Quality Summary Report:

Transcription

1 Quality Summary Report: Speech/Language Therapy (SLT) Adult Services: SLT - Adult Community SLT Adults Chelsea & Westminster Hospital Assistive Communication Service (ACS)

2 CLCH Quality Report Jan Dec 2011 Location (CQC ID) Service exact name Address line 1 Address line 2 Town/city County Postcode No. beds Website [Insert CQC ID] Speech & Language Therapy Adult Services Parsons Green Centre/Edgware Community Hospital 5-7 Parsons Green/Burnet Oak Broadway London/Edgware London SW6 4UL/HA8 0AD N/A/CLCH Barnet has 65 rehabilitation beds including 14 stroke Main telephone Completed by Approval Claire Withey / Julia Binder/ CLCH Barnet- Patricia Hill/Elizabeth Shillingford Service Manager SLT / Professional Lead SLT/ Divisional Manager & AHP Professions Lead for CLCH Barnet Judith Barlow/Fiona Jackson Associate Director Children, Family, Health and Wellbeing/Associate Director of Operations CLCH Barnet

3 CLCH Quality Report 2011 Summary report for Speech & Language Therapy Adult Services Directorate Service area Children, Family, Health and Well-being/Barnet Services SLT Adult Services: SLT Adult Community Inner CLCH, SLT Adults C/W Hospital, Assistive Communication Service CLCH Barnet- SLT Adult services: SLT Adult Community (ICS), Intermediate Care Wards, Parkinson Service,, Early Supportive Stroke Discharge Service, Home Enteral Feeding Service & Voice Clinic Boroughs Barnet Kensington & Chelsea Hammersmith & Fulham Westminster CQC statement of purpose for this service Speech and Language Therapy (SLT) is a large, complex and integrated CLCH wide Service. We provide assessment, diagnosis and intervention to babies, children and adults who have wide-ranging speech, language, communication needs, and provision of specialist feeding and swallowing services. The service is designed to be flexible and comprehensive, with a professional structure so that the therapist with the right skills sees the client at the right time, in the most appropriate setting. Individual, group, joint working and training packages are provided. Goals are planned and agreed with clients on an individual basis, involving family and carers wherever possible. The service is delivered through a wide range of clinical pathways and multi-professional teams and agencies, some via Service Level Agreements. We work closely with other professionals to provide information and ensure that individuals are treated holistically, as effective communication and nutrition are central to all aspects of well-being and successful recovery of function. All SLT Teams undertake SLT Student training placements. Referral processes are in line with Professional Guidelines and centralised local procedures.

4 This Adult SLT Quality Report comprises data from across a range of Adult SLT services provided by CLCH, including data specific to these Services. It focuses on the discreet Service areas outlined below, but it should also be noted that Adult SLT is integral to many areas of multi-disciplinary pathway working including Community Rehabilitation, bedded services including continuing care, palliative care, neuro- rehabilitation, Early Supported Discharge Stroke, and Specialist Services, and for these areas SLT have been part of multi-disciplinary PREMs, reported by these Service Lines across CLCH. 1) Adult SLT Community Service Inner CLCH: In addition to the embedded SLT components within the Community Rehabilitation Teams, bedded services and Specialist Services across CLCH, the Adult SLT Community Service sees clients whose primary need may be for SLT intervention only, whether this is in relation to a communication and/or swallowing difficulty. Clients may be seen in their own home or in a community setting, as appropriate. Examples of services provided include a specialist intensive Voice Therapy Service for people with Parkinson s Disease (Lee Silverman Voice Therapy LSVT), in line with NICE Guidance and a CLCH wide Conversation Partners Scheme (CPS) for people who are post therapy following a stroke, but who may still need support in the community, due to on-going language difficulties (aphasia) and the impact of these on regaining and maintaining independence and social inclusion. We also work closely with the Dietetics Service to provide a holistic approach to those people who may be malnourished as a result of swallowing problems and have a robust training and development programme in place for those who work with / care for the clients we are involved with. o Adult SLT Service Chelsea and Westminster Hospital: Through a Service Level Agreement, CLCH SLTs provide the SLT In-Patient and Out-Patient Services at Chelsea and Westminster Hospital. We offer assessment, treatment and advice for adults (16 and over) who are affected by communication and / or swallowing difficulties (dysphagia).these may arise from

5 a wide range of conditions, including stroke, head injury, progressive neurological conditions, other neurological deficits, cancer and other aetiologies. We provide Out-Patient voice and dysfluency services for people who have a stammer. In-Patient and Out-Patient Dysphagia Services, including use of X-ray video swallows and a full dysphagia training programme are provided. In collaboration with the patient, and working closely with family and carers, we generally work as part of multi-disciplinary teams to develop a programme of care tailored to maximise the communication and swallowing potential of each individual referred to us. Assistive Communication Service (ACS): The ACS is a specialist service, providing specialist assessment and advice in relation to the use of augmentative and alternative (AAC) communication systems. AAC includes high and low-tech aids or systems, such as computers, dedicated devices or communication books to help people communicate if they have difficulty speaking. The service is for adults and children with complex communication disability who may benefit from the use of AAC. Clients are seen in their home, school / college, or at work as appropriate. We work closely with local therapists/teachers/care-workers and families to support the implementation and use of recommended devices / systems and their peripherals. Please also refer to the separate Summary Report for SLT Children s Services. The Barnet Picture The services listed above are integral to the multi-disciplinary pathways which were introduced in Despite small clinical teams, SLT provision forms an integral part of the service provision to adult patients in CLCH Barnet, providing inpatient SLT on Stroke and Rehabilitation wards, voice clinics, community based SLT, specialist SLT sessions in the Edgware Day hospital for Parkinson patients.

6 Overall summary of quality performance and next steps The CLCH SLT Service (Adult and Children) has an established format across the whole Service for planning, co-ordinating, undertaking and reporting activity relating to Quality, Audit and Research and Evaluation, which links into the CLCH Quality Metrics and Clinical Governance work plans, working closely with colleagues from the Quality Leadership / Clinical Governance departments, as summarised within this report. As a service we continue to strive to improve quality and to ensure that the principle of No decision about me without me is at the centre of everything we do. This is achieved through understanding, providing and facilitating professional working across all areas of the Service against the 3 key elements of Quality Performance: Safety, Effectiveness and Experience. An activity and performance section against each of these areas is enclosed. This needs to be achieved both within a professional framework and in line with the Corporate objectives and values of CLCH, so that as services and structures we are able to provide consistent standards of care, that are responsive to changing health, well-being and social care needs and agendas. Throughout 2011, the SLT Service for Adults has performed well overall in providing safe and effective services and has made good progress in seeking and addressing feedback from key stakeholders including patients, relatives, carers, staff and others involved in their care. This has been achieved over the year through a range of feedback mechanisms across all the SLT Clinical Teams, as detailed below, including the use of Patient Reported Experience Measures (PREMs) and Patient Reported Outcome Measures (PROMs) and through analysis of incident reporting, audit activity and service evaluation. The focus for 2012 will be to continue to monitor how well we provide services against clearly laid out standards and pathways of care, to continue to seek feedback from our stakeholders on the services we provide and their outcomes, in a range of ways best suited to those accessing our services and to remain responsive as a Service within CLCH, so that we remain a Provider of choice for commissioners of SLT Service.

7 Safety Overview We aim to make our service as safe as possible at all times. A robust system is in place across the SLT Service to ensure that all SLTs undertake annual mandatory training, including Protection of Vulnerable Adults / Safeguarding training, professional training, continuing professional development (completing an online Continuing Professional Development log, which is subject to audit by the Royal College of SLTs) and have regular clinical supervision and annual appraisals. Professional Standards of Client Care, as laid down by the RCSLT and the Health Professions Council, clinical guidelines and clinical protocols are in place against which standards of care for clients can be measured. These are reviewed regularly by the SLT Service Manager and SLT Professional Lead. And in Barnet by the service manager and AHP professional Lead. SLTs are encouraged to report all clinical incidents and near misses, in line with CLCH policies and procedures and through a culture of learning from experience. Key achievements this year We identified the following 2 safety improvement actions in our 2010 Quality Report. This section outlines the progress we have made on each of them: 1) A standard letter is sent to any Referrer who sends an initial Adult SLT referral to an incorrect site in CLCH: Completed. There have been no further reported incidents in 2011 of a delay in processing Adult SLT referrals following this implementation. 2) Carer and GP were advised re process to use to order sufficient quantities of drink thickener, so that thickening recommendations to manage dysphagia could be followed appropriately at all times: Completed. No re-occurrence of this type of incident reported in The service has also made the following safety improvement action that was not identified in last year s report: 1) Incident reporting system: The system across CLCH for recording and

8 managing incidents electronically on Datix has improved, and we continue to encourage and facilitate SLT staff to report incidents and near misses. The SLT Service is now part of the CLCH Learning From Experience Group and Clinical Reference Group. In CLCH Barnet, as the SLT service forms part of Long Term Conditions and the Intermediate Care Service, all activity is reported by the pathway as a whole and therefore not specific to SLT. The Quality Accounts for these specific pathways contain the composite of this information. Key results Total incidents Jan-Dec 2011 by category The graph above shows the incidents for both children s and adults SLT services. For the 3 SLT Adult Services detailed across Hammersmith &

9 Fulham, Kensington & Chelsea and Westminster, there were a total of 3 incidents during this reporting period: Adult Community SLT = 3, Adult SLT CW Hospital = 0, Assistive Communication Service = 0 Total incidents Jan-Dec 2011 by severity Low Minor Medium High Catastrophic Level of reporting: In this service, incidents are recorded in every case. Near misses are recorded in most cases. All Staff are encouraged to report all incidents and near misses, so that there is a shared learning through experience culture. The low number of reported incidents reflects what is believed to be a generally safe service. Themes arising Numbers of incidents reported were insufficient to generate themes, or to correlate with the two incidents that were reported by the Service in The three incidents reported in 2011 involved: Temporary misplacement of RIO Smartcard by a staff member (which was subsequently found). CLCH and SLT reporting Procedures were followed to report the misplaced card and staff reminded of the importance of taking all reasonable precautions to safeguard smartcards. Non-adherence of staff in a Nursing Home in following SLT Guidelines for using thickener for a Client with swallowing problems, which potentially put the client at increased risk of aspiration. Nursing Home training need identified (see Actions below) An isolated incident of a Community SLT reporting that on arrival at a client

10 visit, the client was on the floor and alcohol was in evidence. The Client was subsequently able to get up and engage in the therapy session, but SLT highlighted it with regard to adhering to the CLCH Lone Worker policy and reflecting if processes are working effectively, in this case through the relevant supervisory process according to Trust Policy.(See Actions below) In CLCH Barnet, as the SLT service forms part of Long Term Conditions and the Intermediate Care Service, all activity is reported by the pathway as a whole and therefore not specific to SLT. The Quality Accounts for these specific pathways contain the composite of this information. Safety Action Expected Named Improvement completion lead Actions for date 2012 SLT Training to be delivered to Nursing Home Staff Training SLT following results of a training needs analysis carried programme Team out in 2011 delivered Lead throughout Adult 2012 Commun ity Continue to monitor the efficacy of the Lone Worker On-going at SLT Policy in place for Community SLTs 6 weekly Team peer Lead supervision Adult meetings Commun ity Effectiveness

11 Overview We aim to achieve the best possible outcomes for patients. To do this, we regularly check to see that we are delivering care and treatment according to best practice standards, and we increasingly look to measure and improve clinical and patient reported outcomes. Throughout 2011, the Adult SLT Service has further developed the work that was on-going throughout 2010 (reviewing and piloting a range of Patient Reported Outcome Measure (PROMs) that are relevant for clients in respective clinical areas), to ensure that at a PROM, as well as a PREM (Patient Reported Experience Measure) is being used across the Service. PROMs provide a means of gaining an insight into the way patients perceive their health and the impact that treatments or adjustment to lifestyle have on the quality of life. Each of the SLT Clinical Teams for Adult SLT Adult Community Inner CLCH, Adult CW Hospital and Assistive Communication Service (ACS) has been using a PROM: Adult Community / ACS Using the Goal Attainment Scale (GAS), as part of a multi-disciplinary joint goal setting tool used across CLCH Rehab teams in Hammersmith &Fulham, Kensington and Chelsea and Westminster. Adult CW Out-Patient SLT - Using Outcome Rating Scales (ORS) and Session Rating Scales (SRS) from Solution Focused Brief Therapy (SFBT). Major themes arising from the data collected from these PROMs include the benefits of developing and using PROMs that have been piloted and which are appropriate for the needs of the clients with whom we work, particularly those with significant communication difficulties. The use this year of the Goal Attainment Scale in analysing patient reported outcome measures has enabled a formalised scoring system of goal analysis with clients, and enabled us to review whether goals are being achieved. This is in comparison to last year s use of Therapy Outcome Measures (TOMs), which did not provide a scoring system. Overall, across the different areas of the SLT Adult Service, clients report highly positive outcomes in their ratings of their SLT intervention. In CLCH Barnet, as the SLT service forms part of Long Term Conditions and the

12 Intermediate Care Service, all activity is reported by the pathway as a whole and therefore not specific to SLT. The Quality Accounts for these specific pathways contain the composite of this information. Key achievements this year We identified the following clinical effectiveness improvement actions in our 2010 Quality Report. This section outlines the progress we have made on each of them: 1) Results of the SLT 2010 PROMs pilot study analysed and information gained used to inform therapeutic input / management with clients: This action has been completed. 2) Results of the SLT 2010 PROMs written up and reviewed as a measurement of reported clinical outcomes across the SLT Adult Service, to inform further development and use of PROMs within the Service in 2011: This action has been completed. Key results Patient Reported Outcome Measures (PROMs) PROMs completed across the service show that clients report make significant progress in their speech, language, communication and eating/drinking abilities. PROMs used are appropriate to the specific clinical areas where clients are seen. Examples of specific PROMs in use across Adult SLT are: Session Rating Scales (SRS) and Outcome Rating Scales (ORS) quality measures carried out in 2011 The SLT department at Chelsea and Westminster Hospital have used Session Rating Scales (SRS) and Outcome Rating Scales (ORS) since a successful trial period in 2010 which were also a subject of audit. (Scott Miller. Institute for the study of Therapeutic Change USA 2002) The results showed them to be an effective way of measuring therapeutic change and the patient s experience of therapy sessions. The department uses these scales regularly as part of their quality measures. Summary of findings across the service area: The responses from 63 SRS therapy sessions were audited, from patients who

13 attended the SLT out patient service at Chelsea and Westminster Hospital and include a varied diagnostic case load, including voice problems, dysphagia (swallowing problems), neurological and chronic diseases, stammering and stroke. There are four parameters that the patient is asked to comment on Relationship, Goals and Topics, Approach and Method and Overall. Patients/clients are asked to place a mark somewhere along the the10 centimetre scale line of each parameter. Each parameter has a maximum mark of 10.The maximum total across the four parameters is 40 or 100% For the purposes of clarity in the audit findings the marks have been expressed as a percentage. The audit findings show an overall excellent result. The figures will be broken down into specific parameters for the detailed report. In summary: 40 sessions were rated at 100% satisfaction. No parameter was rated below 60% satisfaction. 96% of patients rated the sessions as strongly agree with the therapy approach, method, goals, relationship. The therapists have found that peer review and support have helped in joint patient/therapist working and goal setting. Some patients have found these rating scales difficult to understand. This reflects our case load which will include people with language difficulties. Capturing data from this group of patients remains an area for on-going work within a multidisciplinary setting. The department plans to continue in-service training and peer support. A single case study has been written up to demonstrate the effectiveness of Outcome Rating Scales (ORS) and Session Rating Scales (SRS) and to show how they work together to determine the patient s therapy goals. These, and the detailed summary of the SRS and ORS PROM evaluation, are available as separate detailed reports. These patient reported outcomes demonstrate how a solution focused approach can work well with this framework and with the client group seen as Out Patients

14 in the SLT Department. PROMS for patients who have received treatment/intervention from the ACS Augmentative and Alternative Communication (AAC) describes aids or systems that help people to communicate if they have difficulty speaking. The Assistive Communication Service (ACS) role is to assess an individual s need for AAC, and access to computer technology. Many of our clients are highly complex, and evaluating the impact of our service can be difficult. There are no set standards for AAC intervention but the national AAC charity- Communication Matters, has this year published some draft guidelines: These include Quality Statements which refer to outcome measures and goal setting with clients. These and National Standards from NICE and NSFs have influenced our use of PROMs in this Service. Our aim was to establish outcomes from the client s perspective, in order to ensure that we are providing a service that achieves positive outcomes and an effective service for our clients. An adapted version of the Goal Attainment Scale (GAS) (Kiresuk and Shermam,1968) was used. It was adapted by combining it with Light s model of communication competence (Light, J 1989), a tool commonly used for assessment in AAC. At the beginning of an intervention with the ACS, goals were set with each client, and classified according to Light s model of communication competence. Goals were re-reviewed during input. They were then reviewed at the end of input. If a client had difficulties expressing themselves, support would be given, e.g. use of a Talking Mat to set or review a goal. The GAS is a mathematical technique for quantifying the achievement (or otherwise) of goals set, and it is commonly used in rehabilitation and is now beginning to be widely used across CLCH in a variety of teams, including the rehabilitation teams, in which the Adult Community SLTs also work. (Please also refer to separate Quality Report for these Services). The majority of clients with whom goals were able to be set and analysed were

15 over the age of 20. The condition of the clients the majority of goals we set with was Stroke. The most common goal type set was Operational: Technical skills used to operate a system. This included the ability to access switches, mouse, keyboards, in order to operate a communication aid or computer. The majority of clients (19/20) achieved the goals they had set with the therapist. 1 client was unable to achieve their goal, due to recurrent illness. (Please also refer to the Detailed Summary Report for this PROM). Supervision, clinical case discussion, in-service training and peer review have been identified as being important for the consistent, continued use of these measures which help us to provide an effective, responsive service for patients. Clinical Outcomes Re-Audit of Dysphagia Outcome Measure (DOM) Chelsea & Westminster Hospital Measuring the effectiveness of dysphagia therapy is notoriously difficult for a number of reasons. Spontaneous recovery plays a major part. Many stroke patients initially present with oromotor weakness which then resolves. Therapists will assess and advise on appropriate management but can the effect of intervention be measured? Pre-morbid levels, medical diagnosis and co-existing medical problems, levels of alertness, motivation, awareness, age, cognition and family support are all relevant. In some cases specific swallowing or muscle strengthening exercises can make a difference, but in many cases recovery to normal swallowing is difficult to attribute to the specific expertise of the therapist. What can be measured, however, is the safe management and progress of patients from starting base line to discharge. This can show an outcome and trace the trajectory of therapeutic input. For this reason a straightforward numerical graph was devised and used in the Speech and Language Therapy (SLT) department for a trial period in 2009/2010. (Please see 2010 SLT Audit Report) That audit demonstrated that outcomes could be identified and were of value.

16 As a result the SLTs have used the DOM since that time. The same formula has been used for this audit and the same parameters have been measured. Aim of project: To audit the outcomes of dysphagic patients by tracing change over time. To compare patient numbers to the same period in the previous year. To assess average number of SLT contacts for dysphagic patients. To look at any age related effects on dysphagia outcomes. To audit the time from referral to assessment (SLT Standard). Objectives: The SLT Department use a graph showing a score from 0-4. A cross is marked on the graph against the appropriate number e.g. 2 = modified diet and thickened fluids. No Criteria Target Exceptions Source of evidence 1 All patients who are admitted with a diagnosis of stroke are assessed for swallow competence. 100% Patients who refuse intervention. Patients who are too ill for assessment at time of referral. NSF Long Term Conditions & Older People, National Stroke Strategy 2 All other in patients who have been referred by medical team/ward nurses/other for assessment of dysphagia 100% Patients who refuse intervention. Patients too ill for assessment at time of referral. Clinical / RCSLT Guidelines. SLT department standard. Survey period: 01/03/ /05/2011 A 3 month period. The same months as the previous audit.

17 Sample size: 79 Patient s Files, data Collection from SLT patient notes Sampling approach: All DOM graphs for the period March to May 2011 were audited to act as a direct comparison with the previous audit so that number of patients, age related effects and number of SLT contacts could be directly compared. Summary of Results: There was good compliance with the use of the DOM. A measure of outcome has been gained and it has been possible to track the change in patients with dysphagia. As previously discussed the improvement in swallow ability cannot claim to be solely due to therapy intervention, but it can be argued that the change from nil by mouth, through a modified diet to normal fluids and food has been expedited by appropriate therapy intervention and that therapy has had a positive effect on recovery. The number of contacts and the number of patients assessed was very similar to previous audits. An average of four SLT patient contacts for dysphagia has been consistent over several audits and suggests an efficient and effective therapeutic intervention. There was no indication that age had a bearing on clinical outcome for dysphagia, but the group with the highest numbers were between ages and had the most patients with diagnosis of stroke. Conclusions: The DOM has been used consistently by the SLT department. It was quick and easy to use. It has been able to demonstrate several useful findings for evaluation and audit. Each SLT contact has been noted on the DOM (suggestion/finding from previous audit) The audit was able to show an efficient use of therapy time and prompt response to all dysphagia referrals. (Please refer to Detailed Report for full details) Recommendations and Quality Improvement Actions

18 The SLT department will continue to use this outcome measure for dysphagia and to incorporate any innovations or quality improvements. Clinical Audit Participation in Trust-wide audits during 2011 The SLT service completed the CLCH trust wide records Audit. All four boroughs were involved and audited the following number of records: 1) Barnet 102 2) Kensington and Chelsea 115 3) Hammersmith and Fulham 72 4) Westminster 97 The service achieved a mean compliance rating of 76.15% Initial analysis indicated that therapists were writing complete ethnicity descriptions within case note files but not always using codes. Further analysis is required for each team, so that Action plans can be put in place to address issues arising. We also need to review questions in relation to specific Service requirements. In addition to the above Record Keeping Audit, in This year our clinical audit plan within the Adult SLT Service has focused on the following audits: 1) Re-audit of Dysphagia Outcome Measure (as detailed above) 2) An audit to identify baseline knowledge of carers regarding dysphagia (swallowing problems) in Nursing Home settings and the effect of training in dysphagia on the knowledge and awareness of the same carers. This audit is currently on-going and is due to be completed in A training needs analysis was undertaken to establish a baseline of knowledge of dysphagia in staff in a Nursing Home in Hammersmith and Fulham, pre

19 dysphagia training sessions provided by SLT, with re-assessment of knowledge of dysphagia post attendance at the training sessions. The project is not yet complete, however initial results show that there has been an increase in the knowledge of dysphagia by both Nurses and Health Care Assistants within the pilot Nursing Home. Ten nurses and HCAs were due to attend both pre and post training sessions.however, some difficulties have been encountered with staff attendance at the Dysphagia training sessions and the subsequent reassessment of staff knowledge post training, in part due to high staff turnover. Audit findings will be used to identify the most appropriate ways to further increase knowledge of dysphagia in Nursing Homes. 3) An audit of SLT Patients discharged from Chelsea and Westminster Hospital and subsequent referral on to CLCH Community SLT Services This is also an on-going Audit in 2011/12 and will be completed and is due to be reported on in July The audit aims to measure SLT discharges against National Professional and local standards of Patient care, to ensure that standards are being met and that processes are safe and effective so that all Patients who require Community SLT follow-up following In-Patient SLT intervention at Chelsea and Westminster Hospital receive a timely, seamless SLT service. This audit is related to wider objectives of improving discharge planning from acute to community and maximising independence for patients through provision of out of hospital care. Audit findings will be summarised and reported through the CLCH online Audit reporting template once completed in Findings will be reviewed across the SLT Adult Services to identify and address any areas for Service improvement. NICE compliance The following NICE guidance is either fully or partially relevant to this service: Between January 2011 and December 2011 no NICE Guidance was published that was fully or partially relevant to the SLT Adult Service. However, for information only the Speech and Language Therapists working with Adults were alerted to the Guidance for:

20 Anxiety (partial update) January 2011 CG22 Lung Cancer (update) April 2011 CG121 Endoluminal Gastroplication for Gastro-oesophageal Reflux Disease July 2011 IPG 404 To ensure that we are complying with best practice guidance, we have carried out the following actions in 2011: Details of all NICE Guidance issued are circulated centrally on a monthly basis to the SLT Professional Lead, who in turn responds by confirming receipt of these and any actions arising if Guidance is relevant to the SLT Service. The Guidance and any associated action plan is then discussed with the SLT Service Manager and passed on to an identified and agreed SLT who will have responsibility for following up the agreed action plan. This may involve cross-disciplinary pathway working as well as service specific follow up. If on receipt of new NICE Guidance any potential barriers for putting guidelines into operation are identified by the SLT Professional Lead and SLT Service Manager, these will be highlighted at the appropriate level within CLCH. All NICE Guidance which is relevant to the SLT Profession is also highlighted at the bi-monthly SLT Quality, Audit, Research and Evaluation (SQUARE) Group, which a SLT representative from each of the clinical SLT Teams for both Adult and Children s SLT attend. Research and innovation During 2011, several SLTs within the SLT Service were studying for Masters degrees. Of these, one SLT within the Adult SLT Service was successful in achieving an MSc, with a dissertation looking at What are the factors that influence malnutrition in elders over the age of 65 years? One of the aims of the SLT undertaking this research was to inform clinical practice, disseminating the

21 results across the various Teams and Services and reflecting through clinical supervision and mentorship in CLCH on implications for how this might influence how we work with clients, carers and colleagues in this very important area. In this SLT will be looking to undertake a clinical audit looking at the correlation between clients that have been screened as malnourished and those assessed as having swallowing difficulties. CLCH has, throughout 2011, continued to provide excellent opportunities for Staff to participate in innovative quality improvement initiatives. An example of this is the Quality Improvement Module at University of West London, set up in 2011 in conjunction with the CLCH Clinical Leadership Team, which a number of Speech and Language Therapists are undertaking, in conjunction with colleagues from a range of CLCH clinical services, working on innovative workplace based projects, which will be further reported on, on their completion in A number of SLTs have identified within their Personal Development Plans that they would like to be Quality Champions within CLCH and further development of these roles will be on-going throughout During 2012, the SLT Service will develop a QUIPP (Quality, Innovation, Productivity and Prevention) Work plan, as part of the wider National QUIPP and CLCH Objectives and work streams. From this, on-going work in all areas of quality (safety, effectiveness and experience) will be undertaken. What the patients say about the outcomes of their care and treatment As highlighted at the beginning of this Report, whilst this summary details information specifically focusing on the Adult SLT Service in relation to all aspects of quality, we very much work as part of multi-disciplinary and multiagency care pathways. Our aim is to ensure that clients are at the centre of everything we do, in all aspects of our work, It is so valuable to receive feedback from people who use our Services about what they view the outcomes of their care and treatment to be. The following are two examples of actual spontaneous written feedback received by the Adult SLT Service: Example A is from a Carer s perspective and highlights the role we have to

22 play in collaborative care and pathway working: an overseer of a patient with multiple needs, who takes an interest in the whole health affairs and eases the carer s journey through the maze! I wanted to thank you personally for the way you helped me over the past few weeks in organizing assessments for my Mother. And, I do ask that you forward this to your manager (and other relevant parties) so that others may hear of (and hopefully copy) your service to my Mum and in effect to her clan of eight worried children. Recent weeks have been a very emotionally turbulent time for all the family seeing our precious Mum s increasing fragility and having to deal with a number of emergent health issues and services all in one go: failing voice, loss of weight and now permanently dislocated shoulder - alongside her pre-existing conditions Parkinson s and arthritis, regular visits to podiatry, chiropody and continues. Whilst I am sure many professionals must get too busy to imagine carer s difficulties in emotionally coping let alone commandeer the many paths through health services, the way you gently took the wheel and steered me til I understood what was what, who was who and what could/could not be done for her in a temporary home was such a gift. More so, the relief you brought when you went the extra mile: triggering the required health service assessments, liaising with the care home in Streatham her temporary home and above all feeding back to me ad explaining what was to be expected and when. This was well above (to me) the call of duty: Your extra kindness, thoughtfulness and activity as well as your professionalism will be remembered by me for a long time yet - easing the worry of coordinating it all. You are an example of great service especially when needs are many and complex and increasing age can be a deterrent to some wanting to help. We should have more of you in the community setting an overseer of a patient with multiple needs, who takes an interest in the whole health affairs and eases the carer s journey through the maze! Finally, my thanks to the administrator who efficiently referred my call to you as she sympathetically and without judgment picked up on our difficult situation.

23 Example B: Is written feedback received by one of the SLTs in the Adult Service in relation to a specific episode of SLT Intervention Many thanks for your report. We have completed the survey and posted it today. I would like to take this opportunity to thank you for your support, professionalism and good humour throughout the last 6 months. I particularly wanted to say that I was very grateful how you treated X with so much dignity and respect. You were always so positive but realistic about X's abilities. You highlighted the positives and praised X on small achievements. X's journey of recovery from March to now would not have been possible without your intervention and help. I have met numerous S&LT since X's stroke. You were the absolutely best one of all, simply because you did not write X off and were willing to give him a chance. And it has paid off! You are a highly motivated individual and that was so evident with your treatment of X. You have made a huge difference to X's life and mine. The evidence is in family and friends commenting on what a difference in X's communication skills between March and now. Once again, thank you for support and good luck in the future. In CLCH Barnet, as the SLT service forms part of Long Term Conditions and the Intermediate Care Service, all activity is reported by the pathway as a whole and therefore not specific to SLT. The Quality Accounts for these specific pathways contain the composite of this information. Clinical Effectiveness improvement actions Actions Expected completio Named lead n date Review CLCH Record Keeping findings for SLT March SLT Prof

24 Service and formulate appropriate Action plan to address any areas requiring improvement 2012 Lead & SLT Service Manager Review SLT Profession Specific Record Keeping Audit tool and work with Clinical Governance Lead to incorporate with CLCH record keeping tool, so that a full record keeping audit for SLT can be undertaken simultaneously Oct 2012 SLT Prof Lead & SLT Service Manager The SLT Service will develop a QUIPP (Quality, Innovation, Productivity and Prevention) Work plan for , as part of the wider National QUIP and CLCH Objectives and work streams. From this, regular on-going work in all areas of quality (safety, effectiveness and experience) will be undertaken. April 2012 on-going with review dates as per work plan SLT Prof Lead Experience Overview We care about treating everybody with kindness, dignity and respect at all times. Throughout 2010, the Speech and Language Therapy Service collected Client s feedback regarding their views of our services, across all clinical areas and began reporting feedback from these PREMs in line with CLCH Quality Metric guidance and commissioning agreements. Across the Adult SLT Teams, consistently high levels of satisfaction were expressed in relation to key areas: being treated respectfully and with dignity, being listened to and involved in planning their treatment and receiving easy to understand information from the

25 SLT staff. In 2011, a CLCH wide centralised system of collecting Patient Reported Experience Measures was introduced, This was based on a questionnaire format, with a number of trust wide core questions and some service specific questions. All Teams within the SLT Service for Adult and Children were involved in the development of the questionnaires, working with Clinical Leadership and Governance and Fr3dom Health. The format of the PREMs were designed, so that where appropriate visual rating scales were used to ensure that clients with communication difficulties were able to participate in telling us about their experience of using Speech and Language Therapy Services and any areas that they felt could be improved. Experience gained throughout 2010 in relation to collection of PREMs informed this process and the development of service specific questions. In CLCH Barnet, as the SLT service forms part of Long Term Conditions and the Intermediate Care Service, all activity is reported by the pathway as a whole and therefore not specific to SLT. The Quality Accounts for these specific pathways contain the composite of this information. Key achievements this year We identified the following patient experience improvement actions in our 2010 Quality Report. This section outlines the progress we have made on each of them: Within the SLT Service Quality, Audit, Research and Evaluation (SQUARE) Group and within SLT Clinical Teams, to review the PREM feedback gathered to date in order to: a. Evaluate any specific areas of Service Provision requiring action: Completed for and On-going for b. Share examples of best practice: Completed and On-going for c. Ensure all PREMs include core CLCH question themes: Completed. All SLTs reminded to send in all compliments received so that these

26 can be centrally collected by PALS, as some SLT Teams appear to be under-reporting compliments given by clients: Completed. However, CLCH process for central collection of compliments changed in year in 2011, so see Patient Experience Actions for 2012 below As detailed above, the SLT Service Teams worked with Clinical Leadership and Fr3dom Health to develop CLCH wide PREMs for Adult and Children s SLT teams. These are questionnaires that ask patients specific questions about their experience of the service or services that they have received. The questionnaires can be completed in writing or online, depending upon Patient preference. In CLCH Barnet, as the SLT service forms part of Long Term Conditions and the Intermediate Care Service, all activity is reported by the pathway as a whole and therefore not specific to SLT. The Quality Accounts for these specific pathways contain the composite of this information. Patient survey results Patient surveys (known as Patient Reported Experience Measures PREMs Summary of results for core patient experience measures (Aug-Dec 2011) for Speech and Language Therapy Adult Services Inner CLCH (Please note that these figures represent an amalgamation of PREM data for the Adult Community SLT, Out-Patient SLT and Assistive Communication SLT Services in Inner CLCH). Where SLTs work as part of multi-disciplinary Rehabilitation Teams in CLCH, PREMs for Rehabilitation Services have separately reported. In CLCH Barnet, as the SLT service forms part of Long Term Conditions and the Intermediate Care Service, all activity is reported by the pathway as a whole and therefore not specific to SLT. The Quality Accounts for these specific pathways contain the composite of this information.

27 Question Result for this service Trust-wide average % patients/carers rating overall experience good or excellent 94% 93% % patients saying they were definitely involved in planning their treatment 66% 56% % patients saying they were always treated with dignity & respect 95% 92% % patients saying they definitely understood explanation 94% 88% % patients satisfied with waiting time 87% 74% Interpretation of PREM results Generally, across the core PREM questions, results for this service are very positive, with 94% of respondents rating their overall experience as good or excellent, 66% saying they were definitely involved in planning their treatment, 95% of clients reporting that they were treated with respect and dignity, 94% of clients definitely felt their SLT input was explained in a way they could understand and 87% were satisfied with the waiting time for their appointment. The SLT Service will need to further evaluate the PREMs data in relation to each of the SLT Adult Services listed to ensure that where results have been amalgamated across the Service, any variation within Teams can be identified and addressed. Similarly, in relation to the Service specific questions that were included on the PREMs, results were very positive, with high or very high satisfaction levels consistently expressed in relation to interaction with SLT, provision of information about their care and input, confidence in advice given by SLT, being seen on time, and rating of how helpful the input had been. Again, further analysis is

28 required of any free text responses given by clients in each team, so that Action plans can be put in place to address issues arising. We also need to review the Service specific questions to evaluate whether these require updating in 2012 PREM collection. As a service, we need to continue to consider how we ensure that PREMs are accessible to clients with communication difficulties, who may find questionnaire formats difficult to engage with, and to share examples of additional / alternative methods of collecting PREMs with colleagues across CLCH eg: use of Talking Mats in Services for Children and Adults with Learning Disabilities. There also needs to be a CLCH wide review of the current system of PREM administration by Fr3dom Health at a corporate level to address on-going issues with data collection, processing and reporting processes. PREM methodology The following table summarises the number of patients who responded to a PREM this year, and shows this as a percentage of all referrals during the survey period (August December 2011). Our aim was to achieve a representative view of patient feedback, so we set out to survey all patients attending the Adult SLT services detailed above throughout this period, Some of the Services are Specialist Services and have relatively small numbers of new referrals, PREM volume targets Total (Aug-Dec 2011) Number of patients who responded to a PREM 34 Total new referrals 78 % of new referrals who responded to a PREM 43.5% Target % of respondents 15% Target achieved? Yes

29 Compliments and Complaints Compliments and Complaints Number of compliments Jan 2011 Dec 2011: 30 Number of complaints Jan 2011 Dec 2011: 0 The numbers of recorded Compliments has increased almost three-fold in 2011 and as in 2010 no complaints were received for the SLT Adult Service. The system for recording of compliments changed in year in 2011 and we estimate that there may have been some under-recording of compliments due to this. The SLT Service will ensure that an update is circulated to the SLT Service re the current procedure for forwarding compliments and the importance of doing this. In CLCH Barnet, as the SLT service forms part of Long Term Conditions and the Intermediate Care Service, all activity is reported by the pathway as a whole and therefore not specific to SLT. The Quality Accounts for these specific pathways contain the composite of this information. Other qualitative feedback CLCH Conversation Partner Scheme (CPS) (January 2010 December 2011) In December 2009, the Adult Community SLT teams across Inner CLCH were invited to participate in a project to pilot the North West London Conversation Partner Scheme (CPS). The NWL Stroke & Cardiac Network had undertaken to support the funding, development and evaluation of the project in Autumn The project was developed in conjunction with Connect, the UK aphasia charity. Connect had created and continued to develop the CPS and continues to roll it out with healthcare providers across the UK. The CPS supports isolated people with aphasia in their own homes by training volunteers without aphasia to offer 'supported conversation'. The volunteers visit people with aphasia at home once a week for approximately 6 months, offering conversation and companionship. The scheme acts as a cost-effective support service to people with aphasia for whom one to one SLT is no longer appropriate and/or accessing social/aphasia groups in the community may not be not be feasible.

30 One SLT from each of the community teams in Westminster, K&C and H&F worked together to develop and administer the project on behalf of service users with aphasia in CLCH. The project developed in 3 phases: 1) Set up and training: Training of those administering the scheme (Speech and Language Therapists and Rehabilitation Assistants), training of people with aphasia to support volunteer training, development of documentation and systems. 2) Recruitment & pairing: Attracting and training volunteers, recruiting people with aphasia wishing to have a partner, pairing with volunteers. 3) Supervision & Evaluation: Ongoing one-to-one supervision of volunteers, peer support meetings, scheme evaluation. The aims of the CPS pilot project in CLCH are: To maintain/increase the confidence of people with aphasia in their skills as communicators. To support people with aphasia to use their communication strategies beyond therapy sessions, thus consolidating skills and moving them on from therapy. To decrease the isolation of people with aphasia. For would-be recruits to the allied health professions to gain experience of the realities of communicating with people with aphasia and an understanding of challenges faced by people living with stroke and aphasia. To support volunteers from the community to communicate with people living with stroke and aphasia. A full Report and Recommendations of this scheme is available. Summary of Key Outcomes, Evaluation and Qualitative Feedback to date: Outcomes: 6 people trained to run the Conversation Partner Scheme (3 still in