Garden House Hospice
Quality Account 2013 – 2014
“A fantastic place.
I have a few experiences of the Hospice and all have been
wonderful. For an awful time you make it so much more bearable.
You took away my worries every time I had to leave my aunt.
Thank you.”
Quote from a Family Carer Questionnaire 2013
Part 1: A Statement on Quality from the Hospice Management Team
Welcome to the third Quality Account of Garden House Hospice; a summary of our
performance against selected quality measures for 2013 - 2014 and our initiatives and
priorities for quality improvement in 2014 - 2015.
It has been produced to inform service users (current and prospective), their families, our
staff, our supporters, commissioners and the public.
Garden House Hospice is an organisation based on values. These values are enshrined in
the way we offer a quality service providing care for our patients.
By quality we mean striving to meet the needs of our patients and supporting their
families, to the best of our ability.
Garden House Hospice
Philosophy of Care
Palliative care is the total care of patients at a time when
their disease is no longer responsive to curative treatment and
when life expectancy is relatively limited.
Our philosophy of care is based on the following principles:
That palliative care
v respects the patients wishes
T
v is a team approach composed of
both professional staff and
trained volunteers
v integrates psychological and
spiritual care for patients, so
that they may come to terms
with their own death as fully and
constructively as they can
v aims to provide relief for
patients from pain and other
distressing symptoms
v helps the family cope during the
patient’s illness and in
bereavement
v offers a support system to help
the patient live as actively and
creatively as possible until death
v affirms life and regards death as
a normal process; it seeks
neither to hasten nor to
postpone death
To achieve the level of care we aspire to requires a dedicated multi-professional team
supported by trained volunteers. We recognise that attention to detail can contribute
significantly to the patient and family experience.
The following comments affirm for us that we can be justly proud of the work of the
hospice team.
“My sister’s care has been 100% at all times, enabling her to get better
enjoyment of the time she has left. Medical and emotional care – always
brilliant. She has kept her dignity and retained control of her choices.”
“I appreciated the support we received from the people who visited the house,
again who were always so kind, caring and patient. We were also grateful for
the advice we received over the telephone, the ready ability of people to speak
to us and the concern they constantly showed for my husband’s welfare.”
“The ethos of care and compassion was present in all aspects of Y’s care –
from the cleaners to the receptionists, from the flower arrangers to the cooks,
from the tea ladies and gentlemen to the Hospice Medical Director, and
certainly throughout all the nursing staff who so skilfully cared for Y on good
days and bad.”
“Thanks to your constant and overwhelmingly compassionate care for my Mum,
I will always be able to reflect on the final stages of her life with a sense of
peace and the knowledge that her needs were safeguarded in every possible
way. I really am so grateful for that – thank you.”
As a Management Team, we are responsible for this report and its contents. To the best of
our knowledge, the information reported in this Quality Account is accurate and a fair
representation of the quality of the healthcare services provided by our Hospice.
Dr Viv Lucas
Medical Director
Sally Alford
Matron
Jenny Lupton
General Manager
Part 2: Priorities for Improvement and Statements of Assurance
from the Hospice Management Team
Priorities for Improvement
North Herts Hospice Care Association is the governing body for Garden House Hospice.
Garden House Hospice is situated in Letchworth Garden City. It opened in 1990 to provide
specialist palliative care to the residents of Stevenage and North Hertfordshire. Due to its
location, close to the Bedfordshire border, some patients come from Bedfordshire.
Since 1990 the services offered by Garden House Hospice have grown and developed to
meet the needs of the community. From an initial In-Patient only service, Garden House
Hospice now provides: §
12 bedded In-Patient Unit
§
Hospice at Home
§
Day Services; including Outpatients
§
Family Support Services
§
Specialist Palliative Care Advice Line
Mission Statement
Garden House Hospice offers hospice care and support to patients with life limiting
illnesses and their families.
All those who work at Garden House Hospice, in whatever capacity, share in the
common purposes, to: §
provide relief for patients from pain and other distressing symptoms.
§
help patients to live their lives with dignity, by bringing together the
psychological, emotional, spiritual and physical aspects of care.
§
provide care in a variety of settings, appropriate to the individual needs of each
patient.
§
offer support to families and carers both during a patient’s illness and into
bereavement.
Garden House Hospice is constantly seeking ways to improve the quality of care provided,
for patients and their families.
Garden House Hospice was inspected by the Care Quality Commission on 23rd September
2013.
These are the results of our most recent checks showing
whether this care service is meeting each of the standards
that the government says you have the right to expect.
1 Standards of treating people with respect and involving them in their care
Overall
2 Standards of providing care, treatment and support that meets people's needs
Overall
3 Standards of caring for people safely and protecting them from harm
Overall
4 Standards of staffing
Overall
5 Standards of quality and suitability of management
Overall
Key to our latest checks on standards
All standards were being met when we last checked.
Summary Inspection Report
People we spoke with during our inspection who used the service were very positive
about the care and support they received. One person said: “It is a wonderful place”.
Another person told us they had regained their appetite and said: “The food is
excellent”.
Assessments of people’s needs were centred on their preferred priorities for care and
support and were completed by a multi-disciplinary team of staff trained in palliative
care. The hospice had systems in place to ensure that care was planned and delivered
to meet people’s needs, and the needs of those close to them, at every stage of their
care.
There were effective arrangements in place to protect people in respect of the
prevention and control of infection and the safe use and management of their
medicines.
People who used the services were cared for in safe, accessible surroundings that
promoted their wellbeing.
We spoke with members of staff from a range of roles within the staff team. They all
confirmed that they received good support and appropriate training to enable them to
carry out their roles effectively.
Priorities for Improvement 2014 – 2015
Safety
Priority
Garden House Hospice will achieve Level 2 compliance with the Information Governance
Toolkit.
How was this identified as a priority?
Information Governance concerns the way that organisations ‘process’ or handle
information. It covers personal information, i.e. that relating to patients/service users and
employees, and corporate information, e.g. financial and accounting records.
The Information Governance Toolkit is an online system which allows health and social
care organisations to assess themselves against Department of Health Information
Governance policies and standards which themselves have a legal basis. It also allows
members of the public to view participating organisations' IG Toolkit assessments.
Garden House Hospice has always taken seriously its responsibilities for handling personal
information; everyone who works at the Hospice is aware of their legal duty to maintain
confidentiality.
The Trustees and Hospice Management Team identified that completion of the
Information Governance Toolkit would demonstrate Garden House Hospices’ compliance
with relevant legislation and standards and identify any areas where practices need to be
strengthened or revised.
Level 2 compliance would also allow Garden House Hospice to apply for a secure NHS
internet connection (N3) via which patient information could be shared with other
organisations involved in a patient’s care. Level 2 compliance gives two way assurance
that patient information will be sent / received securely and processed fairly and lawfully
by each organisation.
It was identified that, being able to access test results and information relevant to an
individual’s care from another ‘organisation’ (i.e. a hospital or GP) would help to improve
the quality of care the patient receives whilst at Garden House Hospice. Similarly, prompt
and secure transfer of discharge information to the health care professionals who will be
responsible for the patient’s on going care will smooth the individual’s transition between
services.
It was specifically identified that many of the GP practices, who refer patients to Garden
House Hospice, use a computer package called SystmOne to record patient information. If
Garden House Hospice moved to the same package this would enable even more
beneficial, appropriate, sharing of patient information.
Note; sharing of information on SystmOne is not only safeguarded by both organisations
requiring to demonstrate at least Level 2 compliance with the Information Governance
toolkit but also requires express permission from the patient.
How will this be achieved?
§
The Trustees have agreed funding to release an individual to co-ordinate the
completion of the Information Governance Toolkit; commencing on 1st April 2014.
§
Current Hospice policies and practices will be reviewed against the required
standards.
§
All Hospice Team Members will attend Information Governance Training.
§
An Action Plan will be drawn up with realistic deadlines for completing any changes
from current practice to best practice.
How will progress be monitored and reported?
In accordance with the requirements of the Information Governance toolkit, an
Information Governance Committee has been formed. One of the functions of this
Committee will be monitoring the progress towards achieving Level 2 compliance.
Information Governance has been made a standing agenda item for the Clinical
Governance Group, which is attended by all Heads of Department who are responsible for
cascading information to their teams. Any changes in practice will be taken to the Clinical
Governance Group. Training will be provided to appropriate individuals if any significant
changes to practice are made.
The Information Governance Toolkit requires that evidence is uploaded in support of
compliance declarations. Toolkits must be published every year (1st April) and are available
to be viewed online by members of the public.
Effectiveness
Priority
The Distress Thermometer will be implemented across the Hospice and used for all
patients.
How was this identified as a priority?
The Distress Thermometer is a screening tool for assessing the distress of patients with
terminal illness. The tool can be used to start a conversation between the professional
and the patient and can help identify services, support and resources that may help, both
the professional and the patient themselves, address the patient’s difficulties, enabling
holistic care.
How will this be achieved?
The Family Support Service will be responsible for the role out of the Distress
Thermometer throughout Garden House Hospice.
The Family Support Service will plan and provide a teaching session for all relevant team
leaders and will also plan how this information will then be disseminated from the team
leader to all members of their team.
To ensure the Distress Thermometer is integrated into the ongoing assessment of patients
by the Multi-Disciplinary Team chair person at the weekly Multi-Disciplinary Meeting will
ensure that each patient’s Distress Thermometer is discussed at every meeting. The
Distress Thermometer will also be used as a tool to aid in patient handovers and
debriefing session.
Patients will be offered the opportunity to complete the distress thermometer: §
As part of the In-Patient Unit admission process
§
As part of Hospice at Home assessment
§
Within 3 attendances at Day Hospice as part of the assessment process
§
As part of the Outpatient assessment process
The distress thermometer will also be offered as part of ongoing assessment: §
When a change in circumstances occurs
§
When a patient accesses a new service within Garden House Hospice
§
When there is a change in the patients condition
§
When treatment or interventions begin. End or change
§
When the patient presents with signs and/or symptoms of distress
How will progress be monitored and reported?
A “trail” will be developed on iCare, the electronic data recording system used at Garden
House Hospice, to monitor and review the usage of the Distress Thermometer. Audit will
be carried out every 3 months initially, and reported to the audit meeting and clinical
governance group.
Experience
Priority
Garden House Hospice In-Patient Unit will pilot planned respite for patients that have been
referred to the Hospice.
How was this identified as a priority?
Through conversations with community teams, and looking at the services offered by
other Hospices it has become evident that they may be a need for planned respite care.
Garden House Hospice currently provides emergency respite care, when there is a bed
available and the need arises. This service will continue to be offered alongside planned
respite.
How will this be achieved?
Garden House Hospice will have 1 dedicated “bed” for planned respite, which can be
booked directly by the community nursing team for any patient who has already been
referred to the hospice.
The respite stay will be for either three nights (Tuesday afternoon to Friday morning) or 4
nights (Friday afternoon to Tuesday morning) and is designed to give the patients carers a
break.
In order to facilitate this planned respite the community team will be responsible for
booking the patients transport both to and from the hospice, making sure they have a
package of care that is already working set up for when the patient is discharged, and for
ensuring the patient has enough medication for their stay, and subsequent discharge.
The patients stay will be mainly nurse-led. They will see a doctor on admission, and may
receive complementary therapy during their stay, but would not have access to regular
medical review or wider hospice services.
A plan will be put in place if a patient in the planned respite “bed” deteriorates, or needs
their symptoms controlling, and therefore needs to remain at the Hospice for a longer
period of time.
How will progress be monitored and reported?
The planned respite pilot will be audited by monitoring: §
How regularly the planned respite “bed” is in use
§
Any problems with: o Transport
o Package of care
o Medication
§
Whether any patients have needed to remain at the Hospice for longer than their
planned respite for symptom control or terminal care.
Results will be fed back through the audit committee, clinical governance group and via
the locality meeting.
Priorities for Improvement 2013 – 2014
Safety
Priority I
All six individual patient rooms will have overhead tracking hoists fitted.
What has been achieved
Prior to 2013 – 2014 three of the six individual patient rooms had overhead tracking hoists
fitted; one when the new wing opened (2008) and two fitted in January 2011.
On 21st May 2013 overhead tracking hoists were fitted in the remaining three individual
patient rooms. These hoists were funded by a specific donation for patient equipment.
The additional overhead tracking hoists have enabled patients with more complex needs
to be cared for more efficiently, with increased safety for both the patient and the Nursing
Team.
Having a tracking hoist in each side room lowers the infection risk as the hoist is not being
shared, and protects the nurse from having to move a hoist around the building whenever
it is required.
Priority II
All Garden House Hospice syringe drivers will be the same model and make as used
throughout the East of England Strategic Clinical network.
What has been achieved
During June and July 2013 all Registered Nurses, from Garden House Hospice, undertook
training in setting up and administering medication via a (McKinley) T34 syringe driver.
In order to measure the effectiveness of the training, all Registered Nurses were asked to
complete a pre and one month post training confidence questionnaire. The questionnaire
consisted of the following seven questions: Q
1. How confident do you feel in changing the battery on a McKinley Syringe Driver?
Q
2. How confident do you feel to check the battery level on a McKinley Syringe Driver?
Q
3. How confident do you feel to load the syringe into a McKinley Syringe Driver?
Q
4. How confident do you feel to set the rate of infusion on a McKinley Syringe Driver?
Q
5. How confident do you feel to set a McKinley Syringe Driver running?
Q
6. How confident do you feel about managing a McKinley Syringe Driver if it alarms?
Q
7. How confident do you feel to use a McKinley Syringe Driver?
Each question had to be scored, on the following scale, where 0 (L) is not at all confident
and 10 (J) is totally confident: -
L
0
1
2
3
4
5
6
7
8
J
10
9
21 pre and 13 post course questionnaires were returned (11 individuals completed both).
The graph below shows the average confidence, for each of the seven questions, before
and after the training.
McKinley Syringe Driver Training Questionnaire
10.0
9.0
8.8
8.8
8.3
8.0
8.2
8.2
8.1
7.9
7.0
Average Score (Before)
Average Score (After)
6.0
Score 5.0
4.0
3.0
2.0
1.0
1.0
0.9
0.7
0.5
0.8
0.5
0.7
0.0
1.
2.
3.
4.
Question Number
5.
6.
7.
Four Registered Nurses, from Garden House Hospice, also undertook additional training to
become ‘trainers’ in the use of T34 syringe drivers.
Prior to the introduction of the T34 syringe driver, at Garden House Hospice, the
‘trainers’: §
Assessed the competency of every Registered Nurse, in the use of the T34 syringe
driver.
§
Trained every Healthcare Assistant and Senior Healthcare Assistant how to monitor
a T34 syringe driver.
The ‘trainers’ are and will continue : §
Providing full training in the use of the T34 syringe driver to any newly appointed
Registered Nurses and assess their competency before they are able to set up and
administer medication, at Garden House Hospice, via a T34 syringe driver.
§
Providing training on how to monitor a T34 syringe driver to any newly appointed
Healthcare Assistants and Senior Healthcare Assistants.
§
Providing annual refresher training on the use of the T34 syringe driver (to all
Registered Nurses, Healthcare Assistants and Senior Healthcare Assistants); as
part of the rolling programme of Clinical Mandatory Training.
§
Re-assessing the competency of every Registered Nurse, in the use of the T34
syringe driver, annually.
T34 syringe drivers were introduced, at Garden House Hospice, on Saturday 2nd August
2013; to avoid confusion, all the old MS26 syringe drivers were withdrawn on this date
and only T34 syringe drivers were available to be used.
There have been two reported accidents, incidents or near misses relating to syringe
drivers, at Garden House Hospice, during 2013 – 2014;
* Trouble with setting up a T34 syringe driver after a battery change. The staff member
involved has been retrained in how to use this new piece of equipment.
* T34 Syringe driver finished running one hour before due, no problems with T34 found.
There have been no failures of or adverse incidents related to syringe drivers, at Garden
House Hospice, during 2013 – 2014, which required reporting to the Medicines and
Healthcare products Regulatory Agency (MHRA).
Priority III
The needles, intravenous cannulae and administration sets, used at Garden House
Hospice, will have safety features, to minimise the risk of sharp injuries occurring during
use and disposal.
What has been achieved
On 11th May 2013, the Health and Safety (Sharps Instruments in Healthcare) Regulations
2013 was published. Regulation 5(1)(b) Use safer sharps (incorporating protection
mechanisms) is explained as follows (by the Health and Safety Executive): –
The employer must substitute traditional, unprotected medical sharps with a ‘safer
sharp’ where it is reasonably practicable to do so. The term ‘safer sharp’ means
medical sharps that incorporate features or mechanisms to prevent or minimise
the risk of accidental injury. For example, a range of syringes and needles are now
available with a shield or cover that slides or pivots to cover the needle after use.
Prior to 11th May 2013, the Garden House Hospice designated Infection Prevention and
Control Lead Nurse: §
Liaised with the East and North Herts NHS Trust (with whom Garden House Hospice
has a Service Level Agreement, for Infection Prevention and Control) regarding
which ‘safer sharp’ products they would be using.
§
Arranged for representatives from ‘safer sharp’ product suppliers to come to Garden
House Hospice and demonstrate use of their product(s) to members of the Clinical
Team.
§
Ensured training in the use of selected ‘safer sharp’ products was cascaded to all
appropriate members of the Clinical Team.
§
Arranged for suitable quantities of the selected ‘safer sharp’ products to be ordered.
In line with the legislation, stocks of sharps were used up and replaced with ‘safer sharp’
products; this process was completed by December 2013. Since the introduction of ‘safer
sharp’ products, at Garden House Hospice, there have been no reported accidents,
incidents or near misses, relating to sharps.
An observational audit was undertaken, between April and July 2013, to measure the
Clinical Team’s compliance with the North Herts Hospice Care Associations Policy for Safer
Management of Sharps. The results of the audit demonstrated that there is generally
good practice when using sharps. The following items were highlighted as requiring
improvement: § Temporary closure mechanism, on sharps bin, must be deployed between each use
§ When a sharps bins is assembled it must be labelled with;
o Hospice postcode
o Signature of person undertaking the assembly
o Date of assembly
§ Locked sharps bins must be retained in Clinical Prep whilst awaiting disposal
A repeat observational audit is currently being undertaken to measure if the required
improvements have been made and if practice when using sharps remains good.
Effectiveness
Priority
The patient notes will be redesigned to: §
Make them more user friendly for the whole Multidisciplinary Team
§
Avoid duplication
§
Facilitate audit
What has been achieved
Two sets of ‘dummy notes’, containing copies of all the current documentation, in the
order it is currently filed, were made up and circulated around the Multidisciplinary Team
for them to comment on: §
order of documentation;
§
usability of each individual document;
§
what works well;
§
what needs to be improved;
§
how the notes as a whole could be improved;
§
how individual documents could be improved.
Sets of notes were also sourced from other hospices and these were also circulated for the
Multidisciplinary Team to look at and gain ideas from.
A series of meetings were held for members of the Multidisciplinary Team to discuss each
others ideas and reach a consensus on the issues listed above. It was agreed that: §
File dividers would be used to create 13 separate sections in the notes.
§
Each section of the notes would have a specified content (with documents being
present according to individual patient need)
§
An index sheet would be created. This would include listing all the standard content
of each section in order it must be filed, indicating which documents are mandatory
and which are added according to individual patient need.
§
Some documents would be removed, to avoid duplication.
§
A new Assessment of Capacity page would be introduced; a ‘best practice’ idea
picked up from another hospice’s notes.
Two dummy sets of notes were then compiled and the Multidisciplinary Team was given
opportunity to comment on the proposed new format.
It was then agreed that the new format would be introduced on Wednesday 2nd October;
to coincide with the arrival of the new Specialist Registrars
Prior to the introduction of the redesigned notes they were ‘demonstrated’ to the Nursing
Team; highlighting what had changed and how they should be used.
On their first day of induction, the new Specialist Registrars were given a comprehensive
session on how to use the multidisciplinary notes at Garden House Hospice.
All other members of the Hospice Medical Team and Multidisciplinary Team were trained
individually or in small groups, during the week that the new notes were introduced.
Seven, complete, reference sets of notes each with an index at the front were produced
and distributed throughout the Hospice. Additionally eleven copies of the index were
laminated and distributed.
Comment sheets were created to enable the Multidisciplinary Team to record any
difficulties they experienced using the new notes, along with suggestions for how this
could be improved.
Within the first three months, several minor amendments were made and additional
continuation pages were developed.
Three months after the new notes were introduced an audit was carried out to identify if
they were being used correctly. The audit demonstrated that the new notes were
generally being well completed. An Action Plan was drawn up, for the following areas for
further improvement to be taken to all relevant Team meetings, by 1st March 2014: §
Notes are multidisciplinary; all sheets can/should be used by any Team
§
Remember to number the top of pages
§
If making any entry in the patients notes you must sign the Signing Sheet
§
Ensure pages are filed in the correct Section and in the correct order
It is planned to carry out a re-audit in May 2014; to assess if there has been an
improvement in the listed areas and to identify if the notes continue to be used correctly.
Experience
Priority
Planned discharges, from the In-Patient Unit, will be managed smoothly, effectively and in
a timely manner for the patient, their family and carers.
What has been achieved?
Over the past year one Trained Nurse and one Healthcare Assistant have been rotated to
work in Hospice at Home. These 2 team members have spent a year in Hospice at Home
before returning to the In-Patient Unit. All new staff recruited by Garden Hospice House
are employed across the whole Hospice to allow for easy rotation to Hospice at Home, the
In-Patient Unit and Day Services. This enables the Nursing Team to experience what it is
like to work and be cared for in the community, and in an In-Patient setting. This
experience helps to inform the nursing team when planning for discharge.
A leaflet has been designed called “preparing for discharge” which is given to patients as
soon as we start thinking about discharge. This explains how a discharge is likely to be
arranged, and contains telephone numbers of professionals that may be involved in a
patients care once they return to the community.
Each discharge is overseen by 2 named members of the nursing team; however, the
whole nursing team is responsible for ensuring a smooth discharge.
Family and Professionals Meetings are arranged if necessary prior to a patients discharge.
A template has been devised to provide structure to Family and Professionals Meetings
and ensure all meetings are planned, conducted and recorded in a consistent way.
Statements of Assurance from the Hospice Management Team
The following are statements that all providers must include in their Quality Accounts.
Many of these statements are not directly applicable to specialist palliative care providers;
explanation of these statements and why they do not apply to Garden House Hospice has
been included, in italics, where appropriate.
Review of Services
During 2013 - 2014 the Garden House Hospice provided the following NHS services: §
In-Patient Unit
§
Hospice at Home
§
Day Services – including Outpatients
§
Family Support Services
§
Specialist Palliative Care Advice Line
Garden House Hospice has reviewed all the data available to them on the quality of the
care in all of these NHS services.
The income generated by the NHS services reviewed in 2013 - 2014 represents 100% of
the total income generated from the provision of NHS services by the Garden House
Hospice for 2013 - 2014.
The income generated from the NHS in 2013 - 2014 represents 38% of the overall running
costs of Garden House Hospice in 2013 - 2014; 36% from NHS Hertfordshire and 2% from
NHS Bedfordshire.
The remaining 62% of overall running costs is sourced through voluntary income
generation; donations, fundraising, charity shops, lottery activity and income from
investments.
Participation in Clinical Audit
Garden House Hospice was not eligible in 2013 - 2014 to participate in any national clinical
audits or national confidential enquiries and therefore there is no information to submit
This is because Garden House Hospice only provides palliative care and none of the 2013 2014 national audits or confidential enquires related to specialist palliative care.
Research
The number of patients receiving NHS services provided or sub-contracted by Garden
House Hospice in 2013 - 2014 that were recruited during the period to participate in
research approved by a research ethics committee was NIL.
While Garden House Hospice has not recruited any patients to participate in research in
2013 - 2014 it has fully supported any patients who were participating in research for
other providers during this period.
Use of the CQUIN Payment Framework
A proportion of Garden House Hospice income in 2013 - 2014 was conditional on
achieving quality improvement and innovation goals agreed between Garden House
Hospice & NHS Hertfordshire and Garden House Hospice & NHS Bedfordshire, through the
Commissioning for Quality and Innovation payment framework.
Further details of agreed goals for 2013 - 2014 and for the following 12 month period are
available in Appendix 1. and Appendix 2.
For NHS Hertfordshire the CQUIN payment equates to 2.5% of their total contribution.
For NHS Bedfordshire the CQUIN payment equates to 2.5% of their total contribution.
Statement from the Care Quality Commission
North Herts Hospice Care Association is required to register with the Care Quality
Commission and its currently registered to carry out the following regulated activities:
a.
Diagnostic and screening procedures
b.
Personal care
c.
Treatment of disease, disorder or injury
For Regulated Activities a. and c. the Nominated Individual is: Vivian Lucas
For Regulated Activity b. the Nominated Individual is: Sally Alford
North Herts Hospice Care Association has the following conditions on registration:
1.
The Registered Provider must ensure that the regulated activities a. b. or c. is
managed by an individual who is registered as a manager in respect of the
activity, as carried on at or from the location Garden House Hospice.
2.
This Regulated Activity may only be carried on at or from the following locations:
Garden House Hospice, Gillison Close, Letchworth Garden City, Hertfordshire,
SG6 1QU
The Care Quality Commission has not taken enforcement action against Garden House
Hospice During 2013 - 2014.
Garden House Hospice has not participated in any special reviews or investigations by the
Care Quality Commission during the reporting period.
Data Quality
Garden House Hospice did not submit records during 2013 - 2014 to the Secondary Uses
service for inclusion in the Hospital Episode Statistics which are included in the latest
published data.
This is because Garden House Hospice is not eligible to participate in this system.
Information Governance Toolkit Attainment Levels
Garden House Hospice did not participate in formal Information Governance Assessment
in 2013 - 2014.
Garden House Hospice has policies and procedures in place for confidentiality, information
management and records management.
As a Voluntary Sector Organisation, Garden House Hospice plans to explore the
requirements for establishing an N3 connection and use of the NHS Information
Governance Toolkit in 2013 – 2014 (see Priorities for Improvement 2014 – 2015; Safety).
Information Governance Assessment, leading to an Information Governance Grading, is
achieved through completion of the NHS Information Governance Toolkit.
Clinical Coding Error Rate
Garden House Hospice was not subject to the Payment by Results clinical coding audit
during 2013 - 2014 by the Audit Commission.
Part 3: Review of Quality Performance
The National Council for Palliative Care (NCPC): Minimum Data Sets
The NCPC minimum data sets are the only information on hospice activity collected
nationally. The figures provide one measure of activity and outcomes of care for patients,
at Garden House Hospice, during the period 2013 – 2014 (2012 – 2013 figures provided
for comparison).
In-Patient Unit
2013 - 2014
2012 - 2013
Total number of admissions
260
268
Total number of patients
215
224
Number of new patients
197
199
% Occupancy
71
067
% Patients returning home
39
038
Average length of stay – cancer patients
12.4 days
11.5 days
Average length of stay – non-cancer patients
7.9 days
09.5 days
2013 - 2014
2012 - 2013
Total number of patients
125
108
% New patients
83.2
080
% Patient attendances
87
086
% Patient non attendances
13
014
2013 - 2014
2012 - 2013
Total number of patients
239
230
% New patients
92
091
% Re-referred patients
3
002
Day Services
Hospice at Home
Total face to face contacts
2270
2094
Total telephone contacts
954
820
17.7 days
21 days
Average length of care
Outpatients
2013 - 2014
2012 - 2013
89
103
Patients Diagnosis; Cancer/malignant diagnosis
68
172
Other diagnosis
16
125
Not recorded
5
126
56
173
6
104
Seen by Palliative Care Doctor (1 and follow up visits)
78
137
Seen by Physiotherapist
52
Not recorded
Seen by Complementary Therapist
229
Not recorded
2013 - 2014
2012 - 2013
Total service users
107
089
Number of telephone contacts
126
146
Number of individual counselling sessions
408
354
Number of group counselling sessions
65
N/A
Total number of patients
% New patients
% Re-referred patients
st
Bereavement Support
Performance against Commissioning for Quality and Innovation
(CQUIN) Payment Framework 2013 - 2014 - NHS Hertfordshire
CQUIN
Target
Implementation of Friends and Family Test
> 15%
CQUIN Achieved
Pressure Ulcers Improvement
>50%
CQUIN Achieved
Falls Improvement
>20%
CQUIN Achieved
Improvement in referral rates to hospice
services for non cancer diagnosed patients
> 10%
CQUIN Achieved
NHS Safety Thermometer Implementation
Complaints
Complaint on-going from 2012-2013: § Written complaint; Son and Daughter unhappy with Father’s care.
Outcome; Complaint not upheld. Ombudsman was involved and the complaint was
not taken any further.
During the period 2013 - 2014: Total Number of Complaints
11
Total Number of Complaints Upheld in Full
2
Total Number of Complaints Upheld in Part
1
Total Number of Complaints Not Upheld
7
Total Number of Complaints Still On-Going
1
Complaints Upheld in Full:
§
Email Complaint; Letter received as part of the recruitment process.
Recommendations;
o Letters sent out to be written by administration assistant, then checked by
the HR manager
o Old documentation/ templates to be deleted to avoid confusion
§
Verbal Complaint; Volume of Nurse call bell system.
Recommendations;
o Volume on call bell system reduced.
o Team requested to keep door to bathroom/ toilet corridor closed to minimise
disturbance from call bell control panel.
Complaints Upheld in Part:
§
Written Complaint; Unhappy experience of attending Day Hospice
Findings;
o Contact made with complainant who did not want a written response, but
was happy to have been heard.
o Reflection took place with Day Hospice staff.
o Complainant subsequently had a positive in-patient admission, and the
preferred place of care remained Garden House Hospice.
Complaints Not Upheld:
§
5 Written Complaints/ Emails; Cancellation of a fundraising event.
Findings;
o Correct process for management of complaints was not followed.
o Letters of explanation and apology sent to all complainants.
§
Written Complaint; Concern regarding a fundraising event
o Discussion with complainant by Voluntary Services Manager, which was
relayed to the General Manager and Head of Fundraising.
o Written response sent to complainant.
§
Verbal and written complaint; concern over decision making and care of
complainants husband.
o Complaint arose during a meeting between complainant, complainants
friend, and 2 members of the Hospice team.
o Written summary of dissatisfaction presented at meeting by complainant
o Written response sent to complainant and bereavement support offered.
Complaints Still On-Going:
§
Written Complaint; Communication between agencies when multiple agencies
involved in a relatives care.
Concerns
During the period 2013 - 2014 no concerns were raised.
Patient Accident, Incidents and Near Misses
The following patient related accidents and incidents were reported and investigated
during the period 2013 – 2014 (2012 – 2013 figures provided for comparison).
Medicines Related Incidents
10
(20)
Slips, Trips and Falls
32
(27)
Other*
43
(18)
Pressure Damage on Admission
48
(34)
Pressure Damage During Admission
08
(09)
The majority of slips, trips and falls related to deteriorating patients trying to maintain
their independence.
Examples of Others
* Several incidents occurred relating to patient transport, these matters were taken
directly to transport services to investigate.
* A patient specimen was not taken by the postman to the Lister Hospital as it had been
pushed to the back of a shelf and was therefore not seen; procedure changed to ensure
this does not happen again.
* Patient spilt a hot cup of team on their legs.
* Patients dentures were disposed of after vomiting into a bowl that dentures were in.
* Patients ear burnt when using curling tongs as requested; to use curlers in the future.
* Out of hours call unable to be referred to a community team as neither Herts nor Beds
would take responsibility for the patient, patient lived in Beds but had a Herts GP;
situation clarified with community teams the following day, no ill effect to patient.
* Patient became agitated and hit wife; support given to wife and patient reviewed.
Clinical Audit
During the period 2013 - 2014 the following, audits, were undertaken, using national audit
tools designed specifically for hospices, by Help the Hospices.
Audit Title
Date
Recommendations
Actions
Completed
Infection Prevention and Control
1. Policies and Processes
02/14
Add transmissible spongiform
encephalopathies to infection
control policy when next
reviewed.
Due for review
2015
2. Hand Hygiene
02/14
None
N/A
3. Patient Areas
01/14
Small stain on one curtain,
curtain needs cleaning
Yes
4. Clinical Rooms
01/14
None
N/A
5. Bathrooms
12/13
None
N/A
6. Patient Toilets/Bidets
02/14
None
N/A
7. Sluice/Dirty Utility
05/13
Some decorating work required
Yes
8. Domestic Rooms
08/13
None
N/A
9. Care of Deceased Patients
12/13
None
N/A
10. Sharps
01/14
None
11. Protective Equipment
02/14
None
Improvement
seen from last
years audit
N/A
12. Kitchen Areas
(excluding Main Kitchen)
07/13
Some general cleaning required
Yes
13. Public Areas
07/13
Plan required for cleaning floors Yes
and curtains
14. Toilets for Public Use
05/13
Signage required for availability Yes
of cleaning products
15. Offices within Clinical Areas
05/13
None
16. Visitors’ Accommodation
12/13
Communal items found in Removed
ensuite bathroom to be removed immediately
04/12
None
N/A
Bereavement Support
Bereavement support service
audit tool
N/A
Internal clinical audits in the period 2013 - 2014 included: Audit Title
Date(s)
Recommendations
New Documentation Audit
1/10/1301/12/13
Ensure all members of the team
use all sections of the notes.
Remember to number pages.
Signing sheet to be completed by
anyone writing in the notes.
Ensure pages are filed in the
correct order
Bereavement Support
Group Questionnaire Audit
01/06/13- Results to be used to review the
31/12/13 service offered and inform
decisions about future planning of
the service.
Raising Concerns About
Poor Practice
12/12/13
Permission to Destroy
Medication Audit
01/06/13
Do Not Attempt
Resuscitation Audit
1/06/1330/09/13
Blood Transfusion Audit
Nov 2013
Antibiotic Audit
01/1211/12
Include examples of what
constitutes minor or significant bad
practice in the policy when it is
next reviewed.
The Hospice Medical Team need to
be reminded of the need to
document permission to destroy
medication, on admission.
Actions
Completed
Action plan
produced and
taken to team
meetings.
To be
re-audited.
To be
re-audited in 6
months
N/A
Doctors
reminded of
the need to
document via
their white
board.
Discuss DNAR with patient (and To be
relative) before discharge home or reaudited
transfer from the Hospice. The
leaflet “Your Medical Care at the
Garden House Hospice” should
continue to be used to facilitate the
discussion and clarify the situation.
Despite anecdotal reports that
some patients receive transfusions
outside policy recommendations,
N/A
there was no evidence of this.
Reaudit in 6
Clearer documentation required
months
around reason for starting
antibiotics, any adverse effects and
whether cultures had been sent off.
Staff Survey
Garden House Hospice repeated the Staff Survey run by Birdsong Charity Consulting, in
July 2013. Questionnaires could be completed, anonymously, on-line or paper copies were
available from the Staff Room. This was to see if improvements had been made following
the previous years recommendations.
Following the results of the 2012 staff survey, staff were given the opportunity to attend a
number of focus group meetings. Although not well attended, the meetings did generate
a large number of staff suggestions. These were summarised and passed to the Hospice
Management Team members for consideration. An action plan was drawn up and
circulated to all team leaders for discussion with staff at team meetings. In addition,
volunteers were sought to progress a number of the suggestions e.g. the layout of the
Staff Room, organising more social events for staff. Regrettably, no one has come
forward to work on any of the suggestions to date. However, the Hospice Management
Team members are keen that staff reconsider the action plan and if they wish to assist
with any of the suggestions, they speak with their Team Leader or a member of the
Hospice Management Team.
The Trustees offered a “meet and greet” opportunity and the Hospice Management Team
members have given staff the opportunity to meet with them.
The 2013 survey was divided into four sections: 1. The Organisation and Communication
2. Morale and Work Life Balance
3. People Management
4. Development and Reward
Each section consisted of a number of statements which could be scored; strongly agree,
agree, neutral, disagree or strongly disagree.
68 of 103 members of paid staff responded to the survey; a response rate of 66%.
§
90% (85%)
Understand what the organisation wants to achieve
§
90% (88%)
Were proud to work for the charity
§
85% (90 %)
Felt they were making a difference
§
93% (86%)
Enjoy the work they do
§
96% (92%)
Enjoy working with the people in this charity
§
48% (42%)
Did not feel they were well informed about what was
happening in the charity
§ 31% (37%)
Felt their views were not listened to and valued
(figures in brackets are last years findings).
The findings were circulated to all staff, who then had the opportunity to feed back, to
their team leader, any suggestions arising from the survey.
Feedback from Patients and Families on Services
Garden House Hospice values the feedback we receive from patients and families; the
Hospice Team is constantly looking for ways to maintain and improve the quality of care
for patients and their family/carers.
Patient Questionnaires are given out during a patient’s stay on the In-Patient Unit, in
conjunction with their first Day Hospice Review (usually the 4th visit) and by the
Hospice @ Home Team, to respite patients, on their fourth visit. Matron reviews returned
questionnaires and acts on any issues raised, immediately. Questionnaires are confidential
but patients are given the option to give their name; if they would like a written response
or the opportunity to comment further on our services. Questionnaires are audited every
six months.
Family/Carer Questionnaires are sent out, via the Family Support Team, with the offer of
bereavement support, six weeks after the patient’s death, given to family/carer on a
patient’s discharge from the In-Patient Unit and displayed around the Hospice for families
and carers to pick up. Matron reviews returned questionnaires and acts on any issues
raised, immediately. Questionnaires are confidential but family/carers are given the option
to give their name and address; if they would like a written response or the opportunity to
comment further on our services. Questionnaires are audited every six months.
Family Support Service Questionnaires are sent out to all individuals who have completed
a series of planned support sessions, with the Family Support Service, within two weeks of
their sessions finishing. The Family Support Service Manager reviews returned
questionnaires and acts on any issues raised, immediately. Questionnaires are confidential
but individuals are given the option to give their name and address; if they would like a
written response or the opportunity to comment further on our services. Questionnaires
are audited every six months.
All these questionnaires ask the individual to score statements, about the various Hospice
Services and Departments, from 1 – 4; 1=very dissatisfied, 2=dissatisfied, 3=satisfied,
4=very satisfied N/A=Not Applicable.
Doctor Feedback Questionnaires are sent (with a reply paid envelope) to patients who
have attended Garden House Hospice for a first Out Patient consultation, are seen at
home, or by a different Doctor. There are ten questions about the consultation which can
be scored; Yes definitely, To Some Extent, Not Really, Definitely Not or Does Not Apply.
There is an additional question, ‘Overall, how satisfied were you with the doctor that you
saw?’ This can be scores; Very Satisfied, Fairly Satisfied, Not Really Satisfied or Not At All
Satisfied.
Patient Questionnaires
Comments relate to Patient Questionnaires received back between 1.1.2013 and
31.12.2013. During this year 20 Patient Questionnaires were received back.
Care and Support
How satisfied were you with your involvement in planning your care?
§
Scored 54/56; 95.5% satisfaction
“The gentle yet professional care is wonderful. As G’s carer I had felt very lonely and
unsupported. After the first week I felt a weight had been lifted. Absolutely amazing for
both patient and carer.”
Nutrition and Diet
Were your dietary needs met
§
Scored 31/32; 97% satisfaction
“I cannot express highly enough my gratitude at the expertise and caring my husband
received in the four days before his death. A wonderful environment and superb staff.
Thank you.”
Day Hospice
Structure of the day
§
Scored 28/28; 100% satisfaction
“I appreciate my Wednesday visit as the nurses listen to any concerns and my treatment
progress and I go home feeling inside a group rather than “out of the loop” especially as I
live on my own and am new to the area.”
“I look forward to my weekly visit, due to the ambience of the facility and total friendly
attitude of all the staff & volunteers. This has a “knock- on- effect” to other attendees,
leading to a pleasant visit. Also, all aspects of my condition are fully dealt with promptly.”
Inpatient
Suitability of bathroom facilities
§
Scored 27/28; 96% satisfaction
Hospice at Home
Is the service reliable? (Yes/No response)
§
Scored 8/8; 100% satisfaction
“The support given from Hospice community nurses is great – I could not have managed
without their help and cheerful faces, i.e. such wonderful personalities, caring they gave D
and always asking how I am coping. All Hospice community nurses are a breath of fresh
air.”
Family/Carer Questionnaires
Comments relate to Family/Carer Questionnaires received back between 1.1.2013 and
31.12.2014. During this year 142 Family/Carer Questionnaires were received back.
In Patient Care
Information regarding changes in care
§
Scored 266/276; 96% satisfaction
“I cannot put into words what a wonderful experience it was to meet all involved in the
hospice. I did not realize before that there was such a wonderful service being given.”
“Cannot think of any improvements to the care my father received or the support given to
the family.”
Quality of your relative’s meals
§
Scored 257/268; 96% satisfaction
“Excellent facilities with friendly staff who looked after my wife with care &
thoughtfulness. Always attentive & considerate. Meals were of a high quality throughout.”
Suitability of environment; Privacy
§
Scored 176/182; 97% satisfaction
“Our mum LC was a wonderful loving kind and gentle lady that deserved the best care and
respect that this could give to her, and she got that from you. Thank you very much. Xxx”
“My wife’s condition was terminal. Our family could not have asked for greater loving care
as she slipped away peacefully, painlessly and with dignity.”
Day Hospice
How valuable is/was your relatives attendance at Day Hospice to you?
§
Scored 88/92; 93% satisfaction
“Of great benefit and gave me time to go out and not worry for a few hours. Can’t thank
the staff enough. They are fantastic.”
“Gives me his wife much needed break. Very much appreciated.”
Hospice at Home
Your involvement in planning care
§
Scored 231/236; 98% satisfaction
“I can only repeat what I said to the nurses. They are angels in disguise. They supported
both of us in the most caring way and I will never forget them.”
Family Support Service Questionnaires
Comments relate to Family Support Service Questionnaires received back between
1.3.2013 and 28.02.14. There was a response rate of 66% (37/56).
Before your first appointment
Was the time you waited for your first appointment acceptable?
§
Scored 134/144; 93% satisfaction
“In the same way that the Hospice team helped M to die in his own home with love and
care, the FSS have helped me start living. I was frozen and unable to move forward and J
helped me take little steps to start enjoying life on my own. I will be forever grateful on
both counts.”
Your sessions with the Family Support Service
Were you able to feel comfortable and at ease in the session?
§
Scored 145/148; 98% satisfaction
“We have always been received and made to feel assured of your care & understanding
with a welcome that I have not felt anywhere else – ever. Thank you.”
Do you feel the person supporting you understood what you talked about in the
sessions?
§
Scored 144/148; 97% satisfaction
“I found my experience of counselling with JC extremely helpful. She was always
welcoming, sensitive and understanding and I do feel she helped me to move on. I would
certainly recommend the service to someone else who was in my position. My experience
of the Garden House Hospice has been amazingly positive and it is wonder that everything
is so welcoming and given with such generosity. I shall always be in debt to you!”
Now your sessions with the Family Support Service have come to an end
Do you feel the support from the Family Support Service has been helpful to you?
§
Scored 140/148; 95% satisfaction
“The sessions were really helpful. The person supporting actively listened and then offered
a summary, which was very useful in clarifying thoughts and provoking a “next step”,
without any “pressure” being applied.”
How likely would you be to recommend the Family Support Service to another person?
§
Scored 138/144; 96% satisfaction
“The support sessions were very helpful and supported me immensely during my grieving
period.”
Doctor Feedback Questionnaire
As Doctor Feedback Questionnaires have been in use since November 2012 and are
audited annually. Questionnaires and comments are reviewed, as soon as they are
returned, so that any necessary actions can be taken.
No actions have been necessary to date.
The following comments relate to the 8 Doctor Feedback Questionnaires received back
between 1.04.2013 and 31.3.2014.
Overall, how satisfied were you with the doctor that you saw?
§
Very Satisfied
8/8
§
Fairly Satisfied
0/8
§
Not Really Satisfied 0/8
§
Not At All Satisfied 0/8
“Very thorough, the Doctor had all the relevant medical information which was necessary
for the meeting, so therefore we were able to discuss fully.”
“I found Dr X to be attentive and considerate during my consultation with him and he
managed to give me peace of mind after what had been another difficult time for me.”
“Everything was extremely satisfactory on my meeting with Dr Y and there is nothing I
could suggest that would improve matters.”
“Made us fell very welcome and did not make us feel like a NHS number, but a person.”
“I found Dr Z to be very kind and easy to talk to. No examination were needed at the
time, mainly questions and answers at this first visit. I know the circumstances are
different, but if all doctors were like Dr Z, the world would be a far better place.”
“Dad has only had 1 initial visit so far but on that occasion, Dad was involved in decision
about his care.
It was a respectful, comfort visit and put my Dad and myself at ease.”
External Statements:
NHS Hertfordshire
GARDEN HOSPICE, Letchworth Garden City
Statement
East and North Hertfordshire CCG have reviewed the information contained in the Quality Account.
During 2013-14, Garden Hospice continued to deliver high quality care to the population of
Hertfordshire. The Quality Account clearly sets out achievement against the priorities set for 201314 and demonstrates continued quality improvement with a number of improvements being made
to ensure the safety of patients receiving care. During the year the Hospice also received a positive
CQC inspection where they were found to be compliant with all the outcomes assessed.
The hospice has a strong emphasis on seeking feedback from patients and their families on all
services including family support, through their range of satisfaction surveys. The quality of service
provided is evident through the positive feedback received from patients and relatives throughout
the year.
The priorities set out for 2014-15 build upon the successes of 2013-14 and demonstrate a
commitment to quality improvement. The priorities identified aim to achieve greater
responsiveness with regard to sharing of information, supporting discussion with patients and
providing greater support for carers.
During 2014-15 the CCG looks forward to building on the relationship already developed with the
hospice to ensure open dialogue and continued quality improvement for the population of
Hertfordshire.
Healthwatch Hertfordshire’s response to Garden House Hospice Quality
Account 2014
Healthwatch Hertfordshire is pleased to submit a response to Garden Hospice’s Quality
Account. We welcome the emphasis that the Hospice places on being a values based
organisation and the care values which are stated at the beginning of the document
The Quality Account gives a clear a picture of what has achieved in the year and
detailed proposals to show how priorities for 2014-15 will be met.
We are pleased to note that the Hospice received such a positive CQC inspection and
met all the checks on standards.
Priorities for 2014-15 are a good combination of the patient and carer focused (the
implementation of the distress thermometer and the introduction of a respite service)
and system improvements including improved information governance.
Progress on the priorities from 2013/14 is effectively demonstrated. The excellent
survey results showing significant increases in nurse confidence in using the McKinley
syringe driver, demonstrates the effectiveness of the training provided. The Hospice also
includes the ongoing training and management systems to ensure continued effective
use of the syringe driver. The Hospice has implemented overhead tracking hoists in six
individual service rooms as planned, introduced safer sharps and redesigned patient
notes. We welcome the progress made and the continuing audits to show continuing
good practice and improvement. Progress towards smooth management of planned
discharge is also described (though in a less detailed way).
Garden House’ Quality Account provides helpful details on complaints received and the
way the information is presented shows a clear intention to learn from complaints and
implement improvements to avoid repetitions.
Information on patient accident, incident and near misses shows a similar picture to
2012-13 except for a noticeable growth in the ‘other’ category. Some useful examples
showing the breadth of issues are provided, though it will be important for the Hospice
to monitor this area carefully and ensure any lessons are learnt by the Hospice and its
partners.
The account includes detailed and very impressive satisfaction results and comments
from its patients and families (including satisfaction with Doctors), and results from the
staff survey and also
Healthwatch Hertfordshire thanks garden House for this opportunity to comment and
looks forward to opportunities to work together in the coming year.
Sarah Wren MBE, Chairman Healthwatch Hertfordshire, June 2014
Chairman
Health Scrutiny Committee
19/05/2014
Seamus Quilty
County Councillor
Bushey South
County Hall
Postal Point: CH0147
Pegs Lane
Hertford
SG13 8DE
Tel 01992 556557
Fax 01992 556575
email:
seamus.quilty@hertfordshire.gov.uk
Dear Colleague
Unfortunately, due to the recent departure of our health scrutiny officer, the committee is unable to
provide the resource needed to respond to the Quality Account on this occasion. Despite this,
regular communication between the Health Scrutiny Committee and the Trust over the past 12
months leaves us confident of continued support for the scrutiny process. The committee anticipates
working with the Trust on future Quality Accounts.
Yours sincerely
Seamus Quilty
Chair, Health Scrutiny Committee
NHS Bedfordshire
No response was received from NHS Bedfordshire.
Healthwatch Bedfordshire
No response was received from Healthwatch Bedfordshire.
Bedfordshire Health Scrutiny Committee
No response was received from Bedfordshire Health Scrutiny Committee.