Quality Account 2014 - 2015
Vision Statement
Our vision is that every adult and child within our
area can choose how and where they want to be
cared for towards the end of life, knowing that they
will receive high quality specialist care
Charity No. 1140386
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Table of Contents
TITLE PAGE AND VISION STATEMENT
PAGE
CONTENTS
PART 1
CHIEF EXECUTIVE AND MISSION STATEMENT
3-4
PART 2
PRIORITIES FOR IMPROVEMENT AND STATEMENT OF
ASSURANCES FROM THE BOARD
PRIORITIES FOR IMPROVEMENT 2014/2015
REPORT ON PRIORITIES FOR IMPROVEMENT 2013/2014
STATEMENT OF ASSURANCE FROM THE BOARD
2a REVIEW OF SERVICES 2014/15
2b PARTICIPATION IN NATIONAL CLINICAL AUDIT
2c PARTICIPATION IN RESEARCH
2d CSNAT(Carers Support Needs Assessment Tool) 2014 UPDATE
2e USE OF THE CQUIN PAYMENT FRAMEWORK.
2f STATEMENT FROM THE CARE QUALITY COMMISSION
2g DATA QUALITY
2h CLINICAL CODING ERROR RATE
5-8
9-11
12
12
13
14
14
15
15
16
16
PART 3
REVIEW OF QUALITY PERFORMANCE
QUALITY MARKERS TABLES
CLINICAL AUDIT REPORT 2013/14
STATEMENTS ENDORSING 2014/15 QUALITY ACCOUNT
17
17
18-19
20-23
APPENDICES
1. GROVE HOUSE DAY SERVICES MAY 2014
2. SKIPP RESULTS 2013
3. AUDITS COMPLETED 2013-14
4. HOSPICE AT HOME SURVEY RESULTS
CLINICAL SERVICES SURVEY RESULTS
HEALTH CARE PROFESSIONAL SURVEY RESULTS
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24
25
26
27
28
29
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Part 1: RENNIE GROVE HOSPICE CARE Chief Executive and Mission
Statement
It gives me great pleasure to present the second Quality Account for Rennie Grove
Hospice Care (RENNIE GROVE HOSPICE CARE) for 2014/2015.
We welcome the
opportunity to provide the wider population with an annual report about the high quality of
services we provide for our patients and carers. This report allows us to demonstrate to
the public, our stakeholders, our trustees and our staff the commitment we have to quality
improvements so that we can give the best possible quality care to all our patients and
their carers, at the same time delivering a cost effective service.
Quality is at the heart of all RENNIE GROVE HOSPICE CARE does and we evidence that
through Clinical Governance which ensures continuous quality monitoring, in which any
shortfalls are identified and acted upon quickly. It also ensures a patient centred service
and one that can deliver the aspirations laid out in our Mission Statement.
In the last year RENNIE GROVE HOSPICE CARE has cared for almost 3000 patients and
their families - around 20% more than in the previous year because more patients are
turning to us for support. We provide our care at no cost to our patients and families
thanks to huge local fundraising and our hospice shops which pay for 87% of the costs of
our care.
Our high quality care is only possible thanks to our dedicated staff and the commitment of
over 1,500 volunteers.
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 health care services we provide.
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Our Mission is:
To offer excellent palliative and end-of-life care based around patients and their families
both day and night.
Our Values are based on:
Excellence, collaboration, respect, dignity and professionalism.
Jennifer Provin
Chief Executive
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Part 2: Priorities for improvement and statements of assurance from
the Board
Priorities for Improvement 2014-2015
The priorities for quality improvement we have identified for 2014/15 are set out below.
These priorities have been identified in conjunction with staff, stakeholders and as far as
possible by consulting our patient and carer group. The priorities we have selected will
impact directly on each of the priority areas:
Patient safety – Facilitation of information sharing with professionals involved in patient
care
Clinical effectiveness- Skills needs assessment for nurses to adapt to the changing
needs of patients within the community
Patient experience – Following a strategic review we will begin to implement a 3 year
plan involving the restructure and development of day services to meet the changing
needs of patients and families.
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Priority One: Patient Safety
Information sharing between professionals both within Rennie Grove and externally with
other healthcare professionals (such as G.P’s, Specialist Consultants and Nurses) is a key
element in the safe, efficient and effective delivery of care for our patients. A secure
network is required to ensure the safe exchange of information with NHS colleagues.
In preparation for applying for a secure network connection the Information Governance
toolkit was completed by the end of March 2014. All staff have been trained in Information
Governance using the NHS modular programme. Rennie Grove is now in the process of
applying for an N3 connection which we hope to achieve within three months.
How was this identified as a priority?
Local NHS community teams are working toward a ‘paper light’ patient notes system. This
will eventually be transferred to an electronic record which Rennie Grove would be unable
to access under the current arrangements. To negotiate access it is necessary for the
organisation to have an N3 connection and the associated Information Governance
compliance. This was also identified as a priority by the Clinical Commissioning Groups
(CCGs) who require us to share and input patient information within their data reporting
structures and a centralised end of life patient register.
How will priority one be achieved?
A reporting process for information breaches has been implemented to identify areas
where sharing of patient data may be compromised. Completion of the Information
Governance toolkit has been achieved and submitted prior to applying for the N3
connection. Our local CCG leads have sponsored this application in writing to the NHS
governance team. We are awaiting the outcome of the application.
How will progress be monitored and reported?
Once the N3 connection is achieved we will be working with our NHS partners and the
CCGs to agree the ongoing data sharing process. Quarterly reports will be sent to the
CCGs to identify progress.
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Priority Two: Clinical Effectiveness
The increasing complexity of needs of patients cared for in their own home demands a
broad skill base of nurses working in the community. In order to adapt to the demands
required of the service, Rennie Grove has identified the need to undertake a formal ‘Skills
Needs Assessment’ across the nursing teams.
In order to identify the required essential skills to carry out the safe assessment, planning
and delivery of specialist palliative care for patients being nursed in their own home it is
necessary to undertake a Skills Needs Assessment across all levels of nursing staff. This
is in response to the changing needs of patients and carers within the community and the
changes to service provision across other agencies.
How was this identified as a priority?
Working alongside professional partners within the community has highlighted the need for
more skill sharing across all agencies to create a seamless and timely approach to care.
How will priority two be achieved?
Working with our partners we will identify the additional skills required across our nursing
teams to enable equitable working within patient’s homes. The results of this assessment
will inform the training requirements needed by the organisation to meet the current and
projected increasing demands on the service. A training programme will be developed and
implemented across the nursing teams.
How will progress be monitored and reported?
Outcomes from this work will better equip our nurses to triage patient’s needs and identify
and treat changing conditions in a timely manner. Prompt and accurate reporting with
medical staff of this assessment will enable timely symptom control reducing the risk of
hospital admission. This will be monitored through activity data reported to the Senior
Clinical Team.
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Priority Three: Patient Experience
Grove House, part of Rennie Grove Hospice Care, has been a provider of a range of
Palliative Care Day Services in the Dacorum and St Albans/Harpenden area of
Hertfordshire for 20 Years. These services include the provision of Occupational therapy,
Physiotherapy and Family Support Services alongside Day Hospice and a sitting and
befriending service. A strategic review of Grove House services was carried out in 2013
and this will be implemented in 2014/15
Grove House will redesign and restructure a new model of service provision in 2014/15.
This new service structure will aim to increase professional and self referral creating the
opportunity for improved access and increasing appropriate use of the service for patients
and their families.
How was this identified as a priority?
Working closely with G.P providers and other healthcare professionals in 2013 has
identified that the changing needs in the community might be more successfully addressed
with a restructuring of the existing services. This would provide a more flexible model of
care incorporating a range of day services including a ‘drop in’ service. Year on year
activity data has indicated a decline in numbers of patients accessing the current Day
Hospice and associated services within the existing structure. Local hospice partners have
also acknowledged similar trends. Working in partnership we have identified a number of
service developments which will aim to meet the needs of those in the wider community.
How will priority three be achieved?
Working with hospice partners we have identified additional services and ways of working
collaboratively which would better serve the community. A restructure of the existing day
hospice, reducing the days from four to three, gives additional hours to create services
such as drop in, carer groups and supporting breathless patients on a more flexible basis.
A provisional programme of services can be seen in appendix 1 page 24. Marketing of the
services will take place within the community and across healthcare providers.
How will progress be monitored and reported?
Activity data will be monitored to indicate uptake of the services and evaluation tools have
been developed to monitor the effectiveness of all new services and interventions.
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Report on Priorities for Improvement 2013-2014
Priority one: Patient safety
Medicines management is a core element of the service provided by our hospice at
Medicine
management
is a in
core
element
of theand
service
provided
by ourrequirements
hospice at home
home team.
The increase
patient
numbers
associated
medicine
team.
The
in patient
numbers
associated
medicine
requirements
calls for
called
for increase
more stringent
monitoring
andand
training
to ensure
patient safety.
All
more
stringentAssistants
protocols,inmonitoring
training
to ensure
patient
safety.
Healthcare
addition toand
qualified
staff
have been
trained
in medicines
management during 2013/14. The Rennie Grove Hospice Care Medicine Guidelines,
which include syringe driver/pump guidelines, have been updated and disseminated to
all staff, in user friendly A5 booklet form. During 2013/14 a new medication matrix for
assessing risk following drug errors has been adopted. Training in the use of the
McKinley pump has been provided for all staff using the McKinley syringe pumps
which were introduced in 2013.
To date there have been no syringe driver errors reported in 2013/2014. All other
medication errors have been scored and acted upon using the risk matrix and the drug
error reflection form as appropriate. A small number of near miss incidents noted that
drugs had been sent to the home with a near or even out of date expiry. In order to reduce
risk (especially for lone working and out of hours checking) the organisation has provided
credit card sized magnifying glasses for all nurses in order to help reduce potential errors
in drug administration. Feedback from staff has already indicated that these have been
useful in poorly lit home environments.
Medication training for all health care assistants has proved invaluable enabling them to
double check with staff particularly at night resulting in one near miss drug error being
reported as a result of due vigilance.
Continuous audit of training and numbers of errors will be undertaken to monitor
performance and patient safety.
During 2013/14 with the roll out of the McKinley Syringe driver in Hertfordshire, the
Professional Development Team provided training in the use of the T 34 McKinley Syringe
driver for 40 of Rennie Grove staff and bank staff. 17 other Health Care Professionals also
attended the training.
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Priority two: Clinical Effectiveness
Following merger it was identified that there were a range of databases being utilised to
facilitate and document patient care. This hindered cross organisation communication and
for many clinicians it created the need for multiple data entry for individual patients. This
was time consuming, inefficient and posed a potential risk to patient safety. During 2013/14
a single database (Infoflex) has been identified and has been implemented across the
services. The process has been completed in a phased manner including training for all
staff. Buckinghamshire based teams are now fully integrated. The process is in its final
stages within the Hertfordshire based teams which include Clinical Services at Grove
House. The final Merger of the two databases occurred in April 2014. The organisation is
aware that further development will be required of the system but is committed to the
ongoing improvement to enable accurate and timely communication between teams to
facilitate excellence in care.
Ongoing training for both the nursing administration team and the clinicians who are
required to input onto the system is underway with the aim of reducing the time taken to
input data and patient information and to ensure accuracy. An ongoing time and motion
study is in place across the teams where the system is operational to monitor time used in
this way against the increased time spent with patients and families. We hope to see the
balance improve throughout the current year once the single system is fully implemented.
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Priority Three: Patient Experience
In 2013/14 Patient and Carer surveys of hospice at home and Grove House Clinical
services surveys included an additional question to ‘Would you recommend the service to
other family members or friends?’. The answer format across both surveys differed slightly
and is presented accordingly. The results are shown below.
Hospice at Home Carer Satisfaction Survey April 13 – September 13
Question
Would you
recommend the
service to
others?
Response
102
Skipped
22
Answer
Extremely likely
Likely
Neither likely nor unlikely
Extremely unlikely
Results
Sep 13
97 95%
3
3%
1
1%
1 1%
The Grove House Clinical Services Survey September 13 - out of 32 respondents 2
skipped the question. The remaining 30 respondents answered YES they would
recommend the service to others.
The Organisation will continue to include this question in the 2014/15 surveys and will use
the same answer format across both from April 2014.
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Statement of Assurance from the Board
The following are statements that all providers must include in their Quality Account. Many
of these statements are not directly applicable to specialist palliative care providers, and
therefore explanations of what these statements mean are also given.
2a. Review of Services 2014/2015

During 2014/15 it is Rennie Grove Hospice Care’s intention to provide Herts Valleys
Clinical Commissioning Group (CCG) and Chiltern and Aylesbury Vale Clinical CCGs
commissioning priorities with regard to the provision of local specialist palliative care
in the community by providing:

Part funded Hospice at Home
In addition Rennie Grove Hospice Care will support the CCGs by providing the
following services through charitable funding:

Day Hospice

Outpatient services to support and promote wellbeing

Occupational Therapy

Physiotherapy

Home sitters

Cancer Information

Complementary Therapies

Cancer the Next Step

Family support Services, including bereavement support services and spiritual
care

The income generated by the NHS services reviewed in 2013/14 represents 13% of
costs of our care generated from the provision of NHS services by Rennie Grove
Hospice Care for 2013/14.
The palliative care funding review in 2012/13 focused on the provision of community
hospice at home specialist palliative care. Rennie Grove Hospice Care is funded through
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an NHS grant and the remaining income is generated through our fundraising and PR
activity, Retail and Trading, Hospice Lottery activity and investments.
2b. Participation in National Clinical Audit

During 2013/14 and prior to this document, no national clinical audits or confidential
enquiries covered NHS services provided by Rennie Grove Hospice Care.

During that period Rennie Grove 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 any.

The national clinical audits and national confidential enquiries that RENNIE GROVE
HOSPICE CARE are eligible to participate in during 2013/14 are as follows: NONE.

The national clinical audits and national confidential enquires that Rennie Grove
Hospice Care participated in during 2013/14 are as follows: Not applicable

The national clinical audits and national confidential enquires that RENNIE GROVE
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. Not applicable

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 RENNIE
GROVE HOSPICE CARE.

RENNIE GROVE HOSPICE CARE was not eligible in 2013/14 to participate in any
national clinical audits or national confidential enquiries and therefore there is no
information to submit.
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What this means:
As a provider of specialist palliative care RENNIE GROVE HOSPICE CARE is not eligible
to participate in any of the national clinical audits or national confidential enquires. This is
because none of the 2013/14 audits or enquiries related to specialist palliative care. The
Hospice will also not be eligible to take part in any national audit or confidential enquiry in
2014/15 for the same reason.
2c. Participation in Research
The number of patients receiving NHS services provided or subcontracted by
RENNIE GROVE HOSPICE CARE in 2013/14 that were recruited during that period
to participate in research approved by a research ethics committee was NONE.
2d. CSNAT (Carers Support Needs Assessment Tool) 2014 Update
During 2013 Rennie Grove Hospice Care participated in the implementation of the
Carers Support Needs Assessment Tool (CSNAT). (CSNAT is an evidence-based
direct measure of carer’s support needs in 14 domains and is suitable for both endof-life research and practice.) It is a research project supported by Manchester and
Cambridge Universities in partnership with the National Association for Hospice at
Home. Two hospice at home teams participated in the project which aimed at all
carers having access to an assessment of their needs. The research project
acknowledges the extended role of informal carers in supporting patients to remain at
home. The tool enables nurses to complete a more comprehensive, structured
assessment which leads to discussion around support needs imperative for shared
action planning. This part of the study ended in November 2013. Our bereaved
carers will be contacted via the research team to look at the impact of using the tool
and assess if the tool improved the experience of caring.
Within the organisation training has been provided for all nursing teams including
those working in day hospice. The tool is used with each carer at the first visit.
The continued use of CSNAT in practice demonstrates our commitment to assess the
support needs of carers as well as provide a clear record of activity in relation to carer
support. This activity will now be easily available for use as evidence for
commissioning or audit purposes.
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2e. Use of the CQUIN payment framework
Up to 2.5% of RENNIE GROVE HOSPICE CARE income in 2014/15 is CQUIN
dependant and conditional on achieving quality improvement and innovation goals
agreed between RENNIE GROVE HOSPICE CARE and any person or body they
entered into a contract, agreement or arrangement with for the provision of NHS
services, through the Commissioning for Quality and Innovation payment framework.
2f. Statement from the Care Quality Commission
RENNIE GROVE 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 and personal Care.
Statement of reasons
The registration of the provider of these regulated activities is subject to a registered
manager condition under Regulation 5 of the Care Quality Commission (Registration)
Regulations 2009
These regulated activities may only be carried out from the following locations:
Grove House
Gillian King House
Rennie House
Waverley Road
Three Households
Unit 3
St. Albans
Chalfont St. Giles
Tring Industrial Estate
Herts
Bucks
Tring
AL3 5QX
HP8 4LS
Herts
T 01494 877200
HP23 4JX
T 01727 731000
T 01442 890222
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The Care Quality commission has not taken any enforcement action against RENNIE
GROVE HOSPICE CARE during 2013/14.
RENNIE GROVE HOSPICE CARE has not participated in any special reviews or
investigations by the Care Quality Commission during 2013/14 and was inspected at all
three sites during 2013/14 and was announced to be fully compliant with the Essential
Standards of Quality and Safety
2g.
Data Quality
Statement of relevance of Data Quality and actions to improve Data Quality.
RENNIE GROVE HOSPICE CARE did not submit records during 2013/14 to the
Secondary Users service for inclusion in the Hospital Episode Statistics which are included
in the latest published data.
Why is this?
This is because RENNIE GROVE HOSPICE CARE is not eligible to participate in this
scheme. However, in the absence of this we have this year worked to complete and submit
the Information Governance toolkit to level 2 with a view to obtaining an N3 connection to
connect with our NHS partners. With patients consent, we share data with other health
professionals to support the care of patients in the community. An audit of the signing of
patient consent forms occurs annually. Our data protection policy is reviewed and updated
annually.
2g.
Information governance toolkit attainment levels
2h.
Clinical coding error rate
RENNIE GROVE HOSPICE CARE was not subject to the Payment by results clinical
coding audit during 2013/14 by the Audit Commission. This is because RENNIE GROVE
HOSPICE CARE receives payment under a block contract and not through tariff and
therefore clinical coding is not relevant.
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Part 3: Review of Quality Performance
Quality Markers Tables
RENNIE GROVE HOSPICE CARE continues to work on consolidating our data from the
clinical, nursing and family support databases. Data is submitted to the CCGs and CQC
quarterly and annually. We will present annual data returns for 2013-14 to the National
Council for Palliative Care (NCPC) minimum data set which is the only information
currently collected nationally on hospice activity.
Quality Markers we have chosen to measure.
In addition to the limited number of suitable quality measures in the national data set for
palliative care and hospice at home, we have chosen to measure our performance against
the following:
Out of Hours activity – data collection commenced January 2014
Prevention of hospital admissions
Clinical Complaints
Deaths At Home
Patients Achieved Preferred Place of Care (PPC)(if wish expressed)
Medication Errors
Clinical Adverse Incidents
INDICATOR
April 2013/14
Total number of complaints (clinical)
2
The number of complaints completed
2 ( 1 verbal withdrawn)
The number of complaints process ongoing
0
INDICATOR
April 2013/14
No. Patient Deaths at Home
613
No. Patient’s achieved PPC
709
Prevention of Hospital admission
119 (1st Jan 2014 on when first recorded)
Out of hours activity
1061 visits, 1609 telephone calls
INDICATOR
April 2013/14
Medication Errors
7
Clinical Adverse Incidents
15
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Clinical Audit Report 2013/14
Clinical Audit is a way in which the organisation can learn and improve the delivery of its
services, the outcome for patients and the experience they have. The Clinical Audit team
has undertaken a programme of audits during 2013/14 including infection control which is
based on a national audit tool designed specifically for hospices. Clinical staff are also
involved in the audit processes and a number of staff have led on audits.
The Grove House Day Hospice staff introduced the SKIPP (St Christopher’s Index of
patient priorities) Questionnaire. The quantitative data supported by the patients’
comments demonstrated that attendance at Day Hospice has a positive effect on patients’
quality of life and overall sense of wellbeing. The initial improvements seen in the vast
majority of patients during the first 4 weeks was largely maintained through to week 8.
SKIPP will continue to be used as part of the Day Hospice assessment, as a way of
enhancing our understanding of how to maintain and improve our service to patients. See
appendix 2 page 25 for an overview of the results.
Audit of the Non Medical Prescribers led to the prescribers designing a new prescription
copy form to send to G.P’s. This has resulted in improved communication after
prescriptions have been issued and positive feedback has been received from G.P’s. The
audit also identified that further resources for prescribers would be useful to support
practice. As a result the organisation has ensured that each prescriber has an up to date
British National Formulary (BNF) and access to the Palliative Care Formulary at every
base.
Progress on the action plans following audits undertaken is monitored through the Clinical
Audit Group and reported to the Clinical Governance Committee to ensure that they are
completed in a timely manner. Appendix 3 page 26 shows the audit plan that was
undertaken in 2013/2014
Feedback from Patients and Carers on services
We value feedback we receive from patients and their carers as this is an important way in
which staff can identify issues, resolve problems and improve the quality of the care we
provide. As part of our commitment to ensuring patients and their carers have a voice we
send hospice at home patients a survey after 6 clinical visits and a carer satisfaction
survey 6 weeks post bereavement. The patients and their carers who receive clinical
services based at Grove House receive a survey once every six months. These surveys
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are evaluated every six months and the results sent to all clinical staff and the Clinical
Governance Committee. The surveys are anonymous but where concerns are raised and
the respondent has chosen to be identified, their issues are followed up and resolved
where possible. As required by Care Quality Commission (2009) Essential Standards of
Quality and Safety the questions asked to patients and carers reflect their treatment and
the care they receive from the services. In addition annual surveys are sent out to users of
the Family Support services. The Paediatric service sends bi-annual surveys to parents/
carers together with specially designed children’s surveys appropriate to their age. This
survey will be repeated in 2014. Health Care Professionals with whom we work are also
sent Bi- annual surveys. This includes hospitals, GP practices, district nurses and
specialist services such as MacMillan. Feedback from this survey in 2013 has helped
improve communication but has also helped the organisation identify areas for
development including the identification of Skills Needs Assessment (across the spectrum
of nurses) from HCA to CNS in 2014/15 Quality Account.
Responses to key questions from all surveys can be seen in appendix 4 pages 27-29.
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STATEMENT ENDORSING RENNIE GROVE HOSPICE CARE QUALITY ACCOUNT
2014-2015
NHS Chiltern and Aylesbury Vale CCGs response to Rennie Grove Hospice Care (RENNIE
GROVE HOSPICE CARE) Quality Account 2014/15
Chiltern & Aylesbury Vale (CCG) has reviewed Rennie Grove Hospice Care Quality Account for
14/15 and is providing this response to the provider against their Vision on Quality improvement
priorities for the year ahead.
The Quality Account provides an overview of the quality of care provided by the Hospice during the
previous year 2013-14. The priorities for quality improvement are also set out for the next 12
months. Chiltern and Aylesbury Vale CCGs are satisfied as to the accuracy of the data contained
in the Account. There is evidence that Rennie Grove Hospice Care has used both soft and hard
data in addition to evidence of active and collaborative stakeholder engagement in providing
assurance on the quality and safety of its services.
The commissioners are pleased to see that more patients and families are electing to use the
Hospice at home. It is noted that the wishes and needs of patients are being responded to
following a strategic review last year to create a more flexible service including a drop-in service
and carer groups. It is welcomed that this has been developed with G.Ps and other Healthcare
professionals in the local community to respond to evolving local needs and enhance patients
choice and flexible access to the service. Commissioners would welcome further evidence of
patient involvement in the ongoing service restructure over the coming three years.
Patient Experience
The commissioners note the focus on gathering the views and experience of patients and families
using the service through implementation of the National Friends and Family survey of patient
satisfaction. It is noted that use of evidence based practice by use of the SKIPP tool has been
agreed for use in daily care gathering more robust information on quality of life of patients. The
views of patients and carers are further identified through a care satisfaction survey.
Commissioners commend the service on the active use of this intelligence and additional work to
gather staff views through annual and bi-annual surveys which are fed back to their Clinical
Governance Committee to bring strategic focus.
Patient Safety
Commissioners support their continued focus on patient safety as evidenced in areas such as
Medicines management training and syringe pump training for Healthcare Assistants, and adoption
of a more robust risk review following drug errors.
Commissioners note the adoption of the CSNAT measure of carers support needs supported by
Manchester and Cambridge Universities and would welcome further evidence of improvements in
carers experience by its continued use.
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It is welcomed that the service was inspected by the CQC at all three sites in 2013/14 and was
announced to be fully compliant with the Essential Standards of Quality and Safety.
Clinical Effectiveness
It is welcomed that linked to the restructuring of the service there has been a review of clinical skills
and also use of face to face clinical time with patients to ensure best use of resources.
Commissioners would welcome evidence of how this results in changes to training or supervision
practice as the newly configured service moves forward.
It is noted that there is also a considerable focus on upgrading the IT support supporting the
Hospice work through implementation of a single database across services which saw integration
of the Buckinghamshire and Hertfordshire teams in April this year. Commissioners note that there
has been alongside this focus on robust Information Governance and success in submitting the IG
toolkit to level 2.
Commissioners would like to see further information against the elective quality markers of the
number of patient deaths at home and the number of patients who receive their preferred place of
care.
Conclusion
The Quality Account is a comprehensive view of the Quality of services currently being provided to
the local community and how these are being further developed with local stakeholders by Rennie
Grove Hospice. Commissioners look forward to continuing to work in partnership with the service in
meeting the needs of local service users, their carers, and staff in providing high quality flexible
care.
Charity No. 1140386
www.renniegrove.org
21
Statement from Herts Valleys Clinical Commissioning Group
End of Life Care Commissioning Manager and Community Contracts Manager
Herts Valleys CCG see Rennie Grove Hospice Care as a key partner is the delivery of
integrated end of life care for the patients of West Hertfordshire. We value the excellent
open and regular communication that we have them and we are committed to working with
them to continue to deliver a high quality and much valued service to our population.
During 13/14 Rennie Grove Hospice care continued to provide high quality Hospice at
Home Care, prioritising patient safety, clinical effectiveness and enhancing patients’ and
their families’ experience. Progress towards these improvements was monitored through
regular contract review meetings.
Herts Valleys CCG was pleased to provide additional funds for the expansion of the
Hospice at Home service to patients within the St Albans and Harpenden locality.
Looking forward to 14/15, Herts Valleys CCG is delighted to continue to work closely with
the hospice as a key partner in helping us to achieve our End of Life Strategy. The
strategy reflects the aims of both organisations to continually improve and provide good
quality end of life care to its patients and the community.
June 2014
Charity No. 1140386
www.renniegrove.org
22
Healthwatch Hertfordshire’s response to Rennie Grove Hospice Care
Quality Account 2014
Healthwatch Hertfordshire is pleased to submit a response to Rennie Grove Hospice
Care’s Quality Account.
The Quality Account gives a clear picture of what has achieved in the year and where
the focus will be in 2014-15 to meet the stated priorities of patient safety, clinical
effectiveness and enhanced patient experience. The organisation shows its commitment
to meeting the changing needs of communities by changing the ways it operates to
provide a more flexible model of care
Progress on the priorities from 2013/14 is clearly shown. Rigorous approaches to ensure
effective medicine management including management of risk and increased training are
welcomed and we note that continuous audit of training and number of errors is being
undertaken
The focus on addressing database and communication issues following the merger to
reduce any risk to patient safety and avoid inefficient use of resources is recognised. We
welcome the monitoring of time spent on activities to ensure that increased time can be
spent with patients and families.
The patient experience results provided show strong satisfaction scores for the ‘friends
and family’ test for the first 6 months of the last financial year. Standardising the way
questions are asked is good practice.
Rennie Grove has shown its commitment to Carers by introducing the Carers Support
Needs Assessment Tool (CSNAT) and we are pleased that this will continue to be used.
We welcome a number of initiatives highlighted under the clinical audit including the
audit tool for infection control, the use of SKIPP (St Christopher’s Index of Patient
Priorities) at Grove House Day Hospice and the new prescription form for GPs.
Healthwatch Hertfordshire thanks Rennie Grove for this opportunity to comment and
looks forward to opportunities to work together in the coming year.
Sarah Wren MBE, Chairman Healthwatch Hertfordshire, June 2014
Charity No. 1140386
www.renniegrove.org
23
APPENDIX 1 Grove House programme of services
Day Services at Grove House
What is it?
Grove House
Drop In
Description
For patients, carers and
HCPs to explore GH
services with support
from nurses
Nurse led session for
emotional support and
symptom control for
patients 1 day per
week
When is it?
How do I join?
Tuesdays 9am –
1pm
Drop in session
Wednesdays,
Thursdays, Fridays
10.15am -3pm
By referral and
assessment
Gentle exercise class to
promote well-being and
self-management
6 week course
29th April – 27th
May
Tuesdays 2pm –
4pm
By referral and
assessment
Craft and Chat
Social group for
patients and carers
2nd and 4th Tuesday
of the month
2pm – 4pm
Drop in session
Carers Support
Group
Informal session for
carers of Rennie Grove
patients
3rd Tuesday of the
month
2pm – 4pm
By referral and
assessment
1st Tuesday of the
month
2pm – 3.30pm
By referral and
assessment
Monday – Friday
9.30am-4.30pm
(Last appt 3.30pm)
By appointment
For patients with
complex palliative care
needs
Wednesday
morning
By appointment
Benefits Advice
Independent free
advice from CAB
Advisor
2nd Tuesday
morning of the
month
By appointment
Complementary
Therapy
Range of
Complementary
Therapies for patients
and carers
Monday - Friday
By referral and
assessment
Family Support
Services
Support for patients,
carers and bereaved
people
Monday - Friday
By referral and
assessment
Information and
Support Centre
Monday – Friday
10am – 4pm
Drop in
Day Hospice
Yoga
Bereavement
Support Group
Nurse Clinic
Medical Clinic
CANCERi
Charity No. 1140386
www.renniegrove.org
Informal session for
bereaved people whose
relative/friend was
cared for by Rennie
Grove Hospice Care
Appointment with
Specialist Nurse for
emotional support /
symptom control for
patients and carers
24
APPENDIX 2 Overview of the results from the SKIPP audit 2013
Individual
changes in QoL
score over
timeChange in
QoL score
Improvement
No Change
Worse
% of patients
% of patients
44.4%
43.3%
12.2%
58.3%
23.8%
17.9%
Individual changes in QoL score over time
Has the Day Hospice made an overall difference?
Charity No. 1140386
www.renniegrove.org
25
APPENDIX 3 Rennie Grove Audits completed April 2013 - March 2014
Audit
Clinical Services Survey (Grove House
users)
Health Care Professionals Survey
Hand Hygiene Audit
CORE counselling
SKIPP
Complementary therapies effectiveness
(MYCAW) audit
Month
APR 13
MAY 13
JUN 13
JUL 13
AUG 13
Patient Records Audit (quality of record
keeping)
Non-medical prescribing audit
Notes audit Crosscare
SEP 13
Clinical Services Survey (Grove House
users)
H@H Carer Survey
H@H Patient Survey
SOVA staff awareness questionnaire
OCT 13
GH building audit
NOV 13
Notes audit Infoflex
DEC 13
Complementary therapies effectiveness
(MYCAW) audit
JAN 14
Data protection audit
SOVA audit
FEB 14
Paediatric Survey Review
APR 14 awaiting report
Charity No. 1140386
www.renniegrove.org
26
APPENDIX 4 Key Questions from surveys
Hospice at Home Patient Satisfaction Survey April 13 – September 13
Question
Response
Skipped
Question
Answer
Results Results Sep 13
Mar
13
89%
49
92%
11%
4
8%
On the whole, do you
find the experience of
H@H caring for you:
53
3
Very satisfactory
Satisfactory
Dissatisfactory
Very
dissatisfactory
Do you feel your
privacy and dignity
are respected?
55
1
93%
7%
54
1
98%
2%
Do you feel the
RGHC staff make an
effort to meet your
individual needs and
wishes in relation to
culture, faith and
disability?
Do you feel you are
treated with courtesy
by H@H staff?
52
4
Always
Most of the time
Some of the time
Never
Always
Most of the time
Some of the time
Never
90%
8%
0%
2%
49
3
94%
6%
51
5
Always
Sometimes
Occasionally
Never
98%
2%
51
100%
Some of the comments we have received from our patients in the last six months:
 They give their advice knowledgeably and with confidence. In turn, this inspires my
confidence in them
 The care and attention provided by IRGH staff was exemplary. Just what was
required at a critical time.
 It is always a great comfort to know that the Hospice is at the end of a telephone
ready to help
 I am grateful for the emotional support given to me. It's nice to know they are just a
telephone call away
 The Iain Nurses were always professional and friendly and provided information
and comfort
Some of the comments we have received from our carers in the last six months





Fantastic service in difficult circumstances.
The staff were fantastic throughout. Always felt nothing was too much trouble. They
were really kind and compassionate and we felt lucky to have them around.
A wonderful team. Courteous, respectful, kind, helpful and always responded with
reassurance and gave one confidence to cope. Truly professional and efficient
I admired the communication between the Hospice at Home team, our GP & the
district nurses. It was obvious it was good & most reassuring
My wife and I thought the at home staff were the kindest most caring ladies we had
ever met in our lives
Charity No. 1140386
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27
Clinical Services Survey for users of Grove House facilities April 13 – September 13
Question
Response
Skipped
Question
1
10
9
How would you rate
the quality of
care/treatment that
you received from
Grove House? Scale
1(poor) – 10
(excellent) -
31
Did staff involved in
your care introduce
themselves to you?
Did you feel involved
in the decisions made
about your care and
support at Grove
House?
How did you feel that
staff and volunteers
respected your
privacy and dignity?
Did you feel that you
were treated fairly
with regards to
culture, faith and
disability?
Would you *
recommend our
service to others?
32
0
28
Answer
Results Sep 13
27
4
87%
13%
10(Always)
9
30
2
94%
6%
4
Always
Usually
23
5
82%
18%
32
0
Always
32
100%
27
5
Always
27
100%
30
2
Yes
30
100%
Some of the comments we have received from our users of Grove House facilities in the
last six months:
 Impressed with care and attention, not only to patient but those supporting.
 The quality of care provided is first class (I was nursing all my working life).
 Great food and beautifully cooked.
 My husband saw it as the highlight of his week.
 The team do an amazing job. I don’t know how I would cope without their support
and understanding .
 The aftercare has been amazing.
Charity No. 1140386
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28
Health Care Professionals Survey April 13
The following feedback was given to questions about referrals to and from IRGH services,
and to working relationships.
Agree
Agree
No
Disagree Disagree
strongly
opinion
strongly
I have a good working
relationship with the IRGH
68%
30%
2%
team(s)
IRGH respond efficiently
66%
30%
2%
2%
to requests for help
The involvement of IRGH
64%
16%
18%
2%
promotes patient choice
The additional resources
IRGH brings can help a
73%
23%
2%
2%
patient to stay at home
Some of the positive comments received included:
 ‘I found that the IRGH communicate well with myself in terms of patient's needs’
 ‘Wonderful team, dedicated, respectful, hardworking’
 ‘I have always found IRGH services invaluable in patient and family support’
 ‘Patients and family always commenting how good / supportive IRGH are’
 ‘Iain Rennie offers a solid service for our patients at home. I have always found the
service input very thorough with excellent communication’
 ‘The service is very prompt, excellent communication. Patients and carers always
speak highly of the service’
 ‘Especially useful monthly palliative care meeting’
Some constructive criticism

‘Very variable response to referrals when being made. Not consistent which may
lead to referring to other agencies’ (Ticked both satisfied and dissatisfied)

Cross team communication sometimes appears to be a bit limited. Occasionally
aware of giving same information twice to different team members, or receiving
same info twice from different team members’

‘Making a decision if offering specialist palliative care service or hospice at home
service, where if patients are end of life whether Iain Rennie will provide end of life
care by carrying out personal care, because patients can wait for a long time for
care packages and patients may then be too poorly to transfer to home’
Charity No. 1140386
www.renniegrove.org
29