Quality Statement from the Chief Executive............................................3 Types of Service We Deliver.........................................................................4 Our Vision....................................................................................................5 Clinical Priorities for 2012/13.....................................................................5 Priorities for 2013/14..................................................................................8 How Do We Measure Performance?..........................................................9 How Do We Review Our Services?...........................................................15 Patient Story..............................................................................................18 Improving Our Services............................................................................20 Impact on Patients....................................................................................22
Quality Statement from the Chief Executive I am delighted to be able to present the Humber NHS Foundation Trust (HFT) Quality Account for 2012/13. The document provides an opportunity to inform you of what quality we have provided in 2012/13 and how we intend to improve the quality of our services in 2013/14 and beyond. The information in this report describes the changes that have been made in services across the Trust in terms of quality improvement and the enhancement of safety. Some of our key achievements during this year have been: • improving the collection of real time feedback from service users and carers in a number of services to help us measure patient and carer experience • improving the quality of patient care planning and ensuring that the patient’s wishes are translated into their care plan • the introduction of the Recovery Star model to support patients on their pathway to recovery • improving the management and prevention of falls, pressure ulcers and other physical conditions across services for older people • continuing to improve the quality of care and support for patients who are on the end of life pathway and in doing so, providing better support to their carers • improving the effectiveness of discharging from community hospitals
• widening the availability of services to support the awareness and diagnosis of dementia • improving the management of wound care in line with best practice and providing better value for money with improved patient outcomes • moving towards a more community-focused approach to the management of children with mental health and emotional wellbeing conditions • strengthening the use of the care programme approach to support people with mental health needs in the community • forensic services have introduced the shared pathway model, improving the recreational and educational opportunities that are available to all patients within the forensic service.
We will continue to take every opportunity to learn lessons from the work and the progress that we have already made. We continue to work hard to ensure that we have a highly skilled and confident workforce, able to deliver care with compassion, in environments that are the best we are able to provide. We are also committed to addressing key recommendations and lessons learned from the Francis Report regarding the systemic failings found at Mid Staffordshire Hospitals Trust. On behalf of the Board, I would wish to reaffirm our commitment to improving the services that we provide to the communities that we serve on an ongoing basis, and ensuring that safety and quality sit at the heart of everything that we do.
David Snowdon, Chief Executive Humber NHS Foundation Trust | Quality Report 2012/13 | 3
Types of Service We Deliver We offer a comprehensive portfolio of services, many of which can be accessed through the Single Point of Access (a fast track to treatment, help and support). These include:
• A&E liaison for working age adults and older people • addictions, including inpatient alcohol detox • bladder and bowel specialist care • child and adolescent mental health services (CAMHS) • children’s services • chronic fatigue • counselling • diabetes services • community nursing
• health services within prisons • health trainers • health visiting • Huntington’s disease team • inpatient and community mental health for working age adults • inpatient and community mental health for older people • intermediate care • learning disability community and inpatient services
• East Riding Community hospitals
• long-term conditions
• falls prevention
• nutrition and dietetics
• forensic services for mental health, learning disability patients and personality disorder patients, including some from outside our area
• out of hours and unscheduled care
• physiotherapy • podiatry • psychiatric liaison • psychological interventions • psychotherapy • school nursing • self-harm • stroke services • therapy services (physiotherapy, speech and language) • tissue viability • traumatic stress • unscheduled care
• Macmillan nurses
• palliative care • perinatal mental health
This list is not exhaustive. For more information and for referral pathways, go to www.humber.nhs.uk/services.htm To contact the Single Point of Access, phone 01482 617560 or email email@example.com
4 | Quality Report 2012/13 | Humber NHS Foundation Trust
To improve the health and wellbeing of the communities we serve.
Clinical Priorities for 2012/13 Our clinical priorities were chosen through a process of consultation with Trust staff and stakeholders. A summary of our progress is explained below:
Safeguarding The Trust has a responsibility to prevent the abuse of children and adults who are at risk. Healthcare professionals have a key role in safeguarding, firstly in identifying abuse, harm and neglect and secondly, responding appropriately to it. The rules on how we keep children and adults safe have changed. The priority for 2012/13 was to make sure that all staff knew what the changes were and how important safeguarding is. Safeguarding children and adults training is mandatory for all staff and is refreshed every three years. Throughout the last year, the Safeguarding team have produced a range of resource materials to help support staff with any safeguarding queries they may have. These resources include diary inserts, credit card-sized information handouts, decision making pathway posters and patient and carersâ€™ information leaflets.
Electronic Records Lorenzo The Trust introduced a new electronic record system, Lorenzo, within some of services during 2012/13. This will improve how records are kept. The Trust completed the successful implementation of the Lorenzo system on time and within budget at the end of May 2012. There has been a great deal of work looking at how services and teams can make better use of and benefit from the functions already available as well as looking at what else Lorenzo can provide.
SystmOne SystmOne is an electronic recordkeeping system currently in use across some of our services (community services, therapies, children and young people). Our aim is to ensure that the system is used to its full potential so that record keeping is improved.
Humber NHS Foundation Trust | Quality Report 2012/13 | 5
Clinical Risk Assessment Tools Clinical Risk Assessment is used to record what a clinician sees as levels of risk in a patient. We identified the need to ensure clinical risk assessments are carried out using the most appropriate tools and the findings are acted upon in a timely manner, balancing the patient’s wishes with clinical need. The Trust has developed pages on the Intranet that list the main assessment tools which have been approved and are for use across mental health, learning disabilities and community services.
NICE The National Institute for Health and Care Excellence (NICE) issues guidelines and standards nationally, supporting the government’s priorities and objectives. NICE guidance helps health and social care professionals deliver the best possible care based on the best available evidence. Procedures and processes have been put together within the Trust to manage and monitor the implementation of all appropriate guidance. All applicable guidance is given to all our clinicians to inform them of best practice.
Patient Feedback (Meridian) During 2012, a priority within our organisation was to make it easier for patients to tell us what they think about their care and treatment. This is essential information to help us improve our services according to what truly concerns our service users. Feedback from people who use, or care for someone who uses our services, is a valuable way for the Trust to understand how the service was and find out what people feel. This is used to help identify ways to improve services in the future. Meridian collects patient and carer feedback, using a touch screen computer. The computers are available in different Trust areas. Meridian was rolled out within the community and inpatient areas across adult mental health services and older people’s mental health services. A system of “You Said, We Did” posters has been established, identifying changes that occurred as a direct result of patient feedback. Below are some “You Said, We Did” examples from the East Riding Community Hospital.
6 | Quality Report 2012/13 | Humber NHS Foundation Trust
East Riding Community Hospital Community Ward “You Said”
“The grab rails in the shower areas are difficult to use effectively”
We have contacted our estates department, who are re-positioning the rails.
“The drinking water in the jugs is too hot.”
Patients water jugs to be changed twice a day.
“That the food served on the ward was not hot enough.”
Catering manager will explore the options of purchasing new heated food trolleys that could be positioned on the corridor of the ward and plugged into the electric to ensure that the food served is closer to the patient’s room and hotter.
“The ward is fantastically clean.”
Hotel services manager feeding back congratulations to her staff.
“That the food served on the ward was very tasty with good choices.” “The spacious surroundings are matched by helpful and willing staff who made my stay easier to cope with.”
Matron feeding back congratulations to the multi disciplinary team.
“I would just like to say that the nursing staff are wonderful. So caring and kind to both mum, who is on the Liverpool pathway and to myself - making sure we are both comfortable as possible.” “A recliner chair with a foot rest would have been beneficial for oedema of legs.”
Recliner chairs are available on the ward. To ensure staff communicate this to the patients.
“The chairs are not very comfortable.”
Service manager exploring the options of purchasing a new range of chairs.
“The chairs are too low.” Patient feels they have not had the same level of physiotherapy as in Hull Royal Infirmary.
Physiotherapy staff are trialling a new way of working to ensure all patients are allocated structured therapy time daily.
“I am unsure why I have to sign my file notes.”
Our philosophy is that you should be fully involved and informed of your aims and goals. The nurse/therapist would have asked you to sign your care plan following discussion with you about your treatment plan.
Patient Outcome Measures Another priority for the Trust was to develop tools to measure the outcome of patient care and treatment. These tools measure the difference we make to people’s lives and the quality of services we provide. They are usually questionnaires. Outcome measures are important for the people who are using services, the clinicians who are providing care and the commissioners who will want to know that the services they commission are delivering the best possible care and achieving real improvements in the wellbeing of people who are using services.
Humber NHS Foundation Trust | Quality Report 2012/13 | 7
Priorities for 2013/14 The development and delivery of the Trust’s clinical priorities have been aligned to the Trusts Clinical Networks. There are now 22 networks covering the services provided by Humber NHS Foundation Trust. The main function of the clinical networks is to set the clinical direction for their group of patients, supporting and informing the service’s clinical governance objectives and actions. The clinical networks also provide a balance to the operational management structure of the Trust, acting as the clinical governance lead and conscience. An event was held for external stakeholders, Governors, staff and patient group representatives. During the event, presentations of the proposed priorities were delivered. Following group discussion those present were then asked to vote for their preferred priorities. The 12 identified priorities to be taken forward next year are: • Audit of essence of care standards and actions in older people’s mental health services • Dementia detection and diagnosis pathway in older people’s mental health services • Development of single neighbourhood care and older people’s mental health service teams • Roll out of Meridian real time patient satisfaction survey in older peoples services • Audits of SystmOne electronic patients records system, compliance with national standards • Develop cardiac care clinical pathways • Implementation of framework for user and carer satisfaction in child and adolescent mental health service • Advanced care planning within end of life care • Develop end of life dementia care pathway.
Clinical network leads will be asked to develop systems of monitoring and recording progress of these priorities throughout the year, these will be developed via action plans. Progress on these actions will be reported and monitored through the Clinical Effectiveness and Compliance Committee (CECC) which feeds into the Governance Committee. Minutes of these meetings will be shared with Stakeholders and progress will be reported. Progress will also be reported within future Quality Account reports.
8 | Quality Report 2012/13 | Humber NHS Foundation Trust
How Do We Measure Performance? Key National Priorities The priorities for the NHS are set out by the Department of Health in the NHS Framework each year. In order to measure whether these priorities are being achieved the framework sets out a range of performance indicators and targets which the Trust uses to measure and demonstrate its achievements. At the start of 2012/13 the Trust identified which of the national priorities were key to this Trust, some of which are described below. Some indicators we have included this year have changed from those reported in the 2011/12 report. This is due to the necessity to comply with requirements to provide information on set indicators, i.e. Patient Safety, Clinical Effectiveness and Patient Experience.
Seven-day follow-up The National Suicide Prevention Strategy for England recognises that anyone being discharged from inpatient care under the Care Programme Approach (CPA) should be contacted by a mental health professional within seven days of their discharge. The Trust has set a local performance standard that all patients should be seen face to face. However, telephone contact is acceptable under exceptional circumstances where face to face is not possible. The aim of this priority is to ensure everyone discharged from a mental health inpatient unit and who is considered by the clinical team to require continuing care and treatment managed within the Trustâ€™s CPA, is followed up within seven days within the criteria set by Monitor. As a National Key Performance Indicator, our goal is to achieve the 95% target of all patients followed up within seven days of discharge. Throughout the year the Trust has not only achieved the 95% target but consistently remained above 97% performance. The seven-day follow-up process continues to be developed and improved and the robust methods of monitoring ensure continued success in achieving this target. Previous yearly averages were 98.67% in 2009/10, 99.33% in 2010/11, 99.18% in 2011/12 and 99.12% in 12/13.
Immunisation Rate for Human Papillomavirus (HPV) Immunisation against Human Papillomavirus (HPV) highlights an area of national and international concern to end the transmission of preventable life-threatening infectious diseases. Vaccines prevent infectious disease and can dramatically reduce disease and complications in early childhood, as well as mortality rates. The vaccination for HPV is delivered in three doses. The 90% target relates to the uptake of the complete course of vaccination, measured as the total number of 12 to 13 year old girls in East Riding of Yorkshire schools who have received all three doses. This is a Tier 2 Vital Signs Monitoring indicator with a locally agreed target, that >90% of girls aged 12-13 have completed a full course (3 doses) of immunisation against HPV.
Humber NHS Foundation Trust | Quality Report 2012/13 | 9
Due to the difference between the financial year we are describing in this report (April 2012 to March 2013) and the academic year that dictates the delivery timings of the vaccination doses (September 2012 to July 2013), we are not able to report the completed vaccination cycle for 2012/13, as vaccination for Dose 3 will continue into July. So far in 2012/13 the Trust has delivered Doses one and two to 94.2% of 12 to 13 year old girls in East Riding of Yorkshire schools. The Trust has also started the delivery of Dose three and has vaccinated 29.3% of girls at the end of March 2013, which is ahead of the plan and higher than the same time last year. We are therefore confident of achieving the 90% target by the end of the academic year. Between September 2011 and July 2012 the Trust delivered all three doses of HPV immunisation to 92.3% of girls aged 12-13 in East Riding Schools.
Emergency Re-admissions Helping people to recover from episodes of ill health. To monitor all patients aged 15 years and above who have been readmitted within 28 days of discharge. Although the national target is to be confirmed, the Trust has levied their own internal target of 10% or less. The percentage target is worked out by dividing the number of re-admissions by the number of discharges. At Year End there were a total of 738 admissions. Of which only six patients were admitted as an emergency (0.81%). The highest monthly figure was two readmissions from 59 discharges (3.39%).
Gate keeping A mental health inpatient admission is said to have been gate-kept if the service user has been assessed by a crisis and home treatment team (CRHT) within 48 hours prior to their admission and if they were involved in the decision-making process which resulted in the admission. Every referral for admission is individually assessed to ensure the most appropriate method of care is provided across both Hull and East Riding. Only when a patientâ€™s care and treatment cannot be best met in their own home, is an admission made. At Year End there were a total of 354 admissions. The Trust reported that 100% of all admissions to its acute inpatient units had been gate-kept. This is above the national target of 95%.
Delayed Discharges This indicator measures the impact of community-based care in facilitating timely discharge from hospital and the mechanisms in place. People should receive the right care, in the right place, at the right time. The target on this National Key Performance Indicator is currently below 7.5%.This figure compares the number of days delayed with the number of occupied bed days for mental health and community hospitals. It is the aim of the Trust to achieve this target. Trust reported a Year End percentage of 4.16% delays which is 3.34% below the measure and deemed very good. The number of occupied bed days is reported through the Trustâ€™s patient administration system (Lorenzo) and the community services clinical reporting system (SystmOne). 10 | Quality Report 2012/13 | Humber NHS Foundation Trust
Early Intervention Referrals come through from a variety of sources including education, child care, child and adolescent mental health services (CAMHS), family, GP and self. A number of referrals come through the Single Point of Access service. Assessments and treatment are carried out within this service. Meeting commitment to serve new psychosis cases for ages 14-35. At year end it is the Trustâ€™s aim to meet the local commissioner targets of 217 on caseload and 83 new cases. Currently figures for new cases and caseload are manually collected. There has been a significant reduction in the number of referrals coming through from East Riding over the year and a drop in referrals from Hull in the last quarter. The Year End target of 83 new cases has not been met with the Trust achieving 70 cases (84.33% of target). For 2012/13, the Trust has exceeded its total Year End target of 217 on caseload by achieving a caseload of 225. Percentage of Patients Seen within 18 Weeks for (Admitted &) Non Admitted Pathways (Community Services) The Trust provides consultant-led outpatient clinics at the Alfred Bean Hospital for a limited range of acute specialties including orthopaedics and rheumatology, in order to make the clinics more accessible to patients who would otherwise need to travel to the acute trusts in the region. The national target is for at least 95% of patients receiving outpatient care for these specialties to start their treatment within 18 weeks of referral. The Trust treated 1,960 patients in the acute specialty outpatient clinics provided at Alfred Bean Hospital during 2012/13, and has consistently ensured that over 97% of patients attending the clinics start their treatment within 18 weeks, against the target of 95%.
Home Treatments The home intensive treatment teams support patients in their own homes and, where appropriate, may allow for a patientâ€™s earlier discharge. This works alongside the gate-keeping function as home treatments may also prevent unnecessary admission by providing a more appropriate method of treatment. For a single home treatment contact to be registered as being achieved, each service user must receive treatment in their home or usual place of residence on a minimum of two occasions. There are four individual home treatment teams in operation to ensure that all adult and older adult patients are served across the geographical area. The Trust Year End Integrated Performance Measures Return (IPMR) target is 1115 home treatments. 661 for Hull and 454 for East Riding Both Hull and East Riding exceeded their individual targets. Overall the Trust carried out 1254 home treatments by year end (112.47%). 693 for Hull and 561 for East Riding. Home treatments continue to be monitored on a weekly basis to ensure the Trust maintains its target. This is reported on a monthly basis via internal performance reports and to the Board. It is also reported monthly (via the contract activity report) to our commissioners.
Humber NHS Foundation Trust | Quality Report 2012/13 | 11
Percentage of infants breastfed at six to eight weeks There is clear evidence that breastfeeding has positive health benefits for both mother and baby in the short- and longer-term (beyond the period of breastfeeding). Breastmilk is the best form of nutrition for infants and exclusive breastfeeding is recommended for the first six months (26 weeks) of an infant’s life. However, a majority of mothers give up breastfeeding in early weeks and infants therefore lose out on the many health benefits. Prevalence of breastfeeding at 6-8 weeks is therefore a key indicator of child health and wellbeing, with parents getting help and support with breastfeeding in hospitals and in the community from health visiting and midwifery teams, General Practices, Child Health services and Children’s centres. At the start of the year the target ceased to be a nationally mandated Vital Signs indicator and became a local Public Health target. A new target was agreed with our commissioners, reflecting the recognition that the old national requirement of a 2% increase per year had not been achieved nationally and was stretching ever further out of realistic reach. The new target was set at 43%, increasing by 0.5% each quarter to 44.5% in Quarter 4, to be reviewed at the end of the year. The Trust has not achieved the target for the majority of the year.
Patient Safety Incidents During the reporting period, Humber NHS Foundation Trust had 2,789 patient incidents reported. Of these, 20 resulted in severe harm or death, which equates to 0.72%.
Total Incidents 2012/13
Total Incidents 2011/12
No Causing Severe Harm or Death 2012/13
April – June
July - September
October - December
January - March
No Causing Severe Harm or Death 2011/2
Serious Incidents Reported Externally 2012/13
Serious Incidents Reported Externally 2011/12
The National Patient Safety Agency (NPSA) reports nationally on all incidents relating to patient safety. Within these figures, the national median rate for incident reporting is 23.8 per 1000 bed days. Humber Foundation Trust’s reporting rate is 22.6 incidents per 1000 bed days. This puts the Trust in the middle range for incident reporting.
12 | Quality Report 2012/13 | Humber NHS Foundation Trust
National Patient Survey In 2012 the National Patient Survey was sent to 850 of our service users. There was a 32% return rate, which was the same as the national average. There are ‘better/ same/ worse’ categories which are intended to help Trusts to identify areas where they have performed better or worse than others. Using this analysis method, our Trust scores the ‘same’ as other Trusts nationally. In the region Humber scores the highest overall. It is ranked first in ‘medications’ and second in the region for ‘crisis care’. The Trust is comparable to others in the region on the other domains.
Staff Who Would Recommend the Trust as a provider of care to family/friends
Trust result 2012 KF24. Staff recommendation of the trust as a place to work or receive treatmen
Trust result 2011
Worst result Nationally - Mental Health Trusts
Median result Nationally - Mental Health Trusts
Best result Nationally - Mental Health Trusts
Ref; Trust Staff Survey 2012
This data is extracted directly from the report of our 2012 staff survey undertaken by an independent contractor using the nationally specified criteria. It is calculated from three questions in the survey (Questions 12a, 12c and 12d) and expressed as a score between 1 (worst) and 5 (best). The trust continues to undertake to consult and involve staff in service improvement and service development wherever possible. As the vast majority of our staff are part of our local communities and therefore they and their families are also part of our patient population we endeavour to ensure that staff operate on the principle of whether the service they provide they would consider good enough for themselves or their family. As part of the Trust actions following the publication of the second Robert Francis QC report into Mid Staff Hospital Trust, the Chief Exec supported by Directors, senior managers and non exec directors has undertaken an extensive Trust wide “listening exercise” to engage staff at all levels and across all services in conversation about the quality of service delivery, the issues and challenges for staff and linked to the Francis report what the trust might prioritise to change and thereby better enable staff to offer the best possible service.
Humber NHS Foundation Trust | Quality Report 2012/13 | 13
Clostridium (C.) Difficile This indicator measures the number of C.Difficile cases where a Foundation Trust has a centrally set objective. The target on this National Key Performance Indicator is currently not to exceed 4 cases (2 in Hull & 2 East Riding). It is the aim of the Trust to achieve this target each year. Trust reported a Year End position of 3 cases of C.Difficile. All 3 cases were attributable to the Trust Community Hospital setting. The data is governed by standard national definitions.
Methicillin-resistant Staphylococcus Aureus (MRSA) This indicator measures the number of MRSA cases where a Foundation Trust has a centrally set objective. The target on this National Key Performance Indicator is currently to be no cases of MRSA. It is the aim of the Trust to achieve this target each year. Trust reported a Year End position of 0 cases of MRSA. The data is governed by standard national definitions.
14 | Quality Report 2012/13 | Humber NHS Foundation Trust
How Do We Review Our Services? CQUINs (Commissioning for Quality and Innovation) CQUIN is an annual scheme where commissioners and providers agree on which areas need more focus for improvement and payments are made for showing evidence on those improvements. The scheme is refreshed every 12 months and each scheme may be different from other years. This year’s scheme is worth around £2.6 million.
Patient Experience Surveys in Mental Health and Community Hospital Patient and Carer Experience. (Also part of the Trust CQUIN scheme) Our goal in 2012/13, was to roll out the Meridian patient feedback system across the Trust using patient feedback to inform service and care improvements in a timely manner. 17 service areas have used Meridian-based questionnaires. It has continued to be used in a range of services, including the adult and older people’s mental health services. It also been implemented in other service areas for the first time.
Areas of improvement gained through ‘real time’ feedback from patients Below are some examples of areas which have seen significant improvement during 2012/13 due to the quality of the feedback received.
Patients ‘feeling safe’ in adult inpatient units Patients reported an improvement in feeling safe during their stay in adult inpatient units during 2012/13. Only 65% of patients reported feeling safe during 2011/12 but results have improved to 95% during 2012/13 (100% for Older Inpatient Units). Staff now routinely offer advice to patients about what to expect during their stay, such as hearing noise on the ward at night, and what to do if they feel scared or unsafe. Staff continue to encourage patients to seek reassurance and a number of options are available to help patients adapt during their stay in the inpatient units.
Improving food to meet dietary needs Patients reported an improvement in the variety of food available during their stay on the units which met their dietary needs. Dietary needs may be cultural, religious or health-related (i.e. diabetes). Initial results of 81% in June 2012 have risen to 94% in December 2012. This has been achieved by consultation with patients and feedback to the catering staff resulting in improved menus on the units over the year.
Humber NHS Foundation Trust | Quality Report 2012/13 | 15
Activities during the week for inpatients Patient engagement in activities has been shown to reduce challenging behaviour and maintain a calm atmosphere on inpatient units. 74% of patients reported that they had a good range of activities to choose from during June 2012. Inpatient staff have worked with patients to improve the range of activities available which resulted in 92% satisfaction in December 2012.
Waiting time for appointment 94% of people reported that the waiting time for their first appointment was acceptable; this is an increase in satisfaction from 88% reported earlier in the year. This has been achieved by explaining the current expected waiting time in the first appointment letter, improving the capacity in some of the assessment teams and working to reduce the number of DNAs (Did Not Attend), which ensures appointments are kept.
Care Quality Commission The Care Quality Commission regulates quality within all NHS Trusts. They monitor our standard of care through inspections, patient feedback and other external sources of information gathered. The Care Quality Commission publish which Trusts are compliant with all the essential standards of care they monitor and which organisations have ‘conditions’ against their services which require improvements to be made. Humber Foundation Trust registered with the Care Quality Commission in April 2010, and its current registration status is ‘registered without conditions’.
Complaints and PALS (Patient Advice and Liaison Service) The Complaints and PALS Department records and responds to complaints, concerns, comments and compliments received from all areas of the Trust. It is up to the caller/complainant to decide whether they wish to have their concerns considered formally through the NHS Complaints Procedure or informally through PALS. Offering both services through one department allows the Trust to monitor all concerns, whether formally or informally, to see if there are any trends and to provide a consistent approach to complainants/callers. Below are examples of a few of the compliments which have been received:
all the staff, I would like to thank you all for taking care of my husband. " "ToI know it would have been quite difficult for you at times. Without your care
and understanding I wouldn’t have been able to cope.”
Older people’s mental health, inpatient
16 | Quality Report 2012/13 | Humber NHS Foundation Trust
last April 2011 I have been involved with a changeover of medication " "Since and (staff name) has been working with me during this time. I must point out
that (staff name) has helped me over this period of time by taking me out an visiting with me on a regular basis helping to boost my self esteem. (Staff name) was very professional in his approach and I felt very comfortable in sharing challenges with him during this period.”
Working age adult mental health, community
and I wish to express our heartfelt thanks to each and every member " "(name) of staff involved in his care, rehab and general wellbeing. Your level of
commitment, kindness, compassion, patience, support and hard work has enabled him to make such amazing progress. You have given him independence and dignity back and brought the man I love back to me. Thank you!”
my husband and I have been attending the clinic for podiatry we were very " "Since fortunate to meet (staff name) who is a kind, caring, efficient and professional
person. The podiatry department is enriched by the service (staff name) provides.”
thanks for your past care and attention. This enabled me to travel to " "Many Oxford to see my son at university and witness his success which I would have
surely been unable to do without your help. Many thanks.”
Bladder and bowel health
Humber NHS Foundation Trust | Quality Report 2012/13 | 17
Patient Story Life after alcohol thanks to inpatient detox Julie is enjoying what life has to offer after stopping drinking with help from our Trust’s addiction services. Julie used to drink instead of dealing with her feelings. She started at 14 and began binge drinking at 21. ‘I found my mum after she’d had an aneurysm at the age of 52 and I just wasn’t the same after that. The hospital refused to operate on her until my dad came home from sea to sign the consent forms; by the time that happened she had brain damage and she was doubly incontinent, could speak and couldn’t walk. ‘When my mum got worse, I’d drink; this went on for 20 years. I had some counselling and realised that I blamed myself and that everything stemmed from my childhood.
had four detox’s altogether. One was in the community years ago, one " "I’ve at Baker Street that failed because I was getting hassle from people and it was
Christmas, never a good time to try and stop drinking. I did a detox at Buckrose in Bridlington and it was successful for seven months, so I thought I was normal and I could have a social drink; soon I was worse than before.”
‘I started off drinking after work then it built up and I was having days off work; they noticed and things deteriorated. Eventually I was drinking first thing in a morning just to feel normal and I could get through up to 16 cans of strong cider a day, or more. ‘I hit rock bottom and took overdoses. I thought I was depressed but it was the drinking that made me feel so bad. My daughter describes me as a ‘monster’ during that time. I hated being like that and I just wanted a detox to find ‘me’ again. I couldn’t bear to look in a mirror. ‘I went back to the alcohol and drug service and asked to be referred back to services at Baker Street. I spent two weeks at Mill View on the inpatient detox ward in June this year. It took a while to organise because they had to put a plan together; it’s not just about the two weeks you’re in there, it’s about what happens afterwards. ‘It was very relaxing on the detox ward. We sat in the garden, watched TV, used the art room and attended groups where we discussed how we were feeling and doing. As soon as I left I went to HART and carried on going there for 12 weeks, five days a week. It was brilliant, the best thing I’ve ever done. I’m doing peer support there now, helping other people to come off the drink like I have.
18 | Quality Report 2012/13 | Humber NHS Foundation Trust
‘I’m on special medication now to stop the cravings but I’ve also changed a lot of things in my life. I didn’t rush back to work and I started going to AA and Abstain.
kids have been amazing. They said they thought they’d lost me, but I’m back " "My now and I’m determined to make it work this time. I’d recommend the detox
programme to anyone who is ready to take that step.”
Julie’s advice to anyone thinking of going through detox: • You’ve got to want to do it, for yourself and no-one else • Attend as many groups as possible • Go through all the agencies; there’s a really good set-up in Hull • Keep going back, keep trying • Don’t blame yourself • Accept you’ve got a problem – you can’t have a social drink • Don’t let your guard down • Don’t think you can handle a drink • Take it day by day
Humber NHS Foundation Trust | Quality Report 2012/13 | 19
Improving Our Services New Community Hospital Our community hospitals are based in Beverley, Withernsea and Bridlington and they accept patients from all over the East Riding. In July 2012 the new East Riding Community Hospital (ERCH) opened its doors. One of the first patients was taken to their new room and thought they had been put into a private suite by mistake; in fact, it was one of our 18 single-bedded units. The new ward at ERCH takes a variety of patients with a range of needs, including rehabilitation following surgery, a stroke, or a long term health problem; palliative care for patients who choose to stay with us in their last few days or weeks or who want some support before going home to be with their loved ones. We accept admissions from people who have just been discharged from an acute hospital or those at home who need some medical and nursing support. The hospital has a team that includes nurses, healthcare assistants, physiotherapists, occupational therapists, speech and language therapists and associate practitioners. The team is committed to putting patients first and their philosophy is “helping patients to help themselves” by creating a therapeutic environment as similar to their own home as possible. The building enhances the therapeutic environment with a variety of indoor and outdoor space that enables staff to work with patients in a range of ways, such as a game of skittles to develop and improve balance and manual dexterity. The Trust has plans to continue to improve the service we offer to the local community and our patients over the next year. We are developing falls suites for patients who are at high risk of falls, dementia suites to give a higher quality of care to patients who have memory impairment, reducing the levels of anxiety of the hospital environment by improving orientation and increasing our staff skills and knowledge to ensure we mirror the patient’s home environment as much as possible. We are lucky enough to have a large ward, with lots of corridors and to make the most of this space we are developing an indoor rehab track which will take you on a ‘walk through the East Riding’, so all our patients should have a destination on the track that is close to their home. We are building links with our local community, including schools, to offer work experience and create seasonal art work that can be displayed on the ward to support orientation of our patients who have memory impairment. We will also offer students a project on technology-based rehabilitation that they can come and support our patients to use. We are building our volunteer base by asking people from the local community to come and volunteer on the ward. We are increasing the range of roles we can offer volunteers so that they can become part of a range of ward activities. We want to give back as much to the community as we are given, including supporting local charities by building links, offering support and raising money. We are developing a community group where we can all work together to support our local area.
20 | Quality Report 2012/13 | Humber NHS Foundation Trust
Staff Awards Staff from across the organisation received recognition for their hard work and dedication at our Annual Staff Awards.
Awards included: • The Chairman’s ‘Who Cares, Wins’ award - voted for by members of the public and staff and recognises someone who has really gone the extra mile in a caring role. This year’s award was won by clinical specialist physiotherapist Kirsteen Hasney, for running a pulmonary rehabilitation programme, focussing on education and exercise, which has changed patients’ lives. • The Chief Executive’s ‘Making a Difference’ award - went to the Lorenzo project team. • Service Delivery - East Riding Cardiac Rehabilitation Service for their work using the HEARTlink programme to fast-track patients into community cardiac rehabilitation provided nearer to patient homes. • Innovation and Progress - Humber Centre FC, who have introduced a programme of football for staff and patients to help speed up recovery. • Improving Patient Dignity and Respect and Team of the Year - Estates Development team, for organising and facilitating the build of the Forget-me-not suite at the children’s hospice Sunshine House. • Improving Patient Safety - Antipsychotic Review Project Team for their project work, which reviewed antipsychotic prescribing in dementia patients. • Promoting Equality in Service Provision - Health Trainers, for work they’ve done with minority groups. • Inspirational Leader - Natalie Belt achieved first place in the Most Inspirational Leader category. She leads a small team across the East Riding who work with the public to improve health and wellbeing - particularly hard to reach groups in isolated communities.
Humber NHS Foundation Trust | Quality Report 2012/13 | 21
Impact on Patients Park Art An afternoon of creative inspiration was enjoyed at Castle Care Villages when Barchester Healthcare and Humber NHS Foundation Trust came together to promote positive mental health through creative art. The day was packed with activities ranging from samba and swing dancing to Tai Chi and theatrical performance. Attendees at the event got involved in creating a magnificent Union Jack embellished 3D teapot from papier maché. Tai Chi and Lindy Hop sessions were also on offer and were enjoyed by visitors and residents. The event raised funds for Reflections Art health charity and social enterprise, My Voice. Park Art is about challenging the stigma and discrimination around mental health problems through music, dance and arts and crafts. Hull Samba, Kingston Swing and The Acting Group were among local groups that entertained on the day. A patient from Windermere House Independent Hospital won an award for best work of art which was judged by residents from Castle View. The winning entrant’s design was created using batik art techniques and depicted Elvis Presley.
Management and Prevention of Falls The falls team have focused on training and supporting care home staff to help prevent falls in these settings. Training sessions have taken place across Care Homes in the East Riding. There is now a pathway for Care Home staff to ring the falls service when they are concerned and need advice to support safer management of patients at risk of falls. This means that the falls specialist can provide a quick response with telephone advice before visiting the team in the Care Home. This has been well received by Care Home staff and is supporting prevention of acute admissions to hospital where falls have been prevented as a result of this approach. Training sessions took place in 2012/13 delivering falls training to 354 Care Home staff.
Discharge from Community Hospitals In community hospitals, all patients are now involved in planning their discharge date within 7 days of admission, and usually within 48 hours. Most of the time this discharge date doesn’t change, but if it does, another date is set with the patients. All patients who have had their discharge date changed have told us through patient surveys that when their date is changed they know why and what their new date is. We have achieved this through improving patient review meetings, improvements in discharge planning and an increased focus on multidisciplinary working.
Recovery Star/ Care Planning Recovery planning is now an integral part of a person’s journey when they are admitted into services within working age adults, reviews are now person centred, recovery focused meetings. We have four teams who are offering the Recovery Star to people using services within our recovery teams.
22 | Quality Report 2012/13 | Humber NHS Foundation Trust
Humber NHS Foundation Trust Willerby Hill, Beverley Road, Willerby, East Riding of Yorkshire. HU10 6ED Tel: 01482 301700