Devon Partnership - NHS Choices

devonpartnership.nhs.uk

Devon Partnership - NHS Choices

Devon PartnershipNHS TrustQualityAccount2010/11


ContentsPart 1Chief Executive’s Introduction 3Part 2Priorities for Improvement in 2011/12 4 - 5Statements of Assurance 6 - 8Part 3Review of Quality Performance 9 - 23Statement of Directors’ Responsibilities 24Supporting Statements 25 - 28Quality Account 2010/11


Devon Partnership NHS TrustPriorities for ImprovementThe Trust has expressed its aim to provide services that are ‘goodenough for my family’ and the organisation’s long-term strategicobjectives are designed to support the attainment of this goal. In orderfor services to be good enough for our own families the Trust believesthat they have to be:SafeMinimum risk of harm to people and bestpossible quality of careTimelyServices available when people need them,without unnecessary waitingPersonalisedTailored to meet the needs of individuals,and planned with themRecoveryfocusedEmphasising hope, opportunity and theability to exercise control over treatmentand life choicesSustainableMaking best use of our human andfinancial resources, building our reputation,establishing consistency and reducing ourcarbon footprintThe Trust has identified three priorities as quality improvement indicatorsfor 2011/12 in the fields of safety, clinical effectiveness and improvingthe experience of people who use services.To establish these priorities, the Trust set-up a representative groupthat included clinicians, senior managers and representatives fromthe medicines management and safety teams. They were alsoshared with the Quality and Safety Committee, shadow Governorsand non-executive directors of the Board. In addition, the indicatorsthat have been selected reflect the priorities expressed by the Trust’scommissioners and are aligned to the Trust’s Commissioning for Qualityand Innovation (CQUIN) priorities (see page 23 for further details).4Quality Account 2010/11


Devon Partnership NHS TrustPerformance against the prioritieswill be reviewed each month atQuality and Safety meetings andalso considered by the Trust’sBoard of Directors. The Trust’scapacity and capability to deliverenhanced quality improvementwill also be regularly considered atthese groups.Priorities for 2011/12SafetyThe Trust has invested significantlyin medicines management overthe last couple of years and iscommitted to doing everythingpossible to improve quality andreduce errors and mistakes in theadministration of medicines.The goal for 2011/12 is for 95% ofpeople to have their medicineschecked within 72 hours ofadmission to hospital. This will bemonitored through audits ofpeople’s medicines charts.Maintaining good communicationwhen people are transferred fromone place or service to another isa key factor in delivering safe care.The goal for 2011/12 is to followup95% of adults within 48 hoursof their discharge from hospital.This will be recorded on the RiOelectronic care records system.Clinical EffectivenessThe Trust has set-out a clear set ofstandards that relate to the careand recovery of people using itsservices.The goal for 2011/12 is toincrease the percentage ofrecovery standards that arebeing met across the Trust. Thiswill be measured through therefreshed Clinical Record Self-Monitoring tool (see page 11 forfurther details).Improving the Experience ofPeople Using ServicesWhat people say about theservice they receive is one ofthe most important indicators ofquality and whether or not theTrust is getting the basics right.The goal for 2011/12 is toincrease the percentage ofpeople who rate the service asgood or excellent and wouldrecommend it to a familymember. This will be measuredthrough the monthly surveywhich now goes out to 1,000people who use the Trust’sservices.Compliance with NationalPrioritiesThe Trust will strive for continuedcompliance with those prioritiesidentified at the national levelfor all mental health trusts (seepage 9) and, in particular, willbe planning to further minimisedelayed transfers betweendifferent care settings.Quality Account 2010/115


Devon Partnership NHS TrustNo national clinical audit reports were reviewed by the Trust.The reports of 48 local clinical audits were reviewed by the Trust in2010/11 and the Trust is taking the following actions to improve thequality of healthcare provided:• The Trust records specific action points following clinical auditswhich are presented to the Clinical Effectiveness Group on a monthlybasis. The Clinical Effectiveness Group members inform the relevantDirectorate Governance groups in all localities and specialities acrossthe Trust. In addition to this, the Clinical Effectiveness Group isinformed of key issues and any risks identified as a result of an auditare brought to the attention of the Risk Management Team. TheClinical Effectiveness Group also formally reports to the Quality andSafety Committee within the Trust’s governance reporting structure.• The number of people receiving NHS services provided or subcontractedby the Trust in 2010/11 that were recruited during thatperiod to participate in research approved by a research ethicscommittee was 252.• A proportion of the Trust’s income in 2010/11 was conditional onachieving quality improvement and innovation goals agreedbetween the Trust and any person or body with whom it entered intoa contract, agreement or arrangement for the provision of NHSservices, through the Commissioning for Quality and Innovationpayment framework.• The Trust is required to register with the Care Quality Commissionand its current registration status is registered to provide the followingregulated activities: Treatment of disease, disorder or injury;Assessment or medical treatment for persons detained under the1983 Mental Health Act; and Diagnostic and screening procedures.As at 31 March 2011, the Trust has no conditions on its registration.• The Trust is fully compliant with its registration with the Care QualityCommission.• The Trust has not been asked to participate in special reviews orinvestigations by the Care Quality Commission during 2010/11.Quality Account 2010/117


Devon Partnership NHS TrustThe Trust takes the following actions to improve data quality:• Clinicians use online data quality reports to identify and resolveindividual data errors• The Trust complies fully with the Information Governance Toolkitrequirements for data quality and has a data quality policywhich guides action in relation to data quality improvement• Trends are monitored routinely to ensure data quality issues aredealt with• Audits have been, and will continue to be, carried out againstthe data quality of key performance and quality indicators,including those highlighted in this publication.The Trust submitted records during 2010/11 to the Secondary UsesService for inclusion in the Hospital Episode Statistics, which are includedin the latest published data. The percentage of records in the publisheddata:• Which included people’s valid NHS number was 99.28% foradmitted patient care (figures for outpatient care and accidentand emergency care not applicable)• Which included the people’s valid General Medical PracticeCode was 99.64% for admitted patient care (figures foroutpatient care and accident and emergency care notapplicable).The overall score for the Trust’s Information Governance ToolkitAssessment for 2010/11 was 72% and all individual requirements werescored at 2 or above, resulting in a rating of ‘satisfactory’ and a gradingof ‘green’.The Trust was not subject to the Payment by Results clinical coding auditduring 2010/11 by the Audit Commission.8Quality Account 2010/11


Devon Partnership NHS TrustReview of Quality PerformanceLast year, the Trust set out threepriority areas as indicators ofquality improvement. These were:Improving Care PlanningA good, up-to-date personal careplan is a key factor in providinga safe, high quality service forpeople. Our aim for 2010/11 wasto ensure that every person usingthe Trust’s services, if appropriate,had a personal recovery plan thatwas reviewed at least once everysix months.How did we do?Data from the Trust’s ClinicalRecord Self-Monitoring toolshows that more than 86% ofpeople had a personal recoveryplan in place and that morethan 78% of people had hadtheir plan reviewed withinthe past six months. The Trustis continuing with its plans toincrease these percentages.Reducing Slips, Trips and FallsThe organisation is committedto ensuring that every aspect ofa person’s care and treatmentis safe and of a high quality– including their physical care.The Trust’s aim for 2010/11 wasto reduce the number of slips,trips and falls experienced by thepeople in its care.How did we do?The Trust has now developeda falls protocol based onnational best evidence. We arenow focusing on the trainingrequired to ensure that themanagement of slips, trips andfalls is embedded into practiceacross all services.Although there is not yet sufficientdata to demonstrate a sustainabledownward trend, the Trust hasseen a reduction of more than50% in the number of slips, tripsand falls recorded between2009/10 and 2010/11The issue of flooring has beencarefully considered during the£4.6m refurbishment of four ofthe Trust’s older people’s wards.Safety, infection control, slipresistance,ease of cleaning anddesign are all factors that havebeen considered and a floorcovering that appears to meet allof these criteria is currently beingpiloted at one site. In due course,the Trust plans to establish aworking group to review the issueof flooring to ensure consistencyand maximum safety across thewhole organisation.Improving the PatientExperienceWhat people say about theirexperience of the service, or thatof a family member, is one ofthe most important indicators ofquality. The aim for 2010/11 wasfor people who have experiencedservices to say that they wouldrecommend them to a familymember or friend.How did we do?At the end of 2010, the Trustintroduced a regular monthlysurvey which is sent to 1,000people who use services. Theearly results of this are veryencouraging, with more than90% of people reporting thatthey are treated with dignityand respect and almost 90%confirming that they wouldrecommend the service to afamily member or friend (seepage 16 for further details).National complianceThe Trust compliedwith the three nationalperformance indicatorsspecified for all mentalhealth trusts during2010/11:• 96% of peoplereceived follow-upcontact within sevendays of theirdischarge fromhospital (againsta target of 95%)• only 4.4% of hospitalbed occupancywas due to a delayin the transfer ofcare to anothersetting (against atarget of 7.5%)• 97% of peoplereceived anassessment by thecrisis resolutionand hometreatment servicebefore they wereadmitted to hospital(against a target of90%).Quality Account 2010/119


Devon Partnership NHS TrustOther Developments and ImprovementsQuality ImprovementFrameworkThe Trust has developed aquality improvement frameworkbased on the measurementof compliance with standardsand the evaluation of servicesby people who use them. Thesemeasures are combined withother quality and performanceinformation to allow monitoringat the individual team levelthrough the quality performance‘dashboard’. The dashboard,which has been developed overthe last couple of years, enablesteams to see performancedata quickly and easily toassess how they are doingagainst the key indicators andstandards. It also enables theTrust to identify those teamsthat require additional supportto maintain standards, allowscomparisons between teamsand directorates and informs theTrust’s Quality Improvement Plan,which is monitored fortnightlyat the Quality ImprovementCoordinating Group.Care Quality CommissionComplianceAt the end of 2010, the CareQuality Commission (CQC)began a planned review ofthe Trust’s services under itsnew performance assessmentarrangements, which measure theperformance of services against16 essential standards.Every team was requiredto complete a series of selfassessments,known as ProviderCompliance Assessments (PCAs),under each of the 16 outcomeareas, resulting in about 1,700PCAs being completed acrossthe Trust. While this process wasextremely demanding in termsof the time and commitment offrontline staff, it has been a helpfuladdition to the work that wasalready under way to drive-upquality and safety.The CQC made 15 unannouncedvisits to ten locations across thecounty, during which inspectorsassessed the quality and safetyof the care being provided andspoke to staff and people usingservices.The feedback from the CQC,which was received in March2011, was very positive.Commenting on the review, IanBiggs, Regional Director of theCQC in the South West, said:“This has been a very thoroughreview of the services providedfor people with mental illness inDevon. Devon Partnership NHSTrust provides a vital service to alarge population – and overall thetrust has emerged with a clean billof health.”In particular, the CQCacknowledged the significantimprovements that have beenmade to staff supervision andappraisal across the Trust. Lastyear, poor performance in thisarea resulted in a conditionbeing placed on the Trust’s CQCregistration. This condition hasnow been lifted, which leaves theTrust free to proceed with its veryimportant bid to become an NHSFoundation Trust.The CQC did identify someareas where there is still room forimprovement.10Quality Account 2010/11


Devon Partnership NHS TrustThe Trust has already startedto address these and actionplans have been submitted andapproved by both the CQC andthe Board.Concerns were raised at six sitesbut the majority of these wererelatively minor in nature. Moreserious concerns were raised inrelation to the Melrose Unit inTiverton, which was suspendedby the Trust in December 2010because of its own concernsand those of local GPs. The Trusthas, however, worked hard toaddress the issues and the MelroseUnit re-opened on a phasedbasis at the end of March 2011.The longer-term function of theunit is being considered by astakeholder group which includeslocal GPs, Age UK, a local carerrepresentative and cliniciansfrom both the Trust and TivertonHospital.The actions to address the CQC’smoderate concerns regardingone standard at Whipton Hospitaland Langdon Hospital havenow been completed and theCQC has been notified that thisimprovement work has beenundertaken.Teams will continue to use the PCAprocess to assess their compliancewith both CQC and Truststandards. Progress with actionplans is monitored using an impactrating score and exceptions aremonitored by the CoordinatingGroup.Improving Standards of PracticeThe Trust has worked withclinicians, managers and peoplewho use services to set standardsof practice for the assessment,planning, delivery, coordination,and review of care.Quality Account 2010/11Compliance with these practicestandards is now monitoredthrough the review of a monthlysample of clinical records whichis taken by each clinical teamleader or ward manager. TheClinical Record Self-Monitoring(CRSM) tool has been developedfor this purpose and has three keyfunctions:• To provide assurance throughthe team dashboard that thestandards of practice arebeing met• For clinical team leaders to usein their supervision andappraisals with staff• To measure the impact ofthe Care Quality DevelopmentProgramme, a Trust-wideinitiative to underpin the workthat is being done to drive-upquality.The CRSM tool was reviewed withclinicians in February 2011 andteams’ performance is regularlymonitored by the CoordinationGroup. The Trust’s QualityImprovement Plan sets targets forimproved CRSM performance andcompliance with standards andthe implementation of RiO andthe Care Quality DevelopmentProgramme will support continuedimprovement across all practicestandards.The results of the CRSM reviewindicate that the following threeareas are priorities for furthertraining and development:• Clinical risk assessment andmanagement (includingcontingency planning)• ‘Think family’ (improvingsupport for families at risk) andsafeguarding• Routine enquiry for traumaand abuse (including domesticabuse).11


Devon Partnership NHS TrustElectronic Patient RecordsThe Trust has gradually beenintroducing a new records system,called RiO, over the last coupleof years and the system is nowoperational across the majority ofthe Trust’s services. This has beena major project and has involvedthe training of 1,850 staff, as wellas a significant investment in newtechnology and support services.The RiO system, which is widelyused by mental health Trusts acrossthe South of England, replacespaper records and the existingelectronic recording system. Itmeans that the Trust now has anintegrated patient record thatcan follow a person seamlesslyfrom hospital to community, withdifferent healthcare professionalsable to share a single, secure careplan that they can all update inreal time. People who use serviceswill benefit from improved qualityof care and safer services asthe risk of losing paper records,duplicating information andholding multiple records for oneperson is removed.Recovery CoordinationNationally, the Trust is at theforefront of work to embed thenotion of personal recovery andrecovery practice at the heart ofmental healthcare. Much of thematerial that the organisationhas produced is endorsed bythe Royal College of Psychiatristsand is available on its website.Recovery is about building ameaningful life, as defined by theperson themselves, whether ornot there are ongoing problems.It represents a movement awayfrom focusing on illness andsymptoms towards a focus onhealth, strengths and wellness.Over the past year, the Trusthas continued to embed theprinciples of personal recoveryand has placed a sharp focuson the quality of individual careplanning - which is an importantcomponent of the Care QualityCommission’s standards. Thework so far has been particularlyconcentrated in inpatient settings,where a good deal of trainingand development has takenplace to raise the overall quality ofpeople’s care plans.The Trust has also been selected asone of just six pilot sites across thecountry to participate in a newinitiative to put recovery at theheart of mental health services.The Supporting Recovery projectwill use research from the Centrefor Mental Health which sets outten key indicators for organisationsto support the recovery of peopleusing mental health services.It is the result of a partnershipbetween the Centre for MentalHealth, the NHS Confederationand the National Mental HealthDevelopment Unit and is anational initiative.Initial evaluation results will bepublished nationally within 12months. The Supporting Recoveryproject will assist organisations toundertake self-assessments againstten indicators, plan changes andreport their outcomes over twoyears.This work addresses the followingHigh Impact Areas:• More people will receivecare which is, as far as possible,‘self-directed’ and reflects theirpreferred goals and outcomes12Quality Account 2010/11


Devon Partnership NHS Trust• More people with serious orsevere mental health problemswill be able to use their ownexperience and expertiseto manage their symptoms, inpartnership with professionals• More people with serious orsevere mental health problemswill be in employment• More people with seriousmental health problems will beliving in appropriateaccommodation.The Trust offers recoverycoordination master classes andprovides the opportunity for staffto undertake a degree moduleUnderstanding Recovery Principlesand their Application to Practiceat the University of Plymouth. Theexpectation that all staff haveappropriate recovery knowledge,skills and qualities for their work isnow in all job descriptions.The How well is life working out foryou? practice tool helps supportthe principle of being moreperson-led and becoming muchmore focused on how someoneis doing, rather than leading onwhat the service has to offer.Services for Older PeopleThe Trust has worked closely withthe Care Quality Commission overthe last couple of years to developand improve its services for olderpeople. Of particular note in thiswork is the investment of almost £5million to refurbish four of the Trust’sinpatient wards for older peoplein Barnstaple, Exeter and Torbay.These wards are due to re-openbetween August and October2011 and will provide far safer,more therapeutic environments inwhich to deliver high quality care.The environments will also providemore privacy and dignity.The Trust is continuing with itsplans to shift the emphasis awayfrom inpatient care towards moreand better community servicesfor older people. This will enablegreater access to services by theever-increasing number of olderpeople with mental health needswhile ensuring that hospital bedsare available for the very smallnumber of people with the mostsevere and challenging needs.Last year also saw an importantdevelopment in terms of accessto a wider range of services byolder people. The Trust’s CrisisResolution and Home Treatmentteams, which were previously onlyaccessible to people under 65years of age, have now receivedadditional resources and their rolehas been extended to providecare for adults of all ages.Peer Validation Visits andExecutive Safety WalkaroundsAs part of its plans to drive-upsafety and quality, and maintainan accurate picture of frontlineservices, the Trust has initiateda programme of regular visits tofrontline services.Peer Validation Visits are carriedout by clinical peers, are focusedon the standards developed bythe Care Quality Commission andprovide immediate feedback tostaff so that action can be takenback into practice.This technique offers a powerfultool for quality improvement andpatient safety. Progress on eachteam’s compliance in meeting thestandards is reported to the Boardand to the teams themselvesvia the quality performancedashboard.For more informationabout the SupportingRecovery project goto the Networks, MentalHealth Section atwww.nhsconfed.orgQuality Account 2010/1113


Devon Partnership NHS Trust14Executive Safety Walkaroundsare conducted regularly byexecutive directors. Verbalfeedback and recommendationsfor action are given to the localteam immediately after thewalkaround, and in writing as soonas possible. Where appropriate,important issues and themespicked-up during these visits arealso escalated for discussion andaction.Single-sex AccommodationIn line with best practice andnational guidance, mixed-sexaccommodation has beeneliminated in all of the Trust’sinpatient services. Every personusing these services has the rightto receive high quality care thatis safe, effective and respectful oftheir privacy and dignity. DevonPartnership NHS Trust is committedto providing everyone with samesexaccommodation, because ithelps to safeguard their privacyand dignity when they are oftenat their most vulnerable.From April 2011, all NHS Trusts arerequired to display a declarationof compliance on their website.The declaration for our Trust is setout opposite and can be foundat www.devonpartnership.nhs.ukThere are certain circumstanceswhere, for reasons of clinicalneed, the same-sex guidelinesmay be breached and thesecircumstances have been agreedand set out with NHS Devon, asthe Trust’s lead commissioner.Reporting arrangements tomonitor performance are in placethrough regular monthly meetingsand no reportable breaches haveoccurred to date.In general, people can expect thefollowing when they use the Trust’sinpatient services:• The room where their bed is willonly have people of the samesex as them• Their toilet and bathroom willbe for people of their sex only,and will be close to theirbedroom• There will be both men andwomen on the ward, but theywill not share sleeping areas.People may have to crossa ward corridor to reach theirbathroom, but they will nothave to walk through oppositesexareas• Most communal space, such asday rooms or dining rooms, willbe used by both men andwomen but there will be asitting room reserved for womenonly• It is probable that both maleand female nurses, doctors andother staff will need to comeinto people’s bed area onoccasion• If people need help to use thetoilet or take a bath (forexample to use a hoist orspecial bath) then they may betaken to a ‘unisex’ bathroomused by both men and women,but a member of staff will bepresent, and other people willnot be in the bathroom at thesame time.The Board of Directors closelymonitors the delivery of samesexaccommodation and theTrust will seek feedback frompeople who use services throughits questionnaires, programme ofindependent ward visiting andcomments made through thePatient Experience Team.Quality Account 2010/11


Devon Partnership NHS TrustTalking and Listening to PeopleA strategy and workplan are inplace to ensure that the Trust talksand listens to people who use itsservices, their families and thewider community. This currentlyincludes key stakeholders suchas Local Involvement Networks(LINks) and local authorityHealth Overview and ScrutinyCommittees, although thesearrangements are set to changeunder the government’s newHealth and Social Care legislation.The aim is to encourage people toseek information, comment, raiseconcerns or make a complainton an individual or representativebasis. This can be throughcontacting the Patient ExperienceTeam, completing a commentcard, participating in a surveyor attending an open meetingor focus group to hear aboutdevelopments and provide views.Many people are involved insharing their personal experienceand opinions at specific meetingsto plan or monitor services. Othersare involved in activities suchas visiting wards to meet withpeople using services, workingin partnership to recruit staff orspecific activities such as creatingtraining DVDs for staff.In recent years, feedback fromall sources has revealed thatthe attitude of staff and theneed for good communicationare amongst the top prioritiesfor people. The main reasonsfor raising concerns or makinga complaint continue to beinsufficient information aboutthe services available and howto access them, or a qualityof service which falls short ofpeople’s expectation.As a result, a number ofprogrammes have beenintroduced where people whohave personal experience ofservices are involved in stafflearning and development. Thisincludes revised and improvedmonthly staff induction sessionsand In My Shoes training.These activities provide animportant source of feedbackto the Trust. Much of this activityis captured through the PatientExperience Team, which providesadvice and support, handlesenquiries, complaints and patientand public involvement. ThePatient Experience Team reportson a quarterly basis to the Qualityand Safety Committee. Thesereports provide examples offeedback received, arising themesand action taken.New Survey LaunchedThe Trust has worked withpeople who use services toidentify the key qualities ofservices which underpin agood experience and positiveoutcomes. A questionnaire hasbeen developed to measure thedegree to which people considerthey have experienced thesequalities and their satisfaction withthe service provided. This is nowsent to a sample of 1,000 peopleeach month and the results areanalysed and reported in teamdashboards.Single-sexAccommodation -Declaration ofComplianceDevon Partnership NHSTrust is pleased to confirmthat we are compliantwith the Government’srequirement toeliminate mixed-sexaccommodation, exceptwhen it is in the patient’soverall best interest, orreflects their personalchoice. We have thenecessary facilities,resources and cultureto ensure that patientswho are admitted to ourhospitals will only share theroom where they sleepwith members of the samesex, and same-sex toiletsand bathrooms will beclose to their bed area.Sharing with members ofthe opposite sex will onlyhappen when clinicallynecessary such as wherepeople need the highestlevel of one to one nursingsupport and observationfor short periods of time(for example in a highdependency or ‘extracare’ area in an acuteinpatient ward).If our care should fall shortof the required standard,we will report it. We willalso set up an auditmechanism to make surethat we do not misclassifyany of our reports. Wewill publish the resultsof that audit as part ofour ‘quality of care andpatient experience’ reportin September 2011.Quality Account 2010/1115


% no responseDevon Partnership NHS Trustpossible side effects explainedpurpose of medication explainedclean and well maintained environmentstaff have necessary skillssupport available in urgent needsThe table below gives further details of how people evaluated the Trust’s services:10090807060% disagree orstrongly disagree% neither agreenor disagree% agree orstrongly agree50403020100fully involved in decision about caregiven information to make decisionssupported to set goalssupport to meet goals was availablegiven guidance to maintain wellbeinghelped to keep control over decisionssupported to maintain aspects of lifehelped with practical needshelped with physical needsknow who is responsible for careknow who to contact if concernedsatisfactory response to concernsstaff have supported me to keep safeQuality Account 2010/1117


Devon Partnership NHS TrustThis is monitored through the workof the Trust Infection Preventionand Control Committee which,in addition, provides assurancereports to the Quality and SafetyCommittee.The Board of Directors receivesmonthly statistics against MRSAbacteraemia and also Clostridiumdifficile, which provides anadditional alert to the Boardof any developing patterns orconcerns.The Trust has identified a NonexecutiveDirector as a championfor infection control and alsohas a number of identified LinkPractitioners within frontline teamswho help promote best practice ininfection prevention and control.The Care Quality Commissionhas confirmed that the Trust iscompliant with its standards(outcome 8) and that appropriatearrangements are in place forthe prevention and control ofhealthcare associated infections,with the exception of Exeter Prison– where some concerns remain.The Trust has been working inpartnership with Her Majesty’sPrison Service, NHS South Westand the Health Protection Agencyto undertake the necessaryimprovements to comply withthe standards. Many of the issuesrelate to the physical environmentat the prison and the fabric ofthe building. The short-term issueshave now been addressed andan improvement plan for theinpatient unit at the prison is soonto be agreed. Work to refurbish theprimary care areas at the prisonis planned to start during 2011and this will ensure compliancewith the relevant environmentalstandards.There have been no cases ofMRSA bacteraemia, but there wasone healthcare associated caseof Clostridium difficile in an adultinpatient unit in November 2010– the first in the Trust since 2008.A root cause analysis wasconducted which revealed goodadherence to infection controlprocedures and there was notransmission to other people.The Trust is performing well interms of meeting the nationalspecifications for cleanliness.Patient Environment Action Team(PEAT) inspections took placein March 2011 and have beensubmitted to the National PatientSafety Agency. Encouragingly,there has been an improvementacross-the-board in terms ofthe level of compliance withcleanliness standards, which rosefrom 73.9% in the first quarter of theyear to 93.2% in the third quarter.The latest data shows that 89%of staff are up-to-date with theironline compulsory training ininfection prevention and control.Face-to-face essential training isalso provided for relevant staffgroups and plans are in place tomaximise attendance at thesesessions. In 2011, the InfectionPrevention and Control Team willalso be piloting a new system ofpractical hand hygiene training forstaff working in hospital settings.Mental Health ActThe Trust sets out its arrangementsand authorisations in relationto the Mental Health Act in aScheme of Delegation, whichis approved by the Board ofDirectors. The Trust is responsiblefor the appointment of HospitalManagers who act on behalf ofpeople detained under the Act.Quality Account 2010/1119


Devon Partnership NHS TrustThe Trust has 15 Hospital Managers,who ensure that the Act is appliedappropriately and fairly, and thathearings, appeals, reviews andother activities are conducted inaccordance with the legislation.To ensure that Hospital Managersunderstand their role and remainup-to-date, training seminars,including assessing and managingrisk, have been established ona twice yearly basis. Additionaltraining is provided for those whoChair Mental Health Act hearings,appeals and reviews. The MentalHealth Act administration officeworks closely with the HospitalManagers and a wide rangeof clinicians from across theorganisation to improve the qualityand safety of the Trust’s servicesand develop best practice.Patient Safety ProgrammeThe theme of patient safety hasbeen at the heart of much ofthe Trust’s work during the pastfew years and will continueinto 2011/12 and beyond. Theorganisation has invested inleading-edge Patient SafetyOfficer training with the Institute ofHealth Improvement and providesleadership for patient safetytraining. It also provides a range ofquality improvement techniquesfor senior staff, such as the Plan,Do, Study, Act (PDSA) approach,which uses small tests of changeto explore potential improvementin a wide range of areas, forexample shorter waiting times, areduction in serious incidents orimproved access to services.The Trust is now working with othermental health services in theregion, and NHS South West, toimprove services across a range ofareas, including:• Safe and reliable care(including falls prevention)– adopting local, national andinternational evidence-basedbest practice• Prevention of suicide –improving communication afterdischarge from hospital• Provision of patient and familycentredcare• Medicines management– improving safety around theprescription and administrationof medicines.Medicines ManagementThe Trust has made significantstrides forward in the field ofmedicines management over thelast couple of years. It has beenan area of sustained improvementand good practice is nowbecoming embedded in everypart of the Trust where medicinesare used. The recent review bythe Care Quality Commissiondid identify some relatively minorareas for improvement but thesehave now been addressed and,overall, the feedback was verypositive.In addition to providing acomprehensive range of policiesand procedures related to coremedicines management activities,the Medicines Management Teamcontinues to enable people to usemedicines safely and effectivelyby:• Supporting prescribers– a range of evidence-basedprescribing guidance isavailable. A recent exampleis the launch of informationthat has been developedjointly across the localcommunity giving up-to-dateguidance on the treatment of20 Quality Account 2010/11


Devon Partnership NHS TrustOther notable findings include:Areas where we performed well:• Percentage of staff havingequality and diversitytraining in the last 12 months(81% against a nationalaverage of 47%)• Percentage of staffreceiving health and safetytraining in the last 12 months(95% against a nationalaverage of 80%)• Percentage of staff feelingvalued by their workcolleagues (83% against anational average of 79%)• Percentage of staff usingflexible working options (74%against a national averageof 67%)Areas where we have to improve:• Percentage of stafffeeling that there are goodopportunities to developtheir potential at work (34%against a national averageof 45%)• Percentage of staffreceiving job relevanttraining, learning ordevelopment in the last 12months (73% against anational average of 80%)• Staff recommendation ofthe Trust as a place to workor receive treatment (scoreof 3.18 compared to anational average of 3.49)• Fairness and effectivenessof incident reportingprocedures (score of 3.30compared to a nationalaverage of 3.45)The overall indicator for staffengagement was below theaverage for mental healthproviders and this will be anarea of sharp focus over theforthcoming year.The Trust will be looking closelyat the findings from this year’sstaff survey and is taking actionto address the key themes. Fora full report on the survey, visitwww.cqc.org.uk or call theCommunications Team on01302 208693.Clinical AuditThe Clinical Audit Programmefor 2011/12 was developed inconjunction with staff from theTrust’s four Clinical Directoratesand is led by a Co-MedicalDirector. The programmeintegrates quality improvementand mainstream clinical auditwork. This reflects the widerorganisational shift towards anincreased emphasis on serviceimprovement, safety and thequality of people’s experience ofservices. The work programme isbased on the Trust’s priorities forquality improvement and clinicalaudit activity and reflects bothnational and local priorities in thefield of mental health.The Trust’s current priority areas forclinical audit cover both nationaland local priorities and include:• Medicines management• Schizophrenia• Dementia• Violence• Improving communication atdischarge from hospital• Physical health checks• Mental Health Act compliance.22 Quality Account 2010/11


Devon Partnership NHS TrustResearch and InnovationDevon Partnership NHS Trustis committed to increasing itsparticipation in research andcontributing to better healthoutcomes for the people using itsservices. In 2010/11, the numberof people recruited to researchprojects approved by a researchethics committee was 252. Theorganisation is currently involvedin conducting 16 clinical studies,of which 12 are supported withinthe National Institute of HealthResearch portfolio.The Trust collaborates with thePeninsula Medical School andco-hosts its Mental HealthResearch Group. It has closelinks with the West Hub of the UKMental Health Research Networkand the South West Dementiaand Neurodegenerative DiseasesNetwork.Data QualityThe Trust has moved to a newelectronic clinical record system,RiO, which is a major step forwardin terms of data quality. In thepast, data entry was additionalto the updating of the papercare record – now the core roleof clinicians documenting careis through the electronic system.Inevitably, some new data qualityissues have emerged and thePerformance Information Teamcontinues to identify these andhas systems in place to rectifyerrors quickly and effectively. Highpriority issues are flagged-up andmonitored by senior managerswithin the Trust’s four clinicaldirectorates.Commissioning for Quality andInnovation (CQUIN)The CQUIN payment frameworkis a national initiative thatmakes a proportion of income(1.5%) available to those Trustsproviding services if they meetcertain quality and innovationtargets agreed with their localcommissioning organisations.For its 2011/12 CQUIN scheme,our Trust has agreed a list ofindicators which includes targetsrelated to dementia, followinguppeople after discharge fromhospital, personal health budgets,medicines management andimproving the patient experience.The priority areas for qualityimprovement selected by the Trustfor 2011/12 reflect some of theseindicators.Quality Account 2010/1123


Devon Partnership NHS Trusthas been a focus for qualityimprovement. NHS Devon issupporting further improvementin this area through next year’sCQUIN scheme.NHS Devon supports the Trust’spriorities for 2011/12 which are inline with those of NHS Devon inimproving people’s experienceof mental health services throughthe provision of consistently highquality care across all service userpathways.The Quality Account recognisesthe importance of joint workingrelationships and NHS Devon isdelighted to support the Dementiawork programme that is plannedwith The Royal Devon and ExeterNHS Foundation Trust. This jointwork will enable staff to moreeasily identify the individual needsof one of our most vulnerablegroups of people in order thatthey have a better healthcareexperience.NHS Devon will continue tosupport quality improvementsthrough the agreed CQUINschedule for 2011/12. The Trust hasfocused on areas that will makea significant impact on improvingpatient outcomes, for exampleimproving follow up on dischargefrom inpatient services, medicinesmanagement and reconciliationand carer assessments forthose caring for someone withdementia. The 2011/12 CQUINsare challenging this year butboth the Trust and NHS Devon areaware that these are issues whichcan make a significant differenceto patient outcomes and theirindividual healthcare experience.NHS Devon supports the ongoingprogress made in qualityimprovement within the QualityAccount and support DevonPartnerships NHS Trust’s totalcommitment to place quality andsafety at the heart of everythingthey do. The Trust has performedwell overall against the 2010/11quality schedule, however theTrust recognise within the QualityAccount that there are still areaswhere further improvement mustbe achieved. Both organisationswill continue to work together toensure these areas are addressedin 2011/12.The alignment of the Trust’sphilosophy for quality of care withNHS Devon is critical as it is onlya partnership of commissionerand provider and its managersand clinicians that will driveimproved outcomes for peopleusing the service. The descriptionof the achievements made in2010/11 and the focus on qualityduring 2011/12 demonstrate thecommitment of the Trust fromward to board in improving qualityof care and NHS Devon supportsthe approach the Trust is taking forthe future.Commentary by Devon CountyCouncil’s Health and Adults’Services Scrutiny CommitteeDevon County Council’s Healthand Adults’ Services ScrutinyCommittee (SC) determined tocomment on Devon PartnershipNHS Trust’s (the Trust) QualityAccount 2011-12. All referencesin this commentary relate to thereporting period 1 April 2010 to 31March 2011 and pertain only tothe Trust’s relationship with the SC.The SC believes that the QualityAccount 2011-12 is a fair reflectionof the services provided by theTrust and gives a comprehensivecoverage of the provider’sservices, based on the knowledgethe SC has of the Trust.26 Quality Account 2010/11


Devon Partnership NHS TrustThe Trust is currently registeredwith the Care Quality Commission(CQC) without conditions aftersignificant improvements hadbeen achieved in the arena ofstaff supervision and appraisal.Last year, the performance inthis area resulted in a conditionbeing placed on the Trust’s CQCregistration which has now beenlifted. This provides very powerfulexternal assurance of the Trust’squality of services.The Trust has been engagingregularly with the SC throughoutthe reporting period andhas responded to reportingrequirements promptly, forexample to the older peoplemental health task group updatein November 2010 or the supportfor carers task group update inMarch 2011. The SC continues tohave an excellent informal as wellas formal working relationship withthe Trust.The SC is content with the levelof the Trust’s public engagementwhich demonstrates that the Trustvalues a continued dialogueand stakeholders’ views and iscommitted to partnership working.For example, the Trust’s ChiefExecutive and senior managersinvited the SC’s Chairman for aninformal briefing on the Trust’solder people mental healthprogramme in March 2011. TheTrust has also been providingregular newsletters, briefingnotes and reports on varioustopics at its own initiative, suchupdates on developments withininpatient units as part of thewider older people mental healthprogramme.The SC also fully supports the Trust’sbenchmark for quality to provideservices that are ‘good enough formy family’ as well as its long-termstrategic objectives, to provideservices which are safe, timely,personalised, recovery-focusedand sustainable.Commentary by Devon LINkLINk Devon’s remit is to promoteand support the involvement ofpeople in the commissioning,provision and scrutiny of theirlocal health and care services. Tothis end, LINk Devon welcomesthe opportunity to provide astatement to Devon PartnershipNHS Trust for their Quality Account.The LINk’s response is based oninvolvement with and knowledgeof the Trust to date.LINk feels that this is a coherentand carefully prepared account,which makes clear the Trust’scontinuing commitment toongoing improvement and tothe importance of systematicallycollecting, analysing and usingfeedback from people who useour services and their carers inthe development of their policy,practice and provision which LINkDevon commends.LINk Devon is encouraged by theTrust’s commitment to improvingthe patient experience andwill support any effort to workin partnership with the Trust toensure the views of patientsand the public are heard andimprovements are implementedas a result. LINk Devon has takenevery opportunity to regularlyfeed back comments or concernsvia the Trust’s patient and publicinvolvement structures. Theseviews have been receivedthrough community engagementand LINk’s own surveys, and LINkDevon undertakes to continue thisactivity.Quality Account 2010/1127


Devon Partnership NHS TrustFeedback that LINk has receivedfrom the public, has providedthe basis for project work thatLINk Devon has carried outrelating to ‘Access to EmotionalWellbeing Services’ and ‘LeavingHospital’. For both projects, theTrust has provided informationon request from LINk Devon. LINkDevon proposes that the Trustconsiders the evidence andrecommendations provided inboth reports, which are due to bepublished imminently, with a viewto developing a joint approach todevelopment work that may arisefrom the recommendations madeby the LINk.LINk Devon acknowledges (onpage 16) the Trust’s recognitionfor where further improvementscan be made. As a result of theirpatient experience questionnaires,areas of concern have beenrecognised which are similar tothose raised with the LINk, andthe recommendation that bettercommunication from healthprofessionals to patients is aconstant in all three of the areasidentified.LINk Devon attends the NetworkAction Groups (NAG) and hasdeveloped a working partnershipwith Be Involved Devon (BID).BID and LINk Devon are lookingat current working practices ascommissioning for BID is underreview.LINk Devon undertakes to promoteand support involvement underany new arrangements that maybe made.LINk Devon will continue toengage with the Trust, in particularby highlighting to them, ona regular and ongoing basis,any concerns people raisewithin the network, as well ascontinuing to publish reports andrecommendations about specificissues, enabling communities torepresent their views about thequality and standard of servicesprovided through the Trust. LINkwelcomes the opportunity towork in partnership with the Trustas a result of any LINk projectdevelopment work.Commentary by Torbay LINkComments were sought fromthe Torbay LINk on the QualityAccount 2010/11 but none werereceived.Engagement in Producing theQuality AccountThe Trust sought ideas andsuggestions for inclusion in theQuality Account from all of its keystakeholder groups, including staff,the people using services and theircarers and families. The QualityAccount was also discussed withshadow governors at the Trust’sshadow Council of Governors’meeting on 21 April 2011.28 Quality Account 2010/11


Devon Partnership NHS TrustWonford House HospitalDryden RoadExeterEX2 5AFTel: 01392 403433www.devonpartnership.nhs.ukRef number: 247/06/11

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