Pennine Care NHS Trust

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National Service User Survey Results2007

• Pennine Care NHS Trust

2
Context

• NHS Plan
• Mandatory annual national surveys (patient and
  staff)
• Health Check core and developmental standards
  20 references to MH survey 22 references to
  staff survey in Criteria for Assessing Core
  Standards. Developmental standards not yet
  published but are likely to include areas such as
  care planning, access to out-of-hours services
  etc (full details in Management report)
• Conclusion Patient and Staff surveys are a major
  source of data for HC evaluating Trust
  declarations
• Healthcare Commissions Role
• Organise and run the national surveys
• Publish comparative data for each Trust to inform
  public and guide funding
• Use patient and staff survey data to assess
  accuracy of Trust self-declarations on Health
  Check
• Inspect, sometimes unannounced or short notice -
  c.1 in 5 chance of being inspected in any one year

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Key Points

• Establish differences between patients and
  manager/clinicians views of service
• National Service User surveys 2003 - 2007 used
  essentially same methodology
• Comparison here with c. 17,000 Service Users in
  55 MH function Trusts (79 of the total number of
  Trusts)
• National Response Rate 38

• Youngest service users and very old have lowest
  response rates 16-24s 28 55-64s 45
  65-74s 44 over 85s 24. 75 have highest
  number of blank/ineligible returns.
• Service users on standard CPA have slightly
  higher response rate Standard 39 Enhanced 35

• Ethnicity has major impact on response rates
  White service users 39 Asian 29 Black 31
• Women respond in larger numbers than men Women
  40 Men 35

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Performance Issues

• Performance differences between Trusts caused by
• Differences in practice and quality but also
• Differences in social composition
• Ethnicity Asian and Black service users have
  different pattern of contact less use of TT,
  more contact with Psychiatrists. Asian patients
  less positive about care planning, CCs, fewer
  have access to out-of-hours service Black
  service users have double the rate of sectioning
  than whites
• Age Young patients less satisfied than older
  patients up to 18 point difference on
  information issues etc between 16-24s and 64-75s
• Gender Women less positive than men
• Still big differences perceived in service
  quality between geographically based teams in
  some Trusts
• Differences in composition of CPA register of
  service users on Standard CPA ranges from 22 to
  93 between Trusts in this survey (2006 - 25 to
  92)
• Enhanced CPA users have different pattern of
  contact more use of Psychiatrists, CPNs far
  higher level of info on Care Co-ordinator more
  have a care plan, have a care review, get
  information and help, have access to out-of-hours
  services etc
• So, the kinds of service users in your sample are
  crucial

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CPA Range
6
National Trends 2003-2007
7
National Trends 2003-2007
8
National Trends 2003-2007
9
National Trends 2003-2007
10
National Trends 2003-2007
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Key Scores in 2007
INSERT CHART
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Respondents Details
13
Contact Psychiatrists
14
CPNs Other Staff
15
Medications Counselling
16
Co-ordinators, Plans, Reviews
17
Community Support
18
Crisis Care
19
Overall
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Positive Aspects

• 89 of service users seen in last 3 months high
  contact rate
• High rating for contact with Psychiatrists high
  relative contact level with CPNs and other
  staff (defined as SWs, OTs, Psychologists,
  someone else)
• Trust and confidence ratings for Psychiatrists
  and CPNs high
• Respect and dignity ratings for Psychiatrists,
  CPNs and other staff high
• High level of continuity in terms of seeing same
  Psychiatrist for successive appointments
• Continuing high levels of awareness of the care
  co-ordinator
• Increased numbers aware of having a care plan
• More SUs aware of having had a care review, and
  more found it helpful
• More SUs received help getting benefits

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Issues for Action

• 46 have their appointments with Psychiatrists
  cancelled or changed
• Better information on medication purposes side
  effects, decisions on medications where possible
• Assess unmet need for talking therapy and plan
  improved access in light of apparent reduction in
  coverage this year
• Further improve access to Care Co-ordinator and
  out-of-hours support from them despite high
  scores 13 not aware of having a Care
  Co-ordinator
• Continue action to ensure all get a hard copy of
  care plan, and understand contents 30 not given
  a care plan
• Further improve incidence of care reviews 29
  say they havent had one in last year
• Care reviews further action on awareness of
  possibility of relatives/friends presence
• Further extend help to those wanting it on
  finding work, benefits, support groups
• Ensure all service users have access to
  out-of-hours support telephone number 38
  dont have the number
• Review time taken to respond to helpline calls in
  minority of cases
• Ensure all patients have their diagnosis clearly
  discussed with them

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Calibrating Your Action Plan

• Major differences between different types of
  Service Users on organisational issues
• Aware of having a Care Co-ordinator
  Enhanced 80, Standard 80
• Given/offered copy of care plan Enhanced 67,
  Standard 50
• Not had a care review in last year Enhanced 29
  Standard 30
• Given out of hours phone number Enhanced 50,
  Standard 54
• Calibrate the Action Plan and ensure policy is
  implemented in the way the Trust wants
• Differences between E and S CPA in Pennine Care
  are some of the smallest in the country

• Age is clearly an important variable nationwide,
  but less pronounced in impact in Pennine Care
• Major driver of results in most Trusts is the
  differential application of policy as between
  enhanced and standard CPA Service Users
• In the best Trusts like Pennine Care these
  differences disappear because policy is applied
  universally
• Nationally, inclusion of the over 65s in survey
  means
• Better scores for people
• Lower scores usually on organisational issues
• But in Pennine Care organisational scores are
  more or less equal across the age ranges

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Movement 2006-07

• More SUs report seeing a Psychiatrist up from
  74 to 91 and higher continuity with the
  same Psychiatrist
• Significant increase in absolute numbers of SUs
  seeing a Social Worker
• Decline in numbers having talking therapy down
  from 42 to 26, and a sharp decline in absolute
  numbers
• More SUs given a care plan up from 52 to 60
• More SUs have had a care review in last year up
  from 47 to 57
• More SUs received help getting benefits

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Link with Health Check

• HC assesses the national patient survey data
  also will be used by HC inspectors
• They will manipulate the data for each Trust by
  reference to
• Size of the data set
• Distribution of values
• Stat process control to examine trends over time
• Patient surveys to be used are Inpatients
  Paediatrics AE OPD PCT, CHD national survey
  Mental Health CPA

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Specific Survey Questions in Health Check

• First Domain Safety Q21 and Q22 - purposes
  and side effects of medicines
• Second Domain Clinical and Cost Effectiveness
  Q26, Q28, Q29, Q30, Q31, Q35 Care
  Co-ordinators, care plans and care reviews
• Fourth Domain Patient Focus Q6, Q13, Q17
  staff treating patients with respect and
  dignity, information about medicines and
  diagnosis, information for families and
  carers
• Fifth Domain Accessible and Responsive
  Care Q23, Q24, Q25, Q42, Q44, Q45
  counselling and talking therapy, contact out
  of office hours
• Sixth Domain Care Environment and
  Amenities Q6, Q13, Q17 respect and dignity

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The Next Steps

• Integrate with Health Check action plans and
  declaration
• Specific action plans in place to deal with top
  patient related issues. Build a performance
  management system which makes managers
  accountable exec team to set and monitor local
  targets and performance manage them through the
  system build the sandwich
• Lead the process within the Trust. Keep the
  pressure up, dont stop. Repeat messages
• Publicise achievements
• Next survey is CPA again January 2008