quality account 2013/14

| Quality Account 2013-14

First Community Health & Care

Quality Account 2013/14


Our Vision, Mission & Values

About First Community Health & Care

Part 1: Introduction from our Managing Director

Part 2: Our Priorities for improvementPriority 1 - Patient SafetyPriority 2 - Clinical EffectivenessPriority 3 - Patient ExperienceStatutory Statements of Assurance

Part 3: A review of the quality of our services from 1st April 2013 - 31st March 2014

Stakeholder Statements

Glossary

Contents


Our Vision, Mission & Values

Our vision is...

‘To be recognised, respected and trusted by patients, carers, professionals and staff as the best provider and innovator of integrated community services.’

Our mission is to...

Enable people to maximise their health and well being potential

Meet and exceed quality and safety requirements

Prevent unnecessary hospital admissions and facilitate hospital discharge

Deliver integrated services with a single point of access

Be customer focused at all levels within the organisation (commissioner and patient)

Develop our business skills that allow FCH&C to respond to and shape market opportunities and threats in line with our vision and values

Become the employer of choice

Develop IT systems and infrastructure that maximise service productivity and patient outcomes

Use our estate efficiently and ensure a welcoming environment for patients and staff

Services for our community

Infrastructure(valuing our staff)

BusinessCapability


Values - How will we behave?

We will...

Care about you

We will be

Caring Conscientious Sensitive Empathetic Approachable

Provide a seamless service

Where we can we will ensure

Patient choice Integrated services Timely services Continuity of care


Be business focused

We will ensure

Our customers are valued We are skilled in business We offer bespoke care We are productive and efficient

Our staff will be

Well trained and knowledgeable Using the best care and treatments available Professional and helpful Compassionate, caring and kind Supported to develop their potential


AboutOur Quality Account 2013-14

What is a Quality Account and why do we produce one?

Each year all providers of NHS healthcare are required to produce a Quality Account to inform the public about the quality of the services they provide. It follows a set structure to enable direct comparison with other provider organisations.

It enables us to share with the public and other stakeholders:

• what we are doing well

• where we can make improvements in the quality of the services we provide

• how we have involved our service users and other stakeholders in evaluation of the quality of our services and determining our priorities for improvement over the next 12 months

• how we have performed against our priorities for improvement as set out in our last Quality Account. For each of these priorities we will tell you if we have delivered them and how we know this. If we have not delivered any we will tell you why not and what we will be doing in the future to address this.

What does our Quality Account include?Our Quality Account is divided into three sections:

Why we produce this annual accountPart 1 gives a statement of quality from our Managing Director with an introduction and overview of who we are and what we do.

In Part 2 we look at our priorities for improvement in the quality of our services. We start by looking back at each of the three priorities we set last year, reviewing our progress and outlining our plans for future development.

We then look forward, setting three new priorities for improvement for the coming year.

The priorities, both looking back and looking forward, reflect the three domains of quality (see glossary) to ensure a balanced view of the services we provide: patient safety, clinical effectiveness and patient experience.

We then provide statutory statements of assurance which relate to the quality of the services we have provided in the period 1st April 2013 to 31st March 2014. The content is common to all NHS providers, allowing direct comparison across organisations.

Part 3 gives us an opportunity to review the quality and performance of our services using these three domains of quality. We also include a section on staff experience as we recognise the impact this has on the quality of the services we provide.

How have we involved stakeholders in our Quality Account?

We welcome the views of our stakeholders in the development of our account and have consulted with a broad range of stakeholders, including our commissioners, Healthwatch and our Community Forum asking them to tell us what is important to them, their thoughts on how we presented our information last year and what they would like to be included in our account going forward.

Our published Quality Accounts are also available for public scrutiny on our website at:

http://firstcommunitysurrey.com/who_we_are

Glossary of terms: This year we have included a glossary of terms (page 49) which explains some of the terminology used.


PART 1: Introduction

About FCH&C: Who are we and what do we do?

First Community Health & Care (FCH&C) is a not-for-profit social enterprise , providing community healthcare services since October 2011 to people living in east Surrey and parts of West Sussex. Just like GPs, First Community Health & Care remains part of the NHS family and will continue to deliver NHS services with the community interest ethos, where our patients and clients are at the centre of everything we do.Community NursingProvide a broad range of specialist nursing interventions and care mainly in the home setting.

Nurse Advisors for Care HomesProvide support, advice and facilitate training to care home staff.

Heart Failure ServiceProvide specialist assessment and support to promote self-management for people with heart failure.

Respiratory TeamA multi-disciplinary team providing care for patients with certain types of respiratory disease.

Specialist NursesWe have specialist nurses providing care for people with skin conditions for both children and adults (Dermatology) and Multiple Sclerosis. We also have specialist nurses who advise and manage the prevention of infection and wound care.

Rapid ResponseA nursing and therapy service facilitating patient discharges from hospital and can respond within two hours to patients in the community to prevent unnecessary hospital admission.

AudiologyProvide specialist assessment and diagnosis for people with hearing loss and balance problems and provide appropriate support such as digital hearing aids and specialist advice.

Nutrition & DieteticsProvide a service in the community for children and adults.

Occupational TherapyProvides a holistic assessment of how an illness or disability affects an individual’s daily life and helps the individual overcome these.

PhysiotherapyProvide specialist assessment and treatment for a wide range of mobility problems including recovery after illness or injury e.g. heart attack, fractures, joint replacements and sports injuries.

Speech and Language TherapyProvide specialist assessment and advice to both patients and carers for speech, language, communication and/or swallowing difficulty.

PodiatryFormerly known as chiropody, podiatrists assess and treat a range of foot problems.

OrthoticsAssess patients who have a weakness or deformity in a part of the body as a result of a long term condition to see if provision of an orthotic appliance e.g. splints, braces, callipers would help improve mobility and support the affected area.

Neurological Rehab TeamConsists of a range of therapists with specialist rehabilitation skills to assist people with neurological conditions (e.g. Stroke, Brain Injury, Multiple Sclerosis) to maximise their independence particularly after a hospital admission.

Integrated Care & Assessment Treatment Service (ICATS) Provide assessment and diagnosis of joint and muscle injury or conditions such as arthritis, back pain and other joint problems.

0-19 Universal Children ServicesHealth Visitors, School Nurses, Staff Nurses, Community Nursery Nurses and Admin Support Workers working together with children and young people and their families, offering advice and information to support their health, development and well-being.

Caterham Dene WardA 28 bedded inpatient ward for people aged 18 years and over requiring a period of rehabilitation after illness, injury or for certain conditions. Admission to the ward reduces the pressure on acute hospital beds, ensures that such patients receive the most appropriate care and enables them to return home after a period of assessment and treatment provided by a close-working multi-disciplinary team.

Rapid Assessment ClinicA GP, community nurse or ambulance crew may refer patients here for assessment, investigations (such as blood tests and X-rays) and treatments to prevent them being sent to an Emergency Department of a main hospital or needing a spell in hospital for treatment such as a blood transfusion.

Minor Injuries UnitFor people aged 18 years or over with minor injuries that cannot be managed by the GP or practice nurse.

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It gives me great pleasure to introduce First Community Health and Care’s Quality Account for the period 1st April 2013 to 31st March 2014 sharing our achievements over the past year and our plans for improvement during 2014/15.

We are a not-for-profit social enterprise and, as such, our staff are invited to become shareholders. Being a shareholder is intended as a symbol of commitment to patients’ services, giving staff a say as to how to develop our services in the best interests of the community. We currently have 403 staff and 274 (68%) are shareholders (as at 31st March 2014).

Over the past year we have strived to provide the highest quality services for our community and ensure our patients and service users remain at the centre of what we do. Our quality account contains many examples of how we have done this and how we will continue to do this in the year ahead.

This year we have extended our services which you can read about on pages 21-24 . This reflects the commitment of our staff and the continual evaluation of the services we provide in response to our community’s needs. For example, we have worked with Parkinson’s Disease UK (a charity) and patient and carer representatives during the recruitment process for a specialist post to support people in the community with Parkinson’s Disease, aligning this post with the Community Neurological Rehabilitation Team.

We have been working hard to improve how we listen to and understand the experiences of our service users. To achieve this we are working in partnership with ‘iWantGreatCare’, a company who provide the most detailed, accurate and timely monitoring of patient experience. This gives us real time feedback and enables our patients to tell us what is important to them. We discuss and act on this at all levels within the Organisation including at Board level to ensure we are listening and responding. You can read more about this on pages 12 and 41.

We are also undertaking “Board walks” at our local community hospital enabling us, as Board members, to talk to our patients as they use our services in order to understand and respond to what they tell us. I would like to take this opportunity to thank our patients and service users, on behalf of all the staff at First Community Health & Care, for their time in giving us their views and sharing their experiences.

During 2013 we have seen the publication of The Francis Report, detailing serious failings in quality of care and patient safety. The report details 290 recommendations, for all NHS trusts, commissioners and external regulators to ensure similar failings in care and safety are not repeated. Our Chief Nurse has worked closely with all of our staff to consider and act upon these recommendations to improve safety. We developed a “plan on a page” to ensure quality and safety are central to what we do. This plan is centred around improving patient and service user experience and feedback, creating a caring and open culture, providing individualised care and strengthening our clinical leadership.

To safeguard and promote our service users’ safety, we have continued to use the NHS Safety Thermometer to benchmark our local information with national data, ensuring we perform in line with or above the national average. Analysis of our incident data has enabled us to work on reducing the incidence of pressure ulcers and reduce the risk of our patients falling in our hospital ward.

Philip GreenhillManaging Director

IntroductionFrom our Managing Director

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To ensure we are clinically effective we have developed our clinical audit policy and strategy, refining our reporting framework. Our third ‘Celebrating Quality Improvement’ day welcomed over 100 of our staff, including Board members, all celebrating and sharing examples of quality improvement. Our process of ensuring our services implement, or are compliant with, guidance on best practice as set out by the National Institute for Health and Care Excellence (NICE) has seen developments such as raising awareness of Osteoporosis and timely changes to our Rapid Assessment Clinic Deep Vein Thrombosis pathway to ensure patient care reflects best practice.

We run our social enterprise with our patients and service users at the heart of what we do. Our staff and patients help steer our social enterprise to ensure that we serve our community in the best way. To this effect we have a Council of Governors, a group of staff elected by their peers to stand office for a period of two years, and a Community Forum, established in April 2013, which provides a forum for engaging with our local community. We reinvest our profits through the Council of Governors’ Community Development Fund which supports our core purpose as a social enterprise to add social value back into the heart of our community (see glossary).

Our Quality Account for the period 1st April 2013 to 31st March 2014 highlights further achievements that continue to demonstrate our commitment to the provision of high quality care.

On behalf of the Board I would like to take this opportunity to thank all of our staff whose commitment and professionalism enables us to provide high quality services and continually improve the quality of care we provide.

In accordance with the NHS (Quality Accounts) Amendment Regulations 2011 No 269:

“I hereby state that to the best of my knowledge the information in this document is accurate”.

Philip GreenhillManaging Director


PART 2: Our Priorities for Improvement

In our last account we chose three priorities for improvement, one in each of the three domains – patient safety, clinical effectiveness and patient experience. We will review our progress against each of these priorities before outlining our priorities for the coming year.

Looking back… What we said we would do last year…

Priority 1 Update 2012-13Patient Safety

“To improve patient safety we will identify all patients within our Clinical Commissioning Group area with a urinary catheter. We will create a catheter register and ensure we are providing the right care, in the right place, at the right time.”

We wanted to create a catheter register to help us to ensure that patients are on the correct care pathway and that they are receiving the right care. However, since setting this priority, there have been developments in the local health economy which have affected the way in which the priority has been delivered. Our local acute hospital has developed a patient-held Catheter Passport which we are in the process of adopting for use within our services. This allows for all services involved with the patient to have the most up-to-date information, thus providing the most appropriate care. This proactive management will empower patients and help to reduce the risk of catheter associated problems. Catheter registers continue to be maintained at team level enabling practitioners to monitor the number of patients on their caseload with a catheter, and to plan and implement individualised packages of care.

We continue to raise awareness on the prevalence of catheters through the monthly ‘Safety Thermometer’ point prevalence surveys. This is a monthly national survey that looks at the ‘harms’ to patients in relation to catheter associated infections. We report our information each month to the national Health & Social Care Information Centre. The results are available to the public and commissioners via the Quality Observatory website: http://www.qualityobservatory.nhs.uk/.


“To develop our clinical effectiveness we will support all registered clinical staff (Nurses and Allied Health Professionals) to access clinical supervision (a formal way to maintain and improve quality care through protected time for reflection and learning) in their preferred format, time and place from

a menu of options.”

First Community Health & Care are committed to the provision of clinical supervision for all our clinical staff. Clinical supervision plays a key role in supporting and empowering our staff to achieve their potential and thus provide the highest quality of care. All of our registered clinical staff are supported to access clinical supervision in their preferred format, time and place. For example, at the end of March 2014, 131 of our 247 registered clinical staff were accessing group-facilitat-ed clinical supervision. The remainder were accessing other options from our clinical supervision menu.

In May 2012 First Community Health & Care introduced new guidelines, providing a framework for the implementation and maintenance of an innovative approach to clinical supervision. This framework offers a range of options for staff to participate in clinical supervision that accommodates variations in work settings and individual learning needs. Whilst priority for clinical supervision has been given to registered staff - nurses and therapists – we currently include community nursery nurses and associate practitioners and plan to extend provision to non-registered staff across all clinical services.

A review was carried out in May 2013 using an online survey tool to find out how the new clinical supervision guidelines and menu of options are working for all clinical staff and identify any training/development needs. It was reassuring to find that staff found clinical supervision supportive and gave them protected time to reflect on their practice.

Priority 2 Update 2012-13Clinical Effectiveness

What we said we’d do in 2012-14 What we’ve done…“We will undertake an annual survey of clinical supervision practice within FCH&C and use these results, and the recommendations in the Francis Report (2013)*, to inform, review and update our guidelines and menu of options.”

We have reviewed our guidelines and menu of options in November 2013; the survey findings also informed the content and frequency of training for staff and managers.

“We will monitor the effectiveness of clinical supervision and clinicians’ commitment to their chosen option.” We have completed our annual survey and the results have been shared with staff.

“We will provide workshops to enable new and existing staff to use clinical supervision effectively.” We have delivered 15 workshops, attended by 118 out of 330 (36%) clinical staff since July 2012.

“We will train group facilitators, provide protected time to facilitate groups and support them through updates, facilitator supervision and the appraisal process.”

We have trained nine new facilitators in September/October 2013 and offered an annual update/development day for existing facilitators in April 2013. This means we will be able to offer seven staff a place in a clinical supervision group for each facilitator who takes on a group.

“Our Chief Nurse will champion clinical supervision throughout the organisation.” The Chief Nurse has had budget-holding responsibility for clinical supervision since April 2013 and secured funding for the new facilitator and ‘train the trainer’ training in September/October 2013.

“We will provide quarterly progress reports to the Clinical Quality and Effectiveness Group.” We have continued with this.

“We will raise the profile of clinical supervision with our Self-Managed Business Teams.” (see page 44) We have done this through quarterly reporting at the Clinical Quality and Effectiveness Group and presentations at the Senior Team Meeting.

“We will complete the learning and development process by embedding learning from clinical supervision into appraisal.”

We have introduced new appraisal documentation and training with prompts for managers to ask staff about their clinical supervision activity i.e. group attendance/other activities completed and resultant learning.

* The Mid Staffordhsire NHS Foundation Trust Public Inquiry Final Report 2013http://www.midstaffspublicinquiry.com


What next? We will continue to review our guidelines at least annually to ensure they remain fit for purpose and reflect local need and national best practice and ensure recurring learning themes from group supervision inform clinical practice and management. We will explore further options for non-registered staff. Our facilitators will continue with annual development days and facilitator supervision groups for their support and development. Our Chief Nurse will continue to champion clinical supervision and quarterly reporting will continue.

“To improve our patient experience feedback we will use the Friends and Family Test (Net Promoter Score) process to collect and analyse user feedback.”

The national Friends & Family Test was launched in April 2013 by NHS England. They have an extensive rollout plan which started with the Friends and Family question “Would you recommend this service to your family and friends if they needed similar care or treatment” being asked in acute hospital wards and A&E departments. We have developed the Friends and Family question with ‘iWantGreatCare’ (iWGC) which is now being piloted in our community services ahead of the mandate in December 2014. First Community Health & Care have worked in partnership with iWGC as a pilot in the community to roll out the Friends and Family Test (FFT) since April 2013. We started by asking the initial FFT question about our Minor Injuries Unit (MIU), Rapid Assessment Clinic (RAC) and Community Hospital Ward. Our results in this pilot stage were extremely positive. For example, when compared with three other similar MIU environments, also using an iWGC methodology, First Community Health & Care received the highest Net Promoter Score (NPS) in the February 2014 reporting month (see chart adjacent).

Priority 3 Update 2012-13Patient Experience

We plan to use the FFT across all our community services from April 2014.

We have worked with iWGC to expand our original question, to include three core questions looking at quality of care and experience, and three service specific questions. We use this feedback to inform comparative benchmarking across our services.

We no longer use patient satisfaction surveys as the data from FFT has enabled a more detailed level of reporting. We use feedback to triangulate against other quality metrics including patient compliments, complaints, incidents and performance indicators to give our patients a chance to be heard. This can act as an early warning signal of a potential reduction in quality so we can respond in a timely fashion. In December 2014, we shared our learning with other organisations as part of the iWGC national symposium for patient experience to help others implement FFT in the community setting.


What next? We will continue to collect patient FFT and feedback and use the information to make continual improvements to our services and compare quality across our services. We will ask for additional information to comply with the Equality Act 2010. We will use the themes from feedback to monitor what questions we will ask in the future. We will have more ‘You Said, We Did’ boards in public facing areas and clinics.

What we said we’d do in 2012-14 What we’ve done“We will design our Friends and Family Test question and process for collecting patient feedback for both the inpatient ward and Minor Injury Unit at Caterham Dene Hospital for use from 1st April 2013.”

We have rolled this out in April 2013. Results are displayed in the department and on our website. We have now included all adult services.

“We will work with a company called ‘IWantGreatCare’ (iWGC) who will collect and collate our patient feedback forms and send us back monthly reports and use the information to create a five star rating.”

We are working with iWGC who receive our feedback forms and analyse the data to create our reports.

“We will ask the patient for their age and gender.” We are asking patients for their age and gender

“We will ask every patient (or their carer) the following question:

How likely are you to recommend our ward/service to friends and family if they needed similar care or treatment?

- Extremely likely - Likely - Neither likely nor unlikely - Unlikely - Extremely unlikely.”

We have expanded this question as part of our roll out to include three core questions and three service specific questions.

“We will give patients (or their carers) an opportunity to use a free space to make comments about their care by asking the following question:

What was good about your care, and what could be improved?”

We have used this information to good effect, helping us to understand patient experience and improve the care environment.

“The results will be available to patients and the public and we will respond to them.” We use a number of channels to monitor patient feedback and publish our FFT results including ‘Patient Opinion’, NHS Choices, Twitter and ‘iWantGreatCare’. We display the results on our public facing notice boards at Caterham Dene Hospital and have a ‘You Said, We Did’ section on our website.

“We will implement a monthly employee survey to help us to establish the ‘cultural health’ of all of our staff. This will include a question to enable us to identify the number of staff employed by First Community Health & Care who would recommend our organisation as a provider of care to their family and friends.”

Please see staff experience section on page 44.


We put together a list of possible priorities by considering our performance over the past year and national/ regional priorities.

We considered how we would be able to measure these possible priorities by considering what measurements and data collection was already in place.

The list was then arranged under the headings of the three domains of quality: patient safety, clinical effectiveness, and patient experience with the ambition of having one priority under each domain.

The list was discussed and consulted on internally through our service leads to ensure staff engagement.

The final selection was made by the Board after reviewing their feedback. Each priority has been allocated to a responsible Board member to ensure commitment at Board level to these quality improvements.

Looking forwardIdentifying our priorities for 2014 - 15

This forward looking section of our report shows our plans for quality improvement and why we have chosen these priorities. It demonstrates how we will develop our quality improvement capacity and capability to deliver these priorities.

To ensure our priorities for the coming year match those of our patients, carers and partners we also went through a process of external consultation inviting contributions from a range of stakeholders including our Community Forum and HealthWatch Surrey.


PRIORITY 1 Patient Safety

“We will measure medication error and harm from error identifying the proportion of patients that are ‘harm free’ on a given day each month on Caterham Dene Ward.”

Why have we chosen this? In response to incident reports, and in recognition of the National Patient Safety Agency (NPSA) documentation and Care Quality Commission Outcome 9*, it was decided to complete a quarterly missed and omitted dose audit for 2013-14. There has been no improvement in recorded missed and omitted doses, despite changes in practice. We have undertaken extensive analysis as to why this is and have found that there is some overlap between the use of drug charts patients are admitted with and starting new drug charts for use on the ward. This would indicate that doses are not being missed or omitted but rather that there is a recording discrepancy. We have therefore initiated start date and time on each new drug chart and will be reviewing this action against data from the Medication Safety Thermometer.

Further to these actions we will also implement the Medication Safety Thermometer. This focuses on medication reconciliation, allergy status, medication omission, and identifying harm from high risk medicines in line with Domain 5 of the NHS OutcomesFramework.

How will we measure this? Data will be collected on one day each month to provide a baseline to direct improvement efforts and then to measure improvement over time. This will enable the ward to understand the burden of medication error and harm and connect frontline teams to the issues of medication error and harm, enabling immediate improvements to patient care.

How will we achieve this? We will use the Medication Safety Thermometer tool on the national website at: http://www.safetythermometer.nhs.uk/. This is a national tool with a three step process that measures medication error and harm from error through medication review, detailed review of high risk patients and appropriate response.

*The Care Quality Commission (CQC) Essential Standards (2010) Outcome 9: Management of Medicines states that “People should be given medicines they need, when they need them and in a safe way.”

April May June July August September October November December January February March

2014 2015

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data

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Review data.Action plan

for improvement

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What we will do & when


PRIORITY 2 Clinical Effectiveness

“We will have a transition contact with 85% of children in year 7.’

Why have we chosen this? A transition contact is an interaction between a school nurse and children moving from primary to secondary education. It is about introducing the year 7 group and their parents to the school nurse team to ensure young people have access to health advice and information and parents know how to raise concerns and how to support their child. It is part of the Healthy Child Programme which is a best practice guide to the services we deliver. Transition between primary and secondary school, and the way schools work with other agencies to manage transition, can influence children’s future school careers and the climate and culture of the whole school community*. A report published by the Youth Council, in which children in Surrey were well represented, demonstrated children did not know who their school nurse was and what they did.

A transition visit will:

• increase children’s and their parents’ awareness of the health services available to them

• introduce them to their school nursing service

• support young people and their parents to access health advice

• improve emotional and physical well being

• impact on adolescent health choices and the reduction in risk taking behaviour.

How will we measure this? Contacts - We will review the number of referrals into our service to see if they increase.Attendance data – We will find out how many children are absent from the assemblies we attend so we can ascertain if we have met our target of contact with 85% of children.

How will we achieve this? We will attend assemblies and give out information to all children in year 7 at the schools in our area regarding the role of the school nurse.

*TaMHS, Extended Services and Young Minds (No Date) The Transition from Primary to Secondary SchoolHow an understanding of mental health and emotional wellbeing can help children, schools and families http://www.youngminds.org.uk/assets/00001303/Transitionfromprimarytosecondary.pdf


PRIORITY 2 Clinical Effectiveness PRIORITY 3 Patient Experience

“We will increase our stakeholder engagement in clinical audit.”

Why have we chosen this? Clinical audit is defined as “a quality improvement cycle that involves measurement of the effectiveness of healthcare against agreed and proven standards for high quality, and taking action to bring practice in line with these standards so as to improve the quality of care and health outcomes.” As a community interest company, we want to involve our patients / service users and the public in clinical audit. Patients and carers have a unique view of the services we provide and may assess the quality of the care they receive in different ways to healthcare professionals. We are committed to the principle of involving patients/carers in the clinical audit process. We want to increase this involvement from asking patients their views through surveys to involving them in the clinical audit process and identification of our annual audit priorities.

Our clinical audit strategy 2013-2016 operational action plan includes the following objective:

‘To increase service user involvement in clinical audit and other quality improvement activities across FCH&C – moving from consultation (asking service user views and using these views to inform decision-making) to collaboration (active on-going partnership with service users) over the three year period of the strategy.’

How will we measure this?

Audit of clinical audit - In 2013 we carried out an audit of the clinical audit process so we have existing data to benchmark our improvement.

Clinical audit data – We have redesigned our audit reporting template and database so we can capture and measure this.

How will we achieve this?

• Implementation of the clinical audit strategy 2013-2016 operational action plan.

• Implementation of our ‘In Your Shoes’ patient / service user involvement strategy.

• Consultation regarding audit priorities with our commissioners (East Surrey Clinical Commissioning Group & Surrey County Council), Community Forum, Healthwatch Surrey, etc.

• Invite stakeholders to annual ‘Quality Improvement Day’ (page 30-32).

• Monitoring / recording patient /user involvement in clinical audit at individual and business unit level and looking at ways in which we can increase it further.

• Implementation of “You said…we did” feedback across all services, via noticeboards and our website.

• Ultimately we will work towards enabling carer or service user led audits.

HQIP (2001) How to use this book. IN: Burgess, R (ed) NEW Principles of Best Practice in Clinical Audit Oxted: Radcliffe Publishing


Statutory Statements of AssuranceThe statutory statements in this part of our Quality Account relate to the quality of the service we have provided in the period 1st April 2013 to 31st March 2014. The content is common to all providers allowing comparison across organisations.

Review of ServicesAll of our services continuously provide, maintain and evaluate evidence of the quality and safety of care they provide to maintain their Care Quality Commission (CQC) registration under the Essential Standards of Quality and Safety. This evidence is critiqued and analysed by the Board as part of our internal governance structure.

The Board have undertaken nine ‘Board walks’ on Caterham Dene Ward since June 2013. These visits by members of the Board were unannounced in order to enable real time analysis of progress against the CQC standards, including patient safety, cleanliness and record-keeping.

Participation in Confidential Enquiries First Community Health & Care was not required to participate in any confidential enquiries during this reporting period.

National audit During the reporting period we have not identified any relevant national audits to participate in. We have considered both the national audits for Quality Accounts and National Clinical Audit and Patient Outcomes Programme. We have not been asked by a national audit provider to participate in a national audit.

During the reporting period there were no national confidential enquiries that covered NHS services provided by First Community Health & Care.

ResearchThe number of patients receiving NHS services provided or sub-contracted by First Community Health & Care in the reporting period that were recruited during that period to participate in research approved by a research ethics committee was zero.

In our last quality account we reported on a research study, conducted by one of our student health visitors, using grounded theory methodology. In brief the study, entitled: ‘Exploring the Perspectives of South Asian Clients regarding the Health Visiting Service’, found that South Asian clients distinguish between health and parenting advice, being more likely to accept health advice from their health visitor and more likely to accept parenting advice from their family.

Because there had been no previous research in this area within health visiting these are regarded as “new findings” and offer important insights into how South Asians perceive the service. This will be used to inform the local health visiting service, providing practitioners with a better understanding of how best to improve the experience of South Asian clients who access this service. The author is hoping to publish these findings in a national journal during 2014.


Goals agreed with our commissioners (CQUINs) A proportion of First Community Health & Care’s income from 1st April 2013 to 31st March 2014 was conditional on achieving quality improvement and innovation goals agreed between FCH&C and our commissioners for the provision of NHS services, through the Commissioning for Quality and Innovation (CQUIN) payment framework. This equated to 2.5% of our contract value with the East Surrey Clinical Commissioning Group. Three of the four targets have been achieved successfully. The fourth was affected by issues outside of our control.

The four areas are in relation to delivery of the Safety Thermometer monitoring; education provided by the Tissue Viability Service; service provision by the Nurse Advisors for Care Homes; and the service delivery and outcomes of the proactive care community matrons.The Safety Thermometer Survey is a national point prevalence survey conducted on a prescribed day in the month and is a national CQUIN. The CQUIN targets were set for FCH&C for 2013/14 with an emphasis on data collection and monthly reporting to the Quality Observatory on prevalence of harms. FCH&C maintains 100% participation in the Safety Thermometer survey for eligible services.

Care Quality Commission (CQC) First Community Health & Care is registered with the Care Quality Commission, the regulatory body for health and social care. First Community Health & Care have no conditions on registration. The Care Quality Commission has not taken enforcement action against First Community Health & Care during the period 1st April 2013 to 31st March 2014. First Community Health & Care has not participated in any special reviews or investigations by the CQC during the reporting period.

In January 2013 we developed a booklet to give to all staff as a guide to the Care Quality Commission Standards. Throughout 2013 the CQC registered manager and clinical governance administration manager attended all team meetings and ran drop-in sessions to issue the booklets ensuring all staff groups were covered. The booklets are also routinely issued at staff induction sessions. All staff now have access to a booklet.

The booklets have been used successfully as prompts for key learning and clinical teams are encouraged to have CQC standards as a standing item on their team meeting agenda as a prompt for discussion and a reminder of key pathways, contact details and protocols. Staff who have been involved with CQC inspection visits have said that the booklet was an extremely

useful tool to understand and demystify the requirements of CQC registration.

CQC carried out a routine, unannounced inspection of Caterham Dene Hospital on 6th March 2014. The following standards were inspected:

• Care and welfare of people who use services

• Meeting nutritional needs

• Cleanliness and infection control

• Staffing

• Assessing and monitoring the quality of service provision

All aspects of these standards were met.

The personal care and treatment records of people who use the service were looked at and the inspectors observed how people were being cared for at each stage of their treatment and care. They also talked to service users and staff and reviewed the information provided to them by First Community. During the inspection they visited the ward, Minor Injuries Unit and spoke to staff from the Rapid Assessment Clinic.

The report states that patients spoke positively about the care and treatment they received:


“Staff are attentive and always there when you need them”

“The staff are always so helpful if you want anything”

Patients stated that they were involved in the planning of their care and that staff were “professional” and “friendly”.

During the previous CQC inspection of Caterham Dene on 25th March 2013, the inspectors identified issues with the care records. In response to this an action plan was developed as outlined in our last account. This action plan has been implemented and was signed off by CQC at their visit on 6th March 2014. The inspectors recognised that a lot of work had been undertaken to improve the care records and felt that the patients’ needs were fully assessed. Care plans were developed with the patient and were accessible to both staff and the relevant patient. There was good evidence that patients had been fully involved in developing their care plan as well as being involved in helping to determine what support or treatment they needed.

The full report is available on the CQC website at: http://www.cqc.org.uk/directory/1-298932083

Data Quality At First Community Health & Care, we see data quality as everybody’s responsibility. Such an approach helps us ensure high standards in data quality are maintained throughout the organisation.

We believe excellent data quality builds the foundations for the delivery of quality care, good patient experience and cost-effective services. It also assists with clinical decision-making. We continue to monitor information such as incident reports, complaints, compliments, activity data and data quality within our IT system. This enables us to see how our services are performing in their entirety, to identify risks and take any necessary actions.

We also use our data to ensure we provide services which represent good value for money and best patient care. We use RiO, a safe and secure electronic patient record system which connects to the Spine – the secure database of key information about a patient’s health and care which forms the core of the NHS Care Records Service.

Some examples of what our data tells us for the period 1st April 2013 to 31st March 2014:

• Rapid Response & Falls Service saw 11,064 first-time appointments

• Caterham Dene Ward had 381 admissions and discharged 375 patients, 209 were back to their usual place of residence

• Our Minor Injury Unit (MIU) saw 5,175 patients

• Our Rapid Assessment Clinic (RAC) saw 1,373 first-time appointments and 609 follow-up appointments including on-going treatment patients

• Health visiting teams saw 10,552 first time appointments and 23,656 follow-up appointments.

NHS Number and General Medical Practice Code ValidityFirst Community Health & Care have submitted records to the Secondary User Service for inclusion in the Hospital Episode Statistics for the period1st April 2013 to 31st March 2014. We will be compiling our 2012/13 data for submission shortly.

Clinical coding error rate First Community Health & Care was not subject to the Payment by Results clinical coding audit from 1st April 2013 to 31st March 2014 by the Audit Commission.

Information Governance Toolkit attainment level The First Community Health & Care Information Governance Assessment Report overall score for 2013/14 was 69% and graded as satisfactory (green).


PART 3: A review of the quality and performance of our services

New services for 2013/14Caterham Dene Minor Injuries Unit Extended HoursThe Minor Injuries Unit at our Community Hospital, Caterham Dene, extended its opening hours in February 2014. The Minor Injuries Unit is now open from 9.00am - 8.00pm, 365 days a year.

Managing Director, Philip Greenhill said:

“Our hugely popular Minor Injuries Unit is a safe and convenient alternative to A&E for minor injuries. Our MIU currently sees 70 – 100 patients per week and we consistently receive excellent patient feedback results via the national Friends and Family Test. There is no need to book an appointment, and we have limited free parking on site. With the centre being open for longer hours, this will only serve the needs of our population better.”

Dr Joe McGilligan, GP and East Surrey Clinical Commissioning Group Chair said:

“Extended opening hours for the popular Minor Injuries Unit in Caterham is excellent news for local people. With the service now open 9am - 8pm, 7 days a week, working people will find accessing the service much easier.

It is important that patients access the right service for the right illness, often people go to A&E because they are worried and unsure of where else to go. The Minor Injuries Unit provides convenient treatment for sprains, strains and minor burns, so there is no need to go to A&E.”


Some feedback from users taken from website reviews in February 2014:

“Being seen by a medical professional on the day and at the time I needed treatment for a minor injury was amazing.

After completing a short questionnaire, I waited about 10 minutes before I was seen by the nurse who was courteous, informative, friendly and treated me in a professional manner.

I would not have gone to A&E for treatment as it was not an emergency but, as it was the weekend, I was not able to get an appointment at my doctors. I was very grateful to have the option of receiving treatment at the Minor Injuries Unit and would recommend it to family and friends.”

“Very attentive, informative, professional & friendly from

beginning to end. NHS at its most very best, excellent model for

other walk in hospitals.”

“Not long to wait for x-ray, fantastic care by

radiographer & nurse Philip was fantastic. I cannot thank you enough for the care you

gave to my mother.”

“Very fast, very professional. Open on a Sunday.

Excellent”


New Health Visitor/School Nurse RoleIn July 2013, a new role was created within the 0-19 Service for a Health Visitor/School Nurse for homeless children, young people and families in recognition of the complex health needs of the vulnerable families living in our community. The remit of the role is to achieve the best possible health outcomes for clients living in guesthouse, hostel and refuge accommodation through delivery of health care and advice, advocacy, multi-agency working and support for practitioners within the FCH&C 0-19 service.

This service enables families in very disadvantaged situations to receive a detailed health needs assessment that informs timely and client-led health interventions and support, enabling them to engage with other services. The service is supported by an experienced Community Staff Nurse and is currently working with 45 families. We will evaluate service user experience via the ‘iWantGreatCare’ process during 2014.

Increasing expertise within the Rapid Response ServiceWe appointed an Associate Practitioner at the end of 2012. She is successfully progressing patients with their exercise programmes and is running the seated exercise class within our rehabilitation unit alongside the physiotherapist.

A physiotherapist from the Rapid Response service is attending an Independent Prescribing course. This will benefit the patient and the Team, as the patient can receive a prescription immediately rather than waiting for a GP or a nurse from the Team to visit the patient. This also means that the patient will not need to repeat their symptoms to another health professional.


Better Balance Exercise ClassIn response to the National Audit of Falls and Bone Health (2012), a Better Balance Exercise Class was set up in June 2013 as a joint initiative between FCH&C and the YMCA at Redhill adding social value to the health and wellbeing of residents in the Reigate and Redhill area. This is a very exciting project which aims to help people reduce their risk of falls, feel more confident in carrying out their daily tasks and prevent any unnecessary admissions to hospital. In November 2013, we conducted an audit to review the effectiveness of the Better Balance Exercise Class and found there was a relatively high drop-out rate, mainly for health reasons. We therefore introduced these classes as a rolling programme to ensure that patients did not have to wait for weeks for another class to start and so the number of participants remained high throughout the eight week programme. A total of 41 people have attended and benefitted from the classes since June 2013.

Our plan going forward:

• The Associate Practitioner will be completing the postural stability instructor’s course. This will provide time for other staff to see more patients with complex needs and means there are more people trained to take the class.

• To promote the Better Balance Exercise Class to other healthcare professionals to increase referral rates and maintain a good level of participants.

Feedback from participants indicates that, for the majority, this programme has been successful in meeting its expected outcomes:

“Excellent class”

“The whole classes have been excellent, including the staff”

“I have improved with all of my exercises and feel better for having done them”

“So far so good, thank you for your patience”

“All the staff were very friendly, and informative. It’s a pity that more people don’t avail themselves of all the help that is available”

Increased community bed capacityDuring the reporting period the Rapid Response Team increased its community bed capacity by 110% (from 10 to 21 beds). This will help to facilitate early hospital discharge for patients with complex health and social care needs, giving the patient a longer period of time to rehabilitate and/or for health professionals to identify any on-going care needs. The team has built up pathways and processes within four nursing homes to ensure a smooth transition of care from the hospital to the patient’s discharge home or to a permanent residential or nursing home.

As this was a new cohort of patients for Rapid Response with patients requiring complex health and social care interventions, specific staff training needs around end of life care, mental health and dementia were identified. The Community Matrons have delivered one training session on end of life care, attended by nine members (25%) of the Rapid Response Team and other sessions are planned to ensure all practitioners are aware of current best practice inthese areas. Five members of staff from FCH&C also completed a four day Dementia Care Mapping course. The aim is to provide further training in the use of this mapping tool to improve care of patients with dementia across First Community.


Review of our servicesWe will now provide an overview of some of our quality improvements for the period 1st April 2013 to 31st March 2014.

Patient SafetySafeguarding adults

• FCH&C now has a dedicated Adult Safeguarding Lead in post to provide advice and support to staff relating to Adult Safeguarding matters. This post reports directly to the Executive Lead for Safeguarding, the Clinical Operations Director.

• All staff within the organisation attend Adult Safeguarding training on induction and are required to attend an update every three years. A spot check in December 2013 revealed that 84% of all staff were compliant with training. This is higher than the 80% threshold accepted by the CQC at their inspection visit in March 2013.

• There were no Deprivation of Liberty Safeguards applications at Caterham Dene ward during the year.

• Over the last year we have developed FCH&C Adult Safeguarding operational guidance which includes escalation flow charts to provide clear guidance on information sharing and reporting, and Mental Capacity Act assessment guidance, in line with Surrey Multi-agency Safeguarding Adults policies. Two launch events were held in October 2013 to raise awareness of adult safeguarding matters.

• We work in collaboration with our health and social care partners by representation on the Surrey Safeguarding Adults Board (SSAB) and Social Services Safeguarding Adults Group

• At our hospital ward and community clinics we display leaflets and posters to promote our service users’ awareness of safeguarding and signpost them where to get help.


Safeguarding childrenIn the reporting period, 85% of staff in the Children’s 0-19 Service, have completed Level 3 Safeguarding Children training. A further 8% of staff joined the organisation in September 2013 and are completing modules working towards Level 3. There are three levels of Safeguarding Children training that move from basic awareness to advanced training for practitioners who require in depth training. All FCH&C staff receive Level 1 training as part of their induction, but registered practitioners who are required to hold a safeguarding caseload can only do so once they have completed training at Level 3. Staff who have not completed the multi-agency training do not carry a safeguarding caseload. All staff who have previously completed this training and who hold a safeguarding caseload have received their annual update during the reporting period.

We have continued to ensure support for our 0-19 staff with a safeguarding caseload by increasing the number of staff trained to provide safeguarding supervision; an additional three members of staff trained as safeguarding supervisors in the reporting period with plans to train further staff during 2014. All registered staff continue to receive safeguarding supervision every three months.

We collect monthly performance data with regard to safeguarding which enables us to assess the quality of our health visiting service and informs our service redesign. For example, if we have a high number of young parents (under 18s) we can tailor services to meet their needs. This data also ensures that the health professionals carrying a safeguarding caseload receive the appropriate levels of supervision and support. For example, we have increased the number of nursery nurses supporting teams who carry a high safeguarding caseload, enabling them to provide packages of care to the most vulnerable families. This might include support with behavioural issues, parenting or healthy eating on a budget.

Medicines ManagementIn March 2014 we implemented our new Medicine Policy after an extensive review by the FCH&C Lead Pharmacist, and consultation with front-line staff and senior management. This gives our clinicians clear working guidelines to ensure the safe management of medicine.

As part of the Medicine Policy governance requirement, a quarterly Medicine Incident Report is presented to the Clinical Quality and Effectiveness Group. Medicine administration incidents at Caterham Dene Hospital ward are the most frequently reported incidents each quarter. An analysis of these incidents together with the annual Drug Chart Audit reported a number of missed and omitted doses (see glossary definition). This has been taken in consideration when agreeing priority 1 going forward for 2014-15 (see Part 2, page 15).


Safety Thermometer The NHS Safety Thermometer is a point prevalence survey to allow teams to measure ‘harm’ and the percentage of patients that receive ‘harm free’ (see glossary for definitions) care in relation to pressure ulcers, falls, urinary tract infections in patients with urethral catheters (UTIs) and venous thromboembolism. We report on this monthly and feedback to our teams. We have compared our data with the national picture as a method of benchmarking our results and have provided our 2013/14 quarterly data for comparison in the table below:

Criteria measured (each out of 100%)

Q1 2013 - 2014 Q2 2013 - 2014 Q3 2013 - 2014 Q4 2013 - 2014FCH&C National FCH&C National FCH&C National FCH&C National

Harm Free 92% 92% 94% 93% 97% 94% 97% 94%Pressure Ulcers All 7% 5% 4% 5% 3% 5% 2% 5%Pressure Ulcers New 2% 1% 1% 1% 0% 1% 0% 1%Catheters with UTIs 1% 1% 1% 1% 0% 1% 0% 1%New Harms 3% 3% 3% 3% 1% 3% 2% 3%

We have used this tool to help us measure our performance in other areas, inparticular the completion of nutrition screening to identify people at risk of malnutrition. Malnutrition occurs when the food a person eats does not give them the nutrients they need to maintain good health or when someone does not eat enough food (sub-nutrition).

We screen our patients for risk of malnutrition or undernourishment using the Malnutrition Universal Screening Tool (MUST).

The chart adjacent shows the percentage of patients who have had a MUST assessment on a certain day each month. We are working to increase these levels both to improve the way in which we collect and analyse the data and to understand if those patients without a MUST assessment require one.


Incident Reporting Adverse incidents (something that was not expected to happen) will occur within any organisation and when they do it is important to ensure that what happened is documented and shared with the aim of preventing, or reducing the likelihood of a recurrence. In some circumstances the incident will be a “near miss” or “good catch” which means that an adverse event would have happened but action was taken to prevent it.

Over the last year 599 incidents have been reported, an increase of 45 from the previous year. We have completed Root Cause Analysis (see glossary) on all grade 3 and 4 pressure ulcers.

During the period 1st April 2013 to 31st March 2014 we had a total of 18 Serious Incidents (3% of the total incidents reported) – 13 concerned the acquisition or deterioration of pressure ulcers, three were in relation to falls resulting in a fracture and two were safeguarding concerns.

Reducing the risk of patients falling in our hospital ward

An analysis of reported falls incidents took place in 2013 which resulted in the implementation of an action plan to reduce patient falls and harm. This included training for staff in assisting patients to mobilise and transfer safely; the implementation of a robust system for communicating every patient’s moving and handling precautions; relaying the day room to maximise the space for safe mobility; and the provision of slipper socks. Falls prevention has been given a high profile on the ward and during Falls Prevention Week the ward hosted an event for patients, relatives, carers and staff to promote falls prevention, inviting speakers from FCH&C Falls Prevention Team, Telecare and Caterham Dene Physiotherapy department who undertook interactive sessions with those who attended.


Infection Prevention and Control

• Infection rates – During the reporting period, there were no cases of MRSA bacteraemia or Clostridium difficile.

• MRSA screening – Patients within our community hospital are screened on admission and re-screened four weeks following admission. During the reporting period, we completed this screening with 100% of our patients.

• Infection Prevention and Control updates – Annual updates on infection prevention and control are offered to staff either as face to face sessions or e-learning modules. A spot check during the reporting period showed 89% compliance with mandatory training.

• Hand hygiene audit – At our community hospital we observe our staff washing their hands to ensure they are doing this properly. During the reporting period 100% of staff observed washed their hands correctly. All community based healthcare teams undertake a peer review of their hand hygiene technique at least annually. Some results from this are:

– Our Rapid Response team achieved 100% correct hand washing technique in November 2013

– The in-patient therapists at Caterham Dene achieved 100% in July 2013.

• National Standards of Cleanliness – Cleanliness within our community hospital is audited monthly using the standard 49 point audit form*, providing a useful indicator of cleanliness standards. At one point during the reporting period, a fall in standards was identified, quickly enabling the organisation to work with the cleaning contractor to raise standards to an acceptable level.

*http://www.dhsspsni.gov.uk/environmental_cleanliness_standards_in_hsc_acute_hospital_facilities.pdf


Clinical EffectivenessAnnual Quality Improvement Day Every year we host a Quality Improvement Day where we invite our Business Units to showcase their quality improvement work. All members of the organisation are invited including the Board. This year all Business Units took the opportunity to do this, producing posters detailing their work. We also heard from individual clinicians about quality improvement and clinical audit work they had undertaken.

We were privileged to welcome representatives from both The National Institute for Health and Care Excellence and the Healthcare Quality Improvement Partnership (HQIP). The representative from HQIP later wrote a blog about the day, an extract of which can be seen below:

“Over the course of three sessions we saw 14 varied and interesting presentations, with

clinical audits alongside other quality improvement projects, with a dozen or so

exhibition stands attracting interest in the breaks.

The ongoing success of the event has seen an increase in quality improvement activity amongst

the nurses, therapists and other clinicians in the organisation with … a corresponding increase in

the quality of the projects, the confidence of those who carry them out and the improvements to

services they deliver.”


Project title Aim of the project Description Results Actions / Future plansIdentifying the Speech and Language Therapy (SALT) needs of children under 5 in order to develop a menu of options / appropriate support to meet these needs.

• To reduce SALT referrals and inappropriate referrals (present waiting list is 6-9 months for assessment)

• Explore parents’ expectations that child will receive assessment and therapy

• Equip parents with up to date information and advice to support their child’s speech and language development.

A survey of staff and parents who have accessed SALT.

• Families to gain information about local SALT services and processes

• Reduction in inappropriate referrals to SALT

• Families and staff to have a greater understanding of SAL development leading to a more realistic expectation of SAL in the under 5s. In turn would reduce overall number of referrals.

Next steps:

• Stakeholder Engagement (SALT)

• Staff focus group

• Service user focus group

Project title Aim of the project Description Results Actions / Future plansEmergency catheter call outs for the Evening & Night Service 2013

• To enable the service to identify whether a catheter change is required.

• To indicate whether we are all carrying out best and consistent practice.

• To help identify areas where training is required to enhance our practice.

• To help identify problematic catheters that require review.

We recorded data on all unplanned catheter visits as these visits are due to patients experiencing problems with their catheters which we want to avoid by individualising care.

There were 109 patients with catheters on our caseload, 21 supra-pubic, 56 urethral and 32 not documented.

• For 29% (n=32) of these catheters we had not stated in the records of care whether the catheter was urethral or supra-pubic (through the tummy into the bladder).

• We also had not recorded the reason some of our patients had a catheter, this is important to enable us to review if our patients still require a catheter.

• We have reduced the use of catheter maintenance solutions in the management of catheter problems from 27% in 2012 to 20% in 2013. This is good, as there is limited evidence to support the use of catheter maintenance solutions to manage blocked or bypassing catheters.

• The average time it takes to care for our patients who have problems with their catheters is 28 minutes.

• We will make changes to our documentation to ensure we record all relevant details.

• We will adopt the catheter passport to ensure continuity of care.

• We will ensure all our staff maintain their competence to care for our patients with catheters through formal assessment against agreed competencies for catheter care.

• We will undertake a further review of the use of catheter maintenance solutions.

We have included a summary of some of the presentations in the tables below.


Project title Aim of the project Description Results Actions / Future plansAntibiotic Prescribing: Drug Charts at Caterham Dene Hospital Ward.

• Assess and monitor antibiotic prescribing against local guidelines.

• Review the implementation of the 2012 action plans.

A snapshot audit of all available drug recording charts available on a specific day.

Overall, antibiotic usage was in line with the local primary care guidance or local acute trust guidance where appropriate.

We will continue to monitor this to ensure our practice remains safe and in line with best practice guidance.

Other clinical audit workDuring 2013 a booklet for clinicians “How to undertake a clinical audit” was developed. These were distributed at the Annual Quality Improvement Day and are given to new clinical staff at induction.

Clinical Audit Policy and StrategyThis year we have also developed and launched a new clinical audit policy and strategy. We have refined our reporting processes to enable sharing of clinical audit activity, including plans, results and action plans.

Community NursingAll our District Nurses have completed a supported programme on clinical audit which has involved them planning an audit. We now have a clinical audit group in District Nursing.

DieteticsThe dietetic department will revisit the MUST audit for inpatients as a priority in the 2014/15 audit timetable.

Audiology Following a medical records audit to support the UKAS accreditation process, a review of the documentation of the follow-up pathway has been completed to identify any shortfall in documentation. New standard operating procedures have been written and implemented and re-audit indicates a significant improvement with 95% compliance.


NICEA policy has been developed to provide guidance for staff in First Community Health & Care with regard to the dissemination, implementation and monitoring of NICE guidance. It describes how FCH&C will disseminate knowledge about new NICE guidance and the process for assessing whether FCH&C services are compliant with the recommendations.

A clear process to respond effectively to NICE guidance brings benefits to patients ensuring that the care provided is both clinically and cost effective. It helps the organisation to meet standards set by the Care Quality Commission (CQC). The process supports the organisation’s governance framework and provides assurance to the Board.

Some examples of work undertaken within FCH&C during the reporting period, with regard to specific NICE guidance follows.

Raising awareness of osteoporosis The NICE clinical guideline ‘Osteoporosis fragility fracture’ www.guidance.nice.org.uk/CG146 recommends the use of the FRAX® tool (see glossary). During 2013 we introduced the use of this online tool within the Falls Service and with the Community Matrons. We have begun to trial this within other community services in 2014 and will audit its effectiveness in identifying which patients require bone protection or further investigation. The introduction of the FRAX® tool has received a positive response from GPs:

“Thanks for the FRAX osteoporotic risk scores. They are useful. Please keep them

coming.”

DVT pathwayThe DVT (Deep Vein Thrombosis) pathway at the Rapid Access Clinic (RAC) now reflects the NICE clinical guideline ‘Venous thromboembolic diseases: diagnosis of deep vein thrombosis’ http://guidance.nice.org.uk/CG144. Documentation used in the RAC has been updated and ratified via FCH&C’s Clinical Practice Group. This piece of work was presented at the audit day, evidencing improvements these changes have made.

Deep Vein Thrombosis is a condition in which a blood clot forms in a vein, particularly the deep veins of the leg. The thrombus (clot) can dislodge and travel in the blood to the pulmonary arteries causing a fatal pulmonary embolism. A non-fatal clot can result in long term illness, venous ulceration, or post thrombotic limb, which can have a significant effect on quality of life. In 2010/2011, 56,000 people were diagnosed with blood clots.

Our Rapid Assessment Clinic accepts referrals from GPs for patients suspected of having a deep vein thrombosis. The publication of NICE CG144 enabled us to audit our service against criteria and standards of best practice. From this we were able to adapt and change our pathway to enable us to provide our patients with the highest quality service which is both safe and effective, as evidenced by the clinical audit process.

The changes include the development of a patient information leaflet and improved assessment documentation.

In October 2013 we collected data after these changes had been introduced to ensure they had had the desired effect of meeting the criteria and standards set out by NICE CG144. We looked at all patients attending the RAC in September suspected of a DVT - a total of 19 patients.

Here are some of the results:

• 100% of patients were assessed using the two level DVT Wells Score, the assessment tool recommended by NICE

• 100% of patients with a ‘likely’ Wells Score (meaning they have risk factors and signs of a DVT) were offered a proximal leg vein ultrasound scan to confirm or rule out the diagnosis (only two patients had a ‘likely’ Wells Score).

• Of these two patients only one had their scan within 24 hours of being assessed; however both patients received the recommended treatment (an interim 24 hour dose of parenteral anti-coagulant e.g. Enoxaparin) whilst they waited for their scan.


Productive Community Services

Productive Community Services is an organisation-wide change programme which helps front line staff improve quality and productivity.

It aims to:

• Increase patient-facing contact time

• Reduce inefficient work practices

• Improve the quality and safety of care

• Revitalise the workforce

• Put staff at the forefront of redesigning their services

FCH&C are using this framework as an enabler, aligning modules to the needs and priorities of our services to ensure we provide the best quality care for all our patients. An example of our work is detailed on the right.

0-19 Service - Planning Your Workload The 0-19 Service plotted their daily travel data and looked at the routes covered, with a view to possibly reducing travelling time in future. From mapping a day-in-the-life travel snapshot the team have divided their caseload geographically. There has been a reduction in mileage and a more cohesive approach to caseload management as shown below.

Enhancing Quality Initiative

Enhancing Quality (EQ) is an innovative clinician-led quality improvement programme launched in January 2010 across Kent, Surrey and Sussex.

By clinicians analysing where to intervene for greatest quality improvement, EQ aims to improve patient outcomes and reduce variation in care, every patient, every time. The programme is evidence-based and data-driven, providing the opportunity to benchmark our patients’ outcomes with other organisations across the three domains of quality: clinical effectiveness, patient safety and patient experience. Out of six work-streams, managing heart failure in the community was the only one relevant to First Community Health & Care.

Our Heart Failure Team has successfully managed 207 patients with heart failure since joining the EQ initiative in October 2011 and have exceeded all targets set by EQ for our local area to February 2014 (see chart on following page).

Comparison of 0-19 Team mileage for 2012 - 2013


The above chart demonstrates how we have achieved and exceeded our targets. For example we have achieved 98.0% effectiveness at managing ACE inhibitor and ARB medication which exceeds our EQ target of 93.4%. We have also achieved 95.6% effectiveness at managing our patient beta blocker medication, which exceeds our target of 89.6%. The Management Complete Quality Score (CQS) and Actual Care Score (ACS) targets relate to the number of patients receiving the optimal medication for their condition. This improves the patient’s heart function and lessens their symptoms associated with heart failure e.g. shortness of breath, ankle swelling and fatigue.

ACE InhibitorAn ACE inhibitor (or angiotensin-converting-enzyme inhibitor) is a medicine used primarily for the treatment of hypertension (elevated blood pressure) and congestive heart failure (CHF)

Angiotensin IIAngiotensin II receptor antagonists, also known as angiotensin receptor blockers (ARBs), are medicines that are often used to treat high blood pressure.

Beta BlockersBeta-blockers (also known as beta-adrenoceptor blocking agents) are medications used to treat several conditions, by reducing the workload of the heart soas to put it under less strain.

Management Actual ScoreManagement Actual Score (ACS) is the percentage of people titrated on the medications who have not reached the maximum recommended dose of 10mg but have reached the maximum that they can tolerate.

Management Complete Quality Score (CQS)Management Complete Quality Scores (CQS) is the number of patients who have reached the maximum target amount of 10mg of ACE (Ramipril) and beta blocker (Bisoprolol).


Patient ExperienceComplaints & Compliments

We have received a total of 23 complaints between 1st April 2013 and 31st March 2014. Four of these complaints related to incidents where Surrey & Sussex Healthcare were the lead organisation (see chart below).

As a result of these complaints:

• The Podiatry and Physiotherapy Departments have reorganised their administration teams to ensure integrated working which allows greater flexibility. This has improved scheduling of podiatry patients to maximise clinic appointments and also improved telephone access to the departments.

• The menu choices and availability of vegetarian meals for Caterham Dene Ward patients have been reviewed. An appropriate escalation process has been implemented to enable immediate action to be taken to deal with patient concerns about the food choices provided.

All teams receive compliments not only verbally but also by way of ‘thank you’ cards, e-mails, and letters. For this period the teams received 86 written compliments and 89 gifts. Teams also receive feedback through the Friends and Family Test.

Our complaints policy states we will acknowledge all complaints within two working days. In the reporting period, 96% of complaints were acknowledged within two working days. The 4% not acknowledged relates to one complaint received within the organisation. Initially this was considered to be a complaint about a partnership organisation, however, it was later agreed that FCH&C would investigate the complaint and respond on behalf of both organisations.


UNICEF Baby Friendly Initiative

In October 2013 the health visiting teams (health visitors, staff nurses and community nursery nurses) at First Community Health & Care achieved outstanding results as part of the Stage 2 assessment of UNICEF’s and the World Health Organisation’s ‘Baby Friendly Initiative’ (for more information go to: http://www.unicef.org.uk/babyfriendly/).

Health visiting teams at First Community were evaluated against a set of criteria which demonstrate high standards of care for all families. First Community achieved 100% in all criteria, with the exception of one result of 98%*. This is an outstanding result, only achieved by one other organisation nationally, exceeding the national standard of 80% to pass this stage.

Many mothers stop breastfeeding earlier than they want to. The initiative ensures that health visiting teams can help mothers (and just as importantly - their partners) overcome the inevitable difficulties and challenges that many experience in the early days, weeks and months of parenthood to carry on breastfeeding for as long as they wish to.

We have seen a 3% increase in the number of infants receiving breast milk at 6-8 weeks in east Surrey (from 57% in Quarter 3 2012-2013 to 60%

Quarter 3 2013-2014).

First Community Health & Care also works with local partners including Children’s Centres, the National Childbirth Trust, Mum2Mum peer supporters and Tandridge Education Partnership to offer three Baby Cafés in the area.

The UNICEF assessor stated in the report “First Community presents an extremely positive approach to breastfeeding. The level of knowledge and understanding combined with emotional sensitivity and insight demonstrated by staff interviewed was exceptional and both assessors were greatly impressed by the findings.’’

“Having a safe environment to get used to public feeding has boosted my confidence.”

“Always hoped I would be able to breastfeed. The Baby Café provided good advice in a friendly environment.”

“I breast-fed my baby for longer than I originally thought. This is down to the support I have received from the Baby Café and the friendships.”

First Community will continue to work towards Stage 3 of the Baby Friendly Initiative to become a fully accredited organisation in November 2014.

Baby Cafés are a relaxed, friendly place to drop in for support and advice for breastfeeding mothers. This year (2013-14) we have seen an 8% increase in the number of visitors to the Baby Cafés (1,525 as compared with 1,412 in 2012-2013). Some of the feedback received from Mums during 2013-14:

*Results related to one ‘unsure’ response to criterion 7: HV and support staff who gave an adequate explanation of how they would determine that a baby was receiving enough breast-milk.


Health Visitor Call to Action

The health visiting service is based on high quality , evidence-based services delivered through effective partnerships with Children’s Centres, GPs and other key early years providers through a four tiered model (see glossary).

The key aim of the Health Visitor (HV) Call to Action is to improve services and health outcomes in the early years for children, families and local communities, through expanding and strengthening health visiting services and promoting learning and good practice.

For FCH&C, this means an increase of 10.3 whole time equivalent (WTE) health visitors by March 2015. In March 2012 FCH&C employed 19.8WTE health visitors. At the end of March 2014 we have achieved an increase of 44% with a total of 28.44WTE health visitors now in post. Since September 2013 we have been achieving above the agreed trajectory and remain on track to achieve a 50% increase in our health visitor numbers overall by 2015.

The increase in the number of health visitors within the service has had a positive impact on the delivery of our services for families with children under the age of five years. One of the most significant impacts has been seen in the area of the new birth contact. The requirement to contact the mother following the birth of the baby dates back to the 1946 National Health Service Act. The national Healthy Child Programme recommends that this contact results in a face-to-face review (home visit) by the health visitor, ideally within 10-14 days following the birth. The chart below shows the increase in the number of new birth contacts completed within 14 days since the increase in health visitor numbers.

“The start of life is a crucial time for children and parents. Good, well resourced health visiting services can help ensure that families have a positive start, working in partnership with GPs, maternity and other health services, Sure Start Children’s Centres and other early years services. That is why the Coalition Government has made the challenging commitment to an extra 4,200 health visitors by 2015.” (DH 2011)

New birth visit made on or before 14 days after birthNew birth visit made after 14 days after birth


Dignity and respect in our Rapid Access Clinic

In our last quality account we told you about how we had used the Essence of Care (2010) to consider the dignity of our patients attending the clinic. This is a national benchmarking tool addressing the fundamental aspects of care, dignity forming one aspect of this.

We have now completed the actions for improvement and have:

• purchased blinds to cover an opaque window to increase privacy

• installed signage so staff can recognise when a room is ‘engaged’

• put a keypad on the room where we keep our medical records in a locked cabinet in order to protect the confidentiality of these records of care.

We will be repeating this benchmarking process during 2014.

Quality improvements in the Audiology ServiceIn February 2014 the FCH&C Audiology Service was accredited by the United Kingdom Accreditation Service for adult assessment and rehabilitation and complex assessment and rehabilitation. It is currently the only community service in the UK to be accredited for complex assessment, the twelfth service overall and the second non-acute trust service. The assessment required a formal submission and a three day assessment process with inspectors spending time in the department as well as speaking to staff and patients. There are five mandatory actions that have to be completed prior to the 2nd May 2014 which will be reviewed internally through the Clinical Quality and Effectiveness Group.

Prior to moving to a cost per case tariff contract on the 1st September 2013, the FCH&C Audiology Service was in breach of the 18 week ‘referral to treatment time’ national target (see glossary). This resulted in long waits of over a year for hearing aid provision from date of referral. Since the change of contract, FCH&C has successfully reduced wait times through funding additional capacity in the form of clinics to target the backlog. Wait times from referral to assessment and provision of a hearing aid has reduced from 54 weeks pre-September 2013 to just three weeks at the end of March 2014, well within the 18 week target. This means that people with hearing loss now receive a timely service.


Conversation Partnership Scheme

In our last account we wrote about a pilot project for training volunteers to work with isolated people with communication difficulties. In collaboration with the Tandridge Befriending Scheme the Conversation Partner Scheme aims to train volunteers to support people living with communication disability who would benefit from befriending in the community. Funding was identified to continue this scheme for another year. Another group of eight volunteers (making a total of 16) have been trained by the FCH&C Speech and Language Therapy (SLT) team. For various reasons five of these volunteers are no longer able to visit, leaving 11 active volunteers. On-going support is being provided to the volunteers at Tandridge Befriending Service by a process of supervision meetings and individual support to volunteers as needed.

Twelve people, who themselves have communication difficulties as a result of stroke, have also been trained to act as conversation partner volunteers and expert patients in the scheme. There have been a total of 21 referrals into the scheme and 16 of these have been matched with a volunteer conversation partner.

Going forward, the FCH&C Speech and Language Therapy department will be work-ing closely with Connect (the communication disability charity), who have been awarded lottery funding to support conversation partner schemes throughout the country.

This has been a very positive scheme for both people with communication difficulties and for the volunteers themselves. Our evaluation of the service indicated that:

• Volunteers felt more confident, enjoyed the visits, had a better understanding of stroke and aphasia and were well supported by SLT

• People with aphasia looked forward to the visits, and enjoyed the wide range of topics, the chance to chat, and the company

Those receiving visits said:

“Helps you get up because you are expecting a visit”

“Gives you confidence”

“I am now happy to order a beer or a coffee”

Volunteers said:

“Finding a way to help”

“I’ve gained a friend”

“We always managed to find the words”

“We enjoy our time together and are still finding new areas of conversation”


Patient Satisfaction Surveys, the Friends & Family Test and ‘iWantGreatCare’Community Neuro-Rehabilitation Team (CNRT)The CNRT have been using ‘iWantGreatCare’ as the vehicle for patient feedback since October 2013. There was some specific feedback in December 2013 (two comments out of a total of five responses) relating to an area of improvement around involving patients more in their care planning and agreeing/providing them with clear rehabilitation goals. As a result of this feedback the team has designed a ‘goal sheet’ which enables patients to set and agree goals with the health professional. Patients keep a copy of this. These goals are reviewed in multi-disciplinary meetings and with patients on a weekly basis with changes documented to show progress and agreement. The sheets are signed off at the end of the treatment period with the patient. These will be audited as part of the bi-annual record-keeping audit.

Caterham Dene WardPatient experience is of primary importance and all service user feedback is used to improve services. All service users are given a copy of the Friends and Family Test (FFT) questionnaire on discharge. The results are collated externally every month and provide scores in a number of areas including dignity, patient involvement, information, staff, cleanliness, trust and the help received by patients. Scores haveremained consistently high.

All comments are analysed and where appropriate any negative comments and suggestions are acted upon. For example, in response to patient comments regarding difficulty in attracting the staff atten-tion when in the day room, a new call bell system is to be fitted which includes the provision of patient held call bells which are worn around the neck or on the wrist so that patients can call for a member of staff when they are away from their bed space.

Comments have included:‘Staff nurses very polite, nothing was too much trouble’

‘A great experience – built me up ready for home’‘Lovely caring staff’

‘Visitors always made welcome’‘The staff nurses, physios, OT were all wonderful and helpful’

The survey results are made available to staff and the survey results are a standing item at team meetings.


Clinic in a Box‘Clinic in a Box’ is a mobile clinic led by school nurses offering sexual health and relationship advice to young people, weekly during term time. ‘Clinic in a Box’ is currently provided in two secondary schools within the east Surrey locality. During 2014/15 we plan to offer this service to the remaining five secondary schools in the locality, subject to their agreement.

During 2013 the ‘Clinic in a Box’ service saw a 23% increase in attendance compared with 2012 and an overall increase of 240% compared with 2011 when it was first introduced (see chart adjacent). The three months from January to March 2014 continue to show an upward trend in attendance with an increase in levels of satisfaction with the service.

Young people attending ‘Clinic in a Box’ are asked to complete an evaluation questionnaire at each contact. Accessibility, appropriateness and confidentiality of the service continue to be highly valued by all attendees. In the reporting period more than 99% of total responses across all criteria (compared to 93% in our previous account) were either ‘strongly agree’ (92%) or ‘agree’ (7%). The only ‘disagree’ response was in response to the statement: “I would recommend this service to members of my family”. This was due to a concern from the young person that recommending the service indicated they had personal experience of the service which might, therefore, compromise the confidentiality of their consultation (see chart below).

We continue to monitor and review the content and process of evaluation against the ‘You’re Welcome’ criteria and Friends and Family Test Question to ensure the service meets the needs of all young people attending the schools where ‘Clinic in a Box’ is delivered. The 0-19 Service, together with ‘iWantGreatCare’, have developed a unique tool designed to enable young people to provide us with feedback on their ‘Clinic in a Box’ experience. This will be introduced during 2014 and, with the use of mobile IT devices, will ensure that user feedback is captured in real time.


Staff ExperienceCouncil of Governors

Our Council of Governors (CoG) is an elected group of staff who represent shareholder staff and their views. They meet on alternate months and act on behalf of staff members as a link to the Board and help make decisions in the best interests of our patients and the organisation.

KEY ACHIEVEMENTS 2013-2014 PRIORITIES 2014-2015We have…. We will….…developed a much clearer vision of our role and function within the Company Articles as a staff voice in the maintenance of FCH&C Community Interest Company’s principles and responsibilities as a transparent and genuine Social Enterprise.

…continue to be a staff voice at Board level.

…reappointed two Non-Executive Directors and the Chairman and contributed toward the Organisational Development Plan.…developed and implemented a new meeting structure to enable CoG to function independently of the Board.

…recruit to any vacant CoG seats, to ensure that all staff group views are represented.

…developed the process for the application and allocation of the Community Development Fund, as part of FCH&C’s Community Interest Strategy, to help our community and add social value, donating approx. £20,000 to community groups, including Age Concern and St Catherine’s Hospice.

…consider opportunities to add social value to our community for the year and to fully implement the process for the application and allocation of the Community Development Fund.

…attended and promoted FCH+C events reinforcing our commitment to add social value to our organisation, including attendance at the Community Forum and AGM.

…continue to attend and promote FCH+C events including our Community Forum to enable us to network with our community and other stakeholders.

…given presentations about the role of CoG at the AGM and at six staff engagement sessions throughout 2013-14, to encourage an increase in the number of shareholders.

…plan and attend staff engagement sessions and the AGM to enable us to engage with staff about the company’s social mission and Community Interest Strategy and increase the number of staff shareholders and our collective staff voice.


Staff Survey (‘iWantGreatCare’)The Friends and Family Test is mandated for NHS staff from April 2014. First Community Health & Care started the staff survey questions in January 2014. We have had two pilot months of reporting since this time. We send out our survey for two weeks of each month electronically.

In January 2014, our first month of surveying, 13% of staff completed and returned the survey. (The national benchmark is predicted to be set at 15% although this figure is still to be set in guidance and has not yet been released). Feedback was widely positive and we have produced a monthly feedback blog: “You Said, We’re Listening, We’re Doing” to summarise the comments. Feedback from staff indicated that monthly surveys were too often. We are going to continue with the FFT for staff on a quarterly basis from April 2014 as suggested by the NHS England guidance.

Developing our leadersSelf-Managed Business Team (SMBT) ProgrammeWe have continued to develop our leaders by implementing the SMBT programme to support Business Partners in their evolving role leading their Self-Managed Business Teams. Self-Managed Business Teams are semi-autonomous teams whose members determine, plan and manage services, empowering clinical teams to adopt delegated responsibility for financial management, performance, quality assurance and operational management. As a part of this programme the following progress has been made this year:

• A Decision Making Rights Framework has been agreed clarifying responsibility at business partner, executive and Board levels

• Business Plans have been developed for each business unit outlining existing services and key areas for development over the next 18 months

• An innovation form has been cascaded allowing ideas from the ground to be implemented where practical and commercially viable

• A Leadership Development Training programme has been delivered to support Business Partner development

• A Competency Framework has been implemented allowing Business Partners to identify their areas for individual development and support

• A draft SMBT Dashboard has been worked up allowing business partners and their teams to have real time information about their services and performance

This programme has been supported by a dedicated Programme Manager with members of the Executive Team leading individual work-streams. A monthly meeting with both Business Partners and the Extended Management Team has been prioritised to ensure the progress of this work.


Queen’s Nurse AwardThe title of Queen’s Nurse (QN)* is open to community nurses, with more than three years’ experience, who want to demonstrate their commitment to patient-centred values and continually improving practice. Achieving the Queen’s Nurse title enables practitioners to join a growing network of like-minded nurses, marking the beginning of a process of learning and leadership. Managers and patients provide feedback about applicants, which is assessed along with their application. Two members of staff received this award in April 2013 and a third member of staff is currently going through the application process.

Supporting our staffInstitute of Health VisitingIn March 2014 the 0-19 Service invested in corporate membership of the Institute of Health Visiting (iHV) for all health visitors, including students, employed by FCH&C.

The Institute of Health Visiting was launched on the 28th November 2012 to promote excellence in health visiting practice to benefit all children, families and communities. The iHV “supports the development of universally high quality health visiting practice so that health visitors can effectively respond to the health needs of all children, families and communities enabling them to achieve their optimum level of health, thereby reducing health inequalities.” (http://ihv.org.uk/)

Glenda Vella & Carol Hedger, QNI

AppraisalWe recognise the importance of developing our staff through regular appraisal. We have been reliant on manually counting the number of staff who have had an appraisal and have recognised the need to improve our systems. This year we have worked on new appraisal documentation, started to roll out a training programme for appraisals for both the appraiser and appraisee, which will take full effect during 2014, and implemented an electronic process to record appraisal dates. This includes monitoring personal development plans to enable training needs analysis. We will also introduce a more planned approach to appraisals with all appraisals being undertaken where possible in the first quarter of the financial year.

*http://www.qni.org.uk/for_patients/queens_nurses_2


STATEMENT FROM HEALTHWATCH SURREY

“As the independent champion for the views of patients and social care users in Surrey Healthwatch Surrey is pleased to comment on the 2013/2014 Quality Account of First Community Health and Care.

First Community Health and Care is thanked for working openly with Healthwatch Surrey to improve the quality of services for people who have had a stroke following Healthwatch’s Stroke Pathway Report.

Healthwatch commends the extension of the MIU opening hours at Caterham Dene and Audiology reduced waiting times, people tell us that such access to services is important to them and a good experience.

Healthwatch recognises that measuring success can be challenging but would like to stress how important it will be to show this in the 2014/2015 Quality Accounts.

Healthwatch supports the continued prioritisation of staff clinical supervision to improve clinical effectiveness.

Just one question, how could more people benefit from the balance class?”

Jane Shipp Healthwatch Surrey13th June 2014

STATEMENT FROM EAST SURREY CLINICAL COMMISSIONING GROUP

We would like to thank Healthwatch Surrey for their statement. We will be reviewing the promotion of the

balance class over the coming year.


STATEMENT FROM HEALTHWATCH SURREY STATEMENT FROM EAST SURREY CLINICAL COMMISSIONING GROUP

Our Managing Director added to his statement on page 8

“For example, we have worked with Parkinson’s Disease UK (a charity) and patient and carer representatives during the recruitment process for a specialist post to support people in the community with Parkinson’s Disease, aligning this post with the Community Neurological Rehabilitation Team.”Our Managing Director added to his statement on page 8

“During 2013 we have seen the publication of The Francis Report, detailing serious failings in quality of care and patient safety. The report details 290 recom-mendations, for all NHS trusts, commissioners and external regulators to ensure similar failings in care and safety are not repeated. Our Chief Nurse has worked closely with all of our staff to consider and act upon these recommendations to improve safety. We developed a “plan on a page” to ensure quality and safety are central to what we do. This plan is centred around improving patient and service user experience and feedback, creating a caring and open culture, providing individualised care and strengthening our clinical leadership.”Our Managing Director added to his statement on page 9

“We reinvest our profits through the Council of Governors’ Community Development Fund which supports our core purpose as a social enterprise to add social value back into the heart of our community (see glossary).”We have added two sentences on page 10

“We wanted to create a catheter register to help us to ensure that patients are on the correct care pathway and that they are receiving the right care.”“This proactive management will empower patients and help to reduce the risk of catheter associated problems.”We have added a sentence to page11

“All of our registered clinical staff are supported to access clinical supervision in their preferred format, time and place. For example, at the end of March 2014, 131 of our 247 registered clinical staff were accessing group-facilitated clinical supervision. The remainder were accessing other options from our clinical supervision menu.”We have added a timeline to page 15We have added a sentence to page 17

“Ultimately we will work towards enabling carer or service user led audits.”

The initial response from East Surrey Clinical Commissioning Group was received on 24th June 2014 and, as a result, we have made the amendments detailed below:


GLOSSARY STATEMENT FROM EAST SURREY CLINICAL COMMISSIONING GROUP

We would like to thank East Surrey CCG for their statement. We look forward to working collaboratively

over the coming year.


GLOSSARY

18 weeks There are currently 18-week ‘referral to treatment time’ (FTT) targets in England (introduced in 2009). FTT refers to the waiting time between a GP referral and treatment, which, in the case of audiology, is usually hearing aids. These figures relate to people who have been referred by their GP direct to audiology (direct access patients). They do not include people who go to ENT (ear, nose and throat department) first, or people who already have hearing aids who are waiting for further treatment or support, such as digital upgrades or the second issue of a hearing aid. Within the overall 18 week target there is a six week diagnostic (primary pathway) target which refers to the time from referral to initial assessment (hearing test). The term ‘people with hearing loss’ refers to people who are deaf, deafened and hard of hearing.

Baby Friendly Initiative (BFI)The Baby Friendly Initiative is a worldwide programme developed by UNICEF and WHO to ensure that health care organisations are able to offer the highest standards of care for pregnant women and breastfeeding mothers and babies. The Initiative ensures that all health professionals are trained to offer the best possible advice and support to breastfeeding mothers so that their babies can have the very best start in life.

Care Quality Commission (CQC)The CQC is the regulator for all health and social care services in England, ensuring that the Government standards or rules about care are met. From April 2009, every NHS healthcare provider must be registered with the CQC.

Clinical auditClinical audit measures the quality of care and services against agreed standards and suggests or makes improvements where necessary.

Clinical Coding Error Rate Clinical coding translates the medical terminology written by clinicians to describe a patient’s diagnosis and treatment into standard, recognised codes. The accuracy of this coding is a fundamental indicator of the accuracy of patient records.

Commissioning for Quality and Innovation (CQUIN) payment framework The CQUIN payment framework enables commissioners to reward excellence, by linking a proportion of NHS providers’ income to the achievement of local quality improvement goals.

Community Interest CompanyA Community Interest Company (CIC) is a special type of limited company which exists to benefit the community rather than private shareholders.

Deprivation of Liberty SafeguardsThe Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom. The safeguards should ensure that a care home or hospital only deprives someone of their liberty in a safe and correct way, and that this is only done when it is in the best interests of the person and there is no other way to look after them.

STATEMENT FROM EAST SURREY CLINICAL COMMISSIONING GROUP


Harm Free CareFor more information go to http://harmfreecare.org/wp-content/uploads/DH%20ST%20Guidance%2025%205%2012.pdf

High Quality Care for AllHigh Quality Care for All (June 2008) set the vision for Quality to be at the heart of everything the NHS does, and defined quality as centred around three domains: patient safety, clinical effectiveness and patient experience.

Information Governance Toolkit attainment levelThe Information Quality and Records Management attainment levels assessed within the Information Governance Toolkit provide an overall measure of the quality of data systems, standards and processes within an organisation.

National Institute for Health and Care Excellence (NICE)NICE is an independent organisation responsible for providing national guidance on promoting good health and preventing and treating ill health. Visit: www.nice.org.uk

National Patient Safety Agency (NPSA)The NPSA leads and contributes to improved, safe patient care by informing, supporting and influencing the health sector. It aims to reduce risks to patients receiving NHS care and improve safety. Visit: www.npsa.nhs.uk

Net Promoter Score (NPS) Net Promoter Score (NPS) measures the loyalty that exists between a provider and a consumer. The provider can be a company, employer or any other entity. The provider is the entity that is asking the questions on the NPS survey. The consumer is the customer, employee, or respondent to an NPS survey.

NHS Number and General Medical Practice Code ValidityThe patient NHS number is the key identifier for patient records. Improving the quality of NHS number data has a direct impact on clinical safety.

Omitted MedicineAn omitted medicine is the failure to prescribe a drug in a timely manner; it is also the failure to administer a dose when the next dose is due or, in the case of once only doses (stat doses), failure to administer a drug within two hours of the time the dose is due. A delayed medicine is when the administration of the drug is two hours or more after the time the dose is due (definitions as set out in the FCH&C Omitted and Delayed Medicines Guidelines, 2014).

Participation in Confidential EnquiriesConfidential Enquiries are special enquiries that seek to improve health and health care by collecting evidence on aspects of care, identifying any shortfalls in this, and disseminating recommendations based on these findings. They include the Confidential Enquiry into Maternal Deaths and Child Health (CEMACH), Confidential Enquiries into Stillbirths and Deaths in Infancy (CESDI), the National Confidential Enquiry into Patient Outcome and Death, and the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness.

Root Cause Analysis Root cause analysis (RCA) is a method of problem solving that tries to identify the root causes of faults or problems. A root cause is a cause that once removed from the problem fault sequence, prvents the final undesirable event from recurring.


Social EnterpriseThe Government defines social enterprises as “businesses with primarily social objectives whose surpluses are principally reinvested for that purpose in the business or in the community, rather than being driven by the need to maximise profit for shareholders and owners.” As with all businesses, they compete to deliver goods and services. The difference is that social and environmental purposes are at the very heart of what they do, and the profits they make are reinvested towards achieving those purposes.

The DVT Wells ScoreThe DVT Wells Score uses 10 criteria to calculate the probability or risk of a deep vein thrombosis (DVT).

The FRAX tool The FRAX tool has been developed by the World Health Organisation (WHO) to evaluate fracture risk of patients. It is based on individual patient models that integrate the risks associated with clinical risk factors as well as bone mineral density (BMD) at the femur neck.

The Health Visitor Improvement Plan The Health Visitor Improvement Plan 2011-2015 outlines four different levels (tiers) of service based on assessment of the needs of the child and family:1. Community Service: A range of services offered to all families in a community that reflect the needs of the community. 2. Universal Services: provided for all families with children aged 0-5, for example, immunisations, health and development reviews, drop-in health clinics and a range of community services and resources. 3. Universal Plus Services: offered to families with children aged 0-5 with specific issues, for example, postnatal depression, sleep issues, weaning or any other concerns about parenting. 4. Universal Partnership Plus Services: Health visitor teams, working together with a range of local services, provide on-going support to families with children aged 0-5 with complex needs.

The Mid Staffordhsire NHS Foundation Trust Public Inquiry Final Report 2013On 9 June 2010 the Secretary of State for Health, Andrew Lansley MP, announced a full public inquiry into the role of the commissioning, supervisory and regulatory bodies in the monitoring of Mid Staffordshire Foundation NHS Trust.

The Inquiry was established under the Inquiries Act 2005 and is chaired by Robert Francis QC, who made recommendations to the Secretary of State based on the lessons learnt from Mid Staffordshire. It builds on the work of his earlier independent inquiry into the care provided by Mid Staffordshire NHS Foundation Trust between January 2005 and March 2009. Click on link for further information http://www.midstaffspublicinquiry.com.

UNICEF United Nations Children’s Fund (formerly United Nations International Children’s Emergency Fund). UNICEF UK is a registered charity raising funds and awareness to support UNICEF’s work to protect child rights worldwide, in accordance with the UN Convention on the Rights of the Child (CRC). UNICEF UK also runs programmes in schools, hospitals and with local authorities in the UK.

WHOThe World Health Organisation is the directing and coordinating authority for health within the United Nations system. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends.


Our Vision is... “ To be recognised, respected

and trusted by patients, carers,

professionals and staff as the best

provider and innovator of integrated community services.”

Further Information/Feedback

If you would like to find out more about our services, please visit our website at: http://firstcommunitysurrey.com

If you would like this information in another format or language, or would like to provide feedback about this account or any of our services, please contact:

Communications Team First Community Health & Care 2nd Floor, Forum House41-51 Brighton RoadRedhillSurreyRH1 6YS

© First Community Health & Care 2014

t: @1stchatterw: www.firstcommunitysurrey.com

t: 01737 775450e: [email protected]

quality account 2013/14

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