Saint Catherine’s Hospice
Quality Accounts
2013/14
Your Community, Your Hospice, Our Care
Part 1- Statement from the Chief Executive
On behalf of our Board of Trustees and the Senior Management Team, I am pleased
to present the Quality Account for Saint Catherine’s Hospice 2013/14. The continued
work of our dedicated members of staff and volunteers enables the Hospice to
deliver high quality services. Our team here continues to strive for excellence in all
they achieve.
Our patients, their families, and carers are at the very centre of our care and
delivering quality care to them is our main focus. Our Vision is to be the provider of
choice for excellent palliative and end of life care, which meets patient need and for
which we have the skills and knowledge to make a difference. Saint Catherine’s
Hospice exists to provide care to improve the quality of life for patients and their
families, facing their death, irrespective of their diagnosis. Quality is therefore a
central feature of our work in that only if the service we provide is of the highest
quality can we ensure that the quality of the patients’ life is improved.
The Hospice has established a strong governance framework from that enables us
to focus on the quality of our services. Our Board of Trustees is focussed on good
governance and through both the Board and the Finance, Clinical Governance,
Resources and Fundraising sub-committees play a key role to ensure the
organisation is both viable and responsible. Our Executive Team delivers the
operational assurances through a framework of clinical and corporate governance
groups.
Audit is a regular feature of the work that we do to ensure that policies and
procedures are being carried out as they should and that they are still appropriate.
Patient and carer feedback is sought regularly through our “compliments, comments
and complaints” leaflet, through patient and carer questionnaires and by listening to
patient and carer views through a range of supportive groups.
During the last year we have been working with Clinical Commissioning Groups to
pilot new ways of working which will enhance the quality of care for patients nearing
the end of their life and those living with long term conditions. These pilots are
subject to on-going monitoring and evaluation to assess the impact of these
interventions and validate the quality of their delivery.
Our regulators, the Care Quality Commission, have inspected our patient areas
across all three sites and confirmed that they meet their demanding clinical
standards. Our services are not simply about meeting standards and delivering high
quality and excellence in all we do. They are about delivering holistic care and
embracing people as individuals, providing care, improving their personal experience
and ensuring dignity and privacy.
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 the healthcare services provided by Saint Catherine’s
Hospice, Scarborough.
1.1 Our Intent
The hospice works under the banner of Your community, Your hospice, Our care
Your community
 To take the lead in securing excellent end of life care for patients in our
community.
 To work collaboratively with other healthcare providers to support integrated
care for palliative and end of life care patients in our community.
 To enable patients to be cared for in the right place, at the right time for their
needs.
Your hospice
 To be a kite mark for quality and compassion wherever we work.
 To use our charitable endeavours to add value to statutory provision.
 To develop our volunteers and staff and support them in their roles.
Our care
 To put patients at the centre of everything we do.
 To provide high quality specialist palliative care for those patients with
complex needs.
 To support the provision of good end of life care and long term palliative care
for patients with less complex needs.
Part 2 – Measuring Quality in Detail
Saint Catherine’s Hospice monitors the quality of care that is provided across the
organisation via its Clinical Governance Committee. The importance of providing
quality care is underlined by the membership of the committee which includes the
organisations most senior clinicians, the Director of Patient Services and the Medical
Director. The Clinical Governance Committee also has representatives from the
Board and co-opted members who provide specialist input.
On a day to day level the Senior Management Team support the development and
improvement of services to ensure quality and to enable the organisation to meet the
challenges within the health care economy of Scarborough, Whitby, Ryedale,
Bridlington and Driffield. To support this approach we measure quality against
nationally agreed areas which are shown below:
- Patient safety
- Clinical effectiveness
- Patient experience
Priority 1- Patient Safety
Utilising SystmOne to improve consistency of risk assessment and
communication across the wider team
On admission risk factors for all patients are assessed utilising all patients
SystmOne. Risk associated with pressure ulcers, mobility, falls and the use of
bedrails are considered at admission and reviewed throughout the patients stay. The
multi-disciplinary team have moved from departmental specific assessments to a
shared tool which has improved consistency and communication between
professions. All records are recorded on SystmOne so that all member of the team
have access to the same information.
Undertake audits of clinical services to ensure that the care delivered is safe and
of a constant standard
Saint Catherine’s Hospice undertook a number of audits to ensure that the care that
we provide is both safe and consistent in quality.
Audit of medical prescribing practices: The medical and nursing staff conduct a
twice yearly audit of our prescribing and administration practices with formative
feedback to individual clinicians and nursing teams.
Audit of Advance Care Planning: We undertook an audit to ensure that ACP was
accurately coded, the quality of the ACP documentation and the communication of
the ACP to relevant health and social care professionals.
Audit of Nurse Led Beds: An audit of patients transferred from Scarborough
General Hospital to Saint Catherine’s Hospice Nurse Led End of Life Care Beds
was undertaken. Detailed the numbers and clinical diagnoses of patients as well as
average length of waiting time for bed, level of interventions required for patients
post transfer and patient/relative feedback.
Patient Safety Audit’s: In January 2014 we began to benchmark our safety data
against other hospice. We compared our rates of falls, Pressure Ulcers and
medication incidents with the other participating hospices
Priority 2- Ensuing Clinical Effectiveness
Utilising nationally recognised tools to identify the effectiveness of our services
The Edmonton Symptom Assessment System (ESAS) was introduced in
Scarborough Day Hospice in 2013 as a way of identifying the effect of attendance
at day hospice on patients’ symptoms and well-being. 62 patients scored key criteria
at the beginning of their attendance at day hospice and again after four weeks. The
table below sets out the findings of the study and will be used as a benchmark.
35
30
25
20
15
10
5
0
44
pain
59
25
42
49
51
55
tirednes
depressi
nausea
anxiety drowsy appetite
s
on
60
45
52
18
well
being
sob
bowels
other
worse
22
25
13
14
18
20
21
18
14
21
better
16
27
10
20
25
22
25
30
24
20
same
5
7
3
10
8
4
7
8
5
8
We recognise that the tool is not ideal for assessing symptom burden and severity in
palliative care patients because of the progressive nature of their illness. It did
however introduce an objective measure of the impact of our clinical service which
highlighted areas where we made a significant impact and other areas where we
may need to focus in more depth for patients.
Improving the quality of palliative care within care homes
NHS Scarborough and Ryedale Clinical Commissioning Group has extended its
funding of the Care Homes Project and as such we continued to develop our work
with care homes to improve the quality of care for residents nearing the end of their
lives. We aim to improve collaborative working between GP’s, hospitals, primary
care teams to reduce the number of unnecessary admissions to hospital in the last
stages of life, enabling residents to die in their ‘home’. We provide an in-house
education programme for nursing and residential homes and work with the education
department at the hospice to facilitate end of life care training. We also provide
clinical support and advice for palliative care residents in care homes, to enhance
the care already delivered by the care home, GP and community teams.
In the last 12 months we have worked with 15 care homes and delivered 244
education sessions. In addition there have been 135 referrals to the Saint
Catherine’s Hospice care home team and of those residents who specified a
prefaced place of death as the care home 92% achieved this.
Facilitating rapid discharge from an Acute Hospital for End of Life Care
Saint Catherine’s Hospice was commissioned by NHS Scarborough and Ryedale
Clinical Commissioning Group to open 4 Nurse Led End of Life Care Beds. The 12
month pilot project commenced on October 2013 The aim was to offer patients in
Scarborough Hospital the option of receiving excellent end of life care in the hospice
environment thus increasing the choice available to patients and carers at the end of
life and reducing in-hospital mortality.
In the last 5 months covered by the report there where 62 referrals to this project,
with an average length of stay of 4 days. The average waiting time for a bed was 12
hours. The majority of patients referred to the hospice were not previously known to
Specialist Palliative Care. Feedback from patients and relatives about this service
has been uniformly positive.
Priority 3- Patient Feedback
Measuring quality through patient feedback
In 2013/14 80 patients and 26 carers completed our feedback surveys. We found
that 87% of patients and 91% of carers who returned a questionnaire rated the care,
advice and support they received from the Hospice as very good.
One of the Hospices key outcomes for patient care is the control of pain and
symptoms. Of the patients who returned a questionnaire 87% reported that we have
been very effective or effective in controlling pain and symptoms.
Feedback from patients regarding the care received on the IPU was also very
positive with


92% rated the care as “better” or “much better” than similar services
100% stated they were treated as individuals with respect for their dignity and
privacy
We also collected general feedback those using our day hospice services and found
that:


75% patients stated we were “effective or very effective” in controlling pain
and other symptoms
100 % of carers who answered the questionnaire stated they received
sufficient support
Within our Bereavement support service feedback was that:

99% of the clients who had completed a questionnaire found the support had
helped and would recommend the service to others
Saint Catherine’s Hospice participated in a national survey of bereaved relatives
asking them to rate the care their family member received from the hospice service
in a number of domains. 21 of 33 questionnaires were returned and the results were
very positive with 90% of respondents rating the patients comfort as “very
satisfactory” and 10% as “satisfactory” in the last days of life.
As an organisation was also receive many thank you cards and comments on
facebook and twitter each of which are reviewed by the Senior Management Team.
The following comment provides a flavour of the responses we have received this
year.
“Our Mum was given the privacy, respect and dignity we sought for her final
days. We are aware of how privileged it has been for her to be nursed in such
a caring environment. This should be the same standard for all people
irrespective of place” (Patient via survey feedback 2014)
Part 3- Regulatory Requirements and Assurance from the Board
The following are formal statements, under various headings that all providers of
NHS healthcare services must include in their Quality Account, even though many of
the statements are not directly applicable to us as a Specialist Palliative Care
provider.
Review of Services
During 2013/14 Saint Catherine’s Hospice has provided for the NHS:










In-Patient Care
Daycare Services
Community Services
Care Home Services
Lymphoedema services
Bereavement support
Out of hours Telephone help-line
Rapid discharge from hospital to Hospice at End of Life
Carers Support
Out of Hours Phone Support
What This Means
Saint Catherine’s
Hospice
is(Mandatory
funded through
a combination of a grant from
Participation
In Clinical
Audit
Statement)
the NHS and fundraising activity. The grant that is allocated by the Statuary
bodies is £1,754,277 which represents approximately 27% of the hospice
total income
Participation in Clinical Audits
During the year 2013/14 Saint Catherine’s Hospice participated in the following
clinical audits or national confidential enquiries.

Palliative Care Funding Review- collection of data regarding the resources
provided by Saint Catherine’s Hospice in the provision of specialist palliative
care in order to develop an evidence base for per-patient funding mechanism
for palliative care.

Association for Palliative Medicine Service evaluation- national survey of
bereaved relatives views on the care their relative received from Saint
Catherine’s Hospice in the last days of life
What This Means
Saint Catherine’s Hospice has participated in a number of National audit or
National Confidential enquiries relating to specialist palliative care.
Research
In the year 2013/14 patients were recruited to participate in research approved by a
research ethics committee. The research projects included
The FAB Study (Fan, Activity and Breathlessness)- This is a phase II multi-site
parallel arm feasibility randomised controlled non-blinded study, being run in
collaboration with Australia. 60 participants with intractable breathlessness due to
cardio-respiratory disease were randomised to one of three groups. Scarborough
screened 19 participants between Feb-July 2013 and recruited 10, which was our
target. Australia is still recruiting to this study, but we are closed to further recruits
and awaiting study closure.
Assessing Palliative Care needs in Parkinson’s Disease: Developing a needs
assessment tool – clinimetric testing of the NAT-Parkinson’s Disease- This
project is also on the NIHR Portfolio, sponsored by HYMS, and is being run by Dr.
Ed Richfield. It involves clinical consultations with the patient/carer to complete the
new NAT-Parkinsons Disease needs assessment tool. Our target of 50 recruits was
achieved within the parameters of Sept 2013 – Feb 2014.
IMPACCT (Improving the Management of Pain from Advanced Cancer in the
Community)- This is a Health economics survey to establish health state utility
values and health care preferences of patients with cancer pain. NIHR-funded, on
the Portfolio and co-ordinated through the Institute of Health Studies at the University
of Leeds, we have recruited 36 out of our projected 40 participants so far, having
screened 51.
Subcutaneous Furosemide in Heart Failure- This is an ongoing service
development project, for which we are continually collecting data. The first round
of audit data was published in 2011 and a follow up editorial was published in 2012.
Haematology Study- Factors associated with place of care and place of death in
patients with haematological malignancies. This project aims to provide an evidence
base, identifying key areas to ensure that patients are cared for and die in their
preferred place of care. The research will consist of abstraction of information from
patient’s notes, qualitative interviews with patients, carers, haematology and
palliative care practitioners as well as General Practitioners. Scarborough is a
Patient Identification Centre for this study, which is being run by the Yorkshire &
Humberside Haematology Network and will be ongoing.
Pharmacovigilence Study- Saint Catherine’s Hospice is involved in the collection of
data for an international pharmacovigilence study led by Prof David Currow’s Team
in Australia. This is collating the impact of specific medications on palliative care
populations and to date we have entered data on Haloperidol, Metoclopramide and
Dexamethasone
The MAP Project (Magnetoencephalography Appearances in breathless
Patients)- This feasibility study aims to test the possibility of using MEG scanning to
study brain activity in 20 individuals with chronic breathlessness. Consenting patients
with lung or heart disease will have breathlessness induced by gentle leg exercise
whilst seated in the MEG scanner. Patients complete all procedures during a single
visit to the scanning centre (York neuro-imaging centre, York University).
Scarborough is a Patient Identification Centre for this study – we have screened 3
patients since April 1st 2013, one of whom consented but proved ineligible at a later
date.
What This Means
Saint Catherine’s Hospice has participated in a number of research projects
relating to specialist palliative care.
Use of the CQUIN Payment Framework
The grant received by Saint Catherine’s Hospice was not conditional on achieving
quality improvement and innovation goals through the Commissioning for Quality
and Innovation payment framework (CQUINS).
What This Means
Saint Catherine’s Hospice is not eligible to participate in the CQUINS
payment scheme. We do however produce activity figures for the Clinical
Commissioning Group in respect of the grant that we receive. In the period
2013/14 our bed occupancy target was 70% and we achieved 68%
Care Quality Commission (CQC)
Saint Catherine’s Hospice is required to register with the Care Quality Commission
and its current registration status is Independent Hospice for Adults. It is registered
to provide the following regulated activities:
•
•
•
Transport services, triage and medical advice provided remotely
Treatment of disease, disorder or injury
Diagnostic and screening procedures
Saint Catherine’s Hospice has the following conditions on registration:
•
The Registered Provider must not treat persons under eighteen years of age
The CQC has not taken enforcement action against Saint Catherine’s Hospice
during 2013/14.
Saint Catherine’s Hospice has not participated in special reviews or investigations by
the CQC during 2013/14.
Saint Catherine’s Hospice was inspected by CQC on the 21st November 2013 and
was found to be compliant with all standards and outcomes.
What This Means
Saint Catherine’s Hospice must register with the CQC the activities it wishes
to carry out. Once registered the CQC periodically inspect Saint Catherine’s
Hospice to ensure we are delivering safe and effective services. When we
were last inspected we were found to be compliant with all standards and
outcomes
Data Quality
Saint Catherine’s Hospice did not submit records during 2013/14 to the Secondary
Uses Service for inclusion in the Hospital Episode Statistics which are included in the
latest published data.
What This Means
Hospital Episode Statistics are collected for NHS organisations as a method
of determining payment for services. Saint Catherine’s Hospice done not
receive payments in this form and as such was not required to submit any
records.
Information Governance Toolkit Attainment Levels
Saint Catherine’s Hospice Information Governance Assessment Report overall score
for 2014 - 2015 is 66% and is graded Green (satisfactory), meaning that we
achieved Attainment Level 2 or above on all requirements (Version 8 or after).
The Information Quality and Records Management attainment levels assessed within
the Information Governance Toolkit (IGT) provide an overall measure of the quality
of data systems, standards and processes within an organisation.
What This Means
Saint Catherine’s Hospice completes the NHS Information Governance
Toolkit to demonstrate the quality of data systems, standards and processes
within an organisation. This provides assurance that we are handing
personal and sensitive data in an appropriate way.
Clinical Coding Error Rate
Saint Catherine’s Hospice does not have a Clinical Coding Error Rate.
What This Means
Organisations that receive payment by results funding have to provide
accurate coding for the work the carry out and must report on clinical coding
errors. Saint Catherine’s Hospice is not eligible for this founding and as such
did not submit data.
What others say about us.
The Primary Care Trust / Clinical Commissioning Group said the following about
Saint Catherine’s Hospice:
“St Catherine’s Hospice should be congratulated on their commitment to
providing such a high quality, patient-centred service. We have always found
them to be more than willing to work collaboratively with us and other health
organisations, and the work we have undertaken jointly to provide care home
link nurses is of particular note.
“As the new lead commissioner of NHS services in the area, it is very
encouraging to see one of our care providers perform so well in their CQC
inspection and it clearly demonstrates their dedication to providing excellent
care for the patients they serve.
“I look forward to our continued collaboration.”
Dr Phil Garnett
Chair
NHS Scarborough and Ryedale Clinical Commissioning Group
What This Means
The Lead commissioner of services that we provide for the NHS is very
happy with the quality of our work and outcomes for patients and has
indicated future collaboration on similar lines.