SOMERSET PARTNERSHIP NHS FOUNDATION TRUST QUALITY ACCOUNTS PRIORITIES 2018/19 1. INTRODUCTION 1.1 The Quality Account is published annually by each NHS healthcare provider and made available to the public. 1.2 The quality of the services provided is measured by looking at: patient safety; the effectiveness of treatments that patients receive; patient feedback about the care provided. 1.3 As always, while our aim remains to achieve continuous quality improvement in all our services, each year we focus on a number of particularly key issues where we think improved quality would make the most difference to our patients. 1.4 We then agree ways to measure how we have improved these aspects of our care delivery and report at the end of the year how they have made a difference both across the Trust and locally within teams. 2. CONSULTATION 2.1 For 2017/18, we identified the following priorities for our Quality Accounts: improving personalised care planning; increasing carer involvement and support; improving understanding and recording of capacity and consent; investigating and learning from unexpected deaths and SIRIs; improving the understanding and recording of restraint; reducing the incidence of Venous Thromboembolism (VTE) in inpatients. Quality Account Priorities 2018/19 February 2018 Council of Governors - 1 -
2.2 We monitor progress in quality improvement of these priorities on a quarterly basis and share the updates with Somerset Clinical Commissioning Group and Healthwatch Somerset. 2.3 Priorities for next year will be drawn from our own review of our quality performance and the identification of areas for improvement - whether continuing existing areas or developing new themes from quality issues or feedback. 2.4 As in previous years, our Chief Nurse, linking with Executive Team colleagues, has undertaken a review of quality performance during 2017/18 to consider areas where we might wish to focus our priorities for quality improvement during 2018/19. This included a review of the issues identified by the Care Quality Commission (CQC), during their inspection visits, undertaken in 2015 and 2017. 2.5 This process also took into account: our CQC action plan, drawn from the CQC s Comprehensive Inspection reports; national patient safety and patient experience initiatives; patient, carer and public feedback on our services; learning from complaints, PALS, incidents and quality reviews; patient surveys and patient satisfaction questionnaires; feedback from Patient Safety Walkrounds and other staff listening events; feedback from other external reviews of our services (Healthwatch, external and internal audit); feedback on last year s Quality Account; our strategic objectives and service development plans. 2.6 From this review, an initial list of priorities was shared with our Board and Council of Governors at an away day held on Tuesday 12 December 2017. The Board and Council of Governors reviewed this initial list and identified further potential Quality Account priorities for 2018/19, to produce a resultant long list of priorities which is attached as Appendix 1. February 2017 Council of Governors - 2 -
3. QUALITY ACCOUNT PRIORITIES 2018/19 3.1 Following the discussions in December 2017, the general feedback has been supportive of the overarching approach and of the issues and priorities identified. 3.2 We have developed key measures to make sure we are delivering these priorities and will develop further performance measures and monitoring arrangements as national and local CQUIN targets and other national performance indicators are agreed. 3.3 While all of these are important and we will make sure they are part of our quality improvement programme, we normally aim to focus on five or six key priorities each year to monitor more closely and make sure we are getting right and we will report on these in more detail in our 2017/18 Quality Report. 3.4 From the feedback received and our own assessment, we would propose that the following areas comprise our Quality Account priorities for 2018/19: Improving the understanding and recording of capacity and consent; Enhancing procedures for reducing Venous Thromboembolism (VTE) in inpatients; Reducing the incidence of pressure ulceration; Increasing the skill set of staff when caring for patients with dementia/cognitive impairment; Improved incident reporting; Improved personalised care planning. 3.5 We will look to take forward other priority areas through different monitoring and improvement programmes, in particular: the improvement of mental health services for young people will form a key part of the work we are doing with the Local Authority and the Clinical Commissioning Group arising from our mental health gap analysis and we will report to the Board on progress against these plans; we will continue to progress the Triangle of Care programme to roll out support for carers into community health and mental health services across the Trust and report progress through the Triangle of Care Steering Group; Quality Account Priorities 2018/19 February 2018 Council of Governors - 3 -
we have recently undertaken staff and stakeholder engagement audits to inform work on developing more effective communications. We will monitor progress against these plans through the Patient and Public Involvement Group and through the newly established People Committee. 4. EXTERNAL AUDIT OF THE QUALITY REPORT 2017/18 4.1 In May 2018 we will produce our report on the Quality Account for 2017/18 which will set out progress we have made on improving the quality of our services, in relation to the priorities listed at paragraph 2.1 above as well as other areas. 4.2 As part of the external assurance process for the Quality Account, KPMG, our external auditors, will conduct an audit of our Quality Report for 2017/18. 4.3 One of the aspects of the audit is to look in detail at THREE of the performance indicators (the ways we measure what we do) to see if our stated performance is fully accurate. 4.4 Two of the performance indicators to be tested are decided by NHS Improvement in national guidance. 4.5 However, the auditors will also look at one other local indicator which we identified in the Quality Account and make sure we have measured and reported it correctly and see what progress we have made. 4.6 For this, we are asked to seek the views of Governors as to which ONE of the local indicators you feel is appropriate to be reviewed in more detail by the external auditors to assure the Board and the Council of Governors that we are monitoring and reporting it effectively. 4.7 In the last two years we have audited the local indicator of Patient safety incidents reported to the National Reporting and Learning Service (NRLS) because of consistent concerns regarding the low reporting of incidents. 4.8 We identified three local indicators in 2017/18 to be included in the Quality Account, one of which will be subject to external audit. The indicators are: A. Recording of Risk Indicator - The percentage of clients under our care who have had a formal assessment of risk and safety recorded February 2017 Council of Governors - 4 -
Rationale In our recent internal reviews and in the Care Quality Commission (CQC) report the level and quality of recording of risk assessments was deemed to be inconsistent across services. B. Cancelled appointments Indicator - Percentage of first appointments cancelled by the Trust Rationale Being able to access services when and where they are needed is a consistent theme of patient feedback and issues raised from cancelled or re-scheduled appointments in relation to some services have been themes of PALS and Friends and Family feedback. C. Patient Safety Indicator - Patient safety incidents reported to the National Reporting and Learning Service (NRLS) Rationale - This remains an area of risk in relation to the potential under-reporting of incidents to the NRLS. The CQC and external agencies continue to identify that incident reporting levels were lower than they would have anticipated and considered there were barriers to reporting. Our recent benchmarked information for reporting physical assaults also showed that we continue to be in the lower quartile for reporting compared with other mental health trusts. 4.9 Last year Governors decided that the auditors should review Indicator C Patient safety incidents reported to the National Reporting and Learning Service (NRLS). Given that this area remains an issue for potential under-reporting, we would recommend that this is audited again this year. 4.10 We would ask the Council of Governors to agree which of the local indicators will be put forward for the external audit of the Quality Account 2017/18. 5. RECOMMENDATION 5.1 The Council of Governors is therefore asked to: consider the long list of priority areas for the 2018/19 Quality Account set out in paragraph 3.4 and confirm it would support these as the Trust s principal quality priorities. The final agreed priorities will be presented to the Trust Board in March 2018; Quality Account Priorities 2018/19 February 2018 Council of Governors - 5 -
agree which of the local indicators will be put forward for the external audit of the Quality Account 2017/18. DIRECTOR OF GOVERNANCE AND CORPORATE DEVELOPMENT February 2017 Council of Governors - 6 -
APPENDIX 1 QUALITY ACCOUNTS PRIORITIES The following long list of priorities was identified: 1. mental health of young people 2. patient experience and involvement 3. incident reporting 4. venous thromboembolism 5. pressure ulcers 6. suicide prevention 7. capacity and consent 8. restraint 9. personalised care planning 10. learning from deaths 11. physical health in mental health settings / mental health in physical health settings 12. delayed transfers of care 13. the need for effective communications / education (in plain English) 14. carers support mental health and physical health 15. using education around prevention / early intervention 16. greater use of the voluntary sector as part of community services (needs resourcing) 17. record keeping 18. observations in mental health Quality Account Priorities 2018/19 February 2018 Council of Governors - 7 -
QUALITY ACCOUNT PRIORITY ENGAGEMENT COMMENTS FROM HEALTHWATCH SOMERSET & STAFF 31 January 2018 APPENDIX 2 Overall, feedback would indicate support for focusing on the priorities around mental health of young people, capacity and consent and communication. 1. SUMMARY 1.1 The long list of Quality Priorities was shared with Healthwatch Somerset and Trust staff. We asked for comments about what was important to patients, carers and the public in Somerset. TRUST STAFF 1.2 Priorities from the long list endorsed by Trust staff were as follows: 1. Mental health of young people 7. Capacity and consent 9. Personalised care planning 13. The need for effective patient communication and education in plain English 15. Using education around prevention and early intervention 1.3 New priorities suggested were: Dementia support: This is part of Older Adults mental health and wellbeing, and also impacts significantly on carers and families as the illness progresses. Record sharing: the ability to see patient records in acute and primary settings recently heard a GP refused to give summary printout info to District Nurses. This would save so much time and duplication and we would have the whole picture to work with so give the most effective care to our patients. HEALTHWATCH SOMERSET 1.4 Priorities from the long list highlighted by Healthwatch as important for patients in Somerset were: Mental health of young people Patient experience and involvement: It would be good to know what aspect of this you intend to focus on. Would this include the complaints February 2017 Council of Governors - 8 -
handling process? In addition, we would be happy to input into any plans to address any issues in this domain. The need for effective patient communication and education in plain English: We have readers panels who can help with this. The greater use of the voluntary sector as part of community services: It would be good to know more about how you plan to go about this. Capacity and consent 1.5 Overall, feedback from staff and governors would indicate support for the priorities around mental health of young people, capacity and consent and communication February 2017 Council of Governors - 9 -