Mission Statement
Bolton Hospice exists to provide
specialist palliative and end of life care
that focuses on symptom control whilst
also supporting people and their
families to live well through their illness
and cope with the end of life.
Our core purpose is to improve the
experience of dying by supporting
people to live well until they die, by
focussing everything we do on the care
of the patient and their family in a
warm, caring, inclusive and
compassionate way.
BOLTON HOSPICE
Quality Accounts April 2012–March 2013
Bolton Hospice Quality Accounts
2012-2013
JE/dw/June 2012
Chief Executive’s Statement
These Accounts are prepared to report on the qualitative aspects of the services and care delivered
by Bolton Hospice in compliance with the Health Act 2009.
The Hospice is an independent charity (registered number 518704) and is constituted as a company
limited by guarantee (registered number 02114925). The charity is run by a Board of Trustees. The
Trustees are Directors of the Company.
Bolton Hospice makes no charge to its patients or their families and carers. 28% of the £3.75m
needed to run the charity is provided by the Bolton Primary Care Trust, the remaining 72% is
provided through fundraising, a lottery, a retail operation and through voluntary donations from
individual members of the public and local businesses. The charity, through its Trustees, is directly
answerable to its membership, who are drawn from the local community we serve.
The Hospice is also answerable to the general public as well for if they find fault or are not satisfied
with the services we deliver or the actions we take, they are under no obligation to continue to
fundraise to support the Hospice.
It is a fundamental tenet of the provision of Hospice care that the services are delivered to a high
standard. The public, as the main contributors of funds, do so in the expectation that those
members of their community who require the Hospice’s services will receive high quality care.
The Trustees and Managers of Bolton Hospice believe that the quality of our services is not an
adjunct to the delivery of these services; it is an integral part of the work of all our staff and
volunteers. Ensuring the quality of our work, at all times, is part of the ethos of all staff and
volunteers, it is not a top down, imposed management programme but a way of life here.
However, this does not mean that there is no room for improvement, nor does it negate the
requirement of Hospices to be open and transparent about all aspects of the charity’s work and
this includes qualitative assessment of performance.
The quality of services delivered by Bolton Hospice is considered by the Trustees and Managers to
be safe and delivered to a high standard but improving delivery of care is as much a matter for
front line staff as it is for the Senior Managers’ Group and the Board of Trustees. Trustees and
Managers therefore foster a culture of staff and volunteers taking ownership of the services they
provide and feeling free to challenge, raise issues and concerns knowing they work in an open,
transparent, no blame organisation where quality really counts.
The challenge in presenting Quality Accounts is to quantify and provide an evidence base of the
quality of our services, to describe the ongoing measures we are taking to further improve what
we do and to identify some specific measures against which we have set targets and which we can
measure year on year. However, the qualitative elements of the service are not easy to separate
into easily measureable units. The measures chosen therefore are limited in describing and
assessing the quality of our service. The Hospice will continue to develop systems to capture
qualitative information to enhance our evidence base and to support future Quality Accounts
whilst not diverting resources away from the delivery of care to the collection of data.
The Board of Trustees and the Senior Managers’ Group are committed to the delivery of a high
quality service to our patients and their families and friends. We also believe that there is always
room for improvement. We must never become complacent.
These accounts will identify measureable areas of quality, which are essential to the provision of a
high standard of care. They will evolve rapidly over the ensuing years.
Leigh Vallance
Chief Executive
Bolton Hospice Quality Accounts
2012-2013
JE/dw/June 2012
WHAT OUR ORGANISATION IS DOING WELL
Patient Safety
o In November 2011,
o
o
o
o
o
o
o
we had an unannounced Care Quality Commission Inspection
and were fully compliant in all Outcomes assessed.
Of the 5513 bed days and attendances across all services there were 53 incidents of
patient falls of which 45 sustained no injuries and 8 very minor injuries.
This year all our staff have undertaken Information Governance Training which
promotes all aspects of safety and security of our patients’ personal and confidential
data.
We now have 24/7 security and caretaking provisions.
All staff have been trained to administer all intravenous therapies via electronic
pumps.
We are a learning organisation which deals promptly with all incidents and fosters an
open culture whereby risk management and incident reporting is encouraged.
We have purchased 2 new medicine trolleys allowing us to comply more efficiently
with our Management of Medicines Policy.
All In-patients are routinely assessed for their thromboprophylaxis status.
Extract from a letter received in June 2012
“We both drew strength from your support and N passed away peacefully in a place she felt
secure and this has helped all the family come to terms with her loss”.
OTHER PATIENTS’ SAFETY DATA
Total Number of Drug Errors
(this figure is broken down as below)
-
32
Near Misses
Prescribing Error
Omissions
Administration
Dispensing Error
Stock Delivery
- Documentation
5
2
5
6
2
3
5
Number of controlled drug errors reportable to the Local Intelligence
Network
This is an increase of 25% compared to 3 last year.
4
Number of pressure ulcer occurrences
This is a decrease of 80% compared to 18 last year
10
Number of complaints
2
Number of patients infected with MRSA whilst on the Inpatient Unit
0
Number of patients with C.Difficile whilst on the Inpatient Unit
0
Bolton Hospice Quality Accounts
2012-2013
JE/dw/June 2012
Clinical Effectiveness
o
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o
o
o
o
o
All our staff, clinical and non-clinical have received Communication Skills training at
foundation, enhanced or advanced level.
There has been a 4% increase in the number of patients with non-malignant disease
being cared for within Hospice services especially within Hospice at Home.
We have continued to provide a 24 Hour Advice Line, which has been accessed by 388
Professionals, Patients and Carers this year.
The Liverpool Care Pathway was used for 99% of expected inpatient deaths.
All clinical staff have received education and training in all aspects of Spirituality and its
importance to good End of Life Care.
Hospice at Home has worked in collaboration with district nurses to provide 1223 visits
2011-2012 helping patients to remain at home.
We pride ourselves on our ability to undertake a comprehensive holistic assessment of
the needs of our patients and their families.
Extract from a relative whose wife had accessed all Hospice services over a number of
years and died at home:
“We would like to thank you all for the excellent care you gave to A, you always brightened our
days and I don’t know how I would have managed to care for A at home without your help”.
Audit and Quality
o
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o
We increased the number of audits undertaken by 22% from 22 to 27, patient and staff
surveys by 72% from 11 to 19 during 2011- 2012. We have used both internal and
external tools, allowing us to benchmark ourselves against other Hospices nationally.
Examples of audits and surveys include our Car Parking Facilities, Catering, Noise
Levels on the In-patient Unit, Staff Views, Medicine Management, Infection Control and
our Discharge Procedure.
Bolton Hospice submitted Audit Data to the National Minimum Data Set for Specialist
Palliative Care. Results are available publically, from the National Council for Palliative
Care: http://www.ncpc.org.uk./publication/ index.html
Education and Training
o
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We have appointed a Hospice Educator who is instrumental in planning, delivering and
evaluating Specialist Palliative and End of Life Care Education within the Hospice and
within the Community of Bolton
We are currently a hub for Spirituality Training within Bolton.
We have delivered 36 education sessions and provided education and training on many
aspects of Specialist and palliative care for 285 health care professionals within Bolton.
Extracts from attendees’ evaluation forms:
“The day was very thought provoking and informative”
“Brilliant insight into dealing with emotional issues”
“Excellent content, well presented and great facilities”
Bolton Hospice Quality Accounts
2012-2013
JE/dw/June 2012
Patients’ and Family Experience
o
Where possible we seek the views of all our service users on service development,
refurbishments and patient information.
Following a recent Carers’ Day within Bolton Hospice Support Services, they were
asked what they had gained from the day. They commented:
“Nice relaxing day”.
“I felt stressed and tired when I arrived but now feel refreshed and relaxed”.
“I feel better than I have in a long time”.
“More help on how to relax at home”.
o
We undertake a yearly Patient Satisfaction Survey for all Hospice services; these are
some of the results:
100% of respondents said staff always made an effort to meet their individual
needs and wishes.
100% of respondents said they were always treated with dignity and respect.
93% of respondents stated staff involved in their care always explained what they
were doing, with the remainder stating that they explained most of the time.
When asked if there was anything else they would like to tell us about their care, these
are some of their responses:
“Our daughter spent the last 4 weeks surrounded by love, care and dignity. Thank You”.
“Just perfection”.
o
We survey families’ experiences of the care their loved ones received at the end of
their lives. These are some of their responses;
“I would recommend the Hospice to any person wishing their relative to have the best of
everything before they die”.
“All staff treated us with care, compassion and respected N’s dignity in every way possible”.
“I wish to commend the staff for their dedication, professionalism, skill and compassion”.
o
During an unannounced Care Quality Commission Inspection they spoke with 3
patients who all had family and friends with them, these are some of their comments
“The care was 5 star”.
“I can’t find any faults”.
“I feel I can ask for anything if I am not sure”.
“I can’t fault the care but I don’t like the bed quilts”.
“As soon as you come through the door people are happy and smiley”.
Bolton Hospice Quality Accounts
2012-2013
JE/dw/June 2012
WHERE IMPROVEMENTS IN SERVICE
QUALITY ARE REQUIRED
Bolton Hospice is a key provider for Specialist Palliative and End of Life Care within Bolton
and relies heavily on the generosity of local people as well as a financial contribution from
the Department of Health. We cannot and must not become complacent as our reputation
for excellence in practice is core to our success, both now and in the future.
Patient Safety
o Reduce the number of patient falls and embed patient care rounds for all vulnerable
o
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patients.
All clinical staff will undertake Management of Medicine Competencies Training in
2012-13.
Better systems to determine dependency and skill mix.
We need to widen the use of the Psychological Assessment Tool to Out-patients and
In-patients settings.
Clinical Effectiveness
o Ensure all Policies, Procedures and Protocols comply with peer review measures.
o Improve our documentation and communication of patients preferred place of care
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across all healthcare settings.
All staff to undertake education and training on non-malignant conditions as we have
seen a 4% increase in this patient group in 2011-2012.
Promote collaborative working across all healthcare settings to enhance patients and
carers’ experiences of co-ordinated care with the provision of 7 day working.
“The Macmillan Team in the Hospital and Community would like to thank ALL the staff at
Bolton Hospice who have been so supportive during the implementation of 7 day
working”.
Review of all patient literature.
Patients’ and Families Experience
o We continue to conduct an annual Patient Satisfaction Survey for all services with the
o
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inclusion of relative’s views of the care their loved one received at the end of their
life.
We are to seek the views of the bereaved to shape our future Bereavement Services.
Build on the views and involvement of patients within Bolton Hospice Support
Services through St. Christopher’s Projects, Dying Matters Week and other
community led initiatives to raise public awareness of the importance of living well
during life limiting illnesses.
Bolton Hospice Quality Accounts
2012-2013
JE/dw/June 2012
OUR PRIORITIES FOR
2012-2013
We have an ongoing commitment to prioritise patient safety, clinical effectiveness and
enhance patients’ experiences over the next year. This will require a workforce that is not
only skilled in this field of care but one that also possesses a compassionate and caring
approach to those living and coping with life limiting illnesses.
We will monitor our achievements in respect of the following priorities by reporting
progress through Bolton Hospice Quality and Standards Group, Clinical Governance,
Audit and Quality and ultimately through the Board of Trustees:
Patient Safety
Quality Measurement
All staff involved in the nutritional care of our patients
are to undertake food safety training.
Reduce patients falls by 10%
Embrace the Institute for Innovation and Improvement
Programmes within clinical areas.
Incorporate Catering and Housekeeping services within
the clinical structure.
To continue to meet Care Quality Commission outcomes
for quality and safety.
Undertake an Occupational Stress Survey for all
employees.
Training Profile
Audit
Efficiency savings
Changes within current
clinical structure.
Quality Monitoring
Calendar, Compliance
Report.
Audit group
Clinical Effectiveness
Quality Measurement
To actively engage with the Bolton Dementia
Strategy Group for End of Life Care.
Implement the Key Worker Concept with all
clinical areas.
Raise public and professional awareness of
Hospice services ensuring all aspects of
diversity are explored and embraced
Measure ourselves against the Nice Outcomes
for Palliative and End of Life Care.
Incorporate
within
Bolton
Hospice Education Strategy.
Meet
Cancer
Network
requirements.
Monitor all aspects and provide
comparison data.
Within Hospice 5 year Strategy
and Buisness Plan.
Utilise relevant tools to capture
our achievements and set our
priorities.
Patients’ and Families’ Experience
Quality Measurement
Identify and collect appropriate data in order to have an
evidence base to substantiate the ‘Qualiative’
experiences of patients and families.
Review all our patient literature.
Utilise esblished user patient user group.
Undertake a Listening Event for patients and their
families who are living with a life limiting illness.
Bolton Hospice Quality Accounts
2012-2013
Patient focus groups
Documentation Group
Be an active member
Monitor attendance
JE/dw/June 2012
Chairman’s Statement
I have great pleasure to endorse the Quality Accounts for Bolton Hospice for 2012/2013.
It will be evident to all our patients, their families and carers that Quality is at the centre
of everything that we do and the Board of Trustees has a commitment to ensure that
the highest standard of palliative care is delivered to those in need of our services.
This commitment encompasses Corporate and Clinical Governance.
In Corporate Governance, the Board ensure that systems and processes are in place to
maintain our growth as a viable organisation and that our income streams are assured
because without these funds, we could not continue with the level of care required by
our patients. Clinical Governance is critical to ensure that our services are of the
highest possible standard as confirmed in our Mission Statement.
Whilst Clinical targets are an important element in the service we provide, it is the
human service that is such an integral part of our mission, particularly ensuring that
patients are treated with respect, compassion and dignity.
Elsewhere in the Quality Accounts are extracts from the letters we have received from
patients and families. These are typical testaments to what we do at Bolton Hospice
and as Chairman of the Board of Trustees; I pledge our commitment to continue to
build improved quality based on the feedback we receive from patients, families and
carers.
Graham Yardley
Chairman
Extracts from letters and cards received 2011-2012:
“Just to say thank you for the help and support given to us during my mum’s illness”.
“With love and many thanks to you all. You were such a great help to mum”.
“God Bless and thank you all for the care you gave him and the support you gave me. You are in
my thoughts often”.
“I can’t express enough thanks for the special care you all gave ‘B’ in her last few weeks of
illness”.
“We are extremely grateful for the loving care and attention you have given to A during his stay in
the Hospice”.
Bolton Hospice Quality Accounts
2012-2013
JE/dw/June 2012