Primrose Hospice
Quality Account 2014-15
1

PART 1
Chief Executive’s Statement of Quality
This Quality Account, the fourth one we have produced, is for all our stakeholders - our patients, their families and carers, the general public in our communities and the local statutory and voluntary sector organisations that we work with.
Our Director of Care and her team are responsible for the preparation of this report and its content. To the best of my knowledge the information in the Quality Account is accurate and a fair representation of the quality of health care services provided by Primrose Hospice.
We provide all our services free to our patients and their families and we strive to offer the highest quality we can. This report provides clear information about the quality of our services so that our patients feel safe and well cared for and their families and friends are supported and reassured.
We welcome feedback from patients and their families and hold regular user forums.
The information gathered is then used to help us develop and improve our services as providing excellent quality services that are tailored to meet people’s individual needs is our top priority.
To deliver services to the high standards we set ourselves, we rely on the commitment and dedication of our staff and over 400 volunteers including our Board of Trustees. I extend my gratitude and thanks to all of them for helping us to continue to provide services of such high quality.
Helen Garfield
Chief Executive Officer
Primrose Hospice
Quality Account 2014-15
2

To all staff, volunteers, Chaplains and all who attend the hospice each week. Each and every one of you played a part in helping mom through a very tough journey, one she struggled with every day. Watching her deteriorate before our eyes became so unbearable and she is now at peace and no longer suffering this terrible disease. The words, ‘thank you’ simply don’t seem enough. We all, including mom, got so much from the hospice which helped so much for us as a family to prepare for what was ahead of us.
Family of a Day Hospice patient
This service has helped me beyond belief. I started my six weeks in pieces and came out a much stronger person learning how to live without my mum.
Bereaved relative (counselling service)
The support we received from members of the Hospice at Home team was unexpected but hugely appreciated and will never be forgotten. It wasn’t just the practical help, it was care and kindness in their truest form, consideration and devotion to a profession that granted us confidence in the help mum received and quite often reduced us to tears in assurance and relief
Family of a Primrose at Home patient
Primrose Hospice
Quality Account 2014-15
3

Primrose Hospice is a local charity with a base in Bromsgrove and provides services to patients and their families across the whole area around Redditch and
Bromsgrove. We support anyone with an end of life diagnosis. This has traditionally been Cancer but now we frequently focus on other illnesses such as Motor Neurone
Disease, Parkinson’s Disease, Heart Failure etc.
We do not have inpatient beds as those are provided at the Princess of Wales
Community Hospital by the Worcestershire Health and Care Trust but we offer a wide range of services to our patients and also do a huge amount of work with their families and carers. Last year nearly 900 local people received our help!
There are three main parts to our services.
1.
Our Day Hospice – patients usually attend one day per week and have access to a wide range of specialist nurses, occupational therapist and physiotherapist, counsellors, and other emotional and spiritual support.
2.
Our Family Support Service – families are supported both prior to and after a bereavement. Our specialist counsellors and trained support volunteers help individuals and families to come to terms with losing someone they love. Our specialist children’s worker helps children and young people to express their emotions through craft and play activities. We offer help both here in our specialist centre and in people’s homes.
3.
Our Primrose at Home Service – specially trained care providers will visit a patient at home either in the day time or overnight to provide one to one care for someone during their last few weeks of life. This enables the family to get some rest and often fulfils someone’s wish to stay at home for as long as possible.
The service is funded by a range of income streams. About 20% is funded by the local
Clinical Commissioning Group and the rest comes from local support including donations, legacies, fundraising events, a lottery and our 6 shops in Redditch,
Bromsgrove, Studley, Rubery, Droitwich and our furniture shop in Headless Cross.
Primrose Hospice
Quality Account 2014-15
4

PART 2
Priorities for Improvement 2015-16
Primrose Hospice is fully compliant with the section 20 regulations of the Health and
Social Care Act 2008. As such, the Board did not have any areas of shortfall to include in the priorities for improvement for 2015-16.
Future Planning
The priorities set for the next year result from discussions with staff, service users and stakeholders and we have tried to ensure that they are achievable, measurable and will provide improvements that are important to those who use our services.
Improvement Priority 1: Day Hospice remodelling project.
We plan during this year to embark on a project to provide a different model of Day
Hospice. The aim is to increase accessibility to a broader range of people looking for a more individualised and creative answer to their emotional needs than is found in a traditional Day Hospice. The plan is in response to feedback from existing service users who are asking for a wider range of activities and therapies and eligible service users who have declined traditional Day Hospice. The new model will provide a range of activities and therapeutic pursuits such as creative writing, art therapy, music therapy, T’ai Chi, yoga and others, and will offer much greater flexibility for people, allowing them to pick and mix which activities or therapies are of interest and benefit to them. To achieve this we first need to secure robust funding for a project lead with the necessary skills in the use of the arts as therapy and the timescale will be dependent on this.
Method of measurement: An outcome measurement tool will be used for participants in all newly introduced activities. Outputs will be measured by the numbers of patients participating in each activity.
Expected outcome (Assuming that funding is secured and a project lead is in post before the end of the year): An increase in the number of patients accessing support and services at Primrose Hospice. The total number of referrals to Day Hospice during 2014-15 was 63 and we would hope to see an increase of 10% in the year following the introduction of the new model. The outcome measurement tool will demonstrate measurable benefits in terms of emotional support and improved physical symptoms.
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Quality Account 2014-15
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Improvement Priority 2: Increase the percentage of people supported at home by
Primrose at Home who achieve their preferred place of care.
The Primrose at Home service provides practical and nursing support so that people are able to remain at home at the end of life, if that is their preference. Where patients have told us where they would prefer to die we document that against their actual place of death. Where it was not achieved we document and consider the reasons, with a view to improving systems and services in the future.
Method of measurement: Data collection already in place at Primrose Hospice
Expected outcome: An increase in the number of people who die in the place of their choosing due to support from the Primrose at Home Service. During 2014-15,
72 out of 79 patients cared for by Primrose at Home who had previously specified their preferred place of dying achieved their wish (91%).
Improvement Priority 3: Information Governance.
An information governance committee is meeting regularly to work through the requirements of the NHS Information Governance Toolkit. As an independent sector organisation we are not obliged to follow these requirements but consider them to represent good practice. We aim this year to complete a mapping exercise of all transfers of information within Primrose Hospice, to risk assess them and put into place any extra measures necessary in order to strengthen existing security of all person sensitive information.
Method of measurement: Risk assessments made of every type of information transfer and completion of any actions required. New policy and procedures for transfers of information written and ratified.
Expected outcome: Increased assurance by the public that information governance is properly managed at Primrose Hospice and that person sensitive information is treated in accordance with the Data Protection Act 1980 at all times.
Improvement Priority 4: End of Life Care Quality Assessment tools (ELCQuA).
We will complete 2 of the self assessment measures on the ELCQuA website, benchmarking our services against the NICE standards for end of life care and against other end of life providers.
The two measures we intend to look at initially will be:
1.
NICE Quality Statement 6: Holistic Support: Spiritual and Religious
2.
NICE Quality Statement 14: Care After Death: Bereavement Support
Method of measurement: Completion of the 2 ELCQuA self assessment measures, including the creation and completion of an action plan.
Primrose Hospice
Quality Account 2014-15
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Expected outcome: A benchmarking of our care compared to others. Improved care experience for patients and families in line with the NICE quality statements for end of life care.
Progress against the Improvement Priorities identified in 2014-15
During 2014-15 the hospice implemented a number of initiatives to enable it to provide a more responsive and comprehensive contribution to end of life care within our local community in spite of the financial challenges of the current climate and the uncertainty created by major organisational changes within the NHS.
Progress is discussed below.
Progress made against Priority Improvement 1: Measuring Outcomes for Day
Hospice patients
We have achieved this in that we now have a tool which will provide measurable results, is easy to use and acceptable to patients and focuses on those issues which are at the core of what we try to achieve in a Day Hospice setting. The patient completes a straightforward questionnaire each week and their responses provide a score which demonstrates changes for better or worse in a variety of physical and emotional areas. Very early scores show improvements for a couple of patients in pain, feelings of self worth, feeling that life is worth living and levels of family anxiety. The difficulty that arises is that frequently patients do not attend consistently because they aren’t well enough and sometimes only come once or twice, making comparison of scores irrelevant. However, we now feel that we have a tool and that over time it will provide the data that we are looking for.
Progress made against Priority Improvement 2: Piloting a weekly drop-in group
The idea of a weekly drop in group was put forward by our service user group and a pilot was set up, run by a student at Primrose Hospice. Initial results were disappointing, but analysis has shown that the original concept for this group, put forward by service users, was for it to be provided in a more central location than the Hospice, such as Redditch or Bromsgrove town centres. We further felt that we could have done more to market the group. We are therefore planning to try again this year, and will be hoping to secure a suitable and more central venue and to improve our marketing.
Primrose Hospice
Quality Account 2014-15
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Progress made against Priority Improvement 3: Exploring the possibility of opening up hospice space for a support group for one long term condition
The thinking behind this priority was to add to a range of methods to open up access to the Hospice to a wider range of patients and their families, and to encourage the use of our facilities by groups representing long term conditions who haven’t traditionally benefited from Hospice care. In spite of approaches to various groups no-one has yet taken us up on this offer. However, our accessibility to patients with non-malignant conditions has grown significantly over the past couple of years and we are building sound relationships with colleagues from other specialties such as
Heart Failure, Neurological Diseases, Learning Difficulties, COPD and others. Around
30% of new referrals to Day Hospice in the past year had a non-malignant diagnosis, which is a significant increase on previous years.
Progress made against Priority 4: Increase the skills and knowledge of 75% of staff in caring for those with learning disabilities.
We achieved this priority, having made a helpful and positive link with the Learning
Disabilities (LD) team. A teaching session provided by Clinical Nurse Specialists from the LD Team was attended by 75% of the Day Hospice team plus additional staff from the Family Support Service and the Primrose at Home Service. This proved to be a useful interactive session and we were able to share knowledge and skills. We see only a small number of patients and carers with a learning disability but we believe that having made this professional link we will now feel more confident in providing care and will also know where to go for additional help and support.
Progress made against Priority 5: development of a reflexology lymphatic drainage technique to complement our existing support for the Worcestershire Health and
Care Trust Lymphoedema Service
This priority has been achieved in terms of obtaining training for the therapists in the specific technique of Reflexology Lymphatic Drainage. They attended a course taught by Sally Kay who developed the technique and whose recent trials have shown promising results. There have been opportunities for the therapists to use the techniques with clients who have lymphoedema, and we have received some positive feedback anecdotally. It is hoped that this will be extended to a formalised approach with close links to the Worcestershire Lymphoedema Service which would measure outcomes in terms of reduction of lymph volume using approved measuring equipment and photographic evidence.
That this process has not yet been established is due to entirely unrelated pressures on the complementary therapy service which has restricted resources including available volunteer time, as well as a change in personnel within the Worcestershire
Lymphoedema Service. It is anticipated that a member of the therapy team would take on responsibility for coordinating and supervising delivery of the techniques and for recording results. Referrals from the Worcestershire Lymphoedema Service would be welcomed.
Primrose Hospice
Quality Account 2014-15
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Statements of Assurance from the Board
The following are a series of statements that all providers must include in their
Quality Account. Many of these statements are not directly applicable to hospices.
Review of Services
Hospices are required to report against those services commissioned by their local
NHS. Primrose Hospice receives a grant representing just under 20% of its care costs from the Redditch and Bromsgrove Clinical Commissioning Group and currently provides the following services: o Day Hospice o Outpatient facilities o Family Support Services o Primrose at Home
Participation in clinical audits
During 2014-15, no national clinical audits and no national confidential enquiries covered NHS services relating to palliative care. Primrose Hospice only provides palliative care. During that period Primrose Hospice was not eligible to participate in any national clinical audits and national confidential enquiries.
As Primrose Hospice was ineligible to participate in the national clinical audits and national confidential enquiries, and for which data collection was completed during
2014-15, there is no list below alongside the number of registered cases submitted by the terms of the audit or enquiry.
The reports of 16 clinical audits were reviewed by Primrose Hospice during 2014-15.
As a result of these audits the following actions have been taken to improve the quality of healthcare provided:

Improvements made to our documentation in clinical notes systems

A review of the way patients who may be at risk of falls are screened

Plans to remodel Day Hospice in response to service user feedback
 Improvements to patient information
 Updating of some areas of the Hospice, including a new kitchen area in the
Coppice Centre
Research
The number of patients receiving NHS services provided or sub-contracted by
Primrose Hospice in 2014-15 that were recruited during that period to participate in research approved by a research committee was 0. There were no appropriate, national, ethically approved research projects studies in palliative care in which we could participate.
Primrose Hospice
Quality Account 2014-15
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Quality Improvement and Innovation Goals agreed with our Commissioners
Primrose Hospice income in 2014-15 was not conditional on achieving quality improvement and innovation goals through the Commissioning for Quality and
Innovation payment framework.
What others say about us
Primrose Hospice is required to register with the Care Quality Commission (CQC) and its current registration status is unconditional.
The Care Quality Commission has not taken any enforcement action against
Primrose Hospice during 2014-15.
Primrose Hospice is subject to periodic reviews by the Care Quality Commission and its last unannounced on-site inspection review was on July 23 rd
2013. The hospice was fully compliant. Primrose Hospice has not participated in any special reviews or investigations by the CQC during the reporting period.
The Quality Risk profile of Primrose Hospice states that the hospice is low risk and a comprehensive quarterly quality report is submitted to the CQC to maintain this ranking.
Primrose Hospice is subject to a quarterly review of quality as part of its contract with the Redditch and Bromsgrove Clinical Commissioning Group and all actions discussed during these meetings have been completed to the satisfaction of the commissioners.
Data quality
In accordance with agreement with the Department of Health, Primrose Hospice submits a National Minimum Dataset (MDS) to the National Council for Palliative
Care.
Primrose Hospice did not submit records during 2014-15 to the Secondary Uses
Services for inclusion in the Hospital Episode Statistics which are included in the latest published data. Primrose Hospice score for 2014-15 for Information Quality and Records Management was not assessed using the Information Governance
Toolkit. This toolkit is not applicable to palliative care.
Primrose Hospice
Quality Account 2014-15
10

PART 3
Quality Overview
Primrose Hospice is a small, independent charity based in North East Worcestershire and covering Redditch and Bromsgrove and surrounding areas. The Hospice is staffed by a total of approximately 60 people, including a number of ‘bank’ nursing staff who provide our Primrose at Home service, the staff who manage our charity shops and back office administration, finance and fundraising.
The table below shows the breakdown of the clinical team only.
The clinical team during 2014-15 was staffed as follows:
Post Head
Count
Director of Care 1
Day Hospice Team Leader 1
Staff nurses
Primrose at Home contract carers
2
3
1 Family Support Team
Leader
Clinical Supervisors
(counselling)
Macmillan Children and
Families Practitioner
Complementary Therapies
Coordinator
2
1
1
Day Hospice Administrator 1
Primrose at Home
Administrators
2
Family Support
Administrators
2
Cooks
Total
2
19
WTE Vacancy
1 0
0.88 0
1.4 0
1.44 0
1 0
0.64 0
1 0
0.5 0
1 0
0.86 0
1.5 0
0.64 0
11.86 0
Subcontracted staff included:
Post
Physiotherapist
Head Count WTE Employed by
1 0.8 Worcestershire Health and Care Trust
Occupational Therapist 1
CAB Advisor 1
Chaplain 1
0.4 Worcestershire Health and Care Trust
0.6 Wyre Forest Citizen’s Advice Bureau
0.32 Bromsgrove Baptist Church
Primrose Hospice
Quality Account 2014-15
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The most recent National Minimum Dataset covers the period 1
March 31 st st
April 2013 to
2014. Primrose Hospice data for 2014-15 has been collated but there is no comparative data available at the time of writing.
The National Council for Palliative Care: Minimum Data Sets for 2013-14
Primrose Hospice National Median
Day Hospice
New patients
Places used
New patients with a non cancer diagnosis
Average length of attendances (days)
%
62.9
50.6
21.9
Number
152.0
66
1,365
23
%
59.9
58.6
21.2
Number
237.5
43
1,009
15
Outpatients
New patients
Total clinic attendances
Bereavement Services
New service users
All service users aged under 16
All service users aged
16-24
%
57.1
%
75.1
12.0
3.8
Number
142
2,014
36
Number
238
38
12
%
72.0
%
68.2
2.7
2.8
Number
149
37
Number
286
Figure not available
Figure not available
2,310 Total contacts
Primrose at Home
New patients
All patients with a noncancer diagnosis
Patients who died at home
Average length of care
(days)
Total shifts provided
%
92.0
15.9
93.8
Number
27.0
793
104
18
76
%
95.2
20.0
90.1
Number
25.5
747
104
18
68
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Quality Account 2014-15
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The National Minimum Dataset (MDS) for 2013-14 compares Primrose Hospice with the national median values for other small Day Hospices, i.e. those who cared for fewer than 112 patients during the year.
The percentage and number of new patients attending Day Hospice during 2013-14 exceeded the national median. The percentage of places used was slightly less and less than our own figure for previous years, but the actual number was considerably more than the national median. ‘Places used’ refers to the number of actual attendances divided by the number of available places. Under-use of Day Hospice places is a common issue, and uptake of Day Hospice is better measured by places booked, since on any day there will be patients who are too unwell to attend due to the nature of the patient group for whom we care. However, this metric is not reported by the MDS so cannot be used for comparison with other units.
The percentage of patients with a non-malignant diagnosis continues to rise rapidly at 21.9% during 2013-14, up from 17.6% the previous year and only 7.8% the year before that, and as previously discussed, this is due to better and sustained links with colleagues from other specialities.
Last year the average length of attendance at Primrose Day Hospice fell considerably from 207 days to 152 days. This measures the period of time in days from the first day that a patient attended until the last day that they came, rather than the number of attendances, which is usually one day per week. The relevance of the figure is that Day Hospice attendance needs to be long enough for meaningful benefits to be gained, but not so long that patients become dependent, or suffer multiple bereavements as they make friends and then lose them. A period of around
3 to 6 months is probably ideal, though not always possible.
Outpatient figures at Primrose Hospice refer to a Clinical Nurse Specialist who runs a regular nurse-led clinic once or twice each week. The percentage of new patients, compared to similar sized clinics across the country is lower, but the actual number of new patients is almost identical.
Primrose Hospice has a busy and established bereavement service. This year’s MDS compared the Primrose Hospice Bereavement service with other large units, because the number of service users was greater than 262. For the last 3 years we have been included in the ‘medium’ category and prior to that in the ‘small’ category. For a
Hospice of our size serving a community of the population of Redditch and
Bromsgrove this demonstrates a significant rise in demand for our services.
Our service also supports a significantly higher percentage of children and young people, thanks to our Macmillan children and Young People’s Practitioner who has now been in post for 2 years.
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Quality Account 2014-15
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The Primrose at Home service provides Healthcare assistants able to support patients to die at home, if that is their preference. Our service has been established over many years now and figures show that we are working in line with other, comparable services.
In addition to the limited number of suitable quality metrics in the national dataset for palliative care we have chosen to measure our performance against the following metrics:
Indicator
Total number of people who received care or support from services provided by Primrose Hospice
2014-15 2013-14 2012-13
1,007 971 915
Total number of new referrals to Primrose Hospice
Total number of outpatient attendances
Total number of Day Hospice attendances
Total number of Primrose at Home shifts provided
Total number of complaints
The number of complaints which were upheld in full
608
337
1392
631
2
1
0
537
331
525
243
1,365 1,821
793
1
1
0
1,084
1
1
0 The number of complaints which were partially upheld
The number of serious patient safety incidents
(excluding falls)
Slips, trips and falls
The number of patients who experienced a fracture or other serious injury as a result of a fall
0
1
0
0
2
0
0
0
0
Number of clinical audits completed 16 12 18
Indicators for 2014-15 show an increase in referrals to Day Hospice and attendances, having had a quiet year in 2013-14. Primrose at Home referrals continue to come in quite late, so that although numbers remain fairly constant, the number of shifts delivered has fallen for the second year.
We document all incidents and near misses and this year have introduced more specific methods of documenting and reviewing clinical incidents. During the year 5 non-clinical incidents were reported and 4 clinical incidents. All of the incidents were reviewed at the regular Health and Safety meetings and the clinical incidents at the
Clinical Governance Committee.
We encourage staff and volunteers to report near misses and potential problems and one of our learning points this year was to take robust action when this has been done to make quite sure that no accident occurs after a hazard has been reported. A further action involved a tightening of security measures to reduce the risk of intruders accessing the premises particularly at the beginning or end of the day when less staff are around.
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Quality Account 2014-15
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The reported clinical incidents also involved near misses rather than any actual harm and provided a useful means of reflecting on difficult situations, finding ways to reduce risk and the introduction of written patient information to prepare patients who are likely to need increased assistance with moving and handling in advance.
Details of reported incidents were also shared where relevant with other agencies involved with a patient’s care, to enable them to carry out their own reviews.
Six accidents were reported during the year, two of which involved patients. No serious injury was reported. One staff member sustained a needlestick injury and the set protocols for dealing with this were followed.
Two complaints were received during the year of which only one was upheld.
Actions included discussion with the complainant and staff member to fully understand what had taken place and ensure that it was not repeated. The complainant received an apology.
We are putting in place systems to document and count compliments more accurately for the coming year, but last year 40 written letters of thanks and compliments were documented, and many more verbal expressions of thanks are received on a daily basis.
Participation in clinical audits
The following audits were completed during the audit year 2014-15. Primrose
Hospice conducted all audits using national hospice-specific audit tools, which have been peer reviewed and quality assessed. *
There is an ongoing emphasis on infection control with a number of mini-audits being carried out on a regular basis.
* except where stated
Infection Control
Self assessment against the
Health and Social Care Act
2008 Code of Practice
Patients’ toilets
Sluice
Domestic Room
Offices in clinical areas
Toilets for public use
Clinical Room
Patients’ bathroom
Sharps
Hand Hygiene
This audit is carried out every two years to ensure our full compliance. Some minor points relating to information for patients on our infection control arrangements, and the public display of agreed cleaning schedules have been rectified.
These mini observational audits are carried out every year. No major concerns were raised this year, but the regular checking of these areas ensures that minor repairs or issues of housekeeping are kept up to date.
The hand washing audit covers the facilities that are in place but not the issue of staff behaviour, and to rectify this we are developing an observational audit tool to see whether staff and volunteers are washing their hands using the correct technique and
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Quality Account 2014-15
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Kitchen areas (excludes main kitchen)
External Inspection frequency. A new kitchen has been installed in the
Coppice Centre as a result of audit.
Medicines
Medicines management
Controlled Drugs
Accountable Officer (CDAO)
Day Hospice
Day Hospice Admission
To strengthen our infection control arrangements we also invite the Infection Control Nurse from the
Worcestershire Health and Care Trust to undertake a full inspection of our premises and infection control measures. This is a very thorough inspection including all areas. This year’s report, as in previous years, gave positive feedback on our approach to infection control and the way in which we prioritise infection control and aim at all times to minimise risk, and note was made of the ways in which we keep staff and volunteers up to date on infection control issues and maintain a comprehensive infection control folder. A number of minor issues of housekeeping and maintenance were pointed out, some of which apply to our cleaning and maintenance staff and some which apply to the clinical cleaning schedules carried out by nursing staff. An action plan was produced and all essential actions have been completed. Other, less essential actions will be completed when funding allows.
We carry out an audit of our medicines management systems at least annually and more often if any concerns arise as a result of our audits. This is in spite of the fact that the majority of patients attending the
Day Hospice self administer their medicines. This year’s audit shows continued improvements in all areas and in particular the documentation of a full drug history for all patients at initial assessment, and on an ongoing basis.
There is a very limited role for a CDAO at Primrose
Hospice as we don’t order, stock or supply CDs and only very rarely administer them to patients attending
Day Hospice. However we audit our arrangements every year as required and this year again achieved
100% compliance.
This audit was carried out last year and highlighted a number of issues of documentation and practice that required attention. Resulting changes have included significant improvements in documentation, including the recording of a full drug history on admission. A clearer process has been put in place to screen patients who may be at risk of falls.
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Quality Account 2014-15
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Record keeping
Consent in Systmone This is now an annual audit of the electronic clinical record used by all of the hospices and palliative care services across Worcestershire and checks that consent has been obtained from the patient for the use of the record. Significant improvements have been noted this year, in that overall our average compliance has increased from 67% to 93.25%.
What patients and carers say about the organisation
The User Forum meets whenever there is an issue on which we need to consult. We invite service users from all parts of the organisation, including Day Hospice patients, outpatients, those attending groups, including carer’s groups or bereavement groups, and those attending counselling or receiving support in other ways. We try to gather a group of at least 10 – 12, providing a broad representation of types of service users, from current patients accessing a variety of services through to carers and the bereaved. Groups are facilitated by a volunteer or member of staff from the
Family Support Service.
This year the Service User Forum met in October 2014.
Meetings are minuted and an action plan created. Minutes and action plans are taken to the Clinical Governance Committee, which is a sub group of the Board, and results of actions taken are fed back to participants. The table below shows some of the issues raised and how we responded.
What service users said:
People don’t know enough about hospices and believe that they are just places to die. Why can’t you lose the word ‘hospice’ from your title, which would make more people want to come there? We also don’t like the strap line on your logo: ‘Living well at the end of
Life.’
Car parking is insufficient at times which is a particular problem for disabled service users.
Your buildings can be very hot at times and the draughts. automatic doors create
How we responded:
These comments crop up very regularly.
This year the Board did reconsider our title, and although we have not removed the word Hospice from our title we have amended our full logo and removed the strap line.
We have also taken on board the feedback that our marketing could be better, and have restructured our fundraising team to include a marketing/communications role.
We are costing out the provision of more disabled car parking spaces and have negotiated some staff car parking in an adjacent sports club.
We have adjusted the heating. The draughts from the automatic doors is a problem during the winter months but
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Quality Account 2014-15
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We would like more of your services than you are offering us (this applied specifically to days per week in Day
Hospice and complementary therapies)
We are upset that you have changed the arrangements for the bereavement group.
We would like a facilitated pre bereavement group. seating areas are not directly affected.
We will however take this into consideration when we upgrade the Day
Hospice and reception area, which will be when funding allows.
We have fed back to service users that the number of days offered in Day
Hospice is determined by individual need. We are flexible in our approach and some patients do attend for more than 1 day a week where a clinical or psychosocial need has been identified.
However, we are not able to make that offer simply because someone enjoyed the day.
Our complementary therapy service is provided by volunteers and our ability to offer therapies is constrained by the resources that we have. Patients, particularly those attending Day Hospice, are usually offered therapies for as long as they want them and we prioritise our service to this group. We generally offer a time limited package of 6 sessions to carers or bereaved family members, and if they want to continue to receive therapy beyond that we signpost them to private therapists.
We run a number of bereavement groups and sometimes need to take some action to move on a group that has been attending for a long time. A member of the Family Support team has now been tasked with working with group facilitators and participants to try and resolve the mismatch between what service users would like and we are able to offer.
This is being developed.
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I would like to say how grateful I am for all your support throughout dad’s illness. I don’t think I would have coped without you al being on the end of the phone. So just a massive thank you from me personally.
Daughter of a Day Hospice patient
I came to Primrose because my nan sadly passed away and I needed to talk to someone about it because I was upset and felt alone because I was so close to her.
Coming to Primrose helped by making me feel better about myself and I know that I can talk to someone about it and I now know that I can talk to people about my feelings and can be supported with my problems through different ways.
I love my sessions because Jenni lets me make things that I can take home to make me think about my nan and think happy thoughts about her and to show that I was close to her.
Bereaved child
Very appreciative of time and therapy given by a caring and helpful lady who has been so supportive to me.
Complementary Therapy client
Primrose Hospice
Quality Account 2014-15
19

Annexe
What Redditch and Bromsgrove Clinical Commissioning Group said about Primrose
Hospice’s Quality Account for 2014-15:
A significant component of the work undertaken by NHS Redditch and Bromsgrove
Clinical Commissioning Group (RBCCG) includes the quality assurance of services provided for the population of Redditch and Bromsgrove that are all or part funded by the NHS. This includes steps to assure the public that the content of this Quality
Account is an accurate reflection of the quality of services provided by Primrose
Hospice.
RBCCG has continued to receive quarterly data in alignment with an agreed annual
Quality Reporting Schedule. This is in addition to engaging in Quality Assurance ‘walk through’ visits and Contract and Quality Monitoring Review meetings with Primrose on a bi-annual basis that have included presentations to highlight the outcomes of services provided to local people (for example the Bereavement service and work to help families and young people cope with the loss of a loved one). RBCCG therefore is in a good position to confirm that as far as it is possible the content presented in this Quality Account appears accurate.
In response to the Primrose Quality Account for 2013-14, RBCCG stated that supporting more people to attain end of life care at home, where this is their preference, would have been a welcome priority. We are therefore very pleased that the Primrose team has decided to focus on this as an improvement priority for 2014-
15. The intention to use specific outcome measure tools for other improvement priorities will demonstrate whether planned changes are effective in meeting individual need.
Progress made in 2014-15 in increasing access to services for people with a learning disability will support RBCCG in its aim to reduce barriers in achieving the right care in the right place for all members of its local community. With a continued commitment to supporting equality of access for those who are at risk of being marginalised, RBCCG would support a priority to improve access to services for people with dementia by increasing awareness amongst staff and making links with other local providers. The 2015-16 priority to consider providing services in a range of alternative locations, where people who may not choose to visit a Hospice setting can benefit from the wealth of skills and knowledge of the Primrose staff team, is most welcome.
The reporting of individual satisfaction reported by users of services is a strong indicator of whether a service is reflective of need and RBCCG is pleased to confirm that there has been a consistent presentation of high levels of satisfaction with the services provided by Primrose throughout 2014-15. Numbers of complaints are low but where they occur the CCG is assured that there is a transparent process for investigating concerns and learning from findings.
Primrose Hospice
Quality Account 2014-15
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The Account highlights the continued commitment of Primrose to promote a learning culture where the reporting of incidents and near miss events is encouraged in order to reduce the risk of recurrence and enhance staff and visitor safety.
Positive improvements have been implemented as a result of audit findings.
In summary RBCCG considers the Primrose Hospice Quality Account for 2014-15 to be a balanced and fair report that reflects the high quality of services delivered.
RBCCG continues to wish the team at Primrose Hospice every success in continuing to deliver highly valued and well respected services for local people.
On behalf of NHS Redditch & Bromsgrove CCG.
Primrose Hospice
Quality Account 2014-15
21

April 2015
What the Worcestershire Health Overview and Scrutiny Committee said about
Primrose Hospice’s 2014-15 Quality Account:
Primrose Hospice is the first Worcestershire hospice which has provided a Quality
Account for observations, which is in itself a testimony to openness. The following observations are made:
1.
Primrose Hospice's Quality Account is very accessible and clear to read.
2.
The addition of a brief overview of the type of services provided, to the opening pages of the Quality Account, would be helpful for those who are not familiar with this hospice. A few words about funding may also be of interest to the public.
3.
It is evident that service users are involved in shaping service provision, an example being renewed efforts to set up a weekly drop-in group.
4.
Detail provided about the hospice's actions in response to service user feedback is comprehensive and welcomed.
5.
Overall the data on quality is clear, and HOSC members are pleased that requests for minor clarification have been taken on board (including numbers alongside percentages and clarifying figures for length of attendance)
6.
The hospice has several charity shops and it may be of interest to the public to include location details in the quality account.
7.
Whilst appreciating that resources for marketing are scarce for smaller hospices such as Primrose, opportunities for raising the profile of the hospice across north
Worcestershire are encouraged.
Primrose Hospice
Quality Account 2014-15
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What Healthwatch Worcestershire said about Primrose Hospice’s 2014-15 Quality
Account:
Healthwatch Worcestershire
Reference: Primrose Hospice Quality Account 2014/15
1.
Do the priorities of the provider reflect the priorities of the local population?

 HWW welcomes the plan to remodel the Day Hospice improving accessibility and a broader range of activities. This reflects the needs of the diverse population and offers more personalised and person centred care recognising the choice of the individual.
 Increasing the number of people who die in the place of their choosing demonstrates the commitment of the Hospice in quality end of life care and individual choice, putting consumer’s first.
 Benchmarking end of life care services against NICE standards is good practice demonstrating a commitment to improving the experience of care for patients and families
2.
Are there any important issues missed?
 It would be useful to know which other providers will be used when benchmarking the end of life care services, for example, will they be providers of a comparable size and nature to Primrose Hospice?
3.
Has the provider demonstrated that they have involved patients and the public in the production of the Quality Account?

 There is a clear commitment to involving service users and carers through the User Forum. However, as the forum met only once in the year 14/15 it may be useful to consider other methods of involvement giving service users and carers more choice in how they get involved.
4.
Is the Quality Account clearly presented for patients and the public?

 The Quality Account is written in a clear and concise manner and easy to read for the general public.
Written by Felicity Jones with involvement from Directors and Co-opted Board
Members.
Primrose Hospice
Quality Account 2014-15
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