Quality Account
High quality care for all
Reporting period:
1st April 2011 to 31st March 2012
1
Patients’ Forum February 28th 2012
We feel comfortable here and find the staff to be professional and compassionate.
Nothing is too much trouble and they are always there. A member of staff always
tries to resolve any issues straight away. The members of staff have helped us to
produce a care plan so that we can plan for our future care. Of importance to us,
our families feel supported.
We feel like we are individuals and not a disease.
The standard of support provided by the volunteers is very high and they feel like
part of the team to us. They are committed, dedicated and very professional.
Carers’ Forum March 16th 2012
The hospice is an absolute life-line and we know that there is always someone at the
end of the phone should something go wrong. The 24/7 advice line is invaluable.
2
Chief Executive’s Statement
Together with the Board of Trustees, I would like to thank all of our staff and volunteers for
their achievements over the past year. The hospice has continued to provide a high quality
service and remains financially sound. We have achieved this by providing high quality,
cost-effective services to our patients and their families.
The Douglas Macmillan Hospice has been a leader and innovator in the hospice movement
and has a well established governance function. This has enabled the hospice to focus on the
quality of the services provided. Our regulators have not inspected the hospice this year.
However, the CQC state on their website that all the standards were found to have been met
following our declarations and evidence supplied during registration in October 2010. This
is a tribute to the hard work of every member of staff working for the Douglas Macmillan
Hospice.
The hospice has a culture of continuous quality monitoring, in which any shortfalls are
identified and acted upon quickly.
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.
The safety, experience and outcomes for all our patients and their loved ones are of
paramount importance to us. We continue to actively seek the views of our service users.
Michelle Roberts
Chief Executive
17th May 2012
3
Section 1 Improvement priorities
Priorities for improvement 2012-2013
Following our last self-assessment against the National Minimum Standards, the hospice was
assessed as not needing an inspection. There were no areas for improvement identified. To
date, the hospice has not been inspected against the Essential Standards of Quality and
Safety.
However, the CQC state on their website that all the standards were found to have
been met following our declarations and evidence supplied during registration in October
2010.
The Care Quality Commission has categorised the hospice as a low risk organisation. To
maintain the Quality Risk Profile at this level, the hospice provides quarterly reports to the
Care Quality Commission. These reports are also provided to the commissioners of hospice
services.
In developing the strategic plan for the hospice, particular attention was paid to the rapidly
changing health and social care environment. The Board looked at how the hospice could
extend its services to meet the needs of the local population, enabling people to receive care
in the place of their choice.
Following consultation with the staff and the Patients’ Forum, the DMH confirmed the top
three quality improvement priorities for 2012 to 2013 to be as follows:
Future planning Priority 1
7 day admissions
A key priority for the coming year is to continue to develop the ability to admit patients to the InPatient Unit over 7 days a week. Over the last year, progress has been made in this regard, with an
increase from seven admissions on weekends and bank holidays in 2010 to 31 in 2011. The
intention is to enable increased numbers of admissions at weekends and bank holidays over the
coming year to provide a more responsive service to patients.
4
Future planning Priority 2
Exploring Carers’ needs
The hospice is developing a co-ordinated approach to assessing and meeting holistic needs of
carers. This is in line with the recent NICE quality standard for end of care which states “families
and carers of people approaching the end of life are offered comprehensive holistic assessments in
response to their changing needs and preferences, and holistic support appropriate to their current
needs and preferences.”
Assessing Carers’ Needs
In 2012-13, the hospice is acting as a pilot site as part of a national palliative care study assessing
needs of carers. The community staff will utilise a validated tool for assessing carers’ needs
during second phase of the pilot
Carers’ Support Group
The hospice is linking with external agencies, such as North Staffordshire Carers’ Association
(NSCA), to utilise systems that are already in place to help the carers of hospice patients. The
hospice plans to develop a training package for NSCA.
The hospice is developing a Carer Support Group with support from our Psychological Therapist
and our PCNS team.
Carers’ Forum
The hospice is developing a Carers’ Forum in which carers are able to help the hospice to develop
services.
All these projects aim to give carers greater confidence and help them to deal with the pressures of
caring for someone with a life limiting illness
Future planning Priority 3
Meeting the challenges of the changing health and social care environment
Following a review of the operations and performance of the Board of Trustees by the Cass
Business School, and as part of a review of the hospice strategy, the hospice is developing the
Board to enable it to meet the challenges that lie ahead.
The hospice must have the necessary skills to ensure its survival within the third sector. The
5
following strategic priorities and objectives are being considered.
Be a leading advocate for hospice care.
Promote and support excellence in care.
Expand the capacity of the hospice.
Be a source of expertise and intelligence.
To resource the strategy.
The strategy and objectives will be finalised and a Gap analysis will be carried out to ensure the
systems and processes are put in place to achieve the agreed outcomes.
Progress against the improvement priorities identified in 2011-2012
Throughout 2011-2012, the hospice had a number of initiatives to enable it to offer a more
comprehensive service to the local community, whilst remaining within the limitations of the
financial constraints at that time. All plans for improvement were identified through needs
assessments of the local community and direct patient involvement. As far as possible, we
had discussed all initiatives with the hospice’s Patients’ Forum.
Inevitably, progress against the quality improvement priorities for 2011-2012 was influenced
by financial constraints of the charity. Progress is discussed below.
Progress made against Improvement Priority 1: Provision of home care in
Community Lodges
The Community Lodges were opened officially on March 22nd 2011 and started to receive
patients in May 2011. These innovative Community Lodges reflect the vision for the future of
palliative and end of life (EOL) care services set out in the Demos report entitled Dying for
Change. The hospice has developed this model of care to meet the needs of the local population.
The aim of this nurse-led facility is to have a significant role in improving the quality,
accessibility, flexibility and integration of palliative and end of life (EOL) care in North
Staffordshire.
The Community Lodges have provided an alternative place of care for patients, where they are
able be with friends and family, have their personal care looked after and their pain relieved.
Between opening and 31st March 2012, 66 patients have chosen to have care in the Lodges.
The Patients’ Forum and the Carers’ Forum have provided very positive feedback on the
Community Lodges.
6
Progress made against Improvement Priority 2: A new spiritual area,
bereavement suite and reception area.
On April 1st 2011, the hospice began the major three-part building project, which was driven by the
requirements of our patients and their families.
The hospice obtained part of the costs in grants. As this project was considered to be of such high
priority the Board of Trustees agreed to support the balance of the funding needed from reserves.
A new multi-faith spiritual area
The new spiritual space has been purpose built away from the hustle and bustle of the main
building. The building was opened officially on 18th December at 2.00pm when the hospice
declared the area to be our spiritual space, available to those of all faiths and none, and with the
hope that all would find it a place of peace and tranquillity. The space is being used on a daily
basis for Christian services and for use by patients with other faiths. In addition, baptisms and
marriages have been conducted, including civil services.
Bereavement suite
The new bereavement suite opened in January 2012. The suite is close to reception, allowing
bereaved relatives to access the service without needing to enter any clinical areas which may hold
difficult memories or associations for them.
Reception area
The new reception area was opened in late 2011, bringing together the main functions of the
hospice around one new user-friendly access and circulation area. This area is providing a more
acceptable space for visitors who are returning to the hospice to collect certificates and belongings.
A separate room is available for those relatives who need a private space.
Progress made against Improvement Priority 3:
Enhancing the knowledge and skills of the Multi-disciplinary Team
Appointment of a Psychological Therapist
In order to meet the demand for psychological therapy at Level 4 (NICE Guidelines, 2004), the
hospice has appointed a permanent, full-time Clinical Psychological Therapist. The post-holder
has reviewed current practice and taken the service forward in line with current guidelines and best
practice.
7
The new role has enhanced psychological services in the following areas:

Through the provision of a core member of the MDT

Provision of psychological therapy for patients

Provision of pre and post-bereavement support for carers

Input into the education and training of staff.
Appointment of a Physiotherapist
The hospice has appointed a permanent, full time physiotherapist, who is developing services to
rehabilitate patients, enabling them to maintain independence and to maximise their quality of life
for as long as possible. In addition, the physiotherapist is providing specialist input to non-cancer
patients, particularly patients with COPD.
The physiotherapist is a core member of the MDT providing:

Specialist physiotherapy

Group sessions with a focus on breathing and fatigue.

Input into the education and training of staff
8
Section 2 Mandated Statements
Statements of assurance from the board
The following are a series of statements that all providers must include in their Quality
Account. Many of these statements are not directly applicable to hospices.
Review of services
During 1st April 2011 to 31st March 2012, the DMH provided the following services:

In-Patient Unit

Day Therapy Unit

Out Patients

Hospice at Home

Palliative Care Nurse specialist Service
The DMH’s two Clinical Governance Committees receive quality reports, which enable
them to review the quality of care provided by all clinical services. The Clinical Governance
Operational Group meets bimonthly and the Clinical Governance Committee, which is a subcommittee of the Board, meets quarterly. A Clinical Governance report is submitted to the
Board of Trustees on a quarterly basis.
Participation in clinical audits
During 2011/12, the DMH was ineligible to participate in the national clinical audits and
national confidential enquiries.
Research
The hospice is a pilot site in a national, ethically approved research project entitled
“Implementation and Evaluation of the Carer Support Needs Assessment Tool in Hospice
Home-Care Services.” The hospice will compare carer assessment and support with and
without the use of a formal, validated research tool. This will be an ongoing process, which
is scheduled for completion in November 2013. The research is led by Gunn Grande and
Lynn Austin, University of Manchester.
The hospice is involved in a local, ethically approved, qualitative research study being
undertaken by Susan Walker, whose PhD is entitled Preferred Place of Death: One UK
Hospice Perspective. This study is ongoing but has led to three publications at this time
9
Walker, S., Read, S (2011). Accessing vulnerable research populations: an experience with
gatekeepers of ethical approval.
International Journal of Palliative Nursing 17(1):14-18
Walker, S., Read, S., Priest, H. (2011) Identifying, documenting and reviewing preferred
place of death: an audit of one UK hospice.
International Journal of Palliative Nursing 17(11):546-551
Walker, S., Read, S., Priest, H. (2011) Is routinely ascertaining preferred place of death for
hospice patients possible or desirable?
Journal of Palliative Medicine 14(11):1
Quality improvement and innovation goals agreed with our commissioners
The goals and indicators for the hospice were as follows:
Goal 1
Completion of an annual patient and carer survey to measure Patient
and carer related Outcome Measures (PROMs and FROMs) and
Patient and Carer Related Experience Measures (PREMs and FREMs).
Indicator 1a
Carry out a survey of patients and carers who have recently completed
an episode of care with the hospice.
Indicator 1b
Demonstrate that the results have been reviewed and any learning
points have been actioned and shared with hospice staff and
patients/carers.
Indicator 1c
share the results and any subsequent action plan from the survey with
NHS Stoke-on-Trent.
The schedule of patient and carer surveys commenced in October 2010 and was repeated in
2011. These surveys have been designed to enable the hospice to quantitate the responses
given for the following measures:

Patient Reported Experience Measures (PREMs)

Patient Reported Outcome Measures (PROMs)

Carer Reported Experience Measures (CROMs).

and Carer Reported Outcome Measures (CROMs)

Overall satisfaction.
In 2011, 1007 questionnaires were sent to patients and carers with 553 (55%) completed
surveys returned giving a confidence interval of 2.36 and a confidence level of 95%. A
summary of the results is given in Table 1.
10
Table 1
Patient and carer survey
2010
In-Patient Unit
Patients
Carers
Day Therapy Unit
Patients
Carers
Community
Patients
Carers
Hospice at Home
Carers
2011
Experience
Outcome
Satisfaction
Experience
Outcome
Satisfaction
Measure
Measure
Measure
Measure
Measure
Measure
94%
95%
88%
93%
91%
94%
96%
94%
91%
88%
94%
91%
92%
94%
89%
91%
91%
93%
93%
93%
89%
90%
91%
91%
94%
98%
90%
93%
93%
95%
95%
96%
89%
89%
92%
93%
98%
96%
97%
96%
91%
94%
The scores for 2011 were very similar to those achieved in 2010. There is no national survey
of this type for patients receiving specialist palliative care and no comparative data.
What others say about us
The DMH is required to register with the Care Quality Commission and its current
registration status is unconditional.
The Care Quality Commission has not taken any enforcement action against the DMH
during 2011/12.
The DMH is subject to periodic reviews by the Care Quality commission. The last on-site
inspection was on 5th February 2009 and the last self-assessment was completed in
November 2009; the hospice was assessed as not requiring an inspection for the period
ending 31st March 2010. The CQC website states that the DMH has not been inspected but
“all standards were found to have been met following our assessment of declarations and
evidence supplied by the service itself during registration” which took place on October 1st
2010.
The Quality Risk Profile of the hospice states that the hospice is low risk and the hospice
provides a comprehensive quarterly quality report to the CQC to maintain this ranking.
11
Data quality
In accordance with agreement with the Department of Health, the DMH submits a National
Minimum Dataset (MDS) to the National Council for Palliative Care. The DMH provides
the MDS report and a copy of the quarterly quality report to the local commissioning PCT
Cluster.
The DMH will be taking the following actions to improve data quality:

The IT Manager and the Clinical Governance Manager will continue to review
the data outputs in order to improve the quality of patient data reporting.
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Section 3 Quality overview
Comparison with national minimum data sets
The most recent National Minimum Dataset covers the period 1st April 2010 to 31st March
2011. DMH data for 2011-12 have been collated but there are no comparative data available
at the time of writing.
Community: Palliative Care Nurse Specialist
MDS data for the Community Specialist Palliative Care team is given in Table 2.
Table 2
Community Specialist Palliative Care MDS data
2011-2012
DMH
2010-2011
DMH
No
comparative
data are
available
% New patients
% New patients with a noncancer diagnosis
Average length of care
Face to face visits
Telephone contacts
National
Median
Data have been compared to 31 large units
63.9
17.8
64.8
15.5
67.4
11.4
198.8
5.0
12.0
199.2
7.2
8.6
99.6
4.0
3.7
The hospice sees the community team as providing a significant role in improving the
quality, accessibility, flexibility and integration of palliative and end of life (EOL) care in
our catchment area.
There has been a 27.2% increase in the total number of contacts per annum, which has risen
from 32,218 to 41,144 since April 1st 2007 (see Figure 1).
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Figure 1
The number of home visits is 5.0 per patient per annum, which is 25% higher than the
national median value of 4.0, and the number telephone contacts is 12 per patient per annum,
which is three time the national median value of 3.7.
The relatively high level of input from the community PCNS service is indicative of the
vision of the hospice for the future of palliative and end of life (EOL) care services set out in
the 2010 Demos report entitled Dying for Change.
Thank you for all the care and support you gave to my husband and me. You made life
easier. My husband was so fond of you and you treated him with dignity and respect.
Feedback from the widow of one of our patients
I wanted to express my gratitude. Following your last visit I had the best night sleep in
weeks. My mind was at rest as was my body. Thank you enormously.
Feedback from one of our patients
14
In-Patient Unit
MDS data for the In-Patient Unit is given in Table 3.
Table 3
In-Patient Unit MDS data
2011-2012
DMH
2010-2011
DMH
No
comparative
data are
available
% New patients
% Occupancy
% New patient with a noncancer diagnoses
% Patients returning home
Average length of staycancer
Average length of stay- noncancer
National
Median
Data have been compared to 44 large units
83.1
76.1
13.4
82.5
73.4
8.3
89.3
77.5
9.8
46.5
12.5
50.0
12.2
44.5
14.4
10.7
10.4
11.9
The hospice has a specialist community team, including two medical consultants, nurse
specialists and Hospice at Home. As a result, patients are managed in their home
environment, or alternative place of care, for as long as possible. Once the need arises for an
in-patient admission, the hospice is committed to supporting patients to return to their home,
or alternative place of care, as soon as their symptoms have been managed.
Over the past 12 months, the percentage of non-cancer admissions to the In-Patient Unit has
increased from 8.3% to 13.4%, which is higher than the national median of 9.8%. This is in
accordance with the charity’s aims to offer comprehensive specialist palliative care to adults
in North Staffordshire with progressive, advanced disease and a limited life expectancy,
Since 2006-7, the In-Patient Unit has reduced its average length of stay (LOS) from 13.6 day
to 12.5 days for cancer patients and 10.7 days for non-cancer patients, which is lower than
the national median (cancer patients 14.4 days: non-cancer patients 11.9 days). The LOS
and the effective use of the admission and discharge criteria enable the timely admission of
patients needing specialist in-patient palliative care. This in turn has resulted in a
percentage occupancy of 76.1%, which is slightly higher than the national median value of
75.5%. The hospice is putting in place processes, such as 7-day admissions, which should
15
result in an increase in percentage occupancy. The hospice is setting a target for the coming
year of 80% occupancy.
My care on the In-Patient Unit has been brilliant. From the first day on the unit, my view
on life really did change from me being lethargic and miserable, to immediately having a
craving for marvellous food and a new way of life. Wonderful!
Feedback from one of our patients
I would like to take this opportunity to thank you for all your kindness, dedication,
consideration and concern is easing my brother’s passing. He quietly slipped away, painfree and with dignity. It takes a very special person to become a DMH nurse, you should
all be proud of yourselves. You are fantastic and are all angels; I would describe your
hospice as a halfway house to heaven. I would also like to thank you on my behalf, for the
support and backup offered to me during my brother’s confinement. It has provided great
comfort during this stressful and emotional time.
Feedback from a family member
On behalf of us all I would like to say a heartfelt thank you for everything you did for our
friend in making her as comfortable as you possibly could. We can’t thank you enough.
You helped her with such dignity and for that we are truly grateful.
Feedback from friends of a deceased patient
16
Day Therapy Unit
MDS data for the Day Therapy Unit is given in Table 4.
Table 4
Day Therapy Unit MDS data
2011-2012
DMH
2010-2011
DMH
No
comparative
data are
available
% New patients
% New patient with a noncancer diagnoses
% Places used
Average length of attendance
(days)
National
Median
Data have been compared to 48 large units
64.2
20.6
64.8
25.8
65.8
14.0
58.5
297.7
50.5
263
59.5
149.7
The percentage of new patients attending the Day Therapy Unit is 64.2%, which is the same
as the national median value. The percentage of places used (58.5%) is 8% higher than last
year and is very similar to the national median value of 59.5%. During the past year, the
hospice has changed the focus of this unit from a day hospice to a day therapy unit, with an
emphasis on clinical interventions.
Feedback for the Patients’ Forum and the Carers’ Forum indicates that this support is highly
valued.
We always feel uplifted when we come here and we don’t feel so lonely. Coming here
gives us purpose and something to look forward to. It helps to know we are not alone.
Coming here and being with other patients helps us to come to terms with our situation
Patients’ forum
We feel peace of mind as we know that our loved one is safe when they come to Day
Therapy Unit. We have a few hours of respite, in which we can recharge our batteries
because we don’t have to worry or think about our loved one.
Carers’ Forum
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Outpatients
MDS data for Outpatients is given in Table 5.
Table 5
Outpatients MDS data
2011-2012
DMH
2010-2011
DMH
No
comparative
data are
available
% New patients
% New patients with a noncancer diagnosis
Attendances per patient
Attendances per clinic
% attendances with a
Medical Consultant
National
Median
Data have been compared to 52 medium sized units
85.6
21.3
77.4
14.2
57.5
10.2
3.4
4.3
24.7
0.9
1.6
100
1.8
2.2
49.6
The hospice now records outpatient attendances/consultations with all members of the MDT
and not just with the medical consultant. This is evidenced by the 280% increase in patients
seen and a reduction from 100% to 24.7% in the patients seen by the medical consultant
during the reporting year. The percentage of non-cancer patients seen was 21.3%, which is
an increase of 7.1% from the previous year.
The changes were driven by the hospice’s
commitment to enable patients to be treated in their preferred place of care and to enable
them to remain at home, if this is their choice.
Hospice at Home
MDS data for Hospice at Home is given in Table 6.
Table 6
Hospice at Home MDS data
2011-2012
DMH
2010-2011
DMH
No
comparative
data are
available
% New patients
% New patients with a noncancer diagnosis
Average length of care
Face to face visits
Telephone contacts
National
Median
Data have been compared to 14 large units
92.3
13.6
94.2
10.4
89.1
12.7
19.5
3.1
9.6
17.3
5.7
0
17.3
5.7
1.5
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Many hospices provide a Hospice at Home Service. However the model provided by
hospices is not identical and it is not easy to compare like with like. It is therefore difficult
to understand the significance of the number of 3.1 face-to-face visits provided by the
Douglas Macmillan Hospice, which is 54% of the national median and the number of
telephone contacts of 9.6, which 6.4 times the nation median. As would be expected for
this service, the percentage of new patients seen by the Hospice at Home Service is 92.3%,
which compares to the national median value of 89.1%. In accordance with the priorities of
the hospice, the percentage of non-cancer patients has increased to 13.6%, which is slightly
higher than the median value of 12.7%.
The hospice is participating in a project being undertaken by Help the Hospices in
association with Hospice at Home leads to produce a set of core standards for Hospice at
home services. In addition, the project may help hospices to benchmark their Hospice at
Home services.
On behalf of our family I would like to extend sincere gratitude to the Hospice at Home
staff for their care and kindness and for helping us to enable my aunt to remain at home
to the end and to retain her dignity in the face of great suffering. We were overwhelmed
by your professionalism, compassion and sensitive, unobtrusive support. I know my aunt
appreciated everything that you did for her, as did we.
We were also grateful for the support provided by Sunflower Home Care with whom my
aunt felt very comfortable.
I would like to say thank you for the time spent with my mum. Your team came to our
home and sat and talked and explained everything very clearly but being sensitive to our
feelings. I want to say that you were appreciated by me and my family. Without people
like you it wouldn’t be possible to have had mum at home for us to spend the quality time
that we valued so much. She had her family around her in the final hours knowing she
was loved.
Two examples of the feedback from family members
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Local quality measures
In addition the national dataset for palliative care, the following measures reflect our
performance.
Referrals
Over the past five years the total number of referrals to the hospice has increased from 1328
to 1661 i.e. an increase of 25.1%. From 1st April 2009, there is there has been a 27%
increase in the proportion of non-cancer patients supported by the hospice. (see Table 7 and
Figure 2).
Table 7
Category
Cancer
Non-cancer
Unknown
Referrals to the hospice between 1st April 2007 and 31st
March 2012
1st April 2007 31st March
2008
(n=1328)
81.6%
1st April 2008
- 31st March
2009
(n=1436)
85.2%
1st April 2009 31st March
2010
(n=1406)
85.3%
1st April 2010 31st March
2011
(n=1494)
82.8%
7.2%
8.8%
13.9%
15.5%
80.2%
17.6%
11.3%
6.0%
0.8%
2.0%
2.2%
Figure 2
20
1st April 2011
- 31st March
2012
(n=1661)
24/7 Advice Line
A 24/7 advice line is provided 24 hours a day for 365 days of the year by a team of
experienced and trained Palliative Care Nurse Specialists (PCNSs). The PCNSs are
provided with the necessary training, skills and information sources needed to keep their
clinical knowledge fully up-to-date. The hospice uses an electronic patient database, which
means that the PCNS taking the call has direct access to the patient records of all patients
known to the hospice.
The hospice standard is that all calls to healthcare professionals will be responded to within
15 minutes of call receipt; over the past 12 months, this standard was met for 98.5% of calls.
Between 1st April 2011 and 31stMarch 2012, this service took 3653 calls, of which 55% of
calls were from patients/carers. The Carers’ Forum has stated how invaluable this service is
to them. This is supported by the fact that 273 attendances at Accident and Emergency were
prevented over the past 12 months.
Supporting patient choice
The death location of the 1301 hospice patients who died between 1st April 2011 and 31st
March 2012 is given in Tables 8a & b.
Table 8a
Location
Home
Hospice patients who died at home
Number of patients
(Total deaths=1301)
506
Figures from EOL Intelligence Network 2008-2011
(n=17530)
38.9%
19.2%
The percentage of hospice patients (all diagnoses) dying at home was 38.9% for the year
ending 31st March 2012. This compared to 19.2% for all deaths of patients living in
Staffordshire and Stoke-on-Trent. This is externally verified evidence that it is twice as
likely that patients receiving hospice care will be able to die at home as those end of life
patients who are not referred to the hospice.
Table 8b
Location
Hospital
Hospice patients who died in hospital
Number of patients
(Total deaths=1301)
312
23.9%
Figures from EOL Intelligence Network 2008-2011
(n=17530)
54.9%
21
The percentage of hospice patients (all diagnoses) dying in hospital was 23.9% compared to
54.9% for all deaths of patients living in Staffordshire and Stoke-on-Trent. This is externally
verified evidence that it is half as likely that those patients who are receiving hospice care
will die in hospital when compared to those end of life patients who are not receiving
hospice care.
The death location of the 1073 cancer patients, who were receiving care from the hospice
and died between 1st April 2011 and 31st March2012 is given in Tables 9a & b.
Table 9a
Cancer patients receiving care from the DMH who died at
home
Location
Year ending 31st March 2012
(n= 1073)
Home
405
Figures from EOL Intelligence
Network 2008-2011
(n=4917)
37.7%
26.0%
The percentage of hospice cancer patients dying at home was 37.7 % for the year ending 31st
March 2012, which compared to 26% for all cancer patients living in Staffordshire and
Stoke-on-Trent. This provides externally verified evidence that 45% more cancer patients
who receive care from the hospice are able to die at home.
Table 9b
Cancer patients receiving care from the DMH who died in
hospital
Location
Year ending 31st March 2012
(n= 1073)
Figures from EOL Intelligence
Network 2008-2011
(n=4917)
Acute hospital
276
41.9%
25.7%
The percentage of hospice cancer patients dying in hospital was 25.7% for the year ending
31st March 2012, which compared to 41.9% for deaths of cancer patients living in
Staffordshire and Stoke-on-Trent. This is externally verified evidence that 63% more cancer
patients will die in hospital if they are not receiving hospice care.
In accordance with the data for 2005-2007 released by the West Midlands Cancer
Intelligence Unit, the Douglas Macmillan Hospice had a relatively high percentage of cancer
patients dying in the hospice. This is a trend which the hospice is seeing consistently and is
stated as usually being seen in more affluent areas. Such evidence shows the commitment of
the hospice to serve the needs of the local community.
22
User feedback provided during the episode of care
403/625(64.5%) admissions to the In-Patient Unit, were randomly selected to provide user
feedback. 251 (62.3%) questionnaires were completed, giving an overall confidence interval
of 4.47 and a confidence level of 95%. Feedback from the in-patients is summarised in
Table 10.
Table 10
Real-time monitoring of in-patient satisfaction
Question asked
Response
(n=251)
C1 4.47
CL 95%
Have the first 3 days of your stay been satisfactory
Have you understood the reasons for your admission and what we
are trying to achieve for you
Have you found the staff approachable
Have you been given the opportunity to discuss treatments
Have you expressed any concerns or issues you may have
100.0%
Are we doing everything for you that you would wish us to do?
If you had a complaint about the care you are receiving, would you
know what to do?
98.8%
94.8%
99.2%
99.6%
96.0%
98.8%
In all cases, there is documented evidence that the issues raised by the patients were dealt
with immediately.
A quality indicator: Prevention and management of pressure ulcers
Between 1st April 2011 and 31st March 2012, 625 patients were admitted to the IPU. A
Waterlow score was determined for 95.4% of patients. The average Waterlow score was
19.8 with a range of 7- 48 (high risk = a score of ≥ 20), which is an indication of the frailty
of the patients being cared for.
94/625 (15%) patients had pressure ulcers on admission. All pressure ulcers, and areas at
risk of developing into a pressure ulcer, were given a grading using the EPUAP classification
system.
All at risk patients had a documented care plan, which includes monitoring on an ongoing
basis. Preventative measures were put in place for all at risk patients, such as pressure
relieving mattresses and cushions.
23
Seven serious injuries (≥ Grade 3) were reported to the CQC. This represents 1.1% of the
patients cared for. In all cases, the patients were particularly frail and their skin was very
vulnerable. In all cases, appropriate treatment was given to minimise the risk of further
deterioration.
Our participation in clinical audits
To ensure that the hospice is providing a consistently high quality service, we undertake our
own clinical audits, using national audit tools developed specifically for hospices, which
have been peer reviewed and quality assessed. This allows us to monitor the quality of care
being provided in a systematic way and creates a framework by which we can review this
information and make improvements where needed.
Each year, the Board approves the audit schedule for the coming year. Priorities are selected
in accordance with what is required by our regulators and any areas where a formal audit
would inform the risk management processes within the hospice.
Through the Clinical Governance report, the Board of Trustees is kept fully informed about
the audit results and any identified shortfalls. Through this process, the Board has received
an assurance of the quality of the services provided.
The following audits were completed between 1st April 2011 and 31st March 2012.
Self-assessment by the Accountable This audit has to be completed annually.
Officer
The hospice was fully compliant with the legal
requirements.
Management of controlled drugs
This audit has to be completed annually to provide
evidence to support the self assessment by the
Accountable Officer.
A few minor shortfalls were identified. The Board is
assured that the hospice is now fully compliant.
Infection control: Code of Practice
The hospice is fully compliant with the code of
Practice.
24
Pre-bereavement care
This was an audit of the support provided by inpatient staff to carers and patients prior to the
bereavement. A few minor shortfalls were identified.
The Board has been given assurance that the hospice
will fully comply on completion of the action plan.
Self-administration of medicines
Very few patients admitted to the In-Patient Unit are
well enough to self-medicate.
There was a significant improvement in the rate of
compliance when compared to the audit completed in
2009.
The processes relating to self-administration and to
the destruction of patients’ medication need to be
examined.
Hospice at Home Team
Minor areas of shortfall were identified and an action
plan was put in place. The Hospice at Home Team is
Moving and Handling
working with the physiotherapist to write a procedure
for Hospice at Home staff.
The hospice audit team is continuing to develop.
Bereavement Support
One of the Charity’s aims is to offer professional advice and support to families and carers
during the patient’s illness and during the initial stages of bereavement. As stated above,
pre-bereavement care was audited using a national audit tool and the service had a few minor
shortfalls.
Between 1st April 2011 and 31st March 2012, 238 carers received bereavement support. The
MDS data, published in 2011, showed that clients received 4.7 contacts. This figure was
very similar to the national median value of 5.0 (Data compared with that of 44 medium
sized unit).
25
What our staff says about the organisation
The DMH values the opinions of the staff regarding the quality of the service provided. The
Hospice undertakes a staff survey every 2 years to ascertain engagement levels, celebrate
success and to highlight areas for improvement. The survey was completed by 3,428 staff
(including paid staff and volunteers) in 29 Hospices. Section 2 of the survey focussed on
morale and work/life balance (Figure 3)
Figure 3
Question
Number
14
15
16
17
18
19
20
21
22
23
24
25
26
27
Question
I enjoy the work I do
I enjoy working with the people in the hospice
I like my working environment
I feel I am making a difference
I fee l appreciated
I am not worried about being blamed when things go wrong
it is safe to challenge the way things are done
I have a good work/life balance
the workload in my job is reasonable
I rarely get stressed at work
I am happy with flexible working practices here
I rarely work more than my contracted hours a week
I am not concerned about my job security
morale is high in this charity
The trend in responses received from DMH staff correlated closely to that of the other 28
hospices.
26
One of the Board of Trustees undertakes an annual visit. At the last visit, carried out on 29th
March, the Trustee found the staff to be very open and helpful and very supportive of the
hospice.
The hospice took part in the Chartered Institute for Personnel & Development (CIPD)
Resourcing and Talent Planning Annual Survey 2011of turnover in the UK by sector.
20072008
Staff leaving (including
retirement)
Total staff employed (at end of
year)
Turnover of DMH staff
Comparison to Voluntary,
Community, Not-for-Profit
Sectors*
2008-2009 2009-2010 2010-2011 2011-2012
11
21
31
16
34
207
215
215
255
256
5.3%
9.6%
14.4%
6.2%
13.3%
16.4%
15.9%
13.1%
Not
Not
available available
Over the last 12 months, the turnover of staff has been essentially the same as the average for
the sector.
The Board of Trustees’ commitment to quality
The Board of Trustees is fully committed to the quality agenda. The hospice has a well
established governance structure, with members of the Board having an active role in
ensuring that the hospice provides a high quality service in accordance with its Statement of
Purpose.
On March 29th, a member of the Board undertook an unannounced visit and produced a
quality report for the Board. During this visit, the Trustee spoke to patients and staff on the
In-Patient Unit and in the Day Therapy Unit. In this way, the Board has firsthand
knowledge of what the patients and staff think about the quality of the service provided.
The Board is confident that the treatment and care provided by the Hospice is of high quality
and is cost effective.
27
References
DH 2008. End of Life Care Strategy:
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digita
lasset/dh_086345.pdf last accessed 02/05/12
Leadbeater, c. and Garber, J., 2010. Demos Report: Dying for Change. Demos, London.
www.demos.co.uk/files/Dying_for_change_-_web_-_final_1_.pdf
Last accessed 02/05/12
Goodridge, D. & Marr, H. 2002, "Factors associated with falls in an inpatient palliative
care unit: an exploratory study", International journal of palliative nursing, vol. 8, no. 11,
pp. 548-556.
Pearse, H., Nicholson, L. & Bennett, M. 2004, "Falls in hospices: a cancer network
observational study of fall rates and risk factors", Palliative medicine, vol. 18, no. 5, pp.
478-481.
West Midlands Cancer Intelligence Unit. Report provide by Tim Evans (personal
communication)
http://www.wmciu.nhs.uk/documents/core_docs/info_pub/End_of_life_v2.0.pdf last accessed
02/05/12
End of Life Profiles http://www.endoflifecareintelligence.org.uk/profiles/2/Place_Cause_of_Death/help.htm Last accessed 02/05/12
28
Annex A
On Behalf of the Staffordshire Cluster of PCTS
We are pleased to comment on this Quality Account for 2011/12 which includes accounts of
patient and carer views and experiences.
Review of 2011/12
It was pleasing to note the organisation’s commitment to continuous quality improvement
and the involvement of patients and carers in service developments.
The innovative approach to the provision of palliative and end of life care was demonstrated
by the introduction of the Community Lodges. This model of care has received positive
feedback from both the Patients’ and Carers’ forums.
The needs and wishes of patients and their families have also influenced the design of the
new spiritual area, bereavement suite and reception in the hospice.
The appointment of a fulltime Clinical Psychological Therapist and a fulltime
Physiotherapist has helped improve the range of care offered to patients and their carers and
provide training and support for hospice staff.
Priorities for 2012/13
The hospice has identified three main priorities for 2012/13 which were developed in
conjunction with staff and the Patients’ Forum. Commissioners support the intention to
continue to extend the service to meet the needs of the local population, enabling people to
receive care in the place of their choice. The continued development of the ability to admit
patients to the Inpatient Unit 7 days a week will ensure that the service is more responsive to
the needs of patients and their families.
The focus on assessing the needs of carers is welcomed as is the partnership working with
North Staffordshire Carers’ Association. This will provide the organisation with the
opportunity to extend the support offered to carers and enable them to continue to care for
their relatives and friends with a life limiting illness.
The hospice has recognised the need to develop their Board of Trustees to meet the
challenges of the changing health and social care environment.
29
Quality Overview
Commissioners are pleased to note the achievement against the 2011/12 CQUIN goal which
required the hospice to carry out patient and carer surveys which have encompassed patient
/carer experience and outcome measures.
The hospice has demonstrated robust process for monitoring and reporting the quality and
safety of the care they provide which includes a schedule of internal clinical audits using
national audit tools.
The organisation is a participant in both local and national research projects and is working
with Help the Hospices to produce a set of core standards for Hospice at Home services.
To the best of the commissioner’s knowledge, the information contained within this report is
accurate.
Staffordshire Cluster of PCTs
Headquarters
Blackheath Lane
Stafford
ST18 0YB
30