Quality Account 2014 - 15

Quality Account

An annual report detailing the quality of services we offer to our community

Our vision is to be the outstanding provider of high quality, integrated care to the communities we serve.

Our values will guide how we will achieve that vision and face up to the challenges that lie ahead.

Health is our passion, with patients at the heart of everything we do Exceptional care as standard Actively supporting each other to do our jobs Responsive, professional and innovative Trusted to deliver

b Introduction

Simon Gilby, Chief Executive

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b Section 1

Foreword from the Board

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b Section 2

Performance overview 2014/15

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b Section 3

Innovation in service delivery

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b Section 4

Quality assurance of the services we deliver

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b Section 5

Bringing high quality services closer to home

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b Section 6

Volunteer and membership

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b Section 7

Objectives for 2015/16

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b Section 8

Statement from Healthwatch Wirral

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b Section 9

Statement from Wirral Clinical Commissioning Group

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b Section 10

Statement from Local Authority

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b Section 11

Our services

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Contents

b About

our trust

Who we are

Who we serve

Wirral Community NHS Trust is located in Wirral in

Our Wirral population comprises around 320,000

North West England. We provide high quality

residents across 145,000 households (based on

primary, community and public health services to

projections from the 2011 census).

the population of Wirral and parts of Cheshire and Liverpool. Registered with the Care Quality Commission (CQC) without conditions, we play a key role in the local health and social care economy as a high performing organisation with an excellent clinical reputation.

We employ over 1,400 members of staff, 90% of whom are in patient-facing roles, the majority of these being employed in our nursing and therapy

There are pronounced extremes in Wirral, with affluent areas very close to communities experiencing significant levels of poverty and deprivation. Variations in life expectancy are amongst the highest in England.

Just over 5% (16,101) of Wirral’s population classify themselves as being from a black and ethnic minority population group.

services. Our workforce represents over 70% of

Wirral has a relatively high older population and a

the costs of the organisation and are our most

relatively low proportion of people in their twenties

important and valued resource.

and thirties compared to England and Wales as a whole. The older population (aged 65 years and above) is expected to increase faster than any other age group over the next decade.

This changing age profile, along with conditions caused or exacerbated by lifestyle, will place increased demands on our services in future, particularly in some nursing services.

Introduction b This Quality Account reflects our commitment to providing the best possible standards of clinical care, shows how we are listening to patients, staff and partners and how we have worked with them to deliver services that meet the needs and expectations of the people who use them.

During 2014/15 we can share many examples of where we are providing excellent clinical care including the achievement of our Commissioning for Quality and Innnovations (CQUIN) schemes and quality objectives in areas such as pressure ulcer care, access to integrated and coordinated care teams, infection prevention and control and clinical innovation.

In September 2014, the CQC carried out a comprehensive review of all our services and we are proud to have received an overall rating of ‘Good’.

The inspection considered how safe, caring, effective, responsive and well led our services were and we continue to be registered with the CQC with no conditions.

Our quality governance assurance framework was inspected during 2014

by Monitor, the NHS financial watchdog.

The results of this review were also very positive.

The findings of the Francis Report following the events at Mid Staffordshire hospital continue to drive our ambition to continuously improve quality across all of our services. We have led the way this year in developing a ‘Right Staffing’ project which helps us to make certain that the right staff with the right skills are available at the right time and in the right place for our patients.

We have aimed high again in setting challenging quality goals for 2015/16.

These include a continued focus on effective wound care and prevention of pressure ulcers. We are committed to our patient safety and leadership walkrounds, a process by which executive and nonexecutive directors meet with staff and patients to find out how it is for them.

We are determined to achieve financial stability and recognise that quality is both a clinical and business priority for us as we move into more difficult financial times.

Our ambition to achieve foundation trust status during 2015/16 will support this, as will the commitment and dedication of our staff as we work to ensure our services are as efficient as possible.

On behalf of the Trust Board, I would like to thank all of our staff who have contributed to what has been a successful year improving quality across all services on a daily basis and for the care they take in doing the very best for each and every person they meet.

I confirm on behalf of the Trust Board that, to the best of my knowledge and belief, the information contained in this Quality Account is accurate and represents our performance in 2014/15 and our priorities for continuously improving quality in 2015/16.

Simon Gilby Chief Executive 3

b  Section 1 Foreword from the Board

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Quality Account 2014 - 2015

The Quality Account aims to provide assurance to our patients, commissioners and the local population that our services are safe, effective, caring, responsive and well-led.

Our priorities for 2015/16 are set out in this report and have been developed in partnership with patients, members, healthwatch and our commissioners.

They are aligned with the NHS constitution and aim to meet the expectations of the populations we serve.

Our priorities for 2015/16 - we will: • identify and support people with dementia • reduce avoidable admissions to hospital • integrate therapy services • reduce avoidable grade 3 and 4 pressure ulcers acquired during care • achieve 4.0% staff sickness levels or below • achieve foundation trust status during 2015/16

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b Section 2

Performance overview 2014 - 2015

Our patients and communities Section 2 sets out our objectives for 2014/15 and details how well we did against each one. b Meet the milestones of right staffing During 2014/15 we have made great progress in establishing the right levels of staffing across many of our services and have met all our project milestones.

b 95% of staff feel confident and able to raise concerns about patient safety and effectiveness of care Our regular programme of patient safety & leadership walkrounds gives staff and patients the opportunity to talk directly with members of the Trust Board about a

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range of topics, especially patient safety and how services may be improved.

We are delighted that almost all of our staff tell us that they feel able to raise any concerns that they might have. This is consistent with our open and honest culture that encourages the reporting of any incidents and near misses to promote learning and improvement.

b 95% of complaints and concerns responded to in three days There were 79 written complaints received in 2014/15 compared with 40 written complaints received in 2013/14.

100% of complaints and concerns were acknowledged within three working days. Complaint themes include aspects of clinical care, communication and attitude.

Improvements resulting from complaints include: • recruitment of additional staff to the podiatry service • implementation of a Community Health Care Project Lead and Support Practitioner working closely with the community nursing teams Patient concerns and complaints are received by the trust through a variety of

Quality Account 2014 - 2015 routes eg e-mail, feedback cards, telephone and via the trust website.

During 2014/15 there were no referrals to the Parliamentary and Health Service Ombudsman in relation to our trust.

b Increase the number of completed patient experience questionnaires from all clinical services by 10% All clinical services use the patient experience questionnaire to learn from feedback provided by patients, families and carers. The questionnaire also collects information about who is using the service so that we have a better understanding of people’s needs associated with different groups of patients.

As a trust we have increased the participation of patients, families and carers and achieved an increase greater than 10% in completing patient experience questionnaires.

To improve feedback we have developed patient experience feedback questionnaires especially for children and young people and people who have a disability due to brain injury and have installed feedback kiosks in our GP Out of Hours and Walk-in centre services.

Customer care training is also available for all staff.

b Friends and family score of 80% or more The NHS friends and family test is a simple feedback tool which asks the question: How likely are you to recommend our service to friends and family if they needed similar care or treatment?

Response options range between ‘extremely likely – extremely unlikely’ and people can leave anonymous comments too.

The trust has adopted the friends and family test ahead of national guidance and consistently scored above 88% when patients are asked if they would recommend our services to friends and family.

b Staff confident to raise concerns about patient safety and fraud In the last 12 months, 678 concerns raised via the Raising Concerns Policy have been investigated.

Awareness raising with staff on how to raise a concern has taken place through the weekly staff bulletin, posters and StaffZone (the trust’s staff intranet).

All formal concerns raised are monitored through the Education and Workforce Committee in relation to patient safety and fraud matters.

b Additional safety information Serious Untoward Incidents (SUIs) Serious incidents requiring investigation in healthcare are rare, but when they do occur the trust has processes in place to respond quickly, protecting patients by ensuring a robust investigation is carried out. This provides an opportunity for the trust to learn from all serious incidents, minimising the risk of the incident happening again.

In 2014/15 we had approximately 1.1 million patient contacts across our core services. During this time 1,780 patient safety incidents were reported.

Learning from all incidents has been used to develop new policies, procedures and training to support staff to deliver safe care.

Never Events Never events are serious, largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented.

We had one never event during 2014/15.

The incident was a wrong tooth extraction which was disclosed immediately to the patient and a full apology provided.

A thorough investigation has taken place and learning has improved and strengthened processes to prevent a recurrence of this type of incident.

During 2013/14 we reported 11 SUIs, and during 2014/15 we reported 19 SUIs. We have worked closely with our commissioners over the last year to ensure we report all suspected and actual serious incidents within a maximum of 48 hours from the time the incident is known.

As a result, there has been an increase in reporting which is not directly comparable to the previous annual reporting. Enhanced reporting processes fully supports the trust’s continuing commitment to embed an open, honest, transparent culture of learning from experience, ensuring patients are protected from harm whilst receiving care from our clinical services.

All SUIs are fully investigated and shared with our commissioners. Learning themes are reviewed and shared across the trust to prevent them from reoccurring.

We report all patient safety incidents to NHS England via the national reporting and learning system.

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b Section 2

Performance overview 2014 - 2015

Our services

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b Access to integrated and coordinated care team

b 95% clinical audits completed

Integrated and coordinated care teams include both health and social care professionals working together so people have just one referral and assessment.

Individuals will benefit from a single key contact who is aware of their current treatment history and needs.

Clinical audit supports healthcare staff to continually improve quality of care as patient safety is a key priority. 100% of clinical audits were completed.

• Community Nursing identified the need for new technology to improve assessments to help guide treatment options for patients with leg ulcers

The key quality outcomes included:

• Continence Service highlighted the need for more enuresis alarms as first line choice of treatment for children with nocturnal enuresis

Access to the service can be via various professional routes:

• Wheelchair Service continues to improve care for patients using wheelchairs to reduce the risk of developing pressure ulcers

b National Institute of Clinical Excellence (NICE) standards implemented

GP, Department of Adult Social Services, secondary care, voluntary agency, domiciliary care agency, patient and carer’s self-referral.

• personalised care plan audit showed 100% of records evidenced care planning was in place and partnership working with the patient and carer

Key achievements include: • development of a new IT system to track all new guidance, ensuring we

Quality Account 2014 - 2015 support staff to provide outstanding care for patients • Quality Standard for Constipation in Children and Young People, was launched and we updated our care pathway to ensure children are assessed, offered treatment and referred on appropriately • new Metastatic Spinal Cord Compression guidelines have been implemented • we used this new guidance to update our leg ulcer care policy and training for our nurses • our minor injuries handbook for head injuries have been updated for clinical staff to ensure patients are managed safely and effectively We are planning to launch a new update for clinical staff in 2015 to highlight best practice standards across all our services.

b 60 Frontline Focus visits completed Frontline Focus visits enable the trust to review the quality of care provided to patients, and helps staff to solve quality and patient safety related problems. They provide assurance to the Trust Board that the care our patients receive is compliant with the Essential Standards of Quality and Safety from the (CQC). This is achieved by an Advanced Practitioner working alongside a staff member for part of their working day.

What has been achieved: • patient information leaflets have been developed to support patients whilst receiving care and services • the privacy and dignity of patients receiving care had been assured • trust documentation has been updated to ensure patients have all the information they need to make informed decisions For 2015/16 a new framework is being developed to evidence on-going compliance with the new Care Quality Commission (CQC) fundamental standards. This reflects the changes from

our care regulator; the CQC. A broader more detailed observation will be undertaken by a team of staff looking at all aspects of care.

b 95% harm free care We use the national NHS Safety Thermometer standards to measure patient harm in relation to: • falls • urinary tract infections in patients with catheters • pressure ulcers • venous thromboembolism (blood clots)

‘‘

During 2014/15 we achieved 96%.

Have found the service and help and advice I was given was very comprehensive and all the staff are very caring.

Cardiac Rehabilitation

’’

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b Section 2

Performance overview 2014 - 2015

Our people b 95% of staff to have annual appraisal and development plan We achieved 100% of staff having an appraisal and development plan during 2014/15. We aim to review guidance for managers and ensure specific, measurable, attainable, relevant, timebound (SMART) objectives are set for staff within the appraisal window of May – July.

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b Implement staff friends and family test We have conducted the staff friends and family test in each of the first three quarters of the year, once as part of the national NHS staff survey.

We ranked top of all community trusts for the percentage of staff who would recommend their trust to friends or family for care or treatment. For the percentage

of staff who would recommend their trust as a place to work, we were in the top five community trusts in the country.

In both cases our results were significantly higher than the national, local or community trust average.

Quality Account 2014 - 2015

b 95% staff to attend corporate and local induction

b Decrease in staff sickness rates to 4.2%

We achieved 90% of staff attending corporate and 96% local induction.

For 2015/16 this objective has been reviewed with the development of the ‘Onboarding’ process. New starters will complete their corporate induction online prior to starting and then undertake local induction with their manager within four weeks of their start date.

In 2014/15 the sickness rate for the organisation was 4.9%.

b 95% staff to attend core mandatory training 95% of staff completed their core mandatory training 2014/2015.

Developments: • we will be introducing new Conflict Resolution elearning training for our non clinical staff to support their health and wellbeing in the workplace • we will be revising our clinical core training to ensure we deliver exceptional care to our patients – with specific consideration for those who may be vulnerable in the community such as patients with learning disabilities or dementia

We have seen a reduction in sickness absence The Managing Attendance Policy has been revised to include additional guidance for managers and signposting for support for staff. Absence rates are monitored by the Education and Workforce Committee with identified actions being reviewed to assess effectiveness.

b 75% eligible staff to receive flu vaccination Influenza can be a serious illness.

To protect our staff and patients we offer all our staff the opportunity to have a free flu vaccine. Our 2014 Staff Flu Campaign was extremely successful, and we saw an overall increase of 16.6% staff uptake compared to 2013.

We were the top performing community trust with 71.6% of our eligible workforce vaccinated. This considerably exceeds the national figure of 54.9% of frontline staff vaccinated and to other community trusts.

‘‘

Wonderful, happy, pleasant and courteous staff!

Community Dental

’’

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b Section 2

Performance overview 2014 - 2015

Our sustainability b 95% staff to complete Information Governance training During 2014/15, 96% of our staff completed online information governance training.

This includes how we ensure patient information is managed safely and securely and is appropriately shared when necessary as part of the patient clinical care pathway.

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b Achieve level 2 on IG toolkit

b Implement practice development partnership

Of the 39 standards assessed, 38 are applicable to us and we achieved level 2, the required level, in all. In addition, we achieved level 3 in nine (24%) standards compared to five (13%) in 2013/14.

We have developed a practice development partnership working collaboratively with the University of Chester and our clinical services.

Current research projects include: • understanding what helps patients make decisions about their end of life care

Quality Account 2014 - 2015

‘‘

I cannot praise all the staff high enough for their professional care to all patients of rehab thank you one and all.

Wheelchair Service

• exploring patients’ individual experiences of two layer and four layer bandaging systems for leg ulcer care; comparing patient outcomes and informing future decisions regarding care and treatments

b Establish funding stream for innovation and research We are committed to active innovation and research across the trust, continuously improving clinical services and patient outcomes.

In 2014/15 we developed an innovation fund open to all staff to apply for grants of up to £5000 to implement clinical innovations within their service area.

Each applicant must demonstrate how their ideas meet the following criteria: • improve care for patients • improve responsiveness for patient care • improve patient safety

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• improve how services for patients are well-led • improve the effectiveness of patient services Our clinical forum review each submission and awards funding following a presentation delivered by the clinical teams.

Successful applications include: • implementing pressure mapping, within the Wheelchair Service to support patient education and pressure ulcer prevention • introducing a two layer compression bandaging system across the Community Nursing Service to promote patient comfort whilst improving compliance with leg ulcer treatments. This was supported by purchasing additional Dopplex machines, to assist nursing staff with their clinical assessments

b Implement continuous quality improvement programme We have trained 110 staff since April 2014 on effective ways to make quality improvements, sharing new ways of working and learning from patient’s feedback.

To make further improvements in care over 2015/16 we will: • carry out a minimum of four innovation projects via a clinical innovation fund • encourage clinical teams to share their local quality improvements with all services so we can learn from each other • provide opportunities for all staff to attend quality improvement workshops

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b Section 2

Performance overview 2014 - 2015

Performance overview b Safe - Right Staffing Our Right Staffing project is central to our ambition to deliver safe, caring and effective services. We have excellent staff who care deeply and we recognise that in order to support them to do the best job they can do, we need the right staff in the right place at the right time with the right skills.

The right staffing project has helped us to work out how many community nurses we need to deliver safe, caring services to our housebound population. In addition, our walk-in centres are now able to provide the right level of staffing every day based on the number of people

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we estimate might need the service on that day.

We plan to continue this work until we are satisfied that we understand what staff and skills are required in all our services.

b Responsive - open and honest care and duty of candour We are committed to delivering care that is open, honest and transparent. In 2014/15 the contractual duty of candour and NHS England’s Open and Honest Care programme were introduced.

The new contractual duty of candour means that we inform patients, family

members and carers when they are involved in a patient safety incident that results in moderate or severe harm or death. All incidents will be investigated and feedback on lessons learned offered to patients and their families.

The ‘open and honest care’ programme supports trusts to publish monthly data on their public websites about key areas of healthcare quality, including: • harm free care information • information on healthcare associated infections • pressure ulcers • falls causing moderate or greater harm • information on staff experience

Quality Account 2014 - 2015 • information on patient experience • a patient story • an improvement story describing what the trust has learnt and what improvements they are making

compassion and support for those with dementia and their carers.

communication channel that helps to shape the organisational culture.

Leadership

These are a few of the things that staff have influenced or been directly involved in:

We are currently finalising our reports with NHS England prior to publication.

We support our leaders with management development programmes and we link with the NHS Leadership Academy for our nationally recognised leadership courses.

b Caring - Hello my name is…

Feedback from healthcare students

In our recent Care Quality Commission inspection report, our staff were recognised as being compassionate and caring. For us this was great feedback and a welcome reminder to our excellent staff that they do a great job every day.

In 2014/15 we have provided learning opportunities for many students, medical, nursing , speech & language therapy, dietitians, podiatry and health visiting students. We invite students to share their learning experiences through feedback.

b Well-led - successful tenders Building on this feedback the trust is now involved in the ‘hello my name is...’ campaign. This is a national campaign started by Dr Kate Granger, a cancer sufferer and clinician. Kate noticed that during her own treatment, not all health workers, including doctors and nurses introduced themselves to her.

She suggested that this simple introduction is first rung on the ladder to providing compassionate care and often getting the simple things right, means the more complex things will follow more easily and naturally.’

b Effective - learning and development / workforce development In 2014/15, we supported 95 staff to access academic modules at local universities to enable them to respond to the needs of services and the patients they care for. In addition to areas relating to prescribing and clinical examination examples of other modules are:

During 2014/15, we have successfully bid for some key services. This is a demonstration of the confidence our commissioners have in the quality of the services we provide.

Our new services include the 0-19 Health and Wellbeing Service. This brings together all preventative, public health services for children and young people into one single service. Health visitors, school nurses, nurses and health trainers will work alongside our valued partners in Home-Start, Brook and Barnardo’s to ensure that children have easy access to high quality health services.

b Staff Council

• tissue viability for care of wounds

The Staff Council meet regularly with members of the board to discuss matters that affect staff at work. Following staff council elections in 2014/15 there is improved representation of trust services and it continues to be a valuable

We are delivering dementia awareness training for all clinical staff to ensure we can provide outstanding care,

• dialogue with the board regarding the experiences of front line staff • reintroducing the staff retirement course • supported the promotion of the ‘hello my name is…’ campaign with staff • supported staff awards scheme • contributed to the plans for CQC visits in September 2014

b Staff awards The trust held its third annual ‘For You Thank You’ Staff Awards in February 2015. Held to celebrate and recognise the exceptional work of staff from across the trust, nearly 70 nominations were received for individuals and teams across the eight categories.

This year the trust launched its Patient Choice Award which generated a huge response from the public. Members of Staff Council and public members of the trust were involved in the judging process and the event was well received by everyone who was involved.

We will also be delivering our outstanding Specialised Dental Service across Cheshire West, Chester and Wirral from April 2015. Previously known as Community Dental, this new service provides specialised dentistry to children and adults which cannot be provided by a general dental practitioner.

• supporting patients with long term conditions • safeguarding vulnerable group

• articulating staff concerns at times of reorganisation and relocation

The winner of our Patient Choice Award, Niamh McTague pictured with Councillor Steve Foulkes, Mayor of Wirral.

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b Section 3

Innovation in service delivery

Innovation in service delivery b Ideas scheme, innovation fund, research programme

2014. Staff can view all the ideas online and see how they are progressing.

The trust recognises that participation in research and working innovatively provides multiple benefits across the organisation and health and social care economy.

Through advances made, the trust contributes to the delivery of high quality care, with improved outcomes for patients.

In addition to the development of a clinical innovation fund, we set up an ideas scheme encouraging staff to share their ideas with the trust’s senior management team for consideration.

We have received over 50 new ideas since its launch on StaffZone in October

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Research priorities Our current research priorities, based on NHS England guidance include: • research into clinical interventions and innovations that have the greatest impact on outcomes

• supporting the NHS as a good place for both commercial and noncommercial research • the establishment of clear links with clinical leaders across all professions, with academia, industry, and with non-clinical researchers in health and social care The trust is currently working with the National Institute for Health Research Local Clinical Research Network and Academic Health Science Network.

A framework to support the expansion of research and innovation throughout the

Quality Account 2014 - 2015 trust will be developed during 2015/16, to ensure that we achieve our research ambitions.

b Continuous Quality improvement Programme

The 0-19 Health and Wellbeing Service includes: • health visiting and family nurse partnership support • infant feeding support • school nursing and immunisations

We have implemented the following quality improvements to enhance care for patients:

• work with primary and secondary schools on nutrition, oral health and contraception

• speech and language therapists are using new assessments to help support patients who have difficulties swallowing safely - early results show a significant improvement in nutrition, well-being and extra support for carers

• weight management support for children, young people and their families

• our night nursing service is providing additional training for nursing auxiliaries to support nursing care for palliative patients

• personal, informative, tailored advice and support

• community nursing have been using new ways to care for patients with leg ulcers which help healing and reduce risk of infection occurring

• drop-in support

• targeted work around drugs, alcohol and smoking • support for young carers

Clients receive a free lifestyle assessment with a health trainer to look at what support they could benefit from. They are then signposted to the appropriate sessions which may include; a box fit session; attendance at the wellness gym, cook yourself slim; chair based exercise or a stop smoking group session. People who are giving up smoking can also attend the Breathewell, Singwell group focused particularly on those with chronic obstructive pulmonary disease.

Livewell have an allotment where people can meet weekly and tend to the vegetable and flower plot. All the vegetables grown there can be taken home and used to cook healthy meals using the recipes provided.

• emotional health and wellbeing support

• more patients are being cared for in their own homes including those who need more specialised care from nurses when they require antibiotics

b Service examples – Livewell

b Service examples – 0-19 Health and Wellbeing Service The new service, delivered by the trust and our partners Barnardo’s, Brook and Home-Start Wirral, will help improve the current and future health and wellbeing of children and young people, help reduce health inequalities, respond to local need and provide universal and targeted support as required.

The Livewell service offers a comprehensive free programme supporting local people to make positive lifestyle changes.

The programme looks to encourage people to:

‘‘

Great communication and follow up, very understanding and compassionate.

• get more active • eat healthier • quit smoking • lose weight • relax and unwind

Wheelchair Health Visiting Service

’’

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b Section 4

Quality assurance of the services we offer

Internal assurance b Frontline Focus In 2014/15 we undertook 60 Frontline Focus visits which enable the trust to review quality care provided to patients.

• disinfection of stethoscopes and blood pressure monitoring equipment between each patient consultation.

These visits have resulted in improvements in:

Overall many services consistently met all standards of quality and safety.

• provision of patient support information • patient privacy in clinic areas Following the quality assurance visits we were able to raise awareness of the: • hand hygiene in home visiting services

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b Clinical audit Clinical audit supports healthcare staff to continually improve quality of care as patient safety is a key priority for the organisation. Our objective was to

complete 95% of clinical audits, we have completed 100%.

The key quality outcomes included: • Wheelchair Service continues to improve care for patients using wheelchairs to reduce the risk of developing pressure ulcers • personalised care plan audit showed 100% of records evidenced care planning was in place and partnership working with the patient and carer

Quality Account 2014 - 2015 • Community Nursing identified the need for new technology to improve assessments to help guide treatment options for patients with leg ulcers • Continence Service highlighted the need for more enuresis alarms as first line choice of treatment for children with nocturnal enuresis • following an audit of standards on the prevention of patient falls, a new patient information leaflet on falls prevention was produced

b Infection Prevention and Control We strive to provide services that meet the infection prevention and control needs of our patients. We undertook a programme of audits which included clinical procedures, hand hygiene and the cleanliness of the premises where we provide treatment. This enables us to see how well we are doing against national best practice standards and our internal policies and procedures. Our aim is to ensure consistent standards of infection prevention and control and enable continuous quality improvement.

b Mersey Internal Audit Agency Throughout 2014/15 WCT worked with the Mersey Internal Audit Agency (MIAA) to test out how good our governance processes are. MIAA gave us a rating of significant assurance following a quality health check and recognised the value and assurance provided by our right staffing project.

b Revalidation Revalidation is required by all nurses to ensure that they remain fit to practice.

A new process is due to be tested by the Nursing and Midwifery Council during 2015 and we have developed staff appraisals to ensure that nursing staff are able to provide the right kind of evidence to support this.

Are you a nurse?

Make sure you know about revalidation!

Revalidation is a process that all nurses and midwives will need to engage with to demonstrate that they practise safely and effectively throughout their career.

All nurses and midwives are currently required to renew their registration every three years. Revalidation will strengthen the renewal process by introducing new requirements that focus on: • up-to-date practice and professional development • reflection on the professional standards of practice and behaviour as set out in the Code, and • engagement in professional discussions with other registered nurses or midwives Make sure you know your renewal date and how you can prepare for revalidation by visiting www.nmc.org.uk

b Safeguarding audit Every year we are required to audit our safeguarding processes. This year we have focused on this important area of work and are due to achieve all key indicators during 2015/16. In particular we have reviewed safeguarding training and supervision opportunities for staff.

RevalidationRollerBanner.indd 1

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b Section 4

Quality assurance of the services we offer

External assurance b Care Quality Commission The CQC regulates all health and adult social care services in England. Through inspections and information monitoring, it ensures that essential common quality standards are met. We are registered with the CQC without exceptions.

In September 2014, we were inspected by the CQC under their new inspection framework. We were visited by 30 inspectors who spent time with all our services for one week.

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We are proud to have achieved a ‘Good’ rating across all areas. Our staff were recognised as being caring, compassionate and safe. Services were congratulated for being effective and responsive to patient needs and the organisation as a whole was found to be well-led.

b Monitor Review During the summer of 2014 our quality governance arrangements were also inspected by Monitor, the NHS financial regulator. We were found to have good quality governance arrangements in place.

b Information Governance In 2014/15 the trust maintained level 2 compliance with the national information governance toolkit requirements.

b NHS Protect Audit Providers of NHS services must put in place and maintain appropriate counter fraud and security management arrangements. Those arrangements are governed by a body called NHS Protect.

NHS Protect has developed a national strategy and a series of security

Quality Account 2014 - 2015 standards for providers, which incorporates the provision of a safe and secure environment for patients, staff and visitors and to protecting NHS property and assets. It is the responsibility of the organisation as a whole to ensure it meets the required standards.

In July 2014 our compliance with these standards was reviewed by NHS Protect as part of the quality assurance programme. The review considered findings from an earlier inspection

conducted in October 2013. This review graded the trust’s response to these standards utilising a red, amber and green rating. Overall the trust has been rated as ‘Green’ for security management with compliance evidenced in 29 of the 30 assessed standards.

b Trust Development Authority

with the TDA during 2014/15 to achieve our ambition of becoming a foundation trust. In March 2015 the TDA referred us to Monitor for our final review and we aim to become one of the first community foundation trusts by September 2015.

This will provide us with more financial flexibility and enable us to be more innovative in our development of services.

The Trust Development Authority (TDA) is the NHS body that supports aspiring NHS foundation trusts. We have worked closely

‘‘

We appreciate very much the kind and efficient treatment we receive and are very thankful.

Podiatry

’’ 21

b  Section 5

Bringing high quality services closer to home

We continue to support the local NHS to reduce hospital admissions and support early discharge by providing high quality, specialist services in the community.

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Quality Account 2014 - 2015 b Integration The challenge continues to grow as Wirral’s health and social care system faces further financial pressure moving into 2015/16. The demand for services is increasing as our population gets older and more individuals experience complex long term health conditions.

We have released a lot of efficiency savings over the past few years, but we now recognise that radical transformation across all health and care organisations is the only way that we will make the saving required to deliver high quality health and care support to the population of Wirral in the future. The joint strategy which supports this is Vision 2018.

b Vision 2018 Local leaders are working in partnership to develop and implement the Vision 2018 strategy. This is aimed at providing better outcomes for the people of Wirral through integrated services which are run efficiently and achieve high standards of care.

The programme also aims to work with Wirral residents, empowering them to manage their own health and wellbeing needs through appropriate, accessible information, use of technology, preventative support and shared decision making.

b Integrated Care Coordination Teams

professionals who are already involved in the patient’s care.

This is a community based service aimed at improving and coordinating care for adults with a health and social care need within the community.

The team’s assessment will consider patient’s needs under a broad range of headings eg mobility.

The aim of the Integrated Care Coordination Teams (ICCT) is to provide an integrated, responsive stepped approach for both planned and unplanned care at home which is both person centred and responsive to an individual’s health and social needs.

b Integrated Discharge Team The development of the Integrated Discharge Team underpins the health economy objectives to improve quality, productivity and prevention by using whole system solutions and promoting person centred approaches.

b Continuing healthcare Continuing healthcare is a package of care that is arranged and funded solely by the NHS for individuals who are not in hospital but have complex, ongoing healthcare needs.

These needs are then given a weighting marked priority, severe, high, moderate, low or no needs.

If a patient has at least one priority need, or severe needs in at least two areas, they could be eligible for NHS continuing healthcare. Patients may also be eligible if they have a severe need in one area plus a number of other needs, or a number of high or moderate needs, depending on their nature, intensity, complexity or unpredictability.

In all cases, the overall need, and interactions between needs, will be taken into account, together with evidence from risk assessments, in deciding whether NHS continuing healthcare should be provided.

The assessment takes into account the patients views and the views of carers they may have.

Assessments for continuing healthcare are undertaken by a ‘multi-disciplinary’ team of health or social care

‘‘

As a family we have used the walk-in centre a number of times and could not fault the service received at any time. Staff are always friendly and explain information to you. Brilliant facility.

Eastham Walk-in centre

’’

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b Section 6

Volunteers and membership

Volunteers and membership b Members Members are at the heart of our trust.

Being a member means finding out about what’s going on and having the chance to influence the development of your community NHS trust. We have over 5,000 public members and all of our permanent staff are members too.

Members engage with trust in many ways and in the past year we have established member involvement in groups such as the Community Equality Panel, Medicines Management Group and Practice Research Steering Group.

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In the coming year we plan to establish a Patient Experience Group with trust members and we expect, most importantly, that all members get the chance to vote for the people they want to represent them in our Council of Governors.

b Volunteers We have continued to develop new volunteer placements across the trust.

We now have volunteers in teams and services including our Breastfeeding Support Group and Speech & Language Therapy.

We continue to work closely with our allied charities: the League of Friends and Wirral HeartBeat. Last year we helped the League of Friends improve the process by which trust services may apply for funding and saw a massive increase in the number of requests.

These were for items that aren’t paid for from core NHS funding but enhance the work of our teams.

This year the requests included a demonstration skeleton and other items of kit for physiotherapy and equipment to support singing classes for the Livewell service.

Quality Account 2014 - 2015 b Work placements In 2014/15 the trust provided 20 placements for students in year 12 and 13 during a three week period in June and July and supported more throughout the year.

Students enjoyed their placements and found them valuable in helping identify future careers, whilst staff have found it very rewarding to take part.

“I could not have asked for a more exciting, enjoyable and invaluable work experience than my week with the Programme Management Office”

“…many thanks for giving me the opportunity to show a school placement what our trust is about” We were delighted that our work placement programme was included in Health Education England’s Widening Participation Directory of Best Practice this year.

b Preparing for our Council of Governors As part of applying to become an NHS foundation trust we are preparing to form a Council of Governors. Foundation trusts have more freedom to plan and invest in services for the benefit of their local population. Governors are elected by public and staff members and

appointed by partner organisations. As a group they represent the interests of local people. The trust board becomes accountable to them for its performance.

Once we enter the last stage of our foundation trust application process we will call elections for public and staff governors. During 2014/15 we have been informing people about what governors do and the election process. We want as many enthusiastic and committed people as possible to stand for election.

We will support our new governors with an induction and development programme, making sure they have the information and training they need to be able to fulfil their new duties. We will provide on-going support to our governors. They will meet regularly to make sure the trust is performing well and planning to meet people’s needs.

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b  Section 7

Objectives for 2015 - 2016

Our Vision: To be the outstanding provider of high quality,

Our quality statements: Our patients:

Our people:

We protect people from avoidable harm

We value and listen to our staff

We will identify and provide appropriate care for all patients aged 75 diagnosed with dementia following an episode of emergency unplanned care.

We will ensure that 95% of staff complete mandatory training during 2015/16.

We will identify the best model(s) for effectively managing the single point of access with the aim of reducing avoidable admissions to acute care.

95% of staff will have their Appraisal May – July 2015.

We will reduce avoidable grade 3 & 4 pressure ulcers acquired during our care.

We will achieve 4.0% staff sickness levels or below.

We will increase the percentage of staff who would recommend Wirral Community NHS Trust as a place to work / receive treatment as measured by the NHS national survey.

95% of patients will be seen within 30 minutes for initial assessment within our walk in centres.

We will achieve a friends and family test score of 85%.

Underpinning Govern 26

Quality Account 2014 - 2015

integrated care to the communities we serve.

Our services:

Our sustainability:

We deliver clinical excellence

We are a sustainable organisation

We will develop and implement a Wirral wide integrated therapies pathway to expedite safe, timely discharge and prevent avoidable admission to hospital care.

We will achieve foundation trust status during 2015/16.

We will reduce the proportion of avoidable emergency admissions to hospital by working in partnership to plan safe out of hospital care.

We will support a minimum of four innovation projects via our clinical innovation fund.

All clinical staff in our 0-19 service will receive safeguarding supervision in accordance with the Safeguarding Supervision Policy.

We will improve the rating achieved within our Information Governance Toolkit submission year on year.

We will use staff ideas to help us reduce waste and become more cost effective.

We will ensure that daily nursing staffing levels and skill mix against assessed patient acuity levels are maintained at 95% of the required fill rate.

nance and Assurance 27

b Section 8

Supporting statement from Healthwatch Wirral

Supporting statement from Healthwatch Wirral Healthwatch Wirral (HW) would like to thank Wirral Community NHS Trust for the opportunity to comment on the Quality Account for 2014/15. The HW Quality Account sub group met on 14th May 2015 to compile this response.

• the trust has exceeded its target in completed clinical audits

Priorities for 2015/16

• the trust achieved a ‘Good’ rating in their CQC inspection

The 6 priorities were noted and HW would welcome more detail particularly in the integrated therapy services and how they would benefit patients.

HW looks forward to receiving the quarterly reviews on progress against these priorities.

Review of Performance in 2014/15 It was positive to note that: • the trust is using their right staffing project to enable them to work out how many community nurses are needed to deliver a safe, caring service to the housebound population. In addition, the trust can now determinate the right level of staffing in walk in centres based on the number of people they estimate might need the service each day. HW acknowledges that the trust has made great progress in establishing the right levels of staffing across many of the services and have met all of the project milestones but would welcome further detail about the milestones achieved and the timescale of the project.

• 95% of staff felt confident about raising concerns, which is consistent with an open and honest culture • there was decrease to 4.2% in sickness absence during the year • the trust have consistently scored more than 88% in the Friends and Family Test when patients are asked whether they would recommend the service to family and friends • the number of completed patient experience questionnaires have increased and a questionnaire for children, young people and people who have a disability has been developed

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• the harm free care target has been exceeded • the Continuous Quality Improvement Programme has been implemented

HW would welcome more information on the Integrated and Coordinated Care teams. Also, of interest would be the impact on reducing avoidable admissions to hospital along with details of outcome measures that the trust will monitor against.

ulcers, identifying the need for new technology to improve assessments and treatment options for patients with leg ulcers and the production of a patient information leaflet on falls prevention.

Other measures of internal assurance were noted including audits on Safeguarding, Infection control and the Mersey Internal Audit Agency (MIAA) which tests how good the trust governance processes are.

The trust were given a rating of significant assurance from MIAA. HW look forward to receiving reviews on these audits and the achievement of key indicators.

The trust should be congratulated on achieving 100% of staff having an annual appraisal and development plan, including supporting staff to access academic modules. The trust is also delivering dementia awareness training.

Quality assurance -external

HW were pleased to note the trust’s successful bid for some key services and look forward to hearing how these are progressing.

Overall, the Quality Account was positive, however, HW had concerns about the increase of significant untoward incidents reported and in particular the reporting of 1 Never Event. HW would recommend that the trust should continue using a robust learning process which includes Root Cause Analysis.

The trusts Quality Statements were noted and HW looks forward to receiving reviews on their progress.

Quality assurance -internal The Frontline Focus visits were noted which have resulted in improvements in the provision of patient support information and patient privacy in clinic areas.

HW would welcome the opportunity to participate in future visits.

It was pleasing to note that the trust had exceeded their objective to complete 95% of clinical audits which resulted in key quality outcomes. These included improving care for wheelchair users to reduce the risk of developing pressure

The Care Quality Commission inspected the trust in September 2014 and HW were pleased to note that the trust were awarded a ‘Good’ rating and that staff were recognised as being caring.

HW has enjoyed working alongside the community trust as it recognises the value in our relationship and has utilised the functions, duties and powers of HW to provide challenge and assurances. HW appreciates the opportunity to comment on the report as a “critical friend” and we look forward to working with the trust to support the implementation of the Quality Account and strategic plans.

Karen Prior Healthwatch Wirral Manager On behalf of Healthwatch Wirral

Statement from Clinical Commissioning Group

Section 9 b

Supporting statement from Wirral Clinical Commissioning Group As lead commissioner Wirral CCG is committed to commissioning high quality services from Wirral Community NHS Trust. We take very seriously our responsibility to ensure that patients’ needs are met by the provision of safe, high quality services and that the views and expectations of patients and the public are listened and acted upon This account reflects quality performance in 2014/15 and clearly sets out the direction regarding quality for the 2015/16.

We acknowledge and congratulate the community trust on their achievements over the past year in achieving the objectives set and the rating of ‘good’ following the comprehensive review of all services by the Care Quality Commission in September 2014.

Our patients and communities: We note that there has been a ‘never event’ reported in 2014/15. This was due to wrong site surgery. A root cause analysis has been undertaken to identify causal factors and lessons learnt. The trust is to be commended on being an earlier implementer of the Friends and Family test ahead of national guidance and for consistently scoring above 88% for the services delivered.

Our services: We commend the trust on the use different ways to gain insight into the quality of care that is being delivered by practitioners. This includes the front line focus visits to services. We acknowledge the work the trust has undertaken in relation to pressure ulcers and in view of this have achieved 96% against the NHS safety thermometer standards of harm free care.

Our people: In order to deliver high quality services, the induction and training of staff is of paramount importance. Whilst we acknowledge the achievement in local induction for staff, improvement needs to be made in relation to attendance at corporate induction. This was not achieved in 2013/14.

It is noted that the staff sickness levels are at 4.9% which is higher than the national average and an increase in last year. We acknowledge the increase in flu vaccination and performance benchmarked against other comparable organisations; however the local target set has not been achieved. We acknowledge that the trust will strive to improve this in 2015/16 and this will be monitored by the CCG throughout the contracting year.

Looking forward in 2015/16, the CCG is reassured that the priorities for improving quality that have been identified by the trust are priorities for the CCG including: • Identify and support people with dementias • Reduce avoidable admission to hospital • Integration of therapy service • Reduce avoidable grade 3 and 4 pressure ulcers acquired during care • Achieve 4.0% staff We believe that this quality account gives a high profile to continuous quality improvements in Wirral Community NHS Trust and the monitoring of the priorities for 2015/16. Wirral Clinical Commissioning Group looks forward to continuing to work in partnership with the Trust to assure the quality of services commissioned over the forthcoming year.

Pete Naylor Wirral CCG

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b Section 10 Statement from Local Authority

Statement of support Wirral Council The Families and Wellbeing Policy and Performance Committee undertake the health scrutiny function at Wirral Council.

The Committee has established a Panel of Members (the Health and Care Performance Panel) to undertake on-going scrutiny of performance issues relating to the health and care sector. Members of the Panel met on 12th May 2015 to consider the draft Quality Account and received a verbal presentation on the contents of the document. Members would like to thank Wirral Community NHS Trust for the opportunity to comment on the Quality Account 2014/15. Panel Members look forward to working in partnership with the trust during the forthcoming year.

Members provide the following comments:

above 88% when patients are asked if they would recommend the trust’s services to friends and family. This outcome is welcomed by Members and demonstrates the quality of services provided by the trust.

Overview

Our people

Members acknowledge the excellent performance of the trust as measured against the targets for 2014/15. The performance of the trust was confirmed during the year by the overall rating of ‘Good’ being achieved following the comprehensive review carried out by the Care Quality Commission (CQC) in September 2014.

Staff Friends and Family Test

The Members welcome the layout of the Quality Account and the clarity with which the information was presented to them.

Members also support the priorities selected for improvement for 2015/16.

Section 2 Performance Overview 2014/15

2014/15 resulted in an increase in the number of reported Serious Untoward Incidents ( to 19). However, it is acknowledged that this is partly explained by the trust aiming to more openly report incidents and encourage such reporting.

The trust’s approach of “staff being supported; not blamed” is to be applauded.

It is very welcome that Wirral Community NHS Trust ranked top of all community trusts for the percentage of staff who would recommend their trust to friends or family for care or treatment. In addition, the trust was ranked in the top 5 community trusts in the country for the percentage of staff who would recommend their trust as a place to work.

While recognising the trust’s reputation as a good employer, Members have noted the potential national issue regarding the recruitment of community nurses and will be interested in monitoring progress in 2015/16.

Our patients and communities Concerns raised by staff

Annual staff appraisal and development plans

In the context of the Francis Report and other national reports, it is important to note that almost all staff feel confident and able to raise concerns about patient safety and effectiveness of care. This is reassuring and is a comment upon the culture which the Trust actively tries to engender.

Members note the high priority which the Trust clearly places on staff and their training. Achieving 100% of all staff having an appraisal and development plan is noteworthy.

Friends and Family Test Against a target score of 80%, the trust has reported that it has consistently scored

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Serious Untoward Incidents / Never Events

Staff sickness rates Members note that, although the target for staff sickness in 2014/15 was 4.2%, the actual rate for the trust was 4.9%. However, it is also noted that a more difficult target of 4.0% has been adopted for 2015/16.

Our sustainability Funding stream for innovation and research During 2014/15, the trust developed an innovation fund open to all staff to apply for grants of up to £5000 to implement clinical innovations within the service area.

It is also noted that the continuation and expansion of the scheme is identified as a priority for 2015/16. This approach to the empowerment of front-line staff is welcomed by Members.

Section 5 Bringing high quality services closer to home With regards to future planning, the emphasis and commitment placed on service integration and the Vision 2018 programme is welcomed by Members.

Section 7 Objectives for 2015/16 In general, Members support the priorities selected for improvement for 2015/16. In particular, the increased emphasis towards reducing avoidable grade 3 and 4 pressure ulcers acquired during care is welcomed.

In the response to last year’s Quality Account, Members welcomed the work that was being developed by the trust to support care homes to develop improved care for residents, in particular with regard to pressure ulcers. Members trust that this initiative will continue.

I hope that these comments are useful.

Councillor Moira McLaughlin Chair, Health and Care Performance Panel and Deputy Chair, Families and Wellbeing Policy & Performance Committee

Our services b

b 0 - 19 Health and Wellbeing Service

b Ophthalmology (eye care)

b 24 Hour Community Nursing Service

b Palliative Care (specialised care for serious illness)

b Centralised Booking

b Parkinson’s Disease

b Community Discharge and Liaison

b Phlebotomy (blood tests)

b Rehabilitation at Home Service

b Physiotherapy & Rehabilitation

b Continence

b Podiatry (foot care)

b Deep Vein Thrombosis (blood clots)

b Sexual Health Wirral

b GP Out Of Hours

b Single Point of Access (referral service)

b GP Practices

b Specialised Dental Services

b Heart Support

b Speech & Language Therapy

b Infant Feeding

b Tissue Viability (skin care)

b Livewell Programme (healthy lifestyles)

b Walk-in Centres (Eastham, Wallasey and the All Day b Health Centre at Arrowe Park)

b Minor Injuries Unit b Nutrition & Dietetics

b Wheelchair Service

Support Services Infection Prevention & Control, Quality & Governance and Safeguarding.

Communications & Marketing, Estates Management, Finance, Human Resources, Business Intelligence and Information Technology.

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If you would like this information in another format or language, or would like to provide feedback about any of our services, please contact our Patient Experience Service: Telephone: 0151 514 6311 Freephone: 0800 694 5530 or patient.experience@wirralct.nhs.uk

www.wirralct.nhs.uk