derbyshire health united quality account...

Derbyshire Health United

Quality Account

2015/16

DRAFT

Contents

Introduction and CEO Message 2

Section 1 Message from Our Chairman 3

Section 1 Who we are 4

Section 1 Our Objectives 2014/15 5

Section 2 Our Services 6

Section 3 Our People 31

Section 4 Our Quality Assurance 46

Section 5 Our Patient Experience 63

Section 6 Our Innovation working in partnership 73

Section 7 Our DHU Objectives 2015/2016 79

Section 8 Statement of Director Responsibilities 80

Section 9 Statement from Commissioners 81

Section 10 Statement from HealthWatch 83

Section 11 Glossary 84

Derbyshire Health United Ltd. Quality Account 2015/2016

Index Page Number

1

Introduction & CEO Message


Introduction to the Derbyshire Health United Quality Account 2015/16 from Stephen Bateman, CEO

2

Welcome to our Quality Account for Derbyshire

Health United Ltd (DHU) which sets out what we

have strived to do to safeguard and improve the

quality of our services during the year 2015/16.

This years Quality Account has been produced in

line with national requirements and it is intended

that it provides a realistic assessment of the

quality of care provided by DHU. The content and

format of this Quality Account is laid down in the

NHS (Quality Accounts) Regulations 2010 which

came into force on 1 April 2010.

As a provider of healthcare, we are required to

present certain information which has been

nationally determined, in the form of statements.

We encourage our staff, patients, public and

healthcare partners to look at this Quality

Account to understand what we are doing well

and where improvements in services are

required.

This Account outlines our priorities for continuous

improvement in the coming year (2016/17) and

we welcome comment on, and involvement in,

determining future priorities for improvement.

Our Quality Account provides the opportunity for

us to report on the progress we have made in the

last year and our plans for improvement this year.

I believe we have made significant progress over

the last 12 months and we continue on

our journey of continuous quality

improvement.

Many of the improvements we have made so far

have been widely recognised by the Care Quality

Commission (CQC) following their inspections of

our Out of Hours service and NHS111 Services in

November 2015.

DHU have achieved “Good” ratings for all of our

services from CQC inspections; however there

was also a feeling of disappointment that we did

not achieve ‘outstanding’ in some of the

standards. Our reasoning for this was due to the

innovation shown in these services through

2015/16 and especially following the exceptional

feedback we received immediately after the

inspections.

The significant changes at Board level in early

2015 have been very successful leading to

improvements in the overall corporate, clinical

and financial governance of the organisation with

“Patient safety” remaining the primary focus of

our Board.

This has resulted in the Board gaining assurance

on the quality of care and compassion we

demonstrate, together with a transparent culture

aimed at reducing incidents of avoidable harm to

patients through ensuring learning and outcomes

are acted upon to improve patient safety. DHU

exists to provide caring, high quality, safe and

effective healthcare to our patients and the

communities that we serve, with a clear vision to

engage with our employees and improve our

services and to be the healthcare provider of

choice to Commissioners.

I hope that you will see that our Quality Account

clearly demonstrates our commitment to this

vision. Our Board meetings always commence

with a patient story presented by our Director of

Nursing & Quality, and these have proved to be

enormously beneficial to us by really bringing to

life the patient experience.

Continue to page 3

Stephen Bateman

Chief Executive Officer

Introduction & CEO Message

Derbyshire Health United Ltd. Quality Account 2015/2016 3

In addition to the positive outcomes of the CQC

inspections there have been some significant

highlights for 2015/16 as follows:

Clear focus on improving Staff

Engagement & Communications through

the staff forum and engagement events

aimed at embedding the “DHU Vision,

Values and Behaviours” and recognition

of the Staff Appraisal programme and

Limelight Awards.

Dealing proactively and transparently

with the NHS111 whistleblowing incident

and associated media coverage with the

outcome being that the NHS England

investigation concluded that all

allegations were unfounded.

The Contract Award of the East Midlands

NHS111 Telephony Service in March

2016, a 5 Year contract that now includes

Lincolnshire as from 1st October 2016.

Contract extension for our Derbyshire

Out of Hours service to 30 June 2017, and

Community District Nursing service to 31

March 2017.

Improved performance on national and

local clinical Out of Hours Quality

Standards.

Being part of three NHS England

Vanguards in Erewash, Greater

Nottingham and Leicester, Leicestershire

and Rutland (LLR).

Excellent Patient feedback through

Friends & Family test, NHS111 and Out of

Hour’s Patient satisfaction surveys and an

overall increase in the patient

compliments about the services we

provide.

I am grateful to those who have

contributed to the content of this year’s

Quality Account (2015/16) and to those

who have worked with us to ensure that

they accurately reflect the work that we

have undertaken this year.

As Chief Executive, I am pleased to confirm that

the information contained in this Quality

Account is, to the best, of my knowledge,

accurate.

Message from our Chairman


Message from our Chairman David Whitney

It is once again a real privilege to say a few words of introduction to

this annual report as Chair of DHU. It has been a very challenging

year and a fast learning curve for the new Board and myself.

Throughout it all the one constant feature has been the high quality

of all DHU clinical services. This has been reflected in a number of

excellent reports from the Care Quality Commission; such accolades

are hard won and reflect strong leadership and wide ownership of

the clinical quality agenda by DHU staff. DHU also emerged from a

difficult period in the national media spotlight with complete

endorsement of the quality of the services we provide. Clinical

Quality will always remain our primary focus.

The DHU Board is committed to building upon the strong

foundations of our core services and to consider new opportunities

as they emerge including participation in three NHS England Vanguard projects across the geographic

area we serve.

My aim is to spend more time in the year ahead meeting all staff in the organisation and to hear your

views regarding how we can work together to develop and improve even further the services we

offer. We will also be in continuing discussion with new and existing external partners as we seek to

grow the breadth and range of our clinical services. We look forward to working closely with

patients, staff and our partners as we move forward together in the year ahead.

David Whitney

DHU Chairman

Section 1 Meet our Board


Derbyshire Health United Board of Executive and Non-Executive Directors (March 2016)

Section 1 Who we are


Who we are

6

Derbyshire Health United (DHU) is a 'not-for-profit' social enterprise organisation and is the provider for NHS Out-of-Hours services on behalf the

North Derbyshire, South Derbyshire, Hardwick and Erewash Clinical Commissioning Groups.

DHU are the provider for the NHS111 Services for Derbyshire, Nottinghamshire, Northamptonshire, Leicestershire, Leicester and Rutland and were

the provider of Offender Health and Justice services for HMP Sudbury and Foston Hall prisons. DHU believe that patients deserve good quality

treatment in a caring and safe environment.

As a team, DHU are committed to providing the best possible patient care in the right way, at the right time, in the right place, by the right people

to ultimately improve the health and wellbeing of our patients 24 hours a day, 365 days of the year.

DHU's quality account is intended to provide assurance of the quality of our service using information generated both internally and from

external organisations.

Top Row— Left to Right Bottom Row—Left to Right

Jenny Tilson—Director of Nursing and Quality Pauline Davis—Non-Executive Director

Dr Aqib Bhatti—Clinical Director Keith Nurcombe—Non-Executive Director

Dave Walsh—Director of Human Resources and Organisational Design Margaret Amos—Non-Executive Director

Stephen Bateman—Chief Executive Officer David Whitney—Chairman

Pauline Hand—NHS 111 Programme and Operations Director Christine Bain—Non-Executive Director

Dr John Blissett—Clinical Director Dr Phillip Cox—Deputy Chairman, Non-Executive Director

Peter Quinn—Director of Finance, Performance & IT Carly Gray—Company secretary (in Attendance)

Dr Trevor Mills—Non-Executive Medical Director

Section 1 Our Objectives 2015/2016


Objective 1 Patient Safety

We will provide a high quality effective and safe

service to all our patients. Placing patients at

the heart of safe, compassionate and

competent care.

Objective 5 Integration through partnerships

We will develop new models of integrated care

through embedding key partnership working

which commenced in 2014/15. This will Include

the redesign of Emergency and Urgent care

pathways.

Objective 3 Supporting our workforce

We will aim to attract, recruit, retain and

develop all our staff to be part of delivering

good quality healthcare services.

Objective 2 Focus on prevention and self-care

We will use our experience and expertise to

work with patients, families and our local

communities to develop resilience and capacity

in preventative services and self care.

Objective 4 Good Governance

We will be a well led, financially viable

organisation, balancing effective decision

making with innovation and transforming

services.

We will continue in 2015/16 to improve the quality of our services, to ensure they are safe, effective, caring , responsive

and well led.

Section 2 Our Services


DHU delivers Out-of-Hours Primary Care Service to

over a million people in Derbyshire

Dr Aqib Bhatti

Clinical Director

“The changing face of primary care

has drastically increased the

demand on the out of hours service

which has seen year on year

growth.

2015 to 2016 was the busiest yet

with over almost 100,000

appointments and almost 30,000

home visits.

The organisation has worked very

hard to ensure patient safety stays

at the forefront of all of our

objectives and this is reflected in

achieving the out of hours national

quality standards consistently for the last 12 months.

Highlights from last year - we have developed the role of the clinical pharmacist

within the organisation which has shown great promise and provided a new stream

of clinicians within the health care environment. We have also been pivotal in

supplying health care provision for the planned Erewash MCP Vanguard project.

Along with this, DHU has provided a home visiting service for Erewash, Hardwick,

Chesterfield Royal Primary Care and South Derbyshire practices by highly skilled

Nurse Practitioner's which has allowed GP's to spend more time in practice seeing

patients.

The future direction with the planned changes to the way GP's work will be a

challenge for the company but I am certain we will bridge the changes and continue

to provide a fantastic service.”

Derbyshire Health United (DHU) continues to

provide Out of Hours (OOH) GP Primary Care

Services across the county of Derbyshire.

DHU is commissioned collectively by Derbyshire’s four

Clinical Commissioning Groups (CCG’s):

North Derbyshire Clinical Commissioning Group

(NDCCG)

South Derbyshire Clinical Commissioning Group

(SDCCG)

Hardwick Clinical Commissioning Group (HCCG)

Erewash Clinical Commissioning Group (ECCG)

DHU provide local access for patients from a total of 13

locations situated throughout the county. These services

operate when your local GP surgery is closed between

the hours of 6:30pm & 8am Monday to Friday with

services being available 24 hours a day weekends &

bank holidays.

DHU Out of Hours Primary Care Services form part of an

integrated healthcare provision working alongside the

NHS 111 service and the evening / overnight District

Nursing service for Derbyshire. Integration of the three

services has allowed DHU to improve the patient

journey encompassing a multidisciplinary approach to

ensure a referral to the appropriate healthcare

professional.

In addition to the Primary Care Centres (PCC’s) located

across Derbyshire DHU also operate a fleet of 22

vehicles to support the delivery of both the Out of Hours

Primary Care Home Visiting teams & District Nursing

services.

The fleet of vehicles undertake ‘urgent’ (within two

hours) and routine (within six hours) home visits to the

elderly, terminally ill or housebound patients that

require a face-to-face assessment and are unable to

travel to one of our centres.

DHU Out of Hours GP Primary Care Services have PCC’s

and home visiting services based within many locations.

Within the PCC’s our General Practitioner’s (GP’s), Nurse

Practitioner’s (NP’s) and Minor Conditions Nurses

(MCN’s) have undertaken a total of 209,431

consultations. Incorporating a total of 28,084 home

visits, 82,353 telephone consultations and 98,994 face

to face consultations in the last year.



Delivering our

Service Out of

Hours During 2015/2016 DHU have experienced an

increase in the number of patients requiring

OOH Primary Care Services across Derbyshire.

Of the 98,994 patients that attended for a face to

face consultation in one of DHU’s PCC’s the

following PCC’s were accessed. The illustrated map

of Derbyshire highlights all of the PCC’s that DHU

work from;

Ashgate Manor – Chesterfield (19,665

patients)

Buxton Hospital (2,199 patients)

Chesterfield Royal Hospital (9,096 patients)

Derby Urgent Care Centre (23,096 patients)

Ilkeston Community Hospital (6,577 patients)

Long Eaton Health Centre (2,969 patients)

North High Peak Walk in Service (9,866

patients)

Swadlincote Walk in Service (13,777 patients)

The above services are open 7 days a week during

the Out-of-Hours period, with Ashgate Manor, Derby

Urgent Care Centre and Ilkeston Community

Hospital also having services available overnight. The

following additional facilities are open at the week-

end & also on Bank Holidays:

9. Ashbourne St Oswalds Hospital Walk in

Service (3,756)

10. Bolsover Hospital (564)

11. Clay Cross Hospital (2,179)

12. Ripley Hospital (4,599)

13. Whitworth Hospital (651)

Patient Compliment: “Nurse Practitioner visited wife, husband says he cannot praise her enough , very nice, and followed up next morning, very pleased excellent service."”



Patient Compliment: “Wanted to thank doctor and driver for excellent home visit and service in early hours ."”



11

All of DHU’s services are available to the residents of Derbyshire

and can be accessed by contacting the NHS 111 Service. Following

a thorough and detailed assessment of a patients healthcare

requirements, a NHS 111 Advisor can recommend to each patient

the most appropriate course of action such as:

Self-care advice

Contact a local pharmacy

Contact a local dentist

Contact own GP during daytime opening hours

Arrange an appointment with a GP or Nurse Practitioner

Out of Hours

Arrange an advisory telephone call from DHU’s Clinical

Team if Out of Hours

Arrange an Emergency Ambulance for a Life Threatening

Emergency

Advise attendance at an Emergency Department

If a patient requires an appointment DHU employ a large

healthcare team working together to deliver a comprehensive

service to patients across the county in addition to supporting

the wider healthcare community across Derbyshire.

DHU employs the following healthcare professions to support the

delivery of Derbyshire’s Out of Hours services. This comprises of

the following:

General Practitioners (GP’s)

Emergency Care Practitioners (ECP’s)

Advanced Nurse Practitioners (ANP’s)

Nurse Practitioners (NP’s)

Minor Conditions Nurses (MCN’s)

District Nurses (DN’s)

Pharmacist Independent Prescribers (PIP’s)

Nurse Advisors (NA’s)

Mental Health Specialist Nurses

Healthcare Assistants (HCA’s)

Receptionists

Drivers

Support Staff

Phlebotomists

Pharmacy Technicians

In addition Healthcare Professionals such as Paramedics and

Community Nursing services also access DHU during the out of

hours period via the NHS 111 service for clinical support, advice

and guidance relating to patients within their care.

Patient Compliment: “Excellent experience from start to finish - thank you.”



Improved access to our Out of

Hours Primary Care Service When patients attend an appointment in one of our Primary Care Centres, they will initially be

welcomed by DHU’s team of frontline HCA’s and Receptionists. Over the last year we have

increased the presence of this valuable team to be on duty at all centres to provide further

support for clinicians and advice to patients while waiting to attend their booked appointment

with one of DHU’s many GP’s, NP’s or MCN’s.

In addition during 2015/2016 we have increased the availability of the clinical services that we

provide at many of our sites across the county. Increased opening times, additional

appointments available at local centres and an increase in the number of clinicians at many of

our centres have enhanced local accessibility for a number of patients.

Patients living in the following areas: Ashbourne, Clay Cross, Ilkeston, Long Eaton, New Mills

and Swadlincote now have increased access to appointments locally with either a GP or ANP. In

addition to these services our main centres in Derby and Chesterfield are always open

whenever the GP surgeries are closed.

We continually review all of our primary care services to improve the availability of

appointments, the access to these appointments and the services that we are able to provide.

In addition to the above Primary Care Centres, DHU have a fleet of vehicles for GP’s or NP’s to

undertake urgent and routine home visits to the elderly, terminally ill or housebound patients

that require a face-to-face assessment and are unable to travel to one of our centres. DHU have

a highly trained and experienced team of drivers that work alongside the clinicians when

visiting patients in their own homes.

Patient Compliment: “Practitioner at Ripley was attentive, courteous, full of empathy and extremely kind”



13

DHU Out of Hours

Primary Care

Services

Performance The National Quality Requirements (NQR’s) for Out of Hours

(OOH) services have to be achieved by all providers of OOH

services. During 2015/16 DHU were able to fully achieve the

majority of the National Quality Standards requirement for Out

of Hours primary care services.

Within the NQR’s, National Quality Requirement 10 (NQR10) & National

Quality Requirement 12 (NQR12) mainly focus on Out of Hours service

delivery alongside additional local key performance indicators.

NQR10, Face to Face Clinician assessment for Urgent Walk in Patients

and Routine Walk-In Patients. DHU achieved above the target of 95%

compliance every quarter throughout 2015/16. DHU clinicians were able

to see and treat 95.2% of all urgent Walk-In Patients within 1 hour of

arrival and 97.9% of routine Walk-In Patients within 2 hours of arrival.

NQR12, Face to Face Clinician assessment. This standard relates to

patients that are identified as requiring an appointment at one of DHU’s

primary care centres or a Home Visit. During Quarter 1 (April 2015-June

2015) as an organisation although achieving the majority of the

standards for Out of Hours services we identified that a small percentage

of ‘urgent’ (appointment within 2 hours) patients were at times waiting

longer than the defined requirement. Following review of our clinical

service provision, increased staffing levels and analysis of opening times

at our centres alongside a review of internal processes DHU took an

active and focused approach to improve the delivery of services to

ensure patients that required an appointment or home visits received

these within the specified timeframe. As a result of our commitment to

patient care we have achieved a significant improvement in our

performance.

National Quality Requirement 12 had been the area of challenge for DHU

during Quarter 1 (April 2015-June 2015) where 2 parts to this 8 part

standard needed improvement. Although achieving above the required

standard for patients requiring an ‘Emergency’ (within 1 hour) and

‘Routine’ (within 6 hours) home visit or face to face consultation a

clinically led service improvement team was formed specifically to focus

on the service improvement required to achieve the ‘urgent’ (within 2

hours) target for patients that required a face to face consultation or

home visit.

Although at DHU we continue review and prioritise the improvement of

all areas of care that we deliver within the OOH service we are delighted

to report that from Quarter 2 onwards we were able to achieve all 8

parts of this standard and have continued to do so throughout the

remainder of 2015/ 2016.

Our key focus for 2016/2017 will be to continue to maintain if not

improve further our performance while ensuring improved delivery of

service, improved patient outcomes and positive patient experience.

Derbyshire Health United

Out of Hours Performance Report

Requirement / Category Target

QR10: Face-to-Face Clinical Assessments for

walk in patients at a PCC

Walk In Patients:

Identification of Life threatening condition (and

treatment initiated if required) within 3

minutes

95%

Urgent Total

Urgent Within Limit

Patients triaged as Urgent - seen with 1 hour 95%

Patients triaged as Routine - seen within 2

hours 95%

QR12: Face-To-Face Consultations

Primary Care Centre

Emergency Within 1 hour of Assessment % 95%

Urgent Within 2 hours of Assessment % 90%

Routine Within 6 hours of Assessment Limit % 85%


Home Visits - Seen within allotted timescale

Emergency Within 1 hour of Assessment % 95%

Urgent Within 2 hours of Assessment % 90%



Patient Compliment: “Thank you both for everything you did for our son. He is here today because of you, so again thank you”



14

Local Target NQR Standard NHS 111 Target

Apr May Jun QTR 1 Jul Aug Sep QTR 2 Oct Nov Dec QTR 3 Jan Feb Mar QTR 4

N/a N/a N/a N/a N/a 100.0% N/a 100.0% N/a N/a N/a N/a N/a N/a N/a N/a

28 18 15 61 25 30 17 72 24 37 29 90 37 21 32 90

28 18 15 61 20 29 17 66 22 36 28 86 34 18 32 84

100.0% 100.0% 100.0% 100.0% 80.0% 96.7% 100.0% 91.7% 91.7% 97.3% 96.6% 95.6% 91.9% 85.7% 100.0% 93.3%

100.0% 100.0% 100.0% 100.0% 98.3% 96.4% 99.3% 97.8% 99.3% 94.0% 98.3% 97.2% 97.4% 97.7% 95.2% 96.6%

100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

78.9% 82.8% 88.2% 83.0% 88.5% 91.2% 91.9% 90.5% 92.5% 91.0% 92.9% 92.2% 91.6% 94.6% 91.1% 92.3%

92.4% 94.9% 95.7% 94.2% 99.6% 99.5% 99.8% 99.6% 99.5% 99.8% 99.0% 99.4% 99.2% 99.8% 99.3% 99.4%

97.5% 99.3% 99.0% 98.5% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

100.0% N/a N/a 100.0% 100.0% N/a 100.0% 100.0% 100.0% N/a 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

86.0% 88.3% 93.9% 88.7% 91.4% 94.0% 92.6% 92.7% 95.2% 94.6% 96.3% 95.4% 94.0% 94.5% 93.8% 94.1%

92.0% 93.5% 95.4% 93.5% 94.6% 94.4% 96.1% 95.0% 94.1% 95.4% 95.5% 95.0% 94.8% 95.2% 94.3% 94.7%

100.0% 100.0% 100.0% 100.0% N/a N/a N/a N/a 100.0% N/a N/a 100.0% N/a N/a N/a N/a

Patient Compliment: “impressed with the service and the speed at which she was attended to”



15

The DHU Out of Hours Primary Care team of clinicians are also actively working with our

local Clinical Commissioning Groups (CCG’s) and a number of healthcare organisations and

GP Practices across Derbyshire in delivering services to patients during the ‘in-hours’ period.

In hours services are provided between the hours of 8am-6.30pm Monday—Friday.

DHU are Leading on the delivery of many services across Derbyshire and working collaboratively with

North Derbyshire, South Derbyshire, Erewash and Hardwick CCG’s, Derbyshire Community Health

Services NHS Foundation Trust (DCHS), Chesterfield Royal Hospital NHS Foundation Trust (CRH), Royal

Derby Hospitals NHS Foundation Trust (RDH) and Chesterfield Royal Primary Care Services to provide

access to many of the additional following services:

Royal Primary Care – Home Visiting Service

Erewash CCG Urgent ‘same-day’ GP & NP appointments

Erewash CCG Home Visiting Service

Hardwick CCG Home Visiting Service

London Road Community Hospital Clinical Support

DCHS Community Hospital Admission Clerking

DCHS telephone consultation support

DCHS Community Hospital Visiting service

Bassetlaw – telephone consultation support

QUEST (GP Practice teaching cover)

GP Practice telephone support

South Derbyshire CCG Phlebotomy Service

Foston Hall Prison visiting service & clinical support Driver quote “ “START………………………………………………………………………………….

……………………………………………………………………………………….. END”

Patient Compliment: “Thank you for being there, for being kind and understanding”



16

Co-Location at Chesterfield Royal

Hospital DHU work closely with Chesterfield Royal Hospital (CRH) NHS Foundation Trust to provide a

Primary Care service within the Emergency Department (ED). The service operates for 4 hours

weekday evenings and all day every weekend and bank holidays.

This co-location service was commenced in in November 2012 to strategically identify those patients who

present to the ED but actually can be assessed and treated by one of DHU’s Primary Care team either a

General Practitioner (GP) or Nurse Practitioner (NP).

Having the Primary Care Centre co-located within the Acute Trust has enabled enhanced patient care as

there is direct access to speciality services on-site.

On a patient’s arrival at the ED reception, a senior NP will rapidly clinically assess each patient and

appropriately transfer (stream) them to the Primary Care Centre to see a out of hours GP or NP unless the

patient has presented with symptoms requiring the care of ED.

Patients who attend with primary care conditions that require a primary care clinician will be streamed into

our Primary Care Centre to see either a GP or a NP. The waiting times for patients

This service has been found to relieve patient flow pressures within the ED at Chesterfield Royal Hospital

NHS Foundation Trust.

During 2015/16 working closely with CRH, DHU have continued to develop the service it provides at CRH.

Further discussions will support the service to evolve and develop. Over the last year we have been able to

increase the number of patients that we stream from ED into this service. The average patient outcomes are

as in the chart opposite. As highlighted in the chart opposite, the majority of patients who attend this

service are treated within the Primary Care Centre by one of our GP’s or NP’s and discharged without having

to access the ED or be admitted to hospital.

Streamed Patients

Patient Compliment: “very caring service from start , very nice , excellent service”



CQUIN Targets and

Achievements Each year DHU are set a series of targets by our Commissioner’s

which are audited quarterly. This is called the Commissioning for

Quality and Innovation Schedule (CQUIN). For the year 2015/2016

we have had two CQUINS based on the prescribing of antibiotics.

CQUIN 1

This target was based on the prescribing of a particular type of antibiotics

called broad spectrum antibiotics to measure that they were only used

within the local antimicrobial guidance. These include antibiotics such as

Coamoxiclav and Cephalexin. It is well known that these types of

antibiotics increase the risk of C Difficile, MRSA and resistant infections and

should not be used without good indication or when other types of

antibiotics are ineffective. Our clinical audit team reviewed a random

selection of prescribing cases to audit whether prescribing was within the

local guidance.

The results showed that we had an overall improvement on last year’s

prescribing. This improvement was achieved by a continuing campaign of

education and information to both our prescribing clinicians and the public.

We provided access to prescribing education sessions for staff, published

information in our internal newsletters, in addition to running quizzes and

crosswords based on the use of antibiotics to both for our staff and public.

This was displayed at events where DHU have attended to promote the Out

of Hour’s service and contribute to improving the health of our community.

CQUIN 2

This CQUIN target aimed to reduce the overall use of oral antibiotics given

to patients attending the out of hour’s service whether at a primary care

centre or at a home visit. The World Health Organisation and Public Health

England both have national and local initiatives to reduce the unnecessary

prescribing of any antibiotics.

This particular target has always been a challenge and there has been an

overall increase in the percentage of antibiotics prescribed in the year

2015/16 compared to the previous year. The nature of conditions that we

see in the Out of Hour’s period includes patients with a very high level of

infections which often require urgent attention. In addition to this, the

number of patients seeking medical care from out of hours and urgent care

is increasing overall each year.

There is little evidence of studies being carried out in other Out of Hours or

Urgent Care services for us to compare our prescribing to, which makes it

difficult to understand whether we are achieving a good result. It has been

reported by an English Surveillance programme that nationally there has

been an overall increase of 32% in antibiotic prescribing between 2010 and

2013 by community services such as Out of Hours and Urgent Care instead

of primary care services in General Practice.

To assist in improving health care, through better understanding and

prescribing of antibiotics both worldwide and nationally, DHU were invited

to take part in a World Health Organisation initiative to develop strategies

to tackle this growing problem. Our clinicians contributed to a research

project undertaken by Public Health England to look at the barriers to

prudent prescribing in the Out of Hours service.

We look forwards to the results of this study and putting and new measures

and initiatives into place to help resolve this growing problem.



NHS England introduced NHS111 to make it easier for

patients to access local NHS healthcare services in England.

Patients dial NHS 111 when they need medical help fast when

it is not a 999 emergency. The NHS111 service makes it easier

for patients to get the right care 24 hours a day 365 days a

year.

Derbyshire Health United (DHU) is commissioned to provide the NHS

111 service for Derbyshire, Nottinghamshire, Northamptonshire,

Leicestershire, Leicester and Rutland.

In order to provide the NHS111 service, DHU employ fully trained

NHS111 Call Advisors and Nurse Advisors, along with Dental Nurses,

Pharmacists and Paramedics to enable the provision of an efficient,

effective and quality service to our patients. DHU pride ourselves in

the skill mix we employ to ensure we deliver the most appropriate

outcomes for patients. DHU focus on the patient journey, ensuring

that our Advisors are fully trained in all aspects of the NHS 111 service

to ensure patients are directed to the local service that is right for

them.

Although DHU provide the NHS 111 service for Derbyshire,

Nottinghamshire, Northamptonshire, Leicestershire, Leicester and

Rutland, in Derbyshire DHU is also the provider for the Out-Of-Hours

(OOH) GP Service and OOH Community Nursing Service which enables

us to provide seamless integrated care for patients.

What does this mean?

The integrated NHS111 and Out-Of-Hours service in Derbyshire deliv-

ers a streamlined approach to patient care. DHU staff are able to

directly book appointments into 12 primary care centres or allocate a

home visit across Derbyshire from the patient’s first point of contact

with the service. DHU are able to track and trace the patient’s journey

from the start to finish

If the patient re-contacts the NHS 111 service with a query on their

Out of Hours contact in Derbyshire, then the Call Advisor or Clinical

Advisor will have visibility of the OOH system to advise the patient on

their query e.g. to inform them how long it will be for their telephone

call back from a nurse or other clinician.

When you call NHS111 for Derbyshire, Nottinghamshire,

Northamptonshire, Leicester, Leicestershire and Rutland you will be

answered by a member of our team based in one of our call centres.

Where are the staff based?

DHU’s NHS111 Services operates from 2 call centres in Derbyshire and

1 call centre in Leicestershire providing local knowledge in the areas

we provide the NHS111 service.

Our NHS111 Service

Pauline Hand

NHS 111 Programme and Operations Director

“I am delighted that DHU has had the quality of its NHS

111 service recognised in 2015/16; not only by an

excellent report from the CQC but NHS England investing

in piloting innovative ways of working in the service and

Health Education England selecting DHU as one of only

three NHS 111 providers to develop the NHS 111

workforce of the future “

Patient “ I am glad he had got me on the phone and said that I was very kind and helpful and that the 111 service is a very good service”



2012-13 2013-14 2014-15 2015-16

Derbyshire calls

offered201,181 240,134 294,627 292,966

% Increase from

previous year573% 19% 23% -1%

050,000

100,000150,000200,000250,000300,000350,000

111

calls

off

ered

111 calls offered - Derbyshire

2012-13 2013-14 2014-15 2015-16

LLR calls offered 0 172,696 201,662 214,685

% Increase from

previous year0% 0% 140% 25%

0

50,000

100,000

150,000

200,000

250,000

111

calls

off

ered

111 calls offered - LLR

2012-

13

2013-

14

2014-

15

2015-

16

Northamptonshire

calls offered0 172,696 201,662 214,685

% Increase from


0

50,000

100,000

150,000

200,000

250,000

111

calls

off

ered

111 calls offered - Northamptonshire

2012-

13

2013-

14

2014-

15

2015-

16

Nottinghamshire calls

offered98,744 174,909 252,166 268,794

% Increase from


050,000

100,000150,000200,000250,000300,000

111

calls

off

ered

111 calls offered - Nottinghamshire

Patient Compliment: “Wishes to say that he is very impressed by the level of professionalism shown by CA and NHS 111”

Our Overall Call Volumes for 2015/16

These graphs indicate the increase in call volumes year on year from 2012 and the projected call volumes for 2015/16

for the NHS 111 contracts currently held by DHU in Derbyshire, Leicestershire, Leicester, Rutland, Northamptonshire

and Nottinghamshire. Where there is no bar on the chart in 2012/13 the service in that area had not yet commenced.

Patient demand increased from 2013/14 to 2015/16 by 234,83 calls. Last year DHU answered 956,707 patient calls

through the NHS 111 service. In 2015/16 we forecast that we will answer the telephone to over a million patients,

approximately 1.1 million.



2012-13 2013-14 2014-15 2015-16

All Four NHS 111 Contracts calls

offered299,925 674,614 957,189 1,037,033

% Increase from previous year 207% 125% 42% 8%

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

11

1 c

all

s o

ffe

red

111 calls offered - DHU all four contracts

Patient Compliment: “Rang 111 and three hours later I had an appointment. Nurse Practitioner was very helpful and kind. Thank you.”



Our NHS111 Performance There are numerous Key Performance Indicators (KPI) that have to be achieved by an NHS 111 provider. These include achieving less than 0.05% of calls engaged, less than 5% abandoned calls, answering 95% of calls within 60 seconds and less than 10% calls transferred to 999 ambulance.

Reports on these KPIs are sent to commissioners daily and weekly telephone conferences take place with commissioners to discuss weekly performance. DHU also provide monthly reports which are submitted to commissioners of the service and to the NHS 111 National Team. This enables commissioners and NHS England to be able to make comparisons against other NHS 111 providers.

A monthly meeting focusing on adherence to the performance standards and quality of the service is held between DHU and our commissioners.

This meeting is in addition to the monthly Clinical Governance Meetings held jointly with commissioners and other stakeholders that have a connection to the NHS 111 service, such as East Midlands Ambulance Service, Emergency Department representatives, Out of Hours Representatives from all Counties, District Nursing Services, Patient and Public Involvement Representatives.

DHU have fallen slightly below the 95% national target for answering calls in 60 seconds, although usually achieve higher than the National average. The average length of time it has taken DHU to answer call during 2015/16 is 22 seconds, which is an excellent achievement.

Our emphasis during 2016/17 is to improve upon this target and to ensure all patients are answered with line with national KPI’s. DHU continue to increase our staffing numbers in order to meet the rising demand and are actively scrutinising all aspects of our service to aim to consistently achieve all national targets.

A further national KPI measured within the NHS111 service is the time for Clinical Advisors to call patients back following transfer to our nurse triage queue. We have found this target to be challenging due to increasing patient demand and some difficulties in recruiting Clinical Advisors .

To ensure that our service is safe for patients we have employed the assistance of Agency Clinicians who are clinically trained in NHS111 Pathways. Furthermore due to the integrated NHS111/OOH service in Derbyshire we have been able to provide our NHS111 service with additional GP support. Nurse recruitment is currently a national problem. DHU have developed a recruitment strategy

focusing not only on the recruitment and retention of Nurse Advisors but Dental Nurses, Pharmacists and Paramedics.

The target of Clinical Advisor call backs is currently being reviewed nationally in line with the new NHS111 specification and DHU are in discussion with our commissioners in terms of agreeing a more appropriate locally agreed target.

DHU have one of the lowest referral rates to 999 ambulance from an NHS 111 service in the Country at approximately 10.8% of calls.

The graph highlights the percentage of final dispositions that result in an emergency ambulance being dispatched on total triaged calls.

Our Ambulance Despatches to date

Patient Compliment: “patient wanted to say that we get a lot of bad press but his experience has been very good with the 111 service and we deserve more recognition for what we do”



22 Patient Compliment: “impressed with the service and the speed at which she was attended to”



23

Our NHS111 2015/16

Key Achievement In order to ensure all NHS 111 staff are supported, motivated

and engaged to deliver a high quality service we have

restructured our frontline management team.

Our NHS111 management restructure has resulted in us having clearer

and consistent clinical and operational leadership on every shift. It also

ensures each staff member has a named Team Manager who supports

them to improve and sustain their performance against the clinical and

operational targets. A Lead Clinician role is also in place to ensure

delivery of clinical leadership and the safety of our service.

We continue to employ Dental Nurses and Paramedics to complement

our clinical team and have now also recruited Pharmacists ensuring

patients have access to a variety of health care professionals to meet

their specific and individual needs.

Pharmacists supporting patients

Another key development was the introduction of a Pharmacist into

the call centres to support patients with calls regarding medications. If

a patient is concerned they have taken too much of their medication or

missed a dose the advisor can direct these calls to a Pharmacist to

ensure they get expert advice in a timely manner. Pharmacists can

also take to patients or callers following toxic ingestion where

appropriate.

NHS 111 Internal Updates

In order to ensure all NHS 111 staff are continually informed of new

developments, training initiatives and any learning from incidents and

complaints last year we introduced a NHS 111 Update specifically for

this task which is sent out to staff on a fortnightly basis (more often if

required).

NHS111 Live Update

This has been a very successful communication tool which has been

welcomed by staff. During 2015/16 we have added to our

communications by introducing a ‘Live Update’ which informs advisors

of any real-time changes to service delivery ensuring all staff are fully

updated on a daily basis

NHS 111 Audit Team

We have implemented a dedicated expert audit team. This team will

ensure call audits are completed in a timely manner as per our licence

agreement and that the learning outcomes from audit are fed back to

staff members. Subsequent evidence of change in practice will be

collated to demonstrate DHU is supporting staff development within a

learning cycle.

DHU Staff Engagement Events

Our desire for a motivated and engaged workforce has prompted us to

provide regular staff engagement events which are well attended and

well received by staff providing them with the opportunity to meet

with Directors and Board members away from the call centre setting.

Patient Compliment: “Wanted to thank myself and the 111 service for being such a good service and getting the help she needed straight away, thinks it is the best part of the NHS.”


Derbyshire Health United Ltd. Quality 24

NHS 111 Clinicians Home working

We now have a number of clinical advisors who can work remotely

on the NHS 111 service from home. This provides us with a pool of

staff with a high degree of flexibility to assist our patients at times

of high service demand.

Nikki Argent—NHS 111 Clinical Lead: “Working from home suits me

down to the ground as I am able to assist the service during busy

periods, whilst maintaining a healthy work/life balance”

Paramedic in Call Centre

Another key development is the introduction of a Paramedic into

the call centre to support EMAS with their winter pressures. The

paramedic reviewed selected ambulance outcomes to assess

whether the patient is clinically safe to make their way to the

Emergency Department by means alternative to an ambulance.

29 NHS 111 staff are also taking up the opportunity to shadow a

Paramedic on emergency calls to provide them with the

opportunity to understand what is a life threatening emergency

and therefore an appropriate 999 referral.

Our DHU UXL Program

In 2015 DHU have continues with their successful UXL

program, an innovative internal learning and

development program targeted to support front line

employees.

DHU takes an active approach in order to improve the patient’s

safety, journey, experience and the quality of our service delivered.

UXL enables this by providing methods of support which include

one to one coaching, training sessions and frequent feedback to

our NHS111 employees.

UXL continues to be delivered by our team of highly qualified and

experienced trainers to further support staff and to gain their

contribution to improvements in delivery of our clinical and

operational targets.

Comments from staff following UXL interventions include:-

Interesting & good suggestions for call shortening safely.

Good to refresh on questioning

Good data packages

All relevant to role & helps to build up skills after time &

experience in call centre

Patient Compliment “I wanted to compliment Call Advisor and Nurse who was very kind, caring, empathetic, warm, and helped

me to open up and talk which I find very difficult”.



Reflective

Supervision Reflective supervision was introduced within our NHS111

service to provide additional support for our employees.

Based around the principles of clinical supervision it has

proved to be a valuable tool which has cumulated in the

development of the reflective supervision policy.

Reflective supervision has been made mandatory in order to

support both Call Advisors and Nurse Advisors following

completion of their training.

This reflective supervision process is unique to our NHS111 service.

Call Advisors and Nurse Advisors are encouraged to attend a

reflective supervision session with their reflective supervisor

following involvement in a serious incident, complaint and

following calls that have been distressing or difficult.

Our reflective supervision sessions take place on a regular basis to

enable our employees to have discussions with their reflective

supervisor in a confidential safe environment.

By providing reflective supervision for our employees, we aim to

improve patient safety, staff retention, provide a high quality

service and encourage a positive learning environment.

Susan Hubbard (Right) Reflective Supervision Supervisor delivering a supervision session with Carole Dysart NHS111 Nurse Advisor (Left)



The DHU out of hours Community Nursing service

provides skilled, flexible nursing care to meet the

needs of individuals and carers in the community.

The service is delivered in a caring and non-judgmental

manner in agreement with the individual and carer, taking

into account their physical, social, psychological, cultural

and ethnic requirements.

The out of hours service will provide both planned and

unplanned care to patients in their own homes in

partnership with the day time Community Teams and

evidence based interventions may include but not be

restricted to:

Bowel Management

Catheter Management

End of Life – Terminal Care / Palliative Care

Leg Ulcer Management

Medicine Administration

Syringe Driver Management

Wound Care/Tissue Viability including complex

wound management

Our aim is to provide high quality nursing care, in the most

appropriate setting to reduce hospital admissions,

promote quality of life, facilitate early discharges and

coordinate complex packages of care. The service

operates 7 days a week.

The District Nursing Service at DHU operates from

6pm-8am in Derbyshire County and 10pm-8am in Derby

City 7 days a week.

DHU employ District Nursing Sisters, Community Staff

Nurses and trained Health Care Assistants. We have a

number of bases across the county, during the evening we

have seven teams working until midnight and two teams

after midnight.

The nurses always travel in fully equipped company

vehicles. Our minimum requirement is that each vehicle is

manned by at least 1 Registered Community Nurse and 1

trained Health Care Assistant.

District Nursing Service Out of Hours

26

Patient Compliment: “Numerous contacts with the DN service - patient

has passed away needing to cancel the DN phone calls and visits, also

wanting to say a big thank you from the family of the patient and the

community nurses for their help ”



27

DHU taken delivery of a fleet of

brand new response vehicles

to boost our ability to reach

housebound patients in

remote areas of the county.

DHU has provided the out of hours District

Nursing service for Derbyshire since April 2011,

and recently we have upgraded our fleet of

vehicles to enable us to continue to meet the

needs of these patients in all weathers across

the county.

We have taken delivery of 6 brand new Renault

Kadjar 1.6dCi dynamique four wheel drive

response vehicles and these are now being used

by our District Nursing teams based in Buxton,

Matlock, Chesterfield and Derby.

The cars are fully equipped to allow the District

Nursing teams to carry out their duties

throughout the county.

Patient Compliment: “Wants to complement the service in general, but in particular the nurses that went to her this morning”



28

Participation Initiatives

Members of the DN team at DHU are actively involved in the

following initiatives:

DHU Patient Participation and Involvement Group.

DHU Communication and Engagement Forum.

The Care and Compassion Agenda (Caremakers) NHS

England.

Signing up as Dignity Champions.

Becoming Dementia friends.

Queens Nursing Institute

By being involved in these initiatives, members of the DN team at

DHU are hoping to enhance the care received by, and the service

delivered to, the patients of Derbyshire.

Joined up Working and Communication

The District Nursing Service in Derbyshire offers a 24/7 service to

housebound patients requiring nursing care within their own

home. The daytime service in Derbyshire County is delivered by

DCHS 8am-6pm and the out of hours service is delivered by

Derbyshire Health United 6pm-8am. In Derby City the daytime

service is operated by DCHS until 10pm. The daytime service can

refer patients for planned care in the out of hours period, if

appropriate. We therefore work collaboratively with DCHS in order

to provide a seamless transition between the in hours and out of

hours service. We aim to do this in a number of ways:

Bi-monthly operational meetings between DHU and DCHS

team leaders.

Sharing of incidents and issues promptly between

organisations when they arise.

Automatically sending a record of all patient contacts to

the GP practice following a visit (if consent is gained).

Referring patients back to their own day team the following

day, if required.

Following the care plan as agreed by the day DN team and

the patient.

Use of Rightcare plans to view important patient

information relating to long term conditions and end of life

care.

Liaising with care agencies, care co-ordinators and DN

teams regarding ongoing care.

End of Life Care and Syringe Drivers

Every month the DN team carries out an average of 80 visits where

the patient has, or requires a syringe driver. Syringe drivers are

essential pieces of equipment used in end of life care and the

District Nursing team at DHU has syringe drivers available at its’

bases.

The District Nursing team at DHU is very experienced in caring for

patients at the end of life and participate in ongoing training and

development provided by the Derbyshire Macmillan End of Life

Care Development team. DHU also has representation on the

North Derbyshire End of Life Forum, the North Derbyshire End of

Life Project, the DCHS End of Life Care Group and the Derbyshire

wide End of Life group.

By being engaged with our partner organisations in these groups

we aim to be actively involved in service development which hopes

to improve End of Life care across Derbyshire. Our nurses support

the out of hours service carrying out verification of expected death

for patients who have chosen to die at home. Our District Nursing

team carries out approximately 50 of these visits each month, and

we attend training to enable us to carry out this service.

Patient Compliment: “Extremely helpful, very friendly, treatment with a personal touch”

Patient Compliment: “Wants to compliment the service in general, but in particular the nurses that

went to her this morning. The service gives her great confidence especially as she is on her own ”



End of Life Care and Syringe Drivers

Every month the DN team carries out an average of 80 visits where the patient has, or requires a syringe

driver. Syringe drivers are essential pieces of equipment used in end of life care and the District Nursing

team at DHU has syringe drivers available at its’ bases. The District Nursing team at DHU is very experienced

in caring for patients at the end of life and participate in ongoing training and development provided by the

Derbyshire Macmillan End of Life Care Development team.

DHU also has representation on the North Derbyshire End of Life Forum, the North Derbyshire End of Life

Project, the DCHS End of Life Care Group and the Derbyshire wide End of Life group. By being engaged with

our partner organisations in these groups we aim to be actively involved in service development which

hopes to improve End of Life care across Derbyshire.

Our nurses support the out of hours service carrying out verification of expected death for patients who

have chosen to die at home. Our District Nursing team carries out approximately 50 of these visits each

month, and we attend training to enable us to carry out this service.

Training and Development

The DHU District Nursing team undertake a range of training and development activities. They are required

to undertake mandatory training as part of their role, which includes basic life support, information

governance, health and safety, safeguarding and infection control.

In addition to this, the DN team also attends a patient handling study session and dementia awareness.

Other training available has been verification of death, catheter management, percutaneous endoscopic

gastrostomy management and domestic abuse training. There has been training specifically aimed at our

Health Care Assistants including second checking and clinical skills. We also offer sessions relating to

chaperoning and customer care.



DHU District Nursing Team Activity

In 2015/2016 the DHU District (DN) Nursing team carried out 18398 visits

across Derbyshire. We aim to visit those with a high priority within 4 hours as

per our service specification, or sooner wherever possible. We achieve this

target in 99% of cases. We aim to visit those assessed as requiring a routine

visit within 6 hours.

Incidents

At DHU we encourage our staff to report incidents, and all reported incidents

are investigated to allow positive change and improvement in our services

and learning from the issues raised.

90 incidents were reported and investigated by the DN team in 2015/2016.

On average there are 7 incidents logged per month that have been allocated

to the DHU DN team. In 2015/2016 we had he largest number of reported

incidents related to pressure ulcers, numbering 15 (17%). This reflects the

locally agreed process relating to the recording and reporting of new

pressure ulcers.

The second largest group of incidents related to medication and syringe

drivers at the end of life which totalled 14 (16%). DHU recognises the

importance of prescribing at the end of life and is actively involved with our

partner organisations in education and training of staff groups relating to end

of life care.

The DN team leaders have been working with their colleagues within

Derbyshire Community Health Services (DCHS) to ensure improved continuity

and communication between the in hours and out of hours services.



DHU Offender Health &

Justice Services

The Offender Health & Justice Division is responsible for

delivering high quality care to prison establishments across the

Derbyshire County. A wide range of service are delivered

including:

Primary Mental Health

Clinical Substance Misuse

Long Term Conditions Management

Urgent Care

GP Services

Sexual Health & Contraception

Immunisation & Vaccinations

Medicines Management

The purpose of the service is to ensure individuals residing

within the prison establishment receive a high quality of care

that is equitable with healthcare services available to the

general population within the community.

HMP Sudbury HMP Sudbury is a Category D (Open) Prison that has the

capacity to hold up to 584 male prisoners, over the age of 21.

HMP Sudbury is a resettlement prison designed to support the

reintegration of longer serving prisoners back into the

community.

The Healthcare service operates 7 days a week between 07:30

and 17:00.

HMP Foston Hall HMP Foston Hall is a closed female establishment that has the

capacity to hold up to 381 prisoners over the age of 18.

HMP Foston Hall also has a dedicated unit to support patients

with a confirmed personality disorder.

The healthcare service operates on a 24/7 basis and is

delivered by a multi-disciplinary team.



Paper-light

Accreditation DHUs Prison Healthcare services were successfully awarded

paper light accreditation by the Arden & GEM Commissioning

Support Unit in 2015.

This is a significant achievement for our Administration and

Support teams who worked to ensure we had the appropriate

policies and procedures in place to obtain our accreditation.

DHU is proud to be one of the few prison healthcare services in

the country to receive this accreditation.

Patient Stories DHUs Offender Healthcare service works with some of the

most challenging, disadvantaged and hard to reach

patients in society. Here are just a few examples of how

we have helped patients improve positive health

outcomes:

Early Identification & Screening

By working with patients from the moment they arrive into our

care DHU can maximise a patients opportunity to improve their

wellbeing. When a patient arrived into Foston Hall in 2015, DHU

worked with the individual to have a series of tests to ensure they

had not contracted any blood born viruses (BBVs) since their

release into the community some months prior.

Unfortunately the patient had contracted a virus whilst in the

community. DHU, in conjunction with the Prison and colleagues at

the local clinic arranged for the patient to received fast access to

specialist care following her diagnosis. Although the patient was

only in custody for just over six weeks, our early identification and

proactive care plan approach ensured this lady was released back

into the community with a confirmed diagnosis and clear

management plan in place.

DHU also ensured that the patient received continuity of care back

into the community, through effective clinical handover to

community services. Had DHU not have taken a pro-active and

timely approach this patient may well have been unaware of her

condition.

Engagement with Healthcare

A patient who arrived into our care was complaining of severe

abdominal pain. The Nurses arranged for this patient to be taken

to a local hospital, where they were suspected of having a sever

abdominal problem. The GP & Nursing Team at HMP Foston Hall

worked to ensure that the patient received timely and effective

care.

By liaising with community services, our team were able to

confirm that the patient was due to undergo investigations whilst

in the community, but had failed to attend their appointment due

to their chaotic lifestyle. Whilst in custody the DHU healthcare

team ensured that the patient received the appropriate

investigations which confirmed a life threatening condition.

As the patient was due to be released following diagnosis, DHU

worked with the patient to ensure that a clear care plan was in

place and arranged for the patient to receive surgery at the local

hospital. The patient has since made a full recovery.

Patient Compliment “Just wish to say a massive thank you to all the staff, as you are all so kind, caring and understanding. I know it's your job but you still go above and beyond. This is very much appreciated, thank you.” Patient Compliment “I would like to thank all the staff for their help and support over the past 18 months, they are a great professional and friendly team.” Patient Compliment “I would like to thank all the healthcare staff for their help and support whilst being at Sudbury. All the Healthcare Team are always polite and respectful. It's a shame other prisons don't have a healthcare like this one.”

Section 3 Our People


Many of our staff have backgrounds in other areas of the health

community and many of them retain their skills and knowledge by

also working at DHU. During 2015/16 our staff worked with the

Executive Directors to develop our vison, values and behaviours which

are now embedded within our organisation. We have since added the

new vision, values and behaviours to the performance and

development review process. During 2015/16 DHU have focused on

employee retention, employee career development, how we engage

with our employees and how our employees receive recognition for

their contribution to DHU. Successful key achievements during

2015/16 and our actions taken to engage our employees over the last

12 months are as follows;

Improved recruitment process.

Use of LinkedIn & Job Boards.

Introduced assessment centres within our NHS111 service

Relaunched Recommend a Friend Scheme.

Provided our Managers with training/workshops in

appraisals, return to work and exit interviews and absence

management.

Improved our corporate induction process.

Commenced a Communication & Engagement Forum (CEF)

made up of staff representatives from different divisions

across our organisation.

Introduced employee loyal service awards

Introduced employee recognition scheme ‘The Limelight

award’.

Carried out and fed back an employee engagement survey.

Developed and introduced new vision, values, behaviours.

Produced a monthly Board Brief.

Produced a fortnightly NHS111 Newsletter.

Successfully held Annual & Bi-Annual Communication Events

Ran development workshops for 20 line managers.

Improved and updated or HR policies.

Introduced an appraisal window to measure percentage

completed (94% achieved 2015/16 ).

Reviewed and increased rates of pay in our NHS111 service.

Provided an attendance bonus over winter period.

Launched GCC events across 7 teams within DHU promoting

health and wellbeing.

Leaver & exit Interview administration reviewed and

amended.

Recruited a HR Advisor aligned to our NHS111 service,.

33

Derbyshire Health United (DHU) is

dedicated to our workforce with a

strong history of attracting and

retaining loyal and committed staff.

Patient Compliment: “wonderful, thank you for employing brilliant staff”



34 Patient Compliment: “Felt the call advisor did a good job , says she was very ,very helpful and pleased with the whole experience”



Communicate DHU set up the Communication & Engagement Forum (CEF) in

2014 to improve communication and Engagement between all

divisions of DHU.

This forum consists of employee representatives from across

the entire organisation where we meet on a monthly basis. An

open discussion is held with the CEO and Director of HR during

the formal meeting with suggestions, actions and minutes

which are shared on our intranet will all staff.

DHU believe employees will be able to perform at their best

when they know and understand their duties, obligations, rights

and have the opportunity to make their views known to the

management team on issues that affect them. Through their

representatives on the forum.

DHU has made improvements in 2015/16 to internal and

external communications and engagement. This has enabled

DHU to have the ability to exchange views, issues, receive

instructions and discuss new ideas.

The Communications and Engagement forum have worked on

some amazing initiatives to improve communications and

employee engagement within DHU.

These include for example developing a recognition scheme The

Limelight Award, Loyal Service Awards presented at our Staff

Engagement Events in October, our staff annual survey and

developing our Vision, Values and Behaviours.

Patient Compliment: “Service was brilliant.... staff there were wonderful, caring and considerate”



36

Develop We have a long standing annual Performance and Development

review process which takes place once per year between April

and September. This year we achieved 94% of completed

appraisal reviews. Only our staff on long term sickness or

maternity leave were unable to be reviewed at that time.

Managers and staff were able to discuss and record the

following:

Comment on objectives set in the last review, and

summarise evidence gathered to support a rating.

Summarise and expand on what has been done well as

well as summarising and expanding on aspects/areas of

performance where there could be improvement,

Discuss and record training and development needs and

possible outcomes.

Agree and set objectives for the coming year.

Agree career aspirations and record any succession

planning implications.

Achieve Human Resources (HR), the Payroll department and the

Communications department have been working on several

issues during 2015/16 In order to improve employee

engagement and retention. We have introduced assessment

centres for all our recruitment in Out of Hours, Prisons,

Walk-in-centre, NHS111 and corporate divisions. This is to

ensure we attract and retain the right calibre of candidates, and

this initiative has led to the successful recruitment of 180

people in last 6 months. Once recruited they attend our

improved and re-launched corporate induction process.

The Communications and Engagement group continues to

thrive. Our monthly meetings have improved communications

and engagement across all levels of staff. We provide staff

newsletters, external communication and are conducting our

second employee survey. HR has also been pivotal in helping

line managers to improve attendance by running absence

management training workshops for line managers and

conducting absence management surgery sessions.

The Payroll team have worked on the Payroll system and

continue to administer changes to the NHS Pension scheme,

successfully launched the NEST Pension Scheme and

administered Pension auto enrolment.

On top of this the team provided an employee relations service

which includes revising policies, advising on disciplinary,

grievance issues and managing TUPE transfers.

Phillip Plumb - Staff Representative for NHS111 Call Advisors

“I am 65 years old and have a dual role at DHU that splits my

time between call advising and the Rota team. I lived in Berlin

for many years and have worked in aviation for most of my life.

My free time is spent taking pictures, listening to jazz and the

cinema. Having been involved with the German works councils I

enjoy the challenge of the Forum and look forward to

representing ideas, suggestions and criticisms”.

Our Staff Appraisal Process

Within the staff appraisal process, individual objectives and targets are set which are related to the Company’s corporate objectives.

The overall aim of this scheme is to maximise individual employee effectiveness and potential. Our substantial Education and Training

Division encompasses all mandatory training within the company which includes Safeguarding Children and Vulnerable Adults,

Information Governance, Basic Life Support, Moving and Handling, Infection Control and Health and Safety. We also offer our sessional

GPs supported training days, a system of alerts on clinical issues accessed via a login-protected area of our website and other

professional support services.

Patient Compliment: “Patient called to compliment service - says we are lovely team”



The communication and Engagement Forum (CEF) played a key part over 2015/16 in developing our Vision, Values and Behaviours. At DHU we care for our

employees as well as the patients we treat. It was through the use of the word ‘CARE’ that the strapline ‘DHU we CARE for you’ was developed to help embed

our vision, values and behaviours. At DHU we believe that everyone should always show Care and compassion, Always professional, Respect and show dignity

and to always remember that Everyone matters. ‘DHU we CARE for you’ represents how we feel towards our patients and colleagues. In 2015 our employees

were presented with new lanyards with ‘DHU we CARE for you’ written on them to remind the public and patients, that is what we are here for.

DHU we CARE for you Care & Compassion

Putting patients interests at the heart of everything we do

We believe:

In a deep desire to help our patients and our colleagues

In going out of our way to help others in a less fortunate position

In putting the patients interests first

In being truly compassionate and genuinely understand, feel and identify with their needs of

our patients and colleagues

We behave:

We will actively listen to understand and empathize with others’ distress, suffering, misfor-

tune, and individuals realities, with a desire to alleviate it by to support both patients and

colleagues

We will always ask the question of ourselves ‘Would it be good enough for one of my family

members?’

Always Professional

Demonstrate excellence in everything we do.

We believe:

In delivering an efficient and effective service for the patient at the right time at the right

place.

In public and patient involvement

In the development of our Get things ‘Right First Time’ services

We behave:

We will be accountable for consistently delivering high quality healthcare for our patients.

Mission: DHU exists to provide caring, high quality, safe and effective healthcare to our patients and the communities we serve

Sue Fallon, Clinical Lead, Senior Nurse Practitioner and Audit Lead said “Being part of the

Communication and Engagement Forum means sharing feedback from colleagues and seeing

positive results. It is also great to share issues with other staff group, and being able to see

situations from a different perspective.”


Respect and Dignity

Everyone has the right to respect and dignity

We believe:

In maintaining and respect patients dignity to ensure it is never compromised

That treating people as individuals, whatever their differences or values, and ensuring

that their particular needs are met

We behave:

We will actively listen to each other and our patients to answer their concerns or

questions.

We will maintain and respect patients dignity and must ensure it is never compromised

Everyone Matters

Placing our colleagues and patients at the heart of the organisation

We believe:

To achieve the full potential of the organisation we will develop skills and talents for the

mutual benefits of patients and staff members.

In providing a stable and positive working environment for all

We behave:

We will actively encourage feedback from both patients and colleagues to continually

improve our service

Ensure everyone has an opportunity to have their voice is heard

To ensure everyone has an opportunity to further develop their skills and competencies.

38 Vision: DHU will engage our staff and improve our service in order to become the provider of choice to Commissioners




In June and November 2015 David Whitney

(DHU Chair) and Stephen Bateman (Chief

Executive Officer) invited all employees to

attend our Staff Engagement Events which

were held in Derby, Alfreton and

Chesterfield.

Following feedback from our staff engagement survey, in June and

November 2015 DHU held three Staff Engagement events so that our

employees understood developments within DHU. This gave our

employees the opportunity to ask questions, and for both David and

Stephen to offer their time to colleagues in a face to face arena.

These events were an opportunity for Stephen to highlight to

employees organisational changes within the last year and to share with

them the DHU strategy for 2015/16.

At these events, Stephen gave a presentation based on each of the

main organisational services including the Out-of-Hours service, NHS111

service, Health and Justice (Offender Health) and our District Nursing

Service. The aim of the presentations was to give colleagues the

opportunity to gain an understanding of the wider picture of all DHU

services.

David and Stephen introduced our new DHU Non-Executive Board

members, along with other board members who will play a major part

in shaping the organisations future.

The DHU Staff Engagement Events in June and November 2015 were an

overall success. DHU will now be holding our Staff Engagement Events

on an annual basis.



Rewarding our employees for their

loyalty working for DHU to provide

quality services for our patients.

Introducing the DHU Loyal Service

Award.

Following feedback from staff at Communication and

Engagement events we asked the representatives from

all divisions of DHU attending the Communication and

Engagement Forum to develop a DHU Loyal Service

Award. The award was approved by the Executive

Directors and the Board of Directors in summer 2015.

On the 1st October 2015 we introduced the new loyal

service award to all employees within our organisation.

The award was designed to recognise individual’s loyal

service to DHU.

It was also agreed by the Executive Directors and the

Board of Directors that if an employee was employed

prior to this by the two founding companies Derbyshire

Medical Services and Derbyshire Health Care would

also be entitled to this award.

During our staff engagement events on the 18th, 25th,

26th November and the 2nd of December these

awards were presented to our employees from

Stephen Bateman (CEO), David Whitney (Chairman)

and Dr Phillip Cox (Vice Chairman).

Employees were presented with Love 2 Shop vouchers

up to the value in accordance with the number of years

they have been loyal to DHU.

In addition, our employees received a congratulatory

letter from Stephen Bateman and were presented with

a gold pin stating how many years of loyal service they

have shown to DHU.

These awards will take place annually at our Staff

Engagement Events and our HR department will

monitor on an annual basis who will receive their loyal

service award during the year.

Pam Garvey - Call Advisor. “I really enjoyed

receiving my loyal service reward, not many

organisations provide you with this, and its

nice to know my work is recognised by our

organisation”

Engaging with our staff and rewarding their loyalty to providing quality

services for our patients across Derbyshire and the wider East Midlands

Lisa Riley

Call Advisor presented with a 15 Year award

Steve Ault

ECP presented with a 10 Year award

Sue Pitcher

Payroll Assistant presented with a 10 Year award



Our Staff Satisfaction DHU carried out a staff satisfaction survey to obtain information about employee views and opinions and how they feel working for DHU. The staff survey was e-mailed out to every employee within the company.

Feedback from the Staff Survey Feb/March 2015 was provided to our Communication and Engagement Forum and then shared with the entire organisation via their Line Manager.

Our survey questions were split in to the following 5 areas of focus;

1. Provide staff with clear roles, responsibilities and rewarding jobs

2. Provide staff with personal development, access to appropriate education & training

3. To provide support & opportunities for staff to maintain their health, wellbeing & safety

4. To engage staff in decisions that affect them and the services they provide.

5. Staff Satisfaction

Overall there were a lot of positive messages arising out of the staff survey. The following are the four areas that DHU are performing at our best;

1. I am satisfied with the quality of care I give to patients / service users

2. I feel that my role makes a difference to patients / service users

3. In the last 12 months I have had an appraisal, annual review, development review or probationary review

4. Overall in staff satisfaction the numbers who are sometimes, often and always satisfied are higher than those who is higher than those who are rarely or never satisfied

Staff Areas Completing Survey



There were a number of areas in which we needed to do some work as below;

1. Although the percentage was very low of the proportion of staff feeling bullied or harassed by Managers/Team Leaders or other colleagues this was addressed urgently.

2. Although the percentage was very low of the number of staff feeling bullied or harassed by patients or service users this was also addressed urgently.

3. A proportion of staff felt that they were not involved in deciding changes introduced that affected their work area/team/department.

4. Some staff felt communication between senior managers and staff was not as effective as it could be.

We tackled this by:

1. Sharing the results with the Employee Communication & Engagement Forum.

2. Communicated actions we were proposing to take in the News Letters/ Board Briefs and Staff Engagement Events.

3. Pledged to take action and then feedback prior to the next survey due in May 2016.

4. Asked staff at engagement events for their ideas on the best ways to tackle the issues.

5. Held staff focus groups at departmental level to feedback results and discuss any issues

6. Promoted the whistleblowing Policy.

7. Provided line Managers with a suite of training sessions.



The Limelight Award

The “Limelight” recognition scheme was introduced in February 2015 and has successfully awarded so

far 14 employees within the organisation over 15/16 for their contribution in providing not only quality

patient care but care and compassion displayed towards colleagues.

This scheme is designed to reward our employees who have gone that extra mile to help, support and

care for patients or colleagues. The title of this scheme has been chosen to reflect this, as “Limelight”

and is to illuminate not rank DHU employees.

The “Limelight” award is a monthly award where employees nominate colleagues within the DHU via

the online nomination form found on our intranet. The decision who wins the award is made by staff

representatives on the Communication and Engagement Forum.

The winners are announced in conjunction with the dates of the Communication and Engagement

forum which is the 3rd Tuesday of every month. The winner is then presented with a small financial

reward in vouchers and the honorary “Limelight” pin badge which our employees wear on their lanyard

to show they have been recognised for their contribution to DHU.

The winner also appears in our internal monthly Board brief highlighting why they have won the award.

The winner also receives a thank you message from Stephen Bateman CEO, and a personalised letter

written by our CEO which is then placed in their personal file.

Throughout 2015/16 this award has been presented to our employees for contributing some

outstanding levels of care in not only patient facing roles within DHU, but corporate roles as well. At

DHU we are very proud of our Limelight award and look forward to recognising more employee efforts

in the future.

43

An intense illumination of employee effort, as someone placed in the

“Limelight”, centred on their exceptional contribution to DHU in providing

not only quality patient care but care and compassion for each other.

Limelight Winners (Top row, left to right) Lyn Kinder (Evening Nursing Service) - November

2015 Winner, Paul Tilson (Deputy Clinical Director, Primary Care Division & Operations)

October 2015 Winner, Jean Rigby (Health Care Assistant) July 2015 Winner.

(Bottom row, Left to right) Claire Nesbeth )CQI Non Clinical Pathways Trainer), February 2016

Winner and Rebecca Harrison (CQI Manager) who was the very first winner of the Limelight

Award when the scheme first started in February 2015.



Global Corporate Challenge At Derbyshire Health United (DHU) we value our employee health and

happiness and that’s why DHU gave our employees the opportunity to

participate in the GCC (Global Corporate Challenge).

The GCC was a 100 day virtual journey across the globe. It was a great way to

introduce some fun and healthy competition amongst not only our employees

at work, but with other organisations taking part. More than 300,000 people

from around the world were taking part this year.

We encouraged seven teams of ten employees to join in from September,

finishing in December. Our teams of seven had to track their daily activity using

a GCC Pulse accelerometers that GCC provided to measure the number of steps

made. The more active the team, the further our teams progressed around the

world.

The DHU winning team was ‘Quality in motion’. Members of Quality in Motion

were Beckie, Beth, Claire, Karen , Linda , Stephen and Zarka. They travelled

4,373 miles and visited 149 locations across the globe including Sydney

Australia, Hong Kong, New York, Canada etc. Quality in Motion received a DHU

Health and Wellbeing Cup, a certificate each and a £20 JD sports gift card each.

Beyond the 100 days, the GCC also provided our employees with a 12-month

platform to ensure that learning and positive healthy habit formation

continued throughout the year.

Overall the GCC has been a complete success at DHU and plans are being made

for our employees to take part in the Global Corporate Challenge which starts in

May 2016 to further improve our health and wellbeing here at DHU.

44

Tom Oxley: “I really enjoyed taking part in the global corporate challenge, I found it extremely

motivating and encouraging to get healthy. It was not just about increasing the amount of

exercise, it was about improving my sleep pattern, my eating habits and measuring my fitness

overall. This challenge has helped me to make some lifestyle changes that I still do today,

Thanks DHU for signing up to the GCC and encouraging me to take part”



DHU employee charitable work for our community

During Christmas 2015, our NHS111 Deputy Service Delivery

Manager Cara Brazier organised and facilitated the collection

of gifts placed in shoe boxes for a local refuge. DHU Employees

made donations of money/gifts and in total collected 35 bags/

shoe boxes full of gifts for the local refuge in order to make a

difference to people’s lives on Christmas Morning.

There were 20 adult and 15 children present bags and Boxes,

which were kindly handed over to the Domestic Abuse

Manager on Tuesday 15th December 2015.

The local refuge informed DHU they would be delivered to 7

local refuges in time for Christmas and she thanked DHU

dearly for our kind donations.

Cara Brazier “I must say I have been amazed with the

generosity and kindness of others while collecting donations

and I feel proud to work for a company like DHU with such

compassion and kindness for others in need”.

DHU make time For “DIGNI-TEA”

On Monday the 1st February 2016 DHU held a bring and buy

cake sale at Ashgate Manor, Mallard House, Fosse House and

Charlotte House to raise money for Charity and support the

awareness of dignity and compassion to each other.

The Dignity in Care campaign began in November 2006 to

inspire health & social care staff and local people to place dig-

nity and compassion at the heart of care services

At DHU our employees wanted to show our support to the

Dignity Champions who are doing what hey can to make a

difference in peoples’ lives.

Dignity Action Day takes place on 1st February every year. It is

not necessarily a day for the ‘grand gesture’ but more about

taking the time to do something, however small, for people

who too often feel isolated and of little value to society.

At DHU, we remember Dignity is everybody’s

business!



Image Employees at Derbyshire Health United (DHU) have raised

over £2,300 for 23 charities over the last twelve months at

our Ashgate Road offices. The cash has been raised

through a charity snack box where our staff donate

money for healthy snacks, drinks, sweets and soup.

Our staff have all ‘tucked in’ to the snack box scheme by

choosing the charities they wish to benefit. Ashgate Hospice,

Chesterfield Care Group and Chesterfield Royal MacMillan

Cancer Centre are among the 23 charities to each benefit from

£100 donations.

Mel Myhill, NHS111 Service Delivery Manager, “At DHU charity no

longer begins at home but in the workplace. The response to the

snack box scheme has been fantastic with staff fully supporting

the scheme so that charities important to them can benefit. Staff

have already nominated the next 25 charities we will be

fundraising for.”

The following charities, chosen by DHU staff, have all received

£100 through money raised from the snack box scheme:

Ashgate Hospice, RSPCA , Cardiomyopathy Association, The

Alzheimer’s Society, Chesterfield Care Group, The Roy Castle Lung

Cancer Foundation, Pathways Homeless Day Centre,

Endometriosis UK , Derbyshire, Leicestershire, Rutland Air

Ambulance, Motor Neurone Disease Association, United

Response, British Heart Foundation, Pancreatic Cancer Research

Foundation, The Juvenile Diabetes Research Foundation, The

Derbyshire Pride Event 2015, The Children’s Heart Unit Fund, The

Nepal Earthquake Appeal, Anaphylaxis Campaign, MIND and The

Chesterfield Royal MacMillan Cancer Centre, Edale Mountain

Rescue, JOEL: The complete package, Sri Lanka Cancer Hospital.

On Christmas Day 2015 a number of DHU

employees gave up their time to feed the

homeless and lonely. On the run up to

Christmas for 4 weeks DHU employees donated

food, gifts, crackers and much more for

everyone to enjoy.



DHU strive to increase the

employee benefits for working

for DHU.

There are many benefits to working for DHU.

Our rates of pay are comparable to NHS Agenda for

Change in our Clinical roles.

Our other roles are benchmarked against local pay

and terms and conditions of employment. Our

Executive and senior management salaries are

reviewed via our Remuneration Committee.

DHU are able to offer membership of the NHS

Pension Scheme. The scheme is contributory;

people who do not want to join the NHS Scheme are

given the choice to opt out and will be given other

pension options for them to explore.

At DHU our employees are entitled to free

membership of Westfield Health once they have

reached 6 months service.

This benefit covers optical, dental, therapy, dental

trauma, MRI, CTI scans, hospital treatment

insurance, 24 hour counselling, Westfield Rewards

and a high street shopping discount scheme.

Generous holidays are offered starting at 25 days

which then go on to raise with service, plus 8

statutory Bank Holidays. Staff who transfer in to DHU

from the NHS will preserve their current NHS

entitlement. Staff working part time will receive the

pro rata equivalent of this holiday and Bank Holiday

entitlement

A discretionary loyal service award in recognition of

an individual’s loyalty to DHU is presented after 5

years’ service and every 5 years thereafter.

DHU has developed an employee recognition

scheme called ‘The Limelight award’. This award

represents an intense illumination of employee

effort. The award is presented to an employee on a

monthly placing someone in the “Limelight”,

centred on their exceptional contribution to DHU in

providing not only quality patient care but care and

compassion for their colleagues.

At DHU we support all our employees in their

career and professional development. During

2015/16 DHU has provided revalidation sessions for

all our Nurses going through revalidation.

As well as providing mandatory training, we also

provide additional training for both clinical and non

clinical employees in mental health awareness,

domestic abuse, suicide awareness, end of life care,

dementia awareness and disability training.

47

From left to right, David Whitney - Chairman, David Walsh - Director of Human

Recourses and Organisational Design

Section 4 Our Quality Assurance

Care Quality Commission inspection of our NHS111 Service and Out of Hours during November 2015

The Care Quality Commission (CQC) regulates all health and adult social

care services in England through inspections and monitoring. It aims to

ensure essential quality standards are met by all care providers. All of

our services are registered with the CQC.

On the 10th and 11th November 2015 CQC visited our Out-of-Hours

and NHS 111 services. CQC visited the NHS 111 call centres at Ashgate

Manor and Mallard House. The inspection also included Out of Hour’s

site visits at the Ashgate Out of Hour’s Centre, Buxton Cottage Hospital,

Chesterfield Royal Hospital, Swadlincote Health Centre and Derby Ur-

gent Care Centre. The inspection team was led by a large team of CQC

inspectors and specialist advisors.

Before visiting, CQC reviewed a range of information about the

Out-of-Hours and NHS 111 service at and asked other organisations to

share what they knew about the service.

Information was also reviewed that had been provided at the request of

the inspection team. The CQC team visited DHU over two days and

spoke with members of staff including Doctors, Nurse Practitioners,

Receptionists, Drivers, NHS 111 Call Advisors, NHS 111 Nurse Advisors,

Directors and the members of the DHU board including Non-Executive

Directors.

Patients and carers who used the service were also spoken to by the

inspection team.

To understand the patients’ experience of care CQC asked the following

5 questions:

Are services safe?

Are services effective?

Are services caring?

Are services responsive to people’s

needs?

Are services well-led?

Jenny Tilson, Director of Nursing and Quality; “We are committed to the delivery of excellent care, making sure our patients are at the heart of everything we do.

We are passionate about listening to patients, and involving them in our work. We strive to ensure that they receive safe, effective and compassionate care.”

“CQC - well-led and managed by an enthusiastic and knowledgeable senior management team and board of directors, and their values and behaviours were shared by staff”




Summary of Findings Ashgate Manor Primary Care Centre , Buxton and Chesterfield Royal Hospital To understand the patients’ experience of care CQC asked the following 5 questions:

Are services safe?

CQC; “


CQC; “


CQC “

Are services responsive to people’s needs

CQC; “


CQC; “

Access to the full report can be found on the CQC website.

49

OVERALL RATING FOR THIS SERVICE GOOD

Are services safe? Requires

improvement

The area where the provider must make improvements are:

“The provider must ensure there are effective and robust systems in place across all locations for the control and security of blank prescriptions.”

The system which was already in place for recording distribution and receipt of blank prescriptions from our main site to peripheral locations has been enhanced to ensure it’s robustness in response to the recommendations from CQC. Regular audits and spot checks will provide assurance of it’s effectiveness.

Are services effective? Good

Are services caring? Good

Are services responsive to people’s needs? Good

Are services well led? Good


Summary of Findings Mallard House Call Centre, Swadlincote Clinic and Derby Urgent Care Centre

To understand the patients’ experience of care CQC asked the following 5 questions:

Are services safe?

CQC; “


CQC; “


CQC “


CQC; “


CQC; “




Are services safe? Requires

improvement

The area where the provider must make improvements are:

“The provider must ensure there are effective and robust systems in place to ensure con-trolled drugs registers are completed correctly across all locations.”

The inconsistence in the terminology used to record the receipt of stock of medication at Mallard House was rectified immediately and written confirmation was provided to the satisfaction of the CQC. Regular audits and spot checks will ensure that this standard is maintained.







Summary of Findings Ashgate Manor NHS 111 Service

To

understand the patients’ experience of care CQC asked the following 5 questions:

Are services safe?

CQC; “


CQC; “


CQC “


CQC; “


CQC; “


51


Are services safe? Good






Summary of Findings Mallard House NHS 111 Service

To understand the patients’ experience of care CQC asked the following 5 questions:

Are services safe?

CQC; “


CQC; “


CQC “


CQC; “


CQC; “




Are services safe? Good







The safeguarding team consists of a Named Nurse for Safeguarding

Children, a Lead Nurse for Vulnerable Adults and two part time

assistant safeguarding nurses. They ensure that there are robust

processes in place with the organisation to enable staff to safeguard

Children and Vulnerable adults who contact DHU.

This is achieved by ensuring there are robust referral pathways

within the company in addition to strong communication and

information sharing links with other organisations. The safeguarding

team are also responsible for providing all staff with regular

extensive training updates relevant to their roles.

Key Achievements for 2015/16

Last year there was a national focus on the detection and

prevention of female genital mutilation as a safeguarding

concern. At DHU information was cascaded to all our staff to

make sure that they were able to identify children and

young women at risk or who have already been affected by

this practice.

It became a legal requirement from October 2015 to report

to the police any confirmed cases and this process for re

porting such incident was disseminated to all our staff in

training sessions.

Following the introduction of the Care Act in March 2015,

DHU has ensured that all information and training is in-line

with the Care Act recommendations. The DHU referral form

has been amended to reflect the wishes of the patient and

mandatory training includes the importance of ‘making

safeguarding personal’.

New to Adult safeguarding has been the introduction of the

care concern referral process. This has enabled all DHU staff

to share relevant information with adult social care

regarding any issues when a patient requires further help

and support that can be provided by Social care.

DHU continues to recognise the importance of treating

people with Dignity and respect. DHU was awarded the

Dignity in Care Award by Derby Adults Safeguarding Board in

June 2015. DHU celebrated National Digni-tea day, raising

awareness of Dignity in Care whilst raising money for a local

charity.

Proposals for 2016/17

The focus currently and for the next year is Child Sexual

exploitation (CSE) All staff will be given training in addition to

information on useful materials and toolkits which can help

them assess children who they suspect are or maybe at risk

of CSE.

Two members of staff were trained to become Prevent

trainers. The new prevent trainers coupled with the

Prevent lead for the organisation will develop the Prevent

agenda and training strategy and this will be a focus for the

forthcoming year. “Prevent” is a national campaign, aimed

at reducing the risk of vulnerable young people and adults

being recruited into extremist organisations and behaviours.

Derbyshire Health United (DHU) is committed to

safeguarding and promoting the welfare of children

and vulnerable adults.



Key Achievements for 2015/16

The Minor Conditions Nurse course which was an innovation in

DHU to help address the shortage of advanced clinicians is now in

its second year. Two of the first nurses who successfully

completed the first programme have now become Nurse

Practitioners working in the Out Of Hours Service. The remaining

nurses are working to full capacity as Minor Conditions Nurses

supporting the Clinicians in the out of Hours service. A second

group are nearing completion of their initial training. (April 2016).

This initiative has increased the provision for patients to be seen in

a more efficient and safer service in our centres providing support

for the Out of Hours clinicians.

A large number of our Senior Nurse Practitioners and Nurse

Practitioners have successfully completed a specialist Masters

Degree module in Core Paediatric Principles in Primary Care. They

were part of the pilot and evaluation of this programme run by

Sheffield Hallam University. The development of specialist

programmes like this are an important part of developing

education for healthcare and an example of the academic

establishments working closely with service delivery organisations

to shape healthcare for the future. DHU continues to supplement

the NHS 111 pathways standard training programme with

additional elements. Awareness of Domestic violence and

dealing with challenging callers are just two of the topics covered

in these sessions which provides enhanced skills and

understanding to our NHS111 Call Advisors.

DHU have had a number of Medical and Nursing students on

placement throughout the year from Nottingham University and

Derby University. Feedback from students is fantastic and the

placement is highly regarded by the students who all volunteer to

attend DHU. Anonymised feedback given to the University of

Derby, and send to DHU in April includes the following statements:

Student 1 Comment – “It was a valuable placement with a steep

learning curve. It was at times quite a challenging placement

because of working with Senior Nurse Practitioners and GP’s

constantly who have a lot of experience within the out of hours

field” I enjoyed working with the different teams enabling me to

see the diversity of Derbyshire Health United, but feel I would have

benefitted from working more shifts with the District Nurses.

Student 2 Comment – “The learning opportunities and

experience are brilliant. There is plenty of exposure to all types of

conditions in different types of patients (pregnancy,

elderly, children etc.) The placement is not only increasing

my knowledge and providing exposure to variety of conditions, I

am also learning how to adapt practice and communication skills

required to effectively engage with individual patients, other

professionals and services. Evidence based best practice is essential

as people are working autonomously; accountability and

justifying actions and decisions is essential. The 6 C’s were

practiced to a high standard”

Student 3 Comment – “I worked with Nurse Practitioners, not only

did they practice the 6 C’s but were so knowledgably allowing me

opportunities to diagnosis and encourage me to participate at

every opportunity. The knowledge base of the Nurse Practitioner is

so wide that allows so much learning”

Our commitment to lifelong learning and development for all groups of staff.



These placements not only benefit the student but the

organisation in that they promote integration between primary and

secondary care and education in addition to encouraging interest

in the service for future recruitment.

The DHU training team has developed a training programme to

improve the skills of our receptionists who are in the process of

undertaking “recognition of the unwell adult,” and “recognition of

the unwell child” training. This will improve the safety of our

patients while they wait to be seen by a member of the clinical

team.

DHU has completed an evaluation of an innovative early warning

score for children developed by Leicester Royal Infirmary called

POPS (Paediatric Observational Priority Score). This evaluation has

shown that the introduction of POPS to DHU may improve clinical

safety and as a result of this evaluation will be rolled out across the

organisation. It has also contributed to the information being

gathered by Leicester Royal Infirmary on this innovation

The training team has developed a unique competency assessment

process for our clinical staff who are required to complete

telephone assessments, and home visiting as part of their role

within the out of hours service as some of the challenges of

working in Out of Hours can differ very much from “in hours”

primary care. This competence package enhances the

organisations ability to ensure our staff are safe to perform the role

that they are employed to perform.

Image of

Training




Work is underway to ensure that all our non registered staff who

work in the clinical areas or have a face to face role with patients

are working towards achieving the “Care Certificate“. This is a set

of standards for health and social care jointly developed by NHS

England and Skills for Health. In DHU we plan to use this as a

minimum basic standard and then continue to provide further

development appropriate to each role, enabling our staff to

develop an extensive portfolio of their skills and competencies. The

aim of the Care Certificate is to ensure that all staff have the same

skills, knowledge and behaviours to provide compassionate, safe

and high quality care and support. It also provides a basis for career

development within DHU and the Health community for our staff.

A full study day based on “Hot Topics” in Primary care has been

arranged for our out of hours Clinical staff . In addition to the Nurse

Practitioners directly employed by DHU, invitations have gone out

to the GP’s in the health community who work with us both in and

out of hours. The whole day is tailored specifically to the

challenges of out of hours care with updates on some of the

current local and national clinical concerns . Education events such

as this not only improve care of our patients but strengthen

education ties between colleagues and disciplines.

The Minor conditions nurse role will continue to be established

within our out of hours clinical service with further cohorts of

nurses in training. The increased levels of skills and competencies

learned on this course will also be trialled and evaluated by one of

the nurses in our Evening Nursing service who is completing the

course. This innovation will hopefully improve the outcome and

effectiveness for patients using this service.

Image of

Training



Derbyshire Health United follows the principles and guidelines of

the Department of Health Document Securing proper access to

medicines in the Out of Hours. This means that in addition to

being able to prescribe medicines when required for patients

they also carry stocks of approved out of hours medicines to

issue to patients urgently.

Key Achievements 2015/16

During the last year the Out of Hours Formulary was

reviewed and updates adding new recommended

medicines and removing ones no longer considered to be

best practice for prescribing. This was performed in line

with both local and National guidelines. The formulary

was then approved by the local Joint Advisory

Pharmaceutical Board.

To ensure that our service to the patients remains both

safe and efficient a number of our newest recruited

Nurse Practitioners who achieved to competence level

for a Senior post, successfully completed the Non

Medical Prescribing course enabling them to prescribe

medicines if required at the point of contact with

patients.

Other nursing staff who are not qualified to prescribe are

trained to supply medicines under Patient Group

Directions (PGD’s) for the patients and conditions they

are competent to assess and treat. The development of

these PGD’s is governed by a specific group, consisting of

skilled practitioners and medical staff working with

Pharmacists who also review the existing PGD’s making

any changes in line with local and national

recommendations and guidelines.

Derbyshire Health United continue to work closely with

our pharmacy colleagues in the Health community and

have participated in a pilot scheme with the NHS

workforce Development Team, where pharmacists are

involved in both the NHS 111 and Out of Hours service

dealing with patients who call with queries relating to

medications.


The pilot scheme using pharmacists in theNHS111 and

Out of Hours is to continue and will be evaluated in

conjunction with both Sheffield University and Swansea

University.

Development of further Patient Group Directions are

scheduled, to enhance the service provision further with

the introduction of our new Minor Conditions Nurse

service expanding across the county in the Out of Hours

service.

Work is continuing to reduce the use of antibiotics

unnecessarily in line with National guidelines as this is

still a National and European concern in health

communities. Regular audits of prescribing in conjunction

with education for both staff and patients is helping to

achieve targets set by our commissioners.

Medicines Management

Audit is a quality process designed to improve patient care and outcomes and is recognised as

one of the components of Governance.

DHU has an annual audit plan covering both Clinical and non-clinical areas of the service.

Key Achievements 2015/16

The redesign of the organisational governance structure now means that the overview of audit

comes under our newly established Clinical Effectiveness Audit and Policy Sub-Committee. This

enables audit to be integrated more effectively into clinical developments and service.

A number of regular audits were carried out over the year including Health & Safety, Infection

Control, Clinical Records, Rightcare© Service, Safeguarding service and Medicines use and

safety. The results of these audits were used to redesign services and make improvements

where required. For example audits have demonstrated that an education campaign on the use

of antibiotics improved effective prescribing and Infection control audits led to an introduction

of new measures to improve the safe disposal of sharps.

The number of staff and hours for the Clinical audit team has been increased on par with

recruitment of Clinicians into the service. This has meant that we can continue to regularly audit

all clinicians in line with recommended guidelines from the Royal College of General

Practitioners (RCGP). Clinical Audit maintains and improves standards of care for patients, in

addition to providing valuable feedback and learning for staff and their continuing development.


A plan has been developed and approved by the Clinical Effectiveness Audit and Policy

Sub-Committee, identifying areas for audit in the coming year. In addition to regular audits on

specific areas including Health and safety, infection control and Medicine safety, other audits

will be carried out as required by local commissioners and NHS England and for the continuing

development and improvement of our services. These audits will continue to shape our

provision of safe and effective health care for patients and education and development for staff.

Clinical Audit





Health & Safety within Derbyshire Health United (DHU) continues

to be a primary function that requires specific focus to enhance

the provision of service, to maintain the levels of protection

offered to all of our staff, patients and visitors and to ensure that

our excellent record in managing Health & Safety across the

organisation is maintained.

All DHU staff view Health & Safety as a key activity and all staff play

a vital role in the identification of potential risks & hazards and will

go the extra mile to ensure that anything that may pose a risk to

the organisation, its staff or to visitors and patients is raised at the

appropriate levels to effect any remedial actions required.

Throughout 2014/15 the key focuses on Health & Safety have

culminated in a safer, robust and more proactive culture around

the provision for the whole Health & Safety agenda.

The key focuses of this period 2015/16 were;

Securing commitment from the organisation in improving

stress management both within and across the

organisation

Implementation of an Environmental Management System

to assist in the overall reduction of environmental impact

including;

Energy usage

Water usage

Fuel usage

Carbon Deposits in to the atmosphere

Waste production

The aim of the environmental management system is to promote

DHU as a responsible and sustainable organisation and to align us

with what is determined as best practice.

Key achievements in 2015/16 we have;

Maintained a robust Health & Safety Management Structure to

oversee the Health & Safety Agenda.

Maintained a program of continual audit and risk analysis

Reviewed and update of risk assessments across key contract

Seen a reduction in the number of workplace accidents reported

comparable to 2014/15

DHU are keen to maintain this positive safety culture going

forward and value the support and input of all staff, patients,

visitors & contractors.

Key Focuses for 2016/17 are;

Implementation of strategies to enhance the management of

stress across the whole workforce

Redesign and coordination of call centres to enhance work

environments and improve on welfare facilities available to all staff

Improving further on the positive safety culture of Derbyshire

Health United involving staff at all levels who are able to make a

difference.

Health & Safety



Information Governance is a core part of Derbyshire Health

United’s business and in line with information governance

requirements set by the Health & Social Care Information Centre

(HSCIC). Derbyshire Health United has consistently met the

standards of compliance in order to deliver the services that it

provides.

DHU continues to make improvements to its information

governance agenda on an annual basis and maintain its status as

an NHS Business Partner.

The five principles of information governance are,

Information is:

Held securely and confidentially

Obtained fairly and efficiently

Recorded accurately and reliably

Used effectively and ethically

Shared appropriately and lawfully

Key focuses for 2015 – 2016 were;

Develop and implement a robust Information Governance

Structure to meet the demands of the organisation (chart

attached).

Increase compliance and monitoring of Information

Governance Training across the whole organisation.

Review and update key information sharing agreements

with relevant third parties.

Implementation of access to Summary Care Records and

the Medical Interoperability Gateway (Leicestershire &

Nottinghamshire).

Key priorities for 2016 – 2017 are;

Continue with the development of the organisational

strategy for Information Governance.

Develop closer working partnerships with smaller

organisations.

Improve information sharing through innovative

technological advances such as the Medical

Interoperability Gateway (MIG) & Summary Care Records.

Form further working partnerships with Information

Governance Groups across areas of the business in order to

enhance DHUs involvement in the developing face of IG.

Enhance the close working partnerships with local GP

Practices.

Information Governance Information Governance Structure



Derbyshire Health United ensures infection prevention and

control (IP&C) remains a core underlying element in its

healthcare delivery.

To achieve this, all staff members are required to undertake IP&C

training both on appointment and at regular intervals. This

training is reviewed on a regular basis to ensure it reflects best

practice. Recent updates to the training package has incorporated

specific Clostridium difficile infection (CDI) training and future aims

are to incorporate sepsis guidelines also within the training.

The organisation also recognises that effective hand hygiene is

one of the main methods of preventing healthcare associated

infection and actively encourages good hand hygiene practices

amongst all staff members. DHU has participated in the World

Health Organisation (WHO) hand hygiene auditing programme. In

addition to this, annual IP&C audits are carried out at all sites to

ensure quality and patient safety.

Key achievements in 2015/16 were;

The review and update of all IP&C related policies to reflect

current best practice., including the development and role

out of national policies and guidelines in response to

public health concerns. This has included antiviral

strategies and Middle East Respiratory Syndrome (MERs)

equipment provision and protocol cascade.

To trial and replace the current sharps disposal system

with a safer product design and monitoring scheme,

through the ‘sharpsmart’ programme. Acknowledging and

investing in the safety of staff and patients alike.

To adapt procedures alongside the introduction of fridge

data monitors to allow effective continuity systems if fridge

failures were to occur.

To begin to develop stronger antimicrobial stewardship

and awareness in the company balanced alongside

increased awareness regarding early detection and

management of sepsis.

Key focus for 2016/2017 include the development and

implementation of a DHU cleanliness charter and the development

and implementation of a sepsis awareness and treatment

campaign.

Victoria Slack, Infection Control Lead Nurse: “Infection control

is essential and integral part of modern healthcare in an ever

evolving biological world. Within DHU and my role I

endeavour to ensure that rigorous standards of infection

control are upheld on a daily basis to protect patients and

staff alike. I aim to ensure that the company is fully prepared

with the skills and equipment required to respond to any

local, national or global infection control concerns.”

Infection Prevention and Control



Care Makers are an initiative set up by the NHS

Employers and NHS England to develop the culture of

compassionate care.

The first cohort of 55 Care makers was recruited prior to the

Chief Nursing Officer’s Conference back in 2012 ,they made a

commitment to support frontline implementation and delivery

through the promotion of the new ‘Compassion in Practice’

nursing, midwifery and care strategy and the values of the 6Cs

associated with it. Now three years on there are

approximately 900 established Care Makers across health and

social care settings.

The 6C’s consist of the following actions Care, Compassion,

Competence, Communication, Courage and Commitment and

each of these values and behaviours carry equal weight.

What is a Care Maker?

Care Makers are ambassadors for the 6C’s, creating a unique

link between national policy and strategy to frontline practice.

The original idea of the Care Maker programme came from

the London 2012 Games, where they had Games Makers who

were recruited, trained and valued to instil the spirit of energy

and enthusiasm they created throughout the games.

Laura Rennie,. Care Maker said; “I chose to become a Care

Maker as I wanted to show that I can support and

demonstrate compassionate, person-centred care and that I

am motivated to ensure excellent care not only in my clinical

role but as a line manager, by making a positive difference in

a way no matter how big or small. Being a Care Maker opens

up a lot of opportunities to spread the word about Compassion

in Practice and the 6C’s and bring this ethos into my own work

environment here at Derbyshire Health United.

I work a long side the Director of Nursing and Quality here at

Derbyshire Health United to improve the way our staff here

can involve the 6C’s into their work”

This is achieved through the following;

Workshops

Education

Training and Development

Recruitment

News Letters/ Communication Boards

Staff Meetings

Open days and Conferences

DHU Care Maker Involvement



DHU Care Maker key achievements in 2015/2016

The 6C’s and questions around Compassion were used

within recruitment questions for advertised posts for

Trained and HCA vacancies within the District Nursing Team

as well as recruitment for Nurse Advisor roles.

As the Care Maker Lead I attended Nurse Advisor and

Nurse Practitioner staff meetings to promote the 6C’’s,

through film, discussion and explaining how the 6C’s can be

influenced in their everyday practice.

Attended an Open Day at Whitworth Hospital to promote

the Care Maker programme to the general public with DHU

to show the commitment the organisation has taken on.

Compassion Boards were installed in the Ashgate and

Mallard bases encouraging staff to share their own

compassionate experiences they had with the patients or

their colleagues.

The Derbyshire Care Makers Hub had their initial set up

meetings where DHU will play a large role in supporting the

group who also consist of staff from Royal Derby Hospitals,

DCHS and Mental Health teams. Professionals involved in

this hub are Clinical and un-clinical staff, as well as OT,

Physio’s and Managerial. The hub has been set up to liaise

with the Regional Co-ordinator from NHS England in which

to help raise awareness of the 6C’s, share Compassionate

Care stories. Help provide improved recruitment to

organisations, decrease complaints and procedures. To also

challenge bad practice, share good news stories and

celebrate success to influence good caring leadership. This

will be measured through case studies, strategies with the

6C’s and to also involve patients who also might like to be a

Care Maker.

DHU Care Maker attended the Chief Nursing Summit as an

ambassador to help spread the word of the 6C’s and

Compassion in Practice and to develop ideas with other

Care Makers that can be used within DHU.

Representing DHU, myself as a Care Maker and the Director

of Nursing and Quality attended, the Care Maker

Programme- ‘Celebrating the value and impact of Care

Makers’ at Edge Hill University. The conference was a

chance to celebrate the value of Care Makers and show

cased some amazing achievements that have happened

within the past three years and how Care Makers promote

the 6C’s to drive the Compassion in practice as part of their

role.

The conference brought together many disciplines such as

Care Makers, Care providers, regional and national teams

as well as commissioners and students. It was a great

opportunity for sharing and networking and learning with

colleagues as well as well as promoting DHU to be

recognising the Care Maker programme.

Our values and behaviours are at the heart of the vision and all we do…

Care Compassion Competence Communication Courage Commitment

Care is our core business and that of

our organisations and the care we

deliver helps the individual person

and improves the health of the whole

community. Caring defines us as our

work. People receiving care expect it

to be right for them consistently

throughout every stage of their life.

Compassion is how care is given

through relationships based on

empathy, respect and dignity; it can

also be described as intelligent

kindness and is essential to how

people perceive their care.

Competence means all those in

caring roles must have the ability to

understand an individual’s health and

social needs and the expertise,

clinical and technical knowledge to

deliver effective care and treatments

based on research and evidence.

Communication is central to

successful caring relationships and to

effective team working. Listening is

as important as what we say and do

and essential for the “no decision

about me with me without

communication”. Communication is

the key to good workplace and with

benefits for staff and patients alike.

Courage enables us to do the right

thing for the people we care for, to

speak up when we have concerns

and to have the personal strength

and vision to innovate and embrace

new ways of working.

A commitment to our patients and

populations is a cornerstone of what

we do. We need to build on our

commitment to improve the care and

experience of our patients to take

action to make this vision and

strategy a reality for all and meet the

health and social care challenges

ahead.

Collaboration underpins these values and behaviours in Derbyshire Health United

Image provided by www.changeday.nhs.uk



DHU has received a Dignity award from Derby

Safeguarding Adults Board. The Dignity award

recognises DHU’s commitment to Dignity in care and

provides evidence that staff members uphold the

main ethos behind the initiative.

Julie Tomlinson

Lead Nurse - Safeguarding Vulnerable Adults

Section 5 Our Patient Experience


As an organisation, we welcome patient feedback which

is valuable in order for us to improve the patient

experience.

All complaints, concerns and patient

feedback are dealt with by our

experienced team of staff within the

Integrated Governance Department.

Formal complaints are handled in line with

the 2009 NHS complaints and social care

regulations.

DHU received 289 complaints excluding informal

prison complaints in 2015/16 compared with

312 complaints excluding informal prison

complaints received in 2014/15.

100% of complaints were acknowledged within

three working days. All complaints are

thoroughly investigated and trends are

identified. The top three complaint themes in

this period included staff attitude,

communication and diagnosis & treatment.

Complaints involving staff attitude are all fed

back to the individuals concerned in order for

our employees to reflect on their behaviour.

Every complaint is investigated thoroughly.

Learning outcomes are fed back to our managers

and employees within team meetings, one to

ones and within our internal communications.

When necessary changes in policy and

procedures within the organisation takes place

to ensure that learning is embedded.

Our handling of complaints was reviewed as part

of the inspection of our NHS 111 & Out of Hours

service in November 2015.

The CQC stated the following in the inspection

report:

We looked at a summary of complaints for each

contract for this period (October 2014 –

September 2015). We found that these had been

generally satisfactorily handled, demonstrated

openness and transparency and dealt with in a

timely manner. We saw that the complaints

had been investigated and a response sent to the

complainant, which included an apology where

appropriate.

NHS 111 Complaints: 01 April 2015 – 31

March 2016

Number of patients who made contact

with our service

Total number of complaints

received

% of complaints from total

patient contacts

169 1,142,527 289 0.025

Overall DHU Complaints Received and Closed

(1st April 2015 — 31st March 2016)



Serious Incidents DHU have an open and honest approach to reporting Serious Incidents. During 2015/16 we

reported 24 Serious Incidents across all of our contracts. DHU’s procedures for reporting Serious

Incidents follows the NHS England Serious Incident framework. All Serious Incidents are reported to

our Commissioners within 2 working days, in line with the Serious Incident framework.

All Serious Incidents are investigated thoroughly and undergo a full Root Cause Analysis (RCA). This

allows DHU to learn from the incident, minimising the risk of it happening again and protecting

our patients from future harm. Themes are reviewed and learning from serious incidents is shared

across the organisation both on an individual basis and group learning via our Weekly NHS111

Newsletters and monthly Clinical Updates to prevent them from reoccurring. The CQC reviewed our

Serious Incident procedures as part of the inspection of our NHS 111 & Out of Hours service in No-

vember 2015. The CQC stated the following in the inspection report:

“Staff spoken with told us that they received feedback on serious incident reports

and they were able to give examples of shared learning.”

Incidents Staff can easily report incidents by having access to Datix electronic incident reporting forms via the

company intranet which they are trained to use within their induction and on-going professional

development. This allows incidents to be investigated quickly, to review practice and to identify

trends and patterns. DHU believe in being open and fair, by sharing information openly with staff

when an incident happens. Staff receive feedback on incidents they have reported or were

involved in. Our incident reporting processes were reviewed as part of the inspection of our NHS

111 & Out of Hours service in November 2015. The CQC stated the following in the inspection

report:

There was an effective system in place for reporting and recording serious incidents and staff understood and fulfilled their responsibilities to raise concerns, and were encouraged to report incidents and near misses. Lessons were shared to make sure action was taken to improve safety in the service.

Overall DHU Incidents Received and Closed


CQC Report: “The provider was aware of and complied with the requirements of the Duty of Candour, and a clear vision and strategy to deliver high quality, safe and effective healthcare and promote good outcomes for patients. The provider was responsive to feedback received from patients and staff and used information available proactively to drive service improvements.”



Duty of Candour The Duty of Candour was recommended by the Francis report to

promote openness and transparency and ensures that patients harmed

by a healthcare service are informed.

DHU have developed a ‘Being Open’ policy to guide staff and improve

communication with patients when something goes wrong.

DHU have developed processes to inform patient’s families of Serious

Incidents and they are offered a copy of the investigation reports.

Some families choose not to receive this level of detail. DHU welcome

meetings with families to discuss events face to face.

Compliments We encourage staff to report positive patient experiences. All

compliments are recorded on our Datix system. All staff mentioned in a

compliment will receive an e mail or letter from our

CEO. Compliments are included in our internal board brief, monthly

governance reports and our quarterly quality report.

We have received thank you cards, compliments via Client Focussed

Evaluation Program (CFEP), Friends and Family, verbal over the phone

and following face to face consultations. Our compliments received

consistently outweigh our complaints received on a monthly basis.

Overall DHU Complaints against Compliments Received




Over the past year Derbyshire Health United (DHU) have attending numerous public events to promote our services and

to engage with the patients and public of Derbyshire.

Throughout the year different staff groups have represented DHU at health information events and open days with some of our partner

health organisations, e.g. Whitworth Hospital open day, Derbyshire Community Health Service’s ‘Working Together to Improve Quality

Care’ event where many care coordinators and nursing home managers were able to gather and exchange information.

As part of the national NHS Care Maker initiative we have a nominated individual who proactively promotes The 6 C’s (care,

compassion, courage, competence, commitment and communication) both within and outside the organisation. Over the Summer they

have attended several national and local events to network and bring new ideas back for the benefit of our patients to ensure that the

care you receive, is of the highest quality. Earlier in the Summer DHU hosted stands at the Hasland Gala, the Chesterfield Carnival and

Chesterfield’s first ever gay pride event. At all of these events many members of the public came to visit our stands, learn more about

the services we provide and participated in our quizzes/games. The staff who manned the stall enjoyed and felt very proud to promote

DHU to the public.



Patient Experience During 2015/16 we have worked hard to better understand

and learn from our patient’s experience when they access

our services.

We have improved the way we collect and manage feedback

from patients in order to maximise patient safety and

improve experience.

We have in 2015/16;

We have rewritten our Terms of Reference for our Patient

and Public Involvement Sub-Committee to ensure that we

have an improved assurance process for our DHU Board.

Continued to engage with the patient forum who appraise

our patient information, newsletter and who are actively

involved in service developments.

Appreciated the value of having patients present during

our Patient and Public Involvement Sub-Committee.

Explored our methods of collecting patient feedback and

have plans to target a wider audience via the means of

social media.

Reviewed our patient complaints leaflet again in October

2015 and made the amendments to our existing

communication which is available in different languages.

Continue to gather valuable data from the Friends and

Family Test at all our Primary Care Centres where we see

patients face to face.

Trialled the Friends and Family Test within our District

Nursing Service to obtain feedback from visited patients.

Continued to receive a source of feedback from

an independent organisation called Client Focused

Evaluation Programme (CFEP), and engaged fully with

Healthwatch.

Involved Data Analysts in the patient feedback information,

created meaningful data in the forms of charts and

graphs for the ability to have more in depth discussion at

our Patient and Public Involvement Sub-Committee. This

information is shared with our assurance committees.



Our Patient

Engagement In 2015-16 we continued to build on 2014-15 and engage

with our patients attending a variety of meetings, events

and patient participation group (PPG) meetings including

liaising with the CCG’s and other stakeholders regularly to

inform, receive feedback and ensure continuous

improvement of the service.

During 2015-16 we have continued with the ‘You Said, We Did….’

Approach as this has proven that for patients to engage in

improving their services then they need to feel that it is a)

worthwhile them putting their views forward and b) that

something tangible will come out of it and the proof of this is in

the ‘You Said, We Did….’ of which we have many examples.

We have also looked at using Social Media as a way of reaching

some of our young patients and ‘Hard to Reach’ groups and as well

as the existing methods also looking at alternative mechanisms for

obtaining feedback, e.g. I.T and web-based as well as potentially

setting up listening and focus groups.

We have facilitated/undertaken both individual and group visits to

our bases and incorporated demonstrations of the systems we use,

e.g. NHS 111 Pathways etc as well as tours of our facilities.

We already have dates in the calendar for 2016-17 to further

engage with patient groups and the wider health economy, e.g.

Healthwatch Derbyshire etc. to heighten the patient experience/

journey.

In 2016-17 we will need to ensure that if appropriate we are

adhering to the Accessible Information Standards that have come

into effect.

Judith Brown, Patient Experience Relationship Manager said:

“I find the role both personally and professionally very fulfilling and

rewarding as well as being very diverse. Every day is different,

there are certainly no dull moments, there are interesting

conversations to be had, interesting and diverse people to meet

across the generations etc. and I feel that my role is an integral

part of the Patient and Public Involvement of DHU in ensuring that

our patients continue to receive clinically safe and effective services

and enabling change if required and if my role can be a part of the

vehicle for making this possible then long may it continue.

If through the work we all do within DHU means that even a small

change can be made or even within my role being able to answer

patients questions, allay any fears or misapprehensions and change

patients perceptions or misconceptions and if I can get just one

patient to access our services that wouldn’t have previously and

they tell ten people who tell another ten people and so on and so

forth makes me proud of what I do and proves that by actively

working hard to engage patients “

Judith Brown, Patient Experience Relationship Manager



Our Friends and

Family Test The Friends and Family Test is an important opportunity

for patients to provide feedback on the care and treatment

they receive. The Friends and Family Test is a simple way

to identify both good and bad performance

and encourage organisations to make improvements.

Introduced in 2013, the test asks patients whether they would

recommend health services to their friends and family if they

needed similar care or treatment. This test enables patients to give

feedback on the quality of the care they receive, giving service

managers and employees a better understanding of the needs of

their patients to enable improvements. The test asks the standard

question, “How likely would you recommend Derbyshire Health

United to friends and family if they needed similar care or

treatment?”

Patients will use a descriptive five-point response scale to answer

the question with the following response categories:

• Extremely likely

• Likely

• Neither likely or unlikely

• Unlikely

• Extremely unlikely

Both the positive and negative answers are analysed using a given

formula which results in a score (Net Promoter). Only the

Extremely Likely response is used as part of the calculation, please

refer to the ‘NHS Friends and Family Test’ publication guidance

2013 for further clarification.

Derbyshire Health United have been performing this test since

January 2014. Below is a chart that shows the average result for

each Primary Care Centre from April 2015 - March 2016. We are

extremely pleased with our results.

Throughout the year overall 83% of patients agreed they would

recommend the service they have received to friends and fami-

ly. The test also gives patients the opportunity to comment on our

service, and we have taken an active approach to respond to these

comments.

Tom Oxley, PA to the Director of Nursing and Quality commented,:

“the test is key to understanding where patients feel the

services we provide requires improvement. Having

reviewed the data for 2015/16 the score for the

majority of sites have increased from last year which is

excellent.

I am always delighted to read the comments patients

leave talking of their positive experience, support of the

service and complimenting staff; which are always fed

back. It is also nice to see that the staff at each site are

always keen to know the latest score which

demonstrates their pride in the service they provide to

our patients. ”



Derbyshire Health United - Friends and Family Test Results

(average) for April 2015 - March 2016

Section 6 Our Innovation working in partnership


Stephen Bateman, CEO “ We are committed to working with commissioners and key partners to transform services in line with the joined up care strategies across Derbyshire”



Erewash HUB

During 2015/16, DHU have continued to work with Ere-

wash CCG as the Lead Provider in partnership with Derby-

shire Community Health Services to continue the pilot in

providing two Primary Care Hubs, one in Long Eaton and

one in Ilkeston. These Primary Care Hubs operate Monday

to Friday evenings as an extension to daytime GP primary

care services and from 9am to 12pm at weekends and Bank

Holidays. Appointments within the two Primary Care Hubs

can be booked via the patients own GP Practice reception-

ist, via the NHS 111 service or the local Minor Injuries Unit

following an assessment.

This extension of daytime GP primary care within the Ere-

wash CCG locality has provided an average of an additional

600 appointments for patients within the Ilkeston and Long

Eaton areas. This additional local access to GP primary care

services also provides additional clinician availability to

your local GP practice, reducing the need to attend your

nearest Emergency Department, Urgent GP Out Of Hours

services or Minor Injuries Unit.

The overall aim of the service is to provide extended access

to primary care via the two locality hubs. Broader aims and

objectives are to:

Allow Local NHS providers and commissioners to use re-

sources effectively within the health economy.

Provide extended capacity to primary care via two locality

hubs.

Improve local access to primary care in the evenings and

weekends.

Improve the patient access experience to local GP services.

Reduce A&E attendances particularly children under 5

years.

Facilitate integration of services to provide the right care,

right place at the right time.

Work to establish links with Out of Hours GP services, Mi-

nor Injury Units and community teams to ensure patients

receive the right services at the right location.

Improve urgent care pathways amongst GP practices, Mi-

nor Injury Units the NHS 111 & Out of Hours GP services.

Have a shared appointment system across all surgeries.

Although this initiative is still within the pilot phase prelimi-

nary evaluation of the service has been extremely positive

for patients.

? Avi quote ? Rakesh ? Outcome data in relationto local

treatment completion rather that ED attendance



Erewash CCG Acute

Home Visiting

Service During November 2015 DHU were pleased to continue

working as the Lead Provider with Erewash CCG and

commence an Acute Home Visiting Service for patients

across Erewash.

DHU Nurse Practitioners are providing support to the 12 GP

Practices surrounding Ilkeston and Long Eaton areas. Two DHU

NP’s are providing the service Monday—Friday 9.30 am—6.30

pm. One NP is based in the Ilkeston area and one is based in Long

Eaton. All GP Practices can access the service. Home Visit requests

are booked directly via the patients own GP Practice receptionist.

This further addition of clinical resource within daytime GP

primary care services within the Erewash CCG locality has been

able to support over 1,600 patients receiving a home visit across

the Erewash locality between November 2015—March 2016. This

additional resource to ‘in hours’ GP primary care services has

facilitated additional clinician availability within each local GP

practice by allowing GP’s & NP’s within each practice to release

additional appointments as they are having to visit less patients in

their own homes.

In addition this service has facilitated when necessary a more

timely review for patients in their own homes by having a

dedicated team to respond promptly and visit patients according

to clinical priority reducing the need for patients to contact the

Emergency Services or attend their nearest Emergency

Department, Urgent GP Out Of Hours services or Minor Injuries

Unit. The overall aim of the service is to provide extended access

to primary care services. Broader aims and objectives are to:

Allow Local NHS providers and commissioners to use

resources effectively within the health economy.

Provide extended capacity within local GP Practices.

Improve the patient access experience to local GP

services.

Reduce unnecessary Emergency Department attendances

Facilitate integration of services to provide the right care,

right place at the right time.

Work to establish links with Out of Hours GP services,

Minor Injury Units and community teams to ensure

patients receive the right services at the right location.

Improve urgent care pathways amongst GP practices,

Minor Injury Units the NHS 111 & Out of Hours GP

services.

Have a shared appointment system across all surgeries.

Although this initiative is still within the pilot phase preliminary

evaluation of the service has been extremely positive for patients.

75



Hardwick CCG Acute

Home Visiting

Service The Acute Visits Pilot (AVP) has continued to operate

since April 2014. The key aim of the pilot is to undertake

urgent home visits to patients within Hardwick CCG,

covering 16 practices.

The pilot aims to improve services for patients requiring urgent

care, improve patient safety and reduce unnecessary Emergency

Department (ED) attendances and admissions. This therefore

should result in increased capacity in General Practice to deal with

practice based demand.

This service is delivered by an experienced Advanced Nurse

Practitioner and operates Monday to Friday 0800hrs – 1830hrs.

The GP triage’s the patients by telephone and then refer’s through

to the service if suitable. The Advanced Nurse Practitioner

completes the visit within 2 hours of triage and the notes are

forwarded electronically back to the GP when the visit is

complete. The GP remains clinically responsible for the patient

and is available for telephone support.

In the past twelve months the service has visited 933 patients

with 90% of patient’s being successfully assessed and treated at

home. The figures for ED assessment and admission are very low.

5% of patients were referred to the Emergency Department and a

further 5% were referred for admission to hospital.

The project continues into the new financial year with ongoing

review of service delivery and outcomes.

Patient: ‘I was very surprised to find there were other people avail-

able to help me in a concerned, caring and professional way. It is

a great service, well done to you all!’

Kirsty Osborn—Head of Clinical Services (North Derbyshire) “The

main benefit I see of this service is the quality of patient care in

particular for the housebound who are able to access primary care

in their own home in a timely manner”



Mental Health Nurses in Call Centre

DHU have continued to work in partnership with Derbyshire

Healthcare Foundation Trust mental health support within

the NHS111 call centre and for Out of Hour’s clinicians.

Members of the mental health team are trained to work

alongside the NHS111 Call Advisors and Nurse Advisors. The

mental health nurses are able to access the ‘Paris’ system in

order to access the psychiatric notes to ensure a clinically

enhanced assessment takes place and appropriate care going

forwards.

This enhanced service reduces unnecessary referral to the

emergency department, out of hour’s home visits and 999

calls ensuring a more clinically effective service.

We are working with Hardwick CCG, Derbyshire Healthcare

Foundation Trust, EMAS, Derbyshire Constabulary and

Derbyshire Adult Care via the Crisis Concordat to develop a

mental health advice hub that all services can access when

required. Our present integrated service has suffered from a

lack of resources in terms of staffing at times and by

combining all resources a more robust and consistent service

will be developed.

Jenny Doxey - Deputy Clinical Director said “Having the

resource of these specialist nurses within the NHS111 and Out

of Hours services ensures the patient receives the optimum

support, advice and care whilst supporting our NHS111 Call

Advisors, NHS111 Nurses and face to face Clinicians”.

Pharmacists in the DHU NHS 111/OOHs

We now have three pharmacists working within the call

centre mainly at the weekends.

They will have medication enquiries and toxic ingestions

directed to them, helping the NHS 111 service for all four

counties and repeat prescription requests helping the

Derbyshire out of hour’s service.

This happens automatically by the Adastra system when the

rota is activated by the rota team showing that they are

available.

The cases will show in the Pathways clinician queue and

should a pharmacist not be available or their queue is too

large then pathway’s clinicians can also pick these calls up as

they normally would. This is similar to the way the dental

nurses queue works.

DHU Pharmacist said - “Pharmacists are reducing workload

on GP's and Nurses - are able to deal with medicine/

Pharmacy queries thoroughly and effectively”

Patient comments included:-

“The service gives you peace of mind”

“Very efficient service, dealt with my problem very quickly, I

had insufficient medication to last me until the end of the

bank holiday.”

“The assistance I received was excellent”

“Reliable and helpful service”

Dental Nursing

Dental nurses are now an integrated and embedded part of

our clinicians working within the NHS 111 service. This

enables our service to provide a specialist advice service for

those patients suffering from dental pain who make up a

large proportion of our NHS 111 contacts from the public.

Dental nurses have the expertise and knowledge to help the

patient and direct them to the appropriate dental service for

their needs. They also are able to empower patients to self

manage their symptoms and avoid unnecessary trips to the

Emergency Departments. Our out of hour’s GPs have also

noticed that they do not have to manage patients with dental

symptoms for whom they are not an expert in treating as

often as they used to..

Patient experience has improved and we have less complaint

about dental problems in the out of hour’s periods. However

there has also been improved out of hour’s urgent dental

clinics provided within the health system and this has also

improved the position.

We are working with urgent dental care providers to be able

to book appointments for patients; however this has IT

communication issues that need resolving.

Patient Comment: “Had bad toothache and the lady

who handled the call was fantastic. She was

compassionate and understanding”



RightCare© RightCare© is a care plan developed by GPs to adapt

to specific patient needs and improve the

management of (particularly chronic) conditions. It is

aimed at tackling a number of extremely pressing

needs identified in the NHS and in an international

health care context; namely, involving patients in the

design and delivery of their treatment and reducing

unnecessary hospital admissions.

In 2015/16 the CCG worked closely with the local health and

social care communities, DHU and a local lay member to

improve the layout of the RightCare© plan, how it works and

how it is viewed by the wider health and social care

communities. It was decided during the early part of 2016

that the RightCare© plan was to be a part of the Derbyshire

wide care plan and was to be renamed to encompass all types

of care duly noted as the Derbyshire Health and Social Care

summary.

Our main aim this year is to ensure that patients that have

care plans are moved over to the new Derbyshire Health and

social care Summary and that this can be viewed via the

summary care record. This will give an instant view of that

patients’ care plan held at their GP practice and will depict

their needs and what is usual for them – thus enabling any

Clinician to instantly assess that patient’s needs and wishes at

the click of a button anywhere in the UK.

Section 7 Our DHU Objectives 2015/2016


Objective 1 Patient Safety

We will provide a high quality effective and safe

service to all our patients. Placing patients at

the heart of safe, compassionate and

competent care.

Objective 2 Integration through partnerships

We will develop new models of integrated care

through embedding key partnership working

which commenced in 2014/15. This will Include

the redesign of Emergency and Urgent care

pathways.

Objective 3 Supporting our workforce

We will aim to attract, recruit, retain and

develop all our staff to be part of delivering

good quality healthcare services.

Objective 4 Focus on prevention and self-care

We will use our experience and expertise to

work with patients, families and our local

communities to develop resilience and capacity

in preventative services and self care.

Objective 5 Good Governance

We will be a well led, financially viable

organisation, balancing effective decision

making with innovation and transforming

services.

We will continue in 2016/17 to improve the quality of our services, to ensure they are safe, effective, caring , responsive

and well led.

Section 8 Statement of Director Responsibilities


The directors are required under the Health Act 2009 to prepare a Quality Account for each financial year. The Department of Health

has issued guidance on the form and content of annual Quality Accounts (which incorporates the legal requirements in the Health Act

2009 and the National Health Service (Quality Accounts) Regulations 2010 (as amended by the National Health Service (Quality

Accounts) Amendment Regulations 2011).

In preparing the Quality Account, directors are required to take steps to satisfy themselves that:

The Quality Accounts presents a balanced picture of the organisations performance over 2015/16.

The performance information reported in the Quality Account is reliable and accurate.

There are proper internal controls over the collection and reporting of the measures of performance included in the Quality

Account, and these controls are subject to review to confirm that they are working effectively in practice.

The data underpinning the measures of performance reported in the Quality Account is robust and reliable.

Conforms to specified data quality standards and prescribed definitions, and is subject to appropriate scrutiny and review.

The Quality Account has been prepared in accordance with Department of Health guidance.

The directors confirm to the best of their knowledge and belief they have complied with the above requirements in preparing the

Quality Account.

By order of the Board

5th May 2016 ….......................................................................... Chairman of the Board

5th May 2016 ….......................................................................... Chief Executive Officer

Section 9 Statement from Commissioners


Commissioner Statement

Section 9 Statement from Commissioners


Section 10 Statement from Healthwatch


Healthwatch Derbyshire

Section 11 Our Glossary


A&E— Accident and Emergency

ANP—Advanced Nurse Practitioner

CEF—Communication and Engagement Forum

CCG—Clinical Commissioning Group

CQC—Care Quality Commission

DSE—Display Screen Equipment

DCHS—Derbyshire Community Health Services NHS Foundation Trust

DHU—Derbyshire Health United

DN—District Nurses

ECP—Emergency Care Practitioner

ED—Emergency Department

GP—General Practitioner

HCA—Health Care Assistant

HMP—Her Majesties Prison

HMIP—Her Majesties Inspectorate of Prisons

IP&C—Infection, Prevention and Control

KPI—Key Performance Indicators

NICE—National Institute for Health and Care Excellence

OOH—Out of Hours

PGD—Patient Group Direction

PPG—Patient Participation Group

SCR—Summary Care Record

STEIS—Strategic Executive Information System

TUPE—Transfer of undertakings (Protection of Employment )

derbyshire health united quality account...

Documents