Quality Improvement Plan2017 / 2018

ContentsPart One – Quality Matters

Joint statement from our Chief Executive and Chair of Trustees 3Leonard Cheshire Social Care Services 5Celebrating Success 6

Part Two – Our Priorities for Improvement

Our Achievements for 2016 / 2017 7Our Priorities for 2017 / 2018 9Monitoring, Measuring and Reporting 10Registration 15NHS Funding 15National and Local Audits 16Research Statement 16

Part Three – Key Indicators

Customer Experience 17Customer Safety 20Clinical Effectiveness 22

Part Four – Annexes

Annex 1 – Stakeholder Feedback 23Annex 2 – Amendments Following Feedback from Stakeholders 23Annex 3 – Research Summary 23

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Part One – Quality MattersJoint statement from our Chief Executive and Chair of Trustees.

Welcome to our annual Quality Account, a summary of our performance against significant quality measures for 2016-17 and our initiatives and plans for the year ahead.

Our new five year strategy is designed to deliver three key objectives by 2022, all with the overarching aim of supporting people’s journeys toward independence;1. Impact through partnerships;2. Support through communities;3. Influence through insight.

We will meaningfully and effectively put people with disabilities at the heart of our decision making in the design of all of our services and projects. We will organise ourselves to ensure that their experience with us is seamless and personal.

For our care and support services our aspirations for the year ahead are simple. From October 2017 onwards we are aiming to have all of our services rated as Good or above when our care regulators inspect us. We have a dedicated and motivated team of staff and volunteers to help us achieve this ambition.

Neil Heslop OBE, Chief Executive

Sally Davis, Chair of Trustees

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Highlights from 2016 / 2017

• Strategic Development – The last year has been a year of significant change for Leonard Cheshire with a new executive management team who have developed our strategy for 2017 to 2022 in discussions with customers, partners and other organisations. The new strategy is, by definition, looking to the future, but it also represents a significant achievement for us over the last year. Periods of major change can also result in periods of anxiety for customers, relatives and staff and our new plans for the future provide all our teams with a new sense of purpose and focus.

• Fair Place to Work – we have undertaken the largest ever consultation exercise with our care staff in our history, engaging over 6,000 staff to discuss how we can clarify and improve the offer to our staff. As a result of this, over 90 per cent of our frontline staff will be on significantly improved terms and conditions in the year ahead. Importantly we will have a fair, sustainable and modern services employment framework that enables career progression and transparency.

• Transitioning Services – we have had to take the tough decision to close three of our longstanding services during the year. Our Honresfeld care home in Rochdale closed in June, whilst our Wiltshire and Solent Care at Home services closed in September and March respectively. In both cases we worked hard with new providers to ensure our customers’ care transitioned smoothly and effectively and staff who wanted to were supported in transfers to new employers.

• Building for the Future – in preparation for the implementation of the Apprenticeship Levy we have been working to build our development offer for our staff. We received recognition at the House of Commons from the Apprenticeship Delivery Board for our commitment to apprenticeships. Our service at Oakwood won “Large Employer of the Year” for Outstanding Commitment to Supporting their Staff in achieving their qualifications. Our plans for the coming year also include roll out of our Managing for Excellence development programme for our Service and Deputy Managers.

The coming year affords new and exciting opportunities for us to develop our social care services, making them truly outcome-focused and fit for a future where we can continue to support our customers’ individual journeys toward independence.

Neil Heslop OBE, Chief Executive Sally Davis, Chair

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Care homes

Can Do locations Discover IT centres

Other care and support services

LEONARD CHESHIRE SERVICES IN THE UK

LCD Social Care ServicesAcross the UK we support more than 3,000 customers a year in our 163 social care services. These are a mixture of nursing, residential and community-based services.

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Celebrating SuccessOver the last year our staff have continued to consistently demonstrate their commitment and dedication to support our customers. Here we highlight some of our staff who have made a significant impact on the lives of our customers across the work of Leonard Cheshire.

2016 Staff Award Winners

Chair’s Award – Orpa OgotOrpa has provided leadership and guidance to our inclusive education project in Kenya. This project supports disabled girls in the Kisumu area, particularly by advocating for policy change that will make education inclusive for everyone. This is a complex project that has posed many challenges since its launch, but Orpa has been dedicated and open-minded in her lead of all activities on the ground. Orpa has also represented the charity at national and local government negotiations in Kenya, engaging with other organisations to support our work.

Chief Executive’s Award – The Maples Team, Belfast The Maples in Belfast is one of our newest services. Over the previous 18 months the team has worked together dynamically and flexibly to get the service up and running for the 31 tenants. The positive impact on people living at The Maples has been huge, with one saying ‘when I moved here I got my life back. I got my family back and they got their mother back.’ The success of the service is, in large part, thanks to the committed and supportive team.

Excellence and Impact – Godfrey Robinson House Team, YorkshireAt the end of last year, the team at Godfrey Robinson House were put to the test when they experienced an outbreak of illness which affected most of the staff and residents. The challenge became bigger when a resident passed away, major refurbishment works took place and a surprise CQC inspection happened all at once. Despite this, the team worked together to make sure they were still able to fully support the people living at their service. They were given a good overall CQC report, with one area being marked ‘outstanding’. They were also sent a letter from a resident’s family thanking them for making his last few years so happy.

Innovation and Improvement – MaryClare Faulkner, Gloucestershire House, GloucestershireOver the last year, MaryClare’s led the development of an inclusive cycling project in the Forest of Dean to boost opportunities for people using our Gloucestershire House service. This involved consulting with residents and families, fundraising, attending events and meetings, reaching out to new contacts and making sure that the service has a robust project plan for working with large funders.

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Inspirational Manager – Sue Weeks, Greathouse, Chippenham Sue’s clear vision for the service has helped improve the culture and atmosphere for everyone at Greathouse. Sue achieved this through continued improvements, including a new goat petting therapy initiative, which has had a lot of praise and press coverage. Her passion, commitment and enthusiasm have lifted staff morale, and helped to manage challenging behaviour from some residents. Sue’s also been pivotal in securing the correct fees for placements.

Other Great Achievements

William Gallagher – Outstanding Contribution to Home Care AwardWilliam Gallagher, service manager at Randall Close in London, who won the Outstanding Contribution to Home Care Award at The Towergate Care Awards on Thursday 23 March. Out of three finalists, William won the award for supporting people to maintain independence within their own home and community. The award, sponsored by the Daily Mirror, highlights and celebrates the importance of the role that home care workers play.

William was nominated for the award by Connie Lally, Keeping Independence Through Enablement (KITE) service manager. KITE gives short-term support to people in their own homes to help them be as independent as possible. In 2016, William worked towards launching a Dignity in Care campaign between KITE and Leonard Cheshire, to raise awareness and train staff working in every care facility in the borough.

Change100 – RIDI Innovation in Assessment Award The Recruitment Industry Disability Initiative Awards are designed to celebrate employers who drive change in recruitment and remove the barriers faced by the millions of disabled people who are entering or progressing through the job market.

Change100 won the RIDI Innovation in Assessment award. Our Change100 programme aims to address the under-representation of disabled people in the workplace and kick-start the careers of a growing population of talented disabled students by matching them to paid internship placements within prestigious companies.

It received the RIDI award in recognition of its inclusive assessment and recruitment processes. It currently offers a wide range of reasonable adjustments and clearly communicates to applicants, in a variety of ways, about all the adjustments they can request.

All Change100 interns said, not only would they recommend the programme to others with disabilities, but that the programme has strengthened their CV, improved their confidence in the workplace and been truly life-changing.

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Part Two – Our Priorities for ImprovementDuring this reporting period, from April 2016 to March 2017, Leonard Cheshire Disability provided 43 nursing care services. In total we have 144 regulated services across the UK, of which we run a variety of service types and models. Alongside the 43 nursing care services we run a further 60 residential care homes. The remaining 41 services are made up of supported living services, care at home services and a small number of day services.

We have reviewed all the data available on the quality of care in these services.

Our Achievements for 2016 / 2017This is our first Quality Improvement Plan but this doesn’t mean we have been resting on our laurels. The last 12 months have been very busy.

Future-Proofing – We have undergone a significant transformation over the last 12 months with a new CEO and Executive Team. A key priority for us has been a fresh approach to engagement with all our staff and the development of our new strategy for the next five years. Our five year plan is designed to deliver three key objectives, all with the overarching aim of supporting peoples’ journeys toward independence;1. Impact through partnerships;2. Support through communities;3. Influence through insight.

Fit for Quality – we have reshaped our Quality Improvement Team to ensure it is more agile and flexible. In doing so we realigned our internal inspection process with our national regulators to make it more useful and more recognisable for our service managers. The team now has a much stronger focus and greater capacity to support services to realise change. We have also introduced our new trustee-led Care Quality and Innovation Comwmittee to oversee our UK care services.

Responsiveness and Visibility – we have developed a new Service Improvement Database to support services in monitoring their own performance, whilst improving our overview of services. This will be rolled out in the coming year and will equip us to identify services in need of support as well as identify services working effectively and successfully so we can share best practice.

Financial Stability – we have worked hard with our commissioning partners to ensure the financial stability of our services. Our new strategy will also see us increasing our voluntary income to support and grow our core activities.

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Clinical Governance – we have undertaken a root and branch review of our clinical governance arrangements and introduced some key changes including the appointment of an external expert Clinical Lead, as well as creating a new Head of Clinical Excellence role to lead on clinical governance. Our new Clinical Governance Forum is now overseeing and developing our clinical care.

Apprenticeship Strategy – in preparation for the implementation of the Apprenticeship Levy we have been working hard to develop our development offer for staff. We have received recognition at the House of Commons from the Apprenticeship Delivery Board for our commitment to apprenticeships. Our service at Oakwood won “Large Employer of the Year” for Outstanding Commitment to Supporting their Staff in achieving their Qualifications.

Information Governance – In March 2017 we confirmed our own assessment of compliance with Level 2 of the NHS Information Governance Toolkit. This follows significant work over the year to review our information governance, data protection and information sharing arrangements and safeguards. There is more to do to fully embed and sustain this work over the coming year.

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Priorities for 2017 – 2018Our new five year plan focuses on supporting people towards independence. We have set ourselves some ambitious targets for the first year of this plan which centres on nine priorities.

Priority Key Theme We Will

1 Customer Outcomes

Develop and deploy an outcomes-based approach to care and support which promotes the ambitions and aspirations of our customers.

We will celebrate our customers’ achievements as part of our centenary 100 for 100 programme by developing 100 customer outcome stories.

2 Customer Engagement

Improve our customer engagement by strengthening our Customer Action Network and support their engagement with our Customer Council.

Develop and improve the ways we listen to our customers and use their feedback to improve our service offer.

3 Customer Insight

Better understand of our customers’ needs to improve our support and the accessibility of our services through the creation of an Insight team and a Customer Council.

4 Clinical Excellence

Develop our clinical leadership with improvements to our management induction and the piloting of our new Nurse Consultant role.

Improve our medication compliance through the review of our pharmacy contract and the introduction of electronic medication management.

5 Service Innovation

Develop our service models to promote independence and com-munity inclusion.

6 Service Visibility

Improve the lines of sight into our services with the roll out of our Service Improvement Database, improvements to our senior management audits and expansion of our internal inspections.

Embed our new Care Quality and Innovation Committee in to our governance structure to strengthen accountability and promote innovation.

7 Information Governance

Build on our information governance work to embed compliance with the NHS Information Governance Toolkit.

8 Staff Supervision and Support

Improve our support offer to staff through more agile and flexible supervision and learning and development opportunities.

9 Management Development

Deliver our new Managing for Excellence development programme for our Service Managers and Deputy Managers.Develop and deliver a new training package for Team Leaders.

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Monitoring, Measuring, ReportingFor each of the key priorities identified above we have set milestones to ensure success. Responsibility for delivering our Quality Improvement Plan rests with our operational Directors, who oversee our care services on a regional basis. Responsibility for monitoring the Plan rests with our Head of Quality Improvement who is responsible for gathering information on progress and reporting to our Operations Board and our Care Quality and Innovation Committee.

Key Priority 1 Customer Outcomes

Key Outcome Outcomes-based approach to support

Key Milestones Referral, assessment and care planning policies are reviewed to ensure outcomes are embedded in the way we assess and support customers

September 2017

Incident management and complaint policies are reviewed to ensure outcomes are embedded in the way we respond to and investigate incidents and complaints

September 2017

Safeguarding and mental capacity policies are reviewed to ensure outcomes are embedded the way we safeguard customers and manage risk

December 2017

A suitable outcomes monitoring tool is identified and piloted to support customers to identify priorities and progress

September 2017

The outcomes monitoring tool is rolled out to all services March 2018

Key Outcome Celebrate our customers’ achievements by developing 100 customer outcome stories

Key Milestones Launch 100 for 100 Customer Outcomes July 2017

30 stories are gathered and shared September 2017

60 stories are gathered and shared December 2017

100 stories are gathered and shared March 2018

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Key Priority 2 Customer Engagement

Key Outcome Strengthening our Customer Action Network

Key Milestones The Customer Action Network is re-launched and promoted across all services

August 2017

New CAN Representatives have been identified and trained September 2017

Communication channels from services to CAN Representatives are established

September 2017

CAN Representatives for the Customer Council have been selected

October 2017

Key Outcome Improve the ways we listen to our customers and use their feedback

Key Milestones New complaints monitoring arrangements and targets are in place

May 2017

The Customer Insight Team is established August 2017

Existing customer surveys have been reviewed, adapted and deployed

November 2017

New suite of feedback approaches have been identified November 2017

Suite of feedback approaches have been signed off at annual CAN conference

January 2018

New feedback approaches are rolled out and feedback collated and communicated

March 2018

Key Priority 3 Customer Insight

Key Outcome Better understand of our customers’ needs to improve our support and the accessibility of our services

Key Milestones All revised and new policies and procedures are available in Easy Read versions

July 2017

Data is available on all our customers’ key communication needs

July 2017

Key customer facing information is reviewed to ensure it is readily available and accessible for customers

September 2017

Regional Accessibility Champions are identified and trained to advise and develop best practice

December 2017

Service locations are reviewed and we have identified priorities for technological infrastructure improvements

March 2018

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Key Priority 4 Clinical Excellence

Key Outcome Develop our clinical leadership with improvements to our management induction and the piloting of our new Nurse Consultant role

Key Milestones Clinical management induction is reviewed to ensure clear guidance for new managers

May 2017

Clinical care metrics are reviewed and reporting mechanisms strengthened

July 2017

All new Service Managers receive an on-site clinical induction within their first month

July 2017

Clinical roles and delegated tasks are reviewed to enhance clinical leadership and practice

September 2017

Recommendations from review of clinical roles are identified and actioned

October 2017

Nurse Consultant role is piloted in North of England October 2017

Recommendations from Nurse Consultant pilot are identified and actioned

December 2017

Key Outcome Improve our medication compliance through the review of our pharmacy contract and the introduction of electronic medication management

Key Milestones Pharmacy contract is procured July 2017

Medication Audits are recorded on the Service Improvement Database for all services

July 2017

Medication Management Plan is in place for all nursing services August 2017

EMMS is piloted in ten nursing and residential sites in England and Wales

September 2017

Self-Medication is fully reviewed in all care and support plans to promote greater independence

October 2017

EMMS roll out programme is agreed and actioned November 2017

Key Priority 5 Service Innovation

Key Outcome Develop our service models to promote independence and community inclusion

Key Milestones Hub and community model piloted in Scotland July 2017

Hub and community model piloted in Northern Ireland and Wales

October 2017

Hub and community model rolled out in England March 2018

Review staff deployment to ensure services are maximising staff availability to support customers’ independence

March 2018

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Key Priority 7 Information Governance

Key Outcome All services are compliant with the NHS Information Governance Toolkit

Key Milestones All nursing services have up to date risk assessments, asset registers and IG audits

July 2017

All nursing services have an up to date Business Continuity Plans

July 2017

All non-nursing services have up to date risk assessments, asset registers and IG audits

October 2017

All non-nursing services have an up to date Business Continuity Plans

October 2017

IG Toolkit compliance is audited in a sample of nursing services October 2017

Recommendations from the IG Compliance Audit are agreed and actioned

December 2017

Key Priority 6 Service Visibility

Key Outcome Roll out of our Service Improvement Database, Senior Manager Audits and Service Support Framework

Key Milestones Roll out new Service Improvement Database and agree new quality reporting schedules

April 2017

Roll out new Senior Manager Audit tool with guidance and thematic reviews

April 2017

Service inspection schedule and Service Support Framework in place

May 2017

First Service Quality Report based on Service Improvement Database customer and local audit metrics

July 2017

Service Quality Report based on first set of self-assessed Service Quality Audits

October 2017

Review of Service Improvement Database and Service Support Framework

January 2017

Key Outcome Care Quality and Innovation Committee is established and embedded in to our governance structure

Key Milestones The new Care Quality and Innovation Committee is established April 2017

Reporting mechanisms agreed both to and from the CQIC June 2017

CQIC signs off Quality Improvement Plan and agrees monitoring and review schedule

June 2017

Mid-year progress review of Quality Improvement Plan November 2017

Agree Quality Improvement Priorities for 2018 / 2019 March 2018

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Key Priority 8 Staff Supervision and Support

Key Outcome Improve our support offer to staff through more agile and flexible supervision

Key Milestones Staff Supervision Policy is reviewed to include flexible supervision options

July 2017

Supervision KPIs are recorded for all services in the Service Improvement Database

July 2017

Supervision quality is monitored through Senior Manager Audits and Service Inspections

October 2017

Key Outcome Improve our support offer to staff through learning and development opportunities

Implementation of our Apprenticeship Strategy May 2017

New Learning Management system is purchased to improve training management and planning

July 2017

Training Needs Analysis is reviewed August 2017

Staff Induction and Care Certificate programme is revised and updated

October 2017

Updated programme of core and specialist training is in place March 2018

Key Priority 9 Management Development

Key Outcome Improve our support offer to staff through more agile and flexible supervision

Key Milestones Review Managing for Excellence pilot course and apply learning to course design

May 2017

First Service Manager cohort commenced M4E programme June 2017

Deputy Managers registered to undertake Level 5 Certificate in Management as part of the Apprenticeship strategy

October 2017

Team Leader development programme available October 2017

Ten cohorts of Service and Deputy Managers completed the M4E programme

March 2018

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RegistrationLeonard Cheshire Disability is required to register with the Care Quality Commission for services in England.

Conditions of registration include the management by an individual who is registered as a manager in respect of that activity at all locations and maximum number of beds for its services in the following regulated activities:• accommodation for people who require nursing or personal care• diagnostic and screening procedures• personal care• treatment of disease, disorder or injury

We are also required to register with;• the Care Inspectorate in Scotland• the Care and Social Services Inspectorate Wales• the Regulation and Quality Improvement Authority in Northern Ireland

Conditions of registration vary but include;• management by an individual who is registered as a manager• the number of people supported• the types and nature of services provided

The Care Quality Commission has taken enforcement action against Leonard Cheshire Disability during the period of 1st April 2016 to 31st March 2017. This was in relation to two services. In the first instance the service has achieved the required improvements and the enforcement action has been ended. In the second all the necessary improvements have been made and have been quality assured by an independent auditor. As of 31 March we were awaiting a re-inspection by the CQC.

Leonard Cheshire Disability has not participated in any special reviews or investigations by the CQC during the reporting period.

NHS FundingThe income generated by the NHS services reviewed represents 35 per cent of the total income generated from the provision of NHS services by Leonard Cheshire Disability for the reporting period. The remaining income is generated from Local Authorities and from private fees.

Leonard Cheshire Disability’s income in the period 1st April 2016 to 31st March 2017 was not conditional on achieving quality improvement and innovation goals through the Commissioning for Quality and Innovation payment framework because it is not currently a contractual requirement.

Leonard Cheshire Disability was not subject to the Audit Commission’s payment by results clinical coding audit during the period 1st April 2016 to 31st March 2017.

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National and Local AuditsFrom 1st April 2016 to 31st March 2017 Leonard Cheshire was not eligible to participate in national clinical audits. During the period from 1st April 2016 to 31st March 2017 there were no national clinical audits or national confidential enquiries covering the NHS services that Leonard Cheshire Disability provides.

Leonard Cheshire Disability maintains a Quality Assurance Framework, reviewed in 2016, which provides the framework for our core audit and inspection programme which runs from April to March each year.

The core audit and inspection is risk-driven, and for care homes with nursing includes record keeping, medicines management, falls prevention, manual handling, pressure ulcer assessment and management, care at end of life, infection prevention and control including environmental and hand hygiene audit. The monitoring, reporting and actions following these audits and inspections ensure care delivery is safe and effective.

Key performance indicators and service inspection outcomes are reviewed on a monthly basis by the Quality and Compliance Forum and the Clinical Governance Forum. The Executive Management Board and the Care Quality and Innovation Committee receive quarterly Service Quality Reports.

Learning from the service inspections is summarised in our monthly Quality and Compliance Reports and is shared through our Shared Learning Briefings.

Leonard Cheshire Disability was not required to submit records during the period from 1st April 2016 to 31st March 2017 to the secondary uses service for inclusion in the hospital episode statistics.

Leonard Cheshire Disability’s score for the reporting period, 1st April 2016 to 31st March 2017, for Information Quality and Records Management, assessed using the Information Governance Toolkit was 66%. Progress on improving information governance is a key priority for the coming year.

ResearchThe research undertaken by Leonard Cheshire Disability is shown in detail in Part 4 of this report. Of the research undertaken, 614 customers were recruited from our social care services to participate in the Future Choices project. Of these 431 were from nursing care services. The remaining research projects engaged participants from the wider general population.

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Part Three – Key IndicatorsCustomer ExperienceInspection OutcomesEach UK nation regulates and rates services differently. As of the 31st March 2017 we had one service yet to be inspected by CQC under their new inspection regime, which was previously fully compliant, and one service yet to be inspected at all.

As a broad measure, as of the 31st March 2017 86.6 per cent of our services were rated ‘compliant’ – which either means complaint with national care regulations or rated as Good or above by the Regulator. At the 31st March 2016 the equivalent rate of compliance was 82.1 per cent. Within this breakdown our nursing services face the greatest regulatory challenges, with 67.5 per cent rated good or above.

Whilst our performance is above average compared to other social care providers, it is our ambition that all our services inspected will be rated as Good or above and our Quality Improvement Plan is designed to target the areas where we can make the biggest difference to customers’ experience of our services.

Regulatory Ratings Percentage Services

Very Good or Outstanding 14.6 21

Good 70.8 102

Requiring Improvement 12.5 18

Inadequate 0.7 1

Yet to be Inspected 1.4 2

TOTAL 100 144

Customer FeedbackIn July 2016 we reported on an annual customer survey. A total of 1,418 responses were received from 138 services. 94 per cent of customers reported as being happy with the care they receive and 87 per cent are likely or extremely likely to recommend LCD services to family or friends.

Figures represent the percentage of positive answers

All 2015

All 2016

East & South East

North West & South West

Northern Ireland

Scotland Wales

Percentages

Do care and support services help you to have a better quality of life?

94 93 93 91 95 95 95 100

Do you feel safe in the service?

91 93 91 93 93 96 95 93

Overall how satisfied are you with the care you receive from LCD?

88 94 92 93 94 95 98 97

How likely would you be to recommend LCD to friends or family?

86 87 86 85 87 90 94 93

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The major area for improvement from the survey related to customers’ wish for more social activities both within and outside the service. Additionally, previous survey reports have been split across residential and non-residential services. Future surveys will specify the outcomes and responses for nursing services to improve future reporting.

Future ChoicesFuture Choices is Leonard Cheshire’s initiative to embed customer-centric services. We sit with our customers on a one to one basis and ask them what is working, what is not working and what is important for the future. The information is used to promote personal independence and forms the basis of service co-production workshops. It also provides evidence for national research into customer needs and aspirations.

In total 641 customers took part, of which 413 were from nursing care services. Nationally the research found that customer’s top priority was to reduce agency usage and to have more staff to support them to access the local community. We responded to this by moving significant resources from capital development to front line staff pay to boost recruitment and staff numbers. ComplaintsWe define a complaint as ‘any expression of dissatisfaction, whether justified or not, about any aspect of our services’. Complaints can be made by anyone and in any way. We aim to acknowledge complaints within two working days and provide a response to the complainant in 28 working days. A review of this process indicates the need for better oversight and improved performance monitoring which will be a key activity in the year ahead as part of our customer engagement priority.

Over the last 12 months we have received 173 complaints in total of which six were subsequently withdrawn and five complaints were still being dealt with at 31st March 2017. Of the remaining 162 complaints the table below summarises the complaints we have received and how their outcomes compared to 2015 / 2016, for which period we received 220 complaints. 44 of the complaints dealt in the past year were nursing services compared to 86 in the previous year.

As with the previous year the majority of complaints continue to relate to staff performance and communication.

Staff Practice Staff Levels Environment Care Other

15/16 16/17 15/16 16/17 15/16 16/17 15/16 16/17 15/16 16/17

Resolved at 1st Contact 28 25 7 4 4 3 9 12 1 4

Partly Upheld 31 30 11 6 6 2 9 9 2 3

Upheld 33 19 12 1 4 3 9 6 2 2

Not Upheld 27 17 6 6 3 2 12 6 4 2

Total 119 91 36 17 17 10 39 33 9 11

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Customer SafetySafety Incidents

Incident 2015 / 2016 2016 / 2017

No. of incidents resulting in death 1 1

No. of incidents resulting in permanent or long-term harm 0 0

No. of customer slips, trips or falls resulting in hospital visit 15 40

Number of reports under RIDDOR 11 8

Root CauseNursing Non-Nursing

15/16 16/17 15/16 16/17

Care Practice 31 29 39 25

Communication 9 7 9 8

Delay 2 3 3 2

Diversity-Related 0 0 3 1

Pressure Ulcer 15 12 14 8

Other 46 29 60 32

Other Service and Care Cause 12 9 23 13

Quality 8 11 4 3

Safety 16 11 10 4

Total 139 111 165 96

Safeguarding During the last 12 months we have had 303 safeguarding alerts logged on our CASS system of which 207 relate to our accommodation-based services, compared to 304 in 2015 / 2016. The table below summarises the root cause analysis of these alerts.

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DOLS Applications and AuthorisationsApplications made under the Deprivation of Liberty Safeguards apply only where customers lack capacity and there is a need to put in place care and support measures that restrict their freedoms in some way. Throughout 2016 / 2017 we have adjusted the way we monitor DOLS applications. The table below highlights the level and frequency of reporting in our English and Welsh services where the Safeguards apply. In total 127 applications have been made of which 61 were pending a decision as of the 31st March. This picture reflects the challenge nationally in dealing with the significant volume of DOLS applications.

2015 / 2016 New Apps. Renew. Apps. Total Apps. Apps. Refused

Apps. Authorised

Nursing 117 25 142 97 45

Residential Care

57 31 88 59 29

Total 117 25 142 97 45

2016 / 2017 New Apps. Renew. Apps. Total Apps. Apps. Refused

Apps. Authorised

Nursing 64 19 83 5 29

Residential Care

11 33 44 0 32

Total 75 52 127 5 61

Data from 2015 / 2016 does indicate a drop in applications over the last year (down from 142 to 127). It also indicates a substantial decrease in the number of applications refused. There has been considerable work over the period to increase understanding of mental capacity and DOLS across our staff group. As is reflective of the wider national picture we also experience extensive delays in Local Authority authorisations.

DeathsOur services support customers with significant and complex care needs, many of whom will have degenerative or life limiting conditions. We fully review each occasion where a customer dies whilst in our care. In 2015 / 2016 we reported 156 deaths during the year, of which 60 were unexpected. In the last year this has dropped to 121 deaths 43 of which were unexpected. Each of these deaths was reviewed at the service in which they occurred.

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The incidence of pressure sores appears to have reduced compared to the previous year and we need to ensure that this trend is a measure of improvements in care and not a reflection of changes in reporting.

Infection Outbreaks During the year we have had eight infection outbreaks. Of these:• Two cases had in identifiable cause;• Four cases were related to diarrhoea and vomiting;• Two cases we related to norovirus.

Internal External

15/16 16/17 15/16 16/17

Stage 1 0 1 0 0

Stage 2 5 2 3 1

Stage 3 18 12 7 4

Stage 4 6 0 2 2

Ungradable 1 1 0 0

Not Stated 0 1 0 1

Total 30 17 12 8

Clinical EffectivenessPressure UlcersThe table below shows the frequency by which pressure ulcers were managed within our services broken down by stage and by those acquired in a service and those acquired externally.

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Part FourAnnex 1 – Stakeholder FeedbackLeonard Cheshire approached its top 10 CCG funders for feedback. Whilst all positively received the draft plan there were no specific comments from them.

Our Customer Action Network also reviewed the Plan and provided the following feedback;

“Nothing about us, without usIn this Leonard Cheshire Centenary Year, the New Quality Improvement Plan suggests a positive shift in thinking. It highlights a welcomed renewed focus (within our organisation) as it recognises the paramount importance of its customer engagement.

From Trustees, through to Executive and Senior Management, we recognised the importance of improving our customer insight and customer based outcomes. The Customer Action Network has already seen this ethos in practice by our involvement in reviewing this Plan from the beginning.

With this promise of commitment, starting at the top, we will strengthen our national networks, and look forward to working in a co-productive manner to achieve these key priorities within this new ‘Quality Improvement Plan’. This will undoubtedly improve quality for customers.

What customers are always asking for is honesty, dignity, respect and essential feedback from staff, services and the wider organisation. CAN strongly agree that these cannot be achieved without the organisation being honest and identifying what is not working well and prioritising realistic operational improvements. This will then contribute to the enabling of customer aspirations to give choice and control through independence. Good examples of what has already been committed to, in this document, is identifying the need to invest more in our front line staff to improve motivation & making this organisation an attractive place to work, develop and stay for the future. Through the organisation’s acknowledgement for the need to prioritise key changes such as: improve and embed stricter auditing, especially complaints monitoring arrangements, clinical and information governance etc. we feel these are a positive start to the 2017/18 year.

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Annex 2 – Amendments Following Feedback from StakeholdersWe are grateful to CAN for their involvement in reviewing the plan. A number of minor changes were made with their agreement to its wording. They were particularly keen to ensure the commentary in the plan reinforced Leonard Cheshire’s commitment to a social model of disability and we adapted the text to ensure this was properly reflected.

Annex 3 – Research SummaryThe State of Social CareIn order to understand more about people’s experience of social care, between 28 April and 10 May 2016 we worked with ComRes to do an online survey of 1,032 British adults with impairments who were aged between 18 and 65. Data was weighted to be representative of adults in Great Britain, by gender and region. ‘Disabled’ refers to those who answered ‘Yes’ to ‘Do you have a longstanding physical or mental condition or disability that has lasted or is likely to last 12 months and which has a substantial adverse effect on your ability to carry out day-to-day activities?’

In addition, we worked with YouGov to survey 1,704 British adults about their views on health and social care in Britain. Fieldwork was undertaken on 11-12 August 2016. The survey was carried out online. The figures have been weighted and are representative of all GB adults (aged 18+).

We also conducted focus groups and one-to-one interviews with 89 disabled people in England, Wales and Scotland to understand their lived experience of social care.

The outcome of this research is our report ‘The state of social care in Great Britain in 2016’. Additionally the intelligence gathered from the research has informed our social care and employment policy work, campaign work, engagement with Parliament and further consultation with customers and stakeholders.

Future ChoicesFuture Choices is our initiative to embed customer-centric services. We speak with our customers on a one to one basis and ask them what is working, what is not working and what is important for the future. The information is used to promote personal independence and forms the basis of service co-production workshops. It also provides evidence for national research into customer needs and aspirations.

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Over 641 customers took part of which 413 were from nursing care services. Nationally the research found that customer’s top priority was to reduce agency usage and to have more staff to support them to access the local community. We responded to this by moving significant resources from capital development to front line staff pay to boost recruitment and staff numbers.

The Leonard Cheshire Disability and Inclusive Development CentreThis is an academic research centre that is a partnership between the University College London (UCL) and Leonard Cheshire Disability. The Centre:• undertakes research: qualitative and quantitative field based

studies, policy reviews, theoretical and sector wide analysis to help build the evidence base on disability in international development and global health

• undertakes research studies with Leonard Cheshire Disability, partners of the Global Alliance, and many other research partners around the world

• provides expertise for policy makers and other stakeholders (UN agencies, donor agencies, NGOs and DPOs) primarily on developing countries in international development and global health, inclusion, empowerment and mainstreaming

• participates in academic networks, and shares research expertise and knowledge through fieldwork, publications, teaching and consultation.

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The Centre has a range of research activities underway throughout 2016 / 2017, many of which will continue over the year ahead including;

• Bridging the Gap – This research programme aims to give an in-depth understanding of how people with impairments are at increased risk of exclusion as social and economic development increases

• Girls Education Challenge – Pioneering Inclusive Education Strategies for disabled girls in Kenya’ to address physical, cultural and social barriers to education for girls with disabilities, and to ensure that 2,050 disabled girls in 50 primary schools in Lake Region receive a full, quality and inclusive primary education

• Disability and Climate Resilience Research Project – The overall purpose of this one year research =project is to increase understanding of the links between disability and climate resilience and to support delivery of policy and programme work that builds the resilience of people with impairments to climate shocks and stresses.

Global Disability Innovation HubThe GDI Hub is a collaboration between partners who are closely connected to Queen Elizabeth Olympic Park, and the communities and experts who delivered the London 2012 Paralympic Games. Leonard Cheshire Disability is a key partner of the GDI Hub. In May 2016 the GDI Hub held its first series of ‘pop-up’ Hackathons funded by a ‘Grand Challenges UCL 2034’ grant with support from the Queen Elizabeth Olympic Park. Topics included;

• Can we design the world’s first digitally printed, fully customisable wheelchair?

• How can disabled children get to school in Zimbabwe?

• Post skins: where does fashion meet science meet disability?

• How can we harness the power of elite disability sport to drive community participation?

The Centre is also working to develop a world first inter-institutional Masters Programme in Global Disability for 2017/18

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Leonard Cheshire Disability is a registered charity no: 218186 (England & Wales) and no: SC005117 (Scotland), and a company limited by guarantee registered in England no: 552847.

www.leonardcheshire.org

Leonard Cheshire Disability66 South Lambeth RoadLondon SW8 1RL+44 (0)20 3242 0200qualitymatters@leonardcheshire.org

Visit: www.leonardcheshire.org