1
Part 1:
Trust Board Chairman’s Statement
The Trustees of St Barnabas Lincolnshire Hospice are committed to ensuring that
any person in Lincolnshire, affected by a life limiting illness, is able to access the
support they need to live well and die with dignity in the knowledge that their family
and friends will continue to be supported by the Hospice for as long as they
require.
The Hospice works as part of the healthcare system and is mindful of the
issues described by Robert Francis QC, chairman of the Inquiry into the Mid
Staffordshire NHS Foundation Trust, in his final report published on 6th February
2013. The report provides salutary reading for all healthcare providers, detailing
the terrible and unnecessary suffering of hundreds of people who were failed as a
result of corporate self-interest ahead of patients and their safety. The Inquiry
made 290 recommendations designed to prevent such an event happening in the
future. There are opportunities to learn and to improve and we have considered
each of the recommendations and incorporated those that are relevant into our
annual continuous improvement plan. Most importantly, we will continue to ensure
that the culture within our organisation puts patients at the heart of everything we
do.
Our promise is that our services will be designed to reflect the needs of our
patients and their families. Feedback from our “It’s the small things that make a
difference” campaign confirms that the dedication of our staff, volunteers and
supporters translates into high quality, personalised care and treatment.
“Nothing was too big or small; you listened to
us and comforted us when we needed it.”
At our recent inspection by the Care Quality Commission the inspector described
the Hospice as an organisation that was not aiming for compliance but is aspiring
for excellence.
The achievements of our teams during the last year are testament to this
observation:




319 (51%) more people have accessed our new style day therapy service
More patients have been transferred from hospital to our in-patient unit
1640 patients have been cared for in their own home.
In year the number of people dying in their own home has increased to 85%
(average throughout the year 79%)
1
 40% more patients with a non-cancer diagnosis have accessed our
day therapy services
 3212 people supported to claim benefits of over £6million
 Younger people are more confident of our modern approach and are
increasingly accessing our services.


Our Palliative Medicine Consultants are working together to improve access
to Specialist Palliative Medicine for patients in hospital, in the community
and across our own services.
78% more patients have accessed out-patient treatments.
Donations from individuals, groups and companies have made a real difference to
our patients. With this valued financial support we have been able to continue to
deliver a full range of services, replace our bed frames so that we are compliant
with recently updated safety guidance, fund bereavement support groups, organise
an event dedicated to the needs of carers and provide personal care items such as
flannels, soft tooth brushes and washing bowls. Reinforcing our view that attention
to detail is as important to patients as major developments.
As our services continue to evolve and we extend our support to patients with
different needs we recognise that we must continue to invest in developing the
knowledge and skills of staff and volunteers and continually adapt our ways of
working to reflect the feedback from our patients and their families. Over the last
year through our surveys, comments and complaints we have identified that we
need to consider how to support bereaved young adults, to develop the palliative
rehabilitation ethos of our in-patient services and to ensure that as we develop our
facilities we consider how we can provide flexible accommodation that ensures that
patients can be afforded the dignity they deserve regardless of their personal
circumstances.
In the coming year we have pledged to support the continuous improvement of our
services through a range of different initiatives including working in partnership to
establish a local in-patient service in Grantham Hospital (a Hospice within a
Hospital), developing our knowledge and skills so that we can support patients in
secure settings and establishing an extended Day therapy service in East Lindsey.
On behalf of the Trust Board I am pleased to present this Quality Account for
2012/13 and, to the best of my knowledge, the information contained therein is
accurate.
Mr Robert Neilans
Chairman of the Board of Trustees
2
Trust Board Endorsement of the Quality Account
We, the Trust Board of St Barnabas Lincolnshire Hospice, are pleased to endorse
the content of the Quality Account and, to the best of our knowledge, the
information contained therein is accurate.
Trustee
Signatures
Mr Paul Pumfrey
Mr Tom Murray
Mrs Jacky Smith
Mr Graham Hale
Mr David Carmichael
Mrs Sue Glaister
Mr Peter Jordan
Mr Phillip Hoskins
Approved - signature unavailable
Mr Richard Davies
Approved - signature unavailable
Mr Keith Darwin
3
Part 2: Priorities for Improvement and Statements of Assurance from the Board (in
regulations)
1. IMPROVEMENT
The Board of Trustees continues to support the continuous development and
improvement of its services to ensure that the care and support it provides evolve
to meet patient and carer needs.
The priorities for quality improvement we have identified for 2013/14 are set out
below. These priorities have been identified in conjunction with patients and
carers, staff and stakeholders. The priorities we have selected will impact directly
on each of the three priority areas; patient safety, clinical effectiveness and patient
experience.
1a. Priorities for Improvement 2013 – 2014
Priority One
Patient Safety, Clinical Effectiveness and Patient Experience
Priority One: The development of robust operational polices to support the
care of patients in secure / locked settings, including prisons and mental
health units by Hospice at Home staff. To ensure the delivery of safe and
effective care for patients and support to staff within these settings that will
reduce inappropriate admission to hospital for the patient.

An ageing prison population means that more people with palliative and
end of life needs will need to be cared for within the criminal justice
system.

Patients with mental health care needs who require care within a secure
setting may also have physical health needs that require palliative and end
of life care. These patients may be required to, or may choose to, remain
in a ward where they have lived for some time and where they know staff
and staff know them.

In both settings end of life care is not common and therefore staff have
little experience and limited opportunities to develop their skills and
competence in palliative and end of life care.
4
How was the priority identified?
This priority was identified as a result of Hospice at Home staff being asked to
support the care of patients in secure settings and the resulting observations and
discussions with patients and staff.
How will priority one be achieved?
This priority will be achieved by working together with other organisations,
including Lincolnshire Partnership Foundation Trust (LPfT) and the Criminal Justice
System, to develop the operational policies and procedures, training and support
to ensure safe and effective care is provided that supports a positive patient
experience and patient choice within the limits available.
How will progress be monitored and reported?
Progress will be monitored through quarterly reports to the Patient Care Executive.
Priority Two
Clinical Effectiveness and Patient Experience
Priority Two: Identify, and embed into practice, a small range of patient
reported outcome measures that assess, from the patient’s perspective, the
effectiveness of medical and nursing interventions and the outcomes of
care for the patient.

The effective measurement of the outcomes of care and treatment are vital
for the continuous improvement of services and the delivery of care.

The patient is the only person who can measure the difference that care
has made to their symptoms, be that physical or emotional.

Effective measurement of outcomes enables staff to review care, be that
programmes of care in the Day Therapy service, or individual symptom
management within the Inpatient Unit.

Effective outcome measures facilitate communication between patients
and staff and also support the patient to be in control of, and a partner in,
their care.
5
How was this identified as a priority?
This priority was identified through discussion in the Clinical Governance Group
and wider debate within palliative and end of life care. It is part of the national
palliative care agenda.
How will priority two be achieved?
This priority will be achieved by identifying appropriate, evidence based1, valid2 and
reliable3 tools,
The tools will be trialled in a variety of settings to ensure that they are suitable for
and acceptable to patients.
The tools will be added to the clinical patient record and training in their use
provided to all clinical staff.
How will progress be monitored and reported?
Progress on this priority will be monitored through quarterly reports to the Clinical
Governance Group and to the Patient Care Executive.
1
Evidence based practice is the integration of best research evidence with clinical expertise and
patient values. 2Valid means that the tool measures what it is supposed to measure. 3Reliable
means that the tool will give the same or compatible results in different clinical settings.
6
Priority Three
Patient Experience and Clinical Effectiveness
Priority Three: The development of a fully refurbished six bedded unit at
Grantham District Hospital to provide a ‘Hospice within a Hospital’. This
development will be provided in partnership with United Lincolnshire
Hospitals Trust (ULHT).

The need for six local palliative care beds covering Grantham and the
surrounding area was identified as long ago as 2009. NHS Lincolnshire
were unable to procure the beds through a tendering process.

The aim of this service is to provide local palliative care inpatient facilities
for patients who, whilst requiring an inpatient stay, do not require the
consultant led, specialist palliative care available in Lincoln.

This means that patients will be able to receive inpatient care whilst
remaining closer to home.

The beds will be provided in a separate, fully refurbished, ward within
Grantham and District hospital. There are two reasons for developing the
service in this way:
o A stand alone unit of six beds is not cost effective and is not
financially viable.
o The service has been designed to enable staff to in-reach into the
hospital to better support the palliative care needs of patients on
other wards, so improving palliative care throughout the hospital.

The beds will serve as a catalyst for the wider review of palliative care
pathways across the locality to ensure that more patients achieve their
preferred place of care and death.
How was the priority identified?
This priority was identified because patients who require inpatient care, and their
families, who live in the Grantham locality tell us that if they had a choice, and their
needs allowed, then they would prefer to be cared for closer to home.
The NHS Lincolnshire needs analysis in 2009 identified a need for generalist
palliative care beds in the locality.
South West Lincolnshire Clinical Commissioning Group has identified the provision
of palliative care beds and the wider review of palliative care pathways as a priority
for the locality.
7
How will priority three be achieved?
St Barnabas Hospice and ULHT will work closely to deliver this project. St
Barnabas has been fortunate to obtain a substantial grant of £510,000 from the
Department of Health Capital Grant Programme for hospices for the refurbishment
of the building and will lead on the refurbishment of the ward and associated
rooms. Other elements of the project, including the delivery of the clinical service
will be jointly managed.
How will progress be monitored and reported?
Progress will be monitored through monthly project meetings and reports to the
Boards of St Barnabas Lincolnshire Hospice and United Lincolnshire Hospitals
Trust.
1b. Priorities for Improvement 2012 – 2013
Patient Safety
Priority One: Replace 50% of the bed frames within the Inpatient Unit to
ensure compliance with the new advice on bed safety rails and, at the same
time, provide patients with greater comfort.

The advice about safety rails on beds has changed. Currently this is
advisory but is likely to become mandatory in the next few years.

As part of this we will ensure that the bed frames can be moved into a
variety of positions to provide additional comfort and better meet the needs
of patients.

Our aim is to be compliant with this advice within the next two years and
we have a replacement programme to meet this requirement.

During the year the Trust has replaced nine of the eleven bed frames, the
majority of these have been provided through donations and we would like
to thank the organisations and individuals whose generosity has made this
possible.

The bed frames can be moved into a variety of positions, both by staff and
by the patient to ensure effective positioning providing additional comfort for
patients. This is illustrated in the photograph below which shows a bed in
the ‘chair’ position, often used for patients with cardiac problems and
breathing difficulties.
8

The remaining bed frames have been ordered and the Trust is now
compliant with the new regulations which come into force this year.

The Trust was also able to replace pressure relieving air mattresses. These
are used to reduce the likelihood of a patient developing pressure damage.
Fig 1. A new bed, in the ‘chair position, donated to the unit
by RAF Waddington.
9
Patient Experience and Clinical Effectiveness
Priority Two: People approaching end of life who experience crisis will
receive prompt, safe and effective care

The Marie Curie Rapid Response Service in Lincolnshire provides Out of
Hours palliative care for patients experiencing crisis. The aim of the
service is to prevent admission to hospital, where it is not necessary, and
to support a patients’ choice of place of care and death.

It is essential that where an intervention has taken place out of hours,
services in hours receive this information without delay to ensure that they
provide the appropriate ongoing support. Information required by the key
worker in the community should reach them without delay in order to
reduce the risk of further crisis, and possible inappropriate admission to
hospital.

The Palliative Care Co-ordination Centre (PCCC) will alert the patient’s
key worker to the fact that the Rapid Response Service has been called to
a patient and where this is not possible escalate to the Hospice at Home
service so that a prompt reassessment of the patient and appropriate
interventions can be provided.
.

The PCCC is housed within the Hospice building and its role is to manage
packages of care prescribed by Community Case Managers, Specialist
Nurses and Community Nurses who act as Key Workers, for patients with
end of life care needs who wish to stay at home. This means that they will
have care delivered by a number of different providers including Marie Curie
Nursing Service, St Barnabas Hospice at Home and independent Care
Agencies, depending on their level of need.

The aim was to improve the flow of information to crisis calls made to the
Rapid Response service by ensuring timely response through the case
manager / key worker or, if they were not able to respond promptly, then
through the Hospice at Home services.

A palliative care crisis intervention requires a timely and effective response.
Information required by the key worker in the community should reach them
without delay in order to reduce the risk of further crisis, improve patient and
carer experience and possible inappropriate admission to hospital.
10

The operation procedure was completed and approved by all organisations
during April. A training programme was developed in partnership with
Lincolnshire Community Health Services (LCHS) to support the
dissemination of the operating procedure to staff in the community. The roll
out of the training was planned for the summer.

There was limited progress on this initiative during the summer as the date
for the roll out of training was deferred by LCHS and was rescheduled to
commence in November. It was anticipated that it would be completed by
December 2012 and that the full standard operating procedure would be
operating from January 2013.

The training for LCHS staff took place and the procedure was implemented
in December. Early data showed that the procedure was not being followed
and discussions took place with the LCHS palliative care lead. This
identified that the procedure was not effectively disseminated to LCHS staff.
We have experienced severe difficulties in progressing this priority and have
re-offered our support in providing training on the procedure to LCHS staff.

We are determined to ensure we do achieve this propriety despite the
delays. We have been working closely with Marie Curie rapid response
service to develop new ways of transferring information as the number of
calls to their service have increased.

On a positive note the number of patients cared for by our Hospice at Home
service, who are admitted to and die in an acute hospital, is small and the
majority of these admissions to hospital are appropriate to the needs of the
patient. Overall 85% of patients cared for by the Hospice at Home service
achieve their preferred place of care and death.
Patient Experience and Clinical Effectiveness
Priority Three: To increase the number of patients with a non-cancer
diagnosis and from hard to reach groups accessing the Welfare Benefits
and Day Therapy Services.

The number of patients with a non-cancer diagnosis accessing the Welfare
Benefits and Day Therapy Service will increase.

The number of patients from hard to reach groups, e.g. migrant
communities and travellers groups accessing the service will increase.

Early indications are that patients from these groups accessing the
Welfare Benefits Service are more likely to go on to access care and
support from the Day Therapy service.
Day Therapy
11
During the year the day therapy has cared for over 900 patients, a rise of 51% on
the previous year. The graph on the following page shows the increase in the
number of patients we saw compared to the previous year. Our priority was to
increase the number of patients with a non-cancer diagnosis attending for
treatment and the graph shows an increase of 40% in this patient group. There
are a number of patients for whom we cannot report a diagnosis. This is because
of the SystmOne electronic patient record. By looking at this data we know that a
high percentage of these patients also have a non-cancer diagnosis. Changes that
have been made recently to the SystmOne palliative care template have already
started to improve our ability to report diagnosis and we expect to see this reflected
in the figures for the non-cancer patient group.
Welfare Benefits

The figures for the number of non cancer patients have not increased
despite publicity and meetings with providers and organisations who care for
patients with a non cancer diagnosis. Part of the reason for the difficulty in
raising the referral levels is that, unlike cancer patients, the majority of
patients with a non cancer diagnosis will have been living with the condition
for several years and welfare benefits have already been claimed. The
exception to this is Motor Neurone Disease; we do receive referrals for
patients at diagnosis from the neurological team.

With regard to ethnic minorities, for example, migrant workers we have seen
these numbers remain constant; the localities with the highest referrals
being Boston and Lincoln. This mirrors the demographic of the areas. The
majority of these patients have a cancer diagnosis and have been referred
by the Macmillan Information Pods in Boston and Lincoln.
12

The Louth and Coastal area, including Skegness which is in an area of high
deprivation, is seeing a month on month increase in referrals, rising from
14% to 21% of the total case load for the service. This is the result of
significant publicity in the area. The opening of the new day therapy unit in
Louth should also attract publicity which may increase further the referrals
we receive.

The National Carers Awareness day, on 30th November 2012, provided an
opportunity to run a Carers Awareness Day at our Day Therapy centre in
Lincoln. The event was run in partnership with Lincolnshire Carers & Young
Carers Partnership. Twenty-eight organisations had stands providing
information for carers. Welfare Benefits and Citizen's Advice Bureau clinics
were available during the event. There was also a timetable of short talks
running during the morning. The event was sponsored by Tesco and Boots
and thanks to their generosity we were able to provide refreshments and to
raise £300.00 from the raffle. As an added bonus, carers were offered the
opportunity for a free makeover courtesy of the Lincoln Boots No 7 Team.
Fig 2. Carers Event held at St Barnabas Hospice – Lincoln
13
Fig 3. Carers enjoying refreshments at the Carers Day event

Feedback following the event was very positive and as part of the day an
information pack was produced with information about the organisations
involved and how to contact them in the future. This was given to all who
attended. The event was also attended and publicised by local media, the
Lincolnshire Echo and Lincs FM.

A networking lunch for organisations completed the event: this was a great
opportunity for all the organisations present to make contacts and meet our
day therapy staff.
Non-Cancer Workshop
In February 2013 the Palliative Care Co-ordination Centre hosted a non-cancer
workshop brining together nine disease group and a number of different statutory
and voluntary organisations to support better access to palliative and end of life
care for their client / patients groups. Through the discussion a number of actions
were identified that would improve access for these clients and patients and the
group is now prioritising these actions and developing a plan of work for 2013/14.
14
2.
STATEMENT OF ASSURANCE FROM THE BOARD
The following are statements that all providers must include in their Quality
Account. Many of these statements are not directly applicable to specialist
palliative care providers, and therefore explanations of what these statements
mean are also given.
2a.
Review of Services
During 2012/13 St Barnabas Lincolnshire Hospice supported NHS Lincolnshire’s
commissioning priorities with regard to the provision of local specialist palliative
care by providing the following services:
o
o
o
o
Hospice at Home
Inpatient Unit
Welfare Benefits
Palliative Care Co-ordination Centre
In addition the Trust has provided the following services through charitable funding:
o
o
o
o
o
Day Hospice
Occupational Therapy
Physiotherapy
Lymphoedema
Family Support Services, including bereavement support services
During the reporting period 2012/13 St Barnabas Lincolnshire Hospice provided
three NHS services. St Barnabas Lincolnshire Hospice has reviewed all the data
available to them on the quality of care in all of these NHS services.
The income generated by the NHS services reviewed in 2012/13 represents 61 per
cent of the total income generated from the provision of NHS services by St
Barnabas Lincolnshire Hospice for 2012/13.
What this means:
St Barnabas Lincolnshire Hospice receives NHS funding, through the National
Community Contract, for the Hospice at Home service and Palliative Care Coordination Centre and partial funding for the Inpatient unit and Welfare services.
The Trust also has a small contract with Lincolnshire County Council for the
provision of community Occupational Therapy services. The remaining income,
to support the delivery of Day Therapy, Occupational and Physiotherapy and the
Lymphoedema service, Family Support Services, including bereavement, is
generated through fundraising, shops and lottery activity and investment income.
2b.
Participation in Clinical Audit
15

During 2012/13 no national clinical audits or confidential enquiries covered
NHS services provided by St Barnabas Lincolnshire Hospice.

During that period St Barnabas Lincolnshire Hospice participated in no
national clinical audits and no confidential enquiries as it was not eligible to
participate in any.

The national clinical audits and national confidential enquiries that St
Barnabas Lincolnshire Hospice was eligible to participate in during 2012/13
are as follows: NONE.

The national clinical audits and national confidential enquiries that St
Barnabas Lincolnshire Hospice participated in during 2012/13 are as
follows: Not applicable.

The national clinical audits and national confidential enquiries that St
Barnabas Lincolnshire Hospice participated in and for which data collection
was completed during 2012/13 are listed below alongside the number of
cases submitted to each audit or enquiry as a percentage of the number of
registered cases required by the terms of that audit or enquiry. Not
applicable.

The reports of no national clinical audits were reviewed by the provider in
2012/13. This is because there were no national clinical audits relevant to
the work of St Barnabas Lincolnshire Hospice.

St Barnabas Lincolnshire Hospice was not eligible in 2012/13 to participate
in any national clinical audits or national confidential enquiries and therefore
there is no information to submit.
16
2c.
Research
The number of patients receiving NHS services provided or sub-contracted by St
Barnabas Lincolnshire Hospice in 2012/13 that were recruited during that period to
participate in research approved by a research ethics committee was NONE.
What this means:
As a provider of specialist palliative care St Barnabas Lincolnshire Hospice is not
eligible to participate in any of the national clinical audits or national confidential
enquiries. This is because none of the 2012/13 audits or enquiries related to
specialist palliative care in settings other than acute care and were therefore not
relevant.
Despite not being eligible we do monitor the work we do, undertaking audits and
patient and carer surveys. The results of our audits and patient and carer
surveys can be found further on in this report.
The Hospice will also not be eligible to take part in any national audit or
confidential enquiry in 2013/14 for the same reason.
This year one of our Palliative Medicine Consultants has been selected as the
lead for palliative care research. Over the next year we expect to start working
with colleagues from other organisations in the region in joint research activity.
2d.
Use of the CQUIN Payment Framework
A proportion of St Barnabas Lincolnshire Hospice income in 2012/13 was
conditional on achieving quality improvement and innovation goals agreed between
St Barnabas Lincolnshire Hospice and any person or body they entered into a
contract, agreement or arrangement with for the provision of NHS services,
through the Commissioning for Quality and Innovation payment framework.
Further details of the agreed goals for 2012/13 CQUIN payments and for the
following 12 month period 2013/14 will be available electronically at
www.stbarnabashospice.co.uk from 1st July 2013.
17
2e.
Statement from the Care Quality Commission (CQC)
St Barnabas Lincolnshire Hospice is required to register with the Care Quality
Commission and is currently registered to carry out the regulated activity:
Treatment of disease, disorder or injury.
“St Barnabas Lincolnshire Hospice has the following conditions on registration:

The registered provider must ensure that the regulated activity, ‘treatment for
disorder or injury' is managed by an individual who is registered as a manager
in respect of the activity as carried on at or from a Specialist Palliative Care
Unit.”
Statement of reasons
The registration of the provider of this regulated activity is subject to a registered
manager condition under Regulation 5 of the Care Quality Commission
(Registration) Regulations 200.

The Registered Provider must only accommodate a maximum of 11 patients at
Specialist Palliative Care Unit.
Statement of reasons
We are imposing this condition because your service is set up to accommodate 11
persons. The premises, management or staffing provided at this location are
suitable only for a maximum of 11persons.

The Registered Provider must not treat persons under 18 years in respect of
the regulated activity 'Treatment for disorder or injury' at or from Specialist
Palliative Care Unit.
Statement of reasons
We are imposing this condition because your service is set up to accommodate
persons aged 18 years or over. The premises, management or staffing provided at
this location are suitable only for persons aged 18 years or over.
This Regulated Activity may only be carried on at the following locations:
Specialist Palliative Care Unit, 36 Nettleham Road, Lincoln, LN2 1RE
The Care Quality Commission has not taken any enforcement action against St
Barnabas Lincolnshire Hospice during 2012/13.
St Barnabas Lincolnshire Hospice has not participated in any special reviews or
investigations by the Care Quality Commission during 2012/13.
18
The Care Quality Commission made an unannounced inspection on 3rd and 4th
January 2013.
The report is available on the CQC website
www.cqc.org.uk/directory/1-140658893 and also on the St Barnabas Hospice
website www.stbarnabashospice.co.uk.
2f.
Data Quality
Statement of relevance of Data Quality and your actions to improve your Data
Quality.
St Barnabas Lincolnshire Hospice did not submit records during 2012/13 to the
Secondary Users service for inclusion in the Hospital Episode Statistics which are
included in the latest published data.
Why is this?
This is because St Barnabas Lincolnshire Hospice is not eligible to participate in
this scheme. However, in the absence of this we have our own system in place
for monitoring the quality of data and the use of the electronic patient information
system, SystmOne. This is important because, with the patients’ consent, we
share data with other health professionals to support the care of patients in the
community.
What have we done?
This year we have reviewed the use of SystmOne patient care plans to ensure
that we are able to provide timely and accurate information. To support this we
are developing and revising care plans. This will ensure that they enable us to
report patient outcomes and related information that will support the Trust in
delivering its priorities and ensure that services and interventions are effective
and achieve the required patient outcomes.
2g.
Information Governance Toolkit Attainment Levels
St Barnabas Lincolnshire Hospice Information Governance Assessment Report
score for 2012/13 was:





Level 0 - 0%;
Level 1 - 0%;
Level 2 - 93%;
Level 3 - 3%;
Not Relevant – 3%
This means that we have attained 100% Level 2 or above compliance, which is the
requirement for any organisation to access the NHS’s network. Organisations are
graded either satisfactory or unsatisfactory.
19
St Barnabas Lincolnshire Hospice
Prepared on 15/04/2013
Assessment
Level
0
Level
1
Level
2
Level
3
Not
Relevant
Total
Req'ts
Overall
Score
Grade
Version 10
(2012-2013)
0
0
27
1
1
29
67%
Satisfactory
Fig 4.Table IG Toolkit Assessment Summary Report
Version 10 (Published) Breakdown by
AttainmentLevel
4%
3%
Level 0
Level 1
Level 2
Level 3
Not Relevant
93%
Fig 5. Breakdown of Attainment Level for IG Toolkit Version 10
What this means.
Organisations are graded either satisfactory or unsatisfactory.
St Barnabas Trust was graded as ‘satisfactory’ and meets all of the
Connecting for Health standards. This provides patients with the confidence
that their information is being dealt with safely.
2h.
Clinical Coding Error Rate
St Barnabas Lincolnshire Hospice was not subject to the Payment by Results
clinical coding audit during 2012/13 by the Audit Commission. This is because St
Barnabas Hospice receives payment under a block contract and not through tariff
and therefore clinical coding is not relevant.
20
Part 3: Review of Quality Performance
The National Council for Palliative Care (NCPC): Minimum Data Sets (MDS)
We have chosen to present information from the NCPC minimum data set which is
the only information collected nationally on hospice activity. The figures below
provide information on the activity and outcomes of care for patients.
Hospice Inpatient Unit
St Barnabas Lincolnshire Hospice
Specialist Inpatient Unit Services
2010/11
Total number of patients
151
% New patients
83%
% Re-referred patients
11%
% Admissions from
patient’s own home
% Admission from acute
hospital
% Occupancy
69%
% Patients discharged to
51%
their home
Average length of stay –
17 days
cancer
Average length of stay –
14 days
non-cancer
2011/12
183
92%
3%
2012/13
190
93%
5%
69%
60%
30%
36%
83%
74%
45%
41%
17 days
15 days
13 days
24 days
There has been a small increase in the number of patients admitted to the unit
during the last year, with an increasing number transferred from acute hospital.
This is a result of the work the two palliative care consultants in post during the
reporting period have been undertaking.
“I’m so grateful the service was there for my husband
and our family. I can not fault the care he received.”
21
Specialist Outpatient Service
Specialist Palliative Care Outpatients
2010/11
Total number of patients
% New patients
% Re-referred patients
% Continuing patients
2011/12
239
90%
0
10%
2012/13
348
91%
1%
9%
This year we have increased the Outpatient activity by 78%.
Day Therapy
Day Hospice
Total number of patients
% New patients
% Re-referred patients
% Places used
% of places booked but not
used
Average length of care
2010/11
515
66%
4%
56%
2011/12
625
67%
2.5%
2012/13
944
63%
5%
34%
30%
8%
184 days
218 days
131 days
There has been an increase of 51% in the number of patients accessing the Day
Therapy service during the year. The tailored packages of care and choice of
appointment times, together with proactive management of the appointments has
reduced the figure for appointments not used from 30% to just 8%.
“From the time I was informed of St Barnabas by my
Macmillan Nurse I have been so impressed by the quality
of everything, the receptionists, the volunteers and staff.
What a wonderful facility, thank you so very much”
22
Hospice at Home
Hospice at Home
Total number of patients
% New patients
% Re-referred patients
% of patients who died at
home
% of patients who died in
acute hospital
Average length of care
2010/11
2011/12
2012/13
1637
1545*
1640*
85%
6%
85%
5.5%
85%
5.2%
79%
79%
79%
9%
9%
57 days
40 days
9%
43 days
* This figure does not include night care patients as it did in 2010/11.
The Hospice at Home service has seen an increase of 6% on the number of
patients accessing the service. The number of patients achieving their preferred
place of care is 85% with 79% dying at home.
“We were humbled and incredibly grateful for the loving
and dignified care you gave.”
Family Support Service
Bereavement Support
Total Service Users
Number of telephone
contacts
Number of group work
contacts
Number of individual
support sessions
Number of individual
counselling sessions
2010/11
2011/12
2012/13
257
250
1,617
693
1,444
1,620
3,418
4,169
4,302
426
204
441
797
339
In the last year we have reviewed the way we collect data within the service and
this now reflects more accurately the work done by our highly trained and
committed volunteers. There are currently 52 groups for bereaved people each
month throughout the county run by the Family Support Service and this would not
23
be possible without the continued support, enthusiasm and commitment of these
volunteers.
“St Barnabas enabled my husband to be in our home
when he died. The bereavement group is now helping
me to come to terms with living again.”
Welfare Benefits Service
Welfare Benefits Service
2010/11
2011/12
2012/13
Total Clients
2124
2837
3212
New Clients
1718
1979
1842
Re-referred Clients
406
588
1370
£4,366,623.28
£5,426,965.68
£6,483,581.68
Total money claimed on
behalf of clients
The Welfare service continues to provide vital support to patients and their families
and carers in navigating the complexities of the welfare benefits system. For the
third successive year they have increased the amount that they have claimed for
patients by a staggering £1,000,000.
“Excellent service” “Both the wife and I have used
the service as we are both ill”
The overall number of referrals is up from 2837 to 3212 which is an increase of
13% in workload. The number of new referrals is down slightly, a decrease of 7%.
The number of returning patients requiring assistance has increased by 132%
which is indicative of the complexity of the types of benefits with which we are now
assisting. The majority of disability related benefits are now reviewed regularly by
the Department of Work and Pensions (DWP), with lengthy forms being sent to
patients for completion often on a six-monthly basis. The ongoing changes to the
welfare benefits system have seen many long-term patients being transferred from
Incapacity Benefit to Employment & Support Allowance; this involves
questionnaires being sent to patients who are struggling to complete them without
support. The further changes anticipated as a result of the welfare reforms are
likely to see this trend continue as benefits are more tightly managed by the DWP
with demands for ongoing evidence of illness to maintain the benefits.
We
believe that part of our role is to advocate for patients and we will be highlighting
both locally and nationally the negative impact the Welfare Reform Act changes
are likely to have on our patients.
24
Quality Markers We Have Chosen To Measure
In addition to the limited number of suitable quality measures in the national data
set for palliative care, we have chosen to measure our performance against the
following:
INDICATOR
2010/11
Complaints
Total number of complaints (clinical)
8
2011/12
2012/13
6
7
The number of complaints upheld in full
5
1
2
The number of complaints upheld in part
3
2
5
The number of complaints not upheld
0
3
0
Two upheld complaints related to:


A patient having to wait for more than 10 minutes for a commode in the
Inpatient Unit, this was addressed in full with the Ward Manager and was
resolved.
Miscommunication issue between relative and staff at the Inpatient Unit
which has been fully investigated and addressed.
Five partially upheld complaints related to:





Changes in day therapy service at Spalding, addressed with family.
Changes in day therapy service at Grantham, investigation ,discussions and
learning completed.
Working issues regarding provision of agency care by PCCC, resolved.
Loss of patient’s raincoat which was reimbursed. Also some concerns
regarding care, reviewed and addressed accordingly.
Miscommunication between Grimsby Hospital and Inpatient Unit regarding a
patient transfer, investigated and resolved.
25
INDICATOR
Patient Safety Incidents
The number of serious patient safety incidents
(excluding falls)
2010/11
2011/12
2012/13
2
1
0
The number of slips, trips and falls
21
37
35
The number of patients who experienced a
fracture or other serious injury as a result of a
fall.
0
0
0
Number of patients admitted to the Inpatient Unit
38
36
42
with pressure damage
Number of patients who developed pressure
18
39
43
damage whilst in the Inpatient Unit
Vigilance and effective reporting ensure that we capture information on all pressure
damage, however minor. The majority of pressure damage was grade one.
INDICATOR
Patient Safety
Number of patients, clients and families referred
to Family Support Services because of
safeguarding issues
Infection Prevention and Control
The number of patients know to be infected with
MRSA on admission to the Inpatient Unit
The number of patients infected with MRSA
whilst on the Inpatient Unit
The number of patients with MRSA bacteraemia
2010/11
2011/12
2012/13
7
11
16
7
1
0
0
1
0
0
0
0
2
1
0
0
0
0
The number of patients known to be infected with
an alert organism for example, Staph aureus,
Pseudomonas aeruginosa, ESBL, Klebsiella,
and Streptococcus pneumoniae on admission
11
10
6
The number of patients who contracted any of
these infections whilst in the Inpatient Unit
5
1
4
The number of patients admitted to the Inpatient
Unit with C. difficile
The number of patients infected with C. difficile
whilst in the Inpatient Unit
26
Clinical Audit
Clinical audit is a way in which the organisation can learn and improve the delivery
of its services, the outcomes for patients and the experience they have. The Audit
group has undertaken a programme of audits using national audit tools designed
specifically for hospices.
Patient and relative surveys are also administered to all patients / relatives (as
appropriate) admitted to the Inpatient Unit. The survey reflects the Care Quality
Commission outcomes from the Essential Standards. Clinical staff continue to be
involved in the audit work with a number of staff participating in infection control
and syringe driver audits. The table on the following pages shows the work
undertaken in 2012/13.
Where issues are identified during an audit an action plan is developed to put the
problems right. Progress on the action plans is monitored through the Clinical
Governance Group to ensure that they are completed. We will then undertake a
further audit to see if the actions we have taken have resolved the issues identified.
Audit
Completed
Action
Plan
Actions to be undertaken
to improve practice
Action Plan
Completed / to
be completed
Medicines
Management Audits
General
Medicines
Medicines
ManagementManagement
of Controlled
Drugs and
Accountable
Officer
October
2012
December
2012
Yes
Yes
Working issues including
review of medication
storage, review of
documentation and
provision of pre-printed
envelopes for patients
medications to be taken to
outpatients appointments.
Completed
Staff reminded of correct
documentation procedures
and information on reversal
agents to be displayed
clearly in clinical room.
Key points
completed.
Review of parking for staff
safety for the delivery and
collection of controlled
drugs from pharmacy.
Re-audit
June 2013
27
Audit
Syringe Driver
Monitoring
Forms
Medical
Gases(oxygen)
Patients’
Medications on
Discharge
Home.
Electronic
Remote
Direction to
Administer
Completed
December
2012
January
2013
March
2013
February
2013
Action
Plan
Yes
Actions to be undertaken
to improve practice
Staff reminded to complete
all elements of
documentation when
replenishing syringe driver.
Ensure staff provide all
patients with an Information
leaflet on commencement
of a syringe driver.
Yes
Review of training for staff.
Improve the prescribing
oxygen to patients.
Yes
Ensure appropriate
supervision of GP
Registrars.
Ensure all staff aware of
availability of strengths of
medications in the
community.
Yes
Patient identification labels
to be used to reduce the
risk of errors.
Deletions and transcribing
to be timed, in addition to
being signed and dated.
Action Plan
Completed / to
be completed
Completed.
Action plan in
progress.
Re-audit
May 2013
Ongoing.
Completed.
Re- audit
June 2013
Infection Prevention and Control Audits
Hand
Hygiene(IPU)
Sharps
March 2013
March 2013
No
On going throughout the
Trust.
Yes
Display information for
staff detailing appropriate
and inappropriate items for
sharps bins.
Discuss with staff the
financial implications of
filling sharps bins with
inappropriate items.
N/A
Completed.
28
Audit
Annual External
Infection
Prevention and
Control:
 Inpatient Unit
 Hawthorn
Road
Cleanliness
Audits:








Inpatient Unit
Lincoln
Gainsborough
Spalding
Boston
Grantham
Skegness
Louth
Completed
Action
Plan
Actions to be undertaken
to improve practice
Action Plan
Completed / to be
completed
January
2013
Yes
Minor issues identified and
addressed.
Yes
Quarterly
If
required
Minor issues only. Any
issues identified are
addressed promptly.
Ongoing
Surveillance
Surveillance:
1. Infections
2.Urinary catheter
associated
infections (IPU)
Tissue Viability
Surveillance of
Trust Incidents
Monthly
Monthly
Monthly
If
required
Clear rationale to be
documented if urinary
catheterisation is performed.
Education regarding
infection prevention and
urinary catheterisation is on
going throughout the Trust.
Ongoing
If
required
Pressure relieving
mattresses are available in
the inpatient unit for patients
who are identified, through
initial assessment, as being
vulnerable to skin damage.
Ongoing
If
required
The Clinical Governance
Nurse collates all incidents,
performs a risk assessment
and reviews the actions
taken by the appropriate
managers. Any trends are
identified.
Ongoing
29
Audit
Completed
Action
Plan
Actions to be
undertaken to improve
practice
Action Plan
Completed / to
be completed
Other Clinical Audits
Nursing
Handovers(IPU)
March
2013
Yes
Minor issues only Nursing team to
discuss findings at an
arranged workshop.
Customer
Satisfaction/Accuracy
of Documentation
(Welfare)
March
2013
Yes
Minor issues only Discuss documentation
accuracy with staff.
Completed
Mattress Audit (Park
House external audit
& St Barnabas audit)
January
/ February
2013
Yes
Static mattresses to be
audited 3 monthly.
Storage of spare
mattresses to be
reviewed.
Completed.
Completed.
Patient and Relative Surveys
Patient Survey
Apr 2012 to
Mar 2013
March 2013
Yes
To be compiled by the
IPU Ward Manager
Ongoing
Relative Survey
Apr 2012 to
Mar 2013
March 2013
Yes
To be compiled by the
IPU Ward Manager
Ongoing
30
Feedback from Patients and Families on Services
We value the feedback we receive from patients and families as this is an
important way in which staff can identify and resolve problems and improve the
quality of the care we provide. We are always looking for new ways to receive
feedback.
This year, in addition to the survey we give to all patients discharged from the
Inpatient Unit or send a survey to the family of patients who die on the unit, we
have used new methods of collecting feedback.
Friends and Family Test
As part of a national programme acute hospitals and some hospice inpatient units
have asked patients if they would recommend the service they provide to their
friends and family.
All of the patients we asked said they would recommend our service to their
friends and family.
The table below shows the results we achieved each month throughout the year.
Data
Inpatient
Discharges
Responses
<48hrs
Promoters
Passive
Detractors
Score
Sample
Size
Apr 12
May 12
Jun 12
Jul 12
Aug 12
Sep 12
2
4
8
8
5
5
2
1
7
7
3
5
2
0
0
100%
1
0
0
100%
7
0
0
100%
7
0
0
100%
3
0
0
100%
5
0
0
100%
100%
25%
88%
88%
60%
100%
Data
Inpatient
Discharges
Responses
<48hrs
Promoters
Passive
Detractors
Score
Sample
Size
Oct 12
Nov 12
Dec 12
Jan 13
Feb 13
Mar 13
4
4
4
6
9
6
3
3
4
6
8
5
3
0
0
100%
3
0
0
100%
4
0
0
100%
6
0
0
100%
8
0
0
100%
5
0
0
100%
75%
75%
100%
100%
89%
83%
31
It’s the small things …
Last year we started the “It’s the small things that make a difference” project,
another means by which patients, clients, carers and families can feedback to us.
We provide them with a postcard which they can send back to us, identifying the
small things that have made a difference to them.
Below is a selection of comments about the small things that made a difference to
our patients during the last year.
Treat my husband
with dignity and
consideration
Professionalism,
regular and welcome
visits, knowledge of
pain control
Being there when
nobody else was – in
the worst nightmare
of my life and
knowing you will be
there to the end
Friendly happy
people always
welcoming. Laughing
with staff and
patients.
Day Therapy
Some where to
come where you’re
not alone
Family Support
Just listened and
supported me
Cared about me as
well as my mum
The over the bed
table meant my
husband could reach
his drink, it made
such a difference to
us both
32
The Patient Survey
The annual Patient survey from April 2012 to March 2013 had a response rate of
46%.
We asked patients about their care and treatment. We asked the following
questions based on the Care Quality Commission Essential Standards of Quality
and Safety1.
Was your privacy and dignity respected?

92% of patients said ‘yes always’
Was your right to independence respected?

88% of patients said ‘yes always’
Did you feel that the care, treatment and support you were given met your
needs?

92% of patients said ‘yes always’
Did you feel that the care, treatment and support were delivered in a safe and
effective manner by members of the healthcare team?

88% of patients who responded said ‘yes always’
Did you have confidence and trust and feel safe in the care of the staff
treating you?

88% of patients said ‘yes always’
How would you rate the Hospice food and drink?

96% of patients rated the food and drink as ‘very good’ or ‘good’
Did you feel that the hospice room or ward that you were in was clean?

1
100% of patients who responded said ‘yes always’
Care Quality Commission (2009) Essential Standards of Quality and Safety
33
Did you feel safe and comfortable with the equipment used by the staff?

100% of patients who responded said ‘yes’
We also asked what could be done to develop our services patients said:

“My stay was perfect in every way.”

“Could not have asked for anything more you are all ”Brill”.”

Defective shower rail in the male shower room reported to a member of
staff. Did not appear to be acted upon.”

“I feel that it would be almost impossible to suggest any improvement or
indeed an insult to even try.”

“The overall design of the large bathroom didn’t feel quite right another small
shower room would have been ideal otherwise what a fantastic place and
fantastic caring staff, nothing was too much trouble for anyone. I felt totally
cared for in everyway.”

“No suggestion to change what is already a very good organisation and I
thank you very much for your care of my son. I have asked him the
questions and these are his replies.”
The Relatives’ Survey
The annual Relatives’ survey from April 2011 to March 2012 had a response rate
of 39%.
When asked what could be done to develop our services, relatives said:

“No not really. Myself and my partners family cannot thank you enough for
the wonderful care and compassion which you showed throughout.”

“The care and service was excellent and all the staff were very professional
and attentive.”

“St Barnabas Hospice provided excellent service for my brother in the last
week of his life. He felt safe and well cared for – so pleased that he was
near the patio windows – so he could see and visit the garden. Please don’t
move site!”
34

“One comment, the second day in the hospice my wife said this is how
nursing used to be. Many, many thanks.”

“Our abiding memory of Lincoln St Barnabas is how every member of staff
we came into contact with, from cleaner to consultant, knew XXXXX by
name, treated him with kindness and respect and gave us confidence in
their professional approach.
Copies of the full surveys will be available on the Trust website
www.stbarnabashospice.co.uk from June 2013.
Real Time Reporting
In addition we have been involved in a Real Time Reporting project. This project,
led by Help the Hospices, and working with health and social care organisations
across Lincolnshire, has tested a method of collecting patient and carer feedback
electronically, using tablet devices, and provide timely feedback to organisations.
This short pilot gave us an opportunity to test these devices and to collect feedback
in our Day Therapy service and Inpatient Unit. The pilot found that the tablet
devices were acceptable to most people who found them easy to use. For those
that didn’t, staff and volunteers were able to help them. The questionnaire
provided positive and useful feedback to us and the project team is now working
with carers and patients to refine the survey questions.
35
Statement of Director’s Responsibilities in Respect of the Quality
Account
The directors are required under the Health Act 2009 to prepare a Quality Account
for each financial year. The Department of Health has issued guidance on the
form and content of annual Quality Accounts (which incorporates the legal
requirements in the Health Act 2009 and the National Health Service (Quality
Accounts) Regulations 2010 (as amended by the National Health Service (Quality
Accounts) Amendment Regulations 2011).
In preparing the Quality Account, directors are required to take steps to satisfy
themselves that:

the Quality Account presents a balanced picture of the Trust’s performance
over the period covered;

the performance information reported in the Quality Account is reliable and
accurate;

there are proper internal controls over the collection and reporting of the
measures of performance included in the Quality Account, and these
controls are subject to review to confirm that they are working effectively in
practice:

the data underpinning the measures of performance reported in the Quality
Account is robust and reliable, conforms to specified data quality standards
and prescribed definitions, and is subject to appropriate scrutiny and review;
and

the Quality Account has been prepared in accordance with Department of
Health guidance.
The directors confirm to the best of their knowledge and belief they have complied
with the above requirements in preparing the Quality Account.
By order of the Board
Date: 28 June 2013
Signature:
Chairman
Date: 28 June 2013
Signature:
Chief Executive
36
HEALTH SCRUTINY COMMITTEE
FOR LINCOLNSHIRE
HEALTHWATCH
LINCOLNSHIRE
Statement on St Barnabas's Quality Account for 2012/13
This statement has been prepared jointly by the Health Scrutiny Committee for
Lincolnshire and Healthwatch Lincolnshire.
Priorities for 2012/13 and Achievements
We congratulate St Barnabas on its efforts to meet its three priorities for 2012-13.
There will be genuine benefits for patients as a result of the Trust's bedreplacement programme (Priority 1).
We commend St Barnabas for making progress with training and preparations for
the developing the crisis intervention service (Priority 2), but we are somewhat
concerned that this progress was limited by the fact that procedures were not
properly disseminated to Lincolnshire Community Health Services (LCHS) staff.
We support St Barnabas in continuing to ensure the agreed processes are followed
by LCHS and note that further training has been offered to the relevant front line
staff.
We also congratulate St Barnabas on the continued rise in the number of patients
receiving the Hospice at Home Service.
In relation to Priority 3, we note that the intention of increasing the number of noncancer patients in receipt of welfare benefits advice has not been met, but accept
the reasons cited for this. However, we commend St Barnabas for continuing to
increase both the number of patients in receipt of welfare benefits advice overall
and the amount of benefit they receive. This is a significant achievement, which
will make real differences to the lives of the people concerned and their families.
We would also compliment St Barnabas increasing its day therapy service
provision by 51%, compared to the previous year.
37
Priorities for 2013-14
We support St Barnabas's three priorities for 2013-14. We believe that Priority 1
(Development of Operational Policies to Support Patients in Secure Settings) is
important, as people held within the criminal justice system should be able to
access appropriate palliative care.
Priority 2 (Development of Patient Reported Outcome Measures) is also important
and recognises that only the patient can measure the difference that care has
made to their symptoms.
In particular, we would like to highlight that Priority 3 (the development of a six
bedded unit at Grantham and District Hospital), as this will represent a significant
development for the people of Grantham and its surrounding area. We are
pleased that St Barnabas has developed a positive working relationship with
United Lincolnshire Hospitals NHS Trust to take this initiative forward. We look
forward to future reports on progress with this priority.
Francis Report
We are pleased that St Barnabas has taken heed of the Francis Report in the
development in its Quality Account. This shows that St Barnabas is taking forward
the relevant recommendations in the Francis Report, to consider how its services
could be improved.
Feedback from Patients and Families on Services
We are pleased that St Barnabas has received positive feedback on both the
friends and family test and the patient survey. This is a credit to the organisation
and we congratulate the staff on their work to receive such positive feedback.
Presentation and Accessibility of Information to the Public
The Quality Account is clearly presented and accessible to members of the public.
For example, where percentages are used, they are supported by actual figures,
which we believe is more meaningful for readers. We are also particularly pleased
to see a paragraph under each of the priorities for the coming year indicating how
progress on the priority will be monitored and reported.
38