Quality Account 2010/11 1
Contents Quality Narrative 3 Commissioning PCT Statement 4 Review of 2010/2011 NHS Stockport Commissioning for Quality Care Quality Commission Data Quality 5 6 Information Governance 7 Review of Services Service Reviews 8 Patient Safety 9 Patient Experience 13 Clinical Effectiveness 17 Continuous Quality Improvement and Innovation 19 Workforce 21 Stockport LINKs Statement Contact Us 26 2
Statement of Quality In 2008, former Health Minister Lord Darzi published the High Quality Care for All report. The aim of the report was to ensure the NHS provided high quality and effective patient care by making it publicly accountable for the services it delivers. The report also proposed that all organisations providing services for the NHS should be required to publish annual Quality Accounts - a yearly report to the public about the quality of services delivered. Community Health Stockport (CHS) is an NHS organisation which delivers healthcare, early intervention and health improvement outside of hospital and within the communities of Stockport. Legally, we are part of NHS Stockport but we operate as an Autonomous Provider Organisation. This enables us to concentrate on providing high quality services to patients, while the commissioners of NHS Stockport focus on securing the best healthcare for the population of Stockport. We have made our commitment to the population of Stockport through: Improving health and providing services no matter who you are or where you live in Stockport; Organising our services to reduce the length of time you have to wait, involve you, your family and carers in your care, and include other services when needed; Improving and providing high quality services that meet or exceed NHS standards; Gill Frame Director of Community Health Stockport Ensuring that we keep you safe by making sure the environment in which we provide care is clean and safe, that our staff are well trained, that we use the available evidence to provide the best care and that we continuously monitor standards and look for areas to improve; Listening to people who use our services so that we can continuously improve them and develop the services based on their needs. Community Health Stockport provides a comprehensive range of services to care for everyone in our communities throughout their lives. Services like Health Visiting and Children s Therapy support children, young people and their families including those with disabilities. Services like District Nursing and Palliative Care provide care for adults and older people including those with a long term illnesses, those requiring ongoing treatment or rehabilitation following a hospital admission, those requiring short term treatment for an injury or illness and those requiring support and care at the end of life. The health inequalities between Stockport s most and least deprived neighbourhoods present us with a real challenge with the gap in life expectancy between these communities being 12 years for men and 9 for women. It is vital we continue to work with our partners to redress the balance whilst continuing to offer high quality care to all of Stockport s 285,000 residents. Community Health Stockport has a good track record of working well with our partners like the Local Authority, Stepping Hill Hospital and General Practitioners to ensure that the care we provide is joined up and we are able to deliver the right care, in the right way and in the right place. 3
NHS Stockport Statement Quality Accounts are annual reports to the public from providers of NHS health care about the quality of the services they deliver. By publishing quality information this way, Community Health Stockport is offering up our approach to scrutiny, debate and reflection and will enable the people of Stockport to have a picture of the quality of services we deliver and what our improvement plans are. NHS Stockport recognises and Community Health Stockport s commitment to improve their services over the last year building as they do on already good quality provision. The Quality Account is a well presented and balanced view of service quality in 2010-11. NHS Stockport receives a detailed quality report, serious untoward incident reports and patient complaints data and reviews these with CHS at a quarterly contract meeting to discuss the quality of services provided. We also meet regularly with clinicians and managers through a network of clinical boards covering areas such as cancer, maternity, urgent care etc. As a consequence of the full participation of Community Health Stockport in these structures and the routine information they provide we believe the facts and evidence as submitted in this report are correct. We detail below examples of improvements and quality in areas we have tracked over the year and areas where we wish to support their desire for further improvement. NHS Stockport commends CHS for its system of service reviews and the generally high level of compliance with national standards and good practice this demonstrates. Another area in which we believe CHS has significantly improved over the last few years is in understanding its patients experience and responding to this. The generally high net promoter scores are an outcome of this approach. Similarly the roll-out of an electronic incident reporting system has improved the reporting and learning from incidents and thereby improving safety. NHS Stockport measures 18 specific quality indicators. CHS performance in achieving in full 17 of these was excellent and again demonstrates not only the quality of services but the level of commitment to quality improvement within the service as a whole. Leadership is critical to this and the process of leadership walk rounds is also to be commended. Another important element of continual quality improvement is benchmarking with other organisations and shared learning. In this respect NHS Stockport is pleased to note CHS membership of Safety Express with its focus on reducing Falls and Pressure Ulcers and the sharing of information and learning with other healthcare providers. We wish to encourage CHS to continue on its drive for quality improvement. In particular we would expect to see considerable effort to go in to reducing pressure ulcers, improving the management of patient information, and responding to complaints in a timely manner; exacerbating a service failure with poor complaint response times needs addressing. Having improved the level of incident reporting we would ask them to give more consideration to the quality of investigation and developing an integrated understanding of the key root causes across the organisation as a whole. In the view of the commissioners CHS is a good quality community healthcare provider with a genuine commitment to improvement. With all the changes it is facing during 2011-12 in terms of leadership and ownership we ask that it ensures this focus is not lost. 4
NHS Stockport Commissioning for Quality NHS Stockport (Stockport PCT) buy Community Health Stockport services on behalf of the people of Stockport. A proportion of Community Health Stockport income in 2010-11 was conditional on achieving quality improvement and innovation goals which were agreed between Community Health Stockport and NHS Stockport (the PCT Commissioner) through the Commissioning for Quality and Innovation (CQUIN) element of the NHS contract. The use of CQUIN reflects the discussions between the PCT Commissioners and Community Health Stockport in striving to continually improve the quality of care and services we provide. The 18 CQUIN quality indicators for 2010-11 were in 6 goal areas Area Improving the quality of our data Delivering the Health Child Programme Reducing waiting times for clinics End of life care Measuring the healing rates of wounds Infection prevention and control Achieved 17 out of the 18 indicators were achieved, with one indicator relating to end of life care being missed by 1%. The Palliative Care Team already has an action plan in place to demonstrate improvement in this indicator. The district nursing service is also changing their working hours to be able to make contact with palliative care patients earlier in the day. Each year, new CQUIN indicators will be negotiated and will reflect the aim to continuously improve our services and the outcomes for the people we work with. Further details of the agreed goals for 2010-11 and for the following 12 month period are available by writing to our customer care email address sto-pct.customercare@nhs.net Also see contact details at the rear of this publication. 5
Care Quality Commission The Care Quality Commission (CQC) regulates all health and adult social care services in England, including services provided by the NHS, Local Authorities, private companies and voluntary organisations. The CQC make sure that essential common standards are being met where care is provided. Community Health Stockport is required to register with the Care Quality Commission and our application for registration was approved with no additional conditions required. The Care Quality Commission has not taken any enforcement action against Community Health Stockport, nor has Community Health Stockport participated in any special reviews or investigations by the CQC during 2010-11. Data Quality CHS is committed to improving patient care and to support this we are taking a proactive approach to improve the quality of the data that is recorded on our electronic systems. Since the implementation of Lorenzo (an Electronic Patient Record) in 2008 this has enabled us to obtain daily information about the types of contacts and the completeness of those records. Which is one aspect of patient safety. During 2010/11 we introduced a reporting system which allowed us to make considerable progress in producing internal and external reporting of performance data. The reporting system provides managers and directors with daily up to date information about their service. This enables high quality clinical care which is cost effective and identifies where efficiencies can be made without compromising patient s safety. For 2011/12, we have set a key business objective of making sure that all services are in a position to record, report and analyse their activity and performance data to enable them to manage capacity and demand, ensure delivery of contractual requirements, increase quality of services and measure the outcomes from service improvement initiatives. The chart shows some of our key data quality indicators. We are looking at an action plan to start to improve the collection of ethnicity information throughout 2011/12 which will help us to provide culturally sensitive community services. 6
Key data quality indicators Quality Indicators 2010/11 Ethinicity recorded 51.90% Appointment type field completed 99.90% Populated specialty field 99.68% Authorised Referral 95.47% NHS number recorded 97.81% 0 10 20 30 40 50 60 70 80 90 100 Information Governance Information governance is the term used to describe the set of standards that the NHS must follow to make sure that it carries out its duty to: maintain full and accurate records of the care provided to service users keep records about service users confidential, secure and accurate. Although all NHS staff are aware of the confidential nature of their work, the Department of Health have introduced an Information Governance Toolkit for all NHS providers to complete. This also includes an e-learning staff training package. Stockport PCT has declared an overall training score of 46% for 2010/11 on the Information Governance Toolkit. The scores are lower than anticipated however and a detailed action plan has been developed which includes reports by service on their achievement of the e-learning training targets. Both the Internal Audit department and NHS North West have approved our action plan for 2011/12 and our intention is to meet all requirements by March 2012. We are aware of the challenge this will represent.. With senior management support we will continue to raise the importance of Information Governance training and ensure the engagement of key staff members. 7
Review of Services During 2010-11, Community Health Stockport provided 31 NHS services. Community Health Stockport has reviewed all the data available to them on the quality of care of these 31 NHS services. This report will focus on our quality measure of Service Reviews, followed by the three areas within the national definition of quality in the NHS: Patient Safety Patient Experience Clinical Effectiveness Service Reviews The Service review process focuses on each individual service provided by Community Health Stockport and measures it against the national quality standards. Each service has to present their evidence about how they have met the quality standards and the process has been updated to reflect the 16 Essential standards of quality and safety produced by the Care Quality Commission (CQC) in 2010. In deciding which of the 16 CQC outcomes services needed to provide evidence for, the following criteria were used: Number of patient safety incidents Number of complaints Number of risks This was completed so that the outcomes allocated to each service were the most appropriate ones. The services which had not previously undertaken a service review or had scored below 80 percent in a previous service review, are required to produce evidence for all 16 of the outcomes. There are only 2 services whose results fell short of the 80% target. The District Nursing service was one of these services and being the largest service within Community Health Stockport it is important to acknowledge that the collecting of evidence is much more difficult than those smaller services that tend to score much higher. However, it is an area where the Head of Service is working hard to improve upon. The second service was the Nutrition and Dietetic service and they too have an action plan to improve their achievements for this year. 8
Patient Safety Benchmark Incidents National Patient Safety Agency Report The National Reporting and Learning System (NRLS) is a central database of patient safety incident reports. The following report shows incidents submitted by Community Health Stockport between 1 st April and 30 th September 2010 and is a benchmark with other organisations. The report shows that: as an organisation we report incidents in a timely way showing effective reporting systems as an organisation we report incidents on a regular basis showing a positive patient safety culture as an organisation there are low numbers of staff accidents The 2 categories that require further work in order to improve safety of patients are: Medication Errors Pressure Ulcers Volume of Reporting Community Health Stockport reports the average number of incidents per head of population and we are the second fastest in England to report our incidents Comparative reporting rate, per 10,000 population, for 68 primary care organisations with no in-patient provision 65 61 57 53 49 45 41 37 33 29 25 21? Top 25% of reporters? Middle 50% of reporters? Lowest 25% of reporters 17 13 9 5 1 0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% 9
What do we report? The top 3 categories that we report on are: 1. Medication Errors: Improving safety for patients and learning from incidents is a priority for the organisation and this includes learning from incidents. Considerable work has been done over the year focusing on reducing the number of medication errors. This has included a project that looked at the whole process of medication administration. Following this project, there has been close analysis of medication errors within the district nursing service. Another area now in development is the electronic patient index which will reduce patients being accidentally missed off visiting lists. 2. Pressure Ulcers: Pressure ulcer incidents are individually investigated in order to learn lessons and to continuously improve patient care. As part of the Safety Express initiative, developed by the Advancing Quality Alliance (AQuA), CHS are looking to reduce pressure ulcer numbers by 30% (of the 2010/11 total) during the next2 years. 3. Medical Devices: All medical device incidents are analysed at the Medical Devices Advisory Group in order to learn how to improve our services. Safety Express Community Health Stockport is currently taking part in the Safety Express programme as the host organisation. This means that we are the lead organisation for the programme working in partnership with Stockport NHS Foundation Trust and a number of care homes. This work is across the whole health economy. Safety Express is a national improvement programme which aims to achieve significant reductions in four avoidable harms: pressure ulcers, serious harm from falls, catheter acquired urinary tract infections and Venous Thrombo Embolism (VTE). It also supports improvements in efficiency. The specific aims for the programme are: Category III & IV pressure ulcers reduced by 80% in hospital Category III & IV pressure ulcers reduced by 30% in community Catheter acquired urinary tract infection reduced by 50% Serious injury from falls reduced by 50% Venous Thrombo Embolism reduced by 50% Achievements so far Executive sponsor for the programme identified Working groups for each of the harm areas have commenced the work Falls learning day hosted in Stockport Data collection commenced using the NHS Safety Thermometer 10
Leadership walk rounds As an organisation we are registered with the Patient Safety First Campaign to show our commitment to patient safety. Community Health Stockport has implemented the leadership walk rounds which are led by either the Director or an Associate Director accompanied by a patient safety lead. It is an opportunity for staff to voice any patient safety concerns they may have, directly to senior staff. Leadership walk rounds have been completed at the following community bases: Hazel Grove Cheadle Hulme Bramhall Marple Kingsgate Shaw Heath Heaton Norris Gatley Woodley The visits have been embraced positively by front line staff. Action plans have been developed from each visit and this has encouraged staff to share their innovative ideas. This is an important point as Community Health Stockport want staff to feel able to share new ideas. The Leadership walk rounds will be reviewed for the coming year to ensure suggestions are taken on board from front line staff. Infection Prevention and Control Good infection prevention and control help to ensure the provision of safe care. The Health and Social Care Act (2008) Code of Practice on the prevention and control of infections sets out 10 criteria which Community Health Stockport has to comply with in relation to cleanliness and infection control. Following the Code of Practice helps to demonstrate that we meet essential levels of quality and safety, as set by the Care Quality Commission, who require assurance that standards are being met. The Code of Practice is available on the Department of Health website and provides information for users of services as well as guidance for organisations that provide care. www.dh.gov.uk/en/publicationsandstatistics/publications/publicationspolicyandguidance/dh_122604 There are a number of activities which demonstrate our commitment to promoting infection prevention. 11
Hand Hygiene Good hand hygiene is the single most important measure to avoid the transmission of harmful germs and prevent the spread of infections. The Clean your hands campaign, aimed at improving hand hygiene nationally, was launched in community settings in 2008. Community Health Stockport has been a part of the campaign since it was launched. Posters and information leaflets are available in all of our clinics. We have 21 staff who champion hand hygiene in the workplace and who meet regularly to ensure hand Essential Steps to Safe, Clean Care The Department of Health introduced Essential Steps in 2006 with the aim of reducing infections. When caring for patients, staff use the best practice and national guidance Essential Steps recommends. They are assessed regularly to ensure they are competent to deliver safe care. Staff Training Infection prevention and control training is mandatory for all new staff employed by Community Health Stockport and for all clinical staff on a regular basis. As well as hand hygiene, staff receive training about how infections are transmitted, when protective equipment should be used, what policies and procedures are available and how to reduce the risks of transmitting and developing infections. Clinics and Health Centres Over a period of three weeks, in April 2010, all of our clinics and health centres were assessed to see if they met standards of cleanliness and infection control. These assessments were performed by staff from the Health Protection and Control of Infection Unit at NHS Stockport. All the premises assessed achieved the required standard. Where there were any areas of concern, for example, building repairs or stock rotation, action plans were devised to ensure problems would be addressed. It is expected that assessment of premises will continue to ensure care is provided in clean, safe environments. Advancing Quality Alliance (AQuA) Community Health Stockport is involved in a national programme aimed at improving patient safety. We have a collaborative working group looking at reducing harm for patients with urinary catheters who may be at risk of developing urinary tract infections. The group includes nurses and representatives from Community Health Stockport, NHS Stockport, Stockport NHS Foundation Trust and Borough Care. Specialist input from the microbiology team at Stepping Hill Hospital, pharmacists and GP s is available when required. The group is looking at standardising information and care related to urinary catheters across Stockport in order to improve patient safety. This programme is ongoing until December 2012. Further information is available from www.advancingqualityalliance.nhs.uk 12
Patient Experience Customer Care Community Health Stockport (CHS) is committed to; Putting patients and service users at the heart of all we do, Listening to local people, Making sure our services meet their needs and preferences, Actively encouraging them to express their views and experiences of our services, Improving the way we deliver services as a direct result of feedback, Informing them how their feedback has been used, Giving people a say on how services are planned, delivered and evaluated. We are working hard to achieve these progressive aims through the introduction of a number of initiatives: People s Champions All CHS services have a nominated Champion who is the link person for Customer Care. Their role involves: Planning patient experience surveys for the service, Disseminating customer care information to colleagues and Ensuring that patient experience is considered at all team meetings. Dignity in care Champions CHS supports the Dignity in care agenda and is committed to providing high quality services that respect people s dignity. This has been achieved by; People s Champions working within their teams to promote the dignity challenge and encouraging colleagues to sign-up, Presentations to groups of staff including Clinic Administrators and students on placement in Stockport, CHS Director and Associate Directors registering themselves and wearing the Dignity pin-badge, We currently have approximately sixty staff registered on the national data-base. Our target is to continue to increase the numbers over the next year. 13
Patient Experience Surveys Capturing the experiences of the patients and public who use CHS services is very important. Our Customer care Strategy sets out the direction for the engagement work. During the past year CHS has undertaken Patient Experience Surveys in a number of services. In the second half of the year, electronic touch-screen devices have been used which has made collecting patient experience much easier. Ten services used the devices during 2010/11 and all have produced individual reports and actions/ recommendations. A small number of services used paper-based surveys and one service produced a DVD of a carer talking about their experiences to use as a training tool. Recommendations have included services looking at their appointment systems and also communication with patients regarding explanation and apologies for any delays. CHS have also used the Net-promoter Score in all surveys. This asks the person to rate how likely it is that they would recommend the service to a friend, relative or neighbour. It captures what people say in terms of word of mouth locally and tells us if they are talking positively about the service. Levels of satisfaction are generally very high. A Net-promoter score above 50% is classed as a good score as there will be more promoters than critics! 14
Patient Written Information The quality of our patient written information has been addressed. A Patient Written Information Group operates as a virtual group to review and quality check all leaflets, resulting in faster use in practice (usually within one month). We have also standardised our service information leaflets to comply with the Care Quality Commission (CQC) recommendations and ensure the information is relevant, accurate and consistent. How do we let you know how we are doing? This has been achieved through local radio broadcasts as well as newspaper releases, via the website and clinic notice boards. All survey results are shared with LINks and there is a patient representative on the Patient Safety & Experience Governance Committee. In addition, LINk s have a representative on Community Health Stockport Committee. Staff are informed of customer care work through their People s Champion, via Team Brief and the quarterly Customer Care Newsletter. Complaints There has been an increase of 2 in the number of Community Health Stockport complaints this year. A total of 47 complaints were recorded from 1 st April 2010 to 31 st March 2011 compared to 45 complaints received for the previous year. Each year, Community Health Stockport staff have almost 500,000 contacts with patients and service users. The table below shows all complaints received by quarter during 2009/10 and 2010/11: Complaints 2010/11 Q 1 Q 2 Q 3 Q 4 Total Total complaints 2010/11 15 16 6 10 47 No. not responded to in time frames 5 5 2 5 17 Some complaints are very complicated and can involve other services such as General Practitioners or Stockport Foundation Trust, therefore investigating across a number of organisations can take additional time. However, it is recognised that we do need to improve on reporting back to complainants within agreed timeframes. All complaints by quarter 2009/2010 compared to 2010/2011 15
The chart to the left shows the number of complaints against each category, the two highest being Clinical treatment and Access to service & waiting times. Responding to and resolving complaints All complaints in 2010/11 were resolved locally, with no requests for an Independent Review or referral onto the Health Service Ombudsman. Learning from complaints and improving services We are keen to learn how we can do better when we receive a complaint. Most people do not complain lightly so when they do, it not only gives us a chance to apologise but it also enables us to review the service to see where improvements can be achieved. As a result of the complaints received by Community Health Stockport, the following examples of service improvements have been made. Weight Management Recruiting extra staff to avoid appointments being cancelled. When producing leaflets consideration will be given to the language used, particularly when referring to the weight of the potential service user. District Nursing (DN) Treatment Room booking line now have additional staff to cover peak periods Central booking system updated and admin staff can now book follow up appointments. Change to DN leaflet to highlight to patients that a student may accompany staff and that consent will be sought. Community Equipment Service has developed guidance around equipment failure out of hours. Children s Physiotherapy Patient information leaflet to be devised to describe the role of each clinician in the Footsteps clinic. Health Visitors Process in place to ensure answer machine messages as responded to in a timely manner. Podiatry Staff reminded that clinic is a Walk In and is for emergency and urgent care. Staff reminded that prescriptions for pre booked appointments to be given priority. 16
Clinical Effectiveness Community Health Stockport is committed to ensuring that everything we do is safe, effective and provides the best possible outcomes for our patients and clients. This involves using the best possible evidence to shape all that we do and opening our practice to scrutiny by reviewing and assessing all that we do and, where possible, comparing our practice with similar healthcare providers. These activities come under the umbrella term of Clinical Effectiveness. NICE Guidance The National Institute for Health and Clinical Excellence (NICE) is an independent organisation which was set up to ensure everyone has equal access to medical treatments and high quality care from the NHS, regardless of where they live in England and Wales. Guidance from NICE exists to provide advice to NHS clinical staff, commissioners and patients as to those treatments that are clinically and cost effective. Community Health Stockport is committed to the implementation of NICE guidance and works closely with Commissioners to ensure that the healthcare we provide is in line with the NICE recommendations. New NICE guidance is reviewed by each service. Where current practice is not in line with guidance the service develops a plan to ensure that where possible, the guidance is implemented within a specific time frame. Our commissioners are involved in discussions where services may not be able to fully meet the guidance without additional resources. In 2010/11, 17 new or revised Clinical Guidelines issued by NICE which were of relevance to services provided by Community Health Stockport. Examples include Constipation in children and young people Chronic Heart Failure Hypertension in pregnancy Nocturnal enuresis (night-time bed wetting) Community Health Stockport support the implementation of NICE guidance and will audit services on two areas of compliance in 2011/12. Further information about NICE guidance can be obtained from www.nice.org.uk 17
Audit Community Health Stockport aim to deliver high quality care which is measured through Clinical Audit. This includes Community Health Stockport audits which we devise and implement ourselves and internal audits where we are audited by independent auditors. The purpose of an audit is to check whether we are actually doing what guidance says we should be doing. This covers every aspect of being a healthcare provider and can range from how we manage patient information and records to how we carry out a clinical procedure. In 2010/11 Community Health Stockport completed 15 audits. These were a combination of National and local audits The National Audits included a review of falls practice and continence care. Locally we covered areas of practice as diverse as record keeping, leg ulcers and medication induced constipation. Following each audit, services are required to produce a Service Improvement Action Plan in order to guide and demonstrate continuous quality improvement. What we have learnt through audit: We have learnt that our Contraception and Sexual health Service is 92% compliant with NICE guidance in relation to heavy menstrual bleeding and that, 87% of their clients were offered chlamydia screening. This is an increase of 22% on the findings in 2008. We have learnt that all mothers received an assessment of their emotional health 4-6 weeks after giving birth and that 94% received another assessment at 3-4 months. We have learnt that 53% of patients with lower leg wounds, in the care of district nurses, were treated in line with best practice guidance for the management of leg ulcers. Services are required to implement an action plan for practice development when an audit demonstrates that there is scope to improve the care our patients receive. Such action plans often include extra training for staff and closer monitoring of practice. 2011/12 The audit plan for the coming year is now in development and will include National Audits and local audits as prioritised by the leaders of each service. 18
Continuous Quality Improvement & Innovation Essential Public Health: Over 1000 Health and Social Care Staff in Stockport have undertaken our innovative practical training. This has lead to a 70% improvement in knowledge and confidence in discussing significant lifestyle issues such as smoking, obesity and alcohol. The training package has now become nationally recognised as a practical effective method of achieving level 1 competency in public health. Over the past year it has income generated over 40,000 to date in national sales to other PCTs and Strategic Health Authorities. Electronic Master Patient Index: District Nursing Patient Allocation System In December 2010 a 5000 grant was awarded to aid the development of an electronic scheduling system to improve safety and quality. The main aims were to the reduce the incidence of errors relating to missed visits, as well as improving patient choice and involvement in planning their own care. We have successfully piloted the system in Cheadle Health and hope to introduce it to all teams during 2011/12. Wellsprings A project aimed at steering Stockport s homeless away from harmful drinking has won a prestigious award and won a major cash injection. The scheme, to be set up at the town s Wellspring Centre, was up against 12 other teams bidding, in front of a Dragon s Den-style panel, for the 50,000 funding. An ex service user rapped about his experiences of the centre and how the scheme could have helped him. The successful pitch was to get funding to buy a blood test machine that measures the amount of deterioration of the liver. Unlike other machines, this one gives the results in minutes so clients can see instantly how alcohol is damaging their livers. Dr Mian, of Mastercall Healthcare, said Previous studies have shown that using liver function tests to motivate people to reduce their alcohol intake really works. With this machine, we can improve the quality of care we offer homeless and vulnerable people and hopefully reduce the number of times they end up at A&E. Nurse Practitioner Lucy McJannett, of Community Health Stockport, added We re delighted at winning this award as it gives official recognition to the importance of the work being done. The Wellspring Centre, which is open 365 days a year, provides homeless and people in need in Stockport with food, shelter, clothing and companionship as well as access to health care, education and life skills. 19
Speech and language therapy service (SLT) The Speech and Language Therapy service were awarded 25,000 from the Innovate Now award scheme, which is a regional innovation fund from the North West. The funding will allow us to develop and deliver a specially designed training and intervention package within local schools. The project aims to set up pre-referral clinics in schools where teachers can discuss concerns about children without having to make a referral to the specialist SLT caseload. The SLT school therapist provides universal training across schools and targeted advice for intervention packages with the aim to support teachers and children in early speech and language therapy work, therefore preventing the need for a referral to the specialist SLT service at a later date. The vision is to support schools in meeting more children's needs in the early stages. As a result children who do require specialist SLT intervention will have more opportunity to receive direct intervention from specialist practitioners. Productive Community Services Community Health Stockport has embraced the opportunities the Productive Community Series, which is underpinned by Lean methodology, has provided us with. It has given us the tools and techniques required for our staff to get involved, make a difference and meet some of the efficiency targets. A number of projects are underway and some examples of completed activities this year include: Clinical Stock Control Project Community Rehab Team Review Hazel Grove Area District Nursing Team Merger Pre Registration Student Allocation Project Aims to: Reduce waste due to out of date stock. Increase nursing time by minimising time spent looking for items. Standardise and improve the current paper based ordering process. Improve time efficiency, particularly surrounding referrals. Audit patient outcomes. Reduce travel time and related costs. Improve the office and clinic environment to support effectiveness. Address lone working and safety issues. To improve the complete process of allocation (400 students per year). Reduce administration. Ensure all students receive timely correct information. 20
Workforce Factors Student Placements At Community Health Stockport we are committed to delivering a high standard of care for all our patients and clients, and understand the important role that students bring to this process. We work in close partnership with our local universities in order to provide high quality placements for all students and we value the contributions that students bring to our team. In 2010, we supported over 240 placements for pre-registration students within our services. During these placements, students are invited to nominate an individual or team for a Certificate of Excellence, for those staff who have provided particularly excellent learning experiences. During 2010, 78 teams or individuals were nominated for this award. At CHS we are also committed to Inter-Professional Learning (IPL). This means we actively promote opportunities for students from all professions to come together and learn with, and about each other; and where students can learn together about other important areas of care, such as palliative care, safe-guarding adults, and child protection. Last year we carried out a survey with service-users, to see what they felt students should be learning, particularly regarding other professions. Feedback from the survey included the following comments: Students should be taught about the importance of working together, to help patients. What matters most? That they tell each other about me! What matters is that they listen to me and have good communication with me and each other. CHS have therefore developed an IPL toolkit which will help students to learn about other professions and to understand the importance of working closely together with the patient/client, and all health and social care colleagues. The aim of the toolkit is to help students to develop effective team working skills, which will enhance the quality of care they provide. We actively promote primary care as a potential future career for students, and since 2004, have recruited over 36 newly qualified staff into the organisation. We welcome constructive feedback from students regarding their learning experiences, and will use this information to inform and enhance the future learning experiences we offer. Here is some feedback from some of our recent students:- 21
I have had a brilliant first placement and the best start I could have for my nurse training! All staff were extremely helpful and taught me really well both mentors were fantastic! I would recommend both for future students. I couldn t have asked for a better mentor! Supportive, encouraging and knowledgeable about all areas. The placement was invaluable! I m glad I had the opportunity to come to the community and see the vast amount of services. Excellent! An encouraging and supportive team, who enabled me to undertake tasks and be given responsibilities that 3 rd year students need and should be given. It has increased my confidence and will help tremendously in my future role. Our People Community Health Stockport (CHS) continues to be proud of the skill, dedication and professionalism of all its staff who deliver high quality health care for the community of Stockport. The organisation continually strives to improve the experience of our staff and engage them in all the important decisions which affect them and the care they deliver. As an NHS employer we remain fully committed to the 4 staff pledges outlined in the NHS Constitution which sets out a framework for how we treat our people at work to ensure that all our staff are trained and empowered to deliver safe and respectful care. Workforce Strategy The Workforce Strategy is currently being updated to ensure we continue to deliver high quality, effective health care to all our service users through the planning and developing of a highly skilled and up to date workforce. The key parts of the strategy are: Developing the right size diverse workforce Recruiting and retaining the right people Developing the right people in the right way Supporting and engaging the workforce Developing and measuring excellent performance Developing excellent leadership 22
Staff Survey results 2010 The results of the latest NHS National Staff Survey (2010) demonstrated our commitment to giving all staff good development, training and support. 88% of CHS staff feel that their role makes a difference to patients 82% of CHS staff have had an appraisal (compared to a national average of 79%) 82% of CHS staff reported that they have received job relevant training, learning or development (compared to a national average of 79%) 77% of CHS staff reported they have a personal development plan (compared to a national average of 69%) 94% of CHS staff reported they believe that the organisation provides equal opportunities for career progression or promotion (compared with a national average of 92%) 78% of workers reported being able to use flexible working options 83% of staff report having Health and Safety Training (compared to 78% nationally) However, there are areas that we need to improve upon, for example, we are above the national average for work related stress and below the national average for staff reporting good communications between senior management and staff. 2010/11 has been a challenging year due to organisational changes, where a range of options were explored for our future organisational home. We need to learn from the findings of the staff survey and ensure that communications are more effective and timely for staff. Further exploration of this finding will be done with staff groups to get their ideas about what would improve communications. Staff Engagement and Communication A range of events and initiatives have taken place over the past 12 months to ensure that staff are engaged in decisions that effect them and feel empowered to put forward improved ways to deliver better and safer services for patients and their families. Our approach has been both formal and informal working on an individual and group basis with staff, as well as through local partnership working with trade union and professional bodies. This has included: a series of road shows which the Executive Director led personally; the issuing of a monthly team newsletter to all staff; the running of the annual employee awards which recognises good practice; innovation and contribution; podcasts; the setting up of a dedicated communications email account; senior management team drop-in sessions around all clinics and health centres and patient safety drop in clinics when senior managers have met informally with groups of staff to discuss ways of improving the patient experience. 23
We also have established a champion framework where staff are invited to nominate themselves to highlight important issues by volunteering to become a champion for example green champions for the environment, dignity champions, and clean your hands champions. Wellbeing 10.3 million working days are lost in the NHS in England each year (CIPD Annual Survey of Absence Management). This is the equivalent of 45,000 whole time equivalent (WTE) staff costing 1.7 billion a year to the NHS. The proportion of working days lost to sickness absence varies widely between trusts, the average rate of sickness absence is 4.96%. There is a direct relationship between the quality of care provided, as measured by a range of factors, and the levels of sickness absence within departments and wards. The average sickness absence for CHS during 2010/11 was 4.6%, slightly lower than average. However, one of the Institute for Innovation and Improvement s 10 high impact actions relates to being Fit and well to care which aims to reduce sickness absence in the nursing and midwifery workforce to no more than 3%. A team across CHS will work together during 2011/12 towards this aim. The organisation continues to actively work to support staff in maintaining good health and wellbeing and has a range of policies and procedures in place to identify potential hazards and difficulties and proactively promote well being for example an annual entitlement of 10 hours health bank time per year. All Line Managers are trained to manage staff attendance in a supportive framework which includes stress risk assessments and referrals to occupational health where appropriate. The organisation also operates a fast track physiotherapy service for employees to encourage a speedy return to work, in addition to a confidential employee assistance programme which can be accessed by all employees. Leadership Dynamic, professional and skilled clinical leaders are essential in being able to provide high quality services. CHS staff have a range of leadership opportunities depending on an individuals needs, for example Clinical leaders Key skills for managers Alliance Aspiring Directors 24
Action Learning sets Degree and Masters 360 degree assessments The direct link between leadership capability and sustained high performance is now widely acknowledged. No amount of infrastructure and financial investment are guarantees of success if there is a lack of talent and leadership within the organisation. Community Health Stockport is committed to facing the challenge of continuing to provide healthcare services within budget and at the same time, increase productivity, improve quality and achieve greater patient satisfaction. This aspirational goal can not be achieved without robust and effective leadership at all levels throughout the organisation. By supporting leadership opportunities, of Community Health Stockport want to encourage a culture of creativity and innovation at all levels within the organisation which recognises, values and develops leadership and talent. Community Health Stockport continue to support staff in their professional and academic development. Clinical staff can use opportunities to extend and develop their clinical knowledge at different academic levels and CHS support additional study and learning in order to keep providing up to date, research based and clinically effective practice. During 2010/11, CHS supported a range of clinicians (nurse and therapists) to study at the following levels Diploma 16 places Degree 5 places Masters 16 places Education and Training In addition, central funding from NHS North West allowed us to support 52 staff in accessing clinical education updates, conferences or courses and for us to buy in training for larger groups of staff, for example, ear care for district nurses, basic life support for training for all front line staff and neonatal behaviour assessment training for health visitors. We will continue to actively support staff development and learning opportunities to ensure both the quality and effectiveness of care we provide. It is vital for staff to remain up to date with developments in clinical healthcare, as research knowledge about healthcare is expanding constantly. 25
LINks Statement The Stockport Local Involvement Network (LINk) expresses its appreciation for the efforts and achievements of Community Health Stockport (CHS) in such a demanding and unsettling year. CHS has considerable success in maintaining standards and making improvements against all the uncertainties of the organisational changes towards Transforming Community Services. LINk is pleased to note that where measures show a service is below standard corrective actions have been put in place promptly. Of particular importance must be Speech and Language Therapy the needs of young people to be able to express themselves easily and clearly must be paramount. The overall achievements by the staff can be clearly seen in the Patient Satisfaction Survey. LINk is particularly pleased to note the initiatives and the successes as demonstrated by: System to improve reliability of visits through scheduling system Achieving a grant for a blood test machine for the Wellspring Centre. We are pleased to have been able to co-operate with Community Health Stockport when changes have been planned and we have been able to contribute. Feedback on QA We hope you have found this publication useful and that it has given you an understanding of some of our mechanisms for measuring quality care and how we engage service users in measuring the quality of the care they receive. If you have any comments or suggestions to make about this Quality Account, please e-mail: sto-pct.customercare@nhs.net Telephone: 0161 426 5631 Write to: Customer Care Community Health Stockport Floor 10 Regent House Heaton Lane Stockport SK4 1 BS Future Plan. As part of the government policy Transforming Community Services NHS Stockport is currently in negotiation with Stockport Foundation Trust about the integration of Community Health Stockport into Stockport Foundation Trust. Guidance on Quality Accounts suggests that once community providers have integrated, only one Quality Account will need to be produced, with the community provider element as a sub section of the main report. 26