2012 - 2013
Quality Account
Reporting period: 1st April 2012 - 31st March 2013
Contents
Chief Executives Statement
Page 2
Section 1 – Improvement priorities 2013 - 2014
Page 3
Section 2 – Mandated Statements
Page 5
Section 3 – Quality Overview
Page 9
The Board of Trustees’ commitment to quality
Page 14
1
Chief Executive’s Statement
The staff and volunteers of Treetops Hospice are our greatest asset.
2012 - 13 has seen significant growth and improvements across the whole
organisation. This is reflected not only in the delivery of Clinical Services but
also in the departments that provide the funds and resources. Altogether, this
makes Treetops Hospice a successful and financially viable business.
This year the hospice had an unannounced inspection by the Care Quality
Commission where no shortfalls were identified. This is a tribute to the hard
work of each member of staff, and their dedication and passion for their roles.
It is the staff and volunteers who make Treetops Hospice a safe, secure and
happy place for all.
I am responsible for the preparation and contents of this report and to the best
of my knowledge, the information reported in this Quality Account is an
accurate and fair representation of the quality of Clinical Services provided by
Treetops Hospice.
“Where every day counts” reflects our ethos and commitment to all those who
are supported by Treetops Hospice with the best quality of care available
across all services.
George Cameron
Chief Executive
15th May 2013
“Your nurse, who was with my mother in her last hours on this earth, made the
journey for her and myself so very bearable. You have demonstrated not only
that every day counts but also every hour.”
Feedback from a carer
2
Section 1: Improvement Priorities 2013 - 2014
The Day Care unit had an unannounced inspection by the Care Quality
Commission (CQC) in November 2012. The inspection report is available on
the CQC website and confirms that the Hospice met all the assessed
standards, as described in the Guidance about compliance: Essential
standards of Quality and Safety.
In 2012 we produced a five year rolling strategy where we identified both
planned development of service provision and improvement priorities.
2013 - 2014 strategic priorities will incorporate new service developments and
improvements that have been identified following the successful application to
the Department of Health for a stand-alone Clinical Support Centre.
Priority 1
Hospice at Home
With the continued recommendation for facilitating choice of preferred place of
care for patients in their terminal stage of life, the growth in activity and
specialism of our Hospice at home service has been an identified priority
since April 2012.
During 2012 - 2013 we recruited an additional 6 Health Care Assistants to the
team and increased our activity by 30% on the previous year by providing in
excess of 6,000 more hours.
During 2013 - 2014 it is our intention that this growth will be sustained and
continued with the aim of supporting more patients and their families to have a
real choice of place of care and ultimately, death.
Identified targets
 To increase the number of hours of care provided from 29,000 hours
to 30,000 hours
 To increase the number of patients cared for from 650 to 700
Priority 2
Nursing team development programme
During 2012 we embarked on a learning agreement partnership with the
Royal College of Nursing. Investing in two of our Hospice at Home senior
nurses, we have co-supported their training to become RCN learning
representatives for the Hospice. Regular education/support meetings are now
facilitated by the learning representatives and nurses’ attendance has grown
significantly in the year.
Identified target
 To increase the number of sessions offered from 6 to 8 and introduce 3
more core competencies
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Priority 3
Review of the Day Care unit
Following the opening of our purpose built unit in 2010 there was a
substantive growth in patients’ attendances, which more than doubled our
previous weekly provision. During 2013 - 2014 we plan to undertake a full
review of the service.
Our model to date has been traditional in style with access to Art and
Complementary therapies and creative activities.
Our focus for the future will be to review the patient experience of Hospice
Day Care provision. We propose to widen the choice of activities outdoors,
both in the grounds and outside the hospice environment, and indoors,
offering more physical and intellectual stimulation.
It is intended to review the current Patient Day Care notes documentation in
order to eliminate duplication of information and significantly increase the
amount of measurable data for audit purposes.
Identified target
 To introduce 3 additional activities into the Day Care experience
Priority 4
A new Clinical Support Centre
The successful application to the Department of Health for funding a new
Clinical Support Centre, will allow Clinical Services to be developed in line
with the five year Strategy.
Three main areas of development have been identified:



A bespoke Bereavement Centre
Increased office space for Hospice at Home co-ordination hub.
Introduction and development of a Support and Information Service.
The new centre will be built in the hospice grounds and will reinstate the
Bereavement Service from its current off site location to within close proximity
of the rest of our clinical services. The stand-alone sensitively designed centre
will provide user-friendly access to support and care which it is hoped make
the visiting experience less intimidating. This will be particularly important with
regard to bereaved clients who may find it difficult to access areas that are
designated for End of Life patient care.
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Section 2 Mandated Statements
Statements of assurance from the board
Within a submitted Quality Account all providers must include the following
statements, despite some of them not being applicable to hospice services.
Review of services
During 1st April 2012 - 31st March 2013 Treetops Hospice provided the
following services:

Day Care

Hospice at Home

Bereavement Support
Clinical Services are governed by the Clinical sub-committee of the Board of
Trustees, who meet bi-monthly and receive service reports which enable them
to review the management and quality of care provided by all services. The
reports are then submitted to the whole Board of Trustees at their meetings.
Participation in clinical audits
During 2012 - 2013 Treetops Hospice did not participate in any local or
national clinical audit.
Our Bereavement Service was involved with Help the Hospices and the
Association of Bereavement Service Co-ordinators (ABSCo) in the
development of a national evaluation tool for work with bereaved adults. To
date ABSCo are still in the process of developing this tool.
The Childhood Bereavement Network similarly is in the process of developing
a national evaluation tool for Bereavement projects working with children and
young people. Treetops Families service has contributed to this process by
providing a focus group of young people to help design the evaluation form.
Research
During 2012 - 2013 the hospice was not involved in any research projects.
5
Quality improvement and Innovation goals agreed with our
Commissioners
CQUINN targets and indicator of quality for 2012 - 2013 were:
 Submission of Day Care patients’ bi-monthly evaluations (Guest voice)
 The collection and submission of 95% of our patients GP code of which
we achieved 100%
 The collection and submission of 80% of our Hospice at Home patients
“preferred place of care”
What others say about us
Care Quality Commission
Treetops Hospice is registered with and regulated by the Care Quality
Commission in accordance with the Health & Social Care Act 2008.
Our most recent inspection report dated 2012 is available on the CQC
website.
Service Evaluations
Day Care Service
Evaluation of our Day Care service is surveyed bi-monthly on a rolling
questionnaire programme that includes 8 domains:
 Before you got to Treetops Hospice Day Care
 Your journey to Treetops Hospice Day Care and your first day
 Relationships with staff and volunteers
 Dignity and Safety
 Your care
 Catering
 Transport
 Activities
The criteria for referral to our Day Care unit are that the patient has been
medically assessed as being in the last 12 months of life. Therefore, the
decisions to adopt a bi-monthly process is to ensure that we capture more
patients’ views and are able to be more pro-active in our response to
suggestions or concerns.
“All the staff and volunteers I have come into contact with have good
anticipation of needs. I enjoy being here.”
“I rate the service, help etc., far above my expectations and I’m sure the
others do also. Thank you all.”
“I feel very comfortable coming to Treetops and I know I shall be looked after.
It gives my husband a well-deserved break.”
Guests’ Voice (Day Care Patient questionnaire)
6
Hospice at Home service
1. Carer Evaluation
Each year we send out a service evaluation to the carers of (1 in 4)
patients who died in our care during the year.
Of the 60 carers who returned the evaluation last year:
 88% found the service extremely or greatly helpful
 90% said that the amount of care provided was sufficient
 95% were totally at ease or comfortable about the way we cared
for their loved ones
 85% felt that the service had completely or greatly enabled them
to care for their loved ones at home
2. Referring professionals’ evaluation
Each year we send out a service evaluation to referring health
professionals.
Of the 24 health professionals who returned the evaluation last year:
 92% said that that the Treetops Hospice at Home nurse coordinators are very helpful
 92% said the patient and carer were satisfied with our care
 83.5% reported that our service helped to prevent or delay
hospital admission.
“The nurses that came to look after my husband were very professional but I
felt like a friend was coming into our home. I cannot praise them enough and
would recommend your service to anyone.”
“I was very pleased to have such caring people in my home - at first it seemed
strange to leave my husband with someone he didn’t know but we were soon
reassured as he was treated with such respect and kindness. Thank you all.”
“Your nurses do a very responsible job and we felt very supported by their
expertise and by them as people. We could not have fulfilled our relative’s
wish to stay in the home in which she was born 94 years ago without their
help.”
Carer evaluations
7
Adult Bereavement Service
All clients who finish receiving support during the year are asked to complete
an evaluation of their experience.
Of the 25 clients who returned the evaluation last year::
 84% said that the support they received made the experience of
bereavement more bearable
 96% said they were satisfied with the service
 96% said they would recommend the service to others
“It’s hard to explain how much the support meant to me and has given me the
strength to cope with all the other stuff that life throws at me. I know that I am
in a far better place than I was.”
“It got me through a difficult period when I felt almost as if I was on another
planet.”
Adult Bereavement Clients
Families Bereavement Service
Feedback forms are sent out to service users and their parents/carers who
have finished receiving support during the year.
Of the 14 children who returned the evaluation last year:
 100% of the Children/Young people were unhappy before any
therapeutic sessions were given
 100% said that they were feeling happier after the sessions ended
 100% of Children/Young people said they would tell a friend about the
support we can offer if they felt needed help.
“I liked the support, it was probably the best thing that I did and helped to
make my feelings more understandable and clear.”
“It helped because of talking about my mum”
Young bereaved people
Of the 10 carers who returned the evaluation last year:
 90% of Parents/Carers felt that the needs of their child in relation to
their bereavement were addressed
 100% said they would make use of the service again should the need
arise with their child
“It has made a huge difference in making me feel Y is able to talk about his
bereavement. I have found being able to talk to him, a big help with my own
feelings too”
Carer of young bereaved person
8
Section 3 Quality Overview
Treetops Hospice submits a National Minimum Dataset (MDS) to the National
Council for Palliative Care. A summary of the MDS is included in the Annual
Report which is submitted to the commissioning PCTs.
Comparison with National Minimum Data Sets
The most recent available National Minimum Data set covers the period 1 st
April 2011 – 31st March 2012. Treetops Hospice data for 2012 – 2013 have
been collated but there are no comparative data available at this time.
Day Care Unit MDS data
2012-2013
Treetops Hospice
No comparative
data are available
2011-2012
Treetops
Hospice
National Median
Data have been compared to 47
large units
% Places used
% New patients with a noncancer diagnosis
92
100
58
39
31
15
% New patients aged over 84
22
13
11
For the past 8 years the Day Care Unit occupancy rate has averaged 93%
compared to 61% nationally. This has been achieved by overbooking each
day from 10-15% depending on the clinical needs of the particular group.
Our commitment to providing End of Life care to all patients irrespective of
diagnosis is reflected in the percentage of new patients with diagnoses other
than cancer.
We are noticing a significant rise in the number of patients aged 85 and above
reflecting the National Council finding that “the 'oldest' old are having more
contact with specialist palliative care."
Hospice at Home MDS data
2012-2013
Treetops Hospice
No comparative
data are available
2011-2012
Treetops Hospice
National Median
Data have been compared to 16 large
units
% New patients with a noncancer diagnosis
27
18
16
% New patients aged 65-84
57
61
58
% New patients aged over 84
27
24
20
% Home deaths
82
81
68
9
We continue to be committed to supporting people at the End of Life
regardless of diagnosis and our figures reflect the National Council for
Palliative care finding that “More people with conditions other than cancer are
accessing specialist palliative care services.”
While the percentage of our patients aged 65-84 remains stable and in line
with the national average, the percentage of those over 84 years has risen
steadily over the years demonstrating the increased need for care in an
ageing population. (This year we cared for 5 patients aged over 100 including
the then oldest man in Britain who died aged 110).
The percentage of our Hospice at Home patients who die at home has
remained at around 80% for the last 5 years. In addition to this, 82% of
patients who had a recorded preferred place of care/death achieved their
choice.
Bereavement Service MDS data
2012-2013
Treetops Hospice
No comparative
data are available
% New service users under
16 years
% New service users 16-24
years
% of deceased with noncancer diagnosis
% of non-cancer deaths in
new service users under 18
years
% of deaths related to suicide
in new service users under
18 years
2011-2012
Treetops Hospice
National Median
Data have been compared to 40 large
units
24
24
N/A
6
7
2
50
42
11
71
72
N/A
25
18
N/A
Our Bereavement Service is very unusual in Hospice terms as we accept
referrals from anyone in the community regardless of any association with
Treetops Hospice. We also provide Bereavement support to children and
young people under 18 years old.
The impact of this is that our Bereavement Service supports a much larger
than average percentage of clients dealing with non-cancer related deaths
including unexpected deaths. This is especially significant in our Families
Service where 25% of new service users presented with issues related to
parental suicide.
10
What our staff says about the organisation
For the past three years Treetops Hospice has surveyed their staff by
investing in the Help the Hospices Birdsong Hospice staff survey.
In 2012 the results of the survey as measured against other hospices was
very encouraging with our satisfaction rates predominantly higher than others.
As measured against the previous two years, the results in certain areas of
the domain “The organisation and communication”, showed a marked decline
in staff confidence.
Treetops staff % response to communication statements
2010
2011
2012
100
81
80
69
61
63
62
62
60
42
40
38
42
20
0
I feel well informed about Communication between Senior management are
what is happening within
different
well informed about what
the charity
teams/departments is other staff think and do
efffective
It has been acknowledged that the decline could be a result of the rapid
growth of the organisation, where three major departments are now located
off-site, and the number of retail outlets has reached 14.
However, the Senior Management Team with support of the Board of
Trustees, have taken this issue very seriously and have instigated measures
to improve communication across the organisation which include:




Improvement of the internal website, ensuring that information is upto-date and relevant.
All remote and retail premises now having internet access, including
the internal website and Treetops email accounts.
Enhancement and promotion of our internal staff and volunteer
newsletter encouraging recipient participation.
Organisation of the first Treetops Hospice staff conference in May
2013

We currently employ 114 staff with only 7 leaving during the year giving a staff
turnover of 6%.
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The Board of Trustees’ commitment to quality
The Board of Trustees is fully committed to the quality agenda.
The Clinical Sub-Committee, that represents the clinical arm of our
governance structure, is made up of 6 members of the board. Members are
either current or retired health or social care professionals and/or have an
interest in the delivery of end of life care. They contribute to ensure that the
hospice provides a high quality service in accordance with its Vision, Mission
and Values.
Vision
That everyone living within the communities we serve has access to end of life
care of the highest quality.
Mission
To make every day count through giving the highest quality support for
patients and carers living with life limiting illness or affected by death and
dying by:

Ensuring we have the skills and experience to deliver and promote
excellence in end of life care provision.

Working in partnership with other local end of life service providers to
ensure the best possible patient experience is achieved.

Developing services to reflect the changing needs of the diverse
community we serve.
Values
Respecting the unique worth of every person
We believe that every person is different but equal and that everyone’s unique
needs and contribution should be recognised and supported.
Exercising responsible stewardship
The commitment of our staff and volunteers to making the best use of all our
resources enables us to deliver high quality care today and in the future.
Working with hope
Our hope is to enable patients and carers supported by the Hospice to live
well and die well.
Sustaining a culture of trust, warmth and safety
Everyone who comes into contact with Treetops Hospice is treated with care
and respect.
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The Board is confident that the treatment and care provided by Treetops
Hospice is of high quality and is cost effective.
As part of their commitment to the organisation all our trustees recently took
part in the Board Development training programme facilitated by Cass
Business School, through funding received from Help the Hospices with the
aim of being more effective in both the quality and governance of the
organisation.
In addition, a biography of each trustee is available to staff via the internal
website. All new trustees complete an induction programme, which includes
meeting staff from each department to give them a more detailed
understanding of all aspects of Treetops Hospice’s work.
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Southern Derbyshire
Clinical Commissioning Group
Quality Account 2012/13
Treetops Hospice
STATEMENT
GENERAL COMMENTS
NHS Southern Derbyshire Clinical Commissioning Group (the CCG) is the coordinating commissioner for the NHS contract held with Treetops Hospice. In this
role the CCG is responsible for ensuring pre-publication clearance of the Quality
Account produced by the Charity for 2012/13.
The production of a Quality Account is not currently a mandatory requirement for
independent sector providers of NHS funded care but it is considered good
practice.
COMMENTARY
The Quality Account submitted by Treetops Hospice has been reviewed by the
CCG and is pleased to confirm that it agrees with all the contract related data that
is stated in the Quality Account.
This is the first Quality Account that has been produced by Treetops Hospice and
whilst it gives a good overview of the year 2012/13; it does not fully reflect the
tremendous amount of work that has been undertaken within the organisation.
They are to be congratulated on their successful application to the Department of
Health for the stand-alone Clinical Support Centre. This will allow them to achieve
the strategic developments outlined within this report to benefit access to
supportive services and improve the patient experience.
Treetops Hospice have taken an active role in the End of Life Implementation
Group to set out a vision, for the development of end of life services for the
people of Southern Derbyshire and Erewash by working strategically with partner
organisations
14