THE HUNTERCOMBE GROUP

Quality Report

2010/2011

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The Huntercombe Group The Huntercombe Group The Huntercombe Group The Huntercombe Group –––– Quality Report 2011Quality Report 2011Quality Report 2011Quality Report 2011

Part 1 Statement on quality from the Board of Directors 2-4

Building on last year’s achievements 5-7

National Conferences 6

Our Priorities for 2011 / 2012 6

Monitoring our Progress 7

Part 2 Priorities 8-12

Priority 1 – Infection Control 8

Priority 2 Review of the Audit system 9

Priority 3 Implementation of benchmarking tool 9

Priority 4 Clinical Outcome Measures 9-10

Priority 5 Activity 10

NHS services provided by The Huntercombe Group 11

National Clinical Audits 12-13

Research 13-14

Participation in clinical research 13

Research Projects 1st April 2010 to 31st March 2011 13-14

Proportion of income from CQUIN 15

Registration 15

Part 3 How we have performed in quality 2010 – 2011 16-18

Patient Safety - Patient on Patient assault 16

Clinical Effectiveness - Pressure Area Care 17

Complaints 18

Satisfaction Surveys 19-22

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Part 1 Statement on quality from the Board of Directors

Dr Peter Calveley Chief Executive, Four Seasons Health Care The Huntercombe Group is a leading specialist provider of health and social care services, working in partnership with the NHS and Local Authorities throughout England and Scotland to provide effective healthcare solutions for all its patients. The Huntercombe Group operates as the specialist provider arm of Four Seasons Healthcare. The Huntercombe Group provides the following services

• Mental Health, Alcohol and Substance misuse, • Eating Disorders, • Child and Adolescent Mental Health, • Adult Mental Health, • Acquired Brain Injury Services,

• Neurodisability, • Children with specialist needs • Learning Disabilities.

It is our goal to deliver effective care and treatment in a safe and welcoming environment, and, that this treatment and quality of care reflects national standards and is evidence based by placing the patient at the forefront of their care. This quality account covers those of our hospitals and centres that provide NHS funded care across all our specialities. This document is published under the guidance issued by Department of Health which outlines requirements for independent providers to the NHS should report on data and accounts that are collated into a publishable format to be shared via the NHS Choices website and at our own website at www.huntercombe.com in helping to inform patient choice and patient care.

This quality account sets out those priorities for the year ahead as well as showing a

comparison of the results of our work over the past year in the areas of Patient Safety, Clinical Effectiveness and the Patient Experience.

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Should you have any feedback or suggestions about this quality account please email; neil.powell@fshc.co.uk Progress in the following areas has been noted by the Board to include:

• Increasing adoption of research and evidence-based learning to improve patient experience and the treatments we provide.

• Ever increasing standards in: patient safety, clinical effectiveness and the patient experience.

• Driving strategic development of all our services across England. • Continually seeking improvement in the quality of care that we deliver. • The outcome reporting process has made significant advancements both in terms of

using data effectively and the way in which the data is gained.

• Well managed incidence reporting system implemented across our services, equipping our staff with the autonomy to identify trends and allocate resources effectively.

• High levels of compliance and engagement to staff learning and development via a purpose-built e-learning system.

The Huntercombe Group has recently undergone the process of re-registration with the Care Quality Commission (CQC), where we demonstrated that we meet the requirements set out by CQC in the quality of care we deliver. Other registration requirements included that the environment we provide for patients was safe and clean and that our centres/hospitals were staffed by staff, who were appropriately trained, supervised and in sufficient numbers to carry out safe and high quality, effective care. The Huntercombe group strives to promote a culture of learning from clinical experience by the review of incidences and by keeping staff informed of the latest research, development and practice in our field, including the implementation of an internal Research and Governance Ethics Committee whose membership includes our Medical Directors and Managing Director. Patients and our staff are placed at the centre of our quality framework and in addition to being fully involved in patient care and treatment, via participation in day-to-day decision making including patient community groups and carer groups.

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Part 1 Statement on quality from the Board of Directors

Margaret Cudmore Managing Director, The Huntercombe Group In order to deliver a provision of high quality care and treatment that is expected both by the individuals in our care, their families and carers, commissioners and the public, The Huntercombe Group continuously examines the quality of care and treatment provided against the three standards of patient safety, clinical effectiveness and patient experience. This examination is undertaken both from within the organisation, through our own internal audits such as; the Team Audit Programme and externally through the regulatory visits of the Care Quality Commission / OFSTED, together with peer review through the Royal College of Psychiatrists. (eg; Quality Networks such as the Quality Network for inpatient CAMHS) Patients, patient families and commissioners and carers are at the centre of our quality review and feedback is obtained on the quality of the care we provide and treatment through our satisfaction surveys, patient / carer/family forums and face-to-face meetings. We also review our provision of quality care and treatment through regular dialogue with commissioners, via our annual referrer questionnaire. This information is used to inform operational and strategic development of services.

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Part 1 Building on last year’s achievements

In reviewing the three domains of patient safety, clinical effectiveness and patient experience, it is evident that there has been a significant improvement in the way we deliver care and improved on our quality delivery throughout the Huntercombe Group over the past year. Some of the outstanding results over the last year have been;

• A new electronic information database has been introduced enabling real time reporting of incidences and has equipped staff to accurately identify trends and allocate resources in response to this.

• 60% reduction in the number of cases of MRSA from 15 cases in 2009 – 2010 to 6 cases in 2010 – 2011.

• 20% reduction in the number of pressure ulcers, from 47 in 2009-2010 to 39 in 2010-2011.

• A new infection control risk assessment process has been introduced across the group to identify patients at risk prior to admission so that appropriate care and treatment can be tailored to patient need from the moment of admission.

• A review of internal documentation was undertaken, and as a response to consultation from all parties new documentation has been introduced in the neuro-rehabilitation and neurodisability sites that reflect a more patient- centred approach.

• There has been a reduction in the number of complaints relating to the quality of care provided to our patients, down from 14 to 8 with the other areas of environment, treatment and catering also showing a significant decrease.

• A minimum suite of Outcome Measures has been introduced by the Board and implemented based on commissioner requirements over the past year, within the different specialities of our services. These tools include the Northwick Park Dependency Scale, FIM FAM and the Rehabilitation complexity score. This is an addition to the outcome scales already in use, such as HONOS, and HONOSCA and nationally recognised risk assessment tools such as the HCR 20.

• The introduction of a quality visit schedule with the incorporation of thematic reviews. This quality visit schedule ensures that all centres/hospitals are visited quarterly, (monthly in the case of the OFSTED units) and that the centre or hospital is assessed against both the CQC and OFSTED standards / outcomes as well as adhering to the National Service Frameworks and NICE good practice guides.

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National Conferences

The Huntercombe Group is one of the leading providers in the field of Acquired Brain Injury

and Neurodisability. Some of the conferences that the Group have hosted and presented at

include;

• Rehabilitation Master Class. This course was partnered in conjunction with the University of the West of England as part of the syllabus for the ‘Neurosciences for Health’ CPD module. Each year a number of our staff organise a complete day of lectures/ presentations/workshops for participants.

• Avon & Wiltshire Positive Behaviour Network, held at the University of the West of England. A range of talks/workshops were held regarding management of challenging behaviour (contemporary issues) and restraint reduction approaches. A senior member of Huntercombe staff lectures on this course.

Our CAMHS services have participated in;

• Medication considerations in Teenage ADHD” April 2010, Maudsley Annual Reviews, Institute of Psychiatry, London

• “Autism: Resolving Complexities and Comorbidities” June 2010, Birmingham. This one-day event was organised and chaired by one of our Medical Directors and two of our consultants gave presentations. This event was hosted by The Huntercombe Group.

Our Priorities for 2011 / 2012

In establishing what our priorities are as a leading healthcare provider over the coming year

we consulted with patients and carers/families through our satisfaction questionnaires and

patient carer forums, as well as examining evidence from our audits and results of

regulatory, commissioners’ reports and CQUIN requirements.

Over the coming year The Huntercombe Group plans to;

• Introduce a new quality audit framework that incorporates national standards, outcomes and good practice guidance.

• Consider the adoption of a nationally recognised benchmarking tool across the Group.

• Develop a more effective method for collating and distributing outcome information in order to better target resources.

• Reduce the level of MRSA infection still further to ensure that the environment that the patient is cared for is clean and safe.

• Undertake a review of patient activities provided across the group to ensure that the wishes and needs of the patients in our care are catered for and acted upon.

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Monitoring our Progress

The monitoring of progress is an integral part of our quality agenda and The Huntercombe

Group intends to use the principles of integrated governance to monitor our progress on the

priorities as stated on page 6.

Through the use of outcome collation tools, patient and family/ carer feedback and the on-

going quality visits, The Huntercombe Group will monitor progress on our priority objectives.

This process will also include a review of audit data against National Standards and Good

Practice Guidance to ensure that the patient care and treatments that are delivered are safe,

of excellent quality and reflect the needs and wishes of the patients in our care.

This quality account has been presented to the Board and to the best of my knowledge the

information in the document is accurate.

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Part 2 Priorities

Patient Safety

Priority 1

Infection control

MRSA Rates

MRSA rates across the units have seen a significant reduction over the past two years. The priority for the next year is to reach zero numbers of MRSA infection acquired within the group, and early identification of those infections acquired prior to admission. This is being addressed by the introduction of a pre-admission infection control risk assessment which will aid in the planning of care and management of persons referred into our units.

Staff education and training continues to be a priority for the Group and last year saw the introduction of a compulsory ‘e’ learning module titled; infection control for all staff. This is being supplemented by infection control lead / infection control champion training for key staff in each unit and will be further developed over the coming year.

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2009-2010 2010-2011

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Quality Visits

As part of the quality initiative for The Huntercombe Group, a quarterly quality inspection is being carried out on across all centres/hospitals. This quality visit is undertaken by clinicians external to the centre/hospital and uses the Care Quality Commission Judgement Framework as a guide and will routinely include an environmental / clinical observation inspection using the Infection Control Code of Practice as a benchmarking tool.

Thematic Reviews

The visit schedule includes a series of focused reviews, concentrating on one specific area of care. The first of which is intended to carry out a review of all infection control practices across The Huntercombe Group.

Clinical Effectiveness

Priority 2

Review of the Audit system

The Huntercombe Group currently uses a team audit programme (TAP) as a central core audit tool. Other tools used are bespoke to the individual centres/hospitals and reflect the specialist nature of the services.

The TAP audit consists of 15 distinct tools that cover all areas of the hospital / centre, including; documentation, medicines, health and safety, environment, human resources, nutrition and training.

With the changing of legislation and the publication of the Care Quality Commission essential standards (www.cqc.org.uk), the process of the audit itself is being re-examined so that the results provide comprehensive, concise, accurate and timely data that will meet the requirement of the Care Quality Commission and reflect current good practice guidance, national audit activity and the national service framework.

Priority 3

Implementation of benchmarking tool

From examining the requirements placed in CQUINS, a priority need has been identified to establish a benchmarking tool across all our centres/hospitals that will promote good practice in local areas. The Huntercombe Group is considering the Department of Health Essence of Care benchmarking tool. This contains 12 benchmarks, which the Department of Health has published with the aim ‘to support localised quality improvement’. This tool can be used to provide a structured approach to sharing and comparing practice, while identifying best practice and developing action plans to remedy poor practice.

Priority 4

Clinical Outcome Measures

Outcome measures provide valuable information in regards to the effectiveness of care and treatment of patients in our care and provide invaluable information that is an essential part in the development of an effective healthcare service.

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Priorities

The Huntercombe Group uses a variety of outcome measures across its services, which have been identified as being appropriate for each centre/hospital speciality. These include FimFam, RCS, NPTDS, Bartel, HONAS and HONOSCA. The priority for the company over the coming year is to develop an electronic database to ensure that this information can be used in the strategic planning of services.

Patient involvement

Priority 5

Activity

Each year individual centres/hospitals within The Huntercombe Group issue surveys to their clients/ patients and to the relatives of those patients to obtain feedback on the service they provide or have received. The views of commissioners who commission our services are also sought and these views are used to develop operational and strategic plans. A review of last year’s surveys found that while the overall feedback was excellent an identified area for improvement for some centres/hospitals revolved around the provision of more varied activities choice for patients/ clients. As the graph shows in the centres and hospitals reviewed there was a drop in activities choice for patients however this was found to be due to staff vacancies in the units involved and has now been addressed for the period. The Huntercombe Group employs, amongst others, activity staff, teachers and occupational therapists in its units and where there has been an identified shortfall the Group will make it a priority to address this over the coming year through a dynamic recruitment campaign.

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A B C D E F G

2010

2011

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NHS services provided by The Huntercombe Group

NHS Services During the period April 1st 2010 to March 31st 2011 The Huntercombe Group provided the following services to the NHS;

• Brain Injury rehabilitation and neurodisabilities • Adult Mental Health • Drug and Alcohol Addiction • Learning Disabilities

• Services for Children with Specialist Needs • Eating Disorders • Child and Adolescent Mental Health Services

Name of unit Child and adolescent

Eating disorder

Addictions Brain Injury Rehabilitation

Mental Health Low secure services

Neurodisability Learning disability

Services for children with specialist needs

Huntercombe Hospital Maidenhead

Huntercombe Hospital Stafford

Huntercombe Hospital Roehampton

Frenchay Brain Injury Rehabilitation Centre

Blackheath Brain Injury rehabilitation and Neurodisability centre

Abbeymoor Granville Stockton Sunderland Peterlee Aspley Hothfield Hucknall

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National Clinical Audits

During the period April 1st 2010 to March 31st 2011 five national clinical audits and one

national confidential enquiry covered NHS services that The Huntercombe Group provides.

During the period April 1st 2010 to March 31st 2011 The Huntercombe Group participated in

(0%) national clinical audits and (100%) national confidential enquiries in which it was

eligible to participate.

The national clinical audits and national confidential enquiries that The Huntercombe Group

was eligible to participate in during the period April 1st 2010 to March 31st 2010 are as

follows

National Audits

RCPH National Childhood Epilepsy Audit

National Adult Diabetes Audit

National Audit of Psychological Therapies

Prescribing in mental health services (POMH)

National Audit of Schizophrenia (NAS)

The national clinical audits and national confidential enquiries that The Huntercombe Group

participated in during the period April 1st 2010 March 31st 2011 are as follows

National Confidential enquiry into suicide and homicide by people with mental illness

The national clinical audits and national confidential enquiries that The Huntercombe Group

participated in, and for which data collection was completed during the period April 1st 2010

to March 31st 2011 are listed below alongside the number of cases submitted to each audit

or enquiry as a percentage of the number of registered cases required by the terms of that

audit or enquiry.

National Confidential enquiry into suicide and homicide by people with mental illness

100%

A review of the Healthcare Quality Improvement Partnership published reports for 2010 found that only one report that was applicable to The Huntercombe Group was published in this period. The report of one national clinical audit was reviewed by the provider in the period April 1st 2010 to March 31st 2011 and The Huntercombe Group intends to take the following actions to improve the quality of healthcare provided:

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National Clinical Audits Following a review of the National Adult Diabetes Audit, The Huntercombe Group will undertake a review of its services to patients with diabetes using the National Adult Diabetes Audit as a benchmark to ensure that a full and effective service is provided in all units. The reports of seventeen local clinical audits were reviewed by the provider in the period April 1st 2010 to March 31st 2011 and The Huntercombe Group intends to take the following actions to improve the quality of healthcare provided: The TAP audit has shown a consistent improvement across all areas of the service examined by the audit over a quarter-by-quarter comparison. Where there has been a minor decline this is being addressed by the centre/hospital managers and regional managers through local initiatives, including recruitment and training.

Research

Participation in clinical research The Huntercombe Group has an active research and publication group and research partners include Goldsmiths in London and King’s College, London. The Group is also involved in a number of international studies. The group is dedicated to engaging and participating with pioneering research and effectively applying useful findings to its practice across the group and within the field of discipline it relates too. Research that the Huntercombe Group has been involved in over the past year has been; Research Projects 1st April 2010 to 31st March 2011 Blackheath Brain Injury Centre and the Institute of Psychiatry, King’s College, London “A phenomenology study of decision-making capacity in different mental disorders” This research aims to address how and should the notion of Mental Capacity be interpreted and applied in the context of psychiatric disorder. Blackheath Brain Injury Centre and the Intensive Care National Audit & Research Centre “RAIN- Risk Adjustment in neurocritical care- prospective validation of risk prediction models for adult patients with acute traumatic brain injury to use to evaluate the optimum location and comparative costs of neurocritical care” The aim of this study is to improve the outcome and care given to patients who have suffered a traumatic brain injury. Blackheath Brain Injury Centre and Roehampton University “How Day/ Night Shift Work may be Affected by Perceived Stress” The aim of this study is to investigate the relationship between shift work and perceived stress. This project was completed in November 2010.

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Blackheath Brain injury Centre and the Institute of Psychiatry, King’s College, London “A Qualitative Study Exploring Brain Injury Patients’ Families Expectations of Neurological Rehabilitation” This study investigates brain-injury patient’s families’ expectations and perceptions of neurological rehabilitation. The research aims to assist with the engagement of families and explore if families’ expectations of the service are met. Huntercombe Hospitals Maidenhead, Stafford, Edinburgh and Great Ormond Street Hospital for Children NHS Trust “The Ravello Profile- The neurocognitive profile of Anorexia Nervosa” This study aims to investigate whether specific neuropsychological impairments consistently identified in the majority of those with Anorexia Nervosa, cluster together to form distinct cognitive profiles in this population, using well validated, standardised assessment procedures. Huntercombe Hospitals Maidenhead, Stafford, Edinburgh and The Institute of Psychiatry, King’s College, London “Internet Based Relapse Prevention in Anorexia Nervosa Patients” This is a randomised controlled trial assessing the efficacy of an internet-based relapse prevention programme in Anorexia Nervosa. Huntercombe Hospital- Maidenhead and the Institute of Psychiatry, King’s College, London “Service Utilisation & Alternative Care Pathways for Adolescents with Eating Disorders” This study aims to identify different treatment models, or care pathways, that exist for adolescents with eating disorders across Greater London and parts of Surrey and Hampshire, and to examine the impact of these on treatment outcomes. Huntercombe Hospitals Maidenhead, Stafford, Edinburgh and Oslo University (RASP), Norway “Season of Birth in Anorexia nervosa (AN)” The aetiology of AN is complex and far from fully understood. Amongst the identified risk factors for AN is a consistent finding of a spring Season of Birth (SoB) bias. This study aims to explore the earlier findings of a SoB bias in AN, using a research design that overcomes previous methodological flaws and to test four hypotheses for the SoB bias in AN Blackheath Brain Injury Centre and the Institute of Psychiatry, King’s College, London “A phenomenology study of decision-making capacity in different mental disorders” This research aims to address how and should the notion of Mental Capacity be interpreted and applied in the context of psychiatric disorder. The number of patients receiving NHS services provided or sub-contracted by The Huntercombe Group in the period April 1st 2010 to March 31stthat were recruited during that period to participate in research approved by a research ethics committee was 209

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Proportion of income from CQUIN

A proportion of income in the period April 1st 2010 to March 2011 was conditional upon achieving quality improvement and innovation goals agreed between The Huntercombe Group and any person or body they entered into a contract, agreement or arrangement with for the provision of NHS services, through the Commissioning for Quality and Innovation payment framework. Further details of the agreed goals for the period April 1st 2010 to March 31st 2011 and for the following 12-month period are available electronically from mark.williamson@fshc.co.uk.

Registration

The Huntercombe Group is required to register with the Care Quality Commission and OFSTED. Current registration status is that all our units are registered with the appropriate bodies. The Care Quality Commission has not taken enforcement action against The Huntercombe Group during the period April 1st 2010 to March 31st 2011. OFSTED has taken enforcement action on an inspection in April 2010. This enforcement

was removed in June 2010.

The Huntercombe Group has not participated in any special reviews or investigations by the CQC during the reporting period. The Huntercombe Group will be taking the following actions to improve data quality. It will

complete the submitted action plan for the information governance toolkit.

The Huntercombe Group did not submit records during the period April 1st 2010 to March 31st 2011 to the Secondary Uses service for inclusion in the Hospital Episode Statistics which are included in the latest published data.” The Huntercombe Group was not subject to the Payment by Results clinical coding audit

during the period April 1st 2010 to March 31st 2011 by the Audit Commission.

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Part 3 How we have performed in quality 2010 – 2011

Patient on Patient assault

Comparing those centres and hospitals that submitted information for last year’s Quality

Account, it can be seen that there has been a decrease across sites in the number of face-

to- face incidents. This is due to a number of positive factors including; on-going training

programme for staff and a quality and audit framework.

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A B C D E

2009 - 2010

2010 - 2011

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Clinical Effectiveness

Pressure Area Care

These figures are of pressure areas reported across the units that provide NHS services in

the areas of neurodisability and neurorehabilitation. These figures include both pressure

ulcers that have been formed whilst in our care and those that the patient had when being

admitted to the units.

As the diagram indicates there has been decrease in the number in 50% of the units with

one unit remain unchanged, one additional case in unit A and two additional cases in unit D

from the previous year.

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A B C D E F

2009

2010

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How we have performed in quality 2010 – 2011

Complaints

All units are required by legislation to keep a complaints log, for example, listing the

complaint, action taken and outcome. A review of the last two years has been undertaken

to ascertain trends in complaints so that appropriate measures can be taken to address

these.

These figures are for complaints made and investigated. All complaints were resolved

locally in consultation with commissioners and where appropriate, carers and relatives.

It can be noted that there has been a significant reduction across those units that fall within

the scope of this quality account, with the exception of staff behaviour. The company has

addressed this both through the investigation process and through review of supervision and

training provision across the sites.

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Quality of

Care

Staff

Behaviour

Treatment Catering Environment Other

2009 - 2010

2010 - 2011

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Satisfaction Surveys

Patient, carer, family, referrer satisfaction surveys are not only a legal requirement but are

also a valuable source of information for the Huntercombe Group to ensure that the service

that is offered meets the needs of those in our care.

The method of collecting data has evolved since the last quality account and a new, generic

form for clients and relatives is now in use across all our neurodisability/neuro rehabilitation

units. This will be developed over the next 12 months to include all our other units. We

have been using the same generic survey for our referrers since 2007 and going forward,

we are intending to use online survey versions to increase the overall response rate for this

particular survey.

Client/Relative Surveys

The generic client/ relative survey comprise questions on the following:

• the welcome pack/ client’s handbook • patient / client involvement in the care plan • the clinical team • treatment of patients/ clients as individuals • the centre appearance, facilities and activities • the quality of care

For the purpose of this report, it was decided to focus on three questions that we believe

provide a good indication about the overall experience of our patients/ clients:

• How involved do you feel you are in your/ your relative’s care?

• Do you feel you/ your relative are treated with dignity and respect?

• How would you rate the quality of care you/ your relative has received so far?

As one example of how we use our data, the following graphs show two years comparable

data for our centre in Blackheath, London for the three questions listed above. The

response rate in 2009 was 50% and in 2010 was 67%.

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How involved do you feel you are in your / your relative's care?

(% responding "totally"/" to some extent")

88%

95%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

2009

2010

Do you feel you/ your relative is treated with respect and dignity?

(% responding "totally" / "most of the time")

81%

95%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

2009

2010

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From these graphs, it is evident that at our centre in Blackheath we have seen good

improvements in treating our patients with dignity and respect and in involving them in their

care. Our result on the quality of care received so far is similar for the two years.

Results for 2009 – 2010 for the neurorehabilitation and Neurodisability services:

The following graph shows the Group’s 2009/ 2010 results for our 16 neurorehabilitation

and Neurodisability units. As a Group, we are typically achieving over 85% in all three

areas. Our 2010/2011 group results will be available in July 2011.

Referrer Surveys

Our group referrer survey includes questions on the following:

How would you rate the quality of care you have/ your relative has

received so far? (% responding "very good"/"good")

88%

85%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

2009

2010

2010 survey results

85%

89%

88%

0% 10

%

20

%

30

%

40

%

50

%

60

%

70

%

80

%

90

%

100

%

How involved do you feel you are in your/ your relative's

care? (% responding "totally"/"fairly involved")

Do you feel you / your relative is treated with dignity and

respect (% responding "totally"/"most of the time")

How would you rate the quality of care you have/ your

relative has received so far? (% responding "very

good"/"good")

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• Effectiveness of our communication with referrers

• Clinical aspects of our service

• Future service needs

• Future referral patterns

For the purpose of this report, we have focussed on whether our referrers would refer to us

again in the future and if they would recommend us to a colleague. Our 2010 results are

based on a response rate of 13% and are as follows:

Over 90% of our referrers would refer to us again and over 80% would recommend our

services to a colleague. Our 2011 results will be available during July 2011 and a

comparison with 2010 will be made to see if progress has been made.

Referrer Survey 2010

89%

81%

95%

91%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100

%

BI/ NDU

MH/LD/Other

Refer to us

again

Recommend

to colleague