Quality account 2010/11Executive Summary

you and your care

2 Dr Adnan Hafeez Adult Psychiatrist

Everything we do is based on personal safe and effective interventions.

3

Welcome to the Executive Summary of Bradford District Care Trust’s Quality Account for 2010/11.

Our Quality Account for 2010/11 sets out our commitment to ongoing improvement in the quality of services that we deliver. The Quality Account is a public document that we publish annually to assure our commissioners, service users, carers and the wider community of our developments in striving for quality in all that we do.

Following the guidelines produced by the Department of Health our full Quality Account is very detailed. Therefore, the Trust Board wanted to produce a summary to make its contents as accessible as possible. A copy of the full document is available at www.bdct.nhs.uk/news-publications/quality-accounts/

Last year was a particularly busy one in which we feel we made big steps towards improving and assuring quality of services for service users and carers.

We have continued to put in place the values of the organisation which reflect the ongoing commitment of the Trust Board and our staff to make sure that quality is central to our strategies and improvement plans.

these values are:

• Respect

• Openness

• Improvement

• Excellence

• Together

We are committed to increasing quality through improving the safety and effectiveness of our services. Working with service users and carers we have developed and approved the following quality statement:

Everything we do is based on personal, safe and effective interventions.

We know that the key to making sure quality is improved, is to put service users and their carers central to the decisions we make. We have worked hard throughout the year to increase the involvement of service users, carers and the community in our work and strategic decision making. This is leading to real involvement within service development and audit, the impact of which will be evident over years to come.

Bradford District Care Trust, as a specialist health and social care trust, has been serving people (of all age ranges) with mental health problems and adults with a learning disability across Bradford, Airedale and Craven since April 2002. On 1 April 2011 most of NHS Bradford and Airedale’s community health services transferred to the Trust as part of the national transforming community services initiative. As a result, we have grown considerably with increasing opportunities for strengthening care pathways and improving outcomes for local people. In 2011/12 we will work to make sure our processes for quality, and those indicators which reflect the quality of our care, will accommodate the enlarged Trust.

Foreword by chair and chief ExecutiveQuality Account 2010/11

Barry Seal Chair

Simon large Chief Executive

Throughout the year we have worked hard to make continuous improvements in the quality of our services.

During 2010/11 the Trust reviewed all available data relating to service delivery. In response, a number of service improvements have been achieved in the last year, these are as follows:

Review of Quality PerformanceQuality Account 2010/11

4

Older People’s Mental Health Services Older People’s Mental Health Services have been successful in securing £600,000 new investment to enhance community services together with acute and care home liaison and a limited programme of memory assessment and treatment services.

Adult Mental Health Services There has been a slight reduction in the number of admissions to in-patient care for adults as greater focus is placed on care ‘closer to home’. This will continue to be a priority throughout 2011/12 as work continues in this area.

Child & Adolescent Mental Health Services (CAMHS) Child and Adolescent Mental Health Services have had an award winning year. They have also extended their ‘U Can B Heard’ young people’s engagement group and developed a commissioner supported business case for an eating disorders service.

Substance Misuse Services Substance Misuse Services have been working to achieve common service provision on a district-wide basis whilst developing ideas for local programmes. These include the acute hospital based alcohol care team in Bradford, and the Airedale antenatal service in partnership with the third sector.

Low Secure Services The service’s approach to achieving ‘25 hours of meaningful activity’ for every service user every week, has been showcased at regional level.

Learning Disability Services Within the health care part of learning disability services, the health facilitation service and community matrons have worked closely with other health providers (GPs and hospitals) to make sure clients receive a well-rounded package of care.

Leadership Development Exciting Futures is a leadership development programme which supports the further development of leadership potential. It links staff with service users and carers in the delivery of a range of community and service improvement projects. Cohort II are about to complete and this programme will be extended to include colleagues recently joining our Trust from community services. This programme is for all staff with leadership potential.

Quality Improvement – ProcessesIn addition to the services improvements already identified there have been a number of improvements to the supportive processes we operate to ensure quality services.

During 2010/11 a programme of quality and safety walkabouts were put in place for Board members. Executive and Non-Executive members of the Board were paired together and set out on a series of walkabouts in service delivery areas. This makes sure that Board members are informed, first hand, regarding the quality and safety concerns of staff. It also demonstrates a visible commitment to listening and supporting staff when quality and safety issues are raised. These walkabouts are also instrumental in reinforcing our open reporting culture.

Indicators of QualityThe Quality Account guidance requires Trusts to identify at least three quality indicators for each of the quality domains of safety, effectiveness and patient experience. We also chose to include indicators for quality measures from a workforce perspective, as we think this is key in delivering quality care.

Along with our stakeholders we have selected 17 indicators to report on, to demonstrate how we are doing in relation to the quality of services. The following table lists those indicators and the performance recorded over the last three years. We have summarised the rationale for selection of these individual indicators. A more comprehensive account is provided in the full Quality Account. The table also shows the national benchmark (or measures) that we are working towards, where one was available.

5

Table 1

Quality Domain &Associated Indicators

Reason for Selection

Performance10/11 09/10 08/09 Benchmark

SaFEty

Proportion of all in-patients who have experienced physicalaggression (Defined as assault)

The Trust has been commended for its recording and analysis of incidents. We continue to be committed to this and have selected to monitor our performance in addressing incidents of assault in in-patient services.

Moderate16

Moderate9

Moderate8

No nationalbenchmark

Major1

Major3

Major1

No nationalbenchmark

Catastrophic0

Catastrophic0

Catastrophic0

No nationalbenchmark

% Purposes of any new medications explained (Community SurveyQuality Health Report)

It is vitally important that service users have the purposes of any new medications explained to them so that it can be used safely. We and our stakeholders also feel that it is a good measure of service user involvement in their own care.

94% 73% 71% 93%

6

Quality Domain &Associated Indicators

Reason for Selection

Performance10/11 09/10 08/09 Benchmark

EFFEctiVEnESS

Adults in settled accommodation(Learning Disabilities)

Throughout the stakeholder engagement process it was stressed that employment and housing access was a key indicator of well-being and should be included as a measure of care outcome.

80.8% 80.8% 86.5% 73.2%

Proportion of adults on CareProgramme Approach receiving secondary mental health services in settled accommodation

50.5% 25.2% 50.3%

Proportion of adults on Care Programme Approach receiving secondary mental health services in employment

7.3% 2.8% 5.0%

Number of service users readmitted to in-patient care within 28 day period

Readmission was also identified as a key measure of effectiveness of care throughout the stakeholder engagement process and it was agreed that this would be an important measure of quality.

7.9% 10.9% 11.9%

Number of admissions to acute wards that were gate kept by Crisis Resolution / Intensive Home Treatment teams

The Crisis Resolution and Home Treatment Teams were seen by stakeholders as an important stage in the care pathway and we feel that access to this support should be monitored.

98.1% 92.6% 90.0%

PatiEnt EXPERiEncE

% Patients given enough time to discuss their condition and treatment (score from Community Survey Quality Health report)

Service users feeling involved and informed in all aspects of their carewas a high priority for qualityidentified through our stakeholder events.

94% (Annual Result)

64%(Annual Result)

73% 93%

% Definitely have enough say in decisions about care and treatment (overall rating – Community Survey Quality Health report)

Indicator no longer collected in same manner

as part of questionnaire

47%(Annual Result)

42% 43%

% Patients treated with respect and dignity (from Community Survey Quality Health report)

The Trust aims to be a leader in equality, diversity and human rights and therefore the work in theprivacy and dignity action plan needs to be monitored as part of ourquality work.

98% (Annual Result)

84%(Annual Result)

87.5% 97%

% Have the number of someone from local mental health services to phone out of hours (CommunitySurvey Quality Health report)

To maximise service user access to out of hours support throughredesigns and developments in our services. We have included this indicator so that we can monitor the progress of this work.

51% (Annual Result)

42%(Annual Result)

48% 50%

7

Quality Domain &Associated Indicators

Reason for Selection

Performance10/11 09/10 08/09 Benchmark

WoRKFoRcE

The extent to which the Trust values my work (NHS Staff Survey)

During 2009 the Trust developed a new set of values, a set of leadership competencies and a training programme to further develop our workforce. Although not required within the quality account, our stakeholders agreed these indicators will help to measure the impact of these and other developments.

42% (Annual Result)

39%(Annual Result)

38% 36%

My immediate manager helps me to find a good work life balance (NHS Staff Survey)

62% (Annual Result)

64%(Annual Result)

66% 62%

Staff believing the Trust provides equal opportunities for career progression or promotion (NHS Staff Survey)

93% (Annual Result)

90%(Annual Result)

82% 89%

% of staff with up-to-datemandatory training – Fire Training

It was viewed by our stakeholders that it is integral to the quality of our services that our workforce is up-to-date with training.

80.4% 75.6% 45.6%no national

target /benchmark

% of staff with up-to-datemandatory training – OtherMandatory Training

77.2% (31 March 2011)

61.2%(31 March 2010)

27.2%no national

target /benchmark

% of staff with an in-date appraisal

Appraisal is a key mechanism for engaging with staff and although the Trust is above the national average in carrying out these, we and our stakeholders feel the effective delivery of staff appraisal contributes to overall quality of services.

82.8% (31 March 2011)

92.1%(31 March 2010)

80.5%

70% (2008 National

average for Mental Health /

Learning Disability Trusts)

8

The Quality Account guidance asks that we pick a minimum of three improvement priorities to work on in the forthcoming year.

Alongside our stakeholders, the Trust Board, in agreeing its annual plan for 2011/12, has selected a number of improvement priorities over the next financial year. These reflect the three domains of quality: effectiveness, patient safety and patient experience and are:

• Improving the physical health care support for people within our learning disability, adults and older people’s mental health services.

• Reducing and addressing the cause of some safety related incidents.

• Increasing the effective use of risk assessments as part of the care planning process within community mental health services.

• Improving support to carers.

• Improving the collection and use of equalities data so that we can better plan services to meet the needs of our diverse population.

Further details in relation to these improvement indicators, the current performance and agreed improvement targets are shown in the table on page nine. The rationale for selection, key improvement initiatives and methods for monitoring progress are outlined in the full Quality Account.

Priorities for improvement 2011/12Quality Account 2010/11

9

Table 2

Improvement Indicator

Current Performance as at 31/3/2011

Performance as at 31/3/2010

Agreed ImprovementTarget

EFFEctiVEnESSPhysical Health Checks within Learning Disabilities, Adults and Older People’s Services

Number of learning disability clients in residential, respite and nursing home beds with a Health Action Plan

85% 70% 100%

% of clients that receive physical health checks in Adult and Older People’s wards 95% 80% 100%

SaFEtyReducing and addressing the number of safety related incidents

Level of Slips, Trips and Falls Trust wide (All incidents involving patients)

1010 1122 Reduction of 10%

Number of reported incidents where service users detained under the Mental Health Act are absent without leave (Trust wide)

50 64 Reduction of 10%

Increase the effective use of risk assessments as part of the Care Planning Process within Community Services

Incidence of documented Risk Assessment within Community Services 96.6% 60% 100%

PatiEnt EXPERiEncE Improve support of carers

% of carers offered a carers assessment n.b. Low Secure Services are not included 35.4% 30% 63%

Improve the collection and use of equalities data

% of service user record with completed religion / belief

71.5% unavailable 100%

% of service user record with a completed record of a person’s disability Note: this has previously been recorded with narrow disability categories

1.0% 1.5 %

The improvement target is to ensure

comprehensive data collection facility in

place within RiO

% of service user record with a completed ethnic group. Note: ‘completed ethnic group’ is a record with a valid entry. Empty field, ‘not known’ and ‘not stated’ are invalid and so are not counted within this %

96.1% 93.3% 100%

10

We undertake a full programme of audit on clinical and social care performance which is reported to the Trust Board via the Service Governance Committee.

We are committed to this programme as we believe that it enables clinicians, managers, service users, carers, the community and commissioners to understand how we are delivering high quality care in line with recommended standards. It also provides data to enable quality improvements to be made where there are quality gaps.

the trust audit programme includes the following:

• National audits

• Commissioning for Quality and Innovation (CQUIN) audits

• Commissioner requested audits

• Local audits

Our Audit Department along with our Involvement Team are working together to continue to support and develop effective service user and carer involvement in audit activity.

Clinical Research

We believe that research is a key driver for improving quality care. Over the past 18 months, we have substantially progressed our research strategy, launched during 2009. The aim of the strategy is to develop our ability and reputation to deliver excellent applied health research that has the potential to improve the health and well-being of the population served by the Trust.

Data Quality

We are committed to making sure that the data we are using to measure our performance is accurate and used comprehensively across the Trust. Improving our data quality remains key in order to effectively monitor and report on our performance.

Registration Status

We are required to register with the Care Quality Commission and our current registration status is fully registered.

Additionally we are required to register against a set of requirements on infection control and health care acquired infection. The Trust was registered ‘without conditions’ (the best possible outcome) and has continued to further develop the systems in place during 2010/11.

Statements from our Partners

As part of the assurance system for the Quality Account we are required to ask our Local Involvement Networks, Overview and Scrutiny Committees and Primary Care Trust to make a comment on our Quality Account. We are delighted to receive supportive comments from these organisations as to the content of our Quality Account. Their full comments can be found within the Quality Account.

Moving Forward

We are delighted to publish our Quality Account for 2010/11 as this provides a platform for us to celebrate the areas the organisation has excelled at whilst recognising the areas requiring improvement.

On June 27 2011 the Trust held another stakeholder event, incorporating the community health services which have transferred into the organisation on 1 April 2011. The purpose of the workshop was to reflect on progress made during 2010/11 and start to identify possible areas and indicators for improvement during 2012/13. Indicators for our community services will be identified and included in the Quality Account for 2011/12. The existing indicators for mental health and learning disability services will remain for 2011/12 as they form part of our long-term delivery plan.

The full Quality Account can be downloaded from www.bdct.nhs.uk/news-publications/quality-accounts/

Participation in clinical auditsQuality Account 2010/11

11Rachel Priestley PA

throughout the year we have worked hard to make continuous improvements in the quality of our services.

you and your care

to ‘like’ our facebook page, search: Bradford District Care Trust

Follow us on twitter for the latest news: @Bradford_DCT

Bradford District care trust Trust Headquarters New Mill Victoria Road Saltaire Shipley BD18 3LD

tel: 01274 228300 Web: www.bdct.nhs.uk Email: communications@bdct.nhs.uk

translation information:

Publ

ishe

d: S

ept

2011

Rev

iew

Dat

e: S

ept

2012

Pin

: 002

79v1