Derbyshire Community Health Services

Derbyshire Community Health Services

NHS Foundation Trust

Annual Quality Report 2015/16

Contents

Part 1 - Introduction

Part 2 - Priorities for improvement and statements of assurance from the board

Part 3 - Review of Quality Improvements 2015/16

3.1 What have we done to improve patient safety?

3.2 Ensuring services are clinically effective

3.3 Caring - What we have done to improve patient experience?

3.4 Ensuring our services are responsive to patients’ needs

3.5 Ensuring our services are well led

Appendix 1 - Workforce

Appendix 2 - Trust Risk Ratings

Appendix 3 - Information Governance Toolkit submission for 2015/16

Appendix 4 - Progression of Quality Always, the DCHS Way

Appendix 5 - Third party statements - CCGs/Healthwatch

Appendix 6 - Statement of Directors’ responsibilities in respect of the Quality Account

Appendix 7 - Independent Auditors

Appendix 8 - The Core Quality Account Indicators

Glossary

Part 1 - Introduction

Welcome to the 2015/16 Annual Quality Report

I am delighted to introduce this Quality Report which sets out how we have been working in the last year to assure and improve the quality of the services we provide and achieve our vision of being the best provider of local healthcare and a great place to work.

Highlights of the year have included:

98% of the more than 16,000 patients we surveyed recommending the Trust to their family and friends.
Developing the provision of vital children’s, sexual health and wellbeing services across Derbyshire with a range of partner organisations following competitive tender processes managed by Derbyshire County Council.
Expanding the range of integrated services we provide to include general practice and taking over responsibility for adult community services provision in Derby City.
Delivering a sustained reduction in avoidable pressure ulcers within our services, recognising that the overall level of pressure damage across our communities remains a significant concern.
Playing an important role in enabling an increasing number of patients with complex needs to avoid hospital admission or leave hospital earlier, particularly over the winter period when local hospitals have experienced unprecedented pressures.
Maintaining a positive, open, quality focused culture as evidenced by our high levels of incident reporting and our national staff survey results, where our colleagues reported performance that was average or above average against 30/32 key areas compared to our peer community trusts.
Increasing again our overall level of staff engagement reported through the national staff survey to one of the highest levels amongst peer trusts.
Developing our Quality Always Clinical Assessment and Accreditation Scheme across the Trust to underpinning our approach to making sustainable quality improvements and providing assurance about the care we deliver.

This report reflects on our achievements and challenges in improving quality during 2015/16. We hope that you will agree that much progress has been made as a result of the great commitment of our staff and I would like to take this opportunity to recognise and thank them for their continued dedication.

Our staff are at the heart of the way we care for our patients and looking after them effectively is one of the most important things we can do to deliver excellent care. During 2016/17 we will continue to develop our staff health and wellbeing services, focus on staff safety and on ensuring a culture across the Trust where everyone feels comfortable and supported to raise concerns and speak out about things which need to improve.

We continue to set ourselves high ambitions on behalf of the people we care for and support across the community. There is more that we want, and need, to achieve to continue to improve the quality of our services for them and we have set out in this report our priorities for 2016/17. These build on what we know about our services and learning from our staff at the frontline of care delivery, what our patients have told us is important to them and in response to local commissioners and national priorities.

I can confirm on behalf of the Trust’s Board that to the best of or our knowledge and belief, the information contained in this Quality Report is accurate and represents our performance in 2015/16 and our priorities for continuously improving quality in 2016/17.

Tracy Allen, Chief Executive

Declaration of Accuracy

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Part 2- Priorities for improvement and statements of assurance from the board

2.1 Priorities for improvement

This quality report demonstrates our achievements for the year 2015/16, describes the areas where we would still like to make improvements and our quality objectives for the coming year.

Each year DCHS sets itself stretching improvement targets referred to as ‘The Big 9’ The Big 9 are split into three domains quality services quality people and quality business in line with the DCHS Way.

During 2015/16 our three key quality priorities focused the whole organisation on quality improvement in areas of patient safety, clinical effectiveness and patient experience.

These priorities were:

To improve information sharing – Information Governance regulations restrict clinicians from sharing patient information with colleagues unless the patient has given their informed consent. Sometimes this inhibits the way in which we care for our patients as up-to-date information related to their condition is not readily available, this objective was set to ensure clinicians have up-to-date information regarding their patient whilst maintaining the patients right to confidentiality.

To increase the number of referrals to Smoking Cessation services made by DCHS staff. We know that smoking has one of the biggest negative impacts on our population’s wellbeing and as responsible health providers want to support our patients wherever we can to quit smoking.

To identify where patients with a learning disability access our services – Patients with a learning disability may need additional help and support to ensure equitable access to our health services. During 2105/16 we set out to try to identify patients with a learning disability to ensure that they were appropriately supported when using our services.

Whilst progress has been made against all three of these stretch quality improvements we are disappointed that we have not achieved the targets that we set ourselves.

Improvements in information sharing. We set out to improve access to health records by asking our staff to ask their patients at each contact for permission for their health records being shared with other health practitioners to ensure better continuity of care. Many services have made good improvements with this target and some have excelled although there is still room for improvement. Significant progress has also been made across the health and social care community with the development and agreement of information sharing protocols which allow the sharing of information between health professionals where it is in the patients’ best interest and meets stringent information governance standards. Further work is required to develop our information technology infrastructure to improve data flows and information accessibility. This work will be continued during 2016/17 and will be supported by our continual roll out of our electronic patient management system. Progress against this target will be reported to and monitored by the information governance group.

Increase the number of referrals to smoking cessation services. This target has proved most challenging in terms of data capture again due to our information systems not having the facility to easily capture smoking cessation referrals. We will continue to work with our staff to make improvements and to use the Making Every Contact Count framework(MECC) the mechanism by which we achieve this. Performance will be reported through our performance dashboard which is updated on a monthly basis.

Identify where patients with a learning disability access our services. This target was chosen in an attempt to better understand where patients with a LD access DCHS services so that we can ensure access to appropriately trained staff and information. It has proven difficult to capture this information due to the broad spectrum of learning disability and some patients not declaring a particular need when accessing the services. Through our equality, diversity and inclusion forum we will continue to work toward improving our data capture and have a particular work stream regarding development of more accessible information.

In addition to our organisation-wide quality improvement targets in 2015/16 we have been working to achieve a combination of quality objectives and service improvements which we set ourselves, together with quality targets which are set out in our contract with local health service commissioners. These are reported in more detail in the body of this report.

Our quality priorities build upon what we already know about our services, what our patients have told us are important to them and in response both to commissioners’ and national priorities. We also place a great emphasis on learning from our staff who are at the frontline of care delivery and we have developed an effective network of ways to engage with them and hear their feedback. We are particularly proud of our annual staff survey results 2015, which listed us as one of the best performing trusts, based on feedback from our staff.

2.2 Things we want to do better in 2016/17

We are continually striving to improve the quality of the services we provide and to learn from things that did not go so well.

For 2016/17 our Board of Directors has agreed three strategic quality improvement objectives:

Quality Objectives / Monitoring progress
1) Patient Safety – to decrease the overall burden of pressure damage within our health community by a reduction of pressure ulcer incidents as a percentage of patients looked after by our services / Implementation of our pressure ulcer reduction plan will be monitored monthly through the patient safety group and reported monthly to Quality services committee (QSC) and board via the Big 9 performance framework. A six monthly deep dive on progress and issues will be presented to QSC.
2) Clinical Effectiveness – to introduce across our services a nationally recognised measure of frailty which will help us to identify patients at risk and proactively manage their care / The frailty screening measure will be reported monthly via the BIG 9 performance framework and will be monitored through the clinical effectiveness group on an exception reporting basis
3) Patient Experience – to improve our performance in relation to complaint response rates ensuring that patients receive a response to any concerns raised within a reasonable timeframe / Complaints response times will continue to be monitored by the patient engagement and experience group on a monthly basis and reported monthly via the Big 9 performance framework to the board

These three quality improvements have been chosen as a result of feedback from our board of directors, our governors, our staff and most importantly our patients. Pressure ulcers and increasing frailty have been identified as significant issues within our local population and account for a large percentage of the resources we deploy. Ensuring services are appropriately aligned for these issues will mean that our services are delivered as effectively and efficiently as possible and bring benefit to the greatest number of patients. Ensuring that patients who raise concerns about our services receive a comprehensive and timely response is a trust priority, however, we know from feedback from our patients and commissioners that we could improve further hence our third improvement target. Metrics for each of these improvements will be identified and will be measured on and reported on a monthly basis as part of our performance monitoring to the board.

In addition we will continue to strengthen our internal processes for quality improvement and assurance using our Quality Improvement and Assurance Framework. We are committed to being able to demonstrate the consistency and quality of our services and we want our patients and their families to feel safe and well looked after.

We recognise the need for a continuous focus on improving our quality assurance measures so during 2015/16 we have developed our processes for assuring the quality of services and are very proud of the work we have completed towards out clinical assessment and accreditation peer review – Quality Alwayssee section 3.5.

2.3Statements of assurance from the board

2.3.1 Contracted services

This section includes text and reports mandated by NHS England and Monitor

During 2015/16 DCHS provided and/or sub-contracted 36 relevant health services.

Of these services, 30 were NHS commissioned services and a further 6 were commissioned by local authorities. Services included rehabilitation, community nursing, health visiting, school nursing, sexual health services, community dental services for patients with mental health problems and learning disabilities services, as well as a wide range of planned care services such as podiatry, physiotherapy, speech and language therapy and occupational therapy. Strategically we have continued to redesign our services with an aim to support our patients as close to home as possible.

As part of our duty of care we have continuously reviewed the quality of all of our services. DCHS has reviewed all the data available to them on the quality of care in all of these NHS services.

The income generated by the relevant health services reviewed in 2015/16 represents 100% of the total income generated from the provision of relevant health services by DCHS for 2015/16.

2.3.2 Core Indicators

Since 2012/13 all NHS Foundation trusts are required to report performance against a set of core indicators using data made available to them by the Health and Social Care Information Centre. Many of the core indicators are not relevant to community services. Those that are applicable to us appear in the table below. For completeness we have included the full set of core indicators at appendix 8.

Prescribed information / Related NHS Outcomes Framework Domain & who will report on them / 2014/15 / 2015/16
(national average)
21 / The data made available to the National Health Service trust or NHS foundation trust by the Health and Social Care Information Centre with regard to the percentage of staff employed by, or under contract to, the trust during the reporting period who would recommend the trust as a provider of care to their family or friends. / 4: Ensuring that people
have a positive experience of care
Trusts providing relevant acute services / 89% / 90% (69%)
DCHS considers that this data is as described for the following reasons: we have worked actively with our staff to engage them in service development and delivery. DCHS has reported consistently excellent staff survey results for the last two years.
DCHS intends the following actions to improve this percentage score and so the quality of its services, by continuing to actively engage with staff and to focus on the support of new staff to the service.
Comparative Data taken form National staff survey in England in 2015
When asked whether, if a friend or relative needed treatment, they would be happy with the standard of care provided by their organisation, 69% of staff agreed or strongly agreed.
21.1 / Friends and Family Test – Patient. The data made available by National Health Service Trust or NHS Foundation Trust by the Health and Social Care Information Centre for all acute providers of adult NHS funded care, covering services for inpatients and patients discharged from Accident and Emergency (types 1 and 2).
Please note: there is not a statutory requirement to include this indicator in the quality accounts reporting but NHS provider organisations should consider doing so. / 4: Ensuring that people
have a positive experience of care
Trusts providing relevant acute services / 98.7% / 98% (95%*)
DCHS considers that this data is as described for the following reasons: we have worked with our patients to ensure effective and robust feedback from across the breadth of our services and this is monitored by our patient experience and engagement group.
DCHS has taken the following actions to improve this percentage score: engage with patients and carers, actively seek feedback, encourage completion of FFT cards, collate the findings from feedback and report on changes through our patient experience and engagement group and so the quality of its services, by improving car parking, furniture, accessible information and confidentiality.
Comparative Data taken from NHS England Friends and Family Test data website
Data for March 2015* shows average of 95% of patients would recommend their local community services to friends and family. Annual data not available.
23 / The data made available to the National Health Service trust or NHS foundation trust by the Health and Social Care Information Centre with regard to the percentage of patients who were admitted to hospital and who were risk assessed for venous thromboembolism during the reporting period. / 5: Treating and caring for
people in a safe environment and protecting them from avoidable harm
Trusts providing relevant acute services / 99.3% / 99.8%
DCHS considers that this data is as described for the following reasons: DCHS has trained its staff well and has clear clinical policies.
DCHS has taken the following actions to improve this percentage score and so the quality of its services, by reviewing in detail any venous thrombo-embolism case to ensure any learning is shared throughout the organisation.
Comparative data for community trusts is not available.
25 / The data made available to the National Health Service trust or NHS foundation trust by the Health and Social Care Information Centre with regard to the number and, where available, rate of patient safety incidents reported within the trust during the reporting period, and the number and percentage of such patient safety incidents that resulted in severe harm or death. / All trusts
5: Treating and caring forpeople in a safe environment and protecting them from avoidable harm / Total - Patient Safety Incidents / 9637 / 10,227
Severe harm or death / 6 / 39
% severe harm or death / 0.06% / 0.38%
DCHS considers that this data is as described for the following reasons:DCHS has a culture of high reporting of clinical incidents as reported bynational reporting and learning scheme NRLS. The increase in severe harm incidents is related to a higher threshold for severe pressure ulcers being introduced.
DCHS has taken the following actions to improve this rate and so the quality of its services, by developing a supportive reporting culture and ensuring that lessons learned from clinical incidents are shared organisation wide.
Comparative data NRLS April –Sept 2015 DCHS has highest reporting culture rate per 1000 bed days compared with19 NHS community trusts.<1% of incidents in this period were reported as resulting in severe harm or death.

2.3.3 National audits