Garden House Hospice
Quality Account 2012 - 2013
“When my partner said she wanted her last days at a Hospice
I didn’t know what to expect
but from the minute we got there I was totally amazed
by the staff and surroundings.
Every single person there was fantastic.”
Quote from a Family Carer Questionnaire 2012
Garden House Hospice
Part 1: A Statement on Quality from the Hospice Management Team
Welcome to the second Quality Account of Garden House Hospice; a summary of our
performance against selected quality measures for 2012 - 2013 and our initiatives and
priorities for quality improvement in 2013 - 2014.
It has been produced to inform service users (current and prospective), their families, our
staff, our supporters, commissioners and the public.
Garden House Hospice
Philosophy of Care
Palliative care is the total care of patients at a time when
their disease is no longer responsive to curative treatment and
when life expectancy is relatively limited.
Our philosophy of care is based on the following principles:
That palliative care
v respects the patients wishes
v is a team approach composed of
both professional staff and
trained volunteers
v integrates psychological and
spiritual care for patients, so
that they may come to terms
with their own death as fully and
constructively as they can
v aims to provide relief for
patients from pain and other
distressing symptoms
v helps the family cope during the
patient’s illness and in
bereavement
v offers a support system to help
the patient live as actively and
creatively as possible until death
v affirms life and regards death as
a normal process; it seeks
neither to hasten nor to
postpone death
The word ‘hospice’ often conjures up an image of a peaceful death with dignity in hushed
surroundings. The very essence of hospice, then, is quality care and as this report shows;
hospice care now embraces a whole range of services aimed at improving ‘quality of life’
well before the final curtain is drawn down.
But exactly what is ‘quality of life’ and how can it be measured is a much more vexed
question. We need to make some attempt to demonstrate ‘quality’ through words and
numbers. Sententious platitudes no longer suffice as we all have to strive to increase the
quality of care in an increasingly businesslike culture in times of financial constraint.
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Garden House Hospice
Such a culture can have adverse effects so we are determined to continue to provide
compassionate care to our patients and their families. And when all is said and done it is
their views that matter, so let them have the final word as they encapsulate the values of
our organisation.
Comments received by letter from a patient’s daughter;
“All without exception, both the medical and voluntary staff throughout my father’s three
week stay, at the hospice, were amazing, and that is a gross understatement. The whole
three week experience, had a powerful effect on us all, and renewed my faith in human
nature.
The Doctors and nurses all looked after my father with the greatest patience, kindness,
respect and diligence. Also the catering and voluntary staff gave my father the most
incredible consideration and respect and nothing was ever too much trouble for them.”
Comments posted on our Facebook page by a patient’s children;
“There is no way that my family or I can say ‘thank you’ enough ….. the level of care and
the compassion you showed were above and beyond what we expected ….. the
volunteers, nurses & doctors have made this terrifyingly painful experience easier to deal
with, because we know our mum is being treated with the love and dignity she deserves.”
Comments received by email from a patient’s son;
“I am writing to thank you for the quality care that you gave to my father ….. who died in
your care ….. At first when I heard he was going to a hospice, I was really worried that he
would suffer & would be neglected. I heard a few stories of hospices but I had never seen
one for myself.
After the very warm welcome that all of you gave us and after a good conversation my
worry was put to rest straight away. I have never seen such a caring staff and nice place
to be.
I can’t thank you all enough for the quality care you gave to my father. You didn’t let him
suffer and gave him pain relief when required. You were always there and just so friendly.
You even offered advice and after care for me and my family if we required it. I really
appreciate this and you all gave me good advice on what to do after (his) death.”
Comments posted on our Facebook page by a patient’s sister;
“During December and early January, my lovely little sister was cared for by the wonderful
staff and volunteers at Garden House. My husband described them as “angels with their
wings folded away”. I cannot praise everyone at Garden House highly enough, we were
loved and cared for at the most difficult time in our lives. Thank you!”
Dr Viv Lucas
Medical Director
Sally Alford
Matron
Jenny Lupton
General Manager
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Garden House Hospice
Part 2: Priorities for Improvement and Statements of Assurance
from the Hospice Management Team
Priorities for Improvement
Garden House Hospice is situated in Letchworth Garden City. It opened in 1990 to provide
specialist palliative care to the residents of Stevenage and North Hertfordshire. Due to its
location, close to the Bedfordshire border, some patients come from Bedfordshire.
Since 1990 the services offered by Garden House Hospice have grown and developed to
meet the needs of the community. From an initial In-Patient only service, Garden House
Hospice now provides: §
12 bedded In-Patient Unit
§
Hospice at Home
§
Day Services
§
Outpatients
§
Family Support Services
§
Specialist Palliative Care Advice Line
Mission Statement
Garden House Hospice offers hospice care and support to patients with life limiting
illnesses and their families.
All those who work at Garden House Hospice, in whatever capacity, share in the
common purposes, to: §
provide relief for patients from pain and other distressing symptoms.
§
help patients to live their lives with dignity, by bringing together the
psychological, emotional, spiritual and physical aspects of care.
§
provide care in a variety of settings, appropriate to the individual needs of each
patient.
§
offer support to families and carers both during a patient’s illness and into
bereavement.
Garden House Hospice is constantly seeking ways to improve the quality of care provided,
for patients and their families.
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Garden House Hospice
Garden House Hospice was inspected by the Care Quality Commission on 5th February 2013.
These are the results of our most recent checks showing
whether this care service is meeting each of the standards
that the government says you have the right to expect.
1 Standards of treating people with respect and involving them in their care
Overall
2 Standards of providing care, treatment and support that meets people's needs
Overall
3 Standards of caring for people safely and protecting them from harm
Overall
4 Standards of staffing
Overall
5 Standards of quality and suitability of management
Overall
Key to our latest checks on standards
All standards were being met when we last checked.
Summary Inspection Report
During our inspection on 5 February 2013 we spoke with four people who had
experienced a service from the in-patient hospice, day hospice and hospice at home
service. We also spoke with one person’s relatives. Without exception, people praised
the service they, or their relative, had received. People told us that the staff understood
and met their needs. One person’s relative told us, “The quality of care is excellent. All
staff are very understanding and respond quickly. It’s a service they can be proud of.”
People told us that they were given information about the service and the care and
treatment they received and what they could expect.
People were cared for by staff who were trained and well supported to deliver care and
treatment safely and to an appropriate standard. People praised the staff saying they
were, “very professional” and, “always had time to talk”. One person told us, “[The
staff] have always been able to answer my questions. They’ve given me information on
what help I can get and numbers to call if I do need help. They give me reassurance.
They’ve talked to my [relative] and explained things to [them] too.”
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Garden House Hospice
Priorities for Improvement 2013 – 2014
Safety
Priority I
All six individual patient rooms will have overhead tracking hoists fitted.
How was this identified as a priority?
When the In-Patient Unit was redeveloped, in 2008, an overhead tracking hoist was fitted
in one of the six side rooms.
In January 2011, funding was secured for two additional overhead tracking hoists.
At present, if a patient, known to require hoisting, is admitted they are allocated one of
the three individual patient rooms with an overhead tracking hoist. It has become
apparent that this is not always possible due to these rooms already being occupied by
other patients.
There has been an increase in admissions of patient’s with more complex needs; more
patients are requiring hoisting.
Additionally, patients’ needs may change during an admission making hoisting necessary;
it is not Hospice policy to move patients between rooms during an admission (unless
infection risk makes this mandatory).
Garden House Hospice does have a mobile hoist which can be used, when and where
necessary but: §
The overhead tracking hoists have much better manoeuvrability than the mobile
hoist.
§
There is potential for spreading infection when using the mobile hoist.
§
There is only one mobile hoist to cover three individual patient rooms and two
three bedded bays.
It has therefore been identified that fitting another three overhead tracking hoists, one
into each of the remaining three individual patient rooms, will alleviate some of the
current issues and improve safety for patients and Hospice Team Members.
How will this be achieved?
§
Hospice Management Team to source grant funding.
§
Order will be placed for three overhead tracking hoists.
§
Capacity of In-Patient Unit to be temporarily reduced by one bed to allow fitting of
tracking and hoists.
§
Hoist testing to be carried out prior to first patient use.
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Garden House Hospice
How will progress be monitored and reported?
Successful sourcing of grant(s) will be reported to Clinical Governance Group.
Support Services Manager will liaise with hoist manufacturers and the Senior Sister
In-Patient Unit to ensure a suitable time is arranged for fitting the tracking and hoists.
Installers will provide written proof that the new hoists have been tested and are ready for
patient use.
Clinical Governance Group will be informed when the new hoists are operational.
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Garden House Hospice
Priority II
All Garden House Hospice syringe drivers will be the same make and model as used
throughout the East of England Strategic Clinical Network.
How was this identified as a priority?
To date, two types of syringe driver have been in use throughout the East of England
Strategic Clinical Network: Graseby MS16A
rate measured in millimetres per hour
used in the community
Graseby MS26
rate measured in millimetres per day
used at the Hospice
There has been the potential for confusion leading to under or overdosing of medication if
the wrong rate calculation was used for the type of syringe driver.
At Garden House Hospice, patients admitted with a community syringe driver (MS16A) in
place have always had these replaced, immediately; a fresh batch of medication drawn up
and administered via a hospice syringe driver (MS26). No medication errors or ‘near miss’
incidents have been reported at Garden House Hospice.
On 16th December 2010 the National Patient Safety Agency (NPSA) issued a Rapid
Response Report (NPSA/2010/RRR019) ‘Safer ambulatory syringe drivers’, which stated;
“Between 1 January 2005 and 30 June 2010 the NPSA received reports of eight deaths
and 167 non-fatal reports involving ambulatory syringe drivers. Four of the deaths were
reported in 2009. Many of these incidents described infusions that had either run through
much quicker than expected or had not infused at all…..
… Errors include the wrong rate of infusion caused by inaccurate measurement of fluid
length or miscalculation or incorrect rate setting of the device. Dose errors also occur
because of different models using mm per hour or mm per 24 hour. Other issues include
syringes becoming dislodged, inadequate device alarms and lack of internal memory (a
technical issue which makes establishing the reason for any over or under-infusion
difficult).”
The NPSA required the following action, with an agreed date to complete transition to
syringe drivers with additional safety features, within five years;
“Develop a purchasing for safety initiative that considers the following safety features
before ambulatory syringe drivers are purchased:
o rate settings in millilitres (ml) per hour;
o mechanisms to stop infusion if the syringe is not properly and securely fitted;
o alarms that activate if the syringe is removed before the infusion is stopped;
o lock-box covers and/or lock out controlled by password;
o provision of internal log memory to record all pump events.”
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Garden House Hospice
How will this be achieved?
Meetings have already taken place within the East of England Strategic Clinical Network to
consider: §
Choosing an appropriate ‘new’ syringe driver.
§
Purchasing arrangements for the ‘new’ syringe driver.
§
Education on how to use the ‘new’ syringe driver; for all staff who will set up and
administer medications by syringe driver.
It has been agreed that Garden House Hospice will purchase fifteen T34 syringe drivers;
this has been made possible by a generous grant from the Graham Rowlandson
Foundation.
All Registered Nurses, from Garden House Hospice, will undertake training in setting up
and administering medication via a T34 syringe driver; this training has been planned, for
June and July 2013, at various locations within the East of England Strategic Clinical
Network.
Four Registered Nurses, from Garden House Hospice, will undertake additional training to
become ‘trainers’ in the use of T34 syringe drivers. The ‘trainers’ will;
§
Assess the competency of every Registered Nurse, in the use of the T34 syringe
driver, prior to their introduction at Garden House Hospice.
§
Train every Healthcare Assistants and Senior Healthcare Assistants how to monitor
a T34 syringe driver, prior to their introduction at Garden House Hospice.
§
Provide annual refresher training on the use of the T34 syringe driver (to all
Registered Nurses, Healthcare Assistants and Senior Healthcare Assistants); as
part of the rolling programme of Clinical Mandatory Training.
§
Re-assess the competency of every Registered Nurse, in the use of the T34 syringe
driver, annually.
§
Provide full training in the use of the T34 syringe driver to any newly appointed
Registered Nurses and assess their competency before they are able to set up and
administer medication, at Garden House Hospice, via a T34 syringe driver.
§
Provide training on how to monitor a T34 syringe driver to any newly appointed
Healthcare Assistants and Senior Healthcare Assistants.
Once all the Registered Nurses, at Garden House Hospice, have been trained and assessed
as competent in setting up and administering medication via a T34 syringe driver, a date
will be set for transferring from the current MS26 syringe drivers, to the new T34 syringe
drivers.
To avoid confusion, there will not be a phased introduction; on the designated day all
MS26s will be withdrawn and only T34s will be available to use. It is expected that the
transfer will take place on 1st September 2013.
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Garden House Hospice
How will progress be monitored and reported?
All Registered Nurses will be asked to complete pre and post training confidence
questionnaires, to measure the effectiveness of the training.
The Senior Sister In-Patient Unit will keep a record of when each Registered Nurse: §
attends Network training in setting up and administering medication via a T34
syringe driver;
§
is assessed as competent in setting up and administering medication via a T34
syringe driver.
Once the T34 syringe drivers are in use, Registered Nurses will be required to complete an
Accident, Incident, Near Miss Report Form for any issues that arise relating to syringe
drivers.
Any accidents, incidents or near misses which occur will be investigated, within 48 hours.
Resulting changes in practice, if any, will be cascaded to the Nursing Team, at the earliest
opportunity, via the appropriate internal mechanism(s).
In accordance with the North Herts Hospice Care Association Procedure for Reporting
Adverse Incidents Relating to Medical Devices; failure of or adverse incidents related to
syringe drivers must also be reported to the Medicine and Healthcare products Regulatory
Agency (MHRA).
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Garden House Hospice
Priority III
The needles, intravenous cannulae and administration sets, used at Garden House
Hospice, will have safety features, to minimise the risk of sharp injuries occurring during
use and disposal.
How was this identified as a priority?
In 2010 the European Commission published the EU Directive 2010/32/EU on the
prevention of sharps injuries in the hospital and healthcare sector.
Much of the Directive already formed part of health and safety law in Great Britain.
Other parts of the Directive were already accepted ‘best practice’, in Great Britain, and
together with the existing legal requirements were used as the basis for the North Herts
Hospice Care Association Policy for the Safe Management of Sharps.
On 11th May 2013 those requirements of the Directive which are not already law in Great
Britain will be published as the Health and Safety (Sharps Instruments in Healthcare)
Regulations 2013.
Regulation 5(1)(b) Use safer sharps (incorporating protection mechanisms) is explained as
follows (by the Health and Safety Executive): –
The employer must substitute traditional, unprotected medical sharps with a ‘safer
sharp’ where it is reasonably practicable to do so. The term ‘safer sharp’ means
medical sharps that incorporate features or mechanisms to prevent or minimise
the risk of accidental injury. For example, a range of syringes and needles are now
available with a shield or cover that slides or pivots to cover the needle after use.
How will this be achieved?
Garden House Hospice has a Service Level Agreement, for Infection Prevention and
Control, with the East and North Herts NHS Trust. In the light of this, it has been decided
that, where possible, Garden House Hospice will stock & use the same ’safer sharp’
products as the Trust.
The Garden House Hospice designated Infection Prevention and Control Lead Nurse has
obtained a list of products and suppliers from the Trust and is in the process of arranging
for representatives from the suppliers to come to the Hospice and demonstrate their
products. Products will be considered against the following factors (from the Health and
Safety Executive) before a final decision is made on what products to stock: §
the device must not compromise patient care;
§
the reliability of the device;
§
the care-giver should be able to maintain appropriate control over the procedure;
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Garden House Hospice
§
other safety hazards or sources of blood exposure that use of the device may
introduce;
§
ease of use (taking into account the existing clinical practices commonly in use by
the relevant health professionals – but not assuming custom and practice is safest);
§
is the safety mechanism design suitable for the application? The following are
relevant:
o if activation of the device is straightforward, it is more likely to be used;
o if the safety mechanism is integral to the device (ie not a separate
accessory) it cannot be lost or misplaced;
o for many uses a single-handed or automatic activation will be preferable;
o an audible, tactile or visual signal that the safety mechanism has correctly
activated is helpful to the user; and
o the safety mechanism is not effective if it is easily reversible.
Once a decision has been reached over which products will be stocked & used, at Garden
House Hospice, training sessions will be arranged for the Clinical Team; this may be by
‘trainers’ being trained and cascading the knowledge or by every Clinical Team Member
being expected to attend training with a representative from the supplier.
Sharp Safety will become part of the rolling programme of Clinical Mandatory Training.
This will include refresher training in the use of ‘safer sharps’ as well as other aspects of
Sharp Safety set out in the Health and Safety (Sharps Instruments in Healthcare)
Regulations 2013 and existing Health and Safety legislation.
The designated Infection Prevention and Control Lead Nurse will review the North Herts
Hospice Care Association Policy for the Safe Management of Sharps to ensure that it
complies with the Health and Safety (Sharps Instruments in Healthcare) Regulations 2013.
How will progress be monitored and reported?
Decisions regarding which products will be stocked & used, at Garden House Hospice, will
be reported to the Clinical Governance Group and Health and Safety Committee.
Once ‘safer sharps’ are in use, the Clinical Team will be required to complete an Accident,
Incident, Near Miss Report Form for any issues that arise relating to ‘safer sharps’.
Any accidents, incidents or near misses which occur will be investigated, within 48 hours.
Resulting changes in practice, if any, will be cascaded to the Nursing Team, at the earliest
opportunity, via the appropriate internal mechanism(s).
Reports will also be made, to external agencies, as required by legislation.
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Garden House Hospice
Effectiveness
Priority
The patient notes will be redesigned to: §
make them more user friendly for the whole Multidisciplinary Team;
§
avoid duplication;
How was this identified as a priority?
The annual audit of multidisciplinary patient notes, 2012, made the following
recommendations: §
All patient documentation needs to be reviewed for usability.
§
Divide the notes into sections to make the notes easier to navigate.
A discussion took place, at the Clinical Governance Group; the Multidisciplinary Team
agreed that improvements could be made to the patient notes.
How will this be achieved?
The Quality and Practice Development Facilitator has been nominated to lead on this
project.
Requests have been made to other local hospices for copies of their patient
documentation.
Two sets of ‘dummy notes’, containing copies of all the current documentation, in the
order it is currently filed, have been made up and circulated around the Multidisciplinary
Team for them to comment on: §
order of documentation;
§
usability of each individual document;
§
what works well;
§
what needs to be improved;
§
how the notes as a whole could be improved;
§
how individual documents could be improved.
Sets of notes received from other hospices have also been circulated for the
Multidisciplinary Team to look at and gain ideas from.
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Garden House Hospice
It has been decided that: §
File dividers will be used to create 12 separate sections in the notes.
§
Each section of the notes will have a specified content (with documents being
present according to individual patient need); the standard content of each section
will be listed, in order, on the divider.
§
Some documents will be redesigned, to make them more user friendly, or removed,
to avoid duplication.
§
The Multidisciplinary Team will receive training in the use of the newly designed
notes.
§
There will be a 3 month trial of the new notes, during which any issues can be
identified e.g. documents in the ‘wrong’ section, documents that need revising or
documents that are no longer required.
§
After the initial trial of the new notes, (once the content has been standardised),
local printers will be approached to quote for printing the dividers and documents.
How will progress be monitored and reported?
The Quality and Practice Development Facilitator will delegate work, to members of the
Multidisciplinary Team, but will remain in over all control of the project. When work is
delegated it will be: §
Specific;
§
Measurable;
§
Achievable;
§
Realistic;
§
Time Bound.
The Quality and Practice Development Facilitator will report back to each Clinical
Governance Group on progress that has been made.
After the new notes have been trialled, for the 3 month, their use will be reviewed, by:§
asking the Multidisciplinary Team to comment on them;
§
undertaking a multidisciplinary notes audit.
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Garden House Hospice
Experience
Priority
Planned discharges, from the In-Patient Unit, will be managed smoothly, efficiently and in
a timely manner for the patient, their family and carers.
How was this identified as a priority?
Several issues have arisen which have highlighted the need to further improve how
discharges are managed: §
Staff, on the In-Patient Unit, have identified the need for greater collaboration and
understanding between the In-Patient Unit and the Community Teams; so that
more patients experience seamless discharges.
§
Patients with complex needs have sometimes had their discharge delayed by a lack
of available services in the community.
§
An audit highlighted that discharge planning paperwork was not always being
correctly or completely filled in.
§
Some patients and/or their families and carers have been confused or anxious,
about;
o the discharge process;
o who is responsible for what after discharge.
How will this be achieved?
Nursing Team Members from the In-Patient Unit will rotate in to Hospice at Home. This
will enable them to experience what it is like to work and to be cared for in the
community. It is hoped that when they return to the In-Patient Unit their discharge
planning will be more informed because of this experience.
Following the audit of discharge planning paperwork, the Senior Sister In-Patient Unit has
been asked to devise an Action Plan for improvement.
Each discharge will be overseen by a designated member of the In-Patient Unit Team who
is responsible for co-ordinating the discharge planning.
A discharge leaflet will be produced, to be given to patients at the start of the discharge
planning process, so that they (and their family and carers) have a written explanation of
the process, which they can refer back to. The leaflet will include sections on: §
what to expect during discharge planning;
§
what each agency’s responsibilities are after discharge.
A Family and Professionals Meetings Procedure has been written, to be followed, when
required, to facilitate complex discharges.
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Garden House Hospice
How will progress be monitored and reported?
Rotation in to Hospice at Home will be monitored at appraisal and six month review.
Feedback from the first Nursing Team Member(s) to rotate will be used to develop the
experience for subsequent Team Members.
The Action Plan from the discharge planning paperwork audit will be presented at the
June 2013 Audit Meeting. If appropriate, changes in practice will be reported to the
Clinical Governance Group in July 2013. Re-audit will be undertaken six months after any
changes in practice have been implemented.
The Information Group will be responsible for agreeing the final wording of the Discharge
Leaflet and reviewing this on an annual basis. The Nursing Team will be required to log
which patients are given a Discharge Leaflet. This log will be compared against the actual
number of patient discharges to indicate whether the leaflet is being used.
A record will be kept, by the Senior Sister In-patient Unit, of those occasions when a
patient is ready for discharge but this is delayed, to include the length and reasons for this
delay. This record will be analysed to indicate whether the delay was due to a failure to
commence discharge planning early enough or due to circumstances beyond the control of
Garden House Hospice.
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Garden House Hospice
Priorities for Improvement 2012 – 2013
Safety
Priority
All Healthcare Assistants and Senior Healthcare Assistants (HCA) will have to achieve
designated competencies and demonstrate on-going proficiency.
What has been achieved
§
The Senior Sisters and Sisters have identified skills for which competencies are
required.
§
Work is well under way in writing appropriate competencies.
§
It has been identified that, in order for the work on writing and assessing
competencies (both HCA and Registered Nurses) to progress at the desired rate,
ongoing, designated, Senior Registered Nurse time is required.
§
At the Business Planning Meeting, held on 1st February 2013, it was proposed that a
Competencies and Education Senior Staff Nurse post, 15 hours per week, be
created.
§
The Hospice Management Team and Trustees have undertaken a feasibility study
for the creation of a Competencies and Education Senior Staff Nurse post.
§
It has been agreed that a Competencies and Education Senior Staff Nurse post, 15
hours per week, will be created in 2013 – 2014.
§
Whilst formal HCA competencies have not been in place during 2012 -2013, any
concerns about an individual’s competence have continued to be addressed
immediately with re-training and/or supervised practice provided, where necessary.
Whilst it is disappointing that this priority has not been fully achieved in 2012 – 2013
significant progress has been made and there is a plan in place to ensure the profile of
competencies is raised further in the future.
Patient safety has not been compromised in 2012 -2013 because the measures already in
place are adequate. Once fully implemented, competencies will further enhance patient
safety.
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Garden House Hospice
Effectiveness
Priority
The PEPSI COLA Holistic Needs Assessment framework will be used to present in-patients
at Multidisciplinary Team meetings and to record patient outcomes and decisions made.
What has been achieved
§
Several different documents have been trialled, by the In-Patient Team, for
presenting patients at Multidisciplinary Team Meetings and recording the
outcome(s) and any follow up action that has been decided upon.
Each document trialled so far had benefits and drawbacks.
The Clinical Team continue to work towards a document, based on Holistic Needs
Assessment, which is user friendly and records the necessary information.
§
The PEPSI COLA Holistic Needs Assessment continues to be used on admission to
the In-Patient Unit.
§
Medical discharge letters are produced using a standard template based on the
PEPSI COLA Holistic Needs Assessment.
§
Nursing discharge letters are now produced using a standard template based on
the PEPSI COLA Holistic Needs Assessment. Where possible these letters are now
typed.
The review of Patient Notes, planned for 2013 – 2014 will include the further development
and use of the PEPSI COLA Holistic Needs Assessment framework, including a
document/tool for use at Multidisciplinary Meetings.
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Garden House Hospice
Experience
Priority
The format of Day Hospice will be changed to better reflect the needs of the patient group
and their families. This will include offering more outpatient appointments, therapies and
treatments.
What has been achieved
§ Day Hospice has been renamed Day Services during 2012 – 2013; it is hoped this
new name better reflects the variety of services/sessions on offer and the on-going
developments that are planned. It may also make the services more accessible to
patients, as illustrated by the following comment form a Patient Questionnaire;
“How do you improve on an already excellent service? The only problem is the word
‘Hospice’. Not enough people know of the Day Care Hospice, so automatically link
the word with only one thing. I know you are working on this problem.”
§
The current structure of Day Services is as follows;
DAY
Monday
AM
PM
Lung Clinic
Complementary Therapy and Physiotherapy Outpatients
‘Traditional’ Day Hospice 10am – 3pm; patients may attend full or part day
Tuesday
Drop In and Medical Outpatients
Complementary Therapy and Physiotherapy Outpatients
‘Traditional’ Day Hospice 10am – 3pm; patients may attend full or part day
Wednesday
Drop In and Medical Outpatients
Complementary Therapy and Physiotherapy Outpatients
Outpatient Medical Treatments e.g. blood transfusions
Thursday
Drop In and Medical Outpatients
Complementary Therapy and Physiotherapy Outpatients
Lung Clinic
Friday
Patient and Carer Relaxation
Complementary Therapy and Physiotherapy Outpatients
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Garden House Hospice
§ There is capacity within the week to run additional groups and/or services. The Day
Services Review Steering Group are considering the following options;
o
o
o
o
a ‘non-cancer’ patient morning
extending Lung Clinic to incorporate patients with heart failure
art therapy groups
additional patient and carer relaxation sessions
§
Hospice Medical Team hours were increased in April 2012 and this has allowed
more Outpatient appointments to be offered, at Garden House Hospice.
§
Lung Clinic continued, following recommendations from the pilot clinic, offering
flexible attendance for patients with advanced, incurable lung disease. In the 12
months 1/01/12 – 31/12/12 there were 139 attendances (28 patients).
Patient’s satisfaction with Lung Clinic were audited in December 2012 – January
2013. Nine patients were asked the following question, by a Hospice Team Member
who had never been part of the Lung Clinic Team;
o What were Your Expectations of the Hospice Lung Clinic?
“I thought it would be all old people & a depressing place. I thought I came
here to prepare me for when the worst happens & I want to die here.”
“I was not too sure. Meeting other people with similar conditions.”
o Were Those Expectations Met?
“Would like to attend more.”
“I was wonderfully surprised to be able to do exercises other than breathing
ones.”
o What did you like or find useful about Lung Clinic?
“The support that I am getting as it also helps my wife. I have felt since
2009 that I ‘fell through the net’.”
“It made me get out of the house & it was good to talk to other people with
lung problems.”
o Have you found it beneficial attending?
“ Yes, 100%. I know that someone is caring for me – not just leaving me ‘on
the heap’.”
“Relaxing. I enjoy the social side as I live on my own. Lovely place. I go
home quite content.”
o Is there anything else you can suggest that would improve this service?
“No, not really.” (5 of 9 patients audited)
“Yes. Relaxation sessions after every lung clinic.”
- 19 -
Garden House Hospice
Patients and Staff at Lung Clinic
Day Services Patients and Staff
Enjoying a Game of Cards
- 20 -
Garden House Hospice
§
The Patient and Carer Relaxation sessions have been well attended and received.
Between 13th April 2012 and 11th January 2013;
o 129 patient attendances
o 070 carer attendances
o 007 average attendance (minimum 1, maximum 14)
o 018 Hospice Team Members trained to assist the complementary therapist,
physiotherapist and Sister who run these sessions
§
The Hospice team Members who received relaxation training have been able to
offer 1:1 relaxation sessions for patients and carers across all Hospice Services.
§
Hand massage training was given, to staff and volunteers, in November 2012. Hand
massage can now be offered to patients and carers across all Hospice Services.
§
Acupuncture continues to be offered to patients and the number of treatments
given doubled in the year 2012 – 2013; 53 treatments were given.
The Day Services Review Steering Group will continue to meet every 6 – 8 weeks and the
services offered will continue to evolve, according to patient need and preference.
The Day Services Team will continue to raise the profile of their services. Early referral will
be encouraged to enable patients to benefit from the full range of services on offer.
- 21 -
Garden House Hospice
Statements of Assurance from the Hospice Management Team
The following are statements that all providers must include in their Quality Accounts.
Many of these statements are not directly applicable to specialist palliative care providers;
explanation of these statements and why they do not apply to Garden House Hospice has
been included, in italics, where appropriate.
Review of Services
During 2012 - 2013 the Garden House Hospice provided the following NHS services: §
In-Patient Unit
§
Hospice at Home
§
Day Services – including Outpatients
§
Family Support Services
§
Specialist Palliative Care Advice Line
Garden House Hospice has reviewed all the data available to them on the quality of the
care in all of these NHS services.
The income generated by the NHS services reviewed in 2012 - 2013 represents 100% of
the total income generated from the provision of NHS services by the Garden House
Hospice for 2012 - 2013.
The income generated from the NHS in 2012 - 2013 represents 40% of the overall running
costs of Garden House Hospice in 2012 - 2013; 38% from NHS Hertfordshire and 2% from
NHS Bedfordshire.
The remaining 60% of overall running costs is sourced through voluntary income
generation; donations, fundraising, charity shops, lottery activity and income from
investments.
Participation in Clinical Audit
Garden House Hospice was not eligible in 2012 - 2013 to participate in any national clinical
audits or national confidential enquiries and therefore there is no information to submit
This is because Garden House Hospice only provides palliative care and none of the 2012 2013 national audits or confidential enquires related to specialist palliative care.
Research
The number of patients receiving NHS services provided or sub-contracted by Garden
House Hospice in 2012 - 2013 that were recruited during the period to participate in
research approved by a research ethics committee was NIL.
While Garden House Hospice has not recruited any patients to participate in research in
2012 - 2013 it has fully supported any patients who were participating in research for
other providers during this period.
- 22 -
Garden House Hospice
Use of the CQUIN Payment Framework
A proportion of Garden House Hospice income in 2012 - 2013 was conditional on
achieving quality improvement and innovation goals agreed between Garden House
Hospice & NHS Hertfordshire and Garden House Hospice & NHS Bedfordshire, through the
Commissioning for Quality and Innovation payment framework.
Further details of agreed goals for 2012 - 2013 and for the following 12 month period are
available in Appendix 1. and Appendix 2.
For NHS Hertfordshire the CQUIN payment equates to 1% of their total contribution.
For NHS Bedfordshire the CQUIN payment equates to 1% of their total contribution.
Statement from the Care Quality Commission
North Herts Hospice Care Association is required to register with the Care Quality
Commission and its currently registered to carry out the following regulated activities:
a.
Diagnostic and screening procedures
b.
Personal care
c.
Treatment of disease, disorder or injury
For Regulated Activities a. and c. the Nominated Individual is: Vivian Lucas
For Regulated Activity b. the Nominated Individual is: Sally Alford
North Herts Hospice Care Association has the following conditions on registration:
1.
The Registered Provider must ensure that the regulated activities a. b. or c. is
managed by an individual who is registered as a manager in respect of the
activity, as carried on at or from the location Garden House Hospice.
2.
This Regulated Activity may only be carried on at or from the following locations:
Garden House Hospice, Gillison Close, Letchworth Garden City, Hertfordshire,
SG6 1QU
The Care Quality Commission has not taken enforcement action against Garden House
Hospice During 2012 - 2013.
Garden House Hospice has not participated in any special reviews or investigations by the
Care Quality Commission during the reporting period.
- 23 -
Garden House Hospice
Data Quality
Garden House Hospice did not submit records during 2012 - 2013 to the Secondary Uses
service for inclusion in the Hospital Episode Statistics which are included in the latest
published data.
This is because Garden House Hospice is not eligible to participate in this system.
Information Governance Toolkit Attainment Levels
Garden House Hospice did not participate in formal Information Governance Assessment
in 2012 - 2013.
Garden House Hospice has policies and procedures in place for confidentiality, information
management and records management.
As a voluntary sector organisation, Garden House Hospice plans to explore the
requirements for establishing an N3 connection and use of the NHS Information
Governance Toolkit in 2012 - 2013. Information Governance Assessment, leading to an
Information Governance Grading, is achieved through completion of the NHS Information
Governance Toolkit.
Clinical Coding Error Rate
Garden House Hospice was not subject to the Payment by Results clinical coding audit
during 2012 - 2013 by the Audit Commission.
- 24 -
Garden House Hospice
Part 3: Review of Quality Performance
The National Council for Palliative Care (NCPC): Minimum Data Sets
The NCPC minimum data sets are the only information on hospice activity collected
nationally. The figures provide one measure of activity and outcomes of care for patients,
at Garden House Hospice, during the period 2012 – 2013 (2011 – 2012 figures provided
for comparison).
In-Patient Unit
2012 - 2013
2011 - 2012
Total number of admissions
268
265
Total number of patients
224
225
Number of new patients
199
209
% Occupancy
067
071
% Patients returning home
038
039
Average length of stay – cancer patients
11.5 days
11.4 days
Average length of stay – non-cancer patients
09.5 days
13.0 days
2012 - 2013
2011 - 2012
Total number of patients
108
95
% New patients
080
64
% Patient attendances
086
79
% Patient non attendances
014
21
2012 - 2013
2011 - 2012
Total number of patients
230
270
% New patients
091
091
% Re-referred patients
002
002
2094
2208
Day Hospice
Hospice at Home
Total face to face contacts
Total telephone contacts
Average length of care
820
-
21 days
41 days
- 25 -
Garden House Hospice
Outpatients
2012 - 2013
2011 - 2012
103
100
Patients Diagnosis; Cancer/malignant diagnosis
172
177
Other diagnosis
125
016
Not recorded
126
007
% New patients
173
180
% Re-referred patients
104
102
Seen by Palliative Care Doctor
137
171
2012 - 2013
2011 - 2012
Total service users
089
096
Number of telephone contacts
146
144
Number of individual counselling sessions
354
467
Total number of patients
Bereavement Support
In addition to individual bereavement counselling sessions, group bereavement counselling
sessions were trialled in 2012 – 2013. The aims of this were to: §
enable people to have a choice of how they are supported
§
make bereavement support available for more people
Quantitative evaluation of these sessions is currently been undertaken. Qualitative
evaluation (from telephone ‘interviews’) indicates that the sessions are well received and
meeting a need; it is therefore planned to continue and extend these sessions in 2013 –
2014, with more open access for bereaved family/carers.
There is currently no data recorded on these sessions; the process for formally recording
attendance will be developed in 2013 – 2014.
- 26 -
Garden House Hospice
Performance against Commissioning for Quality and Innovation
(CQUIN) Payment Framework 2012 - 2013 - NHS Hertfordshire
For all palliative care patients regardless of diagnosis who are expected to be within the
last year of life, to ensure that they have received the appropriate assessment and care
planning from the provider at key points during their patient journey.
CQUIN
Target
In-Patient
Unit
Hospice At
Home
No. of Holistic Needs Assessments completed
on admission
> 85%
100%
98.08%
No. of end of treatment plans completed for
transfers of care
> 85%
100%
96.85%
> 85%
86.63%
81.34%
> 80%
73.10%
94.49%
No. of patients offered an Advance Care Plan
(ACP) with no prior offer or ACP at time of
admission
Preferred Place of Death Achieved
The reporting of all patient activity regardless of diagnosis who have received a service
from the provider in any setting.
In-Patient
Unit
Hospice At
Home
Requests for admission to the service; non-cancer
13.74%
13.21%
Requests for admission to the service; cancer
86.26%
86.79%
0%
07.01%
Admission to the service; non-cancer
12.75%
13.11%
Admission to the service; cancer
87.25%
86.89%
No. of appropriate patients not; admitted within 5 days
0%
-
No. of appropriate patients not; assessed within 3 days
-
0%
12%
-
No. of requests that were inappropriate
No. of Out Of Hours admissions
- 27 -
Garden House Hospice
Complaints
During the period 2012 - 2013: Total Number of Complaints
6
Total Number of Complaints Upheld in Full
2
Total Number of Complaints Upheld in Part
2
Total Number of Complaints Not Upheld
1
Total Number of Complaints Still On-Going
1
Complaints Upheld in Full:
§
Verbal Complaint; Attitude of a member of staff.
Findings;
o Staff member aware that her manner was not acceptable and has reflected
on how she may manage similar situations in the future.
§
Written Complaint; Attitude of a staff member
Recommendations;
o Staff member to undergo further communication skills training
o Staff member’s conduct to be monitored by Line Manager
Complaints Upheld in Part:
§
Verbal Complaint; Concerns regarding husband’s care (patient sustained a fall).
Findings;
o Patient was checked regularly overnight and had his call bell to hand.
o An injection for nausea may have contributed to the patients fall; the
injection may have contributed to the patient becoming confused.
o No changes in practice recommended.
§
Verbal Complaint arose during bereavement support. Complaints process for
Garden House Hospice explained.
Written Complaint; Issues with patient care at Lister Hospital, by Macmillan Team
and at Garden House Hospice.
Outcome and Recommendations;
o Family invited to discuss issues with the Medical Director, a member of the
Nursing Team and a member of the Family Support Service.
o Advice and support given on how to follow up complaints relating to Lister
Hospital and Macmillan Team.
o Further meetings with Family Support Service offered.
o Hospice Medical Team to ensure opportunities to communicate with families
of deteriorating patients are fully utilised.
- 28 -
Garden House Hospice
Complaints Not Upheld:
§
Written Complaint; Access to Hospice Services - Community Professional unhappy
with response to a request for an Out Of Hours Admission for a patient not
previously referred to the Hospice.
Findings;
o Correct procedures were followed by Garden House Hospice Clinical Team.
o Patient’s condition required Acute Hospital admission for urgent treatment
for a reversible cause.
o Awareness to be raised, among the community team, of the prompt
questions used by the hospice team when taking requests for admission and
to clarify admission criteria.
o The question ‘has the patient deteriorated rapidly within last 24-48 hrs?’ to
be added to the list of prompt questions.
Complaint Still On-Going:
§
Written Complaint; Son and daughter unhappy with their father’s care
Concerns
During the period 2012 - 2013 no concern were raised.
- 29 -
Garden House Hospice
Patient Accident, Incidents and Near Misses
The following patient related accidents and incidents were reported and investigated
during the period 2012 – 2013 (2011 – 2012 figures provided for comparison).
Medicines Related Incidents
20
(24)
Slips, Trips and Falls
27
(53)
Other*
18
(05)
Pressure Damage on Admission
34
(data not collected 11 - 12)
Pressure Damage During Admission
09
(data not collected 11 - 12)
The majority of slips, trips and falls related to deteriorating patients trying to maintain
their independence.
Other
* One patient spilt his hot drinks.
* One patient made an allegation of assault; the patient was confused and had made
similar allegations against her husband and other carers.
* One patient lost their dentures; patient’s family aware that he repeatedly removed his
dentures and put them down anywhere.
* One patient knocked his leg on his wheelchair.
* Unexplained haematoma found on a patient’s leg.
* One patient was found smoking a cigarette in bed.
* £5 was found in the safe which had not been returned with a patient’s property.
* Patient confidentiality was breached by a Reception Volunteer; re-training has taken
place.
- 30 -
Garden House Hospice
Clinical Audit
During the period 2012 - 2013 the following, audits, were undertaken, using national audit
tools designed specifically for hospices, by Help the Hospices.
Audit Title
Date
Recommendations
Actions
Completed
Infection Prevention and Control
1. Policies and Processes
11/12
None
2. Hand Hygiene
03/13
None
N/A
3. Patient Areas
02/13
Floor seals need to be redone in
some areas*
Partial
4. Clinical Rooms
03/13
Alcohol hand gel replaced
Yes
5. Bathrooms
10/12
None
N/A
6. Patient Toilets/Bidets
11/12
None
N/A
7. Sluice/Dirty Utility
04/12
Bed pans/ urinals and jugs must Yet to be
be stored inverted or on racks
re-audited
8. Domestic Rooms
05/12
None
N/A
9. Care of Deceased Patients
11/12
None
N/A
10. Sharps
11/12
Sharps containers labelled with
date/locality and signed when
assembled
Temporary closure mechanism
in use when bin not in use
Both issues
raised with
Clinical Team;
Yet to be
re-audited
11. Protective Equipment
11/12
None
N/A
12. Kitchen Areas
(excluding Main Kitchen)
04/12
Checklists and rotas for cleaning Yes
Beverage Rooms need to be put
in place
04/12
None
Bereavement Support
Bereavement support service
audit tool; Policies and
Procedures, Confidentiality and
Record keeping, Personnel,
Training, Information Provision,
Service Evaluation
N/A
* In some patient areas, the joints in the Altro flooring are not fully sealed. This issue was
already known about at the time of the audit and alternative solutions are being
investigated and trialled by the manufacturers.
- 31 -
Garden House Hospice
Internal clinical audits in the period 2012 - 2013 included: Audit Title
Date(s) Recommendations
Audit of Patients on the 1/04/12- Ensure correct and complete
30/09/12 paperwork is being used.
Liverpool Care Pathway
(LCP) at Time of Death
Ensure all necessary information is
transferred to the LCP
documentation.
Audit of Patients Not on the 1/04/12- All patients to be coded correctly on
30/09/12 iCare.
Liverpool Care Pathway
(LCP) at Time of Death
All patients, in the terminal phase,
should be commenced on the LCP.
Actions
Completed
To be
re-audited
To be
re-audited
To be
re-audited
To be
re-audited
Nutritional Screening Tool
Audit
21/03/13
None.
N/A
4 Monthly Controlled Drug
Checks
30/04/12
Alterations to be made correctly.
No
10/09/12
None
N/A
28/01/13
Alterations to be made correctly.
To be
re-audited
Patients own drugs; one page To be
re-audited
required for each drug.
Discharge Paperwork Audit
1/01/1230/06/12
Discharge paperwork to be fully
and accurately completed.
All entries to be dated, timed and
signed (even if marked N/A).
Action Plan
awaited from
Nursing Team;
to be
re-audited
No brackets or dittos to be used.
Discharge Letter Audit
Waiting Time for
Bereavement Support
1/01/1230/09/12
01/1211/12
Amend standard template to
include additional items including;
Preferred Place of Care,
Preferred Place of Death,
Advance Care Plans,
resuscitation status and
follow up.
Yes
None.
N/A
- 32 -
Garden House Hospice
Staff Survey
Garden House Hospice was one of 30 Hospices to use a Staff Survey run by Birdsong
Charity Consulting, in June - July 2012. Questionnaires could be completed, anonymously,
on-line or paper copies were available from the Staff Room.
The questionnaire was divided into four sections: 1. The Organisation and Communication
2. Morale and Work Life Balance
3. People Management
4. Development and Reward
Each section consisted of a number of statements which could be scored; strongly agree,
agree, neutral, disagree or strongly disagree.
Birdsong reported back, to the Hospice Management Team, on the Garden House Hospice
results, with comparative data for other Hospices. In addition, Birdsong provided
comparative data to a further survey they had conducted across 170 charities in the UK.
49 of 120 members of paid staff responded to the survey (27 on-line and 22 on paper); a
response rate of 41%.
Response to the questionnaire was varied with Garden House Hospice employees
indicating higher levels of satisfaction, than both other Hospices and charities in general,
in some areas and lower levels of satisfaction in other areas.
§
85% (42 people) Understand what the organisation wants to achieve
§
88% (43 people) Were proud to work for the charity
§
90% (44 people) Felt they were making a difference
§
40% (19 people) Felt that they got stressed at work
§
31% (15 people) Did not feel they were well informed about what was
happening in the charity
§
37% (18 people) Felt their views were not listened to and valued
In response to the results, a series of focus groups have been held for staff to,
anonymously, put forward comments and suggestions on the outcome of the survey and
the way forward. The results of these have been taken back to the Hospice Management
Team and an Action Plan has been drawn up.
It is hoped that the Action Plan will address some of the areas where staff satisfaction was
lower. This will be measured by undertaking the 2013 Birdsong Staff Survey.
- 33 -
Garden House Hospice
Feedback from Patients and Families on Services
Garden House Hospice values the feedback we receive from patients and families; the
Hospice Team is constantly looking for ways to maintain and improve the quality of care
for patients and their family/carers.
Patient Questionnaires are given out during a patient’s stay on the In-Patient Unit, in
conjunction with their first Day Hospice Review (usually the 4th visit) and by the
Hospice @ Home Team, to respite patients, on their fourth visit. Matron reviews returned
questionnaires and acts on any issues raised, immediately. Questionnaires are confidential
but patients are given the option to give their name; if they would like a written response
or the opportunity to comment further on our services. Questionnaires are audited every
six months.
Family/Carer Questionnaires are sent out, via the Family Support Team, with the offer of
bereavement support, six weeks after the patient’s death, given to family/carer on a
patient’s discharge from the In-Patient Unit and displayed around the Hospice for families
and carers to pick up. Matron reviews returned questionnaires and acts on any issues
raised, immediately. Questionnaires are confidential but family/carers are given the option
to give their name and address; if they would like a written response or the opportunity to
comment further on our services. Questionnaires are audited every six months.
Family Support Service Questionnaires are sent out to all individuals who have completed
a series of planned support sessions, with the Family Support Service, within two weeks of
their sessions finishing. The Family Support Service Manager reviews returned
questionnaires and acts on any issues raised, immediately. Questionnaires are confidential
but individuals are given the option to give their name and address; if they would like a
written response or the opportunity to comment further on our services. Questionnaires
are audited every six months.
All these questionnaires ask the individual to score statements, about the various Hospice
Services and Departments, from 1 – 4; 1=very dissatisfied, 2=dissatisfied, 3=satisfied,
4=very satisfied N/A=Not Applicable.
In November 2012 the Hospice Medical Team started using a Doctor Feedback
Questionnaire. This is sent (with a reply paid envelope) to patients who have attended
Garden House Hospice for an Out Patient consultation. There are ten questions about the
consultation which can be scored; Yes definitely, To Some Extent, Not Really, Definitely
Not or Does Not Apply. There is an additional question, ‘Overall, how satisfied were you
with the doctor that you saw?’ This can be scores; Very Satisfied, Fairly Satisfied, Not
Really Satisfied or Not At All Satisfied.
- 34 -
Garden House Hospice
Patient Questionnaires
Comments relate to Patient Questionnaires received back between 1.1.2012 and
31.12.2012. During this year 37 Patient Questionnaires were received back.
Care and Support
How satisfied were you with your involvement in planning your care?
§
Scored 92/92; 100% satisfaction
“Staff in all areas were very professional, caring and considerate. Everyone listened &
acted upon requests. All services worked together to provide a very high standard of
care.”
“I have been very fortunate to receive such caring.”
“A wonderful experience when I was feeling low.”
Nutrition and Diet
Were your dietary needs met
§
Scored 73/76; 96% satisfaction
“Exceptional staff throughout. Needs well supported.”
Day Hospice
Structure of the day
§
Scored 38/40; 95% satisfaction
“The days I attended Hospice Day Centre was very pleasurable & delightful.”
Inpatient
Suitability of bedroom facilities
§
Scored 67/68; 99% satisfaction
Suitability of bathroom facilities
§
Scored 67/68; 99% satisfaction
“We are unanimous in our view that J could not have had a better or suitable place to
spend the last few days of her life.”
Hospice at Home
Is the service reliable? (Yes/No response)
§
Scored 16/16; 100% satisfaction
“Hospice at Home well done we need this help.”
“A team of very pleasant nurses all of whom are very kind and considerate and very
helpful. They inspire confidence.”
- 35 -
Garden House Hospice
Family/Carer Questionnaires
Comments relate to Family/Carer Questionnaires received back between 1.1.2012 and
31.12.2012. During this year 153 Family/Carer Questionnaires were received back.
In Patient Care
Information regarding changes in care
§
Scored 344/364; 95% satisfaction
“Everyone at the Hospice cares about patients and their carers. Service is second to none.
Atmosphere is caring and helpful and happy. Well done to all staff and management.”
“We felt that staff at Garden House Hospice dealt with mum superbly and were not only
for her but the family as well. They made Mum’s last few weeks as easy and comfortable
as they could. Thank you for everything.”
Quality of your relative’s meals
§
Scored 324/332; 98% satisfaction
“I couldn’t have coped without all the wonderful staffs help and neither could my brother.
Also full credit to the kitchen staff for their meals and sandwiches.”
Suitability of environment; Privacy
§
Scored 389/420; 93% satisfaction
“My husband’s care was beyond the call of duty. We were treated with the utmost respect
and love. His final hours were peaceful and serene.”
“Overall no complaints at all about the service provided. However, felt all inpatients should
have had own rooms felt communal wards were not very private.”
Day Hospice
How valuable is/was your relatives attendance at Day Hospice to you?
§
Scored 96/96; 100% satisfaction
“My brother really enjoyed coming on Wednesdays and looked forward to it each week.
We couldn’t have asked for anything more. Brilliant staff and volunteers.”
“There was always a friendly welcome in day hospice and always someone for me as a
carer to talk things over with and receive help and understanding.”
Hospice at Home
Your involvement in planning care
§
Scored 199/204; 98% satisfaction
“The care given to my husband and the kindness and help given to me was outstanding. I
don’t think the help given to me could have been improved."
“I cannot express how much I appreciate the help we received. It was there when we
wanted it, the amount of help we needed and delivered with kindness, understanding and
love.”
- 36 -
Garden House Hospice
Family Support Service Questionnaires
Comments relate to Family Support Service Questionnaires received back between
1.3.2011 and 29.2.2012. There was a response rate of 51% (36/71).
Before your first appointment
Was the time you waited for your first appointment acceptable?
§
Scored 133/140; 95% satisfaction
“I was very impressed & appreciative of the way I was treated by the staff – very timely
communication, always phoned me back, quick to get counselling sessions organised for
me. Thank you very much. Very empathic, friendly and understanding.”
“It would have been more helpful if I could have seen someone sooner, but it was over
Christmas/New Year period and could not be helped.”
Your sessions with the Family Support Service
Do you feel the person supporting you was actively listening to you?
§
Scored 135/136; 99% satisfaction
Do you feel the person supporting you understood what you talked about in the
sessions?
§
Scored 135/136; 99% satisfaction
“I cannot fault the support I was given. Anne was brilliant, she understood my moods, and
it was easy to open up to Anne my feelings, which I felt I could not talk to my family.”
“Anne, my counsellor was very supportive. She would ask me sometimes to clarify things,
which really made me think. She mad me feel it was OK how I felt, that it is a big thing to
have happened, made me understand.”
Now your sessions with the Family Support Service have come to an end
Do you feel the support from the Family Support Service has been helpful to you?
§
Scored 137/140; 98% satisfaction
“I really wasn’t sure about approaching the hospice for support, but after persuasion from
my school and my best friend I finally did. The care and support I have received has been
excellent and really put me at ease to start to help me work through my bereavement and
other issues. Thank you so much Garden House.”
How likely would you be to recommend the Family Support Service to another person?
§
Scored 139/140; 99% satisfaction
“This service was a lifeline at a time of extreme distress. I had lost six members of my
family within two years, although I had been offered counselling I had declined this as I
thought I was managing the grieving process, then my mother passed away and my
whole world fell apart. My counsellor was fantastic, she helped me through the grieving
process and enabled me to focus. I would highly recommend this service. Thank you.”
- 37 -
Garden House Hospice
Doctor Feedback Questionnaire
As Doctor Feedback Questionnaires have only been in use since November 2012 they have
not been formally audited yet. Questionnaires and comments are reviewed, as soon as
they are returned, so that any necessary actions can be taken.
No actions have been necessary to date.
The following comments relate to the 10 Doctor Feedback Questionnaires received back
between 1.11.2012 and 31.3.2013.
Overall, how satisfied were you with the doctor that you saw?
§
Very Satisfied
9/10
§
Fairly Satisfied
1/10
§
Not Really Satisfied 0/10
§
Not At All Satisfied 0/10
“Excellent treatment.”
“It was so nice to have as much time as needed. You feel with most doctors they do not
have much time.”
“Very often during the course of my illness I have felt as though I was not treated with
much dignity and compassion. Of course there are exceptions. I count Dr Lucas and his
team most helpful and compassionate, and that I was treated like a human being that
mattered. Thank you.”
“Best treatment I have had for a long time. Dr Vooght was very professional and
considerate.
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Garden House Hospice
External Statements:
NHS Hertfordshire
Garden House Hospice has continued in 2012/13 to maintain the high standards of care and
intervention expected by its Hertfordshire Commissioner.
Offering a range of services for those with palliative care needs and particularly those within the
last year of life, the Hospice remains a valued and valuable resource to its patients as well as
relatives and carers.
Of particular note is the willingness of the Hospice to support a range of initiatives which has
included supporting the education of health and social care students, supporting Dying Matters
week and the Hospices involvement in the local community.
Under new CCG arrangements, the Hospice remains a keen and willing partner to continue to
develop best quality practice in supporting those who are at the end of life or need a Hospice
environment and to be involved in the further development of services for those with a palliative
care need.
The Hospice will in 2013/14, be further developing it’s learning through implementation of the
Friends and Family Test, as well as monitoring those it cares for through use of the NHS Safety
Thermometer.
Gordon J Pownall
Community Commissioning Manager - Commissioning Lead for End of Life and Palliative Care
NHS Hertfordshire
Hertfordshire Overview and Scrutiny Committee
To date (27th June 2013) no response has been received from Hertfordshire Overview and Scrutiny
Committee.
- 39 -
Garden House Hospice
Healthwatch Hertfordshire
Healthwatch Hertfordshire thanks Garden House Hospice for the opportunity to read and
comment on their draft Quality Account. However we do not feel that we are in a
position to make comments about the quality of service provided this year but note the
following:
·
The Quality Account is informative with some excellent examples of patient
feedback.
·
The priorities are presented clearly showing why they have been chosen and how
they will be achieved.
·
Actions taken to improve discharge from the In Patient Unit by collaborative
working with the Community Teams is welcomed.
·
Review of the effectiveness of last year’s priorities has allowed the Hospice to
make plans for further quality improvement.
·
The increase in day services offered to reflect patient need is commended.
We look forward to seeing the results from your chosen priorities and would value
increased engagement with the Hospice through our Stakeholder Panel.
Sarah Wren MBE, Chairman Healthwatch Hertfordshire, June 2013
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Garden House Hospice
NHS Bedfordshire
I have passed this to our quality Team for a response. (3rd June 2013)
Deborah Cakmak; NHS Bedfordshire Lead on Quality Accounts 2013
No further response has been received to date (27th June 2013).
Bedfordshire Overview and Scrutiny Committee
Thank you for sending this through to me, l have no comments to make.
Cllr Mrs Rita J Drinkwater (Chairman) SOCIAL CARE, HEALTH & HOUSING OVERVIEW &
SCRUTINY COMMITTEE
Healthwatch Bedfordshire
To date (27th June 2013) no response has been received from Healthwatch Bedfordshire.
- 41 -
Garden House Hospice
- 42 -
Garden House Hospice
Appendix 1: Commissioning for Quality and Innovation payment
framework goals 2012 - 2013
NHS Hertfordshire
To improve the care of patients who are on a cancer or palliative care / pathway End of Life –
50% of total CQUIN
Description of
Indicator
For all palliative care patients regardless of diagnosis who are expected to be
within the last year of life, to ensure that they have received the appropriate
assessment and care planning from the provider at key points during their
patient journey.
To ensure: A. A Holistic Needs Assessment is completed at key points for any patient with
cancer, while the patient remains under the active care of the provider, and
at the point of any transfer of care
B. An end of treatment plan is in place where the provider is transferring care
to another provider following active or palliative treatment
C. The offer of an Advance Care Plan for all patients who have been identified
by any provider to be within the last 12 months of life
CQUIN Goal
o To improve the quality of care for patients with cancer and any other life
limiting illnesses.
o Ensuring that the health and social care needs of all patients are
comprehensively assessed.
o To ensure that all patients within the last 12 months of life, regardless of
diagnosis are offered the opportunity to complete an Advance Care Plan
accessible to all professionals who may provide health or social care
support, including emergency services.
Baseline value Quarter 1 data will form baseline. Following the setting of the baseline, value
indicators for quarters 2, 3 and 4 will be set by the commissioner. This will be
based on the expectation within the NICE guidance that 85% of patients will
have had their holistic needs assessed. In addition where relevant 85% of
patients will have received an end of treatment plan and / or will be offered the
opportunity to complete an advance care plan.
Both holistic needs assessment targets and (for patients within the last 12
months of life) Advance Care Plan targets must be met consistently for the full
year to achieve the CQUIN.
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Garden House Hospice
Activity and Performance Reporting – Informing strategic planning – 50% of total CQUIN
Description of
Indicator
The reporting of all patient activity regardless of diagnosis who have received a
service from the provider in any setting.
The key elements of this indicator upon which the providers will be measured
will be evidence of: a. Reporting template completion and return to the Commissioner applying
agreed definitions of data reporting to maintain reporting consistency
across all providers of similar services
b. Achieving the timescales for reporting as defined within the CQUIN
c. Achieving data completeness in terms of detail ensuring that gaps in data
do not exist in any aspect of the information required
d. Use of the agreed template to facilitate collation of all reporting across a
range of services and settings
CQUIN Goal
o To improve planning of quality care for patients on an end of life pathway
o To ensure that Commissioners have access to comprehensive activity data
to facilitate strategic planning
o To evidence activity across Hertfordshire Hospice provider services to
inform benchmarking reviews and correlate financial investments with
referral and discharge activity across the wider population
o To improve the use of existing service provision through understanding
current activity and trends
Baseline value Quarter 1 will form baseline for review of the reporting template. Following the
setting of the baseline, value indicators for quarters 2, 3 and 4 will be set by
the commissioner. This will be based on the expectation of full data completion.
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Garden House Hospice
NHS Bedfordshire
Goal
no.
Description of Goal
Quality
Domain(s)
Indicator Indicator name
number
1
The development of internal
pathways, that include key
trigger points to deliver and
embed NICE Quality
Standards into service
delivery.
Effectiveness/ 1
Patient
experience
1a
(I)
Effectiveness/ 1a
To develop and implement
Patient
clear systems and processes
experience
for staff to follow when
communicating and providing
information appropriate to
the stage reached by the
person who is approaching
end of life and for responding
to people’s change in
circumstances.
1a
(II)
Appropriate education and
training is delivered to staff
to ensure they are confident
to communicate and provide
information to patients,
families and carers.
1a
(III)
NHS Bedfordshire patients,
families and carers are
provided with information on
PEPS.
1b
(I)
To develop and implement
systems and procedures for
the provision of
comprehensive holistic
assessments in response to
the changing needs of the
patients, families and carers.
1b
(II)
To have clear systems and
processes in place for
referring NHS Bedfordshire
patients to PEPS.
Effectiveness/ 1b
Patient
experience
Indicator
weighting
Deliver and
embed NICE
Quality
Standards.
100%
QS 2:
Communication
and Information.
100%
QS3:
Assessment, care
planning and
review.
100%
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Garden House Hospice
Appendix 2: Commissioning for Quality and Innovation payment
framework goals 2013/14
NHS Hertfordshire
Goal number
Goal name
Indicator number
Indicator name
Indicator weighting
(% of CQUIN scheme
available)
Description of indicator
Numerator
Denominator
Rationale for inclusion
Data source
Frequency of data collection
Organisation responsible for
data collection
Frequency of reporting to
the commissioner
1
Friends and Family Test
1
Friends and Family Implementation
1.0%
Implementation of Friends and Family Test
n/a
n/a
National CQUIN scheme
Local provider response to local commissioners.
Review of returns submitted to commissioners. Data to be
presented on the MS Excel Template as provided for activity
reporting.
Garden House Hospice
At the end of each Quarter of the financial year – to be
received by the commissioner within one calendar month of
the end of the preceding quarter.
Baseline period/date
n/a
Baseline value
n/a
Final indicator period/date
Payment may be made in Quarter 3 of the financial year
(on which payment is based) 2013/14 providing full achievement to date for quarters 1-3.
Final indicator value
Full delivery of the nationally set milestones
(payment threshold)
Provider to demonstrate to commissioner that milestones
Rules for calculation of
have been met as indicated in the associated Friends and
payment due at final
Family Guidance.
indicator period/date
(including evidence to be
supplied to commissioner)
Final indicator reporting
Response from the providers to the commissioners at the
date
end of February 2014
Are there rules for any
Needs to be full and consistent implementation for payment
agreed in-year milestones
in line with national guidance
that result in payment?
None
Are there any rules for
partial achievement of the
indicator at the final
indicator period/date?
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Garden House Hospice
Milestones (only complete if the indicator has in-year milestones)
Date/period Rules for achievement of milestones
Date
milestone
(including evidence to be supplied to
milestone
relates to
commissioner)
to be
reported
End of
Quarter 1
End of
Quarter 2
End of
Quarter 3
Provider to have established processes and
implemented the friends and family test, have
tested the processes and evidence achievement of
responses from a minimum 5% of the potential
respondents.
Full delivery of friends and family test achieving a
minimum of 15% of all possible respondents.
Full delivery of friends and family test achieving a
minimum of 15% of all possible respondents and
evidence of provider review of the outcome scores
with an action plan, if needed, to achieve
improvement in service provision
End of
Quarter 1
Milestone
weighting
(% of
CQUIN
scheme
available)
N/A
End of
Quarter 2
End of
Quarter 3
N/A
Total
N/A
N/A
Rules for partial achievement at final indicator period/date (only complete if the
indicator has rules for partial achievement at final indicator period/date)
Final indicator value (payment threshold)
% of CQUIN scheme available
N/A
N/A
- 47 -
Garden House Hospice
Goal number
Goal name
Indicator number
Indicator name
Indicator weighting
(% of CQUIN scheme
available)
Description of indicator
Numerator
Denominator
Rationale for inclusion
Data source
Frequency of data collection
Organisation responsible for
data collection
Frequency of reporting to
the commissioner
Baseline period/date
Baseline value
2
Implementation of the Safety Thermometer
1
NHS Safety Thermometer Implementation
1%
To collect data on the following three elements of NHS
Safety Thermometer: pressure ulcers, falls and urinary tract
infections in patients with a catheter. To increase the
proportion of patients receiving harm free care by reducing
the prevalence of pressure ulcers, and the proportion of
patients with harm from a fall in care using Quarter 1 as a
baseline of activity. Improvements will be to year end and to
achieve CQUIN will be a 50% improvement in new pressure
ulcers in bed based units and community teams and 20%
improvement in falls with harm in bed based units subject to
exclusion of patients with clinical conditions that predispose
them to fractures.
The number of patients recorded as having a new category
2-4 pressure ulcer as measured using the NHS Safety
Thermometer on the day of each monthly survey. The
number of patients recorded as being harmed by a fall, as
measured using the NHS Safety Thermometer on the day of
each monthly survey. The number of patients who have a
UTI, as measured using the NHS Safety Thermometer on
the day of each monthly survey.
The total number of patients surveyed on the day
National CQUIN scheme
Provider submission to the commissioner – reporting
template (MS Excel) is available at
http://www.ic.nhs.uk/thermometer
One day per month
Garden House Hospice
At the end of each Quarter of the financial year – to be
received by the commissioner within one calendar month of
the end of the preceding quarter.
April 2013 – June 2013
For each of the elements requiring improvement (pressure
ulcers, falls and UTI, the median of three consecutive
monthly data points between April 2012 and June 2013
forms the baseline.
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Garden House Hospice
Final indicator period/date
(on which payment is based)
Final indicator value
(payment threshold)
Rules for calculation of
payment due at final
indicator period/date
(including evidence to be
supplied to commissioner)
Final indicator reporting
date
Are there rules for any
agreed in-year milestones
that result in payment?
Are there any rules for
partial achievement of the
indicator at the final
indicator period/date?
Payment may be made in Quarter 3 of the financial year
2013/14 providing full achievement to date for quarters 1-3.
For each element, achievement of an increasing trajectory
of improvement across each area maintained at a rate
better than the baseline.
Improvement on the baseline as evidenced using the MS
Excel reporting framework.
Response from providers to commissioners at the end of
February 2014
Needs to be full and consistent implementation and
improvements as described above for payment.
No
Milestones (only complete if the indicator has in-year milestones)
Date/period Rules for achievement of milestones
Date
milestone
(including evidence to be supplied to
milestone
relates to
commissioner)
to be
reported
Quarter 1
Quarter 3
Baseline established and monthly reporting/audit
being undertaken
Evidence of consistent reporting and
improvements made and maintained at a rate
better than baseline
End of
Quarter 1
End of
Quarter 2
Total
Milestone
weighting
(% of
CQUIN
scheme
available)
N/A
N/A
N/A
Rules for partial achievement at final indicator period/date (only complete if the
indicator has rules for partial achievement at final indicator period/date)
Final indicator value (payment threshold)
% of CQUIN scheme available
N/A
N/A
- 49 -
Garden House Hospice
Goal number
Goal name
Indicator number
Indicator name
Indicator weighting
(% of CQUIN scheme
available)
Description of indicator
Numerator
Denominator
Rationale for inclusion
Data source
Frequency of data collection
Organisation responsible for
data collection
Frequency of reporting to
commissioner
3
Non Cancer Patients
1
Improvement in referral rates to hospice services for
non cancer diagnosed patients
0.5%
Increased referral rate for non cancer patients
Total number of patients referred to the service across all
service areas
Total number of patients with a non cancer diagnoses as a
percentage of all referrals
Strategic priority to respond to non- cancer diagnosed
patients in response to Herts CC Scrutiny (awareness
raising) and CCG strategic plans
Local provider response to local commissioners
Review of returns submitted to commissioners. Data to be
presented on the MS Excel Template as provided for activity
reporting.
Garden House Hospice
At the end of each Quarter of the financial year – to be
received by the commissioner within one calendar month of
the end of the preceding quarter.
Baseline period/date
Quarter 1 in FY 2013 - 2014
Baseline value
The response rate (which must be at least 15%)
Final indicator period/date
Payment may be made in Quarter 3 of the financial year
(on which payment is based) 2013/14 providing full achievement to date for quarters 1-3.
Final indicator value
Provider achieving an increase in response rate that
(payment threshold)
improves on Q1 and is 10% or over for the number of non
cancer patients referred to the service (for services offering
IPU and Community services, an aggregate score will be
used across all services provided)
Final indicator reporting
Response from providers to commissioners at the end of
date
February 2014
Are there rules for any
N/A
agreed in-year milestones
that result in payment?
No
Are there any rules for
partial achievement of the
indicator at the final
indicator period/date?
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Garden House Hospice
Milestones (only complete if the indicator has in-year milestones)
Date/period Rules for achievement of milestones
Date
milestone
(including evidence to be supplied to
milestone
relates to
commissioner)
to be
reported
Milestone
weighting
(% of
CQUIN
scheme
available)
Total
Rules for partial achievement at final indicator period/date (only complete if the
indicator has rules for partial achievement at final indicator period/date)
Final indicator value (payment threshold)
% of CQUIN scheme available
N/A
N/A
- 51 -
Garden House Hospice
NHS Bedfordshire
Bedfordshire 2013/14 CQUINS are not yet agreed
- 52 -
Garden House Hospice
Gillison Close
Letchworth Garden City
Herts
SG6 1QU
Telephone: 01462 679540
E-mail: enquiries@ghhospice.co.uk
Website: www.ghhospice.co.uk
North Herts Hospice Care Association Registered Charity Number 295257