.
Charity Number : 517656
Quality Account
Reporting period:
1st April 2012 to 31st March 2013
The Hospice is regulated and inspected by the Care Quality Commission, provider
number 1-101634329.
1
Patients’ Feedback
‘From the doctors, nurse to housekeepers and volunteers all people communicative
and open’
‘The nursing staff were exceptionally sensitive, perceptive and thorough in their care’
‘The kindness and respect for patients was impressive. They treated each one as an
individual’
‘I am amazed at the standard of care I received was so consistently high’
‘All staff very helpful above their call of duty’
Source
Patient survey 2011
Carers’ Feedback
“It is without question that she received an outstanding level of professional care, but
we also want to thank you for so many other things that go beyond training or
experience”
“We know that mum felt safe with you. You always spoke to her, and to us, with
genuine care and respect, and always had the time.”
Source
Correspondence 2012 / 2013
2
Chief Executive’s Statement
I am pleased to present our 2012 - 13 Quality Account on the work of The Mary Stevens
Hospice. Although we are a charity separate from the NHS, we welcome the opportunity to
prepare this report in recognition of the financial support we receive from the NHS and the
contribution we in turn make to local NHS services. Mary Stevens Hospice delivers specialist
palliative and end of life care for people with a progressive and life threatening illness, their
families and carers.
The Board of Trustees, the Senior Management Team and all of the staff and volunteers at
Mary Stevens are committed to providing the best possible experience for patients and their
families. We aim to achieve this by providing consistent, high quality, cost effective care,
underpinned by sound governance across all aspects of the organisation. Our care is based
on an active collaboration with patients, their families and carers to establish their wishes
and needs, underpinned by expert holistic assessment by our multi-professional team.
Mary Stevens Hospice is answerable to several regulatory bodies in terms of our quality
standards. Following an unannounced visit by the Care Quality Commission undertaken
during this year we received a very positive assessment with no requirement for action.
The Hospice has worked hard to develop a culture of continuously monitoring the quality of
our services to ensure any shortfalls are identified and addressed as quickly as possible and
opportunities for improvement addressed. This culture is the responsibility of every
employee and volunteer at the Hospice and is reflected most importantly of all in the
feedback we receive directly from the people who receive our care, as illustrated on the
previous page.
Our care is provided without cost to those that need it. In 2012/13 we received 21%
funding from the NHS with the remaining £1.837 million being raised from the local
community. This in itself is testament to the regard in which we are held by those we serve.
I am responsible for the preparation and content of this report, working through the Clinical
Director: to the best of my knowledge, it is an accurate and fair representation of the
quality of our services.
This account considers 2012/13 and looks forward to some of our priorities in 2013/14 as
we continue to strive for improvements that benefit patients and carers and their
experience of the Hospice’s services.
Peter Holliday
Chief Executive
3
Section 1 Improvement priorities
Introduction
The Mary Stevens Hospice aims to achieve the best care possible for patients and support of
their families; we focus on excellence and continuous improvement, not merely compliance
with minimum standards. Through internal quality measures and feedback from patients,
the hospice can demonstrate that the care we offer is over and above the essential
minimum standards of quality and safety. The current system of health care regulation by
the Care quality Commission assesses for compliance with standards and does not highlight
where these standards have been surpassed, neither does it acknowledge excellence in
care.
The Mary Stevens Hospice is fully compliant with the essential standards of quality and
safety set by the Care Quality Commission (CQC). These consist of a significant number of
the Health and Social Care Act 2008 (Regulated Activities) Regulations (2010) and the Care
Quality Commission (Registration) Regulations 2009. These regulations describe the
essential standards of quality and safety that people who use health and adult social care
services have a right to expect.
Mary Stevens Hospice had its annual unannounced inspection on 16 th January 2013 and
were inspected against, and met, the following standards:
Respecting and involving people who use services – Outcome 1 (Regulation 17)
Consent to care and treatment – Outcome 2 (Regulation18)
Care and welfare of people who use services – Outcome 4 (Regulation 9)
Cleanliness and infection control – Outcome 8 (Regulation 12)
Management of medicines – Outcome 9 (Regulation 13)
Supporting staff – Outcome 14 (Regulation 23)
There were no recommendations or requirements as a result of the inspection. The
hospice’s internal audit programme, which utilises Help the Hospices’ audit tools based on
CQC essential standards and national guidance, has not identified any significant areas of
non-compliance.
The hospice is reviewing its quality strategy which will be implemented during 2013 / 2014
and will then be evaluated by the Clinical Director and Medical Director who report to the
Clinical governance Committee.
4
Priorities for improvement 2013-2014
Following discussions at clinical services meetings, Mary Stevens Hospice confirms the top
three quality improvement priorities for 2013 to 2014 to be as follows:
Future planning Priority 1
Quality Domain: Patient Experience
Timely capture of patient feedback to facilitate improvements in care
The hospice will participate in the Help the Hospices Patient Survey
The hospice will introduce an internal patient feedback mechanism to effectively capture
patient experience and identify areas for improvement.
Future planning Priority 2
Quality Domain: Safety
The reduction of patient trips, slips and falls.
All patients will have a falls risk assessment on admission which will be revised as the
patient’s condition changes.
All patients identified at risk will have a care plan in place to minimise their risk of falling.
All clinical staff will have training to increase their awareness of the risk of patient falls and
measures to take to reduce the incidence of falls.
The prevention of urethral catheter related infections
Patients will only be catheterised if it is the most appropriate method of managing their
clinical need.
All catheter interventions will be managed in accordance with urinary catheter care
guidance
The duration of insertion will be minimised to reduce the potential for catheter related
urinary tract infection.
5
Future planning Priority 3
Quality Domain: Effectiveness
Evaluation of care and support provided
The hospice will introduce St Christopher’s Hospice Index of Patient Priorities (SKIPP) within
the Day therapies Clinic to measure patient and staff reported outcome measures to monitor
and improve the effectiveness of interventions.
Quality Improvements made in 2012/2013
These are the first quality accounts published by Mary Stevens Hospice and therefore there
are no formal quality priorities against which to evaluate progress. However, the following
improvements were made during 2012/2013 and reported through the Clinical Services and
/ or Clinical Governance Committees.
Clinical Governance
The hospice reviewed its governance structure in 2011 and introduced a Clinical Governance
Committee to provide assurance about the quality of clinical care. The committee is chaired
by a Trustee who is a medical Consultant and comprises of the Chief Executive, Clinical
Director (Registered Manager), Medical Director and three lay Trustees. Meetings are held
quarterly and reports sent internally to the Board of Trustees and externally to the Care
Quality Commission to inform the hospice Quality and Risk Profile.
Essence of Care
The hospice used Essence of Care benchmarks to improve the following areas of clinical
care. Essence of Care 2010 is a useful benchmarking tool which identifies best practice and
highlights how this can be achieved.
Skin care and the prevention of pressure sores
The working party for skin care and the prevention of pressure sores reviewed this aspect of
care within the hospice against essence of care benchmarks and introduced a systematic
approach to patient assessment, care planning, implementation and evaluation. Training
was then included as part of clinical staff’s mandatory training to raise awareness and
improve practice in this aspect of clinical care.
6
Diet and nutrition.
The essence of care group, which includes nurses and catering staff, worked together to
improve how we meet patients’ dietary needs. A nutritional assessment has been
introduced to personalise nutritional care and catering staff work as part of the
multidisciplinary team to ensure individual needs and preferences are met.
Falls Prevention
A new patient falls assessment and care plan bundle has been implemented to ensure early
identification of patients at risk of falling and minimise the risk of harm. Falls prevention has
been added to the annual mandatory training of clinical staff.
Medicines Management
The hospice has a very low rate of untoward incidences associated with the management
and administration of medicines. It is important that this does not lead to complacency
which may then threaten care quality. The following changes have been made to practice to
support patient safety, efficacy of treatment and promote a positive experience of care for
patients:
Introduction of a revised prescription chart to improve clarity and accuracy and
reduce risks associated with administering medicines.
All Registered Nurses have achieved 100% in a new drugs calculations test
implemented to assure clinical competency.
Introduction of a new policy for the reporting and management of drugs incidences
which further promotes learning from incidents and therefore aims to reduce
reoccurrences.
Hospice November 2012 Cohort: Patient Dependency, Nursing Activity,
Quality and Staffing Benchmarked against UK Hospices
During November 2012 a comprehensive review of the clinical workforce was completed
within the in-patient unit which included the assessment of patient dependency and an
7
evaluation of the quality of care. The review was facilitated by St. Anne’s Hospice Practice
Development Department with data collected by independent professionals.
The project confirmed that patients cared for have high dependency needs and made
recommendations regarding staffing ratios and skill mix based on academic evidence gained
within the speciality. In response to the report the hospice will modify its staffing in the inpatient unit to increase the hours provided by experienced Registered Nurses and will also
introduce a new higher level Health Care Assistant role, increasing the level of support
worker hours. The hospice now has a robust workforce plan underpinned by robust
evidence.
Day Hospice Re-structure
In May 2012, as part of a wider hospice consultation, the Day Hospice was re-structured to
develop a new Day therapies Clinic with integrated complementary therapies. The skill mix
comprises Registered Nurses, Higher Level Health Care Assistants and qualified
complementary therapists equipped to manage the complex holistic needs of patients and
carers.
The restructure included the introduction of a new level of Health Care Assistant to provide
a higher level of holistic support to patients under the supervision of registered nurses.
Level 3 Health Care Assistants have completed training to discuss advance care planning
with patients and are achieving palliative care competencies for Health Care Assistants.
8
Section 2 Mandated Statements
Statements of assurance from the board
The following are a series of statements that, although not directly applicable to hospices,
all providers must include in their Quality Account:
Review of services
During 1st April 2012 to 31st March 2013, Mary Stevens Hospice provided the following
services:
In-Patient Unit
Day Therapy Unit
Bereavement Service
The Clinical Services Committee comprises clinical staff representing all services and
disciplines and meets bimonthly to discuss operational issues including patient care delivery,
policy development, training, and quality and risk management. The Clinical Governance
Committee, which is a sub-committee of the Board, meets quarterly to scrutinise quality
indicators and challenge Clinical Directors to exercise their responsibilities of clinical
governance and to assure clinical quality and safety. The committees providing clinical
governance oversight receive quality reports which enable them to review the quality of
care provided by all clinical services. The Clinical Governance report is submitted to the
Board of Trustees on a quarterly basis.
Participation in clinical audits
During 2012/13, Mary Stevens Hospice did not participate in national clinical audits.
9
Research
During 2012/13, Mary Stevens Hospice did not participate in national or regional
programmes of research.
Quality and Safety Performance Measures
Measures
2011 / 2012
2012 / 2013
Number of patients cared for with MRSA
0
1
Number of patients contracting MRSA
when in the hospice’s care
1
0
Number of patients contracting MRSA
per 100 bed days
0
0
Number of patients cared for with C
Difficile infection
1
4
Number of patients contracting C
Difficile infection when in the hospice’s
care
0
0
Number of patients contracting C
Difficile infection per 100 bed days
0
0
Number of patients developing pressure
sores whilst in the hospice’s care
3
11
Number of patients developing pressure
sores whilst in the hospice’s care per
100 bed days.
0.1
0.4
Number of formal complaints received
1
0
Number of formal complaints received
as a % of patients accessing services
0.2
0
Number of adverse comments received
0
4
Number of adverse comments received
as a % of patients accessing services
0
0.8%
Number of required actions specified by
the Care Quality Commission
0
0
Number of recommendations made by
the Care Quality Commission
0
0
Number of reported drug errors
11
6
Number of reported drug errors per 100
bed days
0.4
0.2
Number of patient accidents reported in
the year (trips, slips &falls).
35
53
Number of patient accidents per 10,000
hours of care (trips, slips &falls).
4
4
10
What others say about us
Mary Stevens Hospice is required to register with the Care Quality Commission and its
current registration status is unconditional. The Care Quality Commission has not taken any
enforcement action against Mary Stevens Hospice during 2012/13. Mary Stevens Hospice is
subject to periodic reviews by the Care Quality commission. The last on-site inspection was
on 16th January 2013. The CQC website states that Mary Stevens Hospice has been
inspected and that “all standards were found to have been met following our assessment of
declarations and evidence supplied by the service itself during registration” and the
unannounced inspection which took place on 16th January 2013.
The Quality Risk Profile of the hospice states that the hospice is low risk and the hospice
provides a comprehensive quarterly quality report to the CQC to maintain this ranking.
Data quality
In accordance with agreement with the Department of Health, Mary Stevens Hospice
submits a National Minimum Dataset (MDS) to the National Council for Palliative Care.
Mary Stevens Hospice provides a copy of the quarterly quality report to the local CQC.
Mary Stevens Hospice will be taking the following actions to improve data quality:
The Registered Manager will continue to review the data outputs in order to
improve the quality of patient data reporting.
Data will be audited and systems involved in the collection and reporting of
information reviewed with the aim of improving reliability.
11
Section 3 Quality overview
Comparison with national minimum data sets
The most recent National Minimum Dataset covers the period 1st April 2010 to 31st March
2011. Mary Stevens Hospice data for 2011-12 have been collated but there are no
comparative national data available at the time of writing.
Comparison with regional data sets
The hospice participates in regional benchmarking of quality data on a quarterly basis,
discussed at the West Midlands Hospices Nurse Managers meetings. With regard to the
safely dimension of quality, the West Midlands Region is collating data on a monthly basis in
the following areas:
Percentage occupancy
Pressure ulcers
Slips trips and falls
Infection control
Deaths and discharges
The West Midlands Nurse Managers (WMNM) scrutinise the data on a quarterly basis.
Following reflective discussion, the WMNM are in agreement that there is consistency
between the hospices in the West Midlands Region.
Through this process of continuous quality monitoring, the WMNM would quickly identify
any significant differences between hospices and act to identify the underlying cause(s).
In-Patient Unit
The minimum data set for the In-Patient Unit is given in Table 1; there is no National MDS
available for this period.
Table 1
In-Patient Unit MDS data
Mary Stevens Hospice
Admissions
% Occupancy
75%
% Patients
discharged
38%
Average length
of stay
-
2009-2010
-
2010-2011
224
75%
28%
13
2011-2012
233
72%
22%
-
2012-2013
239
76%
21%
9
46%
12
National Median
2010-2011
-
75%
12
The hospice is committed to supporting patients to return to their home, or alternative
preferred place of care, as soon as their symptoms have been managed; the reduction in the
percentage of patients returning home in the two years since 2010/2011 from 28% to 21%
reflects both the increase in patients referred for terminal care for whom the hospice is
their preferred place of death and patients being referred to the hospice closer to the
moment of death.
Since 2006-7, the In-Patient Unit has seen a decrease in the average length of stay (LOS) for
patients from 14 days to 9 days. The reduction in LOS is in part the result of effective use of
the admission and discharge criteria but is also due to the late referral of patients in the
terminal phase of their illness.
Feedback from one of our patients
“The nursing staff were exceptionally sensitive, perceptive and thorough in their care”
“The kindness and respect for patients was impressive. They treated each one as an
individual”
“I am amazed at the standard of care I received was so consistently high”
“All staff very helpful above their call of duty”
2010/2011 Hospice Patient Survey
13
Day Therapy Unit
MDS data for the Day Therapy Unit is given in Table 2.
Table 2 Day Therapy Unit MDS Data
Mary Stevens Hospice
MDS
New patients
% Occupancy
% Occupancy
2012-2013
62
96%
_
2011-2012
43
87%
_
2010-2011
58
97%
74%
The percentage occupancy of patients attending the Day Therapy Unit is 96%. There are no
national data for 2012/2013 but in 2010/2011 MSH percentage occupancy was 97% which
was 22% more than the national mean which is 74%. During the past year, the hospice has
changed the focus of this unit from a day hospice to a day therapy unit, with an emphasis on
therapeutic interventions. Feedback from the Patients’ Survey and the Carers’ Group
indicates that this support is highly valued.
Patients’ Feedback
“What a lovely place, my needs have always come first to them.”
“They have given me a purpose to carry on with life and enjoy what's left.”
“The staff at the hospice were extremely compassionate in the way they handled the "end of life"
information and how the final days would be adapted to suit my wishes.”
2010/2011 Hospice Patient Survey
14
Local quality measures
Referrals
Over the past five years the total number of referrals to the hospice has increased from 326
to 476 i.e. an increase of 46%. Tables 3 and 4 illustrate the upward trend in in-patient
referrals and admissions. The decrease in referrals to the day therapies clinic but increase in
new patients may indicate a greater awareness of referral criteria resulting in fewer
inappropriate referrals.
Table 3
Referrals to the hospice between 1st April 2008 and 31st March 2012
st
st
st
st
st
Service
1 April 2008 st
31 March
2009
1 April 2009 st
31 March
2010
1 April 2010 st
31 March
2011
1 April 2011 st
31 March
2012
1 April 2012 st
31 March
2013
Day Therapies
Clinic
IPU
215
131
148
138
113
111
212
233
287
363
Table 4
Admissions to the hospice between 1st April 2008 and 31stMarch 2012
st
st
st
st
st
Service
1 April 2008 st
31 March
2009
1 April 2009 st
31 March
2010
1 April 2010 st
31 March
2011
1 April 2011 st
31 March
2012
1 April 2012 st
31 March
2013
Day Therapies
Clinic (New
patients)
IPU
(Admissions)
64
77
58
43
62
200
233
244
233
239
During the period 2008 / 2013 there has been a 227% increase in referrals to IPU resulting in
a 20% increase in the number of admissions. The increase in the number of patients
referred to the hospice may reflect an increase in awareness of hospice services by referrers
and the local population. It may also be indicative of an increase in the need for palliative
care services and may be affected by changes to NHS community services. It does however
demonstrate a high level of confidence in the care provided by Mary Stevens Hospice.
15
The lack of parity between referrals to the in-patient unit and actual admissions can be
accounted for by the number of patients choosing to stay at home following support from
hospice staff and those referred late for terminal care who die before admission shown in
table 5.
Table 5
2012 / 2013
No. Referrals to IPU
No. admissions to IPU
No. Patients who died
No. Patients who died
prior to admission
at home following
support
363
239
72
32
Supporting patient choice
The hospice supports patients in their choices and all patients attending the Day Therapies
Clinic are offered the opportunity to complete an advance care plan; patients admitted to
the In Patient Unit are offered support to do this as appropriate depending on the reason
for admission and clinical condition.
All patients are involved in care planning decisions to the level they choose and participate
in the evaluation of their care and its outcomes.
Although the hospice does not have a community team the senior nurses responsible for
the assessment of patients prior to admission / attendance perform roles often associated
with hospice community staff. Patients are sometimes referred to the hospice for care but
on assessment reveal alternative preferences; community support sisters discuss care
available and liaise with other services to achieve the care package which best meets the
patient’s preferences. This activity was not captured fully during 2012/2013 but table 5
demonstrates the difference between the number of patients referred and those admitted,
together with those patients that died before they were admitted.
16
Reducing Acute Hospital Admissions
Mary Stevens Hospice reduced the number of occupied bed days within acute hospitals by the
following actions:
Admission of patients from community who would have been admitted to an acute hospital
Transfers to the hospice from acute hospitals
Table 6 below shows the impact of these actions.
Table 6
2012 / 2013
Prevented hospital admission (Admissions from
Transfer from hospital
home excluding respite)
97
86
A quality indicator: Prevention and management of pressure ulcers
Between 1st April 2012 and 31st March 2013, 239 patients were admitted to the IPU. A
Waterlow score, which is evidence based tool used to assess a person’s risk of developing a
pressure sore, was determined for 94% of patients. The average Waterlow score was 20
with a range of 7- 37 (high risk = a score of ≥20), which is an indication of the frailty of the
patients being cared for.
65 patients had pressure ulcers (sores) on admission. All pressure ulcers, and areas at risk
of developing into a pressure ulcer, were given a grading using the European Pressure Ulcer
Advisory Panel (EPUAP) classification system. This system grades sores depending on their
size, depth and the extent of damage to tissue. All at risk patients had a documented care
plan, which includes monitoring on an ongoing basis. Preventative measures were put in
place for all at risk patients, such as pressure relieving mattresses and cushions.
17
Our participation in clinical audits
To ensure that the hospice is providing a consistently high quality service, we undertake our
own clinical audits, using national audit tools developed specifically for hospices by the
National Audit Group at Help the Hospices. The tools have been peer reviewed and quality
assessed. This allows us to monitor the quality of care being provided in a systematic way
and creates a framework by which we can review this information and make improvements
where needed.
Each year, the Clinical Services Committee approves the audit schedule for the coming year.
Priorities are selected in accordance with what is required by our regulators and any areas
where a formal audit would inform the risk management processes within the hospice.
Through the Clinical Governance report, the Board of Trustees is kept fully informed about
the audit results and any identified shortfalls. Through this process, the Board has received
an assurance of the quality of the services provided. Table 7 shows the audits completed
between 1st April 2012 and 31st March 2013.
Table 7 Audits completed between 1st April 2012 and 31st March 2013.
Self-assessment by the Accountable
This audit has to be completed annually.
Officer
The hospice was fully compliant with the legal
requirements.
Management of controlled drugs
This audit has to be completed annually to provide
evidence to support the self assessment by the
Accountable Officer.
A few minor shortfalls were identified in the
documentation of advice given to patients which
have now been resolved. The Board is assured that
the hospice is now fully compliant.
Management of general medication
The hospice was fully compliant with the legal
requirements.
18
Storage, prescribing and
This audit was completed in response to concerns
administration of oxygen.
highlighted nationally by the Medicines and
Healthcare products Regulatory Agency (MRHA). The
hospice modified its systems to achieve compliance
with the recommendations. This included the
development of standard operating procedures and
staff training related to the ordering, procurement,
storage, prescribing and administration of oxygen.
Infection control: Code of Practice
The hospice is fully compliant with the code of
Practice.
Infection control: Hand washing
To ensure a high level of practice and compliance this
audit is completed on a quarterly basis. In May 2012
the hand hygiene audit showed 96% compliance, a
10% increase on the previous audit. The provision of
hand washing facilities and hand washing practice by
staff and visitors achieved 100% compliance through
observation and documented evidence. The only area
of non-compliance was the absence of a foot
operated pedal bin in one of the areas.
Management of Pain
This audit is conducted to measure the outcomes of
symptom control measures at the hospice. A high
level of compliance with best practice standards was
achieved.
Nutrition and hydration
This audit was completed as part of the hospices
“Essence of Care” programme. It informed changes to
practice and the development of staff training. A
nutritional tool to identify patients’ nutritional needs
has been introduced within the day therapies clinic to
ensure we are meeting the individual dietary and
nutritional needs.
19
Bereavement Support
One of the Charity’s aims is to offer professional advice and support to families and carers
during the patient’s illness and during the initial stages of bereavement. Between 1st April
2012 and 31st March 2013, the bereavement service provided support provided by
registered nurses and trained bereavement volunteers. The hospice also provided training
for pastoral care staff employed by Dudley Local Education Authority.
What our staff say about the organisation
Mary Stevens Hospice values the opinions of the staff regarding the quality of the service
provided. The hospice plan to survey staff during June 2013 using an external charity called
“Birdsong” which will benchmark responses against those of other participating hospices
and charities. Representatives of the Board of Trustees undertake a bi-annual visit. At the
last visit, carried out on 06/02/12, the Trustees found the staff to be very open and helpful
and very supportive of the hospice.
The Board of Trustees’ commitment to quality
The Board of Trustees is fully committed to the quality agenda. The hospice has developed
a new governance structure which has included the development of a Clinical Governance
Committee. Members of the Board having an active role in ensuring that the hospice
provides a high quality service in accordance with its Statement of Purpose.
The Board is confident that the treatment and care provided by the hospice is of high quality
and is cost effective.
20
Appendix 1
What the Clinical Commissioning Group (CCG) says about the organisation
Dudley CCG and Sandwell and West Birmingham CCG were provided with the proposed
draft of the Quality Account with the request for comments and feedback on the
following:
1. The presentation of the accounts
2. How readable you find the accounts
3. The specific measures proposed on page 8 of the accounts
4. Whether you feel there are any omissions in the accounts
5. Whether you feel there are other measures the hospice should be considering.
At the time of publishing these Quality Accounts the hospice had not received
feedback from the Clinical Commissioning Groups. Their comments will be added
when they are available.
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Appendix 2
What Dudley Healthwatch says about the organisation
Dudley Healthwatch were provided with the first draft of the Quality Account with the
request for comments and feedback. They made suggestions about the content, such as
wording and the need for definitions for some clinical measures, which has been used to
produce this final draft.
They provided the following comments relating to the presentation, readability, priorities
chosen and additional measures; their suggestions will be incorporated into future
accounts.
1. Presentation
Healthwatch were satisfied with the presentation overall but made the following
suggestions for future Quality Accounts from the perspective of stakeholders or readers
with less specific knowledge of some of the issues addressed or interest in tables,
figures;
consider making it less formal in appearance
more use of colour to make it more exciting to look at
2. Readability
From the reviewers perspective it was clear and readable document but they felt it may
be useful to assess the report in terms of its ease of reading from a public perspective,
for example by applying the standards of “plain English”
3. Priorities
Healthwatch thought that the priorities were reasonable and will want to comment more
in the future when they can assess what progress is made is made in achieving them.
4. Additional measures.
It is hard to judge at this stage what other measures might be considered - in future we
will be able to compare reports and outcomes, however, case studies, narratives, etc
that set out stories, experiences, etc in rich detail can be useful addition to more
quantitative data.
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