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First-rate people. First-rate care. First-rate value.

Quality Account 2018 to 2019

1 www.firstcommunityhealthcare.co.uk

PrefaceWhat is a Quality Account and why do we produce one?Each year all providers of NHS healthcare are required to produce a Quality Account to inform the public about the quality of the services they provide. It follows a set structure to enable direct comparison with other organisations.

It enables us to share with the public and other stakeholders:

• What we are doing well

• Where we can make improvements in the quality of the services we provide

• How we have involved our patients, service users, families and other stakeholders in evaluation of the

quality of our services and determining our priorities for improvement over the next 12 months

• How we have performed against our priorities for improvement as set out in our last Quality Account.

Our published Quality Accounts are also available for public scrutiny on our website at: www.firstcommunityhealthcare.co.uk/about-us

What does our Quality Account include?Our Quality Account is divided into three sections:

provides a statement from our Chief Executive with an introduction and overview

of who we are, what we do and why we produce this annual account.

focuses on our priorities for improvement in the quality of our services, by looking back at

the priorities we set last year and by setting new priorities for improvement for the coming

year. We then provide statutory statements of assurance which relate to the quality of

the services we have provided in the period 1 April 2018 to 31 March 2019. The content is

common to all NHS providers, allowing direct comparison across organisations.

provides a selection of how we review and improve the quality and performance of

our services. This is set out around the Care Quality Commission’s five key questions:

• Are we safe?

• Are we effective?

• Are we caring?

• Are we responsive to people’s needs?

• Are we well-led?

Part 2

Part 1

Part 3

2Quality Account 2018 to 2019

Introduction

Part 1

www.firstcommunityhealthcare.co.uk3

Foreword from the Interim Chief ExecutiveOn behalf of the Board I am proud to introduce our annual Quality Account for 2018/19. The document reflects our ambition as a Community Interest Company to deliver first-rate care, through first-rate people, offering first-rate value to achieve our vision of rejuvenating the wellbeing of our communities.

Throughout the past year we have continued our commitment to an open,

transparent learning culture and this is reflected in the number of incidents reported

and our staff survey results. We understand there is always learning around how

we can improve and strive to implement learning from what we do well and where

we can do better. I believe our improvement priorities for this year will help us on this

journey and make an impact on the quality and safety of our services.

Over the past year I am particularly proud of the achievements we have made

to improve how we use volunteers to enhance our patients’ experience whilst

staying on our ward, and our partnership working as part of Children and Family

Health Surrey to transform our service delivery and share good practice.

Over the next 12 months we will continue to work with our partners in care to

deliver high quality, safe care to our community. We hope to achieve this in a

number of areas, with a particular focus on improving and increasing our patient

and public involvement.

The high quality care we deliver is a credit to our exceptional staff who often go

above and beyond what is expected of them and I would like to thank them and

our volunteers for everything they do.

Val FrostInterim Chief Executive

Quality Account 2018 to 2019 4

About First Community Health and Care

Our vision: “Rejuvenating the well-being of our community”

First Community is part of the NHS family and provides community healthcare services to people in East Surrey and the surrounding area, and is rated outstanding by the CQC.

We offer a friendly face with first-rate care, delivered

by our first-rate people, offering first-rate value. We

provide high-quality nursing and therapy teams,

specialist care teams, children and family advice

and support as well as a rehabilitation ward, rapid

assessment clinic and minor injury unit at Caterham

Dene Hospital.

We are an employee-owned community interest

company and any surplus we make is used to

reinvest into our services. We are constantly striving

to improve services for our community, and our

passion is to deliver the highest quality of care for

our patients, service users and carers.

As an employee-owned organisation, we have

turned the traditional organisational hierarchy on

its head so the managers and Board are there to

support the function of clinical services and their

interface with patients and public. The inverted

triangle is stabilised by two smaller triangles - The

Council of Governors and Community Forum.

Staff

Community Forum Council of Governors

Patients and Public

Board


Our Services

Here is a list of the services we provide. For further information please visit our website: www.firstcommunityhealthcare.co.uk/what-we-do

Minor injury walk in Rapid assessment/treatment clinic

• Community neurological rehabilitation

(including multiple sclerosis, Parkinson’s

and stroke specialist nursing)

• Community physiotherapy

• Intermediate care

• Occupational therapy

• Nurse advisors for care homes

• District nursing

• Heart failure

• Respiratory

• Continence (adults)

• Tissue viability

• Proactive care

Community and specialist rehabilitation therapies and nursing

• Audiology

• Integrated care & assessment

treatment service (ICATS)

• Orthotics

• Outpatient physiotherapy

• Nutrition and dietetics

• Podiatry

• Speech and language therapy

Therapies in clinics

• Caterham Dene Hospital ward

(nursing and therapies)• Community beds

Bed based care

Health visiting Immunisations School nursing Therapies

Adult Services

Children & Family Services


*www.surreyi.gov.uk/health-profiles/east-surrey

Surrey is generally not as

ethnically diverse as the rest

of England. In east Surrey

8.3% of the population

is of non-white ethnic

backgrounds compared

to 14.6% for England. There

are around 288 Gypsy, Roma, and Travellers

residing in 72 pitches

across seven sites.

There were 2,235 live

births in 2015. A third

were to mothers over 35 years. The East Surrey

Clinical Commissioning

Group birth rate for

women aged 15-44

years (66 births per 1,000

women) is slightly higher

than the Surrey average

(63 births per 1,000 women).

Our East Surrey Community*

Around 18%

(32,365) of the

population are

aged 65+ years The registered

population is

181,742 in

east Surrey


• The Quality Account presents a balanced picture

of the organisation’s performance over the

period covered

• The performance information reported in the

Quality Account is reliable and accurate

• There are proper internal controls over the

collection and reporting of the measures of

performance included in the Quality Account, and

these controls are subject to review to confirm

that they are working effectively in practice

• The data underpinning the measures of

performance reported in the Quality Account is

robust and reliable, conforms to specified data

quality standards and prescribed definitions, and

is subject to appropriate scrutiny and review

• The Quality Account has been prepared in

accordance with Department of Health guidance.

The directors confirm to the best of their knowledge and belief they have complied with the above

requirements in preparing the Quality Account.

By order of the Board

Florence Barras Val Frost

Chair Interim Chief Executive

5th June 2019

Statement of Directors’ Responsibilities in Respect of the Quality AccountThe directors are required under the Health Act 2009 to prepare a Quality Account for each financial year. The Department of Health has issued guidance on the form and content of annual Quality Accounts which incorporates the legal requirements in the Health Act 2009 and the National Health Service (Quality Accounts) Regulations 2010 as amended by the National Health Service (Quality Accounts) Amendment Regulations 2011.

In preparing the Quality Account, directors are required to take steps to satisfy themselves that:


Our priorities for improvement

Part 2


Looking Back – Reporting on Our 2018/19 Priorities for Improvement

In our last account we chose four priorities for improvement focusing on the themes of patient safety, clinical effectiveness, patient experience and staff experience. The following information reviews our progress against each of these priorities, before outlining our priorities for the coming year.

Patient Safety – AchievedPatients with a urinary catheter are cared for under a urinary catheter pathway.

Why we chose this What we have done

The E-Coli programme is a directive from NHS England to reduce E-Coli infections by 20% by 2020. This has now been extended to 2022 with the ambition of a reduction of 50%. Urinary catheters increase the risk of E-Coli infection. Ensuring people with urinary catheters follow an evidence based care pathway can help to reduce the risk of transmitting infections.

We have been part of a system-wide working group aiming

to reduce the incidence of E-Coli infections in East Surrey.

Part of this group‘s work has been the care of people with

urinary catheters.

We have:

• Updated our catheter policy

• In partnership with Surrey and Sussex Healthcare, their

catheter passport has been updated and reviewed

• Arranged access to the catheter passport for any patient

who does not have one

• Reviewed the care of all people with catheters

on community caseloads to review the reason for

catheterisation, products being used and the overall care

of these patients

• We have implemented the Houdini protocol, which is an

assessment tool to understand the need for a urinary

catheter and consider its removal

• Every patient with a urinary catheter that is referred to our

teams (Caterham Dene ward and community) has been

and will be reviewed with this protocol to determine if they

are suitable for a trial without catheter.

There are 150 patients on the district nursing caseload with

an indwelling urinary catheter who have been reviewed

using the Houdini protocol. Of these, 12 were followed up

for a trial without catheter and 5 have had their catheter

successfully removed.


Patient Experience – AchievedWe have reduced the time people, aged over 16 years, have to wait for a routine outpatient musculoskeletal physiotherapy appointment to within 6 weeks.

Clinical Effectiveness – AchievedWe have supported clinical staff within adult services to develop their clinical record keeping.


Feedback from our patients and our data indicated people were waiting too long for an appointment. We have improved the pathway for musculoskeletal services which will be compromised if there are long waiting times.

We have started to undertake first assessments over the

telephone rather than face to face appointments for:

• People who have had total hip replacements

• People who have had uncomplicated total knee

replacements

• People that have suffered from soft tissue injuries such as

ankle strain

• People that have recent onset of muscular skeletal pain

We receive electronic referrals from all of our GPs following

the implementation of a new system.

We are piloting self-referral that people can access via their

GP surgery without the need for seeing a GP.

Currently, the average wait for an appointment is 4 weeks,

whilst the longest wait is 6 weeks and the shortest wait is

2 weeks.


Record keeping featured in our serious incident investigations and good record keeping is essential to providing high quality, safe care.

We have designed and embedded a peer review record

keeping audit that is informed by other data such as serious

incidents.

The audit tool is designed to capture areas of required

improvement and exemplar practice in order to learn from

what is done well and what needs improving.

The process is about allowing people to work

collaboratively and to share insights around record keeping.

Feedback and learning is immediate as everyone is

part of the process. It fosters a culture of continuous

learning regarding patient safety and best practice in

documentation.

100% of community nursing staff have undergone peer

review. Feedback has been positive and there has been

evidence of improved record keeping when reviewing

incidents.


Staff Experience – AchievedWe have continued to invest in leadership training to develop confident, collaborative leaders.


We are using the Workplace Well-being Charter to benchmark ourselves against best-practice standards for a healthy workplace. This process presented us with an opportunity to develop a leadership pathway to help our staff develop their leadership skills further including empowering people to lead and manage others with authenticity, to give staff access to the tools they need to lead empowered teams, and to move the organisation towards a devolved model leading to increased trust and personal responsibility.

We have created and rolled out a leadership programme

with the help of an external expert who leads this

programme for our staff.

Learning and development is supported across First

Community by the learning and development team

maintaining a presence at all meetings to support the

learning agenda.

79 members of our staff have completed our leadership

programme to help strengthen our leadership capability

across the organisation. Delegates have given feedback

and the programme has been further developed in

response. Feedback has been overwhelmingly positive

in areas such as clarifying their identity as a leader,

supporting challenging conversations and setting

objectives for staff.

We have used a validated tool to measure the impact of this

programme and this has shown a significant increase in the

overall confidence of leaders at the end of the programme.


Looking Forward – How We Identified Our Priorities for 2019/20

First Community is committed to ensuring and improving the quality and safety of the care we provide. We recognise there is always more we can do, which is why we continue to pursue improvements to achieve our key values:

First-rate valueFirst-rate care First-rate people

Patient safety Clinical effectiveness Patient experience

Our priorities for improvement for 2019/20 have been developed through engagement with and learning

from patients, carers and our staff. We have looked at the feedback we receive and learning we have

identified throughout the year to understand where we need to focus our quality improvement activity.

We have used the three domains of quality of:

We developed our priorities for quality improvement in 2019/20 by:

Draft list of priorities

compiled based on

2018/19 performance

and national/

regional priorities

Considered

how to measure

these possible

priorities including

measurements and

data collection

already in place

Further engaged

with our stakeholders

to develop our

priorities and how

we will measure them

The list discussed

and consulted

internally through

service managers,

service leads and

Council of Governors

(a group of elected

staff shareholders)

to ensure staff

engagement. Board

made the final

selection

The list arranged

under the headings:

patient safety,

clinical effectiveness

and patient

experience with the

ambition to have

one priority under

each domain


Looking Forward – Setting Our Priorities

Patient ExperienceWhat are we going to do?

We will provide access for adults to dietetic treatment through the implementation of

group education sessions.

Patient SafetyWhat are we going to do?

We will undertake a multi-incident root cause analysis to understand if we can reduce

the risk of people falling and reduce the harm from falls.

Clinical EffectivenessWhat are we going to do?

We will enable people nearing the end of their lives to communicate their care

preferences by implementing the ReSPECT process.

Why we chose this How we will measure our success

• To increase/improve access to dietetics

• To be more efficient in the way we offer our appointments

• To enable mutual/peer support for patients and carers.

• Number of attendances/contacts increased

• Waiting times for appointments reduced

• Patient outcomes improved, for example HBA1c

measurements for diabetic patients.


The three main incidents recorded at First Community are pressure ulcers, slips, trips and falls and medicines. The number of incidents for slips, trips and falls increased from 19 during March, April and May 2018 to 40 during June, July and August. This is an increase of 110% (n=21).

• Incident reports completed to understand

how and why falls happen and the level of

resulting harm

• Triangulation of our falls prevention strategy

with the outcome of the aggregate root

cause analysis.


ReSPECT is a process that creates personalised recommendations for a person’s clinical care in a future emergency in which they are unable to make or express choices. Implementation will help ensure such decisions are made in accordance with a person’s own choices.

• Number of ReSPECT processes completed

• Good staff awareness/knowledge.


Statutory Statements of Assurance

The statutory statements in this part of our Quality Account relate to the quality of the service we have provided in the period 1 April 2018 to 31 March 2019. The content is common to all providers allowing comparison across organisations.

Review of ServicesDuring the period 1 April 2018 to 31 March 2019 First Community Health and Care provided NHS services. First

Community has reviewed all the data available on the quality of care for all of these NHS services.

Participation in National Clinical Audit and Confidential EnquiriesParticipation in national clinical audits and confidential enquiries enables us to benchmark the quality of

the services that we provide against other NHS Trusts, and hence highlight best practice in providing high

quality patient care and drive continuous improvement across our services. During the period 1 April 2018

to 31 March 2019 there were no national confidential enquiries covering NHS services that First Community

provides.

We take part in national audits to benchmark ourselves against the national care guidelines and also

against services providing a similar service across the UK.

The national clinical audits that First Community Health and Care participated in during the period 1 April

2018 to 31 March 2019 are as follows:

National Audit of Care at the end of Life

Number of cases submitted % submitted – 0% (no eligible cases)0

National Audit of Intermediate Care

80 out of 100 patients returned their service user

questionnaire and patient reported experience

measure. This is based on a national score and is

given on admission to the service and on discharge

to understand the effectiveness of the intervention.

• Our caseload of patients is less independent than

the national average on admission to the service

• After intervention and on discharge from First

Community, patients achieve a higher level of

independence compared to the national average

• Our patients reported a positive experience

when compared with the national average in

relation to confidence and trust, and dignity

and respect.

This year’s audit demonstrated an increasing number of readmissions to the local district general hospital

and we are working in partnership with our integrated discharge team to ensure referrals to our service

are clinically safe.


Cerebral Palsy Integrated Pathway

First Community’s children’s physiotherapy team

is part of the Cerebral Palsy Integrated Pathway,

a pathway for monitoring and preventing hip

displacement in children with cerebral palsy. This

enables these children to be cared for under a

specific assessment pathway which includes regular

assessment and pelvic x-rays. The assessments

used meant that small changes in musculoskeletal

presentation are identified early and acted upon.

Care is clinically reasoned, thorough, timely and

joined up by involving specialists when necessary,

ultimately leading to improved comfort and therefore

quality of life for the children and their families.

To date we have:

• 51 children with cerebral palsy in the local area

who are enrolled on the pathway

• The assessments have led to 14 orthopaedic

referrals and 2 spinal referrals

• 7 of these have had an intervention or have this

planned eg surgery

• All of the children seen in the pathway have had

changes made to their physiotherapy treatment

programmes as a result of the assessment.

National Audit of Pulmonary Rehabilitation

We are part of this audit which aims to collect information on patients referred to and who receive

pulmonary rehabilitation. Data collection has just opened for this so we are starting to submit our data.

National Diabetes Foot Care Audit

We have embedded the reporting tool into our standard patient notes in order to be able to participate in

this national audit to measure our performance against NICE clinical guidelines and other providers. This will

enable us to determine areas for improvement where necessary.

Sentinal Stroke National Audit Programme (SSNAP): Early Supported Discharge for People who have Suffered a Stroke

SSNAP is a major national healthcare quality

improvement programme measuring the quality and

organisation of stroke care in the NHS.

The overall aim of SSNAP is to provide timely

information to clinicians, commissioners, patients,

and the public on how well stroke care is being

delivered so it can be used as a tool to improve the

quality of care that is provided to patients.

We are currently analysing the information gathered

to date to see what improvements need to be

made. However we have recognised that the

Modified Rankin Scale scoring, which measures the

degree of disability or dependence experienced

by someone who has had a stroke, can be

inconsistent across different staff and this is a

training need. We are taking this forward with an

ongoing online training programme.


Reviewing Reports of National and Local Clinical AuditsOur clinical audit priorities are selected on the basis of national requirements, commissioning requirements

and local evidence that has emerged from themes from incidents or complaints.

First Community completed 123 local clinical audits and quality improvement projects in 2018/19.

Some of the actions from these projects have been to:

ResearchThe number of patients receiving NHS services provided or sub-contracted by First Community Health

and Care from 1 April 2018 to 31 March 2019 that were recruited during that period to participate in research

approved by a research ethics committee was zero.

Data Quality – Using Our Electronic Patient Record System, EMISEnsuring that all data we collect is of the highest quality and accuracy continues as an ongoing priority.

2019/20 will see the launch of an ongoing Data Quality Improvement Programme which aims to maintain

the standard of the data that we hold. Data sharing has expanded to include read-only access for our

partners in the Children and Family Health Surrey contract to allow for joined up care for families across Surrey.

Care Quality Commission (CQC)First Community is required to register with the Care Quality Commission (CQC) and is currently registered

with no conditions. We received our inspection in March 2017 when we were rated as Outstanding overall.

For the full report please visit: https://www.cqc.org.uk/provider/1-274331683

First Community continues to use the Key Lines of Enquiry (KLoEs) the CQC uses in inspections of

healthcare providers in planning, reviewing and evaluating services. In particular during the reporting

period we have reviewed the updated KLoEs and implemented an assurance and improvement

methodology around the KLoEs which embraces our transparent learning culture, supporting services to

identify and learn from what they can improve and what they do well.

Goals Agreed with Our Commissioners (CQUINs)

• Review and update DESMOND training for

people with diabetes. DESMOND is the

collaborative name for a family of group

self-management education modules, toolkits

and care pathways for people with, or at risk of,

Type 2 diabetes

• Increase training for staff on our ward around

the multi universal screening tool

• Provide further information to increase

attendance at our physiotherapy stability

classes

• Strengthen our medicines management on our

ward and minor injuries unit.

A proportion of First Community’s income in the

reporting period was conditional on achieving

quality improvement and innovation goals agreed

between First Community and any person or

body they entered into a contract, agreement or

arrangement with for the provision of NHS services,

through the Commissioning for Quality and

Innovation payment framework. First Community’s

CQUINS both related to Children’s Services and

have been taken forward with our partners in

Children and Family Health Surrey.


NHS Number and General Medical Practice Code Validity First Community did not submit records during the reporting period to the Secondary Uses service for

inclusion in the Hospital Episode Statistics which are included in the latest published data.

Information Governance Toolkit Attainment Level The Data Security and Protection Toolkit (DSPT)

replaced the Information Governance Toolkit as

the national standard for assessing standards

of data protection, confidentiality and technical

security across the health environment in the

2018/19 financial year. The standards imported

the 10 key recommendations of the National

Data Guardian (Caldicott) Report ‘Data Security,

Consent & Opt-outs’ of July 2016. This overhaul

of the toolkit into the DSPT also incorporated the

new legislative standards of the General Data

Protection Regulations (GDPR) and the UK Data

Protection Act (2018).

First Community was required to complete 40

overarching assertions with 100 items of mandatory

evidence needed. We were able to evidence 99

out of 100 mandatory evidence requirements which

meant that 39 of the 40 overarching assertions

were met. This is a strong result for First Community

and a significant improvement against last year’s

Toolkit score. The only exception was not being

able to provide evidence for the audit of our

confidential waste contractors, however the audit

has now been arranged and we will be able to

publish our Toolkit as fully compliant.

From April 2019, First Community has contracted

NEL to provide IG Compliance and Data Protection

Officer support to strengthen our processes and

management of personal data.


Overview of the performance of

our services

Part 3


Are We Safe?

Investigations and Learnings from DeathsWe have a mortality review process for people who reach the end of their life whilst staying on our ward

at Caterham Dene. We also investigate deaths that occur soon after transfer to another place of care to

identify if we could have done anything differently.

During the reporting period one person died while they were an inpatient on our ward.

0 Quarter 1

0 Quarter 3

1 Quarter 2

0 Quarter 4

By 31 March 2019, we carried out one case record review and no investigations for the one death included

in the reporting period. There were no cases where a death was subjected to both a case record review

and an investigation.

The number of deaths in each quarter for which a case record review or an investigation was carried out was:

0 Quarter 1

1 Quarter 3

0 Quarter 2

0 Quarter 4

0 representing 0% of the patient deaths during the reporting period are judged to be more likely than not

to have been due to problems in the care provided to the patient. These numbers have been estimated

using a local mortality review checklist.

First Community undertakes a review of care for all patients that die within 72 hours of transfer to another

care setting. During the reporting period 2 patients died within 72 hours of transfer and a local mortality

review was undertaken using a local mortality review checklist. Neither of these cases are judged to be

due to problems in the care provided to the patient.

Infection ControlWithin the reporting period…

Number of cases

of MRSA or C Diff

bacteraemia

Number of cases of

E coli bacteraemia

Number of outbreaks

of diarrhoea and

vomiting on Caterham

Dene Ward which were

contained. Two cases

were confirmed as

Norovirus and one had

no organisms isolated

100


Safety ThermometerThe Safety Thermometer is a point prevalence survey that reviews four key harms

that are deemed to be indicators of a safe organisation. These harms are pressure

ulcers, falls with harm, catheter associated urinary tract infection, and new venous

thromboembolism (VTE). This provides the overall percentage of patients that receive

‘harm free’ care. We report on this monthly and feedback to our teams.

falls with harmvenous

thromboembolism (VTE)

pressure ulcerscatheter associated urinary tract infection

Staffing Levels on the WardCaterham Dene ward has a safe staffing level which is displayed on the ward for all staff, patients and

visitors to see. We have an escalation plan in place to cover when staffing levels are reduced due to

sickness absence.

During the reporting period we have been unable to fill 0.3% of shifts on our ward at Caterham Dene

Hospital with agency and/or bank staff when substantively employed staff are not available. In these

cases we have maintained safe staffing levels by reassigning other qualified staff to clinical positions.

National Cleanliness AuditFirst Community prioritises the provision of a clean and safe environment and we use the National

Cleanliness Audit to monitor and improve this. Our community hospital has exceeded the national

standards for cleanliness.

audit result for cleanliness for each month in 2018/19 at First Community97%

National target95%

of people received harm free care compared with 97% nationally99%


Medicines IncidentsAll incidents involving medicines are reviewed and relevant learning taken forward. There has been an

increase in the number of interface incidents between 2017 and 2019. Examples of interface incidents

include a drug chart not being sent after discharge from acute hospital, dispensing errors, and

incomplete or inaccurate documentation and recording.

Each incident is discussed and collaborative work is undertaken as required to ensure transparent and

robust processes are in place when a patient is transferred from one care setting to another.

40

35

30

25

20

15

10

5

0

Q1

20

16/1

7

Q1

20

17/1

8

Q1

20

18/1

9

Q2

20

16/1

7

Q2

20

17/1

8

Q2

20

18/1

9

Q3

20

16/1

7

Q3

20

17/1

8

Q3

20

18/1

9

Q4

20

16/1

7

Q4

20

17/1

8

Q4

20

18/1

9

Interface Incidents Total Number of Incidents

Nu

mb

er

of

Inc

ide

nts

First Community Interface Incidents


IncidentsIn our staff survey more of our staff are telling us they have witnessed errors and incidents and our

incident reporting has increased. The increase in incidents reported has not seen an increase in the level

of harm to people who use our services. A high level of incident reporting helps protect both patients and

staff from avoidable harm by increasing opportunities to learn from mistakes and where things go wrong.

First Community has an open, learning culture, in part demonstrated by our high number of incidents

reported where there is insignificant harm and additionally by what our staff told us in our 2018 NHS staff

survey:

• 73% of staff responded positively when asked if First Community treats staff who are involved in an

error, near miss or incident fairly

• 96% of staff reported positively that First Community encourages the reporting of errors, near misses or

incidents.

Total number of incidents

% of incidents where harm was

insignificant

% of incidents that caused moderate

harm

% of the moderate harm that was

caused externally to First Community

1 April 2018 to

31 March 2019983 95% 5% 73%

1 April 2017 to

31 March 2018765 87% 13% 76%

1 April 2016 to

31 March 2017938 88% 12% 75%

Some of the learning from incidents has included:

• A pilot programme to easily identify people who are at a high risk of falling

• Review and change of the Abbreviated Mental Health Score used to assess patients’ capacity in line

with NICE guidance. Teaching sessions around how to use this are being rolled out to staff

• Review of our signage on the ward to ensure it is easy for our patients to read and understand.

Nationally there is a rise in people with dementia and we need to make sure our signage is clear and

concise for this patient group.

• We have reviewed our onward referral pathway from ICATS to secondary care.


Safeguarding Adults

Deprivation of Liberty (DoLs) Applications

We continue to safeguard people who lack mental capacity who are staying on our ward by making DoLs

applications when we need to restrict their liberty to ensure we do this legally and safely, acting in their

best interests. In recent years the number of DoLs applications were:

3 2018/193 2017/187 2016/17

Total no. of staff trained 1 April 2016 to

31 March 2017


31 March 2018


31 March 2019

Mental Capacity Act

and DoLs89% 95% 94%

Safeguarding level 2

(within last 3 years)95% 94% 94%

On call managers

level 3 (within last

3 years)

100% 82.6% 94.7%

97.2% of staff received training on Prevent Awareness, which is part of the government’s counter terrorism

strategy.

In June 2018 a new Safeguarding Adults Policy was created by the Surrey Safeguarding Adults Board and

in August 2018 the RCN published the Adult Safeguarding Intercollegiate Document.

Both these documents discuss roles and competencies and we are working to review our training to

ensure it is reflective of both of these documents by August 2019.

Safeguarding ChildrenWe trained 96% of staff in the 0-19 service in level 3

Safeguarding Children training against a target of

85% set by Surrey Safeguarding Board.

93% of all First Community staff have received

safeguarding children training at level 2.

In the reporting period, there were 51 safeguarding children referrals made. Neglect

remains the main cause for concern. First

Community is part of a Surrey-wide, multi-agency

neglect delivery group which has agreed that

a new risk assessment tool will be used by all

practitioners for evidenced based referrals to the

Multi-Agency Safeguarding Hub.

It is recognised that there is an increased number

of exploited children in Surrey, subject to sexual

and criminal abuse, and First Community is part of

a multi-agency group which is exploring ways to

identify and support these children.


Encouraging Communication by Empowering

Patients

Investigating the Level of Speech and Language Therapists for

Adults Who Stammer in Kent, Surrey

& SussexPositive Use of Volunteers

Eye Movement Desensitisation

and Reprocessing

A Multi-disciplinary Team

Approach to Reducing Length

of Stay

Patient and Public Involvement

Are we Effective?

Quality Improvement DayFirst Community’s eighth annual quality improvement day took place on 21 March 2019 and we were

pleased to showcase clinically led improvement initiatives across the organisation. We welcomed 120 guests, including staff from First Community, our commissioners and colleagues from other organisations

such as NICE.

Presentations on the day included a wide range of topics:

Cerebral Palsy Integrated Pathway Developing the

Dietetic Children’s Allergy Service

Life After Stroke

Internal Audit and the Link with Quality

Improvement

Medicines Management

International Dysphagia Diet Standardisation

Initiative

Preventing Hospital

Admissions


Improving Multi-disciplinary WorkingWe have made improvements to the way our staff work together on our rehabilitation ward at Caterham

Dene which has included increasing all staff cover to seven days a week. This has resulted in a number of

enhancements in the service we provide:

• Patients have rehabilitation sessions more

frequently

• Usually patients are seen five times a week

rather than three times a week

• Completing Wash and Dress Assessments,

Kitchen Assessments, practicing transfers at home

heights in a timely manner after therapists have

completed initial assessment to help identify care

needs and ongoing rehabilitation needs

• Therapists working at the weekend to facilitate

discharges at the weekend or early the

following week

• Development of initial assessment form which

helps identify any pressure areas and any need

for pressure relieving equipment which can be

ordered and delivered more quickly

• Completing welcome meetings with patients and

their family/carer in a timely manner to identify

any potential issues that may delay discharge

• Development of allocation diary ensuring

patients are prioritised and allocated

appropriately for discharge planning.

Rehabilitation WardWe have admitted more patients to our Rehabilitation Ward during the past 12 months than the previous

year whilst treating and discharging them more quickly.

• Bed occupancy has averaged at 99% throughout 2018/19

• 4% increase in admissions from previous year

• 11% decrease in average length of stay over the year.

Appraisals82% of our staff had an appraisal between 1 April

2018 to 31 March 2019, which is below our target of

95%. Last year we aimed to improve this by:

• Implementing an annual cascade of appraisals

according to banding

• Advising that all appraisals must be completed in

the first quarter of the year.

We have completed this work and further reviewed

the reasons for not meeting our target. We have

now worked with staff to simplify the appraisal

process and will continue to develop our staff

through our leadership programme, appraisee and

appraiser training and to validate the appraisal

process for our staff.

National Institute for Health and Care Excellence (NICE)First Community continues to assess and implement NICE guidance relevant to the services provided. In

2018 we shared our process and learning for implementing NICE guidance as a shared learning example

which can be found on the NICE website: www.nice.org.uk/sharedlearning/governance-of-nice-implementation-our-journey

And www.intopractice.nice.org.uk/principles-putting-evidence-based-guidance-into-practice


Acute Hospital ReadmissionsWe monitor readmissions to the acute hospital from our community beds and have noticed an increase in

readmissions during certain periods. We are working to understand the reasons for these on a case by

case basis as part of our ongoing quality and safety improvement work.

12

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Readmissions to the acute hospital

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Are we Caring?

End of Life, Preferred Place of CareWe aim to support people at the end of their life to die at the place of their choice and during the

reporting period we supported 90% of people to die at their preferred place.

Bereavement PacksWe aim to support people who are caring for a loved one at the end of their life by giving them the right

information at the right time in our bereavement pack. We have been working to support our staff by

giving them the skills, knowledge and confidence to be able to do this.

Our aim: 90% of family members/significant others will be offered a bereavement pack by the District

Nursing Teams in the last days of a patient’s life.

We offered 79% of family members/significant others a bereavement pack during the reporting period,

which has increased from 72% in March 2018.

We will continue to work on this in order to achieve our aim.

CarersOur staff have completed 50 carer’s prescriptions during the reporting period so local voluntary

providers, Action for Carers, can get in touch with family members or friends - who provide unpaid support

to someone close to them - and offer them support. During 2019/20 we will review the way we support

and identify carers, including our staff who have carer responsibilities. This will enable us to promote our

integrated approach to supporting carers’ health and wellbeing needs.

Thanks to the activities of our volunteers we have been able to respond to patient requests by:

VolunteersWe have improved the recruitment process

of our volunteers over the past 12 months

to reduce the time it takes to recruit and we

have increased the number of volunteers

that work on our ward.

volunteerspets as therapy

dogs

6 2

Carrying out more activities

Providing daily newspapers in the day room

Making guest Wi-Fi available

for patients and visitors

Running themed afternoons with activities such

as quizzes, word searches,

colouring

Installing additional TVs in

the ward bays purchased by the League of Friends

Running themed talks in coffee

groups including falls education

and befriending


Our volunteers have told us:

Complaints and Compliments

Knowing that you make a difference is

reward enough

I have met some really

interesting people“ “

“

It is important to give back and time is

what I can give

“

“I leave feeling gratified that I have made a positive difference to a few patients that day“

““

I wanted to do something

for my local community“

“

There have been a total of 19 formal complaints

for the reporting period. There were 31 for 2017/18.

There have been a total of 41 informal complaints

for the reporting period. There were 37 for 2017/18.

Of the formal complaints 14 were upheld or partially

upheld, which means our investigation agreed that

the service received did not meet the standard

that should have been expected, 4 were not

upheld and one is currently under investigation.

Some of the changes we have made in response

to these complaints are:

• Improved our electronic records to include what,

when and how to communicate with people’s

next of kin and/or family members

• Changes to the way our paediatric therapy

reports are written to ensure clarification of

information sources.

We received 292 compliments during the reporting period. We received 250 compliments during 2017/18.


Intermediate Care Team

Yesterday two incredible physios came to the aid of my dad. I cannot stress enough how

brilliant they were with dad. Their kindness, patience and the understanding given to him was

exceptional. He really could not have received better care from them

““

To all the wonderful team at Caterham Dene, thank you so much for looking after our

mum so well. It’s a great Valentine’s Day gift to get her and dad back together

“

“

I wanted to say a huge thank you for everything you have done for Marcus*, the blended diet

has undoubtedly been absolutely pivotal to his health and this wouldn’t have been implemented

without your guidance and support

““Dietetics

Caterham Dene Ward

*Not real name

Thank you all so much for the wonderful care you gave Claire* during her final days at home.

Words can’t express my appreciation of your efforts to keep Claire* comfortable and pain free

“

“

Thank you for your on-going support, you’re full of knowledge and reassurance and you’ve

filled me with confidence at my hardest times

“

“

My quality of life has improved beyond my most optimistic expectations

“

“

District Nursing

Orthotics

Children’s Dietetics


Behaviours FrameworkWe can only truly deliver first-rate care, through first-rate people, offering first-rate value if we behave

in a way that is first rate. We have refreshed our behaviours framework in partnership with our staff to

reflect the behaviours they believe are important. How we behave makes a difference, our behaviours

are hugely important and they define us as a healthcare provider.

Inclusive Kind

Empowering Collaborative

Positive Transparent & accountable

Continuously improving

VisionRejuvenating the wellbeing of our

community

Firs

t-ra

te p

eo

ple

•

First-rate care • F

irst-rate

value

•

Mixed Sex Accommodation0 mixed sex accommodation breaches during the year

Friends and Family TestThe number of people who would recommend our services

to family and friends is equal to the national average.

Some of the actions we have taken as a result of feedback:

• Outpatient physiotherapy has extended the

opening hours of its central booking phone line

to include an evening each week

• The falls team has created a timetable of all the

exercise classes in the area to give people more

choice to continue some physical activity.

of people would recommend our services97%


Are we Responsive?

Community ForumWe held four Community Forum meetings over

the past 12 months engaging with more than 20

different local organisations.

This year Community Forum focused on transforming

digital services, involving the public in improving

services, and the NHS Long Term Plan and likely

implications for our local area. As well as sharing

news about new services from First Community,

such as the new stroke pathway and physiotherapy

services at GP surgeries, the Community Forum

helped forge positive relations among attendees.

As a direct result of the Community Forum, working

with Surrey County Council, ABC GP Federation and

British Red Cross, First Community provided a new

Winter Home Hub offering help and assistance to

older people at four local GP surgeries needing

extra support during the cold months to stay safe

and well. The innovative project aimed to prevent

people, especially those with a long-term health

condition or a disability, being admitted to hospital.

The Community Forum also enabled us to build

strong relationships with East Surrey YMCA, which

now provides us with free facilities for a peer-

support stroke group and a preventing falls

stroke programme.

First Contact PhysiotherapistsWe are undertaking a 12-month pilot in partnership with ABC GP Federation to provide first contact

physiotherapists in five GP surgeries in east Surrey. This is part of a national pilot and in east Surrey, this

means that patients with musculoskeletal problems can book an appointment with a physiotherapist

rather than a GP. This saves GP time and gives people timely access to physiotherapist advice with First

Contact Practitioners seeing up to 19 patients a day.

Flu Vaccinations58% of our staff were vaccinated against the flu virus this year, compared to 47% in 2017/18.

This year we offered clinics run by a pharmacist at a range of First Community bases as well as vouchers

for staff to have their vaccinations at their place of choice. We are always looking to improve our uptake

and encourage our staff to tell us how to make flu vaccinations more accessible.

10%

20%

30%

40%

50%

60%

70%

0%2015/16 2016/17 2017/18 2018/19

Pe

rce

nta

ge

Full vaccination uptake by staff

42%

58%

47%

36%


18-Week Referral to Treatment TargetsIntegrated Care and Assessment Treatment Service

Achieved Assessment and treatment planning for people with musculoskeletal problems

Audiology

Achieved Assessment and treatment for people with hearing loss and balance problems

Minor Injuries UnitWe have an average wait time of 19 minutes to be seen at our Minor Injuries Unit with

the shortest wait of 14 minutes and the longest wait of 32 minutes.

We have seen 18,432 people at the Unit in 2018/19.

Children’s Therapy Services’ Waiting TimesChildren are having to wait too long to access our children’s therapy services, in particular our

occupational therapy service. We are working with our staff, partners and commissioners to reduce this

over the next 12 months.

Bed Occupancy on Caterham Dene Ward99% for 2018/19

New Birth Visits87% of people who have given birth

received a visit from our 0-19 service

within 14 days.


Are we Well Led?

Council of GovernorsThe Council of Governors is a group of staff that have been appointed to represent staff views, opinions,

ideas and concerns at Board level.

The Council continues to raise its profile in representing staff at Board level and in other areas. The

number of staff who choose to become shareholders and the number of Council members in office help

us measure our effectiveness.

2016 - 17 2017 - 18 2018 - 19

Number of shareholders N/A 72% 70%

Number of Council of Governors members 6 12 9

The Council of Governors has been involved in the Health and Wellbeing Charter putting out weekly health

and wellbeing messages to staff as part of First Community’s #HealthyMe campaign. This has resulted in a

positive growth in the NHS staff survey results for 2018.

NHS Staff Survey theme 2016 2017 2018

Health and Wellbeing 6.4 6.5 6.4

Does your organisation take positive action

on health and wellbeing?32.5% 33.4% 38.6%

The Council of Governors has been actively involved in a wide range of activities:

Membership of the Equality and Diversity

Inclusion Group

Recruitment of First Community’s Chair Staff awardsReviewing policies

and guidelines that affect staff

Board meetingsInduction

Co

uncil of Governo

rs

Recruitment of shareholders


Duty of CandourAs an NHS organisation we have a statutory and contractual commitment to be open and honest with

our patients when something that goes wrong with their treatment or care causes harm. This includes an

apology to the patient or the patient’s carer or family.

First Community has undertaken 5 duty of candour conversations due to serious incidents between 1 April

2018 – 31 March 2019.

Audiology AccreditationFirst Community has held accreditation with United Kingdom Accreditation Service since 2014 for our

Audiology services. We complete a yearly submission and are inspected every two years.

We completed our fifth submission in November 2018 and had two areas that were recommended we

could improve upon compared with 16 in 2017 and 16 2016 which is a significant improvement.

We have taken action to improve the two areas identified in line with our policies.

Patient and Public Involvement2018/19 saw us create First Community champions

with an interest in this work to form a Public

Involvement Group. Additionally, we have

developed a stakeholder document identifying

partners to be used to integrate our public

involvement work with others. During the year the

group has:

• Developed the First Community Plan and Principles

• Developed a Toolkit for teams to use for a range

of public involvement work

• Identified an evaluation tool to identify the

benefits of public involvement work

• Participated in a film to promote involvement.

Several teams have completed public involvement

work during 2018/19:

• Speech and Language Therapy: Focus groups on

the experience of various aspects of the service

• Physiotherapy: Telephone survey on people’s

experience of the single point of access referral

process

• Audiology: Face to face questions on people’s

experience of appointment booking, information,

and letters

• Respiratory: Focus groups to evaluate the

pathway

• Homeless Team: Co-production open event for

our community and teams to share best practice

and develop the Gypsy, Roma and Traveller

project bid.

Our ambitions for 2019/20 are:

• Wider engagement with more clinical teams to

further embed public involvement

• Wider engagement with external partners to

develop links for public involvement work.


Staff SurveyWe are grateful to all our staff who complete the annual staff survey sharing their individual experiences

of working in First Community. We use the results to understand what we are doing well and where we

need to make improvements.

We are encouraged by the results of the 2018 survey. Our overall staff engagement has remained stable

at 7.5 out of 10 compared with 7.7 out of 10 last year with 71% of our staff completing the survey.

Their responses show that we have made a significant improvement from last year in relation to:

Identifying development

needs in appraisal

Opportunities to show initiative

Taking positive action on health and well being

This indicates that the ongoing work around leadership and management development, health and well-

being and developing the achievement review process is having a positive impact and we are continuing

to work on these areas.

We need to do better where staff experience hasn’t significantly improved, and they have told us they

need improved IT. We are continuing to prioritise this work, progressing with our IT turnaround programme.

Staff have told us that recruitment and staffing is difficult and we continue with recruitment and retention

work, raising our profile at recruitment events and through social media campaigns.

The inclusion agenda is also very important to us. We are developing leaders to take forward this

agenda, engaging our black and minority ethnic staff in how we improve staff experience.

Equality, Diversity and InclusionThe NHS Constitution states that the NHS provides a comprehensive service, available to all irrespective of gender, race, disability, age, sexual orientation, religion, belief, gender reassignment,

pregnancy and maternity or marital or civil partnership status. The service is designed to diagnose, treat

and improve both physical and mental health. It has a duty to each and every individual that it serves and

must respect their human rights.

This means for all of our staff, whatever their

background, we want:

• Equality - Ensure there are equal opportunities

for everyone

• Diversity - Respect and value all individuals and

enable them to fulfil their potential

• Inclusion - Remove barriers that create

separation and enable everyone to participate.

In order to achieve this we have a dedicated

leader for our inclusion and governance

framework.

Our immediate priorities for equality, diversity and

inclusion are:

• Training a member of staff to become a

Workforce Race Equality Standard (WRES) expert

• Making our leadership team more aware of

workforce race equality issues, a member of the

national NHS WRES team came to speak at our

Senior Team Meeting in March 2019

• Reinvigorating our black minority ethnic staff

network to improve staff experience around race

equality and to provide support, advice and

guidance

• Producing an equality report and action plan for

2019/20

• Collating data for the Workforce Disability Equality

Standard (WDES) and making any improvements

required to support staff with disabilities

• Implementing a system to review and improve

our performance for people with protected

characteristics.


Speaking Up First Community staff can speak up by phone, in person or email by contacting a wide range of leaders

and staff including our Freedom to Speak Up Guardian, who acts as an independent and impartial source

of advice to staff. Our Floor to Board in 5 commitment enables any member of staff to speak to a Director

within five minutes of calling the Head Office.

Our leadership team has been trained in receiving concerns and will give information about where people

can go for more support. If for any reason staff do not feel comfortable raising their concern internally,

First Community provides information on how to raise concerns with external bodies.

The Board has oversight of concerns raised and receives high level information about all concerns raised

by our staff and what we are doing to address any problems.

1 Freedom to Speak Up issue raised during the past year


Children and Family Health Surrey (CFHS)Children and Family Health Surrey is the Surrey-wide NHS community health service for children and young

people from birth up to 19 years of age (up to 25 for young adults with additional needs) and their parents

and carers. First Community works in partnership with CSH Surrey and Surrey and Borders Partnership NHS

Trust as Children and Family Health Surrey to ensure children and young people are at the centre of the

care they receive.

Services include health visiting, school nursing and school-age immunisation services as well as specialist

paediatric, nursing and therapy services to support children and young people who have additional

needs requiring on-going care. Our health services are closely linked to Surrey’s mental health services,

and wider health services, such as the therapies for school-age children provided by Surrey County

Council. This helps improve the care and support families receive.

Some of Our Achievements Working in Partnership…

Gypsy, Roma, Traveller Health

In 2018 First Community secured funding from the Queen’s Nursing Institute to further develop our service

provided to the Gypsy, Roma, Traveller communities with the aim of reducing inequalities in health and

treatment and to challenge the life expectancy for these communities which is significantly lower than the

rest of the population.

Some of the outcomes over a 12 month period:

26

42

32

children with poor dentition were referred for dental treatment

health promotion contacts, leading to three onsite immunisations

blood pressure checks led to signposting to primary care services for further treatment

This foundation and partnership working has enable the outreach support to be extended across Surrey

from 1 April 2019. The aim is to improve engagement with the 0-19 service and other connected services.

Clinical Standards

The Children and Family Health Surrey partnership

recognises that all services require clear clinical

policies and procedures to ensure high quality best

practice service provision. The partnership’s clinical

procedural and policy documents form an integral

part of its governance and risk management

processes and provide corporate identification,

clarity and consistency in compliance with legislation,

statutory requirements and best practice.

In October 2018 the partnership established a multi-

disciplinary clinical forum to take responsibility for

the scrutiny and approval of all clinical documents.

The CFHS Clinical Practice Forum, is chaired by a

Director of Nursing from within the partnership and

has provided monthly opportunity for discussions

and procedural agreement on clinical best practice

for aspects relating to children’s care pathways.

Examples of their activity includes developing

a Clinical Standard Operating Procedure for

reviewing the health needs of looked after children

including the completion of a review health

assessment, continence/enuresis management

and immunisations.


Advice Line

Work has been completed to extend the advice line model, that was

developed in First Community in 2017, across Surrey. First Community is

leading this on behalf of Children and Family Health Surrey and the advice

line went live on 1 April 2019 operating Monday – Friday from 8am to 5pm

to take calls from families and other professionals. This ensures equity of

service across Surrey and enables an increase in clinical capacity locally.

Recruitment

Recruiting health visitors, paediatric therapists and school nurses across Surrey has been

a challenge. Working in partnership as Children and Family Health Surrey, joint interviews

have been put in place so vacancies can be filled across Surrey rather than at provider

level. We have further promoted recruitment opportunities through local education providers.

One Stop

One Stop is a single point of referral to Children

and Family Health Services to ensure referrals are

managed in a timely way. Since January 2019 One

Stop has been extended to accept referrals from

the local authority for therapy reports for Education

Health Care Plans (EHCPs). These care plans are

used to recommend any additional support a child

may require and the revised referral process has

improved the timeliness of access to health advice

and improved communication with the Local Authority.

Since go live One Stop has received an

average of 1,200 referrals per month. Four

services, physiotherapy, speech and language,

occupational therapy and enuresis, accept direct

referrals from parents and carers and since

January 2019 an average 5% of all referrals via One

Stop have been direct. This has reduced the need

for GP or school involvement.

More recently One Stop has further evolved and

from April 2019 is now integrated into the Surrey

and Borders Partnership Single Point of Access

for children. This will bring further qualitative

improvements to children and families in the

coming year.

Antenatal

We are working to increase the contact we have with women who are pregnant by sending an

initial introductory letter to ensure they are aware of the support and advice services available

during and following pregnancy for them and their families.

Breastfeeding

We are achieving our target of 62% of parents continuing to breast feed at 8 weeks with March 2019 at 63.1%.

Achieving our target of 73% at 10 days has been more challenging with March 2019 at 62%. However we

now have three permanent infant feeding leads supporting our commitment to the UNICEF Baby Friendly

Initiative. They are embedding and sustaining training and best practice to support families in Surrey.

New Birth Visits and Follow up Review

Despite challenges within recruitment and retention, health visitors have continued to achieve above

our local target of 77% to offer a new birth review to all parents between 10-14 days with an increasing

trajectory from January to March 2019 achieving 86.51%.

We also provide follow up reviews for babies between 9 and 12 months. A revised model has recently

been implemented to support this aim. This model will ensure all families are offered information and are

aware of the options available to access professional support and advice across Children and Family

Health Surrey. Where any concerns are highlighted these are followed up by our health visiting team.


Immunisations

We are now offering access to all pre-school

immunisations at our community clinics, and have

extended the role of our immunisation nurses to

administer all childhood immunisations. MMR uptake

of two doses in Surrey is an area we are focussing

on with uptake currently standing at 79%. Our aim is

to increase immunisation uptake within our hard to

reach groups.

Children with missing immunisations are identified at

school entry and offered the opportunity to access

immunisations through our community catch up clinics.

We are in the process of producing

immunisation reminder cards to be given to

parents at 1 year and 27 month checks.

We have seen an increased uptake of nasal

flu immunisation for primary school children across

Surrey. Autumn 2018 saw the offer to immunise

extended to children from reception class through

to year 5 in all state and independent primary

schools. We achieved 71% uptake, which is above

the national average.

Children Continuing Care

Our Children’s Continuing Care service undertook a deep dive review of the standards of their care

including assessment and management of nutritional needs. The review showed all children and young

people had been assessed for nutritional needs on admission to the caseload, and all children with an

identified need had dietetic support and reviews. One child did not have a feeding plan and this was

therefore rectified.

Paediatric Therapies

A new pathway has been developed for children with acquired brain injury to facilitate

discharge from specialist centres to the community. This was presented as a poster at

a national conference. The team contributes to the Hip Surveillance in Cerebral Palsy

pathway across South East England.

Special Educational Needs and Disabilities (SEND)

Paediatric Therapies has developed a single advice template to ensure consistency of information

and to meet the outcome focussed requirements of Education Health Care Plans which are used to

recommend any additional support a child may require.

Positive verbal feedback was received regarding health assessments and interventions following the

CQC and OFSTED Joint Revisit of SEND in Surrey. The written report is currently awaited.


Statement on Behalf of the Sussex and East Surrey Clinical Commissioning Groups

The Quality Report has been reviewed and the CCGs confirm that the account clearly describes the achievements made against the four priorities identified for 2018/19. It provides detailed information across the three areas of quality: patient safety; patient experience; and clinical effectiveness in a structured way and demonstrates an on-going commitment and responsiveness to improving quality of care. The great achievements reflected in this Quality Account Report, and the outstanding CQC rating should be celebrated.

The following successes in 2018/19 are a clear recognition of the hard work and

determination of all those working in the organisation to deliver high quality care,

most notably:

• Being committed to supporting the national challenge to reduce Gram-negative

Bloodstream infections, especially E. Coli. Having improved the catheter pathway

used and through implementing best practice, patients are already benefiting

from positive outcomes like successful continence management and removal of

catheters

• The Quality Improvement Day event provides a clear demonstration of the

learning culture in the organisation. The showcasing of the implemented quality

improvements with external organisations and colleagues was presented by the

staff and patients who worked on the projects, highlighting the positive outcomes

realised through collaboratively working with volunteers. First Community has an

ambition to continually improve beyond standards of an outstanding CQC rating

• The focus on reducing routine outpatient musculoskeletal physiotherapy

appointment waiting times has resulted in an average wait of just 4 weeks, with

some patients waiting as little as 2 weeks. This is very good for patients and is

highly commended by CCGs. This responsive approach joined with the planned

self-referral pilot will further support the achievements already realised in

resolving this issue

• The CCGs were encouraged to see a priority aimed primarily at staff

development. CCGs note the progress made so far and would recommend

follow up of any feedback from members of staff who have completed the

leadership programme

• First Community achieved excellent results on the Friends and Family Test with

97% of patients recommending the services they received which is equal to the

national average

• A clear demonstration of learning is the embedding of a peer review process on

record keeping within community nursing. CCGs note the 100% coverage that this

process has had.


It is observed that as with the year before, there are no priorities focused on

children and family services. However, First Community work with Children and

Family Health Surrey and through this partnership have supported clinical best

practice with breastfeeding, new birth and follow up reviews and immunisations to

support children and their families.

CCGs would like to recommend a focus on research activity as there was no

recruitment to studies in the last financial year.

First Community identified that recruitment and retention of staff continues to be

a challenge and it is reassuring and innovative to see that First Community is

working in partnership as Children and Family Health Surrey. The CCG support the

objective to include new roles and enhance existing staff training to improve staff

experiences and support retention as identified in the staff survey.

The Quality Report outlines the priorities for improvement in 2019/20 as well as how

success will be measured, evidencing a robust process for their selection and

the CCGs support these priorities and will continue to support and work with First

Community, in fulfilling their ambition to continuously improve quality and outcomes

for people who use their services throughout the year via our established

assurance processes.

Sussex and East Surrey CCG Commissioners also look forward to continual working

with First Community through the sustainability and transformational partnership

(STP) and towards the shared visions shaped within the NHS long term plan for

sustainable models of care and the health of our local population.

Further Information and FeedbackIf you would like to find out more about our services, please visit our website at

www.firstcommunityhealthcare.co.uk

If you would like this information in another format or language, or would like to provide feedback about this account or any of our services, please contact:

Telephone: 01737 775450

Email: [email protected]

Twitter: @1stchatter

First-rate people. First-rate care. First-rate value.

Publication date: June 2019

quality account 2018 to 2019 - assets.nhs.uk · teams (caterham dene ward and community) has been...

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