Quality
Account
2009/10
Introduction to KMPT’s first Quality Account
This is Kent and Medway NHS and Social Care Partnership Trust’s first Quality Account. From
1 April 2010 it is a legal requirement to produce this. The document aims to ensure that quality
has the same importance as that of the financial account, but wholly focuses on the quality of
services and treatment.
We hope that by publishing an annual quality account it will assist the public, service users and
others to understand:
• What the organisation has done well
Contents
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Where improvements in service quality are still required
Introduction Statement from the Chief Executive
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What the Trust’s priorities for improvements are for the coming year 2010/2011 and what we
aim to achieve
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Section one
Priorities for Quality Improvement
Patient experience
Patient safety
Clinical effectiveness
How service users, staff and others with an interests in the organisation have been involved in determining these priorities.
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The preparation of the account involved consultation, discussion and the use of a survey with the
Patient Consultative Committee, the Chaplaincy service, shadow governors, public and staff from
across the Trust at all levels and from all disciplines.
Section two
Review of quality performance
The way forward
NHS number code validity
Research and development
Goals agreed with commissioners
The process for hearing people’s views
We had a number of formal and informal information gathering activities. These include:
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• Information from the National Patient Survey
• Themes from the Patient Advice and Liaison Service
• Complaints, concerns, comments and compliments
• Staff and Trust Board members
• The Shadow Board of Governors.
Section three
Quality improvement initiatives
Patient experience
Patient safety
Statements from other organisations
Appendices
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Service users and carers helped the Trust Board to choose its quality improvement priorities for
2010-2011 by responding to a questionnaire asking them to rate and comment on a list of quality
issues. This was cascaded through the Patient Consultative Committee who consulted and fed back
issues from their networks. Information was sent to all parts of the organisation through the clinical
governance groups. This was supported by presentations and briefings and, in turn, responses were
received. Finally, non statutory organisations were consulted for their views and priorities eg Rethink,
the carers’ support groups and informal day care services across the whole of Kent.
The quality account is predominantly for members of the public, service users and staff and aims to
demonstrate the activity around quality for the last 12 months and to show our objectives for the
coming year.
• The account is formed of three sections
• Section one details our current priorities for improvement in 2010-2011
• Section two is a review of our quality performance which underpins and sets the scene for the
final part
• Section three reports on our first qualiy account which ran from 2009-2010.
Quality Account 2009/10
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Quality Account 2009/10
Statement from the Chief Executive
It is a pleasure to present our first Quality Account, which outlines our
achievements this year through the hard work and commitment of our
staff. Our vision is to promote positive mental health and well being
while providing value for money services that are free from stigma. Our
commitment to social inclusion has led us to be chosen to participate in
‘Communities of Influence’ a National Social Inclusion Programme. The
project empowers Foundation Trust Governors to provide stronger links
between the Trust and the local community.
As a Trust committed to preventing harm we report incidents to the
National Reporting and Learning Scheme, and have recently implemented
Datix, a system that will effectively give our staff relevant information
about incidents so that they can learn the lessons from them.
Led by our Executive Medical Director, we have implemented a Quality Strategy, which includes the
development of a dedicated Quality Improvement Team. In order to improve patient experience
our real time surveys ensure that we can respond to our patients and constantly improve our
service delivery.
Our journey to Foundation Trust status is progressing. This will bring new opportunities to offer
quality services, which are steered by our local community.
While we will have a lot of hard work ahead, we are starting from a firm base, as an innovative
organisation grounded in sound business approaches. Our values reflect an accessible, proactive
and responsive organisation, which listens and learns from the contributions of its service users,
their carers, staff and organisational partners. With this in mind I look forward to welcoming
increased contributions from our local communities, partners, members and governors, as we
continue our pledge to improving quality.
This report looks at the progress we have made on some of our priorities throughout the year
and the information contained within this document is to the best of my knowledge an accurate
reflection of the quality of services provided by Kent and Medway NHS and Social Care Partnership
Trust.
Section one
Priorities for Quality Improvement
2010-2011
This section starts with the Trust Board objectives which demonstrate the
link between the detail of the objectives and the overall direction of the
organisation.
The nine priorities for improvement are divided into the three areas
that constitute quality, the patient experience, patient safety and clinical
effectiveness. Each area has three issues to focus upon for improvement.
Each priority describes the reason for the choice, where the Trust is currently
positioned, the way that the priority is measured and the means of
monitoring progress.
Appendix A details the Quality Improvement choices that our stakeholders
were consulted upon to decide priorities; the Trust Board ratified the
priorities for 2010-2011 as set out in this account. There was complete
agreement with our stakeholders views.
Erville Millar
Chief Executive
Quality Account 2009/10
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Quality Account 2009/10
Strategic context
The quality account is fully aligned with the Trust Board Objectives and Annual Operating Plan,
to ensure the right issues are selected at the right time. The Trust Board objectives are detailed in
the table below.
1. Achieve excellence in integrated
health and social care
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Develop services of the highest quality
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Implement national and locally agreed standards
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Provide services sensitive and responsive to the diversity of
the local population
2. Attract, retain and develop an
effective, flexible and highly skilled
workforce
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Be regarded as an ‘employer of choice’, recruiting, developing
and retaining the best individuals
3. Develop and maintain user, carer and
public involvement
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4. Develop and maintain a modern
infrastructure
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Implement capital strategy to support the development of
clinical services
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Implement IT strategy to support the modernisation of clinical
and non clinical services
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Implement health informatics strategy
5. Maintain financial viability and
business excellence
The priorities for improvement for the coming year are listed under the three dimensions
of quality: the patient experience, patient safety and clinical effectiveness.
A) Patient Experience
1) To reduce the number of inpatients detained under the
Mental Health Act, who abscond from our wards
Rationale
To ensure vulnerable service users are cared for in a place of safety.
Current status
The total percentage of in-patients who absconded during the year 2009-20010 was:
• Quarter 1 = 5% (of total number of detained patients)
Meet the equality and diversity needs of a wider patient and
public group
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Achieve Foundation Trust status
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Improve user experience while meeting national targets and
achieving financial surplus
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Improve efficiency and effectiveness
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Be provider and partner of choice for users and purchasers
• Quarter 2 = 4%
• Quarter 3 = 4%
• Quarter 4 = 6%
Plans
• The Trust is introducing a form that sets out the leave status for service users while
being compulsorily detained. The clinical team works with the service user to agree
the right course of action
• The Trust is undertaking a review of Psychiatric Intensive Care Services to assess
whether service users are being cared for in the most appropriate environment
• A new observation policy has been agreed and is being rolled out to teams.
How measured
The number of detained service users who abscond is reported quarterly to the PCT.
How monitored
The Director of Operations scrutinises numbers as part of her performance monitoring.
6. Achieve governance excellence
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Involve service users, staff and the public in key decision
making
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Ensure strong internal assurance arrangements
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Ensure strong governance arrangements for hosted services
2) Analyse complaints data to demonstrate which issues
cause service users to complain
Rationale
7. Become a responsible corporate
citizen
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Embrace sustainable development and tackle health
inequalities through day to day corporate activities
The Trust actively seeks feedback about its services and complaints are a key source of information.
Until this year there had been no systematic process for recording complaints that lends itself
to consistent analysis. Addressing complaints raises confidence, the Trust learns from negative
experiences and is committed to change.
Current status
Until the implementation of DATIX in March 2010 there has been no systematic shared data
collection.
Quality Account 2009/10
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Quality Account 2009/10
Plans
• A quarterly analysis of trends and themes in complaints has commenced
• Results will be fed back into the Trust wide Learning From Experience Group
• Where necessary Trust wide action plans will be developed to resolve issues.
How measured
B) Patient Safety
1) Prevention of in-patient suicide
Rationale
Quarterly trends are reported to the Patient Experience Group.
Reduction of suicides is a national and local target and the Trust works to ensure its wards are safe,
that service users are clinically assessed and risk assessed effectively.
How monitored
Current status
DATIX is now being used for data collection.
There was one in-patient suicide on our wards in 2009-10.
3) Decrease the number of incidences of patients
experiencing mixed sex accommodation
Plans
Rationale
• Ensure the organisation learns from incidents and that these are processed by the Trust’s
learning from experience group
National and local drivers are in place to care for service users in gender specific accommodation,
this objective links to the Trust’s work on dignity and respect.
• Clinical risk assessment training
• Health and Safety Audits of ligature points
The measures we report against are as follows for the year 2009-2010:
• The National Patient Safety Agency has a list of ‘never events’. These are incidents that should
not happen as they are preventable. One of these relates to inpatient suicide by suspension
from non-collapsible rails, the Trust is rigorous in its assessment of such risks.
• Number of service users experiencing mixed sex accommodation = 0
How measured
Current status
• Number of mixed sex wards without women-only lounges = 0
The number of near misses and incidents are reported monthly to the Board. Incidents of
in-patient suicides are recorded on a National Data Base called STEIS and are reportable to the
Commissioning Primary Care Trust and the Strategic Health Authority.
Plans
How monitored
• Number of instances of service users having to use mixed sex bathrooms = 2
Any areas where breaches occur complete a self-assessment tool and develop a local action plan.
• Through Suicide Prevention group
• Reports and monitoring by commissioning PCT through quality monitoring process.
How measured
Monthly reporting of breaches through the Quality Performance Indicators.
How monitored
The work is monitored through the Trust Acute Care Forum and rating on Quality
Performance Indicators.
2) Prevent incidences of cross infection and outbreaks
Rationale
The Trust is committed to reducing the risk of Hospital acquired infection; hand hygiene, methods
of cleaning and diligent screening are part of its drive to keep patients safe and well.
Current status
For 2009-2010 there was one instance of clostridium difficile and one of methycillin
resistant staphyloccus aureus (MRSA).
Plans
• To improve the numbers attending relevant training and updating according to the Trust policy
• To achieve compliance with the Hygiene Code which the Board certifies annually.
Quality Account 2009/10
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Quality Account 2009/10
How measured
Numbers of incidences and outbreaks are reported monthly to the Board.
C) Clinical Effectiveness
The work is monitored through the Infection Prevention and Control group.
1) All service users to receive Health of the Nation Outcome
Scores on a bi-annual basis
3) Increase the number of assessments of patients at
high risk of falls
Rationale
How monitored
Rationale
To prevent harm and injury to service users by reducing the numbers of slips, trips and falls.
Current status
The Trust receives on average 72 reports a month from the older people’s in-patient mental health
services.
Plans
Clinical coding helps the Trust to give an understanding to its service users and staff on the
expected outcomes of our interventions.
Current status
The target is that all service users on new Care Programme Approach, will have had one rating by
the end of 2011. Training for all staff is complete.
Plans
To develop an action plan to ensure implementation and electronic recording is undertaken.
• Identify triggers from collated incidents and reduce risk
How measured
• Continue with the awareness Campaign with posters and communication warning of risks and
hazards
How monitored
The compliance will be measured quarterly electronically.
This will be managed through clinicians’ performance management framework, and promoted as needed
with individuals and groups. Its progress is monitored through the Executive Management Team.
• Falls potential risk assessment training
• Once risk identified a falls care plan is implemented for that service user.
A reduction in the monthly numbers of slips, trips and falls.
Quarterly audit of case notes to ensure a care plan follows a risk assessment.
2) To improve implementation of National Institute of Clinical
Excellence (NICE) guidance for people with mental illness
How monitored
Rationale
How measured
The Trust is committed to providing the most effective interventions for service users enabling
choice and access to the best possible care.
Quarterly by the Patient Safety Group.
Current status
All clinicians receive new guidance, but the Trust needs to be able to demonstrate that the
guidance is implemented.
Plans
Review the Trust process for monitoring implementation by NICE reference group.
Review clinical governance terms of reference and processes.
How measured
By clinical audit.
How monitored
Targeted use of clinical audit.
Quality Account 2009/10
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Quality Account 2009/10
3) Enable GPs to access advice about client management from
a mental health professional within 24 hours
Section two
Rationale
This is a response to an expressed need for expert advice to support primary care teams to deliver
care for the commonest mental health problems and to enable the team to know when, who and
how to refer.
Current status
There is no agreed Trust wide standard for this service.
Review of Quality Performance
This section of the account covers aspects of our quality review that we are
required to report on in the accounts.
Plans
• To agree a standard
• Map out how the service will operate
• Develop a communication cascade to support this initiative.
How measured
Monitoring of issues and themes.
How monitored
Evaluate the intervention with GPs at year end, this is an existing CQUIN.
Quality Account 2009/10
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During 2009-2010 the Trust provided 11 contracted NHS services. There is one
principle contract for the provision of mental health (including specialist)
services, Child and Adolescent Mental Health Services (CAMHS) and specialist
learning disabilities. This is a block contract with the Primary Care trusts (PCTs)
in East Kent, West Kent and Medway. There are also contracts with Kent
County Council and other NHS organisations. The resources are allocated across
geographical directorates for mental health and service directorates for the
other services, each director being responsible for managing the directorate’s
budget.
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Quality Account 2009/10
The way forward
The Trust is moving from divisions determined by geographical boundary to Service Line
Directorates which focus upon specific aspects of care delivery these are:
• Older adult services in the community and in-patient areas and a range of specialist services
including Child and Adolescent Mental Health services
• Acute Services, including the provision of Psychiatric Intensive Care, and crisis teams
• Community Recovery Services, including first response, enablement and coordination services,
rehabilitation of service users as inpatients, community and in residential care
• Medium secure services including prison tertiary mental health and forensic psychological
services.
The Trust is responding to its resource challenge at this time of change and restructure to ensure
that resources are focussed to produce better care, and to refine working practice to ensure best
value for money is provided.
Appendix D details our year end outcomes for quality performance indicators agreed with NHS Medway,
who commission our services.
Social inclusion
Part of our quality initiative involved developing partnerships. The Trust has committed to many social
inclusion projects.
Mind the Gap – is an art project going into its third year, each year has a different theme 2010/11 is ‘A Box
of Dreams’; service users and carers from across Kent & Medway are provided with cardboard boxes and
encouraged by professional artists to produce works of art supporting the theme. The project also holds a
‘Big Sing’ event in collaboration with Christchurch University as part of the Canterbury Festival and during
the next year will hold several art exhibitions at venues across Kent & Medway.
Charlton Athletic Football Club – are working with the Early Intervention in Psychosis Teams to
provide activity programmes for the young service users with mental health problems.
The current group of young people also have the opportunity to become involved in
volunteering at the London 2012 Olympics.
Time to Change – The Trust has been involved with the National Time to Change project funded by Comic
Relief and the Big Lottery, the aim of the project is to challenge and shift the stigma surrounding mental
health issues. KMPT in conjunction with Unison arranged a Time to Change Roadshow in Maidstone in
2009 and is holding a wellbeing event in September 2010 promoting physical exercise.
Webb’s Garden – This is a project based in Canterbury in an old walled garden, it is run in partnership
with the Friends for Mental Health (East Kent), Chaucer Homecare, KCA, Porchlight and Skillnet
supported by Kent and Medway Partnership Trust, the service users grow vegetables and flowers while
learning new skills and enjoying a social experience in lovely surroundings.
Quality Account 2009/10
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The Buddy Scheme – Health and social care students and other trainees on practice placement within
KMPT, have a service user mentor, known as a Buddy, in addition to a professional mentor, with whom
they work in an equal partnership, utilising a range of educational resources developed by service users
comprising a training package of DVD, training manual, CD Rom and live website with Blog at
www.thebuddyscheme.co.uk (includes DVD clip).
By participating in the Buddy Scheme, service users have been concurrently enabled to move forward
in their recovery, as they find meaningful occupation and valued, paid employment, influencing service
development and improvement.
The scheme is an innovative method of practice education enabling health and social care students and
other trainees to access service users’ personal knowledge and use this as an educational tool to develop a
greater understanding of mental illness and related issues from a service user’s perspective. In partnership
with education, the Buddy Scheme is validated by the Nursing and Midwifery Council and has been
integrated into the curriculum for mental health nursing students, junior Doctors and GP trainees.
The work was promoted as an intervention in the recovery of users of secondary mental health services,
in a range of settings, with an evidenced, resultant reduction in care packages with cost benefit to KMPT
(featured in The Human Factor www.guardianpublic.co.uk 5/11/09).
The Buddy Scheme is evidenced by a service evaluation completed by a team of service users
and providers, educationalists and students in two mental health service settings, community and
rehabilitation inpatient units, over five years.
Awards won by the Buddy Scheme include: National Endowment for Science, Technology and the Arts
(NESTA) grant of £40,000 to produce the training package and DVD and up scale the Buddy Scheme
nationally, Community Care Award 2005 (Mental Health), Medway Council Excellence and Innovation
Award 2006, Kent and Medway “Team Mentor of the Year Award in 2006.
A service user who mentors midwifery and paediatric nursing students, was joint runner up in the Lilly
Outstanding Achievement in Mental Health Awards 2006 – “An inspiration to others”.
Registration with the Care Quality Commission (CQC)
Kent & Medway NHS and Social Care Partnership Trust is required to register with the Care Quality
Commission against the Hygiene Code and its current registration status is registered without conditions.
The Care Quality Commission has not taken enforcement action against Kent and Medway NHS
and Social Care Partnership Trust during April 2009/March 2010.
NHS number code validity
Data quality
KMPT submitted records during 2009-2010 for inclusion in the hospital episode statistics which
are included in the latest published data. The Trust records which included the patient’s valid NHS
number was 97.9% for admitted patient care and 99.8% for out patient care.
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Quality Account 2009/10
Information Governance toolkit attainment levels
Information Governance Toolkit attainment levels for the Trust for information Quality and
Records Management, assessed using the information Governance toolkit was 79%.
Clinical coding
The Trust was not subject to the payment by results clinical coding audit during 2009-2010 by the
Audit Commission. However, audit of clinical coding has been undertaken. The comprehensive
case notes were found to be in good order; everything was neatly filed in chronological order.
The discharge summaries were an accurate source of information, thus aiding the coding process.
The audit examined 165 episodes. Of the 165 episodes audited, there were a total of 165 primary
diagnoses present, and 159 (96%) of these were correct. A total of 386 secondary diagnoses were
recorded, of which 306 (79%) were correct. There were 65 instances where relevant co-morbidities
were not coded even though they were documented in the case notes.
Review of services
During 2009/10 the Kent and Medway NHS and Social Care Partnership Trust provided Adult
mental health services, mental health services for older people, child and adolescent health
services, learning disability services, addiction services, community brain injury team, disablement
services centre, early intervention and psychosis, forensic mental health, eating disorder services,
healthcare resolutions, Kent clinical neuropsychology, Kent and Medway Chronic Fatigue - myalgic
encephalopothy, mother and infant mental health, personality disorders, and West Kent
neuro-rehab, there are no sub-contracted services for Kent and Medway NHS and Social Care
Partnership Trust for 2009/10. During 2009/10 the Trust provided 11 NHS services.
The income generated by the NHS services reviewed in 2009/10 represents 92.7 per cent of the
total income generated from the provision of NHS services by the Trust.
Participation in clinical audits
During 2009-2010 three national clinical audits and one national confidential enquiry covered NHS
Services the Trust provides.
Learning points and the actions taken as a result of the Trust taking part in national clinical audits,
local clinical audits and service evaluation projects can be found in the Trust Annual Clinical Audit
and Effectiveness Report 2009-2010 at www.kmpt.nhs.uk
Research and Development (R&D)
176 patients who were receiving NHS services provided or sub-contracted by Kent and Medway
NHS and Social Care Partnership Trust in 2009/2010 were recruited during the period to take part in
research approved by a research ethics committee.
Historically, there has been both limited R&D and infrastructure to support this activity in the Trust.
To grow R&D in the Trust from this low base, a three year strategy was approved by the board in
January 2009. A key objective of the strategy was to grow National Institute for Health Research
(NIHR) portfolio activity in line with Department of Health policy objectives as outlined in “Best
Research for Best Health”. Following approval of the strategy, R&D in terms of studies approved,
has significantly increased. Between 2008 and 2009 NIHR portfolio studies approved have increased
by 100% and overall research activity, in terms of study approval, has increased by 46%. The Trust
has also demonstrated a positive commitment to service-user involvement in R&D. In particular a
service user / carer sub-group, reporting directly to the R&D group, has been formed and meets
regularly. This group was shortlisted for a Trust award.
Research is a key driver for improving the quality of care and staff employed by the Trust are
increasingly involved in submitting grant applications both as Principal and Chief Investigators. In
the period 2009/2010 – five grant applications were submitted to NIHR funding streams of which
three were short listed. This increasing, and continuing, level of participation in clinical research
demonstrates the commitment of the Trust to improving the quality of care and contributing to
general health improvements.
Praise and complaints
A summary report regarding service user, carer & public contacts with Patient Advice and Liaison
Service (PALS), together with any common themes, follow up actions and implications regarding
service improvement are collated on a quarterly basis. These are available from the PALS
department. Compliments received to date within KMPT were 586 and the number of formal
complaints received in 2009/10 was 184.
During that period the Trust participated in 100% of all national clinical audits and 100% of
national confidential enquiries in which it was eligible to take part. The results are displayed as
Appendix B Table 1.
The national clinical audits and national confidential enquires the Trust participated in, and for
which data collection was completed during 2009-2010 are listed in Appendix B table 2, 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.
The reports of five national clinical audits were reviewed by the Trust in 2009-2010.
The reports of 51 local clinical audits and service evaluation projects were reviewed by the
Trust in 2009-2010.
Quality Account 2009/10
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Quality Account 2009/10
Workforce and leadership development
Engaging with staff working together
We are committed to measuring and improving staff engagement. The results of the national staff
survey 2008/2009 were published in 2009. Overall the results show an improvement on the 2007
results, however there is still significant room for improvement.
Key areas for work are appraisal, staff satisfaction and understanding of how individual roles fit in
with the wider Trust. There is determination on the part of Trust management in partnership with
the Staff Side committee (Joint Negotiating Forum) to deliver improved performance in these areas
next year. The Trust recognises that it needs to place high emphasis on leadership and management
development and is developing on Organisational Development Strategy to focus on these areas.
The Trust has commissioned quarterly ‘Pulse’ surveys which provide locality based feedback
and gives every staff member an opportunity to provide feedback over the year. Effective
communication is vital in delivering high quality services. Employees systematically receive copies of
the bi-monthly staff newsletter, Partnership Matters, a monthly staff briefing and also have access
to the Trust’s website and intranet.
Section three
Quality Improvement Initiatives
for 2009-2010
This section reports on our improvement initiatives for the previous year,
again the report is divided into the three sections that determine quality: the
patient experience, patient safety and clinical effectiveness.
As this was our first year with the quality account we focused upon just four priorities.
The topics covered are wide and varied including news, best clinical practice, finance information
and performance data. We encourage feedback and provide a route for concerns to be aired. Road
shows for staff are run on key topics, such as the Trust’s move to Foundation Trust status and all
staff are encouraged to contact the Chief Executive directly via email or phone. In 2009/10 the
Trust held its second Staff Excellence Awards to recognise and celebrate the work of Trust staff.
A series of staff involvement events were also held.
Goals agreed with commissioners
Use of the CQUIN payment framework
A proportion of the Trust’s income in 2009-2010 was conditional on achieving quality improvement
and innovation goals agreed between the Trust 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 (CQUIN) payment framework.
Further details of the agreed goals for 2009-2010 and for the following 12 month period are
available on our website www.kmpt.nhs.uk where further information can be obtained.
The CQUIN payment framework aims to support the cultural shift towards making quality the
organising principle of NHS services, by embedding quality at the heart of discussions between
NHS Medway, our commissioning primary care trust, and ourselves. This has ensured that local
quality improvement priorities and progress in achieving them were discussed and agreed at board
level and through quarterly quality assurance meetings between the Trust, primary care trust and
strategic health authority throughout the year.
The CQUIN framework made part of KMPT’s income dependent on locally agreed quality
and innovation goals (0.5% on top of actual outturn value in 2009/10). The use of the CQUIN
framework indicates that KMPT has been actively engaged in quality improvements with
commissioners. The CQUIN goals for 2009-2010 are in Appendix C.
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Quality Account 2009/10
1) Patient experience
2) Patient Safety
A) Engaging with our service users and carers
A) Reducing infection
What we did
This objective is being taken forward into this year’s work.
• We have begun a series of real time surveys capturing our service users and their carers views
• We attended a variety of community events in order to engage with as many people as
possible, at the Kent Show in July we had a dialogue with many people over the three days of
the event
• In 2009 the Trust participated in the first national survey of mental health inpatient units.
Of the 758 surveys, 216 were returned with a response rate for the Trust of 29%. The report
compares the Trusts results with those of other trusts, and then compares the survey with the
finding of those in NHS hospitals.
What we did
• The Trust has an infection control team who focussed upon surveillance and rapid
identification of potential outbreaks, as previously mentioned just 2 incidences of reportable infection
occurred, we were quick to isolate the problem and to explore and share lessons learned from these
• A methycillin resistant staphyloccus aureus screening tool was implemented to ensure the Trust
is not reporting MRSA that originated elsewhere
• There was a major initiative to raise awareness of hand washing, with both training posters,
and the availability of gel
The Trust’s scores in comparison to other mental health trusts:
• Cleaning procedures are regularly reviewed
• About the ward, were about the same or less positive
• On hospital staff the results were generally less positive
• During the year 87% of clinical staff and 51% of non clinical staff were trained in hand
washing procedure
• On care and treatment scores were generally the same
• The Trust Board receives regular reports on matters around prevention and control of infection.
• For service users rights the scores were mixed
B) Reducing injury through falls
• For leaving hospital were the same or less positive.
Again this objective is carrying forward into this years quality account.
These scores indicate this Trust has considerable work to give its patients an experience comparable
with the best in the country.
Service users and carers helped the Trust Board to choose its Quality Improvement Priorities for
2010-2011 by responding to a questionnaire asking them to rate and comment on a list of quality
issues. This was cascaded through the Patient Consultative Committee who then consulted with
their networks and fed back issues.
Information secondly was sent to all parts of the organisation, through the Clinical Governance
Groups. This was supported by presentations and briefings and responses were received. Finally,
non-statutory organisations were consulted for their view and priorities eg: Rethink, the Carers
Support Groups, informal day Care Services across the whole of Kent.
What we did
• A poster campaign raised awareness of slips, trips and falls
• We achieved our target that 70% of adults admitted to our services who are at risk of falls in
our older people’s wards are risk assessed within seven days of admission.
3) Clinical effectiveness
A) Measuring outcomes
Again, this objective is carrying forward into this year’s quality account.
What we did
• All our clinicians are now trained in the use of this electronic system. We began using Health of
the Nation Score (HONOS) in October 2009
• By 31 March 2010, 52% of our service users on enhanced CPA had at least one rating, our target
for the whole year was 60%
• The Quality Performance indicator for next year is 60%.
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Statements provided from commissioning PCTs, LINks or OSCs
The LINk has assembled information from a range of sources to inform its commentary using
qualitative and quantitative data and academic input from a local university.
The Trust’s draft quality account was sent to the above groups for comment. In addition a copy was
sent to the chair of the Joint negotiating forum for comment. The full range of their comments
will be available on our website.
1. Aiding public understanding
The document is generally well written but there are examples of unexplained abbreviations and
jargon (such as PCC and PCCI). The acronym KMPT is used inconsistently and terms such as Never
Event are not universally understood. The visual presentation of the document could have been
improved, for example by including individual stories in the section on social inclusion projects
established by the Trust to demonstrate good quality patient experience.
The Kent County Council Health Overview and Scrutiny Committee is not going to comment on any
NHS Quality Accounts for 2009-2010.
Statement from Medway Primary Care Trust
NHS Medway can positively verify quality figures in the accounts for example in relation to Quality
Indicators and performance targets. NHS Medway has no reason to believe that other information
within the Quality Accounts is not accurate.
In subsequent years it would be useful for the Trust to include performance against Commissioning
for Quality and Innovations targets.
NHS Medway has worked closely with the Kent and Medway NHS and Social Care Partnership Trust
(KMPT) throughout the year to ensure and improve the levels of quality in the services provided.
The Trust was highlighted nationally in year as being a Mental Health Trust with high levels of
patient deaths, however, after internal review by the trust and assurance by NHS Medway it was
confirmed that KMPT’s outlier status was as a result of not following national criteria for reporting
rather than as a result of high numbers of patients safety related deaths.
The Trust has developed action plans designed to improve quality in year in response to perceived
areas for improvement. These have included the number of locum and acting consultants and the
redesign and establishment of new services. Action plan completion has been monitored by KMPT
and NHS Medway.
With regard to Serious Untoward Incident investigation, management and closure, KMPT has
demonstrated progress in the year.
NHS Medway is aware that, in common with other providers, KMPT has been subject to significant
time constraints in producing these accounts in the launch year. We are looking forward to
working closely with the Trust in developing the accounts for subsequent years.
Statement from the Kent LINk
The Kent LINk would like to thank Kent and Medway NHS and Social Care Partnership Trust for
the opportunity to comment on its Quality Account for 2009 / 10. This comment will focus on the
extent to which the LINk believes that the account achieves the following:
2. Improvements made
Indicators such as reducing infections and reducing injury through falls seem to reflect national
rather than local priorities. The inclusion of baseline information would demonstrate improvement
more clearly. The target for conducting a falls risk assessment on 70% of new admissions to older
people’s wards within a week is quoted as having been achieved, but is not supported by figures.
The presentation of the Trust’s scores for the National Survey of Mental Health Inpatient Units is
unhelpful, without additional data.
Most participants in the LINk’s focus groups and interviews were unfamiliar with the Health of the
Nation outcome scales. The account outlines the Trust’s intentions to allow service users access to
these but how this will be done is unclear.
The focus groups and interviews undertaken by the LINk strongly indicated that service users
and carers do not feel that they are being listened to. Although it is commendable that the Trust
has begun the process of real time surveys, it is disappointing that the response rate was so low.
Alternative methods of gaining input may be required to extend the range of service users and
carers responding.
Priorities for improvement for 2010/11
Priorities for improvement have been identified, but are missing targets to enable future progress
to be monitored.
Who has been involved in preparation of the Quality Account
The Trust has used input from service users and carers (among others) to establish its future
priorities. However, the questionnaire appears to have been devised by health professionals and as
such would not be easily accessible to most respondents.
The priorities may have looked very different if service users and carers had been able to report in
their own words, as reflected by our focus groups and interviews. Further information from the
survey would demonstrate the number of service users and carers involved.
The LINk recognises that limited time has been available to put the accounts together for this year
and hopes to support the Trust with the process in the future.
1. Aiding the public’s understanding of what the Trust is doing well
2. Outlining improvements made throughout the year
3. Selecting priorities for improvement for the coming year
4. How the Trust has involved service users, staff and others in determining those priorities for
improvement.
Quality Account 2009/10
22
23
Quality Account 2009/10
Appendix A
Patient Safety
The quality improvement initiatives stakeholders
were asked to prioritise
Quality Priorities for 2010/11
Yes
Improve Patient safety on inpatient
units
Improve Infection Control
Eradicate occurrence of “Never
Event” In-patient suicide - using noncollapsible rails,
No
Comments
Patient Experience
Increase the number of assessments of
Patients at high risk of Falls
Ensure completion of quarterly survey
of patient experience by services.
Ensure that action plans are developed
and shared with service user groups
Increase the number of patients
admitted who have a physical health
check (by wellbeing nurse or physical
assessment) at admission
Actively participate in South East
Coast Enhancing Quality Programme Dementia pathway development
Deliver improvements in the physical
health of those with severe mental
health problems
Work with relevant staff to Improve
service user involvement in care
planning process.
e.g. could include actions on smoking
cessation
Widen the learning from analysis of
Serious Untoward Incidents, claims &
complaints
People with Learning Disabilities Develop and implement an agreed
action plan to make reasonable
adjustments in mainstream MH
services to aid understanding for
people with a learning disability
Clinical Effectiveness/Outcomes
To reduce/monitor the proportion of
detained acute inpatients who have
absconded in last three months
All patients to receive Health of the
Nation Outcome scores (HoNOS)
on a bi-annual basis or more frequently
if required to aid with their recovery
pathway
Demonstrate clearly how carer’s
support has increased and in which
areas
Enable GPs to access advice about client
management from a Mental Health
professional within 24hrs
Decrease the number of mixed-sex
wards without women only lounges
Improving the implementation of
National Institute of health and clinical
evidence (NICE) guidance for patients
with mental health problems
Decrease/monitor number of
incidences of patients experiencing
mixed sex accommodation
Provide evidence of more service users
with severe mental health problems
being supported to find or stay in work
Analyse complaints – to show numbers
reported and trends identified
Conduct a trust-wide audit to
determine by ethnic group - Actual
Length of Stay, rates of detention, use
of seclusion
Quality Priorities for 2010/2011
No
Comments
Staff Working
Ensure that all Care Plan reviews
take place twice a year with service
user and carers (Care Programme
Approach)
Quality Priorities for 2010/11
Yes
Reduce the incidents of violence against
MH Staff (inpatient and community)
resulting in physical assault
Yes
No
Comments
Demonstrate Improvements in staff
working environment
Reduce stigma and discrimination
of mental ill health across Kent and
Medway
Produce evidence to show that more
service users with severe mental health
problems are being helped to find
settled accommodation
Quality Account 2009/10
24
25
Quality Account 2009/10
Appendix B
Appendix C
Table 1
CQUIN programme agreed with NHS Medway 2009-2010
The national clinical audits and national confidential enquiries that Kent and Medway NHS
and Social Care Partnership Trust took part in during 2009-2010 are as follows:
Topic
POMH: prescribing topics in mental health services
Quality network for forensic mental health services
Quality improvement network for multi-agency CAMHS (QIMAC)
Quality network for inpatient child and adolescent MH services (QNIC)
National confidential enquiry into suicide and homicide by people with
mental illness
Number of cases
100%
100%
100%
100%
Commissioning
for Quality and
Innovation (CQUIN)
CQUIN
1. Developing
Payment By Results
(PBR) currencies
1.1
3. Improving mental
health service
access and support
for people from
BME groups and
People with
Learning
Disabilities (PLD)
26
Freq of report
Progress reports
4% x 1/12
bi-monthly
1.2
Set up project team
4% May
June
1.3
Presentation of financial information by
service line
4% year end
bi-monthly
1.4
Presentation of activity grouped into
relevant number of Clusters or care
packages
4% year end
bi-monthly
1.5
Presentation of ‘pilot’ areas - Costs and
Care Packages
4% year end
bi-monthly
2.1
Two service user-led evaluations of
specific services per quarter
5% year end
qtly
2.2
Devise, agree and implement a
continuous process for monitoring
patient satisfaction, by survey
5% year end
qtly
3.1
Provide data on ethnicity of service users
- inpatients and outpatients (data split by
Primary Care Trust – PCT)
1.25% per
quarter
qtly
3.2
Audit to determine by ethnic group –
Actual Length Of Stay (ALOS), rates of
detention, use of seclusion - twice yearly
(in Sept and March) - data split by PCT
2.5% per
audit
six monthly
3.3
PLD - record and monitor the number
of service users with LD who access
mainstream health services - quarterly
report
1.875% per
report
qtly
3.4
PLD - Develop and implement an
agreed action plan to make reasonable
adjustments in mainstream Mental
Health services for people with a
learning disability
7.5% when
complete
qtly
98.64%
2. Routine
evaluation of
patient experience
Quality Account 2009/10
Bonus
27
Quality Account 2009/10
4. Improving
outcomes for
people with severe
mental illness and
substance misuse
problems
4.1
4.2
4.3
4.4
5. Routine access
to mental health
services
5.1
Publish quarterly data on number and
% of clinical staff trained in all areas in
screening and case finding for use of
alcohol and drugs (quarters two, three
and four)
2.5% per
quarter
Qtly
Publish quarterly data from quarter two
on number and percentage of service
users assessed
2.5% year
end
Q The
CQUIN
goals for
2009-2010
are outlined
below.
By end quarter two provider and
substance misuse services to have
developed jointly agreed working
protocols for parallel or integrated
treatment of people with dual diagnosis
5% end Q2
Mental Health Joint Strategic Needs
Assessment (JSNA) refresh 2010 to
include the coexistent severe mental
illness and substance misuse problems
for people on Care Programme Approach
(CPA)
5% when
complete
Deliver a four week response for GP
referrals for all age groups - 90% target.
Monthly exception report
25% x 1/12
(for each
month on
target)
Quality Account 2009/10
28
Appendix D
Year end quality performance indicators agreed with
NHS Medway
end Q2
end year
monthly
Quality Performance Indicators
Freq of Report 09/10 Plan
Year end
CORE - Psychological Therapies
(% clients) - Primary Care
Qtrly
90%
96%
CORE - Psychological Therapies
(% clients) - Secondary Care
Qtrly
60%
72%
Mental Health Minimum Data
Set - submitted on time
Qtrly
100%
yes
Mental Health Minimum Data
Set - degree of completion
Qtrly
100%
97%
Clostridium difficile - actuals
Monthly
1
1
MRSA Bacteraemia - actuals
Monthly
0
1
Audits of Hand Hygiene
(All Inpatient sites listed)
Annually
100%
100%
Hand Hygiene Training
- All staff
Qtrly
75%
78%
Hand Hygiene Training - Clinical
Qtrly
95%
87%
Nutrition - % of nutritional assessments completed (based on
audit of 10 sets of notes from
two wards per month) - OPMH Incremental Target
Qtrly
50%;60% Qtr
3, 80% Qtr 4
88%
Falls - OPMH inpatients - Assessments of risk within one
week of admission to service
Qtrly
70%
70%
Falls - OPMH in CMHTs- Actuals
reported
Qtrly
Actuals
15
Falls - OPMH inpatients
- Actuals
Qtrly
Actuals
867
Observations (of physical health) Qtrly
- % of on time, fully completed
and correct patient observations
- OPMH
70% rising to
80% Qtr4
93%
All clients on CPA (community
Qtrly
or inpatient) have had a physical
health checks in last 12 months
(MH08)
80% of enhanced
30%
Enhanced clients in receipt of
advance directives
Qtrly
Actuals
420
Number of SUIs - reported on
STEIS, trends, ethnicity & actual
Monthly
Actuals
27 British white
1 Other white
1 Ethnic group
1 not known
Number of patient safety
Qtrly
incident related deaths reported
to NPSA
Actuals
3
Adult Protection / Safeguarding
- % of all staff trained
Qtrly
70%
78%
Standards for Better Health Self assessment updates
(October & March))
6M
√
yes
29
Comments
Target changed mid year to
include all staff
Awaiting IT solution as
information is not available
on Trust server
Quality Account 2009/10
Quality Performance Indicators
Freq of report
09/10 Plan
Year end
Percentage of acute inpatients
(all age) experiencing one or
more incidents of control and
restraining (MH02) - Quarterly
reported
Qtrly
Set a target
based on Q1
outturn
0.57%
Percentage of acute inpatients
(all age) experiencing one or
more incidents of seclusion
(MH03) - excludes forensics
Qtrly
Set a target
based on Q1
outturn
11%
Number of all patients who had
recorded incidents: physical
assault on the patient (MH10)
Qtrly
Actuals
817
The proportion of detained
acute inpatients who have
absconded in last three months
(MH14)
Qtrly
Set a target
based on Q1
outturn
4.79%
Number of mixed-sex wards
without women only lounges
Monthly
Nil by end
March 2010
0
Number of incidences of
patients experiencing mixed sex
accommodation
Monthly
Nil
0
Number of instances of patients
having to use mixed sex
bathrooms
Monthly
Nil
2
Participation in antipsychotic
(Prescribing Observatory for
Mental Health) POMH - UK
audits (MH16) TBA
TBA
Yes
Yes
Complaints - number - report
trends & actual
Qtrly
Actuals
184
Complaints - ratio to contacts report actual
Qtrly
Actuals
0.08%
Turnover - report actual &
trends
Monthly
Actuals
2.72%
Staff Sickness - report actual &
trends
Monthly
Actuals
4.77%
Number of (non-medical)
Agency Staff utilised - actual
Monthly
Actuals WTE
269
Number of (non-medical)
Agency Staff utilised - non PASA
- actual
Monthly
Actuals WTE
172
Violence against MH Staff (inpatient) assaults (MH11) - actual
Qtrly
Actuals
1173
Violence against MH Staff (community) assaults (MH11) - actual
Qtrly
Actuals
11
Medications - HCC patient
survey questions % increase report actual & trends
Annually
At least 20%
improvement
on 2008/09
52%
The proportion of all clients on
new Care Programme Approach
who have had a HoNOS assessment in last 12 months (MH07)
Qtrly
60%
52%
Patient involvement in
decisions about their own care
(as reported by patient) (MH09)
Annually
95%
47%
Quality Account 2009/10
30
Comments
Two breaches affecting 15
patients Investigation in
progress
Comparison not possible as
last year’s survey was in the
community and this year on
in patient units
Highest score across all
trusts were 64%
31
Quality Account 2009/10
Your views
We want to know what you think about the Trust or the local NHS. Therefore, if you have any
comments to make about this report, or you would like further copies, please contact:
Communications
Kent and Medway NHS and Social Care Partnership Trust
Trust Headquarters, 35 Kings Hill Avenue, Kings Hill, West Malling, Kent ME19 4AX
Tel: 01732 520441
e-mail communications@kmpt.nhs.uk
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