5328 bdct quality accounts 12pp a4:layout 1 · the full quality accounts document is very detailed,...

You and Your Care

Quality Account 2009-2010Executive Summary

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Quality Account 2009 – 2010 Executive Summary

We welcome the opportunity of producingour first annual report to the public aboutthe quality of services we provide. TheDepartment of Health guidelines requirethe Trust to use a Quality Account to helpthe public, patients/service users and otherswith an interest in our service tounderstand the following:

• What our organisation is doing well• Where improvements in service quality

are required• What our shared priorities for

improvement are for the coming year;and

• How we have involved service users,carers, staff and others with an interestin our organisation in choosing thosepriorities for improvement.

By adhering to the Department of Healthguidelines for producing Quality Accountsthe full Quality Accounts document is verydetailed, therefore the Trust Board wantedto produce a summary of the document tomake its content as accessible as possible. Acopy of the full document is available athttp://www.bdct.nhs.uk/communications/news/publications/quality-account.phptogether with a simpler easy read version.

This last year has been a particularly busyone for the Trust in which we feel we havemade big steps towards improving andassuring the quality of services for serviceusers and carers. A revised set of values forthe organisation have been developed thatreflect the ongoing commitment of theTrust Board and our staff to ensure thatquality is central to our strategies andimprovement plans.

These are:• Respect• Openness• Improvement• Excellence• Together

It is our mission to be one of the country’sleading integrated mental health andlearning disability providers improving livesthrough delivery of high quality care inpartnership across our diverse communities,available locally to meet individual needsand achieve excellence in service userexperience.

As an organisation we always strive toinclude service users and carers in our workand we are delighted in how service users,carers, staff and other key stakeholdershave worked together in agreeing thepriorities for improvement and indicatorsof quality set out within the QualityAccount. We are pleased that the QualityAccount contains positive feedbackregarding the effective involvement in itsdevelopment process.

Introduction by Chair and Chief Executive

Welcome to the Executive Summary of Bradford District Care Trust’sQuality Account for 2009 – 2010.

Simon LargeChief Executive

Barry SealChair

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Review of Quality Performance

Throughout the year we have worked hardto make continuous improvements in thequality of our services. We have done thisby establishing rigorous processes andsystems that monitor the information wecollect about our services. This knowledgeis then used to drive up standards in thesafety and effectiveness of our services andin the experience of our service users whenusing them. Below are a number of serviceimprovements, fuller details are containedwithin the Quality Account.

• Leadership development across all care groups –

We are improving the quality of leadershipthrough initiatives like the Exciting FuturesProgramme. This programme supports thefurther development of leadershipcompetencies and links staff with serviceusers and carers in the delivery of a rangeof community projects.

• Child & Adolescent Mental Health Services (CAMHS) –

A review of CAMHS services using the leanmethodology has taken place. Theoutcomes of the review will result in animproved skill mix, distribute resourcesmore equitably across the service, providegreater flexibility to meet the needs ofclients and improve client access across allCAMHs services.

• Low Secure Services –The service has carried out a largeworkforce modernisation programme,called the Population Centric Project, whichensures staff profile and skill mix match thepopulation both within and outside of theward environment for now and the future.

• Substance Misuse Services –The service has relocated to a moreappropriate location offering enhancedprivacy for service user consultation andtreatment.

• Learning Disability Services –There have been several external reviewsshowing improved Care QualityCommission ratings in residential andrespite accommodation.

• Older Peoples’ Services –The team have improved service userexperience on Duchy Court with theprovision of specific male and femaleaccommodation following the Privacy andDignity audit.

• Adult Service In Patient Care –The Adult Mental Health Team hasdeveloped a new model for anOccupational Therapy Service withextended 12 hour/7 day access for serviceusers. The model will provide service userswith activities as part of their carefollowing a comprehensive and holisticassessment of their individual needs. Theservice has been equality impact assessed atthe start of the development to ensure thatthe needs of all communities areconsidered.

You and Your Care

Exciting Futures Team ‘In touch with Art’.

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Quality Improvement –Processes

In addition to these service improvementsthere have been a number ofimprovements to the supportive processesthat the Trust operates to ensure quality ofservices. These are in the areas of ServiceGovernance systems, Incident and RiskManagement, Safeguarding Children andVulnerable Adults, work on swine flu,Infection Control, Privacy and Dignity,Patient Environment Action TeamAssessments, Falls Assessment and Equality,Diversity and Human Rights.

Indicators of Quality

The Quality Account guidance requiresTrusts to identify at least three qualityindicators for each of the quality domainsof safety, effectiveness and patientexperience. It is not a requirement to select

quality measures from a workforceperspective but we have decided to add ina further domain to ensure we are lookingat this important indicator of quality servicedelivery.

Along with our stakeholders we haveselected 17 indicators to report on todemonstrate how we are doing in relationto the quality of services. The followingtable lists those indicators and theperformance recorded over the last threeyears. We have summarised the rationalefor selection of these individual indicators,a more comprehensive account of which isprovided in the full Quality Account. Thetable also shows the national benchmarkthat we are working to, where one wasavailable.

We have developed this section to give abalance between celebrating the successeswe have achieved and the areas that wefeel we have room for improvementthrough the development of QualityImprovement Plans.

Table 1

Quality Domain and Associated Indicators

SAFETYProportion of all in patients whohave experienced physicalaggression.

(defined as assault)

The Trust has been commended forits recording and analysis ofincidents. We continue to becommitted to this and have selectedto monitor our performance inaddressing incidents of assault ininpatient services.

Moderate 9

(31 March 2010)

Major3

(31 March 2010)

Catastrophic0

(31 March 2010)

Moderate8

Major 1

Catastrophic0

Moderate7

Major0

Catastrophic0

No nationalbenchmark



Rationale for Selection Performance09-10 (as at) 08/09 07/08 Benchmark

% Purposes of any new medicationsexplained (Community SurveyQuality Health report)

It is vitally important that serviceusers have the purposes of any newmedications explained to them sothat it can be used safely. We andour stakeholders also feel that it is agood measure of service userinvolvement in their own care.

73%(annual result)

71% 56% 67%


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Table 1 continued

Quality Domain and Associated Indicators Rationale for Selection

Performance09-10 (as at) 08/09 07/08 Benchmark

EFFECTIVENESS Adults in settled accommodation(Learning Disabilities)

Proportion of adults on CareProgramme Approach receivingsecondary mental health services insettled accommodation

Proportion of adults on CareProgramme Approach receivingsecondary mental health services inemployment

Number of service users readmittedto inpatient care within 28 dayperiod

Number of admissions to acutewards that were gate kept by CrisisResolution / Intensive HomeTreatment teams

Throughout the stakeholderengagement processes it wasstressed that employment andhousing access was a key indicator ofwellbeing and should be included asa measure of care outcome.

Readmission was also identified as akey measure of effectiveness of carethroughout the stakeholderengagement process and it wasagreed that this would be animportant measure of quality.

The Crisis Resolution and HomeTreatment Teams were seen bystakeholders as an important stagein the care pathway and we feel thataccess to this support should bemonitored.

80.8%(31 March 2010)

25.2%(31 March 2010)

2.8%(31 March 2010)

149 serviceusers

10.9%(31 March 2010)

92.6%(31 March 2010)

86.5%

50.3%

5.0%

11.9%

90.0%

Notcollected

Notcollected

Notcollected

9.8%

Notcollected

73.2%

PATIENT EXPERIENCE % Patients given enough time todiscuss their condition and treatment(score from Community SurveyQuality Health report)

% Definitely have enough say indecisions about care and treatment(overall rating – Community SurveyQuality Health report)

% Patients treated with respect anddignity (from Community SurveyQuality Health report)

% Have the number of someonefrom local mental health services tophone out of hours (CommunitySurvey Quality Health report)

Service users feeling involved andinformed in all aspects of their carewas a high priority for qualityidentified through our stakeholderevents.

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

To maximise service user access toout of hours support throughredesigns and developments in ourservices. We have included thisindicator so that we can monitor theprogress of this work.

64% (annual result)

47%(annual result)

84%(annual result)

42% (annual result)

73%

42%

87.5%

48%

71%

38%

86%

51%

69%

43%

84%

47%

You and Your Care


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Table 1 continued

Quality Domain and Associated Indicators Rationale for Selection

Performance09-10 (as at) 08/09 07/08 Benchmark

WORKFORCEThe extent to which the Trust valuesmy work (NHS Staff Survey)

My immediate manager helps me tofind a good work life balance (NHSStaff Survey)

Staff believing the Trust providesequal opportunities for careerprogression or promotion (NHS StaffSurvey)

% of staff with up to datemandatory training – Fire Training

% of staff with up to datemandatory training – OtherMandatory Training

% of staff with an in date appraisal

During 2009 the Trust developed anew set of values, a set of leadershipcompetencies and a trainingprogramme to further develop ourworkforce. Although not requiredwithin the quality account, ourstakeholders agreed these indicatorswill help to measure the impact ofthese and other developments.

It was viewed by our stakeholdersthat it is integral to the quality ofour services that our workforce is upto date with training.

Appraisal is a key mechanism forengaging with staff and althoughthe Trust is above the nationalaverage in carrying out these, weand our stakeholders feel theeffective delivery of staff appraisalcontributes to overall quality ofservices.

37%(Annual result)

63%(Annual result)

90%(Annual result)

75.6%

61.2%(31 March 2010)

92.1%(31 March 2010)

38%

66%

82%

45.6%

27.2%

80.5%

35%

61%

60%

NotCollected

NotCollected

74.6%

34%

61%

88%

Nationaltarget100%

No nationaltarget /

benchmark

70% (2008National

average forMentalHealth/

LearningDisability

Trusts)

Please note that these figures were collected on the dates listed above and as a result of time delay in paper based systems e.g. incidentreporting, may be slightly under the final ‘to date’ figures.


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Priorities for Improvement 2010 – 2011

The Department of Health’s QualityAccount Guidance specifies that we shouldpick between three to five improvementpriorities to work on in the forthcomingyear.

Working alongside our stakeholders, the Trust has selected the following fivepriorities for targeted improvement to the quality of our services over the next 12 months.

• Improving the physical healthcaresupport for people within our Learning Disabilities, Adults and Older People’s services

• Reducing and addressing the cause ofsome safety related incidents

• Increasing the effective use of riskassessments as part of the care planningprocess within community services

• Improving support of carers• Improving the collection and use of

equalities data so that we can planservices to meet the needs of our diversepopulation better

Further details in relation to theseimprovement indicators, the currentperformance and agreed improvementtargets are shown in the table overleaf. The rationale for selection, keyimprovement initiatives and methods formonitoring progress are outlined in the full Quality Account.

You and Your Care

Sport 4 Health project seeing services across Bradfordworking together to promote health and well-being forpeople with mental health problems.


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Table 2

Improvement Indicator Current Performance as at 31.3.2010Agreed Improvement

Target

Improve support of carers

Patient Experience

% of carers offered acarers assessmentn.b. Low Secure Servicesare not included

30% 63%

Improve the collection and use of equalities data

% of service user record withcompleted religion / belief

% of service user recordwith a completed recordof a person’s disability Note: this has previouslybeen recorded withnarrow disabilitycategories

% of service user recordwith a completed ethnicgroup. Note: ‘completedethnic group’ is a recordwith a valid entry. Emptyfield, ‘not known’ and ‘notstated’ are invalid and soare not counted withinthis %

100%

The improvementtarget is to ensure

comprehensive datacollection facility in

place within RiO

100%

Unavailable

1.5 %

93.3%

Please note that these figures were collected on the dates listed above and as a result of time delay in paper based systems e.g. incidentreporting, may be slightly under the final ‘to date’ figures.

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

Effectiveness

Number of learningdisability clients inresidential, respite andnursing home beds with aHealth Action Plan

% of clients that receivephysical health checks inAdult and Older People’swards

70%

80%

Level of Slips, Trips andFalls Trust wide(All incidents involvingpatients)

Number of reportedincidents where serviceusers detained under theMental Health Act areabsent without leave(Trust wide)

Reduction of 10%

Reduction of 10%

1122

64

Incidence of documentedRisk Assessment withinCommunity Services

100%

100%

100%

Reducing and addressing the number of safety related incidents

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

Safety

60%


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You and Your Care

Participation in Clinical Audits

The Trust undertakes a full programme ofaudit on clinical and social careperformance which is reported to the TrustBoard by the Service GovernanceCommittee. We are committed to thisprogramme as we believe that it enablesclinicians, managers, service users, carers,the community and commissioners tounderstand and demonstrate how we aredelivering high quality care in line withrecommended standards. It also providesdata to enable quality improvements to bemade where there are quality gaps.

The Quality Account provides details of ourinvolvement in the following:

• National audits• Commissioning for Quality and

Innovation (CQUIN) audits• Commissioner requested audits• Local audits

The Trusts Audit Department along withour Involvement Team are workingtogether to continue to support anddevelop effective service user and carerinvolvement in audit activity.

Clinical Research

We believe that research is a key driver forimproving quality care. During 2009 theTrust launched a Research andDevelopment Strategy to increase itsparticipation in research and create anorganisational framework for involvementin research activity. The Trust works incollaboration with the West YorkshireComprehensive Local Research Networkand the Quality Account provides a breakdown of our research involvement.

Data Quality

The Trust is committed to ensuring that thedata we are using to measure ourperformance is accurate and usedcomprehensively across the Trust, thisincludes breaking down data into equalitystrand groups.

Registration Status

The Trust is required to register with theCare Quality Commission and its currentregistration status is “registration withoutconditions” (the best possible outcome).

Additionally the Trust is required to registeragainst a set of requirements on infectioncontrol and healthcare acquired infection.The Trust was registered again “withoutconditions” and has continued toimplement a number of actions to furtherdevelop the systems in place during2009/10.

Annual Health Check Results

Bradford District Care Trust (like all NHSTrusts) receives an annual health checkscore from the Care Quality Commission.This includes assessment of how well wemeet the Standards for Better Health, ourperformance against a set of targets andour financial performance.

The Trust has seen a steady improvement inresults over the last three years as follows:

Table 3

Year Quality ‘score’ Use of resources ‘score’

2008 / 09

2007 / 08

2006 / 07

Good

Good

Fair

Good

Fair

Fair


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Statements from our Partners

As part of the assurance system for theQuality Account we are required to ask ourLocal Involvement Networks, Overview andScrutiny Committees and Primary Care Trustto make a comment on our QualityAccount. We were delighted to receivesupportive comments from theseorganisations as to the content of ourQuality Account and to note their positivecomments regarding our engagementprocess. Their full comments can be foundwithin the Quality Account.

Moving Forward

We are delighted to publish our QualityAccount for 2009/10 as this provides aplatform for us to celebrate the areas theorganisation has excelled at whilst alsorecognising the areas requiringimprovement.

We are grateful for the way in which ourstakeholders have worked with us inidentifying these improvement targets andwill strive to make progress in all theseareas to ensure that we are delivering highquality care across all our services. Progressin relation to the priorities forimprovement and quality indicators will bereported and reviewed routinely at ServiceGovernance Committee, a formal subgroup of Trust Board and we will continueto ensure that stakeholders are involved inreviewing and commenting on ourprogress.

The full Quality Account and ‘easy read’version can be downloaded fromhttp://www.bdct.nhs.uk/communications/news/publications/quality-account.php

You and Your Care

Partnership projects such as the Jewels aim to improvephysical health of people who use our services.

Michael Smith our Vice Chair at one of our ‘InvolvingYou’ events which encourages feedback to help improveour services.


You and Your Care

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Bradford District Care TrustNew Mill

Victoria RoadSaltaire

West YorkshireBD18 3LD

Tel: 01274 228300

[email protected] www.bdct.nhs.uk

Your opinions are valuable to us. If you have any viewsabout our Quality Account Executive Summary please

contact us at the above address.

5328 bdct quality accounts 12pp a4:layout 1 · the full quality accounts document is very detailed,...

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