2013 - 2014
Quality Account
“This place isn’t somewhere to come and die,
it’s somewhere to come and live.”
Comment from a Day Care guest quoted in the Care Quality Commission
report published in March 2014.
Reporting period: 1st April 2013 - 31st March 2014
Contents
Chief Executive’s Statement
Page 2
Part 1 - What we achieved in 2013 - 2014
Page 3
Part 2 - Mandated Statements
Page 6
Part 3 - Quality Overview
Page 13
Part 4 - Priorities 2014 - 2015
Page 17
NHS Southern Derbyshire
Clinical Commissioning Group (CCG) Statement
Page 20
1
Chief Executive’s Statement
As a provider of NHS healthcare, Treetops Hospice is required to produce an
annual Quality Account that reports and demonstrates to the public how we
measure the quality of services we provide, and how we involve patients,
carers and NHS health professionals in the evaluation of this process.
Quality sits at the centre of all that the hospice provides and we strive year on
year to develop and improve what we offer to people within the community
who access our services.
We were delighted that the quality of our services was acknowledged in a very
positive report from the Care Quality Commission following an unannounced
inspection, where no shortfalls were identified. This, once again,
demonstrates the hard work, dedication and commitment of each member of
staff. It is the staff and volunteers who make Treetops Hospice a safe, secure
and happy place for all.
I am responsible for the preparation and contents of this report and to the best
of my knowledge the information reported in this Quality Account is an
accurate and fair representation of Clinical Services provided by Treetops
Hospice.
Our corporate and clinical governance structure ensures that we have both
the systems and processes in place to maintain a viable and responsible
business, whilst ensuring that our services are of the highest quality and meet
the aspirations of our mission statement: - “Where every day counts.”
George Cameron
Chief Executive
May 2014
2
Part 1: What we achieved in 2013 - 2014
The Day Care unit had an unannounced inspection by the Care Quality
Commission (CQC) in January 2014. The inspection report is available on the
CQC website and confirms that Treetops Hospice met all the assessed
standards, as described in the Guidance about compliance: Essential
standards of Quality and Safety.
In 2013 we produced our second five year rolling strategy where we identified
both planned development of service provision and improvement priorities.
1. Review of the Day Care unit
The number of patients attending Day Care increased from 224 to 240.
The current Day Care patient notes documentation was reviewed in order to
eliminate duplication of information and significantly increase the amount of
measurable data for audit purposes.
Identified target

To introduce three additional activities into the Day Care experience.
During the year, the team introduced gardening and armchair exercises which
have proved very popular.
Pets as Therapy dogs have been introduced to the Day Care unit on three
days each week which the guests find very enjoyable. One guest said
“Because of my condition I can’t have a dog and I have always had dogs.”
The team have also introduced themed weeks e.g. during the summer when
the theme chosen was a day at the seaside. The creative worker and her
volunteer team worked with the guests to produce decorations and posters,
fish and chips were served wrapped in newspaper for lunch and overall the
guests and all that were involved created a real buzz in the unit.
2. Hospice at Home
A total of 4,219 home visits were provided over the year. Of these, 30% of
visits were made by Registered Nurses and 70% by Health Care Assistants,
maintaining the skill mix at 30:70.
Identified targets


To increase the number of hours of care provided from 29,000 hours
to 30,000 hours
To increase the number of patients cared for from 650 to 700
Both these target were achieved, providing 30,000 hours of care to 711
patients.
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3. Nursing team development programme
Our two Royal College of Nursing (RCN) learning representatives delivered an
excellent educational/support programme for the team which has been well
attended and received.
Identified target

To increase the number of sessions offered from six to eight and introduce
three more core competencies
During the year, eight sessions were offered and the following six core
competencies were covered:Equality and diversity
Communication
Tissue viability at the end of life
End of life care for non-malignant conditions
Documentation – DNACPR and End of Life Care Pathways
End of life care in neurological conditions
4. Bereavement Service
The total number of clients supported by the service rose from to 242 to 334,
an increase of 38%.
During the year, the Adult, and Children and Families Bereavement services
amalgamated which has allowed them to utilise counsellors and support
workers more flexibly and effectively. The appointment of a part-time
Bereavement Service administrator has had a huge impact on the operation,
relieving the manager and the two counsellors of a large amount of clerical
work.
During the year, the bereavement team has increased from 25 to 37
volunteers (27 Treetops trained volunteers and 10 volunteer counsellors).
They have also introduced a Student Placement Service where students in
their final year of a recognised counselling qualification are given an
opportunity to work with clients. In return, they give Treetops a commitment to
stay with the service for a minimum of two years and receive continuous
training, mentorship and supervision. There are now 10 students working
within the department, bringing the total number of volunteers to 47.
5. A new Clinical Support Centre
The successful application to the Department of Health for funding has
allowed a NEW Clinical Support Centre to be built in the hospice grounds,
which is due for completion in June 2014.
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6. External Education programme
During the year we facilitated our third very successful study day for health
professionals on Motor Neurone Disease funded by Derbyshire Workforce
Development. The day was supported by Nottingham University Hospitals
NHS Trust, Derby Hospitals NHS Foundation Trust, Southern Derbyshire and
Nottingham West CCGs and the Motor Neurone Disease Association. The
day included an overview of the disease and such subjects as bulbar
weakness, respiratory issues and end of life care planning, each delivered by
an expert clinician in the field. Sixty-two delegates attended, including
community nurses, physiotherapists, speech and language therapists and
palliative care specialist nurses. The day was extremely well evaluated by the
attendees and some of their comments are reported below.
“Emotional, thought provoking and educational”
“Highlighted the complexity of this disease and the importance of MDT
working with regards to its management”
“When each speaker was presenting you could hear a pin drop – this says it
all”
“Emotional day but wonderful how much passion and care is out there”
We also secured funding to continue our successful series of courses for
bands 1- 4 staff in hospitals, community and nursing homes on palliative
care, practical care of MND patients and bereavement and loss.
In addition to this, Southern Derbyshire CCG commissioned us to provide End
of Life training to staff in residential homes.
7. Partnership working
The Director of Clinical Services is an active member of the Southern
Derbyshire End of Life group. The remit of the group is to ensure that
equitable care of the highest possible standard is available to the community
they serve.
To achieve this goal it is established that communication and partnership
working across both health and social care providers is co-ordinated and
understood by all providers.
A recent example of the group’s work was the identification of a small cohort
of patients who had died within 72 hours of hospital admission, and then
examining the circumstances around these admissions to identify any
strategies that may have achieved a better outcome.
5
Part 2: Mandated Statements
Statements of assurance from the board
Within a submitted Quality Account, all providers must include the following
statements, despite some of them not being applicable to hospice services.
Review of services
From 1st April 2013 to 31st March 2014, Treetops Hospice provided the
following services to three CCGs in Derbyshire and four CCGs in
Nottinghamshire:


Day Care
Hospice at Home
An additional service has been provided to the three Derbyshire CCGs:
Bereavement Support
Treetops Hospice raises 67% of the funding for these services through retail
outlets, lottery and fundraising. The remaining 33% comes from the NHS via
the above CCGs through cost and volume contracts.
Clinical Services are governed by the Clinical sub-committee of the Board of
Trustees, who meet quarterly and receive service reports which enable them
to review the management and quality of care provided by all services. The
reports are then submitted to the whole Board of Trustees at their meetings.
Participation in clinical audits
During 2013 – 2014, Treetops Hospice did not participate in any national
clinical audit or national confidential enquiries.
Research
During 2013 – 2014, the hospice was not involved in any research projects.
NHS Quality Improvement and Innovation Goals
Treetops Hospice has quality requirements set by the commissioning CCGs
All quality requirements for 2013 - 2014 were met:

Enhancing the quality of life for people with long term conditions

Ensuring that people have a positive experience of care
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
Treating and caring for people in a safe environment and protecting
them from avoidable harm
CQUIN requirements were met:
To achieve objectives as set in the End Of Life implementation plan
(copy available)

To improve carer satisfaction – see carer evaluation
7
What others say about us
Care Quality Commission
Treetops Hospice is registered with and regulated by the Care Quality
Commission in accordance with the Health & Social Care Act 2008.
Our most recent inspection report dated 8thJanuary 2014 is available on the
CQC website and finds us meeting the standard in all five core criteria
inspected.
Below are some of the comments that were included in the summary:

The staff are friendly and treat patients with dignity and respect.

The staff encourage patients to be as independent as possible and
patients are involved in decisions about their care and support.

The establishment is clean and there were no concerns regarding
prevention and control of infection.

The staff are well trained and motivated and have the skills to deliver
care that meets the patients’ needs.

The hospice has appropriate systems in place to monitor the quality
and safety of the service and people who use the service have the
opportunity to give feedback about their experience.
Day Care Service
Service user evaluations
Due to the constantly changing client group, our Day Care service is surveyed
bi-monthly on a rolling questionnaire programme to ensure that we capture
more patients’ views and are able to be pro-active in our response to
suggestions or concerns.
Areas surveyed are::
 Before you got to Treetops Hospice Day Care
 Your journey to Treetops Hospice Day Care and your first day
 Relationships with staff and volunteers
 Dignity and Safety
 Your care
 Catering
 Transport
 Activities
8
“Coming to Treetops changed my life. All I have to say is praise for such a
wonderful place”.
“I enjoy very much coming. It’s kept me going”.
“I’ve felt a lot better since I’ve been coming here – more happier in myself”.
“Just a perfect place and time to be - everything is good. You feel so safe here
and nothing is too much of a problem”.
Guests’ Voice (Day Care Patient questionnaire)
Hospice at Home service
Referring professionals’ evaluation
Each year we send out a service evaluation to referring health professionals.
Of the 29 health professionals who returned the evaluation last year:
100% said that that the Treetops Hospice at Home nurse co-ordinators
are very helpful.

93% said the patients and carers were satisfied with our care.

96.5% said that our service was reliable.

89.5% reported that our service helped to prevent or delay hospital
admission.
“As a professional I have had excellent and appropriate support from the
Hospice at Home co-ordinators with good feedback, when appropriate,
regarding the patient’s condition”.
“Your service has been invaluable and has assisted patients/carers/families to
have quality of life during the last few months of their progressive illness,
allowing dignity, and supporting other health professionals”
From referring professionals evaluations
9
Carer Evaluation
Each year we send out a service evaluation to the carers of (1 in 4) patients who
died in our care during the year. These are measured against the same
questions from the previous year.
Percentage of carers who responded positively to the questions:
Was the referral to the service timely?
Was the amount of care provided sufficient?
Were you at ease about the way we cared
for your loved ones?
Did our nurses take time to listen to your
concerns?
Did the service enable you to care for your
loved ones at home?
2012 - 13
2013 - 14
94%
97%
82%
90%
100%
100%
97%
98.5%
100%
100%
“All the nurses came on time, were compassionate in dealing with my
husband and took time to listen to me regarding his care and also how I felt at
the time.”
“The care provided was outstanding. Your nurse, who was in attendance
when my husband passed away, was caring, compassionate and really did
make such a terrible time a little easier. The dignity she allowed him was
second to none.”
“Always sensitive and extremely helpful, they made us feel reassured that we
were doing the right thing in caring for our family member at home.”
“We could not have coped without your help, so generously given and
compassionate at all times.”
“I was very surprised to learn how knowledgeable your staff were. It helped
me no end to get through that terrible time.”
“When we needed help you were there - a professional, caring, nursing
service who truly listened to our needs.”
Carer evaluations
10
Bereavement Service
All clients who finish receiving support during the year are asked to complete
an evaluation of their experience.
Adults
Of the 42 adults who returned the forms:
95% said that the support had made their experience of bereavement
more bearable.

98% said they were satisfied with the service provided.

100% said they would recommend the service to other people.

86% said the support was offered at just the right time.
“Thank you for helping me through this terrible time in my life, without you I
would still be struggling to make any sense of it all.”
“The service was a lifeline for me when I was at my lowest ebb. It was offered
to me in a friendly, caring environment with a support worker who was kind,
caring, supportive and knowledgeable.”
“Every session (although not easy) was useful and very worth having. I now
feel like a different person.”
Adult Bereavement evaluations
Parents/Carers
Of the 16 parents/carers who returned the forms:
94% were happy or very happy with the speed of response to the referral.

75% reported a decrease in their level of concern about their child after the
support had finished.

88% were happy or very happy with the extent to which the support had
addressed their child’s bereavement needs.

100% would recommend the service to other people.
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“I was extremely concerned about my daughter as the bereavement altered
her character and personality. The difference in just a few weeks was positive
and I cannot thank your service enough.”
“I have noticed a positive change in my daughter. I feel that by contacting you
I have given her the extra support she needed at the time she needed it.”
Parent or Carer evaluations
Children/Young People
Of the 14 children who returned the forms:
86% reported an improvement in their feelings after the support.

64% said the sessions had helped them. 29% were not sure if the
sessions had helped them.

93% said they would recommend the service to other people.
“I just would like to say a big thank you because you made me realise the
person I really am. It could of not been any better, I am really happy now.”
“It helped a lot and I enjoyed it especially making things for my dad.”
Children’s evaluations
12
Part 3: Quality Overview
Treetops Hospice submits a National Minimum Data set (MDS) to the National
Council for Palliative Care.
Comparison with National Minimum Data Sets
The most recent available National MDS covers the period 1st April 2012 to
31st March 2013. Treetops Hospice data for 2013 – 2014 have been collated
but there are no comparative data available at this time.
Day Care Unit MDS data
2013 - 2014
2012 - 2013
Treetops
Hospice
Treetops
Hospice
National
Median
Total number of patients
240
224
228
% Places used
100
92
58
% New patients
% New patients with a non-cancer
diagnosis
% New patients aged over 84
50
48
66
39
39
19
16
22
12
The total number of patients has gone up by 7% and our percentage of new
patients has remained at about 50%.
Our high occupancy rate (100%) reflects our commitment to making the most
effective use of the resource.
We have an unusually high percentage of patients with a non-cancer
diagnosis (39%) which highlights our dedication to providing care for all
palliative conditions.
The percentage of patients aged over 84 at time of referral has gone down
this year although 43% of new patients were over 75 years old, reflecting the
profile of an aging population.
13
Hospice at Home MDS data
2013 - 2014
2012 - 2013
Treetops
Hospice
Treetops
Hospice
National
Median
Total number of patients
711
652
572
% New patients
% New patients with a non-cancer
diagnosis
% New patients aged over 84
87
92
87
23
27
16
26
27
20
% Home deaths
82
82
64
The percentage of patients aged over 84 at referral has remained high,
corresponding to the demographics of the general population.
The percentage of our Hospice at Home patients who die at home has
remained at 82% by comparison with the Office of National Statistics data for
all deaths which show that 21.8% of people died at home and 51.5% in
hospital. The PRISMA survey of preferences in 2010 showed that 45% of
people aged over 75 years would prefer to die at home.
(MDS Full Report for the year 2012 - 2013).
In addition to this, 79% of our Hospice at Home patients who had a recorded
preferred place of care/death achieved their choice.
Bereavement Service MDS data
2013 - 2014
2012 - 2013
Treetops
Hospice
Treetops
Hospice
National
Median
Total service users
334
242
184
% New service users under 16 years
18
24
1.7
% New service users 16-24 years
9
6
3
% of deceased with non-cancer diagnosis
41
50
7
Our Bereavement Service is very unusual in Hospice terms as we accept
referrals from anyone in the community regardless of any previous association
with Treetops Hospice. We also provide bereavement support to children and
young people under 18 years old.
The impact of this is that our Bereavement Service supports a much larger
than average percentage of clients dealing with non-cancer related deaths,
including unexpected deaths. This is especially significant in our Children’s
Service where 25% of new service users presented with issues related to
traumatic death by accident, suicide or murder and a further 25% from
unexpected health related deaths such as ruptured aneurysm or heart attack.
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What our staff says about the organisation
For the past four years Treetops Hospice has surveyed their staff by investing
in the Help the Hospices Birdsong Hospice staff survey.
Following last year’s decline in reported staff confidence in communication
within the organisation, the Board of Trustees and the Senior Management
Team instigated measures such as improvement of the internal website,
providing all remote and retail sites with internet access and email accounts,
enhancement of the internal staff and volunteer newsletter and held the first
ever Treetops Hospice staff conference in May 2013.
The effect on staff response has been marked and is shown below.
Treetops staff % response to communication statements
2011
2013
92
100
80
2012
69
67
61
62
60
60
42
40
42
38
20
0
I feel well informed about
Communication between Senior management are well
what is happening within the different teams/departments informed about what other
charity
is effective
staff think and do
As in previous years, our results as measured against other hospices were
very encouraging with the comparison for the same statements shown below.
Hospices responses to communicaton statements
Treetops Hospice
100
90
80
70
60
50
40
30
20
10
0
All hospices
92
66
67
60
36
38
I feel well informed about
Communication between Senior management are well
what is happening within the different teams/departments informed about what other
charity
is effective
staff think and do
15
Complaints and compliments
Complaints
During 2013 – 2014 we received no clinical service complaints.
Compliments
In addition to the positive evaluations of our services, we also received 114
individual cards and letters of thanks during the year and 80% of our in
memoriam donations came from the families and carers of those who were
cared for by our services.
“I would like to thank you all for your care and compassion which you gave to
my wife. She loved coming to Treetops.”
“The work you do allows families like us to care for our loved ones and keep
them at home with us in the most difficult of times. We hope this donation
goes a little way to helping you support another family who so desperately
needs help like yours.”
“A heartfelt thank you to all who looked after our mother, helping to make it
possible for her to be in her own home as was her wish.”
“We would like to thank your nurses who helped us through our most difficult
time with dignity and care. Please accept this donation towards helping
others.”
“I am so grateful for the assistance of a very professional outfit with wonderful
staff. I was in awe of their interpersonal skills. My mother got her wish to die at
home, made so much more comfortable by you guys.”
Patient Safety Indicators
Patient safety is paramount to our Day Care unit and all incidents are reported
and logged. We ensure that every incident is assessed, relevant risk
assessments reviewed and any wider implications are considered.
Number of patient slips, trips and falls
Number of falls resulting in fracture
2
0
We have a Health and Safety committee, made up of staff and trustees, who
meet quarterly and receive departmental reports. They review and drive
forward the health and safety action plan and scrutinise all accidents and
incidents in order to identify trends.
16
Part 4: Priorities for 2014 – 2015
1. To open the new Clinical Support Centre that will be known as the
Cheetham Centre in recognition of our founder, Cally Cheetham.
Our new Clinical Support Centre has been built in the hospice grounds and
will open in June 2014. This will allow Clinical Services to be developed in line
with the five year strategy.
2. To develop and enhance Day Care Services
A new role of Day Care Services Manager has been introduced that will have
wider responsibilities than that of the current Day Care Unit Manager. The
main difference will be the added responsibility of the introduction and
management of a new Support and Information Service based in the
Cheetham Centre.
We will be aiming for closer working partnerships with specialist health
professionals involved with the care of our client group e. g. heart failure and
respiratory nurses, and we will continue to explore the introduction of
nurse- led clinics into the Day Care Unit.
We will continue to work towards broadening both the psychological and
occupational activities offered in Day Care to promote and enhance the
guests’ experience.
The supportive services of both Complementary and Art Therapies will be
reviewed to achieve a more integrated and therapeutic approach. We will
also be re-launching our peripatetic Complementary Therapy Service
following the recruitment of a new nurse/complementary therapist who will
offer treatments in people’s own homes to those who are unable to travel to
the hospice.
3. To review Carers’ Support
A carers’ development worker has been recruited on a five month temporary
contract to explore a much more client-led carers’ service which will look at
developing programmes that relate to specific illnesses, symptoms or long
term conditions.
4. To develop Hospice at Home Services
During the year, the co-ordination team will move into more suitable
accommodation in the Cheetham Centre, which includes a private office for
such things as making condolence calls, appraisals and 1-1
meetings/supervision.
Our aim is to increase Hospice at Home provision to 33,000 hours and
continue to consider expansion of the Hospice at Home service into new
geographical areas.
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We intend to map the source of our referrals to the Hospice at Home service
against GP practices to identify areas where hospice care at home is not as
frequently being accessed. We will then work with community health care
professionals to promote the service in these areas.
We will also aim to maintain the very high level of service satisfaction reported
in our carer evaluations.
5. To continue the nursing team development programme
One of our RCN learning representatives is due to leave the organisation
mid-year but the remaining nurse educator is keen to continue to develop and
support the programme.
One of the Day Care HCAs will attend a course to become a certified manual
handling trainer to support our existing trainer.
A new full time senior staff nurse will be appointed during the year to replace
the existing 30 hour post holder who is retiring. He/she will be jointly
responsible for the organisational manual handling and infection control
training.
6. To develop the Bereavement Service
The move into the Cheetham Centre will reinstate the Bereavement Service
from its current off-site location to within close proximity to the rest of our
clinical services.
The stand-alone, sensitively designed centre will provide user-friendly access
to support and care which it is hoped will make the visiting experience less
intimidating.
The new centre will have five counselling rooms for adults and three for
children and families. The increased availability of space, which includes two
group therapy rooms, will allow far more flexibility e.g. the development of
various groups such as people bereaved by suicide, widowed parents,
teenage groups etc.
It is intended to promote and develop a student placement educational
programme which will also be opened to external paying professionals, to
create a centre of excellence and learning in relation to bereavement work.
Additional students will be recruited on a rolling basis. There is a high demand
for placements which allows us to select only the most competent and
committed candidates.
There is also the scope to recruit and train further volunteers as demand
requires although this would have an impact on management and supervision
of such a large team.
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As part of the strategy to increase referrals, we have commenced a
programme of approaching agencies such as GP practices and schools that
have not accessed our service before.
7. To launch and develop a new Support & Information Service
Our most exciting development will be the opening of a NEW Support and
Information Service which will be launched in the autumn of 2014, following
the appointment of a Clinical Nurse Specialist (CNS) who will be responsible
for the project with support from trained volunteers.
The service will provide help for those diagnosed with, or affected by, a lifelimiting illness, in making sense of their individual situation. This will include:

access to medication and symptom control advice

counselling and support

a benefits advisory/information service

an internet resource and library service
8. Partnership working
The Director of Clinical Services will continue as an active member of the
Southern Derbyshire End of Life group, with an on-going commitment to
improved collaboration and integration of End of Life care.
Additionally, with the nationally agreed withdrawal of the use of the term and
concept of End of Life care pathways, the director has also been involved in
the development of a supportive care plan that can follow a patient on their
End of Life journey and promote delivery of high quality care.
Gold Standard Framework for hospices
During the year, Treetops will be investing in the adoption of a new Gold
Standard Framework (GSF) for hospices.
Although we recognise that, as an End of Life care provider, we already have
many of the skills and practices required to achieve the standard, two senior
staff have been tasked to look at ways of improving working practice for our
clinical teams. Initially they will conduct surveys to establish a baseline of staff
confidence in respect of delivering a gold standard service, thereby identifying
areas for training and development.
We will also be looking at best practice for co-ordination of care across the
wider health and social care community, to promote the standard such that all
patients that meet the criteria for GSF are identified, registered and benefit
from the full range of Treetops Hospice services.
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Southern Derbyshire
Clinical Commissioning Group
Quality Account 2013/2014
Treetops Hospice
STATEMENT
GENERAL COMMENTS
NHS Southern Derbyshire Clinical Commissioning Group (the CCG) is the coordinating commissioner for the NHS contract held with Treetops Hospice. In this
role the CCG is responsible for ensuring pre-publication clearance of the Quality
Account produced by the Charity for 2013/14.
The production of a Quality Account is not currently a mandatory requirement for
independent sector providers of NHS funded care but it is considered good
practice and Treetops are to be congratulated on the completion of their second
quality account.
COMMENTARY
The Quality Account submitted by Treetops Hospice has been reviewed by the
CCG and is pleased to confirm that it agrees with all the contract related data that
is stated in the Quality Account.
This is the second Quality Account that has been produced by Treetops Hospice
which gives a good overview of the year 2013/14, fully reflecting the tremendous
amount of work that has been undertaken within the organisation including
comprehensive priorities for 2014/15.
Treetops have had a notable successful inspection from CQC this year, achieving
all the five core standards. This is indicative of a high quality and clinically
effective service. The Clinical Support Centre is almost complete and will provide
additional support services to patients, staff and the public leading to further
improvements in patient experience.
Treetops Hospice continue to have an active role in the End of Life
Implementation Group to set out a vision for the development of end of life
services for the people of Southern Derbyshire and Erewash by working
strategically with partner organisations.
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