Iain Rennie Grove House Hospice Care
Quality Account
2012 - 2013
Vision Statement
Mission Statement
Iain Rennie Grove House Hospice Care
passionately believes that every adult and child
with advanced progressive, life-limiting illness,
deserves and should receive the care they
need to live as fully as possible at home or
wherever they choose to be, to the very end of
their life.
1
Part 1
IRGH Chief Executive/ Trustee Chairman Statement
It gives me great pleasure to present the first Quality Account for Iain Rennie Grove House
Hospice Care (IRGH) for 2012/2013. We welcome the opportunity to provide the wider
population with an annual report about the high quality of services we provide for our
patients and carers. This report allows us to demonstrate to the public, our stakeholders,
our trustees and our staff the commitment we have to quality improvements so that we can
give the best possible quality care to all our patients and their carers, at the same time
delivering a cost effective service.
Quality is at the heart of all IRGH does and we evidence that through Clinical Governance
which ensures continuous quality monitoring, in which any shortfalls are identified and
acted upon quickly. It also ensures a patient centred service and one that can deliver the
aspirations laid out in our Mission Statement.
The recent merger of the two hospices, Grove House and Iain Rennie Hospice at Home
has successfully brought wider local benefits to more patients and families – and has put
us in a strong position to face tough care and funding challenges as patient numbers and
diversity of needs continues to increase. In the last year IRGH has cared for over 2,500
patients and their families - around 10% more than in the previous year because more
patients are turning to us for support. We provide our care at no cost to our patients and
families thanks to huge local fundraising and our hospice shops which pay for 85% of the
costs of our care.
Our high quality care is only possible thanks to our dedicated staff and the commitment of
over 1,500 volunteers.
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 health care services we provide.
Mark Lister
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Part 2
Priorities for improvement and statements of assurance from the Board (in regulations)
Improvement
The Board of Trustees did not submit a report for 2011-2012 but IRGH is fully compliant
with the National Minimum Data set and has recently been registered as a merged
organisation with the Care Quality Commission. At the time of report we have not had an
inspection.
The priorities for quality improvement we have identified for 2012/13 are set out below.
These priorities have been identified in conjunction with staff, stakeholders and as far as
possible by consulting our patient and carer group. The priorities we have selected will
impact directly on each of the priority areas:
Patient safety
Patient experience
Clinical effectiveness
1a
Priorities for Improvement 2012-2013
Patient Safety
Priority One
Mandatory training is the term used to cover all training that IRGH must provide in order to
comply with legislation, Care Quality Commission standards and best practice guidance.
All clinical staff will complete a modular mandatory workbook which will ensure that their
compulsory training needs are met as well as some of their in house training requirements.
Non-clinical staff and volunteer training requirements will be met using individual sections of
the workbook that are appropriate to their roles. The workbook contains a wide range of
modules that reflect the IRGH current policies and procedures. The portfolio includes health
and safety, infection control, safeguarding vulnerable adults and children and equality and
diversity. At the end of each module the staff member is required to complete a short
knowledge questionnaire to ensure understanding of the programme. This workbook will
complement the current induction programme, and the in house training that is already
provided.
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How was this identified as a priority?
This was identified as a priority after mandatory training records illustrated staff members
had difficulties accessing external mandatory training courses due to their increasing
clinical case loads. A reduction in places available to IRGH, an independent healthcare
setting, also meant NHS training courses were becoming less accessible to our staff. It
was also identified as a cost-effective exercise due to reduction in travel costs, staff time
and any training course charges.
How will priority one be achieved?
A pilot of the workbook has already been completed using the Infection Control module
with positive feedback from staff. The workbook has been individualised to reflect local
training needs and will be rolled out to all clinicians in the next couple of months.
How will progress be monitored and reported?
Progress will be monitored through IPR, 1:1 updates with line managers and reported to
Clinical governance committee via our Professional Development Lead.
competencies will be monitored in this way.
Individual
Staff feedback will be analysed through the
Education service review due in 2013. The completion of the workbooks will be recorded
and the learning monitored through the appraisal process. Patient safety will be prioritised
as all clinical staff will be trained and will receive annual updates in their mandatory
training. Non-clinicians will also be assured of the training they require annually for their
roles.
Priority two
Clinical Effectiveness
IRGH has recently merged with Grove House based in St. Albans and we are now able to offer
a wider range of patient clinical services, including a day hospice, within Hertfordshire with the
strategy to expand these services in to Buckinghamshire in the near future. We recognise that
in order to ensure a co-ordinated seamless service for our patients and their families we need to
enhance our professional working relationships with other health care providers. We will be
sending a health care professional’s satisfaction questionnaire to all our colleagues which will be
analysed and an action plan made and implemented.
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How was the priority identified?
A satisfaction questionnaire was last completed in 2003 and indicated that there were
some services that local health care professionals had a lack of information about, in
particular the family support service and the paediatric nursing team. Due to the recent
merger and in order to improve patient care and continuity IRGH realised a need to raise
awareness of all available services, ascertain satisfaction with services provided as well as
the level of satisfaction with communication and liaison between us and our health care
professional colleagues.
How will priority two be achieved?
A survey will be distributed to all GP’s, District nursing teams, Community Specialist
nurses, Site Specific Macmillan nurses, Children’s Community staff, Community Matrons,
Allied Health Professionals, Intermediate Care teams and local hospice settings.
The
short survey will be given out by the nurses attending multi-disciplinary team meetings,
and Gold Standard Framework meetings with a request to complete the survey by the next
meeting.
How will progress be monitored and reported?
Progress will be monitored by sending a reminder via email to all groups with the aim of
maximising responses in order to gain reputable data. All the data will be analysed and
the full results and findings circulated to all clinical staff, trustees, the clinical governance
committee and our patient and carer group.
An action plan will be formed through
discussion with senior management and disseminated to all staff. All qualitative data will
be analysed and discussed and feedback will be acted upon to ensure good, stable
working relationships with all health care professionals we liaise with.
Priority Three
Patient Experience
Patient’s experience will be enhanced by the rollout of the Communication and Documentation
Protocol for Advance Care Planning within the Hertfordshire IRGH nursing teams. The aim of
the protocol is to improve the documentation of patients Advance Care Plans (ACP) and prompt
discussions, along with improving the internal and external communication of patient’s ACP. An
ACP Checklist will be placed in the shared patient’s records with their consent which will inform
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other health care professionals of the progress of patient’s end of life discussions.
How was the priority identified?
A snap shot audit was carried out in the St. Albans team patient records and the results
showed that end of life conversations and advance care plans were not easily identifiable
amongst the electronic patient documentation. This led to a risk of duplication of end of
life conversations with patients and their carers. As part of a degree being completed by a
clinical nurse specialist a pro-forma for documenting advance care plans has been written
and is being piloted in the St. Albans and Harpenden Hospice at Home teams. It is
envisaged that more patients should realise their preferred place of care (PPC) as their
wishes are easily accessible amongst all their documentation. An increase in the numbers
of patients realising their preferred place of care is also linked to IRGH CQUIN payment
framework.
How will priority three be achieved?
Internal staff training sessions during team meetings are planned and aimed at
establishing this communication and documentation protocol in all clinical teams. Follow
up prompting sessions will also take place.
How will progress be monitored and reported?
A repeat audit of patient electronic records will take place in early 2013 to establish the
use of the protocol and an action plan will be formed and be reported on. All patients’ PPC
are recorded on referral and the analysis of whether these wishes were achieved and a
comparison with last years figures will illustrate improved patient experience.
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STATEMENT OF ASSURANCE FROM THE BOARD
The following are statements that all providers must include in their Quality Account. Many
of these statements are not directly applicable to specialist palliative care providers, and
therefore explanations of what these statements mean are also given.
2a. Review of Services
•
During 2012/13 it is IRGH intention to provide NHS Hertfordshire Trust and NHS
Buckinghamshire Trust’s commissioning priorities with regard to the provision of local
specialist palliative care in the community by providing:
•
Part funded Hospice at Home
In addition IRGH will support the Trusts by providing the following services through
charitable funding:
•
Day Hospice
•
Occupational Therapy
•
Physiotherapy
•
Home sitters
•
Cancer Information
•
Complementary Therapies
•
Cancer the Next Step
•
Family support Services, including bereavement support services and spiritual
care
•
The income generated by the NHS services reviewed in 2011/12 represents below
15% cent of costs of our care generated from the provision of NHS services by IRGH
for 2011/12.
The palliative care funding review in 2011/12 is focused on the provision of community
hospice at home specialist palliative care. Iain Rennie Grove House Hospice Care is
funded through an NHS grant and the remaining income is generated through fundraising
activity, shops, lottery activity and investments.
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2b. Participation in Clinical Audit
•
During 2011/12 and prior to this document, no national clinical audits or confidential
enquiries covered NHS services provided by IRGH.
•
During that period IRGH participated in no national clinical audits and no confidential
enquiries of the national clinical audits and national confidential enquiries as it was
not eligible to participate in any.
•
The national clinical audits and national confidential enquiries that IRGH eligible to
participate in during 2011/12 are as follows: NONE.
•
The national clinical audits and national confidential enquires that IRGH participated
in during 2011/12 are as follows: Not applicable
•
The national clinical audits and national confidential enquires that IRGH participated
in and for which data collection was completed during 2011/12 are listed below
alongside the number of cases submitted to each audit or enquiry as a percentage of
the number of registered cases required by the terms of that audit or enquiry. Not
applicable
•
The reports of 0 national clinical audits were reviewed by the provider in 2011/12.
This is because there were no national clinical audits relevant to the work of IRGH
Hospice Care.
•
IRGH 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.
What this means:
As a provider of specialist palliative care IRGH is not eligible to participate in any of the
national clinical audits or national confidential enquires.
This is because none of the
2011/12 audits or enquiries related to specialist palliative care. The Hospice will also not
be eligible to take part in any national audit or confidential enquiry in 2012/13 for the same
reason.
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2c. Research
The number of patients receiving NHS services provided or subcontracted by IRGH in
2011/12 that were recruited during that period to participate in research approved by
a research ethics committee was NONE.
2d. Use of the CQUIN payment framework
1% of IRGH income in 2012/13 is CQUIN dependant and conditional on achieving
quality improvement and innovation goals agreed between IRGH and any person or
body they entered into a contract, agreement or arrangement with for the provision of
NHS services, through the Commissioning for Quality and Innovation payment
framework.
2e. Statement from the Care Quality Commission
IRGH Hospice care is required to register with the Care Quality Commission and is
currently registered to carry out the regulated activity:
Treatment of disease, disorder or injury and personal Care.
Statement of reasons
The registration of the provider of these regulated activities is subject to a registered
manager condition under Regulation 5 of the Care Quality Commission (Registration)
Regulations 2009
These regulated activities may only be carried out from the following locations:
Grove House
Gillian King House
52a Western Road
Waverley Road
Three Households
Tring
St. Albans
Chalfont St. Giles
Herts
Herts
Bucks
HP23 4BB
AL3 5QX
HP8 4LS
T 01727 731000
T 01494 877200
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T 01442 890222
The Care Quality commission has not taken any enforcement action against IRGH
during 2011/12.
IRGH Hospice has not participated in any special reviews or investigations by the
Care Quality Commission during 2011/12 and at this moment in time are awaiting an
inspection.
2f.
Data Quality
Statement of relevance of Data Quality and your actions to improve your Data
Quality.
IRGH did not submit records during 20011/12 to the Secondary Users service for
inclusion in the Hospital Episode Statistics which are included in the latest published
data.
What is this?
This is because IRGH is not eligible to participate in this scheme. However, in the absence of
this we have our own system in place for monitoring the quality of data and will be installing a
new electronic patient information system during 2012/13 with the aim of combing the nursing
and clinical services data bases. This is important because, with the patients consent, we
share data with other health professionals to support the care of patients in the community.
An audit of the signing of patient consent forms occurs annually.
2g.
Information governance toolkit attainment levels
We will be putting in place the relevant framework documentation, polices, training, and
security infrastructure to be able to report on attainment levels in 2012/13. This means
that we will be compliant with Connecting for Health’s standards and provide patients with
the confidence that their information is dealt with safely.
2h.
Clinical coding error rate
IRGH Hospice was not subject to the Payment by results clinical coding audit during
2011/12 by the Audit Commission. This is because IRGH Hospice receives payment
under a block contract and not through tariff and therefore clinical coding is not relevant.
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Part 3: Review of Quality Performance
Following our recent merger IRGH is in the process of consolidating our data from the
clinical, nursing and family support databases. This will occur in 2012/13 and next year we
will present information from the NCPC minimum data set which is the only information
collected nationally on hospice activity.
Quality Markers we have chosen to measure – out of hours care.
In addition to the limited number of suitable quality measures in the national data set for
palliative care, we have chosen to measure our performance against the following:
Clinical Complaints
Deaths At Home
Patients Achieved Preferred Place of Care ( if wish expressed)
Medication Errors
Clinical Adverse Incidents
INDICATOR
April 2011/12
Total number of complaints (clinical)
4
The number of complaints completed
3
The number of complaints process ongoing
1
INDICATOR
April 2011/12
No. Patient Deaths at Home
441
No. Patient’s achieved Preferred Place of
566
Care ( if wish expressed)
INDICATOR
April 2011/12
Medication Errors
7
Clinical Adverse Incidents
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All medication errors are debriefed by the Locality Nurse Manager and the learning for the
individual or the team as a result of the incident is identified. The Professional Education
Lead trains staff using the incidents as scenarios and the outcomes will be shared to all
staff via the nursing and clinical audit group representatives. The Clinical Governance
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Committee will discuss all incidents and a report of high risk events will be sent to
Trustees.
Clinical Audit
Clinical audit is a way in which the organisation can learn and improve the delivery of its
services, the outcomes for patients and the experience they have. The Clinical Audit
groups have undertaken a programme of audits during 2011/12 including infection control
which is based on national audit tools designed specifically for hospices. Clinical staff are
involved in the audit processes and a number of staff have led audits, in particular the
reviews related to the family support service and hand hygiene. If issues are identified
during audit an action plan is developed and reviewed. Progress on the action plans is
monitored through the Clinical audit groups and reported to the Clinical Governance
Committee to ensure that they are completed. We will then undertake a further audit to
see if the actions we have taken have resolved the issues identified.
The table on the following page shows the audit plan that will be undertaken in 2012
IRGH Audit plan 2012
•
•
•
•
Audit
Independent Nurse prescribing
Clinical governance newsletter (Biannual)
Infection Control (Laundry) (GH
building)
Provisional start date for 1:1
bereavement visitor review
Month
June 2012
•
•
•
COSHH audit
Living with Cancer – MYCAW review
Provisional start date for implementing
CORE with counsellors
July 2012
•
Patient records (clinical services)
August 2012
•
•
•
Consent (all services)
Infection control GH building
Data Protection (including
confidentiality) (all 3 sites)
Patient records (H@H) Using the Help
the Hospices Community audit tool
Review Quality Accounts priorities
September 2012
•
•
12
•
•
•
•
•
•
•
•
•
Living with Cancer/2nd MYCAW review
Prep/training for Cambridge Carer’s
research project (CSNAT)
Lone worker/out of hours audit
October 2012
CSNAT Cambridge Uni carers’
research project start
Evaluation of life coaching (MYCAW)
Syringe driver audit
Winter clinical governance newsletter
Review Quality Accounts priorities
Medicines management
November 2012
December 2012
Feed back from patients and carers on services.
We value the feedback we receive for patients and their carers as this is an important way
in which staff can identify issues, resolves problems and improve the quality of the care we
provide. As part of our commitment to ensuring patients and their carers have a voice we
send Hospice at Home patients a survey after 6 clinical visits and a carer satisfaction
survey 6 weeks post bereavement. The patients and their carers who receive clinical
services based at Grove House receive a survey once every 6 months. These surveys are
evaluated every 6 months and the results sent to all clinical staff including trustees. The
surveys are anonymous but where concerns are raised and the respondent can be
identified, their issues are followed up and resolved to learn from what went wrong. As
required by Care Quality Commission (2009) Essential Standards of Quality and Safety
the questions asked to the patients and carers reflect their treatment and the care they
received from the services.
The Patient Satisfaction Survey October 2011– March 2012
Patient response rate for H@H October 2011 – March 2012 was 78%
The response rate for patients referred to Grove House was 42%
Question
Response
Skipped
question
Answer
Results
Sep 11
On the whole do you find
the experience of H@H
caring for you:
95
1
Very satisfactory
Satisfactory
Dissatisfactory
Very dissatisfactory
84%
16%
13
Results Mar 12
79
14
1
1
83%
15%
1%
1%
Question
Response
Skipped
question
64
1
Question
Response
Skipped
question
Do you feel your privacy
and dignity are
respected?
92
4
Question
Response
Skipped
question
Do you feel your privacy
and dignity are
respected at Grove
House?
61
4
Question
Response
Skipped
question
89
7
Response
Skipped
question
62
3
Question
Response
s
Skipped
question
Do you feel you are
treated with courtesy by
H@H staff?
94
2
Question
Response
Skipped
question
Did you feel you were
treated with courtesy by
the Grove House staff?
50
15
Grove House
On a scale of 1 – 10 (1 =
poor and 10 = excellent)
how would you rate the
quality of care/treatment
that you received?
Do you feel the IRGH
staff make an effort to
meet your individual
needs and wishes in
relation to culture, faith
and disability?
Question
Do you feel the IRGH
staff make an effort to
meet your individual
needs and wishes in
relation to culture, faith
and disability at Grove
House?
Answer
10/10
9/10
8/10
7/10
6/10
Answer
Always
Most of the time
Some of the time
Never
Answer
Always
Sometimes
Occasionally
Never
Answer
Always
Most of the time
Some of the time
Never
Answer
Always
Most of the time
Some of the time
Never
Answer
Always
Most of the time
Some of the time
Never
Answer
Results
Sep 11
62.5%
25.0%
10.7%
1.8%
-
Results
Sep 11
96%
3%
1%
Results
Sep 11
98%
Results
Sep 11
88%
12%
Results
Sep 11
100%
Results
Sep 11
99%
1%
Results
Sep 11
Results Mar 12
42
14
6
1
1
Results Mar 12
89
2
1
97%
2%
1%
Results Mar 12
61
100%
Results Mar 12
82
5
1
1
92%
6%
1%
1%
Results Mar 12
62
100%%
Results Mar 12
87
6
1
93%
6%
1%
Results Mar 12
50
14
65%
22%
9%
2%
2%
100%
Some of the comments we have received from our patients in the last six months:
•
•
•
•
•
They were always there when I needed them and I couldn't have wished to have
been treated any better with such lovely people
I have nothing to add except to say members of your team are unfailingly kind,
helpful and friendly. Well done!
Completely happy. Very reassuring to know that there is someone on the end of
the phone all the time
(Do you have confidence in the staff) - The staff are always highly professional. Their
knowledge of drugs suitable for my personal problem is impressive and effective
(Were you given the opportunity to ask about your fears and worries?) – To me this is one
of the best bits - always heard sympathetically and reassuring.
The Carer Satisfaction survey October 2011– March 2012
Carer response rate for H@H October 2011 – March 2012 was 63%
Question
On the whole did the
service you received
from H@H meet your
expectations?
Question
Responses
152
Responses
Skipped
question
1
Answer
Yes
No
Skipped
question
On the whole did the
service you received
from Grove House meet
your expectations?
Results
144
8
Answer
Yes
No
94.7%
5.3%
Results
100%
Some comments made by carers selected from the recent survey
Overall did you have confidence in the staff you met?
•
•
•
•
Always professional and the family were confident with everyone we met
The staff went out of their way to explain everything to XX & asked her how she
wished to be addressed. XX felt included in all the decision making, in fact she was
in control
Everyone gave exemplary service and kindness and compassionate consideration.
They were all very professional but also considerate
True professionals.
Overall did you understand the explanations given to you by IRGH about the treatment, choices and
care being offered?
• Being an SRN I wished to nurse my husband myself. I was supported in my wish at
all times by XX. I felt I had a friendly, supportive colleague whose experience was
invaluable.
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• Were punctilious about checking that we did understand - and going over areas of
concern again.
• The information was clear, not at all patronising and usually given sitting down!
Which gave time to reflect and absorb.
Did you have the opportunity to talk about your individual needs, concerns and preferences?
• They were never in a rush to get away which made us feel relaxed
STATEMENTS ENDORSING IAIN RENNIE GROVE HOUSE QUALITY ACCOUNT
2012-2013
Statement from the Buckinghamshire Health Scrutiny Committee
The Chairman of the HOSC does not feel that the committee would be in a position to
contribute to your quality account report this year. Thank you for offering us the
opportunity.
Statement from Buckinghamshire Community Commissioning ManagerNHS Buckinghamshire response to Iain Rennie Grove House (IRGH) Hospice Care
Quality Account 2012/13
NHS Buckinghamshire and their constituent Clinical Commissioning Groups have
reviewed the Buckinghamshire Healthcare Trust’s Quality Account against the three
domains of quality: patient experience, patient safety and clinical effectiveness. There is
evidence that IRGH has relied on both internal and external assurance mechanisms and
the commissioners are satisfied as to the accuracy of the data contained in the Account.
Within the report the Hospice clearly identifies their achievements to date, but also areas
within their service delivery requiring improvement. The PCT welcomes the openness of
this approach and is committed to supporting the organisation in achieving improvement in
the areas identified within the Quality Account through existing contract mechanisms and
collaborative working.
One of the purposes of the Quality Account is to support the IRGH Board in assessing
quality across the totality of the services they offer. The document does this. The other
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purpose is to help patients assess the quality of services and make choices between
different providers. The commissioners would encourage that IRGH further develop ways
of supporting patients in making informed choices based on quality of services.
Patient experience
IRGH clearly demonstrates that it values feedback about the patients’ experience and
uses this to help shape improvements for the future.
The commissioners note the feedback from patients and carers which are reviewed every
six months. The Commissioners were pleased to note the level of patient satisfaction,
however would like to see how Iain Rennie use the patient experience where there have
been complaints to improve services.
Patient Safety
The commissioners note the work of the audits undertaken by The Clinical Audit groups
and the outlined plan for 2012/13. Iain Rennie has highlighted that the last questionnaire
was completed in 2003. Commissioners would like to see what lessons have been learnt
since then and as a result any consequent improvement plans that were put in place.
Clinical effectiveness
For 2011/12 Commissioners note the quality markers within the quality account, however
would recommend that they were presented in a percentage format against the overall
caseload to facilitate benchmarking.
The Future
The 2012/13 priorities contained in the Quality Account are consistent with priorities
agreed with NHS Buckinghamshire in improving the care of patients accessing these
services.
Conclusion
This Quality Account provides a comprehensive overview of the quality of care within the
Iain Rennie Grove House Hospice and commissioners look forward to continuing to work
alongside Iain Rennie in meeting the quality aspirations of local users, carers, partners and
staff.
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Statement from the Hertfordshire Health Scrutiny Committee
To date the Health Scrutiny Committee has focused on the NHS bodies in Herts or trusts
with substantial involvement in Herts (e.g the ambulance service). It is unlikely that
members have the capacity to greatly enlarge this. I am sorry that we are unable to assist
your organisation's quality account commentary.
Statement from Hertfordshire LINk – Local Involvement Network
Hertfordshire LINk’s response to Iain Rennie Grove House Hospice Care Quality
Account
Hertfordshire LINk has read your Quality Account with interest and thanks you for the
opportunity to comment on it. However we do not feel that we are in a position to make
comments about the quality of service provided this year.
We look forward to hearing about your progress on your chosen priorities.
Henry Goldberg, Chair Hertfordshire LINk, June 2012
Statement from Hertfordshire Community Commissioning Manager- Commissioning
Lead for End of Life and Palliative Care
During 2011/12, IRGH Hospice continued to provide a high quality and much valued
service to the population covered within Hertfordshire. Further investment in end of life
care through the Hospice will commence in 2012/13, expanding the Hospice at Home
service through a partnership between NHS Hertfordshire (and the emerging clinical
commissioning Groups) and the IRGH Hospice.
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IRGH 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 IRGH 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.
June 2012
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