Agenda item

Karen Cvijetic, Head of Quality and Patient Engagement, to present

Karen Cvijetic, Head of Quality and Patient Engagement, gave the following powerpoint presentation:-

 

Quality Report

-          Nationally mandated

-          2015/16 was the eighth quality report

 

Care Quality Commission (CQC) Ratings (September 2015)

-          Overall rating – requires improvement

-          Safe – requires improvement

-          Effective – requires improvement

-          Caring – good

-          Responsive – good

-          Well-led – good

 

What the CQC said we do well

-          Learning Disability Services

Solar Centre – commended by patients and carers

88 Travis Gardens – outstanding for caring

-          Adult Mental Health Services

Mental Health Crisis Teams – rated overall by CQC as Outstanding

Mulberry House – introduction of the ‘Perfect Week’

Doncaster Perinatal Service

Rotherham dedicated service for deaf patients with mental health problems

-          Children and Young Peoples’ Mental Health Services

Safeguarding Advisor in post and training at a high level across all services

Out of hours duty system provides excellent coverage of emergency/crisis calls

Peer Support Workers assist with transition to Adult Mental Health Services

-          Drug and Alcohol Services

Peer Mentor Scheme developed including training packages to provide service users with the skills and knowledge to become Peer Mentors

Peer Mentors from New Beginnings worked across the services in Doncaster and three had progressed into paid employment

-          Older People’s Mental Health Services

Community-based services for Older People rated as Outstanding for Caring

Young Onset Dementia Day Care offering carer respite and patient engagement

Male Carers Support Group for patients with Huntingdon’s Disease

Cognitive Stimulation Programme – support patients with cognitive functioning

Kings Fund advice and guidance to make Wards Dementia Friendly

 

Our Approach and Response

-          September, 2015 – immediate actions were taken and action plan drafted following initial feedback from CQC

-          November, 2015 – Trust Quality Improvement Plan developed following receipt of draft CQC reports

-          December, 2015 – Executive Director leads identified for all quality improvement actions

-          February, 2016 – Trust Quality Improvement Plan shared at Quality Summit

-          March, 2016 – action plan submitted to CQC

 

Governance Arrangements

-          Published CQC reports to the Board of Directors’ meeting on 28^th January, 2016

-          Monthly action plan updates to Board of Directors

-          Monitoring and oversight by Executive Management Team (EMT)

-          Divisional action plans monitored through Trust Board of Directors’ Sub-committees

-          Divisional-level action plans to address local issues and share learning

 

Patient Safety

Quality Metric	Baseline 14/15	Aim	Q1 15/16	Q2 15/16	Q2 15/16
Patient Safety
		Aim to Reduce Major/ Moderate Medication Errors to 0 by March 2018
Number of Serious incidents	88		24	17	18
			2015/16 forecast: 82
Number of Trust reported suicides/suspected suicides	21		4	5	2
			2015/16 forecast: 18
Number of Trust reported suicides/suspected suicides expressed as a rate per 100,000 England population	0.05		0.01	0.01	0.01
			2015/16 forecast:0.01
Number of Grade 3 pressure ulcers	29		2	0	4
			2015/16 forecast:8
Number of Grade 4 pressure ulcers	5		0	0	0
			2015/16 forecast:0
Number of restrictive interventions	Not reported in 14/15		417	301	345
			2015/16 forecast:1436
Number of falls (serious incidents)	2		1	1	2
			2015/16 forecast:4
Number of medication errors	45		8	3	Reported quarter   Retro-spective
			2015/16 forecast:32

 

Patient Experience

Quality Metric	Baseline 14/15	Aim	Q1 15/16	Q2 15/16	Q2 15/16
Patient Friends and Family Test
Percentage of service users/patients who would ‘be extremely likely/likely to recommend our service to friends and family if they needed similar care or treatment’	95.6% (Q4 14/15	To achieve % above national average	84.7%	87.3% (July/ Aug 2015)	88.3%
Complaints
Number of complaints received	124	Aim to reduce by 5% (117 in 15/16)	33	24	34
			2015/16 forecast:114
Percentage of complaints ‘upheld’	17%	Reduce by 5% (16% in 15/16)	9.1%	12.5%	Reported Quarter Retro-spective
			2015/16 forecast:10.5%
Annual Community Mental Health Survey
Score for ‘overall care received in the last 12 months’ (CQC annual community mental health survey)	7.3 (about the same as other Trusts)	Aim to be ‘better than other Trusts’	Annual survey results published Autumn 2015	Annual survey results published Autumn 2015	7.2
Score for ‘were you involved as much as you wanted to be in agreeing what care you will receive?” (CQC annual community mental health survey)	7.9 (about the same as other Trusts)	Aim to be ‘better than other Trusts’	Annual survey results published Autumn 2015	Annual survey results published Autumn 2015	7.7
Score for ‘were you involved as much as you wanted to be in discussing how your care is working’ (CQC annual community mental health survey)	9.1 (about the same as other Trusts)	Aim to be ‘better than other Trusts’	Annual survey results published Autumn 2015	Annual survey results published Autumn 2015	7.7
Percentage of service users who responded to annual community mental health survey	26%	Aim to increase response rate above national average	Annual survey results published Autumn 2015	Annual survey results published Autumn 2015	32%

 

Clinical Effectiveness

Quality Metric	Baseline 14/15	Aim	Q1 15/16	Q2 15/16	Q2 15/16
CQUIN
Percentage of CQUIN achieved in Mental Health and Learning Disability Services	96%	Aim to achieve 100%	100%	100%	Reported quarter retro-spective
Percentage of CQUIN achieved in Community Services	100%	Aim to achieve 100%	100%	100%	Reported quarter retro-spective
Percentage of CQUIN achieved in Forensic services	100%	Aim to achieve 100%	100%	100%	Reported quarter retro-spective
Clinical Audit
Percentage of clinical audits rated as ‘Outstanding’	To be developed in 15/16	To be developed in 15/16	22%	25%	0%
Percentage of clinical audits rated as ‘Good’	To be developed in 15/16	To be developed in 15/16	33%	25%	50%

 

Finally

-     Receive Select Commission’s comments for inclusion in the Quality report – May, 2016

-     Report to Board of Directors – 28^th April, 2016

-     Report to Council of Governors – 13^th May, 2016

-     Report to Monitor – 27^th May, 2016

-     Review by Audit Commission – April/May, 2016

 

Discussion ensued and the following points were raised/clarified:-

 

·           The Learning Disability Service had received a rating of ‘Inadequate’.  The CQC were concerned that the staffing levels in North Lincolnshire were not safe in the community team.  To mitigate that, a business case had been submitted for additional funding as the staff in that team were based on the funding received.  A business case had been submitted to the North Lincolnshire CCG the outcome of which was awaited

 

·           The issue within the Adult Mental Health Community Teams was the care record planning.  Plans were in place, as could be seen through the action plan, had been rapidly escalated and hopefully resolutions put into place

 

·           The difference between the 2 Community Health Teams – 1 was the Mental Health Services.  In Doncaster Community Services were also provided e.g. End of Life Care, District Nursing, School Nursing, Health Visitors.  The other was specially Mental Health Community Teams

 

·           The Inadequate rating related to staffing issues; there had not been any comments in the CQC report that they had found clients wrongly allocated

 

·           CQC reports do not split outcomes by locality but where it was possible, the data would be separated so as to give actions specifically for Rotherham

 

·           As well as investigating the root causes of falls, any possible underlying cause was also investigated to ascertain if there was a medical condition.  The majority of falls were by elderly people on Wards.  If necessary work would take place with Acute Care colleagues to ensure medical care was taken

 

·           The reporting of medication errors had now changed.  The number of medication errors that were moderate or above where RDaSH had had involvement with the service users involved had fallen drastically.  Pharmacists went onto Wards, worked across all the Community Teams, looking at how medication was prescribed, was it recorded properly etc.

 

·           There was no trend particularly with minor medication errors.  An assessment had been conducted and reported to the Clinical Governance Group.  If there were any areas, the pharmacist would go to the Wards or Community Teams to address the issues

 

·           When looking at medication errors, the organisation was trying to focus on the areas that were of higher importance; if you got the bigger areas correct it would help with the minor areas. RDaSH had focussed on the moderate severity or above where there may be harm to patients, so that improved the practice across the board including a reduced number of minor areas.  Using resources more wisely to get the better impact across the organisation

 

·           RDaSH had been involved in the Children’s Looked After and Safeguarding CQC action plan and had attended monthly meetings with the CCG, Acute Care Trust and other partner organisations to implement the action plan.  That action plan was hopefully being signed off shortly as being complete and RDaSH’s actions as an organisation had been achieved. RDaSH was also part of the MASH where it had a member of staff sat within the team. 

 

·           RDaSH continued to hold events around CSE and awareness raising as well as Safeguarding training (adults and children), Domestic Abuse Compliance Level 1 and an e-learning package commissioned for Level 2

 

·           There had been 2 reported suicides/suspected suicides in Quarter 3.  However, it was not confirmed as yet whether they were in fact suicides as unexpected deaths were now classed as pending review until the outcome from the Coroner’s Office was known

 

·           For each serious incident, not just an unexpected death, the Trust would undertake a formal serious incident investigation and a member of staff appointed who had not had any dealings with that service user.  The Trust had to report to the CCG and were monitored.   The outcome was shared within the organisation and a 6 monthly  learning matters bulletin available on the Trust website which included lessons learnt from a serious incident, complaints etc. by themes

 

·           If a serious incident involved a specific clinician and the investigation identified additional training needed for that clinician that would be dealt with.  There were things the Trust were going to improve e.g.  care records.  The Trust’s Clinical Commissioning Audit Team and the Internal Audit Service had been commissioned to undertake an audit.   As a first step supervisors were to check through the 1-1s with each clinician i.e. did all the clinicians’ cases have a current meaningful care record  

 

·           Delayed discharges in care were reducing.  Q3 5.1% - had been 6.9% at the end of last year.  Some of the reasons for the delays were due to family choice.  The majority was in Older People’s Mental Health Services and transferring into care homes, making sure the adaptations done at home etc. before the Service user transferred.   Service users and families could choose not to accept the first place they were offered. The Trust worked closely with the Council to get the adaptations done as quickly as possible

 

·           A number of service users and families used the Patient Advice Literacy Service (PALS).  The Service talked to a person where required and linked them up with someone to help them.  It was important to make sure service users and carers could access advocacy services to support them

 

·           Each complaint received was subject to a similar process as that of serious incidents.  All were investigated, all received a response from the Chief Executive and all included actions.  The top themes were communication/information available so the Trust had carried out a lot of work to make sure that the information given about the service was correct.  Work was needed with Service users as sometimes there were higher expectations than the Trust was able to meet and/or commissioned to deliver

 

·           The Trust had ways of collating information including the Your Opinion Counts forms, Services worked with Service users to collect patients’ stories, information was published in Learning Matters and there were regular patient stories to the Board.  A number of the Services had twitter feeds so the information was collated and tailored to the needs of the population.  There were Facebook pages, Services going out and collecting stories, the Health Bus and there had been a young person’s event held recently in the CAMHS service

 

·           That was a monthly publication, Trust Matters, which shared good practice both within the Trust and of the joint partnership working.   That was provided to all the Trust members and available on the Trust website

 

Resolved:  (1)  That the presentation be noted.

 

(2)  To agree a date for receiving the draft Quality Account.

 

(3)  That the Health Select Commission submit their comments agreed by the date agreed with RDaSH