“ Thank you for caring”
Carer of a Rowcroft patient
Quality Account
2014/2015
2
Rowcroft Hospice
Quality Account 2014/2015
Contents
Chief Executive’s introduction .......................................................... 3
What our organisation is doing well ................................................ 4
Operating safely ....................................................................................................................4
Making sure our Service is effective................................................................................5
Audit.......................................................................................................................................................... 5
Patient and carer feedback............................................................................................................. 5
Staff training and support................................................................................................................ 5
How are we caring?..............................................................................................................6
Patient feedback.................................................................................................................................. 6
Holistic assessment and planning............................................................................................... 6
Bereavement support........................................................................................................................ 6
Outside space....................................................................................................................................... 6
Reaching out......................................................................................................................................... 6
Being responsive....................................................................................................................6
Demonstrating our organisation is well led..................................................................7
Education................................................................................................................................................ 7
Statutory information.......................................................................... 8
Performance – last year’s priorities.................................................. 9
Staff core competencies.................................................................................................................. 9
Patient, family and friends feedback.......................................................................................... 9
Rowcroft Hospice at Home............................................................................................................ 9
Chapel area............................................................................................................................................ 9
Wi-Fi provision – Inpatient Unit................................................................................................... 9
Areas for improvement – our priorities for 2015/2016.................. 10
Safety......................................................................................................................................................... 10
Caring....................................................................................................................................................... 11
Leadership.............................................................................................................................................. 11
Chairman of the Board of Trustees statement................................ 12
Annex...................................................................................................... 13
NHS South Devon and Torbay Clinical Commissioning Group statement............. 13
Healthwatch Torbay statement.................................................................................................... 14
3
Chief Executive’s
introduction
Rowcroft Hospice is an independent charity providing the only specialist
palliative care service to patients and their families across the 300 square
miles of South Devon. The service delivery over this past year has been
funded for the most part through the charitable giving of the people
of South Devon (73%); the balance being funded through a block grant
contract from the local NHS. In this past year of economic challenge we
are grateful for the continued generosity of our supporters to enable us to
provide high quality hospice services.
In our fifth Quality Account, we report on how Rowcroft assures our
patients, their families and friends, the people of South Devon and local
NHS commissioners that Rowcroft Hospice delivers safe, effective,
caring, responsive and well-led care. In this account we reflect on our
achievements over the year and state those areas we want to continue to
improve on. We set out our key priorities for continuing to deliver the best
possible care in the coming year.
All of this is only made possible by the dedication of our staff and
volunteers, the executive team and our Board of Trustees. All those working
and volunteering in our services are passionate in their aim to deliver the
best possible care to those who need it, whilst maintaining the highest
standards in corporate, financial and clinical governance.
I am pleased to support this report as a fair and accurate account of the
quality of the services we provide as an organisation.
Giles Charnaud
Chief Executive of Rowcroft Hospice
What our organisation is doing well
What our organisation
is doing well
For this year’s report we have used the new fundamental
standards (safe, effective, caring, responsive and well-led)
developed by the Care Quality Commission to report on
how Rowcroft Hospice is doing well
Operating safely
The safety of our patients and staff in all settings remains our utmost priority.
Patients have an individualised care plan that
balances robust risk assessments to prevent
avoidable harm with respect for patient dignity
and choice. There is a culture of open reporting
of clinical incidents and near misses and these
are investigated by a clinician who reports to the
Director of Patient Care.
Any incidents (for example falls, pressure sores)
and near misses are discussed at the monthly
Quality and Patient Safety Committee and,
where appropriate, at the Health and Safety
Committee. Trends in incidents are discussed
quarterly and action plans developed where
the need for change or improvement is
identified. Findings are reported to the Clinical
Governance Committee, which has Board
of Trustee membership. Patient safety data
are shared and benchmarked with hospices
regionally and nationally.
During 2014-15, all incidents resulted
in no harm or low harm to patients
There is a dedicated Infection Prevention
Practitioner, a clinician who oversees
environmental audits – 120 per year - and
provides advice and training to staff. This
clinician also reports to the Director of Patient
Care and has significant input into the annual
ward and outpatient maintenance programme.
During the last 5 years, no patient has
suffered from a hospice acquired infection
“The right care at the right time”
Rowcroft patient
“Staff at Rowcroft are kind,
sensitive, supportive, skilled
and could not do more... Never
intrusive but always responsive.”
Rowcroft patient
We have, for the first time, facilitated a Patient
Led Assessment of the Care Environment,
(PLACE) in which service user representatives
are given training and the opportunity to
access all areas and comment on cleanliness,
food served and the internal and external
environment. Their feedback has been
submitted to the Health and Social Care
Information Centre and the results collated.
PLACE standards are based on those required
for NHS facilities. Our score was over 90%
compliance, in some cases exceeding the
specified standards.
Staff undertake mandatory training in
Safeguarding (Adults and Children), the Mental
Capacity Act and Deprivation of Liberty
Safeguards; our Senior Social Workers lead
on these matters. There are clear policies and
procedures in place to ensure that staff can raise
concerns when necessary.
The Pharmacy Committee, comprising senior
clinicians and a Pharmacist, oversees the
management of medications. There is a robust
audit programme in place to ensure that high
standards are maintained in the ordering, storing,
prescribing and administration of medicines.
4
What our organisation is doing well
5
Making sure our Service is effective
We employ several methods to ensure that we
continue to provide an efficient and effective service.
Audit
A process by which we test our
performance against agreed standards
Our Audit Lead co-ordinates the annual audit
programme and assists staff in identifying new
areas for audit and potential service improvement.
In addition to the environmental audits, a further
25 Audits have been completed and approved at
the Quality and Patient Safety Committee during
the year. New areas audited this year include
the prescription, administration and storage of
medical gases, respiratory assessment for patients
diagnosed with motor neurone disease and
discussions with patients regarding resuscitation.
A very comprehensive audit of medicines
management was repeated and it demonstrated
a significant improvement in compliance using
the standards identified by Hospice UK. We have
recently submitted data for a regional audit based
on the ‘One chance to get it right’ initiative, which
aims to ensure that patients and their families are
given the information to make informed choices at
the end of life.
Results of a regional audit on preferred place of
care demonstrated that 90% of Rowcroft’s patients
who had stated their preferred place of care at end
of life achieved this. We have also contributed to
several regional data collection initiatives to enable
new standards to be identified for future audits.
There have been no relevant research projects
to take part in this year. We have plans to engage
in a research project next year about videoconferencing with patients/families.
“I cannot thank you enough
for all your help and support
throughout this difficult time.
You enabled my mother to stay
at home and the support given
to me as her carer was without
doubt the very best.”
Carer of a Rowcroft patient
Patient and carer feedback
We commission ‘I Want Great Care’ (an
independent company who collate and report
patient feedback) to give every patient and carer
the opportunity to tell us about their experience
of our services and to make suggestions for any
improvements. Feedback can be on paper or
online and is anonymous. Results are examined
monthly and trends identified quarterly. The
Hospice at Home and Bereavement Services use
bespoke feedback systems. All services have an
ongoing action plan based on feedback received.
Staff training and support
We invest time in induction and ongoing training
for our staff linked to annual appraisal and there is
a comprehensive mandatory training programme.
There is provision for enhanced communication
skills training. The ward manager arranges regular
skills update sessions for registered and nonregistered staff.
Medical staff conduct regular peer review meetings
where challenging issues, incidents, medical
guidelines and audit findings are discussed.
A new nursing model has been introduced in the
last year and a new method of nursing handover is
currently being piloted. Each patient has a named
nurse and Health Care Assistant responsible for
their care for each shift.
What our organisation is doing well
6
How are we caring?
Patient feedback
There is an overwhelming level of patient and
carer feedback supporting the caring ethos of
staff at all levels. Support services and volunteers
are often mentioned along with clinical staff and
this is fed back to those concerned.
Holistic assessment
and planning
Great care is taken to discover what really
matters to our patients and their families /
carers. Psychological, spiritual and social wellbeing are given as much attention as physical
needs. Preferences for future care are explored
as far as people feel able or willing to discuss
them and family support is considered a key
aspect of patient care.
There is a relatively open approach to visiting,
including well behaved pets, subject to time
being allowed for a patient’s need for personal
care and rest.
Bereavement support
Our Bereavement Service supported 189 people
last year. We also reviewed our bereavement
support groups in response to user feedback.
Outside space
This year an NHS grant enabled us redevelop the
garden area of the Inpatient Unit. The completed
garden won a ‘Building Better Healthcare award’ in
the patient experience class, as the garden is now
more accessible to patients using wheelchairs or
in their beds.
Reaching out
We are developing more skills in the care of
patients with dementia and have instigated
changes to make our environment more dementia
friendly; our WCs have traditional handle flush
mechanisms; wall and floor colours contrast in
colour as far as possible. Research has shown that
such measures can help the person with dementia
to function in an unfamiliar environment.
Being responsive
• The Chronic Oedema User Group meets
with team members regularly. In response
to feedback via I Want Great Care, telephone
appointments are now available should they
experience problems or have queries outside
their scheduled appointment times.
• We are looking at the suitability of the chapel
as a spiritual space in response to feedback
from our Hospice User Group.
• We have identified a process by which
those involved with the recently formed
local service for the frail elderly can access
specialist palliative care advice and guidance.
• This year the Chief Executive has
implemented a fortnightly meeting with
different members of staff to gain their views
on the service and its future development.
• Due to the increasingly complex needs of
patients, the Community Clinical Nurse
Specialist role was reviewed. As a result,
they have been provided with a nursing kit,
which enables them to carry out a range
of observations and tests in the home
setting to better inform the assessment and
management of a patient’s condition
What our organisation is doing well
7
Demonstrating our organisation is well led
As a Charity, Rowcroft has a Board of Trustees and an Executive Team. Over the years, many
changes have been made to encourage effective ways of working together for the benefit of the
organisation and therefore our patients and staff. Where there are vacancies for Trustees, the Board
will be actively seeking to recruit members who can offer certain skills and who will eventually
form part of a team that is representative of our patient population.
In addition, the Trustees are refreshing the hospice’s governance structure to enable even closer
working with staff for effective strategic planning. Quality Assurance is established via our Quality
and Patient Safety Committee, which from May will report to the Executive Team and onward to
the new Strategic Management Board.
Education
Rowcroft continues to demonstrate its
commitment to supporting, developing and
educating others in end of life care. Even in the
current economic climate, we have continued
to fill our courses and workshops, providing 120
different events for over 1500 participants this year.
“Thank you so much for a well
thought out training session, a
sad subject made interesting.”
Participant in Recognising and
Talking About Dying Workshop
We pride ourselves in our flexibility and ability to
respond to new national and local developments;
our programme has therefore incorporated
sessions on the recommendations from reports
such as the “More Care, Less Pathway” review of
the Liverpool Care Pathway (LCP). We developed
and delivered a series of six workshops entitled
“Beyond the LCP” which were designed to support
professionals in applying the principles into their
practice. These covered core topics such as:
• We have continued to offer 2 hour workshops
for health and social care workers, but have
added a study day for registered healthcare
professionals, all of which have been
oversubscribed
• Recognising and discussing dying
Participants at our educational events have
told us they value access to facilitators who are
also practising clinicians. Through mentorship
and support for our practitioners, we have seen
an increase in the numbers of our staff who
share their extensive knowledge both in formal
educational events, and informally, when they are
working with colleagues from other specialities.
• Ethical and moral decision making
• Advance care planning
• What matters most in the last weeks, days
and hours – developing individual care plans
• Prescribing effectively and safely
in the last few days
• Communicating with families and children
experiencing loss, grief and bereavement
We will be developing this course to integrate the
guidance from “One Chance to get it Right” into
a “Priorities for Care” series and other workshops
and courses we deliver.
In addition to working with local specialist
dementia teams to provide two workshops per
year about dementia and end of life care, we have
responded to requests for more targeted education
in this area.
• Our own staff and volunteers have been able to
attend Alzheimer’s society inspired Dementia
Awareness sessions led by one of our
volunteers who has undertaken the training
Statutory Information
Statutory information
Rowcroft Hospice provides
the following services:
Numbers of people referred
to our service this past year:
• 17 bedded Inpatient Unit
997 Community Referrals
• Community specialist palliative care service
427 Hospice at Home Referrals
• 24/7 Hospice at Home service
304 Chronic Oedema Referrals
• Outpatient services
358 Inpatient Unit admissions
• Chronic Oedema service
2674 Outpatient Appointments
• Bereavement service
• Education and training for health and social
care staff, volunteers and carers, in palliative
and end of life care
Rowcroft Hospice is required to register
with the Care Quality Commission and is
currently registered (2010) under the following
categories: treatment of disease, disorder or
injury; diagnostic and screening procedures;
transport services, triage and medical advice
provided remotely and ‘personal care’ for our
enhanced Hospice at Home service.
Rowcroft Hospice has the following
conditions on registration:
• The establishment may provide
overnight beds for a maximum of
19 patients at any one time.
• The establishment may not treat
patients under the age of 18 years.
• The prior written approval of the Care
Quality Commission must be obtained
at least one month prior to providing
any treatment or service not detailed
in the statement of purpose.
Rowcroft Hospice is subject to periodic review
by the Care Quality Commission (CQC). The
last inspection was in November 2013 and the
report is available at: www.rowcrofthospice.
org.uk/web/data/care-quality-commissionreport-2014.pdf
“I have received every possible
care and consideration from
Rowcroft. The suggestions and
helpful advice have been of the
highest order. It has been a great
comfort to myself and wife that
the specialist nurse is ready
available. Wonderful service!”
Rowcroft patient
8
How we have performed against last year
Performance –
last year’s priorities
Staff core competencies
Rowcroft Hospice at Home
The guiding principles have been established but
this project has expanded into a wider exercise
that also encompasses a training needs analysis
for all staff. Some needs have been addressed
immediately, including a new medicines
management training module, which is now a
mandatory training requirement for registered
nurses. The expanded project continues into
2015/16. There will be strong links between this
project and a Leadership initiative currently in its
formative stages.
As planned, we have re-evaluated our service and
identified areas for further development to provide
more care to more patients. We are working
closely with the NHS and hope that, as financial
resources allow, we might seek to expand this
service in the future.
Patient, family and
friends feedback
The ‘I Want Great Care’ feedback system
commenced as planned on 1st April 2014. This
undertaking involved eight hospices in our
region. We have a full year of patient feedback
for our own hospice and are working closely
with other hospices to learn from each other’s
feedback. Although overwhelmingly positive,
the feedback is examined monthly; each service
area has an ongoing action plan, designed to
affirm and encourage good practice as identified
in the feedback and to address any issues where
potential improvement is noted. We are continuing
the use of ‘I Want Great Care’ into 2015/16.
Examples of patient and relative feedback this
can be accessed via: www.iwantgreatcare.org/
hospitals/rowcroft-hospice
“Everything from reception to
seeing the nurses is excellent.
They take time to talk you
through anything you’re
unsure about and nothing is
too much trouble.”
Rowcroft patient
Chapel area
Our Board have made the decision not to progress
the refurbishment as planned at this time, as this
area will now be considered within wider strategic
planning of our accommodation needs as we look
to our future inpatient provision over the next
5–10 years and beyond.
Wi-Fi provision
– Inpatient Unit
The problems with Wi-Fi coverage over the
Inpatient Unit were identified and remedied.
Following some rewiring and the installation of
a second router, all patient areas are now able to
access Wi-Fi.
During the last year, we have had to revisit some
of our previous priorities to maximise the use of
our resources and to ensure the sustainability of
our services.
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Our priorities for 2015 / 2016
10
Areas for improvement –
our priorities for 2015/2016
Our focus for future developments as we move into 2015/2016 will be:
Safety
Our open culture of reporting and our
benchmarking process led us to believe
that our incidence of pressure ulcers was
potentially greater than other hospices. Senior
nurses examined the reported cases and met
with the Tissue Viability Lead for the local
NHS Trust. It was apparent that a significant
percentage of the reported ulcers were not
due to pressure damage. This is encouraging,
but we wish to ensure that we remain vigilant
with regard to the condition of patients’ skin,
no matter what the cause of any breakdown.
During the next year, we will:
• Continue to work with the Tissue Viability
Lead to improve our skills in identifying
pressure damage and other issues with skin
care. Education sessions will be provided
for clinical staff.
• Identify a lead nurse to link with the tissue
viability service, ensuring that current best
practice is cascaded to all staff.
• Introduce a reporting system to alert staff
to any wound/ break in the skin separately
from the pressure ulcer reports. This will
ensure greater accuracy in the reporting
benchmarking process, whilst enabling
other skin care issues to be highlighted as
required.
Outcome Measure
• Training in place for the Tissue Viability
Link Nurse by September 2015 and for all
nursing staff by December 2015
• Separate reporting for pressure ulcers
and other skincare issues in place on the
electronic patient record by December
2015.
“The support you gave to me and
my fa mily at this difficult time
was invaluable. We could not have
coped without you. Thank you.”
Carer of a Rowcroft patient
Following our audit on medical gases, we
have decided to upgrade our oxygen storage
facility to comply with the latest guidelines.
This will provide easier access to oxygen
cylinders for staff, who currently rely on
Estates personnel to transfer cylinders into the
building. We will:
• Construct a larger safe storage area on the
outside wall of the building.
• Create access to the storage unit from
inside the building.
Outcome Measure
• New storage unit in place by April 2016.
• Staff able to access cylinders from main
storage unit 24/7.
Our priorities for 2014 / 2015
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Areas for improvement –
our priorities for 2015/16
“All our questions were well
answered and we felt put
at ease. Instead of thinking
this is as good as it gets, we
now feel hopeful”
Rowcroft patient
Caring
Leadership
We have prioritised the need to develop our
education provision around spiritual issues.
We aim to provide additional education for
our own staff and to increase the profile of
the spiritual aspects of care in appropriate
courses for the wider health and social care
community
We would like to improve our corporate and
clinical governance structures, streamlining
the process and improving our collaborative
and collective leadership. During the next
year, we will:
Outcome Measure
• Course outlines and learning outcomes
demonstrate spiritual content where
appropriate.
• Agree the particular skills and experience
required for future trustees to support our
desire that the Board and the organisation
is representative of the area and population
we serve.
• Form a Strategic Management Board
(Trustees and Executive) designed to ensure
a collective decision making process.
Outcome Measure
• Strategic Management Board operational by
Summer 2015.
• An agreed strategy for enhancing
leadership capacity across the organisation.
The staff are all friendly
welcoming and caring.
Always pleased to see you.
A caring smile. Always
ready to listen. Thank you.
Rowcroft patient
12
Chairman of the Board
of Trustees statement
Having served on the Board of Trustees for many years, I am now
pleased to add my statement to the Quality Account for the first
time as its Chairman.
These are challenging times for any charity and for this hospice in
particular. The incentive to provide the best possible specialist palliative
care services in our communities drives all our efforts and we continue
to be grateful to so many people in South Devon for their support and
encouragement. Every penny they provide, either in terms of a financial
contribution or in volunteering their time, allows us to develop and
enhance those services, so we can then reach more and more of those
in most need.
The Quality Account demonstrates our commitment to providing safe
and effective care to our patients and their families, in whatever setting is
most appropriate for them, whilst responding to all their needs with care,
compassion and professionalism. It shows that we are never complacent,
seeking to improve wherever we can, whilst being prudent in managing
resources. The quality of care is a testament to the continued efforts of our
staff, volunteers, Executive Team and Board of Trustees.
Our aim for the patients and families we serve is to make every day the
best day possible.
As Chairman of the Board of Trustees, I endorse this report. As always, the
Board of Trustees will continue to support the Executive Team and Staff of
Rowcroft Hospice to meet the outcomes of the priorities for 2015/16.
Mr Bill Grahamslaw
Chairman, Board of Trustees
13
Annex
NHS South Devon and Torbay Clinical
Commissioning Group statement:
South Devon and Torbay Clinical Commissioning
Group (SD&T CCG), as the lead NHS commissioner
for Rowcroft, is pleased to provide our
commentary on this Quality Account for 2014
/15. SD&T CCG has taken reasonable steps to
corroborate the accuracy of the data provided
within this Quality Account and considers it
contains accurate information in relation to the
services provided.
SD&T CCG see Rowcroft as a key partner in the
delivery of integrated end of life care, and we value
the excellent open and regular communication
we have with them. For 2015 onwards, we have
agreed a unique, three year rolling contract
(reviewed annually) as a clear commitment to
working together.
Looking Back:
Rowcroft Hospice committed last year to a
number of priorities, including reviewing staff
competencies. We are pleased to note the
project was expanded to include a training needs
analysis for all staff, and that a new medicines
management training module has been
developed.
We are also pleased to see that Rowcroft will
continue to use ‘I Want Great Care’ in 15/16, and
we look forward to seeing in more detail the
outcome of the patient feedback for 14/15.
We commend Rowcroft for their educational
work, in particularly the ‘beyond the Liverpool
Care Pathway’ and dementia workshops they have
undertaken in conjunction with local specialist
dementia teams.
Priorities for 2015/16:
It is reassuring to see Rowcroft focusing on
reducing and preventing pressure ulcers. Pressure
ulcers cause pain and discomfort, and can cause
infection. Preventing them from starting, and
healing them quickly when they begin, is an
important patient safety priority. We will note with
interest the development of a separate reporting
for pressure ulcers and other skincare issues on
the electronic patient record.
Caring is something that Rowcroft are well known
for — it is therefore impressive that Rowcroft wish
to take this one step further and prioritise the
need to develop education provision around the
spiritual aspects of care.
The CCG is happy to support the quality
improvement priorities chosen for next year as
set out in the Quality Account. We are pleased to
note the continued focus on patient safety and
experience.
We acknowledge the important role of the Hospice
at Home service and look forward to working with
Rowcroft to further develop this service.
General Comments
Quality Accounts are intended to help the general
public understand how their local health services
are performing and with that in mind they
should be written in plain English. Rowcroft have
produced a comprehensive, attractive and well
written Quality Account which is easy to read and
clearly set out.
Overall we are happy to commend this Quality
Account and Rowcroft for its continuous focus on
quality of care.
14
Annex
Healthwatch Torbay statement:
Healthwatch Torbay’s role is to give Torbay people a stronger voice to
influence and challenge how health and social care services are provided
within their locality (Department of Health. Health and Social Care Act…).
With this in mind, it is a pleasure to read a report which is clearly written in a
way that the public will understand. Healthwatch Torbay has various ways to
encourage the public to provide feedback. This growing body of knowledge
provides the basis of our comment.
The Rowcroft Hospice reputation as a caring organisation has given people
expectation that their needs will be met and the success of this is reflected in
the comments from patients and their families. Rowcroft Hospice continues
to be rightly proud of its reputation for education in end of life care. Sharing
knowledge and learning about the change of approach embedded in “One
Chance to get it right” is an example of this expertise. One could not wish for
a better mission than “...to make every day the best day possible” (Chairman,
Board of Trustees).
Healthwatch Torbay is pleased to note that patient and carer feedback and
reporting on challenging issues and incidents are all taken seriously within
peer review. Although feedback is mentioned throughout the Account, there
is little detail on how this was collected other than by the “I want Great Care”
reports. More specific examples of criticism and how they were handled would
be reassuring to an external audience. Healthwatch Torbay has received two
incidents reported by the public. These were appropriately resolved following
our intervention.
Improvement priorities for 2015/16 are practical and aimed at improving
the quality of patient experience. The decision to address improvements in
leadership indicates a reflective organisation. It would be informative to be
given more detail of stakeholder engagement and how this influenced the
choice of priorities, especially as stated 73% of funding is from the people
of South Devon. Elderly people are just as likely to choose a hospice or at
home for the end of their life (source: Cicely Saunders International), so it
is disappointing that the update on 14/15 performance, Hospice at Home,
included the phrase “we might seek to expand”, although we do recognise that
a charitable organisation has to fund services realistically.
Overall the Quality Account points to an organisation intent on doing the best
for its patients and their carers with staff and volunteers given opportunities to
develop their skills. Healthwatch Torbay looks forward to being kept informed
of progress and will play, in turn, its part in keeping the public informed.