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Quality Account 2009/10

Quality Account 2009/10€¦ · This is Kent and Medway NHS and Social Care Partnership Trust’s first Quality Account. From 1 April 2010 it is a legal requirement to produce this

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Page 1: Quality Account 2009/10€¦ · This is Kent and Medway NHS and Social Care Partnership Trust’s first Quality Account. From 1 April 2010 it is a legal requirement to produce this

Quality Account 2009/10

Page 2: Quality Account 2009/10€¦ · This is Kent and Medway NHS and Social Care Partnership Trust’s first Quality Account. From 1 April 2010 it is a legal requirement to produce this

Quality Account 2009/10 2 3 Quality Account 2009/10

ContentsIntroduction 3 Statement from the Chief Executive 4

Section one Priorities for Quality Improvement 5Patient experience 7Patient safety 9Clinical effectiveness 11

Section two Review of quality performance 13The way forward 14NHS number code validity 15Research and development 17Goals agreed with commissioners 18

Section three Quality improvement initiatives 19Patient experience 20Patient safety 21Statements from other organisations 22Appendices 24

Introduction to KMPT’s first Quality Account This is Kent and Medway NHS and Social Care Partnership Trust’s first Quality Account. From1 April 2010 it is a legal requirement to produce this. The document aims to ensure that quality has the same importance as that of the financial account, but wholly focuses on the quality of services and treatment.

We hope that by publishing an annual quality account it will assist the public, service users and others to understand:• What the organisation has done well

• Where improvements in service quality are still required

• What the Trust’s priorities for improvements are for the coming year 2010/2011 and what we aim to achieve

• How service users, staff and others with an interests in the organisation have been involved in determining these priorities.

The preparation of the account involved consultation, discussion and the use of a survey with the Patient Consultative Committee, the Chaplaincy service, shadow governors, public and staff from across the Trust at all levels and from all disciplines.

The process for hearing people’s viewsWe had a number of formal and informal information gathering activities. These include:

• Information from the National Patient Survey

• Themes from the Patient Advice and Liaison Service

• Complaints, concerns, comments and compliments

• Staff and Trust Board members

• The Shadow Board of Governors.

Service users and carers helped the Trust Board to choose its quality improvement priorities for 2010-2011 by responding to a questionnaire asking them to rate and comment on a list of quality issues. This was cascaded through the Patient Consultative Committee who consulted and fed back issues from their networks. Information was sent to all parts of the organisation through the clinical governance groups. This was supported by presentations and briefings and, in turn, responses were received. Finally, non statutory organisations were consulted for their views and priorities eg Rethink, the carers’ support groups and informal day care services across the whole of Kent.

The quality account is predominantly for members of the public, service users and staff and aims to demonstrate the activity around quality for the last 12 months and to show our objectives for the coming year.

• The account is formed of three sections

• Section one details our current priorities for improvement in 2010-2011

• Section two is a review of our quality performance which underpins and sets the scene for the final part

• Section three reports on our first qualiy account which ran from 2009-2010.

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Statement from the Chief Executive

It is a pleasure to present our first Quality Account, which outlines our achievements this year through the hard work and commitment of our staff. Our vision is to promote positive mental health and well being while providing value for money services that are free from stigma. Our commitment to social inclusion has led us to be chosen to participate in ‘Communities of Influence’ a National Social Inclusion Programme. The project empowers Foundation Trust Governors to provide stronger links between the Trust and the local community.

As a Trust committed to preventing harm we report incidents to the National Reporting and Learning Scheme, and have recently implemented Datix, a system that will effectively give our staff relevant information about incidents so that they can learn the lessons from them.

Led by our Executive Medical Director, we have implemented a Quality Strategy, which includes the development of a dedicated Quality Improvement Team. In order to improve patient experience our real time surveys ensure that we can respond to our patients and constantly improve our service delivery.

Our journey to Foundation Trust status is progressing. This will bring new opportunities to offer quality services, which are steered by our local community.

While we will have a lot of hard work ahead, we are starting from a firm base, as an innovative organisation grounded in sound business approaches. Our values reflect an accessible, proactive and responsive organisation, which listens and learns from the contributions of its service users, their carers, staff and organisational partners. With this in mind I look forward to welcoming increased contributions from our local communities, partners, members and governors, as we continue our pledge to improving quality.

This report looks at the progress we have made on some of our priorities throughout the year and the information contained within this document is to the best of my knowledge an accurate reflection of the quality of services provided by Kent and Medway NHS and Social Care Partnership Trust.

Erville MillarChief Executive

Section one

Priorities for Quality Improvement 2010-2011

This section starts with the Trust Board objectives which demonstrate the link between the detail of the objectives and the overall direction of the organisation.

The nine priorities for improvement are divided into the three areas that constitute quality, the patient experience, patient safety and clinical effectiveness. Each area has three issues to focus upon for improvement.

Each priority describes the reason for the choice, where the Trust is currently positioned, the way that the priority is measured and the means of monitoring progress.

Appendix A details the Quality Improvement choices that our stakeholders were consulted upon to decide priorities; the Trust Board ratified the priorities for 2010-2011 as set out in this account. There was complete agreement with our stakeholders views.

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Strategic contextThe quality account is fully aligned with the Trust Board Objectives and Annual Operating Plan, to ensure the right issues are selected at the right time. The Trust Board objectives are detailed in the table below.

1. Achieve excellence in integrated health and social care

• Developservicesofthehighestquality

• Implementnationalandlocallyagreedstandards

• Provideservicessensitiveandresponsivetothediversityofthelocalpopulation

2. Attract, retain and develop an effective, flexible and highly skilled workforce

• Beregardedasan‘employerofchoice’,recruiting,developingandretainingthebestindividuals

3. Develop and maintain user, carer and public involvement

• Meettheequalityanddiversityneedsofawiderpatientandpublicgroup

4. Develop and maintain a modern infrastructure

• Implementcapitalstrategytosupportthedevelopmentofclinicalservices

• ImplementITstrategytosupportthemodernisationofclinicalandnonclinicalservices

• Implementhealthinformaticsstrategy

5. Maintain financial viability and business excellence

• AchieveFoundationTruststatus

• Improveuserexperiencewhilemeetingnationaltargetsandachievingfinancialsurplus

• Improveefficiencyandeffectiveness

• Beproviderandpartnerofchoiceforusersandpurchasers

6. Achieve governance excellence • Involveserviceusers,staffandthepublicinkeydecisionmaking

• Ensurestronginternalassurancearrangements

• Ensurestronggovernancearrangementsforhostedservices

7. Become a responsible corporate citizen

• Embracesustainabledevelopmentandtacklehealthinequalitiesthroughdaytodaycorporateactivities

The priorities for improvement for the coming year are listed under the three dimensions of quality: the patient experience, patient safety and clinical effectiveness.

A) Patient Experience1) To reduce the number of inpatients detained under the Mental Health Act, who abscond from our wardsRationaleTo ensure vulnerable service users are cared for in a place of safety.

Current statusThe total percentage of in-patients who absconded during the year 2009-20010 was:

• Quarter 1 = 5% (of total number of detained patients)

• Quarter 2 = 4%

• Quarter 3 = 4%

• Quarter 4 = 6%

Plans• The Trust is introducing a form that sets out the leave status for service users while

being compulsorily detained. The clinical team works with the service user to agree the right course of action

• The Trust is undertaking a review of Psychiatric Intensive Care Services to assess whether service users are being cared for in the most appropriate environment

• A new observation policy has been agreed and is being rolled out to teams.

How measuredThe number of detained service users who abscond is reported quarterly to the PCT.

How monitoredThe Director of Operations scrutinises numbers as part of her performance monitoring.

2) Analyse complaints data to demonstrate which issues cause service users to complainRationaleThe Trust actively seeks feedback about its services and complaints are a key source of information. Until this year there had been no systematic process for recording complaints that lends itself to consistent analysis. Addressing complaints raises confidence, the Trust learns from negative experiences and is committed to change.

Current statusUntil the implementation of DATIX in March 2010 there has been no systematic shared data collection.

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Plans• A quarterly analysis of trends and themes in complaints has commenced

• Results will be fed back into the Trust wide Learning From Experience Group

• Where necessary Trust wide action plans will be developed to resolve issues.

How measuredQuarterly trends are reported to the Patient Experience Group.

How monitoredDATIX is now being used for data collection.

3) Decrease the number of incidences of patients experiencing mixed sex accommodationRationaleNational and local drivers are in place to care for service users in gender specific accommodation, this objective links to the Trust’s work on dignity and respect.

Current statusThe measures we report against are as follows for the year 2009-2010:

• Number of service users experiencing mixed sex accommodation = 0

• Number of instances of service users having to use mixed sex bathrooms = 2

• Number of mixed sex wards without women-only lounges = 0

PlansAny areas where breaches occur complete a self-assessment tool and develop a local action plan.

How measuredMonthly reporting of breaches through the Quality Performance Indicators.

How monitoredThe work is monitored through the Trust Acute Care Forum and rating on Quality Performance Indicators.

B) Patient Safety1) Prevention of in-patient suicide

RationaleReduction of suicides is a national and local target and the Trust works to ensure its wards are safe, that service users are clinically assessed and risk assessed effectively.

Current statusThere was one in-patient suicide on our wards in 2009-10.

Plans• Clinical risk assessment training

• Health and Safety Audits of ligature points

• Ensure the organisation learns from incidents and that these are processed by the Trust’s learning from experience group

• The National Patient Safety Agency has a list of ‘never events’. These are incidents that should not happen as they are preventable. One of these relates to inpatient suicide by suspension from non-collapsible rails, the Trust is rigorous in its assessment of such risks.

How measuredThe number of near misses and incidents are reported monthly to the Board. Incidents of in-patient suicides are recorded on a National Data Base called STEIS and are reportable to the Commissioning Primary Care Trust and the Strategic Health Authority.

How monitored• Through Suicide Prevention group

• Reports and monitoring by commissioning PCT through quality monitoring process.

2) Prevent incidences of cross infection and outbreaks

RationaleThe Trust is committed to reducing the risk of Hospital acquired infection; hand hygiene, methods of cleaning and diligent screening are part of its drive to keep patients safe and well.

Current statusFor 2009-2010 there was one instance of clostridium difficile and one of methycillin resistant staphyloccus aureus (MRSA).

Plans• To improve the numbers attending relevant training and updating according to the Trust policy

• To achieve compliance with the Hygiene Code which the Board certifies annually.

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How measuredNumbers of incidences and outbreaks are reported monthly to the Board.

How monitoredThe work is monitored through the Infection Prevention and Control group.

3) Increase the number of assessments of patients at high risk of falls

RationaleTo prevent harm and injury to service users by reducing the numbers of slips, trips and falls.

Current statusThe Trust receives on average 72 reports a month from the older people’s in-patient mental health services.

Plans• Identify triggers from collated incidents and reduce risk

• Continue with the awareness Campaign with posters and communication warning of risks and hazards

• Falls potential risk assessment training

• Once risk identified a falls care plan is implemented for that service user.

How measuredA reduction in the monthly numbers of slips, trips and falls.Quarterly audit of case notes to ensure a care plan follows a risk assessment.

How monitoredQuarterly by the Patient Safety Group.

C) Clinical Effectiveness

1) All service users to receive Health of the Nation Outcome Scores on a bi-annual basis

RationaleClinical coding helps the Trust to give an understanding to its service users and staff on the expected outcomes of our interventions.

Current statusThe target is that all service users on new Care Programme Approach, will have had one rating by the end of 2011. Training for all staff is complete.

PlansTo develop an action plan to ensure implementation and electronic recording is undertaken.

How measuredThe compliance will be measured quarterly electronically.

How monitoredThis will be managed through clinicians’ performance management framework, and promoted as needed with individuals and groups. Its progress is monitored through the Executive Management Team.

2) To improve implementation of National Institute of Clinical Excellence (NICE) guidance for people with mental illness

RationaleThe Trust is committed to providing the most effective interventions for service users enabling choice and access to the best possible care.

Current statusAll clinicians receive new guidance, but the Trust needs to be able to demonstrate that the guidance is implemented.

PlansReview the Trust process for monitoring implementation by NICE reference group.Review clinical governance terms of reference and processes.

How measuredBy clinical audit.

How monitoredTargeted use of clinical audit.

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3) Enable GPs to access advice about client management from a mental health professional within 24 hours

RationaleThis is a response to an expressed need for expert advice to support primary care teams to deliver care for the commonest mental health problems and to enable the team to know when, who and how to refer.

Current statusThere is no agreed Trust wide standard for this service.

Plans• To agree a standard

• Map out how the service will operate

• Develop a communication cascade to support this initiative.

How measuredMonitoring of issues and themes.

How monitoredEvaluate the intervention with GPs at year end, this is an existing CQUIN.

Section two

Review of Quality PerformanceThis section of the account covers aspects of our quality review that we are required to report on in the accounts.

During 2009-2010 the Trust provided 11 contracted NHS services. There is one principle contract for the provision of mental health (including specialist) services, Child and Adolescent Mental Health Services (CAMHS) and specialist learning disabilities. This is a block contract with the Primary Care trusts (PCTs) in East Kent, West Kent and Medway. There are also contracts with Kent County Council and other NHS organisations. The resources are allocated across geographical directorates for mental health and service directorates for the other services, each director being responsible for managing the directorate’s budget.

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The way forward

The Trust is moving from divisions determined by geographical boundary to Service Line Directorates which focus upon specific aspects of care delivery these are:

• Older adult services in the community and in-patient areas and a range of specialist services including Child and Adolescent Mental Health services

• Acute Services, including the provision of Psychiatric Intensive Care, and crisis teams

• Community Recovery Services, including first response, enablement and coordination services, rehabilitation of service users as inpatients, community and in residential care

• Medium secure services including prison tertiary mental health and forensic psychological services.

The Trust is responding to its resource challenge at this time of change and restructure to ensure that resources are focussed to produce better care, and to refine working practice to ensure best value for money is provided.

Appendix D details our year end outcomes for quality performance indicators agreed with NHS Medway, who commission our services.

Social inclusion

Part of our quality initiative involved developing partnerships. The Trust has committed to many social inclusion projects.

Mind the Gap – is an art project going into its third year, each year has a different theme 2010/11 is ‘A Box of Dreams’; service users and carers from across Kent & Medway are provided with cardboard boxes and encouraged by professional artists to produce works of art supporting the theme. The project also holds a ‘Big Sing’ event in collaboration with Christchurch University as part of the Canterbury Festival and during the next year will hold several art exhibitions at venues across Kent & Medway.

Charlton Athletic Football Club – are working with the Early Intervention in Psychosis Teams to provide activity programmes for the young service users with mental health problems. The current group of young people also have the opportunity to become involved in volunteering at the London 2012 Olympics.

Time to Change – The Trust has been involved with the National Time to Change project funded by Comic Relief and the Big Lottery, the aim of the project is to challenge and shift the stigma surrounding mental health issues. KMPT in conjunction with Unison arranged a Time to Change Roadshow in Maidstone in 2009 and is holding a wellbeing event in September 2010 promoting physical exercise.

Webb’s Garden – This is a project based in Canterbury in an old walled garden, it is run in partnership with the Friends for Mental Health (East Kent), Chaucer Homecare, KCA, Porchlight and Skillnet supported by Kent and Medway Partnership Trust, the service users grow vegetables and flowers while learning new skills and enjoying a social experience in lovely surroundings.

The Buddy Scheme – Health and social care students and other trainees on practice placement within KMPT, have a service user mentor, known as a Buddy, in addition to a professional mentor, with whom they work in an equal partnership, utilising a range of educational resources developed by service users comprising a training package of DVD, training manual, CD Rom and live website with Blog at www.thebuddyscheme.co.uk (includes DVD clip).

By participating in the Buddy Scheme, service users have been concurrently enabled to move forward in their recovery, as they find meaningful occupation and valued, paid employment, influencing service development and improvement.

The scheme is an innovative method of practice education enabling health and social care students and other trainees to access service users’ personal knowledge and use this as an educational tool to develop a greater understanding of mental illness and related issues from a service user’s perspective. In partnership with education, the Buddy Scheme is validated by the Nursing and Midwifery Council and has been integrated into the curriculum for mental health nursing students, junior Doctors and GP trainees.

The work was promoted as an intervention in the recovery of users of secondary mental health services, in a range of settings, with an evidenced, resultant reduction in care packages with cost benefit to KMPT (featured in The Human Factor www.guardianpublic.co.uk 5/11/09).

The Buddy Scheme is evidenced by a service evaluation completed by a team of service users and providers, educationalists and students in two mental health service settings, community and rehabilitation inpatient units, over five years.

Awards won by the Buddy Scheme include: National Endowment for Science, Technology and the Arts (NESTA) grant of £40,000 to produce the training package and DVD and up scale the Buddy Scheme nationally, Community Care Award 2005 (Mental Health), Medway Council Excellence and Innovation Award 2006, Kent and Medway “Team Mentor of the Year Award in 2006.

A service user who mentors midwifery and paediatric nursing students, was joint runner up in the Lilly Outstanding Achievement in Mental Health Awards 2006 – “An inspiration to others”.

Registration with the Care Quality Commission (CQC)

Kent & Medway NHS and Social Care Partnership Trust is required to register with the Care Quality Commission against the Hygiene Code and its current registration status is registered without conditions.The Care Quality Commission has not taken enforcement action against Kent and Medway NHS and Social Care Partnership Trust during April 2009/March 2010.

NHS number code validityData quality

KMPT submitted records during 2009-2010 for inclusion in the hospital episode statistics which are included in the latest published data. The Trust records which included the patient’s valid NHS number was 97.9% for admitted patient care and 99.8% for out patient care.

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Information Governance toolkit attainment levels

Information Governance Toolkit attainment levels for the Trust for information Quality and Records Management, assessed using the information Governance toolkit was 79%.

Clinical coding

The Trust was not subject to the payment by results clinical coding audit during 2009-2010 by the Audit Commission. However, audit of clinical coding has been undertaken. The comprehensive case notes were found to be in good order; everything was neatly filed in chronological order. The discharge summaries were an accurate source of information, thus aiding the coding process. The audit examined 165 episodes. Of the 165 episodes audited, there were a total of 165 primary diagnoses present, and 159 (96%) of these were correct. A total of 386 secondary diagnoses were recorded, of which 306 (79%) were correct. There were 65 instances where relevant co-morbidities were not coded even though they were documented in the case notes.

Review of services

During 2009/10 the Kent and Medway NHS and Social Care Partnership Trust provided Adult mental health services, mental health services for older people, child and adolescent health services, learning disability services, addiction services, community brain injury team, disablement services centre, early intervention and psychosis, forensic mental health, eating disorder services, healthcare resolutions, Kent clinical neuropsychology, Kent and Medway Chronic Fatigue - myalgic encephalopothy, mother and infant mental health, personality disorders, and West Kent neuro-rehab, there are no sub-contracted services for Kent and Medway NHS and Social Care Partnership Trust for 2009/10. During 2009/10 the Trust provided 11 NHS services. The income generated by the NHS services reviewed in 2009/10 represents 92.7 per cent of the total income generated from the provision of NHS services by the Trust.

Participation in clinical audits

During 2009-2010 three national clinical audits and one national confidential enquiry covered NHS Services the Trust provides.

During that period the Trust participated in 100% of all national clinical audits and 100% of national confidential enquiries in which it was eligible to take part. The results are displayed as Appendix B Table 1.

The national clinical audits and national confidential enquires the Trust participated in, and for which data collection was completed during 2009-2010 are listed in Appendix B table 2, 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.

The reports of five national clinical audits were reviewed by the Trust in 2009-2010.The reports of 51 local clinical audits and service evaluation projects were reviewed by the Trust in 2009-2010.

Learning points and the actions taken as a result of the Trust taking part in national clinical audits, local clinical audits and service evaluation projects can be found in the Trust Annual Clinical Audit and Effectiveness Report 2009-2010 at www.kmpt.nhs.uk

Research and Development (R&D)

176 patients who were receiving NHS services provided or sub-contracted by Kent and Medway NHS and Social Care Partnership Trust in 2009/2010 were recruited during the period to take part in research approved by a research ethics committee.

Historically, there has been both limited R&D and infrastructure to support this activity in the Trust. To grow R&D in the Trust from this low base, a three year strategy was approved by the board in January 2009. A key objective of the strategy was to grow National Institute for Health Research (NIHR) portfolio activity in line with Department of Health policy objectives as outlined in “Best Research for Best Health”. Following approval of the strategy, R&D in terms of studies approved, has significantly increased. Between 2008 and 2009 NIHR portfolio studies approved have increased by 100% and overall research activity, in terms of study approval, has increased by 46%. The Trust has also demonstrated a positive commitment to service-user involvement in R&D. In particular a service user / carer sub-group, reporting directly to the R&D group, has been formed and meets regularly. This group was shortlisted for a Trust award.

Research is a key driver for improving the quality of care and staff employed by the Trust are increasingly involved in submitting grant applications both as Principal and Chief Investigators. In the period 2009/2010 – five grant applications were submitted to NIHR funding streams of which three were short listed. This increasing, and continuing, level of participation in clinical research demonstrates the commitment of the Trust to improving the quality of care and contributing to general health improvements.

Praise and complaints

A summary report regarding service user, carer & public contacts with Patient Advice and Liaison Service (PALS), together with any common themes, follow up actions and implications regarding service improvement are collated on a quarterly basis. These are available from the PALS department. Compliments received to date within KMPT were 586 and the number of formal complaints received in 2009/10 was 184.

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Workforce and leadership developmentEngaging with staff working together

We are committed to measuring and improving staff engagement. The results of the national staff survey 2008/2009 were published in 2009. Overall the results show an improvement on the 2007 results, however there is still significant room for improvement.

Key areas for work are appraisal, staff satisfaction and understanding of how individual roles fit in with the wider Trust. There is determination on the part of Trust management in partnership with the Staff Side committee (Joint Negotiating Forum) to deliver improved performance in these areas next year. The Trust recognises that it needs to place high emphasis on leadership and management development and is developing on Organisational Development Strategy to focus on these areas.

The Trust has commissioned quarterly ‘Pulse’ surveys which provide locality based feedback and gives every staff member an opportunity to provide feedback over the year. Effective communication is vital in delivering high quality services. Employees systematically receive copies of the bi-monthly staff newsletter, Partnership Matters, a monthly staff briefing and also have access to the Trust’s website and intranet.

The topics covered are wide and varied including news, best clinical practice, finance information and performance data. We encourage feedback and provide a route for concerns to be aired. Road shows for staff are run on key topics, such as the Trust’s move to Foundation Trust status and all staff are encouraged to contact the Chief Executive directly via email or phone. In 2009/10 the Trust held its second Staff Excellence Awards to recognise and celebrate the work of Trust staff. A series of staff involvement events were also held.

Goals agreed with commissionersUse of the CQUIN payment framework

A proportion of the Trust’s income in 2009-2010 was conditional on achieving quality improvement and innovation goals agreed between the Trust and any person or body they entered into a contract, agreement or arrangement with for the provision of NHS services, through the Commissioning for Quality and Innovation (CQUIN) payment framework.

Further details of the agreed goals for 2009-2010 and for the following 12 month period are available on our website www.kmpt.nhs.uk where further information can be obtained.The CQUIN payment framework aims to support the cultural shift towards making quality the organising principle of NHS services, by embedding quality at the heart of discussions between NHS Medway, our commissioning primary care trust, and ourselves. This has ensured that local quality improvement priorities and progress in achieving them were discussed and agreed at board level and through quarterly quality assurance meetings between the Trust, primary care trust and strategic health authority throughout the year.

The CQUIN framework made part of KMPT’s income dependent on locally agreed quality and innovation goals (0.5% on top of actual outturn value in 2009/10). The use of the CQUIN framework indicates that KMPT has been actively engaged in quality improvements with commissioners. The CQUIN goals for 2009-2010 are in Appendix C.

Section threeQuality Improvement Initiatives

for 2009-2010This section reports on our improvement initiatives for the previous year, again the report is divided into the three sections that determine quality: the patient experience, patient safety and clinical effectiveness.

As this was our first year with the quality account we focused upon just four priorities.

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1) Patient experience

A) Engaging with our service users and carers

What we did• We have begun a series of real time surveys capturing our service users and their carers views

• We attended a variety of community events in order to engage with as many people as possible, at the Kent Show in July we had a dialogue with many people over the three days of the event

• In 2009 the Trust participated in the first national survey of mental health inpatient units. Of the 758 surveys, 216 were returned with a response rate for the Trust of 29%. The report compares the Trusts results with those of other trusts, and then compares the survey with the finding of those in NHS hospitals.

The Trust’s scores in comparison to other mental health trusts:• About the ward, were about the same or less positive

• On hospital staff the results were generally less positive

• On care and treatment scores were generally the same

• For service users rights the scores were mixed

• For leaving hospital were the same or less positive.

These scores indicate this Trust has considerable work to give its patients an experience comparable with the best in the country.

Service users and carers helped the Trust Board to choose its Quality Improvement Priorities for 2010-2011 by responding to a questionnaire asking them to rate and comment on a list of quality issues. This was cascaded through the Patient Consultative Committee who then consulted with their networks and fed back issues.

Information secondly was sent to all parts of the organisation, through the Clinical Governance Groups. This was supported by presentations and briefings and responses were received. Finally, non-statutory organisations were consulted for their view and priorities eg: Rethink, the Carers Support Groups, informal day Care Services across the whole of Kent.

2) Patient Safety

A) Reducing infection

This objective is being taken forward into this year’s work.

What we did• The Trust has an infection control team who focussed upon surveillance and rapid

identification of potential outbreaks, as previously mentioned just 2 incidences of reportable infection occurred, we were quick to isolate the problem and to explore and share lessons learned from these

• A methycillin resistant staphyloccus aureus screening tool was implemented to ensure the Trust is not reporting MRSA that originated elsewhere

• There was a major initiative to raise awareness of hand washing, with both training posters, and the availability of gel

• Cleaning procedures are regularly reviewed

• During the year 87% of clinical staff and 51% of non clinical staff were trained in hand washing procedure

• The Trust Board receives regular reports on matters around prevention and control of infection.

B) Reducing injury through falls

Again this objective is carrying forward into this years quality account.

What we did• A poster campaign raised awareness of slips, trips and falls

• We achieved our target that 70% of adults admitted to our services who are at risk of falls in our older people’s wards are risk assessed within seven days of admission.

3) Clinical effectivenessA) Measuring outcomes

Again, this objective is carrying forward into this year’s quality account.

What we did• All our clinicians are now trained in the use of this electronic system. We began using Health of

the Nation Score (HONOS) in October 2009

• By 31 March 2010, 52% of our service users on enhanced CPA had at least one rating, our target for the whole year was 60%

• The Quality Performance indicator for next year is 60%.

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Statements provided from commissioning PCTs, LINks or OSCs

The Trust’s draft quality account was sent to the above groups for comment. In addition a copy was sent to the chair of the Joint negotiating forum for comment. The full range of their comments will be available on our website.

The Kent County Council Health Overview and Scrutiny Committee is not going to comment on any NHS Quality Accounts for 2009-2010.

Statement from Medway Primary Care Trust

NHS Medway can positively verify quality figures in the accounts for example in relation to Quality Indicators and performance targets. NHS Medway has no reason to believe that other information within the Quality Accounts is not accurate.

In subsequent years it would be useful for the Trust to include performance against Commissioning for Quality and Innovations targets.

NHS Medway has worked closely with the Kent and Medway NHS and Social Care Partnership Trust (KMPT) throughout the year to ensure and improve the levels of quality in the services provided. The Trust was highlighted nationally in year as being a Mental Health Trust with high levels of patient deaths, however, after internal review by the trust and assurance by NHS Medway it was confirmed that KMPT’s outlier status was as a result of not following national criteria for reporting rather than as a result of high numbers of patients safety related deaths.

The Trust has developed action plans designed to improve quality in year in response to perceived areas for improvement. These have included the number of locum and acting consultants and the redesign and establishment of new services. Action plan completion has been monitored by KMPT and NHS Medway.

With regard to Serious Untoward Incident investigation, management and closure, KMPT has demonstrated progress in the year.

NHS Medway is aware that, in common with other providers, KMPT has been subject to significant time constraints in producing these accounts in the launch year. We are looking forward to working closely with the Trust in developing the accounts for subsequent years.

Statement from the Kent LINk

The Kent LINk would like to thank Kent and Medway NHS and Social Care Partnership Trust for the opportunity to comment on its Quality Account for 2009 / 10. This comment will focus on the extent to which the LINk believes that the account achieves the following:

1. Aiding the public’s understanding of what the Trust is doing well2. Outlining improvements made throughout the year3. Selecting priorities for improvement for the coming year4. How the Trust has involved service users, staff and others in determining those priorities for improvement.

The LINk has assembled information from a range of sources to inform its commentary using qualitative and quantitative data and academic input from a local university.

1. Aiding public understandingThe document is generally well written but there are examples of unexplained abbreviations and jargon (such as PCC and PCCI). The acronym KMPT is used inconsistently and terms such as Never Event are not universally understood. The visual presentation of the document could have been improved, for example by including individual stories in the section on social inclusion projects established by the Trust to demonstrate good quality patient experience.

2. Improvements madeIndicators such as reducing infections and reducing injury through falls seem to reflect national rather than local priorities. The inclusion of baseline information would demonstrate improvement more clearly. The target for conducting a falls risk assessment on 70% of new admissions to older people’s wards within a week is quoted as having been achieved, but is not supported by figures. The presentation of the Trust’s scores for the National Survey of Mental Health Inpatient Units is unhelpful, without additional data.

Most participants in the LINk’s focus groups and interviews were unfamiliar with the Health of the Nation outcome scales. The account outlines the Trust’s intentions to allow service users access to these but how this will be done is unclear.

The focus groups and interviews undertaken by the LINk strongly indicated that service users and carers do not feel that they are being listened to. Although it is commendable that the Trust has begun the process of real time surveys, it is disappointing that the response rate was so low. Alternative methods of gaining input may be required to extend the range of service users and carers responding.

Priorities for improvement for 2010/11Priorities for improvement have been identified, but are missing targets to enable future progress to be monitored.

Who has been involved in preparation of the Quality AccountThe Trust has used input from service users and carers (among others) to establish its future priorities. However, the questionnaire appears to have been devised by health professionals and as such would not be easily accessible to most respondents.

The priorities may have looked very different if service users and carers had been able to report in their own words, as reflected by our focus groups and interviews. Further information from the survey would demonstrate the number of service users and carers involved.

The LINk recognises that limited time has been available to put the accounts together for this year and hopes to support the Trust with the process in the future.

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Quality Account 2009/10 24 25 Quality Account 2009/10

Appendix A

The quality improvement initiatives stakeholders

were asked to prioritise

Quality Priorities for 2010/11 Yes No Comments

Patient Experience

Ensure completion of quarterly survey of patient experience by services. Ensure that action plans are developed and shared with service user groups

Actively participate in South East Coast Enhancing Quality Programme - Dementia pathway development

Work with relevant staff to Improve service user involvement in care planning process.

People with Learning Disabilities - Develop and implement an agreed action plan to make reasonable adjustments in mainstream MH services to aid understanding for people with a learning disability

To reduce/monitor the proportion of detained acute inpatients who have absconded in last three months

Demonstrate clearly how carer’s support has increased and in which areas

Decrease the number of mixed-sex wards without women only lounges

Decrease/monitor number of incidences of patients experiencing mixed sex accommodation

Analyse complaints – to show numbers reported and trends identified

Conduct a trust-wide audit to determine by ethnic group - Actual Length of Stay, rates of detention, use of seclusion

Ensure that all Care Plan reviews take place twice a year with service user and carers (Care Programme Approach)

Quality Priorities for 2010/11 Yes No Comments

Reduce stigma and discrimination of mental ill health across Kent and Medway

Produce evidence to show that more service users with severe mental health problems are being helped to find settled accommodation

Patient Safety

Improve Patient safety on inpatient units

Improve Infection Control

Eradicate occurrence of “Never Event” In-patient suicide - using non-collapsible rails,

Increase the number of assessments of Patients at high risk of Falls

Increase the number of patients admitted who have a physical health check (by wellbeing nurse or physical assessment) at admission

Deliver improvements in the physical health of those with severe mental health problems

e.g. could include actions on smoking cessation

Widen the learning from analysis of Serious Untoward Incidents, claims & complaints

Clinical Effectiveness/Outcomes

All patients to receive Health of the Nation Outcome scores (HoNOS) on a bi-annual basis or more frequently if required to aid with their recovery pathway

Enable GPs to access advice about client management from a Mental Health professional within 24hrs

Improving the implementation of National Institute of health and clinical evidence (NICE) guidance for patients with mental health problems

Provide evidence of more service users with severe mental health problems being supported to find or stay in work

Quality Priorities for 2010/2011 Yes No Comments

Staff Working

Reduce the incidents of violence against MH Staff (inpatient and community) resulting in physical assault

Demonstrate Improvements in staff working environment

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Quality Account 2009/10 26 27 Quality Account 2009/10

Appendix B Table 1

The national clinical audits and national confidential enquiries that Kent and Medway NHS and Social Care Partnership Trust took part in during 2009-2010 are as follows:

Topic Number of casesPOMH: prescribing topics in mental health services 100%Quality network for forensic mental health services 100%Quality improvement network for multi-agency CAMHS (QIMAC) 100%Quality network for inpatient child and adolescent MH services (QNIC) 100%National confidential enquiry into suicide and homicide by people withmental illness 98.64%

Appendix CCQUIN programme agreed with NHS Medway 2009-2010

Commissioning for Quality and Innovation (CQUIN)

CQUIN Bonus Freq of report

1. Developing Payment By Results (PBR) currencies

1.1 Progress reports 4% x 1/12 bi-monthly

1.2 Set up project team 4% May June

1.3 Presentation of financial information by service line

4% year end bi-monthly

1.4 Presentation of activity grouped into relevant number of Clusters or care packages

4% year end bi-monthly

1.5 Presentation of ‘pilot’ areas - Costs and Care Packages

4% year end bi-monthly

2. Routine evaluation of patient experience

2.1 Two service user-led evaluations of specific services per quarter

5% year end qtly

2.2 Devise, agree and implement a continuous process for monitoring patient satisfaction, by survey

5% year end qtly

3. Improving mental health service access and support for people from BME groups and People with Learning Disabilities (PLD)

3.1 Provide data on ethnicity of service users - inpatients and outpatients (data split by Primary Care Trust – PCT)

1.25% per quarter

qtly

3.2 Audit to determine by ethnic group – Actual Length Of Stay (ALOS), rates of detention, use of seclusion - twice yearly (in Sept and March) - data split by PCT

2.5% per audit

six monthly

3.3 PLD - record and monitor the number of service users with LD who access mainstream health services - quarterly report

1.875% per report

qtly

3.4 PLD - Develop and implement an agreed action plan to make reasonable adjustments in mainstream Mental Health services for people with a learning disability

7.5% when complete

qtly

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Quality Account 2009/10 28 29 Quality Account 2009/10

4. Improving outcomes for people with severe mental illness and substance misuse problems

4.1 Publish quarterly data on number and % of clinical staff trained in all areas in screening and case finding for use of alcohol and drugs (quarters two, three and four)

2.5% per quarter

Qtly

4.2 Publish quarterly data from quarter two on number and percentage of service users assessed

2.5% year end

Q The CQUIN goals for 2009-2010 are outlined below.

4.3 By end quarter two provider and substance misuse services to have developed jointly agreed working protocols for parallel or integrated treatment of people with dual diagnosis

5% end Q2 end Q2

4.4 Mental Health Joint Strategic Needs Assessment (JSNA) refresh 2010 to include the coexistent severe mental illness and substance misuse problems for people on Care Programme Approach (CPA)

5% when complete

end year

5. Routine access to mental health services

5.1 Deliver a four week response for GP referrals for all age groups - 90% target. Monthly exception report

25% x 1/12 (for each month on target)

monthly

Appendix DYear end quality performance indicators agreed with NHS Medway

Quality Performance Indicators Freq of Report 09/10 Plan Year end Comments

CORE - Psychological Therapies (% clients) - Primary Care

Qtrly 90% 96%

CORE - Psychological Therapies (% clients) - Secondary Care

Qtrly 60% 72%

Mental Health Minimum Data Set - submitted on time

Qtrly 100% yes

Mental Health Minimum Data Set - degree of completion

Qtrly 100% 97%

Clostridium difficile - actuals Monthly 1 1

MRSA Bacteraemia - actuals Monthly 0 1

Audits of Hand Hygiene (All Inpatient sites listed)

Annually 100% 100%

Hand Hygiene Training - All staff

Qtrly 75% 78% Target changed mid year to include all staff

Hand Hygiene Training - Clinical Qtrly 95% 87%

Nutrition - % of nutritional as-sessments completed (based on audit of 10 sets of notes from two wards per month) - OPMH - Incremental Target

Qtrly 50%;60% Qtr 3, 80% Qtr 4

88%

Falls - OPMH inpatients - As-sessments of risk within one week of admission to service

Qtrly 70% 70%

Falls - OPMH in CMHTs- Actuals reported

Qtrly Actuals 15

Falls - OPMH inpatients - Actuals

Qtrly Actuals 867

Observations (of physical health) - % of on time, fully completed and correct patient observations - OPMH

Qtrly 70% rising to 80% Qtr4

93%

All clients on CPA (community or inpatient) have had a physical health checks in last 12 months (MH08)

Qtrly 80% of en-hanced

30% Awaiting IT solution as information is not available on Trust server

Enhanced clients in receipt of advance directives

Qtrly Actuals 420

Number of SUIs - reported on STEIS, trends, ethnicity & actual

Monthly Actuals 27 British white 1 Other white 1 Ethnic group 1 not known

Number of patient safety incident related deaths reported to NPSA

Qtrly Actuals 3

Adult Protection / Safeguarding - % of all staff trained

Qtrly 70% 78%

Standards for Better Health - Self assessment updates (October & March))

6M √ yes

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Quality Account 2009/10 30 31 Quality Account 2009/10

Quality Performance Indicators Freq of report 09/10 Plan Year end Comments

Percentage of acute inpatients (all age) experiencing one or more incidents of control and restraining (MH02) - Quarterly reported

Qtrly Set a target based on Q1 outturn

0.57%

Percentage of acute inpatients (all age) experiencing one or more incidents of seclusion (MH03) - excludes forensics

Qtrly Set a target based on Q1 outturn

11%

Number of all patients who had recorded incidents: physical assault on the patient (MH10)

Qtrly Actuals 817

The proportion of detained acute inpatients who have absconded in last three months (MH14)

Qtrly Set a target based on Q1 outturn

4.79%

Number of mixed-sex wards without women only lounges

Monthly Nil by end March 2010

0

Number of incidences of patients experiencing mixed sex accommodation

Monthly Nil 0

Number of instances of patients having to use mixed sex bathrooms

Monthly Nil 2 Two breaches affecting 15 patients Investigation in progress

Participation in antipsychotic (Prescribing Observatory for Mental Health) POMH - UK audits (MH16) TBA

TBA Yes Yes

Complaints - number - report trends & actual

Qtrly Actuals 184

Complaints - ratio to contacts - report actual

Qtrly Actuals 0.08%

Turnover - report actual & trends

Monthly Actuals 2.72%

Staff Sickness - report actual & trends

Monthly Actuals 4.77%

Number of (non-medical) Agency Staff utilised - actual

Monthly Actuals WTE 269

Number of (non-medical) Agency Staff utilised - non PASA - actual

Monthly Actuals WTE 172

Violence against MH Staff (inpa-tient) assaults (MH11) - actual

Qtrly Actuals 1173

Violence against MH Staff (com-munity) assaults (MH11) - actual

Qtrly Actuals 11

Medications - HCC patient survey questions % increase - report actual & trends

Annually At least 20% improvement on 2008/09

52% Comparison not possible as last year’s survey was in the community and this year on in patient units

The proportion of all clients on new Care Programme Approach who have had a HoNOS assess-ment in last 12 months (MH07)

Qtrly 60% 52%

Patient involvement in decisions about their own care (as reported by patient) (MH09)

Annually 95% 47% Highest score across all trusts were 64%

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Your views

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Tel: 01732 520441e-mail [email protected]

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