ST ANDREW’S
HOSPICE
Our Vision
Providing excellence and choice for everyone
affected by a life-limiting illness
Making Each Day Count
QUALITY ACCOUNT 2013-2014
Contents Page
St Andrew’s Hospice Mission Statement
Part1
Chief Executives Statement
Part 2
Monitoring and Reporting of the Priorities for
Improvement 2013-2014
2.2 Priority 1 - Patient Experience
Work with partner organisations to identify any gaps within 24/7
provision of care
2.3 Priority 2 – Clinical Effectiveness
Review existing Day Therapy services to ensure that they support the
needs of the patients and their families
2.4 Priority 3 - Patient Safety
Ensure that the premises are fit for purpose and offer a therapeutic
environment to deliver a high standard of care to patients and their
families
Part 3
Priorities for Improvement 2014-2015
3.2 Priority 1 - Patient Experience
Providing Care in the Patients Home
3.3 Priority 2 – Clinical Effectiveness
3.3a Continue to develop Day Therapy services to ensure that they meet
the needs of the patients and their families
3.3b Increase and develop medical provision within the wider Palliative
and End of Life Care Partnership to provide care at the point of need
3.4 Priority 3 - Patient Safety
3.4a Ensure that the premises are fit for purpose and offer a therapeutic
environment to deliver a high standard of care to patients and their
families
3.4b Explore the use of patient safety parameters to analyse and evidence
the high standard of care provided
1
Part 4
Statements of Assurance from the Board of Directors
4.1 Reviews by the Care Quality Commission
4.2 National Minimum Data Sets (MDS) and Data Comparison for Children‟s
Services
4.3 Review of Services
4.4 Participation in Clinical Audits, National Confidential Enquiries and
Research
4.5 Quality Markers- What we have chosen to measure
4.6 What others say about St Andrew‟s Hospice
Part 5
Supporting Statements
5.1 Statement from North East Lincolnshire Clinical Commissioning Group.
5.2 Statement from Health and Wellbeing
5.3 Statement from St Andrew‟s Hospice Patient Representatives
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St Andrew’s Hospice Mission Statement
“St Andrew’s Hospice will strive to make each day count for people of all
ages with life limiting illnesses and to support those who care for them.”
To ensure that we achieve our mission:
We will offer specialist palliative care which is flexible to the needs of patients with
progressive disease, where curative treatment is no longer possible.

We will act with openness, honesty and sensitivity, to respect the rights of all
patients to make decisions based on informed choice and to include families and
close others in decision-making where appropriate.

We will commit to provide a physical, spiritual, psychological and social approach
(holistic) to all care; delivered by a multi skilled team to promote the quality of life of
patients, families and close others.

We will work together with everyone involved in the patients‟ care (lay carers and
professional staff), recognising and respecting their contribution to ensure an
integrated, seamless service is provided and sign up to Together for Short Lives and
Royal College of Nursing/Royal College of General Practitioners Patients Charters.

We will continue to care for family and close others following bereavement, in a
sensitive and supportive environment.

We will provide continuing education and training opportunities for all staff and
volunteers in order to develop commitment, expertise, specialism, innovation and
the sharing of knowledge. We will also offer placement opportunities to students of
all disciplines.

We will ensure the quality and standard of service is of a consistently high level,
undertaking regular internal and external audits and responding to changing needs.

We will maintain confidentiality and demonstrate that we can be trusted.

We will maintain an environment that is uplifting, comfortable, friendly and patientcentred.

We will make the best use of our resources, providing the highest quality of care in
the most cost-effective and efficient way possible.
Approved at April 2009 Board meeting
Acknowledgement to TREE Group for their input to this document
Reviewed July 2012
3
Part 1:
Statement from the Chief Executive
On behalf of our Board of Directors and the Senior Management Team I have pleasure in
presenting our annual Quality Account Report for St Andrew‟s Hospice.
Quality is central to the care that we provide. The Hospice has developed a strong
framework in both corporate and clinical governance and has a culture of continuous quality
monitoring, in which any shortfalls are identified and acted upon quickly. Our Patient &
Carer Involvement Group are represented within our governance framework and play a key
role in communicating feedback and offering advice to ensure that all our services and
activities are responsive and deliver on quality.
We have commenced the redevelopment of our building and we are looking to complete
phase one and two by mid-2015. Phase One will see us increasing our bedded unit by 50%
to twelve beds, and provide a community hub and consulting rooms. Phase Two is our
Health and Wellbeing Unit, which will consist of treatment rooms, resistance pool,
hairdressing and physiotherapy/gym facilities. This has been a long time in the planning and
has included the views of patients, their families and carers, staff and volunteers. It will
create an enhanced environment for everyone and it is hoped that members of the local
community will feel able to come in and use the facilities within the community hub.
We are a registered charity which provides specialist palliative care to people of any age
(children and adults) living with a life-limiting or life-threatening illness. We make no charge
to patients or their families/carers for the services we deliver. We care not only for the
person who is ill, but for the whole family, friends and carers. We respect the patient‟s
dignity and strive to enable the patient to achieve their personal goals and priorities.
We provide a range of specialist palliative care services that include:
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An 8 bedded Adult In-patient Unit
A 4 bedded Children‟s & Young Peoples Unit
Day Therapy within both units
Special bedroom (within Children‟s & Young Peoples Unit)
A Lymphoedema Service
Complementary Therapies
Chaplaincy
Creativity
Carers Support
Physiotherapy
Bereavement Support (pre & post)
An out of hours telephone advice line for professionals
All services are supported by a multi-disciplinary team of professionals, including a
Consultant in Palliative Medicine, Speciality Doctors and Nursing Teams, who are, in turn,
4
supported by the wider team of dedicated staff who work or volunteer at the Hospice
providing catering, household and administrative functions. Excellence in quality requires a
team approach. This year has seen us formalise our working arrangements with the local
provider of health and social care, Care Plus Group. They provide Community Nursing,
Macmillan and Marie Curie services and all their staff that work predominately in Palliative
and End of Life care are based at the Hospice. Over this next year we will be looking at a
structure to enable us to manage both organisations‟ staff as one resource, thereby utilising
resources efficiently and effectively, enhancing the care for patients and their families.
Our services are monitored by the Care Quality Commission as well as by our local
commissioning organisation – North East Lincolnshire Clinical Commissioning Group
(CCG). We are also measured against National Cancer Peer Review Quality Standards, as
well as Fire and Environmental Inspections. Following an unannounced inspection by the
Care Quality Commission in July 2013, they identified no shortfalls in the services provided
by the Hospice. This is a tribute to the hard work of every member of staff working for St
Andrew‟s Hospice; therefore I would like to take this opportunity to thank all of our staff
and volunteers for their achievements over the past year. Despite the current economic
climate, the Hospice has continued to provide a high quality service and remain financially
sound. We have achieved this by providing high quality, cost-effective services to our
patients, their families, friends and carers. Our team continues to strive for excellence in all
they deliver.
Feedback from the community we serve is very important to us, therefore we undertake an
annual satisfaction survey, as well as encouraging feedback from patients/families and carers
as they are receiving care/services.
We recognise there will always be challenges and will continue to strive for the highest
quality in all care provided, putting our patients, their families, friends and carers at the
heart of everything we do.
I am responsible for the preparation of this report and its contents. To the best of my
knowledge, the information reported in this Quality Report is accurate and a fair
representation of the quality of the healthcare services provided by St Andrew‟s Hospice.
The safety, experience and outcomes for all those using our services are of paramount
importance to us.
Alison Carlisle
Chief Executive
15th May 2014
5
Part 2:
2.1
Monitoring and Reporting of the identified Priorities for Improvement
2013-2014
Three priorities were identified within the 2013-2014 Quality Accounts relating to Patient
Experience, Clinical Effectiveness and Patient Safety. The progress of these priorities is
reported below:
2.2
Priority 1 - Work with partner organisations to identify any gaps within
24/7 provision of care
Actions/Progress:
The Strategic Lead for Palliative & End of Life Care was identified as the project lead from a
partner organisation to take this initiative forward. She has had the terms of her project
time increased from two years to an open ended position. This means there is a dedicated
person to lead on all aspects of development in relation to Palliative and End of Life Care for
the locality.
There is now a Memorandum of Understanding between the Hospice and North East
Lincolnshire Care Plus Group to work in partnership when reviewing services and delivering
palliative and end of life care. A Board has been established and the strategy reviewed to
identify agreed priorities for improving palliative and end of life care to patients and their
families. The existing medical care provision has been reviewed and is now led by the
Hospice as part of the partnership agreement, to provide medical care at the point it is
needed, preventing duplication and wasted time. The Strategic Lead for Palliative & End of
Life Care is working closely with the Head of Care from the Hospice to review and develop
all care and services provided by the Partnership, identifying new ways of working.
Within the priorities identified for 2012-13 Quality Accounts, it was recognised there were
gaps in service delivery for children with life limiting conditions and the Hospice began
working closely with the Strategic Lead for Palliative & End of Life Care and the Children‟s
Complex Care Manager to develop a strategy to develop services. The Children‟s
Community Nursing Service has been reviewed and restructured during this period, as part
of the review of the entirety of Children‟s Services provided within North East Lincolnshire.
This locality-wide review was required as existing services were not able to meet the
changing focus of need and demographics within the area. Opportunity has now arisen, from
this restructure of Children‟s Community Nursing Service, for the Hospice to start
delivering palliative and end of life care in the community as one of the identified Children‟s
Community Nursing roles, with an Advanced Nursing Assistant to work alongside this role,
fully supported and funded by the North East Lincolnshire CCG. Both of these roles will be
based at the Hospice to ensure continuity of care and support.
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Further requests have been made for the Hospice to provide care, commissioned by the
North East Lincolnshire CCG on an individual patient basis. This care has been provided
within both the Adult and Children‟s Services.
2.3
Priority 2 - Review existing Day Therapy Services within both Adult and
Children’s Services to ensure that they support the needs of the patients
and their families
A review of present Day Therapy Services has commenced, however due to the current
environment not being suitable we have not been able to fully implement changes
immediately. Through the redevelopment the layout and provision of space will be changed
to promote a more flexible approach to the services we can deliver. Patients, their families
and carers have been involved in the redevelopment discussions, with the plans being
available and consultations taking place through the TREE group (user involvement group)
and Day Care Sessions.
The Adult Services Manager and Integrated Team Manager attended a conference titled
Developing and Delivering Quality Assured Palliative Day Care Services delivered by the
Association of Palliative Day Services. A number of Hospices attended from across the
country, all having slightly different approaches to the way they delivered day therapy
services. The key aspects coming out of the conference were that most hospices delivered a
mixed model of social and medical approach. Much was learnt from the event that will shape
how we phase in a new approach to our own Day Therapy Service recognising the value of
both models.
A working group is to be established, including patients, their families and carers as well as
staff and volunteers.
Visits have also taken place, by the Chief Executive, Head of Care, Adult Services Manager
and Integrated Team Manager to other units to review good practice models within Day
Therapy which will be shared with this working group.
2.4
Priority 3 - Ensure that the premises are fit for purpose and offer a
therapeutic environment to deliver a high standard of care to patients
and their families
Work has now commenced on the construction of new build following the demolition of
the old annexe building. The estimated time for completion of this phase of the build is
December 2014 and will give an additional 4 beds, improved facilities for providing Day
Therapy Services and a large Community “Hub”.
Staff, volunteers, patients, their families and carers, local community, professionals and
business people have been involved in shaping the redevelopment to ensure that we are „fit
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for purpose‟. We have liaised with the community through the local media and hosted
events for local community groups, including Rotary Clubs, to engage their support for the
build.
A number of visits to other new units have taken place to utilise new concepts/layouts,
learning from their experiences and identifying good practice.
The Care Quality Commission (CQC) has been informed and consulted with to ensure that
the plans are „fit for purpose‟.
Part 3:
3.1
Identified Priorities for Improvement 2014-2015
The Senior Management Team has produced a Strategic Plan that covers the period 20122015. This was produced following consultation with staff, patients and the Board of
Directors. Looking ahead to 2014-2015 we have identified the following priorities to be
worked on in the next twelve months, picking up two from last year‟s objectives that we are
still working towards. These priorities impact directly on each of the three priority areas patient experience, clinical effectiveness and patient safety.
3.2
Priority 1:
Patient Experience
Providing care in the patients home
How was this identified as a priority?
There is an opportunity for hospices to continue to increase the support they provide for
people who are at home. The Commission into the Future of Hospice Care identify that
home remains the preferred place of care for most people, but without the right models of
well-coordinated care, which remain elusive, people‟s wishes will remain unfulfilled. This
view is supported by the Together for Short Lives report reviewing the future of Children‟s
Hospice care, suggesting that caring for a child 24/7 puts tremendous strain on parents and
families, and help is not readily available.
One of the key outcomes from the North East Lincolnshire Palliative and End of Life
Partnership Strategy is to develop services within the community to support more people
to be cared for and die in their preferred place.
A changing social context will pose new challenges to providing care within the patient‟s
home. More people are living alone and families are more fragmented, with these numbers
set to increase. With the average family size expected to shrink and more people being in
employment, there will be fewer people able to provide full-time care.
8
It has also been reported that older people are particularly vulnerable to social isolation and
loneliness owing to loss of friends and family, mobility or income. Social isolation and
loneliness have a detrimental effect on health and wellbeing. This impact on an individual‟s
health and wellbeing has cost implications for health and social care services. There is an
opportunity to utilise the benefit of the Hospice volunteer cohort to help alleviate loneliness
and improve the quality of life of older people, reducing dependence on more costly
services.
How will the priority be achieved?
Having just been awarded the funding to provide a Senior Nurse and Advanced Nursing
Assistant through the review of the Children‟s Community Nursing Service, a Senior NurseCommunity Lead has been appointed. Work will be undertaken to develop and write
policies, procedures and competency frameworks to support the nursing team who will
provide care in the child‟s home. An Advanced Nursing Assistant will be appointed to the
existing Children‟s Nursing Team, who will develop their skills to provide an in
reach/outreach service between the Hospice and the child‟s home, ensuring continuity of
care and maintain existing relationships.
Over the last year, the Haven Team has been developed in partnership by Care Plus Group,
Marie Curie and St Andrew‟s Hospice. The Haven Team provide palliative and end of life
care to patients in their own home, 24 hours per day 7 days per week. However, it has
been recognised that alongside clinical care, patients and their families, living with life limiting
illnesses also need practical help with everyday tasks. These can include picking up
prescriptions, taking the dog for a walk, hanging out the washing, doing the shopping or
helping out in the garden. It is proposed to develop the existing Hospice volunteer role into
a community volunteer scheme that will really help those who want to remain at home.
How will progress be monitored and reported?
Progress will be monitored by the following:
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Number of referrals to the Children‟s Community Team
Development of the caseload for the Palliative and End of Life Children‟s Community
Team
Up-take of home care by existing children and families
Identification and delivery of Preferred Priorities of Care (PPC) for both adults and
children
Number of referrals to the volunteer scheme (Haven Team)
Development of services available within the patients home delivered by the
volunteer
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3.3
Priority 2:
Clinical Effectiveness
3.3a
Continue to develop Day Therapy Services within both Adult and
Children’s Services to ensure that they support the needs of patients and
their families
How was this identified as a priority?
This objective was identified as a priority last year and the development work is on-going, as
discussed earlier.
How will the priority be achieved?
The review into current services will continue, developing a working group made up of
patients, their family and carers, staff and volunteers. It is proposed that all members will
have opportunity to visit other hospice services providing a mixed social and medical
approach to Day Services.
Different approaches, for example, an appointment system or an option to book onto
therapeutic group work, will be trialled within the existing service before being finally
implemented within the new build.
The approach in Children‟s Services is quite different. Day Care provides an alternative to a
nursery/school/college placement, and as such is of great value to the parents. However a
full review of the care and services provided as part of this is necessary to ensure we are
providing individualised effective care and social activities.
How will progress be monitored and reported?
Progress will be monitored by the following:
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3.3b
Increase in number of referrals to Day Care Services
Increase in attendance to Day Care Services
Development of a „menu‟ of services and activities to be provided to the patients and
their families within both Adult and Children‟s Services
Increase and develop medical provision within the wider Palliative and
End of Life Partnership to provide care at the point of need
How was this identified as a priority?
Reviewing and developing the medical provision is not only identified within the Hospice
Strategic Plan but also supports the Strategic Direction for Palliative and End of life Care
Partnership within North East Lincolnshire.
The Partnership is involved with a seven-day working pilot currently being undertaken
within North East Lincolnshire. In line with seven-day working guidance, there is a need to
10
increase medical cover to two full time Medical Practitioners and a full time Consultant to
meet the needs of all patients with a life limiting conditions within the locality.
How will the priority be achieved?
Following the approval of the Hospice Board to increase the hours available to the Medical
Team, and the amalgamation of the provision through the partnership, opportunity has
arisen to fully review the service and ensure medical care is utilised effectively and
efficiently, to work in the most suitable setting to meet the patient‟s needs. A further review
of Out of Hours provision is required to be able to offer medical support at any time of the
day/night.
The increase in resources will enable patients to have more choice over where they are
cared for, reduce inappropriate admissions to the local acute trust, provide more medical
support to patients living within care homes and provide an equitable service 7 days per
week, 365 days per year.
How will progress be monitored and reported?
Progress will be monitored by the following:
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Development of an integrated medical work plan
Development of a rota, fully staffed to provide provision seven days per week
Monitoring the place where care is provided and level of activity
3.4
Priority 3:
Patient Safety
3.4a
Ensure the premises are fit for purpose and offer a therapeutic
environment to deliver a high standard of care to patients and their
families
How was this identified as a priority?
This objective was identified as a priority last year and the development work is on-going, as
discussed earlier.
How will the priority be achieved?
The completion date for phase one (and two) of the redevelopment is December 2014 (and
June 2015).
Patients, their families and carers, staff and volunteers will be involved in the colour and
design of the rooms, and the furniture and equipment to be purchased.
How will progress be monitored and reported?
Progress will be monitored by the following:
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3.4b
Successful completion of phase one and two
Smooth relocation of services from the old building to the new
Feedback from patients, their families and carers, staff and volunteers
Explore the use of patient safety parameters to analyse and evidence the
high standard of care provided
How was this identified as a priority?
Help the Hospices 'Commission into the future of hospice care‟ (2013) identified key
principles for hospices in relation to patient safety. These are being able to plan, analyse and
act on good data and being able to articulate value. They suggested it is important to
influence how quality is monitored in hospice care by regulators/commissioners and be
influential in the quality of care provided by others.
Through discussions at Hospice Governance a number of patient safety parameters have
been identified, that could assist with the analysis and reporting of any patient safety aspects.
These improvement tools are for measuring, monitoring and analysing patient harms and
'harm free' care. They provide a quick and simple method for surveying patient harms and
analysing results so that we can measure and monitor improvement and harm free care over
time.
Help the Hospices have recently piloted and are about to start a national Hospice Inpatient
Safety Benchmarking project for hospices to learn and improve clinical practice. It will also
assure our patients, their family and carers, ourselves, our Boards, public and CCG‟s „harm
free‟ care is being provided.
How will the priority be achieved?
We will review a selection of tools available, involving patients, their families and carers and
staff in this review. We will then pilot the identified tool and following training implement
throughout the adult and children‟s services.
Data will be submitted to the Help the Hospices Inpatient Safety Benchmarking project. The
metrics being measured are falls, pressure damage and drug errors. Data will be collected in
both adult and children‟s inpatient units, with results being discussed through clinical and
governance meetings as well as at the Board.
How will progress be monitored and reported?
Progress will be monitored by the following:
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Produce an options paper and pilot identified tools
Evidence of data submitted and quarterly progress reports
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Part 4:
4.1
Statements of Assurance from the Board of Directors
Reviews by the Care Quality Commission
St Andrew‟s Hospice is required to register with the Care Quality Commission (CQC) and
is currently registered to undertake the following regulated activities:
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Treatment of disease, disorder or injury
Diagnostic and screening procedures
Transport services, triage and medical advice provided remotely
The Regulated Activity may only be carried out in the following location:
St Andrew’s Hospice, Peaks Lane, Grimsby, North East Lincolnshire, DN32 9RP
The CQC has not taken any enforcement action against St Andrew‟s Hospice during 20132014.
St Andrew‟s Hospice has not participated in any special reviews or investigations by the
CQC during 2013-2014.
St Andrew‟s Hospice, Adult Services, received an unannounced inspection by the CQC on
24 July 2013. The Hospice was reviewed against the following five CQC standards:
 Consent to care and treatment (Outcome 2)
 Care and welfare of people who use services (Outcome 4)
 Management of medicines (Outcome 9)
 Staffing (Outcome 13)
 Complaints (Outcome 17)
St Andrew‟s Hospice was „compliant‟ with all of the above outcomes and no sanctions or
requirements were made by the CQC following the inspection.
“A patient we spoke with told us, "They have kept me fully informed of everything and have
never done anything without my consent." A second patient said, "They have asked me about
referring me to other services" and "I have seen my care documents and I'm happy with
everything in them."(Care Quality Commission Report 2013)
“We found people who used the service had their support needs met by sufficient numbers of
appropriate staff. The hospice's workforce planning schedule indicated the staffing levels
required for each shift. It specified numbers of staff and the level of skill mix. It also stated
that depending on occupancy and patient need levels could be increased or decreased as
necessary.” (Care Quality Commission Report 2013)
“We spoke with three volunteers who told us, "I wanted to give something back, the hospice
looked after my Dad and the care he received was out of this world", "It's (the hospice) such an
amazing place and I wanted to help in any way I could" and "The care my family member
received was amazing so I wanted to do something in return, I give my time but get so much
more in return." (Care Quality Commission Report 2013)
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4.2
National Minimum Data Set (MDS) figures
We have chosen to present information from the National Council for Palliative Care
(NCPC): Minimum Data Sets (MDS) which is the only information collected nationally on
adult hospice activity, with 143 hospices participating. The figures below provide information
on the activity and outcomes of care of patients. Based on our return we have been
included in the small unit category (fewer than 11 beds) for three of the four categories,
with outpatients being classified as a large unit (more than 316 patients) and data was
received nationally from 48 small units.
Adult Inpatient Unit
Adult In Patient Services
2011-2012
Small unit – fewer than 11
beds
St Andrew’s
National
Hospice
Median
Total number of patients
% New patients
% Re-referred patients
% Occupancy
Average length of stay
% Inpatient stays ending in
discharge
% Patients aged 25-64yrs
% Patients over 84yrs
% New patients with noncancer diagnosis
2012-2013
Small unit – fewer than 11
beds
St Andrew’s
National
Hospice
Median
160
91.3%
4.3%
78.9%
11.4
60.9%
132
90.7%
6.1%
78.9%
10.95
52.8%
147
78.2%
18.3%
78.4%
16.6
62.7%
166
89.0%
7.8%
76.2%
11.15
49.8%
25.3%
16.4%
19.9%
30%
11.9%
8.3%
32.2%
12.2%
7.8%
30%
12.1%
8.3%
The number of In Patient stays ending in discharge is much higher than the national average,
with nearly 63% of admissions ending in discharge. This could be due to the provision of
respite and having a proactive approach to discharge planning.
The occupancy has remained steady for 2012-2103. With only eight beds, there are
variations in our occupancy where we can be fully occupied one day and following death or
discharge have available beds the next. However we find once we have informed a
professional that we have no available beds, they don‟t referrer for a number of days/weeks,
even with plenty of encouragement and explanation. Also having identified beds for respite
care can be difficult when managing occupancy, as we don‟t have as much
flexibility/availability with the current number of beds. It is hoped with four additional beds
that we will be able to improve the management of the variation in occupancy.
For 2012-2013 the number of new patients with a non-cancer diagnosis fell, albeit remaining
in line with the national average. However looking at our own data collection, for that
period, overall we were caring for 19% non-cancer patients. The only explanation for this
fall has been the reduction in referrals of non-cancer patients directly into the In Patient
Service.
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Adult Day Therapy Unit
Adult Day Therapy
2011-2012
Medium unit – 114 to 177
patients
St Andrew’s
National
Hospice
Median
Total patients accessing
% New patients
% Patients aged 25-64yrs
% Patients over 84yrs
Day therapy attendances
% Places used
% New patients with noncancer diagnosis
130
56.9%
12.2%
18.9%
2166
86.8%
24.3%
142
64.1%
27.5%
11.6%
1761
57.8%
16.9%
2012-2013
Small unit – fewer than 111
patients
St Andrew’s
National
Hospice
Median
105
50.5%
24.5%
7.5%
1915
78.6%
17%
83
61.7%
25.4%
11.1%
1010
56.9%
19.1%
For 2012-2013 places used within the Day Therapy Unit are down, although as a hospice we
remain higher than the national average. As previously identified, we are currently reviewing
Day Therapy provision as feedback has identified we are not meeting the needs of all
patients, and also in response to the down turn in the number of patients attending the
service.
It is also evident there has been a fall in numbers of patients over the age of 84 years
accessing Day Therapy. This could be due to the model of care currently provided, the
length of the day and the reduction in transport available. Through the Day Therapy review,
we are also reviewing the wider provision of transport.
Adult Outpatients
Adult Outpatients
2011-2012
Large unit – more than 321
patients
St Andrew’s
National
Hospice
Median
Total patients accessing
% New patients
% Patients aged 25-64yrs
% Patients over 84yrs
Outpatient clinic attendances
Attendances per patient
% New patients with noncancer diagnosis
312
41.3%
41%
8%
1297
4.2
26%
506
48.1%
23%
0.6%
1019
2.0
20%
2012-2013
Large unit – more than 316
patients
St Andrew’s
National
Hospice
Median
355
34.6%
52.0%
6.5%
1367
3.9
4.1%
513
39.9%
40.3%
8.0%
1202
1.9
14.9%
Within 2012-2013 we had more patients attending the Outpatient Service, however, still
not as many as the national average. As a unit we only just fit within the large category,
whereas for all other departments/categories we are classed as a small unit, so for this
department we are compared against much larger organisations.
15
The most noticeable difference is the fall in new patients with a non-cancer diagnosis. This is
due to a more proactive review process for all patients, and the subsequent discharge of all
patients with a primary diagnosis of Lymphoedema. There is also a perception within our
community that we only care for cancer patients. We are about to explore a new business
model with the local skin integrity team to develop a service for all patients.
Bereavement Support
Bereavement Support
2011-2012
Small unit – fewer than 114
service users
St Andrew’s
National
Hospice
Median
Total people accessing
% New people
% People aged 25-64yrs
% People aged 65-84yrs
% Patients over 84yrs
Total contacts
% contacts group sessions
% deceased patients with noncancer diagnosis
67
70%
66%
25.5%
0.0%
402
32%
15%
67
72%
45%
22.2%
0.0%
314
6%
7%
2012-2013
Small unit – fewer than 114
service users
St Andrew’s
National
Hospice
Median
95
56.8%
40.7%
24.1%
0.0%
512
39.3%
38.9%
70
69.1%
48%
23.1%
1.6%
366
10.7%
9.3%
2012-2013 saw an increase in the number of people accessing the bereavement support
service. This is due to the introduction of a formal case management approach which
includes some level of provision for all family members and carers. The increase in the
percentage of family and carers of patients with a non-cancer diagnosis receiving support
can also be attributed to this approach.
There was also an increase in the percentage of contacts via group sessions, which
continued to be much higher than the national average. Following feedback, there has been
an increase in the number of group sessions held, as well as the caseload management
approach identifying more participants to join closed and open group sessions.
It is disappointing to note both as an individual hospice and the national average there are so
few people over the age of 84 accessing bereavement support services. This may be due to
a generational view, the difficulty in accessing services, the cultural expectation that they
don‟t need support or that our current services don‟t meet the needs of this group of
society.
16
Data comparison for Children’s Services
It is disappointing to report that there has been no national data collected for children‟s
hospice services, similar to the MDS for adult hospices, for the last couple of years. It is
therefore a challenge to benchmark against other children‟s hospices in relation to activity
and service provision. For the purpose of this report, a comparison will be made between
the previous two years of activity data for St Andrew‟s Children‟s Hospice, identifying
improvements or challenges faced.
Children & Young Persons Services
2012-2013
Number of Families
supporting
% of children aged below
2 years
% of children aged above
16 years
Total bed nights available
% Occupancy of Beds
Total number of
admissions
% Occupancy of Day Care
Special Room usage
(number of children/
number of nights)
2013-2014
85
101
6%
8%
26%
27%
1005
92%
1448
99%
311
409
75%
64%
5 children / 53 nights
5 children / 31 nights
There has been an increase in the number of families we are supporting, as well as in the age
of the children we are caring for.
The last year has seen significant investment in relation to the staffing establishment to
increase the provision of services in the Children‟s Hospice, which is shown in the increased
activity data for 2013-2014, with an additional 443 bed days available, supporting a 24%
increase in the total number of admissions.
One area where there is a notable fall in activity is within the Day Care Service. As
previously discussed, this is undergoing a review and it is anticipated this figure will increase
next year.
4.3
Review of Services
All providers must include the following statements in their Quality Accounts. Many of these
statements are not directly applicable to specialist palliative care providers and therefore,
where appropriate, further explanation of the meaning of certain statements is provided.
17
During 2013-2014, St Andrew‟s Hospice supported North East Lincolnshire Clinical
Commissioning Group‟s commissioning priorities with regard to the provision of specialist
palliative care. The following services were provided:










Adult, Children‟s & Young People‟s In Patient Units
Adult, Children‟s & Young People‟s Day Therapy
Lymphoedema
Physiotherapy
Complementary Therapies
Creative Therapy
Pre and Post Bereavement Support/Counselling
Patient Forum
Carer‟s Group
Out of hours advice line for professionals
All of the above are supported by a multi-professional team employed by the Hospice.
The income generated by the NHS services provided by St Andrew‟s Hospice and reviewed
in 2013-2014 represents 100% of the total income generated from the provision of NHS
services by St Andrew‟s Hospice for the reporting period 2012-2013.
What this means:
St Andrew’s Hospice is currently funded through an NHS grant and fundraising activity. The grant
allocated by North East Lincolnshire Clinical Commissioning Group represents approximately 12% of
3.2
Participation in Clinical Audits, National Confidential Enquiries
the Hospice’s total income. The remaining income is generated through fundraising, public
donations,
shops, lotteryinactivity
andAudits,
investments.
The level
of the NHS grant
means that
all services
3.4
Participation
Clinical
National
Confidential
Enquiries
and
delivered
by the Hospice are substantially funded from charitable funds with the NHS funding a small
Research
proportion of the current services provided.
4.4
Participation in Clinical Audits, National Confidential Enquiries and
Research
During 2013-2014 there were no clinical audits or national confidential enquiries covering
NHS services relating to palliative care. St Andrew‟s Hospice only provides palliative care,
therefore were ineligible to participate.
St Andrews Hospice is part of a research project being led by the University of Manchester
which is undertaking a study looking at assessing carer‟s needs in order that they are
supported in their caring role. The tool being used is CSNAT (Carers Support Needs
Assessment Tool) which looks at a number of domains including financial support;
understanding your relative‟s illness; home support; and death and dying. The tool has
helped carers and staff on a number of levels to identify carers support, which has resulted
18
in admissions to the Hospice for respite and signposting to specialist support. The pilot
concludes May 2014, leaving us with the licence to continue to use the tool as we wish.
To make sure we are providing a consistently high quality service, we take part in our own
clinical audits, using national audit tools developed specifically for hospices where available.
This allows us to monitor the quality of care being provided in a systematic way and creates
a framework where we can review this information and make improvements where needed.
We have recently appointed a Professional Development and Quality Lead to coordinate
the audit programme and lead the audit agenda.
Through Hospice Governance, all staff and the Board of Directors are kept fully informed
about the audit results and any identified shortfalls.
The following are some of the audits that were completed during the audit year 2013-2014:
Audit Title
Outcome
Controlled Drugs
To review the compliance of management of
CDs in line with Help the Hospice Audit
tool.
Overall the outcome of this audit was very good
with more than 90% compliance being recorded.
There were a couple of areas for improvement
relating to the legibility of signatures and the
procedure of discontinuation of medication.
Both of these areas have been addressed within
team meetings to identify the required
improvements.
The audit shows there has been an overall
improvement in the number of forms completed,
however the documentation is still quite poor
and the forms are completed and updated by a
very small percentage of the nursing team.
Recommendations are to 1)improve the paper
work; 2)produce a process for completion; 3)
communication training for all Clinical Staff;
4)Stress the importance of the Multi-Disciplinary
Team to complete the forms.
A quality audit was undertaken and it became
clear the patients and their carers were not
aware of this process and as such were not able
to comment on the effectiveness. They agreed
with the principles and reported they wouldn‟t
expect anything less from the Hospice. The staff
however had mixed views, ranging from it being
a valuable process to an added pressure on their
time. The recommendations from this audit
were to ensure all patients and their carers are
made aware of the process and know what to
expect as a minimum standard and to discuss the
process with the staff through their team
meeting to reiterate the value to the patients
and the nursing team of this process.
The outcomes measured were Relaxation,
Anxiety and Pain. The standards were agreed by
Preferred Priorities of Care
Review if this has been discussed and
recorded and if not, a reason recorded.
Hourly Rounding
To review the effectiveness of hourly visiting
to In Patients from the patient, carers and
staff members perspective
Complementary Therapies
To audit patient outcomes post treatment
19
the NEYCA Complementary Therapy group and
included a benchmarking exercise with other
hospices participating.
Health & Safety Audit
An audit of the Hospice‟s health and safety
status
HR - Return to Work Interviews
To audit the return to work interviews
against the policy and procedure for quality,
consistency and accuracy.
Cleaning Audit
Quality audit of cleaning throughout the
Hospice
4.5
The results showed that 78% of people felt more
relaxed; 60% were less anxious and 38% were in
less pain.
Using a template downloaded from „Tips &
Advice‟ a comprehensive audit was undertaken
looking at a number of areas relating to health
and safety including the policy, reporting
arrangements, risk assessment, fire safety,
personal protective equipment (PPE), display
screen equipment (DSE) and manual handling. As
this was the first time of completion it was
pleasing to report there were no key gaps
highlighted by this process, however there were
some areas which have been addressed through
an action plan for the Health and Safety
Committee to complete.
Prior to the review of the Attendance Policy in
2014, an audit was carried out with regard the
“return to work” interview process which is
conducted following an absence from work. The
audit looked at the process, timeframes and
completion of the documentation. Overall the
results showed certain areas of the process were
carried out more effectively than others and the
recommendations included review of the
documentation, further coaching for line
managers and supporting guidelines to be drawn
up as a management aid.
This was a re-audit and the results identified a
continued good level of quality in relation to
cleaning, but disappointingly did not show an
improvement. It should be emphasised that
patient‟s bedrooms in both units continued to
score 100%. There is more work to be done
with the Household Team to enable these
results to improve and discussions have taken
place within the team meeting.
Quality Markers – What we have chosen to measure
Accidents 2013-2014
The number of trips and falls within an Adult Hospice/Palliative Care Unit is 5.7-6.2 falls per
occupied bed per year (Goodridge, 2002; Pearse, 2004), therefore the range is 41.5-45 falls
within the Hospice for 2013-2014.
20
Accidents
Trips & Falls
2012-2013
46
2013-2014
33
In 2013-2014 one patient accident was reportable to HSE under RIDDOR.
Patients are assessed using a falls risk assessment tool to identify any potential risks and
action is taken to ensure that patients are safe whilst in our care. Clinical staff have
received training in identifying how to manage patients who are at risk of falling, including
recognising indicators and triggers which can affect a patient‟s balance. We are really pleased
with the results of the reduction in falls.
Within St Andrew‟s Hospice we support our patients to continue to be as independent as
their illness allows. Although many of our patients are weak and vulnerable the majority
wish to retain their independence for as long as is possible. This however increases the risk
of accidents occurring. Our philosophy is to support patients while allowing them the
freedom to move around the Hospice.
Patient Safety Incidents
Indicator
No of Patients admitted to
the In-patient Unit with
pressure damage
No of Patients who
developed pressure damage
whilst in the In-patient Unit
No of medication errors
No of Significant Events
2012-2013
Patient Safety Incidents
22
2013-2014
15
12
25
14
30
18
34
of which 2 were positive events
No of Complaints
No of Clinical Complaints
No of Non-clinical Complaints
2012-2013
2
8
2013-2014
1
10
The Hospice receives many letters and cards of thanks. The number of compliments far
outweighs the number of complaints.
The Chief Executive and Senior Management Team are accessible via email and contact
details are available on the Hospice website, making the Hospice Management Team
accessible to everyone.
21
4.6
What Others Say About St Andrew’s Hospice
What our Staff Say
During 2013 we participated in the Help the Hospices/Birdsong Hospice Staff Survey. 88% of
St Andrew‟s Hospice workforce completed the survey with positive results. The survey
consisted of five sections covering the organisation and communication, morale and work
life balance, people management, development and reward and others aspects of working. St
Andrew‟s Hospice data was compared to the other 42 hospices that took part in the survey.
We previously participated in this survey in 2009, and a comparison was made between
these two sets of results.
In three of the five sections, the Hospice staff responded extremely positively (with a
response score of 70% or above) with the sections concerning morale and work life balance
and development and reward faring less positive (scores ranging from 60- 65%). The lower
responses related to working more than contracted hours, morale, and pay being
competitive and handled fairly. Work is now being undertaken to further understand the
responses within these two sections.
Comparing the benchmark data, St Andrew‟s fared well compared to the other 42 hospices,
with 66% of questions being answered more positively or the same as other hospices. Also
in comparison to the previous survey in 2009, there was an identified improvement in
responses to all the sections.
Levels of engagement are very important to the Hospice as a high level of staff
engagement/satisfaction results in high standards of patient care, reduced absenteeism and
organisational effectiveness.
Employees Whom Tendered
Resignation
Staff Absence (excluding
bereavement/carer leave)
4.7
2012-2013
12.6%
2013-2014
12.3%
3.03%
2.39%
What others say about St Andrew’s Hospice
Feedback from patients, family, carers and supporters:
In those first few days my daughter and my eldest granddaughter were able to come and play at
the Hospice enabling the whole family from both sides and friends to be as one. This will be an
experience that I am sure no one will ever forget. This for me was pivotal to our grieving process
and we were able to be there for our children and family, spend time grieving with [Name] but
also not feel isolated from one particular person within the family.
(Comments from Thank You cards)
Every member of staff at St Andrew's are super hero's 365 days a year :)
(Post for Superhero Friday on Facebook page) 22
“Dear all, just a note to thank you all for the care you gave [Name] whenever she came in for
respite or her Thursday bath and she loved her back massages so very much, even the meals
that were so cleverly liquidised for her. I am so pleased that so many people have donated
money to the Hospice in [Name’s] memory – she would have been so proud. Thank you all
[Name]”.
(Comments from Thank You cards)
Recommendations 5* Such wonderful caring staff and a peaceful caring environment. My
stepdad has a beautiful room looking out onto a lovely garden. Thank you so much to all the
staff.
(Post on Facebook page)
St Andrew‟s Hospice values the feedback it receives from patients, their families and carers,
as this is an important way in which the organisation can identify issues, resolve problems
and improve the quality of the care we provide.
Feedback is received by questionnaires following access to services, complaints, letters of
thanks, feedback books within clinical areas, social media postings and verbal conversations.
Bereavement support is offered to people who have accessed services from the Hospice.
Views are sought from those whom access bereavement support on the care and services
received by people in the last months of life. It also looks at the care the Hospice provided
to family and friends. Results from the survey undertaken in 2012/13 indicate that
satisfaction levels across both aspects of care and support provided to patients and their
families/carers are high and that Hospice services are meeting patient/carer need. 83% of
patients had benefitted from attending Day Unit with 85% of patients coming to the Hospice
prior to death. Those who came prior to death were very satisfied (95%) with the help
available to meet the patients‟ personal care needs.
We also believe that it is important to include patients/families and carers in the
development of services at the Hospice and therefore hold meetings 3 times per year with
them to elicit views. Patients and families have been involved in shaping a national initiative
to inform work being undertaken by Help the Hospices to define quality in hospice care.
Involvement will continue to inform further development of the initiative thus supporting
the potential for future development of quality indicators and outcomes. These will enable
hospices to evidence their contribution to end of life care and support others by leading and
influencing quality of care.
St Andrews Hospice participated in a national patient survey during 2012/13 which looked
at the provision of day care and in patient services. This survey is compliant with Essential
Standards of Quality and Safety – Outcome 1 (Care Quality Commission March 2010). The
results of the survey were positive. Areas addressed within the survey looked at a number
of satisfaction levels linked to the provision of information, staff attitudes, involvement in
care and planning, confidence in staff, privacy and courtesy, catering and hygiene and
23
awareness of how to make a complaint. Participation in this survey enables comparison
with others to take place. Some of the key results emerging from the report highlight that
satisfaction with hospice services see the highest satisfaction rating at (90% or more) for
being treated with respect and dignity, with regard to privacy, and confidence in staff. Areas
with almost as high levels of satisfaction (80% or more) were quality of information and
cleanliness of hospices.
In December 2013 the Board of Directors undertook an unannounced visit. Two members
of the Board and a Lay Member spent a day at the Hospice partaking in conversations with
patients, a parent, staff and volunteers to find out details, and matters relevant to the
workings of the Hospice for the benefit of patient care and, alongside it, the development
and professional considerations of the staff. The feedback received was very positive, with
emphasis often relating to maintaining the high standards of care delivered. There was
nothing but praise received from the patients and parent interviews, with comments
received relating to the warmth of the welcome always given and compliments about the
level of care and consideration from all members of the care teams. It was also evident
that every staff member and volunteer felt valued by the organisation, identifying the levels
of support and training as being important. One aspect highlighted to the Senior
Management Team was the importance of communication, ensuring the current practice of
including and involving everyone at all levels continues, while always looking for ways to
improve.
Part 5:
5.1
Supporting Statements
Statement from North East Lincolnshire Clinical Commissioning Group
St Andrews Hospice, as a key partner in the delivery of the local End of Life Care strategy,
has demonstrated great commitment in developing a joint working arrangement with the
community provider in order to develop a hub of excellence for the delivery of Palliative
and End of Life Care. Working cohesively it supports the continued evolution of services to
ensure the needs of the local population are met. As an active member of the Locality End
of Life Care Board and Provider Network, it ensures the development of services in line
with patient and family centred values, offering choice and promoting high quality care for
all.
In 2013/2014 St Andrews hospice have been instrumental in the success of improved care
and associated outcomes for people living in North East Lincolnshire who have a life limiting
condition.
5.2
Statement from Health and Wellbeing Board
No statement was received following request.
24
5.3
Statement from St Andrew’s Hospice Patient Representatives
The identified priorities for 2014-2015 have been discussed with a representation of
patients attending St Andrew‟s Hospice. Unfortunately these were not able to go to the
TREE group (patient representation group) due to this group only meeting three times per
year. Therefore all patients attending Day Therapy sessions were given the opportunity to
comment, with a total of 23 patients being involved.
All patients agreed with the identified priorities and there was a lot of discussion around
how they all interlinked to underpin the wider development of the partnership working.
There was an interest in the changes to Day Therapy and also the delivery of home care.
They were very excited about an increase in medical hours, very much wanting medical
input via Day Therapy.
25