The Rowans Hospice
Quality Account
2013 - 2014
Our Vision is that within our community of Portsmouth and
South East Hampshire all those affected by life-shortening
disease have access to the excellent specialist and
supportive care provided by the Hospice, thus ensuring their
quality of life is optimised
Part 1
STATEMENT FROM RUTH WHITE,
CHIEF EXECUTIVE OF THE ROWANS HOSPICE
It gives me great pleasure to present the Quality Account for The Rowans
Hospice, Registered Charity No. 299731 for the fiscal year 2013/2014.
We are very proud of the services we provide to our local community and
therefore relish this opportunity to share our work with a wider audience.
The quality of our service is very important to us; we therefore make
every effort to ensure our care services meet the expectations of those
whom we serve.
Registered with the Care Quality Commission (CQC) and subject to
annual inspection we are delighted that our service has been recognised
as achieving the highest standards. This has been further endorsed by
the peer review audit programme CHKS, which has achieved service
accreditation for the past decade. The review by CHKS is not mandatory but chosen by Trustees and the
Executive to demonstrate compliance over a range of robust quality standards. Investment to support and
demonstrate quality is important to us; providing evidence to reassure all stakeholders, whether they are
commissioners, donors, staff, volunteers, other partners in care provision and most importantly the service
users who trust us to support their care needs.
Quality is at the heart of all we do and is what we continually strive to achieve and optimise within allocated
resources. Both clinical and non-clinical audits are undertaken through a systematic process of review, with
reports cascading throughout the organisation and ultimately to Trustees. A ‘showcase’ is featured annually
with poster presentations demonstrating the quality of our services and displayed in public areas throughout
the Hospice. The exhibition culminates with a plenary session where commissioners in both health and social
care are invited to join staff and volunteers to celebrate the achievements across all service domains and offers
the opportunity to recognise the vital partnership with NHS and other statutory care services.
Systems to continually monitor quality are critically examined and robustly reviewed should standards come
into question. Complaints and concerns are taken seriously and responded to within defined policies and
recorded for review by CQC, CHKS and by Trustees.
The quality of our service is not confined to the Hospice building but reaches out into the community with
peripatetic services such as Hospice at Home. The quality of care, at home, presents further challenges to
ensure we provide a timely, efficient and sensitive service to those who invite our team into their homes.
This is both an honour and a privilege; complementing and supplementing community nursing and social
care services to take the philosophy and ethos of hospice care outside of The Rowans. Hospice philosophy
combines person-centred care across physical, social, spiritual and emotional domains with specialised nurses
who have the empathy, knowledge and skills to support families when a close family member or friend is
dying. This service reaches people who may not historically have received hospice care as they had chosen
to be supported at home and may have experienced more enduring chronic health difficulties, leading to a
slow decline as opposed to those with more acute symptoms who were more likely to have been referred for
specialist support from The Rowans Hospice in-patient unit or therapeutic Day Care services.
Our high quality care is only possible thanks to our dedicated staff and our skilled volunteer community
who reduce the cost of our service through their gift of time. We also thank and appreciate those who give
donations directly to The Rowans Hospice; to its subsidiary Trading Company; through gifts in Wills and
participation in our fundraising activities.
To the best of my knowledge, the information reported in this Quality Account is accurate and a fair
representation of the quality of health and social care services we provide.
Ruth White
Chief Executive
2
PART 2
Priorities for development and improvement and
statements of assurance from the board of trustees
Introduction
This Quality Account considers quality issues within the provision of clinical care and relevant support services
necessary to provide this care. It does not take into account the fundraising and administrative functions of the
organisation where separate quality initiatives are employed and evidenced through Governance.
The Rowans Hospice Business Plan outlines our Vision to develop services. Strategic objectives have been set
for 2014 - 2016 as listed below:
1. To be a leading advocate for the population we serve to be able to access the specialist and supportive
palliative care services they need. Driving the development of accessible services; available from diagnosis
of a life-shortening illness until death; supporting the person to optimise their quality of life and achieve a
‘good’ death in their desired setting.
2. To promote, support and strive to deliver timely expert specialist and supportive palliative care at all times
across all settings to the patient, family members, lay carers throughout illness and into bereavement.
3. To regard its staff and volunteers as its most valuable asset, supporting and investing in them to develop
and maintain their specialism as far as this may be possible.
4. To undertake sound financial management and through innovation, generate sufficient income to ensure
sustainability of current services. Capitalise on opportunities arising from and generated in response to the
20th Anniversary year and opportunities to optimise statutory funding.
Our Vision, as always, is inspired by the needs of people affected by a life-shortening illness and we are
continually seeking ways in which to improve existing services to ensure they remain flexible and able to
respond to people’s changing needs.
Registration
The Rowans Hospice is fully compliant with the Essential Standards of Quality and Safety as set out in Care
Quality Commission (Registration) Regulations 2009 and the Health & Social Care Act 2008 (Regulated
Activities) Regulations 2010.
3
Priorities for improvement – 2014/2015
The priorities for quality improvement identified for 2014/15 are set out below.
These priorities have been identified in conjunction with staff, stakeholders and, as far as possible, by
consulting our patients and carers. The priorities selected below will impact directly on one or more of the
following areas:
• Patient Safety
• Patient Experience
• Clinical Effectiveness
IT Systems
Patient Safety, Clinical Effectiveness
This remains a significant challenge as each patient is likely to come into contact with four providers during their illness
(including their general practice service). As The Rowans Hospice works with two community Trusts, even if GP notes
and social services databases are disregarded there are four clinical databases in use for relevant patient records.
The Rowans Hospice strives to ensure that all appropriate clinical staff are able to access and read the appropriate
IT systems to ensure that information concerning patients is transferred across all providers. Southern Health NHS
Foundation Trust has provided assistance and resources for Hospice at Home nurses, which was gratefully received.
An essential key objective for 2014/15 - The Hospice aspires to an integrated software system across all providers
and to look at developing a complete electronic patient record. It is anticipated that this will not be possible unless
there is a desire and acknowledgement as a priority by our partners.
It has been recognised by the Board of trustees that an increase in resources is required to lead in taking hospice
Information and Technology Services forward. Recruiting an IT lead/manager and Data Analyst to support the
existing team is currently in progress.
The hospice continues to strive to achieve access to the electronic Palliative Care Register for sharing essential
advance planning information in conjunction with the locality SPC NHS services.
Increase in-patient ward activity, decrease number we are “not able to admit”
Patient Safety, Patient Experience, Clinical Effectiveness
Figures collected for the minimum dataset show stable activity
over all for the last five years.
In the last year our bed occupancy figure has reached the level we
wish it to be at – average 76.2%. This has resulted from increased
median length of stay; additionally just under one in six admission
stays is over three weeks; these two factors reflect the complexity
of the casemix.
On the other hand we are still keen to be available for short-notice
admissions where the patient’s condition is deteriorating rapidly
particularly when they seem to be in their last days of life. The
availability of the Hospice at Home service to “hold” a situation at home provides the opportunity to accept a
late request for early the following day. Hospice at Home may also be reducing demand however, for example
by supporting patients’ rapid discharge from hospital in cases which might otherwise have led to Hospice
admission as an interim step.
In the second quarter of this year bed occupancy reached 80.7% and this was accompanied by an inability to
admit 17 patients in that quarter (July-September). Although three of these had expressed a change of mind,
two died on the admissions list. Conversely there were many days in the year when we had capacity to admit
more patients than we had requests for.
4
The strategy for achieving improvement in the “not admitted” figures is as follows:
• Focus analysis of data collected each week on those whom we had to turn down and on the daily capacity
figures.
• Continue to prioritise maintaining staff numbers, particularly medical and nursing staff who complete the
admission assessments, seven days a week.
• Continue to work with oncologists (Queen Alexandra Hospital) to maximise the opportunities to take
patients in the terminal phase with a minimum of delay. There is often a very small window of opportunity
as realisation that a terminal stage has been reached can come quite suddenly. Unfortunately the acute
oncology service can only run a five-day week and so earliest possible warning is essential.
• In the community the emphasis is on working with the newly formed ‘virtual wards’ to encourage
consideration of ‘real ward’ assessment and care for some patients whose subsequent care at home can be
informed and optimised by such admission.
• Continue to use our medical team resources in flexible ways to try and achieve same-day admission if at all
possible.
• Team reflection in those cases where our response was too late, adapting our services in response where
possible.
• As stated in last year’s account, we also expect that public awareness and demand for in-patient services will
increase through our new initiatives, in particular access to supportive therapeutic services for people living
with long-term conditions and increasing frailty. Empowering future patients will not bring about a rapid
improvement in number of requests however.
In promotion of the service through community engagement, we continue to stress that, with a day or two’s
notice we can generally admit someone for expert care in their dying, if that is in their interests and accords
with their wishes. With Hospice at Home we can often support the patient in their ‘wait’.
Develop Therapeutic Day Care Services
Clinical Effectiveness, Patient Experience
Develop Therapeutic Day Care Services and opportunities to engage with
like-minded organisations to develop new services for new patient groups
which may not previously have accessed Hospice care e.g. people with
dementia, young adults who are in transition between children’s and
adult services.
Following the successful pilot to offer a service to community patients
experiencing breathlessness and lethargy, through the provision of a
joint six week intervention programme, consideration will be given to
the provision of discrete aspects of care and therapeutic interventions
as ‘stand-alone’ services in addition to offering the full range to all those
attending Day Care.
The aim is to increase the number of community patients accessing
Therapeutic Day Care Services each week. The development of Day Care
will continue to evolve, working with patients and carers to adapt the model to meet the needs of a wider
audience. It is, however, envisaged that the current model of Day Care, which offers carers a real break, will
continue for those who benefit from a longer stay and particularly for carers who benefit from respite. New
services currently being considered include a bathing service, lymphoedema clinic, creativity workshops,
mindfulness practice, dementia café and other community outreach programmes to support people to ‘live
well’, despite progressive and life-shortening illness and these can be developed within the ‘Living Well
Centre’, which should be built and open by April 2015. This development has been made possible following
the successful application to the Department of Health. It is also envisaged that the new building will offer a
facility for like-minded charities and other statutory provider services to work in partnership to support people
who are approaching the end of their lives, their carers, family members and friends throughout the illness and
through into bereavement.
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Reablement Project
Patient Safety, Patient Experience, Clinical Effectiveness
To maintain and work to extend the reablement pilot with Portsmouth
Integrated Commissioning Unit and develop this concept into south-east
Hampshire.
The Rowans Hospice was successful in its application to Portsmouth City
Council Integrated Commissioning Unit, for grant funding to provide
a ‘reablement specialist social worker’ to offer specialised social care
support to patients living at home who were deemed to be in the last
year of life. Previously patients choosing to remain at home did not
have access to a specialist palliative care social worker as access was
only possible through referral to The Rowans Hospice in-patient unit or
Hospice Day Care. The aim of the specialist service is to help maintain
patients safely at home and to ensure each person has access to the
social support they may require to avoid social crisis, which can often
lead to an unplanned hospital admission. The specialist social worker
also offers a bridge between generic palliative care services and specialist
services provided by The Rowans and the NHS Specialist Palliative Care
Clinical Nurse Specialists and Allied Health Professional services. Offering access to a specialist resource
earlier can also support a timely referral to specialist palliative care services should they be required, with the
social worker acting as advocate for both patient and informal carers. This pilot is also supported by trained
volunteers who provide emotional, practical and domestic support as part of a wider hospice initiative, Hospice
Companions.
How will progress be monitored for Future Priority Improvements – 2014/2015?
The Rowans Hospice Board of Trustees, and more specifically, the Clinical Executive Group, will monitor,
benchmark and account on progress through a variety of methods including:
• Annual Return to the Charity Commission
• Annual Review and audited Report and Accounts
• Business Plan
• Quality Accounts, Clinical Governance Report
• Annual audits and patient surveys
• Annual General Meeting of the Charity
• ‘Reaching Out’, The Rowans Hospice Newsletter and other periodic communications
• National data as collected by Help the Hospices and the National Council for Palliative Care
• Research – both internal and external to The Rowans Hospice
• Patient surveys for individual doctors, as required by General Medical Council Revalidation
• As a designated body under Medical Revalidation legislation, the Hospice governance structures and
medical staff performance are overseen and subject to annual report by the Responsible Officer provided by
Southern Health NHS Foundation Trust
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STATEMENTS OF ASSURANCE FROM THE BOARD OF TRUSTEES
The Board of Trustees is fully committed to delivering high quality services to all our patients whether in the
Hospice or community setting.
The Board is involved in monitoring the health and safety of patients, the standards of care given to patients,
feedback from patients including complaints, and plans to improve services further. They do this by receiving
regular reports on all these aspects of care and discussing them at Board meetings.
Of equal importance our Trustees visit the Hospice and other settings where services are delivered. Some
of these visits are unannounced and written reports are discussed by the Board and copies are available on
request from the Chief Executive.
During the visit Trustees speak to patients, carers, staff and volunteers. In this way, the Board has first hand
knowledge of what patients, families and carers think about the quality of services provided, along with
feedback from staff and volunteers. This year the Trustees have officially made at least 5 separate visits to
different areas of our service. The Board is confident that the care and treatment provided by The Rowans
Hospice is of a high quality and cost effective.
Following a recent unannounced inspection by the Care Quality Commission (CQC) in February 2014 the Board
of Trustees are reassured that despite a storage issue for medicines which was rectified immediately, The
Rowans Hospice is compliant with the quality and safety standards set by CQC.
PART 3
REVIEW OF SERVICES
The aim of the Quality Account is not only to set future priority improvements but also to evidence
achievements on priorities for improvement from the previous year. To ensure the needs of service users are
met, The Rowans Hospice identified areas of priority where improvements were needed to enhance the care
experience. Examples of developments and improvements that occurred in 2013/14 are outlined below:
Outreach into the community with the Hospice Companions Service
(formerly MacMillan Solutions)
Clinical Effectiveness, Patient Experience
Financial support from MacMillan came to an end in Dec 2013 for the pilot project MacMillan Solutions, this
service now known as Hospice Companions has become an integral part of hospice services.
Hospice Companions supports patients and carers in the community; a team of carefully selected volunteers
provides dedicated, flexible, practical (cleaning, cooking, shopping) and emotional support to patients and
family members.
The hospice has received 144 referrals to this service, supporting patients and carers on over 700 occasions in a
number of practical and supportive ways.
‘Serena’ has a brain tumour which has limited her mobility and she is no longer able to do any housework or
ironing. A Hospice Companion volunteer calls in weekly and spent time ironing and vacuuming the carpets
and mopped the kitchen floor.
‘Serena’ said I can’t thank the volunteer enough. I was feeling very low, looking at the ironing piling up and
the carpets had begun to look dirty. I don’t want to keep asking my family to do it for me. Anyway when my
family visit I want them to talk to me, I don’t want them to be busy doing other things. The volunteer helping
me with these things is lovely and always makes me a coffee and we chat for a while. I really appreciate her
giving up her time to help me. She makes a lot of difference’.
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‘Sarah’ lives with her husband who has pancreatic cancer; a life shortening-illness; and is in a hospital bed
in their lounge. Sarah has some medical issues of her own and is unable to leave their home to get some
shopping. A Hospice Companions Volunteer visited weekly to collect Sarah’s shopping list and then she
popped out to pick up the shopping.
Sarah said “I am so grateful for the volunteer’s help. I desperately wanted to tempt my husband with some
food that he has always loved but was unable to go any further than the corner shop. The volunteer gets just
what I need, she unpacks it all and makes us a cup of tea so then we have a chat before she goes. She has
made such a difference”.
Pilot oncology admissions
A three month pilot commenced on the 1st October 2013 where direct referrals from a member of the
oncology medical team were taken for patients deemed to be in the dying phase and appropriate for transfer
to the hospice. Previously all referrals had been referred to the hospital Specialist Palliative Care team for
assessment, which sometimes delayed the process resulting in missed opportunities for those seeking support
from the hospice as they may be too ill to transfer by the time they have been assessed. Clear guidance notes
were produced. Over the 3 month pilot, 6 valid requests for admissions were received. As a result this work
continues leading to extension of this offer to be even more inclusive.
Education and Training
Patient Safety, Clinical Effectiveness
A range of educational and training courses are delivered to health and social care professionals who support
patients with palliative care needs in the community and hospital. We are also actively involved with meeting
the objectives relating to training and education in support of the National ten years End of Life Strategy
(2008).
To support generic palliative care training, The Rowans Hospice, in partnership with NHS SPC providers, actively
pursues opportunities to provide palliative care education and training through developing bids to secure NHS
and social care funding. To this end a number of educational training activities are being delivered including:
• Advanced Communication Skills Training
• Sage and Thyme - Level 1 - Communication skills training
• End of Life and Bereavement Care Training
• Medical Students Training
• GP Registrar Training
• uDNACPR training to GPs and primary health care staff
• Advance Care Planning training for health and social care
professionals
• Symptom management
In addition to these activities, ongoing professional support and guidance is provided to qualified nurses,
health care support workers, volunteers, administrative staff, doctors, trustees and allied health professionals.
This includes the delivery of statutory training such as health and safety, fire, manual handling and courses
which are core to the charity’s objectives, for example, Working with Loss and Induction training.
Development of Bereavement and Psychology Services
Patient/Client Experience, Clinical Effectiveness
The Rowans Hospice is committed to developing these services by employing a Clinical Psychologist who works
across both Bereavement and Clinical Psychology services. The concept of cross working will support clinical
effectiveness and the patient/client experience.
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CHKS
Patient Safety, Clinical Effectiveness, Patient Experience
The Rowans Hospice continues to maintain accreditation with CHKS for a further three years following the
survey in October 2012 and monitoring submission April 2014, demonstrating the high quality of the service
and its robust Governance across clinical and operational domains of practice.
Participation in clinical audits
As a provider of specialist palliative care, The Rowans Hospice was not eligible to participate in any of the
national clinical audits nor national confidential enquiries as none of the audits or enquiries related to
specialist palliative care.
The Rowans Hospice Quality and Audit Programme facilitated many service improvement audits during
2013/14. The Hospice also used a number of audit tools by the umbrella organisation, ‘Help the Hospices’ of
which we are a full member.
Audit tools included:
• Infection Control environmental modules
• Accountable Officer
• Management of Controlled Drugs
• General Medicines
The tools are relevant to the particular requirements of hospices, allowing our performance to be
benchmarked against that of other hospices. The Rowans Hospice is a member of a regional audit group and
benchmarks the results of these audits on a regular basis. Our compliancy results have been high, achieving
above average in all the comparative audits in 2013/14.
In addition to the above, the following actions have been undertaken to ensure The Rowans Hospice continues
to improve the quality of healthcare provided:
• Participation in the National Benchmarking Pilot facilitated by Help the Hospices covering benchmarking the
rate of Pressure Sores, Drug Errors and Patient Falls.
• Review of Hospice at Home that included external professional views
Other audits carried out included:
• Evaluating the Well-being Group
• Patient Preferences
• Transfers to hospital
• Switching between opioids
Data Quality
For the year 2013/2014 The Rowans Hospice submitted audit data relating to patient activity to the National
Minimum Data Set for specialist palliative care. Results are available publicly from the National Council for
Palliative Care (NCPC), www.ncpc.org.uk.
Research
Two research proposals have been submitted to The Rowans Hospice Ethics Executive Group (EEG) in 2013/14,
both were granted internal ethical approval as well as receiving a favourable response and endorsement from
the local NHS Research and Ethics Committee:
• Asset or Optional Extra? The impact of volunteers on hospice sustainability
• A study examining the Attitudes of Hospice Nurses towards the Useful Conversation Tool
Quality Improvement and Innovation Goals Agreed with our Commissioners
The Rowans Hospice income in 2013/14 was not conditional on achieving quality improvement and innovation
goals through the Commissioning for Quality and Innovation payment framework.
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REVIEW OF QUALITY PERFORMANCE 2013/2014
This section provides:
• Data and information about how many patients use our services
• How we monitor the quality of care we provide
• What patients and families say about us
• What our regulators say about us
The National Council for Palliative Care: Minimum Data Sets – 2013/2014 – a full report can be located at
‘mds@ncpc.org.uk’.
In-patient Unit (IPU) – 2013/14
•
•
•
•
Completed In-patient admission episodes – 390
(397)
Of the above, 124 (31%) admitted from hospital (32.7%)
Average length of stay for patients − 13.5 days
(11.9) (wide variation according to need)
There were 3 instances where a target date for admission to IPU had been not been met:• 2 patient’s choice
• 1 related to bed capacity
• Of the 37.5% (147 patients) who were discharged,
82% returned to their home
(80%)
• 7.3% of patients had a diagnosis other than cancer (12.8%)
(The figures in brackets are for the previous year)
Therapeutic Day Care Services Traditional Day Care –
• 205 new referrals
• 17.6% of patients had a diagnosis other than cancer
• Attendance average was 74.7%, which is very good where patients are nearing the end of their life
The Heath Centre, a therapeutic clinic for patients newly diagnosed with a life-limiting illness offers patients
and their carers the opportunity to attend for six consecutive sessions where members of the multiprofessional team support patients to consider advance care planning.
• 153 new referrals
• Average patient attendance 60%
• 256 carers – average attendance 55%
Bereavement and Rowan’s Meerkat Services
The Bereavement Service provides extensive support in a variety of ways for adults linked to The Rowans Hospice.
Rowan’s Meerkat Service is a district-wide service helping support children and younger people up to the age
of 18 years, prepare for the loss of a close or significant adult and offers continued support into bereavement.
Hospice at Home Service
•
•
•
•
•
•
•
•
354 patients were referred to the service (322 - 2012/13)
77% (271) Malignant diagnosis (56%- 2012/13)
15% (52) Non-malignant diagnosis (12%- 2012/13)
8% (30) two or more defining conditions - mixed malignant & non-malignant
31% of referrals were not known to the SPC Team/Hospice
51% known to the SPC Team/Hospice
18% undetermined if known to the service prior
14% (50) of patients were referred through Portsmouth Hospitals Trust to support statutory Community
Teams with discharge home
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Regularly Measured Quality Markers
In addition to the limited number of suitable quality measures in the National Data Set for palliative care, we
have chosen to measure our performance against the following:
Indicator
2012/2013
Preferred Place of Death
Establishing and understanding patients’ preferences for place of death and supporting patients to achieve
their wishes is key. As part of the admissions process, discussions take place with the patient (and family if
requested) asking questions related to treatment, care options and the patients’ and families preferences,
including their preferred place of death. These discussions are recorded on a “preferences form” and form
part of their care.
Achieved preferred place of death at the Hospice
83.3%
Preferred place of death undetermined
6.3%
10.4% of patients indicated preferred place of death was home, however due to reasons, such as acute
changes in their medical condition, this was not possible. However, in all cases the family indicated their
satisfaction that the patient remained in the Hospice.
Resuscitation Decisions
100% compliance – records indicated forms were completed following discussions with patients/families as
appropriate.
Patient Safety
Patient safety accidents/incidents include a patient reported to have had a fall, slipped out of a chair, rolled
out of bed in their sleep, collapsed as a result of their illness and so forth. All incidents were reported
and investigated and appropriate actions taken in addition to outcomes being reported back through
governance reporting structures. Risk assessments are regularly reviewed following any reported incident.
As part of the investigation, any trends and themes or are identified and analysed.
The number of patient safety incidents (including patient-related reported
through Day Services)
The number of slips, trips, falls; including slipping from a chair and found on the
floor
111
99
Systems are in place to indicate and raise awareness of patients who have fallen or have been found on
the floor during their stay. Additional staffing is used for patients whose safety is deemed to be at risk.
Continual efforts are made to ensure we achieve our 2014 target to see a reduction in the number of
patient falls with the measures taken.
The number of serious patient safety incidents
The number of patients who experienced a fracture or other serious injury as a
result of a fall
0
0
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Infection Control
Total number of patients known to be infected with
Nil hospice acquired
MRSA whilst on the In-patient Unit
1 colonisation –
acquired whilst in
hospital
Total number of patients known to be infected with C.
Nil hospice acquired
difficile whilst on the In-patient Unit
One patient transferred
to the hospice from
hospital with C. difficile
Drug-related incidents – All drug-related incidents/errors are reported and investigated, appropriate action
is taken and the incident is reported through the appropriate channels. Examples of incidents reported
included clerical errors such as missed signature when a drug had been administered, a missed signature in
the Controlled Drug Register, when witnessing the dispensing of a controlled drug, or an oversight in that a
drug had not been given.
There were 44 drug-related incidents. All were investigated and corrective action taken. There were no
serious consequences from these incidents.
Quarterly drug error/incident reports are produced for the Medicines Management Group and discussed in
detail, addressing operational procedures, circumstances around the error and determining any outcomes
and recommendations as appropriate. It is evident from the quarterly reports for 2013/14 that the
changes implemented following previous reports have resulted in the reduced number of errors/incidents
reported.
Discontinuation of the Liverpool Care Pathway (LCP)
Misconceptions and inaccurate information about the Liverpool Care Pathway published in national and
local press (and available on the internet) have caused concern for health care providers who understand
the substantial benefits of evidence-based structured end of life care for patients and their families. A
formal national review was commissioned and led by Baroness Julia Neuberger. The full report with
recommendations was published in July 2013; concluding that the LCP should be phased out over the
next 6 – 12 months and be replaced with a personalised end of life care plan, backed up by Good Practice
Guidance specific to disease groups.
This was considered by the Hospice Executive Group which agreed it would be difficult to defend the
continuation of the LCP following the negative press and media coverage. A decision was made to
withdraw the LCP documentation and to maintain individualised care plans, ensuring that all goals included
within the LCP remain achieved; reported; and documented. At that point is was anticipated that national
work would continue to look at a replacement care plan. However, as part of a senior staff nurse’s diploma
module, a careplan has been devised that covers aspects of recording care for those patients who are less
well and on the dying trajectory. This has been reviewed by the clinical management team and agreed to
pilot for a six month period. This commenced on the 1st January 2014 and will be closely monitored and
reviewed, reporting back to the appropriate clinical teams and Hospice Executive Group reporting to the
Clinical Trustee Executive Group.
The outdated “Care of the Dying” leaflet produced by the LCP Group has been replaced by one of our own,
though of course its principles are universal. Relatives were consulted on the content and layout.
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Specialist Palliative Care Audit and Service Evaluation
The Clinical Quality Strategy Group has achieved wide involvement in clinical quality assurance activity and
developed systems for prioritisation, reporting and discussion of results with the overall aim of a higher quality
of clinical and supportive care. The continued involvement of clinical managers is vital for this.
The Clinical Quality Strategy Group (CQSG) continues to develop a Quality Impact Analysis (QIA), which takes
account of regulatory requirements, adverse incidents and complaints. The QIA is reviewed six-monthly to
ensure that levels of concern and risk reflect the most recent data. Ad hoc projects of interest to the services
are also monitored through the QIA.
Service Showcase
The CQSG Showcase has developed over the past five years as a vehicle to raise awareness across the domains
of service of all the quality improvement work that is undertaken. Posters are produced by both clinical and
non-clinical departments and displayed for one month in the Seminar Room as well as throughout the Hospice.
A Plenary Session allows emphasis on certain key initiatives and serves as a forum for celebrating quality and
success.
Education and Training – Palliative and End of Life Care
There is a full and varied programme of in-house education and training, led by a Ward Manager in partnership
with the Education Facilitator and a Consultant in Palliative Medicine.
As detailed earlier in this report, the Education Facilitator supports the in-house training programme in
addition to the core focus on engaging with the community team and social care providers.
WHAT OTHERS SAY ABOUT US
We listen to our patients and carers and those who access our services. We have a robust Complaints and
Concerns Policy and Procedure which is made available to all who use our service.
In 2013/2014, we received 8 complaints/concerns (written/verbal) related to:25% (2) were not related to The Rowans Hospice and were redirected to appropriate teams
25% (2) were related to miscommunication - this was addressed through team discussion and acknowledgment
to those involved.
12.5 % (1) was in relation to the hospices’ admission process/noise in corridor and practice reviewed.
12.5% (1) was related to Hospice at Home the discharge policy reviewed as a result
12.5% (1) was related to care in Hospice at Home / miscommunication which was resolved through discussion
with those involved.
12.5% (1) was related to the hospice discharge process the MDT reflected within teams
All concerns raised have been addressed in consultation with the person who raised the concern; reflected
upon by the staff involved and practices or procedures have been reviewed as appropriate; followed by
written feedback. Information is provided to the complainant on how to seek independent scrutiny from the
Ombudsman should the internal investigation be deemed inadequate. For this period all complaints and
concerns were managed internally and no further action was sought.
Many letters and cards have been received from former patients and service users, praising the staff and
volunteers for the service they have received. In addition, verbal recognition is received from relatives or
families who remain in contact with the Hospice.
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Satisfaction questionnaires continue to be sent out to all patients who have been discharged; Day Care
patients; and the Heath Centre patients and carers. Views are also invited from the bereaved through an
open invitation card within the bereavement information booklet. Carers continue to use the feedback sheets
available in loose leaf files within the patient area. Again, feedback received is very positive and reflects
patients’ and families’ appreciation of the services they receive.
Evaluations from service users receiving Bereavement Support are monitored and reported.
Here are some examples of feedback received:
“I found stay in hospice to be beneficial as
it helped me become more mobile, able
to breathe better and more like a human
being, not a patient number”
“Please continue as you are. It is an
excellent service that you provide”
“Day Care is a club no-one wants to belong
to and no-one wants to leave.”
“During my stay I was made to feel
safe, cared for and I was treated with
compassion and respect”
“Nausea under control so eating properly,
building up strength again. Pain under
control, husband had a good break from
caring bit”
“Gave me more confidence about going
home – support etc , stabilised my drug
regime to improve my quality of life”
Carers
The Rowans Hospice continues to recognise the vital role carers play throughout the year by providing them
with a special support service. The Hospice supports a monthly Carers’ Group in addition to the annual
National Carers’ Week with a variety of events including “pamper days” and information days.
“Even though the last few weeks were so
harrowing for us as a family, your care and
support towards us was immeasurable. You
are a wonderful team in a wonderful place
“I would like to put into words the thanks I owe
you for your very caring support and help over
the difficult months of my husband’s illness.
You helped us in so many ways
“We were particularly appreciative of the
way you enabled our family to come together
and be there for mum and made us feel
welcome whatever time of day or night.”
“I never thought how much the service
would impact my life. I really don’t know
where I would be without this service.
It’s hard to talk about things like this
with a stranger but they make you feel so
comfortable”
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Statements from Care Quality Commission (CQC)
Following the recent unannounced inspection on 19th February 2014, CQC produced a report on their findings:
It was clear that members of staff we spoke with understood the importance of promoting the dignity of
people who used the service. They confirmed that people were asked their opinions and for their consent for
treatment and support. We saw that signs were hung on the door when care and support was being given
which said “staff member in attendance”. This protected people’s privacy and dignity as no one seeing the sign
would know what was happening in the other side of the door.
People said they felt respected by staff and that staff always explained what was happening. We observed that
staff would explain every time they offered medicines, what was being offered and what it was for. We heard
staff talking with people and gently explaining about what was happening as the person was distressed.
People’s needs were assessed and care and treatment was planned and delivered in line with their individual
care plan. We looked at four care plans and they reflected specific needs that people told us about. Care plans
had information on the aim of the care plan, what help was needed, and the actions needed by staff. This
included clear guidance about how people should be assisted with moving including the use of moving and
handling equipment and personalised guidance. There were clear instructions about the support each person
liked with regard to their personal care, including people’s preferences with regard to the toiletries they liked
to use.
We saw that care plans did not just focus on people’s healthcare, a holistic approach had been taken.
We met two people who were being discharged with a support package, which included staff from The
Rowans. Relatives told us how well they felt supported in caring for their relative and they did not feel “alone”.
When talking to people, staff were friendly and professional. They spoke clearly to ensure they were
understood and listened carefully to make sure they knew what was expected of them. The atmosphere
throughout the day was calm and one relative told us it was “intangible”, and staff were observed to have a
good relationship with everyone.
We saw examples of clinical governance checks and audits, all these examples showed that the service was
monitoring the quality of the care it offered. The provider had an effective system to regularly assess and
monitor the quality of service that people receive. The provider had an effective system in place to identify,
assess and manage risks to the health, safety and welfare of people who use the service and others.
Care Manager/Student Social Worker
I just wanted to again say thank you very much to you and the team taking time out for me to gain a bit of
insight into your role at The Rowans. I have to say that the experience was very positive and definitely food for
thought in terms of how the role of social workers can vary depending on the setting. I am sure you are told all
the time but I wanted to reiterate that the environment, staff and work you do is absolutely amazing!
CHKS Accreditation
There is good evidence of collaborative working both at the senior team and operational levels and it is evident
that the Trustees are committed to The Rowans Hospice by the ‘walk about’ programme. Commitment by the
Chief Executive and the management team is evident and there is a good working atmosphere at The Rowans
Hospice with staff taking pride in their work and appearance. The guidelines and protocols on the rapid and
effective communication between specialties, services, and health professionals, to provide co-ordinated
individualised care and treatment.
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Staff
The Rowans Hospice has a Staff Forum providing an opportunity for staff to express their views and feedback
on areas linked to ‘Improving working lives’. Staff participated in an external Staff Satisfaction Survey led by
“Bird-Song” in 2013 which indicated overall staff satisfaction alongside suggestions of ways further to improve
upon internal communications. In addition to this, staff are offered regular supervision in recognition of the
challenging, and at times emotive, nature of their work.
Volunteers
Volunteers are an integral part of The Rowans Hospice. Annual meetings and update training is offered to volunteers
as well as a comprehensive Induction Programme, which offers the opportunity to learn about all Hospice services
and more in-depth training relating to working alongside people who are dying and bereaved. We also run a
Volunteers Forum that meets quarterly where volunteer representatives can raise any issue on behalf of other
volunteers in a confidential meeting, some of which may be related to the clinical services the hospice provides. Any
concerns or issues raised will be reported back to the Senior Management team for further action or discussion.
Commissioning Groups Statement –
“PSEH CCGs are always very impressed with the high quality of service, which is provided by The Rowans
Hospice to support patients and their families. Much of the work is ‘behind the scenes’ as highlighted by the
Showcase presentation, which was a demonstration of the quality of services, evidenced through audit and
service evaluation. The Rowans Hospice also makes a big contribution as an independent healthcare provider
to the wider health economy, working in partnership with NHS providers to deliver an integrated and seamless
palliative care service, which is why we choose to grant a financial contribution to their work. Any visit to
the Hospice will demonstrate that the service is received positively by the local community, evidenced by
satisfaction questionnaires, letters of appreciation and, of course, the financial contribution given by the public
to support the charity through donations, including the gift of skills and time from over 1000 volunteers.”
Jonathon Price
Portsmouth City Councils has an excellent partnership relationship with The Rowans Hospice. The Social Work
Team provides an excellent person led service delivering high quality care that represents excellent value for
money and enables individuals to have maximum choice and control over the support they require at what can
be a very difficult time. The training provided by The Rowan’s is also available to our staff, providing first class
specialist training which is appreciated and used. The continuing development of services provided demonstrate a
clear understanding of the changing face of end of life care. As a commissioner of services, The Rowan’s provides
a high quality value for money service, and we hope the partnership continues for many years to come.
Angela Dryer
Assistant Head of Social Care
Assessment, Care Management & Social Work
CONCLUSION
This account is by no means exhaustive, however hopefully it provides evidence on how the quality of our
service is constantly reviewed and evaluated and where needed enhancements are made.
For further information please visit www.rowanshospice.co.uk or telephone 023 92238541 asking for the Chief
Executive, Ruth White.
Registered Charity Number: 299731
Quality Account 2013/2014
Approved by: Board of
Trustees
Revision No.
Date of Approval:
2
June 2014
Date of Implementation:
Revision due by:
June 2015
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