MCH quality account 2013-2014

2013 - 2014

‌leading the way in excellent healthcare

Quality account April 2013 to March 2014

Presented by: Fiona Stephens Clinical quality director

Medway Community Healthcare CIC providing services on behalf of the NHS Registered office: 5 Ambley Green, Bailey Drive, Gillingham, Kent ME8 0NJ Tel: 01634 382777 Registered in England and Wales, Company number: 07275637

…leading the way in excellent healthcare

3.7 3.8 3.9 4.

Contents 1. A message from our Board

Page

3

2. Looking Forward

Page

4

3. Looking Back

Page

6

3.1 3.2 3.3 3.4 3.5 3.6

Quality of services provided Quality improvement programme Local Audits Implementing NICE guidance Participation in research Goals agreed with commissioners

Quality …we are caring and compassionate

Page Page Page Page Page Page

6 8 9 10 11 12

What others say about MCH Student placement feedback Quality data

Page 14 Page 16 Page 17

Review of quality performance

Page 19

4.1 4.2 4.3 4.4 4.5 4.6

Page 19 Page 20 Page 20 Page 21 Page 26

4.7 4.8 4.9 4.10 4.11 4.12

Our values Our pledge Privacy and dignity Quality services Patient experience Achievement against 2011/12 Quality priorities Providing safe clean environments Reducing falls and pressure ulcers Personalised care plans Delivery of healthy child Programme Reduced waiting times Palliative care

Page 29 Page 30 Page 30 Page 31 Page 31 Page 31 Page 32

5

Statements from our stakeholders

Page 33

6.

How to provide feedback

Page 34

7.

Appendices 1.

Table of National Audits 2 Local audits - Planned care 3 Local audits - Unplanned care 4.

Local audits – Independent services

Page 35 Page 36 Page 38 Page 39

…we deliver quality and value

…we work in partnership

2

…leading the way in excellent healthcare

1

It is with confidence and pride that MCH presents its Quality Account for 2013/14, as an accurate and honest representation of the quality of care. Building on the great work that has been completed this year, improving the quality of our services, we now look towards getting even better in 2014/15. We have been registered with the Care Quality Commission (CQC), without conditions, since 2011, meeting all standards inspected in 2013/14.

The Francis Report offered a timely reminder of those things each and every person delivering healthcare needs to remember in everything they do. We need to continue to listen to our patients and staff, encouraging openness and honesty, and monitoring our performance carefully. Our approach to transformation and further improvements to quality are, and will always be, delivered in the framework for delivery as set out in the Francis Report.

A message from our Board As we enter our fourth year as a social enterprise our Board felt it was important to take a look at the vision and strategy of our organisation to ensure that they capture the kind of organisation we intend to be and how we aim to achieve this. We have revised our vision to describe how we see Medway Community Healthcare (MCH) in the future as: a successful, vibrant, community interest company that benefits the communities it serves. Whilst our purpose sets out the primary focus and direction of our business: to provide community health and social care services, principally across Medway and the surrounding areas.

The themes of the report of the Mid Staffordshire NHS Foundation Trust Public Inquiry chaired by Robert Francis QC formed the cornerstone of our work this year. Patients are the first and foremost consideration of MCH and we will continue to listen to our patients and staff, encouraging openness, transparency and candour. We will ensure senior and professional accountability through the measurement and understanding of performance utilising both local and national indicators, addressing any issues immediately. We will continue to develop as a community interest company as a key enabler to the continued delivery of high quality, safe patient care.

High quality patient care continues to be at the centre of all we do.

A major challenge will be finding new ways of working to enable us to meet increasing demand, within a constrained funding envelope. We continue to develop services that are fit for the future and enable us to keep people in their homes, and cared for in the community by embracing technology; empowering our people; and reviewing our systems We, the Board of MCH, with and on behalf of all our staff, commit ourselves to continuing to deliver high quality patient care. The information in this Quality Account provided from our data management and quality improvement systems is to the best of our knowledge accurate, and provides a true reflection of our organisation.

Martin Riley

…we are caring and compassionate

Peter Horn

Managing director Chair …we deliver quality and value …weBoard work in partnership On behalf of the MCH

3

…leading the way in excellent healthcare

2

Looking forward

Effectiveness of Care: understanding different treatments for different conditions. Assessing this will include clinical measures, such as mortality or survival rates, complication rates and measures of clinical improvement. Just as important is the effectiveness of care from the patient’s own perspective. Examples include improvement in pain scores or returning to work after treatment. Clinical effectiveness may also extend to people’s wellbeing and ability to live independent lives

This second part of our quality account looks forward to the next financial year (2014 -15) and details what areas have been identified as priorities for improvement, why these priorities have been chosen, how improvement will be achieved and how it will be measured. There are also Board statements relating to the quality of the services we provide.

To realise our vision of a successful, vibrant, community interest company that benefits the communities it serves, we will focus on a number of priorities which include our quality goals.

In order to support high quality care, each year we focus on key Quality Priorities. Priorities for improvement have been selected through a consultation process with staff, patients, our community forum and commissioners led by the MCH Quality Committee.

Our Quality Goals will help us deliver excellent and harm free care and are identified to reflect the learning from the Francis Report and include the Chief Nursing Officer’s 6 C’s - care, compassion, competence, communication, courage and commitment. For the coming year our Quality Priorities are:

Patient safety: High quality care means care that is as safe and effective as possible, where patients are in control and are treated with compassion, dignity and respect; their experience of care being as important as the outcomes of that care.

High quality care also means focusing on the prevention of illness.

We believe that everyone has a role to play in supporting this – it is not just about clinical staff and how they care for patient; our administrative and support staff contribute in many ways helping ensure our services are high quality.

The three domains of high quality care have been defined as being: Patient Safety: that we do no harm to patients, ensuring that the environment is safe and clean and reducing avoidable harm, such as falls and pressure ulcers.

1. Continue to provide environments and care where the risk of infection is minimal.

How will we measure?  staff being bare below the elbow  compliance with hand hygiene requirements  cleaning audits in areas we are responsible for  compliance with MRSA screening in St Bartholomew’s Hospital.  reported C difficile infection or MRSA bacteraemia How will we report?  Quarterly updates will be published on our website

Patient Experience: the quality of caring, how personal care is delivered, the compassion, dignity and respect with which patients are treated. It can only be improved by analysing and understanding our patient’s experience.

…we are caring and compassionate

…we deliver quality and value

…we work in partnership

4

…leading the way in excellent healthcare Quality Governance Patient safety (cont.)

2. Continue to reduce incidences of avoidable falls and pressure ulcers, as well as enable patients and carers to understand what they can do too.

How will we measure?  Use safety thermometer to monitor progress

5. Continue to seek the views of our staff through our engagement programme, to ensure staff are supported in delivering high quality care.

How will we measure?  Through staff engagement, eg staff survey  Quarterly updates will be published on our website

How will we report?  Quarterly updates will be published on our website

Clinical effectiveness:

“Excellent Service Excellent Staff.”

3. Support patients with long term conditions – encouraging self-care and reducing acute hospital admissions with the use of technology, the integrated discharge team and the introduction of case management.

How will we measure?  Working with Medway clinical commissioning group (CCG) and other providers to implement these new services.

How will we report?  Quarterly updates will be published on our website

“Courtesy, cordiality, commitment and extreme care.”

Patient experience: 4. Continue to improve patient information, understanding and engagement through the roll out of My Plan – a shared plan designed to support the co-ordination of care, provide a framework for capturing patient goals, evidence effective practice and facilitate sharing of information.

How will we measure?  Using the Community IT System monitor the use of My Plan

…we are caring and compassionate

…we deliver quality and value

…we work in partnership

5

…leading the way in excellent healthcare

3

Looking back

Additional reporting of complaints, incidents, contractual performance and quality measures are included as part of this review.

The purpose of the operational performance group is to scrutinise this data, identifying any areas where performance is of concern or exemplary. Key actions for any required resolution are then identified and implementation sought. The process identifies risks associated with performance, eg increased patient waiting times, vacancy levels, high levels of safeguarding work, etc. and seeks assurance in regard to mitigation.

3.1 Quality of services provided During 2013/14 MCH provided and/ or sub-contracted 48 NHS services.

MCH has reviewed all the data available to them on the quality of care in all of these.

The income generated by the NHS services reviewed in 2013/14 represents 100 per cent of the total income generated from the provision of NHS services by MCH for 2013/14.

MCH performance monitoring process MCH has a clear and transparent performance framework that draws together the available data from all services into a comprehensive overview in performance dashboards described at organisational, business unit and service level.

The monthly dashboards of performance are reviewed and analysed at the business unit meetings and commentary is then provided to the operational performance meeting.

Key issues within services are considered for more comprehensive review through a ‘deep dive’ process which is undertaken at various levels dependent upon the issues. These investigations will, where appropriate, include peer review and support. The outcomes and action plans resulting from the ‘deep dive’ are reported to the executive team and Quality Committee by service managers and team members where possible.

Service level performance is reported to the quality committee where there is challenge and interrogation from executive and non-executive directors.

This informs a report to the Board allowing further opportunity to challenge key issues and actions to provide our Board with the assurance they demand.

There is consistent data collected across all services with data quality assurance built into the process, including review of both the process and the data enabling appropriate detail to understand the key issues, variables and influences.

The data collected comprises key indicators across the four cornerstones of performance:  clinical quality and outcomes  patient activity  financial health  organisational health ( our workforce)

…we are caring and compassionate

…we deliver quality and value

…we work in partnership

6

…leading the way in excellent healthcare MCH performance monitoring process (cont.)

There is a formal contract review process in place which is supplemented and enhanced by regular meetings between commissioners and MCH executive and senior management teams.

These processes review the delivery of the contract from a quantitative and qualitative perspective. The performance data and key service issues are highlighted and managed through the Service Delivery Improvement Plan (SDIP); the quality performance indicators and CQUINs are monitored through the clinical quality review meeting.

"Staff andinstill instilaa "Staffvery veryprofessional professional and confidence their abilityto to provide provide aa confidence in in their ability first class caring service with easy to first class caring service with easy to follow guidance. All staff are very follow guidance. staff are verya respectful to theirAll patients.

Always smile for us.

TOP HOSPITAL." respectful to their patients. Always a smile for us. TOP HOSPITAL."

…we are caring and compassionate

…we deliver quality and value

…we work in partnership

7

…leading the way in excellent healthcare

3.2 Quality improvement programme Participation in clinical audit During 2013/14 six national clinical audits and no national confidential enquiries covered NHS services that MCH provides. We participated in 100% of the national clinical audits for which we were eligible to, these are as follows:      

National Audit of Intermediate Care 2013 Health Technology Memorandum (HTM) 01-05 Decontamination in Dental Services Patient-Led Assessment of Care Environment Audit Sentinel Stroke National Audit Programme (SSNAP) and Stroke Improvement National Audit Programme (SINAP) Chronic Obstructive Pulmonary Disease 2013 Audit Child Health Programme – Support with introducing solids

The national clinical audits that MCH participated in and for which data collection was completed during 2012/13 are listed below alongside the number of cases submitted to each audit or enquiry as a percentage of the number of registered cases required by the terms of that audit or enquiry.

National audit National audit of Intermediate Care 2012 HTM01-05 Decontamination in Dental Services SINAP

No. of cases submitted NA 14 NA

% NA 100% NA

The reports of five national clinical audits were reviewed in 2011/12 and MCH intends to take the following actions to improve the quality of healthcare provided: Please see a detailed table of these National audits in appendix 1 page 34.

…we are caring and compassionate

…we deliver quality and value

…we work in partnership

8

…leading the way in excellent healthcare

3.3 Local audits Clinical improvement programme Local clinical audit is important in measuring and benchmarking clinical practice against agreed markers of good professional practice, stimulating changes to improve practice and remeasuring to determine any service improvements.

“I found this a fantastic service and happy that it took place in my own home.”

The reports of 40 local clinical audits were reviewed by in 2013/14 and MCH intends to take the following actions to improve the quality of healthcare provided.

The results from our local audits can be found in appendices 2, 3 and 4 at the back of this document.

We have an annual clinical improvement programme that includes mandatory audits, which all services are required to participate in, and is reported to our quality committee. Local service audits are reported to business units. All improvement programme findings are shared with the services and teams through the Governance Assurance Information Network. We undertook 11 mandatory audits (excluding infection control or medicines management audits). All services participated in at least 1 mandatory audit (10% increase from last year). These included a mixture of clinical and workforce audits ranging from patient experience to student placement.

“I was very pleased to receive this service as it was all new to me and so grateful for it. Very well looked after. Can't praise it enough.”

Some key results of the programme were:    

Training provision for the personalised care plan tool My plan focusing on appropriate goal setting and motivational interviewing. On re-audit a significant increase in patients having a plan and been offered a copy has been demonstrated.

High quality placements being provided for pre-registration students.

Audit return rate for all audits has improved significantly therefore improving the quality of the information.

Audit training developed and delivered to 56 staff members throughout 2013/14, this has resulted in a 100% increase in high quality local audits being conducted.

…we are caring and compassionate

…we deliver quality and value

…we work in partnership

9

…leading the way in excellent healthcare 3.4 Implementing NICE guidance

Recommendations

The National Institute for Health and Care Excellence (NICE) produce evidence based guidance and standards to ensure best practice in health and now social care. We are generally compliant with guidance that is relevant to our services and are working with commissioners to look at ways of developing services to enable the commissioning of services to meet the recommendations.

  

Key areas of improvement Every piece of NICE and other national guidance is reviewed and, where needed, action plans developed to ensure the recommendations are reviewed and implemented. The table below outlines the guidance that required action plans and the improvements made.

NICE Guidance CG161 Falls CG168 Varicose veins in the legs CG170 Management of autism in children and young people CG171 Urinary incontinence in women CG172 Myocardial infarction: secondary prevention TA287 Pulmonary embolism and recurrent venous thromboembolism – Rivaroxaban TA290 Overactive bladder – Mirabegron QS37 Postnatal care

In light of the release of the updated “Into Practice” guidance from NICE, a review of our current process will be undertaken.

The new process must ensure a robust review of applicable guidance across a multi-professional forum with actions and risks identified and recorded.

Promotion of NICE is a priority especially as they work with the CQC to include fundamental standards within the Quality Standards issued in future.

Improvements 2013-14 The identification of a need for a revised falls policy and assessment tools Update to policy and assessment criteria GPs informed re duplex scans There is work ongoing with educational psychology, pediatricians and commissioners to develop a satisfactory service to meet this guideline.

MSK physio purchased a new urine test kit Implementation plan in place.

Agreed that a diagnosis of DVT made by MedOCC a prescription for Rivaroxaban would be initiated according to the DVT pathway.

It has been agreed as second line for incontinence and would only be specialist initiation.

Practical skills audits and training updates for all HV staff. Audit records to ensure breastfeeding checklist is being used and recorded in child's notes.

Trajectories agreed for workforce growth and coverage of HCP contacts up to April 2015 Develop a training plan to train HVs in identification and intervention for post- natal depression

…we are caring and compassionate

…we deliver quality and value

…we work in partnership

10

…leading the way in excellent healthcare 3.5 Participation in research Research is a core part of the NHS, enabling the providers of NHS services to improve the current and future health of the people it serves. Clinical research is research that has received a favourable opinion from a research ethics committee. Our growing engagement with clinical research demonstrates our commitment to testing and offering the latest treatments and techniques for our patients.

Sixty Eight clinical staff participated in research approved by a research ethics committee in MCH during 2013/14. These staff participated in the following studies:      

CLOTS 3 A randomised controlled trial to establish the effectiveness of intermittent pneumatic compression to prevent post stroke deep vein thrombosis BMET The Brief memory and Executive Test a screening tool for identifying cognitive impairment in small vessel disease.

CROMIS-2 Clinical Relevance of Microbleeds in Stroke - a study looking into their clinical relevance TARDIS- Triple Antiplatelets for reducing Dependency after Ischaemic Stroke- a study looking at testing a new 3-drug combination for stroke treatment.

Stroke Rehabilitation Nursing Study- a study reviewing the role nurses play in the rehabilitation process following stroke. (University of Leeds).

Emotion in amyotrophic lateral sclerosis / Motor Neuron Disease. King's College led

by Tamlyn Watermeyer

In the last three years, no internal publications have resulted from our involvement in National Institute of Healthcare Research (NIHR).

As a member of the Comprehensive Local Research Network (CLRN), the Academic Health Science Network (AHSN) and the Health and Europe Centre, we have the opportunity to be involved in research studies covering a wide range of topics.

Following the publication of our research policy there has been a notable increase in the numbers of staff showing an interest in participating in or recruiting patients to research studies. Our involvement in research helps us to improve patient experience and bring professional recognition of the profile of MCH.

…we are caring and compassionate

There are a number of key areas we are focusing on including stroke, palliative care, occupational therapy and health visiting. One example of research we have been involved in with our patients is the Stroke Nursing Rehabilitation Study.

Understanding, exploring and enhancing the nursing role in stroke rehabilitation is key to the Merton Ward stroke rehabilitation unit at St Bartholomew’s Hospital who took part in the study undertaken by the Academic Unit of Elderly Care and Rehabilitation and School of Healthcare, University of Leeds. It sought to identify if nurses capitalise on their role as providers of rehabilitation and ways in which nurses and therapists work together to maximise patient outcomes.

The Sunlight Surgery is working with the Primary Care Research Network (PCRN) in the recruitment of patients to the studies that are open to general practice.

University partnerships Other areas of interest to us have been research studies in partnership with higher education institutes. These have included:University of Kent: Dance Café: a study into the effectiveness of a dance intervention on dementia patients’ quality of life.

This is a joint funding bid for DH research monies to see if a Dance Café may help patients with dementia. Older people with dementia, living in two residential care homes, will be invited to attend the Dance Café, held weekly for two hours over ten weeks and to meet others attending to eat, drink and chat.

University of Greenwich: Dementia end of life care We are developing a research proposal for submission for Research for Patient Benefit funding for this work in the area of end of life care and dementia.

University of Greenwich research fellow (funded by the CLRN) will support MCH staff to scope current level of services within Medway for end of life care and dementia, conduct a systematic review of the literature in the area and prepare the application.

…we deliver quality and value

…we work in partnership

11

…leading the way in excellent healthcare Medway School of Pharmacy: MIST (Medicine support In Stroke and Transient Ischaemic Attack (TIA)) We are collaborators in a Stroke Association research funding bid with NHS East and South East England Specialist Pharmacy Services to identify Stroke and TIA survivors’ needs and preferences for short and long term medicines support in order to develop a patient centred service which can be integrated into current stroke care.

Canterbury Christ Church University: Cognitive behavioural therapy in COPD The respiratory team developed a preliminary proposal to undertake research into managing anxiety in patients with COPD to reduce or prevent presentation at A&E, which was presented at a research fair where prospective PhD students select their research area.

Research in development Stroke POD- testing a proof of concept design, working with Medvivo, utilising a touch screen tablet device and bespoke clinical decision support software to enable the remote management of stroke patients with speech and language therapy needs.

Speech and language therapists are exploring the feasibility of conducting remote consultations via web camera links and remote monitoring of clinical parameters including mood state, fatigue and service satisfaction through questionnaires available on the device.

We are looking at the feasibility of participating in a number of other studies, including: 

PLORAS-Predicting Language Outcome and Recovery after Stroke- currently reviewing in conjunction with Clinical Studies Officer Age and Ageing.



ARCS- Assessing Recovery of Comprehension and Speech post Stroke- currently reviewing in conjunction with Clinical Studies Officer Age and Ageing.

3.6 Goals agreed with commissioners Use of the Commissioning for quality and innovation (CQUIN) payment framework A proportion of our income in 2013/14 was conditional on achieving quality goals agreed between MCH and commissioners we entered into a contract, agreement or arrangement with for the provision of NHS services, through the CQUIN payment framework.

The CQUIN payment framework aims to support making quality the organising principle of NHS services, by embedding quality at the heart of commissioner and provider discussions. It is identified as an important lever to ensure that local quality improvement priorities are discussed and agreed at Board level within and between organisations. It makes a provider’s income dependent on both national and locally agreed quality and innovation goals (2.5% 2013/14).

For MCH use of the CQUIN framework shows that we are actively engaged in quality improvements with commissioners, some of which impact beyond the boundaries of the organisation and improve patient pathways across the local health economy. Agreement being reached with commissioners about quality improvement goals is an indicator of our contribution to quality improvement in local health services more broadly.

“I have had the best level of care I could ask for!”

MCH is also an active member of the University of Greenwich Centre for Positive Ageing and the Dementia Research Forum lead by Dr Pat Schofield and currently reviewing studies across a variety of ageing areas.

…we are caring and compassionate

…we deliver quality and value

…we work in partnership

12

…leading the way in excellent healthcare Overview of 2013/14 CQUIN achievements The 2013/14 CQUIN Scheme agreed with Medway CCG contains five headline topics with 13 indicators.

Two of these were nationally defined:  The use of the Friends and Family Test  The Safety Thermometer.

Three were locally defined on a Medway wide basis with other providers of healthcare. The indicators have different financial values attached to them dependent on the activity and weight placed on the scheme by the commissioners.

2013/14 CQUIN achievements CQUIN Scheme

Q1

Friends and Family Test

Achieved

Safety Thermometer

Not achieved

Q2

Q3

Q4 Achieved

Not achieved

Not achieved

Referrals to smoking cessation

Not achieved Not achieved

Effective discharge

Achieved

Long Term Conditions

Achieved

Achieved Achieved

Achieved

Achieved

Full details of the 2013/14 CQUIN Scheme are available on request from medwaycustomercare@nhs.net.

…we are caring and compassionate

…we deliver quality and value

…we work in partnership

13

…leading the way in excellent healthcare

3.7 What others say about MCH What our patients said about Darland House Statements from the Care Quality Commission (CQC) MCH is currently registered with the CQC with no conditions. The CQC has not taken enforcement action against MCH. As a provider of regulated health services we have a legal responsibility to make sure they meet essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care. The essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the CQC (Registration) Regulations 2009. The CQC regulate against these standards.

“The care is excellent and on-going. I would recommend Darland House to anyone.”

The CQC carry out inspections of registered locations at least once a year to judge whether or not the essential standards are being met. All inspections are unannounced unless there is a good reason to do otherwise. There are 16 essential standards, grouped into five key areas that relate directly to the quality and safety of care. Four of our five registered locations received unannounced inspections from the CQC in 2013/14. At all sites all outcomes inspected against were met.

Darland House Outcome 2. Consent to care and treatment Outcome 4. Care and welfare of people who use services Outcome 5. Meeting nutritional needs Outcome 8. Cleanliness and infection control Outcome 12. Requirements relating to workers Outcome 17. Complaints

“It is a friendly and warm environment with very capable and friendly staff who offer good care to all the residents.”

What the CQC said about Darland House “People were offered choices at every meal time and could choose where they ate their meals. We saw that people were encouraged to drink and were offered snacks throughout the day. We saw that people were given the assistance they needed to eat and drink in a sensitive and discreet way”.

…we are caring and compassionate

…we deliver quality and value

…we work in partnership

14

…leading the way in excellent healthcare St Bartholomew’s Hospital Outcome 2.Consent to care and treatment Outcome 4.Care and welfare of people who use services Outcome 6.Co-operating with other providers Outcome 9.Management of medicines Outcome 16.Assessing and monitoring the quality of service provision Outcome 17.Complaints

Wisdom Hospice Outcome 2.Consent to care and treatment Outcome 4.Care and welfare of people who use services Outcome 5.Meeting nutritional needs Outcome 8.Cleanliness and infection control Outcome 12.Requirements relating to workers Outcome 16.Assessing and monitoring the quality of service provision

What the CQC said about St Bartholomew’s Hospital “People said that staff understood their individual needs and preferences. People told us that they had been involved in planning their care and setting goals. People spoke very highly of the staff and the services provided.”

What our patients said about St Bartholomew’s Hospital

What the CQC said about Wisdom Hospice “People experienced effective and safe care which met their needs and promoted their rights. Care was person centred and delivered by a skilled multi-disciplinary team. People told us that the staff and the services offered were ‘Superb, there's no other word for it’.”

What our patients said about Wisdom Hospice

“I have really appreciated my stay in St. Bart’s. It has been excellent for rehabilitation. My confidence has increased. I have never been able to balance or hop before - I certainly can now. I have been encouraged every step of the way. The staff have been fantastic and friendly and the food has been good.”

…we are caring and compassionate

“Thank you and all your team for the gentle, considerate and supportive care that we both received during the short time that Michael was under the Hospice care.

We had not experienced such support on our long journey through his illness and it made those last months more bearable for us both.”

…we deliver quality and value

…we work in partnership

15

…leading the way in excellent healthcare 3.8 Student placement feedback

Medway on call care (MedOCC) Outcome 4.Care and welfare of people who use services Outcome 8.Cleanliness and infection control Outcome 9.Management of medicines Outcome 12.Requirements relating to workers Outcome 16.Assessing and monitoring the quality of service provision

We support and encourage both pre and post registration placements for all professional groups, from nurses to trainee GPs, paramedics to dietitians. These are some of the things students said about their experience with us:“This placement has been fantastic to me and learning. Everyone member of the Health visiting team was supportive, encouraging and always willing to help me”.

What the CQC said about MedOCC “People using the service benefitted from an organised and responsive service because the quality of the service was closely monitored. The service was continuously improved by learning from events and incidents”.

What our patients said about MedOCC

“Very efficient service nice doctor - good treatment.”

“Had no problem accessing MedOCC (via 111) and was dealt with quickly and professionally.”

…we are caring and compassionate

“Darland House is an amazing placement. All staff were welcoming and friendly.

My mentor was the most supportive mentor I have had to date. She allowed and encouraged all opportunities to learn and be involved. I could see myself working at Darland in the future! Amazing, thank you!.”

“I just want to say a huge thank you to all the team at MedOCC, this has been an absolutely fantastic placement which not only have I enjoyed but also gained so much from for my studies and developing role. This is a brilliant placement for students with interactive and supportive mentors who are not only interested in teaching but also in utilising the knowledge and skills of students to form clinical opinions gaining valuable input into patient care.”

“I have had a fantastic placement on William ward and feel that I have learnt so much whilst here. Being part of the Multi-Disciplinary Team has been an excellent experience. My mentor has been extremely supportive. This is a brilliant placement for students and I can’t give all staff enough credit for what they do here.”

“Working at St Bartholomew’s Hospital was an open opportunity for me as a student nurse. For the future reference I believe St Bart’s is a good place where student nurses can get as much experience and opportunity for the future.”

“I thoroughly enjoyed my placement whilst with the district nursing team. The skills and knowledge I have learnt will be transferable to all different areas of future placements/work and I feel that it has greatly improved the care that I can deliver to a patient.”

…we deliver quality and value

…we work in partnership

16

…leading the way in excellent healthcare “Very supportive team, I enjoyed all aspects of this placement. This is the best placement I have had the pleasure of to date, and has convinced me that community nursing is where my passion still is.”

“I felt strongly supported by each professional and I was always made feel involved while caring for patients. Brilliant placement in the Respiratory Team over all due to a great teamwork.”

“I really enjoyed being part of the Physiotherapy team and having more responsibility for patients and management than I had had on previous placements. Everyone was very welcoming and supportive and I feel this really helped me progress during the placement.”

“I have felt like a member of the Speech and Language Therapy team from the start. The support I have received from both my mentors has been huge. They have put a lot of time and effort into welcoming me into their team, and offering me as many opportunities as possible.”

3.9 Data quality With the introduction of the electronic patient record and the gradual withdrawal of paper records the subject of data quality has become more prominent. The link to the Personal Demographic Service (PDS) means that resources have been redeployed from manual corrections of demographics and NHS number to maintaining the quality of the patient record. The availability of other electronic tools such as these has also helped clinical services become better able to maintain data quality standards and reduce the dependence on central data quality processes.

By reducing the need to enter data in more than one system, data completeness has improved. Engagement with clinical services at systems configuration level has enhanced the quality of the clinical record and enabled central audit of clinical records.

Areas for development Areas for investigation or development are identified by multi-disciplinary groups of clinical and information technology staff. Approved changes are made to systems to simplify data entry and improve workflow making data quality easier to maintain by those entering data. Patient record level reports are regularly sent to clinical teams for validation.

Areas we are currently monitoring:  Clinic appointments without an associated consultation recorded  Validity of waiting times data  Checking for duplicate patients  Ensuring that entries are correctly identified as being either clinical or administrative on the electronic patient record.

…we are caring and compassionate

…we deliver quality and value

…we work in partnership

17

…leading the way in excellent healthcare NHS number and general medical practice code validity MCH submitted records during 2013/14 to the Secondary Uses service for inclusion in the Hospital Episode Statistics which are included in the latest published data. The percentage of records in the published data which included the patient’s valid NHS number was 100% for admitted patient care and those which included the patient’s valid General Medical Practice Code was 100% for admitted patient care.

Information Governance Toolkit attainment levels The MCH Information Governance Assessment Report overall score for 2013/14 was 81% identifying we scored at or above the required national standards The Information Quality and Records Management attainment levels assessed within the Information Governance Toolkit provide an overall measure of the quality of data systems, standards and processes within an organisation. The information governance toolkit brings together all the requirements, standards and best practice that apply to handling information. The information we collect from patients helps us to give the best possible care. Keeping personal information secure and confidential is of the utmost importance to us. This applies to manual and computer records as well as any conversations about a patient or their treatment.

Clinical coding error rate MCH was not subject to the payment by results clinical coding audit during 2013/14 by the Audit Commission.

…we are caring and compassionate

…we deliver quality and value

…we work in partnership

18

…leading the way in excellent healthcare

4

Review of quality performance

4.1 Our values Our Values • • •

What has influenced quality improvements 2013/14 This year our on-going quality improvements have been influenced by: -

         

Clinical quality strategy 2013/16 published Our Values and Our Pledges Listening events post Francis Report Governance assurance information network (GAIN) has provided an excellent forum for sharing lessons learnt, good practice and influencing a culture of compassionate care Quality dashboards developed Staff development away days My plan training Clinical audit training Real time reporting survey system introduced Improvements in cost effectiveness of patient experience programme through the use of technology

…we are caring and compassionate

We are caring and compassionate We work in partnership We deliver quality and value

Our values were developed with staff and patients to support the transition to social enterprise and are embedded in our processes to attract, select, recognise and develop our people. Our values reflect the NHS constitution and remind us of how our behaviour makes a real difference to the experience of those who use our services. The winners and runners up of our quarterly Recognising Excellence Awards for staff are great examples of our values in action, as nominated by patients, partners and colleagues. They represent just the tip of the iceberg as nominations are celebrated throughout the year in teams and at quarterly awards.

During 2013-14 we refreshed the behaviours which support our values in the light of the Francis Report to ensure transparency and candour are reflected in everything we do and to encourage all staff to speak out when quality or safety is compromised. The values underpin our core objectives, which apply to all staff, and are prominent in our patient and customer surveys. At the same time we strengthened our leadership qualities; these align with and support our values, applying to leaders at every level in the organisation.

The values are playing an ever increasing role in attracting and recruiting people who share our organisational philosophy on quality and value and they are integral in informing individual and team performance, which continues to be a primary concern in providing a first class community health service.

…we deliver quality and value

…we work in partnership

19

…leading the way in excellent healthcare 4.2 Our pledge By fully understanding our patients’ needs, staff feel empowered to stand up and make changes to ensure our values are expressed through our behaviours.

“Courage enables us to do the right thing for the people we care for, be bold when we have good ideas, and speak up when things are wrong.”

Establishing a clear concept of quality makes it easier for staff to deliver services they are proud of and for our patients to receive care and support that treats them with dignity and respect and fully meets their needs.

Each of our services has developed ‘Our Pledge’ displayed as a poster which is based on NICE quality standards for patient experience; aligned to our organisational values and ensures that our organisation fulfils the NHS constitution. Through this patients, relatives, our staff and carers have a mutual understanding of exactly what to expect from each service and also what we expect from them in return, ensuring that all expectations are met.

4.3 Privacy and dignity It is extremely important that anyone being treated by any of our services is treated with respect and cared for in an environment that meets their needs. Over the last year we have asked through our patient experience programme just under 20,000 of our patients if they felt they were treated with dignity, privacy and respect over 95% of those who responded stated they were happy or very happy.

…we are caring and compassionate

…we deliver quality and value

…we work in partnership

20

…leading the way in excellent healthcare 4.4 Quality services

Long Term Condition/Case Management

MedOCC has continued to respond to the challenges faced by the

In 2013/14 we introduced the nurse case management role to support people with multiple long term conditions (LTC) and the frail elderly.

implementation of NHS 111 working with other agencies to refine and streamline processes. This work has led to the establishment of MCH OneCall, a single point of access for GPs and hospital services predominantly to refer their patients directly to MCH services in a timely and paper-free way. The service is hosted at MedOCC, Quayside and staffed by trained call takers who take the relevant details and pass the referrals on to the required service. Calls have been taken for a wide variety of services in MCH and also for services run by Medway Council. Work continues to refine the process which will become an electronic process as the roll out of our new IT system progresses to cover all of our community healthcare system.

In response to the national review of emergency departments in acute hospitals and the consequent developments and workflow at Medway Hospital, our MedOCC team based at the hospital has relocated to a new clinical area within the hospital.

The new facilities have potential to support future developments for the service working together with Medway NHS Foundation Trust (MFT).

“Fantastic service and lovely Doctor.”

The Sunlight surgery has established a patient group which is meeting regularly and taking forward the initiatives of on-line appointment booking and electronic prescribing.

…we are caring and compassionate

These patients often have complex care needs, are at high risk of admission to hospital, are users of many services and have often not been well served by a more traditional ‘see, treat and discharge’ approach to care.

Case management as a service combines both preventative and responsive care, for patients with multiple LTC and those identified as high risk of deteriorating health. The service provides a skilled nurse, working closely with patients and their families, co-ordinating care and regularly evaluating the effectiveness of service provision.

The case management service is provided by senior community nurses with expert knowledge and skills who work collaboratively with health and social care services such as community nursing, social workers, diabetes, heart failure and respiratory teams.

The service is further enhanced by advice from specialists such as a geriatrician, respiratory physician or cardiologist who are specifically contracted to support the case managers.

“I can't praise them enough in everything they do. As I have said, everyone is so nice and friendly, that I am sure they treat everybody the same keep up the good work. We are grateful for all you do. Thank you.”

…we deliver quality and value

…we work in partnership

21

…leading the way in excellent healthcare Support patients with long term conditions – encouraging selfcare and reducing acute hospital admissions through use of technologies In 2013/14 MCH participated in a telehealth pilot that monitored and supported Long Term Condition patients in their own homes. The telehealth service included a home monitoring systems, external clinical triage and clinical advice and care from our cardiology, respiratory and case manager services.

MCH feels that it is important that patients and referring professionals are able to easily find information and access our services with a focus on signposting them away from Accident and Emergency departments.

An MCH mobile app is now available for referrers and patients. This provides information such as clinic addresses, opening times, contact details and referral criteria. These details are also present on Sky and Virgin digital TV for those who are not computer friendly and functions similarly to the old teletext function, linking into local bus timetables, train times and also external self-help health apps.

At our new MCH House clinic we have established a kiosk that allows musculoskeletal and phlebotomy patients to check in for their appointment and submit real time patient experience feedback.

…we are caring and compassionate

…we deliver quality and value

…we work in partnership

22

…leading the way in excellent healthcare Community Diabetes/waiting times MCH community diabetes service offers tailored packages of care to people with type 1 and type 2 diabetes to enable and promote diabetes control. This includes patient education, clinic appointments and telephone advice to support individuals, carers and/or relatives.

The X-PERT education programme is a six week group course suitable for people who have had diabetes for some time. Participants have the opportunity to learn all about the up-to-date treatments and management and explore problems and issues that they may have with their diabetes.

Our X-PERT programme is award winning for continuing to deliver high quality education demonstrated by the greatest reduction in long term glucose levels (HbA1c) in patients. A better understanding of managing glucose levels makes a real difference to their quality of life.

“The nursing team are an ABSOLUTE safety net. Their patient care skills are without equal. God Bless them All!.”

MINT1E is a structured education course for people with Type 1 diabetes on multidose injections (Basal Bolus). This involves individuals attending a full day session every week for four consecutive weeks and the course focuses on carbohydrates and insulin and the impact this has on blood glucose levels.

Due to the increasing number of diabetics identified in the Medway and Swale area the demand for education places is high resulting in long waiting times. In response to this demand the local commissioners have funded MCH to provide additional education courses and have begun discussions regarding the commencement of new X-PERT insulin programme.

…we are caring and compassionate

…we deliver quality and value

…we work in partnership

23

…leading the way in excellent healthcare

“First class treatment by dedicated staff, with very good care.”

“All the staff I came into contact with were consistently polite and professional. The treatment I received was effective and had a positive outcome.”

“Service is good. Nurses were very good to me. I don't think I would get a better service anywhere else.”

“This service helps put your mind at rest and don't worry.” unnecessarily

“I have never received better dental treatment in my life, with amazing results.”

…we are caring and compassionate

…we deliver quality and value

…we work in partnership

24

…leading the way in excellent healthcare Quality services in response to public feedback Musculoskeletal (MSK) outpatient physiotherapy Over the years, MSK outpatient physiotherapy has received many complaints and comments regarding the clinic at Medway Hospital. Patients were unhappy with the road access and levels of traffic, which often caused them to be up to 45 minutes late or even missing their appointment. In addition, they were often unable to find parking spaces, causing further delay and frustration. Patients often commented that they struggled to afford to pay for parking, especially when attending twice a week. In addition, toilet facilities were unsatisfactory, access to disabled facilities was limited and the department regularly failed their cleaning and infection control audits.

In November 2013, MCH opened a new purpose built physiotherapy clinic at MCH House in Gillingham. As a result of moving the MSK outpatient service to MCH House, lost appointments due to road delays have almost been eliminated and patients regularly remark on the clean, professional and welcoming atmosphere. We have the added advantage of an increased numbers of private treatment rooms, including a designated women’s health room for extra privacy where required. We have been able to extend our clinic hours and now regularly hold clinics between 7:30am and 7pm.

Additionally we are able to give patients free, on-site parking The co-located phlebotomy service also benefits from the excellent access and parking facilities, plus they have extended their opening hours in response to patient feedback at MCH House.

MSK physiotherapy has also undertaken considerable work to reduce waiting times for patients. We have reviewed the booking processes, introduced extra clinics, validated the waiting list and invested in additional staff. This work has culminated in a 13 week reduction in waiting times.

Occupational Therapy Six day working The occupational therapy team based at MFT introduced a six day working pilot using the winter pressures funding. Three qualified staff members work to cover all the elderly, medical and surgical wards. On average 1-2 patients are discharged home from Medway Hospital every weekend. All patients seen by the team have their discharge coordinated and are often discharged by the OT team. The pilot has helped Medway Hospital to manage their bed occupancy. Delayed discharges due to waiting for OT intervention has reduced dramatically and staff are enjoying the flexibility of working at the weekend.

This pilot has been extended until the end of March 2015 and has been met with much praise and enthusiasm from patients and staff.

“Excellent physio/service in excellent facility.”

Improving use of cancellations The MSK outpatient physiotherapy department have worked hard to ensure that any cancelled appointments are refilled with new patients. By reviewing our processes we have ensured that any unused slots are utilised and now report an average of only 3% unused slots. We now have designated call takers and have extended the booking team hours to enable us to contact patients outside traditional working hours. We also now provide more extensive information with the confirmation letter to reduce missed appointments or patients arriving at the wrong location.

…we are caring and compassionate

…we deliver quality and value

…we work in partnership

25

…leading the way in excellent healthcare 4.5 Patient experience The patient experience programme in 2013/14 has involved the development of service specific toolkits that examine the needs of users. The toolkits were developed and piloted with the staff and user group and then produced, distributed and analysed throughout the year. Return rate remains high at 23%, which is above the 20% national target. The overall experience score for 2013/14 was 96% the same as achieved in 2012/13 and 2011/12.

What our patients say

The friends and family test organisational score for 2013/14 is 74%. This means 96% of patients asked whether they recommend MCH services to their friends or family stated they would be highly likely or likely to recommend.

The Friends and Family Test All services have the friends and family test as a benchmarking question. This question is a validated, reliable tool to establish loyalty to our services.

The question is: ‘How likely would you be to recommend this service to your family and friends if they required similar care or treatment?’

The response: Highly Likely; Likely; Neither likely or unlikely; Unlikely; Very unlikely; Don’t know The score is established utilising the following formula: Promoter score: Highly Likely (% score) minus the total percentage score of detractors (Neither likely or unlikely, Unlikely, Very unlikely and Don’t know). The score achieved for ‘Likely’ are not included within the equation as they are seen as passive. It is calculated in a way that provides a percentage score that can then be compared locally and nationally to evidence improvements or to benchmark across the services. The %score is between 100 to +100.

People we provide care for The overall friends and family score for the organisation is 74% which indicates good to excellent services. The service level score will be utilised as a benchmarking outcome measure for 2013/14 programme.

…we are caring and compassionate

Above is a word cloud formed of the adjectives expressed by the responders about the attitude of our staff. The larger the words appear the more frequently they have been articulated.

Our staff The percentage of staff employed during the reporting period who would recommend the organisation as a provider of care to their family or friends is 80% MCH considers that this is a positive result but also believes there is always room for improvement. Our staff engagement strategy and patient experience programme are key to our plans to increase this percentage.

…we deliver quality and value

…we work in partnership

26

…leading the way in excellent healthcare Patient Feedback Feedback given by patients about their experience of care and treatment is important to us and helps us to make improvements. Patients are actively encouraged to provide feedback and share their comments, compliments, concerns and complaints and we promote this through our Tell Us leaflet and website. This year, we have asked our patients to be interviewed and recorded sharing their experiences with us, which can then be used in training, at Listening Events and Board meetings.

Our patients shared with us the difficulties they experienced when attending Physiotherapy services at Medway Hospital. As a result and as part of a wider Estates strategy, the service was moved to a refurbished building specific to the purpose of providing clinical services, with easy access and ample parking.

During 2013/14 we made 850,755 patients contacts, some for the first time and some for follow up appointments in a variety of community settings. Over that time we received 145 complaints; that is only one complaint for nearly every 6000 patient contacts. One complaint has been passed to the Health Service Ombudsman and we are still awaiting an outcome from the review.

As part of quality assurance ensuring that we are listening and learning from what our patients tell us, Medway CCG as part of our review against the Francis Report, reviewed our management of complaints. The CCG recommended implementing an improved process to ensure all aspects of a complaint were responded to both internally and with other organisations.

Although we have not identified any trends in the clinical care or treatment, we have identified some issues with communication, particularly around making, changing and confirming appointments. As a result our services have changed the style of patient appointment letters to make it clearer.

Last year, a new telephone system was installed in the podiatry service and, as a result, there has been a marked decrease in complaints about contacting the service. General communication and therefore understanding between clinicians and patients and carers continues to be important to us and customer care training has been reviewed and updated providing a different approach. Our organisational values and the service pledges support working in partnership and being caring and compassionate.

Waiting times for and access to services are things our patients have also commented on.

We are commissioned by the CCG and others to provide health and social care services.

Each service is commissioned against a set of eligibility criteria and as a result we have comments regarding these decisions, all have been answered on an individual basis.

…we are caring and compassionate

…we deliver quality and value

…we work in partnership

27

…leading the way in excellent healthcare Real-time patient feedback We researched and procured a new survey system that provides a wider scope for patient and customer feedback and audit functionality. A real benefit of this programme is the availability of real-time reporting. This provides services with instant feedback to allow immediate action which will ensure customer experience is at heart of all they do.

Implementation is now completed and has been operational from 1 April 2013.

Recommendations 2014/15     

Increase comparisons of clinical indicators and develop service level dashboards Quality improvement action plan to be used for sharing lessons learnt and improved assurance Patient stories to enhance Listening Events Increasing the use of technology Our pledge reviewed against reviewed values and behaviours.

“Excellent care. Nothing too much trouble. No one ever said "I can't do". There was always a solution. All my family feel the same about the care.”

…we are caring and compassionate

…we deliver quality and value

…we work in partnership

28

…leading the way in excellent healthcare 4.6 Achievement against our quality priorities for 2013/14 Indicator Indicator

Target

Patient safety 1. Provide environments and care where the risk of infection is minimal  Staff being bare below the elbow 

Compliance with hand hygiene



Cleaning audits



Compliance with MRSA screening



Reported C.difficile or MRSA

2. Continue to reduce incidences of avoidable falls and pressure ulcers, as well as enable patients and carers to understand what they can do.

Q1

Q2

Q3

Q4

87%

96%

97.2%

99%

97%

100%

100%

100%

100%

100%

95%

100%

99%

99%

100%

87%

88%

89%

93%

90%

100%

96%

100%

95%

98%

0

1 C diff

0

1 c diff

0

4.25%

4.18%

5.28%

6.4%

6.02%

1.79%

1.29%

1.94%

2.9%

2.72%

Target

Clinical effectiveness 3. Support patients with long term conditions – encouraging self-care and reducing acute hospital admissions through use of technologies, eg telehealth.

4. Improve the health and wellbeing of children, as part of an integrated approach to supporting children and families through the delivery of the healthy child programme.

Indicator 3. Patient experience 5. Continue to work to reduce waiting times and appointment cancellations for patients in services where there are challenges.

6.Palliative care – continue to build on giving patients ownership of their care through advance care planning and provide them with a copy of their agreed management plan.

…we are caring and compassionate

…we deliver quality and value

Q1

Q2

Compliance with CQUIN

Met Met Met

Met

Compliance with implementation plan

Met Met Met

Met

Target

Q1

Q3

Q2

Progress against achievement of improvement plans

Met

Met

Monitor the roll out and use of My Plan

Training initiated

My Plan being used

Q4

Q3

Met

…we work in partnership

Q4

Met

29

…leading the way in excellent healthcare 4.7 Providing safe clean environments We are committed to providing safe clean environments and continually look at ways we can minimise the risk of cross infection.

We now have a purpose built clinical centre at MCH House with a modern environment to deliver our physiotherapy and phlebotomy services.

We continually work with our staff, landlords and commissioners to improve the sites we use across Medway by implementing programmes of refurbishment such as at the Wisdom Hospice.

We have in place a robust system to monitor the cleaning and infection control standards in all the sites we use.

Staff attend annual infection control training and are routinely observed in practice to ensure that they provide the best infection control standards in their patient care, e.g. correct hand hygiene and for specific treatments such as the insertion of urinary catheters.

At St Bartholomew’s Hospital patients are screened for MRSA bacteria on their skin and we ensure that the correct treatment is given if required. Four patients had their screening undertaken outside the required 48 hour timeframe; the matron is working with staff to ensure the screening happens correctly for all patients.

We are required to report serious infections of patients who are in our care at St Bartholomew’s Hospital, Wisdom Hospice and Darland House to the Department of Health – MRSA blood stream infections and Clostridium difficile infections.

This year is the second consecutive year we have had no patients with MRSA blood stream infections. Two patients developed C.difficile infections. A review of the cases showed that the contributory factor was the use high risk antibiotics whilst in acute hospital care.

…we are caring and compassionate

4.8 Reducing falls and pressure ulcers We aim to deliver high quality, safe patient care and to ensure we know how we are doing we monitor patient safety incidents and report these to our commissioners, as well as, through the Safety Thermometer (an improvement tool for measuring, monitoring and analysing patient harms and 'harm free' care) report to the Department of Health.

For the first time, this year we reported against four potentially avoidable harms that people may experience: falls, pressure ulcers, venous thromboembolism (VTE) and urinary catheter infections (CAUTI). Whist few patients suffered CAUTIs, no patients suffered VTEs. We had a small percentage of patients who acquired or were treated for pressure ulcers and a number who fell whilst in our care.

Over the year we have been able to more closely identify underlying causes for patients we care for with pressure ulcers, many patient come to us from hospitals or care homes, or even their own home before care, with existing ulcers. A smaller number have developed whilst in our care, each is fully investigated, and reported, to ascertain the cause. This has led to staff receiving more intensive training and supervision, reviews of equipment and assessment skills as well as the identification of the need to work with other healthcare providers and the patients and carers to raise awareness of the risk of pressure ulcer development when people are unwell, undernourished or suffering from disabilities. This work is on-going through the coming year.

In our inpatient units we have had a number of patients who for various reasons have suffered a fall. As with pressure ulcers every fall is investigated and reported. Where a patient sustains an injury, such as a fractured hip we report these to our commissioners. The patients we care are becoming noticeably sicker and frailer. This in itself leads to a greater risk of falling. As a result we have put a greater focus on assessing individual risks, ensuring patients are monitored and observed and supported to prevent falling. This remains a key priority for us going forward into 2014/15.

…we deliver quality and value

…we work in partnership

30

…leading the way in excellent healthcare 4.9 Personalised care plans We will continue to improve patient information, understanding and engagement through the roll out of My Plan – a shared plan designed to support the co4.10 Delivery of the healthy child programme ordination of care, to provide a framework for capturing patient goals, evidence effective practice and facilitate the sharing of information across multi-disciplinaryIn 2013/14 investment in the health visiting service has resulted in improvements to families teams. by delivering the Healthy Child Programme.

All children are now offered a routine health and development check at 2.5 years either at home or in one of the local Medway Children’s Centres. This has proved popular with families with an uptake of around 65%. Looking forward there are plans to provide greater access to the service for working parents with clinics after work or on Saturdays.

There are also plans to work on improving the services for families with children under one with group sessions running at the children’s centres and the introduction of a health and development review at 10-12 months.

“Excellent, considerate, compassionate, professional care that has helped give me a better quality of life.”

4.11 Reducing waiting times Progress against improvement plans Children ‘s physiotherapy services- The Children’s physiotherapy service experienced high numbers of staff on maternity leave during 2013/14 and as a result there was a risk that there would be an increase in waits for young service users and their families which could impact on their physical wellbeing. The Independent Business Unit management team looked at utilising the clinical skills and expertise of some senior managers resulting in those managers shifting their focus to the delivery of direct care to provide clinical assessment and treatment to young people requiring physiotherapy and supervision to junior staff.

Podiatry – access to podiatry services had been an issue that had been raised as a concern by service users, and in particular being able to contact the service by telephone. The service reviewed the feedback from service users and the number of complaints it was receiving.

The service worked with colleagues in procurement and a telephone system that was fit for purpose was purchased and installed. As a direct result of this investment the service has seen a significant reduction in the number of complaints regarding accessibility to the service thereby improving the patient experience considerably.

…we are caring and compassionate

…we deliver quality and value

…we work in partnership

31

…leading the way in excellent healthcare 4.12 Palliative care Palliative care clinicians discuss and develop the plan of care. Consent to the care plan is agreed with every patient, whether in the ward or community setting. All patients are offered a copy of their assessment details and clinic letters. Consent is sought to have the patient’s wishes recorded on the My Wishes register: a record of the patient’s decisions about the type of care they would like to receive as they approach their end of life, including any cultural or religious wishes, preferred place of care, and organ donation. It also records key information about diagnosis, condition and medical treatment. The register is held online and can be accessed securely only by staff responsible for the care of the patient, including GPs, ambulance service, community nurses, social care and hospice services.

Access to My Wishes will be extended to Swale from 1 April 2014.

Therapeutic goals are set and agreed with patients and carers accessing other areas of the specialist palliative care service, including the day hospice.

“The service you provide is second to none. Thank you all.”

…we are caring and compassionate

…we deliver quality and value

…we work in partnership

32

…leading the way in excellent healthcare

5

Statements from our stakeholders

In line with the Department of Health letter, the draft version of our quality account was shared with HealthWatch and Medway CCG for comment. We also sought comments from the Medway Council Health Overview and Scrutiny Committee. Their responses are below. We did not receive any comments from HealthWatch, and the Overview and Scrutiny Committee did not comment on the Account this year.

Our draft quality account was also shared with the MCH community forum, the MCH staff elected members’ forum and staff - their comments have been incorporated hopefully leading to greater clarity and an ease of reading for the general public.

We thank everyone for their interest and support.

Statement from NHS Medway Clinical Commissioning Group In response to the draft Medway Community Healthcare (MCH) Quality Account submitted to NHS Medway Clinical Commissioning Group (MCCG) please find detailed below the MCCG statement in accordance with the National Health Service (Quality Accounts) Amendment Regulations 2012.

NHS MCCG welcomes the 2013/14 draft Quality Account submitted by MCH and can confirm that the CCG has reviewed it against all the Department of Health reporting requirements and as far as can be determined the commentary and data presented are an accurate and honest reflection of progress made in improved service delivery and patient outcomes and meets national reporting requirements.

The CCG commends MCH on the engagement through a consultation process with staff, patients, community forum and commissioners for the selection of priorities for 2014/15 ensuring that the priorities are set with local needs in mind.

…we are caring and compassionate

MCCG acknowledges and supports the five priorities detailed within the Quality Account around Patient Safety, Clinical Effectiveness, Patient Experience and Quality Governance.

Ensuring a positive patient experience is central to service delivery and core to the services commissioned for the Medway population.

The CCG supports MCH in the range of measures and strategies used to create a positive patient experience, including the introduction of ‘telehealth’ ‘to monitor and support patients with Long Term Conditions in their own homes; the ’X-PERT’ education programme for people with diabetes and the relocation of the outpatient physiotherapy and phlebotomy services to MCH House Clinic.

The CCG recognise the organisation’s use of patient feedback to improve service delivery through the implementation of a real-time patient feedback system which allows immediate action which will ensure customer experience is at heart of all they do.

Four of the five registered MCH sites, St. Bartholomew’s Hospital, Darland House, Wisdom Hospice and Medway on call care (MedOCC), received unannounced inspections from the Care Quality Commission in 2013/14 and all were found compliant against the standards inspected.

The organisation failed to meet the 2013/14 target for the Commissioning for Quality and Innovation (CQUIN) for the reduction of pressure ulcers, however this continues to be an area for improvement and the CCG welcomes that this remains a priority and will be a key performance improvement initiative as part of both national and local CQUINs in 2014/15.

NHS MCCG look forward to continuing to work closely with the Clinical Quality Director and colleagues at all levels within the organisation to assure the quality of local services. We look to continue to strengthen our relationship through the Clinical Quality Review Group with the aim of gaining the on-going assurance that the quality of local services provided by MCH are maintained and continually improved in all areas of the organisation.

…we deliver quality and value

…we work in partnership

33

…leading the way in excellent healthcare

6

How to provide feedback on this account

We would like to hear your comments and feedback on the quality account and any suggestions you may have for the priorities and content for our future quality account.

Your feedback For further information or to request a hard copy of this report please contact the medch.communications@nhs.net or call 01634 334686.

Other languages This information can be made available in other languages and formats You can now find information about MCH services by using our new App on your smartphone or on Virgin and Sky TV or Wii games console.

To download the MCH services App to your phone simply scan the QR code below: To become a member of our community forum www.medwaycommunityhealthcare.nhs.uk/join-in

Scan me:

…we are caring and compassionate

…we deliver quality and value

…we work in partnership

34

…leading the way in excellent healthcare

7

National audits 2011/12 five national clinical audits were reviewed and we intend to take the following actions to improve the quality of healthcare provided

Appendices

 National Audit National Audit of Depression Screening and management of staff on long term sickness absence by OH services in the NHS; round 2

 



 SINAP 2011





Appendix 1: National audits 2011/12 review

 HTM01-05 Decontamination in Dental Service

Patient environment action team (PEAT) The Combined National Audit of Falls and Bone Health in Older People 2011/12 Older people’s experiences of exercise programmes as part of a falls prevention service

   



Actions Discussion with the Occupational health (OH) team to consider ways to improve recording of depression in notes and to ensure that fitness to work action plans are clear to managers.

Clinical supervision – nurses to discuss cases and how to approach sensitive issues. Further training to be offered for asking questions about suicide, self-harm.

OH to continue to work closely with us to ensure early referral to OH staff on long term sickness absence.

Number of patients scanned within 24hrs of arrival at hospital - independency with MFT and CT department protocol & correlates with direct admission to Acute Stoke Unit (ASU) No of patients who arrived on stroke bed within four hours of hospital arrival out of hours – interdependency with MFT with regard to protocol for direct admission to ASU out of hours To obtain funding to purchase a bladder scanner to aid assessment – Fund raising event at MFT Social Club.

Actions included Facilities and environment requirements to meet best practice Key actions undertaken by dental staff immediately Identified areas of con compliance with regard to the condition of the buildings; working with NHS Property Services to include on work programme for upgrades.

No local actions

35

Appendix 2: 2013/14 Local audits – Planned Care

Local audit title Planned care Anti-coagulation: Patients ability to self-test (for INR result)

Actions 

 Cardiology: An audit to determine if the local heart failure population attending nurse-led heart failure clinics weigh themselves daily and report rapid weight gain, in line with local and international guidelines Adult Learning and Disabilities Team: Evaluating physio service and input to service users at Enhanced Care Unit



Apply for grant to buy some self-test machines to loan to patients who would benefit most from having their own machine.

Review patients’ time in range every 6 months.

To promote one to one home education to patients that either request or will benefit from it.

…leading the way in excellent healthcare Local audit title Community Nursing Team – continence care: Gap analysis for NICE guidance: Urinary incontinence in neurological procedures

Community physiotherapy: A clinical audit of core competencies to ensure standardised & best practice Community Respiratory: Acapella audit Community Respiratory: Comparison of oral nutritional supplements (ONS)

Actions  Targeted training  Inclusion in the continence care integration plan  Need to review referral from neurological services.

Referral form to continence service to include bladder scan request  Audit staff knowledge  Ensure catheter check list includes training family members  Annual competency updates  All new staff to complete competency training within 6 months of start date  Arrange training from internal & external sources as needed to ensure up to date & best practice 



 Dermatology: Biopsy audit – skin legions





  

Regular visits to ECU by Physiotherapist or Associate Practitioner will be established All referrals will be documented on the file at the ECU and reviewed on every visit

Intermediate Care – Walter Brice: 15 Step Challenge

  

  

…we are caring and compassionate

…we deliver quality and value

Purchase a stock of Acapellas, for all appropriate patients under CRT’s care, which will be replenished as required.

To continue using standard product (SP)-ONS as first line oral nutritional supplements but consider partially modified (PM)-ONS as second line oral nutritional supplement in patients with poor appetite and/or oral intake and/or early satiety.

To consider using PM-ONS in patients with poor oral nutritional supplement tolerance.

Maintain Dermatology Histopathology Database Investigate Nurse Led Surgery updates to advance skills.

To promote recognition of suspicious skin lesions and highlight the appropriate referral pathways.

Cutting down on the amount of literature on the reception area Look at moving the ticket machine Look into staff collecting patients from the waiting area rather than relying on other members of the public to do it.

Ensure a cleaning log for the curtains is available Ensure clearer signage for the Phlebotomy service Look to see if a clear area for wheelchairs and buggies can be established in the waiting area.

…we work in partnership

36

…leading the way in excellent healthcare

Local audit title Neuro-physiotherapy: Vestibular Symptoms in MS patients and their response to vestibular rehab

Tissue Viability and wound therapy: Evaluation of mattresses in nursing homes and assessment of pressure ulcers

Actions  Vestibular screening tool to be used in  neuro-physiotherapy assessment for MS patients even when there are no obvious vestibular symptoms.  Research study with larger sample size and a control group to provide more evidence of the significance of vestibular rehab in MS patients. 

 



To offer and deliver on-going pressure ulcer assessment and prevention training to nursing homes To re-audit in 3 months to see if there has been an improvement in the dressing choices To reinforce to the nursing homes their responsibility for dynamic loan equipment and returning equipment within a timely manner.

To continue with the tissue viability pressure prevention role to be able to offer education and advice to the whole of Medway on a continuous basis.

37

Appendix 3: Local audits 2013/14– Unplanned Care Local audit title Unplanned care Adult Rehabilitation (St Bartholomew’s Hospital): 15 Step Challenge Reaudit Adult Rehabilitation (St Bart’s Hospital): Review of Functional Ability in Relation to Length of Stay

Actions     

  

Dementia care team: Supporting People to Live Well with Dementia (NICE) MedOCC: Minor illness nurse –standards of care



Night nursing: Catheter care audit





 Stroke Services: An evaluation into the effectiveness and efficiency of running speech and language therapy groups

…leading the way in excellent healthcare

    

De-cluttering notice boards and patient dining areas Ensuring that equipment is out of the corridors Placing warning notices on uneven floors Ensuring that patient notes are secure Ensure full compliance with completion of Elderly Mobility Scale on admission and discharge to improve data collection.

Repeat in 4 months to review identify further improvement Ensure larger sample size – data to be collected over greater period of time (6 months) Review length of stay an EMS against different conditions: e.g. Falls (no injury), hip fractures, myocardial infarction, gastrointestinal surgery, etc.

There were no actions acquired from completion of this gap analysis.

The nurses who did not met standard had 1:1 meetings to discuss outcome of audit and were given targets for improvement and re audit completed within two weeks.

Ensure that any equipment that is identified as lacking by the night staff is either ordered by them or brought to the attention of the day team. Ensure that the night team routinely carry all basic equipment required for basic catheter care.

Access a supply of leaflets for any necessary distribution by the night team.

To identify sensitive and clear self-rating scales to evidence effectiveness.

Re–evaluate the goal setting process with patients To review length of time for group sessions to run To establish a more effective way of capturing feedback from patients and carers.

To develop group protocols for clinicians to follow for patients with communication difficulties.

Local audit title Stroke Services: Upper limb therapy group audit Stroke Services: Service evaluation - To follow national guidance by piloting a system of reviewing patients at 6 and 12 months post stroke and gathering data on the longer term needs after stroke Sunlight Surgery: Service evaluation - Practice nurse time management

Actions 

Re-audit with a more sensitive outcome measure within six months



To develop a business case to consider commissioning long term reviews and rereferral back into Stroke service



Nurses that they will book one appointment to log on, get ready etc, one at the end of the sessions to catch up.

Identified criteria for patients requiring longer than 15 minute appointments.



38

…leading the way in excellent healthcare Appendix 4: Local audits 2013/14– Independent Services Local audit title Independent Services Adult speech and language therapy: Dysphagia trained nurse audit

Actions   

Adult speech & language therapy: Evaluation of clinical supervision Children’s Therapy Service: Spasticity management in children

     

Clinical assessment service: Service evaluation Secondary Care referral outcomes to Medway Hospital Orthopaedic Department Darland House: Documentation of medicines management (CQC outcome 9) Health Visiting: Evaluating use of the Infant Feeding Antenatal Checklist, Breastfeeding Assessment Form, Breastfeeding Postnatal Checklist and Formula Feeding Postnatal Checklist by HV staff



    



Arrange for SWAN training dates targeting high pressure/high patient flow wards, such as AMU, CDU – targeting orthopaedic nurses Arrange for further SWAN training for wards with high incidences of dysphagia SLT team to arrange Dysphagia Trained Nurses training for stroke nurses and stroke bleep holders Facilitators to raise issue of how to improve sessions with supervisees.

Groups to be re-configured To record Gross Motor Function Classification System on all notes To identify on programmes whether low loading active stretching or low loading passive stretching.

To identify specific children who require muscle testing To liaise with paediatric consultants regarding management of spasticity in children with cerebral palsy.

No actions

Workshops to update all members of staff on requirements of recording on MAR charts.

Floor managers to monitor and support individual members of staff.

Monthly audits of MAR charts Peer review Staff identified as consistently not completing checklists will have a oneto-one discussion with specialist health visitor public health / team coordinator Re-audit of documentation relating to all babies born during April 2014 (audits to be completed in June 2014)

39

…leading the way in excellent healthcare

Local audit title Health Visiting: Evaluation of health visiting teams breastfeeding knowledge and skills

Actions   

Health Visiting: Evaluation of information provided to pregnant women and new mums by HV staff

 



MSK physiotherapy: Audit of physiotherapy use of EQ5D questionnaire (is a standardised instrument for use as a measure of health outcome).

 

 

Nutrition & Dietetics: Measuring waste of prescribed nutrition supplements Nutrition & Dietetics: Nutrition screening and goal setting

Results of the interviews to be discussed within teams Training planned to update knowledge and skills with update to follow if required Staff knowledge and skills interviews to be repeated to evaluate uptake of information and effectiveness of training methods

Training planned to update knowledge and skills with update to follow if required Pregnant women and new mum interviews to be repeated to re-evaluate their knowledge Develop a collaborative breastfeeding pathway through pregnancy, the early days post-delivery and through babyhood and childhood

Reminder on CHS to complete EQ5D Train booking team to complete EQ5D over the phone when patients call to say they no longer require physio Changes in routine of initial assessment so the questionnaire is first Improved awareness of need to use EQ5D



New food record charts to be implemented to facilitate consistent recording of supplements consumed



Audit of care planning and communication of screening results and care plans Check validation of palliative care nutrition assessment Decision on protocol for screening in community i.e. out-patient settings

 

Local audit title Nutrition and Dietetics: Patients on supplements monitoring audit

Nutrition and Dietetics: An Audit of Weighing Scales on Adult Wards at MFT

Actions  

 

 

 Nutrition & Dietetics: An Evaluation of the Knowledge of Care Home Staff on Enteral Feeding Tube and Site Care



Nutrition & Dietetics: A re-audit of current practice of swallow assessment and nutritional screening on an acute stroke ward



 



To re-train key staff on screening tool To work on a procedure for ward staff to communicate with dietitians for newly admitted patients on supplements and measurement of waste Re-audit A record of all weighing scales available and calibration dates to provide a reliable record of available equipment and calibration schedules and status Ideally all wards would have both hoist and seated weighing scales available.

Ward staff should be made aware of the importance of calibration of weighing scale equipment and ensure this is completed An audit should be carried out yearly at MFT to improve patient care on wards.

To offer all care homes with entrally fed patients attendance at training session provided by feed provider nutrition nurse To record training sessions and offer yearly refresher training To ensure all the questions within the questionnaire are addressed at the training by providing a copy of this report to our feed provider nutrition nurse Contact ward manager and arrange training on the importance of referring patients requiring tube feeding within 24hrs requiring modified consistency diets for more than 3 days and malnutrition screening Contact ward manager and discuss stroke pathway and raise awareness with ward staff

40

…leading the way in excellent healthcare Local audit title Occupational Therapy: Audit of Outcome Measures for Patients post Reconstructive Surgery (Elective and Trauma)

Occupational Therapy: Supervision audit

Palliative Care, Wisdom Hospice:

Actions  All therapists to write MTW on Disability of Arm, Shoulder and Hand (DASH) to aid separation of data.  All patients now to have the DASH as their outcome measure regardless if trauma or elective. Continue visual analogue scale with patients post Trapeziectomy in addition.  Patient Satisfaction Questionnaires to be repeated  All to ensure conditions clearly documented.  Therapists to ensure that when referring that have included DASH score or an instruction that it needs completing  Team leads to relay outcomes of the audit to all staff and identify the preferred method.  Team leads to confirm model at next team leads meeting.  Team leads to plan sessions with staff, ensuring that records of attendance, outcomes of discussion are kept, and that reflection is actively encouraged to support learning and development.  Re audit outcomes. 

  

Podiatry: Insole Quality Control audit

  

Local audit title

Actions

Family Nurse Partnership: Outcomes and short-term maternal and child health development indicators

Number of clients continuing to breastfeed at six weeks       

Team attend yearly updates Working with peer supporters and breastfeeding networks Utilising breastfeeding group drop-ins Sharing client stories with new clients Team yearly updates Liaising with stop smoking services Proactively planning with client in recognition of number of women nationally who resume smoking after stopping in pregnancy.

Tailored lockable drugs trolley to ensure selfmedication and controlled drugs (CD) can be stored together Ensure all equipment required is kept in the drugs trolley to reduce travel to the CD cupboard Review system for restocking drugs Consideration that a form of identification is visible to allow patient’s relatives/visitors/ nurses to recognise that nurses cannot be interrupted during drugs distribution Advise patients on suitable footwear prior to issue of device Advise laboratory staff to check device not wider than shoe shank to enable fit Stock of footwear catalogues ordered and held in clinic as example of suitable footwear

41