Quality Account 2015 - 2016
Vision Statement
Our vision is that every adult and child within our
area can choose how and where they want to be
cared for towards the end of life, knowing that they
will receive high quality specialist care
Charity No. 1140386
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TABLE OF CONTENTS
TITLE PAGE AND VISION STATEMENT
CONTENTS
PART 1
CHIEF EXECUTIVE AND MISSION STATEMENT
PART 2
PRIORITIES FOR IMPROVEMENT AND STATEMENT OF
ASSURANCES FROM THE BOARD
PRIORITIES FOR IMPROVEMENT 2015/2016
REPORT ON PRIORITIES FOR IMPROVEMENT 2014/2015
STATEMENT OF ASSURANCE FROM THE BOARD
2a REVIEW OF SERVICES 2014/15
2b PARTICIPATION IN NATIONAL CLINICAL AUDIT
2c PARTICIPATION IN RESEARCH
RESEARCH PROPOSAL 2014-15
2d CSNAT(Carers Support Needs Assessment Tool) 2014 UPDATE
2e USE OF THE CQUIN PAYMENT FRAMEWORK.
2f STATEMENT FROM THE CARE QUALITY COMMISSION
2g DATA QUALITY
2h CLINICAL CODING ERROR RATE
PART 3
REVIEW OF QUALITY PERFORMANCE
QUALITY MARKERS TABLES
QUALITY AND AUDIT REPORT 2014/15
INFECTION CONTROL
INFORMATION GOVERNANCE 2014-15
FEEDBACK FROM PATIENTS CARERS AND HEALTHCARE
PROFESSIONALS
STATEMENTS ENDORSING 2014/15 QUALITY ACCOUNT
APPENDICES
1. Criteria applied to Prevention of Admissions
1a Overnight team Audit form
2. RGHC Audits/Surveys 2014/15
3. Key questions from Surveys
H@H Patient and Carers
Clinical Services at Grove House
Paediatric survey (Pepper)
Working party review 2014
Health Care Professional Survey
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Part 1: RENNIE GROVE HOSPICE CARE Chief Executive and
Mission Statement
Our Mission is: To offer excellent palliative and end-of-life care based around patients
and their families both day and night.
Our Values are based on:
Excellence, collaboration, respect, dignity and professionalism.
It gives me great pleasure to present the third Quality Account for Rennie Grove Hospice
Care (RENNIE GROVE HOSPICE CARE) for 2015-2016. We welcome the opportunity to
promote the high quality of the services we provide for our patients and carers and to
demonstrate to all stakeholders our commitment to quality care.
The patient is at the heart of all Rennie Grove Hospice Care and we endeavour to ensure
that all our care is both patient centred and of the highest standard through clinical
governance.
In 2014/15 Rennie Grove Hospice Care Hospice at Home service cared for 1,627 patients,
an increase of around 9% on the previous year. Over 2,000 patients and carers were
seen by the wider Rennie Grove services and 534 were contacted by our Family Support
Services. We provide our care at no cost to our patients and families thanks to the
income generated by local fundraising, local retail and trading and a small contribution
from the NHS.
Our ability to offer community hospice services including hospice at home and day
services is possible thanks to our dedicated staff and the commitment of over 1,500
volunteers.
I am responsible for the preparation of this report and its contents. To the best of my
knowledge, the information reported in this Quality Account is accurate and a fair
representation of the quality of health care services we provide.
Jennifer Provin
Chief Executive
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Part 2: Priorities for improvement and statements of assurance from
the Board
Priorities for Improvement 2015-2016
The priorities for quality improvement we have identified for 2015/16 are set out below.
These priorities have been identified in conjunction with staff, stakeholders and as far as
possible by consulting our patient and carer group. The priorities we have selected will
impact directly on each of the priority categories:
Patient safety –The Introduction of McKinley syringe drivers across Buckinghamshire.
Clinical effectiveness- An Evaluation of the night Service leading to a research proposal.
Patient experience – The HCA role. Evaluation of the role and a Pilot project which looks
at the role of the HCA, including reviewing need for complex respite, carer support and
practical care.
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Priority One: Patient Safety (2015-16)
In December 2010, The National Patient Safety Agency (NPSA) in the UK issued a Rapid
Response Report regarding ambulatory syringe drivers. All Graseby syringe drivers were
to be replaced by December 2015 due to errors in use, including the wrong rate of infusion
caused by inaccurate measurement of fluid length or miscalculation or incorrect rate
setting of the device.
To ensure that all our clinical staff are trained in and competent to use the McKinley
T34 syringe pump - being introduced in Buckinghamshire in 2015. CNS's are to
access the Buckinghamshire Community Trust (BCT) Train the Trainer sessions and
disseminate the training to RGHC staff. Continuous audit of training and the number
of errors will be undertaken to monitor performance and patient safety.
How was this identified as a priority?
This is a national directive and subsequently a priority for the organisation. Herts trust
changed to McKinley T34 in 2013 and since then we have recognised a risk within the
organisation for staff working with 2 types of syringe drivers across the teams. We are now
able to work in collaboration with BCT to provide consistency across the organisation. The
key outcomes are to prevent errors associated with the new pumps and to reduce adverse
drug incidents.
How will priority two be achieved?
Working with Florence Nightingale Hospice we will ensure all RGHC staff and community
staff are trained and conversant in the new pump. Plans for train the trainer sessions by
McKinley are underway. A user guide/procedure for the safe practice and use of the
McKinley T34 syringe pump has been added to the RGHC Medicine and Syringe Pump
Procedures and Guidelines 2013.
How will progress be monitored and reported?
Progress will be monitored through audit of training received and review of medication
incidents reported. Staff will attend annual training updates on the McKinley T34 pump.
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Priority Two: Clinical Effectiveness (2015-16)
Rennie Grove Hospice Care (RGHC), previously known as Iain Rennie Hospice at Home,
has been a provider of Hospice at Home services for 30 years. The service provides 24
hour planned and responsive care to patients in the community. A review of the service
was carried out in 2010 and a dedicated waking night shift was piloted for 3 months from
November 2010. This progressed to a fully established waking night service to strengthen
and maintain 24/7 service availability for patients.
RGHC has written a research proposal and intends to win sufficient grants to undertake
research into the evaluation of the hospice at home night service with a particular
emphasis on the prevention of hospital admission during the night.
How was this identified as a priority?
Hospice at Home has been consistently well evaluated and the responsive 24/7 element
has been especially highly evaluated by patients and carers. Recent commissioning
priorities have highlighted the need to prevent unnecessary hospital admissions. There
have been many previous attempts to positively identify incidences of prevention of
admission to hospital but assessment is highly subjective. RGHC hopes to contribute to
the evidence base through the development of a structured assessment which will be used
to evaluate the effectiveness of the night service
How will priority three be achieved?
Each patient visit and intervention between 21.15 and 07.15 hours will be assessed using
a structured assessment tool and the findings recorded on the Night Team Audit form. The
form was adapted in August 2014 and updated in January 2015 with increased detail for
complex symptoms.
How will progress be monitored and reported?
The information collated from the overnight audit forms will provide assessed and
standardised information that can be evaluated and used as evidence for the planned
research project. Identified prevention of admissions are reported on monthly and per
CCG. (See Appendix 1, 1a page 24, 25.)
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Priority Three: Patient Experience (2015-16)
Rennie Grove Hospice at Home teams have included Health Care Assistant (HCA) roles
across some or all of the teams for a number of years. Securing additional funding from
the Chiltern Clinical Commissioning Group in 2013-14 provided the opportunity to increase
the numbers of HCA roles and for a pilot to be undertaken to review the role profile and
associated competencies in order to maximise the impact on the service to patients. All
Hospice at Home Adult teams now include HCAs. ‘The Health Care Assistant role will be
developed to provide a broader range of support to patients and families improving the
patient experience. The aim is to develop additional clinical skills related to patient care to
further enhance the provision of Hospice at Home. These will include clinical observations,
medications management and phlebotomy where the HCA is already competent. The
HCA’s will work more cohesively as a team and independently, to ensure the range of
needs for patients across the locality are met. This will be in addition to providing respite
(which may be complex and responsive at times), personal care, wound care, emotional
support and practical care for the patient and family.’
How was this identified as a priority?
Ongoing increases in the number of referrals to the service has created the need to
increase the capacity of the teams in an efficient and cost effective way, therefore it has
been necessary to broaden the skill mix within the teams. Each of the HCA’s has brought
a range of skills and experience to the positions, allowing us to explore the potential
development of the role. The nursing teams are seeing the benefits of having an HCA
allocated to their team and recognise the further potential for ongoing support. Access to
other services in some areas of the community, (particularly personal care for people who
are very near the end of life), is often difficult to obtain in a timely and consistent manner
How will the priority be achieved and monitored.
The HCA team will be supported by the Locality Nurse Managers and Professional
Development department to develop a consistent and more cohesive approach to patient
care. A coordinating role will exist within the HCA team to support the management and
allocation of workload. A training program and competencies will be developed to ensure
patients receive a consistent service from the team. Progress will be monitored through
the number on patients on RGHC caseloads with associated HCA input. Referrals for HCA
input will be recorded. HCA’s will have IPR processes for competency sign off. Team
nurses will feed back through Line managers and team meeting processes.
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Report on Priorities for Improvement 2014-15
Priority One: Patient Safety
N3 access remains a key strategic initiative as:-.
Local NHS community teams are continuing to work towards a ‘paper light’ patient notes
system. This will eventually be transferred to an electronic record which Rennie Grove will
be expected to update directly.
The Clinical Commissioning Groups (CCGs) have also been asking for some time that we
share and input patient information within their data reporting structures and a centralised
end of life patient register.
Neither outcome will be possible without N3 access.
During 2014 several unsuccessful attempts were made to resubmit the N3 application but
all were rejected (for varying reasons). As a result the plan was scaled back to providing
N3 access on a smaller group of specific PCs. This would be less accessible and therefore
less useful but would at least enable the organisation to develop some understanding of
the solution while utilising the system in some way. However this application was also
rejected. Liaison with our Southern Commissioning support team has identified there may
be an alternative technical solution but Rennie Grove require expert support to achieve N3
access.
Rennie Grove believes it fulfils the security requirements and has shown its commitment to
improve Information Governance practice on a number of levels. Significant resources
have been dedicated to improving our level of compliance monitored by an Information
Governance Committee and enforced by new organisational practices. Level 3 compliance
(with the NHS Information Governance toolkit) was achieved in March 2015.
Recent discussions with St Christopher’s and Pilgrims Hospices have confirmed the real
value in direct access to Trust records such as Oncology, Pathology and Ambulance
services, creating a more accurate and effective patient record and reducing admin time
spent on correspondence and phone calls and improving patient care if only N3 access
can be achieved.
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Priority Two: Clinical Effectiveness (2014-15)
In order to identify the required essential skills to carry out the safe assessment,
planning and delivery of specialist palliative care for patients being nursed in their
own home it is necessary to undertake a Skills Needs Assessment across all levels
of nursing staff. This is in response to the changing needs of patients and carers
within the community and the changes to service provision across other agencies.
A mandatory training needs analysis was completed for all clinical staff.
The induction programme has been evaluated and reviewed taking into account our
recruitment of Health Care Assistants to the organisation.
Competencies around Medicine Management have been written and are being
implemented with new staff to the organisation.
Plans are in place to develop HCA competencies in line with KSF dimensions at IPR
Twice yearly meetings with the Education Team and the LMNs have taken place to identify
the staff who wish to undertake post graduate training, reviewing Personal Development
Plans and course application requests informing budget planning.
Clinical skills training has taken place in History taking and Assessment skills of the
abdominal and respiratory system for 24 nurses by an external provider
A collaborative education programme has been put together and will be delivered
throughout the year by RGHC, Hospice of St Francis, Peace Hospice and Herts
Community Trust.
Additional equipment such as pulse Oximeters and additional training have been made
available to nurses to extend their assessment skills.
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Priority Three: Patient Experience (2014-15)
Working Closely with G.P. providers and other healthcare professionals in 2013, Grove
House identified the need to redesign and restructure a new model of service provision in
2014-15. The aim was to provide a more flexible model of care to meet the changing
needs in the community and to increase professional and self referral, creating the
opportunity for improve access and increased use of the service for patients and families.
The restructure of the existing Day Hospice, reducing the days from four to three, gave
additional hours to create a ‘Drop In’ on a Tuesday from 9-1pm which is open to all. In
addition Carer Support groups, Yoga, Tai Chi and Auricular Acupuncture Courses have
been developed. An ‘Inspire’ group supporting patients with breathlessness on a more
flexible basis has also been introduced
Following the restructure there has been a marked increase in patients’ attendance, not
only in the Day Hospice but also through the Drop In and in the classes/groups available.
Patient evaluation of the new services has shown a positive response and clinical outcome
benefits from those attending.
To date there has been a 45% increase in attendances in the Day Services over the last
11 months and with 321 people using the Drop In service. The ‘Inspire’ group have
continued to support patients with breathlessness both in the group sessions with peer
support, education and gentle exercise and also via ‘virtual’ support when they are not well
enough to attend the class and this has proved a very valuable service.
In addition, collaborative working with external providers has led to the planned
introduction of a ‘Caring with Confidence Course’ over 5 weeks every Monday from
February and a planned workshop for patients in the Breast Clinic at St Albans Hospital
where we already have close links.
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Statement 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, and
therefore explanations of what these statements mean are also given.
2a. Review of Services 2014/2015
In 2014/15 Rennie Grove Hospice Care’s provision of local specialist palliative care in the
communities of Herts and Bucks included part funded;
 Hospice at Home
 Day Hospice
 Outpatient services to support and promote wellbeing
 Occupational Therapy
 Physiotherapy
 Home sitters
 Cancer Information
 Complementary Therapies
 Cancer the Next Step
 Family support Services, including bereavement support services and
spiritual care
The 3 CCG commissioning groups fund 14% of the total income generated with the
remaining being generated through our fundraising, Retail and Trading (23 shops),
Hospice Lottery activity and investments.
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2b. Participation in National Clinical Audit

During 2014/15 and prior to this document, no national clinical audits or confidential
enquiries covered NHS services provided by Rennie Grove Hospice Care.

During that period Rennie Grove Hospice Care participated in no national clinical
audits and no confidential enquiries of the national clinical audits and national
confidential enquiries as it was not eligible to participate in any.

The national clinical audits and national confidential enquiries that RENNIE GROVE
HOSPICE CARE are eligible to participate in during 2014/15 are as follows: NONE.

The national clinical audits and national confidential enquires that Rennie Grove
Hospice Care participated in during 2014/15 are as follows: Not applicable

The national clinical audits and national confidential enquires that RENNIE GROVE
HOSPICE CARE participated in and for which data collection was completed during
2043/15 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. Not applicable

The reports of 0 national clinical audits were reviewed by the provider in 2014/15.
This is because there were no national clinical audits relevant to the work of RENNIE
GROVE HOSPICE CARE.

RENNIE GROVE HOSPICE CARE 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.
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What this means:
As a provider of specialist palliative care RENNIE GROVE HOSPICE CARE is not eligible
to participate in any of the national clinical audits or national confidential enquires. This is
because none of the 2014/15 audits or enquiries related to specialist palliative care. The
Hospice will also not be eligible to take part in any national audit or confidential enquiry in
2015/16 for the same reason.
2c. Participation in Research
The number of patients receiving NHS services provided or subcontracted by
RENNIE GROVE HOSPICE CARE in 2014/15 that were recruited during that period
to participate in research approved by a research ethics committee was NONE.
A Research Proposal for 2014-15.
Prevention of acute hospital admissions at night for patients approaching the end of
their lives.
Unlike most models of hospice care in the UK, Rennie Grove Hospice Care at night is
provided by a dedicated team comprising of a palliative care nurse and health care
assistant who respond to calls for assistance and visit patients in their own homes. Under
the supervision of our Chairman Stephen Spiro (Professor of respiratory medicine) we ran
a 6 month pilot study in 2014 using agreed criteria to assess the reasons for a night call
and to judge whether our care prevented unnecessary admission to hospital. This showed
that we prevented 59 hospital admissions at night over that period.
Working with the Marie Curie Department of Palliative Care at University College London,
we now plan to conduct a 2 year study. See Appendix page for key questions raised in
the proposal.
The hypothesis we are testing is that ‘Rennie Grove’s approach keeps people with end of
life conditions at home and that we do this more cheaply and with higher levels of
satisfaction than through admissions to acute hospitals’.
The Rayne Foundation has kindly agreed to support this proposal (with a grant towards
the costs of the project) and we anticipate that we will be making a start using lessons
learned from the pilot to inform the next stage of the research during 2015.
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2d. CSNAT (Carers Support Needs Assessment Tool) 2014 Update
During 2013 Rennie Grove Hospice Care participated in the implementation of the
Carers Support Needs Assessment Tool (CSNAT). (CSNAT is an evidence-based
direct measure of carer’s support needs in 14 domains and is suitable for both endof-life research and practice.) The research project was supported by Manchester
and Cambridge Universities in partnership with the National Association for Hospice
at Home. Two Rennie Grove hospice at home teams participated in the project which
aimed at all carers having access to an assessment of their needs. The CSNAT tool
enables nurses to complete a more comprehensive, structured assessment which
leads to discussion around support needs imperative for shared action planning. This
part of the study ended in November 2013. Since the end of the project Rennie
Grove has provided training for all nursing teams including those working in the Day
Hospice and has rolled out the tool to incorporate all Hospice at home teams. The
tool is used or given to each carer at the first visit. At this point we have not audited
the responses but plan to review its usage in 2015. The continued use of CSNAT in
practice however demonstrates our commitment to assess the support needs of
carers.
2e. Use of the CQUIN payment framework
Up to 2.5% of RENNIE GROVE HOSPICE CARE income in 2015/16 is CQUIN
dependant and conditional on achieving quality improvement and innovation goals
agreed between RENNIE GROVE HOSPICE CARE and any person or body they
entered into a contract, agreement or arrangement with for the provision of NHS
services, through the Commissioning for Quality and Innovation payment framework.
2f. Statement from the Care Quality Commission
RENNIE GROVE HOSPICE CARE is required to register with the Care Quality
Commission and is currently registered to carry out the regulated activities:
Treatment of disease, disorder or injury and personal Care.
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Statement of reasons
The registration of the provider of these regulated activities is subject to a registered
manager condition under Regulation 5 of the Care Quality Commission (Registration)
Regulations 2009
These regulated activities may only be carried out from the following locations:
Grove House
Gillian King House
Rennie House
Waverley Road
Three Households
Unit 3
St. Albans
Chalfont St. Giles
Tring Industrial Estate
Herts
Bucks
Tring
AL3 5QX
HP8 4LS
Herts
T 01494 877200
HP23 4JX
T 01727 731000
T 01442 890222
The Care Quality Commission has not taken any enforcement action against RENNIE
GROVE HOSPICE CARE during 2014/15.
RENNIE GROVE HOSPICE CARE has not participated in any special reviews or
investigations by the Care Quality Commission during 2014/15 but has not yet been
inspected for 2014/15.
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2g.
Data Quality
Statement of relevance of Data Quality and actions to improve Data Quality.
RENNIE GROVE HOSPICE CARE 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.
Why is this?
This is because RENNIE GROVE HOSPICE CARE is not eligible to participate in this
scheme. However, in the absence of this we have this year worked to complete and submit
the Information Governance toolkit to level 2 with a view to obtaining an N3 connection to
connect with our NHS partners. With patients consent, we share data with other health
professionals to support the care of patients in the community. An audit of the signing of
patient consent forms occurs annually. Our data protection policy is reviewed and updated
annually.
2g.
Information governance toolkit attainment levels
2h.
Clinical coding error rate
RENNIE GROVE HOSPICE CARE was not subject to the Payment by results clinical
coding audit during 2014/15 by the Audit Commission. This is because RENNIE GROVE
HOSPICE CARE receives payment under a block contract and not through tariff and
therefore clinical coding is not relevant.
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Part 3: Review of Quality Performance
Quality Markers Tables
RENNIE GROVE HOSPICE CARE continues to work on consolidating our data from the
clinical, nursing and family support databases. Data is submitted to the CCGs and CQC
quarterly and annually. We will present annual data returns for 2014-15 to the National
Council for Palliative Care (NCPC) minimum data set which is the only information
currently collected nationally on hospice activity.
Quality Markers we have chosen to measure. Comparatives year on year
In addition to the limited number of suitable quality measures in the national data set for
palliative care and hospice at home, we have chosen to measure our performance against
the following:
Prevention of hospital admission
Clinical Complaints
Deaths At Home
Patients Achieved Preferred Place of Care (PPC) (if wish expressed)
Drug Errors
Adverse Incidents
(Prevention of hospital admission data is in it’s formative stages, pilot data suggests that
104 hospital admissions may have been prevented during 2014-5 see Appendix 1,1a for
criteria pages 24, 25)
INDICATOR
April/Mar 13/14
Total number of complaints (clinical)
1 withdrawn
April/Mar 14/15
0
The number of complaints completed
0
0
The number of complaints process ongoing
0
0
No. Patient Deaths at Home
613
680
Total number of deaths
881
977
INDICATOR
April 2013/14
PPC 84%
April 2014/15
Drug Errors
7
2
Adverse Incidents
15
10
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Quality and Audit Report 2014/15
Audit is a way in which the organisation can learn and improve the delivery of its services,
the outcome for patients and the experience they have. The Rennie Grove Hospice Care
Quality Assurance Programme 2014-15 included a programme of Clinical and Non Clinical
Audits. Progress on the action plans following audits undertaken is monitored through the
Clinical Audit Group and reported to the Clinical Governance Committee and Trustees.
Safeguarding of Vulnerable adults and the Section 11 audit (for Children) were completed
to ensure that as an organisation we are monitoring our SOV process and adequately
supporting staff with training as appropriate. An audit of our Human Resources (HR)
department (using a tool adapted from the CQC Essential Standards assessment)
demonstrated that we have adequate safe recruitment and workforce practices in place
with an IPR process including Clinical Supervision and mentorship for all clinical staff.(as
well as other educational opportunities such as Action workshops Clinical Nurse Specialist
forums and, Journal Club.) Clinical staff are also involved in the audit processes. Link
nurses from the Clinical Audit Group took part in reporting 2 consent form audits and the
process of adapting consent form wording to inform tighter regulation in consent for
patients who do not have capacity.
The Grove House Day Hospice staff continued to use the SKIPP (St Christopher’s Index of
patient priorities) Questionnaire. A short audit on the quality of life question continues to
demonstrate that attendance at Day Hospice has a positive effect on patients’ quality of life
and overall sense of wellbeing.
The annual Audit of the Non Medical Prescribers supports non medical prescribing
practice in line with Rennie Grove Procedure. All prescribers are following safe practice
guidelines. Following the audit one change in practice was made – to retain
unused/wasted scripts for audit purposes before shredding (in line New NHS Protect
England guidance 2013). Prescribers now have an up to date British National Formulary
(BNF) and access to the Palliative Care Formulary at every base.
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Infection Control.
The Infection Control team have undertaken a number of audits over the last twelve
months. At Grove House we have completed Laundry, Cleaning and Building Audits.
Within Hospice at Home we have undertaken Hand hygiene, Sharps and Personal
Protective Equipment Audits. The first Dress Code Audit (Hospice at Home) and Uniform
Audit for Day Hospice nurses at Grove House have been completed this year.
Education sessions where clinical staff have an opportunity to practice with the Globox
have been introduced across the organisation, with five sessions scheduled for 2015, one
of which is at the day hospice in Grove House.
New staff also have Infection Control training as part of their induction, and non clinical
staff including volunteers, receive our quarterly newsletter to keep them up to date on
timely topics and changes to practice within the organisation. All staff also receive
seasonal Infection Control updates via e-mail.
Information Governance 2014-15
The Quality and Audit department has worked closely with the Information Governance
Committee in the completion of the organisational requirements as noted in the N3
connection application. A number of requirements were designed and carried out by the
audit team to support this process. These included a staff awareness questionnaire (based
on the requirements of Data Protection Act), A short patient questionnaire was carried out
(with a selection of hospice at home patients over the telephone, patients at the day
hospice and electronically by the User involvement group) to assess whether patients
trusted the organisation with the use of their personal and sensitive information. A two
week pilot of spot checks was also organised to assess and highlight risk of information
breaches across the organisation. This is in the process of being reported and the
development of an ongoing managerial spot check system is anticipated to be the way
forward. All outcomes from this work were reported to the Information Governance
Committee in a timely fashion for the completion of the second stage of the N3 application
deadline at the end of March 2015 where we were successful as an organisation in gaining
level 3 compliance.
Appendix 2 page 26 shows the audit/survey plan that was undertaken in 2014/2015
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Feedback from Patients Carers and Health Care Professionals
We value the feedback that we receive from patients and their carers as this is an
important way in which staff can identify issues, resolve problems and improve the quality
of the care we provide. As part of our commitment to ensure that patient’s and their carers
have a voice (and to demonstrate commitment to improving response rates) we have
completed a review of the Hospice at Home and Clinical Services surveys in 2014/15. The
questionnaires have been shortened and smartened with the aim of improved usage of
patient and carer sensitive data. As the new surveys are anonymous but where concerns
are raised and the respondent has chosen to be identified, their issues are followed up and
resolved where possible. The biennial Paediatric survey (sent to parents/ carers together
with specially designed children’s questionnaires appropriate to their age) were also
completed in 2014 with positive responses.
The Health Care Professionals with whom we work are also sent biennial surveys. This
year’s survey was completed in April 2015 and includes hospitals, GP practices, district
nurses and specialist services such as MacMillan. Feedback from this survey in 2015 has
helped improve communication but has also helped the organisation identify areas for
development including the identification of Skills Needs Assessment (across the spectrum
of nurses) from HCA to CNS in 2014/15 Quality Account.
Responses to key questions from all surveys published in 2014-15 can be seen in
Appendix 3 pages 27-32
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NHS Chiltern and Aylesbury Vale CCGs response to Rennie Grove Hospice Care
(RENNIE GROVE HOSPICE CARE) Quality Account 2015/16
Chiltern & Aylesbury Vale (CCG) has reviewed Rennie Grove Hospice Care Quality Account for
15/16. As in previous years RGHC has used a range of data to provide assurance that the
services it delivers are safe and of a high quality.
Chiltern and Aylesbury Vale CCGs are satisfied as to the accuracy of the data contained in the
Account. There is evidence that Rennie Grove Hospice Care has used both soft and hard data in
addition to evidence of active and collaborative stakeholder engagement in providing assurance on
the quality and safety of its services.
RGHC has shown commitment and tenacity in their journey to gain the necessary permissions for
an N3 connection despite several setbacks outside their control. This connection will further enable
patient’s wishes to be met through improved communications.
There is evidence of investment in people with the continued move to improving the skill set of their
staff. The reorganisation of services provided has increased the numbers of patients now
accessing the support they need.
The commissioners are pleased to see the priorities of care for 15/16. The planned introduction of
new Syringe drivers is an excellent example of the collaborative working that we see between
RGHC and our other providers and health care professionals in Bucks. We welcome the plan to
add to a robust evidence base through their research proposal and we hope they are successful in
securing the necessary grants to achieve this.
Conclusion
The Quality Account is a comprehensive view of the Quality of services currently being provided to
the local community and how these are being further developed with local stakeholders by Rennie
Grove Hospice. Commissioners look forward to continuing to work in partnership with the service in
meeting the needs of local service users, their carers, and staff in providing high quality flexible
care.
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Statement from Herts Valleys Clinical Commissioning Group
End of Life Care Commissioning Manager and Community Contracts Manager
Herts Valleys CCG see Rennie Grove Hospice Care as a key partner in the delivery of
integrated end of life care for the patients of West Hertfordshire. We value the excellent
open and regular communication that we have and we are committed to working with them
to continue to deliver a high quality and much valued service to our population.
During 14/15 Rennie Grove Hospice care continued to provide high quality Hospice at
Home Care and expanded their services to patients within the St Albans and Harpenden
locality. Rennie Grove Hospice Care continued to prioritise patient safety, clinical
effectiveness and enhancing patients’ and their families’ experience. Progress towards
these improvements was monitored through regular contract review meetings.
Looking forward to 15/16, Herts Valleys CCG is delighted to continue to work closely with
the hospice as a key partner in helping us to achieve our End of Life Strategy. The
strategy reflects the aims of both organisations to continually improve and provide good
quality end of life care to its patients and the community.
April 2015
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Healthwatch Hertfordshire’s response to Rennie Grove Hospice Care
Quality Account 2015
Healthwatch Hertfordshire is again pleased to submit a response to Rennie Grove Hospice
Care Quality Account. Priorities for improvement in 2015/16 are simply and clearly stated
and these have been developed in conjunction with staff, stakeholders, patients and carers
whenever possible.
We very much welcome the focus on preventing hospital admissions and the desire to
create a robust methodology for assessing this. The Research proposal provided in the
quality account provides further detail on this.
The priority focusing on patient experience and enhancing the role of the HCA seems
good practice, both for efficient running of the organisation and for enhancing patient care.
Progress on the 2014-15 priorities is reported clearly and transparently, and the frustration
of not having N3 access is evident. The clinical effectiveness focus on assessing
necessary skills has proved useful and Rennie Grove have responded to the assessment
with key improvements. Perhaps the most notable development has been the
reconfiguration of day services with a 45% increase in attendance reflecting the new more
flexible approach implemented.
Also worth mentioning from the review of performance section is the sharp increase in out
of hours’ activity.
The quality and audit report provides useful evidence of the good governance in place and
we welcome the continued use of SKIPP. The involvement of patients to assess their level
of trust in the organisation’s use of information is welcomed as is the programme of spot
checks on risks of information breaches.
Finally the report provides as appendix 3, feedback from patients and their families. The
quantitative responses give impressive results, but these are overshadowed by the
powerful comments from those who have benefitted from the services provided
Michael Downing, Chair Healthwatch Hertfordshire, June 2015
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Appendix 1
Criteria applied to Prevention of Admission( POA) Assessment from (1.8.14)
1.
2.
3.
4.
5.
6.
7.
8.
9.
Complex symptoms
Medication administration
Sudden change in condition/symptoms
Anxious/agitated patient
Anxious / agitated relative or carer
Carer breakdown/family dynamics
Bladder/bowel symptoms
Haemorrhage/clinical crisis
Other ( plus explanation on bottom of form please )
Amended Criteria applied to POA (from 1.1.15)
1. Pain
2. Nausea & vomiting
3. Sepsis
4. Seizure
5. Fall
6. Bladder/bowel symptoms
7. Haemorrhage/clinical crisis
8. Medication – administration/change required
9. Sudden change in condition/symptoms
10. Anxious/agitated patient
11. Anxious/agitated relative/carer
12. Carer breakdown/family dynamics
13. Other ( with explanation )
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Appendix 1a.
OVERNIGHT TEAM AUDIT FORM
Total Mileage:
Total travel time:
Total number of deaths attended - Herts:
Total number of incoming calls:
Total number of hospital admissions:
Date:
Bucks:
On duty staff names:
Bucks *
PLEASE TICK appropriate boxes . 2 QUESTIONS need YES/NO as indicated
Identify Herts or Bucks patient and put *
H/B
H/B
H/B
H/B
H/B
if patient surgery is one of the following :
Edlesborough/Pitstone, Aston Clinton,
Wendover, Cross Keys, Wellington House
Time of Call
Reason for Incoming Call
1. planned visit from late shift
2. symptom control
3. carer support
4. death
5. death verified by night team Yes/No
6. message
7. other eg personal care, equipment issue
8. advice required by other HCP
Reason for Not Visiting
1. patient/carer reassured/settled by tel advice
2. managing another patient
3. other service required
4. incoming message/feedback
5. end of shift/time management
Passed to Other HCP/Service
1. early shift nurse
2. DN service
3.GP service
4. ambulance service
5. hospital team
Reason call passed to other HCP
1. prescription needs
2. new symptom/unexpected change
3. urgent medical attention necessary
4. involved with another patient
5. admission necessary
Reason for Hospital Admission
1. complex acute symptoms
2. discharge complications
3. patient/carer choice
4. carer breakdown
5. other
Was hospital admission prevented Yes /No
Rationale ? See key & record number
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H/B
Appendix 2 Rennie Grove Hospice Care Audits/Surveys Apr 2014 - Mar 2015
Audit/Survey
Month


SOV Safeguarding Adults audit
H@H and Clinical services Survey
reports









Section 11 Paediatric SOV audit
Quality Account published
GH Laundry audit
Paediatric Survey
HR Audit Safe recruitment l
Non Medical Prescribing audit
RGHC Consent Audit
H@H and Clinical Services survey
reports
H@H Sharps and PPE audit
Working party review of H@H and
Clinical services surveys
GH building audit (Infection
Control)
Hand Hygiene Audit
Information governance review of
audit requirements
Consent audit (Info gov)
SKIPP analysis Day hospice
Info governance staff
questionnaire
Spot checks process review(info
gov)
Pilot draft survey Day hospice
patients
Consent audit (Info gov)
Info gov Tel questionnaire
H@H/DH patients
Infection control Dress code audit

Health care Professional survey
MAR 15


New surveys published
Quality Account to CCGs
APR 15












Charity No. 1140386
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MAR14
APR 14
MAY 14
JUN 14
JUL 14
JUL-AUG 14
SEP 14
OCT 14
NOV 14
DEC 14
JAN 15
FEB 15
26
APPENDIX 3 Key Questions from surveys
Hospice at Home Patient Satisfaction Survey Sept 14 – March 15
Question
Response
Skipped
Question
Answer
On the whole, do you
find the experience of
H@H caring for you:
47
1
Very satisfactory
Satisfactory
Dissatisfactory
Very
dissatisfactory
Do you feel your
privacy and dignity
are respected by
RGHC staff?
Do you feel the
RGHC staff make an
effort to meet your
individual needs and
wishes in relation to
culture, faith and
disability?
Do you feel you are
treated with courtesy
by H@H staff?
46
2
42
6
42
6
Results
Sept
14
85%
15%
Results
Mar 15
39
7
0
83%
15%
0
1
2%
Always
Most of the time
Some of the time
Never
Always
Most of the time
Some of the time
Never
98%
2%
44
2
96%
4%
91%
9%
38
3
0
1
91%
7%
0
2%
Always
Sometimes
Occasionally
Never
98%
0
0
2%
42
100%
Some of the comments we have received from our patients in the last six months:
 They are all fantastic. They treat us with empathy and always do what they say they
are going to do.
 You have helped me through a very difficult time. Cancer plus death of my husband
and daughter’s illness would be very difficult without your wonderful support.
 I have been amazed at how hands on and excellent this hospice is. Long may it
continue to provide such an essential service to this community.
 Everyone we have seen from RG has been knowledgeable and helpful.
 Everything has been wonderful. I can’t praise the nurses enough.
Some of the comments we have received from our carers from our most recent report
(during Apr 14 to Sept 14):.
 We had experienced such care, consideration and sympathy that left us so grateful.
Such a pillar of support – second to none.
 Faultless attention to detail and communication – particularly in regards to
education of my mother’s carers practically and in regard to the carers unrealistic
expectations.
 You are at a loss to deal with something you know nothing about. As soon as your
team came on board, we felt so much better, knowing they knew what to do.
 They were supportive, understanding, caring and compassionate, a true pleasure to
have around.
 My husband was always reassured just by the presence of one of the team.
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Clinical Services Survey for users of Grove House facilities April 14 –
September 14
Question
Response
Skipped
Answer
Question
6
10 (Excellent)
9
8
7
6
5
How would you rate
the quality of
care/treatment that
you received from
Grove House? Scale
1(poor) – 10
(excellent) -
28
Did staff involved in
your care introduce
themselves to you?
33
1
Did you feel involved
29
in the decisions made
about your care and
support at Grove
House?
How did you feel that
29
staff and volunteers
respected your
privacy and dignity?
Did you feel that you
25
were treated fairly
with regards to
culture, faith and
disability?
Having used this
31
service, how likely
are you to
recommend it to other
members of your
family or friends?
5
3
Results Sep 14
22
2
2
1
0
1
79%
7%
7%
4%
0
4%
10(Always)
9
8
7
Always
Usually
Sometimes
25
4
1
3
22
5
2
76%
12%
3%
9%
76%
17%
7%
5
Always
Usually
26
3
90%
10%
9
Always
Most of the time
22
3
88%
12%
Extremely likely
Likely
Neither likely nor
unlikely
Extremely
unlikely
24
6
77%
19%
1
3%
Some of the comments we have received from our users of Grove House facilities from
our most recent report (Apr to Sept 14):
 It also provided the opportunities to find out that you are not alone in what you
experience and that help is available. It encouraged you to think about yourself
more.
 I think the time I spent at Grove House gave me confidence and attitude – I always
felt better after a day there.
 Having the opportunity to talk to other patients. So much of what worried me was
common but I didn’t know that. I’ve made some very special friends. The medical
support was also great. Lots of tips, advice and reassurance which helped me cope.
 There is a very good chef and the meals are excellent.
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
Everyone at Grove House should be congratulated for the care and service they
offer. We are all lucky to be helped in this way. Thank you.
Comments for Review (Clinical services survey)

Several respondents felt that more detail on services offered would be useful. New
information sheets for each service subsequently produced.

Several respondents mentioned the acoustics in the Day Hospice. Acoustics cannot
be addressed at the moment but will be a priority for future development. A
separate room is available for conversations with staff.
Paediatric Survey Results (Pepper Team) – August 2014
Nine completed surveys were returned (27%). All families felt that:

The Pepper team worked well with other professionals

If they needed it, they had received support in emergencies or in times of crises. If
not an emergency, all felt that they would feel able to speak to a member of the
Pepper team day or night.

They were supported with their child’s physical needs.

The nurses were calm and reassuring and they trusted their judgement and felt
confident leaving their child in their care.

The nurse visits enable families to take time out for themselves.
Some of the comments we received from families whose child was being cared for by the
Pepper team:

Always very caring and understanding.

The Pepper nurses provide a wonderful service and make a real difference. We
very much appreciate all they do for us.

“L” is an amazing support to our family…. we are extremely lucky and blessed to
have her in our lives.
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Working Party review of Patient / Carer Feedback Questionnaire 2014
The new questionnaire (to replace the Hospice at Home and the Clinical Services
questionnaires) was developed as part of a review of RGHC existing patient and carer
satisfaction questionnaires. It was introduced into the organisation in April 2015. As
RGHC has a 6 monthly reporting cycle, the first results using the new questionnaire will
not be available until the Autumn of 2015. During the review the focus was on simplifying
the questionnaire and restricting it to essential data collection only. It is hoped that this will
maximize the response rate, which is currently one of the key questions asked for by
CCG’s in the quarterly report..
Health Care Professionals Survey May 2015
The following feedback was given to questions about referrals to and from IRGH services,
and to working relationships.
Agree
strongly
I have a good working
relationship with the
RGHC team(s)
RGHC respond efficiently
to requests for help
The involvement of RGHC
promotes patient choice
The additional resources
RGHC brings can help a
patient to stay at home
Agree
No
opinion
Disagree Disagree
strongly
48%
43%
9%
0
48%
45%
7%
0
50%
39%
11%
0
56%
30%
14%
0
0
0
0
0
Some of the positive comments received included:
 Excellent services
 We have a great working relationship with the Pepper nurses.
 Always available or will ring back if needed.
 I have rung main number on referral form - always very helpful.
 The service provided is extremely important and helpful to patient and carers.
 V useful 2 way communication re patients.
 We value the monthly palliative care meeting at the surgery
 Excellent service, thank you.
 A great team. Thank you, really helps us getting people home.
 Excellent team, great communication skills and a pleasure to work with.
 Very useful to have your nurses involvement at out MDT when they are available.
 Thank you for attending pal care MDT in hosp.
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Some constructive criticism
Communication issues
 Sometimes confusion between role/input hospice at home and district nurses
 Hospice at Home. We receive phone calls but it would be nice to be copied into
written correspondence
 Overall the process works well. However, unless I contact team I rarely receive a
call to talk through referral. Unless I fax further info I never get a request for further
info. There have been times when a first contact with patient has been delayed,
neither pt nor I have been contacted re reason why. There have been times when I
have had to chase referrals due to no contact within the stated time slot on SPA
form.
 Perhaps sharing/communicating, re patients between teams could be improved.
This applies to us aswell! Works both ways.
 South Bucks and Wycombe teams rarely update us regarding patients and also
don't let us know when patients RIP. This can be very variable in practice.
 Often not advised of patient who have RIP. Would also be useful to know when
patients had first visit.
 Very little feedback from teams.
 Poor at reporting back after referral.
 Increase awareness of services.
 Often not advised of patient who have RIP. Would also be useful to know when
patients had first visit (as above). Dacorum/Ridgeway team are excellent at
communicating, very efficient team.
Collaboration
 Hold a meeting in the home to give staff an update.
 Continue to work collaboratively in regards to our day services avoiding duplication.
 Advise staff/by teaching
 Always good to know if somebody is coming in as an emergency, thank you.
 Could a member of your team arrange a visit to us to discuss your services?
 Having syringe driver training booked would like some teaching sessions regarding
end of life care.
Referrals and case load management
 On occasions, due to workload, patients may have to "wait" to be seen or "books
closed" to new referrals.
 Referrals via SPA are straightforward. However, how soon referrals are picked up is
completely unpredictable.
 We have had experience of response times being slow when you are at capacity otherwise great service. But I do find the interface with district nursing a challenge have to refer to IRH@H and DN - why must we do 2 referrals when you share the
care?
 We make our referrals at the end of the day. Don't always manage to talk to
somebody if we need to. Better than it was with new nights service. If I put on form
to contact before visit doesn't always happen.
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






Ensure communication @ referral point to ensure patient does not have to duplicate
info already given when meeting RGHC. Discuss delayed referrals. To ensure
RGHC aware of all info to date, limited space on SPA form. I do try to give as much
info as I can to support referral to RGHC.
Guidelines and referral criteria information to give to our patients/families on what to
expect from service/time scales for visiting.
Rennie Grove provide a great service to our community patients. However, I feel
that the teams are now so busy with increased caseloads that the level of input has
dropped. We do have patients admitted who say they have been occasionally
disappointed at the response they have had when ringing the out of hours number.
Saying this, still believe the service is providing comprehensive specialist palliative
care.
Please address the referrals to DN/yourselves for same pt when you are sharing
care.
Improve communication which now feels very one way. ? referral to some services
because of delays in pick up due to high case loads - esp in S Bucks services.
Condense referral form a little!
Occasionally "To be aware referrals" not always clear what to do with these.
Other
 See more people!
 Greater parity of service provision across the different teams and in relation to other
palliative care providers. Delays in take up of patient’s (?). Team meetings needing
to happen before 1st visit? Why?
 Palliative care support for non-cancer diagnosis eg heart or respiratory disease.
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