moving forward together - nhs · moving forward together quality accounts for 2011/12. section 01...

Moving forward togetherQuality accounts for 2011/12

Section 01

Section 02

Section 03

Contents

Tracking progress ...................................................................... 02

Priorities for improvement ........................................................ 04

Patient safety .............................................................................14

Clinical effectiveness .................................................................19

Patient experience .................................................................... 24

Involvement .............................................................................. 28

Feedback .................................................................................. 29

Regulatory information ............................................................. 07

01Section

01 Quality accounts for 2011/12 | St Andrew’s Heathcare

The Secretary of State recently opened our new medium secure mental health service in Northampton, the award-winning William Wake House. In the House of Commons he described St Andrew’s as a charitable model for the future of NHS care, and told his fellow MPs that the new facility “...will provide �rst-rate, state-of-the-art care for mental health patients”. We are proud to have received this recognition of the work of our expert teams, and the value the Charity adds to mental health care.

As a Charity we reinvest all our surpluses in advances in care and treatment, including brand new services. Our latest service, St Andrew’s Nottinghamshire, includes our national, leading innovation in medium secure care for men with autistic spectrum disorders, as well as being a much-needed regional centre of excellence for secure learning disability care. This year we have also been busy with the refurbishment of St Andrew’s Essex, with therapeutic areas and accommodation being redeveloped to provide the best possible environment for recovery for men and women with mental illness and personality disorders. Several units at Northampton are also bene�tting from refurbishment in line with the latest low secure standards.

Within all of our services, shorter lengths of stay and a clearly de�ned and managed recovery pathway are the prime focus. Learning from our service users’ views, we have taken the lead in publishing the �rst national research on key tools such as the ‘Recovery Star’, and we were chosen to be the only independent provider pilot site in the Implementing Recovery Organisational Change (ImROC) programme. As part of our vision to be a teaching hospital, in 2011/12

our clinicians published over 81 academic papers and two books, with a strong focus on service excellence and patient outcomes. Over 300 service users consented to being involved in research sanctioned by external NHS research ethics committees.

We believe St Andrew’s has an exciting future as the leading charitable provider of public healthcare and a proud member of the NHS family.

Professor Philip SugarmanChief Executive Of�cer

St Andrew’s has a proud tradition over 170 years of collaboration and innovation – enabling us to work with others, and deliver the right services to the people who need them. In an environment where NHS budgets are increasingly constrained, the population is living longer and the cost of care is increasing, this is exactly what we need to do to meet the needs of future service users.

Tracking progress 01

St Andrew’s Heathcare | Quality accounts for 2011/1202

Since our last report the Charity has been recognised as ‘Third Sector Provider of the Year’, our newest hospital, William Wake House, has won a prestigious national construction award and our catering team won the Hotel Services category at the ‘Independent Healthcare Awards’. At a Soil Association Best of Hospital Food event at Clarence House, HRH Prince Charles also commended the quality of St Andrew’s food.

This recognition re�ects our commitment to delivering the highest quality of care to our service users through excellent clinically effective services and by providing the best possible environment in which they can continue their journey of recovery.

We have set ambitious targets for quality for the coming year. We will be working with our service users to focus on their experiences and how we can increase their involvement in their care.

We also fully embrace the national emphasis on quality assurance in healthcare, and have appointed a Director of Quality and Governance to lead a team responsible for ensuring that the Charity delivers safe, effective, high quality care to all of its service users.

On behalf of St Andrew’s Healthcare I con�rm that, to the best of my knowledge, the information in the following document is accurate and was approved by the Charity’s Board on 25 May 2012.

Dr Fiona MasonChief Medical Of�cer

Welcome to our Quality Accounts for St Andrew’s Healthcare covering the period from 1 April 2011 to 31 March 2012. This of�cial publication outlines the �ndings of a review of our performance and our future plans to further improve.

01Tracking progress


Over the next �ve years the Charity has a strategic aim, in relation to quality, to:

“... be the market leaderproviding safe, outcomefocused healthcare whileensuring continuousimprovement and supporting innovation.”

Our strategy has set three key objectives to guide our achievement of this aim over the next �ve years. These are:

1. To have an embedded culture of excellence.

2. That staff, Commissioners, service users and their carers will work together to ensure treatment, which promotes recovery and reduces risk, is provided in appropriate high quality environments.

3. To provide effective clinical services led by nationally recognised clinicians.

In preparing these accounts, the Charity discussed quality priorities with service users, staff and trustees. The results of these conversations have led to us agreeing the improvement priorities for 2012/13.

The priorities for 2012/13 which will take us towards achieving our objectives are laid out in the table below.

During the 2011/12 reporting period the Charity has fundamentally reviewed its approach to managing, developing and assuring the quality of its services. The recommendations of this review are still being implemented. In parallel with this work the Charity has reviewed its �ve year strategy and set some ambitious targets for developing the quality of its services in 2012/13.

Priorities for improvement

Quality Priorities Why this is important Objectives Measurement of success

Quality Quality Domain Initiative

Clinical My Shared We want all our service Roll out of My Shared Care Increase in service users using Effectiveness Pathway users fully involved in decisions Pathway across the Charity. My Shared Care Pathway about their care and treatment. processes and tools.

Effective Our service users and carers Improve our ability to monitor Baseline data available with audit Therapeutic need to be assured that their care compliance with NICE of compliance established. Practice and treatment is based on the Quality Standards. latest evidence based guidance.

Quality We need to be con�dent that Quality improvement plans will Each registered service will Improvement our investment of resources and be developed and implemented provide a quarterly update on Plans time in quality improvements are for each registered location progress against their priorities locally relevant and based on based on sound information and an end of year report. objective performance information and feedback from service and service user and carer users and carers. experience and feedback.

Compliance We have not achieved full Each registered location will have Each registered service will have with essential compliance with CQC an annual schedule of internal updated their current baseline standards standards in all registered checks against the CQC position against the minimum services throughout the year. essential standards. standards. We need to improve our internal checking process so we continue Registered services’ quality to move towards full compliance improvement plans will address in all areas. identi�ed areas of non-compliance will be in place.

All services will achieve full compliance with the essential standards.

01


Priorities for improvement

Quality Priorities Why this is important Objectives Measurement of success

Quality Quality Domain Initiative

Patient Patient surveys We want to improve how we Introduction of service speci�c All hospitals will demonstrate Experience gather and use service user patient experience reports and. quarterly improvement in patient feedback to drive continuous patient satisfaction surveys experience measures. improvement in patient experience.

Recovery The ImROC project covers a Complete our Improving Project milestones achieved. number of work streams focused Recovery project (ImROC). of developing services based on a recovery ethos. This is important because it enables people’s personal interests, strengths and assets to be emphasised in their recovery journey.

Complaints On too many occasions last Improvement in complaints 95% of complainants will get a year it took us too long to respond management and reporting. full response to their complaint to people’s complaints. We need within 30 days. to ensure when things do go wrong our service users and their carers get a full and timely response and are assured that we are improving our services where required.

Therapeutic ‘Star Wards’ is a national initiative Each registered service to All registered locations to include activity which supports wards to achieve a minimum of 50% of their plans to achieve ‘Star Wards’ improve people’s experience while their wards with ‘Star Wards’ accreditation in their annual in hospital. It has a particular focus accreditation by the end of quality plan. on encouraging recreational and the year. meaningful activity on wards.

Patient Safety Hospital out Our service users and carers Strengthen our resilience to Achieve 24 hour hospital project of hours need to be con�dent that all manage all healthcare events milestones for 2012/13. our registered services are as and situations in all our registered capable of managing urgent services at any time of healthcare situations as safely at day or night. night as they do in the day.

Low secure Our service users in low secure Ensure nominated low secure 100% of low secure wards have standards areas should be con�dent that wards meet the new low completed a gap analysis and low their wards meet the new secure standards. secure wards are compliant with national standards. low secure standards.

Prescribing Our service users need to be Introduce a Charity wide Prescribing 100% of prescribing is compliant assured that they are prescribed Formulary and new procedures with Formulary and off license medicine safely and in line with for off licence prescribing. procedure. guidelines.

This report will be used regularly to monitor performance against targets and invite feedback from our partners. St Andrew’s will track progress in the following ways:

• Document the targets and key information on our intranet

• Report updates against targets to Board meetings

• Invite input on key targets and ongoing performance from service users.

01


02Section

Part 2, containing the information relevant to the quality of NHS services provided or sub-contracted by the provider during the reporting period which is prescribed for the purposes of section 8(1) or (3) of the 2009 Act by paragraph (2).

Reporting period: 1 April 2011 to 31 March 2012

Name of provider: St Andrew’s Healthcare

This section provides information in the of�cial format required under the National Health Service (Quality Accounts) Regulations 2010.


Review of servicesDuring the reporting period 1 April 2011 to 31 March 2012 St Andrew’s Healthcare provided services in the �eld of mental health, learning disability and brain injury to over 700 service users, commissioned by more than 130 different NHS Services or organisations.

St Andrew’s Healthcare has reviewed all the data available to them on the quality of care in respect of all the services for which it provides clinical NHS services.

The income generated by the services reviewed in 2011/12 represents 100% of the total income generated from the provision of NHS services by St Andrew’s Healthcare for 1 April 2011 to 31 March 2012.

Participation in clinical auditsDuring the reporting period 1 April 2011 to 31 March 2012, four national clinical audits and zero national con�dential enquiries covered NHS services that St Andrew’s Healthcare provides.

During that period St Andrew’s Healthcare participated in 100% of the national clinical audits it was eligible to participate in.

The national clinical audits that St Andrew’s Healthcare was eligible to participate in during the reporting period are zero con�dential enquiries and four national clinical audits.

The national clinical audits and national con�dential enquiries that St Andrew’s Healthcare participated in during the reporting period were:

• Prescribing Observatory for Mental Health

- Prescribing antipsychotics for people with dementia

- Assessment of the side effects of depot antipsychotics

- Monitoring of service users prescribed lithium

- Use of antipsychotic medication in CAMHS.

The national clinical audits and national con�dential enquiries that St Andrew’s Healthcare participated in, and for which data collection was completed during the reporting period 1 April 2011 to 31 March 2012, are listed 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.

*Figures based on service users who met the criteria in the auditing period.

Audit Participation Participant numbers* Sample size

Prescribing antipsychotics for people with dementia Yes 40 service users 100%

Assessment of the side effects of depot antipsychotics Yes 72 service users 100%

Monitoring of service users prescribed lithium Yes 18 service users 100%

Use of antipsychotic medication in CAMHS Yes 64 service users 100%

700

St Andrew’s Healthcare provided services in the �eld of mental health, learning disability and brain injury to over

service users

Regulatory information 02


The reports of two of the national clinical audits were reviewed by St Andrew’s Healthcare during the reporting period 1 April 2011 to 31 March 2012 and we intend to take the following actions to improve the quality of healthcare provided:

Prescribing antipsychotics for people with dementia• Discussed and reviewed at Medicines

Management Group

• Action plan developed and in place

• Pharmacy Newsletter to staff regarding the audit results and required actions

• Medicines Policy updated (for issue April 2012) and Medication Care plans under development for key high risk medicines or areas of prescribing including prescribing in dementia

• Initial medication care plans already on RiO, our electronic patient record system

• Medication training is also under review – training plan developed and sent to training team to develop new medication training in line with updated medicines policy and procedures during quarters 1 and 2 in 2012/13.

Assessment of the side effects of depot antipsychotics• Discussed and reviewed at Medicines

Management Group

• Action plan developed and in place

• Pharmacy newsletter to staff regarding audit and results and required actions

• Medicines Policy updated (for issue April 2012) and Medication Care plans under development for key high risk medicines or areas of prescribing

• Depot care plans already on RiO include requirements for monitoring and a recommendation of side effect monitoring tool

• Currently assessing how the tool could be added to RiO as a template.

The reports of a further 110 local clinical audits were reviewed by St Andrew’s Healthcare in the reporting period and we intend to take a range of actions to improve the quality of healthcare provided.

Further details are available electronically from the Clinical Audit team; please email [email protected] for this information.

ResearchThere were 319 service users receiving NHS services provided or sub-contracted by St Andrew’s Healthcare during the reporting period 1 April 2011 to 31 March 2012 who were recruited during the period to participate in research approved by a research ethics committee.

Use of the CQUIN payment frameworkA proportion of St Andrew’s Healthcare’s income in the period 1 April 2011 to 31 March 2012 was conditional on achieving quality improvement and innovation goals agreed between St Andrew’s Healthcare 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 payment framework.

The Charity achieved 100% CQUIN payment.

Further details of the agreed goals for the reporting period and for the following 12 month period are available electronically by emailing our contracting team at the following address; [email protected]

Statements from the Care Quality CommissionSt Andrew’s Healthcare is required to register with the Care Quality Commission and is currently registered for:

• Treatment of disease, disorder or injury

• Assessment or medical treatment of persons detained under the Mental Health Act.

St Andrew’s Healthcare currently has the following conditions on registration

• The registered provider must not provide services for people under thirteen years of age at the location St Andrew’s Healthcare, Adolescent Services, Northampton

• The registered provider must only accommodate a maximum of 132 service users at the location St Andrew’s Healthcare, William Wake House, Northampton.

St Andrew’s Healthcare has eight registered locations:

1. Adolescent Service

2. Men’s Service

3. Neuropsychiatry Service

4. William Wake House

5. Women’s Service

6. Essex

7. Birmingham

9. Nottinghamshire

Each location is subject to periodic review by the Care Quality Commission. Between 1 April 2011 and 31 March 2012 St Andrew’s Healthcare has had eight unannounced visits across its registered locations. During this time period the CQC have not published any enforcement actions against any of St Andrew’s Healthcare registered locations.

St Andrew’s Healthcare has not participated in any special reviews or investigations during the reporting period.



Registered Date of Last Standards Outcome of Improvement Progress Location Inspection Checked Inspection Actions Identi�ed

Adolescent Service 13/01/2012 1 Compliant N/A N/A

4 Compliant N/A N/A

7 Compliant N/A N/A

10 Minor concerns Need for improvements All requirements for in cleanliness and improvement have now maintenance of environment been met. At the time of in John Clare and writing this report we Church Wards. were awaiting the outcome of unannounced visit on 08/03/2012*.

14 Compliant N/A N/A



Essex 20/07/2011 4 Moderate concerns Need for improvements The location has developed in ensuring service users its care planning process to have the opportunity to ensure service users always review and comment on have the opportunity to their care plans. contribute to their care plan.

7 Compliant N/A N/A






Men’s Service 31/10/2011 1 Compliant N/A N/A

4 Compliant N/A N/A

7 Compliant N/A N/A





Birmingham** Has not been inspected since registration


The table below provides a summary of the �ndings of each of the six most recent published 1 visits for each registered location. It also provides an update on the actions St Andrew’s Healthcare has or is in the process of taking to address the areas identi�ed for improvement.



Nottinghamshire*** 28/02/2012 1 Compliant N/A N/A

2 Compliant N/A N/A

4 Moderate concerns One service user did not Improved process for have an up to date copy of updating care plans in ward care plans in their paper �le. rounds and ensuring all care Some care plans did not plans are updated in paper always pick up on all the �les following ward rounds information from the have been introduced. assessments.

7 Major concerns An alleged safeguarding All safeguarding allegations incident had not been are now reviewed daily by reported to the CQC. the senior management team and reported to safeguarding and CQC in line with policy.

13 Major concerns Excessive use of Increased local recruitment agency staff. activity and a signi�cant number of vacant posts have been �lled.

A work plan to establish a local staff bank system has been brought forward.

Developed an approved list of agency staff that have worked regularly for the unit and had full induction.

Daily checking of staff rosters to ensure best deployment of available resources across the location.

In the interim we deployed additional resources from our main site in Northampton.

14 Moderate concerns Insuf�cient staff supervision Increased number of ward team meetings.

Introduced one to one monthly management supervision sessions for all staff in addition to established clinical supervision meetings.

Strengthened ward management.

16 Major concerns Management oversight Actions as per outcome 7. of safeguarding allegations.

Inadequate staff supervision. Outcomes as per outcome 14.

Some gaps in seclusion Daily review of seclusion registers. registers by ward managers /nurse in charge.




Neuropsychiatry Has not been inspected since registration


William Wake House 14/02/2012 4 Minor concerns Care plans were not Care plans are regularly always written in a reviewed in ward rounds personalised way. to ensure personalisation.

Additional staff training has been provided.

7 Minor concerns Service users did not Additional stocks and range always have access to of sizes of safe clothing have appropriately sized safe been ordered and are now clothing when put in available. seclusion.


Women’s Service 13/02/2012 4 Minor concerns Service users did not Developing improved easy always understand why to read materials on how restrictions were placed service users are given upon what they were increased levels of personal allowed to do. responsibility in line with reduced levels of risk behaviour.

Some staff were not Increasing Healthcare adequately trained to support Assistant training in service users in understanding communicating with people why they were not allowed with learning disabilities. to do certain things.

7 Moderate concerns Records for a service user in Staff training and supervision seclusion did not adequately to ensure they record all describe what had happened antecedents to restraint and prior to the events that led seclusion events. to seclusion.

All incident reports of restraint or seclusion to include antecedent events.

*At the time of writing the CQC had issued a draft report following a visit to the Adolescent Service on 08/03/12. The Service was found to be compliant in all areas.

**At the time of writing the CQC had issued a draft report following a visit which took place on 05/04/12 and 10/04/12. The Service was found to be compliant in all areas inspected.

*** Nottinghamshire has had two visits in this year. The �rst visit was on 15/09/11 and the second visit was on 28/02/12. A follow up visit took place at St Andrew’s Nottinghamshire on 12/04/12 and the Service was re-assessed and found to be compliant in outcome 16.



Data quality Good quality data underpins the effective delivery of service user care at St Andrew’s Healthcare. The Charity strives to be able to produce accurate and timely information which can be used to in�uence management decisions and the effective care of our service users.

St Andrew’s Healthcare continues to ensure that the information we record, hold and use in the treatment and care of our service users:

• is updated and validated in a timely manner

• is monitored for accuracy and completeness

• complies with the NHS national clinical coding ensuring consistency in reporting information that can be comparable with other organisations.

St Andrew’s Healthcare will be developing a revised Data Quality Strategy for 2012/13. The new strategy will focus both on areas where it is recognised that an improvement in data quality is required, alongside maintaining those areas with existing excellence in data.

Throughout the coming year we will be introducing an audit schedule which will monitor and track scheduled Information Governance audits. We will also be looking to support data quality across the Charity through exciting new developments such as the introduction of a Data Warehouse and the Information Asset Owner projects.

NHS Number and General Medical Practice Code ValiditySt Andrew’s Healthcare did not submit records during the reporting period 1 April 2011 to 31 March 2012 to the Secondary Uses service for inclusion in the Hospital Episode Statistics which are included in the latest published data.

Information Governance Toolkit attainment levelsOur Information Governance Assessment Report score for the reporting period 1 April 2011 to 31 March 2012 was 48% of the toolkit requirements and was graded Red*. To achieve a “satisfactory” rating, we need to comply with all requirements to a standard of level 2 or above. A signi�cant Information Governance project has been initiated within the Charity that will ensure we achieve a better assessment in the 2012/13 reporting period. The project involves the completion of a full records inventory throughout the Charity, which will enable us to identify areas that require better standards of data quality to be applied

* Our percentage is not calculated from 100% as there are a number of elements which we are not required to comply with. This �gure therefore represents 78% as an overall score.

Clinical coding error rateSt Andrew’s Healthcare was not subject to the Payment by Results clinical coding audit during the reporting period by the Audit Commission.

St Andrew’s Healthcare willbe developing a revisedData Quality Strategy for2012/13 including animprovement plan focusing on areas where animprovement in data qualityis required or where thereis a requirement for alreadyexcellent data quality tobe maintained.



03Section

Review of quality performance

In preparing last year’s Quality Accounts, we discussed our priorities with service users, staff and trustees. The results of these conversations led us to agree the following improvement priorities for 2011/12.


On track with patient safetyKeeping people safe is a top priority for the Charity. We do everything we can to provide a safe and secure environment for service users, staff and visitors, but we also recognise that unplanned events can and do happen when providing healthcare. We know that having systems in place to identify, respond appropriately and learn from these events is crucial to achieving our goal of clinical excellence.

Serious Untoward Incidents (SUI’s)The Charity has worked hard to improve incident reporting and to make services safer by learning from incidents. This year we have seen incident reports increase overall and the number of incidents which are graded as ‘serious’ reduce. This suggests an overall improvement in the safety of our services and indicates a positive cultural shift with regards to clinical quality. This was achieved alongside a marked increase in occupancy.

Making Services Safer The Charity has made many improvements during the year which has helped to make services safer. These include:

• Strengthening our processes for assessing the safety of new and existing equipment and furniture. This has signi�cantly improved the safety of our care environments.

• Ensuring clients with identi�ed physical health problems get earlier proactive physical health reviews thus helping to reduce medical emergencies.

• Developing the role of our pharmacy technicians on the wards, this is improving the safety of our medicines management.

• Introducing a ‘Falls team’ to ensure prevention and care planning for falls is in place for our ‘at risk’ service users.

• Roll out of a standardised risk assessment tool linked to service users’ care plans. This allows clearer communication about risk issues and ensures that care plans are aligned to improve safety.

• Improved and appropriate management of Serious Untoward Incidents (SUI’s) includes learning lessons and re-designing services based on safety and risk. Where recommendations from governing bodies have been made, implementation of improved processes and practices has been carried out, resulting in a safer environment with enhanced governance.

Safety Management SystemsThe Charity has retained its British Safety Council (BSC) 5 Star Award for Health and Safely Management Systems in Northampton and Birmingham. We have also gained BSC recognition for our site in Nottinghamshire.

This achievement has been supported by improving the processes we use for reviewing our most serious incidents, and ensuring the plans we agree for improvements are completed.

Patient safety

Monthly % SUI’s (All incidents)

Year total SUI’s

2011

2010

0 20 40 60 80 100 120 140 160 180 200 220 240 260 280 300 320 340 360

2011

2010

0.00 0.50 1.00 1.50 2.00 2.50 3.00 3.50 4.00

03


Essen Climate Evaluation Scale (EssenCES)EssenCES remained an important priority for the last year. This indicator is part of the Commissioning for Quality and Innovation (CQUIN) payment framework and a Care Quality Commission requirement.

This scale explores how much service users feel safe and supported, by both their peers and care staff. Evidence suggests that service users respond better, engage more and recover faster where they feel safe and comfortable.

In 2011/12, the Charity focussed on service user perceptions of the ‘risk status’ system.

We implemented a number of initiatives that relate to the areas of Therapeutic Hold, Patient Cohesion and Experienced Safety for all services, with the exception of Neuropsychiatry. Over the last year these were regularly tracked and a range of outcome measures have been recorded including rates of attendance at therapeutic sessions, service user and staff satisfaction, positive behaviour changes and staff education.

Examples‘Therapeutic Hold’ has improved via the proactive engagement of service users in one to one sessions and ward based activities. In Birmingham this included the involvement of the Geese Theatre Company. Therapeutic drama based sessions were held for service users to explore changing behaviour and rehearse

new skills and strategies for dealing with the issues that they come across everyday on the wards. The service users that took part were asked to complete self-reports about the project topic, before and after the sessions. They were also interviewed to help evaluate their views of what they have gained from the project.

“I learned more con�dence, how to listen to others more ef�ciently, how to ‘think on my feet’ and how to deal with potentially dif�cult situations.”

Service UserSt Andrew’s Birmingham

‘Patient Cohesion’ initiatives have included the ‘Living Together’ group, a social gathering and the community meeting. On Robinson ward, in William Wake House, engagement has been very positive with both staff and service users welcoming the opportunity to work collaboratively to �nd solutions to issues on the ward through role play. The meetings were well attended with only one service user out of the 17 on the ward declining to participate. There are plans to further extend the meetings to a suggestion box and monthly service user forum.

Both of these initiatives have contributed to an increase in ‘Experienced Safety’.

“I learned more con�dence,how to listen to othersmore ef�ciently, how to‘think on my feet’ and howto deal with potentiallydif�cult situations.”Service UserSt Andrew’s Birmingham

Patient safety 03


Design manual We are committed to providing well designed healthcare environments. We want to create safe, homely spaces that people feel comfortable living in as they recover.

We need to make sure that our hospitals provide safe and secure environments for service users and staff. Agreed quality standards and sharing information on product testing has meant that all of our facilities can learn from past experience.

In 2010/11, the Charity developed a design guide which sets standards for the quality of our hospital environments. The guide builds on the national regulatory standards, and includes information to make sure that any development or refurbishment meets and (where appropriate) exceeds those requirements. It also helps colleagues to learn from the Charity’s experience and share information about environments and products for particular service user groups. The design guides are a framework for our clinical environments. There has been a collaborative approach across the Charity with staff and service users assisting in the development of the manuals.

During 2011/12 we worked with service users to develop the guide further, and

include speci�cations for speci�c room types. Design guides for Medium Secure, Low Secure and Psychiatric Intensive Care Units were launched in October 2011 for inclusion in all projects including refurbishments. The guide prevents unnecessary risks and identi�es areas that may be susceptible to problems. This includes information on products tested, to minimise risk and encourage shared learning without stopping creativity.

The Charity has looked at seclusion rooms and the necessary requirements to ensure staff and service user safety. This was done through using a range of methods including 2D plans, 3D modelling and visits to secure sites such as Rampton high secure hospital.

The next stage of the project is to design and build a prototype to allow thorough testing of all design elements to ensure we have a robust and cost effective solution.

A total of 36 environmental incidents have been reported over the two year period. There has been an increase of 25% from 2010/11 to 2011/12. This increase can be attributed to two new services opening, Nottinghamshire in September 2010 and William Wake in December 2010. All other services show a decrease of 38% in reported incidents.

38%decrease in reported incidents

Patient safety 03


Patient safety

Safe access to technologyMany secure mental healthcare providers routinely prevent service users from accessing technology; however we make every effort to help people access technology for work, leisure, education and communication and so we focus on managing access and risk assessing individuals to ensure they access technology safely.

In 2011/12, we dedicated more resources and support to service users. This included risk management training sessions and providing regional testing equipment.

The Charity’s ‘Patient Access to Technology Group’ organised training on managing risks safely which was run through a full day workshop with over 70 members of staff attending from across all four sites. The session aimed to highlight to staff the technology that is available to service users and how to manage risks safely.

We have increased resources for forensic screening by the recruitment of an IT Security and Digital Analyst. We have also supported our security teams across all sites by offering them digital forensic triage training which has reduced the time it takes for devices to be returned to service users. We are the only independent mental healthcare provider to have a digital forensic lab that inspects technology in accordance with the Association of Chief Police (ACPO) guidelines. In addition to the

forensic lab in Northampton, we are looking to establish secure areas in Birmingham, Essex and Nottinghamshire.

Investigation into the potential for a music library is still underway including supervised access to sites such as iTunes where service users are able to download music. The service user intranet project is currently being reviewed and resources, both clinical and IT, are being evaluated to make further progress.

We have explored various ways of helping service users connect with relatives. We have now introduced secure PC based video conferencing which ward staff can access via a ward laptop or education PC. The system allows service users to stay in touch with family and friends where contact would otherwise have been problematic. It has also been used to allow service users to virtually attend remote tribunals or court appearances with the minimum of disruption to their routine.

Ben Meade, Head of IT Support Services at St Andrew’s, says: “Because of the security built in to the system, we can use it for virtual meetings between staff. We can also provide a con�dential and convenient environment at any of our sites for our service users to keep in touch with their friends, family and care team.

“It was easy to set up a trial of the system and we soon realised that it would be valuable to improve collaboration between our multi-disciplinary teams, and save

travelling costs. We have also been able to provide a truly international service to our customers, linking up a service user in Northampton with a member of their care team who was away in India and family members in Abu Dhabi in the UAE. We realised that it also offered real bene�ts to people using our services for deaf people, because they can still bene�t from seeing a British Sign Language interpreter.”

03


Many secure mentalhealthcare providersroutinely prevent serviceusers from accessingtechnology; however wemake every effort to helppeople access technologyfor work, leisure, educationand communication use.

“Because of the security built in to the system, we can use it for virtual meetingsbetween staff. We can also provide a con�dential and convenient environment at anyof our sites for our service users to keep in touch with their friends, family and care team.It was easy to set up a trial of the system and we soon realised that it would be valuable to improve collaboration between our multi-disciplinary teams, andsave travelling costs. We have also been able to provide a truly international service toour customers, linking up a service user in Northampton with a member of their careteam who was away in India and family members in Abu Dhabi in the UAE.We realised that it also offered real bene�ts to people using our services for deaf people,because they can still bene�t from seeing a British Sign Language interpreter.”Ben Meade Head of IT Support Services at St Andrew’s

Patient safety 03


Recovery planningRecovery is a key focus for the Charity. We aim to put service users at the centre of their care; to help them to explore what is right for them and live the best life they can, in the context of their mental illness. By working in partnership, a person’s life experiences and understanding of their own illness is recognised and valued.

As a pilot site for Implementing Recovery: Organisational Change (known as ImROC), we have reviewed and challenged our existing services to �nd ways to build on existing good practice.

All service users, with the exception of those within our Neuropsychiatry service, are offered the opportunity to complete a recovery plan appropriate to their needs. This is typically Recovery Star or Teen Stars for adolescents. Service users are encouraged to review the plans at least every six months and develop and review actions as part of this process

We monitor the uptake and report quarterly on performance of the ImROC project through CQUIN reports.

ImROC progress and achievements so far include:

• The introduction of a core group with indenti�ed leads for the six work streams

• Establishing a Recovery Forum with representation from all of our registered hospitals

• Roll out of workshops across the Charity to increase awareness of recovery for staff and service users

• An increase in service user involvement in training, including at staff induction and participating in focus groups to be used in future training.

A group of female service users participated in the recently introduced Research Training Programme, in collaboration with the University of Northampton, which has had an extremely positive impact on both service users and staff. The group has been a role model to not only their peers but also to staff on what can be achieved. We aim to involve service users in all aspects of the Charity, including research and with this project the service users were leading the group in the direction that they chose. Having successfully completed phase one of the project they are now very excited about moving on to phase two and looking at how their �ndings can in�uence improvements and developments in services.

Clinical effectiveness 03



Recovery planningRachel West, Head of Clinical Services, Women’s Service said:

“The project was an opportunity to enable service users to participate in research in a meaningful way. The growth of the individuals in the group in terms of con�dence, willingness to share ideas, getting to know new people, listening and respecting was well worth the challenge of setting up the group.”

The Recovery Star is another key tool that the Charity has been using to help mental health staff and service users discuss recovery, and to provide a measurement of progress across a range of issues strongly believed to be key in the recovery journey. Importantly, the tool emphasises the uniqueness of each individual’s recovery from mental illness, and is particularly focused on human issues like identity, hope and self-esteem rather than on symptoms.

Lead author Dr Geoff Dickens, a mental health nurse and academic at St Andrew’s, said: “Mental healthcare which focuses on an individual’s needs and hopes for recovery is increasingly acknowledged as a key element in achieving positive and lasting change.”

“It is important that tools are available to help professionals to provide this recovery-orientated care. The work we have undertaken shows promising early signs that the Recovery Star has the potential to do this, and points a clear way forward for further development of the tool.”

Our service users have also been working with the Mental Health Providers Forum in conjunction with Triangle Consulting in developing the Secure Star, an adaptation of the Recovery Star for secure environments

“Mental healthcare whichfocuses on an individual’sneeds and hopes forrecovery is increasinglyacknowledged as a keyelement in achievingpositive and lasting change.”Dr Geoff DickensMental health nurse and academic at St Andrew’s


Care Programme Approach (CPA)The Charity follows the Care Programme Approach (CPA), a national clinical framework for supporting people with complex mental health needs. Every service user has an individual care plan, and an appointed care co-ordinator, who meet individual service users at least weekly to discuss their care plan and how things are going.

Through CPA, we support service users to help them achieve optimal mental health and recovery. The focus is on working in partnership with service users to plan and manage their treatment programmes. This helps them to move out of secure care and back into the community.

In 2011/12 we reviewed our CPA processes, to bring together clinical practice and the contractual requirements of our Commissioners. This work will continue through 2012/13 including, refreshing our policy and agreeing key roles and responsibilities.

From the review all administration has now been standardised and training for key workers and clinical secretaries will be rolled out this year. The role of our CPA measures as part of the Charity’s performance management framework is still under review.

Service users’ views have been an important part of the process too, with their contribution at workshops and forums to discuss both the design of the CPA and the service user experience. In February and March 2012 service users attended a number of workshops and forums to look at the service user ‘Twenty De�ned Standards’ from the Yorkshire & Humber region. Service users have currently added another twelve that they would like to be adopted by the Charity in its commitment to service users, their families and Commissioners.

In quarter three of the reporting period we conducted an audit with 421 service users across the Charity. The results of the audit provide us with a measure to compare against as we embed My Shared Pathway and the revised standards into our practice. This change will be re�ected in a further review of CPA process to demonstrate a more recovery focussed process. A summary of the results is shown below.

The My Shared Pathway project will allow service users to actively shape CPAs further.

We are using My Shared Pathway workbooks to further engage service users, and then provide feedback on their experiences. Two of our hospitals, St Andrew’s Birmingham and St Andrew’s Essex, are participating in the national pilot scheme of the My Shared Pathway workbooks, with each hospital identifying ten service users from the male mental health pathway, who were willing to take part in the pilot study.

Feedback from service users and from staff is being collected throughout this pilot phase by the co-ordinators, as well as more formal individual feedback provided by both groups through the evaluation team from York University, led by Dr Liz Hughes.

The information gathered from the pilot study will allow My Shared Pathway to be rolled out across all secure services with the aim of 100% compliance by 31 March 2013. The progress will be reported quarterly through CQUIN reporting.


In quarter 3 of the reporting period we conducted an audit with 421 service users across the Charity.

were able to identify their key worker

had been given an explanation of CPA

did not know if they had been given an explanation

Respondents rated their current level of involvement in their CPA using the scale of 1 (not at all involved) to 5 (fully involved).

rated their level of involvement 1 or 2

rated their level of involvement 4 or 5

82%7%

89%

26%25%


Clinical effectiveness

Enhancing physical healthcareLike everyone else, people with mental health dif�culties need access to good physical healthcare. Regular health checks, screening programmes and vaccinations mean we can identify possible problems and ensure service users get any treatment they need.

Physical health was a continued priority for us last year. A high proportion of people referred to us have diabetes - around 10% of service users are diabetic, compared to a national average of 4% (source: Diabetes UK, 2009). In 2010, we piloted a structured six-week programme to help diabetic service users to manage it themselves with support from staff.

Both primary care and physical healthcare nurses have been working collaboratively with key clinicians, including dieticians, to ensure that the National Institute for Health and Clinical Excellence quality standards for diabetes in adults are being worked towards. In addition to this an external audit of diabetes control (HbA1c) was conducted by a Diabetes Specialist Nurse from the National Service for Health Improvement. The team identi�ed diabetic service users with an increased HbA1c for a baseline and then an intense programme was introduced for those individuals with poor control, as this leads to an increased risk of complications.

You are working with a dif�cult patient group, who oftenhave very poor diabetic control. The service users whoare controlled have fantastic control, many of whom havean HbA1c of less than 6%. This is very rare in generalpractice and again is down to your professional care. I also wanted to mention the high quality of record keepingI witnessed and the obvious dedication by your team.”Jo PerezDiabetes Specialist Nurse Advisor, National Service for Health Improvement

10%of service users are diabetic

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“You are working with a dif�cult patient group, who often have very poor diabetic control. The service users who are controlled have fantastic control, many of whom have an HbA1c of less than 6%. This is very rare in general practice and again is down to your professional care. I also wanted to mention the high quality of record keeping I witnessed and the obvious dedication by your team.”

Jo PerezDiabetes Specialist Nurse AdvisorNational Service for Health Improvement

We have undertaken a number of other physical healthcare initiatives during the reporting period. All new service users arriving at our Northampton site are assessed by our practice nurses who are able to identify any primary healthcare needs and put care plans in place for issues such as nutrition, physical activity, glycaemic control and diabetes.

During the reporting period we reviewed the objective around cleanliness and developed a ‘Cleanliness’ electronic KPI tool. The tool was completed Charity-wide by Facilities Managers on a quarterly basis and recorded on the electronic Matrix system for quality assurance.

We have successfully exceeded the World Health Organisation in�uenza vaccination target of 75% for over-65s, with 80% of our service users aged over 65 receiving the vaccination during 2011/12. We achieved 56% in 2011/12 for the number of under-65s and we aim to increase this to 75% in 2012/13.

25 hours therapeutic activitySince 2007, medium secure healthcare providers have been required to provide 25 hours of therapeutic activity to each service user weekly. Activity and engagement are often closely linked, so we aim to fully engage service users in focusing on their recovery. That way, they understand what is happening and can sign up to the bene�ts of getting involved.

The Charity follows the 2007 Offender Partnerships Best Practice Guidance for Mental Health Services.

Evidence suggests that boredom and reduced motivation results in poorer clinical outcomes for service users in secure care. This work promotes a balanced and structured day of meaningful activity, linked to agreed care plans that promote recovery.

To align the Charity’s systems and treatment programmes with the agreed national de�nition of ‘meaningful activity’ we have implemented a standard template known as a Pre Admission Assessments Form (PAAF). This tool allows clinicians to link an individual’s identi�ed needs to a care plan and their treatment. To ensure it is meaningful activity, each of our services has a directory of therapeutic activity which is monitored by the Effective Therapeutic Practice Group (ETPG).

The Charity’s aim is to achieve the targets set nationally and in the reporting period we have achieved all targets relating to 25 hours of therapeutic activity.

An audit of services using a benchmarking tool in September 2011 demonstrated that we were 96% compliant with action plans in place for each service to improve. The service action plans are reviewed quarterly to further improve quality.

We have been working on developing a new performance framework tool which involves adapting the ‘community diary’ on our patient records system to develop timetabling modules linking to progress notes, and help us to record and report activity hours.

We will shortly be trialling the new system and should be ready to launch in 2012/13.

Clinical effectiveness

80%We now vaccinate

of over 65s against in�uenza. This successfully exceeds the WHO target of 75%

03


Dining Food quality and menu choices are very important to the daily life of most service users. By giving people freshly-cooked, tasty produce we can help improve their quality of life as well as their physical and mental health. We aim to maintain the high level of service user satisfaction that we had last year.

Our priorities for 2011/12 were to complete the analysis of all recipes and publish the ‘healthiest options’ on the intranet. This will include an online ‘menu builder’ where chefs can pick items from a list. The intranet hosts a resource of over 300 recipes, all with a complete nutritional analysis including a traf�c light guide to help with menu planning. Recipes are listed under headings such as lighter meal options, vegetarian, vegan and further resources to give information to chefs on catering for conditions such as diabetes and dysphagia.

We have now planted several herb gardens to support the Charity’s kitchens. Plans are underway in our longer term project to support service users to grow fruit and

vegetables with the provision of allotments on our Northampton site, allowing them to grow salad crops for the summer and vegetables for Christmas lunch and build the service users understanding of food production.

At our Workbridge facility, staff and service users have historically grown soft fruit for use in the canteen and coffee shop onsite. Workbridge is a vocational extension to the care pathway allowing service users to learn new skills and gain con�dence working in their garden centre, coffee shop and ceramics workshop.

Just over half of all food ingredients are sourced locally or from sustainable schemes such as Red Tractor and/or are ethically produced such as Organic and Fairtrade.

Our nutrition and wellbeing training programme has been integrated at various levels. All new staff now complete an awareness session and workbook activity on nutrition and health and further training is provided at ward level for the nutritional care for the specialist needs of different service user groups.

Throughout the year a number of health and wellbeing events have been held to raise awareness for both staff and service users of good nutrition with dieticians and catering staff working together to present on a range of subjects which have been consistently received positively.

Customer satisfaction levels with the dining experience continue to be high with the renewal of the Hospitality Assured accreditation from the Institute of Hospitality for the third year running in December.

His Royal Highness, The Prince of Wales, praised the quality of food we provide to service users. He made the comments during a reception hosted at Clarence House to congratulate fourteen hospitals for their work to provide excellent food. The Soil Association selected the hospitals for this celebration of the best of British hospital food.

Patient experience

His Royal Highness,The Prince of Wales,praised the quality of foodwe provide to service usersHe made the commentsduring a reception hostedat Clarence House.

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“We know that food plays an important role in the lives of the people who useour services and it makes a real difference. Satisfaction levels of 80% andabove speak for themselves and our catering teams can be rightly proud ofwhat they have achieved. They have received six national awards in the last two years, recognising the amazing things they have done. This really adds to our service users feeling that their fresh-cooked food is truly wholesome, helping them regain their health and wellbeing.”Professor Philip SugarmanChief Executive Officer

Patient experience 03


Patient experience

Research extractNutritional management of individuals with Huntington’s disease: nutritional guidelines

Ailsa Brotherton , Lillian Campos , Arleen Rowell , Vanessa Zoia , Sheila A Simpson , Daniela Rae

Neurodegenerative Disease Management, February 2012, Vol. 2, No. 1, Pages 33-43.

Identi�cation of nutritional risk by nursing staff in secure psychiatric settings: reliability and validity of St Andrew’s Nutrition Screening Instrument

A. Rowell BSc Hons1,

C. Long PhD4,*,

L. Chance BSc2,

O. Dolley BSc3

Article �rst published online: 10 JAN 2012. DOI: 10.1111/j.1365-2850.2011.01848.x

Dignity Helping vulnerable service users to retain their dignity whilst in secure care is hugely important to us. Supporting people to give them the best quality of life throughout their stay is likely to achieve better service user experiences of care.

We reviewed our dignity, choice and care policy and identi�ed a number of actions and key milestones required to ensure our approach to dignity still meets the very latest industry practice.

These included protected meal times especially on wards where we care for people that require assistance during mealtimes such as our Huntington’s Disease unit.

There have been two signi�cant events to recognise the importance of dignity held in the last year. The �rst one was a joint presentation for staff and service users with Age UK. Staff presentation posters were subsequently displayed illustrating the research and outcomes for older people across the Charity. There was also a poster raising awareness of dignity in care and highlighting the importance of dignity - “Dignity is a human right, not an optional extra”. During this event a dignity diary was handed out to members of staff

where they were encouraged to make one entry over �ve working days as to how you promoted a person’s dignity.

Age UK also highlighted the services that they provide for older people in the local community and during this time we also collected clothing, books, and bric-a-brac for Age UK to sell in their Charity shops.

In February 2012 we held a Dignity Action Day. It aims to ensure that people in care are treated as individuals and are given choice, control and a sense of purpose in their daily lives and provide stimulating activities.

The day gave everyone the opportunity to contribute to upholding people’s rights to dignity and provide a truly memorable day for people receiving care.

Involvement and personalisation strategyWhere service users and care staff work in partnership, service users are likely to move through a shared pathway more quickly. This can mean shorter stays and

better service user experiences of care. This indicator is part of the Commissioning for Quality and Innovation (CQUIN) payment framework.

We are dedicated to providing a wide range of opportunities for service users to get involved in to help shape the Charity. People can contribute formally through work-related tasks, informally through activities and feedback, and of course in�uence the recovery process.

We encourage service user input to develop Charity practice and enhance recovery. As part of the Charity’s involvement in ImROC, a strategy for involvement and personalisation has been implemented.

The main objective within the strategy is to increase the involvement of service users in training and research.

As part of our corporate and local inductions, service users share their recovery story with new staff joining the Charity. This has given staff a clear understanding, from their �rst day in their new job, of the types of people we care for, what it is like to be at St Andrew’s Healthcare and how each and every member of staff can help on a service user’s recovery journey.

“Dignity is a human right,not an optional extra.”

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We held 18 central induction sessions in 2011/12, with over 1000 individuals attending in Northampton. Attendees included new staff, volunteers and students. Service users have delivered a 30 minute session at 16 of these central induction events.

This work has had a huge impact on the patient experience at St Andrew’s and staff have bene�tted too. 96% of those attending induction each month rate the service user sessions as good or excellent. The ‘below average’ and ‘poor’ scores occurred mainly from two occasions when the service user could not attend.

This experience and involvement extends beyond the �rst few days of joining the Charity. We ensure that service users are involved in many training topics such as awareness of seclusion and risk. Our service users have produced two DVDs for staff which share their views on restraint and seclusion, including what it feels like and how people wish to be treated, as well as risk and safety and how to involve service users in managing this themselves.

Research is a large part of the Charity, with 81 research papers published in 2011. We have involved service users in some of our research projects over the last year. One of these was to develop a service user involvement charter which included service

users from across the Charity taking part in training at the University of Northampton and gaining key research skills and experience.

We continue to make good progress on the development of Care Pathway Star and have received positive feedback from the Mental Health Providers Forum who commented that the Charity has made the largest contribution to the development out of the four hospitals involved. This continued work allows us to positively involve and enhance the patient experience.

At the beginning of the last reporting period, we set an objective to produce a joint service user and staff report, to show how the Charity can achieve the choices made by service users. Whilst this reporting continues to be developed, there have been many occasions where staff and service users have collaborated to plan and implement their choices and make decisions affecting them. This work includes adding a further 20 national standards to the CPA policy around which work continues, making decisions on facilities that will be developed on our parkland areas at our Northampton site and in�uencing developments in our food provision and the development of conferences and events.

Patient experience

Service Users and their involvement (May-Oct 2011 extract)

Excellent 66%

Good 30%

Below average 2%

Poor 1%

No response 1%

96%of those attending induction each month rate the service user sessions as good or excellent

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Who have we involved?In producing this document we have listened to a range of partners who have an interest in our work.

The people formally consulted on these accounts are:

• Lead Commissioner

• PCT

• Overview and Scrutiny Committee

• Local Involvement Network LINk

• Colleagues

• Service users

Partnership working is very important to St Andrew’s Healthcare. we work with hundreds of people and organisations to support service users, develop and manage services and share best practice.

The diagram below outlines some of the key partners we work with, and what we achieve together.

Involvement

Service users

St Andrew’s

St Andrew’s

NetworksShare best practice and

in�uencing opportunities

CarersShare knowledge

and understanding to support people

Education specialistsPartner us to provide

learning opportunities

CommissionersWork with us to provide

safe and suitable placements

ResearchersDiscover and share

information to improve quality of care

RegulatorsCheck we’re upholding the

law and meet national standards

CommunitiesHelp us to prepare

people for life

GovernorsProvide an independent

view of our work

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“...The improvement priorities for 2012/13 identi�ed in the Quality Accounts appearlogical and reasonable and to support the delivery of the three key objectives setout in the Charity’s strategy. The emphasis given to making improvements in thefollowing areas is particularly welcomed:

Involving service users and carers in decisions about their speci�c care and treatment and in working to improve the overall patient experience.

Developing and delivering quality improvements that are objective and relevantto local needs.”Councillor Judy Shephard Chair, Health & Social Care Scrutiny Committee (Northamptonshire)

Following discussions with Northamptonshire LINk, it was noted that currently there were not suf�cient organisational relationships to enable informed commentary on the St Andrew’s Healthcare Quality Accounts this year. It was agreed that David Ward (LINk) and David Thomas (Director of Quality & Governance, St Andrew’s Healthcare) would work together to resolve this during the coming year.

“In general it looks very good and represents a true account of your performance...”Phil Brian Commissioning Manager, Birmingham and Solihull Mental Health NHS Foundation Trust

Feedback 03


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