2009/10 quality account - nhs

2009/10 Quality Account

2009-10 Quality Account, version 1.8 of 26

Introduction A Quality Account is a report which demonstrates that the Board of the Hampshire Partnership NHS Foundation Trust regularly scrutinises the quality of all of its services and which demonstrates that the Board ensures improvements are made year-on-year. A Quality Account should also tell you about how we performed in previous years and our plans for the coming year. We have written our Quality Account in accordance with:-

♦ Quality Accounts toolkit: Advisory guidance for providers of NHS services producing Quality Accounts for the year 2009/10 (Department of Health, February 2010);

♦ Response to consultation: Additional annual reporting requirements for 2009-10

(Monitor, March 2010). The above documents dictated much of the content of our Quality Account. However, we know from feedback from our 2008/09 Quality Report that many readers valued examples of our service improvements and patient stories, so you will find case studies and patient stories included too. In order to make this report accessible we have provided a content list which briefly describes the content of each section and we have included more detailed information in the appendices. We value your feedback, please let us know what you think of this report by emailing us at the following address, please mark the subject heading ‘Quality Account’:-

[email protected]

OR write to us at:-

Quality Account Feedback Hampshire Partnership NHS Foundation Trust 6 Sterne Road Tatchbury Mount Southampton SO40 2RZ


Contents Page numberIntroduction 2

Tells you what a Quality Account is & how to give us your feedback Part 1 - Statement on quality from the Chief Executive & Chair 4

Tells you our view of the quality of our services and confirms that to the best of our knowledge the information in this report is accurate

Part 2 (a) – Priorities for 2010/11 6 Tells you the areas we want to improve during 2010/11

Part 2 (b) – Statements relating to quality of NHS services provides 7 These statements must be included in all Quality Accounts and allow you to compare our performance with that of other NHS trusts

Review of services 7 Participation in clinical audits 7 Participation in clinical research 9 Commissioning for Quality and Innovation (CQUIN) payment framework

10

Statements from the Care Quality Commission (CQC) 10 Data quality 11 Information Governance Toolkit 11 Clinical Coding error rates 12

Part 3 (a) – Review of national quality performance 12 Tells you how we performed in 2009/10 against national priorities

Part 3 (b) – Review of local quality performance 12 Tells you how we performed in 2009/10 against the local priorities we set in 2009/08

Part 3 (c) – Quality indicators for 2010/11 12 Tells you how we will measure and monitor Safety, Effectiveness and Service User Experience in 2010/11

12

Part 3 (d) – Who we involved and engaged with during the preparation of this report

17

Part 3 (e) – What our commissioners, LINks and Health Overview Scrutiny Committees (HOSC) say about our Quality Account

17

Appendix 1 – Explanation of the abbreviations and terms used in this report 18 Appendix 2 – Detailed information about the indicators we will use in 2010/11 19 Appendix 3 – Examples of good practice and how we improved services during 2009/10

21

Appendix 4 – Examples of some experiences of people who use our services 25


Part 1 – A Statement on quality from the Chief Executive and Chair The opening statement in our Quality Strategy is “Quality is at the heart of everything we do”. To support this bold statement during 2009/10 we put in place a number of measures, including:-

♦ An Executive Lead with responsibility for the production of our Quality Accounts; ♦ An Executive Lead with responsibility for each of our quality priorities; ♦ Annual improvement plans which are monitored monthly; ♦ A Quality and Governance Committee; ♦ A Patient Safety Committee; ♦ An Assurance Committee with delegated Board responsibility for quality, patient

safety and patient experience; ♦ We have increased the information presented to the Board relating to quality,

patient safety and patient experience and; ♦ A variety of ways for engaging with stakeholders to ensure that we are delivering

services that are wanted and that our plans for improving the quality of those services are also what are wanted.

This report presents a small snap-shot of the information used by clinicians and managers to improve services and it provides only a brief view of some of the quality improvement work we have done and will continue to do. The directors are required under the Health Act 2009 and in the terms set out in the NHS (Quality Accounts) Regulations 2010 (“the Quality Accounts Regulations”) to prepare Quality Accounts for each financial year. In preparing these accounts, directors are required to take steps to satisfy themselves that:

The Quality Accounts present a balanced picture of our performance over the period covered;

The performance information reported in the Quality Accounts is reliable and accurate;

There are proper internal controls over the collection and reporting of the measures of performance included in the Quality Accounts, 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 Accounts is robust and reliable, conforms to specified data quality standards and prescribed definitions, and is subject to appropriate scrutiny and review; and

The Quality Accounts have been prepared in accordance with relevant requirements and guidance issued by Monitor.

To ensure our Quality Accounts are a fair and accurate reflection of the Trust’s quality ambitions and performance there are a number of measures in place. For example, during 2009/10 we regularly review our performance against key indicators and national targets; and the Executive Directors and the Assurance Committee (formerly the Clinical Governance and Risk Committee) reviewed information relating to quality, patient safety and patient experience. Stakeholders, including staff, service users and carers, governors, commissioners, the Strategic Health Authority (SHA), Southampton and Hampshire Health Overview & Scrutiny Committees (HOSC) and Southampton and Hampshire Local Involvement Networks (LINks) were consulted and involved in a variety of ways, including:

Public Board meetings Council of Governors meetings


Member Constituent meetings Strategic exchange meetings with Primary Care Trusts Senior managers representing the Trust in Local Implementation Teams Non-Executive Directors’ involvement in Trust Committees User and Carer representation on Trust and Directorate Committees Staff representation on Trust and Directorate Committees Annual Clinical Governance Conference Completion of an on-line questionnaire to help inform the Trust’s quality indicators for

2010/11.

Finally, the collection and reporting of the information given in our Quality Account has been subject to internal audit by Deloitte & Touche Public Sector Internal Audit Limited. The directors confirm to the best of their knowledge and belief they have complied with the above requirements in preparing these Quality Accounts and that the information in this document is accurate.

Nick Yeo Carol Bode Chief Executive Chair

May 2010


Part 2 – (a) Priorities for improvement for 2010/11 During 2010/11 we want to improve the following areas:-

♦ The safety of service users, staff and visitors; ♦ Clinical effectiveness; and ♦ The experience of our service users.

Maximise safety for service users, staff and visitors We are making safety a priority, so that avoidable deaths and avoidable harm remain just that… avoided. To support this work we have established a Patient Safety Group chaired by our Medical Director. During 2010/11, this group will:

• Launch a revised risk assessment policy (CP92) which includes a single risk

assessment tool for use across the Trust, the launch of this important policy will be supported by the development of improved risk assessment training for clinical staff.

• Undertake a safety climate survey in in-patient wards in the Trust. This will enable us to set a baseline from staff and service users perspectives and indicate areas for further improvements.

• Improve the quality of Critical Incident Reviews (CIRs). CIRs are the detailed investigations we undertake after all serious incidents. We will ensure that:

o CIRs are completed within timescales; o CIRs are independently checked for quality o All recommendations in CIRs are SMART (Specific, Measurable,

Achievable, Realistic, and Timely). Improving clinical effectiveness Clinical effectiveness is about doing the right thing at the right time for the right service user to achieve the right outcome. To improve clinical effectiveness during 2010/11 we will

♦ Implement a Trust-wide electronic patient record (called RiO) and ♦ Introduce the use of clinical outcome measures (HoNOS and HoNOS65+) in

community mental health teams. RiO will help us deliver effective and safe care to service users, as it will help healthcare professionals view service user’s records, histories and results. During 2010/11 our focus is on the successful and safe implementation of RiO. For example, by ensuring that RiO ‘go live’ dates are achieved and that care plans and risk assessments for high risk service users are available on RiO within 2 weeks of ‘go live’. The Health of the Nation Outcome Scale (HoNOS) is a series of clinical outcome tools which helps us measure if the treatments and therapies we provide make a difference to the lives of service users. During 2009/10 we introduced HoNOS in all Adult Mental Health (AMH) inpatient units and HoNOS65+ in all Older Persons Mental Health (OPMH) inpatient units. During 2010/11, HoNOS and HoNOS65+ will be implemented in all AMH and OPMH community mental health teams. In addition, during 2010/11, other clinical outcome tools, such as Recovery Star, are being tested by our OPMH services. We have not yet tested the HoNOS tool for Learning Disability services (HoNOS-LD) and so we are not yet using it.


Improving the experience of our service users Although the care we deliver always focuses on our service users, their needs can sometimes be assumed and the powerful role their views can play in improving our services can sometimes be overlooked. Service users should drive the design and delivery of our care. To support our patient experience work, we have established a ‘Task and Finish Group’ chaired by the Director of Nursing & Operational Services. The other members of this group include the Directors of Operations; Programme Director for Service Engagement; Consumer Experience Development Manager and Head of Consumer Experience & Engagement. During 2010/11, this group will:

• Develop a five year strategy for Patient Experience, including the involvement of

service users and carers, members, Governors and other stakeholders.

• Map the current Patient Experience work that is underway within Service Directorates.

• Explore the use of obtaining service user experience feedback using the Developing

Recovery Enhancing Environments Measure (DREEM). This will include a baseline assessment, which is a self report instrument used by service users to record their current experience, based on mental health recovery and includes how they think staff and systems could be more supportive of their recovery.

• Identify and agree patient experience indicators for inclusion in the 2010/11

Directorate and Trust dashboard. Part 2 – (b) Statements relating to quality of NHS services provided The following statements must be included in all Quality Accounts and therefore allow you to compare our performance with that of other NHS trusts. Review of Services During 2009/10, the Hampshire Partnership NHS Foundation Trust provided or sub-contracted 33 NHS services. The Hampshire Partnership NHS Foundation Trust has reviewed all the data available to them on the quality of care in 32 of these NHS services. The income generated by the NHS services reviewed in 2009/10 represents 99.75 per cent of the total income generated from the provision of NHS services by the Hampshire Partnership NHS Foundation Trust for 2009/10. Participation in clinical audits: During 2009/10, four national clinical audits and one national confidential enquiry covered NHS services that the Hampshire Partnership NHS Foundation Trust provides. During that period the Hampshire Partnership NHS Foundation Trust participated in 50% national clinical audits and 100% confidential enquiries which it was eligible to participate in. The national clinical audits and national confidential enquiries that the Hampshire Partnership NHS Foundation Trust was eligible to participate in during 2009/10 are as follows:


National audits: • Prescribing Observatory for Mental Health (POMH) • The National Audit of Psychological Therapies for Anxiety and Depression pilot • National continence audit pilot • National audit of the organisation of services for falls and bone health in older people

National confidential enquiries:

• National Confidential Inquiry (NCI) into Suicide and Homicide by People with Mental Illness

The national clinical audits and national confidential enquiries that the Hampshire Partnership NHS Foundation Trust actually participated in during 2009/10 are as follows: National audits:

• National continence audit pilot • National audit of the organisation of services for falls and bone health in older people

National confidential enquiries:

• National Confidential Inquiry (NCI) into Suicide and Homicide by People with Mental Illness

The national clinical audits and national confidential enquiries that the Hampshire Partnership NHS Foundation Trust participated in, and for which data collection was completed during 2009/10, are listed below alongside the number of cases submitted to each audit or enquiry as a percentage of the number of registered cases required by the terms of the audit or enquiry.

National Audit / Confidential Enquiry

Percentage of Required Cases

Submitted

Reason for Not Submitting Full Number

National continence audit pilot 50% 5 bladder aged 64+ 5 bowel aged 64+

One week before the audit, the sample size was increased to include people aged 18 - 64 and the Trust was unable to meet these new requirements at short notice.

National audit of the organisation of services for falls and bone health in older people

100%

N/A

National Confidential Inquiry (NCI) into Suicide and Homicide by People with Mental Illness

100%

N/A

The reports of one national clinical audit were reviewed by the provider in 2009/10 and the Hampshire Partnership NHS Foundation Trust intends to take the following actions to improve the quality of healthcare provided:-

• Results reviewed by the Trust’s Lead for falls and considered by the Older Person’s Mental Health Directorate Falls Committee;

• Trust’s Lead for falls to work with the Risk Department to produce calculated overall inpatient falls rate against activity (e.g. per admission or occupied bed day) and the injurious falls rate against activity;


• The Trust currently cannot meet the standard to provide walking aids within 24 hours of admission, but they can be provided within 72 hours. The Trust’s Lead for falls will investigate the areas that cannot comply with this standard and

• Falls policy and paperwork is to be reviewed and amended when the NICE Osteoporosis Risk Guidance is available.

The reports of 68 local clinical audits were reviewed by the provider in 2009/10 and the Hampshire Partnership NHS Foundation Trust intends to take the following actions to improve the quality of healthcare provided:-

• Change practice relating to risk assessment for patients at risk of falling, clinical waste disposal and completing CPA prior to discharge.

• Improve information available to staff, for example, NICE, accessing Children’s Services and medical devices.

• Improve information available to service users and carers notably relating to infection control, treatment options and medications.

• Revise paperwork relating to discharge, medication monitoring, leave and handovers.

In 2009, 3 audits undertaken by the Trust were short listed by the Healthcare Quality Improvement Partnership (HQIP) for the annual national clinical audit awards for showing sustained improvement or for involving patients and the public. An audit of the recording of outcome measures at Leigh House went on to win the national sustained improvement award. More information is available in the Trust’s Annual Clinical Audit Report which can be obtained via [email protected]. Participation in clinical research The number of patients receiving NHS services provided or sub-contracted by the Hampshire Partnership NHS Foundation Trust in 2009/10 that were recruited during that period to participate in research approved by a research ethics committee was 285. This increasing level of participation in clinical research demonstrates the Hampshire Partnership NHS Foundation Trust’s commitment to improving the quality of care we offer and to making our contribution to wider health improvement. The Hampshire Partnership NHS Foundation Trust was involved in conducting 78 clinical research studies. The Hampshire Partnership NHS Foundation Trust completed 94% of these studies as designed within the agreed time and to the agreed recruitment target. The Hampshire Partnership NHS Foundation Trust used national systems to manage the studies in proportion to risk. Of the 28 studies given permission to start, 11%* were given permission by an authorised person less than 30 days from receipt of a valid complete application. 36%# of the studies were established and managed under national model agreements and 22% of the 18 eligible research involved used a Research Passport. In 2009/10 the National Institute for Health Research (NIHR) supported 24 of these studies through its research networks. In the last three years, 260 publications have resulted from our involvement in NIHR research, helping to improve patient outcomes and experience across the NHS.


* Delays were due to contract or sponsorship negotiations or awaiting further information from investigators and were out of the control of the Research and Development Department. # Other projects were studies to which the model agreements did not apply; e.g. student projects.

CQUIN payment framework. A proportion of the Hampshire Partnership NHS Foundation Trust income in 2009/10 was conditional on achieving quality improvement and innovation goals agreed between the Hampshire Partnership NHS Foundation Trust and any person or body they entered into a contract, agreement or arrangement with for the provision of NHS services, through the Commissioning for Quality and Innovation payment framework. During 2009/10 our income conditional upon meeting quality and innovation goals (CQUIN) was:- Commissioner CQUIN Income % Received

Agreed Target * Received NHS Hampshire 215,422 215,422 100NHS Southampton 75,138 75,138 100National Commissioning Group 32,888 32,888 100South Coast Specialist Services Commissioning Group 90,448 90,448 Total 413,896 413,896 100 * As per contracts

Further details of the agreed goals for 2009/10 and for the 12 month period are available on request from [email protected]. Statements from the CQC: The Hampshire Partnership NHS Foundation Trust is required to register with the Care Quality Commission and its current registration status is registered with no conditions. The Care Quality Commission has not taken enforcement action against the Hampshire Partnership NHS Foundation Trust during 2009/10. The Hampshire Partnership NHS Foundation Trust is subject to periodic reviews by the Care Quality Commission and the last review was on March 2009. The CQC’s assessment of the Hampshire Partnership NHS Foundation Trust following that review was:

Performance Indicator Our 2008/09 score

Access to appropriate support and treatment Having a contact number for someone from their local mental health services to phone out of office hours.

High

Having or being offered Cognitive Behavioural Therapy (talking therapy) if it is appropriate for them.

Average

Service user involvement Being given or offered a copy of their care plan. High Being involved in developing the care plan. Average Having their diagnosis discussed with them. Average Having a care plan that contains an advance directive or crisis and contingency plan. An advance directive allows a person to plan their future treatment.

Low


Having a care plan that contains an advance directive or crisis and contingency plan where there is reference to an agreed choice of antipsychotic.

Average

Being given enough of a say in decisions about their care and treatment. Average Having had a review of their care in the last 12 months – this is a meeting to discuss how the care plan is working, between all those involved in the care.

Average

Knowing who their care co-ordinator was. Average Having a say in decisions about which medications to take, for those who were on medications.

Average

Being told the possible side effects of new medication they were asked to take. Average Recovery and social inclusion

Having their physical health reviewed in the last 12 months, (if applicable for them).

Average

Receiving an assessment of their work/ vocational status in the last 12 months, or were employed and did not want an assessment.

Average

Receiving any help, if they wanted it, with finding work in the last 12 months. Average The Hampshire Partnership NHS Foundation Trust intends to take the following action to address the points made in the CQC’s assessment:

♦ Increase provision of Cognitive Behavioural Therapy (CBT) ♦ Increase service user involvement in the development of their care plan and ♦ Develop care plans that have an advance directive or crisis and contingency plan.

The Hampshire Partnership NHS Foundation Trust has made the following progress by 31st March 2010 in taking such action:-

♦ Applied for NHS Education South Central (NESC) funding to increase staff training in CBT;

♦ Provided in-house CBT training; ♦ Undertaken a six monthly audit of Care Planning to test whether service users are

actually involved in developing their care plans; ♦ Developed guidelines for staff to ensure that the Wellness Recovery Action

Planning (WRAP) crisis plan is captured on RiO (the new electronic patient record) and

♦ Revised staff CPA training to ensure that advanced decision making is included. The Hampshire Partnership NHS Foundation Trust has not participated in special reviews or investigations by the Care Quality Commission during 2009/10. Data quality The Hampshire Partnership NHS Foundation Trust submitted records during April 2009 and January 2010 to the Secondary Uses Service for inclusion in the Hospital Episode Statistics which are included in the latest published data. The percentage of records in the published data which included the patient’s valid NHS number was: 95.7% for admitted patient care 99% for out patient care The percentage of records in the published data which included the patient’s valid General Medical Practice Code was: 100% for admitted patient care 99.9% for out patient care



Information Governance Toolkit The Hampshire Partnership NHS Foundation Trust’s score for 2009/10 for Information Quality and Records Management, assessed using the Information Governance Toolkit was 70.2%. The Trust declared that items 407 (relating to A&E records) and 511 (relating to Code of Conduct for Payment by Results) were not relevant at the time of the declaration. Clinical Coding error rates The Hampshire Partnership NHS Foundation Trust was not subject to the Payment by Results clinical coding audit during 2009/10 by the Audit Commission. Part 3 – Review of quality performance In this part of the Quality Account we aim to tell you

(a) how we performed in 2009/10 against national priorities; (b) how we performed in 2009/10 against our local priorities; (c) the quality indicators we will be measuring and monitoring during 2010/11 (d) who we involved and engaged with to determine the content and priorities

contained within our Quality Account and (e) what our commissioners, LINks and HOSC said about our Quality Account.

3(a) - Review of national quality performance Table 1 shows an overview of our performance in 2009/10 against the key national priorities. 3(b) - Review of local quality performance In table 2 we have summarised our performance in 2009/10 against the local priorities we identified in our 2008/09 Quality Report. 3(c) - Quality indicators for 2010/11 Detailed information about all of the following indicators is provided in Appendix 1 or can be obtained by emailing us at: [email protected]. During 2010/11, we will be measuring and monitoring the following patient safety indicators:-

♦ Escape from medium secure units; ♦ Slips/Trips/Falls and ♦ Violence and aggression

The clinical effectiveness indicators we will be measuring include:-

♦ Under 18’s admitted to adult mental health wards; ♦ Pressure ulcers and ♦ Infection outbreaks

During 2010/11, we will be measuring the experience of service users via:-

♦ Length of stay; ♦ 7 day follow-up and ♦ Complaints

Table 1 - Our performance during 2009/10 against national targets.

Monitor Targets Result as at 31st March 2010

Is this good?

Notes

Percentage of beds occupied by service users who have not been discharged when expected (Delayed transfers of Care) 3.3%

Percentage of service users who were contacted by our services within 7 days of their discharge 97.3%

Percentage of service users who have access to crisis resolution/home treatment services 96.5% Number of Crisis Resolution Home Treatment Teams 6

Care Quality Commission (CQC) Targets * Result as at 31st March 2010

Is this good?

Notes

Percentage of beds occupied by service users who have not been discharged when expected (Delayed transfers of Care) – CQC construction

Achieved

Percentage of service users discharged on CPA who are contacted by our services within 7 days - (wider measure in line with CQC indicator. Performance against narrower, Monitor indicator, 97.4% ↓) 96.60%

Percentage of service users in inpatient learning disability services who have a care plan 100.0%

Mental Health Minimum Data Set (MHMDS) data completeness – this is a measure of our ability to submit information to national data collections. Not Achieved

x Not able to comply with this indicator until full

implementation of RiO. MHMDS - % of discharged patients on CPA that have a care coordinator in place (Patterns of Care). Not Achieved

x Not able to comply with this indicator until full

implementation of RiO. Best practice in mental health services for people with a learning disability (Green Light toolkit) Achieved

7 green; 5 amber with action plans in place.

Campus closure - number of people receiving care in (or discharged from) Learning Disabilities campus who have a discharge plan 100.0%

Percentage of service users with a recorded ethnic code 87.9%


Child and Adolescent mental health services - assessed against 6 elements and given a rating of 1 to 4, 1 being the poorest and 4 the highest level. Achieved

3 rated as level 4 3 rated as level 3.

Staff Satisfaction Achieved

Drug Users in Effective Treatment (Retaining drug misusers in treatment for 12 weeks) Achieved

Access to Healthcare for people with a learning disability - shadow indicator for 2009/10 in development

Ị CQC have not yet published the

indicators. * At the time of writing, very few of the CQC parameters had been published, and so we have had to use 2008/09 parameters

Core Standards Declaration to CQC Result as at 31st March 2010

Is this good?

Notes

Declared full compliance with all core standards Achieved

Full compliance declared in 2007/08

and 2008/09.


Table 2 - Our performance during 2009/10 against our local priorities.

Physical Health Priorities Result as at 31st March

2010

Is this good?

Notes

All service users receive physical health checks in conjunction with primary care

Partially achieved

Ị Audits to be undertaken during 2010/11 to ensure we are achieving this measure.

Staff are trained to carry out physical health assessments Achieved Developed a new one day training course for staff.

Promote healthy options Achieved

Health Outcomes Result as at 31st March

2010

Is this good?

Notes

The number of HoNOS scores recorded on admission and discharge Achieved

Patient Experience Result as at 31st March

2010

Is this good?

Notes

Obtain feedback from Patient Experience Trackers (PETs) Achieved Patient responses to 2 questions from PETs are now reported to the Board.

Foundation Trust membership & governor engagement in the patient experience agenda Achieved Established a Governor Patient

Experience Task Group. Service user & carer involvement in staff recruitment Achieved

Participate in the NHS Institute of Innovation & Improvement’s Experience Based Design (EBD) project Achieved

Project undertaken in the Specialised Services Directorate & focused on the experience of patients who transfer into our services from prison.

Patient Safety Result as at

31st March 2010

Is this good?

Notes

100% Compliance with the Strategic Health Authority’s reporting requirements for Serious Untoward Incidents (SUIs)

Not Achieved

x 24% of SUIs reported during 2009/10 within timescale. Improving reporting is a priority of the Patient Safety Group for



2010/11.

Analysis of slips, trips and falls Achieved

A total of 1149 falls were reported in 2009/10; 5 of which resulted in severe injury.

Analysis of absence without leave and missing persons Achieved

In 2009/10, there was a total of 122 occurrences of AWOL or missing persons.

Completion of the National Patient Safety Agency’s Seven Steps to Patient Safety in mental health self-assessment tool Achieved

We achieved an overall score of 83% & have an action plan to improve step 2 (supporting staff); 4 (promote reporting) & 5 (involving patients).

Participation in the Health Foundation’s Safety in Mental Health Programme Achieved

We participated in projects on medicines reconciliation; perceptions of safety on wards and leadership walk rounds.

Monitor Implementation of the National Institute for Clinical Excellence (NICE) Achieved Achieved 100% compliance with NICE Technology Appraisals.

3(d) - Who we involved and engaged with during the preparation of this report. We invited a group of clinicians, managers and information analysts to develop a list of potential indicators for use during 2010/11. The list was then shared with:-

♦ Staff; ♦ Service users; ♦ Governors; ♦ Commissioners; ♦ The Strategic Health Authority; ♦ Southampton and Hampshire Local Authorities (via their Health Overview &

Scrutiny Committees); ♦ Southampton and Hampshire Local Involvement Networks (LINks) and ♦ The public (via a survey on our website)

We considered the comments received from the groups above and used this information to devise the final list of measures as listed in Part 3c of this report. Our 2010/11 priorities and indicators have been approved by the Board. 3(e) What our commissioners, LINks and HOSCs say about our Quality Account NHS Hampshire and NHS Southampton City response to Hampshire Partnership NHS Foundation Trust Quality Account NHS Hampshire as lead commissioner has coordinated the review of the Quality Account produced by Hampshire Partnership NHS Foundation Trust. The review concluded that: 1. The Quality Account provides information covering the elements of quality as defined by

Lord Darzi. These are patient safety, patient experience and clinical effectiveness (patient outcomes).

2. Commissioners are satisfied that the Quality Account incorporates all of the mandated elements required.

3. There is evidence, within the Quality Account, that Hampshire Partnership NHS Foundation Trust has utilised both internal and external assurance mechanisms.

4. Commissioners are satisfied with the accuracy of the data contained in the Quality Account. Some elements are not possible to comment upon due to the variation in reporting mechanisms.

The account identifies significant progress in relation to: ♦ Health of the Nation Outcome Scales – this is a clinical outcomes measure to assess

the effectiveness of treatment and therapies of a patient. This mechanism is being rolled out across the Trust.

♦ Falls – the amount of inpatients falling whilst in the care of Hampshire Partnership NHS Foundation Trust has reduced.

♦ 7 day follow up – when inpatients / service users are discharged, mental health / LD services are required to follow up within seven days to ensure patients remain well.

Hampshire Partnership NHS Foundation Trust has identified in its quality account a number of changes linked to the experience of patient’s such as length of stay. In addition to the items outlined in the Quality Account, Hampshire Partnership NHS Foundation Trust has also worked closely with commissioners during 2009/10 to virtually eliminate mixed sex accommodation. NHS Hampshire would also note the positive steps taken by the Trust to establish a dedicated Patient Safety Committee in addition to the Quality and Governance Committee. It is felt that this has significantly improved the reporting culture within the Trust. D. M. Fleming (Mrs)


Chief Executive NHS Hampshire The commentary from the Southampton Local Involvement Network (LINks) is reproduced below: Southampton LINk is pleased to be able to comment on the quality accounts this year. The relationship between Southampton LINk and the trust has strengthened during the year and we hope that it will further strengthen in the coming year. Hampshire Partnership Foundation Trust is invited to all our steering group meetings and a representative normally attends. One of our members attends the Southampton constituency meeting. In order to be more actively involved Southampton LINk would hope that it might be possible for one of the steering group members to be invited to sit on one of the Trust management groups such as Governance. Southampton LINk had only had one occasion to request information from the trust and that request was dealt with effectively and efficiently. The concern involved the lack of a particular service and the trust advised that they were not commissioned to provide the service in question. Further enquiries with the commissioning Trust has resulted in them establishing a focus group to look at this and related issues. At a recent discussion between the trust Chair and the Chair of Southampton LINk, it was proposed that we should explore future co-ordination of member activity with a view to providing better patient feedback on health and social care issues. This proposal is welcomed and will be pursued in the coming year. We found the draft quality accounts easy to follow and appreciate the inclusion of case studies We support the idea of a task and finish group to improve patient experience and for the development of a strategy. We would hope to be consulted as this project progresses We wish the Trust well as it embarks on its plans for 2010 – 11. H F Dymond Chairman Southampton LINk The Hampshire and Southampton Health Overview and Scrutiny Committees (HOSC) and the Hampshire Local Involvement Networks (LINks) were also given an opportunity to provide a comment on our 2009/10 Quality Account. Whilst they all welcomed receipt of the Quality Account, they all declined to provide a commentary.


Appendix 1 – Explanations of the abbreviations and terms used in this report Abbreviation Description AMH Adult Mental Health – a part of the Trust that delivers services to working

age adults AWOL Absent without leave or missing person – when a patient leaves a unit

when they should not CBT Cognitive Behavioural Therapy CMHT Community Mental Health Team CIR Critical Incident Review – the detailed investigation we undertake when

something has gone wrong CPA Care Programme Approach CRHT Crisis Resolution Home Treatment Team CQC Care Quality Commission – the regulator for health and adult social care

services in England CQUIN Commissioning for Quality and Innovation, a way that PCTs pay

incentives for quality improvement DH Department of Health – The national headquarters of the NHS. DREEM Developing Recovery Enhancing Environments Measure – a tool for

measuring service user experience EBD Experience Based Design - aims to bring staff and service users together

to improve care and re-design services HoNOS Health of the Nation Outcome Scale – a tool to measure if the treatments

and therapies we provide make a difference to service users lives HOSC Health Overview & Scrutiny Committee - part of Local Authorities with

responsibility for scrutinising the NHS and making it more accountable to the local population.

LD Learning Disabilities - a part of the Trust that delivers services to people with learning disabilities

LINks Local Involvement Networks – organisations with responsibility for representing service users, carers and the local population

MRSA Methicillin Resistant Staphylococcus Aureus – a bacteria that can cause infection in wounds, the bloodstream and ulcers

NCI National Confidential Inquiry NICE National Institute of Health and Clinical Excellence – an organisation that

provides national guidance on the promotion of good health and the prevention and treatment of ill health.

NIHR National Institute for Health Research – responsible for research in the NHS

NHS National Health Service OBD Occupied bed days – a term used to count in-patient activity OPMH Older Persons Mental Health - a part of the Trust that delivers services to

people aged 65+ PCT Primary Care Trust – NHS organisations with responsibility for delivering

local health care services PETs Patient Experience Trackers – mobile devices used to obtain feedback POMH Prescribing Observatory for Mental Health - a national clinical audit R&D Research and Development department SHA Strategic Health Authority – the local headquarters of the NHS,

responsible for ensuring national priorities are made into local plans. SMART Specific, Measurable, Achievable, Realistic and Timely SUI Serious Untoward Incident – are serious unplanned events WRAP Wellness Recovery Action Plan – plans made between service users and

staff to aid recovery


Appendix 2 – Detailed information about the indicators we will use in 2010/11. 1. Patient Safety 1.1 Escape from medium secure units Medium secure units provide treatment for people with mental health disorders that are at significant risk of harming themselves or others. We will therefore measure the number of patients who escape from medium secure units, where escape is defined as “a detained patient escapes from a unit/hospital if he or she unlawfully gains liberty by breaching the secure perimeter that is the outside wall, fence, reception or declared boundary of that unit” (Ref: Absent without leave: Definitions of escape and abscond DH October 2009). Any escapes from medium secure units are reported to our commissioners and the Strategic Health Authority as a Serious Untoward Incident and are subject to a full Critical Incident Review. In 2008/09 there were 2 escapes from medium secure units, whilst in 2009/10 there were none. 1.2 Slips/Trips/Falls Slips/Trips/Falls are the most common type of accident in hospitals, and many can be prevented. We will therefore be measuring (a) the total number of falls and (b) the percentage of falls resulting in severe injury (such as fractures) and via the 6 monthly OPMH falls audit we will monitor (c) that service users have a completed risk assessment and (d) falls risk assessments are completed in the first 6 hours after admission. Our aim is to reduce the incidence of falls, particularly those resulting in serious injury. 1.3 Violence and aggression Everyone has the right to feel safe on our units. We will therefore be monitoring (a) the number of incidents of violence and aggression to staff by service users resulting in injury (any level of harm) and (b) the number of incidents of violence and aggression to service users by service users resulting in injury (any level of harm). Our aim is to reduce the number of such events that result in injury. 2. Clinical effectiveness 2.1 Number of under 18’s admitted to adult mental health wards. Section 31(3) of the Mental Health Act 2007 places a duty on hospital managers to ensure that patients aged under 18 are treated in an environment suitable for their age, subject to their needs. This will be measured by the number of 16-17 year olds atypical and over-riding admissions, where these are defined as:

• Atypical - are those who after an individual assessment of need are deemed would be better served by admission to an adult acute unit (example could include a member of the military or a 17 year old single mother being admitted to mother & baby unit).

• Overriding - are those who we are “forced” to admit because there was no specialist CAHMS bed available at the time of the admission.

This information will be used to inform the CAMHS Partnership, Children’s Trust Board and commissioners, to develop comprehensive care pathways, across agencies and all tiers. 2.2 Pressure ulcers If service users get pressure ulcers during whilst in our care in in-patient units, it can be a sign that we did not provide good, basic care. We will therefore measure (a) the number of Grade 4 (severe) pressure ulcers which develop during admission to in-patient units


(excluding those individuals who transferred into our care with Grade 4 pressure ulcers); and (b) the Pressure Ulcer point prevalence, which is determined by

Number of persons with a pressure ulcer x 100 ____________________________________________

Number of persons in the in-patient unit

2.3 Infection outbreaks No-one wants to come into hospital and become ill with an infection they got during their treatment. We will therefore measure (a) the total number of outbreaks; where an outbreak is defined as 2 or more people on a ward/unit having similar symptoms that could be related; and (b) how long the ward/unit is closed to new admissions and/or transfers as a result of an outbreak; as this is an indication of the effectiveness of the Trust’s infection control measures, cleaning procedures and use of isolation, etc. In 2008/09, there were 73 reported outbreaks. We have not set a target for this indicator as we have not previously measured the duration of unit closure due to outbreaks. 3. Service User Experience 3.1 Length of stay (LoS) Many patients admitted to mental health in-patient hospitals stay for long periods of time due to the nature of their conditions. Managing the LoS, and where appropriate reducing it, can improve the patient experience by encouraging people to plan for their discharge and reducing unnecessary time in hospital. We will monitor and measure LoS by

• Average LOS for AMH admission wards • Average LOS for Ravenswood House • Average LOS for OPMH functional illness wards

3.2 7 day follow-up When we discharge service users, we have a duty to check them within 7 days to ensure they remain well. We will measure this by (a) the percentage of service users discharged on CPA that were followed up by our services by face-to-face or telephone contact within 7 days of their discharge. Our previous performance for this indicator is shown below:-

Indicator Plan/ Target

2009/10 Result

2008/09 Result

Note

7-day follow-up rate year to date

≥ 95% 97.3% 96.8% Performance exceeded that required by a national target

3.3 Complaints The Trust has performed well in response to the introduction of the New Complaints regulations during 2009/10. As at 31 March 2010, the Trust had received 195 complaints. 167 of these were responded to so far, 158 of which were answered within their deadline. Nine complaints failed to make their deadline (5%). Fourteen complaints remain open and 11 were withdrawn. Of the complaints which have been responded to, 56% were upheld.


Appendix 3 – Examples of good practice and how we have improved services during 2009/10 Falls Staff at an Older Persons Mental Health unit contacted the Trust’s Moving & Handling Adviser with concerns that a service user was struggling to move around. Their poor eye sight meant that when they did move, they would often fall over. This unfortunate situation meant the service user was reluctant to leave the unit, which was affecting their quality of life. Our Moving & Handling Advisor found that the service user’s Zimmer Frame was no longer suitable and that a Power Assisted Wheelchair was required. A new wheelchair has since been purchased, and gives this service user more freedom to move around and leave the unit when they wish; it has also significantly reduced the number of falls and injuries they experience. Infection Control Background: “Annie” receives care with our Adult Mental Health services. She has a long history of cutting herself; she frequently opens and reopens wounds causing infections which need frequent antibiotic treatment. Improving quality of care: In May 2009, the Hampshire Partnership NHS Foundation Trust introduced screening for MRSA in line with Department of Health (DoH) guidelines. “Annie” met the criteria for screening and so samples were taken to determine if she had MRSA. The results showed that she was positive for MRSA in her nose and groin but negative in her wounds. Decolonisation therapy was started. This involves treating the nose with a cream and washing with a special solution (Chlorhexidine). Every 5th week suppression therapy was repeated to stop potential MRSA infections. How has this made a difference? Since this started, Annie’s self harm has not reduced but the number of infections she develops because she opens her wounds has significantly reduced. This has meant that she has needed fewer antibiotics. Improved personal care in OPMH Background: Relatives and carers on some Older Persons Mental Health wards raised concerns that there was a lack of information given to them on admission and that sometimes staff had only a limited knowledge of the service user as a person. Improving quality of care: As a result a guidance leaflet for relatives was developed to detail what they can expect from us and what is expected of them. This has proved to be particularly useful for first time admissions onto a mental health wards. In addition, staff developed a ‘Life History Diary’. This is used to record the service user’s life history and it can be transferred with the service user on discharge to support community staff. The ‘Life History Diary’ helps staff understand each service user’s unique experiences and is thereby promoting improved more personal care. Service User Privacy & Dignity Clinical Audit In 2009, the Trust worked with service users to undertake an audit of privacy and dignity. Seventy-three inpatients were interviewed on 15 adult in-patient wards. Improvements made as a result of this audit included:-


• The admissions checklist was redesigned to include best practice requirements. • The audit findings were used to revise staff privacy and dignity training. • Information about each ward, care and how to make complaints was included in

admission packs and displayed in patient communal areas. • The outcomes of the audit were fed back to patients via a newsletter

The above audit was so successful that in 2010 we repeated it in our Older Persons Mental Health inpatient units. The results identified areas of good practice:-

♦ Service users have good access to private phones; ♦ Consultations, examinations and treatments are conducted in private; ♦ There were good levels of cleanliness on the wards; ♦ There was excellent, all day provision of beverages; ♦ There are safe rooms for family and friends to visit with children ♦ Staff knock before entering bedrooms and introduce themselves

However, areas for improvement were also found, including:-

♦ Poor access to lockable facilities for storing personal items ♦ Service users were not asked about their values and beliefs ♦ Insufficient planned activities on the wards

Action plans are currently being written to address these shortcomings. Many service users told us that they liked the opportunity to tell someone what it was like on our wards. We are hoping to roll out a bigger programme which will include aspects of care other than privacy and dignity. Drug sniffer dogs At Ravenswood House, our Adult Medium Secure Psychiatric Unit, physical searches had shown that cannabis and other illicit substances were being brought into the unit by service users. This can have a detrimental effect on the efficiency of some prescribed medications and can present significant problems. To minimise the effects of drugs being brought into the unit, a Drug Sniffer Dog was hired on several occasions. This proved so successful, that Ravenswood House invested in their own Drug Sniffer Dog called ‘Charlie’. He and his handlers Jane Rosindale and Claire Bird have been trained by the company who supplied Charlie and he is now working within the Specialised Services Directorate, with the possibility to help out elsewhere in the trust in the future. The use of Drug Sniffer Dogs has been well received by service users, as it is less invasive than searches. Star Wards Background: The Management Team at one of our adult mental health inpatient units identified that the number of individuals who were absent without leave (AWOL) had been steadily increasing. Their investigations highlighted a number of factors which contributed to this. On speaking to patients who had gone absent, one of the issues identified was boredom and nothing going on, feeling restricted and ‘closed-in’ on ward environments. We decided to address this by looking at staff engagement, environment and activities available on the unit.

Improving care: We used the Star Wards concept as it promotes recreational and social activity within acute inpatient wards. We worked with our Patient and Carer Councils during this project. We had


two benchmarking meetings to assess our current position against the Star Wards document and then developed an action plan with clear objectives and responsibilities. We ran workshops and training events for staff to ensure they had the skills to think more creatively about developing, organising and running recreational and social activities on the wards, in consultation with service users. How has this made a difference? Star Wards provided an opportunity for the Patients Council and Carers Council to work with the Clinical Management Team together for the first time on a project. Training for Health care support workers continues and has been presented across the Trust via our Clinical Governance forums and a recent Modern Matron workshop. Alongside other initiatives, such as changing the main doors, this project has contributed to a 76% reduction in the number of incidents of absent without leave within the first six months and this continues to reduce significantly. Patient Safety Leadership Walk Rounds Background: The aim of the Patient Safety Leadership Walk Rounds are to promote a culture where patient safety is central by:-

♦ Providing executives and senior managers with an understanding of patient safety concerns

♦ Raising the profile of patient safety throughout the Trust ♦ Improving communication with staff dealing with patient safety issues ♦ Providing a forum for staff to discuss patient safety issues ♦ Obtaining and acting on information gathered to improve patient safety.

A pilot took place in December 2009, involving walk rounds at three inpatient units across the Trust. Improving patient safety: The staff at these units raised a number of concerns in relation to patient safety. At the end of each walk round they agreed with the executive the key areas of concern that they felt needed to be addressed. Examples include:-

♦ Take action to prevent service users climbing on window sills in the ward areas ♦ Review the location of, and procedures for, the use of High Care ♦ Improve responsiveness from doctors through increased attendance on the ward

How has this made a difference? Action plans have been written at each unit which participated and by each executive. These are currently being implemented, and will be monitored by the Trust’s Patient Safety Group. Immediate improvements have included a review of the window sills by Estates & Facilities; a review of High Care procedures and increases in doctors attendance at wards. Learning Disabilities Background: “David” has mild learning disabilities; he has a history of aggressive behaviours including violence towards other people. He also had a history of substance misuse and poor engagement with services. He had been arrested and convicted of several serious offences. David was unable to engage with the support being offered, was vulnerable to exploitation and influenced by other non disabled offenders. His behaviour got


worse and David was admitted under the Mental Health Act. Unfortunately David was admitted to an independent provider approximately 250 miles from his family. Improving Quality of Care: The opening of the Ashford low secure service in the Trust meant that we were able to evaluate David’s placement. David was subsequently transferred to the Ashford unit, with the aim of supporting his anger control, ability to problem solve, violence risks, coping with anxiety and developing his skills with a view to finding him an occupation. On arrival at the Ashford Unit, David was found to have additional complex health needs. An overall treatment plan was developed to include all of David’s needs. How has this made a difference? David progressed and after 10 months he was moved from the Ashford unit to the step down service. After a further 6 months David was able to be discharged to his own flat, with support from an integrated learning disability service and a social care agency. We were able to transfer David from an out of area placement and provide him with specialist assessment and treatment locally. This allowed David to be near to his family. He still requires support but his overall quality of life has improved significantly.



Appendix 4 – Examples of Service User & Carer experiences in 2009/10. In the other sections of this report we have shown how we are doing and we have shared our plans for the future. However, we felt it was important that this report also told us about the experiences of people who use our services. We therefore asked a random sample of service users and carers to tell us what it is like for them; what we did well and what they wanted us to improve. There follows a selection of their stories and quotes. We would like to thank everyone who shared their experiences with us; we have removed names and some other information, to maintain confidentiality. “After the birth of our second child, my wife became very ill and had to be admitted to the Mother & Baby Unit in Winchester. This was a very difficult time for us. The staff were very understanding and helpful; they spent lots of time with my wife and with us and really helped us through a difficult period. At the time, I didn’t like her being there but looking back I recognise that we couldn’t have coped without their help. Thankfully she is now doing well; but we keep in contact with the services so we know support is available if we need it again.” “I have Learning Disabilities. I am happy; I like it here and I like my helpers.” “I’ve joined a Patients Council since I’ve been on this unit. I wasn’t sure at first; it seemed like a stupid idea and a waste of time. I joined in the end to fill my day. The group works with some of the staff; they appear to be listening to us and are trying to get things done. I’m glad I joined; but I don’t want the lads to know that. I don’t always like the food on the unit, and the choice isn’t always very good, particularly at weekends. I get bored sometimes, but the Patients Council is working to change that. I’ve been to worse units, and I reckon I’ve probably not been anywhere better”. “Dad tells me that he feels like he’s failed when he has to be admitted; he thinks it means he can’t cope on his own; but he can’t always. He is happier at home, but who wouldn’t be? I can see that the staff try their best, and he can be very difficult, it can’t be easy for them.” “I don’t always feel happy here, the other patients can be very disruptive, swearing and shouting at all hours of the day and I don’t always understand what is going on. Sometimes it’s frightening; sometimes I don’t know where I am and I want to go home, but they won’t let me yet”. “I’ve had mental health problems for years; I also drink and use drugs. People often swear at me in the street, and the local kids like to have a go; I know they don’t like the look of me, they think I’m a freak. People don’t understand what its like; I don’t want to hear voices, I don’t want to be ill and I didn’t choose this”.

2009/10 quality account - nhs

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