QUALITY ACCOUNT 2014-2015
Excellence and choice in end-of-life care for everyone
QUALITY ACCOUNT CONTENTS
Part One
Part Two
Part Three
Statutory
Statements
1.1
Statement of quality from the Chief Executive
1.2
Assurance of accuracy
2.1 What is a Quality Account?
2.2
Prospect Hospice and quality
2.3
How do we measure quality?
2.4
Looking ahead: Our priorities for 2015-2016
3.1
About Prospect Hospice:
Our vision, our mission and our strategic aims
3.2
Looking back: Progress in 2014-2015
3.3
Audits and information
3.4
Knowing how we are doing
3.5
Inspection outcomes
3.6
Assurances for the Board of Trustees
4.1
Statutory statements: Statements we are required to include
4.2Feedback
PROSPECT HOSPICE QUALITY ACCOUNT 2014-2015
QUALITY ACCOUNT PART 1
1.1 STATEMENT OF QUALITY FROM THE CHIEF EXECUTIVE
Welcome to Prospect Hospice’s Quality Account. This report is for our patients, their
families and friends, as well as the general public. It is also for local NHS organisations.
Its aim is to give clear and unambiguous information about Prospect Hospice and the
quality of its services to demonstrate that the people who access the care and support we
provide feel safe and well cared for, confident that our services are of a high standard and
that the NHS, which makes a contribution to the services we provide, is receiving very good
value for money.
Within the Quality Account, we not only reflect on the achievements and challenges of
2014-2015, but also share some of our key priorities for the year ahead.
Prospect Hospice’s focus is, and always will be, our patients, their families and carers
but our achievements could not be realised without the commitment of our staff and
dedication of our many volunteers. I would like to thank them for their support and
commitment to maintaining the highest of standards.
If you have any comments on the information included, please let us know. You can do so
via email info@prospect-hospice.net or telephone 01793 813355.
Angela Jordan
Chief Executive
PROSPECT HOSPICE QUALITY ACCOUNT 2014-2015
QUALITY ACCOUNT PART 1
1.2 ASSURANCE OF ACCURACY FROM THE CHIEF EXECUTIVE
AND THE CHAIR OF THE BOARD OF TRUSTEES
The Quality Account is a balanced picture of Prospect Hospice’s performance
during 2014/15 .The information reported is reliable and accurate
Angela Jordan
Chief Executive
PROSPECT HOSPICE QUALITY ACCOUNT 2014-2015
Tim Willis
Chair of the Board of Trustees
QUALITY ACCOUNT PART 2
2.1 WHAT IS A QUALITY ACCOUNT?
Quality accounts were introduced to strengthen
provider accountability for quality, and place quality
reporting on an equal footing with financial reporting.
They are intended to be both retrospective and
forward-looking. They look back on the previous
year’s information regarding quality of services, and
explain both where a provider is doing well and
where improvement is needed. Quality accounts also
provide a forward look, outlining what a provider
has identified as priorities for improvement over the
next reporting period and how they will achieve and
measure success
The duty to publish quality account applies to
all providers of NHS-funded healthcare services
(whether NHS, independent or voluntary sector),
including services like Prospect Hospice that receive
only a proportion of their funding from the NHS.
Quality within the context of the quality account
relates to the delivery of services that are effective,
and care that is safe and provides a positive
experience.
2.2 PROSPECT HOSPICE AND
QUALITY
Prospect Hospice provides its specialist palliative
care and dedicated end of life care and support
PROSPECT HOSPICE QUALITY ACCOUNT 2014-2015
services to adults living with and dying from
advanced and progressive life limiting conditions in
Swindon and north east Wiltshire. Care and support
is individualised, is available to families and friends of
the people we meet, and extends into the period of
bereavement. Care and support is offered free at the
point of delivery.
Care and support is provided through a range of
bespoke services that are delivered within the
main hospice building and across the community,
including at the Great Western Hospital and in local
care homes. In much of its work, Prospect Hospice
seeks to complement and enhance as opposed to
replace or duplicate the work of local statutory or
independent providers. Prospect Hospice deploys
its confident expertise to enable the best possible
experience for people often at a time of anxiety and
fearfulness. Additional to this, Prospect Hospice is
committed to bolstering the skills and confidence
of other providers through its range of bespoke
education and training courses.
The services provided include in-patient care, day
hospice and supportive out-patients, hospice at
home, access to clinical nurse specialists and medical
consultant assessment and review at home, in
hospital and in care homes, a range of family support
activities including specialist social work assessment,
carer support and bereavement care and support,
therapy services (including physiotherapy and
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occupational therapy) and a lymphoedema service.
Quality matters to Prospect Hospice in everything it
does - in its future development as well as its day-today operation.
Quality means providing the best possible experience
for all those we meet - offering the right care or
support to the right person when and where it is
needed most.
Quality means that we do what we say we will do.
In all that we do we want people experiencing our
care and support to feel respected, supported, cared
for and valued. We want them to know that they
matter. We also want the teams we work with to feel
empowered by the skills and confidence they acquire
though our working together or our education and
training.
2.3 HOW WE MEASURE QUALITY
We measure quality throughout the year through
regular review, audit and evaluation. We involve
others through actively seeking their views on their
experience of our care and support in real time. We
also collect compliments and investigate complaints.
Additionally we engage with our staff and draw
upon their confident expertise to reflect on care
and services provided so that changes can be made
to improve experience. We also meet with partners
PROSPECT HOSPICE QUALITY ACCOUNT 2014-2015
and stakeholders - at meetings and through regular
events.
In response to the growth in demand for all that we
do, we are inspired to reach even further and to close
the gap on unmet need.
If you’d like to know more about what we’ve been
doing in 2014-15, please take a look at our annual
report. You will find it on our website www.prospecthospice.net. Alternatively you can request a copy by
emailing info@prospect-hospice.net or telephoning
01793 813355.
2.4 LOOKING FORWARD:
PRIORITIES FOR IMPROVEMENT
AND DEVELOPMENT IN 2015-2016
Prospect Hospice is committed to developing the
quality of the services it provides for patients, families,
and carers. This commitment is evident in its future
plans.
The Senior Management Team and the Board of
Trustees agree key priorities for improvement and
development that link our vision, our mission and our
strategic aims. They link to implementation plans and
seek to ensure that Prospect Hospice is fit not only
for today but also for the future. Additionally, dayto-day priorities for improvement and development
emerge through service review and feedback.
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Prospect Hospice’s future plans comprise a range of
approaches that extend from improving the quality
of patient experience through its provision of direct
services, through the delivery of education and
training and through raising awareness of the needs
of people living with and dying from advanced and
progressive life limiting illness across our community.
Plans include but are not restricted to the following
priorities.
2.4.1 FUTURE PRIORITY 1
Effectiveness and experience: Service review
and redesign
During the course of 2014-2015 a programme of
service review and redesign was developed and
commenced. This work activity is now contributing to
the development of a plan that will set the strategic
direction for Prospect Hospice’s directly provided
services over the next 3 to 5 years.
The 2014-2015 reviews identified a number of priority
actions for delivery in 2015-2016 and endorsed
by Trustees. Actions focus on strengthening the
systems and processes that work well, and identifying
and redesigning systems and processes where
effectiveness and efficiency can be improved.
The 3 to 5 year plan will evolve and transform the way
patient and family services work together to bring
about improvements in the palliative and end of life
PROSPECT HOSPICE QUALITY ACCOUNT 2014-2015
care and support provided to people across Prospect
Hospice’s community. The plan will seek to align
people, resources, leadership and energy to shape
the future of Prospect Hospice’s patient and family
services.
How was this identified?
During 2013-2014 Hospice UK, the umbrella
membership organisation for adult hospices, created
the Commission into the Future of Hospice Care.
The Commission delivered a range of proposals and
recommendations for hospices to consider as they
prepared for the challenges of the future. In the
autumn of 2014, Prospect Hospice commissioned a
piece of work to help it better understand local need.
This review is now informing future planning and
underpinning strategic planning for the next 3, 5 and
10 years.
Specific themes included:
„„ Increasing demand due to population growth and
specifically an ageing population
„„ Increasing complexity of need due to more
people living with multiple conditions
How do we plan to achieve this?
In 2015-2016 we will present a patient and family
service plan for adoption and monitoring by
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Trustees that will outline the key priorities for service
development and delivery in the future.
2.4.2 FUTURE PRIORITY 2
Effectiveness and experience: Increasing access
to care at home
The availability of our Prospect@Home service will
be increased to enable improved access to dedicated
care and support at home during a crisis in a persons
condition and at the end of life.
How was this identified?
Prospect Hospice and local Clinical Commissioning
Groups recognised that there continued to be
occasions where despite clearly expressed preference
for care at home, many people were still dying in
hospital. There were also occasions where people
in hospital waited too long to return to their own
homes. Increased availability of Prospect@Home was
identified as a key mechanism for improving the care
and support of patients where there was no medical
requirement for treatment to be provided in hospital.
How do we plan to achieve this?
We will increase the capacity of the Prospect@Home
service to enable more people to be cared for and to
die in the place of their choosing.
PROSPECT HOSPICE QUALITY ACCOUNT 2014-2015
2.4.3 FUTURE PRIORITY 3
Safety: Enabling mobile access to electronic
health care records
Improved mobile access to electronic health care
records will assure patients safety and increase the
efficiency of our community based teams. With new
technology staff will have prompt access to integrated
information at the point of care. This will allow for
safer interventions and reduce risk by providing our
staff with access to the most up to date information.
How was this identified?
Advances in technology solutions as well as the
increased availability of 4G across our area of
operation triggered the requirement for a review of
our existing solutions. We believe that investment
in this area will enable prompt and joined up
communication within Prospect Hospice as well as
access to the SystmOne portal.
How do we plan to achieve this?
We will identify the best possible solution and project
manage implementation by December 2015. We will
ensure that all solutions meet information governance
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requirements.
2.4.4 FUTURE PRIORITY 4
Effectiveness: Implementing patient outcome
measures
The Outcome Assessment and Complexity
Collaborative (known as OACC) comprises a team of
palliative care experts who believe that the routine
use of outcome measures in hospices could improve
the services provided to patients and families.
They believe that the information collected could
drive quality improvements and future service
developments through an improved understanding of
peoples needs
The Collaborative identified six different measures.
How was this identified?
It is important to Prospect Hospice to ensure that
the service it offers to people is both high quality and
meets their needs. The tools developed by OACC
are both validated and recommended by Hospice
UK. These two things leave Prospect Hospice feeling
confident that they will be suitable for use within our
services and will deliver meaningful information that
will be useful to the hospice.
How we plan to achieve this?
Prospect Hospice will implement at least two of
PROSPECT HOSPICE QUALITY ACCOUNT 2014-2015
these measures in our in-patient and community
services. We will robustly evaluate the data that is
generated and use this information to inform our own
decision making and increase the understanding of
commissioners and partner organisations.
2.4.5 FUTURE PRIORITY 5
Effectiveness and experience: Extending the
Care Home Passport to more people working
within care homes
In 2014-2015 Prospect Hospice designed a pilot
education and training course for non-registered care
home staff. This locally unique modular programme
comprises a taught programme and work place
assessments and culminates in the award of an end
of life care passport qualification. We believe that
through extending the skills and confidence of care
home staff, the quality of care and experience for
people living in care homes will be improved. In
2015-2016 we will increase access to this programme
so that more staff are able to acquire the skills they
are seeking to develop.
How was this identified?
This priority was identified in response to local
evidence and increasing numbers of people living the
end of their lives in care homes. Concurrently, the
Prospect Hospice Care Home Service was receiving
increasing requests from care home managers and
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staff to provide bespoke education and training for
non-registered care home staff. This requirement was
also confirmed in feedback from a Prospect Hospice
Care Home Conference which took place in October
2015.
How do we plan to achieve this?
We will increase the number of places available on
this programme so that more non-registered care
home staff are able to attend. We will review the
robustness of evaluation tools so that we are able to
evidence the difference this makes.
2.4.6 FUTURE PRIORITY 6
Experience: We will lead the development of a
local Dying Well Community Charter
Prospect Hospice will form and lead a collaboration
that will develop a dying well community charter that
will enable a common and shared understanding of
those things that matter to people as they approach
the end of their life.
How was this identified?
The needs of people approaching the end of life
need to be well understood and expressed in a
clear and unambiguous way if sustained progress
in improving experience is to be achieved. A newly
formed and multi-agency group, led by Prospect
Hospice, believes that a charter is one mechanism
PROSPECT HOSPICE QUALITY ACCOUNT 2014-2015
for achieving this. This view is upheld by the National
Council for Palliative Care who are currently working
with a number of pathfinder groups across the United
Kingdom.
How do we plan to achieve this?
We will use a combination of national evidence
and best practice to inform the development of the
charter. We will add to this the views of local people
which were collected during national Dying Matters
Week.
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3.1 ABOUT PROSPECT HOSPICE
3.1.1 OUR VISION, OUR MISSION, AND
OUR STRATEGIC AIMS
Our Vision
Excellence and choice in end of life care for everyone
Our Mission
Prospect Hospice works within our community
in partnership with patients, their families and
organisations to provide and influence excellent care,
support and understanding at the end of life.
Our Strategic Aims
„„ We will provide end of life care services to
patients and their families, maximising reach and
quality
„„ We will influence other organisations to improve
the care of everyone at the end of life by sharing
our experience and expertise
„„ We will increase our community’s understanding
of the breadth of our work and the positive
impact we make locally on our patients and their
families.
3.2 LOOKING BACK: PROGRESS
AGAINST PROSPECT HOSPICE
PRIORITIES IN 2014-15
3.2.1 PRIORITY 1
Effectiveness: Service review and redesign
During the course of 2014-2015, a programme
of service review and redesign was developed
and commenced. This work sought to evolve and
transform the way patient and family services
work together to bring about improvements in the
palliative and end of life care and support provided
to people across our community. The programme
focused on strengthening the systems and processes
that work well, and identifying and redesigning
systems and processes where effectiveness and
efficiency can be improved.
A series of current state service reviews were
completed during the year, and generated a set
of action plans. These action plans are now being
implemented. Outcomes from this work have so far
included:
„„ A review of the role of the discharge planning
coordinator on the in-patient unit to ensure that
peoples preferences for care are acted upon
quickly
„„ An evaluation of hospice at home services to
increase accessibility and response times
PROSPECT HOSPICE QUALITY ACCOUNT 2014-2015
QUALITY ACCOUNT PART 3
„„ An evaluation of an expanded therapy assessment
and review service that increased availability from
5 days a week to seven days a week.
This programme of work forms the foundation for the
development of a patient and family services strategic
plan in 2015-2016.
3.2.2 PRIORITY 2
Safety: Future clinical workforce requirements
Future clinical workforce requirements were reviewed
in 2014-2015, and a series of recommendations
were generated to safeguard future care and support
by minimising the risks associated with the ageing
clinical workforce. The outcomes of this review are
influencing the development of a people strategy in
2015-2016.
3.2.3 PRIORITY 3
Safety: Assessment of current skills and
knowledge
An assessment of the current skills and knowledge
of the patient services team was completed in
2014-2015 with a view to identifying any gaps in
competencies and identify priorities for development
in the future. The outcome of this review has shaped
development priorities for individual staff and
services.
PROSPECT HOSPICE QUALITY ACCOUNT 2014-2015
3.2.4 PRIORITY 4
Experience and effectiveness: Delivering more
care closer to home
During 2014-2015 a key focus was the development
and delivery of more services closer to home for
more people. This priority was informed by our
understanding of people’s preferences to live life fully
and when the time comes, die in the place of their
choosing alongside evidence that showed the further
away from the hospice people live, the less likely they
are to access the Hospice’s services. Three separate
areas of development were progressed during the
year:
Prospect@Home service was expanded to include
a rapid response service meaning that more people
were able to access skilled care at home during a
crisis in their condition or extra care to enable them
to return home from hospital for care at the very
end of life. The quality outcomes from this service
expansion have secured additional funding in 20152016.
Additionally, through the allocation of new funding
during the winter, the therapy service was increased
from five to seven days a week. This enabled timely
assessment for people with rapidly changing needs,
and the provision of equipment to help maintain
confidence.
Finally, a new model for community based service
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delivery was developed during the year, and a new
site identified at Savernake Community Hospital. In
2015-2016 a range of Prospect Hospice outpatient
services for patients, families and carers will be
introduced.
3.2.5 PRIORITY 5
Experience: Understanding the experience of
people accessing care and support
With dedicated funding from one of our Clinical
Commissioning Groups, Prospect Hospice has
introduced a new patient feedback system which
enables patients, families and health and social care
professionals to feedback in real time their views on
the quality of their experience with Prospect Hospice.
This new system was introduced in the autumn of
2014 for people accessing care and support at the
Hospice and during 2015 will be progressively rolled
out across the entirety of our services.
Real time feedback is available for staff and provides
the opportunity for enhanced reporting to Trustees
and timely change to occur to improve experience. It
also offers staff the opportunity to recognise the little
things that make a big difference for patients and
families accessing care.
PROSPECT HOSPICE QUALITY ACCOUNT 2014-2015
3.2.6 PRIORITY 6
Experience: Improvements in support and facilities
for families
Prospect Hospice’s care and support extends to
families, and in 2014-2015 two specific quality
initiatives were introduced to improve experience:
Firstly, July 2014 saw the opening of two new family
lodges offering improved accommodation for
families who wished to stay near to patients at the
Hospice who were approaching the end of their lives.
The availability of the lodges provided reassurance
to patients that family members are able to rest.
Feedback has already indicated that the availability
of the lodges has made a time that is understandably
framed by sadness and distress a little easier for the
people important to patients.
Also in the year, the Family Support Team expanded
their bereavement care and support service to
include bi-monthly Evenings of Reflection and
Remembrance. These poignant occasions offer
families and friends of patients who have died the
opportunity to remember together. The number of
people who choose to attend these events has grown
as they have become more established and the
feedback received has been excellent.
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3.2.7 PRIORITY 7
Effectiveness: Releasing capacity to care
During 2014-2015, Prospect Hospice applied the
principles outlined in an NHS project toolkit called
the ‘Productive Ward’ on its in-patient unit. This
toolkit was used as a framework to review the
processes that are in place to guide the way in which
care is delivered, and help the nursing team identify
ways in which these could be improved so that more
time is available to be alongside patients and their
families. In 2014-2015, this led to the review of the
in-patient unit shift pattern and the introduction
of longer shifts. This has contributed to improved
coordination. This work programme has also seen
changes implemented in the management of
medicines administration.
3.2.8 PROGRESS AGAINST
PRIORITIES AGREED WITH CLINICAL
COMMISSIONING GROUPS (CCG) IN
2015-2016
Priority 1: Safety: A review of safeguarding
will take place to ensure full compliance with
safeguarding standards
During 2014-2015, Prospect Hospice commenced
a review of safeguarding to ensure compliance with
essential standards. This review has been completed
PROSPECT HOSPICE QUALITY ACCOUNT 2014-2015
in part but is ongoing in 2015-2016 due to the
requirements of the Care Act and changed case
law affecting mental capacity assessment and the
deprivation of liberty safeguards.
Priority 2: Effectiveness: Prospect Hospice and
Swindon CCG will develop a service specification
for Prospect@Home
During 2014-2015 in principle funding was
secured to enable the expansion of Prospect@
Home to more people. Subsequently this funding
has been confirmed as recurrent. A plan for
implementation has been agreed to enable service
delivery to commence in Quarter 2 of 2015-2016.
Key performance indicators have been agreed to
demonstrate impact and outcome.
3.3 CLINICAL AUDIT AND
INFORMATION
Prospect Hospice has led and participated in a
broad range of audits to monitor compliance and
outcomes. This activity is informed by a range of
factors and is both planned and ad-hoc, and is an
important element of how we monitor quality at
senior management team and Board of Trustees level.
The following is a sample of the audits that were
completed in 2014-2015:
„„ Falls audit
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„„ Documentation audit
Falls:
„„ Infection control audits including environment
audits and hand-washing audits
Close analysis of data relating to patient falls has
occurred throughout the year. Increased complexity
of need and frailty combined with an extended length
of stay for a small number of patients experiencing
repeated falls was a contributory factor in the
minimally higher than the national hospice average
number of falls in Quarter 2 and 3. There were no
incidents of serious harms as a result of falls. A full
review of falls assessment and care plans has taken
place and the range of equipment in use to minimise
the risk of harm from falls has been increased.
Specifically an additional high low bed has been
purchased and falls sensor mats purchased for beds
and chairs.
„„ Outcome audits relating to complementary
therapies
„„ Pressure ulcer incidence audits
„„ Medicine prescription audit
In addition to internal audits, Prospect Hospice also
participated in regional audits as part of the South
West Hospice Group, and in benchmarking audits
coordinated by Hospice UK.
See the table on Benchmarking Audit results on the
next page
EXPLANATION OF BENCHMARKING
AUDIT RESULTS
Occupancy rate:
Enabling access to care at the point of need is a
high priority for Prospect Hospice. The higher than
national average occupancy rate is an indicator of
accessibility. Accessibility to care has been increased
during 2014-2015 through the introduction of an
additional bed (increasing the total number available
from 15 to 16). This bed has been designated a rapid
access bed for people who are imminently dying and
whose preference it is to die in the hospice.
PROSPECT HOSPICE QUALITY ACCOUNT 2014-2015
Medicine – Related Incidents:
There was an increase in the number of medicine
related incidents in two quarters last year. This
predominantly related to a delay in the administration
of medicines during a change in procedures. A review
of procedures at the end of quarter 3 resulted in a
reduction in the number or reported incidents. In
2014-2015, Prospect Hospice also conducted a range
of service evaluations that included:
„„ An evaluation of the ‘Open Programme’
„„ The use of the Family Lodges
„„ The introduction of extended shifts to promote
continuity of care and support for patients and
families accessing in-patient care
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Bench marking audit results
Occupancy:
Q1Q2Q3Q4 Prospect Hospice
94% 90%
92%
95%
National hospice avg.
79%78%78%80%
Falls per 1000 occupied bed days: Q1Q2Q3Q4 Prospect Hospice8.512.411.89.5
National hospice avg.
11.611.610.510.9
Medicines incidents per 1000 occupied bed days:
Q1Q2Q3Q4 Prospect Hospice
2.3 12.4
8.8
2.9
National hospice avg.
5.85.76.36.1
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3.4 KNOWING HOW WE ARE
DOING: FEEDBACK FROM
PATIENTS AND FAMILIES
3.4.1 PATIENT AND FAMILY FEEDBACK
Many patients and family members choose to share
their views on the care and support provided by the
hospice spontaneously. Compliments received in
writing are collected and shared across teams and
with Trustees. The addition of a real time feedback
mechanism during the course of the year provided an
additional rich source of feedback that has indicated
a high level of satisfaction.
Additionally, Prospect Hospice maintains a
compliments register that captures compliments
across all service areas.
The following excerpts provide a sample of the
feedback received:
“Thank you to everyone at Prospect at Home for
everything you do for us, we wouldn’t cope without
you and we are so grateful. This journey has been a
long and tough one but knowing you are all there has
been a blessing”.
“I would like to tell my appreciation for your
professional and caring attitude towards my wife
who had a short illness with cancer, I can’t thank the
nurses enough for the advice and support and all the
PROSPECT HOSPICE QUALITY ACCOUNT 2014-2015
FRIEND AND FAMILY TEST
Following the introduction of the real
time mechanism in the autumn of 2014,
the freinds and family test revealed
the following levels of satisfaction in
Quarter 3 and 4:
In-patient Unit:
Q3 94%
Q4 100%
Community Clinical Nurse Sepcialists:
Q3 98%
Q4 100%
Therapy Services:
Q3 96%
Q4 100%
Family Support Services:
Q3 96%
Q4 100%
Lymphoedema Services:
Q3 95%
Q4 100%
Prospect@Home:
Q3 96%
Q4 100%
Day Hospice:
Q3 98%
Q4 96%
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staff while we were in the hospice for two days, we
had our last Christmas dinner at the hospice. Thank
you for your kindness and support”.
In all cases the complaints were resolved or
addressed sufficiently to the satisfaction of the
person who raised the concern.
“Thank you so much for helping mum have a peaceful
last few days. Our family would like to say thanks
for all the support we have been given. After all the
trauma we endured before mum came to Prospect it
was lovely just to enjoy her as mum and nan. For me
it was a weight off my shoulders”.
Two complaints were upheld. Action plans generated
in response to lessons learnt, and included a review
of the role of the discharge planning coordinator and
a review of the information provided to patients and
families.
“We cannot thank you enough for all that you did
for my dad and us as a family. My dad spent a very
short time in your care before he so sadly passed
away. Due to your kindness and caring support it was
a precious and peaceful time for me and my family.
We are comforted by the fact that we chose to bring
him to the Prospect Hospice - he was so dearly cared
for in such a peaceful, calming atmosphere. Not only
did you take such wonderful care of my dad, you also
took care of us too. That was such amazing support
for us as a family”.
3.4.2 COMPLAINTS
Prospect Hospice investigates all complaints
thoroughly to maximise learning and reduce the
likelihood of further incidences occurring in the
future.
During the year, there were ten complaints relating to
care and support.
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Patient and family services complaints are reported
to the Patient Services Committee, a sub-committee
of the Board of Trustees on a quarterly basis. All
complaints received during the year have been
resolved.
In addition to direct complaints, Prospect Hospice
staff have been involved in the resolution of
complaints relating to general end of life care issues
in the community and at the Great Western Hospital.
Complaints response times were maintained in all
circumstances.
It is noted that there has been an increase in the
complexity of complaints handling which has
occurred in response to a growth in the number of
complaints addressed to multiple agencies.
Where another agency is responsible for coordinating
a complaints response, Prospect Hospice has
cooperated fully.
QUALITY ACCOUNT PART 3
3.5 INSPECTION OUTCOMES
Prospect Hospice is registered as an independent
healthcare provider under the Health and Social
Care Act (2008) and is regulated by the Care Quality
Commission.
Two inspectors carried out a routine inspection in
February 2014 to check if the essential standards of
quality and safety were being met.
The inspectors made their judgements by a
combination of methods including direct observation,
talking to patients, families, staff and volunteers, and
reading documentation.
Their report confirmed that Prospect Hospice was
compliant with the requirements in each of the areas
they inspected:
„„ Consent to care and treatment
„„ Care and welfare of people who use services
„„ Cleanliness and infection control
„„ Management of medicines
„„ Supporting workers
The full report can be viewed at: http://www.cqc.
org.uk/sites/default/files/old_reports/1-117219570_
Prospect_Hospice_INS1-623821447_
Scheduled_25-03-2014.pdf
PROSPECT HOSPICE QUALITY ACCOUNT 2014-2015
EXTRACTS FROM THE CARE QUALITY
COMMISSION REPORT:
One person we spoke with who used
the service told us "The nurses always
check before they do anything. If I'm not
feeling up to it they will always come
back later". A family member told us "If I
need anything all I have to do is ask and
they do it straight away".
We spoke with one person who
accessed the day services. They told
us they were able to access a variety of
different activities which they had found
beneficial to their well-being. They told
us "The staff are all wonderful, I can talk
through any worries as they will always
make time for me".
People we spoke with and their
family members told us that they had
no concerns regarding the hygiene
standards of the Hospice. One relative
told us "the place is always clean and
hospitable".
QUALITY ACCOUNT PART 3
3.6 ASSURANCE FOR THE BOARD
OF TRUSTEES
3.6.1 THE BOARD OF TRUSTEES’
COMMITMENT TO QUALITY
The Board of Trustees is fully committed to the
delivery of high quality services to all patients and
families accessing the hospice’s direct services and to
influencing the care and support of all people living
life with uncertainty following the diagnosis of an end
of life condition across our community.
Trustees are active members of the hospice
community and are involved in monitoring the
quality of experience and care delivered. They do
this by receiving regular reports on services, care
and feedback received, and discuss them at both
committee and board meetings.
Additionally, two trustees visit the hospice and other
settings where care is delivered twice a year.
Reports are produced following these visits and are
discussed with the senior management team, the
patient services committee and the board of trustees
meeting. Reports are also shared with staff. Copies
of these reports are also made available to the Care
Quality Commission during their visits to the hospice.
PROSPECT HOSPICE QUALITY ACCOUNT 2014-2015
3.6.2 TRUSTEE PROVIDER VISITS
As part of a series of ongoing provider visits at
Prospect Hospice, Trustees visit various departments
to assure themselves of the quality and consistency of
experience offered to people accessing the hospice’s
services. Visits to the following areas have taken
place:
„„ In-patient Unit
„„ Day Hospice
„„ Prospect at home
„„ Voluntary Services
„„ Human resources
During a visit to the in-patient unit, Trustees spoke
with the medical consultant and the in-patient unit
nurse manager. Discussions focussed on the broad
range of activities undertaken by the medical team
which included influencing others and teaching, as
well as direct clinical care. Discussions also revealed
the potential opportunities for the hospice to become
involved in clinical trials in the future.
Discussions with the in-patient unit manager
explored the first impressions of the manager who
was new in post and the early priorities to develop
the team. This included changes to the nursing model
of care that have since been progressed.
QUALITY ACCOUNT PART 3
Trustees visited day hospice soon after changes to
the day hospice programme had been made and
encountered some small change related issues
amongst the staff, volunteer and patient groups.
Illuminating these issues enabled the day hospice
manager to focus on resolving concerns within the
team around her so that the benefits for patients
were central to their thinking and practice.
]Since the visit changes have become more
embedded and the number of people accessing the
service has grown in line with hospice’s strategic
ambitions.
Within Prospect@Home trustees noted that there was
a gap between the demand for the services and the
capacity required to respond to this. Since this time, a
business case has been submitted to Swindon CCG to
support an expansion in this service.
EXTRACTS FROM THE TRUSTEE
PROVIDER VISITS REPORTS:
It was clear that staff had realised
so much and remained morivated
throughout.
The medical team overall should feel
very proud of their achievements.
We feel confident that the already
excellent care will grow under the
leadership of the new in-patient unit
nurse manager.
The atmosphere (in day hospice) was
positive and can-do.
The manager development
programme was having positive
benefits .
Volunteers we spoke to felt
appreciated and were motivated by
the role they played.
PROSPECT HOSPICE QUALITY ACCOUNT 2014-2015
QUALITY ACCOUNT PART 4
4.1 STATEMENTS WE ARE
REQUIRED TO PROVIDE
4.1.1 REVIEW OF SERVICES
During 2014-15 Prospect Hospice provided NHS
commissioned services for specialist and end of life
care. It should be noted that NHS makes a funding
contribution which is subsidised through Prospect
Hospice’s fundraising activity.
PROSPECT HOSPICE PROVIDED THE FOLLOWING SERVICES IN 2014-2015:
„„ A 16 bed in-patient unit
„„ Community clinical nurse specialist service
„„ Care home clinical nurse specialist service
„„ Hospital based clinical nurse specialist service
„„ Day hospice and supportive out-patients including complementary therapy
„„ A hospice at home service known locally as Prospect@Home
„„ Therapy services including physiotherapy and occupational therapy
„„ Lymphoedema service
„„ Family support services including carer support and welfare and benefits advice
„„ Bereavement service
„„ Education and training for health and social care professionals in palliative and end
of life care
PROSPECT HOSPICE QUALITY ACCOUNT 2014-2015
QUALITY ACCOUNT PART 4
4.1.2 PARTICIPATION IN NATIONAL
CLINICAL AUDIT
During 2014-15, there were no national clinical audit
or national confidential enquiries that covered the
NHS services that Prospect Hospice provides.
4.1.3 PARTICIPATION IN CLINICAL
RESEARCH
No patients receiving NHS services provided or subcontracted by Prospect Hospice in 2014-2015 were
recruited by Prospect Hospice during that period to
participate in research approved by a research ethics
committee.
4.1.4 GOALS AGREED WITH
COMMISSIONERS
A small proportion of Prospect Hospice’s income
in 2014-2015 was conditional on achieving quality
improvements and innovation goals agreed
with Clinical Commissioning Groups through
Commissioning for Quality and Innovation payment
framework. In 2014-2015 these goals were achieved.
The Care Quality Commission has not undertaken a
planned or unannounced inspection during 20142015. The most recent inspection was in February
2014.
Prospect Hospice has not participated in any
special reviews or investigations by the Care Quality
Commission during the reporting period.
4.1.6 DATA QUALITY
Data is used to support individual delivery and
wider developments of services, as well as to inform
process improvements and to evidence contract
compliance. This involves working with operational
teams to review data relating to how the services are
functioning. Performance and data quality is reviewed
by the Senior Management Team and the Board of
Trustees and its sub-committees.
4.1.7 INFORMATION GOVERNANCE
Prospect Hospice will be working with its Clinical
Commissioning Groups in 2015-2016 to complete the
information governance toolkit.
4.1.5 CARE QUALITY COMMISSION
4.1.8 CLINICAL CODING
Prospect Hospice is required to register with the Care
Quality Commission. Its current registration status is
‘registered’.
Prospect Hospice was not subjected to clinical
coding audit during 2014-2015.
PROSPECT HOSPICE QUALITY ACCOUNT 2014-2015
QUALITY ACCOUNT PART 4
4.2 FEEDBACK
4.2.1 FEEDBACK FROM HEALTHWATCH
Healthwatch Swindon and Healthwatch Wiltshire
are pleased to have the opportunity to comment
on the draft Quality Account. We have received
no adverse comments from the public during the
year about Prospect which is a reflection of the
widespread appreciation of the Hospice’s work in
our communities. We have noted the progress made
with improvements proposed during 2014/15 and
will be monitoring those intended for 2015/16. We
have noted in particular the acknowledgement of and
response to the increase in quarters two and three
of 2014/15 of both falls and medicine incidents. We
hope that the downward trend in quarter 4 will have
been maintained in to 2015/16.
We are pleased that our joint awareness-raising work
with the Hospice and others during Dying Matters
Week 2015 (in Swindon) was successful and that our
involvement with the development of the Dying Well
Charter will continue.
4.2.2 FEEDBACK FROM CLINICAL
COMMISSIONING GROUPS
NHS Swindon CCG Response to the Prospect Hospice
Quality Account 2014-2015
NHS Swindon Clinical Commissioning Group (CCG)
has reviewed the information provided by the
Prospect Hospice in its 2013-2014 Quality Account.
In so far as we have been able to check the factual
details, our view is that the Quality Account is
materially accurate and is clearly presented in the
format required by the Department of Health Toolkit
and the information it contains accurately represents
the Prospect Hospice’s quality profile.
The Quality Account provides information across a
wide range of quality measures in relation to patient
experience, clinical effectiveness and patient safety.
Patient Experience
The Prospect Hospice clearly identifies that the
experience of their service users, families and staff is
key to informing how service improvements can be
identified and acted upon. A range of priorities such
as the Productive Ward CQUIN have been described
within the quality account, which illustrates progress
made in terms of quality improvement and the CCG
welcomes the additional documentary evidence for
assurance.
The strategic planning review (Autumn 2014) has we
PROSPECT HOSPICE QUALITY ACCOUNT 2014-2015
QUALITY ACCOUNT PART 4
note highlighted a concern in regards to future
capacity increase required; by growing population
and particularly for those with increased
complexity of need (due to living with multiple
conditions). NHS Swindon CCG will continue to
support the Prospect Hospice in the monitoring
of improvement outcomes related these work
streams.
Clinical Effectiveness
The Prospect Hospice has demonstrated
participation in both local and regional audits. The
CCG look forward to receiving the compliance
data and the learning and improvements achieved
as a result of the audit process.
NHS Swindon CCG fully recognises the ongoing
challenges with regard to the enhanced Hospice
at Home Service in Swindon, and will continue
to work closely with the Prospect Hospice in
order to monitor local performance of improved
accessibility and response time for those who
choose to die at home.
The CCG is delighted to see the planned
introduction of outcome measures in the inpatient and community services; which will
provide improved understanding of people’s
needs and vital data for future planning and
assurance.
PROSPECT HOSPICE QUALITY ACCOUNT 2014-2015
Patient Safety
NHS Swindon CCG notes that there have been no
incidents of harm as a result of patient falls and also
the actions to address a rise in medicine related
incidents during 2014-2015. The CCG would request
the inclusion of incident themes within the future
quality account; setting out any lessons learned
within the organisation as a result of root cause
analysis investigations. The identification of any
associated changes in service delivery as a result
of learning from the incident investigation process
would also be welcomed.
NHS Swindon CCG has a structured quarterly local
quality contract review meeting with the Prospect
Hospice, using a range of quality measures to help us
to support and monitor improvements. We welcome
the specific priorities for 2015-2016 to improve on
patient safety, patient experience and effectiveness
which the Hospice has highlighted in the Quality
Account. All are appropriate areas to target for
continued improvement, building on improvements
already achieved in 2014-2015.
Gill May
Executive Nurse
NHS Swindon CCG
Email: info@prospect-hospice.net
www.prospect-hospice.net
Prospect Hospice Official page
@prospecthospice
Moormead Road Wroughton Swindon SN4 9BY
Tel 01793 813355 Fax 01793 815432
www.prospect-hospice.net
Prospect Hospice Ltd. Registered Charity No. 280093
Company Registration in England No. 1494909