes.
Patient Safety Initiatives
The Trust is currently involved with three key patient safety projects, the Safety Measurement and Monitoring Framework pilot, the Sign up to Safety campaign and the Positive and Proactive Care initiative.
Measurement and Monitoring Framework
New approaches to patient safety focus on preventing harm occurring rather than learning the lessons after harm has already taken place.
The Measurement and Monitoring of Safety Framework pilot is an 18 month programme, sponsored by the Health Foundation, and delivered by us in partnership with the Academic Health Science Network Improvement Academy and Bradford Teaching Hospitals.
The framework is being tested over the next 12 months to demonstrate its strengths and weaknesses and to ensure its applicability across health services. We are specifically looking at the risks associated with transitions from inpatient to community care and transitions from child and adolescent to adult services..
Sign Up to Safety
Sign Up to Safety is a 3-year national campaign also focusing on new approaches to patient safety.
It is about listening to patients, carers and staff, learning from what they say when things go wrong and taking action to improve patients’ safety and creating a system of continuous learning and improvement.
The Trust has made the following pledges:
• Put safety first. Commit to reduce avoidable harm in the NHS by half and make public the goals and plans developed locally. We will; Develop and monitor baseline levels of harm with the aim of long term, sustainable reduction
• Continually learn. Make their organisations more resilient to risks by acting on the feedback from patients and constantly measuring and monitoring how safe their services are. We will; Use information available from the friends and family test and other patient feedback to identify appropriate improvement action as required.
• Honesty. Be transparent with people about their progress to tackle patient safety issues and support staff to be candid with patients and their families if something goes wrong. We will; Improve the skills of senior nurses and clinicians in communicating with patients and families when things go wrong.
• Collaborate. Take a leading role in supporting local collaborative learning, so that improvements are made across all of the local services that patients use. We will; Test and develop the new framework for measuring and monitoring patient safety in collaboration with the Health Foundation, the Academic Health Science Network and with Bradford Teaching Hospitals Foundation Trust.
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• Support. Help people understand why things go wrong and how to put them right. Give staff the time and support to improve and celebrate the process. We will; Openly share examples of improvement experience; encourage the sharing and discussions of these cases at team meetings and quality and safety meetings.
There are three other key projects that relate to this campaign:
1. Smoking Cessation - We are working to introduce this across all of our inpatient services in line with the National Institute for Health and Care Excellence (NICE) guideline to work toward achieving smoking cessation in secondary care.
2. Positive and Proactive Care - we are looking to reduce the level of physical intervention used across in-patient services. This is a guidance framework which aims to develop a culture across health and social care where physical intervention is only ever used as a last resort.
3. Pressure Ulcers – we are looking to reduce the number of pressure ulcers occurring in our community services. Pressure ulcers are reported nationally through the safety thermometer programme.
For our trust, Sign up to Safety embraces and fits well with work we are already progressing through our quality and safety work programme.
Positive and Proactive Care (Minimising the use of restraint)
The Department of Health (DH) has launched Positive and Proactive Care: reducing the need for restrictive interventions. The guidance is aimed at promoting the development of therapeutic environments and minimising all forms of restrictive practices so they are only used as a last resort.
We have many current processes in place that are in line with the DH guidance, however these processes require review, enhancement and in some cases, development in order to provide assurance and support a restrictive practice reduction program.
A steering group meets to assess further requirements and initiate developments needed in order to both assure the organisation of current practice and develop further a reduction program in the use of restrictive practice.
The physical intervention training course is now combined with conflict resolution training and breakaway training. These three subjects were previously taught separately. This new approach increases the emphasis that physical restraint should be used as a last resort.
The Managing Violence and Aggression Policy is being reviewed and retitled in line with the Positive and Proactive Care Guidance framework.
Positive and Proactive Care Plans have been developed and are now being piloted. These individualised plans, which are devised collaboratively by clinicians and patients, aim to support the reduction of restrictive interventions.
In addition we deliver Translating Research Into Practice (‘TRIP’) sessions for our staff; these have included exploration of how staff communicate with patients, culture, approach and attitude, and examine the triggers that can cause tense situations on a ward.
NHS Litigation Authority (NHSLA) standards
The Trust achieved 100% compliance at NHSLA Level 1 in December 2012; the NHSLA no longer undertake compliance assessments of this nature therefore the Trust retained Level 1 compliance throughout 2013/14.
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Part 4: Priorities for Quality Improvement for 2015/16
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Part 4: Priorities for Quality Improvement for 2015/16
22. QUALITY PRIORITIES Quality
The Trust is a provider of high quality services. It benchmarks very well against national and local indicators, has done so over a sustained period and has taken a proactive stance in responding to external quality and performance challenges.
The Trust has secured a rating of ‘good’ from the Care Quality Commission (CQC) following an inspection conducted in June 2014.
Existing high performance is underpinned by a robust system of quality governance, directed by a Board whose primary concern is to maintain and improve the quality of services provided; that system of quality governance is described in the Quality Strategy and includes:
• The Quality and Safety Committee which meets every six weeks and seeks assurance, on behalf of the Board, in relation to all quality-related matters. The committee sits at the apex of a pyramid of locality and team quality governance meetings.
• A Quality Governance Improvement Plan derived from the recommendations of numerous external assessments
• The Taking Quality Forward (2) plan developed in response to the Francis report and subsequent reports (for example Keogh, Berwick, Cavendish)
• The annual Quality Account which explains clearly and publicly how we have performed against our main quality goals and, where performance has been suboptimal, the remedial actions that will be implemented. The Quality Account also sets out the quality goals for the forthcoming year which have been co-produced with key stakeholders
• A programme of Quality and Safety walkabouts, where Executive and Non-Executive Director pairings visit front-line teams and services to see and hear how they discharge their duties in a safe and effective manner and to hear any concerns those teams have about impediments to the delivery of high quality services; all concerns raised are investigated and appropriate action taken
• A programme of self-assessment against CQC standards • Commissioning for Quality and Innovation (CQUIN) requirements • Quality impact assessment of all cost improvement plans and change programmes, undertaken by a
panel of senior clinicians and managers and signed off by the Medical and Nursing Directors
The NHS Trust Development Authority’s overall escalation rating for the Trust is 5 which is the best available and implies no interventions with the possibility of less frequent oversight.
In 2015/16 the Trust will build on this excellent foundation, introducing and embedding a ‘Total Quality Culture’ based around our vision wheel. This means that, where benchmarked performance indicators exist, the Trust will expect to be in the top quartile, of comparable Trusts, for all measures. Each indicator will map directly to one of the four quadrants of the vision wheel: quality, relationships, value for money and patient experience.
Quality Priorities
These are: (i) to deliver measureable, year-on-year improvements in every area of patient safety, (ii) to deliver measureable, year-on-year improvements in patient and carer engagement and satisfaction and (iii) to improve outcomes for patients via evidence-based practice. These three quality priorities are described in the quality quadrant of the vision wheel as safe, personal and effective.
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Quality Goals
Each quality priority is underpinned by a small number of specific, measureable goals which are also described in our Quality Strategy. These goals have either been co-produced with stakeholders or identified by localities as particularly pertinent for 2015/16. The quality goals are as follows:
Safe Improve the rate of harm-free care, measured by a reduction in pressure ulcers, harmful falls, catheter-associated urinary tract infections and new cases of venous thrombo-embolism. {applicable to Bradford Districts, Bradford City and AWC localities}
Reduce the risk of serious incidents by ensuring that people discharged from in-patient mental health services receive early follow-up, measured by an increase in the number of patients seen within three days of discharge. {applicable to Acute Care locality}
Encourage a culture of openness, transparency and continual improvement, measured by (i) an increase in the proportion of staff who would feel secure raising concerns about unsafe clinical practice and (ii) remaining in the top 20% of comparator Trusts for this measure in the NHS Staff Survey. {applicable to all localities}
Personal Improve the number and quality of carers’ assessments, measured by an increase in (i) the number of carers offered an assessment and (ii) the number of documented assessments {applicable to all localities}
Improve integrated, community care for people at high risk of falls, measured by an audited increase in the quality of care plans. {applicable to Bradford Districts, Bradford City and AWC localities}
Ensure personalised packages of care are identified for mental health service users by improving clustering performance, measured by an increase in the proportion of service users with an ‘in-date’ cluster. {applicable to all localities}
Effective Improved response for people with a mental health crisis, measured by a reduction in the number of people detained by the police under Section 136 of the Mental Health Act. {applicable to Acute Care locality}
Address the physical health inequalities experienced by people with mental illness, measured by (i) introduction of a smoke-free policy across all in-patient environments and (ii) an increase in the number of in-patients and community EIP patients having a comprehensive cardio-metabolic risk assessment, with results recorded and shared with the patient and their GP. {applicable to all localities}
Encourage staff pride in the quality of services provided by the Trust, measured by (i) an increase in the proportion of staff who would recommend the Trust as a place to work or receive treatment and (ii) entering the top 20% of comparator Trusts for this measure in the NHS Staff Survey. {applicable to all localities}
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How we consulted with stakeholders about our quality goals
We consulted widely to ensure that as many people as possible have had a say in the quality goals we have identified for 2015 /16.
The range of people we have consulted includes:
• Our staff • Patients / Service Users • Carers • Commissioners • Our members • Partner organisations including Healthwatch, advocacy and voluntary organisations • The public in general
We have used a number of approaches as follows:
• Issue of a survey to all of the groups listed above • A specific event for service users, carers, advocacy and involvement representatives (including staff);
unfortunately attendance was hampered due to the bad weather • Engagement with existing patient / service user groups
We have used the responses to inform our quality goals. Performance against these goals will be reported upon in the next Quality Account;
Our stakeholders also identified a number of other issues that they wished us to focus on during the next year; we will therefore include updates on the following areas of work in our next Quality Account:
• How the First Response service has made a difference • Our work on improving transition between services • How we use service user and carer feedback to support improvement • Examples of how we have learned from best practice • How we have met the safer staffing requirements
23. COMMISSIONING FOR QUALITY AND INNOVATION 2015/16 (CQUIN) As part of our contracts for 2015/16, CQUIN targets have been agreed with commissioners of the Trust’s services.
The CQUINs agreed comprise nationally identified goals (where these apply to Trust services) and locally agreed goals. Below is a brief description of each of the priorities identified.
Nationally identified CQUIN:
1. Improving physical healthcare of people with severe mental illness; to reduce the 15 to 20 year premature mortality in people with severe mental illness and improve safety through improved assessment, treatment and communication between clinicians. This is an extension of the CQUIN from 2014/15.
2. Urgent and Emergency care – Care Home Liaison; this is a local variation on the National CQUIN. Care Home Liaison will deliver an educational programme to staff in identified care homes which will result in the Care Home Liaison team working proactively with staff in the care homes to develop care plans to avoid unplanned admissions where appropriate.
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Local CQUINs agreed with Clinical Commissioning Groups:
1. Care Planning – Falls assessment; in line with NICE guidance (2013) ensuring that all patients who are assessed as high risk of falls have an appropriate assessment and care plan in place.
2. Self-care; working in partnership with colleagues from neighbouring acute Trusts ensure that self-care is embedded within clinical practice across community services, through inclusion in care planning discussions, decisions and care plan documentation. Recognising the time required to embed this change, this CQUIN will stretch over two years and continue into 2016/17.
3. Personalised Care; working together with Airedale NHS Foundation Trust to design, agree and implement a framework to inform improvements to care provision, ensuring that the patient is central to the care planning and goal setting process.
4. Integrated discharge co-ordination – Community Nursing Service responses and implementation of ‘early supported discharge’ processes; this CQUIN is a continuation of the 2014/15 CQUIN to integrate discharge planning from acute Trusts to including 24 hour community nursing response.
This CQUIN also includes a new section on collaborative early supported discharge planning.
CQUINs agreed with NHS England for Low Secure Services
1. Supporting carer involvement; this CQUIN builds on the carer involvement strategy developed during 2014/15, evaluating its effectiveness and further developing ways to involve carers, family and friends.
2. Smoking Cessation; supporting service users in Low secure Services to stop smoking.
3. Collaborative risk assessment; during 2014/15 an education programme was developed for patients and qualified staff around collaborative risk assessment and management. This CQUIN takes forward the practical application of the training.
CQUIN agreed with NHS England – Health Visiting Services and Family Nurse Partnership
1. Health visiting: Building community capacity; to provide advice to all families within the local community by maximising family resources and the development of community resources.
Successful delivery of these targets will contribute to the on-going improvements to patient safety, experience and clinical effectiveness.
24. QUALITY PRIORITIES; CONCLUDING POINTS In addition to the priorities and goals outlined in sections 22 & 23, we will also strive to meet the quality indicators agreed with our commissioners through our quality schedule and contractual arrangements.
Where appropriate indicators will be identified to monitor and evidence the quality improvement and they will be incorporated into our performance reporting and monitoring for 2015/16. As in 2014/15, for a number of our indicators we will continue to set ourselves challenging targets of 100% achievement in order to support our vision for providing excellent services.
We will also continue to use patients’ and carers’ own experiences and provide stories and narrative to show the quality of the services we provide.
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Part 5: Statements received from our stakeholders Commissioners
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Millennium Business Park Station Road Steeton West Yorkshire BD20 6RB
15th May 2015
Dear Simon
Bradford District Care Trust (BDCT) Quality Accounts 2014/15 Feedback from Airedale, Wharfedale and Craven CCG
Thank you for sending through the Bradford District Care Trust 2014/15 Quality Accounts for review.
Overall, the BDCT Quality Account provides a detailed, open and honest reflection on the activities undertaken throughout 2014/15. It shows clear evidence of continuous improvement in the quality of services delivered. The Account is comprehensive and clear to the reader and the design layout successfully links the quality agenda to the NHS Outcomes Framework. This provides an assurance to the reader that the national drive to improve quality is deeply embedded in the culture and overall direction of travel of BDCT.
Throughout the report, the use of statements and action plans provides in depth quality detail, resulting in an informative document.
AWC CCG support the priorities put forward for 2015/16 and recognises the challenging goals BDCT strives to achieve. The CCG also notes the good progress which has been made against the priorities of 2014/15.
The Vision of BDCT on the first page sets the scene and informs the reader clearly the values which underpin service delivery.
The Trust should be commended for the diverse patient and stakeholder engagement initiatives put in place, especially in the use of social media and targeting young people. The examples of inter-agency working highlight the partnership and collaboration ethos embedded with the organisations culture. One such example was the ‘troubled families; pilot working with social care and the local police force.
BDCT have conducted a number of clinical audits throughout 2014/15 with areas for improvement being addressed by the Trust. It is noted that the number staff conducting and of patients recruited to research projects has decreased from 2013/14, however acknowledges that research features high on the agenda, reflecting a healthy allegiance to innovation and progress.
Data quality targets on NHS Number and General Practice Code Validity were high achieving 99.6% for admitted patient care and 100% for outpatient care. Clinical coding error rates have significantly improved from last year, resulting in a score of 95% on Primary Diagnosis and 87% on Secondary Diagnosis
AWC CCG acknowledges there is a data time lag with the reporting of some of the CQUIN achievement levels, though it is noted that ‘communication of information to a patients GP following discharge from in-patient care’ was 47.9% against a target of 90%. The CCG suggests BDCT should continue development work in this area and strive to achieve a much higher compliance level.
The Quality Account clearly illustrates numerous areas of good practice and innovation where staff should be congratulated. Examples include, Award for ‘excellence in care planning policy and practice statements’ at the Care Coordination Association Good Practice Awards; development of the Young People with Autism toolkit and ‘Can you C me?’
It is pleasing to read that 87% of patients said that they would recommend the Care Trust to friends and family, however the account would have benefited from including the reasons for the negative responses and how BDCT intends to address these issues.
Centred around a strong organisation is an effective workforce, the staff annual survey results are varied, yet an improvement plan has been developed and the CCG expects that implementation of this will feature as a high priority over the coming months.
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The section on Safeguarding provides an interesting synopsis of the improvement work being undertaken. The CCG acknowledges the Health Passport for young people and wishes the Trust well in the forthcoming awards.
In regard to Infection Prevention and Control, BDCT continue to score 87% against the national cleanliness guidelines audit. This is the minimum pass rate and shows a slight improvement from last year’s figures. In addition, Infection Prevention training uptake was 82.8% against a local target of 80%.
The CCG acknowledges the open and honest culture around incident reporting and notes that the organisation is in the top quartile of reporting organisations. The CCG recognises the mechanisms in place to investigate incidents and the developed recovery plans to prevent similar episodes.
The Complaints and Compliments section highlights a pictorial breakdown of issues received during the year. There were seven perceived confidentiality breaches by staff, this increasing from 3 in 2013/14, however, it is acknowledged that following thorough investigation none were upheld as breaches. Furthermore, there were 40 complaints regarding staff attitude. The account touches on in patient initiatives to address this, however neglects to outline the wider community.
Finally, it is recognised that BDCT provides a diverse array of service provision, and it would be difficult in this account to include every area, however, the narrative includes very little around Community Nursing, Allied Health Care Professionals and salaried Dental Services. The CCG would suggest these are areas that receive particular focus in next year’s account.
I hope that you agree that this summary provides an objective review and should you have any further questions please do not hesitate to contact me.
Kind regards
Steph Lawrence. Executive Nurse
BDCFT response to AWC CCG
The Trust thanks Airedale, Wharfedale and Craven CCG for their comments. We would wish to make the following statements / commitments in response:
We note the comment that BDCT performance for the national CQUIN ‘Communication of information to a patients General Practitioner, following discharges from in-patient care’ was below target and we are committed to continuing to improve our performance throughout 2015/16.
In terms of the query relating to the reasons for negative responses to the Friends and Family test for patients, we can confirm that as part of our internal reporting and monitoring processes any negative responses are fed back to the relevant service manager, on a weekly basis. Responses and actions taken are to be reported on a 6 monthly basis to the Quality & Safety Committee during 2015 / 16. We anticipate including examples of these in our 2015/16 document.
We note the feedback regarding the view that the content of the Quality Account does not fully reflect the diverse array of our services, and we have now included information on the following services in response:
• Salaried dental services (page 33) • Community nursing (page 33)
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In addition to the statements received from our local CCG’s I would like to note that we also provided Healthwatch and the Health and Wellbeing Board the opportunity to provide a statement for inclusion; neither were able to comment on this occasion.
BDCFT response to BDCCG’s
The Trust thanks Bradford City and Bradford Districts CCGs for their comments. We would wish to make the following statements / commitments in response:
In terms of the view that there is little reference to safer staffing monitoring in community services we can confirm that we have added further information to the safer staffing section (page 37) to address this.
In relation to the comment that the Quality Account does not fully reflect the improvements in community nursing during 2014/15, we have now included information on the following services in response:
• Salaried dental services (page 33)• Community nursing (page 33)
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Appendices
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APPENDIX 1 - The Trust’s PLACE-14 Local Improvement Plan
The PLACE Improvement Plan provides the Trust with a strategy for improvement from the recommendations and outcomes of the national PLACE Annual Assessment 2014 (to be achieved within the financial year 2014-15).
Element Issues identified by Patient Assessors
Action
Courtyard Maintenance
Although improvements have been made during the previous year further aesthetic improvements are required in some external courtyards areas. Management of cigarette ends in courtyards proves problematic resulting in untidy courtyard spaces. Some areas have limited planting.
• Grounds maintenance inputs within courtyard areas to increase in number and quality of provision.
• Where redesign of landscape is required to provide an aesthetic improvement, Property Services, in conjunction with Nursing, are to review current provision and identify future requirements
Review 136 Accommodation
The designated rest area within the 136 suite was identified as being inappropriate due to the size of the room.
• The 136 area within Lynfield Mount is to be re-designed and larger accommodation and improved facilities are to be provided in the coming months. The comments made by the Patient Assessor have been forwarded to the architects commissioned by the Trust for inclusion within the new design.
Internal / External Décor
Internal/ external décor scored highly overall although there were some areas identified for redecoration. The full list of areas / rooms is held within the Facilities department.
• Programme for redecoration of areas identified to be agreed with Property Development Manager and implemented.
Floor Covering
Floor covering scored highly overall although there were some areas that were identified as in need of replacement. The full list is held within Facilities.
• Programme for floor covering replacement of areas identified to be agreed with Property Development Manager and implemented.
Furniture Replacement
Furniture across the sites scored highly overall however replacements were identified in some areas due to the requirement for wipe-clean, end of life or damage to coverings.
• Requirements to be formalised and costed. Funding has been identified. Improvements are to be made in LMH Outpatients and Airedale Centre for Mental Health in-patient areas.
Cleanliness Exceptions
The Trust performed highly with regard to cleanliness outcomes overall however there were some exceptions that need addressing including the defrost arrangements for ward kitchen freezers and the cleanliness of underneath dining tables.
• Defrost of freezers to be discussed with Ward Managers by the Hotel Services Manager
• Cleaning of underneath of tables to be communicated to cleaning teams
External Signage
Directional signage located on the Lynfield site has been recently upgraded with the exception of signage at the top of the site which needs replacing.
• Property Services to action
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Appendix 2 Services provided 2014/15
1. A&E Liaison 2. Adult Mental Health Acute
Inpatient Services 3. Intensive Home Treatment 4. Psychiatric Intensive Care
Unit 5. Psychiatric Rehabilitation
Services 6. Older People's Mental Health
- Acute Inpatient Services 7. Criminal Justice Liaison Team 8. Low secure and forensic -
community team 9. Low secure and forensic -
inpatient service 10. Primary Care Mental Health
Services 11. Health Trainer Service 12. Psychological Therapies -
specialist service 13. Alcohol Specialist Clinical
Nurse Service 14. Bradford Working Women's
Service 15. Substance Misuse - GPSI
Service 16. Substance Misuse - Physical
Health Nurse Team 17. Substance Misuse Service -
Fountains Hall 18. Substance Misuse Service -
Keighley Primary Care 19. Substance Misuse Service -
North Bradford 20. Substance Misuse Services -
Secondary Care 21. Carers Support Service 22. Champions Show the Way 23. Community Nursing Children
with Special Needs in Special Schools
24. Chronic Obstructive Pulmonary Disease
25. End of Life Education Team 26. Palliative Care Team 27. Pulmonary Rehabilitation 28. Tissue Viability 29. Continence Service (adults) 30. Speech and Language
Therapy 31. Podiatry 32. Dental Public Health
Programmes, including fluoride varnish, oral health and epidemiology
33. Salaried Dental Service: clinical plus decontamination
34. Dental unscheduled care 35. Assertive Outreach 36. Community Mental Health
Teams - working age adults 37. Older People's Mental Health
- Community Mental Health Teams
38. Child and Adolescent Mental Health Services
39. Learning Disabilities - Assessment and Treatment Unit
40. Learning Disabilities - Health Facilitation and Community Matron Service
41. Learning Disabilities - Intensive Support Team [formerly known as Behavioural Outreach Service]
42. Learning Disabilities - Specialist Therapies Clinical Liaison Team
43. Learning Disabilities - Speech and Language Therapy
44. Early Intervention in Psychosis
45. Case Managers 46. Community Matrons 47. District Nursing 48. Nursing Support Team 49. Family Nurse Partnership 50. Health Visiting 51. School Nursing 52. Looked After Children's
Health Team 53. Safeguarding Children - Child
Protection 54. Youth Offending Team:
Health Team 55. Falls Exercise Classes 56. Men and Boys Health Team
[formerly known as Health of Men Team]
57. Health on the Streets 58. Health Trainers 59. Homeless and New Arrivals
Team 60. Hospice at Home 61. Housing for Health 62. Child and Adolescent Mental
Health Services – Eating Disorders Tier 3
63. First Response
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Appendix 3 Independent Auditor’s Report
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90
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Appendix 4: How to contact us Let us know what you think
Hopefully, our quality account has been informative and interesting to you and we welcome your feedback, along with any suggestions you may have for next year’s publication.
Please contact us at: [email protected]
Bradford District Care NHS Foundation Trust Trust Headquarters New Mill Victoria Road Saltaire Shipley BD18 3LD
Check out our website
Do you want to know more about the services that we provide? Visit us at www.bdct.nhs.uk
This Quality Account can be found on the NHS Choices website at www.nhs.uk
By publishing the report with NHS Choices, Bradford District Care Trust complies with the Quality Accounts Regulations.
Join us as a member and have a say in our future plans
A representative and meaningful membership is important to the success of the Trust and provides members of our local communities the opportunity to be involved in how the Trust and its services are developed and improved. Membership is free and the extent to which our members are involved is entirely up to them. Some are happy to receive a newsletter four times a year and come along to membership events.
For further information please contact our Foundation Trust Office on:
Tel: 01274 363556 Email: [email protected]
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Appendix 5: Glossary of terms This section aims to explain some of the terms used in the Quality Account. It is not an exhaustive list but hopefully will help to clarify the meaning of the NHS jargon used in these pages.
6 C’s of Nursing
http://www.england.nhs.uk/wp-content/uploads/2012/12/6c-a5-leaflet.pdf
Agile Working
Agile working can be described as the effective use of modern technology to allow staff to work in the way that best suits their best job role; allowing work to be completed in the most appropriate place, at the best time, and in a way that delivers the best possible care to service users.
Audit
Audit is the process used by health professionals to assess, evaluate and improve care of patients in a systematic way in order to enhance their health and quality of life.
Calderdale Competencies
The Calderdale Framework (CF) provides a clear and systematic method of reviewing skill mix and roles within a service to ensure quality and safety for patients. Following this CF was used to develop a core competency set for nursing support staff It is wholly transferable to any health or social care setting, and enables patient focused development of new roles and new ways of working, leading to improved efficiency in utilisation of roles2 The process of applying CF leads to the development of a detailed competency training document, based on tasks and functions which are needed to deliver patient focused services. This provides the basis for work-based training, and reduces unjustifiable variations in care.
Care Plan Approach (CPA)
The Care Programme Approach (CPA) was introduced by the Department of Health in 1991 as a framework for the assessment and management of persons with a mental health disorder, both in hospital and in the community
Care Quality Commission
The Care Quality Commission or (CQC) is the independent regulator of health and and social care in England. The CQC regulates care provided by the NHS, local authorities, private companies and voluntary organisations. The organisation aims to make sure better care is provided for everyone - in hospitals, care homes and people's own homes. The CQC seeks to protect the interests of people whose rights are restricted under the Mental Health Act.
Commissioner
Commissioners are responsible for ensuring adequate services are available for their local population by assessing needs and purchasing services. Clinical Care Groups (CCG’s) are the key organisations responsible for commissioning healthcare services for their area. They commission services (including acute care, primary care and mental healthcare) for the whole of their population, with a view to improving their population’s health.
CQUIN (Commissioning for Quality and Innovation Payment Framework)
High Quality Care for All included a commitment to make a proportion of providers’ income conditional on quality and innovation, through the Commissioning for Quality and Innovation (CQUIN) payment framework.
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_091443
Francis Report
The report of the public inquiry, led by Robert Francis QC, into the failings at Mid-Staffordshire NHS Foundation Trust between January 2005 and March 2009.
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_113018
Foundation Trust (FT)
Foundation Trusts are still part of the NHS, and still have NHS inspections and standards to meet.
Friends and Family Test (FFT)
The NHS friends and family test (FFT) is an important opportunity for patients / service users to provide feedback on the care and treatment they have received. This feedback will used to improve services.
Health Visiting Well Child Quality service Standards & Guidance for Practice
http://www.phru.net/phn/healthvisitingreview/Literature%20Review%20and%20Evidence/Bradford%20HV%20standards%20-%20Nov%2005.pdf
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Healthwatch
An independent consumer champion for both health and social care that replaced LINk from 1 April 2013.
Hellomynameis
A campaign started by Kate Granger to encourage all staff to introduce themselves before they begin delivering care.
http://hellomynameis.org.uk/
My Shared Pathway
My Shared Pathway evolved as part of the Secure Services Quality Improvement Productivity and Prevention (QIPP) Programme, it is one of three initiatives that have been developed to reduce lengths of stay in secure care.
National Patient Safety Agency (NPSA)
A national body who lead and contribute to improved, safe patient care by informing, supporting and influencing organisations and people working in the health sector
NHS Constitution (March 2013)
The NHS Constitution is a formal document which aims to set out clearly what patients, the public and staff can expect from the NHS and what the NHS expects from them in return.
http://www.nhs.uk/choiceintheNHS/Rightsandpledges/NHSConstitution/Documents/2013/the-nhs-constitution-for-england-2013.pdf
NHS England
NHS England is an executive non-departmental public body of the Department of Health. NHS England oversees the budget, planning, delivery and day-to-day operation of the commissioning side of the NHS in England as set out in the Health and Social Care Act 2012. It holds the contracts for GPs and NHS dentists.
NHSTDA – NHS Trust Development Authority
An organisation responsible ensuring providers of NHS care are fit for purpose as they move towards foundation trust status.
NHS Safety Thermometer
The NHS Safety Thermometer gives nurses a template to check basic levels of care, identify where things are going wrong and take action. It is being used by frontline healthcare workers to measure and track the proportion of patients in their care with pressure ulcers, urinary tract infections, venous thromboembolisms and falls.
https://www.gov.uk/government/news/guidance-to-support-the-nhs-in-implementing-the-nhs-safety-thermometer-published
NHS Staff Survey
An annual anonymous survey to staff in all NHS organisations
http://www.nhsstaffsurveys.com/Page/1019/Latest-Results
NICE - National Institute for Health and Care Excellence
The National Institute for Health and Care Excellence (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. This role was set out in a 2004 white paper, Choosing health: making healthier choices easier, and is intended to help people to make well-informed choices about their health.
https://www.nice.org.uk/
OFSTED
Ofsted is the Office for Standards in Education, Children’s Services and Skills. They report directly to Parliament and are independent and impartial. They inspect and regulate services which care for children and young people, and those providing education and skills for learners of all ages.
http://www.ofsted.gov.uk/
Partners in Audit Network (PiAN)
A service user and carer audit network
Quality
Quality is defined by Lord Darzi in High Quality Care for All (2008) as an NHS that gives patients and the public more information and choice, works in partnership and has quality of care at its heart – quality defined as clinically effective, personal and safe. Quality is an NHS that delivers high quality care for all users of services in all aspects, not just some.
Quality Account
A Quality Account is an annual report to the public about the quality of services delivered. The Health Act 2009 places this requirement onto a statutory footing. Quality Accounts aim to enhance accountability to the public and engage the leaders of an organisation in their quality improvement agenda.
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Quality and Safety Committee (QSC)
The quality and safety committee is a committee of the Trust Board that monitors, reviews and reports to the board on the adequacy of the Trust’s processes in the areas of clinical and social care governance. It ensures the Trust is effectively organised to meet the requirements of external inspectorate bodies and seeks assurance that systems and processes are in place to demonstrate that the quality of services is of a high standard.
R4
The Trust’s clinical information system for salaried dental services.
RiO
The Trust’s clinical information system for mental health services.
Safer Staffing
NHS organisations are now publishing ward level nurse staffing information on NHS
Choices
http://www.nhs.uk
Stakeholders
A person, group or organisation, who is affected or can be affected by an organisation's action.
‘Stretch’ target
An aspirational target that is set at a level that ensures the organisation are challenged to deliver.
SystmOne
The Trust’s clinical information system for community services.
The NHS Carer Strategy 2014-2016
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/368478/Carers_Strategy_-_Second_National_Action_Plan_2014_-_2016.pdf
Winterbourne View Report
A Department of Health review into the criminal abuse of patients at Winterbourne View Hospital, December 2006 – June 2011
https://www.gov.uk/government/publications/winterbourne-view-hospital-department-of-health-review-and-response
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