Accessible, Responsive Community Healthcare South Birmingham Community Health Quality Account Dental Services Birmingham Dental Hospital 2009-10 Contents Part 1 Statement on quality from the Managing Director of the organisation 2 Part 2 Statement of assurance from the Board and priorities for improvement Statement of assurance from the Board 3 Priorities for improvement 4 Review of services 5 Participation in clinical audit 7 Participation in clinical research 9 Goals agreed with commissioners 10 What others say about the Provider 14 Data quality 15 Part 3 Review of quality performance (Provider determination) Review of quality performance 16 Who has been involved in this quality account? 16 Statement from Local Involvement Network 17 How to provide feedback on the Quality Account Inside back cover Part 1 Statement on quality from the managing director of the organisation I would like to thank everyone for their hard work and achievements in the last year. South Birmingham Community Health has continued to develop as an independent organisation and has delivered outstanding care to patients whether in their own home, the community hospitals or in the many other care settings around Birmingham and beyond. Whilst we remain financially stable and prudent, we prioritise the safety of patients, the positive experience they have and the effectiveness of our care delivery as paramount. We have achieved this by providing high quality cost effective care to our patients and listening and responding to their feedback. Patients, service users and the population we serve are at the heart of this organisation and we not only believe that their lives matter, but we care enough to want to make a real difference to them. Everybody has a right to expect to be treated with dignity and respect and to receive high quality, clinical care when it is required and delivered by committed and competent professionals. Birmingham Dental Hospital Quality Account includes a review of what has been achieved in the last twelve months and outlines our plans to achieve our expectations for high quality responsive care. To achieve this, our well trained and motivated staff that have daily contact with many service users, carers and their families, provide us with a first hand understanding of how we can continually improve our services. This is the first of what will be an annual quality report highlighting all the excellent work we are doing to deliver accessible, responsive, patient-focussed care and also setting out the areas we have identified where we can implement changes that will raise our standards higher still. The publication of a Quality Account for Birmingham Dental Hospital follows a year of significant developments many of which are outlined in the account. The development of the account has included input from services users, clinicians and managers and has been led by the clinical executive of the organisation in conjunction with the commissioners of dental services. To the best of my knowledge as the executive lead for the Board of South Birmingham Community Health, the information contained within the account is accurate and reflects the commitment to quality of care and the provision of services which are both safe and clinically effective. I hope you will find the information useful and would encourage you to complete and return the evaluation form at the end of the account so that your views, ideas and concerns can help us produce our quality report in future years. Tracy Taylor, Managing Director, South Birmingham Community Health Quality Account Dental Services 2009-10  Part 2 Statement of assurance from the Board and priorities for improvement Statement of assurance from the Board South Birmingham Community Health has made huge progress over the last year and experienced significant gains in quality measures and service improvement. In addition to introducing significant programmes to develop our culture and capabilities around quality, we have sought to actively reduce health care acquired infection rates and to improve access to services. In making improvements the Board also recognises that we still face some challenges going forward into 2010-11. Implementation of an electronic dental record and development of clinical outcome measures are identified priority areas for improvement in the coming year and will challenge clinicians and managers alike. Birmingham Dental Hospital, in partnership with the University of Birmingham School of Dentistry, provide training and development of the dental workforce for the West Midlands Region and beyond. As such, the partners ensure that all members of the dental team of the future receive a well rounded education and have the opportunity to maintain and extend those skills throughout their working lives. In addition to our internal quality assurance measures, compliance with external regulators is achieved through • compliance with Care Quality Commission standards • participation in national clinical audits • agreeing quality standards with commissioners (the people who are responsible for purchasing our services on your behalf) The Board of Directors is assured that the processes and systematic approach to monitoring quality, patient safety and positive patient experience is robust, effective and fit for purpose. This is the cornerstone of our commitment to providing accessible, responsive patient-focussed healthcare.  Quality Account Dental Services 2009-10 Priorities for improvement We have considered our priorities for improvement based upon our review of services and the work that we have been doing with our commissioners. The priorities include: • smoking cessation • decontamination • using the adult outpatient survey to take account of our patients’ personal needs. These priorities align to the Commissioning for Quality and Innovation (CQUIN) payment framework agreed with our commissioners, in accordance with the national framework for how NHS services are commissioned. Progress to achieve these priorities will be monitored and measured using CQUINs and the development of quality indicators for 2010-11. Service development and improvement plan A continuous process of service development is followed by the Trust and with its commissioners. In 2010-11 the following areas have been prioritised: • development of quality indicators for each service specification • referral review and analysis to document the patient pathways attributable to each specialty • development of a revised workforce and capacity template to provide accurate monthly and quarterly information to commissioners. Additional details around the goals agreed with our commissioners can be found further on in the report. The following section provides more information about our ongoing improvements and development and how they link to our review of services. Quality Account Dental Services 2009-10  Review of services During 2009-10 Birmingham Dental Hospital provided seven core specialty services in support of patients across the West Midlands. The following statements provide an insight into the wide range of developments and ongoing improvements effected to support service provision to patients within these core services: Clinical effectiveness 1. The outline business case for the new Dental Hospital has been approved and the parts of the project are now being established to produce the first stage of the Local Improvement Finance Trust (LIFT) business case. 2. The initial stage implementation of a new patient administration system (iPM) was completed successfully in August 2009. Contracts have been signed for the next stage of the national dental IT system. 3. A business plan for the introduction of cone beam radiography has been supported within the Capital Plans 2010-11. A business case is currently being developed. 4. Birmingham Dental Hospital and the University of Birmingham School of Dentistry is a major training establishment, responsible for developing the workforce of the future. The School of Dental Hygiene & Therapy has been revalidated following the five year review by the University of Birmingham, evidencing that the course meets the required academic standards. 5. Detailed service specifications have been developed for the wide range of dental specialties and sub-specialties delivered by Birmingham Dental Hospital and their respective aims, objectives and service provision on behalf of patients. Patient safety 6. Best practice is maintained by implementing national guidelines, regulatory body’s advice and internal audit: - The Medicines and Healthcare products Regulatory Agency (MHRA) is the government agency which is responsible for ensuring that medicines and medical devices work, and are acceptably safe. - The review and implementation of National Institute for Health and Clinical Excellence (NICE) guidelines. - The review and action of National Patient Safety Agency (NPSA) Alerts e.g. Birmingham Dental Hospital swiftly implemented recommended changes highlighted within NPSA alerts addressing ‘Oxygen safety in hospitals’ and midazolam revised dosage regime.  Quality Account Dental Services 2009-10 Patient safety (continued) Birmingham Dental Hospital is part of the ‘Patient Safety First!’ campaign. Measures contributing to patient safety include: - implementing the World Health Organization surgical checklist in the General Anaesthetic and Theatre setting - the transfer policy between Birmingham Dental and Birmingham Children’s Hospital for critically ill children was reviewed together with the emergency drugs used in general anaesthetic critical care transfer - the resuscitation policy was updated and the range of resuscitation equipment extended (e.g. finger pulse oximeters) - Immediate Life Support and Auto External Defibrillation training updates were undertaken - new wrist bands with printed names are now used for the General Anaesthetic department - injectable medicines risk assessments (annual audit) - amendment and implementation of the revised Children’s Clinic treatment planning record - Post Exposure Prophylaxis guidelines updated. Patient experience 7. Birmingham Dental Hospital had reduced the patient waiting time from initial referral to new patient appointment from 13-weeks April 2006 to 5-weeks by April 2008, and progressed to achieve the Department of Health patient wait target of 18-weeks from referral to commencement of treatment by December 2008. However, referral rates have continued to grow, and this requires constant review of the clinical capacity required by each specialty to meet the needs of patients as confirmed by the detailed workforce plan. 8. To ensure that the patient pathway from referral to new patient appointment takes no longer than five weeks, clinicians have revised the referral criteria for referring clinicians. This helps general dental and medical practitioners (dentists and doctors working in primary care) to provide the information required to support their application for secondary (hospital based) care at the time of referral. This avoids delays for patients due to referrals being returned when they lack the depth of information required, or when referrals are inappropriate. 9. A plan for the investigation and learning from complaints has been implemented. Issues raised in complaints are discussed at senior management team meetings, and lessons learned cascaded appropriately to promote and improve patient experiences. 10. A comprehensive review has been undertaken of all standard letters and improvements made to the style and content. A review of patient information leaflets is currently in progress. Quality Account Dental Services 2009-10  Participation in clinical audit There were no confidential enquiries relevant to South Birmingham Community Health during this period. The relevant national clinical audits that South Birmingham Community Health participated in, and for which data collection was completed during April 2009 to March 2010, are listed in the table below, alongside the number of cases submitted, as a percentage of the number of registered cases required by the terms of that audit. National Audit Submitted data as % of required sample Sentinel Stroke Audit – Interim There were no cases Organisation Audit (2009) reviewed whilst undertaking 1 the organisational audit (undertaken jointly with University Hospital Birmingham Foundation Trust) 2 National Continence Audit 41 % Of these, the continence audit will be reported within the Quality Account for the period 2010-11. South Birmingham Community Health also received reports of the following national audits previously undertaken: • Sentinel Stroke Clinical Audit • National Clinical Audit of Falls and Bone Health • National audit of the occupational health management of NHS staff with lower back pain and depression. These were reviewed and changes made to services as appropriate. Although there were no specific national audits relevant to dental services during this period, dental services undertake clinical audit around dental equipment to support improvements in compliance with Department of Health HTM 01 05 guidance which is a national and legal requirement. Birmingham Dental Hospital also takes part in Trust-wide audits, and 23 registered local audits have been undertaken across the dental services.  Quality Account Dental Services 2009-10 Examples of clinical audit Listed below are some examples of local audit conducted within the dental services: • assessing the quality of referral letters received by the Restorative Dentistry Department • recording of patient smoking histories • management of patients on warfarin by general dental practitioners in the West Midlands • national oral care for adults with epidermolysis bullosa • audit of patients who failed to attend appointments in the paediatric department • the concept of the paediatric dental trauma team and the treatment received by patients who attend the trauma clinical session at the Birmingham Dental Hospital • support for children and young people, during general anaesthesia for dental extractions. Improvements made following clinical audit Listed below are examples of actions that have been implemented to improve the quality of healthcare provided around clinical effectiveness and patient safety: • improved documentation for recording medication on admission • an increase in surgical dental equipment to continually improve compliance with HTM 01 05 • purchase of new fridges to improve storage of medicines • clearly defined cleaning standards in all clinical areas • implementation of national cleaning standards at the Birmingham Dental Hospital following environment audits • Trust-wide standardisation of hand hygiene products in line with the National Patient Safety Agency ‘Clean Your Hands’ campaign. Additional details around clinical audit activity can be found in the clinical audit annual reports. This information can be requested through the clinical governance department on 0121 465 7890. Quality Account Dental Services 2009-10  Participation in clinical research • The number of patients receiving NHS services provided or sub-contracted by dental services in April 2009 to March 2010 that were recruited during that period to participate in research approved by a research ethics committee was 26 (actual portfolio research) and 307 (expected/estimated non-portfolio research). • This increasing level of participation in clinical research demonstrates dental services commitment to improving the quality of care we offer and to making our contribution to wider health improvement. Dental services was involved in conducting 24 (1 portfolio research study and 23 non-portfolio research studies) clinical research studies. • Dental services completed 37.5 per cent of these studies as designed within the agreed time and to the agreed recruitment target. • Dental services used national systems to manage the studies in proportion to risk. Of the six studies given permission to start, 50 per cent were given permission by an authorised person less than 30 days from receipt of a valid complete application. • 50 per cent of the studies were established and managed under national model agreements and none of the six eligible studies involved used a Research Passport (i.e. the research passport is only required for research carried out by non-NHS staff). • In April 2009 to March 2010 the National Institute for Health Research (NIHR) supported one of these studies through its research networks. There has been a further study granted by NIHR within 2010-11. • There is currently a portfolio research study ongoing. Innovation A fundamental part of developing the quality and safety of care is the need to constantly challenge and improve the mechanisms through which that care is delivered. This includes not only procedures and practice but also the technology deployed. Through innovation, dental services strive to harness the opportunities made available by advances in science and engineering, to the benefit of patient care. Example of innovation within the dental services Researchers in Birmingham Dental Hospital are for the first time looking at the use of saliva to identify biological markers of disease. Along with colleagues in biosciences, they are working towards developing markers which will lead to development of diagnostic tools and ultimately saliva could be used to diagnose other systemic diseases.  Quality Account Dental Services 2009-10 Goals agreed with commissioners During the period 2009-10, of the CQUINs agreed between commissioners and South Birmingham Community Health there were none which specifically related to the dental services. However, targets have been set for 2010-11 and a proportion of Birmingham Dental Hospital’s income received in 2010-11 will be conditional on achieving quality improvement and innovation goals agreed with Solihull NHS Care Trust through the CQUIN payment framework. The following section details the outline of the CQUIN goals for 2010-11 along with details of the rationale behind them: 1. Patient experience Objective Improve responsiveness to the personal needs of patients using the adult outpatient survey Rationale Birmingham Dental Hospital will participate in the NHS outpatient survey during 2010-11, led and run by the Picker Institute. The questionnaire will be refined in conjunction with the Institute and commissioners, to ensure it accurately reflects and relates to care delivery at a dental hospital rather than an acute medical hospital. The process will be independently led by the Picker Institute, who will draw the patient sample, conduct the survey, provide an advice line, translation sheets and language line facilities, data entry, analysis and reporting and where applicable benchmark against national results. Reporting Birmingham Dental Hospital will report quarterly to commissioners progress made against the implementation plan developed with the Picker Institute. The NHS outpatient survey will provide insight and understanding of patients experience when attending the dental hospital for a new patient appointment. The data gained will then be used to target improvements in service experience and satisfaction. Quality Account Dental Services 2009-10  2. Outpatient clinical code descriptions and pathway quality Objective Provision of clinical code descriptions to commissioners, participate in Payment by Results (PbR) Audit 2010-11, phased population of outpatient commissioner data set including input of referral code and referral organisation information, to assist commissioners/providers to fully understand pathways and better meet patient needs. Rationale The operation of a dental hospital outpatient department differs in many respects to an acute medical hospital. Although both report outpatient appointments in terms of activity, including counts of new patient and follow-up attendances, the majority of interventions and procedures in a dental hospital are performed under the reported ‘follow up attendances’ and a minority as day case attendances. All Trusts have to clinically code inpatient and day case operations. Outpatient procedural coding is not a statutory requirement at present, thus dental procedures undertaken as an outpatient attendance cannot be electronically identified within the data set. Data sets for patients must include the code for their general medical practitioner, as this dictates which Primary Care Trust will fund the dental care delivered. General dental practitioners can be private practitioners and thus will not have an allotted national administrative code. Therefore for the future, a single code is sought which will reflect the general dental practitioner who initially referred the patient to the hospital. Birmingham Dental Hospital is working in conjunction with commissioners to develop a phased plan to achieve these objectives and to gain a clear insight into the case mix and complexity of outpatient attendances provided annually by clinicians. Reporting The 2010-11 plan will include: • Clinical coding: Commissioners wish to gain a better understanding of each specialty and specialist sub categories of care, through the clinical coding infrastructure applied to outpatient activity. • Participation in the national Payment by Results Audit 2010-11: Some of the aspects to be included are methodology, quality of coding, review of policy and procedures for information and coding as applicable to dental hospitals. This audit will then act as a baseline for future improvement planning. • National administrative codes (NACs): To work in conjunction with commissioners and associates to refresh the NAC codes, and develop a means of ensuring general dental practitioners include a referral code for their surgery within their referral letters sent to Birmingham Dental Hospital.  Quality Account Dental Services 2009-10 3. Decontamination standards Objective A national strategy for the modernisation of decontamination services was established by the Department of Health to ensure Trusts achieve compliance with the Medical Devices Directive (93/42/EEC). Rationale In response the Pan-Birmingham Decontamination Project Board was established to deliver this strategy for NHS Trusts in Birmingham, including Birmingham Dental Hospital. The main aims are to provide a consistent, efficient, safe and economical decontamination service to each member Trust to support the delivery of clinical services to its patients. The service model adopted was to tender for the provision of two compliant, high quality ‘state of the art’ central sterile services departments (CSSDs) within Birmingham, which would deliver economies of scale. The service principles are to ensure the product is returned to a compliant standard, within the agreed turnaround timescale, and each stage of the process is recorded to provide traceability. Reporting Birmingham Dental Hospital is in the process of transferring instruments to be decontaminated to the approved central provider in Birmingham. This phased migration plan will be closely monitored by commissioners and the Pan-Birmingham Decontamination Project Board during 2010-11. Quality Account Dental Services 2009-10  4. Smoking intervention Objective To record whether a patient is a smoker during the new patient clinical assessment and offer information or provide direction to stop-smoking programmes Rationale Commissioners have asked for evidence of the percentage of new patients attending an outpatient appointment with smoking status recorded (age 16 years and above, with certain defined exceptions) who received a brief intervention to reduce tobacco use, with evidence of stop-smoking literature and advice having been provided. Reporting Progress reports will be provided during quarters two, three and four of financial year 2010-11. Further details of the agreed goals for financial year 2010-11 are available on request from the communications team by calling 0121 442 3708 or by e-mail on email@example.com.  Quality Account Dental Services 2009-10 What others say about the Provider Statement from the Care Quality Commission South Birmingham Community Health is required to register with the Care Quality Commission and its current registration status is unconditional. This means that the Trust is able to continue providing care without any restrictions being imposed by the Care Quality Commission. What our patients are saying Birmingham Dental Hospital takes seriously all comments received from patients. It uses negative patient feedback to drive improvements in the quality of care. Below are some examples of what patients have said about Birmingham Dental Hospital through the NHS Choices website http://www.nhs.uk/Pages/HomePage.aspx I have been a patient at Birmingham Dental Hospital for about twenty five years. I think the treatment I have received has been excellent”. Patient in December 2009 My dentist was friendly, very knowledgeable and very professional. I felt at ease through the consultation and examination and her assistants were also well mannered and respectful. I was impressed with the service and guidance offered by all of the people in the team. Well done and keep up the good work. And of course thank you for making my visit a pleasure”. Patient in March 2010 The dentist was very understanding. I was so nervous that my blood pressure was very high. They talked to me and put me at ease”. Patient in February 2010 Appointments made very soon after referral. Excellent service by friendly, reassuring, competent dentists. No pain - just as promised! Thanks!” Patient in January 2010 My 9 year old daughter had an operation today at Birmingham Dental Hospital; she was terrified, all the staff were great with her, thank you all so much”. Patient in October 2009 Quality Account Dental Services 2009-10  Data quality This section looks at the details around data quality for South Birmingham Community Health within the dental services and across the Trust. 1. NHS number and general medical practice code validity Birmingham Dental Hospital within South Birmingham Community Health submitted records during 2009-10 to the Secondary Uses Service for inclusion in the Hospital Episode Statistics. The percentage of records in the latest published data (March 2010); – which included the patient’s valid NHS number was: • 100 per cent for day cases • 97.3 per cent for outpatient care – which included the patient’s valid general medical practice code was: • 99 per cent for day cases • 97.1 per cent for outpatient care 2. Information Governance toolkit attainment levels South Birmingham Primary Care Trust (PCT) commissioner and provider score for 2009-10, assessed using the information governance toolkit, was 28 out of 33 (84.8 per cent) for information quality and records management. Please note South Birmingham PCT is not required to submit level scores against all requirements listed in the Quality Account toolkit which are predominantly acute-based. The following sections were not required against the PCT assessment: 402, 404, 406, 407, 503, 505, 506, 507, 508, 510 during the period 2009-10. 3. Clinical coding error rate Birmingham Dental Hospital was not required to take part in the Payment by Results clinical coding audit conducted by the Audit Commission in 2009-10 but will participate in 2010-11. However, 100 per cent clinical coding was achieved on the commissioner data set submission for day cases.  Quality Account Dental Services 2009-10 Part 3 Review of quality performance South Birmingham Community Health has made good progress towards ensuring consistency of high quality care thanks to the commitment and dedication of all our staff. This report reflects what we have done so far and also highlights what we want to do to continue building on those achievements. Quality assurance at board of directors level, ensuring the highest standards of patient care and safety, is a fundamental responsibility of the Boards of all NHS organisations. For South Birmingham Community Health, continual improvement to the quality and safety of care and the overall patient experience is of the highest priority. Our Board receives monthly reports, giving regular quality assurance updates which demonstrate a culture of ongoing improvement and accountability. Reporting framework A series of structured quality reports are developed for commissioners and internal quality management processes which address: • monthly report of selected key performance indicators, organisation-wide and specific to directorates, as applicable • contract quality requirements 2010-11 • gender and ethnicity trends • nationally specified events and associated key performance indicators • locally specified events and associated key performance indicators. Our organisation will continually strive to drive up the quality of our services and to exceed the external standards against which we are assessed. This report confirms to the Board the work that is being done to achieve this. The following have been involved and engaged in developing this Quality Account South Birmingham Community Health Managing Director Medical Director Director of Nursing and Therapies Associate Director of Therapies Birmingham Dental Hospital Business Information Unit Associate Director Clinical Audit and Effectiveness Manager Clinical Lead Clinical Governance Facilitator Business Manager External Communication Lead Trust and University Clinical Staff Information Governance Manager Governance Manager Patient Experience Lead General Manager Patient Services Patient Safety and Clinical Risk Manager R&D Consortium Manager Quality Account Dental Services 2009-10  We have introduced a rolling programme of patient safety walkabouts, giving clinical teams the chance to show directors the work they have done to raise standards of safety, cleanliness and infection control and to discuss ideas for further improvement. Rick Roberts, Medical Director Receiving regular updates on the continual work being done to raise the quality of our services is invaluable in giving directors a clear overview of what is working well, where we still have room for improvement and in helping to shape the Board’s strategic vision going forward. John Craggs, Non-Executive Director Statement from Local Involvement Networks Local Involvement Network This report reflects the continuing improvement and up-dating of the services offered within the Dental Hospital, taking into account that it is a teaching hospital and also a research centre, it is a remarkable achievement that waiting times have come down and standards are maintained at a very high level. We look forward to working with the Dental Hospital in progressing their plans for new premises.  Quality Account Dental Services 2009-10 Evaluation form We would like to hear your views on the Dental Quality Account. The Department of Health will direct some of our content i.e. quality measures that every organisation must publish. However, South Birmingham Community Health have an opportunity to publish information about local quality initiatives. Your feedback will give us an opportunity to include the initiatives you want to hear more about. Please fill in the evaluation form below, tear it off and return to us. No postage is required, simply fill in the form and drop it into a post box. Thank you for your time. Please return your completed evaluation form to us by 1 October 2010. ! Evaluation form Why? What best describes you? (please circle) ............................................................................ Patient / carer / member of public / staff / other ............................................................................ ............................................................................ How can we improve the Dental Quality Are you aware of quality highlights you Account? would like to see included in next year’s ............................................................................ Quality Account? ............................................................................ ............................................................................ ............................................................................ ............................................................................ ............................................................................ Which sections stood out for you? (please tick) Statements in part 1 and 2 Are you aware of any quality challenges you would like to see included in next year’s Priorities for improvement Quality Account? Review of services ............................................................................ Participation in clinical audit ............................................................................ ............................................................................ Participation in clinical research Goals agreed with commissioners How would you like to receive the Quality Account? What others say about the provider ............................................................................ Data quality ............................................................................ Review of quality performance ............................................................................ The results of this questionnaire will be read by the editorial team in preparation for next year’s publication. If you would like to request a copy of this document in an alternative format, or have any other queries about its content, please contact the South Birmingham Produced by Clinical Illustration and Information Design Tel: 0121 237 2775 Ref: 00000 05/10 Community Health communications team: Tel: 0121 442 3708 Email: firstname.lastname@example.org The report is also available at www.sbch.nhs.uk !
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