Quality Account 2014/15

Excellent care at the heart of the community Quality Account 2014/15 Page 2 of 73

Summary In the report entitled the Five Year Forward View published in October 2014, the chief executive of NHS England Simon Stevens described how and why the NHS needs to change, what this change might involve and how we can achieve it. He reaffirmed the core values and achievements of the NHS, and acknowledged that new technology and advances in medicine offer new opportunities. However, he argued that the NHS must evolve to meet the challenges of; more and more people living longer and with complex long-term and care health needs; the need to support people to lead healthier lives; and the demands of providing health and care support when the public finances are constrained. As Simon Stevens said as he started his new job with NHS England in April 2014, “An ageing population with more chronic health conditions, but with new opportunities to live as independently as possible, means we’re going to have to radically transform how care is delivered outside hospitals.” His assessment reflects what we know about people’s preferences. If they are unwell, people generally want to be cared for in or near their own homes, close to family and friends and the things with which they are familiar. They prefer not to go to hospital if this can be avoided, and if they need a hospital stay, they want support to return to home as quickly as possible. In fact around 90 per cent of people’s contact with the NHS is in the community, either with primary care – for example their GP or local pharmacy – or with services run by community organisations like us - Sussex Community NHS Trust (SCT). This is why we speak in our vision about excellent care at the heart of the community. SCT is the main provider of community health and care across Brighton & Hove and West Sussex. Our teams deliver essential medical, nursing and therapeutic care to over 8,000 adults, children and young people a day, including some of the most vulnerable people in our communities across the age range. At all times, we prioritise quality and compassion. Our aim is to support people to manage and adjust to changes in their health to enable them to live healthy, independently lives. With quality as our top priority, we care for most people in their own homes or as close to home as possible in our community hospitals, or in the clinics and centres we work from. We put the people we care for at the centre of everything we do, wrap care around them and work closely with GPs, hospital trusts, local authority social care partners and voluntary organisations to ensure people get the support they need. To do this work we employ around 4,500 staff. Most of them are expert clinicians (doctors, dentists, nurses and therapists), and they get great support from specialists in areas such as governance, education and training, medicines management, information technology, human resources, finance, facilities and estates. Amongst our teams, we have: • Health visitors working with families with young children. • School nurses caring for the school-age population. • Specialist doctors, nurses and therapists looking after children, young people and adults with complex health needs, mobility problems and long-term health conditions. • Multidisciplinary community teams caring for the frail elderly. • Specialist clinicians caring for people at the end of their lives.

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Our strategic goals To deliver our vision of excellent care at the heart of the community we have three strategic goals: • We will provide excellent care every time to reinforce wellbeing and independence. • Working with our partners, we will personalise services for the individual. • We will be a strong and sustainable business, grounded in our communities and led by excellent staff. To guide our work, our core values and behaviours are now very much part of our culture, so the people we care for and our other stakeholders know what to expect from us: • compassionate care – caring for people in ways we would want for our loved ones. • working together – as a team forging strong links with the people we care for, the wider public and our health and care partners, so we can rise to the challenges we face together. • achieving ambitions – for our users, for our staff, for our teams, for our organisation. • delivering excellence – because the people we care for and our partners deserve nothing less. Around 1.1 million people live in the area we serve in Brighton & Hove and West Sussex. It is very likely that most of them will encounter our services in some way at some time: as a patient, a carer, relative, neighbour or friend of a patient, or through a link with one of our staff members or volunteers. Every GP practice in England is now part of a Clinical Commissioning Group (CCG). CCGs commission (plan and buy) the majority of health services, including emergency care, elective hospital care, maternity services, and community and mental health services for patients. The CCGs in our area are: • NHS Coastal West Sussex CCG, covering Arun, Adur, Bognor Regis, Chanctonbury, Chichester, and Worthing, and including 56 GP surgeries and more than 482,100 residents. • NHS Horsham and Mid Sussex CCG, covering Burgess Hill, East Grinstead, Haywards Heath, Horsham and the surrounding area, and including 23 GP practices and approximately 225,000 residents. • NHS Crawley CCG, covering Crawley and the surrounding area, and including 13 GP practices and approximately 120,000 residents. • NHS Brighton & Hove CCG, covering the city and including 47 GP practices and approximately 300,000 residents. We also provide services to people living outside of these areas, including in East Sussex.

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Contents

Introduction 6 Part 1 - Chief Executive and Chair Statement 7 Part 2 - Looking Ahead 8 2.1 Our Priorities for Quality Improvement in 2015/16 8 2.2 Priorities for Improvement 2015/16 8 2.3 Statements of Assurance from the Board 10 2.4 Clinical Audit and Confidential Enquiries 10 2.4.1 Trust-Wide Audits 12 2.4.2 Local Clinical Audits 13 2.5 Participation in Research 16 2.6 NICE Guidance 21 2.7 Commissioning for Quality and Innovation (CQUIN) Framework 21 2.8 Statements from the CQC 23 2.9 Data Quality 23 2.10 NHS Number and General Medical Practice Code Validity 27 2.11 Information Governance Toolkit Attainment Levels 27 2.12 Clinical Coding Error Rate 27 2.13 Incidents and Patient Safety 27 2.14 Non-Patient Safety 30 2.15 Environmental Impact 30 2.16 Estates 32 2.16.1 Building a Healthier Sussex 32 2.16.2 Modernising our estate around our service needs 32 2.16.3 Redevelopment of Brighton General Hospital 33 2.16.4 A unique partnership between SCT and Capita 33 2.17 Organisational Culture 34 2.18 Staffing Levels 34 2.19 Becoming an NHS Foundation Trust 34 2.20 Working with Patient Representatives 36 2.20.1 Healthwatch 36 2.20.2 Local authority scrutiny committees 36 2.20.3 Engagement with the voluntary & community sector 37 2.20.4 Engaging for change 37

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Part 3 Looking Back 38 3.1 How we did last year 38 3.2 A Review of our Priorities for Quality Improvement in 2013/14 39 3.3 Additional Achievements in 2013/14 44 3.4 Clinical Quality Half Days 49 3.5 Complaints 49 3.6 Compliments 51 3.7 Equality & Diversity 52 3.8 Volunteers 52 3.9 Safe Care 53 3.10 Patient Centred Care 56 3.11 Staff Care 57 Part 4 Statements of Assurance 61 4.1 The Board 61 Part 5 Who did we involve? 62 Part 6 Statements provided by stakeholders 62 6.1 Brighton & Hove City Council’s Health and Wellbeing Overview and Scrutiny Committee 62 6.2 Commissioners 63 6.3 Healthwatch Brighton and Hove 65 6.4 Healthwatch West Sussex 66 6.5 West Sussex County Council Health & Adult Social Care Select C’ttee 69 Part 7 Conclusion 70 Part 8 Glossary of terms 71 Part 9 Feedback 73

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Introduction A Quality Account is an annual report to the public by a provider of health and care services about the quality of care they deliver. All NHS health and care bodies are required to publish their Quality Account each year, and we embrace this requirement as an important way to report to you - the people we serve - on our work and on our progress against our quality improvement priorities. The Department of Health (DH) provides guidance on what a Quality Account is for and how to produce it. The DH says that the account should seek to: • Encourage our board of directors and leaders to assess quality across all of the services we provide. • Demonstrate our commitment to continuous, evidence-based quality improvement. • Explain our progress to the public we serve. We have a strong commitment to be open and accountable – for example by reporting on key activities at the board meeting in public each month and in the annual Quality Account. By being open in this way we offer for scrutiny debate and reflection, our approach to quality and our performance in key measurable areas - things like patient safety, the effectiveness of treatments and what patients say about their experiences of care. Our staff work hard to provide the very best quality of service, whatever their role. We’re pleased that in their inspection of our work in December 2014, the Care Quality Commission (CQC) inspectors said: “All the staff we saw and spoke with demonstrated commitment to the delivery of safe, effective and caring treatment…We observed staff responding to patients, their families and carers with kindness in a compassionate and professional manner.” Delivering quality care like this is an on-going process and like all organisations, we aim to continually update and adapt our plans and priorities to reflect our own progress and the needs and wants of the people we serve - from our patients, their families and carers - through to our health and care commissioners. The Quality Account looks both backward and forward - showing how we did over the year just gone and where we plan to go in the year ahead. This enables us to reflect on progress against our priorities from previous years, show where we are doing well and where we can make improvements. It allows us to look forward, explaining our quality improvement priorities for the coming year, and how we will achieve and measure these. These are annual reports, so we want you to see continuity and progress over time. In short, our Quality Account is a way to provide assurance to you about our commitment to quality and our performance against our goals. We try to ensure our account is accurate, balanced and fair, and we ask our partners to comment how far we have achieved this. We include their feedback at the back of the report. We publish our Quality Account via the NHS Choices website and our own website. Copies are also available in different formats and in different community languages on request.

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Part 1 - Chief Executive and Chair Statement We are delighted to open our Quality Account for 2014/15 with the Care Quality Commission’s assessment of the quality of our services. The Chief Inspector of Hospital’s team visited Sussex Community NHS Trust in December 2014 and in March 2015. We received the inspector’s final report in March, which not only rates our services as “good” overall, but also confirms that our end of life care is “outstanding”. The NHS Trust Development Authority (NHS TDA) said “It is one of Paula Head Sue Sjuve the best inspections that we have seen in NHS Chief Executive Chair trusts in the South” and we hope that it confirms your own view of the safe, compassionate, responsive, caring and well-led services we provide. This is all due to our excellent staff who work very hard, very thoughtfully, very skilfully and very professionally, to deliver care to the 1.1 million people who live in the area we serve. The inspection report paves the way for SCT to continue the journey to become an NHS Foundation Trust and justifies the confidence placed in us by our commissioners and partners. This has been a very challenging year for the Trust and for the local health and care system within which it operates. The Trust has worked with its health and social care partners to alleviate the pressure on acute hospitals, to wrap care around individuals and families and to manage public money and resources to maintain high quality care and a good experience for those who use our services. The coming year will see further improvements in quality through continuing transformation in the way that we deliver our community-based services. High quality patient care continues to be at the centre of all we do. Our major challenges this year will be the further improvement of quality whilst we deliver our recurrent cost improvement programme in an environment of constrained funding. Our Transformation Programme will enable us to do this and to keep people well and independent in their homes, and cared for in the community. We will ensure that patients continue to be our primary consideration. We will continue to listen to our patients and staff, encouraging openness and honesty, and will monitor our performance carefully. Our approach to transformation and further improvements to quality will ensure that the care our patients receive from primary care, social care, and other health service providers is co-ordinated with the aim of providing a seamless experience. We hope you will agree that our Quality Account provides many examples of where we already provide high quality care. We are confident that during 2015/16, our staff and volunteers will work together with our patients, partners and commissioners to ensure continuous improvement across all services. On behalf of the Trust board, we thank everyone who has contributed to what has been a very challenging, but successful year improving quality across all services. This account highlights the pride and commitment of our staff throughout the organisation to delivering excellent care at every opportunity for the people who use our services. We confirm, on behalf of the Trust board that to the best of our knowledge and belief, the information contained in this Quality Account is accurate and represents our performance in 2014/15, together with our priorities for 2015/16.

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Part 2 - Looking Ahead 2.1 Our Priorities for Quality Improvement in 2015/16 To make certain our care is excellent we must ensure that we provide the three elements that denote high quality care in every encounter we have with our patients. These three elements are: safety, clinical effectiveness and patient experience and all three elements are embedded in our Clinical Care Strategy and our Quality Account and form the basis of our adult integrated care and support, children’s integrated care and support, specialist community and wellbeing organisational design. The priorities we have set for the coming year are organised around these three core elements of quality.

2.2 Priorities for Improvement 2015/16 Following national evidence and local data collection, e.g. from incidents, complaints, staff, stakeholder and service feedback, together with national and locally agreed CQUINs and the quality improvement objectives within Trust’s Clinical Care Strategy, the following priorities for improvement have been agreed.

Safe Care Improvement Expected Outcomes How will we do it? Priority Area Infection There will be no Maintain the framework for Infection Prevention Prevention & incidents of preventable and Control with a view to constant improvement. Control (IP&C) transmission of Hand hygiene audits will be fully implemented in healthcare acquired the community. infections (HCAIs). Medicines – There will be a reduction All wards will establish a Medication Action Group missed doses in the number of missed and identify a local lead. (A missed medication doses within Each Group will produce an action plan. medication the adult inpatient Medication administration will be discussed and dose is where it wards. monitored monthly. is unclear if a The Medicines Management team will collect data patient received to provide a monthly Medication Safety the medication Thermometer to indicate progress. or not because the medication The Medicines Management team will conduct an administration annual Missed Doses Audit to assess chart has not achievement. been signed.) Pressure There will be a Every patient will have a holistic assessment and Damage reduction in the will be screened for their risk of developing occurrence of pressure pressure damage. damage due to a lapse Those patients deemed ‘at risk’ will have a in our care. pressure damage prevention care plan. A care plan for carers will be provided to support care staff.

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Effective Care Improvement Expected Outcomes How will we do it? Priority Area Quality To extrapolate and Review current metrics and develop appropriate Improvement interrogate data metrics to monitor progress and demonstrate Metrics for regarding specialist improvement. Specialist services, specifically Services diabetes care, and leg ulcers. Falls To further reduce the Each bedded unit to set individual targets for percentage of patients in reducing the number of falls and develop local our care who fall. action plans. The Falls Prevention Steering group will identify and implement additional tools to reduce the number of falls for patients with dementia and will monitor and report on progress. An annual audit of compliance with national falls prevention initiatives will be undertaken to indicate achievement of expected outcomes. Compassionate To improve care and Implement the ‘Sit and See’ Observational Tool care compassion in practice. within community services, adding ‘Hello my name is …’ as an introduction. Develop and implement documentation, such as ‘Knowing me..’ to enable personalised care in bedded units for people with specific needs, such as dementia. Patient Centred Care Improvement Expected Outcomes How will we do it? Priority Area Missed/deferred The number of Written information will be provided to all patients visits complaints received on the community nursing ‘live’ case list giving from patients regarding information of what to do in the event of a missed missed visits will be visit. significantly reduced. Develop and implement an improved process for informing patients of changes to planned visits. Missed visits will be reported and reviewed at Senior Management Team meetings. Written information will be provided to all patients on admission to community services regarding service visits and contact information. Complaints Improve the response Evaluate the newly implemented complaints times for handling of process. complaints, and To commence monitoring initial response times recording compliments. and the time taken to respond to complaints.

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Complaints To reduce the number of All staff to have access to Customer Care training, cont. complaints citing staff with those teams identified as having a high attitude. incidence of complaints citing staff attitude targeted to attend. Safeguarding 90% of all staff will have Safeguarding training will be revised and Adults attended Safeguarding expanded to include support services previously Adults training by the not included. end of the year. Nutrition & Improve patient nutrition Develop a strategy based on the Hospital Food Hydration and hydration in bedded Standards report on food and drink in NHS 1 units. hospitals . Develop an action plan for delivery through the multidisciplinary Nutrition & Hydration Forum and monitor progress. Establish feedback to identify achievement of outcomes. Additional quality improvement goals are included in the trust-wide Quality Improvement Plan available on our website.

2.3 Statements of Assurance from the Board During 2014 to 2015, Sussex Community NHS Trust provided and/ or sub-contracted over 90 NHS services. We deliver our services to people in their own homes, in clinics or as inpatients across Brighton & Hove and West Sussex. Our bedded units are at Arundel & District Community Hospital, Bognor Regis War Memorial Hospital, Crawley Hospital, Horsham Hospital, the Kleinwort Centre in Haywards Heath, Midhurst Community Hospital, Salvington Lodge in Worthing and Zachary Merton Community Hospital in Rustington. We also provide services from GP premises, schools and community facilities. SCT has reviewed all the data available to them on the quality of care in all of these NHS services. The income generated by the NHS services reviewed in 2014/15 represents 83.2 per cent of the total income generated from the provision of NHS services by SCT for 2014/15.

2.4 Clinical Audit and Confidential Enquiries During 2014/15, four national clinical audits and one national confidential enquiry covered NHS services that SCT provides. During that period, the Trust participated in 100% of national clinical audits and 100% of national confidential enquiries of the national clinical audits and national confidential enquiries in which it was eligible to participate. The national clinical audits and national confidential enquiries that SCT was eligible to participate in during 2014/15 are as follows: • National Clinical Audit for Rheumatoid and Early Inflammatory Arthritis. • Sentinel Stroke National Audit Programme (SSNAP). • Chronic Obstructive Pulmonary Disease (COPD) Audit. • National Audit of Intermediate Care (NAIC). • Sepsis Study - National Confidential Enquiry into Patient Outcome and Death (NCEPOD).

1 The Hospital Food Standards Panel’s report on standards for food and drink in NHS hospitals, Department of Health, August 2014

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The national clinical audits and national confidential enquiries that SCT participated in, and for which data collection was completed during 2014/15, are listed below, alongside the number of cases submitted to each audit or enquiry, as a percentage of the number of registered cases required by the terms of that audit or enquiry.

National Clinical Audit / Confidential Enquiries Participation % Cases Submitted Rheumatoid and Early Inflammatory Arthritis Audit (British 16 100% Society for Rheumatology) SSNAP (Royal College of Physicians) 351 100% Chronic Obstructive Pulmonary Disease (COPD) Audit (Royal Data Submission College of Physicians) collection is due July 2015 in progress NAIC (NHS Benchmarking Network) 350 100% Sepsis Study – Organisational Questionnaires (NCEPOD) 8 100%

The reports of two national clinical audits were reviewed by the Trust in 2014/15 and SCT intends to take the following actions to improve the quality of healthcare provided. The reports for the remaining two national clinical audits will be reviewed following their publication.

National Clinical Audit Reports Outcomes and actions Rheumatoid and Early Inflammatory The report was reviewed and no actions were Arthritis Audit (British Society for identified. Rheumatology) NAIC (NHS Benchmarking Network) The national report and local benchmarking information have been received and are under review. SSNAP (Royal College of Physicians) The report will be reviewed following publication in December 2015. COPD Audit (Royal College of Physicians) The report will be reviewed following publication in February 2016.

During 2014/15, SCT participated in four optional national clinical audits considered relevant to local clinical practice, resulting in the following outcomes and actions:

National Clinical Outcomes and actions Audit Back Pain Although compliance with evidence-based guidelines on back pain Management Re-audit management exceeded the benchmark, the service is raising Faculty of performance further by: Occupational Medicine • being proactive in taking appropriate actions when identifying the psychological risk factors of long-term disability and inability to work; • offering further training to the team to identify psychological risk factors.

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National Re-audit of In most categories, results exceeded the national benchmark. Where Record Keeping the benchmark was not met: Faculty of • clinicians will be reminded that any alternations or corrections in Occupational Medicine records must be countersigned and dated as per Nursing and Midwifery Council (NMC) Guidance on Record Keeping; • staff will be reminded that use of abbreviations must be understandable. Where clarity is required, clinicians will write the word in full at least once in the entry with the abbreviation in brackets. MoHawk In most categories, results exceeded the national benchmark. Where (Management of the benchmark was not met: Health at work and • all clients referred to the service will be seen within 10 working days; knowledge) Re-audit • all reports will be sent out within two working days of a client being Faculty of seen; Occupational Medicine • all clients referred for lower back pain to be assessed for the psychological risk factors of long-term disability and inability to work. National Audit of Data on 6 patients was submitted. The results will be shared at the Unstageable / European Wound Management Association (EWMA) conference in Ungradeable Pressure May 2015. The Trust will review the results to identify potential Ulcers actions. Tissue Viability Society

2.4.1 Trust-Wide Audits During 2014/15, SCT completed ten trust-wide clinical audits considered relevant to local clinical practice resulting in the following outcomes and actions:

Audit title Outcomes and actions Management of The management of medical devices is monitored by each service Medical Devices audit using self-audit, to check compliance with the medical devices policy. programme Results of these self-audits are compiled centrally on a biannual basis. The next report is due at the end of 2015/16. Omitted doses re- Six wards showed an improvement and five wards showed an audit. increase in the number of omitted doses compared to the 2013/14 audit. Results informed a list of recommendations and action plan for Matrons and Ward Managers to achieve to ensure a further reduction in omitted doses. Antimicrobial re-audit Results showed an improvement indicating that antimicrobial prescribing is following approved guidelines and good practice. A short list of recommendations for improvement is in place and a re- audit is planned in 2015/16. Prescription chart re- The results showed an improvement in most areas of the Trust; audit however, some areas require further work. Recommendations and an action plan are in place and aim to be completed by July 2015. Controlled drugs (CD) The number of staff trained rose to 85%. Recommendations have training re-audit been agreed and actions put in place to increase training compliance to by a further 10% during 2015/16.

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CD reconciliation and Results demonstrated an improvement in CD reconciliation compared receipts audit to a previous report by an external auditor. It also showed the procedure for CD receipts is not followed consistently. An action plan is in place for Ward Managers to complete. Infection Prevention 123 environmental audits were carried out with 98 (80%) achieving full and Control compliance. Actions taken as a result of the audit include: new Environmental Audit cleanable shelving for linen cupboards, new vinyl flooring, programme standardisation and purchase of commodes, leak testing of wheelchair cushion covers, compliant hand hygiene sinks, new bedside lockers, standardisation of products to improve decontamination and improved sharps management. Heath Records Audits Each service is required to audit their health records once every two programme years using set standards that have been compiled with reference to nationally agreed standards. 95% of services have completed their audits and each team will have used their findings to populate an action plan. Do Not Attempt All adult inpatient wards undertook a spot audit of current inpatients Cardiovascular according to nationally agreed criteria. In all but two cases, the Pulmonary DNACPR orders satisfied the criteria. The GPs concerned were Resuscitation notified that they had not completed the DNACPR orders correctly and (DNACPR) Audit the orders were corrected immediately. Monitoring the The audit identified a transition towards a harm prevention approach implementation of the with standards of assessment, care intervention and evaluation Trust’s Pressure scoring highly. Areas to be improved include care-planning standards, Damage Prevention consideration of self-care options, standards of record keeping and Operational Framework handover and communication.

2.4.2 Local Clinical Audits 76 local clinical audits were undertaken in 2014/15, of which 30% were re-audits. 51 audits were complete by year-end. The reports of 39 local clinical audits were reviewed in 2014/15 and SCT intends to take the following actions to improve the quality of healthcare provided:

Audit title Outcomes and actions Continence Pad Usage Staff were found to be using the assessment tool correctly; however, – Inpatient wards weaknesses in the assessment tool itself were identified. The tool is being revised to ensure all patient needs are identified. Static Commode Use – Inpatient wards discussed the results and agreed a standard way of Inpatient wards identifying which patients are most suitable to use a static commode and stand to experience the greatest benefits from using one. Audit of The audit found the majority of guidance was met. To increase implementation of compliance with guidance on intensity of therapy visits provided, the NICE Stroke guidance team will audit the number of patients who could benefit from more (CG162) – Community therapy visits to provide the best chance for neurological recovery Nero Rehab Team following stroke. The findings will inform a service review. (CNRT) Clinical screening audit The findings prompted implementation of a Standard Operating – Community Rapid Procedure to ensure consistency with all assessments, including the Response Service admission and assessment criteria and discharge standards for the

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Audit title Outcomes and actions service. Malnutrition Universal Screening Tool (MUST) and Waterlow assessments to be completed during all initial screenings. Pressure damage care plans will be created when MUST/Waterlow assessments are carried out and targeted training will be offered to staff on how to complete MUST and Waterlow assessments. Audit of completed To increase the proportion of newly referred patients being screened initial assessment for anxiety and depression at the first point of care, staff will complete forms to assess the screening tools during initial assessments. By doing so, the whether depression provision of earlier and therefore more effective neuropsychological and anxiety screening interventions is increased, which in turn may also improve a patient’s is undertaken – CNRT engagement with other aspects of their rehabilitation following a neurological event. Steroid Injection Audit The audit results showed that steroid injection therapy continues to be – Musculoskeletal an effective method for treating musculoskeletal conditions and is service safe whilst guidelines and protocols are followed. Audit into the use of Results indicated the number of patients a physiotherapist needs to acupuncture – treat with acupuncture each year to remain competent requires Physiotherapy service agreement, together with the minimum amount of time a patient is asked to rest following treatment, prior to leaving the department. Audit of patient notes The findings were reported at a team meeting in August 2014. It was to check all patients agreed that the annual review completion rate was unsatisfactory. It receive an annual was also agreed that different coloured sheets would be used to review of pulses, prompt clinicians to update the records as required. monofilament and medication – podiatry service Audit of the number of The audit indicated approximately 10% of 5 year olds across Brighton 5 year olds not & Hove do not receive a hearing screening due to unreturned consent routinely receiving a forms. Additionally, approximately 2% of parents declined the hearing screen screening. These results were obtained whilst a single consent form following a request for was used for both hearing and vision screening. Separate consent written parental forms have now been introduced. consent – Paediatric audiology Audit of local This audit highlighted areas where compliance standards were not standards regarding met for this client group. This included staff knowledge and training treating children with and access to assessment resources. Recommendations were made dyspraxia – Children’s to improve standards in these areas, and a re-audit is planned in Speech and Language September 2015 following implementation of the action plan. The Therapy Service action plan includes: (SaLT) SLT manager to identify Specialist SLTs for Motor Speech Disorders. Specialist SLTs to provide training/work-shops at team forums/professional study days. Two new Diagnostic Evaluation of Articulation &Phonology to be purchased so there are at least 3 in the service. Red flag markers added to case-history form and modified form used in all new files.

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Audit title Outcomes and actions An audit of the doses Domperidone is associated with a small increased risk of potentially of prescribed life-threatening effects on the heart. Electronic medication notes were domperidone – Chailey audited against new guidance from the Neonatal and Paediatric Heritage Clinical Pharmacists Group. Following results of the audit, the lead Services Consultant will consider reducing prescribed doses, accounting for patients’ pre-existing cardiac diseases and other medications. This will be evaluated at each individual’s health review and will reduce the possible risks associated with higher than recommended doses of domperidone being prescribed. Re-audit of the Key actions: Safeguarding • The current assessment tool should be used for all young people assessment tool for under 18 who attend the service. young people – • Referral pathways should be clearly recorded and individual Contraception and assessments updated at each attendance. Sexual Health Clinic • When creating electronic patient records the assessment tool should form the basis of an under 18’s assessment, and should include assessing vulnerabilities and risk of child sexual exploitation in sexual health services. Re-audit of Alcohol Key actions: Screening Practice Circulate audit findings to all clinical staff in the service. using the Fast Alcohol Amend screening tool proforma to: Screening Tool (FAST) • include an alcohol unit assessment; – Contraception and • include a ‘not applicable’ response to the FAST question; Sexual Health Clinic • record if patient information leaflets and referrals have been accepted or declined. Carry out refresher training to address FAST screening and the changes on the proforma. Audit of timeliness of Key actions: vascular assessment • Centralise all referrals via a Vascular Nurse Specialist and/or and surgical Vascular Multidisciplinary Team Co-ordinator. intervention – • Ensure all Sussex AAA Screening referrals are distributed equally Abdominal Aortic to vascular surgeons. Aneurysm (AAA) Screening Service • Establish an audit trail for every referral with dialogue about comments/reasons for any delays in either vascular assessment and/or surgical intervention. Audit of effectiveness The audit found that kinesiotaping can play a role in the management & family compliance of mild neurological disorders and should be considered as a with the use of treatment option, where families are able to manage taping at home kinesiotaping to once taught. The treatment will be embedded within the splinting improve function of pathway in children’s therapy services. children with cerebral palsy

During 2014/15 to support and encourage clinical audit activity, eight ‘Introduction to Clinical Audit’ workshops were provided to staff of various clinical backgrounds. This increased engagement with clinical audit activity will be supported through a new model for planning and

Quality Account 2014/15 Page 16 of 73 monitoring audit to reduce administrative overheads and by implementing a rotation of audits for teams to complete each calendar month. The calendared audits will be influenced by real time learning from incidents, complaints, patient feedback and other priorities. This process ensures high standards of clinical audit are undertaken in line with emerging divisional priorities, as well as facilitating effective sharing of learning and outcomes from audit. SCT’s internal auditor TIAA reviewed the effectiveness of the Trust’s clinical audit process, assessing the Trust’s clinical audit methodology, structure, performance and culture. TIAA’s report found ‘reasonable assurance’ with a single recommendation that all relevant clinical governance groups consider adding clinical audit as a standing agenda item. This action will be led by the Trust’s Medical Director.

2.5 Participation in Research The number of patients receiving relevant health services provided or sub-contracted by SCT in 2014/15 that were recruited during that period to participate in research approved by a research ethics committee was 567 into 10 studies. In addition, 1033 clinical staff and health professionals were recruited to 5 studies that had been approved by a research ethics committee during this period, making a total recruitment of 1600 participants to 14 studies. Please note health service research studies often involve patients, carers and clinical staff, study numbers are therefore not mutually exclusive.

Figure 1: Participant recruitment by clinical

7 12 62 124

Cancer Tissue Viability Diabetes

355 Palliative Care Neurological conditions Children's Rehabilitation 1005 Infection Health Service 34 1

Opportunities for our patients, carers and clinical staff to participate in research and improve clinical services and treatments have steadily increased over the past five years. Our research activity has grown in both the number of studies and participants, and the complexity of the research work undertaken, notably intervention studies evaluating treatments or service re- configurations.

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Types of studies and clinical areas Our clinical research studies involved adult services (10 studies) and children’s services (3 studies) in the clinical areas of: palliative care, tissue viability, neurology, diabetes, cancer and children rehabilitation (Figure 1, above). Our research studies comprised five intervention studies evaluating treatment or service reconfigurations and 9 observational studies (Table 1, open studies 2014-2015). Our staff (Dr Catherine Evans, Dr Will Farr and Dr Liz Bryant) led three nationally funded research studies as chief investigators. The evaluation studies involved clinical services in: • Palliative care comprising a service reconfiguration for frail older people with non- malignant conditions (OPTCare Elderly - Optimising palliative care for older people in community settings); and a psychological intervention for patients with depression (CanTalk). • Cancer services evaluating a psychological intervention for patients with anxiety and depression (Getting Down to Coping). • Tissue viability services in our inpatient rehabilitation settings to improve assessment and equipment to prevent and treat pressure area damage (Pressure2). • Children’s services comprising rehabilitation interventions for children with cerebral palsy to improve: mobility and bone density for children with (Petra Bike Study); and the effectiveness of virtual reality exercise for children with ambulatory cerebral palsy (Wii Fit and Ambulant Cerebral Palsy Feasibility Study). Our observational work involved increasingly complex studies with participation in multi-site national studies (Table 1). For example, a national study on measuring complexity and service outcomes in palliative care (C-Change); and a national study looking at what is important for quality of life for people living with neurological disorders (TONIC). We achieved the highest recruitment across the multiple NHS sites involved in these two national studies.

Outputs and impact of our research work and activity Our increasing participation in clinical research is contributing to improving clinical effectiveness in the Trust and building research capacity and infrastructure to support clinical and health service research. Improving clinical effectiveness is a national priority – both implementing research evidence into clinical practice to improve patient outcomes and for clinical staff to stay abreast of advancements in treatments; and increase opportunities for patients/carers to participate in research to improve the quality and effectiveness of treatments and services. For example: • Participation as a study site for an international study Pressure Ulcer Risk Assessment Framework (PURAF) on the assessment of risk to pressure area damage led to revision of the Trust’s processes of assessing risk to pressure area damage and implementation of the study’s findings ( http://etheses.whiterose.ac.uk/7570/ ) • Work led by Dr Diane Sellers at Chailey Heritage Children Services and funded by the NIHR to develop a classification tool for eating and drinking ability for children with cerebral palsy (EDACS) is used nationally and internationally with translations into 15 languages http://www.sussexcommunity.nhs.uk/get- involved/eating_drinking_classification.htm Our increasing research activity is enabling us to build our research capacity with a growing number of staff leading research studies as chief investigators, as co-applicants on research

Quality Account 2014/15 Page 18 of 73 grants, and as site principle investigators leading the implementation of our research studies. This growth is reflected in increasing publications – both as a lead or co-author, conference presentations and awards of esteem in research (table 2). Our dissemination demonstrates our commitment to improving patient outcomes and experiences across health and social care locally, regionally and nationally. The National Institute for Health Research (NIHR) (or their partners) are the main funders of our work (13 studies, see Table 1).

Table 1: Open research studies 2014-2015 *Indicates own account studies led by Trust staff or hosted by the Trust

Research Studies actively recruiting or in active follow up locally Portfolio studies - funded and supported by the National Institute for Health Research Adult Services Title Chief Investigator & Funder affiliation Optimising palliative care for older people *Dr Catherine Evans, NIHR Research for in community settings: development and SCT & King’s College Patient Benefit evaluation of a new short term integrated London service.

Getting down to Coping *Dr S Faithfull, NIHR Research for University of Surrey Patient Benefit grant

Can Talk: the clinical and cost Dr Mark Serfaty, NIHR Health Technology effectiveness of CBT plus treatment of University College Assessment Programme depression in advanced cancer: a London randomised controlled trial.

Pressure Relieving Support Surfaces: A Professor Jane Nixon, NIHR Health Technology Randomised Evaluation 2 University of Leeds Assessment Programme

Validity and Reliability of Integrated Dr Fliss Murtagh, NIHR Programme Grant Palliative Care Outcome Scale (IPOS) King’s College London

Trajectories of Outcome in Neurological Professor Caroline Motor Neurone Disease Conditions Young, Walton Centre Association NHS FT

Chronic Fatigue Syndrome in the NHS: Dr Simon Collin, NIHR Postdoctoral Outcomes after treatment by Specialist University of Bristol Research Fellowship Services

Comprehensive Geriatric Assessment, Dr Sasha Shepard, NIHR Health Service & How best to deliver comprehensive University of Oxford Delivery Research geriatric assessment (CGA) in a cost- Programme effective way

DARE: Diabetic Alliance for Research in Professor Andrew Wellcome Trust England Hattersley, University of Exeter

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Themis: A Multi-site evaluation of Dr Kelly Buckley, Co- Henry Smith Charity, The hospital-based Independent Domestic ordinated Action OAK Philanthropy Ltd Violence Advisor services Against Domestic Sigrid Rausing Trust Abuse Children, Wellbeing & Reablement IAPT Services Wii Fit and Ambulant Cerebral Palsy *Dr Will Farr, SCT NIHR Research for Feasibility Study Patient Benefit grant The introduction of Petra running-bikes to *Dr Donna Cowan, SPARKS (The Children's encourage and facilitate weight-bearing SCT CHCS Medical Charity) exercise for children with cerebral palsy who are unable to walk independently: a pilot study. Diagnostic test accuracy of a modified Dr Catherine Hill, Action Medical Research screening questionnaire and home pulse Southampton oximetry parameters in the diagnosis of University Hospitals obstructive sleep apnoea in children with NHS Trust Down Syndrome. TraCCS - Transforming community health Professor Gillian NIHR Health Service and services for children and young people Parker, University of Delivery Research who are ill: a quasi-experimental York Programme evaluation. Non-NIHR portfolio studies (not funded or supported by NIHR e.g. NHS England or charity-funded studies) Adult Services Culture of Care Barometer Professor Anne Marie NHS England Rafferty, KCL Children, Wellbeing & Reablement IAPT Services An Epidemiological ASD Study and Dr Jeremy Parr, Autistica Establishing a Research Database. Newcastle University

Table 2: Outputs by clinical research staff from Sussex Community NHS Trust Articles published peer reviewed journals Title Authors and year Journal publication Place and Cause of Death in Evans, C J, Y Ho, et PLOS Medicine 11(6): Centenarians: A Population-Based al. (2014) e1001653 Observational Study in England, 2001 to 2010 Development and reliability of a system to Sellers, D, Mandy, A, Developmental Medicine classify the eating and drinking ability of Pennington, L, & Child Neurology. 56 (3) people with cerebral palsy. Hankins, M and Morris, 245–251 C (2014) A systematic review of ordinal scales Sellers, D, Pennington, Developmental Medicine used to classify the eating and drinking L, Mandy, A and & Child Neurology. 56 (4) abilities of individuals with cerebral palsy Morris, C (2014) 313-322

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Recent advances in assistive technology Cowan, D and Judge S Disability & and engineering (RAATE) – a UK (2014) Rehabilitation: Assistive perspective Technology. 9 (1) 31- 32 The Concept of a Toolbox of Outcome Wright, V and A Journal of Child Measures for Children with Cerebral Majnemer (2014) Neurology 29(8): 1055- Palsy: Why, What and How to use?" 1065 Can a six-week exercise intervention Bryant, E, Pountney, Clinical Rehabilitation. 27 improve gross motor function for non- T, and Williams, H (2) 150-159 ambulant children with cerebral palsy? A (2013) pilot randomised controlled trial Factors associated with quality of life in Reilly C, P Atkinson, et Journal of European active childhood epilepsy: A population- al. (2015) Paediatric Neurology based study. Society: 1-6. Published online 7.1.15 Parent- and Teacher-Reported Reilly, C, P Atkinson, Journal of Attention Symptoms of ADHD in School-Aged et al. (2014) Disorders. Published Children With Active Epilepsy: A online 21.11.14 Population-Based Study. Screening for mental health disorders Reilly, C, P Atkinson, Epilepsy Research. inactive childhood epilepsy: Population- et al. (2014) 108(10): 1917-1926 based data. Academic achievement in school-aged Reilly, C, P Atkinson, Epilepsia: 55(12): 1910- children with active epilepsy: A et al. (2014) 1917 population-based study. Pathological Demand Avoidance in a Reilly, C, P Atkinson, Research in population-based cohort of children with et al. (2014) Developmental epilepsy: Four case studies. Disabilities 35(12): 3236- 3244 Neurobehavioural Comorbidities in Reilly, C, P Atkinson, Pediatrics Official Journal Children with Active Epilepsy: A et al. (2014) of the American Academy Population-Based Study. of Pediatrics 133(6): e1586-93 Books or book contributions Electronic Assistive Technology. Cowan D, Rogers J, In: Taktak A, Ganney P, Najafi L, Panthi F, Long D and White P eds. Wade W, Lievesley R, Clinical Engineering: a Adam T and Long D handbook for clinical & (2014) biomedical engineers. Academic Press, pp.359- 388 Mechanical and Electromechanical Cowan D, Smith M, In: Taktak A, Ganney P, Devices. Gardiner V, Horwood Long D and White P eds. P, Morris C, Holsgrove Clinical Engineering: a T, Mayhew T, Long D handbook for clinical & & Hillman M (2014) biomedical engineers. Academic Press, pp.407- 432

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Published conference abstracts The clinical use of functional classification Killian L, Bryant E & Developmental Medicine systems for children and young people Sellers D (2014) & Child Neurology (Vol with cerebral palsy. 56), Supplement s4, p32. Abstract presented at the European Academy of Childhood Disability, Vienna, July2014 To what extent are risk factors for McGill K, Bryant E, Osteoporosis osteoporosis and fracture measured and Walker-Bone K (2014) International 25 (s6) recorded among children with severe and s684-s685. Abstract complex disabilities: an audit presented at the National Osteoporosis Conference, Birmingham, Dec 2014 Esteem Awards Paul Polani Award to encourage research Dr D Sellers, March British Academy of and innovation in the field of Paediatric 2015 Childhood Disability & Neurodisability Royal College of Paediatrics & Child Health NIHR Research and Development Ms L Southby & Dr C J NIHR Leadership Leadership Programme, Ashridge Evans Programme for Business School Research, Development & Innovation NIHR Leadership programme for senior Dr C J Evans NIHR Leadership clinical academics Programme NIHR Clinical Lectureship; a joint post Dr C J Evans, March HEE/NIHR Integrated between Sussex Community NHS Trust 2011-February 2015 Clinical Academic and Kings College London, working in Training Programme for Palliative Care non-medical healthcare professions

2.6 NICE Guidance In 2014/15, SCT identified 21 Clinical Guidelines issued by the National Institute for Health & Care Excellence (NICE) as Directly Applicable. SCT has a robust policy and process for the dissemination, review, implementation and monitoring of applicable NICE guidance and use of the guidance to assess practice. The Trust wide Clinical Governance Group and the Services’ Clinical Governance Groups oversee and monitor NICE Guidance.

2.7 Commissioning for Quality and Innovation (CQUIN) Framework Each year, a proportion of the money SCT receives (our income) is paid only if we achieve quality improvement and innovation goals that have been agreed between SCT and any other person or organisation they have a contract, an agreement or arrangement with to provide NHS services. This happens through the CQUIN payment framework.

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2014/15 There were seven CQUIN indicators at 2.5% of the contract value in 2014/15. Two of the CQUINs were nationally mandated and the others were locally agreed. Nationally mandated • Family and Friends Test. • Safety Thermometer. Locally agreed • Seven day working. • Proactive Care. • Frailty. • Immunisations School Aged children. • AAA screening.

2015/16 For 2015/16, CQUINs continue to attract 2.5% of contract value. There are two national schemes with the others agreed locally: Nationally mandated • Dementia. • Admissions Avoidance through the development of schemes on the community. Locally agreed • Transition plans for young people with disabilities or complex health needs moving to adult health services. • Implementation of EKOS goal setting tool for children’s speech and language therapy. • Mental health screening. • Frailty (second year of the two year scheme). • Improve uptake of AAA screening where this is identified as low in the health equity audit report. • Improved handover between maternity and health visiting services. • CHIS: Improvements in monitoring, recalling, scheduling and record keeping for Hep B vaccinations. We are continuing to discuss with commissioners their proposals for schemes associated with end of life care and proactive care.

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2.8 Statements from the CQC SCT is required to register with the Care Quality Commission. The Trust has 10 registered locations and is registered to carry out the following regulated activities: • Nursing care • Family planning services • Treatment of disease, disorder or injury • Surgical procedures • Diagnostic and screening procedures The Trust was inspected in December 2014 under the Chief Inspector of Hospitals regime. The CQC inspected four groups of services: Community health inpatient services, Community health services for adults, Community health services for children young people and families and End of life care. The inspection focused on the five key questions: • Are services safe? • Are services effective? • Are services caring? • Are services responsive? • Are services well led? The Trust was rated as “good” in all the areas and achieved an overall rating of ‘Good’. The Trust undertakes proactive internal ‘Assurance Reviews’ to self-assess its service user, visitor and staff safety; clinical effectiveness; and service user experience against the CQC outcomes. Any areas identified for improvements are followed up ensuring remedial actions are completed.

2.9 Data Quality The table below details the actions Sussex Community NHS Trust is taking to improve data quality. Key to this is the implementation of a new clinical information system, which is in the process of being deployed throughout the Trust. The new system enables staff to record accurate, timely and complete data against the patient record. As part of this deployment, the Trust is piloting a mobile working solution to community-based staff, significantly improving data quality by enabling data to be recorded at the point of patient contact.

2013-2015 Core Data Quality Strategy actions Action Achieved? Anticipated Progress Outcomes Data quality is best On target All staff will have an Work on raising awareness of when it is captured awareness of the data quality via management directly by the person importance of data awareness days, intranet, user who performs the quality and the tools to groups and data quality activity, at the time the support record data reports. A mobile working activity takes place. accurately at the point solution is being piloted to it is created. enable data to be collected in real time.

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It is of paramount On target Clear guidance to This is a fundamental aspect importance that all support staff on of training in the new clinical data collected is of accurate data system and continues appropriate quality in collection at the Trust throughout the system roll out. dimensions, which moving towards include accuracy, compliance with the integrity and Community freshness. Information Data Set (CIDS) & Children and Young People’s Health Services (CYPHS) All data that is On target A ‘baseline’ review of Review of current data use collected must be high current data use and and system analysis has been quality and focused, to system analysis is included as part of planned ensure it is being used required. deployment of new system. as effectively as possible. Staff can usually On target A trajectory of Data quality indicators have improve data quality in improved data quality been incorporated in their normal work, for in all teams will be performance dashboards, example by reducing agreed through our allowing services to monitor input delays and Business Planning accuracy and completeness of checking at the point it Process. data. Services are routinely is created. asked to provide narrative indicating how they are working to improve data quality, increasing understanding and ownership. Staff training in any On target A full training Experienced trainers have data collection. programme to support been recruited and detailed the implementation of training is provided to each the Trust’s Data service deployed, training is Quality Strategy in tailored for each service and place. staff role. Data quality reports are developed against each deployment to ensure that users have understood their training and prevent bad habits from forming. System changes must Yes The Trust will devise A change advisory board be communicated in and document a robust meets weekly to discuss and an effective and timely change control approve any system changes. manner to ensure process in a new All clinical changes are those collecting data policy. directed to the clinical are as informed as information assurance group possible. for ratification.

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*Quality Indicator 19 SCT National Best performing Worst performing rate average Community Trust Community Trust The percentage of patients readmitted to a hospital which forms part of the Trust within 28 days of being discharged from a hospital which forms part of the Trust during the reporting period; aged: (i) 0 to 15; and (ii) 16 or over. *We are unable to report our performance against Quality Indicator 19 as current data is unavailable from the Health & Social Care Information Centre (HSCIC).

Quality Indicator 21 SCT National Best performing Worst performing rate average Community Trust Community Trust The percentage of staff 72% 70% 83% 62% employed by, or under contract Cambridgeshire Liverpool to, the Trust during the Community Community Health reporting period who would Services NHS Trust NHS Trust recommend the Trust as a provider of care to their family or friends. 2012 2013 2014 67% 68% 72% SCT considers that this data is as described for the following reasons. The data has been supplied by an external organisation following strict protocols and downloaded from the HSCIC. SCT intends to take the following actions to improve this score, and so the quality of its services; continue to work to engage staff in the leadership of the Trust to create a culture of excellence and pride in the organisation. This includes engaging staff on our staff survey results and raising awareness of how the Trust is responding, development of our leadership strategy, and promotion of support mechanisms to help staff be effective at work, e.g. flexible working opportunities.

Quality Indicator 25 SCT SCT National National Highest Highest Lowest Lowest rate Oct rate Apr Average Average National National National National 13 - Mar 14 - Sep Oct 13 - Apr 14 - Oct 13 - Apr 14 - Oct 13 - Apr 14 - 14 14 Mar 14 Sep 14 Mar 14 Sep 14 Mar 14 Sep 14 Number of 2,292 2,085 1,991 1,963 4,058 3,068 883 873 patient safety incidents reported

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% Rate of patient 101.4 110.73 98.5* 95.57** 206.3* 196.26** 30.7* 32.44** safety incidents reported (per 1,000 bed days) Number of 7 8 24* 19** 139* 90** 1* 0** incidents that resulted in severe harm or death % Rate of 0.3 0.4 1.15* 0.84** 5.3* 3.9** 0.1* 0** incidents that resulted in severe harm or death (per 1,000 bed days) Note: The NHS Patient Safety Division recognise that a high level of patient safety incidents reported can be a useful indicator of an open and transparent organisation. * Based on 15 Community Trusts submitting data over the same reporting period. ** Based on 11 Community Trusts submitting data over the same reporting period. SCT considers that this data is as described for the following reasons: the data has been extracted from information supplied by the National Reporting and Learning System (NRLS) following strict protocols and downloaded from the HSCIC. The Trust has taken the following actions to improve this indicator and so the quality of its services, by implementing the following initiatives as part of the Trust Quality Improvement Plan 2014-15; Management of Pressure Damage Incidents There has been an improvement in the number of pressure damage incidents reported, with a 14% reduction in 2014-15, due to the preventative work undertaken over the last year including; • Implementation of pressure damage prevention framework. • Changing ethos that pressure damage is everybody’s business. • Implementing Purpose T risk assessment tool. • Design of pressure damage prevention flowchart and toolkit to realign Trust documents to support the process. • Improved reporting / data quality including. • Improved process for reporting ‘unstageable’ to prevent double reporting. There has been an improvement in the number of slips, trips and falls, with a 12% reduction in 2014-15, due to the preventative work undertaken over the last year including; • Patients are identified as at risk or not at risk of falls on admission via the falls bundle & appropriate care planning is commenced. • If a patient falls this is identified on a falls safety cross and an incident form is completed. This is also reflected at handover and by the patient status board above the patient’s bed so that all staff are aware of the fall. • A running total of falls is kept for each patient and this is handed over each shift, including what the falls triggers are. • Consideration is given to cohort nursing in bays for multiple patients who are at risk and

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extra staff are provided to maintain safety. • Use of falls prevention equipment such as sensor pads and alarms. The Trust will continue to improve incidents which result in harm, through the development of the Quality Improvement Plan and the Sign up to Safety Improvement initiative.

2.10 NHS Number and General Medical Practice Code Validity SCT submitted records during 2014/15 to the Secondary Uses service for inclusion in the Hospital Episode Statistics, which are included in the latest published data. The percentage of records in the published data that included the patient’s valid NHS number was: 2010/11 2011/12 2012/13 2013/14 2014/15 For admitted patient care 98.5% 99.9% 100% 99.9% 100% For outpatient care 99.8% 99% 99.4% 99.6% 99.8% For accident & emergency care 95.3% 99.2% 99.4% 99.2% 99.3% The percentage of records in the published data included the patient’s valid General Medical Practice Code was:

2010/11 2011/12 2012/13 2013/14 2014/15 For admitted patient care 99.9% 99.7% 99.4% 98.2% 99.3% For outpatient care 99.9% 99.7% 99.8% 99.8% 99.3% For accident & emergency care 100% 100% 100% 100% 100%

2.11 Information Governance Toolkit Attainment Levels SCT’s Information Governance Assessment Report overall score for 2014/15 was 75% and was graded green - meaning our rating was satisfactory. This score was an increase from the 2013/14 score and shows an improvement in our information governance compliance. The assessment has been audited and the Trust has been given substantial assurance. Reaching an improved rating of 75% demonstrates the Trust has appropriate processes in place to maintain the protection and confidentiality of its patient information and that it adheres to data protection legislation and good record keeping practice. The Trust has a Senior Information Risk Owner and a Caldicott Guardian who are engaged with information governance and the protection of patient information. In 2015/2016, the Trust will work to improve its information governance scores further and best practice.

2.12 Clinical Coding Error Rate SCT was not subject to the Payment by Results clinical coding audit during 2014/15 by the Audit Commission.

2.13 Incidents and Patient Safety SCT continues to use an incident reporting system called ‘Safeguard’ which enables staff to report any incident or near miss they have witnessed or become aware of. Safeguard also allows the Trust to monitor reporting themes and trends, and to ensure incidents are rapidly responded to. The data warehouse also extracts data from Safeguard to contribute to the Trust’s comprehensive performance reporting.

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During 2014/15, 6525 incidents were reported, representing a 3% decrease compared with 2013/14, as shown in the chart below.

The three most frequently reported categories of incidents in 2014/15 remain the same as those reported in 2013/14 and were: • Pressure Damage (including pressure damage originating in another organisation); • Slips, trips and falls; and • Medication Errors (including medication errors originating in another organisation).

The Trust plans to implement a new incident reporting system ‘Datix’ over the forthcoming year, to continue to improve incident reporting and data quality. All NHS Trusts in England are required to report patient safety incidents every week to the National Reporting and Learning Service (NRLS) in order to promote learning. The Trust has continued to meet its responsibility to send incidents relating to patient safety, which is used for comparative bench marking. The target for this indicator is to be below the national average for the percentage of incidents that resulted in severe harm or death; based on comparative 2013/14 data, the Trust has achieved this. The Trust considers that this data is as described for the following reasons: • The approach taken to determine the classification of each incident, such as those ‘resulting in severe harm or death’ will often rely on clinical judgement. This judgement may acceptably, differ between health professionals.

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• In addition, the classification of the impact of an incident may be subject to a lengthy investigation, which may result in the classification being changed. This change may not be reported, so the data held by a Trust may differ to that held by NRLS. • SCT’s board regularly reviews patient safety incident reports for themes and trends.

All Community NHS Sussex Community NHS Trust Trusts 2013/14 2013/14 2014/15 Number of % of Degree of Number % of Number % of Incidents Incidents Harm of Incidents of incidents Incidents Incidents Not yet 3 0.05 55 1 assessed 16351 49 No Harm 2662 51 2073 43 1822 35.5 Low 2162 42 2204 46 4762 4.3 Moderate 340 7 384 8 317 1 Severe 16 0.3 20 0.4 68 0.2 Death 4 0.07 39 0.8 Near Miss 16 0.3 55 1 Total 5203 100 4830 100 The above patient incidents and near misses have been bench-marked against National Community Trust incidents reported from 1st April 2013 to 31st March 2014. During the year 2014/15, the Trust reported 4830 patient incidents, representing a 7% decrease when compared to 2013/14. During 2014/15 the Trust has revised the way in which it records against ‘death’ to include any unexpected death of a patient who has had involvement with one or more SCT service. This has resulted in an increase in the number of deaths reported; however, the outcome of those deaths requiring investigation, or a Coroner’s inquest did not conclude the causes of death to be attributed to the Trust. Whilst the number of incidents reported overall has reduced, the majority (89%) were scored as ‘No’ or ‘Low’ Harm. During 2014/15, the process for incident reporting and harm scoring was revised. As an unexpected consequence, the number of incidents ‘yet to be assessed’ increased, and the process has been amended to prevent this from reoccurring. There is no correlation of data to suggest any specific reasons for the increase in severe incidents. The Trust will be implementing the following actions to reduce the level of incidents resulting in harm to patients: • Actively encouraging incident reporting to increase improvement actions and organisational learning. • Revising the role of the Patient Safety Leads to Quality and Patient Safety Improvement Nurses to enable them to work clinically and embed lessons identified from incidents, serious incidents and complaints.

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• Continue to work with the Kent, Surrey and Sussex Patient Safety Collaborative on identified work streams. • Continue to enable service level ownership and monitoring of incidents and patient safety through the clinical governance structure. • Continued to undertake Falls Assessments and falls prevention work in our bedded inpatient areas. • Continue to deliver against the Pressure Damage Prevention Framework. • Implement the incident reporting system ‘Datix’ to improve incident reporting and data quality.

2.14 Non-Patient Safety SCT internally reports non-patient incidents and near misses, which are monitored by the Health and Safety Group, chaired by the Chief Nurse. During the year 2014/15, the Trust reported 4830 patient incidents, representing a 13% increase when compared to 2013/14.

Non Patient Incidents Sussex Community NHS Trust and Non Patient Near Miss Incidents 2013/14 2014/15 Degree of Harm Number of % of Number of % of Incidents Incidents Incidents incidents Not yet assessed 2 0.1 16 0.9 No Harm 934 62 1027 61 Minor 487 33 549 32 Moderate 67 4 69 4 Severe 0 0 4 0.2 Catastrophic 0 0 1 0.05 Near Miss 7 0.4 29 1.7 Total 1497 100 1695 100 Of the non-patient incidents, 9 were reportable under RIDDOR, (the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations) a decrease from 2013/14 when 12 incidents were reported.

2.15 Environmental Impact In 2010, SCT adopted its first Board-approved Sustainable Development Management Plan (SDMP). Nicknamed “15 by 15”, the SDMP set a trajectory to reduce all key environmental impacts from Trust operations (including, most significantly absolute CO2 emissions) by 15% by 2015, along with a zero waste to landfill commitment. The purpose was simple – to demonstrate the benefits of taking action to become more environmentally sustainable and lay the foundations for a more ambitious and longer-term sustainability strategy. In 2014, our Board approved a new and more holistic sustainable healthcare strategy, Care Without Carbon (CWC) – an innovative approach to delivering health services that care for both people and the environment. The strategy is aimed at addressing one of our core strategic objectives - to be a strong, sustainable business, grounded in our communities and led by

Quality Account 2014/15 Page 31 of 73 excellent staff, and it has been designed to dovetail into all major Trust strategic and operational initiatives. CWC sets challenging sustainability targets for 2020, with a long-term aspiration to become the first carbon neutral healthcare NHS provider in the UK. It identifies seven different areas for action - including buildings, journeys, procurement and health & wellbeing. In this way, its focus is on integrating sustainability across Trust operations, providing benefits to staff and patients, as well as substantial cost savings and reduced emissions. Since 2010, we have achieved* the following:

Buildings Reduced our carbon footprint by 985 tonnes (15.7%), meaning we have met our 15 by 15 target a year early. Procurement Recycled 62% of our non-healthcare waste, with zero non-healthcare waste going to landfill. Also introduced offensive waste stream, meeting our 35% target. Journeys Cut our vehicle emissions by 9.8% by introducing cleaner commercial vehicles, including our first electric courier vehicle and are progressively capping engine emissions through our lease car scheme. Buildings Improved the efficiency of our buildings, with a 14.5% increase in energy efficiency (kgCO2e/m2) and 40.8% increase in water efficiency (m3/m2). This was achieved through the introduction of energy efficient and renewable energy technology; improving space utilisation; and introducing water efficiency and leak detection schemes. Journeys Worked through our Business Travel Plan to introduce our first electric bike to the fleet alongside our first zero emission pool car, taking our low emission fleet vehicles up to 16. We have also continued to develop our well-utilised Travel Bureau to support managers and their staff reduce travel time and costs. Culture Launched a new staff engagement campaign, Dare to Care, in February 2015 to promote Care Without Carbon and encourage grass-roots action in support of its goals. Dare to Care invites staff to take a simple ‘Dare’ (or pledge) that benefits them and the environment, incentivised by a supplier-sponsored quarterly prize draw. Staff sign up through our new website www.carewithoutcarbon.org with the campaign being continually updated throughout the year. Wellbeing Drawn together the sustainability and workforce wellbeing agendas through our Dare to Care campaign. Each Dare has been selected because it supports CWC’s three core goals: enhancing care quality, improving resource efficiency and maximising productivity. Procurement Further developed collaborative projects with key suppliers to reduce the environmental impacts of products/services used by the Trust. Adaptation Started work on a Climate Change Adaptation Plan for the Trust. Initial work has focussed on identifying how the Trust will be impacted by our changing climate, with increased extreme weather events (such as floods and heat waves) and increased temperatures predicted. Impacts on Trust buildings and on patients were considered, for example the potential increase in both heat and flood-related illness/death. We look forward to working with clinical teams to develop this further this year.

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Pioneering Won the national Institute of Healthcare Engineering and Estate Management (IHEEM) Sustainable Achievement Award in 2014, as well as being runner up for the Energy Saving Trust’s Fleet Heroes awards with commendation for reducing business mileage by almost a million miles. Nominated for the NHS Sustainability Awards for Behaviour Change, HR and Clinical. Presented on Care Without Carbon at an NHS England sustainable practice event in 2014 as well as several others throughout the year. We are also taking a lead role in facilitating a South East sustainability best practice network this year at the request of NHS England.

*Achievements listed are based on validated 2013/14 data, or 2014/15 input for qualitative achievements.

2.16 Estates

2.16.1 Building a Healthier Sussex Our estates and facilities are key to supporting our vision of delivering effective care at the heart of the community. As a community Trust with more than 4,400 staff, covering more than 800 square miles, accommodation is a key issue for us. We currently operate from 300 locations, including 60 main sites and there is huge variation in the age and quality of the buildings we work in and from where we deliver our services. SCT inherited many of these sites from a number of different organisations in 2010. Our five-year estates strategy looks at how to improve the quality of our accommodation, support our clinical services strategy, be more efficient with the space we use, improve options for flexible working and at the same time save money. We have recently reviewed and refreshed our estates strategy for 2015 – 2020 in order to: • Ensure that all our plans for our estate are clinically led. • Align with service transformation programmes to improve the capacity and resilience of our services in a financially constrained context. • Coordinate with commitments to invest in information technology, particularly the rollout of SystmOne to support paper-less working, and enable more agile and productive working to improve patient services and staff working lives. Please see the estates strategy on our website www.sussexcommunity.nhs.uk/trustreports

2.16.2 Modernising our estate around our service needs The estates strategy sets out a number of principles for modernising the estate, from which some specifics can be determined. These include: • Administrative/ community health services hubs to support resilient teams. The majority of services we provide are in patients own homes, or in other premises such as GP surgeries. We are organising our services to support inter-disciplinary and inter- organisational teams with the capacity to respond to need in the community. A ‘hub’ is a central administrative space where staff can base themselves. Hubs are not locations to which patients would expect to have to go. We aim to have six hubs in key geographical areas. Those already in place include: Brighton General Hospital (Brighton & Hove area), The Quadrant, Lancing Business Park (Lancing and Shoreham area), Southfield House (Worthing area), Southgate House (Chichester and Bognor area), although we plan to relocate to better quality office facilities in Chichester in mid-2015.

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• Further hubs are required for Mid Sussex and for the Crawley/Horsham area. The exact requirements will be worked up in the current year, as the exact model will vary dependent on local geography and commissioners requirements. Nevertheless, the principle of establishing administrative hubs distinct from clinical facilities will apply. • Improved integration and co-location of services. We are working closely with our local authority partners (Brighton & Hove City, and West Sussex County Councils in particular) to co-locate teams around care groups. Increasingly, teams such as health visitors are located with other children’s services provided jointly with partners in shared facilities such as children’s centres. • We are supporting patients with a greater level of acuity in the community and are working with commissioners and partners to deliver new patient pathways. This has implications for our estate, e.g. in the need for increased high quality clinical accommodation and diagnostics. To support a new musculo-skeletal (MSK) service we are improving facilities at Crawley and Horsham Hospitals as well as Hove Polyclinic to provide high quality diagnostic and treatment facilities around the service need.

2.16.3 Redevelopment of Brighton General Hospital Our largest and oldest facility is Brighton General Hospital. Dating from the 1860s the facility was originally built as a Poor Law Institution (workhouse) and has undergone many changes of use. It no longer provides inpatient services, but accommodates a range of clinical, administrative and support functions. The buildings are no longer suited to today’s needs with the result that the facility overall is approximately 50% under-utilised. Initial feasibility has established that it would be possible to procure a new clinical facility built to modern standards, relocate other services in offices and other accommodation elsewhere in a way that can save costs and potentially release land for much needed housing development in the city. Drawing on the expertise of our partners Capita, we will be working up a more detailed master plan and proposal with a view to securing a business case for major changes to the Brighton General Hospital site over the next 5 years.

2.16.4 A unique partnership between SCT and Capita Our strategic goals are clear, but the means of achieving these are not straightforward. Following the production of a business case in 2013, approved by both SCT and Capita, the two organisations entered into a 5-year strategic partnering agreement that commenced in April 2014. SCT staff who provided the management and administration function within the estates team were transferred to Capita at this time. This partnership enables: • Continued delivery of an excellent estates and facilities service to the Trust. • Delivery of estates transformation and improvement of asset utilisation. • Accelerated opportunities such as the redevelopment of the Brighton and Hove site. • Commercialisation of the estates and facilities function. • Robust assurance to ensure that all Trust accommodation is CQC and infection control compliant. • Alignment of estates related investment with associated investment in information technology to implement agile working and deliver greater productivity overall. • Source alternative funding mechanisms to support strategic property development. • Ability to supplement existing skills via the capabilities of the wider Capita structure.

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2.17 Organisational Culture Culture has a significant impact on staff satisfaction, which in turn has an impact on the care delivered. SCT seeks to ensure that our organisational culture supports staff in the delivery of excellent care. Building on the internal cultural inquiry (SCT, 2013), we have developed and embedded a values and behaviours pledge, and used our values explicitly in recruitment and appraisal. We have continued to offer a range of leadership development opportunities including an annual leadership conference, which in 2014 focussed on culture. SCT piloted the Culture of Care barometer tool in 2013 with King’s College London. In addition to testing the tool, it was helpful to see the results of the pilot, which triangulated with what our staff survey results had told us. Developing a tool such as this gives recognition of the importance of positive culture to the delivery of quality services and patient care. Feedback from the pilot found the tool particularly useful within teams or groups of staff as a way of breaking down barriers, challenges and problems distinct to a particular area. SCT will be suggesting it is used when supporting teams, or as a “before” and “after” measure for teams undergoing change. Culture is being addressed in a wider context by the organisation, for example, in work relating to the staff survey action plan, organisational values, reward and recognition and staff engagement.

2.18 Staffing Levels SCT is engaged in a number of activities around recruitment and retention of staff including recruitment campaigns, an international recruitment exercise, reviewing how we market ourselves for recruitment purposes, and streamlining our recruitment processes. The Trust has also reviewed its temporary staffing arrangements and is introducing a new system through a master vendor contract, which aims to reduce bank and agency staff costs. Recruitment drives taken forward during 2014/15 included: • National media campaigns online and in print, attendance at recruitment fairs attracting candidates from all parts of the UK. • Recruitment from Italy, Spain and Portugal. • Local media and banner advertising. • Introduction of a ‘recommend a nurse scheme’ providing incentives for Trust staff to introduce new colleagues to the organisation. • Progress made on a review of how temporary staff are engaged to increase the supply of skilled, safe and trained agency and bank workers while being able to control costs more effectively. In the period from 1st April 2014 to 31st January 2015, SCT recruited just under 750 new staff, which included 176 registered nurses, 85 allied health professionals and 22 doctors or dentists, and 197 clinical support staff. There is a significant amount of activity taking place to ensure we have investigated every avenue to attract staff. The Trust Workforce & Development Group will review the Recruitment & Resourcing Plan on a bi-monthly basis to consider what activities the Trust should continue to invest in, or alternative methods to attract applicants.

2.19 Becoming an NHS Foundation Trust The NHS Trust Development Authority (NTDA) continues to fully support the Trust on our journey to becoming an independent NHS Foundation Trust (FT) in 2015/16. Following a

Quality Account 2014/15 Page 35 of 73 successful board to board with the NTDA in June 2014 and a “Good” rating from the Care Quality Commission (CQC) Inspection in December 2014, the Trust is placed in the highest category (A1) for onward approval to Monitor. In June 2014, senior Trust leaders met with officials from the NTDA. We had the opportunity to describe the Trust’s progress to date and articulate the Trust’s new 5-year strategic plan to improve the quality of patient care we provide and deliver a sustainable model of care to deliver benefits across the wider local health economy system and improve individual patient care and experience. The NTDA continued to recognise the significant progress that was being made by the Trust and this was echoed by positive statements of support from our commissioners and partners in the NHS and local government across Brighton & Hove and West Sussex. The introduction of a revised Care Quality Commission (CQC) inspection regime in 2014, as a result of the Robert Francis Report, necessitated a delay in the Trust’s FT planning timelines as a “Good” inspection result or better, became a prerequisite for approval to the Monitor stage. The Trust welcomed the opportunity for an independent assessment of our quality standards and was very pleased with the overall “Good” grading received across all 5 domains (Safe, Caring, Responsive, Effective and Well-Led). The Trust was particularly proud of the “Outstanding” grading received in the End of Life Care Responsive domain. Having received a “Good” rating in March 2015, the next steps include a final board to board with the NTDA in June 2015 and then handover to Monitor later in 2015 for several months of detailed scrutiny, before Monitor can recommend FT status. Therefore, as a result of the CQC inspection requirements the final approval to become an FT may be delayed into 2016. FTs were established to devolve decision-making power from central government to local organisations and communities. FTs are not directed by the government and are accountable to local communities. This means that they have greater freedom to determine, (with their governors and members (see below)), their own strategy and the way services are run. FTs also have more financial independence than NHS Trusts, and can use this to improve services for patients and service users. FTs are not-for-profit, public-benefit corporations. Public-benefit corporations are different from other public authorities, such as local councils, in that they have membership. We strongly believe that being an FT will help us to: • Improve patient care. • Be more open and accountable. • Strengthen our links with local people. • Build on the work we have already done to make our services more sensitive to the needs of patients. Many people feel a strong sense of connection to the NHS and to NHS service providers. The principles behind FTs build on this sense of connection and ownership. FTs have a duty to engage with their communities and encourage local people to become members of the organisation. They must also take steps to ensure their membership is representative of the communities they serve. Anyone who lives in the areas we serve, works for the Trust, or has been a patient or service user, can become a member of the FT. This gives staff and local people a real stake in the future of their community services and means you can have a say in how the Trust is run. • Call us on 01273 242127 • Visit our website www.sussexcommunity.nhs.uk/ft

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• Email us [email protected] • Write to us FREEPOST RSXG XTCJ BBBT, Foundation Trust Membership Office, Brighton General Hospital, Elm Grove, Brighton, BN2 3EW. • Complete the feedback form on the final page of this document. By March 2015, we had recruited over 4,200 public members and are on course to achieve our 5,000 public members target by the end of 2015 and encourage as many local people to join.

2.20 Working with Patient Representatives Our engagement strategy adopted by the Trust board in April 2014 shows how we will work to ensure the patient’s voice is at the heart of every decision we make. To help us achieve this goal we engage with a range of representative bodies that speak on behalf of the people we serve, from groups that are set up with statutory powers to hold health and care providers to account (Healthwatch, scrutiny committees) through to community and voluntary sector organisations (VCS) that reflect the views of local people.

2.20.1 Healthwatch Healthwatch England is the national consumer champion in health and care. It has significant statutory powers to ensure the voice of the consumer is strengthened and heard by those who commission, deliver and regulate health and care services. Healthwatch England works across a broad range of organisations from local and specialist partners to national health and care bodies and the government. It seeks views from all sections of the community, and has close ties with the many organisations that represent the public, both at a local and national level. Healthwatch England supports local Healthwatch bodies across the country. We work closely with our two local Healthwatch organisations in Brighton & Hove and West Sussex, and are committed to develop and strengthen our relationship, as below: • People from Healthwatch attend our regular meetings with patient representatives hosted by our chair, Sue Sjuve, and our Patient Experience Group, chaired by our Chief Nurse, Susan Marshall. • We welcome Healthwatch to our events, such as our annual general meeting and meetings of the Trust board in public. • We engage with Healthwatch about our plans for strategic and service development. • We send weekly updates about our work and regular news items about the Trust for inclusion in Healthwatch communications. • We share Healthwatch news updates with our staff. • Healthwatch representatives attend our Patient Experience Group. • We respond in an open and timely manner to Healthwatch requests for information about our work and performance.

2.20.2 Local authority scrutiny committees We have equally strong relationships with our two health and overview scrutiny committees – West Sussex Health & Adult Social Care Select Committee (HASC) and Brighton & Hove Health & Wellbeing Overview Scrutiny Committee (HWOSC). These bodies are made up of locally elected councillors and have the power to hold NHS organisations to account for the quality of their services. We speak with both bodies regularly

Quality Account 2014/15 Page 37 of 73 about our plans for strategic and service development and regularly attend their meetings in public to offer presentations about our work.

2.20.3 Engagement with the voluntary & community sector We engage with community and voluntary sector organisations (VCS) that reflect the views of our local communities, maintaining details to identify and segment VCS groups in our area. We manage a programme in which our leaders attend and present at VCS meetings, using these opportunities to explore our vision, strategic goals and plans and secure support for our work. In this engagement work we: • Engage proactively with groups that speak on behalf of health and care users or reflect broader interests within the area we serve. • Seek engagement opportunities with groups that speak on behalf of our more marginalised communities (e.g. disabled people, people from the black and minority ethnic communities).

2.20.4 Engaging for change The ambitions of the NHS nationally and locally – and our vision of excellent care at the heart of the community – require change in the ways care is delivered. Engagement with all our stakeholders with regard to the development of change and the ways change is implemented is the central purpose and point of our engagement strategy. We follow good practice and statutory requirements to ensure engagement with regard to change are timely, purposeful and meaningful. We will work to deliver engagement in collaboration with statutory and VCS partners, building upon existing structures and relationships. We use the full range of engagement processes and methodologies – including formal public consultation where appropriate - following careful assessment of the issues and the needs and circumstances of the stakeholders most directly affected. All this will help allay concerns, give reassurance, build support for change and improve the decision-making process. Ultimately, it will support us to realise our vision of excellent care at the heart of the community, and put the voice of the people we serve at the heart of every decision we take.

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Part 3 - Looking Back 3.1 How we did last year The objectives of this Quality Account align with the inspection model applied to community health and care providers like SCT by the independent regulator of health and social care in England, the Care Quality Commission (CQC). The CQC inspects the quality of work delivered by health and care providers and publishes a rating to describe this quality. To do this the CQC looks for evidence that services are safe, effective, caring, responsive and well led. On the basis of the CQC inspection carried out in December 2014, England’s chief inspector of hospitals: • Rated the overall quality of services we provide as Good. • Rated our end of life care as Outstanding for how it responds to people’s needs. • Rated some elements in the safe domain for our inpatient care services require improvement, including medicines’ management (missed doses), training in the care of people with dementia, record keeping and care planning. The inspectors looked at the quality of care in four of our main services areas: community health services for adults; community health services for children & young people; end of life care and community inpatient care. In the process they found: • Good practice to ensure safe and responsive care, and some exceptional and innovative practice. • Caring staff who consistently provide good care. • Clear leadership, a positive culture and good engagement. • Partnership working that protects vulnerable people from abuse. • Staff who feel valued and supported by their managers, supervisors and the Trust board. As part of the CQC’s recommendations, the inspectors advised us to: • Take new steps to boost recruitment and improve staffing levels. • Work with our partners to improve the quality of parts of the estate we work from. • Review the rollout of IT systems that support patient care. We will work hard to maintain the momentum that helped us achieve a “Good” rating and helps show the people we serve that our services are safe, effective, caring, responsive and well led. We will build on our strengths and address with extra clarity and energy the inspectors’ recommendations for improvement. The process is already well underway. In this Quality Account, you will see much more information about our progress against our quality goals, and about those areas where we know improvement is needed.

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3.2 A Review of our Priorities for Quality Improvement in 2013/14 How did we perform against the priorities for 2013/14 as listed in last year’s Quality Account?

Safe Care Improvement Expected What we said we’d do How did we do? Priority Outcome Falls To reduce  Extend the Falls Bundle We have exceeded the the number work, benchmark target we set ourselves by of patients community hospitals reducing the number of Falls who fall audit data; review the within Community Hospitals whilst in our community assessment by 12%. We have also care by for falls risk and review reduced the percentage of 10%. compliance with falls resulting in moderate updated NICE harm. Guidance. Medication For the  Encourage reporting 601 medication incidents Incidents number of  through internal have been reported from 1st st medication mandatory training April to 31 March 2015, incidents courses for staff. compared to 726 medication reported to incidents reported in the Discuss, shared learning plateau, or & improvements made same period last year. continue to locally from medication increase incidents & throughout The number of reported demonstrati the Trust’s governance medication incidents has ng an open structure. decreased. The target of culture of Communicate with staff plateauing or increasing the reporting by using the Trust’s number of medication staff. communication incidents reported for 2014/15 channels. has not been achieved. It is worth noting that a number of the incidents reported do not relate to SCT care and delivery, but originated from

outside SCT and reported by SCT.

For the  Review medication The proportion (%) of proportion incidents at medication incidents (%) of organisational level; assessed as causing harm medication identify learning & was 16 % compared to 23% incidents improvements via the in the same period last year assessed as Trust’s Medicines Safety meaning the target has been causing & Governance Group. achieved. This is a positive harm to be Produce medication trend as this means fewer lower than incident reports every 6 medication incidents caused the previous months. harm to patients in 2014/15 year. compared to the previous Continue to improve the year. Trust’s incident reporting

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system and to review, audit and improve medicines processes and training. Healthcare For there to  No incidents of preventable Acquired be no transmission of HCAIs have Infection incidents of occurred in 2014/15. (HCAI) preventable  Undertake mandatory Statutory training is offered transmission training by all clinical to all clinical staff. Hand of HCAIs. staff. hygiene practical training is offered in all bedded units.  Undertake hand hygiene Hand hygiene audits are audits. undertaken regularly throughout the year in all bedded units and gradually increasing in community teams.  Develop a C.difficile C.diff reduction action plan reduction action. has been revised and improved.  Share learning from incidents investigated. Never Events For there to  Through continuous staff There have been no ‘Never be no ‘Never training, appraisals, staff Events’ reported. Events’. safety awareness, newsletters and regular patient safety messages cascaded through team talk – SCT’s team briefing system. VTE For no in-  A VTE risk assessment To date, no in-patients have patient in the completed on admission been diagnosed with a VTE care of SCT for all in-patients, as due to a lapse in our care services to appropriate. since April 2014. develop a  For in-patients at risk of VTE risk assessment forms Venous developing a VTE to are being completed in all Thromboem receive the appropriate inpatient units. bolism prophylaxis. (VTE).  Undertake a root cause Prophylaxis is provided for all

analysis investigation inpatients at risk of (RCA) will be conducted developing a VTE according where any VTE occurs in to NICE guidelines. SCT in-patient care. Where a VTE occurs in SCT care, a root cause analysis will be conducted.

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Effective Care Improvement Expected What we said we’d do How did we do? Priority Outcome Mortality A thorough  Introduce new patient Front line clinical staff have Reviews review of all death review forms to all tested new mortality review patients who teams. forms and feedback has die within been collated. The form, our care will together with an explanation take place, of why the data is being including a collected is available to all new staff on the Pulse. quarterly  Introduce quarterly The first mortality review multi- mortality review meeting was delayed due to disciplinary meetings. the roll out of the new forms,

mortality together with staff training review taking longer than expected. meeting. The meetings commenced in February 2015. Pressure For there to  Develop and implement There has been a 14% Damage be a an operation framework reduction in the number of reduction in for the prevention of pressure damage incidents the number pressure damage. reported in 2014/15. of cases of  Undertake an audit The professional framework pressure against the framework to has been implemented across damage. ensure zero tolerance of all adult services.

preventable pressure The framework’s

damage. implementation was audited during June 2014 and the Trust continues to report reduced pressure damage. Pressure For staff to  For 85% of relevant staff During April 14 – March 15, Damage be equipped  to have undertaken 407 staff accessed formal with the pressure damage wound care/pressure damage necessary prevention training. prevention training. Capturing skills to localised training numbers enable them centrally to support robust

to prevent/ Trust reporting remains a manage challenge. pressure Pressure damage prevention damage training is provided through a effectively. suite of delivery options including: mandatory training day, multidisciplinary training sessions, bespoke team sessions, the Preceptorship programme and online e- learning and Bite-size modules. The new Purpose T risk

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assessment tool has been adopted by the Trust and is incorporated into all training as appropriate. The risk team have delivered training regarding pressure damage incident reporting resulting in a significant reduction in inappropriate reporting and an increase in the quality of pressure damage reporting. A ‘top ten tips’ programme has been developed and will be delivered to all new staff joining the Trust during mandatory induction and included on statutory training days from January 2015. Patient Centred Care Improvement Expected What we said we’d do How did we do? Priority Outcome Care Plan Every  Audit against the The Trust has moved patient operation framework for significantly forward on identified as the prevention of ensuring individualised being at risk pressure damage. prevention care plans are in of pressure place for those patients at risk damage will of developing pressure

have a damage. The audit found at patient least 97% of patients had an centred appropriate holistic pressure assessment on admission, damage which included identification prevention of their individual risk of care plan pressure damage occurring. 86% had specific pressure damage prevention care plans as a result of their assessment. Friends and Patient  Roll out the FFT across The FFT rollout has been Family Test feedback further services, achieved in line with national (FFT) gained, and according to national guidance and early acted upon, guidance. implementation as defined by using the the national FFT CQUIN. national We achieved the aim of 20% FFT. of services/activity by 1st October 2014 with the remaining 80% of services by 1st January 2015.

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Patient For patients  We will provide PALS PALS surgeries commenced Advice & and families surgeries at key Trust as planned in September Liaison to be able to sites in line with the 2014 and we held two Service meet with an recommendations of surgeries in our community (PALS) independent both the Clywd and Hart hospitals in Crawley and liaison Review and Patients Horsham. The attendance officer. Association Peer was disappointing, although Review. PALS staff actively visited in- patients to gain feedback and ensure they were aware of the service. Feedback received was all positive. PALS are considering alternative options to capture community-based services and how the PALS service can work with colleagues in partner organisations such as Healthwatch by July 2015. We are continuing to explore our options to provide surgeries at various sites and considering our advertising methods.

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3.3 Additional Achievements in 2013/14

April 2014 Proud to Care Our Brighton & Hove community neurological rehabilitation team (pictured right) won the team communication award at the Sussex and Surrey Proud to Care Awards. The team was recognised for their drive to improve the ways they communicate with people and obtain patient feedback. Strengthening our leaders We hosted the first of our quarterly Leadership Exchange sessions to give our leaders the chance to meet together and with members of the executive leadership team to share ideas and explore some of the big items on our agenda. We’re continuing the programme into 2015/16 and staff say they find the sessions positive, energetic and uplifting!

May 2014 Welcome to Horsham We hosted a visit by councillors from Horsham District Council to meet our community, nursing and therapy teams at Horsham Hospital and learn more about our support for people in the community with long term conditions, including young children and their families, and the frail elderly. At least two councillors were so impressed they went on to register to become public members of our NHS Foundation Trust.

June 2014 Sue Eckstein leadership award At our leadership conference we presented the inaugural Sue Eckstein leadership award to family nurse supervisor Suzy Portway. Sue Eckstein was an accomplished academic and writer who died in November 2013. Her experience of NHS care and her work on clinical ethics at the Brighton and Sussex Medical School led her to consider what good care looks like – insights she shared with us at our leadership conference in 2013, and at our Annual General Meeting in 2011. The Sue Eckstein award acknowledges Sue and her support for our work – especially our rehabilitation services and the Brighton & Hove palliative care partnership. It celebrates how leadership commitment and enthusiasm plays such a critical role in enhancing the quality of care, and helps embed the values and qualities Sue felt so passionate about. Sue’s husband Alistair Burtt was able to join us to present the award to our first winner, Suzy Portway, as seen in the photo.

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Good for kids Our Rainbow nursery at Crawley Hospital received a ‘Good’ rating from Ofsted. The inspector praised staff for the good relationships they have with the children and noted that children play and learn in a safe and secure environment. At the same time, our Hilltop nursery in Brighton achieved the Healthy Choice award for the second time. This is given to early years settings that meet all the conditions set for healthy eating, and is a joint scheme by Food Safety Team, Brighton & Hove Food Partnership and Brighton and Hove CCG.

July 2014 Wedding guests With help from local chaplain Rev. Steve Lomas, our staff at Arundel Hospital arranged a wedding blessing so one of our patients could be part of his grandson’s wedding celebrations. He passed away soon after, but the groom and bride have said how important the event was to him and their family: “We are so thankful to the hospital for their hard work. Everything worked out perfectly and it was great our grandfather was part of our wedding blessing”. Spreading good practice Zoe Faulkner, breastfeeding peer support coordinator for Brighton & Hove, spoke to fellow practitioners around the world about the achievements of our Brighton & Hove breastfeeding team as part of an online international conference iLactation. Our Sussex specialist community public health nurse/health visitor education practice teachers reached the final of the Community Practitioners’ and Health Visitors Association awards to celebrate efforts to improve the lives of children and families.

September 2014 Sign up to Safety To help promote an open culture in which staff put patient safety and wellbeing first and have the confidence to express concerns, we registered for the national Sign up to Safety campaign designed to promote the ambition to make the NHS the safest healthcare system in the world. A good PLACE The quality of the care environment at our community hospitals compares favourably with the best, as confirmed by the patient-led assessment of the care environment (PLACE) report published by the Health and Social Care Information Centre (HSCIC). PLACE requires self- assessment by a team of reviewers from external partners and members of the public to ensure independent scrutiny and objectivity. They review a range of non-clinical areas that reflect public concerns, including cleanliness (including bathrooms, furniture, fixtures & fittings), food & hydration (including choice, taste, temperature & availability), privacy, dignity & wellbeing (including changing & waiting facilities, single sex facilities, telephone access & appropriate patient clothing) and condition & maintenance (including decoration, signage, car-parking). A top employer We were delighted to secure a place in the Health Service Journal’s (HSJ) Best Places to Work list of the top 100 health and care employers in England. This success reflects the positive feedback staff offered in the confidential NHS staff survey.

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How we do it Our West Sussex family nurse partnership (FNP) team hosted a visit by Kate Billingham CBE, the international ambassador for FNP at the University of Colorado and three health ministers from Norway, where they are preparing to launch their own FNP programme and were keen to see how we do it.

October 2014 Winners again We won the Institute of Healthcare Engineering and Estate Management’s national sustainable achievement award for our Care Without Carbon strategy. This recognises our use of innovative technology and sustainable practices, together with our unique approach to sustainability across key areas. And it’s not the first time our efforts to reduce our environmental impact have enjoyed national recognition - in 2011 we received the HSJ’s good corporate citizenship award. But I’m not unwell! One of our proactive care team leads, physiotherapist Nick Seecharan, presented an evaluation of our proactive care work at Physiotherapy UK’s national conference. His presentation ‘But I’m not unwell! Changing the conversation’ shared experiences of multidisciplinary team working and implications for physiotherapists working with patients with long-term conditions. Embedding our values Our children’s community nursing service included an award ceremony in their annual awayday to recognise colleagues in four categories reflecting our values: compassionate care, working together, achieving ambitions, delivering excellence. There were 40 powerful nominations, and the winners are shown right.

November 2014 Time to Talk Our award winning talking therapies service Time to Talk introduced self-referral for people in the Mid Sussex area thanks to the support of our local clinical commissioners. Subject to the progress, we plan to introduce the self-referral option across West Sussex. Time to Talk offers a range of support including guided self-help via the phone or face-to-face, group courses, cognitive behavioural therapy (CBT) and counselling. To promote the service we secured coverage in the local media, produced and distributed a leaflet and uploaded a promotional video to YouTube. You can see this by visiting You Tube and searching for Time to Talk West Sussex.

December 2014 They’re all winners! Our Sussex rehabilitation centre team were runners-up at the Limbless Association prosthetics and orthotics award 2014, with Clare Johnson placed as runner-up in the best prosthetist category. This achievement reflects as well the work of our colleagues at Ottobock who provide us with both orthotic and prosthetic services.

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Our Midhurst Macmillan specialist palliative care service was commended at the national Quality in Care (QiC) oncology awards 2014 in the end of life care and bereavement category. Our OneCall OneTeam service won the Kent, Surrey and Sussex (KSS) Leadership Collaborative award for outstanding collaborative leadership. Our nurseries manager Cara Mitchell was runner-up in the inspirational leader category at the KSS Leadership Collaborative.

January 2015 Winners again We won two awards: 1) most improved community provider; and 2) enhancing innovation through collaboration at the celebration of innovation and improvement organised by the Kent Surrey Sussex academic health science network (KSS AHSN). Our success was based on our DocoboWeb project in Coastal West Sussex, which involved our community matrons working with local nursing/residential care homes to use online technologies to manage risk and reduce avoidable interventions and admissions. The results are impressive - a 75 per cent reduction in hospital admissions compared with a year earlier, with nearly half of the residents in the pilot not needing an admission. Picture this BTEC Art and Design students at Collyer’s College crossed the road to Horsham Hospital to display their artwork at our Horizon Unit in an initiative arranged between ward manager Dawn Fincham and Sharon Rolfe, subject leader at Collyer’s. The students’ artwork work will remain on display until the end of 2015. The Horizon unit offers intermediate care and rehabilitation, especially for elderly patients recuperating after serious illness or surgery. The art display really helps to cheer up the ward and promotes interaction between the young people and our generally older patients. Hello, my name is… Patient safety is at the heart of our commitment to an open culture, and is reinforced by our commitment to compassionate care. For these reasons we’re pleased to support the hello my name is… campaign pioneered by Dr Kate Granger, a hospital consultant from Yorkshire who works in elderly care. Dr Granger has terminal cancer, and is motivated by her experience as a patient and how she feels when staff don’t introduce themselves to her. She tells of the difference it makes when people begin with something as simple as ‘hello my name is’, helping her feel like a person, rather than a patient. Time to Talk – again! Our talking therapies service in Mid Sussex Time to Talk was listed by NHS England as a national good practice site, which means we’ll work with our local commissioners to offer insight to other health and care communities on how to best deliver the national improving access to psychological therapies (IAPT) programme. NHS England said we rank alongside ‘high performing, world class services’.

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Best for breastfeeding Thanks largely to the hard work of our breastfeeding support team and health visitors, Brighton & Hove recorded England’s highest rate of exclusive breastfeeding at 6-8 weeks of age. Our success builds upon the hard work of the midwives at Brighton & Sussex University Hospitals NHS Trust and of a network of dedicated volunteers, all working together to give local mothers the best possible chance of successfully breastfeeding their babies. Palliative Care The Cicely Saunders Institute in London praised our Brighton & Hove community palliative care team for their support for a research study to help demonstrate the impact palliative care can make. Working with colleagues from Martlets Hospice and the Royal Sussex County Hospital’s palliative care team, we were the first site to reach the study’s recruitment target.

February 2015 Staff survey success Given the link between staff engagement and quality of care, we’re pleased that our staff responded more positively than the national average in 25 of the 29 key findings in the 2014 NHS staff survey published this month. Our staff engagement and staff satisfaction measures went up again and are significantly above the national average. We can show improvement across all the survey's key findings, and we perform better than average for 15/17 of key themes highlighted by the Francis report into failures of care at Stafford Hospital. However, our staff are more likely than average to feel under pressure and to experience bullying, harassment or abuse from patients' relatives or the public. Too many report working extra hours - 72 per cent, the same as the national rate. And our score for staff experiencing stress is similarly too high, although it has come down since 2013, and is below average. These are all areas we’re taking steps to address. In total nearly 1,700 staff responded. Dare to Care begins Our staff have taken up our Dare to Care challenge as part of our aim to deliver services that care for the environment as well as people. We are asking them to sign up to a challenge to help reduce waste and carbon emissions - anything from printing double sided, switching off lights or taking the bus to work instead of driving. Dare to Care is part of SCT’s sustainable healthcare strategy called Care Without Carbon. It provides a way to cut costs, improve the wellbeing of staff and patients and helps to reduce waste and emissions.

March 2015 NHS sustainability awards We achieved three places in the national NHS sustainability awards shortlist to celebrate the work of health and care organisations to promote sustainable practice - an area where we've already built a national reputation, having won a HSJ Good Corporate Citizenship prize in 2011 and other recent awards.

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3.4 Clinical Quality Half Days SCT’s board and clinical executive committee have given ALL teams the opportunity to meet together to look at quality improvement ideas, by setting aside four clinical quality half days during which teams have the freedom to stop all non-urgent work and instead meet together to discuss ideas and agree their own plans to improve the quality of care/experience they provide to the people they care for. It's their opportunity to review what they currently do and how they can continuously improve and the team’s themselves decide the agenda for these sessions as they are best placed to know the most important quality issues for their colleagues and patients. The first day took place on Tuesday, 4 November 2014 and some examples that teams shared to improve practice are listed below: • How making use of our library resources can help support and develop clinical teams. • The Falls team worked together to deliver a consistent approach and share best practice. • Children’s physiotherapy – ways to provide a better service – responding to demand and feedback. • Marketing and communications team – internal communication channels – staff survey. • Reducing the risk of catheter encrustation. • Catheter cocktail. • Community Citrus Clear. The second day took place on Wednesday, 11 February 2015 and some examples that teams shared to improve practice are listed below: • The Horsham Community Nursing team looked at how they could personalise care plans, reviewed how they worked and standardised their triage process to optimise how they worked. • The Intermediate Primary Care teams in Brighton & Hove reviewed the pressure damage information available and undertook training on how to use the new Pressure Ulcer Risk Assessment – Purpose T form. The next half days will take place on Thursday 4 June and Tuesday 17 November. Urgent care services will continue to run during these times.

3.5 Complaints All NHS Trusts are required to follow the NHS Complaints Regulations, which the Trust has continued to meet during 2014/15. In 2014/15, SCT received 245 formal complaints, representing an increase of 20%, compared to 204 in 2013/14. In addition, 25 complaints were resolved outside of the formal complaints process. These involved complainants who did not wish to access the formal complaints process, but made their complaint verbally, and were happy with the resolution achieved within 1 working day. They are recorded by the Trust for monitoring purposes, but are not recordable under the Complaints Regulations; however they help to form part of our overall complaints data. Whilst the number of complaints reported in 2014/15 has increased by 20% from 2013/14, when benchmarked against the increase in activity from 2014/15, complaints have actually only increased by 0.001%.

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Of the 245 complaints received, these can be broken down into the following complaint types: • 172 low/medium risk complaints • 73 complex complaints (categorised as complaints that involve more than one organisation and/or have involvement with a recordable Serious Incident or a Safeguarding Alert).

3.5.1 Categories of Complaint The three most frequent complaints received are in relation to: • Access to appointments / waiting times (Clinical Provision) • Staff Attitude (Communication) • Nursing Care (Clinical Provision)

3.5.2 Closed Complaints At the time of reporting, of the 245 low/medium and complex complaints received in 2014/15, 185 were resolved with the following outcomes.

3.5.3 Lessons identified from Complaints/Patient Advice & Liaison Service contacts All complaints are investigated to establish their cause and to identify actions and learning to reduce, where possible, the likelihood of a re-occurrence. All complaint investigations and responses are approved by the Head of Service, Deputy Chief Operating Officer and Chief Executive.

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The actions below are some examples of changes made as a result of feedback through our complaints and PALS contacts: • A Community nursing service have increased the triage of incoming new referrals and enhanced initial assessments re accessing services outside the home environment. • Community Short Term Services have increased opportunities for family members to be involved in therapy and exercise sessions, where patients consent. • “OneCall One Team” have revised their email handling system to ensure all actions relating to a referral have been completed. • A process change has been initiated for the use of a computerised system for paediatricians and their administration staff to record all outstanding results and requests for information. • Community Hospitals will include comfort-rounding training on the induction of new staff. • Volunteers at a Community Hospital will be trained to answer the telephone to reduce the time callers are waiting. Lessons identified from complaints are communicated across the Trust in a number of different ways to maximise the opportunity for all relevant staff to benefit, including: • Immediate changes to practice implemented in the relevant service. • Locality governance meetings and cascade of information and knowledge from these meetings to relevant teams. • Promotion of lessons identified including themes, through information pages on the Trust intranet, clinical governance newsletters and the Trust’s weekly update newsletter. Patient stories in relation to complaints are also presented at the every board meeting.

3.6 Compliments SCT records compliments, received through letters and cards of thanks on a centralised database, and shares them across the Trust. The Trust received 2540 compliments in 2014/15 compared with 2165 in 2013/14. The ratio is currently 9.4 compliments to every complaint received.

Some examples of compliments received are: “My care and treatment is as first class as any in the country, first class. I cannot think of any part of my care that is not 1st class. The nurses are friendly and on time when required. Overall a marvellous and caring service. God bless them all!" Chichester south proactive care team.

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“Just a little note to say "Thank you!" (We) are really grateful. You have such a talent with young children and I admire you and really want just to let you know how much we appreciate the opportunity to do the Earlybird course. Thank you again, there is something very special about you!” Children’s Speech and Language Therapy.

3.7 Equality & Diversity SCT is committed to a vision of excellent care that always includes equality. Over the past year, an ambition for equality and human rights - of ‘equitable care at the heart of all our communities’ for patients, carers, service-users and workers has been developed. During 2014/15, we have promoted this ambition through the setting of standards in a new Equality and Human Rights Policy and analysis tool and through developing leadership: • Briefing executives on current performance. • Facilitating a seminar for non-executive directors on equitable decision-making. • Engaging senior clinical, operational and community leaders and other external stakeholders through our ‘Valuing all Voices’ programme. • Increasing staff equality and diversity training compliance by 10% through new face-to- face training and a workbook. The Trust has also won a bid to pilot a regional leadership development programme called ‘Awakening Inclusive Leadership’ which will continue to promote our ambition and strengthen the capability of our leaders to deliver it. To sustain progress, the Trust has refreshed its Equality and Diversity Group of senior leaders and is currently engaging stakeholders through a series of community and leadership events to update our strategy to address evidence of inequitable service quality and health and employment outcomes. The results of this will be published on the Trust’s website in 2015/16. The Trust is proud to have retained its status as a ‘Two Ticks’ disability positive employer during 2014/15. We are committed to employing, retaining and developing the abilities of disabled staff. During this year, the Trust has supported the development of a disabled staff network to promote leadership and accessible workplaces.

3.8 Volunteers Volunteers play an invaluable role in SCT and we ensure they are fully supported, supervised and developed in order to enhance service delivery and patient experience. Voluntary Services sits within the Public Health Department. Our Volunteering Steering Group oversees the work of volunteers throughout the organisation in the Brighton & Hove, Coastal and North localities working in conjunction with the Expert Patient Programme, Sussex Snowdrop Trust and Community Macmillan Volunteer Managers. The group ensures best practice in the engagement and support of volunteers and aims to reduce obstacles and increase opportunities in order to make volunteering in SCT inclusive and accessible for all. A new database management system is now fully embedded to ensure governance procedures throughout the Trust for volunteers are robust. In 2014/15, the service has delivered volunteer specific statutory training to 420 volunteers and we are in the process of developing a refresher-training booklet. Our new and updated policy has been ratified and we are working closely with clinicians to ensure it is embedded within services and to strengthen our volunteer workforce within our bedded units and community services.

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In 2014, we delivered a successful project called iConnect4Life that was about enabling housebound and socially isolated patients to get on-line and access the internet with the help of buddy volunteers. Further roll out of this project is expected in 2015. Voluntary Services Data is also being collected to identify the demographics of our volunteer workforce; once this is complete, the service can work towards developing a strategy, which will fit within SCT’s clinical strategy. We will also be looking to develop how we work with our partners in the contribution volunteers have in supporting health improvement. SCT has committed to delivering a three yearly Trust-wide thank you event and a yearly recognition award for volunteers.

3.9 Safe Care 3.9.1 Serious Incidents and Incident Reporting SCT is required to report all Serious Incidents (SIs) to the Clinical Commissioning Group (CCG) in line with the NHS England ‘Serious Incident Framework’. The Trust remains compliant with this obligation, and has consistently met the timeframes for submission of Serious Incident Reports to the CCG’s Serious Incident Scrutiny Panel. In 2014/15, 45 SIs were raised, six were downgraded by the CCG, leaving 39 SI’s. This is an increase from the previous year where 30 SI’s were reported.

The most frequently reported Serious Incident categories of incidents in 2014/15 were: • Slips, Trips and Falls (resulting in a fracture) and; • Pressure Damage.

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Those reported under ‘other’ include a software failure (1), delayed treatment (2) and a communication failure (2). Since 2013/14, the number of ‘pressure damage’ incidents reported as a SI has reduced by 15 incidents, whilst ‘slips, trips and falls’ have increased by 11 incidents. All SIs are investigated to establish their root cause and contributory factors and to identify actions and learning to reduce, where possible, the likelihood of a re-occurrence. All SI Reports are scrutinised and approved by the Trust’s Serious Incident Review Group to ensure consistency, identify trends and themes and enable trust wide improvement from lessons identified. The role of the Patient Safety Leads has been revised to Quality and Patient Safety Improvement Nurses to enable them to work clinically with services to identify themes and embed lessons identified from incidents. Lessons learned from SIs are communicated across the Trust in a number of different ways to maximise the opportunity for all relevant staff to benefit, including: • Immediate changes to practice implemented in the relevant service. • Locality governance meetings and cascade of information and knowledge from these meetings to relevant teams. • Promotion of lessons identified including themes, through information pages on the Trust intranet, clinical governance newsletters and the Trust’s weekly update newsletter. Patient stories in relation to Serious Incidents are also presented at the board bi-annually.

3.9.2 Healthcare Associated Infections (HCAIs) In 2014/15, our Infection Prevention and Control (IP&C) Team were involved with Post Infection Reviews (PIR) for three patients who had Methicillin-resistant Staphylococcus aureus (MRSA) blood stream infections. No lapses in the quality of care provided by SCT were identified and none of these infections were apportioned to SCT’s target. During 2014/15, our IP&C team led on the Root Cause Analysis (RCA) of 10 patients who were identified as having Clostridium difficile (C. diff.) infection whilst in our bedded units. Due to the timing of the specimens, nine of these patients were apportioned to SCT. Following investigation one case was identified as being associated with a lapse in care. This was due to an error in the prescribing antibiotics by our GP colleagues. Training has now been provided to prevent this from occurring again. . NHS England has issued new guidance for 2015/16 and our RCA procedures have been updated to take this into account. Cases will only be apportioned to the target if lapses in SCT care are identified. IP&C have a C.diff reduction plan in progress and have continued to work closely with other members of the local health economy towards reducing the occurrence of this disease.

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3.9.3 Central Alert System The Department of Health (DH) Central Alert System (CAS) is designed to rapidly disseminate important safety and device alerts to nominated leads in NHS Trusts in a consistent and streamlined way for onward transmission to those who need to take action. Trusts are required to acknowledge receipt of each alert and respond as relevant within specified timescales.

2012/13 2013/14 2014/15 Total number of alerts received 115 233 158 Acknowledged within 2 working days 110 (96%) 231 (99%) 157 (99%) Found to be applicable to SCT 46 (40%) 41 (17%) 11 (7%) Applicable alert responses within prescribed 43 (94%) 39 (95%) 11 (100%) timescales

It was expected that NHS England would implement a revised system in late 2014, which would enable stronger correlation between incidents reported through NPSA and NRLS, Alerts and Serious Incidents and improve feedback through the introduction of national networks via CAS. During 2014 SCT participated in further scoping exercises for this system, however the system is yet to be implemented.

3.9.4 Never Events There have been no ‘Never Events’ during the reporting period. Never events are serious medical errors or adverse events that should never happen to a patient.

3.9.5 Safeguarding Everybody has the right to be safe no matter who they are, or what their circumstances. Safeguarding is everyone’s concern and is the basis of safe and effective care. All staff (including volunteers) within SCT have a responsibility to keep children, young people and adults safe and to promote their wellbeing and this process starts with safe recruitment processes. Safeguarding is about the protection of harm by abuse and/or neglect. Safety from harm and exploitation is a basic need, being and feeling unsafe undermines our relationships and self- belief. Safeguarding is a range of activities aimed at upholding children’s and adults right to be safe. This is important as some children, young people and adults are unable to protect themselves because of their age, environment, situation, or circumstances. All staff access mandatory basic training in both safeguarding children and adults and for those working in specific areas, higher levels of training is provided. The framework for all safeguarding children training is aligned to the intercollegiate document (RCPCH, 2014) and meets this quality standard. There is currently no equivalent for safeguarding adults. The Trust has policies and procedures, which are updated to reflect good practice, current guidance and are based on evidence. These support the Multi-Agency Sussex procedures for safeguarding children and adults. Last year the Trust commissioned an external review on Safeguarding across children and adults and the 22 recommendations were accepted by the Trust Board and are being implemented. The Trust has secured additional resources and a Head of Safeguarding has been recruited.

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There is an internal structure of delivery groups in both the adult and children’s & specialist services divisions, reporting to a Steering Committee, chaired by the Chief Nurse. The Chief Nurse has Board accountability for safeguarding children and adults. SCT is represented at the Safeguarding Adults and Children’s Boards in both Brighton & Hove and West Sussex, ensuring there is a multi-agency response to keeping adults protected from abuse and neglect. Specialist staff have been offered specific training on the Mental Capacity Act and the Deprivation of Liberty Safeguards ensuring they can assess the capacity of patients and clients. The Trust upholds the principles of the Act - that every adult has the right to make their own decisions and must be assumed to have capacity to do so, unless it is proved otherwise. During the year, the Trust has prepared for the changes the Care Act 2014 has made to making safeguarding personal and to ensure the patient/client is informed and outcomes are identified. The Trust has participated in the multiagency audit and an internal service audit to ensure quality of service and provision. The safeguarding teams in Brighton & Hove and West Sussex have named and specialist nurses in Children Safeguarding. Both teams work closely with children’s services, police, third sector and others to work effectively to respond to neglect and abuse. To ensure their effectiveness, there is a programme of single agency and multi-agency audits and case file reviews and these are reported to the Trust Safeguarding Steering Committee. Learning from all child deaths is important to ensure that any preventable factors can be identified. The Trust has dedicated staff in Brighton & Hove and West Sussex who assist and support staff in collating information for the Child Death Review Panels.

3.10 Patient Centred Care Throughout the year, our services collected patient feedback using different methods including via the Friends and Family Test, surveys and one-to-one interviews. Feedback and actions taken in response to issues raised are reported to the Trust’s Patient Experience Group, examples include:

Team Issue Outcome Salvington Lodge – A call bell was found on the An investigation found the bell was Inpatient ward floor by a relative. prone to falling on the floor. This was resolved by attaching a clip to the bell so it could be clipped on to bed sheets. Salvington Lodge – Noise from call bells at Call bells now have a lower tone at Inpatient ward night. night. Chichester One patient asked whether The team addressed this by Community Nursing they could be assessed for commencing with in house diabetes Team their diabetes rather than sessions and with an evening event solely having insulin looking at the whole person approach administered. to patients with diabetes, i.e. their personal goals, implications for their eyes, feet, etc. Children’s Speech A child was seen by a Actions were taken with recruitment and Language number of different and absence to minimise the changes Therapy – Brighton therapists over the period of of staff covering a particular caseload. Team time he was supported by the service.

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3.10.1 Patient Advice & Liaison Service (PALS) In line with the Robert Francis Report and the Clywd and Hart Complaints Review, the Trust recognises the importance of a dedicated Patient Advice and Liaison Service (PALS) and has made the service more accessible to patients and their families. The Trust has introduced locally held PALS surgeries at our services in Crawley and Horsham. Healthwatch, in both Brighton & Hove and West Sussex have expressed interest in attending future West Sussex events. During 2014/15, PALS received 1019 contacts, representing an increase of 21%, compared with 839 in 2013/14. Of these contacts, 456 were signposted to other organisations and services. The PALS officer has also attended meetings with complainants to support and act as an advocate. SCT’s PALS service runs alongside the complaints process and ensures that when a serious issue is identified, it can be escalated quickly via the complaints route. As an internal resource, the PALS officer has specialist knowledge, skills and relationships with Trust services, which ensure our patients, and their families/carers receive an effective and responsive service.

3.10.2 Friends & Family Test In July 2014, NHS England published guidance on how the Friends and Family Test (FFT) should be implemented in community trusts. The test asks patients a simple question: “How likely are you to recommend our service to your friends and family if they needed similar care or treatment?” In line with NHS England’s guidance, FFT was rolled out to all clinical services prior to January 2015. FFT has been well received by patients with the Trust receiving approximately 2500 responses a month. To enable staff to be able to respond more quickly to patient comments left via FFT, options for using touchscreen tablets to conduct FFT in real time are being explored in 2015/16.

3.10.3 Overarching Patient Experience Plan In 2014/15, the SCT created an Overarching Patient Experience Plan (OPEP) to consolidate patient experience work from a number of sources including the Patient Experience Strategy, the Trust Development Authority’s Patient Experience Development Framework and actions arising from analysis of complaints and incidents. The Patient Experience Group focuses on monitoring the progress of the OPEP.

3.11 Staff Care 3.11.1 Staff Communications To strengthen staff engagement, we continue to improve the ways we communicate with staff, and promote good dialogue between staff and the senior team. • We launched our new intranet, ensuring all relevant content is included. • We deliver a monthly team briefing system to carry messages from the executive leadership team to frontline staff, encourage discussion in teams and generate feedback. • We send out a weekly message from our chief executive to all staff, linking what’s going on within the Trust and locally to the bigger national picture. • We publish our staff magazine and employee of the month scheme, showcasing best practice and recognising achievement. • Members of the board and executive leadership get out across the Trust visiting services.

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• We are running surveys and other audit measures to evaluate the effectiveness of our internal communication channels.

3.11.2 Staff Experience The annual NHS staff survey provides an insight into staff views on the organisation and their experience of working within it. The survey is a key measure of staff engagement and wellbeing, which directly correlates with patient outcomes and experience and is essential to the provision of high quality services. When compared to previous years, the results can prove a useful tool in measuring progress and aiding our continuous improvement. In 2014, we were required to survey a random sample of 850 staff and our response rate was 51%. In addition to the mandatory sample, we opted to survey all 4,000 eligible staff. In total, 1691 staff responded (including the 419 sample respondents), a response rate of 42.33%. This is 1% less than in 2013. Following a steady increase in scores over previous years, the Trust has stabilised and there are not many areas showing a significant change from last year. This means that,overall, we have maintained the improvements made in previous years and on the whole, the Trust is still scoring better than our comparator group. However, there are still areas of concern that need attention.

What we did Promotion of staff health • Produced “Steps to health and wellbeing” handbook for all staff. • Produced a mindfulness CD for all staff. • Stress training for managers. • Reviewed the No-smoking policy and the promotion of stop smoking services. • Promoted a Workstation Exercise video. Violence and Aggression from patients, relatives and members of the public • Increased the Security Management Team. • Rolling out the ‘Skyguard’ lone working devices to teams who have identified that they have a need for them. Staffing levels • Staffing templates have been reviewed in some services in accordance with safer staffing guidance. • The Trust-wide bank has been further developed to enhance the provision of internal temporary workers and robust agency arrangements. • The productive team have supported teams to work smarter and release time to care using LEAN methodology. Supervision and appraisal • We have maintained high levels of participation in supervision and increased the proportion of teams demonstrating 100% compliance, which is now over 80%. • Developed the Staff Performance Management Framework, which will reinforce behaviours in accordance with Trust values. • Appraisal rates have been rising and reached 89% in December 2014. Culture • My behaviours and values pledge launched. • Piloted Culture of Care Barometer.

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• Over 100 staff have participated in the Transformation Development Programme to develop skills in achieving small and large-scale change. Core training • Improvement in uptake of the training delivered through the statutory training day. • Rolling attendance rates rose from 43% in April 2013, to 64% in December 2013 and 78% in 2014. Where we are now? The Trust has managed to maintain the positive set of scores from last year. All the Key Findings are as good as or better than last year. When compared with other community trusts, SCT is doing particularly well. We score better than other organisations on 22 out of the 27 Key Findings and are worse on only two. Where our scores are worse, we are not far from the average. As a result of this, our Staff Engagement Score continues to improve year on year and remains above the average for other community trusts.

3.11.3 The Transformation Plan SCT’s Board approved the Trust’s 5-year transformation plan in June 2014. It describes how we will achieve our vision of excellent care at the heart of the community, building on the many good things about our services, while recognising that we cannot achieve our strategy and meet future challenges without change. Many of the transformation programmes and projects involve working with partners such as GPs, Social Services, acute hospitals and other NHS Trusts. The transformation plan is delivered through an agreed programme of work, overseen by the Trust Transformation Board, chaired by the Chief Executive. In order to ensure changes - particularly cost improvement plans - do not have a negative impact on quality, they are assessed through a formal Quality Impact Assessment (QIA) process and must be approved by the Trust’s Medical Director and Chief Nurse. The 2015/16 transformation programme is in development, but is likely to include the following major transformation projects: • Rolling out a new clinical IT system (SystmOne) that will facilitate safety, quality and efficiency improvements. • Reviewing and better aligning our rapid response, intermediate care, specialist and community nursing services to enable best, efficient and consistent service to patients. • Improving the way we provide administrative support to our clinical services to provide better, more efficient services to patients and clinicians. • Reviewing and redesigning our children’s and families services to provide better- coordinated care following the change of commissioners. It will also include smaller front-line, clinically led, service-level improvement projects, using the skills of the 100 members of staff who have been trained as transformation leads and facilitators. Transformation Development Programme 114 staff volunteered for an opportunity to be trained in improvement methodology, change management, leadership skills and project management processes. These improvement leads and facilitators have developed the skills to support small-scale local change, or to lead larger scale projects and changes.

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The programme has ensured there is a critical mass of staff using a common range of tools and techniques that will help to embed an attitude of continuous improvement and innovative culture into the organisation. The programme has evaluated well and plans are well under way to spread the skills and techniques more widely within the organisation during 2015/16. Productive Team The Productive team support services to capture data to help them improve the quality of their services and release time to care through the introduction of efficient working processes. Focus during 2014 has been on the development of toolkits, support in skills development and developing new ways of working. The teams input was invaluable in the preparations for the Care Quality Commission inspection at the end of 2014 and the plan is to develop these skills in the transformation facilitators to maximise the benefit across the Trust.

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4 Statements of Assurance 4.1 The Board Statement by a senior employee in respect of the Quality Account The directors are required under the Health Act 2009 to prepare a Quality Account for each financial year. The Department of Health has issued guidance on the form and content of annual Quality Accounts (in line with requirements set out in Quality Accounts legislation). In preparing their Quality account, directors should take steps to assure themselves that: • The Quality Account presents a balanced picture of the Trust’s performance over the reporting period. • The performance information reported in the Quality Account is reliable and accurate. • There are proper internal controls over the collection and reporting of the measures of performance included in the Quality Account, and these controls are subject to review to confirm they are working effectively in practice. • The data underpinning the measure 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. • The Quality Account has been prepared in accordance with any Department of Health guidance. The directors confirm to the best of their knowledge and belief that they have complied with the above requirements in preparing the Quality Account. By order of the Board

2nd June 2015

Paula Head Chief Executive, Sussex Community NHS Trust 2nd June 2015

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5 Who did we involve? Clinicians, managers and support staff have all been invited to contribute to the 2014/15 Quality Account, identifying their priorities for improvement for 2015/16. Stakeholders who were invited to be involved in the development of the Quality Account include: • Brighton & Sussex University Hospitals • Sussex Partnership NHS Foundation Trust • NHS Coastal West Sussex CCG • NHS Crawley, Horsham and Mid Sussex CCG • Brighton & Hove CCG • South East Coast Ambulance Service • Healthwatch, Brighton & Hove • Healthwatch, West Sussex • Our staff • Service users (via our Patient Experience Group) All our Commissioners, Brighton & Hove City Council and West Sussex County Council via their respective Health & Wellbeing Overview & Scrutiny Committee (HWOSC) and Health & Adult Social Care Select Committee (HASCS), Healthwatch Brighton & Hove and Healthwatch West Sussex have all been asked to comment via separate letters. These responses can be read below. 6 Statements provided by Stakeholders 6.1 Brighton & Hove City Council’s Health and Wellbeing Overview and Scrutiny Committee The statement from Councillor Sven Rufus, Chair, HWOSC was sent via email to SCT on 28 May 2015: Brighton & Hove City Council’s Health and Wellbeing Overview and Scrutiny Committee (HWOSC) appreciates the high quality work that Sussex Community NHS Trust (SCT) carries out for the residents of Brighton and Hove, and for the wider Sussex region. SCT is always willing to come to the scrutiny committee with proposals for changes in service provision and they are happy to listen to suggestions that members make. The Trust acts in a way that keeps the needs of residents at the heart of their services. They provide many useful community services for Sussex residents. HWOSC members were very pleased to note that their services have recently been recognised as ‘good’ by the Care Quality Commission. Councillor Sven Rufus, Chair, HWOSC

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6.2 Commissioners

Amendment to previous letter - sent on 19 May 2015 Attn: Paula Head Chief Executive Officer Lower Ground Floor Sussex Community NHS Trust Crawley Hospital West Green Drive Crawley West Sussex RH11 7DH Sent Electronically Tel: 01293 600300 (ext. 4255) Email: hsccg.contactus- [email protected] 14 May 2015 Dear Paula Sussex Community NHS Trust – Quality Account The CCGs; Brighton and Hove, Crawley, Horsham and Mid-Sussex, High Weald Lewes Havens, Eastbourne, Hailsham and Seaford, Hastings and Rother and Coastal West Sussex, would like to congratulate the Trust on its CQC report and the good standard of care delivered over the past year. The approval to move to Foundation status is noted and the current work underway in addressing care will build upon the foundations of a good CQC report and TDA support. The Quality Account appears to meet the requirements of the Department of Health Guidance and has clearly outlined quality developments over the year 2014/15 and ambitions going forward. The CCGs agree that priorities for improvement in the Quality Account meet the key issues arising from Quality Reviews with the Trust over the past year, notably the missed and deferred visits which have been cause for concern, and the falls and pressure damage work. The CCGs welcome the work on organisational culture and its links to the staff survey action plan. The staff recruitment and retention work is welcome however, the need to recruit to Community Nursing posts remain a concern and the CCGs look forward to working with the Trust and health system in addressing these needs. It is pleasing to note the work with Partners and local authority Safeguarding Committees, Healthwatch and the voluntary sector. The 5 year forward view challenges Organisations to change the way they deliver services, and makes partnership working essential to enable innovative changes to take place. The CQC mentioned areas for improvement. The work to boost recruitment and improve staffing levels is welcomed, also the need to review the rollout of IT systems is particularly welcome given the issues which have arisen with the implementation of new Child Health immunisation System.

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Work to improve the quality of the Estate is welcome as it impacts upon the delivery of patient care, and makes it more difficult for staff to deliver improved services. The CCGs note the emphasis upon continuous improvement for clinical care and agree that areas outlined in the report align with CCGs findings from monitoring and review meetings throughout the year. There are areas for improvement as outlined but the CCGs believe that the Trust have realistically identified where improvement is needed. The recent CQC review did not uncover any surprises in this repsect and as a Trust you appear to be taking the necessary steps to ensure these improvements take place. The Trust transformation plan Quality impact assessment process is commendable and it would be helpful to have mention of at least one instance where the process prevented a development deemed unhelpful to patient care or experience. A mention of lessons learned from System Implementation for Child health records immunisations would be helpful and how these lessons will improve other care plan implementations in the future. A fuller description of the challenges in recruiting to Community Teams and how the Trust is addressing these challenges would be helpful. The CCGs note the good work on being an International Study site for work with Children with cereberal palsy led by Dr Diane Sellis. The CCGs commend the Trust on its improvements over the past year and look forward to working in partnership to address the challenges outlined in the Quality Account. Yours sincerely

Mona Walker Head of Quality/Chief Nurse

Crawley Clinical Commissioning Group Horsham and Mid Sussex Clinical Commissioning Group

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6.3 Healthwatch Brighton and Hove

Sussex Community Trust Quality Account Response At a time when we are moving towards a more community oriented model of care, Sussex Community Trust plays a key role in ensuring that the people of Brighton and Hove receive services that are safe and of high quality. We would like to congratulate the trust on their recent Care Quality Commission inspection, particularly around the ‘outstanding’ rating for End of Life Care in our area. We would also like to commend the trust for their timely implementation of the Friends and Family Test. Other local trusts have found it beneficial to move to an electronic system of gathering data for the test, and we support Sussex Community Trust’s interest in pursuing this.

Appointments Our own primary data confirms that the topics of ‘access to appointments’, ‘staff attitude’, and ‘nursing care’ are the three most common complaints for the trust, and are important areas for improvement in 2015/2016. Healthwatch Brighton and Hove has been monitoring missed and deferred home visits in our area, and supports this as a key priority for improvement going forward. We would like to offer our support in terms of proofing and promoting any written information explaining what people should do if their appointment is delayed or missed. We would also like to offer our support in ensuring that patients are at the heart of redesigning the systems in place for informing them when there are changes to planned visits.

Care and Compassion We also support the inclusion of the ‘Sit and See’ observational tool as a way to measure care and compassion in community health settings, along with the other measures indicated this area. Healthwatch Enter and View Volunteers have recently been trained in ‘Sit and See’ observation, and our in-house trainer will pass this training on to additional volunteers in 2015. Healthwatch Brighton and Hove would like to open a conversation with Sussex Community Trust about how we can work together to observe and improve compassionate care together.

Brighton General Hospital Brighton General Hospital is, as the Quality Account presents, an aged building which is now largely unsuitable for clinical care. We welcome the provision of a new building, and the feasibility work which has already taken place. We would like to be kept up to date on how patient experience will be built in to this ongoing process in the future, particularly with regard to designing new spaces, looking at locations, and opportunities for patient voice to be heard. Healthwatch Brighton and Hove and Sussex Community Trust have built a positive working relationship, which we would like to maintain and develop over the next financial year. Quality and safety can only improve where the voices of patients are listened to, and we will continue to ensure this happens in 2015/2016.

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6.4 Healthwatch West Sussex Working to make sure the consumer’s voice is always heard and helps shape the provision of health and social care services in West Sussex Quality Account comment Sussex Community NHS Trust 2014/15

Introduction As the independent champion for health and social care for patients across West Sussex Healthwatch (HWWSx) are pleased to be invited to comment on Sussex Community NHS Trust (SCT) draft Quality Account (QA) for 2014-15. The Trust’s draft QA 2014-15 clearly demonstrates a willingness to be open and transparent under the Duty of Candour. SCT delivers a wide diversity of services, working in both acute and community settings. We are pleased to see some evidence of cross agency working and would encourage further commitment to partnership working in order to ensure a seamless services for patients. We note that the Care Quality Commission (CQC) has awarded a “Good” rating generally to the Trust with some areas reported as “Outstanding”. The CQC particularly mentioned the excellent attitude of staff to patients and carers. However, they did identify a need to improve medicines management, training in the care of dementia patients, record keeping and care planning, therefore, we are delighted to see these issues addressed in the priorities for 2015/16. HWWSx welcomes the inclusion of Additional Achievements 2013/14 which demonstrates some notable successes both nationally and locally and underpins the Trust’s commitment to patients, their family and carers at the centre of care. Given the national concern over the quality of End of Life care we are pleased see that the Trust are proposing to implement a number of improvements in care of the dying in both inpatient and community care. Our commentary reflects the content of the Trust’s draft QA 2014/15 and draws from patient experience as recorded in our Client Relationship Management database system. HWWSx received both positive and negative comments from patients mostly concerning Bognor Regis War Memorial Hospital.

In summary Positive • We are pleased to say that the majority of patients who contacted us reported a good experience at the hospital in the treatment they received and especially noted the caring and considerate attitude of staff. Negative • We received a concerning report of inappropriate discharge where friends and family had to intervene to ensure services were in placement before the patient returned home. • A concern was raised that there is a problem with the wheelchair service for disabled children with special needs in the north of the county. Further anonymised details can be supplied if required.

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Safety Reported improvement 2014/15 HWWSx welcome the reduction in hospital acquired infections and pressure damage by specific training being offered to widely across the Trust. A plan to improve access to services addresses a number of issues which have been reported to us. The recruitment of a Head of Safeguarding is to be welcomed. Priorities for 2015/16 We were pleased to note the introduction of IP&C C Diff reduction plan and a plan to reduce the incidence of pressure sores. This will be of particular benefit to the elderly residents of West Sussex. As the CQC raised the issue of inappropriate medicines management we note the Trust aims to reduce the number of incidents in this area. We trust that this action will also reduce the number of serious incidents. Serious incidents and near misses are a source of learning and we welcome the Trust’s renewed focus on disseminating this learning to staff. We would wish to see evidence of this included in the Quality Account 2015/16. We have been made aware of national concern around stroke and therefore are pleased to see the Trust is introducing SSNAP standards.

Effectiveness Reported improvement 2014/15 As above we welcome the Introduction of the Purpose T risk assessment tool for pressure sores and its use continued in 2015/16. We commend the Trust in working towards transparency around the increase of complaints, evidencing learning from them and actions taken accordingly. Priorities for 2015/16 We welcome the priority of a seamless care pathway between primary and secondary care as it will address some of the issues reported to us. Planned review of alignment of rapid response, intermediate care specialist and community nursing services are further welcomed. Data quality and accuracy of coding are a major issues for all healthcare providers. We are pleased to note that the Trust is reviewing these areas. The roll out of a new clinical IT system will support data capture and analysis across the Trust to improve quality and efficiency of service. We hope to see evidence of this improvement in the QA 2015/16. The Trust is to be commended in recruiting a falls champion which it is hoped will reduce the incidence of fractured neck of femur.

Patient experience Reported improvement 2014/15 As the independent patient’s voice we commend the Trust in its efforts to hear directly from patients, their families and carers and offer more information on their services through the Valuing All Voices programme, Awakening Inclusion leadership, retaining the Two Ticks disability positive employer, improved access to PALS. We note the priority placed on improved response to complaints and overarching Patient Experience Plan analysis of complaints and incidents. We would wish to see continued evidence of improvements made as a result of patient feedback in the 2015/16 QA.

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Priorities for 2015/16 HWWSx very much welcome the inclusion in the QA of increased patient feedback through focus groups and a Customer Care programme to support the philosophy of patients at the heart of care. The development of Cultural Champions will assist staff and ensure that individuals with protected characteristics receive equal access. The introduction of an Equality and Diversity team which will be responsible for publishing the results of stakeholder events is commendable. The proposed priorities of reducing missed visits through revised appointment system addresses complaints received by HWWSx. Poor nutrition is often referred to as part of overall unacceptable quality of care in the elderly and therefore we commend the Trust for addressing this. Safeguarding of children and adults in healthcare situation is of paramount importance to HWWSx so we are pleased to see a focus on this area throughout the Trust.

Conclusions from the service user perspective As an independent organisation representing the patient their family and carers viewing evidence of service improvement is of primary importance to us. HWWSx commends the Trust for their stated aim of putting the patient at the heart of their care. A commitment to high quality, safe and compassionate care with a view to continuous improvement is welcomed together with the introduction of Sit and See to enable personalised care. We congratulate the Trust on the improvements achieved as identified in the QA 2014-15 report but would wish to see a more outcomes focused approach in the future with clear evidence of actions taken as a result of serious incidents, complaints and meaningful patient engagement. We welcome the Trust’s commitment to working in partnership with Social Services, primary and acute care. We recognise and commend in particular the improvement in Health Visiting services but would wish to see further evidence of improvement and focus on children and family services. It is noted that the Trust plan to implement a review of the Transformation and Development Programme for staff which promotes and supports an organisational culture of compassion and supports staff values and behaviours. However, the QA priorities for 2015/16 does not mention any review of staffing levels and skill mix which has been a concern raised with us in the past. HWWSx looks forward to continuing to work with the Trust in an open, transparent and mutually respectful relationship with support continuous improvement in the delivery of healthcare for all patients

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6.5 West Sussex County Council Health & Adult Social Care Select C’ttee Mrs Margaret Evans County Hall Chairman West Street Health & Adult Social Care Select Committee Chichester West Sussex 033022-22551 PO19 1RQ e-mail address: [email protected] website: www.westsussex.gov.uk If calling please ask for 19 May 2015 Suzanne Thompson Janet Parfitt Quality Improvement Lead, Clinical Quality Division Sussex Community NHS Trust

SENT VIA E-MAIL

Dear Janet 2014-15 Quality Account Thank you for offering the Health & Adult Social Care Select Committee (HASC) the opportunity to comment on Sussex Community NHS Trust’s (SCT) Quality Account for 2014-15. We welcome the strategic goals to deliver excellent care at the heart of the community through the core values and behaviours of compassionate care, working together, achieving ambitions and delivering excellence. HASC congratulates the Trust on its ‘Good’ overall Care Quality Commission inspection result and will work with the Trust if any substantial changes to services arise from the continuing transformation programme. Yours sincerely

Mrs Margaret Evans Chairman, Health & Adult Social Care Select Committee c.c. Dr James Walsh, Mrs Ann Rapnik, Mr Bryan Turner

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7 Conclusion SCT’s Quality Account 2014/15 documents our quality improvement priorities for the next year and reports on how we did against those priorities we set ourselves last year. The process has been inclusive and illustrates that improving the quality of care we give is not the responsibility of one person, or service; it is a collective responsibility – part of the culture of our Trust. This Quality Account has been prepared in accordance with the Department of Health’s Quality Account Toolkit, first published in December 2010 and available electronically at www.dh.gov.uk/publications .

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8 Glossary of terms Term Description Assurance Providing information or evidence to show that something is working as it should, for instance the required level of care, or meeting legal requirements. Care Quality The independent health & social care regulator for England. Commission - CQC Clinical Audit A process used to improve the quality of care. This is done by reviewing the care given against explicit criteria. Analysis of the results is then used to highlight any gaps. An action plan can then be put in place to address those gaps and then a re-audit takes place to review whether those actions have worked to plug the gaps identified. A clinical audit can also highlight good practice, which can then be shared across SCT. Clinical Coding Instead of writing out long medical terms that describe a patient's complaint, problem, diagnosis, treatment or reason for seeking medical attention, each has its own unique clinical code to make it easier to store electronically and measure. Clinical Commissioning Groups of GPs who are responsible for designing local health Groups - CCGs services in England. Clinical Effectiveness Is the clinical intervention used doing what it is supposed to? Does it work? Clinical Governance Clinical governance is a systematic approach to maintaining and improving the quality of patient care within the NHS. Clostridium Difficile - C. A contagious bacterial infection, which can sometimes reproduce difficile rapidly – especially in older people who are being treated with anti- biotics – and causes potentially serious diarrhoea. Commissioning The process of buying health and care services to meet the needs of the population. It also includes checking how they are provided to make sure they are value for money. Commissioning for A payment framework, which commissioners use to reward Quality and Innovation - excellence, by linking a proportion of the Trust’s income, to its CQUIN achieving set local quality improvement goals. Community Information CIDS makes locally and nationally comparable data available on Dataset - CIDS community services. This helps commissioners to make decisions on the provision of services. Data Warehouse In computing, a Data Warehouse is a database used for collecting, and storing data so it can be used for reporting and analysis. Department of Health - A UK government department responsible for government policy for DH health and social care matters and for the National Health Service (NHS) in England. EKOS East Kent Outcomes System

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Falls Bundle A bundle of interventions that when used helps to reduce falls and related injuries. Healthwatch Healthwatch England is the independent consumer champion for health and social care in England. It ensures the overall views and experiences of people who use health and social care services are heard and taken seriously at a local and national level. Improving Access to A national programme including Time to Talk. Psychological Therapies (IAPT) Information Governance A system that allows NHS organisations and partners to measure Toolkit themselves against Department of Health Information Governance policies and standards. Intranet An intranet is a computer network that uses Internet technology to share information between employees within an organisation. SCT’s Intranet system is called the Pulse. Malnutrition Universal MUST is a five-step screening tool used to identify adults who are Screening Tool - MUST malnourished, at risk of malnutrition, or obese. It also includes guidelines, which can be used to develop a care plan to manage the problem. Methicillin-Resistant Staphylococcus aureus (Staph) is a type of bacteria that is Staphylococcus Aureus commonly found on the skin and in the noses of healthy people. - MRSA Some Staph bacteria are easily treatable, while others are not. Staph bacteria that are resistant to the antibiotic methicillin are known as Methicillin-resistant Staphylococcus aureus or MRSA. Metrics Measures, usually statistical, used to assess any sort of performance such as financial, quality of care, waiting times, etc. National Institute For A government body that coordinates and funds research for the Health Research - NIHR NHS in England. National Institute for An independent organisation responsible for providing national Health & Care guidance on promoting good health, and on preventing and treating Excellence - NICE ill health. National Patient Safety Leads and contributes to improved and safe patient care by Agency - NPSA informing, supporting and influencing organisations and people working in the health sector. National Reporting and An NHS national reporting system, which collects data and reports Learning System - on patient safety incidents. This information is used to develop NRLS tools and guidance to help improve patient safety. Patient Advice & A service providing a contact point for patients, their relatives, Liaison Service - PALS carers and friends where they can ask questions about their local healthcare services. Productive Series A set of practical tools, such as patient experience surveys, Programme developed by the NHS Institute for Innovation & Improvement, to help NHS services redesign and streamline the way they work. Productive Ward A ward based element of the Productive Series. The Pulse The Trust’s intranet for staff.

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9 Feedback We would very much like to know what you think about our Quality Account this year. Please use this form to let us know what you think about this report and what you would like us to include in next year’s. 1. Who are you? Patient, family Member Other member or of staff (please carer specify)

2. What did you like about this report?

3. What could we improve?

4. What would you like us to include in next year’s report?

5. Are there any other comments you would like to make?

6. Sussex Community NHS Trust is applying to become a Foundation Trust. Are you interested in becoming a member? If so, please provide your name and address below.

Thank you for taking the time to read this report and give us your comments. Please post this form to: Paula Head Chief Executive Sussex Community NHS Trust J Block, Brighton General Hospital Elm Grove, Brighton East Sussex BN2 3EW You can also contact us via social media using: • twitter.com/nhs_sct • facebook.com/sussexcommunitynhs