Woodlands Hospice Quality Account - NHS · Woodlands Hospice Woodlands Hospice Charitable Trust UHA...

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Woodlands Hospice

www.woodlandshospice.orgWoodlands Hospice Charitable TrustUHA Campus, Longmoor Lane,Liverpool L9 7LA

Quality Account 2013 - 2014

Tel: 0151 529 2299Charity No. 1048934

“Thank you for the wonderful care, kindness, attention andtime you gave us. Woodlands is in a league of its own. Pleaselet all your staff and volunteers know how very much we valuedtheir hard work, friendliness and dedication”.(Letter from a relative, March 2014)

Incorporating Priority Areas for 2014/15

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Contents

Chief Executive’sStatement4 - 5

Section 1Priorities forImprovement6 - 16

Section 2Statutory Information andStatement of Assurances from the Board17 - 20

Section 3Quality Overview and What others say about us21 - 34

Welcome to Woodlands HospiceQuality Account 2013/14

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CHIEF EXECUTIVE’S STATEMENTWoodlands Hospice Charitable Trust is an independent charity committed to deliveringthe best possible practice and development of Specialist Palliative Care for people withcancer and other life limiting illnesses. It honours people’s right to dignity and respect atwhatever stage of their illness, by its aim to improve the quality of life for patients andtheir carers.

Woodlands is based in North Liverpool and covers a population of over 330,000 in NorthLiverpool, South Sefton and Kirkby in Knowsley.

Our key priority here at the Hospice is to ensure high quality care for all patients and theirfamilies and we pride ourselves on the excellent standards achieved on a consistentbasis. We are always looking for ways to develop and further enhance every patientexperience and have progressed well with the three priorities we set ourselves in theQuality Account for last year.

The progress we have made through the Tissue Viability working group to minimise therisk of pressure ulcer development has been very pleasing with results indicatingimprovement with reduced incidents. Staff training in this area has been heightened andall nursing staff are now even more proactive in the identification and management ofdeveloping ulcers.

Measuring the difference we make to patients’ outcomes has always been difficult toachieve and there is much discussion locally and nationally about the best tools to dothis. Our second priority last year to introduce the use of the Patient Outcome Scaleversion 2 (POS2) and the Palliative Performance Scale (PPS) helped us to make goodstrides to measure the difference we make and using them has assisted with ongoingclinical decisions, The professional team are keen to keep abreast of developmentswithin the tools and will be adopting the updated version of the POS tool throughout thisyear, keeping us at the forefront of this important quality measure.

It has always been our intention to develop a Patient and Family Forum and our thirdpriority last year ensured we worked towards this in a structured way. Getting such agroup off the ground takes good preparation to ensure the membership is open to avaried representation and we were delighted to have hosted our first meeting of theForum in March 2014 with excellent feedback. It is really important to Woodlands that welisten to those who use, or have used, our services and encourage them to influence ourfuture services and developments. The Forum has got off to a great start and we lookforward to working with the members over the coming years.

One of our key areas of quality and safety is our continuing focus around infectionprevention and I am delighted once again to report that we have had no Hospiceacquired infection at all during the year. This is reflective of all the hard work the team putin to ensuring these highest standards are maintained.

Every day we receive positive comments regarding the high quality, personalised servicewe provide, whether this be through talking with patients and/or families, cards andletters and even now via social media for all to see. It makes me extremely proud to beleading an organisation which shows such care and compassion and which treats all

patients with great dignity and respect. It humbles me that patients say they feel ‘lucky’ tobe with us here at Woodlands and that families repeatedly talk of the warmth, comfortand support they feel in such a safe environment.

From time to time we are not able to fully meet individual’s expectations and anynegative comment or complaint is taken extremely seriously and looked into thoroughly.We did have a small increase in the number of written complaints during the year but weopenly encourage all concerns to be raised so that we can continually learn fromfeedback to ensure our high standards of quality and safety are consistently applied to allpatients in all services.

Our quality assurance framework is very robust and with the appointment of our newQuality and Improvement Manager in year whose role it is to continually drive andmonitor the Quality agenda, we are confident that despite regular development to keeppace with the ever changing healthcare provision and expectations we will retain ourfocus on ensuring high quality care for all our patients and their families.

Every year brings new quality priorities to concentrate on and this coming year we havedecided on the three priorities which are also of national importance.

Our first priority is to extend the good work we progressed last year on the Inpatient Unitwith nutrition and hydration into all our services. Linking nutrition to tissue viabilityensures we follow on from our pressure ulcer work of last year.

There has been much publicity and debate over the last 12 months regarding theLiverpool Care of the Dying Pathway (LCP) and its ultimate withdrawal from use in July2014 and we, like all health care providers, will be developing more individualised careplans for patients at end of life and working in the coming year on other aspects of therecommendations which were published last year. This will be our second priority for theQuality Account.

Finally our third priority centres round the sharing of clinical information across all ourservices to ensure we minimise the number of times a patient has to tell their story whenaccessing any of our services. Over the last year our non-Inpatient services have movedto a new computer system to integrate more fully with the Inpatient Unit and this year wewill be working on developing the information systemsfurther.

Woodlands Hospice is absolutely committed to deliveringthe highest standards of quality and safety for all ourpatients and we have a strong ethos to ensure dignity andprivacy at all times. We continue to strive for continuousquality improvement whilst maintaining the high standardswe are very proud of.

I confirm that to the best of my knowledge, theinformation contained within this Quality Account is a trueand accurate account of quality at Woodlands HospiceCharitable Trust.

Mrs Rose H Milnes

Chief Executive

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Mrs Rose H MilnesChief Executive

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Section 1: Priorities for ImprovementThe priorities for quality improvements identified for 2014/2015 are set out below andhave been identified by the Senior Clinical Team in agreement with the SeniorManagement Team following feedback from patients, carers and staff.

1a. Priorities for Improvement 2014-2015

Patient Safety

How was this identified as a priority?

The Hospice clinical team acknowledges the importance of appropriately assessingthe nutrition and hydration requirements of patients using the service and providingnutrition and hydration appropriate to the patient’s needs whilst maintaining dignityand promoting independence and choice. In order to achieve this, a multiprofessional steering group was established and a baseline audit of nutritional careon the Inpatient Unit was completed highlighting areas for improvement. Thisincluded the completion of an evidence based nutrition policy and procedure and thepublication of a patient information leaflet providing nutritional advice. The policyprovides guidance for staff in relation to clinically assisted nutrition and hydration andconsideration of benefits, burdens and risks of this treatment for patients in the lastdays of life. Staff training in relation to assessment of a patient’s nutritional needs andimplementation of care in accordance with the nutritional policy has been completedon the Inpatient Unit.

Following evaluation of these improvements on the Inpatient Unit, the hospice clinicalteam recognises the need to extend improved practice in nutritional care to the Well-being and Support Centre (incorporating day therapy and outpatients). This willensure best practice for patients across all services.

How will this be achieved?

• Completion of staff training in relation to the nutritional assessment tool, care planand nutritional policy and procedure

• Introduction of the nutritional assessment tool and care plan to the assessment ofpatients attending the Well-being and Support Centre

• Establishing a regular audit of nutritional care within the Well-Being and SupportCentre

Priority 1: Nutrition & Hydration – the Hospice will extend improved practicein nutritional care to the Well-being & Support Centre

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How will progress be monitored and reported?

Progress will be monitored through evidence of audits including patient feedback andachievement of actions following audit. Reports of progress against the above planincluding staff training and audit results will be submitted to the Clinical GovernanceCommittee and Board of Trustees bimonthly.

Clinical Effectiveness


The Neuberger Report about the Liverpool Care of the Dying Pathway (LCP)suggested that the LCP should be phased out in July 2014. The report makes anumber of recommendations that all organisations involved in end of life care shouldaddress. Woodlands Hospice developed and implemented an action plan based onthis report and its recommendations. An End of Life (EoL) care communication recordwas created and implemented on the Inpatient Unit and has been in use from March2014. This document highlights areas that are important for discussion with patientsand families in the dying phase, for example agreeing a plan of care, explanation whythe team feels that the patient is dying, comfort measures to be put in place,hydration and nutrition needs and spiritual care. The document is mainly completedby the medical staff at the hospice. However the delivery and documentation of thecommunication record needs to be implemented further to include all end of life caredelivered by the care team at the hospice. This is particularly important for any carereceived after initial discussions about the dying phase have taken place and theplan of care has been completed, and also for care given after the patient has died.This needs to also be accompanied by revised written information for carers.

In addition to the Hospice plans for managing EoL communications, further guidanceon EoL care is expected from the Leadership Alliance in the coming months.Depending on the recommendations they make, a further action plan may need to bedeveloped to improve end of life care documentation at Woodlands Hospice.

How will this be achieved?• Sustained implementation of the EOL care record.

• Integration of EoL care into existing nursing care plans and documentationincluding immediate bereavement care. This will be done jointly with the AintreePalliative Care Team to guarantee consistency of approach in this area.

• Development of a relevant information leaflet around coping with dying for carers.

• Implementation of an action plan depending on further guidance from theLeadership Alliance.

Priority 2: Care of the Patient who is Dying – the Hospice will furtherintegrate its revised end of life care documentation into all relevant domainsof clinical care.

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Progress will be monitored through audit of the use of the EoL communication recordand the revised nursing care plans once implemented.

Trustee visits (by medical and lay representatives) will be introduced to review EOLcare on the Inpatient Unit on a regular basis.

Reports of progress against the above plan and audit results will be reviewed by theClinical Effectiveness group and submitted to the Clinical Governance Committeeand Board of Trustees bimonthly.

The Clinical Effectiveness group will also develop and oversee implementation of therelevant action plan for new recommendations by the Leadership Alliance.

Patient Experience


A significant amount of work has been done over the past 12 months to aligncomputer systems across Woodlands Hospice clinical services and as a result allservices with the exception of our Hospice at Home Service now use SIGMA. Thiswas chosen as this is the system used within University Hospital Aintree with whichthe Hospice has very close working relationships and it was already established onthe Inpatient Unit. This has enabled much better collation of data and activity but ithas also highlighted that there remains a disparity in how clinical information frompatient assessments is documented and shared across hospice services. Forexample if a patient is well known to Outpatient services through the Well-being andSupport Centre and is then admitted to the Inpatient Unit the relevant informationfrom Outpatient assessments doesn’t always follow the patient for that transition intheir care.

This can result in patients having to repeatedly go over details about their illnessincluding discussions that may be distressing when they are already known to otherHospice services and in addition potentially important information which could impacton their care may not be handed over.

We therefore feel this is a priority area to focus on to enhance the patient experienceand minimise the number of times a patient is asked to repeat personal details whenthey are already known to our services. It is important that patients feel there is aseamless integration when they are moving between services and better sharing ofclinical records is a key component of this.

Integral to this is also the sharing of any documented wishes and preferences madeas part of an Advance Care Plan (ACP). Not every patient will wish to formulate an

Priority 3: The Hospice will ensure Integrated Sharing of Clinical Information(including Advance Care Planning) between hospice services to ensure weminimise the number of times a patient has to tell their story.

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ACP but where this is done it is essential that this is shared with all relevanthealthcare professionals and hence how any ACP information is shared betweenservices within and external to the hospice will also form part of this patientexperience priority.

How will this be achieved?

• Consideration of the introduction of standardised multi-professional initialassessment documentation which could follow the patient across hospiceservices.

• Explore the possibility and challenges of electronically scanning clinical recordsfrom the Well-being and Support Centre through the Electronic DocumentManagement System currently used by the Inpatient Unit.

• Consider introducing an electronic pro forma for Outpatient initial assessmentwhich would allow the sharing of this information via SIGMA which would make itreadily accessible to all services across the hospice.

• Collaborate where possible with other health care providers to produce consistentdocumentation to support ACP and effective sharing of that information.

• The Hospice is looking to appoint an ACP Facilitator who will predominately have acommunity focus but will also be able to support the structure and process of ACPwithin the Hospice.


• Patient Experience Surveys will include questions to ascertain patients’perceptions as to how well their personal information is shared across hospiceservices

• A baseline audit of the existing arrangements for ACP will be carried out

• Improvements to initiating, recording, documenting and sharing End of Life andAdvance Care Plans will be guided by the Clinical Effectiveness Group andsupported by the Documentation Group

• Regular ongoing audit of progress against the above plans to be carried out

• Reports of achievements against the above plans, including audit results and anypolicy or procedure revision, will be reported to the Clinical GovernanceCommittee and Board of Trustees for approval and ratification.

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1b. Priorities for 2013-14 Review of progress

Patient Safety:

• A tissue viability working group was established to manage this priority.

• Following review of data collection and audit tools relating to patient risk andincidence of pressure ulcers, a more comprehensive system has beenimplemented.

• We have had an independent review of tissue viability in the hospice andaddressed the recommendations which included: integration of tissue viability witha nutritional link role, clarity of responsibilities for nursing staff roles in theprevention and management of pressure ulcers and improved data collection.

• Facilities for photographing pressure sores and reporting through UniversityHospital Aintree’s DATIX incident reporting system have been implemented.

• We have commenced a review of the policy for prevention and management ofpressure ulcers. It is envisaged that this will be completed and implemented by theend of June 2014.

• All relevant nursing staff have completed prevention and management of pressureulcer training.

• A patient and carer information leaflet in relation to preventing pressure ulcers hasbeen developed.

• Progress against this priority, including audit of pressure ulcer incidence, has beenreviewed. Results indicated improvement with reduced incidence of pressureulcers.

• Tissue viability will remain a key and ongoing priority for the Hospice with regularaudit and review.

Clinical Effectiveness:

• Patient Outcome Scale version 2 (POS2) and Palliative Performance Scale (PPS)have now been implemented for multi-professional day therapy patients in the Well-being & Support Centre, and for Inpatients.

Priority 1: Tissue Viability – The Hospice will maintain high standards of skincare for patients and minimise the risk of pressure ulcer development

Priority 2: To introduce the use of Clinical Outcome Measures – the hospicewill incorporate the use of outcome measures into clinical practice to aid multi-disciplinary team working, clinical decision making and help assess quality ofcare.

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• The scores are collated weekly for these patients and are presented as part ofweekly clinical meetings to assist with clinical decision making.

• A summary sheet is used to identify trends and also help focus where particularinterventions may be required

• By keeping abreast of national developments on outcome measures for palliativecare we are now looking to adopt an updated version of the Patient OutcomeScale (IPOS)

• Education around the use of outcome measures is ongoing and additionalmethods to support learning including the possibility of e-learning are beingexplored

Patient experience:

• Different ways of delivering patient involvement forums were investigated andplanning meetings were held to agree the format and recruitment process for thefirst meeting.

• The first meeting of the Woodlands Patient & Family Forum was held at theHospice on 26th March 2014.

• As well as patients and carers, there was also representation from localHealthwatch organisations, Person Shaped Support, a local Carer’s Associationand a local student social worker.

• The Aintree Hospital Patient & Carer Representative joined the group as a guestspeaker to talk about the achievements of patient and carer groups she has beeninvolved in.

• The aim of the group was agreed as:

• To support achievement of the aim, the group agreed Objectives, Terms ofReference and Ground Rules.

• Members of the group reviewed and commented on draft Hospice leafletsincluding ‘Care of the Dying’ and ‘Advice on Hand Washing for Visitors’.

Priority 3: Development of a Patient and Family Forum to ensure that peoplewho are using our services have a more active role in the planning,development and evaluation of services.

“To engage with patients, carers and the public who are interested in theongoing development and quality of services delivered at

Woodlands Hospice”,

…and to provide

“Information from the community, for the community”.

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• Comments from attendees at the meeting included:

• Feedback from the first meeting was shared with all attendees, staff, the SeniorManagement Team and the Clinical Governance Committee.

• The group agreed to meet bi-monthly for the first six months to enable it to developand establish membership, develop its strategic plan, and start to influencechange and improvement. Meeting dates for the first six months of 2014/15 wereagreed.

• Work will continue to support the group to become an active and essential part ofservice development at Woodlands.

• Consideration will be given to sharing the planning of future Quality Accountpriorities with the group.

Other Quality improvements 2013-14Monitoring of Quality

• The annual clinical audit plan and non-clinical audit plan continued to bedeveloped (and supported by relevant working groups where appropriate).

• All audit results and resulting action plans were reviewed by the Governance andClinical Governance committees (as relevant).

• The review of Care Quality Commission (CQC) Provider Compliance Assessmentscontinued as services developed.

• Monthly Trustee visits continued throughout the year to review compliance withCQC Essential Standards of Quality and Safety.

• The Risk Register was maintained and regularly reviewed by Governance andClinical Governance committees and the Board of Trustees, highlighting areas ofconcern and identifying actions to be taken.

• A Clinical Effectiveness Group was established, consisting of Senior Clinical Teammembers, to monitor and advance Hospice clinical priorities.

• The Chief Executive Officer carried out interviews with patients, and the PatientServices Manager carried out regular patient ‘ward rounds’, to ensure that patientexperience of services was included in the monitoring of quality.

• Incident report monitoring continued throughout the year. No Serious UntowardIncidents were reported.

• A Quality and Improvement Manager role was identified, and recruited to, to leadthe quality agenda.

“Excellent meeting; greatinformation and presentation;look forward to the next one”

“Sharing of ideas;Friendliness; Open& honest approach”

“Excellent– glad tobe here”

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Working groupsMulti-professional working groups continued to meet regularly to support quality andimprovement across all services. Outputs during 2013/14 included:

Dignity• The multi-professional Dignity Working Group met four times during the year tosupport the prioritisation of dignity throughout the hospice; both in the care givento patients and their families, and in the workplace.

• The Group reviewed and revised the Dignity Policy.

• The Group developed and agreed a Dignity Charter. This is now displayed in allInpatient bedrooms and in clinical areas of the Well-being & Support Centre.

• The Group is currently reviewing patient satisfaction surveys across theorganisation with a view to developing one cross organisational survey that can beused to survey patients from all our services annually and replace the individualsurveys that are currently completed for each service.

• The Group produces quarterly reports in relation to dignity in care performance forthe Clinical Governance Committee.

Infection Control• The Infection Prevention group met regularly with membership from all services.

• The comprehensive annual audit programme was reviewed and implemented.Monthly audit results were generally good with most achieving at least the required95% pass rate. Where opportunities to improve were identified, an action planwas developed and monitored to completion. (Some examples of improvementare included in the table of patient safety audits included in Section 3).

• A staff training programme was initiated and is currently ongoing.

• Ongoing review of audit results and action plans by this group and the ClinicalGovernance Committee continued throughout the year.

• The Hospice group linked in to Aintree University Hospital Infection Control groupfor advice and support.

Nutrition• A multi-professional steering group met regularly to support the maintenance ofadequate nutrition and hydration to patients.

• A training package was developed and implemented for clinical staff.

• A nutritional care audit was carried out, using the Help the Hospice audit tool,which identified the need for a co-ordinated approach to nutritional care.

• As a result of the audit, a new policy and procedure for Nutritional Care wasdeveloped and implemented and a patient information leaflet was approved.Printed versions of leaflets are now available on the ward.

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• Re-audits using the same tool identified an improvement in nutritional care.

• The steering group is currently developing our own audit tool, to be used for futureaudits, to demonstrate compliance with the Hospice policy and procedure fornutritional care.

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Falls

• A Multi-professional Falls Group met quarterly to review the management of fallsacross all services.

• All patients have falls risk assessment completed, and their ongoing care plannedaccordingly.

• Falls system equipment was reviewed and replaced in accordance with warrantyrequirements.

• The Falls Link Nurse has delivered staff training on the use of new falls equipmenton the Inpatient Unit. Falls training continues to be a part of induction training forall clinical staff (including bank staff).

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Medicines Management

• A multi-professional group continued to meet monthly to review medicinesmanagement across the hospice with good attendance across all disciplines.

• The group continued to review policies such as the Self Administration ofMedicines policy, which was updated to ensure the safe storage of medicineswhen patients are participating in the scheme.

• An improved medicines chart was developed and safely introduced to the InpatientUnit. The chart now includes a colour-coordinated section specifically for syringedriver medicines to mitigate errors.

• The Hospice Pharmacist provides medicines management training for nursingstaff, and a comprehensive medicines audit programme continues.

Documentation

• Following recommendations from the CQC on the need to have moreindividualised Care Plans in place for patients, Care Plans on the Inpatient Unitwere reviewed and updated. A regular audit was established and hasdemonstrated improvement in this area.

• The audit tool for the review of nursing documentation on the Inpatient Unit wasreviewed and improved to correlate with the documentation sheets in use. Thisenabled audits to be completed easily, and problems to be resolved faster.

• An audit tool for Hospice at Home documentation was developed and will beimplemented in 2014/15.

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• The group recognised the need to audit Well-being & Support Centredocumentation. An audit tool will be developed and incorporated into the 2014/15clinical audit plan.

• A multiprofessional group continues to meet regularly to review clinicaldocumentation across the organisation.

Patient InformationWoodlands continued to develop information forpatients on a wide range of clinical and non-clinicaltopics; this includes leaflets on Nutritional Advice,Bereavement Support, and a range of leaflets aboutthe support groups available to patients such as theCreative Group and the Supportive Living Programme.A selection of those leaflets can be seen here.

EducationOver the past 12 months, Woodlands Hospice staffhave contributed to a wide range of education, both inhouse and also to that provided by Aintree SpecialistPalliative Care Services Group on a wider footprint.The education sub group of the Palliative CareServices Group is chaired by Clinical Lead forWoodlands Hospice, Dr Graham Whyte and is hostedat Woodlands. Education provided includes:

• A collaborative programme of GP education, working in conjunction withWillowbrook and Marie Curie Hospices, to produce a series of evening sessionson Palliative Care for non-malignant conditions.

• The delivery of the ‘Six Steps to Success’ programme of education for care homestaff in South Sefton.

• ‘Opening the Spiritual Gate’ – a series of 1 day workshops, (plus an e-learningoption provided by Queenscourt Hospice), exploring spirituality at the end of life.

• End of Life Workshop for Social Workers.

• Core and Intermediate Communication Skills Training.

• Education to support the implementation of the new regional unified ‘Do NotAttempt Cardio-Pulmonary Resuscitation’ (DNA CPR) policy.

There is also an ongoing programme of in house education for hospice staff whichhas included Consent to Care & Treatment, the Mental Capacity Act and Deprivationof Liberty Safeguards (key features of the CQC’s strengthened focus for 2013-16).

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Community Engagement• The Hospice actively participated in Dying Matters Week, May 2013, to raiseawareness of issues around death and dying and promote Advance CarePlanning.

• The hospice actively promoted Hospice Care Week in October 2013, involving allstaff and volunteers.

• The Hospice continued to promote Hospice at Home in locality meetings.

• The recently appointed Well-being and Support Centre Manager is activelyengaged, along with her team, with external referrers to continue to raiseawareness of the redesigned service within the community.

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Section 2: Statutory Information andStatement of Assurances from the Board

The following are statements that all providers must include in their Quality Account.(Not all of these statements are directly applicable to specialist palliative careproviders.)

2.1 Review of ServicesDuring 2013/14, Woodlands Hospice Charitable Trust provided the following services

• In-patients

• Well-being and Support Centre (incorporating day therapy, outreach, outpatients and group sessions)

• Lymphoedema

• Bereavement, family support and counselling

• Hospice at Home (In South Sefton only)

Woodlands Hospice has reviewed the data available to them on the quality of care ineach of these services.

The income generated by the NHS services reviewed in 2013/14 represents 73% ofthe total income required to provide services which were delivered by WoodlandsHospice Charitable Trust in the reporting period.

2.2 Participation in clinical audits During 2013/14, Woodlands Hospice was not eligible to participate in any of thenational clinical audits or national confidential enquiries. This is because none of theaudits or enquiries related to palliative care.

The Hospice clinical audit programme for 2013/14 included audits of MedicinesManagement, Controlled Drugs, Infection Control, and Care Plans. A retrospectiveaudit of Hospice inpatient ‘length of stay’ was also carried out. We have continued touse the Help the Hospices Audit Tools where possible; these are particularly relevantto the requirements of hospices and enables performance to be benchmarkedagainst other hospices.

In addition to its own clinical audit programme, Woodlands Hospice also participatesin a number of Regional and Supra-regional audits as part of the Merseyside and

What this means: Overall, 73% of our total costs are currently funded by theNHS. The majority of NHS funding is related to the In-patient Unit whichtransferred over from the NHS in 2009 with a three year funding arrangementwhich has been rolled over annually since. We rely on Fundraising activitiesto generate the remainder of our income.

Cheshire Palliative Care Network Audit Group. Results of some of the auditsundertaken and/or presented in 2013/14 can be seen under ‘Clinical Audit’ in Section 3.

2.3. ResearchDuring 2013/14, no patients receiving NHS services provided by Woodlands Hospicewere recruited to participate in research approved by a research ethics committee.The Hospice has a policy to cover inclusion in research but, during this period, therewas no appropriate national, ethically approved research study in palliative care inwhich we could participate.

However, Woodlands senior medical staff are involved in research into decisionmaking for patients with advanced head and neck cancer jointly with UniversityHospital Aintree, and into the benefits of interventional pain management for cancerpain. Senior medical staff are also leading on general development of researchopportunities in palliative care in the region on behalf of the Cheshire & Mersey EOLcare network.

Staff from the Woodlands therapy team are conducting research into therehabilitation of lung cancer patients jointly with University Hospital Aintree and theLiverpool Heart and Chest Hospital. In addition, staff have contributed to a number ofpublications in peer reviewed scientific journals and participate in a regular weeklyjoint journal club. We have also hosted an academic clinical fellow from theMerseyside palliative care rotation.

2.4 Quality Improvement and Innovation goals agreed withour commissioners.Woodlands Hospice’s income in 2013-14 was not conditional on achieving qualityimprovement and innovation goals through the Commissioning for Quality andInnovation payment framework because it is a third sector organisation; it wastherefore not eligible to take part (Mandatory statement).

2.5 What others say about usWoodlands Hospice is required to register with the Care Quality Commission and itscurrent registration is for the following regulated activities:

• Diagnostic and Screening procedures

• Treatment of disease, disorder or injury

Woodlands Hospice is subject to periodic reviews by the Care Quality Commission.During August 2013, the Care Quality Commission carried out an unannouncedinspection and found that the Hospice was fully compliant with the followingStandards:-

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Outcome 2: Consent to care and treatment - Before people received care or treatment they wereasked for their consent and the provider acted inaccordance with their wishes.

“The people we spoke with told us that they werefully informed about the care they received and thateverything had been fully discussed before anyprocedure had been carried out.”

Outcome 4: Care and welfare of people who useservices - People should get safe and appropriatecare that meets their needs and supports their rights.

“Care and treatment was delivered in a way thatintended to ensure people’s safety and welfare.Staff demonstrated a strong understanding ofpeople’s needs and how to support them. Wefound that each person using the service had acare file which contained a set of care plansappropriate to their care and support needs.”

Outcome 8: Cleanliness and infection control - People should be cared for in a clean environment andprotected from the risk of infection.

“During our visit we undertook a tour of the unitand inspected a number of bedrooms, bathroomsand communal areas. We found them to be cleanand tidy. People we spoke with gave us verypositive feedback about the cleanliness ofWoodlands. Staff told us that they received regulartraining in infection prevention and controlincluding training in hand hygiene.

Outcome 12: Requirements relating to workers - People should be cared for by staff who are properlyqualified and able to do their job

“Appropriate checks were undertaken before staffbegan work. People told us that they felt safe andconfident in the care they received from theprovider. Staff we spoke with understood the careand treatment people needed and were passionateabout the support they offered people atWoodlands.

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Outcome 21: Records - People’s personal records, including medical records,should be accurate and kept safe and confidential

“People’s personal records including medicalrecords were fit for purpose. Staff were aware ofthe need to ensure clear records were maintainedand stored safely and securely.

We saw a leaflet that was provided for people whoused the service to explain what information waskept on a person and how it was used.

Environmental HealthOnce again, the high standards of kitchen hygiene and catering have beenmaintained and an Environmental Health inspection undertaken in January 2014awarded the Hospice a 5 star rating.

Fire SafetyThe Hospice Fire Safety policy and training model was revised, approved andimplemented during 2013/14, taking into account recommendations following a FireSafety Inspection carried out in January 2013. A routine review of Fire Safety inFebruary 2014 (undertaken by the Fire Brigade) identified no areas of concern.

2.6 Data QualityWoodlands Hospice did not submit records during 2013/14 to the Secondary UsesService for inclusion in the Hospital Episode Statistics which are used to provide non-clinical and administrative data for analysis by a range of organisations includinglocal commissioners.

Woodlands Hospice score for Information Quality and Records Management was notassessed in 2013/14 using the Information Governance Toolkit but work commencedon compliance with the toolkit in preparation for signing-up to an NHS StandardContract for all Hospice at Home services commencing in April 2014. Our aim is toachieve level 2 for 2014/15.

Why is this? This is because Woodlands Hospice is not eligible to participatein this scheme. However, in the absence of this we audit our clinical recordsregularly and submit annually National Minimum Dataset reports to ensureour data is as accurate as possible.

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SECTION 3 – Quality overview

Review of quality performanceWoodlands Hospice is committed to continuous quality improvement.

This section provides:

• Data and information about the number of patients who use our services

• How we monitor the quality of care we provide

• What patients and families say about us

• What our regulators say about us

Monitoring activity The Hospice submits information annually to the The National Council for PalliativeCare (NCPC) Minimum Data Sets which is the only information collected nationallyon hospice activity.

Inpatient Unit (15 beds) 2012-2013 2013-2014

Total number of patients 284 220

%New patients 87.7% 86.3%

% occupancy 85.9% 86%

% Patients returning home 55% 63%

Average length of stay 13.3 days 14.3 days

Inpatient UnitIn the Inpatient Unit, where there are 15 beds, theaverage length of stay in 2013/14 was 14.3 days whichis slightly higher than last year. The multi professionalteam are proactive with discharge planning andsupporting patients to achieve their preferred place ofcare. A retrospective audit of patients with prolongedlength of stay identified that these patients havecomplex symptom control issues at the end of life andrequire ongoing specialist palliative inpatient care. Theunit admits patients 7 days per week and has aconsistently high occupancy level of 86%. During theseven months from September 2013 to March 2014,198 bed days were lost whilst building work wasundertaken. This affected the total number of patientsthat could be admitted.

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Day TherapyFollowing the reconfiguration of services, the data indicates a reduction in daytherapy activity from 2012/13 to 2013/14. This is due to day therapy services (nowreferred to as multi-professional assessment days) being reduced to two days aweek with just 15 places on each day (was previously 100 places per week spreadacross four days).

New services have since been introduced to provide attendance for patients on theremaining days. The activity from these services is described by the outpatientservices data, where an increase is seen.

Well-being & Support Centre (incorporating Day Therapy, Outreach, and Outpatients)

A redesign of services within the Well-being and Support Centre has beenundertaken. A combination of multi-professional assessment days, outreachtherapies, group programmes and nurse/therapy led clinics are now available whichenables more focus on individualised care planning. Feedback from the recentpatient survey has been very positive about these services.

Day Therapy (30 places week from May 2013) 2012-2013 2013-2014


% New patients 70.2% 79.6%

% Places used (patient attendances) 50.3% 60.3%

Average length of stay 158 days 158.5 days

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Outpatient services 2012-2013 2013-2014

Number of patients 415 502

% new patients 28.9% 58.2%

Number of clinics 148 748

Number of outpatient attendances 1082 2066

% non-cancer patients 6.1% 5.6%

Outpatient Services

The increase in activity from 2012/13 to 2013/14 is due to the introduction of newoutpatient services (identified from a review of all day therapy services) which includeindividual Outpatient Clinics and therapy groups such as the Breathlessness Groupand the Supportive Living Programme. These new services replace two of theprevious day therapy days and are being actively promoted to increase attendance.

Bereavement services 2012-2013 2013-2014

Total number of users supported 101 151

% new service users 62.3% 80.8%

Total contacts 565 639

Bereavement Services

Individual support is offered to bereaved people by members of the clinical team whohave been key workers to the families. In addition a Bereavement Group is heldmonthly at the Hospice and a ‘Celebration of Life’ service is held annually.

Bereavement services saw a 50% increase in the total number of users supported in2013/14, compared to the previous year. The percentage of new users of the serviceincreased by 18.5% and the total number of contacts increased by 74.

Community Outreach ServiceThere is a Community Outreach service providing Occupational Therapy,Physiotherapy and Complementary Therapy interventions in the patient’s home, forthose patients who are unable to travel to the Hospice.

The data from these services demonstrates an increase of 9.6% in the number ofpatients enabled to die at home (bringing the total percentage closer to the findingsof the British Social Attitudes survey, published May 2013, which identified that 67%of patients would prefer to die at home). The percentage of non-cancer patientsreceiving services has also increased.

Community Outreach Services 2012-2013 2013-2014


% New patients 86.3% 92%

% patients who died at home 53.6% 63.2%

% patients with non-cancer 13.2% 14.5%

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Hospice at Home The Hospice at Home service is currently provided only in South Sefton, offeringescorted discharge home from hospital or hospice, a 24 hour sitting service andconsultant led crisis intervention/prevention.

The number of ‘sits’ provided topatients by the Hospice at Homeservice increased by almost a thirdin 2013/14, taking the total numberfrom 650 to 863. The percentage ofpatients enabled to die in their ownhome (or place of residence)increased from 76.1% to 84.6% andthe number of patients needing tobe transferred to hospital to diereduced from 7.5% in 2012/13 tojust 2.1% in 2013/14.

Hospice at Home 2012-2013 2013-2014


Crisis intervention home visits 53 52

Accompanied transfer home (from Hospice or Hospital) 15 10

Sitting service 85 patients 91 patients

(650 sits) (863 sits)

% Home deaths (place of residence) 76.1% 84.6%

% Hospital deaths 7.5% 2.1%

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Quality Markers we have chosen to measureIn addition to the quality measures used to provide information to the nationalpalliative care minimum dataset, we have chosen to measure our performanceagainst the following:

Patient Safety Incidents

The Multi-professional Falls Group continues to meet on a regular basis to review theincidence of slips, trips and falls across all services and further develop localstrategies to reduce the incidence of falls.

Whilst the number of falls in this period is the same as the previous year, the numberof serious patient safety incidents or injury as a result of a fall reduced to zero.

A falls risk assessment is completed for all in-patients, those attending the Well-beingand Support Centre and Hospice at Home patients. Where risk of falls is identified,action is taken to minimise that risk.

A falls prevention system in use on the Inpatient Unit identified that the bed padsattached to the alarm had to be placed on top of the mattress and were not suitablefor patients who are at risk of developing a pressure sore. Alternative bed pads weresourced and are now in use for patients at risk of developing pressure sores. Stafftraining in the use of this equipment is ongoing to ensure competence and maintainpatient safety.

Infection Prevention and Control

INDICATOR 2012-2013 2013-2014

Number of serious patient safety incidents 2 0

Number of slips, trips and falls 43 43

Number of patients who experienced a fracture 1 0or other serious injury as a result of a fall

INDICATOR 2012-2013 2013-2014

Number of patients admitted with MRSA bacteraemia 0 0

Number of patients infected with MRSA bacteraemia 0 0during admission

Number of patients admitted with clostridium difficile 1 0

Number of in patients who contracted clostridium difficile 0 2*

*not health care acquired

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Excellent standards of infection prevention and control have been achieved againthis year with no incidents of health care acquired infections. The two cases ofclostridium difficile were not related and the infection control team completed a rootcause analysis in both cases which confirmed that the incidents were not health careacquired and that patient care was in line with national guidance; this was confirmedby an independent review arranged by Woodlands.

The Needle safe European Directive came into force in May 2013 in an attempt toreduce the incidence and risk of infection for health care workers from needle stickinjuries. Woodlands Hospice successfully achieved the recommendations of thisdirective and had sourced and implemented needle safe alternatives for allprocedures involving needles prior to the implementation date.

Clinical Audit (see also section 2.2, Participation in Clinical Audit)The Hospice uses clinical audit to monitor quality and support service improvement.Where an audit identifies room for improvement, an action plan is developed,reviewed, and monitored to completion. In addition to internal audit, the Hospiceparticipates in Regional and Supra-regional audits as part of the Merseyside andCheshire Palliative Care Network Audit Group.

The Hospice Board of Trustees support Quality Assurance and adherence to theCare Quality Commission’s Essential Standards of Quality and Safety by undertakinga rolling programme of unannounced Trustee Visits. During these visits, Trusteestalk to patients, visitors, volunteers and staff, asking them about their experiencesand observing practice. Trustees also look at policies, information and supportingdocumentation to enable them to produce a report of their findings withrecommendations for improvement where necessary. An action plan is thendeveloped from the Trustee recommendations and is again, monitored to completion.

Patient and family feedback is also gathered through surveys, comments forms, thePatient Services Manager’s ward round and informal visits by the Chief Executive.

These processes support the Hospice’s Quality Assurance framework.

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Patient SafetyAudits

Infection Control Management ofthe ‘Dirty Utility’room

Infection Control Safe handling &disposal ofdepartmentalwaste

Infection Control Inpatientenvironmentalaudit

MedicinesManagement Self-administration ofmedicines

Safety AlertsAudit of receipt &handling of SafetyAlerts

Findings and Actions to be takento improve compliance/practice

An audit carried out in May 2013 identified someinappropriate items being stored in the dirty utility room.The items were removed; staff were reminded of theirresponsibility to keep general areas clean; a regularinspection was introduced with a daily cleaningschedule. Re-audit in June confirmed that the room wasfree from inappropriate items.

The audit identified that all staff are aware of wastesegregation procedures. However, a poster identifyingcorrect waste segregation was not displayed at the timeof the audit. This has since been rectified.

The audit identified that not all items in the clinical roomwere stored above floor level. Storage was reorganisedto address this.Some chairs were not covered with an impermeablematerial. A planned replacement with appropriatecovers was completed.

The audit identified overall good compliance with policy.However, the following improvements were identifiedand implemented:• Self-administration status was not identified on alldrug cards. A new drug card to be introduced with aspecific space to record administration status.

• Policy and documentation needed update to supportself-administration and storage of medicines bypatients.

A revised policy and procedure for receiving & handlingSafety Alerts was introduced in January 2014.Compliance with the new procedure was audited inJanuary and February 2014.The January audit identified that some elements of theprocedure were not fully understood by staff, resulting insome uncertainty between clinical and non-clinicalalerts. The procedure was reiterated to teams and a re-audit inFebruary 2014 identified that adherence to theprocedure had improved and documentation wasaccurate.

Action plancompleted

June 2013

October2013

December2013

January2014

February2014

The following table shows a sample of the audits and Trustee Visits undertakenduring 2013/14

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Patient SafetyAudits

MedicinesManagement Administration ofMedicines

DocumentationCare Plans


The audit was carried out following the introduction of anew medicines administration chart. The results of theaudit were generally good although the followingimprovements were identified and implemented:• Improvements to be made to the recording of allergyand self-administration status on cards.

• Improving legibility when a non-administration codeis entered.

• Adhere to the ‘new’ administration codes (some staffwere still using the ‘old’ codes from the previouscharts).

An audit in March 2014 identified that the standards ofcompleting Care Plans had slipped slightly fromprevious months and highlighted some incompleteentries. The Acting Ward Manager shared the results with allward staff and reiterated the importance of completingCare Plans at handover & ward meetings.A re-audit in April showed an improvement.


March2014

April2014

Regional Audits

PathologicalFractures

PsychologicalSupport Services


This audit demonstrated a wide variation in referraland management of pathological fractures. Newregional guidelines have been developed. Theseguidelines incorporated scoring systems to be usedto help predict the risk of fracture and these havebeen laminated and placed in clinical areas. It alsohighlighted the consideration that should be given tothe use of newer drugs such as Denosumab inthese patients.

This audit reviewed our provision of and access toLevel 3 and 4 psychological support services. Thisaudit highlighted the requirements for both adult andchild support services. As a result of the audit weare reviewing our referral guidance and also thetraining available for psychological assessment andmanagement strategies.


February2014

Inprogress

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Trustee Visits

May 2013:Outcome 7.Safeguarding people whouse the services fromabuseGeneral Comments:The Trustee was veryimpressed with theSafeguarding Lead and herknowledge and experienceof standards and practice.The Trustee was alsohappy that staff would beable to recognise signs ofabuse and how to escalatea problem if it wasnecessary.

September 2013Outcome 9.Management of medicinesGeneral Comments: “I found the Management ofMedicines on the In-patientunit robust, and all staffinterviewed were wellversed on policies andprocedures”.

January 2014: Outcome 12Requirements relating toWorkers. General Comments: “Thereis lots of enthusiasm withinthe Hospice and the ‘newbuild’ will bring peopletogether. I was veryimpressed with thediscussions I had aboutPDRs and 6-weekly 1:1s.The patients I met spokeextremely positively abouttheir experiences. The newWell-being & SupportCentre Manager appears tobe embracing the changes”.


• Staff to be reminded of the ‘No Secrets’document and where it can be locatedin the hospice.

• Line managers need to re-iteratesafeguarding information a little afterinduction to ensure it is clear to all staff.

• Spot checks on Safeguarding to beincorporated into the Patient ServiceManager’s ward round.

No specific improvements were identifiedfrom this visit but the Trustee highlighted:• That she had seen (from audits) animprovement in competency withcontrolled drug documentation.

• And that the input of the pharmacist (aclinical specialist in palliative caremedicines) was valued by all staff andhad improved efficiency.

• Recruitment and inductiondocumentation and filing to be broughtup to date.

• Create a general inductionchecklist/record that new starters cansign, and which can be placed in theirindividual staff record.

• Improve the management of thedocumentation included in the‘practicing privileges’ folder, ensuringthat contracts are signed and copies ofmedical indemnity are taken and filed.

• Improve the timeliness of staff contractdevelopment and signing so that asigned copy of an individual’s contractis available in their individual staffrecord within two months of starting.

Progress to date

Completed

Completed

Completed

Completed

In progress

Completed

Completed

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Trustee Visits

March 2014: Outcome 2Consent to Care &TreatmentGeneral Comment:“The hospice staff are veryaware of the need forconsent throughout theirdealings with patients. Ihave no recommendationsto make as the currentsystem seems to beworking well”.

March 2014: Outcome 16Assessing & monitoring thequality of service provision. General Comment: “All the staff I spoke toknew the importance ofassessing and monitoringthe quality of serviceprovision. There weresome excellent examples ofgood practice, e.g. the useof audit, KPIs andfeedback.”


• Training in ‘Consent’ to be introducedfor all relevant staff and incorporatedinto relevant staff induction training.

• Cascade training plan for MentalCapacity Act (MCA) and Deprivation ofSafeguarding Liberties (DoLS) to beput in place for all relevant staff oncetraining of senior staff is complete.

• Audit reports need to be improved todemonstrate that actions are followed –this information needs to be sharedacross the organisation.

• A ‘Quality & Improvement Brief’ shouldbe developed to share results/actionplans/audits etc with all staff.

• Improve the reporting of near-missincidents across the organisation.

• Press on with plans to deliver trainingon complaints handling to all staff.

Progress to date

Training inConsent,MCA andDoLS is nowin place for allclinical staffacross theHospice.Expecteddate ofcompletionJune 2014

In progress

Completed

In progress

In progress

ComplaintsThe Hospice receives very positive feedback from the people who use our services,sometimes verbal but often in the form of letters and thank you cards. This type offeedback is most welcome and we make every effort to share it with our staff andvolunteers.

We actively encourage all types of comments and feedback, including complaints, sothat we learn from these to make sure that our standards continually improve andmistakes are rectified.

We take all complaints very seriously and during 2013/14 we updated our policy forhandling complaints, as well as our ‘Comments, Compliments and Complaints’ form,to help us to improve the way complaints are dealt with consistently across theorganisation. Training in the new complaints procedure is planned for all staff andvolunteers during May 2014.

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There was an overall small increase in the number of written complaints receivedduring 2013/14 compared to the two previous years, whilst verbal complaints fellmarginally. The trends and themes of these complaints could broadly be divided intothree categories.

Number of complaintsWritten Complaints 2011-2012 2012-2013 2013-2014Total number received 2 4 6

Verbal Complaints 2011-2012 2012-2013 2013-2014Total number received 11 11 9

Trends/themes of complaints

Theme

Communication

Attitude

Processes andProcedures

Numbers (NB - Some complaintsraised more than one issue)

7

6

11

Examples of resultingActions/Improvements

• Following a problem which arose fromthe lack of communication within theteam of telephone discussions with acarer, the process for documentingcommunication with 3rd party contactswas reviewed and revised. All staff arenow working to the new process.

• Following a complaint from a carer whowas approached regarding fundraisingwhilst supporting a patient attending foran appointment, the sale of raffle ticketsand other requests for donations arenow restricted to the main reception (i.e.no longer to take place in clinical waitingareas).

• During January 2014 when the Hospicewas undergoing extensive buildingworks, an increase in fire alarmactivations caused a disturbance to localresidents. Our on site builders took stepsto ensure that alarms could not beaccidentally triggered and no furtheraccidental alarms were sounded. TheHospice generator testing process wasalso reviewed.

All written complaints are acknowledged in writing by a member of the SeniorManagement Team within one working day of receipt. A full investigation isundertaken by the appropriate Senior Manager and resulting actions are monitoredto completion. Verbal complaints are handled with the same level of importance aswritten complaints. An investigation is undertaken by the Manager of the serviceinvolved and the resulting outcome is recorded.

An anonymised report of all complaints is reviewed regularly by the Board ofTrustees and relevant committees. Learning from the management and handling ofcomplaints is shared across the Hospice at team meetings.

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3.1 What our patients and families say about theorganisationThe Hospice welcomes all comments and feedback from patients, carers andfamilies and there are many ways in which people can send these to us. We havean organisational-wide ‘Comments, Compliments and Complaints’ form, which isgiven to all patients in information packs and is also available on reception forvisitors, carers and family members to complete; traditionally we have receivedletters and thank-you cards from patients, carers and families; and of course, peoplehave always been welcome to speak to us in person about their experiences. Morerecently however, as people become more familiar with social networking and otherforms of communication, we are starting to receive comments by general email,through ‘just giving’ pages, via Facebook pages, and even through ‘Twitter’. Thefollowing are a selection of comments we have received over the past year, througha variety of methods.

“Thanks forthe care given to my

dad in his final days andfor the letters and leafletsyou sent, helping usthrough a verydifficult period.”

“I’m running the St Helens 10kfor Woodlands because they do great

work and deserve support; they do a greatjob caring for those in need.”

“Thank youfor all your care

and love you gave her whilstshe was at the hospice.Your support made adifficult time mucheasier, we will neverforget everything youdid for us as a family.”

“To all, not forgetting volunteers. As a family, thank you all

from the bottom of our hearts for lookingafter our mum. You looked after her so

well, you are special people.”

“Since my stay at Woodlands I have appreciated everything

they have done for me. I feel healthier becauseof good nursing, medication, food, doctors,physio, hygiene, and pleasant surroundings.

I am grateful to Woodlands.”

“I am so grateful forall the skill, care and real belief in caring

for the person, not the disease, which is being shownhere all the time – in what you do as individuals and as ateam. It’s easy to be cynical, and I’m as guilty of that asthe next person, but being here has changed that.Thank you for reminding me that there is so

much good in the world.”

“AtWoodlands there are no problems only solutions"

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“We would liketo thank you all very, very

much for all you did for Mumover the years. It wasn’t just themedical side of things, she lovedthe social side, making things,talking, having her hair done toname but a few. Thank you forall your friendship and support,not only to Mum but to us

as a family.”

“I had a great nurse.I must say she does an amazing joband gave me confidence. Thank youto the Woodlands for having such

lovely dedicated staff.”

“I can thinkof a number of cases

where patients would have beenadmitted to hospital if rapid intervention

would not have been made”.Specialist Palliative Care Nurse

“Knowing patientsand carers have extra supporthas given them the confidence to

choose to go home.”Discharge Planner

“We particularly valuethe accompanied transfer

home service. All of our patients/relatives benefited from this

fantastic service.”District Nurse

“The service hasprovided benefit to a great extentto deal with emotional issues andpractical issues for carers and

patients.” GP

“As a family weare very grateful for the

compassionate care all your staffshowed to our father. It was our wishthat dad remain at home and withyour help this was made possible,

something we will always be very grateful for.” “Thank

you for thewonderfulcare,

kindness,attention and timegiven to my partnerand me. Woodlandsis in a league of itsown. Please let allyour staff and

volunteers know howvery much we valuedtheir hard work,friendliness anddedication.”

“Beautifulpeople and abeautiful place;Woodlands lookedafter my sister withtender care andcompassion.”

“Theyalways treatus with

utmost dignityand respect.We are all asa family soproud andpleased to

have met suchlovelypeople.”Carer

“I think theservice is an integral

part of the patient’s packageof care and proved a greatsource of psychological

support for both the patientand family.”

Community Specialist Nurse

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3.2 What our regulators sayWoodlands Hospice is registered with the Care Quality Commission and as such issubject to regular review in the form of unannounced inspections. Please see section2.5 for details of our most recent review (August 2013).

3.3 The Board of Trustees’ commitment to qualityThe Board of Trustees of Woodlands Hospice Charitable Trust is fully committed toprioritising the quality of patient and family care. All Trustees participate in theprogramme of unannounced Trustee Visits giving them an opportunity to familiarisethemselves first hand with the workings of the Hospice and to hear the views ofpatients, families, staff and volunteers. The organisation has a robust QualityAssurance framework with Trustees taking an active role in ensuring that the Hospiceprovides the best possible evidence based care and fulfils its Statement of Purpose.

3.4 Supporting Statements

Healthwatch

Unfortunately, Healthwatch Sefton were unable to provide a commentary on thisoccasion. However they expressed their hope to work in partnership with us in thecoming year.

Comments from Healthwatch Liverpool and Healthwatch Knowsley are awaited.

Clinical Commissioning Groups

Woodlands Hospice has worked closely with South Sefton CCG, Liverpool CCG, andKnowsley CCG throughout the year and would anticipate supporting comments forthe next Quality Account.

www.woodlandshospice.org

Woodlands Hospice Charitable TrustUHA Campus, Longmoor Lane, Liverpool L9 7LA

Tel: 0151 529 2299Charity No. 1048934

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