Part 1:
Trust Board Chairman’s Statement
St Barnabas Hospice has the needs of the patients at the centre of everything we do.
We seek to ensure that patients with palliative and end of life care needs, irrespective of
their diagnosis, have access to and receive high quality support and care that is centred
around them. Whether we are delivering care in the patient’s home, nursing home or
hospital we seek to improve their experience and enhance their quality of life. The
priorities the Trust has established for the forthcoming year will support better
communication and choice for patients, improve access and experience for those with
learning disabilities, and strengthen our ability to deliver effective psychological support
to people with emotional distress.
Having recently established the “Hospice in the Hospital” at Grantham and seen the
ensuing enhancement to care across the local community it is entirely appropriate that
we reappraise our current service delivery in all locations across the county. This
coming year will see our plans for enhanced delivery developed to improve the patient’s
experience.
On behalf of the Trust Board I am pleased to present this Quality Account for 2014/15
and, to the best of my knowledge, the information contained therein is accurate.
Mr Robert Neilans
Chairman of the Board of Trustees
1
Trust Board Endorsement of the Quality Account
We, the Trust Board of St Barnabas Lincolnshire Hospice, are pleased to endorse the
content of the Quality Account and, to the best of our knowledge, the information
contained therein is accurate.
Trustee
Signature
Tom Murray
Jacky Smith
Bob Neilans
Graham Hale
Sue Glaister
Peter Jordan
Keith Darwin
David Libiszewski
Ann Daulton
Tony Maltby
Paul Banton
2
Part 2: Priorities for Improvement and Statements of
Assurance from the Board (in regulations)
1. IMPROVEMENT
The Board of Trustees is committed to a culture of continuous development and
improvement throughout the organisation and to ensuring that services evolve to meet
patient and carer needs and to widening access to palliative and end of life care for all.
The priorities for quality improvement we have identified for 2015/16 are set out below.
These priorities have been identified in conjunction with patients and carers, staff and
stakeholders. The priorities we have selected will impact directly on each of the three
priority areas; patient safety, clinical effectiveness and patient experience.
1a. Priorities for Improvement 2015 – 2016
 Priority One
Clinical Effectiveness and Patient Experience
Priority One: Cognitive Behavioural Therapy (CBT) training for hospice nursing
staff; promoting patient self-management and improving outcomes.

The foundation level CBT course will be delivered to 20 nursing staff within the
Trust, this course enables staff to provide psychological support at level 2 (NICE
2004).

Nurses will have a greater understanding of the emotional reactions to physical
illness, coping and the role CBT can have in reducing stress.

To ensure there is effective support and supervision to these nurses four Specialist
Nurse Practitioners (SNPs) will attend the advanced CBT in palliative care course,
classified as NICE (2004) Level 3 psychological support. This will also enable
them to deliver higher level CBT to patients.
3
How was the priority identified?
This priority was identified by the Specialist Nurse Practitioners within the organisation.
Emotional distress is common in palliative care and access to expert psychological help
is limited (Mannix et al 2012)1.
Having reviewed the literature the team identified that Cognitive Behavioural Therapy
(CBT) has the strongest empirical support of any psychological intervention for the
management of symptoms typically seen in a palliative care setting.
It is a
psychotherapeutic treatment tool that aims to enable individuals to change negative
thoughts and behaviours and has been shown to be beneficial in a number of problems
in palliative care; anxiety, depression, breathlessness, poor sleep, pain, and goal setting
and family support (Sage et al 2008)2. Emerging evidence indicates that palliative care
nurses can be trained effectively to undertake CBT with their patients (Dunlop 2010)3.
Whilst CBT is not a panacea for all problems, it is a quick and effective way of dealing
with psychological challenges for many patients. Indeed it has been recommended by
NICE4 for the treatment of anxiety and depression. It has been suggested as helpful in a
wide range of palliative illnesses including Multiple Sclerosis, Cancer, Chronic
Obstructive Pulmonary Disease, Heart Failure, and Parkinson’s Disease (Sage et al
2008). Additionally CBT has been identified as helpful for a wide range of palliative
problems including anxiety, depression, quality of life, denial, panic, pain, fatigue, sleep,
body image and is helpful to support carers (Sage et al 2008). Indeed, in a feasibility
study within a hospice it was identified that 80% of patients could potentially benefit
from CBT skills (Anderson et al 2008)5.
How will priority one be achieved?
This priority will be achieved by working with St Christopher’s Hospice, London, who will
provide the training. The cost of the training is being support by a grant from the
Burdett Trust.
How will progress be monitored and reported?
This priority will be monitored through quarterly reports to the Patient Care Executive.
1
Mannix et al
Sage, N. et al 2008, CBT for chronic illness and palliative care; a workbook and toolkit
3
Dunlop, S. End Life Care 2010 ;4: Cognitive behavioural therapy in palliative and end-of-life care
2
4
Depression in adults: The treatment and management of depression in adults. NICE guidelines [CG90]
Published date: October 2009
5
Anderson, T. et al (2008) The use of cognitive behavioural therapy techniques for anxiety and
depression in hospice patients: a feasibility study Palliative Medicine 09/2008; 22(7):814-21.
4
 Priority Two
Patient Experience and Clinical Effectiveness
Priority Two: Advance Care Planning (ACP) in other settings.

Advance care planning provides an opportunity for patients to express their wishes
and choices around the care at the end of life when they may no longer have
capacity to make decisions for themselves.

Advance care planning supports clinicians to make decisions that are right for the
patient, enabling patients to be cared for and die in their place of choice. It can
prevent unnecessary admission to hospital.

Advance care planning can reduce anxiety and distress by enabling patients to
discuss and share their wishes. Planning early supports patients to live well until
they die.

The care settings will include a prison and specialist community teams supporting
people with learning disabilities and those with newly diagnosed early dementia.
How was the priority identified?
This priority was identified when working with patients and clinical colleagues in both
acute and community care settings. They recognised that the experience of patients at
end of life, and their families, could have been enhanced and their care been tailored to
their wishes had an advance care plan been in place. The Parliamentary and Health
Ombudsman’s report (2015) Dying without dignity also highlights the poor experience
patients may have without adequate care planning.6
How will priority two be achieved?
This priority will be achieved through a training and education programme to support
clinical and support staff within these settings to have discussion with patients and by
identifying and promoting specialist resources for people with learning disabilities7 to
support them in making informed choices about their care.
How will progress be monitored and reported?
This priority will be monitored on a quarterly basis by the Patient Care Executive.
http://www.ombudsman.org.uk/about-us/news-centre/press-releases/2015/too-manypeople-dying-without-dignity,-ombudsman-service-report-finds
7
http://www.palliativecareggc.org.uk/uploads/file/events_docs/study_day_oct2012/Learning%20disabilities
%20-%20building%20Bridges.pdf
6
5
 Priority Three
Patient Safety, Patient Experience and Clinical Effectiveness
Priority Three: Develop a resource pack and care plan to support the care of
patients with learning disabilities within palliative care services.

Discussion between the St Barnabas Specialist Nurse Practitioners and learning
disability nurse specialists identified the potential for organisations to work together
in a more integrated way to provide safer and more effective end of life care for
people with learning disabilities, providing a better experience for patients and their
families.

There are currently 2,500 patients in Lincolnshire on the primary care learning
disability register with 780 receiving services.

People with learning disabilities die at a younger age than the population in
general. It can be more difficult to diagnose people with learning disabilities and
there are risks that signs and symptoms are ascribed to the person’s learning
disability rather than a physical cause.

Staff require support to develop the skills to make reasonable adjustments to meet
the needs of people with learning disabilities and to avoid unspoken assumptions
about the current and future quality of life of the individual when making decisions
about the risks and benefits of specific treatments.
How was the priority identified?
This priority was identified following a review of a number of case studies involving
patients who had a learning disability who were cared for within our services and the
paper ‘Reasonable Adjustments for People with Learning Disabilities – Implications and
Actions for Commissioners and Providers of Healthcare’8 which identifies a number of
issues related to the care of people with a learning disability and ways in which these
may be addressed.
How will priority three be achieved?
This priority will be achieved through the development of a resource pack and care plan,
working with specialist community and acute care staff and tested within a palliative
care inpatient unit. It will also be piloted within community settings.
8
https://www.improvinghealthandlives.org.uk/uploads/doc/vid_11084_IHAL%202011%2001%20Reasonable%20adjustments%20guidance.pdf
6
Once the pilot is completed, a review undertaken and changes made it will be made
available to all organisations providing palliative and end of life care to people with
learning disabilities.
How will progress be monitored and reported?
This priority will be monitored on a quarterly basis by the Patient Care Executive.
1b. Priorities for Improvement 2014 – 2015
 Priority One
Patient Safety, Clinical Effectiveness and Patient Experience
Priority One: Working with other health and social care organisations to lead
the development of a palliative care specific pressure damage prevention
pathway for the county.

The prevention of pressure damage is a national ambition 1 for all patients
receiving care because it has a significant impact on the safety and experience of
patients.

End of life patients are particularly vulnerable to pressure damage because the
skin, as an organ, also fails during the dying process and patients may experience
other symptoms that preclude some pressure damage prevention activities, for
example turning a patient to relieve pressure.

Patients at home may not wish to accept pressure relieving equipment in their
homes when they are very unwell.
1
NHS and Midlands Strategic Health Authority. http://nhs.stopthepressure.co.uk/
During the past year we have worked closely with specialist tissue viability staff from
United Lincolnshire Hospitals Trust and Lincolnshire Community Health Services to
develop a pathway that reflects the NICE Pressure damage guidance 9 published in April
2014.
This pathway has been approved by the St Barnabas Clinical Governance Committee
and by Lincolnshire Community Health Services and is disseminated and adopted in
practice. It is awaiting final approval by United Lincolnshire Hospitals Trust.
9
https://www.nice.org.uk/guidance/cg179/resources/guidance-pressure-ulcers-prevention-andmanagement-of-pressure-ulcers-pdf
7
The palliative care and end of life pressure damage pathway aims to work in partnership
with other key healthcare providers, ensuring proactive, effective and consistent care of
pressure damage, balancing implementation of current NICE guidelines with quality of
life patients approaching end of life.
Prevention of Pressure Damage for Palliative and End of Life Patients
The skin is one of the first organs to fail in palliative and end of life patients. This may
lead to pressure damage that is unavoidable despite optimal pressure relieving
interventions. This does not mean that skin deterioration should be accepted by nurses
(Beldon 2011). The principles listed below are adapted from SCALE 2009 and identify
key considerations in practice with an aim to prevent pressure damage and support
patient comfort and dignity. The flow chart below reflects Preventing pressure damage
in adults. NICE guidance (2014) but underpins specific considerations for palliative and
end of life patients. The notes overleaf provide further detail adapted from SCALE, Skin
Changes at Life’s End (2009) to also support care of skin at end of life.
Pathway
Prevention of Pressure Damage in Palliative and
End of Life Patients
Identification of palliative and
end of life patients
Aim to anticipate pressure damage
Communicate and record patient goals of
care
Complete documentation / SSKIN
documentation
Signposting
Specialist advice
Anticipate disease trajectory and
plan for deterioration.
Consider impact of symptom
management and co-morbidities
Identify when healing may be
achieved or when pressure
damage may be unavoidable
Consider Kennedy Ulcers
Holistic individualised care
planning.
Consider psychological/emotional/
spiritual factors.
Inclusion of end of life goals
Robust documentation of all
interventions.
Ongoing communication
Education/evaluations with patient,
family and carers
Repositioning at end of life should
depend on patients wishes
Comfort and dignity even if in
conflict with best practice
guidelines
It requires a common sense
approach based on individual and
cultural circumstances
8
Key principles- adapted from SCALE 2009
1. Physiological changes that occur as a result of the dying process (weeks to days) may affect
the skin. This may manifest as observable objective changes in skin colour, turgor, or integrity,
or as subjective symptoms such as localized pain. These changes can be unavoidable and may
occur despite the application of appropriate interventions that meet or exceed the standard of
care.
2. The plan of care and patient response should be clearly documented and reflected in the
patient record. The impact of interventions should be assessed and revised as appropriate.
3. Patient-centred concerns should be addressed including pain and activities of daily living. A
comprehensive individualised plan of care should not only address skin changes and any comorbidities, but any patient concerns that may impact on quality of life including physiological
and emotional issues.
4. Skin changes at life’s end are a reflection of compromised skin (reduced soft tissue perfusion,
decreased tolerance to external insults, and impaired removal of metabolic wastes).
5. Expectations around the patient’s end of life goals and concerns should be communicated
among the members of the inter-professional team and the patient’s circle of care. The
discussion should include the potential for SCALE including other skin changes, skin
breakdown, and pressure damage.
6. Risk factors symptoms associated with SCALE may include:
 Weakness, progressive limitation of mobility, suboptimal nutrition including loss of appetite,
weight loss, cachexia, low serum albumin/pre-albumin and low haemoglobin as well as
dehydration.
 Diminished tissue perfusion, impaired skin oxygenation, decreased local skin temperature,
mottled discoloration and skin necrosis.
 Loss of skin integrity from any of a number of factors including equipment or devices,
incontinence, chemical irritants, chronic exposure to body fluids, skin tears, pressure,
shear, friction and infections
 Impaired immune function.
7. A total skin assessment should be performed regularly and document all areas of concern
consistent with the wishes and condition of the patient.
8. Consultation with a specialised healthcare professional is recommended for any skin changes
associated with increased pain, signs of infection, skin breakdown (when the goal may be
healing) and whenever the patient’s circle of care expresses a significant concern.
9. Prevention is important for well-being, enhanced quality of life and to avoid unplanned medical
consequences for end of life care.
10. Patients and concerned individuals should be informed regarding SCALE and the plan of care.
Kennedy Ulcers
A Kennedy ulcer is a pressure ulcer that some people develop as they are dying. It usually presents
on the sacrum and can appear like a pear or butterfly. The borders are irregular and may be red,
yellow or purple. It has a sudden onset and associated with imminent death. Although further
research is required it may be caused by a blood perfusion problem and may reflect what is going
on in the body as part of the dying process. It is unlikely that a Kennedy ulcer will heal but
individualised
care
can
aim
to
minimise
further
damage.
http://www.kennedyterminalulcer.com/
9
References:-
http://www.epuap.org/wp-content/uploads/2012/07/SCALE-Final-Version-2009.pdf
http://npuap.org
http://www.nice.org.uk/guidance/cg179
http://www.stop the pressure.co.uk
Beldon. P. (2011) Managing skin changes at life’s end. Wound Essentials 6: 76-9
Westwood. R.(2014) The principles behind end of life care and the implications for patients skin. Journal
of Community Nursing. Vol. 28. No 3 pgs. 58-64
 Priority Two
Clinical Effectiveness and Patient Experience
Priority Two: The Palliative Care Co-ordination Centre (PCCC) will be used to
recall of equipment from patients’ homes when it is no longer required.

Patients require equipment to support care when they are at home, examples
include mattresses to prevent pressure damage, commodes and hospital type
beds.

When the patient dies this equipment is no longer required and families want the
equipment removed as soon as possible; particularly when the equipment is in the
main living areas.

It is currently the community nurse responsibility to initiate the collection of
equipment.

The Palliative Care Co-ordination Centre is already notified of the death of a
patient and has mechanisms for ensuring a variety of agencies are notified in a
timely manner.
The recall of equipment is now taking place and is fully embedded in working practice.
This is saving time for community nurses and also ensuring that notification of collection
is made at the earliest opportunity.
Feedback from community staff is that it saves them time which can then be used to
support patients and also that families appreciate the swift collections.
The table below details the information about collections for March 2015, with the PCCC
raising 57% of the equipment collections. In April this figure rose to 75%.
10
Equipment Recall Report for March 2015
During the month of March there have been a total of 110 patient deaths. The chart below shows the breakdown of
requisitions the PCCC have raised:Total RIPs for March '15
110
PCCC raised the requisition
for collection
62
Another source raised the
requisition
41
Patient RIP - no equipment
in the home
7
Patient RIP before
equipment delivered
0
57%
37%
6%
0%
Of the 41 requisitions raised by another source, 8 were specifically for 2 day collection
Of the 62 requisitions raised by the PCCC, the outcome is as follows:-
Date
01/03/2015 to
08/03/2015
w/e
15/03/2015
w/e
22/03/2015
w/e
29/03/2015
30/03/2015 to
31/03/2015
Number of
requisitions
the PCCC
raised for
collection
Collected
within 5
days
Post 5
days no
reason
given
Post 5
days
family
request
New date,
Addressee
not home
initially
when
driver
called
28
19
2
4
1
1
11
9
1
0
0
11
6
0
3
4
3
1
8
4
62
ICES
unable
to
contact
service
user
No room on
van collection
rescheduled
Requisition
cancelled
Still waiting
for
collection
notification
from ICES
Total
0
1
0
28
0
0
0
1
11
0
0
0
0
2
11
0
0
0
0
0
0
4
0
0
0
0
0
1
3
8
41
4
7
1
1
0
2
6
62
66%
6%
11%
2%
2%
0%
3%
10%
11
 Priority Three
Patient Experience
Priority Three: St Barnabas will support the Lincolnshire West CCG in
developing a mechanism for gaining feedback from patients and carers who
may find it hard to have their voices heard.

The importance of volunteer input in gaining feedback from patients and carers
was identified during the Real Time Reporting project undertaken in Lincolnshire
in 2012 /13 and led by Help the Hospices, the National End of Life Care
Programme and Marie Curie.

Training will be provided to volunteers before they interview patients and carers
in their own homes, in hospital and in other care settings.

The focus of the volunteers’ work will be on those patients and carers who may
find it hard to have their voice heard in other circumstances, for example they
may have a sensory deficit that makes attending focus groups or completing
paper based or electronic surveys difficult.

The informal, semi-structured interviews will be based on the 11 themes within
the National VOICES survey to elicit key information that will be used to develop
services across the health and social care community that improve clinical
effectiveness and patient and carer experience.
During the year we have recruited and trained 15 volunteers to undertake informal, semi
structured interviews. We worked with ‘experts by experience’, those who understand
because they have had the experience, to develop and deliver the training and how the
semi structured interview would work. The volunteers also provided feedback into the
process and participated in role play exercises before embarking on interviews with
participants.
Significant work has taken place on raising awareness of this project and the work of
our ‘Listening Volunteers’ as they have become known. This involved providing
information to Practice based Public and Patient groups within Lincolnshire West
Clinical Commissioning Group, using social media to contact 130 community groups
and through the St Barnabas ‘Caring Times’ publication to 16,500 people across the
county.
Information has also been provided to local communities through our
volunteers.
We have also promoted the project with our Family Support Service
volunteers, who have subsequently identified participants for the project.
14
The number of participants has been small, this has allowed us to further hone the
process and the information participants have shared with the volunteers has been of a
depth and richness that is not captured within usual survey methods.
The information is then themed in line with the NICE (2004) Guidance on Supportive
and Palliative Care and is then sent to the Quality and Engagement Manager at the
Clinical Commissioning Group (CCG). This information and learning has then been
shared with General Practices within the locality.
The impact of the information has been profound and as a direct result GPs have said
that they will encourage patients and carers to access this project. They have also
identified ways in which they could improve patient experience and these are being
taken forward.
2. 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
During 2014/15 St Barnabas Lincolnshire Hospice supported the Lincolnshire’s four
NHS Clinical Commissioning Group priorities with regard to the provision of local
specialist palliative care by providing the following services:




Hospice at Home
Inpatient Unit
Welfare Benefits
Palliative Care Co-ordination Centre
In addition the Trust has provided the following services through charitable funding:





Day Hospice
Occupational Therapy
Physiotherapy
Lymphoedema
Family Support Services, including bereavement support services
During the reporting period 2014/15 St Barnabas Lincolnshire Hospice provided three
NHS services. St Barnabas Lincolnshire Hospice has reviewed all the data available to
them on the quality of care in all of these NHS services.
The income generated by the NHS services reviewed in 2014/15 represents 54 percent
of the total income generated from the provision of NHS services by St Barnabas
Lincolnshire Hospice for 2014/15.
15
What this means:
St Barnabas Lincolnshire Hospice receives NHS funding, through the National
Community Contract, for the Hospice at Home service and Palliative Care Coordination Centre and partial funding for the Inpatient unit and Welfare services. The
Trust also has a small contract with Lincolnshire County Council for the provision of
community Occupational Therapy services. The remaining income, to support the
delivery of Day Therapy, Occupational and Physiotherapy and the Lymphoedema
service, Family Support Services, including bereavement, is generated through
fundraising, shops and lottery activity and investment income.
2b. Participation in Clinical Audit
 During 2014/15 no national clinical audits or confidential enquiries covered NHS
services provided by St Barnabas Lincolnshire Hospice.
 During that period St Barnabas Lincolnshire Hospice participated in no national
clinical audits and no confidential enquiries as it was not eligible to participate in any.
 The national clinical audits and national confidential enquiries that St Barnabas
Lincolnshire Hospice was eligible to participate in during 2014/15 are as follows:
NONE
 The national clinical audits and national confidential enquiries that St Barnabas
Lincolnshire Hospice participated in during 2014/15 are as follows: Not applicable
 The national clinical audits and national confidential enquiries that St Barnabas
Lincolnshire Hospice participated in and for which data collection was completed
during 2014/15 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 no national clinical audits were reviewed by the provider in 2013/14.
This is because there were no national clinical audits relevant to the work of St
Barnabas Lincolnshire Hospice.
 St Barnabas Lincolnshire Hospice 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.
2c. Research
The number of patients receiving NHS services provided or sub-contracted by
St Barnabas Lincolnshire Hospice in 2014/15 that were recruited during that period to
participate in research approved by a research ethics committee was one patient and
one carer.
16
What this means:
As a provider of specialist palliative care St Barnabas Lincolnshire Hospice is not
eligible to participate in any of the national clinical audits or national confidential
enquiries. This is because none of the 2014/15 audits or enquiries related to
specialist palliative care in settings other than acute care and were therefore not
relevant.
Despite not being eligible we do monitor the work we do, undertaking audits and
patient and carer surveys. The results of our audits and patient and carer surveys
can be found further on in this report.
The Hospice will also not be eligible to take part in any national audit or confidential
enquiry in 2015/16 for the same reason.
What the Hospice has done.
The hospice has made links with the University of Lincoln to further the development
of palliative and end of life care research across both organisations. This work will be
progressed during the coming year.
2d. Use of the CQUIN Payment Framework
A proportion of St Barnabas Lincolnshire Hospice income in 2014/15 was conditional on
achieving quality improvement and innovation goals agreed between St Barnabas
Lincolnshire Hospice 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.
Further details of the agreed goals for 2014/15 CQUIN payments and for the following
12 month period 2015/16 are available electronically at
www.stbarnabashospice.co.uk .
2e. Statement from the Care Quality Commission (CQC)
St Barnabas Lincolnshire Hospice is required to register with the Care Quality
Commission and is currently registered to carry out the regulated activity: Treatment of
disease, disorder or injury.
“St Barnabas Lincolnshire Hospice has the following conditions on registration:

The registered provider must ensure that the regulated activity, ‘treatment for
disorder or injury' is managed by an individual who is registered as a manager in
respect of the activity as carried on at or from a Specialist Palliative Care Unit.”
17
Statement of Reasons
The registration of the provider of this regulated activity is subject to a registered
manager condition under Regulation 5 of the Care Quality Commission (Registration)
Regulations 200.

The Registered Provider must only accommodate a maximum of 11 patients at
Specialist Palliative Care Unit.
Statement of Reasons
We are imposing this condition because your service is set up to accommodate 11
persons. The premises, management or staffing provided at this location are suitable
only for a maximum of 11 persons.

The Registered Provider must not treat persons under 18 years in respect of the
regulated activity 'Treatment for disorder or injury' at or from Specialist Palliative
Care Unit.
Statement of Reasons
We are imposing this condition because your service is set up to accommodate persons
aged 18 years or over. The premises, management or staffing provided at this location
are suitable only for persons aged 18 years or over.
This Regulated Activity may only be carried on at the following locations:
Specialist Palliative Care Unit, 36 Nettleham Road, Lincoln, LN2 1RE
The Care Quality Commission has not taken any enforcement action against St
Barnabas Lincolnshire Hospice during 2014/15.
St Barnabas Lincolnshire Hospice has not participated in any special reviews or
investigations by the Care Quality Commission during 2014/15.
The Care Quality Commission made an unannounced inspection on 10th January 2014.
The report is available on the CQC website www.cqc.org.uk/directory/1-140658893 and
also on the St Barnabas Hospice website www.stbarnabashospice.co.uk.
2f. Data Quality
Statement of relevance of Data Quality and your actions to improve your Data Quality.
St Barnabas Lincolnshire Hospice 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.
18
Why is this?
This is because St Barnabas Lincolnshire Hospice is not eligible to participate in this
scheme. However, in the absence of this we have our own system in place for
monitoring the quality of data and the use of the electronic patient information system,
SystmOne. This is important because, with the patients’ consent, we share data with
other health professionals to support the care of patients in the community.
What have we done?
This year the Trust data analyst has reviewed the inputting of specific information
required for the Minimum Data Set (MDS) to ensure accuracy of information. To
support this we are developing an action plan and audit process.
2g. Information Governance Toolkit Attainment Levels
St Barnabas Lincolnshire Hospice Information Governance Assessment Report score
for 2014/15 was:
Level 0 - 0%;
Level 1 - 0%;
Level 2 - 87%;
Level 3 - 10%;
Not Relevant – 3%
This means that we have attained 100% Level 2 or above compliance, which is the
requirement for any organisation to access the NHS’s network. Organisations are
graded either satisfactory or unsatisfactory.
Assessment
Stage
Version 12
(20142015)
Publishe
d
Level
0
Level
1
Level
2
Level
3
Not
Relevant
Total
Req'ts
Overall Score
0
25
3
1
29
70%
Satisfactory
Fig 4. Table IG Toolkit Assessment Summary Report
Grade Key
Not Satisfactory
Satisfactory with
Improvement Plan
Satisfactory
Not evidenced Attainment Level 2 or above on all requirements (Version 8 or
after)
Not evidenced Attainment Level 2 or above on all requirements but
improvement actions provided (Version 8 or after)
Evidenced Attainment Level 2 or above on all requirements (Version 8 or
after)
19
Fig 5. Breakdown of Attainment Level for IG Toolkit Version 11
What this means.
Organisations are graded either satisfactory or unsatisfactory.
St Barnabas Trust was graded as ‘satisfactory’ and meets all of the Connecting for
Health standards. This provides patients with the confidence that their information is
being dealt with safely.
2h. Clinical Coding Error Rate
St Barnabas Lincolnshire Hospice was not subject to the Payment by Results clinical
coding audit during 2014/15 by the Audit Commission. This is because St Barnabas
Hospice receives payment under a block contract and not through tariff and therefore
clinical coding is not relevant.
20
Part 3: Review of Quality Performance
The National Council for Palliative Care (NCPC): Minimum Data Sets (MDS)
We have chosen to present information from the NCPC minimum data set which is the
only information collected nationally on hospice activity. The figures below provide
information on the activity and outcomes of care for patients.
Hospice Inpatient Unit
St Barnabas Lincolnshire Hospice
Specialist Inpatient Unit Services
2011/12
Total number of
183
patients
% New patients
92%
% Re-referred patients
3%
% Admissions from
69%
patient’s own home
% Admission from
30%
acute hospital
% Occupancy
83%
% Patients discharged
45%
to their home
Average length of stay
17 days
– cancer
Average length of stay
–
13 days
non-cancer
2012/13
2013/14
2014/15
190
183
162
93%
5%
93%
4%
97%
0%
60%
56%
63%
36%
44%
36%
74%
81%
83%
41%
30%
39%
15 days
17 days
18 days
24 days
12 days
22 days
“Your care and love for my husband was a great comfort to me”
“I would like to thank you for your loving kindness you have given me during my
stay”
“All the care I received was first class, given by extremely dedicated and caring
staff and volunteers”
“Food was 5 star, the team in the hospice kitchen do an awesome job. Quality,
choice, imaginative tempting food. Nothing was too much trouble. Cannot praise
any higher. Amazing thank you xxx”
“The team at all levels e.g. Consultants, Doctors, Nurses etc. treated me with the
upmost respect and were not in a rush to get to another patient. Equally, the
kitchen team and volunteers were always trying to meet your every need”
21
Specialist Palliative Care Outpatients
Specialist Palliative Care Outpatients
2011/12
Total number of patients
239
% New patients
90%
% Re-referred patients
0
% Continuing patients
10%
2012/13
348
91%
1%
9%
2013/14
314
90%
0.3%
10%
2014/15
319
100%
0%
0%
In 2013/14 the hospital support increased with the three consultants and the data now
sits within the Hospital Support section below.
Specialist Palliative Care Hospital Support
2011/12
2012/13
Total number of patients
% New patients
% Re-referred patients
% Continuing patients
2013/14
317
100%
0%
0%
2014/15
362
93%
0%
7%
Day Therapy
Day Hospice
Total number of patients
% New patients
% Re-referred patients
% of places booked but
not used
Average length of care
2011/12
625
67%
2.5%
2012/13
944
63%
5%
2013/14
1736
60%
4%
2014/15
1802
60%
5%
30%
8%
11%
3.6%
218 days
131 days
132 days
159 days
“‘A big thank you for your wonderful care and kindness shown to xxx over the
last few years”
“The staff and the building are excellent as are your volunteer helpers”
“Everyone was supportive & friendly. Thank you”
“It has been wonderful, so helpful and kind. We have been fortunate to
have found you”
22
Complementary Therapy
“Thank you very much for all the time you gave me to help select a wig”
“Wonderful on the day of the reflexology but it is a long standing problem I have.
Every little helps thank you….”
“This is an amazing service that helps in so many ways. I really look
forward to my sessions. Wonderful people using their skills for so much
good”
Hospice at Home
Hospice at Home
2011/12
2012/13
Total number of
patients
2013/14
2014/15
1545
1640
1851
1718
% New patients
% Re-referred patients
% of patients who died
at home
% of patients who died
in acute hospital
85%
5.5%
85%
5.2%
85%
7%
89%
7%
79%
79%
86%
80%
9%
9%
7%
6%
Average length of care
40 days
43 days
44 days
40 days
“Your daily visits were the highlight of our day”
‘‘You showed such love, care and attention, he felt very safe in your hands”
“‘We appreciate all that you have done for us, you are very special people.”
“Your gentleness, fun, laughter and listening ears were so appreciated, we
couldn’t have walked this journey with mum without all of you”
Welfare Benefits Service
Welfare Benefits Service
2011/12
2012/13
2013/14
2014/15
Total Clients
2837
3212
3667
3754
New Clients
1979
1842
1960
1864
Re-referred Clients
588
1370
1707
1890
£5,426,965.68
£6,483,581.68
£6,956,128
£7,111,426
Total money claimed
on behalf of clients
23
“Thank you for all your help, you treated me with care and respect which bought
a tear to my eyes. No one has been this kind and helpful to in the past and XXX
staff members name managed to do more in a day and half than he has managed
in a year.”
“I want to thank you for helping me with my claim for Attendance Allowance. This
time I have been awarded the higher rate for an indefinite period so thank you
again”.
“I wanted to thank all in the Welfare team for the support and advice that has
been ongoing to both my daughter for the last year and me over the past 3
months. I would not have coped with all the bureaucracy without your input.”
“Thank you for your assistance with my Attendance Allowance and Disabled
Parking forms. I have now received both thank you again”.
Monetary Gain
April 2012 - March 2013
April 2013 - March 2014
April 2014 - March 2015
Total Number Of
Patient Referrals
Total Annual Cash
Gained
Average Per Patient
3212
3667
3754
£6,483,581
£6,956,128
£7,111,426
£2,018.55
£1,896.95
£1,894.36
The number of patients benefitting from the welfare service continues to increase year
on year, with a 2.5% increase. The average income for patients has reduced very
slightly again this year as a result of changes to benefits.
Family Support Service
Our Family Support and Bereavement Service also receives many positive comments:
“Just a note of sincere thanks to you all for all your kindness and loving support
given to me at your Monday afternoon meetings”
“Please extend my best wishes to the team looking after me, and to all those who
attend the group”
‘I want to thank you all for being so kind during a very sad time for me…”
24
Quality Markers We Have Chosen To Measure
In addition to the limited number of suitable quality measures in the national data set for
palliative care, we have chosen to measure our performance against the following:
INDICATOR
2011/12
2012/13
Complaints
2013/14
2014/15
Total number of complaints
(clinical)
6
7
9
4
The number of complaints upheld
in full
1
2
3
0
The number of complaints upheld
in part
2
5
1
1
The number of complaints not
upheld
3
0
5
3
One partially upheld complaint related to:

This complaint related to multi agency concerns including St Barnabas Hospice.
The learning for the Trust is to strengthen documentation to ensure teams’ record
complete information to enable effective communication within internal and
external teams.
INDICATOR
2011/12 2012/13
Patient Safety Incidents
2013/14
2014/15
The number of serious patient safety
incidents (excluding falls)
1
0
0
0
The number of patient falls
(IPU/Community/Day Therapy)
37
35
32
23
The number of patients who
experienced a fracture or other serious
injury as a result of a fall.
0
0
0
0
Number of patients admitted to the
Inpatient Unit with pressure damage
36
42
55
37
Number of patients who developed
pressure damage whilst in the Inpatient
Unit
39
43
41
50
25
INDICATOR
2011/12
Patient Safety
2012/13
2013/14
2014/15
Number of patients, clients and families
referred to Family Support Services
because of safeguarding issues
11
16
38
34
The number of patients know to be
infected with MRSA on admission to the
Inpatient Unit
1
0
1
0
The number of patients infected with
MRSA whilst on the Inpatient Unit
1
0
0
0
The number of patients with MRSA
bacteraemia
0
0
0
0
The number of patients admitted to the
Inpatient Unit with C. difficile
1
0
0
0
The number of patients infected with C.
difficile whilst in the Inpatient Unit
0
0
0
0
The number of patients known to be
infected with an alert organism for
example, Staph aureus, Pseudomonas
aeruginosa, ESBL, Klebsiella, and
Streptococcus pneumoniae on
admission
10
6
3
4
The number of patients who contracted
any of these infections whilst in the
Inpatient Unit
1
4
3
4
26
Clinical Audit
The Trust considers clinical audit to be an important activity for reviewing processes and
procedures and for supporting the continuous quality improvement of our services. The
Trust Audit Officer is supported by three audit volunteers who assist with selected audits
and make an invaluable contribution to the audit work. They all have different skills
which are utilised to maximum effect and their contribution to the audit work is greatly
appreciated.
The Audit and Research Group continues to thrive and provides advice to staff
regarding audit activity throughout the Trust. Below are 2 of the many projects which
are in progress:
St Barnabas continues to participate in the Patient-led Assessments of the Care
Environment (PLACE) which are used to measure the quality of the environment in
which patients are cared for. This year we are delighted that a patient and a member of
the Patient and Public Experience Group agreed to form part of the assessment team
for the Inpatient Unit, together with a bereaved relative and a St Barnabas Trustee. In
addition to the Inpatient Unit, the PLACE assessments have been extended to include 3
day therapy bases - the first one being Louth. Once again, a patient was part of the
assessment team. This input is much appreciated, providing a different perspective that
is helpful to the Trust to ensure that the environment promotes optimum care.
Patient feedback within the Hospice at Home service is being gathered using real-time
reporting. Patients are given the opportunity to complete a survey following four visits
from the Hospice at Home team. Patients can choose to complete the survey either on
paper or electronically. Although anonymous, the responses are reviewed by the Audit
Officer, as they are received, and learning is shared with teams. As the name suggests
the real-time nature of the survey assures that improvements can be implemented,
where necessary, at the point of care.
Re-audit is an important element of the audit cycle, and audits which identify areas
requiring review are performed for a second time following development and
implementation of an action plan.
The audit schedule for 2015-16 is being developed, with audits from various teams
across the Trust being planned.
27
Medicines Managements Audits
(including controlled drugs which are now completed six monthly as a requirement by
the Local Intelligent Network Group)
Audit
Controlled
Drugs
(Selected
elements from
audit tool)
Controlled
Drugs
(Selected
elements from
audit tool)
Completed
Action
Plan
Actions to be taken
to improve practice

June
2014
Yes
October
2014
Yes




Controlled
Drugs
(Selected
elements from
audit tool)

March
2015
Yes



Discharge
TTO Snapshot
re-audit
(medicines to
take home)

May
2014
Yes
Strengthen documentation in
relation to policy standards
Separation of high and low
strength opiates to minimise
risk
Strengthen receipting
documentation
Ensure patient information
leaflets available in all To
Take Out drugs packs
Review transfer process to a
new CD register as current
process is lengthy
Strengthen completion of
nursing documentation of
controlled drugs bought into
the unit to facilitate audit trail
Electronic TTO form requires
additional column to detail
amount of drugs dispensed
from pharmacy
Update policy to strengthen
management of controlled
drugs on patient transfers
Confirm separation of high
and low strength opiates to
minimise risk
Inconsistencies remain within
the documentation. Plan to
implement electronic form as
a priority
28
Action Plan
Status
Complete
Complete
In process
Complete
Audit
Completed
Action
Plan
Yes
(community)
May
2014
Blood
transfusion
electronic
documentation
June
2014
Yes

Syringe Driver
Documentation



Anticoagulation
(Snapshot reaudit)
June
2014
Yes

Cost of opioids
within the
Inpatient unit
General
Medicines

July
2014
N/A
Nov
2014
Yes




Management
of Blood
Transfusions
Low Molecular
Weight
Heparin
(LMWH)
November
2014
February
2015
Yes
Yes
Actions to be taken
to improve practice
Action Plan
Status
To revise syringe driver
monitoring form
Plan for re-audit June 2015
Complete
Strengthen recording of
symptomatic benefit of
transfusions, consent and
post transfusion haemoglobin
Update of anticoagulation
assessment form to ensure
capture of anticoagulation
history
To strengthen review of
requirement for post
admission anticoagulation
Review of drug costs.
Sustained decrease in costs
Replace anaphylaxis box
Review management of
electronic TTO sheets
Clarify procedure for
cancellation of medicines on a
prescription
Review of self-administration
of medicines policy and
patient group directions
Transfusion practice confirmed as
robust

Strengthen paper and
electronic documentation

No patients continued on
LMWH if a contraindication
existed but staff to be
reminded to complete
assessment sheets
29
Complete
Complete
N/A
All actions
completed
other than
review of
policy which
will be
completed
by
September
15
Complete
In process
Audit
Blood
transfusion
electronic
documentation
re-audit
Completed
Action
Plan
March
2015
Yes
Actions to be taken
to improve practice

Implementation of specific
blood transfusion prescription
to include all key information
in one place
Action Plan
Status
In process
Additional Audits
Audit
Patient led
Assessment of
the care
environment
(PLACE)
Inpatient Unit
Completed
Action
Plan
April
2014
Yes
Actions to be taken
to improve practice





Service
evaluation of
discharge
letters
April
2014
Diversity of
referral PCCC
June
2014
Hazard Alerts
July
2014
Yes

N/A
Review general signage and
labelling of equipment within
the building and ensure that
these comply with dementia
friendly standards
Review availability of lockable
storage facilities for patients
personal possessions
Improve communication
between volunteers and care
staff at meal times to ensure
assistance is provided as
required
Provide time for assessors to
see the paperwork before the
assessment
Reduce content of letters so
that essential information only
is sent to GPs
Improve timeliness of sending
out letters

No significant issues noted

Revise referencing of Medical
Device Alerts updates
Ensure documentation of
follow up of all actions
Yes

30
Action Plan
Status
Complete
Complete
N/A
Complete
Patient falls
Inpatient Unit
Phase 1

July
2014
Yes


Audit
Do Not
Attempt
CardioPulmonary
Resuscitation
(DNACPR)
Completed
Action
Plan
Actions to be taken
to improve practice

July
2014
Yes

Documentation
(Snapshot)
SystmOne
recording by
nursing staff
/Allied Health
Professional’s
within the
Inpatient Unit
(pilot)
Patient led
assessment of
the care
environment
(PLACE)
Assessment
re-audit IPU
Identification and
management of
Inpatient Unit
patients with
delirium
Phase 1:
Identification of
cognitively
impaired patients
with a possible
diagnosis of
delirium

August
2014
October
2014
November
2014
Strengthen documentation
regarding a patient fall.
Introduction of fall standards
to support falls management
Review of staffing levels on
night duty
Re-audit in planning stage
N/A as
pilot
audit
Yes
N/A

Medical team to be reminded
to complete all sections of the
form on discharge
Review of the DNACPR form
to reflect legal rulings from
recent court cases regarding
discussions with patients
when completing the
documentation
Discuss pilot audit with Teams
before taking forward to all the
bases
Clinical Governance Nurse
and Trust Audit Officer to
support teams when and as
required.
Improvement demonstrated from
the previous assessment
conducted in April 2014
 Completion of improvement
to the Unit regarding dementia
friendly standards
 Additional items of food to be
added to the menu
 Not applicable as Phase 1 was
to identify numbers of patients
only.
31
Phase 1
complete
Phase 2 in
process
Action Plan
Status
Completed
In process –
DNACPR
form
remains
under review
through a
county-wide
health group
N/A
Completed
Phase 2 will
identify how
many
patients from
phase 1
meet the
diagnostic
criteria of
delirium.

Patient
prognosis
admitted to the
Inpatient unit
November
2014
Yes
Audit
Completed
Action
Plan
Evidence of
Whole family
approach to
hospice care
in relation to
Children
Management
of Hazard
Alerts
Actions to be taken
to improve practice

December
2014
Yes


January
2015
Yes

Patient led
assessment of
the care
environment
(PLACE)
Inpatient unit
March
2015
Patient led
assessment of
the care
environment
(PLACE)
Louth Day
Therapy
March
2015
Yes



Yes
Not applicable as the audit
demonstrated that the fast
track scheme is being used
appropriately for St Barnabas
Hospice patients within the
Inpatient unit



Develop a template within the
electronic notes to accurately
record and retrieve details of
young families
Additional training for all staff
who record patient and family
details
Addition of the role and
responsibilities of the recently
appointed Medical Device
Safety Officer to the Hazard
Alert Policy
Dialogue with the Central
Alerting System to ensure that
all appropriate alerts are
received by St Barnabas
Completeddisseminatio
n of results
to key staff
was the only
action
required
Action Plan
Status
Action plan
is in
progress
Action plan
is nearing
completion
Review of outdoor signage
Continued implementation of
dementia friendly standards
including consistency of
signage
Review range of equipment
available for patient use
Action plan
has been
developed
and is in
progress
Implementation of dementia
friendly standards as
appropriate
Review of outside signage
Review of equipment
available for patient use
Action plan
is in process
of being
developed
32
Audit
Isolation
precautions
Inpatient Unit
Infection
Prevention
performed by
CCG (IPU)
Decontamination
of equipment
Infection Prevention and Control Audits
Completed
Action
Actions to be taken to improve
Plan
practice
April
2014
No
Practice confirmed to be in
adherence with policy
Action
Plan
Status
N/A
Reported as a very positive visit
June
2014
No
N/A
No

Yes
Practice confirmed to be in
adherence with policy
 To update barrier nursing
leaflet
June
2014
Isolation
precautions
Inpatient Unit
Audit
Completed
Cleanliness and
tidiness audits
Trust wide
Hygiene Code
Ongoing
programme
Hand Hygiene
Ongoing
Trust wide
2014
Reminder to staff regarding
single use symbol.
Action
Plan
Yes
November Yes
2014
No
Actions to be taken
to improve practice
NA
Complete
Action Plan
Status

Site specific minor working
issues e.g. lime scale on some Complete
taps
 Good evidence of sustained
compliance with the Hygiene In process
Code.
Key issues from action plan: Update and strengthen some
key policies.
 Implement infection prevention
strategy for 2015-2018

No specific issues identified
33
N/A
Patient and Relative Surveys
Audit
Completed
Patient Nutritional
Surveys-Inpatient
Unit (snapshot)
Complementary
Therapy Service
Patient
Evaluation
Survey
January
2015
April
2015
Action
Plan
N/A
Actions to be taken to improve practice

No

formal
action
plan
Patient Survey
(Inpatient Unit)
April 2014 to
March 2015
April
2015
Yes
Relatives Survey
(Inpatient Unit)
April 2014 to
March 2015
April
2015
Yes
Action
Plan
Status
Continue to monitor patient
satisfaction with the food and drink
provided via the patient surveys
N/A
Complementary Therapy Lead to
continue to monitor the responses
on receipt.
N/A

Responses and actions compiled
by the IPU Ward Manager and
added to survey reports.

Responses and actions compiled
by the IPU Ward Manager and
added to survey reports.
34
Issues
address
ed as
they
arise
Issues
address
ed as
they
arise
Feedback from Patients and Families on Services
We value the feedback we receive from patients and families as this is an important way
in which staff can identify and resolve problems and improve the quality of the care we
provide. We are always looking for new ways to receive feedback.
Friends and Family Test
As part of a national programme hospitals, community services and some hospice units
have asked patients if they would recommend the service they provide to their friends
and family. This gives us a Net Promoter (NP) score.
All of the patients we asked said they would recommend our service to their
friends and family.
The table below shows the results we achieved each month throughout the year.
Inpatient Unit
Data
Inpatient
Discharges
Responses <48hrs
Promoters
Passive
Detractors
NP Score
Sample Size
Data
Inpatient
Discharges
Responses <48hrs
Promoters
Passive
Detractors
NP Score
Sample Size
Apr 14
May 14
June 14
July 14
Aug 14
Sept 14
8
8
8
8
7
3
7
7
0
0
100%
87.5%
7
7
0
0
100%
87.5%
7
7
0
0
100%
87.5%
6
6
0
0
100%
75%
4
4
0
0
100%
57%
3
3
0
0
100%
100%
Oct 14
Nov 14
Dec 14
5
6
5
Jan 15
5
Feb 15
3
Mar 15
6
4
4
0
0
100
80%
6
6
0
0
100
100%
3
3
0
0
100
60%
5
5
0
0
100
100%
3
3
0
0
100
100%
6
6
0
0
100
100%
Apr 14
20
10
10
0
0
100
50%
May 14
33
4
4
0
0
100
12%
June 14
40
7
7
0
0
100
17.5%
July 14
59
18
16
2
0
89
30.5%
Aug 14
63
16
16
0
0
100
25%
Sept 14
35
9
9
0
0
100
25.7%
Day Therapy
Data
Discharges
Responses <48hrs
Promoters
Passive
Detractors
NP Score
Sample Size
35
Day Therapy Continued
Data
Discharges
Responses <48hrs
Promoters
Passive
Detractors
NP Score
Sample Size
Oct 14
11
4
4
0
0
100
36.4%
Nov 14
17
10
10
0
0
100
58.8%
Dec 14
17
7
7
0
0
100
41.2%
Jan 15
15
7
7
0
0
100
46.7%
Feb 15
Mar 15
15
8
5
3
0
62
53.3%
42
24
23
1
0
96
57.1%
Staff Friends and Family Test
This asks staff how likely they would be to recommend the service they work in to
friends and family. It is measured annually. In the last staff survey, June 2014. 96% of
staff said they would recommend the service. This compared with 94% the previous
year.
It’s the small things …
We continue to receive comments through the “It’s the small things that make a
difference” postcards. We provide them with a postcard which they can send back to
us, identifying the small things that have made a difference to them. This is another
means by which patients, clients, carers and families can feedback to us.
Below is a selection of comments about the ‘small things’ that made a difference to our
patients during the last year.
‘In our hour of
need you did your
good deed’
‘Walking
through our
door’
‘Had the time to
talk, reassure and
comfort through
the hardest times’
‘You were there.
Not a small thing
but a massive
relief to us all’
‘My wife looked forward
to the nurses coming,
and also helped me to
cope with her illness’
‘The loving care
and attention they
paid xxx, they
were all fantastic
& kind to me’
‘Words cannot
express how
grateful we are
for everything
you have
done’
36
‘Respectful,
caring &
honest.
Supported all
the family’
The Patient Survey
The Patient survey from April 2014 to March 2015 had a response rate of 48%
(32 patients in total).
We asked patients about their care and treatment. Please see below a selection of
questions from the survey based on the Care Quality Commission Essential Standards
of Quality and Safety. The questions are regularly reviewed to ensure optimum clarity
for the patients completing the survey. The completed surveys contained the following
responses:
Were you given enough privacy and dignity when discussing your
condition/treatment?

29 patients (91%) said ‘yes always’ - 3 patients said ‘yes sometimes’
Was your independence respected?

28 patients (88%) said ‘yes always’ - 1 patient said ‘no’
Did you feel that the staff involved in your care communicated with each other to
meet your needs?

29 patients (91%) said ‘yes always’ - 1 patient said ‘no’
Did you feel that the care, treatment and support were delivered in a safe and
effective manner by members of the healthcare team?

30 patients (94%) said ‘yes always’ - 1 patient said ‘no’
Were you asked about what type of food and drink you preferred or if you had any
special requirements?

27 patients (84%) said ‘yes’ - 2 patients said ‘not applicable’
How clean was the Hospice?

31 patients (97%) said ‘good’
When you had important questions to ask a doctor or a nurse, did you get
answers that you could understand?

30 patients (94%) said ‘yes’ or ‘yes sometimes’
37
We also asked what could be done to develop our inpatient service. Please see
below a selection of comments from patients:
(Comments are direct quotes as they appear in the surveys)
‘After coming to the Hospice & meeting the staff & doctors it put my mind at rest for any future
visits or admission. Everyone was kind & helpful’
‘99.9% Good experience’
‘I think the shower seat requires modification so that it drains. I finished my shower in a pool of
water. An observation not a complaint’
‘I find it difficult to offer any suggestions to improve your already outstanding service. A truly
amazing group of caring and sensitive staff. Thank you for all your help’
‘Just continue the wonderful inpatient service- can continue now, for a while in comfort with pain
and medication under control. Thank you’
‘The staff were amazing & would not want to be treated by anyone else’
‘I cannot praise the service & the staff highly enough!’
‘The Hospice was well run and my stay was a positive experience. I feel very grateful to all staff
& management & volunteers’
‘For bedbound or very limited mobility patients the use of the new 4 way slide sheet was
extremely beneficial. Far less manhandling so greater patient comfort & much less stretching &
straining for staff’
The Relatives’ Survey
The Relatives’ Survey from April 2014 to March 2015 had a response rate of 64% (50
relatives in total)
When asked what could be done to develop our services, relatives said:
(Comments are direct quotes as they appear in the surveys)
‘I cannot thank everyone enough for all your help, support and kindness received during my
relatives stay in the hospice. I would suggest perhaps, if possible, somewhere to keep a patient
after death especially during bank holidays’
‘My daughter wanted to stay at home to die, but she asked to go back to the Hospice at the end.
I was able to stay with her all the time. We were all with her when she passed away which was
a comfort to us all. Thank you all very much’
‘I have no negative comments to make. There are only positives to come out of a very sad time.
I would not hesitate to recommend your facility or staff both in the Hospice and at home.
Everything about your organisation is excellent. Thank you’
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‘I think and know you gave my dad the best care anyone could give. All the family just
wished he went there earlier than being moved about at the county hospital where they
don’t cater for that sort of care my DAD needed. We think you do a great job and so
glad there is a place like the hospice you run. We need this. All your staff are like
angels’
‘The staff made us feel very welcome always. I ate there one evening which really
helped. The only thing which sometimes was really hard was parking! I know you only
have a small car park and can’t do much about this’
‘I attend the Hospice Bereavement Support Group, and I am finding it most helpful’
‘Thank you to all the staff’
‘The Hospice staff gave myself and family amazing support, which made a difficult time
a lot easier to deal with and I cannot thank them enough for the care my husband
received’
‘Some questions/answer choices need to be changed for patients in the latter stages of
their illness’
‘Whereas the staff were aware of the fact I was with my brother the whole time, this
information was not passed on once my brother passed away and I feel it important on
future occasions that this situation is taken on board when the person present is not
next of kin’
‘Thank you to everyone at the Hospice, you have helped us enormously at a difficult
time’
‘Treatment & care excellent to both my sister & myself & family. Perhaps MacMillan
Nurses could cover any gaps for stretched night staff to be with patients unable to call
for help e.g. pain relief’
‘My husband was extremely well looked after by all the staff and volunteers and I will
always be grateful for the care he received and the support myself and my children
received’
‘Everyone was exceptionally kind & caring to my husband, myself & family. I will always
be truly grateful for this’
Copies of the full surveys
www.stbarnabashospice.co.uk
are
available
39
on
the
Trust’s
website
Statement of Directors’ Responsibilities in Respect of the Quality
Account
The directors are required under the Health Act 2009 to prepare a Quality Account for
each financial year. The Department of Health has issued guidance on the form and
content of annual Quality Accounts (which incorporates the legal requirements in the
Health Act 2009 and the National Health Service (Quality Accounts) Regulations 2010
(as amended by the National Health Service (Quality Accounts) Amendment
Regulations 2011).
In preparing the Quality Account, directors are required to take steps to satisfy
themselves that:

the Quality Account presents a balanced picture of the Trust’s performance over the
period covered;

the performance information reported in the Quality Account is reliable and
accurate;

there are proper internal controls over the collection and reporting of the measures
of performance included in the Quality Account, and these controls are subject to
review to confirm that they are working effectively in practice:

the data underpinning the measures of performance reported in the Quality Account
is robust and reliable, conforms to specified data quality standards and prescribed
definitions, and is subject to appropriate scrutiny and review; and

the Quality Account has been prepared in accordance with Department of Health
guidance.
The directors confirm to the best of their knowledge and belief they have complied with
the above requirements in preparing the Quality Account.
By order of the Board
Chairman of Trustees
Chief Executive
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Statement - St Barnabas Lincolnshire Hospice
Quality Report for 2014/15
This statement has been prepared on behalf of Healthwatch Lincolnshire and we are
pleased to have been asked by St Barnabas Lincolnshire Hospice to make a
contribution to their Quality Report.
Priorities for 2015/16
Healthwatch Lincolnshire support the three priorities for 2015/16. The priorities are very
relevant to the needs of the patient, families and providers and we hope will result in
real tangible improvement for quality of care. We feel the introduction of cognitive
behaviour therapy (CBT) has great potential and welcome the very sensitively
developed priority around patients with learning disabilities. From the quality account
we have no reason to believe there are any gaps within the priorities for this forthcoming
year and are assured that patient engagement has supported the priority development.
Priorities for 2014/15
We acknowledge the work and progress made with priorities for 2014/15 and would
hope that work will continue to regularly review and maintain the standards achieved in
2014/15.
We note and welcome the pathway that has been developed around pressure damage,
however, would welcome a more detailed understanding of what the timescales are for
ULHT to give final approval for this 2014/15 priority.
The recall of equipment has clear benefits to all and it is encouraging to see how this
priority has developed and improved; priority 3 and in line with the Healthwatch function,
we are delighted to read the work with patients and carers has had impact and would
have liked to have seen within the report what way those impacts had been acted upon.
It was excellent to see the patient and carer comments and further development of
those statements will add depth to the achievements in future reports.
Healthwatch Lincolnshire felt that within the statement relating to funding sources and
services provided, it would be helpful to see figuratively the total funding from NHS
sources and how much of the individual services are supported in this way.
Overall, Healthwatch Lincolnshire felt that this was a well presented and easy to
understand report which provides clear indicators going forward. We hope these will
further develop the services provided to patient, family and staff alike.
Healthwatch Lincolnshire look forward to continuing engagement with St Barnabas and
its continued improvement in the services provided to patients.
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Statement on St Barnabas'
Quality Account for 2014/15
HEALTH SCRUTINY COMMITTEE
FOR LINCOLNSHIRE
This statement has been prepared by the Health Scrutiny Committee for Lincolnshire.
Priorities for 2014/15
We welcome the progress by St Barnabas Hospice with its three improvement priorities
for 2014/15. In relation to Priority One (Development of a Specific Pressure Damage
Prevention Pathway), we support the pro-active work undertaken in this area and we
also welcome the involvement of Marie Curie Cancer Care and other partners in the
development of the pathway. We recognise that there are challenges in treating
terminally ill patients, balancing the need to move patients to help prevent pressure
ulcers and keeping them in a comfortable position.
We are pleased that Priority Two (The Recall of Equipment from Patients' Homes by the
Palliative Care Co-ordination Team) has been fully embedded into working practices.
This will be of benefit to patients, as equipment can be reused.
Priority Three (Developing a Patient Feedback Mechanism) has led to some 'profound'
feedback, which is making the Trust believe that there are ways that the patient
experience can be improved.
Priorities for 2015/16
We support St Barnabas' three priorities for 2015/16 and make the following comment
on each:



Priority One (Cognitive Behavioural Therapy Training for Hospice Nursing Staff)
recognises the emotional distress that patients can often suffer and is strongly
supported. We believe that Cognitive Behavioural Therapy will be helpful to many
patients.
One of the outcomes of Priority Two (Advance Care Planning in Other Settings) will
be reduction in inappropriate admissions to hospital. This is strongly supported, as it
will help to reduce the stress and anxiety experienced by patients.
Priority Three (Developing a Resource Pack to Support the Care of Patients with
Learning Disabilities) is strongly supported, as people with learning disabilities are
often overlooked.
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Achievements During 2014/15
We would like to highlight the opening of the Hospice in a Hospital at Grantham and
District Hospital, as a significant achievement by St Barnabas. The Hospice in a
Hospital remains the only one of its kind in England, and is already benefiting patients
by its location within a hospital setting.
We also note the high scores achieved by St Barnabas in the Friends and Family Test,
in particular those scores from inpatients.
Engagement with the Health Scrutiny Committee for Lincolnshire
The Health Scrutiny Committee looks forward to engaging with St Barnabas Hospice at
its Committee meetings in the coming year. The Committee recognises the contribution
of the Hospice to innovation in the areas of palliative care.
Presentation and Accessibility of Information to the Public
We believe that the information in the Quality Account is clear and accessible to
members of the public.
Conclusion
We would like to congratulate St Barnabas Hospice on its achievements over the last
year, in particular the opening of the Hospice in a Hospital at Grantham and District
Hospital. This is an innovative approach to palliative care and St Barnabas should be
recognised and commended for this.
43
Statement - St Barnabas Lincolnshire Hospice
Quality Report for 2014/15
NHS Lincolnshire West Clinical Commissioning Group (LWCCG) welcomes the
opportunity to review and comment on the St Barnabas Lincolnshire Hospice Annual
Quality Accounts 2014/15.
The key Quality priorities for the coming are clearly articulated and these are supported
by LWCCG as very important areas of focus. It is well outlined within the account as to
how and why these priorities were identified for action. The CCG looks forward to
implementation of these actions to improve palliative and end of life care for the people
of Lincolnshire, particularly this year for Learning Disability patients.
The Hospice has worked hard this year to achieve the 2014/15 Quality priorities and it is
pleasing to read the progress with the Pressure Ulcer pathway, utilisation of the
Palliative Care Centre for equipment recall and the feedback initiative for patients and
carers. The latter particularly has been in partnership with the CCG, and we are thankful
for the opportunity to work together in this important area. Other organisations are now
seeing the benefit of this work and will be adopting a similar approach to patient and
carer opinion surveys in the coming year.
The extent of local audit undertaken to improve the Quality of care is impressive. The
numerous positive testimonials by patients clearly demonstrate the Hospices success in
delivering care quality and the continued pursuit of ongoing Quality improvements.
Feedback through the CCG’s Patient Experience Committee has highlighted that
patients and the public are not always well sighted on the expanse of work that the
Hospice undertakes. Recent visits by Hospice staff to General Practice Patient
Participation Groups to highlight the Hospice’s work have been well received for this
purpose. The CCG suggests these visits and similar continue throughout the coming
years to continue to improve public understanding of all the good work taking place
every day, delivered by the staff of St Barnabas.
The commissioner can confirm that to the best of our knowledge the report is a true and
accurate reflection of the quality of care delivered by St Barnabas Hospice and the
information contained in the report is accurate.
Wendy Martin
Executive Lead Nurse/Midwife & Quality
Lincolnshire West Clinical Commissioning Group
44