Wirral Community NHS Trust Quality Account 2013-14

Quality Account 2013 – 2014

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

Contents b Introduction

Simon Gilby, Chief Executive

Section 1

Foreword from the Board

Section 2

Performance overview 2013/14

Section 3

Innovation in service delivery

Section 4

Quality assurance of the services we deliver

Section 5

Bringing high quality services closer to home

Section 6

Volunteers and membership

Section 7

Objectives for 2014/15

Section 8

Statement from HealthWatch Wirral

Section 9

Statement from Wirral Clinical Commissioning Group

Section 10

Statement from Local Authority

Quality Account 2013/14

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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

Introduction b

“

It gives me great pleasure to introduce Wirral Community NHS Trust’s third set of Quality Accounts sharing our achievements during 2013/14 and our plans for 2014/15.

This Quality Account reflects our commitment to providing the highest possible standards of clinical quality, and shows how we are listening to our 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 2013/14 we can point to many examples of where we are providing excellent clinical care including the achievement of our CQUIN schemes and quality objectives in areas such as dementia care, long term conditions, end of life care and infection prevention and control.

We have further developed our patient experience model and, over the last year have expanded our programme of Safety and Patient Experience Walk Rounds by our leadership team.

We have treated all our patients within the 18 week target and in April 2013 the Care Quality Commission again registered all services provided

by Wirral Community NHS Trust without conditions.

The events at Mid Staffordshire Hospital and Robert Francis’s historic report has brought to the forefront national concerns and

Quality Account 2013/14

recommendations on re-examining what the NHS does, how it does it and how every organisation can improve further. We take all this into account, and have in this report set out our priorities for improving the quality of care, patient safety, effectiveness and patient experience in 2014/15.

We have aimed high, and believe we can deliver, as achievement will be built from the frontline services up.

”

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 2013/14 and our priorities for continuously improving quality in 2014/15.

We are determined to achieve a sustainable, financially stable and efficient organisation. Quality is the foundation of everything we do in delivering safe and effective services and we recognise that quality is both a clinical and business priority for a successful healthcare organisation.

It is important as we move into financially challenging times that we balance our drive for quality, productivity and efficiency, with the right support and development for staff so that they feel engaged, valued and empowered in leading and driving quality across the organisation.

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 pride they take in doing

Simon Gilby Chief Executive

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b  Section 1

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Foreword from the Board

Quality Account 2013/14

This Quality Account aims to assure our patients, commissioners and local population that we provide services that get the basics right, and which are safe, effective, caring, responsive and well led.

Our priorities for 2014/15 are set out in this report and have been developed to meet the expectation of the NHS Constitution, the expectations and priorities in the Mandate for the Government to NHS England, and the measures in the NHS Outcomes Framework and our commissioners.

Our priorities for 2014/15 are: • Pressure ulcer care • Preventing harm • Continuous quality improvements • Vulnerable children • Patient experience • Staff experience • Integrated care • Continuing healthcare

Quality Account 2013/14

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b Section 2

Performance overview 2013/14

Last year we set objectives relating to our four quality themes:

b Delivering b Patient

care

experience

b Getting

staffing right

b Staff experience

In 2013/14 we identified and achieved specific objectives under each of these themes:

Delivering care...

Dementia care

Leg ulcer care

Objective:

Objective:

90% or above of community nursing patients aged 65 and over to be screened for potential signs of early dementia.

Introduce new bandaging which is more comfortable to wear and easier to walk in whilst still supporting early healing rates at 15 weeks for 70% of patients.

Achieved:

Achieved:

• Over 90% of community nursing patients were successfully screened for potential signs of early dementia and referred to their GP

• Our community nurses have healed over 90% venous leg ulcers within 15 weeks over 2013/14

• A new pain scoring chart has been introduced especially designed for patients who have been diagnosed with dementia to provide timely pain relief when required, improving quality of care • The trust is working in partnership with the Achieving Quality Alliance (AQuA), which aims to improve the quality of healthcare, to spread best practice across services to improve care delivered to patients with dementia and support for their carers

• A new bandaging system has been introduced which is more comfortable to wear and easier to walk in. We now work with patients to select dressing options which best meet their needs • New equipment has also been purchased to improve the quality of monitoring patients after their leg ulcer has healed to help prevent a further leg ulcer developing

Pressure ulcer care Objective: Work in partnership with colleagues in care homes to reduce the development of pressure ulcers.

Achieved:

Dr Ewen Sim, Medical Director and Sandra Christie, Director of Quality and Nursing.

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• Our community nurses have worked in partnership with care home staff to develop a shared care plan for all new patients who were identified as being at risk of developing a pressure ulcer

Quality Account 2013/14

Children with complex needs Objective: Undertake a full review of the standards of healthcare delivered by our Health Visiting Service for children with complex long term conditions and identify how we could improve the parent’s experience.

Achieved: • Health visitors have achieved over 90% of best practice quality care standards for parents who have children with complex long term conditions • Specialist health visitors have worked with families to produce a new information bulletin explaining how to access additional resources and support.

Parents stories have been gathered to help listen to parents views and deliver services that best meet their needs

Quality Account 2013/14

“

There is our health visitor who I can always phone.

I even spoke to her this morning; it feels like you are speaking to a friend.

She helps us all the time with everything.

”

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b Section 2

Performance overview 2013/14 Preventing harm – the NHS safety thermometer

End of life care Objective: Maintain our best practice standards for end of life care patients in community nursing and improve family and carers experience when a loved one is dying.

The NHS Safety Thermometer is a national quality improvement target, measuring ‘harm free’ care from the patient’s perspective.

Objective:

Achieved: • Community nurses have achieved over 90% of the best practice quality care standards for end of life care patients and their families • We have listened to national public concerns regarding the Liverpool Care Pathway and introduced a more personalised care plan • We have listened to carers to learn from their experiences about how care can be improved • We have provided education sessions in care homes to ensure patients receive consistently exceptional care wherever they receive it

“

Use 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)

Achieved: During 2013/14 we achieved the national target of delivering 95% harm-free care to our community patients and were identified as the safest community trust in England to have submitted data to the national database.

The Trust has achieved a reduction in the number of community acquired pressure ulcers and took part in a very successful STOP pressure ulcer day event.

The community nurses had a scoring system where they could measure my mums pain because mum couldn’t actually describe her pain, her speech had gone mostly towards the end. It was called the Abbey pain chart, which I thought was very good. It did

”

seem to work out quite well.

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Infection prevention and control Objective: To have no avoidable healthcare associated infections caused by our services and that we would work with other organisations to reduce infections.

Achieved: We had no avoidable healthcare acquired infections in our services.

b Duty of Candour The Duty of Candour means that all NHS organisations will be required to tell patients if something goes wrong with their care - this is set out in the NHS Constitution.

Being open with patients when something goes wrong is a key part of our safety culture.

Quality Account 2013/14

Additional safety information Never Events Never Events are serious, largely preventable, patient safety incidents that should not occur if the right processes are in place.

We had zero Never Events in 2011/12, 2012/13 and 2013/14.

Significant Untoward Incidences (SUI) Serious incidents requiring investigation in healthcare are rare, but when they do occur the Trust has processes in place to respond to them that protect patients and ensure a robust investigation is carried out. This results in the Trust learning from the incident and minimising the risk of the incident happening again, During 2013/14 we reported 11 SUI’s. All SUI’s are fully investigated. Themes are reviewed and learning from these incidents is 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.

In 2013/14 we had around 1.1 million patient contacts across our core service divisions. During that period 2,277 patient safety incidents were reported. Three of these were coded as high risk and three were coded as unexpected death.

All incidents are fully investigated and learning from them shared across the trust.

New reporting criteria for serious untoward incidents has been agreed with our commissioners and as a result, there has been an increase in reporting which is not directly comparable to the previous annual reporting. This new approach enables the Trust to maximise every opportunity to learn from incidents, demonstrating a culture of patient safety and continuous quality improvement.

Quality Account 2013/14

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b Section 2

Performance overview 2013/14

Patient experience...

During 2013/14 we have worked hard to better understand and learn from our patients’ experience of accessing our services for the first time, and improved the way we collect and manage feedback from both patients and staff to maximise patient safety and experience.

Questionnaires

Patient experience champion

Objective:

Objective:

Increase the number of completed patient experience questionnaires from all clinical services by 10%.

Develop a Patient Experience Champion role in all clinical divisions.

Achieved:

Achieved:

We achieved this increase in patient experience questionnaire returns.

20 Patient Experience Champions have been developed to facilitate and support improvements with colleagues to help ensure that the patient’s experience of healthcare meets their needs and they are shown respect and compassion at every visit.

Patient shadowing Objective: Carry out 12 patient shadowing exercises across our divisions and increase opportunity for patients to tell us about their experience.

Achieved:

Recommendations Objective: 80% of patients telling us about their experience would recommend our services to their friends and family.

12 patient shadows were conducted across our divisions and achieved the following:

Achieved:

• Improved signage on arrival at our continence clinics

97% of patients agreed they would recommend the service they have recieved to friend and family.

• Revision of patient documentation for symptom assessment to ensure continence patients use the documentation better

(From 2014/15 the trust will use the net promoter calcuation from NHS England guidance to calculate the Friends and Family test.

This will ensure that the public can easily compare results between care services).

• Better understanding of the client’s experience of their first health trainer session with the Livewell programme and improved information for clients • Better understanding of the patients perception of their treatment plan when attending leg ulcer clinics.

A hand held patient care plan is now being trialed.

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Quality Account 2013/14

Patient feedback Objective: To review the processes for the management of complaints and concerns.

Achieved: There were 40 written complaints received in 2013/14 compared with 48 written complaints received in 2012/13. 100% of complaints were acknowledged within three working days.

Complaint themes included aspects of clinical care and communication and access.

Improvements resulting from complaints include: • the development of an integrated booking service for patients via a single telephone number • better referral processes and improved signage at some of our sites Patient concerns are received by the Trust through a variety of routes eg e-mail, feedback cards, telephone and via the trust website.

We responded to 100% of concerns and complaints within three working days.

During 2013/14 one formal investigation was referred to the Parliamentary and Health Service Ombudsman in relation to our Trust.

‘ACCLAIM’ Programme In response to the Francis Report (2013), the Trust has developed ‘ACCLAIM’, a patient safety and experience programme to achieve high quality compassionate care. The programme has allowed us to capture patient stories from people who use our services. These stories have been heard by the Trust Board, and Trust staff at team meetings, committee meetings, training and various Trust presentations. Hearing patient stories enable staff to identify with the person telling their story bringing insights and empathy. Here are some examples of where patient stories have a direct impact: • Improved communication with patients about what happens after having an x-ray at the Minor Injuries Unit at Victoria Central Health Centre • A review of the referral documentation in the Wheelchair Service from GPs patient stories • Changes have been made to the appointment booking system within the Podiatry Service • Trust wide implementation of the Abbey Pain Chart which helps staff to assess a person’s pain by their behaviour and non-verbal communication cues in the absence of the patient being able to communicate verbally

Quality Account 2013/14

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b  Section 2

Performance overview 2013/14

Getting staffing right...

Corporate induction Objective: 95% of staff joining the organisation to attend corporate induction within six weeks of their start date.

We achieved 90.9%. We continue to monitor attendance at corporate induction and aim to improve next year.

Mandatory essential learning Objective: 95% of staff to attend Mandatory Essential Learning within the agreed timeframe.

Achieved: Including staff booked on Mandatory training for completion within agreed timescales, we have achieved 95% attendance this year.

Local induction Objective: 95% of staff joining the organisation to complete their local induction within 6 weeks of their start date.

Achieved: 98.8% of staff completed thier local induction within six weeks of their start date.

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Quality Account 2013/14

Staff experience...

Annual appraisal

Job satisfaction

Objective:

Objective:

95% of eligible staff to have an annual appraisal.

A 0.05* increase of staff reporting job satisfaction in the national NHS staff survey.

Achieved:

*This objective is measured against a scale summary score rather than a %. The minimum score is always 1 and the maximum is 5.

96%* of eligible staff had an annual appraisal. *The annual appraisal figure was the highest score of any community trust.

Achieved: The 2013 staff survey showed a decrease from 3.70 to 3.65. Nevertheless, we continue to be above average as the national average for community trusts was 3.60.

Personal development Objective: 95% of eligible staff to have a personal development plan.

Achieved: 96% of eligible staff had a personal development plan.

Staff sickness Objective: Reduce the staff annual sickness rate to the national NHS target of 3.4%.

We have had a strategy in place to improve attendance since 2012 and we recognise that there is still work to do to ensure we manage all forms of absence consistently and robustly. In 2013/14 the sickness rate for the organisation was 4.7%.

This was higher than we had aimed for and we are putting in place incremental targets for 2014/15 and 2014/16 to provide a realistic but stretching objective.

Recommendations Objective: A 5% increase in staff recommending the Trust as a place to work or receive treatment.

In 2012 60% of staff said they would recommend the trust as a place to work. This figure was the same in 2013. The national average was 54% In 2012 73% of staff said “If a friend or relative needed treatment, I would be happy with the standard of care provided by this organisation�. In 2013 this increased to 76%. The national average was 66%.

Reporting concerns Objective: 95% staff reporting that they know how to report concerns regarding fraud and malpractice in the National NHS staff survey.

Achieved: We achieved 97%.

Quality Account 2013/14

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b Section 2

Performance overview 2013/14

b Staff Council The Staff Council influences what happens in our Trust and helps to shape the organisation’s culture. Here is just a snapshot of things they have influenced or been directly involved in: • judging the annual Staff Awards • setting up an IT User group • re-introducing a staff retirement letter • membership recruitment • staff listening events • contributing ideas to the development of staff benefit schemes including the Lease Car Salary Sacrifice scheme

b Staff awards The annual staff awards recognise and celebrate the excellent work of staff in all areas of the Trust. This year we received over 75 nominations from a broad section of clinical and non clinical teams and the winners were selected by panels of staff and public members.

b Clinical forum We have introduced a new Clinical Forum to provide an opportunity for clinicians to champion new initiatives.

It will assist in the development of clinical leadership among the body of multi-professional clinicians across the Trust and provide support in driving service change and improvement.

b Learning and Development b Opportunities One of the Trust’s quality objectives is to have sufficient numbers of staff with the right competencies, knowledge, qualifications, skills and experience to deliver our vision and values. This is essential to ensure that all staff are fully equipped to deliver world class healthcare.

In particular we are supporting our non-registered care staff to access training opportunities in the fundamentals of care as recommended by the Cavendish Review (July 2013). This means they will have bespoke training to ensure they have the skills and knowledge to fulfil their roles safely - this will be in addition to their mandatory training.

We plan to develop a Fundamentals of Care certificate over 2014 - 2015 which will include some of the following sessions depending on the patients needs: • wound care training • venepuncture training • dementia care training • caring for palliative care patients • patient experience training to ensure we meet and exceed patients expectations • immunisation training The certificates will be for support staff in nursing and those working within allied health professional teams as they play a valuable role in delivering quality health care.

b E-learning E-learning across all health care settings is increasing.

The benefits include: • Staff can access the learning at a time of their choosing • It decreases travel time, which releases time for staff to care for patients • It reduces travel costs at a time when all funding has to be used wisely • Nationally developed training uses evidence based practice so staff have the most up to date skills and knowledge • This type of training helps the Trust monitor training so we can support all staff

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Quality Account 2013/14

b The National Core Skills Training b Framework In 2013/14, the Trust signed up to the UK Core Skills Training Framework (Skills for Health, 2013). The Framework provides guidance on the minimum standards expected for organisations delivering training in the mandatory subject areas of: • NHS conflict resolution • equality, diversity and human rights • fire safety • health, safety and welfare • infection prevention control • information governance • moving and handling • resuscitation • safeguarding adults • safeguarding children

Responding to local priorities and national drivers In 2013/14, we have continued to respond to the Prime Ministers’ Challenge on Dementia. Our aim is to increase earlier diagnosis by providing staff with the appropriate knowledge and skills to provide excellent care for ‘anyone and everyone’ effected by dementia. By March 2015 it is projected all relevant front line clinical staff will have received dementia care assessment training and clinical support staff will have undertaken awareness raising e-learning modules.

We have built on previous training to more effectively support patients, their families and carers nearing the end of their life. Bespoke training is now delivered that enhances the knowledge and skills of staff delivering care after death.

In addition to this bespoke training the Trust has supported 74 places on academic modules at local universities so that staff can respond to the needs of services and patients they care for.

Examples of modules undertaken include: clinical examination and non-medical prescribing modules.

Equipping staff with knowledge and skills in these areas ensures that patients have more timely access to medicines and patient centred care without compromising patient safety.

Preparing the next generation of health care professionals We have close links with North West universities as we prepare the next generation of health and social care professionals. In 2013/14 we provided over 300 community placement experiences for undergraduate medical and dental students, postgraduate medical student (GP trainees), exercise physiology, pre-registration physiotherapy, occupational therapy, dietetic, paramedic, speech and language therapy, podiatry, health visiting, nursing and midwifery students.

Quality Account 2013/14

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b Section 3

Innovation in service delivery

We continue to improve the quality of our services and to ensure they are safe, effective, caring, responsive and well led. Below are some examples of how we developed in these areas during the last 12 months. b Safe

b Caring

Our Leadership and Patient Safety Walk Rounds ensure frontline staff have the opportunity to engage on a frequent basis with the Trust Board and Executive Team, to discuss patient safety in clinical practice at the point of care delivery.

Highly commended at the Health Service Journal (HSJ) and winners of Best NEW Initiative at the Trust staff awards, the work of the Speech and Language Therapy Service has changed the lives of many under 5’s across Wirral.

The purpose of the walk rounds are: • Increase the awareness of safety among all clinicians • Obtain and act on information gathered that identifies areas for improvement • Promote a learning culture to ensure the delivery of safe clinical services • Encourage an open culture of incident and near miss reporting and learning from experience • Build communication and relationships with frontline staff • Establish local solutions to minimise risk

b Effective We have developed a programme of Rapid Improvement Events where internal facilitators work with individual teams to ‘make radical changes to current processes and activities within very short timescales’ (NHS Institute for Innovation & Improvement). Teams are encouraged to take ownership of their processes and make changes that have a positive impact and improve efficiency and effectiveness.

Each solution is assessed against risks and impacts to: • patient safety

Nationally, 50% of children enter school with below average speech and in areas of deprivation this figure is as much as 83%*. As a result, these children are less likely to access higher education and employment.

Working in partnership with Wirral Council, the Speech and Language Service developed a strategy to improve and support speech, language and communication in the early years. The strategy focused on providing training in pre-school settings, children’s centres and schools to help early identification of young children with speech, language and communication needs.

Practitioners were given resources to start intervention without needing to wait to see a Speech & Language Therapist. Assessments were relocated to their local school rather than a clinic. Schools were given opportunity to buy in additional speech & language therapy to support a whole school approach to speech, language and communication.

As a result, all of the 18,500 under 5s in Wirral have access to screening and intervention (either at 2 years through Health Visitors, in pre-school/daycare or on starting school). There are now fewer children needing to be referred to the Speech and Language Therapy Service (reduction of 500 last year (25%) and children with specific speech & language difficulties are being seen more quickly.

• patient experience • and the quality of the service delivered.

*figures according to children’s communication charity I CAN

Final approval for any rapid changes proposed is provided by the Trust’s Director of Quality and Nursing.

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Quality Account 2013/14

b Responsive The NHS needs to plan for, and respond to, a wide range of incidents and emergencies that could affect health or patient care. These could be anything from extreme weather conditions to an outbreak of an infectious disease. The Civil Contingencies Act (2004) requires NHS organisations, and providers of NHS-funded care, to show that they can deal with such incidents while maintaining services.

In order further develop resilience the trust took part in a number of training exercises including ‘high tide’, a severe weather event.

As part of winter planning 2013/14 the Trust worked in partnership with other health providers to manage demand at peak time including integrated working at Accident and Emergency helping to achieve the four hour target in Wirral for the period October to December 2013, including the busy Christmas period.

b Well led The relationship between leadership and performance is critical and leads to a good organisational culture.

This culture helps create staff satisfaction and loyalty which then leads to a sustainable, high performing organisation.

The responsibility for leadership does not simply sit with the board, it runs through the whole organisation. We are committed to engagement across all levels of the organisation and in 2013/14 we held a series of 18 ‘Listening Events’ whose purpose was to provide our staff with the opportunity to share their ideas, thoughts and feedback on what we do, the way we do it and be part of shaping and leading the organisation.

In addition, business planning events were held across all the different services to support the planning of future services development and quality improvement.

This created a shared ownership amongst staff of how the Trust will develop as an organisation in delivering value for money and an exceptional level of service to our patient population.

Quality Account 2013/14

“

Each and every person I was involved with showed respect and concern. All were cheerful and eager to help in my recovery.

”

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b Section 4

Quality assurance of the services we offer

Our aim is to deliver high quality services. In this section we tell you about how we measure and assess the quality of our services.

Internal assurance b Frontline Focus

b Clinical audit

In 2013/14 we undertook 60 Frontline Focus visits which enable the trust to review quality care provided to patients.

These visits have resulted in improvements in:

We successfully completed 36 clinical audits over 2013/2014. The key quality outcomes included:

• infection prevention and control standards • management of patient information and privacy settings on computer screens • translation services for patients in our primary care settings, making them more easily available and improved patient experience feedback forms

• Community Nursing Service redesigned the way they monitor best practice standards for patients who require treatment for their leg ulcers • Wheelchair Service identified innovative ways to prevent pressure ulcers for patients and promote patient safety • Health Visiting Service updated their Family Health Review documentation in line with best practice

Following the quality assurance visits we were able to raise awareness of the:

• Staff in the Dental Service updated their consent form in line with Department of Health new guidance for adults who lack the capacity to consent to treatment

• importance of offering all patients a feedback card so we can learn from their personal experiences of our services

• An increase in the number of clinical staff having clinical supervision which helps promote a culture of quality, care and compassion

• need for some services to undertake new training to assess nutritional needs of patients at risk of developing pressure ulcers • essential quality standards for being bare below the elbow to reduce potential risk of infections • quality standards for providing translation services for patients when required

b Infection prevention and control b audits The infection prevention and control audit is an essential component of the Trust’s infection prevention and control framework. It allows us to benchmark both environmental standards and clinical practice against national best practice standards, and compliance with internal policies and procedures, to ensure safety and quality.

In addition, there is a programme of quarterly observational audit of key clinical interventions.

Effective hand hygiene is one of the most important ways to prevent the spread of infection and our hand hygiene audits continue to report compliance at 99%.

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Quality Account 2013/14

b MIAA audit programme Throughout 2013/14, Wirral Community NHS Trust worked with Merseyside Internal Audit Agency (MIAA) to test out how good some of our processes are. MIAA have looked at our quality and governance system and have given a rating of significant assurance that we have a good quality framework in place.

b Professional revalidation Revalidation is the process by which registered nurses and midwives are required to regularly demonstrate to the Nursing and Midwifery Council that they remain fit to practice. A new process is currently being developed and is due to be implemented during 2015.

b Feedback from students on b placements Feedback from students has been obtained through a range of methods across professions. In 2013/14 a pilot exercise was undertaken to obtain more timely feedback on placement experience using an online questionnaire.

The use of this tool will be rolled out across the organisation in 2014/15 as one of a range of feedback methods.

Based on feedback we develop action plans, and where students have specifically raised concerns relating to quality of care, information is also reported externally to the Cheshire, Warrington and Wirral Quality Surveillance Groups.

“

Thank you for making my time on placement a great experience.

I feel that I have learnt so much

”

from you all!

Quality Account 2013/14

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b Section 4

Quality assurance of the services we offer

External assurance b Care Quality Commission The Care Quality Commission (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 by all care providers. We are registered with the CQC without exceptions.

In 2013 the CQC carried out routine inspections of our services in the following areas: • Eastham Walk-in Centre • Victoria Central Health Centre Walk-in Centre • Arrowe Park Dental Service, General Anaesthetics Sedation Service • Clatterbridge Dental Service • Devonshire Park Dental Practice The inspections identified that we met all of the standards assessed including: • quality and suitability of management.

• staffing • care treatment and support that meets people needs • treating people with respect and involving them in their care • caring for people safely and protecting them from harm As part of the inspection process the CQC inspector spoke with patients and the report particularly highlighted the extremely positive patient feedback that the inspectors received.

For more information about the work of the CQC and to find details of inspection reports on our services visit the website www.cqc.org.uk

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“

I found everybody most helpful and can only say how grateful I am for the treatment I have had. Thank you very much.

”

Quality Account 2013/14

b  Information Governance During 2013/14 the Trust maintained level 2 compliance with the National Information Governance Toolkit requirements.

96% of staff completed on line information governance training.

Patient information leaflets are provided to all new users of the Trust’s services at first contact. This details how we collect, use and securely share information when necessary as part of the patient clinical care pathway.

Quality Account 2013/14

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b Section 5

Bringing high quality services closer to home

We continue to support the NHS direction to reduce hospital admissions by providing high quality services in the community. b Integration

b Our role as a trust

The Wirral health and social care system is under increasing financial pressure, and it is becoming more challenging. The traditional efficiencies will not be enough to ensure high quality and affordable health and care services continue in the future and alongside the financial pressures, the demand for local services is increasing.

Community services are pivotal to enabling new models to develop, which is reflected in our position as a lead organisation within this programme.

Locally, leaders of health and social care have agreed to work in partnership to develop a health and social care strategy called ‘Vision 2018’.

b Vision 2018 Vision 2018 is about providing better services and outcomes for our patients, empowering them to manage their health and wellbeing, reducing inefficiencies and tackling the expected financial shortfall the NHS and social care faces in Wirral.

As part of this vision we need to transform the way we provide community care, to ensure we are working as efficiently as possible, and we will need services that empower patients to manage their health and wellbeing.

People will share in the decision-making process about themselves and their care and support.

b Seven day working

Key priorities are: • The ability to monitor key indicators of clinical practice through the creation of a care dashboard based on the delivering care outcome measures. This will provide assurance to the Trust Board of the quality of the clinical services provided by the organisation • Increasing the use of technology by our clinical staff particularly helping those working in patients’ homes to work more flexibly and more effectively by increasing mobile working and their ability to access patients’ information remotely. This will help improve the integration of patient care • To focus on those parts of the care network which require our specialist skills, where we can use our specialist clinical expertise and resources most effectively • To support other parts of the care network, particularly primary care, so that more patients can be helped and supported in primary care, without needing to access specialist secondary services, unless they are clinically required

The links between community, residential and hospital services will be improved, with care delivered through integrated services seven days a week that are joined up around the needs of patients. This integrated care will be provided across the community, bringing specialised care and treatment (when appropriate) into community settings near patients’ homes, to enable the right care to be provided at the right time and the right place, with patients supported to self-care as appropriate.

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Quality Account 2013/14

“

I am most grateful to the staff for their professional and sympathetic approach and for access to this invaluable service.

Quality Account 2013/14

�

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b Section 6

Volunteers and membership

We aim to engage people in the life of our trust to benefit our patients and wider community. We have over 4500 public members and regularly involve them in events and surveys. We also benefit from having many volunteers who enhance patient care and we are investing in the future by providing work placements for young people in Wirral. b Members

b Volunteers

We want membership to be useful, interesting and personal. Members can specify how they want to be involved with our Trust when they join.

During 2013/14, over 100 volunteers gave their time to help the Trust, working across 11 of our services. Two charities, the League of Friends and Wirral HeartBeat entirely run by volunteers operate on our sites and raise funds to benefit our patients. We support these charities by recruiting and training their volunteers.

Through online surveys we gain member feedback on a range of topics. Members also took part in the judging panels for our staff awards.

We held regular member events and in 2014/15 we will be focusing on providing opportunities for members to help us improve the quality of our services.

This will involve: • holding four member events that include an interactive session to discuss improving some aspect of Trust services • inviting members to participate in six online surveys • giving members the opportunity to take part in ‘Welcome Visits’ to assess the quality of our care settings

Last year we focused on improving the placement development and recruitment process. Our aim is to identify those placements that will be of the greatest benefit, both to the Trust and the volunteer. Our volunteer placements are now advertised on our website so that potential volunteers can apply for the placements that are of most interest to them.

We have also introduced: • a uniform for patient-facing volunteers • a volunteer handbook • a volunteer agreement • a volunteer supervisors’ bulletin • new placement induction and evaluation forms Our aims for 2014/15 are to: • maintain a population of 50 – 100 volunteers across the Trust • expand the number of services providing volunteer placements

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Quality Account 2013/14

b Work placements As well as hundreds of clinical work placements, the Trust also trialed non-clinical work placements for students aged 16-18.

The aim of the placements was to help young people in Wirral expand their knowledge of NHS careers, get experience of the workplace and maybe inspire some future employees!

An NHS careers evening was held at St Catherine’s Health Centre in February 2014. All GCSE students on Wirral were invited. This landmark event, held in partnership with Wirral University Teaching Hospital NHS Foundation Trust and Cheshire & Wirral Partnership NHS Foundation Trust received very positive feedback from students, staff and schools. It has led to work placements being continued for 2014/15 and also promoted to sixth form students in four partner institutions and to young members.

The Trust is also planning to extend the range of support it provides to young people by facilitating NHS Cadetships in some of its departments.

Quality Account 2013/14

“

Student comments:

Loved each and every part of all I have done… fabulous insight into the NHS. I’m now thinking about a clinical career…

A welcoming, positive and supportive team.

”

Nothing to improve upon… a brilliant experience. I learnt a lot.

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b  Section 7

Objectives for 2014/15

Our clinical development plans and am informed by our overall vision and our strategy. They are as follows: Strategic objective Our patients & community

We will deliver safe and effective patient care.

We will deliver a positive experience of our services.

Reducing inequalities will be integral to all service development and delivery.

We will further develop and maintain a competent, capable, caring and responsive workforce.

Our services

We will lead the delivery of out of hospital integrated care.

We will deliver the expectations of our commissioners and demonstrate quality and value.

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Our people

We will deliver transformation supported by innovation and research.

Our sustainability

We will optimise the use of our resources.

Quality Account 2013/14

bitions for the future have been commissioning partners’ future Quality goals 2014/15

Priorities for 2014/15

Meet the project milestones for safe staffing

Pressure ulcer care

95% of staff feel confident and able to raise concerns about patient safety and effectiveness of care

Vulnerable children

95% of complaints and concerns responded to in three days

Patient experience

10% increase in patient experience Friends and Family Score of 60 or above Staff confident to raise concerns about patient safety and NHS fraud Access to Integrated and Coordinated Care Team

Preventing harm

95% Clinical Audits completed

Integrated care

NICE standards implemented

Continuing healthcare

60 Front Line Focus Visits completed 95% Harm Free Care 95% staff to have annual appraisal and development plan

Staff experience

Implement staff Friends and Family Test 95% staff to attend corporate and local induction 95% staff to attend core mandatory training Decrease in staff sickness rates to 4.2% 75% eligible staff to receive flu vaccine 95% staff to complete Information Governance training Achieve level 2 on IG toolkit

Continuous quality improvements

Implement Practice Development Research Partnership Establish funding stream for Innovation and Research Implement Continuous Quality Improvement Programme Our quality goals for 2014/15 are based on our organisational strategic objectives and our quality model within our Quality Strategy. The model recognises that our patients are at the heart of all we do and our staff are vital to the delivery of high quality community based services. It also recognises that sustainability underpins quality and that we are working with our local community and Health and Wellbeing Board to create the conditions for improved health and wellbeing.

Quality Account 2013/14

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b Section 7

Objectives for 2014/15

Our people In achieving these goals our staff will play a vital role.

We aim to support the individual, the team and the organisation. Take a look at some of the plans and actions for this year in more detail. b Workforce planning

b Staff development

A critical part of how we will achieve these aims is outlined in our Workforce Plan for 2014/16. This sets out the changes in staffing levels for the next two years, taking account of the key pressures and opportunities facing the Trust.

We want to develop staff who are enthusiastic and committed. We will do this by providing education, training and development that equips our leaders and the workforce with the necessary knowledge and skills to perform in changing times and through exemplary employment practices enhance the health and wellbeing of the workforce.

• Requirements of safe staffing • Drive to integrate services across health and social care to benefit the health economy • Service plans and developments

b Safe staffing Following the Francis Report (2013) and the Berwick Review into Patient Safety, the National Institute for Health and Care Excellence (NICE) has been asked by the Department of Health and NHS England to produce guidelines on safe staffing capacity and capability in the NHS. Safe staffing within the Trust is a key focus for 2014/15 with levels agreed for nursing in the early part of the financial year. We will ensure safe staffing is in place when there are reductions in the workforce due to annual leave, training, sickness and maternity.

The Trust requires all staff to have an annual appraisal and agreement of a personal development plan. We have performed well in the last two years in relation to the level of appraisal completion (98%), however the development of a new appraisal system for implementation in 2014/15 will achieve four key aims: • Improve the quality of appraisals ensuring all staff receive structured feedback on their performance • Ensure all staff have an individual Personal Development Plan in place which identifies both future potential and areas for development.

• Provide a clear link between individual objectives/ performance and the objectives/performance of the team and organisation • Link the achievement of key performance objectives with incremental pay progression

b Staff sickness Staff sickness absence is one of our workforce priorities as we recognise the impact it has on safe staffing and team morale, as well as to the financial bottom line. We have had a strategy in place to improve attendance since 2012 and we recognise that there is still work to do to ensure we manage all forms of absence consistently and robustly.

In 2013/14 the sickness rate for the organisation was 4.6%.

This was higher than we had aimed for and we are putting in place incremental targets for 2014/15 and 2014/16 to provide a realistic but stretching objective.

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Quality Account 2013/14

Supporting statement from HealthWatch Wirral

b Section 8 

Supporting statement from HealthWatch Wirral Members of the Healthwatch Wirral Quality Accounts sub group met with Sandra Christie, Director of Quality & Nursing and Director of Infection, Prevention & Control on 10th January 2014 to discuss the Quality Account for The Wirral Community NHS Trust for 2013/14.

Healthwatch Wirral would like to thank Wirral Community NHS Trust for the opportunity to comment on the Quality Account for 2013/14. The sub group met on 16th April 2014 to compile this response.

Healthwatch Wirral were pleased that the Trust had taken on board their comments at the meeting with Sandra Christie and her deputy, Paula Simpson.

The Quality Account was presented in a user friendly format and it was pleasing to see that a list of services provided by the trust was included in the document.

Delivering care The Trust should be commended for identifying and achieving objectives in delivering care under the specific themes, especially Dementia care and Children with complex needs. They should also be commended for giving a clear description on performance

Quality Account 2013/14

against the 13/14 objectives but may want to include comparative data in next year’s account.

Patient experience Healthwatch Wirral are pleased that the Trust have continued with their range of patient experience activities including the development of the ACCLAIM patient safety and experience programme as the programme uses learning from patient and staff feedback to improve services.

Compliments and complaints It is commendable that the Trust have received fewer complaints during this year and that 100% were acknowledged within 3 days. We noted that improvements resulting from complaints include the development of the integrated booking service via a single telephone number and improved referral processes.

Healthwatch Wirral would like to see more evidence of the learning from complaints and concerns including the impact of the Board hearing patient stories.

2013/14 the sickness rate for the organisation was 4.7% which was higher than the Trust target.

Healthwatch Wirral will be particularly interested to hear the impact of the planned introduction of safe staffing establishments on the quality of care provided during 2014/15.

Innovation and quality assurance Quality assurance, internal and external regulations were noted.

Healthwatch Wirral look forward to hearing how the innovations will be further developed in the coming year.

Objectives for 2014/2015 Healthwatch Wirral look forward to receiving quarterly reviews from the Trust on progress with the implementation of the Quality Account and the impact on patient care, in particular safe staffing, getting staff right, staff experience and integration, including 7 day working.

Karen Prior Healthwatch Wirral Manager

Getting staff right and staff experience We were pleased that the Trust continue to invest in staff development but it is disappointing to see that in

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b  Section 9

Statement from Clinical Commissioning Group

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.

Patient experience: We commend the Trust on the use of different ways to gain insight into the patient and the development of the ACCLAIM programme. This will ensure the recommendations made in the Francis report will be embedded into the organisation, which in turn will lead to safer patient care.

This account reflects quality performance in 2013/14 and clearly sets out the direction regarding quality for 2014/15.

Getting staff right: 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.

We acknowledge the achievements made in achieving the objectives set last year regarding: Delivering care: We welcome the Trust’s focus and note the performance in dementia screening. The reduction in pressure sore formation remains a priority for the CCG and the work that is being undertaken between the community trust and care homes is a positive step forward.

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Staff experience: It is noted that the staff sickness levels are at 4.7% which is higher than the national average.

We acknowledge that the Trust will strive to improve this in 2014/15 and this will be monitored throughout the contracting year.

Looking forward in 2014/15, the CCG is reassured that the priorities for improving quality that have been identified by the Trust are priorities for the CCG. 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 2014/15.

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.

Phil Jennings Chair, Wirral CCG

Quality Account 2013/14

Statement from Local Authority

b Section 10

Statement of support Wirral Council The Families and Wellbeing Policy and Performance Committee undertakes the health scrutiny function at Wirral Council. The Committee has established a Panel of Members (The Health and Care Performance Panel) to review the draft Quality Accounts received from health partners. Members of the Panel met on 29th April 2014 to consider the draft Quality Account and received a verbal presentation on the document.

Members would like to thank Wirral Community NHS Trust for the opportunity to comment on the Quality Account 2013/14. Members provide the following comments:

Overview Members acknowledge the excellent performance of the Trust as measured against the targets for 2013/14.

Members are reassured that the Trust achieved the major objectives that they set out last year under the headings of delivering care, patient experience, getting staffing right and staff experience. The number of initiatives based on patient experience, documented within this Quality Account, demonstrates a positive approach. Council Members look forward to working in partnership with the Trust during the forthcoming year and would welcome the opportunity to receive regular updates regarding progress towards achieving next year’s objectives.

Section 2 Performance Overview 2013/14 Delivering care Pressure ulcer care Members particularly welcome the work that is being developed by the Trust to support care homes to develop improved care for residents, in particular with regard to pressure ulcers. Members are keen for the programme of support for care homes to expand, with the ambition being for this work to become embedded with a larger number of care homes.

Preventing harm – the NHS safety thermometer The Trust is to be commended for achieving the national target of delivering 95% harm-free care to their community patients and being identified as the safest Community Trust in England to have submitted data to the national database.

Patient experience Positive patient experience is demonstrated by over 95% of patients saying that they would recommend the Trust’s services to their friends and family. An effective complaints system is also an important feature for managing patient experience.

Members welcome the achievement of 100% of concerns and complaints being responded to within three working days. The 40 written complaints received during 2013/14

are also recognised as being a low figure and shows a reduction from the previous year.

Getting staffing right and Staff experience Annual appraisal The Trust appears to place a very high priority on motivating and developing the potential of staff. It is noted that, during 2013/14, 96% of eligible staff received an annual appraisal.

Members commend the Trust for achieving the highest score for all Community Trusts in the country.

Reporting concerns Particularly in the post-Francis environment, it is important for all health providers to develop a culture where staff are able to raise concerns with management. Members, therefore, welcome the achievement of 97% of staff reporting that they know how to report concerns regarding fraud and malpractice in the National NHS staff survey; although this in itself does not necessarily mean that they will be willing to do so.

Staff Sickness The sickness rate of 4.7% for 2013/14 is noted to be higher than the national NHS target (and the Trust target) of 3.4%. However, it is recognised that the Trust has set a target to reduce sickness rates to 4.2% for 2014/15.

continued over ...

Quality Account 2013/14

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b  Section 10 continued Learning and Development Opportunities In response to the Francis Report and the Cavendish Review, the emphasis that the Trust is placing on providing opportunities for staff training in the fundamentals of care is welcomed.

The priority placed on dementia care training for staff is particularly appreciated. The intention to ensure that patients with dementia receive care from staff who are appropriately trained in dementia care is pleasing.

Section 5 Bringing high quality services closer to home With regards to future planning, the emphasis and commitment placed on

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service integration and the Vision 2018 programme is welcomed by Members.

Section 7 Objectives for 2014/15 Members acknowledged that the 2013/14 objectives included a number of targets, under the ‘delivering care’ heading, which included dementia care, leg ulcer care, pressure ulcer care, children with complex needs, end of life care, the NHS safety thermometer and infection prevention / control. Members are disappointed that such specific examples of the level of care are no longer included among the objectives for 2014/15.

Members note that a number of the other Quality goals are replicated from 2013/14. As the targets were exceeded in 2013/14, the question is raised as to whether performance is being sufficiently stretched in the forthcoming year.

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

Quality Account 2013/14

b Our services

Wirral Community NHS Trust b Our

Services

24 Hour Community Nursing Service Centralised Booking Community Equipment Community Dental Community Discharge and Liaison Community Therapy & Falls Prevention Continence Deep Vein Thrombosis GP Out Of Hours GP Practices (All Day Health Centre at Arrowe Park and Leasowe Primary Care Centre) Health Visiting Heart Support Independent Living Centre Infant Feeding Livewell Programme Minor Injuries Unit Nutrition & Dietetics Ophthalmology Palliative Care Parkinson’s Disease Phlebotomy Physiotherapy & Rehabilitation Podiatry Sexual Health Wirral Single Point of Access Speech & Language Therapy Tissue Viability Walk-in Centres (Eastham, Wallasey and the All Day Health Centre at Arrowe Park) Wheelchair Service

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

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

Quality Account 2013/14

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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: T: 0151 514 6311 Freephone: 0800 694 5530 or patient.experience@wirralct.nhs.uk

www.wirralct.nhs.uk