Quality Account 2012-13
Libby Mytton
Nurse Manager
Registered Charity No. 700272
Primrose Hospice
Quality Account 2012-13
1
‘Thank you for the support you have given to our mother. She enjoyed
her Thursday visits to the Day Hospice, including delicious lunches, craft
activities and healing/therapeutic sessions. A special thank you to E, who
would always chase up any concerns about appointments or equipment
so efficiently. We would also like to thank the many drivers who have
taken mum to and from the Hospice. Thank you again for all the support
and care you showed our mother, which helped in making her last years
as full and rewarding as possible.’
‘Thank you so much for all the care and support you gave to J and myself
during the last few months of his life. I just can’t tell you how much we
appreciated your help: you have all been amazing.’
Primrose Hospice
Quality Account 2012-13
2
PART 1
Chief Executive’s Statement of Quality
This Quality Account, the second one we have produced, is for our patients, their
families and carers, the general public in our communities and the local NHS
organisations that fund around 15% of our total costs. The balance of our income is
generated through trading activities, legacies and fundraising to which over £70,000
was donated by the families and friends of our patients.
Our services are free to users at the point of delivery and the objective of this report
is to provide clear information about the quality of those services so that our
patients feel safe and well cared for and their families and friends are supported and
reassured that those services are of the hIghest standard and that the NHS receives
good value for money.
To deliver services to the high standards we set ourselves, we rely on the
commitment and dedication of our staff and over 220 volunteers, and, together with
the Board of Trustees, I extend my thanks to all of them for continuing to provide
services of such quality.
Our Nurse Manager and her clinical managers are responsible for the preparation of
this report and its content. To the best of my knowledge the information in the
Quality Account is accurate and a fair representation of the quality of health care
services provided by Primrose Hospice.
The safety, experience and satisfactory outcomes for all those who access our
services and for those who care for them of are very important to us. At the same
time we shall actively continue to seek the views of all those who use our services.
Alvin Robinson CEO
Primrose Hospice
Primrose Hospice
Quality Account 2012-13
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PART 2
Priorities for Improvement 2013-14
Primrose Hospice is fully compliant with the section 20 regulations of the Health and
Social Care Act 2008. As such, the Board did not have any areas of shortfall to include
in the priorities for improvement for 2013-14.
Future Planning
The improvement priorities set for the next year include several with a broad aim of
reducing barriers and improving access to services to groups who historically have
not received support from hospices. This includes patients with end stage heart
failure, prisoners and those suffering bereavement under circumstances which
would not previously have come under the remit of the Hospice’s bereavement
service. We also hope to improve the environment of the Hospice to make it more
appealing to a younger age group, and to expand our pre and post bereavement
services for children and young people.
Improvement Priority 1:
Improve facilities within the Day Hospice environment.
In response to feedback from Day Hospice patients we have submitted a capital bid
to the Department of Health for a grant to improve, modernise, refresh and expand
the facilities currently provided within Day Hospice.
Improvement Priority 2:
Develop clinics/access to services for patients with non-malignant long-term
conditions such as end stage heart failure.
Primrose Hospice is currently piloting the delivery of Palliative Care and Cardiology
clinics for NHS Worcestershire. The aim of these clinics is to enhance end of life care
for patients with end stage heart failure and advanced heart disease, and involves
input from a Cardiology Consultant and one of the Consultants in Palliative Medicine,
as well as one of the Heart Failure Nurses and members of the Day Hospice team.
Improvement Priority 3:
Explore the need, and if appropriate establish access to services within local
prisons.
We aim to explore the potential for the provision of Family Support Services to
prisoners. This may involve the development of an outreach service, or support and
training to existing prison visitors.
Primrose Hospice
Quality Account 2012-13
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Improvement Priority 4:
Expand existing support services for children and families.
Funding has now been secured from Macmillan Cancer Support for the 3 year pump
priming of a Children and Families Practitioner post, to enhance and further develop
the support of children living with the actual or impending loss of a loved one in the
family.
Improvement Priority 5:
Secure recurring funding for bereavement services in Redditch and Bromsgrove.
This is currently a limited (18 month) project supported by a fixed grant. During
2013-14 we will evaluate progress and feedback to the Redditch and Bromsgrove
CCG, with an aim of negotiating more sustainable funding for the service.
Improvement Priority 6
The addition of a volunteer role to our existing Primrose at Home service
A review of our Hospice at Home service has identified a new volunteer role for
patients with low dependency and no personal needs. This would widen access to
the service to patients with life-limiting illness who need some supervision whilst
their family or carer has a break from caring, but who have low clinical need and are
not actively dying.
Progress against the Improvement Priorities identified in 2011-12
During 20011-12 the hospice implemented a number of initiatives to enable it to
provide a more responsive and comprehensive contribution to end of life care within
our local community in spite of the financial challenges of the current climate and
the uncertainty created by major organisational changes within the NHS.
Progress is discussed below.
Progress made against Priority Improvement 1: Expand the remit and scope of
bereavement services within Redditch and Bromsgrove
The Redditch and Bromsgrove Bereavement Service started at the beginning of
October 2012, supported by a fixed grant from the Redditch and Bromsgrove CCG.
This service aims to support anyone registered with a Redditch or Bromsgrove GP
who has suffered a bereavement, and was developed to fill an identified gap in
bereavement services in the area. The service is available to adults and children,
irrespective of the circumstances of the bereavement and particularly where
palliative care services were not involved prior to the death.
With very little advertising, the service has received 34 referrals since October 2012.
The cause of the loss suffered has included, amongst others, suicide, sudden death,
RTA, pneumonia, cot death and neonatal death. Referrals have come predominantly
from GPs (49%), with 15% from a Clinical Nurse Specialist, 12% self referral and 24%
from a variety of ‘other’ sources, including a GP Carer Support Adviser, a CAF
Coordinator and a school.
Primrose Hospice
Quality Account 2012-13
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Progress made against Priority Improvement 2: Expand existing support services
for children and families
Securing funding for a Children and Families Practitioner has taken longer than
hoped, but in November 2012 we received confirmation of Macmillan funding for
this full time post, which will form part of our Family Support Service. An
appointment has been made in March 2013 and the development of this service will
be rolled over as one of this year’s priority improvements.
Progress made against Priority Improvement 3: Increase access to hospice services
to younger patients
It was apparent to the team working in the Day Hospice that there were barriers to
accessing support for younger patients for whom the traditional model of Day
Hospice care doesn’t appeal. A monthly support group for ‘younger people’ has been
set up this year, and feedback has been encouraging. New members have joined
each month and gained mutual support and trust. The group is very much in control
of how each session runs, and a variety of activities have been provided, some to
create a distraction such as a ‘make-over’ session, others with more purposeful
strategies such as relaxation. A separate, Men’s Group, running weekly and
facilitated by a male counsellor has also provided a support mechanism for men
living with life-threatening illness who would not otherwise have accessed our
services.
Primrose Hospice
Quality Account 2012-13
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Statements of Assurance from the Board
The following are a series of statements that all providers must include in their
Quality Account. Many of these statements are not directly applicable to hospices.
Review of Services
Hospices are required to report against those services commissioned by their local
NHS. Primrose Hospice has, to date, received a grant from NHS Worcestershire and
currently provides the following services:
o
o
o
o
Day Hospice
Outpatient facilities
Family Support Services
Primrose at Home
Participation in clinical audits
During 2012-13, no national clinical audits and no national confidential enquiries
covered NHS services relating to palliative care. Primrose Hospice only provides
palliative care. During that period Primrose Hospice was not eligible to participate in
any national clinical audits and national confidential enquiries.
As Primrose Hospice was ineligible to participate in the national clinical audits and
national confidential enquiries, and for which data collection was completed during
2012-13, there is no list below alongside the number of registered cases submitted
by the terms of the audit or enquiry.
The reports of 15 clinical audits were reviewed by Primrose Hospice during 2012-13.
As a result of these audits the following actions have been taken to improve the
quality of healthcare provided:
o
o
o
o
Introduction of nutritional care and food services policies
Introduction of a formal nutritional assessment tool
Working towards a more formal carer’s assessment
A number of minor maintenance issues
Research
The number of patients receiving NHS services provided or sub-contracted by
Primrose Hospice in 2012-13 that were recruited during that period to participate in
research approved by a research ethics committee was 0. There were no
appropriate, national, ethically approved research studies in palliative care in which
we could participate.
Primrose Hospice
Quality Account 2012-13
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Quality Improvement and Innovation Goals agreed with our Commissioners
Primrose Hospice income in 2012-13 was not conditional on achieving quality
improvement and innovation goals through the Commissioning for Quality and
Innovation payment framework.
What others say about us
Primrose Hospice is required to register with the Care Quality Commission (CQC) and
its current registration status is unconditional.
The Care Quality Commission has not taken any enforcement action against Primrose
Hospice during 2012-13.
Primrose Hospice is subject to periodic reviews by the Care Quality Commission and
its last unannounced on-site inspection review was on November 20th 2012. The
hospice was fully compliant. Primrose Hospice has not participated in any special
reviews or investigations by the CQC during the reporting period.
The Quality Risk profile of Primrose Hospice states that the hospice is low risk and a
comprehensive quarterly quality report is submitted to the CQC to maintain this
ranking.
Data quality
In accordance with agreement with the Department of Health, Primrose Hospice
submits a National Minimum Dataset (MDS) to the National Council for Palliative
Care.
Primrose Hospice did not submit records during 2012-13 to the Secondary Uses
Services for inclusion in the Hospital Episode Statistics which are included in the
latest published data. Primrose Hospice score for 2012-13 for Information Quality
and Records Management was not assessed using the Information Governance
Toolkit. This toolkit is not applicable to palliative care.
Primrose Hospice
Quality Account 2012-13
8
PART 3
Quality Overview
The most recent National Minimum Dataset covers the period 1st April 2011 to
March 31st 2012. Primrose Hospice data for 2012-13 has been collated but there is
no comparative data available at the time of writing.
The National Council for Palliative Care: Minimum Data Sets for 2011-12
Day Hospice
% New patients
% Places used
% new patients
with a non cancer
diagnosis
Average length of
attendances (days)
Outpatients
% New patients
Total clinic
attendances
Bereavement Services
% New service users
Total contacts
Primrose Hospice
National Median
62.1%
51%
62.1%
60.6%
7.8%
21.4%
177
209.3
50.9%
216
77.6%
90
78.7%
944
72.4%
902
The National Minimum Dataset for 2011-12 compares Primrose Hospice with the
national median values.
The percentage of new Day Hospice patients during 2011-12 was in line with the
national median for units of a similar size, although the percentage of places used
(51) was significantly lower. However, this shows a year on year increase as during
2010-11only 47.2% of places were used, and the previous year only 38%. Primrose
Hospice has this year launched a monthly support group to improve access to
younger patients which has been well received; figures for this group will be
documented in the 2012-13 Minimum Data Set.
Primrose Day Hospice accepts patients with non-malignant long-term conditions as
well as cancer. Currently the percentage of new referrals with a non-malignant
diagnosis is considerably less than other Day Hospices of a similar size. We hope that
this will improve with the development of joint palliative care and cardiology clinics
at the hospice.
Primrose Hospice
Quality Account 2012-13
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Primrose Day Hospice compares favourably with other similar Day Hospices in the
average length of attendances of patients. The average length (in days) at Primrose
Day Hospice was 177, compared to a national median of 209.3. This figure provides a
broad indication that appropriate patients at the end of life are accessing services. A
very short period of attendance indicates that patients are being referred too late for
any meaningful engagement with the Day Hospice; very long periods of attendance
tend to reflect that patients with fairly stable disease have become dependent,
usually on the social contact provided by a Day Hospice, but as a result are exposed
to multiple bereavements as other patients deteriorate and die.
The bereavement service at Primrose Hospice is busy compared to other units of a
similar size. It also supports a substantially higher number of young people through
its Children’s service. The Minimum Data Sets do not record service users under the
age of 16, but 4.2% of new service users to the bereavement service at Primrose
Hospice were aged between 16 and 24, compared to a national median of 2.9%.
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:
Indicator
Total number of new referrals to Primrose Hospice
Total number of outpatient attendances
Total number of Day Hospice attendances
Total number of Primrose at Home shifts provided
Total number of complaints
The number of complaints which were upheld in full
The number of complaints which were partially
upheld
The number of serious patient safety incidents
(excluding falls)
Slips, trips and falls
2011-12
500
216
1545
1074
0
0
0
2010-11
526
199
1466
937
0
0
0
2009-10
416
196
1106
758
1
1
0
0
0
0
0
2
0
The number of patients who experienced a fracture
or other serious injury as a result of a fall
Number of clinical audits completed
0
0
0
16
3
5
We now document and collect adverse comments as well as complaints, as a way of
demonstrating our response to criticism as well as formal complaints.
The Hospice receives many letters of thanks and compliments, and approximately
10% of our service is funded by families and friends of patients wishing to show
appreciation of our care.
Primrose Hospice
Quality Account 2012-13
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Participation in clinical audits
The following audits were completed during the audit year 2012-13. Primrose
Hospice conducted all audits using national hospice-specific audit tools, which have
been peer reviewed and quality assessed. *
There is an ongoing emphasis on infection control with a number of mini-audits
being carried out on a regular basis.
* except where stated
Infection Control
Bathroom
Clinical Room
Domestic Room
Policies and Protocols
Patient Areas
Kitchen areas (excluding
main kitchen)
Offices within clinical areas
Toilets for public use
Day Hospice Admission
Nutrition
We achieved 100% compliance
We achieved 100% compliance
This area was audited twice. The first time we
achieved 85.2% due to a few minor shortfalls. Having
completed all actions we achieved 100% on the
second audit
We achieved 96.2% compliance on this audit. The
issue requiring attention was a lack of a food services
policy, already in draft at the time of the audit and
now ratified and in use
We achieved 89.5%, due to a couple of very minor
shortfalls relating to the art and craft area. All actions
have since been addressed
Kitchen areas for staff were audited for the first time
in November 2012 and we achieved 83.1%, due to a
couple of minor shortfalls. An action plan has been
written with timescales for addressing the issues
The nurses’ office was audited for the first time in
November 2012. A few issues relating to general wear
and tear and a need for some decorating were
identified. As we are planning to relocate this office
during 2013, no action is currently planned
The first audit of this area revealed a couple of minor
shortfalls which have been addressed
This audit was carried out during May and June 2012.
A number of issues were identified. Some related to
written policies and procedures but most related to
documentation of patients’ notes in the electronic
record system and have since been addressed. A
further issue was the need for a more formal process
to assess the needs of carers, which is in development
An action plan has been written following this audit,
carried out in October 2012. Areas requiring attention
include some very minor amendments to the
Nutritional Care Policy and written information for
patients. The main areas for improvement involved a
need for a more detailed and formalised assessment
of nutritional problems when patients first attend the
Day Hospice, and a tool is being piloted at the
Primrose Hospice
Quality Account 2012-13
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Privacy, Dignity and
Confidentiality
Medicines
Accountable Officer
Medical Gases
moment. We also plan to seek the views of Day
Hospice patients on our catering services by means of
focus groups during the Spring of 2013.
This audit was completed during January 2013, and
used a variety of methods to explore our ability to
provide sufficient privacy and dignity for our patients,
and that we take confidentiality sufficiently seriously.
The outcome was generally very positive and it is clear
that these issues are taken seriously by all staff and
volunteers. A small number of areas were raised as
action points for improvement, including lowering the
height of the engaged signs on toilet doors and
reminding staff in some areas of the need to avoid
corridor conversations, for receptionists to take care
when dealing with sensitive phone calls and for
appropriate doors to be closed in counselling areas
This audit was carried out during March 2013 using an
adapted version of the validated Help the Hospice
audit tool suitable for Day Hospice. The audit
highlighted a minor shortfall on storage (we keep a
tiny stock of simple, over the counter medicines only),
and a need to improve our record keeping. An action
plan has been developed.
All aspects of the Accountable Officer role relevant to
Primrose Day Hospice, which does not order, store,
supply, destroy or manage controlled drugs, are being
met.
A very minor shortfall was highlighted and an action
plan to address it has been written.
What patients and carers say about the organisation
The User Forum has been consulted on a variety of issues including:
• The provision, format and adequacy of hospice leaflets and other written
materials
• User views on the provision of Dying Matters leaflets
• Feedback on negative comments received in DH survey
• User’s initial impressions of the Hospice, including the word ‘Hospice’
• What was good, and bad about engagement with the Hospice
• Feedback on the newly built ‘Coppice Centre.’
• Timing of an offer of bereavement support after death
• Views on the Primrose at the Princess (a separate, NHS inpatient palliative
care unit)
• Views on the environment within the Day Hospice and ways in which it
could be improved, which has been used to shape plans for a major capital
project to refurbish the Day Hospice
Primrose Hospice
Quality Account 2012-13
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‘When I first arrived at Primrose I felt I was in a dark place, but through
the excellent, caring and understanding help I received from all at
Primrose I feel that now I can go forward. Many thanks forever.’
‘I was taken from total despair after my loss, to seeing a way forward,
how to deal with my thoughts and feelings and how to go on with my life
and those around me.’
‘Thank you finding someone to help me.’
Primrose Hospice
Quality Account 2012-13
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Annexe
What Redditch and Bromsgrove Clinical Commissioning Group said about Primrose
Hospice’s Quality Account:
‘A significant component of the work undertaken by NHS Redditch and Bromsgrove
Clinical Commissioning Group (CCG) includes the quality assurance of services
provided for the population of Worcestershire that are funded by the NHS. This
includes steps to assure the public of the data included within this Quality Account.
As this is the first year that the Clinical Commissioning Group has been involved in
monitoring the quality of services provided by Primrose Hospice it is unable to
confirm the accuracy of data presented.
The reporting of areas of success such as the extension of services to people
experiencing non-malignant life limiting conditions, services for bereaved children
and services for recently bereaved individuals not otherwise previously engaged with
palliative care services is welcomed. Redditch and Bromsgrove CCG are committed to
supporting equality of access for vulnerable and marginalised groups of individuals
and hence we look forward to seeing how these services continue to progress
throughout 2013-14.
The Quality Account contains useful details of further priorities that are planned for
2013-14 but Redditch and Bromsgrove CCG would welcome details that are more
outcome focused and measurable. This will enable the public and monitoring
agencies to make a judgement on whether achieved progress was in line with that
expected.
Responses to user feedback are welcomed and it is clear that a number of
improvement priorities have been develop in response to feedback gained through
consultation. More details of views expressed by the User Forum would be welcome,
to give more insight into findings on the themes of consultation. This would enable an
explicit demonstration of actions taken in response to issues raised.
It would be helpful to see information included regarding incident numbers and
themes. There would be an expectation of fairly low numbers of incidents and near
misses but such transparent reporting would further assure Commissioners and the
public of an open and honest reporting culture that is willing to learn from near
misses as well as actual incidents. It is apparent that potential incidents were picked
up via audit activity (for example the need to remind staff to avoid sensitive corridor
conversations).
Overall Redditch and Bromsgrove Clinical Commissioning Group believe the Primrose
Hospice Quality Account for 2012-2013 to be a balanced report that reflects the
quality of health care services delivered. We wish Primrose Hospice every success in
delivering well respected and high quality services for the population of Redditch and
Bromsgrove for 2013-14.’
Primrose Hospice
Quality Account 2012-13
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What the Worcestershire Health and Overview and Scrutiny Committee said about
Primrose Hospice’s Quality Account:
‘The Worcestershire Health Overview and Scrutiny Committee (HOSC) does not take
the view that its role is to be a ‘critical friend’. It aims to be constructive at all times
but it reserves the right to make robust objections when appropriate, which it
considers will help maintain public confidence in the service under scrutiny.
The HOSC also continues to hold the view (which was recently endorsed in the
Robert Francis Report*) that each health provider should make full use of the
statutory requirement to publish Quality Accounts to ensure that progress towards
high-quality care is led by the Board and that the public is provided with meaningful
information on outcomes of care.
It is considered that implicit in the term meaningful information is that the Quality
Account is available for the public and easily understood.
Due to this year’s local elections, the HOSC’s consideration of draft Quality Accounts
was scheduled earlier than usual. Health service providers kindly provided early
drafts of their Quality Accounts to accommodate the HOSC. Councillors are aware
that therefore some of the comments made by the HOSC are likely to be addressed
in subsequent versions of the Quality Accounts.
Primrose Hospice is the first Worcestershire hospice which has provided a Quality
Account for observations, which is in itself a testimony to openness. The following
observations are made:
1. The Quality Account provided by Primrose Hospice takes a business-like
approach but is easily understood. The Hospice is congratulated on the clarity
of its text;
2. It is appreciated that there are limits to availability of comparative data;
3. The efforts to provide more inclusive, outlined in the ‘future planning’
statement and the listed priorities, are appreciated. In particular the initiative
to balance the proportion of patients with non-malignant diagnosis is noted,
which it is trusted will make the Hospice profile more comparable to national
profiles;
4. The Hospice is congratulated on the expansion of the remit and scope of
bereavement services. It is noted that last year’s success will be built upon
through the coming year’s priorities; and
5. A single complaint in three years, during which there have been almost 1,500
new referrals, is a remarkable result. Whilst the Hospice perhaps aims keep
complaints at zero it should be appreciated that ‘Complaints provide vital
information to the Trust about its performance .......... and are a valuable
source of learning about deficiencies that need to be remedied’*.
*The Mid Staffordshire NHS Foundation Trust Public Inquiry – Chaired by Robert
Francis QC’
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What Healthwatch Worcestershire said about Primrose Hospice’s Quality Account:
‘Healthwatch Worcestershire, which came into being on 1 April 2013 welcomes the
opportunity to consider the 2012/13 Quality Account that has been prepared by
Primrose Hospice. We have considered the Quality Account in the light of the
Department of Health’s Guidance and have prepared the following comments:
Do the priorities of the provider reflect the priorities of the local population?
It is evident that patients and service users from the local community have been
involved in shaping the services of Primrose Hospice and that they therefore reflect
the priorities of the community.
Are there any important issues missed in the Quality Account?
We note that the Quality Account provides a review of all the services that Primrose
Hospice provides which extend beyond those that are publicly funded by the NHS.
Has the provider demonstrated they have involved patients and the public in the
production of the Quality Account?
We support the approach Primrose Hospice takes in seeking the views of its patients
and service users in the design and provision of its services which is evidenced in the
Account.
Is the Quality Account clearly presented for patients and the public?
The document is very readable and informative. It is presented in a format with few
abbreviations and the commentary was relevant and understandable.
We look forward to working with Primrose Hospice in the preparation of its Quality
Account for the coming year, and for which we will be able to comment from a more
informed position.’
Primrose Hospice
Quality Account 2012-13
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