Butterwick Hospice Care
Butterwick Adult Hospice
Stockton on Tees
Quality Account
2014-2015
Butterwick Hospice
Middlefield Road
Stockton on Tees
TS19 8XN
Registered Charity 1044816
Our Mission Statement and Philosophy
Why we are here
We aim to improve the quality of life for those who have a progressive life limiting
illness and those close to them and to offer positive support for every challenge
they may encounter during their illness
and to see death as part of life’s journey.
In particular we will:
Provide supportive and specialist palliative care for adults with progressive life
limiting conditions
Ensure each person receives care in a homely environment whilst maintaining
privacy, dignity and choice.
Provide holistic centred care by responding to and respecting the patient and
those close to them by meeting their individual, physical, social, cultural,
educational, spiritual and emotional needs throughout the illness and
bereavement.
Acknowledge and respect the way those close to the patient care for them and
endeavour to continue their chosen pattern of care.
Work together in developing an environment based on support and mutual
respect.
Maintain the high quality of the service through ongoing reflection, evaluation and
education.
Communicate effectively and efficiently both within the Hospice and with external
agencies, to ensure continuity of care and promote service development.
Part 1: Chief Executive’s Statement
It gives me great pleasure to present the Quality Account for the Butterwick Adult
Hospice, Stockton on Tees in respect of the year ended 31st March 2015.
The Hospice is an integral part of Butterwick Hospice Care (registered charity
1044816) which provides services from three separate Hospices in the North East
of England. All of the Hospices’ services are provided totally without charge to our
patients and their carers.
The day to day management of the Butterwick Adult Hospice, Stockton on Tees
clinical services is under the leadership of Mrs Paula Wood (Director of Patient
Care and Service Development) who is designated the Registered Manager in the
Hospice’s registration with the Care Quality Commission.
The Butterwick Hospice endeavours to provide an excellence in evidence based
palliative care for all patients regardless of age or diagnosis; to be a centre of
expertise and a specialist resource within the community as a whole.
The needs of patients and their carers are paramount to the Charity’s existence
and are the root and focus of all we do.
Quality is at the core of the Charity’s strategic and operational priorities.
An independent impartial assessment of the quality of care provided was
obtained when the Care Quality Commission performed a routine
unannounced inspection of the Hospice on 1st September 2014. Their
Report showed that the Hospice was meeting all of the required
standards.
A
copy
of
their
full
Report
is
available
at
:
www.cqc.org.uk/directory/1-113000508.
During the last year we have worked effectively in partnership with the Hartlepool
& Stockton on Tees Clinical Commissioning Group and other partners for the
benefit of the community we freely serve.
The Charity only achieves its key objectives because of the professional skills,
commitment and enthusiasm of our staff and volunteers
I am responsible for the preparation of this report and its contents. To the best
of my knowledge, the information reported within this Quality Account is accurate
and a fair representation of the quality of healthcare provided by our Hospice.
Graham Leggatt-Chidgey
Chief Executive
May 2015.
Part 2: Priorities for improvement and statements of assurance from
the board (in regulations).
1.
IMPROVEMENT
Within the Organisation, quality is fundamental to improvement and
accountability. The Board of Trustees continues to support and promote the
ongoing development and improvement of services to ensure that the care and
support provided evolves to meet patient and carer needs.
The priorities for quality improvement for 2015/16 are set out below.
These priorities have been identified in conjunction with patients, carers, staff and
stakeholders. The priorities we have selected will impact directly on each of the
three priority domains:

Patient safety

Clinical effectiveness

Patient experience
Part 2: Priorities for improvement 2015-2016 and Statements of
assurance from the Board (in regulations)
Section 2.1: Priorities for improvement 2015-16.
Patient Safety

Priority One
For Health Care Assistants to complete the
‘Care Certificate’ introduced by NHS England
in April 2015.
How was this identified as a priority?
The Care Certificate was created following the Cavendish review (July 2013)
which was part of the response to the Francis inquiry into the failings of care at
the Mid Staffordshire NHS Trust. The Cavendish Review highlighted that the
training and development of Health Care Assistants was often not consistent or
good enough. Cavendish proposed that a new certificate of Fundamental Care be
introduced and this resulted in the Care Certificate.
The Care Certificate covers the learning outcomes, competencies and standards
that must be expected from Health Care Assistants. It aims to ensure that all
Health Care Assistants are trained to the same standard in order to provide care,
compassion and a high quality of care in the workplace.
The Care Certificate is made up of 15 standards and encompasses the Code of
Conduct for Healthcare Support workers, the Social Care Commitment and the
6C`s (Care, compassion, competence, communication, courage and
commitment.)
The 15 standards which must be achieved are:
 Understanding your role
 Personal development
 Duty of care












Equality and Diversity
Person centred values
Communication
Privacy and dignity
Fluids and nutrition
Mental health, dementia and learning disabilities
Safeguarding adults
Safeguarding children
Basic life support
Health and Safety
Handling information
Infection prevention and control
The Care Certificate will provide clear evidence to employers, patients and people
who receive care and support from the Hospice that the Health Care Assistants
have been assessed against a specific set of standards and demonstrated that
they have the skills, knowledge and behaviour to provide a high quality of care.
How will Priority One be achieved?
Training sessions will be organised to inform all clinical staff regarding what the
care certificate is, the reasons and methodology behind why it has been
introduced and what the Care certificate involves.
Supervisors are accountable for the decision to delegate care; therefore the
supervisor should confirm that the outcome of any delegated task meets the
required standard. Health Education England suggests that the supervisor should
be a Registered Nurse. The Hospice Registered Nurses will therefore be identified
as Supervisors. Training will be delivered to all the Registered Nurses in relation
to what their roles are as supervisors and how to complete observations of
competencies and how to sign off when a competency has been completed.
Assessors are responsible for making the decision on whether the Health Care
Assistant has met the standard set out in the Care Certificate. In order to be an
assessor the person must themselves be competent in the standard they are
assessing. The Hospice will identify Registered Nurses who hold a teaching
qualification/student mentoring or preceptorship training. Training will then be
delivered in relation to the role of the assessor.
The Hospice will introduce a system of standardisation which will incorporate the
different assessors to meet regularly in order to review the evidence they have
used to make a judgement. The assessors can jointly compare the quality, how
much evidence was used; the type of evidence used and come to an agreement
of what is sufficient. Guidelines regarding the assessment evidence will be agreed
with the assessors.
How will progress be monitored and reported?
The nominated assessors will have regular meetings to review and sign off
competencies/ standards.
There is a monthly Clinical meeting chaired by the Director of Patient Care and
the clinical leads from all departments. The Care Certificate will form part of the
agenda under education and all completed Care Certificates will be reviewed and
agreed then certificates will be issued to the Health Care Assistants who have
successfully completed the Care Certificate.
The clinical education database will be updated for Staff who have successfully
completed the Care certificate. This will provide evidence to the Care Quality
Commission as part of the inspection process.
A copy of the certificate will be sent to Human Resources to file in individual staff
records.
2b: Clinical Effectiveness

Priority Two
To introduce the mental capacity
assessment form within all patient
assessments.
How was this identified as a priority?
All health and social care professionals have a statutory duty to abide by the
Mental Capacity Act which became law in 2005 and there is a requirement to
embed this into clinical practice.
There are 3 essential parts to this process:
1. The professional’s opinion of the best care option based on their expertise
and experience and tailored to the individual.
2. The individuals understanding and opinion of the proposed care option,
based on their wishes and feelings, beliefs and values. If the individual
does not have the capacity for this decision then the understanding and
opinion is carried out on their behalf following the process of best interests
required by the Mental Capacity Act. This requires a series of checks to
ensure that the decision is the one the individual would have made if they
had capacity.
3. The willingness to enter into dialogue between professional and individual
to negotiate the option that is in the best interest of the individual.
The Deciding Right document (April 2014) was developed in the North East and
was the first framework in the UK to integrate the principles of making care
decisions in advance. All care decisions must come from a shared partnership
between the professional and the child, young person or adult. Deciding Right
provides the principles by which all health organisations can set their policies to
encourage this partnership around care decisions made in advance for people who
may lose capacity in the future. Deciding Right is based on the Mental Capacity
Act and the latest national guidelines and has been approved by the NHS.
Although the Hospice promotes the Mental Capacity Act and all clinical staff have
been trained and updated with the guidelines of the act as highlighted in the
Deciding Right Framework the need for clear decisions and protocols during
emergencies has to be balanced against the need to make decisions in advance
that avoid unnecessary or distressing treatment Problems around these decisions
are an individual and organisational risk.
The deciding Right Framework has developed a simple assessment form which
can be used quickly prior to a decision made in relation the individual’s care or
treatment.
The Hospice will incorporate these assessment forms in everyday practice.
How will priority two be achieved?
Teaching sessions will be arranged for the Registered Nurses to attend to update
them on the Deciding Right Framework and to inform the staff when a mental
capacity assessment form should be used.
The mental capacity assessment forms will be kept within individual patient
records to support the decision made of any clinical or medical interventions.
How will progress be monitored and reported?
The Mental Capacity assessment forms will be incorporated into the regular
record keeping audits performed within the Hospice.
The results of these audits will be discussed in the Integrated Governance
meeting held bi monthly attended by the Clinical Leads and bon clinical
managers. Any action required following the audits will be highlighted and
documented.
Any actions required following audits will be feedback to the Clinical Leads who
will then inform the clinical staff within individual departments of any outcomes or
action required.
The minutes of the Integrated Governance meeting form part of the agenda items
in the Clinical Governance and Strategy Committee which has trustee
representation.
2c: Patient Experience

Priority Three
The implementation of the Carers support
Needs Assessment Tool
How was this identified as a priority?
End of Life Care policy and guidance recognises the important contribution of
family carers to patient support and recommends that their needs should be
assessed in order to support them in their caring role.
Although the Hospice mission statement identifies the needs of carers as well as
the patient the Hospice does not use a specific evidence based tool directly for
carers. Currently carer’s needs are assessed within the patient assessment
process.
The Hospice wanted to assess carer’s needs independently and therefore
reviewed the literature to identify if there was an identified validated tool
available.
The National Forum for Hospice at Home endorsed by Help the Hospices had been
involved in a programme of research commencing in 2008 with Dr Gunne Grande
in order to develop an evidence based assessment tool. This work led to the
development of the Carers Support Needs Assessment Tool (CSNAT).
The CSNAT approach is a process which provides carers the opportunity to
consider, express and prioritise any further support needs they have. The
assessment conversation forms the basis for subsequent action planning. The
process of assessment is facilitated by the practitioner and led by the carer.
This validated assessment tool appeared easy to use for the carer and straight
forward for the Hospice to implement.
How will priority three be achieved?
Training sessions will be delivered to the nursing team on the background to
using the tool and how to implement the assessment tool in practice.
The assessment documents will be given to the nursing team in order to
introduce the assessment process to carers during their first visit.
Letters will be sent to the District Nursing Teams informing them that the Hospice
will be introducing the Carers Support needs assessment tool.
How will progress be monitored and reported?
Monthly data will be collated onto the Hospice database in relation to:

The number of new patients referred to the service

The number of Carers Support Needs Assessments distributed.

The number of CSNATS completed.

The number of CSNAT`s actioned.
A questionnaire will be completed by the nursing team prior to the
implementation of the tool and then 6 months after the tool has been
implemented.
Section 2.2: Review of services
During 2014/15 the Butterwick Adult Hospice at Stockton on Tees provided three
key services:

To provide a 24 hour, 7 days a week in-patient service.

To provide a day hospice service five days each week (Monday to Friday).

To provide nursing, medical care, counselling, advice, complementary
therapies and bereavement support to patients, their carers and relatives.
The Butterwick Adult Hospice at Stockton on Tees has reviewed all the data
available to us on the quality of care in all of the above services.
The income generated by the NHS services reviewed in 2014/15 represents 100%
of the total income generated from the provision of NHS services by the
Butterwick Adult Hospice, Stockton on Tees for 2014/2015.
The income
generated from the NHS represents approximately 28% of the overall patient
care costs incurred by the Hospice.
Section 2.3:
Enquiries
Participation
in
Clinical
Audits,
National
Confidential
During 2014/15 no national clinical audits and no national confidential enquiries
covered NHS services relating to palliative care.
During that period Butterwick Adult Hospice, Stockton on Tees, participated in no
national clinical audits and 0% national confidential enquiries of the national
clinical audits and national confidential enquires. The Butterwick Adult Hospice,
Stockton on Tees only provides palliative care therefore were ineligible to
participate.
The following mandatory statements are therefore not applicable to Butterwick
Adult Hospice Stockton on Tees:
“The national clinical audits and national confidential enquiries that [name of
provider] was eligible to participate in during [reporting period] are as follows:
[insert list].”

“The national clinical audits and national confidential enquiries that [name of
provider] participated in during [reporting period] are as follows: [insert list].”

“The national clinical audits and national confidential enquiries that [name of
provider] participated in, and for which data collection was completed during
[reporting period], are listed below alongside the number of cases submitted
to each audit or enquiry as a percentage of the number of registered cases
required by the terms of that audit or enquiry. [Insert list and percentages].”

“The reports of [number] national clinical audits were reviewed by the
provider in [reporting period] and [name of provider] intends to take the
following actions to improve the quality of healthcare provided [description of
actions].”
As part of the contractual requirements by the commissioners the Hospice
produces quarterly quality reports. As part of this report the Hospice comments
on clinical incidents and lessons learned.
Below are summaries of the incidents.
1. A patient fell out of bed whilst trying to go to the bathroom. Bed rails were in
place.
The patient sustained an injury to their head, a small gash to right elbow and
complained of right hip pain. The patient was hoisted back into bed.
Action: The patient was reviewed by a member of the Northern Doctors team
who reported the patient was moving all limbs and had a small bruise to their
forehead. The medical and nursing staff discussed further assessment with the
patient’s family who did not want the patient transferred to Accident &
Emergency. The patient was frail and in the terminal stage of their illness and no
further treatment would have been appropriate. Low harm
2. A patient was found sitting on the floor of their bedroom. The patients stated
they had been attempting to go to the toilet and was not sure how they had
ended up on the floor.
The patient was assisted to use the commode and returned to bed.
Action: Patient was checked by the Hospice physician no injuries were found.
The patient was moved to another room for closer observation. Falls risk
assessment updated. No harm
3. A patient was discharged for the hospice and their relative discovered that
some medication had been omitted on the patients discharge prescription. There
was also an inhaler included in the medication which was intended for another
patient.
Action: The patient’s relative had arranged for further supplies of the missing
medication from the local pharmacy. The patient returned the inhaler when they
attended Day care. No harm
4. A patient was found on the floor in their bedroom. The patient stated that
they had slipped to the floor whilst trying to apply cream to their legs. No injuries
sustained.
Action: The patient was reviewed by the hospice doctor not treatment required.
Falls risk assessment updated and patient reminded to summon assistance from
nursing staff to apply cream. No harm
5. A patient was found on the floor in their room. The patient’s walking frame was
in front of them. The patient stated they had been trying to go to the bathroom.
The patient was checked for injuries and none sustained. The patient was assisted
to the bathroom and then back to bed.
Action: The patient was assessed by the hospice doctor, no treatment required.
The patient was moved to another room for closer observation and a monitor
used in the room overnight. Falls risk assessment updated. No harm
6. Hospice staff contacted staff at North Tees Hospital on 02/02/15 to inform
them we had a bed for patient. There was a lot of confusion about how much
oxygen the patient required, this resulted in the patient transfer being arranged
for 05/02/15.
When the patent had not arrived by mid-afternoon hospice staff contacted the
hospital to postpone the transfer until the following day. Following a succession of
phone calls between the bed manager and hospice Director of patient care it was
agreed the patient would still be transferred on 05/02/15. The patient arrived at
the hospice at 20.10 hours.
Problems identified on admission:
o The patient arrived with their own medication, no discharge medication. A
hospital drug kardex on which some of the patients regular medication had
been crossed off. This gave hospice staff no indication of what medications
the patient was taking.
o The patient had their medical notes and the medical notes plus discharge
letter of a different patient.
Action: Following this and other subsequent incidents the Hospice Director of
Patient Care and Service Development has arranged to meet the Director of
Nursing at North Tees Hospital to discuss the issues. No harm
7. A patient was referred by Ward 27 North Tees Hospital for symptom control.
Hospice staff contacted staff on Ward 27 on 10/03/15 to arrange transfer of the
patient for 12/03/15. Hospice staff specified that it must be a morning transfer
and patient notes, discharge letter and medication to accompany the patient. On
the day of transfer the patient had not arrived by 14.00 hours. Hospice staff rang
the ward to postpone the transfer to the next day.
Action: Following this and other subsequent incidents the Hospice Director of
Patient Care and Service Development has arranged to meet the Director of
Nursing at North Tees Hospital to discuss the issues. No harm
8. A patient was referred by Ward 14 James Cook University Hospital. The
hospice doctor contacted the staff on Ward 14 on 12/03/15 to advise them we
could admit the patient on 16/03/15 and specified we would need medical notes,
discharge letter and discharge medication.
On 16/03/15 hospice staff contacted the ward and was informed that the patient
required oxygen therapy but that none had been ordered. The hospice RGN told
the ward that we would need the oxygen before the patient arrived and we were
happy to admit the patient as long as they were at the hospice by mid-afternoon.
The ward staff contacted the hospice again to say the patient had been taken of
their oxygen for 10 minutes and their saturations had fallen to 91%.
Action: The Hospice doctor explained that this was unacceptable and the
admission was postponed until 17/03/15. No harm
9. On 13/03/15 a patient was referred by Ward 28 North Tees Hospital. Hospice
staff contacted the ward and arranged admission for 18/03/15, the hospital staff
were informed that the patient would need to arrive on the morning of 18/03/15
with medical notes, discharge letter and discharge medication. The patient
required oxygen therapy and the hospice staff informed the hospital ward staff
that this would need to be ordered for 17/03/15 so it was at the hospice when the
patient arrived.
On the morning of 18/03/15 the hospital ward staff contacted the hospice to
inform us the ambulance had been ordered for 10.30am, hospice staff asked
about the oxygen and were initially told it had been ordered, the told it had not
been ordered, then told it had been ordered incorrectly. Despite the confusion we
were able to accept the patient.
Action: Following this and other subsequent incidents the Hospice Director of
Patient Care and Service Development has arranged to meet the Director of
Nursing at North Tees Hospital to discuss the issues. No harm
10. A patient was using the bathroom in Room 4 when 2 wall tiles above the door
fell of the wall to the floor and shattered. The patient was not injured by the tiles
and suffered no adverse effects.
Action: The bathroom was taken out of use and the tiles were replaced. No
harm
11. A patient was found on the floor of their bedroom. The patient stated they
had been to use the bathroom and on return to bed had missed the handrail on
the bed and slipped to the floor. The patient was assessed for injuries, none
noted. The patient was assisted to bed.
Action: The patient was reviewed by the hospice doctor, no treatment required.
Falls risk assessment updated and patient was reminded to summon assistance
when mobilising. No harm
12. A patient attending Day Care stood up from a chair and fell to the floor. The
patient stated they had got up to quickly. The patient was assisted to their feet
and checked for any injuries, none noted.
Action: The patient was reminded to take their time when moving from sitting to
standing position. No harm
Local Clinical Audit and Service Improvement
Butterwick Adult Hospice undertakes a series of audits in accordance with
Butterwick Hospice Care’s comprehensive annual audit programme.
The audit programme includes nationally validated audits from Help the Hospices
where available, internally designed audits and external infection control audits in
line with the Service Level Agreement with our local NHS Trust.
Please see below some examples of these audits, undertaken in the Adult Hospice
during 2014/15.
Infection Control Audit
North Tees & Hartlepool NHS Foundation Trust
Infection Prevention and Control Department
Feedback from Infection Prevention & Control Nurse Unannounced Visit
Butterwick Hospice, Stockton 6.5.15
Hand Hygiene
Score
100% all staff observed to be fully
compliant
Environment
93% see comments below
Standard Precautions
89% see comments below
Satisfactory (x3 mattresses checked,
inpatient and children’s unit)
Mattress checks
Good practice
√
Excellent first impressions with usual high standards evident
√
All staff helpful and welcoming throughout the unit
√
Evidence readily available to show cleanliness and mattress checks and
regular cleaning of equipment
√
Storage within the Children’s Unit notably improved.
Needs improvement

Day Unit - fabric recliner chair, identified as low risk, subject to regular
steam cleaning – replace with wipe cleanable when funding allows. Several
patient chairs discoloured – explore possibility of support from hygienist
team at UHNT regarding steam cleaning

Communal toiletries in use (inpatient unit and children’s unit - stored in
main bathrooms)

Inpatient unit – Sluice - slipper pan rack cracked & requires replacement
(highlighted previously)

Inpatient unit - raised toilet seal in 2-bedded room ensuite – underside
soiled and rusty

Inpatient unit domestic cupboard/flower room – wall damage/staining
behind sink – splashback tiling insufficient

Inpatient unit – some wash bowls once again stored in ensuite basins. As
previously agreed, need to be stored inverted on shower seat

Children’s unit – domestic cupboard/dirty utility – hand wash sink unable to
be accessed due to amount of domestic equipment

Children’s Unit – some enteral syringes, labelled ‘single use only’ are being
re-used. Addressed at the time and donated supply of syringes will be taken
out of use

Children’s unit – piano slightly dusty

2 sharps bin lids were not fitted correctly - both inpatient unit and Children’s
Unit. One sharps bin in Inpatient Unit not signed or dated

Although a schedule has been established for re-sealing of the wooden trim
and window sills throughout the hospice, there remains a large amount
outstanding which needs addressing in order for cleaning to be carried out
effectively
Julie Olsen, Assistant Matron, Infection Prevention and Control
Response Times to Referrals Audit
Day Care performance indicators 01 Oct 2014 - 31 Dec 2014
Target to make telephone contact with patient within 7 days of receiving referral form
Patients contacted within 7 days -98%
Patients not contacted within 7 days-3%
Target to invite patient to attend out-patient appointment within 2 weeks of referral
Patients visited hospice within 10 days -80%
Patient did not visit within 10 days-20%
Patients to attend day care within one month of receiving referral form
Patients attended-40%
Patients unable to attend in hospital-0
Patients unable to attend referred IPU-3
Died-33
Did not want to attend/could not attend-25
Friends and Family Tests
Stockton Site - January 15
Number of F&F Cards
issued:
Number of F&F cards
returned:
Response rate:
12
12
100%
Question 1:
How likely are you to recommend our service to Friends and Family if they needed similar care or
treatment?
Response:
Extremely Likely:
12
Likely:
0
Neither Likely nor unlikely:
0
Unlikely:
0
Extremely Unlikely
0
Question 2:
Can you tell us why you gave that response:
Comments :
An excellent facility.
Because its just a wonderful place to come and be so well looked after and to have caring people
to
talk to whenever you have a problem.
From my own experience I think its wonderful. Can't praise it
enough.
Because all the staff are so helpful, and give all the help required.
A very good team of staff and volunteers with patience and TLC.
Very friendly and helpful.
I think all the care I've received has all been excellent. I can't praise it
enough.
The personal care and attention is so very much thoughtfully given, shared and
appreciated.
110% Staff service & attention. Wonderful experience. Always.
Staff very friendly.
Stockton Site - February 15 Day Care
Number of F&F Cards
issued:
11
Number of F&F cards
returned:
11
Response rate:
100%
Question 1:
How likely are you to recommend our service to Friends and Family if they needed similar care
or treatment?
Response:
Extremely Likely:
10
Likely:
1
Neither Likely nor unlikely:
0
Unlikely:
0
Extremely
Unlikely
0
Question 2:
Can you tell us why you gave that response:
Comments :
I look forward to Butterwick every week, everyone is so good.
Everybody is so caring and friendly. The care I receive is more than
adequate.
The care is wonderful, very friendly, food is very good. No
complaints.
Because the staff are brilliant and caring:-also the volunteers. Because of recent circumstances
I was upset this morning and everyone was very sympathetic and helpful.
The staff & volunteers are wonderful so caring, it has given me so much more
confidence.
Because the care given and compassion shown is second to none.
Because the care is second to none it is very friendly and
wonderful.
Because the staff are brilliant also the volunteers, everyone is kind and will got the extra mile.
Stockton Site . March 15 Day Care
Number of F&F Cards
issued:
7
Number of F&F cards
returned:
7
Response rate:
100%
Question 1:
How likely are you to recommend our service to Friends and Family if they needed similar care or
treatment?
Response:
Extremely Likely:
7
Likely:
0
Neither Likely nor unlikely:
0
Unlikely:
0
Extremely
Unlikely
0
Question 2:
Can you tell us why you gave that response:
Comments :
The very professional attitude everyone has given me and the friendly surroundings
I feel the hospice is a wonderful place for relaxation & massage &
companionship.
I can only think of positives for the service and the staff and the other patients. The only
downside
(potentially) is that it may prove too popular and become oversubscribed.
Everyone is friendly & supportive. It is a time to be relaxed and feel the one being
cared for.
It is a very uplifting experience
Very friendly & helpful information always available, excellent treatment given. Meeting people in the
same
Situation which helps a lot.
The whole experience is something I look forward to, the treatment is hugely uplifting,
physically and
Psychologically. Every one is so friendly and supportive.
Research
The number of patients receiving NHS services provided by or sub contracted by
the Butterwick Adult Hospice Stockton on Tees in 2014-2015 that were recruited
during that period to participate in research approved by a research ethics
committee was: none. Butterwick Hospice Care’s current policy is that we do not
undertake primary research within the hospice.
Section 2.4: Use of the CQUIN payment framework
A proportion of Butterwick Adult Hospice’s income in 2014/15 was conditional on
achieving quality improvement and innovation goals agreed between Butterwick
Hospice Stockton and NHS Tees, through the Commissioning for Quality and
Innovation payment framework.”
“Further details of the agreed goals 2014/15 and for the following 12 month
period are available electronically at [N/A]”
Section 2.5: What others say about us
Statements from the CQC
Butterwick Adult Hospice, Stockton on Tees is required to register with the Care
Quality Commission and its current registration status is:


Diagnostic and screening procedures
Treatment of disease, disorder or injury
Transport services, triage and medical advice provided remotely
Butterwick Adult Hospice, Stockton on Tees has the following conditions on
registration:Conditions:‘The Registered Provider must ensure that the above regulated activities are
managed by an individual who is registered as a manager in respect of this
location.’
“The Care Quality Commission has not taken enforcement action against
Butterwick Adult Hospice, Stockton on Tees during 2014/15.
Butterwick Adult Hospice, Stockton on Tees has not participated in any special
reviews or investigations by the CQC during the reporting period.
The Butterwick Hospice is subject to periodic reviews by the Care Quality
Commission and its last review was 1st September 2014.
The Butterwick Hospice was fully compliant and rated as low risk following
assessment by the Care Quality Commission.
Selection of comments from the last CQC compliance assessment:-
Is the Service Safe?
We found that the provider had systems in place to ensure risks were readily
identified and assessed to ensure the safety of people who used the service. Staff
had completed safeguarding of vulnerable adults training with staff able to
explain safeguarding processes confidently.
Is the Service effective?
We found that visitors were able to visit their relatives and friends at the service
freely in line with people’s wishes.
People had their care and treatment needs assessed prior to admission to the
service. Relatives could have involvement with these assessments in line with
people’s wishes. Specific plans of care were developed from these assessments.
People were encouraged to express their wishes about how they wanted their
care to be delivered.
Is the service caring?
We saw that the service offered a range of holistic care and relaxation techniques.
Staff we spoke with spoke with kindness and compassion about the care they
provided to people. Car and support was offered to people who used the service
as well as their family members and friends.
Is the service responsive?
Care plans demonstrated that where the needs of people changed this triggered
reassessment and planning of care. Where appropriate this included intervention
and input from a range of health professionals. We saw that clinical decision
making was supplemented by a member of the TQRUYST Palliative care team
where necessary.
Is the service well led?
The provider had developed quality assurance systems to actively monitor and
assess the quality of the service they provided. The documentation we looked at
demonstrated that incidents were reported, investigated and analysed for
learning outcomes.
The provider had developed mechanisms to capture the feedback and experiences
of people who used the service, their relatives or representatives and this was
used to take forward actions to improve the service.
What people told us:
Comments made to us included:
“You cannot put a price on this place, they(staff) have been amazing, so very
caring, we have asked so many times where they find them, they are
unbelievable”
“They have helped us so much, I don1t know how we would be coping if we didn’t
have the care and support from here.”
I don’t know how they do it, but for a place filled with so much sadness, the staff
manage to bring out so much happiness”
The full compliance report can be viewed at www.cqc.org.uk .
Patient and Carer feedback
We receive many thank you cards and letters from patients their families and
carers which provides feedback on the quality of service provided by the Hospice.
This feedback also forms part of our CQUIN data and samples of the comments
received are therefore sent on a regular basis as part of the reporting process.
We have included a selection of these comments below:-
A great big thank you to you all. You can’t express what a joy it was to be looked
after you all, in that wonderful place. I do miss the baths and the pampering.
I bet the lamb has grown and got a lot bigger now. Happy memories. See you
soon in day care when I feel stronger. All my love ‘B’.
To all at the Butterwick, would just like to say a big thank you for looking after
Mam your all fantastic. ‘D’.
Thank you so much for the love and kindness you showed Mam and us. We will
never forget the special work the Butterwick does. Your all wonderful! Love and
Thanks. ‘C,J,S,M’ and families.
To all at the Butterwick
Thanks for everything you did for ‘C’. We would have been lost without you all.
Best wishes ‘C&T’.
To all staff at Butterwick. We would like to express our sincere thanks for all the
care and attention you gave to our Mum ‘MH’.
We will never forget the good times we were able to spend with mum, which will
stay with us forever. Your kindness and thoughtfulness at all times will never be
forgotten. You are a special team. Thanks’ for everything. W&S.
To all the staff of the Butterwick.
Thank you for the professional & caring way you helped my mum (MH) in her last
days, the care she received was beyond words.
Words cannot express our thanks to you all for the devotion & care you all gave
to my sister JW it meant so much to all the family, you are all angels in uniform,
your dedication is unswerving & believe me when I say this that J loved you all,
from the chats whenever we were unable to be there, all the love and kindness
from everybody, from M, all the nurses, volunteers, clinical staff in a word
everybody & may you go from strength to strength. Love to you all AR & family.
No words can say how much I owe to you for making ‘R’s’ last days much easier
than they would have been. I thank you all from the bottom of my heart and
know that you are all angels in my eyes. Thank you again, love ‘J’.
Thank you so much for taking care of dad. You were all very supportive and
compassionate towards him and all of us too. Love ‘B’.
It’s hard to put into words our feelings towards each and every one of you who
cared for my dad ‘R’ during the last 3 weeks of his life. We can’t really thank you
enough for trying to make him as comfortable as possible especially during his
last hours. We know you did everything you could to ease his suffering. You are
all very special and merely saying thank you just doesn’t seem enough. Forever
in our hearts, love ‘C&C’
Thank you for looking after my brother ‘TJ’ he was only in there a short while but
thank you and everybody else for all you did for hi. Thank you all so very much
‘I’.
To all staff and volunteers. We would like to express our heartfelt thanks for the
care provided for mum in her (almost) four weeks at the hospice. Not as we
feared a sad place, we were grateful and constantly amazed at how you were able
to provide beautiful gestures and ideas to make mum’s final weeks comfortable
and the best of everything. Your environment and ethos is wonderful-certainly
not a hospital!. Thank you as well for the support given to myself, the family and
mums friends. She was special, very brave lady with a beautiful smile- and even
in her final days she was able to show that, thanks to your care. With our very
best wishes and thanks. ‘C,P,E,& SM’.
Section 2.6: Data quality
NHS Number and General Medical Practice Code Validity
Butterwick Adult Hospice, Stockton on Tees did not submit records during
2014/15 to the Secondary Uses service for inclusion in the Hospital Episode
Statistics which are included in the latest published data.
The following mandatory statement is therefore not applicable to Butterwick Adult
Hospice Stockton:[Name of provider] will be taking the following actions to improve data quality [insert actions].
Butterwick Adult Hospice, Stockton on Tees was not subject to the Payment by
Results clinical coding audit during the reporting period by the Audit Commission.
Information Governance Toolkit attainment levels
Butterwick Adult Hospice, Stockton on Tees was asked to undertake the
Information Governance Toolkit during 2014/15.
Butterwick Adult Hospice, Stockton on Tees’s Information Governance
Assessment Report score overall score for [2014-14] was [68%] and was graded
green]”
Part 3 Review of quality performance 2013/14 (provider determination)
In our first Quality report last year three developments were chosen from the
business plan and Clinical Strategy Action Plan as our focus for quality
improvement and these are reviewed below.
Development 1: Patient Safety
Formalise regular education sessions for
clinical staff as part of the Palliative Care
Consultant sessions at the Hospice.
State how development was identified
Following the successful appointment of a Palliative Care Consultant at our
neighbouring Trust and the formalising of the three consultant sessions to the
hospice, we were keen to ensure that the three sessions were used as effectively
as possible to benefit patients and staff.
As we were developing services within the adult hospice which included caring for
patients with more complex palliative care needs and undertaking additional
procedures, we believed it was important to use one of these sessions for the
education of staff which would ultimately benefit patients.
How was it achieved?
Fortnightly education sessions lasting one hour took place between 2-3pm either
within the sitting room area on the in-patient unit or in the education room,
depending on the subject and if any resources were required. This time slot is
when the morning and afternoon shift are both on duty, thereby enabling more
staff to benefit from the sessions.
The topics covered were influenced by experience on the unit where a case
review may be discussed or a topic identified by staff to meet specific interest or
need.
Staff were also encouraged to participate in these sessions which included
facilitating a group discussing an article they have read or an issue that was very
relevant to the palliative care national or local agenda.
Review and evaluation of success of development
Attendance at sessions was recorded in the hospice’s training book and entered
onto the training database. All sessions were evaluated and the evaluations were
sent to the Quality and Practice Development nurse.
Participation by staff e.g. by leading a session was discussed in staff’s annual
Individual Development Review (IDR) and encouraged as part of staff
development.
These sessions helped staff develop skills and confidence in relation to complex
management of patient symptoms, helped them cope with difficult situations and
challenges through case reviews and offered opportunities for staff to develop
skills in facilitating groups and presenting. We noticed changes in individual staff
in regards to their coping strategies and confidence and this was monitored by
the Clinical Lead within the area of practice.
Development 2
Introduction of a Breathlessness Support
Programme
State how development was identified
In response to an invitation for non –recurrent funding applications, a
neighbouring hospice proposed a programme for patients with heart failure and
Chronic Obstructive Pulmonary Disease. As this proposal was discussed further
with the CCG, the programme developed into a support programme for patients
with long term and progressive pulmonary conditions. The CCG were keen to
provide equality of service over the whole of Tees and Hartlepool and therefore
Butterwick Hospice were asked if they could provide an equivalent service in the
Stockton area.
In their 2010 publication relating to the management of Chronic Obstructive
Pulmonary Disease in adults in primary and secondary care, the National Institute
for Health and Clinical Excellence stated an estimated 3 million people have COPD
in the UK and recognised that these patients require support from various
members of the multidisciplinary team. (NICE. June 2010). Whilst this is a
significant number of patients we must also acknowledge that breathlessness can
be related to other cardiac and pulmonary conditions.
This programme was to therefore help meet the needs of these patients by
establishing a support service for patients who have symptoms of breathlessness
related to a progressive non-cancer diagnosis e.g. COPD, Emphysema, pulmonary
fibrosis and by doing so, also provide a support network for their carers.
The vision of the Clinical Commissioners for Hartlepool and Stockton-On-Tees was
to improve health care by involving service users, carers, staff, providers,
partners and the public to develop services and reduce health inequalities by
working in partnership to transform services.
The Joint Health and Wellbeing Strategy for Stockton-On-Tees 2012-2018,
recognised the need to “Enhance the quality of life for people with Long Term
Conditions” and to “increase primary and community services to support care
closer to home and enable independent living”. (JSNA 2012)
The programme embraced the challenges of health care provision and aims to
work within local strategy requirements to provide safe, high quality, cost
effective care.
Many patients experience increased breathlessness for various reasons
throughout their illness progression. These symptoms are extremely distressing
for the patient and also traumatic for the carer involved in supporting the patient.
Patients are often cared for by members of their own family who may not have
any experience in health care. Carers often state that the worst thing is not being
able to do anything to help the patient when these exacerbations occur. This can
often lead to patients or carers contacting emergency services and patients being
admitted to hospital who could perhaps have remained at home given the
appropriate support.
The programme therefore focused on helping patients recognise and identify the
triggers which contribute to their exacerbations of breathlessness, develop coping
strategies and self-management skills to enable them to cope at these times. The
overall aim was to reduce the patient’s dependency on out of hour’s community
resources as well as reducing the number of inappropriate admissions to the
acute sector.
How was it achieved?
A key objective of the programme was to work alongside other care providers in
primary and secondary care to support patients and their carer’s in the selfmanagement of ongoing symptoms throughout their disease progression.
In order to provide equitable care across the commissioning locality, referral
criteria were identical across the Hartlepool and Tees area and the aims and
objectives of the programme were mirrored across both Butterwick and
Hartlepool Hospice. Referral criteria was agreed and a specific referral form
formulated.
A series of joint meetings have took place with our neighbouring hospice as well
as several meetings between staff at Butterwick Hospice, Community Matron and
Respiratory Specialist Nurse.
Core objectives of the programme was to:




Provide an integrated support service working in collaboration with
primary and secondary care.
Provide patients with self-management tools.
Increase social inclusion and peer support.
Deliver an innovative high quality service.
Signposting to other appropriate services.
The programme consisted of:



1
2
2
1
day per week of specialist day services for 6 weeks.
individual and 2 group counselling / psychotherapy sessions.
complementary therapy sessions
complementary therapy session for patient’s main carer.
In addition during the 6 week programme patients experienced and had access
to:






Weekly relaxation session
Weekly Tai Chi session
Access to diversional activities such as creative writing
One to one advice and support from nursing staff during weekly
sessions
Benefits advice
Bespoke support for smoking cessation and medicine management
where applicable to patients
Carers accessed tuition in providing hand or foot massage
The majority of patients were identified and referred to the service by the
Respiratory Specialist Nurses at University Hospital of North Tees (UHNT) and the
Community Matrons who were able to identify patients who could benefit from
this programme and who may already have had hospital admissions for anxiety
related breathlessness or may have the potential to do so.
Following the structured 6 week period the patients were referred back to the
original referrer.
Non –recurrent funding from the CCG enabled this 12 month pilot programme to
take place and has been evaluated in regards to continuing funding after the 12
month pilot.
Review and evaluation of success of development
The service was audited/evaluated quarterly using recognised audit tools to
identify patient and carer benefits and any areas for improvement. i.e.

Key Performance Indicators determined by the clinical commissioners.

Patient/Carer feedback in the form of a questionnaire. (MYCAW, Family &
Friends Test)

Referrer feedback questionnaire.
The findings of the audit and evaluations are below:
BUTTERWICK HOSPICE CARE
BREATHLESSNESS SUPPORT GROUP
UPDATE REPORT.
OCTOBER 2014
This report provides information on the Breathlessness Support Programme
delivered at Butterwick Hospice Stockton. The report includes information on
attendance and costings for the service.
A breakdown of referrals and evaluation of the service is provided as appendices
for more comprehensive information.
The Breathlessness Support Group programme was developed in April 2014 with
the aim of meeting the needs of patients who experience increased
breathlessness for various reasons throughout their illness progression. These
symptoms are extremely distressing for the patient and also traumatic for the
carer involved in supporting the patient. Patients are often cared for by members
of their own family who may not have any experience in health care. Carers often
state that the worst thing is not being able to do anything to help the patient
when these exacerbations occur. This can often lead to patients or carers
contacting emergency services and patients being admitted to hospital who could
perhaps have remained at home given the appropriate support.
The objective of the Breathlessness Support Group is to provide a support service
for patients who have symptoms of breathlessness related to a progressive noncancer diagnosis e.g. COPD, Emphysema, and by doing so, also provide a support
network for their carers.
This service links in with the commissioners vision to improve health care by
involving service users, carers, staff, providers, partners and the public to
develop services and reduce health inequalities by working in partnership to
transform services.
The Joint Health and Wellbeing Strategy for Stockton-On-Tees 2012-2018,
recognises the need to “Enhance the quality of life for people with Long Term
Conditions” and to “Increase primary and community services to support care
closer to home and enable independent living”. (JSNA 2012)
The Breathlessness Support programme strives to embrace the challenges of
health care provision and work within local strategy requirements to provide safe,
high quality, cost effective care.
The programme focuses on helping patients recognise and identify the triggers
which contribute to their exacerbations of breathlessness, develop coping
strategies and self-management skills to enable them to cope at these times. The
overall aim is to reduce the patient’s dependency on out of hour’s community
resources as well as reducing the number of inappropriate admissions to the
acute sector.
The initial plan was that patients would be identified and referred to the service
by the Community matrons using the Predictive Risk Score which is used to
identify patients who have a high risk of potential hospital admissions. Since
commencement of the programme patients have been referred to the service by
various professionals including Physiotherapists, General Practitioners, Macmillan
Nurses, C.O.P.D. nurses and Practice nurses.
Following the structured 6 week period the patients are referred back to the
original referrer.
Core objectives of the programme
1. Provide an integrated support service working in collaboration with
primary and secondary care.
2. Provide patients with self-management tools.
3. Increase social inclusion and peer support.
4. Deliver an innovative high quality service.
5. Signposting to other appropriate services.
The programme consists of





1 day per week of specialist day services for 6 weeks.
2 individual and 2 group counselling / psychotherapy sessions.
2 complementary therapy sessions
Access to a 24 hour advice line.
1 complementary therapy session for patient’s main carer.
Staffing Resources and Skill mix:






Clinical Manager- to manage the delivery, development and evaluation of
the service.
RGN – responsible for ensuring the assessment and treatment plan for the
patients.
HCA – responsible for providing supportive care, will also provide relaxation
therapy.
Complementary Therapist – to provide complementary therapy to patients
and carers.
Counsellor- to provide group and one to one counselling sessions.
Administrator- to collate information and produce statistics
Evaluation
On completion of the 6 week programme patients and carers are asked to
evaluate the service by completing a questionnaire. General comments are very
positive and include:
SUMMARY OF PATIENTS COMMENTS.

More relaxed and less anxious about my COPD, more able to talk about it,
realising I can do more daily activities

I have learnt a lot from talking to other people in the same situation.


I feel more aware about my breathing and how to keep calm and in
control.
Initially attendance demanded a welcome discipline and subsequently gave
me an opportunity to hear other opinions as well as a venue for expressing
my own.
I have become less anxious. Use the breathing techniques taught.

Very calming and relaxing am very sorry it has come to an end.

Helped to sort out some home issues, so very helpful.

My breathing is better and I feel less anxious.

I am more relaxed and peaceful. I don’t feel so tensed up.

SUMMARY OF CARERS COMMENTS

His breathing is amazing compared to how it was.

Made a huge difference in my dad's life.

I experienced an extremely good neck/shoulder massage.

We both feel this programme was very worthwhile.

I had reflexology and was sceptical but found no problems for a good week
so excellent.
There is no significant improvement in her breathing; however she is able
to control her breathing a lot better.


I enjoyed hearing about the programme when she had gone. I think it's
done Mam good to be with people with the same sort of problems.
A comprehensive record of the information and comments received is included
with this report.
Attendance figures
Referrals
received
45
Patients
attended
programmes
1.2. & 3.
25 = 55%
Patients booked
on future
programmes.
Patients
offered place
but declined.
Patients
requesting
inclusion in 2015.
10 = 22%
9 = 20%
1 = 2%
Development 3: Patient experience
Establish a service user advisory group
State how development was identified
We were aware that patient or service user groups had been established in the
acute sector for some time and also that other hospices had successfully created
groups of carers/service users which had been very beneficial in providing a
patient/user perspective on services provided, new services being developed and
information being provided to people using the services.
Nationally it is seen as good practice to involve patients or carers in these
discussions and many organisations have a patient or carer representative
attending multi-disciplinary meetings.
We had previously discussed the value of having our own service user group in
several clinical meetings but were aware of the difficulties in finding suitable
representatives due to the nature of the service where patients may be too poorly
to contribute or may have a short life expectancy and would be difficult to
establish continuity for the group.
Following our stakeholder questionnaire last year, valuable comments were
received in regards to what the professionals thought would be beneficial for their
patients, both in regards to types of services provided, activities offered within
the Day Care setting and whether the taboo surrounding hospice care prevented
many patients attending and benefiting from the services offered by the Hospice.
We had developed new services over the last few months which had required
patient leaflets as well as information for professionals to be designed and
developed and believe that a specific service user group would be particularly
beneficial when developing these; especially regarding the language and
terminology we so often use and take understanding for granted.
We therefore decided that in order to benefit from the direct views of the people
actually using our services or we would make this one of our priorities for
2014/15.
How was it achieved?
We consulted with other hospices who had successfully established a similar
group.
We also formulated and agreed terms of reference for the group in order that the
group would have a clear purpose and aims.
As part of our patient/user satisfaction surveys we asked for interested parties to
express their interest.
In September we held an open event for the public which enabled people to have
a tour, view the facilities, learn about the services available and during this event
we had information available about the service user group and to enable them to
express interest in joining this representative group.
Review and evaluation of success of development.
The recruitment of suitable representatives was key to the achievement in the
development of a service user group. Unfortunately although the Hospice spoke
to service users and advertised for people to join the group at the Hospice open
day no one expressed an interest in attending.
This could be due to the type of service we operate as many patients are
admitted for acute symptom management or end of life care. Many service users
accessing the family support service have experienced bereavement and
therefore are trying to move on with their life and coping with the loss of their
loved one.
The Hospice will continue to pursue the potential of establishing a service user
group as their participation and input would be invaluable in service development.
3.2 An explanation of those involved in this quality account
The Quality Account was discussed at the Hospices Management Team meeting
which is chaired by the Chief Executive and includes clinical and non clinical
managers, the Director of Patient Care and Service Development and the Director
of Finance.
The task of writing it was delegated to the Registered Manager with a statement
from the Chief Executive.
The Quality Account was also discussed at the Senior Clinical Meeting where the
quality priorities were agreed.
It has also formed part of an Agenda item of the Clinical Strategy and
Governance Committee which is a key element of the Charity’s governance
structure: the Minutes of which are distributed to the Board of Trustees as will a
copy of this Quality Account.
Once completed the Quality Account was distributed to Clinical and non clinical
Managers for comment and approval. The completed Quality Account was then
forwarded to Hartlepool & Stockton on Tees Clinical Commissioning Group and the
local Healthwatch team to approve and comment on the quality priorities
mentioned in the report.
This Quality Account was sent to Healthwatch Stockton in May for comments;
however no comments have been returned.
Please see below statement from Hartlepool and Stockton on Tees Clinical
Commissioning Group.
ANNEX: Statements from Commissioning Group and Local Healthwatch
Team.