Quality Account 2013/14
A report detailing the quality of health care services
provided by St Ann’s Hospice, Manchester
Registered charity number 258085
Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
1
Chief Executive Statement
As Chief Executive of St Ann’s Hospice I am pleased to set out our performance for
2013/14 in our Quality Account. This report is written to provide assurance to a wide
range of stakeholders that the purpose and focus for St Ann’s is:“To provide excellent care and support to people living with or
affected by life-limiting illness.”
The reporting period of 2013/14 reflects the second year of our three year strategic
plan and it is heartening to see how much has been achieved.
The report details a diverse range of measures that we use and continue to develop
to assess the quality and effectiveness of our clinical services. The quantitative data
we report on is strongly underpinned and positively endorsed by the wonderful
comments we receive from patients and families.
There has been a strong focus in the last 12 months on developing partnerships and
working collaboratively to ensure patients and families receive the best care and
services available. This is evidenced in the report through our work with
commissioners, Macmillan, The Myriad Foundation and many others.
The last year has once again seen thorough inspections of our three sites by the
Care Quality Commission. The standards measured were different at each site and I
am pleased to say we met them all and are therefore fully compliant.
However, at St Ann’s one of our strategic goals is “striving to be the best at what we
do” and therefore it is testament to the staff that we also met all our quality
improvement goals and have agreed further ambitious targets for 2014/15.
I am pleased to confirm that the Board of Directors has reviewed the 2013/14 Quality
Account and that it is a true and accurate reflection of our performance.
Jayne Bessant
Chief Executive
Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
2
How we serve Greater Manchester
Who do we care for? St Ann’s Hospice cares for around 3,000 patients (over
the age of 16) and their families and carers every year who are affected by
cancer and non-cancer life limiting illnesses. We deliver care that is special
and unique to each individual person. Around a third of inpatients at St Ann’s
Hospice return home after treatment.
Where do we care? St Ann’s Hospice provides care on 3 sites and in
people’s own homes, working in partnership with acute hospitals, community
services, local authority and social care providers and voluntary organisations.
Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
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St Ann’s Purpose & Strategic Goals
Purpose
To provide excellent care and support to people living with or affected by lifelimiting illnesses.
Core Values

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
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Compassionate
Providing a safe, secure and a caring environment for everyone.
Professional
Aspiring to be the best in everything that we do.
Respectful
Treating everyone with dignity and respect.
Inclusive
Recognising and accepting that everyone is different.
This year’s progress against our Strategic Goals
1.
Putting patients and their carers first
 St Ann’s has continued to work together with its local Clinical
Commissioning Groups (CCGs) to develop monitoring tools that
assess the quality and impact of services in terms of outcomes
and efficiency. These measures demonstrate the importance
and need for our services with our commissioners, healthcare
practitioners and user groups. This year St Ann’s has initiated
reporting on advanced care planning on discharge, the Family
and Friends test and an electronic palliative care coordination
system. Monitoring delayed discharge of patients into the
community also continues from last year. It is hoped that these
will help us and our commissioners to understand and develop
our services.
 Over the last year St Ann’s has worked hard to ensure that it
achieved level two compliance for its organisational processes
for Information Governance in March 2014. This will now allow
St Ann’s to link in to local NHS Trust patient databases
facilitating continuity of care for patients.
Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
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2.
Supporting and empowering our staff and volunteers
 In response to the recent national Francis report into the quality
of care provided at Mid-Staffordshire NHS Trust and it’s wider
recommendations, one initiative St Ann’s has developed is a
training programme on the delivery of compassionate care for its
health care assistant staff. The certificate in compassionate care
offers non registered staff the opportunity to learn more about
fundamental care principles over 6 half day sessions. Modules
include, communication, practical skills, symptom control,
advance care planning, and understanding more about a range
of life limiting illnesses. This certificate has been added to the
education programme and recruitment is underway.
 Our workforce has developed significantly over the last year with
the embedding into role of our newly qualified Assistant
Practitioners. The addition of the new role will help to ensure
that the clinical team has a skill mix that deliver the appropriate
level of care to its patents and carers.
 St Ann’s Lecturer-Practitioner has recently been supported by
the organisation to complete a staff coaching certificate. She will
now train a group of senior staff to deliver quarterly solution
focused group coaching sessions to non-registered clinical staff.
Within sessions non registered staff will consider issues that
impact upon their role, exploring practical solutions to these
issues. This opportunity offers time for reflection not currently
available to non-registered clinical staff. The training of
nominated facilitators will be offered over the summer with the
first groups being offered towards the end of 2014.
3.
Strengthening our foundations as a charitable organisation
 St Ann’s continues to invest in its fundraising team, with the
appointment of a number of new posts, hoping to maximise both
its engagement and return from its supporters across
Manchester.
 We are continuing to work collaboratively with Macmillan Cancer
Support who are currently investing in improving patient cancer
care pathways across the south, central and north Manchester
localities. Recently, St Ann’s in partnership with the University of
Manchester has been commissioned to deliver a workforce skills
evaluation as part of the improvement programme. The
evaluation will identify skills gaps that exist in the current
community workforce and provide recommendations for
addressing these in the near future to improve the care and
support of cancer patients and their families across Manchester.
4.
Engaging with our Communities
 This last year has seen the initiation of a partnership between St
Ann’s and the Myriad Foundation. Volunteers from the Myriad
Foundation, which is represented across Manchester, have
been trained by MacMillan Cancer Support to deliver a new role
as ‘My Cancer Buddy’. It is hoped that such roles will provide
Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
5


additional informal and much needed support to patients who
attend St Ann’s services.
St Ann’s has expanded its work with care homes across
Manchester and Trafford, delivering the ‘6 Steps’ programme,
empowering care homes to provide effective palliative care for
their residents, often fulfilling their wishes for preferred place of
care.
This last year has also seen St Ann’s trialling new ways of
gaining user views by using ‘real time surveys’. Patients who
have been cared for within our inpatient units have been
interviewed during their stay by volunteers, gaining their views
on their satisfaction with both the care they are receiving and the
ward environment.
5.
Looking Forward
St Ann’s increasingly adapts to the localities changing healthcare
economy, reviewing service provision to ensure that we remain a
leader in the delivery of specialist palliative care across Greater
Manchester. We will develop priorities which:
 Maximise our effectiveness by delivering care to the right
patients at the right time, in the in the right setting, to best meet
both their and their families needs.
 Improve patient, family and community engagement and
experience of our services, particularly with hard to reach
cultural and social groups.
 Ensure the continued safe delivery of care to our patients, by
minimising the risk of avoidable harm through improvements in
the monitoring of medicines management, patient falls and
development of pressure ulcers.
6.
Striving to be the best at what we do
 St Ann’s continues to work hard to ensure that the services we
provide continue to improve, delivering high quality. Work
streams are prioritised by organisational need such as training
and education, clinical audit, evaluation, documentation
development, effective governance meetings and engagement
with many service providers across the locality. This ensures
that we continue to strive to do the best for our service users, be
they patients, carers or professionals.
 From our most recent Care Quality Commission (CQC)
inspections, we continue to be fully compliant in all categories.
 This is the now the third year that we are publishing an account
of our service quality –‘Quality Accounts’, which is available on
the NHS Choices website and on our St Ann’s Hospice website.
 We continue to proactively develop our clinical data reporting
dashboards. These dashboards will provide St Ann’s with
detailed information with which it can interrogate, challenge and
develop its own practice. The dashboards also provide a
platform for systematic reporting to our local clinical
commissioning groups, improving monitoring and enhancing
wider understanding of our services.
Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
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Review of services
During 2013/14 St Ann’s Hospice provided the following services to palliative
care patients and their carers and families from across Greater Manchester.
St Ann’s services encompass the localities of Salford, Trafford, Manchester
and Stockport, a total population of approximately 1.2 million people. Our
services are based on 3 sites, St Ann’s Hospice Heald Green, St Ann’s
Hospice Little Hulton and the Neil Cliffe Centre (based within the grounds of
South Manchester University Hospital, Wythenshawe):
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




In-Patient Units
Daycare Services
Supportive and medical outpatient Services
Hospice at Home
Community Palliative Care Nurse Specialist Service
24 Hour Advice Line
Complementary therapy services, including an outreach service
St Ann’s Hospice has reviewed all the data available to us on the quality of
care in all of these services. The income generated by the NHS represented
34% of the total income required to provide the services which were delivered
by St Ann’s Hospice in the reporting period of 2013/14.
Quality improvement and innovation goals with our
commissioners
St Ann’s works closely with its local NHS clinical commissioning consortium.
Each service provided has agreed annual quality performance measures.
St Ann’s NHS quality improvement and innovation goals through the
Commissioning for Quality and Innovation payment framework for April 2013
to March 2014 were to:
Electronic Palliative Care Coordination Systems (EPaCCS):
 Throughout the last year EPaCCS has continued to be implemented
across all NHS health care localities in England. The goal of EPaCCS
is to improve the sharing of information between clinical professionals
on their patients when relevant. It is envisaged that this will enhance
the communication and continuity of care that patients with supportive
and palliative care needs receive. While St Ann’s is still awaiting it’s link
into locality NHS information technology (IT) systems, it has mirrored
the EPaCCS systems provided by its locality NHS providers and
shares information as required. St Ann’s will be fully integrated into
locality EPaCCS once full IT connectivity is achieved later in 2014.
Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
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Friends and Family Test:
 The Friends and Family test is now widely used across the NHS
healthcare economy. St Ann’s has achieved its CQUIN target of
implementing the Friends and Family test questions within its inpatient
units. Over the survey period from October 2013 to March 2014, almost
all respondents (86 to 100%) were extremely likely to recommend St
Ann’s to their family and friends.
CQUINS for 2014/15:
For 2014/15 we have agreed the following CQUINs with our commissioners.
There are 3 in total and reflect both the national CQUIN agenda and that of
Greater Manchester:

The Friends and Family Test, implemented throughout NHS England
in 2013, will continue in St Ann’s inpatient units. For 2014/15 it will now
also be rolled out to other St Ann’s services including outpatients and
day therapy. We will also participate in the staff friends and family test
which includes 2 questions; first would they recommend the services to
friends and family and secondly would they recommend the
organisation as a place to work.

Implement the Patient Safety Thermometer to measure and reduce
harm from pressure ulcers: In 2014/5 St Ann’s will continue to record,
investigate and report on new Pressure Ulcers (acquired 72 hours after
admission) of grade 2 and above. Reports will be provided to
commissioners each quarter. St Ann's will also participate in the
Stockport locality Pressure Ulcer Working Group.

Survey in real time of patient's experience and expectations of St
Ann's Hospice care. The survey will be based on the Better Care
philosophy using 3 questions: What worked well, what didn’t work well
and what would you like to see in the Future. The survey will also
include a question to identify as to whether St Ann’s patients are aware
of how they can make a complaint. A full report will be provided to the
Commissioner each quarter.
What others say about us
Care Quality Commission (CQC)
St Ann’s Hospice is required to register with CQC. The CQC has the power to
take enforcement action against health care providers if required and can
implement special reviews or investigations.
The last on-site inspections were on 10th December 2013 for our Little Hulton
site and 23rd September 2013 for our Heald Green and 19th September 2013
for our Neil Cliffe Centre. As for previous years, all three sites were assessed
as fully compliant.
Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
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Patient Led Assessments of the Care Environment (PLACE)
PLACE puts patient assessors at the centre of the assessment process, and
use the information gleaned directly from patient views to report how well a
hospital or hospice is performing in the areas of privacy and dignity,
cleanliness, food and general building maintenance. It focuses entirely on the
care environment and does not cover clinical care provision or staff
behaviours.
Our last PLACE assessments were carried out in March and April 2014, the
results for which will be available later in 2014.
Our previous assessments were held in October 2013:
St Ann’s Hospice’s Heald Green and Little Hulton sites were assessed, and
both scored above average in every category, with cleanliness at Little Hulton
scoring 100%.
Rachel McMillan, Director of Clinical Services, says “PLACE is an invaluable
tool as it helps us to benchmark against other healthcare providers and
enables us to share best practice. I’m delighted that we’ve scored well above
the national average, which is a testament to all the hard work of our staff and
volunteers in ensuring that we strive to deliver the very best possible care for
our patients and their families.”
PLACE Assessment Findings October 2013
St Ann’s
St Ann’s
National Average
Heald Green
Little Hulton
Cleanliness
99.4%
100%
88.7%
90.1%
92.0%
Privacy, Dignity
and Wellbeing
88.9%
94.3%
97.4%
Food and
Hydration
85.0%
95.9%
96.7
Condition,
Appearance and
Maintenance
95.7%
Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
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Data quality
In agreement with the Department of Health, St Ann’s Hospice submits a
National Minimum Dataset (MDS) to the National Council for Palliative Care.
St Ann’s Hospice also provided the MDS to our local Clinical Commissioning
Group across Salford, Trafford, Stockport and Manchester (previously the
Primary Care Trust Consortia).
NHS Number and General Medical Code Validity
St Ann’s Hospice was not required to and 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.
Information Governance Attainment Levels
During 2013-2014 St. Ann’s has
continued to work in partnership with
Dilys Jones Associates to progress
towards achieving compliance with
level II information governance
requirements. This has now been
achieved in March 2014. This gives
St. Ann’s assurance that it’s systems
for managing its clinical and
corporate information are effective
and secure. St. Ann’s is now in the
process of linking into local NHS
Hospital Trust information systems to
improve the continuity of care that we can provide to our patients when they
transfer between St. Ann’s and NHS services. It is hoped that full connectivity
to local NHS information technology systems will be achieved in 2014.
Clinical coding Error Rate
St Ann’s Hospice was not subject to the Payment by Results clinical coding
audit during 2012/13 by the Audit Commission.
Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
10
Prior to publication, St. Ann’s Quality Account has been shared with our lead
locality service commissioner, Healthwatch Stockport and our local Health and
Wellbeing Overview and Scrutiny Committee.
Feedback has been received from both Stockport Clinical Commissioning
Group and Healthwatch Stockport:
NHS Stockport Clinical Commissioning Group:
‘It appears an extremely comprehensive report and I have nothing to add. It
just serves to confirm to me the excellent care that St Ann’s provides.’
Dr Karen McEwan,
Macmillan GP Cancer Care Commissioning Lead,
NHS Stockport Clinical Commissioning Group.
Healthwatch Stockport:
Healthwatch Stockport commends St Ann’s Hospice on the many areas
where, through hard work and dedication quality improvements have been
demonstrated.
Healthwatch Stockport suggest that the following information is included within
next year’s Quality Account report:
 Figures on enhanced training for non-registered clinical staff.
 Identification of skill gaps in the community.
 How improvements in engagement with hard to reach cultural and
social groups is progressing.
 Details of in-house therapies.
The full Healthwatch Stockport report has been included at the end of this
Quality Account report (Appendix A).
Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
11
CLINICAL EFFECTIVENESS
The following pages give an overview of the quality of the clinical services
provided by St Ann’s Hospice and how we strive to improve the quality of care
delivered to our patients, families and carers.
Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
12
Comparison with national quality
measures
The National Council for Palliative Care produces an annual report called the
‘National Minimum Dataset for Palliative Care’.
The most recent report produced by the National Council covers the period 1st
April 2012 to 31st March 2013, and compares St Ann’s Hospice with the
national median values (the middle values) for all hospice services of
comparable size from across the UK. St Ann’s Hospice currently has 45 beds
and is one of the largest hospices in the UK.
The National Council For Palliative Care: Minimum Data Sets
For Palliative Care 2011-2012
SAH
09 - 10
SAH
10-11
SAH
11-12
SAH
12-13
National
Median
2012 -2013
In-Patient Unit
(N=43)
Total patients
713
658
637
608
371
% New patients
91.9
91.3
91.4
90.8
88.3
% bed Occupancy
82.7
78.0
84.4
79.1
79.1
% Patient stays
64.2
67.9
68.1
64.9
57.3
ending in death
% Patients
35.8
32.1
31.9
35.1
42.7
discharged
Average length of
17.0
17.0
19.1
19.5
14.7
stay- cancer
Average length of
15.0
17.1
20.2
17.3
13.2
stay- non-cancer
% New patients with
6.4
8.0
6.2
9.6
11.5
non-cancer diagnosis
Commentary:
The total number of inpatients admitted decreased slightly in 2012-13, confirming a
trend observed over the last four years of reporting (a 15% decrease overall). Other
parameters remain comparable.
Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
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SAH
09 - 10
SAH
10-11
SAH
11-12
SAH
12-13
National
Median
2012 -2013
Day Hospice
(n=48)
Total patients
400
395
400
423
228
% New patients
77.8
78.0
78.0
76.6
65.6
% Places used
48.1
51.0
51.6
54.9
58.1
Discharges (and
357
355
356
382
198
deaths)
Average length of
68.0
66.0
69.8
63.0
146.2
attendances (days)
Commentary:
The total number of patients attending day care increased slightly in this last
reporting period, including a slight increase in the percentage of places used.
Further work continues into 2014 to address the number of unused places.
SAH
SAH
SAH
SAH
National
09 - 10
10-11
11-12
12-13
Median
2012 -2013
Outpatients
All clients
% New clients
% New patients with a
non-cancer diagnosis
Attendances per
patient
Attendances per clinic
% attendances with a
Medical Consultant
1,265
40.3
28.0
1,165
38.8
30.5
1,074
44.2
32.8
1,069
43.5
25.6
(n=50)
531
39.9
14.9
2.6
2.8
2.9
3.4
1.9
1.6
11.5
1.6
9.4
1.5
8.5
1.5
10.8
3.2
10.8
Commentary:
The service continues to provide a valuable service to patients and carers who are
community based. It is envisaged that this service will develop over the next 12-24
months, in order to engage a larger number of patients and their carers with
palliative care needs from across our local communities.
SAH
SAH
SAH
SAH
National
09 - 10
10-11
11-12
12-13
Median
2012 -2013
Hospice at Home
(n=16)
Total patients
196
236
253
251
231
% New patients
93.4
89.4
87.4
90.4
90.5
% New patients with a
8.2
12.3
13.6
18.9
16.7
non-cancer diagnosis
% home and care
80.8
78.6
71.4
72.0
80.7
home deaths
Average length of care
19.6
22.3
31.7
21.6
25.5
(days)
Commentary:
The proportion of non-cancer patients has more than doubled over the last for years
of reporting, indicating a widening in the accessibility of the Hospice at Home
Service. However, the overall number of patients accessing remains comparable.
Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
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SAH
09 - 10
Community Specialist
Palliative CareTeam
(CSPCT)
Total patients
% New patients
% New patients with a
non-cancer diagnosis
Average length of care
(days)
Face to face visits per
patient
Telephone contacts
per patient
Telephone calls to
patients (average per
patient) (new for 12-13)
Telephone calls to
carers (average per
patient) (new for 12-13)
Telephone calls to
other health care
professionals
(average per patient)
SAH
10-11
SAH
11-12
SAH
12-13
National
Median
2012 -2013
(n=12)
489
76.9
14.4
627
76.7
12.9
634
71.6
15.0
584
75.9
15.1
368
74.7
15.0
56.6
53.3
53.9
49.1
74.0
2.8
3.3
3.0
2.8
4.1
4.8
4.4
No longer
reported
(4.4 in 11-12)
3.8
n/a
n/a
n/a
n/a
4.0
2.5
n/a
n/a
n/a
2.7
0.8
n/a
n/a
n/a
5.9
1.2
(new for 12-13)
Commentary:
St Ann’s CSPCT team have less face to face contact with their patient group in
comparison to the national average. However, telephone contact with carers and
other health care professionals is markedly greater. This may be a reflection of the
increased emphasis from the CSPCT team towards a coordination of care role
across their Salford locality. Next year’s report may reflect this change further
having implemented an urgent response service during 2013/14.
SAH
SAH
SAH
SAH
National
09 - 10
10-11
11-12
12-13
Median
2012 -2013
Bereavement Support
(n=41)
Total clients
94
149
153
150
184
% New service users
74.5
68.5
68.6
68.7
74.2
Contacts per service
7.6
6.9
7.1
6.5
n/a
user
Average length of
126.0
172.6
172.4
140.0
137.0
support (days)
% Discharged
50.0
65.8
69.3
65.6
57.3
Commentary:
The average length of support has decreased in 2012-13 compared to previous. A
higher proportion of clients are discharged per year in comparison to the national
median.
Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
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Liverpool Care Pathway
Inpatient Use of the Liverpool Care Pathway
Jan – Dec Jan – Dec April 2011 April 2012
2009
2010
– March
– March
2012
2013
Total
number of
inpatient
deaths
Inpatients
placed on
LCP
Inpatients
not placed
on LCP
April
2013 –
March
2014
483
507
460
440
446
425
(88%)
444
(88%)
414
(90%)
392
(89%)
336
(75%)
58 (12%)
63 (12%)
46 (10%)
48 (11%)
110
(25%)
The Liverpool Care Pathway (LCP) documentation, has been used over the
last decade by most UK based hospices, to outline the plan of care when a
patient’s condition changes and indicates to the inpatient ward team that the
patient is dying.
In comparison to recent years, the proportion of inpatients where the LCP has
been used as a plan of care has dipped markedly over the 2013-2014
reporting period. This is likely due to the recent controversy surrounding the
use of the LCP in the UK. In response to national recommendations from the
‘Leadership Alliance for the Care of the Dying People, NHS England’, use of
the LCP is to be phased out across England by July 2014 and replaced by an
‘individual plan of care guideline’ for each patient. Future monitoring and audit
of the new guidelines are envisaged.
Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
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Clinical audit activity
Quarterly meetings chaired by our lead for quality and audit with clinical and
medical representation from all service areas are held 3 monthly. A rolling
plan for clinical audit is agreed and reviewed.
Along with internally agreed audits, St Ann’s continues to participate in the
North West Regional Audit Group (NWAG) audit programme.
The following is the clinical audit activity from 2013/14:
TOPIC
Administration of Medicines
Prescribing of Medicines
Reaudit of LCP for the Dying
STATUS
A regular audit conducted by the
Practice Development Facilitators with a
ward nurse. Progress on the agreed
action plan from the last audit in July
2013 is facilitated through the clinical
chart meeting.
Audit conducted by pharmacists 3 times
each year and results fed back to all
doctors
Final report with action plan circulated
and posted on the intranet.
Low molecular weight Heparin
Audit
Final report with action plan circulated
and posted on the intranet.
Week 1 assessment
Documentation Audit
Final report with action plan circulated
and posted on the intranet
Reaudit of use of fentanyl and
opioids at the end of life (NWAG)
Final report with action plan circulated
and posted on the intranet.
Reaudit of antibiotic use
Final report with action plan circulated
and posted on the intranet.
NWAG Reaudit of Nausea and
Vomiting
Final report with action plan being
agreed
Complementary Therapy
Documentation
Sensory Impairment Assessment
on admission
Audit commenced
Report and action plan being compiled
following organisational presentation of
findings
Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
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St Ann’s is participating in the Personal Excellence Pathway (PEP) scheme
for medical students and which includes their involvement in audit activity
which was well evaluated by the students involved.
We are planning to introduce the following:
 Monthly ongoing audit of Antibiotic prescribing
 Monthly ongoing Medicines Safety Thermometer Audits
St Ann’s contributed to the NWAG Audit Conference held on 14th February
2014 and the CSPCT Urgent response Audit was awarded 2 nd prize in the
poster submissions.
Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
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Spotlight on Audit
Specialist palliative care nurse independent
prescribing in the community
-an audit of practice
The St Ann’s Community specialist palliative care team (CSPCT) provides advice
and support to patients and carers when there are unresolved symptoms and
complex psychosocial issues for patients with advanced disease.
An audit was carried out to assess the current prescribing practice of the clinical
nurse specialists within the CSPCT. Fifteen prescriptions from each of the 4 nurse
independent prescribers were audited for quality and relevance. A total of 86 items
were prescribed.
When the quality of prescription writing and documentation was assessed, all
standards achieved 100% compliance excepting the letter sent to the patient’s GP
detailing the prescription. Only 67% were faxed within 24 hour standard set.
Medicines most commonly prescribed by the team were analgesics (50%) followed
by anticipatory medicines for the care of the dying. The CSPCT case load focuses on
managing patients with complex pain and symptoms towards end of life, with
medicines prescribed demonstrating this.
The full results of the audit and action plan were presented to the joint Salford
Palliative Care multi-disciplinary team meeting and at a local palliative care
conference where it promoted discussion challenging the nurse prescribing role in
the community.
The audit provided evidence of robust and quality prescribing by the CSPCT team,
demonstrating effective and timely prescribing for patients in Salford struggling with
complex pain and symptom control issues, as recommended by the NICE guidance
for palliative and supportive care (2004).
Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
19
24 Hour Advice Line
The Hospice’s 24 hour advice line provides telephone support for both health
care professionals and patients and their carers from across Manchester
(Salford, Trafford, Manchester and Stockport).
Calls to the Hospice 24 Hour Advice Line Service
24 HR ADVICE
LINE CALLS
Total number of
calls received
Source of calls
Health care
professionals
Patients and
carers
Other (including
unknown)
2009 –
2010
2010 –
2011
April
2011 –
March
2012
April
2012 –
March
2013
April
2013 –
March
2014
724
704
698
690
717
364
349
372
341
372
306
297
272
303
290
54
58
54
46
55
Reason for call
(more than 1
reason can be
recorded)
Pain control
200
223
210
220
227
Symptom control
259
270
307
265
273
(excluding pain)
Service and
138
87
96
81
108
referral
information
Non clinical
36
36
33
30
20
Other*
134
147
149
173
168
* Includes carer support, (e.g. advice/reassurance, support re. Liverpool Care
Pathway) and information regarding external health care professionals and
equipment loans
The total number of calls has slightly increased from the previous year, with
more calls from health care professionals observed. Types of calls remain
comparable to previous years, with the majority requesting advice on both a
patients’ pain and symptom control. Over thirteen calls are received each
week, 40% of which are from patients and carers. Advice given may help
patients to avoid unnecessary crises referral to hospital, and has the potential
to enable patients to stay in their home.
Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
20
Education
The palliative care education team provide specialist training and
development to staff working for the hospice organisation and for hospital and
community colleagues wishing to increase their confidence and expertise in a
range of issues relevant to palliative care.
Shared learning
Through the palliative care education programme staff from differing
specialities and care environments are offered the opportunity to explore
relevant topics together and to learn from each other. Study sessions
available are advertised through a monthly palliative care education summary
and also are available for those outside the organisation to book through the
St Ann’s Hospice website. Most study sessions are offered twice in the year
once at either hospice site.
Study sessions offered in 2013;
 Enhanced communication skills training (2 days)
 Understanding Cancer for Clinical staff (2 days)
 Understanding Cancer for non-clinical staff
 Advanced Heart failure; supporting the person and their family
 Advanced Liver Disease; supporting the person and their family
 Advanced Renal Failure; supporting the person and their family
 Non Invasive Ventilation in palliative care update
 Advanced COPD; supporting the person and their family
 Exploring spirituality workshop
 Dementia update provided by Dementia specialist practitioner
 Student Nurse Information afternoons
 Introduction to point of care ultrasound (palliative care consultant led)
 Reiki (Introductory course)
 Reiki (Intermediate course)
 Breathlessness management workshop (2 days)
 Palliative Care Emergencies
Commissioned courses
The palliative care education team continue to offer training and development
to community colleagues in partnership with the Macmillan Service and local
End of Life facilitators.
6 Steps to Success Manchester and Trafford
The palliative care education team continue to provide workshops and support
for the yearlong end of life change management programme called the 6
Steps to Success End of Life programme.
The Manchester Education has been provided since 2011 and enables care
and nursing homes to establish high quality systems to ensure the resident is
Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
21
afforded choice, advance care planning, comfort and an opportunity to die in
their preferred place which is usually the care establishment.
Trafford End of Life facilitation project
As part of the 6 steps education provision to care and nursing homes in
Trafford both the education and home facilitation visits are being undertaken
by the hospice palliative care education team. Uptake of the programme by
the homes continues to be buoyant with almost all the Trafford homes being
recruited onto the programme and achieving excellent results re developing
palliative care systems and developing their palliative care knowledge.
Domiciliary care programme
Working with Stockport Adult Social Care and the Stockport Macmillan
Palliative Care Team 2 day “Comfort and Care at the End of Life” programme
has been delivered to front line care workers across Stockport.
5 courses have been provided March 2013 to March 2014.
End of life facilitator training
The Greater Manchester Lancashire and South Cumbria Strategic Clinical
Network commissioned the palliative care education team to provide 2 end of
life role development 5 day courses. Both courses have been evaluated
excellently by the attendees and is assisting them to make real changes in
practice.
Specialist learning for hospice staff
Staff within the hospice have particular learning requirements linked to their
roles. The palliative care team organise and deliver in collaboration with the
Practice Development Facilitators specialist training to address specific
hospice learning needs which are often identified at individual performance
review.
Updates include;
Assistant Practitioner updates (Nutrition pump training, hot and cold pack
training, breathlessness management training)
Mentorship updates
Moving and handling update sessions
Advice and support for a 3 yr. clinical competency roll out working in
collaboration with the Practice Development Facilitators
Mandatory training workbooks have been completed. The overseeing and
developing of statutory and mandatory training is now being reviewed by the
non-clinical training and development manager.
Student co-ordination
The palliative education co-ordinator works with the clinical team to ensure an
effective and supportive student experience. The co-ordinator works with the
partner universities and other Practice Education facilitators. Nursing students
are allocated to St Ann’s Hospice as part of their undergraduate Bachelor in
Nursing placements. Students are allocated at all stages of their training. The
education co-coordinator works with the clinical areas to ensure a quality
learning environment awaits the student on arrival. This year the education
Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
22
co-ordinator has refined the student welcome pack in line with national
requirements. All students have detailed information prior to their placements.
Mentorship registers are maintained and mentorship updates provided for
staff in collaboration with the university link tutors. Feedback has been
particularly positive about the quality of the learning experience at St Ann’s
Hospice.
The education co-ordinator also supports and administers clinical placement
for other staff such as, art therapy students, occupational therapy students,
physiotherapy students and counselling students.
Transform programme
Working in collaboration with the Pennine Acute End of Life Facilitators and
North Manchester Macmillan Service the palliative care education team has
co-ordinated a placement of senior clinical staff from the acute sector to
experience the hospice clinical environment. This rotation will take place at
Little Hulton in June 2014.
Central Manchester and hospice renal exchange programme
This programme has continued to increase in popularity and develop.
Currently plans are being finalised to extend the exchange to other wards in
the medical directorate at Central Manchester. In patient units specialising in
gastroenterology, respiratory, haematology, are now wishing to welcome
hospice staff who wish to shadow their work. Hospice staff at Heald Green will
be offering a 3 day placement to staff across the directorate in an innovative
skills exchange in return.
Library facility
All staff can access journals via Athens and books from the library facilities at
Heald Green, Little Hulton and Neil Cliffe Centre. The content of the library
has been upgraded and staff recommendations for new books have been
incorporated.
External education
The education team administer and co-ordinate applications for external
training to support the development of clinical staff across the organisation.
Monthly summaries of expenditure and course information internal and
external is provided to managers. Booking and liaison with other course
providers is undertaken and recorded by the education co-ordinator.
Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
23
Research & Evaluation
Workforce Modelling in UK Hospices
The project, led by St Ann’s has continued its activity throughout the last year
and has now provided staffing recommendations to an additional four adult
hospice units, totalling forty eight from across the UK.
During 2013-2014, St Ann’s has developed the project into a new care sector,
working collaboratively with six children’s hospices from across England. Dr
Dai Roberts, Lead for Research & Development for St Ann’s and Dr Keith
Hurst, Independent Workforce Analyst has worked in collaboration with the
clinical leads for the six children’s hospices to produce an adapted evaluation
tool applicable to the children’s sector. As with the adult hospice project, child
dependency, nursing activity and workload and ward occupancy data is used
to produce evidence based recommendations for optimal nursing staffing to
ensure cost effective and high quality care is delivered.
This work continues into 2014 with the addition of more children’s hospice
units. A primary outcome for the project will be the generation of a new
benchmark workforce dataset applicable to the children’s hospice sector.
Carer Needs Assessment Tool
The Carer Support Needs Assessment Tool (CSNAT) is an evidence based
tool developed with the help of family carers to aid the assessment of carers'
support needs when caring for a relative or friend at home towards the end of
life. It has been designed as an approach to opening up discussions with
carers about their support needs. The project is led by Professor Gunn
Grande from the University of Manchester and Dr Gail Ewing form the
University of Cambridge.
The Carer Assessment Study will evaluate the implementation of the Carer
Support Needs Assessment Tool (CSNAT) in practice.
As part of the study, St Ann’s Hospice at Home service, is trialling the use of
the CSNAT with all main carers of patients who are cared for at home by the
St Ann’s service. It is hoped that CSNAT will help to identify carers that can
either be addressed directly by the hospice at home team or referrals made
for specialist advice and support.
Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
24
St Ann’s Day Therapy and Neil Cliffe Services –
Service Review and Evaluation
Summer 2013 St Ann’s initiated a review of its Day Therapy services based at
its Heald Green hospice site and at its Neil Cliffe Centre. Subsequent to the
supportive outpatient evaluation reported in last year’s Quality Account, user
views have been gained from both services throughout early autumn 2013.
Focus groups were held with patients and carers attending daycare at Heald
Green and the Neil Cliffe Centre to gain their views on their experiences from
attending the services and also their views on the types of support and
interventions that they valued the most and would wish to see if not already
offered.
Subsequently, in early 2014 St Ann’s has employed a project manager to lead
on the review, remodelling and development of our St Ann’s day therapy and
supportive outpatient services. The reviews key aims are to expand the
opportunities available for supportive care to a wider patient group, ensuring
that St Ann’s reaches out to and meets the needs of as many supportive and
palliative care patients and their carers as is possible.
The service review will continue throughout 2014 with an anticipated
completion before March 2015.
Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
25
PATIENT SAFETY
Clinical Governance Committee
St Ann’s Hospice’s Clinical Governance Committee meets quarterly. The
committee is chaired by a hospice Trustee, with multi-disciplinary membership
from across clinical services, plus external representation from our local
Clinical Commissioning Group (CCG). The committee oversees the approval
of clinical policies and monitors the quality, safety and effectiveness of clinical
service provision via a variety of reports and data dashboards.
Incident Reporting

An organisation wide incident / near miss reporting system was
introduced in 2004 and has been reviewed 4 times in response to the
feedback from its users. A quarterly report is compiled, which focuses
on actions agreed in line with the learning culture.

The incident reporting form has been reviewed to reflect user
suggestions raised in incident training sessions

St Ann’s is participating in the Help the Hospices Benchmarking pilot
for Pressure Ulcers, Falls and Medication Incidents which was piloted
between January and March 2014 and will continue for the rest of 2014

A medicine management meeting is holding its first meeting in May
2014 and will include the discussion of all medicine related incidents
reported during the previous quarter. Attendance will include
representation from pharmacy, medicine , quality and clinical
operational managers and will also contribute to the requirements
recommended in the central alert “ improving medication error reporting
and learning “ received in March 2014.

Clinical Incidents with an external impact are now reported verbally to
the appropriate external manager within the area involved e.g. ward or
service. A copy of the quarterly summary of incidents and near misses
is also copied to the Contract Manager for the Greater Manchester
Commissioning Support Unit, for information.
Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
26
The following summarises the type and number of incident/near miss forms
received.
Total incidents &
near misses
Total Clinical
of these :
- medicine
related
- patient falls
Total Non-clinical
2010/2011
2011/2012
2012/2013
517
521
492
413
433
403
411
96
88
87
97
136
104
177
87
183
48
166
52
41
78
0
1
Total with impact on
Clinical and nonclinical services
2012/2013
541
RIDDOR reports
(Reporting of Injuries,
Diseases and
Dangerous Occurrence
Regulations)
3
6
Actions from reported incidents & near misses include:
 Mobile phone guidance produced to include protection of personal
information
 Donation policy reviewed
 Contribution to the recruitment of a pharmacy technician to support
medicine management
 Updated nurse call system for Heald Green Hospice included in the
Hospice’s Resource and Planning ‘wish list’
 Additional Hospice insurance acquired to cover staff driving vehicles
not owned by the hospice.
Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
27
Infection Control and Wound Care
Infection Control Data
TYPE OF
INFECTION
MRSA (localised
infection and
colonisation)
Clostridium difficile
toxin positive
Apr 09 –
Mar 10
Apr 10 –
Mar 11
Apr 11 –
Mar 12
Apr 12 –
Mar 13
Apr 13 –
Mar 14
5
6
7
5
2
3
1
4
2
(hospice
acquired)
2
(hospice
acquired)
1
2
(On
(on
admission) admission)
Bacteraemias
(blood stream
infections)
0
0
2
Extended
spectrum betalactamases
n/a
n/a
7
-
-
-
carbapenem
producing
coliforms and
other significant
organisms
1
(nonMRSA)
Data no
longer
recorded
0
Data no
longer
recorded
0
0
Surveillance data for the period April 2013 – March 2014:
(St Ann’s infection control reporting is informed by Public Health England).
Infection/colonisation of MRSA data is collected although not a requirement
under PHE standards. This was considered beneficial to the hospice because
not all patients are screened on admission and it gives some insight into
incidence.
Information about infections/colonisation is also obtained via referring services
(e.g. General Practitioners, Nursing Homes and Hospital Trusts), and
management strategies for these cases can then be implemented on patient
admission. This is particularly evident for cases of carbepenem producing
coliforms where our laboratory surveillance data is zero for this reporting
period but there have been several referrals and subsequent admission made
for patients known to be colonising these organisms and are able to be
managed appropriately due to the referral process. With the large increase in
extended spectrum beta-lactamase (ESBL) positive specimens, surveillance
of these organisms is no longer recorded as many have little impact on patient
management.
Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
28
The data for CDI rates reflects whether the infection originated during hospice
admission, or was evident on admission which is in line with reporting to
commissioners. All cases of bacteraemia are recorded not just those
associated with reportable organisms such as E coli and MRSA.
Wound Care Data April 2013 – March 2014
April 2011 – March
April 2012 – March
April 2013 – March
2012
2013
2014
PRESSURE
ULCERS
Grade I
Grade II
Grade III
Grade IV
Total:
WOUNDS
(not
including
pressure
ulcers)*
Present on
admission
(from
hospital/
home/
Other)
Hospice
acquired
(St Ann’s)
Present on
admission
(from
hospital/
home/
Other)
Hospice
acquired
(St Ann’s)
47
85
19
4
155
29
52
0
1
82
38
78
14
14
144
23
39
1
0
63
100
46
89
28
Present on
admission
(from
hospital/
home/
Other)
Hospice
acquired
(St Ann’s)
40
123
13
9
185
65
23
61
1
0
85
33
*Wounds as categorised include forms of wound associated with palliative
patients’ conditions and exclude pressure ulcers.
All patients on admission to our hospice receive a tissue viability risk
assessment, followed by relevant preventative measures (e.g. pressure care
mattresses). However, many patients who are cared for by St Ann’s Inpatient
wards experience deteriorating symptoms due to the progression of their
condition and poor circulation. For example, many patients are prescribed
steroid medication, which increases the risk of diabetes and pressure ulcers
thereafter. This is why in some cases, pressure ulcers can develop while a
person is under St Ann’s care, despite preventative measures being taken. In
such cases, specific management strategies are used, including the use of
care plans and dressings to minimise discomfort and maximise quality of life.
Rates for both pressure ulcers and other wounds have increased over 20132014 (approximately 30%) compared to the previous year (2012-2013).
Throughout 2013-2014, St Ann’s inpatient units have worked hard, via the
continued work of the hospice’s tissue viability link nurse group, to ensure that
reporting of pressure ulcers and wounds is consistent across its two inpatient
sites. We are now confident that this last year’s reporting figures are a true
reflection of wound care rates at St Ann’s. In 2014/15, St Ann’s will be
reviewing its policies, procedures and practices to ensure best practice is
maintained and developed in line with the patient safety thermometer being
implemented this year (page 8).
Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
29
Staff Health, Absence and Turnover
2010-2011
2011 2012
2012 2013
2013 2014
Sickness and
absence
4.6%
4.3%
5.2%
4.7%
Staff turnover
(number of
starters and
leavers)
6.4%
10.8%
7.7%
10.2%
St Ann’s sickness and absence rates in 2013/14 are comparable to previous
years. Staff turnover has increased compared to the previous year. St Ann’s
continually strives to minimise its sickness and absence levels by providing a
healthy and productive environment, including clear organisational values and
goals, within which its workforce can be supported and cared for. In 2014/15
this will be supported by a staff survey which will include staff perceptions of
working at St Ann’s.
Volunteers
The success of the organisation is supported by over 800 volunteers who
contribute over 80,000 hours in total. They are a diverse workforce who bring
new skills and experience. Examples of how our volunteers help include in our
ward areas, charity shops, reception desks, bereavement support service and
administration support.
Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
30
PATIENT EXPERIENCE
1. Comments Scheme
This scheme enables visitors, patients, volunteers and staff to make
suggestions for improvement or comments they have about our services.
The Lead for Quality and Audit is responsible for managing the scheme and
sending comments received to the appropriate manager for consideration and
a response. The responses are collated and approved at an organisational
meeting and then fedback via the hospice newsletter and website along with
organisational distributions of monthly summaries.
A total of 154 comments or suggestions were posted in 2013/2014
Actions implemented in 2013/2014 include:
 changing room door in one of our charity shops modified to improve
privacy
 System for ordering daily newspapers reintroduced
 Improved system for storage and disposal of lost property
2. Patient/Carer Group activity
The patient / Carer group meets every 2 months and has a current
membership of 10 patients and 6 carers who have all had experience with
services provided by St Ann’s Hospice.
The group continues to provide an invaluable contribution to the ongoing
development of the hospice services.
During 2013/14 their views have been sought for the following:








Complementary therapy leaflet review
Counselling Leaflet
Prayers and readings at difficult times
Ideas for assuring confidentiality of patient enquiries
Timing of the display of Christmas cards
Breathlessness leaflet
Revision of the organisational comment card
CSPCT Service user questionnaire
External Involvement
 The group were visited by a representative of the Macmillan
Manchester Cancer Improvement Programme to discuss the
opportunity for them within the user Involvement workstream.
 Macmillan End of Life Factsheet
 Name for Stockport’s Electronic Palliative Care Coordinated System
(EPaCCS) Project
Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
31

The group were visited by the Palliative Care Nurse Specialist from
Salford Royal Foundation Trust to gain their views on expectations of
end of life care and naming of future documentation following the
removal of the LCP and the development of an information leaflet
3. Friends and Family Survey (inpatient unit)
This was introduced in October 2013
Surveys handed
out Oct 2013 –
March 2014
Surveys
returned
147
86(58%)
Responses to question asking if
they would recommend the
hospice :
81/86 ( 94%) extremely likely
4/86 ( 5%) likely
1/86 ( 1%) don’t know
As part of an agreed CQUIN this survey is going to be extended to include
daycare and outpatients starting in July 2014
4. Real Time Survey
Volunteers have been conducting structured 1:1 surveys of ward patients and
visitors on topics including hospice cleanliness, staff attitudes, the
environment , privacy and dignity and information. Their feedback has been
collated and fedback through posters displayed within the Hospice and
specific comments have been processed through the comment scheme.
As part of an agreed CQUIN these interviews will be extended to daycare
attendees.
The questions are in the process of being reviewed taking into account local
issues highlighted from previous findings and incorporating the NHS ‘better
care philosophy’ questions which ask what went well, what did not go so well
and what changes patients would suggest for the future.
The overall results have been very pleasing and have also highlighted a need
to improve patient’s awareness of the bedside booklet which is currently being
addressed.
5. Help the Hospices Patient Survey
The final report was received in November 2013 with very pleasing results.
Actions agreed from the findings include the development of a complaints
leaflet and increasing activities available for ward patients to participate in,
which we hope will be achieved via the My Cancer Buddy project which is
soon to be piloted at HG.
Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
32
More information, including a poster of findings can be viewed by clicking on
the following web links:
http://www.sah.org.uk/about/results-of-patient-surveys
http://www.sah.org.uk/media/424054/day%20care_ward%20results%20poster.pdf
6. Survey of Referrers to St Ann’s Hospice Community
Specialist Palliative Care Team (CSPCT) and Hospice at Home
Service
A questionnaire was circulated using “survey monkey” to all potential referrers
to these services to gain their views and suggestions for service development.
An action plan from the respective findings is currently being agreed by the
Service Managers.
7. Day therapy Service Users at HG and NCC
Focus groups were held to gain the views of the service users as part of a
service evaluation and their views have been considered in the service
developments in the process of being agreed.
Complaints & Compliments
Complaints and Compliments Received 2009/2010 to 2012/2013
COMPLAINT /
COMPLIMENT
April 2010
– March
2011
April 2011
– March
2012
April 2012 –
March 2013
April 2013
–March
2014
Formal complaints
6
2
2
3
Informal complaints
5
3
16
7
481
467
540
*No longer
counted
Compliments (via
letters, cards,
comments cards
and emails)
*St Ann’s continues to receive a large number of compliments on the services
it provides to its patients and carers. However, St Ann’s will focus reporting on
additional quality measures introduced in 2013/14.
Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
33
Complaints:

The number of formal complaints remains low for this reporting period,
while the number of informal complaints which increased last year has
decreased again over this last year. Looking back to the 2012-2013
period, a number of informal complaints related to changing our
chapels to ‘havens’ (multi-faith areas) to encourage diversity and
inclusiveness. This theme for informal complaint has not been evident
over the last year, with the multi-faith worship spaces embedded in
practice.
Examples of compliments received:
Daycare
“The most caring and genuine people I have ever had the pleasure to meet "
“ The minister took an interest in my life outside the hospice as well as inside
and “The Haven” offered a comfortable place for anyone of any religion to
quietly spend time in
“ At certain intervals my appetite worsened, but the staff made sure a tempting
selection was available and not just at meal times but all the day period”
Inpatients
“All members of staff were angels - including housekeeping and volunteers”
“ I found St Ann’s Hospice the most caring and happy surroundings I have
ever stayed in – did not want to leave “
“I would be happy to end my days at St Ann’s when it comes because I know I
will be taken care of with dignity”
Neil Cliffe Centre
“ NCC saved my sanity “
“I was in a dark tunnel and NCC gave me a hand out of it , I became so
positive that people commented on the way I had changed.”
“I was depressed and NCC gave me a positive mindset and the motivation to
live again.”
Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
34
What our staff say about the organisation
St Ann’s Hospice engages its staff in consultation in several ways:




We hold a ‘One Organisational Group’ monthly meeting which brings
together staff from across all clinical and support services (catering,
HR, finance, fundraising, trading company) for shared learning across
the organisation.
A Staff Reps committee meets bi-monthly, representing the views of
grass roots staff from across the organisation.
Regular open meetings are held with the Executive team and all staff at
each site three times a year. These are backed up with more regular
1:1 ‘Directors surgeries’ to maximise staff consultation and
engagement. For 2014/15 these will include an informal walkabout
approach to reach more staff.
Our Chief Executive also publishes a weekly brief and staff are
encouraged to contribute with updates and key messages.
Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
35
What our regulators say about us
St Ann’s services are regularly reviewed by the Care Quality Commission
(CQC). Further information and full reports can be obtained via the following
link:
http://www.cqc.org.uk/
What the CQC icons mean
All standards were being met when we inspected the service. If this
service has not had a CQC inspection since it registered with us, our
judgement may be based on our assessment of declarations and
evidence supplied by the service.
At least one standard in this area was not being met when we inspected
the service and we required improvements.
At least one standard in this area was not being met when we inspected
the service and we have taken enforcement action.
A key aspect of the inspection process is to ask our patients their views on
their care received.
Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
36
St Ann's Hospice Heald Green
St Ann's Road North, Heald Green, Cheadle, SK8 3SZ
Date of Inspection: 23 September 2013
Date of Publication: October 2013
We inspected the following standards as part of a routine inspection. This is
what we found:
Care and welfare of people who use services
Safeguarding people who use services from abuse
Safety and suitability of premises
Staffing
Assessing and monitoring the quality of service provision
St Ann's Hospice is an independent adult hospice. The hospice is registered
for 34 inpatient beds but is currently operating on 27 beds as agreed with their
commissioners. The hospice also runs a day care centre four days a week
and an outpatient clinic twice a week. The hospice has an enclosed garden, a
coffee shop, a small number of lounges and a small multi-faith room.
Summary of the inspection:
We visited St Ann’s Hospice on 23 September 2013 at the time of our visit
there were 24 in patients. At the time of our visit the manager was
unavailable; the inspection was assisted by the Clinical director, Ward
Manager, Training Officer and the lead for quality and audit. We saw staff
caring for patients with respect and compassion. Staff were heard speaking
with patients in a calm and friendly manner. We saw appropriate policies and
procedures in place, staff we spoke with were aware of how to access them
and the correct procedures to follow. We looked at two patients’ records which
contained relevant and factual health information. Patients’ wishes and
preferences were recorded and patients were included in discussions about
their care and treatment. We spoke with three patients and ten relatives. One
patient said “This is a wonderful place; all the staff are so kind and caring I
can’t praise them enough. They make sure I am not in any pain. The food is
very good and nicely presented. ” Another patient told us “The care is
excellent, I am very comfortable.” A relative said “People worry about having
to go into a hospice but the care here is excellent, 10 out of 10. The staff have
time to talk to us and give us as much information and support we need as a
Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
37
family”. Another relative said, “The standard of care is first class”. We spoke
with four members of staff who were aware of the safeguarding procedures
and had an understanding of mental capacity issues and best interests
decision making. Staff told us they were well supported by management and
told us that there was an open door policy and everyone was approachable.
Staff meetings were held regularly, training and professional development was
on-going and annual appraisals were undertaken. Any complaints were taken
seriously and followed up appropriately we saw evidence that regular audits
were undertaken.
St Ann's Hospice Little Hulton
Peel Lane, Little Hulton, Worsley, Manchester, M28 0FE
Date of Inspection: 10 December 2013
Date of Publication: December 2013
We inspected the following standards as part of a routine inspection. This is
what we found:
Respecting and involving people who use Services
Care and welfare of people who use services
Cleanliness and infection control
Safety, availability and suitability of equipment
Assessing and monitoring the quality of service provision
St Ann's Hospice is situated in the Little Hulton area of
Salford, Greater Manchester and is registered as a charity.
The hospice provides palliative and supportive care services
to patients with life threatening illnesses. Services provided
include hospice at home, day therapy and inpatient care. An
extensive garden area is available for the benefit of patients
and visitors. Off street car parking is available and the
location is well served by public transport routes.
Summary of the inspection:
As part of our inspection we focused on the inpatient unit at St Ann's Hospice
as well as the community based services team which provided care to people
Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
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in their own homes. During our inspection, patients made positive comments
about the service they received whilst at the hospice. The people we spoke
with told us they were comfortable and their pain was well managed.
Comments included; “The hospice is fantastic. Staff help me with personal
care and keep my pain under control. The staff are brilliant and the food is
fantastic” and “I have been very well looked after since I have been here. I get
treated with respect and would definitely recommend it to other people and
their families”. We looked at how patients were involved in the care they
received and if they were treated with dignity and respect my staff. One
patient told us; “Staff treat you so well here. Thankfully I can still do things for
myself but staff recognise that and allow me to have a go on my own first”. We
spent some time speaking with the lead for infection control and found the
premises were clean, tidy and odour free. We also checked equipment was fit
for purpose and available in appropriate quantities. We found equipment had
been serviced regularly and stored safely. We found there were appropriate
systems in place to monitor the quality of service provided. This included
regular auditing and the use of patient surveys which were analysed.
Neil Cliffe Centre
Wythenshawe Hospital, Southmoor Road, Manchester,
Greater Manchester, M23 9LT
Date of Inspection: 19 September 2013
Date of Publication: October 2013
We inspected the following standards as part of a routine inspection. This is
what we found:
Consent to care and treatment
Cooperating with other providers
Requirements relating to workers
Complaints
Records
Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
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The Neil Cliffe Centre is based at University Hospital of South Manchester
and provides outpatient services to people at any stage of their illness – from
diagnosis, during treatment, post treatment, at times of reoccurrence and
onward. There is also a medical outpatient clinic held once a week at the
centre.
Summary of the inspection:
We spoke with two people on the day of inspection. Both confirmed that the
staff had explained the care and treatment options to them and staff had
asked for their consent. The people we spoke with were very complimentary
about the staff and services provided. One person said “The care is
phenomenal; I loved the place from the moment I walked in”. Another person
told us “The staff are caring, professional and very thoughtful”. The people we
spoke with confirmed that the centre had put them in touch with other services
and gave them valuable support. One person told us “I was allocated a
keyworker who devised a programme and explained everything to me”. Both
people confirmed they didn’t have any need to make any complaints and felt
the staff would accommodate any issues or concerns that may arise.
Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
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APPENDIX A
Healthwatch Stockport response to St Ann’s Hospice
Quality Account 2013/14
About Healthwatch Stockport
Healthwatch is the new independent consumer champion created to gather and
represent the views of the public, patients, relatives and carers. Healthwatch plays a
role at both national and local level and makes sure that the views of the public and
people who use services are taken into account.
Healthwatch Stockport is a membership organisation run by volunteers with an
interest in health & social care. They are supported by a team of staff to offer help to
members carrying out activity on behalf of the organisation.
Healthwatch Stockport has, amongst others, the following responsibilities;




Promote and support local people to be involved in monitoring,
commissioning and provision of local care services
Obtain local people’s views about their needs for and experience of local care
services
Tell agencies involved in the commissioning, provision and scrutiny of care
services about these views
Produce reports and make recommendations about how local health and care
services could or should be improved
Introduction
Healthwatch Stockport welcomes the opportunity to comment on this Annual Quality
Account (as seen in draft). We recognise that Quality Account reports are a useful
tool in ensuring that NHS healthcare providers are accountable to patients and the
public about the quality of service they provide. We fully support these reports as a
means for providers to review their services in an open and honest manner,
acknowledging where services are working well and where there is room for
improvement.
We share the aspiration of making the NHS more patient-focussed and placing the
patient’s experience at the heart of health and social care. An essential part of this is
making sure the collective voice of the people of Stockport is heard and given due
regard, particularly when decisions are being made about quality of care and
changes to service delivery and provision.
Our wish is therefore that Healthwatch Stockport works with its partners in the health
& social care sector to engage patients and service users effectively and to ensure
that their views are listened to and acted upon. We look forward to continuing to
work alongside St Ann’s Hospice to making sure that the voice and experience of
patients and the public form is heard throughout the provision of services.
Healthwatch Stockport commends St Ann’s Hospice on the many areas where,
through hard work and dedication quality improvements have been demonstrated.
Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
41
St Ann’s Hospice Quality Account 2013/14
The Quality Account is a very well written report, which obviously has to follow a
prescribed format. In the future Healthwatch Stockport would like to see a bit more
information on:

Figures on enhanced training for non-registered clinical staff.

Identification of skill gaps in the community.

How improvements in engagement with hard to reach cultural and social
groups is progressing.

Details of in-house therapies.
The Hospice at Home Service is well covered within the report and Healthwatch
Stockport are pleased to see the Carer Needs Assessment Tool in use at the service.
The uplifting corresponding examples within the Quality Account add some colour to
the prescribed format of the report, which could seem quite dry without them.
Through our working relationship, Healthwatch Stockport took part in the PLACE
(Patient Led Assessments of the Care Environment), the results of which are
particularly good, and congratulate St Ann’s Hospice on the results of this
assessment.
The Care Quality Commission Report also brings heart to the Quality Account and
appears to confirm what the community feels about St. Ann's Hospice.
We are also happy to see the number of pieces of work carried out by the hospice to
collect patient feedback, from their comments scheme, to the Patient/Care Group, a
variety of surveys and the Day Therapy Service Users focus groups.
Conclusion
At Healthwatch Stockport, we have previously received verbal feedback praising the
service received at St Ann’s Hospice. We are glad to see the number of compliments
(as reported in the Quality Account) received to the hospice far outweighs the
number of complaints and that the number of informal complaints has decreased
since last year’s report.
Healthwatch Stockport thanks St Ann’s Hospice for the opportunity to comment on
this document and request consistency in reporting next year to enable a direct
comparison of the information.
If members of the public have any queries or questions or concerns resulting from
this report or annex, Healthwatch Stockport can be contacted by e-mail at
info@healthwatchstockport.co.uk, telephone on 0161 477 8479 or you can visit our
website at www.healthwatchstockport.co.uk.
Healthwatch Stockport
Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
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Quality Account 2013 – 2014, St Ann’s Hospice Manchester.
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