Provide Quality Accounts 2017 - 2018
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Contents
Contents Part 1 - Introduction
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What is a Quality Account?
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Statement of Quality from the Chief Executive
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About Provide Community Interest Company
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Our Services
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Part 2 - Looking Forward
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Statement of Assurance from the Board
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Our approach to Quality & Safety
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Our Vision and Values
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Our Priorities for the Year Ahead
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Part 3 - Looking Back
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Statement from Executive Clinical & Operations Director
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The Care Quality Commission View of the Quality of our Services
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Our 2017/18 Priorities What We Achieved
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Part 4 - Review of Quality Performance
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Safe
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Effective
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Caring
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Responsive
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Well-Led
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Part 5 - Statements from Key Stakeholders
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Part 1: Introduction What is a Quality Account?
Each year all providers of NHS services are required to publish a report on the quality of the services they deliver. This is called the Quality Account. Our Quality Account aims to provide you with information about the quality of the services we deliver and our plans to improve further with the needs of service users and their families at the centre of all we do. Our priority is to ensure that our services are safe, effective, responsive, caring and well-led. To measure our progress against this priority, we collect and review a range of information about our services throughout the year, which we report to our Board and our commissioners. We use this information to identify areas of good practice and to find areas for improvement, so that we can maintain and improve the quality of the services we deliver. We hope you enjoy reading this Quality Account. If you would like to give us your view of our Quality Account, please contact us by email or post: By email: provide.safetyandquality@nhs.net By Post: Quality and Safety Team Provide 900 The Crescent Colchester Business Park Colchester Essex CO4 9YQ 4
Part 1. Introduction
Statement from the Chief Executive Provide CIC is a learning organisation. We believe very strongly that we must continue to improve and learn from our patients, customers and staff. Understanding the needs of those we serve is what we strive to achieve and then respond to those needs in the most effective way possible. We may not always get it right, but as this account shows we get it right the vast majority of times. The year 2017-18 was one of significant change for our services as we took account of the changing demands from commissioners, took on new services and said farewell to others. Maintaining quality during times of change is hard but it is our priority. This account demonstrates yet again that we are very mindful of this with no “Never Events”, a 99.64% referral to treatment time success rate and a 97.5% rating from our Friends and Family Tests. These are just a few of the indicators that assure the Board and myself that we are providing quality care. The accounts also pick out individual compliments from our customers which bring the numbers to life in a way that no amount of bar or pie-charts can. I recommend that you take time to read this account and especially enjoy the snippets of feedback that our customers/patients have taken time to write to us about. We could not achieve any of this without the inspiring dedication of our staff and volunteers. They continue to demonstrate their dedication to their profession and to achieving the highest possible standards of care. I am, as always, extremely proud of them and their achievements. I commend this 2017-18 Quality Account to you and to them.
What do our customers say about our services? The Central Point of Access call handlers were extremely knowledgeable and reassured my entire family in the last few days of my husband’s life. Nothing was ever too much trouble and they went above and beyond what I ever imagined. The District Nurses in my area treated us both with so much care and took all of my husband’s needs into consideration. The whole team made such a difficult time more bearable, knowing if I had a problem I could always call. I am, and will forever be, grateful to the whole team. Many thanks. (FFT Community Nursing Service October 2017)
John Niland, Chief Executive
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About Provide Community Interest Company Provide is a Community Interest Company (social enterprise).
Our services 2017-18
Service Po
What is a Social Enterprise? A social enterprise is a business with primarily social objectives whose surpluses are principally reinvested in the business or community, rather than being driven by the need to maximise profit for shareholders and owners. It means any profits we make are reinvested into the local community or back into the business. They do not go to shareholders and/or owners. Social enterprises operate in almost every industry in the UK, from health and education to retail and recycling.
Locality & Neighbourhood Services
Integrated Care Services
We deliver a broad range of health and social care services in the community and are committed to making sure that they are safe, responsive and of high quality. We work from a variety of community settings, such as three community hospitals, community clinics, schools, nursing homes and primary care settings, as well as within peoples’ homes to provide over 42 services to children, families and adults. We also offer some online services. During 2017-18 we provided services across Essex and in Cambridgeshire (including Peterborough), Suffolk and Norfolk, as well as the two London boroughs of Waltham Forest and Redbridge.
Our locations
ESDAAR* Service
Parkinson’s Disease Service
Assessment & Rehabilitation Service
Minor Operations
Podiatric Day Surgery
Podi
Specialist Children & Adult Services
Children’s Diabetes Service
Children’s Occupational Therapy
Community Paediatrician Service
Children’s Continence & Enuresis Service
Speech & Language Therapy - Adult
Continence Advisory Service - Adult
Diabetes Service
Ear, Nose & Throat (ENT) and Audiology Service
Childr Langu
Primary & Prevention Pathways
Wheelchair Service
Falls Prevention Service
Outpatient Physiotherapy
Additional Services
www.provide.org.uk/our-locations
Care
Please visit our website:
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Lym
Community Hospitals, Minor Surgery & Out-Pati
Community Wards (inc Community Stroke Unit)
What does Provide CIC do?
Domicillary Phlebotomy Service
www.provide.org.uk
Part 1. Introduction
ortfolio
Cambridge & Peterborough CCG
Mid Essex CCG
mphoedema Service
Tissue Viability Service
Cardiac Services
Dermatology Service
Respiratory Service Inc. Pulmonary Rehab
Continuing Health Care
Essex County Council
Pulmonary Rehab Service
ient Services
iatry Service
Stroke – Early Support Discharge Service
Adult Community and Inpatient Therapy Service
Endoscopy
ren’s Speech & uage Therapy
Childrens’ Audiology
Children’s Physiotherapy
Children’s Community Nursing Service
ecall Service
Essex Palliative Integrated Care Children’s Respite Service (EPIC) #
Specialist Healthcare Training -Transport Service
Specialist School Nursing
Specialist HealthCare Training #
SEND Therapies
Child Health Information Service (Essex)
NHS England
Waltham Forest CCG
Redbridge CCG
GP Practices
Wheelchair Service
Wheelchair Service
Child Health Information Service (Essex) (East Anglia)
Wheelchair Service
*Early Supported Discharge Admissions Avoidance & Resettlement
Essex Lifstyle Service
Essex Sexual Health Service
# Co-commissioned service
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Part 2: Looking Forward Statement of Assurance from the Board
Derrick Louis Chairman
As Chairman of Provide, it gives me great pleasure to endorse the 2017-18 Quality Account on behalf of the Board. It is my role, and that of the Board’s, to ensure that the right structures and governance are in place to enable our staff to undertake their roles in safe and secure environments, so that they can provide the highest quality of care. We also have to assure ourselves that this is happening consistently across the organisation and this account forms part of that assurance. This is not the only way that we review our quality but as you can see from the content of this report, it gives us a clear indication that we are delivering on this. All Board members regularly review both compliments and complaints, as well as the numerous statistics that are used to measure quality and customer satisfaction and I am happy that this report reflects these. On my many visits with staff and services I get the opportunity to meet with “real people� who will completely un-prompted, let me know how well they are being treated. This makes me feel very proud and indeed from my own experiences, I feel assured that we are making a positive difference to the lives of our customers. We are of course never complacent and the Board and I know that for some people we do not always get it right. The important thing is that we learn from those small but significant examples and ensure that they do not happen repeatedly. This report highlights the extraordinarily high levels of training that take place within our organisation. It is something that the Board and myself place great emphasis on and will continue to do so. It is also our ambition that we move from Good to Outstanding across all services as rated by the Care Quality Commission. We are setting ourselves a high goal but I believe this Quality Account demonstrates that we are on our way to achieving this. I urge you to read this account and I welcome any feedback you might have to help us improve.
Derrick Louis, Chairman
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Part 2. Looking Forward
Our approach to quality Our focus is to ensure our services are safe, effective, caring, responsive and well-led. To achieve this, the Board has ensured that there are well-defined governance systems and processes in place to support and assure the quality of the services we deliver. Our Board has set robust systems and structures in place to ensure quality of the services we deliver to our customers is at the centre of everything we do. This starts with our organisational culture which is driven by our shared vision and values. Our Board, in consultation with our staff, has set out a clear statement of our vision and values which underpin everything we do.
What do our customers say? A customer recommended the service for: “treating them like a valued customer. People had a sense of humour� (FFT Minor Operations service Dec 2017)
Our Vision and Values
and
with
96
%
of staff are aware Provide has a clear vision and values (Staff Survey 2017-18)
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Our Board Provide has a highly-engaged Board which works in partnership with the senior management team and leaders across the organisation, as well as the Council of Governors, all critical relationships for the continued improvements in quality.
Meet the Board Mark Heasman Vice Chairman, Freedom to Speak Up Guardian
Jayne Peden Chair of the Governors
Richard Atienza-Hawkes Executive Director, Human Resource & Organisational Development
John Niland Chief Executive
Rachael White Non-Executive Director
Vicky Waldon Executive Director, Integrated Pathway Hub
Derrick Louis Chairman
Virginia Craig Non-Executive Director
Stephanie Dawe Executive Director Clinical & Operations Director
Philip Richards Executive Finance Director & Company Secretary
Provide Quality Assurance Process Our Board monitor and assure quality standards by monitoring, reviewing and evaluating a wide range of quality data and information such as: The Board monitor and assure quality standards through: Bi-monthly quality and safety reports. Well-defined processes for risk assessment shared bi-monthly. Specialist reports from all support services in relation to: medicines management, safeguarding, infection prevention, information governance, learning and development, health and safety, service delivery issues and patient experience. The Board is aware of all serious incidents which occur during the year. It sees reports and actions plans from incidents and complaints and Iis able to be assured that appropriate measures are in place to deal with issues when things go wrong. The Board encourages openness and transparency in all we do and has backed the implementation of our statutory duty of candour. Members of the Board regularly visit different areas across the organisation to see first-hand the quality of the services being delivered and to speak with staff and our customers face-to-face.
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The breadth of assurance provided to the Board allows structured discussions at Board meetings and provides detailed insight into the quality of the care being delivered as the norm across services, while recognising the need to improve where things go wrong in an open and transparent manner. This robust governance framework provides assurance for the Chief Executive, the Chairman, and the Board of Directors, CQC Registered Manager and the senior managers and clinicians, that the essential standards of quality as set out by the Care Quality Commission are being met in every part of the organisation.
Part 2. Looking Forward
Our Quality Assurance Structure Provide Board
Audit Committee
Clinical Excellence Group
Customer Feack Group
Infection Protection Group
Medicines Safety Group
Quality & Safety Committee
Health & Safety Group
Risk Management Review Group
Finance & Risk Committee
Strategic Safeguarding Group
Learning & Development Group
Workforce Steering Group
Serious Incident Review Group
Council of Governors Provide is owned by its employees. Every Provide worker, from the frontline clinical staff, to administration support staff, is given the opportunity to become an owner of the company for just £1. As an owner they have a say in the future direction of the company and can make suggestions for improvements. Importantly, the Chair of the Governors is a core member of the Provide Board which enables the Governors, on behalf of the staff, to assure themselves of the quality and safety of services being delivered.
The duties of the Council of Governors is to: Represent the views and interests of the members and provide a link between owners, community stakeholders, and the Board. Work with the Board to develop the organisation’s vision and values and forward plans. Influence the investments of surpluses on behalf of the owners and the community stakeholders. Appoint or remove the Chair and other NonExecutive Directors on behalf of the owners. Decide the remuneration and allowances and other terms of office of Non-Executive Directors. Prepare and undertake reviews of the Governors’ strategy.
Meet the Council of Governors
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Our priorities for the year ahead The way in which we deliver our clinical services and how our staff interact with our customers is fundamental to the delivery of safe, effective, responsive, caring and well-led services as defined by the Care Quality Commission and experienced by our customers. At the same time, we live in ever-changing times where we need to keep pace with the changing healthcare needs of our population, changing healthcare practices and changing levels of resource. With this in mind, in 2016 we developed a three-year clinical strategy to help us look forward and develop our clinical services, not only to keep us relevant and fit for purpose but to ensure that the quality of the services we deliver is continually improving. Our clinical strategy priorities are aligned to our organisational vision and values so that our vision and values become real and our customer and staff expectations are met.
The four key priorities in our three-year clinical strategy are:
Care and compassion To ensure we have a committed workforce which delivers patientcentred care through relationships based on empathy, respect and dignity.
Nurture and empower To nurture a structure that promotes empowerment, fosters a belief in people’s ability to be empowered, and acknowledges there is power in the relationships and care provided.
Innovation To ensure we have an organisational culture which drives innovation that balances cost and healthcare quality.
Competence To ensure staff are equipped with the skills, knowledge, attitudes, values and abilities for effective, competent practice.
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Part 2. Looking Forward
We are now looking forward to implementing year three of our clinical strategy and our top priorities for the year ahead are:
Care and compassion 1
Implement a quality improvement programme in identified services to enable staff to build on the quality of service delivery.
2
Build on patient experience feedback. Implement service 5x5 customer engagement survey.
Nurture and empower 3
Focus on clinical practice development to identify new roles and new ways of working: i
Continue to develop the Care Co-ordination Centre service.
ii
Review competencies for new Associate Nurse roles.
Innovation 4
Create models of care that foster integration and partnership with other agencies for the benefit of the customer.
5
Continue digital innovation in care by deploying appropriate new technology applications to meet the needs of the services.
Competence 6
Build on the range and format of quality data provided to the Board, including benchmarking and control charts to measure performance.
7
Support staff to contribute to organisational learning by increasing clinical audit participation.
Learning from national clinical audits In the year ahead we will also participate in the following national clinical audits National clinical audit
Provider organisation
Sentinel Stroke National Audit Programme (SSNAP)
Royal College Physicians
Learning Disability Mortality Review Programme (LeDeR)
University of Bristol Norah Fry Centre for Disability Studies
National Audit Intermediate Care (NAIC)
NHS benchmarking
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Part 3: Looking Back Statememt from Executive Clinical and Operations Director Our Quality Account is a good opportunity for us to look back at what we have achieved in the past year and look forward to what we aim to achieve in the year ahead. Stephanie Dawe Executive Clinical & Operations Director
At Provide, we aim to put quality at the heart of everything we do. We have worked hard to embed the right systems and processes to enable us to deliver high-quality services and measure our performance throughout the year. It is good to see that overall we have performed well over the past year, but of course there have been occasions where we have not delivered the great customer experience and level of quality we strive to achieve. This always gives us pause for thought and we actively work towards learning from these occasions and use this to refocus and improve on our service performance and delivery. In the past year our clinicians and clinical managers have really embraced our vision and values and they have been tireless and enthusiastic in delivering high standards of care for our customers. I would like to thank you all for your hard work, professionalism and dedication. We are very proud of what you do and I know you will continue to support us with our cycle of learning and improving.
Stephanie Dawe, Executive Clinical & Operations Director
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Part 3. Looking Back
The Care Quality Commission’s view of the quality of our services The Care Quality Commission undertook a comprehensive review of our services in December 2016 and published their findings on 8 March 2017. The CQC rated our services overall as “Good” as we were assessed as being good across all the domains of quality they tested, as detailed in the table below.
What do our customers say? “Very friendly place. Put at ease immediately. Any embarrassment quelled straight away and health outcome great. Feeling so much better.”
Since then we have continued to improve on the quality and safety of our services through delivery of our clinical strategy.
(FFT Continence Service Mar 2018)
Good
Provide CQC Overall Rating: CQC REPORTS
SAFE
EFFECTIVE
CARING
RESPONSIVE WELL-LED
Provide Overall Rating
Good Good Good Good Good
Community Health Inpatient Services
Good Good Good Good Good
Community Health Services for Adults
Good Good Good Good Good
Community Health Services for Children, Young People & Families
Good Good Outstanding Good
End of life care
Good Good Good Good Good
Good
The CQC said
“A culture of putting people first was evident throughout the organisation and without exception patients were treated with kindness, dignity and respect” To view our current CQC reports visit the Care Quality Commission website: www.cqc.org.uk/provider/1-168055209
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Our 2017-18 priorities - what we achieved In 2017-18 we reached year two of our clinical strategy and we set ourselves a range of new priorities to help us continue our journey of improvement. Below is a summary of what we achieved in year two.
Care and compassion
Nurture and empower
Our priority was: build on staff attitude, behaviour and culture change initiatives.
Our priority was: staff to contribute to organisational learning.
What we achieved:
What we achieved:
We supported staff to undertake the Mary Seacole leadership programme which empowers people to turn their success into consistent team success and to champion compassionate patient care.
The Clinical Matters newsletter has been redesigned to incorporate regular updates from the Quality and Safety team to encourage learning and a culture of safety.
Staff undertaking the Mary Seacole programme have developed coaching skills to coach and mentor clinicians in the workplace.
The Clinical Professional Forum has been updated to become the Clinical Excellence Group with a focus on debating and reviewing all areas of clinical and professional practice, as well as taking a lead on the clinical audit and clinical research programmes.
We supported over 150 staff to undertake the Mary Gober training. This training aims to help staff engage positively with customers and colleagues in every interaction so they can provide a better customer experience and improved service delivery. 16 staff were supported to undertake the CMI Management Diploma Programme to support leadership development.
Innovation Our priority was: develop digital innovation in care and utilise technology for virtual consultations. What we achieved: A Digital Strategy Working Group has been developed with the support of the IT team to explore how technology can be utilised to improve service delivery and the quality of the patient experience. The Children’s Community Nursing team is now emailing care plans to families to ensure they have prompt access to their care plans and improved data safety. The Children’s Speech and Language service is now emailing reports to families to ensure they have prompt access to reports and improved data safety. The ESD service is utilising iPads with therapy apps to provide remote consultations and encourage service users to maximise their therapy programme.
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The Clinical Excellence Group members now contribute to horizon scanning for news and initiatives in nursing and AHP practice from the clinical press, conferences and network meetings. News headlines on the agenda now incorporate AHP news and perspectives as well as nursing. We recruited a dedicated Research & Development and Clinical Audit lead. Training in clinical audit has been developed. A range of research and clinical audit tools and templates have been developed and published on the intranet.
Competence Our priority was: review roles to support integration and practice development. What we achieved: Our staff conference, called the Quality Summit, in October delivered a packed agenda on best practice in record keeping. We have contributed to a national working group seeking to develop bespoke apprenticeship training for community nurses. An Apprenticeship Levy implementation group has been established. Workforce planning has been established to explore how a new Associate Nurse role can support the delivery of safe, effective and caring services.
Part 4. Review of Quality Performance
Part 4: Review of Quality Performance In this section we want to share with you how we performed over the past year with delivering safe, effective, caring, responsive and well–led services.
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Sign up to safety In 2014 Provide committed to the NHS Sign up to Safety campaign which aims to make the NHS services the safest healthcare system in the world and in 2017-18 we remained committed to this ambition. Our main objective is to focus on continuous learning and improvement and to deliver harm-free care for every patient, every time, everywhere. We are committed to:
96
Putting safety first and reducing avoidable harm. Continually learning by acting on the feedback from patients and incidents and by constantly measuring and monitoring how safe our services are.
%
of staff said: “If I see an error, near miss or incident that could hurt staff, patients or customers, either myself or a colleague always report it.� (Staff Survey 2017-18)
Being open and honest by being transparent with people about their progress, tackling patient safety issues and supporting staff to be candid with patients and their families if something goes wrong. Collaborating with the wider health, social care and volunteer community to improve the local services that patients use. Supporting and helping people to understand why things go wrong and how to put them right. Giving staff the time and support to improve and celebrate their progress.
Safe Are services safe? Safe services ensure you are protected from abuse and avoidable harm
Incident reporting Across the organisation we have an open and transparent reporting culture which encourages staff to identify and report incidents or near misses. We are committed to learning from incidents. We have systems in place to ensure all incidents or near misses that are reported are investigated. We then work to identify if any changes in practice can be made to prevent a recurrence and improve the quality and safety of service delivery for the future. During 2017-2018 we reported a total of 2,095 incidents across all service areas, demonstrating a good reporting culture which remains consistent.
Number of incidents reported
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2017-18 2016-17
2095 2255
Part 4. Review of Quality Performance
Provide Incidents Reporrted 2017/18 Data extracted from Datix Reporting System
We not only report all incidents but we also measure the level of harm they have caused. The majority of incidents reported caused no harm or minor harm. The number of patient safety incidents reported within the organisation during 2017-18 and the number and percentage of such patient safety incidents that resulted in severe harm or death: NUMBER OF INCIDENTS
2095
NUMBER RESULTING IN SEVERE HARM OR DEATH
8
% SEVERE HARM OR DEATH
0.4%
In 2017-18 there were no deaths resulting from a clinical safety incident. We reported eight clinical incidents as severe harm. All these were as a result of older people falling and sustaining a fracture while on a community hospital ward. Every care is taken to risk assess people for falls and to take measures to help prevent falls occurring when admitted to our wards. On our wards we actively rehabilitate people and encourage them to walk and move to help build their strength and independence. Occasionally this does lead to a fall and sometimes a fall may result in a fracture. We take any falls or harm sustained in our care very seriously and we undertake serious incident investigations to identify the root cause of the incident and resulting learning opportunities. We share these with the people involved in line with our duty of candour obligations.
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Serious incidents We are committed to learning when things go wrong to assure our service users, our commissioners and Board that we are learning from incidents and driving improvement and change. We continue to investigate all serious incidents promptly and we are open and transparent when things go wrong. Following detailed investigations, learning is identified and recommendations for improvements in practice are agreed through a robust system of sign-off and cascade across the organisation up to Board level. As a result of some of the serious incidents we have investigated during 2017-2018 we have made the following improvements: Reviewed our pressure ulcer recording template in our electronic record to include more guidance for staff. Undertaken further training for staff on wound care and pressure ulcer management. Ensured heel protectors (used to prevent pressure ulcers) are now a stock item on the community wards. Reviewed the way we risk assess and manage people at risk from falls. Provided record-keeping training updates and made it our key theme at our annual Quality Summit. Provided more training on Mental Capacity Assessments. Reviewed how we record and review results.
Duty of candour Regulation 20 of the Health and Social Care Act 2008 was introduced in November 2014. This regulation requires all healthcare providers to notify the relevant person that an incident has occurred, to provide reasonable support to the relevant person in relation to the incident, and to offer an apology.
Changed the way we record observations. Provided focused clinical supervision sessions to support staff to consider findings and learning from serious incidents. Planned audits to identify if areas of learning and change in practice had been embedded.
At Provide we are committed to being open, honest and transparent when things go wrong. Not just because it is incumbent on us by the Health and Social Care Act but because we believe it is the right thing to do. To ensure we meet our obligations we have a Duty of Candour policy in place and staff are supported to follow the processes set out in the policy after an incident occurs. To test our compliance with our obligations during 2017-18 we undertook an audit which demonstrated we are meeting the required standard.
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Part 4. Review of Quality Performance
Harm-free care We are committed to ensuring that our services are safe and work to prevent avoidable harm. To help us measure our progress with this ambition we participate in the national NHS Patient Safety Thermometer. This is a national measurement tool to support patient safety improvement. It is used to record patient harms at the frontline and to provide immediate information and analyses for frontline teams to monitor their performance in delivering harm-free care.
What do our customers say? Rated the service for: “Being looked after, feeling safe, staff good.”
Data is collected through a point of care survey on a single day each month on 100% of patients. Analysis of the data enables us to understand the prevalence of particular harms at Provide so that we can focus on making improvements in patient care.
(FFT St Peter’s ward Mar 2018)
The NHS Safety Thermometer focuses on four harms: Pressure ulcers Falls Urinary tract infections (UTIs) in patients with a catheter New venous thromboembolisms (VTEs) We also review our performance in these areas through monitoring of our Datix incident reporting system to identify trends and themes.
ORGANISATION
PRESSURE ULCERS
FALLS
VTE
CATHETER & UTI
Provide %
6.6 0.5 0 0
National %
4.5 1.6 0.4 0.7
The data above shows a snapshot of our performance compared to the national average with the harm-free care agenda. The data numbers in a single month are small so it is not possible to identify specific performance from this single view and is more helpful to view as a trend over time. This is shown in the graphs below.
Data from Feb 2018
Our trends show that in the area of pressure ulcers we fluctuate above and below the national line, compared to all community providers that are consistently above the national line. During 2017-18 we have developed an improved pressure ulcer record, pressure ulcer information leaflet and pressure ulcer training for our staff.
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Falls
PROVIDE LINE NATIONAL LINE
NATIONAL AVERAGE FALLS PER 1,000 BED DAYS - ACUTE TRUST
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TOTAL NUMBER OF FALLS PER 1,000 BED DAYS
2016-2017
2017-2018
(ROYAL COLLEGE OF PHYSICIANS, 2015)
Total number of falls / 1,000 bed days
3.07
3.63
6.3
COMMUNITY HOSPITAL /PER 1,000 BED DAYS (NPSA 2007)
8.6
Part 4. Review of Quality Performance
All Community Pressure Ulcers
PROVIDE LINE NATIONAL LINE
Provide All Pressure Ulcers
PROVIDE LINE NATIONAL LINE
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Catheters
CATHETERISATION NATIONAL LINE
PROVIDE CATHETERISATION LINE
NATIONAL CATHETER AND UTI LINE
PROVIDE CATHER AND UTI LINE
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Part 4. Review of Quality Performance
Venous Thromboembolism (VTE) Risk Assessment In our community hospital wards we aim to risk assess all people on the day of admission for VTE. We achieved this 98% of the time. Where we did not achieve this was in a few cases where the patient stayed less than 24 hours on the ward.
The percentage of people who were admitted to hospital and who were risk assessed for venous thromboembolism
98.3%
no cases
We have had of a patient developing a VTE whilst admitted as an in-patient on our community wards.
VTE
RISK ASSESSMENT NATIONAL LINE
PROPHYLAXIS NATIONAL LINE PROVIDE RISK ASSESSMENT LINE
PROVIDE PROPHYLAXIS LINE
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Infection prevention Provide has dedicated specialist infection prevention nurses who work across the organisation supporting the maintenance of excellent infection control measures according to best practice in infection prevention and control. Compliance with standards is closely Infection Prevention Training Compliance monitored and supported 2017-18 each month was by robust policies and procedures. All of our environments are visibly clean and suitable for the delivery of the care required. We provide robust infection prevention training for both clinical and non-clinical staff and have developed the green card training workbook which aligns with Levels 1 & 2, UK Core Skills, Skills for Health and reflects the key requirements for community services.
above
90% (Against a target of 90%)
Infection prevention training for clinical staff for the year met the compliance target of above 90% for each reporting period. The Infection Prevention team has developed an effective network of champions in infection prevention who act as support across their areas of work and feed back into the infection prevention meetings as well as their own specialist meetings. This network of champions have allowed the maintenance over many years of high infection prevention standards. We also aim to protect our staff and our customers by providing our staff with seasonal flu vaccinations each year.
What do our customers say? “Friendly, clean and on time.� (FFT Minor Operations Service Feb 2018)
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Part 4. Review of Quality Performance
There is a robust infection prevention annual plan in place each year which is part of an overall effective risk management and patient safety programme. 2017-18 has been no exception. The team has seen successes in preventing healthcare associated infection (HCAIs) with zero MRSA bacteraemia and zero Clostridium difficile infections. There was one reported outbreak of norovirus in September 2017 on a community hospital ward. Two patients with confirmed norovirus were successfully isolated and all other patients remained well. All patients are screened on admission for MRSA (meticillin-resistant Staphylococcus aureus). All infections are reported via the ‘alert reporting forms’ to the infection prevention team.
HOSPITAL ASSOCIATED INFECTIONS
NUMBER
NO. PEOPLE AFFECTED
MRSA bacteraemia cases
0 0
Clostridium difficile cases
0 0
Norovirus outbreak
1 2
INFECTION
% PER 100,000 BED DAYS
MRSA infected site
0.1
VRE
0.001
Clostridium difficile
0.003
Norovirus
0.001
ESBL
0.003
During 2017-18 the Infection Prevention team has been involved in several quality improvement projects, all relating to reducing healthcare associated infections and preventing patient harms.
Infection prevention quality improvement project - leg ulcers This project looks at ways to improve the management of leg ulcers in the community .The team completed a point prevalence survey and made recommendations based on the results. One of the recommendations was to work with the Tissue Viability team and develop a leg ulcer passport which is now used by community services.
Infection prevention quality improvement project - CAUTIs (catheter associated urinary tract infections) This project monitors the number of CAUTIs on community wards. The project aims to reduce the infection rates and improve catheter management. The infection prevention team is using the information gathered in this project to improve training and ensure best practice is delivered.
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P r o v i d e
Q u a l i t y
A c c o u n t s
2 0 1 7 - 2 0 1 8
What did our customers say? We asked our service users to audit our hand hygiene compliance. As part of the customer experience surveys undertaken during 2017-18. We asked people to tell us about the performance of our staff in hand washing and they were asked to rate what they felt the performance of the staff member they observed. The question asked was: “As far as you know are staff washing or cleaning their hands between touching patients?” and they circled/marked one of the answers below. a) Yes, all of the time b) Yes, sometimes c) Not sure/can’t remember d) Not really e) No, not at all
Staff observed cleaning their hands before touching patients: % that answered ‘A’
These results demonstrate a good level of hand washing was observed by our patients. Quite often, our patients do find it difficult to recall if they saw staff washing their hands when they are experiencing or recovering from an illness, so we would not expect this survey to demonstrate 100%. However, we do undertake monthly hand hygiene audits in our clinical areas which demonstrate very good compliance in this area.
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Part 4. Review of Quality Performance
Safeguarding All services within Provide are required to fulfil their legal duty under Section 11 of the Children Act 2004 and all staff have a duty to safeguard children by recognising abuse and referring onwards as required (Working Together 2015). Similarly, the welfare of adults is paramount and Provide recognises that an adult has the right to feel safe and protected from any situation or practice that results in them being harmed or at risk of harm (The Care Act, 2014). Provide works collaboratively with other services, teams, individuals and agencies in relation to all safeguarding matters and has safeguarding policies that link with Local Authority policies. Safeguarding children and vulnerable adults is a fundamental component of safe, effective, responsive and well-led care and underpins the care Provide delivers. (This is from the Essential Quality Standard, CQC outcome 7). Provide has a specialist safeguarding team that provides expert advice and support to all Provide services and ensures that care is centred on the child, young person or vulnerable adult. The team provides comprehensive and effective safeguarding care through: Safeguarding supervision, ensuring that Provide practitioners are supported within their role and are empowered to provide the highest quality of care.
The Safeguarding Team is led by the Head of Safeguarding and consists of an Adult Safeguarding Lead for safeguarding adults, families and those with learning disabilities; two Named Nurses for safeguarding children; and a Specialist Safeguarding Nurse Advisor. The team are specialists within the field of safeguarding and work cohesively with local safeguarding networks to ensure best practice guidelines are adhered too. Provide fully supports safeguarding to be ‘everybody’s business’ and the Safeguarding Team ensure that safeguarding is a golden thread throughout all care within Provide.
Level 1, 2 and 3 safeguarding training. Mental Capacity Act (MCA) training. Deprivation of Liberty Safeguards (DoLS) training. Learning disability awareness training. Expert advice and support to all Provide services. Investigation of safeguarding alerts. Quality Assurance of safeguarding practice through policy development, audits, serious case reviews and reports. Participating in local and regional safeguarding panels and boards. Networking with safeguarding colleagues across the health and social care community to promote partnership working and service improvements.
What do our customers say? “A wonderful team of staff. They work very hard to ensure a safe and good stay. Nice environment.” (FFT Halstead ward Dec 2017)
29
P r o v i d e
Q u a l i t y
A c c o u n t s
2 0 1 7 - 2 0 1 8
Medicines management The medicines management team works across all services requiring medicines to ensure our services deliver improved patient outcomes, enhance the patient experience and are safe. The team works alongside services to ensure adequate procurement for all services and provides clinical services across the community hospital inpatient wards. By working alongside the prescribers and nursing staff, we ensure safe medication practices and reduce risks as much as possible by advising on appropriate prescribing and dosages. The team also supports staff to ensure delayed and omitted doses of critical medicines are avoided. The team works with multidisciplinary teams to ensure the prescribing, administration and supply of medication is as risk-free as possible. The team carries out medication training and has trained a team of medicines champions to support the maintenance of high-quality standards in relation to medicines management. Compliance with medicine legislation and standards is closely monitored and supported by policies, guidance and standard operating procedures to maintain best practices across all services. Adherence to these is monitored via audit and quality improvement initiatives. The Medications Safety Thermometer is used as a tool to manage medication safety and enables us to identify harm from higher risk medicines in line with domain 5 of the NHS Outcomes Framework. By encouraging healthcare professional to report medicines incidents, the team has worked across the organisation to raise the profile of medicines incidents, supporting and identifying learnings, and encouraging these to be shared across the organisation.
PATIENTS WHO HAVE HAD AN OMITTED DOSE IN LAST 24 HOURS (EXCL. VALID REASONS AND REFUSALS)
PATIENTS WITH AN OMISSION OF A CRITICAL MEDICINE
PATIENTS RECEIVING A HIGH-RISK MEDICINE IN THE LAST 24 HOURS
PATIENTS ON A HIGH-RISK MEDICINE THAT TRIGGERS AN MDT REFERRAL
FEBRUARY 2018
ALLERGY STATUS RECORDED
PATIENTS WITH RECONCILIATION STARTED WITHIN 24 HOURS
Provide
93.5
20.4
0
0
65.6
2.2
Non-acute settings nationally %
94.9
41.8
3.6
4.4
61.4
0.7
The data numbers submitted in the Patient Safety Thermometer each month are small so it is not possible to make conclusions on overall performance by reviewing a single month’s results. Therefore the graphs below demonstrate Provide’s performance during 2017-18.
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Part 4. Review of Quality Performance
Patients receiving high risk medicaiton in the last 24 hours Data Aug 2012- Feb 2018 from NHS Patient Safety Thermometer
Patients with medicines allergy Status documented Data Aug 2012- Feb 2018 from NHS Patient Safety Thermometer
Patients who have had an omitted dose in the last 24 hours Data Aug 2012- Feb 2018 from NHS Patient Safety Thermometer
High-Risk Medication
Medicine Allergies Documented
Omitted Doses Last 24 hours EXCLUDING REFUSALS
EXCLUDING VALID REASONS EXCLUDING REFUSALS AND VALID REASONS
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P r o v i d e
Q u a l i t y
A c c o u n t s
2 0 1 7 - 2 0 1 8
Other areas where we demonstrate we are safe Policies and guidance
We have up-to-date policies and procedures in place which ensure safe, current care is delivered based on best practice guidance. Risk management
We have a robust risk management process in place to identify, manage and maintain oversight of risks. Staffing levels meet the needs of service users/patients. We report staffing levels to the Board where the data is looked at in relation to incidents to ensure we are able to care safely across all areas. Major incident preparation
We have robust plans in place in the case of a major incident or severe weather that can disrupt service delivery to make sure that service users still receive the care they require.
During 2017-18 our major incident system was tested when there was a major cyber-attack affecting large parts of the NHS. During this incident we were able to maintain business as usual as we had robust IT security in place and a well-coordinated response to manage the emerging situation.
What do our customers say? “My nurses came every day three times a day, in thick snow storms and ice on the roads. Never missed a visit.” (FFT Community Nursing Service Feb 2018)
Our business continuity plans were also tested with our need to respond to the adverse cold weather in the last three months of the year. Again, we were able to maintain service delivery as a result of our robust plans and committed staff. Never Events
We have had no Never Events reported in any of our services. Never Events are incidents which should never happen as they are preventable with the correct policy and procedures in place.
What makes this a great place to work?
Clinical audit
We have an annual clinical audit programme to support evaluation of the quality of our services. Partnership working
We work closely with colleagues across health and social care to improve the quality of services we deliver by actively reviewing incidents and issues that arise when people move between our services.
We also have key staff working in the acute hospital to provide and support the safe and effective discharge and transfer of people back into the community after attending or being admitted to hospital.
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Our staff said: “On the whole, staffing levels enable us to offer a regular and quality service.” (Staff survey 2017-18)
Part 4. Review of Quality Performance
Competent staff fit to practice To ensure our services are effective we also need to ensure we have effective staff. We therefore ensure we have robust recruitment and selection processes in place to ensure we employ skilled staff with the right caring and compassionate attitude.
Effective Are services effective? Effective services ensure your care, treatment and support achieves good outcomes, helps you to maintain quality of life and is based on the best available evidence
During 2017-18, 98% of new starters completed our Corporate Induction programme. The remaining 2%, which applies to three new starters in Q4, are booked to attend the next Corporate Induction in April 2018.
Corporate Induction 2017-18
We also pride ourselves on the support we give our staff to undertake a wide range of training to keep them up-to-date and to support them to grow and develop new skills so they can practice safely and effectively. All our staff are required to maintain their competence in key mandatory training areas such as: Basic life support Moving and handling Infection prevention
Mandatory training compliance 2017-18 each month was
96
or
above %
(Against a target of 90%)
Fire safety Health and safety Infection prevention and control Safeguarding
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P r o v i d e
Q u a l i t y
A c c o u n t s
2 0 1 7 - 2 0 1 8
What do our customers say? Every year we support a wide range of staff to undertake specialist training and attend conferences relevant to their specialist area of practice. This enables them to maintain their competence and learn new techniques and skills which enhances quality, safety and effectiveness of the care we deliver.
“Micro suction Clinic. Came to the clinic not being able to hear. Left after suction completely cured. Thank you.” (FFT Adult ENT Service Nov 2017)
We also support staff to undertake a range of further education training to help them grow and develop.
LEARNING PROGRAMME
What do our customers say? “(Physiotherapist) completed a thorough assessment and was extremely helpful, informative and I have significantly improved as a result. This is an excellent service.” (FFT Physiotherapy Service Mar 2018)
NO. STAFF SUPPORTED
Care Certificate
23
Non-Medical Prescribing
2
MSc Advanced Practice
7
BSc Specialist Practitioner District Nursing
6
Foundation Degrees
4
New Managers’ Survival Programme
13
Apprenticeships
26
Intermediate Certificate in Management
18
Mary Gober Customer Care
150
Record keeping Quality Summit Every year we hold a quality conference called the Quality Summit. This year the theme was record keeping and our key speaker was a leading barrister and lecturer in record keeping and the law. His key message was that good record keeping is an essential component of the care we deliver daily as clinicians or administrators and as such it should be given equal priority to hands-on clinical care.
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Part 4. Review of Quality Performance
Clinical audit When carried out in accordance with best practice, clinical audit: Improves the quality of care and patient outcomes. Provides assurance of compliance with clinical standards. Identifies and minimises risk, waste and inefficiencies. During 2017-18 we completed a clinical audit programme. Throughout the year Provide undertakes a range of clinical audits in the recognition that audit is a recognised way of measuring clinical performance and identifying areas of good practice, as well as areas where patients’ experience and safety could be improved.
This table shows examples of clinical audits completed during 2017-18
Quality Assurance
Clinical Practice
Harm Free Care
Duty of candour
NEWS and deteriorating patient (SEPSIS)
Pressure ulcer themes
Procedural document compliance
Triage and managements of people in ESHS
Workforce
Record keeping
Stratified care approach for low back pain
Falls themes
Infection prevention surveillance
Surgical safety WHO checklist compliance
Acute hospital discharge
Safeguarding
Medicine safety
DNAR CPR
Cold chain compliance
Restraint audit
Antibiotic prescribing
Preferred place of death
Dispensing standards quality scheme
Safeguarding assessment
Insulin incidents 35
P r o v i d e
Q u a l i t y
A c c o u n t s
2 0 1 7 - 2 0 1 8
National audits We participate in a number of national audits to contribute to the national view of care quality. The audits we have contributed data to this year are: Safety Thermometer – the results are shown in the safety section of this report. National COPD audit – pulmonary rehabilitation
The National Asthma and COPD Audit Programme (NACAP) for England, Scotland and Wales aims to improve the quality of care, services and clinical outcomes for patients with asthma (adult and paediatric) and chronic obstructive pulmonary disease (COPD). Provide has contributed data for pulmonary rehabilitation in Cambridge. SSNAP - Sentinel Stroke National Audit Program
This is a national project. All health care settings (hospitals and organisations that provide services for stroke patients directly from 0-6 months) will take part. Participation shows that this organisation is committed to improving stroke care. – Number of cases contributed to audit April – November 2017-18 was 65. – Provide SSNAP Score is A. National Diabetic Foot Care Audit (NDFA)
The national-level report from data collected as part of the NDFA was published on 14 March 2018 and can be found on the NHS Digital website. Data collection is continuous and covers eligible people with diabetes who were first seen by a foot care service, with a new ulceration, between 14 July 2014 and 31 March 2017. The latest published report is for 2016-17 which shows Provide performs well compared to the average across England and Wales.
NDFA DATA FOR 2016/17
ENGLAND & WALES
No. of cases submitted for audit
163 9384
SINBAD score 3 or above (severe)
44% 45.2%
Ulcer episodes seen within two days of presentation
11% 14.7%
Ulcer episodes not seen for two or more months
5.5% 8.8%
Ulcer-free at 24 weeks
58.6% 55.7%
Persistent ulceration at 24 weeks
23.4% 23.7%
Admitted to hospital within six months
36.5% 49.1%
One or more minor amputation Major amputation
36
PROVIDE
2.7% 7.4% 0% 1.3%
Part 4. Review of Quality Performance
Participation in clinical research In 2017-18 we participated in a number of research studies as part of our commitment to contribute to healthcare learning and development locally and nationally. Key achievements for 2017-18 Contributed to local and national research projects. Made the process of research approval simpler by providing a virtual summary of the research to members of the Clinical Excellence Group. Research and Development Strategy agreed by the Clinical Excellence Group and Quality & Safety Committee. Research Policy reviewed and updated. Developed the Research and Development intranet resources, including providing the following research and audit resource content: – R&D training (free online) and GCP training at Broomfield. – Clinical audit training (free online). – Access to the Research Design Service and bid proposal training with University of Essex. – Provide staff encouraged and supported to publish their research and audits in the clinical press. – Introduction to Clinical Audit presentation and a Guidance to Writing a Clinical Audit Report (template) resources are now available on the intranet.
28-day readmission rates Provide is a community provider with community hospital wards. Nationally acute hospitals report on the number of people readmitted within 28 days of discharge. Provide also monitors this for the community hospital wards.
2017-18
% of people 15 or over readmitted to the community hospital wards within 28 days of being discharged
TOTAL NUMBER ADMISSIONS
PROVIDE NUMBER
PROVIDE %
1,102
2
0.18%
Monitoring data quality It is essential that the quality of the data we use to assure quality and safety across the organisation is detailed, correct and meets the needs of the organisation. We have developed high-level data collection systems which are able to inform the Board around the effectiveness of services and meeting the fundamental standards as set by the Care Quality Commission. High quality data allows us to effectively report on the whole of adult and children services and effectively review quality across every aspect of the organisation’s business.
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A c c o u n t s
Information governance Information governance (IG) is how we ensure we look after the information people share with us about themselves. We work hard to maintain the trust people put in us to keep their information safe. Use of the NHS Digital Information Governance Toolkit allows us to effectively assess ourselves against the standards required to protect all patient related information. The last submission of the IG Toolkit took place in March 2018. We achieved 79%, which is an improvement from our last submission. The breakdown of the submission is as follows out of the 39 requirements:
23 @ level 2 14 @ level 3 2 marked as N/A
38
2 0 1 7 - 2 0 1 8
ISO27001 As well as the assurance provided through the IG Toolkit, the organisation also obtained ISO27001 accreditation for its IT and data services in January 2018. ISO27001 is recognised worldwide as the standard for information security management. To gain the ISO27001 award, the organisation proved that we could not only prevent, but defend against potential data system vulnerabilities. This achievement was due to our comprehensive suite of information security controls and the management system we introduced to ensure these controls remain efficient and continue to meet our customers’ needs. This standard will also help to demonstrate compliance with the new General Data Protection Regulations (GDPR) which has formed an integral part of the IG assurance programme over the past year.
Certified for Cyber Essentials Plus Provide is very pleased to have been accredited under the Cyber Essentials Plus scheme. Developed by the UK Government and industry, it defines a set of controls which, when implemented, give assurance that the organisation meets a standard of protection from the most prevalent forms of threats coming from the internet. In particular, it focuses on threats which require low levels of attacker skill, and which are widely available online.
Part 4. Review of Quality Performance
Caring Are services caring? In caring services staff involve and treat you with compassion, kindness, dignity and respect.
Our goal is for our staff to involve and treat people with compassion, kindness, dignity and respect which is why empowering people and care and compassion are the foundation of our corporate vision and values. These are values which we are proud of and work hard to maintain.
During 2017-18 we have:
What do our customers say? “Staff were amazingincredibly informative, reassuring, worked quickly and efficiently and always made sure I was comfortable.” (FFT Podiatry Service Nov 2017)
Delivered caring, compassionate services to our customers as evidenced by the Friends and Family Test feedback and compliments we received. Supported 150 of our staff to undertake Mary Gober customer care training. This training enables staff to engage positively with customers and colleagues in every interaction. We have recruited more volunteers to be a point of contact and help for our customers in our clinics and to provide social engagement and support with activities for people in our community hospital wards. Our wheelchair services undertook a service user telephone survey to seek views about their experience of our services. The results were shared with the Board and service teams along with actions for service improvement. We actively obtained feedback from all our customers about our services. We take part in the national NHS Friends and Family Test (FFT) survey.
What do our customers say? “The nursing was very, very good, they were most helpful and were always available to help when required, and the food was very good.” (FFT Braintree Ward Dec 2017)
Friends and Family Test The FFT survey asks patients whether they would recommend the service they have received to friends and family who may need similar treatment or care. During 2017-18 97.5% of our customers said they would recommend us to family and friends and we have scored consistently month on month above the national average of 96% across community services in England.
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P r o v i d e
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A c c o u n t s
2 0 1 7 - 2 0 1 8
Friends & Family Test Rating 2017-18 What do our customers say? “The personal care and attention, the effort made to ensure we understood what was happening was first class.” (FFT Tissue Viability Service Nov 2017)
Our staff offer the emotional support that service users and their families need and see this as an integral part of their role and the service they offer.
What do our customers say? “An outstanding positive experience. Excellent staff. Made me feel at ease from the start. Information at all stages made me feel confident with my new therapy. Timely, helpful and informative. Couldn’t have been better. Thank you.” (FFT COPD Service Apr 2017)
We believe emotional support is fundamental to the care and compassion we deliver. To enable this to be a core component of the care we deliver we ensure our recruitment processes are based on our vision and values and we incorporate questions in our structured interviews to explore people’s attitudes and ability to be caring and compassionate. Other areas where we demonstrate we are caring: We involve patients in the planning of the care they need and make sure that at all times they feel part of their care. We seek consent before undertaking care or sharing information. We maintain patient confidentiality at all times. We carry out record keeping audits which demonstrate the care and compassion we deliver. We are committed to empowering people to manage their own health and have very close links between our healthy lifestyle services and clinical services to provide advice and encouragement with healthy living. All our staff are trained in equality and diversity and are committed to ensure that all patients across all services are treated with care and compassion, dignity and respect. We also train staff in: – Safeguarding – Dementia awareness – Learning disabilities awareness We adhere to the accessible information standard.
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Part 4. Review of Quality Performance
Responsive Are services responsive? Responsive services are organised so that they meet your needs.
We actively encourage feedback from our customers, good or bad, as we are committed to hearing our customers’ voices and taking action where needed to improve our services and the care we provide. We understand that we do not always get it right, so when we receive a complaint we take it seriously and we have set ourselves a target to respond fully to the majority of complaints we receive within 20 days. We investigate all the complaints we receive with an attitude of openness and honesty, as we believe every complaint can help shine a light on our services and enable us to evaluate what needs to change so we can find ways to do it. It also provides us with the opportunity to engage with our customers and to say sorry when we get it wrong. In this way, we continuously strive to improve the services we deliver. All complaints are reported to our Board and themes and trends are identified, along with recommendations for learning and change. In 2017-18 we received 219 complaints and responded to 93.8% within 20 working days.
2017-18
NUMBER OF COMPLAINTS
NUMBER OF CONTACTS
RATIO COMPLAINTS TO CONTACTS
219 468,036 0.4%
Complaint Response Times 2017-18
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P r o v i d e
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2 0 1 7 - 2 0 1 8
Action we have taken in response to customer feedback You said
We did
During the hot weather last summer we received a number of complaints and FFT feedback regarding the extremely high temperature in the treatment rooms.
The service has now had funding approved for air conditioning units to be installed to ensure the temperature in these rooms is maintained at a more comfortable level for both the patient and the clinician.
A TV was installed at St Peter’s Hospital in one of the waiting areas, however it was not working as there was no aerial.
An aerial has now been installed to enable the use of this facility.
Feedback has been received regarding the waiting times for calls to be answered by the Care Coordination Centre.
A call back service has been made available to reduce the call waiting time.
Waiting times during 2017-18 In relevant services we work hard to ensure we deliver assessment and treatment to our customers within the 18 week waiting time standard.
18 week waiting time for treatment following referral
42
PROVIDE
99.64%
Part 4. Review of Quality Performance
Well-Led Well-led services? In well-led services the leadership, management and governance of the organisation make sure it’s providing highquality care that’s based around your individual needs, that it encourages learning and innovation, and that it promotes an open and fair culture.
What makes this a great place to work? Our staff said: “The fact that Executives and Directors are approachable and listen to what is said.” (Staff survey 2017-18)
As an organisation we have a strong vision and values which were developed in collaboration between Executives, NonExecutives, Governors and staff. Our staff are aware of and promote the vision and values which are now part of our culture. We have well-established governance structures which we are confident work and are able to assure the quality of the care we deliver. The Board are able to take assurance via the governance process.
Fit and proper persons Our Board undertakes an annual check and declaration to demonstrate they are fit and proper people to lead the organisation.
Internal audit We employ auditors to review a wide range of our governance systems and processes annually to ensure they are fit for purpose and improve where they need to.
Accessible leadership All of the Board and Governors are visible and undertake regular visits with staff where they can see first-hand the quality of our services. This also provides an opportunity to staff to engage face-to-face with the senior leaders which develops mutual respect, confidence and trust.
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2 0 1 7 - 2 0 1 8
Promote wellbeing We have excellent programmes in place to promote wellbeing in all our staff which helps with staff morale and promotes the organisation’s open and fair culture. The majority of staff were happy in their jobs and this is seen in the results of the annual staff survey. In 2017-18 we promoted: Good hydration – which included free squash to add to water and advice on hydration. Healthy eating – fruit is available at our main bases Healthy lifestyle advice. Cycle challenges.
Staff engagement Provide is committed to ensuring staff are confident and enjoy the work they do so that they are able to do a good job and deliver the caring, compassionate, safe and effective care we want for our customers. The 2017-18 staff survey demonstrated staff perception of leadership across the organisation was positive, with 85% of the staff taking part indicating that they had confidence in their manager.
Walking challenges. Stop smoking support. Seated massages. Craft hours.
Staff Friends and Family Test (FFT) The Staff Friends and Family Test was launched in April 2014 in NHS trusts providing acute, community, ambulance and mental health services in England. It asks staff whether they would recommend their service as a place to receive care, and whether they would recommend their service as a place of work.
STAFF FFT RESULTS DATA FROM PROVIDE STAFF SURVEY COMPARISON DATA FROM NHS ENGLAND
How likely are you to recommend the organisation to friends and family as a place to receive care?
How likely are you to recommend the organisation to friends and family as a place to work?
44
PROVIDER
2017-18
Provide
84%
NHS community providers
74%
All NHS providers
70%
Provide
62%
NHS community providers
58%
All NHS providers
60%
Part 4. Review of Quality Performance
What makes this a great place to work? Our staff said:
I am nearing middle-age and have worked in the private and public sector and also over a decade in the NHS. Provide is easily the best place I have ever worked. I feel secure and respected and thoroughly enjoy my job and responsibility. The mutual respect between staff at Provide make it a very lovely place to work. I appreciate my role in the company and in my team very much. (Staff survey 2017-18)
How likely are you to recommend this organisation to friends and family if they needed care or treatment?
84
%
of staff would recommend Provide to family and friends (Staff Survey 2017-18)
What makes this a great place to work?
How likely are you to recommend the organisation to friends and family as a place to work?
Our staff said: “Good company culture, with welcoming colleagues and supportive managers.� (Staff survey 2017-18)
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A c c o u n t s
2 0 1 7 - 2 0 1 8
Organisational culture Our staff survey explored what our staff thought about our organisational culture, including how they were welcomed into the organisation at induction. 82% of staff agreed they felt welcomed and well inducted to Provide.
I felt welcomed and well inducted to Provide
What makes this a great place to work? Our staff said: Induction was very good. Made me feel part of the team. (Staff survey 2017-18)
We aim to foster a “can do� culture by providing staff with the flexibility they need to enable them to deliver a great service to our customers. 80% of staff agreed they were given the flexibility they needed. This contributes to staff satisfaction and 89% responded that they feel a sense of pride in their work.
I have the flexibility to do what is needed to provide a great service to our customers
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Part 4. Review of Quality Performance
I feel a sense of pride in my job
89
%
of staff feel a sense of pride in their job (Staff Survey 2017-18)
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A c c o u n t s
2 0 1 7 - 2 0 1 8
Safety culture It is essential that our staff feel confident to report potential or actual safety incidents so that we can act promptly to resolve them and learn from them. We were pleased to see that our staff confirmed that they and their colleagues report safety issues and incidents and feel confident the organisation would address their concern.
96
%
If I see an error or near-miss that could hurt staff, patients or customers, either myself or a colleague always report it.
of staff said: If I see an error, near-miss or incident that could hurt staff, patients or customers, either myself or a colleague. (Staff Survey 2017-18)
If I were to report an incident I am confident my organisation would address the concern
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Part 4. Review of Quality Performance
Leadership A key test of a well-led organisation is how confident staff are in their managers and the senior leaders. Our staff survey demonstrates our staff are confident in their immediate managers as well as the senior leaders.
I have confidence in the leadership skills of my immediate manager
What makes this a great place to work?
My manager encourages the team to explore ideas for innovation and new ways of working
My manager/matron and my colleagues are wonderful to work with, and being involved with patients and their recovery make my job worthwhile. I feel I am supported 100% by my manager. This is the reason I still work for Provide. (Staff survey 2017-18)
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A c c o u n t s
2 0 1 7 - 2 0 1 8
I have confidence in the leadership skills of the senior management team (Executive Directors and Assistant Directors)
What makes this a great place to work? Our staff said: Our team within Provide is great because: I am supported by effective line managers, who show flexibility (which encourages loyalty) when appropriate, to manage clinical work but also be supportive when there are also challenges outside of work. (Staff survey 2017-18)
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Part 5. Statements from Key Stakeholders
Part 5: Statements from Key Stakeholders
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Mid Essex CCG Response to Provide Quality Account 2017/18 As the primary commissioner of services provided by Provide Community Interest Company (Provide), Mid Essex Clinical Commissioning Group (MECCG) values this Quality Account as assurance that open dialogue with the public regarding the quality of care delivered remains a priority. MECCG is required to guarantee that the information in this Quality Account is accurate, impartially interpreted, and represents of the range of services delivered. MECCG is providing comment on the draft version of this Quality Account, but is happy to assure the general content. Where feedback on the content or accuracy of data has been given, it is expected that these will be reflected in the final published version. Therefore MECCG is unable to assure all data reported, as additions/omissions may have been made prior to final publication. This Quality Account describes your governance processes, and how you use these to examine you progress against quality standards through the year. This demonstrates your desire to learn through your serious incidents with these events being shared through to the Board. Your Quality Account details the delivery of your 2017/18 priorities, and outlines your 2018/19 clinical priorities that are aligned to Year 3 of your clinical strategy are. These are:
To Deliver Care & Compassion – ensuring a committed workforce which delivers patient centred care through relationships based on empathy respect & dignity
To Nurture & Empower - to develop a structure that promotes empowerment, fosters a belief in people’s ability to be empowered and acknowledges there is power in the relationships and care provided
To Innovate – To deliver an organisational Culture that drives innovation that balances cost and healthcare quality
Competence – To guarantee that staff are equipped with the skills, knowledge, attitudes, values and abilities for effective competent practice.
MECCG supports these as appropriate areas of focus for improving quality. In conclusion, Mid Essex Clinical Commissioning Group considers Provide CIC Quality Account for 2017/18 as presenting an accurate and balanced picture of key indicators for the reporting period. MECCG encourages the organisation to continue with the implementation of its efforts and initiatives to improve the quality of services in the community. Rachel Hearn Director of Nursing and Quality
Mid Essex Clinical Commissioning Group
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