Quality account summary 2012/13

Transcription

1 Quality account summary 2012/13 This report covers the period 1 April 2012 to 31 March 2013

2 Contents Welcome to the Quality account summary 4 Improved communication between staff and service users 6 Improved waiting time from referral to first contact with services 8 Improved clinical care 10 Improvement priorities in 2013/14 13 How you can help us improve our services 15 If you would like a copy of the full quality account 2012/13 this can be found on the NELFT website at in the news and publications section. If you would like a copy sent to you please contact us at communications@nelft.nhs.uk or by telephone on Or, you can write to us, giving your name and address, at: Quality account request NELFT corporate communications and marketing team Goodmayes Hospital Barley Lane Ilford IG3 8XJ Quality account 2012/13 summary - North East London NHS Foundation Trust North East London NHS Foundation Trust - Quality account 2012/13 summary 3

3 North East London NHS Foundation Trust area Shenfield Waltham Forest Basildon & Brentwood Thurrock Welcome to the NELFT quality account summary for 2012/2013 Grays Tilbury Stanford-le-Hope John Brouder NELFT chief executive: Every NHS healthcare provider publishes a quality account each year, giving information on the quality of services it provides and how it will make improvements over the coming year. The quality account includes a description of the quality of healthcare provided by the organisation, information on how the organisation measures how well it is doing and details about how it will continue to improve the services it provides. In our quality account 2011/12 we set out a number of areas where we wanted to make improvements during 2012/13. These were identified through a process of staff, service user, governor and stakeholder consultation. Some of the things we achieved in these areas over the past year are shown over the next few pages, along with our priority improvement areas for 2013/14. North East London NHS Foundation Trust (NELFT) provides mental health and community services for people living in the London boroughs of Waltham Forest, Redbridge, Barking and Dagenham and Havering. We also provide community health services in south west Essex covering Basildon, Brentwood and Thurrock. With a budget of 314 million in 2012/13, we provide care and treatment for a population of almost 1.5 million. We employ around 5,500 staff. We work with our NHS partners and other organisations to provide services that support people in and out of hospital settings. We provide treatment in our local communities with the aim of reducing the number of people requiring urgent services and to reduce demand on local acute hospitals. Our corporate objectives are consistent with our commitment to delivering high quality services to people who use our services. Our corporate objectives are: To improve service quality and productivity To deliver service transformation and improve our healthcare environments To deliver improvement on financial and performance targets To deliver new business opportunities To improve capability and capacity The good news is that quality is the priority for everyone in the NHS. And despite the scandal of mid Staffordshire it does very clearly serve as a warning for other Trusts against complacency. Our work on quality and clinical risk is being constantly reviewed and developed as a dynamic element of our core responsibilities. We must never get to the point where we think our quality is good enough because that can only be interpreted as a statement of complacency. We must always aspire to do better and I think this Quality Account Summary describes an approach that does just that. 4 Quality account 2012/13 summary - North East London NHS Foundation Trust North East London NHS Foundation Trust - Quality account 2012/13 summary 5

4 Achievements in 2012/13 Improving communication between staff and service users Improving care planning Improving the service user experience Feedback leads to improvements Feedback received through the inpatient and community mental health surveys highlighted that more could be done to improve communication with our service users around care planning. Susan Smyth, senior practice improvement practitioner explains: When somebody is admitted to our mental health unit, a care plan is drafted. We recognised that we had a lot to do to ensure that service users were better involved in this process. Over the past year we have enhanced our training for staff around care planning, and promoted the role of advocates and interpreters in the process, so that service users feel more supported and able to engage. One week before a service user is due to go home, a discharge planning meeting is held NELFT is keen to ensure the people who use our services, and their relatives and carers, have the opportunity to contribute their experiences, views and ideas to service improvements and developments. Over the past year there has been a concerted effort to gain greater input in community service developments from younger service users and their parents. Linking in with local parent support groups, and encouraging their members to participate in local health forums, at both service and strategic levels, has opened up involving the service user and the community team. The care plan is updated to ensure that support is in place and any issues addressed before they leave. All service users are contacted by their care coordinator within seven days of discharge to ensure that the care plan is providing the support needed, and can be amended if needed. Susan continues: Research has shown that the most critical period for mental health service users is within seven days following discharge from the unit, as they adjust to leaving the protective hospital communication channels and opportunities for involvement. Pippa Ward, assistant director, children s targeted services in north east London said: The more feedback and input we can gather from the people who use our services, the greater our understanding of the issues they are faced with when accessing health services. We have been working with a group of local parents during a review of our services for children with complex needs. We learnt from parents it was often not clear who provides support for problems that may be associated with their long environment. The sooner we speak with service users afterwards, the more likely we are to identify issues and address them, to help prevent breakdown and readmission. The more supportive and responsive we can be to the service user s continuing care needs, the better their experience will be of our services. Supporting involvement, improving services term conditions such as issues with sleeping, behaviour and feeding. They were telling us they struggled to find out about the services they needed, and felt they had to fight to receive them. In response we are working with clinicians and parents to develop integrated pathways, which will make it clearer for parents what they can expect, and when to expect it. This work will ensure services are improved for the people who use them and support the development of the Local Offer, required to be produced in every Borough as part of the Children and Families Bill. The Trust s patient and service user involvement team carry out regular surveys to find out more about what the people who use our services, and their family members and carers, think works well and where improvements could be made. Following feedback received from a survey about their service, the children s physiotherapy team in south west Essex identified a key area of improvement for their service. Jackie Ullyart, head of children s physiotherapy, explained: When we received the survey results, one of the issues that really stood out for our team as an area for improvement was around the information we provide to our patients and their family. The survey asked patients and their family, Were things explained to you?. We knew we were explaining the treatment and care during appointments, but the survey results helped us to recognise that this information was not always being fully remembered. We realised that we needed to provide more written information to support what we were explaining, so that patients and their family had something to look at and refer to during conversations with staff, and to take home following their appointment. Want to work with teenagers? Then you will need to impress them at your interview When applying for a role working with young people, many candidates will now find that there is a teenager sitting on the interview panel. Candidates will have reached interview stage because on paper they seem to have all the necessary skills. Having a young person on the interview panel means they are able to provide a unique insight into whether candidates communicate, interact and engage with them appropriately all top priorities for a job working with this age group. 6 Quality account 2012/13 summary - North East London NHS Foundation Trust North East London NHS Foundation Trust - Quality account 2012/13 summary 7

5 Achievements in 2012/13 Improved waiting time from referral to first contact with our services Workshops help reduce waiting times The Improving Access to Psychological Therapies (IAPT) service in Barking and Dagenham works with people who are experiencing common mental health problems such as depression, agoraphobia, social phobia, obsessive compulsive disorder and posttraumatic stress disorder. With demand for its services increasing, the Barking and Dagenham IAPT team needed to find a way to ensure that waiting times for therapy are kept to a minimum. Julie Wilson, service manager, explains: During 2012, the team introduced a number of new initiatives to ensure that clients start to interact with the service as soon as possible, and are not kept waiting for a first appointment. Now clients are invited to attend an introduction workshop within two weeks of being referred to our service. During the workshop we explain what clients can expect from therapy and from our staff. They are given contact telephone numbers for the service and information to read. The following week we contact the client by telephone to confirm their details, discuss their individual needs and to set up a face-to-face appointment. We also provide them with information about how they can start to help themselves and how to prepare for therapy so that they can get the most out of it. This means that by their first face-to-face appointment, they have already spoken with their therapist, been given Through this process we are also able to identify where people are not ready for the types of therapy we offer. When somebody doesn t feel ready for therapy they are less likely to attend their face-to-face appointments information to read and can come along prepared and knowing what to expect. Through this process we are also able to identify where people are not ready for the types of therapy we offer. When somebody doesn t feel ready for therapy they are less likely to attend their face-toface appointments. We can now identify this early and if after discussion they decide not to go ahead, their appointment can be offered to somebody else, helping to keep waiting times down. Clients who are not yet ready for therapy are welcome to call back again, and we will offer a reassessment, by the same therapist where possible. Children s services working hard to reduce waiting times Providing the best possible care for patients is a top priority for our services. We know that not having to wait a long time for an appointment is important for patients and their families, however it is not always easy to offer appointments as quickly as we would like. The children s speech and language therapy service in south west Essex provides specialist assessment and therapy for children with delays and disorders of their speech, language and communication, including those with complex special physical needs, children with autistic spectrum disorders, hearing impairment, stammering, and specific language disorders. The team provide assessments, run therapy clinics, make home visits and carry out reviews. Finding enough time to provide all of these important services can be difficult. Alison Gray, service manager, said: We have been trying new ways of working to try to keep waiting times to a minimum, as we know that parents are understandably anxious if they have a concern about their child s speech and language development. We already run drop-in clinics for parents of children aged under four, so they can come along for immediate advice and information if they have a concern. Over the past year we have been booking appointments further ahead so that we can allocate enough time for each different type of appointment, which helps to balance our workload. There is no point carrying out lots of first assessments if we then cannot provide the child with the followup therapy they need. This is still proving difficult and we need to keep the balance. Booking ahead also means we have a bit more flexibility to fit the needs of parents. We have also been working with schools, GPs and community paediatricians to ensure that referrals are appropriate so that patients do not wait for an appointment unnecessarily. It is disappointing that, despite our efforts to date, we have not been successful in reducing the waiting times on a long-term basis. Next year we plan to look at how we carry out patient reviews. Our experience shows they are not always necessary. However, we need to ensure we continue to carry out reviews where required and provide open access for parents if they feel a review is needed. We will be planning how we might do this over the coming months. 8 Quality account 2012/13 summary - North East London NHS Foundation Trust North East London NHS Foundation Trust - Quality account 2012/13 summary 9

6 Achievements in 2012/13 Improved clinical care Home treatment team integration improves care Improving continence care Working to reduce falls We aim to provide treatment and care for people with mental health problems in the least restrictive environment. This means providing care at home rather than in hospital wherever possible. Over the past year, a lot of work has been done to ensure the role of the home treatment team supports this aim most effectively. Wellington Makala, home treatment team manager explains: Over the past year we have reviewed the role played by our home treatment teams, and how they work with the mental health inpatient wards and the community recovery teams. Our services are now much more integrated than ever before. Whenever a service user becomes so unwell they may need inpatient care, our home treatment team will assess their needs to see whether it is possible to provide them with more intensive care at home to help prevent them going into hospital. Every service user receiving care from a community recovery team now has a relapse plan, so that their friends, family and healthcare professionals can recognise when they may need extra support, at the earliest possible stage. Our home treatment team staff also visit the inpatient wards each day to find out more about the patients and to help plan for their discharge. This helps to reduce the length of time service users need to stay in hospital. We also have members of staff who work in both the home treatment team and on hospital wards which is a tremendous help in the integration of the services. During the past year there has also been the introduction of a specialist older adult home treatment team covering the north east London area. Older adults are more likely to lose functional skills such as cooking and cleaning if they have a stay in hospital, and are less likely to return to social activities following a hospital stay. The older adult home treatment team provides additional support in the home so that service users retain these skills, and continue with their normal daily activities as much as possible. Many people with a continence problem find it difficult to speak about it. The effects can be emotional, such as social isolation, and physical including dehydration due to worry about drinking, and water infections. So, it is important healthcare staff provide support to help patients to manage their condition. Philomena Arthur, head of integrated community teams, explains: We want to ensure our teams have all the skills to carry out thorough continence assessments and are able to identify, and provide practical advice to patients to manage their condition. It is also important that we are able to carry out regular reviews to see how patients are managing. Over the past months, ten healthcare assistants from integrated care teams across the south west Essex area have received intensive training in continence management so they can now provide continence assessments and advice. New continence clinics introduced in community hospitals and clinics to replace most home visits have enabled staff to have more products and information to hand during appointments, and more patients can be seen each day. And, to support continence services across the area, a new centralised appointments system means appointments can be offered at the clinic and time most convenient for the patient. There are a number of reasons why patients might have a fall during their stay in hospital, such as limited physical mobility, the effects of medication, not being familiar with the hospital environment, disorientation, poor balance or inattention. Reducing the risk of patients having a fall during their stay is a key priority, so last year NELFT established a falls group to look at what measures could be taken to reduce falls, and to share best practice across the Trust. The Trust was keen to understand more about why patients fall and to act on observed trends, so that effective measures could be put in place to reduce the risk of recurrence. Andrew Nwosu, clinical lead for stroke (inpatients), explains: By looking through information from incident reports and aligning it with current evidence we are able to identify key factors that may increase the risk of patient falls. This has helped us to focus on the things we need to do to help reduce the risk of falls, and apply these across inpatient units. Where areas of good multi-disciplinary practice are identified, these are shared. A high proportion of patients in our inpatient units may have one or more risk factors which increase the likelihood of falls during their inpatient stay. On admission every patient is assessed for their falls risk, and where increased risks are noted a detailed falls assessment is carried out to and measures put in place to help reduce the risk of injury. Some of these interventions include ensuring the patient has appropriate equipment/mobility aids during their stay, adequate supervision during functional tasks and equipment such as high- low profiling beds which can be lowered close to the floor. We also use falls sensors which alert staff when a patient significantly changes position in bed. The approach adopted is always multidisciplinary and includes aspects of medicines management and review to ensure medication is not contributing to increased falls risk, as well as ensuring good patient nutrition and hydration. Falls prevention training is currently carried out by experienced clinical staff on each inpatient unit. To ensure consistency and to share best practice, NELFT is developing a Trust-wide training programme around falls prevention. Andrew continues: It is important that staff across the Trust have a consistent approach to helping to reduce falls. Reducing the risk of patients having a fall during their stay is the business of every member of staff, clinical and non clinical, and having a shared vision and a shared approach makes a huge difference. 10 Quality account 2012/13 summary - North East London NHS Foundation Trust North East London NHS Foundation Trust - Quality account 2012/13 summary 11

7 Improvement priorities priorities in 2013/14 Improvement priorities in 2013/14 in 2013/14 We have a number of improvement priorities for 2012/13, which have been informed by what our staff, service users and patients have told us are important to them. Some of this feedback has been collected through our quality account questionnaire, and we have also analysed the themes from complaints and looked at feedback from our service users and their relatives and carers. Our three overarching priorities for improvement are: Service user experience: Improved communications between staff and service users Patient safety: Improved waiting time from referral to first contact with our services Quality and clinical effectiveness: Measurable improvement to quality of treatment Patient safety Improved waiting time from referral to first contact with our services In our mental health services we will: reduce the appointment waiting time to six weeks for paediatric speech and language services and community paediatric services north east London we will: implement RiO in all services, and gradually develop the system during 2013/14 south west Essex we will: reduce the appointment waiting times to six weeks for children s speech and language services and community children s services Service user experience Improved communications between staff and service users Quality and clinical effectiveness of treatment Measurable improvement to quality of treatment In our mental health services we will: ensure that all of our staff receive an appraisal, which sets areas for professional and personal development so helping to ensure high quality care improve engagement with carers, and ensure that where clients are carers this is recorded with a view to identifying appropriate support north east London we will: conduct an annual patient satisfaction survey, to understand what rating patients give their experience of our services Implement the Family and Friends test during 2013/14, to understand how many patients would recommend our services to their family or friends conduct a Health and Safety Executive staff stress survey, to benchmark current levels with a view to identifying where improvements are needed support the wide, active engagement of staff in the Trust BME group to improve staff morale and communication south west Essex we will: ensure that each service makes telephone contact with at least five patients each month to discuss their experience In our mental health services we will: measure our performance against question 15 in the inpatient exit survey: As far as you know did staff take your family or home situation into account when planning your discharge from hospital? north east London we will: use the patient safety thermometer to measure the prevalence of four harms: pressure ulcers, venous thrombotic events, falls, and catheteracquired urinary tract infections improve clinical care to help reduce the number of falls in community inpatient units south west Essex we will: share previous pressure ulcer initiatives which have reduced pressure ulcers across the three community hospitals. All wards will introduce red placemats to identify people who need support with their nutritional needs at meal times. A pictorial fluid/drink sheet that supports staff to ensure patients are hydrated will be shared. A pressure ulcer factsheet about action to take if pressure damage to the skin is identified will be introduced. We will share the intentional rounding tool, which is a process to check on patients and ensure their fundamental care needs are met utilise the NHS Safety Thermometer audit tool to monitor the occurrence of pressure ulcers, falls, thrombosis and catheter associated urinary tract infections. We will focus on reducing the rate of grade 2 pressure ulcers through training and education. complete the Department of Health s You re Welcome quality standards which aim to make health services young people friendly. This will be undertaken by a minimum of two services. work in partnership with services that care for people identified as approaching the end of Life to support patients preferred place of care and provide care after end of life. This will lead to an increase in the number of patients achieving their wish to die at home. 12 Quality account 2012/13 summary - North East London NHS Foundation Trust North East London NHS Foundation Trust - Quality account 2012/13 summary 13

8 How you can help us improve our services Development of our quality account The development of our Quality Account and identification of our future improvement priorities is informed by local stakeholder organisations such as our NHS partners, local authorities, people who use our services, the public and by NELFT staff. We gather information from engagement meetings, feedback forms, comment and complaints as well as through a quality questionnaire, which directly informed the priorities for 2013/14. If you would like to complete a quality questionnaire, please contact: Julie Price Suite 1B, Phoenix House Christopher Martin Road Basildon Essex SS14 3EZ Tel: julie.price@nelft.nhs.uk Become a member Becoming a member of our Trust is a great way for you to learn more about what we do, have your say and have a direct influence on the decisions we take. Being a member means you can become actively involved in the work of the Trust and help shape our future plans, get a better understanding of the health services we provide and make sure your views are heard. Being a member is free, it doesn t cost you anything. You are not committed to being heavily involved in the work of the Trust. You can be involved as much, or as little, as you want. If you would like to become a member of our Trust, or would like further details please contact us: Tel: membership@nelft.nhs.uk Or see our website: How to provide feedback on this quality account We hope you find this report useful and informative. We welcome your feedback on how we can improve our quality account the next time round. If you would like to give us feedback on our Quality Account 2012/13, or this summary version, please contact Julie Price (details on page 14) Quality Account 2012/13 If you would like a copy of the full quality account 2012/13 this can be found on the NELFT website at in the news & publications section. If you would like a copy sent to you please contact us at: Tel: communications@nelft.nhs.uk Or you can write to us, giving your name and address, at: Quality Account request NELFT corporate communications and marketing team Goodmayes Hospital Barley Lane Ilford IG3 8XJ 14 Quality account 2012/13 summary - North East London NHS Foundation Trust North East London NHS Foundation Trust - Quality account 2012/13 summary 15

9 North East London NHS Foundation Trust Trust head office Goodmayes Hospital 157 Barley Lane Ilford Essex IG3 8XJ Chair: Jane Atkinson Chief executive: John Brouder