ACORNS CHILDREN’S HOSPICE
TRUST
QUALITY ACCOUNTS 2014 – 2015
Page 1 of 41
Table of Contents
Page
Number
Part one
Statement from the Chief Executive
3
Enduring Principles
4
Part 2
Priorities for improvement and Statements of Assurance
from the Board
6
Priority areas for Quality Improvement for 2014 -2015
7
Review of Quality Improvement Areas for 2014 -2015
9
Mandated Statements
Statements of Assurance from the Board
11
Safeguarding
Participation in National Audits
13
16
Research
16
Quality Improvement and Innovation Goals agreed with
Commissioners
17
What others say about us
18
Data Quality
22
Clinical Coding Error Rate
22
Part 3
Review of Quality Performance
23
The views of Acorns service users
30
Closing statement from Acorn’s Director of Care Services
41
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Part 1: CHIEF EXECUTIVE
STATEMENT
Acorns’ Quality Accounts 2014-15 is intended to provide service users, the public and those
organisations that support us financially, including the NHS, with information on the quality of
the services we deliver. This account will demonstrate how we assess the quality of those
services and ensure evidence based quality improvement on an on-going basis.
The Quality Accounts have the dual function of looking both backwards and forwards. The
narrative of the Quality Accounts will explain Acorns commitment to review its services and
this then influences the priorities for further quality improvement.
Acorns has provided specialist palliative care and support to children and their families since
1988. We welcome the opportunity to demonstrate the work of our dedicated and skilled
workforce (including volunteers), the systems we have developed over more than a quarter
of a century and to share our future priorities.
Acorns Director of Care Services was responsible for the preparation of this report and its
contents bringing together the information systems actively used across the Charity to
measure and review quality. To the best of my knowledge, the information in the Quality
Accounts is an accurate and fair representation of the quality of health care services
provided by Acorns Children’s Hospices. Quality is continually addressed at Executive level
through the Care Governance Group and at Board Level through the Care Assurance
Committee; they both meet on a quarterly basis to ensure a robust and rigorous review of
quality and the monitoring of performance.
Underpinning all our work at Acorns are Vision, Mission and Values statements which are
further guided by our enduring principles. They are respectively as follows:
VISION
Every child and young person living in our region that is life limited or life threatened and
their families should receive the specialist care and support they need.
MISSON
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To provide holistic, specialist, palliative care services to children, young people and their
families. We will deliver these services in partnership with others wherever possible,
championing the cause of palliative care for children and young people.
VALUES
Acorns is a caring, responsive and innovative charity, putting children and young people and
their families first in all our services, while embracing the diversity of our regional
communities, demonstrating professionalism, integrity and quality in all we do.
ENDURING PRINCIPLES
Staying focused on our vision, mission and values to provide an on-going sense of direction
for our Strategy;
Living within our means, especially by controlling our fixed costs;
Ensuring our voice is heeded wherever the cause of palliative care for children and young
people needs to be championed;
Working in partnership with NHS and local authority commissioners and providers, other
charities and like-minded private sector organisations; and,
Maximising sustainable statutory, retail and lottery funding, while maintaining a robust
fundraising portfolio and sufficient operational reserve.
The children and their families are central to all we do at Acorns. Ensuring our services are
responsive to needs has been the driving motivation of Acorns for 27 years. In order to
support the child and his or her family Acorns allocates a family support professional for
every family who will listen to the views of each and every individual family member. This
ensures that the support is personalised and unique to the person concerned.
Over the last 27 years we have more than trebled the number of children and families we
have been able to support developing from one hospice with a family support team
supporting families in the community in 1988 to our current three hospices, three family
support teams and a hospice at home team of nursing care staff providing outreach care in
families homes. We have achieved this while continuing to improve the quality of service
and responding to children and their families in relation to their changing needs over the last
three decades.
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It is our intention to continue to increase and expand our services by offering a clinical
outreach service and a comprehensive home volunteering service to support additional
children and families; we will continue to work closely with all our service users and wider
stakeholders to ensure this is achieved whilst maintaining the highest quality standards in
care.
David Strudley
Chief Executive
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PART 2: PRIORITIES FOR IMPROVEMENT AND
STATEMENTS OF ASSURANCE FROM THE BOARD
The Board’s strategic plan for Acorns, ‘Realising the Vision 2013 - 2018,’ identified key
priorities for the development of services for the next 5 years. 2013-14 was the enabling
year; we used this opportunity to ensure we had the workforce and systems in place to
achieve our priorities. Quality is integral to any growth in, and development of, services. In
2014-15 we added additional resources and implemented the Acorns ‘Integrated Care Model
’ which involved the appointment of outreach nurse leads to support the development of
clinical support being offered to children in home and hospital. The out-reach nurses have
this year worked with colleagues from the hospice who know the children and families. We
also appointed volunteer co-ordinators who have this year developed community out-reach
volunteers supporting children and their families in the community. This year (2015-16) we
are in our third year of implementing the vision strategy and continue to work towards
achieving our offer of care to at least 1,000 children and young people a year by the end of
the decade.
There are sound and robust systems across Acorns that ensure safe high quality care.
Acorns has a Standing Operating Procedures in response to the ‘Implementation of
Controlled Drugs (Supervision on Management and Use) Regulations 2006’. Acorns has an
established Care Governance Group which internally regulates and quality assures all work
across its hospices. A Care Assurance Committee (comprising members from the Board of
Trustees) meets quarterly with the Director of Care to rigorously monitor service delivery and
quality of care services.
There are also systems across the Trust which monitor and
internally regulate Information Governance and ensure compliance under the Data
Protection Act 1998 and the Human Rights Act 1998.
Acorns is registered with the Care Quality Commission (CQC) which exercises external
governance that must be met in order for Acorns to operate its services.
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PRIORITY AREAS FOR QUALITY IMPROVEMENT FOR 2015
- 16
Following consultation with the care managers and hospice leaders and using feedback from
service users, Acorns identified the following three priority areas for quality improvement in
2015-1616.
Quality Improvement Area 1
Real Time Reporting
Service user feedback is integral to ensuring Acorns services are effective and
responsive to children and their family’s needs. Acorns have used annual and
biennial satisfaction surveys and service user involvement to ensure our services are
providing the appropriate level and standards of care. Real Time Reporting supports
an interactive and timely feedback from parents and children using the service, by
utilising technology and software which enables monthly summaries of service users’
views.
The managers can then respond to any concerns or requests promptly.
This will be achieved by:

Identifying Real Time Reporting Champions at each hospice who will promote
and support this project with service users.

Reviewing questions every quarter to monitor targeted areas of hospice
services.

Outcomes from Real Time Reporting will be shared at the Acorns Research
and Development Group with outcomes and responses being available to
families via the family newsletter and the internet and to commissioners via
the impact report.
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Quality Improvement Area 2
Face to Face Service
This is a new service providing parent to parent support for families with children with
Palliative Care needs. The service will provide support at all stages of the palliative
journey from diagnosis to bereavement, empowering parents to make decisions and
choices at each stage including end of life.
This will be achieved by:

Recruiting parents with the time and skill sets to become befrienders

Providing accredited training for all befrienders

Outcomes will be evaluated by Acorns Lead Nurse for Governance & Quality

Befriender’s will receive ongoing support from Acorns Volunteer
Co-ordinators.
Quality Improvement Area 3
Expert by Experience
The Care Quality Commission (CQC) have recruited ‘Experts by Experience’ to be
part of CQC inspection teams when undertaking unannounced visits to care
providers.
Acorns senior care management undertake compliance visits across the hospices to
monitor quality. Acorns will recruit parents who use or have used the service to work
alongside the senior managers on these compliance visits as an additional
mechanism and perspective for quality assurance.
This will be achieved by:Page 8 of 41

Recruiting and briefing parents who have the time and skills for this role.

Undertaking a compliance visit at each of the hospices with an ‘Expert by
Experience’ as a member of the Acorns inspection team.

Producing a report on the compliance visit findings and submitting to Acorns
Board of Trustees and CQC.

Feeding back to CQC the learning of using Experts by Experience in a
children’s palliative care setting.
REVIEW OF QUALITY IMPROVEMENT AREAS FOR 2014-15
Quality Improvement Area 1
Equality Impact Assessments (EIA)
Public sector organisations are required to consider all legislated equality groups as
part of their EIA to ensure their compliance with their duties as a public body.
Acorns is not a public body, however under best practice, particularly with regard to
the Equality Act 2010 and the Together for Short Lives Diversity Toolkit, undertaking
EIA was considered to be evidence of our commitment to diversity for commissioning
purposes, when public bodies are purchasing our services, and for Care Quality
Commission inspections.
What we did:
Acorns devised and implemented an initial Impact Assessment screening template,
the organisational panel has undertaken an EIA for every care policy reviewed and
or developed this year.
What the outcome was:
Care policies have an Equality Impact Assessment where appropriate. This provides
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another governance measure to ensure Acorns services and practices are none
discriminatory and proactively support the equality of assess of services for all.
Quality Improvement Area 2
Standardising End of Life (EoL) Referral Processes
The aim was to ensure Acorns services offered a consistent and immediate
response to all EoL referrals and requests from the West Midlands area.
What we did:
Guidance for the Acorns staff was developed to support the implication of this
practice. The changes to process were further embedded in the form of workshop
discussion sessions at staff meetings.
A new EoL referral form was developed and used across all the hospices when a
referral is made.
What the outcomes was:
When a child is now referred the new system ensures that all the required
information is obtained and all the appropriate professionals in Acorns and partner
organisations are involved in the decision and planning process, thus ensuring a
more responsive and effective service at a time of crisis.
Area 3
Environment Area 3
As a result of securing funding from the Department of Health Capital Appeals Bid
we fitted out the new buildings and extensions for the three hospices. This improved
facilities Acorns is able to offer to families primarily via complimentary and
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therapeutic services. We intended to provide complementary service for an increase
of a minimum 50 children and families across the region.
What we did:
1.
Acorns re-modelled the therapeutic rooms.
2.
The referral processes were refined to promote increased use of
complimentary and therapeutic services.
What the outcomes was:
Over 84% of people who accessed the therapeutic service/ sessions reported they
had immediate improvements following a complimentary therapy session which
resulted in 98% stating they would recommend this service for families and friends.
STATEMENTS OF ASSURANCE FROM THE BOARD
The following are statements that all providers must include in their Quality Account. Many
of these statements are not directly applicable to specialist palliative care providers, and
therefore explanations of what these statements mean are also given.
Review of services
During 2014-15 the hospice provided the following services to the NHS:
Acorns hospices
Acorns has three ten bedded hospices strategically located across the West Midlands:
Walsall for the Black Country; Selly Oak for Birmingham and Warwickshire; and, Worcester
for the Three Counties of Worcestershire, Gloucestershire and Herefordshire. All of the
hospices include separate accommodation for families to stay with their children, if they
desire, and each is specifically designed to create a home from home environment and
atmosphere suitable for the care of children and young people with a diverse range of
needs. The hospices provide skilled paediatric palliative nursing care offering the following
services:

planned short break/ respite care and support;

emergency short break support;
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
end of life care;

day care;

pain and symptom control;

medical support;

hydrotherapy, physiotherapy and complementary therapies;

access to interpreters; and,

Outreach clinical care.
Acorns family support services provided in the community and
across our hospices
Acorns also delivers care and support services to children and young people and their
families, in the community, including:

support to access End of Life Care services, including access to management of pain
symptoms and the provision of psychological, social, spiritual and practical support;

support and advice provided on a 24 hour phone basis via the hospice medical and
nursing teams;

family support team of professionals who provide support on a 24 hour basis by
phone and/or home visits;

access to physiotherapy;

advocacy - the Acorns family support team and the hospice workers work closely
with primary health care teams and the acute hospital teams as appropriate.

pre and post bereavement support by registered/experienced professionals;

sibling support by trained staff;

home volunteers, offering support and befriending;

a variety of support groups for parents, carers and grandparents;

advisory resources to families and professionals;

access to interpreters;

preparation of young people for adulthood with trained youth workers;

enable young people to transition to adult services supported by registered
professionals; and,

Face to Face service; with parents trained as befrienders supporting other parents for
time limited period.
Acorns Hospice at Home Services
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Acorns offers hospice at home services based on the same holistic principle and
incorporating all the services above, tailored to individual needs and delivered in the home.
Such services are currently provided in specific geographical areas under contract to a local
statutory body.
Reporting processes
Acorns reviews all the data available on the quality of care in all its care services.
In addition to the Care Governance Group and Trustee Care Assurance Committee quarterly
reports, the Director of Care and Head of Care Services undertake a minimum of 3 annual
unannounced visits to all sites to measure and monitor quality in service delivery.
All
incidents are reviewed monthly by the Director of Care and reported to the Board directly as
necessary. Acorns also work closely with service users through the established Parent
Champions, and Young Ambassador and the newly formed Sibling Council.
All services delivered by the Hospice are funded through a combination of fundraising
activity and contracts with NHS. The NHS contracts mean that all services delivered by the
hospice are part funded by the NHS. Where NHS funding is secured this contributes up-to
30% of the costs of care of children. Therefore 70% of all care costs are funded by charitable
funds. We also benefit from having teams of skilled and trained care volunteers (over 400)
who support non personal care work across the region.
SAFEGUARDING
Acorns Children’s Hospice Trust wants a world in which children with life limiting and life
threatening conditions have the same rights and opportunities as everyone else. This
includes the rights of all children and young people to be safeguarded and protected from all
forms of abuse and neglect. Acorns are committed to maintaining a safe environment for all
the children. Acorns has a thorough and transparent child protection policy to afford all
children who receive their services maximum safeguards.
Acorns conforms to the requirements of safeguarding as referred to in the ‘Prevent Strategy’
(HM Gov 2011) and to the requirements of the Role of Accountable Emergency Officers for
Emergency Preparedness, Resilience and Response (EPRR) (NHS Operations 2012).
Statement of Intent
Acorns recognises that in protecting and safeguarding children, it is also providing a
framework for all staff which identifies and promotes best practice and minimises uncertainty
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for staff and volunteers working with children. Acorns has a robust policy which is designed
to:
Protect children
Children should be assured of good standards of care and protection from all Acorns staff,
volunteers and representatives.
Protect Acorns Staff and Volunteers
By following the guidelines and procedures everyone working within Acorns should be able
to avoid inappropriate, misguided or wrong behaviour and know what to do if they are
concerned about a child’s welfare.
Protect Acorns
The policy forms part of Acorns commitment to best practice, promotes the organisation’s
integrity and ensures compliance with the Independent Health Care Minimum Standards and
Regulations on Private Health Care.
The effective implementation of Acorns’ approach to child protection is based on and reflects
the principles recognised in UK legislation and in International Agreements, namely that:
• The welfare and protection of children is paramount whatever the circumstances.
• All children and young people, regardless of age, disability, gender, racial heritage,
religious belief and sexual orientation or identity, have the right to protection from all types
of harm and abuse.
• Recognition of the importance of working in partnership with parents, carers and other
agencies including those of diverse communities.
Safeguarding children is EVERYBODY’S responsibility; the following reinforces the specific
expectations of Acorns for the staff groups.
All care team staff are responsible for ensuring:
• They are familiar with all relevant internal policies, safeguarding and child protection
procedures, safeguarding guidance, documentation and access available training
regarding safeguarding of children and young people from Acorns.
• They contribute in a case conference or strategy meeting regarding safeguarding issues
relating to a child or young person.
The Care Management Team are responsible for:
• Ensuring all staff and volunteers receive the appropriate levels of safeguarding training.
(Every 2 years).
• Staff supervision and support is provided in accordance with the Acorns Safeguarding
Supervision Policy.
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• Ensuring that the safeguarding child protection policy, procedures and guidance are
accessible for all care teams.
• Acting in accordance to Acorns procedure when alerted to any safeguarding concerns;
reporting to statutory services and informing Acorns designated Safeguarding Officer.
Acorns Designated Safeguarding Officer (Acorns Director of Care Services) is
responsible for:
• Maintaining overall responsibility for the review of the Safeguarding and Child Protection
Policy and Procedures and Guidance for Acorns Children's Hospice.
• Chairing the Safeguarding Steering Group which monitors and reviews all safeguarding
issues across the organisation.
• Offering support, advice and consultation to the Care Management team who may be
reporting safeguarding concerns to statutory agencies.
• Ensuring the CEO and Trustee Board are informed of any safeguarding issues affecting
an Acorns child.
• Working with the Head of Training and the Safeguarding Steering Group ensuing
safeguarding training is in place across the Trust for all care staff.
• Ensuring Acorns is appropriately linked into the Safeguarding Children’s Boards across
the region.
• Receiving reports of child protection concerns or suspicions.
• Promoting an understanding of Child Protection issues within Acorns.
• Briefing management and staff on Acorns’ other procedures and legal requirements in
relation to child protection.
• Reports all safeguarding incidents occurring on Acorns premises or involving Acorns staff
to the relevant Local Authority Designated Safeguarding Officer and CCG.
• Ensures anyone with an offence is reported to the DBS.
Acorns will ensure there is clear safeguarding documentation to:
• Clarify safeguarding procedures.
• Provide specific documentation for reporting.
• Ensure support and supervision for staff involved in safeguarding situations.
• Provide information for children and young people accessing Acorns services.
• Understand what to do when managing a disclosure from a child.
Monitoring Compliance
• The Review of safeguarding training records is led by the Head of Training, the results
are reported to the safeguarding steering group and through quarterly reports to the
commisioners.
• Monitoring of safeguarding training and incidents takes place every quarter by Acorns
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regional Safeguarding Steering Group and Care Governance Group.
• Unannounced compliance visits completed by the Designated Safeguarding Officer and
Acorns Heads of Service take place annually during these visits staff are interviewed on
their awareness of the safeguarding policy and reporting procedures.
Associated documentation
• Safeguarding and child protection guidance
• Safeguarding and child protect leaflet
• Policy for Safeguarding Vulnerable Adults
• Policy for the confidentiality of records
• Policy for Good Record Keeping
• Policy for notifying local safeguarding boards – child death overview panel (CDOP) of a
clients death
• Policy for Domestic Abuse
• Policy for Managing Aggression
• Safeguarding supervision policy
• Policy for mental capacity
• Prevent Policy
• Whistle Blowing Policy
• IG Policy
PARTICIPATION IN NATIONAL AUDITS
During 2014-15 the hospice was ineligible to participate in the national clinical audit and
national confidential enquiries. This is because there were no audits or enquiries relating
specifically to specialist palliative care in 2014 -15.
RESEARCH
Acorns has not conducted any ‘Clinical Research’ which has needed favourable opinion from
a research ethics committee within the National Research Ethics Committee.
We are
however able to consider working in partnership with universities in supporting research
projects which could further advance the care and services available to the children and
young people we work with. This year Acorns has developed a working relationship with the
Network Support & Palliative Care Research Nurse, from the NIHR Clinical Research
Network, West Midlands. Acorns may be approached and equally can approach this network
if there are joint areas of work identified.
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Acorns supported research with parent champion’s involvement in research undertaken from
Bournemouth University re ‘Understanding the Impact of Children’s Hospices on Parental
Relationships of Life Limited and Threatened Children and Young People’.
QUALITY
IMPROVEMENT
AND
INNOVATION
GOALS
AGREED WITH OUR COMMISSIONERS
A small proportion of Acorns income in 2014-15 was conditional on achieving
Commissioning for Quality and Innovation payment framework (CQUIN).
Acorns is
committed to working with the CQUIN framework to proactively engage in quality
improvements with our commissioners.
The goals and indicators for Acorns identified by the CQUIN were as follows:

Supporting effective transition of those with life limiting /life threatening conditions

Preparing and supporting parents/ carers and young people who are going through
transition to adult services.

Support transition through young people and parent/carer workshops/forums
What has been achieved?
 Four parent carer workshops were held which 29 families benefited from.
 Eight groups for CYP were held with 63 children and young people attending.
Reflection and Impact of Scheme
As an organisation Acorns saw young people become more eloquent and confident in
expressing themselves and getting their needs met.
Young people were prepared for
adulthood by helping to make choices, gain new experiences, understand money, transport,
explore education opportunities, learn about their conditions and what to do in an
emergency.
This work has seen the young ambassadors motivated to pass skills on to younger peers,
they reported they found mentoring new Ambassadors and speaking to other Acorns clients
rewarding and identified they want others to learn from their experiences and not make the
same mistakes. These lessons have been positive in enabling them as young disabled
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people to speak up for themselves, and will provide life skills which will help in a variety of
setting such as when they are employing and retaining their personal carers.
This year young people supported each other when one of their peers; a long standing
Ambassador died. This also led into an extremely in depth discussion on their own mortality
and future wishes for their funeral preparations.
Parents have responded well to meetings, this involved seeing new adult providers which
has supported parents to accept they will need to engage with some adult providers when
leaving Acorns. Parents have had an opportunity to hear other parent’s experiences in
relation to good care they and their son/daughter have received from adult services. This
was identified as being inspirational to other parents who were just beginning to go through
transition.
Actions taken as a result of lessons learnt:1.
There are plans to facilitate ongoing support groups for young people particularly in
relation to mortality and the death of friends and peers.
2.
There will be a short film produced by young people for young people in their role as
ambassadors.
In 2015 we are working with Birmingham
CCG who wish to include a CQUIN in their
contracts. The CQUIN is focusing the outreach lead nurses using capacity available within
the hospice to provide an enhanced outreach service for children who have not engaged
with palliative care services.
WHAT OTHERS SAY ABOUT US
The hospice service is required to register with the Care Quality Commission (CQC) and the
current registration status is unconditional. The hospice service has no conditions on
registration. The CQC did not take any enforcement action against Acorns during 2014 –15.
Acorns is subject to periodic reviews by the CQC and the last on-site inspections were in
2013 and 2014 all the hospices were fully compliant. There were no inspections in 2014-15
however there is an expectation unannounced visits will take place in 2015-16.
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In 2014 two professional days were held at Acorns which was attended by 103 external
professionals. The programmes consisted of Acorns specialist professionals providing an
overview of the care and services available.
Feedback from professionals attending the Black Country and Three Counties
professional’s day September/ October 2014.
All 103 professionals across health and social care services (100%) identified they would be
extremely likely to recommend Acorns to a family.
The professionals were asked the reasons for this recommendation:
 Have referred families in previously so know the difference it can make to the lives of
families-a life line to parents.
 To provide better care for the families I work with due to the services offered by
Acorns Children's Hospice.
 Extremely professional and valuable services available.
 Positive parent feedback. All parents I have spoken to speak highly about Acorns.
 I work with a lot of children with life limiting conditions and feel they would benefit
greatly from Acorns help and support.
 Working as a CCN I see life limited/ life threatened children, hospice for
support/respite is always discussed, the family then decide.
 As a professional I feel hospice is beneficial to the child and family from referral to
after the child’s death. And the important care and support following death.
 Friendly staff, lovely hospice.
 Acorns offer so much and our babies/ children and families need to be aware of the
option available to them.
 I think the support offered by Acorns is fantastic and invaluable to families and
children in this area, especially the variety of support offered for the entire family.
 Family recommendation and reputation.
 Support for whole family. As a CCN I work closely with families.
 Because Acorns offer a lot more than short breaks.
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 As a social work practitioner I support children and their families and I feel that the
support that Acorns can offer is valuable.
 Great feedback from children, young people and families. The link between home
and hospice to help families to stay at home and child as long as they wish.
 The holistic approach of care for the whole family unit.
 Fantastic service, fabulous staff.
 Non-clinical
environment;
friendly
family
atmosphere,
bespoke
packages,
appropriately trained staff who have time and experience.
 The hospice environment is something every family should have the opportunity of
using, it provides such a valuable support for all the family.
 I am impressed with the site, professionalism and forward thinking I have heard
talked about today.
 Welcoming with good knowledge & experience.
 Acorns can offer a family who are experiencing palliative care the support they
require to make end of life care more bearable for the family by enabling them to
seek advice and support as and when they require.
 It seems like a professional, beautiful and peaceful place. Extremely friendly and
supportive staff - very privileged to visit and learn about a wonderful organisation.
 Acorns offers a great amount of support for families and the children throughout their
whole journey.
 I have worked with a lot of families who have received care at Acorns over many
years but this is the first time I have been able to visit and learn all you can offer
families with life limiting conditions.
 I plan to offer the Oncology Support Group to all our families and work with the
Birmingham CLIC team to develop this. Families who have accessed Acorns have
always given very positive feedback about their experiences.
 Clearly a well-established, researched service to meet all the need of the child and
family holistically.
 Holistic approach to practical care.
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 The total support that puts family at centre of care programme & wonderful facilities.
 More aware of holistic nature of service & how early intervention can have huge
impact on EoL care and other services available i.e. support groups and transition
work.
 "Part of my job role as a palliative care nurse is to support child & family. Acorns is
an excellent support network for the child & family as well as for myself"
 "because you provide care and support for family & children when they are most
vulnerable and enable them to make happy memories"
 Very impressed by the service offered, the location and venue.
Friendly and
understanding staff who genuinely are passionate about helping and supporting
children & families.
 Been aware of your services for many years. Happy to recommend your support to
our families.
 Knowing what is available how could I not?
 Caring, professional - lovely environment, welcoming.
 An invaluable support.
 Already involved with families who access our services & Acorns so aware of brilliant
support and care Acorns offers.
 Part of my role is to support the family and families I work with are always full of
praise for the role Acorns plays in their lives.
In 2014-15 Acorns received 128 of compliments from service users in relation to the care
and service provided to them and their children.
In addition to the compliments a formal system of family feedback was undertaken with a
focus on six services. The outcomes from this is available in the section; The Views of
Acorns Services Users: Family Feedback for 2014-15 (page 30).
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DATA QUALITY
Acorns did not submit records during 2014-15 to the Secondary Users Service for inclusion
in the Hospital Episode Statistics which are included in the latest published data. This is
because the hospice is not eligible to participate in this scheme.
Acorns collects and submits the following internal activity/performance data:

annual data to Together for Short Lives;

child death data to Child Death Overview Panels;

activity data via quarterly quality reports to 20 clinical commissioning groups (CCGs);

annual activity data to 20 CCGs, and;

data to evidence that Acorns meets the Key Lines of Enquiry (KLOES) standards as
identified by the Care Quality Commission.
CLINICAL CODING ERROR RATE
The hospice was not subject to the Payment by Results clinical coding audit during 2014-15
by the Audit Commission.
Part 3: REVIEW OF QUALITY PERFORMANCE
There are three tables presented in this section.
Table 1; identifies an overview on the quantity of work undertaken across Acorns in 2014 2015.
Table 2; identified the Quality Performance Indicators which are organised under the
KLOES identified by CQC as the indicator categories they focus on measuring and
monitoring quality and safety in services.
Table 3; highlights the clinical audits undertaken across Acorns in the last 12 months which
support the monitoring and management of clinical effectiveness.
TABLE 1
Figures for April 2014 to March 2015.
Total number of open cases at end of the
12 month period
635 current number of children being
supported
No of families actually supported at the end 866 families being supported
of the 12 month period
An additional 240 bereaved families
being supported
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Total number of children supported for
2014-15
Total number of families supported for 2014
-15
Number of new patients
Number of referrals made – % accepted, %
declined
No of Beds Available (based on 30 beds)
No of Beds Taken
Number discharged from care
Number in transition (16-18 years)
Number of day care episodes
Number of episodes of care in community
Number of deaths
Number of episodes of end of life care
Number of nights provided (in special
bedroom)
768
990
188
205 referrals received
188 referrals accepted
17 declined
10,950
7,299 (67% occupancy) (this includes
day care)
133 TOTAL
65 Bereavement Support Completed
1 Child No longer meets our criteria
3 Closed service
1 Death
10 Discharged to TT
3 Left District
9 No longer able to contact family
5 no longer life threatened
15 No longer requires support
19 Transferred to Adult Service
2 Transferred to other service
53 (52 16-17 year olds and 1 18 year
old)
1,237 (already included in above
figure)
Over 3,623 support sessions with
families in the community with an
additional 7,579 phone support calls
made to families.
Overall support contacts: 15,529.
77
22
133
TABLE 2
The following Quality Performance Indicators (QPI) and Acorns Standards for quality of service
are organised under the 5 domains identified by CQC as the indicator categories to focus on
measuring and monitoring quality and safety in services;
1.
ensuring care services are responsive to people’s needs;
2.
ensuring services are caring;
3.
ensuring services are well led;
4.
ensuring services are effective; and,
5.
ensuring services are safe.
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The progress of the QPIs is reported through quarterly reports by Senior Care Managers to the
Care Governance Group and presented to Care Assurance Committee for quarterly updates.
Ensuring our care services are responsive to people’s need
1.
2
3
4
5
QPI
INDICATOR
Measure
All families and Young People receive an
assessment, highlighting outcomes achieved
from service intervention and or future
desired outcomes, this will be reviewed
annually.
Allocated worker responsibility for YP over
16yrs of age to be transferred to the transition
team when the transition team worker is
undertaking the majority of support to the
family.
All siblings requiring 1:1 Bereavement
Support will be assessed by the sibling
manager and time limited support offered
where appropriate.
Communication groups in each site to
improve the experience for children and
families.
Families with assessed need receive outreach support from clinical teams.
100%
Outcome data base, monthly data identified
by each team via reports.
100%
Report by exception in monthly reporting
system.
100%
Monthly report and quarterly reports
1 group
each site
Quarterly outcome based report to care
governance
20 visits
per
hospice
per month
12
referrals
as year
Additional
6 a year
Providing
support to
20 families
per site
3 pairs per
site to
support
the sibling
groups
Monthly report and quarterly reports to care
governance.
Monthly report and quarterly reports to care
governance.
Monthly report and quarterly reports to care
governance.
6
Out-reach nurse lead to support the increase
the number of referrals
7
Increase in neonates offered a service from
Acorns
Teams of volunteers to work with families to
meet desired outcomes in the community.
8
9
Recruit and train volunteer drivers/mini bus
drivers and escorts to support ;
siblings to access support groups
support families to access to hospices for
short-breaks (via transporting equipment)
10
4 per site
11
Recruit accredited complementary therapists
as volunteers
Recruit and train volunteers with necessary
therapeutic skills for sib groups, role
description to be shared
12
Recruit and Train Face to Face Volunteers
12
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6 per
region
Monthly report and quarterly reports to care
governance.
Monthly report and quarterly reports to care
governance.
Monthly report and quarterly reports to care
governance.
Monthly report and quarterly reports to care
governance.
Monthly report and quarterly reports to care
governance.
Standards
13
14
15
16
17
18
19
20
21
Standard
Newly accepted families or families who have
a child under 16 years of age to have an
allocated CTW.
All newly accepted families will be contacted
within 7 days
All emergency EoL referrals to be responded
in accordance with the EOL referral process
guidance.
Acorns to provide a minimum of 4 hours’
notice for any cancelled visit for hospice at
home in the community.
Hospice at Home Bookings
All families to have a minimum of 1 weeks’
notice of planned bookings
There is an annual review of individual care
plans
There is an annual programme of audits to
meet CQC and organisational requirements.
All young people aged over 14 receive an
initial transition assessment/ transition review
All siblings receive an assessment and
review annually highlighting outcomes
achieved from service intervention and future
desired outcomes
INDICATOR
100%
100%
100%
Measure
Data system identifies allocated worker per
child. Concerns reported through exception
reports
Data system Concerns reported through
exception reports
None compliance to be reported through the
incident reporting process
100%
Data system and exception reports when this
is not the case
100%
Data system and exception reports when this
is not the case
100%
Audit
100%
Reports to Care Gov. group
100%
Data System
90%
Data System
INDICATOR
1 per
Hospice
Measure
Monthly report and quarterly reports
8 per
hospice
Monthly report and quarterly reports
6
meetings
a year to
produce;
BASIL
Magazine
10 per
hospice
per year.
1 per
hospice
per year
Monthly report and quarterly reports
INDICATOR
Measure
OOH collated weekly via first on-call
Ensuring our services are caring
24
QPI
Three Sibling residential bereavement groups
per year to meet the highlighted outcomes
from assessments and reviews
24 Sibling groups per year to meet the
highlighted outcomes from assessments and
reviews
BASIL meetings to support the development
of sibling service utilising sibling perspectives
25
Support groups to be provided for parents
and carers to meet identified outcomes
22
23
Therapeutic bereavement group
26
Standards
24/7 OOH Psychosocial support is available
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100%
To be reported through quarterly reporting
To be reported through quarterly reporting
27
28
29
to all families.
All communications to children and families
to be accurate, timely, respectful and
confidential
Reception areas provide a safe, secure but
warm welcome to the hospices
100%
Record of incident, complaint or IG issue or
quarterly sample feedback from family
100%
Audit
QPI
Develop operational changes to shift patterns
to utilize time effectively.
INDICATOR
Measure
Full report with recommendations to be
considered
Increase and maintain Corporate
engagement as part of Community
Engagement Agenda
Maintain Ambassador and Champion roles
15 groups
per year
per site
Recruit
and train
for roles
Monthly report and quarterly reports
Prepare young people and their families for
transition into adulthood
Deliver 6 prep
for adulthood
events per
hospice / 12
youth clubs
per hospice/ 4
parent group
event per
hospice
Monthly report and quarterly reports
6
meetings
a year
Sibling leaflets and resource pack for families
and professionals developed
INDICATOR
100%
Measure
Audits
90%
HR records
QPI
37 2 nurse prescribers at each site
INDICATOR
38 2 nurses each site each year to achieve
accredited qualification in paediatric palliative
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100%
Measure
To be in process of being trained or
operational
To be in process of being trained or
operational
Ensuring our services are well led
30
31
32
33
34 Sibling council further developed to promote
the work of the siblings and support other
siblings
35
36
Standards
Records and children’s files are maintained
ensuring they are confidential, accessible and
stored in line with principles of information
governance and CQC guidance.
All staff have an Individual Performance
Review and PDP annually which feeds into
the annual training plan.
change in
shift
patterns
Monthly report and quarterly reports
Ensuring our care services are effective
100%
care and clinical assessment skills
39 Achieve occupancy at a level that will
maintain funding from CCGs
Monthly
reports
Report already in place
2
published
reports
and or
conferenc
e
representa
tion
QPI’s to
be
developed
Monthly report and quarterly reports
INDICATOR
100%
Measure
System checks and end of year review.
QPI
43 Develop links between dependency scoring
and day to day staffing to support day to day
occupancy and establishment planning.
INDICATOR
Measure
Quarterly update reports
Standard
All staff and volunteers attend identified core
training on induction and updates as
indicated in training plan.
INDICATOR
100%
Retaining a regional & national presence
40
Re- establish priorities for Lead Nurse Roles
41
Standards
42 All activity codes for children’s data to be
recorded in timely and in an accurate manner
Monthly report and quarterly reports
Ensuring our care services are safe
44
System to
be in
place.
Measure
L&D data base.
OUR PARTICIPATION IN CLIICAL AUDIT
To ensure that Acorns is providing a consistently high quality service, we undertake our own
clinical audits, using national audit tools, where available, developed specifically for
hospices, which have been peer reviewed and quality assessed. This allows us to monitor
the quality of care being provided in a systematic way and creates a framework by which we
can review this information and make improvements where needeEach year the Nurse
Managers and the nurses with additional responsibilities agree the audit schedule with the
Senior Nurse for Quality and Governance for the coming year, this is then reported to the
Care Governance Group. Priorities are selected in accordance with what is required by our
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regulators and any areas where a formal audit would inform the risk management processes
within the hospice.
Through the Care Governance report, the Board of Trustees is kept fully informed about the
audit results and any identified shortfalls. Through this process, the Board has received an
assurance of the quality of the services provided.
The following audits were completed between 1st April 2014 and 31st March 2015.
Clinical Audit
Outcome
-Audit of transition records.
Re-audit to ensure changes in documentation have
been embedded and improvements in documentation
seen. New audit planned for 2015.
Re-audit of Help the Hospice
Medicines Management policy and procedures
general medication audit tool all
reviewed and re-written to reflect the outcome of the
sites.
audit. Re-audit undertaken in all sites for 2014 to
ensure consistent good practice has been
maintained. New audit planned for 2015.
Quarterly one module of Help the
Audits for 2014 have highlighted areas of good
Hospices prevention and control
practice and action plans implemented each quarter
of infection audit tool suite all
to remedy any areas not meeting required standard
sites.
such as updating cleaning schedules. Audit of one
module at each hospice quarterly continues through
2015.
Yearly all sites external infection
Yearly audit of on-going standards shows good
control audit from SLA
practice and action plans for improvement have been
implemented. Next audits due 2015.
Quarterly Hand hygiene all sites
Quarterly audits of hand hygiene maintained to
hospice staff audits
ensure good practice is observed. Continue through
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2015.
Hand hygiene hospice at home
Additional hand cleaning items supplied to staff back
staff audit.
packs for use in homes. Re-audit 2015.
Hospice at home yearly record
2014 audit showed some improved practice, with
keeping audit.
some improvements recommended around devising
new care plans.
Hospice at home audit of medicine 2014 audit produced an action plan for staff training
charts.
updates on recording on medication charts.
Independent non-medical prescriber identified and
commenced training to improve further practice in this
area.
Resuscitation re-audit all sites
Following changes to policy the audit reviewed
practice and identified further changes needed to be
made to policy and practice to reflect the use of
regional documentation around end of life plans and
resuscitation. Re-audit due 2016 following
completion of action plans.
Quarterly mattress audits all sites
This continued across the sites in 2014 and actions
on replacement of covers and mattresses are ongoing continue through 2015.
Record Keeping Audit across all
Some areas of improvement identified across the
sites in-house and community
teams in 2014. Additions to audit criteria made for
teams.
2015 around consent and parent/carer signatures and
a larger sample recommended. Action Plan
developed and being implemented , re-audit due
2015
Audit of record keeping for sibling
2014 Audit completed with some good practice seen,
records.
improvements to consistency of paperwork being
implemented. New audit planned for 2015.
Pain assessment and recording
2014 Re-audit showed some improvements in
re-audit at Birmingham Hospices.
recording and assessment of pain and the use of
charts following implementation of an action plan.
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Pain assessment and recording
2014 audit showed some improvements needed
audit at Black Country Hospice.
around consistency of completing paperwork action
plan in place.
Re-audit of tissue viability
2014 re-audit showed some significant improvement
recording Black Country Hospice
on completion of paperwork and staff understanding
following training and revised paperwork.
Audit of play and activity
2014 audit produced an action plan for improving
provision and recording across all
recording of activity, co-ordination of activity and
sites.
increasing training on outcome recording of activity
undertaken.
Reception area welcoming and
2014 audit highlighted the need for an action plan to
friendly audit across sites.
ensure areas have up to date literature available, a
review of the areas to ensure they are friendly is
required and also that staff/ volunteers greet all
visitors consistently to the same standards that are
expected.
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THE VIEWS OF ACORNS SERVICES USERS
In 2014 Acorns piloted a Real Time Reporting System for seeking children, young people
and families views on services.
utilised.
This was in addition to the feedback postcards being
The Real Time Reporting pilot system enabled service users to complete an
electronic survey which takes only minutes to complete on a hospice iPad for by web link
using a QR code at home. This is service user friendly and has resulted in an increased
response from children and families in relation to Acorns services.
The benefit of the
process being real time means Acorns is able to respond quickly to comments in addition to
providing an annual overview of service user views. This system of seeking service user
feedback is one of the quality improvement areas for 201516.
The following feedback has been collated by a combination of post card feedback and Real
Time Reporting for the following areas:
1. Hospice at Home;
2. Support Groups;
3. Family Events;
4. Complementary Therapy;
5. Hospice Care; and,
6. Young person’s satisfaction.
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CLOSING STATEMENT FROM THE DIRECTOR OF CARE
SERVICES
It is our ongoing commitment that every intervention we have with each and every child and
family is of the highest standard and quality and makes a positive difference to them.
Acorns Impact Report should be read in conjunction with Quality Accounts, the Impact
Report is available on our website which provides an annual overview on the outcomes and
impacts our services have had on our service users in the last 12 months.
Since 1988 we have been providing holistic specialist palliative care services, we are
confident in our expertise provided by our skilled workforce, however we are not complacent.
The ever changing needs of children with different conditions of varying complexities and
changing technological and nursing needs requires us to be progressive in our provision of
health and social care. We will continue to develop and scope our services working in
partnership with colleagues across the hospice movement, colleagues and professionals in
the wider NHS and Social Care statutory sectors and most importantly with our service
users.
Emma Aspinall
Director of Care
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