INDEPENDENT HEALTH GROUP

Transcription

1 INDEPENDENT HEALTH GROUP Providing NHS care of the highest quality IHG Quality Account April March 2017

2 IHG Quality Account April 2016 March 2017 I founded Independent Health Group (IHG) in December 2004 to provide NHS care of the highest quality where patients always come first. I wanted to do this because having worked as a doctor in the NHS for many years I knew that we could do much more to provide patients with the high quality care that we all want, for our friends, families and ourselves. We treated our first patients in the spring of Our focus has therefore always been the delivery of high quality care. We are always interested in what patients say about their care and experience whilst receiving our services and we are obsessive about the collection of data that can inform us about the outcomes from surgery. We use this feedback to continuously improve what we do. IHG has grown and diversified over the last 12 years. We started providing a carpal tunnel surgery service in a GP practice in Swindon. Over the years our range of procedures has grown to include hernia repairs, podiatric surgery, vasectomy, cataract surgery and minor hand procedures but all still provided in community facilities. We have also extended our geographic footprint providing services from Newton Abbot in the South West to Stoke on Trent in the Midlands. This Quality Account describes some of the very many ways that we manage and monitor the quality of our services and sets out our priorities for improvement in the coming year. I am very proud of the standard of care that we deliver and always welcome talking to patients or their families if we fall short of the high standards we set ourselves. To the best of my knowledge the information contained in this quality account is accurate. Dr Matthew Wordsworth MBChB MRCOG MRCGP Chief Executive / Medical Director Page 1

3 Contents Introduction Independent Health Group Values Services Location Map Priorities for Improvement 2017/18 Review of Quality 2016/17 Delivering a Quality Service Stakeholder Feedback CCG / Healthwatch Appendix 1 Services by location Page Page 2

4 Introduction Independent Heath Group (IHG) was established in 2004 to offer patients the very best care through the NHS. It was founded, and is still directed, by Dr Matthew Wordsworth. IHG provides a range of day surgeries in convenient, community facilities such as GP practices avoiding the stress of large busy hospitals. Patients are offered individual appointment and operation times to avoid unnecessary waiting and to reduce anxiety. We provide care quickly and at a patient s convenience. All treatments are undertaken in community operating facilities under a local or regional anaesthetic, meaning that following surgery patients are very usually ready to go home in less than an hour rather than hours or days as usually the case in hospital. IHG has a small number of values that direct the way everyone works at IHG IHG Values Patients always come first Patient safety and excellent clinical outcomes are our top priority. Patients are treated with the utmost respect and dignity;; we will always be empathetic, honest and compassionate. We take the time to listen to patients needs and respond to them. Whenever possible the same surgeon will see you throughout your treatment and all staff are accessible and responsive to patients needs. Our clinical staff are appointed for their record of excellence in patient care Teamwork Delivering high quality services is dependent on strong teamwork and effective communication. We expect everyone who works in IHG to value their colleagues and treat them with respect and consideration. We recognise the importance of clear and timely two- way communication both within IHG and with our stakeholders. Excellence through continuous improvement We continually look for ways to be better at what we do. This can be for better patient outcomes, a better experience for patients, better efficiencies, better communications Excellence is our goal. Service locations Stoke on Trent Leicester Gloucester Swindon Independent Health Group Sites Bristol Reading Bath Westbury Chippenham Newton Abbott Page 3

5 Priorities for improvement in 2017/18 IHG has reviewed the quality of the services delivered in the period April to March and has identified seven areas of care or enablers of quality care that it wishes to focus its improvement activities on in the coming year for the benefit of the patients using its services. Priority 1. Patient Safety: Electronic ordering of pathology and radiological tests Our current process of receiving test results involves a paper request sent from our clinician to the nearest hospital providing the testing facilities and a paper report being returned by the hospital. Both steps can introduce error and delay. Our priority is to introduce an electronic ordering system to run alongside our current electronic patient records system. Why have we chosen this priority? All podiatric patients requiring surgery are routinely swabbed for MRSA and to proceed to surgery the surgeon requires confirmation that the patient has a negative test result. The majority of our podiatric patients will also require X rays and a small number of patients in our hernia service will require ultrasound scans. An electronic system to order and receive test results will reduce the time taken for results to reach our clinicians, therefore preventing delays to patients pathways and help prevent administrative and clinical errors. How will we monitor progress? We plan to have 95% of all pathology tests recorded electronically by December We will monitor uptake of the electronic system monthly and provide training to staff to improve uptake. The only exception to this will be semen analysis, following vasectomy. Priority 2. Clinical Effectiveness: Improving, by reducing, the level of pain experienced by patients following hernia repair surgery Why have we chosen this priority? In Part 2 of this Quality Account, page 9, we have described the improvements made in 2016 to improve the level of post operative pain experienced by patients having foot and hernia surgery with standardisation of post operative analgesic regimes. However, 5% of patients are still advising us that their levels of pain at home following surgery are not acceptable and therefore improvements are needed. We will review and seek to make further improvements to our post- operative pain relief protocol. There are very few centres providing hernia surgery outside of hospitals in England; we can lead on the standardisation of collection of such data across providers of care and this will enable best practice to be recognised and implemented more widely. Page 4

6 How will we monitor progress? By August we will have assessed and implemented any changes identified to the post operative analgesic regime for hernia and foot surgery. By August we will have standardised the collection of data across at least three community providers of hernia surgery to enable benchmarking of performance. We will continue to collect data on all patients having surgery so that we can monitor the impact of changes to procedures or pain relief protocols. Priority 3. Infection Prevention and Control: Improving, by reducing, the incidence of post- operative surgical site infections In part 4 of this Quality Account, page 15, we have described one of the ways we actively monitor post- operative infection rates by sending all patients a questionnaire that includes the following question Did you have a wound infection after the operation requiring antibiotics? This has highlighted in 2016/ 17 that our infection rates following vasectomy and podiatric surgery are higher than that reported in other comparable services. Why have we chosen this priority? Our post- operative infection rate for vasectomy is 8% in 2016/17 compared to 1% in the Association of Surgeons in Primary Care annual audit ( uk.net). IHG is not aware of any patients treated in a hospital setting for infection after a vasectomy. Our post- operative infection rate for Podiatric Surgery is 6% (6 patients in total) compared to 2.6% reported on the PASCOM (Podiatric and Surgical Clinical Outcome Measurement, College of Podiatry) database. Community Specialty YES NO IHG benchmark % Podiatric surgery * Hernia surgery * Hand surgery Vasectomy Total *Note: Podiatric and hernia surgery includes both hospital and community results How will we monitor progress? For vasectomy IHG will review all available data for any variance between clinicians and between centres, review the surgical practice of its clinicians, and come together as a team to share and agree on best practice. By September 2017 IHG will have standardised post- operative wound care after a vasectomy. We will then review what difference these changes have made in a continuous audit process loop. For podiatric surgery, we will review the clinical records of all six patients who had a surgical site infection in 2016/17 to fully assess if we could have done anything differently for these patients and to see if we need to change our practice in the future. We will continue to monitor infection rates on an on- going basis. Page 5

7 Priority 4. Well- led: Improving the health and well- being of staff IHG received very good feedback from its staff following the recent staff satisfaction survey. Nevertheless, senior management wants to continually improve the health and well- being of its staff. Why have we chosen this priority? Staff sickness and absence impacts adversely on patient care, whereas staff that are happy and satisfied have a positive impact on patient care. A satisfied workforce also has lower turnover rates and less reliance on temporary staff all of which contributes to a safer environment for patient care. How will we monitor progress? IHG will undertake a self- assessment of its current performance against the standards in the Wellbeing Charter and based on the results develop an action plan to improve performance. Priority 5. Patient Safety and Responsiveness: Improving access to clinical information Currently, all changes to internal policies and procedures are communicated to our teams via . We are improving our computer systems by introducing a way that remote workers can log in directly to our computer servers. This will ensure that we have a single, continuously updated location for all files and information. Why have we chosen this priority? Consistency of data is key for safe and effective care. In this case, policies and procedures are our focus. By centralising the servers and allowing a single point of access, we help to reduce risk of outdated policies or procedures being shared. We also provide a far more efficient, effective and secure means for remote workers to access company information. This will benefit the patient by ensuring that the best possible procedures are adopted and that improvements to the way we work are efficiently communicated with our teams. How will we monitor progress? By October 2017 all remote workers will be able to directly and securely access the central computer system. This will preserve the confidentiality, integrity and availability of patient and staff information. We will continuously monitor on- going access and ensure that communication is to the highest standard. Any issues will be reviewed internally and taken up with our Internet Service Provider (ISP). Priority 6. Clinical Effectiveness: Encouraging behaviour change in patients use of alcohol and tobacco Smoking is estimated to cost 13.8bn to society ( 2bn to the NHS through hospital admissions, 7.5bn through lost productivity, 1.1bn in social care). Smoking is England s biggest killer, causing nearly 80,000 premature deaths a year and a heavy toll of illness. In England, 25% of the adult population (33% of men and 16% of women) consume alcohol at levels above the UK CMOs lower- risk guideline and increase their risk of alcohol- related ill health. Alcohol misuse contributes (wholly or partially) to 60 health conditions leading to hospital admission, due either to acute alcohol intoxication or to the toxic effect of alcohol misuse over time. Page 6

8 Why have we chosen this priority? This activity, agreed with the Clinical Commissioning Group, contributes to delivering the objectives set out in the Government s Five Year Forward View (5YFV), particularly around the need for a radical upgrade in prevention and to incentivising and supporting healthier behaviour. How will we monitor progress? For the next two years IHG will be screening all patients for smoking and alcohol consumption and then offering brief advice and guidance about how to improve their health and/or sign- posting to further sources of help and information. Priority 7. Well- led: Introducing Organisational Dashboards The aim of this quality priority is to provide staff with near time, meaningful information on reported clinical indicators. This will better inform staff to make daily decisions on the quality and delivery of patient care. The same system will enable IHG to manage employee compliance with training and development more efficiently and effectively. Why have we chosen this priority? It is essential that IHG can not only have information to support its day to day decision making but a system that will support the review of the quality of services and support its assurance systems demonstrating that quality is good. This will enhance the governance of the organisation and provide information to many parts of the organisation that need to review performance and evaluate quality. How will we monitor progress? The senior management team will oversee the introduction of the new system, ensuring that it is fit for purpose and is introduced in a timely way. Page 7

9 Review of quality 2016/17 Services During the reporting period April and March Independent Health Group provided hand surgery, hernia repair surgery, vasectomy, cataract surgery and podiatric surgery. IHG has reviewed all the data available to them on the quality of care in these relevant health services. The income generated by the relevant health services reviewed in 2016/17 represents 100% of the total income generated from the provision of relevant health services by the Independent Health Group for 2016/17. Independent Health Group s income in 2016/17 was not conditional on achieving quality improvement and innovation goals through the Commissioning for Quality and Innovation payment framework. IHG is pleased to set out below its work improving the quality of care for patients and its achievements in many areas. These achievements build on the established quality systems that form the basis of IHG s services, described later in this account. Patient Experience and Patient Reported Outcome Measures Patients are central to IHG s services and its planning. The key indicators we measure and review are patients experiences and the outcomes from their treatment. Friends and Family feedback In 2016/ patients said they were extremely likely to recommend our services to friends and family if they needed similar care or treatment, 56 said they were likely to do so and no patients said they would not recommend our services. Clinical audit and PROMs During 2016/17 one national clinical audit and no national confidential enquiries covered relevant health services that IHG provides. During that period IHG participated in 100% of the national clinical audits and no national confidential enquiries of the national clinical audits and national confidential enquiries which it was eligible to participate in. The national clinical audits and national confidential enquiries that IHG was eligible to participate in during 2016/17 and did participate in are as follows: Elective Surgery National PROMs Programme (Hernia surgery). IHG, as noted in other sections of this report, is fully committed to the use of outcome measures to improve the quality of care for patients. With this motivation it has been submitting data to the National PROMs Programme for hernia surgery, however when staff wanted to review the results it was found that because data is not submitted to the central activity database for hospitals (the Hospital Episode Statistics data set), results and comparison with other providers is not possible. We are working to resolve this issue. No patients receiving relevant health services provided or sub-contracted by IHG in 2016/17 were recruited during that period to participate in research approved by a research ethics committee. Page 8

10 Local audit IHG is committed to maintaining a robust audit programme to ensure the quality of service is of the highest standard and that improvements are continually implemented. IHG undertake audits that are locally required and required by our contracts for services. The reports of eight local clinical audits were reviewed by the provider in 2016/17 and IHG has taken the following actions to improve the quality of healthcare provided in response to these audits: The Surgical Safety Checklist audits identified two areas for improvement, the debrief and use of local anaesthetic nerve blocks. Changes were made to the integrated care pathway to reflect when the debrief was recorded. This change was supported with a guide for staff on the change required. In addition STOP before you Block was introduced to address the use of local anaesthetic nerve blocks as part of the checklist. An antibiotic prescribing policy was developed in line with NICE Guidance CG74 and the Management of Infection Guidance for Primary Care document for CCGs during 16/17. Local audit - Improving pain relief for patients during surgery and at home afterwards As part of our commitment to our patients to continuously improve their surgical experience we ask every patient having a foot or hernia operation to score their pain at different stages of their surgery. We ask patients to score their pain during surgery and immediately afterwards. As all surgery is performed under a local anaesthetic patients can tell us if they experience any discomfort during surgery and we can give additional anaesthetic. On the day after surgery we call all patients that have had a foot or hernia operation at home to enquire how their night was, and to ask them to score their pain. We also ask patients the question Was the pain acceptable?. It can be seen from the data below that a very small number of patients think the pain is unacceptable during their operation and a slightly larger group think their pain is unacceptable when they have returned home. Was intraoperative pain relief acceptable? All hernia and foot surgery patients YES NO % % Was pain relief acceptable at home? All hernia and foot surgery patients YES NO % % In 2016 we standardised our post- operative prescribing to ensure the best possible combination of analgesia was given to all patients to take home. However, as noted above we are not entirely satisfied with the results for patients and have made this a priority for this year. Page 9

11 NHS Staff Survey IHG staff participated in the NHS staff survey. All doctors, nurses and administrative staff were invited to take part and over 90% staff took up this opportunity, which is an excellent response rate. Dr Wordsworth says Overall I was delighted with the feedback on the quality of care we deliver. 97% of staff are positive about their job and all agreed that the care of patients is our top priority. Staff are clear about their responsibilities, feel trusted to do their job and feel supported. All staff would recommend IHG if a friend or family member needed surgery. The NHS has requested that two specific indicators from the staff survey are reported in quality accounts this year. These are: The percentage of staff that experienced harassment, bullying or abuse from other staff in the last 12 months. 3% or one person reported that this happened within IHG in this time period. It happened on no more than one or two occasions. This compares to 11% in other community hospitals. The percentage of staff that believe the organisation provides equal opportunities for career progression or promotion. 100% staff believe that IHG offers equal opportunities, compared to 90% in other community hospitals. Care Quality Commission IHG is required to register with the Care Quality Commission and its current registration status is approved for the provision of diagnostic and screening procedures, surgical procedures and treatment of disease, disorder or injury. IHG has the following conditions on registration, its services are for the treatment of adults over 18 years of age only. The Care Quality Commission has not taken enforcement action against IHG during this reporting year and IHG has not participated in any special reviews or investigations by the CQC during the reporting period. IHG has not been inspected by the CQC under its current approach to inspection but it continuously reviews its services against the five questions set out by the CQC for evaluating the quality of services. The safety of patients, their family and carers and staff is extremely important to all at IHG. IHG plans safety into its services through the development of its patient pathways, policies, systems, staff training and the selection of its facilities. It continues to monitor safety through its governance framework which includes monitoring and learning from incidents and near misses, managing risk and ensuring safe clinical practice such as infection prevention and control measures and treatment in line with best evidence. Where the need for improvement is identified, changes are implemented. IHG does not operate on anyone under the age of 18 but we take our responsibilities to children and young people accompanying patients very seriously. Page 10

12 All staff would recommend IHG if a friend or family member needed surgery. The NHS has requested that two specific indicators from the staff survey are reported in quality accounts this year. These are: The percentage of staff that experienced harassment, bullying or abuse from other staff in the last 12 months. 3% or one person reported that this happened within IHG in this time period. It happened on no more than one or two occasions. This compares to 11% in other community hospitals. The percentage of staff that believe the organisation provides equal opportunities for career progression or promotion. 100% staff believe that IHG offers equal opportunities, compared to 90% in other community hospitals. Care Quality Commission IHG is required to register with the Care Quality Commission and its current registration status is approved for the provision of diagnostic and screening procedures, surgical procedures and treatment of disease, disorder or injury. IHG has the following conditions on registration, its services are for the treatment of adults over 18 years of age only. The Care Quality Commission has not taken enforcement action against IHG during this reporting year and IHG has not participated in any special reviews or investigations by the CQC during the reporting period. IHG has not been inspected by the CQC under its current approach to inspection but it continuously reviews its services against the five questions set out by the CQC for evaluating the quality of services. Are they safe? Are they effective? Are they caring? Are they responsive to people s needs? Are they well-led? The safety of patients, their family and carers and staff is extremely important to all at IHG. IHG plans safety into its services through the development of its patient pathways, policies, systems, staff training and the selection of its facilities. It continues to monitor safety through its governance framework which includes monitoring and learning from incidents and near misses, managing risk and ensuring safe clinical practice such as infection prevention and control measures and treatment in line with best evidence. Where the need for improvement is identified, changes are implemented. IHG does not operate on anyone under the age of 18 but we take our responsibilities to children and young people accompanying patients very seriously. The effectiveness of services is monitored through the collection of Patient Reported Outcome Measures (PROMs). These are a means of collecting information on the effectiveness of care as perceived by the patients themselves. IHG uses a nationally recognised PROM for patients requiring hernia repair surgery and has developed PROMs for vasectomy and hand surgery in line with the Association of Surgeons in Primary Care (ASPC) ( uk.net), uses a validated PROM for podiatric surgery and has developed a further in- house PROM for hernia surgery. Page 11

13 The patients pathways are regularly reviewed by the surgeons and nurses to standardise practice and ensure that surgical technique reflects best practice. We also monitor a range of other KPIs, including infection rates, patients reported pain and transfers to other providers to ensure quality is maintained. We continually monitor how we are performing by asking patients to complete a patient satisfaction questionnaire. Patient satisfaction feedback is monitored monthly to identify trends/opportunities and agree planned actions Our mission is to look after patients as we would like our families and friends to be cared for, we therefore always plan services to meet this goal. On the small number of occasions that we fall short of achieving this, whenever possible we correct matters immediately. If something comes to our attention later, the patient is contacted by the Medical Director or Senior Nurse who will do their best to resolve matters and will share learning from the patient s feedback. IHG is a relatively small organisation and consequently senior management is very close to staff and patients. This enables good relationships and time at the front line for the whole leadership team providing care. The quality of care is monitored at governance meetings, which review each specialty and the outcomes from surgery. IHG values good data to enable it to evaluate its services and is looking to strengthen this aspect of its quality monitoring in IHG signed up to the Sign up to Safety campaign in 2016 inspired by its aim to make the NHS the safest healthcare system in the world through continuous learning and improvement. It champions openness and honesty and supports everyone to improve the safety of patients. IHG has set five pledges to be met by 2019: 1. Putting safety first. Commit to reduce avoidable harm in the NHS by half and make public our locally developed goals and plans We will... Work collaboratively with our local commissioning groups and key stakeholders on quality initiatives intended to improve patient safety and reduce harm. Our first three- year improvement plan will focus on reducing rates of intra operative pain in Hernia repair. Ensure that our patient centered approach is embedded in everything we do. Actively promote a culture that is committed to continuous learning, improvement and focused on the reduction of harm. Maintain safe staffing levels, using nationally recognised staffing ratios. Publish our Sign up to safety pledges on our website and regularly update with progress. 2. Continually learning. Make our organisation more resilient to risks, by acting on the feedback from patients and staff and by constantly measuring and monitoring how safe our services are We will... Continually seek the view of patients / their family / carers and the public in the design, re-development and delivery of the services we provide. Monitor the quality of our service through information obtained from early warning systems to identify areas of concern. Monitor and regularly review serious incidents and complaints to identify any emerging trends and themes. Page 12

14 3. Being honest. Be transparent with people about our progress to tackle patient safety issues and support staff to be candid with patients and their families if something goes wrong We will... Provide a complaints service in line with NHS guidance and ensure that details of how to access the service is published on our website. Actively promote the involvement of patients in decisions about their care and treatment. Support our staff to promote a culture of openness and transparency. Support our staff to ensure the Duty of Candour is fulfilled in a sensitive, honest and open way that allows patients / their families / carers to be involved in investigations as much as they wish. 4. Collaborating. Take a lead role in supporting local collaborative learning, so that improvements are made across all the local services that patients use We will... Promote and support a culture of continuous learning and improvement to reduce harm. Actively seek and share organisational learning from patient safety incidents and complaints with our local commissioning groups and key stakeholders. 5. Being supportive. Help our people understand why things go wrong and how to put them right. Give them the time and support to improve and celebrate progress We will... Have an annual programme of quality visits to our centres, talking to staff and identifying and sharing examples of good practice. Celebrate success through shared learning and award programmes. Create an open culture where staff can raise concerns within the company. Incidents In the reporting year IHG staff reported, 42 Incidents, none of which resulted in severe harm or death. All incidents were investigated; three required a more formal Root Cause Analysis (RCA) investigation, to be completed by IHG. One of these incidents related to the environment for surgery. IHG took learning from this RCA including: The need to improve the process for collecting routine maintenance information on an annual basis, specifically relating to air handling units managed by third parties. Improving the process for collecting maintenance service information relating to air handling units prior to opening any new centre. Two further incidents were categorised as serious untoward incidents (SUIs) and were also investigated at Level 2, a comprehensive investigation involving external agencies. These SUI investigations were commenced during this reporting period and are not completed at the time of this report as further information is being sought. The investigations are both due to be completed in July Learning will be shared with the patients, CCG and across the organisation. There were no Never Events reported. Page 13

15 One safeguarding concern was raised with external agencies during the reporting period. Staff were concerned that a patient with dependents had made arrangements for their care, which was too short term in relation to the patient s projected recovery. All agencies worked with the patient, with their consent, to make alternative arrangements satisfactorily protecting the vulnerable dependents. Implementation of Duty of Candour The statutory Duty of Candour Regulations came into force on 27 November The Duty of Candour places an obligation on the provider to be open and transparent with patients and their representatives when things go wrong delivering care or treatment. The Duty of Candour is also contained in a CQC regulation covering all providers of health or social care in England and gives the requirements a statutory framework within which providers can be held to account. IHG has developed a policy to direct staffs actions to ensure compliance with the Duty of Candour, which has been shared with all staff. Doctors and nurses are also bound by their professional codes of conduct which require them to comply with the Duty of Candour. Data and Information Governance Independent Health Group submitted records during April 2016 March 2017 to the Secondary Uses Service for inclusion in the Hospital Episode Statistics which are included in the latest published data. The percentage of records in the published data: which included the patient s valid NHS number was: 100% for admitted patient care, 100% for outpatient care and not applicable for accident and emergency care. which included the patient s valid General Medical Practice Code was: 100% for admitted patient care; 100% for outpatient care; and not applicable for accident and emergency care. IHG s Information Governance Assessment Report overall score for 2016/17 was 73% and was graded satisfactory /green. During 2016/17 work continued to ensure there is a comprehensive and robust evidence assurance programme to underpin the work of the Information Governance Toolkit (IG). An audit of key information assets will be undertaken during this financial year in compliance with the NHS Information Security Standards. The company has also committed time and resources to ensure that relevant recommendations made by the NHS National Data Guardian, Dame Fiona Caldicott in the Caldicott 2 and 3 Reviews have been incorporated intoto the company s current and future work program. IHG can confirm that no Serious Information Governance Incidents Requiring Investigation (SIRI) were recorded during the reporting period 2016/17. During 2017/18 IHG will be reviewing its internal systems and procedures to ensure compliance with the new General Data Protection Regulations, which come into force on 25th May IHG was not subject to the Payment by Results clinical coding audit during 2016/17 by the Audit Commission. Page 14

16 Delivering a Quality Service Patient Safety Protecting the safety of patients and staff is the top priority for IHG. To achieve this it utilises a range of systems and process to manage risk and to promote safe practice. Risk management is a key activity and is directed by the IHG policy on risk management. The organisation actively manages its risk register to mitigate identified risks. As it was seen earlier in this report, IHG records and investigates incidents and near misses. The learning from these events, which is shared with staff in all locations, helps to build a safer service. IHG utilises best practice guidance to inform its policies and processes. For example every service uses the World Health Organisation recommended safer surgery checklist and an audit of compliance with the standard is undertaken regularly. Infection Prevention & Control A key component of patient safety is preventing infection and managing any infections that occur. We understand that all infections impact on patients and their families in some way and as such preventing infections is a crucial part of all our care pathways. Infection prevention training is vital and plays a key part in our mandatory training programme for all staff. An e- learning module is completed as well as attendance at an annual mandatory training day which incorporates practical infection control issues. Current policies and standard operating procedures ensure a consistent approach to managing infection prevention strategies. Screening for MRSA is carried out according to Department of Health guidelines. All patients are risk assessed for MRSA and all podiatric patients are screened prior to surgery, being the only group of patients we treat that require screening. Infection prevention and control (IP&C) has and will continue to be a key area of focus for IHG. In the last year, we reported: No cases of MRSA or MSSA All patients are sent PROMs / satisfaction surveys three or six months after surgery. The questionnaire asks the following question Did you have a wound infection after the operation requiring antibiotics? The clear majority of the patients responding positively will have seen their GP and been prescribed oral antibiotics. The results by surgical specialty are shown below Community Specialty YES NO IHG benchmark % Podiatric surgery * Hernia surgery * Hand surgery Vasectomy Total *Note: Podiatric and hernia surgery includes both hospital and community results The data reflects the number of returned questionnaires; return rates vary between 19% and 54% Our infections rates for vasectomy are in this period higher than for comparable services, we are reviewing our infection prevention as a team and will make any necessary changes needed. We will then review our infection rates after making changes to see if what we ve changed has made a difference, as noted in priority 3. Page 15

17 The continued monitoring of hand hygiene techniques and environmental cleanliness through regular audit assures a high level of care is provided and maintained. Our hand hygiene audit scored 100% correct technique in all centres as shown in the graph below for our busiest centre at Hathaway Medical Centre in Chippenham Hathaway Medical Centre Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 Effectiveness The effectiveness of the care we provide and its continual improvement is at the core of what we do. In 2016/17 all patients (except for patients having cataract surgery) received a post operation questionnaire to feedback on both their satisfaction with the care provided and also the effectiveness of the treatment they received. This is now a well established method to monitor the effectiveness of the services we provide and is calibrated against other services across England. We performed well in 2016/17 with clinical outcomes in line with other established providers. For example the vasectomy failure rate in IHG is lower than the ASPC average and podiatric surgery outcomes are in line with the PASCOM (College of Podiatry) database for outcomes. Our Did not Attend (DNA) rate is low (see below) and the need for any patient to return to theatre for further surgery is extremely rare. Type DNA Completed Total %DNA Consultations % Operations % Total % Page 16

18 Caring Caring is central to IHG s values. Our most important guiding principle is patients always come first, wherever possible all patients are seen by the same clinician at every appointment. This makes Independent Health Group stand out amongst other NHS providers in the quality of care we deliver and we believe this is reflected not just in the our Friends and Family feedback but in what patients say about us in their own words. In 2016/17 we asked all patients having surgery the question How likely are you to recommend our service to friends and family if the needed similar care or treatment? On the day of surgery 1208 patients said they were extremely likely to recommend our services, 56 said they were likely to do so and no patients said they would not recommend our services Friends & Family scores April 16 to March 17 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Extremely likely Likely We take all patient feedback very seriously and it is important we learn and improve from any complaints. We received nine complaints in the period 2016/17, all complaints were responded to within the time standards set within NHS complaints handling policy and no complainant chose to take his/her complaint further after receiving our response. Page 17

19 Compliments A selection of feedback from patients after: I found this service great. Looked after really well Vasectomy surgery I found this service great. Loads of parking and free. Would highly recommend. Very knowledgeable and took the time to explain my options pre and post operation. The procedure went very well and was as comfortable as possible. Extremely helpful and friendly staff. Hand surgery Thank you for a wonderful experience as any hospital procedure can be. Felt very safe and listened to. For once was treated with respect and dignity and I have had many medical experiences of late with my surgery. Dr Lashbrook and team restored my faith and I felt at ease and confident in the team s ability to help me through. If my other hand should need surgery I will be knocking at your door once again! Thank you. Cannot fault. Very friendly quick and easy operation. I have had carpal tunnel operations on both hands. From the beginning of the process to the end, the treatment I have received has been exemplary and I wish to thank everybody involved in my treatment. Dr Oliver Bradford has been superb. I also wish to thank the admin team who have been very efficient and to highlight the fact that my operations took place promptly following consultations with Dr Bradford. This is the NHS at its very best. Thank you to all concerned. Podiatric surgery Looked after really well - could not have been better in any way. I would recommend other people to come. Excellent. Thanks Cataract surgery A very efficient procedure. Staff supportive and caring. Nice to be treated locally and in a non- big hospital environment. Very good quick service. All my fears were taken away. Friendly. Everyone put me at ease. Punctual. Immaculately clean. Continuity of Surgeon When planning patients care IHG staff do their upmost to ensure that patients always see the same surgeon or doctor at outpatient appointments and for surgery. We believe that the continuity of always seeing the same surgeon or doctor enhances each patient s experience and confidence for surgery. Our results for the last year are shown below: Did you see the same Surgeon at every visit? VASECTOMY CATARACT SURGERY HERNIA SURGERY HAND SURGERY PODIATRIC SURGERY Yes % No % Page 18

20 Responsiveness All patients have access to our services, in line with our Access Policy, to ensure a fair and equitable approach for any patient. Patients can choose appointment times with flexibility to suit them via the choose and book service, if patients would like to change their appointment they are able to call our Patient Administration Centre who will rebook a convenient time via the e-referral service. We have guidelines to support the care of adult patients with dementia and patients who may be autistic or who are on the autistic spectrum Waiting times are monitored weekly to ensure they remain within our KPI s and contractual obligations and we hold a short notice cancellation list for any patients who would like an earlier appointment. We always treat patients within the 18- week referral to treatment time frame and usually treat patients within nine weeks from referral. Any cancellations or DNA s are rebooked in a timely manner and to suit patients preferences. All patients are seen by the same surgeon at their initial appointment through to surgical procedure. Follow up calls are undertaken by our nursing staff who are also available daily for any patient concerns. All our patients are given a contact number on discharge in case of any concerns and up until on the day of surgery will be called back by their operating surgeon for any advice necessary. In our hernia, cataract and podiatric surgery services all patients are contacted the following morning to check on their progress and all patients are encouraged to contact us with any concerns. Patient initiated follow up has been adopted by IHG to give patients the flexibility to contact us at any time following their surgery. If patients have any concerns regarding their care with IHG they can make comments via our Friends and Family questionnaires, PROM forms or through our complaints system either in writing or via our website. INDEPENDENT HEALTH GROUP Patient referral Initial Consultation within 3 weeks Local Anaesthetic Surgery within 6 weeks The very best care through the NHS. Well- led As a relatively small organisation we have a correspondingly small and stable leadership team. Being a small organisation we have been able to embed the vision of providing NHS care of the highest quality where patients always come first throughout the organisation so all of our staff are very much guided by this. Page 19

21 Information Security Data protection through continuous improvements to the security of information will always be a focus. The recent international cyber security attack, reported heavily by the media, only adds weight to the critical importance of computer defence methods. We already have in place several systems and methods to help reduce the risk of a cyber- attack. As a result of this, we did not suffer from the recent wave of virus infections, which affected many across the world. However, security breaches and computer infections are an ever- present threat. We constantly review cyber security bulletins issued by NHS Digital to stay ahead of any possible waves of attacks on the internet. We also undertake regular review meetings to ensure that staff are kept well informed about threats, undergo training on effectively identifying areas that could be improved and to monitor any upcoming improvements to security. We are measured against a national standard of information security and effective management of data. Over the last three years we have demonstrated a consistent upward improvement in our assessments. During 2017/18 IHG will be applying for HM Government Cyber Essentials Scheme. It is believed that implementing these measures can and will significantly reduce the organisation s security vulnerabilities. Stakeholder Feedback Please see below feedback from some of our key Stakeholders. Page 20

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25 Healthwatch Wiltshire and Healthwatch Gloucestershire s joint response to Independent Health Group s 2016/17 Quality Account This statement is provided on behalf of Healthwatch Wiltshire and Healthwatch Gloucestershire. The role of Healthwatch is to promote the voice of patients and the wider public in respect to health and social care services and we welcome the opportunity to comment on Independent Health Group s (IHG) 2016/17 quality account. We are pleased to see that IHG s most important guiding principle is that patients always come first. The experience of patients is of prime importance to local Healthwatch so it is good to know that IHG are committed to monitoring their performance through patient feedback. In addition, it is reassuring to see that patient feedback is taken seriously by IHG and most importantly that they state that this feedback is used in the design, re-development and delivery of services. It is concerning to see that infection rates post vasectomy and podiatric surgery are higher than reported in other comparable services. However, we are pleased to see that Infection prevention and control is a priority for the coming year and it will be important to see improvements in these areas. As local Healthwatch we have spoken to many individuals living with dementia about their experiences of receiving medical care. We know from some that it can often be a confusing and scary experience and therefore It is reassuring to see that IHG have guidelines in place to support the care or adult patients with dementia as well as patients who may be autistic or who are on the autistic spectrum. Healthwatch Gloucestershire and Healthwatch Wiltshire Healthwatch look forward to developing the relationship with IHG over the coming year and working with them to ensure that the experiences of patients, their families and unpaid carers are heard and taken seriously. Page 24

26 Appendix 1 Location of services Facilities Surgery and diagnostics available Bath Fairfield Park Out- patient appointments Carpal tunnel surgery, Hernia surgery Bath Widcombe Surgery Out- patient appointments Carpal tunnel surgery, Hernia surgery Chippenham Hathaway Out- patient appointments, Carpal tunnel surgery, Cataract surgery, Medical Centre investigations and surgery Hernia surgery, Podiatric surgery, Vasectomy Gloucester - The Aspen Centre Outpatient appointments Carpal tunnel surgery, Hernia surgery and surgery Swindon Lawn Medical Centre Out- patient appointments, Carpal tunnel surgery investigations and surgery Leicester (North West) Out- patient appointments and Carpal tunnel surgery, Trigger finger Hugglescote Surgery surgery surgery Leicester (North East) Out- patient appointments and Carpal tunnel surgery, Trigger finger Syston Health Centre surgery surgery Bristol Litfield House Out- patient appointments, Carpal tunnel surgery, Hernia surgery Medical Centre investigations and surgery Reading Forbury Clinic Out- patient appointments, Carpal tunnel surgery investigations and surgery Stoke- on- Trent Out- patient appointments and Carpal tunnel surgery, trigger finger Middleport Medical Centre surgery surgery Swindon Old Town Surgery Out- patient appointments and Carpal tunnel surgery, Hernia surgery, investigations Podiatric surgery Westbury White Horse Out- patient appointment, Carpal tunnel surgery, Cataract surgery, Health Centre investigations and surgery Hernia surgery, Podiatric surgery, Vasectomy Newton Abbot Out- patient appointments and Vasectomy Kingkerswell Health Centre surgery Page 25