Providing excellent care to people with cancer.
2009/10
Quality
accounts
1
Contents Part 1 An introduction from the Chief Executive
3
Part 2 Review of Quality Performance 2009/10: Improving Patient Safety Improving Patient Experience Improving Clinical Effectiveness
5 3 6 8
Priorities for improvement: Improving Patient Safety Improving Patient Experience Improving Clinical Effectiveness
9 9 10 12
Statements of assurance from the Board
14
Part 3 Other Information: Safety indicators Clinical effectiveness indicators Patient experience indicators
20 20 21
Performance against key national priorities and national core standards
23
Annex statements
25
2
An introduction from the Chief Executive Quality is at the heart of what all our staff aim to achieve for all the patients in our care. It is thanks to the professionalism, expertise and commitment of our staff that we are able to provide a high quality service. We have clearly defined our Core Purpose as providing excellent care to people with cancer. Our Vision is to provide outstanding cancer care through excellence in treatment, research, education and training. Our values, developed with our staff demonstrate our commitment to how we work: Passionate about what we do Putting people first Achieving excellence Committed to our future Always improving our care This year has seen the Trust take forward the aims and objectives of its Quality Strategy. The Trust Board has ensured that Quality is a key agenda item at each Board meeting and it monitors the delivery of the Trust’s priorities and initiatives identified in its first Quality Report (2008/09). The Trust Board has reviewed the information that it receives in relation to patient experience and has implemented a process where patient stories are included within the Board reports to enable Board members to hear about the real experiences of our patients. The Board has developed the information that it receives in relation to complaints with full details of each complaint received reported to the Board, not just trends and data. From 2010/11 we plan to also provide this full information to our Council of Governors. Throughout this year we have worked with our staff and our key stakeholders to continue to improve the quality of our services. This year has seen a number of key developments and challenges for the Trust including:
We are pleased to report that we have reported full compliance with our requirements for delivering same sex accommodation (DSSA). Privacy and dignity has been further enhanced by the first stage of our ward refurbishment program with a marked increase in single rooms.
A new challenge for the Trust this year has been the implementation of CQUINS (Commissioning for Quality and Innovation). We have worked closely with our commissioners and the cancer network to ensure that the CQUIN for 2009/10 leads to a real improvement in quality for patients. Our CQUIN enabled the first stage of the development of the Acute Oncology programme recommended in the National Chemotherapy Advisory Group report and the NCEPOD report Systemic Anti-Cancer Therapy; for better, for worse.
We have made good progress with the objectives outlined in our Quality Strategy and have met all / almost all of our mandated targets. I am particularly pleased to be able to report again that we have had no cases of MRSA bacteraemia.
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A particular challenge this year has been the achievement of the 62 day cancer waiting time target and we have worked closely with the DH intensive support team to further deliver improvements in performance.
In 2009 we received our performance rating from the Care Quality Commission and I am pleased to report that we received excellent for quality of services and excellent for use of resources for the 2nd year running. Our infection control inspection by the Care Quality Commission showed no breaches of our duties and we have scored consistently in the top 20% performing Trusts in both the annual staff and patient surveys. Whilst all of the questions in these surveys are important one particular staff survey question provides me with assurance of the quality of care. When staff were asked ‘if a friend or relative needed treatment, I would be happy with the standard of care provided by this Trust’ 94% replied yes. Our annual PEAT (Patient Environment Action Team) assessment has also demonstrated good performance with excellent ratings being given for environment, food and privacy and dignity.
As Chief Executive I am confident that the Trust provides a high quality service and that these Quality Accounts demonstrate this. To the best of my knowledge the information in these accounts are accurate. In summary, CCO has a good track record in delivering a quality service to our patients. We cannot rest on our laurels and as Chief Executive I have a personal commitment to lead the drive for continual quality improvement. We will continue to deliver against the objectives we have set and will continue to improve quality in the challenging times ahead.
Andrew Cannell Chief Executive Date: 26th May 2010
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Review of Quality Performance 2009/10 Our 2008/09 Quality report identified priorities for improving patient safety, experience and outcomes. Progress against these priorities is outlined below.
Improving Patient Safety Patient Safety First
The Trust has implemented a number of elements of the national Patient Safety First Campaign. The Trust Board has committed to lead on the establishment of Patient Safety Leadership Walkrounds to ensure that all staff members have the opportunity to raise any safety concerns directly with Board members. All executive and non-executive directors take part and during 2009/10 nine walkrounds took place in 9 clinical departments in the Trust. Issues raised during each walkround are summarised and a report is provided to each staff member who attended. Agreed actions are followed up and progress reported to the area 1 month and 4 months following the walkround. Examples of issues raised during the Patient Safety Leadership Walkrounds: Handwriting legibility on prescriptions - handwriting legibility on scripts was identified as a potential patient safety issue however checks are in place to prevent errors translating into patient harm and E-Prescribing, which will be implemented across the Trust in the coming months should eliminate this problem. Nurse staffing levels - staff highlighted that agency staff are not able to provide the full services provided by CCO nursing staff which adds to ward pressures and ultimately patient safety. The use of agency staff has greatly reduced since this walkround as many more nursing staff have been employed following the Trust Board’s approval of an increase in the staffing establishment. Feedback on the value of this approach has been very high from both staff and Board members. The second Patient Safety First initiative that the Trust has implemented is Intervention 2: Deterioration. This involves the Trust monitoring and reporting monthly on the number of Cardiac Arrest Calls; Number of rapid response Calls; percentage of patients with observations complete; percentage of trigger patients receiving an appropriate response. The Trust has been piloting the use of the SBAR tool and will include this in the monitoring and reporting for 2010/11. All results and trends are reviewed by the Acutely Unwell Steering group led by the Critical Care Nurse specialist to ensure any actions are taken forward. Examples of results include: Percentage of patients with observations complete: Using the Patient Safety First Campaign Chart Checker adapted for CCO, 30 sets of patient observations/MEWS records for each of the three in-patient wards are reviewed (by the wards) per month. In addition, each set of patient records reviewed during the monthly Global Trigger Tool review are assessed against the CCO Chart Checker. 5
The Critical Care Nurse Practitioner provided additional training to ward staff following the outcome of the initial GTT reviews and is monitoring the chart checker results closely along with carrying out independent MEWS audits. The monthly chart checker results from each of the three inpatient wards, all have shown an improvement since January 2010. The Trust has been focused over the last year in improving the quality of care for acutely ill patients and this initiative has formed a valuable piece of that work. Other elements have included: Improving the identification of deteriorating patients: Throughout the year we have worked hard to improve the skills and competencies of our nursing workforce. We have appointed a new role of Critical Care Clinical Nurse Specialist who has led a program of training and development. six staff nurses attended an HDU course during the year and key staff undertook a work based training program at Aintree University NHS Foundation Trust to further develop skills in trachyostomy management. All ward nursing staff have undergone training in the use of an early warning system and our subsequent clinical audit has shown a clear improvement in patient monitoring. We have also invested in medical equipment to further improve the care of this vulnerable patient group including a high specification blood gas monitor. Implementation of the Global Trigger Tool The IHI Global Trigger Tool (GTT) for Measuring Adverse Events provides an easy-to-use method for accurately identifying adverse events (harm) and measuring the rate of adverse events over time. Tracking adverse events over time is a useful way to tell if changes being made are improving the safety of the care processes. A review of 8 records per month is undertaken which reflects the size of the Trust. The use of the tool this year has proved to be valuable in identifying a baseline of harm incidents to enable the Trust to focus on areas for improvement. All harm events identified have been temporary. Areas that have been identified through the use of the tool are:
Delays Opiate toxicity PEG infections Cannulation Pressure ulcer
All of these areas have triggered initiatives to reduce harm. Nursing Quality Metrics The quality of nursing care is critical to the safety of patients admitted to the Trust. This year we have focused on the development of a series of nursing metrics which are both of meaning to our patient population and the nature of the nursing care that we provide, and, where possible, provides us with an opportunity to benchmark against other hospitals. We have been reviewing the available tools and in particular the Nursing Assessment and Accreditation Scheme (Salford Royal NHS Foundation Trust) , the Advancing Quality Metrics and the recently published High Impact Changes for Nursing by the Department of Health, and have developed Quality in Nursing at Clatterbridge (QINC). The QINC tool will 6
be piloted for 6 months from May 2010 with a full Matron’s audit of all wards every three months. From July 2010 the project will focus on identifying specific areas for targeted improvements. From the preliminary work these are expected to be:
Nursing documentation Management of pressure ulcers, aiming for zero tolerance Improvements to pain assessment implementing the new EPAT tool
Improving Patient Experience Understanding the experience of patients in our care is fundamental to being able to identify areas for improvement. The use of the national patient surveys provides a valuable mechanism to review the whole Trust’s performance but does not provide the level of detail at departmental level. During 2009/10 we have continued to roll out our ‘real time’ patient survey program. This program provides every patient with the opportunity to complete a survey form at any point in their stay with us. The information gathered from the survey is reported both at Trust and departmental level. The questions have been developed in conjunction with our Patient Council to ensure that they are meaningful. Each department is required to review its performance and develop action plans for improvement. It is important that patients see the results of the survey and therefore these are displayed in each clinical area. A summary of the key questions is also put on our website. These can be found at http://www.ccotrust.nhs.uk During this time period we received a total of 2968 forms, compared to 2352 forms for the previous year. The chart below gives an example of some the 29 questions we ask and their results for the last 12 months.
Patient Feedback Survey 2009/10 I felt safe Information w as good Dept w as clean Toilets w ere clean Parking w as easy
Always
I w as treated w ith courtesy and respect
Usually Sometimes
I had confidence in staff
Never
Staff introduced themselves
N/A
Staff w ashed their hands Staff respected my privacy
0%
20%
40%
60%
7
80%
100%
Problem areas that have been identified through the survey are around waiting times. 49% of patients who were asked about waiting times felt that they sometimes had to wait, only 20% never had to wait. This question was changed in January this year from ‘I had to wait’ to ‘I had to wait more than twenty minutes after my appointment time’ to enable us to identify where the problem is occurring on a regular basis. Patients often tell us that they don’t mind waiting if they are kept informed of why they are waiting and the approximate delay. During this year 45% of patients asked felt they were always kept informed. Parking remains a problem. Patients tell us that they are grateful for the free parking, but at certain times of the day it is impossible to find a space in the patient car parking area. We are currently undertaking a car-park accessibility audit which will hopefully lead to some improvements by deterring staff and professional visitors from parking in the patient’s parking area. A key focus for the Trust this year has been the development of a satellite radiotherapy centre in Liverpool. Many of our patients have long travel times and may need to receive treatment every day for up to 6 weeks. To improve the experience of receiving radiotherapy for these patients this centre is being built with the main driver being to reduce travel times and improve access. The centre will open early 2011. Patients and governors have been involved in every stage of the project to ensure that the design of the facility optimises the patient experience. Improving Clinical Effectiveness PROMS During 2009/10 we have commenced working on the development of validated cancer specific PROMS (Patient Reported Outcome Measures) tools that will enable us to proactively monitor patient reported outcomes and to develop action plans to further improve outcomes. There are currently no nationally validated tools for cancer. Initial scoping work has been undertaken for us by Keele University and we hope to have tools available to pilot during 2010/11.
The Trust has been put forward via the Merseyside and Cheshire Cancer Network to take part in phase 2 of the Quality in Cancer Nursing – Nurse Sensitive Outcome Indicators for Ambulatory Chemotherapy project being run by the National Nursing Research Unit, Kings College London and the University of Southampton. Mortality reviews The Trust Board regularly monitors the Trust’s HSMR (hospital standardised mortality rate). Whilst our HSMR rate is low we feel that it is important to strive to understand the cause of patient death in our population. To enable us to achieve this we have commenced this year a detailed review of 30 day mortality following chemotherapy, both radical intent and palliative treatments, over a 12 month period. This is led by the Medical Director. Following the baseline work completed in 2009/10 this project will be further developed. The aim is to present data displayed as control charts, with a 3 monthly moving average, that will identify trends, both by regime and consultant performance.
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Priorities for improvement The Trust Board has agreed the following priorities for quality improvement for 2010/11. The Board will continue to monitor performance against its quality improvement strategy through a quarterly quality report to the Board. In identifying areas for improvement the Trust has undertaken an engagement process with: its staff through its senior managers via the development of departmental Delivery Plans; its Governors at a Board and Governors away day in March; with its lead Commissioner and Cancer Network at its contract quality meetings and with patient and public representatives at a patient experience Workshop in March 2010. Improving Patient Safety Objective: Development of patient safety KPIs including an action planning framework for improvement to include minimisation of avoidable patient harm and elimination of ‘never events’ Rationale for Selection Improvements in patient safety remain a high priority for the Trust. Focusing on specific KPIs will enable the Trust to set clear objectives and priorities for improvement. Selection and monitoring of KPIs will be generated from workstreams and engagement processes that were in place in 2009/10. The KPIs will include: Patient Safety KPI QINC (Quality in Nursing at Clatterbridge)
Venous thrombosis assessment
Source
Engagement
Advancing Lead Quality Commissioner High Impact Changes for Nursing Nursing Assessment and Accreditation Scheme (Salford Royal NHS Foundation Trust)
CQUINS
Lead Commissioner
Monitoring of progress Integrated Governance Committee Contract quality meetings with lead commissioner Project steering group Wards Integrated Governance Committee Contract quality meetings with lead commissioner Wards
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Expected areas of improvement Documentation Pain assessment Pressure ulcer prevention (zero tolerance)
Patient Safety KPI HCAI indicators
Source
Care Quality Commission
Engagement
Lead Commissioner
Monitoring of progress Trust Board Contract quality meetings with lead commissioner
MEWS SBAR
Patient Safety Campaign
Safety KPIs identified in year
Global trigger tool Internal Incidents Complaints Contract Lead Commissioner
Quality KPIs
Internal
Risk Management Committee Risk Management Committee Integrated Governance Committee Contract quality meetings with lead commissioner
Never events
Nationally mandated Contract
Lead Commissioner
Trust Board
Expected areas of improvement Maintain zero performance for MRSA Achievement of C Diff target
Improved use of both tools
Waterlow assessment Nutritional screening tool assessment Falls risk assessment
Maintain zero tolerance
Contract quality meetings with lead commissioner
Improving Patient Experience Objective: Develop a patient and carer experience strategy, including an action planning framework, for improvement to include minimisation of avoidable patient harm and elimination of ‘never events’
Rationale for Selection Improvements in patient experience remain a high priority for the Trust. Focusing on specific patient engagement and reported experience will enable the Trust to set clear objectives and priorities for improvement. Selection and monitoring of priorities will be generated from workstreams and engagement processes that were in place in 2009/10.
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The key areas will include: Patient Experience Improve responsiveness to personal needs of patients
Source
National Patient Survey
Engagement
Lead commissioner
Monitoring of progress Monitoring of CQUIN at contract quality meetings with lead commissioner
Expected areas of improvement Maintain high level of performance (nb CCO is in top 20% of all Trusts for all indicators)
Integrated Governance Committee To capture near Local Patient real time patient Survey (CQUIN) experience data in key areas and demonstrate an improvement in reported experience in year
Developed through patient Experience Workshop with representation from patients, commissioners, carers, staff.
Reduction of waiting times in departments
CCO Patients Council
Internal patient survey
Improved car parking
Monitoring of CQUIN at contract quality meetings with lead commissioner
Targets for improvement to be agreed with commissioner following baseline data.
Integrated Governance Committee Integrated Governance Committee
Reduction of waiting times in departments
Patient Experience Governors Committee Integrated Governance Committee
Patient choice
National patient Survey
Trust Board
Somewhere to keep personal belongings
National patient Survey
Trust Board
Integrated Governance Committee
Hard to reach groups such as men, people with learning disabilities, sensory or literary difficulties, economically deprived are explicitly included
Internal
Council of Governors
Integrated Governance Committee
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Improved car parking
Improve processes to enable where possible a choice of admission date Improvement on national survey score of 66% through ward refurbishment programme Improvement in patient experience in hard to reach groups
Objective: Roll out of the Acute Oncology Program across the cancer network. Rationale for Selection The National Chemotherapy Advisory Group report and the subsequent NCEPOD report identified that an acute oncology service will provide assessment within 24 hours to acutely ill patients, thereby reducing the wait for investigations and specialist treatment and resulting in improved clinical outcome, reduced LOS and improved patient experience. The full implementation of acute oncology has been supported by the CQUINS development for both 2009/10 and 2010/11. Acute Oncology Appointment of all medical oncology consultant posts.
Source
NCAG
Engagement
Lead commissioner
NCEPOD
Monitoring of progress Integrated Governance Committee
Cancer Network CQUINs
Monitoring of CQUIN at contract quality meetings with lead commissioner
Expected areas of improvement Reduced patient waits Improved clinical outcomes Improved patient experience
Improving Clinical Effectiveness Objective: Development of a cancer clinical outcome data development programme including an action planning framework for improvement and external benchmarking Rationale for selection Improvements in patient outcomes remains a high priority for the Trust. Focusing on key clinical outcome measures will enable the Trust to set clear objectives and priorities for improvement. Clinical Outcome measure 30 day mortality
Source
NCAG
Engagement
Council of Governors
NCEPOD
Monitoring of progress Integrated Governance Committee Council of Governors Contract quality meetings with lead commissioner
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Expected areas of improvement Baseline data being gathered
Patient Safety KPI 5 year survival
Source
Internal
Engagement
Council of Governors
Monitoring of progress Integrated Governance Committee Council of Governors
Preferred place of care
CQUINs
Lead commissioner
Integrated Governance Committee
Cancer Network Contract quality meetings with lead commissioner
13
Expected areas of improvement Baseline data being gathered. Overall survival (breast and lung cancer) to be reviewed as model sites. Increased percentage of “palliative patients on the end of life care pathway (LCP) at time of death
Statements of Assurance from the Board Information on the review of services During 2009/10 the Clatterbridge Centre for Oncology NHS Foundation Trust provided and/or sub-contracted two NHS services. The Clatterbridge Centre for Oncology NHS Foundation Trust has reviewed all the data available to them on the quality of care in two of these NHS services. The income generated by the NHS services reviewed in 2009/10 represents 100 per cent of the total income generated from the provision of NHS services by the Clatterbridge Centre for Oncology NHS Foundation Trust for 2009/10. The data reviewed covers the three dimensions of quality – patient safety, clinical effectiveness and patient experience.
Information on participation in clinical audits and national confidential enquiries During 2009/10 four national clinical audits and one national confidential enquiry covered NHS services that Clatterbridge Centre for Oncology NHS Foundation Trust provides. During 2009/10 Clatterbridge Centre for Oncology NHS Foundation Trust participated in 100% national clinical audits and 100% national confidential enquiries of the national clinical audits and national confidential enquiries which it was eligible to participate in. The national clinical audits and national confidential enquiries that Clatterbridge Centre for Oncology NHS Foundation Trust was eligible to participate in during 2009/10 are as follows: National Clinical Audits: Head and Neck (DAHNO) Bowel (NBOCAP) Lung (LUCADA) Oesophago-gastric. National Confidential Enquiries into Patient Outcome and Death: Parental Nutrition Study The national clinical audits and national confidential enquiries that Clatterbridge Centre for Oncology NHS Foundation Trust participated in during 2009/10 are as follows: National Clinical Audits: Head and Neck (DAHNO) Bowel (NBOCAP) Lung (LUCADA) Oesophago-gastric. National Confidential Enquiries into Patient Outcome and Death: Parental Nutrition Study
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The national clinical audits and national confidential enquiries that Clatterbridge Centre for Oncology NHS Foundation Trust participated in, and for which data collection was completed during 2009/10, are listed below alongside the number of cases submitted to each audit or enquiry as a percentage of the number of registered cases required by the terms of that audit or enquiry. National audit / enquiry National Clinical Audits: Head and Neck (DAHNO)
% submitted
Bowel (NBOCAP)
31.0% Remaining couldn't be uploaded due to secondary hospital not registering the patient. Before CCO can register a patient we need to know both whether the patient was discussed at MDT and whether the patient was an urgent GP referral. 100%
Lung (LUCADA)
99.8%
Oesophago-gastric
92.0% Remaining 14 treatments could not be uploaded as the secondary hospital had not registered the patients. Before CCO could register the patients we needed to specify the specific location within the stomach. 1/1 record submitted 1/1 Consultant questionnaire 1/1 Organisational questionnaire
National Confidential Enquiries into Patient Outcome and Death: Parental Nutrition Study
The reports of 5 national audit clinical audits were reviewed by the provider in 2009/10 and Clatterbridge Centre for Oncology NHS Foundation Trust intends to take the following actions to improve the quality of healthcare provided: Continue to provide data to the audits that are relevant to the Trust Continue to provide accuracy and complete data to the audit that are relevant to the Trust The reports of 34 local clinical audits were reviewed by the provider in 2009/10 and Clatterbridge Centre for Oncology NHS Foundation Trust intends to take the following course of action to improve the quality of healthcare provided. Clinical Audit Clinical Audit
Action
Toxicity of Capecitabine given concurrently with preoperative radiotherapy for locally advanced rectal cancer Clinical Audit on Investigation and Management of Carcinoma of Unknown Origin Triage response to clinical trials patients Use of Prophylactic Antibiotics in Chemotherapy Patients
The Colorectal TSG have agreed to reduce taking samples to the 2nd and 4th week of Capecitabine as audit found grade 3 blood toxicity are rare New pathway developed for early referral, to be discussed with Cancer Network Improved education and training for Triage staff. Improved documentation / filing Clinical Director to include a section on prescribing prophylactic antibiotics into the next chemotherapy protocol book.
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Audit of outcomes of stereotactic radiosurgery Cervix Brachytherapy audit
VTE Audit Radiotherapy appointment times patient survey Chemotherapy wastage at CCO Evaluation of the Neutropenic Fever (NF) pathway at CCO Hip replacement prostate radiotherapy HDR Brachytherapy in rectal cancer Baseline audit of incoming triage calls to CCO after the introduction of the follow up service for new patients Chemotherapy Triage Survey Radiotherapy planning for prostate cancer – rectal dose volume constraints Effectiveness of Connective Tissue Stretching An audit of patients with oesophageal cancer referred for consideration of Radiotherapy
To identify the current trend for gastrostomy tube placement in patients undergoing radiotherapy/chemotherapy at Clatterbridge Centre for Oncology Assessment of patients’ spirituality and spiritual beliefs – staff survey Discharge Care Plan Audit of timings for patients admitted with confirmed or suspected neutropenic sepsis
No action required Change to the technique for brachytherapy treatment in cervical cancer. This has led to an increase in dose of 3 fractions of brachytherapy to be given to our cervical cancer patients. This brings the total dose administered in line with those recommended by the Royal College of Radiologist’s guidelines. Reminder from Medical Director to clinicians re: assessment Expand the content of the “preference letter” to explain the appointments system Scheduling change for herceptin patients No action required Standardisation of practice No action required No action required
Number of small actions Follow up prospective audit Develop guidelines and education Conclusion that a dose of 30gy/10# is an acceptable treatment regime compared with those of longer duration with the potential for more toxicity Further review of process
Re-audit Further training. Further testing with staff A new neutropenic assessment tool is being launched Education and training A sepsis discussion group will be formed
NICE Guidance audits
Clinical Audit
Action
TA137 - Rituximab for the treatment of relapsed or refractory stage lll or lV follicular nonhodgkins lymphoma TA110 - Rituximab for the treatment of follicular lymphoma TA101 - Docetaxel for the treatment of hormone refractory prostate cancer TA124 - Pemetrexed for the treatment of nonsmall-cell lung cancer
Fully compliant
TA172 - Head and neck cancer (squamous cell carcinoma) - cetuximab
Fully compliant Fully compliant Non-compliant with good clinical reason. 2 patients received Pemetrexed which is against the NICE recommendation. However, the Pemetrexed was given via the off protocol procedure for both patients due to them having had peripheral neuropathy following 1st line carboplatin/vinorelbine Fully compliant
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TA181 - Lung cancer (non-small cell, first line treatment) - pemetrexed TA183 - Cervical cancer (recurrent) - topotecan TA169 - Sunitinib for the first-line treatment of advanced and/or metastatic renal cell carcinoma
TA178 - Renal cell carcinoma - bevacizumab, sorafenib tosylate and sunitinib TA179 - Gastrointestinal stromal tumours sunitinib IP268 - Brachytherapy as the sole method of adjuvant radiotherapy for breast cancer after local excision TA184 - Lung cancer (small cell) - topotecan TA119 - Fludarabine monotherapy for the firstline treatment of chronic lymphocytic leukaemia
Fully compliant Fully compliant Cohort 1 - not applicable. Cohort 2 - 100%. Cohort 3 – 64.0%. Non-compliances: 3 patients were PS2 and 2 patients received 2nd line sunitinib (all with good clinical reasons). Cohort 4 – 95.0% Non-compliance due to 1 patient not being offered sunitinib due to the clinicians concern about toxicity given patient’s comorbidity and altered liver function as per our local protocol. Fully compliant Fully compliant Fully compliant
Fully compliant Fully compliant
Information on participation in clinical research The number of patients receiving NHS services provided or sub-contracted by Clatterbridge Centre for Oncology NHS Foundation Trust that were recruited during that period to participate in research approved by a research ethics committee was 1418.
Use of the CQUIN framework A proportion of Clatterbridge Centre for Oncology NHS Foundation Trust’s income in 2009/10 was conditional upon achieving quality improvement and innovation goals agreed between Clatterbridge Centre for Oncology NHS Foundation Trust 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. Further details of the agreed goals for 2009/10 and for the following 12 month period are available on request from Andrea Leather, Corporate Governance Manager (andrea.leather@ccotrust.nhs.uk) The monetary total for the amount of income in 2009/10 conditional upon achieving quality improvement and innovation goals, and the monetary total for the associated payment in 2009/10 was £245,481
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Information relating to registration with the Care Quality Commission (CQC) and periodic/special reviews Clatterbridge Centre for Oncology NHS Foundation Trust is required to register with the Care Quality Commission and its current registration status is full registration without conditions as a service provider from the Care Quality Commission in March 2010 for the treatment of disease, disorder or injury and for diagnostic and screening procedures. The Care Quality Commission has not taken enforcement action against Clatterbridge Centre for Oncology NHS Foundation Trust during 2009/10. Clatterbridge Centre for Oncology NHS Foundation Trust is subject to periodic review by the Care Quality Commission and the last review was for 2008/09. The CQCs assessment of the Clatterbridge Centre for Oncology NHS Foundation Trust following that review was excellent for quality of services and excellent for use of resources. Clatterbridge Centre for Oncology NHS Foundation Trust has not participated in any special reviews or investigations by the CQC during the reporting period.
Information on the quality of data Clatterbridge Centre for Oncology NHS Foundation Trust submitted records during 2009/10 to the Secondary Uses service for inclusion in the Hospital Episode Statistics which are included in the latest published data. The percentage of records in the published data: which included the patient’s valid NHS Number was: 99.9% for admitted patient care; 99.8% for outpatient care; and 0% for accident and emergency care (we do not provide an A+E service) which include the patient’s valid General Practitioner Registration Code was: 99.8% for admitted patient care; 99.9% for outpatient care; and 0% for accident and emergency care (we do not provide an A+E service). Clatterbridge Centre for Oncology NHS Foundation Trust’s score for 2009/10 for Information Quality and Records Management assessed using the Information Governance Toolkit was 94.0%. Clatterbridge Centre for Oncology Foundation Trust was subject to the Payment by Results clinical coding audit during the reporting period by the Audit Commission and the error rates reported in the latest published audit for that period for diagnoses and treatment coding (clinical coding) were 6.6%. The results should not be extrapolated further than the actual sample audited and which services were reviewed within the sample.
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Coding Accuracy Findings Area audited
Specialty Chapter
HRG
Overall
Speciality/ % procedures coded % Diagnosis coded % of chapter/HRG incorrectly incorrectly episodes Primary Secondary Primary Secondary changing HRG 370 medical 2.1% 14.0% 6.0% 0.4% 5.0% oncology WA 13.3% 9.1% 7.5% 5.2% 11.9% immunology, infectious diseases, poisoning, shock FZ34C large 3.3% 6.8% 0.0% 0.6% 0.0% intestinal disorders Overall 3.5% 10.0% 5.6% 2.1% 6.6%
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% of spells changing HRG 5.0% 11.9%
0.0%
6.6%
Other information Safety Indicators
MRSA bacteraemia cases / 10,000 bed days C Diff cases / 1,000 bed days ‘Never Events’ that occur within the Trust Chemotherapy errors (number of errors per 1,000 doses) Radiotherapy treatment errors (number of errors per 1,000 fractions) Falls / injuries / 1,000 inpatient admissions
2009/10 0
2008/09 0
2007/08 0
0.30
0.20
0.60
0
0
0
0.19
0.10
0.05
0.84
0.76
1.17
25.90
32.00
27.00
All indicators: Data source: CCO
Clinical Effectiveness Indicators
HSMR 30 day mortality rate (radical chemotherapy) 30 day mortality rate (palliative chemotherapy) 30 day mortality rate (radical radiotherapy) 30 day mortality rate (palliative radiotherapy)
2009/10
2008/09
2007/08
36.4% 1.2%
39.3% 0.5%
42.0% 1.4%
7.6%
9.0%
7.4%
1.2%
0.9%
1.2%
16.2%
17.1%
19.5%
NB: In last years Quality Report we reported the following figures for 30 day mortality for chemotherapy: Radical: 0.4% Palliative: 8.9% 20
These figures have been amended in the above table. This will be due to the Trust being informed of the date of death after the report was produced.
HSMR:
Data source Dr Foster
Mortality rate: Data definition: unadjusted mortality rate as a percentage of all cases treated in that category. Data source: CCO
Patient Experience Indicators 2009/10
2008/09
2007/08
At least 80% of patients rate as ‘always’ in the local patient survey programme when asked ‘I was treated with courtesy and respect’
98.0%
98.0%
97.0%
At least 80% of patients rate as ‘always’ in the local patient survey programme when asked ‘Was the ward / department clean’
92.0%
95.0%
95.0%
2009/10 16.0%
2008/09 17.0%
2007/08 15.0%
At least 80% of patients rate as ‘always’ in the local patient survey programme when asked if ‘I was included in discussions about my care’
87.0%
90.0%
90.0%
At least 80% of patients rate as ‘always’ in the local patient survey programme when asked if ‘the staff washed their hands’
88.0%
92.0%
90.0%
At least 70% of patients rate as ‘never’ in the local patient survey programme when asked ‘If they had to wait’
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Patient survey: Data source: data collected from in-house survey Survey questions based on annual Care Quality Commission In-patient survey Target for compliance agreed by the Trust Board as part of our Quality Strategy Data for 2007/08 only available for part year In January of this year we changed the question from ‘I had to wait’ to ‘I had to wait more than 20 minutes after my appointment time’ to enable us to better understand the nature of the issue Variation is not considered to be statistically significant
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Performance against key national priorities and National Core Standards Standards for Better Health declaration
Clostridium difficile MRSA Maximum waiting time of two weeks from urgent GP referral to date first seen for all urgent suspect cancer referrals Maximum waiting time of 31 days for subsequent treatments for all cancers Maximum two month wait from referral to treatment for all cancers For admitted patients, maximum time of 18 weeks from point of referral to treatment
2009/10 Declared full compliance with all 45 standards that it was required to declare against in its mid year declaration to the CQC. The Trust remained compliant throughout the rest of the year. 8 (target no more than 17)
2008/09 Declared full compliance with all standards throughout year and at year end
2007/08 Declared full compliance with all standards except one throughout year and full compliance at year end
7 ( target no more than 19)
0 (target no more than 2) 100%
0 (target no more than 2) 100%
26 (target no more than 11 cases) 0 (target no more than 2) 100%
98.9% (target 98%)
77.6% *prereallocation (draft target 79.0%) 95.4% (target 95.0%)
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93.3% (target threshold 93.0%).
94.7% (target 93.0%)
As at March 2009, 97.3% (target of 90.0%)
95.9% (target 85.0%)
For nonadmitted patients, maximum time of 18 weeks from point of referral to treatment Maximum waiting time of 31 days from diagnosis to treatment for all cancers Screening all elective inpatients for MRSA
2009/10 97.9% (target 95.0%)
2008/09 98.5% (target 95.0%).
2007/08 96% (target 90.0%)
97.7% (target 96.0%)
99.8% (target threshold 98.0%).
99.8% (target 98.0%)
114.4%
th
* to be concluded by 8 July 2010

For screening the percentage is calculated according to Department of Health requirements.
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Annex Statements Primary Care Trusts and Local Involvement Networks (LINks)
Statement from NHS Wirral As lead commissioner, NHS Wirral is committed to commissioning high quality services from Clatterbridge Centre for Oncology and we take very seriously our responsibility to ensure that patients’ needs are met by the provision of safe, high quality services. The Quality Account, in our opinion, accurately reflects quality performance in 2009/10 and highlights future priorities agreed with commissioners for 2010/11. We are reassured that the Trust Board has reviewed service risks following reported NHS failures such as Mid Staffordshire in order to learn lessons from other organisations. We welcome the Trust Board ensuring that Quality is a key agenda item at each Board meeting and including patient stories within Board reports. We are also pleased that the Trust has established Patient Safety Leadership Walkrounds. We look forward to NHS Wirral senior staff participating in Walkrounds in 2010/11. We note that the use of agency staff has greatly reduced following the Trust Board’s approval of an increase in the nurse staffing establishment. We are also pleased with the development of the Quality in Nursing at Clatterbridge (QINC) tool and look forward to receiving regular reports on the impact it is having on improving patient care particularly in areas highlighted in the Department of Health High Impact Changes for Nursing. We congratulate the Trust on there being no cases of MRSA bacteraemia to report and welcome the continued focus on reducing other Health Care Associated Infections. We have been concerned about performance against the standard for 62 day maximum waits for cancer treatment and are aware that the Trust has worked closely with the Department of Health intensive support team to further deliver improvements in performance. We look forward to seeing future performance is on target. We are pleased to see the progress in capturing near real time patient experience in a structured way to inform action plans and measure improvements as perceived by patients. We have been concerned at patient survey reports highlighting unacceptable waits in Out-patient departments. We will be very interested to monitor the impact of redesigning clinic systems in 2010/11 and hope to hear of improved patient experience through the local CQUIN initiative. The declaration of full compliance in delivering same sex accommodation as at 31st March is most welcome. We have a close working relationship with Clatterbridge Centre for Oncology and meet regularly to receive reports which demonstrate the Trust’s performance against a range of quality measures and discuss and agree remedial action where this is deemed necessary.
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We have collaborated with clinicians and senior managers from the Trust to develop a shared understanding of clinical priorities for quality improvement for inclusion in our 2010/11 contract. We have been very keen to capture feedback from patient experience of services to inform how we measure quality improvement in future and welcome the Trust sharing this information with us. We are reassured to see from this Quality Account the high profile given to continuous quality improvement in Clatterbridge Centre for Oncology. NHS Wirral looks forward to continuing to work in partnership with the Trust to assure the quality of services commissioned in 2010/11.
Kathy Doran Chief Executive NHS Wirral
Statement from Wirral LINks Wirral LINk appreciated the opportunity to comment on Clatterbridge Centre for Oncology NHS Foundation Trust Quality Accounts 2009/2010. The LINk is aware of the timescales imposed upon the Trust in relation to these Accounts this year however, in future years, would recommend and appreciate ongoing dialogue through the year, to ensure an informed response can be provided. Unfortunately due to the very short timescale given for response, the Wirral LINk is unable to make an informed contribution on these accounts but looks forward to working with the Trust over the coming year on is Quality Accounts for 2010-2011
Karen Prior & Lynda Denman Wirral LINk Support Team
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