NCH&C Annual Summary 2019-20

Norfolk Community Health and Care Annual Summary 2019-20


Welcome from Josie Spencer and Geraldine Broderick

The global pandemic, which really hit us just as this reporting period was coming to a close, has understandably had a major impact on our staff and the services we deliver. Whilst this summary is covering a time largely before COVID-19, it would seem odd not to mention it and to acknowledge the continued dedication and professionalism of all our staff during this time. Fortunately, in many ways, we were well prepared for the crisis and many of the successes we talk about in this report enabled us to respond to the pandemic with the resilience and innovation required. We would both like to extend our thanks to all our staff, volunteers and partners for their valued contribution to this year’s success.

2020 sees Norfolk Community Health and Care NHS Trust (NCH&C) mark ten years since it was established with the core purpose of Looking After You Locally. We have come an incredibly long way in this time and had things been different we would have been celebrating throughout this year the daily achievements of our staff and teams that make us the Outstanding NHS Trust we are today.


NCH&C in numbers Every day NCH&C treats almost 10,000 patients. This includes:

Vision & Values

To improve the quality of people’s lives, in their homes and community through the best in integrated health and social care.

664 patients seen in clinics

176 ill and vulnerable children treated

1,516 patients seen in their own home




As one trust, we enhance the lives of our patients through our commitment, support and working together. We are proud to serve our local community by providing integrated quality services with our partner organisations. We respect and value the trust

We provide compassionate, co-ordinated and personalised quality care that is safe and effective. We empower and educate our patients and their carers in the effective delivery and management of their own independence, health and wellbeing. We are dedicated to holistic, compassionate care and demonstrate this through our commitment to our personal and professional development.

Our expertise, commitment and creativity are key to the successful delivery of our services. We are always open to new ideas that support us in delivering effective compassionate care to our patients. We continuously innovate and implement efficient delivery of care.

44 patients in ‘virtual wards’, where they stay in their own homes supported

54 patients in Residential or Care Homes seen

235 total beds across our

inpatient units, including 166 community beds and 69 specialist beds

we are given to enter our patients’ homes and lives.


News from NCH&C this year

Primary Care Networks NCH&C is working closely with primary care and other community colleagues to deliver the NHS Long Term Plan commitments. One such project is the formation of Primary Care Networks (PCNs - groups of neighbouring practices typically covering 30–50,000 people). Practices will enter network contracts, alongside their existing contracts, which will include a single fund through which network resources will flow. PCNs will be expected to take a proactive approach to managing population health and from 2020/21, will assess the needs of their local population to identify people who would

benefit from targeted, proactive support. NCH&C has aligned its services with the PCNs, consulted on a new operational management structure for implementation in 2020/2021, and is working with PCNs on projects to enhance care. The changes agreed will allow NCH&C to ensure that the right people are in place to co-create the most effective ways of providing services to the people of Norfolk. As part of this, NCH&C is creating empowered and autonomous leaders who can make the right decisions at the right time, supported by a structure that provides them with immediate, accurate and timely information.

For the second consecutive year NCH&C was the best performing Community Trust in acting fairly with regards to career progression/ promotion regardless of any protected characteristics, as well as for how staff rate their level of pay and in regards to staff reporting errors. The staff engagement theme, has three sub-themes, one of these is motivation. For three years running now, NCH&C has been at or above average in all three of the questions that makes up this sub-theme. Nationally we are in the top five community trusts for staff recommending our Trust as a place to receive care, with 80% recommending. Click here to see the full results for NCH&C.


Ageing Well

Norfolk and Waveney was selected for funding for the new “Ageing Well” programme as one of seven “Ageing Well” accelerator sites in the country sharing a total pot of £14m of additional monies to develop “rapid response teams” to help support older people to remain well at home and avoid hospital admissions. Being an Ageing Well accelerator site means we will receive investment to help us make additional changes that really change the way we work by providing coordinated assessments of people in need of urgent support. This will ensure people receive suitable care in the quickest possible time, in the most appropriate place. Our Network Escalation Avoidance Teams (NEAT) will play a key role in the Ageing Well Urgent Community Response (UCR) Pathway. We’re particularly looking at how we can increase the number of people who benefit from the type of multi-disciplinary team assessments they conduct. Tracey Bensley, NCH&C’s Senior Clinical Coordinator for NEAT (Norwich) said: “When NEAT receives a referral from a GP, paramedic, social worker, mental health specialist or other professional, it swings into action, co-ordinating and mobilising support and services. By pooling our expertise we arrange the most appropriate package of care or support to meet the needs of each patient, to ensure their problem is quickly resolved. Our teams also put in place plans to avoid problems in the future.”

Number of apprenticeships

We embarked on our most ambitious recruitment of apprentices between May 2019 and February 2020, with a determination to grow our own workforce and ensure we can be an employer of choice across Norfolk and fill all our vacancies to enable us to continue to deliver outstanding community health and care. See page 22 for more information on our ambitious workforce programme.


Dietetics service NCH&C welcomes community dietetics service The community dietetic service transferred from NNUH to NCH&C in December 2020. 25 staff joined us via TUPE in a move to improve patient pathways. Patients continue to be referred to NCH&C community dietetica in the usual way and continue to receive the same service in their homes and community clinics, often seeing the same staff as before at the same venue or close by. Jo Gravells, Louise Sillett and Melissa Goodall are Specialist Learning Disabilities Dietitians. “We’re a team of four Specialist Learning Disability Dietitians covering the whole of Norfolk as a county-wide service. We see patients with a learning disability for a range of nutritional concerns including: nutrition support, Type 1 & 2 diabetes, allergies, intolerances, coeliac disease, IBS, metabolic conditions, weight management and vitamin and mineral deficiencies. We work out in the community with our MDT colleagues and tailor our advice to create bespoke dietary advice for our patients. As Specialist Learning Disability Dietitians we ensure our service users receive the correct dietary advice that is person-centred to their needs, taking into account their learning disability, with reasonable adjustments made to support them where necessary. Multi- disciplinary work is essential and there are five different LD Teams across Norfolk (North, South,

East, West and City) that we cover/work in.” “We’re really happy to be joining an Outstanding and inspiring organisation. We share NCH&C’s values and beliefs around delivering the best patient care. We see this move as a great opportunity to continue to develop our service for our patients. “Transferring to NCH&C will better equip us to work out in the community and spend more time with our patients, with more joined up working with our MDT colleagues. This will in turn help us to provide better patient care. It will also improve our integrated working within the learning disability service and therefore improve the quality, efficiency and effectiveness of care our services uses receive.”

100 years of LD Nursing

2019 marked the 100th anniversary of Learning Disability Nursing. We held a special lunch for all our LD Nurses to say thank you for the unique contribution that this speciality makes to the field of nursing and the wider community. Our CEO, Josie Spencer, who presented our LD Nurses with certificates of thanks, said: “It was an honour to be able to say thank you to this team of nurses. They play such a key role in so many people’s lives, directly supporting people with learning disabilities and their families.”


Flu Over 1,850 NCH&C staff had their flu jab during this reporting period, meaning we surpassed the 80% target. This was the third year we exceeded the target set by Public Health England, which becomes more ambitious every year. A key part of the flu campaign was the video of Paige, a NCH&C nurse, and her sister Neesha, a nurse at Norfolk and Norwich University Hospital (NNUH), talking about their brother’s near death flu experience. It was a really powerful account of how flu can have devastating consequences, even if you think you’re fit and healthy and achieved widespread media coverage to raise the profile of the importance of people having their flu vaccination. Beth Kimber, Head of Infection Prevention and Control, said: “Each year Public Health England raises the bar and each year our staff prove their dedication to keeping their colleagues and patients safe. Our staff carry out fantastic work under pressure, without the added pressure of flu risk. Well done all, especially our Peer Vaccinators who give their time to vaccinate our staff.” Carolyn Fowler, Director of Nursing and Quality, added: “Knowing that our staff are protected from the flu virus is one of the best safety measures we can provide for our patients, especially when they are entrusting us into their homes.“ Click here to watch Paige and Neesha’s video.

National case study for innovation and staff engagement

How has NCH&C improved staff engagement despite being a trust that is geographically spread over more than 2000 sq miles? Further demonstrating our dedication to being an Outstanding employer, NCH&C was delighted to be used as a case study by the NHS to demonstrate innovation in staff engagement. We’re committed to improving staff engagement and two way communication across the trust. Read all about one of the ways we’re doing this on the NHS Employers website.


Financial performance Our financial health has a direct effect on our ability to take care of our patients. Every penny we spend is used to support the people we care for so it’s really important that we manage our finances well.

NCH&C’s efficiency programme of £4.5m consisted of £1.2m of recurrent savings and £3.3m of non-recurrent savings. The programme achieved savings of £4.4m during the year, £0.1m (2.5%) under-achievement. Of these savings £1.1m was recurrent and the remainder achieved through non-recurrent savings.

Working in collaboration with other providers and commissioners through the Norfolk and Waveney Health and Care Partnership (STP) is the key to securing the future for the community services and will continue to be a major component of NCH&C’s long-term financial strategy.

In 2019/20 NCH&C was initially set a control total of break-even, a stretch target of £0.3m was requested to support the wider NHS financial performance. We met this stretch target. NCH&C met its capital resourcing limit (CRL) of £3.8m which relates to the amount of capital expenditure the trust can incur in the year. Against our agency ceiling of £2.5m expenditure was £1.1m (44% of the ceiling). This reflects the work we have done to reduce high cost agency and increase the use of bank and substantive staffing. This performance has seen NCH&C achieve an NHS Oversight Framework Financial Use of Resources rating of 1, which is the highest score achievable and reflects NCH&C’s strong financial management.

NCHC’s financial plan for 2019/20 was to improve on the underlying financial performance of 2018/19 and to deliver a surplus of £0.4m supported by an efficiency programme of £4.5m. The actual surplus delivered was £0.6m, which was an improvement from plan of £0.2m. This compares favourably with the prior year result of a deficit of £12.6m, which included one-off costs in relation to asset impairments (£5.2m) and provision for repayment of VAT (£6.1m). NCH&C’s financial performance is monitored using a number of measures both internally and externally by NHS England and NHS Improvement. The main measure is a control total based on an adjusted surplus/deficit delivery.

£4.5m total

£3.3m non-recurrent savings

£1.2m recurrent savings


Our commitment to continuous quality improvement Each year we produce a Quality Account – an annual report on quality produced for our staff, stakeholders and most importantly, to the people who use our services. Quality remains at the heart of everything we do at NCH&C and the account reflects the importance our Board and our staff place on quality, how care has improved as a result, and what our commitments are for the year ahead. Our aim is to continue to improve quality through the delivery of harm- free, clinically effective and compassionate care. The following pages highlight some of our actions and successes in this regard this year. You can read the full Quality Account here .


Patient safety highlights: Patient safety is about maximising the things that go right and minimising the things that go wrong. It is integral to the NHS’ definition of quality in healthcare, alongside effectiveness and patient experience.

• We’ve continued with our successful ’kitchen table events’ to promote patient safety attended by 60 staff at different venues across our trust. Changes to policies, Standard Operating Procedure and guidelines have originated from these discussions and staff report improvement in knowledge and confidence as a result of attending. • Ahead of legislation for NHS trusts to annually report back on staff who speak up, NCH&C has recruited a full time Freedom To Speak Up Guardian: Nijck Bowman. We’ve also increased the number of Freedom to Speak Up Champions in all of our localities. Click here to hear from Nijck. • During the period 1st April 2019 to 31st March 2020, NCH&C received 94 formal complaints showing a decrease from the 193 we received during the year 2018/19 and 238 the year previously. Undertaking regular thematic analysis across all the complaints helps us in identifying opportunities for learning which we disseminate across NCH&C. • We had an 80.55% uptake of our staff flu vaccination programme in 2019-20. See more about this on page 12. • In February 2020 as part of our response to the emerging pandemic our IPAC team, in conjunction with the IPAC team at East Coast Community Healthcare CIC, were instrumental in setting up and delivering a ‘drive through’ COVID-19 swabbing and testing service for the public in just four hours. The team continues to work within the wider system to ensure evolving government guidance is followed whilst ensuring the highest standards are adopted locally.

We have reduced the number of falls that

cause harm to an average of 2.2 per 1000 occupied bed days which has improved from last year.

The number of avoidable pressure ulcers reported in our inpatient units is below the target we had set ourselves.

Our 2019/20 Safety Thermometer results indicated that the

overall proportion of our patients receiving harm- free care in the reporting period was 87.6%.


Clinical effectiveness highlights:

• There are currently five community trusts rated Outstanding by the CQC (NCH&C was the first stand-alone community trust to receive this rating in 2018). In November 2019, Chief Executives of all outstanding community trusts joined together to explore experiences, influence the landscape of inspection and compliance, identify good practice and shared learning opportunities from collective experience. • Starfish Learning Disability Child and Adolescent Mental Health Service (Starfish LD CAMHS) and Starfish+ have recruited to several new posts this year. On each of the interviews the panel has been made up of Starfish+ team members and a young person with a learning disability or a person with “lived experience”. This has helped ensure the team has the right values and ethos with children and their families at the centre of this. • We’ve successfully recruited and assessed 20 members of staff who are now supporting others in their role as dementia champions and we’ve recruited a further 15 who will be ready for assessment this autumn. These champions have helped complete the national audit ‘Is Your Ward Dementia Friendly’.

• We’re delighted to report that NCH&C has successfully rolled out the digital inpatient project. This means our inpatient units are now using the same electronic clinical patient record as colleagues in the community, sharing clinical information between professionals involved in direct care of our patient with ease.

As an Outstanding NHS Trust we understand the need to demonstrate the continuous learning we undertake and that this informs the way care is delivered. We’ve taken time this year to look at how our staff learn and how they use their learning to improve their practice day on day. We know that there is growing research supporting the view that motivated, engaged and well informed staff is linked to better outcomes for patients.

Almost 90 staff have completed the four day Quality Champion Programme from a range of roles, professions and seniority including clinical and non-clinical staff. NCH&C continues to build collaborations with the University of East Anglia (UEA) and is part of UEA Health and Social Care Partners - a collaboration with health and social care providers and UEA to develop and support research ideas across Norfolk. During 2019/20 NCH&C has been

We continue to build on our research capacity and have been involved in 14 recruiting studies this year. Based on the ratio of recruits to studies, NCH&C is fourth among community trusts and continues to consolidate itself in the community research field.

developing a NNUH neurological strategy together with UEA.


Patient experience highlights:

We recorded receipt of 1,397 compliments from the period April 2019 to March 2020 which is nearly double the figure reported last year.

We thank you most sincerely for all the care and exceptional kindness shown to mum and to us. You enabled Mum to die peacefully in her own home, in her own bed and with us all. Thank you. Community Nursing – City One Team

What our patients tell us about our services helps us to get even better, and we use feedback to understand what we’re doing well, and where we need to raise our standards. That's why we use a range of methods of gathering patient and carer feedback, including the Friends and Family Test (FFT), Patient Opinion, patient and carer surveys, focus groups and Patient Stories.

Everyone was extremely caring and supportive, not only to my husband but also to myself and my family. We will always remember you all with kindness and your dedication to how hard you all work. Words are not enough to express our thanks. You looked after me as much

Our Patient Experience team supported and encouraged localities highlighting the importance of recording compliments and how this can help staff engagement and well-being as well as being a marker for the quality of care. Here’s some of the patient feedback we received this year: I just wanted to express my thanks to you all for your support at yesterday’s meeting. I am absolutely overwhelmed at the professionalism and perseverance of everyone involved who clearly have our son’s best interests at heart. The fact that he has a platform to express his feelings and that he feels listened to is clearly very important to him. He looked extremely happy at the outcome yesterday after the meeting so hopefully we have made the best and right decision for him. Thank you again, we are truly blessed that our son is surrounded by such a fabulous group of professionals. Community Learning Disability Team

I attended a rehabilitation course at North Walsham earlier this year and I just want to let the team know that I’ve just completed a half marathon in 4hour 37 mins….I just wanted to send my heartiest, heartfelt thanks to the Pulmonary Rehabilitation Team, and thank you, you know, it’s been amazing. Pulmonary Rehabilitation – South

as my dad. Thank you. Priscilla Bacon Lodge

Between April 2019 and March 2020 NCH&C received 10,000 responses to the FFT, with over 15,000 positive comments given. The overall percentage of patients recommending NCH&C (extremely likely or likely) was 98% which has been maintained for the past five years. Overall there were not as many responses received as the previous year but just as many comments.

When *** arrived at Caroline House he was very depressed, deep fatigue, weak, unwilling to communicate, closed down and unable to move his limbs on his right side BUT you have ALL helped *** achieve so much, he is definitely far from that person now and so able. This is all because of you all. We will always be so grateful to you all for all the support that you have given him. So thank you so, so much you truly are the most amazing people that we have ever met. Caroline House

Thank you so much for helping me through this wonderful and absolutely fantastic journey. When we first started this before Christmas, I never thought for one single second that 6/7 months later I would be standing with minimum support and only relying on a walking stick, comparing with the last 22 years. Specialist Neurology Team – West


We Are NCH&C Our staff are our greatest asset. Without them we would not be able to help, treat and care for our patients in the outstanding way that we do. With such a variety of services across a huge geographical spread, we would like to shine a light on some of our teams and the work they do, to give a flavour of the scope of what we do as a community trust. For more case studies on our amazing teams across the whole of NCH&C click here.


Growing our own workforce

The apprenticeship solution has enabled us to offer roles to people so they can earn as they learn. This also really helps to support our core value of community. People in Norfolk can begin and progress their career locally. We undertook a successful and targeted apprentice recruitment campaign which resulted in: 599 applicants 235 shortlisted candidates 122 interviews

We recruited:

22 HCA apprentices 22 Assistant Practitioners 40 Trainee Nurse Associates

23 Nursing Degree Apprentices (2 year) 25 Nursing Degree Apprentices (4 year)

This year we embarked on our most ambitious recruitment of apprentices as we committed to growing our own workforce. Being able to help more people begin and progress steadily through their NHS career will help us to ensure our clinical vacancies are filled and that we can continue providing the crucial community health and care our communities rely on and deserve. Like all other NHS Trusts, we are finding it hard to fill our clinical vacancies. We looked at how many registered staff we would need in five years’ time and compared that to the numbers we thought we might have if we did nothing. This gap determined how many apprentices we would need, on which pathways, and when they would need to start. At the same time, services were developing Workforce Transition Plans which showed how they planned to sustain their service in the future. Apprenticeship roles needed to be heavily built into these plans to allow us to grow and train our future workforce to achieve the required staffing levels in order to deliver excellent patient care.

The facts are simple:

Norfolk is a big county – the fourth largest in the UK and NCH&C teams operate out of 76 different sites across this huge patch. That’s a lot of nurses , therapists and other registered professionals needed in lots of fragmented locations.

What next? We have a waiting list for the next cohort of apprentices and we will begin the next round of recruitment in the coming months. We have also added further apprenticeships to our offering. We were so pleased that the first cohort of Nursing Degree Apprentices officially completed their apprenticeships on 1st June 2020 and all five are now working across NCH&C as Registered Nurses. They are all also being supported with their preceptorship period. It is hoped that the first Trainee Nursing Associates cohort will finish by January at the very latest and they too will then be placed in their guaranteed jobs at NCH&C.

• We have an ageing workforce and there is a lack of qualified nurses in Norfolk. The local health and social care system as a whole isn’t attracting enough new nurses into the county and so there is a diminishing number of nurses to go round all the posts in Norfolk.

The success of the ‘Growing our own workforce’ programme has absolutely been down to team work and tenacity. Many different departments have been involved in ensuring that NCH&C could roll out such an aspiring programme. The Clinical Education team plays a key role in supporting apprentices with clinical skills. The Talent For Care team has worked tirelessly to promote the apprenticeships and worked with the recruitment team to recruit to the roles, explaining the different careers options to internal and external candidates. They are also there to make sure apprentices are supported as they progress. A key part of the apprentice experience is the support that they receive from their locality line manager – they really have been pivotal in this programme.

The academic averages in Norfolk are below national standards.


individuals with other services, communities and organisations that best support their needs. Julie Smith is a Health Improvement Practitioner in South Norfolk and has been in post for 11 months. Julie said: “Our role is extremely varied and we never know what we are going to find when we meet the patient for the first time. “Often what appears to be a straight forward physical health condition can soon reveal a complex situation at home, which could be substance misuse, depression, anxiety, abuse, financial problems, homelessness, or any combination of these issues. As our team consists of HIPs from different backgrounds we have a wealth of knowledge and skills to support individuals. “The most rewarding part of the job for me is when you can make a difference and improve the quality of life for our patients. Sometimes it takes months of hard work and perseverance, but it’s worth that investment.” The HIU Service continues to develop and in the next few months the team will be working on a pilot alongside the ambulance service to help reduce the number of 999 calls. Chris’s story Life for Chris used to be lonely and chaotic. Unwell, and with no family he could stay with, Chris was regularly visiting A&E – sometimes as often as twice a week.

Chris was suffering from a serious condition that often resulted in the need for hospital treatment. It was making it difficult for him to eat and drink which made him dizzy, and sometimes liable to falls. He was often without the money to buy essentials like food and he wasn’t claiming the right benefits leading to arrears with his rent. As someone who doesn’t like to ask for help, Chris’ social problems started to spiral and his mental health declined fast, making him more likely to end up needing to call 999. “I was at a really low point by this time. I have always been self-sufficient and never really been the type to ask for help” he said. Chris was referred to a Health Improvement Practitioner (HIP), who said: “Chris knew he needed help but was overwhelmed and didn’t know how to ask or where to start. With my encouragement he has let people in so they can help stabilise his life. I could give him the time and flexibility he needed to sort out some complex problems.” Together, his HIP has helped Chris to claim the right benefits, deal with his housing issues and even start looking for work again. Since he started working with his HIP, Chris has not visited the A&E or dialled 999. “My HIP has got to know me really well, and has never judged me. It was good to have someone who was on my level and not against me. I feel I have come a long way.”

High Intensity User Service (HIU)

The service consists of a team of eight Health Improvement Practitioners (HIPs) who work across Norfolk. Referrals are generated from A&E at the NNUH and Queen Elizabeth Hospital in King’s Lynn.

Following a highly successful 18 month pilot, which helped reduce A&E attendance by 58% with a subsequent 62% reduction in admissions, NCH&C was awarded the permanent contract to provide the High Intensity User Service (HIU), formerly known as The Frequent Attenders Service, in 2019.

The HIPs work with very vulnerable individuals who often call an ambulance or attend A&E as they have nowhere else to turn. Using a health coaching approach, the team help to reconnect


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