Quality Accounts 2022-23 by Provide Community

‘...it has been heart-warming to see the care and compassion our staff have for the people who use our services and for their colleagues.’

Quality Account this is our

2022-2023

provide.org.uk

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Contents PART ONE: Introduction

What is a Quality Account?

How to give your feedback on this Quality Account

Statement from our Group Chief Executive

About Provide Community

Our Vision, Mission and Values

Our Quality Assurance Process

Statement from our Board

PART TWO: Our Priorities

How the Care Quality Commission (CQC) Rates Us

Reporting Against Quality Account Mandatory Core Indicators 12 Mandatory Quality Account Indicators Relevant to our Organisation

Accuracy of our Data

Participation in National Clinical Audit

Taking Part in Clinical Research and Evaluations

Looking Back: Our Priorities for 2022 - What We Achieved

Looking Forward: Our Priorities for 2023

PART THREE: Review of Quality Performance

Statement from our Chief Executive for Health

Safe

Effective

Caring and Responsive

Well-Led

PART FOUR: Statements

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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. This Quality Account aims to provide you with information about the quality of the services we deliver across our NHS health services and our plans to improve further with the needs of services 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 post or email.

we are keen to hear from you...

How to give your feedback on this Quality Account

We are keen to hear from you if you have any views and suggestions on our Quality Priorities for the year ahead 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

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Statement from our Chief Executive I am delighted to present our Quality Account once again to you. Over the past year I have spent a lot of time visiting our services to speak to our staff and service users and it has been heart-warming to see the care and compassion our staff have for the people who use our services and for their colleagues. It is so important that, as people, we do care for each other, particularly as we experience tough economic times and the legacy of the pandemic in our nation and local communities. I am enormously proud of our staff and this Quality Account demonstrates just how much they have achieved over the past year and the level of quality they have achieved in very difficult times. The information included in this Account does also reflect some of the challenges we have faced, particularly with long waiting times in some of our services. During 2022 we have made some steady progress with reducing waiting times in some areas so this will remain a key area of focus for us in the year ahead. In the year ahead we will also focus on the delivery of all the quality priorities we have set out in this Quality Account and you will see that our priorities are to not only improve the quality of our services but through the use of targeted apprenticeships, we aim to provide more social value by offering apprenticeships to school leavers and young people leaving care. We will also be supporting some of our colleagues to get involved in their communities by volunteering. I look forward to the year ahead. I hope you enjoy reading this Quality Account and if you have any feedback to give us, we would be pleased to hear from you.

D Mark Heasman Group Chief Executive

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About Provide Community Established in 2011, Provide Community is a social enterprise group working within NHS and community care settings, and delivers social care support at home. Provide Community also owns Provide Digital and Provide Wellbeing. The organisation is predominantly based across the East of England and Essex, but it does run services across the country. Provide Community operates as a Community Interest Company (CIC), dedicated to reinvesting its profits back into the communities it serves. With a vision to transform lives through care, innovation, and compassion, the company has a growing portfolio of businesses committed to offering continuing improvement, accessibility, and quality of services with a vision to transform lives through care, creativity, and compassion. An example is Provide Digital, creating intelligent digital solutions for better health experiences. As an employee-owned enterprise, Provide Community’s workforce of over 1200 colleagues is represented by a Chair of Governors and is responsible for making key business decisions. These decisions include the workforce nominating local causes to benefit from funding and donation initiatives. To date, the company has donated over £3.5 million to charities, education and community organisations. Provide Community is also one of three organisations that make up Mid and South Essex Community Collaborative (MSECC), which has been nationally recognised as a regional exemplar for its sharing of best practice, collaboration and innovation to improve the quality and efficiency of health and social care services.

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Transforming OUR VISION

lives

Our Vision, Mission and Values 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.

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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. OUR VALUES

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Our Quality Assurance Process

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Our Board works in partnership with colleagues across the organisation to ensure the services we deliver achieve the standards of quality and safety required. The Board has set in place systems and processes including safe premises, safe systems of work, guidance, training, equipment, and leadership to enable colleagues to work safely and effectively. The Board receives regular assurance reports to inform them how the organisation is performing with regards to quality and safety including information on incidents, risks, infection prevention, safeguarding and customer engagement and feedback. Where needed the Board takes action to address any issues affecting quality and safety. The Board promotes a ‘Just Culture’ which supports a culture of fairness, openness and learning where colleagues can feel confident to speak up when things go wrong, rather than fearing blame. The Board has also set in place systems that enable colleagues to speak up (whistle-blow) if they are concerned about quality or safety in the organisation. The Board ensures that we respond to incidents and complaints promptly with openness and honesty so that we can learn from them and ensure the people affected are supported and receive an apology and explanation when things go wrong.

Our Board is highly engaged, visible and approachable and enjoys meeting colleagues and service users first hand when they undertake their regular visits to service areas. 08

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Statement from our Board This Quality Account is a wonderful opportunity to look back on the past year to see what the

challenges improve quality have been and what we have done to

across our services.

It is astonishing how much can be achieved in 12 short months and, once more, the Board would like to thank all our colleagues who work tirelessly and with such enthusiasm to deliver expert care and support to the people using our services and for striving always to improve upon what they do. Our corporate services have also been instrumental in helping to drive improvements, ensuring the right equipment, environments and technology are available at the point of care. The Board has always been committed to ensuring that quality and safety is the core foundation stone that our Organisation stands upon and we can see, from the information provided within this Account, that our foundation continues to stand firm. Under the Health Act 2009 and the National Health Service (Quality Accounts) Regulations 2010 to prepare Quality Accounts for each financial year, our Board is required to ensure that the content of our Quality Account is accurate and presents a balanced picture of the organisation’s performance over the period covered and that the information reported is reliable and accurate and has been prepared in accordance with Department of Health guidance. On behalf of the Board, I can confirm our Quality Account meets the required standards.

Robert Parkinson Group Chair

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TWO

PART

our priorities 10

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How the CQC Rates Us

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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.

Quality Indicators PROVIDE 2021

PROVIDE 2022

Staff Friends & Family Test % of recommending Provide as a provider of care to their family/friends.

95%

VTE (Venous Thromboembolism) Risk Assessment Community Hospital % people risk assessment completed

99%

85%

Clostridium Difficile rate per 100,000 bed days (Provide Community Hospital ward)

Incidents resulting in severe harm

Incidents resulting in death

QUALITY INDICATOR

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Accuracy of Data ACCURACY OF DATA CORE INDICATOR

PURPOSE

Percentage of NHS patent records held which includes 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.

Number contacts 422,211 Missing GP Code 11 (l> 0.003%) Missing NHS Number 85 (0.02%)

NHS Data Security and Protection Toolkit (DSPT)

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

Provide Rating ‘Standards Exceeded’

PROVIDE

Participation in National Clinical Audits Participation in national audits enables us to measure the quality of the services we provide against other organisations delivering NHS care. In this way we can identify areas where we can improve our services.

NATIONAL AUDITS

PROVIDER O R GA N I SAT I O N

SSNAP - Sentinel Stroke National Audit Program

Kings College London

PASCOM Audit for Podiatric surgery

Royal College of Podiatry

National Diabetic Foot Care Audit

NHS Digital

LeDeR - Learning from lives and deaths of people with a Learning Disability and Autistic People

NHS England

CONTRIBUTED TO IN 2022

TO CONTRIBUTE TO IN 2023

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Taking Part in Clinical Research and Evaluations Clinical research and evaluation of clinical care is a central part of the NHS, as it enables the NHS to identify and offer new treatments that improve people’s health. Provide Group promotes participation in research. In 2022 we supported the following research projects: RESEARCH AND EVALUATIONS IN 2022

RESEARCH / EVALUATION LEAD

BECOME study Behavioural Weight Management: COMponents of Effectiveness

Real World Services

UPLIFT Trial UpLifting the occupational wellbeing of NHS staff: A Randomised Controlled Trial. An innovative digital approach to combating stress and burnout in the workplace

NIHR/DASH centre

UrgoStart Treatment Range Evaluation Protocol UrgoStart in the management of Diabetic Foot Ulcers

Urgo and Provide

Chronic Leg Ulcer Pilot Study Identification of ‘subclinical’ infection in the deep tissues in Chronic Leg Ulcers – a prospective study

Mid and South Essex, East Suffolk and North Essex NHS Foundation Trusts

MBA Study A review of how stewardship can be used to deliver NHS service redesign - short survey

Provide/University of Huddersfield

MSc Study Podiatric Surgery Formative Assessment Research - Direct repair of the plantar plate: a retrospective case series

Kings College London

PhD Acuity and Dependency Study To identify practice areas utilising acuity and dependency assessment within district nursing settings

University of Hertfordshire

ProfD Stroke professionals’ views and experiences of supporting Young Stroke Survivors (YSS) who have dependent children.

University of East London

OTHER WAYS WE PROMOTED RESEARCH DURING 2022 We offered National Institute for Health and Care Research (NIHR) Good Clinical Practice (GCP) eLearning as well as face-to-face training. We promoted and encouraged colleagues to get involved with current research studies at Provide and sign-posted them to free online research webinars, events and podcasts. We highlighted Provide employees research publications in peer reviewed journals and promoted the call for abstracts and posters at R&D events.

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Looking Back: Our Priorities for 2022 - What We Achieved In our previous Quaity Account, we set out our quality priorities for 2022. In this section we provide an update on what we did to achieve these priorities. Our aim for 2022 was to ensure the continued delivery of high-quality care across the Provide Group and to contribute to improvement of health and social care services within the health and care systems we work across. We also wanted to prioritise our people to ensure we set in place the systems, culture, training and engagement needed for outstanding service delivery.

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PRIORITY 1:

Establish new roles within the Quality and Safety team to provide enhanced service functionality across the Provide Group, including implementing the NHS Patient Safety Specialist function within the Organisation. WHAT WE ACHIEVED: We established the role of a “People Safety Specialist” within the organisation – we do not use the word patient as our services are delivered to people in many care settings and not just in healthcare inpatient wards. We have become core members of the Integrated Care System Patient Safety Network . We have successfully grown our Quality and Safety Team to provide more capacity to support the oversight and assurance of quality and safety with the recruitment of a new senior Quality and Safety Manager and a new Head of Safeguarding and Deputy Director of Nursing. We have also piloted a new AHP (Allied Health Professional) professional lead role.

PRIORITY 2:

Implement the new Mid and South Essex Community Collaborative Engagement Strategy by putting the agreed principles into practice. WHAT WE ACHIEVED: Provide Community, Essex Partnership University Foundation Trust and North East London Foundation Trust have continued to work collaboratively and have established a system of support for colleagues working on join projects across our community to enable them to consider how and when they can engage with people who use their services as they work to redesign or improve their services.

PRIORITY 3:

Implement the Datix Cloud Incident Reporting System. This system will enable incident reporting to be more accessible to colleagues in the Provide Group WHAT WE ACHIEVED: A lot of work has been undertaken during 2022 to prepare for the implementation of our new incident reporting management system. This new system has now gone live and will enable colleagues across the Provide Group to access the system and report an incident at the time it happens. It will also improve recording and oversight of risks and complaints across the group, thereby strengthening oversight of quality across the organsiation.

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PRIORITY 4:

Evaluate the governance structure across the Provide Group to is strengthen what we do. WHAT WE ACHIEVED: Our Board committees completed a self -assessment to consider where their strengths and weaknesses were in relation to maintaining oversight of quality and safety. They have used this exercise to improve.

PRIORITY 5:

Continue to grow and develop community virtual wards in line with national guidance. WHAT WE ACHIEVED: Our virtual frailty ward and virtual respiratory ward are now well established and our new heart failure virtual ward is now becoming established with positive feedback from the people using the service.

PRIORITY 6:

Implement and evaluate the impact of new technologies implemented in our service including in our community nursing service. WHAT WE ACHIEVED: In 2022 we rolled out the use of a head-worn camera head sets so that staff working alone can undertake video calls to expert colleagues so that they can get advice and direction when undertaking complex clinical care. Our Podiatry service have embraced the use of this new technology and, as a result of being able to get remote support at the time they need it they have avoided having to move or rearrange appointments. You can read more about this on page 19.

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Other ways we improved quality across the Provide Group in 2022 In response to winter pressures in the acute hospitals, we opened a 20 bedded community hospital ward at Halstead Hospital to provide ongoing care, treatment and rehabilitation for people following an acute hospital admission. We ensured all the colleagues working in this new ward had the appropriate training and equipment to provide a quality service to the people in their care. We have developed a new app to enable service users to report quality of life outcome measures in wound care. In our community nursing service, we have undertaken a joint project with colleagues in Essex Partnerships University Foundation Trust and North East London Foundation Trust to improve the way we care for people with urinary catheters in Mid and South Essex. In our Parkinson service we have provided additional training for colleagues and have offered more appointments in places that patients want to be seen, we have also added a prescriber to the team. In this way, care can be more timely and waiting times have been reduced. In our Child Health Information Service (CHIS) we developed a new clinical lead role. Although this is a data handling service, the introduction of a clinician provides access to expert clinical advice and education as well as supporting service development.By working with a wide range of key internal and external stakeholder organisations, including maternity departments, screening facilitators, GPs, practice nurses, practice managers and immunisation providers, the clinician aims to increase the uptake of immunisation and screening across our population. Our Musculoskeletal Physiotherapy service developed a model of service to enable people to be assessed and treated remotely in their own homes rather than having to attend a clinic. This model has been recognised as a good practice example and has been included in new national guidance on remote consultations in adult musculoskeletal (MSK) physiotherapy services that has been developed by NHS England as part of the BestMSK Health Collaborative Programme. We created a Provide Physiotherapy social media accounts, includingTwitter, Facebook and Instagram accounts. This has enabled us to link with people in our communities and enables us to share health promotion, informationbased infographics, service updates and sign-posting to our website, as well as to local community and local authority health and exercise schemes. Examples of some of the areas we cover are stress management, sleep management, alcohol support, smoking cessation, physical activity recommendations, Essex Wellbeing Service, Health in Mind services and virtual exercise classes. We have rolled out new physiotherapy software which allows emailing or texting of exercise programmes to people using the service and they can track their progress as they have the ability to enter on the app when they have completed the exercises, levels of pain they experienced and difficulty which can help to guide further physiotherapy management.

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Technology and Innovation

Camera Headsets We implemented the use of assisted reality headsets as a device to enhance real-time communication between individuals in clinical teams to support decision making by rapidly linking clinicians to specialists and senior clinical colleagues in teams and exploring additional cases for their use in community healthcare. Our Podiatry team have been early adopters of this technology. They used the headset devices to support junior or newly qualified colleagues to work independently without needing to have a senior colleague in the clinic room with them full-time. This stopped clinics being cancelled when a senior clinician was unavailable and gave junior clinicians confidence and safety when practicing alone. In addition, they used the technology to support the wider team to manage more complex wounds as they could access advice from colleagues so the right treatment could be implemented at the time of the appointment instead of referring the service user to see a more expert clinician at their next appointment. The technology enabled one highly skilled clinician to support multiple colleagues in multiple locations, making expert advice and guidance more accessible for the benefit of both colleagues and service users. Service users have also embraced the use of the technology during their care session and it enabled them to hear and speak to the remote expert as well.

The following positive outcomes have been reported as a direct result of using this technology in our Podiatry service. There have been no cancelled or re-arranged clinics. 484.5 hours’ worth of appointments would have had to have been moved or rearranged had the headsets not been available. Of those hours, approximately 45 hours’ worth of clinics would have had to have been cancelled due to staff sickness and no-one being available to support. 29 out of 36 care plans were changed because of getting expert advice and guidance from a more experienced colleague. 81% of staff in the service feeling supported and confident to treat all types of foot ulceration (An increase of 15.2% over baseline (pre-headset roll-out)).

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Looking Forward: Our Priorities for 2023 Our priorities for the year ahead are designed to ensure continued delivery of highquality care across the Provide Group and to contribute to improvement of health and social care services within the health and care systems where 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 focus on maintaining and improving:

OUR PRIORITIES FOR 2023:

1 We will implement the new NHS Patient Safety Incident Response Framework (PSIRF) providing a new approach to prevent and manage safety incidents arising from care delivery.

2 We will implement the new NHS Infection Prevention Training Framework

3 We will review our policy management processes across the Provide Group

4 We will focus on retention of our staff by

ensuring access to wellbeing resources and getting our structures right to support progression and talent management.

Patient safety Patient experience and customer engagement

5 We will support young people to choose a

career in health or social care by extending our school apprenticeship programme and we will provide apprenticeship opportunities specifically for young people leaving care.

Clinical effectiveness

6 We will review our customer feedback

processes across the Provide Group to build on our existing processes for gaining feedback from people who use our services to improve the quality of our services.

7 We will undertake volunteering activities to

benefit our communities. In this way we aim to improve the health and wellbeing of our local communities.

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review of quality performance 21

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This section provides a review of our quality performance in 2022 set against the quality standards of being safe, effective, caring, responsive and well-led. The information included demonstrates some of the ways we measure how well we are doing and enables us to explain where relevant, the action we are taking to improve our performance.

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Statement from our Chief Executive for Health

This Quality Account reflects the work that has gone into improving quality and safety over the past year. We are pleased that in this Quality Account we can demonstrate that we not only achieved all the quality priorities we set ourselves but that we did much more than that.

The quality priorities we set ourselves in our Quality Account each year are designed to ensure we not only maintain high standards of quality and safety but improve upon them. Therefore, alongside our priorities for improvement, we work always to achieve a level of quality and safety that the Care Quality Commission (CQC) would rate as ’good‘ or ’outstanding’. The reason we want to achieve this is not just because it is what our regulator requires, but because we believe safety and quality is central to everything we do. As you will see in this Quality Account, we have maintained a rating of outstanding in our Health Services during 2022. Our quality data included in this Account demonstrates that we are a safe and effective organisation, but we have found managing waiting times in some of our services to be a particular challenge, as has been the case for all providers of NHS care nationally during the past year. Waiting times have regrettably become longer as a legacy of the pandemic and because demand for NHS care has increased. Throughout 2022, we undertook a lot of work to improve our waiting times and we made some good progress towards reducing them in some of our services. However, it remains a challenge for our teams and they will continue to focus on this in the year ahead. Everyone that works at Provide Community contributes to the culture of safety that we nurture and promote, and we would like to thank our colleagues for the enormous contribution they have made to improving quality and for the care they give to people. We look forward to the busy year ahead strengthening and building on what we have already achieved.

Stephanie Dawe Chief Executive for Health

safe

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Safe

Are services safe?

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

Incident reporting We have an open and transparent reporting culture which encourages colleagues to identify and report incidents or near misses. All reported incidents or near misses are investigated and action is taken where needed to improve safety. During 2022, our colleagues continued to demonstrate a good reporting culture with the level of incidents reported increasing as the organisation has expanded and we have provided more services to more people. Of all the incidents reported the majority resulted in no harm or minor harm. During 2022, we reported three serious incidents which resulted in low harm. We reported two other serious incidents where the harm level is currently being determined as the investigations are not yet complete.

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No harm/ damage

Provide Source Incidents by Level of Harm: Health Directorate Minor harm/ damage

Moderate harm/damage

As a safety conscious organisation, if an incident occurs that involves care delivered by another organisation, we report it on our incident management system if it had the potential to impact on patient safety or did impact on patient safety. By doing this we can share the information with the other organisation to alert them to the incident and this enables them to take steps to review and improve their systems and processes. An example of the type of incident we would report would be a medication incident that occurs when someone is discharged home from hospital without the information needed to enable us to administer, the medication safely. By working together with our hospital colleagues and other organisations we can collectively improve safety across the health and social care system. Our ’all incidents‘ data combines the number of incidents reported as Provide incidents as well as those reported as other organisations.

All Incidents Reported FYTD: Health Directorate 300 250 200 150 100 50 0

Apr May Jun Jul Aug Sep 2022 2022 2022 2022 2022 2022 Data

Mean

UCL

Oct Nov Dec Jan Feb 2022 2022 2022 2023 2023 LCL

Mar 2023

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Falls In our community hospital inpatient wards and our virtual wards where we support people to recover from illness in their own homes, we work to minimise the risk of falls by undertaking falls risk assessments and setting in place care plans to help reduce the risk of falls. People who use our services can be frail and prone to falling. In 2022, we increased the number of beds in our virtual ward, and we opened an inpatient ward. When we increased our bed base we looked after more frail people so the number of falls we reported went up. All the falls reported were recorded as no harm or low harm events. PROVIDE 2021

PROVIDE 2022

NHS BENCHMARKING

4.2%

5.45%

6.1%

Falls /1000 bed days

All Incidents Reported FYTD: Health Directorate 20 18 16 14 12 10 8 6 4 2 0

Virtual Frailty Ward increased bed numbers

Apr 2022

May 2022

Jun 2022

Jul 2022

All patient Falls Reported FYTD

Aug 2022

Sep 2022

Oct 2022

Mean

Nov 2022

Dec 2022

Jan 2023

Feb 2023

Mar 2023

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Pressure Ulcers Of all the incidents we report every year, pressure ulcers are the most common incident we report as we mandate the reporting of pressure ulcers. Many of the people we care for are frail with a higher potential risk of developing them. 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 for long periods of time. People who are frail, elderly or very ill are more prone to them. Where people are at risk of developing pressure ulcers, we put in place preventative measures to reduce the risk and to promote healing where they have developed. Most of the pressure ulcers we report result in low harm. Where we identify a pressure ulcer has resulted in moderate or severe harm, we review each case at our harm free care meeting to identify how we can improve practice and care to reduce the likelihood of harm occurring.

Provide Source Pressure Ulcers Reported FYTD: Health Directorate 25 20 15 10 5 0 Apr 2022

May 2022

Category 1

Jun 2022

Jul 2022

Aug 2022

Category 2

Sep 2022

Oct 2022

Category 3

Unstageable-depth unknown - slough Deep tissue injury = Purple or Maroon / Bloodfilled Blister

Nov 2022

Dec 2022

Jan 2023

Category 4

Feb 2023

Mar 2023

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Medication Safety We report and investigate all medication safety incidents. The incidents reported may be because of an issue with the supply, timing, administration, prescription, or storage of medicines. The number of incidents reported are low and the majority result in no harm or minor harm only. We have had no incidents which resulted in severe harm or death. We investigated one incident as a serious incident in 2022. This incident resulted in low harm to the person affected by the incident. During December and January, we reported an increased number of medication incidents associated with people being discharged home or to a community ward following an acute hospital stay. When this is identified as an issue, our community nurses work with the acute hospital and local GPs to resolve the issues promptly, so harm is avoided. Information about these incidents was shared with the Quality team at the acute hospital so they were aware a discharge issue had occurred, and they could then work with the clinical teams to improve practices and processes. Our Medicines Management team review all reported medication incidents that occur in our organisation so that we can improve practice and safety where needed.

Medication Incidents Reported 2022 - Health Directorate Starting 01-04-22 30 25 20 15 10 5 0

Apr 2022 Mean

May 2022

Jun 2022

Jul 2022

Aug 2022

Sep 2022

Oct 2022

Medication Incident = Yes FYTD

Nov 2022

Dec 2022

Jan 2023

Feb 2023

Mar 2023

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Wound Care Delivering safe and effective wound care has remained an important area or focus for us over the past year. Following the success of working in collaboration with Essex Partnership University Foundation Trust and North East London Foundation Trust in 2021 to improve wound care across Mid and South Essex, we have continued to build on this work in 2022. This is what we have achieved: We continued to work on implementing the National Wound Care Strategy as one of the accelerator sites for early adoption and implementation. We have mandated the wound care training competencies for our colleagues and are the first area to do this nationally. We are now working on a plan to ensure our bank staff can access and complete this training alongside our substantive colleagues. We now have in place a Primary Care and Community Care wound dressings formulary that guides GP practice colleagues and community clinicians on which dressings to use so that the most effective dressings are provided to enhance wound healing and standardise practice. We have developed a new wound infection pathway adapted from the Leeds Wound Infection Pathway which supports decision making when a wound at risk is identified. We have continued our rotation of community nurses assigned to work with the Tissue Viability Service for six months, to give them additional specialist knowledge and skills which they can take back to their teams and use to support the management of complex wounds on their caseloads. We continue to support our teams with weekly multidisciplinary meetings that include the community nurses and the Tissue Viability team to review complex cases or non healing wounds. This has been extended to include podiatrists to provide expertise for complex foot wounds. Work has been undertaken to develop a patient reported quality of life outcome measure for wound care so that the people we care for can identify if the care we give has improved their wellbeing and quality of life. This work aims to provide an App for people to record this information so that we can evaluate the impact our service is having on people. In this way we can continue to improve on what we do in a way that benefits people.

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Infection Prevention and Control The Infection Prevention and Control (IPC) Team provides specialist advice and support to the organisation and works closely with our Director for Infection Prevention and Control and our Consultant Microbiologist to ensure the right systems and processes are in place to prevent and control infections in line with national standards, guidance, and legislation.

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IPC Link Practitioners To put infection prevention and control at the centre of our services we have established a highly engaged link practitioner forum.

Each service has a named person within their service who has a passion for infection prevention, and they meet regularly with fellow link practitioners and the Infection Prevention Team to give updates on national and local developments in practice and to undertake education sessions. This year’s forum topics included training for use of a digital audit programme, updates relating to COVID-19, PowerPoint presentations on specific organisms and infection prevention topics such as decontamination. Forum activities aim to encourage participation of the link practitioners using workshops and other interactive resources and members are highly engaged and enjoy attending as we have seen attendance increasing significantly throughout the year. In the winter of 2022 to support acute hospitals to free up beds, Provide opened a community hospital ward to provide an appropriate care setting to support people to receive ongoing clinical care and rehabilitation

following admission to an acute hospital. To support the safe and effective management of care on the new ward, all staff received mandatory infection prevention training as part of a classroom-based induction training programme. The Infection Prevention Team followed this up with direct supervision and support on the ward to ensure staff were familiar with good infection prevention practice including the use of Personal Protective Equipment (PPE), decontamination and cleaning and patient placement and management pathways. Throughout 2022, our Infection Prevention Team worked closely with Mid and South Essex Integrated Care System infection prevention colleagues and Essex Partnerships University Foundation Trust and North East London Foundation Trust to standardise patient pathways and respond to changes in guidance and practice so that the system approach was joined up and effective.

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Infection Prevention Incidents During 2022, no serious infection prevention incidents occurred. The Infection Prevention Team continued to monitor all incidents of COVID-19 experienced by service users or colleagues, ensuring all COVID-19 guidance for testing and isolation were followed. Once the Government’s COVID-19 guidelines changed and mask wearing was no longer required, we used a risk-based approach to respond to rising numbers of COVID-19 infections being reported in the local community When the risk increased, we introduced universal mask wearing in our clinical services. Universal mask wearing means wearing a mask at all times to provide protection to colleagues and service users. Additionally in 2022, a worldwide increase in a previously little-known virus, Monkeypox Virus (MPV), was reported in England. National guidance was introduced for local management and our sexual health services worked closely with our commissioners and the Infection Prevention Team to develop safe areas for the assessment of people with suspected MPV and to support the national response to ensure timely access to testing was available. Throughout the year, a key role of our Infection Prevention Team is to monitor for infections of concern. These are caused by organisms that are particularly harmful as there is high potential for them to cause serious illness or death. If an infection arising from an organism of concern is reported, the Infection Prevention Team undertake a review to identify if any improvements to practice are needed to prevent further cases and to learn from the event. During 2022, there were no infections of concern reported in our community hospital wards and no infections of concern in a community setting where there was any direct learning for Provide.

CO M M U N I T Y H OS P I TA L WA R D INFECTION SURVEILLANCE ORGANISM OF CONCERN

2021

2022

MRSA (Methicillin Resistant Staphylococcus Aureus) Bacteraemia

MSSA Bacteraemia

Clostridium difficile

Escherichia coli bacteraemia

IGAS

Q U A L I T Y

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Safeguarding Provide fully encourages and endorses that safeguarding is ‘everybody’s business’. When we are concerned that someone in our care is being abused, we report this to the Local Authority who has the statutory obligation to investigate and take steps to protect people from abuse. In 2022, we made 198 referrals to the Local Authority and 11 referrals were made to the Local Authority against Provide. Of the 11 allegations of abuse raised against Provide, 2 were substantiated and 9 were not substantiated. As a learning organisation, we have responded by taking action to improve practice. These actions include providing staff with feedback and providing additional training on pressure ulcer grading and wound management record keeping. SAFEGUARDING REFERRALS MADE TO THE LOCAL AUTHORITY

No. referrals made by Provide against other providers

No. referrals raised by other providers against Provide

Liberty Protection Safeguards Preparations for the implementation of the new Liberty Protection Safeguards identified in the Mental Capacity Act (Amendment 2019) to replace the Deprivation of Liberty Safeguards has continued during 2022, working with colleagues in the Integrated Care System. Work has centred on plans for staff training and the development of the new systems and processes that will be required to support practice.

Oliver McGowan Learning Disabilities and Autism Training Throughout 2022, the safeguarding team has been working with Integrated Care System colleagues to prepare for the implementation of the Oliver McGowan Learning Disabilities and Autism training that is now a mandatory requirement for all health and social care colleagues to complete. While we waited for this training to become available, we rolled out Learning Disabilities Awareness update training to colleagues who have not had the training recently. Now the E-learning is available for the Oliver McGowan Training, we will roll this out in 2023.

effective Q U A L I T Y

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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 Practice

Competent staff are a core requirement for a safe and effective service. We therefore mandate a wide range of training appropriate to the role people have in the organisation and we monitor compliance with training and training updates. The information in this section covers all colleagues within Provide not just our health services. Mandatory Training Provided

Basic Life Support & Anaphylaxis

Moving & Handling

Infection Prevention

Fire Safety

Information Governance

Dementia Awareness

Wound Care

Conflict Resolution

Equality & Diversity

Safeguarding

M A N DATO RY T R A I N I N G CO M P L I A N C E

Provide Community

93%

94%

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In addition, we support colleagues to undertake wider training opportunities to help them develop more expertise in their role and to support their personal development. We like to see our colleagues grow and thrive in their role and we hope that many will go on to work in more senior roles in our organisation.

Examples of Training & Development Provided to Individual Staff

Clinical Supervision

Professional Nurse Advocates

Aspiring Managers Programme

Law at the End of Life

Falls Prevention in Safeguarding Level 4 Older People

Safer Recruitment

Dementia Awareness

Falls Assessment & Raizer Chair

Nurse Verification of Expected Death

Palliative & End of Life Care

Clinical Audit Transcribing

Restraint Reduction

Mary Seacole Programme

Oxygen

Non-Medical Prescribing

Specialist IT Accreditations

Wound Care

Health Coaching

First Aid

Minute Taking Skills

District Nursing PGDIP

Advanced Clinical Practice MSc

Clinical Assessment Skills

Enhanced Admin Skills

Diabetes

Chronic Obstructive Pulmonary Disease (COPD)

Joint Injection & Ultrasound

GOSH Children’s Training

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Professional Training & Apprenticeships We love to support people to learn and to obtain formal qualifications. We provide clinical placements and mentoring for university students undertaking nursing, Allied Health Professional or non-clinical training. We also support a wide range of apprenticeships. During 2022, Provide supported 36 colleagues to undertake an apprenticeship in a variety of clinical and non-clinical programmes, 10 have successfully completed their programme with the remainder continuing with their studies. Apprenticeship programmes range across 12, 18 and 24 months depending upon subject and level. Provide employed the first external clinical apprentice in Podiatry. They are being supported by the Podiatry Team and gaining expert teaching from the specialists. This is a 4-year programme to registration. There has been an increase in Allied Health Professions apprenticeships being validated and made available. Provide has commenced colleagues in Occupational Therapy, Speech and Language Therapy and Physiotherapy.

Library To support our colleagues in their training and development we have provided access to the medical libraries at Mid and South Essex Foundation Trust. These specialist libraries provide a quiet space full of books, magazines and digital resources available for our colleagues to access and utilise fully. They can also attend bitesize training sessions including audit and research training, literature review training and study skills. The librarians can support colleagues with learning needs on a one-to-one basis as required. Information about the library services is communicated at corporate induction for all new starters and a dedicated Provide Community Platform (intranet) page has been developed with specific links to all library resources.

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Provide Community’s First Get into Healthcare Programme In 2022, Provide Community partnered with the Prince’s Trust to run a ‘Get into Healthcare’ programme. This six-week training programme aims to give young people, who are not in full-time employment or education, an opportunity to gain free life training, skills and practical work experience that may open a future career path and to explore the breadth of opportunities available for working in health and social care. The Prince’s Trust training included CV writing, interview skills and confidence building. Provide Community delivered practical skills training including basic life support and moving and handling people training, alongside training in information governance and safeguarding. In addition, every applicant completed several weeks of work experience in their chosen service. We had three outstanding trainees who completed the programme successfully and we are pleased that one has gone on to have a permanent job with us in our Learning Disabilities care service. One has used the training and skills gained to apply to join the armed forces and undertake a Uniformed Protective Services BTEC Diploma qualification and the third trainee has signed up to our ‘Get Into Provide’ programme where they can access further skills development training.

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Compliance Audits and Clinical Audit Compliance and clinical audits enable the effectiveness or quality of service delivery to be evaluated or the adherence to standards and procedures to be monitored. Where there are shortfalls in performance, actions can identified to improve the quality of care or patient outcomes; achieve assurance of compliance with clinical standards and identify and minimise risk, waste, and inefficiencies.

Examples of Compliance Audits and Clinical Audits Completed in 2022

Minor Operations Test Results

National Early Warning Score (NEWS2)

Physiotherapy Back to Activity Audit

Antimicrobial Prescribing

IGAS Action Plan Review Audit Safety Alerts & NICE Guidance Dissemination & Response

Children & Young People

Record Keeping

Environmental Cleaning

End of Life Preferred Place of Care Adults and Children

VTE Prophylaxis Audit

Infection Prevention

PICC Lines Audit

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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 we keep. As such a robust Information Governance Framework is in place with accountability provided by our Senior Information Risk Officer (SIRO), working closely with our Head of Information Governance/Data Protection Officer (DPO), Caldicott Guardian and Director of IT Services. We recognise the ever-changing threats to information and information systems, so we regularly carry out effective monitoring and reviews of our systems, policies and procedures, making any necessary changes and updates as required. Most of our key IG policies and procedures were reviewed and updated during 2022 either because of scheduled review or in response to an IG incident or changes in processes.

Data Protection Toolkit

Standards Exceeded 2022 Rating

Data Security and Protection Toolkit We undertake an annual self-assessment of our compliance against using the Data Security and Protection Toolkit which assesses our performance against the National Data Guardian’s ten data security standards. The last submission of the Information Governance Toolkit took place in June 2022, and we achieved a scoring of ‘Standards Exceeded’. We are on track to achieve the same standard in the June 2023 submission.

Cyber Essentials Plus

Accreditation Maintained 2022

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 breaches. Provide have held this certification for several years and have again maintained this certification in 2022 for Provide CIC, Provide Wellbeing Ltd and Calvern Care.

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ISO27001

Accreditation Maintained 2022

ISO27001 is the internationally recognised specification for an Information Security Management System (ISMS) and helps to reduce information security and data protection risks through several standards, audits and continual improvement. A management review of the ISMS was carried out in 2022 in addition to an internal and external audit. Findings and recommendations from the internal audit helped inform and improve the effectiveness of controls and the ISMS as a whole. The external audit achieved a pass and with no non-conformities identified and no rectification actions required.

Vendor Security Management During 2022, we reviewed and improved our process for carrying out due diligence checks prior to appointing suppliers and service providers. As part of the due diligence carried out, we check for any relevant certifications or accreditations held by the supplier that demonstrate appropriate levels of IG and information security practices and assurance, for example ISO27001:2013 and Cyber Essentials Plus. Copies of such certificates are requested and reviewed as part of the process.

Information Governance Incidents Any errors or incidents concerning the handling, use, storage of person identifiable information is recorded, and we take action to investigate these and learn from them. All incidents are risk assessed and, where a serious incident involving personal data occurs and is likely to result in a risk to the rights and freedoms of individuals, this is reported to the Information Commissioners Office and investigated as a serious incident. In 2022, we investigated one reportable incident involving personal data. As an outcome of the investigation and lessons learnt, we reviewed and updated our internal process for the handling of requests for changes to patient contact details in SystmOne, especially where such requests have originated from an external third-party organisation. To ensure we minimise the risk of IG incidents occurring our colleagues continue to take mandatory annual Information Governance refresher training, following the mandatory IG training completed on first joining the organisation. A series of IG best practice and awareness messages were communicated to all staff during 2022 via various methods including our all colleague communications, IG Champions Network, periodic IG newsletters and computer screen displays. In 2022, in partnership with NHS Digital we carried out one simulated phishing exercise to test the ability of our colleagues to identify and manage phishing messages. As a result, we identified that we need to design and administer more sophisticated phishing simulations in order to keep up with the level of sophisticated phishing attacks being used by hackers.

caring & responsive Q U A L I T Y

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Are services caring?

In caring services colleagues involve and treat you with compassion, kindness, dignity and respect.

Are services responsive?

Responsive services are organised so that they meet your needs.

Customer Engagement and Feedback

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.

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frien fam

Friends and Family Test (FFT)

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. People also took time to feedback to us via letter, email, and phone calls. It is good to hear all the positive feedback people have given us but also it is important for people to let us know when their experience is less positive so we can take action to improve our service for others. The results of our FFT survey show 97% of people’s experience of our services is either good or very good. We also ask two additional questions in our survey to ask people to report two outcome measures of quality. The first asks whether the service user feels they were treated with dignity and respect and the second asks if they and their family are involved in their care. In both cases the results show people do feel they are treated with respect and are involved in their care.

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FFT Rating YTD

nds & mily 1200 1000 800 600 400 200 0

Apr 2022

May 2022

Very good

Jun 2022

Jul 2022

Aug 2022

Sep 2022

Good

Neither good nor poor

Oct 2022

Nov 2022

Poor

Dec 2022

Very poor

Jan 2023

Feb 2023

Mar 2023

Don’t know

Were you/your family involved with your care?

400 350 300

250

200 150 100 50 0

Apr 2022

May 2022

Yes

Jun 2022

Jul 2022

Aug 2022

Sep 2022

Oct 2022

Nov 2022

Dec 2022

Jan 2023

Feb 2023

Mar 2023

Jan 2023

Feb 2023

Mar 2023

Were you treated with Dignity and Respect

400 350 300

250

200 150 100 50 0

Apr 2022

May 2022

Yes

Jun 2022

Jul 2022

Aug 2022

Sep 2022

Oct 2022

Nov 2022

Dec 2022

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Complaints In 2022, our complaint numbers remained low, in line with previous years, and 40% of the complaints we received were classed as level 1 (low level concerns) and 60% were classed as level 2 (moderate) complaints. As in previous years we received no level 3 (severe) complaints. Number of Complaints

2019

2020

2021

2022

180

133

137

148

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.

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Timely Access to Services In relevant services 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 lot of our services to enable us to move colleagues to work in critical frontline services. In addition, once our services reopened, we experienced rising numbers of referrals. The impact of these has meant we have much longer waiting times in some of our services and particularly within our Community Paediatric Service. We regret that our service users are experiencing long waits and we are working with our commissioners and other colleagues in the Integrated Care System to consider how we can reduce these waiting times. WA I T I N G TO B E S E E N A N D T R E AT E D

APR 2022

MAR 2023

% of people seen and treated within 18 weeks

81%

78%

% of people seen within 6 weeks (for a diagnostic service)

57%

80%

Number people waiting longer than 52 weeks

202

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Well-Led Well-led Services?

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

The Board sets in place the systems and structures needed to support and improve quality and safety across the organisation. However, they recognise that working in health and social care, while rewarding, can also be stressful. The Board therefore makes provision every year to provide our colleagues with opportunities to take part in activities designed to promote their wellbeing. In 2022, we supported colleague wellbeing in the following ways:

Health and Wellbeing Week

CLICK HERE TO

BOOK

12 - 16 September 2022 Healthy thinking //

Morning

Monday September

Looking after you //

Looking after others //

Money matters

September September September September 12 Tuesday 13 Wednesday 14 Thursday 15 Friday 16

Big Team Challenge Walk

Healthy Living

Money Matters

Looking After You

Money Matters

Healthy Thinking

9.30am – 10.30am

Dealing With Debt! Tom Williams StepChange, UK Debt Charity

Mindful Meditation Tony O’Shea-Poon

11.00am – 12.00pm

All You Need to Know About Wagestream Clair Banks

Tai Chi Robyn Treen Joyful Living

Remember to have your

wellbeing conversations

Lunch

Afternoon

Healthy living //

YOUR SPACE

Back by

POPULA R

demand !

9.30am – 10.30am Women and Money Sophie Parker The Money Charity

11.00am – 12.00pm EASYPAY Made Simple Clair Banks

9.30am – 10.30am Managing Stress Positively Steve Woodford and Lyn Mowforth

11.00am – 12.00pm Mental Health Balance… Working From Home Melissa Re Joyful Living

12.00pm – 2.00pm

Juice and Smoothie Bar Halstead Hospital

Juice and Smoothie Bar Tekhnicon House

Juice and Smoothie Bar Kestrel House

Juice and Smoothie Bar Colchester HQ

Juice and Smoothie Bar Maldon Hospital

12.00pm – 2.00pm

Seated Massage Kestrel House

Seated Massage St Peter’s Hospital

Seated Massage Colchester HQ

Seated Massage Tekhnicon House

Seated Massage Braintree Community Hospital

2.00pm – 3.00pm

2.00pm – 4.00pm

2.00pm – 3.00pm

Cooking on a Bootstrap My Story Jack Monroe, Journalist and food blogger

Cooking on a Budget Anne’s Cooking School

3.30pm – 4.30pm Nutrition – Boost Your Immune System! Audra Chukukere Joyful Living

Don’t worry, if you are not based in Essex, goodies are coming your way!

How to Relieve Tension Headaches Helen Peacock

LIVE STREAM!

Financial Wellbeing Sophie Parker The Money Charity

Cooking spaces availab le!

3.30pm – 4.30pm

Keep Warm This Winter... Create Your Own Chunky Knit! Paula Clark Cocoon&me

Financial Freebies ££ Savings ££ Sharon Coldwell

Look out for

Big Team Challenge Walking prizes!

As part of Health and Wellbeing Week Provide are pleased to pledge their support to The Mental Health at Work Commitment curated by MIND.

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Health and Wellbeing Week This is a dedicated week of activities designed to promote colleague wellbeing covering a broad range of activities including: Dealing with debt Cooking on a budget Mindful meditation Managing stress Mental health balance and working from home How to relieve tension headaches MIND session on mental health at work

Mental Health First Aiders We are developing a network of colleagues willing to be trained to become Mental Health First Aiders to support colleagues with their mental health. Mental Health First Aiders are not trained to be therapists or psychiatrists, but they can offer initial support through non-judgmental listening and guidance. Our Working Well and Essex Lifestyle Service are working in partnership to embed MHFA training within our organisation and encourage colleagues to talk more freely about mental health, reducing stigma and creating a more positive culture.

Workplace Health Champions Our Workplace Champions are volunteers who help develop a range of health and wellbeing programmes throughout the year that aim to make colleagues healthier. The activities they devise include healthy eating programmes, activity classes, inter-company tournaments and pamper sessions, as well as book clubs and fun craft activities where new skills can be learnt or shared.

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Colleague Engagement Our Board engages regularly with colleagues in a variety of ways including walking round the organisation to speak to colleagues, sharing information through webinars, bulletins, and meetings with new starters at induction and within the first six months as well as at our events. An annual Colleague Engagement Survey also provides staff with the opportunity to give their feedback to the Board. Our 2022 annual Colleagues’ Engagement Survey demonstrated we have a culture of care and compassion in the organisation which is role modelled by our senior leaders. It also highlighted that our colleagues are proud to work for Provide Community and are willing to go the extra mile. Our colleagues also would recommend our organisation as a place to work and as a place for their families to receive care if they need it. COLLEAGUE SURVEY QUESTIONS 2021/22

PROVIDE RESPONSE

ETS BENCHMARK

I am proud to work for my organisation

91%

88%

In my job, I am willing to go the ‘extra mile’

97%

89%

To friends and family, I would recommend my organisation as a great place to work

82%

I would recommend my organisation to friends and family if they personally needed treatment or care

95%

My Line Manager / Supervisor is visible and approachable.

93%

87%

Senior Leaders role model our values (eg Care, Innovation and Compassion)

83%

80%

At work my Line Manager / Supervisor is quick to respond if I show signs of being under too much pressure

83%

My organisation really cares about my personal health and wellbeing.

81%

83%

In my team we work well together to help each other meet the needs of our patients / service users / customers

95%

88%

The organisation I work for puts patients / service users / customers at the heart of what it does

93%

92%

I have the right tools and technology to undertake my job

86%

81%

For my job, I am aware of the training and development opportunities available to me

88%

87%

In my organisation, it is safe to speak up and challenge the way things are done

79%

77%

In my organisation colleagues would raise concerns about disrespectful, discriminatory, or abusive behaviours if they witnessed them

96%

In my organisation colleagues from all backgrounds and identities are valued

97%

89%

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