Milton Keynes Community Health Services

Transcription

1 Milton Keynes Community Health Services Services provided and their rating: Service Type Overall Local Provision Trust Rating Inpatient Windsor Intermediate Care Unit, Bletchley Children, young people and families Eaglestone, Stantonbury, Beanhill, Bletchley, Bradwell Common, Fishermead, Great Holm, Middleton, Neath Hill, Olney, Shenley Church End, Stony Stratford, Walnut Tree, Westcroft, Wolverton Adults Eaglestone Health Centre, Bletchley, Stony Stratford, Newport Pagnell, Ashfield, Bradwell Common, Oakridge Park, Olney, Pennyland, Shenley Church End, Wolverton, Neath Hill Community Dental Services Acute wards for adults of working age and Psychiatric Inadequate Eaglestone, Milton Keynes Urgent Care Service, Neath Hill, Newport Pagnell (also Amersham, Aylesbury, Buckingham, High Wycombe, Marlow) The Campbell Centre, Eaglestone Intensive Care Units Long stay rehabilitation mental health ward for working age adults Wards for older people with mental health problems Community based mental health for adults of working age Crisis and health based places of safety Community based mental health for older people Specialist community mental health for children and young people Requires Improvement Requires Improvement Milton Keynes Community Dental Services Areas of good practice: Cherrywood Mental Health Rehabilitation Unit, Wavendon Gate TOPAS: The Older Person s Assessment Service, Bletchley Eaglestone, Westcroft, Bletchley, Stantonbury The Campbell Centre, Eaglestone Central Milton Keynes, Netherfield Eaglestone Buckinghamshire PDS had introduced an initiative to protect staff following a serious incident. Staff had introduced the use of a code phrase used to immediately alert other staff to the potential for a situation to escalate. Buckinghamshire PDS automatically make a safeguarding referral where two or more appointments for a GA are missed. Safeguarding was discussed in the at team meetings and it was a standing item on the agenda for meetings. Buckinghamshire PDS have an accredited dental nurse training centre which offers training and support to dental nurses working within and external to the

2 Milton Keynes Community Health Services service; a supportive learning environment which encouraged interaction with dental nurses across the region to discuss areas for improvement and share good practice. Buckinghamshire PDS worked collaboratively with the hospital when providing care and treatment under GA so that care and treatment could be coordinated with other interventions. Buckinghamshire PDS had developed a care pathway for very anxious or phobic patients which involved collaborating with the IAPT to support patients in managing their anxiety or phobia. collaborative and multidisciplinary team working and effective links between the different clinics in both Buckinghamshire PDS and Hillingdon PDS. This ensured people were provided with care that met their needs, at the right time and without avoidable delay in Buckinghamshire PDS. In Buckinghamshire PDS, an initiative to send patients a text reminder to attend their appointments had reduced the incidence of patients failing to attend. This had helped to reduce waiting lists. Locations viewed were fully accessible for people with a physical disability or who required the use of a wheelchair. Many of the clinics in Buckinghamshire PDS had hoists available to help support safe transfer of people using wheelchairs into the dental chair. Buckinghamshire PDS Oakridge clinic had a plus size dental chair and waiting room chair and people requiring these could be referred from across the region to support their care and treatment. Oral health improvement teams had considered equality and diversity when planning their service initiatives. This included a programme to engage local mosques in Buckinghamshire PDS. Buckinghamshire PDS had an established accredited teaching programme in place for care workers in residential homes for older people and people with learning difficulties. This had promoted the impact and importance of good oral health on people s general health and wellbeing. Services at Buckinghamshire PDS were patient led which meant many patients referred into the service for care and treatment fulfilled a set of assessment criteria which identified them as requiring on-going general dental treatment within a community dental service. It was apparent that the service management teams were strong, particularly in Buckinghamshire PDS, which ensured sustainability and progression of the going forward. Service managers in both Buckinghamshire and Hillingdon had shared ideas in good practice and innovation in order to develop and improve where possible. Areas for improvement: No must do s or should do s identified Milton Keynes Community Health Inpatient Services Areas of good practice: Posters carrying information on how patients could report safeguarding concerns were displayed on walls at WICU; this meant patients were able to contact safeguarding authorities if they had concerns. Appropriate arrangements for the safe keeping of medicines, in WICU each patient s room had a lockable medicines cupboard. Controlled drugs (CDs) were stored securely in locked cupboards within a locked cupboard. CDs administered were counter signed by two nurses. There was secure management of prescription pads. Medicines were disposed of appropriately by the pharmacist Boards displaying ward specific infection control information. Staff hand hygiene technique was regularly audited and showed a high level of compliance. At WICU there was an infection control wall board in the reception area, this included the results of hand hygiene audits. Patients being cared for in WICU due to infection risks. The CQC saw the Trust s infection control lead visiting and providing advice and information to staff on infection control practice. The lead told the CQC staff had engaged with infection control processes. From viewing the staff training records across all community inpatient units the CQC saw staff mandatory training in infection control had been undertaken and was up to date. WICU had a staff member who was the allocated lead for NICE guidelines implementation, this meant patients could be sure staff were taking account of best practice guidance when providing their care. Food temperatures were checked prior to serving of the meals. Patients had a choice of food at meal times with choices being made at the point of delivery. WICU have a cook from a private on-site company who cooked patients food, served the meals, which meant the food provider was able to gain insight into the menu wishes of patients.

3 Milton Keynes Community Health Services Areas for improvement: No must do s and 3 should do s identified Ensure clinical records are well organised. Ensure that the Unit Manager post is filled. Ensure staff receive regular supervision. Milton Keynes Community Health Services for Adults Areas of good practice: Processes in place for sharing and learning from incidents. Incidents that occurred in other areas would be ed to the team and discussed at handover meetings. An example was given of a recent incident in the trust. Learning from the incident was disseminated to all staff and necessary changes in practice put in place. Learning from incidents was discussed in a range of meetings that varied from team to team. Structured processes were in place for cascading information. There was a monthly leadership meeting attended by all district nurses, service manager and district nurse manager, a bi-monthly meeting attended by all service leads and monthly local team meetings. Minutes of meetings were shared with staff. The tissue viability team would meet with the relevant nursing team to discuss outcomes of the investigation and the action plan. The RAIT gave examples of how they had reflected and learned from incidents. A recent investigation of a reported pressure ulcer was undertaken by the manager and tissue viability nurse and all team members had been involved. The outcome of this investigation led to all staff receiving in house training and all disciplines in the team now used body maps. Nurses went on home visits to advise on the use of body maps and Waterlow (pressure ulcer and prevention tool) assessments. Team members did joint visits to learn skills that could be shared. Staff from the district nursing team told us a high level of pressure ulcer incidents had led to changes in practice. This included risk scoring every patient using the Waterlow assessment. Information leaflets were given to patients on pressure ulcer prevention and pressure ulcer checks were part of every routine visit. Following any reported incident the manager from the district nursing team completed a root cause analysis that was sent to the clinical governance department. Pressure injuries grade two and above would also be investigated by the tissue viability team. Serious incidents were discussed at the community nursing serious incident panel which met every two weeks. The CQC saw minutes of the meeting on 2nd and 16th February and noted these referred to duty of candour and actions to be taken or followed up. Reducing avoidable pressure ulcers had been a target in the quality account and this had been achieved. Mandatory training in safeguarding adults was up to date. 85% to 90% of community nursing teams had completed basic safeguarding training. Safeguarding concerns were taken to the district nurse and referral made to the social care safeguarding team and the safeguarding team for the trust was also informed. There was a bi-monthly meeting with GP s where all safeguarding alerts were discussed and actions agreed. Each community nurse had a nursing bag that contained all their equipment. This had been developed by two district nursing students in response to a patient survey that highlighted patient s preferred nurses to come to the house fully equipped. The bags had a list of contents to ensure all the equipment was in place. The development of the district nursing bag had been recognised at the trusts annual gem awards. The bag was now being used by all district nursing teams and phlebotomists in the locality. Hand hygiene audits were completed as part of the essential steps audit, the results of this community nursing service for February 2014 showed 100% compliance. Policies and guidance used by staff reflected guidance from the National Institute for Health and Care Excellence (NICE) and other professional bodies. There was a NICE lead who informed the team of changes to guidance. A community nursing team reported the use of telehealth had reduced acute exacerbation of illness and improved access to timely treatment. The RAIT team had completed the annual national intermediate care audit. Audit of district nursing care records looked at what information was recorded and also the quality of initial assessments, clinical information and on-going care and record keeping; detailed recommendations were made as a result of the audit with time scales for achieving improvements. Staff received specialist training to support them do their jobs. The RAIT team members had received training in monitoring vital signs, pressure ulcers, using the malnutrition universal screening tool (MUST) and venepuncture procedures. Staff were positive about the support they received and said they received regular

4 Milton Keynes Community Health Services supervision. The RAIT team received formal management supervision every six to eight weeks and informal supervision was always available. The handover meeting of the RAIT team showed good communication between all team members, the effective prioritisation of work, discharge planning and discussions of patients with complex needs. Staff respected each other s skills and felt well supported within the team. Referrals to other teams such as the stroke team and social were made in a timely way. The trust was using the friends and family test. The clerk contacted five patients a month for each district nurse team to complete the friends and family test which resulted in responses each month. The summary report for community health Q /15 survey showed 30% of patients were extremely likely to recommend the service to friends and family and 70% were likely. Community nurses worked closely with local palliative care to support people with their end of life care. There was a draft booklet for patients with guidance on making an advance care plan. This had been developed in partnership between the local hospice, hospital and community staff and a cancer group. This was due to be implemented in May 2015 which would help to ensure a coordinated approach. The RAIT team had a duty team member who triaged referrals using a frailty scale. Response times were two hours for urgent referrals with routine first contact within seventy two hours either face to face or by telephone. Response times were audited and were mostly met. District nurses were proud of the work they had done with the out-patient parenteral anti-microbial therapy provision (OPAT) which was set up by the district nursing service to work alongside the team in Milton Keynes Hospital. This enabled IV antibiotics to be given which helped to keep patients out of hospital. This involved in depth training for district nurses which had to be passed at 100% and was good for district nursing skills. Areas for improvement: No must do s or should do s identified Milton Keynes Community Health Services for Children, Young People and Families Areas of good practice: Safeguarding supervision forums were used to enhance learning and sharing of information for staff. Children s Complex Needs Team consider pain management especially in some children with long term conditions and end of life care by using a range of pain assessments and pain management strategies. Community paediatricians carried out child protection peer review sessions every two months, providing time to discuss difficult cases in a relaxed and nonjudgemental atmosphere and were part of their continuing professional development (CPD) programme. Speech and language therapists had the Hanen More than Words parent programme and Hanen It Takes Two to Talk parent programme to meet the needs of children with autism and language delay. Community Child Team focused on health promotion to help children and their families improve their self-care. An example of which is using HENRY, a health, exercise and nutrition for the really young programme. Saturday clinics have been established to meet the needs of looked after children by paediatricians working outside of normal working hours. To improve breast feeding rates, health visitors undertook an additional antenatal visit to mothers at 28 weeks gestation. Staff working with Milton Keynes Football Club (MKI Dons) to develop an innovative charitable scheme called MOTIV8 to promote exercise and health amongst children aged five to 16 years who were above their ideal weight. Sleep clinics provided by health visiting teams. Two health visitors undertaken millpond training, a sleep behaviour management course and shared learning with other team members. Speech and language therapists developed a first access communication tool (FACT) to profile child and young person s speech, language and communication needs. Areas for improvement:

5 Milton Keynes Community Health Services No must do s or should do s identified This section contains actions that are being taken, or are already in progress, in response to the findings presented in the CQC reports. Our conversations with you will help shape these actions and deliver a robust action plan back to the CQC. Milton Keynes Community Health Inpatient Services Safe Care and Treatment Clinical Records Patient s medical and care records have been re-organsied to make sure they are in a good order, are stored safely and are accessible when needed. Unit manager post We have improved our arrangements for clinical leadership at WICU and the unit manager post is currently being shared by two clinical leads that are providing stability to the service. Regular supervision The system of staff supervision has been improved and all staff have a named supervisor and have either received a recent 1:1 supervision with their manager or has a date booked in the near future. We have produced a supervision tree which is now displayed in the staff room for staff to understand their supervision arrangements. We have recently completed an audit of the staff supervisions which showed that staff are regularly supervised by their manager. Consistency between electronic and paper records A new electronic patient record system has been introduced and staff are working on ensuring that paper and electronic records have up to date information about any visits patients have received. Continued Internal Quality Assurance: As part of the Trust s internal initiatives to monitor and drive continuous improvement across CNWL a quality inspection was undertaken between November This involved volunteer staff from CNWL, commissioners and individuals from patient user/carer groups. The inspections were carried out across a number of. Overall the exercise confirmed that the Trust s other internal assurance processes were working well and no serious safety issues were identified during the course of the inspections. The visits reinforced the positive attributes raised by the CQC visit in February and particularly the caring approach of staff. There were many positive comments received about community health and all were described as at least good, with several of our being described as excellent. As well as many positive comments some issues that arose from the visits were: Waiting lists for Occupational Therapy Service: It was found that additional support was needed to reduce waiting lists at the service. The local commissioning group (MKCCG) and MK Council are currently reviewing the service to see how additional support can be provided. In addition staff are working on reducing waiting times for assessment by implementing a selfassessment form, a triage process and a bathing aids clinic. The service have also successfully recruited 2 part time admin staff through a skill-mix exercise to support this new way of working. Improving arrangements for our staff: Recommendations included involving staff in service de-design, improving professional development, improving staff awareness of Trust Values, creating local service strategies and reviewing lone working processes. Staff engagement workshops, newsletters and strategic objectives are now in progress and staff lone workers how have access to a work mobile telephone. The MKCHS continues to review and update the CQC action plan against all the must and should-do s. As of December 2015 the MKCHS had two should-do s left to complete; one relating to the consistency between electronic and paper records and the other relating to Divisional learning from serious incidents, incidents and complaints. Both actions are on track to complete by the end of March An action across the Diggory Division was to implement a robust system of Divisional Learning and this action is in now progress.

6 Services provided and their rating: Service Type Overall Trust Rating Local Hillingdon Provision Inpatient Windsor Intermediate Care Unit, Bletchley Children, young people and families Eaglestone, Stantonbury, Beanhill, Bletchley, Bradwell Common, Fishermead, Great Holm, Middleton, Neath Hill, Olney, Shenley Church End, Stony Stratford, Walnut Tree, Westcroft, Wolverton Adults Eaglestone Health Centre, Bletchley, Stony Stratford, Newport Pagnell, Ashfield, Bradwell Common, Oakridge Park, Olney, Pennyland, Shenley Church End, Wolverton, Neath Hill Community Dental Services Eaglestone, Milton Keynes Urgent Care Service, Neath Hill, Newport Pagnell (also Amersham, Aylesbury, Buckingham, High Areas of good practice: Acute wards for adults of working age and Psychiatric Intensive Care Units Long stay rehabilitation mental health ward for working age adults Wards for older people with mental health problems Community based mental health for adults of working age Crisis and health based places of safety Community based mental health for older people Specialist community mental health for children and young people Inadequate CNWL is: Safe: Requires Improvement, Caring: Outstanding, Responsive: Requires Improvement, Effective:, Well-led: Requires Improvement Requires Improvement Wycombe, Marlow) The Campbell Centre, Eaglestone Cherrywood Mental Health Rehabilitation Unit, Wavendon Gate TOPAS: The Older Person s Assessment Service, Bletchley Eaglestone, Westcroft, Bletchley, Stantonbury The Campbell Centre, Eaglestone Central Milton Keynes, Netherfield Eaglestone In Milton Keynes the trust had developed a pilot street triage service to try and reduce the usage of section 136. In this scheme, which has been in operation since the beginning of January, a nurse is based with the police for seven nights a 7

7 week. Initial results have shown a reduction in admissions to the health based place of safety. Several community involved patients in interviewing prospective new staff members as part of the recruitment process. Most teams held regular forums for patients and carers to give feedback about the service. Milton Keynes have an internal audit process to ensure that must do and should do compliance actions in other areas of the Trust are part of the routine assurance process. Areas for improvement: 3 must do s inpatient Areas for improvement: Specific Milton Keynes recommendations: At the Campbell Centre patients in shared rooms must be able to attend to their personal care needs with an adequate level of privacy and dignity. At the TOPAS centre in Milton Keynes staff must have access to a record of safeguarding alerts so they can know what action to take to keep people safe and learn from previous events. TOPAS must comply with same sex accommodation guidelines. General Trust-wide recommendations: The Trust must implement the training of all staff in new restraint techniques to ensure that staff working together on wards are all trained in the same techniques and in line with current best practice on the use of prone restraint, to prevent injury to staff and patients. Staff must always monitor and record physical vital signs in the event of the use of rapid tranquilisation until the patient is alert. They must improve medical reviews of patients receiving rapid tranquilisation to ensure patients are not at risk. The trust must ensure that records relating to the seclusion of patients provide a clear record of medical and nursing reviews, to ensure that these are carried out in accordance with the code of practice. The trust must take further steps to ensure that risks to detained patients from being absent without authorised leave are minimised. The trust must ensure that, on admission to a ward, patients have a designated bed that is within the ward occupancy levels. Patients returning from leave must have a bed available on their return to the ward. The trust must ensure the acute wards for adults of working age are well led by having contingency plans in place for when the numbers of patients needing a bed increases above the beds available. The trust must ensure information is available to inform patients how to make a complaint. They must ensure verbal complaints are addressed and, if needed, patients and carers have access to the formal complaints process. The trust must ensure that when a person is assessed as requiring an inpatient bed that they are able to access a bed promptly. The trust must ensure that the access to the trusts places of safety promotes the patients dignity and privacy by the provision of a separate entrance. The provider must ensure that where automated external defibrillators (AEDs) are provided because there is a clinical need for this equipment, for example at Hillingdon community recovery team (Pembroke Centre) that they are maintained on a regular basis, accessible and available for use. The provider must ensure that other teams also have resuscitation equipment if needed. A bed must be available for patients who are on leave in case they need to return to the ward. community The trust must ensure information is available to inform patients how to make a complaint. They must ensure verbal complaints are addressed and, if needed, CNWL is: Safe: Requires Improvement, Caring: Outstanding, Responsive: Requires Improvement, Effective:, Well-led: 8

8 patients and carers have access to the formal complaints process. The provider must ensure that all patient risk assessments in community recovery teams are comprehensive, detailed and thorough. They must be reviewed regularly and updated after incidents. There must be a personalised crisis plan in place for each patient. The trust must ensure there are sufficient staff available to work as care coordinators so that duty workers in some are not holding large numbers of patients which could potentially create a risk for the safety and welfare of patients. The provider must ensure that patients using community are referred for regular physical health checks. CAMHS be supported to be dressed in a manner that preserves their dignity, have access to a lockable space to protect their possessions preferably their bedroom, have night time checks that are the least intrusive as possible, be able to close their observation panels in their door from inside their room and participate in the preparation of their care plan and have a copy where appropriate. This section contains actions that are being taken, or are already in progress, in response to the findings presented in the CQC reports. Our conversations with you will help shape these actions and deliver a robust action plan back to the CQC. Safe environment and safe care: The trust must ensure information is available to inform patients how to make a complaint. They must ensure verbal complaints are addressed and, if needed, patients and carers have access to the formal complaints process. Wards for older people with mental health needs Non-compliance for same sex accommodation due to there being no female lounge area. Oak Tree ward and TOPAS must comply with same sex accommodation guidelines to promote peoples safety, privacy and dignity. The trust must ensure information is available to inform patients how to make a complaint. They must ensure verbal complaints are addressed and, if needed, patients and carers have access to the formal complaints process. On Redwood ward at St Charles medication must not be left unsupervised in reach of patients. On Redwood ward at St Charles medication used for emergency resuscitation must be kept in one place so it is easily accessible in an emergency. On Redwood ward peoples physical healthcare checks must take place as regularly as each person needs to ensure their health is monitored. On Redwood ward primarily but also on other wards for older people, patients must At TOPAS improvements to patient s safety have been made by implementing a new safeguarding tracker system. This is regularly updated with all active safeguarding referrals made about patients and is shared with staff to enhance their knowledge of providing care to people to meet all their needs. Facilities audits are carried out to review potential blind spots at TOPAS and Cherrywood. Staff at the Campbell centre have been trained to undertake safer restraint techniques. All seclusion episodes are regularly reviewed by nursing and medical staff and a recent peer reviewed showed that patients were regularly reviewed by staff in line with policy. An automatic defibrillator is now in place in all and in the community in case of a medical emergency and staff have received training on using this; an audit is in place to check that the equipment is in a good working order so it can be used at any time. Staffing Consideration is being given to changing the types of profession employed eg: Pharmacy Technicians. CNWL is: Safe: Requires Improvement, Caring: Outstanding, Responsive: Requires Improvement, Effective:, Well-led: 9

9 A project is underway to ensure that care coordinators case loads are reviewed and are allocated appropriately. Privacy and dignity: At the Campbell centre improvements have been made to install new bathroom doors in dormitory areas which has improved the arrangements for privacy and dignity. At TOPAS improvements have been made to the premises to include a new female lounge area. On TOPAS ward all patients currently have single rooms with en-suite facilities. Regular Privacy and Dignity Audits are carried out by the Matron and any issues are rectified immediately. New Section 136 suite is in place which has a separate entrance to the rest of the unit. Patients at TOPAS are encouraged to wear their own clothing and for this to be appropriate to the time of year and time of day and are assisted, as per care plans to dress. Clothing is laundered on site. All patients at TOPAS have individual rooms, all patients at Campbell Centre have lockable cupboards, all patients at Cherrywood have single rooms and all units have a unit safe for patients to store valuable possessions. All doors on all the units have observation panels which can be opened and closed either side of the door. All night time observations are carried out with the least intrusion either via the observation panel or entering the room if there is not clear visibility of the patient, in line with CNWL Observation Policy. CNWL guidance regarding visibility panels has been circulated to all inpatient units. Care and welfare of people who use : Staff at the Campbell centre have been trained to undertake safer restraint techniques and the majority of staff at TOPAS have also received this training. Safeguarding service users from abuse and patients not being protected against the risk of unsuitable control or restraint: The Trust now produces monthly reports on the use of restraint including prone restraint incidents. All prone restraint episodes are registered with the Trust serious incident system. A No Force strategy is under development via the Director of Nursing and there was good participation from Hillingdon Staff at a training event in May of this year. Designated key staff have all attended positive behaviour support training. The therapeutic management of violence aggression training is mandatory and all staff working in wards are mandated to attend. Bed management: Weekly bed management meeting is in place. Bed manager oversees all admissions to Adult inpatients. Dedicated inpatient consultant in place for TOPAS. Milton Keynes input into weekly bed management meeting and daily teleconference calls. Bed Manager ensures contingency plans are in place whenever there is pressure or potential pressure on beds. A similar system will also be implemented at TOPAS. Bed Manager works closely with the Acute Home Treatment Team who gatekeep all admissions. Protocol is in place regarding use of leave beds for any out of area bed requests (including requests from the rest of CNWL). Bed manager reviews bed state on a daily basis. Complaints: Patients are provided with information about how they can make a complaint and posters are displayed on notice boards. A You said, we did notice board has been implemented to show how we are listening to our patient s feedback and making CNWL is: Safe: Requires Improvement, Caring: Outstanding, Responsive: Requires Improvement, Effective:, Well-led: 10

10 improvements as required. Staff members are aware of the Complaints process for accepting a verbal complaint. Complaints are monitored weekly both centrally and within operational meetings. Services in Milton Keynes have reviewed all compliance actions across the Trust and have undertaken an assurance process to maintain compliance. The below actions reflect existing practice that is embedded across the. Safe environment and safe care: Mirrors are in place at the Campbell Centre to reduce blind spots and CCTV is also in place. Ligature audits are completed annually in line with Trust policy and audits are carried out in addition to this following any incidents. Ligature risks are included on risk registers and all patients are risk assessed and potential ligatures removed. Monthly audits of staff knowledge regarding ligature risks are also planned. Safeguarding audits have taken place. All safeguarding alerts are reviewed/monitored by Ward Manager/Modern Matron. A tracker is in place to record all safeguarding alerts and regular meetings are in place with the Safeguarding Lead and Modern Matron. AWOL is not an issue for in Milton Keynes, however, AWOL incidents are monitored through the monthly Problems in Practice meeting attended by the Police and Campbell Centre. Monthly audit will be completed and the outcome discussed at operational meetings. All staff have read and signed the Risk Assessment Policy. Client records are reviewed as part of a supervision process. with the clinical needs on the unit. Skill mix is reviewed daily to ensure that this meets the clinical needs of the patient group. Staffing issues will be reported on Datix. Acc/Inc are discussed at weekly operational meeting. Safer staffing reports are compiled monthly. Privacy and dignity: At the Campbell centre availability of a new handheld landline is in place so patients can make phone calls in private. Care and welfare of people who use : Medicine Management clinics are in place. Physical health needs are assessed at point of referral. Regular audits as part of the Quality Schedule process. Communication with Primary Care which includes Physical Health needs and care plans is monitored as part of the Quality Schedule process. Complaints: Issues are addressed in the weekly Community Meeting. Suggestion Box is in place. Regular carers meetings are in place. Patients are provided with information about how they can make a complaint and posters are displayed on notice boards. A You said, we did notice board has been implemented to show how we are listening to our patient s feedback and making improvements as required. Respecting and involving service users: All patients are encouraged to be involved in their care planning. Weekly audits of care plans are undertaken which includes patient involvement. Staffing: Review of the rota is undertaken daily to ensure there is adequate staffing to deal CNWL is: Safe: Requires Improvement, Caring: Outstanding, Responsive: Requires Improvement, Effective:, Well-led: 11

11 Discussions from the Quality Summit to be taken forward in partnership with commissioners and other stakeholders: We have provided a number of agency staff short term contracts to provide a continuity of staffing. Needs engagement across the health and social care economy, including statutory and non-statutory sectors. Aim to work together in a virtual organisation, be in a partnership of care and wellbeing for MK residents. Key to this is having the right workforce and for the staff to be in a partnership with the user/ patient. Need to shift from a model that asks What s the matter with you? to one that asks What do you need? Patient/user perspective They want to see the least number of professional people as possible. Look at developing further the key worker model and have a pull model where staff work together in a coordinated way to support user/ patient. Some roles are specialist and will be needed however there is a real possibility that we could look to merge the care assistant and health care assistant into a more generic role. Cross sector working to develop new ways of working across organisations staff to rotate between different. Need more integrated working, and a focus on prevention especially in community and mental health, to help reduce people s need for. Actions: Look at the roles we currently have and develop an integrated role to improve the user/patient service/experience. Create job descriptions together. Link to Open University Look at models involving peer workers Work has taken place to advertise vacancies for nursing staff and to attend jobs fairs. At the Campbell Centre, we have also appointed two practitioners to give patients additional support and an additional health care assistant has been employed at night time to support both wards. Continued Internal Quality Assurance: As part of the Trust s internal initiatives to monitor and drive continuous improvement across CNWL a quality inspection was undertaken between 23 rd -25 th November This involved volunteer staff from CNWL, commissioners and individuals from patient user/carer groups. The inspections were carried out across a number of. Overall the exercise confirmed that the Trust s other internal assurance processes were working well and no serious safety issues were identified during the course of the inspections. The visits reinforced the positive attributes raised by the CQC visit in February and particularly the caring approach of staff. As well as many positive comments some issues that arose from the visits were: To improve learning from serious incidents, incidents and complaints. Action has been taken to implement learning across the MK mental health with the design of a learning template which shares learning in the service, division and with the wider Trust. To ensure that each service completed self assessments to check whether complied with regulations. Action has now been taken by to compile this information and some tangible improvements have been made such as reducing waiting times at our CAMHS service. The MKMH continues to review and update the CQC action plan against all the must and should-do s. As of December 2015 the MKMH had one Must do relating to staff completing safer restraint training and are on track to achieving this by the end of March They also had one should-do relating to Divisional learning from serious incidents, incidents and complaints and systems are being implemented across the Division to address this. An action across the Diggory Division was to implement a robust system of Divisional Learning and this action is now in progress. CNWL is: Safe: Requires Improvement, Caring: Outstanding, Responsive: Requires Improvement, Effective:, Well-led: 12

12 CNWL is: Safe: Requires Improvement, Caring: Outstanding, Responsive: Requires Improvement, Effective:, Well-led: 13