St Teresa’s Hospice - NHS · • St Teresa’s Hospice exists to help people suffering from...

St Teresa’s Hospice, The Woodlands, Woodland Road, Darlington, DL3 7UA | (01325) 254321 www.darlingtonhospice.org.uk

St Teresa’s Hospice

The Darlington & District Hospice Movement

Quality Account ‐ 2011/2012

Index:

Part 1 Quality Statement

Part 2 Priorities for Improvement 2012/13

Report on Priorities for Improvement 2010/11

Statement of Assurance from the Board

Part 3 Review of Quality and Performance

Supporting Statements

Statement of Values • St Teresa’s Hospice exists to help people suffering from life‐limiting illness; we

help patients to keep their dignity, which is paramount, we preserve patient choice, and we provide care and support for carers.

• The organisation is an independent charity and fiercely preserves this status in order to be flexible to respond to areas of greatest need.

• Free care is provided, through a range of services, to patients and to their primary carers; these services are built‐up on the basis of patient need and choice, using a holistic approach.

• Services are accessible to everyone in the community (regardless of race, creed/non‐creed, sexual orientation, social standing, age, or financial status).

• The Hospice team is a dedicated, skilled, eclectic mix of employed and voluntary people; all personnel are valued and supported to achieve hospice and personal goals.

• People who work for the Hospice in any capacity are expected to demonstrate commitment to the cause, and to the attainment of our charitable objectives.

2

Part 1 Chief Executive’s Statement

Quality Accounts now represent a critical part of the overall quality improvement infrastructure of the NHS. St Teresa’s Hospice operates within a culture of continuous improvement. We consider the provision of high quality care to be of paramount importance, and we strive to ensure that quality assurance and control are intrinsic to all Hospice services, whether direct clinical care, support services, or fundraising operations. We maintain a strong focus on both corporate and clinical governance, which enables us to meet our Hospice Philosophy and to deliver excellent, appropriate, safe and effective clinical services.

During the year, the Hospice has completed self assessment and has successfully been audited in an unannounced Care Quality Commission inspection. Findings of both of these identified no shortfalls in our service or governance provision.

This focus on high quality care, with the patient at the centre of our services, has led to significant developments and innovative practice, resulting in St Teresa's Hospice, a local charity, working in partnership with a national charity and the NHS to drive up the quality of patient care in our area.

We have led the development of a county‐wide bereavement consortium, which gives equity of access and choice to all individuals living within Darlington and County Durham via a multi‐disciplinary Family Support Team model, first pioneered by our hospice.

The Hospice is working within the second year of its rolling five year strategy. This is the first Quality Account produced by the Hospice, and covers all of our services, whether funded by NHS contributions, or our own fundraising, personal donations and applications to grant‐making trusts. The Quality Account gives us the opportunity to comment on the quality of our services, rather than simply focussing on financial and statistical information.

This account, written in consultation with service users, is endorsed by our Board of Trustees which is keen to support quality improvement within the Hospice and view this reporting format as an opportunity to demonstrate existing good practice to stakeholders, whilst focusing on the coming year's priorities for improvement. Looking forward, we will continue to focus on maintaining quality of care and driving up the standards as necessary, and have identified key improvement areas across the domains of Patient Safety, Clinical Effectiveness and Patient Experience.

In our 25th Anniversary Year, I am pleased to present this, our first Quality Account which has been prepared as a team effort and, to the best of my knowledge, is an accurate and fair representation of the quality of services provided at St Teresa's Hospice.

Jane Bradshaw, CEO

3

Part 2 Priorities for Improvement

St Teresa’s Hospice Board of Trustees is committed to continuous service improvement and has supported the development and implementation of a formalised five year strategy which focuses on safe, effective care which provides patients and their carers with a positive patient experience. This Quality account focuses on specific improvement priorities for 2012/2013 which cross the domains of Patient Safety, Clinical Effectiveness and Patient Experience.

Service users and staff have been consulted on both the strategy and this Quality Account, and have agreed the outlined priorities for improvement.

St Teresa’s Hospice is fully compliant with the National Minimum Standards (2002) and has satisfied the Care Quality Commission (CQC) that standards are being met through both self assessment and an unplanned CQC inspection in November 2011.

2.1 Improvement Priority 1 for 2012/2013 (Patient Safety)

Introduction of “Deciding Right”

Priority: Introduction of the Deciding Right document to integrate the principles of advanced care decisions for all appropriate patients accessing St Teresa’s Hospice services

Why choose this as a priority?

Deciding Right is an initiative which integrates Advanced Care Planning, the Mental Capacity Act, Cardiopulmonary Resuscitation and Emergency Health Care Plans. Patients are referred to the Hospice from a variety of settings: GP’s, care homes, acute trusts, patients home, and sometimes as temporary residents. A plethora of documents is available in the health care economy which all do similar things but the paperwork is different. By adopting Deciding Right, and supporting its roll‐out in the community, patient safety will be improved as all patients’ advanced wishes will be reported on recognised, colour coded, patient held documentation which is transferrable along the patient pathway. The priority was identified by the Clinical Governance group on recognising the many different documents in patients’ notes, following patient record audit.

How will this priority be achieved?

A switchover date will be set when the Hospice will move to using Deciding Right. Leading up to the switchover date, education and key members of the clinical teams will attend “train the trainers” sessions, and will then cascade training internally. Paperwork will be ordered ahead of the switchover date. Progress will be monitored by the Clinical Governance Group.

How will this priority be measured?

Audit of patient records will indicate the success of the roll‐out of Deciding Right.

4

2.2 Improvement Priority 2 for 2012/2013 (Patient Safety)

Introduction of Patient Safety Thermometer

Priority: Introduction of Patient Safety Thermometer

What is the Patient Safety Thermometer?

The NHS Safety Thermometer provides a quick and simple method for surveying patient harms and analysing results, via the completion of an electronic spreadsheet.


St Teresa’s Hospice views patient safety as its top priority. The safety thermometer is a tool to survey patient harm and harm‐free care, and its use will be a Commissioning for Quality and Innovation (“CQUiN”) measure within the Hospice NHS contract.


The Head of Nursing will oversee the implementation of the tool and any training requirements for staff. Night staff will complete the tool on a daily basis for all in patients.


The results will be reported to the PCT quarterly from October 2012 and to the Hospice Clinical Governance Board; any improvement outcomes will be overseen by the Clinical Governance Board.

2.3 Improvement Priority 3 for 2012/2013 (Clinical Effectiveness)

Introduction of SystmOne to improve Clinical Communication

Priority: SystmOne will be introduced to the Hospice, and will be fully operational with all new patients entered onto the electronic patient management system from November 2012. The introduction of the system will improve clinical effectiveness in the Hospice by improved communication between healthcare professionals involved in a patient’s care, improved medicines management and reporting.


The priority has been identified by staff recognising the benefit which such a system can have in improving communication with professional colleagues involved in a patient’s care, and by the Board of Trustees who are keen to keep pace with local developments. (By the autumn 2012 all GP’s in Darlington will utilise SystmOne). The system will improve clinical effectiveness, as staff will be able to see a full electronic patient record, with up to date interventions by other colleagues involved in a patient’s care. Medicines management will be improved as the system can be used for drug calculations, and reporting on existing services will be more efficient and will inform future services.

5


A full project implementation plan will be drawn up in partnership with the PCT and CSC (System Provider) with timescales aligned to the project implementation. The Hospice has identified project leads who will be tasked with implementing the project and they will report back to the Clinical Governance group and to the PCT project manager.


Training log for all clinical staff, audit of patient records.

2.4 Improvement Priority 4 for 2012/2013 (Patient Experience)

Improved Engagement with Service Users

Priority: To establish a formal integrated User Partnership Group


St Teresa’s Hospice has a Carers’ support group which has been involved and consulted with on service developments. However, the Hospice Board has recognised that increased and more formalised user involvement would be beneficial as the Hospice moves forward, as service users have the most informed views on how our services should develop.


A member of staff will be identified to provide support to the group and will write terms of reference. Service users and their families will be formally asked if they wish to attend and, on appointment, a Chairperson will be invited to attend Board meetings and contribute to the annual report.


Meeting attendance sheets

2.5 Improvement Priority 5 for 2012/2013 (Patient Experience)

Development of the Hospice Day Therapy Services

Priority: To develop Hospice Day Therapy adopting a rehabilitation model


St Teresa’s Hospice constantly strives to follow evidence based practice. The NICE Supportive and Palliative Care Guidance recommends access to rehabilitation services for patients including at the end of life. Senior clinical staff have identified a paucity of allied health professional support for patients at the Hospice but particularly in Day Therapy. Day therapy services will be reviewed to offer a rehabilitation model of care for patients, within which they will be able to access a range of

6

services, including a wider range of complementary therapies and exercise and movement via “Tripudio” (which is a gentle, seated, dance‐based exercise programme, specifically designed for the Day Therapy setting).

Patients themselves have been consulted on the Hospice plans to review services and have tried a “taster” session of Tripudio and as a direct impact of their positive feedback this will be incorporated into the future model.

The future Day Therapy model will improve patient experience by helping patients to improve mobility, or live better with their disability, and will support them to function in daily activities whilst overcoming feelings of loss of control and providing a feeling of well being and self worth.


Allied health professional funding is being sought from a variety of sources. The Hospice’s Strategic Management Team will lead the review and introduction of rehabilitation, a wider complementary therapy range of services and introduction of Tripudio, with patient involvement, and will report back to the Board of Trustees on a bi‐monthly basis.


Patient satisfaction survey

Staff observational reports

2.6 Report on Priorities for Improvement from 2010/2011:

St Teresa’s Hospice is fully compliant with the National Minimum Standards (2002) and has satisfied the Care Quality Commission (CQC) that standards are being met through both self assessment and an unplanned CQC inspection in September 2011.

This document reflects the Hospice’s first Quality Account. However, the Hospice is in year 2 of a 5‐ year rolling strategy within which areas of improvement were highlighted.

The areas of improvement have taken account of the economic constraints. The Board has been in full support of the improvement areas and carers have been consulted where possible.

The identified improvement priorities for 2010/2011 were as follows:

2.6.1 Introduction of a Rapid Response and Rapid Discharge Service

St Teresa’s Hospice has been pivotal to the design and implementation of an innovative Rapid Response and Rapid Discharge service, where the Hospice, a local charity, has worked in partnership with the NHS and a national Charity, Marie Curie. The service crosses the three domains of patient experience, clinical effectiveness and patient safety.

The Rapid Response team comprises a Marie Curie registered nurse and a St Teresa’s Hospice health care assistant who are available 24 hours a day, 365 days a year to respond within an hour to a patient in their own home, wherever this may be. The team aims to prevent avoidable hospital admissions, and to help a patient to achieve their preferred place of care, either by offering support

7

“Dad had pain but we didn’t want to call 999 so we called for the RR Team”

“Thank you so much, this is keeping him at home where he wants to be”

Patient’s wife stated: “we couldn’t have managed without you – it’s been wonderful that you’ve been able to stay here and support us.”

“Pt stated she was going to call an ambulance, but decided to try us first. Pt said she wanted to remain at home and was grateful we helped her to do so.”

in the home, or facilitating a rapid discharge. The funding source is from three key partners: St Teresa’s Hospice, Marie Curie and the NHS (the fourth partner is County Durham and Darlington Foundation Trust).

The project, initially set up as an 18 month pilot, commenced patient activity in October 2011. The interim report published in March 2012 provides excellent outcomes, with over 50 new patients referred over a 6 month period, the majority of these would otherwise have required a hospital admission. Statistical evidence demonstrates the project is realising its aims and patient evaluation is extremely high. The partners are now busy working to secure ongoing funding for the service.

Extracts from Patient and Carer Feedback about the Rapid Response Service:

2.6.2 Introduction of a Comprehensive Patient Pack

The Board was aware of the patient information agenda and agreed to invest in the production of a comprehensive patient information pack. The pack contains individual leaflets on each of the Hospice services and is given to every patient. Specific information is also provided for carers and bereaved individuals. The format is paper copy but is also available electronically and can be translated as necessary. Positive evaluation has been provided by service users. The Hospice is exploring ways of making information available for the visually impaired.

2.6.3 Refurbishment of Day Hospice Areas (Dept of Health Grant)

The Hospice was successful in securing a Department of Health Capital Grant to upgrade Day Hospice facilities.

The purpose of this refurbishment project was to make changes to the building and equipment in our Hospice Day areas, which would increase patient dignity, privacy and comfort. The improvement work has been completed and meets all statutory and regulatory requirements.

8

Upgraded, washable flooring has improved hygiene and, importantly, patient safety by removing fall hazards, the overall quality and accessibility of the environment is much improved including the creation of an additional patient bathroom, and improvements were also made to kitchen an dining facilities, all adding to the quality and feeling of well‐being for patients who visit the Hospice. Patient evaluation has been extremely high.

BEFORE Refurbishment

AFTER Refurbishment

9

Part 2 cont.

2.7 Statement of Assurance from the Board

The following statements must be provided within a Quality Account by all providers. Many of these statements are not directly applicable to St Teresa’s Hospice, therefore explanations are given.

a. Review of Services

During the reporting period 2011/2012 St Teresa’s Hospice, Darlington, provided the following services to the NHS:

• 6 Bedded In patient Unit • Day Therapy Service • Hospice at Home • Rapid Response service • Lymphoedema services • Family Support (including welfare benefits) • Complementary Therapies

During the reporting period 2011/2012 St Teresa’s Hospice, Darlington, provided or sub contracted 7 NHS services (no funding received for Complementary therapies). The Hospice has reviewed all the data available to them on the quality of these NHS Services.

The income generated by the NHS services reviewed in 2011/2012 represents 100 per cent of the total income generated from the provision of NHS services by St Teresa’s Hospice Darlington for 2010/2011. The income generated represents approximately 40 % of the overall costs of running these services.

What this means:

St Teresa’s Hospice is funded by both NHS income and by fundraising activity. The Hospice receives funding from two different PCT areas approximately 80:20 for its NHS funding which reflects patient activity from the two PCT areas. The grants allocated by the NHS contribute to approximately 40% of Hospice total income.

This means that all services are partly funded by the NHS and partly by Charitable Funds. St Teresa’s Hospice for the accounting period 2012/2013 has signed an NHS contract in place of the traditional voluntary sector grant.

b. Participation in Clinical Audit

• During 2011/2012 no national clinical audits or confidential enquiries covered NHS services provided by St Teresa’s Hospice.

• During 2011/2012 St Teresa’s Hospice participated in no national clinical audit and no confidential enquiries of the national clinical audits and national confidential enquiries it was eligible to participate in.

10

• The national clinical audits and national confidential enquiries that St Teresa’s Hospice was eligible to participate in during 2011/2012 was none.

• The National audits and national confidential enquiries that St Teresa’s Hospice participated in, for which data collection was completed during 2011/2012, 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 audit or enquiry.

o St Teresa’s Hospice was not eligible to participate; therefore, there is no information to submit or list here.

What this means:

St Teresa’s Hospice as a provider of palliative care is not eligible to participate in any national audit or confidential enquires as these have not pertained to palliative care during the accounting period

• St Teresa’s Hospice has not reviewed any national or local audits during 2011/2012 and therefore has no actions to implement

c. Research

• The number of patients receiving NHS services provided or sub‐contracted by St Teresa’s Hospice in 2011/2012 that were recruited during that period to participate in research approved by an ethics committee was none. There was no appropriate, nationally, ethically approved research studies in palliative care in which St Teresa’s Hospice could participate.

d. CQUIN Payment Framework

• St Teresa’s Hospice NHS income in 2011/2012 was not conditional on achieving quality improvement and innovation goals through the Commissioning for Quality and Innovation payment framework because it had a voluntary sector grant in place. In the accounting period 2012/2013, CQUIN measures are within the NHS contract.

e. Statement for the Care Quality Commission

• St Teresa’s Hospice is required to register with the Care Quality Commission and its current registration status is for the following regulated activities:

o Diagnostic and screening procedures o Treatment of Disease, disorder or injury o Personal Care

• St Teresa’s Hospice is registered with the following conditions: o Services are provided for people over 18 years old o The maximum of 6 patients may be accommodated overnight o Notification in writing must be provided to the Care Quality Commission at least one

month prior to providing treatment or services not detailed in the Statement of Purpose

11

• St Teresa’s Hospice completed a self assessment for the Care Quality Commission in 2010 and had an unplanned visit in November,2011. St Teresa’s Hospice has not participated in any special reviews or investigations by the Care Quality Commission in 2011/2012.

f. Data Quality

• St Teresa’s Hospice did not submit records during 2010/2012 to the Secondary Users service for inclusion in the Hospital Episode Statistics which are included in the latest published data.

What this means:

St Teresa’s Hospice is not eligible to participate in the scheme.

g. Information Governance Toolkit Attainment.

• ST Teresa’s Hospice did not participate in the Information Governance Toolkit. However, the Hospice has its own internal Information Governance Policy.

h. Clinical Coding error rate

• St Teresa’s Hospice was not subject to the Payment by Results clinical coding audit during 2011/2012 by the audit commission (as it had a voluntary sector grant in place for the reporting period).

12

Part 3 Review of Quality Performance

The review of Quality at St Teresa’s Hospice can be considered across the three domains of Patient Safety, Clinical Effectiveness and Patient Experience. The following information provides information on these areas during the accounting period 2011/2012.

3.1 Performance ‐ Patient Safety

Clinical Incident Reporting‐ reporting on clinical incidents was chosen as it gives an insight for the Hospice and patients as to how “safe” the service was during the accounting period. Clinical incidents are reported by staff involved every time they happen and investigated by the Clinical Governance Board.

Table 1 Demonstrating Clinical Incidents during Accounting Period 2011/2012

Clinical Incident Action Taken

Slips, trips and falls ‐ patients 9 Patient’s mobility evaluated and staff to supervise

Slips, trips and falls – staff and volunteers 2

Drugs 4 Incidents discussed with staff and policies and procedures amended

Clinical issues 7

Detail:

1. Hospice did not notify funeral home that deceased has Hepatitis C.

Nurses reminded to inform funeral homes about infectious diseases.

2. Non Hospice syringes in sharps box Memo to all staff re self medicating.

3. EoLCP commenced without it being signed by Doctor

No action taken

4. On admission discovered that patient was MRSA positive but not been informed about this in advance.

IPU staff to ask question prior to admission of patients.

5. Threatening and abusive behaviour towards member of staff

Head of Nursing spoke with individual involved

6. Hospital discharge letter arrived for patient we did not know.

Hospital and GP contacted to see if they wanted to refer to Hospice.

7. Rapid Response member of staff refused to verify death of patient.

No action verification of death was outside of Marie Curie Policy for this patient

13

3.2 Performance ‐ Clinical Effectiveness

Measuring clinical effectiveness is important to the Hospice as it helps identify areas of improvement and is important to both the Hospice and the public as it helps us demonstrate that our services are achieving what we intended to achieve.

The Hospice collects statistical information on every patient and enters this into a National Minimum Dataset held by the National Council for Palliative Care which allows collation of information on demographics, comparisons between services and conclusions to be drawn on patients' preferences and achievement of these preferences. The following table provides a comparison of the Hospice performance against the most recently published report (May 2011) on the National Council for Palliative Care National Minimum Data Set for 2009/2010 where an appropriate comparison can be made.

Table 2 Comparing St Teresa’s Hospice to the National Minimum Dataset

Area St Teresa’s Hospice 2010/2011

(For info only)

St Teresa’s Hospice2011/2012

Minimum Dataset 2009/2010

In patient services

Total Number of Patients within a year treated

119 181 36,701

Total New Patients 100 122 ‐

Re‐referred Patients 14 14 ‐

Average Bed Occupancy (%) 60% 86% 73%

Cancer Diagnosis (%) 76% 82 % 90%

Non cancer diagnosis (%) 24% 18 % 10%

Average length of stay (days) 6.7 7.7 12.2

Died in Hospice (%) 34 % 73 / 40% 50.6%

Discharge care home (%) 1% 3 / 1%

Discharge acute (%) 1% 5 /2 %

Discharged Home (%) 48% 92 / 49% 38.5%

Day Therapy

Total Number of Patients Treated 137 146

Number of New Patients 72 80

14

Total Days available places 3920 3920

Total Places attended 2014 3247

Total places booked DNA 943 794

Average length of care (days) 213 300 182

Cancer Diagnosis (%) 76% 80% 84%

Non cancer diagnosis (%) 24% 20% 16%

Access to Physiotherapist (total number of Hospices in UK)

No No 51/101

Access to medical consultant (total number of Hospices in UK)

Yes Yes 38/101

Access to occupational therapist (total number of Hospices in UK)

No No 50/101

Access to spiritual support (total number of Hospices in UK)

Yes Yes 47/101

Access to social worker (total number of Hospices in UK)

Yes Yes 51/101

Access to complementary therapist (total number of Hospices in UK)

Yes Yes 70/101

Hospice at Home

Total Number of Patients treated 213 184 ‐

New Patients 164 132 ‐

Patients died in Hospice (%) 23% 15% 17%

Patients died at home (%) 55% 68% 46%

Patients died at Care home (%) 9% 3% 9%

Patients died at Hospital (%) 10% 8% 18%

Patients died at Community hospital (%)

1% 1% 4%

Cancer Diagnosis 55 52 86

Non cancer diagnosis 45 48 14

Length of care (days) 103 127 4.2

Average number of deaths (%) 43% 35% 70%

15

3.2.1 In patient Unit

During the accounting period the Hospice had a total of 181 patients on the In patient Unit, 122 of which were new referrals. Bed occupancy was 86%, higher than the MDS which was 73%. The Hospice recognised during the previous accounting period occupancy was low and took steps to promote the service and make better links with health care professionals in the community. This proved very useful as bed occupancy rose to 86 % [from 60% in the accounting period 2010/2011]. The Hospice was successful at supporting non cancer patients, with 82% of the in patient population treated having a cancer diagnosis compared to the MDS of 90 %. Average length of stay is shorter than the national average during the accounting period. The number of patients dying in the Hospice is also lower at 40% compared to the MDS of 50%. Considering these statistics alongside the place of death for patients, one assumption is that the Hospice was extremely effective at facilitated discharge, enabling a patient to die in their preferred place of care at home with 49 % of patients dying at home, compared to a national average of 38%.

3.2.2 Day Therapy

The total number of places was 3920, with an attendance rate of 3247, an increase on the previous accounting period. Reflecting on this and the following year's statistics the Hospice is reviewing day therapy provision as outlined in the improvement aims. Average length of care was above the national average of 182 days with Hospice average length of care being 300 days. In Day Therpay, as in the In patient Unit, the Hospice is again pro‐active and effective in supporting non cancer patients, with 80% of patients having a diagnosis of cancer compared to the national average 84%. St Teresa’s is one of few Hospices nationally that does not have access to allied health professionals; again this will be addressed within this current accounting period. The Hospice has excellent support from complementary therapy staff and all patients had access to a palliative care consultant.

3.2.3 Hospice at Home

The Hospice at Home service supported 184 patients during the accounting period. 68% of those patients were supported to die at home, 15% died in the Hospice with 3% in a care home and 8% in hospital. Again the Hospice was able to support non cancer patients extremely well with 48 % of total patients having a diagnosis other than cancer.

3.2.4 Rapid Response Service

The Rapid Response service was established during the accounting period, and was operational for 6 months. The service was established with the key aim of supporting patients at home, avoiding hospital admission at the end of life where possible and appropriate. The information provided is quantitative, as qualitative research is being carried out throughout the 18 month pilot project.

The following information depicts performance for the service during this time period.

16

3.2.4 Rapid Response cont.

Type of referral to the service

A total of 50 patients incurring 180 visits Cancer patients x 37 Non‐cancer patients x13. Dementia (3), Parkinson’s disease (1), CHD (1) renal failure (1),

COPD (5), EOLC (2)

Key Performance Indicators

Key Performance Indicators (KPI) were agreed with commissioners prior to the service commencing. The KPI demonstrate if the service is meeting its goals.

Table 3 Key Performance Indicators for Rapid Response

Key Performance Indicator Target Achievement Notes

Response to patient within an hour of referral

95% 100%

Measurement of an advanced care plan in place (ACP)

100% 100% Measurement of the plan in place was achieved at 100%. Of the patients referred to the service only 20% of Patients had it in place (8 out of 50)

Achievement of Preferred Place of Care

50% 66% 33 patients were supported at home avoiding hospital admission

Total Number of Never Events

0% 0% These are events that should never happen

37

3

1 11

5 2Cancer

Dementia

Parkinson's Disease

CHD

Renal Failure

COPD

EOLC

Abbreviations: CHD: Coronary Heart Disease COPD: Chronic Obstructive Pulmonary Disease EOLC: End of Life Care

17

3.2.4 Rapid Response cont.

Invest to Save

One of the drivers for the project was to generate cost efficiencies. During the initial 6 months of the project:

From patients visited, 33 were supported at home, saving the NHS £57.750 in avoidable hospital admissions

From patients visited, 33 were able to stay in their own home at a total saving to NEAS of £6,237.

Total cost saving of £63,987 (based upon cost per non‐elective admission as advised by NHS Durham and Darlington Commissioning support).

In summary, the service within its first 6 months of being operational has achieved its aims, is providing a quality service for patients allowing them to achieve their preferred place of care and is generating cost efficiencies.

Case studies have been collected on every patient, and feedback includes:

− “Thank you so much, this is keeping him at home where he wants to be’

− ‘You are so kind and helpful; I’m really pleased we contacted you’

− Patient’s wife stated ‘we couldn’t have managed without you – it’s been wonderful that

you’ve been able to stay here and support us.’

− ‘Pt stated she was going to call an ambulance but decided to try us first. Pt said she wanted

to remain at home and was grateful we helped her to do so.’

− ‘Pts husband stated that we had done “a lot of good for him today” felt more in control and

reassured.

− ‘Family had commented to another service provider that they had found the RR team to be

“an invaluable service” felt very supported’

− ‘Residential home staff commented how they felt supported and re‐assured by staff

presence.’

− ‘Care home staff thanked us for our help in settling the lady’

− ‘Family said how caring and helpful the team had been’

− ‘Contacted by GP Dr Nevison who thanked us for our input’

− ‘DN thanked us for our input’

18

3.2.5 Clinical Audit

Audit is a valuable way of examining everyday practice. During the reporting period the Hospice has introduced a 12 month program of Clinical Audit. The following audits were undertaken during the accounting period 2011/2012.

Table 4 Summary of Clinical Audits 2011/2012

Name of Audit Date completed Actions to be taken to improve practice

Action plan in place

Target Date of Completion

Essential Steps in Infection Control

January 2012 Yes Yes June 2012

Medicines Management

February 2012 Yes Yes July 2012

Clinical Supervision

March 2012 Yes Yes July 2012

Medical Records March 2012 Yes Yes Sept 2012

All of the findings of the audits are presented to the Clinical Governance Board and action plans agreed, and monitored by the board. The full program of audit will be rolled out through the next accounting period.

19

3.3. Performance ‐ Patient Experience

3.3.1 Patient satisfaction survey

St Teresa’s Hospice carries out bi‐annual patient satisfaction survey. This was completed in the previous accounting year. The Hospice will move to annual surveying in future.

In addition the Hospice also receives many letters of compliment and thanks. Some of the comments are included below:

“Many thanks to the drivers, for the transport during the last month.

I am most grateful for your help and support.”

“...grateful thanks for your help and support during...illness. I found the carers group meetings a great help, to talk to people who understood...I know... enjoyed his time with you and enjoyed the chat...and the change from being at home. Many thanks for all your help and kindness during the sad time.”

“We would like to thank all for you for taking such care of...in her last...days, she couldn’t have wished for anything more, you were kind and caring and we cannot thank you enough.”

“...life became much easier during the weeks in which the hospice was involved...A very big thank you to all the volunteer drivers for making the journey much more pleasant – they do a marvellous job.”

“I am writing to you to praise and acknowledge the nurses and volunteers that work at St Teresa’s Hospice... The nurse’s care for...was for the highest standard, they were at all times caring, compassionate, professional and respectful. Not only was the care for... outstanding, but the support they provided me was what got me through what was possibly one of the worst weeks of my life. Although the nurses were often busy, what little time they did have, they would spend with the patients and their families, and for me during very dark hours, the nurses would lift my spirits and bring a smile to my face

Those nurses are simply the best of the best and the words “Thank You” will simply never be enough.”

“...I would like...to thank the whole team a St. Teresa’s Hospice for the very special care given to... in...last months. Day Care, Hospice at Home and the in‐patient nurses were all excellent! ...had ...dying wish and died at home and had the very best care possible, without your help he would not of had that level of care. We are especially grateful to the Hospice at

Home team for their care and compassion, each one is an angel!”

20

3.3.1 Patient satisfaction survey cont.

“To all the staff that work so hard, I cannot tell you how much I appreciated the two years when I came to you every Friday. Here I am, these years on, and still enjoying life.

I’m sure all the love and care you gave me helped to keep me going. I still miss all the lovely girls we had to encourage us and make us so happy.”

“Thank you for your...bereavement support. I haven’t forgotten how kind and amazing you

all were to...Not forgetting your lovely ‘Sitters’.”

“What can I say? ...

Only that I’ve been happy here on Thursdays at the wonderful Hospice! Everyone has been so helpful towards my recovery. I have enjoyed my days here where I’ve met so many lovely people...Thank you and I am so grateful that I can walk out of your door. You all will be in my thoughts and prayers,

thanks again for the lovely days I’ve spent with you!”

“Thank you very much for your kindness and support you gave to...and myself.

He enjoyed his days out at St Teresa’s...”

“I wish to thank you, on behalf of myself and my family, for all the comfort, care and support given to both...and ourselves during his final few days in St. Teresa’s.

You all made such a difference to our remaining time together.”

“Thank you, for everything you do”

21

3.3.2 Awards and Complaints

The Hospice receives many letters of thanks and recommendations from patients and families which are celebrated with staff teams.

During the accounting period the hospice was awarded a 5* rating for kitchen hygiene following an unannounced visit by EHO.

The Hospice was also awarded a Special Enterprise award for the Hospice Charity Shops by Evolution Volunteer Bureau.

Complaints are seen by the Hospice as an integral part of service improvement as they provide valuable feedback about the quality of service we are providing. Having said this, complaints are rarely received. In the reporting period, 2011/2012 no complaints were received. Each complaint would be thoroughly investigated at Clinical Governance meetings and at the board of Trustees meeting. Although we had no serious untoward incidents, if we did they would be reported to the Care Quality Commission.

Table 5 Complaints received During Accounting Period 2011/2012

Complaint Action Taken and Outcome

None None required

3.3.3 Future Performance Measures

During the forthcoming accounting period 2012/2013 The Hospice will develop further key performance indicators for its services and will explore the National Indicators for Quality Improvement to determine if these can be aligned to our services. Three Quality indicators for the domains of Quality, Patient experience, Patient safety and clinical effectiveness will be chosen and reported against in the next Quality Account, examining both quantitative and qualitative evidence.

The annual program of audit will be fully implemented, reported to the Clinical Governance Board and improvement actions put in place.

The way we collect all of our patient feedback from all sources including new media sources such as Facebook and Twitter will be better organised and collated for presentation in the 2012/2013 Quality Account.

22

3.4 The Board of Trustees Statement

The Board of Trustees is fully committed to the provision of a high quality service at the Hospice.

The Hospice has a well‐established clinical and corporate governance structure, with members of

the Board playing an active part in ensuring that the Hospice fulfils its mission, according to its

charitable intentions, and in ensuring that the organisation remains responsible and compliant in all

areas of CQC Registration, Health and Safety, Employment Law and other relevant legislation.

This Quality Account was approved at the Board Meeting of 24th May, 2012

Signed

Alasdair MacConachie OBE, DL, FRSA, Chairman

Board of Trustees of the Darlington & District Hospice Movement

23

3.5 Supporting Statement by County Durham and Darlington NHS:

St Teresa’s Hospice - NHS · • St Teresa’s Hospice exists to help people suffering from...

Documents

Transcript of St Teresa’s Hospice - NHS · • St Teresa’s Hospice exists to help people suffering from...