Virgin Care West Lancashire Quality Account 2019/20 Services delivered in West Lancashire by Virgin Care Services Limited Contents

03 PART ONE Executive Summary Managing Director’s Introduction Clinical Director’s Introduction

08 PART TWO About Virgin Care Our colleague survey results How our colleagues can speak up Statements from CQC Safeguarding Statement Duty of Candour Statement About West Lancashire Priorities in 2019-20 Priorities in 2020-21 Audits we’ve taken part in Research Statement Learning from deaths Statement on the accuracy of our patient data NHS Staff Survey Overview of CQC inspections this year NHS Friends and Family Test

51 PART THREE Prescribed information Comments by co-ordinating Clinical Commissioning Group

55 APPENDICES 1: Glossary of terms

2 Part one Executive Summary A Quality Account is an annual report which providers of NHS healthcare services must publish about the quality of services they provide. This quality account covers the services provided by Virgin Care on behalf of NHS West Lancashire Clinical Commissioning Group in West Lancashire.

This document aims to demonstrate our commitment to providing the best quality services to local people and is an opportunity for us to take stock of what we’ve achieved and what we have planned for the coming year.

We’ve used the information we’ve presented here to analyse our performance and to set priorities for the coming year. To make sure they reflect the needs of the people who use our services, we’ve included people who use services and community representatives as well as commissioners and frontline colleagues in developing our priorities.

If you would like a hard copy of this document, or a copy in another language, or to provide feedback on this document, or to talk to someone about your experience of using our services please contact our Customer Services Team on 0300 303 9509 or by email: [email protected].

4 Managing Director’s Introduction We began providing these services in 2017 and we have worked hard since then to lay the foundations of the improvements we have made and are still to make during the remainder of the contract.

Over the past year I have been incredibly proud of the achievements we have made in West Lancashire in stabilising the local leadership team and developing a workforce plan to support our patient-facing colleagues. We have delivered significant transformation to increase the quality of the services to the population of West Lancashire.

Over the past 12 months, Virgin Care set the 3-year Quality Strategy to support delivery of the corporate strategy. Locally we have:

• Contributed to Striving for Better networks by working together as one organisation by connecting and sharing across professions and services to make sure we capture the best of everything • We continue to embed the Brilliant Basics strategy in West Lancashire by ensuring our data is accurate and up to date, implemented e-Rostering to ensure we have the right levels of staff and skill mix, have continued to build relationships with our recruitment team to ensure our workforce needs are met and worked with IT to ensure our colleagues have the right equipment to do their jobs effectively and efficiently • Over the past 12 months, we have worked extremely hard to embed a culture that enables our leaders to lead and our colleagues to develop. We have continued with our monthly leadership forums, commenced monthly choc and chat sessions with members of our Senior Leadership team, ran an in house Senior Development Management programme for band 6 and 7 clinicians and successfully seconded three District Nurses to undertake their Specialist Practitioner Qualification course

I am also incredibly proud of the outcomes of our CQC inspections both within our Urgent Treatment Centre and Walk in Centre in Skelmersdale that received good ratings with some outstanding achievements in certain domains.

Over the next 12 months we will continue our work on the transformation programme we set when we were first selected to deliver these services. This will include delivering mobile working technology to all peripatetic workers, introducing online consultations, introduction of assistive technology where appropriate, introducing an appointment-only system in our urgent treatment centre and developing our one workforce model working collaboratively with colleagues in Primary Care, further development of our multi-disciplinary teams and working in partnership with local Primary Care Network colleagues.

I would like to thank our colleagues who have demonstrated in this document the work we’ve done and for the work they will do over the coming year.

In putting together this publication we have sought feedback from colleagues and people who use services and I would like to take this opportunity to thank them for their input into the process.

5 I can confirm that, to the best of my knowledge, the data and information in parts two and three of this report reflects both success and the areas that we have identified for improvement over the next 12 months.

Michelle Lee Managing Director – Lancashire Virgin Care Services Limited

6 Clinical Director’s Introduction As Clinical Director for Virgin Care I am responsible for ensuring that the care we provide is safe, of a high quality and continuously improving and over the past year I am pleased that we have continued to make such a wide range of improvements for our patients, not just in their experience but also in continuing to improve the safety and quality of our services.

We achieve continuous improvement by having a well-defined and working clinical governance system in place. This means that we have strong clinical leaders working in partnership with managers and holding clear responsibilities, processes and systems to ensure we operate safely and that we monitor the quality of care delivered to our patients.

I would like to thank members of my Clinical Directorate, the local Clinical and Quality Leads and the Heads of Services for their involvement in providing the information which makes up this report. It contains many examples which show how we place an emphasis on quality and safe care and react to patient and customer feedback.

We continue to work closely with our partners, the Care Quality Commission (CQC) and other health organisations including the voluntary and faith sectors to demonstrate high standards.

We have further improvements planned for the next year, and I trust you will both enjoy reading this publication and provide us with your feedback on the changes we have planned.

Peter Taylor Clinical Director Virgin Care Limited

7 Part two About Virgin Care We partner with the NHS and local authorities to deliver publicly funded health and care services the Virgin way, so that we can invest in the communities we serve, make a positive difference to people’s lives and help secure publicly funded health and care for the future. We’ve been part of the NHS for more than a decade now, and many of our colleagues – both in our services and across the whole organisation – have always worked in the NHS.

Virgin Group has been investing in our partnerships with the NHS and local authorities since 2010, and since then the Virgin Group has invested £60m (and growing) in improving the quality of patient care and efficiency, allowing the NHS to serve more people and reduce reliance on hospital visits.

We’ve never generated a profit overall, and Sir Richard Branson has committed to re-investing any profit he could take out of the business in the future (over and above his investments) back into NHS and local authority services.

But that doesn’t mean we aren’t committed to delivering efficient services. Our experience is that well run services are financially efficient too, and during 2019-20 we estimate that we’ll have saved the commissioners more than £28m in real terms – that’s a saving of about 10%.

And that isn’t at the expense of quality, either - Virgin Care Services Limited and Virgin Care Limited are both rated ‘good’ by the CQC for community services they deliver, following inspections in 2017. And we’re constantly inspected – in fact, we’ve had more than 500 CQC inspections since 2013, and more than 90% of our rated services are ‘good’ or ‘outstanding’.

You’ll find more about our work in the next section of this document, but you can also find out more about our organisation at www.virgincare.co.uk.

9 Our leadership team

Dr Vivienne McVey

Samantha Kane

Peter Taylor

10 Key achievements during 2019-20

• Quality is at the heart of everything we do, from frontline health and care services through to providing high quality back office functions like finance and IT, as well as clinical governance. We’re proud that 94% of our rated services are rated ‘good’ or ‘outstanding’, compared with an average 82% ‘good’ or ‘outstanding’ ratings across NHS Community Services. Our in-house quality assurance systems have been commended by the CQC. • We’ve increased the volume of feedback we get from the people who use our services – we got 23% more feedback – and still maintained our positive scores of more than 93% of people rating our services saying they’d recommend them. We’ve also kept complaints low, and our approach to investigating and responding complaints means we focus on talking to people, face to face where we can, and putting things right. • We’ve continued to lead the way: in 2012 we were the first NHS provider to collect simple feedback in the way now known as the NHS Friends and Family Test; in 2014 we were the first to introduce a secure mobile working system which clinical systems access and in 2016 we were the first to implement a true Care Co-ordination Centre with clinical oversight. • We’ve begun delivering on the NHS Long Term Plan. This year, we implemented eRostering across all of our business using a tried-and-tested solution to achieve full compliance well ahead of the deadline the national plan sets. It’s already helped us save £2.2m on agency colleagues, meaning more money to invest in seeing more people or in our permanent teams. Our colleagues love the system, saying it makes annual leave and holiday fairer and effectively creates extra capacity by matching staffing to appointments. • Our third Care Co-ordination Centre has evolved the model, and while still delivering key advantages around the reduction of points of contact, we’ve also seen a massive 1,700 hours of administrative time saved each year. One of our centres, on average, answers around 50,000 calls a year from patients which would previously have been dealt with by individual service teams. • In our Primary Care services, we’re bucking the trend: complaints are down 76% despite an overall patient list growth of 35%, we’ve welcomed 13 new GPs to the team since 2018 and we have appointments available within 1.5 weeks compared to an average of more than 2 weeks across England. We’re not stopping there – we’re already looking at how we can use our Care Co-ordination Centre model in primary care to improve the experience for the people who use our GP services.

11 Our colleague survey results We run an annual colleague survey and a pulse check once a year to check progress against our action plans. In 2019-20, 67% of colleagues across England took part and we saw improvements again from colleagues based on data from previous years.

Our engagement score, calculated from a number of questions about how our colleagues find their experience of working with us, is at 71% - the highest it has ever been, and a 6% increase year-on-year. This compares favourably with the wider NHS, which in its most recent survey saw a decrease in colleague engagement.

Our experience shows that following a transfer from one employer to another, and the changes that brings, a dip in engagement follows. But those services we’ve run for a number of years, and where transformations are completed, show that scores jump higher than they were before we started work. Our longest running contract has an 85% score for colleague engagement – an amazing achievement which means happier colleagues, and happier service users.

Our most recent survey showed: • 77% of our colleagues feel they are part of a team committed to continuously improving (against 57% in the wider NHS) • 83% feel like they are part of a team doing quality work (NHS – 70%) • 95% of colleagues have had an appraisal within the last 12 months (NHS – 92%), and 65% (NHS – 21%) say they found that appraisal helped them do their job • 77% of our colleagues would recommend the service they provide to a friend or colleague if they needed treatment (NHS – 75%) • Despite increasing pressure from patient demand, 64% of our colleagues said they have put themselves under pressure to come into work (NHS – 93%).

We worked with a new partner this year – Motif – to make the survey easier to use, and clearer, as colleagues had told us they struggled to understand whether they were answering questions about the national executive team, or their local leadership team.

We also have an action plan in place to improve where colleagues told us we needed to do better or could refine our processes. As part of this, we’ve also put more emphasis on collectively planning improvements in individual teams as colleagues told us last year they didn’t feel and see improvements being made as a direct result of our colleague survey – although they did notice that things improved.

This year, as part of our new agreement, we’re also running a pulse survey in January to check in on progress and keep the focus on improvement.

12 How our colleagues can speak up Our Freedom to Speak Up policy sets out how our colleagues can raise concerns at a number of levels both anonymously and not.

That our colleagues can speak up about any concerns they have at work is really important, because it helps us to keep improving our services and the working environment. While colleagues might feel worried about raising a concern, our policy and our senior leadership team and board are all committed to an open and honest culture. Our policy reflects the recommendations of the review by Sir Robert Francis into whistleblowing in the NHS, and we have fully adopted the policy produced by NHS England and NHS Improvement) alongside all other NHS organisations.

Whenever a colleague raises a concern, they will always be listened to and they will always be supported. Concerns can be raised about risk, malpractice or wrongdoing.

Through Freedom to Speak Up, colleagues can raise concerns: • With their line manager, or another manager in their service • With a lead clinician or tutor • With any member of our Senior Leadership Team • With our Freedom to Speak Up Guardians, whose contact details are available on our Intranet • Through our anonymous online reporting system SpeakInConfidence • With one of three nominated members of the Executive Team • With our independent chairman, David Bennett

Colleagues can also directly contact our Senior Leadership Team and Executive Team at any time, whether they are raising a formal concern or an informal query.

13 Statements from CQC Some services we operate are required to register with the Care Quality Commission (CQC).

As part of this document, it can be confirmed that Virgin Care Services Limited is registered with the CQC and has no conditions attached to its registration. Virgin Care Services Limited’s services have not participated in any special reviews or investigations by the CQC during the reporting period.

Full copies of CQC reports are available on the CQC’s website at www.cqc.org.uk under Virgin Care Services Limited.

Safeguarding Statement We are committed to safeguarding and promoting the welfare of adults, children & young people and to protect them from the risks of harm.

To achieve this we have dedicated National and Local Safeguarding Adults and Children’s Leads and polices, guidance and practices which reflect statutory and national safeguarding requirements: • National Safeguarding Assurance function working across localities and partnership boundaries to respond to national developments, legislative changes leading to continuous improvement and learning across the organisation • Our Clinical Governance and Safeguarding Committees provide board assurance that our services meet statutory requirements • Named professionals are clear about their roles and have sufficient time and support to undertake them • Where appropriate, services have submitted a Section 11 Review report and/or Safeguarding Adult Self- Assessment audit tool • Action plans are monitored across the organisation at committee and board level • Safeguarding policies and systems for children and vulnerable adults at risk are up to date and robust • Safeguarding training is included in induction and integral to the organisation’s training policy

14 Duty of Candour Statement We are committed to being open and transparent with people who use services and, while considering confidentiality, their representatives too.

We encourage colleagues to be open and honest at all times but particularly when a notifiable safety incident has been recognised. Colleagues report incidents via our incident report system and follow our Duty of Candour policy. This ensures that a letter is sent to the service user to apologise for the incident as soon as is reasonably possible and certainly within 10 days of the incident occurring.

We investigate and establish the facts, and report externally as is required as well as having due regard to the relevant safeguarding policy and suitably trained colleague before any disclosures are made. Following the investigation, we’ll send another letter to the person who uses the service to advise them of the outcome, lessons learnt and how we’ll share lessons and knowledge to reduce the chance of the same kind of issue happening again. We may also offer a meeting.

15 About our services in West Lancashire Service type Brief description

West Lancashire West Lancashire Urgent Care Centre is located within West Health Centre- Lancashire Health Centre, Ormskirk and District General Hospital. Urgent Care Centre West Lancashire Health Centre in Ormskirk is an Urgent Treatment Centre which is open 8am to 8pm, 365 days of the year for people needing urgent care for minor illnesses or injuries. West Lancashire Health Centre can help with: • Cellulitis pathway • Sore throats • Ear problems • Coughs and colds • Chest infections • Cystitis and urinary infections • Skin rashes • DVT (blood clot in the leg – certain exclusion criteria apply) • Skin infections • Simple fractures / sprains • Insect and animal bites • Minor burns and scalds • Minor cuts and wounds • Emergency contraception • The centre cannot provide routine GP services such as chronic disease management e.g. diabetes, blood pressure monitoring etc. or routine referrals to consultant

Patients can also book appointments directly via 111 if appropriate.

Skelmersdale Walk in Skelmersdale Walk in Centre is located in The Concourse Shopping Centre Centre, and is open 8am to 8pm, 365 days a year for patients requiring same day care for minor illness and minor injuries. They can help with: • Sore throats • Ear problems • Coughs and colds • Chest infections • Cystitis and urinary infections • Skin rashes • Skin infections • Simple fractures / sprains • Insect and animal bites • Minor burns & scalds • Minor cuts and wounds • Emergency contraception • The centre cannot provide routine GP services such as chronic disease management e.g. diabetes, blood pressure monitoring etc. or routine referrals to consultant

17 There are no x-ray facilities on site and so they are unable to treat suspected fractures.

Patients can also book appointments directly via 111 if appropriate.

Vocare Out of Hours The Out of Hours Service is currently subcontracted by Virgin Care GP Service West Lancashire to Vocare Ltd.

Vocare LTD is based in West Lancs Health centre in Ormskirk and works closely with the Urgent Care staff at West Lancashire Health Centre. Vocare provides out of hours urgent care for West Lancs patients who access the service via 111. Patients will either receive telephone advice, an appointment to see a GP or nurse in West Lancs Health Centre, or at home visit depending on their symptoms.

Acute Visiting Service The Acute Visiting Service consists of an Advanced Nurse (AVS) Practitioner who can assess and treat patients in their own homes on the request of NWAS or GPs and also care homes. The AVS team supports with the reduction of admissions to hospital, A&E attendances and 999 emergency calls through a rapid response home visiting service. Calls to the service are either from NWAS paramedics who are attending a patient following a 999 call who feel that taking the patient to hospital can be avoided, or following a call from a patient to their GP practice requesting an urgent home visit for an acute medical problem. GPs are able to refer patients to the Acute Visiting Service (AVS) when they believe that delaying an urgent home visit might result in the patient going to A&E, calling 999 or being admitted by the GP to hospital.

Community The Community Rehabilitation Team consists of highly qualified Rehabilitation Team and experienced Physiotherapists and Occupational Therapists. They visit patients who are unable to access outpatient services and require therapy at home.

CERT (Community The team works with colleagues in Southport and Ormskirk Hospital Emergency Response NHS Trust (S&O), the Commissioning Support Unit and NHS West Team) Lancashire CCG to provide care to a number of discharged patients to specified assessment beds within a number of care homes. The Community Emergency Response Team (CERT) acts as trusted assessor and facilitates faster and safer discharges. The patients are then put on 28 day care pathway. The service assesses the patients and then ensures care is delivered in the most appropriate place which may be in the patient’s own home with additional support or in a care home, to support hospital discharge and flow.

The Intravenous Therapy Team is based within this team and offers IV therapy support to patients (including palliative care) who would have remained in hospital.

18 Short Intensive This service came into fruition in October 2019. The purpose of SISS Support Service is to support a whole system approach to unscheduled care which (SISS) aims to provide alternatives to attending A&E and subsequent admission through the provision a package of in-home support for up to 72 hours designed to stabilise the patient in their own home.

Community Matrons The Community Matrons support those patients identified at high risk of admission to hospital due to their presenting health needs, through close multi-disciplinary working with primary care, adult social care, mental health services, acute care and the third sector such as Age UK.

Specialist Services This team has a Continence Team, Tissue Viability Nurse, Heart Failure Nurses, Nurse-Led Diabetes Service, Dietetics, Speech and Language Therapy Services, Community Neurological Rehabilitation Team, Podiatry, Falls Prevention Service and Respiratory Team which includes Home Oxygen. The purpose of these teams is to provide care co-ordination for some of the most complex patients in West Lancashire and have a multi-disciplinary approach, working closely with primary and secondary care and the care home sector so the patient has a seamless service.

Care Co-ordination The CCH service is a progression of our Single Point of Access Hub (CCH) (SPA) which has built up over the past twelve months. It is located in Bickerstaffe House and consists of care co-ordinators, clinicians of the day including Community Matrons, District Nursing and Therapists. The CCH provides clinical triage of referrals to ensure that patients are seen by the right clinician at the right time with a strong focus on preventing the urgent need from becoming an emergency need, supporting admission avoidance and reducing unplanned contacts with primary care.

Community Nursing This service is based at Clayton House in Burscough. This is a 24 hour, Services 7 day a week service which treats the whole person by delivering evidence based care to housebound people within West Lancashire in order to avoid unnecessary hospital admissions and support people with complex needs in their own home. This includes end of life care, wound care, continence care and supporting people with long term conditions. The service also provides treatment room services in a number of different locations.

Podiatry Podiatry is a specialist area of health care which provides assessment and treatment of conditions affecting the foot. The team includes specialists who manage complex foot wounds, for example diabetes or circulatory problems.

Phlebotomy Blood Collection (Phlebotomy) is an appointment led service for patients aged 14 and above and is delivered both within the clinic and home settings.

19 Priorities in 2019-20 Virgin Care’s core objective is to be the best community-based provider of care in England, with its stated purpose being “everyone feels the difference.”

Each year, Virgin Care also identifies themes and goals for specific improvements to services. The below achievements reflect the work Virgin Care has completed against both its local objectives identified in last year’s Quality Account and the work towards Virgin Care’s overall objectives.

Priority 1: Ensuring service quality, safety and enhancing user experience: Providing excellent clinical outcomes, meeting and exceeding relevant standards and regulatory requirements.

Quality Strategy Quality is at the heart of everything we do in West Lancashire so it was important to us that we not only embed the National Quality Strategy but bring it alive locally so all of our colleagues understand the part they play in delivering the ambitious goals to: • Reduce harm • Improve care for our patients and service users • Deliver corporate and contractual objectives

Our West Lancashire Quality Strategy described: • Our commitment to participating in the Strive for Better Networks and actively promote wider engagement from teams to design change and improvements in practice. Michelle Lee, our West Lancashire Managing Director, chairs the Adult Community Network. • Opportunities for existing and aspiring leaders to enrol on leadership training and apprenticeships so that they are better developed and coached to drive improvement and take ownership of the quality within the teams. • Support and guidance at service level to ensure there is partnership working and joint accountability. A joint whole business unit quality and governance meeting which will feed up to the executive team and also down to the services and individual delivering the care. Performance dashboards continue to be developed and utilised across West Lancashire so that it is easier to report identify and manage risk, share learning and celebrate our success.

Striving for Better Networks The Striving for Better Networks were introduced in 2019 as part of our commitment to working together as one organisation by connecting professions and service areas to make sure we capture the best of everything. These networks don’t stand alone - they are part of the drive for quality that’s running through the organisation.

Examples of the networks include: • Community Adult Network • End of life Network • Safeguarding network • Pressure ulcer network • Allied health professional network

20 Friends and Family test We have continued to collate our FFT responses and in 19/20 we collected 2542 responses, an increase from previous years, of which 90% completed all five patient-reported experience measures. There is more detailed information in the section below.

Integrated Neighbourhood Teams / MDT working To proactively case manage patients who are at risk of admission to hospital or those that are identified as frequent flyers to our urgent care centres, our community services teams regularly attend and participate in neighbourhood MDTs with colleagues from primary care, social care, palliative care, mental health and voluntary sector organisations where possible.

Supported by our Head of Specialist Nursing and also the Respiratory Team within the Skelmersdale locality, working closely with GPs in Beacon Practice, population management continues for patients have a confirmed diagnosis of COPD and who also score high on the anxiety/depression spectrum. Working collaboratively and in partnership with Practice Nurses and IAPT Support staff (LSCFT), they have developed a joint clinic for this cohort of patients to improve outcomes.

Representation from Virgin Care continues as part of the Cardiac Collaborative Group which meets every six weeks and includes working closely with colleagues from WLCCG, Sefton CCG, S&O Mersey Care and Liverpool Heart and Chest Hospital (LHCH).

In addition to the above, our teams continue to attend and represent community services as follows: • Weekly system integration meetings – Director Level, Rep from WLCCG, S&F CCG, leads for social care • VSCL attendance at monthly MCPs • Continuing attendance at GSF meetings • CERT MDT occurs twice a week with Social Care • Weekly long-stay Tuesday meeting attended with Lancashire and South Cumbria Foundation Trust (LSCFT & Southport and Ormskirk S&O to review long-stay patients (admissions over 21 days). Virtual MDT follows this face to face meeting daily • Monthly adverse discharge meeting with S&O, Social Care, Sefton Social Care & CCG • Working with Practice Nurses regarding spirometry training and supporting the “hub” • Community Matrons continue to attend integrated neighbourhood meetings to represent health services in West Lancashire • Attendance at “cardiology collaborative” a system wide approach to support cardiac teams within the locality to support capacity • Weekly system integration meetings continuing • Support to NHSI and ECIST work programmes with system partners to improve patient flow across the locality

Mobile working We have continued to equip our colleagues with a sustainable mobile working solution, which has been a huge asset in helping us develop a high quality peripatetic workforce. As part of the continuous improvement process, we are consistently reviewing and amending templates to ensure ease for our users and a more efficient patient experience.

21 We are looking to implement mobile working champions within our District Nursing team initially with a view to rolling this out with the wider mobile working role out to other teams during year four. The roles of the champions are to support other colleagues in the service with implementing and embedding new ways of working and mobile working. As a wider organisation, our aim is to grow the champion network across other business units so our champions have the opportunity to share local challenges and solutions, as well as providing advice, support and guidance to each other.

Care Co-Ordination Hub Development The Care Co-ordination Hub (CCH) continues to be the route into all of our services. We have increased capacity of our care co-ordinators who are now all trained appropriately, have built a reliable referral management system, have undertaken work on our Directory of Services which is now shared with our urgent care colleagues and remain committed to supporting and signposting patients, carers and stakeholders efficiently and effectively as possible.

Our Care Co-ordination Hub continues to go from strength to strength. Over the past year we have: • Formalised our referral management process and referrals for all teams are now entered onto EMIS within two hours of being emailed to the Hub • Seen the NWAS pathway go live from January 2020 • Commenced weekend working for our care co-ordinators to support clinicians effectively • Provided Care Navigation training, attended by several of the team, to really understand the importance of their role and how they support West Lancashire patients, carers and others • Launched Clinician of the Day in the Hub • Launched Therapist of the Day in the Hub • Launched District Nurse of the Day in the Hub • Encouraged all clinicians, including AVS, Specialist Nurses, CERT and SISS, to work together to identify patients in crisis, effectively triaging and reducing potential risk of duplication ensuring the right care, at the right time from the right clinician • Supported a reduction in hospital admissions • Seen really positive results from AVS calls coming through CCH, using two clinical systems Emis and Adastra.

Introduction of the Non-Medical Prescribing (NMP) Forum We remain committed to ensuring the safety of patients, colleagues and the public through an integrated approach to Non-Medical Prescribing (NMP) and recognise the importance of implementing and maintaining effective NMP arrangements in order to underpin the organisation’s reputation and performance.

We introduced an internal NMP forum to further support our existing NMPs, this is held bi-monthly and its aim is to provide peer support, training, lessons learnt and shared learning in a confidential environment. It is led and chaired by our Head of Specialist Nursing, whose role is to ensure prescribing practice is audited, support the development and maintenance of continued professional development, maintain an up to date register of all Non-Medical Prescribers (a statutory requirement) and assist with recruitment and selection of Non-Medical Prescribers.

22 To aid the development of our junior nurses, we have enrolled colleagues on the appropriate V150 and V300 courses following discussion and identification during both mid-year and end of year appraisal conversations.

We have also, in the past year, increased our number of non-medical prescribers in our Urgent Treatment Centres from 10 to 14 which includes the recruitment of a Paediatric Paramedic Practitioner. This is mainly due to successful completion of V300 qualification and new recruits.

Introduction of safety huddles in District Nursing Work has been undertaken within the DN service to embed the daily safety huddle. This safety huddle principle has been advocated by the Queens Nursing Institute as best practice within community nursing. The huddle occurs around midday in each of the three localities and is led by the DN team leader. The purpose of the huddle is to ensure robust handover and escalation process for incidents, safeguarding concerns, clinical supervision of priority patients and assurance on allocation of visits.

Specialist Practitioner Qualification (SPQ) We know that our district nurses play a vital role in caring for patients, predominantly who are housebound and as part of our commitment to providing high quality services, during year three, we successfully sent three of our District Nurses to Edge Hill University to undertake their Specialist Practitioner Qualification (SPQ). This course offers an advanced level of training and specialist skills and knowledge to improve practice, aids career progression and ensures our DNs gain insight and skills to be able to lead teams effectively.

Yvonne Manning, District Nursing Team Leader for Hants Lane, was recognised for her outstanding contribution as a student while completing her Community Specialist Practitioner top-up degree at the University of Central Lancashire. The course offers a combination of theoretical teaching and supervised practice in community nursing, developing leadership skills and promoting enhanced patient care. The award, created by the Queen’s Nursing Institute, is offered to the top performing student of the district nursing programme in each university across the UK. As part of the award, Yvonne will have greater access to the QNI, for example through conferences and workshops.

Pressure ulcers Following the implementation of NHS Improvement Guidelines, we continue to enhance work undertaken to ensure that people who are at risk of pressure damage and other high risk wounds will have their care delivered in a way which consistently meets best practice guidance. The revised Virgin Care National policy for Pressure Ulcer Prevention and Management was published in December 2019 to support this process and has been implemented in West Lancashire. When we do not achieve the standard of care we strive for and care is not how we would like it to be and something goes wrong, we learn and share this learning to further improve pressure ulcer management. Harm free weekly panel meetings are established to facilitate this process.

23 End of life care We have continued to work in conjunction with or local hospice, community palliative care service, acute sector and commissioning colleagues to ensure colleagues have the most up to date training and information available to them to support users and families. Our colleagues have accessed CPD training in relation to end of life care via Queenscourt Hospice, and we have supported a colleague on an external course delivered by a Higher Education Institute (HEI).

Transforming Integrated Palliative Care. Our Striving for Better Networks arm of End of life care identified three priorities to focus upon, including a review and ratification of the Verification of Expected death policy.

As part of our year three outcome framework, an End of Life review was undertaken to look at pathways and identify any areas for improvement. The findings of this review were submitted to West Lancs CCG for consideration at the end of March 2020.

Catheter Passport This is national recommendation from NHSI to encourage a consistent approach in delivering evidence based catheter care. The Catheter Passport was introduced to West Lancashire during 2019/20.

IV Bisphosphonate Pathway Within West Lancashire we commenced the IV Bisphosphonate pathway for patients under the care of The Christie NHS foundation Trust. The adjuvant bisphosphonate service provides treatment for patients with early stages of breast cancer, who are post-menopausal. This can reduce the likelihood of developing bone cancer. Our community IV service now delivers clinics to support patients and deliver this treatment closer to home, for the duration of the 3 year programme of treatment.

Patients are invited to attend for a pre-treatment screening appointment, where all the relevant assessment and bloods are taken, with a follow up appointment for the administration of bisphosphonate (if clinically appropriate). The community IV team works closely with the team at The Christie regarding individual cases and will also signpost patients to additional support services as required e.g MacMillan Cancer Support

Urgent Care Patient Survey A patient survey was undertaken in September 2019, focusing on paediatric attendees, to enable WLCCG to gain an understanding of the number of attendances, reasons for attendance which will help shape and support development of their children’s strategy.

The results showed that Beacon Primary Care patients were the highest attendees at UTC with children (26.63%), followed by 20.13% of other, these being out of area patients whose GP’s are in Billinge, Haydock. Maghull, Formby, Southport to name a few.

24 Pulmonary Rehabilitation Our Pulmonary Rehabilitation Programme continued to run from the Youth Zone in Skelmersdale. This programme targets those patients who reside in Skelmersdale who have moderate to severe Chronic Obstructive Pulmonary Disease and who want to improve their quality of life. It was run over 16 sessions and a total of 84 patients were assessed and 15 patients completed the programme.

We have begun research on a new way to deliver PR in light of current COVID restrictions and also as a way for those who were unable to attend the full programme. An App/Web based programme called myCOPD would be suitable for 21/25 patients who were unable to start/complete the course.

We have tried a web-based programme but feedback from patients was not good. Therefore following more research, it has been agreed that when face to face classes begin again (we are aware that social distancing will be a factor in this) we are proposing a mix of face to face PR and use of the App.

Macmillan Cancer Information Support Service (MCISS) Colleagues from the Macmillan Cancer Information Support Service (MCISS) became part of Community Services, based at Clayton House, in October 2019. This service provides a community support and information service to all those affected by cancer and is a key strand in enhancing the health and wellbeing of patients living with and beyond cancer.

This team plays a vital role in supporting teams across community services, is part of MDTs across the locality and work closely with third sector organisations within West Lancashire.

Referral management and triage We have introduced rotational clinicians of the day to ensure referrals are triaged in a timely manner. A competent and appropriately skilled Band 6 or Band 7 clinician reviews the presenting clinical information to help assess the service required and the level of urgency, they then transfer any planned work back to the appropriate team/service to be managed and allocated within the Hub team and any urgent need identified will be scheduled directly into a team member’s diary (where possible) for that day so it can be downloaded onto the mobile device.

Therapy redesign In order to improve the quality of service provision within the therapy teams and with the exception of Community Neuro and SLT, the majority of patients referred to community therapy services are frail elderly or those with long term conditions who are house bound and cannot access outpatient rehab services. For referrers, it is sometimes difficult to distinguish which service to refer their patients to, which has led to multiple referrals to all of the rehab services for the same patient.

Therefore, as part of our visioning work with our therapy teams, led by the Head of Therapies, a service redesign commenced. It soon became evident that a trial period needed to be undertaken prior to full service redesign and, as a result, following a trial period in February 2020, a therapist of the day commenced in CCH in late March 2020, triaging all referrals to community rehab services with all urgent referrals seen on the same day (5 days a week, non-urgent referrals within 2 days.

25 The full redesign has provided capacity and skill mix to: • Provide clinical triage of all therapy referrals • Provide same day face-to-face triage of urgent referrals • Provide a more streamlined referral process (one referral to community therapy services) • Prevent therapy referrals from being placed on a waiting list / reduce risk of deterioration, loss of independence and crisis admission to hospital • Provide further service and colleague development to support MDT working/frailty pathway/long term condition management

We have funded a number of training opportunities for colleagues over the year within Therapies including: • V300 • Leg Ulcer Care and Management (supporting the shared care pathway with DNs) • Vascular Training • Foot Care Assistant Course • Current practice and developments of home enteral feeding • Head and Neck Cancer support (SALT) • Advancing Dysphagia conference

Podiatry We continue to partner with Age UK to provide a toe nail cutting service to patients across the locality. This year we have also provided Age UK colleagues with further training and development for them to expand their service resulting in a competent workforce on providing toe nail cutting to low risk diabetic patients. Pathways are constantly being developed for referral from podiatry to start with and then expand this to allow GP’s to refer directly into Age UK.

We continue to provide update training for GP practice nurses undertaking diabetic foot screening.

Following feedback from patients stating that they would like to have better access to follow up appointments, we started to look at how we can improve access for patients into the service. We visited a podiatry service in Rochdale which adapted a drop-in service for patients to access for treatment and not just emergencies. We had the opportunity to speak with services users in Rochdale who fed back that access was improved with the implementation of these drop-in clinics. We created a questionnaire that was sent to our patients to ask if this is something they would like in the West Lancs area. Due to COVID the results of this questionnaire have not yet been analysed.

Speech and Language Therapy (SALT) Our SALT team attend the care home forum to provide some training and advice to colleagues managing dysphagia within the care homes. To ensure colleagues received the information they needed, our SALT team sent out a questionnaire to all care home managers to ask them about their knowledge of dysphasia. This helped guide the presentation they presented at the care home forum. The presentation: • Provided a brief overview of our service • Explained dysphagia and its signs and symptoms • Described our role in dysphagia

26 • Provided advice and strategies on managing dysphagia • Discussed referrals to our service

Falls Champions We have provided three Falls Champion Workshops for care homes this year. These sessions included: • An introduction to the Falls Champion – a workshop about the many reasons why older people fall and how the factors inter-relate • Cognitive Decline and Meaningful Occupation – a workshop about how cognitive decline affects older adults and falls risk, with guidance and a video case study about strategies that may help residents and why

The topics chosen were in direct response to requests from the care homes.

The sessions have included themed group workshop tasks (which are facilitated by the session organisers) to draw in as much discussion from the participants about their own experiences (acknowledging the wealth of experience of the colleagues and encouraging confidence and peer learning).

Care Homes Training to care homes has been ongoing with updates on React to Red from our Tissue Viability Nurse, continence training has also been provided and Managing Dysphagia training took place in January 2020 by our Speech and Language Therapy Lead.

As part of our outcome framework, it was agreed that our Quality Lead work in collaboration with West Lancashire Clinical Commissioning Group (WLCCG) Quality Facilitator for Vulnerable Adults to discuss and agree the content of a Care Home Information Pack. As a result, a comprehensive amount of work has been undertaken to ensure that this information pack contained the right level and amount of content for use within all care homes across the locality.

Further collaboration was undertaken with representatives from care homes in order for them to be able to see the content of the information pack and to ensure that it met their needs. This information pack has also had input from several teams within Lancashire County Council and West Lancashire CCG Medicines Management team.

The Care Home Information Pack was sent to WLCCG’s Head of Service Redesign and the Quality Facilitator for Vulnerable Adults at the end of March 2020 for review and agreement.

Priority 2: Robust governance: fostering safeguarding and quality assurance processes which are standardised across the business.

Quality and governance We have aligned our internal quality and governance structure to reflect the National Quality Strategy. Quality and Governance meetings are held at service level jointly across both community services and urgent care. It is a meeting were we rigorously discuss and monitor incidents and identify trends and themes.

27 Quality indicators including compliance with quality and safety mandated training is tracked and we monitor progress around outstanding actions relating to audit outcomes, complaints and RCA’s. Friends and Family Test (FFT) / Patient Reported Experience Measure ( PREM) and Patient Reported Outcome Measure (PROM) results are reviewed. We also began the ratification process of our standard operating procedures within these meetings. We feed up to the executive team and also down to the service that deliver care. We provide assurance around governance within our BU.

There are robust internal mechanisms to act upon any safety alerts that are shared with the organisation.

Emergency Preparedness resilience and response (EPRR) We carried out a table top exercise to test our major incident plan in March 2020, reviewing our internal Business Continuity Plans. Covid 19 brought many challenges to the services but our plans ensured we could still deliver critical services such as end of life care, support admission avoidance and timely discharge. In addition we supported external partners in their planning for Covid 19.

Monitoring patient safety We have continued to build upon our ability to monitor patient safety and develop the tools available to us. Our local Operational Management Team is responsible for the monitoring of patient safety and the collection of information and this is reported on via Tableau, our internal reporting tool. This tool allows us to capture robust performance data on patient safety. We continue to use our internal reporting tool, Tableau, to capture performance data for the purposes of monitoring patient safety.

Such data includes: • Complaints and compliments • Clinical and non-clinical incidents (including Serious Incidents, Near Misses, Never Events, RCAs, Safeguarding and Information Governance) • Clinical Audits (NICE, national and local audits or condition-specific pathway audits for example for stroke, diabetes and COPD) • Evidence-based standards and practice (peer consultation review) • Training and appraisal

The utilisation of our Clinical Governance RAG scorecard remains an area of focus for us, as this measures the effectiveness of quality and safety systems and incentivises improvement. Completed monthly, the scorecard reports and measures the operation of clinical governance systems, allowing the local team to focus attention on particular areas of quality and safety requiring input. Services receive a % score for each area of clinical governance, achieving an overall monthly % score for the service, which is RAG-rated. This is monitored via both our monthly Performance Meetings and the Operational Board and is reported at both the local and national Governance meetings.

28 Incident reporting Incident reporting remains a priority for us and we have seen an increase of 58% in internal reporting over the past twelve months. This demonstrates an increase in colleague awareness of the importance of incident reporting, an open and honest culture and a focus on patient safety. There has also been a 56% increase in external provider incident reporting. Many of the themes of these incidents relate to the challenges of supporting complex transfers of care between settings. The level of low harm incidents for Community Services for internal incidents was 34.6% whilst Urgent Care was 66.6%.

Our internal harm free care panel has remained in place during 2019/20, lessons learnt captured and action plans devised.

Grand Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar total 17/18 0 15 22 18 22 22 20 23 14 28 25 28 237 18/19 18 33 20 24 30 28 32 22 7 24 27 16 281 VC Incidents 19/20 25 36 37 33 40 29 39 35 33 46 58 34 445 Var 7 3 17 9 10 1 7 13 26 22 31 18 44

Grand Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar total 17/18 0 6 12 5 15 10 17 16 15 12 8 8 124 External 18/19 12 22 28 35 29 21 23 23 31 30 27 23 304 Provider Incidents 19/20 38 39 29 39 39 41 42 34 28 57 55 35 476 Var 26 17 1 4 10 20 19 11 -3 27 28 12 180

Grand Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar total 17/18 0 21 34 23 37 32 37 39 29 40 33 36 361 Total 18/19 30 55 48 59 59 49 55 45 38 54 54 39 585 Incidents 19/20 63 75 66 72 79 70 81 69 61 103 113 69 921 Var 33 20 18 13 20 21 26 24 23 49 59 30 224

All of our newly recruited colleagues undertake CIRIS, Incident Report training as part of their induction and mandatory training. The CIRIS incident form asks the reporter to identify the type of incident and the degree of harm (if any) to service users, colleagues or visitors. This way of reporting enables service managers and central teams to identify and address trends/themes, to ensure that any incident resulting in actual harm is escalated and monitored closely, and that any learning is shared and applied robustly.

Safeguarding Our Quality and Safeguarding Lead for West Lancashire continues to be responsible for ensuring safeguarding standards are met, working closely with our national safeguarding team to ensure appropriate supervision and support is given.

The Safeguarding Strategy published December 2019 reflects Virgin Care values and sets out our approach to continually improving our safeguarding service to ensure that there are safe and effective systems in place and that our colleagues recognise safeguarding is everyone’s business.

29 Strive for Better networks meetings are established to drive forward safeguarding best practice and share learning across the organisation. There has been a focus on self- neglect with a new guidance on how to work with clients who do not wish to engage.

We have safeguarding champions who meet together to share learning and make sure they are up to date with knowledge of safeguarding issues. They also help share important messages about safeguarding with their colleagues. The group has promoted joint working by welcoming guest from partner organisations to attend and take an active role.

The Safeguarding Training Strategy, shared in September 2019, provides a framework to ensure our colleagues are supported and can access appropriate training, learning opportunities support and guidance. It gives clarity on mandated safeguarding requirements.

Within Mylearning there is a specific platform for safeguarding training which allows colleagues to record all related CPD activities. Safeguarding training uses a blended approach including e-learning, traditional face to face training, webinars and independent learning and reflection.

The national safeguarding audit is competed annually and is based on a combined Children’s Section 11 and Adult Safeguarding Self-Assessment Tool. The audit was comprised of 9 sections relating to: 1. Accountability and Leadership 2. Governance Arrangements and Quality Assurance 3. Safeguarding Policies, Procedures, Processes and Systems 4. Recruitment 5. Training and Induction 6. Complaints, Allegation and Whistleblowing 7. Information Sharing 8. Listening to children, young people and adults 9. Equality of opportunity

West Lancashire submitted six audits and all actions have been completed. Local trends identified a gap for peer supervision which is being addressed nationally and a need for more robust agency induction which has resulted in an induction pack being developed.

Medicines Management Every site and service except one completed the Medicines Safety Audit, including those that do not use medicines as a safety check. Some actions are still in progress and have reduced massively from 244 initial actions to 7 currently in progress in June 2020. The Lead Pharmacist is working closely with the remaining services to get these 7 remaining actions completed.

All prescribers get sent their prescribing information every month with feedback on this from the Lead Pharmacist, so that prescribers can review any anomalies and ensure optimised prescribing for patients.

30 Information Governance We have continued to focus on quality and safety training for Data Security Awareness, achieving 90% compliance by March 2020. We have Data Subject Access Champions and remain complaint with dip sample audit in line with organisational procedure.

Internal Service Reviews We have consistently operated a programme of ‘Internal Service Review’ (ISR), in each of our clinical services. We are required to complete such assessments twice during each calendar year and these reviews continued during year three.

Each ISR is carried out by a Service Lead, Clinical Leads and Registered Managers and peer reviewed by a manager from another Virgin Care service. The results are then logged, analysed and reported using our internal reporting platform ‘Tableau’. The ISR programme covers the same areas as a CQC inspection and produces a rating based on the same scale as the CQC’s reports.

CQC inspections Both of our urgent care centres, the Urgent Treatment Centre at Ormskirk Hospital and our Walk in Centre based in Skelmersdale were subject to CQC inspections this year.

Urgent Treatment Centre The inspection at our Urgent Treatment Centre was carried out on 16th January 2020. This was the first inspection at this site since Virgin Care Services Limited was awarded the contract. As part of this inspection, 57 people provided feedback about the service via comment cards and two people were interviewed by the inspectors. All those that provided feedback were very positive about the service with some patients describing the service as excellent, praising colleagues and GP’s for their caring and understanding attitude.

The five key questions asked were: • Are services safe? • Are services effective? • Are services caring? • Are services responsive? • Are services well-led?

In all domains, the Urgent Treatment Centre was rated as ’good’ with some areas of outstanding practice.

Some of the areas of outstanding practice included the service conducting a variety of real-life scenario tests for emergency medical situations which could arise. These were observed by the inspectors, colleagues debriefed, lessons learnt and adjustments made to improve future responses.

31 Skelmersdale Walk in Centre The inspection at Skelmersdale Walk in Centre was the second inspection, the first one being undertaken in November 2018 which was previously rated as ’requires improvement’. The second inspection was undertaken on 11th March 2020 and as part of this 34 people provided feedback via CQC comment cards of their experience of using the service.

Thirty of these were very positive about the service, one was negative and three were mixed. Overall patients described the service as excellent, praised the colleagues for their caring and understanding attitude, said that they found the service convenient and the clinicians caring and professional. A minority of patients said the waiting time to be seen was excessive. In all domains, Skelmersdale Walk in Centre was rated as ‘good’ with some areas of outstanding practice.

It was also noted that the team had recognised that some local patients with limited means needed to travel to the local A&E Department when facilities at WIC were not appropriate for their needs, resulting in the service providing a free taxi for those patients assessed as needing this assistance.

Contract and Quality meetings These take place on a monthly basis with providers of services we sub-contract: • Vocare - out of hours GP provider • Queenscourt Hospice – Palliative Care /End of Life

Contract meetings are held to discuss any contractual and operational issues and also where quality is discussed. Risk, incidents and safeguarding concerns are raised and monitored. As part of the monthly meeting with Vocare, ‘frequent flyers’ to our services are discussed and strategies put in place to reduce attendances whilst ensuring patient safety.

Priority 3: Continue to be recognised as an outstanding employer

Workforce plan development A workforce plan was developed as part of our year 3 outcomes. This workforce plan clearly sets out our strategic workforce priorities for the next three years and the key themes of work to achieve that vision. Our strategy was built on our culture of innovation and continuous improvement, to strive for better, providing heartfelt service and really embedding our purpose and values.

We wanted to ensure we have a workforce which is highly skilled and engaged to enable them to support the delivery of our business plan. It brings together all workforce related strategies, identifying key priorities and actions for the next three years.

32 Key priorities from our organisational people strategy are:

Leaders who Lead • A mandatory development programme for colleagues developing / progressing at all level of the accountability framework – ‘Leading the Virgin Care Way’ (Leadership Proposition). • Leaders who role model the values and leadership behaviours and drive accountability through role clarity • Every leader is a coach!

Life Long Learning • Delivering clinical and support function externally accredited qualifications (apprenticeships) – growing your career with Virgin Care • Cost effective safety and quality training offer – keeping us safe and ensuring quality • A place for students to learn (and stay)

Feel the Difference • Easy to use, easy to navigate, business aligned system, policy and process delivered by customer focused support services • Creating an environment where our colleagues are challenged, stretched but supported in equal measure to be the best that they can be • Ensuring our colleague voice is actively sought, listened and responded too, ensuring colleagues co-create service improvements to maximise the difference we make to our communities, families and service users • Our teams work together to support each other navigate and respond to our challenging complex and agile environment

All underpinned by a values driven culture where: • Colleagues are encouraged to ‘Think’ about changing things for the better • Motivated to ‘Care’ for others • Empowered to ‘Do’ what needs to be done

Upskilling Year three has seen us undertake a lot of training, upskilling and development of our clinical colleagues, both in Community Services and Urgent Care, particularly concerning paediatric training.

Our Head of Urgent Care engaged with external providers to ensure the staff were (and remain) appropriately trained. In December 2019 a leading external provider, M&K Training and Development for Professionals, delivered a two-day course in recognising and managing a sick child. This was delivered to all nurses in Urgent Care who had not already undergone training. We also offered places on the course to our primary care colleagues.

Two Urgent Care Nurses attended John Moore’s University, studying a twelve-week module in paediatric illness (level 7), successfully completed this and utilising the skills attained in the workplace.

33 There has been the development of a Paediatric Competency Assessment which is based on a national framework. This is used to assess clinicians’ paediatric competencies to ensure they deliver safe and appropriate care. All clinical colleagues are trained in Immediate Life Support (ILS) and Paediatric Immediate Life Support (PILS) and all new recruits undertake this training as soon as practicably possible after commencement. All nurse and paramedic practitioners who are able to see and treat children have received bespoke training delivered on site by an independent clinical training company, M&K.

Senior Nurse Development Programme In 2019/20 we developed and delivered a Senior Nurse Development Programme, which is a bespoke training programme, designed internally and run by our colleagues within TLE. Nurse training often doesn’t cover the leadership and change management skills needed, leaving nurses who are promoted to more senior positions ’learning on the job’. It is therefore, essential that they have the support and development they need during this transition. This programme was designed to develop skills that the existing senior nurses (band 6/7) need to manage their teams more effectively, as well as to introduce new and innovative ways of working. Virgin Care’s Senior Nurse Development Programme consisted of four modules, delivered over four half days: • Roles and responsibilities (wider vision of health care, job description and role responsibility, awareness of others roles and team objectives) • Leadership behaviours and managing people (communication and relationship management, managing teams and key HR policies) • Driving improvement (understanding CQC reviews, root cause analysis and learning from incidents, using performance information for services improvement) • Handling challenges and making decisions (challenging behaviour, difficult conversations, complaints process, clinical supervision, revalidation)

Senior Leadership Development Programme This year we have invested in an externally facilitated leadership programme designed specifically to challenge and develop the senior leadership team across Lancashire. This is a two-year programme developing leadership best practice theory, tools and techniques alongside challenging practice sessions, project work and team development. The programme is aimed at stretching our leadership team to effectively drive change, develop our people and act as critical friends to each other helping to drive continuous improve in outcomes for our patients.

Senior Management Development Programme This year we have also internally developed a Senior Management Development Programme providing existing operational managers with the opportunity to expand their knowledge of wider leadership tools, techniques and knowledge outside of their immediate professional area of expertise. The programme concentrates on better understanding yourself as a leader and how your leadership style interacts and influences others. Participants are given real organisational challenges to work through and opportunities to test themselves with support from members of the SLT.

34 Induction Pack As part of ongoing support to new recruits, local induction packs were created for each location within the business unit, ie, Urgent Treatment Centre, Skelmersdale Walk in Centre, Bickerstaffe House, Clayton House. The local packs were designed to support, navigate and provide vital information to new colleagues commencing into our services. Each pack included information such as layout of the building, who’s who including telephone numbers, safeguarding / infection prevention and control / quality leads, fire plans, policy information, how to navigate JAM, how to book holidays, etc.

Recruitment There have been three successful Open Days, held at both Bickerstaffe House and Clayton House during year three. These events were advertised through social media, local advertising and word of mouth, highlighting vacancies within the business unit. The purpose of these events were to show potential new recruits the environment they would be working in, meet the team, including senior management representatives and the Head of Service, interview potential candidates on the day or signpost to other services where they may not have had the appropriate skill set for work within Community Services or Urgent Care.

As part of these open days, 55 people attended over the three days which resulted in 16 new recruits covering services in both urgent care and community services.

We have developed our own West Lancs bank of nurses and administrators staff, across community and urgent care, demonstrating that colleagues now choose to work with Virgin Care in West Lancashire Services

Within our Urgent Care Centres, recruitment has been ongoing and we were successful in hiring a paediatric paramedic practitioner who brings paediatric knowledge and experience to the centre. He is able to see, treat and diagnose illness and injuries in children, undertakes peer reviews and direct observations with colleagues measuring against paediatric competency framework.

Apprenticeships Apprenticeships are still very high on our training and development agenda and as such we took part and celebrated in National Apprenticeship Week in February 2020. The theme was ‘look beyond’ which was aimed at getting us all to think further than the stereotypical apprentice, ie, school leaver and someone you would have in the building trade, ie, plumbing or bricklaying.

Apprenticeships offer a fantastic opportunity for those wanting to continue to develop their career without having to take a few years away from work to study or to try to juggle a full- time job with evening classes.

During 2019/20, three colleagues embarked on undertaking their Level 5 Operational Manager qualification.

35 Have Your Say (HYS) Our Have Your Say (HYS) annual colleague survey was undertaken in May 2019 with 74% of colleagues participating, this is a very slight increase from year two (73%). This survey is a core part of how we listen to and act on what colleagues tell us.

Taken from the WL score card, the following demonstrates the good news: • 70% of respondents agree or strongly agree that care of patients is the top priority of our business unit • 70% of respondents agree or strongly agree that they are part of a team committed to continuous improvement • 50% of respondents agree or strongly agree that they feel safe and supported at work • 80% of respondents agree or strongly agree that if a friend or relative needed treatment, they would be happy with the standard of care provided by colleagues in West Lancashire • Engagement increased from 61% to 63%

Taken from the WL score card, the following demonstrates the areas identified for improvement: • Did the performance appraisal help you improve how you did your job? • How confident are you that things will change for the better as a result of completing this year’s survey? • Have you been involved in action planning based on the results of last year’s survey? • Do you know if any actions have been implemented as a result of last year’s survey?

As a vital part of our engagement strategy, it is extremely important for us to understand how colleagues feel and put action plans into place to improve engagement scores, improve response rates and most importantly, demonstrates that our senior team/leaders listen to our colleagues and makes the necessary improvements to make our services the best place to work.

Appraisal 92% of colleagues have had appraisal conversations within the past twelve months. These appraisal discussions have been used to identify individual and service wide learning and development plans. The appraisals have also been sampled to review the quality of the conversations that have been taking place and to ensure all colleagues have a full understanding of the organisation and service objectives and the way in which their individual objectives feed into them.

Freedom to Speak Guardians Speaking up about any concern that out colleagues may have at work it vital. It helps us to keep improving our services for everyone who uses them and the working environment for our colleagues.

With this in mind, Freedom to Speak guardians, who are from several areas of the business, are appointed to encourage and empower colleagues to speak up about their concerns at work. These concerns could include anything from relatively minor breaches of procedure to extremely serious unsafe patient and service user or working conditions. This is designed to encourage a culture of openness, honesty and transparency.

36 CEO Awards Our CEO, Dr Vivienne McVey, introduced the Chief Executive Award in July 2019 as a way of acknowledging the big and small things you do to make a difference. Dr McVey selects the winner from articles posted on Jam that show how colleagues, individuals or teams, are making a difference to lives by improving services.

We have had numerous teams nominated for our internal CEO awards and those who have been successful include Podiatry, Falls, Urgent Care, Dietetics and Short Intensive Support Service (SISS). These are services that have been instrumental in making a difference to our patients. Some of the activities attributed to this success include: • Support for care homes around home enteral feeding from our dietetic team • A review of the falls pathway ensuring the patient was seen by the right health professional • Integrated MDT working with podiatrist and Tissue Viability Nurse

Colleague engagement In March 2020 we held our annual awards ceremony which took place at Preston North End Football Club in Preston. This was a joint awards ceremony with our 0-19 children’s service.

As in year two, all of our winners and nominees were put forward by their colleagues who felt they had been truly amazing and deserved the recognition. Each of the colleagues who had nominated an individual or team were filmed stating why they had nominated them. It was inspiring to hear some of the words used by colleagues – “one in a million”, “goes the extra mile”, “10 out of 10”, “lovely”, “passionate”, “patient focused”, “involving”, “caring”, “embeds team spirit” to name but a few.

The nominations were shared with our Executive Team and WLCCG judged the Strive for Better Award for us. The awards categories were again based on our organisational values. There was also a special ‘executive’ category in recognition of the contribution each individual had made, outside of the values.

Heartfelt Service: An individual or team who takes the time to understand and support others so that people feel genuinely valued and cared for.

Winner: Head of Specialist Nursing, Community Services Shortlisted: Head of Specialist Nursing, Discharge Planning Lead and a community Phlebotomist.

These awards were chosen and presented by the Acting Director of Quality for Virgin Care.

Strive for Better: An individual or team who explores ways to do things better, solves problems and makes change happen.

Winner: Macmillan Centre Information Support Service Officer Shortlisted: Macmillan Centre Information Support Service Officer, Clinical Lead for CCH/ CERT/SISS/Community Matrons and, GP Clinical Lead for urgent care

37 Team Spirit: An individual or team, who inspires, motivates and helps others, collaborating with colleagues to achieve results. Works together as a team, and introduces initiatives to help the team work better together.

Winner: Technical Instructor for CERT Shortlisted: Hants Lane District Nurses, Technical Instructor and Heart Failure Team

This award was chosen by both our Head of Urgent Care and Head of Operations for Community Services

In addition to the organisational values, there were additional awards given out to those colleagues/teams that really did go the extra mile. The following award was for:

Outstanding Achievement

Winner: Continence Lead Nurse. Shortlisted: Head of Urgent Care, Continence Lead Nurse and Paediatric Paramedic in Urgent Care.

A new award category was announced at this year’s ceremony and that was an ‘Executive Award’. This was open to all of those who help shape and support West Lancashire in some way. This years’ winner was our Recruitment Advisor for the business unit who has been instrumental in supporting both Community Services and Urgent Care with vacancies and more importantly, has helped us fill these. She works tirelessly with the teams and has a real grasp of service need.

There was one final award that was presented to a team that have been unbelievable over the last few months. This team have faced a challenge of not one but two CQC inspections and we are pleased to report that both inspections were rated ‘good’. A highlight in the report was for the team’s outstanding practice in preparing itself for emergency medical situations by carrying out real-time scenario testing.

This award was the Special Recognition Award and went to our Urgent Care team. Present to accept the award from our Executive team was the Head of Urgent Care, Clinical Lead Nurse, Paediatric Paramedic, the Service Manager and the GP Clinical Lead.

In addition to our local Colleague Awards, earlier in the year the Virgin Care Feel the Difference Awards were held at Warwick Castle. These annual awards celebrate the superb achievements of all colleagues across the organisation that really demonstrate and live our values. Nominations for these awards are again made by colleagues and peers.

In addition to the formal award ceremony, the following were either introduced during 2019/20 or continued to ensure our colleagues are informed and involved in service delivery.

38 Visioning sessions We continued with our visioning sessions, which allow colleagues to become involved in how they want their service to look like and how we continue to improve ways of working. We have had these for our Specialist Nurses and District Nurses during year three with action plans devised.

Leadership forums These are held quarterly and attended by all bands 7 and above colleagues. These bring senior managers together and are a great opportunity to build relationships, contribute to our Business Unit vision and objectives and share best practice from their teams.

Choc and Chats These are informal sessions, scheduled quarterly but also sometimes adhoc, that give colleagues the chance to speak with members of the SLT over a cup of tea. It gives colleagues the chance to get to know senior managers and provides a relaxed environment to encourage colleagues to ask questions and be open and honest about any issues they are having.

Lunch and Learn These have only recently been introduced but essentially they are monthly events (an hour long) that give colleagues the chance to learn skills/gain knowledge about useful topics. So far there has been a session on CQC preparation and one to introduce colleagues to our online marketing tool Page Engine, to help upskill them.

Colleague Wellbeing Colleagues experience challenges in all areas of their lives and if they are finding it difficult to cope, there is a comprehensive range of resources and support they can access.

In 2019/20, we looked for wellbeing champions in West Lancashire to support fellow colleagues in the workplace, direct them to the support available and feed back to our Human Resources Business partners with any ideas for new measures that could be implemented for further help each other. It is important for us to support our colleagues as we understand that everyone goes through difficult times and we want to do our best to ensure that everyone feels well, health and happy at work. Some support available for colleagues include: • A free, independent employee assistance programme available to all colleagues 24 hours a day, 365 days a year. This offers confidential advice, information and emotional support online or over the phone to help manage life’s ups and downs • Occupational health support to help people stay healthy at work and support those returning from a period of ill health • My Wellness on line health and lifestyle platform where colleagues can complete their own wellness assessment, follow a fitness programme and access lots of healthy living advice • A dedicated Wellbeing Hub on Jam

39 Competency Passport Development Our clinical teams continue to utilise the competency passport to ensure they are up- to-date with training and can quickly see, at a glance, expiry dates so this tool acts as a reminder. This is also given to all new recruits for completion.

During 2019/20 work was undertaken to commence on a Health Care Assistant competency passport and this is ongoing.

Feel The Difference successful applications The Feel the Difference Fund is a dedicated amount of money that Virgin Care reserves for colleagues to use for implementing the big and small changes to help make a real difference to the communities we serve.

During 2019/20, three applications from West Lancashire were successful. These were for:

Moleculight technology for photographing wounds to manage wounds more effectively Podiatry and tissue viability have developed clinics to share patient care of ulcer patients with chronic non healing wounds. This new technology enables the clinicians to see the level of bacteria in the wound and if the wound is infected, it can be treated more effectively and efficiently. This makes swab results more reliable as the clinicians can swab precisely where the infection is on the wound bed. It also enables the team to manage wounds more appropriately with antimicrobial dressings.

Echo Minitech PRO hearing amplifier with headset and neckloop x 2 These were purchased for the Community Emergency Response Team (CERT) to improve communication with those patients who are hard of hearing whilst maintaining confidentiality in the area of work. The team conduct therapy and assessments and when patients cannot hear the instructions, it impacts their potential outcome of recovery.

Hoist weighing scales to be able to weigh bed bound patients Our Dietetic Team was successful in its application for weighing scales for bed bound patients. The use of these scales determine better clinical outcomes for the patients, particularly for tube fed patients as the team are able to tailor nutrition plans for the individuals.

Priority 4: Delivering quality health and social care as efficiently as possible

Voluntary Care Faith Sector (VCFS) engagement Our Voluntary Sector Programme Manager continues to work collaboratively with our third sector and Voluntary Community Faith Sector. He has worked incredibly hard to become known to local VCFS organisations and has been instrumental in implementing collaborative and partnership working. During 2019/20 he has: • Developed a partnering agreement with Divine Days CIC which has enabled the securing of funding for two projects through the Big Lottery and Well Skelmersdale • The Legacy Project – funding from Well Skelmersdale MUG Club to deliver a supported internships programme for young people with learning disabilities

40 • Lottery Project – Community Arts Project delivery DiddiDivine Dance session for young people with additional needs and their families. Session also provided support for families in meeting wellbeing and signposting and information on access to services • Continued to signpost to the voluntary sector through DOS development to enable the VCFS directory to be hosted on our internal intranet (JAM) and accessible to all colleagues • Provided ongoing support to Breathe Easy Groups for the respiratory team in ensuring a presence in Skelmersdale and creating links with the Ormskirk Group and negotiating support from the British Lung Foundation • Had discussions with Burscough Community Hub on possible support in community asset transfer and community car scheme development. Support for local funding for Burscough Community Hub Group • Worked with the VC specialist cardiac team to identify potential gap in peer support for those with a cardio/heart conditions in West Lancashire. Provided support for Ormskirk Pulsators exercise group in publicising group activities • Prior to the decommissioning of the service, West Lancs Wellbeing workers were co- located within Bickerstaffe House to raise the profile of the service and receive direct referrals. We discussed creating a project legacy report to correlate the changes in wellbeing scores with the organisations that were signposted into • Secured additional funding for Yewdale Counselling Services by supporting them with their bid • Worked with Age UK – Hospital Aftercare Service – to discuss an increase of and promote referrals into the aftercare service. Possible co-location and participation in multi-disciplinary working was scoped • Secured voluntary sector awareness sessions for Virgin Care Colleagues – three sessions ran throughout the course of 2019/20: Social Prescribing, Ncompass – Carers Support and Age UK Preparing for Winter • Participated in Well Skelmersdale – MUG Club & West Lancashire Health & Wellbeing Partnership

Stakeholder engagement We continue to work in conjunction with local universities and West Lancashire College to support students studying for their NVQs, post-graduate qualifications and also, we worked closely with Edge Hill University to rotate their first year medical students into our Urgent Care Centres. All of this collaborative working is to try to development employment opportunities to local residents. We have reduced the number of students from West Lancashire College to enable more meaningful opportunity to spend time in both Community Services and Urgent Care.

Our Urgent Care team has worked tirelessly to build relationships with the local acute hospital to ensure patients are referred / discussed appropriately and correct care is given.

For the third year running we have undertaken a stakeholder survey, using the same questions as in previous years. The improvements demonstrated in the third survey, which ran in January - March 2020 are as follows: • 33.33% of stakeholders rated interactions with Virgin Care as excellent which is a huge increase from year 2 as nobody rated their interaction with Virgin Care as excellent • 22.22% of stakeholders rated interactions with Virgin Care as poor, which is a slight decrease from year 2 (25%)

41 This demonstrates that the relationship building and on-going engagement with stakeholders continues to grow.

• 30.8% of stakeholders rated contact with Virgin Care very easy, this is a 24.5% increase from year 2 (6.3%) • 7.7% of stakeholders rated contact with Virgin Care quite difficult, this is a very successful 4.8% decrease from our first survey (12.5%) • 14.81% of stakeholders rated making a referral to Virgin Care very easy, compared with no responses in the previous year, this is a great outcome • 11.11% of stakeholders rated making a referral to Virgin Care neither easy or difficult, this is a 4.86% increase from our first survey (6.25%)

This evidences that our information systems and processes are working well and ensuring that our stakeholders are aware of how to contact us and that our referral criteria is easily accessible and known to those that use our services. Our Care Co-ordination Hub has played an integral part in being the central point of contact for all users across the localities.

PROMs/PAMS We continue to collate our patient outcome measures, mainly by use of Patient Activation Measures which are a series of questions that patients themselves complete at the beginning of any intervention and then at the end. This demonstrates if there has been any improvement and also evidences the level of engagement and self-management that the patients have.

Our contractual arrangement continues with Insignia Health which gives us access to a platform called Flourish. This platform ensures we have the ability to report on the data contained within the system and that demonstrate the outcome changes for our patients. The system will match up the start and end scoring for each of the questions and calculate the improvement (or deterioration) in attainment. The 13 PAM questions are still widely used in the NHS and in fact, more and more NHS organisations are using these to demonstrate patient participation, self-management and ownership of improvements in their long-term conditions.

During our third year, we increased the number of teams that were using this tool to seven – Diabetes, Respiratory, Cardiac, Speech and Language Therapy, Continence, Dietetic (HEF) and Neuro-Rehab.

Based on data reviewed in 2019/20, it demonstrated a decrease in the number of patients at levels one and two and a significant increase in patients achieving level four at the end of their treatment.

Urgent Care We have further developed the working relationship with Southport & Ormskirk Hospital Trust Emergency Department to ensure our patients are supported, signposted and cared for in the correct manner. Our GP Clinical Lead has strived to build excellent relationships with the ED Consultant and following facilitated discussions by WLCCG, this has allowed for informal advice and guidance to take place where necessary from the A&E Consultant of the day. This has had a significant impact on the outcomes for patients. As a result, our UCC clinicians are able to refer directly to for example, Gynaecology, Ophthalmology and the Surgical Assessment Unit.

42 Priorities in 2020-21

How we identified our priorities for 2020-21 Virgin Care’s national priorities were identified by its board as part of an annual process, having reflected upon the feedback provided by people who use services and other stakeholders throughout the year in a variety of methods and considering the priorities set for us by commissioners in each local area, alongside our delivery plans in each business unit.

Individual business units, including West Lancashire, were then able to set their own priorities and it is these which are articulated here. The management team within West Lancashire set the priorities in response to: • Themes from complaints • Themes from lessons identified within incidents • The outcome framework • Feedback from FFT • Citizen Panel feedback

Priority 1: Ensuring service quality, safety and enhancing user experience: Providing excellent clinical outcomes, meeting and exceeding relevant standards and regulatory requirements.

FFT It remains a priority to continue to listen to our patients and service users and enable them to feedback about their experiences. We will be focusing this year on encouraging the use of digital platforms to feedback such as SMS test messaging and on line survey, to not only open up opportunities but also reduce the risk of infection.

Pressure Ulcer Prevention We will continue to build upon the work already implemented to ensure that people who are at risk of pressure damage have their care delivered in a way which consistently meets best practice guidance. We will drive forward the priorities identified the Striving For Better Pressure ulcer group.

Safeguarding We will continue to improve safeguarding practice through compliance with legislation, national and Virgin Care polices and through shared learning. We will continue to work towards the priorities identified within the Striving for Better Safeguarding Strategy for this year which includes the implementation of a bespoke Safeguarding Induction pack, Roll out Safeguarding Adult level 3 training aiming for a 40% compliance by September 2020 and to complete the annual Safeguarding Audit for 2020.

Infection Prevention control In line with the VC Health Care Practitioners Strategy, we will ensure colleagues have the knowledge and skills relating to infection prevention control. We aim to establish our Infection Control Champions within the workforce and develop PPE (personal protective equipment) buddies.

43 Urgent Care Both of our urgent care centres will maintain telephone triage and continue to offer appointments across both sites. This is following an implementation of this system during the COVID pandemic and is in line with our transformation plans. We also plan to increase 111 bookings and appointments and to work collaboratively with colleagues in primary care to support extended access. We are also looking to host first year medical students from Edge Hill University from September 2020 which supports our workforce strategy by developing and recruiting local residents.

Medicines Management • Complete the updated Medicines Safety Audit according to the audit calendar and get actions completed within 3 months. • Ensure recently introduced medicines SOPs are communicated to all colleagues and fully implemented. • Continue to send prescribing information and feedback monthly.

Podiatry When the nail cutting service starts up for low risk diabetic patients, the agreement will be for Podiatry to refer at first but to develop and expand this to allow GPs to refer patients who are low risk diabetic following a diabetic foot screening. We expect that this will reduce the number of inappropriate referrals to the podiatry service for low risk nail cutting.

We will also be looking to provide free clinic accommodation for Age UK to perform more clinics across the localities – Burscough and Tarleton.

We would like to pick up talks again about working with the MCP to develop an integrated podiatry pathway which incorporates all foot screening and interventions from low to high risk including the elements of the pathway delivered by the Acute. Due to COVID this was delayed.

Therapies (Physio, OT, SALT) Within our therapy services we have had an inherited waiting list. We have made great progress in reducing this over the past couple of years but the plan for 20/21 is that no patient will sit on a waiting list. Patients referred into the service will be triaged the same day and allocated to the most appropriate therapist. We will do this looking at how our therapist work and introducing a ‘one therapy’ team, working with new technology and reviewing our workforce to provide a more resilient and effective service for our patients.

We have recently appointed 3 new locality lead posts on a secondment for 6 months. These roles are currently development roles and will be working on: • Attending the care home MDTs with the GPs, AMPs, DNs, community matrons etc, with a view to these developing into locality MDTs for all systems. • Responsible for any actions plans that come out of the MDTs • Raising the profile of AHPs within the MDT. • Reviewing and ensuring care plans for patients are progressing and prioritisation on patient needs • Link into care homes etc. and supporting the reduction in inappropriate referrals to therapies.

44 Priority 2: Robust governance: fostering safeguarding and quality assurance processes which are standardised across the business.

Safeguarding Our Urgent Care team is looking to include domestic violence screening as mandatory as part of its patient assessments and will signpost those patients appropriately to local voluntary sector support organisations. Domestic Abuse will be a focus too for our safeguarding champions.

Incident management We will continue to closely monitor incidents and aim to increase our low harm reporting. More robust investigation of incidents will be introduced with continued training around systems and process and root cause analysis.

Emergency Preparedness Resilience and Response We will continue to focus our business continuity and surge plans to ensure COVID-19 is included. A COVID-19 debrief will be planned when we return to business as usual.

Priority 3: Continue to be recognised as an outstanding employer

Appraisals Following our high level of appraisal completion and subsequent feedback in the engagement survey, a key focus for next year will be reviewing the quality of the objective setting. We want to ensure our colleagues are having meaningful discussions and getting the most out the numerous development and training opportunities available. This includes a commitment to growing our apprenticeship and student numbers and developing and retaining key talent.

Due to the additional challenges of COVID-19, managers have also been asked to ensure ‘How Are You’ conversations take place to discuss any additional or changed objectives and ensure appropriate support and development plans are in place.

Partnership engagement The focus for the next 12 months will be on developing our Partnership Forums. These will support increased employee voice and be action and solution focussed, working together to drive improvements within the workforce.

Recruitment events Following the successful of these in 2019/20, our aim is to undertake these quarterly across the business unit.

Training and development We will continue to ensure existing and new employees coming into the business unit are given the same opportunity to upskill and continue to progress within their careers where required and we will promote all apprenticeship opportunities and use this as a recruitment strategy where possible.

45 Our colleagues will continue to be encouraged to participate in both internal and external regional and national learning / professional networks to further develop and enhance skills within community services.

Succession planning To make sure that our business is ready for the future, we aim to develop and create opportunities for colleagues to spend quality time in teams where their interest is. An example could be that one of our Urgent Care Band 5 Nurses has a real interest in Diabetes but has not had an opportunity to spend time in this specialist area. If this is identified as part of a personal develop plan, a structured plan will be devised to ensure this opportunity will come to fruition.

By offering rotations / secondments / formal shadowing arrangements, we can focus on growing our own and building a workforce for the future.

Development of an internal preceptorship As part of our recruitment and retention plans, we intend to develop our own internal preceptorship programme that will enable new recruits to spend time in every one of our teams to give them exposure to all of Community Services and Urgent Care. We have developed a careers framework which is appended to this strategy which shows the level of competence, skills required in each role and development/qualifications needed in order to progress. This will help us in the development of the internal preceptorship and work will commence on the development of this programme during the latter stages of year thee/ beginning of year four.

Priority 4: Delivering quality health and social care as efficiently as possible

Our aim, during 2020/21 is to continue with the use of technology to engage with patients with long-term conditions in order to support a reduction in pressure on the system as patients can opt out of travelling to physical points of care.

Due to the COVID-19 pandemic, we have commenced with AccurX, a telephone/video consultation portal that has been used in Therapies and Urgent Care services. Further exploration of how we can commence the Diabetes and You / Diabetes and More group sessions with the use of technology will also take place.

We will also explore the use of telecare monitoring for Diabetes and Respiratory patients.

Again due to COVID-19 pandemic, we were able to review how our clinics operate. This has enabled us to review the efficiency of what clinics we run, where these are located and how they can look in the future. This review will continue through 2020/21 with an assurance that patients will not be disadvantaged in any way.

Continuing the Pulmonary Rehabilitation service is crucial to our patients and, following research undertaken to explore how we can run this more efficiently during COVID-19, we will continue to deliver this via an App/Web based programme called myCOPD and propose a mix of face-to-face PR and use of technology.

46 We will continue to support the development of colleagues by offering further opportunities for attendance on V300 prescribing courses, level 6 paediatric clinical examinations and minor illness course to commence in September 2020 for our urgent care colleagues.

During the COVID-19 pandemic, both community services and urgent care worked closely with primary care colleagues, so much so that in our Urgent Care Centres, GPs and Advanced Nurse Practitioners formed part of the rota to ensure the right care was delivered to patients at the right time. Working relationships have developed well and we aim for this to continue as much as possible during the rest of the contract.

Audits we’ve taken part in National Clinical Audit Participation: Community Services Over the course of the year, Virgin Care took part in a number of national clinical audits including:

National Clinical Audit participation: Community services The Sentinel Strike National Audit Programme (SSNAP). This clinical audit collects a minimum data set for stroke patients in England Wales and Northern Ireland in every acute hospital and follows the pathway through recovery, rehabilitation and outcomes at the point of the six month assessment.

For more information: https://www.strokeaudir.org

National Safeguarding Audit This is based on the combined Children’s Section 11 and Adult safeguarding self-assessment tool (Best Practice) and this was carried out using a new digital platform on myApps improving compliance to a 100% of audits submitted. A peer review system is undertaken across the organisation.

Research Statement We continue to participate in a number of research, service evaluation and service development projects, which are overseen and governed by our Striving for Better speciality Networks.

We support the participation in research to help improve the care for people who use NHS and Local Authority services, and our plans will continue to develop and promote this area over the coming year.

Current research activity The organisation currently has a number of programmes on its research database which are in progress or due to commence within a few weeks of the publication of this document.

Virgin Care West Lancashire is not currently enlisted to participate in any planed research activity.

Publications None

47 Learning from deaths There were no unexpected deaths reported for Virgin Care West Lancashire services for the period 2019/20.

Statement on the accuracy of our patient data Virgin Care submitted information during the year to the Secondary Uses Service (SUS) for inclusion in the Hospital Episodic Statistics, which are included in the latest published data. Community service outpatient data for SUS submissions is being validated to ensure ongoing submissions are confirmed as being successful.

Not applicable to West Lancashire Community Services

NHS Staff Survey Virgin Care runs its colleague survey ‘Have your say’ on a bi-annual basis with regular ‘pulse checks’ covering a random sample of colleagues.

Overview of CQC inspections this year Registered provider Service Name Full Compliance Action Plan & Status

Virgin Care Services Skelmersdale Good rating Yes – Fully complete Limited Walk-in Centre achieved

Virgin Care Services West Lancashire Good rating Yes – Fully complete Limited Health Centre achieved

NHS Friends and Family Test Like all NHS providers, we ask people who use our services to feed back to us on their experience using the NHS Friends and Family Test.

Our patient experience measures continue to be embedded within our quality framework both internally and externally and are considered our ‘patient’s voice’, to determine where improvements are required, support the high quality of services that we provide and ensure we are meeting the expectations of our patients.

The data collated for 2019/20 shows that we had a total of 2539 FFT responses, of which 2293 patients also completed all 5 PREMS questions which is a conversion of 90.31%, this is very encouraging. As part of our outcome framework, an action plan was devised to focus on those FFT results that were negative in feedback.

48 On analysing the data before and after the action plan was implemented, it demonstrates that the action plan being implemented has had a huge impact on the number of negative responses received.

PREM responses received during year three demonstrate:

“When you had important questions to ask the clinician/people providing care to you, did you get answers that you could understand” Our patient response has increased with 89% of patients reporting yes, this is compared to 85% in year two. Only 1% of patients (25) responded no that they did not feel the answers they received were understood. This demonstrates we need to focus on ensuring our methods of communicating to all patients are in a way that they can understand.

“Did the clinician/people providing care to you, involve you as much as you wanted in decisions about your care and treatment” Our patient response has increased to 90.9% of patients reporting yes to this question. This is an improvement on 85% of patients in year two reporting. Only 1% (26) reported no to this question. Overall 96.39% of patients felt engaged and informed to some extent. The increase in performance of this question demonstrates the work outlined in year 2 to be delivered has been successfully achieved.

“Were you given enough privacy when being examined or discussing your condition or treatment” Patients reported that ‘yes they always did’ in 94.97% of responses compared to 88% in year two. 0.61% of patients (16) reported no that they did not have enough privacy which is a decrease from year two which was 1% (23). The increase in positive feedback and decrease in negative feedback demonstrates work undertaken throughout year three in improving clinical space at Bickerstaffe house and implementation of reception colleagues in community clinics has proved successful.

“Did staff explain the purpose/side effects of new medicines in a way that you could understand” Our response to people fully understanding has increased to 86.63% in year three from 77% in year two. Overall 91.83% of patients understood their medicines as 5.20% did not require an explanation. This demonstrates that work undertaken in year three to improve patients understanding of medications has been successful.

“Overall, did you feel you were treated with respect and dignity" In year two 89% of patients reported that yes they always felt they were treated with dignity and respect however in year three, this has increased to 96.41%. This demonstrated that work undertaken in year three to improve customer services has proved successful with reception colleagues now completing customer service training.

49 Feedback response to main question FY 2019

Extremely likely & Very good 1569

Good & Likely 385

Neither good nor por & 75 Neither likely nor unlikely

Poor & Unlikely 37

Extremely unlikely & Very poor 78

Don’t know 19

0 200 400 600 800 1000 1200 1400 1600

Feedback response to main question FY 2020

Extremely likely & Very good 1847

Good & Likely 511

Neither good nor por & 83 Neither likely nor unlikely

Poor & Unlikely 38

Extremely unlikely & Very poor 52

Don’t know 9

0 200 400 600 800 1000 1200 1400 1600 1800 2000

50 Part three Prescribed information

Prescribed information

12 (a) The value and banding of the Not applicable to West Lancashire summary hospital-level mortality indicator (SMHI) for the trust for the reporting period; and

(b) The percentage of patient deaths within palliative care coded at either diagnosis or speciality level for the trust for the reporting period.

13 The percentage of patients on Care This element is not relevant. Programme Approach who were followed up within 7 days after discharge from psychiatric in-patient care during the reporting period.

14 The percentage of Category A This element is not relevant. telephone calls (red 1 and red 2 calls) resulting in an emergency response by the trust at the scene of the emergency within 8 minutes of receipt of the call during the reporting period.

14.1 The percentage of Category A This element is not relevant. telephone calls resulting in an ambulance response by the trust at the scene of the emergency within 19 minutes of receipt of that call during the reporting period.

15 The percentage of patients with This element is not relevant. pre-existing diagnosis of suspected ST elevation myocardial infarction who received an appropriate care bundle from the trust during the reporting period.

16 The percentage of patients with This element is not relevant. suspected stroke assessed face to face who received an appropriate care bundle from the trust during the reporting period.

52 17 The percentage of admissions to acute This element is not relevant. wards for which the Crisis Resolution Home Team acted as a gatekeeper during the reporting period.

18 The trust’s patient reported outcome This element is not relevant. measures for (i) Groin hernia surgery (ii) varicose vein surgery (iii) hip replacement surgery, and (iv) knee replacement surgery During the reporting period.

19 The percentage of patients aged – This element is not relevant. (i) 0-14 and (ii) 15 or over, readmitted to a hospital which forms part of the trust within 28 days of being discharged from a hospital which forms part of the trust during the reporting period.

20 The trust’s responsiveness to the The FFT, PREMs and PROMs, incidents personal needs of its patients during and complaints in West Lancashire are the reporting period. reviewed monthly and forms part of West Lancashire Internal Governance

21 The percentage of staff employed by, 71%w or under contract to, the trust during the reporting period who would recommend the trust as a provider of care to their family or friends.

21.1 This indicator is not a statutory 93% requirement.

The trust’s score from a single question survey which asks patients whether they would recommend the NHS service they have received to friends and family who need similar treatment or care.

53 Comments by co-ordinating Clinical Commissioning Group The draft quality account was submitted to the West Lancashire Clinical Commissioning Group (WLCCG) on 13 July 2020 and their comments were used to improve the document prior to publication.

‘Thank you for providing West Lancashire Clinical Commissioning Group with the opportunity to review and comment on Virgin Care’s Quality Account for 2019/20. Having reviewed the content of the QA, we believe that the account represents a balanced overview of the quality of care, patient safety and safeguarding provided by Virgin Care Limited. This Quality Account clearly demonstrates the continued progress and numerous achievements for local services based on last year’s priorities and the plans for future development.

This Quality Account provides a clear rationale for the coming priorities for 2020/21 and are supported by commissioners. Commissioners are keen to continue working collaboratively to ensure that the priorities are progressed at pace and in harmony with the West Lancashire CCG’s Building for the Future Together transformation plans. The aim is that these plans will further improve access to services and the physical health of patients.

The CCG continues to work well with Virgin Care Limited specifically around the assurance process of monitoring key quality issues. We are looking forward to continuing this close collaboration in the coming year to further transform services and ensure that we continue to champion the quality, safety and safeguarding agendas together, for the benefit of the patients who we commission services on behalf of.’

54 Appendices 1: Glossary of terms

Care Quality Also known as CQC Commission Independent regulator of health and social care in England. Replaced the Healthcare Commission, Mental Health Act Commission and the Commission for Social Care Inspection in April 2009.

Clinical audit Quality improvement tool, comparing current care with evidence- based practice to identify areas with potential to be improved.

Clinical Commissioning Local organisations which seek and buy healthcare on behalf of Group local populations, led by GPs.

Commissioning Also known as CQUIN for quality and innovation System to make a proportion of healthcare providers’ income conditional on demonstrating improvements in quality and innovation in specified areas of care.

Community Services Health services provided in the community (not in an acute hospital).

Includes health visiting, school nursing, district nursing, special dental services and others.

CP-IS Child Protection Information System

A computerised way of sharing data about child protection securely between organisations.

Did Not Attend Also known as DNA

An appointment which is not attended without prior warning by people who use services.

Healthcare Care relating to physical or mental health.

Healthcare Quality Also known as HQIP Improvement Partnership Organisation responsible for enhancing the effectiveness of clinical audits, and engaging clinicians in reflective practice.

National Institute for Independent organisation responsible for providing national Health and Clinical guidance on promoting good health and preventing and treating Excellence ill health.

56 NHS Outcomes Document setting the outcomes and indicators used to hold Framework providers of healthcare to account, providing financial planning and business rules to support the delivery of NHS priorities.

Patient-reported Self-reporting by patients on outcomes following treatment and outcome measures satisfaction with treatment received.

Here to help/PALS Informal complaint, concern and query service which gives advice and helps patients with problems relating to the access to healthcare services.

57 Virgin Care delivers more than 400 NHS and social care services with a difference across England. For more information on our services or to find out more about the difference we’ve made visit www.virgincare.co.uk.

Virgin Care The Heath Business and Technical Park Runcorn Cheshire WA7 4QX

www.virgincare.co.uk