CandI Quality Report 2020/21

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QUALITY REPORT

Part 1

Statement on quality from the Chief Executive

2

Introduction, language and terminology

5

Part 2

Priorities for Improvement 2020/21

12

Patient Safety

13

Clinical Effectiveness

17

Patient Experience

23

Part 3

29

What we have achieved in 2019/20

29

Quality Improvement

49

Statements of assurance for the Board

56

An overview of the quality of care offered by the NHS foundation trust: Key indicators of safety, effectiveness and patient experience

56

Participation in clinical audit

66

Participation in clinical research

67

Quality and Innovation: the CQUIN Framework

69

Care Quality Commission (CQC)

70

Data quality

73

Reporting against core indicators

76

Key qualities initiatives in 2019/20

82

Additional information as stipulated by NHS England NHS Improvement targets

91 106

Stakeholder involvement in Quality Reports

110

Stakeholder Statements

111

Annex 1: Statement of the Directors’ responsibility for the Quality Report

114

Quality Report 2019/20

QUALITY REPORT Part 1

Statement on quality from the Chief Executive It is my pleasure to present the Quality Report for 2019/20. From January 2020, normal business was dominated by our response to coronavirus and this focus will inevitably continue as we head into winter 2020/21 and face the challenges this will present. Despite this, I am pleased to report, that over the last year we still made good and steady progress

As part of this work, our Medical Director, Dr

against many of our targets.

Programme. Improving the quality of our

Achieving high standards of patient safety and experience, and good outcomes from the treatment we provide, were our three overarching priorities for the last 12 months.

We met, or partially met these, but there is clearly more work to do. This year’s priorities will include a closer focus on suicide prevention, expanding our peer workforce and refreshing our Clinical Strategy.

service users and carers about what more we need to do to keep people well in the community and give them greater choice and control over their care. We need to consider all our services and how they interact to support this aim Key to this is our St Pancras Transformation community facilities is a crucial part of our Clinical Strategy. Good community services and facilities enable people who need our support to receive help early on in their illness, reducing the impact of the illness and the need for a hospital admission. After three years of hard work, several key milestones have been reached and we are near the stage where building work to deliver these brand-new facilities can begin.

In the coming year, our new contractor, BAM,

With the close involvement of our service

will begin demolition work at Highgate East and

users we want to ensure our Clinical Strategy

the building of our brand-new inpatient facility

continues to be closely aligned with the NHS

opposite our existing hospital, Highgate Mental

Long Term Plan to expand and transform

Health Centre.

community mental health services, supported by new investment coming on stream in late 2020.

This will result in a new model of care with hospitals, GPs, the voluntary sector, social care and others, providing joined-up services, with easier access to more intensive, specialist mental health services. Our collective aim is to reduce inequalities in accessing mental health services and promote every individual’s health, wellbeing and independence.

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Vincent Kirchner, will continue talking to staff,

Ensuring our service users’ mental health and physical needs are both met was another priority last year. Achievements included embedding our physical health screening tool in patients’ electronic care-notes; increasing the number of patients whose physical health we screen; an extensive review of our physical health policies and the embedding of e-cigarette use as part of the Trust’s inpatient smoking cessation protocol.

Quality Report 2019/20

Patient safety will always be a top priority

We received a rating of Good overall following

and we partially achieved our 2019/20

a CQC well-led inspection in 2019 which

aim to promote safe and therapeutic ward

found evidence of ‘some outstanding care’ and

environments by preventing violence. Further

positive engagement with patients, carers and

steps to improve this in the coming year include

staff, including a wide range of co-production

the appointment of a dedicated Violence

work. However, it found we still face challenges,

Reduction Specialist and the introduction of a

including a high demand for acute beds;

body cam pilot led by our QI team.

caseloads that are too high in community-

More works need to be done in the area of complaints which remained at an almost identical level – 136 formal complaints compared to 132 the previous year. However, only around

based mental health and delays to both Mental Health Act assessments and serious incidents investigations. We are working hard to resolve these shortcomings.

60% of complaints were responded to within

We have continued to invest significantly in our

the target timeframe of 80%. A review of the

Quality Improvement (QI) programme which has

complaints policy is being undertaken with

flourished and is now well embedded across the

a view to senior managers having a clearer

Trust with 24 successful projects completed in

oversight of issues and resolution plans.

the last year. The QI team continues to support

Against nationally-set CQUIN targets, we did not fully meet the target to improve the uptake of flu vaccinations for frontline clinical

many initiatives and has delivered training in QI methodology, as well as working more closely with divisions on their improvement priorities.

staff although did significantly improve on our

A fundamental and unique aspect of this Trust is

2018 figures. Providing tobacco advice to 90%

the diverse community we serve and our diverse

of service users identified was also not fully

workforce. This year we have further developed

achieved, but the Trust has received excellent

The Our Staff First Project. This has been very

feedback from the ‘Getting it Right First Time’

effective in retaining and developing the Trust’s

team on our approach to smoking cessation.

own staff since its launch in 2017. Almost a

We also didn’t fully meet the CQUIN target for

fifth of bands 8a and 9 roles are now filled by

achieving 70% of second referral appointments

BAME staff – a rise of 4.5% on the previous

taking place by the required deadline. We have

year. Our Staff Survey and WRES results tell us

clear improvement plans in place which will be

that despite introducing Our Staff First, we need

monitored via our Quality & Safety Committee.

to think differently about how we create an inclusive culture where staff feel that their views and experiences are heard and there is fairness for all. This will be a key strategic priority in our refreshed Workforce Strategy and a focus of our refreshed Equality and Diversity Strategy over the coming 12 months.

You can read more about all these initiatives and others in this Quality Report. I believe it reflects our strong commitment to ensuring that we continue to improve service user and carer 3

Quality Report 2019/20

experience, and our priority of recovery-focused care and continuous quality improvement.

I look forward to continuing to work on key projects to further enhance the quality of our care and sharing the outcome of our plans and our progress next year.

The Board is satisfied that the data contained in this Quality Report is accurate and representative.

Signed:

4

Angela McNab

Jackie Smith

Chief Executive

Trust Chair

23 June 2020

23 June 2020

Quality Report 2019/20

INTRODUCTION What is a Quality Report?

All providers of NHS services in England have a statutory duty to produce an annual report to the public about the quality of services they deliver.

This is called the Quality Report.

Quality Reports aim to increase public accountability and drive quality improvement within NHS organisations.

They do this by ensuring that organisations review their performance over the previous year, identify areas for improvement and publish that information, along with a commitment

to you about how those improvements will be made and monitored over the next year.

The safety and quality of the care we deliver at Camden and Islington NHS Foundation Trust is our utmost priority. Here we focus on three areas that help us to deliver high quality services:

• Patient safety • How well the care provided works (clinical effectiveness)

• How patients experience the care they receive (patient experience).

Scope and structure of the Quality Report This report summarises how well we did

The Quality Report includes statements of

against the quality priorities and goals we

assurance relating to the quality of services

set ourselves for the last year and, if we

and describes how we review them, including

have not achieved them, what we set out

data and data quality. It includes a description

to do. We have explained why we have not

of audits we have undertaken, our research

achieved goals and what we are going to do

work, how our staff contribute to quality, and

to make improvements. It also sets out the

comments from our external stakeholders.

priorities we have agreed for the coming year and how we intend to achieve them and monitor progress throughout the year.

In addition to complying with the Quality Accounts Regulations, NHS Foundation Trusts are required to follow the guidance set out by

One of the most important parts of reviewing

NHS Improvement, which includes reporting on

quality and setting quality priorities is to seek

a number of national targets set each year by

the views of our service users, staff and key

the Department of Health. Through this Quality

stakeholders. Last year, we carried out a survey

Report, we show how we have performed

of those involved with the Trust to discover what

against these national targets. We report on a

their concerns were. From this, we drew up a

number of locally set targets and describe how

long list of priorities which we put to a public

we intend to improve the quality and safety of

vote. Our nine quality priorities for 2019 –20 are

our services.

the result of this process and were discussed and agreed by our Board.

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Quality Report 2019/20

If you or someone you know needs help understanding this report, or would like the information in another format, such as large print, easy read, audio or Braille, or in another language, please contact our Communications Department by emailing Communications@candi.nhs.uk.

If you have any feedback or suggestions on how we might improve our Quality Report, please do let us know by emailing Communications@candi.nhs.uk

Language and terminology It is easy for people who work in the NHS

deliver is safe and effective. It also helps the Trust

to assume that everyone else understands

to identify areas for improvement and implement

the language that we use in the course

necessary control systems in place.

of our day-to-day work. We use technical words and abbreviations which can make our reports difficult to understand. In this section, we have provided explanations for some of the common words or phrases we use in this report.

Carenotes is the Trust’s Electronic Patient Records system that holds the record of all patients medical and clinical information recorded by the clinical team. All staff who are directly involved with a service user/patient’s care will have some

Benchmarking

level of access to this system. This system records

Benchmarking is the process of comparing our

information such as patient demographics,

processes and performance measures to other

appointments, clinical notes, discharge

NHS Trusts. Things which are typically measured

summaries, etc. Access to this system is strictly

are quality, time and cost. Through the process

managed through specific login details for each

of best practice benchmarking, we identify the

staff and training is mandatory for all staff before

other Trusts both nationally and/or locally and

they start using the system.

compare the results of those studied to our

Foundation Trust

own results and processes. In this way, we learn how well we perform in comparison to other hospitals.

NHS Foundation Trusts in England have been created to devolve decision-making to local organisations and communities so that they are

Care Quality Commission (CQC)

more responsive to the needs and wishes of local

The CQC is the independent regulator of health,

people.

mental health and adult social care services

Improved Access to Psychological Therapies

across England. Its responsibilities include the registration, review and inspection of services and its primary aim is to ensure that quality and safety standards are met on behalf of patients.

(IAPT) IAPT is a national programme aimed at increasing the availability of talking therapies, such as cognitive behavioural therapy. It is

Datix

primarily for people with mild to moderate

Datix is a quality and safety improvement

mental health difficulties such as depression,

application that enables web-based incident

anxiety, phobias and post-traumatic stress

reporting and risk management for healthcare

disorder.

and social care organisations. The information recorded by the teams across the organisation helps the Trust to ensure the quality of care we 6

Carenotes

ICope is the name for our IAPT service and it has continued to accept referrals throughout the

Quality Report 2019/20

pandemic. Referral criteria have not changed.

developed some webinars specifically around

Along with other IAPT services we initially saw

managing wellbeing during the pandemic and

a reduction in referrals in the first few months

have recorded many of our psycho-educational

of 2020, and this has been gradually increasing

workshops and made these accessible on our

since about July. We are now at about 80% of

website. We have adapted our self-help groups

the referral numbers compared to 2019 and

(on low mood, worry and sleep) to a video group

we anticipate this will get back up to previous

format so they are available remotely.

levels delivering interventions remotely (e.g. video-sessions). We had been using a range of digital treatments prior to the pandemic e.g.

Silver Cloud, IESO and we are involved in a trial of ‘blended therapy’ treatment for Social Anxiety disorder. Next year we will take part in another blended therapy trial involving PTSD treatment.

At step 3 we have developed a brief (2-3 session) CBT-based covid coping intervention to help those who are overwhelmed by the current situation, including those experiencing significant difficulties adjusting to self-isolation or social distancing, frontline NHS or social care staff, or those who may have themselves experienced

We are aware that a small but significant

illness or bereavement related to COVID-19.

number of our service users cannot use remote

The intervention aims to enhance coping and

therapy options – for practical or clinical reasons

resilience and promote adaptive functioning,

and in November will be starting some face-

working towards strengthening and expanding

to-face clinics to ensure everyone has access to

existing support networks.

therapy.

We are aware that people with existing long-

We have adapted the service to enable us to

term physical health problems (LTCs) are

offer a quicker response to people affected

particularly vulnerable during the pandemic and

by COVID-19. Our website has a COVID-19

have adapted interventions at step 2 and step

page which contains a range of useful links

3 to address some of the specific anxieties and

and resources around psychological well-

concerns of these groups.

being, information and practical advice about

Information Governance (IG)

COVID-19.

The Data Security and Protection Toolkit

During the lock-down period we offered

(DSPT) has replaced the previous Information

everyone who was referred wherever possible,

Governance toolkit from April 2018. The

a phone call within a few days to identify any

DSPT requires organization to complete a

covid-related concerns and signpost them to

self-assessment against the ten data security

relevant information. Later on, during the first

standards as well complete an audit on the

wave these questions were integrated into our

assessment to ensure we are compliant with

assessment sessions. Depending what happens

cyber security and data protection legislations.

with the ‘second wave’ we may initiate this early phone call process again.

All staff in Camden and Islington NHS Foundation Trust (the Trust) use a range of

We have made several adaptations to our

information asset and system asset in varying

interventions in response to the pandemic. Our

forms to carry out their daily work, and these

PWP team (step 2) has continued to offer a

assets are fundamental to the successful

range of supported self-help options, with more

operation of the Trust.

emphasis on online CBT programmes (like Silver Cloud) and video or telephone sessions. We 7

Quality Report 2019/20

An Information asset is any individual item or group of information (electronic or otherwise) that can be seen as a discrete collection, has a value to the business (C&I) and supports delivery e.g. collection of paper files, a data base, electronic systems, information in the shared drive, etc.

Mental Health Law, Mental Capacity Act (MCA), and Mental Health Act (MHA) Mental Health Law and Coronavirus At the end of 2019/20 the UK was placed in ‘lockdown’ as a result of the COVID-19 pandemic. In preparation for this the Mental Health Law hub (MHL Hub) put in place measures so that staff could work from home, where possible, and to ensure that there was continuity of service across the Trust. In addition, changes in practice were introduced by the CQC in relation to the Second Opinion Appointed Doctors and by the Tribunal who introduced remote teleconference hearings and via video link. Over the next 12 months the MHL Hub will work closely with our partner agencies to ensure the Trust meets any changing requirements as a result of the pandemic which may extend to changes in the MHA and MCA legislation.

Mental Health Act Monitoring Visits Inpatient wards receive unannounced visits from the CQC every 18 months as part of its regular cycle of MHA monitoring visits. In 2019-20 the following 6 wards received a visit: Domain Area

Emerald

Dunkley

Coral

Amber

Jade

Pearl

Care Plans S132 Rights S17Leave of absence Consent to Treatment General Healthcare

Statutory requirements met Improvement required

The top three concerns raised by the CQC are:

• Consent to treatment: when seeking the patient’s consent prior to the first

adequately reflected, and copies were not

administration of medication and assessing

always shared with patients (Breach of

the patient’s capacity to consent to

Chapter 1 of the Code of Practice to the

treatment, the nature of the decision for

Mental Health Act); and

which the patient’s capacity was being assessed or the evidence for the conclusion of the capacity assessment were not recorded (when the patient was found to lack capacity) was not available (Breach of paragraph 24.41 of the Code of Practice to the Mental Health Act and Section 5 of the Mental Capacity Act); and 8

• Care plans: patients’ views were not

• Section 17 Leave: Trust form not fit for purpose.

It is noted that, in 2019/20 no concerns were raised by the CQC with regard to Section 132 rights (evidence of attempts made to explain their rights to patients, which is a considerable achievement (and had not happened since records began in 2015).

Quality Report 2019/20

The CQC findings are corroborated by internal

MCA is listed as a core skill and is therefore

assurance processes. The Trust introduced

a mandatory requirement for all clinical roles

MHA key performance indicators (KPIs) for all

including doctors to undertake this training. The

Divisions in July 2017 to reinforce accountability

Trust has set a compliance rate of 80%, which

of Operations and make non-compliance issues

was achieved in 2019/20 and will be maintained

more visible. Those KPIs will be reviewed in

throughout 2020/21.

2020/21.

Deprivation of Liberty Safeguards (DoLS)

The Mental Capacity Act (MCA)

DoLS ensure people in a care home or hospital

The Mental Capacity Act 2005 is designed to

who cannot consent to their care arrangements

protect and empower individuals who lack the

are protected if those arrangements deprive

mental capacity to make their own decisions

them of their liberty This means they are under

about their care and treatment. Examples of

continuous supervision and control, not free

conditions that might affect someone’s mental

to leave and lack the capacity to consent to

capacity are dementia, severe learning disability,

these arrangements. The Local Authority checks

brain injury or a severe mental health condition.

the arrangements are necessary and, in the

The law applies to people in England and Wales

person’s best interests and authorises DoLS when

aged 16 or over.

appropriate.

It sets out 2 legal requirements:

Of the 21 DoLS applications made by the Trust

• A two-stage test to determine if an individual lacks capacity

• Where it has been determined the individual lacks capacity and the decision is not covered under the Mental Health Act (MHA), and the decision cannot wait then a Best Interests (BI) assessment must be carried out In order to ensure each assessment covers the legal requirements, Capacity & Consent and Best Interest assessment tools are available to Trust staff via the patient electronic records and their use is monitored via a dashboard which was introduced in 2019/20 as part of the objectives of the Mental Health Law Hub. There were 749 instances where the individual was deemed to lack capacity. In most of these cases the decision was in relation to care and treatment that was then authorised under the MHA. However, there were 65 instances where a Best Interests assessment was undertaken as the decision was in relation to care and treatment covered under the MCA.

in 2019/20, 81% were granted by the Local Authority. The reasons for the Local Authority not granting DoLS were either due to the MHA being used or the patient regaining capacity before the DoLS assessments could be completed. The Trust had set the target of 80% of applications being granted and has met this target.

The Trust works in partnership with the Local Authorities of Camden and Islington in relation to MCA and DoLS where the rates of approved DoLS and the Trusts MCA training compliance are monitored.

As of 1 October 2020, the Liberty Protection Safeguards (LPS) will replace DoLS. In order to ensure a smooth transition to LPS, the MCA Lead established a working group within the Trust working jointly with the Local Authorities of Camden and Islington as part of the Local Implementation Network. Work through these forums scoped the impact the changes would make as well as ensuring plans for preparing the workforce for the change were embedded. This work will continue through 2020/21.

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Quality Report 2019/20

The National Institute for Health and Care

Patient Safety Incident

Excellence (NICE)

A patient safety incident is any unintended or

NICE provides national guidance and advice to

unexpected incident which could have, or led to,

improve health and social care. NICE’s role is to

harm for one or more patients while receiving

improve outcomes for people using the NHS and

NHS care.

other public health and social care services. Its

Quality improvement (QI)

main activities are:

• Producing evidence-based guidance and advice for health, public health and social care practitioners.

• Developing quality standards and

to improving performance by first analysing the current situation and then working in a systematic way to improve it. It is now an integral part of the quality agenda and aims to

performance metrics for those providing

make health care safe, effective, patient-centred,

and commissioning health, public health

timely, efficient and equitable.

and social care services.

Mortality

• Providing a range of informational services

Mortality rate is a measure of the number of

for commissioners, practitioners and

deaths in a given population

managers across the spectrum of health and

Risk Adjusted Mortality Index

social care.

Hospital mortality rates refer to the percentage

Camden and Islington NHS Foundation Trust is

of patients who die while in hospital. Mortality

committed to providing evidence-based care and

rates are calculated by dividing the number

ensuring that there is a process for monitoring

of deaths among hospital patients with a

compliance with NICE Guidance. Compliance is

specific medical condition or procedure, by

monitored regularly, both within the organisation

the total number of patients admitted for that

and externally through summary reports when

same medical condition or procedure. This risk

requested.

adjustment method is used to account for the

Each month, NICE releases new and updated guidance. This is circulated to the Divisional Clinical Directors and relevant Heads of Profession e.g. Pharmacy, to identify which, if any of the guidance is relevant to the Trust. A baseline assessment is completed for relevant guidance and an action plan developed to close any gaps. The action plan is monitored regularly, and updates and evidence requested from the Leads.

In 2020 the Trust will review and update the current NICE guidance policy and process with the aim of providing a more robust way to support the Trust commitment to promoting good health and preventing ill health for our service users.

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Quality improvement is a structured approach

impact of individual risk factors such as age, severity of illness and other medical problems that can put some patients at greater risk of death than others. To calculate the risk-adjusted expected mortality rate, (the mortality rate we would expect given the risk factors of the admitted patients), statisticians use data from a large pool of patients with similar diagnoses and risk factors to calculate what the expected mortality would be for that group of patients.

These data are obtained from national patient records.

Quality Report 2019/20

Risk management Risk management involves the identification, assessment and prioritisation of risks that could affect or harm the organisation or staff and patients. The aim is to minimise the threat that such risks pose and to maximise potential benefits.

Serious incident investigation Serious incidents in healthcare are adverse events where the consequences to patients, families, carers, staff or organisations are so significant that they require some form of investigation.

These cases will be investigated thoroughly, and lessons highlighted to ensure similar incidents do not happen again.

Serious mental illness (SMI) An adult with a serious mental illness will have a diagnosable mental, behavioural or emotional disorder that lasts long enough to meet specific diagnostic criteria. SMI results in serious functional impairment which substantially interferes or limits one or more major life activities.

Statistical Process Control (SPC) chart This is a way of presenting data over time that helps us understand how we are performing and whether changes that happen are due to normal variation in the system, or due to some special cause that we need to be aware of. It helps us better understand how we are doing and is particularly useful in quality improvement to help guide us in understanding whether changes we make lead to better outcomes.

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Quality Report 2019/20

Part 2

PRIORITIES FOR IMPROVEMENT IN 2020/2021 This part of the report describes the

How will these priorities be monitored to

areas for improvement that the Trust has

ensure achievement?

identified for the forthcoming year 2020/21.

The quality priorities for 2020/21 will be

The quality priorities have been derived

monitored via our governance framework within

from a range of information sources,

the Trust. Each Divisional Quality/Governance

including wide-ranging consultations. We

Forum will monitor activities for each priority

have also been guided by our performance

at operational level. The overview of the

in the previous year and the areas of

achievement of these will be through the Trust

performance that did not meet the quality

Quality and Safety Programme Board, chaired

standard to which we aspire. Finally, we

by the Director of Nursing and Quality. The

have been mindful of quality priorities at

overall assurance for the achievement of the

national level, not least the increased focus

quality priorities will be taken to the Quality and

on mortality reviews within mental health

Safety Committee which is a sub-committee of

and learning from deaths.

the Trust Board. Any risks to the achievement

How these priorities will be delivered We are confident that with sufficient energy and focus we can deliver progress with these priorities, and there will be a project plan in place to support their achievement. Each of the quality priorities above will be monitored at local governance meetings and subsequent reports presented at the Quality and Safety Programme Board, which reports to the Quality and Safety Committee. Members of the Board will sponsor relevant priorities and implementation leads will be assigned for each quality priority. This will ensure accountability in terms of oversight for each priority throughout the year with a final update to the Board in Quarter 4 of 2020/2021.

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of the quality priorities will be reported via the governance structure within the Trust.

Quality Report 2019/20

Patient Safety Priority 1

Reducing violence and aggression

New priority

Priority 2

Suicide Prevention

New priority

Priority 3

Refreshed Clinical Strategy

New priority

Priority 4

Improving Physical Health

New priority

Priority 5

Service user and carer experience

New priority

Priority 6

Expanding the peer workforce

New priority

Clinical Effectiveness

Patient Experience

PATIENT SAFETY Priority 1: Reducing Violence and Aggression Priority 1: Promote safe and therapeutic ward environments by reducing violence and aggression, conflicts and containments.

Description of the quality issue and rationale for

of staff, service users and carers, but can impact

prioritising

on the recovery of service users (NICE Guideline

Incidents of violence and aggression may also affect the perception by staff of services and service users in a manner that has a strong negative impact on the overall experience of care (De Benedictis et al., 2011 cited by NICE, 2015)

10, 2015; Mental Health Act Code of Practice, 2015).

The Trust is therefore committed to safe clinical environments for all staff, service users and visitors and has committed resources and engaged in evidence-based based interventions to tackle this issue.

A safe environment has an impact on how

Dedicated Specialist

therapeutic and safe our service users, staff and

The Trust has employed a dedicated Violence

visitors feel; service users and staff experience

Reduction Specialist/Reducing Restrictive Practice

can be negatively impacted if the environment is

(RRP) Lead who started in post in February

perceived to be unsafe.

2020. They are focusing specifically on reducing

Evidence tells us that challenging behaviours, such as aggression and violence, are relatively common in mental health settings, with potential serious consequences that can negatively affect not only the health and safety

aggressive and violent incidents, supporting staff to understand conflicts and containment patterns, and is key to our reducing restrictive practice goals. They have been working with colleagues across the Trust to embed a culture

13

Quality Report 2019/20

of identification and prevention, as well as

that we hope would impact positively in the

promoting less restrictive environments with

reduction of the use of seclusion and the service

early feedback from staff being very positive.

users experience when this intervention is

Implementing SafeWards This is an evidence-based, non-pharmacological

We continue to monitor and review all use of

clinical model known to reduce violence and

restrictive intervention via our monthly Positive

aggression in mental health inpatient settings.

and Proactive Care Group.

The SafeWard Model also places an emphasis

Reducing Restrictive Practice (RRP) Training

of psychologically-informed communication,

There is a vast amount of available evidence

structured activity and service user participation

that indicates a restrictive, overbearing and

in the day-to-day operation of wards. We have

controlling culture in inpatient settings can itself

incorporated safe ward training as part of our

increase service user frustration, gives rise to

induction and into various training programmes.

flash points, cause conflict and lead to more

The Trust worked with Bright Charity to provide

containment (Bowers et al., 2014).

staff training and support on implementation.

We hope to continue to work with SafeWards experts over the coming 12 months to continue to embed the 10 identified interventions on all our wards.

14

needed.

Our RRP Lead is delivering a bespoke training to staff that is focused on a human rights-based approach that will support staff understanding and create an extensive awareness of the impact of a restrictive environment and culture, with the

Policy review, development and

aim of reducing conflict and containment and

Implementation

so reducing restrictions and prompting a least

COVID-19 restrictive intervention protocol

restrictive approach.

The Coronavirus pandemic brought an additional

External Post-Restraint Debrief

challenge across the globe but a more unique

Nice Guidelines 10 recommends a post restraint

challenge for mental health inpatient health care

incident debrief following the use of restrictive

providers. There were concerns that restrictive

intervention. They also recommend that an

interventions will increase across care due to

independent debrief takes place within 72

implementing government guidance for people

hours. This is a unique intervention that is quite

in inpatient services.

challenging to implement.

We developed a COVID-19 restrictive

Our Trust have experts by experience who are

intervention protocol that reflects a least

working as volunteers, facilitating post restraint

restrictive approach and that also ensures that

intervention debrief. This is a unique project

people’s human rights were not impacted on

that has received positive feedback across the

while in care and gives a balance that promotes

country.

the health and safety of staff and other people.

Prevention and Management of Violence

Other guidance

and Aggression Training Standard

We have updated our seclusion policy in line

From April 2021, it will become compulsory for

with the current evidence-based and legal

all NHS Trusts to ensure that the training staff

framework to promote the use of least restrictive

receive conforms to the Restraint Reduction

principles and a human right-based approach

Networks (RRN) training standards. This

Quality Report 2019/20

requirement will be made mandatory and

We now have an established police liaison team

regulated by the Care Quality Commission.

across the boroughs of Camden and Islington

Among other aspects, the standard is aimed at

and the officers visit both the St Pancras site and

ensuring all training syllabuses across the country

Highgate sites weekly. They are supporting staff

meet the same criteria, with the overall aim

and service users with any concerns or questions

of focusing on reducing the use of restrictive

and helping with solving any major issues

interventions. C&I has engaged, and is currently

regarding incidents of violence and aggression.

working with, a provider who has been assessed

Violence and Aggression Data Collection

and certified in line with the RRN standards via the BILD Association of Certified Training. As part of the standard, and in line with other best practice guidance, the Trust is now providing refresher/update training to staff, in line with Covid IPC guidance and use of appropriate PPE.

All violence and aggression data is captured via our online incident reporting system DATIX. The Positive and Proactive Care Group, held monthly and chaired by Deputy Director of Nursing, reviews and analyses violence and aggression data regularly and discusses themes from

Implementing team safety huddles

incidents in monthly meetings with wider Trust

Safety huddles continue to be embedded across

team. All learning from incidents, suggestions

our inpatient teams as one of our interventions

on how to reduce incidents are discussed and

in identifying, preventing and managing violence

solutions disseminated to staff on the wards and

and aggression. The safety huddle is a short

various departments via the Acute and Rehab

briefing that takes place on the wards during the

Quality forums.

course of a shift involving all staff; its focus is to

With services responding to the global

quickly discuss potential escalating behaviour or risk that needs addressing and attend to it in order to prevent a potential conflict situation escalating. It is also used to feed back outcomes of interventions with service users and celebrate positive interactions during a shift.

Body Cam Pilot The Trust is also planning a Body Cam Pilot as part of its violence and aggression reduction strategy. A research article on the feasibility of using body worn camera in an inpatient mental health setting carried out by Northamptonshire NHS Foundation Trust reported a reduction in complaints and incidents following the introduction of Body Cams on an inpatient ward. The project is led by the QI team with

pandemic, this response will be the focus over the coming six months. However, we need to continue to ensure that service users and staff are working together to keep environments safe, reduce the levels of violence and aggression and continue to identify and reduce restrictive interventions.

• Development of a Promoting Safe and Therapeutic Services Strategy with targets including agreed % reductions in restraints, seclusion and restrictive interventions

• Decrease in staff assaults and increased support for staff when an assault has happened.

• To have an increase in staff and service user

input from our RRP Lead, nurses, medical staff,

positive feedback on their experiences while

OTs, psychologists and service users. The pilot

an inpatient or working on the ward

will start with two inpatient acute wards in the autumn.

• Embedding of the Relational Security model and using this to review incidents.

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Quality Report 2019/20

SUICIDE PREVENTION Priority 2: Suicide Prevention Description of the quality issue and rationale for prioritising Suicide prevention is a national and local priority.

knowledge around risk and prevention. The

A Trust wide suicide prevention initiative and

learning package the Trust intends to use has

ambition plan is being developed. This will

been successfully used at another Trust and

be rolled out during the next 12 months. Key

focuses on staff engagement with services users

to this, will be raising staff awareness and

in co-production of safety plans.

Clinical Risk Assessment and Suicide Prevention Workstream Overview A Task and Finish Group was established in

develop online training from November 2020.

2018; a multi-disciplinary group with service

The group has recommended the Zero Suicide

user and carer participation, and representation

Alliance Training is part of core training; this

from all clinical divisions has been in place since

will be recommended at the Quality and Safety

mid-2018 to review the Trust’s risk management

Programme Board in November 2020

model, training and documentation. This has been aligned to the Trust’s Suicide Prevention Strategy.

This workstream has been significantly delayed since February 2020 because of COVID-19. The Task and Finish Group reconvened in September 2020 with a focus on delivering this work in the likelihood of a continuing pandemic and recognising the pandemic’s impact on mental health need and service delivery. Overview was presented to the Quality and Safety Programme Board in January 2020 and endorsed by CCG partners.

The training schedule was developed by the Task and Finish Group with input from service users

and development; the Task and Finish Group has undertaken a review of current documentation templates and agreed to:

• Introduce a risk chronology document (reflecting an evidence base that this assists service users and clinicians assess clinical risk)

• Introduce a safety plan that is co-produced whenever possible with service users and / or carers

• Align the safety plan with the revised care planning tool

• Initial development of these tools has

and carers, divisional representation and external

commenced but has significantly delayed by

partners. The Group recommended one day

the pandemic

face-to-face core training for all clinical staff with additional training for managers. The pandemic prevents face-to-face training, and this will now be replaced with online / virtual training.

A working group and training resource will 16

Carenotes’ (Electronic Patient Record) review

The Suicide Prevention Strategy has been developed by the Task and Finish Group with input from service users, carers, divisional representation and partner agency. The draft requires further development and will be taken

Quality Report 2019/20

to the Trust’s Quality and Safety Programme

• Review and Development of Electronic

Board in Autumn 2020. The Trust is actively

Patient Record Risk Management

participating in the NCL Suicide Prevention

Documentation November 2020

Steering Group. A range of new NCL services, including a referral and support options and a Bereavement After Suicide Service will be launched in the later part of 2020 Next steps and timelines:

• Resumption of the Task and Finish Group September

• Identification of Training Development

• Development of virtual training December 2020 The review and development of the Trust’s clinical governance structure will include enhanced lessons-learnt processes and a dedicated steering group to review, support and learn from suicide deaths is recommended by the Task and Finish Group.

Project Role via Health Education England Continuous Professional Development Planner

• Sign off draft Suicide Prevention Plan October 2020

CLINICAL EFFECTIVENESS Priority 3: Clinical Strategy The Trust has largely achieved many of the

Framework for Adults and Older Adults. We

goals in the previous Clinical Strategy, including

reviewed the needs of our population and

putting expert mental health teams into GP

compared our services to national benchmarking

practices and developing specialist services

data in order to understand where to focus our

for people with specific illnesses in order

attention and investment.

to strengthen the offer of evidence-based interventions. It is therefore a good time to refresh and evolve the strategy.

The two main priorities that we will focus on over the next few years are:

• Developing a model of integrated core community mental health services

• Improving patient flow and experience We undertook a large exercise to hear the views of our service users, carers, staff and partner organisations to co-produce our revised strategy

At the peak of what we want to achieve are four broad outcomes:

• Good clinical outcomes for our service users and carers

• A satisfied workforce • Being a centre of excellence in equality and diversity

• Financial sustainability Our approach to clinical care will be:

• A recovery approach which means a strong

that addresses the ambitions of the NHS Long

emphasis on co-production of care with our

Term Plan and the Community Mental Health

service users and carers 17

Quality Report 2019/20

• A trauma-informed approach that

will require detailed knowledge of community

recognises the impact of traumatic events in

resources that people can be linked into.

the lives of people

Evidence-based mental health interventions will

• Offering evidence-based interventions • Addressing drug and alcohol problems

be protected by having clinicians that specialise in interventions for people with particular conditions. The model also includes borough-

We will expect all our teams to pay special

wide intensive teams to work with people

attention to equality, diversity and inclusion.

with very complex needs. There needs to be

They will also prioritise co-production of their

strong co-operation and easy flow between the

services with service users and carers. Our two

intensive and core teams with an emphasis on

main vehicles for improving and innovating

population-based healthcare. The model requires

will be through using Quality Improvement

newly designed community services operating

methodology and research.

longer hours and a stronger focus on prevention

Our proposed model requires investment to grow our teams in primary care to create core

and recovery which will deliver more out-ofhospital care.

community mental health teams that are aligned

Our services will operate at three population

to Primary Care Network populations.

levels; Primary Care Networks, borough-wide

A detailed analysis of each Primary Care Network population will enable us to tailor services so that they are right for that population. Everyone who works with people with mental health problems in a Primary Care Network population will function as a member of a multi-agency, multidisciplinary team or network.

Mental, physical and social support and interventions will be holistic and joined-up.

We will use a strengths-based approach that

and cross-borough or wider. The main entry points will be through the core community mental health teams, the community acute and hospital liaison services, and directly into some teams who offer a service to well defined groups. The bulk of our work will happen in the community teams.

We aim to change the way our organisation is structured so that we naturally facilitate population-based healthcare.

Priority 4: Improving Physical Health Physical Health & Infection Control

for the challenges of increased physical

Focus for 2020 – Governance, Prevention and

healthcare

Management of COVID-19 with enhanced physical healthcare for all our services users across divisions to reduce risk and prevent

• Staff Safety and Wellbeing

complications.

Activities

Key components /Drivers

Capacity Physical Health and Infection Prevention

• Staff access to information and resources • Training across Divisions, including upskilling staff for potential redeployment and potentially having to stand up services 18

• Delivery of Health Checks

and Control.

• Recruitment to Head of Nursing for Physical Health & Infection Control with the addition of two band 7s, anticipated to be in post

Quality Report 2019/20

for January 2021. In the meantime, the Trust has been committed to supporting teams and ensuring patient safety, with experienced interim staff.

• There has also been a commitment to buddy up with other MH Trusts in NCL towards standardisation and for patient safety.

• Infection Prevention and Control including the Flu Vaccination Programme Planning

• A continued priority for the Trust is to

• Development of an Inpatient Management Pathway of COVID-19 patients

• Development of a Coronavirus Library – useful resources and guidance

• Set up of fast-tracking service for medical equipment

• Early Flu Planning 2020/21 Campaign – network participation to improve uptake in NCL London, aligned to National Programme Staff will be presented with a choice of clinics to attend, including

continue to respond to the challenges

access for staff not directly employed with

of Infection Prevention and Control and

the Trust e.g. ISS, agency, NHSP etc. Also

COVID-19. Substantial investment has been

includes service users and inpatients

made to developing the IPC Team, with recruitment of three additional posts, Head of Nursing for Physical Health and Infection Control and two Band 7 posts.

• Alignment with DIPC Network and NCL IPC critical Friend Network, and Consultant Microbiologist to monitor, audit and develop IPC

• BAF COVID-19 – supported with one

• Increased number of peer vaccinators this year, more than double on last year.

• Investment in IT software, to monitor flu vaccine uptake, stock and build a trajectory towards success of 90% uptake.

Advanced Physical Health Training

e.g. when to test, how to test, results,

The Trust is committed to education and upskilling of staff, recognising it’s crucial to sustainability and provision of

cohorting patients and the development of

physical health services.

designated areas, risk assessment, wearing

In 2020, 20 staff were funded to attend formal

pager guidance and relevant links for timely, relevant, evidence-based practice

of masks and access to personal protective equipment and discharging patients.

Development of a service for symptomatic staff testing, aligned to the Gov.UK testing.

As capacity increases, consideration will be given to testing of staff in designated “hot areas” and potentially rolled out to all clinical patient facing staff.

training courses for the Physical Assessment in Mental Health (11) and Physical Health Assessment and Management (9) modules at North Middlesex University. These courses are a requirement towards being able to undertake the non-medical prescribing.

Additionally, Venepuncture and ECG training has been provided, the latter in byte size sessions in clinical areas. Staff feedback has been positive and demand for these sessions continues to increase, example of the phlebotomy training is attached together with the competency 19

Quality Report 2019/20

framework for sign-off; risk assessments support face-to-face training both internally and externally. The Practice Development Nurses and Consultant Nurse for Physical Health and Infection Control have also provided a framework of bespoke training to clinical areas e.g. Topaz programme attached and are proactive in upskilling staff Trust wide.

• Working on Deteriorating Patient – Resus Equipment Training and Audit, new policy due to be published.

• Escalating concerns SBAR • Health Promotion / Management of LongTerm Conditions (Physical Health Policy / Lester Tool) this is built into the Physical Health Screening Tool; this data informs the Dashboard.

• Sexual Health / Safety QI Project on Ruby ward (PICU). 8th Annual White Ribbon Event 6 November 2020, via MS Teams. Key topics included C&I’s road to becoming a trauma-informed organisation, FGM and Mental Health Care, and Dowry Payments and Domestic Servitude.

• The Smoking Cessation Policy has been

Physical Health Screening focus on the six cardiometabolic parameters of the Lester Tool. The National Screening Programme is also incorporated.

Collection of the screening data supports care planning, onward clinical referral and long-term condition management Contingency plans have included being able to step up and provide physical healthcare provision in a mental healthcare setting, e.g. oxygen therapy, NEWS2 monitoring and SBAR for escalation (all transfers out to acute services for “ill-health are reported on Datix, and have been well-managed and appropriately).

We explored the limits of physical health management possible in a mental health setting with an awareness that our acute hospital colleagues, LAS and other health resources will be stretched to an extraordinary degree. We aim to provide the best possible care on-site to

refreshed and embeds evidence-based

deteriorating and seriously physically ill patients

practice, launched for Stoptober.

until transfer out to an appropriate setting is

• Falls Prevention and Harm Reduction work continues to be effective.

• Pressure Ulcers – safeguarding input • Development of Medical Management for C19 Inpatients

• Patient Safety/Staff Safety – World Patient Safety Day

• Phlebotomy now part of the Newly Qualified Nurses Development Programme

possible.

Clinical Pathways (as above) With expert advice and support provided by colleagues in the acute sector we have developed Clinical Guidance/Medical Management for inpatients. This includes considering their, respiratory conditions, infectious diseases, Microbiology and End of Life Care.

Practice Development Topaz Ward Every Wednesday 2pm-3pm for 1 hour

20

Quality Report 2019/20

Subject

Date

Deteriorating Patient

17th June

Topics being covered

Further information

• NEWS2 (dot and plot) • Why our patients become medically unwell e.g. diabetes/COVID-19/ physical health problems

NEWS2

24th June

• “Talk to me in SBAR” • Wards scenarios for collapsed/ unwell patient, management and escalation

• 999 Calls ECG

1st July

• Revision Anatomy/Physiology

Diabetes

8th July

• Type 1 & Type 2 • Management of Hyper/Hypo • Referral – Diabetic Team • Care of feet, teeth and eyes – onward referral

Depot administration and Medicines Management

15th July

• CDS – Ordering, recording, checking, destroying

With input from pharmacy colleagues

• Prescribing • Administration • Responsibility, accountability, Law

Clinical Governance

22nd July

• Incidents • Shift management (coordinators competencies)

• QI • Audit • Research • Patient Safety/Learning from incidents Smoking Cessation

29th July

• Physical Health Screening Tool

Prep for the session -

• Level 1 Very Brief Advice

Goggle CQUINS 20/21

• CQUINS

https://elearning.ncsct.

• NRT/E-Cigs

co.uk/england

• Level 2 Training

21

Quality Report 2019/20

Physical health driver diagram V1.2 Aim

Staff access to information Enhanced physical healthcare for all of our service users across all divisions to reduce their risk factors for complications from COVID-19

Activities

Key drivers •

Update physical health dashboard to include shielding and at risk group filters for targeting service users (Sep-Oct)

•

Promote use of dashboard (I)

Health information exchange (I) Refinement of SLAs of what services are available and how to access (PF) Map out all roles responsible for physical health and what their connections are

Training across all divisions

Advanced physical health training – who to do and how to use once trained Long term condition management (first get date about transfers due to LTCs)

Delivery of routine physical health checks

Other areas of note: Phlebotomy – training model under development Single resuscitation bag procurement underway No-smoking policy requires refresh Pharmacy proposal to bring on call in house Sustainability of twice a week Clozapine Clinic Capacity of physical health/infection control resource Proposal to step down IPU meetings

Wave 2 upskilling – incl. review of who has already been trained (Sep) Address gaps in medication monitoring as a result of COVID-19 (I) Review of physical health tool (I) Supporting service users to access community physical health (inpatient and community) (I) Supporting service users to access national screening programmes and sexual health (inpatient and community) (I & PF) Flu vaccinations – staff and service users (F) (Sep-Mar)

* = COVID wave 2 preparation priorities I = Integration; PF = Patient Flow; F = Flu

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Quality Report 2019/20

PATIENT EXPERIENCE Priority 5: Service User and Carer experience The Director of Nursing commissioned Leeds Beckett University to undertake a review of patient experience.

Overview of current status Underpinning the review are statutory and non-statutory measures and includes engagement with other agencies like Care Opinion, Healthwatch, research / guidelines (publications) and good practice from other healthcare organisations.

The review has included

• More than 30 interviews of senior and middle level managers

• Engagement with service users • Case study interviews with staff in areas where good examples of patient feedback activities were identified

• Engagement with staff including frontline staff at Divisional Quality Forums and Governance groups

• Interviewing Executive members, Chair, CCG staff, Governance staff, Informatics and Divisional and Clinical Directors

The review is in the final phase with reviewers completing planned engagement with staff identified at the Acute Quality Forum on Wednesday 7th October 2020. The final report is anticipated at the end of October 2020.

Preliminary Findings • Managers and staff have different views of what is happening around patient experience, although there are good examples of patient experience activities

• Patient involvement has a good reputation • Patient experience is not integrated with patient involvement

• The Trust recognises the value of patient and carer experience but there is a lack of

Recommendations to include; • Integration of experience and involvement • Triangulation of patient, carer and staff feedback

• Executive champion to provide leadership and consistency

• Emphasis on data capture and analysis • Invest in people with lived experience

clarity about integrating experience

• A clear model or framework is needed to collect and analyse patient experience information

23

Quality Report 2019/20

The Side by Side Network The Network was started in the Spring 2016 by Beverley Chipp and Cerdic Hall, co-producing with a group of founder members who are still with the Practice Based Advisory Committee, which is representative of the wider network.

The purpose of the group:

• To be a voice for mental health service users

than to take up individual cases, after it was raised as a problem.

• The Network would like to develop closer relationships with the research teams at the Trust The Network does not meet regularly in person but is email-based. Members of the Network report into the Practice-Based Advisory Committee, which meets monthly.

of the Trust and increase coproduction with professionals within the Trust.

• To distribute information to our network on relevant subjects

• To feed into the Practice-Based Advisory Committee and provide a pool of lived experience

• To reach beyond the “usual suspects” of service user involvement and be the voice of those who do not have a regular connection with the Trust but who have a mental health diagnosis. The Network aims to bring in people who might not be able to get to meetings, or who live in Kingston which is an impractical distance from St Pancras.

• The Network is service user-led, and in meetings it works by consensus.

Goals and achievements • The Network has a good relationship with

• Members have collaborated with staff to draft literature designed for service users leaflet about services, surveys, letters and information sheets

• Advice on writing role descriptions for user involvement with staff and distributed opportunities to the Network mailing list, including service user involvement and research involvements with other organisations

• The research opportunities from other organisations have been good, and many offered training in such things as interviewing or thematic analysis and upskilled the bank of service users.

• COVID-19 changes; After it became clear that remote meetings were costing several

the Community Division and staff from

service users a significant amount in

Primary Care Mental Health teams in both

data costs, (not everyone has broadband

boroughs attend meetings.

at home and connect using a PAYG

• There are connections with many outside organisations.

• The Network would like to increase membership, and to monitor diversity in membership. A questionnaire on bullying has been developed, which will be rolled out to explore the extent of the issue, rather 24

Examples of activities over the last year

smartphone), the Network proposed an increase in reward and recognition rate of £5 per meeting allowance for data costs, which was granted by the Trust Service User Alliance meeting in July 2020.

• Health and equalities for inpatients; The Network became aware that service users

Quality Report 2019/20

who were vegan on the wards were poorly-served by limited menu options. Through the Pancras User Forum, this was raised with the Contract Manager who arranged for the range of vegan meals to be increased. This improved the diet of not only vegans, but expanded the range of options suitable for many minorities who do not eat beef or pork, or who have halal or kosher diets.

• Lockdown made us realise that the extent of digital exclusion was far greater and more diverse than we had known. Technical and digital support for service users who were struggling to stay in contact with both service user groups and meetings with staff has been a constant activity since April 2020.

• The introduction of MS Teams by the Trust created a more unequal platform for Network involvement as without an NHS email address Network members attend only as guests, and are not able to see the channels and files shared, sometimes not able to raise a hand and have a more limited range of the Teams features, compared to staff. This is a new structural inequality in terms of co-production.

• The Network contributed to the Digital Consultation Working Group survey on digital consultations and star of the year nominations.

EXPANDING THE PEER WORKFORCE Priority 6: Excellent service - really helped me focus on my needs - I couldn’t ask for a better coach The aim of the Peer Coaching Service is to support the development of each client’s sense of health and wellbeing and their ability to self-manage their long-term conditions by working in partnership across service and organisational systems to deliver personalised and inclusive care and support by:

• Empowering and motivating people to be able to take more control in choosing their support by providing coaching, facilitation and information

• Respectfully exploring goals and challenges for clients experiencing or at risk of experiencing a combination of mental and physical health issues

• Providing a non-judgemental and safe space for clients to develop and operationalize their recovery plans and improve their wellbeing

• Utilising a diverse range of examples of recovery, as illustrated by the lived and working experience of the team The Peer Coaching Service aims to promote and sustain organisational and systemic improvement to service delivery through: 25

Quality Report 2019/20

• Working towards the development of an

Choice and Control Peer Coaching Service

asset-based, peer-led culture by promoting

2019/2020

high-quality peer working through collaborative

Referral reporting

training, education and development with other peer working providers and groups

• Developing a peer coaching cadre for transition into employment in positions throughout the trust as they arise.

• To assist the development of standards of practice related to peer working recruitment, retention and service provision.

Referrals Monthly average Clients seen Client contacts Average sessions for completers Clients currently open SMI clients

236 19 203 1,100 8 127 11%

Primary care remains the key location for the

Service History

work of the team, with the largest referrer being

The Choice and Control Peer Coaching Service

General Practitioners with 46% of all referrals

(CCPCS) has undergone rapid expansion and

coming from this group. Organisationally,

development during the three years of its

GPs were the largest referrer with nurses from

operation. It has collaborated with the Trust,

physical and mental health specialities referring

CCG, third sector and councils to develop

regularly along with local social prescribing

its methods and reach other partners to

navigators.

improve the quality of its training and support

There is a high degree of satisfaction with

infrastructure.

the model. Clients appreciate the flexibility of

Key Points

location and timings of sessions. The activity of

• The CCPCS has developed its work through

the team includes benefits support, linking with

delivering high volumes of contact with

employment and volunteering opportunities,

relevant clients.

advocacy and promoting self-management of

• The CCPCS is well-placed to work with key populations in a manner that meets multiple strategic agendas simultaneously

• CCPS has developed a high-quality coaching approach, facilitatory style and flexible approach that is engaging clients well and impacting on their wellbeing

• The CCPCS has been a leader in the development of local Peer Working initiatives including a Peer Involvement Network and training programme.

conditions. They also promoted physical activity, helped clients challenge loneliness and promoted social prescribing. Crisis planning and drawing together overall care plans was a feature of peer coaching activity.

I feel as if I have a future now.

Several things I’m thinking of doing feel more possible In terms of the impact, the high ranking of the service indicates an ability to link clients up with support, help them self-manage better, assist them to find the right supports, get connected socially and to do this while feeling emotionally supported.

26

Quality Report 2019/20

My Peer Coach was very helpful.

I feel a lot better now. She didn’t tell me what to do. She made me want to change things for myself. I look forwarded to her visit.

Primary Care Network in house Peer Coach role development: The team has worked with the North Islington PCN to develop and recruit to a Health and Wellbeing Peer Coach role that will work directly with those practices to meet the need of complex clients.

Collaborations

Successful expression of interest bid to work with

The Peer Involvement Network

The team will be replicating its training as part of

The Choice and Control Team have provided leadership and input into the development of the Peer Involvement Network, a local forum of statutory and non-statutory organisations utilising peer workers that seeks to promote consistent quality of peer working, shared understandings and responses to challenges and more integration across systems.

Talk for Health Peer Coach Training Programme and Taster groups: Training collaboration with third sector organisation, 18 out of 24 Talk for Health participants have gone on to become Peer Coaches.

Won a small Catalyst Grant to deliver Talk for Health Taster groups to those of our clients who have completed sessions with Peer Coaches but

HEE to deliver a trailblazer training programme; a wider Health Education England programme of expanding the training capacity of Trusts to consistently prepare Peer Workers.

Coproduction activity

• Two improvement days with ex-clients of the service were held during the year. A variety of service design suggestions have been operationalised in response to these including the Talk for Health cafes.

• Had our service leaflet rewritten with help from service clients.

• Created several short films of Peer Coach interviews that are available on the Trust’s YouTube channel.

• We have been actively involved in QI

remain socially-isolated. Peer Coaches continue

initiatives in the Trust, and presented to STP

to facilitate Talk for Health group sessions.

QI group on Coproduction, July 2019.

Primrose A programme in Camden: The Choice

• Currently working with the QI team

and Control Team has been commissioned

to develop an operational manual and

to assist a trial of the GP-based Primrose A

programme of improvement activities.

programme in three GP practices in Camden.

The model combines Practice Nursing Coaching with Peer Coaching support for clients who are listed by GPs as having SMI and Peer Coaches have delivered more than 60 sessions to clients.

Became a partner organisation with Help on Your Doorstep (HOYD). Ease of referrals has led to an increase in referrals from them. Increased use of HOYD for navigation service

27

Quality Report 2019/20

Investment

• The Peer Coaching Team has received investment from the Trust to set up an office space. That space is being shared with the Nubian Users Forum, Islington Community Mental Health Team, and Recovery College.

• The Trust also increased its investment in the team leading to the development of trial Band 5 Senior Peer Coaching roles.

• The team delivered over the commissioned expectation, providing over 1,000 home visits to more than 200 clients.

• Apart from its core work, the team has also been active this year with the following programmes: -

• Provided a key pillar of the Primrose Project, delivering Peer Coaching to SMI clients who were also receiving extra input from GP Practices in Camden. This pilot ran in 3 Kentish Town GP Practices and is currently being evaluated.

• Completed welfare checks, triaging and referral to the Resilience Network initiative in Camden from selected GPs as part of a pilot that is now being rolled out across Camden

• During COVID-19, Peer Coaches worked across localities to support teams to manage with less staff, to reach out to vulnerable clients and to link people with practical supports during lockdown.

28

Quality Report 2019/20

PART 3 1. What we have achieved in 2019/20 Progress against the quality priorities that we set for 2019/2020 This section describes the Trust’s progress against the quality priorities that we set for 2019/20 The Trust had nine quality priorities for the year.

Priorities for improvement in 2019/20 PATIENT SAFETY

Achievement

Priority 1

Promote safe and therapeutic ward environments by preventing violence

Priority 2

Strengthen further Risk Management and Care Planning including overall risk issues in acute ward patient groups

Priority 3

Improve service user safety and staff wellbeing in communitybased teams

PATIENT EXPERIENCE Priority 4

Building a just and learning Culture

Priority 5

Agree and Implement a revised patient experience strategy

Priority 6

Improve signposting for welfare support for service users

CLINICAL EFFECTIVENESS Priority 7

Improve dementia care

Priority 8

Continue progress with Patient flow

Priority 9

Improve Service Users’ physical health care

29

Quality Report 2019/20

PATIENT SAFETY Priority 1: Promote safe and therapeutic ward environments by preventing violence – partially-achieved Description of the quality issue and

Dedicated Specialist

rationale for prioritising

The Trust has employed a dedicated Violence

Safe and therapeutic ward environments with

Reduction Specialist/Reducing Restrictive Practice

prevention of violence, reduction in restraints

(RRP) Lead who started in post in February

and responsive support for service users and

2020. They are focusing specifically on reducing

staff post-incident are Trust priorities. While

aggressive and violent incidents, supporting

progress has been made within this area, further

staff to understand conflicts and containment

achievements are required.

patterns, and are key to our reducing restrictive

Incidents of violence and aggression may also affect the perception by staff of services and service users in a manner that has a strong negative impact on the overall (De Benedictis experience of care et al., 2011 cited by NICE, 2015) A safe environment has an impact on how therapeutic and safe our service users, staff and visitors feel; service users and staff experience can be negatively impacted if the environment is perceived to be unsafe.

colleagues across the Trust to embed a culture of identification and prevention, as well as promoting less restrictive environments with early feedback from staff being very positive.

Implementing SafeWards This is an evidence-based, non-pharmacological clinical model known to reduce violence and aggression in mental health inpatient settings.

The SafeWard Model also places an emphasis of psychologically-informed communication, structured activity and service user participation in the day to day operation of wards. We have

Evidence tells us that challenging behaviours,

incorporated safe ward training as part of our

such as aggression and violence, are relatively

induction and into various training programmes.

common in mental health settings, with

The Trust worked with Bright Charity to provide

potential serious consequences that can

staff training and support on implementation.

negatively affect not only the health and safety

We hope to continue to work with SafeWards

of staff, service users and carers, but can impact

experts over the coming 12 months to continue

on the recovery of service users (NICE Guideline

to embed the 10 identified interventions on all

10, 2015; Mental Health Act Code of Practice,

our wards.

2015).

The Trust is therefore committed to safe clinical environments for all staff, service users and visitors and has committed resources and engaged in evidence-based interventions to tackle this issue.

30

practice goals. They have been working with

Policy review, development and Implementation Covid-19 restrictive intervention protocol The Coronavirus pandemic brought an additional challenge across the globe but a more unique challenge for mental health inpatient health care

Quality Report 2019/20

providers. There were concerns that restrictive

intervention. They also recommend that an

interventions will increase across care due to

independent debrief takes place within 72

implementing government guidance for people

hours, this is a unique intervention that is quite

in inpatient services.

challenging to implement.

We developed a Covid-19 restrictive intervention

Our Trust have experts by experience who are

protocol that reflects a least restrictive approach

working as volunteers, facilitating post restraint

and that also ensures that people’s human rights

intervention debriefs. This is a unique project

were not impacted while in care and gives a

that has received positive feedback across the

balance that promotes the health and safety of

country.

staff and other people.

Prevention and Management of Violence

Other guidance

and Aggression Training Standard

We have updated our seclusion policy in line

From April 2021, it will become compulsory

with the current evidence-based and legal

for all NHS Trust to ensure that the training

framework to promote the use of least restrictive

staff are receiving, conforms to the Restraint

principles and a human right-based approach

Reduction Network’s (RRN) training standards.

that we hope would impact positively in the

This requirement will be made mandatory and

reduction of the use of seclusion and the service

regulated by the Care Quality Commission.

users experience when this intervention is

Among other aspects, the standard is aimed

needed.

at ensuring all training syllabuses across the

We continue to monitor and review all use of restrictive intervention via our monthly positive and proactive care group.

Reducing Restrictive Practice (RRP) Training There is a vast amount of available evidence that indicates a restrictive, overbearing and controlling culture in inpatient settings can itself increase service user frustration, gives rise to flash points, cause conflict and lead to more containment (Bowers et al., 2014).

Our RRP Lead is delivering a bespoke training to staff that is focused on a human right based approach that will support staff understanding and create an extensive awareness of the impact of a restrictive environment and culture, with the aim of reducing conflict and containment and so reducing restrictions and prompting a least restrictive approach.

country meet the same criteria with the overall aim of focusing on reducing the use of restrictive interventions. C&I has engaged with, and are currently working with, a provider who has been assessed and certified in line with the RRN standards via the BILD Association of Certified Training. As part of the standard, and in line with other best practice guidance, the Trust is now providing refresher/update training to staff, in line with Covid IPC guidance and use of appropriate PPE. Implementing team Safety Huddles Safety huddles continue to be embedded across our inpatient teams as one of our interventions in identifying, preventing and managing violence and aggression. The safety huddle is a short briefing that takes place on the wards during the course of a shift involving all staff; its focus is to quickly discuss potential escalating behaviour

External Post-Restraint Debrief

or risk that needs addressing and attend to it

Nice Guidelines 10 recommends a post restraint

in order to prevent a potential conflict situation

incident debrief following the use of restrictive

escalating. It is also used to feedback outcomes 31

Quality Report 2019/20

of interventions with service users and celebrate

are working together to keep environments safe,

positive interactions during a shift.

reduce the levels of violence and aggression

Body Cam Pilot The Trust is also planning a body cam pilot as part of its violence and aggression reduction

interventions.

• Development of a Promoting Safe and

strategy. A research article on the feasibility of

Therapeutic services strategy with targets

using body worn camera in an inpatient mental

including agreed % reductions in restraints,

health setting carried out by Northamptonshire

seclusion and restrictive interventions

NHS Foundation Trust reported a reduction in complaints and incidents following the introduction of body cams in an inpatient ward.

The project is led by the QI team with input from our RRP lead, nurses, medical staff, OTs, psychologists and service users. The pilot will start with 2 inpatient acute wards in the Autumn We now have an established police liaison team across the boroughs of Camden and Islington and the officers visit both the St Pancras site and Highgate sites weekly. They are supporting staff and service users with any concerns or questions and helping with problem solving any major issues regarding incidents of violence and aggression.

Violence and Aggression Data Collection All violence and aggression data is captured via our online incident reporting system DATIX. The Positive and Safe Group, held monthly and chaired by Deputy Director of Nursing, reviews and analyses violence and aggression data regularly and discusses themes from incidents in monthly meetings with wider Trust team. All learning from incidents, suggestions on how to reduce incidents are discussed and solutions disseminated to staff on the wards and various departments via the Acute and Rehab Quality forums.

The next 12 months’ key priorities With services responding to the global pandemic, this response will be the main focus over the coming six months. However, we need to continue to ensure that service users and staff 32

and continue to identify and reduce restrictive

• Decrease in staff assaults and increased support for staff when an assault has happened.

• To have an Increase in staff and service user positive feedback on their experiences whilst an inpatient or working on the ward

• Embedding of the Relational Security model and using this to review incidents.

Quality Report 2019/20

Incidents resulting in harm up to March 2020

The overall trend on the number of incidents suggests continuing reduction in incidents of violence and aggression against staff and service users.

This data shows that the proportion of restraints that are prone restraints are being kept to a minimum.

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Quality Report 2019/20

Priority 2: Strengthen further Risk Management and Care Planning including overall risk issues in acute ward patient groups Identified area for improvement

• Quality and timeliness of risk information

EPR template is being developed with significant

• Review and development of Risk

feedback from clinicians and service users. The

Management Policy

• Review and development of Risk Management training

• Review and development of risk assessment

safety plan will be aligned with the Dialog + new care plan / recovery plan and be based on additional consultation with the service user representatives. This work is closely aligned with the suicide prevention workstream, which

documentation, including risk history

is supported by external stakeholder groups

summaries with the Trust’s electronic recode

pan London and with Camden and Islington

system.

Public Health Department’s development of

• Increased co-production of safety plans / care planning with service users, carers and families

• Review and development of a comprehensive evaluation framework What we have achieved This work has progressed significantly via the Trust Risk Management and Suicide Prevention Task and Finish Group, which has Trustwide divisional representation and service user and carer input. A core training programme has been drafted which will include a trauma-informed approach, a strong focus on therapeutic rapport, co-production, formulation, documentation and communication. This will be supplemented by core training for managers to ensure that staff are supported with complex risk assessment and management, clinical supervision and

34

current risk assessment and management plan

a local Suicide Prevention Strategy. A draft Suicide Prevention Plan will be taken to the Trust’s Quality and Safety Programme Board in November 2020 and will include Training options.

The finalisation and development of Risk Management and Suicide Prevention Training has been identified as a high priority in the Trusts’ Health Education England Registered Nurse and Allied Health Professional Training Plan. This enables a dedicated training resource to progress this work and recruitment to this role is planned for late 2020, (subject to the impact of the C19 pandemic).

The Task and Finish group has achieved initial policy review and identified documentation and training requirements and is aligning this work with an STP-wide suicide prevention initiative.

appropriate lessons learnt process post incident.

The Trust was in the midst of a trial of a new

Clinical safety and staff wellbeing will be integral

approach to care planning that was developed

to this training. The current documentation

with active service user and carer input when

template is under review, via the Digital

the Covid 19 pandemic lockdown happened.

Connections Forum. It is agreed that a new Risk

The trials were in Islington SAMH CMHT, SAMH

Chronology / History template will be added

HTT and EIS, but were suspended as teams

to the EPR, reflecting evidence that previous

were restricting frequency and duration of

risk is an important indicator of future risk. The

face-to-face reviews and the Care Planning

Quality Report 2019/20

process devised was reliant on in-person contact.

We are now adapting approaches in each team and responding to new team working practices so that the pilot can conclude, and an implementation plan developed Next steps/future challenges

• Completion of the multi-disciplinary Task and Finish group review

• A structured implementation plan with the completion of the review

• Development and implementation of a revised, virtual / online training programme with a dedicated resource

• A revised evaluation and ongoing governance framework

Priority 3: Improve service user safety and staff wellbeing in community-based teams Description of the quality issue and

What we have achieved

rationale for prioritising

Zoning Meetings

There has been considerable improvement in the completion of core skills training over the past

Following the audit over the summer the R&R

12 months, with overall compliance reaching

Division has now revised the Zoning Protocol to

88%. There are, however, some skills areas

strengthen the section on clients of concern and

where we have not reached target levels. The

in particular maintaining the safety of clients

critical importance of core skills training was

awaiting MHAs and will re-audit practice against

highlighted by the CQC as part of its inspection.

the revised protocol.

Core skills/mandatory training supports staff to

The zoning meetings are now business as

provide safe and effective care to service users

usual and have been vital during the COVID-19

and is at the core of safe care.

situation. This is because teams are now working

Identified areas for improvement

from the office and remotely so the function of

• Increase accessibility for Breakaway training • Increase the number of days available for, and % of staff completing, CPR and ILS training

• Plan dates well in advance to accommodate all staff and increase uptake

• Reduce number of non-attendance

staff checking in through these meetings has also become very important. In addition, the meetings are used to prioritise clients of concern as well as those shielding and to decide who will receive a phone call or a face to face contact.

The importance of having, and properly using IT is central to this.

With the lone working we are also in a changing situation; we are revising how lone working works in practice.

35

Quality Report 2019/20

Description of the quality issue and rationale for prioritising Service users’ needs are varied and can be

• Early intervention in crisis to improve outcomes and service user experience

complex. To meet those needs, the Trust is

• Input from all multi-disciplinary professionals

continuously thinking of new ways to evaluate

• Recording system to track all actions, from

the needs of patients and to deliver personalised care. One way to identify gaps in meeting service users’ needs relates to the issue of clinical risk management and how this can be dynamic in nature. To address this, community teams in the Rehab and Recovery Division have implemented daily MDT meetings. Attended by all professionals, these daily meetings provide staff with an opportunity to discuss clients of concern, urgent clinical issues and ensure critical pieces of work are not missed by the team. The meetings adopt a Clinical Zoning structured approach to support the wider MDT decide on the resources required to safely carry out the interventions required. As an outcome service users’ needs are met in a timely manner and staff feel greater support when facing issues relating to clinical risk.

Current picture Daily MDT meetings are currently taking place across many Recovery and Rehabilitation community teams, apart from a few who hold

day to day

• Recording of actions and outcomes on Carenotes

• Improved communication with inpatient services to expedite discharges

• Efficient use of resources through joint working with crisis teams

• Improved Crisis planning in relation to high intensity users How we will improve

• Effectiveness of Clinical Zoning – Consistency in standards implementation

• Effective systems for managing concerns and gaps identified

• Improved patient experience • Improved staff experience • Joint quality improvement initiatives between Recovery & the Crisis Team How we will measure success

meetings two to three times a week due to

• Compliance audit

the operation capacity of the teams. Through

• Regular review and evaluation of systems

benchmarking best practice, the Trust developed and implemented a protocol to ensure that these meetings are undertaken in a structured, standardised and consistent way to facilitate the delivery of targeted mental health, physical health and social interventions whilst enhancing collaborative and effective multi-disciplinary work to support service users in their recovery and managing difficult time and crisis. We have undertaken some audits to measure compliance against the protocol

36

Identified areas for improvement

• Monitor rates of inpatient admission • Monitor rate of repeated re-admissions under the Mental Health Act

• Measure service user experience of the service responsiveness

• Measure staff experience

Quality Report 2019/20

Core Skills Description of the quality issue and rationale for prioritising Core skills/mandatory training supports staff to provide safe and effective care to service users and is at the heart of safe care. The critical importance of core skills training was highlighted by the CQC as part of its inspection and commended the Trust on the changes that we had made because there had been a considerable improvement in the completion of core skills training over the past 12 months, with overall compliance reaching 88%. However, due to the COVID-19 pandemic most of the faceto-face training was suspended for a period to minimise cross infection risk. This meant our overall compliance figures dropped, making it challenging for the Trust to reach target levels as shown below.

37

Quality Report 2019/20

Core Skills

Target

Compliance 31st March 2020

Compliance 30th September 2020

Movement From Jan-Sep

NHS | CSTF | Fire Safety

80%

83.2%

79.21%

-4%

NHS | CSTF | Fire Warden

80%

89.6%

80.61%

-9%

NHS | CSTF | MH

80%

88.4%

85.28%

-3.1%

80%

94.1%

87.97%

-6.1%

80%

87.6%

84.80%

-2.8%

80%

88.4%

85.28%

3.1%

95%

89.5%

93.35%

+3.9%

80%

89.4%

86.31%

-3.1%

80%

94.2%

90.98%

-3.3%

80%

73.70%

66.81%

-6.9%

80%

89.3%

86.73%

-2.6%

80%

65.34%

54.83%

-10.5%

Intermediate Life Support

80%

74.48%

69.44%

-5.0%

Safeguarding Adults Level 1

80%

89.9%

85.02%

-4.9%

Safeguarding Adults Level 2

80%

91.5%

86.65%

-4.8%

Safeguarding Adults Level 3

80%

87.5%

74.72%

-12.7%

Safeguarding Children Level 1

80%

89.6%

85.71%

-3.9%

Safeguarding Children Level 2

80%

90.8%

86.21%

-4.6%

Safeguarding Children Level 3

80%

91.1%

75.22%

-15.9%

Prevent 1-2

85%

93.7%

92.41%

-1.3%

WRAP

85%

95.2%

94.84%

-0.3%

MCA

80%

80.7%

80.03%

-0.7%

MHA

80%

87.5%

88.79%

1.3%

NHS | CSTF | Infection Prevention and Control Level 1 - 3 Years NHS | CSTF | Infection Prevention and Control - Level 2 - 2 Years NHS | CSTF | Moving and Handling - Level 1 - 3 Years NHS | CSTF | Information Governance - 1 Year NHS | CSTF | Equality, Diversity and Human Rights - 3 Years NHS | CSTF | NHS Conflict Resolution (England - 2 Years | (Breakaway) Conflict Resolution - Physical Intervention Skills - 2 Years | (PMVA) NHS | CSTF | Resuscitation - Level 2 - Adult Basic Life Support - 1 Year | CPR

38

Quality Report 2019/20

Identified areas for improvement

• Increase accessibility of virtual training during the COVID-19 pandemic

• Plan dates well in advance to accommodate all staff and increase uptake

• Reduce number of non-attendance

making on whether a member of staff will progress to the next pay point.

• Maintaining the level of completion will require managers to forward plan the release of staff at a more measured pace in order to avoid spikes in demand and dropoff in completion levels. Divisions need to

What we have achieved

support their managers to work through

Most of the core skills have maintained the

levelling out the spikes which tend to occur

target 80% compliance level, despite the

between November and March.

pandemic. The increase in the number of days available for virtual Information Governance training made a huge difference. Last year’s compliance rate was 86.2% and the current figure is 93.5%, well-placed to reach the 95% required level Actions that have been put in place for improvement:

• Additional CPR and ILS social distance

Lone Working Device Description of the quality issue and rationale for prioritising Where employees work alone, personal safety is a priority consideration for the Trust. The Trust has therefore implemented policies and guidance on how to manage this risk. In addition to carrying a mobile phone, the lone workers

compliant training sessions have been made

have also been issued with lone working devices

available during the COVID-19 pandemic in

which are remotely monitored to enable a

order to meet uplift in demand.

quick response when summoning emergency

• Monthly Core Skills report will continue to be published on the intranet

• Weekly reporting will continue to enable managers to monitor trajectories at a local level and help to plan for required release of staff to attend core skills training as necessary

• Trajectories will continue to form part of this

services on activation. With these additional safety devices, the risks that lone workers face should be reduced to an acceptable level. The Trust recognises that the implementation of safe working arrangements will largely depend on robust local circumstances, local procedures and protocols which should provide staff with specific guidance in relation to lone working and associated risk reduction techniques. Lone

reporting in order to highlight pinch points

working devices are one element of how the

and to manage supply and demand for

Trust protects the safety of staff in combination

face-to-face programmes

with effective risk assessments, management

• Post-pandemic commissioning of courses will aim to flatten ‘spikes’ caused by periods

plans, checking in after visits and teams undertaking joint visits were applicable.

of concentrated high demand

• Core skills completion is now a requirement under the new Agenda for Change pay deal and will therefore form part of decision-

39

Quality Report 2019/20

Current Picture The Trust has identified over 800 communitybased staff as lone workers and are currently

• Reach the target training compliance level

leasing 580 devices. These devices are either

• Improved access to a device for all staff

a pooled device where two or more staff use it occasionally, or a dedicated device for sole use by a member of staff. Since implementation there has been a notable increase month-on-month of the number of staff using the devices.

There

are still issues with staff undertaking the training to use the device, and as a result, all staff identified as a lone worker have now had the training added to their core skills training making it mandatory. This will also allow training to notify managers of staff that are non-compliant and will ensure that new starters get this within

How we will improve

• Effective systems for managing concerns and gaps identified

• Act on feedback received from the Lone working Device monitoring agency

• Ensure all lone workers have access to a device when lone working How we will measure success

• Undertake a compliance audit of staff carrying a lone working device

their first week at the Trust. The Trust is also now

• Regular review and evaluation of systems

in the process of rolling the lone working devices

• Monitor rates of incidents were the lone

out to all wards for staff to carry when escorting patients outside on Section, to ensure their safety and the welfare of the service users when off-site.

40

Identified areas for improvement

working devices have been activated

• Measure staff experience

Quality Report 2019/20

PATIENT EXPERIENCE Priority 4: Building a just and learning culture Identified areas for improvement

• Implement the local suicide prevention strategy • Set up a group to specifically look at reducing self-harm and suicide What we have achieved:

The Fair and Just Culture programme run by

C&I’s cultural vision is working towards

Mersey Care continues to be put on hold due

creating an increasingly more compassionate,

to COVID-19 and we hope to take this forward

collaborative, connected and responsive culture

in the Spring of 2021. This programme offers

where staff and service users are valued,

insights into how to create an environment

empowered and safe. We reported last time

where staff feel supported and empowered to

that one of the ways of embracing this was via a

learn when things do not go as expected, rather

cultural collaborative where we met with other

than feeling blamed.

local Trusts and shared experiences and ideas of how to develop the culture. This initiative due to COVID-19 restrictions has been put temporarily paused until 2021.

In line with being responsive and compassionate, OD has been working closely with wellbeing to focus on supporting leadership and staff.

Throughout the first wave of COVID-19, all managers and leaders were offered some oneto-one support. Many responded positively to this. Several teams were also offered reflective spaces where the emotional impact of COVID-19 was considered and it gave participants an opportunity to talk openly and safely while supporting one another. OD is also leading on a cross-Trust project team to create these reflective spaces for all teams.

Mentoring and coaching has continued during this period. A group of experienced external coaches and mentors offered their coaching expertise to all staff affected by COVID-19. Over 70 of our staff have been part of this and are finding this very helpful.

41

Quality Report 2019/20

Priority 5: Agree and Implement a revised patient experience strategy Description of the quality issue and rationale for prioritising The Trust aims to deliver improved patient experience. We are revising the patient experience strategy, and its delivery/implementation plan. The current strategy has four over-arching principles:

• always listening, • understanding what we are told, • collaboration and co-production, and, • communication, transparency and accountability.

Identified areas for improvement

• Increase the level of engagement and involvement of service users

• Finalise and launch a clear patient experience strategy

• Increase FFT response rates, a range of feedback mechanisms and the volume of responses

• Increase participation in co-producing care plans and collaborative working in delivering quality and service improvement

• Compliance with the accessible information standard

• Improve patient access and experience for

What we have achieved As described earlier, the Trust engaged with Leeds University to provide support in delivering a strategy fit-for-purpose. Engagement with Care Opinion for partnership working has also commenced Service User and Carer Involvement The Trust is committed to promoting service user and carer involvement in all aspects of its work. Service user representation is now integral to a number of key Trust committees including the Finance Programme and Quality Boards. Operational Divisions are expected to have service user representation at Divisional Management meetings and Quality Forums

people with characteristics protected by

Managers undertaking recruitment are expected

the Equality Act 2010

to involve a service user representative in the interview panel both in face to face and MS Teams based recruitment.

42

Quality Report 2019/20

A monthly service user alliance meeting provides

Next steps/challenge:

a “critical friend forum” for managers to present

• Integration of experience and involvement

proposed changes with the Trust and to seek

• Triangulation of patient, carer and staff

feedback. In recent months, this group has taken presentations on the St Pancras re development, the Trusts response to COVID and the use of peer coaching in C&I.

feedback

• Executive champion to provide leadership and consistency

• Emphasis on data capture and analysis • Invest in people with lived experience

Priority 6: Improve signposting for welfare support for service users Description of the quality issue and

3rd party services, providers, religious settings and

rationale for prioritizing

voluntary networks etc. are all highly important

The Trust has received feedback from service

in supporting our service users to improve their

users that there is insufficient support and

quality of life.

guidance on welfare rights. They have told us that this gap is a factor in not coping with their illness

The Islington Directory, which aims to bring all the contact details of services in Islington into one place. We are at the start of this journey

Identified areas for improvement what we

and continuing to strive to make the directory

have achieved:

the place service users and carers go to, to find

• Improving signposting for welfare of service users.

Islington Council and the Trust Islington Council and Camden and Islington Mental Health NHS Trust are committed to working in partnership to improve the offer available for our

out about local community services and support networks.

The Making Every Contact Count (MECC), is an approach to ensure that every service user we come into contact with has an aim of improving their health and wellbeing. The MECC ensures that each service user is supported to take action to improve their own lifestyle by eating well, maintaining a healthy weight, drinking alcohol sensibly, exercising regularly, not smoking and

service users.

looking after their wellbeing and mental health.

We aim to do this by:

This will include signposting and working in

The Fairer Together Partnership, which has

partnership with GPs, nurses, pharmacists and

been established to bring together a range of

other specialist services.

organisations in Islington to confront the challenges

The Strength Based Approach Model, which is

local people are facing and provide equal access

used in assessments and reviews with individuals

to services. We are aware that statutory services

at both the Trust and London Borough of

have a role to play for the most vulnerable, but we

Islington. There is evidence that the use of a

cannot do it alone. The community of Islington,

strengths-based approach can improve social 43

Quality Report 2019/20

networks and enhance wellbeing for service

There are also three welfare rights advisors

users. A strengths-based approach within mental

employed by the Trust. One is in the Community

health, concentrates on the assets of individuals,

Mental Health Division representing the non-

families, groups and community organisations,

psychosis service line. The other two are in

which can allow service users to obtain a

Rehabilitation and Recovery, specifically in the

more personalised service which focuses on

South and North Camden R&R teams.

prevention and building resilience in individuals by signposting and using community resources.

Camden Council and the Trust Camden adult social care is working closely with

involve going with the person to an activity the

C&I to implement What Matters – Camden’s

first time, or phoning them to see how they got

strengths-based approach. What Matters is

on.

about working in partnership with people, focusing on what they want to achieve, looking together at their strengths, connecting them to informal support networks and community assets, and any formal support that is needed.

A main thread of What Matters is the importance of relational practice and taking the time to connect people to community support rather than just signposting them. This may

44

COVID-19 has presented huge challenges, one of which is ensuring that all those who need support receive it. The VCS, C&I and the local authority have worked closely together to develop a single point of access for voluntary sector support. This support has in some instances replaced formal care support to free up care capacity. The SPA is working well and is an area we want to further develop.

Quality Report 2019/20

CLINICAL EFFECTIVENESS Priority 7: Improve Dementia Care Description of the quality issue and

Next steps/future challenges:

rationale for prioritising

Across our services working with people living

The Trust aims to further enhance our post-

with dementia we continue to work to enhance

diagnosis offer for patients diagnosed with

our post-diagnosis services

dementia. Our Services for Ageing and Mental Health are keen to implement a wider range of clinical interventions to improve clinical effectiveness.

Identified areas for improvement

• Introduction of additional clinical interventions

• Set up a research and innovation group What we have achieved The merger of the Islington Memory Service and Dementia Navigator model is now complete and a new Team Manager and lead Consultant in post. The team is now realigning to work in an integrated way with the Primary Care Networks.

Our memory services continue to promote and support earlier diagnosis Both boroughs remain in the top three best performing CCGs for dementia diagnosis prevalence across London.

Following diagnosis, all our patients with dementia are offered an ongoing service. This provides a single point of contact for the service user and their carer(s) and a regular review.

This allows medication and care to be adjusted

In Camden Memory Service, we are introducing a formal frailty scoring at contact points within care pathway, such as at assessment and at review. This will inform physical health advice provided by practitioners and referrals to other services. We are also piloting a “recovery” planning tool which more formally identifies opportunities to undertake life story work and advance care planning with service users with dementia, and to talk about physical. Also, in Camden, our non-medical prescriber can offer service users living with dementia and their carers, intensive, and importantly ongoing support, with taking dementia medication managing its side effects and interaction with other drugs.

In Islington, the Care Home Liaison Service is expanding with occupational therapy partly funded by North PCN – part of this role will be to improve dementia well-eing and reduce behavioural symptoms of dementia in care homes through enhanced occupation and upskilling of activity coordinators.

and means that the services user doesn’t have

In order to improve the care of people living

to continually re-tell their story as their illness

with dementia across all services, jointly with

progresses.

Whittington Health NHS Trust, we offer Tier 2 Dementia training accessible to all C&I staff and colleagues from Whittington Health, LBI and voluntary sector services and care homes in Islington

45

Quality Report 2019/20

Priority 8: Continue progress with patient flow Description of the quality issue and

A programme of activities and projects are

rationale for prioritising

underway to help achieve our aim, including:

The Trust aims to improve timely access to our services, ensure that patients are assessed and receive appropriate treatment and support in the right clinical and care settings, and are able to be stepped down to suitable services when they need less intensive, or in some cases restrictive, care and treatment.

As examples, we want to ensure that services users and local people having a mental health crisis can be rapidly assessed, ideally in the community.

If they attend local Accident and Emergency Departments, we want to ensure their waiting times are minimised.

If they need an inpatient admission, we want to ensure there is a bed available straight away, and when they are clinically ready for discharge from hospital, ensure they have the right support in the community to enable that discharge to happen quickly and safely.

Patient flow involves the clinical care, physical resources and internal systems needed to get service users from the point of referral/admission to the point of discharge/transfer, ensuring comprehensive high-quality clinical treatment, care and support is offered.

The aim of the Patient Flow Programme is, by July 2021, to achieve bed occupancy of 85%, reduce our length of stay for acute beds to 32 days and eliminate the need for out-of-area placements.

The Trust current status – We have seen a gradual reduction in bed occupancy in 2020, with it dropping 90% after the summer of 2020.

Our length of stay for 2019/20 was 41 days and the Patient Flow programme aims to reduce this further, through a series of workstreams.

46

• Pilot of enhanced OT/psychology input on acute wards

• Male psychiatric inpatient care unit QI project to reduce internal referrals

• Developing standard operating procedures in the acute pathway to reduce variation

• A Consultant Lead for patient flow has been appointed in July 2020

• Collaboration with a third sector organisation to enhance the discharge team Identified areas for improvement

• Eliminating long waits in A&E • Reducing inappropriately long lengths of inpatient stay

• Reducing re-admission rates and patients with high numbers of admissions to acute inpatient care What we have achieved Work to improve patient flow continues; the MADE (Multi Agency Discharge Events) are now business as usual and bring together the acute staff, community teams, local authorities and CCG’ (Clinical Commissioning Groups) to help with discharging patients from our wards. This multi-agency work has helped to reduce the number of long stayers onwards, and also the length of time these patients stay on the wards.

The reduction in the number of long stayers was maintained and the work supporting frequently-admitted patients, which paused at the beginning of the Covid-19 period is now recommencing The next key areas of focus are on supporting frequently-presenting patients, the early identification of deteriorating patients and

Quality Report 2019/20

alternatives to admissions (where clinically

Mental Health Assessment Centre was set up

appropriate).

divert activity away from acute trusts’ emergency

The projects to address these key areas of focus are being undertaken with a QI (Quality Improvement) methodology and see the Delivery Improvement team working alongside the QI team to support front line clinical staff and managers.

Risk stratification of patients The work to improve patient flow changed emphasis during the height of the pandemic, with attention switched to managing the changing demand on C&I’s acute wards and a focus on discharging and freeing up beds.

Ways of working changed during this period; a

departments. This was well-received and a business case has been submitted to make this more permanent. The discharge team focused on all discharges, not just those without a care co-ordinator and this increased discharges at the beginning of the COVID-19 period.

Crisis Houses took step-down patients rather than just trying to prevent admissions, which helped improve discharges. All projects relating to patient flow and experience are monitored and reviewed in the monthly patient flow meeting, which reports into the Clinical Strategy Programme Board.

Priority 9: Improve Service Users’ physical health care Description of the quality issue and

partnership with primary care and other

rationale for prioritising

agencies, with a focus on chronic disease

• The Trust prioritises integrating physical health and mental health care and has made significant progress in this area as described above

• The revised Physical Health Screening Tool (PHST) is now accessible on our electronic patient record system (Carenotes)

• While there has been an increase in the number of patients being screened and treated, this remains a Trust priority.

• The appointment of a physical health lead is significantly improving systems, policies and processes to ensure physical health care is routinely and consistently assessed and monitored.

• In 2019/20 the Trust further increased use of data to improve the quality of care delivery and outcomes for service users

• The Integrated Practice Unit (IPU) continues to develop structured services for the seriously mentally ill (SMI) population in

management.

• The IPU will capture additional intelligence to further understand morbidity and mortality rates and interventions offered The Trust developed its first dedicated Physical Health Lead in 2018. Key outcomes from this role were:

• Embedding the National Early Warning Score (NEWS) that determines the degree of illness of a patient. The development and implementation of medical devices competencies

• Review and development of the physical health screening tool

• Further implementation and development of smoking cessation policy and practice

• Review and development of physical health policy and clinical protocols, including the management of Venous Thrombosis

• The introduction of e-cigarette use in 47

Quality Report 2019/20

inpatient services as part of the Trust’s

for the seriously mental ill population with

smoking cessation protocol

the Trust’s broader physical health agenda

Identified areas for improvements

• Implement the clinical dashboard to

What we have achieved: Training to promote understanding of, and

improve the governance of physical

be able to use, the physical health dashboard

health interventions, including screening /

is underway and a presentation took place at

assessment and signposting to treatment

the Executive Seminar in February 2020. In

options

the meantime, the dashboard continues to be

• Continued training of staff to ensure required competence is supported and monitored

• Improved use of data to improve practice and outcomes

• Further alignment of the Integrated Practice Unit providing physical health interventions

promoted and Divisions are being supported to access physical health screening data to support practice and improved screening performance, currently provided in a report format. The physical health team continue in partnership with IT to improve methodologies for capturing physical health data, for both screening and successive interventions.

Monthly Physical Health incident data will be reported to Divisional Performance Meetings via the Physical Health and Nutrition Group. Trends, themes and learning will then be cascaded.

The NEWS2 is now digitally available and will be piloted on Dunkley and Rosewood wards before making it available Trust wide early in 2020. NEWS2 training is now incorporated into the ILS/CPR training with our new provider.

The physical health team are represented at the Pan London Physical Health Network and have extensively contributed to the new standards. The physical health team are also contributing to developing the Trust Clinical Strategy led by the Medical Director.

Next steps/future challenges

• Review methodology for CQUIN data collection; to include the process for validation

• Weekly monitoring of completeness of data capture through automated reports and

regular audits.

• Development of training for patient-facing staff, level 1 & 2 Smoking /Alcohol

• Launch Physical Health Dashboard and associated training

Numbers of Physical Health Assessment undertaken April 2019 to Mar 2020

48

Division

Number of PH Screening Tool recorded

Acute Community Mental Health Recovery & Rehabilitation Services for Ageing & Mental Health Substance Misuse & Forensics Not Recorded

1305 53 917 425 1 83

Total

2784

Quality Report 2019/20

How were these priorities monitored to

Programme Board chaired by the Director of

ensure achievement?

Nursing and Quality.

The quality priorities for 2019/20 were

The overall assurance for the achievement of the

monitored via our governance framework

quality priorities was assured through the Quality

within the Trust. Each Divisional Quality/

Committee which is a sub-committee of the

Governance Forum monitors activities for each

Trust Board. Any risks to the achievement of the

priority at operational level. The overview of the

quality priorities will be reported via the divisional

achievement of these was through the Divisional

and corporate governance arrangements within

leadership arrangements with oversight being

the Trust.

monitored through the Quality and Safety

QUALITY IMPROVEMENT CQC report November 2019

Staff had been engaged in various ways to learn, improve and innovate and were given time to do this in their day to day roles. The Trust was committed to delivering a Quality Improvement (QI) programme and had invested in this across the organisation. The QI programme had flourished since the last inspection and was well embedded across the trust

Quality Priorities and Improvement The development of Quality Improvement methodology (QI) has been part of the C&I strategy since 2016, aiming to develop a culture of continuous improvement, with strong frontline service user and carer involvement in improvement work at the Trust. A QI team provides training in QI and supports the improvement work across the organisation The QI approach continuous to be further embedded in the Trust culture, with wider training of staff and the methodology has been incorporated into divisional business and quality agendas.

A number Quality Improvement projects led by frontline services aligned with the Quality Priorities 1-9.

49

Quality Report 2019/20

Priority 1 (safety) Promoting safe and therapeutic ward Acute Wards Violence and Aggression Reduction Collaborative

Acute ward Coral began a QI project on reducing violence and aggression in September 2018, which has seen impressive reductions in incidents with physical violence down by 83% and verbal aggression down by 64%.

We know that safety huddles are an effective way to reduce violence. When we launched the Violence & Aggression Reduction Collaborative, teams implementing Safety Huddles first before moving on to focusing on other causes of violence.

The collaborative gives teams a chance to reflect together about what has been working well and learn from each other how to overcome problems they have faced along the way.

50

Quality Report 2019/20

Priority 2 (Safety) Strengthen Risk Management and Care Planning Camden Acute Day Unit

QI projects included

• Improving care plans and compassionate

After implementation of new leaving summary

care using life story on Garnet Ward, an

days between day of discharge and discharge

older adult ward

summary being sent to GP reduced to a range of 0-10 days, with a mean of 2.9 days)

• For 100% service users to have their dual diagnosis needs recorded in their care plans in six months

• For service users on Malachite ward to know what a care plan is, be aware of its contents and satisfied that their needs have been identified.

• Improving crisis care plans in North Camden R&R

• Improving the efficiency of compiling and implementing a treatment plan informed by extended medication history on acute wards.

• Improving staff awareness and skill of minimising risk of falls.

• Development of a clear, safe and effective discharge protocol for clients within cluster 11 from secondary care to primary care, South Camden Recovery Team.

• Improving informal carers identification in the personality

25

disorder service 20

• Implementing a ‘Leaving Summary’ at the Camden Acute Day Unit.

Mean no. of days between discharge and summary production

15 10 5

0 12

34

56

78

91

01

11

2

Week 1-6: Before new summary 7-12: After new summary

51

Quality Report 2019/20

Priority 3 Improve Service User safety and staff wellbeing

Priority 5 Agree and implement a revised patient experience strategy

Surveys from team members working on QI

Quality Improvement Hub Strategy

projects suggest that they can experience better team working, an increase in psychological safety and an increase in confidence and pride.

Taking part in QI work can therefore, in itself, improve wellbeing

By co-producing QI projects with service users and their families, we will make improvements that are important to them and that align with the wider healthcare service they experience.

Involvement with a ‘little i’ means getting service

Also, the QI team have supported several

users’ ideas and feedback at certain stages of a

projects that had the explicit aim to improve

project. Involvement with a ‘bit I’ means that

wellbeing of the teams including several separate

service users are a fundamental part of the team

projects in iCope.

throughout the project. In partnership with service users and carers the QI Hub aims to:

Priority 4 Building a just and learning culture

Projects with Service User Involvement

A QI project is focusing on decreasing the

40

likelihood of BAME staff going through formal

30

disciplinary procedures across the Trust. Key change ideas have included appointing a WRES lead, reviewing the disciplinary policy, using data from pan London Disciplinary procedure analysis, creating a poster on micro aggression and BAME staff career journey. BAME staff have been offered coaching and ‘Unconscious Bias training’ is available for all trust staff.

52

(2019)

20 10

0

Quality Report 2019/20

Build Co-production 2022-2024 • Encourage staff to use their lived experience.

• Encourage staff to ‘refer’ to QI coproduction as a treatment option.

• Encourage teams to coproduce solely with people who have used their services within the last 6 months.

• Encourage staff to take a lead for coproduction in their team.

Build the Processes 2020-2021 • Co-produce guidelines on how to match service users to QI projects according to their strengths.

• Attend service user forums to understand and offer the QI support people need.

• Offer co-produced QI training from the QI Hub, Recovery College and Trust induction.

• Create pamphlet for service users describing benefits of QI and different roles and support available.

• Develop a QI induction for service users.

• Nominate a QI service user lead who helps to make judgements on which projects can be registered.

• Gain service users’ feedback on quality of QI projects in their service during project and at debrief.

• Measure impact of service user involvement on staff wellbeing.

Focus on how Co-production can Help People Recover from Mental Illness 2018-2019 • Focus on how Co-production can Help People Recover from Mental Illness 2018-2019 • Celebrate ‘early wins’ in coproduction.

• Create a service user agreement template.

• Monitor which teams are paying service users for their involvement in QI. • Partner with Service User Involvement Facilitator to share QI projects with service users.

• Invite service user to QI Hub meetings where appropriate.

• Create a service user involvement page in QI resource pack.

• Encourage project teams to involve service users. Discuss at QI training and share examples of how they have been fundamental to projects.

• Agree on and write guidance for payment of service users in QI projects and inform project teams.

• Develop a tool to measure the level of co-production in projects and services.

53

Quality Report 2019/20

Priority 7: Improve Dementia Care Several QI projects are underway in the memory service focusing on ensuring a timely and safe service for service users. These include reducing the length of time between referral and diagnosis, improving Client Satisfaction Questionnaire feedback, improving the multidisciplinary disciplinary team meeting and improving dementia navigators’ clinical time management. One project has been completed which has focused on ‘Remodelling the follow-up procedures of patients with mild cognitive impairment.’ This has led to 87 fewer overdue reviews.

Priority 8: Patient Flow The QI team is working closely with the Patient Flow and Experience group on the projects described earlier in the report and this will be a priority workstream for the QI team in the coming year. Current projects include work on reducing referrals to our psychiatric inpatient ward through outreach work, and a weekly “Big Room” event that brings team members together from across community and acute teams to work out how to improve the pathway across all quality dimensions.

Priority 9: Improving health care: Examples of projects Several services developed physical health focused projects mapping out their own process to understand where changes need to be made then either using the Trust physical health dashboard or devising their own method of measurement so that they can track the effectiveness of the change they are implementing.

For example, the Assertive Outreach Team have focused on training staff how to complete the health check and using the MDT meeting to problem solve booking in difficult-to-engage service users.

Services that worked on improving physical

developing a strong organisational culture

heath through QI projects include:

of continuous improvement.

• Complex Depression, Anxiety and Trauma team

Management System (QMS), bringing

• South Camden R&R

together quality planning and QI. The Board

• Islington Learning Disabilities Partnership

agreed to pursue this approach in 2019

• Sapphire ward • Islington Early Intervention Service.

• Assertive Outreach Team • Ruby Ward Some important milestones in the QI journey 2019/2020

• In 2019/2020 the Executive agreed to strengthen the Quality Improvement team including creating a Head of QI position.

54

• Planning for the development of a Quality

The ambition was to further support

• The QI teams, with Board approval, have already begun work on integration with project managers and the C&I Organisational Development (OD) team.

• The QI team continued to support many projects across the organisation and delivered training in QI methodology, as well as working more closely with divisions on their improvement priorities.

• From Aug 2019 to March 2020. there were 15 successfully-completed projects and by

Quality Report 2019/20

March 2020, more than 500 staff had taken

continuing to focus on supporting frontline staff

up the offer of QI training. There were

and service users lead improvement work.

131 registered QI projects on our online

Next steps on the QI Journey

platform, and these projects which will also

• Support delivery of the Clinical Strategy and

be available on the QI website by the end of

2020/21 Quality Priorities

2020.

• Continue to build QI capability and capacity

The 2019 Staff Survey shows that nearly

and celebrate the contribution of service

two thirds of the workforce feel able to make improvements happen in their area of work, which is at the higher end of national benchmarking. This is one of the main outcome measures for the QI programme Recruitment to the enhanced QI team model was delayed by the pandemic and much of the QI work was paused or disrupted in the beginning of 2020 to support the organisation through the early phases of the pandemic, but the QI

users, carers and frontline teams Develop a Quality Management System that creates local, divisional and organisational learning systems and better co-ordinates the work between governance, improvement and transformation teams within the organisation The QI team and their work are accountable to and supported by the Medical Director and the Quality & Safety Programme Board.

team have now re-started and adapted its work,

“C&I staff along with service-users know at times smoking becomes a personal thinking friend, a comfort zone, especially at times of feeling lonely, isolated, pressured, confused and the thinking of so many thoughts. Do we really believe that smoking helsp us with our mental health wellbeing?

But together we can STOP is being an unhealthy controlling HABIT by way of the individual Cessation Plan.” Paul Ware, Service User Governor Adwoa and Paul with their Driver Diagram 55

Quality Report 2019/20

STATEMENTS OF ASSURANCE FROM THE BOARD During 2019-20, Camden and Islington NHS Foundation Trust provided and/or sub-contracted the following NHS services across approximately 30 Trust sites in Camden, Islington and Kingston; together with presence in GP practices for IAPT and practice-based mental health in all three local authorities Camden and Islington NHS Foundation Trust Divisions

• Acute Adult Mental Health • Community Adult Mental Health • Services for Ageing and Mental Health(SAMH) • Recovery and Rehabilitation • Substance Misuse Services Camden and Islington NHS Foundation Trust has reviewed all the data available to it on the quality of care in each of these NHS services.

The income generated by the NHS services reviewed in 2019/20 represents 100% of the total income generated from the provision of NHS services by Camden and Islington NHS Foundation Trust for 2019/20’

AN OVERVIEW OF THE QUALITY OF CARE OFFERED BY THE NHS FOUNDATION TRUST: KEY INDICATORS OF SAFETY, EFFECTIVENESS AND PATIENT EXPERIENCE Patient Safety The Trust uses Datix to report incidents. All staff

5467 incidents were reported over the year. The

are provided with an introduction to incident

Trust continues to promote an open reporting

reporting at induction. There are online resources

culture. The Trust has maintained a steady rate

to support staff with incident reporting and

of incident reporting over the year,however there

management. The incident reporting policy

has been an overall decline in the numbers of

was updated in June 2019 and included

incidents reported over the past two years. To

clarification for staff and managers of the Trust’s

correspond with this trend, there has been an

minimum standards for incident reporting and

even more dramatic decrease over the past two

management.

years in the numbers of incidents resulting in harm

56

Quality Report 2019/20

Incidents all categories by level of harm:

Patient safety incidents and the percentage that resulted in severe harm or death The proportion of incidents resulting in no/low

low level issues and not just the more serious

harm has remained consistently high over the

incidents. The proportion of incidents resulting in

past three years, accounting for on average 96%

severe harm has remained consistently low over

of all incidents reported. This supports evidence

the past three years, accounting for on average

of a good safety culture within the organisation,

0.5% of all incidents reported.

indicating staff willingness to continue to report

Risk management The Trust has an established process for

A Divisional and Corporate Department Risk

managing risk and detecting and responding to

Scrutiny Group (DRSG) is established, attended

quality concerns. The risk management strategy

by each of the divisions and heads of corporate

is reviewed annually, with the Audit and Risk

departments. This group meets on a quarterly

Committee having oversight of this process.

basis to review each of the divisional and

Each Division has a risk register that is monitored regularly to ensure risks are being managed. The most recent internal audit of risk management concluded that the Trust has a well-designed process for the addition and review of divisional risks. Over the past two years this process has been enhanced through the establishment of risk

departmental risk registers in parallel. Following this, an Executive Risk Scrutiny Group is held on a quarterly basis to review all risks scored 15 and above and is attended by Executive Directors.

This process supports consistency of reporting and risk-scoring, as well as ensuring appropriate challenge is applied across all risk registers.

registers for corporate teams and the migration

Through this process, high level risks are

of risk data to the Datix online system.

routinely escalated and reported to the Audit and Risk Committee and Board. The Audit and 57

Quality Report 2019/20

Risk Committee also undertakes regular “deep

focused management of the strategic risks that

dive” analysis into key areas of risk concern, to

could affect the delivery of its principal objectives

enable scrutiny of risk trajectories and whether

and strategic priorities. The BAF is reviewed

appropriate mitigating actions have been

quarterly and a narrative report to the Audit

identified to manage the risk.

and Risk Committee provides assurance of the continued risk management processes and to

In addition, the Board Assurance Framework

highlight any concerns or areas of progress.

(BAF) provides the Board with a clear and comprehensive method for the effective and Incidents (all categories)

Apr19

May- Jun19 19

Jul19

Aug- Sep19 19

Oct19

Nov19

Dec19

Jan20

Feb20

Mar20

No harm Low harm

354 57

409 51

409 56

397 42

444 37

377 35

420 42

385 38

361 45

404 35

417 47

392 55

10 2

15 3

18 3

10 1

13 3

8 2

14 1

10 2

8 1

11 2

9 3

Moderate harm 9 Severe harm 0 or death

58

Quality Report 2019/20

Seclusion: The use of seclusion continues to decline and demonstrates the Trust is achieving least restrictive practice in this area. In May 2019, another White Ribbon training event was held entitled ‘Sexual Safety and the launch of the Pathfinder Project: Embedding Trauma-informed Practice’. The day included the launch of the Sexual Safety Policy and Poster.

Falls: There is a Falls Prevention Policy in place to support staff with reporting falls. There is a Falls Lead and a Falls Group where falls are reviewed.

Number of falls incidents by harm (Trust 24 Hour Bedded Units & Day Centres) 20 15 10 5

0 -2

20

ar M

20

bFe

19 c-

nJa

v-

19

De

t-1 9

No

19 p-

Oc

Se

9

19

l-1

g-

Ju

Au

Ju

n-

9

Moderate Harm

19

9

-1 ay

M

9 -1

r-1

Ap

19

ar M

19

bFe

18

nJa

18

c-

8

Low Harm

De

v-

t-1

Oc

No

18

8

18 p-

Se

g-

l-1

Ju

No Harm

Au

8

18 n-

Ju

-1 ay

M

Ap

r-1

8

0

Severe Harm or Death

59

Quality Report 2019/20

PATIENT EXPERIENCE INDICATORS We continue to meet the 20% response rate for our Family & Friends Test and patients recommending their service have also remained above 90%. The Trust is currently reviewing how to improve response rates; a survey is being carried out to identify issues and best practice relating to obtaining and inputting the information on to the Trust system (Meridian).

FFT 2018/19 – 2019/20 Financial Year

2018/19

2019/20

Quarter

Q1

Q2

Q3

Q4

Q1

Q2

Q3

Q4

FFT Responses

951

670

578

454

448

878

511

501

% Recommended

82%

90%

92%

93%

91%

87%

95%

92%

Community Mental Health Service User Survey Survey Year

2016

2017

2018

2019

Overall Experience Score

68%

72%

69%

70%

Every year, the Trust participates in the National Community Mental Health Survey. The purpose

Results

• With 255 surveys returned completed, the

of the survey is to understand, monitor and

Trust had a response rate of 21%, down

improve service users’ experience of NHS

from 24% in 2019.

community mental health service. Data is used by the CQC and other organizations for assessment, improvement, governance and regulatory purposes.

This year, a sample of 1,250 CPA and Non-CPA community mental health service users seen by someone face-to-face at the trust between 1 September and 30 November 2019 was generated at random. The survey was carried out from February to June this year.

• The Trust average score has improved to 70 from 66 in 2019.

• The Trust scored in the top 20% of Trusts on 11 questions, the bottom 20% of Trusts on 0 questions. The Trust scored in the middle 60% on the remaining 17 questions.

• Four questions scored significantly better than 2019 and one question significantly worse.

• C&I’s average score was higher than the London average and better than six of the nine other Trusts

60

Quality Report 2019/20

What we are doing well (the top 20% of Trusts)

• Seeing people often enough and service

How we will improve

• We know having a strong response to the survey is important to get the most

users feeling staff understand how mental

meaningful data. We will ensure service

health needs affect other areas of life

users are encouraged and supported to

• joint decision making • knowing who to contact in a crisis • understanding medicine and side effects • organizing care and services well and support with physical health needs; financial advice or benefits; finding or keeping work or joining a group/ taking part in an activity

complete the survey in 2021

• We will continue our work with Leeds Beckett University on our Patient Experience Strategy which will include regular experience feedback mechanisms We will work with teams to ensure all service users have an annual review.

Where we are getting better compared with last year (four questions where the Trust scored significantly better than 2019)

• Explaining treatments and therapies in an understandable way and

• Joint decision making and involving service users in deciding what treatments or therapies to use?

• Providing NHS therapies that have helped Identified areas for improvement

• Asking people for their views on the quality of care they have received (1 question where the Trust scored significantly worse than 2019)

• Holding a specific meeting to discuss how your care is working at least once a year (low score compared with other London Trusts)

61

Quality Report 2019/20

COMPLAINTS – Numbers and Themes Arising The Trust received 138 formal complaints this year, so almost the same as in the previous business year when 136 were received. In addition, 219 concerns received via the Advice and Complaints Service were resolved informally, (against 235 in the previous year). Of course, this only represents a proportion of the issues that staff resolve directly with service users daily. The Acute Division received the most complaints, followed by Community Mental Health. Complaint numbers in substance misuse services and services for older people remain low.

Although complaint numbers appear fairly

services, managing both service user and carer

consistent year-on-year, the feeling is that they

expectations about the level of input that the

are increasing in complexity – number of issues

Trust can provide remains challenging.

raised, scope of issues raised and the difficulty of trying to resolve issues where resolution may already have been attempted without success by the time that formal process begins.

The complaints received cover a wide variety of issues often quite specific to the individual’s care or experience and it is not always possible to identify common themes. However, the following issues have been noted to recur this year:

This business year, around 59% of complaints responded to, were either fully or partially upheld, which is a very similar figure to the previous business year. Generally, we see around half of all complaints being upheld. It may be that as we continue to get better at resolving concerns informally, only the more serious and valid matters are going through formal process.

In Community Mental Health Division, some

The Trust is committed to using the feedback

services continue to have long waiting lists due

we receive through complaints to improve our

to mismatch between demand for the service

services. All teams have a regular slot at their

and available resources. Also noted in this

team meetings where any complaints can be

Division is the challenge of providing support to

discussed and reflected on.

a cohort of people who, while having significant mental health needs, do not meet the criteria for any services that the Trust is currently able to offer. There are ongoing discussions with our commissioners as to how to address both these issues.

Across the Trust, and particularly in the Acute Division, issues regarding communication with service users and their carers/relatives are noted. In Recovery and Rehabilitation 62

Learning from Complaints

Complaints which are either partially or fully upheld, will have an action plan to ensure that recommendations are implemented. Action plans are discussed and reviewed at divisional quality forums.

Below are some examples of improvements made in the last year as the result of feedback from complaints:

• Although respecting patients’ wishes and their confidentiality lies at the heart of our

Quality Report 2019/20

care planning, there is often a delicate and dynamic balance between respecting

Meeting Deadlines

these and also ensuring that all appropriate

The Trust target is for 80% or more of

partners in care, (such as the community

complaints to be responded to within the

team and the family in this case), are

timeframe. This target has remained challenging

appropriately informed and able to

this year, with around 60% of complaints

contribute to the care the patient receives.

meeting deadlines*. We have been successful in

• The Trust will aim to ensure that our soft service provider who is responsible for

making short term improvements but sustaining improvement longer term remains difficult.

catering, is routinely invited to the ward

Meetings have taken place with Divisional

community meetings and that feedback

Leads to discuss these challenges and possible

from these is documented and circulated.

solutions. Investigator resource is an ongoing

• A renewed focus on search training to reduce the possibility of items being brought onto the ward which can be used to self-harm.

• A review of the audio equipment used

issue for the divisions, especially those that receive greater numbers of complaints. A review of the complaints policy has been undertaken, specifically with a view to ensuring that divisional management has clear oversight of their open complaints and of any obstacles to completion

within iCope to determine if there is any

that managers are dealing with. Additional

opportunity to improve the background

management resource was also brought into

sound-cancelling quality of existing

the Complaints Team on a temporary basis, to

equipment (e.g. improved microphones

support process improvement.

on headsets) or to make changes to the environment to reduce the impact of background noise in shared offices. Also, regular reminders to go out to all iCope

The Complaints Team continues to offer support to investigators on an individual basis and have also provided group training to staff.

staff members encouraging them to be

We have continued to encourage prompt

mindful of the noise levels in the room

informal resolution of concerns at team level

when colleagues are on the phone.

wherever possible.

• All clients with booked telephone assessments to receive an appointment letter or some acknowledgement of their appointment in good time before their

Survey Year

2016/ 17

2017/ 18

2018/ 19

2019/ 20

Number of complaints

172

127

136

138

telephone assessment. The appointment/ acknowledgement letter should contain information about what to expect from a telephone assessment and what to do if individuals need urgent crisis support for mental health difficulties while waiting to be seen.

63

Quality Report 2019/20

Clinical effectiveness National data indicates that bed occupancy in acute mental health NHS facilities is often close to 100%. As an organisation, we have achieved an average of 96% each year over the past two years.

Although this figure is high, it has allowed us to ensure service users are admitted to their local services, keeping links with family, friends and the local community. Our organisational aim is to reduce bed occupancy to 85% or below over the next 12 months.

Financial Year

2018/19

2019/20

Quarter

Q1

Q2

Q3

Q4

Q1

Q2

Q3

Q4

Bed Occupancy

97.1%

98.1%

96.5%

95.6%

95.3%

97.0%

95.6%

93%

Average LOS for Acute Wards: We are aware that a person’s length of stay

has worked proactively, establishing an expected

(LOS) in our inpatient services is a key driver

date of discharge soon after admission to ensure

in inpatient bed occupancy rates. Predicting

that service users are receiving safe and effective

length of stay for a person can be a challenge,

care, shaping their journey to make every day

as multiple factors need to be considered; these

count and giving tangible hope at a time when

include the person’s primary diagnosis, physical

they are acutely unwell. Having this expected

health, any substance misuse concerns, housing,

date of discharge facilitates shared decision-

relationship and employment status, functional

making conversations with the service user,

and social impairment. Other organisational

family and carers and supports the wider patient

factors could be the persons experiences whilst

flow and bed management systems.

in the inpatient services and the therapeutic environment of the ward. The Trust completed a focused piece of work on expediting discharges with the involvement of both the Discharge facilitation and Home Treatment teams. The Trust

The NHS Mental Health Improvement Plan indicates that the average time for a person to be in an inpatient service is 32 days. For 201920, our average length of stay was 41 days.

Acute ALOS excl leave 78

UCL

68 58

Mean 45

48 38 28

LCL

64

Mar-20

Feb-20

Jan-20

Dec-19

Nov-19

Oct-19

Sep-19

Aug-19

Jul-19

Jun-19

May-19

Apr-19

Mar-19

Feb-19

Jan-19

Dec-18

Nov-18

Oct-18

Sep-18

Aug-18

Jul-18

Jun-18

May-18

Apr-18

18

Quality Report 2019/20

Emergency Psychiatric Re-admission (30 days)

Emergency Psychiatric Re-admission (90 days)

Area

Target

Trust

8%

Area

Target

Trust

15%

2019/20 Q1

Q2

Q3

Q4

10.6%

6.8%

10.0%

8.0%

Q1

Q2

Q3

Q4

18.5%

20.8%

20.0%

19.0%

2019/20

As an organisation, we have undertaken a focused piece of work to identify those people who use our inpatient services on a frequent basis i.e. three or more admissions in three years This piece of work has led to the formulation of advanced care and crisis plans, which are multi agency led, to meet the needs of these identified service users. This work also includes several projects to help reduce re-admissions at both 30 and 90 days and the early signs are this work is having a positive impact It will be supported, in the future, by the enhanced Crisis Team services, peer-support workers and strengthened community services which aim to reduce re-admissions into hospital through intensive community support.

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Quality Report 2019/20

PARTICIPATION IN CLINICAL AUDITS National audits In 2019- 2020 the following nationally-mandated clinical audits were applicable to Camden and Islington Foundation Trust: a) The Prescribing Observatory for Mental Health (POMH-UK) facilitates national audit-based quality improvement programmes open to all specialist mental health services in the UK. The results for different audits will be published intermittently throughout the year, based on the POMH–UK schedule. The topics this year include the following: - 19a- Prescribing for depression in Adult Mental Health - 17b – The use of depot/long acting injectable antipsychotic medication for relapse prevention - 9d – Antipsychotic prescribing in people with a learning disability under the care of the Mental Health Services b) The Trust will continue to participate in the next round of POMH-UK audits in line with the national schedule. The Trust will use the results of completed audits to prescribing practices implemented in line with audit recommendations. Audit results will also be disseminated locally to share learning.

The table below summarises the national audits that the Trust participated in, the data collection periods, and the number of cases submitted for each one: Audit Title

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Data Collection and submission Period

Number of cases Actions submitted

Topic 19a – Prescribing for depression 31st May 2019 – in adult mental health 28th June 2019

24

Guidance and support are provided to ensure appropriate prescribing and safe practice

Topic 17b – The use of depot/long acting-acting injectable antipsychotic medication for relapse

1st October 2019 – 29th November 2019

94

Guidance and support are provided to ensure appropriate prescribing and safe practice

Topic 9d – Antipsychotic prescribing in people with a learning disability under the care of Mental Health Services

3rd February 2020 – 27th March 2020

45

Guidance and support are provided to ensure appropriate prescribing and safe practice

Quality Report 2019/20

Local Audits

to focus their audit plan around local and trust

The Trust continues to participate in both local

wide priorities when identifying audits.

and trust wide audits, for example Infection

Actions taken in response to local audits

control audits, falls, a trust wide documentation audit and emergency equipment. Each division and discipline are encouraged to identify areas for improvement and develop local audit plans to undertake throughout the year and share

Audit participants are encouraged to share the learning with colleagues in their divisions and across the trust at local quality forums or appropriate meetings.

the learning with staff. Teams were encouraged National Confidential Enquiry (NCE) into Patient Outcome and Death (NCEPOD) - 2018/19 Audit Title

Data collection period

Survey Requested by NCE Surveys Returned

Suicide

1 April 2019-April 2020

19

14

PARTICIPATION IN CLINICAL RESEARCH The Trust is one of the leading mental health Trusts across the country for research, and its performance across key research domains are highlighted below.

Top Five Recruiting Studies Rank Study Name

Local Investigator

Recruitment

1

Lifestyle Health and Wellbeing Survey

David Osborn

304

2

Attitudes to Voices: A survey exploring the

Nicholas Green

80

75

factors associated with clinicians’ perspectives on 3

hearing voices Exploring unusual feelings: a questionnaire study

Harriet Martin

4

Risk Assessment and Increasing Safety in

Sergi Costafreda-Gonzalez 66

5

Dementia – RAISe-Dementia study National Centre for Mental Health (NCMH)

Andrew Black

38

Participant Recruitment As of the 5 March, 956 participants were recruited into 31 research studies

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Quality Report 2019/20

Biomedical Research Centre The broad strategic aims are detailed below: o

Capacity building

o

New treatments,

o

Personalised/precision treatment and data science

There has been success with early career researchers who have gained independent funding for midlevel fellowships with the BRC support.

Institute of Mental Health (IoMH) UCL launched the new Institute of Mental Health (IoMH) in 2019 as a vehicle to centralise research and expertise in mental health. The IoMH aims to be a focal point for UCL’s mental health research community, adding value to current clinical partnerships including C&I and build capacity together.

Professor Anthony David, in his capacity as Director and Sackler Chair of the Institute, joined the R&D Committee in early 2020 and now regularly communicates with members on the latest updates and developments from the IoMH. As part of the redevelopment of the St Pancras site and building on the strong association with IoMH, a title under consideration is the ‘Institute of Mental Health at C&I’.

Biomedical Research Centre (BRC) The BRC mental health theme continues its work into new tests, treatments and theories in mental health, neurology, and dementia. An ablation service has been established at Queens Square for the treatment of mental health disorders, with a clinical pathway being set up for severe treatment resistant depression, to include neurosurgical treatment within Camden and Islington Trust.

Theme members led the mental health component of the Genomics England Pharmacogenetic Service that will roll out across the whole of the NHS in 2020. In anticipation of this, a pharmacogenetic testing service has been set up within Camden and Islington for treatment resistant patients with psychosis and depression and those who have experienced treatment limiting adverse drug reactions.

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Quality Report 2019/20

QUALITY AND INNOVATION: THE CQUIN FRAMEWORK The table below summarises the Trust’s level of achievement against the nationally set targets: CQUIN targets in 2019/20: Indicator

Achievement

CCG3a – Alcohol and Tobacco – Screening:

Achieving 80% of inpatients admitted to an inpatient ward for at least one night who are screened for both smoking and alcohol use.

Partially Met

CCG3b – Alcohol and Tobacco – Tobacco Brief Advice:

90% of identified smokers are given brief advice as outlined in the Alcohol and Tobacco Brief Interventions E-learning programme-including an offer of

Not Met

Nicotine Replacement Therapy (whether this offer had been taken up).

CCG3c – Alcohol and Tobacco – Alcohol Brief Advice:

90% of patients identified as drinking above low risk levels, given brief advice Partially Met or offered a specialist referral.

CCG2: Improving the uptake of flu vaccinations for frontline clinical staff

Achieving an uptake of flu vaccinations by frontline healthcare workers.

Not Met

CCG4: 72hr follow up post discharge

Achieving 80% of adult mental health inpatients receiving a follow-up within

Partially Met

72hrs of discharge from a CCG commissioned service.

CCG5a: Mental Health Data Quality: MHSDS Data Quality Maturity Index

The MHSDS DQMI score is an overall assessment of data quality for each provider, based on a list of key MHSDS data items. The MHSDS DQMI score is defined as the mean of all the data item scores for percentage valid &

Met

complete, multiplied by a coverage score for the MHSDS. The full definition and DQMI data reports can be found at: CCG5b: Mental Health Data Quality: Interventions

Achieving 70% of referrals where the second attended contact takes place between Q3-4 with at least one intervention (SNOMED CT procedure code)

Not Met

recorded between the referral start date and the end of the reporting period.

CCG6: Use of Anxiety Disorder Specific Measures in IAPT

Achieving 65% of referrals with a specific anxiety disorder problem descriptor

finishing a course of treatment having paired scores recorded on the specified Partially Met Anxiety Disorder Specific Measure (ADSM).

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Quality Report 2019/20

CARE QUALITY COMMISSION (CQC) Registration: CQC registers Camden and Islington NHS Foundation Trust services to carry out the following legally regulated activities.

Treatment of disease, disorder or injury

St Pancras Hospital

Highgate Mental Health Centre

Assessment or medical treatment for persons detained under the 1983 Act Registered services

St Pancras Hospital

Highgate Mental Health Centre

Diagnostic and screening procedures

Highgate Mental Health Centre

St Pancras Hospital

Participation in reviews and investigations CQC inspections In October and November of 2019, CQC inspected the following core services ad part of the ongoing monitoring of the quality and safety of healthcare services. The following core service were inspected:

• Acute Wards for adults of working age and psychiatric care units • Long Stay Rehabilitation Mental Health Wards for working age adults • Mental Health Crisis Services and Health Based Places of Safety • The Trust also had a well-led inspection.

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Quality Report 2019/20

Results for this inspection

What the CQC said about our services Across the organisation, the CQC found:

• Patients were treated with compassion and kindness across all services with respect for their privacy and dignity

• ‘Evidence of some outstanding care’ supported by a flourishing and wellembedded QI programme

• Establishment of the Primary Care Mental Health Networks ensuring joined-up care

• Positive engagement with patients, carers and staff including a wide range of co-

• A strategy to improve staff health and wellbeing

• A ‘capable and experienced leadership team’ who are open about the challenges they face

• Effective partnerships with other stakeholders across north London, including the formal alliance with Barnet, Enfield and Haringey Mental Health NHS Trust (BEH), ‘which was progressing well’

production work We still face challenges including high demand for acute beds; caseloads that are too high in community-based mental health; and delays to both Mental Health Act assessments and serious incident investigations. The CQC also identified the need for more work to strengthen support networks to meet the needs of staff and patients with protected characteristics

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Quality Report 2019/20

Mental Health Act Monitoring Visits Our inpatient wards receive an unannounced visit from the CQC every 18 months as part of its regular cycle of MHA monitoring visits. In 2019-20 the following six wards have received a visit so far: Domain Area

Emerald

Dunkley

Coral

Amber

Jade

Pearl

Care Plans S132 Rights S17Leave of absence Consent to Treatment General Healthcare

Statutory requirements met Improvement required The top three concerns raised by the CQC are:

• Consent to treatment: when seeking the patient’s consent prior to first admission and assessing the patient’s capacity to consent to treatment, the nature of the decision for which the patient’s capacity was being assessed was not recorded and/or the evidence for the conclusion of the capacity assessment (when the patient was found to lack capacity) was not available (Breach of paragraph 24.41 of the Code of Practice to the Mental Health Act and Section 5 of the Mental Capacity Act); and

• Care plans: patients’ views were not adequately reflected, and copies were not always shared with patients (Breach of Chapter 1 of the Code of Practice to the Mental Health Act); and

• Section 17 Leave: trust form not fit for purpose.

It is noted that, in 2019/20, no concerns were raised by the CQC re Section 132 rights (evidence of attempts made to explain their rights to patients not being found), which is a considerable achievement (and had not happened since records began in 2015).

The CQC findings are corroborated by internal assurance sources. C&I introduced MHA key performance indicators (KPIs) for all divisions in July 2017 to reinforce accountability of operations and make non-compliance issues more visible. Those KPIs will be reviewed in 2020/21.

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Quality Report 2019/20

DATA QUALITY The Data Quality Policy has been updated during the year, and with the reestablishment of Data Quality Improvement Group (DQIG), the Information ,eam – along with the Data Warehouse and Clinical Applications teams – continue to work closely to monitor and improve the quality of data across the Trust. This includes identifying root causes of several data quality issues and is in the process of embedding these within the recording process, working closely with the Divisions and the Business Performance Teams while addressing the data quality. As part of this process, several new data quality dashboards and reports have been built and are being used widely across the Trust by different teams.

The Information Team is conducting ongoing

Digital published data quality maturity

work to continue improving the data quality

index (DQMI) score for the Trust is 97.4%

through collaborative working with Operational/

(February 2020), compared to 85.5 in April

Clinical teams and Contracts and Costing teams.

2019.

Some of the data quality improvement activities include:

• A new version (v4) of Mental Health Services Data Sets (MHSDS) submission criteria has been implemented. MHSDS and improving access to psychological therapies (IAPT) submissions provide a wide range of quantitative and qualitative information about the services that the Trust offers, and data quality reports are generated to identify any anomalies.

• The introduction of data quality reports and investigations across data quality has resulted in reduction of the number of data quality issues pertaining to MHSDS submission (from around 15,000 to 1500

• The Data Quality Improvement Group meetings are held monthly currently focussing on improving data quality across the Trust. All the relevant stakeholders are included in this group ranging from Finance, Contracts, Clinical Applications, Costing, etc., to ensure all data quality issues are captured and addressed effectively in a timely manner.

• The Trust is promoting a data driven culture where several dashboards, including data quality reports, are being built by the Information Team to ensure data is available to the Trust teams on a near real-time basis to monitor their team performance and data quality.

in the last 8 months). The latest NHS

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Quality Report 2019/20

Information Governance Toolkit Information Governance (IG) is about how NHS and social care organisations and individuals handle information.

The Information Governance Toolkit is a performance tool produced by NHS Digital.

standards for health and social care for holding, processing or sharing personal data.

• Readiness to access secure health and care

It draws together the regulations and central

digital methods of information sharing, such

guidance related to information governance

as NHSmail and Summary Care Records

and presents them as one set of information

• Good data security to the CQC as part of

governance requirements. NHSI have stated that the 2018/19 assessments are “rolling standards”, so will be assessed based on the Trust’s ability to regularly attain, update and publish defined standards on the NHSI toolkit website.

The Trust continually reviews its information governance framework to ensure all personal and medical information is managed, handled and disclosed in accordance with the law and best practice. The Trust is also in the process of

the Key lines of Enquiry (KLOEs).

The Data Security and Protection Toolkit is an online self-assessment tool that enables organisations to measure and publish their performance against the National Data Guardian’s ten data security standards.

The Trust is measuring performance against the National Data Guardian’s 10 data security standards. These are:

ensuring General Data Protection Regulation

1. Personal Confidential Data

compliance and has updated its fair processing

2. Staff Responsibilities

notice.

In addition, we attach great importance to training, data quality and clinical records

3. Training 4. Managing Data Access

management. As a result, we have seen

5. Process Reviews

improvements in several aspects across the Trust.

6. Responding to incidents

Improving Information Governance is a key NHS

7. Continuity Planning

priority. This is reflected in national standards set out in the Data Security and Protection Toolkit (DSPT) which the Trust is required to complete

8. Unsupported systems 9. IT Protection

and submit before end of March 2020 for this

In addition, the Trust has identified Information

reporting period.

Asset Owners (IAO) to embed effective

In March 2019, the Trust’s status for DSPT was

information risk management activities across

standards met. The next DSPT will be submitted

the Trust by embedding these responsibilities in

before 31 March 2020 and the trust is aiming to

day-to-day activities. Project has been initiated

achieve standard met again.

to update the Information Asset register which

Completion of DSPT demonstrates that the organisation is compliant with the following:

• General Data Protection Regulation (GDPR) 74

• Compliance with the expected data security

will then be inputted into the Information Asset Management (IAM) tool. The IAM tool will be intuitive for IAOs to use and regularly update their assets and report any risks to the SIRO.

Quality Report 2019/20

Cyber Security A cyber security programme is in place and progressing well with five

Communication: Office 365 training has

workstreams:

communicate the courses to staff. Yammer is a

Leadership and Governance: The Information asset management work is vital to information flow mapping and risk management. The Information Asset Management and Compliance Manager is in post and will deliver the

commenced, and Yammer was used to collaborative tool. There are 18 Yammer groups set up and an IG Yammer working group. A digital newsletter is sent on a regular basis which features Information governance and cyber security updates.

Information Asset Management programme

Clinical Workstream: The recruitment of Chief

within 6 months working with Asset Owners

Nursing Information Officer (CNIO) role has been

across the Trust, set up support working groups

in the job matching process. The cyber security

and ensure training and awareness for all

clinical work will be well supported following

relevant staff is completed.

recruitment to this post.

Operational: The email system has now been

Procurement: Despite the contract amnesty the

migrated to 365, the organisation currently have

contracts team has made really good progress

both NHS mail and CANDI Mail. The plan is for

and 69% of the contracts over 50K have been

NHS Mail to be switched off and CANDI email

logged. There is further work to be done to

will be used as the secure email domain. This is

review contracts which are processing personal

currently in progress.

information. Both Contracts and Procurement are working collaboratively on this.

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Quality Report 2019/20

REPORTING AGAINST CORE INDICATORS Since 2012/13, NHS foundation trusts have been required to report performance against a core set of indicators using data made available to the trust by NHS Digital.

Q1

Q2

Q3

Q4

7 Day Follow-Up

CPA inpatient discharges followed up within 7 days (Face to face and telephone)

97.3%

98.5%

96.1%

95.8%

Gatekeeping

Proportion of admissions gatekept

by Crisis Resolution Teams

97.9%

98.4%

98.7%

99.1%

Measure

Target

Mental health scores from Friends and Family Test – % positive % clients in employment % clients in settled accommodation (local authority target) Care programme approach (CPA) follow-up – proportion of discharges from hospital followed up within seven days Data Quality Maturity Index (DQMI) – MHSDS dataset score

18/19

Q1

Q2

Q3

(19/20)

(19/20)

(19/20)

NA

89%

91.5%

86.7%

95.6%

6%*

5.7%

6.1%

6.4%

6.1%

90%

69.9%

68.2%

62.9%

67.7%

95%

96.9%

97.3%

98.5%

97.0%

95%

95.5%

94.3%

89.4%

97.4% (provisional)

Proportion of people experiencing a first episode of psychosis treated with a NICE approved care package within two weeks of referral Jan-20

Dec-19

Nov-19

Oct-19

Sep-19

Aug-19

Jul-19

Jun-19

May-19

Apr-19

18/19

Target

People with a first begin treatment with a NICE recommended care package within two weeks of referral

76

56% 75% 81% 87% 75% 87% 87% 94% 94% 89% 91%

Not published

episode of psychosis

Quality Report 2019/20

Patient Experience of Community Mental Health 2019: The Annual Community Survey results were published in November 2019 and showed the Trust had made several improvements on last year’s results. This survey is published by CQC and is the national survey that all mental health trusts participate in.

The survey report uses standardised data to

REVIEWING CARE

generate a score for each question asking the

Continue excellent work on ensuring all service

respondent to rate the service they received.

users are being offered a formal review meeting

This score is then used to benchmark the Trust’s

and that this is made explicit.

position in relation to all other responding

CRISIS CARE

organisations. Most of our scores are in the

Work to ensure service users know who to

intermediate 60% range and some are in the top

contact when in crisis. Investigate the range and

20% of all trusts surveyed;

level of support provided by the out of hours

Summary of results

• There is a general improvement in results since 2018.

• Most scores are in the intermediate range.

service.

NHS THERAPIES Scores have dropped significantly. Seek to understand why: focus on ensuring service users are involved in decisions.

• Six scores are in the top performing category.

• Just four scores remain in the bottom category.

SUPPORT AND WELLBEING There are some positive results here. Focus on involving family members and signposting service users to sources of peer support.

• NHS Therapies needs urgent attention.

• The overall rating of care has improved.

• But do remember – sample sizes are small, and some changes can be hard to explain.

Patient safety incidents and the percentage that resulted in severe harm or death

Actions

Camden and Islington consider the data to be

CARE AND TREATMENT

as described due to the following reasons - the

Continue excellent work on ensuring service

data for this indicator is derived from Datix our

users are seen often enough for their needs.

internal patient safety software. The majority

ORGANISING CARE Seek to understand why some service users don’t feel their care is organised effectively. Drill down into data.

between 72 – 85% of patient safety incidents reported result in no harm and only a small fraction (less than 1%) of patient safety incidents resulted in severe harm. The Trust is committed to learning from serious incidents.

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Quality Report 2019/20

The proportion of incidents resulting in no/low harm has remained consistently high over the past three years, accounting for, on average, 96% of all incidents reported. This supports evidence of a good safety culture within the organisation, indicating staff’s willingness to continue to report low level issues and not just the more serious incidents. The proportion of incidents resulting in severe harm has remained consistently low over the past three years, accounting for on average 0.5% of all incidents reported.

Total Incidents by harm

Risk management The Trust has an established process for managing risk and detecting, and responding to, quality concerns. The risk management strategy is reviewed annually, with the Audit and Risk Committee having oversight of this process.

Each Division has a risk register that is monitored

Departments. This group meets on a quarterly

regularly to ensure risks are being managed. The

basis to review each of the Divisional and

most recent internal audit of risk management

Departmental risk registers in parallel. Following

concluded that the Trust has a well-designed

this an Executive Risk Scrutiny Group is held on

process for the addition and review of divisional

a quarterly basis to review all risks scored 15 and

risks. Over the past two years this process has

above. Executive Directors attend the meeting.

been enhanced through the establishment of risk registers for corporate teams and the migration of risk data to the Datix online system.

A Divisional and Corporate Department Risk Scrutiny Group (DRSG) is established, attended by each of the Divisions and Heads of Corporate

78

This process supports consistency of reporting and risk scoring as well as ensuring appropriate challenge is applied across all risk registers.

Through this process high level risks are routinely escalated and reported to the Audit and Risk Committee and Board. The Audit and Risk

Quality Report 2019/20

Committee also undertakes regular “deep

focused management of strategic risks that

dive” analysis into key areas of risk concern to

could affect the delivery of its principal objectives

enable scrutiny of risk trajectories and whether

and strategic priorities. The BAF is reviewed

appropriate mitigating actions have been

quarterly and a narrative report to the Audit

identified to manage the risk.

and Risk Committee provides assurance of the

In addition, the Board Assurance Framework (BAF) provides the Board with a clear and

continued risk management processes and highlights any concerns or areas of progress.

comprehensive method for the effective and

COMPLAINTS Numbers and Themes Arising The Trust received 132 formal complaints this year, which is similar to the previous business year, when 136 were received. In addition, 185 concerns received via the Advice and Complaints Service were resolved informally (there were 235 in the previous year). Of course, this only represents a proportion of the issues that staff resolve directly with service users daily. * The Acute Division received the most complaints, followed by Community Mental Health. Complaint numbers in substance misuse services and services for older people remain low.

Although complaint numbers appear fairly

a cohort of people who, whilst having significant

consistent year-on-year, the feeling is that

mental health needs, do not meet the criteria

they are increasing in complexity – that is the

for any services that the Trust is currently able to

number of issues raised, the scope of the issues

offer. There are ongoing discussions with our

raised and the difficulty of trying to resolve

commissioners as to how to address both these

issues where resolution may already have been

issues.

attempted without success by the time that formal process begins.

Across the Trust, and particularly in the Acute Division, issues regarding communication

The complaints received cover a wide variety

with service users and their carers/relatives

of issues and are often quite specific to the

are noted. In Recovery and Rehabilitation

individual’s care or experience; it is not always

services, managing both service user and carer

possible to identify common themes. However,

expectations about the level of input that the

the following issues have been noted to recur

Trust can provide remains challenging.

this year: In the Community Mental Health Division, some services continue to have long waiting lists due to a mismatch between demand for the service and available resources. Also noted in this Division is the challenge of providing support to 79

Quality Report 2019/20

Learning from Complaints This business year around 59% of complaints

used to self-harm.

- A review of the audio equipment used

responded to, were either fully or partially

within iCope to determine whether

upheld, which is a very similar figure to the

there is any opportunity to improve the

previous business year. Generally, we see around

background sound-cancelling quality

half of complaints being upheld. It may be

of existing equipment (e.g. improved

that as we continue to get better at resolving

microphones on headsets) or to make

concerns informally, only the more serious and

changes to the environment to reduce

valid matters are going through formal process.

the impact of background sounds in

The Trust is committed to using the feedback

shared offices. Also, regular reminders

we receive through complaints to improve our

to go out to all iCope staff members

services. All staff have a regular slot at their

encouraging them to be mindful of the

team meetings where any complaints can be

noise levels in the room when clinicians

discussed and reflected on. Complaints which

when colleagues are on the phone.

are either partially or fully upheld will have an action plan to ensure that recommendations are implemented. Action plans are discussed and reviewed at divisional quality forums.

Below are some examples of improvements made in the last year as the result of feedback from complaints: - Although respecting patients’ wishes

- All clients with booked telephone assessments to receive an appointment letter or some acknowledgement of their appointment in good time before their telephone assessment. The appointment/ acknowledgement letter should contain information about what to expect from a telephone assessment and what to do if individuals need urgent crisis support for

and their confidentiality lies at the heart

mental health difficulties while waiting to

of our care planning, there is often a

be seen.

delicate and dynamic balance between respecting these and also ensuring that all appropriate partners in care (such as the community team and the family) are appropriately informed and able to contribute to the care the patient receives.

- The Trust will aim to ensure that our

The Trust target is for 80% or more of complaints to be responded to within timeframe.

This target has remained challenging this year because of priorities and resources during the pandemic, with around 60% of complaints meeting deadlines. We have been successful in

service provider, who is responsible for

making short-term improvements but sustaining

the catering is routinely invited to the

improvement longer-term remains difficult.

ward community meetings and that feedback from these is documented and circulated.

- A renewed focus on search training to

80

Meeting Deadlines

Meetings have taken place with Divisional Leads to discuss these challenges and possible solutions. Investigator resource is an ongoing issue for the divisions, especially those that

reduce the possibility of items being

receive greater numbers of complaints. A review

brought onto the ward which could be

of the complaints policy is being undertaken,

Quality Report 2019/20

specifically with a view to ensuring that divisional management has clear oversight of their open complaints and of any obstacles to completion that managers are dealing with. Additional management resource has also been brought into the complaints team on a temporary basis,

NICE Guidelines The table below provides the details and status of NICE (National Institute for Health and Care Excellence) guidelines and Quality Standards applicable to the Trust.

to support process improvement.

Guidance

The Complaints Team continue to offer support

Division

Outstanding Baseline assessments

Partially Implemented

Acute R&R CMH SAMH SMS Trust Total

0 0 0 0 0 1 1

0 0 0 0 0 5 5

to investigators on an individual basis and have also provided group training to staff.

We have continued to encourage prompt informal resolution of concerns at team level wherever possible

Compliments Whilst we are always conscious of the need to learn and improve where we could have done better, we know that there is a lot of excellent practice within the Trust, and this is reflected in some of the positive feedback that we receive.

Here are some examples received by a range of services across the Trust:

• Following a course of CBT, a service user

Quality Standards The table below shows the detail of the Quality Standards that are in progress or baseline assessments that are due to be completed.

Quality Standards Division

Outstanding Baseline assessments

Partially Implemented

Acute R&R CMH SAMH SMS Trust Total

0 0 0 0 0 4 4

0 0 0 0 0 2 2

wrote to say that it had transformed his life for the better. He wrote “It is as if a mighty stone of pain and misery has been lifted from my heart.”

• Feedback for the crisis team: the service user was incredibly impressed by the whole service, he reported that everyone was genuine and caring and not at all patronising.

• The crisis call centre was complimented by a caller for responding immediately, professionally and efficiently.

• Thanks to Garnet Ward from the daughter of a service user for their care and kindness towards her father. She said: “He could not have been in a better place.”

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Quality Report 2019/20

KEY QUALITY INITIATIVES IN 2019/20 Quality Improvement Measurement for Improvement

the most important single change in the NHS… would be for it to become, more than ever before, a system devoted to continual learning and improvement of patient care, top to bottom and end to end

The ambition was to further support developing a strong organisational culture of continuous improvement.

• A key part of reaching this work lies in the co-creation of a Quality Management

Berwick Report: “A promise to learn: a

System (QMS), bringing Quality Assurance

commitment to act” (2013)

(QA), Quality Control (QC), Quality Planning

Overview and Milestones

(QP) and QI closer together. The Board

• 2018/19 marked a significant acceleration of the QI programme with QI work becoming more widespread in teams driven by the establishment of a larger QI teamvIn 2019/2020 the Executive agreed to strengthen the Quality Improvement team

82

including creating a Head of QI position.

agreed to pursue this approach in 2019

• The QI team, with Board approval, have already begun work on integration with project managers and the C&I Organisation Development (OD) team

Quality Report 2019/20

• The QI team continued to support many projects across the organisation and deliver

Graph 1. Numbers of attendees to intro to QI/ QI Lab

training in QI methodology as well as

and much of the QI work was paused or disrupted in the beginning of 2020

Engaging, encouraging and inspiring • Monthly Senior Leadership Team meeting – QI project presented by team

• Website under development- Will increase the profile of QI at C&I, publish stories about QI work, celebrate achievements and share learning to complement training. This is due to launch shortly

200 0 rM 19 ay -1 Ju 9 n1 Ju 9 l-1 Au 9 gSe 19 p1 Oc 9 t-1 No 9 vDe 19 c1 Ja 9 n2 Fe 0 bM 20 ar -2 0

model was delayed by the Covid pandemic

400

Ap

• Recruitment to the enhanced QI team

Graph 2. Numbers of projects coached 250 200 150 100 50 0 rM 19 ay -1 Ju 9 n1 Ju 9 l-1 Au 9 gSe 19 p1 Oc 9 t-1 No 9 vDe 19 c1 Ja 9 n2 Fe 0 bM 20 ar -2 0

improvement priorities

600

Ap

work more closely with divisions on their

• @candi_QI enabled us to collaborate and share learning with other QI teams and experts across the world.

• Spotlight – the QI Newsletter has been sent

Measurement for Improvement

out to all staff monthly, updating on QI

Performance Measures Review Group

stories and projects

The quality of Statistical Process Control (SPC)

• QI Celebration - planning had started in January 2020, but was put on hold due to COVID Developing improvement skills The QI Hub continued to offer a variety of training opportunities to all staff and offered training and skill development to service users and carers

reporting is critical, leading to a group forming in February to have oversight on the following key issues

• To support the development of one main tool, and present data in a uniform manner

• To agree rules on how data is communicated. For example, confidence when resetting control limits and the language used to describe the charts, including icons and colours

• To review arising performance measures to understand the most appropriate method to visually present data. For example, is an SPC chart suitable, is there a simpler way?

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Embedding into daily work

• Membership includes professionals from Governance, Informatics, HR and the QI hub.

We have worked closely with the OD team to develop a training pathway for all staff at C&I to access QI knowledge and development at all levels.

• Improvement Technician Apprenticeship: 8 staff from grades 5-7 enrolled in Sept 2020

• Managers essentials: 10 managers attended • Leadership for Improvement: 20 Senior leaders attended the first day in February 2020

Embedding into daily work Our CQC report said:

Staff had been engaged in various ways to learn, improve and innovate and were given time to do this in their day to day roles. The trust was committed to delivering a Quality Improvement (QI) programme and had invested in this across the organisation. The QI programme had flourished since the last inspection and was well embedded across the Trust https://www.cqc.org.uk/provider/TAF/reports

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PRIORITIES Staff Wellbeing. ‘What Matters to You?’

The Clozapine Services and Pathway

At all initial project meetings, when talking

Formed with multidisciplinary membership,

about the problem staff wanted to improve, QI

the group has developed clear processes and

coaches asked: ‘What matters to you?’ and were

standards of clozapine care. The staff involved in

curious about their wellbeing. This helped judge

this group have started to use QI methodology

readiness. Over the course of the last year we

to support eight key areas of improvement. The

had 9 teams sign up for the ‘pure approach’ and

key outcome measure is the number of days that

139 projects ran with well-being as a key driver

patients continue to adhere to clozapine.

Violence Reduction Collaborative

Physical Health

The collaborative is now focused on bringing

Significant progress has been made in increasing

together the different initiatives including Safe

the number of physical health assessments

Wards, testing body cameras for staff and peer

completed. Key barriers to assessing the

debrief volunteers to outline a standard process

effectiveness is the functionality of the physical

on how the acute wards respond to violent

health screening tool which is currently being

and aggressive incidents, with a key focus on

upgraded. Factors that increase screenings

empowering staff.

include having an identified physical health lead,

Digital Connections Forum The forum continued to support front line teams make changes to clinical applications to

full involvement from the team, the use of a dashboard and psycho-education and training for staff.

enhance their everyday working. It trialled its first ‘Clinical Hacks Event’ which was a huge success with crisis teams making use of the assist tab functions and launching their “Reducing the number of clicks QI project”.

Length of Stay For 2019/20 average length of stay remained unchanged at 41 days. The QI team have supported the work to reduce this time and have worked on a careful analysis on the contributing factors to patient flow problems. Improvement has been made in the number of those who have stayed for more than 50 days.

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ACHIEVEMENTS AND MEASURING PROGRESS

Next Steps

• Development of a Quality Management System at C&I • Co-producing improvement – improving service user feedback systems, involvement and experience

• Developing a QI Coach Programme at C&I • Working with Barnet, Enfield and Haringey QI team. Sharing learning between teams, sharing our QI method and training, collaborating on celebratory events.

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Key programmes we are supporting:

• Patient Flow • Enhancing our community services and

• Supporting Delivery of Digital Strategy, including video consultation

Integrated Care Systems (including physical

• Staff Wellbeing

health of our service users)

• Reducing Inequalities

Completed Projects Care

• Joint working on Acute Wards - to enhance dual-diagnosis care in C&I

• Safeguarding Children - Improving Drs admission clerking Doc of service users’ contact with children Discharge and Recovery

• Dunkley Ward - Discharge medication counselling

• Discharge medication counselling - A nurseled QI project

• Increase the number of Trust staff teaching at The Recovery College

Group Programme

• Increase attendance in groups in Camden Drugs Service

• Improving the group programme at the Margarete Centre

• Focus on me - Group Programme - Better Lives Family Service Physical Health

• Sapphire Ward: Improving Ward Rounds An emphasis on Physical Health

• Camden Acute Day unit: Physical health screening

• Improving Physical Healthcare for Psychiatric inpatients: Sapphire PH

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Process and Procedure

• Clozapine Programme at C&I • Focus Assessment Process • Improving induction for Foundation Drs • Using QI methodology to implement a ‘leaving summary ‘at the Camden Acute Day Unit

• Remodelling the follow-up procedures of

QI Survey. Everyone that completes a project is asked to complete a survey. In 2019/20, 42 people responded.

1. How much impact has QI had on your confidence to affect change in the Trust?

Overall Meridian score for this question: 86.90% (based on 42 responses) 100 80 60

33.33%

40

patients with mild cognitive impairment in

10

Islington Memory Service

0

• Improving the Dementia pathway in Camden learning disability service

57.14%

9.52% Positive Slight impact positive impact

0.00% 0.00%

No Slight Negative impact negative impact impact

• Daffodil Unit Assay Project

2. What impact has QI had on your wellbeing at work?

Overall Meridian score for this question: 77.38% (based on 42 responses)

• Close Observations

100

• Substance Misuse Division.

• Building the Will • Reduce the time spent by clinicians on email requests

80 60 40

30.95%

26.19%

10

0

• Improving service users’ feedback at Islington learning disability partnership

40.48%

2.38% 0.00% Positive Slight impact positive impact

No Slight Negative impact negative impact impact

3. What impact has QI had on teamwork in your service?

Overall Meridian score for this question: 87.50% (based on 42 responses) 100 80 60

57.14% 35.71%

40 10

0

7.14% 0.00% 0.00% Positive Slight impact positive impact

No Slight Negative impact negative impact impact

4. How likely are you to recommend C&I to friends and family as a place to work?

Overall Meridian score for this question: 77.40% (based on 42 responses) 100 80 60 40

40.48%

35.71% 19.05%

10

0

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2.38% 2.38% Positive Slight impact positive impact

No Slight Negative impact negative impact impact

Quality Report 2019/20

Key Focus 2020/2021

Recovery College

On 4 March 2020 NHS England declared a level

The C&I Recovery College continues to offer

four incident due to the COVID-19 pandemic.

public courses on mental health and wellbeing

All QI projects were paused due to the need for

to build the population’s self-care skills and

services to focus on the crisis. As the Trust moves

improve self-management of health conditions.

into the recovery phase, the QI hub is supporting

We treat everyone coming through our door

services with localised changes specifically

holistically, understanding that life has its ups

focused on:

and downs, challenges and happy moments.

• Infection control and social distancing • Equality

Recovery, to the college, is an ongoing journey where we try to increase our resilience by having a toolbox with several different tools available,

• Physical health

discovering which tool works best, when and

• Digital

in what situation. We use the social model of

• Integrated care • Patient flow

disability and use co-production to learn all from each other.

New courses are prepared from scratch through partnership working e.g. Green prescription (Castlehaven Community Centre), Building connections in the community (Mind in Camden), Making the most of your memory (Trust Occupational Therapist), Dealing with Debt (Mary Ward Legal Centre), Living well with a long term condition (Whittington Health Clinician) and Men’s Space (Jules Thorne Clinician).

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The college works with other organisations to access space for running the courses and without these we would not be able to do what we are doing. To name a few: Birkbeck University,

Our “Mental Health Matters” events are a

Kentish Town Community Centre, Kings Place

series of informal quarterly meetings for Trust

Music Foundation, Crowndale Centre, Islington

members, service users and staff to discuss issues

Town Hall and Sapphire Independent Training

relating to mental health. Members of the public

Resource Centre.

are also invited to attend.

We were surprised last year to be asked to provide consultancy for Recovery College Berlin as they were at the early stages of their start-up.

Another organisation, Changing Lives, purchased our Men and Masculinity course materials together with two rounds of tutor preparation courses as they want to use it within their supported housing accommodation services for veterans.

We started to provide training to Newly Qualified Nurses with ‘Co-production and Shared Decision Making’ and ‘Motivational Interviewing’ CPD events. A QI project commenced to extract the benefits of tutoring at the college as a lot of trust employees seemed to use their learning for enhancing their career prospects.

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Mental Health Matters events

Quality Report 2019/20

ADDITIONAL INFORMATION AS STIPULATED BY NHS ENGLAND Equality and Diversity, Staff Engagement and Organisational Development Staff Survey Each year our staff members are invited to take part in the national annual Staff Survey. It gathers views on their experience at work around key areas including on development opportunities, health and wellbeing, staff engagement, and feeling able to raise concerns.

1.1 C&I Staff Survey 2019 Response Rate Trust Score 2018

Trust Score 2019

National 2019 average for mental health

Trust Improvement/ Deterioation

Ranking compared with all mental health trusts 2018

49%

59.7%

54%

Improvement of

Above Average

10.7 percentage points

The Trust’s 2019 staff survey response rate was 59.7%, an increase of 10.7% from last year and above the national average for mental health trusts of 54%. This is the highest response rate for Camden and Islington Foundation Trust.

1.2 Overall staff engagement The Trust recorded a score of 7.0 (on a scale of 1-10) against a national average of 7.0 for mental health trusts.

The tables below show the top and bottom five ranking scores and how we compared to last year’s results as well as to other mental health trusts in England.

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1.3 C&I Top Five Ranking Scores 2019 Trust Score 2018

Trust Score 2019

National 2018 average for mental health

Trust Improvement/ Deterioration

Ranking compared with all mental health trusts 2018

Senior managers try to involve staff in important decisions

42%

47%

38%

5% improvement

Above average

Communication between senior management and staff is effective

46%

51%

42%

6% improvement

Above average

Senior managers act on staff feedback

39%

43%

36%

4% improvement

Above average

Appraisal/review definitely helped me improve how I do my job

33%

31%

24%

2% deterioration

Above average

Able to make improvements happen in my area of work

66%

64%

59%

2% deterioration

Above average

In addition to the above top five ranking question scores, Camden and Islington scores have remained consistently above average (since 2015) for appraisals that agree clear objectives and remains the top-ranking Trust for appraisals that improve how staff do their job.

In terms of ‘Theme’ scores there has been a statistically significant improvement since last year in positive responses to questions indicating staff perception of an environment safe from violence. Meanwhile, scores in the theme relation to Quality of Care also now demonstrate above average performance.

In the themes of Equality, Diversity and Inclusion, Health and Wellbeing, Morale, and Bullying and Harassment, overall scores are significantly below average. There have been improvements in scores for some questions where the Trust was previously ranked lowest amongst mental health trusts; however, scores remain below average in those areas. See table below for bottom five ranking scores 92

Quality Report 2019/20

1.4 C&I Bottom Five Ranking Scores 2019 Trust Score 2018

Trust Score 2019

National 2019 average for mental health

Trust Ranking Improvement/ compared with Deterioration all mental health trusts 2019

I am unlikely to look for a job at a new organisation in the next 12 months

46%

43%

51%

3%

Appraisal/ review: organisational values definitely discussed

32%

Not experienced discrimination from patients/service users, their relatives or other members of the public

83%

Had appraisal/KSF review in the last 12 months

88%

Not experienced harassment, bullying or abuse from patients/service users, their relatives or other members of the public

61%

Below average

deterioration

34%

40%

2%

Below average

improvement 84%

90%

1%

Below average

improvement

84%

89%

4%

Below average

deterioration 62%

67%

1%

Below average

improvement

The Trust has identified the following key themes

The New Workforce Strategy has an associated

to focus on as areas for improvement in 2020/21

delivery plan which includes actions and

• Equality of opportunity and fairness • Experience of bullying and harassment from service users and the public

• Health and wellbeing of staff • Morale (covering questions around autonomy and agency, relationships at work, intention to stay)

• Increase in staff experiencing violence from colleagues

• Number of staff having appraisals and their subsequent access to learning and development opportunities

timeframes to be monitored by the Workforce and Culture Programme Board.

Actions include

• Engagement with staff at a local level to facilitate ownership of action plans to tackle key issues raised in the Staff Survey

• ‘You said, we did’ campaign throughout the year to increase the visibility of the impact of actions

• Workforce Race Equality Standards (WRES) and Workforce Disability Standards (WDES) action plans to raise awareness of challenges, increase representation at higher bands and to support adjustments that enable staff to access opportunities.

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• Improving information on wellbeing

Likely to recommend for Care of Treatment

offerings through the intranet

• Promoting the revised Trauma at Work Pathway,

• Increase the profile of opportunities available to gain apprenticeship qualifications 1.5 Engagement score through Friends and Family Test (FFT) The Friends and Family questions continue to be sent out using the CandiConnect platform.

Two questions are asked in the Family and Friends test:

• How likely are you to recommend Camden and Islington NHS Foundation Trust to friends and family if they needed care or treatment?

• How likely are you to recommend Camden and Islington NHS Foundation Trust to friends and family as a place to work?

A response between “Very Likely” and “Very Unlikely” is required by the survey and an opportunity is given to explain the reason for one’s answer. Answers of “Very Likely” and “Likely” are considered positive scores.

FFT Q4 shows 69% positive for the first question (treatment). This represents a 2% improvement on the same period in 2019. The positive responses for the second question (work) showed a drop of 4% on the same period last year at 63%.

In free text responses relating to recommending the Trust as a place to receive treatment, there were positive comments about the professionalism, empathy and dedication of colleagues with some services highlighted as being exceptional. However, less positive comments refer to perceived under-resourcing, high caseloads and long waiting lists for services.

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Quality Report 2019/20

Positive free text comments recommending the

Replies to the same questions as part of the

Trust as a place to work refer to opportunities

Staff Survey are consistently 5-10% lower than

for development and progression, co-production

in the standalone FFT online survey, which has a

with staff and service users, and a friendliness

considerably lower sample size / response rate.

of colleagues. Less positive remarks are

This implies that there is likely to be a positive

around experiencing a lack of equality of

bias in the standalone FFT surveys. The Staff

opportunity, poor working environments, high

Survey results still show an upward trend since

workloads, bullying behaviours and hierarchical

2015, although recommending as a place to

management.

work has only risen marginally since the 2018 survey.

1.6 Friends and family test questions in the staff survey

Our commitment to ensuring Equality, Diversity and Inclusion A fundamental and unique aspect of this Trust is the diverse community we serve and our diverse workforce. This year we have further developed The Our Staff First Project. This has been very effective in retaining and developing the Trust’s own staff since it was launched in 2017. Almost a fifth of bands 8a and 9 roles are now filled by BAME staff – a rise of 4.5% on the previous year.

Our Staff Survey and WRES results tell us that

to offer of any decision not to recruit a BAME

despite introducing Our Staff First we need

member of staff if the scoring is three points or

to think differently and look at other ways of

less, different to non-BAME candidate.

supporting fairness and discrimination. This will be a key strategic priority in our refreshed Workforce Strategy and a focus of our refreshed Equality and Diversity Strategy.

In conjunction with Our Staff First and our Workforce Race Equality Standard (WRES) Action Plan, the role of the WRES Expert has been further developed to support the equality, diversity and

To further increase the numbers of BAME staff at

inclusion work for BAME and is working closely

8a and above, we have added a new intervention

with the Employee Relations Team to ensure

to our recruitment process and this is overseen by

fairness in the disciplinary process and how it is

the Director of HR & OD who will be advised prior

applied.

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The BAME staff group, Network for Change,

Organisational Development

continues to contribute to the Our Staff First

In 2018/9 there were 16 apprenticeship

strategy and hosted a successful Strength in

starts, undertaking qualifications in Business

Diversity Conference in October, with keynote

Administration, Trainee Nurse Associate,

speakers including C&I’s Human Resources and

Senior Leadership and Human Resources. This

Organisational Development Director and the

represents a new way of addressing learning

Director of the WRES NHS England.

needs and alternative career pathways for new

The Disability+ Staff Network is extremely active and has co-produced material with the

The Trust has entered a collaborative with

Equality, Diversity and Inclusion Lead, including

colleagues in other Trusts to examine our

the Supporting Staff with Disabilities and Long

organisational culture and to build a culture of

Term Conditions (physical and mental health

collaborative leadership. We will be working

conditions) reviewed the Equality, Diversity and

with The Whittington Hospital, Moorfields Eye

Inclusion Policy and supported the renewed

Hospital and Newham Hospital. This initiative is

membership of the Disability Confident Scheme,

due to last 18 months and includes a Discovery,

and are supporting the Trust in achieving the

Design and Delivery phase. During this time,

next level in the scheme.

staff from across bands, professions and services

The Rainbow LGBT+ Staff Network is now fully established and is making headway with

will be invited to be involved in the work and decision making.

their membership of the Stonewall Diversity

The OD Manager has been working with the

Champion Programme and, for the second year

London Leadership Academy and the Estate

running, was due to attend the London Pride

Transformation project team to plan ways to

Parade. The C&I rainbow lanyards continue to

engage staff in the design and reconfiguration of

be a popular way of showing both staff and

services to be housed in the proposed Integrated

service users that we are an open and inclusive

Community Mental Health Centres (formerly

organisation. In addition, the C&I Recovery

known as community hubs).

College and the Equality and Diversity Lead have further developed the range of equality and diversity courses and we now have a LGBT+ Course. All courses are co-produced and copresented with service users.

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Quality Report 2019/20

ENSURING EQUALITY AND TACKLING INEQUALITIES Camden and Islington NHS Foundation Trust recognises the importance of ensuring its services are fair and equitable to all. The diversity of staff, service users, partners and any visitors to our services is celebrated. We expect everyone who visits any of the sites, or who come into contact with any Trust services, or work for the Trust, to be able to participate fully and achieve their full potential in a safe and supportive environment. The organisation welcomes all service users and members of staff irrespective of race, disability, sex, sexual orientation, gender reassignment, marriage and civil partnership, pregnancy and maternity, age, religion or belief.

The Trust meets all its requirements from within the Public Sector Equality Duty (which forms part of the Equality Act 2010). The requirements and how these are met is detailed opposite.

2.1 Stonewall Membership The Trust is in its first year of being a Stonewall

There are currently four active staff networks:

• Network for Change (Black, Asian and

Diversity Champion. Stonewall is the UKs leading

minority ethnic) and allies staff network.

lesbian, gay, bisexual and transgender (LGBT)

Disability+ (mental and physical lived

equality charity and has been

experience) carer’s allies’ disability staff

instrumental in changing the national legislative environment for people who consider themselves to be LGBT+ and taking forward the agenda. The Trust is aspiring to reaching the Top 100 in the Stonewall Workplace Equality Index.

network.Rainbow+ (lesbian, gay, bisexual and transgender) and allies staffWomen (all who identify as women) and allied staff Each staff network has an executive sponsor, whereby an executive director has committed

The Stonewall rating is often seen as an indicator

to championing that group at Board level. They

of an organisation’s approach to equality and

attend at least one meeting a year to understand

inclusion overall and can further increase all

the issues being raised by the group.

diversity in the workplace. included planning for our involvement in the

2.3 Equality and Diversity Training

London Pride parade for the second year.

In 2018/19 the Trust’s compliance rate for

Part of the Trust’s work for LGBT+ equality has

mandatory equality and diversity training was

2.2 Staff Networks

91.0%. Training in equality and diversity is a

The staff networks provide a platform for staff

mandatory e-learning module for all staff and

to voice their opinions and support the Trust to

a key component of the new staff induction

improve working practices and services. It has

process. Following a review of all mandatory

been an invaluable resource that has had several

training, staff will do equality and diversity

positive outcomes.

refresher training every three years, ensuring that 97

Quality Report 2019/20

all employees are equipped with the appropriate

workshop sessions are offered by the Equality,

knowledge and awareness to provide

Diversity and Inclusion Lead for services and staff

consistently fair treatment towards colleagues

members who would like further information

and patients/service users alike. In addition,

and training around inclusion.

Public Sector Equality Duty (introduced 2011

Requirement

Evidence

General duty

• Collection of equality

1. Prevent and eliminate

Employers and employees in the

discrimination, harassment

public sector, and in private or

and victimisation.

voluntary organisations carrying

2. Establish and promote

out work on behalf of a public

equality and equal

sector employer, have a legal

opportunities.

duty in the workplace to:

service users/ staff.

• Equality analysis process in place.

• Equality staff networks.

3. Foster good relations.

Specific duty

• Equality Annual Report.

1. Publish information to

• Analyse and publish

demonstrate compliance

staff and patient equality

with the general equality

monitoring data annually.

duty.

2. Prepare and publish one or more equality objectives to achieve any of the things from the general equality NHS Standard Contract

monitoring information for

duty.

Equality Delivery System 2 (EDS2)

• Published equality objectives.

• Carry out equality analysis on key decisions.

• Equality Delivery System 2 review of grading and actions on an annual basis.

• Implementation of actions Workforce Race Equality Standard (WRES)

• Results collated and submitted to NHS England annually.

• Action plan in place and Workforce Disability Equality Standard (WDES)

being implemented.

• Results collated and submitted to NHS England annually.

• Action plan in place and being implemented.

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Organisational Development (OD) There are currently 31 staff undertaking apprenticeships in Business Administration, Improvement Technician, Trainee Nurse Associate, Masters in Leadership and Data Analyst qualifications. The Trust continues to explore ways to optimise use of the Apprenticeship Levy funds in order to create new career pathways. This offers opportunities for staff to progress and for the Trust to explore alternative skills mix.

The Trust continues to work in a learning collaboration between The Whittington Hospital, Moorfields Eye Hospital, and Newham Hospital in order to examine our organisational culture and to build a culture of collaborative and compassionate leadership.

OD priorities for the coming year:

• Equality and Fairness • Service Transformation • Embedding the Cultural Pillars The OD team also works in close collaboration

Staff from across bands, professions and services

with the Trust Wellbeing Lead, the Quality

have been invited to be involved in the work as

Improvement team and the Equality, Diversity

we progress through the Diagnostic, Design and

and Inclusion and WRES Leads.

Delivery phases over the coming year

Recruitment and Retention In 2019/20 we have recruited 232 new non-medical staff to the Trust excluding trainee positions, we recruited 20 to band 8a and above roles and 30% of these appointments have been BAME Staff.

There has been a key focus on improving

We have worked with the Ministry of Defence

the number of BAME staff we employ and

to achieve the Employer Recognition Scheme

ensuring that the recruitment process is fair and

Silver award for the work we have been doing

transparent. We have worked in partnership

with the armed forces in recognition of the Trust

with BEH, to re-launch our BAME reps’ initiative

putting in place forces-friendly initiative such as

and re-branded this under Equality Champions.

our Employing staff in the armed forces policy.

We have implemented joint training for Equality Champions across both organisations and we are working to set up an automated process to share Equality Champions across both trusts.

We are working closely with the divisions to improve recruitment levels especially in our nursing roles and plan to attend The Times Nurses and Midwifery recruitment fair in March.

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Learning from Death There is a Learning from Deaths process at the Trust. There are weekly Mortality Review Meetings Group meetings where all deaths are subject to case review.

Quarterly Learning from deaths reports are presented at the Board.

Item

Prescribed information

Comments

27.1

The number of its patients who have died during the reporting

Total 185

period, including a quarterly breakdown of the annual figure.

Q1- 102 Q2- 112 Q3 – 101

27.2

The number of deaths included in item 27.1 which the provider

Q4 - 129 72 Hour investigation

has subjected to a local 72-hour investigation or Serious Incident

Q1 - 28

Investigation. Including a quarterly breakdown of the annual

Q2 - 35

figure.

Q3 – 37 Q4 - 42 SI investigation Q1- 8 Q2- 7 Q3 - 1

27.3

Of the deaths reported in item 27.2, all were investigated to

Q4 - 9 Q1- 0 death scored as

determine avoidability of death in terms of provider care. The

<=3

avoidability scale scores from 1-6 with scores. Scores 1-3 confirm that the investigator and review panels (SI and MRG) agreed that the death was definitely avoidable, strong evidence of avoidability or probably avoidable.

27.4

A summary of what the provider has learnt from case record reviews and investigations conducted in relation to the deaths identified in item 27.3: Learning:

• Poor physical health is a key theme in the deaths reported during Quarter 1. Action Plans to address these issues include; training for new staff on the Physical Health Screening Tool and addressing health issues in the service user care plan.

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Q2- 0 deaths scored as <=3 Q3-4 not available

Quality Report 2019/20

Learning continued: • Service users who present with diagnostic uncertainty may not be receiving the care they need at a time they need it. This occurred in two of the investigations where service users experienced delays in accessing the care they required due to them being referred to an inappropriate service, or decisions about referral to an appropriate service were delayed due to diagnostic uncertainty.

• Incomplete documentation continues to be a theme in Serious Incident Reviews. Although direct causal relationships are not clear.

• The option to “create a new” risk assessment function on Carenotes, means that historically important information in the previous risk assessment is not carried forward into the most upto-date report. There is a risk of information getting lost.

• There appears to be gaps in engaging carers of service users and fulfilling the requirements under The Care Act 2014 including undertaking formal carers’ assessments.

• Delays in Mental Health Act assessments and how to support services users during the delays emerged again this quarter.

Learning: Key themes identified from the serious incident investigations undertaken into service user deaths in the Trust.

• Expected natural deaths, are the highest cause of death for this population. Many are the result of many years of poor lifestyle, diet, smoking, sedentary lifestyle and substance misuse.

• The need for prompt engagement by services after a service user death was an area of improvement from one of the reports. Families felt they were not contacted quickly enough, or offered the right support following the death of a loved one. The Being Open and Duty of Candour Policy (2015) outlined the expected timeframes to contact families after the death of a service user. There could be improvement in teams responding as outlined in the Trust Policy.

• Communication and interface within the organisation (between teams), and with external providers (other NHS Trusts, GPs) has been a concern repeated in a number of the deaths’ reviews from this quarter. Investigations evidence that not all necessary information was shared as would be expected. None has been directly linked to the cause of the death; however, this is a key learning point from these investigations.

• The need for joint investigations into care was highlighted with the first recorded service user death from the Specialist Perinatal Mental Health Service (SPMHS). The SPMHS was formed in November 2017, to work across the five North East London Boroughs, (Camden, Islington, Barnet, Enfield, and Haringey). This was an unexpected unnatural death, which found at Inquest that the care provided by the SPMHS was good and the death could not have been prevented.

• NHS England have completed their substantial piece of work to provide literature for services, and families/carers affected by a homicide by a service user with a mental health diagnosis.

These can be obtained online at https://www.england.nhs.uk/london/our-work/mhsupport/.

This is in addition to the “helping hand” booklet, for families and carers of persons who end their life through suicide. The latter has been shared Trustwide. The Homicide literature will be shared accordingly.

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• The reviews of these deaths also brought up issues regarding the planning and discharge process from inpatient units. This includes referral onto community teams in a timely way, with understanding of the triage processes and response time of the receiving team. Also, to ensure discharge plans are communicated clearly with the service user, family, and other C&I and nonC&I providers.

• During this period, one patient death occurred on the ward. This was recorded as a natural death, however learning from the review detailed gaps in physical health management, including ECG and VTE assessments as per the Physical Health and Wellbeing Policy.

27.5

A description of the actions which the provider has taken in the reporting period, and proposes to take following the reporting period, in consequence of what the provider has learnt during the

27.6

reporting period (see item 27.4).

As stated above An assessment of the impact of the actions described in item 27.5

27.7

which were taken by the provider during the reporting period.

As stated above The number of case record reviews or investigations finished in

0

the reporting period which related to deaths during the previous reporting period but were not included in item 27.2 in the 27.8

relevant document for that previous reporting period.

An estimate of the number of deaths included in item 27.7 which the provider judges as a result of the review or investigation were more likely than not to have been due to problems in the care provided to the patient, with an explanation of the methods used

27.9

to assess this.

N/A A revised estimate of the number of deaths during the previous reporting period stated in item 27.3 of the relevant document for that previous reporting period, taking account of the deaths referred to in item 27.8.

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N/A

Quality Report 2019/20

LEARNING FROM DEATHS AND SERIOUS INCIDENTS Description of the quality issue and rationale for prioritising The 2017 Care Quality Commission (CQC) review of the way NHS trusts review and investigate the deaths of patients in England found that learning from deaths was not being given enough priority in some organisations and consequently valuable opportunities for improvements were being missed.

Identified areas for improvement

• To ensure that all data related to deaths

learning from suicides within the Trust

is standardised into the Trust’s approved

• The Governance structure around the

QI process, using various charts this will allow for better detection of special cause variance within a service.

• For a singular Trust Suicide Prevention

scrutiny of Action Plans related to Serious Incidents required improvement in order to make the process more robust and transparent.

Strategy to be developed that draws on the What we have achieved

• The Trust has a Mortality Review Group (MRG) that meets on a weekly basis to review all deaths.

The MRG is attended by the Medical Director, Nursing Director and Chief Operating Officer.

When deaths are reviewed in the MRG, the views and concerns of the family are considered as part of the process.

• The Trust produces quarterly and an annual ‘Learning from Deaths’ reports that are heard at the public Board meetings.

• The Learning from Deaths report includes data for all deaths of Trust service users and draws together the common themes in a thematic review (Please see Chart 1 as an example)

• The data for deaths is broken down into several categories that meet the MAZARS Framework, in addition several other categories are produced that further identify if there are any specific concerns within a certain Division or Team. The categories are as follows: o

Expected Natural (Broken down into “When Expected or Earlier than Expected)

o

Unexpected Natural (Broken down into “Sudden Natural Cause or “Natural Cause but didn’t need to be”)

o

Expected Unnatural (Expected, but not from the cause that was expected)

o

Unexpected Unnatural (Suicides and Homicides)

o

Total Deaths

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Quality Report 2019/20

o

Deaths by division

o

Time between Inpatient deaths

o

Time between deaths caused by self-harm

• The Trust has now developed a suicide reduction strategy that develops and reviews large Trust Wide projects targeted towards the reduction of suicide. These Trust wide projects are developed in response to learning from Serious Incident Investigations following the suicide of a patient.

• To date these projects include: o

Improving the Care Plan Process

o

A complete review of the entire Risk Assessment process including:

• The reviewing and updating of the Risk Assessment template • Introducing and Risk Event Chronology • Reviewing and commissioning new training • Introducing Risk Assessment as a core competency for clinical staff o

Improving access to bereavement counselling for relatives and careers of patients that have committed suicide

o

Improved data sharing with Public Health England

• The Action Plans for Serious Investigations have been fully migrated over to Datix, this will allow for a more transparent view of the completion of Action Plans and how effective they have been at improving patient safety

• 72 Hour Reports have been moved over to Datix, this will allow for more timely responses to incidents of concern that require further enquiry Next steps/future challenges:

• Introducing quarterly surveillance groups related to the key learning from deaths, these will include the Divisional Leads

• Reviewing current divisional Governance structures to ensure that the completion of Action Plans related to Serious Incidents have been sufficiently scrutinised

• Developing a strategy that aligns the Trust to the New National Patient Safety Strategy (July 2019)

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Quality Report 2019/20

Total Number of Deaths (Chart 1) 70

Total Number of Deaths

65 60 55

Mean

50

Lower process limit

45 40

Upper process limit

35 30 25

Common Cause

20

Special Cause Concern

10 5

Feb-20

Dec-19

Oct-19

Aug-19

Jun-19

Aug-19

Feb-19

Dec-18

Oct-18

Aug-18

Jun-18

Apr-18

Feb-18

Dec-17

Oct-17

Aug-17

Jun-17

Apr-17

0

0.0 0.2 0.4 0.6 0.8 1.0

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Quality Report 2019/20

NHS IMPROVEMENT TARGETS In 2018/19 the Trust continued to be assessed on a quarterly basis to meet selected national standards for access and outcomes.

NHS Improvement Single Oversight Framework Camden and Islington NHS FT considers this data is as described due to the following reasons - the data for these indicators is derived from our internal performance systems. Camden and Islington NHS FT has taken the following actions to make further improvements on these indicators even though the indicators are on target, and so the quality of its services, by reviewing the data to identify gaps and taking appropriate actions.

Proportion of people experiencing a first episode of psychosis treated with a NICE approved care package within two weeks of referral Mar-20

Feb-20

Jan-20

Dec-19

Nov-19

Oct-19

Sep-19

Aug-19

Jul-19

Jun-19

May-19

Apr-19

18/19

Target

People with a first begin treatment with a NICE recommended

56% 75% 81% 87% 75% 87% 87% 94% 94% 89% 91% 67% 79%

care package within two weeks of referral Improving access to psychological therapies (IAPT): a) proportion of people completing treatment who move to recovery (from IAPT dataset) b) waiting time to begin treatment (from IAPT minimum dataset):

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Not Published

episode of psychosis

Quality Report 2019/20

Camden and Islington NHS FT considers this data is as described due to the following reasons - the data for these indicators is derived from our internal performance systems. Camden and Islington NHS FT has taken the following actions to make further improvements on these indicators and particularly those relating to ‘proportion of people completing treatment who move to recovery’, and to the quality of its services by close review with improvement plans in place.

Inappropriate out-of-area placements for adult mental health services: NB: Figures include Acute/PICU OAP placements: Camden and Islington NHS FT considers this data is as described due to the following reasons - the data for this indicator are derived from our internal performance system. Camden and Islington NHS FT has taken the following actions to improve this indicator, and so the quality of its services by: 2. The development of plans to reduce

1. Focusing on long-stayers (over 50 days)

admissions

on our acute wards, with a set of actions being developed and implemented

3. Analysis of demand for male PICU, with an

following the recent long-stayer audit

appraisal of options to develop additional C&I capacity to treat all men who need intensive care locally Q1 19/20

Q2 19/20

Q3 19/20

Q4 19/20

219

697

340

331

Inappropriate out-of-area placements for adult mental health services (Occupied Bed days) Ensure that cardio-metabolic assessment

staff to screen all patients and ensure that they

and treatment for people with psychosis is

are assessed appropriately. The physical health

delivered routinely in the following service

policy has been revised and there are several

areas:

physical health initiatives at present to provide

The Trust’s physical health screening tool enables

further support for staff in all service areas.

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Quality Report 2019/20

Admissions to adult facilities of patients

to help the individual articulate their concerns,

under 16 years old

understand what options exist in resolving their

No patients <16 within C&I

concern and helping them reach their own

Freedom to speak up The Trust has commissioned the Guardian Service, an independent and confidential service established to support NHS employees at all levels and in all roles, to discuss any matter relating to patient care, patient safety and work-related concerns. The service was

contact on what actions to take is a fundamental principle of GSL. With the agreement of the staff member, the service escalates the issue in line with agreed parameters, bringing the issue to the attention of the appropriate Executive or management team member.

designed in response to The Francis report. The

On Initial contact service users are informed

Guardian Service fills a much-needed gap for

that instances of patient safety will be reported

both NHS organisations and staff by providing an

following the meeting. The meeting takes place

independent and confidential reporting liaison

with this caveat. Reporting can be anonymous,

service. The Guardian Service covers patient

or with the staff members permission, include

care and safety, whistle blowing, harassment,

their name.

bullying, and work grievances. Today GSL supports nine NHS organizations employing approximately 65,000 staff.

For many individuals, the opportunity to speak about their concerns in a safe environment with a neutral and understanding person can

The service provides information and emotional

be an end in itself. Experience to date has

support in a strictly confidential, non-judgmental

demonstrated that the initial subject matter

manner and in an off-the-record discussion.

raised by an individual is often a symptom of

The one-to-one nature of the service is a

a deeper held concern. The role of a Guardian

fundamental foundation of the service providing

in surfacing these deeper held issues is critical

personal contact in contrast to an online, email

and supports the individual to rationalise their

or drop box approach.

concerns to a point where they can decide for

Initial contact with the Guardian Service is normally by telephone and this is answered by an appointed Guardian to any given organisation.

The call may initially go to the voice mail service of an appointed Guardian and will be responded to within the same working day. The Guardian Service is unique in that all contact is on a personal basis and only via email where this is the preference of a contacting employee. A unique and dedicated number is commissioned for each Trust.

The service is focused on the individual, helping them to articulate their concern and decide what action they wish to take. They do not offer advice, legal or otherwise and their purpose is 108

decision as what to do. Self-determination by a

themselves to take further action or recognise their current reaction as an emotional response.

Quality Report 2019/20

PATIENT BENEFITS

ORGANISATION BENEFITS

EMPLOYEE BENEFITS

Potential patient

Surfaces issues that

Impartial assistance

safety issues identified

otherwise might have

without formalising

immediately

been unknown

their issue

Improved staff experience

Improves performance

Independent and

levels in reducing the

confidential support

reflected in improved patient experience

number of employees experiencing stressful environment Reduces the number of serious grievances and

Help in articulating their concerns Feeling of being listened to

potential litigation

The Guardian Service:

• Allows individuals to seek impartial assistance without formalising their issue, in a confidential manner

• Assists issues to be resolved at an early stage

• Provides facilitation of meetings to resolve issues

• Reduces the number of formal grievances raised in an organization

• Reduces the number of grievances becoming litigious

• Protects working relationships between parties to a complaint

• Surfaces issues for the organisation that might otherwise be unknown

• Ensures action is taken in a timely manner • Reduces organisational time and resources in handling complaints, grievances etc.

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Quality Report 2019/20

STAKEHOLDER INVOLVEMENT IN QUALITY REPORTS The Trust’s quality goals are co-developed with stakeholders and communicated within the Trust and the community it serves.

In order to finalise the selected Quality Priorities for 2019/20, the Trust carried out a survey to gather the views of patients, staff, volunteers, trust members and governors and other stakeholders, on what they feel the Trust needs to focus on to ensure ongoing improvements in delivering quality of care. The information from this survey is used to inform the development of the Quality Report.

A “long list” of potential priorities was developed using a range of sources including quality and safety dashboards, various reports and feedback from trust governance groups and patient groups.

Sources of information included:

• Governance and management leads and groups

• Feedback received through user forums • Commissioners and local authorities’ feedback

• Stakeholder consultation

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Quality Report 2019/20

STAKEHOLDER STATEMENTS Commissioners’ Statement North Central London Clinical Commissioning Group (CCG) is responsible for the commissioning of mental health services from Camden and Islington NHS Foundation Trust on behalf of the population of Islington and all associate CCGs. In its capacity as lead co-ordinating commissioner, the CCG welcomes the opportunity to provide a statement for the Camden and Islington NHS Foundation Trust Quality Account. The 2019/20 Quality Account has been reviewed within the CCG and by colleagues in NHS North East London Commissioning Support Unit.

Prior to the first wave of the Covid-19 pandemic,

an increase in service user involvement in QI

the CCG met monthly with the Trust at its

projects and reduction in verbal aggression.

Clinical Quality Review Group meetings (CQRG).

The CCG would be keen to support ongoing

This forum is where the commissioners are

and future QI initiatives, especially with a focus

provided with assurance regarding the quality

on improvement of care and experience across

of care and services provided by the Trust.

pathways within integrated care.

Throughout the pandemic, CQRGs have been paused. However, the CCG has maintained an open and ongoing dialogue with the Trust during this time. Commissioners look forward to attending the Trust’s internal Quality and Safety meetings next year to obtain the required assurance about quality of care.

The CCG has reviewed the information contained within the draft Quality Account (provided to the CCG in November 2020). We confirm that the document received complies with the required content as set out by the Department of Health, or where the information is not yet available, place holders have been inserted for their inclusion in the final Account.

The CCG is delighted to see the wealth of

The Trust fully achieved four of the nine priorities for 2019/20 and partially achieved the others.

Although the priorities not fully achieved are not priorities for 2020/21, we were pleased to see the Trust will continue to work on these over the coming year.

The Care Quality Commission (CQC) inspected the Trusts’ core services in October and November 2020. The CQC rated the Trust as ‘Good’ overall. Due to the hard work and dedication of the Trust and staff, the Trust was rated as ‘outstanding’ for Effectiveness. The safe domain was rated at ‘requires improvement’ and the Quality Account would benefit from the inclusion of key actions the Trust is taking to address the issues identified.

Quality Improvement (QI) projects in place across the priority areas and a number of these demonstrate the benefit they have provided for patients and service users, for example, 111

Quality Report 2019/20

The CCG supports the six quality priorities identified by the Trust for 2020/21, which focus on:

• Patient Safety: Reducing violence and aggression

• Suicide prevention • Patient Experience Service user and carer experience

• Expanding the peer workforce • Clinical Effectiveness Refreshed clinical strategy

• Improving physical health care The CCG looks forward to hearing of progress against the Trust’s chosen priorities for 2020/21 and the difference they make for our residents.

The CCG will continue to foster an excellent supportive working relationship with the Trust and will continue to work towards greater collaboration, providing both support and constructive challenge where required.

7th December 2020 Comments from Camden Council Health and Adult Social Care Scrutiny Committee

During 2019/20 Healthwatch Islington carried out research with BAME communities into their awareness of a range of mental health support available to residents. Despite those we spoke to having an acknowledged need, there were very low levels of awareness of statutory services. Furthermore, those working in Black and Minority Ethnic-led organisations felt that the Trust needed to reach out into the community more, to enable more people to access support. We are pleased that during the year members of the Trust including [the Head of Business Partnerships (who champions equality within the Trust, and we look forward to seeing more integrated, cross-sector ways of working develop. We know that the Trust continues its work on developing the estates and look forward to working with the Trust to shape that in a way that is as accessible and inclusive as possible. We know it’s been an extremely challenging year for colleagues working in the health and care sectors and we want to give thanks for the way that they have adapted over the year.

No comments received.

Emma Whitby

Comments from Islington Council Health

Chief Executive

and Adult Social Care

Healthwatch Islington

No comments received.

Comments from Healthwatch Camden Healthwatch Camden will not be commenting on any of the Quality Accounts this year.

We look forward to continuing to build upon our work with C&I as part of Camden’s Integrated Care Partnership in the year ahead.

Matthew Parris Director Healthwatch Camden Received 9 December 2020

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Comments from Healthwatch Islington

Received 7 December 2020

Quality Report 2019/20

Response to Stakeholder Statements

Feedback

The Trust would like to thank stakeholders for

on aspect of the Quality Report 2018/19

their comments. We look forward to working

or to ask questions, please contact the

with stakeholders in the forthcoming year to

Governance and Quality Assurance Team.

achieve our priorities.

The team can be contacted by emailing

If you would like to give any feedback

governanceandquality.assurance@candi.nhs. uk. If you would like to give feedback on services at Camden & Islington Foundation Trust, please email us at feedback@candi. nhs.uk or call 020 3317 3117.

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Quality Report 2019/20

ANNEX 1: Statement of the Directors’ responsibility for the Quality report The directors are required under the Health Act 2009 and the National Health Service (Quality Accounts) Regulations to prepare Quality Accounts for each financial year.

NHS Improvement has issued guidance to NHS

• the performance information reported in the

foundation trust boards on the form and content of

Quality Report is reliable and accurate

annual Quality Reports (which incorporate the above

• there are proper internal controls over the

legal requirements) and on the arrangements that NHS foundation trust boards should put in place to support the data quality for the preparation of the Quality Report.

In preparing the Quality Report, directors are required to take steps to satisfy themselves that:

• the content of the Quality Report meets the

collection and reporting of the measures of performance included in the Quality Report, and these controls are subject to review to confirm that they are working effectively in practice

• the data underpinning the measures of performance reported in the Quality Report is

requirements set out in the NHS foundation

robust and reliable, conforms to specified data

trust annual reporting manual 2019/20 and

quality standards and prescribed definitions, is

supporting guidance

subject to appropriate scrutiny and review and

• the content of the Quality Report is not

• the Quality Report has been prepared in

inconsistent with internal and external sources

accordance with NHS Improvement’s annual

of information including:

reporting guidance (which incorporates the

• Board minutes and papers for the period • papers relating to Quality reported to the Board • feedback from commissioners dated (7/12/20) • feedback from Islington Healthwatch dated (7/12/20)

• the Trust’s complaints report published under regulation 18 of the Local Authority Social Services and NHS Complaints Regulations 2009

Quality Accounts regulations) as well as the standards to support data quality for the preparation of the Quality Report.

The directors confirm to the best of their knowledge and belief they have complied with the above requirements in preparing the Quality Report.

By order of the board Signed:

• the national patient survey • the national staff survey • the quality report presents a balanced picture of the NHS Foundation Trust’s performance over the period covered 114

Deputy Chair

Chief Executive

Quality Report 2019/20

ACKNOWLEDGEMENTS Camden and Islington NHS Foundation Trust would like to thank all the staff, service users and partner organisations that contributed to this report.

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