Garden House Hospice
Quality Account 2011 - 2012
“I was always a bit scared of the Hospice
just because of what it meant (not getting better)
but in all the places I visited Mum
the Hospice was the place she wanted to be in,
the support and level of care was second to none.”
Quote from a Family Carer Questionnaire 2011
Garden House Hospice
Part 1: A Statement on Quality from the Hospice Management Team
Welcome to the first Quality Account of Garden House Hospice; a summary of our
performance against selected quality measures for 2011/12 and our initiatives and
priorities for quality improvement in 2012/12.
It has been produced to inform service users (current and prospective), their families, our
staff, our supporters, commissioners and the public.
Garden House Hospice is an organisation based on principles. These principles are set out
in our philosophy, which underpins the way we provide a quality service.
By quality we mean striving to meet the needs of our patients and supporting their
families, to the best of our ability.
Garden House Hospice
Philosophy of Care
Palliative care is the total care of patients at a time when
their disease is no longer responsive to curative treatment and
when life expectancy is relatively limited.
Our philosophy of care is based on the following principles:
That palliative care
v respects the patients wishes
v is a team approach composed of
both professional staff and
trained volunteers
v integrates psychological and
spiritual care for patients, so
that they may come to terms
with their own death as fully and
constructively as they can
v aims to provide relief for
patients from pain and other
distressing symptoms
v helps the family cope during the
patient’s illness and in
bereavement
v offers a support system to help
the patient live as actively and
creatively as possible until death
v affirms life and regards death as
a normal process; it seeks
neither to hasten nor to
postpone death
We also aim to provide a high quality physical environment and have completed an
extensive refurbishment programme.
We recognise that quality care depends on quality staff and we are committed to the
continuous professional development of all staff members.
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Garden House Hospice
Our clinical governance programme helps to ensure that all Hospice Team Members are
involved in monitoring the quality of care and working together to improve patient safety,
clinical effectiveness and each individual patient and family member’s experience.
Without the contribution of volunteers the paid staff could not provide the breadth and
depth of individualised care for patients and their families. The assistance of large
numbers of volunteers helping to raise funds ensures a huge amount
of the additional income that is essential to sustain the services at
Garden House.
We were therefore delighted that our volunteers were awarded the
Queen’s Award for Voluntary Service, in 2011. This is regarded as the
MBE for volunteer groups; a formal recognition of the amazing
contribution that our volunteers make towards the work of the Hospice.
We also actively involve ‘service users’, one of whom wrote in our Open
House Newsletter (Spring/ Summer 2012);
“Becoming part of the Service User Group seemed to be a sensible and practical way to
help the Management Team in their aim of continually developing and improving their
service. It was also a means of trying to help those who, in the future, would find
themselves using the Hospice as I did.”
It seems fitting to have the last words from a patient’s wife. She wrote;
“The Garden House Hospice seems to be such an oasis tranquillity and love. True genuine
love for essence of human beings and human spirits. Human beings are probably not
always at their prettiest or most tolerant stage at the end of their lives. It is so refreshing
to see how much thought has gone into how the place is, designed, decorated… for
patients as well as family.
But the main thing that make it such an amazing place, is you the people that work in
there!”
She also recounted what her husband had said to her;
“ The hospice is like a funnel of care and love: the staff, all the volunteers at the hospice,
volunteers working in the charity shops, people raising money in the community, all that
care and love comes in a funnel to the people who are dying and their families. It such a
community resource.”
As a Management Team, we are responsible for this report and its contents. To the best of
our knowledge, the information reported in this Quality Account is accurate and a fair
representation of the quality of the healthcare services provided by our Hospice.
Dr Viv Lucas
Medical Director
Sally Alford
Matron
Jenny Lupton
General Manager
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Garden House Hospice
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Garden House Hospice
Part 2: Priorities for Improvement and Statements of Assurance
from the Hospice Management Team
Priorities for Improvement
This is the first Quality Account of Garden House Hospice.
Garden House Hospice is situated in Letchworth Garden City. It opened in 1990 to provide
specialist palliative care to the residents of Stevenage and North Hertfordshire. Due to its
location, close to the Bedfordshire border, some patients come from Bedfordshire.
Since 1990 the services offered by Garden House Hospice have grown and developed to
meet the needs of the community. From an initial In-Patient only service, Garden House
Hospice now provides: §
12 bedded In-Patient Unit
§
Hospice at Home
§
Day Hospice
§
Outpatients
§
Family Support Services
§
Specialist Palliative Care Advice Line
Mission Statement
Garden House Hospice offers hospice care and support to patients with life limiting
illnesses and their families.
All those who work at Garden House Hospice, in whatever capacity, share in the
common purposes, to: §
provide relief for patients from pain and other distressing symptoms.
§
help patients to live their lives with dignity, by bringing together the
psychological, emotional, spiritual and physical aspects of care.
§
provide care in a variety of settings, appropriate to the individual needs of each
patient.
§
offer support to families and carers both during a patient’s illness and into
bereavement.
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Garden House Hospice
Between 2007 and 2010 extensive redevelopment work was undertaken to extend and
improve the facilities for patients, families and Hospice Team Members. This work was
funded, mainly, by the generous donations of the local community to our Cornflower
Appeal.
The work completed, includes: §
the building of a new wing on the In-Patient Unit, housing six individual patient
rooms, each with en-suite toilet and washing facilities and a patient and visitors
lounge, with veranda overlooking the rear gardens
§
installation of a new patient call system, including pendant alarms for the safety of
patients moving away from the bedside
§
redecoration and upgrading of the two, single sex, multi bedded bays; reducing
them from four to three bedded, allowing more space and privacy for each patient
§
the building of the, two storey, Sir Nigel Hawthorne Centre, giving purpose built
facilities for;
o Day Hospice; this dedicated area was designed to be used flexibly, with
room dividers allowing for separate areas to be created. The doors to Day
Hospice open on to a dedicated patio area, overlooking the rear gardens
o Medical Outpatient appointments
o Therapy Rooms; used by our Physiotherapist and Complementary Therapists
when seeing Day Hospice Patients, ‘visitors’ to Drop-In and pre-booked
Outpatient and family member appointments,
o Treatment Room; enabling patients to have treatments as day cases rather
than requiring an In-Patient or acute hospital stay
o Hospice at Home Office Base
o Counselling Rooms
o A Salon; where patients can have their hair or nails done, free of charge, by
one of our skilled and trained volunteers
o An on-site Laundry
o Support staff office space
o An Education and Training Room; used for training Hospice Team Members
and external professionals as well as by Specialist Patient Support Groups
e.g. Progressive Supranuclear Palsy Support Group, Lung Disease Support
Group
o A Resource Room; containing specialist books and journals for use by
Hospice Team Members, visiting students and external professionals
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Garden House Hospice
The Main Entrance of
Garden House Hospice
In 1990
The Main Entrance of
Garden House Hospice
In 2012
The Rear of
Garden House Hospice
In 1990
The Rear of
Garden House Hospice
In 2012
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Garden House Hospice
Garden House Hospice is constantly seeking ways to improve the quality of care provided,
for patients and their families.
Initiatives in the last couple of years have included: Patient Falls
A Falls Risk Assessment and Care Plan has been devised. All patients admitted to the
In-Patient Unit or attending Day Hospice are risk assessed for their likelihood of falling.
For patients assessed as ‘at risk’ of falling an individualised care plan is drawn up to
minimise the risk.
A new Accident, Incident, Near Miss report Form is being devised, with an additional
section relating to patient falls, to complement the Falls Risk Assessment. The possible
reasons for the fall will need to be identified and additional precautions identified to
reduce the risk of further falls, where possible. The new form will be used from July 2012.
Following adverse incident reports from the Medicines and Healthcare products Regulatory
Agency (MHRA), Garden House Hospice has developed a policy for the safe use of bed
rails. Bed rails are used to prevent bed occupants falling out of bed and injuring
themselves. They must not be used to assist the patient’s mobility whilst in or transferring
to and from bed.
In circumstances where bed rails are being considered, before bed rails are raised on a
patient’s bed, a risk assessment must be carried out and a Risk Assessment for Bed Rails
form completed. The Risk Assessment must be reviewed, at least, every 24 hours or when
there is a significant change in the patient’s condition.
Bed rails must never be used with patient’s who are confused. This leaves a patient group
who are at risk of falling out of bed but who are not suitable for bed rails. Garden House
Hospice has purchased an ultra low bed, (a Liftcare Protean), in order to be able to care
for this group of patients more safely.
Garden House Hospice has also purchased a FallsX InfraRed Monitor. This device has a
discrete pad, which the individual sits on; if the individual stands up, the infrared beam is
broken and an audible signal alerts staff. For patients who are at risk of falling, if they
mobilise independently, but who also ‘forget’ to call for assistance, using the Fall Saver
can help to prevent falls.
Responsiveness
Responsiveness to requests for admission to the In-Patient Unit has also been improved
by accepting more Out Of Hours (OOH) Admission e.g. admitting patients after 17:00hrs,
weekends and bank holidays.
A Red – Amber – Green (RAG) Assessment Tool has been adopted, for assessing the
needs of patients for whom admission, to the In-Patient Unit or Hospice at Home Service,
has been requested. Patients are admitted in a non-discriminatory way based on patient
need.
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Garden House Hospice
RAG Assessment; In-Patient Admission 01/12/2009 – 17/11/2010
Criteria
Red
Admit/offer bed within 1 day
RAG
Assessment Admissions
on
within
Admission
Criteria
Request
RAG
Assessment
on
Admission
140
140
117
Amber Admit within 3 days
47
47
65
Green
15
15
18
Offer alternative to admission or
admit over 3 days
Actual admissions in period 237; 25 admissions not logged on audit tool.
Out Of Hours admissions in period 36.
RAG Assessment; In-Patient Admission 29/11/2010 – 28/11/2011
Criteria
Red
Admit/offer bed within 1 day
RAG
Assessment Admissions
on
within
Admission
Criteria
Request
184
185+
+
RAG
Assessment
on
Admission
138*
Amber Admit within 3 days
38
30
71*
Green
18
23
29*
Offer alternative to admission or
admit over 3 days
+
13 red patients were not admitted within 24hours;
3 patients were already in acute hospitals and the admissions were transfers
4 patients delayed admission for various reasons
1 patient was offered Hospice at Home until a bed was available
5 patients – no reason known
+
1 amber patients were not admitted within 3 days; patient was already in acute hospital
and the admission was for transfer
*One red and one amber patient declined admission.
Out Of Hours admissions in period 34.
Garden House Hospice operates a 24hour Specialist Palliative Care Advice Line for
patients, families and carers experiencing difficulties and healthcare professionals wishing
to access specialist advice. Registered Nurses, with specialist palliative care experience,
staff the Advice Line, with back up from the Hospice Medical Team, when required.
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Garden House Hospice
Effectiveness
In order to provide other professionals, with consistently high levels of information,
regarding patients, a standard format has been adopted for letters. The format is used for
letters sent, following: §
admission to the In-Patient Unit
§
assessment by Day Hospice
§
a medical Out Patient appointment
Methods for assessing and documenting patient care are constantly evolving. In line with
the National End of Life Care Programme, Garden House Hospice is seeking to implement
an effective holistic assessment process. Therefore, the Hospice at Home service is
currently trialling an alternative format, for patient letters, based on the following Holistic
Needs Assessment: §
P
Physical
§
E
Emotional
§
P
Personal
§
S
Social Support
§
I
Information/Communication
§
C
Control; Choice, Dignity, Treatment Options, Advance Directive,
Preferred Place of Death
§
O
Out Of Hours/Emergency
§
L
Late; End of Life
§
A
Afterwards; Bereavement follow up/support
Once the trial has been evaluated a decision will be made whether to adopt this
alternative format for all patient letters.
Volunteers have always supported the staff and patients at Garden House Hospice,
undertaking tasks, such as; answering the telephone, manning Reception, serving
refreshments to patients and visitors, flower arranging, gardening, administration,
bereavement counselling, Chaplaincy and spiritual care, providing transport for patients
and helping in Day Hospice, assisting on the In-Patient Unit, fundraising, sorting and
delivering donations and serving in our Hospice shops.
All new volunteers are offered a place on the Garden House Hospice Induction
Programme; attendance is a requirement for all volunteers who wish to undertake roles
within the Hospice.
Additional induction and ongoing training are given for volunteers undertaking specific
roles.
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Garden House Hospice
In 2011/12 approximately 470 volunteers contributed more than 90,000 hours to the work
of the Hospice. The value of their commitment and contribution cannot be measured, in
human terms, but based on the minimum wage; this is an estimated financial benefit, to
the Hospice, in the region of £520,000.
Within the last year further volunteer role profiles have been developed to further expand
the support offered. These include: §
Hospice at Home Volunteers; offering respite support to families of patient’s being
cared for at home
§
Catering Volunteers; trained in basic food hygiene, these volunteers assist with
food preparation in the Main Kitchen
§
‘Feeding’ Volunteers; trained to assist patients with feeding
§
Housekeeping Volunteers; working alongside the Housekeeping Team
§
Laundry Volunteers; to assist with ironing
§
Volunteer In-Patient Unit Clerk; answering the telephone and undertaking
administrative tasks, to free-up the Nursing
Team
Experience
Garden House Hospice requires all new staff and specified volunteers to undertake
Essential Communication Skills training (if they have not previously done so). Senior staff,
Band 6 or above, are required to undertake Advanced Communication Skills training.
The Information Group is responsible for reviewing and authorising all leaflets relating to
Garden House Hospice, ensuring the content is accurate and accessible for the target
audience. Leaflets are constantly being written and revised as the service develops.
The General Information Leaflet has been translated into a variety of languages, for use
where English is not the first language.
A stock of leaflets, produced by third parties, is held in the Day Hospice. A list of available
leaflets has been compiled. Patients and families are free to take leaflets or alternatively
they can indicate which leaflets they require, from the list, and the information is supplied
to them.
The Internet is used to source leaflets, on alternative subjects, at the request of patients
and families.
An Information and Communication Folder is held centrally, on the In-Patient Unit,
containing details of sign language, interpreters and translation services. The information
is used by all hospice services and is regularly updated.
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Garden House Hospice
Garden House Hospice fully supports the local initiative, ‘My Purple Folder’ for adults with
learning disabilities. Although not specifically designed for palliative care, the purple folder
is an essential tool for communicating the needs and wishes of the individual. Patients
with learning disabilities bring their folder with them and the information in it is used as
the starting point for planning and delivering their care.
Garden House Hospice has always held an Annual Service of Thanksgiving, at the local
Church of England church, to which families of patients who have died in the previous
12 months are invited. Books of Remembrance, containing inscriptions for all patients who
have died, are available to view; at the Service of Thanksgiving and, by appointment, at
the Hospice.
In addition, a trial, of ‘Time to Remember’, is currently being undertaken. Each month,
families, of patients who died 12 months before, are invited, to the Hospice, for a Time to
Remember evening. The Books of remembrance are available for viewing during the
evening. These evenings are smaller than the Service of Thanksgiving and it is hoped this
will make it more personal for those who attend. By holding them at the Hospice, rather
than in a church, it is hoped that they will be more inclusive.
Throughout 2011 the Family Support Service lead a working group to look at ways to
develop the post-bereavement support offered to families. The working group included
Service Users, whose input was very helpful.
As a result Bereavement Groups have now been set up as an alternative to individual
counselling sessions.
During 2010-12 the Family Support Service have also: §
changed the letter sent following bereavement so that individuals now telephone
the service rather than return a reply slip. This;
o eliminates delays
o avoids inappropriate referrals being received back
o enables an assessment to be carried out; without delay or the need to book
an appointment
§
developed a leaflet, ‘Should I be Seeking Support’, which is given to relatives, when
a patient is admitted to the In-Patient Unit, Hospice at Home or Day Hospice
§
devised a pre-bereavement self-assessment tool, for families, which is being piloted
§
made a successful bid for funding from Macmillan Cancer Support, for the
appointment of a part time Pre Bereavement Co-ordinator. Once filled, this post
should enable waiting times for pre bereavement counselling to be significantly
reduced, in line with Network and National Standards
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Garden House Hospice
Priorities for Improvement 2012 – 2013
Safety
Priority
All Healthcare Assistants and Senior Healthcare Assistants (HCA) will have to achieve
designated competencies and demonstrate on-going proficiency.
Competencies will include;
§
knowledge and skills required by an HCA to witness administration of a controlled
drug
§
checking syringe drivers
§
measuring blood sugars
§
carrying out simple wound care
§
infection control
How was this identified as a priority?
Competencies are already in place for Registered Nurses employed at Garden House
Hospice.
Healthcare Assistants and Senior Healthcare Assistants form a key element of the
workforce at Garden House Hospice. Their value to the organisation has already been
recognised in funding and supporting the completion of NVQ Level 3 in Care; enabling
them to develop and gain promotion. They are also offered places on appropriate study
days.
It was identified that competencies for Healthcare Assistants and Senior Healthcare
Assistants would further develop their skills and ensure patients receive quality care.
How will this be achieved?
The Senior Sisters and Sisters are responsible for writing appropriate competencies. This
includes identifying the skills for which competencies are necessary and the knowledge
required to gain competency.
A booklet of HCA Competencies will be drawn up and every HCA will be issued with a
personal copy, which they are responsible for completing.
An HCA must demonstrate that they have the required knowledge in order to be signed
off as competent; this may include carrying out an activity under supervision on several
occasions.
Competencies will be valid for one year. On-going competence will be monitored at
appraisal and six-month review. Any areas of concern will be addressed immediately and
competence withdrawn until the concern has been addressed. This may include re-training
and/or further supervised practice.
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Garden House Hospice
How will progress be monitored and reported?
Once the first set of HCA competencies is written the Clinical Governance Group will be
informed of the date for implementation.
The Senior Sisters and Sisters will be responsible for informing the HCA’s, as a group: §
which competencies are now required
§
how competency must be;
o demonstrated
o documented
o maintained
HCA competencies are a standing agenda item at Sisters Meetings. This will continue once
the first set of competencies has been agreed, in order for: §
teething problems with the implementation of HCA competencies to be discussed
§
HCA’s who have not completed their competencies to be identified
§
new skills to be identified which require competencies to be written
§
the profile of HCA competencies not to be lost
Senior staff, who carry out appraisals and six-month reviews, for HCAs, will be responsible
for recording when competencies are achieved and when they have been updated, on
Personnel Manager.
Effectiveness
Priority
The PEPSI COLA Holistic Needs Assessment framework will be used to present in-patients
at Multidisciplinary Team meetings and to record patient outcomes and decisions made.
How was this identified as a priority?
The PEPSI COLA Holistic Needs Assessment framework is already being trialled for
standard format letters, in Hospice at Home; in order to provide other professionals, with
consistently high levels of information. If this trial proves successful, the standard format
will be adopted for all patient letters.
The PEPSI COLA Holistic Needs Assessment framework is also being used, as a patient
assessment tool, by the Nursing Teams, on the In-Patient Unit and in Hospice at Home.
The weekly Multidisciplinary Meeting, to discuss the ongoing care of in-patients, was
becoming long and unfocused; a new approach was required.
It was identified that using the same tool for Multidisciplinary Meetings and letters to
professionals would mean a coordinated and cohesive approach to patient needs
assessment and care delivery.
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Garden House Hospice
How will this be achieved?
A member of the Nursing Team has been designated as the lead for PEPSI COLA Holistic
Needs Assessment. It is their responsibility to ensure other Team Members are confident
in the use of the tool, not to complete all PEPSI COLA paperwork personally.
The Nursing Team already complete a PEPSI COLA Aide Memoir, for all patients admitted
to the In-Patient Unit, on admission and as significant issues arise or discussions take
place.
A, complementary, Multidisciplinary Record Sheet has been devised with boxes for each of
the PEPSI COLA Holistic Needs Assessment areas: §
P
Physical
§
E
Emotional
§
P
Personal
§
S
Social Support
§
I
Information/Communication
§
C
Control; Choice, Dignity, Treatment Options, Advance Directive,
Preferred Place of Death
§
O
Out Of Hours/Emergency
§
L
Late; End of Life
§
A
Afterwards; Bereavement follow up/support
From March 2012, the In-Patient Unit Nursing Team will use the information from the
PEPSI COLA Aide Memoir to present the patient’s needs at the Multidisciplinary Meeting;
this will become the basis for discussion and decision-making. The Multidisciplinary Record
Sheet will be used to record the significant outcomes and any follow up action that has
been decided upon.
How will progress be monitored and reported?
This system will initially be trialled for three months.
At the end of the trial period the Multidisciplinary Team will review the system to see
whether: §
Patient’s needs are appropriately assessed across all domains of the Holistic Needs
Assessment
§
Patient care is now planned more effectively
§
Multidisciplinary Meetings are shorter and more focussed
§
Standard letters are easier to write because the information is already documented
in the required format
The results of the review will be taken to the Clinical Governance Group where a decision
will be made on whether to adopt or adapt the system.
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Garden House Hospice
Experience
Priority
The format of Day Hospice will be changed to better reflect the needs of the patient group
and their families. This will include offering more outpatient appointments, therapies and
treatments.
How was this identified as a priority?
The Day Hospice Review Meeting in February 2011 focused on the requirements of Day
Hospice and ensuring the services were used to the best advantage. It was felt that the
current model of Day Hospice was not fully meeting the needs of patients and their
families.
There has also been a reduction in the amount of patients referred for Day Hospice,
leaving the current service under utilised; the reason(s) for this are unclear.
How will this be achieved?
Members of the Day Hospice Team have visited other local Day Hospices to see if there
are any lessons to be learnt from the way they operate.
Ideas have been fed back to the regular Day Hospice Review Meetings and several
proposals have been considered. It has been decided to trial certain elements from
different proposals and evaluate which work for our patient group.
There are plans to trial the following, in the coming months: §
Themed Weeks a topic, relevant to palliative care patients, will form the basis of
activities for a week in Day Hospice. Patients will be able to choose
which day and time to come in; patients would not be expected to
attend for a whole ‘day’ if they preferred not to.
Topics may include; emotional issues, symptom management,
exercise, nutrition and diet.
§
Art Therapy
a volunteer Art Therapist has joined the Hospice Team and will be
available to work with patients in Day Hospice.
§
Relaxation
relaxation has routinely been offered as part of the Day Hospice
day. This will be extended to offer a dedicated relaxation session,
outside of the normal Day Hospice ‘day’. Initially this will take the
form of a one hour session, on a Friday afternoon, from 2.30pm.
Sessions will be open to patients and carers (including those
currently on the In-Patient Unit).
§
Tai Chi
Two members of the Therapy Team have been trained in the
principles of adapting Tai Chi exercises for palliative care patients.
A decision has yet to be made exactly how this will be used within
Garden House Hospice.
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Garden House Hospice
Hospice Medical Team hours were increased from the 1st April to enable more outpatient
appointments and treatments.
The following have been identified as working well and will continue: §
Drop In
Drop In operates from 9am to 1pm on a Thursday. It provides an
opportunity for patients, family members and carers to visit the
Hospice, informally and find out more about the services available; an
appointment is not required.
§
Therapies
Complementary Therapies and physiotherapy are available to;
§
Lung Clinic
·
Day Hospice patients
·
Outpatients
·
Patients in their own homes
·
Visitors to Drop In; provided there is space on the day
·
Family members and carer
Patients with advanced, incurable, lung disease (Chronic Obstructive
Pulmonary Disease (COPD) and Lung Cancer) are referred to the Lung
Clinic by the Pulmonary Rehabilitation Team, Consultant Chest
Physicians (East and North Herts NHS Trust) and Community Matrons.
It had been identified that acute hospital outpatient clinics and
traditional Day Hospice attendance did not best meet the needs of
this group of patients. Running a Lung Clinic at Garden House Hospice
has the following benefits for patients: ·
accessible parking
·
afternoon sessions run at a manageable pace for those with
breathing difficulties
·
flexibility of attendance; one off appointments, ongoing
sessions, regular or irregular review
·
smooth transition from acute to palliative care
·
assistance with Advance Care Planning
How will progress be monitored and reported?
Each trial will be evaluated separately. This will be by: §
feedback from the service users
§
evaluation of attendance figures
§
feedback from Day Hospice Team Members
Evaluation will be reported at the Day Hospice Review Meeting, where decisions will be
made on what to; adopt, further adapt or discontinue.
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Garden House Hospice
Statements of Assurance from the Hospice Management Team
The following are statements that all providers must include in their Quality Accounts.
Many of these statements are not directly applicable to specialist palliative care providers;
explanation of these statements and why they do not apply to Garden House has been
included, in italics, where appropriate.
Review of Services
During 2011-12 the Garden House Hospice provided the following NHS services: §
In-Patient Unit
§
Hospice at Home
§
Day Hospice
§
Outpatients
§
Family Support Services
§
Specialist Palliative Care Advice Line
Garden House Hospice has reviewed all the data available to them on the quality of the
care in all of these NHS services.
The income generated by the NHS services reviewed in 2011-12 represents 100% of the
total income generated from the provision of NHS services by the Garden House Hospice
for 2011-12.
The income generated from the NHS in 2011-12 represents 40% of the overall running
costs of Garden House Hospice in 2011-12; 38% from NHS Hertfordshire and 2% from
NHS Bedfordshire.
The remaining 60% of overall running costs is sourced through voluntary income
generation; donations, fundraising, charity shops, lottery activity and income from
investments.
Participation in Clinical Audit
Garden House Hospice was not eligible in 2011/12 to participate in any national clinical
audits or national confidential enquiries and therefore there is no information to submit
This is because Garden House Hospice only provides palliative care and none of the
2011/12 national audits or confidential enquires related to specialist palliative care.
Research
The number of patients receiving NHS services provided or sub-contracted by Garden
House Hospice in 2011/112 that were recruited during the period to participate in research
approved by a research ethics committee was NIL.
While Garden House Hospice has not recruited any patients to participate in research in
2011/12 it has fully supported any patients who were participating in research for other
providers during this period.
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Garden House Hospice
Use of the CQUIN Payment Framework
A proportion of Garden House Hospice income in 2011/12 was conditional on achieving
quality improvement and innovation goals agreed between Garden House Hospice & NHS
Hertfordshire and Garden House Hospice & NHS Bedfordshire, through the Commissioning
for Quality and Innovation payment framework.
Further details of agreed goals for 2011/12 and for the following 12 month period are
available in Appendix 1. and Appendix 2.
For NHS Hertfordshire the CQUIN payment equates to 1% of their total contribution.
For NHS Bedfordshire the CQUIN payment equates to 1% of their total contribution.
Statement from the Care Quality Commission
North Herts Hospice Care Association is required to register with the Care Quality
Commission and its currently registered to carry out the following regulated activities:
a.
Diagnostic and screening procedures
b.
Personal care
c.
Treatment of disease, disorder or injury
For Regulated Activities a. and c. the Nominated Individual is: Vivian Lucas
For Regulated Activity b. the Nominated Individual is: Sally Alford
North Herts Hospice Care Association has the following conditions on registration:
1.
The Registered Provider must ensure that the regulated activities a. b. or c. is
managed by an individual who is registered as a manager in respect of the
activity, as carried on at or from the location Garden House Hospice.
2.
This Regulated Activity may only be carried on at or from the following locations:
Garden House Hospice, Gillison Close, Letchworth Garden City, Hertfordshire,
SG6 1QU
The Care Quality Commission has not taken enforcement action against Garden House
Hospice During 2011/12.
Data Quality
Garden House Hospice did not submit records during 2011/12 to the Secondary Uses
service for inclusion in the Hospital Episode Statistics which are included in the latest
published data.
This is because Garden House Hospice is not eligible to participate in this system.
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Garden House Hospice
Information Governance Toolkit Attainment Levels
Garden House Hospice did not participate in formal Information Governance Assessment
in 2011/12.
Garden House Hospice has policies and procedures in place for confidentiality, information
management and records management.
As an NHS business partner, Garden House Hospice plans to use the NHS Information
Governance Toolkit in 2012/13 and participate in Information Governance Assessment,
leading to an Information Governance Grading.
Clinical Coding Error Rate
Garden House Hospice was not subject to the Payment by Results clinical coding audit
during 2011/12 by the Audit Commission.
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Garden House Hospice
Part 3: Review of Quality Performance
The National Council for Palliative Care (NCPC): Minimum Data Sets
The NCPC minimum data sets are the only information on hospice activity collected
nationally. The figures provide one measure of activity and outcomes of care for patients,
at Garden House Hospice, during the period 2011/12.
Garden House Hospice did not report NCPC minimum data set before the period 2011/12.
Comparison of this data will be possible in our next Quality Account, for the period
2012/13.
In-Patient Unit
2011/12
Total number of admissions
265
Total number of patients
225
Number of new patients
209
% Occupancy
071
% Patients returning home
39
Average length of stay – cancer patients
11.4 days
Average length of stay – non-cancer patients
13.0 days
Day Hospice
2011/12
Total number of patients
95
% New patients
64
% Patient attendances
79
% Patient non attendances
21
Average length of care
103 days
Hospice at Home
2011/12
Total number of patients
270
% New patients
091
% Re-referred patients
002
% of patients who died at home
065
% of patients who died in Hospice
027
% of patients who died in acute hospital
008
Average length of care
41 days
- 20 -
Garden House Hospice
Outpatients
2011/12
Total number of patients
100
Patients Diagnosis; Cancer/malignant diagnosis
177
Other diagnosis
016
Not recorded
007
% New patients
180
% Re-referred patients
102
Total number of consultations
521
Seen by Palliative Care Doctor
171
Seen by Hospice Nurse
030
Seen by Physiotherapist
211
Seen by Complementary Therapists
109
Bereavement Support
2011/12
Total service users
096
Number of telephone contacts
144
Number of individual counselling sessions
467
In addition to individual bereavement counselling sessions, a trial of group bereavement
counselling sessions is currently being undertaken, at Garden House Hospice. The aims of
this are to: §
enable people to have a choice of how they are supported
§
make bereavement support available for more people
- 21 -
Garden House Hospice
Complaints
During the period 2011/12: Total Number of Complaints
7
Total Number of Complaints Upheld in Full
2
Total Number of Complaints Upheld in Part
2
Total Number of Complaints Not Upheld
3
Complaints Upheld in Full:
§
Perceived lack of continued support from Family Support Service.
Recommendations;
o Adaptation of Referral Form
o Development of ‘Referred on to Other Service’ Form
§
Letter of invitation to join service user group sent to deceased patient.
Recommendations;
o Checking system to be established to ensure letters not accidentally sent to
patients
Complaints Upheld in Part:
§
Husband unhappy with some aspects of wife’s admission.
Findings/Recommendations;
o Husband’s wishes had not been communicated on transfer from hospital to
hospice.
o Plan put in place to monitor visitors.
§
Husband and daughter of patient unhappy with hospice decision re. Respite
admission.
Recommendations;
o Exceptional circumstances – no recommendations
Concerns
During the period 2011/12 one concern was raised and investigated.
The incident of concern was a male relative staying overnight in a female patient bay.
The Nursing Team were reminded of the need to check whether other patients, in single
sex bay, are happy for a relative, of the opposite sex, to stay overnight in the bay.
A Relatives’ Room is provided for relatives to spend the night at the hospice, away from
the bedside.
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Garden House Hospice
Patient Accident, Incidents and Near Misses
The following patient related accidents and incidents were reported and investigated
during the period 2011/12.
Medicines Related Incidents
24
Slips, Trips and Falls
53
Other*
05
*Two patients spilt hot drinks, One patient banged her arm on her bedside table,
one patient left the building, one patient’s garlic allergy was not recorded on admission
The majority of slips, trips and falls related to patients trying to maintain their
independence.
Five falls, in quick succession, related to one patient whose condition had deteriorated
leaving him confused and restless. The use of bed rails was assessed as inappropriate and
all other available actions had been taken to minimise the risk. As a result of these
incidents there was a recommendation to purchase an ultra low bed; a Liftcare Protean,
was purchased in July 2011.
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Garden House Hospice
Clinical Audit
During the period 2011/12 the following, audits, were undertaken, using national audit
tools designed specifically for hospices, by Help the Hospices.
Audit Title
Date
Recommendations
Actions
Completed
Infection Prevention and Control
1. Policies and Processes
02/11
Service Level Agreement to be Yes
negotiated
Policies to be reviewed
Partial
2. Hand Hygiene
03/12
None
N/A
3. Patient Areas
03/12
Patient washbowls to be stored
on patients own locker
No
4. Clinical Rooms
07/11
Remove out of date blood
sample bottles
Yes
03/12
Blood collection bottles on
heater need to be moved
Remove out of date blood
sample bottles (1 day)
Yes
Yes
5. Bathrooms
07/11
None
N/A
6. Patient toilets/Bidets
07/11
None
N/A
7. Sluice/Dirty Utility
07/11
None
N/A
8. Domestic rooms
07/11
None
N/A
9. Care of Deceased Patients
07/11
None
N/A
10/11
None
N/A
10. Sharps
10/11
Signage ‘What to do following a
needlestick injury’ required
Yes
11. Protective Equipment
01/12
None
N/A
12. Kitchen Areas
(excluding Main Kitchen)
02/11
None
N/A
04/11
None
N/A
Bereavement Support
Bereavement support service
audit tool; Policies and
Procedures, Confidentiality and
Record keeping, Personnel,
Training, Information Provision,
Service Evaluation
- 24 -
Garden House Hospice
Internal clinical audits in the period 2011/12 included: Audit Title
Date(s)
Recommendations
Fall Incidents Audit
01/08/11- Falls Risk Assessment to be
31/01/12 completed for each patient.
Create a new Accident,
Incident, Near Miss Form.
Actions from Accidents,
Incidents or Near Misses to be
carried out immediately.
Falls Risk Assessment Audit
01/08/11- Further training required;
27/01/12 How to correctly
complete the Falls Risk
Assessment.
Involvement of patient
and relatives in the Action
Plan.
Nutritional Screening Tool
Audit
23/02/12
4 Monthly Controlled Drug
Checks
25/05/11
12 Monthly Controlled Drugs
Audit
8/12/11
24/10/11
Actions
Completed
Yes
Partial
To be
audited
No
No
Catering Team to improve filing
system for current patients.
Amendments required to make
the Tool better.
Yes
None
None
N/A
N/A
Errors must be scored through
with a single line; correction
fluid must never be used.
Form of medication must be
stated at the top of each page.
Where there is a discrepancy
between the calculated
amount, of liquid medication
remaining, and the actual
amount a statement should be
made that there is “no error in
maths”.
The back of the ‘Controlled
Drugs Check Book’ must be
signed; nightly in black, and
weekly in red, that all is
correct.
To be
audited
Partial
To be
audited
To be
audited
To be
audited
- 25 -
Garden House Hospice
Audit Title
Date(s)
Recommendations
Annual Audit of In-Patient
Notes
1/07/1131/12/11
All documentation needs to be
reviewed for usability; consider
dividing
the
notes
into
sections, particularly so that
correspondence
can
be
separated, to make the notes
easier to navigate.
Documents should be printed
off rather than photocopied;
this would ensure correct
version used as well as
stopping titles being cut off.
All Clinical Teams need to be
re-educated in the necessity to
complete notes; clearly, legibly
and contemporaneously, in
black ink, with all entries
dated, timed and signed.
Family Support team referrals
are still not being copied and
placed in the notes. Take to
Nursing Team Meetings to
ensure this begins to happen.
Review the “recommended
abbreviations” list and ensure
only these abbreviations are
used.
LCP
paperwork to
have
line/box for iCare number
added to all sections.
Discuss if iCare number should
be
added
to
Specialist
Palliative Care Advice Line
Sheet and add if needed.
Actions
Completed
Complete
review
of
documentation
scheduled to
begin August
2012
To be audited
Being taken to
Nursing Team
Meetings and
Medical Team
Meetings
Being taken to
Nursing Team
Meetings / to
be audited
With Medical
Director
To
be
completed
Entire Sheet
to be revised
1/04/11Audit of Patients on the
Liverpool Care Pathway (LCP) 30/09/11
at Time of Death
Ensure correct and complete
paperwork is being used.
Ensure all necessary
information is transferred to
the LCP documentation
To be audited
1/04/11Audit of Patients Not on the
Liverpool Care Pathway (LCP) 30/09/11
at Time of Death
All patients to be coded
correctly on iCare.
To be audited
To be audited
- 26 -
Garden House Hospice
Feedback from Patients and Families on Services
Garden House Hospice values the feedback we receive from patients and families; the
Hospice Team is constantly looking for ways to maintain and improve the quality of care
for patients and their family/carers.
Patient Questionnaires are given out during a patient’s stay on the In-Patient Unit, in
conjunction with their first Day Hospice Review (usually the 4th visit) and by the
Hospice @ Home Team, to respite patients, on their fourth visit. Matron reviews returned
questionnaires and acts on any issues raised, immediately. Questionnaires are confidential
but patients are given the option to give their name; if they would like a written response
or the opportunity to comment further on our services. Questionnaires are audited every
six months.
Family/Carer Questionnaires are sent out, via the Family Support Team, with the offer of
bereavement support, six weeks after the patient’s death, given to family/carer on a
patient’s discharge from the In-Patient Unit and displayed around the Hospice for families
and carers to pick up. Matron reviews returned questionnaires and acts on any issues
raised, immediately. Questionnaires are confidential but family/carers are given the option
to give their name and address; if they would like a written response or the opportunity to
comment further on our services. Questionnaires are audited every six months.
Family Support Service Questionnaires are sent out to all individuals who have completed
a series of planned support sessions, with the Family Support Service, within two weeks of
their sessions finishing. The Family Support Service Manager reviews returned
questionnaires and acts on any issues raised, immediately. Questionnaires are confidential
but individuals are given the option to give their name and address; if they would like a
written response or the opportunity to comment further on our services. Questionnaires
are audited every six months.
All questionnaires ask the individual to score statements, about the various Hospice
Services and Departments, from 1 – 4; 1=very dissatisfied, 2=dissatisfied, 3=satisfied,
4=very satisfied N/A=Not Applicable.
Patient Questionnaires
Comments relate to Patient Questionnaires received back between 1.1.2011 and
31.12.2011. During this year 51 Patient Questionnaires were received back.
Care and Support
How satisfied were you with your involvement in planning your care?
§
Scored 127/128; 99% satisfaction
“Both inpatient and day care at the Hospice have been great. I have nothing but praise for
them. I am getting well so quickly because of the care I have received. Thank you.”
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Garden House Hospice
Inpatient
Suitability of bathroom facilities
§
Scored 147/148; 99% satisfaction
“Everything about the hospice is 100% plus, 83 year old. It can not be bettered.”
Hospice at Home
Is the service reliable? (Yes/No response)
§
Scored 22/23; 96% satisfaction
“We find the Hospice at Home Team most helpful, pleasant, friendly and cheerful.”
Family/Carer Questionnaires
Comments relate to Family/Carer Questionnaires received back between 1.1.2011 and
31.12.2011. During this year 152 Family/Carer Questionnaires were received back.
In Patient Care
Quality of your relative’s meals
§
Scored 353/360; 98% satisfaction
“Superb and cheerful décor. Excellent team of cleaners – and always spotless everywhere.
Food fresh and tastey-looking & always appetising for Mum.”
Suitability of environment; Privacy
§
Scored 425/436; 97% satisfaction
“Your staff treated my mum with dignity, respect and compassion. My family and I are so
grateful and appreciative for the help and support you gave us. Thank you so much, from
the bottom of our hearts x x x.”
Day Hospice
How valuable is/was your relatives attendance at Day Hospice to you?
§
Scored 129/132; 98% satisfaction
“Mum found the care & support exceptional and valued her time at the Day Hospice. This
made life easier for the family knowing she was with people who cared and could support
her properly.”
Hospice at Home
Your involvement in planning care
§
Scored 183/192; 95% satisfaction
“Having your team and all the staff visiting P., made us feel part of the team."
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Garden House Hospice
Family Support Service Questionnaires
Comments relate to Family Support Service Questionnaires received back between
1.3.2011 and 29.2.2012. There was a response rate of 68% (42/62).
Do you feel the support from the Family Support Service has been helpful to you?
§
Scored 165/168; 98% satisfaction
“I felt better immediately after my initial phone conversation as the person I spoke to so
clearly understood and wanted to help. My counsellor was so warm and caring. I felt
completely at ease to tell her anything. She listened and gently nudged me towards
feelings and answers that I would never have discovered without her help.”
How likely would you be to recommend the Family Support Service to another person?
§
Scored 168/168; 100% satisfaction
“I went for support with an open mind not sure what I would gain from it. However, I was
very pleased with the way it really helped me to re-evaluate my circumstances and
changes I have made to my life help me cope with the loss of my father. Many thanks.”
Was the time you waited for your first appointment acceptable?
§
Scored 150/160; 94% satisfaction
“I had to wait a long while for it, but when it did start – it was excellent”
On investigation, this individual was assessed on 25/08/10 and allocated a counsellor on
28/09/10; the assessment was for Level 3 support and home visits. Not all Family Support
Service Team Members are able to offer this level of support and the individual did
indicate that they were happy with the way the service had kept in touch with them while
they waited.
- 29 -
Garden House Hospice
External Statements:
NHS Hertfordshire
During 2011/12, The Garden House Hospice provided a high quality and much valued
service to the population covered within Hertfordshire.
The Garden House Hospice has contributed to the wider review and development of
palliative and end of life care services in the County and it plays a vital part in supporting
people to be supported and cared for in their preferred place of care / death.
2012/13 presents new demands for all Hospices including the Garden House Hospice
including establishing its compliance with new NICE guidelines, responding to a more
comprehensive review of the service against agreed performance metrics and responding
to the challenges of adapting to the new environment of clinical commissioning groups.
The Hospices’ positive and enthusiastic support for these initiatives and willingness to be a
partner for improvement will benefit those who need the general and specialised care and
support services that the Hospice offers.
Gordon J Pownall
Community Commissioning Manager - Commissioning Lead for End of Life and Palliative Care
NHS Hertfordshire
Hertfordshire Overview and Scrutiny Committee
To date the Health Scrutiny Committee has provided commentary for the health trusts in
Herts and the ambulance service. The Health Scrutiny Committee (HSC) has to manage
its business efficiently and it does not have the capacity to enlarge its current quality
accounts focus; therefore, HSC has declined to comment on the quality account but this is
no reflection on the services provided.
Natalie Rotherham
Scrutiny Officer, Assurance Services
Resources & Performance
Hertfordshire Local Involvement Network (LINk)
To date (29th June 2012) no response has been received from Hertfordshire LINk.
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Garden House Hospice
NHS Bedfordshire
To date (29th June 2012) no response has been received from the Commissioning
Manager, Palliative and End of Life Care, NHS Bedfordshire.
Bedfordshire Overview and Scrutiny Committee
To help determine the extent of our response are you able to provide any idea of the
number of patients from the Central Bedfordshire area.
From 01/04/2011 to 31/03/2012 Garden House Hospice had 27 Bedfordshire patients
referred to the hospice, 16 of whom were admitted (on 18 occasions).
I have referred this information to Members to confirm that no response is required from
us.
Jonathon Partridge
Scrutiny Policy Adviser
Corporate Services (People & Organisation)
Central Bedfordshire
Bedfordshire Local Involvement Network (LINk)
To date (29th June 2012) no response has been received from Bedfordshire LINk.
- 31 -
Garden House Hospice
- 32 -
Garden House Hospice
Appendix 1: Commissioning for Quality and Innovation payment
framework goals 2011/12
NHS Hertfordshire
3a
Advance Care Planning;
Number of patients offered Advance Care Planning
3b
Care in the Last Days of Life;
Number of In-Patients cared for using the Liverpool Care Pathway
3c
Death in Preferred Place of Choice;
Number of deaths at home under the care of Hospice at Home, plus number of
In-Patient Unit deaths, with Garden House Hospice as the Preferred Place of Death
NHS Bedfordshire
Goal Description of Goal
no.
Quality
Domain(s)
Indicator Indicator name
number
Indicator
weighting
1
Increase the number of
palliative and end of life
patients who have and
advance care plans.
Effectiveness/ 1
Patient
experience
Advance Care
Plan
80%
2
To increase the number of
palliative and end of life
care patients cared for on
the Liverpool Care Pathway
(LCP) during the last days
of life.
Effectiveness/ 2
Patient
experience/
Safety
Care in the last
days of life
>75%
3
Increase the number of
patients who are able to
die in their preferred place
of choice.
Effectiveness/ 3
Patient
experience
Death in
>70%
preferred place of SQU02
choice
Proportion of
deaths in
usual home.
Target 50%
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Garden House Hospice
Appendix 2: Commissioning for Quality and Innovation payment
framework goals 2012/13
NHS Hertfordshire
To improve the care of patients who are on a cancer or palliative care / pathway End of Life –
50% of total CQUIN
Description of
Indicator
For all palliative care patients regardless of diagnosis who are expected to be
within the last year of life, to ensure that they have received the appropriate
assessment and care planning from the provider at key points during their
patient journey.
To ensure: A. A Holistic Needs Assessment is completed at key points for any patient with
cancer, while the patient remains under the active care of the provider, and
at the point of any transfer of care
B. An end of treatment plan is in place where the provider is transferring care
to another provider following active or palliative treatment
C. The offer of an Advance Care Plan for all patients who have been identified
by any provider to be within the last 12 months of life
CQUIN Goal
o To improve the quality of care for patients with cancer and any other life
limiting illnesses.
o Ensuring that the health and social care needs of all patients are
comprehensively assessed.
o To ensure that all patients within the last 12 months of life, regardless of
diagnosis are offered the opportunity to complete an Advance Care Plan
accessible to all professionals who may provide health or social care
support, including emergency services.
Baseline value Quarter 1 data will form baseline. Following the setting of the baseline, value
indicators for quarters 2, 3 and 4 will be set by the commissioner. This will be
based on the expectation within the NICE guidance that 85% of patients will
have had their holistic needs assessed. In addition where relevant 85% of
patients will have received an end of treatment plan and / or will be offered the
opportunity to complete an advance care plan.
Both holistic needs assessment targets and (for patients within the last 12
months of life) Advance Care Plan targets must be met consistently for the full
year to achieve the CQUIN.
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Garden House Hospice
Activity and Performance Reporting – Informing strategic planning – 50% of total CQUIN
Description of
Indicator
The reporting of all patient activity regardless of diagnosis who have received a
service from the provider in any setting.
The key elements of this indicator upon which the providers will be measured
will be evidence of: a. Reporting template completion and return to the Commissioner applying
agreed definitions of data reporting to maintain reporting consistency
across all providers of similar services
b. Achieving the timescales for reporting as defined within the CQUIN
c. Achieving data completeness in terms of detail ensuring that gaps in data
do not exist in any aspect of the information required
d. Use of the agreed template to facilitate collation of all reporting across a
range of services and settings
CQUIN Goal
o To improve planning of quality care for patients on an end of life pathway
o To ensure that Commissioners have access to comprehensive activity data
to facilitate strategic planning
o To evidence activity across Hertfordshire Hospice provider services to
inform benchmarking reviews and correlate financial investments with
referral and discharge activity across the wider population
o To improve the use of existing service provision through understanding
current activity and trends
Baseline value Quarter 1 will form baseline for review of the reporting template. Following the
setting of the baseline, value indicators for quarters 2, 3 and 4 will be set by
the commissioner. This will be based on the expectation of full data completion.
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Garden House Hospice
NHS Bedfordshire
Goal
no.
Description of Goal
Quality
Domain(s)
Indicator Indicator name
number
1
The development of internal
pathways, that include key
trigger points to deliver and
embed NICE Quality
Standards into service
delivery.
Effectiveness/ 1
Patient
experience
1a
(I)
Effectiveness/ 1a
To develop and implement
Patient
clear systems and processes
experience
for staff to follow when
communicating and providing
information appropriate to
the stage reached by the
person who is approaching
end of life and for responding
to people’s change in
circumstances.
1a
(II)
Appropriate education and
training is delivered to staff
to ensure they are confident
to communicate and provide
information to patients,
families and carers.
1a
(III)
NHS Bedfordshire patients,
families and carers are
provided with information on
PEPS.
1b
(I)
To develop and implement
systems and procedures for
the provision of
comprehensive holistic
assessments in response to
the changing needs of the
patients, families and carers.
1b
(II)
To have clear systems and
processes in place for
referring NHS Bedfordshire
patients to PEPS.
Effectiveness/ 1b
Patient
experience
Indicator
weighting
Deliver and
embed NICE
Quality
Standards.
100%
QS 2:
Communication
and Information.
100%
QS3:
Assessment, care
planning and
review.
100%
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Garden House Hospice
- 37 -
Garden House Hospice
Gillison Close
Letchworth Garden City
Herts
SG6 1QU
Telephone: 01462 679540
E-mail: enquiries@ghhospice.co.uk
Website: www.ghhospice.co.uk
North Herts Hospice Care Association Registered Charity Number 295257