Director of Infection Prevention and Control Annual Report 1 April 2017 - 31 March 2018

Meeting Board of Directors Date 18 September 2018 Agenda item 13 Lead Director Paula Simpson, Director of Nursing and Quality Improvement Claire Wedge, Deputy Director of Nursing Author(s) Annie Baker, Infection Prevention and Control and Patient Safety Manager

To Approve To Note To Assure

Link to strategic objectives & goals - 2017-19 Please mark against the strategic goal(s) applicable to this paper Our Patients and Community - To be an outstanding trust, providing the highest levels of safe and person-centred care We will deliver outstanding, safe care every time  We will provide more person-centred care We will improve services through integration and better coordination Our People - To value and involve skilled and caring staff, liberated to innovate and improve services We will improve staff engagement We will advance staff wellbeing

We will enhance staff development  Our Performance - To maintain financial sustainability and support our local system We will grow community services across Wirral, Cheshire & Merseyside We will increase efficiency of corporate and clinical services

We will deliver against contracts and financial requirements 

Link to Principal Risks in the Board Assurance Framework - please mark against the principal risk(s) - does this paper constitute a mitigating control?

Failure of organisations across the system to delegate appropriate authority to support the integrated care system (Healthy Wirral) Failure to engage staff to secure ownership of the Trust’s vision and strategy Increasing fragility of the social care market

The impact of the outcome of the Urgent Care Review compromising financial stability and the future model of care Services fail to remain compliant with the CQC fundamentals of care leading to patient safety incidents and regulatory enforcement action and a loss of public and system  confidence

Inability to implement the Trust’s clinical transformation strategy and preferred model of care - Neighbourhood care

Commissioning decisions do not promote integrated working across the health and care system

Failure to build the workforce skills and infrastructure to transform services to meet the demographic needs of the workforce and population

Security of public health funding and subsequent contractual decisions impacting on the range of services provided to Wirral & Cheshire East

Failure to foster, establish and manage the right partnerships that enable a response to commissioning intentions

Development of place-based care outside of Wirral, limits the Trust’s ability to expand/retain services in these areas

Failure to deliver the efficiency programme

Failure to achieve all the relevant financial statutory duties

The impact of the outcome of the Carter Review on community services benchmarking on commissioning decisions

Impact of supporting the delivery of the 3-year financial plan and future sustainability of the Wirral system

Link to the Organisational Risk Register (Datix) Risk ID 1637 – Hand Hygiene compliance reporting from SystmOne.

Has an Equality Impact Assessment been  completed? Yes No

Paper history Submitted to Date Brief Summary of Outcome Report submitted annually

Director of Infection Prevention and Control Annual Report 01 April 2017 - 31 March 2018

Purpose

1. The purpose of this this paper is to provide assurance to Wirral Community NHS Foundation Trust Board regarding the Infection Prevention and Control activity undertaken across the organisation for the reporting period 01 April 2017 – 31 March 2018.

Executive Summary

2. This is the seventh Director of Infection Prevention and Control (DIPC) Annual Report for Wirral Community NHS Foundation Trust and is a statutory requirement within The Health and Social Care Act 2008 Code of Practice on the Prevention and Control of Infections and related guidance.

Board action

3. The board is asked to be approve the Infection Prevention Control Annual Report 01 April 2017 – 31 March 2018

Paula Simpson Director of Nursing and Quality Improvement

Contributors Claire Wedge Deputy Director of Nursing

Annie Baker Infection Prevention Control and Patient safety Manager

28 August 2018

Director of Infection

Prevention

and Control

Annual Report

2017/2018

DIPC Annual Report 2016-17 1

Contents

INTRODUCTION ...... 3

CRITERION 1...... 4 IPC Reporting Structure ...... 5 Key Achievements ...... 6

CRITERION 2...... 6 Cleaning Services ...... 6 Environmental Audit ...... 7 Decontamination of Medical Devices ...... 7

CRITERION 3...... 7 Anti-Microbial Resistance (AMR) ...... 8

CRITERION 5...... 9 Gram Negative Blood Stream Infections (GNBSIs) ...... 9 MRSA ...... 10 Clostridium Difficile ...... 10 Antiviral Provision within Care Homes 2017/2018 ...... 12

CRITERION 6...... 12 Essential Steps ...... 12 Hand Hygiene ...... 12 Aseptic Non-Touch Technique (ANTT): ...... 12 Infection Prevention and Control Training ...... 13 Inoculation Incidents ...... 13

CRITERION 7...... 15

CRITERION 8...... 15

CRITERION 9...... 15

CRITERION 10 ...... 16 Occupational Health Service (OHS) ...... 16 Staff Influenza Campaign ...... 16

RECOMMENDATIONS ...... 17

CONCLUSION ...... 17

DIPC Annual Report 2017-18 2

INTRODUCTION

Health & Social Care Act Code of Practice

The Health and Social Care Act (H&SCA) Code of Practice on the prevention and control of infections contains statutory guidance regarding compliance with the registration requirement relating to prevention and control of infection (see table below). The law states that the Code must be taken into account by the Care Quality Commission (CQC) when it makes decisions about registration against infection prevention requirements. Registered providers must demonstrate compliance with the Code to ensure that the premises where care and treatment are delivered are clean, suitable for the intended purpose to deliver safe, effective care or treatment to prevent avoidable harm or risk of harm.

Criterion Description

1 Systems to manage and monitor the prevention and control of infection. These systems use risk assessments and consider the susceptibility of service users are and any risks that their environment and other users may pose to them.

2 Provide and maintain a clean and appropriate environment in managed premises that facilitates the prevention and control of infection.

3 Ensure appropriate antimicrobial use to optimise patient outcomes and to reduce the risk of adverse events and antimicrobial resistance

4 Provide suitable accurate information on infections to service users, their visitors and any person concerned with providing further support of nursing/medical care in a timely fashion 5 Ensure prompt identification of people who have or are at risk of developing an infection so that they receive timely and appropriate treatment to reduce the risk of transmitting infection to other people 6 Systems to ensure that all care workers (including contractors and volunteers) are aware of and discharge their responsibilities in the process of preventing and controlling infection. 7 Provide or secure adequate isolation facilities.

8 Secure adequate access to laboratory support

9 Have and adhere to policies designed for the individual’s care and provider organisation, that will help prevent and control infections.

10 Providers have a system in place to manage the occupational health needs and obligations of staff in relation to infection.

The Infection Prevention and Control Service endeavours to provide a wide-ranging, integrated and proactive service, which is responsive to the needs of staff and public alike, and is committed to the promotion of excellence within everyday practice of Infection Prevention and Control.

DIPC Annual Report 2017-18 3 Reducing the risk of infection through robust infection control practice is a key priority for Wirral Community NHS Foundation Trust and supports the provision of high quality services for patients and a safe working environment for staff.

The report provides assurance of the continual commitment to the prevention and control of infection within all services to achieve positive outcomes.

CRITERION 1 Systems to manage and monitor the prevention and control of infection, these systems use risk assessments and consider the susceptibility of service users and any risks that their environment and other users may pose to them

The Director of Nursing and Quality Improvement is the Director of Infection Prevention and Control and is supported by the Deputy Director of nursing who is the designated Operational Director for Infection Prevention and Control.

Infection Prevention and Control Service 2017/18: • Infection Prevention Control and Patient Safety Manager (1.0 WTE) • Senior Administrative Assistant (0.73 WTE) • Administrative Assistant (1.0 WTE)

Performance against the Health Economy Infection Prevention and Control service specification is reported separately via the Local Authority contracting process.

Health Protection Strategy Group

During the 2017/2018 period, a review of IPC governance and assurance was conducted by the Director of Infection Prevention and Control (DIPC). Following this review a Health Protection Strategy Group was established, acknowledging and reflecting the increased priority of the wider health protection remit across the Wirral health and social care economy.

The Health Protection Strategy Group meets quarterly and is chaired by the DIPC.

The minutes of the Health Protection Strategy Group (HPSG) go to the Quality and Safety Committee.

The HPSG will:

• Ensure that Health Protection (including infection prevention and control) is at the forefront of service planning and delivery • Assure the Trust that the appropriate systems are in place to enable it to meet its statutory requirements in respect of infection prevention and control • Discuss relevant national recommendations, directives and statutory guidelines for infection control and advise the trust on any implications of legislation, key government documents, national enquiries and external inspecting bodies. (e.g. Care Quality Commission) or external reviews • Ensure there are agreed systems, standards and protocols in place to enable concerns to be escalated appropriately when not acted upon in accordance with approved multi-agency procedures • Support the Infection Prevention and Control Lead to deliver against the Code of Practice • Approve and recommend Trust wide protocols and initiatives • Monitor and review the IPC assurance framework • Approve the annual IPC work plan • Support the delivery of the Antimicrobial Strategy and promote prudent antimicrobial stewardship

DIPC Annual Report 2017-18 4

IPC Reporting Structure

Wirral Community NHS Foundation Trust’s reporting structure for Infection Prevention and Control:

Trust Board

Quality and Safety Committee

Health Protection Strategy Group (Quarterly)

Director of Nursing and Quality / Director of Infection Prevention and Control

Deputy Director of Nursing

Infection Prevention Control and Patient Safety Manager

The Infection Prevention and Control Service work closely with trust services to ensure high standards of infection prevention and control are embedded into all areas. As part of this collaboration, the Infection Prevention and Control Service are represented at both trust, and across Wirral health economy meetings with the following meetings being attended by an Infection Prevention and Control Lead:

Organisation Group Wirral Community NHS Catheter Associated Urinary Tract Infection (CAUTI) Group Foundation Trust Clinical Effectiveness Group (CEG) Divisional Quality, Patient Experience and Risk (QPER) Monthly Divisional Exception report meetings Estates Management Group Health, Safety & Wellbeing Group Learning and Development Group Medicines Management Group Medical Supplies & Devices Group Clinical Governance Assurance Group Resilience Action Group Staff Influenza Vaccination Programme Sepsis Quality Improvement Group Wirral Clinical Commissioning Care Home RAG Meeting Group Contract Meeting Clostridium Difficile Case Review Group MRSA Bacteraemia Post Infection Review Group Wirral Infection Control Network Wirral Antimicrobial Strategy Group DIPC Annual Report 2017-18 5 Wirral Seasonal Influenza Group Wirral Antimicrobial Resistance Group Public Health England Health Care Associated Infections Network

NHS England Infection Control Strategic Collaborative Antenatal and New born Screening Programme Wirral University Teaching Hospital Infection Control Committee Hospital NHS Foundation Trust

Key Achievements

• Zero WCT assigned MRSA bacteraemia reported during this reporting period • Zero cases of Clostridium Difficile attributed to lapses in care by services that the trust provide • Achievement of CQUIN target, with 71.2% uptake for staff influenza immunisation • Successful delivery of Hand Hygiene Day in May 2017 • Delivery of promotional activities for Infection Control Week during October 2017 • Full compliance achieved with IPC elements of the trust’s Quality schedule

In addition to internal trust activity, in accordance with the local authority annual commissioned objectives, the Infection, Prevention and Control Service (IPCS) have completed the following: • Development of a robust communications and training plan • Development of a Quality Improvement Programme (QIP) in older persons care homes to support a culture of continuous quality improvement with 16 homes being invited to participate • A comprehensive self-audit programme was developed and implemented across older persons care homes, general practitioners and general dental practices • Delivery of a targeted training programme to high risk care home providers identified to participate in the QIP • Delivery of an IPC programme of activity during infection control week • Delivery of World Hand Hygiene Day using a variety of media communications • Engagement with partners on a variety of levels including Healthwatch Wirral, Primary Care, Department of Adult Social Services (DASS), WCCG and the Care Quality Commission (CQC) • Continued development of a whole economy approach to IPC strengthening collaborative working with Wirral University Teaching Hospitals NHS Foundation Trust (WUTH) Infection prevention and Control team (IPCT)

CRITERION 2 Provide and maintain a clean and appropriate environment in managed premises that facilitates the prevention and control of infection

The Infection Prevention and Control Service continued to provide support to the estates team during 2017/2018 as required.

Cleaning Services

Domestic services in trust premises continue to be provided by Cheshire and Wirral Partnership NHS Foundation Trust.

In areas not managed by the trust but where services are hosted; issues or concerns that are identified are raised with the Estates Team for resolution via Datix, patient experience and feedback.

The quality of the cleaning services is monitored through environmental audits conducted by IPC lead, any areas for improvement are monitored via an action plan and monitored by IPC lead.

DIPC Annual Report 2017-18 6 Environmental Audit

Infection Prevention and Control clinical audit is an integral element of Infection Prevention and Control practice as it allows the trust to measure compliance against national standards.

From November 2017 to March 2018 the IPC lead audited 4 trust premises using an audit tool adapted from the Infection Prevention Society Quality Improvement Tool which reflects local policy.

Of the 4 premises audited, an action plan was produced by the Infection Prevention and Control Lead identifying areas requiring improvement. All 4 action plans where followed up and all actions were completed by the services, providing assurance as per Trust Audit Assurance pathway, and shared with the Health Protection Strategy Group.

During 2017/2018 50 services conducted environmental self-assessment audits; with 84% compliance with the self-assessment.

Areas for improvement were:

• ordering of spill-wipe to safely manage body fluid spillages • several clinics have fabric covered chairs or furniture identified as needing repair, these sites will be included in 2018/2019 environmental audits and any actions reported to estates

An environmental audit plan has been developed for 2018/2019 and prioritises high risk areas identified from self-assessment audits conducted by services and will implemented during Quarter 3.

Decontamination of Medical Devices

The Director of Infection Prevention and Control is the Trust Decontamination Lead.

The Community Dental Service is compliant with Best Practice Standards set out in The Health Technical Memorandum (HTM 01-05) Decontamination in primary care dental practices.

The Podiatry Service uses an accredited Central Sterile Supply Department (CSSD).

CRITERION 3 Ensure appropriate antimicrobial use to optimise patient outcomes and to reduce the risk of adverse events and antimicrobial resistance

The Trust Medicines Management Team continues to work collaboratively with the pharmacists within the Commissioning Support Unit, to support the review of the Wirral antimicrobial guidelines for primary care. A revised formulary was issued in September 2017. The trust’s prescribing levels of co-amoxiclav, cephalosporins and quinolones (antibiotics associated with a high risk of causing development of clostridium difficile) were bench marked against national prescribing data. This data was expressed as the amount of co-amoxiclav, cephalosporins and quinolones prescribed as a percentage of the total antibiotics prescribed. Please see chart below.

DIPC Annual Report 2017-18 7 Prescribing Data benchmarked against Wirral CCG and national levels Dates for comparative Prescribing data for Prescribing data for high National Prescribing data data high risk antibiotics risk antibiotics- Wirral Wirral Community health & Care NHS Foundation Commissioning Trust Q3 2015 14.9% 15.9% 9.3% Q3 2016 12.3% 13.6% 8.4% Q3 2017 11.3% 11.3% 8.3%

Guidance for prescribers to reduce the prescribing of high risk antibiotics has been embedded within GP Out of Hours SystmOne and communicated via the Medicines Management Bulletin, Principles of Non-Medical Prescribing Training and NMP quarterly Forums. Trust employed staff who prescribe, administer or offer advice on antibiotics are also required to complete antimicrobial stewardship e- learning as part of their mandatory training matrix.

As the prescribing data available for analysis of antibiotic prescribing did not include indications or rationales for choice of antibiotics, further audit was undertaken: A trust-wide point prevalence audit was undertaken for all antibiotics prescribed or supplied under Patient Group Direction on 21 March 2018. Adherence with the locally ratified antimicrobial guidelines was measured. From 30 antibiotics prescribed, 28 were compliant with locally agreed antimicrobial guidelines and 2 of prescribed antibiotics could not be checked as the indication was not recorded on the audit tool.

Anti-Microbial Resistance (AMR)

There was a requirement to reduce gram negative blood stream infections by 10% across the health economy during 2017/18 increasing to a 50% reduction by 2021.

The system-wide IPC provider forum chaired by the trust’s Deputy Director of Nursing, have developed a gram negative improvement action plan, this action plan will be updated by the Wirral Wide Provider Forum during Quarter 2 2018/2019.

To promote antimicrobial stewardship, the Governance Pharmacist reviewed an e-learning module “Reducing Antimicrobial Resistance: an introduction”.

This module is now mandatory for all clinical staff. The competency requirements has been added to staff records on ESR and compliance will be reported in IPC Report 2018/2019

As part of the on-going work to support the national ambition to reduce Gram Negative Blood Stream Infections (GNBSIs) across the health economy, the IPCS produced and distributed a range of materials and utilised resources to highlight the importance of hydration, this included:

• Hydration article in WCT’s Chief Executives Wirral Globe health column, this edition was guest edited by the WCT’s Director of Nursing and Quality Improvement

• A hydration Patient Information Leaflet (PIL) was produced and is available on the trusts public website

• A hydration poster was produced to be displayed in prominent public locations, during this reporting period this has been shared with all council leisure centres and golf courses, GP practices, libraries & one stop shop, care homes, supported living and domiciliary care

DIPC Annual Report 2016-17 8

providers. Further distribution will occur throughout 2018-19 and will be included in future reports

The IPCS also produced a patient information leaflet explaining how patients should obtain a Mid- stream Specimen of Urine (MSU) to further support the national ambition to reduce Gram Negative Blood Stream Infections.

CRITERION 4 Provide suitable accurate information on infections to service users,

As part of the World Health Organization’s Save Lives Clean Your Hands campaign on 5th May 2017, the IPCS promoted awareness of hand hygiene to a number of community based health and social care providers, and a local primary school. Stands were set up at St Catherine’s Health Centre and Victoria Central Health Centre where various literatures were available to take away. Members of the IPCS were available to offer advice and support, and demonstrate hand washing technique using the ultra-violet light box. Interesting and informative hand hygiene facts were also sent via Twitter throughout the day.

The IPCS promoted Infection Prevention and Control Week during October 2017 and visited a number of care homes and general practices. In total 21 care homes and 7 general practices were visited by a member of the IPCS to promote the service and key IPC messages. A range of promotional material and resources were provided at each visit. A letter was sent via email to early year’s providers, primary and special needs schools to promote hand hygiene within the setting with a particular focus on promoting effective hand washing with children. A range of resources were shared including links to child themed posters and literature, the updated Public Health England ‘Health protection in schools and other childcare facilities’ and hand hygiene posters.

CRITERION 5 Ensure prompt identification of people who have or at risk of developing an infection so that they receive timely and appropriate treatment to reduce the risk of transmitting infection to other people

Wirral Community NHS Foundation Trust did not have HCAI objectives set at national or local level for MRSA or Clostridium Difficile. All community attributed cases were reported against Wirral Clinical Commission Groups’ (Wirral CCG) objective. Wirral Community NHS Foundation Trust has set an internal target of zero avoidable healthcare associated infections in the services that it provides and this target was achieved during 2017/18.

Gram Negative Blood Stream Infections (GNBSIs)

NHS Improvement, on behalf of the Secretary of State for Health & Social Care, launched the Government’s ambition to reduce healthcare associated GNBSIs and antimicrobial prescribing by 50% by 2021. An initial focus on reducing Escherichia coli bloodstream infections by 10% in year one was introduced as they represent 55% of all GNBSIs with approximately 75% of those occurring outside of the hospital setting.

To support this NHS England has introduced a quality premium;

Part a - reduce gram negative blood stream infections (BSI) across the whole health economy Part b - reduction of inappropriate antibiotic prescribing for urinary tract infections (UTI) in primary care

WCT’s IPCS supported Wirral Health & Care Commissioning (WHCC) ambition through a collaborative pilot with colleagues at WUTH. A pilot was undertaken across both community and hospital IPC teams to identify key themes and trends in GNBSIs, focussing on E.coli bacteraemia from post infection reviews.

DIPC Annual Report 2017-18 9 The outcome of this pilot identified urinary tract Infections (UTIs) as being the main cause of E.coli bacteraemia. 18 community cases were reviewed with the following being identified: • 50% of patients had an identified cause of urinary tract which mirrors the national picture • 28% of patients were male • 72% of patients were female • 11% of patients were care homes residents • 50% of patients were over 65 years of age • 6% of patients had a urinary catheter insitu • 6% of patients had a vascular access device insitu

Actions were discussed and agreed including promotion of hydration needs using a variety of media across the health economy. Work has commenced and will continue throughout 2018-19.

MRSA

A zero tolerance approach of preventable MRSA blood stream infections remains one of the Government’s key priorities.

A Post Infection Review (PIR) is undertaken for all cases of MRSA Bacteraemia. The IPCS lead these reviews where they are identified within the first 48 hours of hospital admission. The purpose of the review is to identify how a case occurred and to identify actions that will prevent similar cases reoccurring in the future. The outcome of the review will determine learning outcomes and attribute responsibility for the case.

There were no WCT assigned MRSA bacteraemia reported during this period.

Figure 1: Annual incidence of Trust MRSA Bacteraemia 2005-2018

Clostridium Difficile

Wirral Clinical Commissioning Group’s health economy target was set as no more than 75 cases of Clostridium difficile during 2017/18, of which 45 were allocated to non-acute care.

DIPC Annual Report 2017-18 10 During the period 01 April 2017 to 31 March 2018 there were 62 pre-72 hour Clostridium difficile toxin positive cases reported to the IPCS via WUTH IPCT.

Figure 2: Pre-72 hour Clostridium difficile toxin positive/clinical cases 2007- 2018

A review of the 2017-18 data has shown the following: • 64% of patients had been in hospital in the 12 week preceding infection • 66% of patients had received antibiotics in the 12 weeks preceding infection • 27% of patients resided in a care home • 73% of patients resided in their own home. • 42% of patients were male • 58% of patients were female • 82% of patients were over the age of 65 • 15% of patients were previous toxin positive cases

All toxin positive and equivocal cases of community attributed Clostridium difficile are followed up by the IPCS. PIRs are completed in all reported community attributed toxin positive and infection control expertise is offered to GPs as required in the management of their patient. Providers are asked to place an alert on the patient record in order to prompt caution for future prescribing.

All patients diagnosed with Clostridium difficile are offered the opportunity to access advice and support from the IPCS and are provided with a patient information leaflet developed by the service. During this reporting period, zero patients requested a visit by the IPCS.

Antibiotics remain a common theme in cases of Clostridium difficile infection with urinary tract infection (UTI) and respiratory tract infection (RTI) being the two most common clinical presentations where antibiotics were prescribed. 45% of patients received antibiotics for UTI and 24% of patients received antibiotics for RTI.

A bi-annual IPC newsletter focussed on Clostridium difficile with the aim of improving understanding and awareness of steps to be taken when presented with a patient or resident who has unexplained diarrhoea not attributed to any other cause. The IPCS also designed a poster highlighting the importance of using the SIGHT mnemonic which was shared with health and social care staff across the health economy.

Wirral health economy experienced an increase in the number of cases of clostridium difficile infection from 49 cases during 2015/16 to 62 cases throughout 2017/18. Reducing Clostridium infection rates remains a high priority for Wirral Health Protection Group and the IPCS will continue to work with DIPC Annual Report 2017-18 11 providers and commissioners in supporting a reduction of cases throughout 2018/19, NHS Improvement (NHSI) guidelines have reduced the number of cases from 75 cases to 74 cases during 2018/2019.

Antiviral Provision within Care Homes 2017/2018

Flu outbreaks in nursing and care homes formed part of the winter planning arrangements for 2017/2018. When an outbreak of influenza like illness in a nursing or care home was declared, the local Public health England (PHE) Health Protection Team undertook a risk assessment and where appropriate recommended the use of antivirals for treatment of cases, and prophylaxis for close contacts in nursing and residential care homes.

During 2017/2018, a total of 376 care home residents were prescribed prophylactic antiviral medication and 6 residents received treatment doses for antiviral medication. During April 2018, 33 residents were treated with prophylactic antiviral medication. The Department of Health & Social Care issued a CAS Alert CEM/CMO/2018/003 which declared to stop prescribing anti-viral medication as circulation of influenza virus in the community has returned to baseline levels. For 2018/2019 Wirral Community NHS Foundation Trust will be working with the CCG to develop a system wide approach for anti-viral prescribing for nursing and care homes.

CRITERION 6 Systems to ensure that all care workers (including contractors and volunteers) are aware of and discharge their responsibilities in the process of preventing and controlling infection

Essential Steps

Essential Steps is a framework that allows the trust to measure compliance with the following Infection Prevention and Control standards to ensure the quality and safety of clinical interventions;

• Hand hygiene • Personal protective equipment (PPE) • Aseptic non-touch technique (ANTT) • Safe disposal of sharps

The current process for recording essential steps compliance is under review (Risk ID 1637). A task and finish group has been established to develop and implement a protocol to ensure compliance is recorded and reported effectively.

Hand Hygiene

Improvement in hand hygiene practices continues to be a priority for Wirral Community NHS Trust. The Infection Prevention and Control Service continue to promote hand hygiene through: • continuing to promote the World Health Organisations (WHO) 5 moments for hand hygiene • completion of hand hygiene clinical observational audit four times per year • promotion of Bare Below the Elbow through screen savers, training and Safety Sound Bite • leadership walkabouts to observe compliance across the trust

Aseptic Non-Touch Technique (ANTT)

The trust purchased a one year licence in February 2018 to deliver Aseptic Non-Touch Technique (ANTT) e-learning. The aim is to:

• standardise aseptic technique for all clinical services to promote high quality harm free care • reduce variations in practice • protect patients from preventable healthcare associated infections

DIPC Annual Report 2017-18 12 • provide education and training for clinical staff to ensure staff follow IPC 5 policy for ANTT

The completion date for all staff is 31 March 2019. Compliance with training will be monitored by the IPC and Education leads reported to Divisional Managers via the monthly QPER report.

Infection Prevention and Control Training

Infection Prevention and Control training is mandatory for all staff. It is undertaken bi-annually using a national E-learning programme.

Clinical staff are required to complete Level 1 and 2 modules and non-clinical staff are required to complete Level 1 module.

Figure 3: Completion of Mandatory Training via E-Learning 01 April 2017- 31 March 2018

NHS|CSTF|Infection NHS|CSTF|Infection Prevention and Control - Prevention and Control - Level 1 - 3 Years| Level 2 - 2 Years| Eligible Eligible Competency Competency number of number of completed completed staff staff 844 Adult & Community Services 565 469 481 378 844 Board 11 11 844 Corporate Services 134 129 13 11 844 Integrated Children's Division 361 341 322 295 844 Urgent & Primary Care Services 266 222 175 140 Grand Total 1345 1174 991 824 87% 83%

To improve compliance for mandatory IPC e-learning and the trust quality strategy; the IPC lead will be shadowing services to raise the importance of preventing Health Care Associated Infections (HCAI) and improve compliance with IPC standards.

FFP3 training

To comply with health and safety legislation it is a requirement that staff who may be required to wear an FFP3 respirator are trained by a competent fit tester. To support the trusts emergency resilience work stream, a one day Fit Test training event was provided in February 2018 to nominated individuals using a “train the trainer” style approach.

Inoculation Incidents

There were 22 inoculation incidents reported via the trust’s incident reporting system during 01 April 2017 – 31 March 2018. Figure 5 highlights that there has been an increase in the number of staff reporting injuries that carry the risk of exposure to blood born virus.

DIPC Annual Report 2017-18 13 Figure 5: Inoculation Incidents 2012-2018

The trust has fully implemented the EU Council Directive 2010/32/EU Health and Safety (Sharps Instruments in Healthcare) Regulations 2013. From analysis of reported incidents, one emerging theme relates to user error of staff or patients.

Analysis of the data has highlighted that within community nursing patients who self-administer insulin are passing used needle back to the nurse for the nurse to dispose of the needle into the sharps container. This contravenes IPC4 Management of Inoculation Injuries including Safe Management of Sharps Policy, which clearly states that never pass sharps from hand to hand.

To disseminate the learning from these incidents, a Safety Sound Bite has been written and circulated across the trust. This approach has been successful in sharing key learning points throughout the trust, and will be expanded further during the 2018/19 period.

A yearly audit conducted by Daniels regarding sharp containers also highlighted areas for improvement. In addition, lessons learnt from these incidents are included within clinical training Administration of Medicines for community nurses.

There were 12 infection control incidents reported via the trust’s incident reporting system during 01 April 2017 – 31 March 2018. Figure 6 shows that there has been a decrease in the number of incidents reported.

With the exception of the theme document in relation to inoculation incidents, no trends have been identified from reported IPC incidents. Maximising learning to enhance delivery of safe clinical care in relation to IPC will be a focus during the 2018/19 period.

DIPC Annual Report 2016-17 14

Figure 6: Infection Control Incidents 2012-2018

CRITERION 7 Provide or secure adequate isolation facilities

There have been no outbreaks relating to trust staff or premises during the reporting period 01 April 2017 - 31 March 2018.

This section is not applicable to the Trust.

CRITERION 8 Secure adequate access to laboratory support as appropriate

Not applicable to community trust

CRITERION 9 Have and adhere to policies, designed for the individual’s care and provider organisations that will help to prevent and control infections

The following polices where reviewed and approved during the reporting period 01 April 2017 - 31 March 2018: • ICP 1 Operational Policy Infection Prevention and Control • ICP 2 Hand Hygiene • ICP 3 Use of Personal Protective Equipment • ICP 4 Management of Inoculation Incidents (Including Safe Management of Sharps) • IPC 6 Single use Medical Device Policy DIPC Annual Report 2016-17 15

• ICP 7 Cleaning and Disinfection Policy • ICP10 Meticillin Resistant Staphylococcus Aureaus (MRSA) Policy

The following IPC Policies will be updated during 2018/2019:

• IPC8 Sterilisation of Re-usable Medical Devices • IPC 13 Policy for the Prevention and Management of Clostridium Difficile Infection • IPC15 Policy for Aseptic Non Touch Technique • IPC16 Guidance on Infection Control in the Built Environment • IPCG1 Care after Death – (IPCG:1) Infection Prevention Control Guidance

CRITERION 10 Providers have a system in place to manage the occupational health needs and obligations of staff in relation to infection

Occupational Health Service (OHS)

The OHS have the responsibility:

• To advise/immunise WCT personnel who are referred to OHS by their Manager in accordance with work place health/Occupational Health protocol; • To provide risk management advice including where necessary advice on work restrictions/redeployment; • Advise the healthcare worker (HCW) regarding the risk of the exposure and the indications for prophylaxis; • Manage the follow up, monitoring, testing and vaccination for HCWs who have sustained a high risk exposure whether or not Post Exposure Prophylaxis (PEP) was commenced; • Offer support and arrange counselling if required to all HCWs who have sustained an occupational exposure to blood/body fluids;

Staff Influenza Campaign

The Project Management Team led the coordination and planning of the staff seasonal influenza campaign and facilitated the Staff Flu Group which met regularly to plan the campaign. To ensure staff had maximum opportunity to obtain a flu vaccine, sessions where delivered in a variety of ways: • provision of drop in staff vaccination clinics across trust locations covering all shift patterns across 7 day working including nights • additional vaccination sessions at staff bases • opportunistic vaccination

The 2017/18 staff seasonal flu CQUIN required all NHS trusts to improve the uptake of flu vaccinations for frontline clinical staff and achieve 70% uptake amongst reportable staff groups in year 1, increasing to 75% in year 2. Wirral Community NHS Trust achieved 71.2% of staff immunised which is a significant improvement on uptake seen in 2016-17.

A robust, dynamic plan for the 2018/19 programme has been developed, incorporating learning and feedback from staff and services from the 2017/18 campaign. There will be enhanced utilisation of communications throughout the programme to fully engage staff. To improve flu uptake from divisions where services had a poor uptake from last year’s flu campaign, this will be discussed at Divisional Quality and Patient Experience (QPER) meetings.

DIPC Annual Report 2017-18 16

RECOMMENDATIONS

• To continue to strengthen collaboration and engagement with partners across the health and social care system, providing enhanced clinical leadership and visibility to influence system changes within an integrated, whole economy approach to IPC • Development and implementation of 2018/2019 IPC improvement plan, providing trust assurance with compliance across all areas of the Code of Practice on the prevention and control of infections • Enhance visible IPC leadership and clinical expertise throughout the trust, embedding IPC into all clinical activities, positively influencing cultural change, through leadership walkabouts and shadowing of clinical services • Active contribution to the development and implementation of a Wirral Health Economy Gram Negative Blood Stream Infection (GNBSI) Improvement Plan • Maximise lessons learned from incident reporting and post infection reviews to reduce rates of healthcare acquired infections • Expansion of the delivery of clinical training directly to community nursing teams, including dissemination of lessons learned from incident reporting • Increase compliance with IPC mandatory training – levels 1 and 2 • To confirm all clinical staff have completed ANTT training • To review premises and clinics during 2018/2019 and develop an environmental audit programme to review high risk areas and implement National Standards across all services • To pilot My Audit mobile app/My Perfect Ward to assess if suitable for hand hygiene audit and all aspects of essential steps • To lead on the CQUIN for improving the uptake of the flu vaccination for frontline clinicians within provider services (75%) • To update all IPC policies and procedures and ensure they are up to date and comply with Health and Social care Act 2008 (Regulated Activities) Regulations 2014: Code of practice on the Prevention and Control of Infections and related guidance • Continue to monitor IPC incidents to disseminate the learning across the trust

CONCLUSION

Wirral Community NHS Foundation Trust is committed to continuous quality improvement to ensure sustainable improvement in Infection Prevention and Control practice whilst supporting a zero tolerance of avoidable infection and harm to our patients and staff.

HCAI reduction and improvement of Infection Prevention and Control standards requires a multi- partnership approach within the health economy of Wirral and the trust remains committed to support this agenda.

The Health Protection Strategy Group to monitor compliance with all infection prevention and control standards and quality improvements

Paula Simpson Director of Nursing and Quality Improvement

Contributors: Claire Wedge, Deputy Director of Nursing Annie Baker, Infection Prevention Control and Patient Safety Manager

28/08/2018

DIPC Annual Report 2017-18 17

Delegation of authority to Quality & Safety Committee for submission of EPRR annual return

Meeting Board of Directors Date 18 September 2018 Agenda item 14 Lead Director Val McGee, Chief Operating Officer (Accountable Emergency Officer) David Hammond, Associate Director of Partnerships & Strategic Author(s) Development

 To Approve To Note To Assure

We will improve staff engagement

We will advance staff wellbeing

We will enhance staff development

Our Performance - To maintain financial sustainability and support our local system

We will grow community services across Wirral, Cheshire & Merseyside

We will increase efficiency of corporate and clinical services

We will deliver against contracts and financial requirements 

Link to Principal Risks in the Board Assurance Framework - please mark against the principal risk(s) - does this paper constitute a mitigating control? Failure of organisations across the system to delegate appropriate authority to support the integrated care system (Healthy Wirral)

Failure to engage staff to secure ownership of the Trust’s vision and strategy

Increasing fragility of the social care market The impact of the outcome of the Urgent Care Review compromising financial stability and the future model of care

Services fail to remain compliant with the CQC fundamentals of care leading to patient safety incidents and regulatory enforcement action and a loss of public and system confidence

Inability to implement the Trust’s clinical transformation strategy and preferred model of care - Neighbourhood care

Commissioning decisions do not promote integrated working across the health and care system Failure to build the workforce skills and infrastructure to transform services to meet the demographic needs of the workforce and population

Security of public health funding and subsequent contractual decisions impacting on the range of services provided to Wirral & Cheshire East Failure to foster, establish and manage the right partnerships that enable a response to commissioning intentions

Development of place-based care outside of Wirral, limits the Trust’s ability to expand/retain services in these areas

Failure to deliver the efficiency programme

Failure to achieve all the relevant financial statutory duties

The impact of the outcome of the Carter Review on community services benchmarking on commissioning decisions

Impact of supporting the delivery of the 3-year financial plan and future sustainability of the Wirral system

Link to the Organisational Risk Register (Datix)

Has an Equality Impact Assessment been  completed? Yes No

Paper history Submitted to Date Brief Summary of Outcome

Delegation of authority to Quality & Safety Committee for submission of EPRR annual return

Purpose

1. The purpose of this report is to:

• Request that Board approve the delegation of WCT’s 2018/19 Emergency Preparedness, Resilience & Response (EPRR) submission to the Trust’s Quality & Safety Committee, and • Advise Board of a change in the Trust’s Accountable Emergency Officer (AEO).

Background

2. WCT must maintain a state of emergency preparedness and resilience, measured against the NHS EPRR Core Standards.

3. The Trust is further required to: • Undertake an annual self-assessment against these core standards identifying its level of compliance • Submit an action plan addressing any areas of improvement • Complete the a statement of compliance identifying the organisations overall level of compliance

4. By 4 October 2018, WCT must submit its annual self-assessment, action plan and statement of compliance against the 2018/19 standards to NHS England.

5. As stated by NHSE, the organisation’s overall assurance rating should be: • signed off by the organisation’s Board • presented at a public Board meeting • published in the organisation’s annual report.

6. The organisation’s EPRR self-assessment should be shared with the Local Health Resilience Partnership (LHRP) and relevant Clinical Commissioning Groups, and should consist of the following: • self-assessment against individual core standards relevant to their organisation type • action plans to ensure full compliance with all core standards • overall assurance rating • Board report

7. In 2017, to provide additional assurance to Board, Quality & Safety Committee’s remit was expanded to include the annual review of the Trust’s self-assessment.

8. Board will next meet on 7 November 2018, which will be too late to approve the submission of the annual return.

9. Board is requested to delegate the approval of the WCT’s 2018/19 submission to September’s Quality & Safety Committee. Board will then receive the submitted return for noting in November 2018.

Change in trust Accountable Emergency Officer (AEO)

10. NHS England expects all NHS funded organisations to have an AEO with regard to EPRR. The AEO will be a Board level director responsible for EPRR. They will have executive authority and responsibility for ensuring that the organisation complies with legal and policy requirements.

11. The AEO will provide assurance to the Board that strategies, systems, training, policies and procedures are in place to ensure an appropriate response for their organisation in the event of an incident.

12. From June 2017 to June 2018, the role of AEO was fulfilled by David Hammond, the Trust’s Interim Director of Business Development & Strategy. Since this post has been removed from the Board structure, the role of AEO is fulfilled by Val McGee, COO.

13. David Hammond, as Associate Director of Partnerships & Strategic Development reporting to Val McGee as COO, has maintained responsibility for the duties and decision-making associated with AEO role.

Board action

14. The Board of Directors is requested to: • Delegate the approval of the WCT’s 2018/19 submission to September’s Quality & Safety Committee. • Note 1) the change in Trust Accountable Emergency Officer and 2) that the Associate Director of Partnerships and Strategic Development has delegated authority and responsibility for duties associated with the AEO role.

Val McGee Chief Operating Officer (Accountable Emergency Officer)

David Hammond Associate Director of Partnerships & Strategic Development

10 September 2018

Care Quality Commission (CQC) Statement of Purpose

Meeting Board of Directors Date 18 September 2018 Agenda item 15 Lead Director Paula Simpson, Director of Nursing and Quality Improvement Author(s) Claire Wedge, Deputy Director of Nursing and Quality Improvement

 To Approve To Note To Assure

Link to strategic objectives & goals - 2017-19 Please mark against the strategic goal(s) applicable to this paper Our Patients and Community - To be an outstanding trust, providing the highest levels of safe and person-centred care  We will deliver outstanding, safe care every time  We will provide more person-centred care We will improve services through integration and better coordination Our People - To value and involve skilled and caring staff, liberated to innovate and improve services We will improve staff engagement We will advance staff wellbeing We will enhance staff development

Our Performance - To maintain financial sustainability and support our local system We will grow community services across Wirral, Cheshire & Merseyside We will increase efficiency of corporate and clinical services  We will deliver against contracts and financial requirements

Link to Principal Risks in the Board Assurance Framework - please mark against the principal risk(s) - does this paper constitute a mitigating control?

The impact of the outcome of the Urgent Care Review compromising financial stability and the future model of care

Services fail to remain compliant with the CQC fundamentals of care leading to patient  safety incidents and regulatory enforcement action and a loss of public and system confidence

Inability to implement the Trust’s clinical transformation strategy and preferred model of care - Neighbourhood care

Commissioning decisions do not promote integrated working across the health and care system

Failure to build the workforce skills and infrastructure to transform services to meet the demographic needs of the workforce and population

Security of public health funding and subsequent contractual decisions impacting on the range of services provided to Wirral & Cheshire East

Failure to foster, establish and manage the right partnerships that enable a response to commissioning intentions

Development of place-based care outside of Wirral, limits the Trust’s ability to expand/retain services in these areas

Failure to deliver the efficiency programme

Failure to achieve all the relevant financial statutory duties

The impact of the outcome of the Carter Review on community services benchmarking on commissioning decisions

Impact of supporting the delivery of the 3-year financial plan and future sustainability of the Wirral system

Link to the Organisational Risk Register (Datix)

Has an Equality Impact Assessment been  completed? Yes No

Paper history Submitted to Date Brief Summary of Outcome

Care Quality Commission (CQC) Statement of Purpose

Purpose

1. The purpose of this paper is to seek approval from Wirral Community NHS Foundation Trust Board for changes to be made to the trust’s CQC statement of purpose.

Executive Summary

2. The CQC is the regulator of health and adult social care in England and ensures:

• Services meet fundamental standards that people have a right to expect whenever they receive care • Care services are registered • Monitoring, inspecting and regulating of care services to ensure they continue to meet the standards • Reporting on the quality of care services, publishing clear and comprehensive information, including performance ratings to help people choose care.

3. The regulations are mapped against 5 key CQC domains of safe, caring, responsive, effective and well-led.

Registration

4. Following a review of the contractual model for the Sexual Health Wirral Service, it has been identified that a consistent approach to governance across the integrated service is required.

5. All Trust subcontractors are required to be independently registered with the CQC for regulated activity.

6. Wirral Brook will independently register with the CQC for the delivery of regulated activities at the Wirral Brook location: Wirral Brook, 14 Whetstone Lane, Birkenhead, Wirral, CH41 2QR

7. Wirral Brook registration with the CQC will be supported by a concurrent process of de- registration of Wirral Brook from the Trust’s CQC registration.

8. The following changes have therefore been made to the trusts CQC statement of purpose:

Removal of the following sites for the identified regulatory activities:

• Wirral Brook, 14 Whetstone Lane, Birkenhead, Wirral, CH41 2QR: Treatment of disease disorder and injury, Diagnostic and screening procedures and Family Planning services

9. Wirral Community NHS Foundation Trust is registered to provide regulated activities from the locations identified in Appendix 1.

Board action

10. The Board of Directors is asked to approve the proposed changes to the trusts CQC statement of purpose.

Paula Simpson Director of Nursing and Quality Improvement

Contributors: Claire Wedge, Deputy Director of Nursing and Quality Improvement

06 September 2018

Statement of Purpose Health and Social Care Act 2008

Wirral Community NHS Foundation Trust August 2018

Statement of Purpose

Health and Social Care Act 2008 Regulation 12 Schedule 3

1. The provider’s name, legal status, address and other contact details

Provider’s Name and Legal Status Full Name Wirral Community NHS Foundation Trust CQC provider ID RY7 Legal Status NHS Organisation

Provider’s Address including for service of Notices and other documents Business Address St Catherine’s Health Centre Church Road Birkenhead Wirral Merseyside CH42 0LQ

Registered Managers Details Paula Simpson Director of Nursing and Quality Improvement Business Telephone 0151 514 2160

Electronic Email [email protected]

2. Aims and Objectives

Located in Wirral in North West England, we provide high-quality primary, community and public health services to the population of Wirral and parts of Cheshire and Liverpool.

On 1 June 2017 the trust formally began to provide integrated adult health and social care services for patients and service users in their local communities. This demonstrates the trusts’ continued commitment to transforming public services responding to the needs of the communities we serve.

We play a key role in the local health and social care economy as a high performing organisation with an excellent clinical reputation.

Our expert teams provide a diverse range of community health care services, seeing and treating people right through their lives both at home and close to home.

Our commitment to quality underpins our determination to achieve and demonstrate the sustainability, efficiency and effectiveness of our organisation. At the heart of this we will retain our focus on delivering and developing demonstrably safe, effective and high quality services. Our vision recognises the important role we play in delivering integrated care with partners in the local health economy.

Our vision is:

To be the outstanding provider of high quality, integrated care to the communities we serve

Our values will help us to achieve our vision:

Our services are local and community-based, provided from around 50 sites across Wirral, including our main clinical bases, St Catherine’s Health Centre in Birkenhead and Victoria Central Health Centre in Wallasey. We are also commissioned to deliver podiatry services outside of Wirral by West Cheshire Clinical Commissioning Group and Liverpool Clinical Commissioning Group (under an Any Qualified Provider contract).

We also provide integrated 0-19 services in Cheshire East comprising health visiting, school nursing, family nurse partnership and breastfeeding support services from 13 bases.

We have no inpatient beds.

Strategic objectives and goals Our vision and values, our assessment of population need and our understanding of local and national priorities have informed our strategic themes and priorities for 2018-2021.

Our strategic themes and objectives are highlighted below.

3. Provider Description

Wirral Community NHS Foundation Trust is located in Wirral in North West England. We were established as an NHS Trust on 1st April 2011, and were authorised as a foundation trust in May 2016.

We have an excellent clinical reputation employing over 1,500 members of staff, 90% of who are in patient-facing roles. Each year we have over 1.1 million face to face contacts and our services are delivered in many settings: clinics, health centres, GP surgeries, schools, prisons and people’s homes.

We serve a Wirral population of around 321,000 residents across 145,000 households. It is very likely that most will come into contact with our services at some point either as a patient, carer, service user or relative of a patient or as one of our members or volunteers. We also provide specific services to the surrounding area of Cheshire, Liverpool and Vale Royal.

Our service provision covers both urban, with significant areas of deprivation, and rural, with challenges in relation to accessibility and engagement, areas. We therefore have extensive experience of developing responsive services across a large geographical and diverse footprint.

We have a reputation for innovation, performance and delivery.

As an organisation we have a strong, clear vision and set of values that were developed with and are supported by our staff and stakeholders. We have established solid leadership and governance arrangements within the Trust to underpin our business, which includes:

 Facilitating and improving the patient journey.  Ensuring the services we provide, and the way we provide them, are sensitive to and seek to address health inequalities. We work in partnership to avoid unnecessary hospital admission and support timely discharge by delivering services in an integrated manner.  Promote innovative care in all that we do.

Our Trust provides a variety of general healthcare and specialist services which are outlined in the Breakdown of Service Areas below. These services are grouped around the following three core divisions:

 Adults and Community Services  Children and Wellbeing  Urgent and Primary Care

4. Regulated Activities conducted by Wirral Community NHS Foundation Trust

Treatment of disease, disorder or injury

Surgical procedures

Diagnostic and screening procedures

Transport services, triage and medical advice provided remotely

Family Planning Service

5. Registered Locations and their Regulated activities

Location Description CQC Treatment of Surgical Diagnostic Transport Family Planning Service disease procedures and services, services Type disorder and screening triage and injury procedures medical advice provided remotely Arrowe Park Dental Service General Anaesthetic Sedation Service Ground Floor Maxillofacial Dept Arrowe Park Hospital Primary Care CHC    Arrowe Park Road Upton Merseyside CH49 5PE

Arrowe Park Hospital GPOOH Arrowe Park Hospital Upton Primary Care CHC     Merseyside CH49 5PE

Arrowe Park Walk In Centre Arrowe Park Hospital Arrowe Park Road Unplanned Upton CHC   Care Merseyside CH49 5PE

Clatterbridge Dental Service Clatterbridge Hospital Primary Care CHC    Clatterbridge Road

Eastham Walk In Centre Eastham Clinic Eastham Rake Eastham Unplanned CHC   Wirral Care Merseyside CH62 9AN

St Catherines Dental Service St Catherine’s Health Centre Church Road Birkenhead Wirral Primary Care CHC      Merseyside CH42 0LQ

St Catherine’s Health Centre Church Road Birkenhead Trust Head Wirral CHC      Quarters Merseyside CH42 0LQ

Location Description CQC Treatment of Surgical Diagnostic Transport Family Planning Service disease procedures and services, services Type disorder and screening triage and injury procedures medical advice provided remotely Leasowe Personal Dental Service Leasowe Primary Care Centre Hudson Road Primary Care CHC    Wirral Merseyside CH46 2QQ

Victoria Central GPOOH Victoria Central Health Centre Mill Lane Primary Care CHC     Wallasey Ch44 5UF

Victoria Central Health Centre Dental Service Victoria Central Health Centre Mill Lane Primary Care CHC    Wallasey Merseyside CH44 5UF

Victoria Central Health Centre Walk In Centre Victoria Central Health Centre Mill Lane Unplanned CHC   Wallasey Care Merseyside CH44 5UF

Location Description CQC Treatment of Surgical Diagnostic Transport Family Planning Service disease procedures and services, services Type disorder and screening triage and injury procedures medical advice provided remotely Wirral University Teaching Hospital Sexual Health Services GUM Clinic Arrowe Park Hospital Children and CHC    Arrowe Park Road Wellbeing Upton Wirral Merseyside CH49 5PE

6. Description of regulated activities

Division: Children and Wellbeing Integrated Health Treatment Disease Disorder The Wirral Healthy Child Programme (HCP) for 0 – 19 year olds has a service delivery Child programme 0- Injury model which includes four multi-disciplinary teams, each based in the Local Authority 19 Service constituencies of Birkenhead, Wallasey, South and West Wirral. Within each team there will be trained Health Visitors, School Nurses and skill mixed staff to deliver the Geographical universal elements of the HCP. locations: Our partner agencies: Brook, Home-Start Wirral and Barnardos will be supporting in the  Cheshire East delivery of the HCP. We also have a specialist team to manage overall provision and  Wirral coordinate delivery against complex targeted need.

An integrated healthy child programme is delivered by the trust across Cheshire East, which includes Health Services 0 – 5 years Health Visitor and Family Nurse Partnership  Health Services School Health 5 – 19  Healthy Child Programme (including the National Child Measurement Programme)  Targeted Breastfeeding Support Service  Vaccinations and Immunisations Programme 5 – 19 Our Cheshire East team deliver their service in partnership with Cherubs Breastfeeding support.

Division: Adult and Community Services Community Nursing Treatment Disease Our fully integrated Community Nursing Service provides healthcare to patients in their Disorder Injury own homes and in leg ulcer clinics. We help people to remain as independent as possible, maintaining comfort and dignity. Patients are cared for with a wide range of health problems, from wound care and acute illnesses to those with complex or long term health problems, including end-of-life care.

We also provide short-term intensive care to try and help patients avoid going to hospital where appropriate.

We work closely with GPs, social services, other health professionals, the voluntary sector, patients and carers. By working together we can make sure patients have all the care, help and support they need.

Wirral Heart support Diagnostic and Screening Wirral Heart Support Service provides specialist support, assessment, lifestyle advice and education for cardiac patients, their families and carers. Our services include Treatment Disease Disorder Injury  Cardiac Rehabilitation  Wirral Intermediate Cardiac Clinic (WICC)  Heart Failure Programme  Living with Heart Failure Rehabilitation

Specialist Nursing Treatment Disease A range of specialist nursing services are provided including Services Disorder Injury Parkinson’s Disease nurses We provide expert care for patients with Parkinson’s Disease (either in the community or in hospital), as well as offering practical and emotional support.

Continence Service The Continence Service supports and treats adults and children with urinary and bowel symptoms or incontinence.

End of Life care Team Our End of Life Care Team was established to ensure that systems and processes are

in place as identified within the National End of Life Care Strategy (DH, 2008) to facilitate the delivery of high quality end of life care, irrespective of the patient’s diagnosis.

Tissue Viability Services The Tissue Viability Service supports patients with wounds such as bed sores, leg ulcers, diabetic wounds, and other wounds that have failed to heal over time.Our Specialist Nurses are trained in advanced wound care. They provide specialist advice and support to health and social care professionals treating patients with a non-healing or chronic wound.

Podiatry Treatment Disease Our podiatry team offer clients the very best in foot healthcare providing the complete Disorder Injury solution for foot care and foot related problems. We specialise in providing assessments and treatments that are focused on relieving symptoms and pain, improving function, preventing disease and improving the independence and well-being of both adults and children.

Nutrition and Dietetics Treatment Disease The Nutrition and Dietetics Service provides expert advice about nutrition, how the body Disorder Injury uses nutrients and the relationship between nutrition, health and disease.

We provide nutritional interventions and support for a variety of needs Dietetic support includes individual dietary counseling, providing individual and group education, motivation techniques, working with support services to help with food provision, the use of prescription nutritional products to treat under nutrition and tube feeding.

We also act as a specialist resource for other health and social care professionals to promote best nutritional care. The Speech and Treatment Disease The Speech and Language Therapy (SLT) service assesses and treats people of all Language Therapy Disorder Injury ages who have speech, language and communication difficulties and have difficulties feeding, chewing or swallowing.

Wheelchair service Treatment Disease The Wheelchair Service assesses and supplies bespoke wheelchairs, special seating Disorder Injury and pressure distribution cushions for adults and children with long-term mobility problems.

We provide:

 ongoing review and assessment of mobility needs for both powered and non- powered wheelchairs  wheelchair and pressure distribution cushions and postural seating systems to use in wheelchairs (based on clinical need).  a repair and maintenance service for people with our equipment.

Wheelchair and buggy provision is determined following assessment and is dependent on clinical need and in relation to equipment supply criteria.

Physiotherapy Treatment Disease The Physiotherapy service offers arrange of services across including Disorder Injury  Musculoskeletal physiotherapy  Neurological physiotherapy  Women’s health physiotherapy  Osteopathy

The service is delivered in a variety of setting including the home and clinics.

Division: Urgent and Primary Care Integrated Sexual Health Family Planning services Sexual health services are delivered by Sexual Health Wirral - a joint initiative by local Services NHS organisations (Wirral Community NHS Foundation Trust, Wirral University (Wirral CT, Wirral Brook, Treatment Disease Teaching Hospital NHS Foundation Trust and The Royal Liverpool and Broadgreen Wirral University Disorder Injury University Hospitals NHS Trust) and Brook. The joint initiative ensures that there is a Teaching Hospital, The simple, up to date source of support, information and service provision across Wirral. Royal Liverpool and Diagnostic and screening Broadgreen University All organisations are individually registered with the CQC. Hospitals NHS Trust) The service operates seven days a week, across five locations and the dedicated website www.sexualhealthwirral.nhs.uk provides information, support and downloadable clinic timetables.

GP Out of Hours Service Surgical Procedures Wirral GP Out of Hours service provides emergency medical care to patients who are unable to wait for their GP practice to re-open. Family Planning The service is accessed through the NHS 111 service. Diagnostic and screening procedures Once an individual is referred to the service, further care can include;

Treatment Disease  Telephone advice Disorder Injury  A face-to-face consultation at one of our centres in Arrowe Park or Wallasey  A home visit where deemed clinically necessary

Community Dental Surgical Procedures The trust provide community dental services covering Cheshire West, Chester, Vale Services Royal and Wirral for both Paediatric Exodontia and Adult and Paediatric specialist Care Treatment Disease service. Disorder Injury The trust are the lead provider within a sub contractual arrangement with Bridgewater Diagnostic and Community NHS Foundation Trust, who deliver services across Cheshire West, Chester Screening and Vale Royal. These services are registered under Bridgewater Community NHS Foundation Trust.

Our Community Dental Service provides a full range of dental care and treatment to

complement and supplement general dental services.

The service operates out of fully Disability Discrimination Act compliant clinics and staff are highly experienced at treating patients with learning disabilities, physical disabilities, mental health problems, dental phobias and anxieties or substance abuse problems.

We also provide specialised services such as sedation, general anaesthetic (GA) and domiciliary for patients referred by their regular dentist or other agencies.

Leasowe Personal Surgical Procedures Leasowe Personal care service provides general dental treatment from premises Dental Service located in Leasowe. Treatment Disease Disorder Injury

Diagnostic and Screening

Ophthalmology Treatment Disease The Community Ophthalmology Service is a partnership between the NHS and local Disorder Injury opticians, enabling patients with many common eye conditions to be treated by an optician within their community, rather than in hospital.

Our walk-in service is available at more than 20 opticians throughout Wirral, without referral. Highly trained Optometrists treat for many common eye conditions

For more serious or long-term conditions we also run a consultant lead clinic at St George’s Medical Centre, where patients can be seen by a specialist eye doctor.

Walk in Centres Treatment Disease Walk-in centre services run 365 days a year and are based at: Disorder Injury  Victoria Central Walk-in Centre  Eastham Walk-in Centre  Arrowe Park Walk-in Centre

Minor Injuries Unit Treatment Disease A nurse led service with radiology facilities that provides assessment and treatment for Disorder Injury minor injuries and illnesses.

Diagnostic and Screening

Phlebotomy Diagnostic and The trust provide routine and urgent blood tests at drop-in service available from Screening Monday – Friday, 8:30am – 4:30pm at the following clinics:

 Victoria Central Health Centre  St Catherine’s Health Centre  Arrowe Park Hospital  Eastham Clinic

When clinically required we are able to visit patients in their own homes.

Single Point of access The Single Point of Access service is a nurse led call centre providing signposting of care pathways for GPs and healthcare professionals who require treatment for one of their patients (aged 16 and over only). We can provide advice, negotiate care pathways or arrange hospital admission.

DVT Service Treatment Disease The DVT and Atrial Fibrillation service is led by specialist nurses who provide Disorder Injury assessment, diagnosis and treatment for patients with suspected DVT and Atrial Fibrillation.

The service is provided at the Arrowe Park Hospital site and at St Catherine’s Health Centre or in the patient’s own home if they are housebound.