Quality Account 2013-2014
Care, comfort, compassion and hope
“You treat us all with compassion and dignity. Your
help and support are always there. We will always
appreciate the kindness shown to us”
Patient
“Every aspect of my care is fantastic”
Patient
Part 1
Statement on Quality
Together with the Board of Trustees, I would like to thank all of our staff and
volunteers for their achievements over the past year. Despite the current
economic climate, the Hospice has continued to provide a high quality service
and remains financially viable. We have achieved this by providing high
quality, cost-effective services to our patients and their families.
Quality is high on the agenda for The Heart of Kent Hospice. We have a fully
developed clinical governance structure, which has enabled the Hospice to
focus on the quality of the services provided. Once again, this year, our
regulators have assessed the treatment and care provided by the Hospice as
being of high quality. Following submission of our self-assessment in April
2012 and a subsequent unannounced inspection in September 2012, the
Care Quality Commission did not identify any shortfalls in the services
provided by the Hospice. This is a tribute to the hard work of every member of
staff working for The Heart of Kent Hospice.
The Hospice has a culture of continuous quality monitoring, in which any
shortfalls are identified and acted upon quickly.
The safety, experience and outcomes for all our patients and their loved ones
are of paramount importance to us. We continue to actively seek the views of
our service users. We achieve this in a range of ways, which include a service
user group, which reports directly into the clinical governance structure of the
Hospice and has proved invaluable in service planning.
The Patient Services Director Mel Burgess has been involved in developing
this Quality Account.
I am responsible for the preparation of this report and its contents. To the best
of my knowledge, the information reported in this Quality Account is accurate
and a fair representation of the quality of healthcare services provided by the
Hospice.
Vicki Morrey
Interim Chief Executive Officer
2013
Part 2
2.1 Priorities for Quality Improvement 2013-2014
The Heart of Kent Hospice needs to continue to develop the services it
provides to the community to better meet the needs of the local population.
Key areas of development opportunities for service improvement have been
identified and their progress will be monitored through the Clinical Care and
Quality Assurance Committee (CCQA) which reports to the Board of Trustees.
The top three quality improvement priorities for 2013-2014 are;
Future Planning Priority 1-Provision of a virtual ward
Funding was agreed to set up a virtual ward to support patients and carers
at home. There are currently eight devises in use and initial feedback from
service users has been positive. The clinical team plans to develop the use
of this IT further to include multidisciplinary meetings and virtual
counselling. The Hospice is currently seeking additional funding to do this.
Future Planning Priority 2-Provision of an outreach service
The Hospice is planning to broaden the range of services offered to
patients and carers in an outreach setting. This would enable a larger
number of individuals to access a wider range of Hospice services. We are
currently seeking to obtain a venue and recruit service users.
Future Planning Priority 3-Three new single rooms on the inpatient
unit
The Hospice has received a grant from the Department of Health to fund
this project, which is driven by the privacy requirements of patients and
their families.
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2.2 Priorities for Quality Improvement 2012-2013
The Hospice had a series of ongoing initiatives to enable it to offer a more
comprehensive service to the local community, whilst remaining within the
limitations of current financial constraints. All plans for improvement were
identified through needs assessments of the local community and direct
service user.
The quality improvement priorities for 2012-2013 were as follows;
Future Planning Priority 1-Provision of 7-day Hospice Specialist
Nurse support
A comprehensive review of the service provided by the Hospice
Community Team recommended that the provision of advice and support
from Specialist Hospice Nurses 7 days a week would enhance service
provision and widen access to the service. Funding was agreed to employ
an additional Specialist Nurse on the team as the first step towards
increasing the specialist community service from 5 to 7 days a week.
This service is now running and the Community Palliative Care Team has
been reviewed again and a skill mix successfully implemented.
Future Planning Priority 2-Development of an outpatient service
The Hospice planned to broaden the range of services offered to patients
and families in an outpatient setting. The plan was to enable a larger number
of individuals to access a wider range of Hospice services. A grant was
received from the Department of Health to carry out a refurbishment to
enable this to happen.
Patients are now seen by the clinical team in the Hospices out-patients
department.
Future Planning Priority 3-A new reception area, outpatient’s facilities,
day therapy centre and quiet room
The Hospice received a grant from the Department of Health to fund this
project, which is driven by the requirements of patients, their families and
carers.
All building works are complete and areas are being used.
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Participation in Clinical Audits
During 2012/2013 The Heart of Kent Hospice did not participate in any
national clinical audits or confidential enquires covered NHS services which it
was eligible to participate in.
Therefore there is not a list of the number of cases submitted to each audit or
enquiry as a percentage of the number of registered cases required by the
terms of the audit or enquiry.
To ensure that we are providing a consistently high quality service, we
undertake our own clinical audits, using national audit tools developed
specifically for Hospices. This allows us to monitor the quality of care being
provided in a systematic way and creates a framework where we can review
this information and make improvements where needed.
Through the CCQA, the Board of Trustees is kept fully informed of the audit
results and any identified shortfalls. Through this process, the Board has
received assurance on the quality of services provided.
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The following audits were completed during the audit year 2012/2013.
Key Performance Indicators-Hospice and CCG Grant including;
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Number of referrals received including source, NHS West Kent
residents, ethnicity, gender, age
Percentage of cancer and non-cancer patients referred to the service
Number of community contacts; new, follow up and telephone
Bed availability and occupancy
Number of discharges from the in-patient unit
Deaths; total number, number on inpatient unit, number at home,
number in preferred place of care and number of patients on the
Liverpool Care Pathway
Number of continuing care patients
Number of bereavement contacts
Number of incidents including drug incidents
Number of Day Therapy places and attendance
Number of complaints/comments
Policy and procedure review
Number of inpatients
Discharges from service
Number of patients on bed waiting list
Evaluation of training and education
Patient surveys – inpatient unit and day therapy
Use of Abstral (sublingual fentanyl) for pain
Liverpool Care Pathway
Palliative Prognostic Indicator
Venous Thrombo-Embolism
Emergency Crisis Response
Use of steroids
Clinical information governance
Infection control
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Part 2
Statement of Assurance from the Board of Trustees
The following are a series of statements that all providers must include in their
Quality Account. Some of these statements are not directly applicable to
specialist palliative care providers.
During 2012/2013 The Heart of Kent Hospice provided the following services;
Inpatient Unit;
Community Service;
Family Services Team including counselling, social work and chaplaincy;
Physiotherapy;
Occupational Therapy;
Complementary Therapy;
Day Therapy Centre;
Drop in Centre;
Education, training and development.
The Hospice has reviewed all the data available to them on the quality of care
in all of these services.
Research
Participation in Clinical Research
No patients under the care of The Heart of Kent Hospice during 2012/2013
have participated in research that required approval by a research ethics
committee.
There were no appropriate national ethically approved research studies in
palliative care, which patients under the care of The Heart of Kent Hospice
could participate in.
Quality Improvement and Innovation Goals Agreed With Commissioners
19.5 % of the Hospices income was received from West Kent Primary Health
Care Trust (PCT) during 2012/2013. This income was not conditional on
achieving quality improvement and innovation goals through the
Commissioning for Quality and Innovation payment framework because it was
received in the form of a grant. The Hospice was however required to submit
quarterly data to the PCT including;
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Number of referrals received including source, NHS West Kent
residents, ethnicity, gender, age.
Percentage of cancer and non-cancer patients referred to the service.
Number of community contacts; new, follow up and telephone.
Bed availability and occupancy.
Number of discharges from inpatient unit.
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Deaths; total number, number on inpatient unit, number at home,
number in preferred place of care and number of patients on the
Liverpool Care Pathway.
Number of continuing care patients.
Number of bereavement contacts.
Number of incidents including drug incidents.
Number of Day Therapy places and attendance.
Number of complaints/comments.
Policy and procedure review.
Number of inpatients.
Discharges from service.
Number of bed waiting list.
The Hospice did not receive any uplift from the PCT during 2012/2013.
What Our Regulators Say About The Organisation
The Hospice is required to register with the Care Quality Commission (CQC)
and its current registration status is that it is registered in respect of the
regulated activities of personal care and treatment of disease, disorder or
injury. The Hospice does not have any conditions regarding registration.
The CQC has not taken any enforcement action against the Hospice during
2012/2013.
The Hospice has not participated in any special reviews or investigations by
the CQC during the reporting period.
Data Quality
The 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.
In accordance with the Department of Health (DoH), the Hospice submits
National Minimum Datasets (MDS) to the National Council for Palliative Care
(NCPC). The Hospice also provides these to the West Kent Clinical
Commissioning Group (CCG).
The Hospice score for 2012/2013 for information quality and records
management was not assessed using the information governance toolkit, as
this is not applicable to specialist palliative care.
Clinical Coding Error Rate
The Hospice was not subject to the Payment by Results clinical coding audit
during 2012/13 by the Audit Commission.
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Part 3
Review of Quality Performance
Comparison of the Heart of Kent Hospice Over A Four Year Period from
2009/10-2012/13
2013/12 2012/11 2011/10 2010/09
Inpatient Unit
% New patients
% Bed occupancy
% Patients discharged
Average LoS cancer
patients
Average LoS non-cancer
patients
94
71.8
27.3
10.4
92
70.7
27.1
9.7
95
78.7
34.3
11.1
95
73.6
39.6
11.0
8.9
9.3
9.6
8.4
57
94
70
78
48
84
92
86
65
21
67
17.2
66
8.5
65
6.7
10,426
2,701
8,227
2,272
9,164
2,392
7,719
2,486
Day Therapy Centre
% new patients
% sessions attended
Community Palliative
Care Team
% new patients
% new patients
non-cancer
Telephone calls
Total number visits
*LoS Length of Stay
The quality overview compares The Heart of Kent Hospice over the last four
years. Since 2011/2012, the in-patient unit’s average length of stay (LoS) has
remained stable for cancer patients at 9-11 and non-cancer patients at 8-9.
This is less than the national average of 12.3 days which may signify the
appropriate timing of admissions and discharges to and from the in-patient
unit and that more patients are being admitted appropriately for symptom
control or end of life care.
The percentage of day therapy sessions attended by patients was 94% which
is significantly higher than the national average of 74 %. In previous years this
figure has been lower than the national average and is reflective of the review
of day therapy centre that was carried out and the services now available.
In addition to the limited number of suitable quality metrics in the national
dataset for palliative care, we have chosen to measure our performance
against the following metrics;
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Indicator
Referrals to the service
IPU admissions
Number of complaints
Number of complaints upheld
Number of RIDDOR reportable
incidents
Number of patient accidents (slips,
trips, falls)
Number of patients admitted with
MRSA
Number of patients contracted MRSA
whilst on IPU
Number of patients admitted with
Clostridium difficile
Number of patients contracted
Clostridium difficile whilst on IPU
2013/2012
628
252
0
0
2 (1 staff 1
volunteer)
34
2012/2011
580
239
2
0
0
2011/2010
599
203
1
0
1-Patient
42
34
1
2
DNA
0
0
0
0
0
DNA
0
0
DNA
*DNA-Data Not Available
On average the Hospice cares for over 750 patients every year. These
patients are assessed by a member of the Community Palliative Care Team
and the appropriate support is then put in place to suit the individual needs of
the patient, their family and carers.
The Hospice receives many letters of thanks and compliments about the
service it provides. The number of compliments far outweighs the number of
complaints. There were no complaints during 2012/13. Many families and
friends of patients show their appreciation of the care provided to their loved
one by making donations to the service.
The quality of the service provided is of paramount importance to the Hospice
and all letters of complaint received are investigated thoroughly and note
taken of any trends. Where shortfalls are identified, immediate action is taken
to minimise the risk of recurrence. The Hospice has reached resolution with
every complaint that it has received in the last three years.
The Hospice admits over 250 patients per year to the in-patient unit. Of these
patients 27% return home with the support of the Hospices community team.
Although many patients are vulnerable, they wish to retain their independence
in their own homes for as long as possible.
The Hospice philosophy ensures that patients maintain their independence
not only at home but also whilst they are in-patients. To enable them to do this
patients are encouraged to move freely around the unit. Every patient is
risk-assessed on admission and provided with the appropriate level of
support, such as walking aids or a mobile nurse call system. The number of
minor slips, trips and falls has fallen and is now at 1.4 falls per occupied bed
per year.
Over the past three years, six patients were known to have MRSA and zero
patients were known to have Clostridium Difficile when admitted to the
in-patient unit. The nursing care and infection control measures in place
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ensured that no patient contracted MRSA, Clostridium Difficile any other
infection during their stay on the in-patient unit.
What Service Users Say About the Hospice
Every year questionnaires are carried out in which service users admitted to
or visiting the in-patient unit and those attending day therapy are asked
questions about the care and services they receive. In both questionnaires, all
service users reported that they were very happy with the services and care
provided.
The Hospice also provides comment cards that visitors to the Hospice can
complete. In the last three years, ten comment cards have been received and
of those, there have not been any negative comments or suggestions for
service improvement. At the time of writing, this quality account the feedback
from staff, volunteers, service users and visitors is all positive. If there were to
be any negative comments, we would look to see if any trends could be
identified and then we would look at ways to make improvements.
Patient Surveys
During 2012/13 the Hospice carried out patient and carer surveys in the
in-patient unit and the day therapy centre. The aim of the surveys was to;
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Establish the views of patients cared for within the Hospice;
Gain ideas, suggestions and comments on how the service could be
improved;
Encourage user involvement.
The results were graded from 1-5 with 1 being very satisfied and 5 very
dissatisfied. Below are a selection of the questions asked and responses from
patients and carers.
Questions Asked
The doctors explanation of your
treatment and care
The nurses explanation of your
treatment and care
Your involvement in decisions
about your care
The food services
The cleanliness of the unit
The opportunity to ask questions
The respect given to your wishes
1
70%
2
10%
90%
40%
4
5
10%
N/A
10%
20%
10%
30%
90% 10%
100%
90% 10%
80% 10%
10
3
10%
10%
Patients and carers were also asked our other questions to which they
answered yes or no. They were;
Questions Asked
Was any information you were given about other
services (written or verbal) easily accessible and
relevant to you?
Were there any services you think you needed but
did not receive?
Do you think anything could have been done
differently?
Are you aware of how to make a complaint?
Yes
70%
No
30%
N/A
100%
100%
40%
50%
10%
The main area identified that needed to be addressed was in relation to
patients and carers knowing how to make a complaint. This has been done.
Here are some examples of positive feedback from patients and carers.
Every aspect has been
brilliant
The service is excellent;
the staff are marvellous,
really kind and helpful
There are no words
to describe the
kindness and love
which exists here
The Hospice has a user’s group (Hugs) is made up of people who have been
patients and carers and they meet every six weeks to discuss a variety of
topics. These include how the views of patients and relatives are collected
and acted upon, policies and procedures, which affect patient care, the
content of Hospice leaflets, the patients’ view on the physical environment of
the Hospice, and how the Hospice is viewed by the community.
At these meetings, Hugs members are also given the opportunity to plan for
the future development of the Hospice and the services provided. The group
is supported by the Patient Services Director and a volunteer who acts as the
meeting secretary.
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What Staff Say About the Hospice
The Heart of Kent Hospice values the opinions of all its staff and volunteers.
In 2011, a staff satisfaction survey was carried out which showed that;
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76% of staff felt morale in the Hospice was high.
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95% of staff stated that diversity is valued by the Hospice.
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91% of staff stated that the Hospice treats them with fairness and
respect.
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95% of staff would recommend the Hospice as an employer.
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94% of staff felt loyalty to the organisation
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100% of staff felt proud to work for the Hospice.
These figures show the levels of engagement that staff feel. These high
percentages are very important to the Hospice as a high level of staff
satisfaction results in high standards of patient care, customer satisfaction,
organisation effectiveness, readiness to innovate and change and a reduction
in turnover.
The Hospice is aware of the importance of staff satisfaction and will aim to
undertake a staff satisfaction survey every three years to ascertain
engagement levels, celebrate success and to highlight areas for improvement.
The Heart of Kent Hospice has a very low turnover of staff. The table below
shows the number of starters and leavers during 2012/13.
Staff Leaving Other Than
Retirement
13/12
12/11
9
13
34
22
New Staff Joining
Complaints
During 2012/13 the Hospice did not receive any complaints about the services
provided.
What Our Regulators Say About The Organisation
The Heart of Kent Hospice is required to submit a self-assessment to the
Care Quality Commission on an annual basis. During an unannounced visit by
the Care Quality Commission in September 2012, the Hospice was inspected
to ensure it was compliant in five areas. They were;
Outcome 02: Before people are given any examination, care, treatment or
support, they should be asked if they agree to it.
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Outcome 04: People should get safe and appropriate care that meets their
needs and supports their rights.
Outcome 05: Food and drink should meet people's individual dietary needs
People were protected from the risks of inadequate nutrition and dehydration.
Outcome 08: People should be cared for in a clean environment and
protected from the risk of infection.
Outcome 14: Staff should be properly trained and supervised, and have the
chance to develop and improve their skills.
The Hospice was found to be compliant in all areas.
The Board of Trustees Commitment To Quality
The Board of Trustees is fully committed to the quality agenda. The Hospice
has a well-established governance structure with members of the Board of
Trustees having an active role in ensuring that the Hospice provides a high
quality service in accordance with its Statement of Purpose. Every six months
two members of the Board undertake an unannounced inspection and provide
a report for the Board. During the visit Trustees speak to patients their families
and staff.
This enables the board to have first hand knowledge of what the patients and
staff think about the quality of the service provided. The Board is confident
that the treatment and care provided by the Hospice is of high quality and is
cost effective.
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References
The National Council for Palliative Care (2013)
National Survey of Patient Activity Data for Specialist Palliative Care Services
MDS Full Report for the year 2011-2012.
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