Butterwick Hospice Care
Butterwick Adult Hospice
Stockton on Tees
Quality Account
2013-2014
Butterwick Hospice
Middlefield Road
Stockton on Tees
TS19 8XN
Registered Charity 1044816
Our Mission Statement and Philosophy
Why we are here
We aim to improve the quality of life for those who have a progressive life limiting illness and
those close to them and to offer positive support for every challenge they may encounter
during their illness
and to see death as part of life’s journey.
In particular we will:
Provide supportive and specialist palliative care for adults with progressive life limiting
conditions
Ensure each person receives care in a homely environment whilst maintaining privacy, dignity
and choice.
Provide holistic centred care by responding to and respecting the patient and those close to
them by meeting their individual, physical, social, cultural, educational, spiritual and
emotional needs throughout the illness and bereavement.
Acknowledge and respect the way those close to the patient care for them and endeavour to
continue their chosen pattern of care.
Work together in developing an environment based on support and mutual respect.
Maintain the high quality of the service through ongoing reflection, evaluation and education.
Communicate effectively and efficiently both within the Hospice and with external agencies, to
ensure continuity of care and promote service development.
Part 1:
Chief Executive’s Statement
It gives me great pleasure to present the second Quality Account for the Butterwick
Adult Hospice, Stockton on Tees.
The Hospice is an integral part of Butterwick Hospice Care (registered charity
1044816) which provides services from three separate Hospices in the North East of
England. All of the Hospices’ services are provided totally without charge to our
patients and their carers.
The day to day management of the Butterwick Adult Hospice, Stockton on Tees
clinical services is under the leadership of Mrs Carole Harrison who is designated
the Registered Manager in the Hospice’s registration with the Care Quality
Commission.
The Butterwick Hospice endeavours to provide an excellence in evidence based
palliative care for all patients regardless of age or diagnosis; to be a centre of
expertise and a specialist resource within the community as a whole.
The needs of patients and their carers are paramount to the Charity’s existence and
are the root and focus of all we do.
Quality is at the core of the Charity’s strategic and operational priorities.
An independent impartial assessment of the quality of care provided was
obtained when the Care Quality Commission performed a routine unannounced
inspection of the Hospice on 28th August 2013. Their Report showed that the
Hospice was meeting all of the required standards. A copy of their full Report is
available at : www.cqc.org.uk/directory/1-113000508.
During the last year we have worked effectively in partnership with the Hartlepool &
Stockton on Tees Clinical Commissioning Group and other partners for the benefit
of the community we freely serve.
In the year the Hospice has achieved the Commissioning for Quality and Innovation
(CQUIN) outcomes detailed in the 2013/14 Contract with NHS Tees.
The Charity only achieves its key objectives because of the professional skills,
commitment and enthusiasm of our staff and volunteers
I am responsible for the preparation of this report and its contents. To the best of my
knowledge, the information reported within this Quality Account is accurate and a
fair representation of the quality of healthcare provided by our Hospice.
Graham Leggatt-Chidgey
Chief Executive
May 2014.
Part 2: Priorities for improvement and statements of assurance from
the board (in regulations)
1.
IMPROVEMENT
Within the Organisation, quality is fundamental to improvement and accountability. The Board
of Trustees continues to support and promote the ongoing development and improvement of
services to ensure that the care and support provided evolves to meet patient and carer
needs.
The priorities for quality improvement for 2014/15 are set out below.
These priorities have been identified in conjunction with patients, carers, staff and
stakeholders. The priorities we have selected will impact directly on each of the three priority
domains:

Patient safety

Clinical effectiveness

Patient experience
Part 2 Priorities for improvement 2014-2015 and Statements of
assurance from the Board (in regulations)
Section 2.1 Priorities for improvement 2014-15.
Patient Safety

Priority One
Formalise regular education sessions for clinical staff as part of the
Palliative Care Consultant sessions at the Hospice.
How was this identified as a priority?
Following the successful appointment of a Palliative Care Consultant at our neighbouring Trust
and the formalising of the three consultant sessions to the hospice, we were keen to ensure
that the three sessions were used as effectively as possible to benefit patients and staff.
As we were developing services within the adult hospice which included caring for patients
with more complex palliative care needs and undertaking additional procedures, we believed it
was important to use one of these sessions for the education of staff which would ultimately
benefit patients.
How will Priority One be achieved?
Fortnightly education sessions lasting one hour take place between 2-3pm either within the
sitting room area on the in-patient unit or in the education room, depending on the subject
and if any resources are required. This time slot is when the morning and afternoon shift are
both on duty, thereby enabling more staff to benefit from the sessions.
The topics covered are influenced by experience on the unit where a case review may be
discussed or a topic identified by staff to meet specific interest or need.
Staff are also encouraged to participate in these sessions which may include facilitating a
group discussing an article they have read or an issue that is very relevant to the palliative
care national or local agenda.
How will progress be monitored and reported?
Attendance at sessions is recorded in the hospice’s training book and entered onto the
training database. All sessions are evaluated and the evaluations are sent to the Quality and
Practice Development nurse.
Participation by staff e.g. by leading a session will be discussed in staff’s annual Individual
Development Review (IDR) and encouraged as part of staff development.
These sessions will help staff develop skills and confidence in relation to complex management
of patient symptoms, help them cope with difficult situations and challenges through case
reviews and offer opportunities for staff to develop skills in facilitating groups and presenting.
We expect to notice changes in individual staff in regards to their coping strategies and
confidence and this will be monitored by the Clinical Lead within the area of practice.
2b Clinical Effectiveness

Priority Two
Introduction of a Breathlessness Support Programme
How was this identified as a priority?
In response to an invitation for non –recurrent funding applications, a neighbouring hospice
proposed a programme for patients with heart failure and Chronic Obstructive Pulmonary
Disease. As this proposal was discussed further with the CCG, the programme developed into
a support programme for patients with long term and progressive pulmonary conditions. The
CCG were keen to provide equality of service over the whole of Tees and Hartlepool and
therefore Butterwick Hospice were asked if they could provide an equivalent service in the
Stockton area.
In their 2010 publication relating to the management of Chronic Obstructive Pulmonary
Disease in adults in primary and secondary care, the National Institute for Health and Clinical
Excellence stated an estimated 3 million people have COPD in the UK and recognised that
these patients require support from various members of the multidisciplinary team. (NICE.
June 2010). Whilst this is a significant number of patients we must also acknowledge that
breathlessness can be related to other cardiac and pulmonary conditions.
This programme is to therefore help meet the needs of these patients by establishing a
support service for patients who have symptoms of breathlessness related to a progressive
non-cancer diagnosis e.g. COPD, Emphysema, pulmonary fibrosis and by doing so, also
provide a support network for their carers.
The vision of the Clinical Commissioners for Hartlepool and Stockton-On-Tees is to improve
health care by involving service users, carers, staff, providers, partners and the public to
develop services and reduce health inequalities by working in partnership to transform
services.
The Joint Health and Wellbeing Strategy for Stockton-On-Tees 2012-2018, recognises the
need to “Enhance the quality of life for people with Long Term Conditions” and to “increase
primary and community services to support care closer to home and enable independent
living”. (JSNA 2012)
The programme embraces the challenges of health care provision and aims to work within
local strategy requirements to provide safe, high quality, cost effective care.
Many patients experience increased breathlessness for various reasons throughout their
illness progression. These symptoms are extremely distressing for the patient and also
traumatic for the carer involved in supporting the patient. Patients are often cared for by
members of their own family who may not have any experience in health care. Carers often
state that the worst thing is not being able to do anything to help the patient when these
exacerbations occur. This can often lead to patients or carers contacting emergency services
and patients being admitted to hospital who could perhaps have remained at home given the
appropriate support.
The programme therefore focuses on helping patients recognise and identify the triggers
which contribute to their exacerbations of breathlessness, develop coping strategies and selfmanagement skills to enable them to cope at these times. The overall aim is to reduce the
patient’s dependency on out of hour’s community resources as well as reducing the number of
inappropriate admissions to the acute sector.
How will priority two be achieved?
A key objective of the programme is to work alongside other care providers in primary and
secondary care to support patients and their carer’s in the self-management of ongoing
symptoms throughout their disease progression.
In order to provide equitable care across the commissioning locality, referral criteria are
identical across the Hartlepool and Tees area and the aims and objectives of the programme
are mirrored across both Butterwick and Hartlepool Hospice. Referral criteria were agreed
and a specific referral form formulated.
A series of joint meetings have taken place with our neighbouring hospice as well as several
meetings between staff at Butterwick Hospice, Community Matron and Respiratory Specialist
Nurse.
Core objectives of the programme are to:




Provide an integrated support service working in collaboration with primary and
secondary care.
Provide patients with self-management tools.
Increase social inclusion and peer support.
Deliver an innovative high quality service.
Signposting to other appropriate services.
The programme consists of:



1
2
2
1
day per week of specialist day services for 6 weeks.
individual and 2 group counselling / psychotherapy sessions.
complementary therapy sessions
complementary therapy session for patient’s main carer.
In addition during the 6 week programme patients will experience and have access to:






Weekly relaxation session
Weekly Tai Chi session
Access to diversional activities such as creative writing
One to one advice and support from nursing staff during weekly sessions
Benefits advice
Bespoke support for smoking cessation and medicine management where
applicable to patients
Carers will have access to tuition in providing hand or foot massage
The majority of patients will be identified and referred to the service by the Respiratory
Specialist Nurses at University Hospital of North Tees (UHNT) and the Community Matrons
who will be able to identify patients who could benefit from this programme and who may
already have had hospital admissions for anxiety related breathlessness or may have the
potential to do so.
Following the structured 6 week period the patients will be referred back to the original
referrer.
Non –recurrent funding from the CCG has enabled this 12 month pilot programme to take
place and will be evaluated in regards to continuing funding after the 12 month pilot.
How will progress be monitored and reported?
The service will be audited/evaluated quarterly using recognised audit tools to identify patient
and carer benefits and any areas for improvement. i.e.

Key Performance Indicators determined by the clinical commissioners.

Patient/Carer feedback in the form of a questionnaire. (MYCAW, Family & Friends Test)

Referrer feedback questionnaire.
The findings of audit and evaluations will be used to drive the service forward throughout the
programme.
Quarterly reports will be sent to the CCG in addition to patient and carer evaluation feedback
following each 6 week programme.
2c Patient Experience

Priority Three
Establish a service user advisory group
How was this identified as a priority?
We are aware that patient or service user groups have been established in the acute sector
for some time and also that other hospices have successfully created groups of carers/service
users which have been very beneficial in providing a patient/user perspective on services
provided, new services being developed and information being provided to people using the
services.
Nationally it is seen as good practice to involve patients or carers in these discussions and
many organisations have a patient or carer representative attending multi-disciplinary
meetings.
We have discussed the value of having our own service user group in several clinical meetings
but were aware of the difficulties in finding suitable representatives due to the nature of the
service where patients may be too poorly to contribute or may have a short life expectancy
and would be difficult to establish continuity for the group.
Following our stakeholder questionnaire last year, valuable comments were received in
regards to what the professionals thought would be beneficial for their patients, both in
regards to types of services provided, activities offered within the Day Care setting and
whether the taboo surrounding hospice care prevented many patients attending and
benefitting from the services offered by the Hospice.
We have developed new services over the last few months which have required patient
leaflets as well as information for professionals to be designed and developed and believe that
a specific service user group would be particularly beneficial when developing these;
especially regarding the language and terminology we so often use and take understanding
for granted.
We therefore decided that in order to benefit from the direct views of the people actually
using our services or we would make this one of our priorities for 2014/15.
How will priority three be achieved?
We will consult with other hospices who have successfully established a similar group.
We will also formulate and agree terms of reference for the group in order that the group will
have a clear purpose and aims.
As part of our patient/user satisfaction surveys we will ask for interested parties to express
their interest.
In September we plan to hold an open event for the public which will enable people to have a
tour, view the facilities, learn about the services available and during this event we will have
information available about the service user group and enable them to express interest in
joining this representative group.
How will progress be monitored and reported?
The recruitment of suitable representatives will be a key achievement. The group will meet
with and feedback to the Director of Clinical Services at regular intervals.
Key projects which the group should be involved in and any leaflets which require to be
formulated will be identified at the monthly meeting of Clinical Managers which are minuted.
Group members will be asked to evaluate the group’s activities in respect of the objectives
laid out in the Terms of Reference annually.
Section 2.2 Review of services
During 2013/14 the Butterwick Adult Hospice at Stockton on Tees provided three key
services:

To provide a 24 hour, 7 days a week in-patient service.

To provide a day hospice service four days each week (Tuesday to Friday).

To provide nursing, medical care, counselling, advice, complementary therapies and
bereavement support to patients, their carers and relatives.
The Butterwick Adult Hospice at Stockton on Tees has reviewed all the data available to us on
the quality of care in all of the above services.
The income generated by the NHS services reviewed in 2013/14 represents 100% of the total
income generated from the provision of NHS services by the Butterwick Adult Hospice,
Stockton on Tees for 2013/2014.
The income generated from the NHS represents
approximately 28% of the overall patient care costs incurred by the Hospice.
Section 2.3 Participation in Clinical Audits, National Confidential Enquiries
During 2013/14 no national clinical audits and no national confidential enquiries covered NHS
services relating to palliative care.
During that period Butterwick Adult Hospice, Stockton on Tees, participated in no national
clinical audits and 0% national confidential enquiries of the national clinical audits and
national confidential enquires. The Butterwick Adult Hospice, Stockton on Tees only provides
palliative care therefore were ineligible to participate.
The following mandatory statements are therefore not applicable to Butterwick Adult Hospice
Stockton on Tees:
“The national clinical audits and national confidential enquiries that [name of provider] was
eligible to participate in during [reporting period] are as follows: [insert list].”

“The national clinical audits and national confidential enquiries that [name of
provider] participated in during [reporting period] are as follows: [insert list].”

“The national clinical audits and national confidential enquiries that [name of
provider] participated in, and for which data collection was completed during
[reporting period], are listed below alongside the number of cases submitted to each audit
or enquiry as a percentage of the number of registered cases required by the terms of that
audit or enquiry. [Insert list and percentages].”

“The reports of [number] national clinical audits were reviewed by the provider in
[reporting period] and [name of provider] intends to take the following actions to improve
the quality of healthcare provided [description of actions].”
Following attendance at a Help the Hospice’s Quality and Audit event during 2013/14, we
decided to participate in the National Hospice in-patient safety benchmarking pilot. The audit
focuses on patient falls, pressure ulcers and medication incidents. Following the gathering of
data from approximately 100 hospices we expect to receive the first report from Help the
Hospices in the next few weeks.
Local Clinical Audit and Service Improvement
Butterwick Adult Hospice undertakes a series of audits in accordance with Butterwick Hospice
Care’s comprehensive annual audit programme.
The audit programme includes nationally validated audits from Help the Hospices where
available, internally designed audits and external infection control audits in line with the
Service Level Agreement with our local NHS Trust.
Some examples of these audits, undertaken in the Adult Hospice during 2013/14, are included
in this report on the following pages.
Record Keeping Audit
Introduction
Record Keeping is integral to nursing care. It is essential that good standards of record keeping are established and maintained.
The audit tool is to be used for auditing standards of record keeping across all sites and services offered by Butterwick Hospice Care. It is divided
into generic and service specific sections. Part A is generic and to be completed for all services. The other sections contain criteria which are
specific to individual services and the relevant section is to be completed in addition to the generic section.
The form can audit details of up to 8 patient records. The number of records auditing will be appropriate to the service.
Criteria
The assessment is made using the entries recorded in the last 3 months or on last admission if this is longer than 3 months.
Results
6 sets of notes were audited covering 27 criteria. Out of the 6 sets of notes 19 of the criteria were met and 3 were almost met. This leaves 5 of the
criteria not met. The following points were identified:
UNMET CRITERIA
 All set of notes had entries that had not been timed. All entries must be timed as this is the proof that the entries are chronological.
 All sets of notes some of the entries did not include the designation of the person making the entry. All entries must include the designation
of the person making the entry.
 Not all of the sheets had the patients Palcare number recorded on each sheet. This was evident in all 6 sets of notes. The palcare number must
be recorded on each separate sheet.
 Not all of the staff had signed the sample signature sheet. Any clinical member of staff making an entry in the patient’s notes must complete
the sample signature sheet.
ALMOST MET CRITERIA
 Any alterations to the text should be scored out with a single line, dated and signed. Most staff do score out alterations and initial the change,
but we must sign and date any alterations in order to meet the criteria fully
 One set of notes did not have the patient’s preferred name documented. It is important that this information is recorded.
 One of Sample signature sheets did not have the patients palcare number recorded
BUTTERWICK HOSPICE CARE
RECORD KEEPING AUDIT TOOL
This audit tool is to be used for auditing standards of record keeping across all sites and services offered by Butterwick Hospice Care. It is divided
into generic and service specific sections. Part A is generic and to be completed for all services. The other sections contain criteria which are
specific to individual services and the relevant section is to be completed in addition to the generic section.
This form can audit details of up to 8 patient records. The number of records auditing will be appropriate to the service. It may be necessary
therefore to use two sheets in areas where a greater number of patients use the service. Please enter PAL number of the record being audited where
indicated and tick yes or no under the relevant column. When scoring the criteria use entries made in the last 3 months or on last admission if this is
longer than 3 months.
* Criteria 6 & 7:- NMC guidelines (July 2009) state that printed name and designation need only be stated after the first entry. However, within
Butterwick Hospice Care, if the patient record consists of separate sheets it is recommended that the printed name and designation should be entered
after the first entry on each separate sheet and this is the standard to be assessed.
Dept/Service
In-Patient Unit
Date of audit
Person(s) completing audit
16/10/2013
Lesley Blakemore.
Quality & Practice Development Nurse
PART A GENERIC (To be completed for all record keeping audits)
Pal No. of record  20130174
20130191
Criteria 
Yes No Yes No
A1 All entries are in black ink
√
√
A2 All entries are dated
√
√
A3 All entries are timed
X
X
A4 All entries use the 24 hour clock or
√
√
clearly state am or pm
A5 All entries are signed with full
√
√
signature (where space allows) or
initials (where space is restricted).
A6 Name of person making entry is
X
X
printed next to the signature. (* see
20130051
Yes No
√
√
X
√
20130096
Yes No
√
√
X
√
20130218
Yes No
√
√
X
√
20130195
Yes No
√
√
X
√
√
√
√
√
X
X
X
X
Yes No
TOTALS
Yes No YES NO
6
0
6
0
0
6
6
0
6
0
0
6
Pal No. of record 
Criteria 
note above)
A7 The designation of person making
the entry is stated after the signature.
(*see note above)
A8 Patients name is on all
documentation sheets.
A9 Patient’s PAL number is stated on all
documentation sheets.
A10 All entries are legible.
A11 All alterations are scored out with a
single line, dated and signed.
A12 There are no gaps between entries.
A13 All entries are in chronological
order.
A14 Irrelevant, speculative, offensive or
subjective statements are not used.
A15 Highlighter pen is not used.
A16 An up-to-date sample list of
signature and initials with staff name
and designation is included in the
patient’s records.
A17 Sample signature list states the name
and PAL no. of the patient to which
the sheet refers.
A18 Patient’s preferred name is
documented.
A19 A risk assessment is identified in the
patient’s care plan where indicated.
A20 Where a risk assessment is
identified, this is completed and
contained in the patient
20130174
Yes No
20130191
Yes No
X
√
X
√
X
√
20130051
Yes No
20130096
Yes No
X
√
X
20130218
Yes No
X
√
X
20130195
Yes No
X
√
X
X
√
X
X
Yes No
TOTALS
Yes No YES NO
0
6
6
0
0
6
√
√
√
√
√
√
√
√
√
√
6
5
0
1
√
√
√
√
√
√
√
√
√
√
√
√
6
6
0
0
√
√
√
√
√
√
6
0
√
√
√
√
√
√
6
0
0
6
X
X
X
X
X
X
X
√
X
√
√
√
√
5
1
√
X
√
√
√
√
5
1
√
√
√
√
√
√
6
0
√
√
√
√
√
√
6
0
Pal No. of record  20130174
Criteria 
Yes No
documentation.
A21 All entries are signed or
√
countersigned by a qualified
practitioner.
A22 Where abbreviations are used, there
√
is a sheet explaining what these
mean.
B1
B2
B3
B4
B5
B6
Is an ‘active decisions’ sheet
completed?
Have ALL sections of the in-patient
information sheet been completed
and signed?
Has the Braden Scale been
completed and reviewed as directed.
Have ALL sections of the patient
profile been completed?
Have ALL sections of the PAL care
form been completed and evidence
of details being checked?
Catheter care. If applicable: Has the
overnight drainage bag been changed
in accordance with best practice.
20130051
Yes No
20130096
Yes No
20130218
Yes No
20130195
Yes No
√
√
√
√
√
6
0
√
√
√
√
√
6
0
√
√
√
√
√
√
6
0
√
√
√
√
√
√
6
0
√
√
√
√
√
√
6
0
√
√
√
√
√
√
6
0
√
√
√
√
√
√
6
0
n/a
n/a
n/a
n/a
n/a
n/a
0
0
RESULTS:
TOTAL COMPLIANCE
A-GENERIC
B-IN-PATIENT UNIT
C-CHILDREN’S UNIT
COLLATED BY:
TOTALS
Yes No YES NO
20130191
Yes No
PERCENTAGE
75%
100%
N/A
LESLEY BLAKEMORE
Quality and Practice
Development Nurse.
SIGNATURE:
Lesley Blakemore
Yes No
COMMENTS AND ACTION PLAN FOLLOWING A RECORD KEEPING AUDIT
This form is to be completed following each record keeping audit. Please give comments where appropriate where criteria are not fully met and
complete action section to show how your department aims to increase the level of achievement for the specific criteria.
Please send a copy of your results to the Quality and Practice Development Nurse for monitoring purposes and collation into the
organisation’s audit log.
Dept/Service
Completed by: Signature
Criteria
No.
A3
A6
A7
A9
A11
A16
In-Patient Unit
Lesley Blakemore
Comments
6 sets of notes had entries that did not indicate
the time they had been written.
6 sets of notes did not have the name of the
person making the entry.
6 sets of notes did not have the designation of
the person making the entry.
6 sets of notes did not have the pal care number
on all of the sheets
Not all alterations were signed and dated. All
alterations were crossed out legibly and
initialled but not signed and dated as required.
Not all of the staff signed the sample signature
sheet.
Date of audit to which this sheet relates.
16/10/13
Name and
Lesley Blakemore
Designation
Quality & Practice Development
Action Plan
By whom
By when
A memo will be circulated to remind all staff
that any entries must be timed.
This criteria will be discussed at the
documentation group. A sample signature sheet
is used within the notes.
A memo will be circulated to remind all staff
that they must include their designation when
making any entry into the notes
A memo will be circulated to remind all staff
that each of the sheets must have the patients
palcare number recorded.
A memo will be circulated reminding staff of
the correct process for alterations
Lesley Blakemore
Lesley Blakemore
25th October 2013
A memo will circulated to remind all clinical
staff of the need to complete the sample
signature sheet.
Lesley Blakemore
25th October 2013
25th October 2013
25th October 2013
Lesley Blakemore
25th October 2013
Lesley Blakemore
25th October 2013
Lesley Blakemore
Criteria
No.
A17
A18
Comments
1 set of notes did not have the patients Palcare
number recorded on the sample signature sheet.
1 set of notes did not have the patients preferred
name documented.
Action Plan
A memo will be circulated to remind all staff
that the patients Palcare number must be
recorded on the sample signature.
A memo will be circulated to remind all staff
that the patients preferred name must be
recorded.
By whom
By when
25th October 2013
Lesley Blakemore
25th October 2013
Lesley Blakemore
BUTTERWICK HOSPICE CARE
MEDICINE KARDEX AUDIT TOOL
This audit tool is to be used for auditing the standards of medication prescribing and completion of Medicine Kardex within the In- Patient Unit.
The tool is based around Sub Topic 4 of the Help the Hospices National General Medicines Audit tool and tailored around the medicine kardex used
by the organisation.
This form can audit up to 6 kardex’s. The number of kardex’s audited will be appropriate to the number of patients in the unit at the time of the
audit.
TITLE OF AUDIT.
MEDICINE KARDEX
Audit undertaken
by:- Name and
Designation
Lesley Blakemore
Dept/Site to which
the audit relates
IN-PATIENT UNIT
Date of audit
16/10/13
SIGNATURE:
Quality & Practice Development Nurse
Number of Kardex’s
6 Pal care No of
audited.
Kardex
Criteria: 1
Patient information.
1.1
The name of the patient?
1.2
Date of birth of the patient?
1.3
Hospice number of the patient?
1.4
Information on any known allergies or
hypersensitivities?
Criteria: 2
Regular medicines prescribed have the
following
2.1
Name of medicine using the generic or
brand name as appropriate?
2.2
Dose of medicine?
20130174 20130191 20130096 2013051
20130218 20130195 TOTALS
Yes
Yes
No
Yes
No
Yes
No
Yes
No
No
√
√
Yes
No
YES
NO
n/a
6
6
4
6
0
0
2
0
0
0
0
0
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
6
0
0
√
√
√
√
√
√
6
0
0
X
X
2.3
2.4
2.5
2.6
2.7
Date of prescribing?
Weight of patient where the dosage of
medication was related to weight?
Route of administration of medicine?
Frequency for administering each dose?
Time for administering each dose?
Number of
Kardex’s audited.
2.8
2.9
6
Pal care No of Kardex
√
n/a
√
n/a
√
n/a
√
n/a
√
n/a
√
n/a
6
0
0
0
0
6
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
6
6
6
0
0
0
0
0
0
20130174 20130191 20130096 2013051
20130218 20130195 TOTALS
Yes
√
√
Yes
√
√
No
Yes
√
√
No
Yes
√
√
No
Yes
√
√
No
No
Yes
√
√
No
YES NO n/a
6
0
0
6
0
0
2.1
3.2
3.3
Signature of prescriber?
Information on any known allergies or
hypersensitivities?
Any special requirements/instructions?
As required (PRN)/ Variable doses
prescribed have the following:
Name of medicine
Dose of medicine
Route of administration of medicine
3.4
3.5
Signature of prescriber
Date of prescribing
√
√
√
√
√
√
√
√
√
√
√
√
6
6
0
0
0
0
3.6
Frequency/Instructions
√
√
√
√
√
√
6
0
0
Criteria: 4
Each prescription is:
Written clearly (handwritten or
preferably computer generated)?
Indelible (handwritten or preferably
computer generated)?
Entries for replaced prescriptions are
deleted clearly, preferably as a
strikethrough to avoid duplication of
medication.
√
√
√
√
√
√
6
0
0
√
√
√
√
√
√
6
0
0
√
√
√
√
√
√
6
0
0
2.10
Criteria: 3
4.1
4.2
4.3
√
√
√
√
√
√
6
0
0
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
6
6
6
0
0
0
0
0
0
RESULTS:
TOTAL
COMPLIANCE
CRITERIA 1
CRITERIA 2
CRITERIA 3
CRITERIA 4
COLLATED BY:
PERCENTAGE
91%
100%
100%
100%
LESLEY BLAKEMORE
Quality and Practice
Development Nurse.
SIGNATURE:
Lesley Blakemore
PATIENT SATISFACTION SURVEY 2013/14
Which Service was used
%
100
80
60
40
79
20
21
0
0
0
0
Day hospice Bishop
Auckland
Outreach at
Sedgefield
Outreach at
Stanhope
0
0
In patient unit
stockton
Day hospice
stockton
Outreach at Barnard Home Care Durham
Castle
Dales
Impressions
very satisfactory
Satsified
somewhat satisfied
very dissatisfied
Not Applicable
100
80
60
40
82
91
87
92
85
84
94
92
78
3 00 4
4 00 4
Overall
impression of
the hospice
13 0 0 9
Staff Attitude
6 00 9
Patient
information
6 0 010
Regular
handwashing
or using hand
gel by staff
3 00 5
Explanation of
facilities
4 00 5
The
cleanliness of
the hospice
5 00 8
The hospice
facilities
Reception
area and
greeting
8 0 010
0
Did you feel
safe
20
Were you offered Complementary Therapy?
100
80
60
95
40
20
1
4
No
No answer
0
Yes
How beneficial did you find this?
100
80
60
40
67
20
14
0
0
19
Satisfied
Somewhat
Satisfied
Very
Dissatisfied
Not applicable
0
Very
Satisfactory
How well did we communicate information to you?
Very Satisfactory
Satisfied
Somewhat Satisfied
Very Dissatisfied
Not applicable
100
80
60
75
66
57
51
9 0 0 25
11 0 1
11 1 0
30
Communication
with you
carers/family
6 0 0 23
Involvement in
decisions
making
Before you
arrived
0
13 0 0 13
Explaining you
treatments
19 1 0 19
37
During you
stay
20
71
61
On your first
visit
40
Catering how well did you rate it?
Very Satisfactory
Satisfied
Somewhat Satisfied
Very Dissatisfied
Not applicable
100
80
60
78
82
82
85
90
85
40
20
13 1 0 8
15 1 0 1
13 0 0 5
8 1 0 6
9 0 0 6
8 0 0 3
0
The quality of Menu variety Presentation
the food
and choice
Prompt
service
Correct
orders
Overall
impression of
catering
services
Our Nurses were they professional and understanding?
Very Satisfactory
Satisfied
Somewhat Satisfied
Very Dissatisfied
Not applicable
100
80
60
92
87
77
75
40
53
44
20
4 0 0 19
3 0 0 23
3 0 0
1 0 0 6
76
11
1 0 0 11
0 0 13
0
Were you treated
with respect?
When you
Was your privacy
requested pain
and diginity
relief was it timely?
maintained?
Were your
Did you feel
Overall impression
questions
supported with any of the nursing care
answered to your emotional issues?
satisfaction?
How satisfied were you with other team members?
Very Satisfactory
Satisfied
Somewhat Satisfied
Very Dissatisfied
Not applicable
100
80
92
60
85
81
40
54
53
20
38
5 0 0 14
6 0 0 9
5 1 1
44
52
43
1 0 0 6
4 0 0
4 0 0
Doctors
Family support team
0
Catering staff
Complementary
Therapist
Chaplain
Day Hospice
Volunteers
100
80
60
40
58
20
65
56
43
37
71
65
59
34
30
29
28
5 0 0
1 0 0
4 1 0
6 0 0
8 0 0
0 0 0
Housekeeping
In-patient volunteers
Maintenance Team
Physiotherapists
Reception team
Volunteer drivers
0
Additional patients or carer comments from survey in regards to their
experiences
IPU
If you would like to mention any particular members of staff or volunteers who
you feel have provided an especially good service, please do so below.
“Think everyone were excellent and provided a good service.”
“All very good”
Butterwick Hospice strives to provide the best of care to patients and carers. Is
there anything the hospice could have done better to improve or enhance the
care you received?
“No”
“No, all care has been second to none, excellent!”
Please provide any further comments or suggestions concerning your visit or
stay at the hospice.
“Would perhaps be nice - I would find it helpful to have a small shelf close to hand
basin to put toothpaste etc on.”
Day Care Stockton
If you would like to mention any particular members of staff or volunteers who
you feel have provided an especially good service, please do so below.
“All staff and volunteers could not have provided better service.”
“XXXXX the volunteer driver is really caring and gives me confidence in the
ambulance”
“Aromatherapist XXXX is always helpful and gives us excellent attention”
“XXXX nurse”
“XXX and XXX exceptional people”
Butterwick Hospice strives to provide the best of care to patients and carers. Is
there anything the hospice could have done better to improve or enhance the
care you received?
“Fully Satisfied.”
Please provide any further comments or suggestions concerning your visit or
stay at the hospice.
“We, as a family have been very happy with xxxx’s care and cannot fault anything.
Thank you”
“Everyone concerned with my care has been most helpful and caring. Every visit is
thoroughly enjoyable and beneficial.”
“Haven’t been coming long enough to pass comment on staff individually”
“I live for a Wednesday, absolutely love my visits.”
Research
The number of patients receiving NHS services provided by or sub contracted by
the Butterwick Adult Hospice Stockton on Tees in 2013-2014 that were recruited
during that period to participate in research approved by a research ethics
committee was: none. Butterwick Hospice Care’s current policy is that we do not
undertake primary research within the hospice.
Section 2.4 Use of the CQUIN payment framework
A proportion of Butterwick Adult Hospice’s income in 2013/14 was conditional on
achieving quality improvement and innovation goals agreed between Butterwick
Hospice Stockton and NHS Tees, through the Commissioning for Quality and
Innovation payment framework.”
“Further details of the agreed goals 2013/14 and for the following 12
month period are available electronically at [N/A]”
Section 2.5 What others say about us
Statements from the CQC
Butterwick Adult Hospice, Stockton on Tees is required to register with the Care
Quality Commission and its current registration status is:


Diagnostic and screening procedures
Treatment of disease, disorder or injury
Transport services, triage and medical advice provided remotely
Butterwick Adult Hospice, Stockton on Tees has the following conditions on
registration:Conditions:‘The Registered Provider must ensure that the above regulated activities are
managed by an individual who is registered as a manager in respect of this
location.’
“The Care Quality Commission has not taken enforcement action against
Butterwick Adult Hospice, Stockton on Tees during 2013/14.
Butterwick Adult Hospice, Stockton on Tees has not participated in any special
reviews or investigations by the CQC during the reporting period.
The Butterwick Hospice is subject to periodic reviews by the Care Quality
Commission and its last review was July 2013
The Butterwick Hospice was fully compliant and rated as low risk following
assessment by the Care Quality Commission.
We have included some comments from our last inspection below.
Selection of comments from the last CQC compliance assessment:We saw that staff were attentive and treated patients with dignity and respect.
Staff responded quickly when patients called for help. We saw that staff
communicated well with people and explanations of care were given in a way that
could be easily understood. One patient said, "The doctors are brilliant, they fully
explained things in a way we understood." "Privacy and dignity are well respected
and I feel safe and secure."
One person who had been admitted for symptom control said, "Within two days of
being here they had my pain under control."
Another person said, "They explained the number of ways to manage my pain, I
was consulted and agreed the treatment plan." They said that for the first time in
a long time they had woken up pain free.
The environment was calm and relaxed. One patient said, "It is so peaceful."
They also described the staff as, "Absolutely fabulous staff, they are so
compassionate and understanding." "Nothing is ever a problem, they are so
reassuring."
The two patients we spoke with and relatives commented that the hospice was
always clean. One patient said, "The cleaners are in a couple of times a day."
Another patient said, "It is immaculate."
Within the hospice there was also the involvement of various disciplines in
providing people with treatment, therapy and care. This included the involvement
of complimentary therapists and physiotherapists.
The patients we spoke with confirmed that other professionals were involved in
their care. Both patients said that during their admission to the hospice they had
been visited by their Macmillan nurse, district nurse or social worker.
The full compliance report can be viewed at www.cqc.org.uk .
Stakeholder survey 2013/14
A key objective of the Hospice Business Plan for 2013/14 was to survey our
stakeholders regarding the adult services currently offered by the Hospice in
Stockton, particularly those who refer, or could, refer patients to us. The aim
being to identify if our services effectively meet the needs of their patients,
explore some ideas for how we could develop or change services to benefit more
patients and enable us to make the most effective use of our resources including
the Hospice’s expertise.
Although the response rate was low (16%) we received some interesting results
and valuable feedback across a range of stakeholders including a good
representation of GP’s. Several of the findings have now been incorporated into
the business plan for 2014/15 and several of the actions contained in the report
have now been completed. A copy of the full report can be found below.
The Views of Stakeholders
into the services provided by Butterwick
Hospice Stockton
Results of the October 2013 stakeholder questionnaire
Carole Harrison
Director of Clinical Services
Butterwick Hospice Care
February 2014
Contents
Page
Introduction
2
Section 1: Questionnaire and Sample
3
Section 2: Responses

Knowledge of current services
3

Individual referral trends and reason for referrals
4

Views on Day Care services
4-6
o
Current service and model
4-5
o
Potential changes
6
o
Accessing Day Care services
5

Views on additional services/opportunities
5-6

In-patient services
6-7
o
Views on potential opportunities
6-7
o
Blood Transfusion at the hospice
7

Community Services
7-8

Telephone advice
8

Outpatient services
8

Support to nursing and residential homes
9

Open day events
9-10

Additional ideas and comments from respondent
10
Section 3: Recommended Actions
Section 4: Opportunities for service development
11
11
11
References
Introduction
The provision of palliative and end of life care has faced many challenges in
recent years and continues to do so. It is therefore essential that hospices are
able to anticipate and meet the changing and growing needs of the community
they serve. (Help the Hospices Commission 2013).
A key objective of the Butterwick Hospice Business Plan for 2013/14 was to find
out the views of our stakeholders into the services currently offered by Butterwick
Hospice at Stockton and to identify whether our services were meeting the needs
of their patients, explore some ideas for how we could benefit more patients and
to maximise the use of resources and hospice expertise.
Section 1: Questionnaire and Sample
It was important to us that we were to gain valuable and meaningful information
which would play a significant role in helping us shape our services for the future,
therefore the questionnaire was designed to enable us to gain qualitative and
quantitative data.
We wished to be able to identify the designation or area of
work of respondents so that we could evaluate responses and target any areas for
development more appropriately. There were also several key aspects of our
services and potential future services for which we wished to gain stakeholder
views; therefore the questionnaire was structured with the following themes:










Knowledge of current services
Individual referral trends and reason for referrals
Views on Day Care services
o Current service and model
o Potential changes
o Accessing Day Care services
Views on additional services/opportunities
In-patient services
o Views on potential opportunities
o Blood Transfusion at the hospice
Community Services
Telephone advice
Outpatient services
Support to nursing and residential homes
Open day events
Additional ideas and comments from respondent
A sample of the questionnaire is available on request.
Sample
A total of 230 questionnaires were sent out to stakeholders working in the
following sectors/specialities:







General Practitioners in referral area
Palliative Care Consultants and Consultant Oncologists
Ward Managers from referring wards at University Hospital North Tees
(UHNT) and James Cook University Hospital
Macmillan Team
Palliative Care Team, UHNT
Community Nursing Team
Social Worker
Specialist Nurses and Matrons, acute sector
36 completed questionnaires were returned. (16%)
The range of respondents can be seen in the table below.
Position/Job Title of Respondents
GP
14 (39%)
Macmillan Nurse/ Specialist Nurse
8 (22%)
Ward manager/Sister
2 (5%)
Consultant
3 (8%)
Psychologist
1 (3%)
Macmillan Technician
1 (3%)
Occupational Therapist
2 (5%)
Anonymous
2 (5%)
Social Services
1 (3%)
Ward Matron
1 (3%)
Physiotherapist
1 (3%)
Section 2: Responses
It can be seen from the above chart that although the response rate was only
16%, the respondents were from a wide area of sectors and professions.
We
were particularly pleased with the response rate from GP’s but the lack of
response from the Community Nursing Team was disappointing as we receive
many referrals from District Nurses and would have liked to have incorporated
more of their views in this survey.
We do believe however that one of the
anonymous responses received was from the Community Team.
The responses and specific comments relating to each question are outlined below
mirroring the questionnaire layout. All comments from respondents are written
as stated in the questionnaire responses.
Question 1
Are you fully aware of all the services Butterwick
Hospice currently offers?
Yes
25 (69%)
No
7 (19%)
Think so
1 (3%)
Not sure
1 (3%)
Most of
them
1 (3%)
No answer
1 (3%)
Question 2
Have you ever referred patients to Butterwick Hospice?
Yes
33 (92%)
If yes, was this for: Day Care
Family Support
and Bereavement
18 (50%)
Complementary Therapy
No
25 (69%)
Symptom
control
11 (30%)
Other :- please state:-
3 (8%)
In- patient
28 (78%)
26 (72%)
Respite
18 (50%)
Psychological Support
22 (61%)
End of life
1 (3%)
If ‘No’ was this because:You were not aware of the services offered by Butterwick
Hospice
2 (5%)
Patient did not wish to go to hospice
2 (5%)
Times/Days not suitable
You felt the patient ‘was not ready for hospice care yet’
1 (3%)
The services provided did not meet your patient’s needs
(if you tick this box please give details below)
Other (please state reason below)



[we] Cope at home with hospice, palliative specialist and Macmillan
advice
We are a specialised practice and have very few patients with life limiting
illnesses
(Aware of services) – not all of them
Day Care Services
Question 3
Do you think the ‘traditional’ day care model such as that described
above, meets the needs of the majority of your patients?
Yes
28 (78%) No
5 (14%) Partly
1 (3%)
Think
1 (3%)
so
If you answered ‘no’ is this because:Patients do not wish to spend a full day (10-3) at the
hospice
Weekdays are not suitable for patients
2 (5%)
2 (5%)
The diversional activities currently offered do not appeal to
4 (11%)
your patients
Other reasons: Some people find this model of care wonderful and gain a lot of support
from it. However, others are more reserved and find contact with
strangers is not what they want/how they deal with problems.
 I have been informed by several patients that use the service, especially
men that so much more could be accomplished/achieved. Male patients
don’t particularly like what is mentioned above as the activities are more
feminine. Introducing male interests would be advised.
 Younger clients feel they are too young or not ill enough.
 Some people may like weekend visits.
 Some younger women may not wish to do the activities suggested and
may want to look at pamper sessions.
 Does not always appeal to teenage and young adult groups, but some
patients are initially wary of attending. They are fearful of what to expect.
Not everyone is comfortable in group settings – also younger people don’t
necessarily feel it is for them.
 Patients would like to attend the day care services more often than they
are open i.e. 2-3 days per week rather than once per week
Question 4
Do you think there is a demand for day care services to be offered:In an evening?
Yes
14 (39%)
No
19 (53%)
D/K
2 (5%)
At a weekend?
Yes
22 (61%) No
9 (25%)
D/K
4 (11%)
Maybe
1 (3%)
 Never asked patients about this.
 Possibly to allow families one off support for events, appointments etc.
 Where there are younger children, situations may arise where the patient
who is unwell is too ill to go out for the day or weekend, therefore the
whole family stay at home. This may improve quality of life for carers and
children.
 You need to ask patients
Question 5
Do you think some patients would like to access specific services only,
rather than attend for a full day care session?
Yes
32 (88%)
No
1 (3%)
N/R
3 (8%)
If ‘YES’ please tick which services you believe they would be interested
in:Complementary
30 (83%)
Relaxation
25 (69%)
Therapies
Meditation
17 (44%)
Clinical support
25 (69%)
Breathlessness clinics
22 (61%)
Gentle exercise
19 (53%)
sessions e.g. Tai Chi or
specialist programmes
Physiotherapy
24 (67%)
Counselling
28 (78%)
Bereavement support
29 (80%)
Other -Please list
4 (11%)
below
Comments
 Did not know about some of the above sessions
 Clinics with the wider multi-professional team. Drop- in clinics re medical
issues i.e. pain, symptom control. Family drop-ins for support.
 Some of my clients would like to have access to bathing facilities only for
full submersion baths. Is this something you do, or would consider? It is
offered by some residential homes in Darlington and at Teesside Hospice.
 Definitely
 Auricular acupuncture for hot flushes.
 One of the services may be a way in, but I believe the benefit of social
interaction is crucial for the patients I see.
 Bathing.
Question 6
Please answer the following in relation to the above:I would like to/have referred patients to day care but the
21 (58%)
patient did not wish to come.
I would like to/have referred patients to day care but the
6 (17%)
patient’s relative/carer did not want them to come.
I believe the hospice is really for patients towards the end of
3 (8%)
their life.
There is a taboo surrounding hospice care which prevents
18 (50%)
patients from coming to the hospice.
Other: I don’t always think of the option.
 Our team members (Macmillan) have referred very suitable patients for
day care, however, on many occasions they have waited far too long to be
assessed by the Hospice Team, therefore have become too poorly to
attend. It would also appear that some patients are favoured over
others………which has been the case for whatever reason!
 I feel patients are not assessed early enough for referral to day care –
sometimes they are ‘taken over’ by secondary care; District Nurse and the
GP doesn’t see them at this stage. It may be appropriate to somehow
target this earlier phase for patient awareness/access.
 Sometimes access is slow/unavailable at the time wanted.
 (Re taboo) Yes, but a little less nowadays.
Comments for Question 6 cont..








Some people feel that the Hospice is there for end of life only and it is
their misunderstanding of what can be offered; sometimes those preconceived ideas put them off - sometimes making it difficult to change that
interpretation.
Patients/carers are often reluctant to be referred until they accept they are
in the final stage of their illness.
Staff in the acute sector tend to only refer patients toward the end of their
life. Further publicity is required to advise day to day care services to
patients who are discharged home being newly diagnosed and referred to
Macmillan services. Could we have leaflets on the wards please to show
what you offer.
Need more advertising/information re services we can access for patients.
I have referred patients to day care and they have been deemed not
appropriate or access has been an issue. By the time this has been
resolved they are too poorly to attend.
Also delays when people are off increased. Time delays to make
arrangements to attend.
Brain and CNS patients may deteriorate unexpectedly between referral
and attendance.
Many people are not aware of service.
Question 7
Do you think there may be a demand for any of the following:a) Service/support for patients newly diagnosed with a life limiting
condition?
Yes
32 (89%)
No
2 (5%)
D/K
1 (3%)
b) Service/support for patients who have completed their course of
treatment and classed as ‘cured’ or in remission?
Yes
26 (72%)
No
5 (14%)
D/K
2 (5%)
7a


Fear of stigma would be a consideration.
If they can get over the stigma of ‘hospice’ many of my patients are not at
the point of accepting this. Perhaps this type of service would needs its
own ‘branding’ – how would this sit with specialist nurses.


Yes, although this is often covered by CNS - could augment this
Survivorship issues as a sub-section of the hospice back to work. This
could be provided by an OT, but am not aware of there being one at
Butterwick..
7b
7ab


Yes but I am not sure that demand is best met by a hospice
[Yes] as long as there is enough capacity
In-patient Services
Question 8
We currently offer in-patient facilities for patients with life-limiting conditions such
as cancer, neurological conditions, end stage heart failure and end stage COPD.
Do you think there is a need/demand to offer this facility to patients with
other conditions such as:End stage renal disease?
Yes
31 (86%)
No
1 (3%)
D/K
2 (5%)
No
1 (3%)
D/K
3 (8%)
No
7 (19%)
D/K
3 (8%)
End stage liver disease?
Yes
30 (83%)
Patients with dementia?
Yes
21 (59%)
Other: COPD
 (Re dementia) - Yes but should still have specialist palliative care needs.
Comments:









Unsure about dementia – what activities would be appropriate.
Although we often find that patients with end stage malignant disease that
get admitted to hospital, whose preferred place of care may be the
hospice, cannot be transferred because of capacity problems. Taking on
more malignant conditions will exacerbate this!
As cancer is increasing - a great deal is given and offered to cancer
patients. There are many other life threatening diseases that deserve
equal support as cancer, but don’t receive it – especially dementia.
I feel all these groups could be very useful though as a GP we are often
not aware of the ‘end stage’ as the patients are often under secondary
care.
Sorry, I am not sure as I don’t come across these groups of patients
regularly enough to answer this question.
(Re liver and renal) Yes, but only very rarely in these cases.
Can’t comment on the above
[all] Yes, but never enough beds to accommodate long waiting list.
Dementia may cause challenges and impact on other patients/families –
we think dementia patients need specialised place of care for themselves.
Question 9
We have now recommenced blood transfusions at the hospice- Is this
something you would be interested in for your patients?
Yes
30 (83%)
No
2 (5%)
N/R
3 (8%)
N/A
1 (3%)
Comments
 Unsure whether hospital or hospice would be appropriate.
 (Yes) but would be trust wide decision. UHNT
Community Services
Question 10
Do you believe there may still be a need for the hospice to provide
support in some way to patients and carers in their own home?
Yes
32 (89%)
No
1 (3%) *
N/A
3 (8%)
If ‘yes’ would this be:A sitting service during the day?
Yes
25 (69%)
No
5 (14%)
D/K
1 (3%)
A sitting service during the night?
Yes
27 (75%)
No
3 (8%)
A rapid response service 24/7 to provide support and help patients
remain at home?
Yes
32 (89%)
No
0 (0%)
D/K
3 (8%)
Other:
 Hospice at Home.
 Specialist palliative knowledge to support D/nurse services.
 New sitting service during the day.
Comments re. Question 10
Re sitting service during the day
 Potentially my clients are often younger with spouses who work – need
finances, and normality, but often give up work to care.
Re sitting service during the night
 ? in addition to any Marie Curie nurses. This would allow family members
to continue to work or to care during the day – often 1-2 nights isn’t
enough per week to give enough respite.
Re 24/7 service
 In certain situations.
 This was an excellent service [reference to OOH].
 Especially when discharged on a fast track discharge pathway.
Telephone advice
Question 11
Have you ever phoned Butterwick Hospice for advice?
Yes
19 (53%)
No
16 (44%)
N/R
1 (3%)
If ‘yes’ was this helpful?
Yes
19 (100%)
No
0 (0%)
Would you like to see a more formal, ?commissioned help line for health
professionals?
Yes
20
No
3 (8%) Not
1 (3%) Not
1 (3%)
sure
necessarily
(55%)
Comments
 Used the on-call palliative care physician
 Didn’t know I could
 Medical advice which was helpful.
 [Yes] spoke to medical team.
Re formal commissioned help-line- It may be useful for some staff.
Outpatient services
Question 12
Would you be interested in accessing a Specialist Palliative Care Clinic for
your patients?
Yes
27
No
3 (8%)
N/R
4 (11%) N/A
2 (5%)
(75%)
Comments
 Not sure how it would function for patients and symptoms control.
 Not in my own role, however, this would benefit the CNS.
 How would this link into MDT, working with the clients current care.
Would this be handed over fully to their clinic or would it be for a one off
specific situation?/ set of symptom?.
 Feel CNS does this in community.
Nursing/Residential Care Home support
Question 13
Do you think there may be a role for Butterwick Hospice to provide support in
palliative and/or end of life care to:Clients/residents in Nursing homes?
YES
27 (75%)
NO
7 (19%)
N/R
1 (3%)
6 (17%)
N/R
1 (3%)
Clients/residents in Residential care?
YES
29 (80%)
NO
If ‘yes’ what kind of support do you think would be beneficial:Support and advice re client/resident’s palliative, end of life care needs?
Yes
25 (69%)
No
2 (5%)
No
2 (5%)
Education and support to staff?
Yes
27 (75%)
Other:



Family members.
Planning end of life care.
Prevention of acute admissions.
Comments





I find the residential/nursing homes are quite good with palliative patients.
‘Rapid Response’.
Not sure, sorry.
The hospice would provide a useful source of telephone advice.
Patients need not be admitted to the hospice – however, staff can give telephone
advice etc. to nursing home staff.
Open day events
Question 14
Would you be interested in attending an open day event at the hospice in
the future?
Yes
19 (53%)
No
15 (42%)
N/R
2 (5%)
If ‘Yes’ what would you be interested in?
Tour of building and facilities
Yes
8 (22%)
No
3 (8%)
Finding out about the services offered and benefits
Yes
16 (44%)
No
1 (3%)
Meeting and talking to a range of clinical staff
Yes
13 (36%)
No
2 (5%)
Taster sessions such as Complementary Therapies, Tai Chi etc.
Yes
9 (25%)
No
4 (11%)
Other
 Clinical education.
 Educational training from clinical staff.
 Contact and referral system etc.
Comments
 Perhaps just an afternoon (my time is well stretched!).
 I already know a lot of the services on offer, however would love to meet
more of the staff in their own roles/areas.
 Have already visited – feel able to contact team for further visit should this
be needed.
 No – have previously attended.
 No – have visited before and also worked as palliative care physician for
five years.
 Hospice at UHNT – referred patient to this service who are on end of life
pathway, unfortunately there have been a lack of beds and patients have
died on the ward instead of their preferred place of death - hospice. Can
patients from the ward be accepted over the weekend and not just
Monday-Thursday.
There appears to be more capacity at Hartlepool’s hospice than at North
Tees. Can this be looked into.
 Benefits advisor – closure of George Hardwick’s Foundation imminent –
massive loss to our trust.
 [No] – I already work closely with hospice staff and visit the hospice as
needed.
Question 15
Do you think an open day event would be beneficial for your patients, their carers or
the general public?
Yes
33 (92%)
No
1 (3%)
Maybe
2 (5%)
Additional comments from respondents
If you have any other comments you would like to make in regards to Butterwick
Hospice’s current or future services please use the space below.




Patients and the general public have an understanding that all those that go to the
hospice go there to die. Publicising the many other sides of the hospice and what it
has to offer will open up new opportunities for the hospice and patients alike. I have
experienced the fabulous care and love the hospice give to those who are
dying……….just wonderful and comforting.
Re-open event for public/patients:- ‘perhaps a regular monthly one which clients could
be encouraged to go to informally.
Your ongoing support is invaluable to those who access the service, whilst I have
ticked ‘yes’ to many questions, I would not like to think of your support being spread
too thinly trying to achieve so much!
You do not provide holistic care as there is no element of rehabilitation.
You have no other manual handling equipment other than a hoist and therefore you
disable individuals who would transfer using a rota-stand etc.
You are selective in who you admit – there is still not clear referral criteria which I
asked for over a year ago.
You are looking at clinics for e.g breathlessness, no doubt you will not employ AHPs,
which would benefit the patient/carer.

I do think that the hospice can be very selective over which patients they accept and
how long different people stay for.
I think respite care should be stopped to enable patients that need to be there for
symptoms control management.
Need to employ own occupational therapist.
Physios need to access equipment themselves if they are recommending equipment.


Joint working and effective two-way communication works very well with day care,
however, I think this can be improved with the inpatient unit by ensuring that we get
discharge summaries in a timely manner, or a telephone update if a letter is not
available, so we can continue to support the patients and carers effectively – Thank
you.
Better discharge communication (written) in a timely manner to those staff supporting
the patient in the community i.e. medication list would be beneficial to both patients
and staff.
Section 3: Recommended actions
We were extremely pleased with the valuable and wide ranging comments we
received from respondents and also grateful for the honesty when writing these.
This will enable us to focus our actions on addressing these issues and take
appropriate measures to clarify and resolve any areas where our services may not
be meeting the needs of patients in the way we would like.
The following key recommendations have therefore been formulated from the
responses and individual comments. In no particular order, they are:









Ensure GP’s are aware of the Specialist Palliative Care Clinic
Meet with Macmillan team representatives to discuss and resolve concerns
re. access to adult services for their patients and availability of specific
moving and handling equipment.
Distribute copies of this report to Hospice Managers and key stakeholders.
Send copy of this report to Contracts Manager and CCG.
Review activities in Day Care and where appropriate introduce activities
which are more appealing to men and younger adults.
Plan and hold an open event for stakeholders.
Plan and hold an open event for the public.
Explore offering support/facilities to patients with end stage renal or liver
disease.
Explore the benefits and feasibility of having a hospice Occupational
Therapist.
Meet with Community Nurses to discuss their views on current and future
services
Section 4: Opportunities for service development
In addition to enabling us to formulate specific actions, the questionnaire was
designed and has enabled us, to identify areas for potential development in the
future and we will be taking the opportunity to discuss these with commissioners
and relevant personnel.



Provision of palliative and supportive care in the community e.g.
o Sitting service during the day
o Sitting service during the night
o Rapid response service 24/7
Support to Nursing and Residential Homes e.g.
o Support for clients/residents in nursing homes
o Support for clients/residents in residential care
o Education and training to support staff working in nursing homes
o Education and training to support staff working in residential care
Sessional Day Care
o Continue to develop sessional services.
References
Help the Hospices (2013) Future ambitions for hospice care: our mission and our
opportunity October 2013. The final report of the Commission into the Future of
Hospice Care. Help the Hospices. London.
Patient and Carer feedback
We receive many thank you cards and letters from patients their
families and carers which provides feedback on the quality of
service provided by the Hospice.
This feedback also forms part of our CQUIN data and samples of the
comments received are therefore sent on a regular basis as part of
the reporting process.
We have included a selection of these comments below:…..her first words on being admitted were that she felt safe and in good hands.
This, we believe, is a reflection on all looked after her during her final days. The
care, time, kindness and compassion that staff gave ensured ‘K’s’ fear of pain and
losing dignity would never be realised. Despite the difficult time we were facing
as a family, your approach to her care (and ours) eased the distress for us all.
We were able to be together as a family, and were made to feel like, for those
final days, the Hospice was our home. You will never know how much that meant
to us all. ‘K’ died peacefully, in her sleep, on the morning of 7th January 2014,
feeling safe and loved. We are eternally grateful to you all for this - thank you so
much.
Thank you all so much – you all do a difficult job so extremely well. Best wishes
to you all with greatest thanks. Sadly my mum ‘B’ passed away Sunday 1st
December. We sadly miss her. We would like to greatly thank all the staff who
cared for her whilst in respite care. She was so well looked after. She particularly
enjoyed her 80th birthday on day care and we all enjoyed seeing the pictures of
her cutting the cake you had made for her. She was so very pleased.
To each and every one of you at the Butterwick – no words can express how
grateful we are for your time, care and support you all showed ‘J’ and us as a
family in ‘J’s’ last days of his life. We feel so privileged to have met each and
every one of you from Maria, the nursing staff and all the volunteers. You truly
do a wonderful job and go the extra mile. I know ‘J’ was in the best place
possible. The Butterwick will hold a special place in our hearts and I feel a great
comfort knowing that we will return to the Butterwick. I would like to say a
special thank you to Jeanette, Michelle and Millie, who were with ‘J’ and myself
when ‘J’ passed away. You all supported ‘J’ and my family until the very end.
You are all amazing people, just keep doing what you all do, we truly respect
each and every one of you.
Words really cannot express my gratitude for the excellent care you gave my dad
‘D’. during the last few weeks of his life. I was so pleased that he was admitted
in to the Butterwick rather than a hospital or having to manage at home, and I
know he really appreciated all help and treatment you gave him (particularly the
Jacuzzi baths). He was a wonderful man and we were very lucky to have him
thank you for the making the end of his life as best as it could be.
We would like to express our sincere thanks and gratitude for all you did for ’K’
during his recent battle with cancer and sadly his death. The care and support
that you offered him and also us was exceptional and the dignity, peace and pain
relief you were able to give will always be remembered and appreciated by us.
The Butterwick is such a special place, filled with extremely special staff. We are
so thankful that there is such a place. We only wish that you could have known
‘K ’as the loving, kind and wonderful man that he was.
We just wanted to say a great big thank you for all the care and support you gave
us all during ‘J’s’ stay. To have been given the use of the family room gave
immense comfort to the whole family which we really appreciated. We apologise
for what must have seemed like we were taking over the place (we’re not the
quietest of families!). However, you made us feel so welcome. The warmth and
generosity of the staff will never be forgotten. Heartfelt thanks.
To all staff – day centre – I would like to thank you for all your hard work you do.
I don’t know how we as a family would have managed without you all in the five
years mam was with you. As mam said you were a life saver for s as a family,
knowing mam was getting looked after, and for mam a reason to get up and fight
another day. I know she classed you all like her second family as well as good
friends, and no doubt she will have left a void in your hearts as she has ours.
Keep up the good work, you will be always in our thoughts hearts and prayers.
The amazing staff of Butterwick Hospice. Thank you does not go anywhere close
to expressing our feelings for the staff who cared for my mum ‘V’. Every single
one of you made her feel part of a little family, and became her friends. The
gentleness and care you showed her made it much easier for us all to cope with
those last few weeks. Your kindness to our family we will never forget, and even
thought we were there for a very sad reason, we have taken away many happy
memories. As for myself, the support you all gave me in that last week was
amazing. I could never thank you enough. You looked after me as well as Mam.
Thank you again.
Section 2.6 Data quality
NHS Number and General Medical Practice Code Validity
Butterwick Adult Hospice, Stockton on Tees 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.
The following mandatory statement is therefore not applicable to Butterwick Adult
Hospice Stockton:[Name of provider] will be taking the following actions to improve data quality [insert actions].
Butterwick Adult Hospice, Stockton on Tees was not subject to the Payment by
Results clinical coding audit during the reporting period by the Audit Commission.
Information Governance Toolkit attainment levels
Butterwick Adult Hospice, Stockton on Tees was asked to undertake the
Information Governance Toolkit during 2013/14. At the time of writing this
report this exercise is still being undertaken and therefore the information was
not available to complete the statement below.
Butterwick Adult Hospice, Stockton on Tees’s Information Governance
Assessment Report score overall score for [reporting period] was [percentage]
and was graded [insert colour from IGT Grading Scheme]”
Part 3 Review of quality performance 2012/13 (provider
determination)
In our first Quality report last year three developments were chosen from the
business plan and Clinical Strategy Action Plan as our focus for quality
improvement and these are reviewed below.
Development 1: Patient Safety
To strengthen the medical and nursing team in order to provide
increased specialist palliative and supportive care.
State how development was identified
In 2010/11 a revised nursing structure was established and successfully
implemented in 2011/12 with key posts of a Clinical Lead for Adult Services
supported by Clinical Team leaders being introduced.
This structure was
supported by a Clinical Strategy, the key aim of which is to ensure we continue to
meet the current and future needs of patients and their families in regards to
palliative, supportive and end of life care needs within a changing health arena.
Key objectives in the clinical strategy for 2013/14 was to continue to up-skill the
nursing staff in several clinical skills such as cannulation, intravenous drug
administration, phlebotomy etc. as well as supporting the Clinical Team Leaders
to achieve advanced skills in regards to independent prescribing and clinical
assessment skills. All of the qualified staff were trained in the former skills during
2011 and three of our Clinical Team Leaders had completed either independent
prescribing or clinical assessment skills course in 2012/13.
Alongside the increasing of nursing skills we had been striving to strengthen our
medical team for some time but without success. With our previous Hospice
physician moving to another post and the Palliative Care Consultant from the local
Trust retiring in December 2012 this need became even more relevant.
Whilst recruitment took place for Hospice Physicians we used a team of locum
GP’s and continued to provide palliative, supportive and end of life care for a wide
range of patients. However, in order to ensure safe and appropriate medical care
we had to use revised admission criteria which resulted in patients with complex
symptom control needs being admitted to other local hospices or the acute trust.
How was it achieved?
Following the successful recruitment of two Hospice Physicians in early 2013, we
began to re-establish specialist palliative and supportive care in June 2013 which
enabled us to admit and care for patients with more complex needs nearer to
home.
This was also supported by the successful recruitment of a Palliative Care
Consultant by the University Hospital of North Tees and the formalisation of three
consultant sessions to Butterwick Hospice.
Although the Palliative Care Consultant does not take on medical responsibility for
the hospice patients, she provides specialist advice and support to the Hospice
Physician and clinical team via attendance at the weekly MDT meeting,
educational sessions and telephone support.
Review and evaluation of success of development
We have been able to admit and care for patients with more complex needs
nearer to home which has been beneficial for patients, carers, referrers and also
reduced the impact on neighbouring hospices.
Our bed occupancy has increased and is more consistent as we have been able to
admit more than one patient per day and the time between referral and
admission has reduced resulting in more patients being cared for in the place of
their choice. In addition, many patients have been admitted on the day of
referral either from home or the acute trust.
Due to the skills of the Hospice Physician patients have been able to have specific
treatments and procedures in the Hospice such as ascetic drainage and
therapeutic IV drug infusion which previously would have required patients to be
transferred to and from the acute trust. This is extremely beneficial for patients
and also reduces the impact on services and resources within the Acute Trust.
Following meetings between the Director of Clinical Services, clinical team and
Palliative Care Consultant to discuss and agree the utilisation of the three
consultant sessions, a planned programme of bespoke educational sessions for
staff has been established which plays a significant part in the education of staff
to meet the needs of patients with complex palliative and end of life care needs.
The medical staff have also been fully supportive of the nursing staff developing
additional skills and mentorship for specific university modules.
Due to the knowledge, experience and skills of the current Hospice Physician, the
number of advice calls to the Palliative Care consultants has decreased thereby
reducing the impact on them from the hospice and enabling them to support staff
providing palliative and supportive care to patients in the acute and community
trust.
Although one of our hospice physicians left the hospice after 6 months to move
nearer to her family, we have still been able to achieve the improvements set out
above. We have not, however, succeeded in recruiting to the vacancy to date.
Development 2
To enable patients to receive blood transfusions and intravenous
medication within the hospice.
State how development was identified
Patients were being transferred from the hospice to the acute trust if they
required a blood transfusion or intravenous medication which could be distressing
for patients and relatives.
We were also aware that some palliative care patients require regular blood
transfusions and were being admitted to the acute Trust for this. We believed
that the hospice environment would be more appropriate and comfortable for the
patients as well as removing the costs associated with these procedures for the
acute trust.
Blood transfusions and intravenous medication had been conducted at the hospice
previously and it was a key objective to re-establish these procedures as part of
the hospice’s clinical strategy.
How was it achieved?
The two new Hospice physicians were confident for these procedures to be reintroduced into the hospice and expressed their support for staff to undertake
blood transfusion and the administration of intravenous medication appropriate to
patient need and the hospice environment.
The competencies of the clinical team in regards to blood transfusion were updated and following liaison with the Blood Transfusion Practitioners at the local
hospital, training sessions were provided for staff and key trainers. This was
carried out as part of our Service Level Agreement for Blood Transfusion Services
with the Trust.
All qualified nursing staff had received training in cannulation and administration
of intravenous antibiotics during 2012 and the IV policy and procedures were put
in place.
The hospice physicians undertook training of all staff in the
management of anaphylaxis and a bespoke anaphylaxis kit was ordered and put
in an appropriate place.
The Quality and Practice Development Nurse liaised with the Clinical Lead for
Adult Services to ensure the staff undertook all required training and their
competencies were assessed prior to the commencement of these procedures.
Review and evaluation of success of development
Blood Transfusions within the in-patient unit were successfully introduced in the
summer of 2013, closely followed by the administration of intravenous
medication.
Patients are no longer transferred to the acute trust for blood transfusion or for
most intravenous medication administration. This has been much less stressful
for patients, carers and reduced the impact on resources at the local hospital.
We expect the number of patients receiving blood transfusions at the Hospice to
increase as 83% of respondents in the stakeholder questionnaire stated they
would be interested in patients being able to have blood transfusions at the
hospice.
Development 3
Patient experience
Pre and post Bereavement Support – Direct GP access
State how development was identified
Pre and post death bereavement support is an essential part of end of life care for
the relatives or carers of the patient and their children.
Prior to the commencement of the pilot scheme, Butterwick had only provided pre
and post bereavement support and family support to relatives and carers of
patients known to the Hospice.
However, we frequently receive requests from GP’s and multi-disciplinary
professionals asking our Family Support Team if they can provide bereavement
support to clients not known to us which we had had to decline due to our
standard resources being fully utilised by providing support to patients and their
families who are or have accessed our services. These requests often include a
need for child specific bereavement counselling within the local area.
Being able to access services in a timely manner is extremely important and we
were aware that often clients currently have to wait up to 6 weeks to access
support via their GP.
We wished to use the skills and resources at the Hospice to provide a high quality
bereavement support service to a wider group of clients, thereby responding to
the requests of local GP’s and other professionals.
This aim of this development was to enable direct access for GPs to refer patients
who were not currently accessing Butterwick Hospice services; therefore adults
and children would be able to access the full range of specialist bereavement
support services at the Hospice.
This development was in accordance with an established, highly successful
service offered by our Bishop Auckland Hospice which provides similar specialist
services in County Durham and Dales for both adults and children.
How was it achieved?
We used the skills of our existing family support staff at Butterwick Hospice as
well as trained volunteer counsellors.
Letters and referral forms were sent to local GPs explaining the services available
and posters were designed and produced to be displayed in GP surgeries enabling
potential clients to be aware of the services and ask their GP to refer them.
The new development was discussed at our weekly clinical meeting attended by
representatives of the multi-disciplinary team and external health professionals.
Information was also included on the Hospice website.
The following services were made available for clients who had not previously
been able to access Butterwick’s Family Support Services:










Individual counselling for patients pre death. (Coping with a bad
prognosis) Preparing to say goodbye etc.
Preparation for death with the use of letter writing, memory boxes, family
D.V.D messages, funeral plans and wishes of the dying or terminally ill
patient etc.
Pre death and post death counselling for relatives and friends of the
patient. Home visits if the client is not able to come into the hospice.
Children’s support. Preparation for the death of a parent or relative by
individual play and support sessions for young children with preparation
and post procedural play carried out by qualified staff.
Young persons counselling pre and post bereavement
Home or school visits if deemed more suitable for the child or young
person.
Telephone support if distance is a problem
Bereavement groups which include a thriving drop in which takes place
every Monday 10 till 12.00 for the newly bereaved and 1.30 till 3.30 for
those further along in their grief (except for bank holidays) And a monthly
evening support group for people who work.
We also run 7 week M.O.T (moving on together group) several times a
year for people who prefer a more structured approach to loss.
Twice Yearly bereavement service’s which serve to unite the bereaved in
their loss with an average attendance of 400/500.people
Children’s bereavement group fortnightly.
As we did not know what the demand would be for the services and wished to
ensure we continued to provide a high quality, timely service, the direct access
project was rolled out to groups of GPs on a planned basis whilst monitoring the
impact on current resources.
Review and evaluation of success of development.
Between April 2013 and March 2104, 66 clients were referred to the Family
Support Team via the direct access scheme. These clients mostly accessed one
to one counselling and 12 referrals were children who received specialist child
grief work.
Evaluation of the service was carried out with clients who had received this and
questionnaires were sent to the practices from which referrals had been received.
Comments received from clients included:






Very much appreciated being able to discuss my problems with such a
lovely lady.
It was helpful to know that what I felt was normal and there was someone
to share it with who understood.
Very good at listening, very caring and I was very much at ease talking
about things.
Would recommend the Family Support Team to other friends
The support is fantastic, caring, understanding.
Only glad there is places like the Butterwick
The service given by the group is second to none
Feedback from referrers:36 Questionnaires were distributed to the GP practices who had referred patients
to the service and 13 were returned (36%) Unfortunately only 8 of the 13
questionnaires returned were completed which equates to a 22% response. 5
questionnaires returned were not completed and the reason for this is unclear.
The questionnaire comprised of 5 key questions and whilst the response is quite
low the feedback received is extremely positive.
The majority of responses indicated that the GP’s were very satisfied with the
service provided and 100% of respondents indicate that they feel the service
should continue.
The results of the evaluation questionnaires are set out on the next pages :-
Question 1. REFERRAL PROCESS
How would you evaluate the referral process?
Very satisfied
8 (100%)
Satisfied
0
Less than
satisfied
How satisfied were you with the response
time from referral to your patient being seen by the
Family Support Team?
0
Very satisfied
6 (75%)
Satisfied
1 (13%)
Less than
satisfied
0
Question 2. CHOICE OF SERVICE
The Family Support Service aims to provide specialist
support to patients facing life limiting illness, including
grief and loss counselling before and after a person’s
death.
How important do you think this is for your patient?
How important was it to you that your patient could
choose which support they felt suitable for their needs
i.e. 1:1 Counselling; MOT work group (seven week
structured group sessions for the bereaved); drop-in
sessions?
Essential
7 (88%)
Important
1 (13%)
Not Important
Essential
0
Important
0
Not important
0
Question 3. LENGTH OF SUPPORT
Our support services are not time limited i.e. we will
work with a client for as long as necessary e.g. not just 6
sessions
How important do you think this is for your patients?
Essential
6 (75%
Important
1(13%)
Not important
0
Question 4. CHILDREN’S SPECIAL SUPPORT
We also provide support for children and young people
before and after a person’s death, including individual,
group, school and home support sessions.
Yes
8 (100%)
Do you feel this is a service which would be of value to your
younger patients
NO
0
General Questions
How would you rate the service offered
by Butterwick’s Family Support Team in
comparison with other counselling
support services that you may have used
prior to the 12 month pilot project?
Better than other
services
Not as good as other
services
No difference
6 (75%)
0
2 (25%)
Please give comments below:
 I have had feedback from families which is very positive. Good comments
regarding prompt service and helpful for teenagers/children.
 I regularly refer patients for Psychological Counselling via Dr Williams.
 N/A as I have been in post less than 12 months.
 Our patients can often experience rapidly deteriorating situations where
their needs change automatically and quickly/ The response time from
referral to support is excellent and invaluable for our setting.
Would you like this service to continue?
Response:
 Definitely!
 Most Definitely!!
Have you received any feedback from your patients in
relation to the Family Support Service?
If yes please provide comment:
 As previously mentioned prompt and supportive.
 They feel it has been invaluable the service you have
provided.
 Patient are “relieved” , “glad”, “pleased” “comforted”
by the service.
 Sensitive, caring and non-judgmental. Quick response
very much appreciate. Felt “tailored to needs”.
 Verbal/very positive.
 Very positive. They have been able to adjust and
accept diagnosis/bereavement.
 Felt well supported.
Response
YES
8 (100%)
NO
0
Response
YES
7 (88%)
NO
0
Please add any other comments you may have regarding the service:






It would be useful to know of the full services that you provide- maybe a
leaflet explaining these. I think it would benefit patients/ carers / family
members – allowing them to understand the services and accept support
more readily.
Valuable service for patients and families in the community who need
access quickly to bereavement and counselling in palliative support.
We really value the service especially in relation to helping to support
young adults who will be bereaved. If the service continued we would be
able to plan with families for this necessity in the same way we try to
establish “preferred place to die”. We are trying to do this earlier when it is
known that treatment for Leukaemia and Lymphoma has not worked.
Wonderful service – please let it continue.
Please continue and further develop.
I didn’t know anything about this service, so something went very wrong. I
lead the CCG locally and haven’t heard about this as a commissioner or as a
GP provider.
In regards to the last comment above, we were surprised and concerned and
therefore investigated this and were able to contact the GP directly. A letter and
poster had been sent to the GP surgery but unfortunately the GP had not been
made aware of the service.
3.2 An explanation of those involved in this quality account
The Quality Account was discussed at the Hospices Management Team meeting
which is chaired by the Chief Executive and includes clinical and non clinical
managers, the Director of Clinical Services and the Director of Finance.
The task of writing it was delegated to the Registered Manager with a statement
from the Chief Executive.
The Quality Account was also discussed at the Senior Clinical Meeting where the
quality priorities were agreed.
It has also formed part of an Agenda item of the Clinical Strategy and
Governance Committee which is a key element of the Charity’s governance
structure: the Minutes of which are distributed to the Board of Trustees as will a
copy of this Quality Account.
Once completed the Quality Account was distributed to Clinical and non clinical
Managers for comment and approval. The completed Quality Account was then
forwarded to Hartlepool & Stockton on Tees Clinical Commissioning Group and the
local Healthwatch team to approve and comment on the quality priorities
mentioned in the report.
ANNEX: Statements from Commissioning Group and Local
Healthwatch Team.
27th June 2014
C Harrison
Director of Clinical Services
Butterwick Hospice
Middlefield Road
Stockton-on-Tees
TS19 8XN
Dear Carole
Re: Butterwick Adult Hospice, Stockton, Quality Account 2013/14 review &
priorities for 2014/15
I am pleased to provide you with a commissioner narrative as requested for your
Quality Account. I would also like to reiterate the continued commitment of NHS
Hartlepool and Stockton-on-Tees Clinical Commissioning Group to actively
engage in meaningful and productive ways with the Butterwick Hospice and key
stakeholders in the prioritisation and development of future Quality Accounts.
NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group (HaST
CCG) welcomes the opportunity to comment on your 2013/14 Quality Account.
Overall the report is presented in a concise and meaningful way, and it is
considered to accurately reflect the Hospices commitment and positive ethos to
deliver quality improvements, demonstrating in an open and transparent manner
its performance during 2013/14 and the key challenges it has encountered. It
would have been a welcome addition, however, to see in the report patient safety
information relating to incidents and complaints that have occurred throughout the
year and the lessons learned and actions taken to address any themes.
In reviewing delivery of the 2013/14 priorities, the CCG specifically acknowledges
the challenges associated with strengthening the medical and nursing team and
the impact on the service model whilst maintaining a clear focus on achieving
positive patient outcomes.
In addition, the CCG recognises that there is a need to improve communication
between primary care and the Hospice if pilot schemes such as the pre and post
bereavement service are to be effective and succeed in the future. The CCG
would like, however, to commend the Hospices success in introducing Blood
Transfusions within the in-patient unit including the administration of intravenous
medication which has resulted in the majority of patients not having to transfer to
the acute hospital.
In relation to the priorities identified for 2014/15 the CCG is supportive and
encouraged by the focused attention on ensuring quality improvement activity
links with the CCGs strategic vision to improve health care and quality outcomes
for patients. The Introduction of the Breathless Support Programme working with
primary and secondary care providers is evident of this. Whilst, the emphasis on
clinical educational sessions and introduction of
a service user advisory Group positively reflects the Hospices desire to continue
to listen and respond to both its own staff and patients through measured and
meaningful approaches.
NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group
(HASTCCG) look forward to continue to work with Butterwick Hospice in 2014/15
to improve the quality of health care services’
Yours sincerely
Ali Wilson
Chief Officer
cc. Jean Fruend, Executive Nurse
Dr Posmyk, Chair
**********
Healthwatch Stockton-on-Tees
Catalyst House
27 Yarm Road
Stockton on Tees
TS18 3NJ
Tel 01642 688312
healthwatchstockton@pcp.uk.net
www.healthwatchstocktonontees.co.uk
Click here to enter text.
Wednesday 2nd July 2014
Dear Carole
Please see below comments from Healthwatch Stockton-on-Tees in response to the
recent Quality Account.
Healthwatch Stockton-on-Tees welcomes our involvement in the Butterwick Quality
Account. In particular, we were encouraged by the service user/ carer involvement
development. We would be keen to be more meaningfully engaged in the Quality
Account process next year.
Yours sincerely
Joanne Shaw-Dunn
Community Development Worker
Healthwatch Stockton-on-Tees