Saint Francis Hospice
Quality Account
2014-2015
Registered charity no. 275913
CQC Provider ID 1-101635251
Our
Vision
Saint Francis Hospice is committed to
helping anyone in our communities
who is affected by life limiting illness
receive excellent person centered care
when they need it and ideally in a place
of their choosing.
Our
Mission
Saint Francis Hospice is an
independent charity that provides the
very best in specialist care for local
people with complex needs related
to life-limiting illness, and inspires and
educates others to support a service
provided completely free of charge to
patients and their families.
Our
Values
These values underpin all that our charity
aspires to do and shape our external and
internal behaviour.
Support
Work collaboratively with all parties in the
provision of services to those affected by
life limiting conditions. Sharing our expertise
within the wider social and healthcare
provision community to ensure the best
possible outcomes and service for the
people who need us.
Fairness
To treat everyone with dignity, trust and
respect. To extend the ethos of the excellent
people focused care we provide to all who
work with or touch our hospice.
Honesty
Be open and accountable, working together
for the benefit of our local community,
partners and our most valued resources, our
people. To communicate clearly, honestly
and appropriately with our communities,
colleagues and partners. We will also be
obsessive about continuous improvement of
our care, meaning we will review objectively
our capabilities and actively seek to
understand the needs of our
communities and partners.
2
Part 1: Chief Executive Officer’s
Statement
Welcome to the fifth edition of the Quality Account
produced by Saint Francis Hospice.
In July 2014 the hospice celebrated thirty years of
care for people affected by a life-limiting illness. This
significant milestone is a testament to the hard-work
and dedication of hundreds of clinical teams, fundraisers,
administration staff and volunteers who have worked at
Saint Francis Hospice over those years.
At the beginning of the 2014/15 financial year we were heartened to receive huge support from our local
community as we launched a successful appeal to help fund repairs to the roof on our inpatient unit that had
been damaged during winter storms. By the end of the financial year more than £213,000 had been raised.
In May 2014 we were pleased to welcome HRH Princess Alexandra to the hospice to inaugurate our new
Memory Tree – a hand-carved sculpture with leaves that people can sponsor and dedicate to a loved one or
mark a special occasion. Thanks to the generosity of Brentwood à Becket Rotary Club we now have our own
Electrocardiogram (ECG) machine that will be used by our doctors and senior nurses to monitor heart rates
and rhythms. This is used before prescribing certain medications and having our own ECG machine means
that we can avoid some journeys to hospital.
Our aim is to always deliver the best possible care to patients, relatives and carers. We know from our own
patient and carer surveys how valued our services are and we also recognise the huge challenges ahead as we
work with a growing and ageing population in our service catchment area.
Once again I am particularly pleased and proud of the excellent feedback received from service users. All
patients and carers are given the opportunity to complete a questionnaire regarding their Saint Francis
Hospice experience, and the results show 98% - 100% satisfaction across our services. However we are not
complacent and in March 2015 launched an extensive consultation process as we shared our vision for our
service provision over the next five years with local health professionals, community groups, service users,
staff and volunteers.
In addition to caring for adults affected by life limiting illness; support is given to their families and carers,
both during illness and after the death of the patient. Our aim is to alleviate suffering which may be physical,
emotional, social and spiritual in order to enhance the quality of life of each patient.
The hospice is also an education and resource centre. This last year we began training care home staff
under the aegis of the Gold Standards Framework that we believe will mean many more people in our local
communities will receive care that treats everyone with dignity.
This Quality Account is the product of a number of individuals and individual audits, all working towards
ensuring that we meet our strategic and business plan objectives. I am pleased to present this Quality
Account for 2014/15 and, to the best of my knowledge, the information it contains is accurate.
Mrs Pam Court
Chief Executive Officer
3
Part 1a: Statement of
Assurance from the Board
The Board of Trustees’ clinical and corporate governance role
is fulfilled through delegated governance committees: Clinical
Governance, Audit and Investment, Voluntary Income and Corporate
Governance. These committees meet quarterly and are updated on
work done to maintain, improve and evidence the high quality services
provided to our patients, their carers, our supporters, volunteers
and staff. The Board also carries out its own half-yearly informal
inspection, speaking to patients, relatives, staff and volunteers.
Review of Services
During 2014/15 Saint Francis Hospice delivered the following
specialist palliative care provision to the communities we serve in
Barking & Dagenham, Havering, Redbridge, Brentwood and West
Essex.
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Inpatient Unit Services
Day Therapy Services
24/7 Community and Crisis Support Services
24/7 Specialist Contact Centre and Helpline
Hospice at Home Service
Education Service
Physiotherapy Service
Occupational Therapy Service
Complementary Therapy Service
Spiritual Support Service
Bereavement Support Service
Child Bereavement Service
Family and Carer Support including welfare advice and psychological support
Carer Support Services
Psychotherapy Service
Outpatient Clinics
Community Equipment Loan Service
All the data available on the quality of care provided for these services has been reviewed. The income
generated by the NHS services provided over the last financial year represents approximately 28% of Saint
Francis Hospice’s total income. The remaining income is generated by fundraising, investments and shops
activity.
This year we have drafted our next five year strategy and that will deliver a clear direction for the hospice.
The Board appreciates that the staff and volunteers at our hospice often go above and beyond the call of
duty as they are passionate about providing excellent care and I would like to add my personal thanks and
gratitude for all that they do.
Dr Robert Weatherstone
Chairman, Board of Trustees
4
Part 2: Priorities for
Improvement 2015-2016
The staff, volunteers and Trustees of Saint Francis Hospice are committed to the delivery of high quality
care, i.e, care that is safe, effective and provides patients and carers with a positive experience.
Here are the key quality improvement projects we are going to prioritise in 2015/2016:
Patient Safety Improvement Project
Priority 1:
To ensure that all relevant national drug and patient safety alerts are received reliably, and within a
week of issue, and that all such alerts are discussed, with a plan of action identified, developed and
executed within an agreed timeframe to identified staff and in line with the requirements of the
alert.
Standards:
That the hospice has systems for capturing and managing relevant national drug and patient safety alerts
and ensuring that any necessary alert is received by the appropriate team, that learning is disseminated
quickly and effectively and within the nationally recommended time frame to the right staff, and that any
action (including change in practice) is identified and processes agreed and implemented securely and
within the nationally recommended time frame.
How was this identified as a priority?
We have realised that there are several National Alert systems that currently sit outside of our current
system, also that the organisational response to national alerts is highly dependent on one or two
individuals, making current systems highly vulnerable. We recognise the need for development of a more
comprehensive and inclusive system as soon as is possible. .
How will this priority be achieved?
The hospice Medicines Management Group will together review the current pathway, identify what is
currently not captured by way of National Alert pathways, and develop a new pathway towards a much
more robust system.
How will progress be monitored and reported?
Progress will be monitored and reported by the Clinical Review Group, and their summary progress report
will be brought to the Clinical Governance Committee through a system of quarterly reports.
5
Clinical Effectiveness
Improvement Project
Priority 2:
To be sure that our referral process is user friendly,
so that any referral can be easily made and any
referral received can be processed quickly, for a
timely response from our hospice services.
Standards:
1) Referral criteria are clearly available for anyone who
wants/needs to make a referral
2) Any concerned referrer knows or can easily find out
how to make a referral to the service
3) The referral process is easy for the referrer
4) The referral process ensures that accurate contact
information and relevant clinical information is supplied
at referral to enable the hospice to quickly prioritise for
urgency and complexity and to respond usefully and
in an informed way to the referer’s and the individual’s
needs.
How was this identified as a priority?
An easy referrals process is critical to the hospice being able to give responsive support to people who need
hospice care, also timely and useful support to their clinical teams.
Most referrals will come from a patient’s clinical care team: usually the GP, district, community or long term
conditions team, a care home or a hospital ward, with a good amount coming from local hospital specialist
palliative care teams. A few will come by other routes (see the hospice website for further guidance as to
who can currently refer).
We are finding that many referral forms are poorly completed, leading to delay as the hospice team
explores e.g. who the patient is/where they are, and what the issues are, and how urgently support is
needed and from what service.
Under the current system very poorly completed forms or those that give clinical information which is out
of date or too thin to give a clear clinical picture of the situation are returned to the referrer, and lead to
further delays.
6
How will this priority be achieved?
Achievement of an easier referral system is in year
1 of our 2015-20 Clinical Strategy.
We have just set up a ‘referrals group’ to work
towards the above standards, fully recognising
flaws in the current system.
Our first step will be to involve referrers in
identifying their recommended best way forward
for making a referral, by asking for feedback from/
drawing on the skills and experience of local GPs,
specialist palliative care partners in care and
community nurse services/care homes. Ideas to be
explored will include website access, choose-andbook, online and telephone referral pathways, also
acceptance of self referrals, as well as the current
fax referrals system.
We will review - and revise as needed - our
referral criteria and service descriptions, then
develop referrals processes according to feedback.
Alongside developments we will ensure that the
criteria, service descriptions and ways to make a
referral are kept updated on the website checking at each change that text is easy for
service users to understand.
Prospective referrers do have referral criteria but we still receive a significant proportion of out of area or
not-for-our-service referrals, which takes up much staff time as we work to navigate the referee and
prospective patient to an appropriate support service.
How will progress be monitored and reported?
This will be one of the strategic priorities for the 2015-2020 hospice’s Clinical Strategy and as such
progress reports will be presented to the Clinical Governance Committee on a quarterly basis.
7
Patient Experience
Improvement project
Priority 3:
To initiate and pilot a regular hospice LINK group
for people who are being discharged from the
Day Therapy Unit or the Inpatient Unit who feel
worried and bereft at thoughts of discharge,
and who would value keeping in touch by
coming back to the hospice for regular meets.
We will work to run the LINK group alongside
a concurrent carer support group/session so
that face-to-face support can be maintained or
developed for LINK Group users’ carers too.
Standards:
Patients need support in managing serious illness
at many times in the illness journey and not just at
times of crisis. Much of this support comes from
family and friends, and the care burden for both
patient and family/friend carers can be heavy.
The palliative care approach has evolved in
response to the need to help people suffering from
advanced illness so that they can live as
actively as possible through the illness,
recognising that they may need physical
(symptom/practical) spiritual, emotional and
social support at different points in the
illness journey. Our own
experience, and that of the World
Health Organisation, is that by
working to enhance quality of life,
palliative care may positively
influence the course of the illness
and experience of life.
Our own standard is to provide
advice and support for people whose
care needs/challenges have outstripped
generalist services, but for some there is
no obvious place or service to direct people to
for ongoing support.
We therefore want to set up and pilot a continuing
face-to-face support group link with the hospice
for people living with the threat of resurgence of
their disease or their issues, even when things are
more settled, and to run it concurrently with carer
support.
.
How was this identified as a priority?
Our user feedback surveys and our 1:1 work with
patients are identifying that people who complete
their course of care under the Day Therapy Unit
can feel really worried about their discharge from
the service, and can feel bereft when that weekly
visit to the hospice goes. There are also people
who have been treated as inpatients who feel
equally worried about losing face-to-face links,
but who do not meet the criteria now for ongoing
face-to-face support by the Day Therapy Unit or
the Community visiting team.
Currently we are not always able to identify
partners in care who can fill the gap these
patients feel. We know that there can be real
benefits for people living with advanced illness
from sharing experiences and companionship,
and from developing self-help skills and nonprofessional networks of support, as well as
from staying in touch with professional support
services.
We also know that for many, thinking ahead,
preparing for the future and advance care
planning will be an ongoing process enhanced by
regular contact in more stable times, rather than
contact limited to crisis only times.
How will this priority be achieved?
The hospice will set up and pilot a
LINK Group, in the Day Therapy
Unit during the course of this
year, and will monitor
attendance, service user
feedback and influence on
development of advance care
planning and the identification
of/achievement of preferred
priorities for care.
If the pilot is successful (gives
positive gain to people) we would ask
for commissioning support to continue
this service.
How will progress be monitored and reported?
This will be one of the strategic priorities for the
hospice’s 2015-20 Clinical Strategy and as such
progress reports will be required for the Clinical
Governance Committee on a quarterly basis.
8
Reflection of progress from
year 2014/2015
The aim of the Quality Account is to look forward and to identify and share priorities for quality
improvement in the forthcoming year. It is also to review and reflect on progress with the priorities for
quality improvement identified at the beginning of last year.
Here follow progress reports on those priorities. All were chosen for their direct impact on the quality of
care that patients and families receive either through patient safety, clinical effectiveness or patient
experience.
Patient Safety Improvement Project
Priority 1:
To ensure that all hospice staff who order and prescribe blood products, take blood samples for
transfusion purposes, collect and transport blood products and administer blood products do so in
line with stringent guidance recently issued by our supplier Trust (Barking, Havering and Redbridge
University Hospital NHS Trust) in their response to national directives, including the Department
of Health Circular HSC 2007/001, “Better Blood Transfusion”, the National Patient Safety Agency
(NPSA) Safer Practice Notice 14, “Right Patient - Right Blood” and the Blood Safety and Quality
Regulations (BSQR-2005).
Standards:
That every institution doing blood transfusions should have an assurance framework for blood transfusion
which includes stipulations for blood product safety to meet all the requirements set by the national
agencies named above.
Summary of Actions:
The blood transfusion policy has been revised and updated along with current guidelines and BHRUT
guidelines. A competency framework has been developed and depending on which part of the blood
transfusion journey (taking blood, or collecting/delivering blood or prescribing blood or administering blood)
a different competency has been developed. New documentation has also been introduced to improve
practice and patient safety.
All current staff and volunteers have now attended training sessions and undertaken competency
assessments. These assessments are valid for 3 years and then they will undertake refresher training and
redo their competency assessments.
All new staff who are involved in any aspect of blood transfusion now undergo assessment either as part of
their induction (doctors) or at the next available transfusion competency day. Ongoing training assessments
and policy updates will be undertaken as needed by the hospice Practice Development Nurse and one of
the hospice nurse Lecturers in Palliative Care.
All feel much more secure in clinical practice and we feel proud to have achieved all of the above this year
so that new skills and competencies absolutely meet with national standards and will be skills/competencies
reviewed/sustained on an ongoing basis.
9
Clincal Effectiveness Improvement Project
Priority 2:
To enhance identification of low mood/depression in our patients, and the sharing of ongoing
supportive care plans for low mood/depression to partners in care.
Standards:
Depression is common in palliative care – prevalence estimate is that around 15% meet the criteria for
a major depressive disorder, with many more patients having depressive symptoms . This compounds the
physical consequences of advanced disease. It has been established that cases of depression in palliative care
are often missed .
We identified the need to raise the profile of low mood (it’s prevalence, it’s burden and the effectiveness of
holistic care in better supporting patients with low mood) with our staff, and the need to develop systems to
better share important information concerning low mood and a supportive care plan with external partners
in care.
Summary of Actions:
After running an audit of our inpatient notes (in November 2012) on identification/assessment and
management of depression we were left concerned that our noting of mood and anxiety was very low for
inpatient unit admission, ongoing care and discharge. We were concerned; were we missing depression?
Were we helping enough?
We agreed 2 new support prompts to raise the profile of low mood as a common challenge for people with
advanced disease and symptom challenges.
1) We introduced an expansion to our symptom assessment tool, the Support Team Assessment Schedule
(STAS), to include a STAS prompt for mood/depression, and,
2) We revised our discharge summary template to prompt for broader issues than symptoms, such as
mood,and coping/support for both family and carers.
This extended tool to flag a ‘problem’ area has really been embraced by staff. When we did a repeat audit of
inpatient stays (an audit of referral forms and admission assessment/inpatient stays for hospice inpatient
admission in Nov 2014) we could clearly see that low mood is often one of the key challenges for people
needing an inpatient bed for care.
As a comparison:
In our 2012 audit (with no tool) 62% had ‘mood’ mentioned as a concern pre admission but only 20% had
‘mood’ identified as a concern on admission. It was often very unclear what was meant by ‘mood’ and what
care was given around ‘mood’ during the stay.
This year, in the repeat notes audit (Nov 14) we found that the new tool was well used: the difference now
was that around 40% of patients were recognised as having significant struggles with low mood or anxiety
on admission, and between 31 and 42 % of carers had the same issue A continued attention to low mood
(and anxiety) was now much more evident in the notes of the patients’ time on the inpatient unit.
10
Patient Experience improvement Project
Priority 3:
To gain feedback on our patients’ experience of psychological services to know how effective our
services are.
Standard:
We have a psychological service and it improves the care of our patients.
Summary of Actions:
Our hospice bereavement counselling team adopted the London Cancer Tool to record and evaluate the
bereavement counselling services offered by the Hospice. It was sent to bereavement counselling clients at
the end of their work along with the hospice bereavement service’s own evaluation form.
In the financial year to date we have had 183 counselling clients finish their work with the bereavement
service: of those unfortunately only 18% responded to our evaluations. However even the 18% has given us
really useful information that we did not have previously.
Of those who responded 70% said that their experience of the psychology services they had was ‘very
helpful’, with a further 21% saying that their experience was ‘helpful’.
One recorded that the support had made no difference (3%), commenting: “I realised during my counselling
sessions at SFH that I had no need for them as I had had my therapy previously with my friends. I left the
SFH of my own volition ... “
(Two correspondents did not answer the question (6%).
A more generic bereavement service evaluation form asked: ‘How helpful was your counselling?’ 76% of
respondents recorded ‘very helpful’, 33% recorded ‘helpful’.
One respondent recorded that the bereavement counselling was ‘unhelpful’, but then went on to record
that “... the counsellor was very good to me. Talk about my husband, who passed away last year, helped so
much.”
And one respondent indicated that the counselling was ‘very unhelpful’. They went on to record that “... the
counselling was not right for me at this time”. However when asked ‘how did you feel before counselling’ and
‘how did you feel after counselling’ the respondent indicated that they had been ‘not good at all’
pre-counselling, but after counselling had been ‘good’.
This data shows us the importance of clinical data. We can use it to reassure ourselves of services that we
find have offered much support/make a difference (as we would hope). We also need it to identify services
that may not be doing what we need them to do – and to identify ways we can improve our services and
our reach. Services which give much support we would want to grow and develop of course, to reach and
support all who might value it and benefit from it.
We are due to provide an end of year report to the Clinical Governance Committee, which will give fuller
details of both service evaluation forms for the bereavement counselling service and will discuss a plan for
ongoing/sustainable service evaluation for the hospice bereavement counselling services.
11
The following are a series of statements that all providers must include
in their Quality Account.
2a. Participation in Clinical Audits
As a voluntary sector organisation Saint Francis Hospice is unable to participate in NHS led national
clinical audits and national confidential enquiries. However clinical audit is high on our priority list. We
recognise that for our services to keep up with best clinical practice, and to develop in quality and reach to
support people with an increasingly wide and more complex range of life limiting conditions we need to be
constantly evaluating our practice against the best standards possible.
• We have an active hospice clinical audit/service improvement programme. The local clinical audits that
were reviewed in 2014/15 are listed in section 3c, along with the outcomes from each audit in terms of
working to improve on the quality of care we deliver.
• We also run a ‘rolling programme’ of audit against nationally recognised excellence standards which have
been researched and developed by Hospice UK (a national charity). Hospice UK has developed supporting
audit tools to enable specialist palliative care services such as ours to benchmark against best standards of
excellence for a large range of health, safety and care delivery standards. In this last year we have conducted
audits using these tools, on infection control, end of life care, the role of the Accountable Officer, the
workings of the controlled and the standard drugs pathway, inpatient admission assessment and
multi-disciplinary care review. Many of the hospice’s national tools audits have been included into a rolling
three year programme of presentations which have been incorporated into the mandatory training
programme for clinical staff, so that results and learning and practice development can be widely owned and
disseminated. (See section 3c for a full list of rolling audits achieved).
• The Hospice also submits annual service delivery data to another national charity, the National Council of
Palliative Care, who have developed a national Minimum Data Set for specialist palliative care services. This
allows us to compare our service throughput with hospices and hospice services of similar size, and with
other local specialist palliative care services. See on to section 3a for our activity data for 2014-15 against
national averages for similar services. Some service user data has now been incorporated into new Key
Performance Indicators for the hospice Board of Trustees (referrals taken on to care and inpatient unit bed
use). We have also included service user feedback (from patients who used any of our services, and from
bereaved carers) concerning their experience of a hospice, including its responsiveness to their need.
2b. Research
The hospice has active links with London South Bank University and Anglia Ruskin University, also with the
Marie Curie Research Institute, and has nurtured a small Research Group which has been exploring the
hospice contribution to research projects in the future, and which has secured a clinical research leaflet
and pathway to support research ideas to development. Local or regional/multicentre Ethics Committee
approval forms part of the clinical research pathway. One research project is under way.
2c. Use of the CQUIN Payment Framework
Saint Francis Hospice income during 2014/15 was not conditional on achieving quality improvement and
innovation goals through the Commissioning for Quality and Innovation payment framework because it is
a third sector organisation and as such was not eligible to participate in this scheme during the reporting
period.
12
2d. Statement from the Care Quality Commission
Saint Francis Hospice is required to register with the Care Quality Commission and is currently registered
for Treatment of Disease, Disorder or Injury and Diagnostic and Screening procedures. Saint Francis
Hospice has the following conditions on registration:
• The service may only be provided for persons aged 17 years or over
• A maximum of 19 patients may be accommodated overnight
• Notification in writing must be provided to the Care Quality Commission at least one month prior to
providing treatment or services not detailed in our Statement of Purpose
The last Care Quality Commission periodic review of Saint Francis Hospice was in October 2013. Following
that review the hospice was assessed as fully compliant with all CQC national standards. No further actions
were required. Saint Francis Hospice has not participated in any special reviews or investigations by the Care
Quality Commission during the reporting period. We have recognised and prepared for the new way CQC
are inspecting Hospices and are ensuring we are compliant with the new fundamental standards issued April
2015.
This year Saint Francis Hospice has made a number of changes in relation to CQC requirements and has
made changes to the statement of purpose and also to their Accountable People - Responsible Individual
-Pam Court (CEO) and Registered Manager - Tes Smith ( Director of Quality and Care).
2e. Data Quality
Saint Francis Hospice does have its own system for monitoring the quality of data which is kept in the
clinical information system, iCare. This is important because, with the patients’ consent, we share data with
other health professionals to support the care of patients in the community. iCare is also used to provide
activity information to our commissioners and in the on-going development of services.
2f. Information Governance Toolkit Attainment Levels
Saint Francis Hospice has maintained the Information Governance Toolkit level for 2015/16.
2g. Clinical Coding Error Rate
Saint Francis Hospice was not subject to the Payment by Results clinical coding audit during 2014/15 by the
Audit Commission.
13
Part 3: Review of Quality Performance
3a. Activity Data
Annual Saint Francis Hospice
statistics
National
Median
2013/14*
2014/15
2013/14
2012/13
2011/12
2010/11
Patients cared for by the Hospice
1523
1476
1527
1536
1479
% Patients cared for with non cancer
diagnosis
26.4%
21.5%
16.5%
14.6%
13.2%
% Patients cared for with cancer
diagnosis
73.6%
78.5%
83.5%
85.4%
86.8%
362
335
93.7%
80%
371
407
401
331
341
371
367
307
360
93.5%
91.1%
95.9%
93.8%
89.6%
83.8%
80.5%
80%
88%
80.3%
% Patients with a non cancer diagnosis
14%
13.2%
7.8%
6.8%
6.8%
13.2%
% Patients with a cancer diagnosis
86%
86.8%
92.2%
93.2%
93.2%
86.8%
% Died
68.3%
69%
71%
72.3%
71.4%
60.7%
% Discharged to home (including care
home)
31.2%
29.4%
27.8%
26.6%
28.3%
0.6%
0%
14.4 days
1.6%
1.2%
0.8%
0.3%
0%
0%
0.3%
0%
13.7 days
12.8 days
12.5 days
14.3 days
14.5
237
225
248
227
243
80.4%
66.1%
72.2%
66.9%
66.7%
Overall Service
In-Patient Unit Services
Total number of admissions
Total number of patients admitted
% New patients
% occupancy
Diagnosis
Outcome of In-Patient Stays ending
% Discharged to an acute hospital
% Discharged to another setting
Average length of stay
Day Therapy Services
Total number of patients
% New patients
253
71.5%
Specialist Community & Crisis
Support Service
1206
1219
1266
1204
1219
% New patients
1226
77.2%
77.9%
72.4%
74.1%
74.5%
70.6%
% Patients with a non cancer
diagnosis
23.2%
20.7%
16.2%
14.5%
12.9%
% Patients with a cancer diagnosis
76.8%
79.3%
83.8%
85.5%
87.1%
Number of face to face consultations
with patient or relative/carer
11933
11868
12544
14290
13915
Number of face to face or telephone
consultations with a health professional
8942
9207
9767
11569
9649
Average length of care (days)
68.1
77.9
88.2
87.5
85
Total number of patients supported
14
2014/15
2013/14
2012/13
2011/12
2010/11
National
Median
2013/14*
469
420
473
443
429
494
% New patients
96.2%
94.5%
94.5%
95.9%
95.8%
89.3%
% Patients with a non cancer diagnosis
27.9%
19%
16.3%
14.7%
9.3%
% patients with a cancer diagnosis
72.1%
81%
83.7%
85.3%
90.7%
Total number of visits
2670
2,486
2,609
2,579
2,694
Total hours of care during visits
12401
11753
11840
11628
12154
% Patients who died at home (including
care homes)
99.4%
99.4%
98%
98.1%
97.9%
83.7%
13.5
15.2
16.2
12
15.7
29
346
91
437
372
313
315
286
109
93
83
111
481
406
398
397
3308
3147
3130
2580
2835
1876
1407
1342
1729
Complementary therapy
2388
1186
1121
1095
1289
1320
Family services (excluding bereavement)
1955
1645
1535
1529
1425
Occupational therapy
2269
455
1443
2578
3308
3757
3811
445
423
393
434
1382
1332
2511
2093
Annual Saint Francis Hospice
statistics
Hospice at Home
Total number of patients looked after
Average length of care (days)
Bereavement Service
Total number of clients: Adult
Children
Total
Number of support/counselling
telephone or face to face consultations
(including health professionals)
Specialist Multidisciplinary Support
Services
Number of face to face
consultations with patient or relative/
carer by service:
Chaplaincy/spiritual support
Occupational Therapy equipment
Physiotherapy
The figures above provide information on the activity and outcomes of care for patients.
*From the National Council for Palliative Care Minimum Data Sets.
15
Activity Data: Education
During 2014-15 the Pepperell Education
Centre has been extremely busy delivering a
comprehensive programme of
training and development for both our own
staff and for external visitors. The education
team also ensure that internal staff receive
the necessary mandatory training to keep
staff, patients and visitors safe. Below are some of our highlights for the year:Study days - The Education Centre delivered over 40 study days last year and welcomed over 520 delegates
to our events. Topics included Communication Skills, Symptom Management, Grief & Bereavement and
other issues around End of Life Care. In addition we deliver study days to cover all the Mandatory Training
required for our staff such as Health & Safety and Fire training as well as professional development training.
London South Bank University - The Education Centre works in partnership with the university to deliver
three degree modules on Symptom Management, Dementia and Non Malignant Conditions. We welcome
health care professionals from various backgrounds such as community, hospital and hospice settings to
attend as part of their degree pathway.
Gold Standards Framework (GSF) Training - We are a regional training centre for GSF which is a training
programme and are currently supporting around 75 care homes through the programme and also 28
Domiciliary Care agencies. This programme enables generalist frontline staff to provide a gold standard of
care for people nearing the end of life.
“I found all the workshops to be very helpful. They were always concise and clear with enough time to go
through everything.”
“The course has been very informative and it is encouraging to see GSF starting to show within our home”
Advanced Communication Skills – We have delivered several courses on advanced communication skills to
doctors, nurses and other health care professionals. This is an intensive two day course which has been
evidenced to improve confidence in practioners in managing complex conversations.
Qualification Credit Framework (QCF) – We are now able to offer a course in End of Life Care for Health
Care Assistants which is accredited by City & Guilds. This was evaluated very well by the participants:-
“Meeting new people and getting to know their difference, experience and learning how we can look after
people – loved the course”
“I am more confident on the subject matter”
“Brilliant course material and knowledgeable approachable trainers – lovely ladies! A very enjoyable training
experience.”
2014/15
2013/14
2012/13
2011/12
2010/11
1,309
1,127
1,012
637
544
1,135
1,368
1,077
1,562
1,278
Education Service
Total numbers attending training Hospice staff
Total numbers attending training external
16
3b. Other Quality Indicators –
What people say about our organisation
Feedback is essential for us to be clear we continue to deliver to the highest of standards. One measure we
use is Questionnaires which have been updated and continue to be given to those discharged from the
Inpatient unit, to current Community and Day Therapy patients and to carers two months after
bereavement. This year we have encompassed the Friends and Family Test.
This process gives us excellent constructive feedback on how we met the needs of individuals and carers
at this time. We continue to hear that the opportunity to give feedback by way of a questionnaire is
appreciated. During 2014-2015 a total of 341 questionnaires were returned.
“I was glad to have the opportunity to give our feedback to an organisation
that has helped us so very much.”
Source: Carers questionnaire 2014/15
“My father was in the best place as his last weeks of life were difficult but
I received specialist support from amazing telephone staff and community
support in my time of need. I was not made to feel guilty for asking for
support in the end – it helped me to have special time without all the
resulting stress. There was never anything negative about the service.”
Source: Carers questionnaires 2014/15
“I can’t sing your praises enough. I have been overwhelmed with the
support and advice that I have received from all your staff. You cover
everything and having a voice at the other end of the phone makes all the
difference.”
Source: Specialist Community & Crisis Support questionnaire 2014/15
17
16
100% of IPU, Community & Day Therapy service users said adequate written
information was available.
100% of IPU, Community & Day Therapy service users said they had no concerns
about being discriminated against.
98% of IPU, Community & Day Therapy service users and Carers agreed or strongly
agreed that were given time to ask questions/voice concerns (334 of 341).
6 people (20%) were not aware that they could have a snack after evening meals and
before breakfast.
6 people (20%) were not aware they could have a light meal between meal times.
“I think more food should be offered for those that need it and more at tea time
other than a sandwich or eggs on toast.”
Source: Inpatient Unit Questionnaire 2014/15
Action taken:
The Nutrition and Oral Care Group have been working with the hospice’s caterers to improve meal
options and to provide menu cards for all patients which will inform them on the reverse that snack
options are available throughout the day.
In addition, the prep room will be redesigned to ensure that it is a designated area for the preparation of
food and drinks for patients. A new fridge-freezer, toaster and microwave will be purchased to increase
the range of snacks available for out of hours and all nursing staff will have access to the prep room any
18
time of the day or night.
“I made about 5 phone calls. 4 were very good, one was not. I was told I was
being transferred but that person could not answer me and transferred
me to another extension that did not answer. I got fed up and hung up my
phone.”
Source: Specialist Community & Crisis Support questionnaire 2014/15)
Action taken:
We evaluated the process and identified that a single CNS on the Specialist Advice line could not manage
the volume of calls into the service so have increased daily Monday to Friday of 2 CNSs on the phone for
incoming calls.
There are organisational plans underway to update the phone system to increase line capacity.
The following information indicates how we have performed during 2014-2015
INDICATOR
2014/2015
Complaints
Total number of complaints received
3
Number of complaints upheld in full
0
Number of complaints upheld in part
3
Patient Safety Incidents
Number of patient safety incidents (excluding falls)
28
Number of slips/trips/falls
29
Number of Serious Untoward Incidents
(SUIs)
1
Infection Prevention and Control
Number of patients known to be infected
with MRSA on admission to In-patient
unit
2
Number of patients infected with MRSA
whilst on the In-patient unit
0
Number of patients admitted to the Inpatient unit with C. Difficile
1
Number of patients infected with C. difficile whilst in the In-patient unit
0
19
3c. Clinical Audit Programme
The clinical audit group meets bi-monthly and, under the guidance of the Clinical Governance Committee,
oversees local clinical audits (with standards locally or nationally set and where possible evidence based). The
annual quality audit committee meets bi-annually and, under the guidance of the Clinical Governance
Committee, oversees all annual ‘rolling’ audits, a number of which are developed by Hospice UK and are
cross referenced to the Care Quality Commission’s outcome measures.
Within the previous twelve months, the Clinical Audit Group and Annual Quality Audit committee have
overseen a combined total of fourteen audits. Five of these were developed by Hospice UK.
An audit notice board is maintained providing information on presentations and news about audits. In
addition an audit update is published annually in the staff newsletter and an annual report provided to the
Clinical Governance Committee. The overall aim is to help foster a culture that continuously encourages
the merits and value of audit in the clinical setting.
The following audits were completed during 2014/2015
CLINICAL AUDITS
An evaluation of the breath-taking group
An audit of the How, When & Why of our Non-malignant Respiratory Disease Referrals
Gold Standards Framework – Progress so far
How do we know counselling works?
Hospice at Home referrals
A retrospective audit of hospice to hospital transfers
An audit to look at the use and compliance of subcutaneous medication advice sheets – one year after
implementation
ANNUAL QUALITY AUDITS
Saint Francis Hospice Resuscitation Policy
Learning Disability audit
Hospice UK self assessment – Accountable Officer
Hospice UK Day Care admissions
Hospice UK general medicines
Hospice UK controlled drugs
Hospice UK bereavement support audit
Hospice UK IPU admissions audit
Hospice UK Community admission - visiting
Hospice UK Community admission – telephone support
Hospice UK Community ongoing support
Hospice UK pain management
Hospice UK pre-bereavement
Hospice UK Infection prevention – IPU
Hospice UK Infection Prevention – Day Therapy
Progress on the action plans are monitored via the Clinical Audit Group or Annual Quality Audit Committee
to ensure all actions are completed. Some of the above are repeat audits which look to embed/sustain
positive practice change.
20
Statement from the Overview and Scrutiny Committees
A copy of this Quality Account was sent to the Overview and Scrutiny Committees of: Brentwood Borough
Council, the London Borough of Havering, the London Borough of Redbridge and the London Borough of
Barking and Dagenham.
We received the following response from the Health & Wellbeing Overview and Scrutiny Committee
2015, Thurrock Council:
Thanks for the information. As you know, this is my first time in the chair of the Health and Wellbeing O&S
Committee so I have a lot to take in and get up to speed on. I have read through the Annual Quality
Account and it seems to be a very thorough and encouraging piece of work.
It shows that, in terms of identifying issues and adopting measures to resolve them, the Hospice is on the
ball and I am particularly encouraged by the amount of training undertaken to keep everybody up to date.
I would like to see some more, in depth, patient feedback, though I appreciate that you are not totally in
control of that. I also noticed that the amount of occupational therapy has dropped off consistently over the
years, is there a particular reason? *
Regards
Cllr Graham Snell,
Chairman,
Health & Wellbeing Overview and Scrutiny Committee 2015-2015
Thurrock Council
*Saint Francis Hospice is currently looking at our Occupational Therapy and Community Services.
21
Statement from NHS Commissioners/Quality Account Leads
A copy of this Quality Account was sent to the Clinical Commissioning Groups of Barking & Dagenham,
Havering & Redbridge, Basildon & Brentwood, Thurrock and West Essex.
We received the following response from Basildon & Brentwood CCG:
Statement from Healthwatch
A copy of this Quality Account was sent to the Healthwatch Managers of Havering, Barking & Dagenham,
Redbridge and Essex.
We received the following response from Healthwatch Havering:
Healthwatch Havering endorses this Quality report. We are pleased to be working with the Hospice on securing improved End of Life Care in residential care, nursing home and hospital settings and with initiatives
such as Dying Matters Week. The Hospice has made our representative at their Governance Committee
welcome.
We look forward to even more co-working in future.
Kind regards
Ian Buckmaster, MA FCIS
Executive Director & Company Secretary
We received the following response from Healthwatch Essex:
Healthwatch Essex is an independent voice for the people of Essex, helping to shape and improve local
health and social care services. We believe that people who use health and social care services and their
lived experience should be at the heart of the NHS and social care services.
Although we have not undertaken any specific work with Saint Francis Hospice over the past year, from our
reading of the Quality Account we are pleased to note that Saint Francis Hospice actively engages service
users and families about the services they receive. In addition, the Hospice receives praise from service
users and their families for the high quality services and invaluable support it provides. Saint Francis Hospice
uses questionnaires as a way of capturing feedback, from those discharged from the inpatient unit,
Community and Day therapy patients, and carers of people after bereavement.
The improvement priorities in 2014-15, included gathering patients’ experience of psychological services.
To understand how effective the bereavement and counselling service is, the Hospice has been gathering feedback. Despite having a response rate of 18%, the feedback suggests the majority of people find the
psychology services beneficial. Additionally, in March the Hospice launched a consultation looking at service
provision over the next 5 years.
In the priorities for the coming year, Saint Francis Hospice is looking to improve the experience of people
who have completed a course of care at Day Therapy Unit and are worried about being discharged. To
provide ongoing support, the Hospice will pilot a LINK Group which will allow these people to maintain
regular contact and support.
Healthwatch Essex believes that lived experience should be at the heart of services, and believes that
listening to the voice and lived experience of patients, service users, carers, and the wider population, is
a vital component of providing good quality care. We are pleased to acknowledge the work Saint Francis
Hospice undertakes in this regard.
Sarah Haines | Information and Policy Officer
Healthwatch Essex
Contact us
Saint Francis Hospice
The Hall
Broxhill Road
Havering-Atte-Bower
Romford
Essex
RM4 1QH
If you would like to know more about our services and
what we can do for you, please contact us by telephone on
01708 753319 or visit www.sfh.org.uk.
If you would like to know more about volunteering or
fundraising for Saint Francis Hospice, please visit our website
at www.sfh.org.uk. Thank you.
Tel: 01708 753319
Web: www.sfh.org.uk
/saintfrancishospice
@SFHUK
saintfrancishospice