Greenwich & Bexley Community Hospice
2013–2014 Quality Account
Wife of patient, Bexley
Version: 2.0 – June 2014
GBCH 2013-2014 Quality Account
Contents
Page
Part 1 – Chief Executive’s Statement
3
Part 2 – Priorities for Improvement and Statements of Assurance from the Board 4-21
2.1
Priorities for Improvement 2014 – 2015
4
2.2
Priorities for Improvement 2013 – 2014
10
2.3
Statement of Assurance from the Board
15
2.3.1
2.3.2
2.3.3
2.3.4
2.3.5
2.3.6
15
15
15
16
17
Review of Services
Income Generated
Participation in National Clinical Audits
Participation in Local Audits
Research
Quality Improvement and Innovation Goals Agreed with
our Commissioners
2.3.7 What Others Say about GBCH
2.3.8 Data Quality
2.3.9 Information Governance Toolkit Attainment Levels
2.3.10 Clinical Coding Error Rate
Part 3 – Review of Quality Performance
3.1
17
17
20
20
21
21-30
Comparison with National Minimum Data sets
21
3.1.1
3.1.2
3.1.3
3.1.4
3.1.5
3.1.6
22
23
24
25
26
27
Inpatients
Day Care
Home Care / Hospice at Home
Hospital Support Teams
Bereavement Support
Outpatients
3.2 Clinical Governance
28
3.3 Training
28
3.4 Health Improvement Network
28
3.5 End of Life Care Clinical Leadership Group
29
3.6 Challenges
29
Appendices
Appendix 1: Greenwich
Appendix 2: Bexley
Appendix 3: Healthwatch
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31-35
31
33
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GBCH 2013-2014 Quality Account
Part 1 - Chief Executive’s Statement
Greenwich & Bexley Community Hospice celebrated 20 years of caring across the
local area this year; and so much has changed since the first day hospice patients
arrived in February 1994. The Hospice continues to seek to improve and extend its
services to meet the needs of dying people across the whole community and it is my
pleasure to present our Quality Account for 2013/14 which documents some of the
progress we have made as well as some of the challenges we face.
Our community services continue to expand in response to need, with an increased
number of people being cared for at home in this year. With this increase we have
also been privileged to support more people with a diagnosis other than cancer
and have been able to facilitate an increase in the number of people who have
been able to achieve a home death (where most people say they wish to be cared
for). We continue to work in partnership with our commissioners and other local
service providers to reduce the number of people who die in hospital and achieved
home or hospice as place of death for 76% of people.
The Hospice is registered with the Care Quality Commission and was inspected on
13th December 2013 and 5th March 2014, the details of these inspections are
included in this report.
The planned development of the Hospice building began in January 2014, and we
began reviewing elements of Hospice service to ensure that the benefits of the
building project are maximised within the year. We are extremely excited about the
opportunities that our building expansion will provide to reach more people who
need our care and support.
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
the Hospice.
Kate Heaps
Chief Executive
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GBCH 2013-2014 Quality Account
Part 2 – Priorities for Improvement and Statements of Assurance from the Board
2.1 Priorities for Improvement 2014 – 2015
The following key Priorities for Improvement 2014/15 have been identified. These
cover the three quality domains of Clinical Effectiveness, Patient Experience and
Patient Safety:
Improvement Priority 1: Access to Hospice Services
Why this was chosen as a Priority
This was an Improvement Priority for 2013-14 but the Hospice strategy identified this
as a key area for development over the next 3-5 years and as such this is a long
term strategic goal. (See page 13 for progress to date).
In 2012 Help the Hospices (HtH) commissioned the Cicely Saunders Institute to
produce an evidence-based report on the future level of need for hospice care.
The fundamental aim of this project, conducted under the auspices of HtH’s
Commission into the Future of Hospice Care, was to predict the likely impact of
demographic changes on the future demand of care provided by hospices. The
report made the following conclusions:
 UK mortality trends have and are changing towards people living longer
and dying with more complex needs and diseases at an older age.
Hospices will therefore need to optimise their capacity to care for older
people at the end of life
 Evidence from the UK shows that home is the most frequently chosen place
to die, however the Older Old (85+) and non-cancer patients are less likely
to die at home than patients with a cancer diagnosis. Hospices therefore
need to better understand why this is and assess patients’ “preferred place
of care” in order to respond to the needs of the local population
 Current models of end of life care provision have been based on past
assumptions and provide “deluxe dying for the few” (Douglas 1991).
Hospices therefore need to review the way they do things
GBCH has an ethnically and socio-economically diverse catchment area. Like
most other hospices, the Hospice does not receive a representative number of
referrals for people across the range of the population; however recent changes
to the model of care provided by GBCH appear to be making some in-roads in this
area.
What does the Access to Hospice Services Priority mean?
The Hospice has developed its services over recent years to ensure that care is
provided across patient pathways in a variety of settings. Opportunities to provide
integrated care in hospital, at home or in a care home and in the Hospice building
have already helped to improve accessibility for people regardless of their
diagnosis, age, ethnicity, preferred place of care etc. However the Hospice
recognises that we still have a long way to go in providing access to Hospice
services for all who need it.
GBCH has identified that, as part of its response to the ever increasing need for
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GBCH 2013-2014 Quality Account
Palliative and End of Life Care (EoLC) for people who may not have traditionally
accessed these services, it wishes to redesign referral pathways, integrating existing
elements of service further and developing new areas of provision.
As part of this, the concept of the Hospice as “a hub” will be developed. This
enables the physical space to be used not only by patients, families and staff, but
also to be a “hub” for the local community. For example, the Hospice may provide
a space for socialising, rehabilitation, volunteering, receiving new kinds of care
and support and training and education. By opening up the Hospice to other
members of the community, we aim to challenge people’s perceptions of who
and what hospices are there for, opening up the doors to support more people
throughout their lives.
What are the plans for this Priority?
 To ensure that people are able to express their preferences, we will continue
to embed Advance Care Planning into the care pathway within and outside
Hospice services in Greenwich and Bexley boroughs. The Advanced Care
Planning project is a scheme to support people with life limiting illness, to
develop their own unique care plan for the future. This project was made
possible by a grant from Comic Relief, to enable the Hospice to recruit and
train Advance Care Planning volunteers.
 To develop and introduce new social support services, including befriending,
supportive groups and drop-in services
 To ensure all Hospice’s medical and nursing staff are more confident and
competent in caring for older people, people with the full range of life-limiting
illness including dementia and those who are living with long term conditions
 Improving and enhancing the delivery of integrated end of life care across
both boroughs and to continue to ensure that people who are in hospital are
enabled to die in their place of choice by improving transitions between care
settings
 To review ambulatory care services to improve access to the Hospice for reablement, complementary therapies, financial and housing advice,
psychological support and so on
 To increase the provision of education and training to local health and social
care partners
In addition, the Hospice will review its referral processes, and ensure that people
receive the most appropriate care in the most appropriate setting, in a timely
manner, through the development of a new co-ordination or “First Contact” centre
at the Hospice.
As part of this strategic goal, GBCH is developing new facilities on the Hospice site
including a purpose built rehabilitation gym, a new education and training facility
and a coordination centre, where we will provide a First Contact centre, integrating
specialist community services, our end of life care services and developing and
building on our partnerships with other health and social care providers.
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Progress against the plan to date:
 Evaluation of Advance Care Planning (ACP) Project in Greenwich, which has
been funded by a grant from Comic Relief, has commenced. It is expected
that the data collection will be completed and the results published later in
2014
 The Hospice’s “Capital Build Project” building work commenced in January
2014. It is anticipated that this building work will be completed by February
2015
 Evaluation of the Hospice Neighbours service (a “befriending” service) is
taking place alongside the delivery of the service and further recruitment is
planned to expand the service during 2014
 The staffing and structure of the Hospice’s new “First Contact” service has
been developed and the operational policy for the new service will be
developed during 2014 in preparation for the completion of the new build
 A review of the service delivery models for Day Hospice and the
Lymphoedema Service are due to take place in 2014
 The Hospice has delivered bespoke training and awareness sessions for local
faith leaders and social care staff from the local boroughs during 2013
 The Hospice’s new Nurse Consultant role was agreed by the Hospice’s Board
of Trustees in 2013 and the post was recruited to in 2014. Initially funded for
one year by NHS Greenwich, the Nurse Consultant will help drive
improvements in care for dying people across and between the Queen
Elizabeth Hospital and the Hospice
 The Hospice has been working with the Greenwich Prison’s Cluster to ensure
that people in custody have appropriate access to end of life care. A regular
review meeting for prisoners with life limiting illness was established in March
2014 and a strategy for end of life care in the prisons will be finalised by July
2014
How progress will be reported
Progress on this priority will be regularly reported to Clinical Leads meetings, the
Quality & Safety Committee, relevant project boards and to the Board and Trustees.
In addition, formal written reports will be submitted to commissioners and grant
funding bodies.
Improvement Priority 2: Embed Clinical Research and Audit
Why this was chosen as a Priority
The Hospice recognises that palliative care research and audit are essential
elements in improving patient care and services. The current evidence base for
many hospice palliative care interventions is limited and is therefore reliant on
hospice and palliative care engagement in research in order to inform practice
and progress. As the report “Research in palliative care: can hospices afford to
not be involved?” (October 2013) for the Commission into the Future of Hospice
Care identified, research in the hospice setting has many challenges and requires
appropriate leadership, resources and expertise. However to date GBCH has not
had the relevant experience to enable us to actively participate fully in research
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GBCH 2013-2014 Quality Account
activities. In terms of clinical audit, although the Hospice has conducting regular
clinical audits, GBCH would like a more co-ordinated and structured approach
which would be very beneficial.
In November 2013 the Hospice appointed a new Medical Consultant who has had
significant experience in research and audit and so a lead responsibility for
research and audit has been added to her practice portfolio.
What is Clinical Research and Audit?
Hospice engagement and understanding of research at different levels is
necessary to ensure evidence based practice. Clinical audit provides assurance
of compliance with best practice standards, with the aim of improving quality of
care and patient outcomes.
What are the plans for this Priority?
Research:
Greenwich & Bexley Community Hospice aims to be a “Research Active Hospice”
adopting the Research Framework for Hospices (Payne and Turner 2012). In this
framework three levels of research engagement described:



Level 1: research awareness in all professional staff
Level 2: engagement in research generated by others
Level 3: engagement in research activities and leadership in developing and
undertaking research
The Hospice has appointed a Research Lead, Dr Ruth Branford and set up a
Research Governance and Management Group in order to achieve, in the first
instance, the first 2 levels of research engagement.
The Hospice has already made progress towards Level 1 with inclusion of research
topics on the regular education programme, regular circulation of palliative care
journals and the development of a multi-professional journal club.
Achieving Level 2 is underway in partnership with the Cicely Saunders Institute, King’s
College London. We are in the set-up process to join the multisite integrated
Palliative Care Outcome Scale (iPOS) validation study, and aim to be involved in the
South London Collaboration for Applied Health Research and Care (CLAHRC). Dr
Branford also maintains her research collaboration with Royal Marsden Hospital. The
Hospice Research Governance and Management Group are also open to other
future research collaborations.
Clinical Audit:
In order to co-ordinate Clinical Audit activity at the Hospice, Dr Ruth Branford has
also been appointed Clinical Audit Lead. The Clinical Audit Lead is responsible for
the development of an annual audit plan. A new system of audit proposal and
approval has been introduced to ensure quality and ensure appropriate
prioritisation.
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GBCH 2013-2014 Quality Account
How progress against the plan will be measured
Progress in Level 1 research engagement will be measured by attendance at
teaching sessions, and journal clubs. Progress in Level 2 will be measured by
successful recruitment to the clinical studies and ultimately publications.
Clinical audit proposals will be discussed at Clinical Leads and results including
recommendations will be fed back to the same group.
How progress will be reported
Progress will be monitored by the Research Management and Governance Group
and reported to the Hospice Quality and Safety Committee.
Clinical Audit activity will be reported to via Clinical Leads to the Quality and Safety
Committee.
Improvement Priority 3: Workforce, Education and Training
Why this was chosen as a Priority
In 2013, Help the Hospices (HtH) produced a number of reports relating to
Workforce, Education and Training:
 Working towards a Hospice Workforce that is Fit for the Future written with
Skills for Health, this paper details some key roles and skills that will be
needed in the hospice workforce in the future.
 The Future of Hospice Education and Training produced with the National
Association of Palliative Care Educators, explores how Hospices can
preserve and improve upon their vital role as educators to the end of life
care sector, in a future which looks markedly different.
Other reports also coming out of the HtH commission looked at specific roles in
Hospices including the Palliative Care Medical Consultant, Clinical Nurse Specialists
and Volunteers.
Like many Hospices and other Healthcare services in London, the recruitment of
suitable staff for some roles has been increasingly difficult over recent years.
The Francis Report, the Berwick Report and the Cavendish Report all highlighted
the importance of organisations investing in their workforce to ensure that the
quality of care is maintained and that organisations have sufficient capacity to
meet the needs of their service users.
What is the Workforce, Education and Training Priority?
Maintaining a diverse, competent and motivated workforce is vital to the future of
Greenwich & Bexley Community Hospice. Our Staff and Volunteers are our most
important asset and it is important that we plan strategically for future challenges
that face us if we are to continue to support our local population.
The Hospice also has an important role in supporting and developing the skills of
staff working for other organisations so that they can provide excellent end of life
care.
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GBCH 2013-2014 Quality Account
What are the plans for this Priority?
We will develop a workforce strategy for the Hospice, which seeks to provide
opportunities for growth for existing staff and volunteers as well as developing
strategies to improve recruitment and developing new creative roles to ensure care
is delivered compassionately, creatively and efficiently.
We will work with other Hospices and Health Education South London (HESL) to
explore new opportunities, roles and training programmes for Volunteers and
Assistant Practitioners.
We will continue to develop our own staff, particularly focusing on advancing the
role of our senior nurses including developing advanced assessment skills and non
medical prescribing.
We will continue to develop training programmes and development opportunities
for external staff in line with the emerging End of Life Care (EoLC) education and
training strategy for South London. This will include us working collaboratively with
other Hospices to develop and deliver new training programmes and evaluate
these.
How progress against the plan will be measured
The Workforce Strategy will include key performance indicators which will be
reported on as part of the Head of Human Resources report to the Board of Trustees.
Service delivery elements of this strategy will also be presented to the Quality &
Safety Committee.
The Hospice has already been instrumental in establishing a South London Hospices
Education Collaborative which has established a number of education projects,
funded by HESL. Each project will be evaluated and the findings will be reported to
the Hospice Education and Training sub group as well as to HESL and London
Cancer Alliance. Ultimately the group will aim to publish its findings.
We will measure the number of staff completing external training and report this to
the Hospice’s Education and Training sub group. The Hospice’s mandatory training
dashboard is also presented to the Quality & Safety Committee every month.
The Annual Report of the Education and Practice Development Team will
demonstrate the reach and impact of their work, both internally and externally. This
report is presented to the Hospice’s Clinical Leads and the Quality and Safety
Committee.
How progress will be reported
Within the Hospice, progress will be monitored though the HR report to the Hospice
Board and through the Education and Training sub group.
Externally, progress will be monitored by HESL and the London Cancer Alliance.
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GBCH 2013-2014 Quality Account
2.2 Priorities for Improvement 2013 – 2014
The key Improvement Priorities for 2013/14 were:
Progress against Improvement Priority 1: Development of a Quality and
Governance Dashboard
What is a Quality and Governance Dashboard?
The “dashboard” allows clinical staff, managers and Trustees to monitor progress
and identify potential trends which may indicate problems that they need to focus
on.
Quality and Governance Dashboards help to drive this process by providing timely
and relevant information for clinical teams, presented in easy to understand
formats, with high visual impact.
What was planned / achieved
 The Hospice has an agreed dashboard format and structure, developed for the
four key areas of:
 Patient Safety
 Clinical Effectiveness
 Patient Experience
 Workforce Data
 The Dashboard covers monthly activity within the reported quarter and figures for
the previous two months and quarters
 An annual monthly/quarterly Dashboard reporting schedule has been
developed for the Quality & Safety Committee
Benefits/outcomes of this Priority
 The Mandatory Training Dashboard is now reported monthly to ensure closer
monitoring of staff attendance at training
 It enables comparison of performance against previous quarters at a glance and
to identify trends
 Confidence in our reporting has allowed us to participate in the Help the
Hospices National Hospice Inpatient Safety Benchmarking project which requires
reporting monthly performance against set criteria – Falls, Pressure Ulcers,
Medication incidents and Bed Occupancy
Any outstanding area to be addressed in 2014/15
 The Hospice plans to expand the areas reported in the Clinical Effectiveness
Dashboard, so that it reflects the data reported to NHS Greenwich and NHS
Bexley through regular commissioner reports
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GBCH 2013-2014 Quality Account
Example of Mandatory Training Monthly Dashboard
Agenda Item 5.3
Quality & Safety Committee - February 2014
Q4(January - March) Mandatory Training Dashboard
Mandatory Training / Clinical
Infection Control
(inc Hand Hygiene)
Dec
Jan
Feb
Forecast
82%
87%
87%
80%
Health & Safety
84%
89%
89%
80%
Fire
84%
89%
89%
80%
Risk Assessment
83%
87%
87%
80%
COSHH
82%
91%
91%
80%
Safeguarding
86%
92%
92%
80%
MCA / DOLS
63%
61%
61%
80%
ACP
73%
74%
74%
80%
Diversity
78%
79%
79%
80%
Moving & Handling
77%
77%
77%
80%
Basic Life Support
66%
69%
69%
80%
Safe Food Handling
69%
72%
72%
80%
Information Gov
71%
77%
77%
80%
Blood Transfusions
49%
68%
68%
80%
Medicine Management
55%
52%
52%
80%
Mandatory Training / non-Clinical
Infection Control
(inc Hand Hygiene)
Dec
Jan
Feb
Forecast
53%
55%
59%
80%
Communication
84%
86%
91%
80%
Information Gov
69%
70%
74%
80%
Safe Food Handling
61%
63%
63%
80%
Compliance
Compliance
Yearly
Target
Yearly
Target
•DetailHealth
any&Mandatory
Training
areas93%
where there are
Safety
85%
88%
80%or
Fireissues meeting
88% the90%
80%
will be, any
Yearly94%
Target, with reasons
Risk Assessment courses
86%spaces
88% etc),
93%if known
80%
(staff availability,
COSHH
84%
86%
91%
• Action plans
/ proposals
for detailed
areas to meet 80%
Moving & Handling
84%
86%
92%
80%
Yearly Target
Diversity
84%
86%
91%
80%
Progress against Improvement Priority 2: Launch a Patient & Carer Survey
Programme
What is a Patient & Carer Survey Programme?
GBCH decided to adopt a variety of formal approaches to capture and collate
patient and carer feedback.

VOICES (Views of Informal Carers) - This is a postal questionnaire which collects
information from bereaved Next of Kin four/five months after the patient has
died. This is a well established and validated tool.

SKIPP (St Christopher’s Index of Patient Priorities) – This is an outcome
measurement tool which enables staff to assess the impact on patients of the
care they deliver and show changes in symptoms over time. It is an established
and validated tool.

FFT (Friends and Family Test) – This is a simple, comparable test which, when
combined with a follow-up clarification question, provides a way of recognising
good and bad performance.
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GBCH 2013-2014 Quality Account
What was planned / achieved
 The VOICES survey was launched in August 2013
 The SKIPP questionnaire (for patient completion) was launched in our Day
Hospice in September 2013
 FFT was launched in the Hospice’s “Let’s Get Moving” and “Stepping Stones”
services in July 2013 and then implemented on the Hospice’s Inpatient Unit
(Woodlands) for patients who are discharged. The FFT was also added to the end
of the SKIPP Follow up questionnaire used in Day Hospice
Benefits/outcomes of this Priority
Since its launch, the VOICES questionnaire response rate has consistently been
around 36%, which is slightly better than the response rate from other hospices. This
response rate is split 63%/30% for our two boroughs of Bexley and Greenwich with the
remaining 7% of responses coming from other areas.
The responses we have received to date have provided views of bereaved carers of
the Hospice’s performance across a number of key areas such as:




Preferred Place of Care
Relief of Pain
Dignity and Respect
Quality of Care
A recent review of the VOICES responses received to date has identified a number
of proposed refinements to the survey:

There should be two versions of the VOICES questionnaire. One version will be for
Bexley and out of area residents, covering Specialist Community Service. The
second version, for Greenwich residents, will cover both the Specialist
Community Service and the Greenwich Care Partnership (GCP). This will enable
more accurate information to be collected for the GCP service

A section is to be added to enable next of kin/carers to provide their contact
details if they would like the Hospice to contact them to discuss or respond to
any points raised or provide more information about Bereavement Support
The Day Hospice staff find SKIPP to be a useful tool. Completion of the questionnaire
with a patient often triggers discussions focussed on areas and issues of concern,
which may not have been previously raised. It has been agreed that SKIPP will
continue to be used in Day Hospice but due to the Hospice’s involvement in the
iPOS validation study, it is not planned for SKIPP to be rolled out in any other areas.
To date the Hospice has had an extremely high response rate and FFT Score across
the areas where FFT has been launched.
Any outstanding area to be addressed in 2014/15
FFT will be rolled out to other Hospice services (Lymphoedema, Community, Social
Work, GCP, Counselling, Hospital Team and Rehabilitation) throughout the year.
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Progress against Improvement Priority 3: Access to Hospice Service
(Ongoing priority, see Improvement Priority 1 on page 4)
What does the Access to Hospice Services Priority mean?
The Hospice has developed its services over recent years to ensure that care is
provided across patient pathways in a variety of settings. Opportunities to provide
integrated care in hospital, at home or in a care home and in the Hospice building
have already helped to improve accessibility for people regardless of their
diagnosis, age, ethnicity, preferred place of care etc. However the Hospice
recognises that we still have a long way to go in providing access to Hospice
services for all who need it.
GBCH has identified that as part of its response to the ever increasing need for
Hospice and End of Life Care for people who may not have traditionally accessed
these services, it wishes to redesign referral pathways, integrating existing elements
of service further and developing new areas of provision.
As part of this, the concept of the Hospice as “a hub” will be developed, this
enables the physical space to not only be used by patients, families and staff, but
also to be a “hub” for the local community. For example, the Hospice may provide
a space for socialising, rehabilitation, volunteering, receiving new kinds of care
and support and training and education. By opening up the Hospice to other
members of the community, we aim to challenge people’s perceptions of who
and what hospices are there for, opening up the doors to support more people
throughout their lives.
What was planned / achieved
Progress against the plan to date:
 Funding has been received from Greenwich CCG for the Nurse Consultant
role and the new post holder is due to start in this role week commencing 9th
June 2014. The job plan for this role includes:
o to assess why people at the end of life are admitted to the local acute
Trust via A&E and if improvements can be made to avoid
inappropriate admissions
o to provide clinical leadership to endeavour to reduce the length of
stay of people at the end of life in hospital
o to develop a strategy to increase the number of “Older Old” and noncancer patients dying at home or at the hospice, in accordance with
their ‘Place of Death’ wishes
o to introduce a nurse led outpatient clinic
o to drive the Hospice’s strategic aim to have nurse led admissions

The Hospice received funding for 3 years from the London Borough of Bexley
to enable the role out of the Advance Care Planning (ACP) project in the
borough

The Hospice has received funding to commence a “Befriending” service (this
has been called “Hospice Neighbours”). A project lead has been appointed
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GBCH 2013-2014 Quality Account
and recruitment and training of new volunteers took place in October 2013.
Volunteers are now working with and supporting carers and patients

For 2014/2015 the Hospice has produced a new annual education curriculum
for staff external to the Hospice and will also be delivering “bespoke” training
to staff external to the Hospice

As part of the Hospice’s “Rolling Education” programme, sessions have been
delivered on Heart Failure and End of Life Care, COPD and End of Life Care,
Renal Failure and End of Life, End of Life Care for people with dementia and
MND and End of Life Care to hospice staff

During 2013/2014 discussions have been taking place with the Hospice’s
commissioners about how End of Life Care in all care settings can be
improved. These discussions are still ongoing

The Hospice has introduced a new drop in “One-Stop Shop”, to support
carers and patients, who require advice on financial, welfare and housing
matters. This service also assists patients who wish to develop an Advanced
Care Plan. In 2014/2015 the Hospice is planning to recruit a number of
volunteers to extend the reach of this service

During 2013 the Hospice’s physiotherapist developed a new service in
partnership with the Lymphoedema Service called “Let’s Get Moving” to
provide a re-enablement and exercise class for people with upper and lower
limb lymphoedema. The service received 2 London Borough of Greenwich
Dignity in Care awards and the Hospice’s Annual Staff Award for Innovation in
2013
Any outstanding area to be addressed in 2014/15
(See Improvement Priority 1: Access to Hospice for 2014/2015 on page 4)
Husband of patient
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GBCH 2013-2014 Quality Account
2.3 Statement 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 specialist
palliative care providers.
2.3.1 Review of Services
During 1st April 2013 to 31st March 2014, The Hospice provided the following services:















Inpatient Care
Day Hospice Services
Specialist Palliative Care Community Services in Greenwich and Bexley
Boroughs
Specialist Palliative Care Team at Queen Elizabeth Hospital
“Greenwich Care Partnership”
Rehabilitation Team
Lymphoedema Treatment and Care Service
Psychological Care Service (including the Telephone Bereavement
Service)
Chaplaincy
Social Services
Education and Training Team
Care Homes Support Team
Advance Care Planning Service
Befriending Service
The Hospice has reviewed all the data available to them on the quality of care in all
its services.
2.3.2 Income Generated
The income generated by the NHS services reviewed in 2013/14 represents 100% of
the total income generated from the provision of NHS services by GBCH for 2013/14.
The income generated from the NHS represented 47% (unaudited) of the overall
cost of running these services.
The above mandatory statement confirms that all of the NHS income received by the
Hospice is used towards the cost of providing patient services.
2.3.3 Participation in National Clinical Audits
During 2013/14, the Hospice was ineligible to participate in any national clinical
audits or national confidential enquiries.
–
Day Care patient
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2.3.4 Participation in Local Audits
The following audits were carried out during 2013/14:
Subject Matter
Outcomes of Audit
Follow-up Actions
Accountable Officer
Audit
Annual audit of Controlled Drugs
and non Controlled Drugs
processes and policies. High
level of compliance recorded
Action plan drawn up for
highlighted areas, progress
reported at Quality & Safety
Committee meetings
Trustees Inspections
Programme
Schedule of unannounced
inspections covering the CQC
Essential standards of quality
and safety outcomes
Reports drafted and action list
updated after each inspection
and reviewed at Quality &
Safety Committee and Board
Use of injectable
Oxycodone
Repeat audit showed improved
documentation for use of
injectable Oxycodone,
switching to Oxycodone and
use of Oxycodone in syringe
pump
No specific actions. Audit to be
repeated later in 2014
Opioid prescription
audit
Good overall compliance with
local prescription guidelines.
Documentation of dose
calculations recommended
Re-audit to be carried out in
2014
Transfer of patients out
of the hospice to acute
care
This is a 2 year case series.
Demonstrated senior led transfer
decisions, multiple reasons due
to unpredicted and predictable
deterioration in condition
unable to be addressed at
hospice. Isolated occasion of
patient preference to be
managed in hospital
Continue to collate information
for case series
Audit of antibiotic
prescribing
Choice of antibiotic and length
of course can be improved
upon. Microbiologist advice
sought appropriately. New
guidelines have been
developed subsequently that
are tailored to the hospice
setting
Implementation of locally
devised antibiotic prescribing
guidelines, and re-audit
DNACPR
documentation audit
Resuscitation Council DNACPR
form introduced in Jan 2014.
Audit of use showed very good
documentation of decision
making including discussions
with patient and family
Regular re-audit and review
Infection Control
Annual Audit
Programme
Agreed schedule defining
Infection Control areas to be
audited and frequency of audits
Findings reported and reviewed
quarterly at Quality & Safety
Committee meetings
Unannounced Hygiene
Inspection
Audits performed by Lead for
Infection Control and a Trustee
on a regular basis
Action List updated after every
audit and reviewed at Quality &
Safety Committee meetings
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GBCH 2013-2014 Quality Account
2.3.5 Research
The Hospice is currently participating in the following research projects:
Assessment of accuracy of prognosis prediction by the Palliative Prognostic Index
(PPI): a prospective multi-centre study. Could the accuracy of prognosis prediction
by PPI be improved by two assessments and could the rate of change of PPI score
be used to prognosticate better?
This research continuing from last year and is still ongoing.
Exploring patient perception of treatment success and benefit in self-management
of breast cancer-related arm swelling (lymphoedema)
This research continuing from last year and is still ongoing.
National Institute for Health Research (NIHR) Collaboration for Applied Health
Research and Care (CLAHRC) South London – Palliative and End of Life Care
CLAHRC and iPOS validation are in the development stage (see Improvement
Priority 2: Embed Clinical Research & Audit, What are the plans for this Priority? on
page 7).
2.3.6 Quality Improvement and Innovation Goals Agreed with our Commissioners
Hospice NHS income in 2013/14 was partly conditional on achieving quality
improvement and innovation goals through the Commissioning for Quality and
Innovation (CQUIN) payment framework.
The agreed Greenwich incentive payment related to Greenwich Care Partnership
(GCP) was:
 Reduction of 5 hospital deaths per month for Royal Borough of Greenwich
Residents
The agreed Bexley additional payment related to Specialist Palliative Care (SPC)
was:
 Short term investment in SPC team
 Exploration of a community liaison role to facilitate improved Hospital
Discharge
 Evaluation and development of a proposal for 2014/15 (and onwards)
2.3.7 What Others Say about Greenwich & Bexley Community Hospice
The Hospice is required to register with the Care Quality Commission and its current
registration status is that we are registered to carry out the following legally
regulated activities:


Diagnostic and screening procedures
Treatment of disease, disorder or injury
The Care Quality Commission has not taken any enforcement action against the
Hospice during 2013/14.
On 13th December 2013, the Care Quality Commission carried out an unannounced
inspection as part of their routine inspection schedule. The following standards were
inspected:
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GBCH 2013-2014 Quality Account




Outcome 4 - Care and welfare of people who use services
Outcome 6 – Cooperating with other providers
Outcome 14 – Supporting workers
Outcome 21 - Records
The Hospice met the required standards for all of the above Outcomes with the
exception of Outcome 21-Records. From their inspection, the CQC stated in their
report:
How we carried out this inspection
We looked at the personal care or treatment records of people who use the service,
carried out a visit on 13 December 2013, observed how people were being cared
for and talked with people who use the service. We talked with carers and / or
family members and talked with staff.
What people told us and what we found
People and family members we spoke with told us they were very satisfied with the
care provided at the hospice. Comments we received included, "I am very well
looked after here, I have no complaints," "the care here is excellent."
At our inspection we found that people received care based on an appropriate
assessment of their needs. Staff were well supported and worked with other health
and social care professionals to ensure people using the service received safe and
effective care.
However, we also found that people's care records were not up to date in all cases.
People were not always protected from the risks of unsafe or inappropriate care and
treatment because accurate and appropriate records were not maintained in all
cases. We have judged that this has a minor impact on people who use the service,
and have told the provider to take action.
On 5th March 2014, the Care Quality Commission returned to carry out another
unannounced inspection.
The CQC stated in their report:
Why we carried out this inspection
We carried out this inspection to check whether Greenwich and Bexley Community
Hospice had taken action to meet the following essential standards:
 Records
This was an unannounced inspection.
How we carried out this inspection
We looked at the personal care or treatment records of people who use the service,
carried out a visit on 5 March 2014 and talked with staff.
What people told us and what we found
At our visit we found that the provider had made improvements to ensure that care
records and documents related to significant decisions were up to date.
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GBCH 2013-2014 Quality Account
Our judgement
The provider was meeting this standard.
People were protected from the risks of unsafe or inappropriate care and treatment
because accurate and appropriate records were maintained.
Reasons for our judgement
At our inspection of December 2013 we had found that not all of the care records
were complete and accurate. We had found that documents related to major care
decisions like Do Not Attempt Resuscitation (DNAR) in the event of death by natural
causes and mental capacity assessment had not been completed appropriately.
The notes did not clarify what discussion had been undertaken with the patient or
their representative. Following our inspection the provider wrote to us to tell us the
improvements that would be made to ensure they were meeting this essential
standard. At our inspection of March 2014 we found that the provider had made
improvements to ensure there was now a clear and up to date documentation
related to significant care decisions.
The provider had amended its policies related to the application of the Mental
Capacity Act and DNAR decisions. We were told the policies were being reviewed
by the clinical leads and the Quality & Safety Committee, prior to their approval by
the board of trustees.
Before people received any care or treatment they were asked for their consent
and the provider acted in accordance with their wishes. Most care plans we looked
at showed that mental capacity assessments had been undertaken and
appropriately recorded for significant decisions such as 'Do Not Attempt
Resuscitation' (DNAR). The notes we looked at clarified what discussions had been
undertaken with the patient or their representative. Staff we spoke with understood
the relevance of DNAR decisions and of giving consideration to the requirements of
the Mental Capacity Act (2005) and were aware of where to look for the DNAR
document.
Daughter of patient
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GBCH 2013-2014 Quality Account
2.3.8 Data Quality
During 2013/14, the Hospice did not submit records to the Secondary Uses Service for
inclusion in the Hospital Episode Statistics, which are included in the latest published
data.
In accordance with our contract with Local Commissioners, the Hospice submits a
National Minimum Dataset (MDS) annual return to the National Council for Palliative
Care.
2.3.9 Information Governance Toolkit Attainment Levels
With help from the South London Commissioning Support Unit, the Hospice
completed its Information Governance Toolkit. At present, this has not been ratified
by NHS Connect; however the Hospice believes it has achieved level 2. We are now
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GBCH 2013-2014 Quality Account
progressing the other necessary steps to ensure we are able to have an N3
connection very soon.
2.3.10 Clinical Coding Error Rate
The Hospice was not subject to the Payment by Results clinical coding audit during
2013/14 by the Audit Commission.
Part 3 - Review of Quality Performance
The Hospice has chosen to present a number of key quality indicators to
demonstrate the level of care that the Hospice services provide:
3.1 Comparison with National Minimum Data Sets
Comparison with the National Minimum Data Sets (MDS) for Palliative Care, provide
a national and local context to Hospice performance over time.
The most recently published National Minimum Data Set for Palliative Care covers
2012/13. Data for the Hospice for 2013/14 has been collated but currently there is no
comparative National MDS data available.
The Hospice has benchmarked data reports for 2012/13 under the following
headings:






Inpatients
Day Care
Home Care / Hospice at Home
Hospital Support Team
Bereavement Support
Outpatients
Daughter of Woodlands patient
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GBCH 2013-2014 Quality Account
3.1.1 Inpatients
MDS data for Inpatients is given in Table 1.
Based upon our return, GBCH was included in the Large category (more than 17
beds).
Nationally, data was received from 44 Large units. For London, data was received
from 13 units.
Table 1 Inpatient MDS data
2013/2014 2012/2013 2011/2012 2012/2013 2012/2013
GBCH*
GBCH
GBCH
National
London
Median
Median
281
309
320
324
338
New Patients
% New Patients
93.7
92.8
92.8
88.1
88.3
with
91.1
93.9
88.8
94.4
93.9
% New Patients with a
Non-Cancer diagnosis
13.5
13.9
12.5
11.5
14.6
Average Length of stay,
Cancer (days)
11.5
15.3
10.6
14.7
14.7
Average Length of stay,
Non-Cancer (days)
12.8
18.0
10.6
13.3
16.4
% Occupancy
73.8
86.4
75.5
79.1
80.9
Percentage of people
who died on the unit
75.3
64.9
58.5
59.0
61.6
% New Patients
Ethnicity Recorded




Due to a combination of financial pressures and recruitment difficulties, the
Hospice board took the decision to reduce the number of inpatient beds
from 19 to 13 in June 2013. This was done in negotiation with commissioners
and the Hospice is currently working on a plan to increase bed availability to
15 beds. Despite this reduction, the average occupancy in the inpatient unit
went down, possibly due to an increase in the number of people being
supported to die at home
The percentage of new patients increased in 2013/14
The percentage of people dying as opposed to discharge increased
significantly in 2013/14, this has a significant impact on the workload of the
inpatient unit
Average LOS for both cancer & non-cancer diagnosis reduced in 2013/14
* 2013/2014 figures are unaudited, based on our submission. These are not MDS
figures.
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GBCH 2013-2014 Quality Account
3.1.2 Day Care
MDS data for Day Care is given in Table 2.
Based upon our return, GBCH (total number of 174 patients) was included in the
Medium category (between 112 and 180 patients).
Nationally, data was received from 49 Medium units. For London, data was received
from 12 units.
Table 2 Day Care MDS data
2013/2014 2012/2013 2011/2012 2012/2013 2012/2013
GBCH*
GBCH
GBCH
National
London
Median
Median
99
129
95
91
110
New Patients
% New Patients
57.6
74.1
56.9
63.2
57.5
with
89.9
98.4
91.6
91.2
90.6
% New Patients with a
Non-Cancer diagnosis
23.2
18.6
22.1
23.3
18.6
Day Care Attendances
2622
2686
2267
1647
1280
% Places Used
69.5
72.6
62.8
56.4
51.1
216.6
158.4
162.8
157.1
134.0
% New Patients
Ethnicity Recorded
Average
Length
Attendances (days)


of
The percentage of new patients with non-cancer diagnosis increased in
2013/14
The average length of stay has significantly increased, possibly due to earlier
referral
Day Care patient
* 2013-2014 figures are unaudited, based on our submission. These are not MDS
figures.
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3.1.3 Home Care/Hospice at Home
MDS data for Home Care/Hospice at Home is given in Table 3.
Based upon the Hospice return, GBCH (total number of 1248 patients) was included
in the Large category (more than 1227 patients).
Nationally, data was received from 12 Large units. For London, data was received
from 5 units.
Table 3 Home Care/Hospice at Home MDS data
2013/2014 2012/2013 2011/2012 2012/2013 2012/2013
GBCH*
GBCH
GBCH
National
London
Median
Median
945
895
968
1137
895
New Patients
% New Patients
71.8
71.7
69.7
66.6
72.3
with
92.3
91.6
85.4
68.6
91.6
% New Patients with a
Non-Cancer diagnosis
26.6
19.3
25.0
19.3
22.9
% Home and Care Home
Deaths
52.9
48.9
50.6
53.3
55.2
% Hospice Deaths
23.0
27.2
24.8
-
-
% Hospital Deaths
19.2
23.1
24.0
-
-
% New Patients
Ethnicity Recorded




There was an increase in the number of new patients in 2013/14
The percentage of new patients with non-cancer diagnosis increased
There was an increase in deaths at home & in care homes and a reduction in
deaths in the Hospice & in hospital
76% of patients died at home, in a care home or in the Hospice in 2013/14
Daughter of Community patient
* 2013-2014 figures are unaudited, based on our submission. These are not MDS
figures.
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3.1.4 Hospital Support Team
Historical MDS data for Hospital Support is given in Table 4.
The 2013-2014 figures were not available at the time of submission. This data will be
included in an updated Quality Account, which will be placed on the GBCH
website, once these figures are available.
Table 4 Hospital Support Team MDS data
2013/2014 2012/2013 2011/2012 2012/2013 2012/2013
GBCH*
GBCH
GBCH
National
London
Median
Median
730
654
860
759
New Patients
% New Patients
92.4
89.3
90.7
90.0
with
100.0
69.0
95.5
96.7
% New Patients with a
Non-Cancer diagnosis
26.7
33.3
27.0
31.6
% Discharged to Home
57.8
51.4
48.3
54.1
8.0 days
7.8 days
8.4 days
8.0 days
% New Patients
Ethnicity Recorded
Average Length of Care
The Hospice Hospital Support Team based at Queen Elizabeth Hospital, Woolwich,
provide support, advice and education to staff in the hospital on end of life care
and symptom control issues, as well as supporting patients and their families directly
and helping to ensure their wishes for care are met.
Social Work client
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3.1.5 Bereavement Support
MDS data for Bereavement Support is given in Table 5.
Based upon the Hospice’s return, GBCH, was included in the Medium category
(between 114 and 262 service users).
Nationally, data was received from 41 Medium units. For London, data was received
from 10 units.
Table 5 Bereavement Support MDS data
New Service Users
2013/2014 2012/2013 2011/2012 2012/2013 2012/2013
GBCH*
GBCH
GBCH
National
London
Median
Median
229
202
172
138
221
% New Service Users
99.5
92.7
68.0
74.2
67.5
% New Service Users with
Ethnicity Recorded
60.0
38.6
70.3
56.3
51.0
% of Deceased with a
Non-Cancer diagnosis
n/k∑
14.9
8.1
7.4
15.4
Contacts per Service User
7.0
12.7
9.5
5.9
5.2
% Discharged
76.5
67.0
53.3
57.3
50.7

The Hospice Telephone Bereavement Service is now well embedded and has
increased the number of contacts that take place over the telephone
–
Counselling client
Mother of Counselling client
Data is not routinely recorded as to the reason why the person’s relative died.
∑
* 2013-2014 figures will be available in time for the final submission. These figures are
unaudited, based on our submission. These are not MDS figures.
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GBCH 2013-2014 Quality Account
3.1.6 Outpatients
MDS data for Outpatients is given in Table 6.
Based upon the Hospice return, GBCH with a total number of 640 patients was
included in the Large category (more than 316 patients).
Nationally, data was received from 50 Large units. For London, data was received
from 14 units.
Table 6 Outpatients MDS data
2013/2014 2012/2013 2011/2012 2012/2013 2012/2013
GBCH*
GBCH
GBCH
National
London
Median
Median
192
255
158
255
133
New Clients
% New Clients
27.6
39.8
24.3
40.0
66.5
with
86.5
90.6
89.2
78.0
93.9
% New Patients with a
Non-Cancer diagnosis
56.8
31.8
50.0
14.4
19.0
Total Outpatient
Attendances
1305
1202
1320
1172
151
1.9
1.9
2.0
1.9
1.6
% New Patients
Ethnicity Recorded
Clinic
Attendances per Patient

The percentage of new patients with non-cancer diagnosis significantly
increased in 2013/14
Stepping Stones client
Lymphoedema patient
* 2013/2014 figures are unaudited, based on our submission. These are not MDS
figures.
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3.2 Clinical Governance
The Quality & Safety Committee has developed and enhanced its Terms of
Reference and annual rolling agenda. It is still supported by a number of topic/
project based advisory groups e.g. medicines, EPR, education, GCP.
The Quality & Safety Committee continues to receive regular reports, including the
Clinical Dashboard and Operational Risk Register as well as responsibility for the
review of existing policies and the development of new policies. It is also responsible
for monitoring the clinical audit programme.
The Quality & Safety Committee has put a number of actions in place to ensure that
there is the correct level of focus, review and monitoring:




CQC and EPR are standing items on the agenda and progress against the
open actions on the internal plan are reviewed monthly
As part of the documentation review, the review period for the Consent, MCA
/ DOLs policies have now been reduced from 3 years to 1 year
Recognising the importance of maintaining mandatory training compliance
for all staff, reporting is now monthly where it was previously quarterly
Development of an annual schedule of Trustees Unannounced Inspections
3.3 Training
The Hospice has continued to invest in the planning, delivery and monitoring of
mandatory training in 2013/14. It also benefitted from additional resource for
Continuing Professional Development from HESL.
Hospice clinical staff continue to be involved in delivering education in external
organisations including King’s College London and the University of Greenwich as
well as to care providers such as local care homes, Oxleas NHS Foundation Trust and
Queen Elizabeth Hospital.
During 2013/14, Greenwich & Bexley Community Hospice was instrumental in
establishing a collaborative of the seven Hospices which serve South London.
Through this collaborative, we have been able to access funding to develop four
new training projects which will provide a variety of opportunities for staff of all levels
to improve their skills and confidence to deliver quality care at the end of life.
3.4 Health Improvement Network
As part of the Health Improvement Network (HIN), the Academic Health Science
Network (AHSN) for South London was established in 2013 to align education, clinical
research, informatics, innovation, training and education and healthcare delivery at
a local level.
Nationally, the AHSNs have four core objectives:



Focus on the needs of patients and local populations
Speed up adoption of innovation into practice to improve clinical outcomes
and patient experience
Build a culture of partnership and collaboration
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
Create wealth through co-development, testing, evaluation and early
adoption and spread of new products and services
The Hospice is a member of the HIN and is represented on the Board by the Hospice
Chief Executive, who also acts as a representative for other member Hospices.
3.5 End of Life Care Clinical Leadership Group – NHS London
Strategic Clinical Networks (SCNs) are a new type of healthcare network hosted by
NHS England and will adopt a whole-system approach to change management
working with providers and other stakeholders across complex pathways of care as
well as offering specialist advice to commissioners on standards and variations in
service. Using the NHS Change Model as the framework for development SCNs will
support change management and quality improvement thought innovation and
transformational leadership. Clinical Networks (CNs) are a variation of Strategic
Clinical Networks, the only variation being that clinical networks are not mandated
by central policy and are subsequently created via local need and priority.
Each CN has a Clinical Leadership Group (CLG) chaired by a clinical director. The
CLG will be the expert vehicle for driving forward change and improvement in the
CN and a source of strategic advice and knowledge to NHS England, the Clinical
Senate and other bodies and organisations.
The CLG provides a forum for multi-professional clinicians to meet and share their
specialist expertise, clinical experience, and strategic knowledge in an impartial and
bi-partisan manner. The CLG will act as the clinical expert arm of the CN and exist to
provide collective knowledge and strategic leadership on behalf of the CN
community.
The Hospice’s Director of Care Services is a member of this new group.
3.6 Challenges
A number of challenges have been encountered in 2013/14, in particular:

The Hospice continued to encounter difficulties recruiting sufficient staff with
the appropriate skills, expertise and attitude resulting in a high number of
vacancies in some services. This problem, which was also seen in other
organisations, resulted in some difficulties in delivering care in as responsive a
fashion as desired. This problem was particularly seen in recruiting staff nurses
and clinical nurse specialists and resulted in us changing the way we respond
to referrals to ensure a safe service continues to be delivered. As a result of
this ongoing challenge, the Hospice is reviewing some service models and skill
mixing to address the challenge in different ways.

The increase in need for community services and the difficult economic
climate has presented problems in meeting the need with existing capacity
and finances. In 2013/14, NHS Bexley provided some short term funding to
invest in Specialist Palliative Care and NHS Greenwich provided short term
funding for a Nurse Consultant. We continue to work with commissioners to
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GBCH 2013-2014 Quality Account
look at ways to reshape services to meet increased need as well as
increasing our own contribution through additional voluntary income.

After a number of delays beyond our control, the Hospice began its building
project in January 2014. We are working hard to ensure that the day to day
operation of Hospice services is not impacted throughout the works and we
are grateful to the dedication of staff and volunteers who have been
inconvenienced by the necessary temporary changes in the Hospice
building.

The changes to the management of our local acute hospital, Queen
Elizabeth Hospital, Woolwich have presented us with a need to provide
stability in a challenging and uncertain environment and we continue to
develop relationships with the new management to ensure that palliative and
end of life care provided in the Hospital is as good as it can be.
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Appendix 1: Greenwich
NHS Greenwich
Marcos Menager – nominated person within NHS Greenwich
It is of great pleasure to see how the local Hospice keeps working year after year to
increase the standards and look for effective ways to adapt to changes and
pressures. The document, as I said before, reads fabulous and shows the results of
commitment and dedication.
Royal Borough of Greenwich Healthier Communities and Older People Scrutiny Panel
Alain Lodge - Scrutiny Officer for our Healthier Communities and Older People
Scrutiny Panel
Introduction
We recognise the value of the work of the hospice which provides a range of
palliative and end of life services including the Greenwich Care Partnership. This
partnership between the hospice, Marie Curie Cancer Care and Greenwich
Community Health Services, provides personal care; a rapid response service; a coordination centre; and planned night visiting. The panel will continue to monitor the
work of hospice and its impact on the health and wellbeing of local people.
Part 1- Chief Executive’s Statement
We support the hospice’s intention that the benefits of the building project can be
maximised within this year.
Part 2- Priorities for Improvement and Statements of Assurance from the Board
2.1 Priorities for Improvement 2014-15
Improvement Priority 1: Access to Hospice Services
We recognise the need to improve access particularly as the borough’s increasingly
diverse population grows and it is important that all members of the community
have access to high quality end of life care and are given the opportunity to make
choices regarding the type of care they receive. We support the development of
the concept of the hospice as a hub for the local community which will help
positively challenge people’s perceptions of what and for whom a hospice is for.
Improvement Priority 2: Embed Clinical Research and Audit
We welcome the prioritisation of embedding clinical research and audit and will
monitor the hospice’s aspiration to reach level 2 ‘engagement in research with
others’.
Improvement Priority 3: workforce, Education and Training
We will monitor the proposed Workforce Strategy and recognise the wider benefits
of the hospice training staff in other health and social care organisations. We
welcome the hospice’s involvement in the South London Hospices Education
Collective.
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2.2 Priorities for Improvement 2013-14
Progress against Improvement Priority 1: Development of a Quality and Governance
Dashboard.
We anticipate further progress on the development of this dashboard and the
benefits to clinical teams from receiving timely and relevant information in an easily
understood format.
Progress against Improvement Priority 2: Launch a Patient and Carer Survey
Programme.
We recognise the importance of capturing and collating patient and carer’s
feedback which can usefully trigger discussions focussed on areas of concern which
may not have been raised previously. We welcome the fact that a review of one of
the methods of obtaining feedback, the VOICE questionnaire, has identified the
need for two different versions of the questionnaire which reflects the different
service configurations within Bexley and Greenwich. This is an area that the panel
will continue to monitor during 2014/15.
Progress against Improvement Priority 3: Access to Hospice Service.
This is a priority that the panel has examined with the Hospice Chief Executive when
she attended our meetings on 12 December 2013 and 27 March 2014. As mentioned
above we support the innovative approach of developing the hospice as a hub for
the community. We also recognise the significant potential benefits of assessing why
people at the end of life are admitted to Accident and Emergency and the
importance of avoiding inappropriate admissions therefore improving the quality of
people’s end of life experience.
We share the hospice’s desire to give all people from the local community the
opportunity to exercise maximum choice about their end of life care.
2.3.7 What others say about Greenwich and Bexley Community Hospice.
Care Quality Commission (CQC)
Following the CQC inspection of 13 December 2013 we are pleased to note that the
hospice has taken the appropriate action to ensure that patient care records and
documents relating to significant decisions are kept up to date.
Part 3- Review of Quality Performance
3.3 Training
We support the priority that the hospice accords to training both for its own staff and
staff within other organisations.
3.6 Challenges
The panel are familiar with the ongoing issue of recruitment which was discussed
with the Chief Executive at our meetings on 12 December 2013 and 27 March 2014,
and we will continue to monitor this issue closely. We also believe it is important for
the hospice to look at ways of reshaping demand to meet increasing need.
Assessing how effectively the Lewisham and Greenwich NHS Trust (LGT) are meeting
the health care needs of local people is an ongoing priority for the panel and we
recognise the importance and will continue to focus on the work the hospice is
doing with LGT. This is an important area that will feature in the panel’s work
programme for 2014/15.
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Appendix 2: Bexley
NHS Bexley
Abi Ademoyero – nominated person within NHS Bexley
No response provided.
Bexley Overview and Scrutiny Committee
Cllr Ross Downing - Chair of the Health OSC
Louise Peek – Support Officer for the Health OSC
No response provided.
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Appendix 3: Healthwatch
Rosaline Mitchell - nominated person within Healthwatch Greenwich
Anne Hines-Murray – nominated person within Healthwatch Bexley
Healthwatch Greenwich and Bexley welcome the opportunity to comment on the
Quality Account for 2013-2014. We have submitted a joint report as the Hospice
provides a service for residents of both boroughs.
Comment on priorities for improvement for 2014-2015
Priority 1 –Access to Hospice Services
Healthwatch are pleased the hospice is continuing to focus on increasing the
access to hospice services, and expanding the social support services available. We
are pleased the Hospice is making attempts to respond to the current demand for
hospice services and plan for the future, particularly in light of an ageing population
who bring with them more complex care needs. We are pleased to see that the
Hospice has been working to ensure people in custody, an often forgotten group,
have appropriate access to end of life care.
We look forward to seeing the evaluation of the Advance Care Planning project
and to explore whether it has been successful in enabling people to make an
informed choice and express their preferences regarding their care. Healthwatch
also welcome the new “First Contact” service working as an integrated care model
to ensure continuity of care for all patients.
We eagerly anticipate the changing role of the Hospice within the local community
in terms of the ambition to become a ‘hub’ for the local community. This will enable
the Hospice to extend the services it provides in order to support a wider population
and Healthwatch look forward to seeing this progression over the coming years.
Healthwatch Greenwich welcome the introduction of the Nurse Consultant role to
work with Queen Elizabeth Hospital and believe that this will greatly improve the end
of life care for residents of Greenwich. We look forward to seeing the impact of this
role has over the coming year for patients and their families.
Priority 2 – Embed Clinical Research and Audit
We are pleased to see the Hospice increasing its participation in research and audits
and setting out a structured approach to participating in research, in order to make
progressions in end of life care.
Comment on priorities for improvement 2013-2014
Priority 1 – Development of a Quality Governance Dashboard
Healthwatch are pleased the Quality and Governance Dashboard has meant the
Hospice is more quickly able to identify areas for improvement and are able to act
on them more quickly. We welcome the expansion of the dashboard to report on
other areas and so provide more information. We would like to see greater
compliance with some of the training areas such as infection control and medicine
management as these are key components of providing a safe environment for
patients.
Priority 2 – Launch a Patient and Carer Survey Programme
We are pleased the Hospice utilised various tools to collect patient feedback,
because patient feedback holds to key to evaluating and improving the service the
hospice provides. Healthwatch Greenwich are disappointed the response rate for
the VOICES questionnaire for Greenwich is so low compared to that of Bexley and
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would like to work with the hospice to identify the reasons for this and to develop
strategies to improve the response rate. We welcome the change in the
questionnaires to collect more accurate information regarding the GCP service in
order to evaluate it as effectively as possible.
Priority 3 - Access to Hospice Services
Healthwatch understand this is an ongoing plan and are pleased with the work
undertaken so far with regards to staff training and innovative new services such as
the “Let’s Get Moving” class. We applaud the Hospice for taking steps to support
patients and their families in all aspects of their lives, and not just with medical
matters.
Other comments
Healthwatch were pleased the CQC found the Hospice met the standard for most
of the outcomes they inspected and that patients and their families have good
experiences of the service. After the CQC identified issues regarding record keeping
the hospice took swift action to remedy this and passed this outcome at the CQC
surprise inspection in March 2014.
We are pleased to see a decrease in the number of deaths in a hospital setting, and
the movement towards supporting people to die at home if they wish. Also, that the
Telephone Bereavement service is being utilised well and is providing support to a
large number of people.
Healthwatch supports the Hospice with making links with the other hospices with the
area in order to collaborate and improve training for staff. We are also pleased to
see the hospice has been providing training for external agencies. We hope this will
be a part of improving integrated end of life care across the borough.
We appreciate the challenges faced by the hospice in the past year and that the
hospice was able to overcome them to still provide an excellent service for the
community.
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