Derbyshire Health United. Quality Account 2015/16 DRAFT

Transcription

1 Derbyshire Health United Quality Account 2015/16 DRAFT

2 Contents Index Page Number Introduction and CEO Message 2 Section 1 Message from Our Chairman 3 Section 1 Who we are 4 Section 1 Our Objectives 2014/15 5 Section 2 Our Services 6 Section 3 Our People 31 Section 4 Our Quality Assurance 46 Section 5 Our Patient Experience 63 Section 6 Our Innovation working in partnership 73 Section 7 Our DHU Objectives 2015/ Section 8 Statement of Director Responsibilities 80 Section 9 Statement from Commissioners 81 Section 10 Statement from HealthWatch 83 Section 11 Glossary 84 1

3 Introduction & CEO Message Introduction to the Derbyshire Health United Quality Account 2015/16 from Stephen Bateman, CEO Stephen Bateman Chief Executive Officer Welcome to our Quality Account for Derbyshire Health United Ltd (DHU) which sets out what we have strived to do to safeguard and improve the quality of our services during the year 2015/16. This years Quality Account has been produced in line with national requirements and it is intended that it provides a realistic assessment of the quality of care provided by DHU. The content and format of this Quality Account is laid down in the NHS (Quality Accounts) Regulations 2010 which came into force on 1 April As a provider of healthcare, we are required to present certain information which has been nationally determined, in the form of statements. We encourage our staff, patients, public and healthcare partners to look at this Quality Account to understand what we are doing well and where improvements in services are required. This Account outlines our priorities for continuous improvement in the coming year (2016/17) and we welcome comment on, and involvement in, determining future priorities for improvement. Our Quality Account provides the opportunity for us to report on the progress we have made in the last year and our plans for improvement this year. I believe we have made significant progress over the last 12 months and we continue on our journey of continuous quality improvement. Many of the improvements we have made so far have been widely recognised by the Care Quality Commission (CQC) following their inspections of our Out of Hours service and NHS111 Services in November DHU have achieved Good ratings for all of our services from CQC inspections; however there was also a feeling of disappointment that we did not achieve outstanding in some of the standards. Our reasoning for this was due to the innovation shown in these services through 2015/16 and especially following the exceptional feedback we received immediately after the inspections. The significant changes at Board level in early 2015 have been very successful leading to improvements in the overall corporate, clinical and financial governance of the organisation with Patient safety remaining the primary focus of our Board. This has resulted in the Board gaining assurance on the quality of care and compassion we demonstrate, together with a transparent culture aimed at reducing incidents of avoidable harm to patients through ensuring learning and outcomes are acted upon to improve patient safety. DHU exists to provide caring, high quality, safe and effective healthcare to our patients and the communities that we serve, with a clear vision to engage with our employees and improve our services and to be the healthcare provider of choice to Commissioners. I hope that you will see that our Quality Account clearly demonstrates our commitment to this vision. Our Board meetings always commence with a patient story presented by our Director of Nursing & Quality, and these have proved to be enormously beneficial to us by really bringing to life the patient experience. Continue to page 3 2

4 Introduction & CEO Message In addition to the positive outcomes of the CQC inspections there have been some significant highlights for 2015/16 as follows: Vanguards in Erewash, Greater Nottingham and Leicester, Leicestershire and Rutland (LLR). Clear focus on improving Staff Engagement & Communications through the staff forum and engagement events aimed at embedding the DHU Vision, Values and Behaviours and recognition of the Staff Appraisal programme and Limelight Awards. Dealing proactively and transparently with the NHS111 whistleblowing incident and associated media coverage with the outcome being that the NHS England investigation concluded that all allegations were unfounded. The Contract Award of the East Midlands NHS111 Telephony Service in March 2016, a 5 Year contract that now includes Lincolnshire as from 1st October Excellent Patient feedback through Friends & Family test, NHS111 and Out of Hour s Patient satisfaction surveys and an overall increase in the patient compliments about the services we provide. I am grateful to those who have contributed to the content of this year s Quality Account (2015/16) and to those who have worked with us to ensure that they accurately reflect the work that we have undertaken this year. As Chief Executive, I am pleased to confirm that the information contained in this Quality Account is, to the best, of my knowledge, accurate. Contract extension for our Derbyshire Out of Hours service to 30 June 2017, and Community District Nursing service to 31 March Improved performance on national and local clinical Out of Hours Quality Standards. Being part of three NHS England 3

5 Message from our Chairman Message from our Chairman David Whitney It is once again a real privilege to say a few words of introduction to this annual report as Chair of DHU. It has been a very challenging year and a fast learning curve for the new Board and myself. Throughout it all the one constant feature has been the high quality of all DHU clinical services. This has been reflected in a number of excellent reports from the Care Quality Commission; such accolades are hard won and reflect strong leadership and wide ownership of the clinical quality agenda by DHU staff. DHU also emerged from a difficult period in the national media spotlight with complete endorsement of the quality of the services we provide. Clinical Quality will always remain our primary focus. The DHU Board is committed to building upon the strong foundations of our core services and to consider new opportunities as they emerge including participation in three NHS England Vanguard projects across the geographic area we serve. My aim is to spend more time in the year ahead meeting all staff in the organisation and to hear your views regarding how we can work together to develop and improve even further the services we offer. We will also be in continuing discussion with new and existing external partners as we seek to grow the breadth and range of our clinical services. We look forward to working closely with patients, staff and our partners as we move forward together in the year ahead. David Whitney DHU Chairman 4

6 Section 1 Meet our Board Derbyshire Health United Board of Executive and Non-Executive Directors (March 2016) 5

7 Section 1 Who we are Who we are Derbyshire Health United (DHU) is a 'not-for-profit' social enterprise organisation and is the provider for NHS Out-of-Hours services on behalf the North Derbyshire, South Derbyshire, Hardwick and Erewash Clinical Commissioning Groups. DHU are the provider for the NHS111 Services for Derbyshire, Nottinghamshire, Northamptonshire, Leicestershire, Leicester and Rutland and were the provider of Offender Health and Justice services for HMP Sudbury and Foston Hall prisons. DHU believe that patients deserve good quality treatment in a caring and safe environment. As a team, DHU are committed to providing the best possible patient care in the right way, at the right time, in the right place, by the right people to ultimately improve the health and wellbeing of our patients 24 hours a day, 365 days of the year. DHU's quality account is intended to provide assurance of the quality of our service using information generated both internally and from external organisations. Top Row Left to Right Jenny Tilson Director of Nursing and Quality Dr Aqib Bhatti Clinical Director Dave Walsh Director of Human Resources and Organisational Design Stephen Bateman Chief Executive Officer Pauline Hand NHS 111 Programme and Operations Director Dr John Blissett Clinical Director Peter Quinn Director of Finance, Performance & IT Bottom Row Left to Right Pauline Davis Non-Executive Director Keith Nurcombe Non-Executive Director Margaret Amos Non-Executive Director David Whitney Chairman Christine Bain Non-Executive Director Dr Phillip Cox Deputy Chairman, Non-Executive Director Carly Gray Company secretary (in Attendance) Dr Trevor Mills Non-Executive Medical Director 6

8 Section 1 Our Objectives 2015/2016 We will continue in 2015/16 to improve the quality of our services, to ensure they are safe, effective, caring, responsive and well led. Objective 1 Patient Safety We will provide a high quality effective and safe service to all our patients. Placing patients at the heart of safe, compassionate and competent care. Objective 3 Supporting our workforce We will aim to attract, recruit, retain and develop all our staff to be part of delivering good quality healthcare services. Objective 4 Good Governance We will be a well led, financially viable organisation, balancing effective decision making with innovation and transforming services. Objective 5 Integration through partnerships We will develop new models of integrated care through embedding key partnership working which commenced in 2014/15. This will Include the redesign of Emergency and Urgent care pathways. Objective 2 Focus on prevention and self-care We will use our experience and expertise to work with patients, families and our local communities to develop resilience and capacity in preventative services and self care. 7

9 Section 2 Our Services DHU delivers Out-of-Hours Primary Care Service to over a million people in Derbyshire Derbyshire Health United (DHU) continues to provide Out of Hours (OOH) GP Primary Care Services across the county of Derbyshire. DHU is commissioned collectively by Derbyshire s four Clinical Commissioning Groups (CCG s): North Derbyshire Clinical Commissioning Group (NDCCG) South Derbyshire Clinical Commissioning Group (SDCCG) Hardwick Clinical Commissioning Group (HCCG) Erewash Clinical Commissioning Group (ECCG) DHU provide local access for patients from a total of 13 locations situated throughout the county. These services operate when your local GP surgery is closed between the hours of 6:30pm & 8am Monday to Friday with services being available 24 hours a day weekends & bank holidays. DHU Out of Hours Primary Care Services form part of an integrated healthcare provision working alongside the NHS 111 service and the evening / overnight District Nursing service for Derbyshire. Integration of the three services has allowed DHU to improve the patient journey encompassing a multidisciplinary approach to ensure a referral to the appropriate healthcare professional. In addition to the Primary Care Centres (PCC s) located across Derbyshire DHU also operate a fleet of 22 vehicles to support the delivery of both the Out of Hours Primary Care Home Visiting teams & District Nursing services. The fleet of vehicles undertake urgent (within two hours) and routine (within six hours) home visits to the elderly, terminally ill or housebound patients that require a face-to-face assessment and are unable to travel to one of our centres. DHU Out of Hours GP Primary Care Services have PCC s and home visiting services based within many locations. Within the PCC s our General Practitioner s (GP s), Nurse Practitioner s (NP s) and Minor Conditions Nurses (MCN s) have undertaken a total of 209,431 consultations. Incorporating a total of 28,084 home visits, 82,353 telephone consultations and 98,994 face to face consultations in the last year. Dr Aqib Bhatti Clinical Director The changing face of primary care has drastically increased the demand on the out of hours service which has seen year on year growth to 2016 was the busiest yet with over almost 100,000 appointments and almost 30,000 home visits. The organisation has worked very hard to ensure patient safety stays at the forefront of all of our objectives and this is reflected in achieving the out of hours national quality standards consistently for the last 12 months. Highlights from last year - we have developed the role of the clinical pharmacist within the organisation which has shown great promise and provided a new stream of clinicians within the health care environment. We have also been pivotal in supplying health care provision for the planned Erewash MCP Vanguard project. Along with this, DHU has provided a home visiting service for Erewash, Hardwick, Chesterfield Royal Primary Care and South Derbyshire practices by highly skilled Nurse Practitioner's which has allowed GP's to spend more time in practice seeing patients. The future direction with the planned changes to the way GP's work will be a challenge for the company but I am certain we will bridge the changes and continue to provide a fantastic service. 8

10 Section 2 Our Services Delivering our Service Out of Hours During 2015/2016 DHU have experienced an increase in the number of patients requiring OOH Primary Care Services across Derbyshire. Of the 98,994 patients that attended for a face to face consultation in one of DHU s PCC s the following PCC s were accessed. The illustrated map of Derbyshire highlights all of the PCC s that DHU work from; Swadlincote Walk in Service (13,777 patients) The above services are open 7 days a week during the Out-of-Hours period, with Ashgate Manor, Derby Urgent Care Centre and Ilkeston Community Hospital also having services available overnight. The following additional facilities are open at the weekend & also on Bank Holidays: 9. Ashbourne St Oswalds Hospital Walk in Service (3,756) 10. Bolsover Hospital (564) 11. Clay Cross Hospital (2,179) 12. Ripley Hospital (4,599) 13. Whitworth Hospital (651) Ashgate Manor Chesterfield (19,665 patients) Buxton Hospital (2,199 patients) Chesterfield Royal Hospital (9,096 patients) Derby Urgent Care Centre (23,096 patients) Ilkeston Community Hospital (6,577 patients) Long Eaton Health Centre (2,969 patients) North High Peak Walk in Service (9,866 patients) 9 Patient Compliment: Nurse Practitioner visited wife, husband says he cannot praise her enough, very nice, and followed up next morning, very pleased excellent service."

11 Section 2 Our Services Patient Compliment: Wanted to thank doctor and driver for excellent home visit and service in early hours." 10

12 Section 2 Our Services All of DHU s services are available to the residents of Derbyshire and can be accessed by contacting the NHS 111 Service. Following a thorough and detailed assessment of a patients healthcare requirements, a NHS 111 Advisor can recommend to each patient the most appropriate course of action such as: Self-care advice Contact a local pharmacy Contact a local dentist Contact own GP during daytime opening hours Arrange an appointment with a GP or Nurse Practitioner Out of Hours Advanced Nurse Practitioners (ANP s) Nurse Practitioners (NP s) Minor Conditions Nurses (MCN s) District Nurses (DN s) Pharmacist Independent Prescribers (PIP s) Nurse Advisors (NA s) Mental Health Specialist Nurses Healthcare Assistants (HCA s) Receptionists Arrange an advisory telephone call from DHU s Clinical Team if Out of Hours Arrange an Emergency Ambulance for a Life Threatening Emergency Advise attendance at an Emergency Department If a patient requires an appointment DHU employ a large healthcare team working together to deliver a comprehensive service to patients across the county in addition to supporting the wider healthcare community across Derbyshire. DHU employs the following healthcare professions to support the delivery of Derbyshire s Out of Hours services. This comprises of the following: Drivers Support Staff Phlebotomists Pharmacy Technicians In addition Healthcare Professionals such as Paramedics and Community Nursing services also access DHU during the out of hours period via the NHS 111 service for clinical support, advice and guidance relating to patients within their care. General Practitioners (GP s) Emergency Care Practitioners (ECP s) 11 Patient Compliment: Excellent experience from start to finish - thank you.

13 Section 2 Our Services Improved access to our Out of Hours Primary Care Service When patients attend an appointment in one of our Primary Care Centres, they will initially be welcomed by DHU s team of frontline HCA s and Receptionists. Over the last year we have increased the presence of this valuable team to be on duty at all centres to provide further support for clinicians and advice to patients while waiting to attend their booked appointment with one of DHU s many GP s, NP s or MCN s. In addition during 2015/2016 we have increased the availability of the clinical services that we provide at many of our sites across the county. Increased opening times, additional appointments available at local centres and an increase in the number of clinicians at many of our centres have enhanced local accessibility for a number of patients. Patients living in the following areas: Ashbourne, Clay Cross, Ilkeston, Long Eaton, New Mills and Swadlincote now have increased access to appointments locally with either a GP or ANP. In addition to these services our main centres in Derby and Chesterfield are always open whenever the GP surgeries are closed. We continually review all of our primary care services to improve the availability of appointments, the access to these appointments and the services that we are able to provide. In addition to the above Primary Care Centres, DHU have a fleet of vehicles for GP s or NP s to undertake urgent and routine home visits to the elderly, terminally ill or housebound patients that require a face-to-face assessment and are unable to travel to one of our centres. DHU have a highly trained and experienced team of drivers that work alongside the clinicians when visiting patients in their own homes. Patient Compliment: Practitioner at Ripley was attentive, courteous, full of empathy and extremely kind 12

14 Section 2 Our Services DHU Out of Hours Primary Care Services Performance The National Quality Requirements (NQR s) for Out of Hours (OOH) services have to be achieved by all providers of OOH services. During 2015/16 DHU were able to fully achieve the majority of the National Quality Standards requirement for Out of Hours primary care services. Within the NQR s, National Quality Requirement 10 (NQR10) & National Quality Requirement 12 (NQR12) mainly focus on Out of Hours service delivery alongside additional local key performance indicators. NQR10, Face to Face Clinician assessment for Urgent Walk in Patients and Routine Walk-In Patients. DHU achieved above the target of 95% compliance every quarter throughout 2015/16. DHU clinicians were able to see and treat 95.2% of all urgent Walk-In Patients within 1 hour of arrival and 97.9% of routine Walk-In Patients within 2 hours of arrival. NQR12, Face to Face Clinician assessment. This standard relates to patients that are identified as requiring an appointment at one of DHU s primary care centres or a Home Visit. During Quarter 1 (April 2015-June 2015) as an organisation although achieving the majority of the standards for Out of Hours services we identified that a small percentage of urgent (appointment within 2 hours) patients were at times waiting longer than the defined requirement. Following review of our clinical service provision, increased staffing levels and analysis of opening times at our centres alongside a review of internal processes DHU took an active and focused approach to improve the delivery of services to ensure patients that required an appointment or home visits received these within the specified timeframe. As a result of our commitment to patient care we have achieved a significant improvement in our performance. National Quality Requirement 12 had been the area of challenge for DHU during Quarter 1 (April 2015-June 2015) where 2 parts to this 8 part standard needed improvement. Although achieving above the required standard for patients requiring an Emergency (within 1 hour) and Routine (within 6 hours) home visit or face to face consultation a clinically led service improvement team was formed specifically to focus on the service improvement required to achieve the urgent (within 2 hours) target for patients that required a face to face consultation or home visit. Although at DHU we continue review and prioritise the improvement of all areas of care that we deliver within the OOH service we are delighted to report that from Quarter 2 onwards we were able to achieve all 8 parts of this standard and have continued to do so throughout the remainder of 2015/ Our key focus for 2016/2017 will be to continue to maintain if not improve further our performance while ensuring improved delivery of service, improved patient outcomes and positive patient experience. Derbyshire Health United Out of Hours Performance Report Requirement / Category QR10: Face-to-Face Clinical Assessments for walk in patients at a PCC Walk In Patients: Identification of Life threatening condition (and treatment initiated if required) within 3 minutes Urgent Total Urgent Within Limit Patients triaged as Urgent - seen with 1 hour Patients triaged as Routine - seen within 2 hours QR12: Face-To-Face Consultations Primary Care Centre Target 95% 95% 95% Emergency Within 1 hour of Assessment % 95% Urgent Within 2 hours of Assessment % 90% Routine Within 6 hours of Assessment Limit % 85% Routine Within 12 hours of Assessment Limit % 85% Home Visits - Seen within allotted timescale Emergency Within 1 hour of Assessment % 95% Urgent Within 2 hours of Assessment % 90% Routine Within 6 hours of Assessment Limit % 85% Routine Within 12 hours of Assessment Limit % 85% 13 Patient Compliment: Thank you both for everything you did for our son. He is here today because of you, so again thank you

15 Section 2 Our Services Local Target NQR Standard NHS 111 Target Apr May Jun QTR 1 Jul Aug Sep QTR 2 Oct Nov Dec QTR 3 Jan Feb Mar QTR 4 N/a N/a N/a N/a N/a 100.0% N/a 100.0% N/a N/a N/a N/a N/a N/a N/a N/a % 100.0% 100.0% 100.0% 80.0% 96.7% 100.0% 91.7% 91.7% 97.3% 96.6% 95.6% 91.9% 85.7% 100.0% 93.3% 100.0% 100.0% 100.0% 100.0% 98.3% 96.4% 99.3% 97.8% 99.3% 94.0% 98.3% 97.2% 97.4% 97.7% 95.2% 96.6% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 78.9% 82.8% 88.2% 83.0% 88.5% 91.2% 91.9% 90.5% 92.5% 91.0% 92.9% 92.2% 91.6% 94.6% 91.1% 92.3% 92.4% 94.9% 95.7% 94.2% 99.6% 99.5% 99.8% 99.6% 99.5% 99.8% 99.0% 99.4% 99.2% 99.8% 99.3% 99.4% 97.5% 99.3% 99.0% 98.5% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% N/a N/a 100.0% 100.0% N/a 100.0% 100.0% 100.0% N/a 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 86.0% 88.3% 93.9% 88.7% 91.4% 94.0% 92.6% 92.7% 95.2% 94.6% 96.3% 95.4% 94.0% 94.5% 93.8% 94.1% 92.0% 93.5% 95.4% 93.5% 94.6% 94.4% 96.1% 95.0% 94.1% 95.4% 95.5% 95.0% 94.8% 95.2% 94.3% 94.7% 100.0% 100.0% 100.0% 100.0% N/a N/a N/a N/a 100.0% N/a N/a 100.0% N/a N/a N/a N/a Patient Compliment: impressed with the service and the speed at which she was attended to 14

16 Section 2 Our Services The DHU Out of Hours Primary Care team of clinicians are also actively working with our local Clinical Commissioning Groups (CCG s) and a number of healthcare organisations and GP Practices across Derbyshire in delivering services to patients during the in-hours period. In hours services are provided between the hours of 8am-6.30pm Monday Friday. DHU are Leading on the delivery of many services across Derbyshire and working collaboratively with North Derbyshire, South Derbyshire, Erewash and Hardwick CCG s, Derbyshire Community Health Services NHS Foundation Trust (DCHS), Chesterfield Royal Hospital NHS Foundation Trust (CRH), Royal Derby Hospitals NHS Foundation Trust (RDH) and Chesterfield Royal Primary Care Services to provide access to many of the additional following services: Royal Primary Care Home Visiting Service Erewash CCG Urgent same-day GP & NP appointments Erewash CCG Home Visiting Service Hardwick CCG Home Visiting Service London Road Community Hospital Clinical Support DCHS Community Hospital Admission Clerking DCHS telephone consultation support DCHS Community Hospital Visiting service Bassetlaw telephone consultation support QUEST (GP Practice teaching cover) GP Practice telephone support South Derbyshire CCG Phlebotomy Service Foston Hall Prison visiting service & clinical support Driver quote START... END 15 Patient Compliment: Thank you for being there, for being kind and understanding

17 Section 2 Our Services Co-Location at Chesterfield Royal Hospital Streamed Patients DHU work closely with Chesterfield Royal Hospital (CRH) NHS Foundation Trust to provide a Primary Care service within the Emergency Department (ED). The service operates for 4 hours weekday evenings and all day every weekend and bank holidays. This co-location service was commenced in in November 2012 to strategically identify those patients who present to the ED but actually can be assessed and treated by one of DHU s Primary Care team either a General Practitioner (GP) or Nurse Practitioner (NP). Having the Primary Care Centre co-located within the Acute Trust has enabled enhanced patient care as there is direct access to speciality services on-site. On a patient s arrival at the ED reception, a senior NP will rapidly clinically assess each patient and appropriately transfer (stream) them to the Primary Care Centre to see a out of hours GP or NP unless the patient has presented with symptoms requiring the care of ED. Patients who attend with primary care conditions that require a primary care clinician will be streamed into our Primary Care Centre to see either a GP or a NP. The waiting times for patients This service has been found to relieve patient flow pressures within the ED at Chesterfield Royal Hospital NHS Foundation Trust. During 2015/16 working closely with CRH, DHU have continued to develop the service it provides at CRH. Further discussions will support the service to evolve and develop. Over the last year we have been able to increase the number of patients that we stream from ED into this service. The average patient outcomes are as in the chart opposite. As highlighted in the chart opposite, the majority of patients who attend this service are treated within the Primary Care Centre by one of our GP s or NP s and discharged without having to access the ED or be admitted to hospital. Patient Compliment: very caring service from start, very nice, excellent service 16

18 Section 2 Our Services CQUIN Targets and Achievements CQUIN 2 This CQUIN target aimed to reduce the overall use of oral antibiotics given to patients attending the out of hour s service whether at a primary care centre or at a home visit. The World Health Organisation and Public Health England both have national and local initiatives to reduce the unnecessary prescribing of any antibiotics. Each year DHU are set a series of targets by our Commissioner s which are audited quarterly. This is called the Commissioning for Quality and Innovation Schedule (CQUIN). For the year 2015/2016 we have had two CQUINS based on the prescribing of antibiotics. CQUIN 1 This target was based on the prescribing of a particular type of antibiotics called broad spectrum antibiotics to measure that they were only used within the local antimicrobial guidance. These include antibiotics such as Coamoxiclav and Cephalexin. It is well known that these types of antibiotics increase the risk of C Difficile, MRSA and resistant infections and should not be used without good indication or when other types of antibiotics are ineffective. Our clinical audit team reviewed a random selection of prescribing cases to audit whether prescribing was within the local guidance. The results showed that we had an overall improvement on last year s prescribing. This improvement was achieved by a continuing campaign of education and information to both our prescribing clinicians and the public. We provided access to prescribing education sessions for staff, published information in our internal newsletters, in addition to running quizzes and crosswords based on the use of antibiotics to both for our staff and public. This was displayed at events where DHU have attended to promote the Out of Hour s service and contribute to improving the health of our community. This particular target has always been a challenge and there has been an overall increase in the percentage of antibiotics prescribed in the year 2015/16 compared to the previous year. The nature of conditions that we see in the Out of Hour s period includes patients with a very high level of infections which often require urgent attention. In addition to this, the number of patients seeking medical care from out of hours and urgent care is increasing overall each year. There is little evidence of studies being carried out in other Out of Hours or Urgent Care services for us to compare our prescribing to, which makes it difficult to understand whether we are achieving a good result. It has been reported by an English Surveillance programme that nationally there has been an overall increase of 32% in antibiotic prescribing between 2010 and 2013 by community services such as Out of Hours and Urgent Care instead of primary care services in General Practice. To assist in improving health care, through better understanding and prescribing of antibiotics both worldwide and nationally, DHU were invited to take part in a World Health Organisation initiative to develop strategies to tackle this growing problem. Our clinicians contributed to a research project undertaken by Public Health England to look at the barriers to prudent prescribing in the Out of Hours service. We look forwards to the results of this study and putting and new measures and initiatives into place to help resolve this growing problem. 17

19 Section 2 Our Services Our NHS111 Service NHS England introduced NHS111 to make it easier for patients to access local NHS healthcare services in England. Patients dial NHS 111 when they need medical help fast when it is not a 999 emergency. The NHS111 service makes it easier for patients to get the right care 24 hours a day 365 days a year. Derbyshire Health United (DHU) is commissioned to provide the NHS 111 service for Derbyshire, Nottinghamshire, Northamptonshire, Leicestershire, Leicester and Rutland. In order to provide the NHS111 service, DHU employ fully trained NHS111 Call Advisors and Nurse Advisors, along with Dental Nurses, Pharmacists and Paramedics to enable the provision of an efficient, effective and quality service to our patients. DHU pride ourselves in the skill mix we employ to ensure we deliver the most appropriate outcomes for patients. DHU focus on the patient journey, ensuring that our Advisors are fully trained in all aspects of the NHS 111 service to ensure patients are directed to the local service that is right for them. Although DHU provide the NHS 111 service for Derbyshire, Nottinghamshire, Northamptonshire, Leicestershire, Leicester and Rutland, in Derbyshire DHU is also the provider for the Out-Of-Hours (OOH) GP Service and OOH Community Nursing Service which enables us to provide seamless integrated care for patients. What does this mean? The integrated NHS111 and Out-Of-Hours service in Derbyshire delivers a streamlined approach to patient care. DHU staff are able to directly book appointments into 12 primary care centres or allocate a home visit across Derbyshire from the patient s first point of contact with the service. DHU are able to track and trace the patient s journey from the start to finish If the patient re-contacts the NHS 111 service with a query on their Out of Hours contact in Derbyshire, then the Call Advisor or Clinical Advisor will have visibility of the OOH system to advise the patient on their query e.g. to inform them how long it will be for their telephone call back from a nurse or other clinician. When you call NHS111 for Derbyshire, Nottinghamshire, Northamptonshire, Leicester, Leicestershire and Rutland you will be answered by a member of our team based in one of our call centres. Where are the staff based? DHU s NHS111 Services operates from 2 call centres in Derbyshire and 1 call centre in Leicestershire providing local knowledge in the areas we provide the NHS111 service. Pauline Hand NHS 111 Programme and Operations Director I am delighted that DHU has had the quality of its NHS 111 service recognised in 2015/16; not only by an excellent report from the CQC but NHS England investing in piloting innovative ways of working in the service and Health Education England selecting DHU as one of only three NHS 111 providers to develop the NHS 111 workforce of the future Patient I am glad he had got me on the phone and said that I was very kind and helpful and that the 111 service is a very good service 18

20 111 calls offered 111 calls offered 111 calls offered 111 calls offered Section 2 Our Services Derbyshire calls offered % Increase from previous year 111 calls offered - Derbyshire 350, , , , , ,000 50, , , , , % 19% 23% -1% 250, , , ,000 50, LLR calls offered 0 172, , ,685 % Increase from previous year 111 calls offered - LLR 0% 0% 140% 25% 111 calls offered - Northamptonshire 111 calls offered - Nottinghamshire 250, , , ,000 50,000 0 Northamptonshire calls offered % Increase from previous year , , ,685 0% 0% 17% 6% 300, , , , ,000 50,000 0 Nottinghamshire calls offered % Increase from previous year , , , ,794 46% 77% 44% 7% 19 Patient Compliment: Wishes to say that he is very impressed by the level of professionalism shown by CA and NHS 111

21 111 calls offered Section 2 Our Services 111 calls offered - DHU all four contracts 1,200,000 1,000, , , , ,000 All Four NHS 111 Contracts calls offered , , ,189 1,037,033 % Increase from previous year 207% 125% 42% 8% Our Overall Call Volumes for 2015/16 These graphs indicate the increase in call volumes year on year from 2012 and the projected call volumes for 2015/16 for the NHS 111 contracts currently held by DHU in Derbyshire, Leicestershire, Leicester, Rutland, Northamptonshire and Nottinghamshire. Where there is no bar on the chart in 2012/13 the service in that area had not yet commenced. Patient demand increased from 2013/14 to 2015/16 by 234,83 calls. Last year DHU answered 956,707 patient calls through the NHS 111 service. In 2015/16 we forecast that we will answer the telephone to over a million patients, approximately 1.1 million. Patient Compliment: Rang 111 and three hours later I had an appointment. Nurse Practitioner was very helpful and kind. Thank you. 20

22 Section 2 Our Services Our NHS111 Performance There are numerous Key Performance Indicators (KPI) that have to be achieved by an NHS 111 provider. These include achieving less than 0.05% of calls engaged, less than 5% abandoned calls, answering 95% of calls within 60 seconds and less than 10% calls transferred to 999 ambulance. Reports on these KPIs are sent to commissioners daily and weekly telephone conferences take place with commissioners to discuss weekly performance. DHU also provide monthly reports which are submitted to commissioners of the service and to the NHS 111 National Team. This enables commissioners and NHS England to be able to make comparisons against other NHS 111 providers. A monthly meeting focusing on adherence to the performance standards and quality of the service is held between DHU and our commissioners. This meeting is in addition to the monthly Clinical Governance Meetings held jointly with commissioners and other stakeholders that have a connection to the NHS 111 service, such as East Midlands Ambulance Service, Emergency Department representatives, Out of Hours Representatives from all Counties, District Nursing Services, Patient and Public Involvement Representatives. DHU have fallen slightly below the 95% national target for answering calls in 60 seconds, although usually achieve higher than the National average. The average length of time it has taken DHU to answer call during 2015/16 is 22 seconds, which is an excellent achievement. Our emphasis during 2016/17 is to improve upon this target and to ensure all patients are answered with line with national KPI s. DHU continue to increase our staffing numbers in order to meet the rising demand and are actively scrutinising all aspects of our service to aim to consistently achieve all national targets. A further national KPI measured within the NHS111 service is the time for Clinical Advisors to call patients back following transfer to our nurse triage queue. We have found this target to be challenging due to increasing patient demand and some difficulties in recruiting Clinical Advisors. To ensure that our service is safe for patients we have employed the assistance of Agency Clinicians who are clinically trained in NHS111 Pathways. Furthermore due to the integrated NHS111/OOH service in Derbyshire we have been able to provide our NHS111 service with additional GP support. Nurse recruitment is currently a national problem. DHU have developed a recruitment strategy focusing not only on the recruitment and retention of Nurse Advisors but Dental Nurses, Pharmacists and Paramedics. The target of Clinical Advisor call backs is currently being reviewed nationally in line with the new NHS111 specification and DHU are in discussion with our commissioners in terms of agreeing a more appropriate locally agreed target. DHU have one of the lowest referral rates to 999 ambulance from an NHS 111 service in the Country at approximately 10.8% of calls. The graph highlights the percentage of final dispositions that result in an emergency ambulance being dispatched on total triaged calls. Our Ambulance Despatches to date 21 Patient Compliment: patient wanted to say that we get a lot of bad press but his experience has been very good with the 111 service and we deserve more recognition for what we do

23 Section 2 Our Services Patient Compliment: impressed with the service and the speed at which she was attended to 22

24 Section 2 Our Services Our NHS /16 Key Achievement NHS 111 Internal Updates In order to ensure all NHS 111 staff are continually informed of new developments, training initiatives and any learning from incidents and complaints last year we introduced a NHS 111 Update specifically for this task which is sent out to staff on a fortnightly basis (more often if required). In order to ensure all NHS 111 staff are supported, motivated and engaged to deliver a high quality service we have restructured our frontline management team. Our NHS111 management restructure has resulted in us having clearer and consistent clinical and operational leadership on every shift. It also ensures each staff member has a named Team Manager who supports them to improve and sustain their performance against the clinical and operational targets. A Lead Clinician role is also in place to ensure delivery of clinical leadership and the safety of our service. We continue to employ Dental Nurses and Paramedics to complement our clinical team and have now also recruited Pharmacists ensuring patients have access to a variety of health care professionals to meet their specific and individual needs. NHS111 Live Update This has been a very successful communication tool which has been welcomed by staff. During 2015/16 we have added to our communications by introducing a Live Update which informs advisors of any real-time changes to service delivery ensuring all staff are fully updated on a daily basis NHS 111 Audit Team We have implemented a dedicated expert audit team. This team will ensure call audits are completed in a timely manner as per our licence agreement and that the learning outcomes from audit are fed back to staff members. Subsequent evidence of change in practice will be collated to demonstrate DHU is supporting staff development within a learning cycle. Pharmacists supporting patients DHU Staff Engagement Events Another key development was the introduction of a Pharmacist into the call centres to support patients with calls regarding medications. If a patient is concerned they have taken too much of their medication or missed a dose the advisor can direct these calls to a Pharmacist to ensure they get expert advice in a timely manner. Pharmacists can also take to patients or callers following toxic ingestion where appropriate. Our desire for a motivated and engaged workforce has prompted us to provide regular staff engagement events which are well attended and well received by staff providing them with the opportunity to meet with Directors and Board members away from the call centre setting. 23 Patient Compliment: Wanted to thank myself and the 111 service for being such a good service and getting the help she needed straight away, thinks it is the best part of the NHS.

25 Section 2 Our Services NHS 111 Clinicians Home working We now have a number of clinical advisors who can work remotely on the NHS 111 service from home. This provides us with a pool of staff with a high degree of flexibility to assist our patients at times of high service demand. Nikki Argent NHS 111 Clinical Lead: Working from home suits me down to the ground as I am able to assist the service during busy periods, whilst maintaining a healthy work/life balance Paramedic in Call Centre Another key development is the introduction of a Paramedic into the call centre to support EMAS with their winter pressures. The paramedic reviewed selected ambulance outcomes to assess whether the patient is clinically safe to make their way to the Emergency Department by means alternative to an ambulance. 29 NHS 111 staff are also taking up the opportunity to shadow a Paramedic on emergency calls to provide them with the opportunity to understand what is a life threatening emergency and therefore an appropriate 999 referral. Our DHU UXL Program In 2015 DHU have continues with their successful UXL program, an innovative internal learning and development employees. program targeted to support front line DHU takes an active approach in order to improve the patient s safety, journey, experience and the quality of our service delivered. UXL enables this by providing methods of support which include one to one coaching, training sessions and frequent feedback to our NHS111 employees. UXL continues to be delivered by our team of highly qualified and experienced trainers to further support staff and to gain their contribution to improvements in delivery of our clinical and operational targets. Comments from staff following UXL interventions include:- Interesting & good suggestions for call shortening safely. Good to refresh on questioning Good data packages All relevant to role & helps to build up skills after time & experience in call centre Patient Compliment I wanted to compliment Call Advisor and Nurse who was very kind, caring, empathetic, warm, and helped me to open up and talk which I find very difficult. Derbyshire Health United Ltd. Quality 24

26 Section 2 Our Services Reflective Supervision Reflective supervision was introduced within our NHS111 service to provide additional support for our employees. Based around the principles of clinical supervision it has proved to be a valuable tool which has cumulated in the development of the reflective supervision policy. Reflective supervision has been made mandatory in order to support both Call Advisors and Nurse Advisors following completion of their training. This reflective supervision process is unique to our NHS111 service. Call Advisors and Nurse Advisors are encouraged to attend a reflective supervision session with their reflective supervisor following involvement in a serious incident, complaint and following calls that have been distressing or difficult. Our reflective supervision sessions take place on a regular basis to enable our employees to have discussions with their reflective supervisor in a confidential safe environment. By providing reflective supervision for our employees, we aim to improve patient safety, staff retention, provide a high quality service and encourage a positive learning environment. 25 Susan Hubbard (Right) Reflective Supervision Supervisor delivering a supervision session with Carole Dysart NHS111 Nurse Advisor (Left)

27 Section 2 Our Services District Nursing Service Out of Hours The DHU out of hours Community Nursing service provides skilled, flexible nursing care to meet the needs of individuals and carers in the community. The service is delivered in a caring and non-judgmental manner in agreement with the individual and carer, taking into account their physical, social, psychological, cultural and ethnic requirements. The out of hours service will provide both planned and unplanned care to patients in their own homes in partnership with the day time Community Teams and evidence based interventions may include but not be restricted to: Bowel Management Catheter Management coordinate complex packages of care. operates 7 days a week. The service The District Nursing Service at DHU operates from 6pm-8am in Derbyshire County and 10pm-8am in Derby City 7 days a week. DHU employ District Nursing Sisters, Community Staff Nurses and trained Health Care Assistants. We have a number of bases across the county, during the evening we have seven teams working until midnight and two teams after midnight. The nurses always travel in fully equipped company vehicles. Our minimum requirement is that each vehicle is manned by at least 1 Registered Community Nurse and 1 trained Health Care Assistant. End of Life Terminal Care / Palliative Care Leg Ulcer Management Medicine Administration Syringe Driver Management Wound Care/Tissue Viability including complex wound management Our aim is to provide high quality nursing care, in the most appropriate setting to reduce hospital admissions, promote quality of life, facilitate early discharges and Patient Compliment: Numerous contacts with the DN service - patient has passed away needing to cancel the DN phone calls and visits, also wanting to say a big thank you from the family of the patient and the community nurses for their help 26

28 Section 2 Our Services DHU taken delivery of a fleet of brand new response vehicles to boost our ability to reach housebound patients in remote areas of the county. DHU has provided the out of hours District Nursing service for Derbyshire since April 2011, and recently we have upgraded our fleet of vehicles to enable us to continue to meet the needs of these patients in all weathers across the county. We have taken delivery of 6 brand new Renault Kadjar 1.6dCi dynamique four wheel drive response vehicles and these are now being used by our District Nursing teams based in Buxton, Matlock, Chesterfield and Derby. The cars are fully equipped to allow the District Nursing teams to carry out their duties throughout the county. 27 Patient Compliment: Wants to complement the service in general, but in particular the nurses that went to her this morning

29 Section 2 Our Services Participation Initiatives Joined up Working and Communication End of Life Care and Syringe Drivers Members of the DN team at DHU are actively involved in the following initiatives: DHU Patient Participation and Involvement Group. DHU Communication and Engagement Forum. The Care and Compassion Agenda (Caremakers) NHS England. Signing up as Dignity Champions. Becoming Dementia friends. Queens Nursing Institute The District Nursing Service in Derbyshire offers a 24/7 service to housebound patients requiring nursing care within their own home. The daytime service in Derbyshire County is delivered by DCHS 8am-6pm and the out of hours service is delivered by Derbyshire Health United 6pm-8am. In Derby City the daytime service is operated by DCHS until 10pm. The daytime service can refer patients for planned care in the out of hours period, if appropriate. We therefore work collaboratively with DCHS in order to provide a seamless transition between the in hours and out of hours service. We aim to do this in a number of ways: Bi-monthly operational meetings between DHU and DCHS team leaders. Every month the DN team carries out an average of 80 visits where the patient has, or requires a syringe driver. Syringe drivers are essential pieces of equipment used in end of life care and the District Nursing team at DHU has syringe drivers available at its bases. The District Nursing team at DHU is very experienced in caring for patients at the end of life and participate in ongoing training and development provided by the Derbyshire Macmillan End of Life Care Development team. DHU also has representation on the North Derbyshire End of Life Forum, the North Derbyshire End of Life Project, the DCHS End of Life Care Group and the Derbyshire wide End of Life group. By being involved in these initiatives, members of the DN team at DHU are hoping to enhance the care received by, and the service delivered to, the patients of Derbyshire. Sharing of incidents and issues promptly between organisations when they arise. Automatically sending a record of all patient contacts to the GP practice following a visit (if consent is gained). Referring patients back to their own day team the following day, if required. By being engaged with our partner organisations in these groups we aim to be actively involved in service development which hopes to improve End of Life care across Derbyshire. Our nurses support the out of hours service carrying out verification of expected death for patients who have chosen to die at home. Our District Nursing team carries out approximately 50 of these visits each month, and we attend training to enable us to carry out this service. Following the care plan as agreed by the day DN team and the patient. Use of Rightcare plans to view important patient information relating to long term conditions and end of life care. Liaising with care agencies, care co-ordinators and DN teams regarding ongoing care. Patient Compliment: Extremely helpful, very friendly, treatment with a personal touch 28

30 Section 2 Our Services End of Life Care and Syringe Drivers Every month the DN team carries out an average of 80 visits where the patient has, or requires a syringe driver. Syringe drivers are essential pieces of equipment used in end of life care and the District Nursing team at DHU has syringe drivers available at its bases. The District Nursing team at DHU is very experienced in caring for patients at the end of life and participate in ongoing training and development provided by the Derbyshire Macmillan End of Life Care Development team. DHU also has representation on the North Derbyshire End of Life Forum, the North Derbyshire End of Life Project, the DCHS End of Life Care Group and the Derbyshire wide End of Life group. By being engaged with our partner organisations in these groups we aim to be actively involved in service development which hopes to improve End of Life care across Derbyshire. Our nurses support the out of hours service carrying out verification of expected death for patients who have chosen to die at home. Our District Nursing team carries out approximately 50 of these visits each month, and we attend training to enable us to carry out this service. Training and Development The DHU District Nursing team undertake a range of training and development activities. They are required to undertake mandatory training as part of their role, which includes basic life support, information governance, health and safety, safeguarding and infection control. In addition to this, the DN team also attends a patient handling study session and dementia awareness. Other training available has been verification of death, catheter management, percutaneous endoscopic gastrostomy management and domestic abuse training. There has been training specifically aimed at our Health Care Assistants including second checking and clinical skills. We also offer sessions relating to chaperoning and customer care. Patient Compliment: Wants to compliment the service in general, but in particular the nurses that went to her this morning. The service gives her great confidence especially as she is on her own 29

31 Section 2 Our Services DHU District Nursing Team Activity In 2015/2016 the DHU District (DN) Nursing team carried out visits across Derbyshire. We aim to visit those with a high priority within 4 hours as per our service specification, or sooner wherever possible. We achieve this target in 99% of cases. We aim to visit those assessed as requiring a routine visit within 6 hours. Incidents At DHU we encourage our staff to report incidents, and all reported incidents are investigated to allow positive change and improvement in our services and learning from the issues raised. 90 incidents were reported and investigated by the DN team in 2015/2016. On average there are 7 incidents logged per month that have been allocated to the DHU DN team. In 2015/2016 we had he largest number of reported incidents related to pressure ulcers, numbering 15 (17%). This reflects the locally agreed process relating to the recording and reporting of new pressure ulcers. The second largest group of incidents related to medication and syringe drivers at the end of life which totalled 14 (16%). DHU recognises the importance of prescribing at the end of life and is actively involved with our partner organisations in education and training of staff groups relating to end of life care. The DN team leaders have been working with their colleagues within Derbyshire Community Health Services (DCHS) to ensure improved continuity and communication between the in hours and out of hours services. 30

32 Section 2 Our Services DHU Offender Health & Justice Services The Offender Health & Justice Division is responsible for delivering high quality care to prison establishments across the Derbyshire County. A wide range of service are delivered including: HMP Foston Hall HMP Foston Hall is a closed female establishment that has the capacity to hold up to 381 prisoners over the age of 18. HMP Foston Hall also has a dedicated unit to support patients with a confirmed personality disorder. The healthcare service operates on a 24/7 basis and is delivered by a multi-disciplinary team. HMP Sudbury HMP Sudbury is a Category D (Open) Prison that has the capacity to hold up to 584 male prisoners, over the age of 21. HMP Sudbury is a resettlement prison designed to support the reintegration of longer serving prisoners back into the community. The Healthcare service operates 7 days a week between 07:30 and 17:00. Primary Mental Health Clinical Substance Misuse Long Term Conditions Management Urgent Care GP Services Sexual Health & Contraception Immunisation & Vaccinations Medicines Management The purpose of the service is to ensure individuals residing within the prison establishment receive a high quality of care that is equitable with healthcare services available to the general population within the community. 31

33 Section 2 Our Services Patient Stories DHUs Offender Healthcare service works with some of the most challenging, disadvantaged and hard to reach patients in society. Here are just a few examples of how we have helped patients improve positive health outcomes: Early Identification & Screening By working with patients from the moment they arrive into our care DHU can maximise a patients opportunity to improve their wellbeing. When a patient arrived into Foston Hall in 2015, DHU worked with the individual to have a series of tests to ensure they had not contracted any blood born viruses (BBVs) since their release into the community some months prior. Unfortunately the patient had contracted a virus whilst in the community. DHU, in conjunction with the Prison and colleagues at the local clinic arranged for the patient to received fast access to specialist care following her diagnosis. Although the patient was only in custody for just over six weeks, our early identification and proactive care plan approach ensured this lady was released back into the community with a confirmed diagnosis and clear management plan in place. DHU also ensured that the patient received continuity of care back into the community, through effective clinical handover to community services. Had DHU not have taken a pro-active and timely approach this patient may well have been unaware of her condition. Engagement with Healthcare A patient who arrived into our care was complaining of severe abdominal pain. The Nurses arranged for this patient to be taken to a local hospital, where they were suspected of having a sever abdominal problem. The GP & Nursing Team at HMP Foston Hall worked to ensure that the patient received timely and effective care. By liaising with community services, our team were able to confirm that the patient was due to undergo investigations whilst in the community, but had failed to attend their appointment due to their chaotic lifestyle. Whilst in custody the DHU healthcare team ensured that the patient received the appropriate investigations which confirmed a life threatening condition. As the patient was due to be released following diagnosis, DHU worked with the patient to ensure that a clear care plan was in place and arranged for the patient to receive surgery at the local hospital. The patient has since made a full recovery. Paper-light Accreditation DHUs Prison Healthcare services were successfully awarded paper light accreditation by the Arden & GEM Commissioning Support Unit in This is a significant achievement for our Administration and Support teams who worked to ensure we had the appropriate policies and procedures in place to obtain our accreditation. DHU is proud to be one of the few prison healthcare services in the country to receive this accreditation. Patient Compliment Just wish to say a massive thank you to all the staff, as you are all so kind, caring and understanding. I know it's your job but you still go above and beyond. This is very much appreciated, thank you. Patient Compliment I would like to thank all the staff for their help and support over the past 18 months, they are a great professional and friendly team. Patient Compliment I would like to thank all the healthcare staff for their help and support whilst being at Sudbury. All the Healthcare Team are always polite and respectful. It's a shame other prisons don't have a healthcare like this one. 32

34 Section 3 Our People Derbyshire Health United (DHU) is dedicated to our workforce with a strong history of attracting and retaining loyal and committed staff. Many of our staff have backgrounds in other areas of the health community and many of them retain their skills and knowledge by also working at DHU. During 2015/16 our staff worked with the Executive Directors to develop our vison, values and behaviours which are now embedded within our organisation. We have since added the new vision, values and behaviours to the performance and development review process. During 2015/16 DHU have focused on employee retention, employee career development, how we engage with our employees and how our employees receive recognition for their contribution to DHU. Successful key achievements during 2015/16 and our actions taken to engage our employees over the last 12 months are as follows; Improved recruitment process. Use of LinkedIn & Job Boards. Introduced assessment centres within our NHS111 service Relaunched Recommend a Friend Scheme. Commenced a Communication & Engagement Forum (CEF) made up of staff representatives from different divisions across our organisation. Introduced employee loyal service awards Introduced employee recognition scheme The Limelight award. Carried out and fed back an employee engagement survey. Developed and introduced new vision, values, behaviours. Produced a monthly Board Brief. Produced a fortnightly NHS111 Newsletter. Successfully held Annual & Bi-Annual Communication Events Ran development workshops for 20 line managers. Improved and updated or HR policies. Introduced an appraisal window to measure percentage completed (94% achieved 2015/16 ). Reviewed and increased rates of pay in our NHS111 service. Provided an attendance bonus over winter period. Launched GCC events across 7 teams within DHU promoting health and wellbeing. Provided our Managers with training/workshops in appraisals, return to work and exit interviews and absence management. Improved our corporate induction process. Leaver & exit Interview administration reviewed and amended. Recruited a HR Advisor aligned to our NHS111 service,. 33 Patient Compliment: wonderful, thank you for employing brilliant staff

35 Section 3 Our People Patient Compliment: Felt the call advisor did a good job, says she was very,very helpful and pleased with the whole experience 34

36 Section 3 Our People Communicate DHU set up the Communication & Engagement Forum (CEF) in 2014 to improve communication and Engagement between all divisions of DHU. This forum consists of employee representatives from across the entire organisation where we meet on a monthly basis. An open discussion is held with the CEO and Director of HR during the formal meeting with suggestions, actions and minutes which are shared on our intranet will all staff. DHU believe employees will be able to perform at their best when they know and understand their duties, obligations, rights and have the opportunity to make their views known to the management team on issues that affect them. Through their representatives on the forum. DHU has made improvements in 2015/16 to internal and external communications and engagement. This has enabled DHU to have the ability to exchange views, issues, receive instructions and discuss new ideas. The Communications and Engagement forum have worked on some amazing initiatives to improve communications and employee engagement within DHU. These include for example developing a recognition scheme The Limelight Award, Loyal Service Awards presented at our Staff Engagement Events in October, our staff annual survey and developing our Vision, Values and Behaviours. 35 Patient Compliment: Service was brilliant... staff there were wonderful, caring and considerate

37 Section 3 Our People Phillip Plumb - Staff Representative for NHS111 Call Advisors I am 65 years old and have a dual role at DHU that splits my time between call advising and the Rota team. I lived in Berlin for many years and have worked in aviation for most of my life. My free time is spent taking pictures, listening to jazz and the cinema. Having been involved with the German works councils I enjoy the challenge of the Forum and look forward to representing ideas, suggestions and criticisms. Our Staff Appraisal Process Develop We have a long standing annual Performance and Development review process which takes place once per year between April and September. This year we achieved 94% of completed appraisal reviews. Only our staff on long term sickness or maternity leave were unable to be reviewed at that time. Managers and staff were able to discuss and record the following: Comment on objectives set in the last review, and summarise evidence gathered to support a rating. Summarise and expand on what has been done well as well as summarising and expanding on aspects/areas of performance where there could be improvement, Discuss and record training and development needs and possible outcomes. Agree and set objectives for the coming year. Agree career aspirations and record any succession planning implications. Within the staff appraisal process, individual objectives and targets are set which are related to the Company s corporate objectives. The overall aim of this scheme is to maximise individual employee effectiveness and potential. Our substantial Education and Training Division encompasses all mandatory training within the company which includes Safeguarding Children and Vulnerable Adults, Information Governance, Basic Life Support, Moving and Handling, Infection Control and Health and Safety. We also offer our sessional GPs supported training days, a system of alerts on clinical issues accessed via a login-protected area of our website and other professional support services. Achieve Human Resources (HR), the Payroll department and the Communications department have been working on several issues during 2015/16 In order to improve employee engagement and retention. We have introduced assessment centres for all our recruitment in Out of Hours, Prisons, Walk-in-centre, NHS111 and corporate divisions. This is to ensure we attract and retain the right calibre of candidates, and this initiative has led to the successful recruitment of 180 people in last 6 months. Once recruited they attend our improved and re-launched corporate induction process. The Communications and Engagement group continues to thrive. Our monthly meetings have improved communications and engagement across all levels of staff. We provide staff newsletters, external communication and are conducting our second employee survey. HR has also been pivotal in helping line managers to improve attendance by running absence management training workshops for line managers and conducting absence management surgery sessions. The Payroll team have worked on the Payroll system and continue to administer changes to the NHS Pension scheme, successfully launched the NEST Pension Scheme and administered Pension auto enrolment. On top of this the team provided an employee relations service which includes revising policies, advising on disciplinary, grievance issues and managing TUPE transfers. Patient Compliment: Patient called to compliment service - says we are lovely team 36

38 Section 3 Our People The communication and Engagement Forum (CEF) played a key part over 2015/16 in developing our Vision, Values and Behaviours. At DHU we care for our employees as well as the patients we treat. It was through the use of the word CARE that the strapline DHU we CARE for you was developed to help embed our vision, values and behaviours. At DHU we believe that everyone should always show Care and compassion, Always professional, Respect and show dignity and to always remember that Everyone matters. DHU we CARE for you represents how we feel towards our patients and colleagues. In 2015 our employees were presented with new lanyards with DHU we CARE for you written on them to remind the public and patients, that is what we are here for. DHU we CARE for you Care & Compassion Putting patients interests at the heart of everything we do We believe: In a deep desire to help our patients and our colleagues In going out of our way to help others in a less fortunate position Always Professional Demonstrate excellence in everything we do. We believe: In delivering an efficient and effective service for the patient at the right time at the right place. In putting the patients interests first In public and patient involvement We behave: In being truly compassionate and genuinely understand, feel and identify with their needs of our patients and colleagues We will actively listen to understand and empathize with others distress, suffering, misfortune, and individuals realities, with a desire to alleviate it by to support both patients and colleagues We will always ask the question of ourselves Would it be good enough for one of my family members? We behave: In the development of our Get things Right First Time services We will be accountable for consistently delivering high quality healthcare for our patients. Sue Fallon, Clinical Lead, Senior Nurse Practitioner and Audit Lead said Being part of the Communication and Engagement Forum means sharing feedback from colleagues and seeing positive results. It is also great to share issues with other staff group, and being able to see situations from a different perspective. 37 Mission: DHU exists to provide caring, high quality, safe and effective healthcare to our patients and the communities we serve

39 Section 3 Our People Respect and Dignity Everyone has the right to respect and dignity We believe: In maintaining and respect patients dignity to ensure it is never compromised That treating people as individuals, whatever their differences or values, and ensuring that their particular needs are met We behave: We will actively listen to each other and our patients to answer their concerns or questions. We will maintain and respect patients dignity and must ensure it is never compromised Everyone Matters Placing our colleagues and patients at the heart of the organisation We believe: To achieve the full potential of the organisation we will develop skills and talents for the mutual benefits of patients and staff members. In providing a stable and positive working environment for all We behave: We will actively encourage feedback from both patients and colleagues to continually improve our service Ensure everyone has an opportunity to have their voice is heard To ensure everyone has an opportunity to further develop their skills and competencies. Vision: DHU will engage our staff and improve our service in order to become the provider of choice to Commissioners 38

40 Section 3 Our People In June and November 2015 David Whitney (DHU Chair) and Stephen Bateman (Chief Executive Officer) invited all employees to attend our Staff Engagement Events which were held in Derby, Alfreton and Chesterfield. Following feedback from our staff engagement survey, in June and November 2015 DHU held three Staff Engagement events so that our employees understood developments within DHU. This gave our employees the opportunity to ask questions, and for both David and Stephen to offer their time to colleagues in a face to face arena. These events were an opportunity for Stephen to highlight to employees organisational changes within the last year and to share with them the DHU strategy for 2015/16. At these events, Stephen gave a presentation based on each of the main organisational services including the Out-of-Hours service, NHS111 service, Health and Justice (Offender Health) and our District Nursing Service. The aim of the presentations was to give colleagues the opportunity to gain an understanding of the wider picture of all DHU services. David and Stephen introduced our new DHU Non-Executive Board members, along with other board members who will play a major part in shaping the organisations future. The DHU Staff Engagement Events in June and November 2015 were an overall success. DHU will now be holding our Staff Engagement Events on an annual basis. 39

41 Section 3 Our People Engaging with our staff and rewarding their loyalty to providing quality services for our patients across Derbyshire and the wider East Midlands Rewarding our employees for their loyalty working for DHU to provide quality services for our patients. Introducing the DHU Loyal Service Award. Following feedback from staff at Communication and Engagement events we asked the representatives from all divisions of DHU attending the Communication and Engagement Forum to develop a DHU Loyal Service Award. The award was approved by the Executive Directors and the Board of Directors in summer On the 1st October 2015 we introduced the new loyal service award to all employees within our organisation. The award was designed to recognise individual s loyal service to DHU. It was also agreed by the Executive Directors and the Board of Directors that if an employee was employed prior to this by the two founding companies Derbyshire Medical Services and Derbyshire Health Care would also be entitled to this award. During our staff engagement events on the 18th, 25th, 26th November and the 2nd of December these awards were presented to our employees from Stephen Bateman (CEO), David Whitney (Chairman) and Dr Phillip Cox (Vice Chairman). Employees were presented with Love 2 Shop vouchers up to the value in accordance with the number of years they have been loyal to DHU. In addition, our employees received a congratulatory letter from Stephen Bateman and were presented with a gold pin stating how many years of loyal service they have shown to DHU. These awards will take place annually at our Staff Engagement Events and our HR department will monitor on an annual basis who will receive their loyal service award during the year. Pam Garvey - Call Advisor. I really enjoyed receiving my loyal service reward, not many organisations provide you with this, and its nice to know my work is recognised by our organisation Lisa Riley Call Advisor presented with a 15 Year award Steve Ault ECP presented with a 10 Year award Sue Pitcher Payroll Assistant presented with a 10 Year award 40

42 Section 3 Our People Our Staff Satisfaction DHU carried out a staff satisfaction survey to obtain information about employee views and opinions and how they feel working for DHU. The staff survey was ed out to every employee within the company. Feedback from the Staff Survey Feb/March 2015 was provided to our Communication and Engagement Forum and then shared with the entire organisation via their Line Manager. Our survey questions were split in to the following 5 areas of focus; 1. Provide staff with clear roles, responsibilities and rewarding jobs 2. Provide staff with personal development, access to appropriate education & training 3. To provide support & opportunities for staff to maintain their health, wellbeing & safety 4. To engage staff in decisions that affect them and the services they provide. 5. Staff Satisfaction Overall there were a lot of positive messages arising out of the staff survey. The following are the four areas that DHU are performing at our best; 1. I am satisfied with the quality of care I give to patients / service users 2. I feel that my role makes a difference to patients / service users 3. In the last 12 months I have had an appraisal, annual review, development review or probationary review 4. Overall in staff satisfaction the numbers who are sometimes, often and always satisfied are higher than those who is higher than those who are rarely or never satisfied Staff Areas Completing Survey 41

43 Section 3 Our People There were a number of areas in which we needed to do some work as below; 1. Although the percentage was very low of the proportion of staff feeling bullied or harassed by Managers/Team Leaders or other colleagues this was addressed urgently. 2. Although the percentage was very low of the number of staff feeling bullied or harassed by patients or service users this was also addressed urgently. 3. A proportion of staff felt that they were not involved in deciding changes introduced that affected their work area/team/department. 4. Some staff felt communication between senior managers and staff was not as effective as it could be. We tackled this by: 1. Sharing the results with the Employee Communication & Engagement Forum. 2. Communicated actions we were proposing to take in the News Letters/ Board Briefs and Staff Engagement Events. 3. Pledged to take action and then feedback prior to the next survey due in May Asked staff at engagement events for their ideas on the best ways to tackle the issues. 5. Held staff focus groups at departmental level to feedback results and discuss any issues 6. Promoted the whistleblowing Policy. 7. Provided line Managers with a suite of training sessions. 42

44 Section 3 Our People The Limelight Award An intense illumination of employee effort, as someone placed in the Limelight, centred on their exceptional contribution to DHU in providing not only quality patient care but care and compassion for each other. The Limelight recognition scheme was introduced in February 2015 and has successfully awarded so far 14 employees within the organisation over 15/16 for their contribution in providing not only quality patient care but care and compassion displayed towards colleagues. This scheme is designed to reward our employees who have gone that extra mile to help, support and care for patients or colleagues. The title of this scheme has been chosen to reflect this, as Limelight and is to illuminate not rank DHU employees. The Limelight award is a monthly award where employees nominate colleagues within the DHU via the online nomination form found on our intranet. The decision who wins the award is made by staff representatives on the Communication and Engagement Forum. The winners are announced in conjunction with the dates of the Communication and Engagement forum which is the 3rd Tuesday of every month. The winner is then presented with a small financial reward in vouchers and the honorary Limelight pin badge which our employees wear on their lanyard to show they have been recognised for their contribution to DHU. The winner also appears in our internal monthly Board brief highlighting why they have won the award. The winner also receives a thank you message from Stephen Bateman CEO, and a personalised letter written by our CEO which is then placed in their personal file. Throughout 2015/16 this award has been presented to our employees for contributing some outstanding levels of care in not only patient facing roles within DHU, but corporate roles as well. At DHU we are very proud of our Limelight award and look forward to recognising more employee efforts in the future. Limelight Winners (Top row, left to right) Lyn Kinder (Evening Nursing Service) - November 2015 Winner, Paul Tilson (Deputy Clinical Director, Primary Care Division & Operations) October 2015 Winner, Jean Rigby (Health Care Assistant) July 2015 Winner. (Bottom row, Left to right) Claire Nesbeth )CQI Non Clinical Pathways Trainer), February 2016 Winner and Rebecca Harrison (CQI Manager) who was the very first winner of the Limelight Award when the scheme first started in February

45 Section 3 Our People Global Corporate Challenge At Derbyshire Health United (DHU) we value our employee health and happiness and that s why DHU gave our employees the opportunity to participate in the GCC (Global Corporate Challenge). The GCC was a 100 day virtual journey across the globe. It was a great way to introduce some fun and healthy competition amongst not only our employees at work, but with other organisations taking part. More than 300,000 people from around the world were taking part this year. We encouraged seven teams of ten employees to join in from September, finishing in December. Our teams of seven had to track their daily activity using a GCC Pulse accelerometers that GCC provided to measure the number of steps made. The more active the team, the further our teams progressed around the world. The DHU winning team was Quality in motion. Members of Quality in Motion were Beckie, Beth, Claire, Karen, Linda, Stephen and Zarka. They travelled 4,373 miles and visited 149 locations across the globe including Sydney Australia, Hong Kong, New York, Canada etc. Quality in Motion received a DHU Health and Wellbeing Cup, a certificate each and a 20 JD sports gift card each. Beyond the 100 days, the GCC also provided our employees with a 12-month platform to ensure that learning and positive healthy habit formation continued throughout the year. Overall the GCC has been a complete success at DHU and plans are being made for our employees to take part in the Global Corporate Challenge which starts in May 2016 to further improve our health and wellbeing here at DHU. Tom Oxley: I really enjoyed taking part in the global corporate challenge, I found it extremely motivating and encouraging to get healthy. It was not just about increasing the amount of exercise, it was about improving my sleep pattern, my eating habits and measuring my fitness overall. This challenge has helped me to make some lifestyle changes that I still do today, Thanks DHU for signing up to the GCC and encouraging me to take part 44

46 Section 3 Our People DHU employee charitable work for our community During Christmas 2015, our NHS111 Deputy Service Delivery Manager Cara Brazier organised and facilitated the collection of gifts placed in shoe boxes for a local refuge. DHU Employees made donations of money/gifts and in total collected 35 bags/ shoe boxes full of gifts for the local refuge in order to make a difference to people s lives on Christmas Morning. There were 20 adult and 15 children present bags and Boxes, which were kindly handed over to the Domestic Abuse Manager on Tuesday 15th December The local refuge informed DHU they would be delivered to 7 local refuges in time for Christmas and she thanked DHU dearly for our kind donations. Cara Brazier I must say I have been amazed with the generosity and kindness of others while collecting donations and I feel proud to work for a company like DHU with such compassion and kindness for others in need. DHU make time For DIGNI-TEA On Monday the 1st February 2016 DHU held a bring and buy cake sale at Ashgate Manor, Mallard House, Fosse House and Charlotte House to raise money for Charity and support the awareness of dignity and compassion to each other. The Dignity in Care campaign began in November 2006 to inspire health & social care staff and local people to place dignity and compassion at the heart of care services At DHU our employees wanted to show our support to the Dignity Champions who are doing what hey can to make a difference in peoples lives. Dignity Action Day takes place on 1st February every year. It is not necessarily a day for the grand gesture but more about taking the time to do something, however small, for people who too often feel isolated and of little value to society. At DHU, we remember Dignity is everybody s business! 45

47 Section 3 Our People Employees at Derbyshire Health United (DHU) have raised over 2,300 for 23 charities over the last twelve months at our Ashgate Road offices. The cash has been raised through a charity snack box where our staff money for healthy snacks, drinks, sweets and soup. donate Our staff have all tucked in to the snack box scheme by choosing the charities they wish to benefit. Ashgate Hospice, Chesterfield Care Group and Chesterfield Royal MacMillan Cancer Centre are among the 23 charities to each benefit from 100 donations. On Christmas Day 2015 a number of DHU Image employees gave up their time to feed the homeless and lonely. On the run up to Christmas for 4 weeks DHU employees donated food, gifts, crackers and much more for everyone to enjoy. Mel Myhill, NHS111 Service Delivery Manager, At DHU charity no longer begins at home but in the workplace. The response to the snack box scheme has been fantastic with staff fully supporting the scheme so that charities important to them can benefit. Staff have already nominated the next 25 charities we will be fundraising for. The following charities, chosen by DHU staff, have all received 100 through money raised from the snack box scheme: Ashgate Hospice, RSPCA, Cardiomyopathy Association, The Alzheimer s Society, Chesterfield Care Group, The Roy Castle Lung Cancer Foundation, Pathways Homeless Day Centre, Endometriosis UK, Derbyshire, Leicestershire, Rutland Air Ambulance, Motor Neurone Disease Association, United Response, British Heart Foundation, Pancreatic Cancer Research Foundation, The Juvenile Diabetes Research Foundation, The Derbyshire Pride Event 2015, The Children s Heart Unit Fund, The Nepal Earthquake Appeal, Anaphylaxis Campaign, MIND and The Chesterfield Royal MacMillan Cancer Centre, Edale Mountain Rescue, JOEL: The complete package, Sri Lanka Cancer Hospital. 46

48 Section 3 Our People DHU strive to increase the employee benefits for working for DHU. There are many benefits to working for DHU. Our rates of pay are comparable to NHS Agenda for Change in our Clinical roles. Our other roles are benchmarked against local pay and terms and conditions of employment. Our Executive and senior management salaries are reviewed via our Remuneration Committee. DHU are able to offer membership of the NHS Pension Scheme. The scheme is contributory; people who do not want to join the NHS Scheme are given the choice to opt out and will be given other pension options for them to explore. At DHU our employees are entitled to free membership of Westfield Health once they have reached 6 months service. This benefit covers optical, dental, therapy, dental trauma, MRI, CTI scans, hospital treatment insurance, 24 hour counselling, Westfield Rewards and a high street shopping discount scheme. entitlement. Staff working part time will receive the pro rata equivalent of this holiday and Bank Holiday entitlement A discretionary loyal service award in recognition of an individual s loyalty to DHU is presented after 5 years service and every 5 years thereafter. DHU has developed an employee recognition scheme called The Limelight award. This award represents an intense illumination of employee effort. The award is presented to an employee on a monthly placing someone in the Limelight, centred on their exceptional contribution to DHU in providing not only quality patient care but care and compassion for their colleagues. At DHU we support all our employees in their career and professional development. During 2015/16 DHU has provided revalidation sessions for all our Nurses going through revalidation. As well as providing mandatory training, we also provide additional training for both clinical and non clinical employees in mental health awareness, domestic abuse, suicide awareness, end of life care, dementia awareness and disability training. Generous holidays are offered starting at 25 days which then go on to raise with service, plus 8 statutory Bank Holidays. Staff who transfer in to DHU from the NHS will preserve their current NHS From left to right, David Whitney - Chairman, David Walsh - Director of Human Recourses and Organisational Design 47

49 Section 4 Our Quality Assurance Care Quality Commission inspection of our NHS111 Service and Out of Hours during November 2015 Jenny Tilson, Director of Nursing and Quality; We are committed to the delivery of excellent care, making sure our patients are at the heart of everything we do. The Care Quality Commission (CQC) regulates all health and adult social care services in England through inspections and monitoring. It aims to ensure essential quality standards are met by all care providers. All of our services are registered with the CQC. On the 10th and 11th November 2015 CQC visited our Out-of-Hours and NHS 111 services. CQC visited the NHS 111 call centres at Ashgate Manor and Mallard House. The inspection also included Out of Hour s site visits at the Ashgate Out of Hour s Centre, Buxton Cottage Hospital, Chesterfield Royal Hospital, Swadlincote Health Centre and Derby Urgent Care Centre. The inspection team was led by a large team of CQC inspectors and specialist advisors. Before visiting, CQC reviewed a range of information about the Out-of-Hours and NHS 111 service at and asked other organisations to share what they knew about the service. Information was also reviewed that had been provided at the request of the inspection team. The CQC team visited DHU over two days and spoke with members of staff including Doctors, Nurse Practitioners, Receptionists, Drivers, NHS 111 Call Advisors, NHS 111 Nurse Advisors, Directors and the members of the DHU board including Non-Executive Directors. Patients and carers who used the service were also spoken to by the inspection team. To understand the patients experience of care CQC asked the following 5 questions: Are services safe? Are services effective? Are services caring? Are services responsive to people s needs? Are services well-led? We are passionate about listening to patients, and involving them in our work. We strive to ensure that they receive safe, effective and compassionate care. CQC - well-led and managed by an enthusiastic and knowledgeable senior management team and board of directors, and their values and behaviours were shared by staff 48

50 Section 4 Our Quality Assurance Summary of Findings Ashgate Manor Primary Care Centre, Buxton and Chesterfield Royal Hospital OVERALL RATING FOR THIS SERVICE Are services safe? GOOD Requires improvement The area where the provider must make improvements are: The provider must ensure there are effective and robust systems in place across all locations for the control and security of blank prescriptions. The system which was already in place for recording distribution and receipt of blank prescriptions from our main site to peripheral locations has been enhanced to ensure it s robustness in response to the recommendations from CQC. Regular audits and spot checks will provide assurance of it s effectiveness. To understand the patients experience of care CQC asked the following 5 questions: Are services safe? CQC; Are services effective? CQC; Are services caring? CQC Are services responsive to people s needs CQC; Are services well-led? CQC; Are services effective? Good Access to the full report can be found on the CQC website. Are services caring? Good Are services responsive to people s needs? Good Are services well led? Good 49

51 Section 4 Our Quality Assurance Summary of Findings Mallard House Call Centre, Swadlincote Clinic and Derby Urgent Care Centre OVERALL RATING FOR THIS SERVICE Are services safe? GOOD Requires improvement The area where the provider must make improvements are: The provider must ensure there are effective and robust systems in place to ensure controlled drugs registers are completed correctly across all locations. The inconsistence in the terminology used to record the receipt of stock of medication at Mallard House was rectified immediately and written confirmation was provided to the satisfaction of the CQC. Regular audits and spot checks will ensure that this standard is maintained. To understand the patients experience of care CQC asked the following 5 questions: Are services safe? CQC; Are services effective? CQC; Are services caring? CQC Are services responsive to people s needs CQC; Are services well-led? CQC; Are services effective? Good Access to the full report can be found on the CQC website. Are services caring? Good Are services responsive to people s needs? Good Are services well led? Good 50

52 Section 4 Our Quality Assurance Summary of Findings Ashgate Manor NHS 111 Service understand the patients experience of care CQC asked the following 5 questions: Are services safe? OVERALL RATING FOR THIS SERVICE GOOD CQC; Are services effective? Are services safe? Good CQC; Are services caring? Are services effective? Good CQC Are services responsive to people s needs Are services caring? Good To CQC; Are services well-led? Are services responsive to people s needs? Good CQC; Are services well led? Good Access to the full report can be found on the CQC website. 51

53 Section 4 Our Quality Assurance Summary of Findings Mallard House NHS 111 Service OVERALL RATING FOR THIS SERVICE Are services safe? Are services effective? Are services caring? Are services responsive to people s needs? GOOD Good Good Good Good To understand the patients experience of care CQC asked the following 5 questions: Are services safe? CQC; Are services effective? CQC; Are services caring? CQC Are services responsive to people s needs CQC; Are services well-led? CQC; Are services well led? Good Access to the full report can be found on the CQC website. 52

54 Section 4 Our Quality Assurance Derbyshire Health United (DHU) is committed to safeguarding and promoting the welfare of children and vulnerable adults. The safeguarding team consists of a Named Nurse for Safeguarding Children, a Lead Nurse for Vulnerable Adults and two part time assistant safeguarding nurses. They ensure that there are robust processes in place with the organisation to enable staff to safeguard Children and Vulnerable adults who contact DHU. This is achieved by ensuring there are robust referral pathways within the company in addition to strong communication and information sharing links with other organisations. The safeguarding team are also responsible for providing all staff with regular extensive training updates relevant to their roles. has been amended to reflect the wishes of the patient and mandatory training includes the importance of making safeguarding personal. New to Adult safeguarding has been the introduction of the care concern referral process. This has enabled all DHU staff to share relevant information with adult social care regarding any issues when a patient requires further help and support that can be provided by Social care. DHU continues to recognise the importance of treating people with Dignity and respect. DHU was awarded the Dignity in Care Award by Derby Adults Safeguarding Board in June DHU celebrated National Digni-tea day, raising awareness of Dignity in Care whilst raising money for a local charity. Key Achievements for 2015/16 Proposals for 2016/17 Last year there was a national focus on the detection and prevention of female genital mutilation as a safeguarding concern. At DHU information was cascaded to all our staff to make sure that they were able to identify children and young women at risk or who have already been affected by this practice. It became a legal requirement from October 2015 to report to the police any confirmed cases and this process for re porting such incident was disseminated to all our staff in training sessions. Following the introduction of the Care Act in March 2015, DHU has ensured that all information and training is in-line with the Care Act recommendations. The DHU referral form The focus currently and for the next year is Child Sexual exploitation (CSE) All staff will be given training in addition to information on useful materials and toolkits which can help them assess children who they suspect are or maybe at risk of CSE. Two members of staff were trained to become Prevent trainers. The new prevent trainers coupled with the Prevent lead for the organisation will develop the Prevent agenda and training strategy and this will be a focus for the forthcoming year. Prevent is a national campaign, aimed at reducing the risk of vulnerable young people and adults being recruited into extremist organisations and behaviours. 53

55 Section 4 Our Quality Assurance Our commitment to lifelong learning and development for all groups of staff. Key Achievements for 2015/16 The Minor Conditions Nurse course which was an innovation in DHU to help address the shortage of advanced clinicians is now in its second year. Two of the first nurses who successfully completed the first programme have now become Nurse Practitioners working in the Out Of Hours Service. The remaining nurses are working to full capacity as Minor Conditions Nurses supporting the Clinicians in the out of Hours service. A second group are nearing completion of their initial training. (April 2016). This initiative has increased the provision for patients to be seen in a more efficient and safer service in our centres providing support for the Out of Hours clinicians. A large number of our Senior Nurse Practitioners and Nurse Practitioners have successfully completed a specialist Masters Degree module in Core Paediatric Principles in Primary Care. They were part of the pilot and evaluation of this programme run by Sheffield Hallam University. The development of specialist programmes like this are an important part of developing education for healthcare and an example of the academic establishments working closely with service delivery organisations to shape healthcare for the future. DHU continues to supplement the NHS 111 pathways standard training programme with additional elements. Awareness of Domestic violence and dealing with challenging callers are just two of the topics covered in these sessions which provides enhanced skills and understanding to our NHS111 Call Advisors. DHU have had a number of Medical and Nursing students on placement throughout the year from Nottingham University and Derby University. Feedback from students is fantastic and the placement is highly regarded by the students who all volunteer to attend DHU. Anonymised feedback given to the University of Derby, and send to DHU in April includes the following statements: Student 1 Comment It was a valuable placement with a steep learning curve. It was at times quite a challenging placement because of working with Senior Nurse Practitioners and GP s constantly who have a lot of experience within the out of hours field I enjoyed working with the different teams enabling me to see the diversity of Derbyshire Health United, but feel I would have benefitted from working more shifts with the District Nurses. Student 2 Comment The learning opportunities and experience are brilliant. There is plenty of exposure to all types of conditions in different types of patients (pregnancy, elderly, children etc.) The placement is not only increasing my knowledge and providing exposure to variety of conditions, I am also learning how to adapt practice and communication skills required to effectively engage with individual patients, other professionals and services. Evidence based best practice is essential as people are working autonomously; accountability and justifying actions and decisions is essential. The 6 C s were practiced to a high standard Student 3 Comment I worked with Nurse Practitioners, not only did they practice the 6 C s but were so knowledgably allowing me opportunities to diagnosis and encourage me to participate at every opportunity. The knowledge base of the Nurse Practitioner is so wide that allows so much learning 54

56 Section 4 Our Quality Assurance These placements not only benefit the student but the organisation in that they promote integration between primary and secondary care and education in addition to encouraging interest in the service for future recruitment. The DHU training team has developed a training programme to improve the skills of our receptionists who are in the process of undertaking recognition of the unwell adult, and recognition of the unwell child training. This will improve the safety of our patients while they wait to be seen by a member of the clinical team. Image of Training DHU has completed an evaluation of an innovative early warning score for children developed by Leicester Royal Infirmary called POPS (Paediatric Observational Priority Score). This evaluation has shown that the introduction of POPS to DHU may improve clinical safety and as a result of this evaluation will be rolled out across the organisation. It has also contributed to the information being gathered by Leicester Royal Infirmary on this innovation The training team has developed a unique competency assessment process for our clinical staff who are required to complete telephone assessments, and home visiting as part of their role within the out of hours service as some of the challenges of working in Out of Hours can differ very much from in hours primary care. This competence package enhances the organisations ability to ensure our staff are safe to perform the role that they are employed to perform. 55

57 Section 4 Our Quality Assurance Proposals for 2016/17 Work is underway to ensure that all our non registered staff who work in the clinical areas or have a face to face role with patients are working towards achieving the Care Certificate. This is a set of standards for health and social care jointly developed by NHS England and Skills for Health. In DHU we plan to use this as a minimum basic standard and then continue to provide further development appropriate to each role, enabling our staff to develop an extensive portfolio of their skills and competencies. The aim of the Care Certificate is to ensure that all staff have the same skills, knowledge and behaviours to provide compassionate, safe and high quality care and support. It also provides a basis for career development within DHU and the Health community for our staff. Image of Training A full study day based on Hot Topics in Primary care has been arranged for our out of hours Clinical staff. In addition to the Nurse Practitioners directly employed by DHU, invitations have gone out to the GP s in the health community who work with us both in and out of hours. The whole day is tailored specifically to the challenges of out of hours care with updates on some of the current local and national clinical concerns. Education events such as this not only improve care of our patients but strengthen education ties between colleagues and disciplines. The Minor conditions nurse role will continue to be established within our out of hours clinical service with further cohorts of nurses in training. The increased levels of skills and competencies learned on this course will also be trialled and evaluated by one of the nurses in our Evening Nursing service who is completing the course. This innovation will hopefully improve the outcome and effectiveness for patients using this service. 56

58 Section 4 Our Quality Assurance Medicines Management Derbyshire Health United follows the principles and guidelines of the Department of Health Document Securing proper access to medicines in the Out of Hours. This means that in addition to being able to prescribe medicines when required for patients they also carry stocks of approved out of hours medicines to issue to patients urgently. Key Achievements 2015/16 During the last year the Out of Hours Formulary was reviewed and updates adding new recommended medicines and removing ones no longer considered to be best practice for prescribing. This was performed in line with both local and National guidelines. The formulary was then approved by the local Joint Advisory Pharmaceutical Board. To ensure that our service to the patients remains both safe and efficient a number of our newest recruited Nurse Practitioners who achieved to competence level for a Senior post, successfully completed the Non Medical Prescribing course enabling them to prescribe medicines if required at the point of contact with patients. Other nursing staff who are not qualified to prescribe are trained to supply medicines under Patient Group Directions (PGD s) for the patients and conditions they are competent to assess and treat. The development of these PGD s is governed by a specific group, consisting of skilled practitioners and medical staff working with Pharmacists who also review the existing PGD s making any changes in line with local and national recommendations and guidelines. Derbyshire Health United continue to work closely with our pharmacy colleagues in the Health community and have participated in a pilot scheme with the NHS workforce Development Team, where pharmacists are involved in both the NHS 111 and Out of Hours service dealing with patients who call with queries relating to medications. Proposals for 2016/17 The pilot scheme using pharmacists in thenhs111 and Out of Hours is to continue and will be evaluated in conjunction with both Sheffield University and Swansea University. Development of further Patient Group Directions are scheduled, to enhance the service provision further with the introduction of our new Minor Conditions Nurse service expanding across the county in the Out of Hours service. Work is continuing to reduce the use of antibiotics unnecessarily in line with National guidelines as this is still a National and European concern in health communities. Regular audits of prescribing in conjunction with education for both staff and patients is helping to achieve targets set by our commissioners. 57

59 Section 4 Our Quality Assurance Clinical Audit Audit is a quality process designed to improve patient care and outcomes and is recognised as one of the components of Governance. DHU has an annual audit plan covering both Clinical and non-clinical areas of the service. Key Achievements 2015/16 The redesign of the organisational governance structure now means that the overview of audit comes under our newly established Clinical Effectiveness Audit and Policy Sub-Committee. This enables audit to be integrated more effectively into clinical developments and service. A number of regular audits were carried out over the year including Health & Safety, Infection Control, Clinical Records, Rightcare Service, Safeguarding service and Medicines use and safety. The results of these audits were used to redesign services and make improvements where required. For example audits have demonstrated that an education campaign on the use of antibiotics improved effective prescribing and Infection control audits led to an introduction of new measures to improve the safe disposal of sharps. The number of staff and hours for the Clinical audit team has been increased on par with recruitment of Clinicians into the service. This has meant that we can continue to regularly audit all clinicians in line with recommended guidelines from the Royal College of General Practitioners (RCGP). Clinical Audit maintains and improves standards of care for patients, in addition to providing valuable feedback and learning for staff and their continuing development. Proposals for 2016/17 A plan has been developed and approved by the Clinical Effectiveness Audit and Policy Sub-Committee, identifying areas for audit in the coming year. In addition to regular audits on specific areas including Health and safety, infection control and Medicine safety, other audits will be carried out as required by local commissioners and NHS England and for the continuing development and improvement of our services. These audits will continue to shape our provision of safe and effective health care for patients and education and development for staff. 58

60 Section 4 Our Quality Assurance Health & Safety Carbon Deposits in to the atmosphere Health & Safety within Derbyshire Health United (DHU) continues to be a primary function that requires specific focus to enhance the provision of service, to maintain the levels of protection offered to all of our staff, patients and visitors and to ensure that our excellent record in managing Health & Safety across the organisation is maintained. All DHU staff view Health & Safety as a key activity and all staff play a vital role in the identification of potential risks & hazards and will go the extra mile to ensure that anything that may pose a risk to the organisation, its staff or to visitors and patients is raised at the appropriate levels to effect any remedial actions required. Throughout 2014/15 the key focuses on Health & Safety have culminated in a safer, robust and more proactive culture around the provision for the whole Health & Safety agenda. The key focuses of this period 2015/16 were; Waste production The aim of the environmental management system is to promote DHU as a responsible and sustainable organisation and to align us with what is determined as best practice. Key achievements in 2015/16 we have; Maintained a robust Health & Safety Management Structure to oversee the Health & Safety Agenda. Maintained a program of continual audit and risk analysis Reviewed and update of risk assessments across key contract Seen a reduction in the number of workplace accidents reported comparable to 2014/15 DHU are keen to maintain this positive safety culture going forward and value the support and input of all staff, patients, visitors & contractors. Securing commitment from the organisation in improving stress management both within and across the organisation Implementation of an Environmental Management System to assist in the overall reduction of environmental impact including; Energy usage Water usage Fuel usage Key Focuses for 2016/17 are; Implementation of strategies to enhance the management of stress across the whole workforce Redesign and coordination of call centres to enhance work environments and improve on welfare facilities available to all staff Improving further on the positive safety culture of Derbyshire Health United involving staff at all levels who are able to make a difference. 59

61 Section 4 Our Quality Assurance Information Governance Governance Training across the whole organisation. Information Governance Structure Information Governance is a core part of Derbyshire Health United s business and in line with information governance requirements set by the Health & Social Care Information Centre (HSCIC). Derbyshire Health United has consistently met the standards of compliance in order to deliver the services that it provides. Review and update key information sharing agreements with relevant third parties. Implementation of access to Summary Care Records and the Medical Interoperability Gateway (Leicestershire & Nottinghamshire). DHU continues to make improvements to its information governance agenda on an annual basis and maintain its status as an NHS Business Partner. The five principles of information governance are, Information is: Key priorities for are; Continue with the development of the organisational strategy for Information Governance. Develop closer working partnerships with smaller organisations. Held securely and confidentially Obtained fairly and efficiently Improve information sharing through innovative technological advances such as the Medical Interoperability Gateway (MIG) & Summary Care Records. Recorded accurately and reliably Form further working partnerships with Information Used effectively and ethically Shared appropriately and lawfully Governance Groups across areas of the business in order to enhance DHUs involvement in the developing face of IG. Enhance the close working partnerships with local GP Practices. Key focuses for were; Develop and implement a robust Information Governance Structure to meet the demands of the organisation (chart attached). Increase compliance and monitoring of Information 60

62 Section 4 Our Quality Assurance Infection Prevention and Control Derbyshire Health United ensures infection prevention and control (IP&C) remains a core underlying element in its healthcare delivery. through the sharpsmart programme. Acknowledging and investing in the safety of staff and patients alike. To adapt procedures alongside the introduction of fridge data monitors to allow effective continuity systems if fridge failures were to occur. To achieve this, all staff members are required to undertake IP&C training both on appointment and at regular intervals. This training is reviewed on a regular basis to ensure it reflects best practice. Recent updates to the training package has incorporated specific Clostridium difficile infection (CDI) training and future aims are to incorporate sepsis guidelines also within the training. The organisation also recognises that effective hand hygiene is one of the main methods of preventing healthcare associated infection and actively encourages good hand hygiene practices amongst all staff members. DHU has participated in the World Health Organisation (WHO) hand hygiene auditing programme. In addition to this, annual IP&C audits are carried out at all sites to ensure quality and patient safety. Key achievements in 2015/16 were; The review and update of all IP&C related policies to reflect current best practice., including the development and role out of national policies and guidelines in response to public health concerns. This has included antiviral strategies and Middle East Respiratory Syndrome (MERs) equipment provision and protocol cascade. To begin to develop stronger antimicrobial stewardship and awareness in the company balanced alongside increased awareness regarding early detection and management of sepsis. Key focus for 2016/2017 include the development and implementation of a DHU cleanliness charter and the development and implementation of a sepsis awareness and treatment campaign. Victoria Slack, Infection Control Lead Nurse: Infection control is essential and integral part of modern healthcare in an ever evolving biological world. Within DHU and my role I endeavour to ensure that rigorous standards of infection control are upheld on a daily basis to protect patients and staff alike. I aim to ensure that the company is fully prepared with the skills and equipment required to respond to any local, national or global infection control concerns. To trial and replace the current sharps disposal system with a safer product design and monitoring scheme, 61

63 Section 4 Our Quality Assurance DHU Care Maker Involvement Care Makers are an initiative set up by the NHS Employers and NHS England to develop the culture of compassionate care. The first cohort of 55 Care makers was recruited prior to the Chief Nursing Officer s Conference back in 2012,they made a commitment to support frontline implementation and delivery through the promotion of the new Compassion in Practice nursing, midwifery and care strategy and the values of the 6Cs associated with it. Now three years on there are approximately 900 established Care Makers across health and social care settings. The 6C s consist of the following actions Care, Compassion, Competence, Communication, Courage and Commitment and each of these values and behaviours carry equal weight. What is a Care Maker? Care Makers are ambassadors for the 6C s, creating a unique link between national policy and strategy to frontline practice. The original idea of the Care Maker programme came from the London 2012 Games, where they had Games Makers who were recruited, trained and valued to instil the spirit of energy and enthusiasm they created throughout the games. Laura Rennie,. Care Maker said; I chose to become a Care Maker as I wanted to show that I can support and demonstrate compassionate, person-centred care and that I am motivated to ensure excellent care not only in my clinical role but as a line manager, by making a positive difference in a way no matter how big or small. Being a Care Maker opens up a lot of opportunities to spread the word about Compassion in Practice and the 6C s and bring this ethos into my own work environment here at Derbyshire Health United. I work a long side the Director of Nursing and Quality here at Derbyshire Health United to improve the way our staff here can involve the 6C s into their work This is achieved through the following; Workshops Education Training and Development Recruitment News Letters/ Communication Boards Staff Meetings Open days and Conferences 62

64 Section 4 Our Quality Assurance DHU Care Maker key achievements in 2015/2016 The Derbyshire Care Makers Hub had their initial set up Representing DHU, myself as a Care Maker and the Director The 6C s and questions around Compassion were used within recruitment questions for advertised posts for Trained and HCA vacancies within the District Nursing Team as well as recruitment for Nurse Advisor roles. As the Care Maker Lead I attended Nurse Advisor and Nurse Practitioner staff meetings to promote the 6C s, through film, discussion and explaining how the 6C s can be influenced in their everyday practice. Attended an Open Day at Whitworth Hospital to promote the Care Maker programme to the general public with DHU to show the commitment the organisation has taken on. Compassion Boards were installed in the Ashgate and Mallard bases encouraging staff to share their own compassionate experiences they had with the patients or their colleagues. meetings where DHU will play a large role in supporting the group who also consist of staff from Royal Derby Hospitals, DCHS and Mental Health teams. Professionals involved in this hub are Clinical and un-clinical staff, as well as OT, Physio s and Managerial. The hub has been set up to liaise with the Regional Co-ordinator from NHS England in which to help raise awareness of the 6C s, share Compassionate Care stories. Help provide improved recruitment to organisations, decrease complaints and procedures. To also challenge bad practice, share good news stories and celebrate success to influence good caring leadership. This will be measured through case studies, strategies with the 6C s and to also involve patients who also might like to be a Care Maker. DHU Care Maker attended the Chief Nursing Summit as an ambassador to help spread the word of the 6C s and Compassion in Practice and to develop ideas with other Care Makers that can be used within DHU. of Nursing and Quality attended, the Care Maker Programme- Celebrating the value and impact of Care Makers at Edge Hill University. The conference was a chance to celebrate the value of Care Makers and show cased some amazing achievements that have happened within the past three years and how Care Makers promote the 6C s to drive the Compassion in practice as part of their role. The conference brought together many disciplines such as Care Makers, Care providers, regional and national teams as well as commissioners and students. It was a great opportunity for sharing and networking and learning with colleagues as well as well as promoting DHU to be recognising the Care Maker programme. Our values and behaviours are at the heart of the vision and all we do Care Compassion Competence Communication Courage Commitment Care is our core business and that of our organisations and the care we deliver helps the individual person and improves the health of the whole community. Caring defines us as our work. People receiving care expect it to be right for them consistently throughout every stage of their life. Compassion is how care is given through relationships based on empathy, respect and dignity; it can also be described as intelligent kindness and is essential to how people perceive their care. Competence means all those in caring roles must have the ability to understand an individual s health and social needs and the expertise, clinical and technical knowledge to deliver effective care and treatments based on research and evidence. Communication is central to successful caring relationships and to effective team working. Listening is as important as what we say and do and essential for the no decision about me with me without communication. Communication is the key to good workplace and with benefits for staff and patients alike. Courage enables us to do the right thing for the people we care for, to speak up when we have concerns and to have the personal strength and vision to innovate and embrace new ways of working. A commitment to our patients and populations is a cornerstone of what we do. We need to build on our commitment to improve the care and experience of our patients to take action to make this vision and strategy a reality for all and meet the health and social care challenges ahead. Collaboration underpins these values and behaviours in Derbyshire Health United 63 Image provided by

65 Section 4 Our Quality Assurance DHU has received a Dignity award from Derby Safeguarding Adults Board. The Dignity award recognises DHU s commitment to Dignity in care and provides evidence that staff members uphold the main ethos behind the initiative. Julie Tomlinson Lead Nurse - Safeguarding Vulnerable Adults 64

66 Section 5 Our Patient Experience As an organisation, we welcome patient feedback which is valuable in order for us to improve the patient experience. Overall DHU Complaints Received and Closed (1st April st March 2016) All complaints, concerns and patient feedback are dealt with by our experienced team of staff within the Integrated Governance Department. Formal complaints are handled in line with the 2009 NHS complaints and social care regulations. and employees within team meetings, one to ones and within our internal communications. When necessary changes in policy and procedures within the organisation takes place to ensure that learning is embedded. Our handling of complaints was reviewed as part of the inspection of our NHS 111 & Out of Hours service in November DHU received 289 complaints excluding informal prison complaints in 2015/16 compared with 312 complaints excluding informal prison complaints received in 2014/ % of complaints were acknowledged within three working days. All complaints are thoroughly investigated and trends are identified. The top three complaint themes in this period included staff attitude, communication and diagnosis & treatment. Complaints involving staff attitude are all fed back to the individuals concerned in order for our employees to reflect on their behaviour. Every complaint is investigated thoroughly. Learning outcomes are fed back to our managers The CQC stated the following in the inspection report: We looked at a summary of complaints for each contract for this period (October 2014 September 2015). We found that these had been generally satisfactorily handled, demonstrated openness and transparency and dealt with in a timely manner. We saw that the complaints had been investigated and a response sent to the complainant, which included an apology where appropriate. NHS 111 Complaints: 01 April March 2016 Number of patients who made contact with our service Total number of complaints received % of complaints from total patient contacts 169 1,142,

67 Section 5 Our Patient Experience Incidents Overall DHU Incidents Received and Closed (1st April st March 2016) Staff can easily report incidents by having access to Datix electronic incident reporting forms via the company intranet which they are trained to use within their induction and on-going professional development. This allows incidents to be investigated quickly, to review practice and to identify trends and patterns. DHU believe in being open and fair, by sharing information openly with staff when an incident happens. Staff receive feedback on incidents they have reported or were involved in. Our incident reporting processes were reviewed as part of the inspection of our NHS 111 & Out of Hours service in November The CQC stated the following in the inspection report: There was an effective system in place for reporting and recording serious incidents and staff understood and fulfilled their responsibilities to raise concerns, and were encouraged to report incidents and near misses. Lessons were shared to make sure action was taken to improve safety in the service. Serious Incidents DHU have an open and honest approach to reporting Serious Incidents. During 2015/16 we reported 24 Serious Incidents across all of our contracts. DHU s procedures for reporting Serious Incidents follows the NHS England Serious Incident framework. All Serious Incidents are reported to our Commissioners within 2 working days, in line with the Serious Incident framework. All Serious Incidents are investigated thoroughly and undergo a full Root Cause Analysis (RCA). This allows DHU to learn from the incident, minimising the risk of it happening again and protecting our patients from future harm. Themes are reviewed and learning from serious incidents is shared across the organisation both on an individual basis and group learning via our Weekly NHS111 Newsletters and monthly Clinical Updates to prevent them from reoccurring. The CQC reviewed our Serious Incident procedures as part of the inspection of our NHS 111 & Out of Hours service in November The CQC stated the following in the inspection report: CQC Report: The provider was aware of and complied with the requirements of the Duty of Candour, and a clear vision and strategy to deliver high quality, safe and effective healthcare and promote good outcomes for patients. The provider was responsive to feedback received from patients and staff and used information available proactively to drive service improvements. Staff spoken with told us that they received feedback on serious incident reports and they were able to give examples of shared learning. 66

68 Section 5 Our Patient Experience Duty of Candour Overall DHU Complaints against Compliments Received (1st April st March 2016) The Duty of Candour was recommended by the Francis report to promote openness and transparency and ensures that patients harmed by a healthcare service are informed. DHU have developed a Being Open policy to guide staff and improve communication with patients when something goes wrong. DHU have developed processes to inform patient s families of Serious Incidents and they are offered a copy of the investigation reports. Some families choose not to receive this level of detail. DHU welcome meetings with families to discuss events face to face. Compliments We encourage staff to report positive patient experiences. All compliments are recorded on our Datix system. All staff mentioned in a compliment will receive an e mail or letter from our CEO. Compliments are included in our internal board brief, monthly governance reports and our quarterly quality report. We have received thank you cards, compliments via Client Focussed Evaluation Program (CFEP), Friends and Family, verbal over the phone and following face to face consultations. Our compliments received consistently outweigh our complaints received on a monthly basis. 67

69 Section 5 Our Patient Experience Over the past year Derbyshire Health United (DHU) have attending numerous public events to promote our services and to engage with the patients and public of Derbyshire. Throughout the year different staff groups have represented DHU at health information events and open days with some of our partner health organisations, e.g. Whitworth Hospital open day, Derbyshire Community Health Service s Working Together to Improve Quality Care event where many care coordinators and nursing home managers were able to gather and exchange information. As part of the national NHS Care Maker initiative we have a nominated individual who proactively promotes The 6 C s (care, compassion, courage, competence, commitment and communication) both within and outside the organisation. Over the Summer they have attended several national and local events to network and bring new ideas back for the benefit of our patients to ensure that the care you receive, is of the highest quality. Earlier in the Summer DHU hosted stands at the Hasland Gala, the Chesterfield Carnival and Chesterfield s first ever gay pride event. At all of these events many members of the public came to visit our stands, learn more about the services we provide and participated in our quizzes/games. The staff who manned the stall enjoyed and felt very proud to promote DHU to the public. 68

70 Section 5 Our Patient Experience Patient Experience During 2015/16 we have worked hard to better understand and learn from our patient s experience when they access our services. We have improved the way we collect and manage feedback from patients in order to maximise patient safety and improve experience. We have in 2015/16; We have rewritten our Terms of Reference for our Patient and Public Involvement Sub-Committee to ensure that we have an improved assurance process for our DHU Board. patients face to face. Trialled the Friends and Family Test within our District Nursing Service to obtain feedback from visited patients. Continued to receive a source of feedback from an independent organisation called Client Focused Evaluation Programme (CFEP), and engaged fully with Healthwatch. Involved Data Analysts in the patient feedback information, created meaningful data in the forms of charts and graphs for the ability to have more in depth discussion at our Patient and Public Involvement Sub-Committee. This information is shared with our assurance committees. Continued to engage with the patient forum who appraise our patient information, newsletter and who are actively involved in service developments. Appreciated the value of having patients present during our Patient and Public Involvement Sub-Committee. Explored our methods of collecting patient feedback and have plans to target a wider audience via the means of social media. Reviewed our patient complaints leaflet again in October 2015 and made the amendments to our existing communication which is available in different languages. Continue to gather valuable data from the Friends and Family Test at all our Primary Care Centres where we see 69

71 Section 5 Our Patient Experience Our Patient Engagement In we continued to build on and engage with our patients attending a variety of meetings, events and patient participation group (PPG) meetings including liaising with the CCG s and other stakeholders regularly to inform, receive feedback and ensure continuous improvement of the service. During we have continued with the You Said, We Did. Approach as this has proven that for patients to engage in improving their services then they need to feel that it is a) worthwhile them putting their views forward and b) that something tangible will come out of it and the proof of this is in the You Said, We Did. of which we have many examples. We have also looked at using Social Media as a way of reaching some of our young patients and Hard to Reach groups and as well as the existing methods also looking at alternative mechanisms for obtaining feedback, e.g. I.T and web-based as well as potentially setting up listening and focus groups. Healthwatch Derbyshire etc. to heighten the patient experience/ journey. In we will need to ensure that if appropriate we are adhering to the Accessible Information Standards that have come into effect. Judith Brown, Patient Experience Relationship Manager said: I find the role both personally and professionally very fulfilling and rewarding as well as being very diverse. Every day is different, there are certainly no dull moments, there are interesting conversations to be had, interesting and diverse people to meet across the generations etc. and I feel that my role is an integral part of the Patient and Public Involvement of DHU in ensuring that our patients continue to receive clinically safe and effective services and enabling change if required and if my role can be a part of the vehicle for making this possible then long may it continue. If through the work we all do within DHU means that even a small change can be made or even within my role being able to answer patients questions, allay any fears or misapprehensions and change patients perceptions or misconceptions and if I can get just one patient to access our services that wouldn t have previously and they tell ten people who tell another ten people and so on and so forth makes me proud of what I do and proves that by actively working hard to engage patients We have facilitated/undertaken both individual and group visits to our bases and incorporated demonstrations of the systems we use, e.g. NHS 111 Pathways etc as well as tours of our facilities. We already have dates in the calendar for to further engage with patient groups and the wider health economy, e.g. Judith Brown, Patient Experience Relationship Manager 70

72 Section 5 Our Patient Experience Our Friends and Family Test The Friends and Family Test is an important opportunity for patients to provide feedback on the care and treatment they receive. The Friends and Family Test is a simple way to identify both good and bad performance and encourage organisations to make improvements. Introduced in 2013, the test asks patients whether they would recommend health services to their friends and family if they needed similar care or treatment. This test enables patients to give feedback on the quality of the care they receive, giving service managers and employees a better understanding of the needs of their patients to enable improvements. The test asks the standard question, How likely would you recommend Derbyshire Health United to friends and family if they needed similar care or treatment? Patients will use a descriptive five-point response scale to answer the question with the following response categories: Extremely likely Likely Neither likely or unlikely Unlikely Extremely unlikely Both the positive and negative answers are analysed using a given formula which results in a score (Net Promoter). Only the Extremely Likely response is used as part of the calculation, please refer to the NHS Friends and Family Test publication guidance 2013 for further clarification. Derbyshire Health United have been performing this test since January Below is a chart that shows the average result for each Primary Care Centre from April March We are extremely pleased with our results. Throughout the year overall 83% of patients agreed they would recommend the service they have received to friends and family. The test also gives patients the opportunity to comment on our service, and we have taken an active approach to respond to these comments. Tom Oxley, PA to the Director of Nursing and Quality commented,: the test is key to understanding where patients feel the services we provide requires improvement. Having reviewed the data for 2015/16 the score for the majority of sites have increased from last year which is excellent. I am always delighted to read the comments patients leave talking of their positive experience, support of the service and complimenting staff; which are always fed back. It is also nice to see that the staff at each site are always keen to know the latest score which demonstrates their pride in the service they provide to our patients. 71

73 Section 5 Our Patient Experience Derbyshire Health United - Friends and Family Test Results (average) for April March

74 Section 6 Our Innovation working in partnership Stephen Bateman, CEO We are committed to working with commissioners and key partners to transform services in line with the joined up care strategies across Derbyshire 73

75 Section 6 Our Innovation working in partnership Erewash HUB During 2015/16, DHU have continued to work with Erewash CCG as the Lead Provider in partnership with Derbyshire Community Health Services to continue the pilot in providing two Primary Care Hubs, one in Long Eaton and one in Ilkeston. These Primary Care Hubs operate Monday to Friday evenings as an extension to daytime GP primary care services and from 9am to 12pm at weekends and Bank Holidays. Appointments within the two Primary Care Hubs can be booked via the patients own GP Practice receptionist, via the NHS 111 service or the local Minor Injuries Unit following an assessment. This extension of daytime GP primary care within the Erewash CCG locality has provided an average of an additional 600 appointments for patients within the Ilkeston and Long Eaton areas. This additional local access to GP primary care services also provides additional clinician availability to your local GP practice, reducing the need to attend your nearest Emergency Department, Urgent GP Out Of Hours services or Minor Injuries Unit. The overall aim of the service is to provide extended access to primary care via the two locality hubs. Broader aims and objectives are to: Allow Local NHS providers and commissioners to use resources effectively within the health economy. Provide extended capacity to primary care via two locality hubs. Improve local access to primary care in the evenings and weekends. Improve the patient access experience to local GP services. Reduce A&E attendances particularly children under 5 years. Facilitate integration of services to provide the right care, right place at the right time. Work to establish links with Out of Hours GP services, Minor Injury Units and community teams to ensure patients receive the right services at the right location. Improve urgent care pathways amongst GP practices, Minor Injury Units the NHS 111 & Out of Hours GP services. Have a shared appointment system across all surgeries. Although this initiative is still within the pilot phase preliminary evaluation of the service has been extremely positive for patients.? Avi quote? Rakesh? Outcome data in relationto local treatment completion rather that ED attendance 74

76 Section 6 Our Innovation working in partnership Erewash CCG Acute Home Visiting Service timely review for patients in their own homes by having a dedicated team to respond promptly and visit patients according to clinical priority reducing the need for patients to contact the Emergency Services or attend their nearest Emergency Department, Urgent GP Out Of Hours services or Minor Injuries Unit. The overall aim of the service is to provide extended access to primary care services. Broader aims and objectives are to: Allow Local NHS providers and commissioners to use resources effectively within the health economy. During November 2015 DHU were pleased to continue working as the Lead Provider with Erewash CCG and commence an Acute Home Visiting Service for patients across Erewash. DHU Nurse Practitioners are providing support to the 12 GP Practices surrounding Ilkeston and Long Eaton areas. Two DHU NP s are providing the service Monday Friday 9.30 am 6.30 pm. One NP is based in the Ilkeston area and one is based in Long Eaton. All GP Practices can access the service. Home Visit requests are booked directly via the patients own GP Practice receptionist. This further addition of clinical resource within daytime GP primary care services within the Erewash CCG locality has been able to support over 1,600 patients receiving a home visit across the Erewash locality between November 2015 March This additional resource to in hours GP primary care services has facilitated additional clinician availability within each local GP practice by allowing GP s & NP s within each practice to release additional appointments as they are having to visit less patients in their own homes. In addition this service has facilitated when necessary a more Provide extended capacity within local GP Practices. Improve the patient access experience to local GP services. Reduce unnecessary Emergency Department attendances Facilitate integration of services to provide the right care, right place at the right time. Work to establish links with Out of Hours GP services, Minor Injury Units and community teams to ensure patients receive the right services at the right location. Improve urgent care pathways amongst GP practices, Minor Injury Units the NHS 111 & Out of Hours GP services. Have a shared appointment system across all surgeries. Although this initiative is still within the pilot phase preliminary evaluation of the service has been extremely positive for patients. 75

77 Section 6 Our Innovation working in partnership Hardwick CCG Acute Home Visiting Service 5% of patients were referred to the Emergency Department and a further 5% were referred for admission to hospital. The project continues into the new financial year with ongoing review of service delivery and outcomes. Patient: I was very surprised to find there were other people available to help me in a concerned, caring and professional way. It is a great service, well done to you all! The Acute Visits Pilot (AVP) has continued to operate since April The key aim of the pilot is to undertake urgent home visits to patients within Hardwick CCG, covering 16 practices. The pilot aims to improve services for patients requiring urgent care, improve patient safety and reduce unnecessary Emergency Department (ED) attendances and admissions. This therefore should result in increased capacity in General Practice to deal with practice based demand. This service is delivered by an experienced Advanced Nurse Practitioner and operates Monday to Friday 0800hrs 1830hrs. The GP triage s the patients by telephone and then refer s through to the service if suitable. The Advanced Nurse Practitioner completes the visit within 2 hours of triage and the notes are forwarded electronically back to the GP when the visit is complete. The GP remains clinically responsible for the patient and is available for telephone support. In the past twelve months the service has visited 933 patients with 90% of patient s being successfully assessed and treated at home. The figures for ED assessment and admission are very low. Kirsty Osborn Head of Clinical Services (North Derbyshire) The main benefit I see of this service is the quality of patient care in particular for the housebound who are able to access primary care in their own home in a timely manner 76

78 Section 6 Our Innovation working in partnership Mental Health Nurses in Call Centre Pharmacists in the DHU NHS 111/OOHs Dental Nursing DHU have continued to work in partnership with Derbyshire Healthcare Foundation Trust mental health support within the NHS111 call centre and for Out of Hour s clinicians. Members of the mental health team are trained to work alongside the NHS111 Call Advisors and Nurse Advisors. The mental health nurses are able to access the Paris system in order to access the psychiatric notes to ensure a clinically enhanced assessment takes place and appropriate care going forwards. This enhanced service reduces unnecessary referral to the emergency department, out of hour s home visits and 999 calls ensuring a more clinically effective service. We are working with Hardwick CCG, Derbyshire Healthcare Foundation Trust, EMAS, Derbyshire Constabulary and Derbyshire Adult Care via the Crisis Concordat to develop a mental health advice hub that all services can access when required. Our present integrated service has suffered from a lack of resources in terms of staffing at times and by combining all resources a more robust and consistent service will be developed. Jenny Doxey - Deputy Clinical Director said Having the resource of these specialist nurses within the NHS111 and Out of Hours services ensures the patient receives the optimum support, advice and care whilst supporting our NHS111 Call Advisors, NHS111 Nurses and face to face Clinicians. We now have three pharmacists working within the call centre mainly at the weekends. They will have medication enquiries and toxic ingestions directed to them, helping the NHS 111 service for all four counties and repeat prescription requests helping the Derbyshire out of hour s service. This happens automatically by the Adastra system when the rota is activated by the rota team showing that they are available. The cases will show in the Pathways clinician queue and should a pharmacist not be available or their queue is too large then pathway s clinicians can also pick these calls up as they normally would. This is similar to the way the dental nurses queue works. DHU Pharmacist said - Pharmacists are reducing workload on GP's and Nurses - are able to deal with medicine/ Pharmacy queries thoroughly and effectively Patient comments included:- The service gives you peace of mind Very efficient service, dealt with my problem very quickly, I had insufficient medication to last me until the end of the bank holiday. The assistance I received was excellent Reliable and helpful service Dental nurses are now an integrated and embedded part of our clinicians working within the NHS 111 service. This enables our service to provide a specialist advice service for those patients suffering from dental pain who make up a large proportion of our NHS 111 contacts from the public. Dental nurses have the expertise and knowledge to help the patient and direct them to the appropriate dental service for their needs. They also are able to empower patients to self manage their symptoms and avoid unnecessary trips to the Emergency Departments. Our out of hour s GPs have also noticed that they do not have to manage patients with dental symptoms for whom they are not an expert in treating as often as they used to.. Patient experience has improved and we have less complaint about dental problems in the out of hour s periods. However there has also been improved out of hour s urgent dental clinics provided within the health system and this has also improved the position. We are working with urgent dental care providers to be able to book appointments for patients; however this has IT communication issues that need resolving. Patient Comment: Had bad toothache and the lady who handled the call was fantastic. She was compassionate and understanding 77

79 Section 5 Our Innovation working in partnership RightCare RightCare is a care plan developed by GPs to adapt to specific patient needs and improve the management of (particularly chronic) conditions. It is aimed at tackling a number of extremely pressing needs identified in the NHS and in an international health care context; namely, involving patients in the design and delivery of their treatment and reducing unnecessary hospital admissions. In 2015/16 the CCG worked closely with the local health and social care communities, DHU and a local lay member to improve the layout of the RightCare plan, how it works and how it is viewed by the wider health and social care communities. It was decided during the early part of 2016 that the RightCare plan was to be a part of the Derbyshire wide care plan and was to be renamed to encompass all types of care duly noted as the Derbyshire Health and Social Care summary. Our main aim this year is to ensure that patients that have care plans are moved over to the new Derbyshire Health and social care Summary and that this can be viewed via the summary care record. This will give an instant view of that patients care plan held at their GP practice and will depict their needs and what is usual for them thus enabling any Clinician to instantly assess that patient s needs and wishes at the click of a button anywhere in the UK. 78

80 Section 7 Our DHU Objectives 2015/2016 We will continue in 2016/17 to improve the quality of our services, to ensure they are safe, effective, caring, responsive and well led. Objective 1 Patient Safety We will provide a high quality effective and safe service to all our patients. Placing patients at the heart of safe, compassionate and competent care. Objective 3 Supporting our workforce We will aim to attract, recruit, retain and develop all our staff to be part of delivering good quality healthcare services. Objective 5 Good Governance We will be a well led, financially viable organisation, balancing effective decision making with innovation and transforming services. Objective 2 Integration through partnerships We will develop new models of integrated care through embedding key partnership working which commenced in 2014/15. This will Include the redesign of Emergency and Urgent care pathways. Objective 4 Focus on prevention and self-care We will use our experience and expertise to work with patients, families and our local communities to develop resilience and capacity in preventative services and self care. 79

81 Section 8 Statement of Director Responsibilities The directors are required under the Health Act 2009 to prepare a Quality Account for each financial year. The Department of Health has issued guidance on the form and content of annual Quality Accounts (which incorporates the legal requirements in the Health Act 2009 and the National Health Service (Quality Accounts) Regulations 2010 (as amended by the National Health Service (Quality Accounts) Amendment Regulations 2011). In preparing the Quality Account, directors are required to take steps to satisfy themselves that: The Quality Accounts presents a balanced picture of the organisations performance over 2015/16. The performance information reported in the Quality Account is reliable and accurate. There are proper internal controls over the collection and reporting of the measures of performance included in the Quality Account, 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 Account is robust and reliable. Conforms to specified data quality standards and prescribed definitions, and is subject to appropriate scrutiny and review. The Quality Account has been prepared in accordance with Department of Health guidance. The directors confirm to the best of their knowledge and belief they have complied with the above requirements in preparing the Quality Account. By order of the Board 5th May Chairman of the Board 5th May Chief Executive Officer 80

82 Section 9 Statement from Commissioners Commissioner Statement 81

83 Section 9 Statement from Commissioners 82

84 Section 10 Statement from Healthwatch Healthwatch Derbyshire 83