Matters Quarter 2 - 2013/14
Listening to and acting on service user feedback Job no. 5587 Oct 2013
What Matters Welcome. . . to the second issue of What Matters for 2013 –14, which offers a snapshot of the activity across our Trust to gather feedback and to respond to what service users and carers tell us is important. In this issue you can read about a range of initiatives, including: • Our accreditation against the Customer Services Excellence standard • What you told us at our Summer service transformation events • An initiative to improve the information we make available to you • Our results from the Friend and Family Test and other surveys • About new services and support, for example Equine therapy and cookery books specially produced for people with a learning disability • Initiatives that support our staff to deliver the best care • Feedback received via our Customer Services team, who are always on hand to answer any questions you might have or to help resolve any concerns or complaints. During the last quarter, the customer services team responded to 166 issues, which is about the same as the previous quarter when 161 issues were raised. Care and treatment was the most commonly raised issue, with both positive and negative feedback offered, followed by staff attitude, communications and waiting times. The team also processed 204 external enquiries, providing information and signposting to services. Please contact the team if you want to raise an issue or to let us know what you think of What Matters.
customerservicesSWYT@nhs.net What Matters Customer Services, Block 10, Fieldhead, Ouchthorpe Lane, Wakefield WF1 3SP
Transforming our services We are reviewing our services to ensure we continue to meet local need, offer best care and better outcomes and are value for money We are calling our reviews service transformation. We are taking account of the changes in our communities, widening health inequalities, and the need to make best and effective use of resources – given the significant financial challenge across the health and social care economy. Over the spring and summer, we have been reviewing our mental health, general community, learning disability and forensic services. These reviews have been informed by engagement with service users and carers and people in local communities, through a series of events at which over 450 people shared their opinions and ideas, with another 50 set of comments submitted via our website. Feedback from these events is on our website at: www.southwestyorkshire.nhs.uk/our-services/transforming-our-services/engagement-events/, but in summary people told us: • To focus on their potential, not their illness • To make the most of available technology, for people who choose to use it • To work with partners so people don’t fall through the gaps • To offer help at the earliest point • To offer choice and explain all the choices available • To support family and carers Our reviews must deliver: • Co-production with people who use our services and our partners • An increase in self-directed and self-managed care • An emphasis on recovery • Alignment with our mission and values • Affordability People have told us they want to be able to access a range of help and support, using creative approaches whilst retaining control over their own health and wellbeing.
You can also join as a member of our Foundation Trust at:
www.southwestyorkshire.nhs.uk/membership If you would like to share your story you can do this by visiting:
Dawn Stephenson Director of Corporate Development 1
Transforming our services Our service reviews will take account of the following:
Community mental health • • • • • • • • • •
Ensure recovery is the underpinning philosophy. A single point of entry with no service user going through Single Point of Access more than once in a given period. Expert triage to ensure people are admitted to the right part of the system – face to face assessment where possible, with diagnosis and clustering. IAPT (Improving access to psychological therapies) remains a separate option and is not a triage service. Integrated psychological therapies. Re-focus on crisis and intensive home based treatment. Community mental health teams to be geographically aligned to support relationship building with GPs. Explore proposals for ABIS (acute brief intervention service) and progress proposals for RAID (rapid access intervention and discharge). Explore the concept of hubs. The service offer should be the same across all four districts as far as possible.
Dementia pathway • • • • • • • •
Demonstrate how Trust expertise can be used – as both a provider and a facilitator. To work as an enabler for service users and carers to form community networks of support using recovery principles. Self-care and self-management supported through recovery services. People stay at home for longer and stay well for longer. Diagnosis will be speedier. Through better managed outcomes, people are less likely to experience the ‘wilderness years’ (following diagnosis and prescribed medication to a crisis hospital admission). Use our expertise to offer consultancy and support to care homes, general hospital and primary care. End of life services are introduced when they are required.
Learning disability services • • • • •
Create pathways that maximise individual recovery. Provide a specialist service for working age adults, in addition to mainstream services. Provide expert community base assessment and treatment services. Provide expert consultancy and advice to primary and acute health providers and care/support homes to support people to remain at home or to get the best service for them within mainstream services. Continue the dialogue with commissioners to explore optimum provision, including community and bed based intensive and specialist provision.
Forensic services • • • •
Extend the care pathway. Sub specialisation, including further development of women’s services, exploration of enhanced medium secure service for men to support earlier transfer from high secure and reduction in admissions to high secure services. Continued review to re-designate current capacity to alternative subspecialties. To further enable sub-specialisation, explore implications of further reconfiguration and refurbishment.
Partner programmes All local health and social care partners have transformation programmes underway and we are connected into each of these, demonstrating where we add value and exploring new ways to work in partnership for the benefit of local communities. Increasingly, as these programmes develop we need to share our work and engagement processes as they are complimentary to broader system transformation.
Community health services • • • • • 3
Through integrated care and high performing teams create a model for community wellness. For long-term conditions, child and family and inpatient and community rehabilitation services provide services in community settings that enable less reliance on hospital-based services and enable people to live life to the full through managed support. Prevent hospital admission and support early discharge where appropriate. Further explore the use of technology, including telehealth and telecare, looking at partnerships and opportunities. A commitment to work more closely in partnership with Barnsley Hospital NHS Foundation Trust on service development. 4
Customer services excellence
Trust achieves national standard for Customer Services Excellence
Service user information project
The Trust has recently been accredited against the Customer Services Excellence Standard. This is a national standard which covers customer insight, culture, information and access, service delivery and timeliness and quality of services. The assessor reported an overall impression:
It was obvious … that SWYPFT met the requirements of the standard… members of staff observed and interviewed came across as extremely motivated and extremely passionate to working at SWYPFT. They also appeared to be firmly committed to providing highly effective services and overall good experiences for their many service users and carers…
The feedback also showed there was structured learning and development linked to providing good customer services. Staff confirmed they received regular reviews. Good evidence was provided of staff feeling empowered to deal with issues and then share the learning in order to develop services.
Areas commended included: internal customer insight and empowerment, an inclusive and values focused approach to recruitment, selection and training, corporate commitment and a committed staff group.
Areas for development included: responding to the national review of the NHS complaints procedure, information for carers, family liaison, continuity of care, cohesion between social services and NHS.
Earlier this year the Trust started a service user information project to improve the information we offer to service users and carers. As part of the project, three project officers have been working with staff and service users to pull together a suite of information that is relevant, up-to-date and in line with national standards. The resulting information will be consistent and easily accessible. As the project has progressed around 400 service users and staff have been involved and have discussed and tested the information currently given out to service users about the most common conditions. A database has now been created of sources of information which will be accessible via the Trust’s website. The project has also produced two other information resources: • Building and access information sheets which provide service users, carers and visitors with practical information about visiting our sites, for example directions, parking availability and how to access buildings. All these guides have been tested by service users with very positive feedback. • A set of self-help guides covering common issues such as sleep problems, improving your mood, healthy lifestyles, managing anger and coping with stress. The project is now nearing completion and the information resources will be available soon.
Your feedback Friends and family test
Trust wide patient experience survey
How likely are you to recommend our service to friends or family, if they need similar care or treatment?
The Trust recently conducted a Trust wide patient experience survey, gathering information using electronic tablet PC’s and an information kiosk. The portable tablet devices had preloaded questions using Viewpoint technology, with questions focusing on care and care planning and how much people felt involved in decisions about their care.
The Friends and Family Test is an easy to understand, comparable question which, from April 2013, has been used in acute inpatient and accident and emergency services to gather feedback from people who use health services. Although many of our services do not fit the target group, in order to test out what you think about our services we are giving people the chance to respond to this question by including it in our surveys. We now routinely collect Friends and Family scores on discharge from our mental health wards in Calderdale, Kirklees and Wakefield and will extend this to our Barnsley mental health wards from November. We also ask the question quarterly as part of our systematic Trustwide inpatient survey, which offers a snapshot of service user opinion. Our latest survey results – collected in July and August are shown in the table below.
A total of 317 responses were recorded in July and August 2013, a response rate of 56%. A breakdown of responses across the Trust is shown below: Barnsley general health – 46 responses Barnsley mental health – 29 responses Calderdale – 35 responses Forensic – 90 responses Kirklees – 35 responses Wakefield – 82 responses
Do you have a care plan?
Your feedback Do you feel involved in producing your care plan?
CQC Community benchmark report The Care Quality Commission national community mental health survey 2013 has now been published. The survey involved 58 NHS Trusts in England and reports on service users aged over 18 years who were receiving specialist care or treatment for a mental health condition and were seen between 1st July and 30th September 2012. The CQC website displays the results, showing where Trusts performed ‘better’, ‘worse’ or ‘about the same’ as the majority of other trusts for each question and section. Our Trust was rated ‘about the same’ for all sections, which is a positive change from the previous survey when two sections - care plan and care review - were identified as ‘worse’. The Trust’s most positive scores related to health and social care workers and the care co-ordinator. The lowest section score was related to day to day living. We will continue to use the national survey results to identify aspects of our services that need improving. We use the results alongside all the other service user experience feedback we receive to make sure we focus on the most critical areas.
Do you think your care plan is helping you?
Your feedback Cardiac and pulmonary rehabilitation survey
Telehealth/Care Navigation telephone survey
80 people recently took part in a survey of our Barnsley Cardiac and Pulmonary Rehabilitation service using hand held electronic devices to share their views.
The Barnsley care navigation service recently conducted a telephone survey to assess service user satisfaction.
• 89% said they know how to contact the services if they have any queries.
As the name suggests, the service helps people to navigate care and provides support to help people be in control of their health condition. This is done in a variety of ways, dependent on individual circumstances, and includes:
• 86% found the signage at the Dorothy Hyman Centre very good or good. • 90% felt involved in decisions about treatment; 99% felt they had the opportunity to ask questions.
• Personalised information and advice about health conditions.
• 99% felt that attending rehabilitation had helped them to understand the benefits of exercise; 91% said it increased their knowledge of their condition.
• Help to access local services.
• Support to identify things that could help improve how people feel. • Monitoring and observing, using electronic equipment, provided at home, free of charge. • Help to spot early changes in a person’s health to prevent things from getting worse. • Motivating people to achieve their goals, with regular contact and friendly encouragement.
In response to our survey: 59% of people said they felt better able to manage their condition following contact from the Care Navigator, 19% were unsure 22% said they were not better able to manage their condition. 100% of people said the care navigator was polite, 100% professional, 96% supportive. 100% said they were given enough opportunity to ask questions. 96% would be happy to speak to the same care navigator again. 85% said that talking to the nurse Care Navigator made them feel that they have all the information they need to understand their health condition. 42% of patients said that their quality of life had improved since talking to the care navigator.
‘‘ ‘‘ ‘‘ ‘‘
It’s an excellent idea, everyone over age of 65 in medical need should have the service.
Couldn’t wish for anything better. Cannot believe everything that has happened thanks to her support, think the world of her.
Felt that the service did not telephone when they said, stayed in for calls and no call made.
Believe that people who have more needs would benefit from the service more.
Focus on Forensics On these pages you can read examples of initiatives to improve quality in our Forensic services.
Listening to and involving service users and carers: At Newhaven medium secure services results of the recent patient experience survey have been generally good. There is an active service user group - One Voice – a winner in the Trust’s Excellence Awards 2012, a carers’ dialogue group and weekly ward community meetings. At Newhaven service users get involved in a range of forums - including advocacy groups, morning planning meetings, 1:1 sessions and regular audits of service user’s current interests.
Care and care planning The service user experience survey undertaken in this period showed generally good results, but with work to be done. Service users are involved in their care planning and are offered copies of the care plans but work needs to done to explain the language used in surveys for example as part of Care Quality Commission and Mental Health Act visits (for example the person who support you is called a care co-ordinator). All our secure services use the Shared Pathway model, which involves staff actively engaging service users in their care and discharge planning, setting clear objectives so that service users have a greater understanding of what is required to move to the next level. The documents used to record information is standardised throughout the secure service and transfers with the service user as they move on.
The following activities are currently available: • Literacy sessions provided by Wakefield Adult education, have been extended by 2 hours each week to provide mathematics. The new sessions started in September and are proving popular. • Castleford Tigers and Yorkshire Cricket Club have been providing sessions which service users have enjoyed participating in. • Trampoline training in the form of Rebound Therapy has been completed by a number of staff and service user sessions commenced in September. • Climbing sessions are planned at an indoor climbing gym and a Creative Mind bid has been submitted to fund this. • Vocational sessions are now held at the community café, giving service users experience of cooking food for members of the public. • Session at a woodwork shop have been secured; one service user recently provided a bird box to the unit that he had made in these sessions. • Newhaven is also exploring vocational opportunities in Horticulture. At the Bretton Centre, initiatives include daily ward planning meetings, a weekly ward based activity program supported by ward based activity co-ordinators, a ward buddy system to help new service users, community social nights and a carers’ group unit visit. To improve the environment new lockable storage units have been provided in bedrooms, new furniture for all wards, planters and a greenhouse have been installed in the internal grounds, and a wider choice of food is on offer. Recreational choices for service users include a walking club, cycling club and angling club.
Recording and evaluating The Care Quality Commission highlighted this as an area the service can improve on at a recent visit. This is being addressed through audit and action planning, and the unit’s practice governance coach is working with clinical staff to improve reporting and documentation.
Staff who are fit and well to care A range of initiatives are underway to support staff who work in our forensic services: • New recruits to the service will take part in a pilot of a fitness testing process, offered by the Occupational Health Team. • Staff who are deemed unable to carry out the full range of duties, on a permanent basis, are supported in reallocation from frontline clinical services. • The service has been active in pilot assessment centres for values based recruitment, and a number of staff are part of a steering group to support the roll out of the programme Trust-wide. • The service offers a comprehensive mandatory training programme specifically tailored to meet service need and staff are assigned a place yearly to ensure compliance with both service and Trust mandatory training requirements.
Safeguarding • The service complies with national standards that are monitored by the Specialist Commissioners. •
The recent redevelopment of Newton Lodge, which has included both refurbishment and new build, ensures a safe and secure environment for both service users and staff. This has provided a superb therapeutic environment as well as a modern, well equipped service for staff to work in.
• As part of this year’s minor capital bids there are 2 planned projects to upgrade the reception facilities at both Bretton and Newhaven. This will meet national guidance and provide a safer reception area for service users, visitors and staff.
Care and care planning Cook and eat
Partnership in equine therapy
The Trust has launched four cook books designed to help people with a learning disability to cook nutritious and tasty meals.
The Trust’s Equine Therapy Programme is a partnership between the Trust and the Wakefield Riding for the Disabled Association.
There are four books in the cook and eat series:
Two sixteen week programmes have been undertaken offering 3 service users each week the chance to participate and enjoy spending time with the horses.
• Small meals – things you might eat at lunchtime. • Big meals – things you might eat at tea time. • Cooking from scratch – meals you might make if you enjoy cooking. • Baking – easy and hard recipes for baking. The books have been written so that people with learning disabilities can follow the recipes and make meals on their own or with help from another person. The recipes are easy to follow because: • They are step by step. • You only need to do one thing at a time.
The feedback from the programme has been positive both in terms of participant comments and facilitator observations regarding the impact of the sessions. Staff observed an overall marked improvement in wellbeing for participants during the sessions, and further programmes are underway.
• It doesn’t matter how long it takes. • There are photos and easy words to follow. • Everything is measured and timed, so you don’t have to guess. The books were launched at a party in October, where people found out more about the books, watched recipes being cooked and had a go at cooking themselves. The event finished with a buffet and disco. The author of the books is one of the Trust’s occupational therapists.
Food you need
I am a 68 year old man, I lost my wife some months ago. Life for me was dark and I felt there was no future. I took up the offer to try. I was given the opportunity to interact with the 150ml Milk give the group 50gaMargarine horses - brushing and combing etc. I was able to give and receive unconditional love and trust I was able to fulfil a boyhood dream to ride a horse. So, in summary, the group has given me new hope, trust and the quality of my life has improved so much. None of the above could have been possible without the leadership from staff and those 200g Plain flour 100g Grated cheese at Riding for the Disabled. Michael – participant in equine therapy
Care and care planning Work has been progressed with service users, carers and clinicians to set out what people can expect from our mental health services in terms of planning and reviewing care alongside their care co-ordinator. This has resulted in co-produced standards to strengthen care planning and reviews of care. These will be shared with service users alongside a card which gives details of the name of the care coordinator, general contact details, who to contact in urgent situations and agreed personal contacts.
12 personal standards for care and support planning
I can plan my care with people who work together to understand me and my carer(s), allow me control, and bring together services to achieve the outcomes important to me.
1. I will have/ everyone will have a care/support plan, a copy of which will be offered to me. 2. My care/support plan will identify my care co-ordinator so that I will always know who they are and how I can contact them (care co-ordinator card). 3. My care/support plan will be recorded so that it can be easily understood by all involved (person centred language). 4. My care/support plan will be jointly produced (as much as I or others are able and want to be involved) and I will have as much control as possible in identifying the kind of care/ support I need. 5. My care/support plan will focus on maximising my quality of life/potential and promote self- management and will reflect my individual path to achieve my desired outcomes. 6. My care/support plan will be centred on my current health and social care needs and personal aspirations. This will be realistic and achievable. 7. My care/support plan will be shared with all involved, unless clear reasons are in place not to share.
I have the information, and support that I need to make decisions and choice about my care and support.
1. I will have my care/support reviewed according to timescales within the care/support plan and at times when my needs change. This will happen at least once within every 12 months. 2. My review will help all involved to see if we are achieving the outcomes that are important to me. 3. My review will focus on my needs and recovery and on maximising my potential. 4. My review will allow all involved in my care and support to contribute to the review. Those involved will have the opportunity for input, regardless of the setting. 5. My review will include the provision of information to enable choice and decision making. 6. I and my carer and others involved will have the opportunity to identify what we will bring to the review and ensure that all are prepared for the review. 7. My review will work through the care/support plan and identify what changes need to be made. The outcome of my review will be to agree changes to my care and support plan, reflecting my needs. 8. I will be included in all decisions for change and all agreed changes will be fully explained to me. 9. I will have a copy of my review and updated care/support plan. 10. I will always know when my next scheduled review will take place. 11. If the outcome from my review is to be discharged from services:
a. All involved need to be communicated with
8. My care/support plan will show clear responsibility for actions of myself and others including when my care is transferred.
b. I will have a clear contingency and crisis plan on when and how I will re-engage when my needs change which will be communicated to all who may need to respond to this.
9. My care/support plan will have clear actions and responsibilities when my needs change (contingency, crisis and safety plans).
12. If my care is transferred I will know in advance:
10. My care/support plan will explain what to do if my needs change and who will take on my responsibilities when/if I am not able to give informed consent, enabling me to plan for my future care needs (advance decisions/statements) 11. My care/support plan will be reviewed at agreed times and at times when changes will warrant a review as well as my or other individual’s request for review. 12. My care/support plan will have achievable and measurable outcomes (achieves what is important to me and recognises changes made).
12 personal standards for reviews of care
Personal standards for care planning and review
a. Where I am going.
b. What I will be provided with to ensure that services will continue to support my recovery journey.
c. Agree and meet my new care co-ordinator.
d. What will be available to support my transfer.
Care and care planning A new criminal justice mental health pilot project in Kirklees was launched this month. The project aims to reduce offending behaviour and prison sentencing by assessing the mental health needs of people who come into contact with the criminal justice system. The pilot project, which will take place over the next year, will provide assessment of an individuals’ mental health needs and, if appropriate, assist in the referral into mental health services for further support and intervention.
Memory Service National Accreditation Barnsley memory services has undertaken the Memory Services National Accreditation Programme, which was developed by the Royal College of Psychiatrists’ Centre for Quality Improvement (CCQI) to support local service improvement. The purpose of programme is to: • Help memory services to evaluate themselves against agreed standards. • Support local clinical and service improvement in line with the standards. • Produce a local report that highlights achievements and areas for improvement. • Produce a national report which allows a local service to compare its performance with other participating services. Evaluation of our service showed:
It has been my privilege to work with the MSNAP Accreditation project as a carer. My experience of the memory service has been: • Initial contact was made with my mother within two weeks of referral. • My mother was seen for initial assessment nineteen days after the original referral date. • I always found that staff were courteous and treated my mother and me with dignity and respect. •
Staff always explained everything that was being done during assessment and the reasons for it. They always made sure that I understood, even though due to the nature of my mother’s illness, she could not.
We were given opportunity to talk through the implications. As carer, I spoke on the telephone with staff members who were very patient and understanding and took time to talk to me. Members of the team were very supportive. They did not mind how many times I contacted them.
My mother was prescribed antipsychotic medication. As this was titrated, she had regular visits from the same nurse to carry out blood pressure checks. She was also visited by the same case manager and saw the same consultant on a three monthly basis.
Pilot project to reduce offending
89% said that staff were always friendly and easy to approach and always listened,11% said sometimes. 78% said the health professional spoke clearly so they could understand, and 78% said they offered them hope and optimism, 22% said sometimes. 72% said the health professional kept their appointments and was on time, 22% said sometimes, 6% said not at all.
I could not have asked for any more superb nurses and assistants.
Staff who are fit and well to care NHS staff survey 2013
Improving access to IT
Every year the Trust participates in the NHS National Staff Survey. The 2013 survey was distributed to a sample of 850 Trust staff in late September / early October. The administration of the survey, which is overseen by the Care Quality Commission, complies with strict national standards of data protection and confidentiality, so staff can feel confident to share their views in the knowledge that they are doing so anonymously.
As a way of enhancing communications with staff who work in all parts of the Trust, we are working with our Staff Side colleagues on a pilot to improve access to IT and the Trust’s intranet – our internal web based information system.
We encourage all members of staff who receive a survey to share their feedback about working in the Trust, so that we can continue to develop as a good employer. The results from the 2012 survey were used to identify areas where the Trust was performing well and can strengthen; and also those areas where we need to develop and improve. The action plan for 2012 focussed on equality and diversity training, health and safety training, near misses and incidents and staff motivation. As soon as the results of the 2013 survey are received we will work with staff to review what the results are telling us and to identify those areas of improvement to focus on.
Staff bank success The Trust operates a staff bank – people who work for us as and when we need additional support to cover perhaps a particular project or temporarily to cover another member of staff’s absence. This works for both the Trust and those people registered with our bank – it helps the Trust manage staff resource costs effectively and helps people who want to work as and when it fits in with their other priorities. The Trust’s staff bank service has been celebrating after reaching the finals of the Health Service Journals Efficiency Awards. The service entered the workforce efficiency category after expanding the staff bank service, enabling it to review staffing needs, reduce risk, improve quality and cut temporary staffing costs. After being shortlisted, the team was invited to London to make a presentation to a panel of judges. The service were named runner-up and received positive comments about their entry from the judges.
An exemplary bank service with consistent standards equality – impressive in a post-Francis era.
The initial pilot, which will focus on Barnsley based catering and domestics teams, will include staff training, provision of log in details and importantly, ring fenced time for regular access to IT facilities. The pilot will also see the installation of PC terminals in suitable accessible areas and there will be monitoring of future intranet usage among this staff group. Results of the pilot will be shared in due course along with plans for roll out to other areas.
Training accredited Learning Disability Nurses and Trust trainers in managing aggression and violence have designed training which has recently been accredited by the British Institute of Learning Disabilities. The training - Caring Approaches to Aroused Situations in Learning Disabilities – is for community staff training and accreditation will help in our offer to other organisations who want to commission training from us in the future. The service is not resting on its laurels, and is already looking at initiatives that will help us improve on training in the future.
Fighting the flu The Trust is keen to share the message about seasonal flu by promoting the flu vaccine. We encourage you to have the vaccine and in turn encourage your family and friends to do the same. We are giving all our staff the opportunity to get their flu jabs at a series of drop in clinics at venues across our Trust. Trust staff provide vital services to our local communities. It is essential we ask staff to get themselves vaccinated against flu - to not only protect themselves and their families but also to protect the people we work with.
Safe Services – our quality strategy The Trust has developed a three year strategy for the development of high quality services.
We put quality is at the heart of everything we do, and understand that ‘quality’ must be measured from a service user perspective and through service user experience. People understand that all support, treatments and interventions are not perfect, but should always expect to be treated with dignity and respect. People who use or visit our services should also be confident that we will never place them at risk from any harm. The aim of our strategy is to make sure we systematically improve quality throughout our services. The following gives an overview of the priorities we have identified in our strategy across our seven quality themes:
Listening to and involving service users and carers • Achieve top 20% for patient experience surveys (overall score).
Person centred Access
• Achieve 90% - 95% in local patient experience audits (e.g. Care Programme Approach). • Achieve 90% - in patient experience commissioner targets. • All clinical teams to be compliant with National Institute for Clinical Excellence (NICE) guidance 136 and 138.
Listening to and involving service users and carers
• All clinical teams to be compliant with essential care standards. • Establish a trust wide carers’ survey to obtain feedback and improve our offer to carers. • Develop a portfolio of evidence of service improvements as a response to feedback.
Care and care planning
• Continue to develop ‘story circles’ and ‘both sides now’ initiatives.
Access Staff who are fit and well to care
Working in partnership
Recording and evaluating care
Efficient and effective
• All clinical teams to be compliant with essential care standards. • Achieve 95% in all access commissioner targets across the organisation. • To create clear access pathways through the transformation programme. • Be compliant with NICE quality standards which refer to access to treatment pathways. • Increase the number of survey questions relating to access to improve monitoring and response. • To achieve a 95% positive response to patient experience survey questions related to timely access to services. • Review our Single Point of Access services and implement any recommendations.
Quality strategy Care and care planning
Staff who are fit and well to care
• Achieve and improve on appraisal targets each year. Evaluate the impact of appraisal system on staff well-being and motivation.
All people who enter our services will receive a timely assessment of their health and social care needs and risk, have active involvement in developing a care plan to meet their personal needs, receive timely treatment options and interventions and have their care evaluated at regular intervals in accordance with their clinical needs.
• Each individual will be allocated a named person to coordinate their package of care. • Development and implementation of standardised clinical care pathways across our mental and physical health services
• Undertake a trust wide clinical supervision audit cycle. • Undertake both national and local staff audits and develop and implement action plans. • Achieve top 20% for national staff survey (overall score). • Achieve and improve on staff absence target each year.
• Development of outcome based service specifications.
• Achieve mandatory training targets.
• Drive the Implementing Recovery through Organisational Change (IMRoC) project.
• Demonstrate impact of training on clinical care.
• Implement actions from clinical audits that help provide personalised recovery based care across all services.
• Work with clinical staff to develop high performing teams.
• Achieve top 20% for national patient survey in the areas of care planning and care reviews.
• Continue and develop values based recruitment and induction. Include ‘experts by experience’ in recruitment activity.
Recording and evaluating care • Undertake an annual trust wide record keeping audit. Develop action plans to address specific concerns at service level and monitor via governance meetings. • Targeted record keeping campaigns planned to address areas of concern from annual audit process. • All clinical teams to be compliant with essential care standard related to record keeping. • Reduce the number of serious incidents that highlight clinical record keeping as an area for improvement. • Invest in electronic clinical record keeping systems to ensure they are fit for purpose. • Provide clinical record training to staff as identified as part of continued professional development. • Monitor and implement action plans on clinical performance data.
Working in partnership • Implement the care pathways that have been developed through transformational change using the skills we now have within the organisation to develop pathways across physical, health and wellbeing and mental health services.
• Continue the development of the talent pool.
• Undertake an analysis of workload for clinical staff. • Review appropriate staffing establishments and skill mix in clinical teams. • Develop a coaching strategy.
Safeguarding • Service users will have a comprehensive assessment of their needs by competent staff. • Continue to upgrade the estate to ensure it provides a safe environment for our staff and service users. • All staff will undertake safeguarding training appropriate to their role. • The mandatory training programme will be reviewed and staff will undertake all mandatory training appropriate to their role. • Our electronic incident recording system will be rolled out across the organisation so that all incidents are recorded and reported in a single place, supporting the organisation to understand trends and develop learning. • Continue to strengthen the governance arrangements to support patient safety (service governance groups, Incident review sub-committee, clinical reference group).
• All clinical teams to be compliant with essential care standards.
• Research and evaluate tools to support decision making in risk assessment and management.
• Develop transition protocols across all trust services and partner organisations.
• Development of a quality assurance tool (self- assessment tools, organisational tools and quality impact assessment).
• Work with service users, carers and staff to develop a core set of quality standards to apply to transfers of care. •
Review our Delayed Transfers of Care processes to ensure we have improved consistency of reporting across our services.
• Identify, review and implement lessons from serious incidents, serious case reviews, disciplinary investigations. Share the lessons trust wide via the service governance groups. • Use the safety thermometer to measure care. • Review medication errors and prescribing practices and learn lessons from the reviews. Our quality strategy will be a ‘live’ document, subject to regular review as we progress work to transform our services. It will be used as a reference point for quality improvement discussions across our services.
Customer services Customer Services Report – Quarter 2 (July – September 2013-14) The Customer Services Team responded to 166 issues under the Customer Services Policy: supporting the management of complaints, concerns, comments and compliments in quarter 2 13/14. 86 formal complaints were received and 196 compliments. A breakdown trust-wide is shown below.
Top six themes
During the period, Trust services also responded to 50 issues of concern at local level. The Customer Services team worked with services to ensure the recording of issues raised informally and to capture action taken in response to this feedback. This promotes our default position of putting things right as and when they happen wherever possible and supports shared learning about service user and carer experience.
What concerns you? Care and treatment was the most frequently raised issue, with both positive and negative feedback offered (264). This was followed by staff attitude (33), communication (22), waiting times, appointments, cancellations (17), admission, discharge and referrals (19) and patient property and expenses (9). Most complaints contained a number of themes.
Action taken and improvements made as a result of feedback Not all complaints require action plans to remedy issues, but all provide helpful feedback which is used in services to support service improvement. The delivery of action plans if monitored to ensure that corrective action is taken. Most complainants meet with Trust staff to discuss their concerns. All complainants receive a detailed response to their issues, and an apology where appropriate. The following are examples of changes made in response to feedback: • More information is now provided to service users and carers about mental health assessment in a Wakefield crisis team. • A community mental health team in Barnsley is reviewing its discharge process, with a service user group working with staff to agree the most helpful discharge information. • Staff in a Calderdale community mental health team have introduced further checks on service user information and consent status prior to sharing information with any third party. • Staff in a community mental health team in Barnsley are to be provided with additional information and training in regards to Asperger’s syndrome. • Wakefield inpatient service is reviewing the process of admission for staff or former staff to take account of preferences for ‘out of area’ care. • People who work in voluntary roles have been provided with additional information regarding the need to be mindful of confidentiality.
Customer services Service improvements across Trust quality priorities
Feedback from compliments – words used most frequently
empathy positive approach
dedication provilege compassionate
care and attention guidance exceptional inspiration
a big thank you strength and courage professionalism eternally grateful support
Listening Care and care planning Recording and evaluating care Working in partnership Staff who are fit and well to work
Vicky Following Vicky’s discharge from care in an acute hospital, a care plan was put in place for Vicky to receive care from both the Hospital at Home team, and additional support from community physiotherapy to help Vicky to regain her mobility and independence. The plan was to last longer than 6 weeks and a referral to the Physiotherapy service was made. However, the referral form had incorrect contact information which delayed Vicky’s care as the service was unable to contact her.
Customer Services efforts continue to focus on gathering insight on service user experience and to support teams to develop action plans to change and improve services as a consequence of feedback. The Trust continues to promote the importance of the best possible customer experience, for example: • Our training initiative ‘Right First Time, Everytime’ which has focussed on ensuring those important first contacts with people, who use, or visit, our services is as good as they can be. The pilot courses have evaluated well and plans for roll out to all staff are being put in place as a means of supporting a positive service user experience and a default position of excellent customer services. •
The Trust’s recent accreditation against the national Customer Services Excellence standard. Preparation for the assessment helped teams to review their performance in respect of all the criteria and showcase evidence and best practice to the external assessor. The Trust is the first NHS Trust in Yorkshire and Humber to receive the Government standard and one of only three in the country.
As a result of Vicky’s feedback, the service has now put in place a system to contact the referrer again where they are unable to establish early contact with the person being referred. The importance of optimal record keeping has also been reiterated to staff.
Tom Information regarding Tom’s tribunal was provided to an ex-partner in error. Tom was unhappy with this and complained to the Trust about this. Although the investigation showed evidence that the ex-partner’s details were recorded as the named nearest relative, Tom had changed his mind about who he wanted to support him in his care planning and treatment, meaning the information held, to him, was out of date. Staff now ask service users to provide a preferred list of carers and families who will be involved in their care planning and treatment, including being invited to Care Plan Approach (CPA) Meetings. This information is also checked on a regular basis.