Isabel Hospice Quality Account
2012 – 2013
MISSION STATEMENT
To maximise the quality of life of those living with cancer and other lifelimiting illnesses; to provide high quality specialist palliative care
including support for those who are in the terminal phase of their illness
and to support the families and carers of patients and to continue such
support into bereavement.
“I have been most impressed with the very high standard of care and food,
which is delicious. Unfortunately, I was admitted quite quickly and did not
have any details of what to expect. I did not know what to bring in or leave
behind. Overall, an absolutely wonderful experience. I would have no qualms
to come again.”
Isabel Hospice
61 Bridge Road East
Hertfordshire
AL7 1JR
Registered charity number: 1046826
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1. Statement from the Chair, Chief Executive and Hospice Director
It gives us great pleasure to present the inaugural Quality Account for
Isabel Hospice for 2012/13. The Hospice is an independent charity
(registered number 1046826) and is constituted as a company limited by
guarantee.
Care and support is provided through an integrated team of Community Nurse
Specialists; Hospice at Home nurses and support workers; a day Hospice
service in four geographically spread locations; and a twelve bed in patient
unit, together with family support team members offering pre- and postbereavement counselling, psychosocial and spiritual care. We also provide
benefits advice, complementary therapies and a twenty four hour seven day a
week advice line. The charity does not charge patients, carers or their
families for any of the services provided.
The charity is run by a Board of Trustees and has strong corporate and
clinical governance arrangements. Quality is at the heart of the service
provided. We evidence this through the Board’s approach to corporate and
clinical governance, and our commitment to staff training and
development.
We develop, implement and maintain systems and processes to ensure
that we grow as a viable and responsible organisation, meeting the needs
of the communities we serve. We ensure that our services are of the
highest quality and deliver the aspirations set out in our mission statement,
philosophy and strategy.
Our philosophy is about recognising the uniqueness of each individual,
valuing their autonomy and promoting choice; it also recognises that each
patient is in a continual state of change – physically, emotionally and
spiritually and that staff are sensitive to these changes, providing care that
is competent, sensitive and compassionate.
Our service is about putting the patient’s needs first, treating them as
individuals with dignity and respect and looking ahead to meet their needs
in a constantly changing healthcare climate. Feedback from patients,
relatives and carers in the form of forums and satisfaction surveys is used
to develop service provision.
Quality is a key factor in our delivery of care and therefore emphasis is set on
having clear achievable standards which are monitored and regularly audited.
Hospice management aims to ensure that every member of staff and
volunteer feels valued and then has appropriate access to regular support
and/or clinical supervision. The views of staff are sought through a staff forum
and findings form the ongoing review of the organisation’s corporate and
clinical strategies.
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We recognise that the excellent care provided cannot happen without the
knowledge, skills and support of the whole Isabel Hospice team, including
the valuable contribution of volunteers and so our thanks go to all of them
at this time. To enable all staff to support the charity’s mission statement,
objectives and strategy, we invest in staff continuing professional
development; ensuring competence is assessed and maintained.
In the past year the Board has strengthened the governance processes
and management by introducing more focused Board committees including
Clinical Governance and by the appointment of a new position; a Head of
Quality, Clinical Compliance & Training.
Also during 2011/12 Isabel Hospice began to implement the Productive
Ward (this is part of the national initiative called Quality, Innovation,
Productivity and Prevention) which is aimed at ensuring the organisation
maintains the highest levels of quality whilst promoting efficiency and cost
effectiveness. A team of nurses and nursing assistants lead this initiative
and have been delighted at the impact it has had on improving their ability
to provide more timely and efficient care.
Several nurses within the inpatient unit have additional lead
responsibilities, e.g. diabetes, wound care, infection prevention and
control,. This enables quality improvement to be led by nurses with
specialist interests by working directly with clinical colleagues to determine
standards and education needs.
Prevention of infection is given a high priority and this is reflected in the
Infection Control Strategy 2011.
We are delighted to present this Quality Account for 2012/13 and, to the
best of our knowledge the information contained therein is accurate.
Signature:
Charles Lewis, Chairman, Board of Trustees
Signature:
Nigel Furlong, Chief Executive
Signature:
Helen Dodd, Deputy Chief Executive and Hospice Director
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2. Priorities for improvement and statements of assurance from the
Board 2012/13
Isabel Hospice is committed to continuously reviewing the quality of care
delivered to its patients. Monitoring occurs in clinical and department team
meetings; the Board and sub-committees of the Board such as the Clinical
Governance Committee; Audit and Risk; Trustees annual inspection; Clinical
Audit Forum; analysis of incidents and complaints; undertaking patient and
relatives surveys; clinical audits; self assessment against the Care Quality
Commission and the collection of the minimum dataset required by the NHS
all of which is regularly reported to and reviewed by the Board. This list is not
exhaustive, merely indicative of the amount of quality monitoring undertaken
at the Hospice.
Monitoring is supported by the use of strong information management such as
Crosscare, the Electronic Patient Record.
2.1 Future planning priorities
Priorities for improvement – Patient Safety
An analysis of patient safety incidents in 2011/12 has revealed that there is
the potential to reduce the number of drug errors and improve the
management of drug errors that may be under-reported; and the number of
slips, trips and falls incidents could be reduced. These are therefore the
priority for improving patient safety in 2012/13. The Trustees annual
inspection also identified falls in patients as an area for improvement.
Priority one
A) Falls
By the end of 2012/13, the charity aims to reduce the number of falls by a
minimum of 10%, compared to 2011/12.
How this will be achieved
 Through review of the incidents to date
 Review of the data collected to ensure trends are better identified
 Review of the use of assessment tools to identify those at risk
 Review of the effectiveness of any aids used
 Review the information needs of patients and their families
 Review national guidance and best practice such as that developed by
the NHS Institute for Innovation and Improvement and the National
Institute of Health and Clinical Evidence
 Review the Isabel Hospice falls strategy and its implementation
 Strengthen the departmental role for managing the prevention of falls;
supporting better health and personal wellbeing
 Review of care practices; managing gaps in care
 Strengthening the patient rounds and ensuring they are documented
on Crosscare
 Staff training and development
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
Clinical audit
This will be supported by the Quality, Compliance and Education department
and monitored through the Clinical Audit and Effectiveness Forum.
B) Reduction in the number of drug errors and an improvement in the
management of drug errors
The number of drug errors are low, however, Isabel Hospice would like to
reduce the number of drug errors and improve the management of any that
occur as we recognise that any drug error can be a source of additional
anxiety to the patient and the family.
How this will be achieved
 Thorough review of the incidents to date to clearly identify gaps in the
investigation and management
 Review of medicines management policy and its implementation
 Strengthen the role of the nurse with responsibility for medicines
 Clinical audit
 Continue the implementation of the competencies developed for all
nurses in relation to syringe drivers, controlled drugs, general
administration of medicines via a number of routes
 Ensure nurses are up to date with intravenous therapy administration
and blood transfusion
How this will be monitored and reported
Progress with reducing the number of incidents for both priorities will
monitored through a number of mechanisms:
 Clinical Audit
 Drugs and Therapeutics Committee
 Clinical Governance Committee, through to,
 The Senior Management Group and Board of Trustees
Priorities for improvement – clinical effectiveness
The charity recognises that clinical effectiveness is not achievable unless
there are skilled and competent staff. At the same time, it is not possible to
confirm this without having a patient information management system to
document all aspects of care planning and delivery. Our priorities therefore
for clinical effectiveness are to implement e-learning as a means of improving
education for clinical staff and continuing to develop the patient information
management system.
Priority two
A) Implement e learning and continue roll out of competencies
Isabel Hospice recognises that people learn in a variety of different ways and
that a variety of mechanisms for learning are best provided. During 2011/12
the charity commenced a review of e-learning packages for introduction in
2012/13. In addition the Competencies Working Group developed a range of
competencies in relation to high risk elements of clinical care and
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implemented a competency for record keeping. This requires continued roll
out during 2012/13.
How



this will be achieved
Pilot two modules – data protection and manual handling
Evaluate learning from the modules
Introduce any changes to the modules and develop a plan to introduce
other suitable modules; identifying leads to design the modules
according to best practice
 The Compliance and Training department will work closely with clinical
senior staff to ensure robust roll out of competencies and the
development of future ones according to clinical risk and policy needs.
How this will be monitored and reported
 Review and update the Education and Training Strategy
 Implement an Education & Training Strategy committee to oversee the
continuous development and implementation of all areas of education
and training.
 In addition, the roll out of the competencies will be closely monitored by
the Quality, Compliance and Training department
 Reports on progress will go to the Liaison committee and Senior
Management Group
B) Development of patient information management system
Crosscare is the charity’s patient information management system that
documents all aspects of clinical care – documenting their physical,
psychological, emotional and spiritual needs and the delivery of care. All
members of the multidisciplinary team can input and view records and the
system can be accessed by all care professionals across inpatient and
community services.
As well as documenting care needs and delivery it is a mechanism for audit
across all areas of Hospice care provision.
How this will be achieved
 The Crosscare Enhancement Group has identified its priorities for
implementation along with timescales
 Close working with the Quality, Compliance and Training department
ensures development considers best practice and ease of audit.
 Regular meetings will be held to ensure enhancement of the system
meets objectives.
How this will be monitored and reported
This will be monitored through the Crosscare Enhancement Group to the
Clinical Audit and Effectiveness Committee.
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Priorities for improvement – patient experience
Priority three
A) Agree service strategy with East & North Herts Clinical
Commissioning Group
The current contract for services with the PCT expires in March 2013, so our
priority is to agree the service configuration with the new Clinical
Commissioning Group (CCG), ready for April 2013 and beyond.
The focus of the strategy will be on providing patients with the best possible
experience in the place they call home, commensurate with their safety and
their family’s/carers needs. This will entail revising the balance of resources
deployed by the Hospice with the community nurses and the inpatient unit and
improving the quality of service delivery in the community by all healthcare
professionals.
Measures
 Increased achievement of preferred priorities of care
 Avoidance of unnecessary and/or inappropriate admissions to hospital
How this will be monitored and reported
The Senior Management Group will monitor progress, using accurate data
collected from Crosscare and the skills of the auditor. Reports will be
received by the Board from the Clinical Governance Committee
B) Planning for reconfiguration of services at QE2 site in Welwyn
Garden City
The Hospice’s inpatient unit is currently attached to the QE11 hospital which
will be replaced by a new local general hospital on an adjacent site by the
middle of 2014. The Hospice is exploring options for a major rebuild that will
put the patient experience at the heart of the design concept.
The project team is examining the options for facilities that meet the needs of
patients that are not better able to be addressed in the community, starting
with a drop in centre for those recently diagnosed through day care to
intensive specialist care.
The initial strategy development and design briefing has so far involved staff
and our professional advisers, but later stages, in particular the detailed
design briefing given to architects, will involve a wider range of stakeholders
including GPs and other healthcare professionals, our catering and cleaning
contract partners and patients themselves.
Success criteria
 Ease of access
 Ease of use
 Patient satisfaction with services, physical environment and ambiance
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How this will be monitored and reported
The Board of Trustees will receive regular reports from the Senior
Management Group and Project team.
2.2 Statements of Assurance
The Hospice undergoes a series of reviews – internal and external reviews
throughout the year.
Internal
Trustee’s unannounced inspection
The Trustees undertake an annual unannounced inspection. This inspection
looks at the quality of the care environment, quality of care and quality of
documentation and interviews patients, their families, Hospice staff and
volunteers to inform their findings. In 2011/12 the Trustees inspection
revealed a requirement to update and improve the complaints file and review
the storage of large equipment. Both actions have been achieved.
Review of Quality and Education department
A review of the Education and Quality department was undertaken which
demonstrated the need to reorganise roles and responsibilities. It was
identified that the department should be led by a Head of Quality, Clinical
Compliance and Training, supported by a Lecturer/Practitioner (already in
post) and an Auditor.
During 2012/13 – this new structure will be
implemented and embedded.
Day services
During 2011/12 service delivery in the day Hospice and four satellites was
undertaken. This led to reorganisation of day services without reducing the
quality of care as patients are able to access day care at a site close to their
home. Among the services delivered in these settings are medical, nursing
observation, complementary therapies, family support, art therapy and mild
forms of exercise though patients often use day services to meet socially and
support each other through illness.
Crosscare restructure
The use of the patient information management system continues to be an
important part of care planning and provision. During 2011/12 it continued to
be reviewed with new information requirements added. Access is controlled
so that there is only access for those providing clinical care and audit or to
support clinicians in their roles.
Staff attitude survey
During the year the Hospice undertook its first ever, independently run,
organisation wide staff satisfaction survey. With 58% participation the result
benchmarked well, but key areas for management action were training and
development and communications. Specific actions plans are in the course of
implementation and the survey will be repeated annually to track the results
and monitor changes in attitudes.
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Clinical audits
Clinical audit is an essential element of assessing and monitoring the quality
of care provided. During 2011/12 a programme of audits was in place across
inpatient and community care; undertaken by doctors, nurses and teams such
as the Lymphoedema Specialist, Family support and complementary
therapies.
Audits included though this list is not exhaustive: hand hygiene, record
keeping, documentation of spiritual needs, controlled drugs management,
inpatient admissions, pressure ulcer management, blood transfusion and
antibiotic prescribing.
External
PCT contract reviews
The Hospice meets quarterly with the End of Life Commissioner from NHS
Hertfordshire and key finance, performance management and clinical activity
indicators are reviewed and discussed as appropriate.
Commissioning for Quality and Innovation Incentive Scheme Payment
(CQUIN)
During 2011/12 Isabel Hospice were required by its commissioners, East &
North Herts to achieve the CQUIN target related to end of life care. There
were three goals, all of which were achieved:
 50% of patients identified as being in the last year of life are offered the
opportunity to complete and advanced care plan identifying their
preferred place of care
 75% of patients identified as entering the last days of life are cared for
an Integrated care pathway (Liverpool Care Pathway or similar)
 30% of all patients able to die in their preferred place of care
3.Review of quality performance
stakeholders in 2011/12
and
engagement
with
other
3.1 Review of Quality performance 2011/12
Services provided:
 Community – clinical specialist nurses, palliative care support workers
and Hospice at Home
 Day care from Hall Grove, Welwyn Garden City and four satellites –
Thorley, Hoddesdon, Bishop Stortford and Waltham Cross
 In-patient care
 Cross setting i.e. medical input, psychological therapy, art therapy,
lymphoedema therapy, bereavement counselling, complementary
therapies such as massage, and the support of allied health
professionals such as physiotherapy and occupational therapy
 Specialised clinics such as Fatigue and Breathlessness and teenage
bereavement
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How funded:
37% of charitable costs are met from the NHS contract with the
commissioning organisation, which requires the Hospice to provide a
minimum level of care for NHS patients. The rest is received through
fundraising and trading activities.
Achievement against plans for 2011/12:
In the Annual Review 2010/11, the following aims and plans were identified
for 2011/12:
 Continuing to improve the quality of care to more patients, including
those with a non-cancer diagnosis, in all settings
 Enabling more patients to live and die in the place of their choice
 Developing the use of end of life care tools such as the Gold Standards
Framework, Liverpool Care Pathway and Advanced Care Planning
 Continuing to evaluate and develop the Hospice at Home service;
evaluating the Palliative Care Support Worker (PCSW) role
 Enabling our patients to be admitted into the Inpatient Unit seven days
a week
 Developing education and training to support other providers of care for
the less complex palliative and end of life patients.
Key performance measures
Isabel Hospice collects a range of information for the purposes of quality
monitoring. This includes requirements set out nationally in the minimum
dataset and measures developed internally. This data is continuously
reviewed and where possible measures include outcomes as well as activity.
The National Council for Palliative Care: Minimum dataset
The time period for this data is 1st April 2011 through to 31st March 2012
Inpatient Services Unit
Number of admissions
Total number of patients
New patients
Re-referred patients
% occupancy (monthly)
Patients returning home
Average length of stay - cancer
Average length of stay – non cancer
Day Hospice
Total number of patients
New patients
Re-referred patients
Average length of care
Day care attendances
Number face to face consultations
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386
278
236
31
Ranged from 66% to 84%
202
11 days
12.8 days
218
153
7
173.5 days
1701
4140
10
Community
Total number of patients
New patients
Re-referred patients
Patients that died at home
Patients who died in hospital
Average length of care
Number CNS face to face contacts
Number other face to face contacts
Bereavement
Total clients
Number new clients
Number of face to face contacts
Average length of care
1205
784
87
260+90 in Care Home
164
140 days
7466
3074
1410
1030
1777 (including Group work)
132 days
Quality Markers we have chosen to measure
In addition to measuring the minimum dataset, Isabel Hospice chose to
monitor the following. Incident and complaints that are reported below are
based on clinical services provided in the inpatient unit and community.
Indicator
%
Preferred
place
of
care
documented
Number of complaints
Number of patient safety incidents
Number of slips, trips and falls
Number of drug errors
Needlestick injuries
Other incidents
Number of C Diff and MRSA
occurring whilst inpatient
45%
13
115
43
18
1
53
1 C Diff
3.2 Stakeholder engagement
Isabel hospice works closely in the following ways with a range of
stakeholders including:
 GP’s in their role as providers of care as well commissioners
 PCT - Regular review meetings and mapping exercises
 Mount Vernon Cancer Network; often providing training for them to
other health care professionals across the sector
 University of Hertfordshire – to provide training to pre-registration
student nurses
 Carers - a forum to ascertain their views and experience
 Care providers across the country where a patient may wish to relocate
in order to meet their preferred priorities of care
 One Clinical Specialist Nurse works closely with nursing home
providers; supporting nursing staff with delivery of care. The Hospice
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



also works closely with schools, helping to create an understanding of
the work of the Hospice
The East And North Herts Acute Trust– clinical supervision for CNS’s
provided by a psychologist
Specialist equipment providers to meet the specific care needs the
patients and community we serve.
Work in partnership with Citizens Advice Bureau on provision of
Hospice Benefits Advisor
Attend Hertfordshire Local CD Intelligence Network
Statement from NHS Hertfordshire (Commissioners)
“During 2011/12, The Isabel Hospice provided a high quality service to the population
covered within Hertfordshire. Their inpatient and community service continues to be an
important community resource and the flexibility and willingness to respond to complex
patients and adapt their approach to meet individual needs has been highly valued by the
commissioner.
The Isabel Hospice has contributed to the wider review and development of palliative and
end of life care services in the County and was a useful and informative participant in the
recent End of Life scrutiny carried out by the County Council recently.
2012/13 presents new demands for all Hospices including The Isabel 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
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