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Version: 2.0 – June 2014

Greenwich & Bexley Community Hospice

2013–2014 Quality Account

Wife of patient, Bexley

GBCH 2013-2014 Quality Account


Contents Page

Part 1 – Chief Executive’s Statement 3

Part 2 – Priorities for Improvement and Statements of Assurance from the Board 4-21

2.1 Priorities for Improvement 2014 – 2015 4

2.2 Priorities for Improvement 2013 – 2014 10

2.3 Statement of Assurance from the Board 15

2.3.1 Review of Services 15

2.3.2 Income Generated 15

2.3.3 Participation in National Clinical Audits 15

2.3.4 Participation in Local Audits 16

2.3.5 Research 17

2.3.6 Quality Improvement and Innovation Goals Agreed with

our Commissioners 17

2.3.7 What Others Say about GBCH 17

2.3.8 Data Quality 20

2.3.9 Information Governance Toolkit Attainment Levels 20

2.3.10 Clinical Coding Error Rate 21

Part 3 – Review of Quality Performance 21-30

3.1 Comparison with National Minimum Data sets 21

3.1.1 Inpatients 22

3.1.2 Day Care 23

3.1.3 Home Care / Hospice at Home 24

3.1.4 Hospital Support Teams 25

3.1.5 Bereavement Support 26

3.1.6 Outpatients 27

3.2 Clinical Governance 28

3.3 Training 28

3.4 Health Improvement Network 28

3.5 End of Life Care Clinical Leadership Group 29

3.6 Challenges 29

Appendices 31-35

Appendix 1: Greenwich 31

Appendix 2: Bexley 33

Appendix 3: Healthwatch 34



Part 1 - Chief Executive’s Statement

Greenwich & Bexley Community Hospice celebrated 20 years of caring across the

local area this year; and so much has changed since the first day hospice patients

arrived in February 1994. The Hospice continues to seek to improve and extend its

services to meet the needs of dying people across the whole community and it is my

pleasure to present our Quality Account for 2013/14 which documents some of the

progress we have made as well as some of the challenges we face.

Our community services continue to expand in response to need, with an increased

number of people being cared for at home in this year. With this increase we have

also been privileged to support more people with a diagnosis other than cancer

and have been able to facilitate an increase in the number of people who have

been able to achieve a home death (where most people say they wish to be cared

for). We continue to work in partnership with our commissioners and other local

service providers to reduce the number of people who die in hospital and achieved

home or hospice as place of death for 76% of people.

The Hospice is registered with the Care Quality Commission and was inspected on

13th December 2013 and 5th March 2014, the details of these inspections are

included in this report.

The planned development of the Hospice building began in January 2014, and we

began reviewing elements of Hospice service to ensure that the benefits of the

building project are maximised within the year. We are extremely excited about the

opportunities that our building expansion will provide to reach more people who

need our care and support.

To the best of my knowledge, the information reported in this Quality Account is

accurate and a fair representation of the quality of healthcare services provided by

the Hospice.

Kate Heaps

Chief Executive



Part 2 – Priorities for Improvement and Statements of Assurance from the Board

2.1 Priorities for Improvement 2014 – 2015

The following key Priorities for Improvement 2014/15 have been identified. These

cover the three quality domains of Clinical Effectiveness, Patient Experience and

Patient Safety:

Improvement Priority 1: Access to Hospice Services

Why this was chosen as a Priority

This was an Improvement Priority for 2013-14 but the Hospice strategy identified this

as a key area for development over the next 3-5 years and as such this is a long

term strategic goal. (See page 13 for progress to date).

In 2012 Help the Hospices (HtH) commissioned the Cicely Saunders Institute to

produce an evidence-based report on the future level of need for hospice care.

The fundamental aim of this project, conducted under the auspices of HtH’s

Commission into the Future of Hospice Care, was to predict the likely impact of

demographic changes on the future demand of care provided by hospices. The

report made the following conclusions:

UK mortality trends have and are changing towards people living longer

and dying with more complex needs and diseases at an older age.

Hospices will therefore need to optimise their capacity to care for older

people at the end of life

Evidence from the UK shows that home is the most frequently chosen place

to die, however the Older Old (85+) and non-cancer patients are less likely

to die at home than patients with a cancer diagnosis. Hospices therefore

need to better understand why this is and assess patients’ “preferred place

of care” in order to respond to the needs of the local population

Current models of end of life care provision have been based on past

assumptions and provide “deluxe dying for the few” (Douglas 1991).

Hospices therefore need to review the way they do things

GBCH has an ethnically and socio-economically diverse catchment area. Like

most other hospices, the Hospice does not receive a representative number of

referrals for people across the range of the population; however recent changes

to the model of care provided by GBCH appear to be making some in-roads in this

area.

What does the Access to Hospice Services Priority mean?

The Hospice has developed its services over recent years to ensure that care is

provided across patient pathways in a variety of settings. Opportunities to provide

integrated care in hospital, at home or in a care home and in the Hospice building

have already helped to improve accessibility for people regardless of their

diagnosis, age, ethnicity, preferred place of care etc. However the Hospice

recognises that we still have a long way to go in providing access to Hospice

services for all who need it.

GBCH has identified that, as part of its response to the ever increasing need for



Palliative and End of Life Care (EoLC) for people who may not have traditionally

accessed these services, it wishes to redesign referral pathways, integrating existing

elements of service further and developing new areas of provision.

As part of this, the concept of the Hospice as “a hub” will be developed. This

enables the physical space to be used not only by patients, families and staff, but

also to be a “hub” for the local community. For example, the Hospice may provide

a space for socialising, rehabilitation, volunteering, receiving new kinds of care

and support and training and education. By opening up the Hospice to other

members of the community, we aim to challenge people’s perceptions of who

and what hospices are there for, opening up the doors to support more people

throughout their lives.

What are the plans for this Priority?

To ensure that people are able to express their preferences, we will continue

to embed Advance Care Planning into the care pathway within and outside

Hospice services in Greenwich and Bexley boroughs. The Advanced Care

Planning project is a scheme to support people with life limiting illness, to

develop their own unique care plan for the future. This project was made

possible by a grant from Comic Relief, to enable the Hospice to recruit and

train Advance Care Planning volunteers.

To develop and introduce new social support services, including befriending,

supportive groups and drop-in services

To ensure all Hospice’s medical and nursing staff are more confident and

competent in caring for older people, people with the full range of life-limiting

illness including dementia and those who are living with long term conditions

Improving and enhancing the delivery of integrated end of life care across

both boroughs and to continue to ensure that people who are in hospital are

enabled to die in their place of choice by improving transitions between care

settings

To review ambulatory care services to improve access to the Hospice for re-

ablement, complementary therapies, financial and housing advice,

psychological support and so on

To increase the provision of education and training to local health and social

care partners

In addition, the Hospice will review its referral processes, and ensure that people

receive the most appropriate care in the most appropriate setting, in a timely

manner, through the development of a new co-ordination or “First Contact” centre

at the Hospice.

As part of this strategic goal, GBCH is developing new facilities on the Hospice site

including a purpose built rehabilitation gym, a new education and training facility

and a coordination centre, where we will provide a First Contact centre, integrating

specialist community services, our end of life care services and developing and

building on our partnerships with other health and social care providers.



Progress against the plan to date:

Evaluation of Advance Care Planning (ACP) Project in Greenwich, which has

been funded by a grant from Comic Relief, has commenced. It is expected

that the data collection will be completed and the results published later in

2014

The Hospice’s “Capital Build Project” building work commenced in January

2014. It is anticipated that this building work will be completed by February

2015

Evaluation of the Hospice Neighbours service (a “befriending” service) is

taking place alongside the delivery of the service and further recruitment is

planned to expand the service during 2014

The staffing and structure of the Hospice’s new “First Contact” service has

been developed and the operational policy for the new service will be

developed during 2014 in preparation for the completion of the new build

A review of the service delivery models for Day Hospice and the

Lymphoedema Service are due to take place in 2014

The Hospice has delivered bespoke training and awareness sessions for local

faith leaders and social care staff from the local boroughs during 2013

The Hospice’s new Nurse Consultant role was agreed by the Hospice’s Board

of Trustees in 2013 and the post was recruited to in 2014. Initially funded for

one year by NHS Greenwich, the Nurse Consultant will help drive

improvements in care for dying people across and between the Queen

Elizabeth Hospital and the Hospice

The Hospice has been working with the Greenwich Prison’s Cluster to ensure

that people in custody have appropriate access to end of life care. A regular

review meeting for prisoners with life limiting illness was established in March

2014 and a strategy for end of life care in the prisons will be finalised by July

2014

How progress will be reported

Progress on this priority will be regularly reported to Clinical Leads meetings, the

Quality & Safety Committee, relevant project boards and to the Board and Trustees.

In addition, formal written reports will be submitted to commissioners and grant

funding bodies.

Improvement Priority 2: Embed Clinical Research and Audit


The Hospice recognises that palliative care research and audit are essential

elements in improving patient care and services. The current evidence base for

many hospice palliative care interventions is limited and is therefore reliant on

hospice and palliative care engagement in research in order to inform practice

and progress. As the report “Research in palliative care: can hospices afford to

not be involved?” (October 2013) for the Commission into the Future of Hospice

Care identified, research in the hospice setting has many challenges and requires

appropriate leadership, resources and expertise. However to date GBCH has not

had the relevant experience to enable us to actively participate fully in research



activities. In terms of clinical audit, although the Hospice has conducting regular

clinical audits, GBCH would like a more co-ordinated and structured approach

which would be very beneficial.

In November 2013 the Hospice appointed a new Medical Consultant who has had

significant experience in research and audit and so a lead responsibility for

research and audit has been added to her practice portfolio.

What is Clinical Research and Audit?

Hospice engagement and understanding of research at different levels is

necessary to ensure evidence based practice. Clinical audit provides assurance

of compliance with best practice standards, with the aim of improving quality of

care and patient outcomes.


Research:

Greenwich & Bexley Community Hospice aims to be a “Research Active Hospice”

adopting the Research Framework for Hospices (Payne and Turner 2012). In this

framework three levels of research engagement described:

Level 1: research awareness in all professional staff

Level 2: engagement in research generated by others

Level 3: engagement in research activities and leadership in developing and

undertaking research

The Hospice has appointed a Research Lead, Dr Ruth Branford and set up a

Research Governance and Management Group in order to achieve, in the first

instance, the first 2 levels of research engagement.

The Hospice has already made progress towards Level 1 with inclusion of research

topics on the regular education programme, regular circulation of palliative care

journals and the development of a multi-professional journal club.

Achieving Level 2 is underway in partnership with the Cicely Saunders Institute, King’s

College London. We are in the set-up process to join the multisite integrated

Palliative Care Outcome Scale (iPOS) validation study, and aim to be involved in the

South London Collaboration for Applied Health Research and Care (CLAHRC). Dr

Branford also maintains her research collaboration with Royal Marsden Hospital. The

Hospice Research Governance and Management Group are also open to other

future research collaborations.

Clinical Audit:

In order to co-ordinate Clinical Audit activity at the Hospice, Dr Ruth Branford has

also been appointed Clinical Audit Lead. The Clinical Audit Lead is responsible for

the development of an annual audit plan. A new system of audit proposal and

approval has been introduced to ensure quality and ensure appropriate

prioritisation.



How progress against the plan will be measured

Progress in Level 1 research engagement will be measured by attendance at

teaching sessions, and journal clubs. Progress in Level 2 will be measured by

successful recruitment to the clinical studies and ultimately publications.

Clinical audit proposals will be discussed at Clinical Leads and results including

recommendations will be fed back to the same group.


Progress will be monitored by the Research Management and Governance Group

and reported to the Hospice Quality and Safety Committee.

Clinical Audit activity will be reported to via Clinical Leads to the Quality and Safety

Committee.

Improvement Priority 3: Workforce, Education and Training


In 2013, Help the Hospices (HtH) produced a number of reports relating to

Workforce, Education and Training:

Working towards a Hospice Workforce that is Fit for the Future written with

Skills for Health, this paper details some key roles and skills that will be

needed in the hospice workforce in the future.

The Future of Hospice Education and Training produced with the National

Association of Palliative Care Educators, explores how Hospices can

preserve and improve upon their vital role as educators to the end of life

care sector, in a future which looks markedly different.

Other reports also coming out of the HtH commission looked at specific roles in

Hospices including the Palliative Care Medical Consultant, Clinical Nurse Specialists

and Volunteers.

Like many Hospices and other Healthcare services in London, the recruitment of

suitable staff for some roles has been increasingly difficult over recent years.

The Francis Report, the Berwick Report and the Cavendish Report all highlighted

the importance of organisations investing in their workforce to ensure that the

quality of care is maintained and that organisations have sufficient capacity to

meet the needs of their service users.

What is the Workforce, Education and Training Priority?

Maintaining a diverse, competent and motivated workforce is vital to the future of

Greenwich & Bexley Community Hospice. Our Staff and Volunteers are our most

important asset and it is important that we plan strategically for future challenges

that face us if we are to continue to support our local population.

The Hospice also has an important role in supporting and developing the skills of

staff working for other organisations so that they can provide excellent end of life

care.




We will develop a workforce strategy for the Hospice, which seeks to provide

opportunities for growth for existing staff and volunteers as well as developing

strategies to improve recruitment and developing new creative roles to ensure care

is delivered compassionately, creatively and efficiently.

We will work with other Hospices and Health Education South London (HESL) to

explore new opportunities, roles and training programmes for Volunteers and

Assistant Practitioners.

We will continue to develop our own staff, particularly focusing on advancing the

role of our senior nurses including developing advanced assessment skills and non

medical prescribing.

We will continue to develop training programmes and development opportunities

for external staff in line with the emerging End of Life Care (EoLC) education and

training strategy for South London. This will include us working collaboratively with

other Hospices to develop and deliver new training programmes and evaluate

these.

How progress against the plan will be measured

The Workforce Strategy will include key performance indicators which will be

reported on as part of the Head of Human Resources report to the Board of Trustees.

Service delivery elements of this strategy will also be presented to the Quality &

Safety Committee.

The Hospice has already been instrumental in establishing a South London Hospices

Education Collaborative which has established a number of education projects,

funded by HESL. Each project will be evaluated and the findings will be reported to

the Hospice Education and Training sub group as well as to HESL and London

Cancer Alliance. Ultimately the group will aim to publish its findings.

We will measure the number of staff completing external training and report this to

the Hospice’s Education and Training sub group. The Hospice’s mandatory training

dashboard is also presented to the Quality & Safety Committee every month.

The Annual Report of the Education and Practice Development Team will

demonstrate the reach and impact of their work, both internally and externally. This

report is presented to the Hospice’s Clinical Leads and the Quality and Safety

Committee.


Within the Hospice, progress will be monitored though the HR report to the Hospice

Board and through the Education and Training sub group.

Externally, progress will be monitored by HESL and the London Cancer Alliance.



2.2 Priorities for Improvement 2013 – 2014

The key Improvement Priorities for 2013/14 were:

Progress against Improvement Priority 1: Development of a Quality and

Governance Dashboard

What is a Quality and Governance Dashboard?

The “dashboard” allows clinical staff, managers and Trustees to monitor progress

and identify potential trends which may indicate problems that they need to focus

on.

Quality and Governance Dashboards help to drive this process by providing timely

and relevant information for clinical teams, presented in easy to understand

formats, with high visual impact.

What was planned / achieved

The Hospice has an agreed dashboard format and structure, developed for the

four key areas of:

Patient Safety

Clinical Effectiveness

Patient Experience

Workforce Data

The Dashboard covers monthly activity within the reported quarter and figures for

the previous two months and quarters

An annual monthly/quarterly Dashboard reporting schedule has been

developed for the Quality & Safety Committee

Benefits/outcomes of this Priority

The Mandatory Training Dashboard is now reported monthly to ensure closer

monitoring of staff attendance at training

It enables comparison of performance against previous quarters at a glance and

to identify trends

Confidence in our reporting has allowed us to participate in the Help the

Hospices National Hospice Inpatient Safety Benchmarking project which requires

reporting monthly performance against set criteria – Falls, Pressure Ulcers,

Medication incidents and Bed Occupancy

Any outstanding area to be addressed in 2014/15

The Hospice plans to expand the areas reported in the Clinical Effectiveness

Dashboard, so that it reflects the data reported to NHS Greenwich and NHS

Bexley through regular commissioner reports



Example of Mandatory Training Monthly Dashboard

Quality & Safety Committee - February 2014

Q4(January - March) Mandatory Training Dashboard

•Detail any Mandatory Training areas where there are or will be, any issues meeting the Yearly Target, with reasons

(staff availability, courses spaces etc), if known

• Action plans / proposals for detailed areas to meet

Yearly Target

Mandatory Training / Clinical Dec JanFeb

Forecast ComplianceYearly Target

Infection Control (inc Hand Hygiene) 82% 87% 87% 80%

Health & Safety 84% 89% 89% 80%

Fire 84% 89% 89% 80%

Risk Assessment 83% 87% 87% 80%

COSHH 82% 91% 91% 80%

Safeguarding 86% 92% 92% 80%

MCA / DOLS 63% 61% 61% 80%

ACP 73% 74% 74% 80%

Diversity 78% 79% 79% 80%

Moving & Handling 77% 77% 77% 80%

Basic Life Support 66% 69% 69% 80%

Safe Food Handling 69% 72% 72% 80%

Information Gov 71% 77% 77% 80%

Blood Transfusions 49% 68% 68% 80%

Medicine Management 55% 52% 52% 80%

Mandatory Training / non-Clinical Dec JanFeb

Forecast ComplianceYearly

Target

Infection Control (inc Hand Hygiene) 53% 55% 59% 80%

Health & Safety 85% 88% 93% 80%

Fire 88% 90% 94% 80%

Risk Assessment 86% 88% 93% 80%

COSHH 84% 86% 91% 80%

Moving & Handling 84% 86% 92% 80%

Diversity 84% 86% 91% 80%

Communication 84% 86% 91% 80%

Information Gov 69% 70% 74% 80%

Safe Food Handling 61% 63% 63% 80%

Agenda Item 5.3

Progress against Improvement Priority 2: Launch a Patient & Carer Survey

Programme

What is a Patient & Carer Survey Programme?

GBCH decided to adopt a variety of formal approaches to capture and collate

patient and carer feedback.

VOICES (Views of Informal Carers) - This is a postal questionnaire which collects

information from bereaved Next of Kin four/five months after the patient has

died. This is a well established and validated tool.

SKIPP (St Christopher’s Index of Patient Priorities) – This is an outcome

measurement tool which enables staff to assess the impact on patients of the

care they deliver and show changes in symptoms over time. It is an established

and validated tool.

FFT (Friends and Family Test) – This is a simple, comparable test which, when

combined with a follow-up clarification question, provides a way of recognising

good and bad performance.




The VOICES survey was launched in August 2013

The SKIPP questionnaire (for patient completion) was launched in our Day

Hospice in September 2013

FFT was launched in the Hospice’s “Let’s Get Moving” and “Stepping Stones”

services in July 2013 and then implemented on the Hospice’s Inpatient Unit

(Woodlands) for patients who are discharged. The FFT was also added to the end

of the SKIPP Follow up questionnaire used in Day Hospice

Benefits/outcomes of this Priority

Since its launch, the VOICES questionnaire response rate has consistently been

around 36%, which is slightly better than the response rate from other hospices. This

response rate is split 63%/30% for our two boroughs of Bexley and Greenwich with the

remaining 7% of responses coming from other areas.

The responses we have received to date have provided views of bereaved carers of

the Hospice’s performance across a number of key areas such as:

Preferred Place of Care

Relief of Pain

Dignity and Respect

Quality of Care

A recent review of the VOICES responses received to date has identified a number

of proposed refinements to the survey:

There should be two versions of the VOICES questionnaire. One version will be for

Bexley and out of area residents, covering Specialist Community Service. The

second version, for Greenwich residents, will cover both the Specialist

Community Service and the Greenwich Care Partnership (GCP). This will enable

more accurate information to be collected for the GCP service

A section is to be added to enable next of kin/carers to provide their contact

details if they would like the Hospice to contact them to discuss or respond to

any points raised or provide more information about Bereavement Support

The Day Hospice staff find SKIPP to be a useful tool. Completion of the questionnaire

with a patient often triggers discussions focussed on areas and issues of concern,

which may not have been previously raised. It has been agreed that SKIPP will

continue to be used in Day Hospice but due to the Hospice’s involvement in the

iPOS validation study, it is not planned for SKIPP to be rolled out in any other areas.

To date the Hospice has had an extremely high response rate and FFT Score across

the areas where FFT has been launched.


FFT will be rolled out to other Hospice services (Lymphoedema, Community, Social

Work, GCP, Counselling, Hospital Team and Rehabilitation) throughout the year.



Progress against Improvement Priority 3: Access to Hospice Service

(Ongoing priority, see Improvement Priority 1 on page 4)

What does the Access to Hospice Services Priority mean?

The Hospice has developed its services over recent years to ensure that care is

provided across patient pathways in a variety of settings. Opportunities to provide

integrated care in hospital, at home or in a care home and in the Hospice building

have already helped to improve accessibility for people regardless of their

diagnosis, age, ethnicity, preferred place of care etc. However the Hospice

recognises that we still have a long way to go in providing access to Hospice

services for all who need it.

GBCH has identified that as part of its response to the ever increasing need for

Hospice and End of Life Care for people who may not have traditionally accessed

these services, it wishes to redesign referral pathways, integrating existing elements

of service further and developing new areas of provision.

As part of this, the concept of the Hospice as “a hub” will be developed, this

enables the physical space to not only be used by patients, families and staff, but

also to be a “hub” for the local community. For example, the Hospice may provide

a space for socialising, rehabilitation, volunteering, receiving new kinds of care

and support and training and education. By opening up the Hospice to other

members of the community, we aim to challenge people’s perceptions of who

and what hospices are there for, opening up the doors to support more people

throughout their lives.


Progress against the plan to date:

Funding has been received from Greenwich CCG for the Nurse Consultant

role and the new post holder is due to start in this role week commencing 9th

June 2014. The job plan for this role includes:

o to assess why people at the end of life are admitted to the local acute

Trust via A&E and if improvements can be made to avoid

inappropriate admissions

o to provide clinical leadership to endeavour to reduce the length of

stay of people at the end of life in hospital

o to develop a strategy to increase the number of “Older Old” and non-

cancer patients dying at home or at the hospice, in accordance with

their ‘Place of Death’ wishes

o to introduce a nurse led outpatient clinic

o to drive the Hospice’s strategic aim to have nurse led admissions

The Hospice received funding for 3 years from the London Borough of Bexley

to enable the role out of the Advance Care Planning (ACP) project in the

borough

The Hospice has received funding to commence a “Befriending” service (this

has been called “Hospice Neighbours”). A project lead has been appointed



and recruitment and training of new volunteers took place in October 2013.

Volunteers are now working with and supporting carers and patients

For 2014/2015 the Hospice has produced a new annual education curriculum

for staff external to the Hospice and will also be delivering “bespoke” training

to staff external to the Hospice

As part of the Hospice’s “Rolling Education” programme, sessions have been

delivered on Heart Failure and End of Life Care, COPD and End of Life Care,

Renal Failure and End of Life, End of Life Care for people with dementia and

MND and End of Life Care to hospice staff

During 2013/2014 discussions have been taking place with the Hospice’s

commissioners about how End of Life Care in all care settings can be

improved. These discussions are still ongoing

The Hospice has introduced a new drop in “One-Stop Shop”, to support

carers and patients, who require advice on financial, welfare and housing

matters. This service also assists patients who wish to develop an Advanced

Care Plan. In 2014/2015 the Hospice is planning to recruit a number of

volunteers to extend the reach of this service

During 2013 the Hospice’s physiotherapist developed a new service in

partnership with the Lymphoedema Service called “Let’s Get Moving” to

provide a re-enablement and exercise class for people with upper and lower

limb lymphoedema. The service received 2 London Borough of Greenwich

Dignity in Care awards and the Hospice’s Annual Staff Award for Innovation in

2013


(See Improvement Priority 1: Access to Hospice for 2014/2015 on page 4)

Husband of patient



2.3 Statement of Assurance from the Board

The following are a series of statements that all providers must include in their Quality

Account. Many of these statements are not directly applicable to specialist

palliative care providers.

2.3.1 Review of Services

During 1st April 2013 to 31st March 2014, The Hospice provided the following services:

Inpatient Care

Day Hospice Services

Specialist Palliative Care Community Services in Greenwich and Bexley

Boroughs

Specialist Palliative Care Team at Queen Elizabeth Hospital

“Greenwich Care Partnership”

Rehabilitation Team

Lymphoedema Treatment and Care Service

Psychological Care Service (including the Telephone Bereavement

Service)

Chaplaincy

Social Services

Education and Training Team

Care Homes Support Team

Advance Care Planning Service

Befriending Service

The Hospice has reviewed all the data available to them on the quality of care in all

its services.

2.3.2 Income Generated

The income generated by the NHS services reviewed in 2013/14 represents 100% of

the total income generated from the provision of NHS services by GBCH for 2013/14.

The income generated from the NHS represented 47% (unaudited) of the overall

cost of running these services.

The above mandatory statement confirms that all of the NHS income received by the

Hospice is used towards the cost of providing patient services.

2.3.3 Participation in National Clinical Audits

During 2013/14, the Hospice was ineligible to participate in any national clinical

audits or national confidential enquiries.

–

Day Care patient



2.3.4 Participation in Local Audits

The following audits were carried out during 2013/14:

Subject Matter Outcomes of Audit Follow-up Actions

Accountable Officer

Audit

Annual audit of Controlled Drugs

and non Controlled Drugs

processes and policies. High

level of compliance recorded

Action plan drawn up for

highlighted areas, progress

reported at Quality & Safety

Committee meetings

Trustees Inspections

Programme

Schedule of unannounced

inspections covering the CQC

Essential standards of quality

and safety outcomes

Reports drafted and action list

updated after each inspection

and reviewed at Quality &

Safety Committee and Board

Use of injectable

Oxycodone

Repeat audit showed improved

documentation for use of

injectable Oxycodone,

switching to Oxycodone and

use of Oxycodone in syringe

pump

No specific actions. Audit to be

repeated later in 2014

Opioid prescription

audit

Good overall compliance with

local prescription guidelines.

Documentation of dose

calculations recommended

Re-audit to be carried out in

2014

Transfer of patients out

of the hospice to acute

care

This is a 2 year case series.

Demonstrated senior led transfer

decisions, multiple reasons due

to unpredicted and predictable

deterioration in condition

unable to be addressed at

hospice. Isolated occasion of

patient preference to be

managed in hospital

Continue to collate information

for case series

Audit of antibiotic

prescribing

Choice of antibiotic and length

of course can be improved

upon. Microbiologist advice

sought appropriately. New

guidelines have been

developed subsequently that

are tailored to the hospice

setting

Implementation of locally

devised antibiotic prescribing

guidelines, and re-audit

DNACPR

documentation audit

Resuscitation Council DNACPR

form introduced in Jan 2014.

Audit of use showed very good

documentation of decision

making including discussions

with patient and family

Regular re-audit and review

Infection Control

Annual Audit

Programme

Agreed schedule defining

Infection Control areas to be

audited and frequency of audits

Findings reported and reviewed

quarterly at Quality & Safety

Committee meetings

Unannounced Hygiene

Inspection

Audits performed by Lead for

Infection Control and a Trustee

on a regular basis

Action List updated after every

audit and reviewed at Quality &

Safety Committee meetings



2.3.5 Research

The Hospice is currently participating in the following research projects:

Assessment of accuracy of prognosis prediction by the Palliative Prognostic Index

(PPI): a prospective multi-centre study. Could the accuracy of prognosis prediction

by PPI be improved by two assessments and could the rate of change of PPI score

be used to prognosticate better?

This research continuing from last year and is still ongoing.

Exploring patient perception of treatment success and benefit in self-management

of breast cancer-related arm swelling (lymphoedema)

This research continuing from last year and is still ongoing.

National Institute for Health Research (NIHR) Collaboration for Applied Health

Research and Care (CLAHRC) South London – Palliative and End of Life Care

CLAHRC and iPOS validation are in the development stage (see Improvement

Priority 2: Embed Clinical Research & Audit, What are the plans for this Priority? on

page 7).

2.3.6 Quality Improvement and Innovation Goals Agreed with our Commissioners

Hospice NHS income in 2013/14 was partly conditional on achieving quality

improvement and innovation goals through the Commissioning for Quality and

Innovation (CQUIN) payment framework.

The agreed Greenwich incentive payment related to Greenwich Care Partnership

(GCP) was:

Reduction of 5 hospital deaths per month for Royal Borough of Greenwich

Residents

The agreed Bexley additional payment related to Specialist Palliative Care (SPC)

was:

Short term investment in SPC team

Exploration of a community liaison role to facilitate improved Hospital

Discharge

Evaluation and development of a proposal for 2014/15 (and onwards)

2.3.7 What Others Say about Greenwich & Bexley Community Hospice

The Hospice is required to register with the Care Quality Commission and its current

registration status is that we are registered to carry out the following legally

regulated activities:

Diagnostic and screening procedures

Treatment of disease, disorder or injury

The Care Quality Commission has not taken any enforcement action against the

Hospice during 2013/14.

On 13th December 2013, the Care Quality Commission carried out an unannounced

inspection as part of their routine inspection schedule. The following standards were

inspected:



Outcome 4 - Care and welfare of people who use services

Outcome 6 – Cooperating with other providers

Outcome 14 – Supporting workers

Outcome 21 - Records

The Hospice met the required standards for all of the above Outcomes with the

exception of Outcome 21-Records. From their inspection, the CQC stated in their

report:

How we carried out this inspection

We looked at the personal care or treatment records of people who use the service,

carried out a visit on 13 December 2013, observed how people were being cared

for and talked with people who use the service. We talked with carers and / or

family members and talked with staff.

What people told us and what we found

People and family members we spoke with told us they were very satisfied with the

care provided at the hospice. Comments we received included, "I am very well

looked after here, I have no complaints," "the care here is excellent."

At our inspection we found that people received care based on an appropriate

assessment of their needs. Staff were well supported and worked with other health

and social care professionals to ensure people using the service received safe and

effective care.

However, we also found that people's care records were not up to date in all cases.

People were not always protected from the risks of unsafe or inappropriate care and

treatment because accurate and appropriate records were not maintained in all

cases. We have judged that this has a minor impact on people who use the service,

and have told the provider to take action.

On 5th March 2014, the Care Quality Commission returned to carry out another

unannounced inspection.

The CQC stated in their report:

Why we carried out this inspection

We carried out this inspection to check whether Greenwich and Bexley Community

Hospice had taken action to meet the following essential standards:

Records

This was an unannounced inspection.

How we carried out this inspection

We looked at the personal care or treatment records of people who use the service,

carried out a visit on 5 March 2014 and talked with staff.

What people told us and what we found

At our visit we found that the provider had made improvements to ensure that care

records and documents related to significant decisions were up to date.



Our judgement

The provider was meeting this standard.

People were protected from the risks of unsafe or inappropriate care and treatment

because accurate and appropriate records were maintained.

Reasons for our judgement

At our inspection of December 2013 we had found that not all of the care records

were complete and accurate. We had found that documents related to major care

decisions like Do Not Attempt Resuscitation (DNAR) in the event of death by natural

causes and mental capacity assessment had not been completed appropriately.

The notes did not clarify what discussion had been undertaken with the patient or

their representative. Following our inspection the provider wrote to us to tell us the

improvements that would be made to ensure they were meeting this essential

standard. At our inspection of March 2014 we found that the provider had made

improvements to ensure there was now a clear and up to date documentation

related to significant care decisions.

The provider had amended its policies related to the application of the Mental

Capacity Act and DNAR decisions. We were told the policies were being reviewed

by the clinical leads and the Quality & Safety Committee, prior to their approval by

the board of trustees.

Before people received any care or treatment they were asked for their consent

and the provider acted in accordance with their wishes. Most care plans we looked

at showed that mental capacity assessments had been undertaken and

appropriately recorded for significant decisions such as 'Do Not Attempt

Resuscitation' (DNAR). The notes we looked at clarified what discussions had been

undertaken with the patient or their representative. Staff we spoke with understood

the relevance of DNAR decisions and of giving consideration to the requirements of

the Mental Capacity Act (2005) and were aware of where to look for the DNAR

document.

Daughter of patient



2.3.8 Data Quality

During 2013/14, the Hospice did not submit records to the Secondary Uses Service for

inclusion in the Hospital Episode Statistics, which are included in the latest published

data.

In accordance with our contract with Local Commissioners, the Hospice submits a

National Minimum Dataset (MDS) annual return to the National Council for Palliative

Care.

2.3.9 Information Governance Toolkit Attainment Levels

With help from the South London Commissioning Support Unit, the Hospice

completed its Information Governance Toolkit. At present, this has not been ratified

by NHS Connect; however the Hospice believes it has achieved level 2. We are now



progressing the other necessary steps to ensure we are able to have an N3

connection very soon.

2.3.10 Clinical Coding Error Rate

The Hospice was not subject to the Payment by Results clinical coding audit during

2013/14 by the Audit Commission.

Part 3 - Review of Quality Performance

The Hospice has chosen to present a number of key quality indicators to

demonstrate the level of care that the Hospice services provide:

3.1 Comparison with National Minimum Data Sets

Comparison with the National Minimum Data Sets (MDS) for Palliative Care, provide

a national and local context to Hospice performance over time.

The most recently published National Minimum Data Set for Palliative Care covers

2012/13. Data for the Hospice for 2013/14 has been collated but currently there is no

comparative National MDS data available.

The Hospice has benchmarked data reports for 2012/13 under the following

headings:

Inpatients

Day Care

Home Care / Hospice at Home

Hospital Support Team

Bereavement Support

Outpatients

Daughter of Woodlands patient



3.1.1 Inpatients

MDS data for Inpatients is given in Table 1.

Based upon our return, GBCH was included in the Large category (more than 17

beds).

Nationally, data was received from 44 Large units. For London, data was received

from 13 units.

Table 1 Inpatient MDS data

2013/2014

GBCH*

2012/2013

GBCH

2011/2012

GBCH

2012/2013

National

Median

2012/2013

London

Median

New Patients 281 309 320 324 338

% New Patients 93.7 92.8 92.8 88.1 88.3

% New Patients with

Ethnicity Recorded

91.1 93.9 88.8 94.4 93.9

% New Patients with a

Non-Cancer diagnosis

13.5 13.9 12.5 11.5 14.6

Average Length of stay,

Cancer (days)

11.5 15.3 10.6 14.7 14.7

Average Length of stay,

Non-Cancer (days)

12.8 18.0 10.6 13.3 16.4

% Occupancy 73.8 86.4 75.5 79.1 80.9

Percentage of people

who died on the unit

75.3 64.9 58.5 59.0 61.6

Due to a combination of financial pressures and recruitment difficulties, the

Hospice board took the decision to reduce the number of inpatient beds

from 19 to 13 in June 2013. This was done in negotiation with commissioners

and the Hospice is currently working on a plan to increase bed availability to

15 beds. Despite this reduction, the average occupancy in the inpatient unit

went down, possibly due to an increase in the number of people being

supported to die at home

The percentage of new patients increased in 2013/14

The percentage of people dying as opposed to discharge increased

significantly in 2013/14, this has a significant impact on the workload of the

inpatient unit

Average LOS for both cancer & non-cancer diagnosis reduced in 2013/14

* 2013/2014 figures are unaudited, based on our submission. These are not MDS

figures.



3.1.2 Day Care

MDS data for Day Care is given in Table 2.

Based upon our return, GBCH (total number of 174 patients) was included in the

Medium category (between 112 and 180 patients).

Nationally, data was received from 49 Medium units. For London, data was received

from 12 units.

Table 2 Day Care MDS data

2013/2014

GBCH*

2012/2013

GBCH

2011/2012

GBCH

2012/2013

National

Median

2012/2013

London

Median

New Patients 99 129 95 91 110

% New Patients 57.6 74.1 56.9 63.2 57.5

% New Patients with

Ethnicity Recorded

89.9 98.4 91.6 91.2 90.6



23.2 18.6 22.1 23.3 18.6

Day Care Attendances 2622 2686 2267 1647 1280

% Places Used 69.5 72.6 62.8 56.4 51.1

Average Length of

Attendances (days)

216.6 158.4 162.8 157.1 134.0

The percentage of new patients with non-cancer diagnosis increased in

2013/14

The average length of stay has significantly increased, possibly due to earlier

referral

* 2013-2014 figures are unaudited, based on our submission. These are not MDS

figures.

Day Care patient



3.1.3 Home Care/Hospice at Home

MDS data for Home Care/Hospice at Home is given in Table 3.

Based upon the Hospice return, GBCH (total number of 1248 patients) was included

in the Large category (more than 1227 patients).


from 5 units.

Table 3 Home Care/Hospice at Home MDS data

2013/2014

GBCH*

2012/2013

GBCH

2011/2012

GBCH

2012/2013

National

Median

2012/2013

London

Median

New Patients 945 895 968 1137 895

% New Patients 71.8 71.7 69.7 66.6 72.3

% New Patients with

Ethnicity Recorded

92.3 91.6 85.4 68.6 91.6



26.6 19.3 25.0 19.3 22.9

% Home and Care Home

Deaths

52.9 48.9 50.6 53.3 55.2

% Hospice Deaths 23.0 27.2 24.8 - -

% Hospital Deaths 19.2 23.1 24.0 - -

There was an increase in the number of new patients in 2013/14

The percentage of new patients with non-cancer diagnosis increased

There was an increase in deaths at home & in care homes and a reduction in

deaths in the Hospice & in hospital

76% of patients died at home, in a care home or in the Hospice in 2013/14

* 2013-2014 figures are unaudited, based on our submission. These are not MDS

figures.

Daughter of Community patient



3.1.4 Hospital Support Team

Historical MDS data for Hospital Support is given in Table 4.

The 2013-2014 figures were not available at the time of submission. This data will be

included in an updated Quality Account, which will be placed on the GBCH

website, once these figures are available.

Table 4 Hospital Support Team MDS data

2013/2014

GBCH*

2012/2013

GBCH

2011/2012

GBCH

2012/2013

National

Median

2012/2013

London

Median

New Patients 730 654 860 759

% New Patients 92.4 89.3 90.7 90.0

% New Patients with

Ethnicity Recorded

100.0 69.0 95.5 96.7



26.7 33.3 27.0 31.6

% Discharged to Home 57.8 51.4 48.3 54.1

Average Length of Care 8.0 days 7.8 days 8.4 days 8.0 days

The Hospice Hospital Support Team based at Queen Elizabeth Hospital, Woolwich,

provide support, advice and education to staff in the hospital on end of life care

and symptom control issues, as well as supporting patients and their families directly

and helping to ensure their wishes for care are met.

Social Work client



3.1.5 Bereavement Support

MDS data for Bereavement Support is given in Table 5.

Based upon the Hospice’s return, GBCH, was included in the Medium category

(between 114 and 262 service users).

Nationally, data was received from 41 Medium units. For London, data was received

from 10 units.

Table 5 Bereavement Support MDS data

2013/2014

GBCH*

2012/2013

GBCH

2011/2012

GBCH

2012/2013

National

Median

2012/2013

London

Median

New Service Users 229 202 172 138 221

% New Service Users 99.5 92.7 68.0 74.2 67.5

% New Service Users with

Ethnicity Recorded

60.0 38.6 70.3 56.3 51.0

% of Deceased with a


n/k∑ 14.9 8.1 7.4 15.4

Contacts per Service User 7.0 12.7 9.5 5.9 5.2

% Discharged 76.5 67.0 53.3 57.3 50.7

The Hospice Telephone Bereavement Service is now well embedded and has

increased the number of contacts that take place over the telephone

∑Data is not routinely recorded as to the reason why the person’s relative died.

* 2013-2014 figures will be available in time for the final submission. These figures are

unaudited, based on our submission. These are not MDS figures.

–

Counselling client

Mother of Counselling client



3.1.6 Outpatients

MDS data for Outpatients is given in Table 6.

Based upon the Hospice return, GBCH with a total number of 640 patients was

included in the Large category (more than 316 patients).


from 14 units.

Table 6 Outpatients MDS data

2013/2014

GBCH*

2012/2013

GBCH

2011/2012

GBCH

2012/2013

National

Median

2012/2013

London

Median

New Clients 192 255 158 255 133

% New Clients 27.6 39.8 24.3 40.0 66.5

% New Patients with

Ethnicity Recorded

86.5 90.6 89.2 78.0 93.9



56.8 31.8 50.0 14.4 19.0

Total Outpatient Clinic

Attendances

1305 1202 1320 1172 151

Attendances per Patient 1.9 1.9 2.0 1.9 1.6

The percentage of new patients with non-cancer diagnosis significantly

increased in 2013/14

* 2013/2014 figures are unaudited, based on our submission. These are not MDS

figures.

Stepping Stones client

Lymphoedema patient



3.2 Clinical Governance

The Quality & Safety Committee has developed and enhanced its Terms of

Reference and annual rolling agenda. It is still supported by a number of topic/

project based advisory groups e.g. medicines, EPR, education, GCP.

The Quality & Safety Committee continues to receive regular reports, including the

Clinical Dashboard and Operational Risk Register as well as responsibility for the

review of existing policies and the development of new policies. It is also responsible

for monitoring the clinical audit programme.

The Quality & Safety Committee has put a number of actions in place to ensure that

there is the correct level of focus, review and monitoring:

CQC and EPR are standing items on the agenda and progress against the

open actions on the internal plan are reviewed monthly

As part of the documentation review, the review period for the Consent, MCA

/ DOLs policies have now been reduced from 3 years to 1 year

Recognising the importance of maintaining mandatory training compliance

for all staff, reporting is now monthly where it was previously quarterly

Development of an annual schedule of Trustees Unannounced Inspections

3.3 Training

The Hospice has continued to invest in the planning, delivery and monitoring of

mandatory training in 2013/14. It also benefitted from additional resource for

Continuing Professional Development from HESL.

Hospice clinical staff continue to be involved in delivering education in external

organisations including King’s College London and the University of Greenwich as

well as to care providers such as local care homes, Oxleas NHS Foundation Trust and

Queen Elizabeth Hospital.

During 2013/14, Greenwich & Bexley Community Hospice was instrumental in

establishing a collaborative of the seven Hospices which serve South London.

Through this collaborative, we have been able to access funding to develop four

new training projects which will provide a variety of opportunities for staff of all levels

to improve their skills and confidence to deliver quality care at the end of life.

3.4 Health Improvement Network

As part of the Health Improvement Network (HIN), the Academic Health Science

Network (AHSN) for South London was established in 2013 to align education, clinical

research, informatics, innovation, training and education and healthcare delivery at

a local level.

Nationally, the AHSNs have four core objectives:

Focus on the needs of patients and local populations

Speed up adoption of innovation into practice to improve clinical outcomes

and patient experience

Build a culture of partnership and collaboration



Create wealth through co-development, testing, evaluation and early

adoption and spread of new products and services

The Hospice is a member of the HIN and is represented on the Board by the Hospice

Chief Executive, who also acts as a representative for other member Hospices.

3.5 End of Life Care Clinical Leadership Group – NHS London

Strategic Clinical Networks (SCNs) are a new type of healthcare network hosted by

NHS England and will adopt a whole-system approach to change management

working with providers and other stakeholders across complex pathways of care as

well as offering specialist advice to commissioners on standards and variations in

service. Using the NHS Change Model as the framework for development SCNs will

support change management and quality improvement thought innovation and

transformational leadership. Clinical Networks (CNs) are a variation of Strategic

Clinical Networks, the only variation being that clinical networks are not mandated

by central policy and are subsequently created via local need and priority.

Each CN has a Clinical Leadership Group (CLG) chaired by a clinical director. The

CLG will be the expert vehicle for driving forward change and improvement in the

CN and a source of strategic advice and knowledge to NHS England, the Clinical

Senate and other bodies and organisations.

The CLG provides a forum for multi-professional clinicians to meet and share their

specialist expertise, clinical experience, and strategic knowledge in an impartial and

bi-partisan manner. The CLG will act as the clinical expert arm of the CN and exist to

provide collective knowledge and strategic leadership on behalf of the CN

community.

The Hospice’s Director of Care Services is a member of this new group.

3.6 Challenges

A number of challenges have been encountered in 2013/14, in particular:

The Hospice continued to encounter difficulties recruiting sufficient staff with

the appropriate skills, expertise and attitude resulting in a high number of

vacancies in some services. This problem, which was also seen in other

organisations, resulted in some difficulties in delivering care in as responsive a

fashion as desired. This problem was particularly seen in recruiting staff nurses

and clinical nurse specialists and resulted in us changing the way we respond

to referrals to ensure a safe service continues to be delivered. As a result of

this ongoing challenge, the Hospice is reviewing some service models and skill

mixing to address the challenge in different ways.

The increase in need for community services and the difficult economic

climate has presented problems in meeting the need with existing capacity

and finances. In 2013/14, NHS Bexley provided some short term funding to

invest in Specialist Palliative Care and NHS Greenwich provided short term

funding for a Nurse Consultant. We continue to work with commissioners to



look at ways to reshape services to meet increased need as well as

increasing our own contribution through additional voluntary income.

After a number of delays beyond our control, the Hospice began its building

project in January 2014. We are working hard to ensure that the day to day

operation of Hospice services is not impacted throughout the works and we

are grateful to the dedication of staff and volunteers who have been

inconvenienced by the necessary temporary changes in the Hospice

building.

The changes to the management of our local acute hospital, Queen

Elizabeth Hospital, Woolwich have presented us with a need to provide

stability in a challenging and uncertain environment and we continue to

develop relationships with the new management to ensure that palliative and

end of life care provided in the Hospital is as good as it can be.



Appendix 1: Greenwich

NHS Greenwich

Marcos Menager – nominated person within NHS Greenwich

It is of great pleasure to see how the local Hospice keeps working year after year to

increase the standards and look for effective ways to adapt to changes and

pressures. The document, as I said before, reads fabulous and shows the results of

commitment and dedication.

Royal Borough of Greenwich Healthier Communities and Older People Scrutiny Panel

Alain Lodge - Scrutiny Officer for our Healthier Communities and Older People

Scrutiny Panel

Introduction

We recognise the value of the work of the hospice which provides a range of

palliative and end of life services including the Greenwich Care Partnership. This

partnership between the hospice, Marie Curie Cancer Care and Greenwich

Community Health Services, provides personal care; a rapid response service; a co-

ordination centre; and planned night visiting. The panel will continue to monitor the

work of hospice and its impact on the health and wellbeing of local people.

Part 1- Chief Executive’s Statement

We support the hospice’s intention that the benefits of the building project can be

maximised within this year.

Part 2- Priorities for Improvement and Statements of Assurance from the Board

2.1 Priorities for Improvement 2014-15

Improvement Priority 1: Access to Hospice Services

We recognise the need to improve access particularly as the borough’s increasingly

diverse population grows and it is important that all members of the community

have access to high quality end of life care and are given the opportunity to make

choices regarding the type of care they receive. We support the development of

the concept of the hospice as a hub for the local community which will help

positively challenge people’s perceptions of what and for whom a hospice is for.

Improvement Priority 2: Embed Clinical Research and Audit

We welcome the prioritisation of embedding clinical research and audit and will

monitor the hospice’s aspiration to reach level 2 ‘engagement in research with

others’.

Improvement Priority 3: workforce, Education and Training

We will monitor the proposed Workforce Strategy and recognise the wider benefits

of the hospice training staff in other health and social care organisations. We

welcome the hospice’s involvement in the South London Hospices Education

Collective.



2.2 Priorities for Improvement 2013-14

Progress against Improvement Priority 1: Development of a Quality and Governance

Dashboard.

We anticipate further progress on the development of this dashboard and the

benefits to clinical teams from receiving timely and relevant information in an easily

understood format.

Progress against Improvement Priority 2: Launch a Patient and Carer Survey

Programme.

We recognise the importance of capturing and collating patient and carer’s

feedback which can usefully trigger discussions focussed on areas of concern which

may not have been raised previously. We welcome the fact that a review of one of

the methods of obtaining feedback, the VOICE questionnaire, has identified the

need for two different versions of the questionnaire which reflects the different

service configurations within Bexley and Greenwich. This is an area that the panel

will continue to monitor during 2014/15.

Progress against Improvement Priority 3: Access to Hospice Service.

This is a priority that the panel has examined with the Hospice Chief Executive when

she attended our meetings on 12 December 2013 and 27 March 2014. As mentioned

above we support the innovative approach of developing the hospice as a hub for

the community. We also recognise the significant potential benefits of assessing why

people at the end of life are admitted to Accident and Emergency and the

importance of avoiding inappropriate admissions therefore improving the quality of

people’s end of life experience.

We share the hospice’s desire to give all people from the local community the

opportunity to exercise maximum choice about their end of life care.

2.3.7 What others say about Greenwich and Bexley Community Hospice.

Care Quality Commission (CQC)

Following the CQC inspection of 13 December 2013 we are pleased to note that the

hospice has taken the appropriate action to ensure that patient care records and

documents relating to significant decisions are kept up to date.

Part 3- Review of Quality Performance

3.3 Training

We support the priority that the hospice accords to training both for its own staff and

staff within other organisations.

3.6 Challenges

The panel are familiar with the ongoing issue of recruitment which was discussed

with the Chief Executive at our meetings on 12 December 2013 and 27 March 2014,

and we will continue to monitor this issue closely. We also believe it is important for

the hospice to look at ways of reshaping demand to meet increasing need.

Assessing how effectively the Lewisham and Greenwich NHS Trust (LGT) are meeting

the health care needs of local people is an ongoing priority for the panel and we

recognise the importance and will continue to focus on the work the hospice is

doing with LGT. This is an important area that will feature in the panel’s work

programme for 2014/15.



Appendix 2: Bexley

NHS Bexley

Abi Ademoyero – nominated person within NHS Bexley

No response provided.

Bexley Overview and Scrutiny Committee

Cllr Ross Downing - Chair of the Health OSC

Louise Peek – Support Officer for the Health OSC

No response provided.



Appendix 3: Healthwatch

Rosaline Mitchell - nominated person within Healthwatch Greenwich

Anne Hines-Murray – nominated person within Healthwatch Bexley

Healthwatch Greenwich and Bexley welcome the opportunity to comment on the

Quality Account for 2013-2014. We have submitted a joint report as the Hospice

provides a service for residents of both boroughs.

Comment on priorities for improvement for 2014-2015

Priority 1 –Access to Hospice Services

Healthwatch are pleased the hospice is continuing to focus on increasing the

access to hospice services, and expanding the social support services available. We

are pleased the Hospice is making attempts to respond to the current demand for

hospice services and plan for the future, particularly in light of an ageing population

who bring with them more complex care needs. We are pleased to see that the

Hospice has been working to ensure people in custody, an often forgotten group,

have appropriate access to end of life care.

We look forward to seeing the evaluation of the Advance Care Planning project

and to explore whether it has been successful in enabling people to make an

informed choice and express their preferences regarding their care. Healthwatch

also welcome the new “First Contact” service working as an integrated care model

to ensure continuity of care for all patients.

We eagerly anticipate the changing role of the Hospice within the local community

in terms of the ambition to become a ‘hub’ for the local community. This will enable

the Hospice to extend the services it provides in order to support a wider population

and Healthwatch look forward to seeing this progression over the coming years.

Healthwatch Greenwich welcome the introduction of the Nurse Consultant role to

work with Queen Elizabeth Hospital and believe that this will greatly improve the end

of life care for residents of Greenwich. We look forward to seeing the impact of this

role has over the coming year for patients and their families.

Priority 2 – Embed Clinical Research and Audit

We are pleased to see the Hospice increasing its participation in research and audits

and setting out a structured approach to participating in research, in order to make

progressions in end of life care.

Comment on priorities for improvement 2013-2014

Priority 1 – Development of a Quality Governance Dashboard

Healthwatch are pleased the Quality and Governance Dashboard has meant the

Hospice is more quickly able to identify areas for improvement and are able to act

on them more quickly. We welcome the expansion of the dashboard to report on

other areas and so provide more information. We would like to see greater

compliance with some of the training areas such as infection control and medicine

management as these are key components of providing a safe environment for

patients.

Priority 2 – Launch a Patient and Carer Survey Programme

We are pleased the Hospice utilised various tools to collect patient feedback,

because patient feedback holds to key to evaluating and improving the service the

hospice provides. Healthwatch Greenwich are disappointed the response rate for

the VOICES questionnaire for Greenwich is so low compared to that of Bexley and



would like to work with the hospice to identify the reasons for this and to develop

strategies to improve the response rate. We welcome the change in the

questionnaires to collect more accurate information regarding the GCP service in

order to evaluate it as effectively as possible.

Priority 3 - Access to Hospice Services

Healthwatch understand this is an ongoing plan and are pleased with the work

undertaken so far with regards to staff training and innovative new services such as

the “Let’s Get Moving” class. We applaud the Hospice for taking steps to support

patients and their families in all aspects of their lives, and not just with medical

matters.

Other comments

Healthwatch were pleased the CQC found the Hospice met the standard for most

of the outcomes they inspected and that patients and their families have good

experiences of the service. After the CQC identified issues regarding record keeping

the hospice took swift action to remedy this and passed this outcome at the CQC

surprise inspection in March 2014.

We are pleased to see a decrease in the number of deaths in a hospital setting, and

the movement towards supporting people to die at home if they wish. Also, that the

Telephone Bereavement service is being utilised well and is providing support to a

large number of people.

Healthwatch supports the Hospice with making links with the other hospices with the

area in order to collaborate and improve training for staff. We are also pleased to

see the hospice has been providing training for external agencies. We hope this will

be a part of improving integrated end of life care across the borough.

We appreciate the challenges faced by the hospice in the past year and that the

hospice was able to overcome them to still provide an excellent service for the

community.

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