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Title of Meeting Trust Board Date 29th March 2018

Title of Paper: Integrated Quality and Performance Report

Author: Phil Lawrence – Director of Contracting, Performance & Information

Presenter: Sheila Stenson – Executive Director of Finance

Executive Director:

Sheila Stenson – Executive Director of Finance

Purpose: the paper is for: Delete as applicable

Consideration: A report containing a positional statement relating to the delivery of the Trust’s functions for which the Board has a corporate responsibility but is not explicitly required to make a decision

Recommendation:

The committee are asked to consider the contents of the report and the performance reported for the month. The areas highlighted will be progressed via the Trusts Performance Management Framework alongside the Operational and Executive scrutiny on a bi weekly basis. The Committee support is requested to assist the care groups in increasing performance where appropriate. A revised IQPR report is currently in development with a draft to be discussed during the March / April committee meetings.

Summary of Key Issues: No more than five bullet points

The Report has been provided to update the committee on the in month performance against a range of Performance Indicators outlined in the Trusts Integrated Performance Report.

The Trust achieved 6 of the 8 regulatory targets in February

Unachieved regulatory targets were:- o CPA patients receiving formal 12 month review. o CPA patients receiving follow-up within 7 days of discharge

The report details the position for all targets mentioned here.

Report History:

None – the Finance and Performance Committee is the first committee that has reviewed this report

Strategic Objectives: Select as applicable

☒ Deliver outstanding quality of care across all of our domains

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☐ Are an attractive place to work promoting employee recruitment, retention and

development

☒ Deliver and embed continuous improvement in all we do

☐ Promote and deliver an internationally based research programmes

☐ Maximise the use of digital technology to improve service access and quality

☐ Optimise our estate to deliver integrated physical and mental health services

across all communities in Kent and Medway

☐ Deliver financial balance and organisational sustainability

☐ Develop our core business and enter new markets through increased

partnership working.

Implications / Impact:

Patient Safety: The Patient safety considerations are being reviewed in line with the Trusts overall responses to the CQC queries alongside the Trusts regulatory requirements under the NHS Standard Contract.

Identified Risks and Risk Management Action: All risks are outlined within the paper below

Resource and Financial Implications: Failure to achieve some of the regulatory, performance or data quality metrics could result in a financial penalty under the NHS Standard Contract.

Legal/ Regulatory: None

Engagement and Consultation: Not applicable

Equality: None

Quality Impact Assessment Form Completed: No

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1. Executive Summary

This paper will update the Board on the Trusts performance against the Key performance indicators outlined in the Trusts Integrated Quality and Performance report (IQPR), as before the Trust will focus on the 8 regulatory targets as well as other key metrics identified. A Trust wide overview of all IQPR measures is included as an annex at the end of the report.

2. Report Summary

The reported position against the 8 regulatory targets is as follows:-

The Trust achieved six out of eight Regulatory targets in February 2018, the exceptions being CPA 12 month Reviews and CPA patients receiving follow-up within 7 days of discharge.

CPA patients receiving a follow up within 7 days of discharge, 7 patients out of a total of 118 were not followed up within the 7 day target, 6 within the community care group and 1 within forensics. The reasons will be discussed with both teams at the forthcoming performance meetings; compliance by CMHT team is illustrated below.

Ref. Measure Target Feb-18 Jan-18 MovementTrend

(Last 12 months where available, left to right)

Previous

Forecast

Next Month

Forecast

1 Regulatory Targets

1.1 CPA patients receiving follow-up within 7 days of discharge 95% 94.0% 93.9%

1.2 CPA patients receiving formal 12 month Review 95% 93.5% 93.0%

1.3 Delayed Transfers of Care 7.5% 6.6% 7.0%

1.4 Admissions to Inpatient Services had Access to CRHTs 95% 100.0% 100.0%

1.5 Meeting commitment to serve new psychosis' cases by EIS 1 95% 125.3% 124.1%

1.6 MHMDS Data Completeness: Identifiers 97% 99.7% 99.7%

1.7 MHMDS Data Completeness: Outcomes for Patients on CPA 50% 80.8% 77.7%

1.8 EIP Waiting Time Proxy (Referral to Care Coordinator in 2 Weeks) 50% 93.7% 81.2%

%Not

followed up

Successfully

followed up

Total CPA

discharges

CMHT 96.15% 78

Ashford Community Mental Health Team 100.00% 0 5 5

Canterbury & Coastal Community MHT 100.00% 0 2 2

DGS Community Mental Health Team 100.00% 0 9 9

Maidstone Community Mental Health Team 100.00% 0 6 6

Medway Community Mental Health Team 92.00% 2 23 25

South Kent Coast Community MHT 100.00% 0 10 10

Swale Community Mental Health Team 75.00% 1 3 4

SWK Community Mental Health Team 100.00% 0 5 5

Thanet Community Mental Health Team 100.00% 0 12 12

Early Intervention Service 75.00% 12

East EIS 62.50% 3 5 8

Medway and West EIS 100.00% 0 4 4

Horizon 100.00% 3

Canterbury & Coastal Horizon 100.00% 0 2 2

Swale Horizon 100.00%

Grand Total 93.55% 6 87 93

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It should be noted that the measure focusses on those discharged under CPA, in February 2018 this equated to 55.3% of discharges across the Trust. As a result 96 discharges are not included in this indicator; of these 19 have no evidence on RiO of follow up at the time of report.

CPA patients receiving a formal 12 month review – 151 patients out of a total of 2,412 did not receive a formal 12 month review within the February reported position. All patients are part of the community care group and the reasons for along with plans to correct will be discussed with the team at the forthcoming performance meetings.

3. CRCG - CPA patients receiving formal 12 month review CMHT activity against this indicator currently accounts for approximately 75% of overall Trust activity. Recent performance by team is shown below:

The improvements identified in last month’s FPC report continued into February with the position by team increasing marginally, 3 teams reported meeting the target in February with six of eight teams improving their reported position when compared to January. The forecast position for demand of CPA reviews per month is illustrated below; this assumes reviews are carried out at 12 months.

2018-01 2018-02 Movement in month

Ashford Community Mental Health Team 97.37% 96.92% -0.4%

Canterbury & Coastal Community MHT 91.51% 92.45% 0.9%

DGS Community Mental Health Team 98.99% 99.50% 0.5%

Maidstone Community Mental Health Team 98.85% 94.02% -4.8%

Medway Community Mental Health Team 94.00% 93.87% -0.1%

South Kent Coast Community MHT 86.49% 87.14% 0.7%

Swale Community Mental Health Team 97.89% 98.57% 0.7%

SWK Community Mental Health Team 92.64% 94.81% 2.2%

Thanet Community Mental Health Team 84.02% 86.22% 2.2%

CMHT Total 91.92% 92.72% 0.8%

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The reduction in the number of patients requiring a CPA review in the upcoming period identified in last month’s report continued in February. Progress continues to be made in reviewing the performance against this regulatory target, and the improvements seen in previous months are expected to continue into the next quarter. There has been a continued reduction in the number of patients who require a CPA review in the upcoming period, the February FPC reported 210 patients requiring a review in April, this has reduced to 174 (17% reduction) The table below illustrates the reported position between reporting periods and the reduction that has been seen. The movement down has continued which has been led by the teams systematically working through the demand over the past few weeks.

CRCG - Referral to assessment 4 week wait CMHT compliance against the 4 week wait to assessment target has maintained an improved position in the second half of 2017/18 and it is positive to note that the reduction observed in January has not continued with the February position being the highest for any month so far in 2017/18. Month on month variation within teams continues to exist despite the increased level of performance overall. The performance is improving however remain off the 95% target at 77.3% for February 2018.

October FPC November FPC January FPC February FPC March FPC

Overdue 354 515 227 138 148

Oct-17 210

Nov-17 301 121

Dec-17 158 111

Jan-18 182 138 52

Feb-18 133 104 41

Mar-18 315 219 130

Apr-18 263 210 174

May-18 205 171

Jun-18 126

Total 1,205 1,018 961 813 749

Variance -187 -57 -148 -64

% Variance -15.5% -5.6% -15.4% -7.9%

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NB: Figures presented above reflect the patients care spell wait for assessment where the first face to face contact takes place within CMHT’s, whilst a clear correlation will exist these numbers and percentages will differ from waiting times presented later in this paper which focusses on flow with CMHT’s in isolation. Summary of current status of those waiting for initial CMHT assessment The data presented below relates to the CMHT referral only and will differ to the measure within the IQPR as the IQPR measure reflects patient contacts against a care spell.

Recent month’s reports noted a reduction in the number of patients waiting for assessment / by the community teams however this has not continued in February. The total number of patients reported in October was 1,958 with January showing 1,230, the current position as of 13/03/18 has increased to 1,432. Within this there has been an increase in the number of patients waiting over 99 days or more, 150 compared to 107 in February. However this is still a significant reduction on the 386 patients that were reported within the October FPC report.

Deep Dive – 99+ days waiting review

10093

64 59

28 25 22 21 2515

150

0

20

40

60

80

100

120

140

160

29-35Days

36-42Days

43-49Days

50-56Days

57-63Days

64-70Days

71-77Days

78-84Days

85-91Days

92-98Days

99+Days

Waiting time status of those waiting more than 28 days

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Over February a deep dive took place examining every person identified in the reporting process used for IQPR as waiting over 99 days for a service. The Care Group AMD and senior administrator have reviewed the original 123 patients on the 99+ list (from data produced on 21st Feb)

Row Labels Count of Referral Team Ashford Community Mental Health Team 8 Canterbury & Coastal Community MHT 11 Maidstone Community Mental Health Team 16 Medway Community Mental Health Team 17 South Kent Coast Community MHT 26 SWK Community Mental Health Team 21 Thanet Community Mental Health Team 24 Grand Total 123

A “response” is available for 120 of these patients, a summary of which is below

category Service users

DNA 52

Difficult to engage 5

Homeless 1

Data Quality 20

Out of area IP 6

KMPT In Patient 7

Other In Patient 7

Under another service 7

Discharged since report run 1

Now being seen by CMHT 6

Other 8

Total 120

Following the review all managers were contacted and forwarded a list of actions. These are now underway and to be monitored over the next week. A second deep dive will take place at the end of March

12/03/2018

Team Dis

charg

ed

Socia

l C

are

package

Inpatie

nt

Me

d A

ppt

required/b

ooked

Conta

ct/assessm

ent

achie

ved

Appt

booked

Oth

er*

To

tal

Comments

C&C

11

11

Ashford 2 1 1

1

3 8 1 complex case, 3 hard to engage persons and contact being made (mostly on-going DNA)

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Maidstone 2

2 2

2 8 16 1 being seen by psychology, 7 for discussion in MDT/senior follow up

Medway 4

1

3 2 10 17 2 of 4 discharges not discharged off the system - 10 actively followed up following DNA

Thanet 1

3

5 15 24 14 with actions followed up by Service Manager, 1 to be discharged

SKC 2

17 7 26 Being followed up by team or under EIP seeing consultant only

SWK 3

3 2 5

5 21 6 actions not complete, 2 appointments booked. Management contacted to progress 15/03/18

Outcomes of the review: Learning from the process has been taken into the Waiting List Project.

o The DNA policy impacts significantly, it has recently been revised and will be ratified

week beginning the 19th of March. The impact will be reviewed through the Waiting List project and the Quality Committee

o Development of a monitoring dashboard – April 2018 o Development of an active review team, a team within the CMHTs who support those

waiting for treatment – May to June 2018 o Standard protocols for the CMHTs when working with people who are waiting for

services – March 2018

Waiting Times 56+ days (previously 99+ days) As noted last month significant work has been undertaken within the community care group to focus upon the waiting time position. The CMHT’s were focussing on referrals who were waiting 99 days or more for assessment the focus switched to patients waiting 56 days or more as the numbers reduced, by expanding this category the teams could continue to focus on those patients waiting longer then anticipated. For reference, as of 13th March there were 150 people waiting 99+ days, some teams have single figures numbers waiting 99+ days and therefore the movement to 56+ allows all teams to continuously improve their position.

The table above identifies that there are 1,230 patients waiting an assessment within the CMHTs, of these 286 have been waiting longer than 56 days; this is an increase of 18 patients

Total referrals open 56+

days with no linked

contact

Have an

unoutcomed

appointment

linked to referral

Have a DNA

since

referral

start

Total

waiters

% 56+

days

Ashford Community Mental Health Team 15 2 10 107 14.0%

Canterbury & Coastal Community MHT 22 1 4 136 16.2%

DGS Community Mental Health Team 12 3 7 155 7.7%

Maidstone Community Mental Health Team 34 3 14 147 23.1%

Medway Community Mental Health Team 27 11 21 152 17.8%

South Kent Coast Community MHT 90 34 51 330 27.3%

Swale Community Mental Health Team 3 1 63 4.8%

SWK Community Mental Health Team 42 7 25 177 23.7%

Thanet Community Mental Health Team 41 4 9 165 24.8%

Grand Total 286 65 142 1432 20.0%

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when compared with February’s FPC report. The number of patients waiting over 56 days who have had one or more DNA recorded continues to be significant with 142 of the 286, the DNA policy has been reviewed by the medical team and will be relaunched which will assist the review of the position and the CMHT management of this position.

Community Mental Health Teams – Caseload Overview The following table provides and overview of CMHT caseloads as at 13th March 2018:

The table identifies a reduction in the reported position of 2,545 patients previously without an allocated pathway and confirms the reduction in patients under CPA (1,321) both movements calculated from the 14th September. Caseloads by professional can only be measured when a pathway is assigned, across the CMHTs:-

There are 7,567 patients within the caseload who have an identified pathway assigned and consequently reported against a health professional/Care Coordinator as their “caseload” and included in relevant KPI’s accurately. This is a decrease from 7,826 reported in February.

Further to this there are 1,987 patients who have an open referral but no pathway (Increase from 1,697 reported in February),

o Within this figure there is a waiting list that would not be expected to have a

pathway; this figure is currently 1,156 (738 having waited less than 28 days and 418 having already breached the 28 day target). This is an increase from 991 reported in February.

The following table summaries Caseloads by WTE for all staff that WTE has successfully been identified from KMPT ESR, KCC staffing data or via manual validations. To date this exercise

TeamAshford

CMHT

Canterbury &

Coastal CMHT

DGS

CMHT

Maidstone

CMHT

Medway

CMHT

South Kent

Coast CMHT

Swale

CMHT

SWK

CMHT

Thanet

CMHT

CMHT

Total

Movement 14th September

2017 - 13th March 2018

Total Referrals 796 949 1165 1036 1266 1775 425 1066 1076 9554 -1868

With a Pathway 614 743 982 792 1083 1366 335 772 880 7567 677

CPA 209 175 406 284 469 387 205 222 495 2852 -1321

Standard 403 568 574 505 597 975 130 545 384 4681 1989

Other 2 0 2 3 17 4 0 5 1 34 9

% on CPA 34.0% 23.6% 41.3% 35.9% 43.3% 28.3% 61.2% 28.8% 56.3% 37.7% -22.9%

Without a Pathway 182 206 183 244 183 409 90 294 196 1987 -2545

Current Inpatient 2 5 2 2 3 4 2 20 7

Current CRHT Ref 5 3 5 3 2 8 1 1 4 32 1

Previously Assigned 3 10 12 5 7 2 6 9 54 -243

Waiting 28 Days No Face To Face 24 27 26 44 17 145 12 72 51 418 -557

Seen Once Face to Face 66 54 39 80 25 82 17 102 42 507 -524

2+ Face to Face 28 27 9 29 41 29 13 24 18 218 -1115

Waiting Less Than 28 Days No Face To Face 56 83 99 74 91 135 45 85 70 738 -114

Those without a pathway listed in priority order as agreed by CPFB

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has allowed the reporting of caseloads against 246 of 277 staff who have a caseload and a primary team on RiO of CMHT:

Whilst the above table summarises all staff groups and roles into a single overview it needs to be recognised that the data spans 6 staff groups and 50+ identified staff roles. As a result there is significant variation in caseload sizes and the understanding of caseload expectation across the range of staff groups and roles needs to be factored in to draw conclusions. This element is being reviewed by the Community Flows Board. Of the 246 staff analysed 104 staff are within the Nursing staff group and have an average caseload of 35.9 per WTE (increase from 39.7), within this staff group the role of CPN (n=60) has an average caseload of 41.1 per WTE (increased from 40.3), senior nurse practitioners (n=10) have seen a decrease from 44.1 to 39.0. By means of comparison against the second largest staff population social workers (n=63) have an average of 28.9 per WTE (decrease from 32.4). Summary of Referrals Starting and Ending in Month by Team

Staff

Count

CPA

Caseload

Standard

Caseload

Other

Caseload

Caseload

Total

Average

Caseload Per

WTE

Ashford Community Mental Health Team 20 212 400 0 612 22.0

Canterbury & Coastal Community MHT 21 158 565 0 723 33.9

DGS Community Mental Health Team 38 395 556 2 953 24.5

Maidstone Community Mental Health Team 26 259 475 2 736 35.1

Medway Community Mental Health Team 31 473 593 16 1082 32.7

South Kent Coast Community MHT 34 363 956 0 1319 36.3

Swale Community Mental Health Team 18 199 128 0 327 18.1

SWK Community Mental Health Team 27 214 527 1 742 26.6

Thanet Community Mental Health Team 31 455 362 0 817 23.9

Grand Total 246 2728 4562 21 7311 28.6

CMHT Referrals Starting in Month

2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 Grand Total

Ashford Community Mental Health Team 102 100 93 121 99 102 119 102 92 94 112 1136

Canterbury & Coastal Community MHT 196 225 230 197 203 194 246 253 224 259 247 2474

DGS Community Mental Health Team 194 201 245 263 233 214 254 244 194 257 235 2534

Maidstone Community Mental Health Team 146 194 181 193 199 180 214 218 198 193 186 2102

Medway Community Mental Health Team 201 339 341 326 277 315 297 320 262 292 316 3286

South Kent Coast Community MHT 197 221 229 218 218 183 221 235 191 207 209 2329

Swale Community Mental Health Team 96 144 130 135 135 115 155 153 97 114 139 1413

SWK Community Mental Health Team 147 152 167 192 156 154 182 173 128 135 146 1732

Thanet Community Mental Health Team 147 172 169 175 180 177 204 209 135 169 166 1903

Grand Total 1426 1748 1785 1820 1700 1634 1892 1907 1521 1720 1756 18909

CMHT Referrals Ending in Month

2017-04 2017-05 2017-06 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 Grand Total

Ashford Community Mental Health Team 68 97 78 101 84 97 118 167 85 117 86 1098

Canterbury & Coastal Community MHT 145 169 117 185 167 254 338 491 369 259 278 2772

DGS Community Mental Health Team 148 221 367 297 318 280 264 275 206 203 241 2820

Maidstone Community Mental Health Team 169 175 176 280 177 199 261 315 198 220 189 2359

Medway Community Mental Health Team 149 320 342 279 274 342 334 625 428 374 326 3793

South Kent Coast Community MHT 93 135 166 284 276 232 219 323 170 163 240 2301

Swale Community Mental Health Team 95 143 156 162 160 169 180 172 133 121 140 1631

SWK Community Mental Health Team 110 145 191 168 188 239 182 259 137 133 126 1878

Thanet Community Mental Health Team 186 179 181 244 196 177 183 221 170 203 199 2139

Grand Total 1163 1584 1774 2000 1840 1989 2079 2848 1896 1793 1825 20791

Data Extract : 13/03/18

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4. Regulatory Performance Targets – further areas to note

Delayed Transfers of Care (DToC)

The Trust achieved the 7.5% target for the second successive month in February 2018 at 6.6% of applicable bed days lost to delayed transfers of care. The Year to Date position is now 7.6%. The pressure continues to be felt significantly in YA acute beds and Older Persons beds with year to date positions of 11.5% and 12.2% respectively. The number of bed days lost to DToCs decreased by 16.8% in month to 786 bed days lost which is below the 12 month average. 41 patients had at least one day delayed in month in February a decrease from 51 in January.

Ongoing work with colleagues at Kent County Council aim to reduce the use of residential care services for those with a mental illness aiming to identify early delayed transfers of care in order for discharge planning to start early and placements to be identified. Within OPMH delayed transfers are predominantly due to KCC placement issues for waiting lists and housing, a monthly bed management meeting with KCC, CCG conference calls, and twice weekly multi agency delayed transfer are in place to manage the process. The breakdown of days lost in February 2018 is shown in the table below: Please note that national DToC guidance has changed which has seen a change in categories available. Changes have been made on RiO in October to ensure correct fields are used going forward.

Acute ServiceCommunity Recovery

ServiceForensic and Specialist Older Adult Grand Total

Awaiting care package in own home 38 38

Awaiting MOJ agreement/permission of pr 28 28

Awaiting nursing home placement 8 215 223

Awaiting public funding 117 85 202

Awaiting residential home placement 110 56 29 195

Housing- Awaiting supported 54 8 62

Patient/family choice (Reason not stated 17 17

Patient/family choice- Care Home With Nu 21 21

Grand Total 327 56 0 403 786

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5. Overview of Selected IQPR Quality Metrics *Full details of all IQPR Quality Metrics can be found appended to end of this

paper.

Waiting Times

An analysis of the 4 week wait for CMHT’s is contained earlier in this report; this reflects approximately 25% of all care spells undergoing their initial assessment in the month. Overall the Care Group achieved 77.6%. The Older Adult Care Group achieved 77.6% in February but it should be noted that despite the second month of reduced performance this is significantly below the year to date position of 85.4 %; the reason for the reduction will be explored and closely monitored. Known capacity issues within the Forensic and Specialist services continues to be monitored and flagged to commissioners where demand is greater than capacity. The Acute service line continued to achieve close to 100% for all assessments, this would be expected due to the emergency nature of such presentations and assessments.

Ref. Measure Target Feb-18 Jan-18 MovementTrend

(Last 12 months where available, left to right)

3 Quality

3.1 Referral to assessment within 4 weeks 95% 84.4% 78.4%

3.2 18 Weeks referral to treatment 95% 90.6% 89.0%

3.3 % of patients with valid CPA care plan or plan of care 95% 86.5% 78.0%

3.4 Crisis Plans (all patients) 95% 90.3% 87.6%

3.34 Care Plans Distributed to Service User 75% 51.6% 55.6%

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6. Quality and safety Reporting: Patient Friends and Family Test – up to February 2018

The graph (left) shows the overall recommend / not recommend response on the Patient Friends and Family Test to the question “How likely are you to recommend our ward / service to friends and family if they needed similar care of treatment?”

During February 95% of patients recommended our wards and services,

an increase from January when 91% recommended.

Between March and October, the Likely to recommend percentage has

been above the regional average. In November KMPT was 92% and

regionally it was also 92%. December – February it has been above.

The Older Adult Care Group and the Forensic & Specialist Care Group had the highest Recommend % during February with 97% recommending their service; Community & Recovery Care Group - 93%; Recommend Acute Care Group - 89%

Extremely likely

Likely Neither

/ or Extremely unlikely

Unlikely Don't know

Mar-17 311 90 6 6 5 3 421

Apr-17 345 241 20 18 13 7 644

May-17 454 158 24 6 3 4 649

Jun-17 447 132 24 7 8 5 623

Jul-17 474 116 21 10 7 6 634

Aug-17 447 157 25 12 12 17 670

Sep-17 415 144 23 8 7 8 605

Oct-17 418 154 29 11 8 15 635

Nov-17 324 89 14 10 5 8 450

Dec-17 249 59 7 8 2 14 339

Jan-18 403 142 13 8 1 36 603

Feb-18 414 181 19 8 3 7 632

87% 95%

91% 94% 93% 93% 90% 93% 90% 92% 90% 91% 95%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Friends and Family Test Likely to Recommend / Not Recommend %

% Recommend

%NotRecommend

RegionalBenchmark (Jan& Feb not yetavailable)

249

59

7 8 2

403

142

13 8 1

414

181

19 8 3 0

50

100

150

200

250

300

350

400

450

Extremely Likely to RecommendLikely to RecommendNeither likely or unlikelyExtremely unlikely to RecommendUnlikely

Breakdown of Responses by Recommendation Choices December , January & February 2018

Dec-17

Jan-18

Feb-18

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PFFT Trust Response Rate - The response rate was above the regional and national averages for April-October.

Response rate December November

National 2.65 3.23

Regional 1.99 3.65

KMPT 2.94 3.28

National and regional response rates for January and February are not yet available. Care Group Response Rate - The graphs show the responses from September to February by each Care Group (left) and Care Group response counts since June 2017 (below). The OACG had the highest response rate during January with 243 of the 603 responses. The OACG had the highest response rate during February with 248 of the 632 responses.

The OACG have been proactive for example Sevenoaks created a “PREM Feedback Station” in their reception area; Freepost envelopes are made readily available in OA teams.

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PALS & Complaints PALS & Complaints In East Kent Coleman House and Ash Eton (SKC) saw the highest level of contacts followed by Laurel House/Kings Road (Canterbury & Coastal) and then the Beacon. The number of reportable complaints appears steady in comparison to previous years rising with the trend seen nationally. The top sub subject remains lack of care/treatment/support (157) followed by access to service (63) and lack/poor information to patients (38). Having analysed the report the

findings for the top subject for both PALS and Complaints are varied and cover the following themes:

Appointments such as wrong location or time and appointments being cancelled without much notice.

Access to service/refused referrals.

Lack of support by care coordinator or and the general feeling of being let down by services

Concerns and confusion over discharge such as being discharged without knowledge or due to DNA circumstances.

Waiting times for access to services such as Psychological Services

The senior leadership have already put in place a support and improvement plan to urgently address patient safety and patient experience concerns,; this is being monitored through a strategic CMHT action plan led by the Chief Operating Officer and supported by the Executive Team Additional support is also being provided to the teams by PALS & Complaints to assist in resolving concerns/complaints within agreed timeframes. . 148 compliments were logged in reporting period, which again is an increase on previous reports. The compliments are evenly reported across the care groups (Acute 28, CRCG 38, Forensic 22, Specialist 33, Older Adults 26 and corporate 1) and display good practice and compassion shown by our staff to patients and their families. National Reporting and Learning Systems (NRLS) All KMPT attributable patient safety incidents are reported to the NRLS. Below are two line graphs that represent our low and high level incidents that have been reported to the NRLS in the last 13 months. Level 4 &5 incidents are considered as Serious Incidents and majority relate to unexpected deaths

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Below is a line graph demonstrating the number of reported incidents by Care group, to indicate that besides consistent reporting of incident categories, that there are consistent rates of reporting by Care Groups.

0

50

100

150

200

250

Feb

20

17

Mar

20

17

Ap

r 2

01

7

May

20

17

Jun

20

17

Jul 2

01

7

Au

g 2

01

7

Sep

20

17

Oct

20

17

No

v 2

01

7

De

c 2

01

7

Jan

20

18

Feb

20

18

Number of Patient Safety Incidents Reported to the NRLS (Level 1-3)

Level 1

Level 2

Level 3

02468

1012

Feb

20

17

Mar

20

17

Ap

r 2

01

7

May

20

17

Jun

20

17

Jul 2

01

7

Au

g 2

01

7

Sep

20

17

Oct

20

17

No

v 2

01

7

De

c 2

01

7

Jan

20

18

Feb

20

18

Number of Patient Safety Incidents Reported to the NRLS (Level 4&5)

Level 4

Level 5

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Serious Incidents The line graph below details how many serious incidents have been declared and closed (not the same incidents) by month for the last 13 months. It is encouraging to see that every month we are closing serious incidents. The CCG’s from the North and west are now attending a joint meeting at KMPT premises and we have the ability to attend this meeting, along with the person who wrote each report. This enables the flow of information to be much quicker as the correct persons are ready to address the issues raised. We have already had two of these meetings, and already there are changes due to take place. The use of conference calls has been considered for the next meeting have been discussed,

383 387

431 418

407 388

413 402

429

351 375

315 299

90

121 115 90

153

123 102

127 102

144 146

178

99

46

20 35

20 24 35

10

49

17 15 19 26 18

57 62 73 74

85

127

62

100

72

117 113 114

67

310

262

289 308

279 270

210

251 226

265

314

354 340

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100

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17

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r 2

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7

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18

Incidents by reported date (month and year) and Care Group

Acute Services

Community Recovery Services

Corporate Services

Forensic & Specialist

Older Adult Mental Health Services

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Patient Deaths and Suspected Suicide Patient deaths and suspected suicides are reported as incidents on the Datix system. The line graph below details the number of patient deaths and suspected suicides that have been reported on Datix for the last 13 months (this would include all deaths of people who would have had contact with KMPT in the last year, so were known these are added to the system, and retrospectively this number could increase as we become aware of more incidents). The patient safety team are currently looking at the Mortality reporting process, and are looking at recruiting a member of staff to lead on this very important piece of work. To this end we have visited an acute trust to see how their system works, and we have also joined a Community of Practice focused on Mortality reviews that is part of the Surrey and Sussex Health Sciences network, and we will benefit from the learning that others have already done. The patient safety team have already learnt from similar community of Practice relevant to serious incidents, so this is felt to be a very good avenue to save us time and ensure we are up to date with current practices. CCGs are involved in all these meetings.

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Serious Incidents declared to STEIS

Opened

Closed

P a g e | 19

Restrictive Practice (Positive and Proactive Care) All restraints

There were 151 Restraints in January 2018, and 131 restraints in February 2018, with a total of 282 incidents of restraint for this period.

149 of the 282 incidents were low level holds for personal care, predominately on Hearts Delight Ward which is a continuing health care ward for older men with dementia and behaviour that challenges.

The decline in the use of restraint continued.

There have been various initiatives throughout the last 12 months to promote and practice, positive and proactive care under the Quality Accounts priorities.

3 7 8 3 2 1

6 1

6 6 4 0 1

72

84

105

120

87

116 104 105

58 52

86

98

56

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All Deaths Reported on Datix and Suspected Suicide

Suspected Suicide

All Deaths reported on Datix

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Prone restraints

The number of prone restraints was 3 in January 2018 (1 each on Foxglove, Amberwood and Riverhill) and 3 in February 2018 (1 on Amberwood and 2 on Pinewood).

The reasons for these prone restrains were as follows: 3x forced forward by the patient 1 x patient preference 1x administration of IM medication.

There has been a decline in prone restraints over the last 12 months.

There has been increased emphasis on provision of therapeutic engagement, use of Positive Behaviour Support plans, ensuring more staff are trained in the prevention and management of violence and aggression as well as de-escalation

0

200

400

Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18

All Restraints

P.I incidents Excl Personal Care

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20

Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18

No. of Prone incidents

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Seclusions

There were 25 seclusions in January 2018 and 30 February 2018.

The highest number of seclusions comes from the Acute Care Group, and in particular the PICU Willow Suite and Boughton Ward which are male only. PICU has a seclusion room on the ward.

Boughton Ward has been undergoing a major period of building reconstruction which has led to a reduction in patient space .

Staff are ensuring that the risk assessments are conducted and least restricted options are always considered in every incident The Positive and Proactive Care Monitoring Group is monitoring the use of seclusion and escalating accordingly.

Positive Behavioural Support plans are being used and staff are being trained across the Trust in how to effectively draw them with patients and use them to avoid escalation of incidents that may lead to seclusion, as well as use debrief and post incident reviews.

The Long Term Segregation and Seclusion Policy was updated in February 2018, the updates are currently being shared with nursing staff, one key update is the expectation that a seclusion observation competency checklist is completed by the Ward Manager.

0

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Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18

No. of Seclusions

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Safety Thermometer

The data above informs the Trust that:

There has been a positive increase in the number of teams that submitted this year January 2018 (17) to last year January 2017 (14).

All wards were safety free on the day of the sample except Woodchurch and Orchards wards.

Woodchurch Ward had a patient who after being assessed for VTE who was deemed not to be at high risk and was appropriately prescribed a prophylaxis.

Orchards Ward had 2 patients who experienced falls, one with no harm and one with low harm. They also have one old Grade 2 pressure ulcer.

Two community teams recorded episodes of harm, these being:

Ashford CMHTOP saw a patient in a nursing home on the day of the survey who had a catheter in situ.

Dartford CMHTOP saw 3 patients, one who had a pressure ulcer, another who had a catheter and one who experienced a fall. These were all seen in the

community or in residential care. The fall did not occur at the CMHTOP base.

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Safeguarding & DOLS

The numbers of referrals received in the safeguarding team fell by 50% during the month of February this includes less physical altercations between individual clients. This could be evidence that the measures put in place to reduce patient on patient incidents such as the ‘safety huddles‘ are having an impact however, it will continue to be closely monitored..

Cases of self-neglect are being picked up which is good practice with these cases the expectation is that practitioners are following the Self-Neglect policy which calls for a multiagency approach to these issues. Within the older adult services practitioners have been very proactive in dealing with cases of self-neglect and ensuring multiagency meetings are being convened.

Self-Neglect was a key future of recent Serious Adult Reviews undertaken by the Kent and Medway Safeguarding Adult Board. Workshops are occurring across Kent so as many staff as possible can attend. KMPT have had involvement with some of the cases going to be presented.

The majority of safeguarding referrals have been dealt with via a single agency report. More serious cases have also been reported to the police. Depending on the complexity of the case the most appropriate individual/s are assigned the investigation.

Overall there are real improvements in the quality of the referrals coming through but still need to give more focus to the making ‘Safeguarding Personal’ elements of the referral. If the client cannot say what they would like the outcome to be from the safeguarding being raised then staff need to be asking the carers and relatives what outcome they would like to see reached. .

Finally with historical cases, the majority of CMHTs have no cases open before March 2016. . Going forward service leads need to ensure that investigators are given time to complete reports for safeguarding concerns when requested otherwise the build-up of open cases going well beyond 6 months will also be an issue. The teams also need prompt feedback form the local authority leads on progress, outcomes and closures in cases outstanding

Physical Abuse Trends There has been a downward trend in patient on patient Physical abuse incidents for the past 3 months

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Jan Feb Mar April May June July Aug Sept Oct Nov Dec Jan Feb

Physical

Pt on Pt

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Ligature Incidents

There were no fixed ligature point incidents in January 2018, however there was one recorded in February 2018 which was on a forensic ward, upon investigation, this was actually a ligature with no fixed point using a cord or clothing, there was no harm to the patient.

The Trust has conducted the annual ligature audit from 1-30 November 2017 in all inpatient settings, the compliance target was 100% and it was achieved.

Results have been shared with all the teams and uploaded on Datix. Boughton and Chartwell which have been identified as high risk areas are currently experiencing major refurbishment, it is envisaged that when this work has been completed, the wards will change to a low risk. Installed door alarms that detect weight put on bedroom and bathroom doors have supported staff with alerting them to incidents related to anchor points and therefore timely response.

Never Events All organisations providing NHS care should use the list that became active on initiation of the updated 2017-19 NHS Standard Contract on 1 February 2018. The Trust has not reported any Never Events year to date.

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Feb 2017 Mar 2017 Apr 2017 May 2017 Jun 2017 Jul 2017 Aug 2017 Sep 2017 Oct 2017 Nov 2017 Dec 2017 Jan 2018 Feb 2018

Ligature with Fixed Points

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Ligature Incidents with no Fixed Points

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Monthly

Integrated Quality and Performance Report

February 2018

P a g e | 26

TRUST SUMMARY PERFORMANCE SCORECARD

Ref. Measure Target Feb-18 Jan-18 MovementTrend

(Last 12 months where available, left to right)

Previous

Forecast

Next Month

Forecast

1 Regulatory Targets

1.1 CPA patients receiving follow-up within 7 days of discharge 95% 94.0% 93.9%

1.2 CPA patients receiving formal 12 month Review 95% 93.5% 93.0%

1.3 Delayed Transfers of Care 7.5% 6.6% 7.0%

1.4 Admissions to Inpatient Services had Access to CRHTs 95% 100.0% 100.0%

1.5 Meeting commitment to serve new psychosis' cases by EIS 1 95% 125.3% 124.1%

1.6 MHMDS Data Completeness: Identifiers 97% 99.7% 99.7%

1.7 MHMDS Data Completeness: Outcomes for Patients on CPA 50% 80.8% 77.7%

1.8 EIP Waiting Time Proxy (Referral to Care Coordinator in 2 Weeks) 50% 93.7% 81.2%

1 Possible to achieve over 100% where new cases accepted to date exceeds average cases required per month to meet target

Ref. Measure Target Feb-18 Jan-18 MovementTrend

(Last 12 months where available, left to right)

Previous

Forecast

Next Month

Forecast

2 Workforce

2.1 Sickness Absence 3.9% 5.4%

2.2 Staff Vacancies 15% 12.4% 13.3%

2.3 Staff Turnover 14% 16.8% 16.7%

2.4 Agency Spend 5%

2.5 Appraisals and Personal Development plans 90% 84.9% 83.9%

2.6 % mandatory training 85% 93.0% 92.3%

2.7 % Eligible staff with enhanced CRB check 100% 100.0% 100.0%

Sickness figure is an early cut of data prior to official 20th return and therefore expected to rise in line with recent months performance.

P a g e | 27

Ref. Measure Target Feb-18 Jan-18 MovementTrend

(Last 12 months where available, left to right)

Previous

Forecast

Next Month

Forecast

3 Quality

3.1 Referral to assessment within 4 weeks 95% 84.4% 78.4%

3.2 18 Weeks referral to treatment 95% 90.6% 89.0%

3.3 % of patients with valid CPA care plan or plan of care 95% 86.5% 78.0%

3.4 Crisis Plans (all patients) 95% 90.3% 87.6%

3.5 % of Service Users in Employment 13% 14.3% 14.1%

3.6 % of Service Users in Settled Accommodation 75% 81.6% 81.4%

3.7 % Reviews undertaken within the maximum cluster review period 95% 65.5% 72.6%

3.8 % of service users assessed with cluster assigned 95% 93.8% 92.9%

3.9 % inpatients with a physical health check within 72 hours 100% 95.3% 94.6%

3.10 Number of Home Treatment Episodes 224 258 302

3.11 Emergency Readmission within 28 days 5% 5.4% 6.2%

3.12 Average Length of stay(Younger Adults) 25 22.6 21.5

3.13 Bed Occupancy: Internal Usage v's Internal Capacity (YA Acute) 84.0% 89.9% N/A N/A

3.14Bed Occupancy: Internal & External Usage v's Internal Capacity (YA

Acute)84.0% 89.9% N/A N/A

3.15Bed Occupancy: Internal & External Usage v's Proposed 174 Capacity

(YA Acute)79.4% 85.8% N/A N/A

3.16 Bed Occupancy: Internal Usage v's Internal Capacity (YA PICU) 99.5% 94.4% N/A N/A

3.17Bed Occupancy: Internal & External Usage v's Internal Capacity (YA

PICU)139.3% 139.6% N/A N/A

3.18 Average Length of stay(Older Adults) 52 88.4 72.0

Act

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P a g e | 28

3.19 Bed Occupancy: Internal Usage v's Internal Capacity (OP Acute) 91.2% 91.7% N/A N/A

3.20Bed Occupancy: Internal & External Usage v's Internal Capacity (OP

Acute)91.2% 91.7% N/A N/A

3.21 Number of unplanned absences (AWOL and absconds on MHA) 0 8 15

3.22 Serious Incidents 0 0 N/A N/A

3.23 Number of Grade 1&2 Sis confirmed breached over 60 days 153 Grade 1&2 Sis breached in las t 12 months N/A N/A

3.25 Complaints (Level 2-4 & MP Complaints) 0 0 N/A N/A

3.26 Never Events 0 0 Never events in las t 12 months

3.27 Information Governance Breaches 0

3.28 Safeguarding training Adult - Basic Introduction 85% 99.6% 99.8%

3.29 Safeguarding training - Children 85% 99.7% 99.8%

3.30 Safeguarding training - Children Level 2 85% 94.3% 93.1%

3.31 IAPT Recovery Rate 50%

3.32 IAPT 0-6 Weeks Referral to Treatment 75%

3.33 IAPT 0-18 Weeks Referral to Treatment 95%

3.34 Care Plans Distributed to Service User 75% 51.6% 55.6%

KEY Description

NHSi Single Oversight Framework Measure

Denotes performance improvement from last month's position

Denotes performance remains at the same level as last month

Denotes performance has decreased from last month

Performance is forecast to improve in following month

Performance is forecast to decrease in following month

Act

ual

s R

epo

rted

Act

ual

s

Rep

ort

ed

Information is withn the quality element of

the report