Quality Account 2011/12
A report detailing the quality of health care services
provided by St Ann’s Hospice, Manchester
Registered charity number 258085
SAH Quality Account 2011 – 2012, Final
1
Chief Executive Statement
Jayne Bessant
Chief Executive
Welcome to our first Quality Account Report. This
report is written to provide a balance to our
financial reports and will focus on the quality of the
care we provide to our patients and their families
and carers.
The reporting period 2011/12 reflects the final year
of St Ann’s Hospice Strategic Plan 2006/11.
In 2011 we spent significant time reviewing our mission statement and subsequently
we developed a new Purpose, Core Values and a new three year Strategic Plan.
These are detailed in the report, but importantly our focus remains on delivering the
best quality care we can to our patients, families and carers.
Our Board of Trustees have reviewed the corporate and clinical governance
framework in the last year and this has led to improved assurance and reporting on
clinical measures and outcomes.
The Executive Team are committed to building on our high standards of quality and
maintaining our reputation for excellence in the delivery of specialist palliative care
across a range of services in the hospice and the community.
Our quality and effectiveness is measured in a variety of ways and we are becoming
more sophisticated in terms of the data we capture. Internally, we have a wide variety
of measures we use to do this and we continue to refine them; for example:
Assessing and monitoring clinical activity;
Analysis of complaints and incidents;
Clinical Audit programme;
Patient and carer surveys.
Externally, we are registered with and inspected by the Care Quality Commission.
These regulators obtain the information about our services from a number of sources
and use these to build a picture of the quality of services we provide. The report at
the end of this account details how we have met these standards. However, we are
not complacent and are committed to improving our care. This relies on feedback
from our users and stakeholders.
A recent report commissioned by NHS Northwest highlights the contribution and
value of hospices. In this report St Ann’s was cited as leading many of the excellent
initiatives to improve the care and support for patients and families, with specific
reference to community services and education projects.
The Executive Team and I are confident that the information set out in this report is a
true reflection of quality in our current care provision.
SAH Quality Account 2011 – 2012, Final
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St Ann’s Purpose & Strategic Goals
Over the last year, St Ann’s Hospice has reviewed its purpose and core
values, developing strategic goals which reflect the values of St Ann’s as a
specialist palliative care provider across Manchester:
Purpose
Purpose
To provide excellent care and support to people living with or affected by lifelimiting illnesses.
Core Values
Core Values
Compassionate
Providing a safe, secure and a caring environment for everyone.
Professional
Aspiring to be the best in everything that we do.
Respectful
Treating everyone with dignity and respect.
Inclusive
Recognising and accepting that everyone is different.
Strategic Goals
1.
Putting patients and their carers first
Delivering excellent care, free of charge, at a place and time right
for each individual;
Providing care that meets the individual needs of patients, carers
and their families;
Working with Commissioners and other health and social care
professionals to support and care for those who need our services.
SAH Quality Account 2011 – 2012, Final
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2.
3.
4.
5.
6.
Supporting and empowering our staff and volunteers
Developing a workforce with the skills and ability to deliver our
purpose;
Creating a supportive, respectful and listening environment for our
valued staff and volunteers.
Strengthening our foundations as a charitable organisation
Making the best use of our existing resources to ensure efficiency
and effectiveness;
Maximising and diversifying our income generation to fund and
develop our services.
Engaging with our Communities
Working with and developing mutually beneficial relationships with
our communities;
Building on and enhancing our excellent reputation and profile;
Committed to widening access and being inclusive.
Looking Forward
Responding and adapting to external influences and changes in a
timely manner;
Being innovative and pro-active leaders in our field;
Developing a hospice for the future by always seeking to improve
our methods and practices.
Striving to be the best at what we do
Aspiring to always exceed quality standards for all aspects of the
care and services that we deliver;
Listening and responding to the needs of our patients and
communities to keep them at the heart of everything we do;
Developing a learning organisation through evaluating our activity
and sharing best practice.
SAH Quality Account 2011 – 2012, Final
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Review of services
During 2011/12 St Ann’s Hospice provided the following services to palliative
care patients and their carers and families from across Greater Manchester.
St Ann’s services encompass the localities of Salford, Trafford, Manchester
and Stockport, a total population of approximately 1.2 million people. Our
services are based on 3 sites, St Ann’s Hospice Heald Green, St Ann’s
Hospice Little Hulton and the Neil Cliffe Centre Wythenshawe:
•
•
•
•
•
•
•
In-Patient Units
Daycare Services
Supportive and medical outpatient Services
Hospice at Home (St Ann’s @ Home)
Community Palliative Care Nurse Specialist Service
24 Hour Advice Line
Complementary therapy services, including an outreach service
St Ann’s Hospice has reviewed all the data available to us on the quality of
care in all of these services. The income generated by the NHS represented
34% of the total income required to provide the services which were delivered
by St Ann’s Hospice in the reporting period of 2011/12.
Quality improvement and innovation goals with our
commissioners
St Ann’s works closely with a number of commissioning groups and each
service we provide has a detailed service specification document which
included quality performance measures. These measures are supported
internally by the hospice’s Council and Executive board in their
implementation and delivery.
St Ann’s NHS quality improvement and innovation goals through the
Commissioning for Quality and Innovation payment framework for April 2011
to March 2012 were to:
Produce a report to commissioners on complaints received, develop a
safeguarding policy and to progress towards level two compliance for the NHS
Information Governance Toolkit. Confirmation has been received from
commissioners that these targets were successfully met, with allocated
funding awarded.
SAH Quality Account 2011 – 2012, Final
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What others say about us
Care Quality Commission (CQC)
St Ann’s Hospice is required to register with CQC. The (CQC) has not taken
any enforcement action against St Ann’s Hospice during 2011/12.
The last on-site inspection was in February 2012, with the Hospice being
assessed as fully compliant.
St Ann’s Hospice has not participated in any special reviews or investigations
by the CQC during the reported period.
Stockport Metropolitan Borough Council – Health Scrutiny Committee
Jayne Bessant, CEO and Rachel McMillan, Director of Clinical Services were
invited to attend the Health Scrutiny committee in Stockport to present the
quality accounts. The feedback and comments were positive and supportive
of the high quality care St. Ann’s provides to the patients, careers and families
it serves. The committee has an awareness and deeper understanding of the
care and services St Ann’s provides and is looking forward to receiving the
following year accounts in terms of achievements, priorities and successes.
The Stockport Local Involvement Network (LINk) is a group of individuals
from across Stockport coming together to ensure that health and social care
services are planned and delivered to meet the need of the people that use
them.
The Stockport LINk commented they have a good working relationship with
St. Ann’s Hospice and hopes to improve this relationship over the following
year as the LINk develops into HealthWatch in 2013.
Overall the Stockport LINk would like to congratulate St. Ann’s Hospice on an
informative report with many positive attributes, in particular to the poster
displays, academic papers produced and the phone advice line is a very
welcome source for patients, carers and professionals.
LINk visited St Ann’s in November 2011, with their feedback being highly
positive of St Ann’s services and its environment:
‘Representatives felt that the cleanliness of the hospice was impressive’
‘The general atmosphere at the hospice is very relaxed and calm’
‘I visited St Ann’s in 1971 when it was first opened and it has more than kept
up its standards’
LINk recommended that a discharge policy should be developed to support
the hospices existing discharge processes and documentation. A working
group has since been established and work is underway.
The NHS North West End of Life baseline report which was published in
November 2011 recognised the value and contribution of hospice services
SAH Quality Account 2011 – 2012, Final
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and cited in the report 3 examples of recent initiatives and best practice which
include collaborative partnership working with neighbouring Foundation Trust
to respond to urgent community assessment. The Hospice @ Home team
have provided education within the Trafford area to GP’s and the district
nursing teams. St Ann’s have been instrumental in providing education to
patients with COPD (chronic obstructive pulmonary disease) and their carers
with an aim to reduce hospital admissions.
Data quality
In agreement with the Department of Health, St Ann’s Hospice submits a
National Minimum Dataset (MDS) to the National Council for Palliative Care.
St Ann’s Hospice also provides the MDS to our local; Primary Care Trust
Consortia (Salford, Trafford, Stockport and Manchester).
NHS Number and General Medical Code Validity
St Ann’s Hospice was not required to and 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.
Information Governance Attainment Levels
St Ann’s Hospice did not require an Information Governance Assessment
Report and, therefore, did not have an overall score and grading for
2011/2012. However, a future goal for 2012/13 is the completion and
submission of the NHS Information Governance Toolkit, to both ensure that
national guidance and standards for information quality and records
management are maintained. Submission will also facilitate connection to
local NHS information technology systems which will improve patients’ future
continuity of care.
Clinical coding Error Rate
St Ann’s Hospice was not subject to the Payment by Results clinical coding
audit during 2011/12 by the Audit Commission.
SAH Quality Account 2011 – 2012, Final
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Quality Overview
The following pages give an overview of the quality of the clinical services
provided by St Ann’s Hospice and how we strive to improve the quality of care
delivered to our patients, families and carers.
SAH Quality Account 2011 – 2012, Final
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Comparison with national quality
measures
The National council for Palliative Care produces an annual report called the
‘National Minimum Dataset for Palliative Care’.
The most recent report produced by the National Council covers the period 1st
April 2010 to 31st March 2011, and compares St Ann’s Hospice with the
national median values (the middle values) for all hospice services of
comparable size from across the UK.
The comparison is with a subset of either small, medium, or large hospice
services, from across the UK that have reported their annual statistics. St
Ann’s Hospice currently has 45 beds and is one of the largest hospices in the
UK.
The National Council For Palliative Care : Minimum Data Sets
For Palliative Care 2010-2011
SAH
2009 - 2010
In-Patient Unit
Total patients
% New patients
% bed Occupancy
% Patients returning
home
Average length of staycancer
Average length of staynon-cancer
% New patients with noncancer diagnosis
SAH
2010-2011
National Median
2010 -2011
713
91.9
82.7
35.8
658
91.3
78.0
32.1
(N=44)
342
89.3
77.3
44.5
17.0
17.0
14.4
15.0
17.1
11.9
6.4
8.0
9.8
Comment:
The total number of patients indicates that St Ann’s is one of the largest hospice
inpatient units in the UK. The higher percentage of new patients combined with the
lower percentage of patients returning home likely reflects that St Ann’s does not
accept referrals for respite patients and that patients admitted have complex pain and
symptom control needs. Together with high bed occupancy levels, this shows that St
Ann’s inpatient services are used effectively, indicating a busy unit.
SAH Quality Account 2011 – 2012, Final
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Day Hospice
Total patients
% New patients
% Places used
Discharges (and deaths)
Average length of
attendance
400
77.8
48.1
357
68.0
395
78.0
51.0
355
66.0
(n=48)
233
65.8
59.9
180
149.7
Comment:
St Ann’s day hospice (daycare) is again one of the largest day hospice services in
the UK. Higher levels of new and discharged patients, together with a lower length of
attendance, reflect the services emphasis as a rehabilitative service, with an active
review and discharge process in place.
Outpatients
All clients
% New clients
% New patients with a
non-cancer diagnosis
Attendances per patient
Attendances per clinic
% attendances with a
Medical Consultant
(n=52)
1,265
40.3
28.0
1,165
38.8
30.5
46.6
16.6
2.6
1.6
11.5
2.8
1.6
9.4
2.1
3.1
9.1
Comment:
St Ann’s outpatient services are the most successful at providing support for noncancer patients (non malignant disease, e.g. heart failure, multiple sclerosis). The
higher percentage of attendances with a medical consultant, reflects the provision of
a dedicated medical outpatient clinic providing pain and symptom control advice to
patients in the community.
Hospice at Home
Total patients
% New patients
% New patients with a
non-cancer diagnosis
% home and care home
deaths
Average length of care
(days)
196
93.4
8.2
236
89.4
12.3
(n=10)
332
77.6
7.1
80.8
78.6
69.8
19.6
22.3
91.4
Comment:
The high percentage of home and care home deaths together with the low average
length of care demonstrates that St Ann’s hospice at home service (St Ann’s Home)
has an emphasis on terminal care, facilitating patient’s wishes to die at home, rather
that for respite care.
SAH Quality Account 2011 – 2012, Final
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Community Nurse
Specialist (CNS) Team
Total patients
% New patients
% New patients with a
non-cancer diagnosis
Average length of care
(days)
Face to face visits per
patient
Telephone contacts per
patient
489
76.9
14.4
627
76.7
12.9
(n=10)
752
76.9
12.9
56.6
53.3
98.3
2.8
3.3
5.1
4.1
4.8
4.3
Comment:
The hospice CNS team covers one of St Ann’s localities, Salford. While the total
number of new patients seen is comparable, patients’ length of time within the
service is lower. The service also differs from its hospice counterparts in having a
slight emphasis for telephone contacts compared to face to face visits.
Bereavement Support
Total clients
% New service users
Contacts per service user
Average length of support
(days)
% Discharged
94
74.5
7.6
126.0
149
68.5
6.9
172.6
(n=43)
168
72.1
5.6
154.8
50.0
65.8
55.1
Comment:
St Ann’s has an active bereavement support team. Bereaved carers receive slightly
more support from the service than for its hospice counterparts, reflected in the
length of support and lower percentage of patients discharged.
In 2010 a bereavement services coordinator was appointed to develop the support
given further. It is anticipated that the data reported for subsequent years will reflect
this change.
SAH Quality Account 2011 – 2012, Final
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Clinical Governance
Clinical Governance Committee
St Ann’s Hospice’s Clinical Governance Committee meets quarterly. The
committee is chaired by a hospice Trustee, with a multi-disciplinary
membership from across clinical services, and also an external representative
from our local Primary Care Commissioning group. The group oversees many
aspects of organisational governance including the development, review and
approval of clinical policies, monitoring of patient falls, infection prevention
and control and incident reporting.
Incident Reporting
An organisation wide incident / near miss reporting system was introduced in
2004 and has been reviewed 3 times in response to the feedback from its
users. A quarterly report is compiled, which focuses on actions agreed in line
with the learning culture.
A development in 2010/2011 was to copy incidents that had an impact
external to St Ann’s to a nominated Primary Care Trust Manager who
facilitates the external learning and in turn feeds back into our quarterly report
and actions agreed.
In 2011/2012 we agreed to highlight information governance incidents within
the quarterly report and routinely raise these at the organisational Information
Governance meeting.
SAH Quality Account 2011 – 2012, Final
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The following summarises the type and number of incident/near miss forms
received
2009/2010
456
2010/2011
517
2011/2012
521
Total Clinical
381
413
433
Of these :
- medicine related
- patient falls
103
153
96
136
88
177
Total Non Clinical
75
104
87
RIDDOR reports
(Reporting of Injuries, Diseases
and Dangerous Occurrence
Regulations)
0
3
6
Total incidents & near misses
Actions from reported incidents & near misses include:
•
the introduction of 6 monthly audits of administration of medicines
o The medicines administration audit and training programme has
led to a continued decrease in reported medical incidents and
both continue as an ongoing initiative.
•
use of incidents in mandatory medicine update training for clinical staff
•
introduction of a specific patient falls reporting form that triggers actions
required following a patient fall.
o This new form has led to a higher rate for falls related incidents.
This is likely due to the hospices improved systems for reporting
and will continue to be monitored in subsequent years.
SAH Quality Account 2011 – 2012, Final
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Clinical audit activity
Quarterly meetings chaired by our lead for quality and audit with clinical and
medical representation from all service areas are held 3 monthly. A rolling
plan for clinical audit is agreed and reviewed.
Along within internally agreed audits, St Ann’s participates in the North West
Regional Audit Group (NWRAG) audit programme and is represented on the
Help the Hospices Audit Group.
The following is the clinical audit activity for 2011/12:
TOPIC
STATUS
Administration of Medicines
Ongoing every 6 months
Prescribing of Medicines
Ongoing 3 times each year
The audit has been accepted
for poster presentation at the
European Association for
Palliative Care conference in
June 2012.
Development of Supportive Outpatient
standards
Standards agreed and will be
incorporated into an
overarching policy.
Medical Documentation Audit
Final report with action plan
circulated and posted on the
intranet.
Bowel Obstruction – North West Audit
Group (NWAG)
Final report with action plan
circulated and posted on the
intranet.
An abstract was accepted for
poster presentation in March at
Palliative Care Congress.
Report with action plan being
compiled.
Use of steroids - NWAG
Chronic Obstructive Pulmonary Disease
(COPD) Management in Palliative Care –
LH only
Report in draft format and has
raised the potential need for a
separate referral form for
COPD patients
An abstract was accepted for
SAH Quality Account 2011 – 2012, Final
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TOPIC
STATUS
Anti-coagulation – National Patient Safety
Agency (NPSA) Standards
Blood transfusion
Mouthcare Prescribing – NWAG
poster presentation in March at
Palliative Care Congress
Final report with action plan
circulated and posted on the
intranet.
An abstract was accepted for
poster presentation in March at
Palliative Care Congress
Final report with action plan
circulated and posted on the
intranet.
Awaiting results.
Pain Assessment and Evaluation
Final report with action plan
circulated and posted on the
intranet.
24 Hour Advice Line Evaluation
Report with action plan being
compiled.
Data collection commenced.
Re-audit Hypercalcaemia Management NWAG
Re-audit of antibiotic usage
Audit form piloted and agreed.
Complaints & Compliments
Complaints and Compliments Received 2009/2010 and 2010/2011
COMPLAINT /
COMPLIMENT
2009 - 2010
April 2010 –
March 2011
April 2011 –
March 2012
Formal complaints
8
6
2
Informal complaints
5
5
3
Not collected for
this period
481
467
Compliments (via
letters, cards,
comments cards
and emails)
SAH Quality Account 2011 – 2012, Final
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St Ann’s receives far more compliments on its care for patients, carers and its
services than it does for complaints, indicating that its services are highly
valued but both patients and their families and carers. For the last two years,
levels of complaints have remained at comparable levels, with themes
covering patient care and communication.
Each complaint received is thoroughly investigated by the clinical and
Executive management team. Each complaint will be acknowledged within
two working days and investigated, with a written response from St Ann’s
Chief Executive within twenty days. Where shortfalls are identified, immediate
action is taken to reduce the risk of recurrence through training and education,
improvements in processes for delivering and documenting clinical care and
through improving processes for communication across hospice teams and
external partners.
Examples of compliments received:
Inpatients:
Daycare:
•
The staff were utterly amazing
with their dedication and care
of patients
•
Staff and volunteers were
extremely kind & helpful,
nothing was too much trouble
•
The hygiene and cleaning
were of an excellent standard
and were a credit to the
Hospice
•
The art class has given me a
new interest in life – I have
bought paints, papers and
brushes to do my new found
hobby
•
Staff were very good at
involving family as well as
patient
•
The food was excellent. I need
a gluten free diet and I have
been catered for beautifully
•
A bright and peaceful
environment
•
It’s like visiting family
SAH Quality Account 2011 – 2012, Final
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Infection Control and Wound Care
Infection Control Data
TYPE OF
INFECTION
MRSA (localised
infection and
colonisation)
Clostridium difficile
toxin positive
Bacteraemias
(blood stream
infections)
Extended spectrum
beta-lactamases
Apr 2009 – Mar
2010
Apr 2010 – Mar
2011
Apr 2011 –
Mar 2012
5
6
7
3
1
4
0
0
2
n/a
n/a
7
Surveillance data for the period April 2011 – March 2012:
Infection/colonisation rates for the Hospice remain very low despite a slight
increase on last year’s surveillance figures.
For MRSA infection/colonisation rates, not all patients are screened on
admission, therefore, true figures for colonisation (rather than infection) are
likely to be higher than reported. However, patients infection status is obtained
from referring services (e.g. General Practitioners, Nursing Homes and
Hospital Trusts), and management strategies implemented on patient
admission.
Rates of Clostridum difficile infection (CDI) are likely to be a true reflection of
incidence due to the associated symptoms.
This year data has seen the inclusion of extended spectrum beta-lactamase
producers. There is an expected future increase in these isolates due to the
increase in organisms gaining multiple antibiotic resistances.
SAH Quality Account 2011 – 2012, Final
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Wound Care Data April 2011 – March 2012
PRESSURE
ULCERS
Grade I
Grade II
Grade III
Grade IV
Total:
WOUNDS (not
including pressure
ulcers)*
Present on admission
(from hospital/home/
Other)
Hospice acquired ( St
Ann’s)
47
85
19
4
155
29
52
0
1
82
100
46
*Wounds as categorised include forms of wound associated with palliative
patients’ conditions and exclude pressure ulcers.
All patients on admission to our hospice receive a tissue viability risk
assessment, followed by relevant preventative measures (e.g. pressure care
mattresses). However, many patients who are cared for by St Ann’s Inpatient
wards experience deteriorating symptoms due to the progression of their
condition and poor circulation. For example, many patients are prescribed
steroid medication, which increases the risk of diabetes and pressure ulcers
thereafter. This is why in some cases, pressure ulcers can develop while a
person is under St Ann’s care, despite preventative measures being taken. In
such cases, specific management strategies are used, including the use of
care plans and dressings to minimise discomfort and maximise quality of life.
Previous year’s data recording has not differentiated between pressure ulcers
and wounds which are associated with palliative care patients specific
conditions. Subsequent years reporting will include this differentiation to
facilitate comparison.
SAH Quality Account 2011 – 2012, Final
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24 Hour Advice Line
The Hospice’s 24 hour advice line provides telephone support for both health
care professionals and patients and their carers from across Manchester
(Salford, Trafford, Manchester and Stockport).
Calls to the Hospice 24 Hour Advice Line Service
2009 - 2010
2010 -2011
April 2011 –
March 2012
Total number of calls received
724
704
698
Source of calls
Health care professionals
Patients and carers
Other (including unknown)
364
306
54
349
297
58
372
272
54
200
259
223
270
210
307
138
36
134
87
36
147
96
33
149
24 HR ADVICE LINE CALLS
Reason for call
Pain control
Symptom control (excluding
pain)
Service and referral information
Non clinical
Other
The advice line remains a valued resource across Manchester, with the levels
and types of calls remaining comparable over the last two years. Almost
fourteen calls are received each week, half of which are from health care
professionals. Advice given may help patients to avoid unnecessary crises
referral to hospital, and has the potential to enable patients to stay in their
home.
SAH Quality Account 2011 – 2012, Final
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Liverpool Care Pathway
Inpatient Use of the Liverpool Care Pathway
Jan – Dec
2009
Jan – Dec
2010
April 2011 –
March 2012
Total number of
inpatient deaths
483
507
460
Inpatients placed
on LCP
425 (88%)
444 (88%)
414 (90%)
Inpatients not
placed on LCP
58 (12%)
63 (12%)
46 (10%)
When a patient’s condition changes and indicates to the inpatient ward team
that the patient is dying, the Liverpool Care Pathway (LCP) is used. The LCP
is a pathway / document that outline’s the best quality care at the end of life
and the LCP helps to achieve this.
The proportion of inpatients placed on the LCP over the last three years has
remained constant. For most patients who were not placed on an LCP,
sudden death, or rapid deterioration was the cause.
Staff Health, Absence and Turnover
2010-2011
2011 - 2012
Sickness and
absence
4.6%
4.3%
Staff turnover
(number of starters
and leavers)
6.4%
Awaiting data
St Ann’s sickness and absence rates are comparable to the NHS (4% to 4.8%
2009-2010). Staff turnover is under half of that seen for the NHS.
St Ann’s continually strives to minimise its sickness and absence levels by
providing a healthy and productive environment, within which its workforce
can be supported and cared for.
SAH Quality Account 2011 – 2012, Final
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Research
St Ann’s Research Committee
A new research committee will meet quarterly. With multi-disciplinary
membership, the group will prioritise and develop research and evaluation
which focuses on developing and improving the care St Ann’s provides to its
patients, carers and families and the wider palliative care community.
Workforce Modelling in UK Hospices
During the reporting period St Ann’s Hospice has lead on a multi-centre
project assessing nursing workforce modelling in hospice inpatient units.
Thirteen hospices (16 wards) from across the UK participated in the study,
originally partially funded by the North West Strategic Health Authority. A
dataset, which profiles and benchmarks hospice ward patient dependency,
nursing workload, staff activity, ward establishments, quality and costs in
sixteen hospice wards has been created. Generally hospice ward staff face
heavier workloads and deliver higher-quality care than their NHS
counterparts. The project provides evidence-based recommendations to
inform future nursing workforce size and mix based on rising workloads.
Compared to most hospices in the dataset, St Ann’s has one of the highest
workloads and highest levels of quality care. The project has informed
workforce modelling within St Ann’s.
In January 2012, St Ann’s delivered, in partnership with Help the Hospices, a
national study day to share the findings of the project. This has further interest
in the work and a number of additional hospices from across the UK are
working with St Ann’s to generate their own evidence based
recommendations for ward staffing and skill mix.
Supportive Outpatient Evaluation
A service evaluation of St Ann’s supportive outpatient services is currently
ongoing. The evaluation will provide information on referral to, access to and
provision of these services including patient reported outcome measures.
Findings from the project will be reported the summer of 2012.
Grant Application
In spring 2012, St Ann’s, in collaboration with Salford University, developed
and submitted a grant application to Marie Curie Cancer Research. If
successful, funding will support a project which will investigate patient’s
preparedness for their future care and the use of professional locality registers
which facilitate both patient and professional communication.
SAH Quality Account 2011 – 2012, Final
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Academic Papers
Five papers have been published, or accepted for publication, over the last
two years by members St Ann’s Hospice team:
Roberts D, Hurst K. Evaluating Nurse Staffing in Inpatient Palliative Care
Wards, using Patient Dependency, Staff Activity, Workload Service Quality
and Cost Data. Palliative Medicine (in press).
Mitchell K, Pickard J, Herbert A, Lightfoot J, Roberts D (2011) Incidence and
causes for syringe driver site reactions in palliative care: A prospective
hospice-based study. Palliative Medicine Nov 14. [Epub ahead of print]
Quinn B, Lawrie I. (2010) Developing Nurse Independent Prescribing in a
Specialist Palliative Care Setting. International Journal of Palliative Nursing.
Aug;16(8):401-5.
Cawley D, Waterman D, Roberts D, Caress A. (2010) A qualitative study
exploring perceptions and experiences of patients and clinicians of Palliative
Medicine Outpatient Clinics in different settings. Palliative Medicine. 2010 Aug
18.
Campbell M, Grande G, Wilson C, Caress AL, Roberts D. (2010) Exploring
differences in referrals to a hospice at home service in two socio-economically
distinct areas of Manchester, UK. Palliative Medicine. Jun; 24(4):403-9.
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What our Service users say about us
User Involvement
St Ann’s is committed to gaining and using the views of it patients and carers
to contribute to the ongoing development of its services as per the Care
Quality Commission (CQC) outcome 1.
Patient / Carer Group
The patient / Carer group meets every 2 months and has a current
membership of 11 patients and 6 carers who have all had experience with
services provided by St Ann’s Hospice.
The group provides an invaluable contribution to the ongoing development of
the hospice services.
Examples of their work include:
• surveying and providing suggestions for improvements on hospice
signage and leaflet displays
• aspects of equality and diversity including multi faith provision
• comments on new or updated service leaflets
• views on the introduction of the new menu and food service
• contribution to the organisations conference programme
• contributions to the network ideas for the Dying Matters week
Comments Scheme
This scheme enables visitors, patients, volunteers and staff to make
suggestions for improvement or comments they have about our services.
The Lead for Quality and Audit is responsible for managing the scheme and
sending comments received to the appropriate manager for consideration and
a response. The responses are collated and approved at an organisational
meeting and then fedback via the hospice newsletter and website along with
organisational distributions of monthly summaries.
A total of 191 comments were posted in 2011/2012
Actions implemented include:
• The upgrading of the ventilation system in the patients smoking room to
reduce the aroma filtering into the neighbouring ward areas.
• Provision of play station games for visiting children
• Public transport information added to the Hospice website
•
Battery disposal boxes on the ward areas
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Help the Hospices Patient Satisfaction Survey
The 2010/11 survey is the forth in a series of 2 yearly surveys on patient
satisfaction with inpatient and daycare services carried out by Help the
Hospices and the Centre for Health Services Studies at the University of
Kent,. All hospices across the UK are invited to take part and in the 2010/11
Patient Survey 39 hospices participated. The questions are reviewed after
each circulation considering the comments from the respondents and Care
Quality Commission requirements.
The method of data collection was a self-completion questionnaire, with one
questionnaire for users of daycare services and another for inpatient services.
Each hospice distributed a questionnaire and an accompanying information
letter to inpatients at discharge and daycare patients at discharge or after 2
months of attending daycare between September 1st 2010 and April 30th
2011.
Our lead for Quality and Audit chairs the Help the Hospice working group that
coordinates this initiative. The report of findings with a collaborative action
plan has been agreed and circulated organisationally.
A poster summarising the findings for St. Ann’s has also been displayed on all
3 hospice sites and on the hospice intranet and website:
http://www.sah.org.uk/media/254040/poster%20version%202.pdf
24 hour advice Line Evaluation
An anonymous satisfaction questionnaire was circulated to callers to the
advice line for a period of 6 months during 2011/2012 and responses are in
the process of being collated. Following feedback a collaborative action plan
will be agreed.
What our staff say about the organisation
St Ann’s Hospice engages it’s staff in consultation in several ways, including a
’One Organisational Group’, Staff Reps Committee and regular open meetings
throughout the year.
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What our regulators say about us
St Ann’s services are regularly reviewed by the Care Quality Commission
(CQC). Further information and full reports can be obtained via the following
link:
http://www.cqc.org.uk/public/reports-surveys-and-reviews
A summary of our latest quality checks by the CQC:
Key to CQC checks on standards
Green Tick -All standards were being met when we last checked. (If this
service has not had a CQC inspection since it registered with us, our check
may be based on our assessment of declarations and evidence supplied by
the service itself.)
Grey Cross -At least one standard in this area was not being met when we
last checked and we required improvements.
Red Cross -At least one standard in this area was not being met when we
last checked and we have taken enforcement action.
St Ann's Hospice Heald Green
St Ann's Road North, Heald Green, Cheadle, SK8 3SZ
Summary of our latest checks on the standards you have the right to
expect:
(Our last check was on 25 August 2011)
Standards of treating people with respect and involving them in their care
Standards of providing care, treatment & support which meets people's
needs
Standards of caring for people safely & protecting them from harm
Standards of staffing
Standards of management
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What people have told us about this care service
(Date written: 25th August 2011)
We spoke to family members, people who used the service and members of
the nursing staff team during our visit on the 22nd July 2011. The told us that
they were very pleased with the service provided by the hospice.
Comments we received were:
“feel well looked after – care second to none – come straight away when
press call bell – lovely with me – no impatience even though busy – they
always have time for you – communication very good”;
“flexible routines – cup of tea anytime – can have anything, within reason of
course”;
“as I do not have a good appetite I get something else – can have anything I
fancy providing the kitchen staff have it in;” “attended day care – lovely
people, go to this when at home”.
We were told by the family members and people who were using the service
that they were very much involved in their treatment and were kept informed
at all times. They also told us that their right to have their privacy, dignity and
independence was respected at all times.
The members of staff we spoke with said that they were well supported by
their managers. We were also told that there was ongoing training available to
keep them up to date with all current procedures in palliative care.
No one we spoke with had any complaints about anything the hospice
provided or any of the people who worked there.
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St Ann's Hospice Little Hulton
Peel Lane, Little Hulton, Worsley, Manchester, M28 0FE
Summary of our latest checks on the standards you have the right
to expect:
(Last check was on 11 April 2012)
Standards of treating people with respect and involving them in their care
Standards of providing care, treatment & support which meets people's
needs
Standards of caring for people safely & protecting them from harm
Standards of staffing
Standards of management
What people have told us about this care service
Date written: 11th April 2012
We talked to a number of people who were being cared for as in-patients at
the hospice during our visit on 7 March 2012. When we asked the people who
use services about their experiences, we ensured that we were sensitive to
their health condition. People told us that they were exceptionally well cared
for and stated that they were treated with dignity and respect. One person
commented that:
"I have been here before. They absolutely take care of me in everyway, your
body, cleanliness and your health, they’re wonderful. Everything is for your
comfort; they make me as comfortable as I can be. They are patient and
never rush me”. Another person told us that “I'm from the old brigade - I
thought hospices were still like in the olden days. I was very pleasantly
surprised. Anything I ask for; it's there. I've never had food so good” Across
the outcomes we looked at, the people who use the service gave very positive
comments.
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