Trust Board of Directors

Trust Board of Directors

Quality Account 2011/2012

Progress Report to the Topic Group, Hertfordshire County Council

  1. Introduction.

Members will recall that NHS Trusts are now obliged to publish annual quality accounts in June each year. These reports show the quality priorities selected by Trust Boards and progress against them, together with evidence of performance in a significant number of other areas defined by the Department of Health.

Foundation Trusts are also subject to extra requirements, with three mandated quality indicators and a duty to include a version of their quality account as part of their annual report to Monitor.

Trusts are obliged to develop priorities and share progress with partner agencies including the local authority through the year, seeking comments on their draft account at the end of the process.

  1. Quality Priorities 2011/2012

The Trust sought the views of these stakeholders in agreeing priorities for the coming year:

  • Service user council
  • Carer council
  • Staff
  • PCT/JCT
  • Herts County Council
  • Governors
  • LINk

These were signed off by Board in March 2011.

Compared to previous years, the list of priorities is longer, reflecting the size of the Trust which now provided services in North Essex, Norfolk and in primary care in Hertfordshire. The breadth of the list also reflects the critical importance of the year as the impact of disinvestment is fully felt and as our programme to preserve quality through service transformation –Leading by Design – enters its implementation phase.

As well as covering the three “quality domains” – patient safety, clinical effectiveness and the service user and carer experience – an extra dimension related to staff has been added in recognition of the major changes and pressures they are experiencing.

  1. Progress Mid-year.

The table below shows progress at the end of quarter 2.

Quality Account 11/12 / Qtr 1 / Qtr 2 / Qtr 3 / Qtr 4
Customer Experience
Access to psychological therapies (working age mental health) / Target / 63% / 66% / 69% / 72%
Actual / 65.9% / 89.1%
Access to out of hours support from helpline / Target / 57% / 62% / 67%
Actual / N/A / 67.0%
Rate of service users saying they could get help when they needed it / Target / 82% / 87% / 92%
Actual / N/A / 92.7%
Rate of service users saying they had a choice in the time they were seen / Target / TBC / TBC / TBC
Actual / N/A / 79.4%
Rate of service users saying they had a choice in the day they were seen / Target / 68% / 73% / 78%
Actual / N/A / 78.3%
Rate of service users saying they had a say in the choice of their medication / Target / 59% / 61% / 63% / 66%
Actual / N/A / 77.4%
Rate of service users saying that if they needed it, they would recommend this service to family and friends / Target / 74% / 76% / 78% / 80%
Actual / 65.8% / 85.8%
Rate of service users saying Trust services have helped them see a positive future for themselves / Target / TBC
Actual / 82.9% / 85.5%
Rate of carers saying they are sufficiently involved in discharge planning (with service user consent) / Target / TBC
Actual / N/A / 87.5%
Safety
Rate of inpatients saying they feel safe / Target / 80% / 82% / 84% / 86%
Actual / 62% / 87.1%
Rate of inpatients who did not share a room or bay with a member of the opposite sex / Target / 90% / 90% / 90% / 90%
Actual / N/A / 96.3%
Breaches of Eliminating Mixed Sex Accommodation rules as reported to PCT / Target / 0 / 0 / 0 / 0
Actual / 0 / 0
7 day follow-up after inpatient care / Target / ≥97% / ≥97% / ≥97% / ≥97%
Actual / 97% / 97.7%
Rate of actual physical assaults on staff on LD inpatient units / Target / <270 / <250 / ≤230 / ≤210
Actual / 214 / 160
Number of falls on MHSOP inpatient units / Target / 76 / <72 / ≤68 / ≤64
Actual / 70 / 65
Rate of serious incidents as a proportion of total incidents reported / Target / ≤0.4 / ≤0.4 / ≤0.4 / ≤0.4
Actual / 0.45% / 0.3%
Clinical Effectiveness
Rate of readmission within 30 days / Target / 4.75% / 4.5% / 4.25% / 4%
Actual / 6% / 3%
Use of 'You're Welcome' standards in CAMHS to drive up quality of clinics / Target / N/A / 25% / 50% / 75%
Actual
Rate of LD service users with HAP / Target / Pass / Pass / Pass / Pass
Actual
Number of older people accessing IAPT services / Target / 153 / 183 / 213 / 243
Actual / 118 / 162
Rate of service users finding psychological therapy helpful (working age mental health) / Target / 58% / 60% / 62% / 64%
Actual / 50.9% / 90.5%
Rate of service users with an advanced decision / statement / EOL plan in place / Target / 6% / 7.5% / 8.75% / 10.0%
Actual / 4.8% / 5.0%
Rate of service users offered advanced statements / Target / 20% / 30% / 40% / 50%
Actual / 7.7% / 7.7%
Rate of service users who have been helped to take part fully in planning their care / Target / 66% / 68% / 70% / 72%
Actual / 64.2% / 85.3%
Rate of service users who had enough support in getting help with any physical health need / Target / 68% / 70% / 72% / 74%
Actual / N/A / 83.7%
Staff
Sickness Rate / Target / 4% / 4% / 4% / 4%
Actual / 4.2% / 4.5%
Rate of completion of mandatory training / Target / 61% / 70% / 79% / 88%
Actual / 52% / 51%
Rate of staff saying they would recommend HPFT as a place to work / Target / 45% / 50%
Actual / N/A / 39.5%

In summary:

greens / 17
reds / 5
unrated / 6
total / 28

Highlights include:

  • A set of very positive results in terms of the service user and carer experience – in many ways the ultimate measure of quality
  • Good results on the 2 indicators relating to discharge from inpatient care, one about rates of readmission and one about carer involvement (this area had been identified by the Topic Group last year as a priority)
  • Ongoing difficulties relating to areas which been entrenched issues for the Trust and which commissioners are focussing closely on, such as advance decisions and statements and mandatory training
  1. Final Points.

It can be seen that not all indicators have targets yet; this is because they are also CQUIN (Commissioning for Quality and Innovation) targets which are yet to be agreed with commissioners.

The robustness of the data used to populate these reports is checked now through both internal audit and external audit from the Audit Commission. The primary data sources are the electronic patient record (care-notes), the patient experience system Having Your Say (now analysed and reported through the Meridian software) and the incident reporting system (datix). Inaccuracies with regard to the latter have just been found and are being urgently addressed.

The Trust has very much come to value the framework provided by the quality account as a means of both monitoring and improving the quality of care at a critical time. Its place is now well established from Board to ward.

We look forward to sharing results with partner agencies at the end of the year and thinking together about areas for improvement in 2012/2013.

Jonathan Wells

Head of Practice Governance

November 2011

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