quality account | 2010 11 1 - nhs

Quality Account | 2010 – 11 1

Quality Account 2010 - 11


Contents

Section

Title Page

Part 1 Statement on quality from the Deputy Director of Solihull Community Services

3

Part 2 Priorities for improvement and statements of assurance from the Board

5

Part 3 Review of quality performance (provider determination)

13

Part 3b Review of quality account priorities (2009/10)

22

Part 4 Statements about this Quality Account

26

Part 5 Feedback

28


Part 1

Statement on quality from the Deputy Director and Lead Nurse of Solihull Community Services NHS regulations and guidance were published in 2011 confirming that a Quality Account would need to be published by all Community Services relating to performance in the 2010/11 reporting year (ending 31 March 2011). Solihull Community Services has been provided under the Solihull NHS Care Trust umbrella from October 2006 until the end of March 2011. Solihull Community Services did produce a Quality Account for 2009/10 that covered the one service captured by the regulations in 2009/10 – podiatric surgery. This exercise served to provide important learning and a good basis for further improvements this year as the Quality Account expands to cover all services provided by Solihull Community Services. Solihull Community Services are committed to providing patients and the public with clear information about quality and safety. Solihull NHS Care Trust went through intense organisational change during 2010/11 including the transfer of Community Services to three other organisations on 1 April 2011: Community Health Services moved to the Heart of England NHS Foundation Trust, Community Learning Disability Health Services moved to Coventry and Warwickshire NHS Partnership Trust, and Equipment and Community Learning Disability Residential Services transferred to Solihull Metropolitan Borough Council. The Quality Account represents the delivery of these services whilst still under the umbrella of Solihull NHS Care Trust from 1 April 2010 to 31 March 2011. Solihull NHS Care Trust itself changed on 1 April 2011, to become Solihull Primary Care Trust. All health partners in Solihull are keen to ensure that the priorities for Solihull Community Services are reflected within their organisations. The Quality Account provides a focus on the 2010/11 reporting year and looks back at achievements as Solihull Community Services setting priorities for 2011/12 in partnership with the new health provider of Solihull Community Services – the Heart of England NHS Foundation Trust. Within this Quality Account Solihull Community Services aim to present a clear picture of what Solihull Community Services deliver, the quality of services based on the information provided to Operational Managers and the improvement plans for 2011/12. Solihull Community Services is keen to make it easy for patients and members of the public to see information about quality and safety. During 2010/11 Solihull Community Services has provided monthly information on quality and safety as part of the Community Services Board reports. These reports are available on the Solihull NHS Care Trust internet site www.solihull.nhs.uk. These reports have included information such as incidents, complaints, patient satisfaction and various other measures covering each of the three domains of quality – patient safety, clinical effectiveness and patient experience.

http://www.solihull.nhs.uk/


Based on the information available and considered by the Community Services Board during 2010/11 Solihull Community Services believe that the quality of services provided is good. Most significantly an average of 90% of patients giving feedback were satisfied or more with the care received. Solihull Community Services has continually worked towards delivering care that is safe and effective measured in part by patient’s experience. Information in this Quality Account shows the good progress and achievements made over the reporting year through monitoring and benchmarking the quality of services. Areas where changes can be made to improve the quality of service have been identified. Examples of achievements in the reporting year include:

Supporting patients needing end of life care in the community and enabling them to die at home if this is their preferred place of care through the nationally recognised End of Life Service. Performance in this area has increased from 78% to 87%;

Routinely obtaining patient views and experiences across a number of health services. This is evidenced by monthly reporting of patient satisfaction across Solihull Community Services to the Solihull Community Services Board;

Monitoring the number of clinics and operations cancelled to ensure that patients receive timely care without any unnecessary inconvenience. Performance in this area has been 2% and 3% retrospectively and this data will be used to measure improvement against in the following reporting year;

Staff being up-to-date with the mandatory training and skills needed to deliver safe and effective care. By the end of the reporting year the level of staff meeting mandatory training requirements had risen to an average of 90%.

Solihull Community Services will continue to improve and develop services for patients in 2011/12 that will include work around prevention and will reflect achievements and progress in future Quality Accounts that are published by organisations that now run Community Services commissioned by Solihull Primary Care Trust. Solihull Community Services has widely consulted with the public, staff, lead Commissioner and external forums around the development of this Quality Account to help include the areas that were important to others. Solihull Community Services hope that you find this Quality Account useful and would welcome any feedback you wish to send through the feedback form at the back of the Quality Account. Solihull Community Services will ensure this is considered when producing future Quality Accounts. To the best of my knowledge the information in this document is accurate.

Vanessa Stuckey Deputy Director and Lead Nurse for Solihull Community Services


Part 2

Priorities for improvement and statements of assurance from the Board

The 2010/11 reporting year represented a period of intense organisational change for Solihull NHS Care Trust that has included the transfer of Community Services from Solihull NHS Care Trust on 1 April 2011. All services provided by the Care Trust transferred to one of three new organisations from 1 April 2011. The Quality Account represents the delivery of these services whilst still under the umbrella of the Solihull NHS Care Trust between 1 April 2010 to 31 March 2011. Solihull Community Services consulted widely on a number of priorities for improvement for 2011/12 related to the Community Health Services that transferred to Heart of England NHS Foundation Trust on 1 April 2011. Staff, patients, public, lead Commissioner, local involvement networks and the local Overview Scrutiny Committee were consulted. If you would like to obtain a full list of the priorities consulted on, please email [email protected] to request further information. From the responses received there were three priorities that received most interest and these have been listed below, aligned to each of the three domains of quality. Each domain is listed below setting out the description of the Quality priority, how this will be monitored in 2011/12 and the reporting process planned to confirm achievement of quality improvement. Solihull Community Services will demonstrate achievement against these priorities within the Quality Account published or 2011/12.

mailto:[email protected]


Patient Safety

Incident Reporting

Description / rationale – It is important to continue to monitor the incidents that occur within services, as it will support improvement in the safety around the care Solihull Community Services deliver. Themes and trends will be reviewed and monitored with support provided to implement actions, and ensure that lessons learnt are shared. Solihull Community Services needs to improve the timeliness of current reporting of serious untoward incidents (SUIs) according to set local and national targets, in order for lessons to be learnt, adverse trends to be identified and advice to be sought in a timely fashion. The use of online incident reporting in Heart of England NHS Foundation Trust will help front line staff report more quickly. Monitor – SUI’s will be monitored through a dedicated forum which will support and drive improvements by offering advice on actions, monitoring the implementation of actions and ensuring lessons have been learnt. The forum will also focus on the timeliness of reporting of SUIs. Solihull Community Services will continue to review all other incidents reported across the services including the review of themes and trends, supporting the improvements identified through risk management structures and reporting arrangements. Report – Progress and updates will be reported to the lead Commissioner through the Clinical Quality Review Group and internally through the Divisional Management Team. This will be done through data presented on the quality and safety reporting dashboard and through reports.

Patient Experience Quality of life measures

Description / rationale – This priority is linked to a Commissioning for Quality and Innovation (CQUIN) agreed with the lead Commissioner for 2011/12. Solihull Community Services have continued to collect and review valuable patient satisfaction feedback across all Community Health Services. This has given insight into the experience patients had after receiving care and has supported towards making the necessary changes within services. Solihull Community Services will now focus on developing other patient experience tools to review the impact and improvements care delivered has had on patient’s lives. This addresses a core aspect of Lord Darzi’s High Quality Care for All report and also the Care Quality Commission standards. Monitor – Progress around this priority will be monitored by a group made up of senior operational managers and supported by the Service Improvement Team. Staff will also be monitoring progress at a service level through local meetings. Report – Feedback will be reported to the lead Commissioners through the Clinical Quality Review Group and internally at the Divisional Management Team. It will also be locally reviewed by staff within the relevant services to help them review their practice and make the necessary changes.


Clinical effectiveness Public Health Training Description / rationale - This priority is linked to the CQUIN agreed with the lead Commissioner for 2011/12 and is co-dependant on the training to be delivered through the PCT. Public health service provides a preventative aspect of healthcare and preventing health issues before occurrence, improving the population’s quality of life. Solihull Community Services will build on and invest towards ensuring public health training is received by front line staff, in relevant services, to provide them with the knowledge and awareness to assist them to give advice to patients when delivering care within their service. Monitor – The Business Information Unit will monitor progress through data received from staff. Training will be reviewed by managers through staff development and training records. Report - Progress and updates will be reported to the Commissioners through the Clinical Quality Review Group and internally at the Divisional Management Team. It will also be locally reviewed by the relevant services.

Review of services


During 2010/11 Solihull Community Services provided and/ or sub-contracted 35 NHS services. Solihull Community Services has reviewed all the data available and reported to the Community Services Board regarding the quality of care in all of these NHS services. The income generated by the NHS services reviewed in 2010/11 represents 100% per cent of the total income generated from the provision of NHS services by the Solihull Community Services for 2010/11. Details of the services provided in 2010/11 are list below:

Audiology CAMHS -Child & Adolescent Mental Health

Services

Community Children’s Nursing Team

Community Liaison Nurses

Community Learning Disability Team

Community Paediatric Service

Community Psychology Service

Community Respiratory Service

Continence Advisory Service

Contraception & Sexual Health

Dermatology and Tissue Viability

Dental Services

Diabetes Service Health Visiting Heart Failure Improved Access to Psychological Therapy (IAPT)

Integrated Musculosketal

Service Intermediate Care

Services (ICS) Integrated Falls Service Integrated Locality Teams

(Community Nursing)

Learning Disabilities - Short Breaks

Logistics Macmillan Specialist Palliative Care

Meadow Centre for Children’s Services

Nutrition Support

Services Paediatric Occupational

Therapy

Physiotherapy - Paediatric Podiatry

Podiatric Surgery Port Health Service School Nursing Short Breaks

SPA Single Point of Access (SPA)

Speech Language Therapy - Adults

Speech and Language Therapy - Children

Participation in clinical audits

During 2010/11, 2 national clinical audits covered NHS services that Solihull Community Services provided. There were no national confidential enquiries that covered NHS services that Solihull Community Services provided. During that period Solihull Community Services participated in 100% of the national clinical audits which it was eligible to participate in. There were no national confidential enquiries which it was eligible to participate in. The national clinical audits and national confidential enquiries that Solihull Community Services were eligible for and actually participated in during 2010/11 are on the following page.


Topic

Eligible

Participated

National Audit - Continence Care

National Audit – Falls and Bone Health

National Audit - National Epilepsy *

(*commenced in March 2011)

The national clinical audits and national confidential enquiries that Solihull Community Services participated in, and for which data collection was completed during 2010/11, 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 that audit or enquiry:

Topic

Submitted data as a percentage of

required sample %

National Audit - Continence Care 35%

National Audit – Falls and Bone Health

There were no cases required as undertook organisational audit

The reports of 2 national clinical audits were reviewed by Solihull Community Services in 2010/11 and the following actions will be taken to improve the quality of healthcare provided:

Improving communication and provision of local, long term, evidence-based exercise interventions for falls;

Developing the use of patient experience to improve the care around falls;

Reviewing screening tools and care plan documentation used by the continence service;

Empowering patients to increase their expectations of care through setting up of a user group within the continence service.

The reports of 15 local clinical audits were reviewed by Solihull Community Services in 2010/11 and the following actions will be taken to improve the quality of healthcare provided:

Reviewing resources and techniques within community paediatrics focusing on childhood obesity;

Strengthening communication and clarity of responsibilities with other care providers, such as GP’s and social care, working alongside community paediatricians around looked after children;

Reviewing indicators and pathways within the sexual health services and the services offered;


Supporting and improving communication, training and resources between GP’s and learning disabilities services;

Introducing a greater level of prospective surveillance of wound infections via a regional database;

Improving communication and training for staff within the Adult Speech and Language Service; and

Reviewing models of care and structures to meet patient needs in Podiatric Surgery.

The list above demonstrates some of the examples of recommendations and actions that have been reported through the clinical audit projects undertaken within Solihull Community Services.

Participation in clinical research The number of patients receiving NHS services provided or sub-contracted by Solihull Community Services in 2010/11 that were recruited during that period to participate in research approved by a research ethics committee was 12. Listed below are some of the examples of the research projects that have been undertaken:

Survey of well-being in young adults with down syndrome;

Powdered Infant Formula: Caregiver Perspectives; and

Reliability of radiographic measures for flat foot.

Goals agreed with Commissioners Use of the CQUIN payment framework A proportion (1.5%) of Solihull Community Services income in 2010/11 was conditional on achieving quality improvement and innovation goals agreed between Solihull Community Services 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. Solihull NHS Care Trust signed off the achievements and did not impose any financial penalties. Further details of the agreed goals for 2010/11 and for the following 12 month period are available electronically at [email protected].

What others say about the provider Statements from the Care Quality Commission (CQC) Solihull Community Services is required to register with the Care Quality Commission and its current registration status is compliant. Solihull Community Services had conditions on registration prior to 1 April 2011 for three of its locations. These locations will transfer over to Coventry & Warwickshire Partnership Trust. Solihull Community Services worked with the new provider Coventry & Warwickshire Partnership Trust to ensure conditions could be lifted on transfer of services under transforming community services.



From 2011/12 onwards, provider registration as part of Solihull NHS Care Trust will cease, and the three receiving organisations under the Transforming Community Services Agenda will take on registration of the services they provide. The Care Quality Commission has not taken enforcement action against Solihull Community Services during 2010/11. Solihull Community Services has not participated in any special reviews or investigations by the CQC during the reporting period.

Data quality

All Solihull Community Services review their data quality on a regular basis and are supported to do this through the Balanced Scorecard performance management system. Data quality measures include 'time taken to enter information' 'ethnicity coding' and 'people waiting outside 18 weeks' are available to managers on a daily basis. Service managers have local practices which provide assurance around data quality, which are monitored through service team meetings and monthly Quality and Performance Forums to help improve the safety, effectiveness and experience of the care delivered. The Performance Team supports and develops internal systems for recording and monitoring data quality. Continuous review will be sought through working with individual service managers and through the Quality and Performance Forums to check the quality of the data Solihull Community Services will now be working towards improving our data quality in line with Heart of England NHS Foundation Trust’s Data Quality framework. An example of how Solihull Community Services are working towards improving the recording of ethnicity data is by supplying front line staff with an easy read template of the ethnicity codes to help approach patients and make it easier to select the ethnicity code that best represents the patient.


NHS Number and General Medical Practice Code Validity Solihull Community Services did not require to submit records during 2010/11 to the Secondary Uses service for inclusion in the Hospital Episode Statistics which are included in the latest published data.

Information Governance Toolkit attainment levels The Solihull Community Services Information Governance Assessment Report registered an overall score for 2010/11 of 72%. This was graded ‘not satisfactory’ based on two areas where the score achieved was level 1, identifying further work needed.

Community Services remain compliant with the NHS Statement of Compliance, as both areas are not key compliance areas. However, the following improvement activities are planned within these two specific areas:

Requirement 309: Information Asset Officers within Community Services will be identified. Their role will be to risk assess their business functions in relation to information assets, link these to the risk register and ensure that business continuity plans are in place to mitigate any known risks.

Requirement 515: Solihull Community Services will implement a robust programme of Data Quality assurance formally documented and embedded into policy and procedure.

Clinical coding error rate Solihull Community Services was not subject to the Payment by Results clinical coding audit during 2010/11 by the Audit Commission.



Part 3

Review of quality performance (provider determination)

How quality is managed within Community Services The quality of the care that Solihull Community Services deliver across Community Health Services is managed in a number of ways, this includes:

Through a number of expert committees and forums, such as the Policies and Procedures Committee, which review new and existing documentation and ensure that this reflects best practice, considers patient safety and the effectiveness of the care and it is readily accessible by staff;

Information reflecting the safety, effectiveness and experience of the care delivered is scrutinised by experts and professionals, including our non-executive directors that are members of the Board and public representatives who are members of various committees and groups within the organisation; and

Quality, safety and performance information is sent through to each service and this is reviewed by staff at their Quality and Performance Forums and action plans are put in place to address any issues.

Below are further examples of the ways in which quality is managed and supported through systems and procedures within the organisation: Serious Untoward Incident Forum The forum has ensured that Community Services has a robust mechanism for identifying and acting on SUI’s. In addition, on going actions are reviewed and service managers attend meetings to discuss progress. This has given assurance that actions have been implemented and supported where necessary. Learning Lessons Bulletin The Tissue Viability Nurse Specialist noticed from collected data that Nurse Prescribers were prescribing simple items (surgical tape, simple wound dressings) that were not on the wound care formulary which identified the most cost effective option. A simple ‘switch’ message was included in the Lessons Learnt Bulletin at the same time as an A5 laminated easy reference formulary guide was sent to all prescribers as a reminder of the first options for treatment. These simple messages bought prescribing back into line with contractual requirements and supported delivery of cost effective care.

How did Solihull Community Services seek views?

Solihull Community Services engaged widely throughout the year on the publication of the Quality Account for 2010/11 to help shape and include areas that meant most to others. This included engagement with the organisations that services have transferred to from 1 April 2011.


Solihull Community Services engaged with staff and the public through a survey, the Annual General meeting and open days. Engagement also took place with the lead Commissioners, Health Overview and Scrutiny Committee and Solihull Local Involvement Network (LINks). Statements from these organisations have been provided in section 4 of this Quality Account.

What measures mean most to Solihull Community Services patients?

Consultation around the 2011/12 priorities for the Solihull Community Services transferring over to Heart of England NHS Foundation Trust has taken place with the following groups:

- Members of the public, through an online survey; - The Health Overview and Scrutiny Committee, containing elected members

from Solihull Metropolitan Borough Council; - Solihull Local Involvement Network (LINks), containing representation of

service users, patients and carers; - The Clinical Quality Review Group, Solihull NHS Care Trust Commissioners;

and - Three groups of staff from the Community Services Clinicians Forum.

The table on the next page illustrates and summarises the priorities which each group consulted felt were most important. There were three groups identified through the clinicians forum and these have been grouped individually as their priorities, patient groups and services are different and are to be recognised separately. There was general feedback that all the priorities were good and suitable, but that priorities which applied to all services within Community Services would be the most suitable for inclusion in the Quality Account.


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1.Managament and investigation of avoidable pressure sores

2. Reducing hospital admissions and interventions

3. Interacting and seeking views of patients, carers and the public

4. Incident reporting

5. Quality of Life Measures / outcomes / patient experience

6. Ensuring staff have core professional and mandatory training

7. Preferred Place of Care

8. Urinary Catheters

9. Public Health – education / smoking cessation

Reflecting on this feedback, Solihull Community Services has demonstrated some achievement to date within these areas and set out below is how Solihull Community Services continue to manage and improve quality through care that is delivered by services headed under the three domains of quality: Patient Safety 1. Management and investigation of avoidable pressure sores A dedicated SUI forum reviews the incidents related to pressure sores to see where improvements could be made to managing the care of the pressure sores and where cases can be avoided. Corrective action plans are supported and lessons learnt are shared across the services. The number of pressures sores reported as SUIs is also reviewed by the forum and will use the data from 2010/11 as a benchmark to review improvements resulting from the work driven through the forum. The timeliness of current reporting needs to be improved and the forum will continue to work with senior managers to support improvement in this area. 2. How Solihull Community Services responded to national patient safety alerts

(NPSA) Solihull Community Services continues to achieve 100% compliance with implementing NPSA alerts within the set timescales. This is supported through the Service Improvement Team and Solihull Community Services will be looking towards strengthening governance arrangements by providing detailed reports to service Quality and Performance meetings where alerts are reviewed, monitored and supported by service managers.


Clinical Effectiveness 3. The number of staff who had core and professional mandatory training Solihull Community Services are committed towards ensuring staff are trained and have worked towards significantly improving the numbers of staff that received mandatory training to an average of 90% including safeguarding and infection control. Solihull Community Services also invested in training and developing care staff around medicines management. Service managers identified staff that required this particular training within the reporting year 2010/11. This gave staff skills and awareness for delivering safe and effective care and supported compliance with Care Quality Commission standards. 4. Infection rates for MRSA and Clostridium Difficile and compliance around

screening Solihull Community Services decreased the number of MRSA and Clostridium Difficile cases recorded from the previous year to nil in 2010/11. Solihull Community Services also continued to achieve 100% compliance in screening this year, as done previously in 2009/10 of all surgical cases. This helped measure and improve the safety and effectiveness of care.

2010/11

2009/10

MRSA and Clostridium Difficile

0

3

Compliance in screening

100%

100%

5. The cleanliness of clinical areas Solihull Community Services achieved above the set target of 90% for reviewing the cleanliness of clinical areas through clinical audit. Results and recommendations are implemented and progress is monitored through the Clinical Quality Review Group, Infection Prevention Committee and by the Infection Control Team. 6. How Solihull Community Services make use of evidence based guidance, such as

National Institute for Health and Clinical Excellence (NICE) guidance Best practice is maintained through the implementation of NICE guidance that continues to be reviewed and monitored monthly through the Service Improvement Team and reported to management teams and Commissioners. Solihull Community Services have reviewed implementation by undertaking clinical audits related to a number of relevant guidance. Monitoring arrangements are strengthened by reviewing routine reports at service Quality and Performance Forums to gain further assurance that actions and recommendations are being supported and implemented.


Patient Experience 7. Results of satisfaction survey The graph below illustrates the responses within March 2011 and the previous three months from the patient satisfaction surveys across services. It demonstrates that the majority of service users have given positive feedback, but where there is an indication of any negative feedback, this is followed up with the service in question to review. Some examples of how Solihull Community Services responded to feedback received are detailed further on in the Quality Account. Solihull Community Services will be looking to review how to include carers’ views as well as the patient in future surveys.

Patient satisfaction feedback March 2011 and previous 3 months

8. The number of appointments and clinics that Solihull Community Services cancelled

Illustrated below is the number of appointments cancelled by Solihull Community Services over the last two years between 2009/10 and 2010/11. Solihull Community Services will continue to use this data to measure against and improve the timeliness of care delivered in 2011/12.


Number of cancelled appointments 2009/10 and 2010/11

Solihull Community Services also continues to review the number of clinics cancelled and the number of patients affected. Reasons are reviewed at service Quality and Performance forums and the Divisional Management Team. This information is also reported to and reviewed by the lead Commissioners. The peak seen in March 2012 represents the impact to changing of buildings where appointments had to be rescheduled to other premises. The graph below illustrates the number of clinics cancelled during 2010/11. On average 2% of clinics were cancelled and Solihull Community Services will use this data to benchmark measure improvements against for the coming year.

2010-11 2009-10


9. The number of complaints and compliments Solihull Community Services

received

Solihull Community Services continue to achieve 100% compliance in responding to complaints within the response times set nationally. Solihull Community Services actively monitor a number of compliments and complaints received through the Quality and Safety dashboard. Solihull Community Services will be working towards service managers having an insight of the types of complaints and the responses sent to patients and their carers for their service. Information around the complaints, compliments and Patient Advice Liaison Service queries will be reviewed at future service Quality and Performance meetings. 10. Preferred place of care The Macmillan service which work in partnership with community nursing has demonstrated an improvement in achieving an increased number of patients dying in their preferred place of care. Performance information indicates that there has been an increase in the number of patients having an advance care plan to indicate preferred place of care. In 2009/10 72% indicated a preferred place of care, this increased to 94% in 2010/11 of all patients that died. Performance information also indicates an increase in patients dying in their preferred place of care. In 2009/10 78% died in their preferred place of care, increasing to 87% in 2010/11. This indicates an improved patient experience for this service. Supporting people to die in the place of care means that proactively managed care decrease the need for inappropriate hospital admissions.



Listening to Solihull Community Services patients

Solihull Community Services actively collects feedback from service users around their experience and satisfaction around the care that they received. Below are examples listed of the positive and negative comments that Solihull Community Services received. These are shared with staff within services and members of the Board. Comments are reviewed by service managers and action plans for improvement are put in place where appropriate. “The staff were very thorough in producing information and trying to find the best solution for me. They tried hard to get me an appointment asap.” Service user comment about the Contraceptive and Sexual Health Service

“Very happy and felt comfortable.” Service user comment about the Pregnancy Counselling Service

“Very happy with my treatment.” Service user comment about the Podiatric Surgery Service

“People who attended to me were very kind and efficient – I have nothing but praise for the NHS.” Service user comment about the Audiology Service

“Very satisfied - went over lots of questions I had - and it is great comfort to know I can have help if required.” Service user comment about the Adult Speech and Language Service

“An excellent meeting with [the nurse]. Very helpful.” Service user comment about the Macmillan Nursing Service

“I am very happy with everything we can’t thank the nurse enough for everything she has done.” “Great help, as skin has improved, thank you.” Service user comments about the Dermatology Service

“My life has been much improved courtesy of the continence advisor and improved and better continence pads”. Service user comment about the Continence Service

“Acoustics in the hall are difficult at times – even with a hearing aid.” “The respiratory care staff are excellent in every way possible. Nothing too much for them to help you.” Service user comments about the Community Respiratory Team

“I am unaware that I was making a decision and I had no idea of what the outcome would be”. “I found the meeting and the information I received helpful.” Service user comments about the Community Liaison Nurse Team


An example of how Solihull Community Services made improvements following negative feedback received from our patients using one of our services has been given below. This demonstrates the commitment to review comments received and make the necessary actions to improve care.

Example of improvements made following a negative comment: Listed below are two cases where the Community Liaison Nurse Team have made improvements from the feedback received from patient’s carers and relatives: Comment: Patient’s relative was not happy about the patient being moved from a care home to a nursing home. Action: A briefing note to staff to re-affirm need to explain why the service needs to move patients.

Comment: Patient’s relative’s feedback regarding the information communicated to them relating to the patient’s discharge. Action: The service reviewed the method of how discharge plans are communicated and explained not only to the patient but also to their carers and relatives.


Part 3b

Review of quality account priorities (2009/10)

Quality Account Priorities focusing on Podiatric Surgery Service - progress over 2010/11

1. Capture regular service user experience information (patient experience) In order to gain valuable feedback from our service users and to work towards the development of Patient Recorded Outcome Measures (PROMs) Solihull Community Services started using a Service User Satisfaction Survey within our community services from June 2010. The Survey was extended out through the reporting year to cover all health services by 31 March 2011. This allows services to capture satisfaction information on a regular basis and results were reported to the Community Services Board All health services receive a monthly breakdown of results set against results for the previous three months. In addition any qualitative comments on surveys are sent to service managers for them to consider and where appropriate make improvements to services involving staff in the feedback and change. Solihull Community Services also share compliments received from patients. The Community Services Board receives monthly results for the service overall and a selection of comments from the surveys, both good and bad, each month within the community services quality report. The following graph demonstrates the overall patient feedback received for podiatric services over 2010/11 and where there were signs of negative feedback this was reviewed by the service.

Patient satisfaction feedback 2010/11 for Podiatric Surgery Services


Below are examples of the comments and feedback received and some of the actions Solihull Community Services have put in place in the Podiatric Surgery Service to improve the care that is delivered:

“Re appointment - told I would receive a letter, never arrived. Required to telephone two months later.”

“Excellent service and diagnosis.” “Treatment and care could not have been better.” Examples of some of the improvements made following negative comments received from our service users:

In house training of nursing team with regard to casting techniques and potential complications;

Post operative telephone contact within 24 hours of surgery to follow patient’s immediate recovery.

2. Deliver 100% compliance with Same Sex Accommodation (patient experience)

Solihull Community Services declared that services required to comply with DSSA (Delivering Same Sex Accommodation) did so for 2010/11. This related to the Podiatric Day Surgery Team. Solihull Community Services revised the process to create day surgery lists in this service to make them single sex from 1 June 2010. The service had one breach, (three people affected) of same sex accommodation within the service on 29 June 2010. The breach related to patient recovery beds. Solihull Community Services reported this breach to Commissioners and took the following actions: To ensure there were no further breaches the following actions were taken and embedded:

All advance theatre lists are checked weekly by the Business and Waiting List Manager, the Consultant Podiatrist and the Theatre Manager.

To ensure that any further breaches were managed effectively:

Consent would be sought from all those involved in an unforeseen breach;

If consent was not gained from all those affected the patient was to be sent home to ensure a single sex list was maintained;

All breaches would be reported via our incident reporting processes;

All breaches would be investigated to identify the cause. Solihull Community Services did then achieve 100% compliance with the DSSA requirement from July 2010. Following Department of Health change in guidance, this service is not longer required to comply with DSSA as it relates to day surgery only.


3. Audit post-operative complications following podiatric surgery (clinical effectiveness)

Solihull Community Services audits and monitors the number of post operative complications following podiatric surgery, which supports the effectiveness of care delivered. These are minor complications seen within this service and to give an idea of how Solihull Community Services address these, some examples have been listed below along with the actions that are put in place by the service to ensure that the service improve the quality of the service delivered. The graph below illustrates the number of complications per month as a percentage of cases seen. Between the periods of April 2010 - March 2011 the average complication rate as a percentage for the total number of cases that had complications is 2.85%.

Types of complications seen:

Post operative infections

Tight dressings post operative

Below knee casts requiring bi-valving due to post operative swelling

Transient metatarsalgia after surgery (pain related to a specific area within the foot)

Post operative pain.

of cases


Actions taken to manage the complications:

Operate an emergency on-call service manned by the consultant and/or registrar for the first 48 hours post operatively so that any patient concerns or problems can be dealt with immediately. This includes advice and further post operative local anaesthesia for pain control

All patients GPs are informed by fax on the day of surgery of the procedure, analgesics issued, type of anaesthetic used, expected recovery time and advice given to patient at discharge

All patients are aware that if difficulties arise after this period they can contact the department directly and advice or an earlier appointment if appropriate will be arranged.

4. Surgical site infection rates in podiatric surgery (patient safety) As well as looking at the number of complications resulting after post operative cases, Solihull Community Services separately monitors the number of cases that result in an infection after surgery. The graph below illustrates the number of complications related to infections per month as a percentage of cases. The average complication rate as a percentage for the total number of cases that resulted in an infection is 1.9% between April 2010 – March 2011. The cases relate to a small number of patients seen within the service.

Solihull Community Services have established a baseline infection rate within this service and will be looking at ways to reduce the infection rates in the future. The service reviews all case and trends on a regular basis at team meetings and make the necessary improvements identified.

of cases of cases


Part 4

Statements about this Quality Account

Solihull Metropolitan Borough Council Healthier Communities Scrutiny Board ‘The Board is pleased to have had the opportunity to comment on the draft and final Quality Accounts of the Solihull Care Trust. The Board is able to confirm that Solihull NHS Care Trust have attended a number of their Scrutiny Board meetings to present the draft and final Quality Accounts. In March 2011, the Board was presented with the draft and emerging Quality Accounts and in June 2011 they were presented with the final Quality Accounts. The Board was supportive of the intended process to be followed. The Board was in principle supportive of the Quality Accounts. However, there were some areas which they had identified where they would like to see improvements being shaped and prioritized over the next 12 months. These were as follows;

The need to rigorously monitor and review incidents which are reported including ‘near-misses’

The need to reduce infection rates in podiatric surgery in response to the recent rise in infection rates in this area.

The need to significantly reduce the number of appointments which are cancelled.

To aim for 100% of staff to attend and receive mandatory training. The Board was broadly supportive of the move to offer more community-based health related provision in place of more costly acute services; however it was highlighted that investment in community-based health provision needed to have a Solihull focus and be accessible to the local community. The Board felt it was very useful to receive some service user feedback within the Quality Accounts but felt that in future reports, it would like to see a more balanced number of case studies from patients whose experience hadn’t been so positive and what lessons had been learnt from this experience. The Board was conscious of all the structural changes which has recently taken place and possible impact on performance and patient experience and would continue to monitor the impact of the transferring community services over the next 12 months. In future Quality Accounts reports for community services, the Scrutiny Board illustrated that they would like to see other information in addition to podiatric surgery service and, receive more detailed information about the financial implications of offering poor quality services.’


Solihull Local Involvement Network ‘Solihull Local Involvement Network (LINk) is a network of individuals and voluntary organisations whose aim is to represent the voice of local people on health and social care issues. Solihull LINk welcomes this Quality Account from Solihull NHS Care Trust, and we are pleased to see a commitment to seeking service user feedback and to improving services. The LINk supports the priority areas identified for community services for the next 12 months. The LINk would like to see more information with regard to how progress is monitored on the issues in this Quality Account, and would like to know more detail about the corrective action in place. We would particularly be interested to see more information available to the public about the trends and themes in patient feedback and the resulting changes in services. Now that Community Services have transferred to three different providers, the LINk remains committed to working with providers, and to promoting service user engagement and involvement.’ Contracting Quality Review Group (on behalf of Solihull NHS Care Trust as Commissioner) Corroborating Statement from Solihull Primary Care Trust – Lead Commissioning PCT ‘Solihull Primary Care Trust is pleased to review and to comment about this Quality Account. A strategic goal of Solihull PCT is to ensure the ‘right care, right place, right quality’ of services for the population it serves and this Quality Account contributes towards that. Solihull PCT through its Clinical Quality Review Group fulfils a remit of quality assurance and improvement and holds Solihull Community Services to account for the quality of services delivered. Members of the group formally review and discuss each month, without limitation, any issues or concerns relating to the quality and safety of care. They also identify and ensure implementation of recommendations and requirements for improvement. Community Services have been very proactive in their approach to Infection Prevention and made significant improvements through out the year. It is encouraging that infection rates are available for podiatric surgery and that overall the rate is less than 2%. We would support and recommend a system of ongoing prospective surveillance to understand the epidemiology of these infections in this patient group. The data provided in this Quality Account is consistent with that supplied to and reviewed by the Clinical Quality Review Group during the year. The work throughout the year and demonstrated within this quality account also identifies Community Services ongoing commitment to improving the quality of care and patient experience. On this basis, Solihull PCT can confirm that this Quality Account represents a fair reflection of the quality of services provided by Solihull Community Services.’


Part 5

Feedback

To view this Quality Account electronically, please go to the NHS Choices website. Evaluation form What best describes you? Please circle Patient carer member of the public staff member other How can we improve on the Community Services Quality Account next year?

What section did you find the most interesting?

Did you find the data and information easy to read? If not, please let us know how we could improve on this.

Are there any other topics you would like to see in the Quality Account next year?

Please send your response to Service Improvement Team, Solihull Community Services, 3rd Floor, Union Road, Solihull, B91 3EF. If you would like to be involved in consultation around next years Quality Accounts, please write to the address above or email [email protected].


quality account | 2010 11 1 - nhs

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