Quality Summit (14 Oct 2016) presentations by Care Quality Commission & NELFT
NELFT Site visit 4 – 8 April 2016 • Announced and unannounced. • Pre site visits to observe board, interview governors, unions and NEDs. Engagement with patient groups. • Large team 60+ – chair, inspection managers, inspectors, assistant inspectors, doctors, nurses, allied health professionals, managers, analysts, planners. • Day zero – 2016 - presentation from trust, CQC planning/team building. • Visits to clinical areas – teams, wards and clinic areas. We carried out observations, spoke with staff, patients and carers, looked at the environment, examined care records, and held focus groups with staff. 2
On site activity • • Visited 62 wards, teams and Spoke with 32 ward and team clinics. managers and more than 468 staff members. • Spoke with 265 patients and • people using services or their Attended and observed 43 multi- relatives and carers, either in disciplinary meetings, including person or by phone. care reviews, handovers and risk meetings • Looked at the care and treatment • records of more than 258 patients. Held 18 focus groups attended by 74 staff. • Collected feedback from 339 • patients, carers and staff using Interviewed 15 senior staff and comment cards. board members . • Joined 6 patient meetings/ groups. 3
Some of our concerns in community health services • Recruitment challenges and staff shortages • Use of agency and bank staff to manage these • High caseloads • Referral to treatment times for accessing specialist nursing services • Waiting times for some community services for children and young people 4
Some of our concerns in mental health services • Brookside – environment, staffing and care plans • However, the trust responded immediately to our concerns and the unit was closed. It has recently reopened, following significant remodelling and refurbishment. • Risk assessments & care planning in acute inpatient wards • Access to psychological therapies 5
Our positive findings – good practice • Feedback from patients, service users and carers: • 339 comment cards. Of these , 274 comments (81%) were positive in their feedback 23 (7%) were negative and 42 (12%) were mixed in nature. • 265 in person or by phone. Most of the feedback we received was positive and patients found the staff were committed, caring and respectful. • Parents of children using the community health services for children, young people and families gave us universally positive feedback. 6
Our findings – good practice community services • In Havering, nursery nurses piloted nursery nurse led child health clinics, receiving positive evaluation by parents of 100% • The community treatment team worked closely with local acute hospitals to reduce emergency admissions to hospitals for patients, who were treated in their own homes. • Partnership with London Ambulance Service (K466 Car) plus national patient safety award. • Diabetes services in Essex using Skype with patients – responsiveness. 7
Our findings – Good practice mental health services. • All memory services were accredited in the Memory Service National Accreditation Programme run by the Royal College of Psychiatrists. • The child and adolescent mental health community teams had joined CYP IAPT - national service transformation programme delivered by NHS England to improve mental health services for children and young people. • Redbridge child and adolescent mental health community team were involved in the ‘puzzled out’ national survey of children and young people improving access to psychological therapies programme. 8
Our findings – good practice at provider level. • The trust had a positive approach to equality and diversity amongst its workforce • nominated for the Diverse Company of the Year award at the National Diversity Awards 2016 • cited as one of the top ten global black and minority ethnic networks by The Economist in February 2016 • The trust has good overall systems and processes for managing safeguarding children and adults at risk. The trust was represented at all local authority safeguarding boards and contributes to sub groups. • Each interview panel had a user representative and they received interview skills training for this work. 9
Ratings community health services Safe Effective Caring Responsive Well-led Overall Requires Community health services for adults Good Good Good Good Good Improvement Community health services for children, Requires Requires Requires Requires Requires Good young people and families Improvement Improvement Improvement Improvement Improvement Requires Community health inpatient services Good Good Good Good Good Improvement End of life care Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Community dental services Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Requires Requires Requires Requires Requires Overall Good Improvement Improvement Improvement Improvement Improvement 10
Ratings for mental health services Safe Effective Caring Responsive Well-led Overall Acute wards for adults of working age and psychiatric Inadequate Requires Improvement Requires Improvement Requires Improvement Requires Improvement Requires Improvement intensive care units (PICU's) Long stay/rehabilitation mental health wards for Good Good Good Good Good Good working age adults Forensic inpatient / secure wards Good Good Good Outstanding Good Good Child and adolescent mental health wards Inadequate Inadequate Requires Improvement Inadequate Inadequate Inadequate Wards for older people with mental health problems Requires Improvement Requires Improvement Good Requires Improvement Requires Improvement Requires Improvement Wards for people with a learning disability or autism Good Good Good Good Good Good Community-based mental health services for adults of Requires Improvement Good Good Good Good Good working age Mental health crisis services and health based places Good Requires Improvement Good Good Good Good of safety Specialist community mental health services for Good Requires Improvement Good Good Good Good children and young people Community-based mental health services for older Requires Improvement Good Good Good Good Good people Community mental health services for people with a Good Good Good Requires Improvement Good Good learning disability or autism Overall Requires Improvement Requires Improvement Good Requires Improvement Requires Improvement Requires Improvement 11
Overall summary • Ten of the 14 core services we inspected were rated as good. This is really positive, particularly as it is operating a highly complex service and faces external pressures. • The trust has over 40 actions it must take to improve care – a large number relate to Brookside • However, the trust is already working on its action plan and have been responsive to the inspection teams findings. 12
Our vision remains unchanged To improve health To improve health and wellbeing outcomes and wellbeing outcomes for local communities for local communities and deliver the and deliver the Best Care by the Best People Best Care by the Best People
What we expect • Patient and staff safety is the priority • Highest calibre – staff, leaders, services • Best outcomes • New innovative approaches • Immediate response
Safety - Quality Improvement Plan Rated overall as Requires Improvement Safe • Safer Staffing • Safe, clean environments Caring Well Led • Assessment and management of risk to patients and staff. Effective Responsive • Track record on safety in MH inpatients
Caring - Quality Improvement Plan Rated overall as Good Our current work plan: • Involvement of carers in community Caring health • Family Liaison post bereavement and Responsive Safe including serious incidents • Refresh of our patient experience strategy Well Led Effective • Values based recruitment which includes ‘by experience’ selection panels for all posts.
Responsive - Quality Improvement plan Rated overall as Requires Improvement Service Planning - delivery and management of risk Responsive • Waiting times in CAMHS Effective Caring • Case loads in Community Health care adults and children's services • Wait times and waiting list breach's for referral to therapy and diagnosis across Safety Well Led children, young people and families community health services. Listening and learning from concerns and complaints
Clinical Effectiveness - Quality Improvement Plan Rated overall as Requires Improvement Skilled staff to deliver care. Effective Assessment of needs and planning of care. Well Led Responsive • Best practice in treatment and care • Consistent outcomes across community adult services and Caring Safety community learning disability services Adherence to the MHA and MHA code of practice Adherence to the MCA
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