QUALITY
ACCOUNTS
2014 - 2015
Bolton Hospice Quality Accounts
2014-2015
JE/dw/June 2014
1
Chief Executive’s Statement
Welcome to our quality account report which is written to provide a focus
solely on the quality of the care we provide to our patients and their families
and in light of the national drive to recognise the significance and importance
of quality, compassionate care.
The reporting period is 2014-15, providing a snap shot of now 2014 and the action planned for
continuous improvement going forward into 2015.
Bolton Hospice is an independent charity (registered no 518704) and constituted as a company limited by
guarantee (registered no 0211495). The Hospice is governed by a Board of Trustees and run by the Chief
Executive and the Senior Management Group (Palliative Care Consultant, Clinical Nurse Manager, Finance
& Corporate Services Manager and Income Generation & Communications Manager).
We provide the following services:
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16-18 Inpatient beds
Medical
Outpatient Clinics
Direct Clinical
Day Support Services
Nursing
24 Hour Advice Line
Care
Hospice at Home
Lymphoedema Clinic
Physiotherapy
Occupational Therapy
Complementary Therapy
Social Work Services
Bereavement Support
Education and Training
Hair and Image Services
Chaplaincy and Reflection
Creative Therapy
Cancer Information and Support Service
All of our services are provided free of charge to patients and their families, we income generate 80% of
our £3.75 million total annual running costs through charitable donations, our lottery and retail
operation. We receive a 28% contribution towards our direct clinical care costs from the NHS via Bolton
Clinical Commissioning Group (CCG). The charity, through its Trustees, are accountable to the Charity
Commission, Companies House and its membership, who are drawn from the local community.
We are registered with and inspected by the Care Quality Commission; the CQC are our regulators who
obtain information about our services from a number of sources and use these to build a picture of the
quality of the care we provide. The CQC inspect our services annually and report on the outcome quotes
from which are referenced in the body of this report.
The Trustees, the Senior Management Group, our staff and volunteers are totally committed to the
delivery of compassionate, quality care to our patients, their family and friends and we commend this
report to you as evidence of just how integral to our culture as a Hospice, quality and compassion is and
how it is embedded throughout our purpose, values, strategic aims and objectives.
Bolton Hospice Quality Accounts
2014-2015
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Our core purpose is to support people to live well until they die, by focussing everything we do on
the care of the patient and their family in a warm, caring, inclusive and compassionate way.
Our Values are based on:
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Being inclusive and non-judgemental
Being open, transparent, accountable and objective
Giving support to the whole family
Constantly striving for excellence and continual improvement
Being committed to embracing, valuing and respecting diversity
Respecting, supporting and celebrating our volunteers
Trust, respect, honesty and integrity in all we do
A compassionate, appropriate and proportionate response to meeting need
Appreciating the value of every £1 donated to our cause and using it wisely
Strategic Aims:
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To provide the best possible palliative and end of life care for the people of Bolton and their families
To enable people to live well through the course of their illness
To help families cope with the impact of end of life
To support the people of Bolton in achieving the principles of a good death for all, wherever possible
To work with Bolton CCG, Bolton NHS FT and Bolton Council to help deliver their palliative and end of
life care strategic objectives too
Strategic Objectives:
1. For Bolton Hospice to continue to be the number one provider of specialist palliative and end of life
care for the people of Bolton
2. For Bolton Hospice to remain financially viable and able to invest in meeting the future palliative and
end of life care needs of the people of Bolton
3. To have a safe, well built, fit for purpose, welcoming environment where operational need, patient
safety and comfort is balanced with therapeutic design and the needs of family and loved ones.
4. To be the hub of specialist knowledge, training, education and community awareness around
palliative and end of life care.
5. For Bolton Hospice to remain true to its core principles, values and charitable purpose
6. To ensure Bolton Hospice can deliver its mission and core purpose by being well led, well run, cost
effective, financially sustainable, inclusive, excellent, well known, valued and respected
Leigh Vallance
Chief Executive
Bolton Hospice Quality Accounts
2014-2015
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WHAT OUR ORGANISATION IS DOING WELL
Patient Safety
We strive to treat people in a safe environment and protect them from avoidable harm
(NHS Outcome Framework Domain 5 Department of Health 2014).
o
In August 2013 we had an unannounced Care Quality Commission Inspection and were fully
compliant in all Outcomes assessed.
http://www.cqc.org.uk/directory/1-106965965?referer=widget1
Patients’ comments made during the inspection:
“I can’t praise them enough - if I want it I can have it“
”They try and keep my spirits up, if I am down they come and hold my hand”
“They regulated my pain and I feel much better”
The Inspector saw evidence of staff awareness of safeguarding procedures and all
complaints/concerns were taken seriously and followed up appropriately.
o
We now submit monthly data for the NHS Safety Thermometer in line with other service
providers within the NHS.
o
Our bed occupancy has reduced this year due to the refurbishment and upgrade of our
Inpatient (IPU) facilities. In addition to the 3898 IPU occupied bed days there has been 565
Outpatients Consultations and 1566 Day Therapy Patient attendances. Of these patients, 44
experienced a fall which resulted in No Harm and 14 had a fall resulting in Low Harm and 1
experienced a fall of Moderate Harm. This is a reduction from last year’s figures which is
contributed to by reduced bed occupancy, falls prevention awareness and purchase of
increased sensory equipment.
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o
We complied with the EU Safer Sharps Directive (May 2013).
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Bolton Hospice deals promptly with all incidents and fosters an open culture whereby risk
management and incident reporting are encouraged. This year we have adopted a generic
incident proforma, which promotes reflection and learning for individuals, teams and the
organisation.
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Development of a patient information booklet for pain relief and opioids now adopted within
the Foundation Trust.
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We have undertaken an NHS Medicine Security Self-Assessment and all controlled drug errors
and drug destruction are now reported within 48 hours via NHS England 2013 Controlled Drug
Reporting mechanism.
o
A full review of the clinical skill mix has been undertaken in light of increased bed capacity to
ensure we do not compromise patient safety and the quality of the service we provide.
o
The multi-professional Nutritional Group ensures all aspects of our patients and their families’
hydration and nutritional needs are met. PLACE patient assessors scored this highly on choice,
taste, temperature, consistency and availability.
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In March 2014, we undertook our first PLACE (Patient Led Assessment of the Clinical
Environment), which we passed with some positive feedback from our Patient Assessors and
External Validator.
Extract from the summary report completed by Patient Assessors at Bolton Hospice
PLACE Inspection - 27th March 2014.
The assessors report said of Bolton Hospice: "Considering there is extensive building works on site, the
cleaning was excellent/immaculate and no dust could be found. Nursing and other staff including the
environment and food was exceptional to the extent that we would be happy to spend our final days
here - Well done!"
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OTHER PATIENTS’ SAFETY DATA
Total Number of Drug Errors: An increase of 2 errors
(this figure is broken down as below):
31
Near Misses
Prescribing Error
Omissions
Administration
Dispensing Error
Stock Delivery
Documentation
Number of controlled drug errors reportable to NHS England 2013-2014
This is a decrease of 5 compared to last year
Number of pressure ulcer occurrences: (a reduction of 48% attributed to reduced
beds, education and training and safety thermometer)
Grade 1
Grade 2
Grade 3
5
5
5
7
3
3
3
16
3
13
0
Number of formal complaints
Number of informal complaints
0
2
Number of patients infected with MRSA whilst on the Inpatient Unit
0
Number of patients with C.Difficile whilst on the Inpatient Unit
2
Inpatient’s assessment for VTE
2
100%
Sharps Injuries
2
Clinical Effectiveness
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The appointment of a Hospice Speciality Doctor now strengthens the medical team.
We have phased out the use of the Liverpool Care Pathway and been involved in development
of network wide End of Life Care documentation.
We have provided 24 Hour Telephone Advice to 254 Professionals and 226 Patients and Carers
which demonstrates an increased usage.
We have improved clinical recording of nutritional and hydration needs of all patients.
Multi-disciplinary team meetings are held weekly with appropriately trained staff in line with
peer review.
We have worked in collaboration with Bolton CCG and Macmillan in the development of the
Bolton Cancer Information and Support Services.
We have increased our nurses with lymphoedema training to support Hospice patients.
Key worker and concerns thermometer embedded within Day Therapy and Outpatients.
We continue to work in partnership with District Nurses and Hospice at Home received 154
referrals compared with 107 in the previous year allowing 99% of patients to die at home.
Extracts from Hospice at Home relatives’ survey of the care their family members and
themselves received at the end of their life:
“The care, compassion and friendship that the team provided Dad and his family and the dignity you
allowed him will remain with us always”.
“In this painful experience, we could not have asked for more, thank you all”.
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Audit and Quality
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We have undertaken 36 audits which is a 33% increase on 2013-2014 and 21 surveys using both
internal and external audit tools.
Examples of changes to practice are evident with improved waste segregation, revised cleaning
schedules, external company sourced to undertake legionella checks, creation of soft food menu
options, the implementation of meet and greet system on the Inpatient Unit, improved carers
support and improved system to monitor our response to a request for admission.
We take part in the Specialist Palliative Care North West Audit Group, which allows us to
benchmark our practices with other local Hospices against national guidance.
We have participated in research into the Practical Needs of Carers with Lancaster University and
this has resulted in the production of a practical guide for Carers.
Bolton Hospice submitted Audit Data to the National Minimum Data Set for Specialist Palliative
Care. Results are available publicly, from the National Council for Palliative Care:
http://www.ncpc.org.uk/sites/default/files/MDS%20Report%202013_1.pdf
Education and Training
o We have invested in our
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Education Department and are now a key provider of End of Life
Training within Bolton.
Our Clinical Learning Profile demonstrates the specialist skills within the Bolton Hospice
workforce.
We achieved 100% compliance with mandatory and competency based training in 2013-2014,
which is an excellent achievement.
All clinical staff will have completed a full day training package on all aspects of living, dying and
caring for someone with Dementia by summer 2014.
We have undertaken the delivery of our first Bolton University End of Life Care Module at Level
6 with excellent student evaluation.
Death, dying and bereavement touches all our lives and we have facilitated training for those
working in Health and Social Care, Schools, Universities and Chaplaincy, which also raises the
awareness within our Community as part of the Dying Matters Campaign
http://dyingmatters.org/
Extracts from attendees’ evaluation forms:
“Before I came, I did not have any experience of ‘End of Life’ care or how to deal with it in my working
life – this course has been a revelation”.
“This session has added to my toolbox of skills for both professional and personal life”.
“Be brave discussing death, don’t be ambiguous”.
“A brilliant session, really informative and focused on what is really important about Hospice
services”.
http://www.boltonhospice.org.uk/training
Bolton Hospice Quality Accounts
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Patients’ and Families’ Experience
Bolton Hospice strives to ensure that people have a positive experience of our care
(NHS Outcome Framework Domain 4 Department of Health 2014)
All our services have undertaken an annual satisfaction survey this year, which has
generated learning for teams, services and the organisation. These are some of our
results:100% of Inpatients stated that they had confidence in the staff caring for them; however, response
to nurse call was not as effective during handover. Adequate staff now remain on the ward during
handover.
100% of Day Therapy patients stated, dignity, privacy and compassion were always shown; however,
some patients were left guessing if a patient had been discharged or died and this is now included in
daily handovers.
100% of Hospice at Home patients’ relatives were very satisfied with the care their loved one
received; however for one daughter she felt different agencies should have a joined up approach and
more advice was needed about what to do next when her father died. We are continually striving to
ensure care is seamless.
100% of bereaved relatives known to Bolton Hospice knew about our bereavement service, 97% of
these felt the bereavement pack was very useful and 33% of these accessed our bereavement
services.
100% of patients and carers surveyed felt complementary therapies helped them cope with the
symptoms associated with their illness or carer’s role.
96% of inpatients’ relatives who were surveyed following the death of a loved one felt that
symptoms were well controlled at the end of life. However, some families felt noise levels from
other patients and ward kitchen areas could be disturbing. Within the refurbishment, separate
kitchen areas will be made available for volunteers.
We surveyed patients’ and families’ experiences of the care they received at Bolton
Hospice. These are some of their responses:
“Only to say that I will be forever grateful for the care, kindness, gentleness and compassion and
professional way you treated my dear husband and myself”.
“The Hospice took unbelievable care of me, there were times when I wanted to give up but a natter
with the staff made me think differently”.
“In this painful experience I could not have asked for more”.
Bolton Hospice Quality Accounts
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We take all comments and feedback seriously and record any concern raised about care as a clinical
incident. We received 2 informal complaints about care during 2013-2014, a daughter who
expressed concerns that a nurse’s attitude was abrupt and a son who believed information about his
deceased father should not be shared with other family members. Both incidents were dealt with
promptly and sensitively and individual and team reflection took place.
When we asked about ‘one thing large or small which would make a difference for you and
your family’, they replied:“As a carer, I did not always feel like my psychological needs were addressed”.
“Regular sessions with other patients would be helpful to discuss problems and symptoms”.
“Only a tiny thing but there was one volunteer who didn’t knock before entering our room – it’s a
courtesy/manners thing that I’ve got”.
Bolton Hospice Quality Accounts
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WHERE IMPROVEMENTS IN SERVICE
QUALITY ARE REQUIRED
Bolton Hospice is a key service provider for Specialist Palliative and End of Life Care within Bolton.
We are accountable to our Commissioners and those who raise funds for us for the quality of the
care we deliver. We cannot and should not stand still in our quest for continuous service
improvements and it is only with this collaboration and shared vision of all those involved in End of
Life Care that we can truly influence the experiences of those living with and dying from life limiting
illnesses.
Patient Safety
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To develop and implement an electronic incident reporting and risk management register
To continue to embrace the NHS Safety Thermometer
Improved sensory equipment for patients’ rooms
Ensure our environment complies with dementia friendly requirements
Develop and deliver a Management of Medicines training package for the clinical team
Utilise our trained volunteers to provide observational support to patients with dementia
Ensure the usage of the PRONE monitoring tool for vulnerable patients
Clinical Effectiveness
o Review all patient literature and circulate widely
o Engage with other stakeholders in End of Life Care
o Start to utilise ELQuA, EPaCCS and ELCA and evidence our practices
o Utilise the provision of grant application to fund our education programmes
o Become the Hub for the delivery of Palliative Care education across health and social care
o To improve clinical data collection and information technology systems
o To work closely with the Bolton CCG to develop the End of Life Care Strategy for Bolton
o Be instrumental in the development of individualised care planning for End of Life
o Improve the supportive networks available to staff and volunteers
Patients’ and Families’ Experiences
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Provide comfortable facilities for families, friends and children visiting our patients
Increase the support and education available to carers
Explore the concept of survivorship and how we contribute to this through supportive services
Generate real time feedback from patients and families instead of annual satisfaction surveys
Improve our entrance area to promote the dignity of patients on admission
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OUR PRIORITIES FOR
2014-2015
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Our reputation for quality care is essential to our existence and how we demonstrate this comes
in a variety of ways. Our quest to meet statutory requirements allows us to benchmark ourselves
against other providers. However, much of our reputation is built on trust, individuals’
experiences, word of mouth and a willingness from the people of Bolton to support and value the
work of the Hospice in providing Specialist and End of Life Care for patients and families.
o
We need to prepare, commission, fund and open our new patient facilities, which includes 11 ensuite rooms, new Pharmacy, family accommodation, Cold Room facilities and a new Multi-Faith
Centre, ensuring that all staff and volunteers are trained in all aspects of patient safety and
security.
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The development of an Integrated Communication Strategy across all Hospice services will allow
us to work in a more uniform way.
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We will remain cost effective whilst demonstrating service improvements and continued quality
for all.
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We will move towards increased use of Information Technology that streamlines patient
information whilst generating meaningful data.
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We will work on addressing any issues raised through our staff satisfaction surveys and Trustees
visits and maximise staff consultation.
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We will monitor our achievements in respect of the following priorities on pages 12 and 13 by
internal and external reporting mechanisms which include Bolton Hospice Quality and Standards
Group, Clinical Governance, Audit and Quality, Bolton CCG, Care Quality Commission, Cancer
Network and ultimately through Bolton Hospice Board of Trustees.
QUOTE FROM A PATIENT
“Thank you for your sensitivity during what was a very difficult time. The Hospice is a lovely peaceful
environment, but it is you staff and volunteers who make it such a special place”
Bolton Hospice Quality Accounts
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Patient Safety
Priorities
Monitored By
We will strive to minimise all patient harms
NHS Safety Thermometer/Clinical
Governance Group
To continue to meet Care Quality Commission
Outcomes for Quality and Safety
CQC/Quality & Standards
Ensure we are open and transparent and make all
relevant
reports available
to the public
www.boltonhospice.org
CQC/Communication Strategy Group/
Quality & Standards
Open new patient facilities ensuring patient safety is
paramount
Patient Feedback/Clinical Governance
Develop a Workforce Strategy for the next 5 years
Board of Trustees/Quality & Standards
Source Leadership & Management Training for key
staff
Education Strategy Group/Board of
Trustees
Clinical Effectiveness
Priorities
Monitored By
Work collaboratively with our partners to help
prevent unnecessary deaths in hospital.
Bolton CCG /Bolton Hospice Audit Group/
Bolton Palliative Care Strategy Group/NHS
Transforming EoLC in acute hospitals
programme
Provide robust data for Bolton Clinical Commissioning
Group
Bolton CCG/Informatics Group/Palliative
Care Funding Review
Implement End of Life Care individualised care
planning and provide internal and external training
Bolton Palliative and End of Life Care
Strategy/Cancer Network/Education
Strategy Group
All employees of Bolton Hospice will undertake
Equality and Diversity Training 2014-2015
Education Strategy Group/Internal training
records
Collaboratively, Bolton Hospice, Bolton CCG,
Macmillan and the Project Lead will progress with
setting up the Cancer Information Support Service
across Bolton by May 2015
Bolton Hospice/CCG/Macmillan
Bolton Hospice Quality Accounts
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Patients’ and Families’ Experiences
Priorities
Undertake a listening event for patients and families
Monitored By
Senior Management Group
Promote the refurbishment of Hospice services to Income Strategy Group
stakeholders, professionals and the general public
Hold 2 training days for carers of patients with Dementia Education Strategy
delivering the “Forgotten Conversations Programme”
Capture patient and family feedback in a timely and Audit & Quality Group/Clinical
continuous manner
Governance/ Quality & Standards
Group
Embed the 6 Cs principles within everyday practices:–
Care – Compassion – Competence – Communication –
Courage - Commitment
Education Strategy/ Quality &
Standards
To work with families to ensure their pre and post Bereavement Support Strategy/
bereavement needs are acknowledged and addressed
Clinical Governance
Extracts from letters and cards received 2013-2014
“Your kindness was much appreciated and please note that I don't want to be an inpatient anywhere
else!”
“She died a happy lady.”
“During the last weeks of his life it was a very upsetting and stressful time for us all but it was made
easier with your support and kindness. I wish you could have known him in the good times”.
“Nothing was too much trouble. Everyone who entered her room acknowledged her, which meant so
much to us all”.
“Until recently, I had been blissfully unaware of the importance of the role of a Hospice. The simple
things that you, as a Hospice do cannot be ‘ticked off’ on any government checklist. The initial
welcome and smile of the Receptionist to the human, non-jargonal conversations that we have with
nurses and doctors, the cleanliness of the building and the willingness to care for her, do everything
to make this exceptionally difficult time as manageable as it possibly can be. Never underestimate
the super powers that you have”.
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Chairman’s Statement
The Quality Accounts for Bolton Hospice 2014/2015 once again show to
all those people we serve; our patients, their families and carers that
quality and effectiveness is at the heart of all we strive to do here at
Bolton Hospice.
We are committed on a daily basis to ensure that we deliver, at all times,
the highest possible standard of palliative care to all those people who
access our services from the Inpatient Unit to our Hospice at Home
service.
This commitment encompasses Corporate and Clinical Governance in all we do.
In Corporate Governance, the board seeks to ensure that we have systems and processes in
place to maintain our growth as a viable organisation, ensuring that we at least, maintain our
income and wherever possible develop further, our income generation to a greater level as
without these funds we could not continue to deliver the level of care needed to ensure our
quality service.
The addition of four more beds on the Inpatient unit and the creation of en-suite facilities once
again add to the quality of service we can provide but also places upon us the need for creative
and effective management of our resources to ensure those facilities can be fully utilised for the
people of Bolton when needed.
Clinical Governance is critical to the smooth running of all our services to ensure that we deliver
to the highest possible standard at all times and whilst clinical targets are an important element,
once again, it is the human service which is such an integral part of our mission, particularly in
ensuring that patients are treated with respect, compassion and dignity at all times.
The Quality Accounts also contain extracts from letters we have received from families and
patients. These are such a small sample of the many letters we receive and are the best
testament to what we do here at Bolton Hospice and as Chairman of the Board of Trustees, I
have great pleasure in endorsing the Quality Accounts and on behalf of all the members of the
Board and our dedicated and caring staff, pledge our commitment to continue to build upon our
existing strengths to improve quality wherever possible.
Judith Bromley
Chairman
Comment made by a daughter of an Inpatient:
“One can pay back a loan of gifts, but one dies forever in debt to those who are kind. Thank you
for helping our dad”.
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