Priory Healthcare Quality Account 20 13-14
PROVIDING QUALITY INSPIRING INNOVATION DELIVERING VALUE Contents
Part 1 Statement from the Chief Executive
03 Statement from the Chief Executive 04 Quality statement from the Director of Corporate Assurance and Chief Nursing Officer
Part 2 Priorities for improvement
05 Summary of progress against 201 3-14 Quality Performance Indicators 06 Detailed review of performance against 201 3-14 Quality Performance Indicators 10 Priorities for improvement 201 4-15 12 Our statements of assurance from the Board
Part 3 Additional information
14 Service user satisfaction – delivering value through clinical excellence 16 Outcomes – the success of our service users 20 Participation in clinical audits 21 The Commissioning for Quality and Innovation (CQUIN) framework 22 Continuous improvement in the delivery of our services 23 Staff opinion 23 Investing in staff, education and training 24 Regulatory compliance 25 Focus sites during 201 3-14 25 Improving safety for our service users
Part 4 Appendix
26 Statement of assurance from our lead commissioner 27 Working in partnership with the NHS 28 Statement of Directors' responsibilities in respect of the Quality Account 29 Independent Limited Assurance Report to the Board of Directors of the Priory Group’s No. 1 Limited on the annual Quality Account 32 Format of this Quality Account 33 Scope of data inclusion
2 Part 1 – Statement from the Chief Executive
Welcome to the latest Priory Group • across all 58 registered healthcare sites Healthcare Quality Account. In publishing nationally not a single service was placed an annual set of Quality Accounts for our under any form of embargo throughout Healthcare Division our aim is to be fully the whole year. transparent and accountable for the services we provide. The account provides Of course, none of these results are a summary of the achievements of our achievable without the ongoing dedication Healthcare business during 2013-14 and hard work of our staff. Our 2013 staff and outlines our priorities for further survey showed that 8 9% of Priory Healthcare improvements in the year ahead. Delivering employees felt that they were able to good care to our service users cannot be contribute to the success of their team and done in isolation and we work in a close 81% felt that they were able to do their job partnership with our staff, service users, to a standard that they were proud of families, Commissioners and Regulators. compared to the NHS benchmark of 7 7%. I was delighted to celebrate our staff In April 2013 we set ourselves ambitious achievements this year with our first ever Quality Improvement Indicators. Of the eight Priory Group “PRIDE” awards where staff were indicators set, I am proud to say we have individually recognised for their care, hard achieved or mostly achieved seven. These work and achievements in underpinning our remain our key priorities for the coming year core values of delivering value, providing as we strive for excellence against a backdrop quality and inspiring innovation. of ever increasing acuity of our patients and continued regulatory changes. I am therefore Throughout all of this however our absolute pleased to outline some of the key highlights: focus remains on service user safety, clinical effectiveness and the service user experience. • 100% Commissioning for Quality and Innovation (CQUIN) targets achieved for Learning from serious incidents and the year complaints is also hugely important to us as • 93% of all outcomes were judged to be met we strive for continued improvement and by the Care Quality Commission at their excellence in care delivery and outcomes. My last inspection aim is to ensure that the safety and wellbeing • 97% of service users surveyed in acute of service users is protected and the highest mental health services would recommend quality standards are upheld whilst further Priory developing integrated care pathways. • 98% of service users felt safe during their stay • 83% of service users in secure services felt I am proud of Priory’s performance over the engaged in their own recovery last quality year and, to the best of my • 75% of young people in Child and knowledge, the information contained in this Adolescent Mental Health Services report is a true and accurate reflection of the (CAMHS) showed an improvement services and outcomes that we have delivered . in their overall wellbeing • 100% of service users in our neuro- rehabilitation service believe they were well cared for and supported • 100% of service users in our specialist Tom Riall autism service felt that they were able to Chief Executive Officer make suggestions about their own care June 2014 3 Quality statement from the Director of Corporate Assurance and Chief Nursing Officer
The Priory Group is focused on delivering “There have been significant improvements safe, compassionate, effectively regulated in the way in which the Group governs for care, that strives for good clinical and manages quality, providing a better outcomes. The focus remains on providing balance of focus across financial, operational excellence in mental healthcare across and quality performance.” the communities we serve. “The creation of a Head of Quality During 2013 the Priory Group benchmarked role within each division has itself against all the recommendations from allowed for a much greater degree the Francis inquiry and delivered on a number of focus on quality and has provided of key areas such as encouraging openness an improved level of capacity to and transparency, focus on safer staffing and manage quality improvement.” improving the service user experience. The PricewaterhouseCoopers external review focus has been to enhance and further raise care standards. Delivery of high quality care remains the priority against a backdrop of high acuity and We continue to invest in our staff through significant challenge. If at times we fall short education and training. In 2013 The Priory of delivering the high standards that we Group launched its Nursing Strategy which expect, we take immediate and robust focuses on delivering compassionate care in remedial action and learn lessons. a consistent manner. A new competency framework has been developed to further There is no room for complacency and we drive up professional standards. In addition, continue to be passionate about the care we are offering apprenticeships which include that we deliver. We proactively seek out the the Diploma in Health and Social Care to areas for improvement and continue to have Healthcare Assistants in some key hospitals. a dedicated arms-length internal inspection We are proud to report that 99% of service team that proactively highlights areas for users in acute mental health services felt they improvement. This assists us in ensuring that were treated with dignity and respect. our services continue to be well-led, safe, effective, caring, responsive and provide good Our ultimate objective is to be world class clinical outcomes. We look ahead to 201 4-15 and a beacon of good practice for other with enthusiasm and focus and continue to health and social care providers. In July 2013, put quality at the heart of everything we do. PricewaterhouseCoopers returned to undertake a further review of our governance processes:
“We are proud to report that 99% of service users in Siân Wicks acute mental health services felt they were treated Director of Corporate Assurance and Chief Nursing Officer with dignity and respect.” June 2014
4 Part 2 – Priorities for improvement
Summary of progress against 201 3-14 Quality Performance Indicators
In 201 2-13, our Quality Account incorporated the feedback from service users, Priory staff, Commissioners and other external stakeholders, to identify three priority domains and eight priorities for improvement in 201 3-14 as our Quality Performance Indicators (QPI’s).
In this section we will summarise our achievement against these priorities. We have used baseline indicators from the 201 2-13 Quality Account where possible to ensure the evaluation of our objectives is as accurate and effective as possible.
QPI Service and Priority Domain Outcome number PRIORY HEALTHCARE DIVISION
All service users to have their physical healthcare needs assessed and a plan put in Clinical effectiveness 1 Mostly achieved place to address areas of physical health need and service user safety
Ensure that unmet need is recorded for all service users to assist in the CPA and Clinical effectiveness 2 Mostly achieved discharge planning process and service user safety
CHILD AND ADOLESCENT MENTAL HEALTH SERVICES
Service users to be more involved and to participate in the planning and review of 3 Service user experience Partially achieved 1 safe, sound, and supportive services
EATING DISORDER SERVICES
4 Increase family and carer engagement and wellbeing Service user experience Achieved
SECURE SERVICES
5 Service users to participate in recruitment across all our secure sites Service user experience Achieved
COMPLEX CARE SERVICES
Increase service user involvement and engagement in meaningful activity to support 6 Clinical effectiveness Achieved their recovery and rehabilitation
ACUTE MENTAL HEALTH SERVICES
Ensure that the service user is signposted to appropriate support services in the event 7 Service user safety Mostly achieved of a crisis upon discharge from acute services
SECURE SERVICES
8 Increase service user satisfaction in relation to care planning and communication Service user experience Achieved
Table 1: Summary of progress against 201 3-14 Quality Performance Indicators
1The wording of this target has been amended since the previous year’s Quality Account. 5 Detailed review of performance against 2013-14 Quality Performance Indicators
All the Quality Performance Indicators selected in 201 3-14, were new indicators for the Healthcare division and involved establishing new data collection processes across sites.
Priory Healthcare division Clinical effectiveness and service user safety Clinical effectiveness and service user safety
QPI 1: All service users to have their physical healthcare QPI 2: Ensure that unmet need is recorded for all needs assessed and a plan put in place to address areas service users to assist in the CPA and discharge of physical health need. planning process.
Target: 90% of service users admitted from September Target: 95% of CPA minutes and MDT review minutes 2013 to have a physical healthcare examination on to record any unmet need and if there is no unmet need, admission to assess any physical healthcare needs. 1 that there is a clear statement outlining this.
Measure: Quarterly audit of CareNotes will commence Measure: Quarterly audit of CPA minutes and MDT from September 2013. review minutes will commence from September 2013.
Mostly achieved: While 80% of service users admitted Partially achieved: This QPI was measured from October since September 2013 received a physical healthcare 2013 and is now fully implemented in all sites. Recording assessment, month-on-month performance against this of unmet needs in March 2014 occurred in 8 7% of CPA indicator has improved and was at 91% for service users and MDT meetings. admitted in March 2014. Data collection processes have been implemented at all sites to enable central monitoring of this via the electronic health records and a monthly scorecard will continue to monitor compliance.
100 100
90 90
80 80
70 70
60 60
50 50
40 40
30 30
20 20
10 10
0 0 Sep Oct Nov Dec Jan Feb Mar Oct Nov Dec Jan Feb Mar
Target Target
Fig 1. Percentage of service users admitted under CPA Fig 2. Recording of unmet needs in CPA and MDT meetings receiving a healthcare assessment
1 The wording of this target has been amended since the previous year’s Quality Account.
6 Child and adolescent mental health services Service user experience
QPI 3: Service users to be more involved and to participate in the planning and review of safe, sound, and supportive services.
Target: Service user presence at 9 0% of clinical governance meetings.
Measure: Clinical governance minutes to record service user attendance and sites to submit a quarterly report to be included in the quarterly service user action plan.
Partially achieved: Young people did not routinely attend clinical governance meetings at all sites but have attended community meetings which feed into site clinical governance meetings.
7 Detailed review of performance against 201 3-14 Quality Performance Indicators
Eating disorder services Secure services Service user experience Service user experience
QPI 4: Increase family and carer engagement QPI 5: Service users to participate in recruitment across and wellbeing. all our secure sites.
Target: 90% of families or carers to be offered a Priory Target: Service users to be involved in 8 0% of interviews Carer Wellbeing Workbook and to attend a wellbeing for senior clinical posts at their sites. planning meeting. Measure: Audit of appointments within secure services Measure: Sites to keep a record of the number of at site level via the HR electronic records. workbooks given out and wellbeing planning appointments taken up. This indicator was measured Achieved: All senior level posts recruited for secure sites from October 2013. during Quarter 4 had service users involved in the interviews. We exceeded the 8 0% target in five of the last Achieved: The year-end position was 10 0% of Eating six months. Disorder families and carers were provided with a Priory Carer Wellbeing Workbook. In 201 4-15, we will ensure this is embedded, consistently happens and at least 9 0% is achieved. In March 2014 all families or carers of patients admitted with eating disorders were provided with a Priory Carer Wellbeing Workbook.
100 100
90 90
80 80
70 70
60 60
50 50
40 40
30 30
20 20
10 10
0 0 Oct Nov Dec Jan Feb Mar Oct Nov Dec Jan Feb Mar
Target Target
Fig 3. Percentage of family and carers being given Priory Fig 4. Percentage of service users involved in interviews for senior Carer Wellbeing Workbook clinical posts (performance for November was 0%).
8 Detailed review of performance against 201 3-14 Quality Performance Indicators
Complex care services Secure services Clinical effectiveness Service user experience
QPI 6: Increase service user involvement and QPI 8: Increase service user satisfaction in relation to engagement in meaningful activity to support their care planning and communication. recovery and rehabilitation. Target: Service user satisfaction to increase by 1 0% from Target: 25 hours of diverse and meaningful activity to be the 201 2-13 baseline of 7 3%. offered to every service user each week. Measure: Through the service user satisfaction survey. Measure: Audit of clinical health records (via CareNotes) to evidence the offer of activity and the number of hours Achieved: Service user satisfaction when surveyed in taken up by the service user. February 2014 had increased to 8 2%, from a baseline in 201 2-13 of 7 3%. This is an increase of 12. 3% in service Achieved: When audited in January 2014 the average user satisfaction. number of hours of diverse and meaningful activity offered to patients in complex care services each week was 30 hours.
Acute mental health services Service user safety
QPI 7: Ensure that the service user is signposted to appropriate support services in the event of a crisis 100 upon discharge from acute services. 90
80 Target: 90% of service users to be offered a crisis card upon discharge. 70 60
Measure: Each hospital to keep a record of the number of 50 cards offered and the number of times a discussion took 40 place to explain the purpose of the card. 30
Mostly achieved: 81% of service users surveyed during 20 the reporting period confirmed that they had been given 10 crisis information upon being discharged. 0 Q1 Q2 Q3 Q4
Target
Fig 5. Percentage of services users being given crisis information (QPI 7)
9 Priorities for improvement 201 4-15
We continually strive to improve both the experience and QPI Two outcomes of our service users in order to achieve the Domain: Clinical effectiveness & service user experience. highest standards of care. This includes developing Quality Category: Unmet need. Performance Indicators (QPIs) across the 3 domains: Objective: To ensure that we record unmet need for all service users. This will assist in the CPA and discharge • Clinical effectiveness planning process. • Service user safety Target: 95% of CPA minutes and MDT review minutes • Service user experience to record any unmet need and if there is no unmet need that there is a clear statement outlining this. For each of these Quality Performance Indicators we have Measurement Source: Care Programme Approach (CPA) established robust monitoring of the processes and minutes and Multidisciplinary Team (MDT) review minutes practices for each service line and for the Priory Group averaged for the 12 month period. overall. For quality improvement priorities for 201 3-14 identified in the 201 2-13 report, the previous year’s data QPI Three is not included, as this year’s priorities have changed. Domain: Service user safety. Category: Medication errors. We have identified nine priorities for improvement in Objective: To improve patient safety by reducing 201 4-15 at a divisional and service level, which are administration errors. detailed opposite and on the following page. Target: Reduce the number of errors as a proportion of the number of reviews undertaken from a divisional Last year we set new ambitious objectives. They require average baseline of 2.35 in March 2014. further embedding as we strive for improvement. In Measurement Source: Prescriptions involving addition we have introduced the ‘Friends and Family test’ administration errors via Ashton Audits averaged for the across all our service lines. It is our intention to report the 12 month period. new test results fully in 201 4-2015. QPI Four Quality Performance Indicators for the Priory Domain: Clinical effectiveness. Healthcare division Category: Clinical supervision. Objective: To ensure hospital nursing teams receive QPI One monthly clinical supervisions. Domain: Clinical effectiveness & service user safety. Target: 90% of hospital nursing and healthcare assistant Category: Physical health. staff to receive monthly clinical supervisions. Objective: For all service users to have their physical Measurement Source: Foundations for Growth averaged health care needs assessed and a plan put in place to for the 12 month period. address areas of physical health need. Target: Newly admitted service users to have a physical Child and adolescent mental health services (CAMHS) health assessment as part of the admission process and 90% of service users where there are physical health QPI Five needs to have a physical health care plan in place. Domain: Service user safety. Measurement Source: Clinical health records Category: Absconsion. (CareNotes) averaged for the 12 month period. Objective: To reduce actual absconsions. Target: To further reduce actual absconsions by 1 0% from the previous year of 148 actual absconsions. Measurement Source: To monitor monthly via incident reporting system and to review the data for actual vs attempted absconsions.
10 Priorities for improvement 201 4-15
Secure services
QPI Seven Domain: Service user experience. Category: Service user involvement. Objective: For service users to participate in the recruitment of at least 8 0% of posts across our secure services. Target: Service users to be involved in at least 80% of the interviews for posts across all secure services. Measurement Source: HR electronic records. Audit against secure wide procedure averaged for the 12 month period.
Complex care services
QPI Eight Domain: Service user experience. Category: Meaningful activity. Objective: For increased service user involvement and engagement in meaningful activity to support their recovery and rehabilitation. Target: A minimum of twenty-five hours of diverse and meaningful activity to be offered to each service user per week. Measurement Source: Clinical Health Records (CareNotes) to evidence the offer of activity and the number of hours taken.
Acute
QPI Nine Eating disorders Domain: Service user safety. Category: Crisis cards. QPI Six Objective: To ensure the service user upon discharge from Domain: Service user experience. acute services is sign posted to appropriate support Category: Family and carer involvement. services in the event of a crisis. Objective: To increase family and carer engagement and Target: For 9 0% of service users to be offered crisis wellbeing. information upon discharge. Target: Priory Carer Wellbeing Workbook to be offered to Measurement Source: Service user survey completed the family and carers of 90% of admissions. upon discharge which includes a question about whether Measurement Source: Each hospital to keep a record of they were offered crisis information averaged for the the number of booklets offered and the number/ 12 month period. percentage taken averaged for the 12 month period.
11 Our statements of assurance from the Board
This statement serves to offer assurance to the public that Priory Healthcare is performing to essential standards, providing high quality care, measuring clinical processes and involved in initiatives to improve quality.
Review of Services During 2013-14 Priory Healthcare participated in no During 201 3-14 Priory Healthcare provided the following national clinical audits and 100% of the national 58 relevant services, comprising: confidential enquiries of the national clinical audits and the national confidential enquiries it was eligible to Healthcare and addictions participate in. Psychiatric care and therapy for a broad range of mental health disorders including acute mental health The national clinical audits and national confidential (depression, stress, anxiety etc.), eating disorders, neuro- enquiries that Priory Healthcare was eligible to participate disabilities, complex care and child and adolescent mental in during 2013-14 are as follows: health services (CAMHS) alongside behavioural and • National Confidential Inquiry into Suicide and substance addictions. Homicide for People with Mental Illness (NCISH)
Secure and step down • National Audit of Psychological Therapies (NAPT) Provision of forensic mental healthcare services through • Prescribing Observatory for Mental Health (POMH) – clinically effective, evidence based treatment Prescribing in Mental Health Services programmes for adult service users who require secure and step down care in a setting that provides physical and The national clinical audits and national confidential psychological security. Facilities enable both medium and enquiries that Priory Healthcare participated in during low secure service users to receive an integrated and 201 3-14 are as follows: holistic approach to their treatment. • National Confidential Inquiry into Suicide and Homicide for People with Mental Illness (NCISH) Priory Healthcare has reviewed all the data available to them on the quality of care in 58 of these relevant The national clinical audits and national confidential health services. enquiries that Priory Healthcare participated in, and for which data collection was completed during 201 3-14, are The income generated by the relevant health services in listed below alongside the number of cases submitted to 201 3-14 represents 85% of the total income generated each audit or enquiry as a percentage of the number of from the provision of relevant health services by Priory registered cases required by the terms of that audit or Healthcare for 201 3-14. enquiry. Participation in Clinical Audits • National Confidential Inquiry into Suicide and During 201 3-14, 3 national clinical audits and one Homicide for People with Mental Illness (NCISH) national confidential enquiry covered relevant health 93% services that Priory Healthcare provides. The reports of 0 national clinical audits were reviewed by Priory participated in the National Confidential Inquiry the provider in 201 3-14 and Priory Healthcare intends into Suicide and Homicide for People with Mental Illness to take the following actions to improve the quality of and the National Patient Safety Agency Suicide healthcare provided. Prevention Audit during this period.
12 The reports of 6 local clinical audits were reviewed by the Statements from the Care Quality Commission provider in 201 3-14 and Priory Healthcare intends to take Priory Healthcare is required to register with the Care the following actions to improve the quality of healthcare Quality Commission (CQC) in England and its current provided: registration status is ‘registered’. Priory Healthcare locations do not have any conditions placed on 1. Safeguarding Mandatory audit to ensure compliance their registrations. against national standards Priory Healthcare is also registered with: 2. HR Files Learning from SUI in relation to safe staff recruitment • Health Inspectorate Wales (HIW) • Care and Social Services Inspectorate Wales (CSSIW) 3. Infection Control Mandatory audit to ensure • Healthcare Inspectorate Scotland (HIS) compliance against national standards The CQC has taken enforcement action against 1 Priory 4. Risk Assessments, Care Plans, CPA and Observations Healthcare location during 201 3-14. Priory Healthcare Assurance audit to ensure key standard practices are in has not participated in any special reviews or place across the division and will act as a triangulation investigations by the CQC during the reporting period. of the quality walk round results There was no enforcement action from the Welsh 5. Preventing Suicide National Patient Safety Agency Tool or Scottish regulators.
6. Clinical Supervision To evaluate the new standardised Data Quality clinical supervision provided to staff. Priory Healthcare were not required to submit records during 201 3-14 to the Secondary Uses Service (SUS) Participation in Clinical Research for inclusion in the Hospital Episode Statistics (HES) which The number of patients receiving relevant health services are included in the latest published data. provided or sub-contracted by Priory Healthcare in 201 3- 14 that were recruited in that period to participate in Information Governance Toolkit research approved by a research ethics committee was 0. Attainment Levels Priory Healthcare Information Governance Assessment Goals Agreed with Commissioners – Report score overall score for 201 3-14 was 6 9% and was Use of the CQUIN Payment Framework graded Green. A proportion of Priory Healthcare income in 201 3-14 was conditional on achieving quality improvement and Clinical Coding Error Rate innovation goals agreed between Priory Healthcare and Priory Healthcare was not subject to the Payment by any person or body they entered into a contract, Results clinical coding audit during the reporting period agreement or arrangement with for the provision of by the Audit Commission. relevant services, through the Commissioning for Quality and Innovation payment framework.
Further details of the agreed goals for 201 3-14 and for the following 12 month period are available on request “Facilities enable both medium and low from [email protected] secure service users to receive an integrated and holistic approach to their treatment. ”
13 Part 3 – Additional information
Service user satisfaction – delivering value through clinical excellence 1
By listening to our service users we can drive service development across the Priory Group Healthcare division. Service users that feel engaged with the care they are receiving and the trust in the health care professionals delivering that care, have significantly improved outcomes.
In 201 2-13 we noted that service users within our low and medium secure services demonstrated lower levels of satisfaction within the service than for other areas within the Healthcare division and we took action to address this. We are delighted to report an increase in service user satisfaction from our secure service users. In particular the Secure Service Users conference was an especially innovative approach to increasing service user involvement and engagement which has been evidenced by the increased service user satisfaction.
abilit ntal healt cent menta therapy ser -dis y se e h s l y vi o rv m se le h ce r i r o e a u c e a d s e e t v d i l n s u c a t h c e d s a s
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2013 2013 2013 2013 2014 98% 2014 95% 2014 93% 2014 83%
Overall satisfaction with the quality of care by service
1 The Quality Performance Indicators in this report are not governed by standard national definitions. 2 Felt the staff are caring and supportive.
14 Highlights from the service user satisfaction survey by service
Acute mental health services Day therapy services
97% Would recommend us to a friend 10 0% Treated with courtesy and respect
99% Treated with dignity and respect 98% We understood their needs and difficulties
98% Felt safe during their stay 97% Felt that therapy was as good as expected
Addiction services Complex care services
99%Treated with dignity and respect 95% Feel they are treated with respect at all times
Staff made them feel welcome Feel they have the opportunity to join 99% 94% when they arrived activities on site and in the community
98% Would recommend us to a friend 93% Feel safe within Priory services
Eating disorder services Secure services
Staff made them feel welcome 99% 80% Felt listened to and understood by staff when they arrived
98% Treated with dignity and respect 81% Have confidence in the ability of the staff
98% Felt safe during their stay 83% Felt engaged in own recovery
Child and adolescent mental health services Neuro-disability services
Felt their healthcare professionals listened 94% 10 0% Believed they are cared for and supported to and understood their problems
Felt they are able to attend service 93% The service helped to deal with their problems 10 0% user meetings
91% Satisfied with the services offered to them 94% Felt treated with respect and dignity
15 Outcomes – the success of our service users
One of the central objectives of the Priory Healthcare Within child and adolescent mental health services, division is to enable every service user to be an active we use the Health of the Nation Outcomes Scales for participant in their own recovery process. Children and Adolescents (HoNOSCA), and the HoNOS Secure tool is used within our low and medium secure Outcomes demonstrate the progression that each service facilities. All of the HoNOS outcomes quoted that relate user has made and are an intrinsic element of every to improvement in overall mental wellbeing refer to personalised care pathway. When appropriate, we service user outcomes at the point of discharge. Across regularly feed outcomes back to the individual, alongside the Healthcare division, additional outcome tools may families and carers, as well as those who commission our also be used, according to the nature of each service. services and form an integral part of the individual's wider care pathway. We believe that progress is made in many forms, and achieving outcomes is relevant to the unique needs of Clinical outcomes within acute mental health, addiction each service user. This means that we also consider the services and eating disorder services use the nationally social, emotional and physical development of the recognised Health of the Nation Outcomes Scales individual alongside their clinical progression. For this (HoNOS). The HoNOS assessment is undertaken upon reason, we place great emphasis on qualitative outcomes admission and again at discharge (or bi-annually within alongside clinical metrics to reflect the success of our our secure services) to ascertain the level of improvement service users. in a service user’s clinical condition during their inpatient stay.
16 Acute mental health services Eating disorder services
2013-2014 2012-2013 2013-2014 showed improvement in 2012-2013 showed improvement in their attitude to diet, shape 82% overall mental wellbeing 86% 84% and weight 80%
2013-2014 2012-2013 2013-2014 2012-2013 demonstrated an improvement gained weight 79% at discharge from therapy 75% 92% 91%
2013-2014 2012-2013 Complex care showed improvement in their 77% overall mental wellbeing 77% 2013-2014 2012-2013 wholly or partially achieved 97% their goals 99% Addiction services
Secure services 2013-2014 showed improvement in 2012-2013 their overall mental wellbeing 92% after 7 days 93% 2013-2014 2012-2013 showed improvement in their overall mental wellbeing 65% 63% 2013-2014 2012-2013 were still abstinent 89% 12 months post discharge 86% 2013-2014 2012-2013 showed improvement in 76% their risk profile 64% Child and adolescent mental health services
2013-2014 of admissions who had incidents 2012-2013 2013-2014 2012-2013 in the first six months went on to showed improvement in their reduce the number of incidents in overall mental wellbeing 61% the second six months n/a 75% 77%
17 Case Study
Adam* Priory Hospital Ticehurst
Adam was transferred to Priory Hospital Ticehurst under section 3 of the Mental Health Act with diagnoses of mild learning disability, borderline personality disorder, social phobia, severe self-harm issues and substance misuse. He was quite ambivalent about his admission to Ticehurst, stating that he had given up all hope of having a ‘normal’ life. Initially he was pessimistic about his future and was reluctant to engage and discuss his issues as he felt he had been let down many times in the past.
On admission, Adam was fully assessed by the multidisciplinary team which consisted of a psychiatrist, nursing staff, occupational therapist and a psychologist. Over time, Adam started to attend dialectical behaviour therapy sessions for his self-harm issues and was seen by an addiction therapist for motivational work and relapse prevention. Furthermore, he found that talking and being open about his anxiety and low self-esteem helped him to take control of his negative feelings.
Adam found that the team at Ticehurst respected his views and positively encouraged him to take ownership of his care and, with some assistance, help to develop his own care plans. The section 3 was rescinded, Adam enrolled with a local college, achieving a distinction on a painting and decorating course which he attended without assistance.
Adam has continued to improve and eventually felt comfortable looking for accommodation within the community with the help and support of the multidisciplinary team, who ensured that the gradual move back to the community was at a pace that was comfortable for him.
Adam was fully discharged into the community with help from the local Community Mental Health Team and is now happily settled within local employment.
ADAM IS NOW SETTLED WITHIN LOCAL EMPLOYMENT .
18 18 ROBERT IS NOW A MEMBER OF VARIOUS SOCIAL GROUPS .
Case Study
Robert* Priory Egerton Road Neuro-Rehab Centre
Robert was a highly paid and well respected computer analyst until at the age of 29 when, as a result of Wolff-Parkinson-White Syndrome, he suffered a cardiac arrest and seizure causing cerebral anoxia.
Initially, Robert was admitted to the Priory Hospital Ticehurst where he underwent a programme of intense rehabilitation with the multidisciplinary team (MDT). Robert stayed at Ticehurst for 3 years and learned to cope with his cognitive disabilities before eventually moving to a small residential home at Priory Egerton Road. Here, Robert lived in the main house with the support of the MDT who worked with him to develop his memory, improve his social skills and independence which he so desperately wanted to regain. As part of his programme the MDT instigated a daily log, listing every activity for that day including the basics such as shaving.
Eventually Robert went back into employment, working part time in Hastings. He was able to visit his parents, travelling independently, and after three years he moved to the annexe of Egerton Road preparing him for the next stage of his journey as well as giving him more control.
In time Robert moved into his own home near his parents. The home was also close enough for the MDT to continue their support with an outreach package tailored to his needs. Robert now lives independently and is a member of various social groups; he is incredibly thankful to Priory Egerton Road MDT for supporting his journey to more independent living.
Staff at Egerton Road continued to outreach with Robert within his own home through a gradually reducing support package.
*Service user’s names have been changed to maintain confidentiality
19 Participation in clinical audits
In 2013-14, a divisional audit calendar was implemented specific audits relevant to them to ensure all their needs that included six large audits in order to ensure divisional were accounted for. The monthly medicine audits at each wide assurance and enable benchmarking between sites, hospital also continue and populate information on a with the opportunity for sites to learn from each other. medicines scorecard that is produced monthly, enabling The topics were chosen strategically using data from issues to be picked up by ward and addressed through the inspections, serious incidents and national requirements. monthly QPI monitoring processes in place. Each hospital/care home also chose at least three site
Audit Title Domain Rationale
1. Safeguarding Service User (SU) Safety Compliance against national standards.
2. Recruitment Staff and SU Safety Safe staff recruitment.
3. Infection Control SU Safety and Clinical Effectiveness Compliance against national standards.
4. Risk Assessments, Care Plans, SU Safety, Clinical Effectiveness and Care Programme Approach Assurance audit to ensure key standard practices. SU Experience and Observations
5. Preventing Suicide SU Safety National Patient Safety Agency Suicide Prevention Toolkit
Staff, SU Safety and To monitor implementation of the new Clinical Supervision 6. Clinical Supervision Clinical Effectiveness Policy.
7. Mental Health Act SU Safety and Experience Compliance with legal requirements and regulatory themes
8. Mental Capacity Act SU Safety and Experience Compliance with legal requirements and regulatory themes
Table 2. Divisional Audits
“During 2013-14 we worked with our pharmacy provider to undertake weekly audit research into our prescribing systems. The feedback and lessons learned were shared across the division and demonstrated a sustained improvement in medication management. A paper was completed and this has been submitted to a number of journals for publication.”
20 The Commissioning for Quality and Innovation (CQUIN) framework
We are proud to have achieved 100% CQUIN requirements across two schemes and better still the service users have really benefitted from some of the initiatives introduced.
All Specialised Mental Health NHS England Highlights Outcome contract
The reports we receive show we are above the national average for percentage of staff up to date Quality Dashboard with safeguarding children and adult training. The dashboards confirm our internal monitoring Achieved processes.
We can now see how people progress through care pathways and the level at which they access Optimising Care Pathways psychological interventions. The full year effect of collecting this data will provide a greater picture Achieved of admission to discharge pathways.
A Priory Physical Healthcare Assessment template was developed and rolled out across sites via Physical Healthcare Achieved CareNotes (electronic patient record).
Priory Healthcare Services have been working with our NHS provider partners in secondary care to Care Programme Approach maintain positive relationships which ultimately assist service users in jointly planning for their future Achieved and preparing for discharge.
Secure Only
Access to literacy and Excellent increase in access to literacy and numeracy; including online education, access to college Achieved numeracy courses and inreach tuition for adult courses.
Increased use of video and tele-conferencing and exploring a secure mobile solution which will Use of technology Achieved enable both internal and external remote communication via a computer or tablet.
Kent and Medway Commissioning Support Unit (CSU) contract for Priory Complex Care services
These CQUINs supported the work we do via our Recovery and Outcomes group promoting and Quarter 1 & 2 Achieved delivering an ethos of recovery, service user involvement and engagement in meaningful activity.
Information about Ensuring we assist our service users to understand the positive effects and potential side effects Achieved Medicines of their medication.
This is proving to be very useful for commissioners to monitor attendance of care coordinators Care Programme Approach Achieved at CPA reviews.
Physical Health We undertake regular physical health assessments for people with Long Term Conditions and ensure Achieved that our service users access primary care services and have, as a minimum, an annual health check.
Our sites which have high levels of service users with physical health needs have been inputting into Patient Safety Thermometer Achieved the National Patient Safety Thermometer database.
Table 3. CQUINs for Priory Healthcare
21 Continuous improvement in the delivery of our services
Providing a high quality service for both our service users Commentary on 2013-14 complaints and those who commission our services is a central objective for the Priory Healthcare division. As such, we For 2013-14 we saw a slight reduction in complaints take all complaints very seriously and utilise this feedback at Stage Two. However, there were three complaints as part of an overall ethos to drive service development at Stage Three, one of which was referred to the through continuous improvement. Independent Sector Complaints Adjudication Service (ISCAS) and the remaining two were referred to the We use the lessons learned from comments and Parliamentary Health Service Ombudsman (PHSO). complaints to help improve the care that we provide to our service users. Examples of the improvements made Stage 3 cases (April 2013 – March 2014) during 201 3-14 include: Independent Sector Complaints • adjusting the content of a number of staff training Adjudication Service modules The complaint referred to ISCAS was partially upheld. • enhancing wi-fi reception at our hospitals • reviewing menus and catering schedules at a number Parliamentary Health Service Ombudsman of sites. Of the two complaints referred to the PHSO, neither complaint was upheld. The majority of complaints that we receive are dealt with at Stage 1 of the complaints process. This means that the manager of the service undertakes an investigation into Complaints per 1000 the concerns that have been raised and provides occupied bed days a response to the complainant. In the event that the 201 3-14 1.41 complainant remains dissatisfied, a further review is undertaken at Stage 2 of the complaints process by 201 2-13 1.32 a senior manager who is independent of the service. 2011-12 1.45 In the event that resolution is not reached at Stage 2 the complaint can be referred to Stage 3 of the complaints 201 0-11 1.40 process. This involves the complaint being reviewed depending on the service user’s funding arrangements, Table 4. Complaints during 2013-14 by the Independent Sector Complaints Adjudication Service (ISCAS) or the Parliamentary Health Service Ombudsman (PHSO). 201 3-14 Stage 2 21 2013-14 Stage 3 3
201 2-13 Stage 2 22
Table 5. Complaints at Stage 2 and 3
22 Staff opinion
The annual Staff Engagement Survey is well received by Result NHS Result Theme staff from the Priory Healthcare division, with a response 2013-14 Benchmark 2012-13 rate of 73% for the 2014 survey (the highest response Feel they are able to Data not contribute to the success 89% 89% rate in the Group, and the highest response rate since the available of their team survey began in 2009). Where possible, the results of this Feel they are able to do survey have been benchmarked against the NHS. their job to a standard 81% 77% 79% they are personally pleased with We recognise that, although staff recognition is higher Would recommend Priory 76% 54% 74% within the Priory Healthcare division than the NHS as a good place to work benchmark identified below, it is still an area of focus Feel they will still be Data not working for Priory in 12 57% 55% for the Group. Our PRIDE Awards, launched in 2013, available month’s time recognise our staff’s significant contribution in delivering Feel they achieve value, providing quality and inspiring innovation and 56% 54% 54% recognition for their work demonstrating leadership. Data not Overall job satisfaction 70% 68% available
Table 6. Staff Engagement Survey key findings
Investing in staff, education and training
Learning and development 2013-14 e-learning Modules 2012-13 Our staff are key to the quality of care delivered and 95% Safeguarding vulnerable adults 94% service user experience. Foundations for Growth, our
97% Safeguarding children 99% internal e-learning programme for staff, was launched seven years ago and in 201 3-14 alone, the programme 98% Confidentiality and data protection 99% has enabled Healthcare staff to complete 87,759 93% Infection control 92% e-learning modules and 23,047 face to face training sessions including mandatory training. However, we also 96% Safe-handling of medicines 97% recognise the importance of learning and development 97% Suicide and self-harm 98% within the wider context of delivering quality and inspiring innovation within our services. For this reason, significant 91% Mental Capacity Act 90% investment has been made in continuing professional 93% Deprivation of Liberty 90% development during 201 3-14.
Table 7. Percentage of allocated e-learning modules completed by Priory Healthcare staff during 201 3-14
23 Regulatory compliance
The Healthcare division covers England, Scotland and Care Quality Commission (CQC) Wales, and is therefore required to work under the of outcomes inspected at the most recent 93% standards set out by regulators within each respective regulatory inspections were met area. 50 of our 58 Healthcare sites were inspected by 199 outcomes identified in the Essential Standards of regulators between 1 April 2013 and 31 March 2014. Quality and Safety were reviewed during the most recent These are broken down by regulators as follows: inspections that took place at Priory Healthcare sites between 1 April 2013 and 31 March 2014. Of these 186 • Care Quality Commission 42 were met and 13 were unmet. Examples of these were • Health Inspectorate Scotland 0 records and care planning. Significant efforts have been • Health Inspectorate Wales 2 made to move these outcomes to compliance. • Care and Social Services Inspectorate Wales 6 Healthcare Inspectorate Scotland (HIS) of outcomes were judged to 100% have been met Internal inspections During the period between 1 April 2013 to 31 March In 2013 every single healthcare site had a full 2014 there were no inspections. The last HIS inspection benchmarking inspection against the relevant outcomes occurred on the 3 December 2012 and was fully and standards for all regulators. A programme of rigorous compliant across all standards inspected. internal compliance inspection and monitoring continues across the Group on an ongoing basis, by arms length Healthcare Inspectorate Wales (HIW) specialist inspectors. Internal compliance activity is Two Priory hospitals were inspected by Health now prioritised based on a robust process of Quality Inspectorate Wales between 1 April 2013 and 31 March Performance Indicator Review, intelligence monitoring 2014 and there were 14 recommendations made relating and risk assessment. Specialist inspection teams comprise to 9 standards. Action plans were immediately of health and safety and regulatory compliance experts, implemented and notification of this sent to the regulator. and experienced financial auditors. During the period specialist inspections took place across the Priory Care and Social Services Inspectorate Wales (CSSIW) Healthcare division as follows: of outcomes were judged to 96% have been met • 136 internal regulatory compliance inspection visits The Care and Social Services Inspectorate Wales • 17 fire risk assessments inspected 22 standards across Priory Healthcare Welsh • 36 health and safety inspections sites between 1 April 2013 and 31 March 2014. 21 of the • 46 financial audits. standards were judged to have been met. One standard was deemed to have been unmet. This site immediately addressed the issue relating to staff meetings.
Embargoes and warning notices There have been no external embargoes in any Priory Healthcare site during the period. There has been one regulatory enforcement action, a warning notice, issued by the CQC at Hayes Grove. An improvement plan was put in place, which has since been completed. As a result of this the division has invited the regulator back to the service for re-inspection as soon as possible, to validate compliance.
• Sites with warning notices 1 • Sites with imposed embargoes to admission 0 24 Focus sites during 201 3-14
When a hospital or care home requires additional support, The Priory Hospital Southampton this is managed through a formalised framework and the The hospital has worked with commissioners to address necessary support put in place for the improvements concerns identified. Commissioners have conducted to be made. As required by the Duty of Candour, Priory regular visits and have been pleased with the progress Healthcare communicates openly and works with that has been made. This hospital is no longer a focus site. regulators and commissioners, service users, their families and carers and other external stakeholders for as long The Priory Potters Bar as necessary to ensure full confidence in our service The CQC found the site to be unmet in relation to is restored. outcomes. A robust recovery plan was put in place with work ongoing. The Priory Hospital Middleton St George This hospital gained compliance very quickly with the The Priory Hemel Hempstead CQC by March 2013 from the warning notice issued in In March 2013, this hospital was found to be unmet January 2013 in relation to staff recruitment. However, for outcomes when inspected by the CQC. The report a longer term improvement plan needed to be put in highlighted poor standards of care and leadership. place to address cultural staff practices and strengthen A recovery plan was put in place and the site was safeguarding processes. The site has made considerable re-inspected in August 2013 and found to be fully progress and this has been expressed by CQC, compliant. This site is no longer a focus site and in commissioners, service users and other external stakeholders. subsequent evaluation and monitoring six months on, including feedback from service users and the family, the hospital has been found to have sustained the improvements and embedded them in practice.
Improving safety for our service users
In order to improve processes and practices within our During 2013-14 there were no incidents that services, and to ensure our Duty of Candour is met, Priory would be classified as never events as defined Group strives to develop an open and transparent culture by NHS England 4. where staff are able to report incidents as they occur. NHS average 2013-14 2012-13 (April 1 3- Since 2012 we have reported all incidents using an September 13) electronic reporting system, which all staff have access Total number of incidents to. Staff are instructed on how to use this within reported (per 1000 25.4 21.8 28.0 induction, and an overview is also provided within the occupied bed days) e-learning modules on Safety, Quality and Compliance. Serious incidents relating to 0.2% 0.2% 0.9% the death of a service user
Our staff are encouraged to report all incidents, serious Incidents resulting in the incidents and near misses in line with a “no-blame” culture permanent harm of 0.1% 0.3% 0.4% a service user and to help us better understand causes and contributory factors at an organisational level. We are pleased to see Table 8. Incidents reported increased reporting of incidents, since this indicates the further development of a patient safety culture.
4 NHS England; “The never events list; 2013-14 update” http://www.england.nhs.uk/wp-content/uploads/2013/12/nev-ev-list-1314-clar.pdf 25 Part 4 – Appendix
Statement of assurance from our lead commissioner
This statement is given to the best of my knowledge for Priory Healthcare has enthusiastically and successfully the period 2013-14 in respect of secure services, adult implemented the national CQUINs across services, and eating disorder services and child and adolescent mental has provided commissioners with good evidence to health services commissioned by NHS England. support the monitoring of achievements each quarter.
Priory Healthcare has been compliant with the Commissioner meetings with service users and the performance reporting cycle and has provided good advocacy service at Thornford Park have been supported quality, timely reporting in relation to the key quality and encouraged by Priory, and this has provided indicators as defined in the contract. commissioners with invaluable feedback on the quality of service provision. The Provider has complied with submissions of serious incident and safeguarding notifications, related reports We will work with the provider over the coming year to and action plans. This has supported the robust ensure robust processes are in place to share learning monitoring of the safety and quality of placements, with across its portfolio of services. areas of concern identified being addressed promptly. Priory have responded well to issues in a transparent manner and are continuing to work with commissioners to strengthen monitoring and reporting processes and Louise Doughty further develop patient safety. They are continually Head of Mental Health & Programme of Care Lead working to recruit and train staff with the level of skills Wessex required for the challenges they face. NHS England
26 Working in partnership with the NHS
Within the Priory Healthcare division alone, 85% of our This means ensuring early visibility of the service user’s services are commissioned on behalf of the NHS and progression throughout each treatment phase relevant to other public bodies throughout the UK. It is therefore their individual goals and objectives and, where possible, essential to us that our services are delivered in close developing a stepped care approach to treatment, with collaboration with referring commissioners and other transparent and flexible pricing frameworks. external care providers to ensure the optimum outcome for each service user, as part of their overall care pathway.
“The last year has been a period of massive change for commissioners and providers. The relationship between the two has seldom been so complex and flexibility has been at the core of the dialogue. In particular areas, notably Tier 4 CAMHS and Adult Eating Disorders, demand has exceeded supply with consequent very real challenges throughout the Care Pathway.
As commissioners we have had daily contact with the Priory Group, both at local and national level. The Group’s national referral process has helped us save time in contacting units, and daily bulletins on bed availability have become essential to commissioners in trying to ensure that patients are placed as close to home as possible.
These processes are an essential part of the quality agenda, as access to services takes on a profile it has seldom had before. Priory continue to demonstrate a customer focus and when we have asked the Group for help in particularly trying times, they always do their best to assist.”
Roger Cook “During our unannounced inspection we found Head of CAMHS and Specialised evidence that people who use the services at The Commissioning at West Midlands Priory are regularly involved in providing feedback Specialised Commissioning Reporting year 2013-14 about the care and support provided. We saw that the relationship between staff and people who use the service was open and inclusive and that people were treated with dignity and respect. We spoke with 10 members of staff across different disciplines and all of them were motivated to give good care. This inspection resulted in no requirements and two recommendations.”
Susan Brimelow Chief Inspector, Healthcare Improvement Scotland, on the Inspection: 3 & 4 December 2012
27 Statement of Directors responsibilities in respect of the Quality Account
The Directors are required under the Health Act 2009 and the National Health Service (Quality Accounts) Regulations to prepare quality accounts for each financial year.
Monitor has issued guidance to NHS Foundation Trust boards on the form and content of the annual quality reports (which incorporate the above legal requirements) and on the arrangements that NHS Foundation Trust boards should put in place to support the data quality for the preparation of the quality report.
In preparing the Quality Account, Directors are required to take steps to satisfy themselves that:
1. The content of the Quality Account meets the relevant requirements set out in the NHS Foundation Trust Annual Reporting Manual 2013-14
2. The content of the Quality Account is not inconsistent with internal and external sources of information including: • Board minutes and papers for the period April 2013 to June 2014 • Papers relating to quality reported to the Board over the period April 2013 to June 2014 • Feedback from commissioners • Feedback from external auditing reviews (conducted by PricewaterhouseCoopers)
3. The Quality Account presents a balanced picture of the Priory Healthcare division’s performance over the period covered
4. The performance information reported in the Quality Account is reliable and accurate
5. There are proper internal controls over the collection and reporting of the measures of performance included in the Quality Account, and these controls are subject to review to confirm that they are working effectively in practice
6. The data underpinning the measures of performance reported in the Quality Account is robust and reliable, conforms to specified data quality standards and prescribed definitions and is subject to appropriate scrutiny and review
7. The Quality Account has been prepared in accordance with Monitor’s annual reporting guidance (which incorporates the Quality Account regulations, published at www.monitor.gov.uk/annualreportingmanual) as well as the standards to support data quality for the preparation of the Quality Account (available at www.monitor.gov.uk/annualreportingmanual).
The Directors confirm to the best of their knowledge and belief they have complied with the above requirements in preparing the Quality Account.
By order of the Board June 2014
Mike Jeffries Tom Riall Chairman Chief Executive Officer The Priory Group The Priory Group
28 Independent Limited Assurance Report to the Board of Directors of the Priory Group’s No. 1 Limited on the annual Quality Account
We have been engaged by the Board of Directors of The Our responsibility is to form a conclusion, based on limited Priory Group No. 1 Limited (the ‘Company’) to perform assurance procedures, on whether anything has come to an independent assurance engagement in respect the our attention that causes us to believe that: Company’s Healthcare Quality Account for the year • the Quality Report does not incorporate the matters ended 31 March 2014 (the ‘Quality Report’). specified in the guidance and Annex 2 to the ARM that are applicable to the Company; and Scope and subject matter The Company has voluntarily applied certain principles • the Quality Report is not consistent in all material of the guidance provided by Monitor to NHS Foundation respects with the sources specified below. Trusts (‘Detailed Guidance for External Assurance on Quality Reports 2013-14’, published 25 February 2014 We read the Quality Report and consider whether it (the ‘guidance’)), and Annex 2 of the NHS Foundation addresses the content requirements of the ARM Trust Annual Reporting Manual (the ‘ARM’), published applicable to the Company, as set out in the Appendix to 14 March 2014. the Quality Report, and consider the implications for our report if we become aware of any material omissions. These principles have been selected based on those deemed applicable to the Company and have been set We read the other information contained in the Quality out in the ‘Format of the Quality Report’ section of the Report and consider whether it is materially inconsistent Appendix to the Quality Report. Monitor’s guidance for with the following documents: the Quality Report incorporates the requirements set • Board minutes for the period April 2013 to the date out in the Department of Health’s Quality Accounts of signing this limited assurance report (the ‘period’); Regulations and additional reporting requirements set • papers relating to quality reported to the Board over out by Monitor. the period April 2013 to the date of signing this limited assurance report; We provide assurance in respect of: i. the content of the Quality Report, in accordance with • feedback from the Commissioners (NHS England) those aspects of the guidance and the ARM relevant dated 25 April 2014; to the Company as determined by management, • the Company’s monthly complaints scorecard; as set out in the Appendix to the Quality Report; and ii. the consistency of the Quality Report with the • feedback from other stakeholders incorporated into documents specified below. the Quality Account (West Midlands Specialised Commissioning, dated 12 March 2014; and, Respective responsibilities of the Directors Healthcare Improvement Scotland, dated and auditors 10 April 2014); The Directors are responsible for the content and the • quarterly patient surveys; preparation of the Quality Report in accordance with those principles of the guidance and Annex 2 of the ARM • the annual staff survey; and that are applicable to the Company, as set out in the • feedback from the Board of Directors. Appendix to the Quality Report.
29 We consider the implications for our report if we become A limited assurance engagement is less in scope than a aware of any apparent misstatements or material reasonable assurance engagement. The nature, timing inconsistencies with those documents (collectively, the and extent of procedures for gathering sufficient, ‘documents’). Our responsibilities do not extend to any appropriate evidence are deliberately limited relative other information. to a reasonable assurance engagement.
We are in compliance with the applicable independence Limitation and competency requirements of the Institute of Non-financial performance information is subject to more Chartered Accountants in England and Wales (“ICAEW”) inherent limitations than financial information, given the Code of Ethics. Our team comprised assurance characteristics of the subject matter and the methods practitioners and relevant subject matter experts. used for determining such information.
This limited assurance report, including the conclusion, The absence of a significant body of established practice has been prepared solely for the Board of Directors of the on which to draw allows for the selection of different but Company as a body, to assist the Company in reporting acceptable measurement techniques which can result in its quality agenda, performance and activities. We permit materially different measurements and can impact the disclosure of this limited assurance report within the comparability. The precision of different measurement Quality Report for the year ended 31 March 2014. techniques may also vary.
To the fullest extent permitted by law, we do not accept or Furthermore, the nature and methods used to determine assume responsibility to anyone other than the Board of such information, as well as the measurement criteria and Directors as a body and the Company for our work or this the precision thereof, may change over time. report save where terms are expressly agreed and with our prior consent in writing. It is important to read the Quality Report in the context of the content requirements of the guidance and of the Assurance work performed ARM, and the Director’s determination of its applicability We conducted this limited assurance engagement in to the Company, as set out in the Appendix to the accordance with International Standard on Assurance Quality Report. Engagements 3000 ‘Assurance Engagements other than Audits or Reviews of Historical Financial Information’ The nature, form and content required of Quality Reports issued by the International Auditing and Assurance have been determined by the Company based on Standards Board (‘ISAE 3000’). Our limited assurance Monitor’s guidance for the purposes of this assurance procedures included: engagement. This may result in the omission of information relevant to other users. • making enquiries of relevant management, personnel and, where relevant, third parties; In addition, the scope of our assurance work has not • reviewing the content of the Quality Report against the included governance over quality or performance guidance and content requirements of the ARM that indicators included in the Quality Report, which have are relevant to the Company, as set out in the been determined locally by the Company. Appendix to the Quality Report; and • reading the specified documents and comparing their consistency with the information included in the Quality Report.
30 Basis for qualified conclusion Qualified conclusion The ARM requires Part 3 of the Quality Report to include Based on the results of our procedures, except for the performance against the relevant indicators and matters described in the basis for conclusion paragraph, performance thresholds set out in the Compliance nothing has come to our attention that causes us to Framework/Risk Assessment Framework. This has been believe that for the year ended 31 March 201 4: included in the Quality Report, except for: • the Quality Report does not incorporate the matters set • percentage of patients on Care Programme Approach out in the guidance and Annex 2 of the ARM that are who were followed up within 7 days after discharge; applicable to the company as set out in the Appendix to the Quality Report; • percentage of admissions to acute wards for which the Crisis Resolution Home Treatment Team acted as a • the Quality Report is not consistent in all material gatekeeper during the reporting period; respects with the documents specified above. • percentage of patients readmitted to hospital within 28 days of discharge; • minimising mental health delayed transfers of care; • meeting commitment to serve new psychosis cases by early intervention teams; • mental health data completeness: identifiers; and, PricewaterhouseCoopers LLP • mental health data completeness: outcomes for Chartered Accountants patients on CPA. Leeds Date: The ARM requires Part 3 of the Quality Report to include an overview of the quality of care offered by the provider The maintenance and integrity of the Priory Group No. 1 Limited’s based on performance in 201 3-14 against indicators website is the responsibility of the Directors; the work carried out by the assurance providers does not involve consideration of these matters and, selected by the Board in consultation with stakeholders, accordingly, the assurance providers accept no responsibility for any with an explanation of the underlying reason(s) for changes that may have occurred to the reported performance indicators selection. The Quality Report does not directly provide an or criteria since they were initially presented on the website. overview in the format prescribed by the guidance, and it is included in Part 2 instead of Part 3.
31 Format of this Quality Account
This Quality Account has been produced using the NHS Foundation Trust Annual Reporting Manual for 2013-14, published by Monitor in March 2014, and the The National Health Service (Quality Accounts) Amendment Regulations 2012. We have excluded sections that are not relevant to the Priory Group.
Data items from the NHS Quality Accounts content checklist not included in the Priory Healthcare division’s 2013-14 Quality Account The table below documents items which were not reported according to the NHS Quality Accounts content checklist annex within the NHS Foundation Trust Annual Reporting Manual for 2013-14 because they were not applicable to the services delivered by the division.
Data guidance item Rationale for exclusion
Part 2 – Priorities for improvement
For quality improvement priorities for 2013/14 identified in the 2012/13 Data not available report, the previous year’s data is not included in the Quality Account
A rationale for the selection of the priorities and whether/how the views There was some involvement of staff and service users in developing of patients, the wider public and staff were taken into account the priorities for improvement
Annex 2 – Care Quality Account Indicator
Care Programme Approach (CPA) service users, either receiving follow-up contact within seven days of discharge or having formal review within 12 months
Minimising mental health delayed transfers of care No crisis resolution home treatment service provided by Priory hospitals Percentage of service users readmitted to a hospital within 28 days of being discharged
Admissions to inpatient services have access to crisis resolution home treatment teams
Meeting commitment to serve new psychosis cases by early No early intervention in psychosis service provided by Priory hospitals intervention teams
Data completeness: identifiers No mental health minimum data set submission required for Priory hospitals Data completeness: outcomes for service users on CPA
Service user experience of community mental health services Priory hospitals do not provide community mental health services
32 Scope of data inclusion
The 2013-14 Quality Account provides an overview of the performance of the Priory Healthcare division against a wide range of internal measures and metrics, relevant to the division itself, or particular services and sites therein.
This data may not represent the entire breadth of services or sites within the Priory Healthcare division; therefore, this appendix sets out the scope of data inclusion, as well as any relevant considerations (such as the methods by which samples were selected for analysis).
Some sites were not fully integrated into the Priory Healthcare division’s systems for the entirety of the period and are therefore not included in all figures, although all sites are reflected in some way across the indicators used in this report. In this appendix, we will refer to two groups of sites, according to their implementation of the service user management system CareNotes. These are: CareNotes sites
• Cefn Carnau • The Priory Hospital Bristol • Chadwick Lodge • The Priory Hospital Chelmsford • Cheadle Royal Hospital • The Priory Hospital Church Village • Farmfield • The Priory Hospital Glasgow • Middleton St George Hospital • The Priory Hospital Hayes Grove • Priory Hospital Dewsbury • The Priory Hospital North London • Priory Hospital Keighley • The Priory Hospital Preston • Priory Hospital Market Weighton • The Priory Hospital Roehampton • Priory Hospital Sturt • The Priory Hospital Southampton • Recovery 1st • The Priory Hospital Woking • The Cloisters – Newbury • The Priory Nottingham • The Priory Heathfield • The Priory Potters Bar • The Priory Hemel Hempstead • The Priory St Neots • The Priory Highbank • The Priory Ticehurst House • The Priory Hospital Aberdare • Thornford Park • The Priory Hospital Altrincham • Ty Gwyn Hall • The Priory Hospital Brighton and Hove • Woodbourne Priory Hospital
Non-CareNotes sites
• 85 Brecon Road • Greenhill • Avalon • Highfields – now part of Craegmoor • Beechley Drive • Mount Eveswell • Brynawel • Princes Street • Caewal Road • Rookery Hove • Charles House • Rookery Radstock • Egerton Road • The Vines • Ghyllside • Ty Ffynu
33 All service users to have their physical healthcare Increase service user satisfaction in relation to care needs and a plan put in place to address areas of planning and communication (p6): physical health need (p6): Data sourced from CareNotes sites only. Surveys were Data sourced from CareNotes sites only. Compliance offered to all service users in the participating sites during was measured through the completion of a Doctor’s the period 24 February to 21 March 2014. Surveys were assessment or Physical Health form in the service users’ included if the following criteria is met: electronic records. Service users are included where the following criteria is met: 1. The service user submitted a paper satisfaction form having answered the relevant question 1. The service user was admitted to our services in the 2. The service user stayed in our services for at least one period from 1 September 2013 to 31 March 2014 night within the period inclusive 3. The form was recorded on CareNotes 2. The service user stayed in our services for at least one night ‘Agreement’ is defined as those people answering “Strongly Agree” or “Agree” to the following statement: This data is accurate as at 2 April 2014. “The service does a good job of supporting my care planning and involving me in the process”. Completion Ensure that the service user is signposted to rate for the period was 41%. appropriate support services in the event of a crisis upon discharge from acute services (p6): All relevant sites were included for the other priorities of All relevant sites included. Agreement was measured improvement, including non-CareNotes sites. through the satisfaction survey, which is offered to all service users upon discharge. Acute patients are included Continuous improvement in the delivery of our where the following criteria is met: services (p22): The Priory Group implemented a new complaint reporting 1. The service user was discharged in the period from system on 1 January 2012. Because of the inherent 1 April 2013 to 31 March 2014 inclusive differences between the previous and new systems, it was 2. The service user stayed in our services for at least not feasible to combine the data with our 2011-12 data. one night Therefore, where we present 2011-12 incident and complaint data, we have used the period 1 April 2011 3. The service user submitted a paper satisfaction form to 31 December 2011. having answered at least one question 4. The form was recorded on CareNotes
‘Agreement’ is defined as those people answering “Yes” to the following question: “Before you left hospital, were you given information about how to get help in a crisis, or when urgent help is needed?” Completion rate for the period is 46%.
34 Improving safety for our service users (p25): All relevant sites included, including non-CareNotes sites. Incidents which meet all of the following criteria are included:
1. The incident involves at least one service user as a participant (incidents involving more than one service user are counted as one incident) 2. The incident is reported on the Priory Group clinical governance system
Incidents leading to permanent harm are rated as having a “high” level of harm (second highest on a five point scale) and are defined as “any incident that appears to have resulted in permanent harm to one or more persons. Serious injury resulting in brain damage, loss of limb or impaired use”.
35 Priory Group, 80 Hammersmith Road, London, W14 8UD