Quality account 2015 - 2016 by Medway Community Healthcare

Quality account 2015 - 2016

Medway Community Healthcare CIC providing services on behalf of the NHS Registered office: MCH House, Bailey Drive, Gillingham, Kent ME8 0PZ Tel: 01634 337593 Registered in England and Wales, Company number: 07275637

www.medwaycommunityhealthcare.nhs.uk Working with us

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Quality account 2015 - 2016

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Contents Part one: Statement of quality

Part two: Looking forward

Part three: Looking back

Goals agreed with commissioners

What others say about MCH

Awards

Part four: Review of quality performance

Quality across our services

Customer experience and feedback

Achievement against our quality priorities for 2014/15

Statements from Healthwatch and CCG

How to provide feedback on this account

Appendix 1

Quality account 2015 - 2016

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Part one:Statement Statement of quality Part one: of quality Each year any organisation that is funded from NHS money to provide healthcare must produce a report which clearly outlines the quality of their services. These are known as their quality accounts. The Department of Health instructs us on what should be included in an organisational quality account, which is a review of what is working well and where there is room for improvement now or in the future. As this is MCH’s fifth quality account, we are able to build upon and demonstrate our continuous improvement and show our commitment to delivering high quality, people-centred services. This year MCH celebrates five years as a community interest company. During that time we have built successful alliances with other social enterprises, developed a local reputation as a provider of high quality community health services, and negotiated contracts and partnerships to deliver over 40 services. In addition, we’ve delivered social value and supported healthcare as a career, through the provision of 51 apprenticeships; through delivering four internships (supported through the MCH Academy), by offering multiple work experience and student placements across MCH services; and by providing the first 'Get into Health and Social Care' programme in the South East with the Prince’s Trust.

Caring and compassionate We have continued to strengthen our work to make sure people in MCH care and their families continue to receive safe, compassionate care, and that both staff and those in our care feel able to tell us if they have concerns. We have assessed our compliance and put in place actions to ensure we meet the recommendations of the Savile Inquiry and Freedom to Speak Up, that we are compliant with the Duty of Candour, and that the new CQC regulations are fully implemented. Ensuring that we provide high quality, compassionate care to the people who use our services is central to everything we do at Medway Community Healthcare (MCH). It is thanks to the professionalism, expertise and commitment of our staff that we are recognised as a provider of choice (92% our staff would recommend MCH as a place to receive care).

Deliver quality and value We invest a lot of time and effort in proactively monitoring and assessing the quality of care we provide. The last twelve months we have continued to successfully embed the GAINing Insights programme - our model of Care Quality Commission (CQC) inspections; GAINing Perspective - a root cause analysis process that involves the whole team to review when a patient safety incident has happened; and Schwartz Rounds - supportive, facilitated sessions that allow MCH staff to reflect on the emotional aspects of their work. People who use our services continue to tell us that their experience of care is good or very good (97%). However we know we have further improvements to make in some areas, particularly relating to those identified during the GAINing insights inspections.

Quality account 2015 - 2016

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Working in partnership We see partnership as key to quality: partnership with people who use our services, our staff, other providers of health and social care, our commissioners and the community as a whole. This requires effective communication, openness and honesty. We are committed to ensuring that as an organisation we will always learn and never become complacent about our care provision. We, the Board of MCH, on behalf of all our staff, commit ourselves to continuing to deliver high quality care. The information in this quality account provided from our data management and quality improvement systems is, to the best of our knowledge, accurate and provides a true reflection of our organisation. Our thanks go to all of our stakeholders - those who have supported the production of our priorities for the next year and to those who have given statements with regard to this account.

Martin Riley Managing director

Quality account 2015 - 2016

Peter Horn Chair

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Part two: Looking forward Part two: Looking forward In this part of our accounts we describe the areas for improvement over the next year in relation to the quality of our services and how we intend to achieve these priorities. As in previous years, these quality priorities are a major contribution to our aims of providing safe, effective, personalised and innovative care to the communities we serve.

Priorities for improvement 2016/17 Understanding what is important to our stakeholders is a key objective of our organisation. Consulting on our priorities for improvement gives us the opportunity to ask for input on what is important to stakeholders. MCH’s priorities have been selected through a consultation process with our community forum, staff and commissioners led by the Clinical Quality Assurance Group. Consultation on the priorities for 2016/17 started with a review of last year’s performance against the priorities. The seven priorities were classified as recommended to continue or not, depending on whether practice required further improvement or not. We reviewed feedback, complaints and enquiries from people using our services, as well as commissioning intentions and other national and local priorities. From this we identified a list of draft priorities that was presented to our Clinical Quality Assurance Group in December and subsequently circulated to key stakeholders for them to vote for their top priority in each category. People using MCH services, staff, our community forum and Medway CCG were given the opportunity to vote. All the responses were collated and from this we determined seven priorities for improvement, many of which will build upon the work in previous years (see page 28 ‘Achievement against our Quality Priorities 2015/16’)

1. Patient safety: 

Continue to provide environments and care where the risk of infection is minimal.

How will we measure?  Staff being bare below the elbow;  compliance with hand hygiene requirements;  cleaning audits in our premises;  compliance with MRSA screening in St Bartholomew’s Hospital; and  reported C difficile infection or MRSA bacteraemia. 

Continue to focus on achieving zero avoidable pressure ulcers for people in our care.

How will we measure?  Monthly monitoring of avoidable pressure ulcers for people in our care; and  measure incidents of avoidable pressure ulcers through quarterly reports and identify themes and trends.

Quality account 2015 - 2016

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Patient feedback I really like the support and care you receive off the staff and how much information and knowledge that they have. All my questions were answered and I couldn't be happier. (Physiotherapy) Very helpful and understanding. Very impressed. Making things more understanding from a parent's view. (Children’s therapy) Fantastic visit from professional, friendly and very helpful nurse. She was very thorough and informative and was very reassuring. Great service. (Cardiology – heart failure) Just excellent care from kind and committed staff maintaining a very high standard of cleanliness.(St Bartholomew’s hospital) Very caring and professional all throughout my son's procedure. Excellent service. (Dental services) Never felt like one of a number. Knew my name and cared. (Stroke service) Quality account 2015 - 2016

2. Clinical effectiveness: 

Work with commissioners and other healthcare providers to ensure the effectiveness of patient care through the identification of measurable quality outcomes.

How will we measure?  Working in partnership with Medway Clinical Commissioning Group (CCG) to develop a mutually agreed programme of appropriate outcome measures for (initially) four of our services (measured through the CQUIN programme). 

People with suspected dementia are referred for appropriate assessment and treatment following application of a memory screening tool

How will we measure?  Quarterly review of the number of people who have a screening tool completed (to see an increase in use, 2015/16 data as a baseline figure) and the percentage of appropriate referrals back to the GP after the completion of a memory screening tool.

3. Patient experience: 

Continue to utilise and monitor the Friends and Family Test (FFT) across all services as part of our patient experience programme.  

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Through monthly monitoring we will achieve an organisational score of 95% recommending our community services; and through monthly monitoring we will achieve an organisational score of 88% recommending our GP services. Through the rollout of Personalised Care Plan on the Community Healthcare System (electronic patient record), we will provide a shared plan designed to support the co-ordination of care, provide a framework for capturing patient goals, evidence effective practice and facilitate measurement of the outcomes of care.

How will we measure?  Through monthly auditing we will achieve 75% of appropriate patients having a Personalised Care Plan with measurable goals.

4. Quality governance 

Through GAIN (Governance Assurance Information Network) enable systematic implementation of lessons learnt arising from complaints and incidents.

How will we measure?  100% representation compliance at GAIN;  100% compliance with the implementation of GAIN alerts (lessons learnt and actions taken); and  100% compliance with lessons learnt, recorded on Datix (incident reporting system) for upheld / partially upheld complaints and incidents. Page 6

Part three: Looking back Part three: Looking back Assuring quality in our services During 2015/16 MCH provided and/ or sub-contracted 48 NHS services within the following business units:  Planned  Urgent Care  Independent  Therapies and children The income generated by the NHS services reviewed in 2015/16 represents 100% per cent of the total income generated from the provision of NHS services by MCH for 2015/16. We have a clear and transparent performance framework that draws together the available data from all services into a comprehensive overview in performance dashboards described at organisational, business unit and individual service level. The monthly dashboards of performance are reviewed and analysed at business unit meetings ensuring that in-month and year-to-date activity is monitored, along with associated trends both retrospectively and forward looking. Business unit meetings have both executive and nonexecutive representation to ensure Board level involvement. The monthly data collected comprises key indicators across the four cornerstones of performance (pictured right). Additional reporting of complaints, incidents, contractual performance and quality measures are included as part of this review, to triangulate performance information and show the impact on different elements of the service. In addition to the monthly business unit meetings, there are two key higher-level groups that oversee service delivery and clinical quality. The Performance Oversight Group and Clinical Quality Assurance Group meet quarterly to identify trends of strong and weak performance. *our workforce

When key issues are identified in services, a ‘deep-dive’ comprehensive review is undertaken. These investigations will, where appropriate, include peer review and support. Service managers and their teams then report on resulting action plans to the executive team and Clinical Quality Assurance group. This year we also introduced the GAINing Insights programme, an internal inspection programme based on the Care Quality Commission model of inspection. We developed our own programme using a team of inspectors, comprising executive and non-executive directors, local commissioners, clinical experts, and experts by experience (people who use our services). During the last financial year we inspected 18 services along with two re-inspections for those services that had scored below a ‘Good’ rating. All services including those who achieved an outstanding produced a quality improvement action plan which was presented to our Board Quality account 2015 - 2016

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members and inspectors at our quality summit. These are monitored to ensure actions are completed.

Services rated outstanding Community respiratory Community cardiology Community dental Diabetes Musculoskeletal physiotherapy Occupational Therapy - hand therapy Community rehabilitation Adult learning disabilities service Clinical assessment service

Services rated good          

Community nursing (Rainham/Gillingham) Nutrition and dietetics Adult speech and language therapy Podiatry Tissue viability Wound care Dentaline Health visiting (review previously rated requires improvement) our Zone Stroke services

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Services rated requires Improvement 

Sunlight GP surgery - Their initial inspection was rated as inadequate in Dec 2014, this was primarily due to concerns raised about staff and patient safety and security. Immediate actions were completed on the priority areas, and upon their review Sunlight was rated as requires improvement. It was noted by the inspection team that improvements had been made but there were still areas that needed development around responsiveness and medical leadership.

Services rated inadequate 

St Bartholomew’s Hospital - This was inspected in November 2015. The main improvement areas identified were: Workforce culture, communication, effectiveness and responsiveness of the service. St Bartholomew’s staff were commended by the inspection team for keeping the people they care for safe; especially the housekeeping team for goods infection prevention and control practice in a difficult environment. A comprehensive motivational improvement programme has been established to ensure the areas for improvements are actioned. This is monitored through our internal governance process.

Quality account 2015 - 2016

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Participation in clinical audit National audit During 2015/16 three national clinical audits and no national confidential enquiries covered NHS services that MCH provides. During that period MCH participated in 100% 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 MCH participated in during 2015/16 are as follows:   

Chronic Obstructive Pulmonary Disease Audit Programme National Diabetic Foot Care Audit (National Diabetes (Adult) Audit) National Sentinel Stroke National Audit Programme (SSNAP)

The national clinical audits and national confidential enquiries that MCH participated in, and for which data collection was completed during 2015/16 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 title

No. of cases submitted

Chronic Obstructive Pulmonary Disease Audit Programme

100

National Diabetic Foot Care Audit National Sentinel Stroke National Audit Programme (SSNAP)

Audit ongoing Submitted via Medway NHS Foundation Trust

N/A N/A

The reports of 2 national clinical audits were reviewed by the provider in 2015-16 and Medway Community Healthcare intends to take the following actions to improve the quality of healthcare provided: National audit title Chronic Obstructive Pulmonary Disease Audit Programme

Actions   

Quality account 2015 - 2016

Continue to provide evidence for extra funding to improve our service and its accessibility; ensure written care plans are issued on discharge; and look into funding for dynanometers to assess muscle strength.

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National audit title

Actions

National Sentinel Stroke audit (SSNAP)

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Quarterly acute reporting continues and action plan with acute trust reviewed as part of wider Stroke Action group; meeting held with acute trust division general manager and agreed to progress costing work to consider 7 day therapy as recommended by audit and CQC inspection; and stroke Operational Performance group to be reestablished to facilitate further joint working between acute trust and MCH teams, and to improve quality of care.

Local audit 2015/16 The reports of 36 local clinical audits were reviewed by the provider in 2015/16 and MCH identified the following actions to improve the quality of healthcare provided. See tables at Appendix 1. Local clinical audit is important in measuring and benchmarking clinical practice against agreed markers of good professional practice, stimulating changes to improve practice and remeasuring to determine any service improvements.

NICE guidance In 2015/16 we measured compliance of our services with best practice guidance issued by the National Institute for Health and Care Excellence (NICE). NICE is an independent organisation that issues guidance based on evidence from medical research. The guidelines refer to nationally agreed best practice for the management of conditions and provide robust standards for us to use when we are planning how to deliver the most effective care to people. Our system of disseminating and monitoring NICE guidance throughout our organisation ensures that we can demonstrate compliance and address areas for improvement. We reviewed all the NICE guidance that was relevant to our services and initiated improvements where necessary to bring our practice in line with the latest guidance. Through 2016/17 we hope to work more closely with our commissioners to fully understand their response to NICE guidance and how it will apply to our local population. The following table provides a sample of the NICE guidance reviewed in 2015/16 and the improvements implemented. NICE guidance title QS77 Urinary incontinence in women

Quality account 2015 - 2016

Improvements 2015-16 

Bladder diary to be given to all patients with urinary incontinence at initial assessment or with their appointment letter. Implemented and re-audit found fully compliant.

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NICE guidance title

Improvements 2015-16

CG148 Urinary incontinence in neurological disease CG171 Urinary incontinence in women

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Continence care policy updated.

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Continence care policy updated; and staff training and development of pelvic health service (physiotherapy).

PH56 Vitamin D: increasing supplement use among at-risk groups

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Education given to all clinicians regarding those deemed to be at high risk by presentation at GAIN meeting and A4 poster created; addition made to Community Healthcare System (electronic patient record) to evidence that staff have spoken about Vitamin D; education given to all health visitors regarding updated guidelines and need to recommend and record usage for ALL children in at risk groups; and education given to MCH staff to remind them to raise Vitamin D concerns with those they connect with in their daily work.

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NICE quality standards are concise sets of prioritised statements designed to drive measurable quality improvements within a particular area of health or care. They are derived from the best available evidence such as NICE guidance and other evidence sources accredited by NICE. They are developed independently by NICE, in collaboration with health and social care professionals, their partners and service users. We achieved the NICE Quality Standard in 2015/16 for the following (relevant recommendations within our contractual restraints): Quality Standard 53: Anxiety disorders Quality Standard 61: Infection prevention and control Quality Standard 63: Delirium Quality Standard 77: Urinary incontinence in women Quality Standard 86: Falls in older people Quality Standard 87: Osteoarthritis Quality Standard 88: Personality disorders: Borderline antisocial Quality Standard 90: Urinary tract infections in adults Quality Standard 93: Atrial fibrillation: Treatment and management Quality Standard 95: Bipolar disorders in adults Quality Standard 96: Dyspepsia and gastro-oesophageal reflux disease in adults Quality Standard 100: Cardiovascular risk and lipid modification All Quality Standards relevant to the care we provide are monitored and reviewed and appropriate action taken to ensure we deliver an effective evidence-based service.

Participation in research “Research is central to the NHS…. We need the evidence from research to deliver better care. Much of the care that we deliver at the moment is based on uncertainties or experience, but not on evidence. …We can only correct that with research”

Quality account 2015 - 2016

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Patient feedback Just know how to do their jobs with care and a smile. Could not ask for better. (Stroke service) The staff at the MCH centre in Gillingham, Kent, were very friendly. The physiotherapist I saw was kind and thorough. I felt like they wanted to take the time to help me. (Physiotherapy) Treated each person with caring and friendly approach. Made you feel relaxed and at ease. Very professional. (Warfarin clinic) I would highly recommend service. My needs were always looked into and I never had any complaints. Very informative. Would recommend to all friends and family. (Nutrition and dietetics) Really supportive, more comfortable, great advice, friendly, not judgemental. (Family nurse partnership) They had so much time and patience. Nothing felt too much trouble. (Dental services)

Professor Dame Sally Davies, Chief Medical Officer for England, Director General of Research and Development and Chief Scientific Advisor for the Department of Health and NHS 2015. The number of patients receiving NHS services provided or subcontracted by MCH in 2015/16 that were recruited during that period to participate in research approved by a research ethics committee was 111. This was achieved with funding provided by the Clinical Research Network (CRN), enabling MCH to employ its first ever Clinical Research Nurse. An initial target of 40 patients recruited was set which was then doubled within year to 80 but actually overachieved with reaching 111 recruits. See below which demonstrates recruitment into a number of studies MCH have been involved in during 2015/16: Completed portfolio studies  CHI+MED stakeholder engagement: Medway (15-040) Interviews focussed on clinical staff who use McKinley Syringe Driver, a particular infusion device used in community settings to administer drugs. We successfully recruited seven participants. 

Evaluation of physiotherapist and podiatrist independent prescribers interviews An observational study aiming to investigate the impact that independent prescribing physiotherapists and podiatrists have on the effectiveness and quality of care. We successfully recruited 97 participants, exceeding the expected recruitment target. Open portfolio studies  Non-specific ‘Mechanisms in Orthodox and CAM’ (MOCAM) management of back pain Participants complete questionnaires:  after their first treatment for a new episode of back pain;  2 weeks later; and  3 months later. The focus is to test hypothesised relationships between five domains of non-specific components, key theoretically-derived mediators (e.g. behaviour change, self-efficacy), and patient outcomes (e.g. disability). To date we have recruited seven participants. Research is a core part of the NHS, enabling the NHS to improve the current and future health of the people it serves. ‘Clinical research’ means research that has received a favourable opinion from a research ethics committee. We report on other areas, which demonstrate commitment to research as a driver for improving the quality of care and to the patient experience, e.g. our work with the Health and Europe Centre – applying for European funding for international projects.

Quality account 2015 - 2016

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There were approximately 50 members of clinical staff participating in research approved by a research ethics committee in MCH during 2015/16. These staff participated in research covering stroke, palliative care and musculoskeletal physiotherapy. Future recruitment intends to extend this scope to include community rehabilitation teams, community respiratory, children’s therapy and health visiting. In April 2016 we reviewed our Research Strategy and successfully realised its key principles. This two year strategy identified a number of key principles to enable the successful development and delivery of research within the organisation in line with MCH’s strategic aims. Research Strategy principles are:      

To establish a thriving research culture; to develop more collaborative relationships; to identify key research areas; to increase recruitment to portfolio studies; to ensure robust governance and management of research activity; and adoption and spread of research findings.

We have strengthened the culture of research within MCH with services’ clinical leads becoming research champions. These champions promote and deliver research within their teams. The workforce has been developed through successfully hosting the National Institute for Health Research (NIHR) ‘Introduction to Good Clinical Practice’ training. 30 staff attended the training, which provided a practical guide to ethical and scientific quality standards in clinical research. Working in partnership is one of our core values as an organisation and we have continued to work in collaboration with research-specific organisations and networks, academic institutions, industry and other care providers both at a local, national and international level. These organisations have included:         

Kent Surrey Sussex Clinical Research Network (CRN) Kent Surrey Sussex Academic Health Science Network (AHSN) Health and Europe Centre/International Health Alliance Kent Health Partners Wisdom Hospice and KSS Palliative Care Research Group National Institute for Health Research (NIHR) Clinical Research Network (CRN) National Children’s Specialty Group University of Kent University of Greenwich/Medway School of Pharmacy Canterbury Christchurch University

Through joint working with the Clinical Research Network (CRN) and in particular the research delivery managers; the scope of research has been broadened across the network divisions. However, we continue to seek opportunities to support development of research in the workforce and look at how we are different as a social enterprise which provides healthcare services. The research team have been involved in projects focusing on organisational form as well as product testing for healthcare products, and aims to continue high levels of recruitment especially National Institute for Health Research (NIHR) portfolio studies. Studies that we have participated in to date have provided some feedback and overarching recommendations, but a more robust system is required to support effective feedback for the services actively involved. This is dependent on the study teams and the time taken to report on data and any adoption into national publications. Opportunities are available to feed back research activity at the Clinical Quality Assurance group but it is a development area for the Quality account 2015 - 2016

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research team to broaden these opportunities. Looking ahead, we have demonstrated this commitment by including research as part of the core annual organisational plan for 2016/17. Future recommendations/plans:     

To develop a future research strategy to be embedded into our Quality Strategy; to continue to further embed research culture and activity with more research champions and development of a research forum; to facilitate communication about research and research activity through use of the internet, intranet and social media platforms; to remain active in research with continued portfolio recruitment with support from the CRN and considering further investment from within MCH; and to continue to support workforce development and training through ‘good clinical practice’ and ‘consent training’ and supporting academic study in research.

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Goals agreed with commissioners Goals agreed with commissioners Use of the CQUIN payment framework A proportion of our income in 2015/16 was conditional on achieving quality improvement and innovation goals, agreed between MCH and the commissioners (who we entered into a contract, agreement or arrangement with) for the provision of NHS services, through the Commissioning for Quality and Innovation (CQUIN) payment framework. The CQUIN payment framework ensures ‘quality’ is the organising principle of NHS services, by embedding it at the heart of commissioner–provider discussions. Local quality improvement priorities are discussed and agreed at board level within – and between – organisations. CQUIN monies are only paid to MCH upon the achievement of the following locally agreed quality and innovation goals. Achieving all of our CQUINS shows that we are actively engaged in quality improvements with commissioners, some of which improve patient pathways even beyond the boundaries of our own organisation. We are eager to agree robust quality improvement goals because we are committed to quality improvement in local health services across the local health economy. Indicator

Outcome

Dementia and delirium – Find Assess, Investigate, Refer and Inform (FAIRI)

Dementia – Leadership/training

 Achieved: Introduction of memory screening tool and staff training which enables clinicians to risk assess for dementia and ensure appropriate referrals. This supports early identification and intervention.  Achieved Developed and provided appropriate dementia training for staff utilising the Dementia Core Skills and Training Framework (2015).

Dementia – carer feedback

 Achieved MCH’s dementia support team is actively working with our customer care lead to develop innovative collection of qualitative information and carer feedback, for those families/individuals who have accessed our dementia support services.

Local pressure ulcer – to achieve reduction or sustain 14/15 Grade 2 service acquired avoidable pressure ulcers

 Achieved: Reduced the number of acquired pressure ulcers of people in our care. This was achieved through effective nutritional screening, development of a hydration tool and appropriate equipment provision.

Reduction in Community Acquired Pressure Ulcers through a collaborative health economy steering group and action plan.

 Achieved Collaborated with Medway NHS Foundation Trust to produce an action plan to reduce the number of acquired pressure ulcers across the Medway community.

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Indicator 13

Outcome

 Achieved The main outcomes reported from the collaborative VTE project were sharing of data between primary, secondary and private care providers in Medway. It was ascertained that the initial assumption that high numbers of patients were developing lower limb VTE post 90 day discharge was not proven. Areas suggested for further exploration by the CCG included public health involvement to raise awareness among the general public and the inclusion of community services for the provision of follow-up services post hospital discharge and to reduce the incidence of both physical and psychological post-thrombotic syndrome. 7 day working - St.  Achieved: Bartholomew's Hospital contacts Enabled seven day therapy at St. Bartholomew's Hospital to enhance rehabilitation programmes and facilitate earlier discharges. Saturday working development -  Achieved: respiratory contacts Extended working to cover six days per week, to avoid inappropriate hospital admissions. Friends and Family Test (patient  Achieved: experience improvement) Achieved 10,558 surveys returned for 15/16 with a satisfaction score of 96.8% for the organisation. This has enabled us to improve patient experience through listening and acting on feedback. Reduction in Hospital and Community Venous Thromboembolism (VTE) through a collaborative health economy steering group and action plan

Our response to the Savile Enquiry and Freedom to Speak Up report The Board have given very careful consideration to the Savile Enquiry and Freedom to Speak Up review, and recommended actions. As an organisation we are committed to providing services that all of us would be happy to receive ourselves or for those we care for – services that are safe, provided with compassion, kindness, dignity and respect. We are working closely with our partners to ensure we learn from failings elsewhere and make sure that such failings do not occur within MCH. As a result of the Savile Enquiry we have developed a dedicated policy, focussed on VIP visits and ensuring that patient safety is paramount. The Freedom to Speak Up action plan acknowledges the significant progress we have already made since the Francis Report and sets out the further actions we will take to embrace the 20 principles outlined in the Freedom to Speak Up report published in February 2015. Many of these focus on embedding good practice already in evidence such as sharing lessons learnt, and continuing to reinforce our values at every opportunity. Continuing to nurture a culture where staff are encouraged to raise concerns and these are addressed effectively and speedily features prominently; and MCH will consider how best to implement the Freedom to Speak Up Guardian role in 2016/17 once national guidance is published.

Quality account 2015 - 2016

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As a result of the Health and Social Care Act Regulations 2008 (Regulated Activities) Regulations 2014 we have implemented an audit of our application of the Duty of Candour; and applied the Fit and Proper Person’s Test for Board members. We are fully compliant with these regulations. Resulting actions and outcomes from the Savile Enquiry, Freedom to Speak Up review and Health and Social Care Act Regulations 2008 (Regulated Activities) Regulations 2014, and other healthcare reports are shared with frontline staff through the ‘Governance Assurance Information Network’ (GAIN) network and internal communications channels.

Quality account 2015 - 2016

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Whatothers others say about What say about MCHMCH Statements from the CQC MCH is currently registered with the Care Quality Commission with no conditions. The Care Quality Commission has not taken enforcement action against MCH. We were inspected once during 2015/16 under the new inspection model. The CQC visited Darland House in January 2016. In addition, we received the final report as a result of the CQC inspection of MedOCC in December 2014. Darland House: What the CQC said about MCH This inspection took place on 25 January 2016 and was unannounced. It followed a previous inspection in August 2014 where the CQC had identified two breaches of regulations. The first related to the effectiveness of recruitment checks on recruited staff with employment gaps on their application forms, and the levels of checks made for staff employed from overseas. At this secondary inspection (in 2016), the CQC found MCH had taken robust action to ensure the correct checks were made for new staff before they were employed. The second breach related to the effective management of medical emergencies such as choking and bleeding. At this secondary inspection (in 2016), the CQC found that MCH had taken robust action by ensuring that nursing and care staff had the most up to date training in relation to medical emergencies. Key findings at the inspection in 2016 were: The service was safe.  Staff were always available in the right numbers to meet people's assessed needs;  risks were assessed and recorded. Medicines were managed and administered safely;  incidents and accidents were recorded and monitored to reduce risk;  the premises and equipment were maintained to protected people from harm and minimise the risk of accidents; and  staff knew what they should do to identify and raise safeguarding concerns. The registered manager acted to protect people who needed safeguarding and notified the appropriate agencies. The service was effective.  People were cared for by staff who knew their needs well. Staff understood their responsibility to help people maintain their health and wellbeing. Staff encouraged people to eat and drink enough;  nursing staff were supported to maintain their professional standards. Staff met with their designated managers to discuss their work performance and each member of staff had attained the skills they required to carry out their role;

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 

staff received an induction and training and were supported to carry out their roles well; and the Mental Capacity Act and Deprivation of Liberty Safeguards were followed by staff.

The service was caring.  People had forged good relationships with staff so that they were comfortable and felt well treated;  people were treated as individuals and able to make choices about their care;  people had been involved in planning their care and their views were taken into account; and  people were treated with dignity and respect. The service was responsive.  People were provided with care when they needed it based on a care plan about them;  information about people was updated often and with their involvement so that staff only provided care that was up to date;  nursing staff were on site to monitor people's physical and mental health. People accessed urgent medical attention or referrals to health and social care specialists when needed;  people were encouraged to raise any issues they were unhappy about and the registered manager listened to people's concerns;  staff understood people's unique communication styles who were living with complex dementia; and  complaints were resolved for people to their satisfaction. The service was well led.  There were clear structures in place to monitor and review the risks that may present themselves as the service was delivered;  MCH and the registered manager promoted person-centred values within the service. People were asked their views about the quality of all aspects of the service; and  Staff were informed and enthusiastic about delivering quality care. They were supported to do this on a day to day basis by leaders within the service. No actions for improvement were identified. MedOCC: What the CQC said about MCH This inspection took place on 27 and 29 November and 3 December 2014 and was an announced comprehensive inspection of MedOCC Quayside. Key findings were as follows:  Access to the service was effective;  there was a clear management structure to support and guide staff;  there were systems to ensure patients received safe and effective care. The CQC saw examples of how GPs and other staff had learned from complaints and incidents. A programme of continuous auditing was to assess the services quality and productivity;  the service had good facilities and was well-equipped to treat patients and meet their needs. Services were provided in facilities which were clean and well-maintained. The service had an effective infection control system to ensure that the risk of infection was minimised; Quality account 2015 - 2016

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  

the CQC saw staff treated patients with dignity and respect. Patients made positive comments about staff and how they were treated. Some patients were unhappy about the length of time they had waited but were confident they would receive a good service when they were seen; evidence-based guidelines provided the service with clear guidance on how services should be provided. These included guidelines for the treatment of deep vein thrombosis and cellulitis and a list of conditions the service was not able to treat. This meant staff had clear protocols for treating patients which were updated to reflect changes in practice; the service implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients; patients were provided with medicines if their need was urgent or if the pharmacies were closed; and reception staff had received customer care training which helped them overcome some of the difficulties they experienced in open reception areas, to help ensure privacy and confidentiality.

Safeguarding Children: What the CQC said about MCH In March we also were part of a CQC single agency inspection in relation to safeguarding and looked-after children. This model of inspection follows cases across all agencies involved with children and families. The verbal feedback we have received in relation to our health visiting and safeguarding teams was extremely positive, particularly:          

Very good service, a positive uplifting inspection; good sense of safeguarding culture, effective safeguarding practice; good leadership from named nurses; good progress with continuing improvement agenda; good quality supervision; highly effective in developing improved practice; front line practitioners are competent and capable; good working with social care; strong training and approach to preceptorship very sound; and clear on areas of development, i.e. more to be done on child sexual exploitation and female genital mutilation, but on the agenda.

The final report is due to be published in May 2016.

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Awards

Kent, Surrey and Sussex NHS leadership recognition awards

Patient Experience Network national awards The musculoskeletal physiotherapy team won the ‘Turning it around when it goes wrong’ category at the Patient Experience Network National (PENN) Awards. The team were recognised for innovation, leadership, positive patient feedback (99% of patients would now recommend the service), staff morale, vastly reduced waiting times and improved access. In addition, the patient experience team was recognised as runner-up in the ‘Team of the year’ category.

The Medway Community Healthcare board was awarded NHS Governing Body of the Year at the Kent, Surrey, Sussex NHS Leadership Recognition Awards 2015. The award recognises the Board's drive to ensure that all MCH staff work together to provide high quality care for the benefit of our local community.

We were announced as HEKSS ‘Apprenticeship Employer of the Year’, an accolade which recognised our robust processes for developing apprenticeships and the additional support MCH provides to help apprentices find employment. North Kent patient experience awards

Social Enterprise UK Awards We were shortlisted for a Social Enterprise UK Award, within the ‘Health and Social Care Provider’ category. The shortlisting recognised excellent vision and strategic direction.

Stroke Association Life After Stroke Awards

Occupational Therapy Show Awards

Highly commended in the Professional Excellence category

Runner up in the Outstanding Service/ Innovation category

Quality account 2015 - 2016

Health Education England (Kent, Surrey and Sussex) apprenticeship awards

In addition, we were recognised at the North Kent Clinical Commissioning Group (CCG) patient experience awards, winning every category entered: Transforming patient experience - MSK physiotherapy; Little things that matter - Children's therapy team; and Sign up to safety – Health visiting team Friends and Family Test Awards 2016 MCH was shortlisted at the Friends and Family Test Awards 2016, within the ‘Best FFT initiative in any other NHS-funded service’ category.

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Data quality Over the last year we have focussed on data quality, ensuring compliance with capturing true waiting times and enabling staff to interrogate this information to drive for more timely appointments and to monitor service productivity. Our Community Healthcare System (CHS) (electronic patient record) has enabled the review of data from anywhere in the organisation. From this we are able review complaints in a timely manner or identify the training needs of staff in relation to patient documentation. Patient information is extracted routinely to demonstrate interventions to meet clinical needs of the local population. Going forward, this information is able to support the collection of quality outcomes such as prevention of a hospital admission or where services have supported the people we care for to go home from hospital. Work continues to educate and train staff from across all levels of the organisation to improve understanding of the reasons for inputting accurate and timely information. This helps shape services. All information is monitored through internal business and performance meetings at the same time as understanding reasons for fluctuations.

Information governance toolkit attainment levels The MCH Information Governance Assessment Report overall score for 2015/16 was 100% and was graded green, achieving level 3. The Information Quality and Records Management attainment levels assessed within the Information Governance Toolkit provide an overall measure of the quality of data systems, standards and processes within an organisation. We have scored 100% in this area. To provide assurance to the Board of the quality of records, an audit of all electronic patient records was carried out. This audit included checking correct patient identifiers were used, entries were contemporaneous, NHS number was recorded and consent to information sharing was recorded. An overall organisation score of 82% was achieved for compliance. Action plans are in place to improve this score and ensure compliance.

NHS number and general medical practice code validity MCH submitted records during 2014/15 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 personâ&#x20AC;&#x2122;s valid NHS number was 100% for admitted patient care and those which included the patientâ&#x20AC;&#x2122;s valid General Medical Practice Code was 100% for admitted patient care.

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Part four: Review ofperformance quality performance Part four: Review of quality In 2015/16 we embedded the new initiatives introduced in 2014/15. Progress within these initiatives is as follows: GAIN – Governance assurance information network This network was identified as one of our Quality Priorities for 2015/16 to ensure that lessons are shared, good practice is celebrated and staff are enabled to raise concerns. It’s an integral part of the governance structure and continues to provide a learning and development forum for staff, and an assurance mechanism for us as an organisation. Looking ahead, attendance is again a priority for 2016/17. GAINing perspective The principle of ‘GAINing perspective’ is to investigate a serious issue or complaint in a fresh, modern way with a staff-centred approach. Staff lead the investigation and identify areas for improvement as well as excellent practice. They work as a team creating their own timeline of events and identify throughout the session what could or should have been done. They identify improvements in their own teams and develop their own action plan. Staff describe feeling empowered by using this method and take more ownership of the action plan that they have created. The results and actions are shared across the organisation at GAIN (see above). In the last financial year we have used this methodology to investigate six issues or complaints. Schwartz Center Rounds® In December 2014 MCH started running Schwartz Center Rounds®, a forum where staff discuss the emotional and social dilemmas that arise in caring for people. The Rounds aim to promote understanding about how an issue may have different emotional effects on individuals, colleagues and teams, encouraging more compassionate care. Staff have the opportunity to share their experiences and feelings on a range of thought-provoking topics, discussing how they might affect them. Schwartz Center Rounds® take place every two months for an hour. Each Round focuses on a different theme. It doesn’t aim to solve problems but to be a forum for discussion, reflection, learning and deeper connection with colleagues. All staff clinical and non-clinical are invited to attend. Themes have included;  OMG Moments  When the shoe is on the other foot  What is compassion?  Tangled in the red tape  Light at the end of the tunnel  Them and us! In the last financial year we have held six Schwartz Centre Rounds® and welcomed 208 attendees. In addition, we have worked in partnership with Demelza House (a children’s hospice in Sittingbourne) to share best practice and support implementation of Schwartz Centre Rounds® for staff. Five attendee spaces are provided at each Schwartz Centre Round® for Demelza House staff, who also form part of the Schwartz Center Round® steering group.

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99% of staff who have attended would recommend the Schwartz Center Rounds® to colleagues. Staff comments have included: “Listening to other people's experiences helped me to realise that you should not take other's role for granted because they are there for a reason”. “An eye-opener. Brilliant. Definitely will pass onto others and would like to return” “Insightful, made me think about my professional practice and how I deal with personal issues. I would recommend this to others” “It was good to spend a short time reflecting on moments from my own career that have caused my heart to sink” “Very useful to see how others cope with feelings in their day to day work. Makes me feel more human. I always feel I have to put on a professional front when I just want to show my human side too”.

Our values and pledges Each service has reviewed their own pledges, (created in 2014/15) which are based on the NICE Quality Standards for patient experience, NHS Constitution and delivering same sex accommodation and are aligned to the organisational values. Teams developed a poster or leaflet with their pledge, which is signed by each member of staff to present a united agreement. In many teams this forms the basis for all aspects of their work with people using the service and their staff, e.g. service planning, surveys, recruitment, performance appraisal.

Our leadership Managers and leaders from across MCH accessed the second LEAD (leading empowering and developing) programme in 2015/16. Designed to ensure that these staff feel confident and competent in their roles, the majority of modules were again facilitated by our own internal experts, with consistently positive feedback. MCH’s leadership qualities were refreshed and underpin the programme - also featuring in selection, talent conversations and our performance and development reviews. ‘Found the session very helpful. Really easy to follow, enjoyable training’ ‘Very interactive, practical and insightful’ ‘The single best training I have done within MCH’ ‘Great participative way to raise self-awareness and appreciation of how to develop relationships’ ‘Great training – very practical and insightful’ ‘Fun, light-hearted style but with a serious message’ ‘Excellent training session considering these are heavy subjects’ ‘An enjoyable session – I learned a lot’ ‘All very relevant to my role’

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Quality across our services Quality across our Services Musculoskeletal physiotherapy MCH’s musculoskeletal physiotherapy service now runs a pelvic health service for men and women, treating a range of conditions including incontinence and pelvic pain. The service has expanded their knowledge, raised the profile of these conditions and the help available, and improved referrals into the service.

Nutrition and dietetics The service now runs an allergy and gastro clinic. This pathway targets many allergy patients with gastro symptoms who are missed in the present system. In addition the service now runs a pregnancy support group session. This session is available for patients with a high body mass index (BMI) to receive nutritional advice during and after pregnancy.

Health visiting This service was awarded the UNICEF level 3 Baby Friendly accreditation in the care of pregnant women and new mothers. This international award is the highest level available and recognises excellence in care, particularly focussing on breastfeeding.

Children's therapy The team accessed the opportunity at The Bobath Centre who announced free open mornings in December 2015. The specialists at Bobath assessed and offered free consultation and advice (normally £250) to two young MCH patients with cerebral palsy. One of the children was then chosen to receive two weeks of free intensive therapy (normally £2,200). The children’s therapy team will continue to signpost families with complex neurological children to this free service offered by The Bobath Centre. The team aims to work closely with the centre and discussed the opportunities for running Bobath satellite clinics at Orchards, Sittingbourne, for Medway and Swale families. The children’s therapy team have introduced a number of initiatives to improve the quality of therapy and access to services. These include: joint therapy groups to enable children to access multi-professional support in one appointment; aqua therapy; supported junior gym membership; advice and support sessions within children’s centres; and physiotherapy groups to enable strengthening activities in an accessible and enjoyable format.

Integrated Discharge Team (IDT) Last year IDT welcomed three voluntary organisations into the IDT team; Carers First, care navigators and carers’ support. The three services are supporting patients and their carers in Medway Maritime Hospital with discharge planning, ensuring that they receive a friendly, responsive approach. They suggest and recommend community service information that will assist patients with befriending, finance, home help, transport and much more when they are back at home. Patients and their carers have often said that the time and care they receive from our voluntary services has had a positive effect improving the quality of their hospital stay.

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Patient feedback All the ladies who visited my husband were the best. Thank you all so very much. My husband is again the man he was before the stroke. (Stroke services)

Wisdom Hospice The Wisdom Hospice benefited from Department of Health funding in 2013/14 which supported redevelopment and expansion of the day hospice as well as the creation of a new physiotherapy gym. Due to these changes MCH has been able to expand the range of services, increasing access for patients and carers to a series of innovative therapeutic programmes. The creation of the physiotherapy gym has allowed increased development of the specialist palliative rehabilitation service including:   

I was treated with the utmost respect and was made to feel valued. Thank you all so very much. (Physio) We are very happy with the care. Someone is always there if we need them. They’re always cheerful and nothing is a problem for them. (Community nurses) I have never been treated with anything other than respect, not has the person I care for. A wonderful place with wonderful people. Thank you! (Palliative care)

 

The new day hospice development promotes the model of person-centred care incorporating patients, carers and local communities. We engage with carers, empowering them to access support, and validating the importance of the caring role. Patients and carers have equal access to a diverse range of support services. Specialist days offer a network of support and opportunities to develop resilience and coping, and enhancing quality of life and communication. The therapeutic services include:  Art therapy: Supporting the expression of feelings and experiences through images and various forms of art work;  the SAFE programme: Six week therapeutic support programme for carers;  a patient and carer group: Offers six sessions providing information, emotional and psychological support;  making meaningful memories using a variety of media including textiles, life story work, personal journals and technology;  relaxation and visualisation: Reducing psychological distress;  complementary therapies;  pamper days: Improving self-image and self-esteem;  neurological specialist service; and  public events: Increasing access to information and support.

Excellent service provided by very caring staff. (Dermatology) Friendly, courteous and very knowledgeable. Gave some very useful advice. Clean and efficient. Prompt time keeping. (Tissue viability)

New weekly circuit exercise group; new three session fatigue and breathlessness group; dedicated outpatient clinic space for assessment and treatment including acupuncture where appropriate; dedicated assessment and treatment space for the use of ward patients and day hospice patients; and a new range of exercise equipment to help patients maintain and improve their independence, strength, mobility and quality of life as well as boost their mood and self-confidence.

Safeguarding adults and children MCH’s safeguarding adults and children teams have continued to embrace and embed learning and practice in response to changes in national/local policy and legislation throughout 2015/16. For those services working with adults we have seen increasing awareness and practice of the guidance of the Care Act 2014 in relation to Self-

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Neglect. The community nursing team in particular has found the Kent and Medway policy to be beneficial in working with adults at high risk of self-neglect; enabling more robust risk assessment, mitigation strategies and multi-professional working with some of the more complex situations that can arise. In addition our inpatient services continue to strive to meet the requirements of the Supreme Court ruling of 2014 in relation to the Deprivation or Liberty Safeguards, ensuring that our most vulnerable patients are safeguarded through access to independent assessment and scrutiny of the care provided. The implementation and practice of the principles of the Mental Capacity Act 2007 was evidenced through our audit programme which showed the increasing awareness and confidence MCH staff are gaining in this sometimes complex area of legislation. The safeguarding children team responded to legislative requirements to report any cases of female genital mutilation (FGM), reviewing mandatory training and developing data capture and reporting processes. The team has also been instrumental in supporting newly qualified MCH health visitors through training and supervision, increasing confidence across all areas of safeguarding children practice. Domestic abuse training has been a key area of development, assisting our staff in recognising symptoms/signs and increasing their skills in responding to disclosure or concerns safely and increasing their knowledge of support agencies available to victims. Both teams have worked together to meet the requirements of the NHS England Standard Contract in relation to Prevent â&#x20AC;&#x201C; the preventative arm of the governmentâ&#x20AC;&#x2122;s anti-terrorism agenda â&#x20AC;&#x201C; developing a training package that is now available to all new starters.

Community nursing The community nursing team together with Medway Foundation NHS Trust introduced catheter passports for patients who have a urinary catheter inserted. This provides a joined-up approach to ensure reviews and changes are recorded and completed in a timely way (reducing the risk of infection) and improved patient information on how to care for their catheter. In addition the community nursing team has revised and revamped their induction programme for new starters. New topics include, dementia training, palliative care, diabetes, patient safety and reflection, infection control, sepsis, no access, preceptorship (supporting newly registered staff for the first year) and revalidation. The programme is reviewed after each round and tweaks made to fit the training requirements for community nursing. The programme is run three times per year and has proved invaluable in achieving consistency of practise across the service, increasing the competencies of the workforce and aiding recruitment.

Falls team In the last year the falls team has seen significant changes to our contract with no further investment. This has resulted in the redevelopment of rehabilitation pathways and blurring of boundaries with the supporting teams, providing a more efficient and responsive service to patients.

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Patient feedback This service has helped me hugely. It's been great having the support and questions answered. I felt quite nervous but now I feel much more confident and happy in my mothering skills. Thank you team! (Health visiting) The ladies in the hand therapy department (MCH) at Medway Hospital were so lovely, very supportive and very informative about my problem. I feel so much more confident my hand issue will be addressed. (OT hand therapy)

The falls team has now introduced a triaging service for all patients within 48 hours and a four hour response to all ambulance referrals, increasing from five to seven days a week. The falls team has also successfully developed a new falls group exercise program which MCH now delivers across more sites in and around Medway.

Long term conditions (LTC) As an organisation we have invested in SpeakSet (set-up box that plugs into any TV to provide video calling) and Yecco (remote monitoring to assist patients in managing their own condition). Our specialist services that assist people living with long term conditions have reviewed (and continue to review) the impact of these technologies on preventing hospital admissions and other added benefits, such as reducing social isolation and anxiety, which is often a major contributor to the exacerbation of some health conditions. Early indicators suggest that certain patients benefit more than others, for example a very anxious patient responded very well to the video conference support thus reducing the need for home visits, but was unsuccessful for another who became very dependent and wanted almost continual monitoring via this forum. By continuing this review and trial of these innovations a clear criteria can be developed to ensure the placement of technology is beneficial and adds value.

The wound care nurses were absolutely fantastic in both their friendly natures and their experience and care. I was able to freely discuss my wound issues and never felt that they were too busy to spend time with me. Lovely ladies. Can't recommend them enough if you need wound care. (Wound care)

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Customer experience feedback Customer experience andand feedback Friends and Family Test NHS England introduced new national guidance in January 2015, which stated that MCH needed to offer all people that use our services the Friends and Family test at any point of their care. This is a simple question which asks how likely they would be to recommend the service to friends and family if they required treatment or care, with a comments box to explain the reason for their answer.

Between April 2015 and March 2016 MCH received 10,558 completed surveys, exceeding last year’s total of 4,686 by 124%. 97% of these said they would recommend a 2% increase from 2014/15, and only 2% stated that they would not recommend. The remaining 1% stated they don’t know or were neither likely or unlikely to recommend.

97% would recommend MCH

The Friends and Family test is reported nationally on a monthly basis; this enables us to identify targets to improve the experience of people using our services. The table below shows our monthly score for January 2016, compared to the national average and the average of other similar independent providers of NHS care.

MCH (Jan 16)

National Average (Jan 16)

MCH (Feb 16)

National Average (Feb 16)

MCH (March 16)

National Average (Mar 16)

% recommend

95%

98%

95%

% not recommend

Complaints We want everyone to have the best possible experience in our care, and patient feedback is crucial. MCH actively encourages people to share comments, compliments, concerns and complaints, through ‘Tell Us’ leaflets, via text (a new system implemented in 2015/16 allowing people who use our services to text their feedback for free) and the website. During 2015/16 we made approximately 900,000 individual contacts with patients, some for the first time and some for follow-up appointments in a variety of community settings. Over that time we received 140 written complaints, 67 verbal complaints, 67 grumbles (a complaint resolved to the complainant’s satisfaction by the next working day) and 35 non-lead joint formal complaints (a complaint involving more than one provider of NHS services). This is a ratio of one complaint for nearly every 3,000 contacts. Seven complaints were passed to the Health Service Ombudsman at the request of the complainant and two were partially upheld.

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Our patients often comment on access to services and waiting times. We recognise that some services have waiting times that are longer than is reasonable and improving this is a priority for those services in the coming year. Sometimes patients cannot access a service because they don’t meet the eligibility criteria agreed with commissioners and this can be disappointing. Ongoing contract negotiations work to address this in partnership with commissioners. Complaints, surveys and other patient feedback point to a need for improvement in larger services such as the out of hours GP practice, Sunlight GP surgery and podiatry. The main themes within these services are around managing the expectations of people who use MCH services and improving communication particularly around waiting times for appointments and changes to services.

Listening and responding Mrs W was unhappy with the care that she had received from MCH community nurses when she needed her Portacath (a device situated under the skin to deliver intravenous medications) flushed. It was identified during the complaint investigation that there were limited staff competencies in managing this type of IV line. It was agreed with the patient that she would help upskill staff by attending training sessions, to demonstrate how to flush a Portacath like hers. We received numerous complaints relating to the Grain phlebotomy clinic only opening for one day per month. The customer experience team invited previous patients and also complainants to attend a focus group to identify their needs and to help re-design the service. The Grain phlebotomy clinic has subsequently increased to fortnightly sessions. Mrs O stated “I was transferred to Kings Hospital for my surgery – Laparotomy, with subtotal gastrectomy, extended right hemicolectomy, partial pancreatectomy and roux en Y; I found that there was little support once I had returned home. I was eventually referred to MCH’s pelvic health physiotherapy by my GP. When I came out of my first session, my husband said I looked radiant. The service provided advice on treating my scars, reassurances that the feelings/pains I was experiencing in certain areas were to be expected and the way I had been stretching to address some of them was correct; and sets of exercises to start strengthening my stomach muscles to regain muscle strength in my arms and legs and build up my stamina. The service also referred me to the MCH Dietary Service.” Mrs O wrote to the service expressing her thanks and gratitude but also wanted to highlight the difficulties she had accessing the service and that no one she had seen (oncologist or Macmillan nurses) were aware of this service and how it can benefit patients with similar conditions. The service listened and has now established a relationship with Medway Hospital oncology team to inform them of this service and how to refer directly. In response to patient feedback we have:  Ensured comfort calls are made to patients who are expecting a home visit by a MedOCC clinician;  provided improved information on the treatments and self-management of conditions;  improved information available within the waiting rooms;  increased the way people can provide feedback, e.g. kiosks in clinic areas, postcards, intranet page, text and email;  endorsed the ‘Hello my name is….’ campaign throughout the organisation;  investigated the opportunity to change the telephone system at the Sunlight Centre Surgery to improve telephone access; and

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ď&#x201A;ˇ

improved the way referrals are allocated to ensure that people who receive care from MCH receive the most appropriate and timely treatment.

1,684 surveys

189 gifts

Compliments 513 verbal

108 award nominations

778 written

Feedback from staff The percentage of staff employed during the reporting period who would recommend the organisation as a provider of care to their family or friends is 92.05%. There was an improved response rate to the full organisational staff survey which took place in November 2015. This indicates that the new approach to the quarterly staff survey (now we only undertake a full organisational staff survey every two years and business unit-specific surveys each quarter) has had a positive impact and reduced the feeling of survey fatigue. There was a 15% increase compared to the previous staff survey. In the last 12 months MCH has undertaken various actions to improve staff experience by increasing staff involvement in organisational initiatives and proposed changes, delivering management development and supporting staff to improve their health and wellbeing through events and training.

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Student feedback This placement met all my expectations and more. It was so organised and is such a friendly working environment. A* quality and support from start to finish. I feel I had the best opportunities to develop and build confidence as a student OT. (OT – hand therapy) I felt extremely supported on this placement, dealing with very sensitive situations. I feel very lucky to have had the opportunity to come to this placement as I can now carry so much knowledge of palliative care with me throughout training and my future career. (Wisdom Hospice) Experience offered in a range of different areas related to diabetes. Very well organised enjoyed the placement, staff were excellent very knowledgeable. I felt that I received all the support I needed whilst on placement from the whole team at Parkwood and was able to achieve the skills and knowledge necessary and regarding their service and will be able to use from now on. (Diabetes)

The results of the survey show a significant improvement in many areas which include:     

Commitment to patients and customers; satisfaction with the way annual appraisals are conducted; good and constructive conversations with line managers; feeling valued (2013 survey); and genuine concern for wellbeing (2013 survey).

In 2016/17 we will focus our efforts on reducing workplace pressure and supporting staff to speak out when they have concerns by delivering a tailored staff health and wellbeing programme. The table below outlines the Friends and Family test percentage score for the last two reporting periods, and the comparison to other local NHS providers (quarter three data):

National Average

88.1%

92.05%

69%

Other NHS providers – Highest 82% (Q3)

Other NHS providers – Lowest 53% (Q3)

Example of listening to our staff During 2015/16 we evaluated the current preceptorship programme (support for newly registered healthcare professionals). We ran a series of focus groups, interviews and questionnaires to current preceptees, those that have recently completed the programme and their preceptors (supporters) and line managers. On evaluation the staff indicated that wanted a programme that enables them to learn while ‘doing’; to move away from e-learning, and also to have a forum where newly registered practitioners can come together to discuss and reflect on work-based issues. The new programme was developed around the needs of our staff, finalised and sent out for consultation; communicated to staff and implemented on the 1 April 2016.

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Achievement against our quality priorities Achievement against our quality priorities Patient safety:  Continue to provide environments and care where the risk of infection is minimal; and  continue to focus on reducing avoidable pressure ulcers, as well as promoting prevention by enabling patients and carers to understand what they can do. Clinical effectiveness:  Support patients with long term conditions, encouraging self-care and reducing acute hospital admissions through the integrated discharge team and case management. Patient experience:  Continue to work to reduce waiting times and appointment cancellations in services where there are challenges; and  through the rollout of My Plan provide a shared plan designed to support the coordination of care, provide a framework for capturing patient goals, evidence effective practice and facilitate measurement of the outcomes of care. Quality governance  Continue to seek the views of MCH staff through our engagement programme, to ensure they are supported in delivering high quality care; increase numbers of staff recommending MCH as a place to receive care; and  through GAIN, enable systematic implementation of lessons learnt arising from complaints and incidents. 1. Patient safety Continue to provide environments and care where the risk of infection is minimal. Indicator

Target

Staff being bare below the elbow

100%

Compliance with hand hygiene

95%

99%

100%

Cleaning audits

87%

94%

93%

94%

87%

Compliance with MRSA screening

100%

96%

89%

94%

Reported Cdiff or MRSA

Commentary: Through our annual infection prevention and control (IPC) programme our infection control team and all staff make IPC a high priority and everyone’s responsibility. We continually train staff and have link practitioners in all services who are actively involved in the audit programme. This continues to be a quality priority for 2016/17.

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Continue to focus on reducing avoidable pressure ulcers, as well as promoting prevention by enabling patients and carers to understand what they can do To work collaboratively to reduce the numbers of community (e.g. care home, patient’s own home etc) acquired pressure ulcer.

100% delivery of action plan by end Q4

On Track

100%

Commentary: Pressure ulcers cost the NHS between £1.4 and £2.4 billion each year. Preventing and reducing pressure ulcers is a national priority as well as a top priority for CCGs. NICE demonstrates that nutritional screening, early intervention and treatment could save £71,800 per 100,000 people. It has also been suggested that the length of hospital stay is two to three times greater for those with a pressure ulcer, than for similar cases without (30.4 days compared to 12.8 days) Utilising our internal preventing harm oversight group to monitor this quality priority and the internal pressure ulcer group as a working group, we have made significant headway in reducing the numbers of avoidable pressures ulcers acquired in our care. These include:       

Developing a hydration leaflet for patients and researching a risk assessment tool to determine risk of dehydration; reviewing of the pressure ulcer policy and procedures and communicating this to frontline staff; trialling a new pressure ulcer risk assessment tool; introducing a new root cause analysis tool for pressure ulcers; improving reporting and understanding of the type of pressure ulcer to ensure appropriate action and treatment is offered; reviewing foot orthotics to prevent heel pressure ulcers; and community nursing ‘Think Pressure’ away days (training provided for all community nurses within MCH and other services that review patients at risk e.g. palliative care). Feedback from these sessions: o o

Very in-depth, lots of opportunity for questions, good interaction. Will be much more mindful of pressure visits and holistically assess; the interactive learning helped me remember certain things about pressure areas as I learn far better by doing and discussing and it gives me a better visual understanding. The legal aspects opened by eyes to the importance of documentation and communication. It was a very educational and entertaining day; and body mapping equipment was really fascinating and is ideal for training.

2. Clinical effectiveness Support patients with long term conditions, encouraging self-care and reducing acute hospital admissions through the integrated discharge team and case management. Working with Medway clinical commissioning group (CCG) and other providers to embed these services.

100% delivery of agreed action plan

On Track

100%

Commentary: This has been fully achieved through the community nursing service redesign. This involved the development of multi-disciplinary meetings with GP’s (to discuss

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complex patients) and improving the way data is captured to inform future practice. There are now seven nurse case managers (NCM) in post and they are fully embedded into the community nursing teams, each NCM has 40 to 60 patients on their caseloads. They all have advanced assessment skills and are independent prescribers. Referrals are mainly generated from GPs or community nurses, and every patient referred is seen and assessed before a decision is made to either support longer term or signpost onto more appropriate services. NCMs have approached every GP surgery in Medway to engage in regular surgery-based multi-disciplinary team (MDT) meetings. Most surgeries have taken up that offer and report finding the MDTs very beneficial in assisting them manage their patients with long term conditions (LTC) more effectively. NCMs also chair regular MDTs (usually monthly) in their bases where any service can refer a patient for discussion with the patients consent. Appropriate services are then invited to attend to assist in the proactive management of complex patients. Successful MDTs have been when multiple services engage leading to more joined up working and information sharing. Success stories include the occasion when multiple services including the GP attended an MDT arranged as part of the management of a patient who was self-neglecting. The outcome of the meeting was that the patient was placed in a residential home where they absolutely flourished and potential lengthy hospital admission avoided. In another case services who wouldnâ&#x20AC;&#x2122;t normally work together were able to co-ordinate a patientâ&#x20AC;&#x2122;s care via an MDT to optimise the patientâ&#x20AC;&#x2122;s health (and therefore rehab) potential prior to surgery, leading to a successful outcome following that surgery. NCMs also run monthly virtual wards where the community nurses can discuss and get advice on complex patients they are concerned about, whether known to the NCM or not. The community nurses report positively about being able to access the NCMs experience and knowledge. The virtual wards can then lead onto the more formal MDTs if necessary and also involve external services, e.g. ambulance services have attended on occasion which they found hugely beneficial. 3. Patient experience Continue to work to reduce waiting times and appointment cancellations in services where there are challenges Through monthly service performance indicators, identify key services and monitor progress against achievement of improvement plans.

Podiatry Reduce waiting list of patients waiting over 18 weeks by 10% each month.

Commentary: Community podiatry waiting times have decreased this year but not as much as we would like, as the demand has continued to rise (five weeks over target). We have reviewed the systems we have to help improve waiting times and implemented improvements into clinical practice. Patient safety is paramount, to ensure high risk patients are seen within an appropriate time frame. Triaging by senior clinicians has been implemented. Although this is not a quality priority for the organisation in 2016/17 this will continue to be a service priority.

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Orthopaedic clinical assessment service (CAS) Reduce waiting list of patients waiting over four weeks. Commentary: The orthopaedic clinical assessment service (CAS) waiting times are now within the service specification and patients are waiting no longer than two weeks for an appointment (unless due to personal preference). Due to high demand CAS has had an average waiting time of six to eight weeks. The service viewed and investigated all the reasons why patients did not attend appointments but were unable to identify any way to reduce these to assist in reducing the waiting times. Therefore, working with the clinical commissioning group (CCG), funding has been provided to increase staffing and now waiting times have reduced to two weeks. In addition the CAS team has assessed and treated approximately 350 patients who were waiting a long time on Medway NHS Foundation Trust (MFT) orthopaedic consultantsâ&#x20AC;&#x2122; list to help reduce pressures in the system and ensure that patients were seen in a timely way. Through the rollout of My Plan, provide a shared plan designed to support the coordination of care, provide a framework for capturing patient goals, evidence effective practice and facilitate measurement of the outcomes of care. 44% Care plan with measurable goals

(98% 90%

Inpatient services)

67%

75%

74%

Commentary: Although there have been improvements in the amount of personalised care plans completed it has not reached our target of 90%. We are committed to improving the personalisation of care and patient-owned care and therefore this will continue to be a quality priority for 2016/17. Evaluations show there is an inconsistency in practice across our services, in part as a result of various versions of â&#x20AC;&#x2DC;My Planâ&#x20AC;&#x2122; documentation tool being utilised. Work is being undertaken to develop a tool on our electronic notes system that meets the needs of services with the aim of increasing consistency in personalised planning and care planning across all clinical services. 4. Quality governance Continue to seek the views of our staff through our engagement programme, to ensure they are supported in delivering high quality care; increase numbers of staff recommending MCH as a place to receive care. Through staff response to the Friends and Family test (percentage of staff who would recommend MCH to friends and family as a place to receive care).

Quality account 2015 - 2016

90% (reduced target based on national reporting)

92.6%

84.4%

88.1%

92.05%

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Commentary: We undertake staff surveys to understand how staff feel about working for MCH and to inform any actions we may wish to take to improve staff experience of working at MCH. Staff feedback during 2014/15 told us that staff were experiencing ‘survey fatigue’ due to the pace of the surveys. In response we reduced the number of surveys sent out this year by only surveying one business unit per quarter. This has been received positively and we have seen an increase in response rates when compared to 2014/15. Our results compare very favourably to other local providers with MCH ranking in the top three for all quarters. Through GAIN enable systematic implementation of lessons learnt arising from complaints and incidents. Attendance compliance at GAIN.

100% services

85%

91%

65%

82%

Commentary: Our Governance Assurance Information Network (GAIN) is an integral part of our governance structure and therefore due to non-achievement of this quality priority in 2015/16 it will continue to be priority for us in 2016/17. Although there are valid explanations as to why the percentage attendance is low (particularly in quarter three), it does mean we do not have the assurance that the information is being cascaded and lessons are being shared and learnt. The priority over the next year will focus on three areas:   

100% representation compliance at GAIN (rather than attendance); 100% compliance with the implementation of GAIN alerts (lessons learnt and actions taken); and 100% compliance with lessons learnt, recorded on Datix (incident reporting system) for upheld / partially upheld complaints and incidents.

GAIN alerts are a new initiative to provide a more timely response to sharing lessons learnt and good practice. This will be in the form of a monthly email newsletter to heads of services with an electronic survey. They will need to complete the survey to assure MCH that the information has been shared and implemented if appropriate.

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Statement from CCG Statement from NHS Medway Clinical Commissioning Group NHS Medway Clinical Commissioning Group (MCCG) welcomes the 2015/16 Quality Account submitted by Medway Community Healthcare (MCH) and can confirm that the CCG has reviewed it against the Department of Health reporting requirements and as far as can be determined the commentary and data presented are an accurate and honest reflection of progress made in improved service delivery and patient outcomes and meets national reporting requirements in accordance with the National Health Service (Quality Accounts) Amendment Regulations 2012. The CCG commends MCH on their continued engagement through a consultation process with staff, patients, community forum and commissioners for the selection of quality priorities for 2016/17 thereby ensuring that the priorities are set with local needs in mind. MCCG supports the seven priorities detailed within the Quality Account around Patient Safety – reducing risk of infection and avoidable pressure ulcers; Clinical Effectiveness – development of measureable quality outcomes and increased dementia screening; Patient Experience – utilisation of Friends and Family Test feedback and the roll-out of Personalised Care Plans; and Quality Governance – implementation of lessons learnt arising from complaints and incidents. In 2015/16 MCH continued to undertake their own internal Care Quality Commission (CQC) national model of inspections called ‘GAINing Insights’ as a way of providing assurance around the quality of their services. These inspections are undertaken by MCH executive and non-executive directors together with commissioners, clinical experts and service users. In 2015/16 18 services were inspected; all produced a quality improvement action plan which was presented to Board members, inspectors and at their Quality Summit. Resulting action plans are monitored through MCH’s internal governance processes. In January 2016 an unannounced CQC inspection using the new inspection model took place at Darland House; the inspectors rated this service overall as ‘Good’. MCH use patient feedback to continue to improve service delivery and provide a positive experience for all in their care. This has been recognised in 2015/16 with the organisation and individual teams winning or being short-listed for a number of national and local awards, including Patient Experience Network National Awards; Kent Surrey and Sussex NHS Leadership Awards; Social Enterprises UK Awards; NHS Health Education (Kent, Surrey and Sussex) Apprenticeship Awards; North Kent CCGs Patient Experience Awards and Friends and Family Test Awards 2016. MCH met all their 2015/16 targets for the Commissioning for Quality and Innovation (CQUINs) and have continued to work collaboratively with the local acute hospital trust for the reduction of healthcare acquired pressure ulcers; this continues to be an area for improvement and the CCG welcomes that this remains a quality priority in 2016/17. NHS MCCG look forward to continuing to work closely with the Associate Director - Clinical Quality and colleagues at all levels within the organisation to assure the quality of local services. We also look forward to maintaining and strengthening our relationship through the Clinical Quality Review Group with the aim of gaining the on-going assurance that the quality of local services provided by MCH are sustained and improved in all areas of the organisation.

We are, as always, very grateful for the comments we receive from our partners and stakeholders and would like to thank NHS Medway CCG for their statement on our 2015/16 Quality Account. Delivery of high quality services is of key importance to MCH and we will continue to work with all of our stakeholders during 2016/17 to ensure our services deliver to the highest standards.

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How to provide feedback on this account How to provide feedback on this account We would like to hear your comments and feedback on the quality account and any suggestions you may have for the priorities and content for our future quality account. Your feedback For further information or to request a hard copy of this report please contact medch.communications@nhs.net or call 01634 334686. You can become a member of our community forum. Visit:www.medwaycommunityhealthcare.nhs.uk/join-in Other languages This information can be made available in other languages and formats. Find us You can find us on:Facebook - www.facebook.com/medwayhealth Twitter - www.twitter.com/medwayhealth LinkedIn - www.linkedin.com/company/medway-community-healthcare Google+ - plus.google.com/+MedwaycommunityhealthcareNhsUk YouTube - www.youtube.com/medwayhealth Visit our website at www.medwaycommunityhealthcare.nhs.uk or by scanning the following QR code into your phone:

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Appendix 1 APPENDIX 1 Local audit 2015/16 Local audit title

Actions

Planned care Care home team



Evaluation    

 



Community nursing team



GP referral audit 

Quality account 2015 - 2016

Virtual Ward Round (VWR) to be provided within nursing homes on alternate weeks with all members of the care home team represented, including consultant geriatrician; VWR to be undertaken with nursing home staff, during surgery times to support assessment and management advice for patients with complex needs; increase surgery times to promote proactive working as per the to-be process map; implement on-site training plan within nursing homes with training packages already developed; Consider care home team ability to admit direct to frailty team for assessment, to develop robust links with Medway NHS Foundation Trust (MFT) frailty team to improve patient turnaround times and reduce length of stay; to be able to refer directly to mental health services, with support of the GP, in liaison with dementia team, to reduce avoidable referral delays and improve patient outcomes; End of Life (EoL) facilitators to undertake two-weekly visits supported by the GP (would require re-banding for this as will include prescribing changes and increased decision-making accountability), to support homes to reduce need for post mortems as GP would be more assured to sign off the patient’s death certificate etc; continue to develop pathways with MedOCC to support decision-making out of hours and ensure patients are reviewed by the right team, at the right time to further reduce avoidable hospital admissions and attendances; consider the implementation of a tele-technology solution (such as the one currently being piloted within MCH), within a nursing home as a pilot, to support VWRs and remote monitoring and early intervention strategies for complex or at risk patients; consider an increase in staffing levels within the care home team, to enable development of proactive ways of working; develop succession planning and to support the critical mass of team; and review KPIs and data performance submissions to the Clinical Commissioning Group (CCG) to ensure these are informative and deliverable. Support clinical nurse managers to attend multi-disciplinary team (MDT) meetings at GP practises as part of the service redesign programme; team administrators to attend clinical meetings to feed back any problems encountered with referral process;

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Local audit title Respiratory Identifying the number of Did Not Attends (DNAs) and try and prevent these occurring

Long term conditions Evaluation of the long term conditions multidisciplinary team (MDT) meeting model

Actions  investigate emailing patient appointment letters;  text message system to remind patients of their appointments;  investigate a protocol - if patients do not confirm the appointment it will be offered to another patient;  investigate if the room that is being used is the most appropriate room for the clinic that is being held; and  identify if clinic appointments are more cost saving and efficient compared to home visits.  Head of service to consider the audit and results by the lead service (nurse case managers – community nursing);  potential tele-technology solutions to be discussed at the technology steering group; and  tele-technology for use within long term condition MDTs for patients and staff (e.g. teleconferencing/Skype) to be investigated.

Therapies and children Children’s therapy service Pooled budget outcomes audit

Orthopaedic clinical assessment service (CAS) Review of the discharge destinations of orthopaedic CAS patients following face to face contacts with a CAS clinician Muskuloskeletal physiotherapy Pelvic health service review and business plan

Muskuloskeletal physiotherapy Evaluating the effect of Extracorporeal Shockwave Therapy (ESWT) on pain levels using the VAS score

Quality account 2015 - 2016

 Findings to be presented at pooled budget KPI meeting with commissioners;  Abbey Court secondary students to be discussed with therapists working there – trial up to ten programme children to be moved to direct input and goals monitored after two terms; and  Hearing impairment provision to be discussed with lead for hearing impairment and for the lead to review goals for those children.  Review a sample of the patients referred to secondary care orthopaedics for evidence of clock stops and other management along the pathway; and  audit outcomes of Medway NHS Foundation Trust (MFT) screening patients referred into CAS.  A talk to nurses on the management of ano-rectal disorders in November 2015;  a pelvic floor talk to the public in January 2016;  pelvic girdle pain/pelvic floor talk to student midwives at Canterbury University in February 2016;  pelvic girdle pain/pelvic floor training to colleagues;  shadowed urogynae consultants and urogynae nurses;  attendance at the gynaecology multidisciplinary team (MDT) meeting every three months; and  safeguarding supervision set up every three months to help the physiotherapists debrief on some of the more difficult patients who may have history of sexual abuse.  To teach all staff how to safely use ESWT for patient and therapist;  to compare, through research, the use of ESWT to other treatments;  keep abreast of current literature regarding ESWT; to increase use of ESWT through muskuloskeletal physiotherapy and increase awareness with orthopaedic clinical assessment service (CAS), orthopaedic consultants and GPs.

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Local audit title Adult speech and language therapy Initial telephone consultation as an effective and efficient mode of intervention for adult dysphagia from care homes. Nutrition and dietetics Reviewing practice against NICE (CG32) and local guidelines for nutrition support at Harty Ward in Sheppey Community Hospital

Local audit title

Actions  Extend format to referrals from outside of care homes;  review telephone consultation format and develop as required;  adapt telephone consultation to Community Healthcare System (electronic patient record) to allow online recording; and  develop training for care homes to improve knowledge of eating, drinking and swallowing difficulties and thus improve quality of referrals made to speech and language therapy.  Staff to ensure that a note is added on Malnutrition Universal Screening Tool (MUST) sheet if a wrong weight has been entered;  staff to make sure usual weight is recorded which will provide an accurate weight loss;  staff to add a note if there is a reason why they are unable to weigh patient on scheduled days;  staff to request training if they feel that will help with improved compliance; and  re-audit in February 2017. Actions

Urgent care St Bartholomew’s Hospital Review of functional ability and length of stay in relation to seven day working MedOCC Consideration of the possibility of pregnancy in female patients seen at MedOCC (April 2015) MedOCC Determining reasons for patients with negative deep vein thrombosis (DVT) results at scan exceeding the predicted 30% for all patients assessed. Local audit title

 Ensure all staff are aware of process on admission and discharge; and  record date of person becoming multidisciplinary team fit, date of actual discharge and also the reason for delay in order to distinguish between clinical influences and external influences.  Remind all MedOCC clinicians to record this;  add the new fast text sentence “Last menstrual period” to the history screen of adult females to assist good record keeping in this area; and  review the standard to demonstrate sustained improvement.  Reinforce message to GPs that same day scans may not always be available; and  training for DVT assessment to be added to the new preceptorship competency pathway for nurses.

Actions

Independent services Tissue Viability and wound therapy Nursing home mattress usage 2015

Quality account 2015 - 2016

 For tissue viability team to review mattresses in nursing homes 6-12 monthly to ensure they remain appropriate for the patient’s needs. Six monthly by tissue viability and six monthly with the mattress suppliers;  to continue to build relationships and work closely with nursing home colleagues to prevent pressure damage and ensure appropriate treatment early on which will prevent harm to patients; and  to reinforce to nursing homes their responsibility in accepting dynamic loan equipment, specifically concentrating on one nursing home.

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Local audit title Tissue Viability and wound therapy Identifying reasons for patients not attending wound clinic appointments to help reduce patient ‘Did Not Attends (DNAs).

Dermatology Evaluation of secondary care referrals for questionable skin cancers

Quality account 2015 - 2016

Actions  Add cancelling of wound clinic appointments to staff Community Healthcare System (electronic patient record) check list reminder;  reduce wound clinic waiting list for appointments by looking at increasing capacity/ new model of working;  review telephone booking/appointment system;  review communication process for GP with regard to DNAs (but also linked to informing of patient’s treatment and discharge from wound clinic); and  initiate text appointment reminder service for patients.  Ensure continued monitoring of diagnosed skin cancer referred to secondary care by community dermatology;  afford training opportunities and equipment for specialist nurses to enhance and maintain recognition of skin cancer presenting in primary care; and  provide ongoing training to primary care clinicians in the recognition of suspicious skin lesions and the appropriate referral pathways.

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Quality account 2015 - 2016

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