Quality Account
April 2013 – March 2014
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Keech Hospice Quality Accounts 2013 - 2014
Table of Contents
Table of Contents .................................................................................................................................................................................................................... 2
Report from the Chief Executive Officer................................................................................................................................................................................ 4
Our vision................................................................................................................................................................................................................................ 5
Report from the Clinical Director............................................................................................................................................................................................ 5
Objectives ............................................................................................................................................................................................................................... 6
Objective 1 – Providing excellent care ................................................................................................................................................................................... 6
Objective 2 – Wider reach ...................................................................................................................................................................................................... 7
Objective 3 – Right choices .................................................................................................................................................................................................... 8
Objective 4 – Value for money ............................................................................................................................................................................................... 9
Objective 5 – Working together ............................................................................................................................................................................................ 10
Priorities for improvement and statements of assurance from the board................................................................................................................................ 12
1a. Priorities for improvement in 2014 – 2015 ..................................................................................................................................................................... 12
1b. Progress against Priorities for improvement in 2013 – 2014........................................................................................................................................... 14
2. Review of services .......................................................................................................................................................................................................... 15
3. Participation in Clinical Audit........................................................................................................................................................................................ 16
4. Research ......................................................................................................................................................................................................................... 16
5. Use of CQUIN payment framework ............................................................................................................................................................................... 17
6. Statement on the Care Quality Commission .................................................................................................................................................................. 17
7. Data Quality ................................................................................................................................................................................................................... 17
8. Information Governance Toolkit .................................................................................................................................................................................... 18
9. Clinical coding error rate ................................................................................................................................................................................................ 18
10. Organisational Structure ............................................................................................................................................................................................. 19
ADULT SERVICES ..................................................................................................................................................................................................................... 20
11. Adult Service Statistics ............................................................................................................................................................................................... 21
Adult Inpatient Analysis ........................................................................................................................................................................................................ 21
Breakdown of patients using the service in 2013/14 ............................................................................................................................................................ 21
Keech Palliative Care Centre Patient Analysis ...................................................................................................................................................................... 22
Other activity undertaken by Adult Services ......................................................................................................................................................................... 25
............................................................................................................................................................................................................................................... 26
12. 12. Infection Control................................................................................................................................................................................................. 27
13. Safeguarding ............................................................................................................................................................................................................... 27
CHILDREN’S SERVICES ........................................................................................................................................................................................................... 28
14. Children’s Service Statistics ........................................................................................................................................................................................ 29
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Children’s In-patient Unit activity statistics ......................................................................................................................................................................... 29
Children’s Community Activity ............................................................................................................................................................................................ 31
Children’s Service Day Support activity statistics................................................................................................................................................................ 31
15. Accidents, Incidents, Complaints and Compliments ................................................................................................................................................... 32
Accidents ............................................................................................................................................................................................................................... 32
Incidents ................................................................................................................................................................................................................................ 33
Complaints ............................................................................................................................................................................................................................ 33
Compliments received ........................................................................................................................................................................................................... 34
16. Quality and Compliance .............................................................................................................................................................................................. 36
Standard of Care ................................................................................................................................................................................................................... 36
Summary of 2013/14 Audits & Surveys ............................................................................................................................................................................... 37
Research ................................................................................................................................................................................................................................ 38
17. Feedback from Our NHS Commissioners:..................................................................................................................................................................... 39
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Keech Hospice Quality Accounts 2013 - 2014
Report from the Chief Executive Officer
Together with the Board of Trustees, I would like to thank all our staff and volunteers for their achievements over the
past year. Despite the current economic climate, the Hospice has continued to increase the number of people it
supports, providing a wide range of services whilst remaining financially sound.
At Keech Hospice we strive to continually deliver safe and innovative services, whilst giving reassurance that the
organisation as a whole has patient care and quality at its core. The safety, experience and outcomes for all our patients
and those close to them are of paramount importance to us. We continue to actively seek the views of everyone who
comes into contact with our services to enable us to gain insight into the care people want and the quality they expect.
In October 2013 we received confirmation that we have for the 2nd time achieved accreditation with the CHKS
(Comparative Health Knowledge Systems) Accreditation Programme for Hospice Services. This accreditation programme incorporates current
national and professional guidance into a set of standards that bring together best practice and a framework for quality assurance and quality
improvement for organisations to work towards and to subsequently gain external recognition for this achievement.
I am responsible for the preparation of this report and its contents. To the best of my knowledge, the information reported in this Quality Account
is accurate and a fair representation of the quality of healthcare services provided by our Hospice.
Mike Keel
Chief Executive Officer
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Our vision
Our Vision is that High quality Palliative care is available to all who need it in our community.
Our Mission statement:
We will be the patients’ champion,
We will seek out all the people that need palliative care, ensure their needs are assessed and ensure that they are
addressed in the way they choose.
We will be the voice of palliative care in our community
By doing this the charity will be supporting the health, social and educational services to meet their obligations
Report from the Clinical Director
Keech Hospice Care provides specialist palliative care to Adults in Luton and South Bedfordshire and Children from
all of Bedfordshire, Hertfordshire and Milton Keynes.
This has been another successful year in delivering services for our patients, children and families. This year has
been particularly marked by the launch of four new services (1) My Care Co-ordination Caseload, (2) My Care Coordination Team, (3) Rapid Response Service and (4) Clinical Day Therapies.
Our strategic objectives continue to be:
1. Providing Excellent Care – to ensure that patient’s, children and families receive outstanding care from all they come into contact with.
2. Wider Reach – To lead the provision of Community services in order to ensure that excellent care is delivered to patients in their own
home (or care home)
3. Right Choices – To ensure that the preferred place of care for all patients and families is recorded and communicated across the whole
health system.
4. Value for money – To ensure better value for money across our hospice services
5. Working together – To build on and develop further partnerships with health and social care professionals in our area
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Objectives
Objective 1 – Providing excellent care
To ensure that patients, children and families receive outstanding care from all they come into contact with.
Highlights from this year include:
 Numbers of compliments received remain high, demonstrating the value patients, children and families place on our service. We continue
to complete a ‘Friends and Family’ test for the commissioners. This requires us to ask the question “would you recommend our service to
a friend or family member?” We continue to receive a good number of very positive responses. This is a nationally approved and
implemented tool which allows for benchmarking and forms part of our CQUIN (Commissioning for Quality and Innovation payment
framework) for commissioners and is related to an additional payment at the end of the year if we meet the targets set.

We received project funding from Macmillan Cancer Support to explore the needs of patients with an early diagnosis and develop a
Palliative Rehabilitation Service. Half way through the project there is progression towards developing a Palliative Rehabilitation Team,
which incorporates a physiotherapist, an allied health professional technician, an occupational therapist and a palliative service
coordinator. Macmillan is involved with bid proposals and launch funding. In conjunction with this team the work streams and subprojects are developing a Fatigue Management Programme, Self Management Programme and exercise regimes for palliative patients,
at any stage of their disease, all with the prerequisite of offering services and links outside of Keech or the hospital clinical environment,
empowering people to live successfully and effectively, whilst living with a with a non-curative disease.

We are continuing to work in partnership with the acute trust, primary care and commissioners for Luton & Bedfordshire in developing
services for all non-malignant palliative disease.

Keech has now completed a new single Bereavement Pathway for children and adults.

A new post-bereavement assessment tool has also been introduced to measure outcomes. The new Shoulders of Support Group (SOS)
started in January 2014. This group is for post-bereaved parents of children who were cared for by Keech.

Keech now chair a new group to identify gaps in services for young people transitioning from Children’s to Adult Services. Membership
comprises of representation from the hospital, community, hospice and social care. This group will develop a paper and recommendation
for the Luton Palliative Paediatric Network on how to improve on this important issue which will be reported to NHS East of England. We
have also made contact with the transition lead for Hertfordshire to develop the pathway there.
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
In Children’s services we continue to work with local partners in developing a paediatric palliative pathway for children in Luton and
designing and implementing the Luton CCG Children and Young People’s Palliative Care Strategy, which is soon to be published.

Recruitment of staff to the Children’s Unit has been successful making our numbers close to establishment.

The Children’s Service has received a number of new pieces of equipment for use with patients, including suction machines and supplies
for memory work.

We continue to implement the Patient Safety Strategy and safety thermometer inspections are being conducted by the Clinical Director
and Quality and Compliance Manager. Our focus has been on the cleanliness of the units and we have adapted some cleaning practices
and protocols as a result. This work is extremely important in complying with CQC and our commissioners.

Managing patient safety is an important part of what we do. In addition to Clinical Risk Assessment training is being delivered to
managers, it has now also been delivered to senior staff nurses.

The occupancy on the Adult In-patient Unit has increased against the previous year and we are currently undertaking some work on how
we can improve the admissions process into the hospice. Two of our health care assistants have almost completed their first year of the
Assistant Practitioners course; this is a two year course which will allow them to work across all areas in the Adult Service.

Continual discussions with the medical lead for paediatrics at the L&D have finally been productive. We have agreed to share a
Paediatric Consultant. We hope to start with two sessions a week from August until March 2015 when we will review if this input is
sufficient. It is extremely exciting to have our own Consultant sessions and places us in an excellent position for the new tariff and
becoming the lead specialist provider for children’s palliative care in our patch.
Objective 2 – Wider reach
To ensure that care is delivered fairly and equitably to all our local population, and to lead the provision of community services to ensure that
excellent care is delivered to patients in their own home (or care home).
Highlights from this quarter include:
•
The four new commissioned services have commenced.
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○ The Care Co-ordination Caseload identifies all adult patients in Luton, in their last year of life. The caseload is held on the
electronic patient record system called SystmOne. This register is now active and as of the end of March 2014 we have registered
149 patients, 20 of whom were already known to Keech.
○ The Care Co-ordination Team works across all agencies to ensure that packages of care, including our own, are put in place to
support patients and families to be at home thus preventing inappropriate admissions to hospital . The team work with patients
directly, following a referral from 9am-5pm on Monday to Fridays and 9am-2pm on weekends and bank holidays,.
○ Our third new service is a Rapid Response Service. This service is delivered by Keech through Palliative Care Support Workers,
responding to patients at home in crisis. It is most likely that this will be needed in the last few weeks/days of a person’s life and
enables them to die with dignity and in the comfort of their home. This team offer a “home from hospital/hospice visit” for palliative
patients to support their return home and are very involved in supporting the discharge of end of life patient’s home from hospital.
○ Our fourth and final new service is an extension of our already successful Keech Palliative Care Centre. Additional funding has been
received to offer infusions, transfusions and ascitic drainage (the draining of fluid which can collect in a patient’s abdomen). To
date we have delivered 29 blood transfusions, 77 infusions and 1 ascitic drainage.
• The numbers of patients attending clinics in the Palliative Care Centre remain high. In addition we have seen 10 additional patients & their
carers out in the community on our new support programmes for people with Respiratory diseases. At the end of March 2014, we had 49
patients on our MDT Register. This area of work, provided in the community, will continue to grow. The next stage of the Outreach
Programme would to be to extend it out to other groups of patients with non-malignant palliative diseases and obtain appropriate funding
to sustain the programme.
• The ABC End of Life Care Education Programme funded by the East of England came to a conclusion at the end of March 2014. This
project has been rolled out in most care homes in Luton and the targets originally set have been met thus far. Care homes in this region
have taken part during this year and the programme has been well evaluated. The challenge will be to continue, without this funding, to
provide support and education to all care home staff and domiciliary agency staff aiming to reduce hospital admissions and promote
dignity in End of Life Care. Care home staff have nominated EOL Champions who attend updates in current palliative and EOL practices.
Objective 3 – Right choices
To ensure that the preferred place of care for all patients and families is recorded and communicated across the whole health system.
Highlights from this year include:
 We continue to discuss with patients their preferred place of care and place of death. Every effort is made to accommodate these wishes.
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
The proposed implementation of the new regional Paediatric Resuscitation Plans in the Children’s Service will assist these discussions
with children and their families.

The new Care Co-ordination Caseload will enable us to understand who needs our support and will record patient preferences so that all
services involved with this patient are aware. We are currently finalising quality metrics which we will present in the next quality report.

A new cross organisational patient and public steering group has been set up to look at how we can improve the way we engage with the
people who use our services and learn from all they tell us.

The Breath of Hope group has now been running for a year which is a user group as well as support group. This group was a follow-up
initiative from the palliative respiratory out reach pilot. Part of this group's aims is to enable patients to discuss subjects that relate to
future planning.
Objective 4 – Value for money
To ensure better value for money across all our hospice services.
o Statutory income has continued to grow this year in excess of predictions. During 2013/14 our statutory income was 20% higher than in
the previous year. This was mostly due to new services being commissioned (My Care Co-ordination Team and Drug Therapies) for
Luton CCG, which was fully funded and worth 15% of the increase. In addition we received CQUIN opportunities from most of our
commissioners, which were achieved and resulted in additional funding. However, as we continue to negotiate our contracts with
commissioners to ensure best value for money, providing the best services becomes more challenging year on year as commissioners
apply annual deflators, although every attempt will be made to maintain/increase our statutory funding levels.
o This year has been particularly difficult due to a large number of changes in CCG/CSU structures and personnel.
o We continue to review all budget lines and ensure we are efficient and effective.
o We continue to develop and work in partnership to bid for new work under the NHS Commissioning and Tendering process, and are in
the process of reviewing additional potential statutory funding opportunities.
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Objective 5 – Working together
To build on and develop further partnerships with health and social care professionals in our area.
Highlights from this year include:
 We are delighted at being able to develop new productive relationships with our commissioners despite the many challenges.
 Our relationship with the Luton and Dunstable Hospital continues to be strong.
 We are currently involved in partnering around submitting a bid for a tender for community services.
 Our Clinical Development Lead for Adult Services continues to grow our existing relationships with local hospitals, Cambridge Community
Services & SEPT around the joint working on non-malignant pathways and forming MDTs (Multi–disciplinary Team) meetings; Nonmalignant MDT; Palliative Respiratory Monthly MDT, Motor Neurone bi-monthly MDT. All the MDTs are hosted at Keech Hospice Care.
 The Palliative Respiratory Non-malignant MDT has been running since December 2012 and has proven to be very successful. Health
professionals from secondary care and community service attend this meeting, as well as Keech Hospice Care doctors and Keech allied
health professionals to discuss patients with complex issues and future care planning. This work is ongoing
 The Chronic Integrated Heart Failure Pathway is now completed and has been developed to provide end of life care for patients with heart
failure. This has been a 2-year working partnership project with a Cardiologist, the heart failure team from secondary care and community
services. The first MDT was held in December 2013 and it has been running successfully for 6 months. As this is our newest MDT there is
more development work to be continued through out the next year
 The Motor Neurone MDT has been running since December 2012 and has also proven to be successful. It has highlighted the inequity of
care and services between South Bedfordshire and Luton regarding patient pathways. We have been working with the neurological
network to prepare a business plan to improve pathways for all neurological services in our area. Bedfordshire CCG have agreed business
plan and we are in talks with Luton’s Acute Hospital Trust, Cambridgeshire Community Services and CCGs on how we can improve
service across this area. Keech Hospice Care is holding the register for all newly-diagnosed MND patients within Luton at this present
time.
 Implementation of the Luton CCG Children and Young People’s Palliative Care Strategy continues. Our Clinical Development Lead for the
Children’s Service is working closely with colleagues from Commissioning, Children’s Social Care, Cambridge Community Services
children’s community nursing team and hospital colleagues on this project.
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 The first of a series of palliative care teaching sessions has already taken place at the Luton & Dunstable Hospital, delivered by our
Clinical Development Lead, and an additional session has been delivered to the Children’s Community Nursing Team in Luton as part of
this ongoing project. The project also includes establishment of a local Paediatric Palliative MDT, and implementation of the new regional
Paediatric Resuscitation Plan for the East of England. This work is ongoing.
 Our Clinical Development Lead for the Children’s Service is also currently working with colleagues across the East of England region to
develop a regional Paediatric Palliative Care pathway and continues to regularly attend and work with colleagues on the East of England,
Luton and Hertfordshire Paediatric Palliative Care Networks.
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Priorities for improvement and statements of assurance from the board
The Council of Management is committed to the delivery of high quality care that is safe, effective and provides patients and carers with a
positive experience.
1a. Priorities for improvement in 2014 – 2015
Providing Excellent Care:
Priority 1:
Target:
How was this identified as a priority?
How will this priority be achieved?
How will progress be monitored?
To increase the range of services provided within the community to those with malignant and nonmalignant conditions.
To scope and explore the needs of children and families and develop a community support model.
To increase the number of adults we see in their normal place of residence
This was identified as a priority through the Charity’s Care Strategy
This will be achieved by becoming a commissioned service to provide new/additional clinics in the
community and building on the My Care Co-ordination Team service within Luton, either in our own
right or as through partnership working with other provider services.
A scoping study will be completed and a new model of service provision will be developed.
Progress will be monitored through our care management structure and the children’s services
steering group.
Wider Reach:
Priority 2:
Target:
Ensure access to services for patients with non-malignant disease and palliative rehabilitation
needs
Develop outreach programmes for those with respiratory diseases, heart failure outreach and rare
neurological conditions.
How was this identified as a priority?
This was identified as a priority through the Charity’s Care Strategy
How will this priority be achieved?
This will be achieved by building on the success of the non-malignant work developed in 2012/13.
Audits of non-malignant activity will be completed and where appropriate benefits to health economy
of providing such services will be written up and published. Keech will seek buy-in from our Clinical
Commissioning Groups (CCGs) to commission as a new service. Keech Hospice Care will also
endeavour to raise funds to provide such services in addition to the commissioning process.
How will progress be monitored?
Progress will be monitored through quarterly quality reports, reviewed at management meetings and
contract reviews.
Value for Money:
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Priority 3:
Target:
Develop a ‘Cost of Care Model’ and review our hospice tariffs, to ensure an efficient and effective
cost and income base.
To develop a statutory income strategy financial framework that can be populated to provide
accurate costs for individual services provided.
How was this identified as a priority?
This was identified as a priority through the Charity’s Care Strategy
How will this priority be achieved?
This will be achieved by developing a ‘Cost of Care Model’ framework, which can used to provide
more accurate costs of individual services and pilots proposals.
How will progress be monitored?
This will be monitored through commissioning meetings and the risk and audit committee.
Working Together:
Priority 4:
Explore opportunities to develop a collaborative research programme and service improvement plan,
offering palliative care education and resources to resources to colleagues in the health economy, to
ensure best practice is offered everywhere.
Target:
Establish a formal relationship with a Higher Education Institute.
How was this identified as a priority?
This was identified as a priority through the Charity’s Care Strategy
How will this priority be achieved?
This will be achieved through the identification of a HEI partner and appropriate
education and research plan.
Progress will be monitored through quarterly quality reports, reviewed at management meetings.
How will progress be monitored?
Patient Experience:
Priority 5:
To obtain meaningful patient and public feedback and use to shape services
Target:
To establish two Patient & Public Involvement Participation Groups (one for adults and one for
children’s services). This group will work within an agreed Terms of Reference to provide a focus
within the charity for involvement and debate. The panel will determine priorities for targeted patient
surveys and involvement.
To hold an annual Stakeholder and Partner Meeting (around October), at which time ideas for
service development and how services should be shaped to address patient and public feedback will
be discussed with commissioners.
How was this identified as a priority?
How will this priority be achieved?
This was identified following a review of the Patient and Public Involvement Strategy.
Engaging with patients and families through the Patient & Public Involvement Steering Groups and
develop a service development plan to present at the Stakeholder and Partner Meeting.
This will be monitored through the Patient and Public Involvement Steering Committee.
How will progress be monitored?
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1b. Progress against Priorities for improvement in 2013 – 2014
Priorities set for 2013/14 were selected to impact on patient safety, clinical effectiveness and patient experience:
Patient Experience:
Priority 1:
Target:
Progress in 13/14
To increase the number of referrals and total beneficiaries to our service
It is planned that by end 2013/14 the number of referrals to our
service has increased in total by 10%.
Patient numbers remain broadly the same as last year.
This represents an improvement given in this year we have
undertaken major building works which reduced our
To develop at least two new community-based services by the end of the capacity.
financial year that are fully funded.
Patient Safety, Patient Experience and Clinical Effectiveness:
Priority 2:
To assure the quality of the services we provide.
Target:
To develop 3 outcomes measure for Children's Services and successfully
achieve adult outcome measures.
To continue to produce a Quality Report that shows an
improvement in trends.
Annual user satisfaction survey has better response and higher
levels of satisfaction.
All targets to be met and full CQUIN payment is received for NHS
contracts.
Clinical Effectiveness:
Priority 3:
Increasing our presence within the community
Target:
To provide care for patients closer to home
Patient Safety, Patient Experience and Clinical Effectiveness
Priority 4:
To work within our new 5 year care strategy
Target:
To further develop and achieve identified targets within our 5
year care strategy
We have continued to develop outcome measures this year,
including developing a new bereavement pathway for children
and adults.
Quarterly Quality Reports have continued to be provided in
house and externally.
We successfully achieved CHKS accreditation for the 2 nd time.
All CQUIN targets were met.
We have developed and delivered four services to support
people at home, including holding the locality register for
people in their last year of life. This has also enabled us to
support people with non-malignant disease.
Progress in 2013/14
This year we introduced the friends and family test and whilst
this produced challenges for this client group we received
exceedingly good scores and very positive comments.
We implemented our new patient safety strategy supported by
monthly safety thermometer inspections. This enables us to
track our performance and make improvements.
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2. Review of services
During 2013/14 Keech Hospice Care provided the following specialist palliative care services to the NHS:
Adult Service
• Inpatient unit
• Palliative Care Centre
• Care Co-ordination Services
Children’s Service
• Inpatient unit
• Day Support
• Community Nursing Team
In addition we have also provided the following services through charitable funding:
• Hospice at Home
• Complementary Therapy
• Music Therapy
• Family and Carer support
• Bereavement Care
• Spiritual Care
• Hydrotherapy pool
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3. Participation in Clinical Audit
•
During 2013/14 no national clinical audits or confidential enquiries covered NHS services that Keech Hospice Care provides
•
During 2013/14 Keech Hospice Care participated in no national clinical audits and no confidential enquiries of the national clinical
audits and national confidential enquiries as it was not eligible to participate in. However we ensured that key audits were completed
using nationally recognised excellence audit tools for hospices developed by Help the Hospices.
•
The national clinical audits and national confidential enquiries that Keech Hospice Care participated in during 2013/14 are as follows:
N/A
•
The national clinical audits and national confidential enquiries that Keech Hospice Care participated in and for which data collection was
completed during 2013/14 are listed below alongside the number of cases submitted to each audit or enquiry as a percentage of the
number of registered cases required by the terms of that audit or enquiry: N/A
•
The reports of 0 national clinical audits were reviewed by the provider in 2013/14. This is because there were no national clinical audits
relevant to the work of Keech Hospice Care.
•
Keech Hospice Care was not eligible in 2013/4 to participate in any national clinical audits or national confidential enquiries and
therefore there is no information to submit.
•
The local clinical audits that were reviewed in 2013/14 are listed further in the document along with proposed actions required to
improve the quality of healthcare provided.
•
Keech Hospice Care submits an annual National Minimum Data Set to the National Council of Palliative Care and uses nationally
approved audit tools (Help the Hospices) to audit Infection Control, General Medication and Controlled Drugs. Since 2009 we have
achieved the status of accredited Hospice with CHKS. This is a quality assurance accreditation which is tailored to Hospice services.
4. Research
The number of patients receiving NHS services provided or sub-contracted by Keech Hospice Care in 2013/14 that were recruited
during that period to participate in research approved by a research ethics committee was NONE.
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5. Use of CQUIN payment framework
A proportion of Keech Hospice Care income in 2013/4 was conditional on achieving quality improvement and innovation goals as specified
by our Commissioning Partners and the agreed CQUIN’s where achieved in 2013/14.
6. Statement on the Care Quality Commission
Keech Hospice Care is required to register with the Care Quality Commission and is currently registered to carry out the regulated
activities:




Treatment of disease, disorder or injury
Accommodation for persons who require nursing or personal care
Nursing Care
Personal Care
There are no restrictions on our registration.
The Care Quality Commission has not taken any enforcement action against Keech Hospice Care in 2013/14.
Keech Hospice Care has not participated in any special reviews or investigations by the Care Quality Commission in 2013/14.
7. Data Quality
Keech Hospice Care did not submit records during 2013/14 to the Secondary Users Services for inclusion in the Hospital Episodes
Statistics which are included in the latest published date because it is not eligible to participate in this scheme. We do however have our
own system for monitoring the quality of data.
We continue to use SystmOne, electronic patient record system, which is also used by many healthcare professionals in the community
meaning that we can share information from and with other services (with given consent from the patient). SystmOne is also linked with
the NHS spine which makes for an easier registration process when a patient is referred into the service, it also means that our doctors
are able to access test results online.
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8. Information Governance Toolkit
Keech Hospice Care achieved 73% using version 10 of the Information Governance Assessment Report for 2013/14: This is well above
the 66% we are expected/required to score.
9. Clinical coding error rate
Keech Hospice was not subject to the Payment By Results clinical coding Audit during 2013/14 undertaken by the audit commission.
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10.
Organisational Structure
Keech Hospice Care – Governance and Management Structure
Council of Management
Clinical Governance Committee
Finance Committee
Clinical Management Team
Income and Marketing Committee
People Committee
Senior Management Team
Education Group
Operational Management Team
Risk Management and Health and Safety Committee
Medical Gases Committee
Clinical Audit Group
Drugs and Therapeutics
Committee
Infection Control Group
Children's Service
Steering Group
Representatives of Employee
Safety Committee
Moving and Handling Group
Legend
– Governance
Notes Audit Group
Joint Consultative Committee
– Management
Patient and Public Involvement
Steering Group
– Operational
Staff Forum
Widening Access Group
– Consultation
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ADULT SERVICES
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11.
Adult Service Statistics
Total number of patients seen was 468 in 2013/14 (against 445 in 2012/13)
Adult Inpatient Analysis
Out of the 121 adult patients who used
the Adult In-patient Unit:
• 2 have had 3 residential stay
• 15 have had 2 residential stays
• 104 have had 1 residential stay
2500
Out of the 74 patients who died on the
Adult In-patient Unit:
• 40 were referred for end of life care
• 32 were referred for pain/symptom
management
• 2 was referred for emotional
support
2000
1500
Out of 51 patients who were referred for
end of life care:
• 40 died on the unit
• 6 were discharged home
• 6 were discharged to a care home
(1 who was discharged home later
came back and died on the unit)
1000
500
0
Bed nights
Emotional Support
End of Life
Pain/Symptom
Management
Total Nights
65
518
1338
1921
Breakdown of patients using the service in 2013/14
Total BME 2013/14 = 16.6%
Total BME 2012/13 = 19.3%
Local BME 35%
These 51 patients were on the unit for a
total of 518 bed nights.
Out of the 121 patients who had an
overnight stay:
• 83% had a cancer diagnosis
• 9% had a non-malignant diagnosis
• 8% had no diagnosis recorded
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Keech Palliative Care Centre Patient Analysis
Total patients seen in KPPC was 215 in 2013/14 (an increase on the 199 seen in 2012/13)
The graph below shows which Palliative Care Centre services patients have accessed:
200
Out of the 215 patients who attended the
Palliative Care Centre in this reporting
period:
180
160
140
•
•
•
•
120
100
80
60 accessed 1 clinic
95 accessed 2 clinics
44 accessed 3 clinics
16 accessed 4 clinics
60
40
20
0
Patients
Nurse Led Clinic
Full Day
Drop In
Doctors Clinic
Methadone
Clinic
177
123
96
38
10
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Keech Hospice Quality Accounts 2013 - 2014
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Keech Hospice Quality Accounts 2013 - 2014
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Supportive Care Services (last years figures were not recorded in this way)
Art therapy activity statistics
Total adult sessions = 74, Total Children’s sessions = 132
Complementary therapy activity statistics
Total adult sessions = 710, Total Children’s sessions= 144
Music therapy activity statistics
Totals (From November 2013) adult sessions = 121, Children’s sessions= 17
Social work activity statistics
Total adults sessions= 672, Total Children’s sessions= 158
Hospice at Home activity statistics
Total patients accessing the service was 149 for 2013/14
Bereavement service activity statistics
Total adults = 354, Children’s = 295
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Other activity undertaken by Adult Services
Out of Hours Nursing Visits and Telephone Advice Line (Adult Service)
Total patients supported 473
My Care Co-ordination Activity
Activity December 2013 – March 2014
Total number of registrations:
Deaths:
Discharges:
Average length of time on caseload:
Number of hospital avoidances:
Non malignant patients:
149 (20 of whom were already known to Keech)
30
4
37.1 days (for those who were discharged or died).
3
16
.
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Keech Hospice Quality Accounts 2013 - 2014
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12.
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Keech Hospice Quality Accounts 2013 - 2014
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12.
Infection Control
Required
For
CQC
13.
2012/13
2013/14
The no. of patients known to be infected
with MRSA on admission to the unit
The no. of patients known to be
infected with MRSA whilst on the inpatient unit
1
1
0
0
The no. of patients admitted to the unit
with C-difficile
The no. of patients infected with Cdifficile while on the in-patient unit
1
0
0
0
The no. of patients known to be infected
with an alert on admission
The no. of patients who contracted an
alert organism infection whilst on the unit
(if known)
0
0
0
0
Safeguarding
Required
For
CCG/
CQC
2012/13
2013/14
The no. of CQC reportable safeguarding
issues
0
1
The no. of non-CQC reportable
safeguarding issues
1
3
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CHILDREN’S SERVICES
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Keech Hospice Quality Accounts 2013 - 2014
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14.
Children’s Service Statistics
Children's Service
Total number of children using the service was 244 in 13/14 (against 268 in 12/13)
Children’s In-patient Unit activity statistics
300
250
200
Total BME 2013/14 = 25%
150
Total BME last year = 30%
BME
100
Non BME
50
0
Bedfor
Luton
d
Herts
Milton Out of
Keynes area
Total
BME
6
37
14
4
0
61
Non BME
42
13
112
14
2
183
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Keech Hospice Quality Accounts 2013 - 2014
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Breakdown of Children’s Services Activity
450
400
350
300
250
200
150
100
50
0
Bed nights
Short Break
Crisis Care
Symptom/ Pain
Management
Hospital Transition
End of Life
396
182
107
40
22
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Children’s Community Activity
300
Total families supported 232 (13/14). This was an increase on 2012/13 activity of 215.
261
250
191
200
150
261
100
250
50
191
0
26
21
21
18
9
8
2
Reason not
recorded
40
Bereavement
(Pre)
41
50
Specialist Play
88
Bereavement
(Post)
101
100
Emotional
Support
136
School liaison
138
150
End of Life Care
200
Comp Therapy
Second in
attendance
Symptom
Control
Professionals
Mtgs
Clinical
Intervention
Assessment
Psychosocial
Care Planning
Emotional
Support
0
Children’s Service Day Support activity statistics
Total number of attendances in 2013/14 was 522
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Keech Hospice Quality Accounts 2013 - 14
Care Planning
300
15.
Accidents, Incidents, Complaints and Compliments
(Hospice Wide Statistics):
Accidents
2012/13
Adult IPU
Palliative Care Centre
Children's IPU
2013/14
Patient (Falls)
15
11
Patient (Accidents)
2
1
Care Staff
5
6
Patient (Falls)
1
0
Patient (Accidents)
2
1
Care Staff
3
0
Patient (Falls)
0
0
Patient (Accidents)
3
1
Care Staff
4
4
35
24
Reportable Accidents
Number of accidents reported to RIDOOR = 0
Number of accidents reported to CQC = 0
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Keech Hospice Quality Accounts 2013 - 14
Incidents
Medication Incidents - Adult
2012/13
11
2013/14
4*
Medication Incidents Children
Patient Care - Adult
7
3
1
5**
Patient Care - Children
4
4
Patient Care - Hydropool
0
1
Non-care Incidents - Adult
IPU
Non-care Incidents Children
Volunteer - Professional
Boundaries H@H
Power failure
7
10
7
3
0
1
0
1
37
32
Number of incidents reported to RIDOOR = 0
Number of incidents reported to CQC = 1 **
Number SUI = 0
Number reported to LIN = 1*
Complaints
2112/13
Patient Care – Adult
(Verbal)
Patient Care – Adult
(Written)
Patient Care – Children
(Verbal)
Patient Care – Children
(Written)
2013/14
0
1*
0
0
2
0
3
1
5
2
Reportable Complaints
Number of complaints reported to CQC = 1*
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Keech Hospice Quality Accounts 2013 - 14
Compliments received
Listed below is a selection of compliments received:
“I cannot praise enough for the
dedication and kindness of all
the staff to each and every
patient”
“Thank you for always
being there for us, you are
the most important place in
our lives and I will be
eternally grateful to ALL of
you.”
“Really lovely, caring and relaxing
environment. Any questions or
worries are dealt with efficiently and
effectively and with sensitivity”
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Keech Hospice Quality Accounts 2013 - 14
Friends & Family
A recent requirement of our commissioners is that we ask our users to complete a friends and family questionnaire. We introduced the
questionnaire at the end of April 2013 and we have received a good response so far. On discharge from the In-patient Units, patients and
families are asked the following question:
“From your/your child’s experience how likely are you to recommend this service to friends and family if they were ever in need of similar care
or treatment.”
Children’s Results:
92% of families rated us as “Extremely Likely” that they would refer someone else to us
Adults Results:
100% of Adults rated us as “Extremely Likely” that they would refer someone else to us
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Keech Hospice Quality Accounts 2013 - 14
16.
Quality and Compliance
Standard of Care
Care Quality Commission (CQC)
On 3rd July 2013 we had an unannounced inspection from the Care Quality Commission (CQC) As expected the inspector concentrated in the
Children’s Service (last year the Adult Service was the main focus of the inspection). We were inspected on the following outcomes:
 Care and welfare of people who use the service
 Safeguarding people who use the services from abuse
 Supporting workers
 Complaints
We have received the inspector’s written report and was found compliant in all of these outcomes.
Accreditation Report (CHKS/HAQU):
We have passed Healthcare Accreditation and Quality Unit (HAQU) inspection for the second time to have achieved the status of
accredited hospice.
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Keech Hospice Quality Accounts 2013 - 14
Clinical Audits Conducted:
The Clinical Audit Group meet quarterly. The group are presented with reports from any new audits and review the progress made against
action plans from previous audits.
Summary of 2013/14 Audits & Surveys:
Audit Title
Infection Control
Infection Control Audit 2013/14 Adult Service
Infection Control Audit 2013/14 Children’s Service
Medication
Medical Gases Audit 2013
Use of Methadone Audit 2013
Controlled Drugs Audit (Adult IPU) 2013/14
Surveys
Adult Service patient experience Survey
Carer Experience Survey
Family Experience Survey
Patient Accident Audit
Controlled Drugs Audit (PCC) 2013/14
Controlled Drugs Audit (Children) 2013/14
General Medicines Audit 2013/14
General
Non-malignant diagnosis (COPD) Outreach Audit 2013
Pain Assessment Audit 2013
Parental Drug Chart Re-audit 2012
Complementary Therapy Audit
Practicing Privileges Audit
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Keech Hospice Quality Accounts 2013 - 14
In addition to the audits listed previously, we also conduct a regular audit of patient records to ensure that each patient has an accurate and
legible clinical record that complies with CHKS Standard 12. The clinical record content enables the patient to receive effective continuing
care and to be identified without risk of error. The record enables the healthcare team to communicate effectively, facilitates the collection of
data for research, education and audit and can be used in legal proceedings.
The graph below shows the results received in our regular record audit since July 2013.
100
90
80
70
60
Adult Service
50
Children's Service
40
Overall
30
20
10
0
Jul-13
Oct-13
Jan-14
Apr-14
Adult Service
99
97
95
95
Children's Service
94
93
94
92
Overall
96
95
94
93
Research
In 2013/14 Keech Hospice Care did not take part in any research. However, this is an area we are interested in pursuing as set out in our
priorities for 2014/14.
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Keech Hospice Quality Accounts 2013 - 14
17.
Feedback from Our NHS Commissioners:
Luton CCG – “I am very pleased to be working with the excellent staff from Keech. There are a lot of exciting innovative services that will
help us meet our CCG targets over the coming years. In these times of stretched financial resources I am looking forward to building our
relationships to deliver high quality, joined up care for the residents of Luton.”
Commissioning Priorities Manager –Cancer, Palliative and End of Life Care, Luton CCG
Herts Valley CCG – “Herts Valleys Clinical Commissioning Group welcomes the opportunity to comment on the Keech Hospice Quality
Account for 2013/14. This reflects the open and collaborative approach of Keech in working with patients, carers and the general public
regarding the quality and ethos of care provide by Keech. The report details the range of work that Keech undertakes locally and considers all
of the relevant mandatory elements. The information presented within the report has been reviewed and HVCCG is satisfied that the position
reflects an accurate account of the quality of the services provided.
Herts Valleys CCG sees Keech Hospice as a key partner in the delivery of integrated end of life care for the children of West Hertfordshire.
We value the excellent open and regular communication that we have with them and are committed to working with them to continue to
deliver a high quality and much valued service to our population.
During 13/14 Keech Hospice continued to provide high quality care to our patients, prioritising patient safety, clinical effectiveness and
enhancing childrens’ and their families’ experience. Progress towards these improvements was monitored through regular contract review
meetings.
Looking forward to 2014/15 Herts Valleys CCG is pleased to continue to work closely with the hospice to achieve its End of Life Strategy and
key priorities. These priorities reflect both organisations aim to continually improve and provide good quality end of life care to its patients and
the community.”
End of Life Care Commissioning
Manager and Community Contracts Manager, HVCCG
East & North Herts CCG has reviewed the information contained in the Quality Account.
During 2013-14, Keech Hospice continued to deliver high quality care to the children of Hertfordshire. The Quality Account set out of
achieving against the priorities set for 2013/14 and demonstrates continued quality improvement and greater access for service users. During
the year the Hospice also received positive CQC inspection where they were found to be compliant with all the outcomes assessed.
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Keech Hospice Quality Accounts 2013 - 14
The Hospice as a strong emphasis on proactive development and identification of new ways of working with partners to improve the quality of
service for patients. In addition, they proactively maintain their involvement and influence in relation to palliative care strategy.
The Hospice’s commitment to patient focussed quality improvement is evident by the high number of service users who said that they would
recommend the service to their friends and family.
The priorities set out for 2014/15 build upon the success of 2013/14 and demonstrate a commitment to all around quality improvement. The
priorities are supported and embedded into the Hospice care strategy.
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 covered in Hertfordshire.
Quality Lead, ENHCCG
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