accounts 2018/19...june 2018, my first months in this role have been enormously inspiring. st...
TRANSCRIPT
QUALITYACCOUNTS 2018/19
St Andrew’s Healthcare Quality Accounts 2018/19
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Section 1: Introductions “Progress and Plans”A welcome from Katie Fisher, our CEO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Dr Sanjith Kamath, Executive Medical Director . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Statement of Directors Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Section 2: Quality PrioritiesQuality Priorities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Statements of Assurance from the Board . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Review of Services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Never Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 National Core Indicators of Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Mortality Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Learning from Mortality Reviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Data Quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 NHS Number and General Medical Practice Code Validity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Clinical Coding Error Rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 NHSE Specialised Services Quality Dashboard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 NHSE Specialised Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Duty of Candour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Participation in Local Clinical Audits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Learning from Clinical Audits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Goals Agreed with Commissioners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
What others say about St Andrew’s Healthcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 CQC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Data Security and Protection Toolkit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Staff Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Complaints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Involvement and Feedback from Key Stakeholders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Northamptonshire County Council Overview & Scrutiny Committee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 NHS England . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Healthwatch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Section 3: Review of Quality Services1 . Empowering carers and patients to make a difference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 312 . Gain parity of esteem between Physical Healthcare and Mental Health . . . . . . 323 . Further reductions in restrictive practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 324 . Right Staff, Right Place, Right Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 355 . Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Section 4: St Andrew’s Healthcare ShowcaseDiversity and Inclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39REDS Academy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39ASPIRE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Section 5: What our patients and carers are sayingPatient and carer quotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Contents
Section 1Introductions
“Progress and Plans”
St Andrew’s Healthcare Quality Accounts 2018/19
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A welcome from Katie Fisher, our CEO
Having joined St Andrew’s Healthcare in June 2018, my first months in this role have been enormously inspiring.
St Andrew’s Healthcare has much to be proud of, and there have been many important achievements in the past year. We have continued to embed our Value Based Healthcare model, within which we measure outcomes for every individual to ensure we are personalising how we care for them. Seeing these outcomes improve is highly motivational for our teams.
We have expanded our portfolio and invested in Broom Cottage, a five-bed residential home in Nottinghamshire. Broom Cottage is home to five people with Learning Disabilities and Autistic Spectrum Disorder, and provides residents with the right support to successfully live in the community.
Building on the success of our innovative provision at Winslow, this addition to our new Community Services Division forms part of our plan to partner with other organisations in delivering local services.
We have also opened a new Carers Centre; a welcoming environment for carers, family and friends of the people in our care in Northampton. Designed in collaboration with our carers, the centre is open seven days a week, offering both face to face support and telephone advice.
The Charity continues to be committed to education. We offer various educational and vocational
opportunities for the people in our care to learn and develop work and life skills in a fully supportive environment. All patients, whatever their skills or level of leave, can get involved with activities including craft, textiles and woodwork.
Some take this a stage further. Over the past year, patients have taken up 46 work placements, many gaining a qualification in the process. In the last 12 months, 1,471 people have been discharged from our care – equipped with the skills and knowledge to move forward with their lives.
Our staff too are always developing their skills, which both creates rewarding careers and helps us retain exceptional people. Over the past year our staff have completed 23,000 days of learning – that’s 5.7 days of learning per staff member – and we have invested more than £3.5m on staff education and career development.
These are exciting times for St Andrew’s Healthcare. Our progress is the result of the indefatigable passion and commitment of everyone who works for the Charity, and I thank them for their ongoing dedication to providing exceptional care.
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Section 1
Introductions “Progress and Plans”
Dr Sanjith Kamath, Executive Medical Director
Following on from a major transformation programme in 2017/18, our care is now being successfully provided within 16 Integrated Practice Units (IPUs).
Each IPU supports people with a similar or related set of health conditions or needs, enabling our care teams to focus their efforts on more bespoke care. Each IPU measures a set of outcomes for each patient to help monitor and measure their progress in mental wellbeing, their physical health and in personalised care. The outcomes data is shaping how we care for our patients in each IPU and is helping us deliver the best value in aiding their progress.
One of our core priorities for the year has been to increase our investment in physical healthcare and to roll out an integrated model of physical healthcare delivery in the IPUs. This is helping us ensure that our patients have timely access to great physical healthcare as well as support for their mental health needs, while allowing the IPUs to further focus on the preventative aspects of physical health problems.
Reducing restrictive practices remains high on the agenda for St Andrew’s Healthcare and we continue to make progress in this area while recognising that
there is still a considerable amount of work that is needed. This will form a large part of the quality improvement we want to progress over the coming year. In particular we are seeking to minimise the use of seclusion and to use de-escalation more effectively before restrictions are needed.
The importance of effective clinical leadership in ensuring a high quality health care system that consistently provides safe and efficient care is well known and therefore a further area of priority for the Charity has been embedding clinical leadership at all levels in the organisation. We have taken some important steps towards this through the appointment of more clinicians in senior leadership roles and developing our leaders.
We recognise that we still have much more to do, but it is important to recognise and celebrate our achievements. Even more importantly, I must express my thanks and appreciation for all our staff, volunteers and partners who help enrich the lives of everyone at St Andrew’s Healthcare.
St Andrew’s Healthcare Quality Accounts 2018/19
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Section 1
Introductions “Progress and Plans”
Statement of Directors Responsibilities The Department of Health has issued guidance on the form and content of the annual Quality Account. In preparing the Quality Account, Directors should take steps to satisfy themselves that:
The Quality Account presents a balanced picture of the Charity’s performance over the period covered
The performance information reported in the Quality Account is reliable and accurate
There are proper internal controls over the collection and reporting of the measures of performance included in the Quality Account, and these controls are subject to review to confirm that they are working effectively in practice
The data underpinning the measures of performance reported in the Quality Account is:
Robust and reliable
Conforms to specified data quality standards and prescribed definitions
Subject to appropriate scrutiny and review
Has been prepared in accordance with Department of Health guidance.
The Directors confirm to the best of their knowledge and belief that they have complied with the above requirements in preparing the Quality Account for 2018/19.
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Section 1
Introductions “Progress and Plans”
Section 2Quality Priorities
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To support our vision of Transforming Lives with C.A.R.E. (Compassion, Accountability, Respect and Excellence) we have identified Quality Priorities aligned to our strategic priorities. We want to continue the great work already achieved and have identified the quality priorities in our 2018 strategy. Value based outcomes underpin the model of care, we are fully committed to patient and carer involvement and co-production of outcomes and we aim for mental health and physical health to be equally valued.
We will do this in the following ways:
1. All aspects of care are co-produced in partnership with our patients and carers
Co-production means delivering services in an equal and reciprocal relationship between professionals, patients and their families. It happens when professionals and patients design, plan and deliver care and support together, recognising that both partners have vital contributions to make in order to improve quality of life for patients who use services. We recognise that co-production goes beyond consultation and is an important element of improving the quality of the care that we provide. Over the next year we will be reviewing how we involve our patients and their carers in care planning and care delivery, with a view to increasing our abilities to deliver truly co-produced care. This will support better patient focused care, a better experience of care while at St Andrew’s Healthcare and improved patient outcomes.
2. Clinical Effectiveness will be embedded in the Charity
Clinical effectiveness is defined as the application of the best knowledge, derived from research, clinical experience and patient preferences to achieve optimum processes and outcomes of care for patients. It involves a framework of informing, changing and monitoring practice. We have launched a Clinical Effectiveness strategy that will ensure that we are delivering effective care across the Charity and that we have systems and process to monitor the effectiveness of treatments. The domains of the strategy include a programme of benchmarking our care against NICE and other national guidelines, the use of data, technology and innovation to improve care delivery, as well as the ongoing measuring and monitoring of mental and physical health outcomes. This will help us drive forward evidence based care across the Charity.
3. To further reduce the use of unnecessary restrictive practices
While we have made progress in reducing unnecessary restrictions for our patients, we recognise that there is still much work to be done in this area. The programme of work over the next years will focus not only on areas of restriction described in the Mental Health Act Code of Practice such as seclusion and Long Term Segregation, but also on areas identified by our patients as being unnecessarily restrictive. We will aim to monitor these at ward and IPU level and work with patients and carers to ensure that the care we deliver in our services is not unnecessarily restrictive.
Compassion Respect ExcellenceAccountability
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Section 2
Quality Priorities
Review of Services
From 1 April 2018 to 31 March 2019 St Andrew’s Healthcare provided services in the field of mental health, learning disability and brain injury to 1440 patients, commissioned by 184 different bodies, of which 92% were NHS services or organisations. The remaining 8% of patients are funded by non-UK organisations, private funders or individuals. St Andrew’s Healthcare has reviewed all the data available on the quality of care in respect of the services for which it provides clinical NHS care.
Never Events
St Andrew’s Healthcare is pleased to confirm that there have been no never events during the reporting period.
National Core Indicators of Quality
The core set of indicators are defined in the quality accounts regulations. All providers are required to report against these indicators using standardised statements as set out in the table below. Providers are only required to include indicators in their Quality Accounts that are relevant to the services they provide. The table below includes all of the core indicators that are applicable to St Andrew’s Healthcare.
Statements of Assurance from the Board
1 . The percentage of patients aged:
I. 0-15 years and
II. 16 years or over
Readmitted to a hospital which forms part of the charity within 28 days of being discharged from a hospital which forms part of the charity during the reporting period.
INDICATOR MEASURE 2017/18 2018/19
The percentage of patients aged: (i) 0-15 Percentage 0% 0%
(ii) 16 or over Percentage 4.70% 2.52%
Readmitted to a hospital which forms part of the charity within 28 days of being discharged from a hospital which forms part of the charity during the reporting period.
Patient safety incidents Number 20708 22949
Patient safety incidents that resulted in severe harm or death Number (%) 14 (0.07%) 17 (0.07%)
2017/18 2018/19
Percentage of patients 0-15 years 0% 0%
Percentage of patients 16 years or over 4.70% (18) 2.52% (10)
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Section 2
Quality Priorities
St Andrew’s Healthcare considers that this data is as described for the following reason: The readmission rate has decreased for the 16 years or over age group – 9 of these readmissions were from our PICU wards. We now have four PICU wards in total (2 in Northampton and 2 in Essex). Our PICU services provide tailored treatment programmes that are developed to recognise individual need. All of our PICUs are members of the National Association of Psychiatric Intensive Care and low secure Units (NAPICU) and comply with their standards and admission criteria.
St Andrew’s Healthcare has taken actions to improve this percentage and so the quality of its services by moving to a value based healthcare approach centred on patient outcomes.
2 . Number of patient safety incidents and patient safety incidents resulting in severe harm or death
2017/18 2018/19
Patient safety incidents 20708 22949
Patient safety incidents that resulted in severe harm or death 14 17
St Andrew’s Healthcare considers that this data is as described for the following reason: All patient safety incidents are reported on our Datix incident reporting system. Data quality checks are routinely undertaken. Data from this system is used to provide the charity and key external stakeholders with detailed analysis of reported incidents.
St Andrew’s Healthcare has taken the following actions to improve this and so the quality of its services by active monitoring, investigation and learning from incidents.
The incident reporting policy and procedures have been reviewed and updated with guidance for staff on reporting incidents and classifying what is a serious incident as per the NHS serious incident framework. We have held training sessions and intend to roll out this training further in 2019/20. A monthly report on serious incidents is submitted on a monthly basis to the Charity Executive Committee. We have started using a Statistical Process Control approach to presenting data, which provides a more accurate position over time and enables action to be taken, when necessary if data shows numbers outside of the expected norm.
The charity operates a serious incident review group which meets twice weekly and sets the terms of reference for serious incident investigations; the membership of this group is made up of clinicians from across the organisation and leads for key services such as pharmacy, safeguarding and investigations. The charity utilises a red top alert system through which any learning from incidents can be cascaded charity wide with immediate effect and there is also a learning lessons newsletter which is distributed to all services. The Quality and Safety Assurance Committee meets quarterly, with standing agenda items that include a report on serious incidents and learning.
Mortality Review
During the reporting period Q1-Q4 (April 2018 - March 2019) 15 patients who were in the care of St Andrew’s Healthcare died.
One patient, who was recently discharged, died in Q3 - this is not included in any of the figures below, but it should be noted that this death is subject to external investigation. This comprised the following number of deaths which occurred in each quarter of that reporting period:
Four in the first quarter; three in the second quarter; six in the third quarter and two in the fourth quarter.
Mortality reviews (case record reviews), using the St Andrew’s Healthcare mortality framework tool, are carried out into all expected deaths. For unexpected deaths a Serious Incident (SI) investigation is commissioned.
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Section 2
Quality Priorities
Of the 15 deaths during the year, two were subject to an investigation and 13 to mortality reviews.
The number of deaths in each quarter for which a case record review or an investigation was carried out was:
Four in the first quarter;
Three in the second quarter;
Six in the third quarter;
Two in the fourth quarter.
Two, representing 15.5% of the patient deaths during the reporting period, are judged to be more likely than not to have been due to problems in the care provided to the patient. In relation to each quarter, this consisted of:
Unexpected death of an inpatient (Q1). Subject to full external Root Cause Analysis investigation
Unexpected death of a patient who was on exit S17 placement (Q4). Death due to physical healthcare problems. Joint investigation between St Andrew’s Healthcare and placement.
One death, representing 25% for the first quarter;
No deaths representing 0% for the second quarter;
No deaths, representing 0% the third quarter;
One death, representing 50% for the fourth quarter.
These numbers have been estimated using the St Andrew’s Healthcare standard mortality review tool.
Learning from Mortality Reviews
In January 2019 the Board of Directors was presented with the Annual Report on Mortality, detailing the work undertaken by the Mortality Surveillance Group. It was noted that to further the interests of transparency and external scrutiny we have secured the attendance of an expert Consultant in Palliative Care to improve the robustness of our mortality reviews and processes. The report also provided for thematic learning drawn from the standardised review of 14 deaths occurring in the Charity between 1 January and 27 November 2018.
The findings from the mortality reviews included improvements in holistic End of Life care plans with clear and detailed documentation, evidence of personalisation of care and examples of outstanding care with care teams reporting increased confidence in practice, learning and positive coping. There was evidence of integrated care and active relationships with the local palliative care team and supportive relationships with families, with positive feedback. Areas which would benefit from further focus and improvement included better advanced care planning around End of Life care for patients who have capacity to make decisions, and also ensuring the consistent consideration of spiritual care for all patients receiving end of life care. The standardised mortality review framework was updated to provide more robustness following our participation in the Royal College of Psychiatrists’ pilot of the review tool in November 2018.
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Section 2
Quality Priorities
Data Quality
Good quality information underpins the effective delivery of patient care and is essential if improvements in the quality of care are to be made. Improving data quality, which includes the quality of ethnicity and other equality data, will thus improve patient care and improve value for money. St Andrew’s Healthcare is taking the following actions to improve data quality:
Implementing a Data Governance Strategy to ensure data is treated as an asset and also drive data quality improvements;
Creating a Data Warehouse where all data is put through strict quality measures;
Profiling, assessing and cleansing data to increase the accuracy of information used to drive decisions;
Defining communication protocols to improve the alignment of all stakeholders involved in the data lifecycle;
Adopting a structured approach to managing data, deriving insight and driving action.
NHS Number and General Medical Practice Code Validity
St Andrew’s Healthcare is submitting the MHSDS dataset in line with national requirements. Codes are checked and validated on a regular basis against national lists.
Clinical Coding Error Rate
SNOMED CT is the fundamental standard for healthcare terminology. SNOMED CT provides the vocabulary for recording structured data in relation to the health and care of an individual in electronic records; as such its use in systems is wide ranging. SNOMED CT also provides features that enable powerful analytics and a high level of expressivity of information about the health and care of the individual. Implementation of SNOMED CT is part of the national requirement for electronic patient records. St Andrew’s Healthcare is working towards implementing the SNOMED coding change, in line with the national requirement for compliance by 2020.
NHSE Specialised Services Quality Dashboard
Specialised Services Quality Dashboards (SSQD) are designed to provide assurance on the quality of care by collecting information about outcomes from healthcare providers. SSQDs are a key tool in monitoring the quality of services enabling comparison between service providers and supporting improvements over time in the outcomes of services commissioned by NHS England. St Andrew’s Healthcare submits data to Mental Health SSQD on a quarterly basis.
NHSE Specialised Services
Specialised services are those provided in relatively few hospitals, accessed by comparatively small numbers of patients but with catchment populations of usually more than one million. These services tend to be located in specialised hospitals such as St Andrew’s Healthcare. As a part of the contractual arrangements with NHS England, St Andrew’s Healthcare works to provide its services in accordance with the service specifications. Staff from St Andrew’s Healthcare meet with colleagues from NHS England specialised services on a quarterly basis to scrutinise contractual achievement. St Andrew’s Healthcare is also required to make an annual self-declaration with the Quality Surveillance Team of its compliance levels with the service specification. This self-declaration is made in June of each year, at last submission (June 2018) full compliance was declared.
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Section 2
Quality Priorities
Duty of Candour
We completed a review of the Duty of Candour processes in January 2019. Between April 2018 and March 2019 three incidents were reported under the Duty of Candour requirement.
We reviewed the role of the Duty of Candour group which meets monthly to review any incidents which have been identified as subject to Duty of Candour requirements. The policy has been reviewed and staff have been provided with training as part of the revised incident reporting training.
Duty of Candour incidents are monitored as part of the report on serious incidents that is presented to the Patient Safety Group and Quality and Safety Assurance Committee and Charity Executive Committee. Learning from Duty of Candour incidents is shared via the charity processes for shared learning.
Participation in Local Clinical Audits
The Clinical Audit & Service Evaluation Proposal process continues to evolve and is regularly updated to improve the effectiveness of clinician led audit activity within St Andrew’s Healthcare.
Changes this year have included a tailored proposal process for the IPUs to submit their NICE related assurance audits and additional clinicians and subject matter experts from other fields have been added to the proposal review panel. Therefore increasing the depth of challenges made to proposals in order to maximise the quality and benefit of the audits or service evaluations. Furthermore all clinical audit proposals are now shared with the Charity Effectiveness Group and the Quality and Safety Assurance Committee for further awareness and oversight.
In keeping with the creation and launch of the Charity’s new Clinical Effectiveness Strategy, the Clinical Audit procedures were reviewed and relaunched. These included specific procedures for local clinical audits that follow the Quality Improvement process of Plan, Do, Study and Act, with the intention of further enhancing the quality, effectiveness and impact of clinical audit activity.
During 2018/19 11 local clinical audits were completed and 12 are in progress following approval via the St Andrew’s Healthcare review process, these are detailed in the table below:
COMPLETED 2018-2019 (11) APPROVED 2018-2019 (12)
Case study in the use of Media Exploring Sensory Processing Difficulties
Change in Level of Functioning of Forensic Patients Vitamin D Monitoring
Contribution of functional ability to risk assessment and intervention in forensic care
Use of PBS to Work Effectively with Patients
Section 17 Leave and Therapeutic ActivitiesSecurity Level Predicted by Health Status, Forensic Risk and Crime Committed
CBT for Psychosis DBT in CAMHS
Secondary Care Physical Health Access Evaluation of Nurse Manager’s Perspectives
Media Service Review Risk Management Training & Record Management
Arts @ St Andrew’s Healthcare Service ReviewChange of Quality of Life outcome measures and Community Leave
Use of PRN Presence of Autism Specific Risk Factors
Evaluation of CL@S pilot initiative Art Case Study (as yet un-named)
Case Study of 1:1 music service provision Review of Psychology Supervision
Staff Training Survey
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Clinical Audit and Assurance Team
A programme of Clinical Audit and Assurance assignments that incorporates audits and reviews against specified categories/drivers is maintained by the Clinical Audit and Assurance Team. These audits and reviews are in addition to the audits completed by Clinicians as part of the Clinical Audit proposal process and the audits or compliance checks performed at an IPU and Ward level.
During 2018/19 17 audits were completed by the Clinical Audit Assurance & Internal Audit Teams and 9 are currently underway at various stages of completion.
A further 4 were completed by clinicians with support from the Clinical Audit and Assurance Team, these are detailed in the following table:
COMPLETED & PUBLISHED AUDITS BY THE CLINICAL AUDIT AND ASSURANCE & INTERNAL AUDIT TEAMS
Care Plan Quality – Patient Care Plan Reviews quarterly report and trend analysis
Consent (to share and to treatment)
Seclusion Reviews – Nottingham ASD & LD
Handover process
Seclusion Reviews – Medical, Nursing and MDT – Birmingham
Meaningful Activity
Seclusion Documentation and Environment – Nottingham IPU
Clinical Records review
Section 17 Patient Leave – Follow-up
Section 132 Patient’s Rights – Follow-up
Complaints Management
Patient Carer Information management – Follow-up
Medical Equipment
Serious Incident Management
Outcome Measures – quality of data
Safeguarding – Follow-up Assurance Review
Infection Prevention & Control – Follow-up Assurance Review
PROVIDED ASSISTANCE TO OTHER CLINICIANS AND MEDICAL STAFF IN SUPPORTING WITH THEIR AUDITS
Acuity / Complexity ASD & LD
MCA Capacity assessments
Falls Outcomes (re-audit)
NICE assurance review – Decision Making and MCA (NG108) – stages 1 & 2
continued over the page
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IPU NICE Assurance Audits
Guidance and quality statements from the National Institute of Health and Care Excellence (NICE) are recognised as important quality standards, drawn from the wider evidence base that can improve clinical outcomes if implemented.
In line with our vision to provide ‘world class care’, we needed a robust capability to identify and prioritise relevant NICE Guidance, Quality Standards and Technology Appraisals, and complete the full audit cycle to implement and sustain improvements. To embed this we have produced a procedure for implementing NICE guidance that sits within our Clinical Effectiveness Policy.
As part of the programme of providing assurance against NICE, we established a schedule of regular Charity-wide deep dive reviews and specific IPU led NICE assurance audits, as selected in consultation with the IPU leadership, Effectiveness Group and Clinical Audit & Assurance Team.
The final reports for all NICE audits and reviews will be published and shared to promote learning, with periodic re-audits and reviews taking place to provide on-going assurance that actions have been taken and practices maintained. Action plans for these audits are owned by the IPU, with progress tracked via the Charity Effectiveness Group and IPU Quality Meeting.
The table below details work currently planned or underway:
ONGOING AUDITS AND REVIEWS AT VARIOUS STAGES OF COMPLETION
NICE assurance review – Personality Disorder related (CG78)
NICE assurance review – Dementia related (NG97)
NICE assurance review – Decision Making and MCA (NG108) – stage 3
Seclusion Environment – Follow-up
Seclusion Documentation
Consent – Follow-up
Anti-Microbial Stewardship Review
Care Plan Quality – Patient Care Plan Reviews
NHS Wales Required Care Outcomes
ONGOING IPU NICE ASSURANCE AUDITS AT VARIOUS STAGES OF COMPLETION
NG10 Violence and aggression
NG53 Transition between in-patient mental health settings and community care or care home settings
PH53 Overweight and Obese adults
NG108 Decision making and mental capacity
NG11 Challenging behaviour and learning disabilities
NG54 Mental health problems in people with learning disabilities
CG142 ASD in adults
QS14 Service user experience in adult mental health services
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Learning from Clinical Audits
The Clinical Effectiveness Strategy and supporting procedures ensure clarity in the use of auditing and embed clinical quality at all levels of the Charity. This helps to create a culture that is committed to learning and continuous organisational development. It also helps to deliver demonstrable improvements in patient care through the development and measurement of evidence based practice.
Four audits undertaken this year have been detailed below as examples of our learning:
Patient Care Plan Reviews – update
NHS contracts and applicable regulations identify the need for the review of individual Personalised Care Plans and the ability to evidence accurate and complete record keeping on an on-going basis.
Reviews, using a specific and continuous audit programme are completed on a monthly basis ensuring a sample of care plans for patients from all IPUs is reviewed on at least a quarterly basis. One of the key benefits of the continuous approach is the ability to provide the Wards with an immediate action plan and an overall assurance rating based on the level of compliance.
The review assists management in gaining assurance that the care and risk of each patient is assessed, planned and managed based on individual needs and that patient views are documented in the care plans, and also that patients’ and their carers’ are involved in care planning, wherever possible.
Identified actions are implemented by Ward personnel and are followed up on the return audit as well as through periodic spot checks on progress. Updates can also be given at the appropriate meetings within the IPUs.
The outcome of all Patient Care Plan audits are collated and maintained on a trend analysis with a quarterly summary provided to management (by IPU), highlighting areas of good practice as well as areas that require improvement.
During 2018-19 we have completed 227 individual patient care plan reviews, with an overall compliance rate of 80.5%. This continues the improvement seen in prior quarters, whereby the rate was 75% (quarter 1), 79%
NG97 Dementia: Assessment, management and support for people living with dementia and their carers
CG170 ASD in under 19s
NG116 (was CG26)
PTSD
NG43 Transition from children’s to adult services for young people using health or social care services
CG178 Psychosis and Schizophrenia in adults
CG120 Coexisting severe mental illness (psychosis) and substance misuse
QS88 Personality Disorder - Borderline & Antisocial
CG77 Antisocial personality disorder
NG7 Preventing excess weight gain
NG10 Violence and aggression
PH53 Overweight and Obese adults
CG178 Psychosis and Schizophrenia in adults
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(quarter 2), 80% (quarter 3). This compares to 2017-18 when the programme of reviews began where the overall compliance rate was 73%, demonstrating a significant overall improvement in the completion and on-going management of care plans since the introduction of the reviews.
Next year the programme is set to evolve further with devolution of the compliance checks carried out at ward (IPU) level whilst the Clinical Audit & Assurance Team focusses on the quality of the care plans.
Patient Care Plan Reviews
2017-18 2018-19
82%
80%
78%
76%
74%
72%
70%
68%
Com
plia
nce
Rat
e
173 Reviews
227 Reviews
Academic data for the Quality Account 1 April 2018 – 31 March 2019:
ARTICLES AND BOOK CHAPTERS
Published Articles Accepted for Publication Book Chapters
19 3 2
CONFERENCE ATTENDANCE
Oral Presentation Poster Presentation Symposium
3 7 3
PATIENT PARTICIPATION IN RESEARCH STUDIES
Men’s and Women’s NPS CAMHS LD/ASD
58 0 6 59
Affiliations
London South Bank University - MOU
Loughborough University - MOU
University of Birmingham
University of Buckingham
University of Kent - MOU
University of Northampton
University of Nottingham
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Clinical Records
Patients should have confidence that their personal records are complete, accurate, appropriate, timely and maintained in accordance with the law, and that they are protected against the risk of unsafe or inappropriate care and treatment arising from a lack of proper information being held about them.
For the purpose of this review we defined Clinical Records “as any record or document collated over time that evidences the care provided to a patient or is used to deliver the care”.
The review checked several areas of patient care for evidence that clinical record keeping is carried out to a good standard, in accordance with local and national regulations and legislation, with core elements based on the main requirements of the MHA Code of Practice and key Charity policies.
The review highlighted many positive findings, including: patients being informed of their rights on admission in a timely manner; consent to treatment forms correctly in place; annual health-checks correctly carried out and the required tests for patients on high dose antipsychotics were being completed correctly and within the right timescales.
Areas for improvement were indicated for various aspects included in the scope of the review and on the whole they related to the incompleteness of some clinical records. Many of the recommendations reflected actions highlighted in more targeted and in-depth audits of the clinical record areas. All actions from Clinical Audits are tracked and reviewed for progress by the Effectiveness Group and Quality Business Partners and followed through to closure to ensure that the necessary changes are made and lessons learned.
Handover process review
Handover and continuity of information is vital to the safety of our patients. Good handover does not happen by chance and is of little value unless action is taken as a result. Formal handovers should become part of good professional practice and meet patient expectations that staff caring for them share information to minimise repetition and maintain safety.
Handovers are carried out when there is a change of shift, from day to night and vice versa. A handover may also be carried out for staff that are working a half shift or alternate hours to the main shift. An optional template is available as part of the policy that staff can use if they wish. In summary, handovers should have adequate time allocated, have clear leadership, ensure members of the team are adequately briefed on concerns from previous shifts, include detail of tasks not yet completed (which should be clearly understood by the incoming team), the tasks should be prioritised, include plans for further care put into place, and should ensure unstable patients are reviewed.
An audit comprised of observing a selection of shift handovers and a survey issued to staff to obtain their views was carried out, with standards based on external guidelines and local policy. It included attendance and timekeeping, the location used, role allocation and documentation. A key element to the audit was the issuing of a survey to all relevant personnel to gauge opinion on the effectiveness of current handover processes, including how staff felt on various issues such as enough time given and the quality of information given.
Positive findings were found with the majority of observed handovers starting on time, however most of these were subject to staff joining late, which was seen in comments from the staff survey. All were led by a qualified
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member of staff using written prompts, however the method and detail varied considerably, with a number of negative staff comments towards the RiO tool. Where an additional Health & Safety induction was required this was identified and carried out. There was differing findings on the length of handover, however the need for flexibility became apparent due to the varying patient groups and length of past events they covered.
As part of implementing the recommendations a solution is being investigated utilising handheld tablets for displaying information that can be used wherever the handover is held. A review of policy and the RiO electronic tool is also planned to make it more suitable and user friendly.
Falls Outcomes
Clinical Audit carried out by a clinician to measure against NICE guidance on falls assessment and prevention, and comparing with the National Audit of Inpatients Falls completed in 2017.
A multifaceted approach was taken, including the review of incident reports, risk assessments, care plans and post-fall review provision and assessment. The audit focussed on the Dementia and HD IPU as the area with the highest concentration of frequent fallers in the Charity.
The audit highlighted that multifactorial risk assessments were fully evident, fracture risk assessments were present in the vast majority of cases. Delirium risk assessments were completed in all cases however there was no evidence of subsequent delirium prevention and management care plans, or a supporting protocol within the Charity. Optician assessments and BP recording were also poorly evidenced.
Falls Care Plans were found to be of a very good quality on some wards however there are gaps in other wards where patients at risk do not have a care plan in place. Many care plans also require improvement in quality to individually tailor them to patient needs and to ensure they are reviewed and kept in date. The conclusion drawn from this was that more serious fallers had a better quality of care plan.
A review of interventions showed significant improvement in practice, all frequent fallers and those who had sustained injury had been reviewed by the Multi-Disciplinary Team on a frequent basis, along with further analysis to identify patterns in frequent fallers.
A post fall assessment had been completed in all cases however the review didn’t include the quality of these.
Recommendations following the audit were made around improving the quality of the multifactorial risk assessment and falls care plans, better evidencing of blood pressure recording.
Participation in Clinical Research
Since the launch of the Research Centre at St Andrew’s Healthcare, in April 2018, we have focussed on establishing solid foundations upon which we will build and integrate research as a ‘core’ activity across our hospitals. The first step was to establish the infrastructure and governance that ensured the conduct and delivery of high-quality, robust research. We have recruited an independent external Research Committee, which draws on a broad range of knowledge, expertise and experience to provide guidance, help and advice. Importantly, and for the first time, this includes representation from patients and carers.
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1. This slight reduction in percentage in Q3 was due to the Charity’s decision to delay the roll out of the REDS Academy to one hospital site until Q4.
2. At the time of writing the results were still to be confirmed (tbc) for Q4
CQUIN TITLE Q1 Q2 Q3 Q4
Recovery Colleges for Medium and Low Secure Patients 100% 100% 87%1 tbc2
Reducing Restrictive Practices within Low and Medium Adults Secure Services
100% 100% 100% tbc2
Improving CAMHS Care Pathway Journeys by Enhancing the Experience of the Family/Carer
100% 100% 100% tbc2
Mental Health Discharge Planning and Care Planning 100% 100% 100% tbc2
We have developed a research strategy that sets a clear direction and priorities for the next 3-5 years. The strategy focuses on three key themes:
1. Personalisation: building a patient-centred knowledge base to change individual care and outcomes
2. Mental and Physical Health: developing treatments for the whole person; exploring the interplay between mental and physical conditions
3. Transition: improving the patient journey across and between mental and physical health systems and settings
The strategy places patients at the centre of everything we do, in alignment with the wider-Charity’s approach, and puts a focus on innovation and utilising technology, with translation into practice the goal for our research.
During the first few months, we conducted a review of the research portfolio, resulting in a 67% reduction to the number of projects (down from some 107 to a focussed portfolio of approximately 33), which are now aligned to our strategy. We have also initiated some new and exciting research programmes, which, although at an early stage, have the potential to create a step change in the treatment of severe mental illness.
Building external relationships and partnerships across a range of mental health institutions and organisations will be critical to our success, and we now have collaborations with 14 UK universities and a number of mental health charities. We aim to promote a positive, research active culture across our care teams. Being research active will not only bring benefits to our patients, it will encourage and support the best clinical staff and enhance the reputation of the Charity.
This year 807 staff members participated in research projects that took place across the charity. This included completing questionnaires as well as face to face interviews.
The number of NHS patients receiving care provided by St Andrew’s Healthcare in the 2018/19 reporting period that were recruited to take part in approved research studies was 123.
Goals Agreed with Commissioners
The Commissioning for Quality and Innovation (CQUIN) programme provides a national framework for improving quality and innovation within NHS funded care to realise better patient outcomes. First launched in 2009/10 the scheme sets annual quality improvement goals.
The current CQUINs are relevant to the specialist care provided by the Charity and are summarised below along with our achievement scores:
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CQC
The Care Quality Commission (CQC) is the independent regulator of health and adult social care in England. All providers of regulated activities must be registered with the CQC under the Health and Social Care Act 2008. As from 1 April 2015 all providers are expected to meet the fundamental standards as laid down by the CQC.
St Andrew’s Healthcare is required to register with the CQC. We are registered to carry out the following regulated activities:
Assessment or medical treatment for persons detained under the Mental Health Act 1983;
Treatment of disease, disorder or injury;
Accommodation for persons who require nursing or personal care.
Conditions of registration require that all regulated activities are managed by a Registered Manager in respect of that activity and that each activity must be carried out at the locations detailed within the Certificate of Registration.
During the year the CQC carried out five inspections with regard to the fundamental standards. The first of these was a focused inspection in Birmingham in June 2018. The second of these visits was to our Northampton site Women’s services in July 2018. Our Nottinghamshire site was inspected in October 2018, the CQC visited our CAMHS service at the end of October 2018 to carry out a focused inspection into seclusion and long term segregation.
The current ratings across the charity are detailed in the tables below:
What others say about St Andrew’s Healthcare
Forensic inpatient/ secure wards
Requires Improvement
Good Good Outstanding Good Good
Wards for people with learning disabilities
or autism
Requires Improvement
Good Good Outstanding Good Good
OverallRequires
ImprovementGood Good Outstanding Good Good
Birmingham
OVERALLSAFE EFFECTIVE CARING RESPONSIVE WELL-LED
CAMHS GoodRequires
ImprovementGood Good
Requires Improvement
Requires Improvement
Overall GoodRequires
ImprovementGood Good
Requires Improvement
Requires Improvement
CAMHS
OVERALLSAFE EFFECTIVE CARING RESPONSIVE WELL-LED
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Acute Wards for Adults of working age and psychiatric
intensive care units
Requires Improvement
Good Good Good Good Good
Forensic inpatient/ secure wards
Requires Improvement
Good Good Good Good Good
OverallRequires
ImprovementGood Good Good Good Good
Essex
OVERALLSAFE EFFECTIVE CARING RESPONSIVE WELL-LED
Acute wards for adults of working age and psychiatric
intensive care unitsGood Good Good Good Good Good
Forensic inpatient/ secure wards
Requires Improvement
Good Good GoodRequires
ImprovementRequires
Improvement
Long stay/rehabilitation mental health wards for
working age adultsGood Good Good Good Good Good
Wards for older people with mental health problems
Requires Improvement
Good GoodRequires
ImprovementRequires
ImprovementRequires
Improvement
Wards for people with learning disabilities
or autism
Requires Improvement
Requires Improvement
GoodRequires
ImprovementRequires
ImprovementRequires
Improvement
OverallRequires
ImprovementGood Good
Requires Improvement
Requires Improvement
Requires Improvement
Men’s Services
OVERALLSAFE EFFECTIVE CARING RESPONSIVE WELL-LED
Wards for older people with mental health problems
Good Good Good Good Good Good
Overall Good Good Good Good Good Good
Neuropsychiatry
OVERALLSAFE EFFECTIVE CARING RESPONSIVE WELL-LED
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Forensic inpatient/ secure wards
InadequateRequires
ImprovementInadequate Good Inadequate Inadequate
Overall InadequateRequires
ImprovementInadequate Good Inadequate Inadequate
Nottinghamshire
OVERALLSAFE EFFECTIVE CARING RESPONSIVE WELL-LED
Wards for older people with mental health problems
Requires Improvement
Good Good GoodRequires
ImprovementRequires
Improvement
OverallRequires
ImprovementGood Good Good
Requires Improvement
Requires Improvement
Winslow
OVERALLSAFE EFFECTIVE CARING RESPONSIVE WELL-LED
Forensic inpatient/ secure wards
Requires Improvement
Good Good Good Good Good
Long stay/rehabilitation mental health wards for
working age adultsN/A Good Good Good Good Good
Wards for people with learning disabilities
or autism
Requires Improvement
Good Good Good Good Good
OverallRequires
ImprovementGood Good Good Good Good
Women’s Services
OVERALLSAFE EFFECTIVE CARING RESPONSIVE WELL-LED
We were very pleased to receive an overall rating of good for Birmingham, with the responsive key question being rated as outstanding and safe being rated as requires improvement. Staff were praised for their admission process and helping patients settle in their ward, provision of physical healthcare, responding to individual patients’ needs, care planning and working with other agencies. Improvements were required in relation to environment and these have been completed. Staff at Birmingham work hard to provide high quality care and are constantly seeking to improve where they can.
The inspection of Women’s services in July 2018 was a focused inspection and did not affect the previous ratings which were good overall, with safe being rated as requires improvement.
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The CQC identified actions we needed to take to improve which included work on the environment, staffing and adherence with the Mental Health Act Code of Practice. All actions have been identified and are subject to regular monitoring. Areas of good practice were identified in relation to physical healthcare, management of safety and support to staff following serious incidents.
We are sorry that the visit to Mansfield in October 2018 resulted in the service being rated as inadequate overall with effective rated as requires improvement and responsive rated as good. As a consequence of these ratings the services were placed in special measures and will be re-inspected within six months of the publication of the report (6 February 2019). We deeply regret that in a small number of instances, care provided to patients at Mansfield fell below our expected standards. As soon as the CQC raised concerns we acted decisively, closing the facility to new admissions and completed a clinical and operational review under new interim management. We identified the actions we needed to take to improve the standard of care and these actions were robustly monitored both within the charity and via meetings with the CQC and commissioners.
The CQC’s main concerns related to the care and monitoring of those in seclusion – a measure that we very much consider to be a last resort. We regret that in a few individual cases, care of those in seclusion fell short of the high standards we strive for. Any instance where we have let patients down is one too many and is unacceptable.
We were pleased that the CQC praised the involvement of patients in the care planning and rated Mansfield as ‘Good’ with regards to responsiveness to patients’ needs.
We will continue to work with staff and patients, patients’ families and carers, as well as the CQC, to promptly address these concerns. We will welcome the CQC back to Mansfield to review improvements within the next six months and are confident this will result in an improved rating for the facility.
Actions arising from all CQC inspections are monitored via the Patient Safety Group, Quality and Safety Assurance Committee and the Charity Executive Committee.
In addition to the fundamental standards inspections described above, the CQC undertook 34 unannounced inspections under the Mental Health Act across the Charity during this year. Overall our position with regard to findings in these reports is very positive, where action plans have been required, 100% of these have been returned to the CQC within the defined timescales.
Data Security and Protection Toolkit
In April 2018 the Data Security and Protection Toolkit replaced the Information Governance Toolkit. It forms part of a new framework for assuring that organisations are complying with their statutory obligations on updated data protection requirements and data security. It is an online self-assessment tool that allows organisations to measure and publish their performance. All health and care services that have access to NHS patient information are required to meet the standards of the Toolkit.
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The Charity’s Data Protection Officer has led this work, with support from IT teams and senior colleagues. This work has been being overseen by the Charity’s Information Governance Group.
A huge amount of work has been completed to ensure that we are complying with all of the requirements:
Updating of data protection policy and procedures and an updated methodology and process for conducting Data Protection Impact Assessments, a new breach reporting procedure, and a new procedure for how we deal with subject access requests and other data protection rights.
We have introduced a layered approach to how we advise people how their personal information will be used. An easy read version of the Patients and Service Users Privacy Notice has been created and we have also created a patient leaflet which has been distributed by the IPUs.
We have carried out due diligence activities on our suppliers to ensure they are handling personal data in line with our policies and standards.
We have created a personal data inventory which includes information about the personal data that we hold. This includes the source of the information, the category of personal data, the legal basis for processing the data, who the information is shared with, where the information is stored and how long for.
We have surveyed all of our IT software to ensure that we documented where we have not been able to keep software up to date. This has involved carrying out data security risk assessments. We ensure that the SIRO is kept up to date when security updates cannot be applied in order that they are informed and can consider the risks properly.
We have developed our strategy for applying security updates and have worked with our IT partner to ensure that they understand their responsibilities.
We have reviewed and updated the staff E learning module to ensure it includes updated data protection requirements.
We have started to carry out spot check access audits on the patient record system to check that access is legitimate.
The submission reflected a “Standards met” position, however, as part of the process to complete this work, we have captured some areas for improvement to ensure we continually assess and audit our data security and protection controls. This work will be overseen by the IGG, which is part of their remit.
Staff Survey
Our 2018 Your Voice Snapshot survey ran between 10 October and 2 November 2018 and contained six engagement questions.
The engagement scores since 2015 have been steadily improving, as detailed below:
2015
59%
2016
64%
2017
64%
2018
66%
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The full 2018 charity-wide results were as follows:
Our 2018 strategic target is 70% which is aligned with a High Performance Benchmark (HPB).
Whilst we still have work to do to achieve this target, when we compare our 2018 results with the HPB in the three engagement categories, the results are as follows:
Energy – A score of 75%, the same as in 2017, means we are achieving the HPB target of 75%.
Pride – A score of 60% was an increase of 4 percentage points from 2017. The HPB target is 74%, which means there is still room for improvement here.
Optimism – A score of 62% was an increase of 1 percentage point from 2017, and means that we have also achieved the HPB target of 62%.
Whilst it’s encouraging to have achieved the High Performance Benchmark for Energy and Optimism, the challenge throughout 2019 will be to maintain these scores, whilst making improvements to improve our Pride score.
We’ve since collectively reviewed the action plans at both an IPU and charity-wide level, and have identified key themes and priorities for us to implement throughout 2019/20 to ensure that more people feel like they’re part of something great at St Andrew’s Healthcare.
Your Voice Snapshot Results - Charity
Energy 75%
Favourable Neutral Unfavourable
I am willing to give extra effort to help St Andrew’s Healthcare meet its goals
0% 20% 40% 60% 80% 100%
82% 14% 4%
I am excited about the way in which my work contributes to St Andrew’s Healthcare success
0% 20% 40% 60% 80% 100%
67% 24% 10%
Pride 60%
I feel like I am part of something great at St Andrew’s Healthcare
0% 20% 40% 60% 80% 100%
62% 25% 12%
I would recommend St Andrew’s Healthcare as a great place to work
0% 20% 40% 60% 80% 100%
57% 28% 15%
Engagement 66%
Optimism 62%
I am very confident in the future success of St Andrew’s Healthcare
0% 20% 40% 60% 80% 100%
54% 32% 14%
If you have your way, will you still be working at St Andrew’s Healthcare 12 months from now?
0% 20% 40% 60% 80% 100%
71% 19% 11%
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Complaints
The total number of complaints received between April 2018 and March 2019 was 249, 25 were dealt with as Serious Incidents (SI’s) and 224 as complaints. By comparison, 328 complaints were received for the same period the previous year.
The complaints are broken down by IPU in the following table:
IPU NUMBER OF COMPLAINTS % OF TOTAL
Brain Injury – Rehab & Care 14 6.3%
Dementia & HD Care 2 0.9%
LD & ASD Secure Care Notts 27 12.1%
LD Secure Care 12 5.4%
ASD Secure Care 7 3.1%
MMH Medium Secure 20 8.9%
MMH Low Secure/Locked 10 4.5%
Mental Health & ASD Secure Care Birmingham 17 7.6%
PICU 6 2.7%
WMH Medium Secure 21 9.4%
Women’s Low Secure & Locked 6 2.7%
Women’s DBT 9 4%
Mental Illness & Personality Disorder Essex 23 10.3%
CAMHS 28 12.5%
CAMHS Developmental Disorders 10 4.5%
Other Departments 12 5.4%
Over the year, 91% of complaints opened were closed within the 30 working day deadline and we continue to focus on improving our response rate. The key themes for complaints in this period were Staff Attitude and Behaviour and Communication/Information followed by Clinical Treatment. All complaints received give us the opportunity to improve and are used to help us to identify when and how we can make changes. Our key improvements following complaints during the year have included:
Further training for staff on safety framework and MDT to ensure its being used consistently
As part of nursing reviews, meals to be offered and a record made whether patient accepts or declines
Ensure procedures are communicated to patients in a way they understand to eliminate confusion.
Care coordinators to ensure weekly 1:1 sessions are completed and logged on RiO
Greater focus on individual patient needs when planning patients’ treatment
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Harness the knowledge of carers and work in closer partnership with them
Plan for extra staff to cover on days when trips are booked
A number of staff have undergone additional supervision or training following complaints about their attitude, competence or behaviour
A complaints audit was conducted and whilst the way in which complaints are handled has areas of good practice, to enhance the process there is a need to provide clear procedural guidance and associated training to frontline staff. We need to ensure that an appropriate threshold is in place for recording complaints, acknowledge and investigate complaints on a timely basis, and use learning from complaints to drive improvements in patient care.
During 2019/20 our focus will be to implement the recommendations from the audit, drive awareness and implementation of the updated complaints policy and ensure lessons learnt are captured and shared for all complaints so that learning is embedded in practice.
Northamptonshire County Council Overview & Scrutiny Committee
As context for this response it should be noted that Northamptonshire County Council adopted a new model for Overview & Scrutiny (O&S) in September 2018. The new model is based on a single O&S Committee, with a remit that is strongly focused on the following areas:
Delivery of Northamptonshire County Council’s current budget and savings plans
Development of the Council’s future budget proposals
Major risks to the Council, the local community and the county
Engagement, alignment and support for the Council’s improvement plans
The O&S Committee’s remit includes the statutory function for scrutinising the planning and provision of health services in Northamptonshire. However, the prioritisation of the focus areas set out above, as well as the need to bring a newly-constituted Committee into operation, has necessarily minimised the amount of health scrutiny work that the O&S Committee has been able to do in 2018/19.
The O&S Committee formed a working group to consider and respond to local healthcare providers’ draft Quality Accounts / Reports for 2018/19. However, as this Quality Account was received after this working group met on 15th May 2019, it was sent to councillors by email for review and the following comments were provided:
Page 10: There seems to be quite a number of 2018/19 patient safety incidents resulting in severe harm or death (17). A breakdown of this figure would be appreciated: Could it be split down into self-harm, patient- patient interaction, carer-patient interaction for instance. Also these figures to be shown in comparison with another similar institution?
Page 32: In respect of the priority relating to reductions in restrictive practices: This needs further clarification. What is the target reduction aimed for in each of the measures, e.g. a 10% reduction or a 50% reduction? How will the effect of this be measured? It would be useful to see these figures over a longer period and to have a comparison with other similar institutions. Also, are there likely to be any other side effects of these reductions, for instance an impact on the severe harm/death figures? Has a comparable reduction been achieved elsewhere and what were the outcomes?
Involvement and Feedback from Key Stakeholders
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Section 2
Quality Priorities
NHS England
‘The St Andrews service has faced a number of challenges over the period and are committed to improve the quality of their services. Specialised Commissioners continue to work in close collaboration with the team at STAH . There have been a number of senior staff changes. The team are well engaged with partnership working as part of the emerging collaborative commissioning projects in the West and East Midlands. There has been a specific focus on restrictive practice; in particular long term segregation. The charity has established monitoring arrangements and the opportunity for confirm and challenge. There has been a continued reduction in beds commissioned in line with the transforming care agenda and some focussed work supporting the charity on a number of patients whose discharge is delayed. The charity is establishing a new blended women’s secure service as a pilot and there is a good level of service user engagement evident’
Healthwatch
Healthwatch Northamptonshire welcomes the appointment of Katie Fisher as the new CEO of St Andrew’s Healthcare. Our meeting with her in January 2019 was very positive and Healthwatch is particularly pleased to hear of her commitment to provide educational and vocational opportunities for people to develop work and life skills whilst in their care. Additionally, supporting staff to develop their skills will also improve career satisfaction, retention and the patient experience.
We support the 2019/20 quality priorities and the commitment to reducing restrictive practices and the use of seclusion.
The involvement of patients in care planning is essential going forward if St Andrew’s Healthcare truly wants to deliver coproduced, outcome focused patient care. It is also imperative that St Andrew’s Healthcare continues to improve its response rates to complaints and sees them as a source of feedback for continuous improvement.
The involvement of families and carers is also essential for the wellbeing of patients and the patient experience and outcomes. The new Carers Centre in Northampton demonstrates the commitment of the Charity to support this.
We look forward to working with St Andrew’s Healthcare over the coming year to ensure that the voice of patients, carers and families continues to be heard.
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Section 2
Quality Priorities
Section 3Review of Quality
Services
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1 . Empowering carers and patients to make a difference
Continue to improve on the immense work that has already commenced around patient and carer engagement and involvement to ensure that both patients and carers are truly empowered to make a difference.
The Patient Involvement Strategy outlines several key areas however our priorities are:
Listen and respond to feedback
Co-produce future plans and services
Demonstrate our impact, share good practice and shape national agendas
The Carers Strategy defines the Triangle of Care as a therapeutic alliance between service user, staff member and carer that promotes safety, supports recovery and sustains wellbeing. The Strategy clearly identifies its seven key priorities as:
Carers and their role are identified at first contact or as soon as possible;
Staff are trained on carer engagement;
Policy and practice protocols concerning confidentiality and sharing information are in place;
Defined post(s) responsible for carers are in place;
Effectively communicating with carers including an introduction to the service and staff;
Provide access to support and information;
Planning, delivery and evaluation of our services.
Why did we choose this priority?
These priorities were selected as the organisation has been very much in its infancy in involving patients and carers. Whilst progress had been made with patient involvement, there had been very little focus on carers which resulted in a carers engagement strategy being developed therefore a priority was to focus on its implementation.
What did we achieve?
Within patient involvement, we increased our response rate to the patient survey and some IPUs developed action plans to address issues together with using feedback from care opinion to inform quality of care improvements.
Whilst we are not at true co-production stage, patients have been more involved in decision making with representation on key committees such as Restrictive Practice Monitoring Group, Research Committee and more recently, recruited for the Quality and Safety Assurance Committee. Patient interview panels have been involved in the recruitment of all senior positions and within some IPUs they have had input into ward staff recruitment. Patients have been consulted on some policies and focus groups have been held to gain feedback on different aspects of service development.
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Section 3
Review of Quality Services
External collaborations have significantly increased through several patient reviews of the Mental Health Act, contributing to the Blended Model Pilot application and over a dozen sessions being held with patients within LD and ASD on Transforming Care and the NHS 10 year plan – this has meant a substantial contribution to the national agenda.
Progress has been made on the implementation of our carers strategy with a new Carers Centre opened in Northampton that provides central support and information. A carers survey has been conducted to establish the views and experience of carers together with general feedback provided to carer centre staff. Guidance for staff on information sharing with carers has been developed and carers had significant input into the Care Plan Approach (CPA) policy and process. Staff training on carer engagement has been piloted and is being reviewed following feedback and input from staff and carers. Carers were also involved with the Mental Health Act review and in research with the National Association of Psychiatric Intensive Care and Low Secure Units.
Carers have shared their experiences at Leadership and Board meetings in the last year.
2 . Gain parity of esteem between Physical Healthcare and Mental Health
Implement the recommendations made by the Physical Healthcare Needs Analysis around the patients’ physical health needs, overall governance of the Service; approaches to physical healthcare and the Charity-wide operational delivery.
Why did we choose this priority?
The physical health of our patients was rightly recognised as a key priority for the Charity. The evidence suggests that individuals with serious mental health problems are at greater risk of developing physical health illnesses such as diabetes, obesity and cardiovascular problems.
What did we achieve?
We undertook a comprehensive review of the physical health needs of our patients and, based on this analysis, we changed the model of physical healthcare delivery to an integrated model of care embedded in the IPUs. To do this we doubled the number of physical healthcare practitioners and have implemented a rota to increase our capabilities to provide out of hours physical healthcare. Through improvements in our data collection and our upgraded electronic patient record, our clinicians have easier access to physical healthcare information and we have refreshed the governance framework to ensure that we have the right systems to effectively monitor physical healthcare delivery.
What are we doing next?
We will continue to improve our capabilities to deliver physical healthcare through specific training around physical health conditions with a specific focus on preventative measures and earlier intervention in long term conditions, aiming to improve patient physical healthcare outcomes.
3 . Further reductions in restrictive practices
Continue to reduce the use of Prone Restraints (unless it is patient choice, care planned and risk assessed);
Minimise the use of Seclusion as a therapeutic intervention;
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Section 3
Review of Quality Services
Maximise the capability of data and analysis when evaluating quality and value within the patient outcome measures;
Ensure staff are trained to deliver positive and safe care and reduce the use of enhanced support and restraint;
To increase the opportunities for the therapeutic use of leave and other off ward activities for patients in keeping with the principles of least restrictive practice and recovery focussed care.
This priority has been partially achieved.
Why did we choose this priority?
Our quality priorities were designed to further enhance the recovery of our patients through ensuring the reduction of the use of restrictive practices.
What have we achieved?
The Restrictive Practice Monitoring Group continues to meet monthly to monitor the use of restraint, including prone restraint, restraints and seclusions. The seclusion policy, enhanced support policy, long term segregation and seclusion policy have all been reviewed during this year to ensure they reflect the latest guidance and learning. The IPUs also monitor this within their IPU quality and governance meetings. The graphs below show data for the period May 2017 to March 2019.
We started to use the Statistical Process Control method to present data in January 2019. This is a key continuous improvement tool recommended by NHS England. The upper (orange), lower (blue) and mean/average (black) reference lines are produced using all the data points – the upper and lower lines are calculated based on the data points within the graph, so will change every month. So, while the graph line may show spikes and troughs, they may well be within expected limits and are nothing to be concerned about. When they are above the upper or below the lower limit, then they become noteworthy.
In addition, an increasing run of 7 or more consecutive points indicates things are steadily getting worse, while a decreasing run is an improvement (in a stable system). A run of 7 or more consecutive points above the mean tends to indicate a period where incidents were consecutively high, while below the mean they were consecutively good (also in a stable system).
This method allows us to identify trends more accurately. The graphs below show data per occupied bed days and whilst there is some variation the graph for prone restraint shows an overall downward trend.
Prone Restraints
2
4
6
8
May 2017
Aug 2017
Nov 2017
Feb 2018
May 2018
Aug 2018
Nov 2018
Feb 2019
Per
100
0 O
BD
Mar 2019
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Section 3
Review of Quality Services
Next steps?
To further refine the data monitoring
To continue to re-inforce the least restictive practice approach with staff and provide training on skills and methods of de-escalation and therapuetic enagement.
4
8
12
14
6
10
Seclusions
May 2017
Aug 2017
Nov 2017
Feb 2018
May 2018
Aug 2018
Nov 2018
Feb 2019
Per
100
0 O
BD
2
6
10
4
8
Rapid Tranqs
May 2017
Aug 2017
Nov 2017
Feb 2018
May 2018
Aug 2018
Nov 2018
Feb 2019
Per
100
0 O
BD
15
25
35
45
20
30
40
Restraints
May 2017
Aug 2017
Nov 2017
Feb 2018
May 2018
Aug 2018
Nov 2018
Feb 2019
Per
100
0 O
BD
Mar 2019
Mar 2019
Mar 2019
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Section 3
Review of Quality Services
4 . Right Staff, Right Place, Right Time
Implement the staffing models identified through the Hurst Assessments and effectively manage the workforce resource to achieve the best outcomes for the patient;
Enhance care hours and the therapeutic time and opportunities for patients including leave, therapy and activity;
Ensure a stable, engaged and skilled workforce working in teams to deliver the highest quality standards and outcomes;
Appropriate reduction of agency staff use.
This priority has been partially achieved.
Why did we choose this priority?
Our quality priorities were designed to further enhance the recovery of our patients through ensuring the correct staffing was in place.
What have we achieved?
The graph below shows that over the time period May 2018 to March 2019 the gap between required staffing levels and the actual has reduced. Staffing is monitored within IPUs and monthly Patient Safety Group and Charity Executive Committee meetings, as well as the quarterly Quality and Safety Assurance Committee meetings. Staffing is also part of the safety framework which we have developed for monitoring key safety elements of services.
Staffing Gap – Nursing
8%
12%
18%
10%
14%
Staffing Gap – Nursing
May 2018
Jun 2018
Jul 2018
Aug 2018
Sep 2018
Oct 2018
Nov 2018
Dec 2018
16%
Jan 2019
Feb 2019
Mar 2019
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Section 3
Review of Quality Services
There has been a significant re-structure in the charity in quarter 4 of 2018/19. A key element of this change was that the operations and nursing responsibilities were separated so that we had the appropriate focus on both of these critical areas. The new roles of a Chief Nurse and a Chief Operating Officer were identified.
What next?
We will use the six months from January 2019 to June 2019 to make sure we have the right focus in each of the two areas. As part of the new Chief Nurse role a further review of staffing has been undertaken to ensure the Hurst model meets the ever changing requirements of the different IPUs.
New processes will be put in place to ensure that all areas are regularly reviewed in accordance with the Hurst Tool, this will then in turn ensure that the right numbers of staff are allocated to wards at all times. A new safer staffing dashboard will also be introduced that shows the number of staff on duty at any time within the charity and will provide an escalation process from ward to board.
Further work will be done on capturing the use of therapeutic and meaningful activities to enhance the patient experience.
5 . Outcomes
To embed outcome driven care throughout the organisation;
Work towards publishing our outcomes data.
Why did we choose this priority?
Improving outcomes that matter to our patients is at the heart of what we do at St Andrew’s Healthcare and to that end the Charity implemented Value Based Healthcare, founded on the principle of using resources as effectively as possible to measure, monitor and maximise these outcomes. This allowed us to work with our patients and carers to focus on those activities that improved outcomes.
MONTH COMMENCING
FILLED BY
1ST APR 2018
1ST MAY 2018
1ST JUN 2018
1ST JUL 2018
1ST AUG 2018
1ST SEP 2018
1ST OCT 2018
1ST NOV 2018
1ST DEC 2018
1ST JAN 2019
1ST FEB 2019
1ST MAR 2019
Staff 25405 26869 25489 25401 26348 25976 28200 27606 26834 28276 24362 26385
Overtime 3720 3879 3770 3869 3555 3305 3402 3317 3246 3547 3621 4472
WorkChoice 4875 5395 5382 5828 6706 6099 6122 6246 6489 6852 6410 7179
Agency 3577 3575 3695 3816 4372 3968 3863 3838 3738 4232 4072 4559
3288 2861 2744 3059 3328 3027 2801 2228 2777 2760 3123 3099
Fill Rate 92.0% 93.3% 93.3% 92.7% 92.5% 92.9% 93.7% 94.8% 93.6% 94.0% 92.5% 93.2%
Shift fulfilment by type of staff
Unfilled
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Section 3
Review of Quality Services
What did we achieve?
As a first step towards true outcomes driven care, we co-produced an outcomes framework with our patients, their carers and our staff. The resulting framework was then mapped across well-established, validated outcome measurement tools. These tools were then embedded in our electronic patient record and systems were put into place to ensure that these outcomes were recorded regularly, monitored and then used to support decision making. All 16 of our IPUs are now measuring outcomes for their patients and these outcomes are being used to improve the care we deliver.
What are we doing next?
The journey to deliver better care with each day continues and the work on outcomes continues to evolve with new tools, specific to different patient groups, being identified and adopted. We are working to build on our clinical dashboards so our clinicians have even better access to the data they need.
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Section 3
Review of Quality Services
Section 4St Andrew’s Healthcare
Showcase
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Diversity and Inclusion
St Andrew’s Healthcare has a diverse workforce, where we employ more women than men, have a higher BAME (Black, Asian and Minority Ethnic) population than the national average as well as more members of the LGBT+ community. We also have broad age distribution across our colleagues.
The Charity Executive Committee appreciates that a highly diverse organisation is a high-performing one, and we are actively seeking ways to become more inclusive and cohesive.
The creation of our Inclusion Leadership Committee was an important part of this. In November 2018 we invited people from across the Charity to help shape our future and make sure that everyone feels welcome and valued here: whether they are a patient, a visitor or a member of staff.
It has been a very positive year for diversity and inclusion. Some important milestones include:
A visit from the Reverend Richard Coles as part of LGBT History month. Having been a patient at St Andrew’s Healthcare at the age of 17, he said that our psychiatric care had ‘saved his life’.
Two women and a director of BAME origin were appointed to the Board over the course of the year. The majority of our Clinical Directors have BAME heritage.
A BAME network was established to provide peer support for people of all ethnicities to facilitate feedback and initiate change.
Training a team of people in Mental Health First Aid, to provide a listening ear and support for colleagues.
The launch of WiSH – Women in St Andrew’s Healthcare – a new network to drive gender equality at work.
REDS Academy
In June 2018 St Andrew’s Healthcare launched the Recovery and Every Day Skills (REDS) Academy.
REDS Academy is a uniquely inclusive offering open to patients, staff and carers alike. Its aim is to increase hope and help all students better manage their mental health and prepare patients for life outside our care.
Each course is designed and delivered in partnership with professionals and people with personal experience of mental health challenges.
Courses cover a wide range of topics from understanding mental health and recovery to meditation and drama. They also give people support with managing money and healthy eating.
Since launch, 111 patients and 127 staff across our four sites have taken part in the full range of courses.
Quotes about REDS:
“Meditation teaches me about my mental health
and gives me coping strategies.”
– student
“As a Peer Trainer my role is to
help create and deliver courses using my lived experience of
mental health alongside my training skills. The aim, though, is to have
more St Andrew’s Healthcare patients involved in doing that.
The empowerment they’ll gain from co-designing and co-delivering
courses is massive.”
– Kyle, REDS Academy Trainer
“It felt honest, engaging and
emotional at times, but well worth taking part in.”
– student on ‘Personality Disorder
and me’
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Section 4
St Andrew’s Healthcare Showcase
ASPIRE
ASPIRE is an initiative which provides both financial and on-going pastoral support (for a period of up to 2 years). The programme enables St Andrew’s Healthcare staff to complete their Nursing degree and is available to individuals who are either starting on their career journey in either mental health (MH) or learning disability (LD) nursing, or for those who are already part way through their MH/LD nurse training. There are two cohorts per year; applicants who meet the criteria can apply for this two year programme, where the Charity provides salary support of up to £16,056 per year. In addition to financial assistance, students in the programme are supported throughout their education with mentorship, pastoral care and regular contact events where they can meet fellow students and peers from the Charity.
Each year we provide nurse bursaries under our ASPIRE programme, funding 25 staff members to undertake their nursing degree, at a cost of over £15,000 per person.
There are currently 90 people at various stages of their academic journey.
Nina joined St Andrew’s Healthcare in 2004 as a Healthcare Assistant at Spring Hill House, on a ward for patients with learning disabilities. Having always had hopes to become a nurse, she was inspired ultimately by her children to begin studying:
“My son had an accident and was being cared for in a high dependency unit. Watching the nurses caring for him focused me on taking the next step. I wanted to make my children proud, and able to say ‘my mummy’s a nurse.’”
Nina first needed to complete her GCSEs and level 4 training in order to start her nursing degree. With a full time job, a five year old and three year old this was no easy task. Having hated school, she was also nervous about studying. But she was well supported by St Andrew’s Healthcare and given adapted hours to complete her studies. She received her GCSE results in August 2016, and started her nursing degree at the University of Northampton just two weeks later.
The course was enjoyable and Nina flew through practical exams, but found the writing side a challenge: “I’d never written academically before, so I had a lot to learn about the style and referencing. The 10,000 word dissertation nearly broke me: I tried to put it off but realised I was spending just as much time worrying about it as it would take just to do it!”
Nina graduated in February 2019 with a First. She says that the ASPIRE programme has changed her as a person: “It’s given me such a sense of pride, especially on coming back to work with my team. I owe a lot to St Andrew’s and particularly the ASPIRE team – Ged, Emma and Karen. And while I love being a Senior Staff Nurse, I want to carry on pursuing my career. My next goal is to become Clinical Nurse Leader.”
CASE STUDY
1
Nina
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Section 4
St Andrew’s Healthcare Showcase
Phil’s ASPIRE journey
Phil joined St Andrew’s Healthcare in 2006 as a healthcare assistant. He progressed to become an assistant practitioner, but wanted to become a fully qualified mental health nurse, so he embarked upon the level 4 certificate of higher education. “Before that, it was about 20 years since I was in school and I had no real academic ability whatsoever,” he explained.
Once Phil had attained the certificate, he applied to the ASPIRE programme and, after a successful interview, gained a spot on the programme.
“Being accepted into the ASPIRE programme and going through the interview process gives you a bit of self-belief that they have seen something in you and are prepared to put the time and investment into you to progress and develop,” he said.
Phil’s consistently high grades on the course allowed him to leave university two years later with a first-class degree. “I couldn’t have done it without ASPIRE. The financial support is a bonus; being a mature student and having commitments, there was no way I could have taken any other route to university, let alone have the confidence to do it.”
He is now back at St Andrew’s Healthcare, working as a staff nurse within our Child and Adolescent Mental Health Service. “Working in St Andrew’s Healthcare as long as I have makes it easier to come back and focus on being a nurse, as you’re not coming in blind.
“There aren’t rules to learn and that sort of thing so you can focus on every aspect of your nursing role when you come back to the ward and build relationships with patients,” he said.
CASE STUDY
2
Phil
The ASPIRE programme has
transformed my life. I am committed to spending my
professional life paying this tremendous ‘gift’ forward
to transform the lives of our patients and help educate
future ASPIRE students.
The ASPIRE programme has been
fantastic for me personally and I know for colleagues
it has been too, it prepares you both mentally and
academically for those who have been out of education for some time, the support
is endless from all areas.
The experience I have been gaining at St. Andrew’s has
allowed me to witness the commitment and dedication that the
charity invests in their patients and staff
alike.
Quotes from other ASPIRE students:
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Section 4
St Andrew’s Healthcare Showcase
The ASPIRE programme provides
a chance for people like me who are struggling
to return to education to become the exception and succeed in their
training.
I am deeply passionate about
nursing and hope that a degree in nursing will
be the development of my career to really
make a difference to the lives of others.
Section 5What our patients and
carers are saying
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“You are loved, you are cared
about and you are worthy of help.”
– a patient
“St Andrew’s Healthcare gives
great care for those they care for, and
gives care for those who care.”
– a carer
Thank you so much for all your wonderful care, we know she is
in safe and loving hands.Wonderful
staff
We received 224 compliments and 49 stories have been captured on Care Opinion
What are our patients and carers saying?
“Came in a mess, was tended to by angels and now I’m better.”
– a patient
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Section 5
What our patients and carers are saying
“I’ve had so many ups and
downs, but thank you for putting me together.”
– a patient
“Sometimes it’s been quite tough, but with carers and health professionals working together we
can overcome the challenges.”
– a carer
“A service user once told me: “This is my home and
you are my family, it’s all I have and all I know.” This has resonated with me ever since, and is what motivates me on a
daily basis to give individuals in our care the best quality of life
and care possible.” – staff member
I feel like the staff are
very supportive. I feel like they are handling
my care very well and I feel like I am
going to have a good and positive
future.
Really good
treatment
This is the best hospital
I have been in
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Section 5
What our patients and carers are saying