mch quality account 2012/13

Medway Community Healthcare CIC providing services on behalf of the NHS Registered office: 5 Ambley Green, Bailey Drive, Gillingham, Kent ME8 0NJ

el: 01634 382777 Registered in England and Wales, Company number: 07275637

Quality account

2012/13

Medway Community Healthcare CIC providing services on behalf of the NHS Registered office: 5 Ambley Green, Bailey Drive, Gillingham, Kent ME8 0NJ Tel: 01634 382777 Registered in England and Wales, Company number: 07275637

www.medwaycommunityhealthcare.nhs.uk

…we are caring and compassionate …we deliver quality and value …we work in partnership


Contents Page

A message from our Board 3

About us 4

Medway Cares charity 5

Looking forward 7

Priorities for improvement 7

Statements related to the quality of services provided 8

Participation in clinical audit 10

Implementing NICE guidance 11

Participation in research 12

Goals agreed with commissioners 13

What others say about MCH 14

Review of quality performance 18

Privacy and dignity 18

Patient experience 19

Compliments and complaints 22

Supporting and developing our staff 27

How you can provide feedback on the account 29


A message from our Board Medway Community Healthcare (MCH) has been operating for two years and we continue to make progress in improving the quality of community healthcare for the local population. Established in April 2011, as an employee-owned organisation, our primary aim is to provide high-quality health services to the people of Medway and beyond. In this, our third quality account, we describe some of the practical steps we have taken to make this happen and look forward to how we will continue to do this in the coming year. MCH was established as a not-for-profit organisation with a key set of values that include putting patients first and delivering high quality care. Any surplus we make is re-invested in ways that support the communities we serve. We are a very unique type of organisation where our employees own the organisation. We believe our model of co-ownership drives innovation and enthusiasm in our staff to make services better. This drive to continuously improve quality and efficiency in all we do for our patients is essential at a time of major change in the NHS. We are proud to say that, on the whole, our patients tell us they are happy with the services they receive from MCH. Once again, we have received some very positive feedback from our patients. This gives us much to celebrate. However, we are determined not to become complacent. We know we can always do more to improve the quality of our services and learn from innovative practise elsewhere. Our quality account acknowledges and illustrates the areas where we know that we can make further improvements. It also outlines the valuable contribution our established patient experience programme and robust assurance processes for safety, effectiveness and experience brings to our delivery of quality. These measures alongside more formal feedback from our regulators, provides us with the evidence and reassurance we seek to ensure we continue to meet the needs of our patients and local community. We will also continue to maximise the very positive impact of our unique business model in which every one of us has a role to play in improving care. Our apprenticeship programme, now in its third year, attracts local young people, giving them hands on experience in clinical and non-clinical work. Through our charity, Medway Cares, we were able to provide community awards worth a total of £33,000. How we work alongside clinical commissioning groups (CCG) for the benefit of patients is absolutely central to how patients experience healthcare. We want to get better and better at this, with patients at the centre of our relationship. This aspiration applies equally to working with colleagues in general practice, social care and the voluntary sector and in local hospitals. Much of the care we provide supports patients after a hospital stay, helping them to regain independence or adapt to life following illness. How we make connections on behalf of patients can make a big difference. These themes are core to our continuous improvement plans for the coming year. Putting together this year’s Quality Account has been a great opportunity to pause, take stock and talk to people about how we are doing. Our conversations have been with the staff who deliver services, stakeholders who oversee them on behalf of local people, our commissioners who buy services on behalf of the local community and, most importantly, with our patients. On behalf of the MCH Board we confirm that our quality account has been developed and reviewed by the Board, executive and senior managers and is an accurate account of the high quality care we provide and the data that supports our achievement.

Martin Riley Peter Horn Managing director Chair On behalf of the MCH Board


About us

…leading the way in excellent healthcare MCH is a £57 million business with 1,250 staff providing a wide range of both planned and unscheduled care in local settings such as healthy living centres, inpatient units and people's homes.

On 1 April 2011 MCH became a social enterprise Community Interest Company (CIC), providing community NHS services to the people of Medway. We have a strong history of partnership working with local GPs, Medway NHS Foundation Trust, Medway Council and other local stakeholders. Becoming a social enterprise is a significant opportunity for MCH and for the local community. We are an

organisation that provides a range of high quality clinical services across Kent and Medway and our vision is to continue to deliver high quality clinical services supported by professional business support services whilst maintaining financial sustainability and delivering excellent clinical outcomes for patients. As part of our culture, working closely with our local community to deliver high quality healthcare, we now have the ability to be different and make a significant difference to the way we provide services. We are part of the new enterprise culture and one of the first phase of social enterprises delivering high quality community health care to local people; from community nurses and health visitors to speech and language therapists and out of hours urgent care. As a social enterprise, MCH is owned and run by its staff members on behalf of the community and trades as a business for social purposes. Many commercial businesses would consider themselves to have social objectives; social enterprises are distinctive because their social purpose is absolutely central to what they do. We have made a commitment to ‘leading the way in excellent healthcare' and our patients, local stakeholders and our staff as co-owners, will have the opportunity to ensure that we are able to:

deliver services according to need and not perceived demand deliver innovative ways to provide care closer to home deliver services in a more flexible, productive and efficient manner deliver services that respect every patients’ dignity and right to privacy our standards

I had an excellent experience. Continue what you are doing.

She is a credit to the service and was a great help with not only the assessment but also with making my life a lot more bearable.


Our approach is focused on improving service quality, patient experience and clinical outcomes; ensuring better use of resources and maximising value for money, and includes six key transformational areas:

We have been reviewing the provision of all of our services and strategies have been implemented to restructure, redesign and integrate the operational services to deliver high quality care more efficiently. We are embedding equality impact assessments into this process to ensure any changes do not have a negative impact on any sectors of the community or our staff.

Our aims and objectives ensure that MCH continues to focus on the right things and we work as a team. It is vital that everyone understands the part they play in successfully achieving these aims and objectives.

It is important that we also continue to measure our progress so that everyone knows how we are doing both as individuals and together as an organisation delivering excellent healthcare to our local community.

Our charity: Medway Cares Helping to make a difference Medway Cares, established in 2012, aims to promote and protect the physical and mental health of people living in Medway. As a social enterprise, one of the ways we can make a difference is by investing some of our operating surplus in the community we serve. At our first annual general meeting shareholders were given the chance to vote for who should benefit from the community awards and they chose children and young people; people with learning difficulties and older people. This year, we were able to offer Medway Cares community awards worth a total of £33,000. Local groups were invited to apply for a community award of up to £10,000 and

acute care closer to home services for children, young people and their families services for health, wellbeing and reducing inequalities rehabilitation services services for people with long term conditions end of life care

I'm treated with dignity and respect at all times. Also, I can discuss with the nurse about my condition, and feel reassured and cared for - thank you.


we were supported by local KM newspaper the Medway Messenger in encouraging groups to apply. We were delighted by the number of applications we received from local organisations. A charity review group made up of a range of staff selected the recipients. Thank you to everyone who took part and congratulations to all our beneficiaries. Beneficiaries 2012-2013

Organisation Project Award

4th Gillingham Sea Scout Group

A safety boat will be purchased to support children to try out water activities on the river Medway.

£2,500

Age UK Portable ramps on day centre buses will help older people to attend activities at day centres.

£1,800

All Saints Community Project

Funding will create 120 free places on the Sam's Place holiday play scheme.

£4,000

Breakaway Four chairs with arm rests and lumbar supports and additional tables will enable more isolated people to attend a luncheon club.

£750

Hands and Gillingham Volunteer Centre

Support community volunteers/befrienders will be recruited to support older people, disabled people and people with mental health problems.

£9,000

Holding On Letting Go Weekend grief support programmes will continue to support bereaved children, young people and their parents or carers.

£6,000

Medway Dragons Rugby League Club

Primary school children will be encouraged to be fit and healthy. The award will enable coaches to deliver ten weeks of fun fitness sessions in 20 local schools.

£3,000

The Word on the Street

More children and young people will be able to attend the Activity Loft which provides a safe haven with after school clubs and school holiday activities.

£6,000


Part two: looking forward This second part of our quality account looks forward to the next financial year (2013 -14) and details what areas have been identified as priorities for improvement, why these priorities have been chosen, how improvement will be achieved and how it will be measured. There are also Board statements relating to the quality of the services we provide.

Priorities for improvement 2013-14 Understanding what is important to our stakeholders is a key objective of our organisation; consulting on our priorities for improvement gives us the opportunity to ask for input on what is important to them. It is essential that as many people as possible are involved in developing the priorities for the next year.

Consultation on the priorities for 2013-14 started with a review of last year’s performance on the priorities. The seven priorities were classified as recommended to continue or not, depending on whether practice required further improvement or not. We reviewed patient feedback, complaints and enquiries, as well as commissioning intentions and other local priorities. From this

rich mix of data we looked for key themes and trends to compile a list of draft priorities that was presented to our quality committee in December and subsequently circulated to key stakeholders for them to vote for their top priority in each category. Patients, staff, Medway LINk, our community forum and Medway CCG were given the opportunity to vote via our Internet site. All the responses were collated and from this we determined six priorities for improvement. Patient safety:

1. Continue to provide environments and care where the risk of infection is minimal. How will we measure?

staff being bare below the elbow compliance with hand hygiene requirements cleaning audits in areas we are responsible for compliance with MRSA screening in St Bart’s reported C difficile infection or MRSA bacteraemia

How will we report? Quarterly updates will be published on our website

2. Continue to reduce incidences of avoidable falls and pressure ulcers, as well as

enable patients and carers to understand what they can do too. How will we measure?

Use safety thermometer to monitor progress How will we report?

Quarterly updates will be published on our website

A pleasure to deal with people who have a good attitude…

They always have a friendly and comforting word.


Clinical effectiveness:

3. Support patients with long term conditions – encouraging self-care and reducing acute hospital admissions through use of technologies, eg telehealth. How will we measure?

Working with Medway CCG and other providers to implement the long term conditions Commissioning for quality and innovation (CQUIN) scheme.


4. Improve the health and wellbeing of children, as part of an integrated approach to

supporting children and families through the delivery of the healthy child programme. How will we measure?

Through the implementation plan we will monitor progress against key milestones


Patient experience:

5. Continue to work to reduce waiting times and appointment cancellations for patients in services where there are challenges. How will we measure?

Through monthly service performance indicators identify key services and monitor progress against achievement of improvement plans


6. Palliative care – continue to build on giving patients ownership of their care through

advance care planning and provide them with a copy of their agreed management plan. How will we measure?

Using the Community IT System monitor the use of My Plan How will we report?

Quarterly updates will be published on our website

Statements related to the quality of services provided.

During 2012/13 MCH provided 46 NHS services. MCH has reviewed all the data available to them on the quality of care in all of these NHS services. The income generated by the NHS services reviewed in 2012/13 represents 100% per cent of the total income generated from the provision of NHS services by MCH for 2012/13.

You cannot improve on the existing standards being practised.


MCH performance monitoring process

MCH has a clear and transparent performance framework that draws together the available data from all services into a comprehensive overview and the analysis is described at organisational, business unit and service level. The monthly dashboards of performance are reviewed and analysed at the business unit meetings and commentary is then provided to the operational performance meeting. The business units include service management leadership and performance is shared within all service areas.

The data collected comprises key indicators across the four cornerstones of performance:

clinical quality and outcomes patient activity financial health organisational health (workforce)

Additional reporting of complaints, incidents and contractual performance and CQUINs are included as part of this review. The purpose of the operational performance group is to scrutinise this data, identifying any areas where performance is of concern or exemplary. Key actions for any required resolution are then identified and implementation sought. The process also identifies and reviews any risks associated with performance, eg increased patient waiting times, vacancy levels, high levels of safeguarding work, etc and seeks assurance in regard to mitigation. Key issues within services are considered for more comprehensive review through a ‘deep dive’ process which is undertaken at various levels dependent upon the issue/s. These investigations will, where appropriate, include peer review/support. The outcomes and

action plans resulting from the ‘deep dive’ process are reported to the executive team and quality committee, presented by service managers and team members where possible. Service level performance is reported to the quality committee where there is challenge and interrogation from executive and non-executive Board members thus enabling a highlight report to the Board allowing further opportunity to challenge key issues and actions to provide our Board with the assurance they demand.

There is a consistent level of data across all services and data quality assurance built into the process, including review of both the process and the data enabling appropriate detail to understand the key issues, variables and influences.

By seeing the same people they get a feel for how you respond and are able to make more personalised plans which is so much better.

Always on time with appointments; always very helpful and pleasant.

You can’t improve on excellence.


There is a formal contract review process in place which is supplemented and enhanced by regular meetings between commissioners and MCH executive and senior management teams. These processes review the delivery of the contract from a quantitative and qualitative perspective. The performance data and key service issues are highlighted and managed through the Service Delivery Improvement Plan (SDIP); the quality performance indicators and CQUINs are monitored through the clinical quality review meeting.

Participation in clinical audit Clinical improvement programme At MCH we have an annual clinical improvement programme that includes mandatory audits, which all services are required to participate in that are reported to our quality committee. Local service audits are reported to business units and performance meetings. All improvement programme findings are shared within the organisation through our new governance assurance information network (GAIN). We undertook 11 mandatory audits (not including infection control or medicines management audits); this is a decrease from last year to ensure we are focusing on quality rather than quantity. These included a mixture of clinical and workforce audits ranging from staff engagement, student placement, record keeping (quality and governance), food and nutrition and patient experience.

During 2012/13 three national clinical audits and no national confidential enquiries concerned NHS services that MCH provides. During that period MCH participated in 100% of the national clinical audits it was eligible to participate in. The national clinical audits that MCH was eligible for and participated in during 2012/13 are as follows: Audit title Findings National Audit of Intermediate Care

This audit was completed by St Bartholomew’s Hospital. The overall compliance was 86%.

HTM01-05 Decontamination in Dental Services

All sites achieved 91% or above. Majority of sites do meet best practice. Majority of failures due to poor ventilation in decontamination rooms, no washer disinfectors and general fabric of rooms are poor.

National Sentinel Stroke Audit and SINAP (Stroke Improvement National Audit Programme)

We have moved up from 3rd to 2nd quartile of performers. Average percentage of the 12 key indicators has increased from 66% to 70.7%.

I felt supported, listened too, involved, cared for and they were always on time too.


The development of personalised care plan tool My plan is being introduced through a series of workshops focusing on appropriate goal setting techniques and motivational interviewing.

High quality pre-registration student placements were evidenced and led to the development of our intranet site and placement information for students

The return rate for all audits has improved significantly improving the quality of the information; we will continue to improve this.

The preceptorship programme for our newly registered clinicians has enabled improved staff retention and evidenced an increase in confidence in undertaking their roles.

A new drug trolley at the Wisdom Hospice has reduced the risk of drug errors through improved efficiency, fewer interruptions and improved the stock control.

Implementing NICE guidance The National Institute for Health and Care Excellence (NICE) produce evidence based guidance and standards to ensure best practice in health and now social care too. We are compliant with guidance that is relevant to our services. Every piece of NICE and other national guidance is reviewed and, where needed, action plans are developed to ensure the recommendations are implemented by services. The table below outlines the guidance that required action plans and the improvements made:

NICE guidance Improvements 2012-13

CG148 and QS15 Patient Experience

Our pledge implemented in each service to encourage ownership of improving and ensuring all patients have a good experience and to manage expectations.

CG140 Opioids in palliative care

Patient information leaflet produced.

CG127 Hypertension Waiting times reduced for blood pressure monitoring to six weeks. Waiting times reduced for electrocardiograms to four weeks. Competency checklist produced and being utilised.

CG139 - Infection control

Improvements made to continence care training.

CG88 Low back pain The number of spine fit exercise classes has decreased due to non-attendance of patients. A weekly Pilates group is now being run within physiotherapy. The format of back education has changed and is now not a stand-alone package as non-attendance was extremely high and it was not cost effective. Education is now provided during the treatment session.

The reports of all local clinical audits were reviewed by the MCH in 2012/13. The following are findings and actions that have or will improve the quality of healthcare provided.

Many thanks for the time and care he showed in dealing with me, the doctor is a credit to you.


NICE guidance Improvements 2012-13

Clinicians give Arthritis Research booklet on low back pain. PH35 Preventing type 2 diabetes

Pathway launched September 2012.

TA249 Atrial fibrillation - dabigatran etexilate

Training required and completed.

QS2 Stroke All MCH stroke nurses are trained to complete swallow assessments and can insert naso-gastric tubes if necessary improving patient outcomes by ensuring appropriate medication and nutrition

QS9 Chronic heart failure

Patients usually seen within two weeks but always within three weeks.

Participation in research Research is a core part of the healthcare, enabling the NHS to improve the current and future health of the people it serves. As a provider of NHS services we aim to provide high quality healthcare. Research helps ensure that high-quality provision is supported by a good evidence-base. Our Research strategy for 2013 -15 recognises research as a means to improving the quality of patient care and services, implementing models of good practice and reducing clinical risk. Although the organisation as a whole is fairly new to participating in research our clinicians have always applied research and evidence to ensuring the highest standards for our patients, staff and stakeholders. Continuing to utilise research findings and increasing participation in research is being encouraged and promoted across the organisation. We are working in partnership with the Kent and Medway Comprehensive Local Research Network1 (CLRN), Health and Europe Centre2 (HEC) and are participating in the Academic Health Science Network3 (AHSN) as well as working closely with our local higher education institutions and other healthcare providers.

Some of our services and clinicians are actively engaged in research, recruiting patients to trials, participating in and undertaking studies. Further developing services and staff to support participation in research is essential if we are to be recognised as a research friendly organisation, and enable us to retain and

1 http://www.crncc.nihr.ac.uk/about_us/ccrn/kent_medway 2 http://www.healthandeuropecentre.nhs.uk/ 3 http://www.dh.gov.uk/health/files/2012/06/Academic-Health-Science-Networks-21062012-gw-17626-PDF-229K.pdf

The number of patients receiving NHS services provided by MCH in 2012/13 that were recruited during that period to participate in research approved by a research ethics committee was 29, although only eight are allocated to the organisation as the patients were recruited by our stroke team at either Medway Foundation Trust or Sheppey Hospital.

They go the extra mile and then some.

The new service has improved things 100% - much more efficient and quicker too.


recruit high quality staff.

Goals agreed with commissioners Use of the CQUIN payment framework The CQUIN payment framework aims to support making quality the organising principle of NHS services, by embedding quality at the heart of commissioner–provider discussions. It is an important lever, supplementing quality accounts; to ensure that local quality improvement priorities are discussed and agreed at board level within, and between, organisations. It makes a provider’s income dependent on locally agreed quality and innovation goals. Use of the CQUIN framework indicates that we are actively engaged in quality improvements with commissioners, some of which impact beyond the boundaries of the organisation and improve patient pathways across the local health economy. Agreement being reached with commissioners about quality improvement goals is an indicator of our contribution to quality improvement in local health services more broadly.

There were 41 clinical staff participating in research approved by a research ethics committee in MCH during 2012/13. These staff participated in the following studies:

Emotional Processing and Social Cognition in Amyotrophic Lateral Sclerosis/Motor Neurone Disease

CLOTS 3 A randomised controlled trial to establish the effectiveness of intermittent pneumatic compression to prevent post stroke deep vein thrombosis

BMET The Brief memory and Executive Test a screening tool for identifying cognitive impairment in small vessel disease.

CROMIS-2 Clinical Relevance of Microbleeds in Stroke - a study looking into their clinical relevance

SO2S Stroke Oxygen Study- A multicentre randomised control study assessing whether routine oxygen in the first 72 hours after a stroke improves longer term outcome

Vestibular stimulation In the last three years, no internal publications have resulted from our involvement in NIHR research. Our engagement with clinical research demonstrates our commitment to testing and offering the latest treatments and techniques.

A proportion of our income in 2012/13 was conditional on achieving quality improvement and innovation goals agreed between MCH and the commissioners we entered into a contract, agreement or arrangement with, for the provision of NHS services, through the CQUIN payment framework.

The team were all very supportive and gave me the willpower to do things for myself.


Overview of 2012/13 CQUIN achievements The 2012/13 CQUIN Scheme for NHS Kent and Medway (K&M) contains six headline topics with 12 indicators. The indicators have different financial values attached to them dependent on the activity and weight placed on the scheme by the commissioners.

CQUIN Scheme Q1 Q2 Q3 Q4

Patient Experience 100% 100% No target 100%

Safe Care 100% 100% 100% 99%

Enhancing Quality programme 100% 100% 100% 100%

Safe Workforce 100% 100% No target 100%

Innovation Health and Wealth HII No target 100% No target 100%

K&M Long Term Conditions Programme 100% 100% 100% 100%

Full details of the 2012/13 CQUIN Scheme is available on request from [email protected].

What others say about MCH

Statements from the Care Quality Commission As providers of regulated health services we have a legal responsibility to make sure they are meeting essential standards of quality and safety. These are the standards everyone should be able to expect when they receive care. The essential standards are described in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the CQC (Registration) Regulations 2009. The CQC regulate against these standards.

The CQC carry out inspections at least once a year to judge whether or not the essential standards are being met. All inspections are unannounced unless there is a good reason to do otherwise. There are 16 essential standards, grouped into five key

areas that relate directly to the quality and safety of care. When the CQC inspect they check all or part of any of the standards depending on the individual circumstances of the service, however they will always inspect at least one standard from each of the five key areas every year. The CQC have completed the 2012/13 inspections of MCH’s five registered sites: St Bartholomew’s Hospital, the Wisdom Hospice, Darland House, Medway on call care (MedOCC) and Unit 5 Ambley Green (a total of 16 different services). Five standards were inspected:

MCH is currently registered with the Care Quality Commission (CQC) with no conditions. The CQC has not taken enforcement action against MCH during 2012/13.

They go the extra mile and then some.


Outcome 1 Respecting and involving people who use services Outcome 4 Care and welfare of people who use services Outcome 7 Safeguarding people who use services from abuse Outcome 14 Supporting workers Outcome 16 Assessing and monitoring the quality of service provision

During the inspection visits the CQC inspector observed how people are cared for and talked to people who use the service, to their carers and to staff. They also reviewed information about our processes and checked service records to ascertain whether the right systems and processes are in place. St Bartholomew’s Hospital: ‘People told us they understood and had been involved in setting goals for their rehabilitation. People described the support and care the therapists were providing for them in order to regain independence to return home. Staff we spoke with were aware of who they must report any suspicions of abuse to. Staff had also received training in the Mental Capacity Act and deprivation of liberty. All new staff were subject to police checks before commencing employment, as well as robust recruitment checks including checks of identity and taking up of references. Staff had a six month period of probation before being confirmed in their posts.’ Wisdom Hospice: ‘There were a range of activities and complementary therapies available for people, including massage, physiotherapy, sensory treatments, as well as arts and crafts. People and relatives we spoke with said that the care and support they or their loved one received was outstanding. One person said "I can't praise them enough." another said "You couldn't wish for a better place."’ Darland House: ‘We found that people were receiving the care and support they needed. We saw that staff assisted people in a caring and sensitive way and understood people's complex needs. We saw that staff treated people with respect and with regard for their privacy and dignity. A relative we spoke with said that Darland House was, "Marvellous" and, "I can't fault the place." Staff said that they received the training and support they needed to enable them to care for the people living at the home.’ MedOCC: ‘We saw that that any discussion about people's care and treatment and the treatment itself happened in private consulting or treatment rooms. There was a notice in the waiting room telling people that phone calls were recorded. Call staff were discreet when answering calls from people and there was a secure fax where information about people was received from GPs. Patient records could only be accessed using a smart card system. The organisation's privacy officer monitored access to make sure only authorised and appropriate people accessed patient records at appropriate times.’

They gave my wife her dignity back.


Ambley Green: ‘The inspection was conducted over two days by two inspectors. We visited eight services that provided three of the six regulated activities registered from Unit 5. We observed interactions between staff and people using the services. We found that staff took time to listen to people, answer their questions fully and check people’s understanding. We saw that staff were polite and provided explanations about people’s care and treatment. One person who used the dermatology service told us, "They always tell me what they are doing and why, they explained what I needed and I was happy with that."’ Data quality The importance of reliable data is both operationally and strategically important for MCH:

for safe and effective treatment and care of our patients for evidencing contracted outcomes for identifying current trends and predicting future trends in activity so that plans can

be made based on the predicted demand

Processes to validate the quality of data are now well embedded into ways of working through the combined efforts of system support staff and clinical services. In addition to maintaining robust validation processes MCH has successfully implemented new systems and tools during the course of 2012/13 which enable achievement of data quality improvement objectives. Notable achievements and progress have been:

1. New community IT system - The first phase of MCH’s deployment of a new

community IT system, Advanced Community, went live in August 2012. By replacing paper patient records and enabling electronic sharing of patient data the level of duplication and mistyped information will be significantly reduced.

2. Data migration onto new community IT system – having considered the possibility of automating the data migration from the old system to the new one the decision was made to perform a manual cleanse of the data held on the old system before entering it into the new one. This will ensure the quality of data held on the new system will be as accurate as possible from day one.

3. Personal Demographic Service (PDS) - this is the national electronic database of NHS patient demographic details eg name, address, NHS Number. Access to this service was made available in January 2013. In addition to avoiding duplication of demographic information it has improved accuracy across the system.

4. Data Quality Improvement Plan (DQIP) – the following were achieved: minimising the changes in data after ‘freeze’ dates; improving waiting time data; data cleansing in preparation for migration onto new community healthcare IT system; standardised clinical coding.

5. Secondary Uses Service (SUS) – MCH agreed its first data quality strategy for SUS submissions in relation to inpatient activity data.

MCH has not been required to participate in any special reviews or investigations by the CQC during the reporting period.

Everyone is always willing to help and answer patients’ needs.


The new community IT system will continue to be deployed to our various clinical services throughout 2013/14 and into 2014/15 and so the benefits described in points 1, 2, and 3 will be further realised as new services go live. As with any deployment the scope for errors due to unfamiliarity are higher in the early stages. To mitigate against this, training and education on the importance of data quality form part of the training provided to all staff using the system. Occasional errors in respect of inaccuracies in inputting were identified early on, so to ensure improvements are implemented all such incidents are logged on our incident reporting system to ensure patterns are identified and addressed. As a result some enhancements were implemented by the supplier to reduce the opportunity for error. NHS number and general medical practice code validity Information governance toolkit attainment levels The information quality and records management attainment levels assessed within the information governance toolkit provide an overall measure of the quality of data systems, standards and processes within an organisation. The information we hold in patient records is of huge personal significance and for details to be disclosed, maliciously accessed or lost would represent a serious infringement of patient privacy. We place great emphasis on the need for confidentiality in respect of personal information. This applies to manual and computer records as well as any conversations about a patient or their treatment. All our staff are required to complete annual training to ensure they are updated on the best ways to prevent information loss or disclosure. We have had a small number of minor information breach incidents, eg a letter being posted to a patient at an old address. Each incident has been investigated and any measures we identify to prevent the same thing happening again are put in place. For example, as a result of an email containing information being sent to the wrong recipient our staff are now required to password protect emails that contain patient or staff identifiable information. Clinical coding error rate

MCH submitted records during 2012/13 to the Secondary Uses service for inclusion in the Hospital Episode Statistics which are included in the latest published data. The percentage of records in the published data which included the patient’s valid NHS number was 99.5% for admitted patient care and those which included the patient’s valid General Medical Practice Code was 99.8% for admitted patient care.

The MCH information governance assessment report overall score for 2012/13 was 78% and was graded green. This means we scored at or above the required national requirements.

MCH was not subject to the payment by results clinical coding audit during 2012/13 by the Audit Commission.


Part 3: Review of quality performance Improvements in the delivery of patient care have been identified within a number of services both through the performance framework and intelligence from other sources such as complaints, incidents, patient experience, recruitment and feedback from our stakeholders. Key review areas: The podiatry service - where a number of patients have experienced issues contacting the service and the length of time they have had to wait for their appointments. The data we reviewed clearly showed evidence of increasing waiting times and delays in communication and / or booking of appointments. The review considered the clinical quality of the service and found no concerns relating to clinical quality however there are clear issue related to processes, response times and engagement with users. A detailed action plan resolving the process and booking system have been put in place and additional short term staffing used to address the waiting times. St Bartholomew’s Hospital - there were a number of areas of concern relating to the experience of patients whilst in the hospital, staff engagement generally, as well as recruitment and absence issues. The review has illustrated a need to enhance the clinical leadership and support to front line staff including reviewing the way the various means of communication directly with patients and carers but also through utilising a multi-disciplinary approach to providing care in this rehabilitation unit. The community nursing service - to review service delivery which is and has been under considerable pressure due to the increasing demand for the service from an ageing population with long term conditions (eg heart and respiratory disease, diabetes, etc), as well as the delivery of care closer to home, and challenges recruiting suitably qualified senior members of staff. A comprehensive service development plan has been put in place to facilitate the delivery of the long term conditions pathway and a workforce plan underpins this at the same time seeks to address the recruitment issues.

The health visiting service is under re-development as a result of the national Call for Action for the service. This includes considerable expansion and development of the workforce to identify and deliver the core elements of the Healthy Child Programme to ensure the best start for children and the right support for parents.

Privacy and dignity It is extremely important that anyone being treated by any of our services is treated with respect and inpatients cared for in an environment that meets their needs. We initially carried out an internal audit throughout our clinic location environments to pinpoint areas in need of improvement. Significant changes were made, such as new signage and bariatric seating; however without consulting with our patients we couldn’t

You have provided high quality, professional care.


fully understand their needs, which is vital to providing a first class service. We have now ensured that the question of privacy and dignity has been included in every patient experience questionnaire throughout our services. The results were excellent for the third year running with 98% of those who responded stated privacy and dignity was good or very good. Further questions have now been implemented into the 2013/14 patient experience programme to further improve feedback so that we continue to improve the services we provide.

Patient experience The patient experience programme for Medway Community Healthcare 2012/13 entailed the development of service specific toolkits that examine the needs of our patients. The toolkits were developed, piloted distributed and analysed throughout the year. The return rate remains high at 36%, significantly above the 20% national target. The overall experience score for 2012/13 remains identical to the score achieved in 2011/12, although there is a significantly higher percentage of respondents stating very good rather than just good (15%). The friends and family test All surveys included the friends and family test; a validated, reliable tool to establish the population’s loyalty to services. The question is, ‘How likely would you be to recommend this service to your family and friends?’. The score is calculated in a way that provides a percentage that can then be compared locally and nationally to evidence improvements or to benchmark across the services. The score is between -100 to +100. The overall friends and family score for the organisation is 74% which indicates: good to excellent services, the service level score will be utilised as a benchmarking outcome measure for 2013/14 programme.


What our patients say

The word cloud above shows the adjectives used by patients in our patient survey - the larger the words appear the more frequently they have been used. A graph to demonstrate the friend and family score (-100 to +100%) for each service. (Key - Independent unit, Planned care, Unplanned care business units). Scores between -50 and 0 are deem poor to fair, 0-50% fair to good, >50% good to excellent.


Recommendations for 2013/15:

Continue to enhance our culture of putting patients at the centre of all we do. Ensure all service users are offered the ability to feedback and improve the

dissemination of findings. Utilising new systems improve the quality and real time reporting capabilities. Review cost implications verses quality of the data required when developing future

toolkits


Compliments and complaints Feedback given by patients about their experience of care and treatment is important to us and helps us to make improvements. Patients are actively encouraged to provide feedback and share their comments, compliments, concerns and complaints and we promote this through our Tell Us leaflet and website. During 2012/13 we saw 796,130 patients, some for the first time and some for follow up appointments. Over that time, we received 163 complaints; that is one complaint for just under every 5000 patient appointments. Three complaints were reviewed by the Health Service Ombudsman and of those; one required us to take action. An expert clinical advisor recommended we ensure our care provision was compliant with the end of life care standards, our review of these showed that we were compliant and met the standards.

Although we have not identified any trends in the clinical care or treatment, we have identified some issues with communication, and therefore understanding, between clinicians and patients and carers. Our staff have customer care training however we are looking at further communication training that may be required. Our organisational values and the service pledges support working in partnership and being caring and compassionate both of which inform individual staff performance review. A number of comments have been received by our customer care team about the difficulties accessing the podiatry appointment telephone system. The issues have included the telephone not being answered, not being able to leave a message or no response when a message was left. Following a review of podiatry systems and processes we are now commissioning a new telephone system - specifications have been drawn up and hopefully a more efficient system will be in use in the next few months. A number of patients described turning up for blood tests before the end of a clinic and being turned away as there were too many patients waiting. We have amended our advertised clinic times so that all patients who attend will be seen. In some areas the clinic days have been changed to meet the demand and plans are in place to open more clinics including Saturdays and early morning.


Changes this year The National Quality Board requires, for the first time this year, reporting against a core set of quality indicators. These core indicators identified in a Department of Health (DH) letter (January 2013) describe only one indicator relevant to MCH, which we may choose to report on:

The staff survey that we undertook last year did not ask this question therefore we have no data to report however for the coming year we will be asking staff whether they would recommend their service and the organisation as a provider of healthcare services and as an employer. Additional questions will asked as to whether staff feel able to raise concerns about patient care and whether they believe that quality is the first priority for MCH. Staff surveys will be undertaken twice in the coming year to ensure that any issues highlighted through the initial survey are acted on and improvements made. We will report the friends and family score in the 2013/14 quality account. Achievement against our quality priorities for 2011/12 In our 2011/12 quality account we identified seven areas that our patients, staff and stakeholders said were important for MCH to focus on. The table below gives the progress we have made on the priorities throughout the year.

Indicator Target Q1 Q2 Q3 Q4

1. Patient safety a. Reduce the number of patients acquiring a pressure ulcer

53 32 46 43

b. Provide environments and care where the risk of infection is minimal

87% 90% 87% 99% 99%

Staff being bare below the elbow 100% 100% 100% 100% 100%

Compliance with hand hygiene 95% 99% 99% 99% 99%

Cleaning audits 87% 91% 92% 93% 90%

Compliance with MRSA screening 100% 100% 91% 93% 98%

Reported Cdiff or MRSA 0 No attributed infections

2. Clinical effectiveness a. Develop personalised care plans for patients with long term conditions

Met

b. Develop outcome measures Partially met

3. Patient experience c. Patient feedback – working toward real-time feedback.

Met

The percentage of staff employed during the reporting period who would recommend the organisation as a provider of care to their family or friends.


d. Intentional rounding Met

e. Reducing waiting times in services where there are challenges

Partially met

The following provides more detail on each of the priority areas action we have taken, processes we have put in place and our achievements as well as areas for continuing focus. 1. Patient safety a. Reducing the number of patients acquiring a pressure ulcer whilst in our care Over the last two years we have worked to ensure all patients who are found to have a pressure ulcer are reported through our incident reporting system. This enables us to undertake an investigation into each and every one to identify why and where the patient developed the pressure ulcer and what, if anything, our services could have done to prevent the ulcer happening. Pressure Ulcer Incidents by Type 2012/13

Q1 Apr 12 - Jun

Q2 Jul - Sept

Q3 Oct - Dec

Q4 Jan 13 - Mar

Acquired (unavoidable) 48 30 40 41 Acquired (avoidable) 5 2 6 2 Inherited (informed) 46 41 30 44 Inherited (uninformed) 19 18 25 29 Totals: 118 91 101 116

Patients developing pressure ulcers are categorised in one of four ways:

Acquired (unavoidable) – despite appropriate pressure relief and advice patients develop a pressure ulcer due to, for example, their deteriorating health or not using equipment appropriately.

Acquired (avoidable) - appropriate equipment or advice, or plan of care was not sufficient to prevent the pressure ulcer.

Inherited (informed) – a patient is referred to the care of our services with a pressure ulcer, for example from a care home, GP, or on discharge from hospital.

Inherited (uninformed) – as above but the service is not informed that the patient has a pressure ulcer, most commonly hospital acquired.

We are pleased that very few of the thousands of patients we provide care for develop a pressure ulcer as a result of less than optimum care from our services; however we are not complacent and continue to work with Medway Foundation Trust, local care homes and others to reduce the number of patients who develop pressure ulcers. Of the 15 patients who did developed avoidable pressure ulcers two were grade 3 and one a grade 4; all of which were reported and investigated as Serious Incidents (reportable to the Department of Health). In all cases the lack of appropriate information and continuity of care led to the patient’s condition to deteriorate. Lessons from these incidents, and many of the others, have led to a review of the leaflet we provide to our patients describing how they can best care for their skin to prevent the risk of pressure damage. We have updated the training staff receive in managing patients who are vulnerable to pressure damage and we are reviewing the provision of equipment such as mattresses and cushions used to prevent and treat such damage.


Reducing harm to our patients remains a quality priority for 2013/14 and we will continue our focus on reducing the incidence of patients suffering pressure damage. b. Continue to provide environments and care where the risk of infection is minimal We continue to work with staff, landlords and our patients to ensure that the patient treatment areas are clean and well maintained. All of the buildings where we provide services are audited against a cleaning standard. Where shortfalls are found, we will take corrective action immediately. However, due to the age of some of the buildings we use, the cleaning scores are not as high as we would aspire to due to the condition things such as flooring and paintwork. Our dress code requires our clinical staff to wear short sleeves and no jewellery except a plain wedding ring. Correct hand hygiene by our staff is one of the important ways we prevent infection and keep our patient safe. All our staff are kept up to date with our hand hygiene approach through their infection control link practitioner, annual training and each clinician is audited for their compliance too. All services are monitored and held to account for their compliance. At St Bartholomew’s Hospital patients are screened for MRSA bacteria on their skin as safe patient care requires. This ensures that if a patient does have MRSA on their skin we can give the correct treatment to remove the bacteria and reduce any risk to them. We are required to report any blood stream MRSA or C.difficile diarrhoea infections that occur in our patients while under our care, through this year we have had no patients acquiring an MRSA blood infection. One patient developed a C.difficile diarrhoea infection as a result of previous treatment in the acute hospital. Our staff are required to undertake a range of training programmes and supervision to keep up to date on preventing this type of infection. 2. Clinical effectiveness a. Developing personalised care plans for patients with long term conditions – The community nursing and community physiotherapy teams have developed a single personalised care plan, My Plan, which aligns to the electronic patient record that is being utilised as part of the roll out of our new community information system. This is being further developed in 2013/14 in line with the multi-disciplinary case management approach within the new long term conditions pathway as well as being rolled out across all services ensuring the patient has one jointly agreed plan that meets their care and treatment needs. Within the palliative care service the staff work with their patients and families to ensure their advance care wishes are explicit and that information made available, with the patient’s consent, through the use of the my wishes register. b. Development of care outcome measures implementation Each of our services has been developing outcome measures that really identify the experience of patients. This is being achieved by three ways: Patient experience – all services are involved in the patient experience programme and have the friends and family test as a key outcome measure for the service. This year’s scores will be used as a benchmark for improvement. To assist with improving the quality


of the information we receive, we have developed a standardised customer survey which includes the friends and family test as well as 12 core experience indicators. This will be used to review the quality of the services across the organisation. Specific Measureable Attainable Realistic Timed (SMART) goals – SMART goals are written and agreed with the patient to ensure they are fully involved and consent to care. It has been evidenced that personalised goals and care plans improves the quality of the care and improves outcomes. During 2012/13 we conducted an audit on the quality of our care plans. The results consistently demonstrated that although we provide care plans for our patients, the detail and use of SMART goals will ensure we are accurately measuring outcomes. These results were presented to the staff at GAIN, it was agreed there were two main requirements to enable improvements; the development of a standardised personalised care plan tool (My Plan) and training on SMART goal setting, motivational interviewing and utilisation of the tool. Training has been arranged throughout 2013/14 and will be mandatory for all staff that develop care plans with patients. To enable us to evaluate the training, this will be re-audited on an individual rather than service basis in the Clinical Quality Improvement Programme 2013-14. Clinical quality measures (eg quality of life questionnaires) -The introduction of the community information system allows services, as implementation rolls out to include clinical outcomes to their assessment forms. This will allow easier access to the information for auditing purposes therefore generate outcome measure reports. 3. Patient experience a. Patient feedback – working toward real-time feedback We researched and procured a new survey system that provides scope for greatly improved feedback and audit systems. The real benefit of this programme will be the availability of real-time reporting. This provides services with instant feedback to allow immediate action, which will ensure customer experience is at heart of all they do. Implementation is now completed and operational from 1 April 2013. b. Intentional rounding National concerns about the ability to provide essential aspects of care have focused attention on ensuring that these are delivered effectively and consistently. Intentional rounding involves health professionals carrying out regular checks with individual patients at set intervals. The approach has clear, measurable aims and expected outcomes that have been evidenced in research studies. Ward teams organise their workload, providing more consistent, individualised and safe patient care. Rounding had been shown to reduce adverse incidents, such as falls and pressure ulcers, and to generally improve patients’ experience of care. The CQC noted in their unannounced inspection report on St Bartholomew’s Hospital: ‘We saw that a two hourly check was carried out on all the people using the service, this check included asking people if they would like a drink, checking their call bell was within reach and having a quick chat to ensure they were not in any pain.’ The nurses and therapists, at St Bartholomew’s Hospital, have consistently maintained intentional rounding throughout the year.


c. Reducing waiting times in services where there are challenges MCH has seen a consistent reduction in the numbers of patients waiting to access services, and improvements generally in waiting times across services. Significant improvements are evident within children therapy services and the children’s pooled budget for school aged speech and language therapy. Dermatology services have also seen a significant improvement. Within physiotherapy (musculoskeletal) and podiatry services there was initially a considerable improvement. However, the demand for both services has increased and this is reflected in waiting times for routine patient referrals although urgent treatment referrals have maintained the improved position. This issue is being addressed in discussion with Medway CCG to seek safe and effective ways to manage the demand. Podiatry has an action plan in place to review waiting times with key actions for increasing patient access and improving the booking process which will help to address the issue. A review of waiting times and booking processes is underway within the nutrition and dietetics service.

Supporting and developing our staff Organisational values and our pledge Our organisational values are well established and integral to staff induction, the probation period we have for all new members of staff, individual assessment of performance and recognition of those staff who go above and beyond. Every service through 2012/13 has, or is in the process of, developing a pledge. Based on the NICE quality standards for patient experience and aligned to our organisational values and the NHS Constitution these help to bring policy into practice by engaging teams to present a united agreement that is signed as a commitment by each member of staff. These bespoke pledges also provide outcome measures which we will utilise in future patient experience programmes. Recognising excellence awards November 2012 saw the first MCH annual recognising excellence awards presentation where the overall winners of our caring and compassion, partnership, quality and value and outstanding achievement awards were celebrated. The awards recognise individuals, volunteers and teams who provide excellent care and service and the difference it makes to patients and colleagues. They are based on our organisational values, that

we are caring and compassionate we deliver quality and value we work in partnership

Congratulations to the winners, runners-up and everyone who has been nominated on their achievement. Nominations continue to flood in every month from patients and staff – a testament to the high quality of the daily work of our staff.


Award Name Team

Winner Outstanding achievement

Kate Henderson-Thynne Children's therapy

Runner-up Frances Okomah, Annabel Cole, Danielle Wanstall and Abi Durham

Human resources

Winner Caring and compassion

Shelley Liddle Adults’ integrated

Runner-up

Gillingham community nursing team - Kelly Spooner, Kay Brisley, Amanda Haley and Sarah Hope

Adults’ integrated

Winner Partnership MedOCC receptionists - Carolyn McNally and Justine Myton

MedOCC

Runner-up Sam Clark Human resources

Winner Quality and value

Margaret Howard and Belinda Jones

Business intelligence and IT

Runner-up Chris Gedge Stroke

Pre-registration student placements MCH provided placements for 284 students during the period Sept 2011- Aug 2012; this amounted to 1504 placement weeks. This is an average of 5.2 weeks per student. There was an increase in nursing placements from 205 in 2010/11 to 219 in 2011/12. Students on placement within teams receive local induction and are fully supervised and supported by local teams, this enables them to develop good relationships.

“The team worked well together and they embraced me and made me feel respected and an important member. This was my first placement in the community and after guidance and orientation to the system was able to gain more confidence and was able to engage and work with a small caseload. Everyone was very willing to help with any queries although my time spent in this placement was a hectic and changing environment.” “Working with other professionals and teams was particularly well facilitated. Self-directed learning and management of own learning needs was encouraged and respected.”


Nursing Times Awards 2013: our nurses were shortlisted in the community placement category of the Nursing Times Awards 2013. In the last year, over 218 nurses have undertaken a placement at Medway Community Healthcare across a range of services including specialist nursing, palliative care and community nursing in clinics; inpatient units and people’s homes across Medway.

Preceptorship The organisation recruited higher numbers of newly registered practitioners in 2012/13 than previous years, the majority of them were nurses, and we have also improved our overall retention rate of newly registered practitioners. All newly registered practitioners have a preceptor to support them through the initial period as a clinician. There is strong evidence that these staff feel supported in their role and are generally gaining in confidence in all areas and are highly satisfied with the programme. Preceptors have also described how valuable the support of their manager is and this is an improvement compared to last year. Developments in preceptorship have meant that a new programme will be introduced using the National Leadership Framework.


Statements In line with the Department of Health letter, the draft version of our quality account was shared with HealthWatch and Medway CCG for comment. We also sought comments from the Medway Council Health Overview and Scrutiny Committee. Their responses are below. We did not receive any comments from HealthWatch. Our draft quality account was also shared with our community forum, the MCH elected members’ forum and staff - their comments have been incorporated. We thank everyone for their interest and support. Medway Council Health and Adult Social Care Overview and Scrutiny Committee: I am writing to thank you for inviting the Health and Adult Social Care Overview and Scrutiny Committee to comment on your Quality Accounts. As the Quality Accounts are often received outside of the business cycle for the Committee the Assistant Director, Adult Social Care and the Assistant Director, Customer First, Leisure, Democracy and Culture have a delegated authority, along with the Chairman and spokespersons of the Committee to respond. Set out below is the response on behalf of the Committee: `The Health and Adult Social Care Overview and Scrutiny Committee welcome the opportunity to comment on Medway Community Healthcare’s Quality Accounts. During the past year the Committee expressed concerns regarding the podiatry service. Concerns about some of the shortcomings with the service are already reflected in the Quality Account The Committee will be taking a continuing interest in the improvements set out in Medway Community Healthcare’s action plan going forward. The Committee looks forward to further engagement with the organisation over the next year’. Kind regards Rosie Gunstone Democratic Services Officer on behalf of the Health and Adult Social Care Overview and Scrutiny Committee NHS Medway Clinical Commissioning Group: In response to the draft Medway Community Healthcare (MCH) 2012/13 Quality Account submitted to NHS Medway Clinical Commissioning Group (MCCG) please find detailed below the MCCG statement in accordance with the National Health Service (Quality Accounts) Amendment Regulations 2012. NHS MCCG welcomes the 2012/13 draft Quality Account submitted by Medway Community Healthcare and can confirm that the CCG has reviewed it against all the Department of Health reporting requirements and as far as can be determined the


commentary and data presented are an accurate and honest reflection of progress made in improved service delivery and patient outcomes. The Quality Account sets out the priorities identified for the year and demonstrates how most of these have been fully achieved or surpassed. The CCG acknowledges the on-going excellent record MCH has with regards to health care acquired infections and acquired pressure ulcers as well as using patient engagement to set priorities and using patient feedback were services have not met their expectations to make necessary service changes. The MCCG acknowledges and supports the 6 priorities for 2013/14 detailed within the Quality Account around Patient Safety, Clinical Effectiveness and Patient Experience. The Medway population will continue to age and with that will come a population that has increased prevalence of longer term conditions with many more people having more than one. This will mean an increased reliance on Community services to help and support people to live with their long term conditions ensuring that where possible we avoid unnecessary hospital admission, whilst always aiming to deliver care closer to home with the right service to meet the patients need. MCH are responding positively to this challenge through continuous review of services and pathways as well as ensuring that the care given is patient centred and that improvement goals are jointly agreed and moved towards. NHS MCCG look forward to continuing to work closely with the Clinical Quality Director and colleagues at all levels within the organisation. We look to continue to strengthen our relationship through the Clinical Quality Review Group with the aim of gaining the on-going assurance that the quality of local services provided by MCH are maintained and continually improved in all areas of the organisation. Yours sincerely Dr Peter Green Chief Clinical Officer NHS Medway Clinical Commissioning Group

How you can provide feedback on our account We would like to hear your comments and feedback on the quality account and any suggestions you may have for the priorities and content for future reports. Get involved To become a member of our community forum join in here > Your feedback For further information or to request a hard copy of this report please contact the communications team or call 01634 382211. Other languages This information can be made available in other languages and formats Visit www.medwaycommunityhealthcare.nhs.uk to find out more about us and the services we provide.

http://www.medwaycommunityhealthcare.nhs.uk/joinin

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mch quality account 2012/13

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