In partnership with
Sub-contract
Community Care Service
Extra Help Team
End of Life Rapid Response Service
Northamptonshire
Quality Account
2014 – 2015
Nene Clinical Commissioning Group
Corby Clinical Commissioning Group
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Statement from Age UK Service Manager
“We have only one chance to get this right”
[Sharon Foley CEO of the Irish Hospice Foundation]
Everything that we do within End of Life Care has to be of the highest possible quality.
We do not have a second chance to get things right for our patients and their families.
Staff employed by Age UK within the Extra Help Team are committed to providing a high
quality service, and should be commended for this.

Each patient is treated by the staff team as an individual with individual and specific
needs

Each member of staff is committed to training and enhancing their knowledge

Each member of staff has regular supervision, and opportunities to reflect on
personal practice

Each member of staff recognises the value of the team of which they are a part, and
works with colleagues to provide quality patient care

Each patient receives holistic care not just from the Age UK Extra Help Team, but
also from their District Nurses, Prime Care Hospice at Home and family carers,
always working together to provide quality patient care and experience
Susan Brazell
Service Manager
Age UK Northamptonshire
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The Extra Help Team
Service Provision
The team document all care given in the patient’s home. This record enables the carers
provide continuity of care to a consistently high standard. The front page of these notes
gives detail of the service, and is included below.
Team Purpose
Our goal is to provide a high quality Home Care service to patients and carers at a critical
time in their lives, working in consultation with other care providers to deliver practical
support as required.
We work alongside Primecare Rapid Response Service and in collaboration with your District
Nurse. There is no charge made to you for this service
Our principal aim is to be responsive to your needs, which we recognise may change
rapidly or on a frequent basis
Carers may undertake a variety of the tasks listed below:
The list is not exhaustive
1. To respond sensitively and appropriately to the needs of patients and their carers
2. To maintain the safety and comfort of the person receiving care
3. Our primary role is to undertake personal care tasks as required. These may include:
 Washing and changing clothing
 Maintaining continence, toileting, catheter care, use of commode,
 Meal preparation
 Provision of fluids
 Feeding
4. In addition to personal care we are occasionally able undertake domestic care tasks
to support you and your carers. These may include
 Housework
 Changing sheets and bedclothes
 Laundry and ironing
 Shopping and running errands
5. To undertake tasks to support the patient’s carer. These may include
 Undertaking care tasks on behalf of the carer to allow them to take a break
 Providing a sitting service to allow carer to sleep or leave the home for a
short period
 Providing the patient with opportunity to talk about the current situation and
their feelings
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The Staff Team
Service Manager
Susan Brazell
Team Manager
Gabrielle White
Office Support
Susan Coats
Carers
Amanda Francisco
Amy Burkinshaw
Anne Coote
Diane Hicks
Elaine Smith
Heather Bramley
Jacqueline Dale
Janet Smith
Jill Croft Pearson
Joanne Whalley
Josphat Kadembo
Judith Warren
Julie Parker
Kathleen Boyle
Katie Fuller
Kay Phillips
Kerri Lack
Lesley Roberts
Linda Day
Marianne Chipperfield
Michelle Harris
Michelle Hawes
Neil Ross
Nicholas Stevenson
Ruth Philpott
Sharon Rose
Shirley Stevens
Susan Coats
William Lindsay
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Staff Retention and Turnover
2014 - 2015
Leavers
Emma McKerral
Kay Phillips
Kim Bendy
Sophie Pickard
With a view to commencing nurse raining
Transferred from salaried to casual hours contract
Ceased casual contract at own request
To take up training for Occupational Therapy
Starters
Diane Hicks
Heather Bramley
Neil Ross
Ruth Philpott
Julie Parker
Length of Service
5+
years
4+
years
3+
years
2+
years
1+
years
Under
a year
1
2
3
4
5
6
7
8
The above table illustrates the fact that staff remain with the team, and that turnover is low.
This helps to further enhance the quality of service provision.
Staff are supported in their work, and feel valued.
Training, supervision and appraisals all contribute to quality service provision
5
Staff Training and Development
Team Meetings
Team meetings are held quarterly, all staff are expected to attend.
Every team meeting contains a training session:
April 2014
Death & Dying, (What on earth do that lot believe?)
Delivered by Rev David Betts, Chaplain, Northampton General Hospital
July 2014
Professional Boundaries for Care Givers
Delivered by Rebecca Warren, Clinical Contract Manager, Prime Care
October 2014
Equality and Diversity
Delivered by Jillian Powell, Age UK Manager
January 2015
Pressure Care
Delivered by Julie Major, Prime Care Nurse
New Starters
In order to ensure all staff are able to meet the stringent requirements of both Age UK and
the Extra Help Team all new starters are subject to a six month probation period.
During this time the Team Manager meets with the member of staff on a monthly basis, and
a schedule of training is completed.
This will include:
 Allocation of mentor
 Completion of Age UK induction paperwork
 Explanation of office procedures
 Handbook - Thorough explanation of Handbook
 Handbook - Signature to agree compliance with Handbook
 Mandatory training to be completed within first six months
 Time spent shadowing other carers
 Time spent with Prime Care Advanced Nurse Practitioner on shift
 Time with Prime Care Link Nurse
Supervision
Supervision is carried out regularly, against minimum requirements
 Staff who work 30 hours+ to receive 3 monthly supervision
 Staff who work between 10 & 30 hours to receive 4 monthly supervision
 Casual staff and those who work less than 10 hours to receive 6 monthly supervision
as a minimum
 All staff have the opportunity to ask for supervision sessions in the interim
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A matrix is maintained by the Team Manager to ensure that supervision is accommodated
into the work schedule of staff
An extract is included below
36
Amanda Francisco
3
6/22.5
Amy Burkinshaw
4
35
Anne Coote
3
C
3
37.5
2.25
24/22.5
21
9
20
24
Annette Price
Diane Hicks
Elaine Smith
Heather Bramley
Jackie Dale
Jill Croft Pearson
Joanne Whalley
Josphat Kadembo
Judith Warren
6
6
3
6
4
4
6
4
4
21.5
32.5
Julie Parker
Katie Fuller
Kay Boyle
4
3
9.5
Kerri Lack
6
10.4.14
obs
17.4.14
31.7.14
15.5.14
1ST
18.8.14
off sick
obs
23.4.14
8.5.14
14.8.14
induction
1.5.14
3.9.14
7.8.14
1.7.14
17.6.14
18.9.14
1.8.14
15.5.14
30.6.14
31.7.14
obs
25.8.14
7.8.14
26.6.14
24.7.14
20.8.14
16.4.14
3.4.14
obs
9.5.14
Appraisal
All staff receive an annual appraisal
This further helps to build quality into the team
Staff have an opportunity to complete a pre-appraisal form as part of the process
Completed paperwork is scrutinised by the Service Manager
Copies are retained by the individual, the Extra Help Team, and Human Resources
Staff Investment
All of these investments in staff development and training serve to enhance the high quality
of patient care provided by the team.
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Quality Audit
On a quarterly basis a number of Quality Audits are undertaken
PRESENTATION
Appropriate Uniform is Worn
Appropriate footwear is worn
Staff Introduce themselves and interact with patients and carers appropriately
Staff are presentable
Name badges are worn and are in date
Jewellery is worn in line with the infection control policy.
Staff are on time.
INFECTION CONTROL
Hands are washed in an appropriate manner before attending to a patient even
when gloves will be (including handling of food)
Hands are washed in an appropriate manner after attending to a patient even
when gloves have been worn (including handling of food)
The staff member is ‘bare’ below the elbows with either short or rolled up sleeves.
Cardigans or fleeces are removed before providing care
No hand or wrist jewellery is worn except for wedding rings
Fingernails are short clean and free of nail polish
Hands are wetted before applying soap
Hands are washed for 10 – 15 seconds using the six step technique
When applying alcohol preparation hands are rubbed together for 10 – 15 second
using the six step technique until the solution dries
Gloves and aprons used for providing patient care
Gloves and aprons are disposed of appropriately
Both of the above audits are undertaken quarterly at team meetings.
Peer audit is the evaluation tool utilised
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Results from individually completed forms are entered onto a spreadsheet, with formulas
embedded within it that will calculate compliance as a %
The results for 2014 – 15 audits are listed below:
April
July
October
January
PRESENTATION
100%
100%
98%
99%
INFECTION CONTROL
100%
100%
98%
100%
Key
Excellent 90%>
Good 80%>
Acceptable 75-79%
Below standard <74%
An audit of patient notes is also undertaken by the Service Manager
Twelve sets of patient notes have been audited during the period April 2014 – March 2015
DOCUMENTATION
Each entry is dated
Each new page has name and date of birth of patient
Each Visit Start Time is documented
Each Visit Finish Time is documented
Each entry is signed
The name or designated identifier of the person making the entry is printed after
their signature
Entries should not include abbreviations [see Record Keeping Policy for exceptions]
All entries are in black ink
All entries are legible
Clear Concise Summary Of Care Given During The Visit Is Evident
Clear Concise Summary Of Any Actions Taken During The Visit Is Evident
Consent Is Evident
The Time of Any Telephone Calls Made During Visit Was Documented
The Full Name of Any Contacts Made During Visit Was Documented
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The results of these 12 audits undertaken in the period April 2014 – March 2015 are
documented below:
Patient 1
Patient 2
Patient 3
Patient 4
Patient 5
Patient 6
98%
100%
99%
96%
100%
99%
Patient 7
Patient 8
Patient 9
Patient 10
Patient 11
Patient 12
98%
98%
100%
100%
98%
98%
The staff team are advised when documentation requirements are not met, and instructed
to comply with the requirements in the specific areas where shortfall has occurred
User Satisfaction
At the end of each month a total of eight questionnaires are sent to families (or in some
cases patients) of those who have ceased to use the service
The text of the questionnaire with space for answers is documented below:
We are sending you this short questionnaire because you or someone that you care for has
recently had support from the Age UK Northamptonshire Extra Help Team.
In order to help us monitor and improve the quality of our care we would value a few
moments of your time to answer the questions below.

The care provided was responsive to the needs of the person for whom it was
provided
 The carers were sympathetic and understanding
 The care was provided with dignity and respect
 The carers arrived at the time agreed
 If the circumstances arose I would recommend this service to a friend (this question
has only been included since January 2015)
Each of the above questions is marked as below:
Strongly Agree
Somewhat Agree
Somewhat Disagree
Strongly Disagree
Additionally a number of open questions are asked:
 Can you identify any support which you did not receive that you may have found
beneficial?
 Can you comment on what might have happened had you not received support from
the Extra Help Team?
 Do you have any comments as to how the service could be altered or improved?
 If you wish to discuss any of the points on this form further please give your name
and contact details below
All of the returned forms are collated, and action taken as appropriate
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The care provided was responsive to the needs of the person for whom it was provided
Strongly
Agree
Somewhat
Agree
Somewhat
Disagree
Strongly
Disagree
Returns
April to June
July to September
October to December
January to March
April to June
July to September
October to December
January to March
April to June
July to September
October to December
January to March
April to June
July to September
October to December
January to March
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The carers were sympathetic and understanding
Strongly
Agree
Somewhat
Agree
Somewhat
Disagree
Strongly
Disagree
Returns
April to June
July to September
October to December
January to March
April to June
July to September
October to December
January to March
April to June
July to September
October to December
January to March
April to June
July to September
October to December
January to March
1
2
3
4
5
11
6
7
8
9
10
11
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13
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The care was provided with dignity and respect
Strongly
Agree
Somewhat
Agree
Somewhat
Disagree
Strongly
Disagree
Returns
April to June
July to September
October to December
January to March
April to June
July to September
October to December
January to March
April to June
July to September
October to December
January to March
April to June
July to September
October to December
January to March
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2
3
4
5
6
7
8
9
10
11
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13
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4
5
6
7
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10
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The carers arrived at the time agreed
Strongly
Agree
Somewhat
Agree
Somewhat
Disagree
Strongly
Disagree
Returns
April to June
July to September
October to December
January to March
April to June
July to September
October to December
January to March
April to June
July to September
October to December
January to March
April to June
July to September
October to December
January to March
1
2
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If the circumstances arose I would recommend this service to a friend (this question has
only been included since January 2015)
Returns
Strongly
Agree
Somewhat
Agree
Somewhat
Disagree
Strongly
Disagree
1
2
3
4
5
6
7
8
9
10
11
12
13
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April to June
July to September
October to December
January to March
April to June
July to September
October to December
January to March
April to June
July to September
October to December
January to March
April to June
July to September
October to December
January to March
A small selection of the additional comments made on the feedback questionnaires are
included here to give a flavour of the type of responses that are received
K’s every need was catered for. Once they realised K had a great sense of humour the
repartee was brilliant and certainly raised her spirits and made everything more bearable.
The service is so good I cannot see any point that could be improved
I would have found it very hard to cope as I had never dealt with illness like this before. The
physical and especially the emotional strains would have been too hard to bear.
Each carer had their own strengths and the variety gave me a lift each day
My partner would have returned to the hospital/hospice as I would not have been able to
cope on my own
Young members of the team not as sympathetic as older members (This respondent gave
their name, and we made attempts to contact them to discuss, but our messages were not
responded to)
It was good to have contact with carers used to dealing with the situation we were facing
I would have been totally lost in the final days
(I would have liked) qualified staff at some points to agree a care plan. Qualified staff
overnight (This respondent was visited to discuss the points raised, which related to issues
wider than the Extra Help Team.)
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18
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I don’t know how I would have coped the care my mother received was second to none,
especially Elaine who I think deserves a medal. Also Marianne who gave us overnight care. I
never realised what Age UK did until we received the care. I cannot rate it highly enough,
the care team were a life line to us.
We had very little night-shift cover and as my father needed someone ‘on-duty’ 24/7 this
left me struggling on with next- to- no sleep for days at a time. (This respondent was with
Age UK only briefly prior to death. Night sits were provided during this time. It was decided
not to contact daughter in this instance)
I would not have managed the situation. Brian did not want to die in hospital, so the team
were wonderful in keeping him at home until the end. Thank you so much.
I am 82 years old and could not manage on my own. Your team gave me 110% help – thank
you
The carers gave my wife support and allowed her a rest
Complaints
Other than the negative comments that were received via the feedback questionnaires no
complaints have been received.
All of the negative comments have been responded to if we were able
Patient visits by Team Manager
As part of our interventions to improve quality and positive experience for patients and
their families the Team Manager has commenced structured recording of her visits to
patients and their families. Extracts from these notes are included below.
Mr L is very poorly and care is directed generally by family. Carers are supportive and friendly. They
are doing a good job. Mr L is now bedbound. His consent is sought before carry out tasks. There is
a large family with good support throughout night and day. They feel they do not require evening
visit but due to poor condition of patient have been advised to keep this visit in place.
Discussion with patient and family indicates some reluctance for care but compliance shown
throughout. Patient refuses to use hospital bed, preferring recliner chair 24/7. Pressure sore on
sacrum reported to district nurse. Family aware of service and H’s daughter-in-law is the daughter
of another patient.
All staff have been really good and friendly. Mrs L talked about her children and her daughter’s cake
business.
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Cards and Letters
In addition to the returned questionnaires the team receive a number of cards and thank
you letters.
A thematic analysis of these cards received in the 6 months received October 2014 – March
2015 and the results illustrated below:
A small selection of comments from the cards is included as a testament to the quality care
provided
On behalf of the family I am writing to thank you very much for the wonderful care and
attention given to my father during the last few weeks of his life. Your staff were extremely
professional and caring. The support given to my Mother was also fantastic. Whilst the past
few weeks have been very traumatic for the family your support has been invaluable.
I just want to thank you all so much for the help and support you gave me and my family in
looking after M in the last weeks he was with us. I know I couldn’t have coped without your
kindness and help, and I want you to know how much we all appreciate it.
Life can be so cruel at times and M didn’t deserve what he had to go through – but nobody
ever said life was fair. We managed between us to do the one thing he wanted, which was
to stay at home.
Life will be so different now but I know that with the help of family and friends I will
somehow get through.
Once again my heartfelt thanks to you all.
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I am enclosing the form you sent, which has spurred me on to write the letter I had been
intending to write since M’s death.
My family and I would like to congratulate your Extra Help team on all they did for us, so
willingly and cheerfully.
I was surprised at first how M took to your team as, being a very independent spirit, no
longer able to be independent; I was worried at his reaction to the personal tasks they
undertook on his behalf. But I noticed they had obviously been trained to ask his permission
beforehand and he had every confidence in them and in their being capable to perform
whatever was required.
You should be rightly proud of your organisation and its participants.
Working Together as a Team
As providers of personal care we see ourselves as being not an isolated unit, but as a vital
part of a community care team committed to enabling a patient at the end of life to die in
their own home, should this be their wish.
Age UK provide 550 hours of care each week, subcontracted by Prime Care within the End of
Life Rapid Response contract in Northamptonshire.
We value the support provided to us by Prime Care, enhancing in a variety of ways the
quality care that we are able to provide
 Advanced Nurse Practitioners who can be contacted to provide an immediate
response when the Age UK carers need to call out a medical practitioner, to seek
clarification or need to ask advice on behalf of the patient or their family
 Additionally Prime Care Advance Nurse Practioners have provided a schedule of
training to enhance the skills and quality of care provided by the Age UK care team.
Subjects have included:
o Life limiting illnesses
o Stoma and catheter care
o Cultural awareness and spirituality
o Moral and ethical dilemmas
o Professional boundaries
o Note taking and record keeping
o Symptom management
o Nutrition and hydration
o Care after death
 Prime Care Health Care Assistants are sometimes able to work alongside Age UK
carers when a patient has deteriorated, and needs an increased package of care.
 The call centre is key in taking referrals, being a point of contact via which carers can
contact the ANP on duty, and a resource for all of those involved in the patient’s care
The District Nurses are the ‘case holders’ for patients in the community, yet Age UK carers
are an essential part of the team supporting the District Nurse, providing care to enable the
patient to stay at home.
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



The District Nurse invariably uses the Age UK carer as their ‘eyes and ears’ in the day
to day provision of patient care.
The Age UK carers communicate directly with the District Nurses via the surgery or
the patient notes
Age UK carers will undertake tasks if requested to do so, or report back to the
District Nurse as required
Many of the District Nurses value the professional judgement of the Age UK carers,
valuing their knowledge and experience.
An essential part of enabling a patient to remain at home in the last weeks of life is the
care that they receive from their family members and sometimes friends. The Extra Help
Team see these individuals as an essential part of the care team.
 Time spent with relatives and carers is often as valuable as that spent with the
patients themselves
 Relatives and carers are the ones who know the patient best, and can help us in
providing quality care tailored to the patient’s needs and preferences
 The carer will often be the one who has vowed to their loved one that they will
enable them to die at home. They need the support of a team of professionals
around them to help to make this possible.
Striving to be The Best
In all that we do we endeavour to give of our best and to be the best.
“We are what we repeatedly do. Excellence then, is not a single act, but a habit”
Aristotle
Su Brazell
Service Manager
April 2015
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