Quality Account 2013-14
Libby Mytton
Director of Care
Registered Charity No. 700272
Primrose Hospice
Quality Account 2013-14
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‘On behalf of myself and all my family I just want to say a very big THANK
YOU to you all for the kindness, love and care shown to my wonderful Dad
during the time he spent with you. Also for the compassion that you
showed to us all as a family.’
‘There are never the right words to express the gratitude that we feel so I
say a big thank you once again from the bottom of my heart.’
Family of a Day Hospice Patient.
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Quality Account 2013-14
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PART 1
Chief Executive’s Statement of Quality
This Quality Account, the third one we have produced, is for all our stakeholders our patients, their families and carers, the general public in our communities and the
local statutory and voluntary sector organisations that we work with.
Our services are free to users at the point of delivery and the objective of this report
is to provide clear information about the quality of those services so that our
patients feel safe and well cared for and their families and friends are supported and
reassured that these services are of the highest standard.
Our Director of Care and her team are responsible for the preparation of this report
and its content. To the best of my knowledge the information in the
Quality Account is accurate and a fair representation of the quality of health care
services provided by Primrose Hospice.
We regularly request feedback from our patients and service users and strive to
continually challenge ourselves to improve. Providing excellent quality services that
are tailored to meet people’s individual needs is our top priority.
To deliver services to the high standards we set ourselves, we rely on the
commitment and dedication of our staff and over 250 volunteers including our Board
of Trustees. I extend my gratitude and thanks to all of them for helping us to
continue to provide services of such quality.
Helen Garfield
Chief Executive Officer
Primrose Hospice
Quality Account 2013-14
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PART 2
Priorities for Improvement 2014-15
Primrose Hospice is fully compliant with the section 20 regulations of the Health and
Social Care Act 2008. As such, the Board did not have any areas of shortfall to include
in the priorities for improvement for 2014-15.
Future Planning
The priorities set for the next year result from discussions with staff, service users
and stakeholders and we have tried to ensure that they are achievable, measurable
and will provide improvements that are important to those who use our services.
Improvement Priority 1:
Measuring outcomes for Day Hospice patients has always presented challenges
because benefits gained tend to be outweighed by a patient’s disease progression
and general deterioration over time. We intend to pilot two tools for measuring
outcomes, to establish their ease of use and the quality and usefulness of
information collected. We aim to have adopted a tool for measuring outcomes by
the end of the year.
Improvement Priority 2:
At the suggestion of our service user forum we intend to pilot a weekly, volunteer
run drop in group open to all service users, increasing access to support. We aim to
decide after 6 months whether uptake and feedback is sufficiently positive to
continue with this group, and at that point to decide on a long term strategy for
resourcing it.
Improvement Priority 3:
At the suggestion of our service user forum we intend to explore the possibility of
opening up hospice space and facilities for a variety of disease-specific support
groups. We recognise the needs of patients living with a wide range of long term
conditions and aim to work closely with colleagues working across a number of
specialities and to widen access to our facilities. We hope to have in place a support
group for at least one long term condition by the end of the year.
Improvement Priority 4:
We are keen to increase our skills and knowledge in caring for those with learning
difficulties and at the suggestion of our service user forum will be seeking
educational opportunities for staff. We aim to have acquired training or education
for at least 75% of clinical staff by the end of the year.
Primrose Hospice
Quality Account 2013-14
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Improvement Priority 5:
We hope to complement our existing support for the Worcestershire Health and
Care Trust Lymphoedema Service by training three of our Complementary Therapists
in the provision of a reflexology lymphatic drainage technique, which is showing
extremely promising results compared to lymphoedema bandaging.
Progress against the Improvement Priorities identified in 2013-14
During 2013-14 the hospice implemented a number of initiatives to enable it to
provide a more responsive and comprehensive contribution to end of life care within
our local community in spite of the financial challenges of the current climate and
the uncertainty created by major organisational changes within the NHS.
Progress is discussed below.
Progress made against Priority Improvement 1: Improve facilities within the Day
Hospice Environment
The Hospice received capital funding from the Department of Health to improve,
modernise, refresh and expand existing facilities in the Day Hospice. Unfortunately,
due to huge demand by Hospices for this funding, we only received 66% of the
funding we had applied for, and had to considerably reduce and amend our plans in
line with the money available. The building work will be completed by the end of
April 2014 and will provide us with a new Garden Room for Day Hospice patients,
providing a quiet and reflective space in contrast with the busier, activity area in the
existing lounge. It has also provided office areas on the 1st floor, freeing up 3 ground
floor rooms currently used as offices, and creating extra space to be used as
consultation rooms for patients.
Progress made against Priority Improvement 2: Develop clinics/access to services
for patients with non-malignant long-term conditions such as end stage heart
failure.
This county wide project has been running in all three of Worcestershire’s hospices.
In Redditch and Bromsgrove progress has been somewhat hampered by low referrals
to the clinics, and the team is working proactively with GPs to raise awareness of the
clinics and of the referral criteria, in order that the model can be properly tested by
the end of the pilot. Outcomes for those patients who have attended have been
positive, in that people suffering from a disease group not regularly linked with a
hospice have been able to access the range of services on offer, and to engage in end
of life care planning if desired.
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Quality Account 2013-14
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Progress made against Priority Improvement 3: Explore the need, and if
appropriate establish access to services within local prisons.
Initial contact has been made with the healthcare team at HMP Long Lartin who
have worked quite proactively to improve facilities for offenders with terminal
illness. A helpful link has been established, and we have made an offer of support
and education to the team. We now need to visit HMP Hewell, to explore the
different needs of that establishment.
Progress made against Priority 4: Expand existing support services for children and
families.
We appointed a Macmillan Children and Families Practitioner in May 2013, and we
have been pleased with the way in which the role has developed during the year.
Previously our Childrens’ service was made up of a committed but very small team of
volunteers, most of whom work full time but offer their spare time to support
children coping with actual or impending loss, usually of a parent or close family
member. The service has now been able to broaden considerably, with increased
referrals, effective links with schools and links with Kemp Hospice who run
residential weekends for bereaved children and families. We are gaining feedback
from children using the service and have been able to provide both internal and
external training for those working with bereaved children.
‘Very good and helps you with worries, it makes you have a good time when you
have worries in you. You don’t have to be scared of telling people what your worries
are.’ (‘A’, aged 11)
‘Thank you so much for the sessions, it really has been amazing. You have shown me
lots of ways to help me be stronger.’ (‘B,’ aged 11)
Progress made against Priority 5: Secure recurring funding for bereavement
services in Redditch and Bromsgrove.
We have been successful in securing a further one year of funding for this service,
which has been expanding over recent months, but will have to wait until next year
to see whether it is a service that the Redditch and Bromsgrove CCG want to
commission in the longer term.
Progress made against Priority 6: The addition of a volunteer role to our existing
Primrose at Home service
We now have a volunteer in place, currently working once a week with a patient
with no personal care needs, but whose family are reluctant to leave her alone. The
intensity of the family’s caring role had put a strain on relationships, made even
more stressful by previous complex bereavements. Having a Primrose
Volunteer Carer has calmed an otherwise fraught situation, enabling the family to
continue their caring role. This service development enables Primrose at Home
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Quality Account 2013-14
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Carers to support other patients who have more complex care needs, therefore we
are economically able to support a greater number of patients. We are aiming to
complete 3 months volunteer - patient contact before reviewing and potentially
increasing to a second volunteer.
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Quality Account 2013-14
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Statements of Assurance from the Board
The following are a series of statements that all providers must include in their
Quality Account. Many of these statements are not directly applicable to hospices.
Review of Services
Hospices are required to report against those services commissioned by their local
NHS. Primrose Hospice has, to date, received a grant from NHS Worcestershire and
currently provides the following services:
o
o
o
o
Day Hospice
Outpatient facilities
Family Support Services
Primrose at Home
Participation in clinical audits
During 2013-14, no national clinical audits and no national confidential enquiries
covered NHS services relating to palliative care. Primrose Hospice only provides
palliative care. During that period Primrose Hospice was not eligible to participate in
any national clinical audits and national confidential enquiries.
As Primrose Hospice was ineligible to participate in the national clinical audits and
national confidential enquiries, and for which data collection was completed during
2013-14, there is no list below alongside the number of registered cases submitted
by the terms of the audit or enquiry.
The reports of 12 clinical audits were reviewed by Primrose Hospice during 2013-14.
As a result of these audits the following actions have been taken to improve the
quality of healthcare provided:




Improvements to our medicines management systems, in particular record
keeping
Highlighting to all staff the importance of obtaining patient consent to the
use of our electronic healthcare record
Improvements to our documentation in healthcare records
A number of minor maintenance and housekeeping issues
Research
The number of patients receiving NHS services provided or sub-contracted by
Primrose Hospice in 2013-14 that were recruited during that period to participate in
research approved by a research ethics committee was 0. There were no
appropriate, national, ethically approved research studies in palliative care in which
we could participate.
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Quality Account 2013-14
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Quality Improvement and Innovation Goals agreed with our Commissioners
Primrose Hospice income in 2013-14 was not conditional on achieving quality
improvement and innovation goals through the Commissioning for Quality and
Innovation payment framework.
What others say about us
Primrose Hospice is required to register with the Care Quality Commission (CQC) and
its current registration status is unconditional.
The Care Quality Commission has not taken any enforcement action against
Primrose Hospice during 2013-14.
Primrose Hospice is subject to periodic reviews by the Care Quality Commission and
its last unannounced on-site inspection review was on July 23rd 2013. The hospice
was fully compliant. Primrose Hospice has not participated in any special reviews or
investigations by the CQC during the reporting period.
The Quality Risk profile of Primrose Hospice states that the hospice is low risk and a
comprehensive quarterly quality report is submitted to the CQC to maintain this
ranking.
Data quality
In accordance with agreement with the Department of Health, Primrose Hospice
submits a National Minimum Dataset (MDS) to the National Council for Palliative
Care.
Primrose Hospice did not submit records during 2013-14 to the Secondary Uses
Services for inclusion in the Hospital Episode Statistics which are included in the
latest published data. Primrose Hospice score for 2013-14 for Information Quality
and Records Management was not assessed using the Information Governance
Toolkit. This toolkit is not applicable to palliative care.
Primrose Hospice
Quality Account 2013-14
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PART 3
Quality Overview
Primrose Hospice is a small, independent charity based in North East Worcestershire.
The Hospice is staffed by a total of approximately 60 people, including a number of
‘bank’ nursing staff who provide our Primrose at Home service, the staff who
manage our charity shops and ‘back office’ administration, finance and fundraising.
The clinical team during 2013-14 was staffed as follows:
Post
Head
Count
WTE
Vacancy
Nurse Manager
Day Hospice Team Leader
Staff nurses
Chaplain
Primrose at Home Team
Leader
Primrose at Home
contract carers
Family Support Team
Leader
Family Support Lead
counsellor
Clinical Supervisers
(counselling)
Macmillan Children and
Families Practitioner
Complementary Therapies
Coordinator
Volunteer Co-ordinator
Day Hospice Administrator
Primrose at Home
Administrator
Family Support
Administrators
Cooks
1
1
2
1
1
1
0.88
1.4
0.32
0.6
0
0
0
0
0
4
1.68
0
1
1
0
1
0.6
0
2
0.56
0
1
1
0
1
0.5
0
1
1
1
0.53
1
0.6
0
0
0
2
1.5
0
2
0.64
0
Total
23
13.61 0
The most recent National Minimum Dataset covers the period 1st April 2012 to
March 31st 2013. Primrose Hospice data for 2013-14 has been collated but there is
no comparative data available at the time of writing.
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Quality Account 2013-14
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The National Council for Palliative Care: Minimum Data Sets for 2012-13
Day Hospice
% New patients
% Places used
% new patients
with a non cancer
diagnosis
Average length of
attendances (days)
Outpatients
% New patients
Total clinic
attendances
Bereavement Services
% New service users
% new service users
aged under 16
% new service users
aged 16-24
Total contacts
Primrose at Home
% new patients
% new patients
with a non-cancer
diagnosis
% of home deaths
% of episodes of
care ending in
death
Total shifts
provided
Primrose Hospice
National Median
63.2%
60.4%
64.3%
57.6%
17.6%
23.5%
207
148.7
62.7%
243
73.8%
123
70.9%
10.7%
74.2%
1.7%
6.5%
2.9%
1,340
928
89%
17.1%
92.1%
17.1%
83.5%
78.7%
85.3%
76.7%
1,084
706
The National Minimum Dataset for 2012-13 compares Primrose Hospice with the
national median values.
The percentage of new Day Hospice patients during 2012-13 was slightly lower than
the national median for units of a similar size, although the percentage of places
used (60.4) was higher, and also higher than our own figure for previous years. We
also now run a monthly support group for younger patients who historically have not
chosen to engage with the traditional Day Hospice model of care. This group
continues to be well received.
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Quality Account 2013-14
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Primrose Day Hospice accepts patients with non-malignant long-term conditions as
well as cancer. The percentage of new referrals with a non-malignant diagnosis is
less than other Day Hospices of a similar size, but has improved considerably on last
year (up from 7.8% to 17.6%). This is due to better links with colleagues working with
neurological long-term conditions, chronic respiratory diseases and end stage heart
failure.
The average length of attendance at Primrose Day Hospice appears to be
considerably longer than others. Comparison above is with units of a similar size,
rather than those providing a similar model of care, and the length of attendance will
vary depending on the model of care provided. The national minimum average for all
units is 14.1 days and the maximum 638.7
Outpatient figures at Primrose Hospice refer to a Clinical Nurse Specialist who runs a
weekly nurse-led clinic. Referrals of new patients, compared to similar sized clinics
across the country are a little lower, but the total number of clinic attendances is
considerably higher.
The bereavement service at Primrose Hospice is busy compared to other units of a
similar size. It also supports a substantially higher number of young people through
its Children’s service, as the figures given above show. This is due to the ongoing
development of our service, further assisted in the last year by the appointment of a
full time Macmillan Children and Families Practitioner.
This was the first year that we submitted figures for our very well established
Primrose at Home service, as the Minimum Data Sets have not always been
applicable to our type of hospice at home service. Our new referral rates are largely
in line with other hospice at home services, and it is pleasing to see that referrals for
patients with a non-cancer diagnosis are also in line. The main aim of hospice at
home is to offer patients a choice in their place of death, and to support families in
caring for their relative at home if that is the patient’s choice. It is therefore an
expectation that episodes of care will end in death at home, and our figures show
that in the majority of cases this is achieved. Comparison of the number of shifts
provided demonstrates the high demand for this service in our locality.
In addition to the limited number of suitable quality metrics in the national dataset
for palliative care, we have chosen to measure our performance against the
following metrics:
Indicator
Total number of new referrals to Primrose Hospice
Total number of outpatient attendances
Total number of Day Hospice attendances
Total number of Primrose at Home shifts provided
Total number of complaints
The number of complaints which were upheld in full
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Quality Account 2013-14
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2013-14
537
331
1,365
793
1
1
2012-13
525
243
1,821
1,084
1
1
2011-12
500
216
1545
1074
0
0
Indicator
The number of complaints which were partially
upheld
The number of serious patient safety incidents
(excluding falls)
Slips, trips and falls
The number of patients who experienced a fracture
or other serious injury as a result of a fall
Number of clinical audits completed
2013-14
0
2012-13
0
2011-12
0
0
0
0
2
0
0
0
0
0
12
18
16
Indicators for 2013-14 show a fall in the number of Day Hospice attendances,
accounted for partly because our capacity was reduced for a period of time whilst
building works were in progress. The fall in Primrose at Home shifts seems to be due
to late referral to the service, as the number of new referrals has remained
unchanged.
We document all incidents and near misses and these are routinely reported on and
reviewed at Senior Manager’s Meetings and Health and Safety Meetings. During
2013-14 a total of 7 incidents and 2 accidents involving patients were recorded. The
first accident involved a patient who fell asleep in a chair and fell forwards, bumping
his head on a table. He sustained only a small graze to his head. The other accident
involved a patient with mild dementia, who fell in the toilet and sustained a
laceration to her forehead which required suturing in hospital. A review took place
following this accident, to ascertain the adequacy of our risk assessment processes.
It was identified that the patient normally managed her own personal care, and a
nurse had accompanied her to the toilet and was waiting outside to provide privacy
when she fell.
Two reported incidents involved near misses, where there was the potential for an
accident to have occurred but no-one was actually injured, and two further reported
incidents involved security worries, both of which turned out to be unfounded. We
continue to encourage staff to use incident reporting mechanisms effectively to
highlight risks and prevent potential problems as well as to document actual
occurrences.
We now document and collect adverse comments as well as complaints,
demonstrating our response to criticism as well as formal complaints. Two adverse
comments were documented during the last year, both relating to the Primrose at
Home Service. Actions included discussion with the families and staff concerned, and
targeted training and supervision to minimise the risk of further problems. One
complaint was received, relating to miscommunication over a counselling
appointment. The complaint was upheld and apology made.
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Quality Account 2013-14
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The Hospice receives many letters of thanks and compliments, and approximately
10% of our service is funded by charitable donations received from families and
friends of patients wishing to show appreciation of our care.
Participation in clinical audits
The following audits were completed during the audit year 2013-14. Primrose
Hospice conducted all audits using national hospice-specific audit tools, which have
been peer reviewed and quality assessed. *
There is an ongoing emphasis on infection control with a number of mini-audits
being carried out on a regular basis.
* except where stated
Infection Control
Sharps
Clinical Room
Bathroom
Toilets for public use
Domestic cupboard
Kitchen areas (excludes
main kitchen
External Inspection
We achieved 94.4% compliance with the audit tool with
only one minor shortfall observed, which was
immediately rectified.
For the second year we achieved 100% compliance for
this audit
We achieved 95.5% compliance this year, due to a minor
shortfall, immediately rectified.
On this occasion the toilets audited were all in staff areas
of the building. We achieved 80% compliance for this
audit. A number of issues were observed, including some
damage to a wall where an extractor fan had been
installed. Some redecoration was needed. Extractor fans
were found to be dusty and all issues were taken up with
our maintenance and household departments
We achieved 85.2% for this audit, due to a number of
minor shortfalls. This area also received some comments
in the external inspection (below) and as a result has
been added as a specific area to the general cleaning
schedule.
This audit looked at kitchen areas other than the main
kitchen, which is subject to inspection by Environmental
Health and last time received the highest rating of 5/very
good. On this occasion the areas inspected included a
temporary drinks preparation area provided in the dining
room during building works. This area presented a few
problems such as lack of hand-washing facilities and a
fresh water supply but was only in use for a short period
of time. The other area inspected was a staff kitchen in
the Coppice Centre, which at the time of the inspection
was awaiting installation of a new hand-wash basin.
Every year, as well as regular mini infection control audits
we invite the Infection Control Nurse from the
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Worcestershire Health and Care Trust to undergo a full
inspection of our premises and infection control
measures. This is always thorough and includes all areas.
This year’s report gave positive feedback on our approach
to infection control and the fact that minimising risk is a
high priority for us. Note was made of the way we
monitor cleanliness, raise awareness and keep staff and
volunteers up to date with matters relating to infection
control with a comprehensive infection control folder. As
usual a number of minor issues were observed, relating
to cleaning staff, maintenance and the clinical team. An
action plan was produced and all actions completed.
Medicines
Medicines management
Controlled Drugs
Accountable Officer
Record keeping
Consent in Systmone
Staff Management
Personnel files
Primrose at Home
personnel files
Medicines Management is audited annually, although
medicines are not routinely administered in the Day
Hospice. We had made progress since last year in all
areas but still need to improve further on record keeping.
There is a limited role for a CDAO at Primrose Hospice as
we don’t order, stock or supply CDs and only very rarely
administer them to patients attending Day Hospice.
However we audit our arrangement each year as
required and this year achieved 100% compliance.
This audit examined the electronic clinical records in use
at Primrose Hospice and all other hospices and palliative
care services across Worcestershire, to check that
consent had been obtained from the patient for the use
of the electronic system. Results were very mixed across
different parts of the service and the average compliance
was 67%. Further team discussion on the reason for this
result seems to have shown that the problem is with
documentation rather than practice, but we will repeat
the audit this year and hope to see an improved result.
This is a simple audit, not using a Help the Hospices audit
tool, but checking Care Staff personnel files for
completeness. Overall results were very positive, with
just a small number of items missing or not yet filed.
This was a repeat of the above audit carried out by the
Primrose at Home Team Leader. Records were largely
complete, with some very minor omissions which were
addressed.
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Quality Account 2013-14
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What patients and carers say about the organisation
The User Forum meets whenever there is an issue on which we need to consult. We
invite service users from all parts of the organisation, including Day Hospice patients,
outpatients, those attending groups, including carer’s groups or bereavement
groups, and those attending counselling or receiving support in other ways. We try
to gather a group of at least 10 – 12, providing a broad representation of types of
service users, from current patients accessing a variety of services through to carers
and the bereaved. Groups are facilitated by a volunteer, or student, as we believe it
is important that people feel free to tell us what they really think without fear of
causing upset or offence. We find that we get much more valuable information from
user forums than from our annual patient satisfaction surveys, and are aiming to
replace the survey with a series of focus groups within Day Hospice.
This year the Service User Forum met in September 2013 and March 2014.
All meetings are minuted and an action plan created. Minutes and action plans are
taken to the Board of Trustees, and the results of actions taken are fed back in turn
to participants. The table below shows some of the comments made by our service
users in the last year and how we responded.
What service users said:
We don’t know enough about the full
range of services available at Primrose
Hospice and the general public knows
even less
The word ‘Hospice’ puts people off as it
has such negative connotations. Can you
rename yourself something like ‘the
Primrose Support Centre.’
How we responded:
Discussions around marketing are
underway, with a view to improving the
information generally available in all
parts of the building. We also plan to
hold another open day for the public.
This has been discussed previously and
discussions revisited since the comments
were made last September. The
disadvantage of losing the word Hospice
is mainly to our fundraising team, as
there are real fears that it would have a
serious effect on our ability to raise
charitable funds. Without that funding
we cannot continue to do our work. We
have no plans to change our name at
present.
This comment, made in the most recent
SU forum is to be taken back to senior
management and the Board of Trustees
for consideration.
If we have to keep the word ‘Hospice’ –
can you please lose the strap line ‘living
well at the end of life’ which follows on
from your logo? How about ‘Primrose
Hospice and Support Centre’? That
would sound more inviting.
Those of us who attend support groups In response to this request we are setting
find that it can feel like a long time up a pilot drop-in group over the next
between groups, especially when the few months, to see what the take-up is
Primrose Hospice
Quality Account 2013-14
16
group is monthly. Can we have
something like a weekly ‘drop-in’
session, when we could just come in a
have a chat with someone if we are
feeling low?
Could Primrose run some support groups
for specific diseases such as Parkinsons
Disease or MS?
and whether it is viable.
Sometimes we have found that messages
aren’t passed on by volunteer
receptionists
We don’t think you always have enough
volunteer drivers, and we would be
happy to make a donation towards the
cost if that would help.
This issue was passed on to the
Volunteer Coordinator for action.
We are going to look at this, and our
approach will first be to talk to specialist
teams working in these areas and see
whether there is the possibility for some
joint working, or maybe providing
facilities within our building for others to
run groups.
We are always looking for more
volunteer drivers but usually manage to
provide the lifts that are requested so
were a bit surprised at this comment.
However we are considering the best
way to provide information on making a
donation to those service users who
would like to, without making those who
can’t afford it feel uncomfortable
‘There is not enough to say how much the nurses helped my wife and the counsellors
helped myself. I am really grateful’ Bereaved Carer/counselling client
"Thank you so much for all your support and kindness over the last few
months. You have made a very difficult time so much easier to get through.
I would like you to know how much I appreciated your help. Also many
thanks to the night staff who made my life a lot easier. You are all very
special, caring people. It has been a privilege to know you all." Bereaved
Carer/Primrose at Home Service
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Quality Account 2013-14
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Annexe
What Redditch and Bromsgrove Clinical Commissioning Group said about Primrose
Hospice’s Quality Account for 2013-14:
A significant component of the work undertaken by NHS Redditch and Bromsgrove
Clinical Commissioning Group (CCG) includes the quality assurance of services
provided for the population of Worcestershire that are funded by the NHS. This
includes steps to assure the public of the data included within this Quality Account.
NHS Redditch and Bromsgrove Clinical Commissioning Group (CCG) engage in
Contract and Quality Monitoring Reviews with Primrose on a bi-annual basis and are
therefore in a position to confirm that as far as it possible the accuracy presented in
this Quality Account appears accurate.
The reporting of areas of success such as the services for bereaved children and
services for recently bereaved individuals not otherwise previously engaged with
palliative care services is to be congratulated. NHS Redditch and Bromsgrove CCG
is committed to supporting equality of access for vulnerable and marginalised groups
of individuals and hence welcome the improvement priority of enhanced engagement
with the population of people with a learning difficulty or disability.
Commissioners agree with the improvement priorities set by Primrose but would also
welcome a priority to continue to improve the percentage of people supported by the
Primrose at Home service who attain end of life care at home where it is their
preference to do so.
The Quality Account contains useful details of further priorities that are planned for
2014-15 but NHS Redditch and Bromsgrove CCG would welcome details that are
more specifically outcome focused and measurable. This will enable the public and
monitoring agencies to make a judgement on whether achieved progress was in line
with that expected.
NHS Redditch and Bromsgrove CCG would wish that the quarterly Contract and
Quality Meetings and Quality Assurance visits are highlighted within the report to
provide the public with assurance and confirmation that service quality is monitored
by Commissioners.
The manner in which responses to user feedback is detailed (‘what users said’/ ‘how
we responded’ provides a clear indication of the value that Primrose places on
information gained through user consultation.
More details of the lessons that have been learned in response to reviews completed
following complaints and incidents and the undertaking of local audits would be
welcome, rather than detailing the specifics of the nature of incidents. This would
enable an explicit demonstration of actions taken to enable continuous improvement.
In the spirit of transparency and Duty of Candour following the recommendations
made by Sir Robert Francis at the Public Inquiry into the failings that occurred at Mid
Staffordshire Hospital, the CCG would welcome the sharing of actions taken in
relation to the upheld complaint to minimise the likelihood of recurrence.
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The transparent reporting of incidents provides assurance for Commissioners and
the public of an open and honest reporting culture that is willing to learn from near
misses as well as actual incidents.
In summary NHS Redditch and Bromsgrove Clinical Commissioning Group believe
the Primrose Hospice Quality Account for 2013-2014 to be a balanced report that
reflects the quality of health care services delivered. The CCG wish Primrose
Hospice every success in continuing to deliver valued, well respected and high
quality services for the population of Redditch and Bromsgrove for 2014-15.
On behalf of NHS Redditch & Bromsgrove CCG.
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What the Worcestershire Health Overview and Scrutiny Committee said about
Primrose Hospice’s 2013-14 Quality Account:
Primrose Hospice is the first Worcestershire hospice which has provided a Quality
Account for observations, which is in itself a testimony to openness. The following
observations are made:
1. The Quality Account provided by Primrose Hospice is very easy and clear to
read, which makes it accessible and reassuring to the public, as well as a
useful tool for fundraising.
2. The report's neutral, factual style is welcomed.
3. It is appreciated that there are limits to availability of comparative data and
that the nature of end of life care makes it difficult to identify measurable
improvements.
4. HOSC members would be interested to see a breakdown of staffing included
in the report.
5. The commentary on the results of clinical audits is helpful and gives
reassurance about actions taken to rectify any shortfalls.
6. HOSC supports the view that complaints offer a valuable source of learning.
The hospice continues to receive extremely low levels of complaints, but the
actions taken to publicize the complaints and compliments process following
last year's HOSC discussion are welcomed.
7. The Hospice is commended on the links being developed with prisons,
although it is appreciated that potential service take-up may be limited.
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What Healthwatch Worcestershire said about Primrose Hospice’s 2013-14 Quality
Account:
Thank you for the opportunity to comment on your report, which
Healthwatch Worcestershire has reviewed using the Department of Health’s
guidelines.
Do the priorities of the provider reflect the priorities of the local
population?
It is welcomed that the suggestions from the Service Users Forum to pilot a
weekly drop-in group, to introduce disease specific support groups and to
arrange more staff training in learning disability have been included in the
2014/15 priorities. Expansion of the Lymphoedema Service and effective
measurement of the Day Hospice service also mirror Worcestershire’s aim
for integrated care and avoidance of acute hospital admissions.
Reporting the Care Quality Commission inspection date and outcome is also
good practice, and including complaints, adverse comments, incidents,
accidents and their investigation outcomes and learning also reassures the
local population that Primrose Hospice is providing a safe environment and
developing a top quality service.
Are there any important issued missed?
It would be useful to know the percentage of total finance which is provided
by the NHS.
The inclusion of recent testimonials is always helpful in demonstrating the
value of the many services provided.
Has the provider demonstrated that they have involved patients and the
public in the production of the Quality Account?
The Clinical Commissioning Groups undertake regular Clinical Quality Review
meetings with Primrose Hospice to ensure that the contract is providing the
service specified for NHS patients.
The plan to hold new focus groups and more frequent user forums should
help to identify continued service improvements.
Is the Quality Account clearly presented for patients and the public?
The report is clear, concise, informative and an easy read for the general
public. The 2013/14 results are well presented and explained.
The learning from clinical audits is welcomed and the National Council for
Palliative Care data sets and comparisons are very helpful and provide
useful information to aid understanding.
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