Quality Account 2012 - 2013
A Statement from the Care Quality Commission
Inspection report November 2012:
‘People using the hospice services received high quality treatment, care
and support that met their needs, was in line with their wishes and
regularly exceeded their expectations.’
A Statement from the November 2012 Day Services
Patient Focus Group:
“Going out anywhere else can be frightening, embarrassing and
knackering....but coming here, even though it’s an effort, is rejuvenating.”
“It’s a life line”.
Part 1
1.1 Chief Executive’s Statement on Quality
St Helena Hospice aims to be the lead provider for palliative and end of life care
within North East Essex and the Colne Valley. Established for nearly 30 years it is a
positive and dynamic organisation determined to make a difference to the quality of
care received by patients and their families, and to ensure year on year that the
extent of unmet need is steadily eroded.
The Hospice has a range of professional teams and services including a large
Hospice Nurse Specialist team, Hospice at Home service, a 15-bedded inpatient
unit, and two day centres – one in Colchester, co-located with the inpatient unit, and
one at our Tendring Centre in Clacton. We also have a large complementary therapy
team, a growing rehabilitation team, vibrant chaplaincy team and excellent
bereavement services. In the past year we have developed a transition service for
young adults in partnership with The J’s Hospice.
In 2013/14 we are leading on the implementation of a 24/7 single point of access for
patients, their families and professionals and will be hosting a combined end of life
electronic register for the locality. We continually explore ways to extend the scope
and responsiveness and quality of our services, and work closely with other
providers and service users.
We provide an education centre, linked with a local university, which has one of the
best specialist libraries in the country, and supports our varied education programme.
We highly value innovation and research and have developed our own in-house
practice development methodology known as the HEARD model (Hospice Education
And Research and Development).
Safety and quality are at the heart of our commitment to excellence in all the
services we provide and we welcome the opportunity to share our progress and
priorities in this report.
For further information about St Helena Hospice, including Strategic Plans, recent
CQC Inspection Reports and Patient Survey Reports please see our website at
www.sthelenahospice.org.uk
Mark Jarman-Howe
Chief Executive
St Helena Hospice
1.2 Hospice Accountability Statement
To the best of my knowledge, as requested by the regulations governing the
publication of this document, the information in this report is accurate.
Mark Jarman-Howe
Chief Executive
This report has been reviewed and approved by:
Mark Jarman-Howe, Chief Executive
Ken Aldred, Patient and Family Services Committee Chair and Trustee
Jane Elliott, Quality and Standards Director
Part2
Priorities for improvement
Future Planning: Priority 1
Clinical Effectiveness / Patient Experience
Hospice Education And Research (and) Development (HEARD)
St Helena is committed to improving the care and experience of people with lifelimiting illness and their families and to continually seek to learn and share
knowledge, skills and new innovations. In order to do this and to ensure that other
health and social care providers have access to the most up to date information and
reliable and proven experience in the field of palliative and end of life care we have
created the HEARD process within the organisation
Standard
To build on, develop and embed a model of practice development, research and
education throughout the organisation. This model will celebrate innovation and
disseminate learning locally, regionally, nationally and internationally in order to
improve palliative and end of life care for patients and families. The aim is to share
the model and promote excellence in palliative and end of life care for the benefit of
patients and families.
Measures
1. Staff will be able to evidence their participation in practice development activities
through their annual appraisal and personal development plans which link
strongly with the organisational strategy
2. The presence of staff teaching on a range of subjects related to palliative and
end of life care, giving presentations and displaying posters at conferences,
study days and on courses held locally, nationally and internationally.
3. The success of innovations in practice will be evaluated using criteria agreed
through a steering group made up of professionals from within the organisation,
service users and academics from local higher education establishments.
4. Innovations and practice development will be available for staff and the public to
view on the organisational website and celebrated at an annual practice
development day.
Future Planning: Priority 2
Patient Experience
Obtaining real time feedback from service users
Statement
Service users will be facilitated to provide feedback about their experience in a
structured way at the time they are receiving the service.
Measure
1. All patients in the inpatient unit , who are well enough to participate, will be
offered the opportunity to give feedback on their experience prior to discharge
2. Day service attendees will be offered the opportunity to give feedback during
the first month of their attendance and before discharge
3. In collaboration with the Service User Group a survey has been devised which
will be distributed to those who have used the Hospice Bereavement Service
4. Analysis of the feedback and action planning from all methods will include
service users
5. Feedback from Service Users will be monitored by the Quality and Standards
Committee and reported to the Clinical Governance committee
Future Planning: Priority 3
Patient Safety
Safe administration of medication by the Hospice at Home service
It has been identified that some patients referred to and cared for by the Hospice at
Home service are too unwell to manage their own medication and do not have a
family member or friend who can administer this for them and there is no provision
for this by statutory services.
Statement
Patients receiving care at home by the Hospice at Home service will be supported to
take their medication by trained and competent assistant nurses.
Measures
1. All Hospice at Home service assistant nurses will undergo a comprehensive
training and competency assessment before being able to assist people at
home with their medication.
2. Hospice at home assistant nurses will be assessed in practice, following
training before commencing this role.
3. Monitoring of safety of medication administration will take place by the
Hospice at Home Co-coordinators through audits of records, observing
practice and feedback from service users or their family members.
4. The audit findings will be reported to the Quality and Standards committee
who report to the Clinical Governance committee
Future Planning: Priority 4
Clinical Effectiveness/Patient Experience
Providing a 24/7 single point of access for patients at end of life
and with specialist palliative care needs
Patients and their families living in the community can experience problems in being
able to access the appropriate service to meet their needs and this can particularly
be a problem outside the normal working hours. They often have a number of
contact numbers to use and this can be confusing. If the need is urgent they can
experience a delayed response which can lead to fear and a use of emergency
services sometimes resulting in a hospital admission.
Standard
St Helena Hospice will provide a 24 hour service, 7 days a week for North East
Essex where patients, family members and health and social care professionals can
ring in and receive advice, information, support and if, appropriate, signposting on
any issues related to palliative and end of life care.
St Helena Hospice will also host the combined electronic register where patients who
are within the last year of their life will be registered so that all health care
professionals regardless of the service they provide will have access to up to date
information allowing them to make informed decisions about the care of the patient.
Measures
1. Feedback from patients/carers and professionals about the responsiveness of
the service
2. Feedback from patients, carers and professionals about the quality of
information and advice received
3. Audit of the quality of advice given
4. The patient and family receive the service in the place of their choosing.
5. Care is co-ordinated across agencies and professionals
Below is a diagrammatic representation of the anticipated effect that the
Single Point of Access will have and how this will benefit the patient, carer and
professional in the future.
Part 3
The following are a series of statements that all providers are required to include in
their Quality Account, however many of these statements are not directly applicable
to specialist palliative care providers.
3.1 During 2012 – 2013 St Helena Hospice provided the following NHS
commissioned services:
• Inpatient
• Day services
• Outpatients
• Hospice at Home
• Hospice Nurse Specialists
3.1.1 St Helena Hospice has reviewed all the data available to us on the quality of
care in these services.
3.1.2
The income generated by the NHS services reviewed in 2012 - 2013
represents 100% of the total income generated from the provision of the NHS
services by St Helena Hospice for 2012 - 2013
What this means
St Helena Hospice is funded through an NHS grant, and fundraising activity.
The income generated from the NHS represents approximately 35% of the
overall clinical operating costs of the Hospice; the remaining income is
generated through fundraising (i.e. events and retail), generous support from
our local community in donations and legacies, and investments.
Part 3.2.1 – 3.2.5
Participation in clinical audits, National Confidential Enquiries
During 2012 – 2013 there were no national clinical audits or national confidential
enquiries relevant to palliative, specialist palliative or end of life care covering the
NHS commissioned services that St Helena Hospice provides or that St Helena
Hospice was eligible to participate in.
A number of internal audits took place during 2012 – 2013 including environmental
cleanliness, infection control, information governance, the inpatient admission and
initial assessment process, recording of patient’s spirituality and Human Resources.
The reports of these audits were reviewed and action / improvement plans are
approved and overseen by the Quality and Standards Committee.
3.3
Research
There were no patients receiving NHS services provided by St Helena Hospice in
2012 - 2013 that were recruited during that period to participate in research approved
by a research ethics committee as none related to palliative care.
3.4
St Helena Hospice’s income in 2012 - 2013 was not conditional on achieving quality
improvement and innovation goals agreed between St Helena 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 because none were identified..
3.5; 3.6; 3.7
Compliance with the Essential Standards of Quality and Safety as
described in the Health and Social Care Act 2008 (regulated
Activities) regulations 2010 and the Care Quality Commission
(registration) Regulations 2009
St Helena Hospice is required to register with the Care Quality Commission. There
are no conditions on registration and The Care Quality Commission has not taken
enforcement action against St Helena Hospice during 2012 -2013.
St Helena Hospice is subject to periodic reviews by the Care Quality Commission
and the last review took place in October 2012. Two separate unannounced, routine
inspections were conducted; one of the Tendring Centre and one of the inpatient and
rehabilitation services at Colchester. The CQC’s assessment of St Helena Hospice
following both reviews was ‘St Helena Hospice was meeting all the essential
standards of quality and safety inspected’
St Helena Hospice has not participated in any special reviews or investigations by
the CQC during the reporting period.
3.8 Secondary Uses Service
St Helena Hospice did not submit records during 2012 – 2013 to the Secondary
Uses service for inclusion in the Hospital episodes Statistics which are included in
the latest published data.
3.9
Information Governance Toolkit attainment levels
St Helena Hospice undertook the annual Information Governance Assessment and
achieved compliance at Level 2 on all components of the toolkit for 2012 -2013. The
overall score for 2012 - 2013 was 67% which is described as satisfactory
3.10 Payment by results
St Helena Hospice was not subject to the Payment by Results clinical coding audit
during 2012 – 2013 by the Audit Commission.
New Quality Indicators
St Helena Hospice is required from 2012-13 onward to report a new set of quality
indicators in their Quality Accounts, where the necessary data is made available to
the organisation by the Health and Social Care Information Centre. There was no
data reported for St Helena Hospice under these indicators for the reporting period.
Patient Safety Incidents
During the period 2012 – 2013 St Helena Hospice reported 2 grade 3 pressure sores
as patient safety incidents to the PCT. One of these originated outside the
organisation and following investigation it was decided that the other could not have
been prevented. St Helena Hospice considers that this data is as described for the
following reasons: The Clinical Governance committee of St Helena Hospice and the
PCT oversees this reporting.
Quality Statement
St Helena Hospice continues to have a focus on quality and works closely with
service users in order to understand their needs and those of the wider community
who are living with life – limiting illness.
Information giving at the point of death
Feedback from families demonstrated that there was a need for better
communication at this time and an audit confirmed this. Extensive work has now
taken place to update information and to ensure that staff are inducted and trained in
how to ensure that information is consistent and correct. Service users were involved
and had input to and approved the written material that is now used.
Working with disadvantaged people
Staff training and education has taken place to raise awareness of the specific needs
of lesbian, gay, bi-sexual, and transgender people. People in these groups can be
disadvantaged by lack of recognition and prejudice. The education aims to ensure
that equality and diversity awareness is embedded in the daily practice of all staff.
Transition Service
A multi-disciplinary day service for people between the ages of 16 and 40 has been
developed and is being provided in collaboration with the J’s hospice. In addition the
service enables access to services close to home and access to age appropriate
services.
The service provides information, advice, advocacy, nursing care, social interaction,
art/music therapy, physiotherapy, complementary therapy, occupational therapy, and
psychological care. It helps young people to achieve their maximum potential in
terms of health, education, and development and supports them to live an active and
fulfilled life for as long as possible.
Work with Service Users
The following has been written by the chair of the Service User group:
"The service user group has acquired some new members and meets monthly or
more frequently if necessary. It continues to have a member on the Clinical
Governance Committee and to play an active role in the annual strategy review. The
group revised the patient questionnaire, distributed it, analysed the results and
presented the findings to the Clinical Governance Committee and the Trustees.
They were asked by the Bereavement Service Co-ordinator to devise a survey to
evaluate the current bereavement service and are about to pilot the draft
questionnaire with some willing bereaved people. Their views are frequently sought
as a 'sanity check' on new patient-focussed information.
Throughout the year the group have provided constructive feedback on various
hospice policies and procedures as they have come due for review and have thus
ensured that the interests of patients and carers are fully represented. The group
has also been able to use its member’s links with support groups and other user
involvement meetings to canvass opinion on various topics and to obtain
participation in relevant research projects.
The user group comprises patients and carers although there is a bias towards
bereaved carers. The group's philosophy is that an unfortunate and distressing
experience can be put to use in a positive way to help the future experience of
others.
Looking ahead, the group plans to have users embedded within the HEARD
(Hospice Education and Research and Development) group as an external
perspective can be invaluable in identifying innovative proactive. It also intends to
play a constructive role in the many developments and improvements in patient care
planned for the next few years."
A conference in the Education Centre
Work with Volunteers
St Helena has more than 1,000 volunteers working in all aspects of the organisation.
This underlines the part of the Hospice Philosophy that says ‘we are a community of
people’. Volunteers are all ages and from all walks of life and parts of North East
Essex and beyond.
Volunteers are an integral part of St Helena, are involved in giving feedback to the
organisation and in the on-going development of services.
Results from the 2012 volunteer survey show:
•
•
•
I enjoy the work I do – 100% agreed
I enjoy working with the people in this charity – 100% agreed
I am proud to work for this charity – 98% agreed
St Helena Hospice’s annual volunteer day
Review of the last year’s quality performance (2011-2012)
Clinical Effectiveness
The use of SystmOne to improve clinical communication:
The clinical patient database named SystmOne has been implemented
across all clinical areas and disciplines.
Sending discharge letters via SystmOne or via NHS secure mail has not yet
been achieved due to the complexity of introducing this new system. The
priority has been to ensure the accuracy and timely recording of patient
interventions and care. Currently the patient takes a copy of the discharge
letter home with them and the GP copy is sent via the GP courier service.
Prevention of Urethral catheter related infections
During the period 2012 – 2013 no catheter acquired urinary tract infections
were reported to the PCT.
Sharing relevant information with the district nurses, about those patients
being discharged into the community with a urinary catheter in situ is now
possible via SystmOne.
Patient Experience
Obtaining Service User feedback via three methods.
This has been achieved. Feedback has been received via the annual
patient survey; comment cards which are available in all patient areas and a
focus group has been held as well as a very large number of
commendations of which there are some extracts below. The annual patient
survey is distributed to all community and day patients and those in-patients
who are well enough to participate. The Service User Group has been very
committed and involved in the process including distributing and analysing
the annual patient survey.
Comments are also received via Facebook and Twitter.
Some comments from patients and families 2012 – 2013 are below:
“The moment I arrive at the day centre I leave my problems in a box at the
door. They are forgotten.”
‘Thank you for preserving her dignity with her long soaks in the bath, and
the styling of her hair. She always looked much brighter after each bath. Her
unstable condition reinforced to us she was in the right place at the right
time of her life, surrounded with caring compassionate people when her
family were not visiting.’
‘Thank you for your help and support in the final months of Mum’s life. The
family couldn’t have coped without all the help we received. Thank you so
much. We managed to keep mum at home as she had wanted and she
passed away peacefully and quietly with me at her side.’
‘This week I have received a form for attendance allowance, an OT visit and
a Day Centre appointment for Friday, so efficient. I feel really cared for and
cannot thank your organisation enough.’
Environmental sustainability
Energy savings are now being generated from the solar panels at the Colchester
site. Cost savings for 2012 – 2013 have been approximately £2,000 which has been
re-invested in patient care.
The staff survey for 2012 was conducted using an on-line survey which was different
to the previous year. The reason for the change was to enable comparison with both
other hospices and the charity sector as a whole, but the change meant there was
no question about whether staff see this as a ‘green’ organisation which was
commented on in the last account.
Gardening at the day centre, Colchester
Comment on this Quality Account from: North East Essex Clinical
Commissioning Group
Essex Health Watch
Statement from Healthwatch Essex for Quality Account report 2012-2013
We recognise that Quality Account reports are a useful tool in ensuring that NHS
healthcare providers are accountable to patients and the public about the quality of
service they provide. We fully support these reports as a means for providers to
review their services in an open and honest manner, acknowledging where services
are working well and where there is room for improvement.
We welcome the opportunity to provide a patient and public perspective on the
Quality Accounts. As a newly-established organisation (we took on statutory
responsibility on 1st April 2013), we are not in a position to comment retrospectively
on the findings of the past year. We will, however, cooperate fully in the future
production of these reports. We are an organisation which intends to provide
comment rooted in evidence – be it ‘soft’ intelligence or more extensive, quantitative
data. Following the Francis Report, we believe there is a significant challenge and
opportunity for the whole health and social care system to look at how evidence
relating to patient experience can be set on an equal footing with standard NHS data
about performance and quality.
We share the aspiration of making the NHS more patient-focussed and placing the
patient’s experience at the heart of health and social care. An essential part of this is
making sure the collective voice of the people of Essex is heard and given due
regard, particularly when decisions are being made about quality of care and
changes to service delivery and provision.
Our wish is therefore that Healthwatch Essex works with its partners in the health
and social care sector to engage patients and service users effectively and to ensure
that their views are listened to and acted upon.
We look forward to working together in the production of Quality Accounts in the
coming year and making sure that the voice and experience of patients and the
public form an integral part of these documents. At a time when the NHS is facing
great change and financial challenge, patient experience and quality of care are
more important than ever, and we welcome the opportunity to help shape the NHS of
the 21st century.
For any questions about this
St Helena Hospice Quality Account
2012 – 2013
Please contact the Chief Executive:
Mark Jarman-Howe
mjarmanhowe@sthelenahospice.org.uk
01206 845566
St Helena Hospice
Barncroft Close
Highwoods
Colchester
CO4 9JU