Mission Statement
Bolton Hospice exists to provide specialist palliative and end of life care that
focuses on symptom control whilst also supporting people and their families to
live well through their illness and cope with the end of life.
Our core purpose is to improve the
experience of dying by supporting
people to live well until they die, by
focussing everything we do on the care
of the patient and their family in a
warm, caring, inclusive and
compassionate way.
BOLTON HOSPICE
Quality Accounts - April 2013–March 2014
Bolton Hospice Quality Accounts
2013-2014
JE/dw/June 2013
Chief Executive’s Statement
These Accounts are prepared to report on the qualitative aspects of the care
delivered by Bolton Hospice in compliance with the Health Act 2009. In light of the
Francis Report into standards of care within the NHS Hospital Stafford, this quality
account is now even more important than ever.
Bolton Hospice is an independent charity (registered number 518704) and constituted as a company
limited by guarantee (registered number 02114925). The charity is governed by a Board of Trustees and
run by the Chief Executive and the Senior Management Group (Palliative Care Consultant, Clinical Nurse
Manager and Finance & Corporate Services Manager).
Bolton Hospice makes no charge to its patients or their families and carers for the care that we provide.
71% of the £3.63m needed to run the charity is generated by our own fundraising via, our lottery and
retail operation as well as through voluntary donations from individual members of the public and local
businesses, the remaining 29% is provided through the Bolton Clinical Commissioning Group (CCG). The
charity, through its Trustees, is directly answerable to its membership, who are drawn from the local
community we serve.
The Hospice is also answerable to the general public of Bolton in a more direct way for if they were to ever
find fault or were not satisfied with the care we provide or the actions we take, they have the power to
stop supporting us and end their fundraising relationship that is essential to our very existence. Quality
has, therefore, to run through everything we do in relation to those we serve.
It is a fundamental tenet of the provision of Hospice care that our services are delivered to a high standard.
The public, as the main contributors of funds, do so in the expectation that those members of their
community who require the Hospice’s services will receive high quality care.
The Trustees and Managers of Bolton Hospice believe that the quality of our services is not an adjunct to
the delivery of these services; it is an integral part of the work of all our staff and volunteers. Ensuring the
quality of our work, at all times, is part of the ethos of all staff and volunteers; it is simply a way of life
here. However, this does not mean that there is no room for improvement, nor does it negate the
requirement of Hospices to be open and transparent about all aspects of the charity’s work and this
includes qualitative assessment of performance, contained in reports such as this one.
The quality of services delivered by Bolton Hospice is considered by the Trustees and Managers to be safe
and delivered to a high standard and that improving delivery of care is as much a matter for front line staff
as it is for the Senior Management Group and the Board of Trustees. Trustees and Managers therefore
foster a culture where staff and volunteers take ownership of the services they provide and feel free to
challenge, raise issues and concerns knowing they work in an open, transparent, no blame organisation
where quality really counts.
The challenge in presenting Quality Accounts is to quantify and provide an evidence base of the quality of
our services, to describe the ongoing measures we are taking to further improve what we do and to
identify some specific measures against which we have set targets and which we can measure year on
year. However, the qualitative elements of the service are not easy to separate into easily measureable
units and therefore they focus on descriptions, assessment and feedback.
The Board of Trustees and the Senior Management Group are committed to the delivery of a high quality
service to our patients and their families and friends. We also believe that there is always room for
improvement. We must never become complacent. These accounts will identify measureable areas of
quality, which are essential to the provision of a high standard of care. They will continue to evolve in the
years to come in line with expected standards of reporting.
Leigh Vallance
Chief Executive
Bolton Hospice Quality Accounts
2013-2014
JE/dw/June 2013
WHAT OUR ORGANISATION IS DOING WELL
Patient Safety
We strive to treat people in a safe environment and protect them from avoidable harm
(NHS Outcome Framework Domain 5 Department of Health 2013).
o
In November 2012, we had an unannounced Care Quality Commission Inspection and were
fully compliant in all Outcomes assessed.
http://www.cqc.org.uk/directory/1-106965965?referer=widget1
Patients’ comments during the inspection:
“There is nothing too much trouble, they think about what is best for you”.
”They don’t treat you like a child”.
The Inspector saw evidence of individualisation as likes and dislikes, personal preferences,
spiritual needs and things of importance to the patient were recorded.
o
We have educated all our staff on the NHS Initiative of Harm Free Care and are currently in
the process of registering with the NHS Safety Thermometer Survey.
o
Of the 5797 bed days and the additional attendance of 611 Outpatients, 68 patients
experienced a fall which resulted in No Harm and 7 had a fall resulting in Low Harm.
o
All staff involved in nutritional care of our patients have received food safety training and we
have adopted the role of the Meal Co-ordinator, who ensures that patients receive adequate
assistance and are not disturbed during meal times.
o
We are a learning organisation which deals promptly with all incidents and fosters an open
culture whereby risk management and incident reporting is encouraged and staff are
informed of the lessons we all learn from this.
o
Catering and Housekeeping Services are now well established within clinical services and the
benefits to patients and the organisation are many.
o
An Occupational Stress Survey was undertaken of all employees with positive results.
o
This year has seen the review of nursing documentation with the development of a Catheter
Care Plan, documentation to assess pain more effectively for those living with dementia and
a revision of the Intentional Rounding Tool.
Extract from a letter received in 2013
“From the lovely receptionist, cleaners, doctors, nurses and everyone else who is connected to
Bolton Hospice, you gave my mum the very best care and attention during her final days. I could
not have asked for anything more. You made all my family welcome and always had a smile, even
during the hardest times”.
Bolton Hospice Quality Accounts
2013-2014
JE/dw/June 2013
OTHER PATIENTS’ SAFETY DATA
Total Number of Drug Errors: A reduction of 7%
(this figure is broken down as below):
29
Near Misses
Prescribing Error
Omissions
Administration
Dispensing Error
Stock Delivery
Documentation
Number of controlled drug errors reportable to the Local Intelligence Network
This is an increase of 3 compared to last year
5
2
4
3
5
2
1
Number of pressure ulcer occurrences:
25
12
12
1
Grade 1
Grade 2
Grade 3
7
Number of complaints
1
Number of patients infected with MRSA whilst on the Inpatient Unit
0
Number of patients with C.Difficile whilst on the Inpatient Unit
1
Inpatient’s assessment for VTE
100%
Sharps Injuries
2
Clinical Effectiveness
o
o
o
o
o
o
o
o
We have completed self assessment against the Specialist Palliative Care Measures required
by The National Cancer Peer Review.
We continue to promote choice to our patients and advocate the benefits of Advanced Care
Planning.
We have implemented the Key Worker concept in Day Therapy and Outpatients.
The Liverpool Care Pathway has been used for 78% of our patients and families are given
sensitive information and explanation especially in light of recent media attention.
We have provided 24 Hour Telephone Advice to 227 Professionals and 202 Patients and
Carers this year.
We run a Lymphoedema Clinic monthly for palliative care patients.
We continue to work in partnership with District Nurses and Hospice at Home delivering
1002 visits and together allowing 98% of patients to die in their own home.
We continue to offer bereavement support to those known to us and work alongside
patients, families and carers helping them to cope and adjust to their losses.
Extract from a letter from a relative
“My mother, my children’s grandmother and great grandmother, had a few extra wonderful days,
all thanks to you. She helped so many people in her life and your support at the end of her life
was priceless”.
Bolton Hospice Quality Accounts
2013-2014
JE/dw/June 2013
Audit and Quality
o
o
o
o
o
o
We have undertaken 24 audits and 21 surveys using both internal and external tools.
All staff are actively encouraged to take part in all aspects of the audit process.
Examples include annual patient satisfaction surveys of all Hospice services; student nurses’
experiences, pressure ulcer incidents, patients’ records, credibility of the Accountable Officer,
adherence to Uniform Policy, staff occupational stress, response to nurse call, care of the
deceased, decision making and prescribing for LCP patients and waste segregation.
Our Quality Monitoring Calendar is reviewed monthly and recommendations and actions fed
back to staff through education and quarterly newsletters.
We value feedback from all people who use our services with the inclusion of staff, volunteers,
families, patients, friends, carers and other healthcare professionals and have implemented a
“Have your Say” comments scheme.
Bolton Hospice submitted Audit Data to the National Minimum Data Set for Specialist
Palliative Care. Results are available publicly, from the National Council for Palliative Care:
http://www.ncpc.org.uk./publication/index.html
Education and Training
o We have a workforce that is skilled within palliative care.
o Mandatory and competency based training is given priority within the organisation.
o We are a highly regarded provider of palliative care based education and training for health
o
o
o
o
and social care providers in Bolton.
Communication skills training is offered to all our staff and volunteers.
Working in partnership with another charity, a training package has been developed which
explores living and dying well with dementia.
We have also delivered training on adult and child bereavement, communication skills,
spirituality and all aspects of symptom management.
In line with The Dying Matters Campaigns to raise awareness in all members of society,
people employed in areas other than health have valued the training offered as death, dying
and bereavement affects us all.
http://dyingmatters.org/
Extracts from attendees’ evaluation forms:
“Before I came, I did not have any experience of 'End of Life' care or how to deal with it in my
working life - this course has been a revelation”.
“I learnt that it does not need to be scary. With careful thought and planning, we can be equipped
and useful”.
“I learnt not to be afraid of silence”
“I learnt that I do not have to have all the answers”.
http://www.boltonhospice.org.uk/training
Bolton Hospice Quality Accounts
2013-2014
JE/dw/June 2013
Patients’ and Families’ Experience
Bolton Hospice strives to ensure that people have a positive experience of our care
(NHS Outcome Framework Domain 4 Department of Health 2013)
o
o
o
o
We welcome feedback both positive and negative and this allows us to change, develop and
adapt to the needs of those for whom we provide care.
Patients and relatives were invited to a consultation meeting prior to the design of the
Inpatient Unit and though all were in favour of en-suite facilities, they would not want the
ward corridor used as access to the Multi-faith Centre.
We have become more confident in our approach to gathering this rich and valuable data and
redesigned our satisfaction surveys to explore aspects of choice, how to make a complaint,
family needs and information requirements about end of life.
We undertake an annual Patient Satisfaction Survey for all Hospice services; these are some
of the results:
All patients rated privacy, dignity and compassion highly; however for 2 patients having to use a
shared bathroom and toilet facilities was not fully satisfactory. This has been taken into account
within the refurbishment of the Inpatient Unit with the provision of en-suites.
100% of those surveyed had confidence in the staff caring for them, though some would like to
feel more involved in their plan of care. Staff now complete their care planning at the patient’s
bedside.
Though many of our patients want more information about what to expect at the end of their life
there are those that choose not to discuss this. Staff are all trained in effective communication
and the ability to tailor information needs to what the patient wants.
Some patients didn’t know how to make a complaint if they needed to so we have increased the
number of notices around the Hospice.
When we asked, one thing large or small which would make a difference for you and
your family they replied:“More comfortable chairs for relatives”.
“Choice of later Outpatient appointment”.
“Me and my family are totally satisfied”.
“Perfection rules OK”.
“Coming to the Hospice is the one place I can be myself, wish you could bottle the atmosphere for
me to take home”.
We surveyed families’ experiences of the care their loved ones received at the end of
their lives. These are some of their responses:
“The whole atmosphere in the Hospice is very positive”.
“She was cared for with the utmost respect and dignity in her last weeks of life”.
“Would have helped to understand what it is like when someone dies, before it happens”.
“My husband and my family were cared for exceptionally well with care, understanding and
dignity”.
Bolton Hospice Quality Accounts
2013-2014
JE/dw/June 2013
WHERE IMPROVEMENTS IN SERVICE
QUALITY ARE REQUIRED
Bolton Hospice is a key provider for Specialist Palliative and End of Life Care within Bolton and as
such, we are accountable for the quality of the care we deliver. We cannot stand still as the very
core of our existence relies heavily on those who help fund us. We pride ourselves on the ability
to care for those in our local community at a difficult time in their and their families’ and friends’
lives.
Patient Safety
o
o
o
o
o
o
o
To ensure effective communication internally and externally.
Continue to monitor patient’s harm.
Purchase new high grade mattresses which meet patient’s preferences.
Re-evaluate safe skill mix due to increased beds.
To embed the Medication Error Reporting Proforma into practice.
Further reduce interruptions during medication dispensing.
Ensure we have staff with the right skills to care for patients with dementia.
Clinical Effectiveness
o
o
o
o
o
o
o
To continue to work towards the requirements of Cancer Peer Review.
To ensure patients’ choices about their end of life care is clearly documented.
To develop a better Marketing Strategy for all our services.
To expand our capacity to deliver palliative care education across health and social care.
To improve clinical data collection and information technology systems.
Embrace the NHS Equality Delivery System within the Hospice.
To continue to contribute to the Bolton Palliative and End of Life Care Strategy Group, to
ensure effective planning and delivery of services.
Patients’ and Families’ Experiences
o
o
o
o
o
o
Utilise patients and families in the development of services even more effectively.
Undertake a Satisfaction Survey of people attending Bereavement Support.
Encourage other groups to work alongside patients within Bolton Hospice Support Services.
Explore the benefits of providing Carer and Family support.
Undertake annual Patient Satisfaction Survey.
Explore survivorship and its implications for the future shape of our service delivery.
Bolton Hospice Quality Accounts
2013-2014
JE/dw/June 2013
OUR PRIORITIES FOR
2013-2014
o Our reputation for excellence in practice is the core to our success, past, present and in the
future. Threaded throughout this is the ability to deliver and demonstrate that we provide
harm free, effective and efficient quality specialist palliative and end of life care to the people
of Bolton.
o We face many challenges over the coming months as we embark on upgrading our Inpatient
facilities, increasing our beds to 18, en-suite in 11 and relocating our Pharmacy, Prayer and
Reflection Room and Cold Room facilities.
o Our greatest task will be to ensure all aspects of quality is not affected, bed closures are kept
to a minimum and services are provided in an alternative way, allowing patients to remain
within the community.
o Providing high quality care is still achievable despite the current economic climate. Our focus
at Bolton Hospice will be to foster a culture that manages its resources effectively and
supports staff and volunteers through change, whilst continuing to deliver high quality care for
patients and their families.
o We will monitor our achievements in respect of the following priorities by reporting progress
through Bolton Hospice Quality and Standards Group, Clinical Governance, Audit and Quality
and ultimately through the Board of Trustees:
Patient Safety
Priorities
Monitored By
Dementia training to be undertaken by clinical staff
Training Profile
Reduce patient falls by 10%
Clinical Governance
Audit Group
Register with NHS Safety Thermometer to monitor falls, pressure
ulcers, urinary infections and VTE
Clinical Governance
Audit Group
To continue to meet Care Quality Commission Outcomes for quality
and safety
CQC Inspection Compliance
Patient Feedback
Publish Bolton Hospice’s response to the Francis Report on our
website.
Public and Professional
Awareness Group
Patient safety and standards of care is not compromised during
refurbishment
Incident Reports
Operational Design Team
Clinical Governance
Develop a Workforce Strategy for the next 5 years
Board of Trustees
Senior Management Group
Help the Hospices
Bolton Hospice Quality Accounts
2013-2014
JE/dw/June 2013
Clinical Effectiveness
Priorities
Monitored By
Develop a better Strategy for Marketing of all Hospice
Services
Increase in referrals/reduced hospital
admissions
Provide robust data for Bolton Clinical Commissioning
Group
Funding for services
CCG
Measure ourselves against the NICE Outcomes for
Palliative and End of Life Care
Bolton Palliative and End of Life Care
Strategy Group/Cancer Network/Peer
Review
Implement Bolton Hospice IT Strategy
Informatics Group
Meet the required standards for Peer Review.
Cancer Network/Bolton Palliative and
End of Life Care Strategy Group
All staff to have access to Education and Training
Education Strategy Group
Patients’ and Families’ Experiences
Priorities
Monitored By
Involve service users in all aspects of clinical services upgrades
Audit and Quality Group
Undertake annual patient satisfaction survey of all Hospice
Services and publish on website
Audit and Quality Group
Produce patient information on pain and symptom management
Nice Guidance/Peer Review
Work in partnership with Bolton CCG and Macmillan to explore
development of Patient/Carer Information Centre at Bolton
Hospice.
CCG
Macmillan
Bolton Hospice
Develop relationship with Bolton CCG to aid strategic priorites in
End of Life Care in Bolton
CCG
Extracts from letters and cards received 2012-2013
“What a wonderful institution, we would have been snookered without you. The care was wonderful; I am
going to change my will”.
“Thank you to all the staff for the wonderful, dignified care you have given to my dear wife”.
“I am so grateful that it was possible for you to admit my husband to the Hospice and I saw daily how much
effort the nursing staff put into making him as comfortable as he could be. All of you worked so hard to
make it possible for him to die with dignity and without pain and for that, words cannot express my
gratitude”.
“We were desperate when we came to you and you helped my husband spend his last days with his
sickness and pain under control. You treated him with both dignity and respect. I will never forget the
care both of us received”.
Bolton Hospice Quality Accounts
2013-2014
JE/dw/June 2013
Chairman’s Statement
I have great pleasure to endorse the Quality Accounts for
Bolton Hospice for 2013/2014. It will be evident to all our
patients, their families and carers that Quality is at the centre
of everything that we do and the Board of Trustees has a
commitment to ensure that the highest standard of palliative
care is delivered to those in need of our services.
This commitment encompasses Corporate and Clinical Governance.
In Corporate Governance, the Board ensure that systems and processes are in place to
maintain our growth as a viable organisation and that our income streams are assured
because without these funds, we could not continue with the level of care required by our
patients. Clinical Governance is critical to ensure that our services are of the highest
possible standard as confirmed in our Mission Statement.
Whilst Clinical targets are an important element in the service we provide, it is the human
service that is such an integral part of our mission, particularly ensuring that patients are
treated with respect, compassion and dignity.
Elsewhere in the Quality Accounts are extracts from the letters we have received from
patients and families. These are typical testaments to what we do at Bolton Hospice and
as Chairman of the Board of Trustees; I pledge our commitment to continue to build
improved quality, based on the feedback we receive from patients, families and carers.
Graham Yardley
Chairman
Comment made on a Patient Satisfaction Survey:
“Bolton Hospice, its staff and volunteers create a wonderful environment. We will be eternally
grateful for the care you have provided to our mother. Thank you so much”.
Bolton Hospice Quality Accounts
2013-2014
JE/dw/June 2013