Quality Account
High quality care for all
Reporting period:
1st April 2013 to 31st March 2014
Impact of Hospice Services 1st April 2013-31st March 2014
The impact of hospice services in our local community is
identified below.
Supporting
our Local
Community

2696 patients received hospice care from between 1st
April 2013 and 31st March 2014. 79.2% of patients had
a diagnosis of cancer.

The hospice received 1583 new referrals (81% cancer
patients).

94% of the referrals were for pain/ symptom
management.

The hospice supports patients for 61-90 days (median).

Patients and carers score us highly in terms of outcome,
experience and overall satisfaction. Patients gave the hospice
an overall rating of 94.8% and carers gave an overall rating of
96.8% for the advice, care and support provided.

Support provided by the 24/7 advice line prevented 212
“999” calls.

There were 646 completed In-Patient stays.

46.2% of patients are discharged following an admission
to the In-Patient Unit.

It is more than twice as likely that patients receiving
hospice care will be able to die at home as those end-oflife patients who were not referred to the hospice.

Hospice support is reducing the percentage of patients
dying in hospital by approximately 60% when compared
to those end-of-life patients who were not referred to the
hospice.
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“I give the care 10/10. I have got my dignity back. That is all I want”.
“People think you come to die in the Hospice. But it isn’t like that. We need to spread the
message. We are all very much alive”.
“The GP saw me first and then a cancer nurse and I thought it was all doom and gloom. But
then I came here ”
“I am very happy with the service”.
“Your help and support and talking to others helps me cope. It has given me a much better
view on life”.
“It is wonderful coming here and talking to everyone”.
“I started to come here soon after my husband died. Your bereavement care helped me to
move on and so I hope to stay until I am ready”.
“I want to be here because I feel someone is caring for me”.
“I feel more confident here, as someone is caring for me. It is like being at home”.
“You feel one of the family here”.
“I can’t find fault”.
Comments from the Patients’ Forum
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Chief Executive’s Statement
Together with the Board of Trustees, I would like to thank all
of our staff and volunteers for their achievements over the
past year. The hospice has continued to provide a high
quality service and remains financially sound. We have
achieved this by providing high quality, cost-effective
services to our patients and their families. The £8.5 million
that is raised from our local community annually is a
testament to the value that the community puts on the provision of our services.
The Douglas Macmillan Hospice has been a leader and innovator in the hospice movement
and has a well established governance function. This has enabled the hospice to focus on the
quality of the services provided. Our regulators undertook an unannounced inspection on
12th July 2013 and assessed us as being fully compliant. This is a tribute to the hard work of
every member of staff working for the Douglas Macmillan Hospice.
The hospice has a culture of continuous quality monitoring, in which any shortfalls are
identified and acted upon quickly.
I am responsible for the preparation of this report and its contents. To the best of my
knowledge, the information reported in this Quality Account is accurate and a fair
representation of the quality of healthcare services provided by our hospice.
The safety, experience and outcomes for all our patients and their loved ones are of
paramount importance to us. We continue to actively seek the views of our service users.
Michelle Roberts
Chief Executive
15th May 2014
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Section 1
Improvement priorities
Priorities for improvement 2014-2015
Following our assessment against the essential standards of quality and safety on 12th July
2013, the hospice was assessed as being fully compliant.
The Care Quality Commission (CQC) continues to categorise the hospice as a low risk
organisation. To maintain the Quality Risk Profile at this level, the hospice provides
quarterly reports to the CQC. These reports are also provided to the commissioners of
hospice services.
In developing the strategic plan, the hospice has paid regard to the rapidly changing health
and social care environment. There are two key clinical objectives that have arisen from our
discussion on future strategy:
To support and enable the enhancement of palliative and end of life care services for
patients of all disease groups in settings appropriate to their needs and to encourage
independent and supportive models of living at end of life.
To have a palliative and end of life service delivery model that seeks to deliver
appropriate care closer to home and encourages the development of patient choice,
independence and supportive care.
Within this context, and following consultation with the staff, volunteers and the Patients’
Forum, the DMH confirmed the top three quality improvement priorities for 2014 to 2015 to
be as follows:
Strategic theme: Increasing Access to a wider range of conditions
The care management of frail elderly patients is a key priority area for the local health
and social care economy. The number of patients classified as “frail and elderly” is
growing. Current patterns of care are not meeting the needs of this group.
Identification of patients at “end of life” is particularly challenging as these patients
often have a number of illnesses, rather than one single “life limiting illness.”
Estimates of numbers of frail patients in this cohort are given below:
300 highly complex patients with extensive needs
1,300 patients with a serious condition and with significant needs
3,000 patients requiring sporadic, infrequent input from healthcare services.
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In 2014/15, the DMH will put in place the processes to support the initiatives within
our locality. The hospice aim is to enable frail elderly patients, with complex needs,
to access hospice services. The objectives of this service are to provide:
an alternative care option
a reduction in the number of frail elderly people attending A&E
a reduction in acute admissions
specialist end-of-life support.
Future planning priority 1
Development of a Palliative Care Specialist
Nurse-led frail elderly/dementia service
This new service will enable patients within North Staffordshire to receive
palliative care within their own home or in a Nursing Home. A service model will
be developed and piloted in 2014/15.
Future planning priority 2
Collaboration with Nursing and Residential
Homes
The hospice is developing a model of working with the Frail and Complex Team,
which will involve working closely with Nursing Homes and Care Homes.
The model will include the development of a frail/elderly/dementia PCNS team
Strategic theme: Delivering care closer to home
Future planning priority 3
Satellite Beds
The hospice has been recognised for its award–winning Community Lodges,
which have illustrated the value of community-led beds.
In 2015-16, the hospice will explore the development of satellite beds in the
community to increase the diversity of hospice services.
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Progress against the improvement priorities identified for 2013-2014
Throughout 2013-2014, the hospice had a number of initiatives to enable it to offer a more
comprehensive service to the local community, whilst remaining within the limitations of the
financial constraints at that time. All plans for improvement were identified through needs
assessments of the local community and direct patient involvement. We discussed all
initiatives with the hospice’s Patients’ Forum and Carers’ Forum.
Inevitably, progress against the quality improvement priorities for 2013-2014 was influenced
by financial constraints of the charity, delay to the grant sign-off process and by the poor
weather conditions experienced over the winter months. Progress is discussed below.
2013-2014 Priority 1 To build a purpose designed unit, from which the
hospice will provide an integrated therapy service
and a bereavement support service.
The hospice was successful in its application for a Department of Health grant to have
a purpose designed out-patient unit, which will provide:
More appropriate rooms with natural light and proper ventilation for all
services
Privacy and dignity for all patients
Improved access for patients using mobility aids
Improved access for patients to the exterior of the building.
Due to the extreme weather conditions experienced in the winter of 2013-14, building
work has fallen behind schedule. Phase 1 of the building work will be completed by
31st July 2014 and Phase 2 by 30th September 2014.
When completed, the hospice will provide the following to the local community:
Phase 1
A massive improvement in the physical environment for patients attending
the hospice for support.
A suite for psychological therapies which maximises clients’ privacy,
dignity and comfort.
Phase 2
New rehabilitation and physiotherapy facilities to enable patients to remain
independent and self supportive.
A much improved facility for the treatment of complex lymphoedema.
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A new out-patient consultation suite. This will improve the capacity of the
out-patient services and enable patients to remain at home with our
support.
2013-2014 Priority 2 To improve the ability of the In-Patient Unit
to manage the increased complexity and comorbidity of patients
Over the last 12 months, the hospice has increased the number of registered staff
and provided administrative support-staff seven days per week.
This has enabled the hospice to provide a more responsive service to
patients.
The In-Patient Unit is now able to admit and discharge patients on a
seven day a week basis.
556 patients were admitted to the In-Patient Unit between 1st April 2013 and
31st March 2014, 478/556 (86.0%) patients had a diagnosis of cancer. Some
patients were admitted more than once, bringing the total number of
admissions to 665.
2013-2014 Priority 3
To develop the provision of
psychological services to hospice
patients
The Psychological Therapist provides psychological interventions at Level 4
(NICE Guidance, 2004) for those patients/carers and family members who are
experiencing complex psychological issues. The service is in high demand as
psychological distress is often a prominent feature for palliative care patients
and care givers.
An Integrative Counsellor has been appointed to enable the Psychological
Support Service to respond to patients requiring both Level 3 and Level 4
support. The Integrative Counsellor provides training to hospice staff to ensure
a consistent approach is used to support patients requiring Level 2 support.
A Body Image and Mindfulness group is being delivered to women who have
experienced physical and emotional changes. This group is run within a local
Community Hub
The Integrative Counsellor provides two bereavement groups, one in the
hospice and one in the community. These monthly bereavement support groups
serve to connect bereaved people within the community.
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Section 2
Mandated Statements
Statements of assurance from the board
The following are a series of statements that all providers must include in their Quality
Account. Many of these statements are not directly applicable to hospices.
Review of services
Between 1st April 2013 and 31st March 2014, the DMH provided the following services:

In-Patient Unit

Day Therapy Unit

Out Patients

Hospice at Home

Palliative Care Nurse specialist Service
The DMH’s Clinical Governance Group (CGG) is a sub-committee of the Board, which
meets bimonthly. The CGG receives quality reports, which enables the group to review the
quality of care provided by all clinical services. A Clinical Governance report is submitted
to the Board of Trustees on a quarterly basis.
Participation in clinical audits
During 2013/14, the DMH was ineligible to participate in the national clinical audits and
national confidential enquiries.
Research
The hospice is a pilot site in a national, ethically approved research project entitled
“Implementation and Evaluation of the Carer Support Needs Assessment Tool in
Hospice Home-Care Services.” The hospice has compared carer assessment and
support with and without the use of a formal, validated research tool. The pilot is
proceeding according to plan and was completed in November 2013. The results of
the pilot will be published at the end of 2014. The research was led by Gunn Grande
and Lynn Austin, University of Manchester.
The hospice is involved in a local, ethically approved, qualitative research study
being undertaken by Susan Walker, whose PhD is entitled Preferred Place of Death:
One UK Hospice Perspective. All data for the study have been collected and the
thesis is due for completion by the end of 2014.
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To improve patient care, the hospice has continued to work with the heart failure
specialist teams at UHNS and Staffordshire & Stoke on-Trent Partnership with regard
to provision of non-oral diuretics for heart failure patients in the community. This
work won first prize in the Cardiac Care category of the Care Integration Awards
2013.
Quality improvement and innovation goals agreed with our commissioners
For the year 2013/14, the hospice received a grant without any specific conditions attached.
What others say about us
The DMH is required to register with the Care Quality Commission and its current
registration status is unconditional.
The Care Quality Commission has not taken any enforcement action against the DMH
during 2013/14.
The DMH is subject to regular inspections by the Care Quality commission. The last on-site
inspection was on 12th July 2013, at which the hospice was assessed as being fully
compliant.
The Quality Risk Profile of the hospice states that the hospice is low risk.
Data quality
In accordance with agreement with the Department of Health, the DMH submits a National
Minimum Dataset (MDS) to the National Council for Palliative Care. The DMH provides
the MDS report and a copy of the quarterly quality report to the local CCG.
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The DMH will be taking the following actions to improve data quality:

The IT Manager and the Clinical Governance Manager will continue to review
the data outputs in order to improve the quality of patient data recording and
reporting.
Information Governance Toolkit attainment levels
The Information Governance Assessment Report overall score for 1st April 2013-31st March
2014 was 67% and was graded green.
Section 3
Quality overview
Comparison with national minimum data set
The most recent National Minimum Dataset covers the period 1st April 2012 to 31st March
2013.
Community
The hospice has a specialist community team, including a Director of Community Services,
medical consultant, doctor, nurse specialists and a Hospice at Home team. As a result,
patients are managed in their home environment, or alternative place of care, for as long as
possible.
Palliative Care Nurse Specialist
A summary of the MDS data for the Community Specialist Palliative Care team is
given in Table 1.
Table 1
Community Specialist Palliative Care MDS data
2012-2013
DMH
National Median
Data have been compared to 34
large units
% New patients
% New patients with a
non-cancer diagnosis
Average length of care
Face to face visits per
patient
Telephone contacts per
patient
1437 (62.2%)
897 (68.0%)
243 (16.9%)
142 (15.4%)
157days
94.7 days
4.5
3.1
3.4
3.5
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The hospice sees the community team as providing a significant role in improving the
quality, accessibility, flexibility and integration of palliative and end of life (EOL)
care in our catchment area.
The number of home visits was 4.5 per patient per annum in 2012-13, which was
45% higher than the national median value of 3.1, and the number of telephone
contacts was 3.4 per patient per annum, which was in accordance with the national
average of 3.5.
The relatively high level of face-to-face contact provided by the community PCNS
service in accordance with the future of palliative and end of life (EOL) care services
set out in the 2010 Demos report entitled Dying for Change.
Comments from bereaved families confirm that this level of support is valued by
family members.
PCNS Team: Comments from bereaved relatives
“Your regular contact and visits were reassuring for me. Thanks to your kindness I
was able to continue to care for dad at home, knowing that you were there if I
needed anything at all.”
“Just a few words to say thank you for what you did for my son. The family thought
how much you cared for him was out of this world. On behalf of myself and my
family I would like to say a big thank you.”
“Thank you most sincerely for your support during mum’s final weeks. Your
knowledge, advice and practical support were a life-line to me and my dad. Your
calm reassurance was vital in giving us the confidence to believe that we could fulfil
Mum’s wish to remain in the comfort and security of her own home.”
“Thank you for the kindness, thoughtfulness, consideration and all your hard work
that you all provided to ensure my mother received such fabulous care in the final
months of her illness. Not only did you care for her but you also provided an
enormous amount of care, consideration and support for us all at such a difficult
time.”
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Hospice at Home
A summary of the MDS data for Hospice at Home is given in Table 2.
Table 2
Hospice at Home MDS data
2012-2013
DMH
National Median
Data have been compared to 15 large units
% New patients
% New patients with a
non-cancer diagnosis
Average length of care
470 (90.0%)
572 (88.6%)
68 (16.1%)
87 (16.1%)
24.6 days
39.9 days
The MDS data for 2012-13 show that the percentage of new patients seen by the
Hospice at Home Service was 90.0%, which is slightly higher than the national median
value of 88.3%.
In accordance with the priorities of the hospice, the percentage of non-cancer patients
increased to 16.1%, which was identical to the national median value.
Hospice at Home:
Feedback from family members
“My Aunt wished to die at home, with her family around her. The Hospice at Home
team helped us to fulfil her wish. She died with dignity. The care was professional,
compassionate and appropriate to her needs.”
“Thank you for making it possible to keep mum at home in the last week of her life.
She had the best care and I had great support during these last days. I am grateful for
everything that you and the team did for her.”
“Words cannot begin to fully express the gratitude I feel for the care given to my
mother during the last week of her life by the Hospice at Home team. I am also
grateful for the support given to me at such an emotional time.”
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On-Site Services
In-Patient Unit
A summary of the MDS data for the In-Patient Unit (IPU) is given in Table 3.
Table 3
In-Patient Unit MDS data
2012-2013
DMH
National Median
Data have been compared to 44 large units
% New patients
% New patient with a noncancer diagnoses
% Patients returning home
468 (84.5%)
324 (88.1%)
62 (13.2%)
32 (11.5%)
45.8%
41.0%
Average length of stay- cancer
12.2 days
14.7 days
Average length of stay- noncancer
10.3 days
13.3 days
In 2012-13, the percentage of non-cancer admissions to the IPU was 13.2%, which remains
higher than the national median of 11.5%. This trend is in accordance with the charity’s
aims to offer comprehensive specialist palliative care to all adults in North Staffordshire with
progressive, advanced disease and a limited life expectancy.
Since 2006-7, the IPU has reduced its average length of stay (LOS) from 13.6 day to 12.2
days for cancer patients and 10.3 days for non-cancer patients, which is lower than the
national median (cancer patients 14.7 days: non-cancer patients 13.3 days). The hospice is
committed to supporting patients to return to their own home, or alternative place of care, as
soon as their symptoms have been managed.
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Effective use of the admission and discharge criteria enable the timely admission of patients
needing specialist in-patient palliative care.
In-Patient Unit
“You have all been so kind, patient and loving with me. I shall be sorry to move on but
I still have a wonderful family who would take care of me. I would never feel
apprehensive about having to return to your team.” Feedback from a patient
“The entire staff treated me to a very high standard of quality care throughout my stay
for which I am most grateful. A very big thank you and my very best wishes to
everyone concerned.”
Feedback from a patient
“The family wishes to express our heartfelt appreciation for the kindness and excellent
care our mother received during her stay at the hospice.
“Of course we are saddened by her death, but we are comforted knowing that she
received the best care available. The sensitivity and support of all staff helped us
through what was a very difficult time. Thank you to everyone for the wonderful work
you do. We will never forget your kindness.”
Feedback from a bereaved family
“Thank you to all the staff for the care given to XX during his stays in the hospice and
particularly during his final days.”
“XX was very apprehensive about coming into the hospice initially but after his first
stay to monitor his pain, he couldn’t speak highly enough of everyone he came into
contact with and happily came in for a second and third stay.”
“I experienced his care during my visits during the day but, when I stayed overnight I
was overwhelmed by the kindness shown to me also. To see the nurses in action
during the night was just amazing. I cannot thank you enough.”
Feedback from bereaved relatives
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Day Therapy Unit
A summary of the MDS data for the Day Therapy Unit is given in Table 4.
Table 4
Day Therapy Unit MDS data
2012-2013
DMH
National Median
Data have been compared to 49 large units
% New patients
% New patient with a noncancer diagnoses
Average length of attendance
(days)
143 (62.7%)
150 (65.4%)
28 (19.6%)
28 (18.9%)
256.3 days
150.7 days
In 2012-13, the percentage of new patients attending the Day Therapy Unit was 62.7%,
which was slightly lower than the national median value of 65.4%
Throughout 2012-13, the hospice continued to change the focus of the unit from a day
hospice to a day therapy unit, with an emphasis on clinical interventions.
Feedback from the Patients’ Forum and the Carers’ Forum indicates that this support is
highly valued.
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Day Therapy Unit: Feedback from the patients
“This is the only day of the week that my son feels relaxed. He knows that I am in
good hands and that I will be safe all day. He doesn’t need to worry about me.”
“Whatever you want the care is there so I look forward to the next visit. You are
always being looked after.”
“The care is excellent. I have no complaints. I feel fully involved in my care”.
“If I am worried about anything there is someone to talk to. Then they ask you ask
you again on the next visit”.
“The care received here is second to none and I wouldn’t want to be anywhere else
when I go, except perhaps overlooking the sea.”
“Everyone is very respectful, all the staff care, we appreciate everything”
“Coming here gives you value of life, it does me the world of good, I love it
and the meals are wonderful”
“All the staff are incredible and that makes DMH very special”
“The staff make you feel like you matter, that is priceless”
“The care is absolutely excellent. It gives me a reason to get up on a Friday morning.
Everyone has my welfare at heart”.
“I enjoy it all. I didn’t think I would. We have a nice dinner. In fact everything is
nice”.
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Out-patients
A summary of the MDS data for Outpatients is given in Table 5.
Table 5
Out-patients MDS data
2012-2013
DMH
National Median
Data have been compared to 50 medium
sized units
417 (71.2%)
255 (40.0%)
% New patients with a non-cancer
diagnosis
53 (12.7%)
43 (14.4%)
% attendances with a Medical
Consultant
5.5%
% New patients
11.6%
The hospice continues to develop the out-patient services to a significant extent.
We have been successful in winning a Department of Health grant of £500,000, which
has enabled us to build a dedicated out-patient facility. Progress has been influenced
by financial constraints of the charity, delay to the grant sign-off process and by the
poor weather conditions experienced over the winter months. Phase 1 will be
completed by the end of July 2014
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Local quality measures
The hospice uses the national definition of quality, which states that the following three
dimensions must be present to provide a high quality service:
clinical effectiveness – quality care is care which is delivered according to the best
evidence as to what is clinically effective in improving an individual’s health outcomes.
The main focus of the hospice is Domain 2 of the NHS outcomes framework: enhancing
the quality of life of patients with long-term conditions.
patient experience – quality care is care which looks to give the individual as positive
an experience of receiving and recovering from the care as possible, including being
treated according to what that individual wants or needs, and with compassion, dignity
and respect (Domain 4).
safety – quality care is care which is delivered so as to avoid all avoidable harm and
risks to the individual’s safety (Domain 5)
In addition to the national dataset for palliative care, the following measures reflect our
performance against the three quality dimensions.
Clinical Effectiveness
Patients receiving care from the hospice
To meet the end of life needs of the local community, the hospice has accommodated a
31.5% increase in the number of patients receiving hospice care since 2009. The
hospice is committed to meeting the requirements of all patients requiring our
specialist support. As a consequence of this commitment, there has been a steady
increase in the percentage of non-cancer patients from 8.8% year ending 31st March
2009 to 16.9% in year ending 31st March 2014.
Table 6 & Figure 2 Number of patients receiving care from the
hospice year ending March 31st 2010- 2014
Year ending 31st
March
Number of
patients
2009
2212
2010
2293
2011
2644
2012
2623
2013
2778
2014
2696
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The majority of our patients (72.8%) are aged 65 years and above. The primary care aim of
94.1% of the patients referred to us is pain and symptom management. Most of our
referrals are from the hospital Clinical Nurse Specialist (34.48%) and the patients’ GPs
(29.7%).
24/7 Advice Line
A 24/7 advice line is provided 24 hours a day for 365 days of
the year by a team of experienced and trained Palliative Care
Nurse Specialists (PCNSs). The PCNSs are provided with
the necessary training, skills and information resources
needed to keep their clinical knowledge fully up-to-date.
The hospice uses an electronic patient database, which means
that the PCNS taking the call has direct access to the patient records of all patients
known to the hospice.
The hospice standard is that all calls to healthcare professionals will be responded to
within 15 minutes of call receipt. Over the past 12 months, this standard was met for
95.8% of calls.
Between 1st April 2013 and 31st March 2014, this service took 3354 calls, of which
65.9% of calls were from patients/carers. The Carers’ Forum has stated how invaluable
this service is to them. This is supported by the fact that 212 “999” were prevented
over the past 12 months.
Supporting patient choice
The percentage of hospice patients (all diagnoses) dying at home was 39.9% for the year
ending 31st March 2014. This compared to 19.1% of all deaths recorded in the End of
Life PCT profile for patients living in North Staffordshire and Stoke-on-Trent (Table 7
and Figure 3).
Table 7
Location of death of all patients in our local community
and patients receiving hospice care
Annual
(n=1338)
Location
Acute Hosp
Community Hosp
Home
Care home
Hospice IPU
Other
251
55
534
141
355
2
18.8%
4.1%
39.9%
10.5%
26.5%
0.1%
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EOL PCT
profile
Oct 2012
(n=4734)
56.9%
19.1%
15.3%
6.5%
2.4%
Figure 3
Location of death of all patients in our local community
and patients receiving hospice care
The percentage of hospice patients (all diagnoses) dying at home was 39.9% for the
year ending 31st March 2014. This compared to published figures of 19.1% given for
all deaths of patients living in Staffordshire and Stoke-on-Trent.
The hospice has consistent, externally verified evidence that it is more than twice as
likely that patients receiving hospice care will be able to die at home as those end of
life patients who are not referred to the hospice.
The percentage of hospice patients (all diagnoses) dying in a hospital was 22.9% for
the year ending 31st March 2014. This compared to published figures of 56.9% for all
deaths of patients living in Staffordshire and Stoke-on-Trent.
The hospice has consistent, externally verified evidence that hospice support is
reducing the percentage of patients dying in hospital by approximately 60% when
compared to those end of life patients who were not referred to the hospice.
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Patient experience
Patients’ Forum
The DMH Patients’ Forum continues to be a very active group, which meets and
rotates the days of the meeting from Monday to Friday to maximise patient
involvement. Due to the type of patient treated by the hospice, the membership of
this group comprises mainly of patients from the Day Therapy Unit (although
meetings are also open to in-patients and community patients).
The Head of Quality and Governance, Stoke on Trent Clinical Commissioning
Group, a Lay Member of the PPI and a representative of the Patients’ Congress
attended the Patients’ Forum on 22nd August. The hospice received very positive
feedback.
User feedback provided during the episode of care
The hospice undertakes real-time monitoring which enables staff to take immediate
action to address any issues raised.
Of the 652 admissions to the IPU between 1st January and 31st December 2013, 523
(80.2%) patients were randomly selected to complete the questionnaire. Where the
patient was unable to complete the questionnaire themselves, a family member or a
volunteer was asked to help the patient. 233 questionnaires were completed (44.6%);
the other patients were too ill to complete the questionnaire, had been admitted
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previously or did not wish to complete the questionnaire. The feedback from inpatients is summarised in Table 8. These data have a confidence level of 95% and a
confidence interval of 5.
Table 8 Real-time monitoring of in-patient satisfaction
Yes
(n=233)
.Question
CL =95% CI=5
Have the first 3 days of your stay been satisfactory
Have you understood the reasons for your admission and
what we are trying to achieve for you
Have you found the staff approachable
Have you been given the opportunity to discuss treatments
Have you expressed any concerns or issues you may have
Are we doing everything for you that you would wish us to
do?
If you had a complaint about the care you are receiving,
would you know what to do?
233
100.0%
231
231
222
231
99.1%
99.1%
95.3%
99.1%
230
98.7%
224
96.1%
In all cases, there is documented evidence that any issues raised by the patients were
dealt with immediately.
Patient-Led Assessment of the Care Environment.
The hospice undertook the national Patient-Led Assessment of the Care Environment
(PLACE) assessment on May 22nd. The assessment was undertaken by members of the
Carers’ Forum.
The benchmarked results were published on September 18th 2013.
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The hospice scored higher than the national average in all areas. The DMH has worked
closely with Help the Hospices to encourage other hospices to take part in this patient-lead
assessment.
In 2014, Healthwatch has agreed to take part in the hospice’s assessment. The team of
assessors will include two members of the Carers’ Forum and an independent reviewer from
Healthwatch.
Safety
A quality indicator: Prevention and management of pressure ulcers
Between 1st April 2013 and 31st March 2014, 665 patients were admitted to the InPatient Unit (IPU). A Waterlow score was determined for 97.7% of patients. The
average Waterlow score was 22.8 with a range of 5- 49 (very high risk = a score of
≥20), which is an indication of the frailty of the patients being cared for.
123/665 (18.5%) patients had pressure ulcers on admission. All pressure ulcers, and
areas at risk of developing into a pressure ulcer, were given a grading using the
EPUAP classification system.
All at risk patients had a documented care plan, which includes monitoring on an
ongoing basis. Preventative measures were put in place for all at risk patients, such
as pressure relieving mattresses and cushions.
No patient developed a Grade 3 or above pressure ulcer during their stay on the InPatient Unit.
Our participation in clinical audits
National hospice-specific audit
In 2013-14, the DMH took part in a national audit of Hospice at Home services
received by 4,800 patients across England and Wales. This piece of work was
undertaken by Help the Hospices, in partnership with the National Association for
Hospice at Home; the work has not been published to date.
Local audit
To ensure that the hospice is providing a consistently high quality service, we
undertake our own clinical audits, often using national audit tools developed
specifically for hospices, which have been peer reviewed and quality assessed. This
allows us to monitor the quality of care being provided in a systematic way and
creates a framework by which we can review this information and make
improvements where needed.
24
Each year, the Board approves the audit schedule for the coming year. Priorities are
selected in accordance with what is required by our regulators and any areas where a
formal audit would inform the risk management processes within the hospice.
Through the Clinical Governance report, the Board of Trustees is kept fully informed
about the audit results and any identified shortfalls. Through this process, the Board
receives assurance of the quality of the services provided.
The following audits were completed between 1st April 2013 and 31st March 2014.
Self-assessment by the
Accountable Officer
This audit has to be completed annually.
Management of
controlled drugs
This audit has to be completed annually to provide evidence to support
the self assessment by the Accountable Officer.
The hospice was fully compliant with the legal requirements.
A few minor shortfalls were identified. The Board is assured that the
hospice is now compliant. The CD Accountable Officer has robust
monitoring processes in place.
Infection control
The hospice had a few minor areas of shortfall, which are being
managed by the Infection Control Team.
Pain Management
The audit highlighted problems with documentation.
Continuous quality monitoring and patient feedback provided
reassurance that pain is managed effectively.
Documentation is being revised and the audit will be repeated in 201415.
Management of General
Medicines
The audit identified an issue with documentation in relation to the
destruction of general medicines. An audit trail was put in place with
immediate effect.
The hospice audit team is continuing to develop. On June 17th, the DMH is cohosting a Regional Audit Day with St Giles’ Hospice. Auditors from the hospices
within the West Midlands are presenting their results and sharing learnings.
Psychological Support
One of the Charity’s aims is to offer professional advice and support to families and
carers during the patient’s illness and during the initial stages of bereavement.
The MDS data, published for 2012-2013, showed that clients received 8.2 contacts.
This figure was 39% higher than the national median value of 5.9 (Data compared
with that of 41 medium sized unit).
Between 1st April 2013 and 31st March 2014, 211 carers received bereavement
support. The majority of clients received support for less than three months.
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What our staff says about the organisation
The DMH values the opinions of the staff regarding the quality of the service provided. The
Hospice undertakes a staff survey every 2 years to ascertain engagement levels, celebrate
success and to highlight areas for improvement.
Staff Survey
In June and July 2013, the DMH took part in the staff survey run by Birdsong Charity
Consulting on behalf of Help the Hospices.
110/275 DMH staff took part in this survey (response rate =40%). 42 Hospices participated
(5,501 paid staff and volunteers).
Table 9
Staff survey 2013
Category
DMH
Hospice Sector
Average
The Organisation & Communication
I understand what the charity wants to achieve as an
organisation
The senior management team is effective
I would recommend this hospice as an employer
96%
61%
81%
91%
56%
76%
Morale and Work/Life Balance
I feel I am making a difference
I enjoy the work I do
I am not concerned about my job security
94%
95%
59%
89%
95%
57%
People Management
I receive useful feedback on how I am performing
I am clear about what is expected of me in my job
my views are listened to and valued
73%
90%
71%
63%
86%
63%
Development and Reward
I receive sufficient training to enable me to do my job
well
there are good opportunities for personal development
overall I am satisfied with my job
80%
69%
85%
71%
54%
80%
In the current financial situation, the hospice has had to ensure that charitable funds are
controlled very tightly. These tight controls have not impacted negatively on staff survey.
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Table 10
Staff turnover
2009-10
Retirements
Staff leaving
Total staff employed
Turnover of DMH staff
Comparison to
Voluntary, Community,
Not-for-Profit Sectors
2010-11
2011-12
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3
215
6
10
255
7
27
256
14.40%
16.40%
6.20%
15.90%
13.30%
13.10%
2012-13
2013-14
8
32
268
1
58
334
14.90%
13.0%
17.70%
15.20%
Overall turnover of staff is similar to the average for the sector.
The Board of Trustees’ commitment to quality
The Board of Trustees is fully committed to the quality agenda.
The hospice has a well established governance structure, with
members of the Board having an active role in ensuring that
the hospice provides a high quality service in accordance with
its Statement of Purpose.
As a way of having first-hand knowledge of what the patients
think about the quality of the service provided, the Chair of
Trustees has attended several meetings of the Patients’ Forum.
“Attending these meetings gives me the opportunity to listen
to what can be done for the patients to improve their lives through our care and support. I
encourage Trustees to attend these meetings.
As the Trustees have ultimate responsibility for the governance of the hospice, this
interaction with the patients provides a valuable insight into the work of the hospice and how
it is perceived by the patients.”
The Board is confident that the treatment and care provided by the Hospice is of high quality
and is cost effective.
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Rating of our service by patients and carers
The hospice does not ask the “family and friends” question but we do ask patients and carers
to score the services.
Table 11
Overall rating of the hospice by patients and carers
Patients gave the hospice an overall rating of 94.5%; carers gave an overall rating of
96.8%.
All service areas achieved over 90%.
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References
Care Quality Commission: Guidance about compliance Essential standards of quality and
safety. Outcome 1. March 2010. http://www.cqc.org.uk/content/essential-standards-qualityand-safety Last accessed 16/04/14
ELCQuA
http://www.elcqua.nhs.uk/ Last accessed 16/04/14
Leadbeater, c. and Garber, J., 2010. Demos Report: Dying for Change. Demos, London.
www.demos.co.uk/files/Dying_for_change_-_web_-_final_1_.pdf Last accessed 16/04/14
National End of Life Care Intelligence Network. EOL PCT profile October 2012
http://www.endoflifecare-intelligence.org.uk/end_of_life_care_profiles/la_profiles_2012 Last
accessed 22/04/14.
Goodridge, D. & Marr, H. 2002, "Factors associated with falls in an inpatient palliative care
unit: an exploratory study", International journal of palliative nursing, vol. 8, no. 11, pp. 548556.
Health and Social Care Act 2012, March 2012.
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NICE Quality standard for end of life care for adults, November 2011.
http://guidance.nice.org.uk/QS13 Last accessed 16/04/14
Pearse, H., Nicholson, L. & Bennett, M. 2004, "Falls in hospices: a cancer network
observational study of fall rates and risk factors", Palliative medicine, vol. 18, no. 5, pp. 478481.
Quality in the new health system - http://www.dh.gov.uk/health/2013/01/quality-healthsystem. Maintaining and improving quality from April 2013, Jan 2013. Last accessed
16/04/14
West Midlands Cancer Intelligence Unit. Where do people die?
http://www.wmciu.nhs.uk/documents/core_docs/info_pub/End_of_life_v2.0.pdf last
accessed 16/04/14
Help the Hospices Commission: Future ambitions for hospice care: our mission and our
opportunity: October 2013
Help the Hospices Commission: Current and Future needs for hospice care: January 2013
Commission on Improving Dignity in Care for Older People (2011)
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Annex
What Stoke -on-Trent and North Staffordshire CCGs say about the
organisation
Statement for Douglas Macmillan Hospice
North Staffordshire CCG and Stoke-on-Trent CCG are pleased to be asked to comment on
the Douglas Macmillan Quality Account for 2013/14.
The CCGs meet with the Douglas Macmillan Hospice twice annually via the Staffordshire
Hospices Clinical Quality Review Meeting to monitor and seek assurance on the quality of
services provided. The Quality Account covers many of the areas that are discussed at
these meetings, which seek to ensure that patients receive safe, high quality care. It is
noted that the hospice was visited by the Care Quality Commission in July 2013 and was
assessed as compliant with the essential standards of quality and safety.
The CCGs also visit the hospice and in August 2013 we were pleased to be invited to attend
the Patient Forum with members from our own Patient Congress. It was impressive to see
how well the hospice listened to the patients and acted upon their feedback which is
reflected in the excellent patient and carer ratings.
Commissioners support the continued use of real time monitoring of patient feedback to
enable staff to take immediate action to address any issues raised. It was pleasing to see
that the hospice scored higher than the national average in all areas of the national Patient
Led Assessment of the Care Environment (PLACE) assessment.
The progress made on 2013-2014 priorities is reassuring and it is good to see that the
hospice are now able to admit and discharge patients on a seven day week basis. They
have identified quality improvement priorities for 2014-2015 which address key important
areas which are aligned to both health and social care priorities namely; providing care
closer to home and supporting the frail elderly.
To the best of the commissioner’s knowledge, the information contained within this report is
accurate.
Received 20th June 2014
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What Healthwatch says about the organisation
Healthwatch Stoke-on-Trent welcomes the opportunity to comment on the Quality Account
of the Douglas Macmillan Hospice. It is noted that there has been mixed progress against
the priorities set for 2013-14 but that there have been a number of external influences which
have affected the achievement of these. However, Healthwatch is pleased to see that firm
deadlines for completion of the building work detailed in Priority 1 have been set and it is
hoped that the opening of these new facilities will support patients and their families with
much needed additional services.
The extension of services through increased staffing and the 7 day a week admission and
discharge service is a welcome addition to patient services. Healthwatch also welcomes
the extension of Psychological Support Service which has further enhanced patient and
family experience through a diverse range of activities.
With the drive in the wider Staffordshire Health Economy to provide appropriate care closer
to home for patients and services users, Healthwatch is pleased to note the aspirations set
out in your 2014/15 Priorities which provide models of care that support this type of
provision for palliative care.
Received 24th June 2014
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