servhil0577 hillingdon annual report 2015-16 · community paediatric nursing ... and have expanded...

1516

Hillingdon Community Healthcare Services Report2015-16

ContentsWhat we are working towards – Wellbeing for life .................................................... 5What we believe in ................................................ 5Hillingdon children’s services ................................ 8Community Paediatric Nursing ............................. 8Hillingdon Health Visiting Service ......................... 9Hillingdon and Harrow Looked After Children Health Team ..................................10Safeguarding Children .........................................13Community Paediatricians Service ......................14Paediatric Physiotherapy .....................................17Paediatric Occupational Therapy ........................19Paediatric Speech and Language Therapy (SLT) .......................................21School Nursing.....................................................24School Immunisation Team .................................26Immunisation Task Force ..................................... 27Hillingdon Tuberculosis(TB) Nursing Service ....................................................28Hillingdon adult services .....................................29District Nursing and Community Matrons Service ...............................29Hillingdon Twilight Service ....................................31Rapid Response ...................................................32Community Cardiac Service ................................33Community Adult Rehabilitation Service (CARS) ..............................35Hillingdon Community Diabetes Service ............ 37Hillingdon Adult Bladder and Bowel Service ...............................................38Adult Speech and Language Therapy ................39Hillingdon Musculoskeletal Physiotherapy Service ..........................................41Hillingdon Podiatry ..............................................42Tissue Viability ......................................................44Hillingdon Centre for Independent Living (HCIL) ....................................46Specialist Palliative Care Service .........................48Hillingdon inpatient services ..............................49Hawthorn Intermediate Care Unit ......................49

4

Dear Colleague,

At CNWL Hillingdon we are incredibly proud of the work we do in supporting our resident families, patients and carers with their community healthcare needs. It is with great pleasure that I present a review of 2015-16 to show you some of our highlights from our community health services over the last year.

We have worked to strengthen our links and partnerships with primary care, the Hillingdon Hospitals NHS Foundation Trust and the third sector. Together we have formed Hillingdon Health and Care Partners and are now on a journey to transform how we collectively deliver care to the residents of Hillingdon.

We have also extended our links with the third sector so more patients can be cared for in their own home through the use of services such as night sitting. We continue to work in collaboration to deliver on the 7 day working initiative to enable patients to access services equitably across the week. Introducing 7 day therapy to our inpatient unit has meant that patients are able to spend less time in hospital.

We are now looking at how we can embed more community expertise within GP practices. Working with our partners we have supported a pilot in 4 GP practices with a specialist nurse and care co-ordinator helping to embed skills, expertise and capacity within practice to anticipate care needs and therefore avoid unnecessary trips to hospital for our more vulnerable residents. This is something we hope to roll out across the whole Borough over the next year.

We were delighted to be asked to lead the Diabetes Pathway in Hillingdon and have worked closely with our partners to review the pathways

and make sure we provide care in the right place at the right time. We are also working with Hillingdon Hospital to develop a new Cardiology pathway and have expanded our own capacity to deliver more enhanced cardiology services within the community.

In March this year our Health Visiting service received confirmation of Stage 1 Baby Friendly Initiative for breastfeeding - a big achievement for the teams and we are working to gain Stage 2 accreditation now.

Our Children’s Community Nurse Team are now offering IV therapy to children at home to reduce hospital stays and admissions.

We want to concentrate our services on fewer but larger sites. This will be more convenient for our families, patients and service users as they can go to ‘one-stop shops’ for all their care and treatment needs. It will mean that how we configure some of our services will change but it also means we can start to offer appointments at more convenient times such as evenings or weekends.

Our Annual Patient Survey told us that 95% of respondents would be extremely likely or likely to recommend community Services. This is up from 93% in 2014. 99% told us they were treated with dignity and respect and 97% felt they were appropriately involved with their care. The Paediatric Speech and Language Team received excellent user feedback results for 2015/16; including 100% of parents within the pre-school children caseload reporting that their therapist was kind and caring and had a good relationship with their child.

All this is a credit to the hard work of all of our

Hillingdon Community Healthcare Services Report 2015-16 | Introduction | 5

staff who day in day out deliver high quality patient focused care to patients and their families or carers.

Whatever the service being delivered, our staff pride themselves in putting the needs of patients first. This year we will launch the #hellomynameis… campaign across our Trust. Delivering compassionate care starts with an introduction and we are encouraging our services and teams to adopt the principles behind Dr Kate Granger’s campaign as a way to ensure we are always putting the needs of our families, patients and service users first.

We value feedback in whatever form it is received. Enshrined within everything we do is a system promoting safe and effective care through reflective practice and learning to ensure when lessons from incidents or complaints and positive patient feedback is identified, they are put into practice not only in the service concerned, but across the Trust as a whole.

Each service report highlights their achievements for the year which include a variety of service improvements, patient engagement projects and delivery of key performance targets and outcomes. All pivotal to maintaining a healthy organisation that is looking forward to delivering even more service transformations in partnership with our patients and their families or carers.

We appreciate your feedback and comments. If you would like to discuss anything in this report then do contact me directly. My number is 020 7685 5806 or email [email protected].

Yours sincerely,

Graeme CaulCommunity Services Director

Vision What we are working towards – Wellbeing for life

To work in partnership with local people to improve their health and wellbeing. Together we look at ways of improving an individual’s quality of life, through high quality healthcare and personal support.

ValuesWhat we believe in

Compassion: We all contribute to a compassionate environment for everyone here; what we say and do helps make the lives of others better

Respect: We will respect and value the diversity of our patients, service users and staff, to create a respectful and inclusive environment, which recognises the uniqueness of each individual.

Empowerment: We will involve, inform and empower our patients, service users, carers and their families to take an active role in the management of their illness and adopt recovery principles. We will ensure our staff receive appropriate direction and support, to enable them to develop and grow.

Partnership: We will work closely with our many partners to ensure that our combined efforts are focused on achieving the best possible outcomes for the people we serve.

6

87% of palliative patients were able to die in their preferred place of care

91% of mothers received a new birth assessment

in 14 days

93% of children received an audio and vision check

4% identified with vision issue and referred on8% identified with hearing issue and referred on650 referrals on made

99% of height and weight checks completed

237 referrals from enuresis support by School Nurses

100% of our Looked After Children assessments undertaken on time

92% of patients using District Nursing, Rapid Response and Case Management screened for dementia

88% of District Nursing referrals contacted within

24 hours of referral

99% of District Nursing urgent referrals seen

within 4 hours

04:00

Year in numbers

Service reports

8

Hillingdon children’s servicesCommunity Paediatric Nursing

Summary of service

The Community Paediatric Nursing Team is comprised of qualified children’s nurses working in the community, special schools and GP surgeries. The Community Children’s Nursing Service provides nursing care for children from 0-18 years of age with acute, chronic or complex conditions. Care may be provided in children’s own homes or in other community settings, seven days a week.

All children/young people referred to the service are contacted by a trained children’s nurse within 48 hours of receipt of referral. Urgent cases are contacted and a visit arranged within 24hours. At first assessment a care plan is developed in partnership with the family.

The team provides structured education and training to children/young people, their carers, statutory and voluntary organisations.

A paediatric dietician is working in the team until November 2017 to support children who receive enteral feeding.

Community Paediatric Matron Service - The paediatric community matron provides minor illness clinics in four GP practices in Yiewsley, five days a week.

Special School Nurses - This service provides resident nursing support to three special schools within the borough: Grangewood, Sunshine and Moorcroft, for children aged 4-19 years.

Activity

The CCNT covers the borough of Hillingdon. The current number of children on caseload is in excess of 200.

The service received 1,855 referrals, with 11,049 appointments or visits made over the course of the year. The Community Children’s Matron sees approximately 16 children per day, five days a week.

The CCNs based in the borough’s three special schools see children/young people on a daily basis. They deliver training to education staff, administer feeds and medication and compile health care plans with school and the CDC consultant.

New developments this year

The team has recently increased its provision of ambulatory care for children requiring IV therapy at home. This means care can continue at home following either a short hospital admission or actual prevention of admission.

A nurse with specialist training in epilepsy management has started working in partnership with a Consultant Paediatrician at the Child Development Centre. The nurse reviews children/young people, monitors their medication and liaises with parents, carers and paediatricians.

Plans for 2016-17

Two special school nurses are undertaking the Nurse Prescribing course. This will enable families to discuss and agree potential medication changes directly with the nurse.

Hillingdon Community Healthcare Services Report 2015-16 | Service Reports | 9

Hillingdon Health Visiting Service

Summary of service

The Health Visiting Service promotes the health and wellbeing of families with children under five. The team includes health visitors, community staff nurses, nursery nurses, health visitor assistants and administrative staff. The team works closely with Children’s Centres, social care and other healthcare professionals, including GPs.

The Health Visiting service is commissioned to deliver the Universal and Targeted elements of the Healthy Child Programme. This includes provision of a named contact for all children and families under the universal services contract, and a named health visitor for all children and young people who require extra support or whose needs are more complex and enduring.

Hillingdon has health visitors specialising in maternal and infant mental health, domestic violence, breastfeeding, hospital liaison and marginalised communities (the Community Engagement Programme).

The team offers expecting mothers and families support before birth, in the early weeks following birth and as the child develops.

The service offers a Saturday morning service at two sites across the borough, enabling easier access for parents and carers who work Monday to Friday.

Activity

The service received 13,292 referrals, with 93,082 appointments or visits made over the course of the year.


The Health Visiting service achieved level 1 in the UNICEF baby friendly breastfeeding award and is working towards reaching level 2 in the coming year.

Health Visitors are reviewing the antenatal programme ‘Your Bump and Beyond’ with the Children’s Centres: this is a universal, ante natal programme delivered in Children’s Centres along with children centre staff and the midwifery service.

Uma Purohit, specialist HV for community engagement, was awarded CNWL employee of the year for her work with the Afghan women’s community to support them with parenting issues.

Plans for 2016-17

There are plans to review the service and management structure for the health visiting service teams, to meet commissioning requirements and ensure effective and efficient delivery of the service.

We are planning user feedback surveys for our families to comment on the service currently offered to them and how it could be improved.

The service plans to review its child health clinics and will look to improve delivery and quality of the experience for service users.

The service plans to share best practice in Hillingdon between Hillingdon, Camden and Milton Keynes for all Health Visitors.

In 2016 a professional practice day with speakers from the Local Authority and the Institute of Health Visiting is planned. This will discuss future service developments around the six early years high impact areas.

10

Hillingdon and Harrow Looked After Children Health Team

Summary of service

The Hillingdon and Harrow looked after children health team provides health services to children who have entered the care system. They ensure that all those involved in the care of these children are able to promote positive health, are aware of and address relevant health issues. The team:

• Ensures children have a comprehensive and high quality assessment of their health needs, by undertaking statutory health assessments which contribute to the child’s health care plan

• Ensures that the child’s immunisations and dental checks are up to date

• Provides advice and information to foster carers to promote health and wellbeing and provides advice relating to child development, emotional difficulties, and common health problems

• Trains colleagues working with looked after children, their families and carers, social workers, foster carers and staff/children in residential establishments

• Reviews the health needs of care leavers

• Advises and supports the Adoption and Fostering Panel

• Liaises and advises hospital trusts, independent contractors and other agencies such as social services, education, police and voluntary services

• Works with partners to address teenage pregnancy and the sexual health of young people and address emotional health issues such as self-harm

• Works directly with young people to actively involve them in the development of services, such as meetings with the Children in Care Council.

Activity

The looked after children (LAC) caseload fluctuates on a weekly basis, as children enter and leave the care system. Data from January/February 2016 show that Hillingdon’s LAC population was 361 and Harrow’s LAC population was 184. There are additional LAC who are placed within Hillingdon by other Local Authorities, and although the overall statutory responsibility remains with the placing authority, the LAC team may be asked to undertake health assessments on their behalf.

During 2015/16 Hillingdon received 554 requests for health assessments, 240 of which were for initial health assessments (IHAs) and 314 for review health assessments (RHA, of which 506 assessments needed to be completed.

From June 2015 to March 2016 Harrow received 254 requests for health assessments (109 IHA and 145 RHA requests) of which 202 were required to be completed.

Total activity for both teams was 708 assessments.



The main change this year has been the newly commissioned Harrow Children Looked After Service from June 2015. In order to ensure smooth transition and implementation of the new Harrow contract the team:

• Held a launch event for Harrow Service with all partners in June 2015

• Spends one day a week with the Local Authority, meeting senior managers to monitor health assessments and being available to social workers

• Attends meetings and links made with key partners – health visitors, school nurses, Youth Offending Team, Child and Adolescent Mental Health Services, and sexual health

• Implemented a programme for foster carer training

• Provided induction training for new social workers and partners

• Successfully applied for and awarded TB grant for £500 which was used for the production of leaflets and posters delivered to all Harrow schools and GPs in consultation with Children Looked After (CLA)/Unaccompanied Asylum Seeking Children (UASC) team

• Hosted a visit from Swedish school nurses interested in our work with UASC and CLA

• Delivered a presentation at the care leavers’ forum, attended by over 40 carer leavers

• Attended a corporate parenting board and corporate parenting managers meeting

• Attended a Children Looked After celebration in Harrow

• Attended a foster carer’s award ceremony. This event provides recognition to foster carers who have provided services to Harrow and delegates awards for long service

• Developed a ‘Handy Hints’ leaflet in conjunction with Children Looked After

12

Other developments were:

• Designated nurse asked to deliver a teaching session at Oxford Brooke’s University

• Team members have implemented new ideas including sexual health packs in all Hillingdon residential homes, and presenting at men’s health week

• New consent form and parent information leaflet introduced

• Introducing a ‘crib sheet’ to help interpreters at health assessments

• Development of written health assessment for non-attenders/refusers.

Plans for 2016-17

During 2016-17 the Hillingdon Looked After Children Health Team will continue to provide a health service to looked after children, as outlined within statutory guidance, working with our health and social care partners. The Harrow Children Looked After Health Team will continue to review existing processes to ensure they are as streamlined as possible, including the introduction of:

• A new way to request adoption medicals and providing medical advice

• Health passports for our care leavers

The team will continue to build upon the success of its first year, working in close partnership with Harrow CCG and Harrow Local Authority.

The joint team to develop an annual client satisfaction audit for 2016-17.


Safeguarding Children

Summary of service

Section 11 of the Children Act (2004) places duties on health organisations to ensure their functions, and any services that they contract out to others, are discharged having regard to the need to safeguard and promote the welfare of children. These organisations should have in place arrangements that reflect the importance of safeguarding and promote the welfare of children. Health professionals are in a strong position to identify welfare needs or safeguarding concerns regarding individual children and, where appropriate, provide support. This includes: understanding risk factors, communicating effectively with children and families, liaising with other agencies, assessing needs and capacity, responding to those needs and contributing to multi-agency assessments and reviews.

Activity

There are over 69,000 children and young people aged under 18 years in Hillingdon. The number of children subject to a Child Protection Plan ranged from 350-390. This number would be in line with what would be expected in the context of the child population size.


• National mandatory reporting of Female Genital Mutilation (FGM) in children was introduced 31 October 2015

• Children’s services staff received bespoke training on child sexual exploitation

• Multi Agency Child Sexual Exploitation panels are now well established and information is shared widely across the health partners in Hillingdon

• A full time health practitioner with access to SystmOne is working in Hillingdon’s Multi Agency Safeguarding Hub (MASH). The team use their shared knowledge and skills to ensure that children and families have access to the right services at the right time

Plans for 2016-17

• Focus on neglect – it is planned to include it in CNWL’s 2016/17 Trust-wide safeguarding children work plan and it is a priority for Hillingdon’s Local Safeguarding Children Board in 2016/17

• Bespoke training for children’s services staff from Hillingdon’s Serious Case Reviews and Domestic Homicide Reviews to be rolled out

• Development of a Trust-wide safeguarding children strategy

• Revise the Trust-wide safeguarding children training strategy

14

Community Paediatricians Service

Summary of service

Hillingdon Community Paediatrician Team works with children who have complex additional needs, disabilities or long term conditions, enabling them to achieve their maximum potential.

The team are highly skilled clinicians who also lead in the following areas for Hillingdon:

• Designated Doctor and Named Doctor for child protection

• Designated Doctor for Adoption and Fostering for looked after children

• Designated Medical Officer - provider link for education

The services provided are for:

• Children with disabilities and complex health needs

• Children undergoing an assessment of their special educational needs, where medical information is provided to support multi professional assessment

• Children with developmental concerns such as social communication difficulties, autism spectrum disorder (ASD), developmental delay or motor co-ordination difficulties

• Babies who are at high risk of developmental difficulties, transferred from the neonatal team

• Looked after children, as part of the statutory requirement for all children in care

• Safeguarding and protecting children


Paediatricians see children with one or more of the following conditions:

• Developmental delay

• Epilepsy

• Cerebral palsy

• Chromosomal disorders

• Neuromuscular conditions

• Neurodevelopmental disorders such as Developmental Co-ordination Disorder and ASD

Activity


Patient experience measures during 2015-16 were met or exceeded:

• 98% of patients were contacted within one week of receiving their referral

• 100% of child protection referrals for medical assessment were responded to within 24 hours

• 100% of medical assessment requests for children with SEN were responded to within six weeks

• 100% of patients who were in transition had a written child development report provided to their adult GP service by the agreed date of transfer.

Comments from Friends and Family Test include:

‘I got very helpful and caring treatment for my son. Thank you all for your help. Also my opinion is heard and a solution is always found.’

‘Always helpful, always greet you.‘

‘Nothing could have been done better.’

16


Review and streamlining of appointments for multidisciplinary team (MDT) assessments in order to deal with increased number of children referred with suspected ASD. This resulted in 235 children being seen, a 20% increase on 195 seen the previous year.

Launched Child Development Centre (CDC) all staff work streams in October 2015 focusing on staff engagement: staff feeling valued and included and service improvement work streams – including strengthening of patient, parent and carer involvement. This has been well received and feedback from patient and carers is informing service improvements.

Plans for 2016-17

The Child Development Centre (CDC) is continuing to develop several workstreams to improve patient experience and allow the wider staff group, parents, carers, young people and our partners in the community to take a more active role in service planning and delivery. Some of the workstreams being developed over the next year include:

• Patient/parent/carer involvement and feedback – focus event in May 2017

• Working through the 15 Step Challenge to look at care in our settings through the eyes of patients and service users, to help capture what good quality care looks, sounds and feels like

• Review of multi-disciplinary diagnostic pathway for children under five – this included involvement from a parent/service user who is also a member of Hillingdon Parent Carer Forum steering group

• Improving processes to support parents when completing questionnaires

A new post has been created for a clinical psychologist who will work closely with the community paediatricians and therapy teams at the CDC, including supporting the diagnostic pathway for ASD and provide invaluable support to the young people and their families who use the service.


Paediatric Physiotherapy

Summary of service

The Paediatric Physiotherapy Service provides a specialist service including assessment, diagnosis and therapy for children and adolescents who have movement disorders as a result of injury, illness or disability. In addition, the service supports children under five who present with musculoskeletal/orthopaedic problems. The service is open to children aged up to 19 years of age and registered with a Hillingdon GP. The service is delivered from the Child Development Centre and also in Children’s Centres, schools (special and mainstream) and in the child’s home.

Activity

The service received 628 referrals, with 6,516 appointments or visits made over the course of the year. Referrals come from health visitors (26%), GPs (23%) and other sources including parents and schools (51%). The maximum wait for an initial appointment is five weeks. This is a key target and has been 100% achieved.


The service had identified the need to improve communication and links with the adult physiotherapy service. The transition pathway from paediatric to adult services was a key area for improvement. The service is now working closely with adult physiotherapy to develop a joint pathway, to ensure an effective transition process is developed to support patients. The outcomes of this work include joint handover appointments with the CNWL Community Adult Rehabilitation Team, and agreed to run a jointly-held clinic with the Alderbourne Rehabilitation Unit at Hillingdon for next year’s cohort. These measures will support a whole-system, integrated approach.

Multidisciplinary assessments (OT and PT) for children referred for motor co-ordination difficulties. Children and families benefit as this saves them attending multiple appointments (and having to ‘retell their story’). Treatment is also improved resulting from co-ordinated care.

Development of a joint exercise group for children with motor co-ordination difficulties.

Setting up the Ponseti Pathway with the orthopaedic consultant at Hillingdon Hospital (THH) for babies born with structural talipes. Through this service time has been saved, stopping families having to travel long distances to tertiary centres to access treatment, and bringing care closer to home. This approach was set up following feedback from parents to Paediatricians who had sought care to be delivered closer to home.

Whole system working has been supported by the service working with the orthotics service at THH which has reduced the waiting times for orthotics from eight weeks to four to six weeks.

18

The service is actively supporting work streams across the CDC including the development of increased patient/parent/carer involvement in service review and new developments.

Plans for 2016-17

• Phase two of the transition pathway from paediatric to adult services which will see the jointly-run clinic set up with the Alderbourne Rehabilitation Unit

• Set up and implement the Cerebral Palsy Integrated Pathway, currently being established across London. This aims to provide a high quality, standardised follow-up programme for children/young people with Cerebral Palsy that will identify musculoskeletal problems through regular physical and radiological examinations. This will allow for effective management of musculoskeletal problems throughout the course of childhood

• Explore a potential opportunity to support the developmental screening of High Risk Children. Currently children who present with motor disorder risk factors receive developmental screening assessments by paediatricians at Hillingdon Hospital. Elsewhere paediatric physiotherapists carry out these assessments, providing advice and intervention and only when necessary refer on for further advice e.g. to paediatricians. This has significant cost saving implications in addition to moving care outside of hospitals. This would involve identifying the numbers of children not already known to the CDC who would require follow up. The level of additional resource required could then be

identified

• Explore extended service provision to support young adults (19-25) who present with impairments of motor function in line with SEND reforms. The Paediatric Physiotherapy service could provide a specialist key working role/function for young adults up to 25 years

• Develop existing treatment pathways and MDT working, in response to feedback and changes from service users in line with patient/user involvement work streams at the CDC.


Paediatric Occupational Therapy

Summary of service

The Community Paediatric Occupational Therapy Service (OT) provides assessment of function, mobility, gross and fine motor skills, sensory processing, perception and development. The service assesses the daily functional impact of any impairment, providing strategies in partnership with parents and children/young people, to modify sensory processing difficulties.

This includes providing splinting and equipment to improve function, prevent deformity, control tone and encourage successful performance of everyday tasks.

The service supports partnership and integrated working, and the education of professionals, parents and carers. The service provides intervention within individual and group settings, as appropriate to the child’s needs.

Therapy activities support the child/young person’s neurological functioning, including attention and concentration, sensory processing, perception, development of physical abilities including fine and gross motor skills, activities of daily living such as dressing and using cutlery.

Paediatric occupational therapeutic interventions support the child/young person’s development through the use of purposeful activity and play, to help them achieve their potential. The service provides input according to the each child/ young person’s stage of development and specific needs, and with consideration of the social, cultural and family background.

Therapy is delivered in a variety of settings including the Child Development Centre, two specialist sensory exploration rooms (one in the south and one in the north of the borough located within local authority schools), Children’s Centres, schools and home visits.

Activity

The service received 759 referrals, with 4,767 appointments or visits made over the course of the year.

20

Feedback:

• Parents reported progress in 97% of usable targets across all groups and sensory exploration sessions

• 100% of parents reported that staff were kind and caring, had a good relationship with their child/ young person, and had a good understanding of their child’s needs

• 100% of all parents reported that staff listened to their concerns, were kind and caring, explained to them what was happening in the session and gave them ideas about how to help their child at home

• In a user satisfaction survey 93% of parents stated that they found the OT session useful or very useful

• 100% rated the OT service excellent or good


The introduction of the new Education, Health and Care Plans (EHCPs) has resulted in a shift towards increased child/young person/family centred way of working which is reflected in the new report format, which includes the child/young person/family’s aspirations, which link with the agreed outcomes.

OT statutory report formats have been reviewed and amended to support efficient working and further develop the quality of reports.

The service has been awarded a new borough-commissioned OT school contract, which will provide OT reviews/programmes and some direct interventions for school age children/young people with an EHCP, largely attending mainstream schools


Paediatric Speech and Language Therapy (SLT)

Summary of service

The Paediatric Speech and Language Therapy (SLT) service aims to provide accurate and timely assessment and therapy for children and young people identified as having moderate-severe speech, language, communication needs or eating, drinking and swallowing difficulties (dysphagia).

Interventions ensure children and young people’s communication/ feeding needs are identified, and they are supported to develop and achieve academically, socially, and emotionally to reach their full potential.

The children and young people the Service works with typically have difficulties with one or more of the following areas:

• Speech difficulties

• Language difficulties

• Social Communication difficulties

• Stammering/dysfluency

• Voice difficulties

• Selective mutism

• Eating, drinking and swallowing difficulties

The SLT service is delivered in the following range of locations, dependent on the needs and age of the child or young person:

• Clinic settings

• Child Development Centre (CDC)

• Children’s Centres

• Home

• Hillingdon mainstream state schools

• Hospital wards (ABI and dysphagia)

• Nurseries

Activity


22

Feedback:

• A survey of school special needs co-ordinators (SENCOs) showed that 88% are happy or very happy with the Service that they receive. SENCOs commented on how helpful advice and strategies are, as well as the support and training provided for school staff. They felt therapists communicated well and provided a helpful and creative service with good support for parents. They also commented that children had made good progress and staff felt confident on how to follow up on SLT advice.

• 100% of parents with pre-school children considered that therapists working with their children had been kind and caring and had a good relationship with, and understanding of, their child.

• 99% of parents reported that the strategies they were given by the SLT would help develop their child’s communication at home.

• 68-82% of teachers rated that their knowledge of how to support the child’s communication skills in class had developed over the academic year. New classroom SLT strategy advice sheets have been developed in order to support teachers with using strategies to support children in their class across the school day.


• Funding for three new posts within the mainstream schools service will help to meet the increased demands for school based SLT support – numbers have more than doubled since 2010. In addition funding for a part time new post to support the ASD diagnostic pathway has been secured for children with complex additional needs.

• A new development screening tool to support early identification and appropriate referrals to the pre-school team has been developed, resulting in increased appropriate referrals to 92.5%.

• The introduction of EHCPs has resulted in a shift towards a more child/family centred way of working, which, as with other services, is reflected in a new SLT report format which includes the child/family’s aspirations which aim to link with the agreed outcomes.

• In response to feedback from the local authority and the increase in the number of tribunals the service is being asked to support, the service has further improved the quality and detail contained in recommendations for EHCP reports.

• The service has developed new care plan and target sheet templates to ensure that children have an identified care plan which is shared with school, nursery and the family. A recent audit showed that 100% of audited children in the pre-school teams had an up to date care plan.


• The service has actively supported the CNWL-initiated partnership review of the ASD diagnostic pathway and support with partners (including LBH, Children’s Centres, HVs and Paediatricians) for children under five and their parents/carers.

Plans for 2016-17

• A new leaflet is being developed which will be given to families of pre-school children already in therapy and about to start school and will be expected to transfer to the mainstream schools’ speech and language therapy team in September 2016. This explains SLT service which is offered in the mainstream schools.

• Development of ways to obtain feedback from school aged children receiving speech and language therapy.

• The increase in staffing in the mainstream schools team will be used to close the gap between the level of service and packages of care offered to children with an EHCP and those without.

• Charitable money has been sourced to develop a video providing useful tips and strategies for parents to support their child’s early language and communication development. This is to raise awareness for parents/communities in areas of higher social deprivation where there are known to be higher levels of speech, language and communication needs (SLCN).

• A nursery pack is being finalised to provide school nurseries with useful strategies to promote the development of speech and language skills in all children.

• The multi-disciplinary ASD diagnostic pathway for under-fives is being reviewed to improve quality.

• A new ASD pathway for children over five is being developed at the CDC

• Multidisciplinary workstreams have been identified at the CDC including strengthening and developing patient/carer involvement: the SLT service is collaborating with this work.

24

School Nursing

Summary of service

The School Nursing team comprises qualified nurses with specialist training in the health needs of school aged children. Some are specialist public health nurses. There are three teams in Hillingdon: Eastcote Team covers North Hillingdon; Laurel Lodge team cover Uxbridge and West Drayton; and Minet Team covers Hayes and Harlington.

The school nursing service delivers the healthy child programme from the age of 4-19.

Universal Services

• Health Screening of vision and screening to all reception children

• National Child Measurement Programme for reception and year six children

• Junior Citizenship – partnership working with local community agencies promoting better understanding of accident prevention and risk with children aged 10-11 before starting secondary school

• Neonatal BCG programme in three clinics

Universal Plus Services

• Nurse-led enuresis clinics – children are seen from the age of five. The Service follows the NICE guidelines for children with bedwetting. Children are seen with a parent and followed up with face to face and telephone contacts

• MEND programme interventions for overweight and obese children. The programme targets children at ages 5-7 and 7-13. These programmes are run twice weekly at schools or leisure centres

• Annual asthma and EpiPen training is provided to all primary and secondary schools for teaching and support staff. All schools have an annual audit


Specialist (Universal Partnership Plus)

• Safeguarding – child protection, child in need. School nursing has a key role in implementing health outcomes and a child’s developmental and emotional wellbeing

• Early intervention – early help assessments and interventions for families in difficulties

• Drop-in clinics in secondary schools: a recent audit highlighted that the young people valued the service and felt that they were treated with dignity and respect

• School nursing works closely with the Looked After Children team and the immunisation Task Force

Activity



• The service set up an immunisation team following a successful tendering process to provide school aged immunisations to schools in Hillingdon, Brent and Ealing

• Secured a tender to provide outstanding neonatal BCG vaccinations to babies in Brent, Ealing and Harrow.

Plans for 2016-17

The school nursing service is working to become more closely aligned with the Health Visiting service, to ensure seamless delivery of care to children aged 0-19.

26

School Immunisation Team

Summary of service

The School Immunisation Team was set up in September 2015 and began vaccination sessions in schools on 2 November 2015. The team has been immunising secondary school age children across Brent, Ealing and Hillingdon in line with the routine childhood immunisation schedule. The team covers 89 secondary schools and has been vaccinating year 8 girls (HPV vaccination), year 10 children (Td/IPV, Meningitis ACWY, and MMR catch up) and year 11 children (Meningitis ACWY). Termly catch-up immunisation clinics have been set up within Brent and Ealing for those who missed their vaccinations in school. Hillingdon children have been accessing existing catch up clinics in Hillingdon.

Activity

Brent:

• 69 school visits.

• 5,228 individual contacts with young people.

• 13 contacts with young people at 3 catch-up clinics.

Ealing:



• 70 contacts with young people at 3 catch-up clinics.

Hillingdon:




• This newly commissioned service was set up in November 2015 for Brent and Ealing schools.

• Termly catch up clinics in Brent and Ealing have been set up for young people who have not received their vaccinations in school; and for those children who are not currently accessing mainstream education.

Plans for 2016-17

• The team will be focusing on Brent and Ealing secondary school age immunisations from September 2016.

• The existing school nursing service in Hillingdon will be undertaking vaccination sessions in Hillingdon schools.

• The team are planning to provide education assemblies for young people (commonly provided in Hillingdon) in Brent and Ealing; giving information on the vaccinations they are due to receive in order to improve the uptake.

• The team is planning to set up a new immunisation catch-up clinic more centrally in Ealing, taking into account the views of parents and children attending the current clinics and feedback from the commissioner.


Immunisation Task Force

Summary of service

The Immunisation Task Force offers a catch up childhood immunisation service to babies and young people, more than 12 weeks behind with immunisation. A one-day Fundamentals of Immunisation training is delivered to all new nurses giving immunisations and to practice nursing, twice yearly.

A half-day Fundamentals of Immunisation catch up training is delivered to all nurses giving immunisations, to update their knowledge of immunisations, also twice-yearly.

Activity

2,371 referrals received and 3,255 contacts achieved.

Three catch up clinics a month are offered across Hillingdon at the Minet, Uxbridge and Eastcote Health Centres. An average of 20 patients per clinic attend monthly. On average, 25 immunisations are given per clinic.

Two monthly clinics for unaccompanied asylum seekers are run at residential homes, where an average of six young people are seen and 18 immunisations given monthly.

Home visits are offered for those families who are unable to attend clinic and have been referred through routes including GPs, social services, the LAC and HV service.


The team hosted a series of catch up clinics at the end of each month for young people who missed the MenACWY and HPV Vaccine at school.

Plans for 2016-17

The team plans to target semi-independent accommodation for looked after young people and offer them an immunisation catch up service.

28

Hillingdon Tuberculosis(TB) Nursing Service

Summary of service

The Hillingdon Tuberculosis (TB) Nursing service provides tuberculosis prevention, control and treatment in patients’ home and community settings. The service aims to prevent, control and treat TB across Hillingdon.

The team comprises three specialist nurses, who work in partnership with the Respiratory Team at the Hillingdon Hospital, attending and reviewing patients in clinic.

The service primarily provides case management, outbreak management, treatment and community support, including:

• Supporting patients with TB and their partners and families in a community setting, offering health promotion advice and treatment

• Following up patients during treatment for medicine adherence (including directly observing therapy), side effects, symptoms, and drug interactions. The team sees patients in their own homes and at other locations as appropriate, this is to help with coherence of their medication regimes and to offer support as required

• Contact screening from active TB cases, to check for latent or active TB.

The service also provides ad hoc health screenings, one of which is conducted annually at a temporary homeless shelter in Hayes.

The service provides assistance with the BCG programme in Hillingdon for babies alongside school nurses.

Activity

In 2015 the team had 79 active TB cases in Hillingdon (equating to 33.1 people per 100,000 population) as well as a number of latent TB cases. 99 new referrals were received in year and 2,343 contacts were achieved.

The service completes on average 140 patient visits each month.


• The service is the Clinical Project Lead for the ‘Latent TB Testing and Treatment for Migrants’ initiative, in conjunction with Hillingdon CCG and Public Health England.

• The service has attended community health promotion events to raise awareness of TB and the services available.

Plans for 2016-17

• Preparing to offer health promotion sessions at Heathrow Airport following a case of smear-positive TB in an airport worker.

• The service has been invited to give a live radio interview as part of live broadcast to include a focus around TB. This is for a new radio station called ‘Voice of Islam’ on their ‘Drive Time Show’ which covers current affairs and health topics. The script for this show covers education on the signs and symptoms of TB, its treatment and prevention, and how to reduce risk of contracting the disease.


Hillingdon adult servicesDistrict Nursing and Community Matrons Service

Summary of service

District Nursing services support housebound patients, by providing nursing care in their own homes. Services work in partnership with specialist community nursing and therapy services, patients, carers, GPs and other social care teams to provide high-quality nursing care and advice. The service offers professional advice, support, teaching and skilled nursing care to enable people with an acute or chronic illness or disability and who have a nursing need to live as independently. District nurses assess the healthcare needs of patients and families, monitor the quality of care that they receive and are professionally accountable for delivery of care. District Nurses also provide an Ambulant Wound Clinic linked with GP referrals at designated sites throughout the borough. Community matrons provide proactive management of long-term conditions, enabling and educating patients to help them live with and manage their disease. They develop tailored packages of nursing care and work to keep hospital admissions or readmissions to a minimum.

The Service has five main functions:

1. Clinical: community matrons have advanced nursing assessment skills and knowledge in managing long-term conditions

2. Care Co-ordination: the service help co-ordinate the patients’ care centrally

3. Communication: the service provides timely and on-going communication with the patient, their GP and their family

4. Coach: community matrons empower the patient to self-care and help them to understand their conditions

5. Care Champions: the service helps patients to plan and achieve their care preferences and goals, and teach family members how to give care to their relatives.

Activity

District nursing received 24,751 referrals and achieved 192,820 contacts in-year. The Ambulant Wound Care clinic received 247 referrals with 4,347 contacts in year. The community matrons received 649 referrals and had 6,848 contacts.

30


• A community matron and a senior community staff nurse were seconded to lead the ‘Care Connection Team’ pilots in the north of the borough. This is part of the Whole Systems Integrated Care programme being driven by the CCG.

• Improved integrated working with other services such as Tissue Viability and Palliative Care.

Plans for 2016-17

Planned changes / service improvements:

• New IT project to incorporate mobile working, allowing community nursing to access patient records at any site or location

• Review of the service as part of a three-year QIPP Programme for community services

• Working to support the End of Life Strategy, by being an active member of the End of Life Forum.


Hillingdon Twilight Service

Summary of service

Twilight is an out-of-hours District Nursing Service. The service visits people across the borough of Hillingdon who have a Hillingdon GP.

The service runs seven days a week between 16:30 and 00:30 and also responds to SOS calls such as palliative care, blocked catheters or wound issues.

Activity


Plans for 2016-17

The Twilight Service is planning to perform a specific patient satisfaction audit.

Twilight will also undertake an audit to establish the number of patients seen, who have a blocked catheter, that require a prescription for bladder maintenance fluid.

32

Rapid Response

Summary of service

Rapid Response is a multidisciplinary team aiming to prevent hospital admissions across Hillingdon. The team accepts referrals from the Ambulance Service, A&E, the Hillingdon Urgent Care Centre, the Clinical Decision Unit, the Acute Medical Unit, care homes and specialist nurses. The team responds within two hours of referral.

Rapid Response also provides early supported discharge service to support the Home Safe Team at Hillingdon Hospital. The team in-reaches to Hillingdon Hospital, supporting early discharge for people admitted under 24 hours.

Rapid Response also offers a non-urgent phlebotomy service, provides community intravenous antibiotics via the ambulatory care pathway and provides access to nightsitting. The service includes experienced clinicians who have developed overlapping skills, registered Mental Health Nurses and, through them, access to the Hillingdon Home Treatment Mental Health Team.

Activity

The service received 7,124 referrals, with 29,342 appointments or visits made over the course of the year. Of these, Rapid Response had 3,621 referrals and 23,669 contacts; Phlebotomy had 3,426 referrals and 4,690 contacts, and Rapid Response IV had 77 referrals and 983 contacts.

A recent peer review rated the service as ‘Outstanding’ in responsiveness and ‘Good’ overall.


• Expansion of the Home Safe partnership with Hillingdon Hospital: following a trusted assessment by a Consultant Geriatrician, Rapid Response to provide treatment and care in the community to facilitate early discharge

• Access to Rapid Access Clinic, a Consultant Geriatrician-led clinic run twice a week

Plans for 2016-17

The team is considering new referral pathways:

• Trusted assessment and referrals from Ealing Rapid Response Team

• COPD outreach joint working

• Referrals from Fracture Liaison Nurse

• Potential pathways from Ambulatory Care


Community Cardiac Service

Summary of service

The Community Cardiac Service has two elements: Cardiac Rehabilitation and Heart Failure. These consist of specialist nurses and a specialist physiotherapist, clinically supported by a consultant cardiologist.

The Cardiac Rehabilitation team provides specialist nursing and specialist physiotherapy exercise advice in the management of adult patients who have suffered MI, ACS, have undergone valve surgery or CABG.

The Heart Failure services manage and treat heart failure for Hillingdon residents in community and clinic settings.

The objectives are:

• Empowering self-management via health education and health promotion

• Engaging patients and their carers in decisions about the care options available to them, including the development of individual care plans and long-term management plans

• Optimisation of evidence based therapies

• Hospital admission avoidance and reduce use of GP time

• Provide a point of escalation for patients with deteriorating disease in services including access to palliative care

• Working in collaboration with secondary care trusts and other agencies.

Activity

• The Community Cardiac Service performance activity exceeded target by 35%

• Two week wait times were met for the year

• The targets for number of admissions prevented (28) and number of saved GP visits (25) has been met and exceeded year to date

• Cardiac Rehabilitation received 117 referrals and had 1,065 appointments and visits. Heart Failure nursing received 124 referrals and undertook 2,914 appointments and visits.

34


• Addressing data issues has enabled the team to better track its performance

• Purchase of an ECG machine has enabled cardiac nurses to take ECGs as part of their service

• Arrangements are in place for cardiac nurses to receive supervision from a Hillingdon Hospital cardiologist to ensure they receive the appropriate clinical support and advice

• Community cardiac rehab classes have commenced, with up to eight patients attending weekly

• One of the cardiac nurses successfully completed an adults physical assessment course

• New investment for cardiac service was agreed by commissioner, resulting in the successful recruitment of 2.4 clinical staff to enhance the service

Plans for 2016-17

• A new integrated cardiac service to be launched

• The Service will develop new leaflets and presentations will be given about the new cardiac service at GP network meetings to improve skill base within primary care and to promote the service

• More nursing students to undertake placements within the service


Community Adult Rehabilitation Service (CARS)

Summary of service

This multi-disciplinary service provides therapy for patients who are housebound and are unable to attend an outpatient department without the assistance of transport. The service also provides a Parkinson’s nurse-led clinic and a physiotherapy-led clinic for those patients who are mobile.

Patients seen in the community are predominately elderly and have a variety of short and long term conditions. The service aims to achieve and deliver a holistic and multi-disciplinary approach to patient care. This includes improving mobility and functional independence, neurological and general rehabilitation, ensuring adequacy of nutritional needs, improving and monitoring swallow and communication, medication management and an assessment of social and psychological needs.

• Specific individually-tailored rehabilitation action plans are provided to patients in their home environment to improve their overall health and quality of life, prevent deterioration and avoid unnecessary hospital admission

• The service consists of physiotherapists, occupational therapists, dieticians, speech and language therapists, therapy technicians, rehabilitation support workers and a Parkinson’s disease nurse specialist

• All patients are continuously reassessed and once the patient has reached their jointly set goals they are discharged from the service. Once a patient is discharged, their GP is sent a full discharge summary and the patient is informed how to contact the service directly in the future. The patient may also be referred on to other services such as district nursing, rapid response, community matrons, social services, voluntary services, wheelchair and orthotic services

Activity

• Number of referrals received: 7,126

• Number of patients seen: 4,272

• Number of contacts: 32,410

• Patients discharged home through falls assisted discharge pathway increased from eight to 15 per week

36


In 2015/16, the service introduced the following changes:

• Expansion of Parkinson’s nurse-led clinic to the north of the borough

• Non-weight bearing pathway introduced

• Began offering a substantive seven-day service in falls assisted discharge and the Hawthorn Intermediate Care Unit

• Offered clinical supervision to an Age UK physiotherapist

• Integrated working with older adult mental health service to provide physiotherapy input to Oak Tree Ward

• Extended falls clinic support from three to four clinics per month.

Plans for 2016/17

In 2016/17, the CARS aims to:

• Extend the physiotherapy provision for Cardiac Rehabilitation from a three to a five day service

• Provide falls prevention and management training to Hillingdon care home staff

• Become paperless by end of the year

• Achieve 100% compliance on all stroke and falls KPIs

• Patient involvement in goal setting, reviews and discharge planning

• Explore the possibility of providing physiotherapy input to patients on the Riverside Mental Health Unit


Hillingdon Community Diabetes Service

Summary of service

The Hillingdon Community Diabetes Service consists of diabetes specialist nurses (DSN), a dietician, a GP with specialist interest and consultant input. The service sees patients throughout Hillingdon both in clinics and at home. The service works closely with services including podiatry and district nursing, Hillingdon Hospital, psychological support services and other secondary care providers.

The aim of the service is to support those with diabetes (both Type 1 and Type 2), as well as their carers, to help people with diabetes to manage their own condition wherever possible, get good control of their diabetes and so reduce the risk of complications.

The patient is always at the centre of their care and no decision is made without their agreement.

The service provides:

• DESMOND education package for newly-diagnosed patients with diabetes

• Education in diabetes to Primary Care including running Topical 1 and Topical 2 courses as well as a selection of half day updates.

Activity

The service received 1,878 referrals, with 11,049 contacts made over the course of the year.

This was a mixture of home visits and clinic patients, including patients who have problems with their diabetes e.g. recurrent hypoglycaemia or complications of diabetes.

A patient survey showed patients were either happy or very happy with the care from the service.

The service has also developed consultant clinics so that patients do not need to go to hospital for their care.


In December 2015 Hillingdon CCG commissioned CNWL to develop a fully-integrated diabetes service as lead provider working with the local acute provider.

The aim is that only patients in the ‘Super Six’ category i.e. Type 1 diabetes (new and Dafne referrals), paediatrics, pumps, pregnancy, renal and foot problems will be seen in the acute hospital. All other patients with diabetes will be managed in a community setting

Plans for 2016/17

To work with partners in primary and secondary care to implement the newly-commissioned integrated diabetes service. This service will work closely with GPs and practice nurses doing virtual clinics, as well as seeing patients with our primary care colleagues.

The service will recruit additional DSNs as well as a consultant and dietician, and increase the number of satellite DSN-led clinics to include Northwood, so patients do not have to travel far to be seen.

38

Hillingdon Adult Bladder and Bowel Service

Summary of service

This is a team of nurse specialists in the field of bladder and bowel dysfunction, offering advice and support for adults aged 18 and over. The team offers clinics around the borough and for housebound patients with complex needs, is able to offer domiciliary visits.

Following a full assessment of symptoms, which includes a bladder scan, urinalysis and pelvic floor assessment, the service offers:

• Lifestyle advice – diet, fluids, weight loss

• Bladder re-training

• Pelvic floor muscle assessment

• Teaching of pelvic floor exercises

• Anal sphincter exercises

• Bowel management/rectal irrigation

• Teaching of intermittent self-catheterisation and indwelling catheters.

If patients do not respond to these treatments, CNWL also offers a home delivery pad service for patients that require more than three pads per day.

Activity

In 2015/2016, the service had a target to see 1,561 patients – this was exceeded by 17%.

Referrals received: 1,591

Total activity: 4,073

The service performs a patient satisfaction audit every year with very positive responses.


The service created a catheter consent form for patients with indwelling catheters. This will be a poster presentation at a national conference and has been entered for three Nursing Times Awards categories.

Plans for 2016/17

The service aims to create Trust-wide bowel management and male lower urinary tract symptoms policies.


Adult Speech and Language Therapy

Summary of service

This service aims to provide accessible comprehensive assessment of communication and swallowing disorders and appropriate therapeutic interventions in patients aged sixteen years and over. The caseload includes stroke patients, those with progressive neurological disease, patients with head and neck cancer and those with pathological and functional voice disorders. Patients are assessed within a five week timeframe and initial treatment plan is setup or discharged appropriately.

The service is provided on an outpatient basis at Mount Vernon Hospital in the north of the borough and at the Warren Health Centre in the south of the borough. There is also SLT input given to cancer patients on Wards 10, 11 and Marie Curie wards at Mount Vernon Hospital. Inpatients on Hawthorn Intermediate Care Unit and Oaktree Ward are also seen by the service. There is a domiciliary/community service that sits within the Community Adult Rehab Service to provide input to patients with poor mobility who cannot access outpatient services.

Specific individually tailored rehabilitation action plans are provided to patients in their home environment to improve their overall health and quality of life, prevent deterioration and avoid unnecessary hospital admission. For SLT this centres around identifying the risk of aspiration and setting up a management plan for that patient. All patients are continuously reassessed and once the patient has reached their jointly set goals they are discharged from the service.

Once a patient is discharged, their GP is sent a full discharge summary and the patient is informed how to contact the service directly in the future. Patients may also be onward referred to services including district nursing, rapid response, community matrons, social services, voluntary services, Palliative Care Team and community rehabilitation services.

Activity

Referrals received: 328

Number of contacts: 4,783

40


• Review of skill mix which resulted in change at leadership level and to have Band 7 clinical area leads, covering head and neck cancer, dysphagia, voice and ENT and acquired disorders of communication

• Recruitment of more junior staff to have generic roles across all clinical areas in order to develop skills and experience in house and provide a more consistent level of service across the team and improve recruitment in the future

• Reduction of the number of sites the staffs are working from to improve better team working/skill mix and peer support

• Review of best practice guidelines for video fluoroscopy swallow study assessment

• Introduction of Therapy Outcome Measures to evaluate the effectiveness of SLT provided to patient groups and help bench mark our service against others

Plans for 2016/17

• Develop newly-recruited junior staff to become fully independent in management of dysphagia

• Become paperless by end of the year

• Achieve 100% compliance on all stroke KPIs

• Improved patient satisfaction

• Evaluate the use of Therapy Outcome Measures to ensure that this is a viable and effective tool for the SLT services provided in Hillingdon

• Patient involvement in goal setting, reviews and discharge planning

• Possibility of providing SLT input to patients on Riverside Mental Health Unit


Hillingdon Musculoskeletal Physiotherapy Service

Summary of service

The Musculoskeletal Physiotherapy Service (MSK) provides musculoskeletal physiotherapy rehabilitation which specialises in solving, preventing, or ameliorating problems of movement, mobility, fitness, strength and stiffness. The aim of this intervention is to facilitate the patient’s recovery according to their individual functional potential.

Essential components of the service include:

• Clinical assessment based on the principles of musculoskeletal physiotherapy to ascertain the patient’s suitability for physiotherapy and physiotherapeutic diagnosis.

• Development of a plan of care based on the assessment findings including patient-centred goals.

Clinics are situated in seven community locations across Hillingdon that are easily accessible for patients. The service offers a single point of access booking system, which allows patients to be seen quickly at the clinic that is most convenient for their home or work situation.

Activity

Number of referrals received: 14,754

Number of contacts made: 42,214


• The service has identified specialisms (for example, women’s health) within the staff base to enable GPs to access the most appropriate person for advice regarding referrals

• A pilot pathway for referral from MSK Physiotherapy to MSK CATs service has been established.

Plans for 2016/17

• Introduction of combined physiotherapy and podiatry gait assessment clinic

• Working toward electronic records as main patient record instead of paper-based system

• Clinical audit: tendinopathy, sse of NICE LBP guidelines, patient satisfaction, OA knee

• Service-specific patient satisfaction audit planned for 2016.

42

Hillingdon Podiatry

Summary of service

The purpose of the podiatry service is to improve the health and wellbeing of the population of Hillingdon by managing and treating a wide range of foot and foot-related pathologies. The service delivers care from a number of health centres, specialist units at Hillingdon Hospital and Mount Vernon for patients with diabetes and other complex complications. The service also treats patients within their homes where patients are housebound.

The podiatry service provides assessment and treatment for foot and/or foot-related problems with an emphasis on prevention and self-management of these problems. The main aim of the service is to maintain tissue viability, improve foot function and patient mobility – services on offer include:

• Curative, preventative and long term management treatment of corns and callus

• Curative and preventative treatment of ulceration

• Preventative treatment of complications of diabetes

• Palliative and preventative treatment of abnormalities as a result of arthritic conditions

• Surgical correction of ingrown toenails

• Orthotics management of biomechanical/musculoskeletal abnormalities

• Nail care for patients with moderate or high risk conditions for whom it would be unsafe or who are not able to carry out their own nail care.

Activity

• Referrals received: 3,067

• Total contacts: 28,381

• 78% of patients rated the service as ‘Excellent’ or ‘Very Good’. Only 1% rated as ‘Average’ and there was no score lower than that. 99% of our patients would recommend our service to friends and family, and 98% that the service received had helped.

• Waiting time target of 12 weeks achieved at 99%.



• New referral pathways which have been developed based on NICE guidelines for diabetic patients depending on their clinical ‘risk’. This enables diabetes patients, especially with the high risk feet and active foot disease such as ulceration, to access care with the right skills. The pathways have also improved integration of patients between community and the acute sites and more prompt access to multi-disciplinary care.

• The step-up step-down clinics continue to work well and patients have been reassigned to the correct tier according to their needs

• The service is also continuing with redefining the risk categorisation of non- diabetes patients’ foot needs. This will be undertaken for existing patients within the service and new patients. This will enable the service to become more responsive to patient need and inform capacity planning of the service

• Governance has been strengthened with regular supervision of all staff and in-house clinical peer review

• Reduction in DNA has been a target and this has been achieved with Hillingdon Podiatry now below the national average 6%.

Plans for 2016/17

• Focusing on ensuring that patients are assessed based on ‘Clinical needs-based risk assessment of the foot’ taking into account the patient’s foot problem and underlying medical condition

• Redesigning the referral form so that referrals to the service are made easily and that the necessary information is provided to enable appropriate triage

• Planned work looking at the MSK patient caseload and the possibility of joint clinics with the MSK Physiotherapy department in order to reduce waiting times, together with looking at ‘off the shelf’ orthotics which will improve the patient pathway meaning patients will only need to attend one clinic.

44

Tissue Viability

Summary of service

The tissue viability service provides a specialist complex wound service for patients registered with a Hillingdon GP who have a complex tissue viability problem or a non-healing deteriorating wound.

The service provides specialist input, undertaking full assessment of patients and then outlining a programme of care and treatment pathway together with the patient, healthcare professional and GP. The specialist team undertakes a full assessment, outlining a care programme with the patient and multidisciplinary team and suggest a treatment pathway. The service provides specialist support to facilitate healthcare professionals to deliver the appropriate management of care.

The majority of patients seen by the service will have leg ulcers and pressure ulcers. The service provides specialist nurse wound care assessment, which can involve a Doppler assessment for leg ulcer management and treatments, and pressure ulcer risk assessment and treatment. The team also offers treatments for patients with burns, and surgical procedures for non-healing wounds or similar problems related to skin integrity, such as venous eczema and varicose veins, or chronic lower leg oedema.

The service is provided in the community, in patients’ homes (including nursing homes) and in clinics by qualified nurses with specialist education and experience. For patients who are housebound, nurses will visit with community staff.

The service also provides an ongoing comprehensive education programme based on evidence and expert opinion for community and primary healthcare professionals, on all aspects of wound management.


Activity

The service received 507 referrals with 3,680 visits and appointments made over the course of the year.

52% of patients stated pain reduction as one objective on first appointment and 56% patients stated pain reduction was achieved at four weeks appointment

65% patients mentioned ‘having privacy’ as one objective on first appointment and 76% confirmed that was achieved at four weeks appointment

91% patients mentioned appropriate hand washing was important for infection prevention on first appointment and 92% confirmed that was achieved on four weeks appointment

The service has exceeded the 60% target for venous leg ulcer healing rate which is measured quarterly

January 2016: 100% simple venous leg ulcers shall be healed within 18 weeks 67% complex venous leg ulcers shall be healed within 24 weeks


• Introduction of SSKIN bundle to increase awareness of pressure ulcer and focus on prevention

Plans for 2016/17

• Introducing VAC therapy in the community to reduce length of stay in hospital and ensuring patient is cared for closer to home

• Working closely with nursing homes to prevent pressure ulcer and make referrals earlier to ensure good practice and preventing harm to patients

• Working with mental health colleagues to standardise care in wound assessment and management using local Trust formulary

• Provide training sessions on pressure ulcer prevention and management to all AHPs to raise awareness on the subject and encourage early action for prevention

• Provide training to care homes on pressure ulcer care to raise awareness on prevention and reduce harm to service users.

46

Hillingdon Centre for Independent Living (HCIL)

Summary of service

The service offers independent advice and support to people who experience difficulties with daily living. There is an extensive range of equipment items on display, which enables self-funding patients to see if the items meet their needs before purchasing them (HCIL does not itself sell items).

Following an assessment and if the criteria is met, the provision of essential aids for patient’s homes, such as toilet and bathing equipment, grab rails and furniture raisers will be issued.

At HCIL there is access to wheelchair accessible scales for people who are not able to stand. This is invaluable, not just to wheelchair users who are concerned about weight gain, but for people who may be PEG fed when they or their carers are not sure if they may be losing weight.

HCIL provide wheelchair courses for carers and Age UK Hillingdon staff and volunteers.

There is a user group which meets four times a year, to share information and experiences and to suggest improvements to services.

The team works closely with staff in Hillingdon Community Health, social services and local voluntary organisations to gain knowledge and provide the best possible service for our clients.

Activity

Referrals: 376

Contacts: 904

537 items of equipment were ordered for clients

59 people attended the weighing clinic

6 wheelchair courses were run for carers

Our 2015/2016 patient satisfaction survey showed that 95% of clients who received the service scored four or above (out of five) to the questions, ‘Were staff helpful?’, ‘Were you treated with dignity and respect?’ and ‘How satisfied were you with the information and service given?’

Comments included: ‘Staff were very caring and helpful and listened to my needs. They were able to recommend products and give advice and went out of their way to provide an excellent service.’



In November 2015 management responsibilities for the service transferred to the Community Adult Rehabilitation Team.

Plans for 2016/17

• The service plans to expand the items on display for demonstration, to reflect the nature of enquires being received

• HCIL plans to take referrals from Hillingdon social services caseload to help decrease their waiting list for occupational therapy assessments

48

Specialist Palliative Care Service

Summary of service

This service provides specialist palliative care to patients registered with a Hillingdon GP. Patients are seen at home or in a care home setting such as a nursing home or residential home.

The SPC team provides care for patients with complex needs who are approaching the end of life. It provides advice and support to patients and their family with regards to symptom management and psychological distress through regular face-to-face intervention.

The service also provides care indirectly by supporting, advising and guiding others involved in patient care such as GPs, district nurses and care home staff. The service offers ongoing, experiential learning for colleagues involved in end of life care as well as formal education.

The service engages in the core end of life planning through multidisciplinary team meetings with GPs, district nurses, nursing home staff, hospital staff and hospice staff.

Activity

Number of new referrals: 810

Total contacts: 5,597

The referral rate over a four year period has increased by 15%


• More collaborative working with district nursing colleagues through joint visits and experiential learning

• Attendance at the End of Life Forum to discuss the end of life strategy for Hillingdon. This forum is attended by health providers, social care, and third sector to discuss and agree how to provide end of life care in Hillingdon collaboratively. This has led to better collaborative working with key partners, with issues raised at the forum with key partners, and solutions worked through.

Plans for 2016/17

• Palliative care across the division will be line managed by one palliative care lead

• As part of the end of life strategy, CNWL is supporting the CCG to develop a 24-hour community nursing service to bridge the gap between 00:30 and 08:00am. Some of the proposed changes may include a seven-day palliative care service, and provision of a single point of access for palliative care with a clinical nurse specialist available to take relevant calls.

• Social finance initiative – this is a project to bid for funds of approximately £1.5m. This bid is led by the CCG, and if successful, may lead to commissioning of CNWL to providing 24-hour community nursing for palliative care.


Hillingdon inpatient servicesHawthorn Intermediate Care Unit

Summary of service

Hawthorn Intermediate Care Unit (HICU) is a twenty two bedded inpatient facility operated and managed by CNWL. The unit is located on the Hillingdon Hospital site, within CNWL’s Woodlands Centre.

It is a nurse-led service, offering a multi-disciplinary team approach to the provision of rehabilitation services, including the input from physiotherapy seven-days-a-week, pharmacy, activities co-ordinator and occupational therapy. Patients are assessed promptly on admission and rehabilitation is delivered through this multidisciplinary team.

The service works closely with acute hospitals, community service, local authority and voluntary service. Some of the benefits of this approach are:

• Patients are familiar with staff

• Discharges are well planned and facilitated

• Rapid response refers patients directly into the service.

The environment enables the team to manage beds in a flexible manner to ensure the health needs of the local population are met and to improve the overall occupancy of the unit.

Activity

• 178 new referrals received in year

• HICU met target of 86% for bed occupancy in 2015/16: average for the year was 88%

• Patient Satisfaction Survey responses exceeded the target almost every month (these are completed when patients are discharged)


• The National Intermediate Care Audit identified HICU as above national average on most of the applicable fields

• The new community care SSKIN bundle (five step model for pressure ulcer prevention) has been introduced on the ward and all staff have received training to improve patient care and this is now being used for all patients

• HICU has introduced close working with the Age UK Take Home and Settle Service which is proving successful

• Nursing supervision has been reviewed and new clinical supervision tools and structures are in place

• Learning experiences at HICU for second and third year students have been reviewed and improved

• Piloted the introduction of a volunteer one morning a week to support the activities coordinator. The initial feedback has been positive and further use of volunteers is

50

currently being considered.

Plans for 2016/17

• Patient care plans to be reviewed and updated

• Develop a Carers Forum

• Explore options to expand devices available to reduce the risk of patient falls

• A member of the nursing team is due to complete her nurse prescriber course this will enhance the skill mix on the unit

• Embed patient self-medication regime as part of the patient’s care

• The occupational therapist and activities coordinator will work jointly to deliver an enhanced rehabilitation programme.

Central and North West London NHS Foundation Trust Stephenson House, 75 Hampstead Road, London, NW1 2PL

www.cnwl.nhs.uk

servhil0577 hillingdon annual report 2015-16 · community paediatric nursing ... and have expanded...

Documents