Quality account 2014-15

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Making a difference

Quality account

Annual review 2012-2013

2014/15 ...you do listen well, show respect and make the patient feel important and not rushed. ‌everything dealt with speedily and professionally.

Excellent.

I went from indescribable pain that reduced me to tears back to normal within 10 minutes of arriving.

Fantastic.

Medway Community Healthcare CIC providing services on behalf of the NHS Registered office: MCH House, Bailey Drive, Gillingham, Kent ME8 0PZ Tel: 01634 337593 Registered in England and Wales, Company number: 07275637

www.medwaycommunityhealthcare.nhs.uk Working with us

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Quality Account 2014/15

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Contents Part one: Statement of quality

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Part two: Looking forward

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Part three: Looking back

7

Goals agreed with commissioners

13

What others say about MCH

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Part four: Review of quality performance

18

Quality across our services

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Achievement against our quality priorities for 2014/15

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Statements from Healthwatch and CCG

32

How to provide feedback on this account

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Appendix 1

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Quality Account 2014/15

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Part one: Statement of quality Each year any organisation that is funded from NHS money to provide healthcare must produce a report which clearly outlines the quality of their services. These are known as their Quality Accounts. The Department of Health instructs us on what should be included in this Quality Account, which is a review of what is working well and where there is room for improvement now or in the future. As this is our fifth Quality Account we are able to build upon and demonstrate our continuous improvement and show our commitment to delivering high quality, people centred services.

This year we reviewed our management structure and governance framework so that our Board of executive and non-executive directors is more assured than ever about the quality of services we provide. The Board examines more information about people’s experience of care as well as the quality and safety of our services.

We invest a lot of time and effort in proactively monitoring and assessing the quality of care we provide. The last twelve months has seen the introduction of our GAINing Insights programme: our model of Care Quality Commission (CQC) inspections; GAINing Perspective: a root cause analysis process that involves the whole team to review when a patient safety incident has happened; and Schwartz Rounds, a supportive, facilitated session that allows our staff to reflect on the emotional aspects of their work.

People who use our services continue to tell us that their experience of care is good or very good (96%) and 87% our staff would recommend MCH as a place to receive care.

However we know we have further improvements to make in some areas, particularly relating to waiting times in some services; and a CQC inspection at Darland House in August rated us as requiring improvement in two areas, both of which are being addressed.

We have carefully considered the findings of the Francis reports, including the Freedom to speak up review, published in February. We have since strengthened our work to make sure people in our care and their families continue to receive safe, compassionate care and both staff and those in our care feel able to tell us if they have concerns. We have assessed our compliance and put in place actions to ensure the recommendations of the Savile Inquiry and the new CQC regulations are fully implemented.

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Ensuring the care we provide for the people who use our services is central to everything we do at Medway Community Healthcare (MCH). It is thanks to the professionalism, expertise and commitment of our staff that we are able to provide our high quality services.

We see partnership as key to quality: partnership with people who use our services, our staff, other providers of health and social care, our commissioners and the community as a whole.

This requires effective communication, openness and honesty. We are committed to ensuring that as an organisation we will always learn and never become complacent about our care provision.

We, the Board of MCH, on behalf of all our staff, commit ourselves to continuing to deliver high quality 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. Our thanks go to all of our stakeholders: those who have supported the production of our priorities for the next year and to those who have given statements with regard to this Account.

Martin Riley Managing director

Quality Account 2014/15

Peter Horn Chair

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Part two: Looking forward In this part of our accounts we describe the areas for improvement over the next year in relation to the quality of our services and how we intend to achieve these priorities.

As in previous years, these quality priorities are a major contribution to our aims of providing safe, effective, personalised and innovative care to the communities we serve.

Priorities for improvement 2015/16 Understanding what is important to our stakeholders is a key objective of our organisation; consulting on our priorities for improvement gives us the opportunity to ask for input on what is important to them. Our priorities have been selected through a consultation process with our community forum, staff and commissioners led by the Clinical Quality Assurance Group.

Consultation on the priorities for 2015/16 started with a review of last year’s performance on the priorities. The seven priorities were classified as recommended to continue or not, depending on whether practice required further improvement or not. We reviewed feedback, complaints and enquiries from people using our services, as well as commissioning intentions and other national and local priorities. From this we identified a list of draft priorities that was presented to our Clinical Quality Assurance Group in December and subsequently circulated to key stakeholders for them to vote for their top priority in each category.

People using services, staff, our community forum and Medway CCG were given the opportunity to vote on our website. All the responses were collated and from this we determined seven priorities for improvement, many of which continue on the work in previous years (see page 28 Achievement against our Quality Priorities 2014/15)

1. Patient safety: 

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 our premises  compliance with MRSA screening in St Bartholomew’s Hospital.  reported C difficile infection or MRSA bacteraemia 

Continue to focus on reducing avoidable pressure ulcers, as well as promoting prevention by enabling patients and carers to understand what they can do.

How will we measure?  Working with Medway Foundation Trust, Medway clinical commissioning group (CCG) and other providers to develop and deliver an action plan.  Measure incidence of avoidable pressure ulcers through quarterly reports

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2. Clinical effectiveness: 

Support patients with long term conditions, encouraging self-care and reducing acute hospital admissions through the integrated discharge team and case management.

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

3. Patient experience: 

Continue to work to reduce waiting times and appointment cancellations in services where there are challenges  Through monthly service performance indicators identify key services and monitor progress against achievement of improvement plans



Through the roll out of My Plan on Community Health System (electronic patient record) provide a shared plan designed to support the co-ordination of care, provide a framework for capturing patient goals, evidence effective practice and facilitate measurement of the outcomes of care.

How will we measure?  Using the community IT system monitor the use of My Plan

4. Quality governance 

Continue to seek the views of our staff through our engagement programme, to ensure they are supported in delivering high quality care; increase numbers of staff recommending MCH as a place to receive care.

How will we measure?  Through staff response to the Friends and Family test 

Through GAIN (Governance Assurance Information Network) enable systematic implementation of lessons learnt arising from complaints and incidents.

How will we measure?  Attendance compliance at GAIN

As a carer, I felt that they listened to me and took my needs into consideration. I was treated with utmost care and consideration in really difficult situations. There was very prompt action when we needed it. They always returned phone calls and phoned to check on the home situation. They provided an immediate response at a time of difficulty.

Quality Account 2014/15

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Part three: Looking back Assuring quality in our services During 2014/15 MCH provided and/ or sub-contracted 48 NHS services within the following business units:  Planned  Unplanned  Independent The income generated by the NHS services reviewed in 2014/15 represents 100% per cent of the total income generated from the provision of NHS services by MCH for 2014/15.

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 individual service level.

The monthly dashboards of performance are reviewed and analysed at the business unit meetings ensuring that in month and year to date activity is monitored, along with associated trends both retrospectively and forward looking. The business unit meetings have both executive and non-executive representation to ensure Board level involvement.

The monthly data collected comprises key indicators across the four cornerstones of performance:  clinical quality and outcomes  patient activity  financial health  organisational health ( our workforce) Additional reporting of complaints, incidents, contractual performance and quality measures are included as part of this review, to triangulate performance information and show the impact on different elements of the service.

In addition to the monthly business unit meetings, MCH has two key higher-level groups that oversee service delivery and clinical quality. The Performance Oversight Group and Clinical Quality Assurance Group meet quarterly to identify trends of strong and weak performance.

When key issues are identified in services, a ‘deepdive’ comprehensive review is undertaken. These investigations will, where appropriate, include peer review and support. Service managers and their teams then report on resulting action plans to the executive team and Clinical Quality Assurance group.

This year we also introduced the ‘GAINing Insights programme’ an internal inspection based on the Care

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Quality Commission model of inspection. We developed our own programme following the CQC new model of inspection, using a team of inspectors, comprising executive and non-executive directors, local commissioners, clinical experts, and experts by experience (people who use our services). During the last financial year we inspected 5 of our services and rated them using the CQC rating system. All 5 services produced improvement action plans (even those that achieved a good or outstanding) to ensure they continue to improve or maintain the quality of care they provide.

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). Quality performance indicators and CQUINs are monitored through the clinical quality review meeting.

Participation in clinical audit National audit During 2014/15 five national clinical audits and no national confidential enquiries covered NHS services that MCH provides.

During that period MCH participated in 100% of the national clinical audits and national confidential enquiries which it was eligible to participate in.

The national clinical audits and national confidential enquiries that MCH was eligible to participate in during 2014/15 are as follows:

    

HTM01-05 Decontamination in Dental Services Chronic Obstructive Pulmonary Disease 2013 Audit (data collection January 2015) Patient-Led Assessment of Care Environment Audit Sentinel Stroke National Audit Programme (SSNAP) and SINAP National Audit of Intermediate Care 2014

The national clinical audits and national confidential enquiries that MCH participated in, and for which data collection was completed during 2013/14 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 title No. of cases submitted National Audit of 3 sites audited Intermediate Care 2013 HTM01-05 Decontamination 14 sites audited in Dental Services Patient-Led Assessment of 3 sites audited Care Environment Audit Sentinel Stroke National 253 Audit Programme (SSNAP) and SINAP

Quality Account 2014/15

% N/A N/A N/A 100%

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Chronic Obstructive Pulmonary Disease 2013 Audit (data collection January 2015) Child Health Programme

N/A

N/A

N/A

N/A

The reports of 3 national clinical audits were reviewed by the provider in 2012-13 and Medway Community Healthcare intends to take the following actions to improve the quality of healthcare provided:   

National Audit of Intermediate Care HTM01-05 Decontamination in Dental Services National Sentinel Stroke audit and SINAP (Stroke Improvement National Audit Programme)

There are no MCH actions for the NAIC audit; this has been used as part of a health economy intermediate care review, the outcome of which has yet to be defined.

National audit title HTM01-05 Decontamination in Dental Services

National Sentinel Stroke audit and SINAP

Actions Refurbishment works have taken place in West Kent & Medway sites Meetings between Medway Commissioning and West Kent Estates Commissioning are taking place to discuss issues.

Internal Dental Decontamination & Environment Group has been set up to discuss issues and plan works.

Review of the joint hyper acute pathway Improvement in ‘door to needle time’ with the development of a thrombolysis treatment room, providing specialist care.

Guidance for use across the hospital to ensure best possible care for stroke patients.

NICE guidance In 2014/15 we measured compliance of our services with best practice guidance issued by the National Institute for Health & Clinical Excellence (NICE).

NICE is an independent organisation that issues guidance based on evidence from medical research. The guidelines refer to nationally agreed best practice for the management of conditions and provide robust standards for us to use when we are planning how to deliver the most effective care to people.

Our system of disseminating and monitoring NICE guidance throughout our organisation ensures we can demonstrate compliance and address areas for improvement.

We reviewed all the NICE guidance that was relevant to our services and initiated improvements where necessary to bring our practice in line with the latest guidance.

Just carry on with the way you do things and I am sure that Through 2015/16 we hope to work more closely with our most patients will be as pleased commissioners to fully understand their response to as I was. It was the first time I NICE Guidance and how it will apply to our local have had to use any care population. services and I was very impressed with what I received.

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NICE guidance title CG179 Pressure ulcers

Improvements 2014-15 Update to policy and training.

CG187 Acute heart failure



QS61 Infection prevention and control QS79 Idiopathic pulmonary fibrosis TA317 Prasugrel with percutaneous coronary intervention for treating acute coronary syndromes TA327 Dabigatran etexilate for the treatment and secondary prevention of deep vein thrombosis and/or pulmonary embolism SC1 Managing medicines in care homes

Continue to triage referrals to ensure most at risk are seen within 2 weeks.  Work with GPs to reduce the numbers of follow ups to allow more new s to be seen.  Work with commissioners to increase capacity of the team.  Work with hospital colleagues to improve planning.  Catheter data information set up on CHS  IV therapy policy in place  Patient information leaflets for Enteral feeding available.  Implementation plan in place to work towards commissioning a new service for this.

Fully implemented.

Fully implemented

 Development of a competency assessment programme.  Introduction a pharmacist to doctors’ rounds.  Improvement in documentation – discharge summary and care plan.

Local audit 2014/15 The reports of 60 local clinical audits were reviewed by MCH in 2014/15 and we identified the following actions to improve the quality of healthcare provided see tables at Appendix 1.

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.

Details of these can be found at the end of this Quality Account, Appendix 1.

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Participation in research Research is a core part of our service delivery; it enables us to improve the current and future health of the people receiving care and support. We work closely with the International Healthcare Alliance, Kent, Surrey and Sussex Clinical Research Network and Allied Health Science Network, as well as our three local universities to support and promote research.

We had nearly 50 clinical staff participating in research approved by a research ethics committee in MCH during 2014/15. In the last three years, we are not aware of any publications that have resulted from our involvement in National Institute of Health research.

Our engagement with clinical research also demonstrates our commitment to testing and offering the latest treatments and techniques.

During 2014/15 we participated in a range of research studies across our services.

Much clinical research within healthcare comes under the National Institute of Health Research (NIHR) portfolio studies. During 2014/15 we engaged with a small number of NIHR portfolio studies either at a ‘setting up’ stage, recruitment and participation phase or through sharing the results once the analysis and final reports have been completed. The following are examples of these: 

Cancer Diagnosis in the Acute Setting (CoDIAS) - This is a study of people diagnosed with lung or colorectal cancer who present for the first time as an emergency.



Schwartz Rounds – These are opportunities for clinicians to speak openly about the emotional experience of care, in a supportive and non-judgemental setting. Participating organisations like us are studying the mechanisms which affect the uptake and successful implementation of Schwartz Centre Rounds, and determine their impact on individual staff well-being, the culture of teams and on the wider organisation.



Evaluation of Physiotherapist and Podiatrist Independent Prescribing – A study comparing services provided by physiotherapists and podiatrists who are qualified to prescribe (PPIP) versus those who are not qualified to prescribe



Non-specific Mechanisms in Orthodox and Complementary and Alternative Medicines management of back pain (MOCAM) – investigating multiple non-specific components in three treatments and relating them to pain theories



Clinical relevance of Microbleeds in stroke (CROMIS-2) - a study looking into their clinical relevance



Triple Antiplatelets for Reducing Dependency after Ischaemic Stroke (TARDIS) - a study looking at testing a new 3-drug combination for stroke treatment



The Brief Memory and Executive Test (BMET) - a screening tool for identifying cognitive impairment in small vessel disease

Additionally MCH has engaged with research studies not listed within the NIHR portfolio. These include commercial (industry-led) studies and post-graduate research studies undertaken within academic programmes. For example:

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

King’s Fund study of quality in community services, We completed an on-line questionnaire and staff were interviewed. The final report has been published in Managing quality in community health services in December 2014, and staff attended a conference in March 2015.



Brain Stroke Pod: to improve the quality of care for strokes and to support the clinical management delivered by the therapist. The secondary outcome is to empower the individual and their carer in understanding their treatment and recovery from stroke.



What attributes of a holistic approach to the care of elderly people with dementia are used in practice to manage challenging behaviours? – looking at staff perspectives and the care environment



An observational study of the frequency of oral symptoms in people with advanced cancer (OASis1) - to determine the prevalence of a range of oral symptoms in people with advanced cancer, and to use this information to develop / validate an oral assessment tool



Organisational Equity Cultures in Public and Hybrid Organisations – to ascertain whether public healthcare organisations like the NHS have cultures and working practices that are as supportive of equity as hybrid healthcare organisations like social enterprises.

I can be a good mum with the help I got from my health visitor.

Very helpful and understanding and very nice people to work with.

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Goals agreed with commissioners Use of the CQUIN payment framework A proportion of our income in 2014/15 was conditional on achieving quality improvement and innovation goals agreed between MCH and the commissioners we entered into a contract, agreement or arrangement with for the provision of NHS services, through the Commissioning for Quality and Innovation payment framework.

The CQUIN payment framework ensures ‘quality’ is the organising principle of NHS services, by embedding it at the heart of commissioner–provider discussions. Local quality improvement priorities are discussed and agreed at board level within – and between – organisations. CQUIN monies are only paid to MCH upon the achievement of the following locally agreed quality and innovation goals (2.5% 2014/15).

1a 1b 1c 2a

2b

3a

3b

3c

3d 3e 3f 3g

Indicator Implementation of the staff Friends and Family Test Implementation of the Friends and Family test for people using services Phased extension of Friends and Family test across all services NHS Safety Thermometer 25% reduction from baseline pressure ulcer prevalence. No more than 10 incidences in each of the 5 consecutive months up to 31st March 2015 NHS Safety Thermometer Community Pressure Ulcer Project Achievement of a quarterly milestone plan Braden Risk Assessment Pressure Ulcer Prevention/Treatment Quality Review Audit.

Malnutrition Universal Screening Tool & St Christopher's Nutritional Assessment Quality Review Audit.

Transition End of life Agreed process and implement pathway Therapy Support Increase in referrals from 13/14 baseline Weekend Working St Bart’s contacts at weekend Weekend Working Occupational Therapy contacts at weekend Weekend Working Contacts

Outcome Achieved Achieved Achieved Achieved

Achieved

Achieved

Achieved

Achieved

Achieved Achieved Achieved Achieved

Achieving all our CQUINS shows that we are actively engaged in quality improvements with commissioners, some of which improve patient pathways even beyond the boundaries of our own organisation. We are eager to agree robust quality improvement goals because we are committed to quality improvement in local health services across the local health economy.

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Our response to the Francis and other healthcare reports The Board of MCH has given very careful consideration to the report by Sir Robert Francis into the serious failings of Mid Staffordshire NHS Foundation Trust and the Government’s response: Patient’s First and Foremost.

As an organisation we are committed to providing services that all of us would be happy to receive ourselves or for those we care for – services with compassion, kindness, dignity and respect. We are working closely with our partners to ensure we learn from failings elsewhere and make sure that such failings do not occur within MCH. We have worked closely with the North Kent Clinical Commissioning Groups to understand Francis and take forward the necessary actions.

By reviewing the findings through a dedicated working group we assessed the reports in the context of our services and established a comprehensive work programme with defined timescales to ensure appropriate implementation and oversight of compliance. This has been scrutinised over the last two years to assure all those who use our services receive the best quality and experience possible.

We are working to ensure we are fully compliant with the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Freedom to Speak Up review and the Savile Enquiry to ensure people we provide care for are kept safe, staff feel able to raise concerns as soon as possible, we apply the Duty of Candour effectively and our Board are appointed utilising the requirements of the Fit and Proper Person’s Test.

What others say about MCH Statements from the CQC MCH is currently registered with the Care Quality Commission with no conditions. The Care Quality Commission has not taken enforcement action against MCH. We were inspected twice during 2014/15 under the new inspection model; the CQC visited Darland House in August 2014 and MedOCC in December 2014.

We are still awaiting the final report for MedOCC however the draft version received in early June rates the service as Good. In March we received the report for Darland; this rated the service as requiring improvement. Two areas for action were identified and plans are now in place to address these: 



Some staff had not been recruited safely because the registered manager could not demonstrate that full employment history or background checks had been made on staff.

All staff files are now being reviewed to ensure gaps in employment history are identified and filled.

Nursing staff were not able to demonstrate they could deal with emergencies such as choking or bleeding. Staff have been tested for their competency to deal with emergency situations and are all compliant.

Despite these areas for improvement the CQC were very complimentary in their observations of care at Darland:

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‘We observed that people were safe and well cared for. Relatives told us that they felt their family members were cared for safely at the home and were satisfied with the care people received. None of the people we talked with had concerns about safety.’

‘People were protected from discrimination which could cause emotional harm. On admission people or their relatives had been supported to express their lifestyle choices. For example what their spiritual and religious needs were. Staff we talked with had a good understanding of equality and non-discriminatory practices’.

“Everyone is friendly”. Other people said, “I have total confidence my relative is cared for well” and “I have nothing but praise for the staff here, they are totally professional”. All the relatives we spoke with told us how caring the staff were. One said “Staff are all excellent here, they know people so well”. Relatives believed that their loved ones were well looked after all of the time. Some relatives told us that their experience of care at this home was much better than they had experienced in other places.’

Awards North Kent CCGs: Mainstreaming Francis Event MCH won the Improving the Culture of Care award for our focus on values and improving the culture within the organisation.

Health Education Kent, Surrey and Sussex apprenticeship awards this month Two of our staff were successful in the advanced clinical category for going above and beyond expectations and being a role model for others. Shauna McFarlane, physiotherapy assistant apprentice, was named runner-up and Leah Haines, respiratory assistant, the category winner.

Leah was previously an apprentice respiratory assistant having chosen this as the best way to gain the experience and skills required for a healthcare role.

At the same event MCH was awarded Apprenticeship Employer of the Year, celebrating our apprenticeship model and the support we give our apprentices.

Kent, Surrey and Sussex Leadership Recognition Awards 2014 Anjie Roots, health visitor, was awarded NHS Innovator of the Year. The award recognised the success of Anjie and her colleagues in developing a programme of post natal groups in the 19 Children’s Centres across Medway ensuring that every new parent receives the same information wherever they live. The team work with families in areas of deprivation and communities with a high migrant population, with 63 nationalities, and where 49 languages are spoken supporting parents to help them give their babies the best start in life.

Heidi Shute, our corporate director, was a runner-up in the NHS Leader of Inclusivity of the Year category.

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Children and Young People Now Awards 2014 Claire Robson, youth offending team health manager, and our children’s speech and language therapists have also had their collaborative work with the Medway youth offending team, recognised with a highly commended in the Youth Justice category.

UK Social Enterprise Awards 2014 Although not a winner, we succeeded in being shortlisted for two national commendations in the Health & Social Care Award and Investment of the Year categories, which celebrate the work taking place within social enterprises across the UK. Our professionalism and commitment to delivering innovative high quality care and support to local people has been recognised regionally and nationally.

Data quality Perfect. I arrived 2 hours early to see the nurse. I was booked in and seen to very quickly. I was impressed with reception, but very impressed with the nurse. I'd like to thank everyone at the Sunlight Centre for their professionalism.

MCH will be taking the following actions to improve data quality With the introduction of the electronic patient record and the 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 electronic patient record.

The availability of other electronic tools such as these has helped clinical services become better able to maintain local data quality standards and reduce the dependence on central data quality processes.

The last of our services are now live on CHS, reducing the need to enter data in more than one system. We are now able to configure our system to meet the needs of our individual services, giving us a better quality clinical record that is not only more complete but also readily available for audit centrally.

Areas for development Multi-disciplinary groups of clinical and information technology staff identify areas for investigation and development. They have simplified data entry and improved workflow, making data quality easier to maintain by those entering data. Patient record level reports are regularly published and scrutinised by 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

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Information governance toolkit attainment levels The MCH Information Governance Assessment Report overall score for 2014/15 was 98% and was graded green.

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. MCH scored 100% in this area. To provide assurance to the Board of the quality of our records, an annual audit of patient records is carried out. This checks twelve areas: that the notes are jargon free, that where appropriate, consent to share has been obtained and that all entries to the record are made at the time of reviewing the patient. A total of 1173 records were checked and an overall organisation score of 80% was achieved for compliance. Action plans are in place to improve this score and ensure compliance.

NHS number and general medical practice code validity MCH submitted records during 2014/15 to the Secondary Uses service for inclusion in the Hospital Episode Statistics which are included in the latest published data. The percentage of records in the published data which included the person’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.

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Part four: Review of quality performance MCH was awarded the ‘Improving the culture of care’ award at the Francis event in January 2015 from North Kent CCG because of the introduction of the following: GAIN – Governance assurance information network This network is run 4 times a year and provides our clinical leaders with a forum to share good practice and discuss areas that require improvement. This has now achieved 100% attendance from our clinical services which provides assurance and also an increased level of engagement by our teams to ensure high quality care is a priority to all services and that information is being shared. We have identified this Network as one of our Quality Priorities for 2015/16 to ensure we share lessons, celebrate good practice and enable staff to raise concerns.

GAINing insights We developed our own internal mock CQC inspections called GAINing Insights. These follow the CQC new model of inspection and are facilitated using a team of inspectors, which includes executive and non-executive directors, local commissioners, clinical experts, and experts by experience (people who use our services). During the last financial year we inspected 5 of our services and rated them using the CQC rating system. All 5 services produced improvement action plans (even those that achieved a good or outstanding) to ensure they continue to improve or maintain the quality of care they provide.

GAINing perspective The principle of gaining perspective is a fresh, modern way of investigating a serious issue or complaint with a staff centred approach. The staff lead the investigation and identify areas for improvement as well as excellent practice. They work as a team creating their own timeline of events and identify throughout the session what could or should have been done. They identify improvements in their own teams and develop their own action plan. Staff describe feeling empowered by using this method and take more ownership of the action plan that they have created. The results and actions are shared across the organisation at GAIN. Schwartz Rounds From December 2014 we started running Schwartz Centre Rounds, a forum where we discuss the emotional and social dilemmas that arise in caring for people. The Rounds aim to promote understanding about how an issue may have different emotional effects on individuals, colleagues and teams, encouraging more compassionate care. The Rounds build on the discussions we had in the Listening Events we held in 2012/13, in response to the Francis Report. Staff have the opportunity to share their experiences and feelings on range of thoughtprovoking topics, discussing how they might affect them.

Schwartz Rounds take place every other month for an hour. Each Round focuses on a different theme. It doesn’t aim to solve problems but to be a forum for discussion, reflection, learning and deeper connection with colleagues. All staff clinical and non-clinical are invited to attend.

Staff comments after Schwartz Rounds have included: “Well done it’s great to see us looking outside the box in terms of support for staff and colleagues” “Very relevant and thought provoking. I feel closer, especially to the panellists, by hearing their stories and feel it will help build working relationships with them”.

“Very brave panellists! Thought provoking. Very useful to have a chance to express emotions that we normally try to hide as we maintain professionalism”

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“Very useful to see how others cope with feelings in their day to day work. Makes me feel more human. I always feel I have to put on a professional front when I just want to show my human side too”.

“Poignant, outstanding, humbling. Tissues need to be provided as well as refreshments.

Epiphany” “It shows the inherent tension that clinicians grapple with in being passionate about service delivery whilst seeking to be professional”.

Our values and pledges Each service has developed and this year reviewed their own pledges which are based on the NICE Quality Standards for patient experience, patient charter and delivering same sex accommodation and are aligned to our organisational values. Teams developed a poster or leaflet with their pledge, which is signed by each member of staff to present a united agreement.

In many teams this forms the basis for all aspects of their work with people using the service and their staff, eg surveys, recruitment, performance appraisal.

Great experience, looking forward to next visit.

Thorough, friendly, personal service. ......honest service, no waiting around.

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Quality across our Services Musculosketetal physiotherapy MCH were successful in being awarded AQP (any qualified provider) status for Musculoskeletal Physiotherapy in September 2014, meaning patients can choose our service from a range of providers. The new service went live on 1st December 2014. The team reviewed all pathways to ensure that there was a seamless transition for people accessing the service as well as staff.

MCH is the preferred provider of choice for patients, GPs and consultants. Waiting times have now been reduced to an average of two weeks.

The new contract also supported and facilitated the further development of pelvic health physiotherapy. Three members of staff have completed accredited training programmes to provide enhanced assessment and rehabilitation for women and men with continence issues.

Additionally all senior physiotherapists are trained to provide specialist acupuncture and to undertake telephone triage to ensure patients are allocated to the most appropriate clinician in a clinically appropriate timescale.

In 2013 physiotherapists were given independent prescribing rights. MCH was proud to have one of the first physiotherapists in the country to qualify as an independent prescriber in the country. Since then a further three physiotherapists across Musculoskeletal Physiotherapy and the Clinical Assessment Service have qualified and three more are on the pathway. All should be qualified by 2016/17. This enhances a one stop shop approach, supports prescribing for management of chronic pain and reduces referral and appointments in both primary and secondary care for initiation of medication and medication reviews.

An additional diagnostic ultrasound machine was purchased to provide more equitable access for patients across Medway and Swale as two additional Orthopaedic Practitioners (Physiotherapist and Podiatrist) completed their training. This development saves time for people accessing care by reducing referrals to secondary care for diagnostics. It also enables more complex injection therapy to be offered in the clinic setting, improving outcomes and enhancing the user experience.

Nutrition & dietetics The team were given national recognition by the British Dietetics Association for their work on standardisation of patient note format. They were cited as an example of best practice and their approach is being adopted by other dietetics services across the country.

Podiatry One of our podiatrists was recognised through our internal staff award scheme for a poster they developed for staff at Medway Foundation Trust. This was used as a visual tool relating to wounds to help staff be certain when to refer to podiatry.

Speech and language therapy We have started a six-month pilot to provide first line advice and telephone assessment to people waiting for treatment. This has proved popular with people who find it difficult to attend clinic. It is expected that this will impact waiting times.

Quality Account 2014/15

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Health visiting Our health visiting service has had a challenging year and has not seen as many children and families as we would expect. The team have modernised the way they work and made significant performance improvements. Health visitor numbers in Medway have increased from 41 in 2011 to 70 this year, just short of our target of 78 set as part of the Prime Minister’s Challenge. We continue to recruit new health visitors and support the training of students.

We are working closely with other colleagues in Medway, particularly children’s centres, to improve the outcomes for families and children. Our Family Nurse Partnership provides intensive support to teenage parents and continues to improve the health and life outcomes for the children and young people they see.

Children’s therapy The children’s therapy team have redesigned their service so that all children are placed on a package of care with an agreed number of contacts. This has been used by both Medway and Swale commissioners to fund extra resources for the team.

In addition, over half of Medway schools already commission enhanced speech and language therapy services from us and this MCH+ service is growing all the time.

MedOCC Paramedic Practitioners from South East Coast Ambulance Service were funded to work at our MedOCC @ Medway Hospital base from 12 noon to midnight, seven days a week over winter.

This meant that paramedics were able to bring more patients directly to the service, alleviating pressure on A&E. This helped Medway Foundation Trust come closer to meeting their four hour wait target and furthered partnership working between our organisations.

Dementia Support team Our team participated in four schemes over the winter period to reduce the number of dementia patients accessing A&E. We worked in conjunction with wards and A&E at Medway Hospital to facilitate early discharge and prevent hospital admission.

We continued the Carer’s first initiative, placing coordinators within the discharge teams to enable early identification of carers and providing them with much needed advice, guidance and emotional support.

We worked with Crossroads to provide urgent care input for up to 72hours to help manage community based crisis. We helped with personal care, night sitting and respite sits.

Finally, we worked in partnership with the mental health provider in a joint initiative deploying the Newcastle model of care into care homes to manage people with escalating challenging behaviour secondary to their dementia. As a result, we have been nominated for a Kent and Medway Partnership Trust excellence award for partnership working.

Dementia support services have tested a range of products designed by Active Minds for helping engage people with dementia in therapeutic activity. Tools included aqua paints, reminiscence cards and customised jigsaw puzzles.

Quality Account 2014/15

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Anticoagulation therapy We secured funding from the charity Medway Cares to purchase self-testing equipment for people on Warfarin. Self-testing enables people to have greater involvement in managing their own health. It helps patients become more aware of how their lifestyle choices affect their blood levels and where they fall in the therapeutic range. The self-test machines are especially beneficial for patients who cannot get to a clinic as a result of mobility problems. When people have their own meter they can test at any time of the day. Since loaning these devices to patients, we have seen a reduction in home visits and an increase in therapeutic target ranges.

The service is now prescribing the new oral anticoagulant Rivaroxaban instead of Warfarin for suitable patients on the DVT pathway, as per the NICE guidance. This makes life easier for people, with fewer side effects and avoids the need for numerous blood tests.

Medication clinic The medication clinic at MedOCC was originally set up to enable people able to attend clinic to receive their injectable medication at a set appointment rather than wait for a community nurse to visit them at home. It is also an ideal learning environment that ensures consistent standards of clinical practice. The clinic enables one community nurse to see more people in one place rather than travel across Medway, improving efficiency and more appropriate use of resources.

Feedback from people using the service have told us they like the service as they know what time they will be seen. The service also enables people to be discharged earlier from hospital and receive their medication safely. We hope to develop this partnership further during the course of the 2015/16, with the medication clinic providing opportunities for our nurses to develop their cannulation skills.

Sunlight The Minor Illness Nurse clinic is a popular choice for people needing same day appointments. It has developed our nurses' skills and left GPs free to see more people.

Diabetes In line with national best practice in diabetes care and maximising on the benefits of integrated working, the diabetes specialist nurses, dietitians, and podiatrists, have been integrated into a community diabetes cervice providing a coordinated approach to the tier 2 and 3 (community elements) of the Medway diabetes model. This model creates a team centred around an individual’s needs and enables professionals to have a high level of clinical debate and supervision, ensuring best practice and evidence based care is provided. The team are able to work together and in partnership with commissioners and other providers to strengthen care pathways and be more responsive in service provision.

Care home team Working together with local commissioners, health and social care providers, MCH has successfully developed and implemented a care home team providing clinical support, advice and education to nursing homes within Medway. The team comprises advanced nurse practitioners, a pharmacist, end of life facilitators and a geriatrician providing a responsive and proactive service to the homes. We aim to improve the quality of care for residents and reduce attendances at accident and emergency. We enable residents in care homes to have access to the same services as people living in their own homes.

Quality Account 2014/15

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Multidisciplinary team model Patients are often cared for by more than one of our services so we are able to share information and coordinate care effectively. In 2014/15 we developed an innovative approach to personalised care for people with long term conditions and/or frailty. We take part in a multidisciplinary forum of health and social care professionals to think, discuss and jointly plan the best way to support people with complex conditions and situations. By working together, we have taken a holistic approach to patient care, which has reduced A&E attendances and hospital admissions and empowered service users.

Working with our community Staff have promoted the health and well-being of the population of Medway by raising public awareness and providing information on a wide range of health conditions. The adult nutrition and dietetics and speech and language therapists hosted a stand to promote nutrition and hydration week. Wisdom Hospice staff promoted Dying Matters week. Two dietitians ran 10km to support mouth cancer care. Two senior managers support act as ‘Medway Champions’, working with the local authority public health team to embed the agenda in MCH. The community equipment loan service helped the 41st Medway Beavers to obtain their disability awareness badge. The children's therapy team worked with the Kent Downs Syndrome group to promote themselves in preparation for a celebration held in March 2015.

We opened a new gymnasium at the Wisdom Hospice to promote independence for our patients and to enable rehabilitation.

The Princes Trust worked in collaboration with staff at Darland House, to improve the outside facilities and garden for the benefit of our residents.

Customer experience and feedback New national guidance from NHS England states that from January 2015 we need to offer all people that use our services the Friends and Family test at any point of their care. This is a simple question that asks how likely they would be to recommend the service to friends and family if they required treatment or care, with a comments box to explain the reason for their answer.

Between April 2014 and March 2015 we had responses from 4686 people, 95% said they would recommend only 2% said they wouldn’t. The remaining 3% didn’t know or were neither likely nor unlikely to recommend. This is a 2% improvement on last year in the patients recommending our services.

% would recommend % would not recommend

Quality Account 2014/15

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The Friends and Family score is now reported nationally on a monthly basis; this enables us to identify targets to improve the experience of people using our services. The table below shows our monthly score for February and March 2015 compared to the national average and the average of other similar independent providers of NHS care.

% recommend % not recommend

MCH Feb 15

MCH Mar 15

National Average (March)

NHS provider s– Highest (March)

NHS provider s– Lowest (March)

Indepen dent average (March)

Indepen dent highest

Indepen dent lowest

96%

96%

95%

100%

86%

95%

100%

90%

1%

2%

1%

6%

0%

1%

0%

4%

Complaints We want everyone to have the best possible experience in our care and patient feedback is crucial to us. We actively encourage people to share their comments, compliments, concerns and complaints, through our Tell Us leaflet and our website. This year, we interviewed and videoed patients who wanted to share their experiences with us. Since January 2015 the views of over 30 people have been captured on video and used in training, team events and Board meetings.

During 2014/15 we made 906,488 individual contacts, some for the first time and some for follow up appointments in a variety of community settings. Over that time we received 91 written complaints, 133 verbal complaints and 37 non-lead joint formal complaints (a complaint involving more than one provider of NHS services); that is a ratio of one complaint for nearly every 3500 contacts. Three complaints were passed to the Health Service Ombudsman at the request of the complainant, however none were upheld.

During 2014/2015 we audited our written complaint response times against our service level agreement of 25 working days; the audit identified that we were only 27% compliant. As a result we have changed the process for dealing with written complaints; the customer care co-ordinator now drafts Prompt service. I was given a the response after receiving comments from the service. solution for my personal need, This has significantly reduced our response time and which was simple but very since November 2014 we have been 100% compliant effective - innersoles. Good, with our target of 25 days. This ensures complaints are clear explanations. Prompt dealt with in a timely way, hopefully reducing the appointments. Ease of making distress experienced by the complainant. appointments.

Our patients often comment on access to services and waiting times. We recognise that we have some services where the waiting times are longer than is reasonable and improving this is a priority for the coming year.

Sometimes patients cannot access a service because they don’t meet the eligibility criteria agreed with commissioners and sometimes this can be disappointing.

Quality Account 2014/15

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Complaints, surveys and other patient feedback point to a need for improvement in our larger services such as the out of hours GP practice, Sunlight GP surgery, podiatry and musculoskeletal physiotherapy. The main themes within these services are around managing our service user’s expectations and communication particularly around waiting times for appointments and changes to services.

In response to patient feedback we have:      

Improved the way we allocate referrals to ensure they receive the most appropriate and timely treatment.

Changed the way appointment times are allocated within our out of hours GP service Provided improved information on the treatments and self-management of conditions Improved information available within the waiting rooms Increased the way people can provide us with feedback, e.g. kiosks in clinic areas, postcards, intranet page, email, etc.

Endorsed the ‘Hello my name is….’ campaign throughout the organisation

2446 surveys

218 gifts

Compliments 731 verbal

389 award nominations

797 written

Quality Account 2014/15

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Feedback from 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 87.18%.

The feedback we have received from our staff reinforces the positive score we have in this area.

Comments include: o MCH provide an excellent variety of quality services and my family and friends have all had positive experiences when using services o I've seen first-hand the treatment the patients receive from our clinicians and know my friends and family would be in safe hands. o Staff are committed to providing the best care for the patients and go above and beyond to achieve this.

The results for this question have remained stable through the year; we believe our staff are dedicated to delivering high quality and compassionate care.

We have taken a number of actions to improve this score including:  



Implementing Schwartz rounds to enable staff to describe, discuss, and deal with the often complex emotional and social demands that arise in their everyday work.

Empower our staff to better care for their mental, emotional and physical wellbeing through our health and wellbeing programme. It is well known that a positive staff experience ensures a good experience, improved outcomes and a reduced risk of harm to people using the services.

Delivered the first cohort of our management development programme – LEAD (Leading, Empowering, and Developing). Our leaders are our future; LEAD is intended to enable them to support staff through change and engage them in shaping the decisions in the organisation.

The table represents the last two reporting periods of staff who would recommend the organisation as a provider of care to their family or friends

Q3

Q4

National Average Q3

Other local NHS providers – Highest Q3

85.85%

94.12%

66%

78%

Quality Account 2014/15

Other local NHS providers – Lowest Q3

46%

Page 26

Achievement against our quality priorities for 2014/15 Indicator

Target

Q1

Q2

Q3

Q4

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

100%

100%

98.4%

100%

100%

95%

92%

99.6%

99%

100%

87%

92%

83%

92%

94%



Compliance with MRSA 100% 100% 97% 95.3% 83% screening  Reported Cdiff or 0 0 0 0 C.diff 1 MRSA 2. Continue to reduce incidences of people acquiring avoidable pressure ulcers and falls with harm, as well as enable people and carers to understand what they can do. 

Acquired pressure ulcers

3.9 %

2.5%

2.8%

2.2%

3%



Falls with harm

1.9 %

2%

1.6%

2.4%

1.5%



Implementation of case management

1.9 %

2%

1.6%

2.4%

1.5%

Clinical effectiveness 3. Support people 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. 

Using technology



Implementation of IDT

Quality Account 2014/15

Roll out of CHS as project plan 100% of patients identified as “not in need of acute care” discharged from MFT within 3 days Where not achieved, reasons why reported, trends identified and actions taken to bring about

Completed roll out to services, working to enhance the software 42.4% In response to economy pressures it has been agreed with CCG that reporting of this KPI is no longer IDT receive/encour required and has been replaced by age referrals updating by the for patients not medically fit to team of the MFT BOS system from ensure which discharge planning can Page 27

improvement, where practicable (identified Medway/Swale) 

Implementation of case management

start asap.

Number of contacts

1376

information is provided to the hospital

1471

1606

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 coordination of care, provide a framework for capturing patient goals, evidence effective practice and facilitate sharing of information.

5 (2 complete 6 Audit 5 services d3 Comp  Complete an audit of registere leted outcome measures in d) appropriate services Audit of My plan Audit Audit agreed with Initial compl complete patient and audit eted 71% benefits 75% Audit Measurable complete  Complete SMART goal goals in place Initial - Report Comp audit (monthly note audit being leted review) complete d Quality governance 5. Continue to seek the views of our staff through our engagement programme, to ensure staff are supported in delivering high quality care. 



Quarterly staff recommend MCH for care and treatment

FFT % positive

90%

85%

86%

94%

Quarterly staff recommend MCH as place to work

FFT % positive

69%

61%

66%

63%

Succe ssful bid

Round held Dec

80%

80%



Implementation of Schwartz rounds



Attendance compliance at GAIN

Quality Account 2014/15

Monthly Round establish in Q4

% services represented

48%

Establ ished

100%

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The following is an explanation of the quality priorities and our achievement against them.

Patient Safety 1.

Provide environments and care where the risk of infection is minimal

We are committed to providing clean environments and continually look at ways we can give safe care by minimising cross infection. We have a robust system to monitor the cleaning standards in the sites where we deliver care. Our infection control nurse also audits the sites, not only looking at the standard of cleaning at the site but also equipment and the maintenance of the environment to ensure that infection risks are minimised. We work with our staff, managers and landlords to ensure areas are refurbished and redecorated as appropriate.

Staff are required to attend infection control and hand hygiene training and are regularly observed in practice to ensure they comply with infection control standards in their care, e.g. following correct wound dressing procedures.

Using reviews of the care we provide to people we have been able to ensure staff understand infection control procedures that should be adhered to. We have also improved the cleaning schedules and monitoring on our ward areas by setting up checking systems by both nursing and domestic staff.

At St Bartholomew’s hospital people being admitted are screened for MRSA on their skin within 48 hours and we ensure, if required, that the correct treatment is given. During this year, 5 people did not have their screening within the first 2 days of admission, fortunately this did not cause them any harm. The matron is working with the staff to ensure that the screening always happens within the required timeframe.

We have to report people getting serious infections whilst in our care to the Department of Health – these include MRSA bloodstream infections and Clostridium difficle (C.diff) infections.

This is the third consecutive year that we have had no one in our care with MRSA bloodstream infections. We had one person who developed a C.diff infection; following a thorough review of the case our infection control team established that the cause was as a result of extensive use of antibiotics required for their care whilst in Medway hospital.

We have devised a referral form that provides information on any infection that requires continued treatments or specific precautions, so that patients transferred to other services are managed safely.

2.

Continue to reduce incidences of people acquiring avoidable pressure ulcers and falls with harm, as well as enable people and carers to understand what they can do.

A pressure ulcer is skin damage (ranging from a reddened area to a full thickness wound which can be down to bone) that is caused by unrelieved pressure or friction, moisture or shearing, most of which can be avoided or the risk reduced. It is estimated that pressure ulcers cost the NHS between £1.4 and £2.4 billion each year and that the length of hospital stay is two or three times greater for those with a pressure ulcer than for other similar case without (30 days compared to 12 days).

We established an internal working group to oversee all aspects of pressure ulcer prevention and nutritional assessment. Representatives from community and inpatient services agreed an action plan that focussed on reviewing and improving the way in which we assess, treat, review and support people at risk. Local information is captured through our incident reporting system, Quality Account 2014/15

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Datix. This system enables us to identify numbers of patients with pressure ulcers, reasons why they develop and whether they could have been avoided or not. Data is also captured monthly and compared with other NHS organisations through a national database known as the NHS Safety Thermometer.

We also worked collaboratively with Medway Maritime Hospital to reduce the number of people admitted with a pressure ulcer. A group was formed to scope the size of the problem and identify where to target prevention work with local community providers such as care homes and care agencies. The group reviewed and amended local processes to ensure care pathways between hospital and community were seamless for the patient and consistent in clinical practice. The group used this information to influence and make recommendations to the wider health and social care economy for pressure ulcer prevention.

Through these approaches we have demonstrated that by working together we can reduce the prevalence of pressure ulcers that either develop or deteriorate whilst patients are in our care.

This has been achieved by raising awareness (with the public and professionals), education, provision of equipment, personalised care planning and sharing information as patients move between or are seen by more than one service.

When a patient has a fall in our inpatient units, this too is reported through Datix, investigated and action taken. If the person falls with serious consequences, for example breaking their hip, this is reported to the Department of Health as a serious incident. Within our inpatient areas we monitor on a weekly basis people who have fallen, and the number of falls they may have had.

Every person is assessed for their risk of falling and action taken to mitigate that risk, eg better fitting footwear, a change in medication and discussing their risk with them.

The independence of people in our inpatient areas is paramount, but for some patients their freedom of movement poses risks, for instance at end of life, during rehabilitation and for those with dementia. We endeavour to keep falls to a minimum and learn lessons when they happen.

Clinical effectiveness 3.

Support people with long term conditions

The nurse case management service support adults who have one or more long-term conditions (eg heart disease, diabetes) and the frail elderly within their own home or a residential care home. The case managers combine both proactive and responsive care for those identified as being at high risk of deterioration in their health.

The case managers work closely with GPs and a range of health and social care services, facilitating multidisciplinary meetings to ensure people receive high quality effective treatment and care.

The case manager does not necessarily provide all aspects of a person’s care, however they take responsibility for co-ordinating that care and signposting to the most appropriate services.

In this manner we aim to improve patient experience, health outcomes and enable better access to services.

Quality Account 2014/15

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Patient experience 4.

My Plan Audit

The My plan (individualised care plan) audit was undertaken by 34 out of 39 services in 2014/15. Overall, My plan is being utilised across services, increasing from 97% in 2013/14 to 98% in 2014/15.

This year more people are being involved in decisions about their care, having a copy of their My plan offered to them and changes to outcomes being recorded. The My plan audit and information governance audit identified the need to record that people were provided with clear and understandable information and/or information leaflets about their condition or treatment; 95% said they did receive clear information. Additional areas for improvement include: recording outcomes of treatment and therapy and reviews of care.

Interestingly 61% services recorded that people were involved in decisions about their care, however 95% people receiving care said they did feel involved.

Quality governance 5.

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

Overall 87% of our staff would recommend us to provide care for their family or friends, this is an increase of 8% compared to 2013/14. Although this is an improvement, we continue to focus on providing a better staff experience which in turn will improve the experience of people using our services.

We have asked our staff to complete the Friends and Family test quarterly this year. This has helped shape our actions to improve staff engagement locally and across the organisation. We have made improvements to the working lives of our staff, which we hope will mean increased numbers of staff recommending MCH as a place to work.

A quarterly survey was seen by staff to be too frequent, so we have reshaped our model for surveying in 2015/16 to ensure we can continue to gather rich feedback.

For further commentary on Schwartz Rounds and GAIN please see page 18 Review of Quality Performance.

Quality Account 2014/15

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Statements from Healthwatch and CCG Any statements from commissioners and Healthwatch including any changes made as a result of receiving those statements.

In response to the draft 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 2014/15 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 at the time of review 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 and voting process with people using their services, their community forum, staff and commissioners for the selection of priorities for improvement in 2015/16 and ensuring that the priorities are set with local needs in mind. MCCG acknowledges and supports the seven priorities detailed within the Quality Account around Patient Safety, Clinical Effectiveness, Patient Experience and Quality Governance.

During 2013/14 MCH implemented a number of best practice initiatives in their approach to improving the quality of patient care and services. This included developing their own internal inspections called GAINing Insights which is based on the CQC national model of inspections; the organisation used the findings from these inspections to improve or maintain the quality of care provided and this inspection model is to be rolled out across the organisation. They have also developed internal assurance information networks and have established ‘Schwartz Rounds’ which provide an opportunity for staff from all disciplines across the organisation to reflect on the emotional aspects of their work. Research into the effectiveness ofSchwartz Rounds shows the positive impact that they have on individuals, teams, patient outcomes and organisational culture. This proactive approach to improving quality led to MCH being awarded the ‘Improving the Culture of Care’ award at the North Kent CCGs annual Francis Event in January 2015.

NHS MCCG look forward to continuing to work closely with the Clinical Quality Director and colleagues at all levels within MCH during 2014/15. We also look forward to maintaining and strengthening 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 sustained and improved in all areas of the organisation.

Quality Account 2014/15

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Healthwatch Medway is the ‘independent consumer champion’ for Medway residents who use local Health & Social Care services.

The aim of Healthwatch Medway is to give citizens and communities a stronger voice to influence and challenge how health & social care services are provided within their locality.

Healthwatch Medway would like to congratulate MCH on achieving such positive staff feedback 85.85 % for Q3 and 94.12% for Q4 against a national average for Q3 of 66%.

Healthwatch Medway welcomes the introduction of Schwartz Rounds as ‘staff experience (How staff are treated by MCH) affects patient care & experience’.

Healthwatch welcomes the health & wellbeing programme available for staff and the start of a management development programme – LEAD. Healthwatch Medway welcomes the introduction (roll out) of My Plan a treatment/care plan for patients which they are involved in which include SMART goals.

Healthwatch Medway also welcome the introduction of ‘GAINing Insights programme’ an internal inspection based on the CQC model of inspection, we see this as good practice and we are aware that ‘mock CQC inspections’ as described is common practice with many Social Care providers.

Healthwatch Medway welcomes the ‘self-testing’ for people on Warfarin, enabling patients to become aware of how lifestyle choices affect their blood levels. We also welcome that the need for improving the Podiatry service has been identified as this is an area that has been brought to our attention on several occasions with people expressing unhappiness regarding referral process, poor communication and waiting times.

The Medway Health and Adult Social Care Overview and Scrutiny Committee welcome the opportunity to comment on the MCH Quality Account for 2014/2015. The account clearly outlines many achievements. Listed below are some comments for consideration:  In relation to the priorities for improvement 2015/2016 the Committee would like to hear more during the year about the positive impact these have on patient outcomes  It was interesting to read about MCH participation in research and the wide range of examples of this through the report. It would be useful if the report could have reflected on changes to practice put in place following involvement in the research programmes  It was positive to see that all the goals agreed with commissioners had been achieved, however it would have been useful to demonstrate the impact of this on the quality of services provided  In connection with the statements from the CQC relating to improvements needed at Darland House it is important that the priorities identified in inspection visits are embedded in priorities for improvement during the year

Quality Account 2014/15

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We are, as always, very grateful for the comments we receive from our partners and stakeholders and would like to thank them for their statements on our 2014/15 Quality Account.

Taking on board these comments we will ensure future Accounts describe more fully the impact research and CQUINs have on the quality of care we provide.

Delivery of high quality services is of key importance to MCH and we will continue to work with all of our stakeholders during 2015/16 to ensure our services deliver to the highest standards.

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 To become a member of our community forum visit:www.medwaycommunityhealthcare.nhs.uk/join-in Find us You can find us on:Facebook - www.facebook.com/medwayhealth Twitter - www.twitter.com/medwayhealth LinkedIn - www.linkedin.com/company/medway-community-healthcare Google+ - plus.google.com/+MedwaycommunityhealthcareNhsUk YouTube - www.youtube.com/medwayhealth Or visit our website at www.medwaycommunityhealthcare.nhs.uk or by scanning the following QR code into your phone:

Quality Account 2014/15

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APPENDIX 1 Local audit 2014/15 Local audit title Planned care Cardiology: Gap analysis: CG187 acute heart failure

Actions   

Community nursing Team: Weekend working staff support audit

Community nursing Team: Reviewing Band 6 weekend activity audit

       

Community Respiratory: Effectiveness of the new Spirometry Clinics at Parkwood HLC



Community Respiratory: Gap analysis QS79 Idiopathic pulmonary fibrosis DentaLine: FP17 forms Dentaline Evaluation



Neurophysiotherapy: Vestibular rehab (ENT) referral evaluation and outcome

   



Tissue Viability and wound therapy: Improving patient outcomes through the introduction of pathways of care for venous leg ulcers audit

   

Quality Account 2014/15

Continue to triage referrals to ensure most at risk are seen within 2 weeks.

Work with GPs to reduce the numbers of follow ups to allow more new patients to be seen.

Work with commissioners to increase capacity of the team.

Work with hospital colleagues to improve planning.

Increase return rate in re-audit & audit to be set up on Meridian Open Rochester Leg Ulcer Clinic Sat & bank holidays Take results to community nursing governance group to share across service To re-audit & encourage a 100% return rate to ensure validity of results Further results of tally chart & separate staff survey to be merged to evidence the positive aspects of the approach To investigate whether the setting of some targeted standards would be beneficial i.e. 100% calls go through to band 6 co-ordinator during core hours To present results at the community nursing governance meeting to share across the service Improve waiting times from spirometery clinic to initial new patient appointment with team by using the “telephone contacts” icon on CHS MyWorld to ensure results are recorded on individual patients notes and clinicians receive a MyWorld alert to be made aware so results can be actioned.

Approach commissioners to enable our organisation to offer a service that meets these standards as we are seeing more and more patients.

To carry out a re-audit of FP17’s in 3-6 months’ time Feedback of individual audit results Review audit questions to ensure relevant Check the current level of service provision to the demand as we have only one qualified member of staff who caters to both neurological referrals and vestibular referrals To check the current level of commissioning for patients with vestibular dysfunction and look for more opportunity to expand the service provision.

Roll out pathways of care to enable best practice and equity to all patients with leg ulcers.

Encourage localities to nominate a LU nurse to enable timely assessment Doppler and planned care.

To sustain improved standards, for TVN to support clinics and offer training opportunities ‘on the job’ and see complex ulcers.

To educate staff in the correct in use of the different standards of compression hosiery, to reduce the onset and recurrence of venous leg ulcers Page 35

Local audit title Tissue Viability and wound therapy: Gap analysis CG179

Actions  Update Pressure Ulcer Policy  Update training for staff

Pressure ulcers

Tissue Viability and wound therapy: Pressure Ulcer Prevalence in Medway Nursing Homes

Local audit title Unplanned care St Bart’s Hospital: Raising Standards of Infection Control Measures for Toileting Equipment at St. Bart’s audit

Dementia care team: Active Minds Product Testing & Evaluation Integrated Discharge Team: Integrated discharge team assessment audit

MedOCC: Documentation audit

Night nursing: Verification of death and timely response to families audit

Stroke services: Using speech and language groups as a way of improving and maximising efficiency re-audit

Quality Account 2014/15

 Continue to deliver education regarding pressure ulcer management  Continue to promote the good practice of the assessment, planning, implementation and the evaluation of care for those residents with pressure ulcers and wound care plans.  Promote through education and training the early detection of, documentation of and interventions required in the prevention of pressure damage  The use of pressure redistributing cushions should be promoted for those residents at elevated risk and/or with pressure ulcers in the seating area who sit out for any period of time  Promote stepping up/stepping down as patient’s condition changes.

Actions  Revise Infection prevention and control commode audit tool to meet the needs of all toileting equipment  Audit toilet equipment using new tool weekly. Send reports to IPC team for collation.  Revise shift patterns of housekeeping staff to meet the cleaning standards of the service  Place cleaning observation charts outside of areas and monitor cleaning actions of all staff.  Ward co-ordinators to engage all staff in the use of the new system and new audit tool  MCH Dementia Support team to test future products as developed  Health Staff MUST training to be completed and supportive literature to be provided  Health staff Braden score training to be completed and supportive literature to be provided  I-lab access to be arranged for all Health staff and further training and supportive literature for safe use  Audit of Rapid Response assessments and referrals  Additional assessment information to be added to IDT assessment form  Acceptable level of scoring should now be increased to 95% to improve and maintain standards. Ensure service delivery remains sound and can be evidenced by documentation  Where there is a known IT issue, ensure that the nursing team and reception staff stay in contact by phone to ensure efficient processing of verification requests.  Ensure that verification calls are treated as priority by both the reception team and the night nursing team. The aim should be to complete the process in around two hours to support family.  Formalise group protocol for other clinicians to follow  Further work with the Stroke Association to develop peer led conversation drop in sessions  To continue to review ways of capturing feedback and Page 36

Local audit title Stroke services: Quick project Improving door to needle time for thrombolysis in Acute Stroke patients

Stroke services: Evaluating method, consistency and exactitude of support for patients on Stroke Rehab Unit with Upper Limb weakness audit Local audit title Independent services Adult speech and language therapy: Patient forum report

Children’s therapy service: Pilot project providing a sensory enriched environment in school

Clinical assessment service (CAS): prescribing audit

Nutrition & dietetics: A Review of Gastrostomy Knowledge amongst Care Home Staff in Medway and Swale 2013

Nutrition & dietetics: Oral nutritional supplement use and wastage in St Bart's wards re-audit Nutrition & dietetics: Nutritional monitoring audit Occupational therapy: Evaluation of 6 day working in occupational therapists in an acute setting Palliative Care: Do Not Attempt cardiopulmonary resuscitation records audit Quality Account 2014/15

Actions evaluate patient self-ratings.  Ambulance service to root cause analyse time delays on hospital arrival.  Investigate pre-registration of patients to enable faster imaging.  Stroke nurses to be trained in & allowed to cannulate in A&E.  Review Consultant on call rota & job plans & fast bleep system.  Review use of stroke medication box/keys in A&E.  Go through Therapy Information Boards with as many staff as possible to ensure understanding.  Nursing staff training day.  Individual ad hoc training with Nursing Staff as required.  Re Audit after training Actions  Ensure detailed discussion about side effects of treatment and possible outcomes related to surgery and provide Macmillan leaflets  To continue to develop clinical skills  To continue to run annual Patient forums to ensure feedback  To feedback student information to students and university  To provide further training for new staff to implement the programme  To present results in a business plan, to implement in other classes  Repeat with stricter protocols (forms returned, fixed deadlines etc.)  Continue to support remaining CAS clinicians to achieve academic qualification to prescribe  Consider future audit to evaluate outcome of prescribing decision and its effectiveness in reducing symptoms in greater detail  To offer all care homes with enterally fed patients a chance to attend a training session provided by our feed provider nutrition nurse  To start a record of 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  Report audit findings to ward staff  Re-evaluate use of Food Record Chart to document supplement consumption  Retrain key stage on referral procedure to include patient with new MUST score of 2+ and patients who are admitted on supplements  To improve return of patient and staff survey numbers to ensure on-going feedback  Healthcare professionals to review individual results to inform future practice  Palliative care head of service to review results by Page 37

Local audit title

MSK physiotherapy: To evaluate the use of the Keele start back tool in patients with low back pain MSK physiotherapy: Lower back pain audit

Quality Account 2014/15

Actions sharing the good practice and initiate training with clinicians responsible for completing DNACPR forms  Re-audit to monitor improvement and compliance  Clinicians to complete a Keele Start tool  Keele Scores could potentially be used to feedback to GP regarding prognosis and need for onward referral  Feedback to manager regarding results to discuss with commissioners about cost effectiveness and evidence based of classes  Feedback results to MSK team with the aim of meeting the standards 1-6  Re-audit standards to see if compliance has improved

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Medway Community Healthcare CIC providing services on behalf of the NHS Registered office: MCH House, Bailey Drive, Gillingham, Kent ME8 0PZ Tel: 01634 337593 Registered in England and Wales, Company number: 07275637

www.medwaycommunityhealthcare.nhs.uk

Quality Account 2014/15

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