The draft Quality Account of the Cheshire and Wirral Partnership NHS Foundation Trust is attached for the Committee’s consideration and comment.  The draft document is currently undergoing a consultation period prior to the publication of the final document in June.

Sheena Cumisky, Chief Executive of the Cheshire and Wirral Partnership NHS Foundation Trust (CWP) presented the Quality Account for 2009/10.

The Quality Account was in three parts:

·  A strategic overview;

·  A forward look at priorities and statement of assurance against the three priorities identified against the three principal areas of service quality – i.e. patient safety, clinical effectiveness and patient experience;

·  A backward look and review of quality performance over the past year.

The Quality Account as presented to the Committee was a draft document for the Committee to comment upon and any comments would be considered by CWP’s Board the following day.

The priorities for improvement included:

Patient Safety

-  improve safety by monitoring trends from Serious Untoward Incident investigations and development of systems to monitor reduction of repeatable themes;

-  reduce preventable falls in in-patient areas by at least 10% by end of March 2011 – the Committee was advised that the current level of falls was 180 per quarter although 97% of these caused low to no harm.  The target would be addressed through monitoring every fall and mapping it against the Falls Policy;

Clinical Effectiveness

-  implement the Advancing Quality programme for schizophrenia and dementia (including development of Patient Reported Outcome Measures). This was a new regional priority for mental health services and measured clinical and patient reported outcomes to determine the level of care that patients had received benchmarked against a set of agreed “best practice” criteria.

-  Develop integrated care pathways in mental health – this had been highlighted as a priority by commissioners, CWP staff and also service users and carers with an aim of seamless care between primary and secondary care;

-  Review physical healthcare for CWP service users – based on research that suggested people with mental health problems had an increased likelihood of physical health problems and premature death.

Patient Experience

-  Collect real time patient experience data – seek the views of patients and carers/relatives during or immediately after treatment to get accurate and timely feedback.

-  Ensure that patient experience of previous Assertive Outreach service users and carers is sought and continuously monitored during the merger of the Assertive Outreach function into Community Mental Health Teams (CMHTs) – this would include regular reporting to the Joint Scrutiny Committee and the Local Involvement Network.

Part 3 of the Quality Account contained a Review of Quality Performance over 2009/10 and specific work to improve the quality of services included:

·  Investment of £2.8 million to co-locate all adult and older people’s services on a single site with improved facilities at Springview Hospital on Wirral;

·  Establishment of three health facilitator posts in mental health services to support public health and health promotion and work with partners;

·  Opening in September 2009 of the Maple Ward, a new 10 bedded emergency service for young people aged between 13 and 18 to enable in-patient mental health care to be available for admissions from across Cheshire and Merseyside for 24 hours a day;

·  Opening in February 2010 of Greenways assessment and treatment unit for adults with learning disabilities that included all en-suite rooms, additional lounges for privacy, patient kitchen, computer suite sensory room and dedicated education and learning spaces;  the Committee would be visiting Greenways prior to its next meeting on 12 July;

·  National praise for the Wirral drug service for work on recovery services.

During the discussion the following issues/questions were raised:

·  Recognition of support to carers was welcomed but information requested as to how the out of hours support was advertised to those who may need it;

·  How was safeguarding dealt with and how were issues or concerns raised by staff; what measures were in place regarding checks on people who undertook Personal Assistant roles;

·  Participation in the National Confidential Enquires relating to suicide was welcomed and information sought as to whether the rate of suicide was particularly high; the Committee was advised that a full risk assessment was undertaken and the environment designed to minimise any opportunities to self harm; CWP had a Suicide Prevention Strategy which showed how work was undertaken with primary care;

·  The achievement of the goal relating to improved access and reduction in waiting times for accessing 0 – 16 specialist Child and Adolescent Mental Health Service was welcomed;

·  Diagnosis of dementia by a specialist – this was welcomed but concern was raised around possible delays and difficulties in checking for dementia symptoms at primary care level;

·  It was felt that the format was not very user friendly and a traffic light approach would make such documents easier to understand and more accessible, although Members noted that the format was largely prescribed.

Resolved - That,

(1) the draft Quality Account for 2009/10 be received, and the information provided on the quality of care and services be welcomed;

(2) the Trust’s priorities for improvement for 2010/11 be endorsed, and progress be reviewed if necessary in year and as part of the consideration of the draft Quality Account for next year;

(3) the format of the Quality Account, although prescribed, does not make it easy to focus attention on any areas of particular concern and it would be better if a “traffic lights” approach or similar could be adopted to highlight specific performance issues. Although the Trust was working to provide in future a “discretionary” summary to help, the issue should be drawn to the attention of the Department of Health, to consider altering the format of the Quality Account reports;

(4) attention be drawn to the following issues:

(a)  reducing inpatient falls remains a priority area for the Trust as despite a number of initiatives the incidence level is 180 falls each quarter, although 97% are in the no or low harm category. The target of a 10% reduction in the number of preventable falls over the next year is welcome, and it would be helpful for the actual figures to be included in the report in future;

(b)  the wording of the Account could be appropriately strengthened in places, for example on page 8 the reference to integrated care pathways should be changed from “who would like to see seamless care between primary and secondary care” to “who are endeavouring to achieve seamless care......”;

(c)  the proposal on page 9 for surveys on the implementation of the Assertive Outreach changes to be reported in year to the Joint Committee is welcome so that the impact of the new arrangements can be monitored;

(d)  the availability of out of hours outreach support for carers (page 11) is viewed as an important element of the service, and further information on how this support will be communicated to carers should be included;

(e)  that the Trust performs well in responding to complaints, generally achieving 100% of response targets. The Trust has also introduced rigorous quality assurance reviews, focussing in particular on the more complex complaints, which are overseen at Board level;

(f)  the Trust has developed a systematic approach to safeguarding for adults and children, but it would be worth saying more in the Quality Account about staff training in safeguarding, and the overlap with the local authority for patients in receipt of social care, and staff awareness of the Council’s procedures for safeguarding; 

(g)  the Committee is concerned about the number of suicides involving people with mental illness, and is of the view that more work should be done to address this. Whilst recognising that the Trust has in place extensive risk assessment procedures, including the provision of a safe environment for inpatients, and a prevention strategy for patients in primary care, the Committee requests further information and data on the Trust’s suicide prevention strategy;

(h)  the Trust’s success in reducing staff sickness absence levels to just under 5.1%, which compares favourably with the national average of 6%. The Committee has requested more detailed information on the management of staff sickness absence;

(i)  good performance by the Trust in diagnosing dementia by a specialist within 13 weeks of referral, which accords with national best practice. Further comment on the participation of GP’s in the referral process should be included in the Account;

(j)  there is welcome recognition in the Account of the importance of physical health wellbeing for patients with mental illness, and the Trust’s contribution towards promoting healthy lifestyles, particularly targets for improving the percentage of inpatients receiving a physical health examination (79%) and having their Body Mass Index measured (83%) are important and should be kept under review.

(5) these comments be forwarded to the Partnership Trust for inclusion in their Quality Account and to the three Primary Care Trusts and Wirral and Cheshire Local Involvement Networks for information.