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Avon and Wiltshire Mental Health Partnership NHS Trust

Quality Account 2014/15

Contents Part 1: Chief Executive’s statement on behalf of the Board Introducing Avon and Wiltshire Mental Health Partnership NHS Trust (AWP) Part 2a: Our priorities for improvement in 2015/16 Priority 1: To improve service user and carer experience Priority 2: To improve the clinical effectiveness of our services Priority 3: To reduce avoidable harm Priority 4: To improve the physical health of our patients Priority 5: To provide services that are compliant with the Care Quality Commission’s (CQC) Fundamental Standards of care Part 2b: Statements relating to quality 2.1 Review of services 2.2 Participation in clinical audits 2.3 Participation in clinical research 2.4 Commissioning for quality and innovation (CQUIN payment framework 2.5 Care Quality Commission (CQC) registration 2.6 Quality of data 2.7 Safeguarding Part 3: Our care quality achievements in 2014/15 3.1 National indicators 3.2 Patient Experience - How we did 3.3 Effectiveness – How we did 3.4 Safety – How we did 3.5 Service user, carer and patient experience 3.6 Learning from incidents 3.7 Patient environment 3.8 Staff survey Part 4: How we developed our Quality Account APPENDICES Appendix A: External assurances and comments Appendix B: Glossary of terms Appendix C: Statement of Directors’ Responsibilities Appendix D: Information by Clinical Commissioning Group Area Appendix E: More information on quality indicators This document is available on our website

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Part 1: Chief Executive’s statement on behalf of the Board Our absolute focus is on improving the quality of our care and the services we provide. I am therefore pleased to introduce on behalf of our Trust Board, our sixth Quality Account. This document summarises the quality improvements we have made to the safety and effectiveness of our services and highlights our focus on improving the experiences of those who use them. The central purpose of our Trust is to provide the highest quality mental healthcare that promotes recovery and hope. This Quality Account describes the progress we have made over the last twelve months and outlines our quality priorities for the coming year. These have been shared with our staff, service users, carers and commissioners; so that everyone is aware of the steps we are taking and the impact we want them to have. The past year has been one of consolidation but also one with significant challenges for us. We have continued to embed the changes we in 2013 with our clinically and locally led service delivery units that are providing services which respond more quickly to the needs of their local communities. Our real time quality improvement system has continually evolved to meet the end user’s needs and the support provided to our operational services by our central quality improvement function has been commended. The Trust has dealt with the increased demands made on mental health as well as a national shortage in qualified nursing staff. The impact of these issues has meant our wards not always having beds available to admit people as close to home as they should be. Also some of our wards have had to temporarily close beds where we do not have enough qualified people to staff them safely. Additional pressures on the overall health and social care system have contributed to patients who are ready for discharge being delayed in mental health beds because suitable alternative beds have not been available. We are working with our commissioners and local authorities to resolve these issues. In June 2014 the Trust received an inspection from the Care Quality Commission’s Chief Inspector of Hospitals. The inspection was comprehensive and, as well as identifying areas of good practice and praising our staff for their compassion and caring attitudes, we were notified of areas of significant concern where we were required to make improvements. These priority areas were: the safety of the environment of our inpatient wards, particularly in relation to ligature risk; ensuring safe staffing numbers and improving our systems and processes to ensure organisational action and learning from incidents, reviews or other sources of information. To make these improvements the Trust implemented a comprehensive plan of action and internally tested our compliance by way of independent visits and developmental support from specialist staff. In December 2014 the Trust was re-inspected by the CQC to test our improvements and we are pleased that these met the CQCs expectations. In addition to these areas the Trust continues to work on the findings of the CQC report as we recognise that we still have more to do to ensure that we have fully embedded the necessary improvements in to our clinical practice and service provision. We are not prepared to stand still. We strive to maintain a culture of continuous quality improvement through ward and team self-assessment, a programme of mock inspections and quality visits and a comprehensive programme of clinical audit. 2

In last year’s Quality Account we set out our Quality Priorities for the year and we are pleased that our work in these areas has progressed well. Our inpatient services were successfully accredited with the Carers Trust Triangle of Care in May 2014 and our community services are ready to apply in May 2015. We have increased the number of service users taking part in the Friends and Family Test service user survey and ensured that our services have listened and responded to this valuable feedback. The physical health of our most seriously ill patients has been a key area of focus ensuring all inpatients receive a thorough physical health check and that we work with GPs and other health professionals to ensure safe and coordinated treatment for both physical and mental health conditions. In the past year we have continued to achieve against the majority of our contractual and national quality performance indicators as well as delivering successfully the quality improvement incentive schemes agreed with our commissioners, however we know through the experience of the CQC inspection that we cannot be complacent. We must continuously strive to improve what we do. We will check and check again how we are doing, to ensure that we routinely provide safe, clinically effective and caring services. In the coming year, we have identified a series of quality in response to the feedback of our regulators, commissioners, our service users and carers’ and our staff. Our objective is to deliver high quality services Trust wide, which are clinically led, locally driven and quality focused and to support this we have set following Quality Priorities for 2015/16:      

We will deliver high quality services Trust wide and aim to achieve a CQC rating of at least ‘good’ across all inpatient, community and specialist services We will continue to implement the ‘Safewards Model’ and reduce the need for restrictive interventions and improve the use of positive and proactive approaches to care and above all to improve the safety of our wards To provide services that our service users would recommend to their friends and family and continue our work to improve our partnership working with carers To improve the clinical effectiveness of our approach to assessment and care planning Implement a new electronic patient record and improve how we record our clinical practice We will continue our work to make sure that that we give equal attention to the physical health of our service users as we do to their mental health.

Our service delivery units will also be continuing to focus on key local areas for improvement in partnership with their patients, service users, carers and commissioners. We have maintained open and honest relationships with our local communities, the people who use our services, NHS commissioners, GP Commissioners and local authorities over the last year. We will build on these relationships to ensure that we improve and develop our services in response the needs of our local communities. I verify to the best of my knowledge that the information in this document is an accurate and true account of the Trust’s quality of services. Iain Tulley Chief Executive

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Guidance to help you when reading this document: 1. We have used a “traffic light” system to rate how well we have done against the standards we have set for ourselves. These are: Red

Standard not met / poor result

Amber

Standard nearly met / adequate result

Green

Standard met / good result

2. We have also used arrows to show the direction of change against target level over the past year as follows: ▲ = Improving ► = No change ▼ = Deteriorating 3. There is an explanation of some terms in the glossary in Appendix B.

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Introducing Avon and Wiltshire Mental Health Partnership NHS Trust (AWP) AWP is a major provider of recovery focused mental health services. Our objective is to be the organisation of choice for service users, staff and commissioners alike, providing a comprehensive range of specialist Mental Health services in primary, secondary and tertiary care settings, across our existing geographical area. AWP provides services for people with mental health needs, for people with learning disabilities combined with mental health needs and for people with needs relating to drug or alcohol dependency. We also provide secure mental health services and work with the criminal justice system. We operate from more than 100 sites across Bath and North East Somerset (B&NES), Bristol, North Somerset, South Gloucestershire, Swindon and Wiltshire, as well as providing specialist services for a wider catchment extending across the South West. We are committed to the delivery of safe, accessible, effective, leading edge, innovative and person-centred services which intervene early and effectively and concentrate on recovery and reablement. We work together with our health and social care partners to provide service users with increased choice in the way they receive support and care which is closer to their homes and to avoid, where possible, disruptive inpatient stays. In 2014/15 the Trust’s community services saw 31,685 individuals from just over 36,000 referrals, and had more than 301,405 contacts with service users (either via the telephone or face to face). In addition, 2,212 people were admitted into our inpatient units for more intensive treatment. Our turnover in 2014/15 was £198m and we employed an average of 3298 (whole time equivalent) staff from a variety of professional backgrounds including psychiatrists, psychologists, mental health nurses and allied health professionals. Fundamental to delivering quality services is continuing to embed the principles of the NHS Constitution within the organisation. This constitution sets out rights of patients, public and staff, pledges which the NHS is committed to achieve, together with responsibilities which the public, patients and staff owe to one another to ensure that the NHS operates fairly and effectively.

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Part 2a: Our priorities for improvement in 2015/16 Our Trust aim is to deliver high quality services Trust wide, which are clinically led, locally driven and quality focused. Set out below are the priorities we are planning to deliver in the year ahead which will be monitored and reported through the Trusts internal quality governance and assurance systems and as required to our Clinical Commissioning Groups’ contract quality governance meetings.

To provide services that are compliant with the CQCs Fundamental Standards of Care

Improve service user and carer experience

To consistently deliver high quality services which are clinically led, locally driven and quality focused Improve patient safety by reducing avoidable harm

To improve clinical practice: assessment formulation and care planning

Improving how we record our clinical practice in the electronic patient record

Improved physical health care through comprehensive health checks

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Priority 1: To improve service user and carer experience Description of issues and rationale for prioritising Understanding the experience of our service users and carers is key to informing how we make adjustments and improvements to our services to meet the needs and expectations of those using them. The Carers Trust ‘Triangle of Care’ Membership Scheme is a recognised as a way to demonstrate our commitment to working in partnership with carers. The actions we will take in 2015/16 are set out in the table below: Improvement Priority To provide services that our service users will be confident to recommend to their friends and family if they required similar treatment.

Actions Development of a new Service User and Carer Involvement Strategy developed in partnership with our service users and carers Complete an in depth thematic analysis of patient feedback and findings from incident reporting The use of the Friends and Family Test (FFT) as a mechanism for gathering realtime service user feedback Improved use of technology to gather service user feedback Development of survey tools to improve the accessibility of the FFT

To enhance carers experience through improved partnership working and carer support.

We will continue to use the Carers Trust ‘Triangle of Care’ self-assessment improvement tool across the Trust and take forward identified improvement actions Implementation of our Family Friends’ and Carers Charter Rolling out carer awareness training across all teams Simplifying carer recording processes on RiO

Success measures Delivery of new strategy endorsed by our Trust-wide Involvement Group Evidence of actions completed to address themes from thematic analysis Evidence of local improvement actions in response to the patient and carer experience 90% of our service users will recommend our services via the ‘Friends and Family Test’ Consistent response rates of 15% for community services across all of our service delivery units

Submission for phase two Triangle of Care accreditation Triangle of care improvement plans in place for 100% of teams and wards 95% of carers asked if they have a carer or person who supports them 85% teams completed carers awareness training

Updating and improving carer information on Carers pages of internal and external website

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Priority 2: To improve the clinical effectiveness of our services Description of issues and rationale for prioritising Clinically effective care is about providing the right care, at the right time and achieving the right outcome. We know from our clinical audit programme, patient feedback, incident investigations and our regulators that we can do more to improve our clinical practice to achieve the best possible outcomes for our service users. The actions we will take in 2015/16 are set out in the table below: Improvement Priority

Actions

To ensure that all service users receive a comprehensive assessment including formulation, assessment of risk, and have a clinically effective care plan that is agreed by the service user

Training and development of staff on formulation, assessment and care planning.

Audits of the clinical record demonstrate that 85% of records have formulation summary recorded.

The clinical toolkit will be reviewed as per yearly review cycle.

95% of service users records include a risk assessment

Guidance on recording assessments and formulations for clinicians will be refreshed following the introduction of open RiO. Checklists for managers will be developed which will enable the review of assessments, formulation and care plans. These will be used monthly. Development of clinical networks to advise on clinical effectiveness and standards

To improve the quality of the electronic patient record (EPR) to aid and reflect clinical practice and decision making

Development and agreement of Trust standards for the completion of a good quality patient record Tailoring of the new EPR to the needs of service users and staff

Success measures

90% of service users have crisis and contingency plan 85% of service users care plans contain the following elements:     

statement of need which has been identified during assessment goals interventions with timescales evidence of service user and carer involvement in the development of the care plan are agreed and signed by the service user

New records management standards agreed by end of September 2015 85% compliance with monthly audits of the clinical record Improved scores in staff feedback survey on use of the EPR

Implementation of a new EPR Delivery of training

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Priority 3: To reduce avoidable harm Description of issues and rationale for prioritising Providing services that are safe and free from harm is our highest priority. We know from themes reappearing in our findings from incident investigations that we need to do better to truly listen, learn and act when things go wrong. ‘Sign up to Safety’ is a campaign that aims to make the NHS in England the safest healthcare system in the world, building on the recommendations of the Berwick Advisory Group. The ambition for the NHS in England is to halve avoidable harm in the NHS and save 6,000 lives as a result. Investigations into abuses at Winterbourne View Hospital and Mind’s Mental Health Crisis in Care: physical restraint in crisis (2013) showed that restrictive interventions have not always been used only as a last resort in health and care. During the coming year we will continue our work to implement the new Department of Health best practice guidance to ensure service user and staff, safety dignity and respect. The actions we will take in 2015/16 are set out in the table below: Improvement Priority Listening to patients, carers and staff, learning from what they say when things go wrong and taking action to improve patients’ safety. Our aim is to reduce avoidable harm by 50% in line with NHS England’s ‘Sign up to Safety’ campaign to save lives and reduce harm for patients over the next 3 years. To reduce the use and need for restrictive interventions and improve the use of positive and proactive approaches to care

Actions

Success measures

We will develop and deliver a patient safety improvement plan and set out our actions to meet the Sign up to Safety pledges:

Achieve CQC rating of ‘good’ in the safe domain

1. 2. 3. 4. 5.

Put safety first Continually learn Honesty Collaborate Support

8% reduction in falls leading to a fracture Maintain and improve our position in the top 25% of organisations by the rate of incidents reported. Evidence of discharging our duty of candour for 100% of serious incidents 90% of actions completed on the Patient Safety Development Plan

Implementation of Department of Health Guidance ‘Positive and Proactive Care: reducing the need for restrictive interventions’. Adoption of the 2015 update of the Mental Health Act 1983: Code of Practice

*

‘Safewards Model’ implemented on all wards 15% reduction in all restrictive practices 10% reduction in the use of seclusion above 8 hours duration Improved score for national inpatient survey question ‘Do you feel safe?’

*

A model of care designed to reduce the use of restrictive practices such as restraint or rapid tranquilisation. 9

Priority 4: To improve the physical health of our patients Description of issues and rationale for prioritising The severely mentally ill (SMI) patient population makes up five per cent of the total population but accounts for 18 per cent of total deaths. There is an excess of over 40,000 deaths among SMI patients which could be reduced if SMI patients received the same healthcare interventions as the general population. We will continue to prioritise work this year to ensure that our highest risk patients receive comprehensive physical health checks whilst in our care and that appropriate action is taken when issues are identified alongside the communication of all identified physical and mental conditions to the GP. The primary aim is to reduce premature mortality, improve patient safety, patient experience and quality of life, through shared communications and coordination of treatments. The actions we will take in 2015/16 are set out in the table below: Improvement Priority *To reduce premature death and improve the physical health condition of severely mentally ill patients and ensure physical health needs are identified and treated.

Actions All inpatients will receive a comprehensive physical health assessment within 72 hours of admission to a ward The full implementation of appropriate processes for assessing, documenting and acting on cardio metabolic risk factors for patients with schizophrenia in our wards and early intervention (EI) services. All inpatients will receive a daily assessment of their physical health condition.

Success measures Meeting 90% (inpatient) and 80% (EI) compliance with the completion cardio metabolic risk factors assessed via the National Audit of Schizophrenia Improved score for national inpatient survey question ‘Do you feel enough care was taken of your physical health needs?’ 95% of inpatients with physical health assessment within 72 hours of admission 85% of inpatients receive daily physical health assessment

Care plans to fully reflect actions to address lifestyle and physical health needs *Ensuring that discharge summaries and care plans are shared with GPs and include comprehensive information including diagnosis, medications, physical health conditions and recovery interventions.

Development of comprehensive guidance and training for clinical practitioners on the inclusion of diagnosis, medications, physical health conditions and recovery interventions in care plans for inpatients

Meeting 90% compliance assessed by a local audit of care plans Improved score for national inpatient survey question ‘Do you feel enough care was taken of your physical health needs?’

*Part of the 2015/16 CQUIN (Commissioning for Quality and Innovation) scheme which is where Trusts can earn additional income dependent on the delivery of a set of measured quality improvement objectives. Details are set out at the following link: http://www.awp.nhs.uk/media/725392/cquin-scheme-2015-16.pdf

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Priority 5: To provide services that are compliant with the Care Quality Commission’s (CQC) Fundamental Standards of care. Description of issues and rationale for prioritising The Government’s response to the Francis inquiry included new measures aimed at improving openness and transparency, and setting minimum standards of care. From April 2015 the Department of Health and CQC have developed a new approach to regulating, inspecting and rating health and social care services based on new Fundamental Standards regulations that set clear standards below which care must never fall. We have work to do to make sure that we understand the new regulations and to make sure that our services are fully compliant with them. We want to build on our progress last year when we introduced a new approach to continuous quality improvement developing local clinical leadership and accountability. Above all we believe that we are beginning to change the culture of our teams and wards to own the quality of the care they provide and to strive to continually improve it. The actions we will take in 2015/16 are set out in the table below: Improvement Priority To ensure that all services are compliant with the CQC Fundamental Standards of care

Actions Self-assessments of compliance at ward and team level Development of a dashboard to provide information at ward and team level to inform improvement activity Locally led and independent/peer review quality walk around programme Mock inspections and independent compliance checks ‘15 steps challenge’ visiting programme Quality improvement training and specialist support for projects Quality improvements plans in place for all service delivery units

Success measures To receive no CQC compliance actions at inspection across all five key questions: Is the service:     

Safe? Caring? Effective? Responsive to people’s needs? Well-led?

95% of wards and teams are taking part in the selfassessment 20% increase in the number of registered quality improvement projects

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Part 2b: Statements relating to quality The Trust’s approach to quality improvement is set out in our Quality Improvement Strategy 2013 to 2017. (Available on our website http://www.awp.nhs.uk/newspublications/publications/trust-strategies/) The strategy builds on our commitment to be a Trust which is driven by quality, clinically led and which is heavily influenced by the views of patients and carers. Our approach to quality improvement is supported by: •

an organisational environment focused on quality improvement

•

a defined ‘Quality Assurance Framework’

• delivery through quality priorities owned and developed by delivery units and Corporate Directorates. The plans also seek to improve quality systems and processes, including those underpinning functions essential for delivering high quality care, such as finance and human resources. The following statements provide information to show that the Trust is performing to essential standards, that we measure our clinical processes and performance and are involved in national projects to improve quality. The Board and it’s Quality and Standards Committee receive and review assurance and progress reports on a regular basis.

2.1

Review of services

During 2014/15 AWP has provided NHS inpatient and community mental health services organised across eight service delivery units, including: 

Specialised and specialist drug and alcohol services



Secure services



Locality led service delivery units across the six local authority areas we serve which provide inpatient and community mental health services to adults.

The Trust has reviewed all the data available to it on the quality of care in the above NHS services. The income generated by the NHS services reviewed in 2014/15 represents 100% of the total income generated from the provision of NHS services by the Trust during 2014/15.

2.2

Participation in clinical audit

National Clinical Audit is designed to improve patient outcomes across a wide range of mental health conditions. Its purpose is to engage all healthcare professionals across England and Wales in systematic evaluation of their clinical practice against standards and to support and encourage improvement and deliver better outcomes in the quality of treatment and care. In mental health there are a number of audits run by the Royal College of Psychiatrists Prescribing Observatory for Mental Health (POMH) and the National Clinical Audit and Patient Outcomes Programme (NCAPOP).

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During 2014/15, one national clinical audit and one national confidential enquiry covered NHS services that AWP provides. During that period AWP participated in 100% of the national clinical audits and 100% of national confidential enquiries in which it was eligible to participate. The national clinical audits and national confidential enquiries that AWP was eligible to participate in during 2014/15 are set out in table 1 below. The national clinical audits and national confidential enquiries that AWP participated in during 2014/15 are set out in table 1 below. The national clinical audits and national confidential enquiries that AWP participated in, and for which data collection was completed during 2014/15, are listed below in Table 1 alongside the number of cases submitted to each audit or enquiry as a percentage of the number of registered cases required by the terms of that audit or enquiry.

Table 1 – Participation in National Clinical Audits *National Audit Topics that AWP was eligible to participate in

AWP involvement

** Cases submitted / cases required

POMH 9c Antipsychotic Prescribing for People With a Learning Disability

YES

55

National Confidential Inquiry into Suicide and Homicide by People with Mental Illness

YES

43/53

*Table 1: Showing the National Audits the Trust was eligible to participate in, those it did participate in, and the level of completion of data requirements. POMH- Prescribing Observatory for Mental Health (Royal College of Psychiatrists) ** No set number of cases are required

2.2.1 Quality improvement actions from national clinical audit The reports of four national clinical audits were reviewed by the Trust in 2014/15 and AWP intends to take the following actions to improve the quality of healthcare provided: National Audit of Schizophrenia This audit of 84 cases, 14 service user surveys and 12 carer surveys, from 24 teams showed improvements on the previous audit and results were generally better than the national average. Areas for improvement were: use and recording of advance decisions; recording of physical health indicators; recording of smoking cessation advice; antipsychotic polypharmacy rates. Actions on physical health were address through the implementation of the National Mental Health CQUIN. Polypharmacy was addressed by medical directors. Improvement actions relating to recording and use of advance decisions remain to be implemented fully. POMH 4b: Prescribing of Anti-dementia Drugs This audit of 342 cases from 16 teams showed high levels of compliance with the standards. No improvement actions were required.

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POMH 12 b: Prescribing for People with a Personality Disorder Data for 155 service users was returned by 10 teams. Results were acceptable, similar to the national picture but had improved since the previous audit. The main concern was weak documentation of decisions to prescribe antipsychotic medication. No actions were needed beyond sharing results for discussion with governance groups. POMH 14a: Prescribing for Substance Misuse: Alcohol Detoxification POMH 14a audited the quality of alcohol detoxification for mental health inpatients needing an unplanned detox. There are 20 to 30 such cases per year in AWP, 15 were audited. Whilst numbers are low alcohol detoxification is dangerous and needs careful management. Areas for improvement are being addressed by the Dual Diagnosis Consultant Nurse and Specialist Consultant by revisions to detox protocols. 2.2.2 Quality improvement actions from local audits The reports of some 60 local clinical audits were reviewed by the Trust in 2014/15 and AWP intends to take a number of actions to improve the quality of healthcare provided. AWP-079-15 Positive Cardio metabolic Indicators in Schizophrenia (National Mental Health CQUIN) Considerable work was carried out to implement assessment of cardio metabolic risk factors. This audit looked at the assessment and interventions for smoking, drug use, alcohol use, body mass index, blood glucose and blood lipid levels (8 indicators in total). We reviewed our results locally and compliance was very high with 1306 of 1400 interventions or tests being done. Compliance was 93.3%. Data was returned for 100 required service users. Of these 88% of service users had all 8 indicators met. Actions were not required, and this work will continue in 2015/16 to our early intervention teams. 74 providers participated in the CQUIN with a range of scores: 0-100; the national average score: 39.52%; 2/3 of providers scored less than 50%. Scoring 52% AWP are placed at the 72nd percentile and in to the top 3rd of Trusts. AWP-077 Transitions Between Oxford Health Child and Adolescent Mental Health Services (CAMHS) and AWP Adult Mental Health Services & Re-audit of Transition Protocol in Swindon, Wiltshire and BANES CAMHS This audit looked the interface between AWP and Oxford Health Trust in three localities. Oxford Health reviewed 28 patients and AWP 26. Compliance with the protocol was generally high and areas of suboptimal compliance were low risk. Actions were to establish joint clinics, create shared lists of patients over 17 years of age or in early intervention services. These actions have been completed. This audit was highly collaborative and resolved some persistent misconceptions. For example there was a perception that referrals were slow to be picked up and exceeded the four week waiting time limit. However these delays were because of the way referrals were written in advance, asking for care to transfer on the service user’s 18th birthday.

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2.3

Participation in clinical research

The Trust is committed to research being part of everything we do. We support high quality research into the prevention, treatment and management of mental health problems, addictions and dementia and aim to put research findings into clinical practice wherever possible. AWP ensures we give everyone who uses AWP services, their carer’s and families (as well as our staff) the chance to find out about research they could take part in. This forms our pledge to make Research for All. In March 2014 AWP became an Everyone Included Trust, which is our way of making sure everyone has the choice to receive information about research. AWP works with the National Institute for Health Research (NIHR) and the West of England Clinical Research Network (WE CRN). The Trust also collaborates locally with universities and acute Trusts through Bristol Health Partners (BHP), the West of England Academic Health Science Network (AHSN) and the NIHR Collaborations for Leadership in Applied Health Research and Care West (CLAHRC West). The Research and Development (R&D) department supports the Department of Health contract for the National Suicide Prevention Programme grant led by Professor Gunnell at the University of Bristol. It also runs the BEST Evidence in Mental Health clinical question answering service in collaboration with the Cochrane Group at the University of Bristol. This financial year AWP has participated in 92 research studies (April 2014 to March 2015) of which 51 were National Institute for Health Research (NIHR) adopted studies. 12 of these studies were sponsored by commercial companies. 41 of these were student and non-NIHR portfolio research. AWP continues to act as a Participant Identification Centre for work with RICE (Research Institute for the Care of the Elderly) and now also works with North Bristol NHS Trust on other NIHR studies. For our last full year of data (April 2013 to March 2014), comparable figures were: 96 active studies in AWP, 45 NIHR studies, 10 sponsored by commercial companies. AWP recruited a total of 978 patients into NIHR studies during this period. The number of patients receiving NHS services provided or sub-contracted by AWP in 2014/15 that were recruited during that period to participate in research approved by a research ethics committee was 701 (correct at 16 March 2015). This represents a 28% reduction in research participation into NIHR studies, the complexity of the studies has dramatically increased by 18% on last financial year.

2.4 Commissioning for Quality and Innovation (CQUIN) payment framework Two and a half per cent of the Trust’s income in 2014/15 was conditional on achieving quality improvement and innovation goals agreed between AWP and any person or body they entered into a contract, agreement or arrangement with for the provision of NHS services, through the Commissioning for Quality and Innovation Payment Framework. During 2014/15 the Trust CQUIN schemes included a series of initiatives agreed locally for each CCG area along with three nationally set schemes. The Trust achieved measurable improvements and received payment for all of the CQUIN schemes. Further details of the agreed goals for 2014/15 and for the following 12 month period are available electronically in an additional document which is available from our website: http://www.awp.nhs.uk/news-publications/publications/quality-account/

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2.5

Care Quality Commission (CQC) registration

AWP is required to register with the CQC and its current registration status is fully registered without conditions. The CQC has taken enforcement action against AWP during 2014/15. AWP has not participated in special reviews or investigations by the Care Quality Commission during 2014/15. Chief Inspector of Hospitals Inspection June 2014 In June 2014 the Trust received a comprehensive inspection, as part of the pilot for the new inspection approach for mental health trusts, led by the CQC Chief Inspector of Hospitals. The Trust was inspected over more than a week by a team of over 70 individuals. The report highlighted areas for improvement as well as recognising the kind, caring and responsive approach of our staff and noted their high skills in the delivery of care. The report also highlights examples of good practice including evidence based practice, centres of excellence in specialist services and motivated clinical leadership. As a result of the inspection the Trust received a report summarising the findings stating that “the trust needs to take significant steps to improve the quality of their services and we find that they are currently in breach of regulations.” Enforcement Actions were issued to the Trust which gave strict timescales for the Trust to make the required improvements. Set out below are the four key areas covered by the enforcement action: 

  

Regulation 10 Assessing and mentoring the quality of service provision - in relation to several examples where the Trust could not demonstrate that it had taken appropriate action or learned from previous CQC inspections or when things had gone wrong Regulation 15 Safety and suitability of premises - for Fromeside medium secure unit in Bristol, in relating to dirty carpets and ligature points Regulation 15 Safety and suitability of premises - for Hillview Lodge acute adult inpatient ward in Bath, about standards of maintenance, décor, cleanliness and lack of privacy and dignity Regulation 22 Staffing - for Fromeside, relating to sufficient numbers of suitably experienced staff

As a result many actions have been completed and improvements made such as increased recruitment, staffing being more closely matched to capacity and needs, an accelerated anti ligature and replacement and refurbishment programme to deal with estate issues, more training and changes to some of our systems. In December 2014 the Trust received a follow up inspection to test whether the improvements had been made in these areas. The Trust is pleased to have been informed that the CQC were satisfied that improvements were made to allow the enforcement notices to be lifted. The report can be found at the following link with full details of the findings. http://www.cqc.org.uk/directory/rvn At the post inspection quality summit hosted by the CQC and the NHS Trust Development Authority (TDA), the CQC expressed its confidence in the leadership of the Trust to resolve the inspection issues and to take the Trust forward. The solution to some 16

of these historic issues will require a co-ordinated push from the Trust, commissioners and social care colleagues as well as support from the CQC and the TDA. Our Trust accepts the inspectors’ conclusions and reaffirms its absolute commitment to delivering consistently the required standards. We are confident that by continuing to work with our commissioners we will strengthen our services and meet the CQC requirements.

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2.6

Quality of data

The Trust has a comprehensive and systematic approach to the management of the quality of data held on its patient information system RiO, which is used for reporting. The quality of the electronic patient record is audited monthly via the Trust’s Records Management audit, which requires senior clinicians to review five randomly selected records and to rate them against 10 criteria. This is supported by a suite of ‘completeness’ metrics that check that key information is available for all patients accessing services and that staff are entering data into the system in a timely manner. Results for these indicators are reported internally to Board Committee and Board and externally to Commissioners each month and team / ward level information is available in ‘real time’ to allow managers to track their performance. Results are presented in table 2 below. Performance across the quality audit and the completeness metrics remains strong, however 2014-15 has seen a dip in performance for the timeliness of data entry. We understand this fall to be due to pilot work we are undertaking to improve the recording of telephone contacts. Table 2: Data quality measures

Target level

2013/14

2014/15

Records Management: monthly audit (local indicator)

75%

84%

87.1%



Data completeness - core fields for patient identification (national indicator)

97%

99.9%

99.9%

►

Data completeness - outcome fields (national indicator)

50%

81.2%

79.6%

▼

Data quality: completion of NHS number (national indicator, new for 2014-15)

99%

NA

99.9%

Data quality: completion of ethnic category (national indicator, new for 2014-15)

90%

NA

100%

Data quality: completion of risk assessment (local indicator, new for 2014-15)

85%

NA

99.9%

Data quality: completion of crisis, relapse and contingency plans (local indicator, new for 2014-15)

85%

NA

89.5%

Data timeliness - system updated in three days of actual event (local indicator)

95%

95.1%

93.2%

▼

 The Trust will be taking the following actions to improve data quality:  

We will continue to complete the Records Management audit on a regular basis, but will review the focus of the audit and the targets to ensure both remain relevant and are supporting continual improvement in record keeping. Completeness metrics for all nine protected characteristics will be provided routinely in 2015/16, allowing for further analysis (meeting the requirements of the Equality Act).

18

Our performance against other key areas of data quality is as follows: The Trust submitted records during 2014/15 to the Secondary Uses Service for inclusion in the hospital episode statistics which are included in the latest published data. The percentage of records in the published data which included the patient’s valid:  

NHS number was 100% for admitted patient care. General Medical Practice Code was 100% for admitted patient care.

The Trust’s Information Governance Assessment report score overall for 2014/15 was 77% and was graded satisfactory (green). AWP was not subject to the Payment by Results clinical coding audit during 2014/15 by the Audit Commission.

2.7

Safeguarding

The Trust continues to regard safeguarding as a priority to protect the people, their families and the communities we work with. AWP remains an active member of the safeguarding multi agency partnerships in our area, including Safeguarding Children and Safeguarding Adults Boards, Domestic Violence partnerships, †MAPPA Strategic Management Boards and Contest and Prevent partnerships. This year there have been significant developments in safeguarding that have led to further development work in the Trust including the on-going actions following the Savile reports, changes to the law including the placing of adult safeguarding on a statutory footing and the Supreme Court judgements in relation to Deprivation of Liberty Safeguards for adults under our care, emerging new issues, including female genital mutilation, child sexual exploitation and modern day slavery, as well as lessons from our own internal investigations in to serious incidents. The Trust has also been involved in working with local authorities, commissioners and local multi agency safeguarding partnerships to develop a range of improvements in safeguarding practice and policy. The Trust has implemented procedures, systems and training, with over 900 staff receiving counter terrorism Prevent ‡HealthWRAP training by the end of 2014/15. The Trust has seen a continuing rise in casework in this area. 2014/15 has seen a rise in safeguarding activity levels with nearly 2000 contacts to the safeguarding team from practitioners during the year. This rise in activity is due to increases in safeguarding statutory duties, the number and complexity of safeguarding partnerships, safeguarding governance requirements and serious case review processes. In 2015/16 we prioritised improvements in the following areas:

†

Multi-Agency Public Protection Arrangements (MAPPA) is the name given to arrangements in England and Wales for the "responsible authorities" ‡

HealthWRAP is the prescribed Home Office/Department of Health training package for Prevent (as a key part of the government’s CONTEST counter terrorism strategy) 19



Planning for the implementation of the Care Act 2014, including the new statutory duties and roles , and the change to person centred adult safeguarding



Planning for the implementation of the new CQC revised regulations on Safeguarding (draft Regulation 13)



Commencing use of the new safeguarding function within the RiO and ensuring effective recording of safeguarding information in other electronic patient record systems



Delivering the detailed actions set out in the Safeguarding Children, Safeguarding Adults at Risk, Domestic Abuse, MAAPA, Prevent and Historical Abuse action plans in the Trust.



Managing the increased demand for safeguarding activity, including safeguarding cases management and enhanced safeguarding governance activity with safeguarding partnerships and commissioners

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Part 3: Our care quality achievements in 2014/15 The Trust has a robust performance and quality improvement strategy. From Board level to frontline services, quantitative and qualitative information is scrutinised covering the areas of patient experience, effectiveness and safety. Reports are reviewed monthly by the Board, and across the Trust, including external scrutiny by our commissioners and a range of care forums. This approach has helped to systematically improve the quality of services. Trust’s quality surveillance system, called ‘Information for Quality’ (IQ), reports data at ward and team level up to local area service delivery unit and Trust level. The system reports across seven key domains as an early warning system to identify areas for improvement. In this section, we describe: 

what we achieved during the year across the areas of patient experience, effectiveness and safety and,



how we have progressed with our quality improvement priorities alongside a series of quality indicators that we routinely use for measuring the quality of services.

For each domain of quality, we have included some measures, as key quality indicators, which show data for the Trust overall. Area level breakdowns to enable local comparison are available in Appendix D and further information on the definitions of the measures used is included in Appendix E.

3.1

National Indicators

Set out in the section below are the national quality indicators that trusts are required to report in their Quality Account. Where the data is made available to the trust by the Health and Social Care Information Centre (HSCIC), a comparison of the numbers, percentages, values, scores or rates of the trust are included. 3.1.1 Care programme approach (CPA) seven day follow up National data - CPA seven day follow up Data Source: Health and Social Care Information Centre (HSCIC)

*Trust Performance Reporting period (for 3 months in quarter)

Quarter 3 2014/15

Quarter 4 2014/15

Number

%

Number

%

484/497

97.4%

454/474

95.8%

Quarter 3 2014/15

Quarter 4 2014/15

National Average

97.3%

97.2%

Highest Score Nationally

100%

100%

Lowest score nationally

90.0%

93.1%

*The national requirement is to report against the previous two reporting periods. The Trust interprets this to be the previous two quarters as reported by the HSCIC.

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The Trust considers that this data is as described for the following reasons: The Trust submits data to the HSCIC for the periods reported and confirm that the reported performance is in line with the Trusts locally reported data. The Trust intends to take/has taken the following actions to improve this percentage, and so the quality of its services, by maintaining robust monitoring arrangements to ensure that key elements of care, such as contacting service users following discharge, are provided routinely to all service users. This approach has led to consistently high performance for this indicator year on year.

3.1.2 Admissions to inpatient services have had access to crisis resolution home treatment teams National data - admissions to inpatient services have had access to crisis resolution home treatment teams Data Source: Health and Social Care Information Centre (HSCIC)

*Trust Performance Reporting period (for 3 months in quarter)

Quarter 3 2014/15

Quarter 4 2014/15

Number

%

Number

%

177/185

95.7%

162/177

91.5%

Quarter 3 2014/15

Quarter 4 2014/15

National Average

97.8%

98.1%

Highest Score Nationally

100%

100%

Lowest score nationally

73.0%

59.5%

*The national requirement is to report against the previous two reporting periods. The Trust interprets this to be the previous two quarters as reported by the HSCIC.

The Trust considers that this data is as described for the following reasons: The Trust submits data to the HSCIC for the periods reported and confirm that the reported performance is in line with the Trusts locally reported data. The fall in Q4 is related to a change in clinical practice in Wiltshire that has inadvertently caused deterioration in the reported performance. The Trust intends to take the following actions to improve this percentage, and so the quality of its services, by maintaining a robust monitoring process to ensure that key elements of care, such as ensuring that community treatment is considered as an alternative to inpatient care for service users in crisis, are provided routinely to all service users.

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3.1.3 Ensuring that people have a positive experience of care Data is provided for this indicator from the annual Care Quality Commission Community Mental Health Survey. The indicator is a composite, calculated as the average of four survey questions that relate patients’ experience of contact with a health and social care worker. Currently the HSCIC have not published this indicator for 2014. We understand this to be because the survey questions in 2014 were changed and therefore the preceding two surveys from 2012 and 2013 are not able to be compared reliably with the 2014 results. National Data – Patient experience indicator

Reporting Period

AWP Score

England average

Highest score nationally

Lowest score nationally

2013

83.5

85.8

90.9

80.9

2012

85.8

86.5

91.8

82.6

The Trust considers that this data is as described for the following reasons: The data reflects the Trusts current position as benchmarked against other similar organisations. The score is judged by the CQC as ‘about the same’ compared to other Trusts. Further detail on our results for the national Community Mental Health Survey are detailed in section 3.5.3. The Trust intends to take the following actions to improve this score, and so the quality of its services, by: 

using the national Friends and Family Test survey which provides team and ward information on service users’ experience on a monthly basis. This allows quick and focused local responses to specific issues raised and informs Trust wide improvement actions.



ensuring that all Local Delivery Units review the quantitative and qualitative community survey data and plan local actions focused on the areas needing improvement.

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3.1.4 Treating and caring for people in a safe environment and protecting them from avoidable harm Patient safety incident data is collected centrally by the National Reporting and Learning Service (NRLS). Two measures are reported below for the rate of incidents reported per 1000 bed days and the rate of incidents which are categorised as causing severe harm or death.

National Data – Patient safety incident data

Reporting Period (6 months)

AWP Score

Number

England Average

Highest score nationally

Lowest score nationally

Rate

i) Rate of patient safety incidents reported per 1000 bed days 01/10/11 to 31/03/12 01/04/12 to 30/09/12 01/10/12 to 31/03/13 01/04/13 to 30/09/13 01/10/13 to 31/03/14 01/04/14 to 30/09/14

2816

24.16

23.5

86.99

0.00

3026

30.19

23.8

70.29

5.44

2742

27.4

32.3

99.8

0.00

3367

34.47

28.03

67.06

0.00

3538

36.22

28.5

58.69

0.00

3772

41.21

32.8

90.4

7.25

ii) Rate of incidents reported that caused severe harm or death 01/10/11 to 31/03/12 01/04/12 to 30/09/12 01/10/12 to 31/03/13 01/04/13 to 30/09/13 01/10/13 to 31/03/14 01/04/14 to 30/09/14

37

1.3%

1.3%

5.3%

0.0%

59

1.9%

1.6%

9.1%

0.1%

32

1.2%

1.3%

9.4%

0.0%

41

1.2%

1.3%

5.3%

0.0%

18

0.5%

1.1%

5.4%

0.0%

34

0.9%

1.0%

5.9%

0.0%

*Incident data is reported via the National Reporting and Learning Service. Not all organisations apply the national coding of degree of harm in a consistent way, which can make comparison of harm profiles of organisations difficult. Notes

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The Trust considers that this data is as described for the following reasons: The data concurs with our own data and we are pleased to note the increase in reporting (both in terms of numbers and rate per thousand bed days) between 2011 and 2014. We believe that this is as a result of actions taken to ensure continuous improvement, such as thematic reviews and executive led quality improvement visits both of which have encouraged reporting and promoted a patient safety culture. We note that our percentage of incidents causing severe harm or death is below the national average. We are confident that our criteria, for serious untoward incidents, is appropriately inclusive and we are assured through our topic specific benchmark work that all efforts are made to make sure our services are as safe as possible. The Trust is taking the following actions to improve this percentage rate, and so the quality of its services, by: The Trust credits the ease of use of its web incident reporting system together with its promotion of a fair blame culture for the improved percentage rate and it plans to further improve through targeted work across services to challenge incident reporting cultures. 3.1.5 Staff Friends and Family Test Data is provided for this indicator from the annual NHS Staff Survey. The indicator is the percentage of staff who answer either ‘agree’ or ‘strongly agree’ to the question “If a friend or relative needed treatment I would be happy with the standard of care provided by this organisation”. National Data – National NHS Staff Survey - Friends and Family Test

Reporting Period

AWP Score

England average

Highest score nationally

Lowest score nationally

2014

47%

66%

93%

36%

2013

48%

65%

94%

38%

The Trust considers that this data is as described for the following reasons: The question gives us an indication of staff confidence in the quality of care provided. Staff survey results for 2014 are disappointing but not unexpected. Against a backdrop of NHS pressures, CQC scrutiny and criticism, our staff have experienced significant internal change during the year and some have experienced job uncertainty. We have analysed the data from the National Survey as well as conducting a quarterly staff friends and family test surveys.

The Trust is taking the following actions to improve this percentage rate, and so the quality of its services, by: Clear themes emerge from the survey feedback and we have set out our approach to addressing these in section 3.8. 25

3.2

Patient experience - How we did

Understanding the experience of our service users and their carers is fundamental to the Trust making sure that we provide good quality services. We continuously strive to improve quality in response to service users and carers experiences. The Friends and Family Test (FFT) survey was introduced to the NHS in 2012 as a single measure to look at the quality of care across the country, promoting the principle that all people should have the opportunity to feed back about their care and treatment. The FFT is a single question that asks people who use the services whether they would recommend the service to friends and family who need similar care or treatment. In addition it asks them to give the reason for their response; it is these comments that can be used locally to highlight good practice and address concerns much faster than more traditional survey methods. AWP introduced the FFT ahead of the national schedule as a national early adopter pilot site in 2013 and 2014. In 2014/15 our focus was to improve the use of the FFT in our community teams and to ensure that this valuable feedback was being promptly responded to by our teams and wards. Progress with our 2014/15 priorities to improve patient and carer experience Last year, our priority quality improvements for service user and carer experience were:  

To use of the Friends and Family Test service user survey to improve service user experience by taking prompt action at ward and team level in response to regular feedback from service users and their carers Using the Carers Trust ‘Triangle of Care’ framework to improve carers’ experience through improved partnership working and carer support.

3.2.1 The NHS Friends and Family Test (FFT) Aims

Actions

Success measures 2014/15 Outcome

To improve service user experience by taking prompt action at ward and team level in response to regular feedback from service users and their carers

To share our real-time service user and carer feedback from the ‘Friends and Family Test’ with staff, service users and carers in wards, reception areas and via our service user and carer groups.

Evidence of local improvement actions and sharing feedback.

We will develop improvement actions in partnership with our service users and their carers.

Achieved

Improved scores for the ‘Friends and Family Test’.

Progress 2014/15 All Service Delivery units have evidenced how they are sharing feedback and developing improvement actions in partnership with staff, service users and carers locally. We have improved our overall survey response rates from 10.2% in March 2014 to 12.5% in March 2015, achieving 14% in December 2014. The score is based on the percentage of service users who would recommend our services and this has fluctuated over the year around 88 to 90%, moving from 88.8% in March 2014 to 89.7% in March 2015. National data available for February 2015 shows AWP scoring above average at 90.5% ‘would recommend’, compared to the national benchmark for mental health services of 85%. 26

Engagement with the Friends and Family Test The key to success of the FFT as a service improvement tool is ensuring the engagement of staff and service users in the process of receiving and responding to the comments received. To do this we have improved our guidance and promotional materials and supported staff in collating and presenting their feedback. Using the ‘you said we did’ format we have used posters in wards and waiting areas but also involved service users and carers in meetings to review feedback and to help plan actions. We measure this in two ways as shown in Graph 1 and 2 below: i.

Percentage of responses that provide a comment – we have seen an increase over the year from 70% to 79%. This indicates that the majority of services users who respond provide a comment. It gives some indication of the level of confidence that the Trust will listen and act on their concerns. In addition, the majority of feedback received is praise which is motivating for staff. See 3.5.4. for examples of feedback and improvements.

ii.

Response rate – this measures the percentage of service users who have responded to the survey out of those who have had a care review or been transferred or discharged from care. We have improved overall from 10.3% in March 2014 to 12.5% in March 2015 although we have noted a recent fall. Notably our community services have increased from 8.7% March 2014 to 11.3% in March 2015. This is set out in Graph 1 below. In 2015/16 we will continue to improve the consistency of the use of the FFT across all service areas. Graph 1 – Friends and Family Response Rate 2014/15

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Our Friends and Family Scores We score the FFT based on the percentage of responses that would or would not recommend our services to their friends or family. Graph 2 below sets out the range of scores across the year for the percentage who would recommend, this shows a fluctuation through the year with a small overall increase. From January 2015 national data has been published for all mental health Trusts. In February, AWP performed above the national average; 90.5% of service users would recommend our services, compared to 85% nationally. Fewer AWP service users said they would not recommend AWP services than nationally (AWP 2.9%, national 5%). When compared to Mental Health Trusts providing similar services, we are one of the top performers for the number of surveys received. Graph 2 - Friends and Family Scores 2014/15

Note: ‘would recommend’ includes ‘extremely likely’ and ‘likely’. ‘Would not recommend’ includes ‘unlikely’ and ‘extremely unlikely’ Responses not shown were either neutral or ‘don’t know’.

28

3.2.2 Our work with carers and the Carers Trust Triangle of Care In the last year, we have continued our work to improve our partnership working with carers using the Carers Trust ‘Triangle of Care’ toolkit and this will continue into 2015/16. Accreditation for inpatients in phase 1 of the Triangle of Care was achieved in May 2014 and for community teams in phase 2 in May 2015.This relates to improved partnership working on acute inpatient units, rehabilitation units and intensive teams. This scheme is recognised nationally as a way of demonstrating a commitment to working in partnership with carers. All teams and wards have a Carer Champion who has received specialist training and lead the use of the Triangle of Care self-assessment toolkit locally. The toolkit provides a framework based around the six key standards, as below, and supports teams to plan and take actions locally to meet them. The six key standards of the Triangle of Care 1. Carers and the essential role they play are identified at first contact or as soon as possible thereafter. 2. Staff are ‘carer aware’ and trained in carer engagement strategies. 3. Policy and practice protocols re: confidentiality and sharing information, are in place. 4. Defined post(s) responsible for carers are in place. 5. A carer introduction to the service and staff is available, with a relevant range of information across the care pathway. 6. A range of carer support services is available. Aims To improve carers’ experience through improved partnership working and carer support.

Actions We will continue to use the Carers Trust ‘Triangle of Care’ selfassessment improvement tool in all services and take identified improvement actions. Implementation of our Family Friends’ and Carers Charter.

Success measures Membership of Triangle of Care.

2014/15 Outcome Achieved

Evidence of 80% of teams and wards using the toolkit and making improvements.

Progress 2014/15 The Trust submitted evidence for the second phase of the process and was awarded accreditation for community teams in May 2015. Actions identified by the Triangle of Care have been implemented with positive results, including carer training, streamlined processes for recording carer work on the patient record (RiO) and Advance Care Planning for which carers and staff have co-produced an information pack and training.

29

Alongside the efforts at local level, the Trust has maintained a Trust wide Carers’ Forum that has led the Trust’s work with carers and partner organisations. In particular the group has advocated for dedicated time for carers work which has been agreed in four localities. It has also overseen the delivery of specialist carer and family training and ensured that all staff receive local training on carer awareness. Four carers from the Carers Forum represent carer views at the Trust Wide Involvement Group. In the National Community Mental Health Survey 2014 there is a specific question on ‘family and carers’: Have NHS mental health services involved a member of your family or someone else close to you, as much as you would like? 59% said yes, definitely; 25% said yes, to some extent; 14% said no, not as much as they would like. Compared nationally AWP score about the same' as most other trusts for this question. Family, Friends’ and Carers’ Charter This charter was developed in 2014 through co-production with carers and staff. The Charter contains a series of statements that can be measured, to demonstrate AWP’s continuing commitment to working in partnership with carers. Posters with the standards have been developed for display in reception and waiting areas and leaflets containing the Charter will be given to carers alongside any information that is normally given to them. Details are published on the Trust’s website. Carers are offered the opportunity to give feedback on how well these standards are being delivered.

30

3.2.3 Patient experience indicators The metrics below in Table 3 reflect key measures of quality for measuring patient experience. These indicators are measures of access to services for assessment and how we are making reasonable adjustments to meet the needs of those service users with a learning disability; as well as various other elements of patient experience such as:  ensuring inpatient accommodation meets the dignity and privacy needs of all sexes  a score for patient experience from the national Care Quality Commission survey  a staff survey indicator of how our staff feel about the services they provide Table 3: Patient experience – how we did Indicator

Standard

2013/14

2014/15 (numerator / denominator

Service users seen for their first appointment within four weeks of their referral

95%

Compliance to Department of Health standards for eliminating mixed sex accommodation

100%

99%

96.4%

►

(12,764 / 13,246)) 100%

100%

►

All criteria met

Fully met

Fully met

►

NHS community mental health survey patient experience question ‘Overall, how would you rate the care you have received from NHS Mental Health Services in the last 12 months?’

National Average

Achieved

Achieved

►

Staff Friends and Family

National Average 3.55

Below average 3.37

Below average 3.33

▼

Meeting six criteria for access to healthcare for people with a learning disability

Score for staff survey question on staff recommendation of the trust as a place to work or receive treatment

Compliance

The poor performance of the staff survey indicator is a key concern of the Trust Board as this is a key indicator of the quality of our services. Further information on staff experience measures and plans for improvement is included in section 3.8. In 2014/15 the Trust implemented the Department of Health Staff Friends and Family quarterly survey to help us monitor this more regularly.

31

3.3

Effectiveness - How we did

Effective services are defined as providing the right care to the right person at the right time. Progress with our 2014/15 priorities to improve effectiveness Last year, our two priority areas for quality improvements were to improve: 

our approach to formulation in our assessment of service users to help our clinical practitioners develop more clinically effective care plans



the effectiveness of our care pathways and interventions with service users

3.3.1 Improving our approach to formulation Aims To improve our approach to formulation in our assessment of service users to help our clinical practitioners develop more clinically effective care plans

Actions Training and development of staff on formulation. Availability of on-line resources through our clinical toolkit.

Success measures Audits of the clinical record demonstrate that 85% of records have a formulation summary recorded.

2014/15 Outcome Partly achieved March 2015 83.9% of records have a formulation summary recorded

Progress 2014/15 The Trust has completed the planned actions however the success measure does not reflect the desired improvement. The measure above is based on a monthly Records Management Audit for each team which includes a review of records to test if a formulation is present and meets the best practice guidance outlined in the Clinical Toolkit. Scores for this audit at the beginning of the year in April 2014 were at 80.1%. Through the year there have been fluctuations around this level with our end of year results showing a some overall improvement with 83.9% of records reviewed had a formulation recorded. The Trust has developed guidance in the Clinical Toolkit to support staff to develop clinical formulations to inform care planning and intervention. This is available via Ourspace. Team based training in formulation has started to be delivered by Trust psychologists to support this alongside additional training for individuals delivered during 2014. This work will be continuing as part of the improvement work planned for clinical practice of assessment and care planning.

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3.3.2 To improve the effectiveness of our care pathways and interventions with service users Aims Actions Success measures 2014/15 Outcome To improve the effectiveness of our care pathways and interventions with service users.

Delivery of local area quality and service improvement plans to improve the care pathways and interventions provided to service users.

Successful delivery of local area quality improvement plans.

Partly Achieved

Progress 2014/15 During the year our Service Delivery Units have progressed with their local quality plans which were developed to meet the specific needs and priorities of the local health community. We have rated this as partly met because not all of our plans were completed as we had to refocus efforts after the CQC inspection in June 2014. Several of the improvement initiatives were part of the Trusts §CQUIN programme agreed in partnership with commissioners. Some examples of the schemes delivered by area are as follows:       

Implementation of ‘Alcohol Use Disorders Identification Test Consumption tool’. This aids the identification of people who would benefit from reducing or ceasing drinking alcohol. (B&NES) Improved effectiveness of inpatient stay and discharge planning in partnership with other services (Bristol) Transition arrangements with Child and Adolescent Mental Health Care services (North Somerset) Autism early intervention (South Gloucestershire) Acute hospital dementia assessments (Swindon) Review of community mental health services model (Wiltshire) Collaborative multidisciplinary risk assessments involving the service user (Medium and Low Secure Services)

§

CQUIN is Commissioning for Quality and Innovation. It is a scheme whereby Trusts can earn additional income dependent on the delivery of a set of measured quality improvement objectives. 33

3.3.3 Effectiveness indicators This section demonstrates how we are doing on key measures of effectiveness as set out in table 5. These measures are indicators for: 

ensuring service users have a timely review of their care



ensuring assessments are made so that service users are only admitted to inpatient care if no other care in the community is appropriate



monitoring that we are identifying the expected number of cases of psychosis through early intervention for the population of the health community served.

Table 5: Effectiveness – how we did Indicator

Standard

2013/14

2014/15 (numerator / denominator

Annual CPA review (care plan review)

95%

96%

95.6%

▼

(2,668 / 2,791)

Admissions to inpatient services have had access to crisis resolution home treatment teams

95%

97%

95.4%

▼

(752 / 788)

Minimising delayed transfers of care