The Butterwick Hospice
at
Bishop Auckland
Quality Account
2014 - 2015
The Butterwick Hospice at Bishop Auckland
Woodhouse Lane
Bishop Auckland
Co Durham DL14 6JZ
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 Hospice at Bishop
Auckland 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 the Hospices’ services are
provided totally without charge to our patients and their carers.
The day to day operational management of the Butterwick Hospice at Bishop Auckland’s clinical
services are 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 at Bishop Auckland 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 8th
July 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/1-113000544.
During the last year we have worked effectively in partnership with NHS Durham Dales, Sedgefield &
Easington Clinical Commissioning Group and other partners for the benefit of the community we freely
serve.
In the year the Hospice has achieved the Commissioning for Quality and Innovation (CQUIN) outcomes
detailed in the 2014/15 Contract with the NHS Durham Dales, Sedgefield & Easington Clinical
Commissioning Group.
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
Trustee’s continue 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
a. Priorities for improvement 2015-2016
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 this priority 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.
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 to the individual’s care or treatment.
The Hospice will incorporate these assessment forms in everyday practice.
How will this priority 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 fedback 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.
Patient experience

Priority Three
To introduce the Child Bereavement
Service Questionnaire within the
Family Support Team.
How was this identified as a priority?
A large proportion of the holistic services provided by the Hospice is bereavement support for adults
and children. In order to continually improve services gaining feedback from service users is vital.
There are various evaluation tools available to gain feedback for family support however there is none
that are specifically designed to evaluate feedback from children who are accessing bereavement
support. The Childhood Bereavement Network has been designing a tool specifically for the use by
children following bereavement support.
The Child Bereavement Service Questionnaire (CBSQ) has been developed through a lengthy process
of consulting, drafting, reviewing and piloting with children and young people, parents, and
practitioners of child bereavement services across the UK.
The aim of the CBSQ is to evaluate the effectiveness of services for bereaved children by looking at
changes in scores before and after accessing bereavement support. The child or young person is asked
to complete the form. There are 3 versions of the form:
 Child form (for under 11 years old) with 6 questions
 Young person long form (for over 11 years old) with 38 questions
 Young person short form (for over 11 years old) with 15 questions.
The parent or carer is also required to complete equivalent forms.
As well as gaining valued feedback from the individual child or young person the CBSQ can also
provide data on the effectiveness of the family support service.
How will this priority be achieved?
The Child Bereavement Service Questionnaire is licensed to the Childhood Bereavement Network. The
Head of family support will contact the network to inform them that the hospice will be implementing
their evaluation questionnaire.
Guidance notes will be issued to members of the family support team in relation to how to implement
and review the Child Bereavement Service Questionnaire.
The family support team meet monthly. The Child Bereavement Service Questionnaire will form part of
the agenda in order for any issues implementing the questionnaire can be highlighted and discussed.
How will progress be monitored and reported?
The pre and post completed questionnaires will be filed in clients notes and may be subject to auditing.
Quarterly evaluation reports will be produced comparing the initial average scores with the review
average scores. In each case you would expect the score to increase from pre to post access of the
service.
The results of the questionnaires will be discussed at the Integrated Governance meeting which has
both clinical and non clinical representation. Any action plan following the evaluation will be agreed and
circulated to the family support team to action.
The minutes of the integrated governance meeting forms part of the agenda in the Clinical Governance
and Strategy Committee which has trustee representation.
2.2
Review of services
During 2014/15 the Butterwick Hospice at Bishop Auckland provided five key services:
 Hospice at Home
 Family support and bereavement service
 Neurological service
 Day Hospices across 4 sites
 Outpatients
We have reviewed all the data available on the quality of care in all of the above services.
Below are some comments from a patient evaluation based on the impact the Hospice has to quality of
life.
‘Do you feel the involvement with the Hospice has had an impact on your quality of life?’









“It enables me to get out and talk with other people with similar problems”
“I feel I could not cope without the help received from all staff and volunteers. I
would recommend the Hospice to others for support”
“Someone to turn to, I would have no one else”
“The Hospice has really improved my quality of life and given me sense of hope”
“I really enjoy the Hospice. Friendly and always there to help you”
“Mrs Butterwick, thank you from the bottom of my heart x “
“Opportunity to talk to other people with same problems. More social interaction”
“I am a new person. My family and myself feel we have had help and advice that
has helped hugely. Thank you”
“Helped to live with my loss and realise life is still worth living”
A patient’s experience of the Butterwick Hospice at Bishop Auckland
‘The Butterwick Hospice at Bishop Auckland’
I’d had a few months of not being well and was then given a diagnosis which was really scary. I had
District Nurses, MacMillan visits and GP and Consultants and I was tired. It was suggested somewhere
down the line that I visit the Butterwick Hospice for a day.” What me? A hospice? I have no intention
of dying yet” was my reaction. Well, I was persuaded for one day to go – not keen but the suggestion
was kindly meant. I was given comfortable, caring transport in the care of two wonderful gentlemen
drivers, Txx and Pxxx – volunteers! Met at the hospice door by Nurse Axx with a warmth and
friendliness so caring. Then shown around every area of the building by a long term volunteer,
another Axx, all Axx’s are lovely. I was seated comfortably in the right sort of armchair for me,
footstool if wanted and offered tea, coffee and scones. The seven or eight other patients, used to us
new nervous people, smiled and waved over and soon we were chatting. Now in a hospice I’d thought
all would be about how ill we are, what we had wrong and treatments etc. No, we are there to talk a
bit, share the past week and then be just like any other group of people. Families, plans, social bits,
interests – all sorts. A day passes very quickly. Tea, coffee or juices whenever, delicious lunches
cooked on the premises. Back in the lounge from the delightful dining room, more drinks and sweets
on the many coffee tables. Now that’s the social type of things which is relaxed, homely and
comforting. Meanwhile the nurses and volunteers don’t sit in an office somewhere, they are right there
with us. Always available to listen, advise, and take part in whatever we’re doing and ready to step
into a need. In the many side rooms, treatments are available from physiotherapy, chiropody,
massage, lymphoedema clinics etc. We’ve had parties and pantomimes, bingo and quizzes; one
volunteer will varnish our nails, another interest us in crafts and music. All have something to offer
and do so generously. Did I infer that now I go every week – I do. A day of caring for me and a day to
himself for my husband who deserves it.
If it is suggested to you, please try it. Not because you are dying, but because you are living.
Thank you Butterwick.’
The income generated by the NHS services reviewed in 2014/15 represents 100% of the total income
generated from the provision of the NHS services by the Butterwick Hospice for 2014/2015. The
income generated from the NHS represents approximately 45% of the overall patient care costs
incurred by the Hospice.
2.3
Participation in Clinical Audits, National Confidential Enquiries
During 2014/15 there were no clinical audits or national confidential enquiries covering NHS services
relating to palliative care. The Butterwick Hospice at Bishop Auckland only provides palliative care
therefore were ineligible to participate.
Local Clinical Audit and Service Improvement
During 2014/2015 the Hospice performed several audits using Help the Hospices (the national umbrella
membership Organisation for independent charitable Hospices) audit tools which are nationally
recognised and which set a benchmark to monitor the quality and efficiency of Hospice services across
the country.
Audits performed during 2014/2015











Record Keeping
Day care admission and initial assessment
Response times to Day Care referrals
Preferred place of care
Support Team Assessment schedule
Medication documentation
Patient questionnaires
Carer questionnaires
Bereavement evaluation tool Response times to referrals and assessment
Infection control audits.
Friends and Family Test
PREFERRED PLACE OF CARE
Results March 2015
INTRODUCTION
Following publication of the preferred place of care document evidence suggested that whilst more
than 50% of patients wish to die at home fewer than 20% actually do so.
The hospice was approached by the End Of Life Project Co-ordinator from Cancer Care Alliance to audit
the preferred place of care for patients within the Palliative Hone Care Services.
CRITERIA
The sample used was looking at 36 sets of notes of patients who died between January – March 2015.
CONCLUSION
The results showed that the preferred place of care was recorded in all cases.
5 patients did not die in the preferred place of care while the remaining 31 died at their preferred place
of care, as they wished. This highlighted that within the Palliative Home Care Service 86% of patients
died in their preferred place of care.
RECOMMENDATIONS

Continue to audit a sample of patients who have died in a 3 month period. This is in order to
identify any underlying trends also to improve recording of information and to identify any areas
for improvement in the service.

Ensure the information regarding PPC is recorded for each patient to provide accurate audit
results.
RESULTS
The results are as follows:
32
30
28
26
24
22
20
18
16
14
12
10
8
6
4
2
0
Died in Preferred Place
of Care
Did not die in Preferred
Place of Care
Not Recorded
No. of Patients
t
ar
n
ep
S
M
Ja
-M
0
9
r
-
-
0
9
9
0
0
7
M
ay ar
1
N
0
ov
O
c
1
t
0
1
0
A
M
p
ay
r
1
1
O
O
c
t
ct
1
1
D
Ja
ec
n
1
1
M
A
a
p
r
r
1
2
D
ec
Ja
n
1
2
Ju
Ju
n
1
l3
S
e
O
p
t
ct
1
3
D
Ja
ec
n
1
3
M
A
ar
p
r
1
4
J
Ju u n
e
l1
4
S
e
O
pt
ct
1
4
Ja
D
n
ec
1
M
4
ar
ch
1
5
ct
A
p
n
6
0
Ja
ct
O
O
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Died in
Preferred
Place
Died
Elsewhere
Not
Recorded
Hospice Hand Hygiene Audit
Hospice: Bishop Auckland Day Unit
Calculation:
yes
x 100%
yes + no (do not include N/A
responses)
Adult / Children
Auditor: Julie Olsen
Audit score: 100%
Audit date: 18.6.14
Yes
1
Wall mounted handrub is available at the entrance/exit to the dept.
√
2
Up-to-date hand hygiene awareness posters are on display.
√
3
All staff comply with the uniform policy and bare below the elbows
guidance.
√
4
Clinical hand wash sinks are designated for handwashing only and are
accessible, clean, free from plugs, overflows, equipment, and patient’s
property.
√
5
Elbow operated or sensor taps are available at all clinical hand wash
sinks.
Liquid soap, paper hand towels and a foot operated waste bin are
available at all hand wash sinks.
√
7
Handrub is available in all patient zones (via wall or bed end mounted
dispensers and/or personal handrub dispensers carried by HCW).
√
8
A wall mounted hand cream dispenser is available on the ward/dept.
√
9
All hand hygiene product dispensers are clean and filled, and drip
trays are clean.
Staff are aware of when it is not appropriate to use handrub
(question 2 staff).
Staff decontaminate their hands before serving meals to the patients
(question/observe two staff).
√
6
10
11
√
√
√
No
N/A
Hospice Standard Precautions Audit
Hospice: Bishop Auckland Day Unit
Calculation:
yes
x 100%
yes + no (do not include N/A
responses)
Adult / Children
Auditor: Julie Olsen
Audit score: 100
%
Audit date: 18.6.14
Yes
1
There is an adequate supply of gloves and aprons available, stored in
dispensers.
√
2
Gloves are worn as single use items.
√
3
Face masks (surgical and FFP3) and face visors are available.
√
4
Staff are observed using and disposing of PPE appropriately
Staff are aware of correct procedure to follow when dealing with
blood spillages (question two staff).
5
√
Sharps bin assembly and accidental exposure to bodily fluid posters
are on display
√
7
Sharps bins are positioned safely, assembled correctly and closed
when not in use.
√
8
Sharps bins are less than two thirds full and free of non sharp items.
√
9
Sharps are disposed of at the point of use (observe/question two
staff)
Locked sharps bins are labelled correctly and stored in a designated
secure room prior to collection.
√
11
12
13
Blood glucose meter storage boxes are free of used sharps.
Staff know what actions to take in the event of a needlestick injury
(question two staff).
Staff understand what post exposure prophylaxis (PEP) is, and how
to access it (question two staff).
N/A
√
6
10
No
√
√
√
√
Performance Indicators
Response time to referrals
October - December 2014
Targets
1. To make contact with patient within 5 working days of receiving referral form
2. To assess the patient within 7 working days of receiving referral form
3. For patient to attend day care within 15 working days of receipt of referral
17 sets of notes from Bishop Auckland and Outreach Day Care Services were audited. These were
notes of all new referrals received from the 1 st of October to the 31st December 2014.
Results
Please see tables attached.
Conclusion
Overall all Day Hospices met targets as stated above.

The results highlighted that 100% of the patients were first contacted within 5 working days.
59% of patients were assessed within 7 working days and 35% of the patients attended for
their first day care session within 15 working days.

Where target hasn’t been met, this is usually in a circumstance where the patient has been
unable to attend sooner. In these circumstances, 2 patients requested dates to suit them which
were later than target, 2 patients was receiving treatment and wanted to wait until their
treatments were finished, 1 patient wished to access after the Xmas period, 1 patient was too
poorly to attend and 5 patients did not wish to access the service.
Action Plan
The next audit will be completed in 3 months.
18
16
14
12
5 Day Target
10
7 Day Target
8
15 Day Target
6
4
2
0
Day Care Referrals
As part of our contractual requirements with commissioners the Hospice produces quarterly
quality reports. Part of the reporting system incorporates clinical Incidents and Lessons
learnt.
Below is a summary of incidents and reported outcomes.
A patient attending the neurological outpatient service attempted to walk into the garden via the day
room patio doors. As he stepped onto the decked walkway he slipped and fell to the floor. He was
checked for injuries and his next of kin was informed. No injuries were apparent.
The decked walkway was very slippery as it had been raining. Signs are now displayed advising
people not to walk on the decked area when wet. A maintenance request form was submitted for anti
slip grips to be fixed to the decked area.
This highlighted some issues with surfacing areas where patients had access. To promote patient
safety all areas were risk assessed to minimise patient falls. No harm
A patient stood next to a chair to remove his T shirt in order to receive a back massage. He lost his
balance and fell to floor. Patient Checked by Lead Nurse for injuries. No injuries apparent. A Falls risk
assessment repeated. No further action required. No harm
A patient who attended the neurological day from a care home usually took responsibility of taking
her own medication from the doset box sent with her. The daughter telephoned the Hospice reporting
that her mother had not taken her medication when it was due.
Care home contacted who stated the doset box had been sent with patient. The daughter was
contacted and she explained that the medication times had changed. Her mother was used to taking
her medication but due to the time change had forgotten. Record made in patient’s records to
prompt patient to take medication in future visits to Hospice.
The Taking own Medication in day Hospice procedure was reviewed and amended. No harm
Note: the number of clinical incidents occurring within the Day Hospice are few due to
patients being under supervision within a large day room.
Part 3
3.1
Review of quality performance 2014- 2015
Development 1: Patient Safety
To introduce a clinical champion for
oxygen and HOOF management.
State how development was identified
An estimated 3 million people have Chronic Obstructive Airway Disease in the UK. The NICE Guidance
for COPD 2010 identified that people with end stage COPD should be given care from a
Multidisciplinary Palliative Care Team.
The number of people referred to the Hospice with a non cancer diagnosis had increased significantly.
The Hospice now provides care to 45% patients with a non cancer diagnosis.
There was also an increase in the number of patients attending the Hospice who require long term
oxygen therapy. Following an incident when a staff member accidentally dropped a transportable
oxygen bottle causing some oxygen to escape it highlighted the importance of training regarding
transportation, storage and management of oxygen. In order to ensure patient safety a Registered
Nurse would be identified as a Clinical Champion to take the lead in the management of patients who
require oxygen therapy and to implement training to the rest of the clinical team.
How was it achieved?
A clinical staff meeting was held to discuss the introduction of a Clinical Champion in relation to oxygen
and HOOF management and a Registered Nurse was identified who had an interest in Chronic
Obstructive Pulmonary Disease.
External training was provided by a clinician to the nominated Clinical Champion with regards to
Oxygen and HOOF management.
The Clinical Champion then arranged a series of training sessions with all the clinical staff in relation to
safety management of oxygen, safe storage of oxygen, safe transportation of oxygen, ordering of
oxygen and safe administration of oxygen.
The Clinical Champion then formulated a competency framework for the management / administration
/transportation and storage of oxygen.
The Clinical Champion reviewed the competencies of all clinical staff using the competency framework
for the management/administration / transportation and storage of oxygen.
Review and evaluation of success of development
Staff training records have been updated once staff had completed training in transportation/ storage
and management of oxygen therapy.
Individual competency records were completed and kept in individual staff files.
An evaluation of patient records and completed HOOF forms was performed to ensure information was
fully completed and accurate.
An audit was performed into the correct storage of oxygen on the Hospice premises.
Development 2 Clinical Effectiveness
The implementation of the Carers
support Needs Assessment Tool
State how development was identified
End of Life Care policy and guidance recognised the important contribution of family carers to patient
support and recommended that their needs should be assessed in order to support them in their caring
role.
Although the Hospice mission statement identified the needs of carers as well as the patient the
Hospice did not use a specific evidence based tool directly for carers. Previously carers needs were
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 was it achieved?
The Hospice Registered Manager and Palliative Home Care Leader attended a training workshop on the
implementation of the Carers Support Needs Assessment Tool.
Training sessions were then delivered to the nursing team on the background to using the tool and how
to implement the assessment tool in practice.
The assessment documents were distributed to the nursing team in order to introduce the assessment
process to carers during their first visit.
Letters were sent to the District Nursing Teams informing them that the Hospice was introducing the
Carers Support needs assessment tool within patient’s homes.
Monthly data was 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.
CSNAT data 1st April 2014-31st March 2015
Number
Number
Number
Number
of
of
of
of
new patients referred to the service
CSNAT forms distributed
CSNAT forms completed
action plans completed
113
72
52 (72%)
97%
A questionnaire was completed by the nursing team prior to the implementation of the tool and then 6
months after the tool had been distributed.
Review and evaluation of success of development
CSNAT Evaluation
April 2015
INTRODUCTION
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).
AIM
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.
RESULTS AND EVALUATION
18 Questionnaires were given out and 7 questionnaires were returned giving a 39% response
rate.
Where the carer had ticked that there was an area they felt they needed more support with,
guidance was given to the carer.
Where the carer highlighted that they needed help with financial, legal and work issues the
details were given for the Macmillan Welfare Support group.
Where the Carer identified they needed more support with equipment for their relative, the
details were given for the Occupational Therapist.
A carer identified that they needed very much more support for getting a break overnight,
therefore the details for the Home Care Team (overnight sitters) was given to the carer and
advice on who to contact to refer into the service.
Advice and support were given for any general worries about their relative’s condition, and their
own needs and wellbeing.
“For each statement, please tick the box that best represents your support needs at
the moment.”
Do you need more support with:
1. Understanding your relative’s illness?
No
5
A little more
1
Quite a bit more
1
Very much more
0
2. Having time for yourself during the day?
No
6
A little more
0
Quite a bit more
1
Very much more
0
3. Managing your relatives symptoms, including giving medicines?
No
6
A little more
1
Quite a bit more
0
Very much more
0
4. Your financial, legal or work issues?
No
5
A little more
0
Quite a bit more
2
Very much more
0
5. Providing personal care for your relative (e.g. dressing, washing, toileting)?
No
6
A little more
1
Quite a bit more
0
Very much more
0
6. Talking with your relative about his or her illness?
No
5
A little more
1
Quite a bit more
1
Very much more
0
7. Practical help in the home?
No
5
A little more
1
Quite a bit more
1
Very much more
0
8. Knowing what to expect in the future when caring for your relative?
No
4
A little more
1
Quite a bit more
2
Very much more
0
9. Getting a break from caring overnight?
No
6
A little more
0
Quite a bit more
0
Very much more
1
10. Anything else?
Comments:
‘All questions have been based on the current situation; some may change as mum’s
illness progresses.’
Patient experience

Priority Three
Implementation of the NHS Friends
and family test within the Hospice.
State how development was identified
Improving patient experience is a key priority for the Hospice and also incorporated in the
Governments vision and is set out in the White Paper `Equity and Excellence`. The 2012/13 Operating
Framework made clear the priority for the NHS was to put the patient centre stage and to have a focus
on improving patient experience.
The NHS Outcomes Framework Domain 4 focuses on ‘ensuring that people have a positive experience
of care’.
The Francis Inquiry report into Mid Staffordshire NHS Foundation Trust highlighted the importance of ‘a
timely, effective mechanism to draw attention to failings to provide adequate level of care’ and in
addition it was important that feedback is gathered from a full range of patients.
The Friends and Family Test is a simple, comparable test which provides a mechanism to identify poor
performance and encourage improvements where services do not live up to the expectation of
patients. It is a quick, consistent, standardised patient experience indicator and will provide a simple,
easily understandable metric based on near time experience, which is comparable from a patient’s
point of view and can act as a benchmark for organisations.
The friends and family Test will enable the public to compare healthcare services, identify those who
are performing well and allow other organisations to improve their services.
How was it achieved?
The Friends and Family Test was produced on a postcard. Information was then displayed in the
Hospice informing patients about the Friends and Family Test. In order to ensure confidentiality and
anonymity for patients’ postcards were posted on completion into a box in the Hospice reception.
The results from the Friends and Family Test were then inputted onto the Hospice database. Results
were then displayed in the Hospice on a monthly basis and the results were also forwarded to the
Clinical Commissioning Group.
Review and evaluation of success of development
The results of the Family and Friends Test were collated into a report with a completed action plan.
This report was then discussed as part of the Integrated Governance meeting which has representation
from all Hospice departments.
Below are some results from the Friends and Family Test
Bishop Auckland. JANUARY 2015:
Number of F&F Cards issued:
Number of F&F cards returned:
Response rate:
8
8
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:
8
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 staff and volunteers will do anything they can for you.
Coming to this hospice gets me out of the house and gets you to mix and meet some lovely people.
The most caring staff and volunteers I've ever come across. Also there is always something we can all take
part in . The cook is very good meals are excellent!! Well done to all.
In my continuing experience as as patient:- Things were great and only getting better.
Because it's true. I've been coming for months and the reason I'm here, you can't get better treatment than here.
Because it is a happy friendly atmosphere. The staff can't do enough for you and are always prepared to
go that one step further.
Comments recorded but requested not to be made public.
Butterwick has given me lot of confidence meeting other patients with problems.
Bishop Auckland. February 2015:
Number of F&F Cards issued:
Number of F&F cards
returned:
Response rate:
7
7
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:
4
Likely:
3
Neither Likely nor unlikely:
0
Unlikely:
0
Extremely Unlikely
0
Question 2:
Can you tell us why you gave that response:
Comments :
Everyone is so kind.
Excellent care provided at all times by staff & volunteers in pleasant surroundings.
Very friendly place and well cared for.
The services provided by Butterwick are very good and the staff are probably the best in the NHS.
It is good for mixing with other people who are the same problems.
I am lonely at home.
Everyone very kind and helpful. I love the care and attention shown to me by the staff and I enjoy coming
very much.
The results formed part of the minutes for the Clinical Governance and Strategy Committee which has
trustee representation.
The National Council for Palliative Care: Minimum Data sets
We have chosen to present information from the NCPC minimum data set which is the only information collected nationally on Hospice activity. The
figures below provide information on the activity and outcomes of care for patients accessing the Butterwick Hospice in Bishop Auckland and outreach
services.
Day Hospices
No' of Patients who attended
Bishop Auckland Day Hospice
No' of attendances to Bishop
Auckland Day Hospice
No' of Patients who attended
Richardson Day Hospice
No' of attendances to Richardson
Day Hospice
No' of Patients who attended
Weardale Day Hospice
No' of attendances to Weardale Day
Hospice
No' of Patients who attended
Sedgefield Day Hospice
No' of attendances to Sedgefield
Day Hospice
Palliative Home Care Team (PHCT)
No' of Patients who received care
from the PHCT
No' of Contacts from PHCT
Total No' of Hours of Care given
Physiotherapy
No' of Patients who were seen by
the Physio at Bishop Auckland
Hospice
April 07 March 08
April 08 March 09
April 09 March 10
April 10 March 11
April 11 March 12
April 12 March 13
April 13 March 14
April 14 March 15
102
89
147
106
91
116
108
105
1407
1229
1250
1049
1317
1317
1208
1196
20
21
38
29
15
37
25
13
307
349
342
264
208
237
300
284
28
28
30
35
17
34
24
15
308
346
300
266
264
284
277
273
29
20
33
30
22
28
23
20
416
473
482
374
479
425
257
277
119
100
182
136
117
137
128
133
1264
1110
987
997
1088
1016
973
963
9855
8964
7546
7703
8063
7458
7218
7059
37
52
42
61
50
46
46
54
Total no' of Physiotherapy contacts
at Bishop Auckland Hospice
No' of Patients who were seen by
the Physiotherapist at Richardson
Hospice
Total no' of Physiotherapy contacts
at Richardson Hospice
No' of Patients who were seen by
the Physiotherapist at Weardale
Day Hospice
Total no' of Physiotherapy contacts
at Weardale Day Hospice
No' of Patients who were seen by
the Physiotherapist at Sedgefield
Day Hospice
Total no' of Physiotherapy contacts
at Sedgefield Day Hospice
No' of Outpatients who were seen
by the Physiotherapist
Total no' of Outpatient
Physiotherapy treatments
Berevement/Family Support
252
145
191
319
342
330
245
518
17
21
14
9
7
4
4
3
153
141
45
23
21
11
4
14
17
19
10
16
12
16
9
7
103
81
39
81
66
56
39
15
23
17
0
7
12
2
0
0
181
129
0
36
81
5
0
0
-
-
-
-
-
18
25
23
-
-
-
-
-
40
57
40
No' of Clients accessing the service
199
170
211
188
235
261
215
278
No' of '1 to 1' Contacts
202
240
233
575
934
794
781
1084
-
-
103
319
416
464
466
487
No' of 'Drop In's'
376
278
297
359
520
869
784
753
No' of Telephone Contacts
Complementary Therapies
No' of Patients who received Comp'
Therapy at Bishop Auckland Hospice
No' of Treatments at Bishop
Auckland Hospice
67
40
103
322
108
230
68
43
84
114
124
78
84
87
87
76
923
925
876
777
882
992
1017
913
No' of Home Visits
No' of Patients who received Comp'
Therapy at Richardson Day Hospice
No' of Treatments at Richardson
Day Hospice
No' of Patients who received Comp'
Therapy at Weardale Day Hospice
No' of Treatments at Weardale Day
Hospice
No' of Patients who received Comp'
Therapy at Sedgefield Day Hospice
No' of Treatments at Sedgefield Day
Hospice
Comp' Therapies - Outpatient
No' of Outpatients who received
Comp' Therapy - Barnard Castle
25
20
29
19
15
30
22
15
194
233
241
176
154
200
290
245
22
33
30
26
22
27
20
15
216
210
198
226
247
261
255
251
32
29
54
26
23
18
19
23
236
210
263
267
210
179
199
227
12
7
11
5
4
3
2
2
No' of Outpatient Treatments Barnard Castle
48
52
30
26
15
5
2
6
No' of Outpatients who received
Comp' Therapy - Weardale
14
15
4
0
2
4
3
7
No' of Outpatient Treatments Weardale
21
27
4
0
11
4
11
13
No' of Outpatients who received
Comp' Therapy - Sedgefield
1
4
7
7
4
4
4
1
No' of Outpatient Treatments Sedgefield
Comp' Therapies - Homevisits
1
5
11
15
6
17
8
3
No' of Patients who received Comp'
Therapy - Barnard Castle Homevisits
11
10
13
12
5
9
11
7
No' of Homevisits Treatments Barnard Castle
90
107
138
59
49
26
55
34
No' of Patients who received Comp'
Therapy - Weardale Homevisits
39
25
48
29
26
27
37
25
No' of Homevisit Treatments Weardale
326
219
295
248
209
193
142
130
No' of Patients who received Comp'
Therapy - Sedgefield Homevisits
15
27
38
22
45
56
38
41
No' of Homevisit Treatments Sedgefield
MS Aromatherapy
174
133
139
99
200
308
205
194
No' of Drop In Patients - Barnard
Castle
9
11
14
9
12
12
11
11
No' of Drop In Treatments
62
56
49
34
45
44
39
37
No' of Drop In Patients - Bishop
Auckland
6
8
10
7
9
13
11
9
No' of Drop In Treatments
43
48
49
33
48
45
38
31
No' of Drop In Patients - Weardale
10
18
10
10
21
13
7
9
No' of Drop In Treatments
Neurological Day Care
67
83
59
33
69
68
36
39
No' of Patients attending
Neurological Day Care
17
36
56
56
76
92
106
106
No' of attendances to Neurological
Day Care
115
231
578
665
712
641
688
641
No' of Patients receiving Comp'
Therapy in Day Care
15
24
53
46
67
85
97
95
No' of Comp' Therapy Treatments
given in Day Care
98
302
365
318
395
475
528
461
No' of Patients receiving
Physiotherapy in Day Care
15
22
47
47
69
86
101
99
No' of Physiotherapy Treatments
given in Day Care
64
219
522
591
666
607
623
589
No' of Patients receiving Counselling
in Day Care
7
14
19
51
56
42
13
0
No' of Counselling contacts in Day
Care
Total No' of patients/clients who
have accessed Hospice Services
16
75
53
139
278
61
16
0
471
486
522
544
601
670
639
701
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 Director of Patient Care and Service Development and 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 the Durham Dales, Easington and
Sedgefield Clinical Commissioning Group and the Health and Wellbeing board to approve and comment
on the quality priorities mentioned in the report.
Research
The number of patients receiving NHS services provided by or sub contracted by the Butterwick
Hospice at Bishop Auckland in 2014-2015 that were recruited during that period to participate in
research approved by a research ethics committee was: none. There were no appropriate national,
ethically approved studies in palliative care that the Butterwick Hospice could participate in.
What others say about us
The Butterwick Hospice is required to register with the Care Quality Commission and its current status
is unconditional. The Butterwick Hospice has no conditions on registration.
The Care Quality Commission has not taken any enforcement action against the Butterwick Hospice at
Bishop Auckland during 2014/15
The Butterwick Hospice is subject to periodic reviews by the Care Quality Commission and its last
review was 8th July 2014.
The Butterwick Hospice was fully compliant and rated as low risk following assessment by the Care
Quality Commission.
Below are some of their findings.
Is the service safe?
Peoples comments included :“I expected to meet others with similar problems but did not
appreciate how much benefit I would get from having a me day.”
“Having contact with other people who had experienced the same
things that I have has helped me a lot.”
“Coming here has given me confidence, it’s a change of scenery and
it’s good to meet other people.”
“All the staff and volunteers can’t do enough for me. I appreciate
everything.”
“I look forward coming to the Day Hospice because it’s a day when
my family don’t have to worry about me. It has definitely aided my
recovery.”
“It is the best thing that ever happened to me in respect of getting
back to life after being so ill.”
Is the service caring?
We saw staff and volunteers showed patience and
gave encouragement when supporting people.
People’s preferences, interests, aspirations and
diverse needs were recorded and care and support
was provided in accordance with people’s wishes.
Is the service effective?
Peoples health and care needs were assessed with them, and they
or their representatives were involved in writing their care plans.
Specialist dietary, social, mobility, equipment and pain control care
needs had been identified in care plans where required.
People’s needs were taken into account with signage and the layout
of the service enabling people to move around freely and safely. The
premises had been sensitively adapted to meet the needs of people
with physical, memory and mental health impairments.
Is the service responsive?
People completed a range of activities in and outside the
service regularly. The Hospice had its own adapted transport,
which helped to keep people involved with their local
community.
This was also used to transfer people to the Day Hospice.
Is the service well led?
The service worked well with other agencies and services to
make sure people received their care in a joined up way.
The service had a quality assurance system. As a result the
quality of the service was continuously improving.
Staff told us they felt supported in their role and we saw staff
supported each other throughout the inspection.
The Butterwick Hospice at Bishop Auckland has not participated in any special reviews or investigations
by the Care Quality Commission during 2014/2015.
Statements
Statement from Durham Dales, Easington & Sedgefield Clinical Commissioning Groups, for
the Butterwick Hospice Quality Account 2014/15.
The CCG welcomes the opportunity to review and comment on the Quality Account for the Butterwick
Hospice for 2014/15 and would like to offer the following commentary.
As commissioners Durham Dales, Easington and Sedgefield Clinical Commissioning Groups (CCG) are
committed to commissioning high quality services from the Butterwick Hospice and take seriously their
responsibility to ensure that patients’ needs are met by the provision of safe, high quality services and that
the views and expectations of patients and the public are listened to and acted upon.
Overall the CCG felt that the report was well written and presented in a meaningful way for both
stakeholders and users and the report provides an accurate representation of the services provided during
2014/15 within the Hospice. The CCG has also conducted a successful commissioner led inspection visit to
the hospital to gain assurances and an insight into the quality of care being delivered to patients.
We recognise the work that the Hospice has undertaken to drive quality improvements throughout the year
particularly around patient experience, and patient safety. Actions taken following patient safety incidents
shown within the report show a commitment from the Hospice to learn from incidents and take appropriate
action to prevent any reoccurrence.
The CCG are pleased to see that the Hospice has fully implemented the Friends and Family Test during
2014/15 and the positive early results.
The CCG welcomes the introduction of the Carers Support Needs Assessment Tool (CSNAT) as an
important step towards addressing the needs of the wider support network for patients. It is reassuring to see
that the hospice continues to take part in clinical audit activity in relation to quality and service
improvements.
Durham Dales, Easington and Sedgefield Clinical Commissioning Group (CCG) welcomes the specific
priorities for 2015/16 highlighted in the report and feel that they are appropriate areas to target for continued
improvement.
The CCG look forward to continuing to work in partnership with the Hospice to assure the quality of
services commissioned in 2015/16.
Gillian Findley
Director of Nursing/Nurse Advisor
DDES CCG