Weston Hospicecare
Quality Account 2010-11
“Every time you visited, you felt like you were the most important person in the
world to them. It was going to be a long journey and I was determined to make
it ‘First Class’ travel for my wife. Weston Hospicecare made it first class all the
way”
Michael Greaves lost his wife Pat on 23rd July 2009, she had a brain tumour.
Part 1
Chief Executive’s Statement
I have great pleasure in presenting the 2010- 2011 Quality Account for Weston
Hospicecare. Under the Health Act (2009), all providers of NHS services are
required to submit an annual Quality Account. As the Hospice receives a small
amount of funding from the NHS we are required to provide evidence and
assurances about the quality of the services we offer to the public. Through a strong
and dedicated staff team, Weston Hospicecare prides itself on delivering high quality
services to meet the rapidly growing palliative care needs of the local community.
Quality is of paramount importance to the Hospice. Our vision of quality goes beyond
achieving clinical targets. At Weston Hospicecare we have one simple, but very
important mission: to maximise the quality of life for those living with cancer and
other life-limiting illnesses. We are proud that our dedicated team of staff and
volunteers show commitment to quality through delivering the highest level of holistic
care to patients and their families.
The Hospice has a strong culture of continuous quality monitoring and improvement.
Through Clinical Governance processes, user involvement and regular audit, any
shortfalls are identified and appropriate actions swiftly taken. Once again this year
our regulators have assessed the treatment and care provided by the Hospice as
being of high quality. Following the submission of our self-assessment in August
2010, the Care Quality Commission identified no shortfalls in the services provided
by the Hospice.
I am responsible for the preparation of this Report and its contents. To the best of my
knowledge, the information reported in this Quality Account is accurate and a fair
representation of the quality of healthcare services provided by our hospice.
Gill Young
Chief Executive
1st June 2011
Part 1
1.1
Priorities for Improvement 2011-2012
Weston Hospicecare is fully compliant with the Essential Standards of Quality and
Safety (2010) and has satisfied the Care Quality Commission, through self
assessment, that standards have been met over the last year. As such, the Council
of Management did not have any areas of regulatory shortfall to include in the
priorities for improvement 2011-2012.
The Council of Management is committed to the delivery of high quality care and,
with this in mind, has considered how services could be developed and improved to
better meet the needs of the local community. In consultation with staff and
considering the views of service users Weston Hospicecare confirm our top three
quality improvement priorities for 2011 to 2012 to be:
Future planning priority 1 - To review and enhance Day Hospice services
Following improvements to the physical environment of the Day Hospice undertaken
last year, it is an appropriate time to review the service provided. Building on our
CQUIN target for 2010-11 we aim to increase the capacity of the service, provide
greater variety and choice for patients, promote a higher level of carer involvement
and provide services for a range of patients with differing diagnoses.
We will monitor our achievements in relation to this goal by reviewing attendance
figures, taking note of user feedback and tracking referral rates and patterns.
Future planning priority 2- Promote equity of service provision for patients
with non- cancer diagnoses
Our second planning priority for 2011-12 is to further promote the use of Hospice
services by those with non-cancer diagnoses. This has been identified as a
Commissioning for Quality and Innovation target for the year. We will endeavour to
fulfil this priority by continuing to provide education and specialist advice to referrers;
expanding our range of day services and reducing barriers to referral; acting on
feedback from patients and carers regarding the services they would find useful and
forging active links with other healthcare services in the local community.
We will monitor our achievements through reviewing our minimum dataset and
listening to feedback from users of our service. Results will be measured against our
Commissioning for Quality and Innovation target and reported to the local Primary
Care Trust.
Future planning priority 3- To work in partnership to reduce the number of
emergency admissions to hospital for end of life symptom control
With more of our patients actively recording their wish to remain at home for terminal
care, or to receive care within the Hospice, we will continue to work to reduce the
number of emergency admissions to hospital for end of life symptom control. We will
achieve this by continuing to provide education to professional and lay carers,
including local nursing homes. We will support our patients in recording their wishes
through advance care planning documents and inform them of how their wishes can
be best achieved. We will provide education and support to carers so that they feel
clear about when and where to access help appropriately. We will also work with
local GP practices and pharmacies to ensure ‘just in case medication’ is available to
all those who may need it.
We will monitor and report this priority as one of our Commissioning for Quality and
Innovation targets for 2011-12.
1.2
Priorities for improvement 2010-2011
Weston Hospicecare is fully compliant with the Essential Standards for Quality and
Safety (2010). As such, the Council of Management did not have any areas of
shortfall to include in the priorities for improvement 2010-2011.
A number of initiatives have been undertaken to improve patient experience at the
Hospice, promote safety and ensure dignity and privacy.
Priority 1 – Upgrading and enhancement of reception and Day Hospice.
Last year we applied to the Department of Health for a grant aimed specifically at
improving the patient experience whilst at the Hospice. Having been successful in
our bid we improved access to the building, enhanced the reception area and
upgraded our Day Hospice and gardens.
Improvements were measured against the ASPECT and AEDET tools and showed
improved scores across both. Service user and staff feedback have been positive
and reflect that the new environment supports enhanced dignity and privacy during
attendance.
Priority 2 – Reinvigoration of Volunteer services
As a Hospice we rely heavily on the support of an extended team of dedicated
volunteers. Over the last year we have reviewed and reinvigorated our recruitment
processes and publicity materials. This has enabled the consistent recruitment of
high quality volunteers who are able to support teams across the organisation. The
new Volunteer Service materials better reflect the range of opportunities available
and the personal skills we seek in new volunteers. In light of the current economic
climate we have also highlighted the benefits of volunteering during breaks in
employment.
We have extended our range of volunteering opportunities by introducing a
Companion Sitter Service to provide support to patients and carers in our local
community. We have also extended training opportunities for our volunteers
including supporting them to achieve relevant NVQ awards and completing distance
learning programmes.
Priority 3 – Development of financial sustainability
An ongoing priority for the Hospice is to ensure that we continue to be a financially
robust and sustainable organisation, able to withstand the difficulties of the current
economic climate. Over the last year we have continued to diversify streams of
income generation and ensured sound financial processes and protocols. We have
grown our Income Generation Team to enable us to explore funding opportunities
from trusts, grants and the corporate sector. We were also successful in increasing
contributions from our commissioning bodies.
Part 2
Statements of assurance from the Council of Management
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.
2.1 Review of services
During 2010/11 Weston Hospicecare provided the following services to the NHS:
•
•
•
In-patient Unit
Day Hospice
Palliative Care Nurse Specialists
During the period covered by this report Weston Hospicecare has reviewed all the
data available to us on the quality of care in all of these NHS services.
The income generated by the NHS services reviewed in 2010/11 represents one
hundred per cent of the total income generated from the provision of NHS services
by Weston Hospicecare for 2010/11.
What this means
Weston Hospicecare is mainly funded through our own income generation activities
such as retail shops, lottery, events and investments. We also receive a small
contribution from the NHS for the clinical services listed above. The NHS contribution
represents only a small proportion (19%) of the total cost of running these services
and is spent entirely on the provision of these services.
2.2 Participation in clinical audits
During 2010/11, no national clinical audits and no confidential enquiries covered
NHS services relating to palliative care. Weston Hospicecare only provides palliative
care.
Weston Hospicecare was not eligible to participate in any national clinical audits and
national confidential enquiries in 2010/11.
As Weston Hospicecare was ineligible to participate in the national clinical audits and
national confidential enquiries, and for which data was collected during 2010/11,
there is no list 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 the audit or
enquiry.
What this means
As a provider of specialist palliative care Weston Hospicecare is not eligible to
participate in any of the national clinical audits or national confidential enquiries. This
is because none of the 2010/11 audits or enquiries related to specialist palliative
care.
The reports of 11 completed local clinical audits were reviewed by Weston
Hospicecare Clinical Audit Group during 2010/11. Weston Hospicecare intends to
take the following actions to improve the quality of healthcare provided:
•
•
•
•
Improve the way consent is recorded in patient notes
Adapt notes to make clear when a patient has been placed on the Liverpool
Care Pathway.
Adopt a new rating scale for pressure care and train all clinical staff in its use.
Continue to work with colleagues in the hospital and community to ensure that
anticipatory drugs are prescribed for all patients recognised as dying.
2.3 Research
The number of patients receiving NHS services provided or sub-contracted by
Weston Hospicecare in 2010/11 that were recruited during that period to participate
in research approved by a research ethics committee was 0. There were no
appropriate, national, ethically approved research studies in palliative care in which
we could participate.
2.4 Quality improvement and innovation goals agreed with our commissioners
1.5% of Weston Hospicecare’s income for 2010-2011 was conditional on achieving
quality improvement and innovation goals through the Commissioning for Quality
and Innovation payment framework.
The goals set were:
•
•
•
To secure the best use of Day Hospice resources taking into account the
relatively high numbers of patients who do not attend.
To support the implementation of the End of Life Care Strategy through
increasing the number of patients with advance care plans including an
indication of preferred priorities for care.
To increase the number of patients with non-cancer diagnoses accessing the
service. Also to increase the number of patients from BME and from focal
areas of deprivation accessing the service.
These were achieved.
2.5 What others say about us
Weston Hospicecare is required to register with the Care Quality Commission and
our current registration status is unconditional. Weston Hospicecare has no
conditions on its registration.
The Care Quality Commission has not taken any enforcement action against Weston
Hospicecare during 2010/11.
Weston Hospicecare is subject to periodic reviews by the Care Quality Commission
and its last review was self assessment in August 2010. The Care Quality
Commission’s assessment of Weston Hospicecare was that the establishment was
assessed as not needing an inspection.
Weston Hospicecare has no actions to take as no points were raised following self
assessment.
Weston Hospicecare has not participated in any special reviews or investigations by
the Care Quality Commission during the reporting period.
2.6 Data quality
Weston Hospicecare did not submit records during 2010/11 to the Secondary Uses
Service for inclusion in the Hospital Episode Statistics which are included in the
latest published data.
Why is this?
This is because Weston Hospicecare is not eligible to participate in this scheme.
However, in the absence of this, we take other steps such as annual auditing of
clinical records and submitting National Minimum Dataset reports to ensure our data
is accurate and of high quality.
Weston Hospicecare submits a National Minimum Dataset (MDS) to the National
Council for Palliative Care annually. This is voluntary.
The Weston Hospicecare score for Information Quality and Records Management
was not assessed using the Information Governance Toolkit. This toolkit is not
applicable to palliative care.
Part 3: Quality Overview
Activity figures for 1st April 2010 to the 31st March 2011
Area
% of nonmalignant
diagnosis
10/11
Out-patients Services
Community Service
Day Therapy (day
hospice)
In-patient Unit
No. 09/10
% of nonmalignant
diagnosis
Increase or
decrease
43
9.3%
27
14%
+ 60%
746
12.6%
668
11%
+ 12%
70
7%
80
11%
-12.5%
187
5.34%
167
7%
+ 12%
Community Service
Last year 746 patients received 7,059 face-to-face visits. This represents a 5%
increase on the previous year. 4,034 telephone calls were handled, a 17% increase
on the previous year. Overall, this equates to an average of 9.5 face-to-face visits
and 5 telephone consultations per patient. Additionally, the team had 585 face-toface discussions with healthcare professionals and 2,262 telephone conversations (a
huge 75% increase on previous year). During the year 373 patients died and 78
were discharged from the caseload; of those who died 211 or 56% died at their own
home (including care homes). This maintains the increase seen in deaths at home
last year.
Out-Patient Services
The large increase in referrals relates to a change in recording process and is not an
actual increase in people seen within the department. This is now showing a more
accurate picture of activity.
Day Hospice
From June to December the Day Hospice operated on a greatly reduced number
due to the building work being carried out in the Hospice. We had 632 attendances
at Day Hospice within the year, but also 418 booked attendances who did not attend.
This year we introduced a student Art Therapist who has been working with the
patients. During the year the Day Hospice undertook 1 blood transfusion.
In-patient Unit
The In-patient Unit currently operates seven symptom control beds and three
continuing healthcare beds. For one month three beds were closed due to
decorating and re-building work being completed. The figures represents an
increase in the number of patients admitted to the In-Patient Unit by 12%, this is an
unexpected increase as the strategic trend is a reduction in in-patient care. Of those
who were cared for on the Unit 107 (57%) died on the Unit and 76 (43%) were
discharged home or to care homes, additionally 1 was transferred to other
healthcare facilities, community hospitals and acute units. The average length of stay
reduced from 13.1 days to an average of 11.25 days
Of the 187 admissions 76% (143) were admitted from their own home to the Hospice
with 20% being admitted from an acute unit, a large increase on previous years. We
had an average of 61% bed occupancy throughout the year although this does not
take into account the bed closures. During the year we undertook 48 blood
transfusions, over double the number undertaken the previous year. 20 paracentesis
procedures were also undertaken within the Unit.
In addition to the limited number of suitable metrics in the national dataset for
palliative care, we have chosen to measure our performance against the following
metrics:
Indicator
2010/11
2009/10
Complaints
Total number of complaints
1
Number of complaints upheld in full
1
Number of complaints upheld in part
0
Patient Safety Indicators
Number of serious patient safety
1
incidents (excluding falls)
Number of slips, trips and falls
28
Number of patients sustaining a fracture
1
as a result of a fall
Infection Prevention and Control
Number of patients known to be
1
infected with MRSA on admission to the
in patient unit
Number of patients infected with MRSA
0
whilst on the In- patient unit
The number of patients admitted to the
1
in patient unit with C. difficile
The number of patients infected with C.
0
difficile whilst on the In-patient unit
2008/09
7
1
2
7
0
2
0
0
33
0
N/A
0
1
0
0
0
0
0
0
0
Overall the Hospice receives approximately 750 referrals a year. Most referrals are
assessed by our Hospice Community Nurse Specialist team and where appropriate
signposted to other teams within the Hospice. Some patients may access our
services via the In- patient Unit, or by self referring for bereavement support.
Many letters of thanks and compliments are received each year expressing how
much the local community values the services provided. We strive hard to meet the
specific needs of our local community and to work in partnership with them. Our
success in this area is reflected in the fact that over 81% of our services are funded
by charitable donations.
Of course, although we strive to, it is not always possible to meet all needs and
expectations. We actively encourage feedback from patients, carers and staff. When
we receive complaints we have a robust process to ensure a thorough investigation
is carried out and any appropriate steps are taken.
3.1 What our patients say
Throughout the year we seek the opinions of our patients and service users through
feedback questionnaires, user involvement sessions and via unannounced visits by
trustees.
We regularly send out post-discharge questionnaires to ask for feedback about how
we could improve our services. Recent comments have included:
‘your food was first class, lovely soup’
‘very good choice of menu’
‘enjoyed the communion service made me feel very rested’
‘I was pleased with my stay – can I come again!’
‘thank you so much for all your love and care’
‘I think you have covered every aspect comfort, care and kindness, made me
feel such an important individual – nothing is too much trouble’
‘I have had a positive experience which has certainly helped me through a
difficult period’
One patient stated a preference for being asked meal choices rather than offered
a menu and one family requested more readily available tea and coffee making
facilities. These concerns have been addressed; the chefs visit each room to
discuss menu options with patients and new tea making facilities have been
installed.
The last provider visit recommended reviewing the availability of tea and coffee
for relatives within the In-Patient Unit. A newly installed kitchenette area has now
been provided.
3.2 What our staff say
Weston Hospicecare holds the Investors in People Award and is recognised as an
excellent local employer. As such we take the views of our staff seriously. An active
Staff Consultation Group meets on a monthly basis and regular staff and team
meetings are held across the organisation. These allow for news and views to be
shared and explored.
Two large scale staff surveys have been completed recently canvassing opinion and
suggestions. Following the survey at the end of 2009 a number of focus groups were
held for all staff and volunteers to attend. From the survey and focus groups an
agreed joint action plan was drawn up and completed. The top five statements from
the survey that staff agreed with most were:
1.
2.
3.
4.
5.
I enjoy the work I do
I enjoy working with the people in this hospice
I understand what this hospice wants to achieve as an organisation
I feel like I am making a difference
I am proud to work for this hospice
This reflects the fact that Weston Hospicecare has a loyal and dedicated workforce.
3.3 What our regulators say
Weston Hospicecare submits a self-assessment report to the Care Quality
Commission on an annual basis. The self-assessment submitted in August 2010,
provided the regulator with sufficient information to grade Weston Hospicecare as
low risk and not in need of an inspection at that time.
3.4 The Council of Management commitment to quality
The Council of Management is fully committed to prioritising quality and an agenda
of continuous improvement. Unannounced Trustee visits offer regular opportunities
to hear the views and experiences of staff, visitors and patients at first hand. The
Organisation has a well established governance structure and members of the
Council of Management take an active role in ensuring that the Hospice provides a
high quality service in accordance with its Statement of Purpose. The Council of
Management is confident that the treatment and care provided by the Hospice is of
high quality and cost effective
3.5 Supporting statements
From Lead PCT/ OSC/ LINk