Quality Account 2014—2015
Welcome to our Quality Account for 2014 – 5.
At St Oswald’s, we have built our reputa on around the first class quality care we provide to North East adults, children
and young people. We are able to fundraise amongst the local community and raise the income we need to sustain
services, thanks to the tes monies of those who have benefi$ed from our care and become our advocates.
We have a range of mechanisms in place to ensure we con nue to provide a quality service. We are monitored and
regulated by the Care Quality Commission (CQC) and at last inspec on (December 2013) we were compliant in all
outcomes and no recommenda ons for improvement were made.
Internally, pa ent experience is measured by ques onnaires, face to face interviews, focus groups and submissions to
our ‘feedback bank’. Our feedback bank serves as a central store for all pa ent experience data, as well as comments,
complaints, compliments and sugges ons from stakeholders. The responses are collated, analysed and then reported in
to our ‘Clinical Quality Group’ for ac on where necessary.
Our Clinical Quality Group is tasked with reviewing all issues rela ng to pa ent experience and providing a quality
service. They take forward any ac on that needed to be taken and update our Compliance Register accordingly. Regular
updates are provided to Trustees via our Clinical Quality & Governance Commi$ee and Council.
This year, we’ve implemented the NHS’ Friends and Family Test to all pa ent and staff surveys. The test involves asking
pa ents or staff if they would recommend St Oswald’s as a care provider and/or an employer. Results are now reported
to our Council of Trustees, as part of our Balanced Scorecard and provide an addi onal quality assurance tool.
Further, we’ve also implemented ‘Care Rounding’, to ensure inpa ents’ needs are being assessed and met on a very
regular basis, throughout the day and to provide a direct feedback mechanism.
Lastly, in the coming year we’re looking to introduce a suite of pa ent outcome measures, using the Outcome
Assessment and Complexity Collabora ve tool (OACC). OACC seeks to improve services and outcomes for pa ents receiving pallia ve care and their families, by measuring elements of rou ne clinical care.
In summary, our commitment to providing quality care across all our services –remains absolute. It is at the core of our
ethos. We couldn’t provide our specialist services without the skill, exper se, experience and dedica on of our staff and
volunteers. It is a huge team effort at St Oswald’s, with over 280 staff and 1400 volunteers, working in direct pa ent
care roles, in support or within an income genera on capacity. We are hugely grateful for their contribu on – they
make St Oswald’s the very special place it is.
James Ellam, Chief Executive
Who we are
St Oswald’s Hospice provides specialist pallia ve care to local adults, young people and
children with life limi ng condi ons from across the North East of England.
Established in 1986, we have gained a local, na onal and interna onal reputa on for
providing first class quality care to local people.
As a charity, our vision is to provide excellence in care for those with life limi ng condions. We do this by caring, campaigning and educa ng.
Our services
We are experts in pain and symptom management and end of life care.
We follow a team approach – including consultants, doctors, nurses, social workers,
chaplaincy, physiotherapists, occupa onal therapists and complementary therapists.
We offer a range of adult services including an inpa ent unit, day hospice, outpa ent
services, lymphoedema management and outreach.
We look aAer people with a range of condi ons, not just cancer. For example,
Motor Neurone Disease, Mul ple Sclerosis and advanced respiratory, neurological or
cardiac condi ons.
We also care for children and young adults with progressive, life shortening
condi ons. We provide specialist short breaks and also offer end of life care.
Our ethos
We value each pa ent as an individual and put their quality of life
first.
We put the pa ent and child at the centre of everything we do.
We follow a holis c approach that aims to address not just the
physical needs of our pa ents, but their spiritual and emo onal
needs too.
We also understand the impact an illness has on the whole family
and offer support for carers too.
“Would you pass on my thanks
to all the Staff at St Oswald’s? I
was privileged to be there last
night when a good friend
passed away and will always be
comforted with the memory
that she died in a room full of
love and care.”
Our future ac ons
In order to fulfil our objec ves, we have a 10 year plan of key ac ons to carry out by
2025:
Develop dedicated accommoda on for carers and bereaved families.
Open the 3/4 remaining adult inpa ent beds.
Develop a Pallia ve Care Co-ordina on Centre – to advise all providers in the North of
Tyne area.
Set up the “North East Pallia ve Care Educa on & Conference Centre” on a commercial
basis.
Provide a separate, dedicated Young Adult unit/provision and then grow children’s acvity to the 8 bed on-site capacity.
Develop exper se and capacity in non-cancer condi ons.
Develop more formal alliances with other local hospices in order to increase access to
high quality care.
Place the NHS lymphoedema service on a sound commercial foo ng with a communitybased network of provision.
PART 2: Priori es for improvement and required statements
St Oswald’s remains commi$ed to the con nuous development of the whole service and through an ac ve approach to pa ent
and stakeholder involvement keeps the service users at the heart of decision making and service improvement.
PRIORITIES FOR IMPROVEMENT—Review of Services
The key objec ves for 2014-2015 were as follows:
To con nue to develop the Hub and Spoke service model for Lymphoedema providing services closer to pa ent’s homes. To
develop the educa on and awareness programme for Lymphoedema pa ents and associated Health Care Professionals.
⇒
This objec ve was met with outreach clinics being set up in Morpeth and Blaydon early in 2014 and in early 2015 the
clinics were increased from on to two days per week. Feedback from the clinics is excellent and are all oversubscribed with some pa ents now being seen at the base in Gosforth un l space becomes available. The pa ent educaon programme con nues to be delivered in a group seKng primarily and evaluates well .
To reduce wai ng mes for Lymphoedema.
⇒
2014-2015 was a significant period of change in Lymphoedema with four more members of staff employed to tackle
the wai ng list. This is now having an impact with wai ng mes returning to the standard rate of eight weeks for a
rou ne appointment.
To implement the bereaved rela ves survey for pa ents who die at St Oswald’s. Results from the surveys will be monitored
alongside other surveys..
⇒
St Oswald’s par cipated in the FAMCARE II project the results of which are s ll outstanding through the Associa on
of Pallia ve Medicine. Outside of the project mes we also survey bereaved families however the return rate to date
has been nil. Feedback through cards and thank you notes remains excellent.
PART 2: Priori es for improvement and required statements
Review of services:
During 2014-2015 St Oswald’s Hospice provided and/ or sub-contracted two NHS services.
• Outpa ent Lymphoedema Service
• Outreach Lymphoedema Service
St Oswald’s Hospice has reviewed all the data available to them on the quality of care in two of these NHS services.
In addi on the Hospice has provided the following services through grants & charitable funding:
• Children’s Service
• Young Adults Transi on Service
• Day Hospice
• Outpa ent Clinic
• Complementary Therapy
• Physiotherapy
• Occupa onal Therapy
• Social Work
• Bereavement Support Team
• Chaplaincy
The income generated by the NHS services reviewed in 2014-2015 represents 30 percent of the total income generated from
the provision of NHS services by the St Oswald’s Hospice for 2014-2015.
PART 2: Priori es for improvement and required statements
Par cipa on in clinical audits:
During 2014-2015, no na onal clinical audits and no na onal confiden al enquiries covered NHS services that St Oswald’s
provides.
St Oswald’s regularly audits various elements of clinical and non-clinical prac ce both via internal procedures and with the
support of internal and external audit partners.
The Clinical Audit Group and the Nursing Audit Group, focus on developing audit within St Oswald’s and con nuously
improving the quality of care provision.
Audits undertaken in 2014-2015 included a review of RIP le$ers sent to GPs, senior medical reviews of inpa ents aAer
admission, compliance with the mental capacity act, review of drug kardexes, use of ultrasound, an bio c usage and use of
the Quality Assurance tool that was introduced aAer the withdrawal of the Liverpool Care Pathway.. Infec on control and
manual handling audits also form part of a regular audit cycle.
Par cipa on in clinical research:
The number of pa ents receiving NHS services provided or sub-contracted by St Oswald’s Hospice in 2014-2015 that were recruited during that period to par cipate in research approved by a research ethics commi$ee was zero.
PART 2: Priori es for improvement and required statements
Use of the CQUIN payment framework:
St Oswald’s Hospice income in 2014-2015 was condi onal on achieving quality improvement and innova on goals through the
Commissioning for Quality and Innova on payment framework.
Targets achieved were as follows:
• Introduc on of the Friends and Family test into pa ent surveys.
•
Net Promoter Score - Staff Surveys: Q1 85% Q3 95.7%
•
Net Promoter Score—Pa ent Surveys Q2 90% Q3 98% Q4 91%
• Implementa on of a pilot of Inten onal Rounding.
•
This has been implemented and well evaluated by majority of staff and pa ents, it is proposed to con nue with
this into 2015-2016 CQUIN targets
Statements from the Care Quality Commission:
St Oswald’s Hospice is required to register with the Care Quality Commission (CQC) and is currently registered to carry out regulated ac vi es:
•
Treatment of disease, disorder or injury.
•
Diagnos c and screening procedures.
•
Transport services, triage, medical advice provided remotely.
St Oswald’s Hospice has the following condi ons on registra on:
The registered provider must ensure that the regulated ac vi es are managed by an individual who is registered as a
manager in respect of the ac vity, as carried on at or from the loca on St Oswald’s Hospice.
1.
2.
This regulated ac vity may only be carried on at or from the following loca ons: St Oswald’s Hospice, Regent Avenue,
PART 2: Priori es for improvement and required statements
St Oswald’s has the following addi onal condi ons:
1. The registered provider may accommodate no more than 19 service users in the adult unit at St Oswald’s Hospice.
2. The registered provider may accommodate no more than 8 service users, aged from birth to eighteen, in the children’s
unit at St Oswald’s Hospice.
The CQC has not taken enforcement ac on against St Oswald’s Hospice during 2014-2015.
St Oswald’s Hospice has not par cipated in any special reviews or inves ga ons by the CQC during the repor ng period.
An unannounced inspec on from CQC was carried out in December 2013 and NO recommenda ons for improvement were
made.
A full report can be found on the CQC website. A provider informa on return was completed in December 2014 in prepara on
of an inspec on visit under the new arrangements as yet an onsite inspec on has not taken place.
Data Quality:
St Oswald’s Hospice con nually works to improve the quality of informa on provided.
St Oswald’s Hospice did not submit records during 2014-2015 to the secondary uses service for the inclusion in the Hospital Episode Sta s cs which are included in the latest published data, however St Oswald’s did con nue to par cipate in the Na onal
Council for Pallia ve Care MDS project and also a Hospice UK benchmarking project.
Informa on Governance Toolkit A3ainment Levels
St Oswald’s Hospice Informa on Governance Assessment Report score overall for 2014-2015 was 82%
The informa on Governance Group will be taking forward the ac on plan from the toolkit audit over the course of 2015-2016.
PART 2: Priori es for improvement and required statements
The Informa on Governance and Quality Group meets bi-monthly and each mee ng has a specific focus, i.e organisa onal or
clinical and the membership is adjusted accordingly around a core of members who a$end each mee ng. We will con nue to
monitor the func onality/effec veness of the new group going forward.
Detailed below is an update on the work undertaken or ini ated:
•
The Informa on Governance Policy and Procedure was reviewed and approved in July 2014.
Con nued SystmOne development and building on the implementa on of SystmOne on the Adult In-pa ent Unit and the
Children and Young Adult’s unit
•
•
Paper light within Day Services.
•
Work con nues on the Informa on Governance Toolkit ac on plan 2015-16.
•
Introduc on of a rolling programme of reviewing evidence submi$ed to the IG Toolkit in prepara on for submission in
March.
•
Staff Informa on Governance skills assessment with a 85% pass rate to be introduced in 2015.
Clinical coding error rate:
St Oswald’s Hospice was not subject to the payment by results clinical coding audit during 2014-2015 by the Audit Commission.
PART 2: Priori es for improvement and required statements
PRIORITIES FOR IMPROVEMENT—key Priori es for 2015-2016
There are a significant number of strategic objec ves for each directorate in 2015-2016, however the three
main objec ve have been iden fied as follows.
1. To develop the Focus on Living project within Day Services increasing the amount of support we can provide
in a flexible and mely manner to a broader range of pa ents. Mee ng this objec ve will be monitored via
a$endance figures and feedback from pa ents.
2. To develop a programme of training in suppor ng children facing bereavement for delivery to schools,
healthcare professionals and hospice staff. Mee ng this objec ve will be measured by the availability of the
training programme.
3. To implement outcome measure using the OACC suite of measures (Outcome Assessment Complexity Collabora ve). Successful implementa on will include the ongoing monitoring of measures through monthly reports.
4. To finalise funding arrangements for our NHS Lymphoedema service from April 2016.
PART 3: Review of performance and user involvement
During 2014 –2015, 1951 adult pa ents, 62 children and 11 young adults benefited
from St Oswald’s services including:
•
•
•
•
•
•
•
•
207 adult inpa ent admissions & 209 completed stays.
171 new referrals into day hospice with 139 pa ents a$ending over the course of
the year for a total of 2,295 days.
5,911 Lymphoedema outpa ent a$endances.
382 Lymphoedema a$endances at our Shiremoor clinic.
250 Lymphoedema a$endances at our Blaydon clinic.
192 Lymphoedema a$endances at our Morpeth clinic.
1,589 Complementary Therapy sessions provided to Outpa ents, Day Hospice
pa ents, inpa ents and carers.
Childrens & Young Adults recorded an occupancy of 92% over the year resul ng
in 1,985 bed days.
We serve adult pa ents from Northumberland, North Tyneside, Gateshead and
Newcastle. In addi on, children and young adults from Sunderland, South Tyneside
and North Durham can also access our services.
Pa ents are referred to us by their GP, consultant or specialist pallia ve care team.
Children and young adults are referred to us by health and social care pathway
co-ordinators.
R
Referrals to the hospice…an overview
R
Referrals (CCG)
32%
20%
17%
NHS Sunderland
CCG
Other CCG
1%
Source Of Referrals
Referrals (Gender/Age Group)
0.0% 10.0% 20.0% 30.0% 40.0% 50.0%
0 - 15
16 - 18 19 - 24 25 - 64 65 - 74 75 - 84
Male
Female
Male
Female
Male
Female
Male
Female
Male
11.4%
0.9%
Female
22.6%
0.8%
Male
14.9%
2.3%
1.4%
0.9%
Female
41.0%
0.7%
450
400
350
300
250
200
150
100
50
0
Male
0.1%
2.0%
1.1%
Female
Young Adults (short stay)
Positive Steps
OP - Medical
OP - Lymphoedema
OP - Hypnotherapy
OP - Complementary Therapy
OP - CBT
OP - Acupuncture
OP - (Other)
In-Patient
Focus on Living
Day Hospice (Day Care)
Childrens (Short Break)
3%
1%
NHS South Tyneside
CCG
NHS
Northumberland
CCG
NHS North Tyneside
CCG
11%
NHS Newcastle
West CCG
NHS Gateshead CCG
15%
NHS Newcastle
North and East CCG
35%
30%
25%
20%
15%
10%
5%
0%
>84
Inpa ent Service
Our 15-bedded inpa ent unit caters for pa ents needing pain and symptom control,
emergency respite, and end of life care.
Our mul -disciplinary team work together and strive to address not just a pa ent’s
physical needs, but their emo onal and spiritual needs too.
Our aim is to ensure pa ents with specialist pallia ve care needs can maximise their
quality of living; facilitate a safe and mely pa ent discharge or transfer to a con nuing
care service, as well as provide a suppor ve environment at the end of life.
We also understand the impact an illness has on the whole family and offer wide
ranging support for carers.
•
Last year...
“When my Dad arrived at
St Oswald’s, he’d almost given
up on life. Within 24 hours,
however, something changed,
he’d picked up. The care he
received was phenomenal, it
was so personal and it made
him feel comfortable and
content. We couldn’t have
asked for be$er."
•
There were 207 adult inpa ent admissions
last year, 118 pa ent discharges and 91
deaths.
•
4485 bed-days were occupied during the year,
with an average occupancy of 85%.
•
Pa ents stayed with us for an average stay of
22 days.
•
All families and carers have access to our
Family Support Unit including bereavement
support.
Inpa ent Service…..discharges overview
2013-2014
Average
Total
17
Admissions
2014-2015
Average
208
17
86%
Percentage Occupancy
Total
207
85%
% Change
-0.5%
-1%
Discharges
9
103
10
118
13%
Deaths
9
103
8
91
-13%
206
17
Finished Admissions
17
209
45%
-11%
Average Age
68 Years
70 Years
+2 Years
average LOS
22 Days
22 Days
No Change
minimum LOS
2 Days
3 Days
+1 Days
maximum LOS
72 Days
71 Days
-1 Days
7 Days
5 Days
-2 Days
Average wait
Total referrals
27
326
28
341
Hospital, 35.7%
1%
50%
% Deaths
Location Before Admission (Discharges)
ser-
Home, 63.8%
Hospice, 0.5%
4%
vice.
· Provide a major resource in pallia ve care.
Diagnosis Class (Discharges)
Non Cancer,
15%
Cancer, 85%
page 14.
· Manage the
Hospice
effecvely.
Age Group (Discharges)
85+
11%
29%
75 - 84
65 - 74
For details
25 - 64
about
19 - 24
0%
our 10
Year
16 - 18 0%
Vision
for the Under 16 Years 0%
Hospice
0%
please
see
25%
35%
10%
20%
30%
40%
Day Hospice
Day Hospice offers pa ents respite, symptom management and support during the day.
Day Hospice facili es are available from Tuesday to Friday, between 10 am and 3pm.
A visit to Day Hospice can be as busy or as relaxed as a pa ent wishes, with each
session tailored around their individual needs. Ac vi es designed to enhance a
pa ent’s feelings of wellbeing and self esteem include: CraAs, reminiscence, music
therapy and crea ve wri ng. All meals and refreshments are provided free of charge
and transport can be provided.
Group sessions are also available including Fa gue management, exercise, relaxa on
and mindfulness.
Members of our care team informally monitor a pa ent’s condi on throughout their
me with us and report any changes or difficul es back to their GP, hospital, or
community team. During each visit, pa ents can benefit from the services of our
nursing team, Physio and Occupa onal therapists, Complementary Therapists, Social
Workers, our Chaplain and Therapeu c Ac vi es Facilitator. Our medical team is also
available when necessary, although a pa ent’s GP retains overall responsibility for their care.
“I absolutely love the
ac vi es. I’d never done
crea ve wri ng before and I
enjoy the peace of mind it
gives me. I’ve been able to
create a memory box of my
wri ng and artwork for my
children, to show them what I
do during my visits to Day
Hospice when they’re at
school.”
Last year...
We received 171 new referrals
•
There was an average of 284 Day Hospice
places booked each month, which is 82%
of our capacity.
•
Average actual a$endance was 67%.
Day Hospice Referrals……..an overview
Referral Source (CCG)
Other CCG
1%
NHS Newcastle West CCG
8%
NHS Gateshead CCG
15%
NHS North Tyneside CCG
16%
NHS Newcastle North and East CCG
22%
NHS Northumberland CCG
39%
20%
30%
40%
50%
Referrals (Age Group/Gender)
34
29
28
20
18
17
14
10
19 - 24
25 - 64
65 - 74
75 - 84
Male
Female
Male
1
Female
40
35
30
25
20
15
10
5
0
Male
10%
Female
0%
Male
%
84%
10%
27%
2%
3%
1%
3%
7%
9%
7%
27%
2%
1%
16%
48%
7%
19%
26%
Female
Count
144
14
39
3
5
2
5
10
13
10
39
3
1
27
13
2
5
7
171
Male
Diagnosis
Cancer
Cancer - Breast
Cancer - Diges ve Organs
Cancer - Eye, Brain & Other CNS
Cancer - Female Genital Organs
Cancer - Ill Defined, Unspecified
Cancer - Lip, Oral Cavity, & Pharynx
Cancer - Lymphoid / Haematopoie c
Cancer - Male Genital Organs
Cancer - Other Specified Sites
Cancer - Respiratory & Intrathoracic
Cancer - Urinary Tract
Cancer - Respiratory Diseases
Non Cancer
Degenera ve Nervous System Diseases
Heart / Circulatory Disease
Other Non Cancer Diagnosis
Respiratory Diseases
Grand Total
>84
“During the winter months I’m not able to get out very much so coming to Day Hospice is oAen the highlight
of my week. There’s always something going on if the pa ents want to get involved. I’ve benefited from physiotherapy, reflexology and reiki. I also enjoy going on the trips out.”
Outpa ent services
Our Outpa ent Services for pa ents and their carers include:
Complementary Therapy Service
We offer a range of complementary therapies to pa ents and carers, on an outpa ent
basis, including: Massage, Aromatherapy, Indian Head Massage, Reflexology, Reiki and
Hot Stone Therapy.
Treatments are offered alongside conven onal medical care and aim to help pa ents
feel be$er physically, emo onally and psychologically.
Hypnotherapy
Clinical Hypnosis can help pa ents feel more in control, reduce their anxiety, raise self
esteem and build confidence. Sessions are provided by Lisa Cairns, who is qualified in
Clinical Hypnosis and has undertaken pioneering work with Northumbria University to
develop the use of hypnosis in pallia ve care seKngs, with a par cular focus on
symptom management.
“When we walked
through the doors of the
Outpa ent Suite for the first
me it was like someone had
wrapped a blanket around us it was a great relief.”
Acupuncture
Our team of physiotherapists offer acupuncture
to St Oswald’s pa ents. Acupuncture can be
used to relieve pain, aid relaxa on, reduce
muscle tension and help manage tension and
sweats.
Focus on Living sessions
Introduced in early 2015, the aim of our ‘Focus on living’ sessions is to enable people
with life limi ng condi ons to feel be$er in themselves, by benefi ng from a range of
structured, sessional ac vi es that are tailored to their individual needs.
Sessions include ‘Posi ve Steps’ – a six week programme introducing the range of
St Oswald’s services and to dispel myths around hospice care, relaxa on classes,
mindfulness, crea ve wri ng, fa gue management, arts and craAs, exercise and music
therapy.
Cogni ve Behavioural Therapy
We offer Cogni ve Behavioural Therapy (CBT) to pa ents who
have ongoing feelings of anxiety, low mood, anger or panic as a
result of their life limi ng condi on.
CBT helps our pa ents to change the way they think about
themselves, their situa on and the future. It is designed to
help pa ents learn effec ve ways of dealing with
difficul es rela ng to their condi on, and can help
when adjus ng to and coping with pain and symptoms.
Sessions are provided to pa ents by Anne Pelham, one of
Consultants and Gill Sa$erley, a Cogni ve
Behavioural Therapist.
“The sessions open up my
thoughts, which enables me
to handle things a lot be$er
and see things clearer. I look
forward to my weekly visit
to St Oswald’s as I know I am
going to be speaking to
someone who understands
my situa on and the way I’m
feeling about life.”
Outpa ent ac vity last year...an overview
Medical OP
A$endances
CCG
NHS Newcastle North and East CCG
NHS Newcastle West CCG
NHS North Tyneside CCG
NHS Gateshead CCG
NHS Northumberland CCG
NHS South Tyneside CCG
NHS Sunderland CCG
Other
Total
8
3
6
0
22
0
0
0
39
Complementary
Complementary
Complementary TheraPosi ve Focus On
Therapy OP A$end- Therapy as Part
CBT A$endances Acupuncture Hypnotherapy
% Ac vity
py for Carers
Steps
Living
ances
of other services
102
63
63
36
246
5
0
8
523
161
73
168
64
366
0
0
2
834
71
22
40
14
82
0
0
3
232
14
25
20
9
32
0
0
0
100
28
1
12
22
54
0
0
0
117
4
21
1
0
23
1
0
0
50
0
3
22
1
38
0
0
0
64
6
2
6
0
18
0
0
0
32
20%
11%
17%
7%
44%
0%
0%
1%
100%
Lymphoedema Service
Recognised as a na onal centre of excellence in Lymphoedema management,
St Oswald’s is the largest specialist Lymphoedema service provider in the North East.
Our senior Lymphoedema prac oners also play a leading role in clinical educa on in
the North East. Working in partnership with Glasgow Universi es, Dr Andrew Hughes,
Kath Clark and Jill Lisle lecture students on Lymphoedema management.
We treat pa ents with cancer-related Lymphoedema, those with oedema as a symptom of their progressive disease and pa ents with non-cancer related Lymphoedema.
As we’ve provided Lymphoedema care consistently over the last 25 years, we are
specialists in our field and we regularly treat the most complex, severe cases.
A large number of pa ents have complicated Lymphoedema, requiring intensive
treatment and a number of review appointments – symptoma c of the specialist
service we provide.
We have Key Workers trained in-house to care for more rou ne cases, through to
specialist nurses for the most complex care. We also have specialist medical input
available.
All pa ents are cared for on a pathway approach, covering assessment, treatment and
planned review and discharge. Our pathways mirror the Interna onal Lymphoedema
Framework Best Prac ce Consensus Document (2006).
Referrals have increased year on year for over 10 years. As a result we’ve developed a
hub and spoke model of care, where pa ents with mild and uncomplicated
Lymphoedema from Gateshead, Morpeth and North Tyneside are treated in their
locality, whilst pa ents requiring specialist care receive treatment on site at the
Hospice. We can also provide home visits to pa ents who are housebound, as a result
of their condi on.
Lymphoedema is an incurable , chronic, progressive and life long condi on. It can
severely compromise a pa ent’s mobility and quality of life. It can affect their ability to
work and causes considerable anxiety and distress.
However, it can be managed effec vely by:
•
Early diagnosis, referral and treatment
•
A treatment programme comprising one or more of: compression bandaging and/or
hosiery, skincare (simple lympha c drainage), manual lympha c drainage and exercise
•
Promo on of self care
•
An integrated care plan which includes long term management
When Lymphoedema is recognised early and treatment is implemented, pa ents have
fewer complica ons, fewer hospital admissions and community nursing interven ons,
the ability to self manage their condi on and a be$er quality of life.
When Health Care Professionals are trained effec vely and teams work collabora vely,
pa ents benefit from more effec ve long term management of their condi on, with
the reduced risk of deteriora on and further complica ons.
Celluli s is a common
secondary complica on
caused by lymphoedema,
presen ng in 20-30% of cases (Vaillant 2002) and
oAen requiring repeated
acute admissions.
According to the The NHS
Ins tute for Innova on and
Improvement, in 2003-2004
there were 45,522 inpa ent
admissions for celluli s
cos ng £87million in total.
It is es mated that for every £1
spent on lymphoedema care,
saves the NHS £100 in acute and
community nursing costs.
Lymphoedema Referrals (CCG)
600
Lymphoedema Attendances (including DLT/MLD)
615
507
454
621
2014/15
0% 5% 10% 15% 20% 25% 30% 35%
2013/2…
29%
2012/13
NHS Northumberland CCG
2011/12
0
2010/11
22%
2009/10
NHS Gateshead CCG
274
100
2008/09
22%
235
NHS North Tyneside CCG
2007/08
200
12%
229
NHS Newcastle North and…
387
300
9%
2006/07
NHS Newcastle West CCG
529
400
4%
2005/06 134
Other CCG
500
157
1%
2004/05
NHS Sunderland CCG
200
1%
2003/04
NHS South Tyneside CCG
7000
Lymphoedema Referrals
700
Lymphoedema Outreach Attendances
60
2186
0
954
1084
1179
1340
485
1636580
1939 733
2260 1015
2192
3259
3734
3453
3725
2002/03
2003/04
2004/05
2005/06
2006/07
2007/08
2008/09
2009/10
2010/11
2011/12
2012/13
2013/2014
2014/15
1381
4000
2109
2013
5000
1935
6000
3000
2000
1000
Treatments
40
30
0
Attendances
50
20
10
0
1
2
3
4
Shiremoor Attendances
5
6
7
8
Blaydon Attendances
9
10
11
12
Morpeth Attendances
24 hour Pallia ve Care Telephone Advice Service
Working in conjunc on with Marie Curie Cancer Care, we run Hospadvice, an out of
hours telephone advice service available for health and social care professionals caring
for adult pa ents from Northumberland, North of Tyne and Gateshead with pallia ve
care needs.
Calls are answered by one of the doctors or qualified nurses on our inpa ent unit.
Hospadvice offers access to advice on medical, clinical and signpos ng op ons.
Last year, 334 phone calls were received from health care professionals to our adult
services pallia ve care advice line.
We also offer a paediatric pallia ve advice line, for health care professionals caring for
children and young people with advanced, deteriora ng or progressing condi ons or
are in need end of life care.
The Paediatric Pallia ve Care Team includes:
•
Dr Ellie Bond, Associate Specialist in Pallia ve Medicine at St Oswald’s
•
Dr Philip Caisley, Staff Grade in Pallia ve Care at St Oswald’s
•
Dr Yifan Liang, Consultant Paediatrician at James Cook University Hospital
•
Dr Alison Guadagno, Consultant Paediatrician at Great North Children’s Hospital
•
Sally Moody, Clinical Care Lead, St Oswald’s
Children and Young Adults Service
We provide specialist short breaks and pallia ve care to children and young adults,
aged from 0 to 25, with progressive, life-shortening condi ons. Specialist, medicallysupported care is provided, 24 hours a day, seven days a week.
Our team of skilled staff provide residen al short breaks to local families. Up to six children and young adults can stay at any one me in our relaxed, home-from-home environment.
Children and young adults from Northumberland, Newcastle, Gateshead, North Tyneside, South Tyneside, Sunderland or Durham City, Chester-le-Street and Derwentside
can benefit from short breaks at St Oswald’s. There is an assessment and referral pathway that has been agreed with health and, social care colleagues and ourselves within
each area.
We work closely with colleagues at the Great North Children’s Hospital, as two of our
Doctors, Ellie Bond and Phil Caisley, are Honorary Doctors at Newcastle upon Tyne Hospitals Trust. They provide paediatric pallia ve care advice and support and share their
exper se with fellow professionals.
Caring for children
Children staying with us can enjoy a range of
ac vi es such as: sensory play, music therapy,
arts and craAs, baking, bowling and the cinema.
Teenagers benefit from their own living area –
complete with games consoles, wide screen TV
and PC’s.
“Having respite at St Oswald’s for a couple of nights
a month helped to give me a
break. While I was doing all
the medical care for my son,
I couldn’t be a mum. Being
at St Oswald’s gave me me
to step back and just enjoy
playing with him and having
fun.”
Young adults
As well as residen al short breaks, we now also offer day care for young adults, two
days a week. In addi on, our Young Adults Social Group remains very popular, which
offers a range of empowering ac vi es and a chance to socialise. Young adults staying
at St Oswald’s tell us how much they value independence from their carers and the
chance to spend me with peers.
Family support
At Oswald’s we are commi$ed to providing services for the whole family. Our care team
offer confiden al 1-1 support to parents and we also strive to bring families together, to
get to know one another and benefit from peer support.
For families wishing to stay with us, we offer four ensuite bedrooms, a bathroom and a
lounge area with kitchene$e. Parents can also benefit from our free complementary
therapy service.
As we know that brothers and sisters of children with chronic condi ons can feel
forgo$en, we offer dedicated support for siblings too. Each year we run two ‘Sibz Days’
for brothers and sisters of children who stay with us for short breaks. Led by our care
team, Sibz Days involve sharing feelings and experiences and expressing them in
different ways – including art, craAs and music.
Children get the chance to have fun, make new friends and even play with medical
equipment that their brother or sister may use, in a safe environment.
If a child dies, at St Oswald’s, their own home or in hospital, we are also here to provide
ongoing, bereavement support to families.
“Words cannot express how important a role you all play in families lives when they
need you the most. You are a tremendous support and we have been privileged to
experience your unique skills when we needed them. Keep up the good work.”
Nights by CCG
Young Adults,
419
164
0
62
Occupied Nights/Avg. LOS
3.0
1930
1985
2013/14
2014/15
3.0
2068
2.9
3.1
2012/13
3.5
1785
3.0
3.1
2.2
•
A further 11 young adults were cared for at St Oswald’s.
•
37% of children staying were aged between 0 and 3
years old
•
645 admissions, 1,985 bed days were occupied
with a 92% occupancy rate.
•
The average length of stay is 3 nights per visit for Children & 4 nights for Young Adults
731
62 children and their families benefited from our Children’s Service.
2005/06
•
582
500
2004/05
1000
124
Last year...
1500
2003/04
Childrens
Admissions
Young Adults
3.0
3.1
2011/12
2.8
2000
3.2
1434
2500
0
Occupied Nights
4.0
3.5
3.0
2.5
2.0
1.5
1.0
0.5
0.0
LOS
Children, 1566
2010/11
0
26
1206
0
171
2009/10
225
1214
214
2008/09
23
141
1299
71
99
80
2007/08
29
125
503
1046
52
2006/07
800
700
600
500
400
300
200
100
0
Children/Young Adults Bed Nights
Avg. Length of Stay
“I love the fact that St Oswald's is
like a great big security blanket
which wraps round you during
the hardest me in your life. We
will never forget the role you
played in our lives during our
son's final years.”
Carer and Bereavement Support
•
Our services to carers include complementary therapy, carers drop-in sessions and
one-to-one support.
•
I know I’m fully supported and someone is always there with a listening ear. I also
use the complementary therapy service, which is lovely. It’s fantas c to have an
hour which is just about me having a break.
•
We also offer a range of support services to bereaved individuals and families on a
one-to-one basis and in groups.
•
Our one-to-one service is available onsite, over the telephone or can be held in the
comfort of a pa ent or carer’s home.
•
Group sessions are usually held at St Oswald’s, where you have the chance to share
feelings and experiences in a warm and welcoming seKng – with others who
understand.
•
We also hold ‘Ozzy Days’ for bereaved children aged from 5 to 15 whose parent,
sibling or other loved one has received care from St Oswald's.
“Thank you to everyone
who made Ozzy day so
brilliant. At this me of year it
is even more difficult for bereaved
children, bombarded with happy
family scenarios on TV and
Christmas celebra ons, to cope with
their loss. Today gave mine a chance
to be with other children who have
suffered loss and share feelings,
thoughts and also laughter.”
Pa ent Feedback…..An Overview
Friends and Family Test Score—93%
The NHS Friends and family test score shows the propor on of pa ents who would strongly recommend the Hospice as a care
provider minus those who would not recommend, or who are indifferent.
New Outpa ent Feedback July to December 2014
Every new pa ent to Day Services is sent a survey to monitor the service they received during their first encounter with St Oswald’s. 185 pa ents were sent surveys in the six months from July to December 2014 and 46 responses were received. A 25%
return rate, a slight reduc on on the 29% in the previous six months. Considera on is being given to u lising online surveys
such as survey monkey to provide another opportunity for pa ents to respond.
Rating
Jan to June 2014
Jul to Dec 2014
10
69%
72%
9
25%
11%
8
6%
15%
<8
0%
1%
The patients gave very positive comments like
• “I cannot fault the quality of care that I receive. Ever since a ending St Oswald’s every one I came into contact with
has been marvellous. I fell very lucky that I come here for my treatment”.
•
•
“I felt welcome. Both by staff & other pa%ent’s regular requests asking if I am alright or want anything. A'tude of all
staff very friendly, smiling & caring”.
“I was extremely surprised at the high level of standard of everything covered from arriving to consulta%on and explana%on of my condi%on and advice to manage my treatment myself”.
Pa ent Feedback…..An Overview
They also provided some suggested improvements, for which a response or action point is also given.
Feedback
Action / Comment
By taking on board the comments made on these surveys, and acting on them. Not just compiling them and ticking a box.
St Oswald’s takes patient feedback seriously and there is a ‘You Said,
We Did’ feedback section on the website.
Send forms out before appointment and insist that they are returned
before appointment, have secretarial staff enter on system so therapist can devote time to treatment not admin. Improve time wasted
between referral and appointment. I also think it would be a good
idea to train Macmillan nurses and junior doctors so they can give
basic advice to patients while they are waiting for first appointment
for Lymphoedema treatment
Shorten waiting time for Lymphoedema.
This should happen as a routine, and we have recently implemented the
checking of information as people arrive at the desk to minimise the admin time spent in clinic.
There is an on-going initiative to educate the wider health community
about Lymphoedema and this is being addressed by the Vision work
stream
Bigger signs for outpatients.
Waiting times are reducing with the appointment of additional staff and it
is hoped within another month or so when the new staff are fully trained
the waiting times will be returned to standard levels.
Feedback provided to Facilities for next review of signage.
At the start of the morning maybe we can be told what activities are
available that day.
Feedback provided to the Day Hospice Operational Group
Provision of speakers detailing care and all services available to patients in the community.
It is difficult to ascertain which kinds of services this feedback relates to.
St Oswald’s does aim to signpost patients on an individual basis where it
is deemed appropriate.
Pa ent Feedback…..An Overview
Lymphoedema Review pa ent Feedback – July to December 2014
A random sample of review pa ents are surveyed each month from the Lymphoedema service and the results always indicate
high levels of sa sfac on.
In July to December 2014 150 surveys were issued and 57 returned, a response rate of 38%, a slight reduc on on previous response rates.
The survey ques ons were very posi ve with 93% of pa ents feeling confident in the staff all of the me.
There were a significant propor on of pa ents who felt they did not know how to make a complaint in the previous report,
however this has improved with the introduc on of the new TV screen being placed in the wai ng area and a set of key messages to be included on the reverse of all le$ers. The current rate is 60%
Pa ents are asked to rank their anxiety about the appointment before and aAer a$ending with 0 being not anxious at all to 5
extremely anxious. As can be seen from the table below, anxiety levels decrease for the vast majority of pa ents.
SCALE
BEFORE
%
AFTER
%
0
21
37%
36
63%
1
6
11%
9
16%
2
7
12%
5
9%
3
9
16%
5
9%
4
8
14%
0
0%
5
6
11%
2
4%
TOTAL
57
57
Pa ent Feedback…..An Overview
Pa ents gave very posi ve comments such as:
•
“I received excellent service & treatment every visit”.
•
“Every member of staff are always very professional, caring & very friendly”.
• “I feel that we are very fortunate to have the marvellous service available and such pleasant and enthusias%c nurses,
physios, helpers etc...”.
•
“Fabulous staff from front desk to volunteers. We are lucky to have such a brilliant service in Newcastle. Thank you”.
•
“Everyone so helpful, kind and caring very professional but down to earth and approachable at all %mes”.
•
“The staff are always very understanding and always have %me to listen to your concerns/worries”.
They also provided some suggested improvements, for which a response or action point is also given.
Feedback
Ac on / Comment
•
“Easier parking”. X2
Car Parking on site is an on going issue that HMT are well aware of however there are
limita ons to the solu ons that can be put in place.
•
Possible to do a refresher educa on course
A full review of the educa on programme is planned for this year and thought is already been given to ‘refresher’ or ‘discharge’ educa on
Pa ent Feedback…..An Overview
Bereaved Rela ves Survey - FAMCARE II
In August 2014 St Oswald's joined the FAMCARE II audit which is a survey of bereaved rela ves from the inpa ent unit which
involves paper surveys being posted to the next of kin with a stamped addressed envelope to return surveys to the Associa on
of Pallia ve Medicine, who will provide a benchmarked report at the end of the audit. The audit covers all deaths over the period June, July and August. The same ques ons have been reflected in the internal survey alongside some addi onal ques ons,
which will con nue aAer the end of the FAMCARE audit is finished which will allow for some con nual benchmarking.
We are yet to receive a report from APM with the results of the survey.
Pa ent Focus Groups
There have been no pa ent focus groups in the past six months, however service specific projects such as Celebrate Life in Day
Hospice have been evaluated with the pa ents involved and the Focus on Living service which was ini ated out of Celebrate
Life has delivered the first of a number of courses including Watercolour Crea ve Wri ng, Mindfulness and Silk Pain ng.
Feedback Bank
Since the launch of the feedback bank there have been 174 posts onto the Feedback, which includes any feedback received
through social media, sugges ons boxes and comments books. A summary of the type of feedback is shown below, and as can
be seen the vast majority is a thank you or posi ve comments (60%).
Where nega ve comments are made, the informa on is forwarded immediately to the department manager and a response
requested, which is updated on the feedback survey should the individual choose to go back and look.
Type of Feedback
Constructive Criticism
Negative Feedback
Neutral
Positive Feedback
Suggestion
Thank you
Grand Total
2013
3
2
18
5
28
2014
9
25
2015
1
10
54
17
15
120
11
2
2
26
Grand Total
10
38
2
83
19
22
174
We campaign
St Oswald’s was founded in the 1970’s thanks to the drive and determina on of our
founders, who felt so strongly that the people of the North East of England should benefit from hospice care, that they set about campaigning for it.
Over the years, our campaigning role has involved forging partnerships and driving forward an agenda to mainstream hospice care.
Today, we work with a number of partner agencies, most notably Help the Hospices
and Together for Short Lives, to campaign collec vely with other UK hospices about issues affec ng adults, children and young people with life limi ng condi ons.
Most recently, we’ve campaigned for:
Be3er provision of transi on services for young adults
In 2012 we devised and published a report called 'Living longer than you thought I
would' with support from Marie Curie Cancer Care Young People and Transi on Programme. The report aimed to be$er understand the situa on, needs and aspira ons of
young people with life limi ng condi ons who are growing into adulthood. The publicaon was launched at a high visibility event in London, aimed at government ministers
and policy makers, as well as local MP’s to garner their support.
Building on this work we are also now regional lead for the ‘Transi on Taskforce’. The
Taskforce is a na onal ini a ve involving agencies such as Together for Short Lives, Help
the Hospices, Marie Curie and the Na onal Council for Pallia ve Care.
The aim of the Transi on Taskforce is to ensure young people approaching adulthood
with life limi ng condi ons make the transi on to adult services and live their lives as
independently as possible according to their wishes, whilst receiving the care and support they - and their carers - need.
We educate
We are a leading provider of specialist pallia ve care educa on in the North East. We
have been providing first class quality care for almost thirty years and are renowned
locally, regionally and na onally for our exper se. Our role as an educator includes:
Medical Specialty Training
We offer postgraduate training for Specialty Registrars. Dr Andrew Hughes, Consultant
in Specialist Pallia ve Medicine oversees our doctors training programme. Andrew is a
commi$ee member and quality lead for the Northern Deanery
Northern GP training programme
We lead the pallia ve care sessions Northern Deanery GP training programme. These
take place twice a month at Coach Lane campus at Northumbria University and are led
by our consultants and specialty doctors. GP colleagues from Teesside also visit St Oswald’s for a week each Autumn to gain an overview and update in specialist pallia ve
care.
Lymphoedema management training, Glasgow University
Our Senior Lymphoedema Prac oners, Kath Clark and Jill Lisle, along with
Dr Andrew Hughes are honorary lecturers at Glasgow University and lead their Advanced Oedema module. They have also helped to shape the Northern Cancer Network’s Clinical Educa on programme for lymphoedema management and also con nue
to provide ‘train the trainer’ sessions to local health care professionals.
Student placements
Fourth year medical students undertake a six week placement twice a year, supervised
by one of our consultants.
Third year CIDR students (Chronic Illness, Disease and Rehabilita on) a$end teaching
sessions at the Hospice for two and a half days a week, every month from January to
June each year.
NHS Newcastle Gateshead CCG
Statement provided by NHS Newcastle Gateshead CCG in respect of the Quality Account
2014/15 to St Oswald’s Hospice.
NHS Newcastle Gateshead CCG is committed to working closely with the Hospice to ensure high quality and safe care is delivered.
The CCG commends the Management and staff of the Hospice on the work undertaken to successfully sustain and further build a quality service that is clearly valued by all who access the expertise of the service.
The Hospice demonstrates a culture of openness and candour with a commitment to continuous improvement and learning.
A significant amount of activity has been undertaken to develop person centred care reflecting the individual needs of the person and
their loved ones. This is evident in every aspect to the work of the Hospice staff and is demonstrated by consistently very positive comments from those people accessing the services.
WE look forward to working with the Hospice to support the delivery of the key objectives outlined in the Quality accounts for 2015/16
NHS Newcastle Gateshead CCG on behalf of all of the CCG’s in the CNTW area is pleased to positively endorse the Quality Accounts
for 2014/15.
The Quality Account for the Hospice is presented in the required format and the information it contains reflects accurately reflects the
quality profile of the organisation.
Chris Piercy
St Oswald’s Hospice, Regent Avenue,
Gosforth, Newcastle upon Tyne, NE3 1EE
Telephone: 0191 285 0063
Fax: 0191 246 9052
Email: enquiries@stoswaldsuk.org Reg Charity No. 503386
www.stoswaldsuk.org