EACH Quality Account
2014-2015
The EACH Vision
We strive to deliver real improvements in
palliative care for children, young people
and their families through a sustained
commitment to excellence, innovation and
fair access.
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Contents
Item
Part 1
Chief Executive’s statement
Part 2 Priorities for improvement and statements
of assurance from the Board
2.1 About EACH
2.2 Priorities for improvement 2015-16
2.3 Statements of assurance
2.3.1 Review of services
2.3.2 Participation in national clinical audits
2.3.3 Participation in local audits
2.3.4 Participation in clinical research
2.3.5 Use of the Commissioning for Quality Improvement
and Innovation (CQUIN) payment framework
2.3.6 What others say about EACH
2.3.7 Data quality
2.3.8 Clinical coding error rate
Part 3 Review of quality performance
3.1 Priorities for improvement 2014-15
3.2 Additional quality markers
3.3 Involving children and families
3.4 Involving EACH staff
3.5 Statements from Healthwatch, Clinical Commissioning
Groups and Overview and Scrutiny Committees
3.6 Independent Auditors’ Limited Assurance Report
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Part 1. Chief Executive’s Statement
I am delighted to present the annual EACH Quality Account.
On behalf of the Board of Trustees, I would like to thank all of our staff, volunteers and
supporters for their achievements over the past year.
EACH has a culture of continuous quality improvement in which opportunities to improve
care delivery and any shortfalls are identified and acted upon. The safety, experiences and
outcomes for children, young people and their families are of paramount importance to us
all at EACH. Our clinical governance committee, a committee of the EACH Board, provides
assurance, oversight and scrutiny on all matters relating to the quality of care.
We have achieved our priorities as planned over the past year. Meeting the changing needs
of children and families and increasing demands on our service will continue to be
challenging. We are well positioned to address this as our more personalised outcome
based model of care and our new approach to promoting the wellbeing of the whole family
take effect. Our priorities for the coming year reflect the importance of these areas of
work.
I am pleased to report that planning permission was gained for the nook, our new hospice in
the heart of Norfolk. We are finalising the internal designs to ensure the building meets
child and family needs as well as the array of regulations and standards which apply to us.
We launched our appeal in the presence of HRH The Duchess of Cambridge in November
2014 and we are pleased with the early progress being made.
The Care Quality Commission inspected our Treehouse hospice and assessed that the
treatment and care provided was fully compliant with the national Essential Standards for
Care.
We look forward to a year which will see further refinement of our care model,
implementation of additional quality assurance measures and an improved approach to
providing clinical supervision for care staff.
To the best of my knowledge, the information reported in this Quality Account is accurate
and is a fair representation of the quality of health care services provided by EACH.
Graham Butland
Chief Executive
26 May 2015
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Part 2. Priorities for Improvement for 2015/16 and
Statements of Assurance from the Board
2.1 About EACH
East Anglia’s Children’s Hospices (EACH) is registered as a service provider under the
Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, to carry out the
regulated activity of the treatment of disease, disorder or injury.
EACH is a registered charity, number 1069284 and has the legal status of operating as a
Company Limited by Guarantee, company number 3550187.
Our Purpose
East Anglia’s Children’s Hospices supports families throughout their experience of caring for
children and young people with life-threatening illnesses and those with complex health care
needs.
We provide a range of physical, emotional, social and spiritual support services which are
offered:
 holistically
 centred on the family
 to all eligible families in East Anglia with children with life-threatening illnesses and
complex health care needs
 across a range of settings, including the home, hospice and hospital
 by specialist staff
 with the engagement of the community.
EACH offers care to families with children and young people who:
 Live in the counties of Norfolk, Suffolk, Cambridgeshire and Essex. There is an
agreed service delivery approach with Keech Cottage Hospice to provide care on an
individual basis to families living in North and East Hertfordshire.

Are less than 19 years of age. Young people referred at 16 years of age and over are
considered individually depending on whether they are entering the final phase of
their life and there are no alternative services available to match their choice of place
of care.

Have or had a condition with no reasonable hope of cure and from which they may
or will die in childhood or early adulthood.

Have a condition (or are diagnosed with a condition in the antenatal period) for
which curative treatment may be feasible but can fail, such as children and young
people with cancer. These exclude deaths from :

Sudden accidental death including road traffic accidents;

Suicide;

Unlawful killing;
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


Stillbirth (>24weeks). If following a post-mortem it is determined that the
baby had a condition that would have met the EACH criteria then a family
support referral post delivery can be accepted.
Miscarriage
Acquired infection e.g. meningitis
Services are delivered wherever they are needed. This includes care and support in the
family home, in one of our three hospices at Milton, Quidenham and Ipswich, in hospital and
in the wider community. Symptom management and specialist advice is provided across
EACH by the charity wide EACH True Colours Symptom Management Team. The
organisational management and care structure is shown below.
EACH Management & Care Structure
Chief Executive
Graham Butland
Director of Finance
Director of Care
Ruth Kiani
Tracy Rennie
Director of Income
Generation
Sam Lucking
Nurse Consultant
Head of Education
& Quality
Head of Service
Medical Director
Dr Linda Maynard
Carolyn Leese
Louise Denby
Dr David Vickers
EACH Milton
Clinical
Psychologist
Specialist
Pharmacist
Nurse, care assistants
play staff, counsellors,
counsellor practitioners,
music therapist, art
therapist, physiotherapist,
occupational therapist,
catering, facilities and
cleaning staff
EACH Treehouse,
Ipswich
Nurses, care assistants
play staff, counsellors,
counsellor practitioners,
music therapist, art
therapist,chaplain,
physiotherapist,
occupational therapist,
catering, facilities and
cleaning staff
Head of Marketing
& Communications
Head of Human
Resources
Simon Hempsall
Helen Grubb
EACH Quidenham
Nurses, care assistants
play staff, counsellors,
counsellor practitioners,
music therapist, art
therapist, physiotherapist,
occupational therapist,
catering, facilities and
cleaning staff
EACH TCT Symptom
Management Team
Clinical Nurse Specialists
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2.2 Priorities for Improvement for 2015/16
There were no areas of improvement identified as a result of the inspections of the locality
services by the Care Quality Commission.
The priorities for improvement are detailed in table 1 and are derived from the strategic
plan (2014-2019) and annual care development plan. These priorities aim to further improve
upon the safety, experiences and outcomes for children, young people and their families
cared for by EACH and are managed by the EACH Care Management Team (ECMT).
Progress is monitored by the Clinical Governance Committee and reported to the Board
quarterly.
Table 1 Priorities for improvement
Desired outcome
Priority 1 Embed the personalised outcome
based approach to care into daily practice by:
Service user experience will be
enhanced through a holistic and
personalised approach to care.

Consolidating previous learning and supporting
teams to understand Holistic Needs
Assessment (HNA*) and Reviews with clear
identification of family priorities. This will be
delivered through group reflective practice and
1:1 support through case management systems.

Implementing ‘family care calls’ processes
through case management systems to review
family priorities for care and to determine how
EACH has made a difference and whether
EACH has ‘done what it said it would’ and
whether we have done it well?

Consolidating previous learning and supporting
Wellbeing team to identify, review and evaluate
family priorities when undertaking targeted
level emotional health and wellbeing
interventions. This will be delivered through
group reflective practice and 1:1 clinical
supervision** processes.
Evidence of clinical effectiveness
will be recognised as a
personalised offer of care is
agreed which matches the most
important priorities for the family
and individual service users.
Achievement will be monitored
through regular review by the
multidisciplinary team.
*HNA is a comprehensive discussion which gathers information
on the needs of all family members to identify and understand
family priorities to inform a personalised service.
** Clinical supervision is a mechanism for staff which provides
regular protected time for facilitated, in depth reflection about
their practice.
This priority arises from our care development
programme.
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Priority 2 Enrich the emotional health and
wellbeing of service users by:


Service user experience will be
enhanced at both universal and
targeted level as there is increased
understanding among staff teams
Creating understanding amongst nursing and
and further emotional health and
wellbeing staff teams about how a) universal
wellbeing interventions become
level emotional health and wellbeing
interventions fit within the EACH model of care accessible to more families.
and; b) the contribution and responsibilities of
Evidence of clinical effectiveness
different roles. This will be delivered through
will be recorded as targeted
practice development workshops, whole team
emotional health and wellbeing
training events and case management systems.
interventions are planned,
delivered and evaluated according
Consolidating previous learning and providing
to agreed priorities of the service
additional learning opportunities for the
user.
Wellbeing team to embed the targeted level
resilience focussed, proactive and preventative
Achievement will be monitored
approach to emotional health and wellbeing
support into their daily practice through whole through regular review by the
team training events, case management systems multidisciplinary team.
and clinical supervision processes.
This priority arises from our care development
programme.
Priority 3 Promote the highest quality care and
support by:
 Implementing a new approach to clinical
supervision delivered through a variety of
opportunities to accommodate the professional
needs, learning styles and communication
preferences (for example in a group situation or
on a 1:1 basis) of the whole multidisciplinary
staff group.
Maintain service user safety by
advancing our approach to clinical
supervision which is integral to
effective clinical governance within
EACH.
Service user experience is
promoted through provision of
care and support by staff that feels
committed to and well supported
by EACH, are able to reflect on
and challenge their own practice
in a safe and confidential
environment and receive feedback
that is separate from managerial
considerations.
Evidence of clinical effectiveness
will be recorded through
development of supervision
contracts between supervisee and
supervisor and through
established management
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supervision and appraisal
processes.
This priority arises from our care development
programme.
Achievement will be monitored
through regular review by the
multidisciplinary team, line
management and appraisal
mechanisms.
2.3 Statements of Assurance from the Board
The following are statements that all providers must include in their Quality Account. Many
of these statements are not directly applicable to specialist palliative care providers, such as
EACH, and therefore explanations of what these statements mean are also given.
2.3.1 Review of services
During 2014-15, EACH provided the following NHS services to children and families living in
Norfolk, Suffolk, Cambridgeshire and North East, Mid and West Essex:
 Short breaks
 End of life care
 Symptom management
 Emotional support for all family members and those important to them, before and
into bereavement
 Music therapy
 Art therapy
 Specialist play
 Hydrotherapy
 Family Information service
Care is delivered by our three hospice based multi-disciplinary teams at Quidenham,
Norfolk, Milton, Cambridge and the Treehouse, Ipswich and by our EACH wide symptom
management team of clinical nurse specialists. Staff are trained to deliver care wherever it is
required.
End of life care and symptom management for the child including face to face care and
access to telephone support is available at any time of the day or night throughout the year
wherever they are being cared for.
EACH also hosts the East Anglia Managed Clinical Network (MCN) which was funded in
2014/15 by Cambridgeshire and Peterborough Clinical Commissioning Group.
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The purpose of the MCN is to provide clinical leadership to promote the provision of high
quality children’s palliative care across universal, targeted and specialist services wherever
and whenever it is required by children and their families across East Anglia.
The MCN brings together professionals and organisations to promote partnership working
amongst those who support families throughout their experience of caring for children and
young people with life-threatening illnesses and those with complex health care needs.
During 2014/15 the MCN provided specialist medical telephone advice, overnight and at
weekends to the EACH symptom management team clinical nurse specialists providing 24/7
care and support to families living in Norfolk, Suffolk, and Cambridgeshire and North Essex.
The MCN also developed and implemented the Region’s Resuscitation Plan and associated
guidance for lead professionals to ensure a consistent approach to clinical practice. The
active education programme is available to all levels of interested professionals.
We have reviewed all the data available to us on the quality of care in our services.
The income generated by the NHS services reviewed in 2014/2015 represents 100% of the
total income generated from the provision of NHS services by EACH.
All services delivered by EACH are funded through a combination of fundraising activity and
funding from the Department of Health, local NHS organisations and two County Councils.
Funding received from statutory sources amounts to 22% of the total income. These
arrangements mean that all services delivered by us are only partly funded by the NHS.
2.3.2 Participation in National Audits
During 2014/15, no national clinical audits and no national confidential enquiries covered
NHS services provided by EACH.
During the period EACH participated in no (0%) national clinical audits and no (0%)
confidential enquiries of the national clinical audits and national confidential enquiries it was
eligible to participate in.
The national clinical audits and national confidential enquiries that EACH was eligible to
participate in during 2014/15 are as follows: NONE
The national clinical audits and national confidential enquiries that EACH participated in and
for which data collection was completed during 2014/15 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: NONE
EACH was not eligible in 2014/15 to participate in any national clinical audits or national
confidential enquiries and therefore there is no information to submit.
The reports of no national clinical audits were reviewed by the provider in 2014/15 and
EACH intends to take the following actions to improve the quality of healthcare provided.
There were no national clinical audits relevant to the services provided by EACH therefore
there are no actions to report.
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2.3.3 Statement: participation in local clinical audits:
EACH has a comprehensive programme of local audits. The following were carried out by
EACH in 2014/15.
1
Medicine & Healthcare Regulatory Agency - audit of procedures for accessing and
acting on alerts
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Medicines Management audits:
2.1
Use and reconciliation of FP10 prescriptions
2.2
Audit of homely remedies in the hospice (Quidenham)
2.3
Management of Controlled Drugs (CDs) in the home
3.
Infection control audits:
3.1
Audit of hand hygiene
3.2
Audit by external provider of infection control services
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Audit of spiritual care practice
5
Audit of delegation of care procedures
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Audit of Paediatric Early Warning System use
Summary of audit findings:
1. Medicines and Healthcare Regulatory Agency audit of procedures
Outcome: to ensure all alerts are triaged within 24 hours of receipt. Training has been
delivered to the Milton team of care managers who take over responsibility from the
Quidenham team for 2015/16. Training included rationale for duty managers to triage and
cascade information within the 24 hour period.
2. Medicines Management Audits
Reconciliation of FP10s prescription forms
Outcome: to ensure FP10 prescription carbon copy books are reviewed by the Non
Medical Prescribing Group (sub group of Medicines Management Quality Group) at their
quarterly meetings. This is both a continuing professional development activity (as
prescribing is an infrequently used skill) and a way of monitoring prescribing practice. This
has been implemented
Management of Controlled Drugs in the Community
Outcome: to develop a buccal medicine administration record and CD stock balance sheet
for use in the home. These initiatives were developed and implemented by the Medicines
Management Quality Group.
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Homely Remedies in the Hospice (Quidenham)
Outcomes: to remind staff of recording requirements in relation to homely remedy use in
the hospice and to amend the Homely Remedy Protocol to include recording when stock is
used in place of a child’s own supply. This amendment was approved by the Pharmacy
Strategy Quality Group in June 2014 and implemented through the Medicines Management
Quality Group.
Controlled Drugs documentation
Data collection for this audit has been completed. Recommendations include minor
amendments to our standard operating procedure for management of just in case
medication and additional focus on training to reiterate practice procedures. The report is
scheduled for approval at the Pharmacy Strategy Quality Group meeting in May 2015.
3. Infection control audit
Hand Hygiene
Outcomes: to ensure staff compliance with dress policy. To provide hand hygiene
information. The findings of the audit are being used to inform mandatory training for
2015/16.
Audit by external provider of infection control services
Audits have been undertaken at Quidenham and Treehouse (Ipswich). The written reports
are awaited. The audit at Milton has been rescheduled into 2015/16 to further improve our
standards of hand hygiene.
4. Audit of spiritual care practice
Outcomes: to identify a replacement volunteer Chaplain; install ‘chaplaincy boards’ at each
hospice, ensure all teams aware of multi faith contact details. These outcomes have been
implemented through the Wellbeing Practice Quality Group.
5. Audit of delegation of care procedures
Data collection for this audit has been completed. The report is scheduled for approval at
the Nursing Practice Quality Group meeting in July 2015.
6. Audit of Paediatric Early Warning System use
This report is completed and awaiting review of recommendations at the EACH care
Management team meeting in May 2015.
2.3.4 Participation in clinical research
The number of patients receiving NHS services provided or subcontracted by EACH in
2014/15 that were recruited during that period to participate in research approved by a
Research Ethics Committee was 9.
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Service users were invited to take part in three pieces of research in collaboration with
Principal Investigators from organisations working in partnership with EACH. There were
five service users recruited to the first research project: ‘Babies who unexpectedly survive
long-term after withdrawal of neonatal intensive care’. This research was led by Dr P.
Clarke from Norfolk and Norwich University Hospitals Foundation Trust.
Four service users have been recruited to the second research project which is currently
underway: ‘EACH Treehouse Choir: Creating music through song’. This research is being
led by Dr J. Gosine, from Memorial University of Newfoundland, Canada in collaboration
with the EACH Treehouse Music Therapist.
An unknown number of EACH service users participated in a third research project: ‘Can
we fix it?!: understanding the impact of children’s hospices on parental relationships of life
limited and threatening children and young people (phase 2)’. This research was led by A.
Mitchell from Bournemouth University.
2.3.5 Use of the Commissioning for Quality Improvement and
Innovation (CQUIN) payment framework
EACH income in 2014-15 was not conditional on achieving quality improvement and
innovation goals through the Commissioning for Quality and Innovation payment framework
because EACH does not deliver any service via an NHS Contract and was therefore not
eligible to access a CQUIN scheme.
2.3.6 What others say about us
Care Quality Commission
EACH is registered with the Care Quality Commission (CQC). The CQC has not taken any
enforcement actions against EACH during the year 2014-15.
EACH has not participated in any special reviews or investigations by the CQC during 201415.
EACH Treehouse (Ipswich) was inspected during the year 2014-15 and was found to be fully
compliant with the required standards inspected. The following statement is the summary
statement made by the CQC following inspection:
Is the service safe?
“CQC monitors the operation of Deprivation of Liberty Safeguards (DoLS) which applies to
hospices. We spoke with the acting manager who demonstrated their knowledge of the
protocols to follow. We saw evidence that all staff had been trained in safeguarding, first
aid and mental capacity. We found risk assessments with clear action plans were in place
to ensure people remained safe.
We saw evidence of a robust system for health and safety in respect of hygiene and
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infection control”.
Is the service effective?
“People told us that they were happy with the care they received and felt their needs had
been met. It was clear from what we saw and from speaking with staff that they
understood people's care and support needs and that they had received appropriate
training. People we talked with who used the service and their relatives were satisfied with
the service provided. A relative said, "The staff are wonderful here. They always sit down
and go through everything with you before each visit. They have always given me the time
I needed to cope with the situation."
Is the service caring?
“We saw that staff interacted positively with people who used the service and people we
talked with about the service told us that staff were caring and friendly. Assessments of
children and young people's care, treatment and support needs were undertaken prior to
using the service. Children and young people, their families and health and social care
professionals involved in their care were consulted during this process. Records confirmed
people's preferences and diverse needs had been accommodated”.
Is the service responsive?
“The hospice provided a range of services that responded to people's needs when they had
a life-limiting illness. The services included medical care, pain management, day therapy
services, spiritual care, counselling, social work advice and community care. The hospice
promoted a stress-free environment where people could relax and rest. A member of staff
told us, "We are very aware of the need to promote a calm environment". People were
encouraged to feedback on the quality of the care and services provided and their views
were taken into account. The hospice maintained close links with the community. The
hospice trained volunteers in the community who were active participants in some aspects
of the service”.
Is the service well-led?
“Staff had a good understanding of the ethos of the home and quality assurance processes
were in place. We found that comprehensive policies and procedures that addressed
every aspect of the service were in place.
People and their relatives or representatives were consulted about how the service was
run and annual survey questionnaires were collected and analysed. Staff told us they were
able and encouraged to express their views and raise any concerns they may have and
said they were listened to. A member of staff told us, "We can raise any concerns and
make suggestions, the management have an open door policy and they listen to us".
Complaints, incidents and accidents were appropriately recorded and audited. There were
audit processes in place to monitor risks, safety and wellbeing. The registered manager
operated a system of quality assurance and completed audits to identify how to improve
the service”.
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External Professionals and Organisations
Below are a few examples of the things that people and organisations external to EACH
have said about us:
“We wanted to say thank you so much for making us all feel so welcome, and for going to the
trouble of putting together a great programme for our day at EACH. We really enjoyed our trip and
have all come away with ‘lists’ and lots of ideas about things we can introduce or change by
attempting a different approach.” Diana Children’s Nurse Children’s Hospice Association
Scotland.
“My apologies for the delay in thanking you for arranging my recent visit to EACH. I had a
wonderful visit and it was enlightening to discuss possible collaboration with you and your team”.
CEO / Medical Director Hospis Malaysia.
“Hello I was wondering if this message could be directed to the Play Specialists. I am one of the Play
Specialists at Claire House and I was wondering if I could gather some information about your work
in the community. Claire House are working towards reaching more children and young people in
our catchment areas and I feel if our Play Specialist could work in the community, this would be of a
great benefit to all our families as well as reaching new families. Would it be possible to send over
any information you have with regards to your community work, maybe how you got it started, how
many sessions you provide a month in the community, how did you approach families about this
service. I am just trying to gather as much information as possible to put together a proposal. Thank
you in advance”. Play Specialist Claire House Hospice.
“Can I just take this opportunity to say how much I have enjoyed working with the hospice and on
this project. The hospice is a wonderful place and I have the utmost respect for all that you and the
staff do there. The children I have met have been fantastic to work with also and such wonderful
characters, so thank you for helping to set it up”. Dance East through The Royal Foundation for
Children in the Arts funding.
2.3.7 Data Quality
Good data quality and information management is essential to delivering high quality care.
The Information governance policy and procedures provide the framework to ensure it is an
integral part of EACH’s governance arrangements.
NHS Number and General Medical Practice Code Validity
EACH did not submit records during 2014-15 to the Secondary Users Service for inclusion
in the hospital episode statistics which are included in the latest published data. This is
because EACH is not eligible to participate in this scheme.
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Information Governance Toolkit Attainment levels
EACH submitted its annual information toolkit assessment in March 2015 for which EACH
received confirmation of the statement of compliance from the Health & Social Care
Information Centre (HSCIC).
2.3.8 Clinical Coding Error Rate
EACH was not subject to the Payment by Results clinical coding audit during 2014-15 by the
Audit Commission.
Part 3. Review of Quality Performance
On 10 April 2015 328 children and young people were receiving care from EACH and 495
family members or those important to the child and family were being supported. This
represents all service users including the bereaved.
During the reporting period, there were 179 children / young people referred to EACH and
67 babies, children or young people died during the year.
There were 481 non bereaved service users who accessed 1:1 support, 82 non bereaved
service users accessed group support and 98 bereaved service users who accessed 1:1
support.
Sessions of care include the care of the sick child or young person, face to face and
telephone access to symptom management advice, play and hydrotherapy as well as face to
face support and group support for family members and those important to the family.
Families also access telephone support which is available 24 hours a day and have met and
linked with other families through family based events such as music in the woods,
Christmas parties, family activity days and activities such as the annual memory days, sibling
days, mums nights, dads nights.
3.1Review of priorities for improvement 2014-15
The priorities identified in the Quality Account 2014/15 are recorded below followed by a
response which reports progress on these.
Monitoring and oversight of the priorities was carried out by the management executive and
Clinical Governance committee. Progress against objectives is reported quarterly to the
Board and a review of care quality and performance formed a major part of the Board
annual away day in January 2015.
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Priority 1 Complete the implementation of the
new personalised outcome based model of care by:
Service user experience will be
enhanced through a more
personalised approach

rolling out the family reported outcomes based
approach across the existing case load including the Clinical effectiveness will be
enhanced as a personalised offer of
Holistic Needs Assessment and a personalised
care is agreed which matches the
offer of care
most important goals and outcomes
 implementing the new ‘customer satisfaction’ care for the family and individual service
users. Achievement will be
calls process and outcomes reporting process
monitored through regular review.
This priority was included as it is one of the objectives of
our 3 year care development programme. The programme
was developed in response to a series of service
evaluations carried out in 2010/11
RESPONSE Priority 1
The outcomes based approach to care and service delivery is inextricably linked to the EACH
person centred, assessment of care needs cycle which includes assessment, planning, delivery of
intervention and evaluation of care at a universal, targeted and specialist level.
During 2014/15 there was greater understanding within the locality care teams regarding the
need to embed service related outcomes into case management practice and articulate clinical
and service effectiveness in as objective way as possible. This approach has been strengthened
through discussion at weekly multidisciplinary panel meetings led by senior managers.
To achieve this improvement, priority modifications to the Holistic Needs Assessment were
completed to include identification of family goals or priorities derived from the summary of the
assessment. These changes were needed to enable family priorities to be used in ‘customer
satisfaction’ care calls to find out from families how the care EACH provided has made a
difference to their priorities after a six month period of care delivery. Further training was
required to ensure staff were confident in undertaking these assessments. This was delivered in
Spring 2015 which has meant that this improvement priority is being continued into 2015/16 and
is identified as Priority 1 in Table 1.
Priority 2 Promote the emotional health and
wellbeing of service users by:

Clinical effectiveness will be enhanced
as targeted interventions are delivered
to meet the agreed goals for support.
Reduced risk of complex grief
reactions through access to a wider
range of preventative, resilience based
support activities
Implementing a resilience based and needs led
model of support adapted from Kazak’s
theoretical framework including restructuring
the staff teams and introducing new ways of
working, developing a wider range of support
activities for service users and developing a new Maintain service user safety by ensuring
staff practice is monitored and
approach to providing practice supervision for
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staff.
This priority was included as it is one of the objectives
of our 3 year care development programme. The
programme was developed in response to a series of
service evaluations carried out in 2010/11
improved through practice supervision.
Enhanced service user experience as
more support activities are available to
more families
RESPONSE Priority 2
Consultation regarding the introduction of new ways of working to promote the emotional
health and well being approach began with staff teams in May 2014 and included information
about:
 The new approach and evidence based theoretical framework
 Moving from generic family support roles to profession specific roles
 The creation of a new identity for the family support team as the Wellbeing team; and
 How the proposed approach would facilitate service users to be supported according to
their level of psychosocial need and potential risk factors in a consistent way, tailored to
their priorities and delivered by staff according to their professional specialism and
capability.
The consultation response, led by the Human Resources Department, showed that the overall
response by staff was very positive.
Existing job roles were restated to reflect a professional role based approach and the skill mix
amended to better meet the needs of all service users. New roles of art therapist and family
therapist were introduced and the generic family support practitioner role was replaced with
counsellors and counselling practitioners. Most roles were subject to ‘slotting in’ and interviews
for restricted competition posts took place in June and July and commenced in August 2014.
Throughout 2014 all staff job descriptions were reviewed to reflect the new approach.
The new Wellbeing team was supported through line management processes in creating their
new identity and were prioritised for training. The identified learning outcomes for initial training
regarding developing understanding about service and practice based outcomes and delivering
goal based interventions were not achieved by all members of the Wellbeing team in November
2014. In response to staff feedback additional reflective practice group support, practice
development workshops and training sessions were carried out by the EACH Clinical
Psychologist and Consultant Nurse in Spring 2015. Alongside these initiatives the new Wellbeing
team undertook a review of their clinical care record and made changes to reflect and support
the new ways of working.
Further events are planned for nursing and care assistant teams in 2015/16 which aim to ensure
that all staff feel supported and have the skills and knowledge necessary to provide a universal
level of emotional health and wellbeing support and recognise service users in need of more
targeted support. This is reflected in Table 1 as Priority 2.
Resilience focused, creative activities which are family or service user directed but facilitated by
17
EACH staff and reflect the new approach have proved successful in terms of engagement with a
greater range of service users, for example, Treehouse choir, Tree fest, themed events
(Halloween) for young people, Fitzwilliam museum family day.
Review of clinical supervision arrangements during 2014/15 showed that the supervision policy
was not always being adhered to and that EACH’s mechanisms for providing and supporting
clinical supervision were outdated, not valued or not possible due to a lack of trained
supervisors. Therefore the clinical supervision policy was refreshed and has been approved and
will be implemented during 2015/16 following appropriate training events and staff preparation.
This is identified in Table 1 as Priority 3.
Priority 3 Strengthen clinical quality, service
user safety and clinical leadership by


Implementing a refreshed Quality and Risk
management framework which promotes
clinical leadership at all levels and across all
teams, reflects the new approach to monitoring
quality by the CQC and focuses on key clinical
risks
Improving our approach to incident
management and learning by implementing an
electronic incident reporting system
This priority was included as it is one of the objectives
of our 3 year care development programme as a result
of a review of our management and leadership
arrangements, a recognition of the increasing
complexity of care provision and the associated risks
and a review of our paper based incident management
arrangements in 2010/11.
Maintain and enhance service user
safety by modernising our approach to
incident management, which facilitates
an easier identification of trends. This
will inform areas for improvement and
enhance shared learning across teams
Maintain and improve clinical
effectiveness through audit of standards
of care and an improved approach to
clinical risk management
A positive service user experience is
maintained as the quality of care is
continuously reviewed and improved.
RESPONSE Priority 3
The care quality and risk framework was restructured to include development of terms of
reference, work plans and a learning from practice reporting system for the 16 single focus
quality groups. The overall aim of the framework is to provide a systematic approach to ensuring
and improving care quality. A matrix management approach has enhanced clinical leadership and
learning across EACH as groups are comprised of representatives from the three hospice
localities and the EACH wide symptom management team.
Activity of the different quality groups has developed in accordance with care operational plan
priorities, for example, the work of the Wellbeing Strategy and Safeguarding Groups has been a
18
high priority this year to support the emotional health and wellbeing developments and to ensure
appropriate systems are in place for supervision in relation to safeguarding the wellbeing of
service users. There has been continuing focus on medicines management through the work of
the Pharmacy Strategy and Medicines Management Groups as this is a recognised higher risk area
of practice. The Occupational Therapy and Physiotherapy Quality Group responded to a change
of hospice vehicles by refreshing the Transporting Service Users Policy and Standard Operating
Procedures. This resulted in the purchase of new equipment to secure wheelchairs in our
minibuses and a change in training provider to ensure staff competence with the new equipment.
The two elements of the electronic risk assurance system (Board Assurance Framework and Risk
Register) have been implemented with training delivered to Trustees and managers in all
departments in EACH. All clinical risks and controls were transferred onto the new risk register
and reassessed by the EACH Care Management Team in March 2015.
A process for risk assessment and hazard analysis (RAHA) has been developed and is undertaken
when the anticipated care needs for a child or young person fall outside our standard operating
procedures. This ensures that controls are in place to mitigate potential risks. All RAHAs to date
have been managed locally, none requiring escalation to the EACH Care Management Team.
The electronic incident reporting system was successfully piloted by EACH Milton in July and
August 2014 and rolled out across EACH from October 2014 following a series of locality based
training events. Ongoing support for teams has been provided through care management systems
and the care quality groups. This new approach has improved our reporting and monitoring
processes and permits us to more easily monitor and review incidents across EACH.
Priority 4 Ensure staff competence to deliver
specialist children’s palliative care to children,
young people and families by:


Ensuring nursing staff continue to be able to
respond to all levels of clinical need by
completing the core knowledge and clinical
skills training
Implementing a training programme to underpin
the new approach to promoting emotional
health and wellbeing
Continued service user safety as staff
knowledge and skills are developed
further to meet the changing needs of
the service users
Clinical effectiveness is maintained as
knowledge and skills are developed to
match care and needs
Enhanced service user experience
through having confidence in the skills
and knowledge of the staff
This priority was included as it is one of the objectives
of our 3 year care development programme to
implement changes to ways of working and in
recognition of the increasing complexity of children’s
nursing needs and changes to interventions and
technology.
19
RESPONSE priority 4
All care staff are recruited according to a role specific job description and person specification.
This ensures that staff who join EACH meet the required standard of skills, knowledge, values
and attitudes expected of them.
The Core Skills and Knowledge (CSK) training is a mandatory three year rolling programme for
nursing care staff. We are two thirds of the way through this programme and on target to
achieve full compliance. All CSK learning and development days were completed as planned
during 2014/15 across the five topic areas of:
Mental Capacity & Consent; Symptom Management, Introduction to Neonatal Care / Volunteers
at EACH, Exploring Spirituality, Emotional Health and Wellbeing; Positive Handling (Team
Teach).
Nursing staff self assessed themselves in relation to competency in the 17 areas which EACH
consider as CSK areas of practice and this was monitored through line management and appraisal
processes with requests for specific training directed to the education team as needed. Care
Assistants were assessed in practice by the clinical education team. The core practice areas are:
Administration of medicines; care for the acutely unwell child; end of life care; enteral feeding
management; neonatal care; oral care; oxygen and suction management; pain management;
personal care; postural care; seizure management; subcutaneous medicines management via
continuous infusion; symptom control; tissue viability; tracheostomy; verification of death.
The clinical education team responded to all requests for specific training during 2014/15 and are
on track to complete the direct assessments of competency with Care Assistants as the three
year rolling programme concludes next year.
The evaluation of the EACH Paediatric Early Warning System (PEWS) identified that PEWS is
acceptable in EACH and in children’s palliative care as an aid to and not a replacement for holistic
clinical assessment. PEWS, in conjunction with clinical assessment can speed up access to
symptom management and improve patient safety in the hospice environment. The report
recommended that:

CSK training should be modified to include Recognising the acutely unwell child and
PEWS refresher sessions and to differentiate between the needs of nurses and care
assistants

CSK training should include specific training on neurological assessment and cardio
respiratory assessment.
An emotional health and wellbeing training plan was developed alongside service and management
processes for implementing the new approach. The training has been subject to a phased
initiation with priority given to the new Wellbeing team during 2014/15 and will continue into the
forthcoming year for other care team staff. This is identified in Table 1 as Priority 2.
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Priority 5 Commence the new children’s
hospice for Norfolk project (subject to successfully
obtaining planning permission)


Complete the internal design plans of the new
hospice building
Launch an appeal for £10million
This priority has been added following a review of the
current facilities by the EACH Board in 2013.Whilst
the current hospice meets the required standards and
is well equipped, there is no scope for further
development on site or within the building.
Improved service user safety through a
modern, purpose built hospice facility
and equipment
Enhanced service user experience as
the new building will be more centrally
located facilitating better access to
more families; have a wider range of
facilities to meet the demands of
providing more complex care and
enhanced care facilities e.g. a
hydrotherapy pool; will have the space
to offer more hospice based activities
for the whole family.
RESPONSE priority 5
Planning permission was granted in Spring 2014 to build our new hospice on a 5 acre woodland
plot in Framingham Earl, Norfolk.
A successful launch event was held at the Norfolk Showground in November 2014 which was
attended by the EACH’s Patron, HRH The Duchess of Cambridge, along with more than 650
guests and members of the media. A bereaved mother eloquently shared her thoughts and
feelings about how valuable the support from the Quidenham team had been for her and her
family: “in the darkest and most painful of times, EACH has given us the best in the worst
possible situation”.
Good progress is currently being made to finalise planning for the internal aspects of the building
with a team of staff working closely with our architects. The overall aim is to ensure that service
user safety is maximised to support children with highly complex care needs whilst at the same
time guaranteeing an environment which is homely, comfortable and pleasurable and provide the
much needed space to cater for a wider range of palliative care activities for all family members
to enjoy.
3.2 Additional Quality Indicators we have chosen to measure
In the absence of a national minimum data set and nationally agreed indicators of quality for
children’s palliative care, EACH monitors:




complaints and concerns (service user experience, clinical effectiveness)
commendations (service user experience, clinical effectiveness)
incidents and accidents (patient safety, service user experience, clinical effectiveness)
staff knowledge, skills and practice development including scholarly activity,
involvement in clinical practice development activities and compliance with
21
professional education and training requirements (patient safety, clinical
effectiveness)
3.2a Complaints and Concerns
All complaints and concerns whether they are made verbally or in writing are treated the
same and are fully investigated. Learning from complaints and concerns is shared with staff
including required changes to practice. The person raising the concern or complaint is
advised of the investigation process, findings and resulting changes to care practice.
Across EACH, there were seven complaints or concerns made during the year (Quidenham
= 2, Milton = 1, Treehouse = 4), six were upheld and all were resolved locally.
1. One family raised concerns that their child’s emergency seizure protocol was not
followed correctly during an overnight short break stay at the hospice and there was
an unnecessary delay in informing the parents that emergency medication had been
administered. The concerns were investigated and the outcome was that the nurse
caring for the child had appropriately used her clinical judgement and had acted in
the child’s best interest. The nurse contacted the parents as soon as possible once
the child’s clinical needs had been met.
The EACH Service Manager visited the family at home to discuss the outcome of the
investigation and confirmed the outcome in writing. The incident occurred at a time
when the child’s condition was changing and work has been undertaken with the
Clinical Nurse Specialist, lead Consultant and family to review the seizure protocol.
2. The father of a service user expressed a concern via email about the way in which a
telephone call was handled by a member of the EACH Volunteer staff. The concern
was investigated to the satisfaction of all involved and a procedure put in place to
assist volunteer staff with an appropriate method of receipt and forwarding
telephone calls.
3. The mother of a child telephoned to complain that a Care Assistant had left her child
with complex needs unattended in the bath during a session of short break care in
the home. Immediate exploration of the situation discovered that this was for a few
moments and that the child came to no harm. Following a thorough investigation the
member of staff was dismissed for gross misconduct by failing to adhere to EACH
policy and procedures. Although this was perceived as a one off event all staff were
advised of procedures for appropriate supervision of children and EACH’s
expectations in relation to provision of care in any environment in which this takes
place.
4. The mother of a young person was concerned about the perceived frequency of
medicine management errors which had been raised with her by staff. This particular
22
incident was discussed with all those who participated in administration of medicines
during the young person’s short break stay in the hospice but the outcome remained
inconclusive. All staff were reminded about the expected standard in relation to
medicines management and additional controls have been put in place regarding
reconciliation of medicines on admission, during a stay and on discharge.
5. One mother expressed a concern that her son did not have the correct amount of
feed sent to school with him from overnight stay at the hospice. The Duty Manager
checked the care record and medicines documentation and spoke to the nurse on
shift. A telephone call to the mother assured her that the correct feed had been
given and that the feed had been placed in the side pocket of her son’s bag. The
mother located this during the return telephone call.
6. The family of one child complained about a reduction in their care package. This was
erroneously directed to us as it related to decisions made by commissioners
regarding their care package and not EACH. The family was provided with a
response explaining the commissioning arrangements and the complaint was
redirected to the relevant person in the NHS Clinical Commissioning Group. The
child continues to access short breaks at the hospice in line with her EACH
allocation.
7. One family complained about the care given to a child who had gone home with an
injury to the back of her leg (a graze to the lower back of the leg, possibly caused by
rubbing against her wheelchair). The parents had been told about this during her
stay and the father was shown the injury on his arrival to collect her. The child had
also been unwell requiring assessment by both the local GP and hospital assessment
unit during her stay at the hospice, which had been acted upon appropriately. During
review of her care record this showed the focus had been on her medical needs
rather than from a more holistic perspective.
The care record also displayed an inconsistent reporting of the leg injury with some
excellent entries but also episodes of care which made no reference to it being
present. The investigation by the EACH Service Manager led to an effective
reflective practice group session which addressed the issues identified from reading
the notes. This approach was facilitated by the consultant nurse and will be used in
other similar situations as an opportunity to review and reflect on such incidences to
optimise all learning.
The EACH Service Manager wrote to the parents with the findings, who spoke to
their care manager following this and reported being satisfied with the outcome and
that they were generally very satisfied with the care their daughter receives.
All complaints were resolved locally with oversight from the EACH Care Management
Team.
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3.2b Commendations
EACH received many commendations throughout the year from families about various
elements of the service. Below are some of the letters and messages received. Locations of
care have been removed and details anonymised to protect the privacy of the families.
“Thank you for your support and care for [child’s name]. It is wonderful to know we have a safe
and homely place to send her for respite” Card from the parent of a current service user.
“Thank you so much for all you have done for [child’s name] over the past 9 years. We are sad to
say goodbye and truly grateful that you have been in our lives. [child’s name] has had such a
wonderful time with you all.” Parent of a young person who no longer needs the service
“I just wanted to say a huge thank you to everyone who made [child’s name], my mum and I feel
so welcome last week. We had such an amazing day and felt so welcome. I still can't get over how
lovely the whole building is, especially the sensory room and how personalised everything was for
[child’s name]”.
“We are so very grateful and really appreciate you looking after us. Lunch was lovely and it was
pure bliss having a hot brew and actually being able to drink it whilst it was still hot”.
“We are very much looking forward to staying 17th until 19th Dec, it truly is the best Christmas
present ever for [child’s name] and I”. Mum of new service user – 1st experience of the care at
EACH
“We would like to take this opportunity to thank everyone at the hospice who looked after [child’s
name]. [child’s name] key worker, [Nurse], arranged his uplift in care. This took enormous
pressure off myself. Respite was coordinated very efficiently between all our care providers. My
emails and telephone conversations with her were always dealt with very quickly and she always
made time for me in her busy day. We really appreciate all of [Nurse’s} help as she made a
stressful situation seem so much better”.
“On [child’s name] first visit following his operation, I met with the OT and physio where we
discussed [child’s name] movement/positional requirements. I found this very reassuring and left
knowing that all of his needs would be met. We were also loaned some equipment which made life
easier for us at home. This helped a great deal as not having been in this situation before we were
not aware of what was available”.
“Due to concern over [child’s name] pain management, [Nurse] contacted the hospital and
arranged for him to be seen at CAU where he was then prescribed oramorph. We are very great
full for [Nurse] involvement”.
“During every handover with a nurse, I felt very reassured as time was taken to allow me to explain
what [child’s name] can and can't do and everything was written down. We were able to relax
during respite periods knowing that he was well looked after. Every time I telephoned, I knew that
information had been passed over efficiently and that every effort was being made to ensure [child’s
24
name] was as comfortable as possible”. Parent of child who had major surgery and was
supported with uplift in care
Feedback from family who accessed end of life at the hospice for their son;
“The care of our family was exceptional. Staff answered all our questions immediately and we were
kept well informed every step of the way. Staff were truthful, even when we asked ‘how long’ as we
knew it was an unknown, they were honest with us. Staff explained all the medical equipment and
how his pain was being managed. Our expectations were met and more. It is an excellent service.”
At the funeral of a child whose end of life care was provided at the [Hospice] the parents
described the care delivered as “the best possible end that we could have wished for”.
Message from an adult sibling at the end of their wellbeing support sessions:
“Just a card to say thank you for your support over the last year. It's been the most difficult year of
my life and without your help I'm not sure I'd have been able to recover so quickly. I have a huge
admiration for everything you and your organisation do and I wish you all the very best in the
future”.
Message from a bereaved child’s consultant at [Hospital]:
“Telephone call with Dr [name] today, updating her on details regarding [child’s name]. She wished
to pass on her thanks to everyone for the care given to [child’s name] and her family”.
Message from family after their first short break stay:
“We stayed at [Hospice] a couple of weeks ago and [child’s name] had a really lovely time. Please
could you pass on our thanks to the team and share the attached photos of [child’s name] enjoying
the sensory garden?”
Message from a family who access short breaks and wellbeing support:
“We just wanted to say a great big thank you for all you have done for us as a family in this last
year and in particular the last few months. We honestly would not have got through without the
valid support that you all have given to us and [child’s name]. We feel very lucky to have such a
wonderful team there when we need them”.
“…..just wanted to thank you and your team so much for all your help with [child’s name] and her
family over the last few weeks. You are amazing”.
“He got wonderful care through out his last few months. I do appreciate the help your team has
given to him and the family. This was my first involvement with your team and I must say they are
fantastic. They communicate well and do spend lot of quality time with family. Thank you for
including me in the management”.
“I wanted to let you all know that mum and dad specifically commented on the high level of support
provided by TCT and their ability to care for [child’s name] was hugely positively affected by the
input received from the team and via TCT On Call. They also commented on the support received
on the day of death and how responsive the team were then, as always. They stated they could not
25
have ever imagined the high level of specialist care provided by our team and because of us [child’s
name] symptoms were well controlled and they were able to experience a peaceful death in the
place of their choice. Well done everyone!”
3.2c Incidents and Accidents
EACH has a positive and proactive approach to incident reporting and management. Staff
are encouraged to report all incidents within the context of a learning culture. Incidents are
categorised by type and severity using a red, amber, yellow and green scoring system.
Service User incidents are scrutinised by the relevant clinical practice groups, for example,
medicines management incidents by the pharmacy strategy and medicines management
groups, infection control and prevention incidents by the infection control group and service
user information incidents by the information governance group. All service user incidents
and accidents are overseen by the EACH Care Operations Group and practice changes are
discussed and noted at the Care Quality and Risk Group. As reported in the response to
Priority 3 for 2013/14 the electronic incident reporting system was successfully
implemented this year.
Incidents which are scored as red are reported to both the management executive and
clinical governance sub committee of the Trustee Board.
There were a total of 297 service user incidents /accidents including near misses across the
whole service. There were no notifiable clinical incidents during 2014/15. Notifiable
incidents are those which have resulted in moderate or severe harm or death of a service
user.
The highest number of incidents (n=186) related to medicines management and
administration. The frequency of medicines incidents reflects the nature and complexity of
clinical interventions and treatment of children and young people we care for.
Medicines incidents coding includes all areas of medicines management operating
procedures including: verification of prescription, reconciliation of medicines brought into
the hospice and returned home with the child, families bringing in insufficient supply for a
stay or medicines which have expired or incorrectly labelled; documentation, pharmacy
labelling incidents as well as incidents related to the actual administration of medicine to the
child/young person.
Most frequent medicines management incidents related to the reconciliation of medicines
into and out from the hospice. Review by the Pharmacy Strategy Group showed that this
was a consistent problem occurring across all three localities. Amendments were made to
the specific standard operating procedure for reconciliation of medicines to add a repeat
reconciliation check during the first night of stay.
The importance of staff not being distracted whilst administering medicines has been
identified as a contributory factor to medicines incidents. As a result staff wear high visibility
26
tabards, medicines are prepared for administration in a room with the door closed
wherever possible and staff have been advised of the importance of not disturbing nurses
whilst administering medicines.
All service user information governance incidents are reviewed and responded to by the
locality management team and action is scrutinised by the Information Governance
Management Group. During the current reporting period these included incorrect storage
of child photographs on an IPAD available for children and young people’s use and a
member of staff sharing their computer log on with a student to enable completion of the
care record. N response, an IPAD set up / build protocol has been implemented with the IT
Department to ensure e-safety for child and young people service users. Procedures are
also being developed to enable students on long term placements to have their own secure
log on procedures to record the care that they have provided in the electronic clinical
record.
Learning and Changes to Practice
The majority of incidents occur as a result of staff not following existing policy and
procedure. These are addressed with the individual and a period of support and supervised
practice is implemented if required. Learning is also shared across the teams and staff are
reminded about policy and practice relevant to the incident. The Care Quality and Risk
framework enables a more consistent approach to shared learning. Examples of some key
learning and changes to practice are detailed below.
1.Five incidents related to the care of a service user transferred from hospital to the hospice
for end of life care. A detailed review of these identified good practice in relation to record
keeping and staff professionalism but key issues relating to clinical and management decision
making when planning a transfer, the timing of the transfer, lack of knowledge about local
medical service availability at a weekend and a lack of understanding by hospital staff
regarding transfers for end of life care were identified.
The review has resulted in the development and implementation of a discharge checklist and
guidance. This outlines key responsibilities of the different EACH staff and external
organisations involved as well as key tasks which need action and in what time frame.
Alongside this, a process for managing clinical decisions to accept referrals for transfer has
been developed so that there is joint decision making between the clinical nurse specialist
and the hospice duty manager.
Training has been delivered to all teams, individual feedback has been provided to all staff
involved and the referring hospital and information has been shared across EACH care to
maximise learning.
2. An incident relating to the care of an acutely unwell child who needed to be admitted to
hospital during a hospice stay was reviewed using a group reflective practice led by the
Consultant Nurse. The review identified a number of issues which resulted in child specific
changes to practice as well as changes which are applicable to all children using EACH. For
27
example: the child’s physiotherapy plan was updated and clearly identified in his care record.
A Paediatric Early Warning System (PEWS) action plan was developed to help staff respond
in a timely way should his vital signs assessment demonstrate deterioration; and the care
manager supported staff in challenging the child’s mother regarding medicines verification
when a discrepancy was identified on admission. More general changes to practice included
strengthening the respiratory care plan with specific ‘pre-set’ questions; encouraging the GP
review to include ‘holistic’ assessment of the child and discussion with the nurse in charge
or clinical nurse specialist; and the development of an assessment template for recognising
the acute unwell child to include qualitative information of ‘baseline’ behaviour as well as a
physical assessment of vital signs and qualitative information about behaviour when unwell.
These actions have been distributed to the relevant clinical quality groups for action and
shared learning.
3.2d Staff knowledge, skills and practice development
The evidence of learning and development activities carried out by staff demonstrates
EACH’s commitment to this aspect of quality assurance.
A summary of learning and practice development activities is provided in the sections below:
3.2d (i) Annual mandatory training and Core Knowledge and Skills Training
(CSK)
Annual mandatory training was provided to care staff in the following areas.










Resuscitation and Anaphylaxis
Moving and Handling
Risk Assessment
Infection Control
Professionalism – behaviour code of conduct
Delegation of nursing care – Nurses (except Clinical Nurse Specialists), Senior Care
Assistants, Care Assistants
Food safety (for staff requiring it)
Information Governance
Fire Safety
Safeguarding
The Core knowledge and skills training is a mandatory three year rolling programme of
training. All staff completed the training relevant to their role as identified in the CSK
programme. Training has been provided in the following areas:





Exploring spiritualty, emotional health and wellbeing
Direct placement jejunostomy insertion
Vagus nerve stimulation
Introduction to palliative and end of life care
Parenteral nutrition in palliative care
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


























Understanding self harm in young people
Communication skills
Mental capacity
Consent
Symptom management
Intravenous therapy management
Verification of death
Introduction to neonatal care
Handling people with special needs – train the trainer
Advanced communication skills
Holistic needs assessment for nurses
Transporting children and young people service users
Dispelling the myths (funeral services awareness)
Eye gaze training
Using the electronic care record
Health and safety for managers
Music therapists vocal workshop
Person centred thinking and planning
WAV wheelchair and passenger restraint systems
Hydrotherapy
Ventilation equipment training
Holistic needs review for Wellbeing team
Positive handling (team teach)
Infection control for infection control (IC) leads
Medical gas safety
Safeguarding supervision
Wellbeing team – goal based approach.
3.2d (ii) EACH Clinical Practice Development Groups
Emotional Health & Wellbeing Strategy Group – responsible for the
development of the new approach to promoting service user emotional health and
wellbeing. Membership includes the Director of Care, Nurse Consultant, Head of
Service, Head of Education & Quality, Paediatric Psychology Consultant, Paediatric
Palliative Care Psychology Consultant, EACH Clinical Psychologist.
Pharmacy Strategy Group – responsible for approving medicines management
policies and procedures, agreement of the audit programme, approval of audit action
plans, monitoring incidents and any resulting action plans. It also agrees the work plan
for the medicines management group. Membership includes Nurse Consultant
Children’s Palliative Care, Medical Director, Head of Service (Controlled Drugs
Accountable Officer), Specialist Pharmacist, Director of Care
Medicines Management Group – responsible for implementing and monitoring
policy and procedure, scrutinising incidents and identifying and sharing learning and
completion of audits. Membership includes the Nurse Consultant Children’s Palliative
Care, Nurses and Care Assistants from the three hospice services, Clinical Nurse
29
Specialist and Clinical Educator.
Health and Safety Committee - responsible for recommending policy and
procedure to the Management Executive, management of health and safety audit
programme, management of health and safety risks and scrutiny of incidents.
Membership includes the facilities manager (competent person), Chief Executive,
Head of Service, Care Managers, Departmental Managers and Head of Quality &
Education
Care Information Systems Steering Group – responsible for recommending
policy and procedure to the ECMT, review the outcomes of audits and recommends
action plans to ECMT, recommends developments to the care information systems to
the ECMT. Membership includes the Head of Service, Nurse Consultant Children’s
Palliative Care, Care Service Managers, Systmone Care records manager
Care Information Systems Champions User Group - responsible for
implementing and monitoring policy and procedure, scrutinising incidents and
identifying and sharing learning and completion of audits. Membership includes Head
of service, Care Service Managers, Systmone Care records manager, members of the
multi-disciplinary care team from the three hospice services and the symptom
management team
Information Governance Management Group – responsible for all aspects of
information governance across EACH. Membership includes the Senior Information
Risk Officer (Director of Finance), Caldicott Guardian (Director of Care) and
Information Governance Lead (Head of Education & Quality)
Information Asset Owners Group- responsible for implementing information
management policies and procedures, risk assessing and managing information assets
and carrying out audits and information governance spot checks
Infection Control Group – responsible for implementing policy and procedure and
recommending changes to the ECMT, carrying out the audit programme and
recommending action plans to the ECMT, scrutinising incidents and sharing learning.
Membership includes Care Service Manager, specialist infection control adviser,
members of the multi-disciplinary care team from the three hospice services and
symptom management team
Moving and Handling Trainers Group – responsible for implementing policy and
procedure, recommending the training programme to the ECMT and the delivery of
training staff. Members include Head of Education & Quality, Clinical Educator and
designated moving and handling trainers from the three hospice services
Physiotherapist/ Occupational Therapist Practice Group – responsible for
recommending policy and procedure to the ECMT, delivering training, ensuring
consistency in practice across locality services. Membership includes the Nurse
Consultant Children’s Palliative Care and the Physiotherapists and Occupational
Therapists from the three hospice services
Positive Handling -Team Teach Trainers Group - responsible for implementing
30
policy and procedure, recommends the training programme to the ECMT and the
delivery of training to staff. Members include Head of Education & Quality, Clinical
Educator and designated team teach trainers from the three hospice services
Young Persons Care Action Group – responsible for implementing person
centred approaches to care for young people, implementing policy and procedure,
recommending changes to practice to the ECMT. Membership includes care
managers, website development officer and care staff from the three hospice services
who are members of the young person case management teams
3.2d (iii) External Practice Development groups
Care staff attended and participation in the following external groups:
The East Anglian Managed Clinical Network (Norfolk, Suffolk, Cambridgeshire
and North and West Essex). This is chaired by the EACH Medical Director and is
attended by the Nurse Consultant Children’s Palliative Care
The Children and Young People’s Strategic Clinical Network for children,
maternity and the new-born, and the associated East of England Children’s
Palliative Care Forum and county based palliative care networks. These are
responsible for developing and implementing the priorities of the palliative care
strategy for the East of England. The regional forum is chaired by the Director of
Care and attended by the Medical Director and Nurse Consultant Children’s
Palliative Care. The county based networks are attended by the Head of Service and
Nurse Consultant Children’s Palliative Care.
National Institute for Health and Care Excellence (NICE)
The Medical Director is Chairperson of the Guideline Development Group (GDG)–
End of life care for children and young people. The Consultant Nurse attended the
scoping workshop in October 2014.
Music Therapy in Palliative Care Forum- A practice development forum
attended by the EACH music therapists
Help the Hospices Executive Leaders in Palliative Care – Eastern Region. A
practice development group attended by the Nurse Consultant Children’s Palliative
Care.
Children’s Palliative Care Nurse Consultant Group- a practice development
group attended by the Nurse Consultant Children’s Palliative Care
Together for Short Lives (TfSL) Leaders of Care forum - attended by the
Director of Care, Nurse Consultant Children’s Palliative Care, Head of Service
TfSL Infection Control Special Interest Group- attended by designated EACH
care staff
31
TfSL / Association of Paediatric Palliative Medicine national research
group – attended by Nurse Consultant Children’s Palliative Care
Norfolk and Suffolk Palliative Care Academy Steering Group. Responsible
for influencing the development of training, education and information resources for
all those who need palliative care irrespective of age. Attended by Nurse Consultant
Children’s Palliative Care
S Langley and Dr L Maynard are members of the editorial team for the TFSL
publication: Synopsis. This includes summaries of current research and evidence
based practice articles
3.2.d (iv) Scholarly activity
Staff were also successful at having work accepted for presentation at national meetings and
conferences:
Paediatric Early Warning System (PEWS): Is There a Need in Children’s Palliative Care?
L Maynard, Nurse Consultant Children’s Palliative Care; M Binns Lead Nurse Specialist
Practice; T Miles, Clinical Educator Specialist Practice
Debrief meetings as an evolving tool for evaluation & development of a high quality Paediatric
Palliative Care service
P Sartori Consultant Paediatric Palliative Medicine; L Maynard Nurse Consultant Children’s
Palliative Care
Both presented at 2nd Global Children’s Palliative Care Gathering in Rome November 2014.
Accessing electronic resources and promoting Athens day. St Christopher’s Hospice annual
hospice study day. S. Langley Library and Information Services Manager.
EACH library service Richard House hospice study day. S. Langley Library and Information
Services Manager.
3.2d (v) External Study and Conferences
EACH supported 90 applications from care staff to undertake training at one day and
extended study learning development activities during the reporting period. Examples
include:




Handling People with Special Needs Education Train the Trainer Course
Helen and Douglas House Young People conference
Mentorship update
Kinetic Lifting Instructor
32

































Anxiety and Depression in Children and Young People
Environmental Art Therapy
Clinical Educators for student placements course
Introduction to Mindfulness for Practitioners
Neuromuscular Study Day
10th Paediatric Pain Symposium (UCL)
Together for Short Lives Conference: Living Matters for Dying Children
British Association of Counselling Practitioners Accreditation workshop
South Central Palliative Care conference - children's palliative care - who cares?
CSK-L2 Certificate in Counselling skills
Digital Media and Art Therapy
Process Communication
Counselling - personal therapy
Dispelling the Myths – funeral awareness
Non medical prescribing
Caring for the adolescent with cancer
Evidence Based Practice Dissertation
Oncology Study day
Moving & Handling for Trainers update
Breathing, Thinking, Functioning International Conference
Art Therapy with Children – Groups
Global palliative care conference in Rome
Association of Paediatric Palliative Medicine conference
Safeguarding Disabled Children
Long term ventilation hospital to home
Paediatric Clinical Assessment
Paediatric Palliative Care Foundation Programme
Leading a choir
Hospice UK: Communications Workshop and Networking Day
British Psychology Society Supervision Facilitation Workshop 1
British Psychology Society Supervision Facilitation Workshop 2
British Psychology Society Supervision Facilitation Workshop 3
British Psychology Society Supervision Facilitation Workshop 4
3.2d (vi) Student placements
EACH provided placements for nursing students from Anglia Ruskin University, University
Campus Suffolk and the University East Anglia. A total of 4 day placements and 31 extended
clinical placements were provided by the three hospices. Two Occupational Therapy
students, one medical student and one play specialist student also had placements in EACH.
3.2d (vii) Commissioned Training
Training was provided by EACH to the following:

Cambridge University Medical Students half day workshops introduction to
children’s palliative care
33

MCN Education programme Subcutaneous (SC) devices and management of SC
medications

MCN Education programme Management of Intravenous therapy for nurses

Hospice GPs- awareness about EACH and managing palliative care symptoms

SEPT Community Services in Bedford on End of Life Care, delivered by Clinical
Psychologist and Occupational Therapist.
3.3 How children and families are involved in EACH and what they
say about the service they received
Examples of feedback received from families are noted earlier in section 3.2b. Mechanisms
to involve families and received feedback in a more systematic way are explained below.
3.3a Child and Family Views
Views are captured in a variety of ways:
 On an individual basis as part of care reviews
 Evaluation of family events and group activities
 Comments cards via the website or the Family Corner newsletter
 The locality based Family Forums
 Compliments, Concerns and Complaints
Specific feedback is sought as required. For example, families were asked for their views
about the proposed changes to delivering emotional health and wellbeing support.
3.3b
The EACH Family Forums
The locality Family Forums met a total of 8 times during the reporting period including one
collective group meeting with the EACH CEO and Director of Care. The forums provide
the opportunity to receive feedback from families and also to test out service developments
and proposed changes to ways of working.
Some of the areas the forums have been involved with this year were:
 Using social media as a means of support for families
 EACH assessments processes – holistic needs assessment and review
 Processes for caring for children who need new or unusual to EACH nursing
interventions
 Improving transition processes for young people moving onto adult services
 Communicating with families using the ‘This is My Day’ initiative
 Booking short break care stays at the hospice
34
 Using SMS text messaging as a communication aid with families
 Giving feedback on using hospice facilities for universal wellbeing activities such as
‘Treefest’; ‘Mum’s night’; Christmas party; using the sensory room and outside play
areas
 Fundraising ideas for our hospices including the new Norfolk Hospice appeal
 Developing the Family Zone on the new EACH website to ensure usability and
accessibility by families
 Multidisciplinary (panel) decision making processes
 Strengthening communication skills training for staff
 The Norfolk Family Forum were involved in the design of the nook, the new hospice
planned in Norfolk.
3.4 Involving EACH staff
EACH operates a variety of ways to communicate with, engage and gather feedback from
employees.
1. EACH Strategic Plan
EACH produces a strategic plan which sets out the objectives and priorities for EACH. The
plan is agreed by the Trustee Board and reviewed annually. It is available to all employees on
the shared drive in the Governance file.
2.Staff Survey
EACH carries out a staff survey annually to seek their feedback about EACH. The findings of
the survey carried out during the year and next steps are detailed below
3. Staff Intranet
EACH has its own staff intranet; a dedicated internal website restricted to EACH staff only.
Content on the site includes a staff contact directory, organisational news articles, a search
facility for useful documents and links to pension information, library resources, e-learning,
our cycle to work scheme and the employee handbook.
4. Shared Drive
The shared drive contains more detailed information on EACH policies, forms, minutes of
meetings and other information.
5. Line Managers
35
Line managers are responsible for ensuring that staff are kept up to date with policy changes
and decisions that affect them and are the first point for staff for information regarding any
issues at work.
They hold regular team meetings to ensure that staff are kept up to date with developments
within EACH on subjects that affect their teams. Team meetings are also an important
opportunity for staff input your ideas, ask questions and give feedback.
6. Annual Report & Statutory Accounts
EACH’s annual report and statutory accounts are available from the Finance department or
can be downloaded from the Charity Commission or EACH websites.
In addition to these arrangements care staff are involved in clinical practice groups and a
group of staff are involved in the design and planning of a new hospice for Norfolk.
Staff survey
EACH participated in the Best Employers in the Eastern Region survey run by eras Ltd, in
partnership with Pure Resourcing Solutions. The survey looked at culture, communication,
morale and work life balance, engagement, people management and development and
reward.
A total of 85 EACH staff completed the survey. Just over one third were nursing staff, 10%
of respondents were Wellbeing staff. We received a large number of extremely positive
comments about working for EACH, as well as areas where we can improve as an
organisation. For example:
“I find working for EACH to be rewarding and take pride in the way it develops and its
commitment to families. It strives to keep practice in line with research and wider
developments”.
“I really enjoy working for EACH, my only concern is that there always seems to be a
number of changes happening within the organisation. I also feel there is quite a hierarchical
system within EACH with senior management & care team members-often feeling like a
"them & us" culture-which we haven't had before. I think it is important that all members of
staff are aware of the Senior Management goals for the organisation and how these
decisions are made”.
The analysis of the data demonstrated that there were no areas of significant concern but
that communications between the Senior Management Team and staff could be improved.
As a result of this the Management Executive (MEX) introduced mandatory MEX and Staff
Briefings. The purpose of these was to share the vision and strategy for EACH with staff,
discuss achievements and challenges and provide an opportunity for staff to ask questions of
the Management Executive. A Q and A sheet is being finalised which will be available to all
staff. Anecdotally, the sessions were very well received and we are currently formally
evaluating the sessions with staff.
36
3.5 Statements from Lead Commissioners, Health watch and
Overview and Scrutiny Committees.
EACH provides services across Norfolk, Suffolk, Cambridgeshire and North and West
Essex. This Quality Account has been sent to Clinical Commissioning Groups, Healthwatch
and Overview and Scrutiny Committees in the above counties to provide the opportunity
for comment and a statement. The list of those who were sent a copy of the Account is
tabled in Appendix 1. Responses were received from the following:
Healthwatch Essex
Healthwatch Essex is an independent voice for the people of Essex, helping to shape and
improve local health and social care services. We believe that people who use health and
social care services and their lived experience should be at the heart of the NHS and social
care services.
Although we have not undertaken any specific work with EACH over the past year, from
our reading of the Quality Account we are pleased to note that EACH actively engages
children and families about the services they receive. In addition, EACH receives high praise
from service users and their families for the high quality services and invaluable support it
provides. EACH gathers this feedback through a number of different channels – family
events, website comments, Family Forums and comment cards. However, in the draft
received we could not find mention of the Annual Family Satisfaction Survey.
In 2014-15, the improvement priorities selected by EACH demonstrated an aspiration to
help improve service user experience. These included promoting a more personalised
approach to care, increased support activities for service users, as well as the development
of a new children’s hospice in Norfolk. Healthwatch Essex recognises the continued efforts
of EACH to improve service user experience.
Healthwatch Essex believes that lived experience should be at the heart of services, and
believes that listening to the voice and lived experience of patients, service users, carers,
and the wider population, is a vital component of providing good quality care. We are
pleased to acknowledge the work EACH undertakes in this regard.
Sarah Haines
Information and Policy Officer
Healthwatch Essex
Received 16 June 2015
37
Norfolk Health and Wellbeing Board Overview and Scrutiny Committee
The Norfolk Health Overview and Scrutiny Committee has decided not to comment on any
of the Norfolk Quality Accounts for 2014-15 and would like to stress that this should in no
way be taken as a negative comment. The Committee has taken the view that it is
appropriate for Healthwatch Norfolk to consider the Quality Accounts and comment
accordingly.
Maureen Orr
Democratic Support and Scrutiny Team Manager
Norfolk County Council
Received 26 May 2015
Suffolk Health and Wellbeing Board Overview and Scrutiny Committee
The Suffolk Health Scrutiny Committee does not intend to comment individually on the
NHS Quality Accounts for 2015. This should in no way be taken as a negative
response. The Committee has, in the main, been content with the engagement of local
healthcare providers in its work over the past year.
Theresa Harden
Business Manager, Democratic Services
Suffolk County Council
Received 27 May 2015
3.6 Independent Auditors’ Limited Assurance Report.
INDEPENDENT AUDITORS’ LIMITED ASSURANCE REPORT TO THE
DIRECTORS OF EAST ANGLIA’S CHILDREN’S HOSPICES ON THE
ANNUAL QUALITY ACCOUNT
We are required to perform an independent assurance engagement in respect of East
Anglia’s Children’s (EACH) Quality Account for the year ended 31 March 2015 (“the
Quality Account”) and certain performance indicators contained therein as part of our
work. NHS trusts are required by section 8 of the Health Act 20009 to publish a quality
account which must include prescribed information set out in The National Health Service
(Quality Account) Regulations 2010, the National Health Service (Quality Account)
Amendment Regulations 2011 and the National Health Service (Quality Account )
Amendment Regulations 2012 (“the Regulations”)
SCOPE AND SUBJECT MATTER
38
The indicators for the year ended 31 March 2015 subject to limited assurance consist of the
following indicators:

Complaints and Concerns (Section 3.2a, page 22)

Incidents and Accidents (Section 3.2c, page 26)
We refer to these two indicators collectively as “the indicators”.
We were unable to review the two of the indicators within the guidance because they are
not applicable to the palliative care sector.
RESPECTIVE RESPONSIBILITIES OF TRUSTEES AND AUDITORS
NHS Trusts and Palliative Care Providers are required under the Health Act 2009 to
prepare a Quality Account for each financial year. The Department of Health has issued
guidance on the form and content of annual Quality Accounts (which incorporates the legal
requirements in the Health Act 2009 and the Regulations).
In preparing the Quality Account, the Trustees are required to take steps to satisfy
themselves that:

The Quality Account presents a balanced picture of the Hospice’s performance
over the period covered;

The performance information reported in the Quality Account is reliable and
accurate;

There are proper internal controls over the collection and reporting of the
measures of performance included in the Quality Account, and these controls are
subject to review to confirm that they are working effectively in practice;

The data underpinning the measures of performance reported in the Quality
Account is robust and reliable, conforms to specified data quality standards and
prescribed definitions, and is subject to appropriate scrutiny and review; and

The Quality Account has been prepared in accordance with Department of
Health guidance.
The Trustees are required to confirm compliance with theses requirements in a statement
of Trustee’s responsibilities within the Quality Account.
Our responsibility is to form a conclusion, based on limited assurance procedures, on
whether anything has come to our attention that causes us to believe that:

The Quality Account is not prepared in all material respects in line with the
criteria set out in the Regulations;
39

The Quality Account is not consistent in all material respects with the sources
specified in the NHS Quality Accounts Auditor Guidance 2014/15 issued by DH in
March 2015 (“the guidance”); and

The indicators in the Quality Account identified as having been the subject of
limited assurance in the Quality Account are not reasonably stated in all material
respects in accordance with the Regulations and the six dimensions of data quality
set out in the Guidance.
We read the Quality Account and conclude whether it is consistent with the requirements
of the Regulations and to consider the implications for our reports if we become aware of
any material omissions.
We read the other information contained in the quality report and consider whether it is
materially inconsistent with the following:

Board Minutes for the period April 2014 to May 2015;

Clinical Governance Committee minutes;

Board Assurance Framework and Risk Register;

Annual Care Development Plan;

Health and Safety Committee Minutes;

Local Clinical audit reports;

Performance report to Clinical Governance Committee April 14 – March 2015

Feed back from the Commissioners dated June 2015;

The latest Best Employers Survey dated 2014;

EACH Risk Management Policy;

EACH Strategic Plan 2014-19

EACH Statement of Purpose;

Performance Report;

Complaints Policy; and

CQC Inspection report for EACH Treehouse - Ipswich
We consider the implications for our report if we become aware of any apparent
misstatements or material inconsistencies with these documents (collectively the
“documents”). Our responsibilities do not extend to any other information.
40
This report, including the conclusion, is made solely to the Board of Trustees of East
Anglia’s Children’s Hospices (EACH).
We permit the disclosure of this report to enable the Board of Trustees to demonstrate
that they have discharged their governance responsibilities by commissioning an
independent assurance report in connections with the indicators. To the fullest extent
permissible by law, we do not accept or assume responsibility to anyone other than the
Board of Trustees as a body and EACH for our work or this report save where terms are
expressly agreed and with our prior consent in writing.
ASSURANCE WORK PERFORMED
We conducted this limited assurance engagement under the terms of the guidance. Our
limited assurance procedures included:

evaluating the design and implementation of the key processes and controls for
managing and reporting the indicators

making enquiries of management

testing key management controls

testing the accuracy, reliability, validity, timeliness, relevance and completeness of
the data supporting the indicators

limited testing, on a selective basis, of the data used to calculate the indicator back
to supporting documentation

comparing the content requirements of the ‘NHS foundation trust annual
reporting manual’ to the categories reported in the quality report

reading the documents.
A limited assurance engagement is narrower in scope than a reasonable assurance
engagement. The nature, timing and extent of procedures for gathering sufficient
appropriate evidence are deliberately limited relative to a reasonable assurance engagement.
LIMITATIONS
Non-financial performance information is subject to more inherent limitations than financial
information, given the characteristics of the subject matter and the methods used for
determining such information.
The absence of a significant body of established practice on which to draw allows for the
selection of different, but acceptable measurement techniques which can result in materially
different measurements and can affect comparability. The precision of different
measurement techniques may also vary. Furthermore, the nature and methods used to
determine such information, as well as the measurement criteria and the precision of these
41
criteria, may change over time. It is important to read the quality report in the context of
the criteria set out in the ‘NHS foundation trust annual reporting manual’.
The scope of our assurance work has not included governance over quality or nonmandated indicators, which have been determined locally by EACH.
CONCLUSION
Based on the results of our procedures, nothing has come to our attention that causes us to
believe that, for the year ended 31 March 2015:

the quality report is not prepared in all material respects in line with the criteria
set out in the ‘NHS foundation trust annual reporting manual’ as applicable to
EACH

the quality report is not consistent in all material respects with the sources
specified in Board Minutes for the period April 2014 to May 2015;
i
ii
iii
iv
v
vi
vii
viii
ix
x
xi
xii
xiii

Performance report to Clinical Governance Committee April 14 –
March 2015;
Clinical Governance Committee minutes;
Feed back from the Commissioners dated June 2015;
The latest Best Employers Survey dated 2014;
Board Assurance Framework and Risk Register;
Health and Safety Committee Minutes;
Local Clinical Audit reports
EACH Risk Management Policy;
EACH Complaints Policy;
EACH Strategic Plan 2014-19
EACH Statement of Purpose;
Performance Report; and
CQC Inspection report for EACH Treehouse – Ipswich;
the indicators in the quality report subject to limited assurance have not been
reasonably stated in all material respects in accordance with the ‘NHS foundation
trust annual reporting manual’.
Price Bailey LLP
Tennyson House, Cambridge, CB4 0WZ
June 2015
END
42
Appendix 1
COUNTY
NORFOLK
CLINICAL
HEALTHWATCH
COMISSIONING
GROUP
Sally Glover - Norfolk Alex Stewart, Chief
CSU
Executive
Patricia Hagan
Great Yarmouth &
Waveney
sally.glover1@nhs.net
SUFFOLK
patriciahagan@nhs.ne
t
Nicola Brunning
Lead Community
Contracts Manager
HWB OVERVIEW&
SCRUTINY
Maureen Orr
Scrutiny Support
Manager (Health)
Norfolk County Council
Alex.stewart@healthwatch
norfolk.co.uk
Maureen.orr@norfolk.gov.
uk
Theresa Harden,
Business Manager
Democratic Services
nicola.brunning@suff
olk.nhs.uk
info@healthwatchsuffolk.c
o.uk
Theresa.harden@suffolk.go
v.uk
Jo Rooney
Sandie Smith
Liz Robin, Director of
Public Health,
Peterborough City
Council
jorooney@nhs.net
sandie.smith@healthwat
chcambridgeshire.co.uk
liz.robin@cambridgeshir
e.gov.uk
PETERBOR
OUGH
As for
Cambridgeshire
Angela Burrows
Chief Operating Officer
Healthwatch
Peterborough
angela@healthwatchpet
erborough.co.uk
As for Cambridgeshire
ESSEX
Carol Anderson,
Director of quality
and Nursing at Mid
Essex CCG
Thomas Nutt (CEO)
Fiona Lancaster
Committee Clerk
03330 139825
carolanderson@nhs.n
et
enquiries@healthwatche
ssex.org.uk
CAMBS
Senior Commissioning
Manager for Children,
Young People and
CAMHS
Administrator Moira
Groborz
Governanceteam@essex
.gov.uk
moira.groborz@healthwatc
hessex.org.uk
43