Quality Summit (14 Oct 2016) presentations by Care Quality - - PowerPoint PPT Presentation

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
• ut observations, spoke with staff, patients and carers, looked at the

environment, examined care records, and held focus groups with staff.

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On site activity

• Visited 62 wards, teams and

clinics.

• Spoke with 265 patients and

people using services or their relatives and carers, either in person or by phone.

• Looked at the care and treatment

records of more than 258 patients.

• Collected feedback from 339

patients, carers and staff using comment cards.

• Joined 6 patient meetings/ groups.
• Spoke with 32 ward and team

managers and more than 468 staff members.

• Attended and observed 43 multi-

disciplinary meetings, including care reviews, handovers and risk meetings

• Held 18 focus groups attended by

74 staff.

• Interviewed 15 senior staff and

board members.

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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

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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

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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.

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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.

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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.

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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.

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Ratings community health services

Safe Effective Caring Responsive Well-led Overall Community health services for adults Requires Improvement Good Good Good Good Good Community health services for children, young people and families Requires Improvement Requires Improvement Good Requires Improvement Requires Improvement Requires Improvement Community health inpatient services Requires Improvement Good Good Good Good Good 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 Overall Requires Improvement Requires Improvement Good Requires Improvement Requires Improvement Requires Improvement 10

Ratings for mental health services

Safe Effective Caring Responsive Well-led Overall Acute wards for adults of working age and psychiatric intensive care units (PICU's) Inadequate Requires Improvement Requires Improvement Requires Improvement Requires Improvement Requires Improvement Long stay/rehabilitation mental health wards for working age adults Good Good Good Good Good Good 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 working age Requires Improvement Good Good Good Good Good Mental health crisis services and health based places

• f safety

Good Requires Improvement Good Good Good Good Specialist community mental health services for children and young people Good Requires Improvement Good Good Good Good Community-based mental health services for older people Requires Improvement Good Good Good Good Good Community mental health services for people with a learning disability or autism Good Good Good Requires Improvement Good Good Overall Requires Improvement Requires Improvement Good Requires Improvement Requires Improvement Requires Improvement

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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.

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Our vision remains unchanged

To improve health and wellbeing outcomes for local communities and deliver the Best Care by the Best People To improve health and wellbeing outcomes for local communities and deliver the 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

Safe Well Led Effective Responsive Caring

Rated overall as Requires Improvement

• Safer Staffing
• Safe, clean environments
• Assessment and management
• f risk to patients and staff.
• Track record on safety in MH

inpatients

Caring - Quality Improvement Plan

Rated overall as Good Our current work plan:

• Involvement of carers in community

health

• Family Liaison post bereavement and

including serious incidents

• Refresh of our patient experience

strategy

• Values based recruitment which

includes ‘by experience’ selection panels for all posts.

Caring Safe Well Led Effective Responsive

Responsive - Quality Improvement plan Rated overall as Requires Improvement Service Planning - delivery and management of risk

• Waiting times in CAMHS
• 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 children, young people and families community health services. Listening and learning from concerns and complaints

Responsive Caring Safety Well Led Effective

Clinical Effectiveness - Quality Improvement Plan

Rated overall as Requires Improvement Skilled staff to deliver care. Assessment of needs and planning of care.

• Best practice in treatment and care
• Consistent outcomes across

community adult services and community learning disability services Adherence to the MHA and MHA code

• f practice

Adherence to the MCA

Effective Responsive Caring Safety Well Led

Well Led - Quality Improvement Plan

Rated overall as Requires Improvement Good Governance (3 tiers and across core services)

• Clinical risk, actual and emerging
• MT, Appraisal, Supervision
• Sustained and shared learning across

core services Communication styles across core services and professional groups

Well Led Effective Responsive Caring Safety

We have our successes

• Nationally recognised adult acute mental

healthcare pathway (Lord Crisp review and HSJ Transforming MH conference)

• Award winning dementia care services plus

dementia crisis support team shortlisted for HSJ awards

• National leader for Open Dialogue
• Nursing Times showcase re dual trained nurses at

NELFT

• Award winning EMN work and BME staff network
• Integrated health and social care services shared

as best practice