Quality Accounts 2020-21 by Provide Community

Our priority is to ensure that our services are safe, effective, responsive, caring and well-led... this is our

Quality Account 2020-2021

P R O V I D E . O R G . U K

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

Contents PART ONE: Introduction

What is a Quality Account?

How to give your feedback on this Quality Account

Statement on quality from our Chief Executive

About Provide Community Interest Company

Our services

Our approach to quality

Our Vision and Values

Our quality assurance process

Statement of Directors’ responsibilities in respect of the Quality Account

PART TWO: Our priorities for improvement

Looking back: Our priorities for 2020/21 - what we achieved

Looking forward: Our priorities for 2021/22

Reporting against Quality Account mandatory core indicators of quality:

Taking part in national clinical audits

Taking part in clinical research

Mandatory Quality Account indicators relevant to our organisation

Accuracy of our data

What the CQC says about our services

PART THREE: Review of quality performance

Statement from Chief Nurse & Operating Officer

Safe

Effective

Caring

Responsive

Well-led

PART FOUR: Statements

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

ONE

introduction... PART

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 and would welcome your feedback.

we are keen to hear from you...

How to give your feedback on this Quality Account

If you have any views and suggestions on our quality priorities for 2021/22 or any feedback on any other aspect of the Quality Account presented here. You can contact us by email or by post using the contact details below. BY EMAIL:

provide.safetyandquality@nhs.net

BY POST: Quality and Safety Team Provide 900 The Crescent Colchester Business Park Colchester, Essex CO4 9YQ

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

Statement on quality from our Chief Executive It is with great sadness I reflect on 2020 as I consider the impact that the coronavirus pandemic has had on our communities, our service users, our colleagues and their families. None of us has been untouched by COVID-19. Yet it is in the face of adversity that people really shine and it is clear when you read our Quality Account that our colleagues have done just that. They worked incredibly hard to keep service users safe and to deliver caring, effective and responsive services. I have great admiration for their stoicism, dedication and courage in the face of great difficulty. Without them we could not have stepped up in the way we did to help the national effort to manage the pandemic in our communities. As you read this Quality Account, you will see how we came together with commissioners and other health and social care providers to tackle the pandemic collectively, adapting and flexing our services to meet the immediate, urgent and rapidly changing needs of people in our communities. The scale of the challenge was enormous but, as you will see from the data we have included in this Quality Account, we responded to and implemented all the relevant Government guidance to keep people in our care safe and we have played a great part in the overall national pandemic response. Throughout it all, our Board have ensured they have monitored the quality and safety of our services and we have shown in this account how we performed. I hope you enjoy reading these accounts and if you have any feedback to give us we would be pleased to hear from you.

Mark Heasman Group Chief Executive

Q U A L I T Y

About Provide Community Interest Company

A C C O U N T S

2 0 2 0 - 2 0 2 1

Provide is a Community Interest Company (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.

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

What Provide does We deliver a broad range of health and social care services in the community. We do this via our main company Provide CIC Ltd. We also deliver some NHS services through our subsidiary companies and specialist subcontractors. This report takes account of our NHS contracted services delivered across the Provide Group. Our main NHS commissioner is NHS Mid Essex Clinical Commissioning Group (CQC). O U R C O M PA N I E S :

Provide CIC Ltd - delivering health and social care services across a wide range of settings in the community Tollgate Clinic Ltd - providing minor surgery Provide Wellbeing Ltd – providing private (self-pay) services Braintree Healthcare Ltd – providing supported living services to people with learning disabilities. We work from a variety of community settings, such as community hospitals, community clinics, nursing homes, and primary care settings, as well as within people’s homes. We are committed to making sure all our services are high quality, safe, effective, responsive and well-led.

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

Our services 2020/21 Service Portfolio

COMMISSIONED

Mid Essex CCG

Adult Community and Inpatient Therapy Service

Assessment & Rehabilitation Service

Cardiac Service

Children’s Audiology

Children’s Community Nursing Service

Children’s Continence & Enuresis Service

Children’s Diabetes Service

Children’s Occupational Therapy

Children’s Physiotherapy

Children’s Speech & Language Therapy

Community Paediatrician Service

Community Wards (inc Community Stroke Unit)

Continence Advisory Service - Adult

Dermatology Service

Diabetes Service

Domiciliary Phlebotomy Service

Ear, Nose & Throat (ENT) and Audiology Service

Endoscopy

ESDAAR* Service

Essex Palliative Integrated Care Children’s Respite Service (EPIC) #

Home First Service

Integrated Care Services

Lymphoedema Service

Minor Operations

Out Of Hours Nursing Service†

Outpatient Physiotherapy

Parkinson’s Disease Service

Podiatric Day Surgery

Podiatry Service

Respiratory Service (Including Pulmonary Rehabilitation)

Special Schools Nursing

Speech & Language Therapy - Adult

Stroke Early Supported Discharge Service

Tissue Viability Service

Wheelchair Service

Southend-on-Sea Borough Council

Uttlesford District Council

Southend Sexual Health Service

Carecall247

Essex County Council

Specialist Healthcare Training - Transport Service

Specialist Healthcare Training

NHS England

SEND Therapies

Healthy Balance

Cambridge & Peterborough CCG

Essex Lifestyle Service

North East Essex CCG

Thurrock Council

Essex Sexual Health Service

East & North Herts CCG

Carecall247

Supported Living

Specialist Healthcare Training

Herts Valley CCG

North Herts Council

Southend CCG

Thurrock Sexual Health Service

Point of contact for service is indicated by outer circle: Prison Healthcare in Chelmsford Prison

Child Health Information Service (Essex) (East Anglia)

Pulmonary Rehab Service

Chronic Obstructive Pulmonary Disease (COPD) Health Coaching Service

Carpal Tunnel

Vasectomy

SELF PAY

Wellbeing

North Herts Assistive Technology Service

Care Co-Ordination Centre 0300 1310 111 provide.ccc@nhs.net

Carpal Tunnel

Tollgate Clinic

Support at Home

Please contact the service direct. For details visit our website: www.provide.org.uk Services are displayed by commissioning authority.

ADOS-Autism Diagnosis Observation Service

AposTherapy

Ear Care

Medical Cosmetics

Physiotherapy

Speech and Language Therapy

Vasectomy

Minor Skin Surgery

Carpal Tunnel

Carecall247

* Early Supported Discharge, Admissions Avoidance & Resettlement # Co-commissioned service

† Referral through 111 service after 11pm

Correct at time of print - Feb 2020

PFS-2350-2005-02

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

Transforming OUR VISION

Our approach to quality

lives

To ensure we meet our commitment to deliver high quality, safe and effective services, our Board has put in place well-defined governance systems and processes to support service delivery and maintain oversight of quality and safety. Our customers are central to everything we do. Transforming lives through care, innovation and compassion is at the heart of our culture and is why our colleagues go the extra mile for the people we serve.

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

An ambitious, employee-owned OUR MISSION

social enterprise, growing in size and influence.

transform lives by treating,

caring and

educating people.

Care , innovation and

compassion. O U R VA L U E S

Q U A L I T Y

Our quality assurance process

A C C O U N T S

2 0 2 0 - 2 0 2 1

Provide has a highly engaged Board who work in partnership with the senior management team and leaders across the organisation as well as with the Council of Governors: all critical relationships for continued improvements in quality. Our Board monitor and assure quality standards by reviewing and evaluating a wide range of data and information such as: Quality and safety reports Risk registers Specialist reports, including reports on key quality areas such as: • Medicines safety. • Safeguarding. • Infection prevention and control. • Health and safety. • Information governance. • Workforce customer engagement and feedback. • Incident trends and learning. The Board are aware of all serious incidents which occur during the year. They see reports about incidents and complaints and are assured that appropriate measures are in place to deal with issues when things go wrong. The Board encourages openness, honesty and transparency in all we do and has set in place systems to enable colleagues to speak up (whistle-blow) if they are concerned. Board members regularly visit our service areas to see first-hand the quality of the services being delivered and to speak with colleagues and our customers face-to-face.

The breadth of assurance information provided to the Board allows structured discussions about quality to take place at Board meetings and provides insight into the quality of the care being delivered as the norm across services. This robust governance framework provides assurance for the Group Chief Executive, the Group Chairman, and the Group Board of Directors, our CQC Registered Managers and our senior managers and colleagues that the standards for quality as set out by the CQC are being met in every part of the organisation.

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

Statement of Directors’ responsibilities in respect of the Quality Account The directors are required under the Health Act 2009 and the National Health Service (Quality Accounts) Regulations 2010 to prepare Quality Accounts for each financial year. In preparing the Quality Account, Directors are required to take steps to satisfy themselves that: The Quality Account presents a balanced picture of the organisation’s performance over the period covered.

B Y O R D E R O F T H E B OA R D :

The performance information reported in the Quality Account is reliable and accurate. There are proper internal controls over the collection and reporting of the measures of performance included in the Quality Account, and these controls are subject to review to confirm that they are working effectively in practice.

Derrick Louis Chairman

The data underpinning the measures of performance reported in the Quality Account is robust and reliable, conforms to specified data quality standards and prescribed definitions, and is subject to appropriate scrutiny and review. The Quality Account has been prepared in accordance with Department of Health guidance. The Directors confirm to the best of their knowledge and belief they have complied with the above requirements in preparing the Quality Account.

Mark Heasman Group Chief Executive

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

TWO

PART

our priorities for improvement 12

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

Looking back: 2019/20 we set our Our priorities for Inpriorities for 2020/21 little 2020/21 - what knowing that 2020/21 would we achieved be such a challenging year due to the worldwide COVID-19 pandemic.

When COVID-19 arrived in March 2020, Provide CIC, along with all providers of health and social care services, focused all efforts on supporting the national NHS response to the pandemic. Our colleagues were at the centre of this incredible collective effort to minimise and manage the impact of the virus on and within our communities. As we tackled the pandemic our focus on our priorities were necessarily diminished. Despite this, we were still able in 2020/21 to maintain and enhance quality and safety within our services and to meet the priorities we set ourselves. Our priorities aimed to move us towards better use of technology, forging partnerships and working in a more integrated way with service users, our community and our fellow health and social care providers in our healthcare system. As it turned out, these priorities were the building blocks needed for us to contribute effectively to the national pandemic response. Below is a summary of how we achieved the priorities we set.

PRIORITY 1:

WHAT WE ACHIEVED:

To deliver a robust group structure quality assurance programme.

Developed a single corporate Group Risk Register providing oversight of risks across the Provide Group. The Group Quality and Safety team delivered specialist advice, support and oversight to ensure standards of quality and safety were met in our subsidiary companies in key areas such as: • safeguarding • infection prevention • medicines management • reporting and learning from incidents. Our response to the COVID-19 pandemic was coordinated via a single command and control structure within the Provide Group to ensure all areas were able to contribute effectively to the national response.

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

PRIORITY 2:

WHAT WE ACHIEVED:

Explore opportunities for multi-disciplinary teams to work across primary, community and hospital settings to facilitate and lead on the delivery of an integrated communitybased care model.

We worked very closely with all system partners to support a multidisciplinary, multi-organisational response to the pandemic, including: Implementing effective discharge pathways to support people to leave hospital and continue their recovery at home or in a community bed. Contributing to a system-wide process to manage beds to ensure people were placed in the right care setting to meet their needs. Creating additional community hospital bed capacity to help free up beds in the acute hospital and provide appropriate clinical care to those who needed on-going hospital-based care. Redeploying colleagues from non-critical services to work in critical frontline services like our community wards and the community nursing service. All redeployed colleagues were given training, support and supervision to ensure they were able to deliver safe, effective care. Our community nursing teams working with primary care teams to support care homes during the pandemic and to support those shielding at home. Developing a multidisciplinary long COVID-19 clinic, COVID-19 pulmonary rehabilitation clinics and a service to deliver oxygen weaning support to people in their own homes following discharge from hospital.

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

WHAT WE ACHIEVED: We implemented the shared care record (SCR) which has enabled clinically relevant information to be available when delivering care, thereby improving safety and effectiveness of care delivery.

PRIORITY 3:

Develop clinical models to support remote clinical delivery. Identify services that can be delivered through remote technology.

We delivered virtual clinics and consultations so that continuity of care could be maintained during COVID lockdowns, thereby supporting staff and service users to stay safe while receiving essential care. We supported service users and their carers remotely to stay safe and look after themselves with the help of expert advice and support when needed, to minimise the number of people going into their homes. We set up a welfare service to support people who were shielding to get help with shopping and other tasks. We introduced virtual conferencing facilities to keep our colleagues connected to ensure business continuity and to support the wellbeing of staff. We supported the healthcare system to monitor people with COVID-19 using pulse oximeters to check oxygen levels. We taught care home colleagues how to manage wounds and insulin administration to minimise visits to care homes and limit opportunities for infection to spread. Our colleagues maintained oversight remotely using video conferencing. We introduced tablet devices into our community hospital wards so our patients could stay in touch with their loved ones when visiting was not permitted.

Our customers said about virtual appointments:

‘The virtual appointments were great. I felt I was able to show my problems through the video consultation. Doing this from home was also a relief, due to the pain I was in.’ (FFT survey 2020 Community Physiotherapy Service)

Q U A L I T Y

PRIORITY 4:

Improve our workforce capacity and performance.

A C C O U N T S

2 0 2 0 - 2 0 2 1

WHAT WE ACHIEVED: We recruited more colleagues into our Workforce Solutions Team to increase workforce capacity. We redeployed colleagues from a range of our community services to support frontline services and create extra community hospital beds in the healthcare system to support the response to the pandemic. All colleagues redeployed received additional training and skills to ensure safe and effective working. Colleague wellbeing has been at the forefront of our pandemic response and we have ensured all colleagues were risk assessed and action taken as appropriate to keep them safe during the pandemic. This included supporting colleagues to shield and work from home. All our colleagues had access to both flu and COVID-19 vaccinations.

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

WHAT WE ACHIEVED: We completed our action plan to implement the recommendations from the investigation into the iGAS outbreak. All our community staff have now received enhanced wound care training.

PRIORITY 5:

Continue to embed lessons learned from iGAS outbreak.

Our Tissue Viability team now holds a virtual MDT with the community nursing teams once a week to review complex cases. We have reviewed the range and availability of dressings to support standardisation and ensure ready access to the most appropriate dressing for each service user. We now leave a wound swab in the home so if required, a swab can be taken promptly.

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

Looking forward: Our priorities for 2021/22 Our priorities for the year ahead are designed to ensure continued delivery of high-quality care across the Provide Group and to contribute to improvement of health and social care services across the health and care systems within which we work. We will also prioritise our people to ensure we set in place the systems, culture, training and engagement needed for outstanding service delivery.

OUR PRIORITIES FOR 2021/22:

1 Undertake quality review audits to assess the level of quality delivered in our services and identify actions for improvement.

2 Develop a customer engagement strategy to enable us to collaborate with our customers on service reviews and development and improve the ways customers can share their feedback with services.

3 Embed and build on the delivery of virtual services and use of technology and innovation to increase access to and versatility of services for the benefit of our customers.

Our priorities focus on maintaining and improving:

Patient safety. Patient experience and customer engagement.

4 Work in collaboration with colleagues across the mid and south Essex integrated care system to review the community nursing service structure required for the future so that good quality care and service delivery can be maintained and enhanced.

Clinical effectiveness. We have set out some of the key workstreams we will undertake to help us achieve these priorities.

5 Continue to embed good practice in wound care and enhance this through participation in national and local wound strategy groups.

6 Continue to support the national response to the pandemic and support enhanced infection prevention practices in line with Government guidance.

7 We will be creating purpose designed and built video conferencing suites to provide clinical colleagues with bespoke facilities to undertake clinical consultations with service users.

8 We will progress our digitalisation programme and bring about greater access to online health records, online booking and improved video consultation functionality for the benefit of service users and colleagues.

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

Reporting against core quality account indicators

In this section we report on how we have performed against key measures organisations are mandated to report against in their Quality Account. As a community provider most of the mandated indicators are not relevant but where we can report we have.

Participation in national clinical audits Participation in national clinical audits and confidential enquiries enable us to measure the quality of the services that we provide against other organisations delivering NHS care. In this way we can identify areas where we can improve our services. During 2020/21 we paused contributing data for national clinical audits in order to focus our attention on supporting the national response to the pandemic. We will resume contributing to the following national audits in 2021/22: SSNAP - Sentinel Stroke National Audit Program PASCOM Audit for Podiatric Surgery National Diabetic Foot Care Audit Learning Disabilities Mortality Review Programme.

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

Taking part in clinical research Clinical research is a central part of the NHS, as it is through research that the NHS is able to offer new treatments and improve people’s health. Provide Group promotes participation in research and have a dedicated research and development lead that works in collaboration with health, social care and university colleagues across our system to ensure we keep up-to-date and involved with relevant research projects. In 2020/21 we supported the following research projects:

MIDFUT - Multiple Interventions for Diabetic Foot Ulcer (DFU) Treatment Trial - Phase II. A study to investigate the short-term efficacy of four treatment strategies compared to treatment as usual (TAU). Provide is estimating a target of 24 patients for recruitment. PhD Study: Acuity and Dependency Study. To identify practice areas utilising acuity and dependency assessment within their district nursing settings. PhD Study: Strength Training in Pulmonary Rehabilitation. An explanatory study into the clinical application of strength assessment and training in pulmonary rehabilitation settings in the UK. PhD Study: Education and Training of Nurse Practitioners in integrated sexual and reproductive healthcare. A qualitative study exploring nurse practitioners’ perspectives on integrated clinics. PhD Study: Research Engagement in Social Enterprise Healthcare Organisations. An exploration of the barriers and facilitators to research capacity. INVITE (8-14) Evaluating Palin Stammering Therapy for School Children (STSC) versus Treatment as Usual: a feasibility study. This is an NIHR noncommercial study.

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

Quality Account mandated indicators which are relevant to our organisation Colleague Friends and Family Test Our aim is for all colleagues in Provide to

have an opportunity to say if they would recommend our organisation as a place for their friends and family to be cared for if they needed it. Their response gives us a good view of the organisation from the perspective of colleagues and gives them the opportunity and confidence to speak up, so we can hear their views and take positive action where needed to improve.

I N D I C AT O R 2 1 C O L L E A G U E F R I E N D S & FA M I LY T E S T

The percentage of colleagues employed by, or under contract during the reporting period who recommend Provide as a provider of care to their family or friends.

PROVIDE 2020/21 REPORTED IN JANUARY 2020

N AT I O N A L BENCHMARK NHS digital National Headline figures Q2 Report 2019/20 Community data

90.2%

85%

Q U A L I T Y

A C C O U N T S

Venous thromboembolism (VTE) risk assessment

2 0 2 0 - 2 0 2 1

A VTE is a blood clot that develops in a vein, typically in the leg or groin. VTE are more likely to develop when people are unwell and immobile for long periods. To reduce the risk of this happening to people in our care, we carefully risk assess each person admitted to our community wards and where we identify they are at risk we will prescribe blood thinning medication to try and prevent the development of blood clots. This is known as giving prophylaxis.

I N D I C AT O R 2 3 V T E R I S K A S S E S S M E N T

The percentage of patients who were admitted to hospital who were risk assessed for venous thromboembolism.

Also known as C. difficile or C. diff, is a bacterium that can infect the bowel and cause diarrhoea. The infection most commonly affects people who have recently been treated with antibiotics and it can spread easily to others. It is therefore important that we work to prevent cases occurring and where they do, we report them and investigate and learn from these incidents.

PROVIDE 2020/21

N AT I O N A L BENCHMARK NHS England & Improvement VTE risk assessment data 4 September 2019

97.40%

96%

Clostridium difficile

I N D I C AT O R 2 4 C . D I F F I C I L E R AT E P E R 1 0 0 , 0 0 0 B E D D AY S

PROVIDE 2020/21

The rate per 100,000 bed days of cases of C. difficile infection reported within Provide community hospital wards during this reporting period.

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

Patient safety reporting As an organisation we report any incidents or near misses that occur. Where these involve patients in our care we rate the level of harm that occurs. Our aim is always to prevent harm and reduce the likelihood of harm occurring. Where harm does occur we investigate and learn from these incidents so service quality and safety can be improved.

INDICATOR 25 INCIDENTS RESULTING IN SEVERE HARM OR DEATH

PROVIDE 2020/21

N AT I O N A L BENCHMARK (NRLS organisation patient safety incident reports: commentary - September 2020)

The number of patient safety incidents reported within Provide.

1,920

The percentage of unavoidable deaths as a result of people being at the end of life following a health issue.

0.9%

The percentage which resulted in death following a patient safety incident.

0.2%

The percentage which resulted in severe harm following a patient safety issue.

0.3%

Provide reported COVID-19 related deaths to the National Reporting and Learning System in 2020/21. All the deaths reported were unavoidable and were not as a result of a safety incident. There were no harms reported as severe harm. Provide intends to continue to monitor all incidents resulting in harm and where severe harm or death occurs these incidents will be investigated to identify where we can learn or improve.

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

Accuracy of our data Organisations need to collect accurate data so they can define the quality of the services they provide. C O R E I N D I C AT O R R E Q U I R E D TO BE REPORTED IN ANNUAL QUALITY ACCOUNT

PURPOSE

Number of patient records held by the organisation including a patient’s NHS number and General Medical Practice Code for a patient’s GP practice.

Recording the NHS number and GP details ensures patients can be identified correctly and receive appropriate treatment and information can be provided to their GP to support continuity of care.

Score achieved by Provide CIC following a self-assessment against the NHS Digital Information Governance toolkit.

Using this toolkit helps providers measure the quality of the IT data systems, standards and processes used to collect data.

P R O V I D E D ATA / R E S U LT S

249,823

Exceed Required Standards

Q U A L I T Y

A C C O U N T S

What the Care Quality Commission (CQC) says about our services

2 0 2 0 - 2 0 2 1

The CQC is responsible for ensuring health and social care services meet essential standards of quality and safety. Provide CIC is required to register with the CQC and is currently registered with no conditions. We received our inspection in May 2019 and we were rated as Outstanding overall.

For the full report please visit: https://www.cqc.org.uk/provider/1-168055209

Our subsidiary company, Tollgate Clinic Ltd, is required to register with the CQC and is currently registered with no conditions. We received our inspection in November 2019 and we were rated as Outstanding overall. For the full report please visit: https://www.cqc.org.uk/provider/1-224105699 Our subsidiary company, Braintree Healthcare Ltd (BHCL), is required to register with the CQC and is currently registered with no conditions. BHCL was inspected in November 2019 and we were rated as Good overall. For the full report please visit: https://www.cqc.org.uk/location/1-125918778 During 2020/21 our subsidiary company, Provide Wellbeing Ltd was not required to register with the CQC for the range of services it delivered.

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

THREE

PART

review of quality performance 26

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

Statement from Provide Group Chief Nurse & Chief Operating Officer

The year 2020 is one that none of us will ever forget. The COVID-19 pandemic had an enormous impact on our communities, our families and our services. Despite the fear and anxiety such a dreadful virus can cause, our colleagues remained steadfast in their duties and continued to deliver care with compassion and kindness and they really did put the people in their care first.

This Quality Account shows how responsive and flexible our colleagues have been throughout the pandemic to adapt to new ways of working to keep people safe and it is a testament to them that the quality of the care we delivered was consistently high. Looking back on what we achieved, it is clear the contribution of our colleagues enabled us to play an immense role in supporting the local and national NHS response to the pandemic. We are enormously proud of our colleagues and I would like to thank them once again for their hard work and professionalism in everything they do. Looking forward to 2021, we are keen to ensure that we embrace some of the new ways of working which we established during the pandemic. We aim to continue to innovate and develop our use of technology so we can continue to improve access to our services and the quality and safety of the care we deliver for the benefit of our customers. We look forward to another successful year.

Stephanie Dawe Group Chief Nurse & Chief Operating Officer

safe

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

Are services safe?

Safe

Safe services ensure you are protected from abuse and avoidable harm.

This section provides a review of our quality performance in 2020/21. The information included in this section demonstrates how we measure how well we are doing and enables us to explain, where relevant, the action we are taking to improve our performance.

Incident reporting We have an open and transparent reporting culture which encourages colleagues to identify and report incidents or near misses. We have systems in place to ensure all incidents or near misses that are reported are investigated and action is taken where needed to improve safety. During 2020/21 our staff continued to demonstrate a good reporting culture with the level of reporting remaining consistent with previous years.

Number of incidents reported

2019-20

2020/21

2,696

2,753

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

We not only report all incidents but we also measured the level of harm they caused. In 2020/21 the majority of incidents reported caused no harm or minor harm. Provide reported COVID-19 related deaths to the National Reporting and Learning System in 2020/21. All the deaths reported were unavoidable and were not as a result of a safety incident. There were no harms reported as severe harm.

Severe harm/Death Moderate harm/ damage

No harm/ damage

All incidents reported 2020-21 by severity of harm

Minor harm/ damage

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

Serious incidents We continue to investigate all serious incidents promptly and we are open and honest when things go wrong. Following detailed investigations, learning is identified and recommendations for improvements in practice are agreed through a robust system of oversight and sign off by the Quality and Safety Committee on behalf of the Board. During 2020/21 we reported 12 serious incidents. None resulted in severe harm or death. As a result of some of the serious incidents we have investigated during 2020/21 we have made the following improvements: Provided controlled drug medication updates to staff. Additional processes put in place to minimise interruptions to staff preparing medications. Provided training to staff on provision of negative pressure wound therapy. Revised our insulin administration standard operating procedure to give more guidance to staff. Revised the way we print and post letters. Provided further safeguarding training and support to a team working with volunteers.

Duty of candour Regulation 20 of the Health and Social Care Act 2008 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. To ensure we meet our obligations, we have a Duty of Candour policy in place and colleagues are supported to follow the processes set out in the policy after an incident occurs. We undertake an annual audit to check our compliance with this duty which confirmed that in all cases we met our duty in full.

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

KEY AREAS WE MONITOR FOR HARMS

Falls People who use our services can be frail and prone to falling, particularly in our community hospital wards where we aim to encourage and improve people’s strength, balance and mobility. However, on the journey towards recovery from illness and building up their strength and stamina, people who use our services may experience a fall. We try to minimise the risk of falls by undertaking falls risk assessments and setting in place care plans to help reduce the risk of falls. In January 2021 and February 2021, we reported a slight increase in the number of falls occurring. This is because we increased our bed numbers from 36 to 56 to support the response to the wave two surge in cases of COVID-19 infections in our hospitals and we were caring for people who were at an earlier stage in their recovery from illness when they transferred to our wards from the acute hospital. None of the falls reported resulted in severe harm.

All Patient Falls Reported FYTD Commencing April 2019 Clinical Quality starting 01-04-19 20 18 16 14 12 10 8 6 4

Mean Special cause - concern

All Patient Falls Reported FYTD Special cause - improvement

Mar 21

Fab 21

Jan 21

Dec 20

Nov 20

Oct 20

Sep 20

Aug 20

Jul 20

Jun 20

May 20

Apr 20

Mar 20

Feb 20

Jan 20

Dec 19

Nov 19

Oct 19

Sep 19

Aug 19

Jul 19

Jun 19

May 19

Apr 19

Process limits - 3x Target

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

Pressure ulcers Pressure ulcers are injuries to the skin and underlying tissue, primarily caused by prolonged pressure on the skin. They usually affect people confined to bed or who sit in a chair or wheelchair for long periods of time. People who are frail, elderly or very ill are more prone to them, especially if they have health conditions which affect their circulation, ability to move or ability to eat and drink. We work hard to ensure we put in place preventative measures to avoid pressure ulcers developing and to promote healing where they have developed. We actively encourage our colleagues to report the presence of any new or worsening pressure ulcers, whether they occurred while in our care or before people came into our care, so we can monitor for problems in care provision and take action to resolve them. Our reporting during 2020/21 demonstrates a good level of vigilance and reporting by our colleagues. The level of pressure ulcers developing while people were in our care are low and we have reduced the number of more severe pressure ulcers classified as deep tissue injuries and category three and four pressure ulcers.

Provide Source Pressure Ulcers 2020/21 12

May

Jun

Category 2 Category 3

Jul

Aug

Sep

Oct

Nov

Dec

Unstageable-depth unknown - slough Deep tissue injury - Purple or Maroon / Blood filled Blister

Jan

Feb

Mar Category 4

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

Medication safety We report, closely monitor and investigate all medication incidents reported by our teams. Our data shows the number of incidents reported have remained stable, despite making changes to services to support the COVID-19 pandemic in 2020/21. The majority of incidents reported resulted in no harm or minor harm only. We have had no incidents which resulted in severe harm or death.

Medication Incidents reported - Clinical Quality starting 01-04-19 40 35 30 25 20 15

Mean Special cause - concern

Medication Incident = FYTD Special cause - improvement

Mar 21

Fab 21

Jan 21

Dec 20

Nov 20

Oct 20

Sep 20

Aug 20

Jul 20

Jun 20

May 20

Apr 20

Mar 20

Feb 20

Jan 20

Dec 19

Nov 19

Oct 19

Sep 19

Aug 19

Jul 19

Jun 19

May 19

Apr 19

Process limits - 3x Target

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

Our customers said about their wound care:

Wound care During 2019/20 a number of patients in our care developed invasive Group A Streptococcus (iGAS) infections. As a result of this, Provide has undertaken to enhance the care we give to people with wounds. In 2020/21 we provided all our community nurses with enhanced wound care training and our Tissue Viability team developed a Wound Care Handbook. This handbook provides an easy reference guide on the assessment and management of wounds and gives helpful information on how to choose the most appropriate wound dressing to optimise healing. Our Tissue Viability team have also worked with our Infection Prevention team to create a new Wound Infection Pathway. It is a detailed algorithm that encourages a holistic assessment and application of best practice to support improved outcomes for patients and promotes prompt recognition and management of infections. We also introduced weekly multi-disciplinary (MDT) meetings between our Community Nursing teams and our Tissue Viability team so that Community Nurses can get prompt expert advice on the management of complex wounds which ensures wound healing is optimised. It also helps our nurses to gain further experience and skills in wound management as they learn from the MDT experience.

‘Your nurses were all very friendly and professional. They took very good care of my wounds.’ (FFT Survey 2020, Community Nursing Service)

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

Our Community Nurses said about the new MDT meetings with Tissue Viability:

‘The Tissue Viability MDT meetings have been extremely beneficial. Being able to discuss patients weekly has enabled us to plan and implement care for patients with complex wounds with specialist Tissue Viability advice. The process of openly discussing any patient that we are concerned about has allowed us to be responsive and commence dressing regimes quickly.’ Our customers said about their wound care:

‘District nurse was excellent. She checked to make sure I had no infection and changed dressing. She also checked I had help with shopping and what exercises I had to do and they made sure I knew to check scar once dressing removed.’ (FFT Survey 2020, Community Nursing Service)

Our customers said about our nurses and PPE:

‘Yes, I would definitely recommend the community nurses to family and friends. They are absolutely brilliant, understanding of patient’s needs, listen when my son asks questions, are very caring and always wear full PPE.’ (FFT Survey 2020, Community Nursing Service)

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

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 monitored and supported by robust policies and procedures. During 2020/21 we ensured we implemented all Government COVID-19 infection prevention and control guidance to keep our colleagues and our service users safe. We adapted our approach as required to keep pace with changes in the guidance as more information about the virus and how it spread emerged. Despite our efforts, we experienced three separate outbreaks across patient and staff groups in our community hospital wards and one in a residential care setting. These outbreaks were managed in line with Government guidance and with the support of Public Health England, our commissioners and expert infection prevention nurses to contain them quickly.

98%

of our staff have had their first COVID-19 vaccination. March 2021

INNOVATION We introduced lateral flow testing so colleagues could test themselves for COVID-19 before coming to work. Our digital team developed an app for colleagues to report their results and enabled managers to monitor compliance.

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

Some actions we have taken to ensure good infection prevention and control during the COVID pandemic: Put in place robust PPE stock level monitoring and replacement supply systems. Fit tested relevant colleagues undertaking aerosol generating procedures so they can wear enhanced PPE. Put in place additional cleaning of high touch points and processes for decontaminating equipment and environments to protect against COVID-19. Kept colleagues up-to-date with guidance and good practice and trained all colleagues on how to put on and remove PPE safely. Risk assessed all colleagues individually to ensure they were supported to work safely and where they were unable to work, we helped them to work from home or shield. Risk assessed our environments and adapted them to support social distancing, ventilation, wearing of face masks and decontamination of hands. Provided all colleagues with lateral flow testing devices so they can test themselves twice weekly at home for COVID -19. We have offered all our colleagues an annual flu vaccination. We have offered all our colleagues a COVID-19 vaccination. Infection prevention training for clinical colleagues for the year met the compliance target of above 90% for each reporting period.

Our customers said about our clinic environment:

‘The service was really friendly, clean and safe.’ (FFT Survey 2020, Podiatry Service)

72%

of our staff have had an annual flu vaccination. March 2021

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

Infection surveillance We monitor infections that occur in our community hospital settings and we monitor in particular for infections related to organisms that are hard to treat or have a high likelihood of causing severe infection or death. During 2020/21 we had reported no infections of this kind in our commuity hospital wards.

INFECTION SURVEILLANCE 2020/21 INFECTIVE ORGANISM

NUMBER OF CASES IDENTIFIED I N C O M M U N I T Y H O S P I TA L WARD SETTING

MRSA BSI Bacteraemia

Clostridium difficile new isolates

Escherichia coli bacteraemia

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

Provide fully encourages and endorses that safeguarding is ‘everybody’s business’. Safeguarding During the pandemic many of Provide Group’s services were suspended so staff could be redeployed to critical frontline services in line with Government guidance. During 2020/21 safeguarding remained a high priority as lockdowns were imposed and our safeguarding team worked hard to be visible and accessible to the teams, spending much of their time working alongside the teams delivering complex care. In addition, we ensured we: Revised and delivered a safeguarding training plan to offer an adapted Level two Adults and Children Safeguarding training for non-clinical staff who were redeployed to work in frontline services. Revised and delivered a safeguarding training plan to offer an adapted Level three Adults and Children Safeguarding training for clinical staff who were redeployed to frontline services. Delivered Mental Capacity Act training to redeployed staff on the wards. Worked within children’s services to increase visibility which enabled the team more oversight of complex family cases, working in partnership with the CCG, social care, police liaison and other specialist services for the benefit of children in our care. Worked within community nursing teams and community wards to provide guidance and support on mental capacity and safeguarding issues.

Continued to offer telephone support to services. Worked with paediatricians and Looked After Children professionals to develop initial heath assessment pathways specifically for use during the pandemic. The team also worked with Braintree Healthcare Limited colleagues during 2020/21 to undertake a safeguarding action plan for the benefit of colleagues and residents. During the course of our work with people in our care we are vigilant to the needs of people and, where we suspect or identify safeguarding concerns, our colleagues report them following the local safeguarding Board procedures. We call this reporting of a concern or incident ’raising a safeguarding alert’.

SAFEGUARDING ALERT FORMS

2020/21

Number of safeguarding alerts raised by Provide to help protect someone from harm.

161

Number of safeguarding alerts raised by others where Provide has potentially caused harm.

All safeguarding incidents raised by others where Provide is suspected of causing harm have been investigated and no significant harm or care issues were identified.

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

OTHERS AREAS WE FOCUSED ON DURING 2021 TO KEEP PEOPLE SAFE

We listened to our colleagues and customers We took action to learn from incidents, complaints and freedom to speak up concerns. The COVID-19 pandemic was a time of great concern and great changes for our colleagues and customers so it was important we kept in touch with them. Throughout the year we had regular colleague briefings and sent out regular communications to colleagues. Managers kept in contact with their teams and our colleagues also worked hard to keep customers informed about changes in their care.

Policies and guidance We included links to relevant Government guidance in our policy library to enable colleagues to access up-to-date guidance on COVID-19. This included links to infection prevention guidance and training.

Risk management During 2020/21 we undertook individual risk assessments with all colleagues to assess their risk for COVID-19 and agree safe working practices with them. We also had a dedicated COVID-19 risk register to record and oversee all the risks facing our organisation, our colleagues and our customers as a result of the pandemic and the mitigating actions we were taking to manage the risks and our contribution to the national response.

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

Safe equipment and premises To ensure we could respond appropriately to the COVID-19 pandemic and the increase in patient numbers with respiratory care needs, we took the following actions: Boosted our equipment supplies by purchasing additional oxygen delivery equipment, pulse oximeters (used to measure people’s oxygen levels) and syringe drivers so we could deliver medication to people being cared for at home and in our community hospital wards. Set up a service to deliver pulse oximeters to people’s homes within a few hours of seeing a doctor so they could monitor their symptoms and get help early if their body oxygen levels dropped. Worked with buildings and estate experts to create additional bed spaces in our community hospital wards in line with hospital building guidelines so we could care for more patients. Ensured all our premises were configured to reflect Government guidelines for social distancing, hand washing and mask wearing and put policies and procedures in place to support colleagues and visitors to be safe and minimise the risk of transmission of COVID-19. Ensured all our colleagues had adequate supplies of personal protective equipment (PPE) so that they could undertake care delivery safely and effectively.

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

Staffing levels To ensure we maintained safe staffing levels during the COVID-19 pandemic we introduced a reporting process to enable every team to report daily on colleague absence and any service issues. We also set up a dedicated redeployment team who would work closely with service managers to identify colleagues with the required skills that could be moved to work in an area where there was colleague absence. This worked very successfully and enabled us to maintain safe and effective care delivery. All our redeployed colleagues received appropriate training and supervision to enable them to work safely in their new environment.

Safety alerts and NICE Guidance We ensured we accessed all relevant NICE Guidance and National Safety Alerts and we distributed them to our teams to ensure action was taken to implement the recommendations.

Business continuity To ensure good co-ordination and management of our response to the impact of the pandemic on our organisation and to contribute effectively to the national, regional and local NHS response, we set up a command and control structure. This enabled us to:

Maintain oversight of the impact the pandemic was having on colleagues and our services. Co-ordinate implementation of government guidance and requirements. Keep our colleagues informed of changes. Co-ordinate service changes and changes to the working practices of our colleagues, such as working remotely. Monitor for and manage any outbreaks in our services. Monitor and manage supplies, equipment and staffing to ensure sufficient resources were available to deliver safe, effective care.

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

Partnership working We worked extremely closely with colleagues across health and social care to ensure we supported our acute hospital to maintain capacity and free up beds. We did this by: Establishing robust discharge pathways. Creating additional community bed capacity. Creating additional community nursing capacity. Supporting Primary Care to see people at home when they were unable to attend their GP practice. Supporting care homes experiencing outbreaks. Supporting community colleagues to share staffing when needed. Supporting care homes and care agencies by providing training and support on infection prevention, administration of insulin and simple wound care.

effective Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

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.

Competent colleagues fit to practise

Mandatory Training Compliance achieved each month during 2020/21

95%

or above

To ensure our services are effective we need to ensure we have effective colleagues. We therefore have robust recruitment and selection processes in place to ensure we employ skilled colleagues with the right caring and compassionate attitude. All new starters complete our Corporate Induction programme and complete a local induction within their service. During the pandemic these standards for safety were maintained.

We pride ourselves on the support we give our colleagues 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 practise safely and effectively. This includes ensuring they undertake mandatory training in key areas such as: Basic life support Moving and handling Infection prevention and control Fire safety Health and safety Safeguarding

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

During 2020/21, we ensured mandatory training continued to be available to colleagues by converting most of the training to virtual classes that they could complete when it was convenient for them. Where classroom training could not be avoided we ensured we followed COVID-19 guidelines to keep our colleagues safe. During the peak waves of the pandemic, colleagues were asked to focus on frontline service delivery so some areas of our mandatory training compliance temporarily dropped below our target of 90% of colleagues being compliant at all times. Despite this, during 2020/21 we were able to maintain overall compliance at 95%.

Mandatory Training Activity/Compliance 97 96 95 94 93 92 91 90 89 88 87

96%

96% 95%

95%

90%

Q4 2019-20

Q1 2020-21

Q2 2020-21

Q3 2020-21

Q4 2020-21

Compliance KPI

KPI

Every year we support a wide range of colleagues to undertake specialist training and attend conferences relevant to their specialist area of practice to enable them to maintain their competence and learn new techniques and skills which enhances the quality, safety and effectiveness of the care we deliver. We also support our colleagues to undertake a range of further education training to help them grow and develop. During 2020/21 we adapted our training to reflect COVID-19 guidelines and respond to the changing landscape. We devised and delivered 270 classes of skills training to support colleagues moving to work in different clinical environments to help with the NHS response to the COVID-19 pandemic.

270

classes

Were developed and delivered to support and upskill colleagues re-deployed to front line roles.

Q U A L I T Y

A C C O U N T S

Other training we supported during 2020/21 Clinical supervision workshops for 36 colleagues enabling them to then offer group supervision to their colleagues. Best Manager programme for 16 colleagues. Early in the COVID-19 response, we delivered training on Managing Virtual Teams to 40 managers in order to support the new ways of working remotely. This enabled them to ensure that colleagues remained safe and engaged. Following publication of the iGAS action plan, two virtual conferences were delivered. These events saw tissue viability specialist speakers deliver up-to-date expert information to colleagues and were recorded and shared with more colleagues within the organisation. Continuing Professional Development for individual colleagues • Prince II Training • Myers Briggs Facilitator training • European Thoracic Society Annual Conference • The Human Resource Professional • Investigation and Learning from Deaths in NHS Trusts • Managing Challenging Behaviour

2 0 2 0 - 2 0 2 1

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

Apprenticeships We supported 37 people on a variety of apprentice programmes during 2020/21, including on the Nurse Degree and Nurse Associate programmes. We are pleased that we have been able to support two Nurse Associates and seven Nurse Degree apprentices to complete their training and join the Nursing and Midwifery register.

Support to students Provide continued to support a number of preregistration students in practice placements throughout the COVID-19 pandemic, ensuring they were appropriately supported. In line with Government guidelines we employed five third-year student nurses on a fixed-term basis. All five worked within the Community Nursing Team and managed their own caseload. They had dedicated assessors who reviewed their student learning outcomes as well as their line manager who supported and advised them with their day-to-day caseload duties. Two have now qualified as registered nurses and have been given permanent jobs and the other three are continuing their training programme.

Our Children’s Speech and Language Team developed an innovative placement to ensure students were able to continue with their training. Their students undertook project work and were supported to carry our Teletherapy (offering therapy to service users virtually by using video calls) alongside a qualified Speech and Language Therapist. 47

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

Redeployed colleagues Our colleagues were at the forefront of the response to the pandemic and many were moved from their substantive areas of work to our frontline services that were battling the pandemic. These colleagues had the courage to take on new roles and learn new skills to ensure patients got the care they needed. To facilitate a rapid change in role, they received training, supervision and mentoring to gain the new skills and competencies they needed.

INNOVATION We developed a ‘ProvideMyStaff’ platform to enable us to match colleagues’ skills to gaps in critical frontline services so we could deploy them safely and it allowed us to monitor and track staff movements during the COVID-19 response.

Our colleagues said about being redeployed:

‘It’s been amazing to meet staff I never would have met if we hadn’t been dealing with the COVID-19 response - it’s been really beneficial to meet and work directly with our front-line staff and I can already see the benefit to my service in having this engagement.’ (Staff survey June 2020)

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

Performance Development Reviews (PDRs) It is important for colleagues to have the opportunity to review their performance and discuss their personal contribution to the organisation’s objectives and the quality of care we deliver. PERFORMANCE DEVELOPMENT REVIEWS (PDRS)

2020/21

% colleagues who had an annual PDR completed

96%

Local clinical audit A clinical audit is the process by which the quality of care and services provided are measured against agreed standards. Where services do not meet the agreed standard, the audit provides a framework where improvements can be made. Local clinical audits are undertaken within our organisation to evaluate aspects of care that we have selected as being important so that we can: Improve the quality of care and patient outcomes. Achieve assurance of compliance with clinical standards. Identify and minimise risk, waste and inefficiencies. During 2020/21, we completed a selected number of clinical audits as the requirement to respond to the pandemic curtailed undertaking a full annual clinical audit programme. The table shows examples of audits completed during 2020-21

Duty of Candour

National Early Warning Score (NEWS2) & Sepsis

Minor Operations Test Result Management

Preferred Place of Care for Children at End of Life

Procedural Document Review Compliance

Parent /Carer Satisfaction with Communication Stations Drop in Sessions

Syringe Driver Medication

Antibiotic Prescribing

Record Keeping

Assessment and Provision of Emergency Contraception in Sexual Health

DNA Audit MSK Physiotherapy

Infection Prevention COVID-19 guideline Compliance

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

Information Governance (IG) Information Governance is how we ensure we look after the information people share with us about themselves. We want to maintain the trust people put in us to keep their information safe and we work to continually improve the security of information and records. Our internal projects and initiatives demonstrate this through a variety of accreditations: Cyber Essentials Plus is the highest level of certification offered under the Cyber Essentials scheme which is a Government-backed scheme that has been developed by the National Cyber Security Centre and helps organisations protect against cyber security breached. Provide has held this certification for a number of years and has again maintained this certification. NHS monthly Cyber Security ATP Report is another way we are measured for our technical controls using the Windows Exposure Score as the means of assessment. Provide is proud to maintain a low Windows Exposure Score and in February 2021 had the lowest score of over 600 organisations that were measured. ISO27001 is the internationally recognised specification for an Information Security Management System and helps to reduce information security and data protection risks through a number of standards, audit and continual improvement. Provide has this year expanded the coverage of IS27001 to all Child Health Information Services in addition to our Technology Services.

Provide has the lowest Windows Exposure Score compared to over 600 organisations measured NHS monthly Cyber Security ATP Report.

Subject access request portal A new portal has been implemented whereby service users can make a subject access request electronically. The portal is a secure encrypted solution, allowing third parties to submit SARs electronically and digitally via online forms. With a full audit trail and management portal behind the scenes, the organisation is able to adhere to strict deadlines by responding within the permitted timeframe. A visual traffic light system helps to prioritise requests and run full performance reports for management reviews.

Q U A L I T Y

A C C O U N T S

Data Security and Protection Toolkit

2 0 2 0 - 2 0 2 1

Our colleagues said about virtual working:

The toolkit is an online self-assessment tool that allows organisations to measure their performance against the National Data Guardian’s 10 data security standards. As a provider of NHS services, Provide completes the Toolkit each year and the 202021 submission is on track to exceed the required standards. We have employed a dedicated, full-time Data Protection Officer. This officer will work across the Provide group to ensure we are processing the personal data of all of our data subjects, including our customers and colleagues, in a way that is safe, secure and complies with the relevant Data Protection Regulations, law and best practice. Building on the established Information Governance Framework, our Data Protection Officer will focus on enhancing the governance of personal data processing activities across the Provide group together with creating and promoting a privacy aware culture. Our technological response to COVID-19 has seen our workforce adapt to new ways of working, including much more working from home and the use of virtual consultations. This work has been underpinned by further investments in technology to allow most colleagues to have a work-issued laptop and mobile or softphone. Many systems were migrated to the cloud to support the new ways of working and Provide have embraced the use of Microsoft Teams as a collaboration tool.

‘Meetings are more productive via internet as people focus on the key points.’ (Staff survey June 2020)

Our colleagues said about virtual working:

‘Because it is so much easier for people to join an online meeting as they do not have to spend time travelling, I believe staff from different services have communicated with each other more.’ (Staff survey June 2020)

Technology in care

INNOVATION Our workforce rapidly adapted to new ways of working. Provide teams have adopted a “virtual by default’ approach and offer appointments virtually where appropriate, using a variety of specialised software, including AirMid and AccuRx.

We brought comfort to people in our community wards by using technology to bring families together virtually so they could spend time together. This was especially important to enable loved ones to say goodbye to people who were at the end of their lives.

caring & responsive Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

Caring and responsive Are services caring?

In caring services users are treated with compassion, kindness, dignity and respect.

Are services responsive?

Responsive services are organised so that they meet your needs.

Competent colleagues fit to practise

Our goal is to involve and treat people with compassion, kindness, dignity and respect. Putting our customers first is a top priority for Provide so we empower our colleagues to make the changes they need to improve service delivery for the benefit of our customers. We do this by listening to our customers and being responsive to their feedback.

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

Our customers said our colleagues were caring because:

‘The nurses always came in with a smile on their face, because of the current situation apart from my eldest daughter they were the only people that I saw and they made me feel special, they were always encouraging and always had time to ask how I was.’ (FFT Survey 2020 Community Nursing Service)

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

‘Staff are knowledgeable polite, friendly, supportive. Always ready to answer questions and go the extra mile.’

frien fam

Friends and Family Test (FFT)

The FFT survey asks service users whether they would recommend the service they have received to friends and family who may need similar treatment or care. During 2020/21, many of our services were paused or delivery was significantly reduced so that staff could be redeployed to frontline critical services in response to the COVID-19 pandemic. In line with national guidance, we paused active collection of Friend and Family Test data so that colleagues could focus on people in their care. However, people were still able to provide feedback to us if they wished to do so and some did. We therefore saw a significant reduction in the number of responses we would normally receive. We would like to thank the people who did take the time to provide feedback about their care experience using the FFT survey and also for the thank you letters, emails, texts and phone calls we have received. Our colleagues appreciate all the kind words and are working on improving their services where we have received feedback on areas where we can improve.

From the FFT feedback we did receive, we can see that our colleagues continue to deliver expert, skilled, responsive and compassionate care. This feedback can be seen in the feedback included here:

(FFT Survey 2020 Community Hospital Ward Service)

‘The support of the whole team each with their own area of expertise. Each team member was supportive, did not rush me and showed genuine interest.’ (FFT Survey 2020 Home First Service)

‘Really kind and understanding staff. Good to talk things through. Given options to think about and put into practise to improve approach to dealing with life! Very helpful.’ (FFT Survey 2020 Lifestyles)

‘Helpful as it got me back to being able to go upstairs and gave me lots of motivation.’ (FFT Survey 2020 Home First Service)

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

nds & mily

‘Very professional, very efficient, very caring, pleasant and friendly, always give helpful advice These comments apply to all the staff in TVC that I have had care from.’ (FFT Survey 2020 Tissue Viability Service)

‘The information/booklet was very useful. Staff phoning and visiting were very professional and polite, also encouraging.’ (FFT Survey 2020 COPD & Oxygen Service)

‘When the children’s community nursing team came for their first visit me and my family where blown away by it. Caring, compassionate, knowledgeable and just out right spectacular. My son had been poorly for a while but thank God for bringing the team into our life with exceptional care and out right holy performance. Would 100% recommend them to any other families than are unfortunately in our position.’ (FFT Survey 2020 Children’s Community Nursing Service)

‘All my questions answered in language that I understand. The lady was also very kind and understanding. I didn’t feel rushed.’ (FFT Survey 2020 Diabetes Service)

‘I felt like I was among friends. Good bedside manner of the consultant and nurses. A big thank you to all, good time keeping as well, didn’t have to wait around.’ (FFT Survey 2020 Minor Operations Service)

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

Complaints It is important that people who experience a problem with their care are able to tell us about it so we can put things right and offer an apology. We use the feedback we get in this way to find ways to improve our services for future customers. During the COVID-19 pandemic we paused some services to enable us to move our colleagues from those services to focus on critical frontline services dealing with the pandemic. Overall through 2020/21 our complaint numbers remained low in line with previous years and 64% of the complaints we received were classed as level 1 (low level concerns.) The remainder (36%) were classed as level 2 (moderate) complaints. As in previous years we received no level 3 (severe) complaints. NUMBER OF COMPLAINTS

NUMBER OF CONTACTS

NUMBER OF COMPLAINTS TO NUMBER OF CONTACTS

2019/20

180

495,349

1 : 27

2020/21

133

303,061

1 : 23

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.

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

Volunteers We use our wonderful volunteers to be a point of contact and help for our customers in our clinics and services and to provide social engagement and support with activities for people in our community hospital wards.

Our volunteers’ vitality, dedication, hard work and great people skills complement the work of our staff in delivering a great customer experience to the people we serve. During the pandemic we received offers of help from many more people and are thankful that our community were so caring and supportive. Our staff were especially pleased when volunteers made them scrubs to wear. Scrubs are a loose-fitting tunic and trouser combination which are worn in clinical services instead of a traditional uniform. These scrubs were invaluable as it allowed us to get colleagues who do not usually wear a uniform into a pair of scrubs and working safely in our critical frontline services to help with the pandemic response.

Q U A L I T Y

27,061

people supported

47,250 jobs allocated to volunteers

A C C O U N T S

2 0 2 0 - 2 0 2 1

Essex Welfare Service During the early part of the COVID-19 Pandemic, responsibility for the clinically extremely vulnerable fell to upper tier Local Authorities under the Government’s ‘Operation Shield.’ This entailed giving wrap around welfare support to 180,000 Essex residents in most need. Provide was tasked with the rapid repurposing of the Essex Lifestyles Service into the Essex Welfare Service (EWS). We recruited 80 additional call handling staff, developed a resident/volunteer management system, matching over 4,000 Essex Volunteers to those needing support and a call handling system that could handle 1500 calls a day. People were supported with tasks such as: Shopping Dog walking Phone buddy Befriending Parent support Medication collection Mental health first aid Keeping fit and healthy for people with disabilities Safeguarding doorstep welfare checks Hospital discharge welfare checks

Since the launch of the Essex Welfare Service we achieved the following; 27,061 people supported 78,358 calls taken and 64,827 outbound calls made 47,250 jobs allocated to volunteers 14,000 Hospital Discharge Welfare Checks completed 24-hour service standard for completion of volunteer jobs achieved

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

Essex and Southend Contact Tracing Service (ESCTS) In June 2020, upper tier local authorities were tasked to deliver contact tracing at local level. Provide was asked by Essex County Council to set up and deliver this service. Within four weeks we had the service set up and running, employing in excess of 90 colleagues and also taking on responsibility for contact tracing in one of the neighbouring Unitary Authorities. The service is delivered by a team with a range of expertise including: Consultants in Communicable Disease Control Environmental Health Officers Team Leaders Contact Tracers ESCTS was the first local contact tracing service to be set up in the East of England with trained experts operating the service seven days a week. The service has been endorsed by Public Health England who have reported that the ESCTS has enabled early and rapid response to identification and management of community outbreaks.

Timely access to services In relevant services, we work hard to ensure we deliver assessment and treatment to our customers within the 18-week waiting time standard. In line with national guidance for community service providers, during the COVID-19 pandemic we had to temporarily pause or significantly reduce the delivery of a number of our services to enable us to move staff to work in critical frontline services. This has inevitably meant our service waiting times have increased as a result. Provide is now working with our commissioners and colleagues across our health care system to ensure we monitor our waiting lists and work to bring waiting times down as soon as practically possible. TIMELY ACCESS TO SERVICES

2020/21

% people who were seen and treated within the 18-week waiting time standard

98.4%

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

Others areas where we demonstrate we are caring and responsive We ensure we deliver services in clean, well maintained premises and we ensure our services maintain COVID-19 safety in line with government guidance. We treat our customers as individuals and collaborate with them to agree care plans and treatment regimes. We seek consent before undertaking care or sharing information and maintain patient confidentiality at all times. 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. When the Board and senior managers speak to colleagues and customers they can see how caring our staff are. Caring is reflected in our organisational values.

Our customers said about COVID-19 safety:

We provide chaperones to maintain people’s safety and dignity. We provide translation services if people do not speak English.

‘I found the staff very professional and followed all the COVID-19 guidelines - very happy with the service.’

We assess and respond promptly to risks. We have robust policies and procedures in place to guide our staff and ensure we deliver up-to-date, evidence-based practice.

(FFT Survey 2020 Assessment & Rehabilitation Service)

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

Our customers said about our responsiveness:

‘The staff were: Highly responsive, helped us out in a very worrying time.’

Our customers said about COVID-19 safety:

‘COVID-19 safe organisation. Reception efficient and clear direction. Appointment happened on time. Nurse and doctor very clear with me on treatment and reassurance. Excellent service all round.’ (FFT Survey 2020 Community Dermatology Service)

(FFT Survey 2020 Community Nursing Service)

Our customers said we support them to manage their health:

‘The whole experience was so beneficial to me. I was informed with pictures and explanations about my condition and I now have a better understanding of how better to look after myself. The exercise routine has not only made me a bit fitter and has taught me how to breath properly but I had other issues like sciatica which I now do not feel. I would recommend this course to anyone if it is offered.’ (FFT Survey 2020 Pulmonary Rehabilitation Service )

well-led Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

Well-led

Well-led Services?

In well-led services the leadership, management and governance of the organisation make sure it is providing highquality care that is based around your individual needs, that it encourages learning and innovation, and that it promotes an open and fair culture.

Vision and Values As an organisation we have a strong Vision and Values which were developed in collaboration between Executives, Non-Executives, Governors and colleagues. Our colleagues are aware of and promote the Vision and Values which are now part of our culture. In 2020 we updated our Vision and Values and in 2021 we have put in place a range of colleague engagement sessions where these can be shared widely.

Strong and effective governance structure We have well established quality assurance and governance structures which we are confident work and are able to assure the quality of the care we deliver.

Accessible leadership All of the Board and Governors are visible and undertake regular visits with colleagues where they can see first-hand the quality of our services. This also provides an opportunity for colleagues to engage face-to-face with the senior leaders which develops mutual respect, confidence and trust.

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

Wellbeing of our colleagues We have excellent programmes in place to promote wellbeing of all our colleagues which helps with morale and enables us to ensure our colleagues are well cared for so they can care well for our customers. During 2020/21, we ensured colleagues were able to access help and support with their mental health during the pandemic and we surveyed our colleagues on how we could best support them during a very stressful period in the history of the NHS.

In 2020/21 we promoted: 1 to 1 support Group support Local colleague support line including employee assistance programme Quiet reflection room Access to information about caring for mental health and wellbeing Access to mental health services Individual risk assessments to support safe working during the COVID-19 pandemic

12%

Disagree

13% Neutral

I feel Provide has cared about my wellbeing at this time and given useful and practical support

75% Agree

Q U A L I T Y

91%

of Provide colleagues felt well informed through communications issues by Provide.

Colleague engagement is a top priority

A C C O U N T S

2 0 2 0 - 2 0 2 1

Our colleagues said about working at Provide:

‘Starting a new job in lock down has not been as challenging as imagined. I have learnt a lot and been supported each day.’ (Staff survey 2020)

Provide is committed to ensuring colleagues are confident, competent and well supported so that they are able to keep well, enjoy the work they do and deliver a great service to our customers. The 2020/21 staff survey demonstrated that perception of leadership across the organisation was positive and colleagues reported they felt well connected to and well supported by their team and their manager.

Our colleagues said about working at Provide:

‘I have been equally surprised, delighted and grateful at how well colleagues have adapted and responded to the situation and the expectations which have been placed upon them. It has made me feel very proud to be an employee and member of Provide.’ (Staff survey 2020/21)

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

10%

Disagree

Neutral

I feel connected to and well supported by my team at this time.

82% Agree

12%

Disagree

Neutral

I feel connected to and well supported by my manager at this time.

81% Agree

Disagree

Neutral

91% Agree

I feel well informed through the communications issued by Provide.

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

Others areas where we demonstrate we are well-led We have low sickness levels. We have good staff retention levels. We have good financial and resource management. We support the community through charitable giving. We support colleagues to achieve their goals. We have awards to recognise outstanding colleagues and services. We have benefits and wellbeing initiatives to support colleagues. We have a wide range of HR polices to support the wellbeing of colleagues and their rights at work. The Board shares information with colleagues and the Executive team share key information in the monthly Team Brief and communications bulletins. Staff Bulletins are regularly published to keep colleagues up-to-date. Our Board and senior managers, and increasingly our colleagues, work closely with our commissioners and all health and social care partners in Mid and South Essex and across our wider delivery localities to promote and forge integrated pathways of care and seamless service handovers to keep people in our care safe and ensure effective continuity of care.

Our colleagues feel Provide is a great place to work because:

‘Good communication of where the business is as a whole, updates and reassurance of service/job stability. Being ‘kept in the picture’. The speed at which decisions were made to make changes to the working environment (from an office-based perspective) and support from the IT Team to ensure it was an efficient move to homeworking.’ (Staff survey 2020/21)

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

Our colleagues feel Provide is a great place to work because:

‘A genuine appreciation from higher management. A sense that everyone is ‘in it together.’ (Staff survey 2020/21)

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

FOUR

PART

statements 68

Q U A L I T Y

A C C O U N T S

2 0 2 0 - 2 0 2 1

If you need this document in:

braille

large print

audio

another language

Please contact our Customer Service Team:

0300 303 9952 provide.customerservices@nhs.net

provide.org.uk PBR-4268-2126-01