Quality Accounts For Northern Pathways 2014/15

Quality Accounts For Northern Pathways 2014/15

Contents PART ONE... 3 Statement on Quality... 3 Statement on Quality from the Chair of the Northern Pathways Board Andy James.. 3 Overview of Services... 5 PART TWO... 6 Priorities for Improvement 2015/16... 6 PART THREE... 7 Quality Review of Performance 2014/15... 7 1. Review of Priorities 2014/15... 7 2. Statement of Assurance from the Board... 10 3. Review of Quality... 14 4. What Others Say About Us... 18 Glossary... 21 Page 2

PART ONE Statement on Quality Statement on Quality from the Chair of the Northern Pathways Board Andy James Northern Pathways is committed to providing high quality services to the people we support, their families and carers and commissioners. This commitment is enhanced by a comprehensive and rigorous clinical governance framework based upon seven core areas, identified by the Department of Health: Safety Clinical and cost effectiveness Governance Client focus Accessible and responsive care Care environment and amenities Public health. Our quality assurance systems and tools are embedded within our operating structures and culture. This allows us to monitor and report against these seven areas, driving up standards and organisational learning. In addition, our Internal Quality Assessment Tool (IQAT) Page 3

embraces all the regulatory standards required by such bodies as the Care Quality Commission. Northern Pathways provide one NHS funded service called Garrow House based in York. Garrow House is a 12 bedded high support service for women stepping down from secure care. The service was developed in response to national high level policy guidance, including Women's Mental Health: into the Mainstream (2002) and the subsequent Implementation Guidance (2003), a regional strategy document, Forensic Services for Women a Strategy Document 2004-2008. The service was developed and is run by Northern Pathways, which is a joint venture between Turning Point and The Retreat. Garrow House has now been open for six years. This year Garrow House has continued to be funded as a women s complex needs service but is also working towards becoming a Tier 4 personality disorder service for women. This has meant continuing to provide an excellent high quality service whilst ensuring that all the operational systems and processes are also appropriate for a new service specification. We believe we have successfully achieved this balance and in 2014/2015 the service achieved all the innovation goals agreed between Northern Pathways and the regional commissioners for the provision of NHS services, through the Commissioning for Quality and Improvement payment framework (CQUINS) and achieved all available incentive payments. Involvement has always been at the heart of the Garrow House service and robust involvement systems mean that the women within the service are actively involved in all aspects of their care and service delivery. For example, the women at Garrow House have been looking at ways that the Multi-Disciplinary Team meetings can be more inclusive. They are also involved outside the service developing educational and vocational skills or attending advisory meetings for Turning Point, The Department of Health or the CQC. Northern Pathways takes a proactive approach to quality assurance and staff, alongside service users work hard to identify areas where improvement is required and take the relevant actions to ensure that all areas are resolved and improved. Quality improvement is an on-going priority for Northern Pathways and is always top of the agenda. On behalf of Northern Pathways, I affirm my commitment to providing high quality services and confirm that, to the best of my knowledge, the content of this report is accurate. Andy James - Chair Northern Pathways Page 4

Overview of Services Northern Pathways is a unique partnership between two well-respected third sector organisations. The partnership combines the national infrastructure of Turning Point, a large health and social care organisation with over 25 years experience in mental health, with The Retreat, a long established York-based mental health provider working with the NHS to provide mental health care for people with complex needs. Garrow House is designed to support women making the difficult transition from secure services back into the community, building independence and life skills while focusing on long term recovery. Registered as an independent hospital, Garrow House caters for women with a range of diagnoses including mental illness, personality disorder and mild learning disability, for a maximum stay of three years. The income generated by the NHS services reviewed in 2014/15 represents 100% of the total income generated from the provision of the NHS services by Northern Pathways for 2014/15. Page 5

PART TWO Priorities for Improvement 2015/16 Continuing to improve our services is an essential corner stone of Northern Pathways values. The Commissioning for Quality and Innovations (CQUINS) payments framework encourages service providers to continually improve the quality of care provided to service users and to achieve transparency. CQUINS enable commissioners to reward excellence, by linking a proportion of service providers income to the achievement of national and local quality improvement goals. Northern Pathways priorities for next year reflect the Mental Health CQUINS for 2015/2016. Priority Collaborative Risk Assessment Smoking Cessation in Secure Services Access Assessment The provision of an active engagement programme to involve all secure service users in a process of collaborative risk assessment and management. This CQUIN continues the successful work achieved on this priority last year. This CQUIN consists of three separate streams. Stream 1: Strategy to improve the smoke free status of the service. Stream 2: Adherence to NICE guidance PH48 for interventions whilst in secure services. Stream 3: Supporting continued cessation while on leave from the hospital and following discharge / transfer. This CQUIN enables providers to get a better understanding of the pathways into a Tier 4 service. Having an agreed assessment framework will support clinicians developing a consistently applied assessment of needs for people accessing Tier 4 Services. This CQUIN continues the successful work achieved on this priority last year. Page 6

PART THREE Quality Review of Performance 2014/15 1. Review of Priorities 2014/15 One of the most important aims for the service must be to look back and objectively review our performance and position throughout 2014/15. The priorities we identified for the last financial year have been listed as below and updates given on the progress made. Priority 1: Friends and Family Test (FFT) Implementation of FFT The FFT is an important feedback tool that supports the fundamental principle that people who use NHS services should have the opportunity to provide feedback on their experience. It asks people if they would recommend the services they have used and offers a range of responses. While the results are not statistically comparable, FFT provides a broad measure of patient experience that can be used alongside other data to inform service improvement and patient choice. Outcome at Year End: At Garrow House, the implementation of the FFT has been achieved for both staff and service users. Service Users are asked the FFT during their exit interview, which is carried out by the Involvement Coordinator 6-8 weeks after the woman has left the service. A collaborative decision was made with the women at Garrow House and staff, that the FFT would also be implemented after their Care Programme Approach (CPA) meeting as these take place every 3-6 months. The FFT has been added to the CPA standard questionnaire, so that all women have the opportunity to complete after their CPA. Garrow House have also implemented the staff family and friends test. After discussions with staff, a survey monkey was created with the work and care questions and the link was e- mailed to all staff at Garrow House and returned within a set timescale. Please see the section in this report: Statement of Assurance from the Board for more detail and results. Priority 2: Improving Physical Healthcare to reduce premature mortality in people with severe mental illness This CQUIN supports NHS England s commitment to reduce the 15 to 20 year premature mortality in people with severe mental illness and improve their safety through improved assessment, treatment and communication between clinicians. This CQUIN will incentivise providers to ensure that service users have recorded comprehensive physical and mental Page 7

health diagnoses, communicated between primary care and specialist mental health clinicians and with the service user. This CQUIN involved the monitoring of service users with a diagnosis of schizophrenia or schizo affective disorder who are prescribed anti-psychotic medication. As Garrow House is a small service with only 12 beds there were only seven women who qualified to be included in the audit. Outcomes at end of year: The Lester Positive Cardiometabolic Health Resource was used to address the required areas: smoking, lifestyle, BMI (Body Mass Index), blood pressure, glucose regulation and blood lipids. The monitoring was organised to fit in with the physical health and wellbeing clinic that is facilitated by Clinical Development Specialist and Project Worker at Garrow House. The women were given appointments and met to discuss the above areas. Physical observations were taken and appointments made for bloods to be taken by the GP who visits Garrow House on a weekly basis. Incorporated into these appointments was the nutrition screening and general healthy living advice. These meetings provided more than enough information for the data collection form that was forwarded to Royal College of Psychiatrists as requested. The information was also used as part of the healthy living interventions within the service and was incorporated into the women s recovery plans. Priority 3: Developing Outcomes This CQUIN enables providers to get a better understanding of the effectiveness of the treatments interventions, improve the quality of care and the service user s experience. Outcome measurements can guide treatment decisions, and enable clinicians to provide patient centred care. Outcomes at end of year: Garrow House has continued to use a number of outcome measures, namely Health of the Nation Outcome Scales (HoNOS), Outcome Star, Manchester Care Assessment Schedule (MANCAS) and Historical Clinical Risk Management-20 (HCR-20). Outcomes measures will continue to be reviewed as the service moves towards becoming a Tier Four service for women with complex needs associated with personality disorders, with specific measures and attendant data analysis developed to meet the needs of the service and women using the service. Priority 4: Specialised Services Quality Dashboards This indicator is aimed at ensuring that providers embed and routinely use the required clinical dashboards developed during 2013/14 for specialised services. Page 8

Outcomes at end of year: Garrow House has submitted all appropriate data required to meet this CQUIN. The dashboard products have been predominantly used within the service to improve quality in two areas: clinical supervision and training. Priority 5: Access Assessment This CQUIN enables providers to get a better understanding of the pathways into a Tier 4 service. Having an agreed assessment framework will support clinicians developing a consistently applied assessment of needs for people accessing Tier 4 services. Outcomes at end of year: Garrow House monitored all referral, admissions and discharges from the service during this reporting period. The service has continued to be funded as a women s complex needs service with a remit to provide step down facilities for women leaving medium/ low secure hospitals. Garrow House is continuing to develop the care pathway into three distinct stages: referral and admission, treatment and transition and discharge to meet the needs of a personality disorder provision for women. Priority 6: Collaborative Risk Assessments Education Garrow House decided it would benefit from a more collaborative approach when considering the implementation of risk assessment tools and overall risk management approaches including safety/care planning. Due to this Garrow House decided to take part in the optional Collaborative Risk Assessment CQUIN. Outcomes at end of year: The last 12 months have involved a comprehensive review of clinical practice at Garrow House and a subsequent project plan that seeks to action the implementation of clinical practice in line with the personality disorder service specification. A workshop has been facilitated, which focused on considering the current views of the women and staff and planning an awareness and education package. It was decided that a new cycle of clinical risk awareness training would be facilitated for all women and members of the clinical team as well as the implementation of a new structured clinical judgement tool (START) which would enable more effective risk assessment and management practice, in collaboration with the women. Priority 7: Provision of literacy, numeracy, IT and vocational skills training Garrow House decided to continue this CQUIN from the previous year, when overall 82.3% of the women at Garrow House engaged in vocational or educational opportunities. It was decided that engagement should be maintained at a minimum of 82%. Outcome at end of year: This target for the year has been met with an overall engagement in vocational and educational opportunities at 88%. This has been completed in collaboration with the Occupational Therapy, wider Multi-Disciplinary Team and echoed the involvement Page 9

ethos of the service. It was important that the pathways were used as a guide to individualise women s engagement in vocational and educational opportunities. An action plan has been developed to ensure that continued engagement in vocational and educational opportunities is maximised. A questionnaire has also been developed to ensure that the views of the women in Garrow House are reflected in this action plan. 2. Statement of Assurance from the Board Review of Services During 2014/15 Northern Pathways provided 1 NHS service, namely Garrow House. Northern Pathways has reviewed all the data available to them on the quality of care in the 1 NHS service. The income generated by the NHS services reviewed in 2014/15 represents 100% of the total income generated from the provision of the NHS services by Northern Pathways for 2014/15. Participation in Clinical Audits During 2014/15, 0 national clinical audits and 0 confidential enquiries covered NHS services that Northern Pathways provides. During 2014/15 Northern Pathways participated in 0 national clinical audits and 0 national confidential enquires, of the national clinical audits and confidential enquiries it was eligible to participate in. The reports of 6 local clinical audits were reviewed by the provider in 2014/15 and Northern Pathways intends to take the following actions to improve the quality of healthcare provided: Set up a new Physical Healthcare monitoring programme providing blood tests, ECG, advice and monitoring of physical health issues. Increase training in areas that were indicated as needing improvement - wound care, Clozapine monitoring. Risk Management - additional training for all staff in START risk assessment tool, relational skills training and personality disorder training. In addition to the local audits Northern Pathways participates in an Internal Quality Assessment tool hosted by one of the partner organisations, Turning Point. This Internal Quality Assessment tool (IQAT) is a set of audit tools that detail how the service will deliver regulated activities and meet the essential standards of quality and safety. Page 10

The Service also provides a quarterly report to the North of England Specialist Commissioning Group (Yorkshire and Humber) of Key Performance Indicators (KPI s). Research The number of patients receiving NHS services provided or sub-contracted by Northern Pathways in 2014-2015 that were recruited during that period to participate in research approved by a research ethics committee was 0. Garrow House has participated in an Intervention framework for patients with psychosis on antipsychotic medication. Cardio metabolic health assessments were carried out and results reported to the Royal College of Psychiatrists (RCP). Goals Agreed with Commissioners - CQUINS A proportion of Northern Pathways income in 2014/15 was conditional on achieving quality improvement and innovation goals agreed between Northern Pathways and the regional commissioners for the provision of NHS services, through the Commissioning for Quality and Improvement payments framework. Garrow House has accomplished 100% of the CQUIN targets for 2014/15. Care Quality Commission Registration Garrow House, Northern Pathways is required to register with the Care Quality Commission (CQC). The CQC has not taken any enforcement action against Northern Pathways during 2014/15. The CQC undertook a Mental Health Act 1983 monitoring visit on 6 th February 2015. By law, the Care Quality Commission (CQC) is required to monitor the use of the Mental Health Act 1983 (MHA) to provide a safeguard for individual patients whose rights are restricted under the Act. Mental Health Act Reviewers do this on behalf of the CQC, by interviewing detained patients or those who have their rights restricted under the Act and discussing their experience. They also talk to relatives, carers, staff, advocates and managers, and they review records and documents. Here are some of the CQC comments from the visit made in February 2015: Staff told us they were well supported in their training needs. They said we haven t used restraint for two years, we focus on de-escalation. All the patients we spoke with were positive about their care. We met with one patient who told us that she had been involved with the consultation on revisions to the Code of Practice as part of the Expert Patient Group. She told us, I ve really enjoyed the work, my voice has been listened to. Page 11

One woman told us she was studying GCSE Maths and English at the local college, I get lots of support from staff, they don t do my homework though! We heard from staff that one woman was doing an Open University course. All the patients we spoke with were positive about their care. Information Governance and Data Quality Garrow House records data on Turning Point s organisation-wide data collection system (Client Information Management - CIM). CIM allows Northern Pathways to do the following: Collect demographic data about our clients Aid and track service activity via client support plans Manage and measure service outputs for us and our commissioners Manage and measure client outcomes. The project has been developed in collaboration with ILLY Computer Systems and enables information within Northern Pathways to be collected more efficiently and is readily available to those who need it. CIM enables Northern Pathways to consistently measure how we help people improve their lives. It means we can speak confidently about the results of the work we do to our commissioners. Information Governance is the way organisations process or handle information. It covers personal information, i.e. that relating to patients/service users and employees, and corporate information, e.g. financial and accounting records. The Information Governance Toolkit (IG Toolkit) is an annual self-assessment audit that organisations are required to complete and submit to the Department of Health. This enables organisations to measure their compliance against the law and central guidance and to see whether information is handled correctly and protected from unauthorised access, loss, damage and destruction. A scoring system rates organisations from 0 3 (high). Turning Point is currently self-assessed at Level Two compliant, achieving Green - Satisfactory ratings on all levels (version 11) and this submission also covers Northern Pathways. We are currently awaiting external audit of this self-assessment, and are confident that our internal audit has been comprehensive and realistic. A dedicated, detailed action plan is in place for appraising and proceeding with achieving compliance and certification against the NHS IG Toolkit. The plan highlights agreed actions, sets departmental responsibilities and deadlines, and reports on progress made to each Information Management Steering Group meeting. Page 12

This plan is owned by the IG Board who manage its implementation and sign off completion of detailed actions within the plan. The Information Commissioner s Office (ICO) have assessed Turning Point as having a high assurance level with a number of areas of good practice within our Information Governance Policies and Procedures. Friends and Family Test Garrow House have implemented the staff family and friends test as per national guidance. After discussions with staff as to how they felt it would be most appropriate to ask the two questions, a survey monkey was created with the work and care questions and the link was e-mailed to all staff at Garrow House and returned within a set timescale. Of the 37 members of staff currently employed, 21 answered these questions (September 2014). The data from these results have been collected. Question1: How likely are you to recommend Garrow House to friends and family if they needed care or treatment? Extremely Likely 12 Likely 6 Neither likely nor unlikely 1 Unlikely 1 Extremely Unlikely 0 Don t know 1 Total Responses Received 21 Question 2: How likely are you to recommend Garrow House to friends and family as a place to work? Extremely Likely 12 Likely 5 Neither likely nor unlikely 2 Unlikely 1 Extremely Unlikely 1 Don t know 0 Total Responses Received 21 There was the opportunity for everybody completing the questions, to make additional comments. These comments will provide feedback into Garrow House s Clinical Governance meeting, in order to identify any specific issues that may have arisen. Page 13

3. Review of Quality Patient Safety Through the quarterly Governance Committee patient safety has been assessed. An analysis of all incidents is undertaken monthly through the service governance and this group reports to the quarterly Governance Committee. To date, the service has been a high incident reporting service and the Committee wished to analyse the type of incidents and trends to determine any improvements to service delivery that should be made. Incidents and Accidents Incident Severity 25 20 15 10 5 0 Incidents by Severity and Incident date (Month and year) High Moderate Low Apr 2014 May 2014 Jun 2014 Jul 2014 Aug 2014 Sep 2014 Oct 2014 Nov 2014 Dec 2014 Jan 2015 Feb 2015 Mar 2015 This table demonstrates an increase in incidents in the last month of this reporting period (March 2015). Many of these incidents relate to one woman within the service but a rise has been expected as the service moves from a women s high support service to a Tier 4 service for women with complex needs associated with personality disorder. Garrow House is working closely with Turning Point s Central Departments (i.e. Risk and Assurance, Operations, Learning and Development) to ensure staff and service users are supported appropriately to make this service specification transition. Page 14

Incidents and Accidents by type Incidents by Type and Incident date (Month and year) 35 30 25 20 15 10 5 0 Apr 2014 May 2014 Jun 2014 Jul 2014 Aug 2014 Sep 2014 Oct 2014 Nov 2014 Dec 2014 Jan 2015 Feb 2015 Mar 2015 There has been an increase in self-harm towards the end of this reporting period. This is being managed appropriately and has been expected as the service moves to a new specification and accepts a number of new admissions to the service. Again much of this increase relates to one woman at Garrow House, whose appropriateness at the service is under constant review. Clinical Effectiveness Outcomes To enable us to evidence that the women are able to move forward significantly in their recovery, we utilise a number of outcome measures within the service. Recovery Star and HoNOS data are collected using the Symptom Checklist- 90 (HCR-20). The data from routine risk assessments (HCR-20 and START) is also recorded as an outcome measure. All women have an initial Recovery Star within 2 weeks of admission to the service and thereafter complete a self-assessment, with a staff member, quarterly, to evidence their recovery journey. The results of these are entered into our Client Information Management (CIM) system. The following graph shows the average recovery star scores for individuals in the Garrow House at the end of March 2015. The reviews show a positive improvement in Page 15

most areas of the recovery star. However, there has been a decline in 8: responsibilities in the 6th review which is due to some women moving from being detained to an informal status, which requires increased levels of responsibility. Complaints, comments and compliments One measure of quality around patient experience used by Northern Pathways is the analysis of the complaints, comments and compliments made by the women at the service. Garrow Page 16

House received one formal written complaint in 2014/15 and three informal complaints. All of these complaints have been resolved appropriately. Any complaint is addressed informally at the earliest opportunity as the first step. However, a complaints procedure is in place, should the complaint escalate. Number Type of complaint Nature Resolved 1 Formal Client (via advocate) re: staff Yes disclosure 1 Informal Client (via advocate) re: staff Yes disclosure 1 Informal Client re: staff changes Yes 1 Informal Client re: room searches Yes These are some of the compliments received at Garrow House during this year. During women s exit Meeting, Women A, a previous service user at Garrow House complimented staff for looking after her so well. During women s exit meeting, Women B a previous service user stated that she was extremely thankful to the staff at Garrow House for their care and felt that all the people, staff and women, made it a stress free environment to get well in. During women s exit meeting, Women C a previous service user provided the following statement: Garrow House was a great place for me to progress. I was very happy to be there. It was spot on. Staff and women were supportive and friendly. I would defo recommend it to other service users. Thank you to all at Garrow for help to become independent again. Staff and women complimented three of the women on recently becoming Informal. Card to all staff: Thank you so much for all you ve done for me whilst at Garrow House. Women s Experience Report by the women of Garrow House, supported by Rachel Tune, Involvement Coordinator, 07th April 2015 During the last three months, the women and staff at Garrow House have been continuing to focus on how to improve involvement within the service. This project has been carried out through workshops, the involvement group, community forums and on a 1:1 basis. The experiences and ideas from this workshop previously informed a plan/list of things that the women would like to adapt, change or review and this was discussed in the involvement group. Page 17

Since this workshop the plans have continued to be worked on and as a result the women are now in Multi-Disciplinary Team (MDT) meetings from the beginning and feel this has helped them to be more involved in their care. The women are also in the process of creating a new Women s Guide to Garrow House, a leaflet which will then be provided to any new admissions. The women have also changed their MDT feedback sheets and we are currently looking into how we can work collaboratively to review other paperwork used in MDT. One of the women at Garrow House continues to work with the Department of Health and the CQC, and another of the women is continuing her role of peer reviewer for the Royal College of Psychiatry. Some of the women continue to attend the Yorkshire and Humber Network meetings as representatives for Garrow House and the work done in these meetings is being used to underpin the involvement project work currently ongoing at Garrow House. We have two women attending the monthly Garrow House Clinical Governance as representatives, who have always engaged and participated well during these meetings, providing ideas/opinions as raised by the other women in Community Forums and Involvement groups. 4. What Others Say About Us Women s Statements The support I received at Garrow House has enabled me to look forward in my recovery with a view to me living in the community. From the day I was admitted, Garrow House were helping me to look forward and support me in planning my discharge. Page 18

Commissioner Statement Garrow House continues to provide an excellent experience for the women who use the service. The service has made considerable progress in year with regards its partnership with other stakeholders in Northern Pathways and has made encouraging progress towards being compliant with the (as yet unpublished) Tier 4 Personality Disorder (T4PD) specification based on review of the specification drafts. The challenge for the service in 2015-16 will be on fully operationalising the new arrangements with the community T4 PD provider and on establishing new pathways both in and out of the service as the client group changes. I have every confidence that they will manage the remainder of this transition successfully. Mick Burns Senior Commissioning Manager Secure and Specialist Mental Health Commissioning NHS England South Yorkshire & Bassettlaw Page 19

Healthwatch York Statement Re: Northern Pathways Garrow House Quality Account 2014/15 Thank you for giving Healthwatch York the opportunity to comment on your Quality Account for 2014/15. We found the Account to be well presented and accessible to lay readers. Our overall impression is that Garrow House is providing a very good experience for the women who use the service. The Quality Account provides an appropriate amount of detail in terms of the experience of the women at Garrow House and demonstrates that they are actively involved in all aspects of their care and service delivery. Making Multi-Disciplinary Team (MDT) meetings more inclusive is a particularly positive step. The creation of a guide for newly admitted women, produced by women currently at Garrow House, is an excellent initiative. The focus on women moving forward in their recovery is pleasing and the results of the Recovery Star are encouraging. We also welcome the development of an action plan to ensure that continued engagement in vocational and educational opportunities is maximised. Healthwatch York welcomes any opportunities for working with Garrow House during the coming year. Carol Pack Information Officer 15 Priory Street, York YO1 6ET 01904 621133 www.healthwatchyork.co.uk Healthwatch York is proud to be part of York CVS Registered Charity No 225087 Company Limited by Guarantee No 493550 (England) Page 20

Glossary CCG Clinical Commissioning Group CQC Care Quality Commission CQUIN Commissioning for Quality and Innovation HoNOS Health of the Nation Outcome Scale MDT Multidisciplinary Team Is a statutory NHS organisation, representing groupings of GP Practices that are responsible for designing local health services in England. They do this by commissioning (or buying) healthcare services. There are 211 CCGs in England. The independent regulator of health and social care in England. It regulates health and adult social care services, whether provided by the NHS, local authorities, private companies or voluntary organisations. Measures which determine whether we achieve quality goals or an element of the quality goal. These achievements are on the basis of which CQUIN payments are made. A widely used routine clinical outcome measure used by English mental health services. A group of different types of clinicians who work together as a team. Page 21

For more information on Garrow House or to give feedback on these accounts please visit our website and complete a contact form: http://www.northernpathways.co.uk/ Page 22