An annual report detailing the quality of services we offer to our community.
Our vision is to be the outstanding provider of high quality, integrated care to the communities we serve. Our values will guide how we will achieve that vision and face up to the challenges that lie ahead. Health is our passion, with patients at the heart of everything we do Exceptional care as standard Actively supporting each other to do our jobs Responsive, professional and innovative Trusted to deliver
Contents
b
Introduction: Karen Howell, Chief Executive
5
b
Section 1: Foreword from the board
6
b
Section 2: Performance overview 2015 - 2016
8
b
Section 3: Quality assurance of the services we deliver
18
b
Section 4: Bringing high quality services closer to home
20
b
Section 5: Objectives for 2016 - 2017
22
b
Section 6: Statement from Healthwatch Wirral
24
b
Section 7: Statement from Wirral Clinical Commissioning Group
25
b
Section 8: Statement from the Local Authority
26
b
Our services
27
About our trust At the heart of the community Wirral Community NHS Trust provides high quality primary, community and public health services to the population of Wirral and parts of Cheshire and Liverpool. We are registered with the Care Quality Commission (CQC) without conditions, and play a key role in the local health and social care economy working in partnership to provide high quality, integrated care to the communities we serve. Our expert teams provide a diverse range of community healthcare services, seeing and treating people right through their lives both at home and close to home. We have an excellent clincial reputation employing over 1,500 members of staff, 90% of who are in patient-facing roles. Our workforce represents over 70% of the costs of the organisation and are our most important and valued resource. Each year we have over 1.1 million face to face contacts and our services are delivered in many settings: clinics, health centres, GP surgeries, schools and people’s homes. We serve a Wirral population of around 320,000 residents across
4 Quality Account 2015 - 2016
145,000 households. It is very likely that most will come into contact with our services at some point either as a patient, carer, or relative of a patient or as one of our members or volunteers. Not unlike most places in the country, the local health and social care economy is faced with the challenge of meeting rising demand, within finite finances. This is driving the growth in provision of community health services and we will play a vital part in enabling people to live more healthy, active and independent lives, reducing unnecessary hospital admissions.
Introduction This quality account reflects our commitment to providing the best possible standards of clinical care. It shows how we listen to patients, staff and partners and how we work with them to deliver services that meet the needs and expectations of the people who use them. During 2015/16 we can share many examples of where we are providing excellent clinical care, including the achievement of our Commissioning for Quality and Innovations (CQUIN) schemes and quality objectives in areas such as; integrated pathways, safeguarding standards and dementia care. Following assessment by the external regulator Monitor, we were found to be a well-led organisation and have recently been authorised as a foundation trust. As a foundation trust we remain fully part of the NHS and will continue to meet nationally set targets and objectives. We now have more freedom from central Government control and are instead more accountable to local people through our trust membership and council of governors. This will help us respond better to the needs and priorities of local communities. Through our work with the Healthy Wirral Partners: Wirral University Teaching Hospital NHS Foundation Trust (WUTH), Wirral Council, Cheshire and Wirral Partnership NHS
Foundation Trust (CWP) and Wirral Clinical Commissioning Group (CCG) we are re-shaping health and social care services to make sure people receive the right care in the right place at the right time and are at the centre of any care planning they need. We have aimed high again in setting challenging quality goals for 2016/17. These include a focus on staff wellbeing and patient safety.
in what has been a successful year improving quality across all services. I confirm on behalf of the Trust Board that, to the best of my knowledge and belief, the information contained in this Quality Account represents our performance in 2015/16 and our priorities for continuously improving quality in 2016/17.
Our staff continue to develop innovations that are transforming community health services and ensuring their sustainability. We are determined to maintain our financial stability and see ‘quality’ as both a clinical and business priority. We have been changing and adapting the way we deliver services, making sure we deliver care efficiently, working with our staff to embed technological solutions that give us more time to provide care to patients. On behalf of the Trust Board, I would like to thank all staff and volunteers for their dedication, energy and passion for quality care,
Karen Howell Chief Executive
5 Quality Account 2015 - 2016
b  Section 1:
Foreword from the board
6 Quality Account 2015 - 2016
The Quality Account aims to provide assurance to our patients, commissioners and the local population that our services are safe, effective, caring, responsive and well-led. Our priorities for 2016/17 are set out in this report and have been developed in partnership with patients, members, governors, Healthwatch and our commissioners. They are aligned to the NHS Constitution and aim to meet the expectations of the populations we serve. Our top three quality priorities are: • To make our organisation more resilient to risk by acting on feedback from staff and patients, monitoring and reporting on how safe our services are and learning from what might go wrong • To deliver excellent patient care through a workforce who are engaged in organisational decision making, and have access to a range of opportunities to maximise their wellbeing • To continue to develop affordable, high quality community services, taking a leading role in system wide transformation
7 Quality Account 2015 - 2016
b Section 2:
Performance overview 2015 - 2016 Our patients and communities b We will identify and provide appropriate care for all patients aged 75 diagnosed with dementia following an episode of emergency unplanned care. We have successfully implemented a ‘case finding’ process which identifies individuals with a diagnosis of dementia following discharge from hospital. Once identified, we are able to provide appropriate support to both the person and their carers including signposting to dementia cafes and house of memories. We have trained over 100 members of staff in ‘advanced dementia skills’ and are developing a strong network of dementia champions.
b Support care navigation through effective Single Point of Access process. During 2015/16, we have tested an alternative model by developing and applying criteria to help prevent admission to hospital. This includes identifying any patient who can be safely managed at home with the support of Integrated Care Coordintation Teams (ICCTs), Community Rapid Response and Community Voice. This has resulted in 57% of people receiving treatment at home, reducing the number of avoidable admissions.
8 Quality Account 2015 - 2016
b We will reduce avoidable grade 3 & 4 pressure ulcers acquired during our care. We have promoted the reporting of pressure ulcers developing througout all of our clinical services. This will ensure that we have accurate information to develop future quality goals to continuously improve quality of patient care. During 2015/16 we identified 16 avoidable grade 3 or 4 pressure ulcers compared with 14 during 2014/15. We have developed a multi-professional review group which supports learning and introduced pressure ulcer champions across our community nursing services. We collaborate with colleagues at WUTH sharing best practice on harm free care. The Tissue Viability Service has provided updates for 127 staff in the trust this year. The service also offers pressure ulcer prevention training to staff in Care Homes across the Wirral. Harm free care remains a prioirty for us.
b 95% of patients will be seen within 30 minutes for initial assessment within our walk-in centres. During 2015/16 our walk-in centre staff saw over 79,000 patients; of these 83.38% were seen within 30 minutes of initial assessment. Wait times were impacted on by the transfer of the 111 service and an increase in demand over the winter months. This target remains a priority for us and will remain a quality goal for 2016/17.
b We will achieve a Friends and Family score of 85%. Our Friends and Family (FFT) score during 2015/16 was 92% exceeding our target of 85%. Our Community and Specialist Nursing, Heart Support, Health Visiting, Livewell and Therapy Services achieved an FFT of 100% throughtout most of 2015/16. The above data represents 6,465 responses (April 2015 to February 2016).
Additional Safety Information Serious Untoward Incidents (SUIs) Serious incidents requiring investigation in healthcare are rare, but when they do happen the trust has processes in place to respond quickly, protecting patients by ensuring a robust investigation is carried out. This provides an opportunity for the trust to learn from all serious incidents, minimising the risk of the incident happening again. During 2015/2016 we conducted 1,076,229 contacts and reported 3419 patient safety incidents,16 (0.5%) of all incidents were classified as resulting in severe harm, with none resulting in death. We have worked closely with our commisioners over the past year to implement new SUI national guidance. As a result we reported 79 SUIs this year, compared to 19 in 2014/15. This increase is due to changes made in the guidance. We have achieved the 48 hour reporting target for all SUIs and have completed all investigations within the timescales set.
Lessons learned have informed quality improvements including, the introduction of ‘patient safety huddles’ across our community nursing service to enhance communication. Never Events Never Events are serious, largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented. We had one never event during 2015/16. The incident was a wrong tooth extraction which was disclosed immediately to the patient and a full apology provided. As this was the second incident of this nature within a two year time period, we worked closely with an external expert who led the investigation and made recommendations for improvement. All recommendations have been fully implemented and are monitored. Learning from mistakes league We are amongst the top 25 trusts in the country for openness and transparency and ranked as ‘good’ in the new Learning from mistakes league table. Duty of candour We take seriously our duty of candour, which means that we inform people and their family members or carers when they are involved in a patient safety incident that results in moderate or severe harm. During 2015/16, we have reported no breaches to our duty of candour and have involved people in the process of investigating incidents, routinely informing them and their families / carers of the outcome.
‘‘Could you please be so kind as to pass on my thanks to the staff for their kind and prompt service that I received on Monday afternoon this week. I had some chest pains which, were causing some worry, I attended the Minor Injuries Unit in Wallasey where I was immediately triaged and seen by a Nurse Practitioner, who tried to get my GP Surgery to see me to no avail. I was sent to the Walk-in centre at Arrowe Park where I was seen immediately, and it was arranged for me to go to the Medical Assessment Unit with a letter for tests. I cannot praise too highly the quality of service I have received from the Walk-in centre service and also from the Acute Assessment Unit at Arrowe Park Hospital. The NHS has delivered with style, immediacy and kindness that is all too often missing in our society. Please pass on my grateful thanks to the people responsible for these services and to the people who actually delivered them. The NHS at its best!’’
9 Quality Account 2015 - 2016
b  Section 2:
Performance overview 2015 - 2016 Our services b  We will develop and implement a Wirral wide integrated therapies pathway to expedite safe, timely discharge and prevent avoidable admission to hospital care. During 2015/16, we have developed integrated pathways across health and social care to ensure that people are supported to live independently at home, preventing avoidable admissions to hospital and making the home environment as safe as possible when people return after a hospital stay. To support this integrated pathway, we have worked with WUTH and the Department of Adult Social Services (DASS) to agree joint processes. We have identifed bases where we have located staff from the different organisations together in integrated care coordination hubs. The rotation of newly qualified occupational therapists and phsyiotherapists across WUTH and the trust will commence in April 2016. This will be extended to include all band 5 therapists and we will explore rotation of band 6 therapists early 2016/17. The next step is to develop a joint recruitment strategy ensuring that we attract physiotherapists and occupational therapists to Wirral.
10 Quality Account 2015 - 2016
b We will reduce the proportion of avoidable emergency admissions to hospital by working in partnership to plan safe out of hospital care. During 2015/16 we have contributed to reducing the number of people admitted to hospital through the following initiatives: • Development of integrated care coordination hubs which are responsive and support people to better manage their long term conditions and prevent the need for admission to hospital • Implementation of a coordinated rapid response service aimed at supporting people to remain at home during periods of health crisis • Enhancing the skills of nurses working within our Community Nursing Service to support the delivery of acute and complex care in the community
• Review of our Community Matron Service to enhance clinical governance and leadership to community nursing teams to support case management and admission prevention
b All clinical staff in our 0 -19 service will receive safeguarding supervision in accordance with the Safeguarding Supervision Policy. We take seriously our commitment to safeguard children and vulnerable adults. To support this, all clinical staff in our 0 -19 Health and Wellbeing Service received safeguarding supervision during 2015/16 in accordance with our safeguarding supervision policy.
b We will ensure that daily nursing staffing levels and skill mix against assessed patient acuity levels are maintained at 95% of the required fill rate. During 2015/16 we have monitored daily staffing levels across our community nursing teams. Where teams have experienced reduced staffing levels as a result of sick leave and difficulties in recruitment, we have responded quickly to ensure that patients and staff remain safe. To support this, we introduced a daily safety huddle where community nursing team leaders get together to discuss issues and find solutions, working across all community nurse teams to ensure that staff are deployed as fairly and safely as possible. We have reviewed our flexible staffing arrangements to ensure a timely response to reduced staffing levels. To support this we are introducing clinical leadership into the nurse bank and developing a relief team.
OPAT Case Study We began treating a patient who had been diagnosed with a serious ear infection with potentially life threatening complications. A critical part of his treatment was to receive antibiotics by daily infusion over the course of a month. Initially it was thought the patient would need to attend hospital 20 miles away as a daily outpatient to receive his treatment. This would have been very inconvenient for him and would have had a negative impact on his health and wellbeing. Fortunately, through joined-up care with both WUTH and Aintree Hospitals, we were able to arrange for the patient to be succesfully treated at home with daily visits from our community nurses. The patient was delighted. “I got great news that you could come to the house and do it. The service was great, the girls were great, in fact, they were superb. I would recommend it to anybody.” OPAT – definition: Outpatient Parenteral Antimicrobial Therapy - the delivery of intravenous (into the vein or IV) antibiotics to patients who are medically stable, within their own homes.
11 Quality Account 2015 - 2016
b Section 2:
Performance overview 2015 - 2016 Our people b We will ensure that 95% staff complete mandatory training during 2015/16 During 2015/16 86% of staff completed their mandatory training with 97% of staff completing their Information Governance training.
b We will increase the percentage of staff who would recommend Wirral Community Trust as a place to work / receive treatment as measured by the NHS National Survey
b We will achieve 4.0% staff sickness levels or below
Our staff survey results for 2015/16 were extremely positive.
In 2015/16 the sickness absence rate for the organisation was 4.7% although we did not meet the target of 4.0% this was an improvement on the previous years’ rate for 2014/15.
Compared to community trusts nationally, 20 of the key findings were better than average, seven of which were higher than any other community trust.
b 95% of staff will have their Appraisal May – July 2015 We achieved 98% of staff having an appraisal and development plan during 2015/16. This was an improvement on the previous year when 95% completion was achieved. During this year, we have developed the “Leadership for All” programme which will be included within the appraisal process for 2016/17. This will provide an opportunity for all staff to review their leadership potential and plan future development.
12 Quality Account 2015 - 2016
The trust scored higher for overall staff engagement than the 2015 average for community trusts, and staff rated us better than the national average compared with all community trusts for recommending the trust as a place to work or receive treatment.
b Staff friends and family test We have conducted the staff friends and family test in each of the quarters of the year, once as part of the national NHS staff survey. We ranked above average for all community trusts for the percentage of staff who would recommend their trust to friends or family as a place to work or receive treatment (Q3 2015/16 results).
b Recruitment Recruitment of nurses and therapists is a national challenge. In February 2016 we held our first recruitment open day and attracted 200 people to consider working with us. We launched a recruitment Facebook page to promote working at the trust. The page has attracted to date over 1000 followers and is a useful way to engage with those interested in working for us.
“Treated with consideration and care for my problem, encouragement too. Came away feeling someone has actually listened to me and not made me feel as if I was moaning on about things.� Nutrition & Dietetics Service
Quality Account 2015 - 2016
b Section 2:
Performance overview 2015 - 2016 Our sustainability b We will achieve Foundation Trust Status during 2015/16. During 2015/16, we were evaluated by the regulator Monitor and were authorised to be an NHS Foundation Trust. This is a great achievement and means that we are now: • free from central government control and able to decide how to improve their services • able to retain any surpluses we generate to invest in new services, and borrow money to support these investments • accountable to the local community, with local people as members and governors
b We will improve the rating achieved within our Information Governance Toolkit submission year on year. We achieved an improved rating within our information governance toolkit submission during 2015/16. Of the 38 standards, we achieved level 3 in 12, an improvement of 3. This reflects the value we place on protecting people’s personal data and privacy.
b We will support a minimum of four innovation projects via our clinical innovation fund. We have supported three innovation projects during 2015/16. These have led to the following improvements: Early identification of high pressure areas in the diabetic foot to help prevent ulceration This will be achieved by the use of pressure mat technology which provides visual data to enable the correct prescription and manufacture of orthotic insoles. It also helps to educate the patient in managing their condition better. Body composition scales This project for cardiac rehabilitation patients will help them maintain healthy long-term lifestyle modifications and create patient-led empowerment through increased understanding and motivation. Breast Pumps for Premature Babies This project will provide a double breast pump to those mothers who are discharged from hospital whilst their premature infant/s remains in a Neonatal Intensive Care Unit. This will enable premature infants to be exclusively fed breast milk.
This is a unique project focused on the most vulnerable babies who are at increased risk of developing severe long term medical conditions. We have also purchased ten breast pumps in Cheshire East to support breastfeeding mums to increase their milk volume/supply, support those mums that are unable to breastfeed for whatever reason and increase breastfeeding continuation rates.
b We will use staff ideas to help us reduce waste and become more cost effective. Staff continue to submit ideas and innovations that contribute to and inform our transformation programme – ‘Transforming care together’. The programme began in 2015 and key outcomes will include: • transforming the model of care • transforming the workforce model • transforming the systems which support clinical care delivery • transforming the partnerships that ensure integrated, patient centred care is delivered
“Lovely, caring staff, professional and very experienced at helping people with dementia.” Community Dental Victoria Central Health Centre 14 Quality Account 2015 - 2016
“Lovely, clean, pleasant, supporting gentle staff made me feel confident. There was no waiting, I was seen to on time. Staff were pleasant and informative. I felt relaxed throughout my visit.� Podiatry
15 Quality Account 2015 - 2016
b Section 2:
Performance overview 2015 - 2016 Safe, responsive, caring, effective, well-led b Safe Sign up to Safety The first priority in our Quality Strategy is: Putting people at the heart of quality A key element of this is our commitment to protecting people from avoidable harm. The strategy is based upon the five Sign Up To Safety themes: 1. Put safety first 2. Continuously learn 3. Honesty 4. Collaborate 5. Support These priorities form the basis of our patient safety improvement plan. We use a web based incident reporting system and triangulate this with learning from complaints, SUI investigations, staff raising concerns and other relevant information. This ensures that we recognise and learn from early warning signs with the aim of minimising risk to patient safety.
b Responsive Transformation programme We have been on our transformation journey since 2013 and started phase two with the launch of our Transforming Care Together programme during 2015/16. Our key priorities for transformation are to: • embed Integrated Care Coordination Hub (ICCH) based teams
16 Quality Account 2015 - 2016
• promote self-care and independence through partnerships with people and community based assets • apply technological solutions to support care delivery • implement effective clinical triage and appropriate allocation of care across our integrated hubs, supporting continuity of care and improved outcomes • work with partners in the co-design of care pathways • systematically align a 90 day improvement cycle to all Quality Improvements
b Caring from Good to Great! Following our comprehensive CQC inspection in September 2014, we have worked hard to fully implement all recommendations made as a result of this process. Our services were all rated as ’Good’, and we were proud to receive feedback that all of our services were found to deliver high levels of care and compassion. The first step in achieving excellence in patient care is to ensure that our staff feel cared for with fairness and compassion. We believe that we do this well and plan to work with staff to strengthen our staff wellbeing programme during 2016/17.
b Effective award winning care We consistently provide innovative, evidence based effective care. During 2015/16 we have been successfully shortlisted for a number of national awards including: British Journal Nursing Awards Maria Hughes was awarded 2nd place in the Tissue Viability Nurse of the Year category and 3rd place in the Innovation Award category. Maria also won Employee of the year at the trust’s annual staff awards in February 2016. Nursing Times Awards Helen Calverley won the coveted Nursing Times Rising Star Award. She was praised for having a profoundly positive impact on patients and others and was described as ‘the living embodiment of compassionate care’. Helen was also winner in the Exceptional care category at the trust’s annual staff awards. Journal of Health Visiting Awards Claire Whitehead was shortlisted in the category; Best practice in Promoting/ Maintaining Breastfeeding. RCNi Awards The trust’s Community Nursing Service has been shortlisted in the Innovation Award category at this year’s awards for their delivery of IV therapy in people’s homes.
b Well – Led Foundation Trust Status As well as achieving an overall ‘Good’ rating in our comprehensive CQC inspection, our Trust Board has also led us through the process of authorisation to become an NHS Foundation Trust. In November 2015 the trust was delighted to announce the formation of its first Council of Governors. The Council of Governors has an important job, overseeing the running of the trust and representing the interests of members and the public. Now that Wirral Community NHS Trust is a foundation trust the governors will have a number of formal powers, which include appointing the Non-Executive board members.
Maria Hughes, Tissue Viability Lead Specialist Nurse and Queens Nurse at the BJN Awards.
“Of the 120 patients or carers we spoke to, all said how pleased they were with the care and treatment provided by Wirral Community Health NHS Trust and said that the staff were kind and caring supporting them in their needs. Every patient we spoke to, spoke highly of the kindness of the nurses and therapy staff.’’ Care Quality Commission
Helen Calverley, Community Staff Nurse, recieves her Rising Star Award.
17 Quality Account 2015 - 2016
b Section 3:
Quality assurance of the services we deliver Quality assurance b Performance framework During 2015/16 we have re-designed our clinical divisions and strengthened our internal performance framework. This has been supported by the establishment of a senior leadership forum which provides operational leadership to all performance areas supporting the triangulation of information to maintain quality and safety.
b Clinical audit programme A key mechanism for internal assurance is our clinical audit programme. Clinical audit supports healthcare staff to regularly review progress and improve care standards. During 2015/16, 23 clinical audits were undertaken and key quality improvements include: • Speech and Language Therapy service re-designed their first telephone triage form for initial dysphagia screening for adults with a learning disability to ensure patient safety As well as internal audits, we participate in national audits that are relevant to our services. During 2015/16 we participated in the UK Parkinson’s Audit.
b Infection prevention and control audits Infection prevention and control continues to be a priority for us. It is an integral part of clinical governance system. During 2015/16, we undertook a programme of audits to assess the cleanliness of premises where we provide treatment. This allows us to review our
18 Quality Account 2015 - 2016
standards against national best practice, and compliance with trust policies and procedures. We achieved very positive results, benchmarking well against national best practice. We will continue to ensure consistent standards of infection prevention and control in premises where we provide care to ensure patient and staff safety.
b MIAA During 2015/16 we achieved significant assurance in the following audits: • safeguarding • quality health check We received the highest level of assurance for Information Governance (IG).
b Revalidation Professional revalidation is required by registered nurses, doctors and allied health professionals to ensure that they remain fit to practice. The process of nurse
revalidation changed in April 2016. We have supported staff in getting ready for this change and have updated the appraisal documentation to make the process as easy as possible.
b Staff raising concerns During 2015/16 we reviewed our raising concerns processes and updated our internal pathway for reporting. We appointed a ‘Freedom to Speak Up’ Guardian in line with recommendations from the Francis Review and re-aligned the policy as a key part of our patient safety improvement plan.
b Care Quality Commission (CQC) Our ambition is to achieve an ‘outstanding’ CQC rating when we are next inspected in 2017. To prepare for this, we have reviewed our self-assessment processes and are developing a set of resources for teams which describe what outstanding looks like.
21 Quality Account 2015 - 2016
b Section 4:
Bringing high quality services closer to home Care closer to home b Healthy Wirral
• Single Front Door at Arrowe Park A&E
b Integrated Care Coordination Hubs The creation of our ICCHs has allowed health and social care professionals to work as one team providing seamless care and support to vulnerable patients. Collectively they help improve quality of life, restore confidence and avoid needless admissions to hospital. Our aim is that people will have one assessment, one care plan and one key coordinator. Patients and service users will benefit from a consistent and seamless approach to their health and social care needs.
20 Quality Account 2015 - 2016
GPs and Pharmacies
y Therap
Vo l u n t e e r Faith Sector
Com m Nur s uni t ing y
es
• Community Rapid Response Service
l Ser vic
• Integrated Care Co-ordination Hubs
Socia
The Healthy Wirral (and Better Care Fund) funded initiatives managed by the trust are our:
r ecto nt S de en ep Ind inion st op ciali Spe
Healthy Wirral programmes are designed to support care delivery in the most appropriate setting, reduction in hospital admissions, early discharge and reductions in expensive nursing home care.
Our...
End of Life Care Ser vices
Healthy Wirral is the plan to re-shape health services and social care in Wirral, whilst supporting people to take more responsibility for looking after their own health. We are key partners in Healthy Wirral, along Wirral Clinical Commissioning Group, Wirral Council, CWP and WUTH.
Integrated care coordination teams
community
We have also been working with partners and the Emergency Care Improvement Programme (ECIP) to support the challenges of 4 hour A&E waits. The ECIP has commended our Single Pont of Access service and our Integrated care Coordination Hubs as good practice.
b Engaging with the public
b Community Rapid Response Service As part of the Healthy Wirral integration plans, the development of ICCHs will continue along with Intermediate Care and Rapid Response Teams. This multidisciplinary service has prevented innapropriate admissions to hospital and provides support to patients in times of crisis.
b Single Front Door Our ‘Single Front Door’ project brings together clinicians from the trust and from WUTH to jointly triage patients who attend Accident and Emergency. They signpost patients to the most appropriate place for that individual such as a Walk-in Centre, GP or pharmacy. In its first month the Single Front Door redirected 15% of patients. Phase 2 will concentrate on what staffing is required to treat and discharge appropriate patients, to further improve the rate of avoidable admissions.
We are active partners in the public engagement work led by Healthy Wirral including the ‘Healthy Wirral, it starts with us’ events in November 2015 which gave colleagues and members of the public the chance to help shape a new, Healthy Wirral. The feedback and insight from this and other events continues to inform how we’re re-shaping services around patient’s needs and expectations.
“Professional, knowledgeable, friendly, helpful, supportive staff, 5 stars. I was seen straight away and accidentally left my child’s favourite toy. One member of staff went out of her way to help us find Mr Monkey. Thank you.” Wirral South Children’s 0-19 service
“To my OT, thank you for all that you have done for me. I know it’s your job and profession but you have taken me out of that black hole. I was just existing, now I’m looking forward.” Rehabilitation at Home Service
23 Quality Account 2015 - 2016
b Section 5:
Objectives for 2016 - 2017
Our Vision: To be the outstanding provider of high quality,
Our quality statements: Our patients:
Our people:
We protect people from avoidable harm
We value and listen to our staff
We will deliver harm free care measured by a reduction in avoidable grade 3 & 4 pressure ulcers acquired during our care from 16 per year to 12 and moving towards zero within three years.
We will achieve 90% uptake in mandatory training for all staff. Through the introduction of our staff wellbeing plan 2016/17 we will achieve 4.0% staff sickness levels or below.
We will reduce the number of missed medication incidents occurring during our care from 15 to 10 or less. We will demonstrate our culture of learning from clinical incidents by improving our rating in the learning from mistakes league moving from good to outstanding. We will maintain a Friends and Family Score of 90%.
We will reduce the % of staff reporting that they work extra hours to the national average or below as measured by national staff survey. We will support staff wellbeing by increasing the level of staff satisfaction in flexible working options measured by the 2016 staff survey.
CQUINs
End of life – helping deliver person centred end of life care through integration Motivational interviewing – developing staff skills to ensure patient discussions lead to effect
Transition – developing a seamless process of transition between children and adult health serv
Underpining Govern 22 Quality Account 2015 - 2016
integrated care to the communities we serve.
Our services:
Our sustainability:
We deliver clinical excellence
We are a sustainable organisation
We will provide staff with access to high quality service specific training programmes with a measured improvement in staff experience in the 2016 staff survey.
We will deliver sustainable models of care measured by 90% achievement of clinically led improvement projects completed in agreed timescales.
We will implement our recruitment strategy, delivering four recruitment open days throughout the year.
We will lead community focussed research by participating in portfolio research project led by the National Institute for Health Research.
We will improve access to community services by developing a centralised clinical triage for all community nursing and ICCH referrals.
We will implement our Leadership for All programme with 98% of staff undertaking talent conversations during the appraisal process.
tive self-care plans for those with long term conditions
vices
nance and Assurance 23 Quality Account 2015 - 2016
b Section 6:
Supporting statement from Healthwatch Wirral Healthwatch Wirral (HW) would like to thank Wirral Community NHS Trust for the opportunity to comment on the Quality Account for 2015/16. The HW Quality Account sub group met on 29th April 2016 to compile this response.
Priorities for 2016/17 The 3 priorities were noted. HW were pleased that the trust developed the priorities in partnership with patients, members, commissioners and Healthwatch. We look forward to receiving quarterly reviews on progress against these priorities.
Review of Performance in 2015/16 It was positive to note that:• the trust had successful achievements in their Commissioning for Quality and Innovations (CQUIN) schemes and Quality objectives in safeguarding standards, dementia care and integrated pathways • the trust have successfully implemented a process for identifying individuals with a diagnosis of dementia following discharge from hospital. This enables them to provide support to both the patient and patient’s carer • a Wirral wide integrated pathway has been developed so that people can be supported to live safely and independently at home, thus preventing avoidable hospital admissions. The Community Trust worked with Wirral University Teaching Hospital Foundation Trust and the Department of Adult Social Services to agree joint processes • the Friends and Family score exceeded the trust’s target for the year
24 Quality Account 2015 - 2016
• the trust has introduced measures to ensure that daily nursing staffing levels and skill mix against assessed patient acuity levels are maintained at 95% of the required fill rate • staffing levels have been monitored daily, a safety huddle has been introduced where community nursing team leaders discuss issues and find solutions and flexible staffing arrangements have been reviewed • the staff survey results were positive and the trust held a very successful recruitment ‘Open Day’ which attracted 200 people who were interested in working for Wirral Community NHS Trust • the ‘Single Front Door’ project which brings together clinicians from the Wirral Community NHS Trust and Wirral University Teaching Hospital Foundation Trust to jointly triage patients attending Accident and Emergency has been successful in redirecting patients to appropriate services However, it was disappointing to read that the trust had not achieved its target of 4% or below in staff sickness levels. The absence rate was 4.7% during 2015/16 but it was positive to read that this was an improvement from the previous year and that the trust intends to keep the 4% target for 2016/17 and focus on staff wellbeing. It was also disappointing to read that the trust had one never event during the year, but reassuring to hear that the trust worked closely with an external expert who led an investigation and made recommendations which the trust fully implemented. (Wirral Community NHS Trust is ranked amongst the top 25 trusts in the country
for openness and transparency in the Learning from Mistakes league table.) HW has enjoyed working alongside the Community Trust as it recognises the value in our relationship and has utilised the functions, duties and powers of HW to provide challenge and assurances. HW appreciates the opportunity to comment on the report as a “critical friend” and we look forward to working with the trust to support the implementation of the Quality Account and strategic plans. Healthwatch would like to add their congratulations to the trust on obtaining Foundation Trust status.
Karen Prior Healthwatch Wirral Chief Officer
b Section 7:
Supporting statement from Wirral Clinical Commissioning Group As lead commissioner Wirral CCG is committed to commissioning high quality services from Wirral Community NHS Trust. We take very seriously our responsibility to ensure that patients’ needs are met by the provision of safe, high quality services and that the views and expectations of patients and the public are listened and acted upon. This account reflects quality performance in 2015/16 and clearly sets out the direction regarding quality for 2016/17. We acknowledge and congratulate the Community Trust on their achievements over the past year including the recent authorisation as a Foundation Trust, and the significant assurance received in internal audit reports for safeguarding and quality health checks.
Our patients and communities: We note that there has been a ‘never event’ reported in 2015/16. This was due to wrong site surgery. Whilst disappointing that this was the second incident of this nature within a two year period, we commend the approach that the trust undertook in the commissioning of an independent expert to lead the investigation. Through the contract monitoring process we are assured that all recommendations have been actioned. The trust has exceeded the 2015/16 target of 85% for Friend and Family, with some areas achieving 100% within the year. The CCG hopes this level to be maintained in 2016/17.
Our services: We acknowledge the work that the trust has undertaken with partner organisations in developing integrated services to reduce avoidable admissions to hospital, and we welcome this being a continued objective for 2016/17 to
support new models of care delivery across the health and social care economy. Our people: In order to deliver high quality services, appraisal and development plans are of paramount importance. We congratulate the trust in the achievement that 98% staff have undergone this process during 2015/15 which is an improvement from last year and in the target set.
work in partnership with the Trust to assure the quality of services commissioned over the forthcoming year.
Sue Wells Acting Chair, Wirral CCG
It is noted that the staff sickness levels are at 4.7% although a 0.2% decrease on last year’s performance. It is disappointing that little impact has been made in this area and is higher than the national average. We acknowledge that the trust will strive to improve this, and it remains an objective for 2016/17 and this will be monitored by the CCG throughout the contracting year.
Looking forward in 2016/17: The CCG can confirm that the priorities for improving quality that have been identified by the trust are priorities for the CCG including: Improving access to community services. Delivering sustainable models of care. Reduce avoidable grade 3 and 4 pressure ulcers acquired during care (this is a 2 year plan). Achieve 4.0% staff sickness levels or below. Increasing research activity within the organisation. We believe that this quality account gives a high profile to continuous quality improvements in Wirral Community Trust and the monitoring of the priorities for 2016/17. Wirral Clinical Commissioning Group looks forward to continuing to
25 Quality Account 2015 - 2016
b Section 8:
Supporting statement from Wirral Council The Families and Wellbeing Policy and Performance Committee undertake the health scrutiny function at Wirral Council. The Committee has established a Panel of Members (the Health and Care Performance Panel) to undertake on-going scrutiny of performance issues relating to the health and care sector. Members of the Panel met on 10th May 2016 to consider the draft Quality Account and received a verbal presentation on the contents of the document. Members would like to thank Wirral Community NHS Trust for the opportunity to comment on the Quality Account 2015/16. Panel Members look forward to working in partnership with the Trust during the forthcoming year. Members provide the following comments:
Members support the continued priority of this target for the forthcoming year, as stated on page 8 although note that it is not included as an objective for 2016/17 on pages 22 and 23. In particular, the continued monitoring of the impact of the transfer of the 111 service is supported.
Overview
Members welcome the high levels of staff engagement as evidenced by results on the NHS National Survey and the staff Friends and Family Test, ranking above average for many of the indicators. The development of a learning culture within the Trust is also welcomed.
The Members welcome the layout of the Quality Account and the clarity with which the information was presented to them. Members also acknowledge the positive performance of the trust as measured against the targets for 2015/16. The extensive work carried out by Monitor, in preparation for the Trust’s authorisation as a Foundation Trust provides further reassurance to Members. Members wish the new Foundation Trust well in the future. Members also support the priorities selected for improvement for 2016/17, and in particular appreciate the focus being given to staff wellbeing and patient safety.
Section 2 Performance Overview 2015/16 Our patients and communities Access to Walk-in centres The target for 2015/16 was for 95% of patients to be seen within 30 minutes for initial assessment within walk-in centres.
26 Quality Account 2015 - 2016
Friends and Family Test Against a target of 85%, the trust has reported a score of 92% when patients are asked if they would recommend the Trust’s services to friends and family, with some service areas achieving a 100% score for most of 2015/16. This outcome is welcomed by Members and demonstrates the quality of services provided by the trust.
Our people
Our sustainability Members are impressed by the aspiration of the trust for the whole workforce to be involved in the improvement process. A clear example is the implementation of the three projects via the clinical innovation fund.
Section 4 Bringing high quality services closer to home The introduction of the Healthy Wirral programme, in conjunction with other partners, is warmly welcomed as is the trust’s clear commitment to the redesign of services which will hopefully lead to care delivery being provided in the most appropriate setting. This should result in more residents being able to live in their own homes for longer. Initial
schemes being developed include the four Integrated Care Coordination Hubs, the Rapid Community Response service and the Single Front Door initiative at A&E. However, Members look forward in the future to seeing further evidence of the impact that these schemes and others are having on the quality of care and the resulting effect on outcomes for patients. As the integration of health and care services continues to gather pace it will also be important to be able to demonstrate that true integration of service delivery is taking place in order to provide person-centred care.
Section 5 Objectives for 2016/17 It is stated that 76% of staff currently work extra hours (as reported in the 2016 staff survey). Members welcome the intention to reduce the figure although it is not apparent how this will be achieved; whether by staff recruitment or other means. Members recognise the challenges faced by the trust in relation to staff recruitment and welcome the initiatives undertaken to help recruitment of nurses and therapists.
Councillor Moira McLaughlin Chair, Health and Care Performance Panel and Deputy Chair, Families and Wellbeing Policy & Performance Committee
Our services
b All Day Health Centre
b Parkinson’s Disease
b 0 - 19 Health and Wellbeing Service
b Phlebotomy (blood tests)
b Centralised Booking
b Physiotherapy
b Community Nursing Service
b Podiatry (foot care)
b Community Discharge and Liaison
b Prostate Cancer Nurses
b Continence
b Rehabilitation at Home Service
b Deep Vein Thrombosis (blood clots)
b Sexual Health Wirral
b End of Life Care Team
b Single Point of Access (referral service)
b GP Out Of Hours
b Specialised Dental Services
b GP Practices
b Specialist Palliative Care (specialised care b for serious illness)
b Heart Support b Livewell Programme (healthy lifestyles) b Minor Injuries Unit b Nutrition & Dietetics b Ophthalmology (eye care)
b Speech & Language Therapy b Tissue Viability (wound care) b Walk-in Centres (Eastham, Wallasey and the All Day b Health Centre at Arrowe Park) b Wheelchair Service
Support Services Infection Prevention & Control, Quality & Governance and Safeguarding. Communications & Marketing, Estates Management, Finance, Human Resources, Business Intelligence and Information Technology.
Information correct as of 31 March 2016. Visit wirralct.nhs.uk
27 Quality Account 2015 - 2016
If you would like this information in another format or language, or would like to provide feedback about any of our services, please contact our Patient Experience Service: Telephone: 0151 514 6311 Freephone: 0800 694 5530 or patient.experience@wirralct.nhs.uk
www.wirralct.nhs.uk