Solihull NHS Care Trust Community Services

Quality Account (covering acute services)

2009/10

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Solihull NHS Care Trust Community Services Quality Account (covering acute services) 2009/10

Part One: Statement on quality from the Community Services Board 1.1 Welcome to our 2009 – 2010 Quality Account. Quality accounts are

annual reports to the public from providers of NHS health services about the quality of services provided. They aim to enhance the accountability of the provider to the public. We will publish a set of Quality Accounts annually to assure our service users, carers, commissioners, and the wider community of our commitment to quality in all that we do.

1.2 Solihull NHS Care Trust Community Services acknowledge the ground-

breaking importance of the report ‘High Quality Care for All’ by Lord Darzi published in June 2008. Lord Darzi defines quality as being made up of 3 domains; safety, effectiveness and patient experience. The Trust is committed to increasing the standard of quality through improving the safety and effectiveness of our services and the experience of our service users and carers whilst using them. Quality Accounts sit within the ‘publishing quality information’ element of the seven steps to quality improvement described in the Darzi report.

1.3 A phased introduction of the statutory requirements to produce a Quality

Account means that for 2009/10, Solihull NHS Care Trust Community Services are only statutorily obligated to produce an account for any ‘acute’ services provided. Based on the definitions in the Quality Account Guidance, and following our CQC Registration categories, the only service we need to cover is Podiatric Surgery.

1.4 This phased introduction provides a good opportunity for Community

Services to produce a Quality Account, and learn from this experience for a Quality Account covering all health services for the 2010/11 financial year.

Statement on the quality of services provided by Podiatric Surgery 1.5 The Department of Podiatric Surgery provides a comprehensive service

consistent with its mission statement “Excellence in Foot Surgery for all”, providing specialty diagnosis and management of foot and ankle disorders.

1.6 The service seeks to support the DoH White Paper “Our Health, Our

Care, Our Say” and the new NHS cultural ethos as outlined by Darzi 2008. The Department of Podiatric Surgery represents a beacon of new working practices consistent with modern NHS thinking. More specifically the service meets the needs of the local population by delivering

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specialist care through highly skilled multi-disciplinary team-working. The model of service delivery within the Primary Care setting affords better access and more efficient resource utilisation thus benefiting the whole health economy.

Declaration

Part Two: Statements of assurance Solihull Metropolitan Borough Council The Members of Solihull Council’s Healthier Communities Scrutiny Board welcome the opportunity of submitting a commentary for inclusion in Solihull NHS Care Trust Community Services Quality Account, specifically covering the acute service of Podiatric Surgery. Whilst the Trust has engaged with the Scrutiny Board over the past year on several issues this is the first time that the Board has received information on this particular service.

The presented Quality Account is in a form that made it easy to read and digest which is important given the purpose of the document. Although the Board’s prior knowledge of this service area is limited, the account appears to be representative and comprehensive. The Board is not aware of any omissions or issues of concern but it will read next year’s Account with interest to gauge progress with the priority improvement areas.

Solihull NHS Trust Board As the commissioning body for Solihull Community Services, we are pleased to endorse this quality account as a balanced reflection of the Podiatric Surgery service provided within Solihull Community Services. We recognise the high standard of service offered and the continued good practice occurring within this service. We are proud of the commitment and improvements made to quality, safety and service user experience both within Podiatric Surgery and across all of the Community Services during 2009/10.

As Interim Director of Community Services at Solihull NHS Care Trust, to the best of my knowledge, the information contained within this document is accurate.

Nette Carder

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We will continue to support Solihull Community Services in the future challenges they face and are committed to working together to ensure they achieve the intended priorities for improvement in 2010/11. We look forward to receiving the full 2010/11 Solihull Community Services Quality Account covering all health services provided.

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Part Three: Priorities for improvement 2010/11

2.1 Full details of all the services provided by Solihull Community Services can be found on our website www.solihull.nhs.uk.

2.2 The income generated by the NHS services reviewed in 2009/10

represents 2 per cent of the total income generated from the provision of NHS services by Solihull NHS Care Trust Community Services for 2009/10.

Overview of podiatric surgery provision 2.3 Community Services provided Podiatric Surgery is a consultant led multi-

disciplinary service that provides assessment, diagnosis and treatment/surgery for those with foot related pathology living in Solihull. The team consists of Podiatric surgeons, anaesthetist, nurses, health care assistants and administrative staff. There are also a significant number of surgical trainees working with the team.

Typical types of provision include:

� correction congenital and acquired forefoot deformity;

� management of foot and ankle arthritis;

� correction of painful flat foot deformity;

� screening, assessment and treatment of complex foot disorders associated with chronic disease (e.g. diabetes, rheumatoid arthritis); and

� foot health promotion / preventative strategies.

The objectives of the Podiatric Surgery service are:

• to deliver clinically effective and cost effective diagnosis, management of foot and ankle pathology through speciality multi-disciplinary team working and within the Primary care setting;

• to maintain a continuous programme of quality monitoring and service improvement;

• to provide a comprehensive range of corrective foot surgery within the Primary Care setting as Day Case, thereby decreasing the number of patients requiring treatment within Secondary Care

• to provide a comprehensive range of corrective foot surgery as Day Case thereby decreasing the length of stay associated with each surgical episode;

• to improve patient choice by offering surgery under local sedation as an alternative to general anaesthetic;

• to reduce both direct and indirect costs and risks associated with general anaesthesia; and

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• to deliver the service within a Primary Care setting thereby improving access and reducing costs associated with hospital admission.

Together with commissioners, the expected outcomes of the Podiatric Surgery service are:

• appropriate and timely management of patients;

• delivery of high quality care as evidenced by validated patient audit tools;

• service delivery which meets both government targets and initiatives; and

• demonstrable reduction in secondary care admissions for corrective foot surgery.

Mandated Quality Account Statements on Podiatric Surgery1 3.1 Solihull Care Trust Community Services is required to register with the

Care Quality Commission and its current registration status is registered without conditions. This registration encompasses the Podiatric Surgery service provided at Chelmsley Wood Primary Care Centre.

3.2 The Care Quality Commission has not taken enforcement action against

Solihull Care Trust Community Services during 2009/10. 3.3 Solihull Care Trust Community Services is not subject to periodic reviews

by the CQC. 3.4 Solihull Care Trust Community Services Podiatric Surgery service has not

participated in any special reviews or investigations by the CQC during the reporting period.

3.5 A proportion of Solihull Community Services income in 2009/10, which

includes the Podiatric Surgery Service, was conditional on achieving quality improvement and innovation goals agreed between Solihull Community Services and Solihull Care Trust, through the Commissioning for Quality and Innovation payment framework. Further details of the agreed goals for 2009/10 and for the following 12 month period are available on request through our website at www.solihull.nhs.uk.

3.6 During 2009/10, there were no national clinical audits and no national

confidential enquires which covered Podiatric Surgery provided by Solihull Care Trust.

3.7 The Department Podiatric Surgery contributes to the National “PASCOM” audit tool developed and led by the Faculty of Surgery, College of Podiatrists. In addition, the service has published a number of papers examining the outcomes of foot surgery using validated tools.

1 In accordance with the ‘Quality Accounts toolkit: Advisory guidance for providers of NHS services producing Quality Accounts for the year 2009/10. Department of Health 2010.

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3.8 A local clinical audit is carried out on a continual basis to assess clinical

outcomes within Podiatric Surgery. The Community Services Policies and Procedures Committee will review an annual report from this audit during 2010; this Committee has delegated authority from the Community Service Board. Resulting actions are taken on an individual basis dependant on the outcome experienced by the service user.

3.9 No patients were recruited to participate in clinical research studies in

2009/10. 3.10 Solihull Care Trust Community Services Podiatric Surgery Service did

not submit records during 2009/10 to the Secondary Uses Service for inclusion in the Hospital Episode Statistics which are included in the latest published data.

Priorities for improvement (acute services only) 2010/11 4.1 Our priorities for improvement within the Podiatric Surgery service during

2010/11 are detailed below. All priorities for improvement will be monitored on a regular basis both internally by Community Services and externally through the Contract Quality Review Group meetings held with our commissioners.

Priority 1: Capture regular service user experience information (Patient Experience) We will strive to improve the experience of service users who access our service by ensuring that we monitor the experiences and satisfaction of service users on a monthly basis. By doing this we will be able to respond to any concerns from service users in timely manner and will work towards the production of Patient Reported Outcome Measures (PROMS) for this service. Results of service users experience measures will be reported to the service alongside performance and activity data to create a complete picture of how the service is performing. During 2009/10 we undertook a review of how service user experience was measured across all services and have identified it as a priority for improvement within all services.

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Priority 2: Deliver 100% compliance with Same Sex Accommodation (Patient Experience) In line with the national requirement to virtually eliminate mixed sex accommodation with inpatient and day surgery areas we aim to ensure we obtain 100% compliance in Podiatric Surgery by June 2010. During 2009/10 we undertook an exercise to identify how well we were performing with delivering same sex accommodation and identified that improvement could be made within our day surgery recovery theatre in Podiatric Surgery. Our plans are to ensure that lists for clinics where service users undergo sedation are structured to ensure they are same sex in nature, thus eliminating the potential for mixed sex service users to be recovering in the same area after surgery at the same time. We will ensure that we monitor and investigate any breaches in same sex accommodation and will report these both internally and externally.

Priority 3: Audit post-operative complications following surgery (Clinical Effectiveness) We aim to be able to demonstrate a low complication rate following podiatric surgery. We will do this by auditing all service users at a defined interval following treatment. This will allow us to monitor the levels of clinical effectiveness within our service. Much preliminary work has already occurred within this service to assess post surgery complications but we would now like to audit this on a regular basis and use this information in much the same way as the patient experience information to build up a complete picture of the service.

Priority 4: Surgical Site Infection Rates (Patient Safety) During 2010/11 we will strive to survey the rates of surgical site infections within the service and will, by the end of the year have identified a baseline level to improve upon in the coming years. Recent NICE guidance surrounding the prevention and treatment of surgical site infections provides a framework outlining actions to be taken both preoperatively and postoperatively to ensure that the levels of surgical site infections are as low as possible. Having implemented these recommendations we will monitor the effectiveness of our practice in order to ensure that the highest levels or patient safety are achieved.

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Overview of improvements in quality throughout our services planned for 2010/11 5.1 CQUIN (Commissioning for Quality and Innovation) As part of the Community Services contracting process, 1.5% of the Community Services health budget from our principle contractor (Solihull NHS Care Trust) is subject to the nationally mandated CQUIN scheme. The focus of the CQUIN scheme is on quality improvements within our health services, and for 2010/11 this covers the following areas:

• Patient Experience Monitoring:

• Increasing Public Health Awareness for Front Line Staff

• Increasing Clinical Effectiveness and Safety

• Improving recording of clinical activity

• Increasing productivity through maximising attendance of staff

• Improving Dementia Care in Community Settings 5.2 Transformation and Productive Community Services Community Services, alongside the Care Trust, is putting into place a Transformation Programme to improve efficiency and productivity whilst maintaining a high level of quality in our services. Part of this Transformation project will include use of the Productive Community Services, with a roll out plan to cover all health services during 2010/11. The PCS programme has been created specifically for NHS Community Services settings, and the Programme Guide states that implementing services will ‘improve the safety, quality, reliability and patient experience of care’. 5.3 Management of quality and safety With the use of a bespoke Performance Management Framework, Community Services has established a robust method through which to manage key issues around quality and safety. The Framework includes monthly dissemination of key quality data, including incidents, complaints and Patient Advice and Liason Service (PALs) data to front line staff, monthly Quality and Performance Forums running in each key clinical area, and the Community Services Board receiving a monthly dashboard containing key quality, safety and service user experience information. Further information on the framework is available from www.solihull.nhs.uk

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Part Four: Review of quality performance for 2009/10 General 6.1 During 2009/10, Community Services worked towards implementing a

framework for monitoring quality (including the areas of satisfaction and outcomes). Some areas are currently more advanced that others in their monitoring and measurement processes. 2009/10 marks the first year that Community Services has published a ‘Community Services Satisfaction Annual Report’ which summarises the results and action plans of the various satisfaction and patient experience surveys which took place in 2009/10. This report will be available from the end of April on the Care Trust website.

Review of quality performance in podiatric surgery 6.2 In accordance with the Quality Accounts Guidance, this section is split

into clinical effectiveness, patient safety and patient experience. 6.2.1 Clinical Effectiveness Evidenced based interventions underpin effective and efficient service models; this mandates a strong research ethos within the service in both identifying relevant evidence and in contributing to the global body of evidence. The Department has a strong track record in the implementation of clinically proven care pathways and in contributing to published research. All research studies and audits are registered with the Clinical Governance Department and are carried out in line with Research Governance requirements.

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The service is a nationally recognised training centre at both pre and post Fellowship levels in Podiatric Surgery and has a number of trainees currently within the department. The newly appointed consultant will also be eligible to serve as a recognised surgical tutor increasing the training capacity. 6.2.2 Patient Safety Prior to admission all patients undergoing non-emergency elective surgery undergo routine MRSA screening. In addition we undertake Venous Thromboembolism (VTE) screening in accordance with NICE Guidance. All admission, surgical episodes and postoperative appointments are audited. Outcome and event data is fed back into the audit cycle and organisation via standardised reporting mechanisms. The Podiatric Surgery service used a nationally validated outcome tool, the Foot Health Satisfaction Questionnaire to audit the perception of foot condition in service users treated by the service. A total of 179 complete data sets were recorded in this longitudinal study with an average participant age of 49.4 years (SD 14.5). The group comprised 164 females and 15 males. The mean days for administration of the FHSQ post operative follow up was 1045 days (149 weeks or 2.9 years).

Recently published articles

A report of UK experience in 917 cases of day care foot surgery using a validated outcome

tool

The Foot, Volume 19, Issue 2, June 2009, Pages 101-106

Anthony John Maher, Stuart A. Metcalfe

Midfoot fusion using a locking plate system: A case report

The Foot, Volume 19, Issue 3, September 2009, Pages 189-193

Natalie G. Taylor, Stuart A. Metcalfe

A review of surgical outcomes of the Lapidus procedure for treatment of hallux

abductovalgus and degenerative joint disease of the first MCJ

The Foot, Volume 18, Issue 4, December 2008, Pages 206-210

Natalie G Taylor, Stuart A Metcalfe

First MTP joint arthrodesis for the treatment of hallux rigidus: Results of 29 consecutive

cases using the foot health status questionnaire validated measurement tool

The Foot, Volume 18, Issue 3, September 2008, Pages 123-130

A.J. Maher, S.A. Metcalfe

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Figure 1: Patient Longitudinal Perception of Original Foot Condition Results for the global anchor question demonstrated that 82 participants (45.8%) perceived their original foot condition was “much better”. Additionally, a further 86 subjects (48%) reported their condition was “better”. Consequently, summation of the data revealed that 94% of the participants reported their original foot condition as either “much better” or “better”. Only 10 (5.6%) participants stated their condition was the “same” and only 1 (0.6%) answered their condition to be “a little worse”. No responses were recorded for “deteriorated”. The service has also modified and incorporated the WHO Safer Surgery Checklist into its everyday surgical practice. 6.2.3 Patient Experience All patients have access to postoperative “on-call” service for a minimum period of 48 hrs postoperatively and each patient admission is audited using a validated patient index score (e.g. Manchester Oxford Foot Questionnaire).

Part Five: Feedback and Quality Accounts for 2010/11

Solihull NHS Care Trust Community Services is committed to ensuring that the Quality Accounts reporting and process is a true representation of the services we offer. Although the 2009/10 Quality Accounts have covered only acute services, we are keen to build on this experience for reporting on all our health services for 2010/11. If you would like to comment on this document, or be involved in the preparation of Community Services Quality Account covering 2010/11 please contact alison.tariq@solihull-ct.nhs.uk or rebecca.brown@solihull-ct.nhs.uk