Air Liquide (Homecare) Ltd Quality Account 2015/16/17

Air Liquide (Homecare) Ltd

Quality Account

2015/16/17

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Contents

Part 1

Welcome and Introduction to the Quality Account 3-5

Statement of Quality from the Managing Director 6-7

Statement of Quality from the Business Relationship and Contracts Manager 8

Statement of Quality and Safety from the Health and Safety Manager 8

HOSAR Mission, Aims and Objectives 9

Part 2 (a)

Looking ahead – Our quality priorities for Improvement in 2016-17 10

Full list of Quality priorities for 2017-18 11

Details of Quality Priorities 12-22

Part 2 (b)

Looking back – Review of Quality Priorities in 2015-16-17 23

Patient Safety 23

Patient Experience 24

Clinical Effectiveness 24

Part 2(c)

Review of Services 25

Clinical Audit 25-26

Goal agreed with Commissioners 27-28

Statements from the CQC 29

Data Quality 29

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Part 3

Other information 30

Staff Training 30

Staff Survey 31

Complaints 32

Patient Satisfaction 32-37

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Part 1

WELCOME AND INTRODUCTION

OUR QUALITY ACCOUNT FOR 2016-17.

The Air Liquide Group is a global business that supplies medical gases and related services to

hospitals, clinics, ambulances and patients in the home. As a world leader in gases,

technologies and services for Industry and Health, Air Liquide is present in 80 countries with

more than 50,000 employees and serves more than 2 million customers and patients.

AIR LIQUIDE IN THE UK:

AIR LIQUIDE HEALTHCARE strives to provide the highest levels of service and quality to our

customers. Our customers include NHS Hospitals & Ambulance services,

Private Healthcare organisations, and Emergency Service organisations such as Fire &

Rescue, GP's, Dental Practices and Veterinary Surgeries.

AIR LIQUIDE (HOMECARE) LTD (ALHC) is a provider of healthcare to patients with long term

conditions such as COPD (Chronic Obstructive Pulmonary Disease). Our range of homecare

services includes Home Oxygen Therapy (HOS) and Home Oxygen Assessment and Review

Service (HOSAR).

We strive to deliver a high quality service to patients and Health Care Professionals HCP's

which is cost effective for the NHS.

We deliver home oxygen to over 39,000 patients in London, North West England, the East

Midlands and South-West of England enabling them to remain active, independent and

improve their overall quality of life and support over 4,000 patients through our Home

Oxygen Assessment and Review Service (HOSAR).

Our staff of over 300 makes sure that patient care and safety is at the centre of all that we

do.

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Air Liquide (Homecare) Ltd (ALHC) provides a HOSAR service in the North East of England

and also in Trafford, Greater Manchester.

Working closely with the NHS Commissioners our teams of Specialist Oxygen Nurses

assess patients according to the national guidelines ensuring each patient receives

the appropriate oxygen therapy according to their clinical need and the locally

agreed pathways, ensuring value for money to the NHS through cost effective

prescribing.

Patients are regularly reviewed in line with national clinical guidelines and best

practice to make sure that their home oxygen therapy continues to meet their

current needs.

The assessments can take place either in the patient’s own home or at a clinic closeto their location

NHS TRAFFORD CCG

OVER 250 OXYGEN USERS

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NORTH EAST CCGS

NHS DARLINGTON CCG, NHS DURHAM DALES, EASINGTON AND SEDGEFIELD CCG, NHS GATESHEAD CCG,

NHS NORTH DURHAM CCG, NHS SOUTH TEES CCG, NHS SOUTH TYNESIDE CCG, NHS SUNDERLAND CCG

OVER 4000 OXYGEN USERS

QUALITY ACCOUNT

All NHS healthcare providers are required to produce an annual Quality Account, to provide

information on the quality of services they deliver.

ALHC welcomes the opportunity to outline how well we have performed over the course of

2015/16/17, taking into account the views of service users, carers, staff and the public. This

Quality Account outlines the good work that has been undertaken; the progress made in

improving the quality of our services and identifies areas for improvement.

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STATEMENT OF QUALITY FROM THE MANAGING DIRECTOR JOHN WEBBER

Thank you for taking the time to read our

2015/16/17 quality account, we welcome this opportunity

to take a look at how well we have performed over the

previous year, to outline the quality improvement priorities

we aim to make in the next year and how we will go about

achieving them.

As Managing Director of Air Liquide (Homecare) Limited, it is my responsibility to ensure

that our core objectives are implemented and that Quality is at the core of everything that

we do.

To that end, Quality simply put means:- “a systematic approach to ensure a continuously

high level of performance in all things we do and staff are empowered/ motivated to

continuously improve both themselves and the service they provide on behalf of Air Liquide

(Homecare) Limited ensuring a high quality service for all our patients, stakeholders and

commissioners”

Air Liquide (Homecare) Ltd is committed to the provision of the highest quality service and

working in partnership with the NHS to ensure that the services delivered result in safe,

effective care and that their patients’ needs and priorities are met. We do this by working

collaboratively and by always putting the patient at the centre of everything we do, ensuring

that we deliver a safe, equitable, consistent and reliable service to all our patients.

The report is designed to assure our patients and our commissioners that we provide high

quality clinical care.

Throughout 2015/16/17 I have overseen continued improvement in the way that we deliver

on quality and safety, and a strengthened assurance and reporting structure with the

introduction of a Quality Assurance Manager and a reconfigured Quality, Governance,

Performance, Safety and Risk Committee.

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We saw a steady increase in the number of patients over 2015/16/17 and continued to

perform extremely well with regard to patient satisfaction.

Patient safety is an overriding priority and our aim in 2015/16/17 has been to minimise

patient harm, recognising that when an incident does occur we act and learn accordingly.

We did not receive an unannounced inspection from the CQC and we look forward to their

inspection.

This year we have continued to endeavour to ensure that our services meet the highest

standards, underpinned by our principle of delivering safe, high quality services by the right

people in the right place at the right time. I believe the evidence provided in this quality

report demonstrates our commitment to providing the highest quality clinical care.

I am very proud of our staff, our achievements and of the services we provide. Equally, I

know that we have more to do to ensure that we consistently provide services that are safe,

effective, responsive, well led and that every service user and family feels that we are

providing the best care.

I hope you will find the information in the document useful. To the best of my knowledge

the information contained in this document is accurate.

JOHN WEBBER

MANAGING DIRECTOR

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STATEMENT FROM THE BUSINESS RELATIONSHIP AND CONTRACTS MANAGER

Quality is a core component in the clinical services we deliver. It is the driver for consistent,

auditable, deliverable effective services for our patients and it is a measurable assessment

used in our Patient and Staff experience audits.

JUDE LIVINGSTON

BUSINESS RELATIONSHIP AND CONTRACTS MANAGER

STATEMENT FROM QUALITY, HEATH AND SAFETY MANAGER

Quality and safety are at the forefront of everything we do in our business. ‘Do it once, do it

right; think safety, act safely.’ Quality and safety first time equals efficiency every time’.

DAVE WILSON

NATIONAL SAFETY, HEALTH, ENVIRONMENT & QUALITY MANAGER

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MISSION, AIMS AND OBJECTIVES

ALHC HOSAR AIM AT ALL TIMES TO WORK IN ACCORDANCE WITH

OUR MISSION, AIMS AND OBJECTIVES.

•To provide excellence in patient centred specialist care, by providing ahigh quality, safe and caring service that promotes independence

•We take great pride in ensuring that our patients are treated asindividuals and that they receive the best treatment to ensure the bestpossible health outcomes for them

•We strive to deliver a personalised, responsive, high quality service in amanner that demonstrates respect and dignity and is sensitive to theirever changing needs

•Essential standards of quality and safety are central to our work

OurMission

•To deliver a comprehensive HOS-AR for the management of patientsrequiring or potentially requiring the provision of home based oxygen

•To identify accurately those who will clinically benefit from oxygentherapy and review existing patients prescribed oxygen therapy but willnot clinically benefit

•Adherence to evidence based recommendation and guidelines

•To provide a comprehensive service using diagnostic equipment. Timelyassessments undertaken by qualified clinicians with relevant expertise

•Safety education and compliance checks at each interaction

•To deliver a service that is appropriate, equitable, effective and efficient

•To reduce inequalities in health, promoting well being andindependence for patients

Our Aims

•To improve the quality of life for people requiring oxygen therapy

•To educate patients and their carers on the effective use andmanagement of oxygen therapy

•To work collaboratively with primary care, community and secondarycare respiratory services

•To ensure that users of the service have a positive experience of care

OurObjectives

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Part 2 (a)

Looking ahead – Our quality priorities for

Improvement in 2017-18

This section of the quality report outlines the key quality priorities identified by ALHC to

improve the quality of our service in 2017-18. We have developed our priorities focusing

upon three key themes:

Lord Darzi defined quality for the NHS as comprising three dimensions:

Safety ( avoiding harm from the care that is intended to help)

Effectiveness (aligning care with science and ensuring efficiency)

Patient Experience (including patient centeredness, timeliness and equity)

All these dimensions count, but one among them – safety – emerges repeatedly as the most

expected; patients, families and the public expect that the people and organisation that

exist to help them will not hurt them. ‘First do no harm’ is not just a slogan in health care it

is a central aim.

ClinicalEffectiveness

PatientExperience

Patient

Safety

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Quality of care and patient safety are core themes underpinning our organisations values

and objectives. Our focus must be on how we can create a culture across the organisation

where every member of staff provides the best care for every patient every time and

delivers services we would be happy to receive ourselves or for our family and friends.

Our continued commitment to improving the quality of our care and service quality for our

patients remains our number one priority.

OUR QUALITY PRIORITIES FOR 2017/2018:

The detail of the work linked to each priority is described below:

Priority One:

Patient Safety

• Embed Risk Assessment

• Sign up to safety campaign

• Embed IncidentManagement

• Introduce a shared lessonslearned document

Priority Two:

Patient Experience

• Introduce Care Plans anddocumentation

• Introduce Patient SurveyFFT

Priority Three:

ClinicalEffectiveness

• Embed auditProgramme

• Embed QA ManagerRole

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PRIORITY ONE: PATIENT SAFETY

WHY WE CHOSE THIS PRIORITY:

Following the publication and recommendations from The Francis Report ‘The Mid

Staffordshire NHS Foundation Trust Public Inquiry’ 2013 and The Berwick report ‘A promise

to learn and commitment to act: Improving the safety of patients in England’ August 2013

Air Liquide Homecare has committed to providing safe services to patients and is aligned to

NHS England commitment to improve patient safety.

Patient safety should be the ever present concern of every person working in or affecting

the NHS-funded care. The quality of patient care should become before all other

considerations in the leadership and conduct of the NHS care, and patient safety is the

keystone dimension of quality. (National Advisory Group 2013).

Air Liquide Homecare follows the recommendations from the Berwick report

Placing the quality of patient care, especially patient safety, above all other aims.

Engaging, empowering, and hearing patients and carers throughout the entire

system and at all times.

Fostering whole-heartedly the growth and development of all staff, including their

ability and support to improve the processes in which they work.

Embracing transparency unequivocally and everywhere, in the service of

accountability, trust, and the growth of knowledge.

Our staff:

Participate actively in the improvement of systems of care.

Acquire the skills to do so.

Speak up when things go wrong.

Involve patients as active partners in their own care.

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GOAL 1: TO EMBED RISK ASSESSMENT

Air Liquide Homecare are aware that every person working in NHS funded care has a duty to

identify and help to reduce risks to the safety of patients and to acquire the skills necessary

to do so in relation to their own job.

Oxygen therapy as with many treatments carries its own risks if not managed and used

safely and correctly. The BTS Guidelines for Home Oxygen Use in Adults (2015) advise that a

risk assessment may be conducted by the home oxygen assessment service and the fire and

rescue service according to local protocols therefore providing a balanced decision between

the individuals’ needs and their safety.

The risk assessment process is about identifying and taking sensible and proportionate

measures to control the risks. Although we already take steps to control the risks, the use of

these tools will help us to decide the safest course of action.

HOW WE WILL DO THIS?

Air Liquide Homecare has developed risk assessment tools to ensure and support the safe

prescribing of oxygen therapy and will in the next year embed these tools into everyday

practice therefore enhancing patient safety. Every new patient that we assess will have a

general pre installation risk assessment completed to assess safety and suitability of an

oxygen prescription and a post installation risk assessment to ensure appropriate

interventions are put in place to minimise all potential risks.

The risks of prescribing oxygen to active smokers will be on a case-by-case basis and will

include a home visit to assess the patient’s home situation, attitude toward risks and

smoking behaviour, a further smoking risk assessment will be completed and appropriate

actions taken. Air Liquide Homecare home oxygen assessment service may decide not to

prescribe home oxygen to smokers if the risks are in their judgement too high.

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HOW WILL WE KNOW HOW WE HAVE DONE?

All patients who are commenced on domiciliary oxygen by ALHC oxygen assessment service

will have a current risk assessment document completed and attached to their account.

Any potential risk will have been highlighted and mitigation will have been put into place.

WHO WILL THIS BE REPORTED TO?

Governance Committee

The risk assessment process and safety issues that are highlighted will be discussed with the

patient and carers.

GOAL 2 – SIGN UP TO SAFETY

ALHC holds Health & Safety as a top priority within the business. We are committed to

prevent injury and ill health and to a continual improvement in Health & Safety

Management and Performance. We have an annual safety plan which sets out our

objectives and we will hold regular reviews and updates against the plan. Our policy is

communicated on induction and in direct briefings with our staff.

The Managing Director has overall responsibility for all matters involving Safety. To

enhance our current focus on safety we will sign up to the NHS England campaign ‘Sign up

to Safety’

‘Sign up to Safety’ is a national initiative to help NHS organisations and their staff

achieve their patient safety aspirations and care for their patients in the safest possible way.

Healthcare is high risk and mistakes can happen. Only safe healthcare services are truly

efficient, effective and able to offer the best experience - patient safety is the organising

principle of the high quality healthcare we all want to provide. Sign up to Safety is helping to

make improvements and create a supportive, open and transparent environment for

patients and staff.

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We will sign up to the campaign by describing the actions we will take in response to the

five Sign up to Safety pledges:

The five Sign up to Safety Pledges

1. Putting safety first. Commit to reduce avoidable harm in the NHS by half and make

public our locally developed goals and plans

2. Continually learn. Make our organisation more resilient to risks, by acting on the

feedback from patients and staff and by constantly measuring and monitoring how safe

our services are

3. Being honest. Be transparent with people about our progress to tackle patient safety

issues and support staff to be candid with patients and their families if something goes

wrong

4. Collaborating. Take a lead role in supporting local collaborative learning, so that

improvements are made across all of the local services that patients use

5. Being supportive. Help people understand why things go wrong and how to put them

right. Give staff the time and support to improve and celebrate progress.


We will publish our Sign up to Safety pledges on our website and regularly monitor our

compliance and progress.


Our sign up to safety pledges will be reported on our website


Commissioning CCG’s

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GOAL 3 – EMBED INCIDENT MANAGEMENT

ALHC is committed to providing a safe environment for its staff, service users and visitors as

well as delivering high standards of care. It acknowledges that sometimes, in the course of

providing healthcare, incidents can occur, some of which may have serious consequences

for service users, their carers, families, staff and the public. In cases, even where human

error is involved, incident investigation may reveal other related organisational failings

which need to be addressed.

It is important that patient safety incidents that could have or did harm a patient receiving

NHS funded care are reported so they can be learnt from and any necessary action can be

taken to prevent similar incidents from occurring in the future. Action may need to be taken

both locally and on a national level, so we encourage open and honest reporting of risks,

hazards and incidents via our incident reporting systems.


We have developed a web /Google based incident reporting process which automatically

populates a shared spreadsheet which allows us to monitor and review any near miss or

incidents that are identified by the clinical team.


This new tool will allow us to provide reports, updates and themes that our clinical services

report. This will allow us to develop action plans and lessons learned throughout the

organisation.


Reported incidents will be periodically analysed and results will be shared at team meetings,

governance committee and with CCG’s and stakeholders where appropriate, enabling the

organisation to learn lessons and support implementation of action to prevent incidents

reoccurring.

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GOAL 4 – INTRODUCE A SHARED LESSONS LEARNED DOCUMENT

Reporting when things go wrong is essential in healthcare but it is only part of the process of

improving patient safety. Incidents may occur because of any one of multiple reasons.

When a patient safety incident occurs the crucial issue is not ‘who is to blame for the

incident?’ but ‘how and why did it occur?’ One of the most important things to ask is ‘what

is this telling us and how can we learn from it?

‘Lessons learned logs’ are designed to be updated immediately or as soon as possible after

an issue or positive outcome has occurred and frequently to ensure all team members are

aware of actions taken forward and progress made. It is recommended that ‘lessons learned

logs’ form part of a regular team meeting agenda, to reinforce the importance of capturing

and acting on learning. The ‘lessons learned log’ should be contributed to by all team

members. We have developed our own ‘lessons learned log’ to use


We have developed Google based document that will be shared throughout the

organisation to allow different departments to share relevant lessons learned with their

teams. The document will be updated frequently to ensure all team members are aware of

actions and progress made in different areas.


The lessons learned document will form part of team meetings and reinforce the

importance of capturing and acting on learning, it will be updated frequently as actions

occur and progress made. All members of the shared group can contribute their own

specific outcomes and actions to the shared lessons learned log.


Governance committee and team meetings

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PRIORITY TWO: PATIENT EXPERIENCE

Why we chose this priority:

Over the past few years several documents and initiatives have highlighted the importance

of the patients experience and the need to focus on improving these experiences where

possible:

Lord Darzi’s report ‘High Quality Care for All (2008) highlighted the importance of the entire

patient experience within the NHS, ensuring people are treated with compassion, dignity

and respect within a clean, safe and well managed environment.

High quality care should be clinically effective, safe ad be provided in a way that ensures the

patient has the best possible experience of care.

Patient experience means putting the patient and their experience at the heart of quality

improvement; by introducing patient held care plans and supportive documentation we opt

to enhance patients’ experience of our service. In order for us to measure patient

experience we currently use a patient satisfaction survey, although this format gives us

valuable feedback we have decided to amend the survey and introduce NHS Friends and

Family test (FFT) to our questionnaire

GOAL 1 – PATIENT HELD CARE PLANS AND SUPPORTIVE DOCUMENTATION


Each time we assess a new patient for domiciliary oxygen therapy and commence an oxygen

prescription the nurse discusses and shares lots of information with the patient and their

relatives/carers, this information sharing will now be supported by a patient held care plan

with individualised supportive documentation. Previously patients have given feedback

stating that we share lots of important information and in conjunction with starting a new

prescribed medication it is often daunting, therefore the patient held care plan and

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supportive documentation will allow the patients to have written information about the

topics discussed. The care plans will also be used for communication between other HCP

involved in the patients care.


We will actively seek verbal and written patient feedback and will act upon the findings.



Team meetings

GOAL 2 – FRIENDS AND FAMILY TEST (FFT)

The Friends and Family Test (FFT) is an important feedback tool that supports the

fundamental principle that people who use NHS services should have the opportunity to

provide feedback on their experience. It asks people if they would recommend the services

they have used and offers a range of responses. The FFT provides a mechanism to highlight

both good and poor patient experience. This kind of feedback is vital in transforming NHS

services and supporting patient choice.


We have adapted our current patient feedback questionnaire to include the friends and

family test. The questionnaire will be sent out with the initial assessment letter and again

handed out by the nurse at the 12 month review.


Responses will be collated and where patients’ comments identify areas where

improvements can be made, action plans will be developed and put into action.

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Patients and public via website

Governance committee

Commissioning CCGs

Team meetings

PRIORITY THREE: CLINICAL EFFECTIVENESS

Clinical effectiveness is an essential component of the Clinical Governance agenda to

improve and assure quality. As with all aspects of Clinical Governance, clinical effectiveness

is about improving patients’ total experience of their healthcare and involves a framework

of informing, changing and monitoring practice.

Clinical effectiveness is about doing the right thing at the right time for the right patient and

is concerned with demonstrating improvements in quality and performance: -

the right thing (evidence based practice requires that decisions about health care are

based on the best available, current, valid and reliable evidence) –

in the right way (developing a workforce that is skilled and competent to deliver the

care required) –

at the right time (accessible services providing treatment at the point of need) –

in the right place (location of treatment / services) –

with the right outcome (clinical effectiveness / maximising health gain)

Clinical effectiveness is thinking critically about what you do, questioning whether it is

having the desired result and making a change to practice if required. It is based on

evidence of what is effective in order to improve patient care and experience

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GOAL 1 – EMBED CLINICAL AUDIT PROGRAMME

Clinical audit is a way to find out if healthcare is being provided in line with standards and

lets us and patients know if our service is doing well, and where there could be

improvements. Clinical Audit is a quality Improvement process that measures current

patient care and outcomes against agreed standards of best practice. In order to inform,

change and monitor our service we have developed a comprehensive clinical audit

programme.


The audit programme has been shared with our governance committee and the clinical

team, several audits are ongoing and we are introducing new audits and re audits at regular

intervals


Quarterly updates on audits progress, changes to practice following audit outcomes



Commissioning CCGs

Team meetings

GOAL 2 – EMBED THE QUALITY ASSURANCE MANAGER ROLE

In 2015/16 we enhanced our clinical and managerial team with the introduction of a new

role, Quality Assurance Manager. The creation of this post confirms the importance that we

place on the governance agenda within the organisation. The main areas of responsibility

will be the co-ordination of the organisations compliance with key areas of Clinical

Governance, such as clinical audit, patient and carer experience.

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The post holder will work with the lead nurses and clinical services manager to, establish,

coordinate and implement key processes to demonstrate assurance and monitoring of

quality standards.


Evidence and production of audit programme report and updates, review of concordance,

introduction of tools to enhance the patient experience, evidence of compliance with

agreed standards. Evidence that we meet local, national and regulation standards.



Commissioning CCGs

Team meetings

.

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Part 2(b)

Looking back – review of Quality goals and priorities

in

2015-16-17

As this is ALHC’s first quality account we are unable to give updates on specific goals and

priorities that were set last year although we can give an update on the excellent work we

have undertaken over the past year to improve patient safety and the quality of the service

we provide.

PATIENT SAFETY

LIFE SAVING RULES, 10 MINUTE TOPICS AND SAFETY FORUM.

June 2015 saw the launch of Air Liquide Homecare enhanced safety programme;

"Life Saving Rules" are twelve rules designed to drive our safety compliance and safety

culture. We have now completed team briefings for each one.

Ten minute topics are a monthly paper/information resource shared throughout the

organisation raising awareness of such topics as smoking.

In 2015 we also introduced the National Safety Forum which is a bottom up committee with

representatives from all areas of our business bringing ideas to the table for change and

involvement of our teams. We have also started the National Safety Committee in addition

to local safety committees. This is a policy and process driving committee.

This comprehensive safety campaign raises awareness amongst the clinical staff when

attending patients’ homes and enhances the safety focus of oxygen provision and

prescribing. Among the ten minute topics we have covered areas such as infection

prevention and control and safeguarding.

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PATIENT EXPERIENCE

PATIENT EXPERIENCE SURVEY

Previously ALHC distributed feedback surveys to all patients at every assessment. However

verbal feedback from service users highlighted that patients were often receiving feedback

surveys every three months, this process has been amended. We now have a rolling

programme patient survey where customer services and the HOSAR nurses hand out patient

feedback surveys at each initial and annual assessment. The feedback is discussed and

shared at team, governance and service review meetings, action plans and lessons learned

are developed, shared and reviewed accordingly.

CLINICAL EFFECTIVENESS

REVIEW OF GUIDELINES

In June 2015 The British Thoracic Society (BTS) published updated guidance on home oxygen

management; this guidance provides detailed evidence-based guidance for the use of home

oxygen for patients out of hospital. It explores the evidence base for the use of different

modalities of oxygen therapy and patient related outcomes such as mortality, symptoms

and quality of life. The guideline also makes recommendations for assessment and follow-up

protocols, and risk assessments, particularly in the clinically challenging area of home

oxygen users who smoke. The home oxygen guideline provides expert consensus opinion in

areas where clinical evidence is lacking, and seeks to deliver improved prescribing practice,

leading to improved compliance and improved patient outcomes, with consequent

increased value to the health service. We reviewed the new guidance, recommendation and

good practice points, to ensure our service is still aligned and shared new recommendations

with the CCG’s and our governance committee.

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Part 2 (c)

REVIEW OF SERVICES

During 2015/2016/17ALHC provided HOSAR services for over 4000 patients covering 8 CCGs

– 7 North East CCGs (Darlington , Durham Dales, Easington and Sedgefield, Gateshead,

North Durham, South Tees , South Tyneside, Sunderland) and 1 North West CCG

(Trafford). In total 8153 assessments were completed during this period.

CLINICAL AUDIT

Although we did not participate in any national audits in 2015/16/17we are committed to

delivering an effective and coordinated clinical audit programme covering all of the clinical

services we provide, our programme is regularly reviewed to ensure it reflects the needs of

our clinical services. Clinical audit is a key quality improvement tool within ALHC to

continually monitor and improve the quality of care provided to patients. We know that

high quality clinical audit enhances the care and safety and provides assurance of

continuous quality improvement. It also contributes towards the wider quality, safety,

assurance and governance frameworks that are in place across the organisation.

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Title of Clinical Audit Aims and Objectives

BTS Guidelines To gain assurance that the HOSAR are providing a service in line with BTSGuidelines

NICE Quality StandardCOPD

To gain assurance that the HOSAR are compliant with Quality Standards setfor COPD

HAND HYGIENE To identify effective hand preparation and hand decontamination of all staffwithin HOSAR to minimise the risk of transmission of infection.

CLEANLINESS To ensure the HOSAR provide and maintain a clean and appropriateenvironment in managed premises that facilitates the prevention and controlof infections

CQUIN To evidence compliance and achievement of CQUIN targets

Clinic To gain assurance that clinical areas comply with Health and Safety

Uniform To ensure that HOSAR staff comply with the uniform policy, and adhere toinfection control and health and safety requirements.

Letter Audit To provide assurance that the HOSAR correspondence is accurate and clinicaldecision making is appropriate.

KLOE To gain assurance that the HOSAR is complaint with CQC standards

Zero concordance To review the concordance of oxygen users and gain assurance thatprescribing is appropriate

Over and Under use To review the concordance of oxygen users and gain assurance thatprescribing is appropriate

Near Miss To audit near miss reports, identifying and analyzing trends

Inhaler Technique To review inhaler technique, and reassess following intervention

Adhoc Visits To review the visit regime and gain assurance that patient safety ismaintained

Hygiene Code To determine how the HOSAR comply with the infection preventionrequirements, set out in the Health and Social Care Act 2008

Safeguarding Procedure To determine how the HOSAR is compliant against Safeguarding Policy

HOSAR Activity To review activity and gain assurance that service is efficient and effective

SBOT To review SBOT and rationalise prescriptions

Record Keeping To review nursing notes on accounts

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GOAL AGREED WITH COMMISSIONERS

USE OF THE COMMISSIONING FOR QUALITY & INNOVATION (CQUIN) FRAMEWORK

The CQUIN framework aims to embed quality improvement and innovation at the heart of

service provision by linking a proportion of providers’ income to the achievement of local

quality improvement goals. A proportion of ALHCs income for 15/16 was conditional on

achieving quality improvement and innovation goals agreed between ALHC and Clinical

Commissioning Groups through this framework.

Details of the CQUIN Goals:

TRAFFORD:

Reducing admissions in COPD patients

COPD checks and signposting

Producing quarterly quality account

In addition to the existing assessment, the HOSAR Team will include additional checks for all

COPD patients to reflect admission avoidance planning and anticipatory care planning/ co-

ordination.

Disease Awareness Check Rescue Pack Check Medication Check

Inhaler Technique Check Nebuliser Check Self Management Plan

Flu Vaccination check Changes in MRC score

This information was captured against each patient to allow for individual patient reporting

A quarterly quality account was produced using Trafford CCG template evidencing a safe

and effective service.

NORTH EAST:

Improving Inhaler Technique.

Where a patient is identified as using inhalers, ALHC will assess their inhaler technique and

provide the appropriate level of training for their particular device. Training will be provided

to the patient and/or carer where required. Where it is felt that the device prescribed is

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not suitable for the patient or where additional consumables, i.e. spacers, are required,

ALHC will make recommendations to the patients managing HCP.

This CQUIN will help to support more cost effective drug usage, improve patient outcomes

and help to manage the inappropriate usage of oxygen to manage their breathlessness.

Managing Patients who require but continue to smoke

All home oxygen patients are provided with stop smoking advice, receive full safety training

and are given safe smoking advice. This is also provided to carers and family members

where appropriate.

Where this advice is not followed patients put both themselves and others at risk.

The ongoing management of oxygen in this patient group needs to be considered and

managed to limit and where possible mitigate the risks. This may lead to the withdrawal of

oxygen.

To be successful in managing these patients a multi disciplinary approach is required. This

needs to be specific to the local organisation.

ALHC will provide patients who smoke and receive oxygen with a formalised bundle

including:

Offer stop smoking referral

Completion of home safety and safety compliance

Provision of written information

Fire Service Liaison

In addition to this ALHC will work with the individual CCGs to develop specific escalation

protocols to manage high risk patients where there are concerns regarding smoking and

oxygen.

All CQUIN were achieved for 2015/2016/17.

Page 29 of 43

STATEMENTS FROM THE CQC

ALHC is required to register with the Care Quality Commission and our current registration

is:

COMMUNITY HEALTHCARE SERVICES

Our regulated activities are;

5 - TREATMENT OF DISEASE, DISORDER AND INJURY

8 – DIAGNOSTIC AND SCREENING PROCEDURES

ALHC have not been inspected by the CQC.

MONITOR

ALHC is also required to register with Monitor, our Monitor License number is:

Licence Number: 200056

Issued 01/04/2014

DATA QUALITY

INFORMATION GOVERNANCE (IG) TOOLKIT ATTAINMENT LEVELS

Information governance means keeping information safe, this relies on good systems,

processes and monitoring. Every year ALHC is assessed by NHS Digital and the Department

of Health Information Governance Toolkit, we audit the quality of specific aspects of

information governance through this toolkit. The Assessment Report overall score for

2015/16 was 100% and was graded green (satisfactory) as level 3 had been achieved for all

relevant requirements (27 out of the maximum 29).

The Information Governance annual training was also completed with all staff in conjunction

with this toolkit.

Page 30 of 43

Part 3

OTHER INFORMATION

REVIEW OF QUALITY PERFORMANCE

In this section we will report on the quality of the services we provide, by reviewing

progress against indicators for quality improvement, and feedback from sources such as

service user and staff surveys.

STATUTORY AND MANDATORY TRAINING

It is important that our staff receive the training they need in order to carry out their roles

safely. All our clinical staff attended mandatory training, in addition to training appropriate

to their role and responsibilities, in the form of study days, informal in house training,

conferences, E-Learning packages, university courses. All staff take part in shadowing and

supervised visits.

To maintain their registration NMC registered practitioners need to be prepared for

revalidation, all nursing staff attended a study session to prepare them for this new process.

A training programme is to be developed to ensure each member of staff achieves an

agreed standard.

Page 31 of 43

STAFF SURVEY 2015

We surveyed all the clinical staff in 2015, 14 team members were in post at the time of the

survey, the feedback and overall responses were very positive. The outcome of the survey

was presented at the team meeting and also the governance meeting. A number of points

were identified, actions were developed and shared.

Air Liquide, world leader in gases for industry, health and the environment

DO YOU FEEL VALUED BY AIR LIQUIDE?

Q2 2015 East Midlands SRG7

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Yes No

2015


HOW MUCH DO YOU AGREE OR DISAGREE?


0

2

4

6

8

10

12

14

16

L&D needs Opportunity todevelop

Mandatory training Career progression

2015


HOW MUCH DO YOU AGREE OR DISAGREE

15 Q2 2015 East Midlands SRG

0

2

4

6

8

10

12

14

Opinions, ideas & viewslistened to

Transparent & open culture

2015


RECOMMEND ROLE TO A FRIEND?


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Yes No

2015


RECOMMEND AIR LIQUIDE AS AN EMPLOYER?


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Yes No

2015

KEY MESSAGES:

Positive changes to ways of

working, support and management

increased moral and feeling like a

team

ACTIONS:

Source different mandatory

training provider

Look at alternatives to the i-PAD

To adopt NHS survey – patient

safety culture/staff questionnaire

In 2016 we adopted the NHS staff survey which gave an overall positive message

Page 6 of 43

COMPLAINTS

ALHC works hard to provide high standards of clinical care delivered with dignity and

compassion, we welcome the valuable information gathered through our complaints

process, it helps us to understand what we do well and what we can improve on and is used

to direct our service improvements and ensure we provide the best possible care to our

patients and carers.

In 2015/16/17 we received three complaints; the theme of the complaints was

communication. All complaints were responded to and closed within appropriate

timescales. All lessons learned from complaints are taken back to the clinical team and

shared with the governance committee.

PATIENT SATISFACTION SURVEY

Listening to our patients is one of the most effective ways of driving improvement in our

services. By asking for their thoughts and feedback demonstrates that we are keen to make

improvements and make service users feel more involved. ALHC patient satisfaction survey

is a continuous programme, each patient receives a survey with the initial appointment

letter and again at their annual assessment. At the end of the assessment the nurse

completes section one of the survey, returns it to the patient and explains the process of

completion and return. As the survey is anonymous the patient also receives a SAE to

return the survey.

The majority of the responses are very positive, when we do receive comments or issues

about the service or staff, action plans are developed to raise awareness and to reduce the

likelihood of similar issues occurring, lessons learned are shared with the team, governance

committee and commissioners. Positive comments are also shared with the team,

governance committee and commissioners.

Page 33 of 43

We collate the number of returns we receive and develop action plans and lessons learned

from any negative comments that are received. The majority of our assessments are home

visits, and this is reflected in the number of clinic returns in comparison to home assessment

returns.

0

20

40

60

80

100

Ap

r-1

5

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

NUMBER OF RETURNS BY LOCATION BY MONTH 2015-16

Clinic Home

0

10

20

30

40

50

60

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

De

c-1

6

Jan

-17

Feb

-17

Mar

-17

NUMBER OF RETURNS BY LOCATION BY MONTH

2016-17

Clinic Home

Total number of surveysreturned 2015-17

1134

Home assessment 1025

Clinic Assessment 109

Page 34 of 43

Our patient satisfaction survey asks a number of questions about the patient experience of

our service, the assessment process and staff. Below are some of the questions and

responses.

0%

20%

40%

60%

80%

100%

Ap

r-1

5

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

TAKING EVERYTHING INTO CONSIDERATION, ARE YOU

HAPPY WITH THE SERVICE YOU RECEIVE?2015-16

No Yes

0%

20%

40%

60%

80%

100%

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

De

c-1

6

Jan

-17

Feb

-17

Mar

-17

TAKING EVERYTHING INTO CONSIDERATION, ARE

YOU HAPPY WITH THE SERVICE YOU RECEIVED?2016-17

No Yes

Are you happy with theservice received?

1065

Yes 1063

No 2

Page 35 of 43

0%

20%

40%

60%

80%

100%

Ap

r-1

5

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

DID THE NURSE DISCUSS THE REASON AND PURPOSE OF THE

ASSESSMENT 2015-16

No Yes

0%

20%

40%

60%

80%

100%

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

De

c-1

6

Jan

-17

Feb

-17

Mar

-17

DID THE NURSE DISCUSS THE REASON AND

PURPOSE OF THE ASSESSMENT

2016-17

No Yes

Discuss the reason andpurpose of theassessment

1129

Yes 1125

No 4

Page 36 of 43

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

100%

Ap

r-1

5

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

DID THE NURSE TREAT YOU IN A COURTEOUS AND

RESPECTFUL MANNER

2015-16

No Yes

0%

20%

40%

60%

80%

100%

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

De

c-1

6

Jan

-17

Feb

-17

Mar

-17

DID THE NURSE TREAT YOU IN A COURTEOUS AND

RESPECTFUL MANNER

2016-17

No Yes

Treat you in a courteousand respectful manner

1136

Yes 1136

No

Page 37 of 43

0%

20%

40%

60%

80%

100%

Ap

r-1

5

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

THE HELPFULNESS OF CUSTOMER SERVICES

2015-16

1 2 3 4 5

0%

20%

40%

60%

80%

100%

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

De

c-1

6

Jan

-17

Feb

-17

Mar

-17

THE HELPFULNESS OF CUSTOMER SERVICES

2016-17

1 2 3 4 5

The helpfulness of staff

1 0

2 1

3 4

4 47

5 941

5 Excellent-----1 Very Poor

Page 38 of 43

0%

20%

40%

60%

80%

100%

Ap

r-1

5

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

29 27 43 66 40 30 49 48 38 36 40 58

THE ACTION TAKEN IN RESPONSE TO YOUR CALL TO

CUSTOMER SERVICES 2015-16

1 2 3 4 5

0%

20%

40%

60%

80%

100%

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

De

c-1

6

Jan

-17

Feb

-17

Mar

-17

THE ACTION TAKEN IN REPONSE TO YOUR CALL

TO CUSTOMER SERVICES

2016-17

1 2 3 4 5

The action taken in response toyour call

1 0

2 0

3 6

4 47

5 789

5 Excellent-----1 Very Poor

Page 39 of 43

Ap

r-1

5

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

HOW LONG DID IT TAKE TO TRAVEL TO CLINIC

2015-16

Less than 30 mins 30 mins to 1 hour Longer than 1 hour

0%

20%

40%

60%

80%

100%

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

De

c-1

6

Jan

-17

Feb

-17

Mar

-17

HOW LONG DID IT TAKE TO TRAVEL TO CLINIC

2016-17

Less than 30 mins 30 mins to 1 hour Longer than 1 hour

How long did it take to travelto clinic

less than 30 minutes 63

30 minutes to 1 hour 38

Longer than 1 hour 2

Page 40 of 43

0

2

4

6

8

10

12

14

Ap

r-1

5

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

De

c-1

5

Jan

-16

Feb

-16

Mar

-16

WERE YOU SEEN LATER THAN YOUR APPOINTMENT?2015-16

No Yes

0

1

2

3

4

5

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

De

c-1

6

Jan

-17

Feb

-17

Mar

-17

WERE YOU SEEN LATER THAN YOUR

APPOINTMENT? 2016-17

No Yes

Were you seen later thanyour appointment

No 91

Yes 7

Page 41 of 43

Some of the comments from our patient surveys:

We review the outcome and findings of the surveys and although we receive predominantly

positive comments on a couple of occasion’s patients have not been totally happy with our

service which is reflected in a few of the tables. Although the format of our current

questionnaire asks patients to give details about their responses; very little qualitative

feedback is received, we have therefore amended our questionnaire to encourage patients

to elaborate on their responses and added in the NHS Friends and Family test which is one

of our quality priorities for 2017/18.

Page 42 of 43

Thank you for taking the time to read our Quality Account for 2015/16/17

We welcome your feedback on this Quality Account and any suggestions you

may have for future reports.

Please contact us as indicated below

Air Liquide Homecare Ltd

Alpha House

Wassage Way

Hampton Lovett

Droitwich

WR9 0NX

Tel: 08000223445

Documents

Air Liquide (Homecare) Ltd Quality Account 2015/16/17