TRINITY HOSPICE
QUALITY ACCOUNT FOR 2012/13
Our vision is of a community in which all people have access to skilled, compassionate end of life
care at the time that is right for them and in the place of their choice.
Quality Account 2012/13
June 2013
Page 1
PART 1
CHIEF EXECUTIVE’S STATEMENT
Trinity Hospice aims to provide the best possible care for people at the end of life. Our
vision is of a community in which all people have access to skilled, compassionate end of life
care at the time that is right for them and in the place of their choice.
At Trinity we support people to live every moment. We focus everything we do on the care
of the patient and their family – directly through our care services and through our education
and support programmes with other care providers in our community.
Our care is centered on the unique physical, emotional and practical needs of the individual.
Our tailored care programmes respect personal and cultural wishes and aim to:
 Help people to regain the confidence they need to maintain independence for as long as
they want
 Give people real choices about their care and empower them to make their own
decisions for as long as they can
 Are flexible and responsive to what may be rapidly changing needs.
Our skilled and experienced staff understand that living with a life-threatening illness will
raise many questions and worries and we take time to listen to our patients, their families
and carers.
We are committed to finding ways to continuously improve the services we provide to
patients and their families and have a robust clinical and corporate governance framework
that supports these aspirations.
In this, our first Quality Account, we set out our priorities for quality improvement for 2013/14.
These priorities will be reviewed against our performance in our Quality Account for 2014/15.
I and Trinity’s team of senior managers have been closely involved in this review and in
developing these priorities which have been ratified by the Board of Trustees.
I am able to confirm that the information in this Quality Account is, to the best of my
knowledge, accurate.
ANNE HOOPER
CHIEF EXECUTIVE
“Trinity’s specialist nurses and other team members are priceless. The quality of care
is outstanding. The human warmth is inspiring. A visit to Trinity helps me – and many
other patients - to soldier on. I have made many new friends there, and they say the
same - Trinity makes our lives better.”
Quality Account 2012/13
June 2013
Page 2
PART 2
PRIORITIES FOR IMPROVEMENTS
We have identified six areas for improvement in the coming year under each of the domains
of quality set out in the Department of Health Report, High Quality Care for All, - patient
safety, clinical effectiveness and patient experience.
Patient safety
1.1 Test out Trinity’s major incident plan
What are we aiming to achieve? We will ensure that we have in place all the appropriate
components of an effective major incident plan, that staff are fully trained and aware of their
roles within the plan.
How will we know what we have achieved? We will carry out a table top exercise with
staff and will have identified any areas where our major incident plan needs to be modified.
1.2 Review our medicines management and safety priorities
What are we aiming to achieve? We will review our medicines management and safety
priorities to ensure they are relevant, appropriate and fit for purpose.
How will we know what we have achieved? We will have in place all relevant policies,
procedures, key reference documents and staff pocket guides.
2. Clinical effectiveness
2.1 Review of discharge procedures
What we are aiming to achieve? We will ensure that we have in place effective discharge
protocols to ensure the safe and timely discharge of patients and to support effective
communication channels with commissioners and other relevant professionals.
How will we know whether this has been achieved? We will undertake an audit of all
discharges to ascertain that we have met our criteria for safe and timely discharges.
2.2 Review of referral and admission process
What we are aiming to achieve? We will review our referral and admission protocols to
ensure that they provide for effective and, where required, rapid access to inpatient and
community services.
How will we know whether this has been achieved? We will undertake an audit of all
discharges to ascertain that we have met our criteria for effective access to our services.
Quality Account 2012/13
June 2013
Page 3
3. Patient experience
3.1 Evaluate our home visiting programme
What we are aiming to achieve? We will commission an evaluation of our volunteer home
visiting service to understand the value it adds to patients, families and carers.
How will we know whether this has been achieved? We will report on the evaluation
findings and use them to direct the continuing development of this service.
3.2 Implement VOICES
What we are aiming to achieve? We want to understand how the current support we
provide to families and carers meets their needs and whether there are unmet needs that we
could provide for.
How will we know whether this has been achieved? We will use the outcomes of the
surveys to identify how we can best target our support for families and carers.
We will review progress in relation to each of these six priority areas at Patient Services
Committee meetings twice a year and produce a final report for the Board meeting in March
2014.
Quality Account 2012/13
June 2013
Page 4
PART 3
REVIEW OF QUALITY OF SERVICES 2012/13
3.1 Service improvements
During 2012/13 we have continued to experience increased demand for all services.
Most of our care is provided to people in their own homes (including care and nursing
homes). During 2012/13 we expanded this team so it can provide more care and support to
more people in the future. Trinity’s team of specialist community nurses support people by
providing expert symptom control and supporting the co-ordination of services with the
person’s GP, district nursing team, hospital team and social services. The team provides
home visits 7 days a week as well as a 24/7 telephone support service. The team are highly
effective at ensuring people can die at home if that is their choice. Overall in London only
20% of people die at home – 73% of people being cared for by Trinity’s community nurses
die at home.
Our outpatient facilities have been expanded and upgraded during 2012/13 and offer a
range of flexible outpatient services aimed at helping people to improve their sense of
wellbeing and feel stronger and more confident so they can cope with the changes that may
be happening in their life. This might involve supporting people with things like managing
troubling symptoms such as pain, breathlessness, depression or fatigue, helping people
cope and come to terms emotionally with the changes in their life caused by their illness,
staying independent and mobile, relaxation and relief from stress and advice on life’s
practicalities.
Our award winning inpatient centre continues to provide excellent care and support to
patients and their families. During 2012/13 we have successfully rolled out a new electronic
patient record system within the centre which has the advantage of enabling patients to be
more involved in their care if they choose.
We have been successful in gaining additional funding to support our dementia project as
well as on-going funding for our work in care homes. We have introduced a new community
visiting programme which has trained volunteers providing support to patients and their
families and carers at home. Our bereavement team have introduced new bereavement
support groups (in addition to our one to one support) which enable us to provide more
support to more people. In the year Trinity has achieved full N3 compliance.
3.2 Review of services
During 2012/13 Trinity Hospice supported the commissioning priorities for Lambeth,
Wandsworth, Richmond & Twickenham, Hammersmith & Fulham, Kensington & Chelsea
and Westminster with regard to the provision of local specialist palliative and end of life care
services by providing:
 Inpatient care
 Care to patients in their own homes (including care homes, nursing homes, sheltered
accommodation, prisons and the street homeless)
 Outpatient services
Quality Account 2012/13
June 2013
Page 5


Bereavement services
Education to health and social care professionals
Patients have access to expert nursing, medical, social work, counselling, physiotherapy,
OT, pharmacy, creative and complementary therapies, welfare, practical and financial advice
services.
3.3 NHS contribution towards total cost of providing Trinity’s services
Statutory funding contributed £2.9million in 2012/13. This equates to approx. one third of
Trinity’s total cost of £9.5million. The remaining £6.6million is raised through local
fundraising, legacies and retail activities.
3.4 Quality reports for Commissioners
Trinity has a community contract with service specification and service activity targets.
Contractual compliance and quality assurance are reviewed quarterly by our Joint
Commissioning Group which comprises all our PCT commissioners. Reports contain the
following information:
Service activity – contracted v. actual
Clinical staffing levels
Incidents and alerts
User surveys
Ethnicity
Complaints
SUIs
CQUIN updated
Deaths by location
PPC/PPD - recording
PPC/PPD – achieved
Future service developments
Quality report contents
3.5 CQUINS agreed with commissioners for 2012/13
A proportion of the funding Trinity receives from its NHS commissioners is contingent on
achieving quality improvement and innovation goals. In 2012/13 the following CQUINS were
agreed with our Joint Commissioning Group:
 In depth inpatient survey
 Delivery of NHS Continuing Healthcare
Both CQUINS have been fully achieved and the results for each as at end March 2013 are as
follows:
 Inpatient survey – four surveys carried out during 2012/13 – for results see section 3.7
 Delivery of NHS Continuing Healthcare – continuing care protocols were audited and
reviewed quarterly by the Joint Commissioning Group and reviewed in the light of those
findings to ensure maximum effectiveness
3.6 CQC inspections
Trinity is registered with the Care Quality Commission and provides the following regulated
activities:
 Treatment of disease, disorder or injury
 Diagnostic and screening procedures
Trinity Hospice was last inspected by the CQC on 12th March 2013 and was found to be fully
compliant with all standards. The CQC has not taken enforcement action against Trinity
Hospice during 2012/13.
Quality Account 2012/13
June 2013
Page 6
3.7 Review of quality performance
Our audit programme reviews the effectiveness of our clinical care as does feedback from
patients under our “What you say matters” programme.
3.7.1 User surveys
During 2012/13, four inpatient surveys have been completed, one survey of our community
service and one survey of our bereavement service. The outcomes of the inpatient surveys in
2012/13 demonstrated very high satisfaction rates with key aspects of care:
Outcomes
2012/13
Not affected by pain
98%
Not at all/slightly/moderately
Not affected by other symptoms
94%
Not at all/slightly/moderately
Food and drink - received what you want at the right time
95%
Always/most of the time
Has the envrionment/facilitie smet your needs
99%
Always/most of the time
Have you been as involved as you want in your care
Always/most of the time
96%
Full information given to you
96%
Practical issues addressed
98%
All addressed/being addressed
Outcomes of inpatient surveys 2012/13
During 2012/13 we undertook annual surveys of our community patients and families which
also showed high levels of satisfaction they had with the services we provided to them.
Outcomes
2012/13
Was the referral made at the right time
Just right
91%
Too early
1%
Too late
8%
Did seeing a Trinty nurse help with the problems you had
Helped with all/most
97%
Quality Account 2012/13
June 2013
Page 7
Outcomes
2012/13
Did your Trinity nurse explain their role in your care
Yes
90%
Do you feel you were involved in planning your care
Always/most of the time
91%
During visits do you feel you are treated with respect and dignity
Always
94%
Do you have the opportunity to ask questions when you need to
Always/most of the time
96%
Outcomes of community survey 2012/13
Outcomes
2012
How satisfied were you with the telephone call you received from the bereavement service:
Very s a tis fi ed/s a tis fi ed
100%
Did you find the written information your received:
Very hel pful /hel pful
90%
Did you find your counsellor:
Very hel pful /hel pful
95%
Were there any difficulties in meeting your counsellor:
No
100%
Thinking about how often you saw your counsellor, was it:
About ri ght
80%
Not enough
20%
Do you think the number of sessions you had was:
About ri ght
89%
Outcomes of bereavement survey 2012
3.7.2 Clinical audit programme
As an independent sector hospice, Trinity does not participate in the national NHS clinical audit
programme that covers subjects that do not apply to hospices. However, we do have an
annual programme of audits which are selected according to internal and external (network
and/or commissioner related) priorities.
Quality Account 2012/13
June 2013
Page 8
In 2012/13 we carried out the following audits:
Subject matter
Implications for practice/outcomes of
audit
Follow up actions
Review of inpatient admissions
An audit was undertaken for the period AprJun12 and demonstrated that 71% of admissions
achieved the target. To further improve
accessibility we have set a target which includes
weekend admissions as standard.
This audit resulted in better information on the
24/7 OOH telephone service being sent to all
GPs
An audit conducted between Ap-Dec12
confirmed that 82% of community patients had a
discussion about their PPC/PPD
An audit conducted between Apr-Dec12
confirmed that 71% of community patients who
died in this period and who had expressed a
preference for their PPD achieved it.
An audit was conducted in Jan-Mar13 of Trinity
community patients who died in hospital during
this period and demonstrated that for 16 patients
(14% of total community patient deaths during
this period) hospital was not their PPD. Clinical
teams are considering the feasibility of direct
admission from the acute sector to Trinity’s
inpatient centre to reduce this number.
An audit was conducted between Apr-Dec12
demonstrated that no grade 3 or 4 pressure
sores were acquired during a patient stay.
100% of patients with a risk factor >10 had a
pressure sore risk reduction care plan
implemented
Monthly audits confirmed that every inpatient has
a falls risk assessment completed on admission
and that all required preventative measures were
in place and being appropriately used.
An audit in Jan-Mar13 identified that the
arrangements for patient discharge are robust
with evidence of careful consideration of patient
and family needs. Delays in discharge
arrangements were found to be mainly those
beyond our control i.e. patient deterioration
and/or family delays
An audit in Mar13 demonstrated that the new
electronic patient records provide accurate and
timely records. Staff are to be given further
training in recording new demographic
information when it becomes available and
improved recording of information to external
agencies post death.
A very high standard of cleaning was found in all
clinical areas
Continue to monitor
Out of hours calls
Preferred place of care/death –
community patients – recording of
PPC/PPD
Preferred place of death –
community patients – achieving
PPD
Deaths of community patients in the
acute sector
Pressure sores
Patient falls
Delayed discharges
Use of electronic patient records
Cleaning audits
Quality Account 2012/13
June 2013
Page 9
No further action
Continue to monitor
Continue to monitor
Continue to monitor
Continue to monitor
Continue to monitor
Continue to monitor
Continue to monitor
Continue to audit
3.7.3 Feedback from patients and carers
“That there is such a wonderful and dedicated centre where help of a most professional kind is
at hand is beyond comforting.”
“Your wonderful palliative care nurse worked closely with the nurse from CJD unit to enable my
husband to die peacefully in his own home as he wished. She also ensured his request for end
of life care were implemented and was a great support to me at this difficult time.”
“Help and support before and after husband's death was amazing. Counselling for our son
(aged 6) was vital and so appreciated. Thank you so much.”
“Humanity at its very best. Kindness and care when it is most required. You light up a life even
as the brightness dims.”
“Care given was superb. As a trained nurse I'm aware of professional attitudes and care and
found the staff of a very high standard - thank you.”
“Everybody was so kind and caring, from volunteers to doctors and nurses. They made the last
three weeks of my husband’s life so peaceful, we will forever be grateful. Thank you all.”
3.8 Clinical governance
We have a comprehensive system of reviewing patient safety issues including a high level
monthly synopsis of key data – see below. Electronic recording of all clinical incidents
provides real time reports with all red and amber classified incidents escalated to senior clinical
staff and the Chief Executive immediately on report. All senior managers and the executive
team receive the monthly synopsis and this is evidence of the way we track critical areas of
care. It also confirms that we have continuing low rates of complaints, significant clinical
incidents (including RIDDOR incidents), pressure sores and infections.
CLINICAL QUALITY SCORECARD
Apr12-Mar13
Apr12-Mar13
Red clinical incidents
0
No. hospice acquired pressure sores
RIDDOR incidents
0
- grade 3
0
Serious untoward incidents
0
- grade 4
0
Amber incidents
6
No. hospice acquired infections
0
Green incidents/near misses:
236
No. complaints
- slips/trips/falls
133
- upheld
- assault/abuse
5
- partly upheld
- manual handling
1
- unsubstantiated
- property loss/damage
1
- theft
1
Actions taken as a result:
- contact with heat/cold
1
- improved information regardung benefits claims process
- security
0
- improvements made to message taking for community team
- medicine related
86
- equipment failure
8
- clearer information on patient confidentialty
Quality Account 2012/13
June 2013
Page 10
12
3.9 Data quality
Trinity Hospice submits annual Minimum Data Set (MDS) returns. We maintain regular
quality checks on our data including our electronic records system. During 2012/13 we
achieved the Information Governance toolkit requirements required to utilise the NHS spine
and are a full partner in the use of Co-ordinate my Care.
3.10 Clinical coding error rate
Trinity Hospice was not subject to the Payment by Results clinical coding audit during
2012/13 by the Audit Commission.
3.11 Opportunities to give feedback on this quality account
We welcome feedback on this quality account. If you would like to do this please email
ahooper@trinityhospice.org.uk or write to:
Anne Hooper
Chief Executive
Trinity Hospice
30 Clapham Common North Side
London SW4 0RN
Quality Account 2012/13
June 2013
Page 11
Quality Account 2012/13
June 2013
Page 12