Quality account 2016 - 2017

Quality account 2016 - 2017

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 2016 - 2017

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Contents Part one: Statement of quality

4

Part two: Looking forward

7

Part three: Looking back

9

Goals agreed with commissioners

23

What others say about MCH

27

Part four: Review of quality performance

32

Quality across our services

34

Customer experience and feedback

41

Achievement against our quality priorities

45

Statements

48

Appendix A

52

Appendix B

53

Quality account 2016 - 2017

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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 an organisational 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 MCH’s sixth quality account, we are able to build upon and demonstrate our continuous improvement and show our commitment to delivering high quality, people-centred services.

MCH is an award winning social enterprise and Community Interest Company established in 2011.

We were originally formed from the services directly provided by NHS Medway and have a strong history of partnership working with a number of local stakeholders including Medway Council, Medway Foundation NHS Trust, local Clinical Commissioning Groups (CCGs), NHS England, and more. We’re a £61 million business with over 1,300 staff and as a social enterprise, we are free to invest any profit we make into further improving our services, and into our local communities.

In our six years as a social enterprise, we have built successful alliances with other social enterprises, developed a local reputation as a provider of high quality community health services, and negotiated contracts and partnerships to deliver over 40 services.

In addition, we’ve delivered social value and supported healthcare as a career, through the provision of 68 apprenticeships; through delivering four internships (supported through the MCH Academy), by offering multiple work experience and student placements across MCH services; and by providing the first 'Get into Health and Social Care' programme in the South East with the Prince’s Trust.

This year some of our community services have been inspected by the Care Quality Commission (CQC) and whilst it is important to know the outcome of this inspection we are very proud to see our staff demonstrate their ongoing commitment to delivering high quality, patient-centred care.

Combined with our existing ‘good’ ratings for Darland House, MedOCC and the Wisdom Hospice, we hope to continue to be the provider of choice of community healthcare in Medway and surrounding area.

We work together to ensure that we deliver a consistently high quality patient experience, and strive towards our vision of a successful, vibrant community interest company, that benefits the communities we serve. Our purpose is to provide community health and social care services principally across Medway and the surrounding areas. Our commitment is to ‘lead the way in excellent healthcare.’ We are incredibly proud of what we do, and believe our achievements reflect the passion, dedication and commitment shown by our staff across all services. These qualities are born out of our values:

Caring and compassionate This continues to be a key driver behind the way we work, ensuring that both staff and those in our care feel able to tell us if they have concerns and receive safe, compassionate care. We have assessed our compliance and put in place actions to ensure we meet the recommendations of the; accessible information standard, workforce race equality standard (WRES), Freedom to Speak Up, Duty of Candour, and that CQC regulations are fully implemented.

Quality account 2016 - 2017

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Deliver quality and value We invest a significant amount of time and effort in proactively monitoring and assessing the quality of care we provide. We have continued to successfully embed the 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 SPACE Rounds - supportive, facilitated sessions that give MCH staff the opportunity 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 (97%). However, we believe in continuous improvement and know we have further improvements to make in some areas, particularly relating to those identified during the GAINing insights inspections, and the CQC inspection of our community services in March.

Working in partnership 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 listen and learn and never become complacent about our care provision.

We, the Board of MCH, on behalf of all our staff are committed to continuing to deliver high quality care through implementing and monitoring our quality framework. The information in our Quality Account is provided from our data management and quality improvement systems, and staff is, to the best of our knowledge, accurate and provides a true reflection of our organisation. Our thanks go to all of our partners and 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 2016 - 2017

Antony Kildare Chair

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Our compliments “Very considerate, explained in detail, very good service and very grateful for all help and advice given.”

(Adult speech and language therapy) “All really nice and caring, excellent service. Care and education after heart trouble” (Cardiology) “Outstanding. I feel very reassured to know that I was given a fully professional diagnosis and a relevant treatment pattern” (Clinical assessment service) “Thank you so much for teaching me the way at Orchards, I really appreciate it. I have really enjoyed working alongside you which has taught me lots.

Thank you.”

(Children’s therapy)

Part two: Looking forward In this part of our account 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.

Quality framework The MCH quality framework was developed this year through extensive engagement and consultation with our staff, our commissioners and the people we serve to ensure our approach to quality is the right approach.

The aim of our quality framework is to provide a road map that directs quality improvement and assurance within the rapidly changing world of health and social care. To enable flexibility the quality framework portrays our standards, commitments and approaches to assuring high quality care and is founded on the Care Quality Commission (CQC) five domains. It is fully integrated with all of MCH’s strategies and values, encompassing our clinical model of care, the ‘I am… Model’ (see figure 1.1.) Each year we will set our quality priorities (one from each of the five domains), measure for impact and publish achievements and progress within our annual quality account.

See appendix A for the quality framework summary Figure 1.1. ‘I am… Quality framework’ Model

“I liked the caring and friendly approach by all.

The treatment I received from the dentist was out of this world, kind, considerate and caring. A credit to her professional.”

(Community dental) Quality account 2016 - 2017

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Priorities for improvement 2017/18 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 stakeholders. The quality priorities for 2017/18 were selected through a consultation process with our staff, commissioners and the people we serve, led by our Quality Assurance Committee. The survey requested participants to vote on the highest priority from our approach list, for each of the five statements (we are safe, effective, caring, responsive and well led) from our quality framework. The results were weighted evenly between the three stakeholder groups. The highest average percentage identified the quality improvement priorities.

The quality priorities have been added to the MCH organisational annual plan and will be monitored within our Quality Assurance Committee and Board. In addition, each business unit and corporate service will incorporate the priorities into their annual plans, service objectives and individual personal development plans recognising that ‘quality is everyone’s responsibility’ (W. Edwards Deming) Our statements: Quality priorities 2017/18 We are safe

Quality priority 1 – we will ensure we recruit and retain high quality staff, through the development and implementation of a recruitment and retention strategy.

We are effective Quality priority 2 – all appropriate clinical services will develop and report on quality outcome measures to evidence the effectiveness of the care we provide, by building on the foundations of the Clinical Quality Outcome Metrics (CQOM) framework.

We are caring

We are responsive

We are well led

Quality priority 3 – we will build on our My Plan model, by examining alternative ways to deliver personalised care, ensuring those who have complex care needs are identified and staff have the appropriate training.

Quality priority 4 – we will implement new models of care and new roles by progressing our involvement and partnership working, truly engaging and codesigning services with our staff, stakeholders and the people we care for.

Quality priority 5 – we will learn and respond robustly to health care regulators, clinical audit findings, investigations and reports into care.

Quality account 2016 - 2017

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Part three: Looking back Assuring quality in our services During 2016/17 MCH provided and/ or sub-contracted fifty one NHS services within the following business units:  Planned and urgent care  Independent  Therapies and children’s  Primary care We have a clear and transparent performance framework that draws together the available data from all services into a comprehensive overview dashboard described at organisational, business unit and individual service level.

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

The monthly data collected by services can be grouped into four key areas but are not reviewed in isolation (pictured right).

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 business unit meetings, there are two key groups that oversee service delivery and clinical quality. The Performance Oversight Group and Quality Assurance Committee meet quarterly. Part of their remit is to identify trends of strong and weak performance.

When areas of concern are identified in services, a ‘deep-dive’ comprehensive review is undertaken. These investigations, where appropriate, include peer review and support. Service managers and their teams are involved in the review and then report on resulting action plans to the Executive Team and Quality Assurance Committee.

*our workforce

GAINing Insights progamme This year we completed and evaluated the GAINing Insights programme, an internal inspection programme based on the Care Quality Commission (CQC) model of inspection. We developed our own programme using a team of inspectors, comprising of executive and non-executive directors, local commissioners, clinical experts, and experts by experience (people who use our services).

Quality account 2016 - 2017

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The programme was designed to prepare services and the wider organisation for the ‘new’ style CQC inspection. All our services have now either been internally inspected or had a CQC inspection. Four services have also had a further GAINing insights inspection completed to provide assurance that they are continuously improving the quality of their services. We are pleased to report that the services that were previously rated as either inadequate or requires improvement have now been rated as good. All services including those who achieved a rating of outstanding produced a quality improvement action plan which was presented to our Board members and inspectors at our Quality Summit. These action plans are monitored through business unit meetings and the Quality Assurance Committee to ensure actions are completed.

Gaining Insights programme

Overall rating

Amherst Court

Good

Anti–coagulation

Good

Cardiology

Safe

Effective

Caring

Responsive

Well-led

Outstanding

Community learning disabilities Outstanding Community nursing Outstanding Community respiratory

Outstanding

Diabetes service

Outstanding

Stroke services

Good

Tissue viability

Good

Wound care

Good

Clinical assessment Community rehabilitation

Outstanding

OT - hand therapy

Outstanding

Phlebotomy Physiotherapy (MSK)

Outstanding

Good Outstanding

Adult speech and language

Good

Dermatology

Good

Nutrition and dietetics

Good

our Zone

Good

Podiatry

Good

Children’s therapy

Good

Health visiting

Good

Dementia crisis team

Outstanding

Darland House*

Good

Wisdom Hospice*

Good

MedOCC*

Good

Dental services

Good

Dentaline

Good

MCH Sunlight

Good

*CQC rating

Quality account 2016 - 2017

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Our compliments “Just wanted to let you know how much I appreciate you and how much you have put yourself out for me lately. And you don’t get many nurses that generally care and you do, so thank you” (Community nursing) “I was very pleased with the care from the lady that saw to me. I could talk to her and she made me feel that I was in good hands. Thank you all very much.”

(Community rehabilitation) “I would just like to say a very big thank you for all your kindness and support you have shown over the last nine years in looking after my wife.

You have given her the upmost care and for that I and my family are very grateful.” (Darland House) “The Dementia Support Team are extremely supportive to us all at Friston House, they have given us good ideas to support us in delivering the right care to our residents on the Dementia Residential Unit.”

(Dementia care team)

Quality account 2016 - 2017

The programme was reviewed through inspection evaluations, surveys and focus groups. It received positive reviews both from inspectors and those being inspected. 100% felt that the programme was meaningful and helped them prepare for a CQC inspection with 90% of services feeling that it helped drive improvements. Staff reported that they liked having a variable inspection team, as it created wider ownership and shared learning across the organisation. However, 83% felt the inspections went deep enough and 77% of services felt that they were not held to account for completing their actions. During 2017/18 we will be adapting the GAINing insights model and assurance processes based on this evaluation and feedback from our recent CQC inspection to ensure it takes into consideration and compliments the new model currently being developed by the CQC and the Clinical Commissioning Groups (CCG) service reviews.

SPACE (Sharing personal and complex emotions) rounds (previously Schwartz Center Rounds®) During 2016/17 we continued with sessions for staff focussing on the emotional impact of their work. We moved away from using the Schwartz Centre Rounds® brand, and created MCH SPACE Rounds in their place.

These sessions are available to all MCH staff including students and apprentices, and are run quarterly in partnership with Demelza Hospice.

Attendees continue to provide positive feedback in relation to their participation and the benefit that SPACE Rounds provide.

Safeguarding adults and children The safeguarding agenda continues to grow and develop. MCH staff now receive training, dependent on their role, in relation to: adult and child protection, self-neglect in adults, domestic abuse, PREVENT and Child Sexual Exploitation.

In response to this growth MCH implemented a change in the structure of our safeguarding teams, bringing together the safeguarding adults and children teams to form one safeguarding service. This is to embed a “safeguarding the family” culture in practice across all services. Work has already begun in this area with Level 1 (induction) training being amalgamated, and closer working across cases where both adults and children are believed to be at risk of harm.

Infection prevention and control (IPC) The IPC team, supported by link practitioners, staff and managers have successfully completed the IPC programme for 2016/17. Highlights from the year include:  mandatory infection control training programme including hand hygiene and aseptic non touch technique  the creation of a new eLearning programme and video on Sepsis  we maintained a high level of compliance with cleanliness and have improved some of our inpatient areas with refurbishment programmes  MCH were compliant with zero MRSA and C.difficile bacteraemia in our care.

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Preventing harm oversight group The group has taken forward a number of projects including:    

reducing the number of acquired in our care pressure ulcers developing the carers’ care plan and introducing “stop boxes” containing first line treatment to prevent further pressure damage in residential care enhancing medicines by undertaking a service review and developing and progressing an extensive work programme including audit and training programmes enhancing falls prevention through a review of the Falls service, referral process and risk assessment tools.

Our values and pledges We have continued to embed our values through performance appraisal, recruitment and our quality priorities. In 2017/18 we will review our processes and practices with a view to further embedding our values in all that we do.

Our leadership Managers and leaders from across MCH accessed the management modules of the LEAD programme (leading empowering and developing) and Unconscious Bias training in 2016/17.

Designed to ensure that these staff feel confident and competent in their roles, the majority of modules were facilitated by our own internal experts, with consistently positive feedback – some examples below:

“Being able to identify types of bias and how they may exist”

“Made me think outside the box and to question myself”

MCH’s leadership qualities feature in recruitment and selection, talent conversations and our performance and development reviews. In 2017/18 we will develop and implement our leadership and development strategy, underpinned by our leadership qualities, which will be embedded at all management levels, with an emphasis on managing change and leading in a system wide context.

Elected Members Forum (EMF) The EMF is a group of staff (clinical and support) who help improve communication flow and engagement between the MCH Board and the wider organisation. This year the EMF worked closely with Helen Cunningham (HR director), Martin Riley (managing director) and Glyn Griffiths (non-executive director) for the successful recruitment of Antony Kildare, chair of MCH. EMF were represented at each working group meeting, reviewing the job description, long listing, short listing and interviewing candidates. This piece of work was started in September 2016 with selection taking place on 11 January 2017.

EMF worked in partnership with the clinical quality team to develop and host the Quality Showcase Day. 150 members of staff attended throughout the day to visit the market place and watch presentations. Additionally, two CQC inspectors, our CCG colleagues and patient representatives also attended. 94% of those who were present said they would attend the showcase again.

Quality account 2016 - 2017

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EMF also developed and utilised a ‘sounding board’ to engage staff with various hot topics such as preparing for the CQC inspection and gathering votes on this year’s quality priorities.

In October 2016 the EMF chair was named as MCH’s Freedom to Speak Up Guardian; with EMF members also becoming guardians. The programme was adopted by EMF who worked closely with the head of organisational development. EMF members had a training day in November to develop their skills and equip them with the tools required to deliver the programme. During this training day, an action plan was created and a decision was made to pilot the programme between January 2017 and March 2017 with the independent business unit. All staff within the independent business unit were asked to complete a pulse questionnaire at the start of the programme and also after the pilot to determine: If staff felt they were able to speak to their managers about any concerns – at the start of the programme, 82% of staff felt they could, after the programme 100% of staff felt they could If staff knew where to go to raise concerns if they felt they could not approach managers – at the start of the programme, 72% of staff knew where they could raise concerns, after the programme 100% of staff knew where they could raise concerns If staff feel listened to when raising concerns – at the start of the programme 68% of staff felt listened to, after the programme 100% felt listened to.

This work will continue in 2017/18.

Quality account 2016 - 2017

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Participation in clinical audit National audit During 2016/17 five national clinical audits and no national confidential enquiries covered NHS services that MCH provides.

During that period MCH participated in three (60%) 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 participated in during 2016/17 are as follows:   

National chronic obstructive pulmonary Disease (COPD) Audit, Pulmonary Rehabilitation Sentinel Stroke National Audit Programme (SSNAP) National Diabetes Foot Care Audit MCH was unable to take part in: Audit title

Reason

Chronic kidney disease (CKD) in primary care

The CKD Audit is available to all GP practices who are current BMJ health analytics customers. This system is currently not used by MCH Sunlight

National Diabetes Audit (Adult)

The audit operates on an opt-in basis. Unfortunately MCH Sunlight was not able to undertake this audit as at the time the service was experiencing severe staff shortages and was inbetween practice managers. The service is now fully staffed and aims to participate in the next stage of this audit

The national clinical audits and national confidential enquiries that MCH participated in, and for which data collection was completed during 2016/17 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.

Audit title

No. of cases submitted

%

National chronic obstructive pulmonary disease (COPD) audit, pulmonary rehabilitation

From Jan – March = 33

Sentinel stroke national audit programme (SSNAP)

Submitted via Medway NHS Foundation Trust

N/A

National diabetes foot care audit

Submitted via Medway NHS Foundation Trust

N/A

The reports of two national clinical audits were reviewed by the provider in 2016/17 and Medway Community Healthcare intends to take the following actions to improve the quality of healthcare provided:

Quality account 2016 - 2017

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Our compliments “This service has been a godsend for us. There's nothing worse than toothache, other than watching your child have one. The staff was friendly and informative. A relaxed atmosphere and a valuable service. Thank you.”

(DentaLine) “All staff was very welcoming and helpful. Check in was easy and the receptionist was very polite and helpful. My treatment was very good and the specialist very good and I didn't feel rushed. Time keeping was perfect.”

(Dermatology)

National audit title

Actions:

Sentinel stroke national audit programme (SSNAP)

Results continue to be shared with Acute Trust colleagues at Stroke Action group and new Nutrition Strategic group established.

New staffing model for enhance therapy intensity and 7 day therapy verbally agreed with MFT but has not progressed with contracts teams from MFT. Stroke SWARM event setup for 21/2/17 to review acute pathway operation, incidents and improvements to develop a action plan with acute trust.

National diabetes foot care audit

Our actions are to improve education for GPs to ensure that patients with diabetic foot ulcers are referred quickly to the specialist foot service as this is where patient experience delays in access the appropriate care. Once patients are referred to us they are seen within 48 hours of referral.

Quality account 2016 - 2017

“Advice was helpful and I was able to ask as many questions as I felt necessary. I did not feel rushed, i.e. I could take the time to explain fully how I felt and the advice and help made me feel confident.” (Health visiting) “Fantastic service.

Everyone has been so lovely and helpful.

I have had such a lovely experience from start to finish.

Thank you for making our experience so easy and stress free.”

(MedOCC)

Quality account 2016 - 2017

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Mandatory audits Medway Community Healthcare is required to assure that we comply with requirements of the Health and Social Care Act 2008, the Care Quality Commission and NHS England Contract 2016/17 regarding patient safety and risk via audit.

During 2016/17 MCH carried out 27 mandatory clinical audits and the following are some of the improvements which are to be implemented:

Audit title

Improvements

Documentation audit

Monthly monitoring of patient notes to ensure records are being completed effectively and that the relevant assessments are carried out.

Aim for 2017/18 to include dental and GP practices, which would result in all applicable services taking part in the audit.

Information governance documentation audit

All staff have the organisation’s standardised signature on emails being sent, including out of office All staff are aware that documents are not secure if saved to desktop – use short cut to ‘N’ or ‘P’ drive

Consent audit

Clinical Assessment Service to modify existing written consent form.

Unexpected deaths

Current processes are satisfactory. Any unexpected deaths going forward in one of MCH’s in-patient units will be notified to Medical Director for review

Complaints audit

Heads of service complete relevant areas of Datix.

Reconcile monthly and chase for outstanding lessons learnt.

Pressure ulcer audit

Community staff to receive training on seating assessment.

Continue training on differentiation between moisture damage, pressure damage and to reiterate the need for Doppler of lower limb ulcerations, especially heels.

Duty of candour audit

Review the Being Open policy to include all key steps required for duty of candour.

Cascade to all staff and ensure that they fully understand why it is important.

Review the incident reporting system (Datix) to full include all aspects of duty of candour.

Quality improvement action plan Results of this year’s audit are very similar to the ones in the audit audit last year. The method of monitoring the service’s quality improvement action plans will be reviewed for the 2017-18 quality improvement programme.

Pooled budget speech and language therapy for children’s therapy service

Quality account 2016 - 2017

Move towards different measure in special schools e.g TOMS which is more functional way of measuring improvements.

Team to consider children on direct packages and whether or not they should actually be on intensive packages.

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Staff to ensure that minimum of two sessions per year for children on direct packages include school staff, so that programmes can be handed over to be supported by school staff between therapy sessions.

Clinical supervision audit

Update and implement new supervision guidelines Communication of new supervision guidelines Review of preceptorship practice - preceptorship audit Explore possibilities re reporting of supervision Undertake questionnaire to re-audit staff about supervision

Audit of GP consultations

Ensure recording which adults accompanied child patients or safeguarding issues considered. Also that appropriate safety netting, red flag and follow up advice had been given.

Audit of nurse consultations

The audit results represent safe and consistent documentation across the nursing team

Out of Hours prescribing Compliance with out of hours formulary

No action required.

As part of the audit programme for 2017/18, Medway Community Healthcare is working towards joining up audit and risk more accurately further assurance. We are subject to an annual internal audit which has highlighted this as a current gap.

Local audit 2016/17 The reports of sixteen local clinical audits were reviewed by MCH in 2016/17 and the following actions to improve the quality of healthcare provided. See table at appendix B. Local clinical audit is important in measuring and benchmarking clinical practice against agreed markers of good professional practice, stimulating changes to improve practice and re- measuring to determine any service improvements.

NICE guidance In 2016/17 we measured compliance of our services with best practice guidance issued by the National Institute for Health and Care 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.

In 2016/17 we reviewed our system of disseminating and monitoring NICE guidance throughout the organisation to ensure that we can demonstrate compliance and address areas for improvement.

The new system will be fully implemented in 2017/18 and will include increased multidisciplinary working to review new guidance.

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

Quality account 2016 - 2017

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The following table provides a sample of the NICE guidance reviewed in 2016/17 and the improvements initiated.

NICE guidance title

Improvements 2016/17

NG21 Home care: delivering  personal care and practical  support to older people living in their own homes

Service leaflet for care provision created Care Certificate protocol implemented to ensure that the ‘unqualified’ clinical health and social care workers (Bands 1-4) employed by MCH have the required values, behaviours, competencies and skills to provide high quality, compassionate care  Complex patient window completed and added to our electronic clinical record system (CHS)

QS114 Irritable bowel syndrome in adults

 All dietetic staff to be trained on first-line advice and knowledge of the IBS pathway  Gastro dietitian to create new, more structured IBS pathway that will allow dietitians, other health professionals and patients to understand the IBS dietary process

NG22 Older people with  Increased awareness of impact of social isolation, advocated by social care needs and nurse case managers multiple long-term conditions Increased use of core clinical assessment tools to assess common care needs, regularly monitored through monthly patient records audit  Carers’ care plans implemented  Development of the use of My Plan CG42 Dementia: supporting  Department of Health's publication 'Everybody's business. people with dementia and Integrated mental health services for older adults: a service their carers in health and development guide' to be circulated to all appropriate staff within MCH and to be used as part of service development social care  Creation of dementia advice information leaflet for more health care professionals, to aid them when dealing with a person newly diagnosed with dementia who may not have involvement from the mental health trust NG46 Controlled drugs: safe Controlled drugs policy updated use and management  Development and implementation of a comprehensive safe management of controlled drugs set of standard operating procedures NG51 Sepsis: recognition, diagnosis and early management

 Sepsis included in the mandatory infection control training, team infection control training and nurses IV update training  Sepsis e-learning module being created by MCH staff

NICE quality standards are concise sets of prioritised statements designed to drive measurable quality improvements within a particular area of health or care. They are derived from the best available evidence such as NICE guidance and other evidence sources accredited by NICE. They are developed independently by NICE, in collaboration with health and social care professionals, their partners and service users.

Quality account 2016 - 2017

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Our compliments “A very helpful dietician explained the reason for gluten free products and was very positive about the advantages for me as I have very recently been diagnosed with severe coeliac disease. The visit was pleasant, helpful, and informative - she offered to answer any questions now, or in the future. Thank you for the service.”

(Nutrition and dietetics) “Staff were supportive and also appeared to be genuinely interested - my appointment lasted 40 minutes and they explained everything in detail and at length.” (Occupational therapy) “At a time of great despair bereavement counseling has been helpful and beneficial for me. Thank you“ (Wisdom Hospice) I was very pleased with the treatment I received. I have a lot more normal movement, feeling and range in my neck.

I am free from pain and stiffness.”

(Physiotherapy)

Quality account 2016 - 2017

We achieved the NICE Quality Standard in 2016/17 for the following (relevant recommendations within our contractual restraints): Quality standard 101: Learning disabilities: challenging behaviour Quality standard 103: Acute heart failure: diagnosis and management in adults Quality standard 107: Preventing unintentional injury in under 15s Quality standard 109: Diabetes in pregnancy Quality standard 110: Pneumonia in adults Quality standard 10: Chronic obstructive pulmonary disease in adults (update Feb 2016) Quality standard 118: Food Allergy Quality standard 119: Anaphylaxis Quality standard 29: Venous thromboembolism in adults: diagnosis and management (update April 2016) Quality standard 122: Bronchiolitis in children Quality standard 125: Diabetes in children and young people Quality standard 128: Early years: promoting health and wellbeing in under 5s Quality standard 143: Menopause All Quality Standards relevant to the care we provide are monitored and reviewed and appropriate action taken to ensure we deliver an effective evidence-based service.

Participation in research “Research is central to the NHS…. We need the evidence from research to deliver better care. Much of the care that we deliver at the moment is based on uncertainties or experience, but not on evidence. …We can only correct that with research” Professor Dame Sally Davies, Chief Medical Officer for England, Director General of Research and Development and Chief Scientific Advisor for the Department of Health and NHS 2015.

The number of patients receiving NHS services provided or subcontracted by MCH in 2016/17 that were recruited during that period to participate in research approved by a research ethics committee was 126 across 6 different clinical specialties. This was achieved through securing additional funding through the Clinical Research Network (CRN), enabling MCH to employ a Senior Research Nurse, Clinical Trials administrator and appointing an overall Clinical Lead for Research and Design. Our studies below demonstrate which demonstrates recruitment into a number of research areas MCH have been involved in during 2016/17:

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Completed portfolio studies 

Non-specific ‘Mechanisms in Orthodox and CAM’ (MOCAM) management of back pain- a study looking into different approaches to back pain management.

Open portfolio studies             

EMBARC- a study looking into a European register for patient with Bronchiectasis.

Alcohol study- a study looking into patients with advanced cancer and their caregivers and alcohol related problems as a coping mechanism.

Assessment of real life care describing European heart failure management (Ariadne) - a study looking into profiling patients on certain medications in the management of heart failure.

Kent Medicine Support in Stroke and TIA (KeMIST)- a study looking into Stroke and Tia survivors attitudes and coping mechanisms of managing their medications post stroke & transichaemic attack.

Boost - a study looking into back pain treatments.

Community Based Rehabilitation after Knee Arthroplasty (CORKA) - a study looking at community based rehabilitation post knee arthroscopy.

Dance Café - a study looking into dance therapy within dementia.

Feeding and Autoimmunity in Downs Syndrome Evaluation (FADES) - a study evaluating feeding and autoimmunity in downs syndrome.

Predicting Language Outcome and Recovery after Stroke (Ploras) - a study looking into predicting recovery of language deficits post stroke.

Prevention of Shoulder Problems Study (Prosper) - a study looking into the prevention of shoulder problems post breast surgery for cancer.

Propel - a study looking into implementation of an evidence based pelvic floor muscle based training intervention for women with pelvic organ prolapse.

Strength training for Adolescents with Cerebral Palsy (Star) - a study looking into strength training in adolescents with cerebral palsy.

Admiral Nurse Study - a study looking into the experience of carers about the Admiral Nursing service.

Research is a vital and is essential to delivering excellent, high quality patient care. To deliver the best possible treatments we need evidence on “what works.” To find out “what works” MCH is committed to engaging in the research agenda and recognises research as a direct contributor to improving the quality of patient care and services.

There were approximately 100 members of clinical staff participating in research approved by a research ethics committee in MCH during 2016/17. These staff participated in research covering, musculoskeletal physiotherapy, cardiology, dementia, stroke, cancer and children’s therapy. Future recruitment intends to expand its portfolio and broaden into other areas include community nursing, dental, primary care and health visiting.

We developed our draft 2017-2020 Research Strategy with the vision that by 2020 all of MCH services will be able to offer the people we care for the opportunity to be involved in research.

Research is regarded as a high priority within MCH’s quality agenda and forms part of our strategic plan and quality framework. This strategy has identified a number of key priority areas, aligning the overarching standards of the five CQC domains with MCH’s organisation values.

The ‘I am…’ Research Model has been created to capture these standards and commitments thus giving strategic direction for the organisation.

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Our research commitments are:  We are safe- People we care for are always protected from abuse and avoidable harm,ensuring appropriate competence and infrastructure to deliver research.  We are effective- People’s care, treatment and support achieves outstanding outcomes, promotes a good quality of life and is based on the best available evidence and research.  We are caring- Our staff always involve and treat people with compassion, kindness, dignity and respect, offering opportunities to participate in research.  We are responsive- Our services are organised so they meet people’s needs delivering timely intervention and access to appropriate studies.  We are well lead- Our outstanding leadership, management and governance of research assures the delivery of high quality person-centred studies, supports learning and innovation and promotes an open and fair culture.

‘I am…’ Research Model

We have continued to strengthen the culture of research within MCH with services’ clinical leads becoming research champions, promoting engagement and the delivery of research within their teams. The workforce continues to be developed through delivery of the National Institute for Health Research (NIHR) ‘Introduction to Good Clinical Practice’ training and participation in the NIHR’s Advanced Leadership Programme.

Central to the success of the MCH Research team this year has been the development of its communications strategies. Internally an intranet page has been developed providing valuable sources of information and links to other research associated organisations, as well as the creation of a newsletter. Externally information has been created in the way of leaflets, internet pages and a space for patients and service users to register their interest in future studies.

Social Media activity via Twitter and Facebook has also enabled the successful raising of MCH’s research active profile.

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Our compliments “The waiting for the appointment was quite lengthy, but I realise this is a service much in demand. The consultation itself was excellent. Everything was fully explained to me by the podiatrist.

My problem was reviewed, analysed and a solution devised. A first class service!” (Podiatry) “Very handy service to have at her age and peace of mind for her son who she lives with.” (Rapid response team) “Thank you once again for all the help and care you've given me and please thank the girls who answer the phones, for their patience and kindness.”

(Respiratory) “Always put you first and nothing is too much trouble. Always got time to listen and give reassurance to the patients. Shame St. Bart's had to close.

10 out of 10.”

(Intermediate care)

Working in partnership is one of our core values as an organisation and we have continued to work in collaboration with research-specific organisations and networks, academic institutions, industry and other care providers both at a local, national and international level. These organisations have included:         

Kent Surrey Sussex Clinical Research Network (CRN) Kent Surrey Sussex Academic Health Science Network (AHSN) Health and Europe Centre/International Health Alliance Kent Health Partners Wisdom Hospice and KSS Palliative Care Research Group National Institute for Health Research (NIHR) Clinical Research Network (CRN) National Children’s Specialty Group University of Kent University of Greenwich/Medway School of Pharmacy Canterbury Christchurch University

MCH are members of the Health and Europe Centre. This alliance enables NHS providers to bid for and run European funded research projects. In 2016/17, we have been successful and won 2 bids. DWELL is a living well with diabetes programme and CASCADE (Community Areas of Sustainable Care and Dementia Excellence in Europe; a research project looking at developing a guest house with care for people living with dementia ‘a home away from home’. In addition we have successfully been given the green light to progress to full application stage for TICC (Transforming Integrated Care in the Community) which the main purpose is to develop a blueprint for implementing international best practice by applying the highly commended Buurtzorg model of neighbour care from the Netherlands.

MCH have continued to be innovative in the delivery of research activity namely in developing a “drop in clinic” style open day with our Embarc study, which was presented at a local conference and are particularly proud to have supported a member of Darland House Dementia team through the research journey to deliver the Dementia Dance Café as part of her Masters Degree Programme.

Future recommendations/plans include the following areas:      

publication of our 2017-2020 Research Strategy. to continue to further embed research culture and activity within the organisation and launch of a research forum; to facilitate communication about research and research activity through use of the internet, intranet and social media platforms as well as MCH’s various quality forums ; to continue to be active in research with continued portfolio recruitment with support from the CRN, whilst exploring wider pan-European initiatives to continue to support workforce development and training through ‘good clinical practice’ and ‘consent training’ and supporting academic study in research. to further strengthen our governance and assurance processes.

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Goals agreed with commissioners Use of the CQUIN payment framework A proportion of our income in 2016/17 was conditional on achieving quality improvement and innovation goals, agreed between MCH and the commissioners (who we entered into a contract, agreement or arrangement with) for the provision of NHS services, through the Commissioning for Quality and Innovation (CQUIN) 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.

Achieving all of our CQUIN schemes shows that we are actively engaged in quality improvements with commissioners, some of which improve patient pathways 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.

Indicator

Outcome

2.1

Introduction of Health and wellbeing Initiatives - Option B

2.1.3

Healthy food for NHS staff and patients

Achieved:  Action plan developed and agreed with CCG  Staff health and wellbeing initiatives reviewed following results from staff survey  Identified need for staff health checks to be included in 17/18 HWB plans  Discounted local gym membership offered to staff  Walking routes for meetings identified and advertised to staff  ‘Climb Kilmanjaro’ team competition completed during March  MSK physiotherapy capacity increased by 50% for staff referrals  MSK physiotherapy for staff promoted via managers, intranet, newsletter – reduction in MSK related sickness reduced  Team based resilience training provided, 38% of workforce attended  Mental health training provided to managers

by Medway Council to increase knowledge and awareness and skills to use within their role  Mental health and stress resources explored and signposting information made available to all staff on the intranet and via newsletter Achieved:  Action plan developed and agreed with CCG  Free fruit made available to staff  Resources developed on staff intranet around healthy eating, calorie counting and ‘small swaps’.

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Indicator

Outcome 

Healthy eating education classes being provided in April and May by Nutrition and Dietetics team  Staff weight management programme introduced ‘Biggest Loser’  Advertising of sugary drinks and high in fat foods banned including promotions in MCH locations Improving uptake of flu vaccines for front line clinical staff

Not Achieved:  Baseline agreed at 48% based on 2015/16 results  Actual number of staff vaccinated was 32%  Flu survey sent to all staff  Out of hours plus in-hours clinics held at request of staff  Six peer vaccinators put in place  Promoted in team meetings, intranet, newsletter, screen savers and posters. Also countdown campaign.  Further promotional work required in 2107/18 to achieve CQUIN

Community Services – Development of clinical quality outcome metrics (CQOM) & KPI’s

Achieved:

3.2

7 Day Working St Barts Hospital (became Saturday working development in Respiratory Service from October 2016)

Achieved:  St Bart’s rationale was to continue seven day therapy to enhance rehab programmes and facilitate earlier discharge  Target of 2,080 contacts for 2016/17 but due to closure on 30 September, part year target of 1,040 agreed for payment in Q2. Achieved.  1 October onwards, CQUIN became ‘Saturday Working Development – Respiratory Contacts’  Target based on 15/16 outturn 630 contacts

3.3

MedOCC GP registration and CCG Allocation

Achieved:  Performance report developed detailing accurate identification of unregistered patients and responsible commissioner allocation at CCG level  Description of activity type included

3.4

Pressure Ulcer Management

Achieved:  Pressure ulcer target was to sustain 2016/17 acquired in MCH care avoidable PUs, grades 2,3,4 and un- stageable also to include those that deteriorated in our care and were avoidable.

Achieved.  Collaboration with Medway Foundation Trust.  5,000 Pressure Ulcer Passports (PUPs) purchased

3.1

Quality account 2016 - 2017



Agreed development and implementation plan of outcome measure collection  Delivery of a developed and agreed quality metrics framework for community nursing, CAS, respiratory and cardiology  KPIs/CQOM agreed for these services  Reporting against KPIs/CQOMs successful and business as usual from April 2017.

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Indicator

Outcome 

  



across MCH and MFT Roll out of PUPs agreed between MCH and MFT, also rolled out to nursing homes with supporting information PUP Training sessions and inclusion on induction programme for new staff – complete Database established on CHS to monitor PUP use and effectiveness PUP implemented at MCH in Q2 for grade 2 and above PUs and also for ‘acquired in MCH care’ PUs Patient and staff survey developed and disseminated in Q3 and results reported to CCG, any changes required identified by MCH

Our response to national policy / reports Accessible Information Standard From 1 August 2016 onwards, all organisations that provide NHS care or adult social care are legally required to follow the Accessible Information Standard. The standard aims to make sure that people who have a disability, impairment or sensory loss are provided with information that they can easily read or understand and with support so that they can communicate effectively with health and social care services. As part of the accessible information standard, we:     

ask people if they have any information or communication needs, and find out how to meet their needs record those needs clearly and in a set way highlight or ‘flag’ the person’s file or notes so it is clear that they have information or communication needs and how those needs should be met share information about people’s information and communication needs with other providers of NHS and adult social care, when we have consent or permission to do so take steps to ensure that people receive information which they can access and understand, and receive communication support if they need it.

 Duty of Candour The statutory duty of candour is the legal duty under the Health and Social Care Act for all providers of health and social care to be ‘open and honest’ if things go wrong. During 2016/17 we audited our ‘being open’ and duty of candour implementation compliance. The results to date show that we are an open and honest organisation and that we apologise if we are responsible for causing harm to anyone in our care. Although the audit showed that disclosure conversations and apologies had been completed, it also identified that staff were not aware of when the statutory duty of candour applies and the formal documentation process (299 had been recorded but only 28 were applicable for the statutory duty of candour). Actions completed following the audit were as follows:  revised and ratified the ‘being open’ and duty of candour protocol and updated the complaints and serious incident policy  mandatory training provided and included on all registered health and care professionals, service managers and senior managers (including Board members) competency matrices  implemented changes to the incident reporting system to improve recording when duty of candour is applicable and provided letter templates and auditable fields  initiated a quarterly audit. Audit and training compliance is monitored quarterly through the Quality Assurance Committee.

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Our  compliments “I've had wonderful treatment from the carers in your stroke service and cannot recommend them enough. I feel I'm very lucky to have been in your care. Thank you.”

(Stroke services) “The reception team are always helpful and the walk-in clinics are great. I used to have wait ages to get an appointment with my old GP”.

(MCH Sunlight) “It is so beneficial to meet with others in similar circumstances and do things that you have never done before and the foot massage gave me a wonderful feeling and was so relaxing”. (Tissue viability/ wound clinic)

Workforce race equality standard (WRES) The WRES is a set of nine indicators of race equality, introduced for all NHS providers from 1 April 2015. The expectation and requirement is for organisations to demonstrate progress in closing the difference in metrics between the treatment and experience of white and BME staff.

MCH has been working to improve staff experience in line with the nine indicators since they were introduced. The results of the yearly data collection and analysis are shared with all staff, and the Board and staff are invited to input into the yearly action plan which aims to improve the experience of staff.

Based on our performance as assessed in July 2016, the desired outcomes which have informed our latest action plan, (available on our website and intranet) are to:         

improve % of BME people in senior positions in MCH improve likelihood of BME people being appointed from shortlisting compared to white people reduce likelihood of BME staff entering formal disciplinary process maintain likelihood of BME staff accessing non-mandatory training and CPD reduce % of all staff experiencing harassment, bullying or abuse from patients, relatives or the public reduce % of all staff, and in particular BME staff experiencing harassment, bullying or abuse from staff improve % of BME staff believing that MCH provides equal opportunities for career progression or promotion reduce % of all staff, and in particular BME staff experiencing discrimination at work from their manager, team leader or other colleagues maintain Board representation of BME staff.

We are currently analysing our data from 2016/17 and will be publishing this and our updated action plan in August 2017.

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What others say about MCH Statements from the Care Quality Commission (CQC) MCH is a social enterprise and as such is classified and inspected as an independent provider of NHS services by the CQC. This means that unlike other NHS Trusts our services are inspected by the registered locations rather than as an organisation as a whole, it is for this reason we do not have an overarching rating and report for MCH. During 2016/17 we have had three of our locations inspected:  Wisdom Hospice, including community palliative care services, day hospice and inpatient unit  MCH House, including community services for adults, children and young people e.g. community nursing, health visiting.  Amherst Court, including community inpatient services, stroke rehabilitation (Endeavour Unit) and intermediate care (Britannia Unit)

Wisdom Hospice (Palliative care services) The CQC inspection took place on 13 and 14 April 2017 and was unannounced. Overall the report was extremely positive, with no improvement actions identified. The official report stated: People said that they felt at ease receiving care from the service and relatives reported that people were in safe hands. Ensuring that staff understood how to safeguard adults and children was central to the running of the service. Staff received training and regular updates throughout the year and demonstrated that they knew how to recognise and report potential abuse.

The service provided a relaxed, comfortable and clean environment. The service had received a large number of compliments concerning the kind, compassionate and caring manner of the staff team. Staff spend time listening and talking to people and people said they were treated as individuals.

The service had a holistic approach to caring for people at the end stages of life. Supporting the person and their family members was seen as key to their well-being. Family members received support after the death of their loved one through individual or group bereavement counselling.

People’s spiritual needs were met and there was a range of complementary therapies which valued the contribution of people with a life threatening illness.

People’s individual wishes with regards to their care were recorded and the staff team advocated for people when necessary to ensure these were met. People and family members were involved in planning their care and treatment and were confident that staff explained everything to them clearly. Care plans were detailed, reviewed and updated on a daily basis.

People’s needs were thoroughly assessed before and at the time of being admitted to the service.

The staff team ensured that care and support was offered in a timely way, and services were offered flexibly depending on people’s needs. People’s care plans were personalised and contained detailed information about their preferences and advanced decisions in relation to end of life care.

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Peoples’ psychosocial, spiritual and therapeutic needs were catered for. The day hospice offered a creative and innovative programme of activities that ensured people were treated as active and valued members of the community. They were given opportunities to express their feelings and emotions through a variety of outlets including creative writing, art, photography and a quilting project.

People were able to make their views known and knew how to make a complaint or raise a concern. People were able to make their concerns known by immediately ‘texting’ them to the service, therefore, making it easier for them to do so. When complaints had been received, these had been investigated and forums held so that lessons were learned to improve the service.

There was an open culture, where people and their relatives were encouraged to share their experience of the service. Staff understood the ethos and values of the service and how to put these into practice. They felt valued, listened to and well supported. This resulted in a staff team who was motivated to give a high standard of care to people who used the service.

The service had a clear management structure and lines of accountability. There was a robust programme of clinical governance and audit to identify any shortfalls. When this occurred action plans were put in place with timescales to address these areas and monitored until completion.

Therefore, there was a process of continuous improvement of the service.

MCH House (community services for adults, children and young people) The CQC inspection took place on the 06 and 07 March 2017 and was an announced inspection.

This inspection included all of our community services registered at MCH House.

We are still awaiting the official report but initial feedback from the CQC was extremely positive with no immediate actions. Inspectors stated our staff were open and honest and they saw outstanding attributes.

Amherst Court (community inpatients) The CQC inspection took place on the 6 and 7 March 2017 and was an announced inspection. A further unannounced inspection was conducted on 15 March 2017. Amherst Court is a private residential care home run by Avante, where we operate our two inpatient units from since the closure of St Bartholomew’s Community Hospital in October 2016. Endeavour suite is our 15 bedded stroke rehabilitation unit and Britannia unit is a 20 bedded intermediate care unit.

We are still awaiting the official report but initial feedback from the CQC was extremely positive with no immediate actions. Inspectors stated our staff were open and honest and they saw outstanding attributes.

Dental NHS England site Inspections: Dental were inspected by NHS England from April 2016 through to November. All 10 community dental sites across Kent were visited by two NHS England Practice Advisors. The Service received recommendations across most of the sites for estate issues. Alterations were needed to hand basins and decontamination rooms along with documentation of site specifics, such as legionella risk assessments, copies of certificates for electrical safety and the wiring circuits and fuses within the building. All recommendations are being actioned by our estates team together with the landlords of the individual sites; some actions have already been rectified and some are outstanding, but work has been reported to the relevant facility landlords. At the time of inspection dental were in the process of implementing Buccolam Midazolam for our emergency Quality account 2016 - 2017

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drug kits and have since successfully introduced these to all community dental and DentaLine (out of hours) sites, along with training for staff and a policy to support its use.

The inspections were positive and great feedback surrounding cleanliness and organisation of the surgeries was received. The visits were positive and afterwards, staff felt more confident about future potential CQC visits.

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Our awards 2016/2017 GoToJobBoard unsung hero awards 2017 Julie Feist, MCH advanced medical receptionist and call taker at our Sunlight Centre GP surgery won a GoToJobBoard Unsung Hero Award in March 2017.

Julie was nominated by her manager after her actions one evening helped to save a man’s life. The caretaker at the Sunlight Centre found an unconscious member of the public and alerted Julie, who put him in the recovery position and called an ambulance. The ambulance team were able to treat him on site. Julie recognised him as a patient and booked him in to see a doctor so that he could continue his care.

X- pert awards 2016 In October 2016, our community diabetes team were recognised at the X-pert National Audit result Awards in the ‘biggest improvement in glyclated haemoglobin’ category.

The team was also highly commended for greatest improvement in cardiovascular disease risk factors (lipids and blood pressure).

Skills for health, health hero awards 2016 Nicola Day, assistant practitioner in the children's therapy team, was named clinical support worker - south east regional winner and Claire Mills, administrator in dementia support service, was named operational services worker – south east regional winner.

Patient experience shared learning event Our physiotherapy service was named winner in the 'providers and patients in partnership' category. The team won for their work on pelvic floor matters which demonstrated patient involvement and sustainability.

Our cardiac rehabilitation volunteers were also named runners-up in the ‘providers and patients in partnership’ category.

Molnlyke wound academy awards 2016 MCH’s tissue viability team won their award for innovation in service delivery for the pressure ulcer passport.

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Academy of Fab Stuff Penguin Award January 2017 Home First was voted by Academy of Fab Stuff as the winner of their January ‘Penguin Award’ for teamship.

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Part four: Review of quality performance Data quality Over the last year we focussed on data quality, ensuring compliance with capturing true waiting times and enabling staff to interrogate this information to drive for more timely appointments and to monitor service productivity.

Our Community Healthcare System (CHS - electronic patient record) has enabled the review of data from anywhere in the organisation. From this we are able review complaints in a timely manner or identify the training needs of staff in relation to patient documentation. Patient information is available at any time to evidence interventions to meet the clinical needs of the local population. Going forward, this information will be able to support the collection of quality outcomes such as prevention of a hospital admission or where services have supported the people we care for to go home from hospital.

Work continues to educate and train staff from across all levels of the organisation to improve understanding of the reasons for inputting accurate and timely information. This helps shape services. All information is monitored through internal business and performance meetings at the same time as understanding reasons for fluctuations. In addition, the business intelligence team has:      

regularly attended the CHS user group to be included in development discussions that may affect data quality and to feedback user-driven data quality issues worked towards standardised entry of data on CHS to align our outputs with national requirements such as the children and young people’s health services data set moved reporting for MedOCC (out of hours doctor service) from the service to the business intelligence team with the benefit being a truer picture of activity for 2016/17 year end and onwards. Data manipulation and reporting is now automated, reducing data quality errors Integrated discharge team data quality has improved via use of CHS leading to centralised reporting children’s therapy data reconfigured to be more user friendly and recorded against each discipline (i.e. physio, OT) closer working with health visiting team to improve data quality. This has led to more timely and accurate recording of activity, especially around key performance indicators (KPIs)

Information governance toolkit attainment levels The MCH Information Governance assessment report overall score for 2016/17 was 93% and was graded green, achieving level 2.

Within the six areas of assurance, 100% was achieved in all areas excepting corporate information assurance and information security assurance, where scores of 83% and 86% respectively were achieved.

To provide assurance to the Board of the quality of records, an audit of all electronic patient records was carried out. This audit included checking correct patient identifiers were used, that entries were contemporaneous, that NHS number and consent to information sharing was recorded. An overall organisation score of 84%was achieved for compliance. Action plans are in place to improve this score and to ensure compliance.

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NHS number and general medical practice code validity MCH submitted 673 records during 2016/17 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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Quality highlights from our services Adult speech and language Quality summary 2016/17  successfully completed diet audit at Medway Maritime Hospital, working with catering to implement correct dysphagia consistency foods on the menu and training for nurses  raised awareness of speech and language with the local community and staff during ‘Giving Voice’ month Quality improvement 2017/18  implementation of care pathways and therapy outcome measures  develop a singing for wellbeing group  develop a singing coaching package  establish our Macmillan Adult SLT service within Darent Valley Hospital.

Children’s therapy team Quality summary 2016/17  successfully reduced waiting times; all appointments are now offered within 18 weeks  development of a staff training pathway  commencement of therapy sessions and activities in the local community including a hydrotherapy pool, a local gym, public parks and libraries  designed and created the ‘Bugzi driving school’ – preparing children for powered mobility  successfully nominated a child for charity funding – sending them on a Dream Flight holiday of a lifetime.

Quality improvement 2017/18  work in partnership with our health visiting team to provide leadership training  embed a new early years pathway across education and health  report outcome measures based on what the child wants to achieve.

Clinical assessment service (CAS) Quality summary 2016/17  successfully secured investment to uplift service capacity  worked in partnership with sunlight centre to put two CAS clinicians in primary care in place of GP clinician – helping with GP shortage and using MSK expertise in new role.  continued investment in increasing skills – rolling programme for independent prescribing within the team Quality improvements 2017/18  working closely with CCG and MFT to develop orthopaedic pathways specific to Medway and Swale  plan to audit introduction of CAS clinicians in primary care in 2017/18, with introduction of new GP site, MCH Pentagon

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Community nursing Quality summary 2016/17  introduction of Stop boxes to support early pressure area care intervention in residential homes.  facilitated consistency of processes/ competencies/ expectations across the 24/7 continuum of care provision within the service  developed our clinical record to assist staff in achieving improved patient outcomes based on current evidence including; a sepsis identification and management process, updating the pressure area assessment in line with updated recommended best practice and developed a process to facilitate identification of vulnerable adults to support emergency planning.  facilitated a mobile IT solution to enable domiciliary patients to have a personalised plan of care, My Plan  production of SCALE leaflet to help support families understanding of skin changes at end of life,  implemented a competency framework to support staff in being able to remove PICC lines in the community, reducing hospital attendances.  introduction of Clinical triaging to ensure appropriate skill and competency allocation of staff, improving the patient experience and making best use of our clinical resource.  encouraged innovation with staff participating in a ‘Dragons Den’ Quality improvements 2017/18  further development of a more robust and intuitive communications strategy.  expanding access to ‘catheter clinics’, night sitting service, medication clinic and IV outreach service.  increasing involvement in research and looking at new ways to deliver care.

Community rehabilitation Quality summary 2016/17  Falls service has worked closely with the CCG to ensure compliance with KPIs. All clients are now being contacted by phone to triage the referrals within 24 hours – improving safety and response time to referrals.

Quality improvements 2017/18  working with fire brigade to set up a joint working initiative – improving identification of patients at risk in the community. (Fire service will offer early interventions and highlight those with greatest need to falls service plus falls service will refer to fire service for their input)

Darland House and the dementia support team Quality summary 2016/17  successfully implemented a screening tool for staff to use with patients with memory problems, providing them with the means to highlight to GPs any patients that fail the assessment  successfully implemented a training package for staff within MCH to raise awareness and education in dementia. This spans corporate induction to team training to formal classroom training – all training is written and provided in line with the National Dementia Training Framework  

successful recruited dementia links/champions within services and provided link information sessions to ensure that each service has a nominated individual who is able to provide advice and guidance provided meaningful work experience placements to students from our local schools and college, both within the inpatient area and community

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       

crisis team, de-stigmatising the myths and lack of awareness around dementia dementia support team rated as outstanding in a GAINing Insights inspection successfully recruited both administrative and health and social care apprentices into both teams provided four secondments for support workers - two into general nursing, one into mental health nursing and one into occupational therapy continue to embrace partnership working with our residents, and their families and friends through social activities including fundraising, Christmas parties and more involvement in research carried out by Dementia UK investigating the quality of care provided

by Admiral Nurses MCH becoming part of the Medway Dementia Action Alliance growing own zero hours bank at Darland House and thereby reducing need for agency cover and costs staff from both services (Darland House and the dementia support team) being nominated for Unsung Hero awards

Quality improvement areas 2017/18  commencement of MCH’s first ever piece of standalone research Dance Café at Darland House. Designed to show the link between movement and nutrition  CASCADE (see research section)  involvement in Kent-wide research investigating care outcomes in nursing homes, this is being facilitated by the University of Kent  further fundraising i.e. Memory Walk in September 2017  continued active engagement in Medway Dementia Action Alliance  dementia support team being integral to collaborative work in Medway around dementia pathways including crisis care, post-diagnostic and supporting care homes  evolution of a carers’ group held at the weekend (first in Medway). This will be facilitated collaboratively by Admiral Nurse / team leader and Carers First – an MCH idea following the work our Admiral Nurse / team leader undertook for her Dementia Fellowship.

Dermatology Quality summary 2016/17  reviewed waiting list to enable reduction of waits.

Quality improvement 2017/18  continue to monitor waiting list  work with commissioners on service redesign.

Health visiting team Quality summary 2016/17  MCH was awarded the contract to deliver a tongue-tie service for families in Medway in August 2016 and a weekly clinic is now run in a local children’s centre facilitated by an experienced tongue-tie practitioner and lactation consultant. Evaluations from parents have consistently demonstrated satisfaction with the service, improved feeding with reduced pain for breastfeeding mums as well as positive feedback recommending the service to friends and family.  a vulnerable parents pathway was developed offering additional health visiting contact and support for those most vulnerable. This includes young parents, looked after children, those with mental health concerns and learning difficulties..  the child development team was formed in January from the existing clinical support staff for Quality account 2016 - 2017

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health visitors. The team has its own management structure and is rapidly developing its role, utilising expertise that was not being fully employed previously.

Quality improvement areas 2017/18  vulnerable parents pathway to provide support with early identification of need and referral to additional services as required  child development team to work closely with the children’s therapy team and children’s centres to create robust, effective pathways and new interventions to ensure there are no gaps in provision.

Integrated discharge team (IDT) Quality summary 2016/17  now fully implemented with the use of CHS, not only for documentation of patient records but as a reporting system too. This has significantly reduced the errors in reporting and ensured our data is accurate.  increased the number of assessments being completed in Medway Hospital by streamlining several administration processes. This ensures that patients are reviewed on a daily basis to ensure their discharge destination is appropriate and individualised to meet their needs  significant improvement in the relationship and integrated working with our Medway Council team members. We have combined resources to ensure our internal processes benefit all parties working within the team but also within Medway Hospital  introduction of ‘medically fit for discharge’ meetings has enabled the hospital to have an improved overview of patients in their beds, and enabled our team to escalate issues in a productive way.

Quality improvements 2017/18  working with whole system to introduce discharge to assess model.  increasing our resource supporting A&E, to prevent inappropriate admission to hospital.

Intermediate care Quality summary 2016/17  highly successful pilot of Home First which helped to reduce DTOCs within Medway Foundation Trust over the summer of 2016 (Home First is a discharge to assess model working in partnership with Medway Foundation Trust, Medway Council and Medway CCG to ensure that clients are provided with enablement services to get them back to independence following their discharge from hospital).  successfully awarded the intermediate care contract which commenced in October 2016 to include the Home First model.  as part of the intermediate care contract we fully opened a bedded rehabilitation unit with twenty beds at Amherst Court in January 2017.

Quality improvements 2017/18  further reporting of data to evidence effectiveness of service.  working with whole system partners to develop an integrated discharge hub.  increase capacity of discharge to assess.

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Long term conditions services Quality summary 2016/17  anticoagulation service is trialling an innovative approach to help service users with their warfarin management independently  waiting times remain a challenge for the service due to increase in demand. LTC team continue to review the processes to ensure service users receive the treatment as soon as possible.

Quality improvements 2017/18  use information and technology to provide continuous support to patients suffering from long term conditions. Most importantly to empower service users to manage their condition

Musculoskeletal (MSK) physiotherapy Quality summary 2016/17  development of pelvic health service into the management of male incontinence issues, inreaching into children’s continence to bridge a gap, working with oncology patients with bowel issues following resection and radiotherapy – resulted in patient experience award at NK CCG patient experience awards  introduced a new way to measure our patients outcomes – using a specific MSK outcome measure which we will audit in 2017/18  expansion of Pilates – now nine classes a week plus staff class under health and wellbeing strategy and a pregnancy class  introduction of Aquatherapy at Splashes Leisure Centre at subsidised rate.

Quality improvements 2017/18  audit specific MSK outcome measure

Nutrition and dietetics Quality summary 2016/17  successfully developed a protocol for the appropriate prescribing of oral nutritional supplements in adults within Medway Maritime Hospital and post hospital discharge  continued to raise awareness of Nutrition and Hydration Week within hospital and community settings  improved effective working with the newly appointed nutrition nurse specialist for Medway Maritime Hospital, improving referral response times and preventing unnecessary hospital admissions for patients coming into the emergency department with problems with feeding tubes.

Quality improvement 2017/18  continue to develop the gastro pathway to reduce referrals to secondary care.  develop group sessions to support patients with long term conditions e.g. Crohn’s disease  develop an ‘Eat well’ mat to support weight loss through portion control and healthy diet.

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OurZone Quality summary 2016/17  the transport was replaced with new purpose-designed/adapted buses  created the patient portfolio – all members have a portfolio includes contact details, medical information and list of medication  successful implementation of ‘my plan’ for all members. Weekly reviews with member’s key worker to update information Quality improvements 2017/18  continue refurbishment of main building – due to open to members in the summer of 2017  collaboration with the Youth Offending Team to support a young adult with a placement within Our Zone  continue working with Medway Voluntary Action to support members with activities.

Phlebotomy Quality summary 2016/17  Improved access to phlebotomy clinics Quality improvements 2017/18  Working with MFT midwifery to develop GGTT (test for diabetes) service in the community – opening up choice of location and timings for pregnant clients.

Podiatry Quality summary 2016/17  2016 winners of the MCH in-house quality and value Recognising Excellence Award  introduced a sepsis and amputation safety cross which will help us identify common themes for admission, reflecting on best practice and areas of improvement.

Quality improvement 2017/18  currently training ward staff at Medway Maritime Hospital on ‘Touch The Toes Test’ to improve the quality of diabetic foot care for inpatients  for those patients with high HbA1c levels we will be offering a one-stop-shop appointment with the dietician and diabetes specialist nurse before seeing the podiatrist for their diabetic foot ulcer appointment.

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Customer experience and feedback Friends and Family test NHS England introduced new national guidance in January 2015, which stated that MCH needed to offer all people that use our services the Friends and Family est at any point of their care. This is a simple question which 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 2016 and March 2017 MCH received 8,171 completed surveys.

97% of these said they would recommend and only 1% stated that they would not recommend. The remaining 2% stated they don’t know or were neither likely nor unlikely to recommend.

97% would recommend MCH

The Friends and Family test is 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 January 2017 – March 2017, compared to the national average and the average of other similar independent providers of NHS care.

MCH (Jan 17)

National Average (Jan 17)

MCH (Feb 17)

National Average (Feb 17)

MCH (March 17)

National Average (Mar 17)

% recommend

98%

95%

94%

96%

96%

96%

% not recommend

1%

1%

3%

1%

2%

1%

Complaints We want everyone to have the best possible experience in our care, and patient feedback is crucial. MCH actively encourages people to share comments, compliments, concerns and complaints, through ‘Tell Us’ leaflets, via text and the website.

During 2016/17 we made approximately 900,000 individual contacts with patients, some for the first time and some for follow-up appointments in a variety of community settings. Over that time we received 156 written complaints, 37 verbal complaints, 77 grumbles (a complaint resolved to the complainant’s satisfaction by the next working day) and 47 non-lead joint formal complaints (a complaint involving more than one provider of NHS services). This is a ratio of one complaint for nearly every 3,000 contacts. One complaint was passed to the Health Service Ombudsman at the request of the complainant and was not upheld. A complaint that was sent to the Health Service Ombudsman in 2014/15 was finalised and partially upheld. A full action plan has been developed to learn from the mistakes made.

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Our complaints are divided into the following themes:  Access  Attitude  Communication  Environment  Information  Quality of Care  Waiting Times Our patients often comment on waiting times and we recognise that some services have waiting times that are longer than is reasonable. Our services have been working hard over the last year to improve the length of time a patient has to wait and work will continue to improve this in the coming year.

Sometimes patients cannot access a service because they don’t meet the eligibility criteria agreed with commissioners and this can be disappointing. Ongoing contract negotiations work to address this in partnership with commissioners.

Complaints, surveys and other patient feedback point to a need for improvement in larger services such as the out of hours GP service and Sunlight GP surgery. The main themes within these services are around managing the expectations of people who use MCH services and improving communication particularly around waiting times for appointments and changes to services.

Listening and responding Mrs M was having difficulty in arranging an asthma review at the Sunlight Centre Surgery. Mrs M explained that she tried to contact the surgery by telephone on four occasions in one day to make the routine appointment, however the phones were not being answered. MCH received similar complaints like Mrs M’s in a short space of time and it was decided that a new telephone system would be implemented. This implementation happened on 25 July 2016 and has reduced the number of complaints relating to telephone access.

We received numerous complaints regarding staff attitude throughout 2016/17. The customer experience team have created a bespoke customer care training programme for services who receive a high level of complaints. The training runs on a quarterly basis and during team meetings as well.

We also receive a vast amount of compliments from patients, which helps boost staff morale. Some examples are below: During the evening of 5 April we received excellent support from the staff during my father's last hours. Our questions were answered with sensitivity and we felt the staff were there for us as well as for my father. Everything we needed was provided, refreshments, comfortable furniture, pillows and blankets and a calm tranquil atmosphere. Derek was particularly kind and also the nurse who was with us at my father's bedside during his last moments. She stayed with us and guided and supported us with tremendous sensitivity . We will be forever thankful to the whole team for their efforts in the care of my father.

The MINT1E Course has been a new starting point for me. After 33 years of being type 1 I had started to lose the will and wished it would go away so I didn't have to deal with it. Staff have been so helpful and supportive and I now realise that I can eventually take control and deal with it. I have learnt so many new things and made me face bad habits that I have picked up over the years. I have enjoyed meeting others with similar issues and talking to people that understand how it is.

The carb counting is beneficial.

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Feedback from staff 92.17% of staff employed by MCH during 2016/17 would recommend the organisation as a provider of care to their friends and family.

In 2016/17 we have undertaken four business unit quarterly staff friends and family test surveys with a total response rate of 38%. The survey results have enabled services and business units to focus on local issues that matter most to staff.

In the last 12 months MCH has undertaken various actions to improve staff experience by increasing staff involvement through roadshows, our executive team have attended 40 team meetings, implemented a refreshed approach to our organisational newsletter, and celebrated 5 years of being a social enterprise with the Platinum award at our annual staff recognition event.

We have continually asked for staff feedback which has informed and shaped our staff health and wellbeing programme as a result of this feedback we have:     

Refreshed our staff intranet health and wellbeing pages provided free staff Pilates classes delivered a team based resilience programme that 38% of the workforce attended. 93% of those that attended rated the development of their skills as good to excellent delivered mental health awareness training to our line managers. All attendees agreed the learning could be applied to their role set up a staff health and wellbeing group that is shaping, and helping to deliver the staff health and wellbeing programme.

In 2017/18 we will continue to focus our efforts on supporting staff to manage workplace pressure, refreshing our approach to staff engagement and improving overall health and wellbeing. We will embed the role of the Freedom To Speak Up Guardians which will further support staff to speak out when they have concerns.

The table below outlines the Friends and Family staff test as a place to receive care, it demonstrates the percentage score for individual business units, for the last two reporting periods, and the comparison to other local NHS providers (quarter three data):

MCH (corporate and primary care) Q3

MCH (planned and urgent) Q4

78%

98%

Quality account 2016 - 2017

National average (Q3) Highest local provider (Q3) 69%

78%

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Example of listening to our staff Over the past year Newly Qualified Practitioners from all professions within MCH have participated in our updated preceptorship iCAPP. This was developed following evaluations and feedback received from a range of staff and has been designed to enable staff to further develop their knowledge and skills within the workplace. The programme also includes multi- professional action learning sets which serve as a safe environment for staff to discuss any concerns that they may have, with facilitators present to guide them to develop personalised action plans to address and move forward any issues raised, aiding their learning and development.

We are in the process of auditing the programme through evaluation, focus groups and questionnaires to ensure that our programme meets the needs of both staff and services.

Evaluations received to date overall have been very positive, although this work continues with a plan to produce a final report in July of this year.

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Achievement against our quality priorities 1. Patient safety 1.1.

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

Indicator

Target

Q1

Q2

Q3

Q4

Staff being bare below the elbow

=100%

100%

100%

100%

10%

Compliance with hand hygiene

>95%

95%

97%

98%

100%

Cleaning audits

>87%

94%

93%

91%

84%

Compliance with MRSA screening

=100%

93%

93%

89%

100%

Reported Cdiff or MRSA

0

0

0

1

0

Commentary: Through our annual infection prevention and control (IPC) programme our infection control team and all staff make IPC a high priority and everyone’s responsibility. We continually train staff and have link practitioners in all services who are actively involved in the audit programme. To increase responsiveness of estates cleaning issues, our estates team are now representatives on our infection prevention and control sub-committee to enable concerns to be escalated directly. We currently have a few concerns regarding some of our rented properties that do not comply with our cleaning standards and are working directly with the landlords to rectify the concerns and review service level agreements.

1.2.

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

Monthly monitoring of grade two avoidable pressure ulcers

<20 / year

2

1

1

3

Commentary: Pressure ulcers cost the NHS between £1.4 and £2.4 billion each year.

Preventing and reducing pressure ulcers is a national priority as well as a top priority for CCGs. NICE demonstrates that nutritional screening, early intervention and treatment could save £71,800 per 100,000 people. It has also been suggested that the length of hospital stay is two to three times greater for those with a pressure ulcer, than for similar cases without (30.4 days compared to 12.8 days) Utilising our internal preventing harm oversight group to monitor this quality priority and the internal pressure ulcer group as a working group, we have made significant headway in reducing the numbers of avoidable pressures ulcers acquired in our care. These directly relate to the pressure ulcer CQUIN. In addition to the CQUIN achievements, community nurses and tissue viability teams introduced stop boxes for the prevention of deterioration of pressure ulcers within residential homes,; ‘Think pressure’ training days; and the roll-out of SSKINs training to all appropriate clinical staff.

2.

Clinical effectiveness

2.1. Working in partnership with commissioners, ensure the effectiveness of patient care through the identification of measureable quality outcome

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Achieved

Achieved

Achieved

Achievement of CQUIN milestones

Achieved

Development of a quality outcome metric framework and application to four services (CAS, community nursing, respiratory and cardiology)

Commentary; This was completed in line with the outcome measure CQUIN. During 2016/17 an outcome metrics framework was developed and agreed in partnership as our future service level quality reporting model. This was implemented, agreed and being reported for four services. This work will continue to be built on in 2017/18 as one of our quality priorities.

2.2. People with suspected dementia are referred for appropriate assessment and treatment following the application of a memory screening tool % of patients who have had the memory screening tool completed and needed to be referred for specialist assessment and treatment

Increase in score indicates 14% 20% 40% 47% improved identification and application of the tool Commentary; The memory assessment tool is easily accessible for staff via our electronic patient notes system and training/advice and guidance regarding its use was disseminated to teams using a variety of methods including team meetings and presentations at governance network meetings. It provides staff with the opportunity to easily identify a memory problem in their patient, and they pass this information onto that individualâ&#x20AC;&#x2122;s GP so that it can be followed up. Use of the tool is monitored on a monthly basis and results are shared through the Preventing Harm Oversight Group.

The results indicate a significant increase in the appropriateness of the application of the tool due to the increased referral rate.

3. Patient experience 3.1.

Utilise the friends and family test across services as part of our patient experience (national benchmarking)

Organisational score of 95% of patients recommending our community services

>95%

98%

97%

98%

96%

Organisational score of 95% of patients recommending our GP services (Sunlight)

>80%

88%

95%

95%

94%

Organisational score of 95% of patients recommending our GP out of hours service (MedOCC)

>80%

98%

85%

95%

91%

Commentary: Providing a good patient experience is a high priority for all our services and this is demonstrated with consistently high friends and family test scores. We have continued to focus on increasing return rates to ensure the scores are valid and a representative sample of the people we serve. In Quarter 4 we did see a drop in our score, on investigation it was found to be mainly due to one service (nutrition and dietetics) which had a number of negative responses about the attitude of a locum member of staff. We have incorporated the friends and family test into all feedback methodologies. In 2017/18 we will find new innovative ways to listen to the people we care for and co-design our services to ensure they meet their needs.

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3.2.

Through the roll-out of ‘My Plan’, provide a shared plan designed to support the coordination of care, provide a framework for capturing patient goals, evidence effective practice and facilitate measurement of the outcomes of care.

Percentage of patients with a personalised care plan

85%

70%

70%

65%

77%

Percentage of care plans with measurable goals

85%

87%

94%

92%

92%

Commentary: Evaluations show there is inconsistency in practice across our services, in part as a result of various versions of the ‘My Plan’ documentation tool being utilised. Work has been undertaken to develop a tool on our electronic notes system that meets the needs of services with the aim of increasing consistency in personalised planning and care planning across all clinical services. This tool went live in January 2017 and now available on mobile devices. Due to this we have seen a slight improvement in score in quarter 4. The evidence does demonstrate that of the care plans that have been completed they have been completed well with measureable goals.

Although there have been improvements in the amount of personalised care plans completed it has not reached our target of 85%. We are committed to improving the personalisation of care and patient- owned care and therefore this will continue to be a quality priority and CQUIN for 2017/18.

4. Quality governance 4.1.

Through GAIN enable systematic implementation of lessons learnt arising from complaints and incidents

100% GAIN representation by clinical services

=100%

100%

92%

72%

96%

Compliance with the implementation of GAIN alerts

>85%

NA

NA

NA

NA

Compliance of lessons learnt recorded on Datix for upheld/ partially upheld complaints and incidents

>80%

72%

99%

77%

97%

Commentary: Our Governance Assurance Information Network (GAIN) is an integral part of our governance structure. Although there are valid explanations as to why the percentage attendance is low (particularly in quarter three), it does mean we do not have the assurance that the information is being cascaded and lessons are being shared and learnt, therefore due to non-achievement of this quality priority it will continued to be monitored along with other key quality assurance meeting at the quality assurance committee.

GAIN alerts were a new initiative to provide a more timely response to sharing lessons learnt and good practice. The intention was to have monthly email newsletter to heads of services with an electronic survey. This was trialled in quarter one but was not found to be helpful and increased bureaucracy, therefore the alert was adapted to be an alert email that was only sent out when an immediate action was needed to be completed e.g. IG breach information regarding blue confidential waste bins.

Compliance of recording lessons learnt has improved this year due to the increased focus and ownership by the heads of service.

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Statements We are, as always, very grateful for the comments we receive from our partners and stakeholders and would like to thank NHS Medway CCG and for their statement on our 2016/17 Quality Account.

Delivery of high quality services is of key importance to MCH and we will continue to work with all of our stakeholders during 2017/18 to ensure our services deliver to the highest standards.

Statement from NHS Medway Clinical Commissioning Group Medway Community Healthcare’s (MCH) draft Quality Account document was sent to Medway Clinical Commissioning Group for consultation and comment. The CCG has a responsibility to review the Quality Account of MCH each year, using the Department of Health’s Quality Accounts checklist tool to ascertain whether all of the required elements are included within the document.

The report is well structured and written in a format that is clear and concise with a good overview of the requirements and focus areas for quality improvement. The CCG confirms that all required areas have been included within this document in relation to the NHS Services provided or sub contracted and is an accurate reflection of achievement.

There are many references to MCHs’ achievement throughout 2016/17 with positive recognition of teams quality focused outcomes. Each service has a tailored quality improvement action plan which provides evidence of the importance MCH places on embedding quality principles across the organisation.

The CQC report following the inspection in March 2017 is still expected. The GAINing Insights programme was excellent preparation for the visit as it was comprehensive, well managed and embedded across the organisation.

MCH has identified five quality priorities for 2017/18, aligned to the 5 CQC Key Questions. These priorities were determined by wide staff and stakeholder engagement, including the CCG, and these will be cascaded within individual service plans. The CCG are in agreement with the priority areas outlined by MCH and recognise that the priorities identified are person and carer centred, appropriate and striving to be effective in improving quality, safety and patient care. The CCG would welcome the opportunity to work with MCH to ensure plans remain on track throughout the year.

To further support MCH’s strategic direction and quality framework MCH have highlighted their planned approach to audits and clinical research strategy, which provide a mechanism to directly contribute to improving quality of patient care and services. The value of staff engagement in relation to improving quality has also been recognised and plans to continue and improve this have been included.

Medway CCG is committed to working with MCH in order to progress their priorities with pace, to ensure continued improvements in healthcare delivery for the local population.

Sarah Vaux Chief Nurse, Medway CCG Quality account 2016 - 2017

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Statement from Medway Council’s Health and Adult Social Care Overview and Scrutiny Committee Representatives of Medway Community Healthcare (MCH) have attended the Committee on two occasions during 2016/17, in June and November 2016. Attendance in June (with Medway NHS Clinical Commissioning Group) was to discuss the proposal to relocate stroke beds from Barts Hospital to Amherst Court care home. The Committee was advised that the current location was not suitable for modern healthcare provision and that Amherst Court was seen as the best option given that it was a modern residential home with single en-suite rooms, lounge and kitchen areas to help with rehabilitation, more parking spaces for visitors and had available beds.

Members of the Committee acknowledged the largely positive nature of the proposal but were critical that the Committee had not been informed of the proposals at a much earlier stage, although this was a criticism directed towards Medway NHS Clinical Commissioning Group rather than at MCH. The fact that the proposed contract was only for two years was a concern to some Committee Members. The Committee was informed that this was not unusual for NHS contracts.

In response to a question from a Member, it was clarified that stroke patients would have a discrete area at Amherst Court but would be welcome to use communal areas such as the café. There were benefits for both organisations in co-location and opportunities to learn from each other. A Member queried whether locating stroke patients in a residential home might send the wrong message.

A Committee Member asked what contingency plans were in place if Avante Care, the organisation which ran Amherst Court, experienced financial difficulties. The Committee was advised that in the event that the site was to close, Medway Clinical Commissioning Group would urgently secure additional beds elsewhere following discussions with Medway Council.

The Committee agreed that the proposals did not amount to a substantial development or variation to health service provision.

At the November 2016 meeting of the Committee, a representative of MCH presented, in conjunction with a representative of Medway Council’s Partnership Commissioning team, an update on the Hospital Discharge Pathway 1 – Home First. The Committee was informed that this pilot scheme supported patients to return home from hospital and regain their independence. The pilot had taken place for a six month period from April to September 2016.

The pilot had included new ways of working, with a key feature being that reablement of the patient was delivered in the patient’s home rather than in a hospital ward or community bed. This freed up hospital beds, relieving pressure on Medway Foundation Trust.

Following the conclusion of the pilot, a new Intermediate Care contract had commenced on 1 October 2016, with Medway Community Healthcare as the lead provider.

A Committee Member stated that the figures provided in relation to the pilot demonstrated that it had been a success and it was noted that the number of people referred to the Home First pathway was above the target.

In response to Member concerns that patients could deteriorate following their initial assessment and that they may not have appropriate support at home, the Committee was advised that assessments were undertaken by an occupational therapist on a weekly basis. 90% of patients were going home with a social care package and medical support could be provided in the short term. Where patients required long term care and there had been no significant improvement within six weeks, they would be handed over to long term care teams. In the event of there being specific Quality account 2016 - 2017

Page 47

concerns about a patient, they could be referred to one of a number of partner services. There was a focus on enabling people to return to their own home as this was generally where patients wanted to be. The Committee was also informed that the demand for beds in nursing homes was reducing due to reablement work being undertaken.

General Comments ď&#x201A;ˇ Some Members of the Committee visited the Stroke Rehabilitation Unit at Amherst Court on 24 November 2016. Those attending met with the manager of Amherst Court and senior managers from Medway Community Healthcare. ď&#x201A;ˇ The Committee relies on Healthwatch Medway, which is a non-voting committee member, to feed back patient views and experiences.

This response to the Quality Account has been submitted by officers, in consultation with the Committee Chairman, Vice-Chairman and Opposition Spokesperson, under delegation from the Medway Health and Adult Social Care Overview and Scrutiny Committee.

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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 medch.communications@nhs.net or call 01634 334686.

You can become a member of our community forum. Visit:www.medwaycommunityhealthcare.nhs.uk/join-in Other languages This information can be made available in other languages and formats.

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 Visit our website at www.medwaycommunityhealthcare.nhs.uk or by scanning the following QR code into your phone:

Quality account 2016 - 2017

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Appendix A - Quality framework summary Our statements: We are safe

Our commitments: Caring for people as we would like to be cared for ourselves with the courage and support to raise and respond to concerns Enabling the safe delivery and sustainability of our services through ensuring we have the right staff, infrastructure and resources

People we care for are always protected from abuse and avoidable harm

We are effective

Preventing avoidable harm to the people we care for and our staff by learning lessons from success and mistakes Supporting our staff to have the right skills and competencies to deliver effective services in a rapidly changing environment Developing, monitoring and continuously improving quality and outcomes of care and service delivery

People’s care, treatment and support achieves outstanding outcomes, promotes a good quality of life and is based on the best available evidence We are caring

Our staff always involve and treat people with compassion, kindness, dignity and respect

We are responsive

Ensuring the people we provide services to have access to evidence based care and research opportunities Being an open and transparent organisation and developing a fair and just culture Actively listening to the people we care for and work with and implement changes to improve experiences Ensuring people we care for are involved in all aspects of their personalised care Co-designing services and pathways through actively listening to the needs of the people we serve and our staff Taking considered risks, using innovation and technology to enhance the services and the care we provide

Our services are responsive and meet the needs of the people we serve

We are well led

Our outstanding leadership, management and governance assures the delivery of high quality person-centred care, supports learning and innovation, and promotes an open and fair culture

Understanding and being responsive to the changing needs of the community we serve

Embracing our quality culture through leadership and our values to ensure a sustainable and engaged workforce Comparing with the best, not the rest; ensuring we have effective communication, governance and assurance

Our approach:  Develop the role of the Freedom To Speak Up Guardians  Safeguarding based around the family  Improve the identification and implementation of lessons learnt from successes and mistakes  Improve feedback mechanisms from incidents and concerns  Recruitment and retention strategy developed and implemented  Continue to examine and implement safe staffing models  Continue developing innovative preventing harm collaborative and initiatives  Development of intelligent real time reporting  People strategy updated and implemented - focusing on developing staff fit for the future  Build on the foundations of the Clinical Quality Outcome Metrics (CQOM) framework  Develop an organisational wide competency framework, linked to the outcome framework  Reduce duplication and improve effectiveness  Work in partnership to assist the development of our staff and the future workforce  Research strategy revised and implemented  Using evidenced based guidelines (NICE) work together with local partners to provide a smoother and safer transition.  Ensure the people we care for who have complex care needs are identified and staff have the appropriate training to be able to deliver personalised care  Building on our My Plan model of personalised care, we will look at alternative ways to deliver personalised care for all the people we care for  Regular audits to ensure we are consistently being open  Monitor the implementation of the quality framework.  Continue to develop and learn from the customer experience programme  Progress the carers care plans  Continue to ensure we are equitable for all  Find new methodologies to truly engage and co-design our services with our staff and the people we serve  Move towards a coproduction model of care delivery  Use our intelligent reporting and data to enhance the services we provide and make comprehensive cases for change  Continue to develop our links with the voluntary sector  Ensure Interoperability between our IT systems  Our future IT strategy to have quality woven in, focusing on enabling process transformation  Taking calculated risks by investing and using new technology  Implement new models of care, new roles and challenge skil mix by progressing our involvement and partnership working       

Engaging with all stakeholders to ensure quality is prioritised in service development and redesign arrangements



Continue to develop a strong leadership culture We need to compare ourselves with the best Risk management strategy reviewed and implemented Robust governance assurance framework with strong strategic direction Improve the document management process Organisational engagement with health and social care economy system wide transformation plans Assurance process in place to ensure we are getting the basics right and fully compliant with statutory regulations Learn and respond robustly to regulators, audit findings, investigations and reports into care

Appendix B - Local audit 2016/17 Local audit 2016/17 Local audit title Planned care Cardiology: Shared care re-audit

Cardiology: re-audit of heart failure referrals

Diabetes: multi-disciplinary foot clinic

Actions The percentage of patients achieving target has reduced complaints and telephone calls have both reduced  GP surgery with issues to be taken to the CCG  To monitor the time from positive echocardiogram to being seen by heart failure nurse 

To work with MFT for direct referral for echo from path lab to work



To further increase the number of patients seen within 2 weeks of discharge from hospital



CHS to allow podiatry team access to the diabetes clinics to book patients



Community Respiratory: To investigate the volume of Patient Group Directive medications issued by the respiratory team over the past year Tissue viability: Pressure ulcer prevalence in nursing homes external report

Create a caseload specifically for the clinic to monitor review times.

No actions



Continue to deliver education regarding pressure ulcer prevention and management to all relevant disciplines.



Investigation should be made to ascertain whether there is a lack of knowledge regarding appropriate equipment selection or a lack of suitable equipment being available regarding seating.



The use of pressure redistributing cushions should be promoted for those residents at elevated risk and/or with pressure ulcers in the seating area if they sit out for any period of time.

Tissue viability: A retrospective review of suspected deep tissue injury in community patients



To continue training on differentiation between moisture damage, and pressure damage and in correct staging of pressure damage

Tissue viability: Audit to pull lessons learnt from mini root cause analysis looking at the deterioration of Grade 1 pressure ulcers to Grade 2 pressure ulcers in MCH care over the period of a year.



Staff to be reminded to check previous documentation prior to documenting themselves to ensure consistency



TV to continue to deliver pressure ulcer training incorporating moisture damage vs pressure damage

Tissue viability: Pressure ulcer passport survey

Quality account 2016 - 2017



Staff to continue to offer appropriate advice and equipment to patients with Grade 1 pressure damage to prevent this deteriorating.

No actions.

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Local audit title

Actions

Therapies and children Adult speech and language therapy: Drink consistency reaudit

  

Adult speech and language  therapy: To improve patient safety by evaluating the consistencies of fluids being given to patients on the speech and language therapy  caseload at Medway Maritime Hospital Children’s therapy service:  Pooled budget therapy outcomes re-audit 

Resource ThickenUp Clear training to ward staff Speak with Tennyson ward manager re: thickener magnets Thickener magnet trial to commence on Tennyson ward.

Ward and SLT informed To take results to upcoming Nutrition Improvement (‘Transforming Care’) meeting and discuss the options available (including the possibility of using pre-prepared, soft, moist, mashed meals) To ensure diet recommendations are handed over to the patient’s family (if appropriate) following alteration Move towards different measure in special schools e.g. TOMS which is more functional way of measuring improvements.

Team to consider children on direct packages and whether or not they should actually be on intensive packages.



Clinical assessment service: Discharge outcome re-audit Local audit title Urgent care MedOCC: Prescribing for urinary tract infection

Staff to ensure that a minimum of two sessions per year for children on direct packages include school staff so that programmes can be handed over to be supported by school staff between therapy sessions.

No actions. Audit to be undertaken annually.

Actions 

All staff to be reminded that the advised length of treatment for women with an uncomplicated UTI is three not seven days



Re-audit all apparently inappropriate prescribing decisions where no documentation is evident to support that decision and feed back to Dr Collins Re-audit a sample of one month in February 2017 Repeat the audit in May for the past six months (November 16to end April 17).

MedOCC: DVT audit

 

Local audit title

Actions

Independent services Darland House: Boots pharmacy advice visit

Quality account 2016 - 2017

   

Store separately on another shelf or in plastic containers Date insulin when removed from fridge Discard the adrenaline Fridge temperature range must have some action taken and recorded

 

Contact LEC for instructions to reduce temperatures Record exact quantity of CD drug/s disposed of in the correct column of the register



Discard specified medications. Do not leave anything unidentifiable

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  

Darland House: End of Life care communication record audit

Wisdom Hospice: Audit of the documentation and communication following death on the inpatient unit at Wisdom Hospice

Quality account 2016 - 2017

Accurate documentation on the MAR sheets. There should be a written trail to ensure these are correctly followed up Mark position of patches on body maps Topical administration should be recorded/documented accordingly in relevant form. Ensure all instructions on cream document file match current MAR instructions



List the nurses who are authorized to give homely remedies; alternatively add a reference to see list of nurses administering medication at the front of MAR files



Ensure residents identified who did not have any communication/ documentation around DNACPR to have them in their files. Qualified staff to talk with the families



Ensure residents identified who did not have the End of Life care communication record to have them in their files.

Qualified staff to talk with families



Ensure residents identified who did not have funeral arrangements to have them in their files. Qualified staff to talk with families

Medical staff should continue to document death activity and new doctors should be informed of the need to do so on CHS alone rather than duplicating this in the paper notes. Regular checks should be made of the accuracy of this recording.

Reconfiguration to CHS system to be made to overcome current issues.

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www.medwaycommunityhealthcare.nhs.uk

Quality account 2016 - 2017

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Quality account 2016 - 2017

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2017

Quality account 2016 - 2017

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