quality account 2013/14 - nhs · 2014-06-30 · quality account 2013 – 42014, st ann’s hospice...

Quality Account 2013 – 2014, St Ann’s Hospice Manchester. 1

Quality Account 2013/14

A report detailing the quality of health care services provided by St Ann’s Hospice, Manchester

Registered charity number 258085


Chief Executive Statement As Chief Executive of St Ann’s Hospice I am pleased to set out our performance for 2013/14 in our Quality Account. This report is written to provide assurance to a wide range of stakeholders that the purpose and focus for St Ann’s is:-

“To provide excellent care and support to people living with or affected by life-limiting illness.”

The reporting period of 2013/14 reflects the second year of our three year strategic plan and it is heartening to see how much has been achieved. The report details a diverse range of measures that we use and continue to develop to assess the quality and effectiveness of our clinical services. The quantitative data we report on is strongly underpinned and positively endorsed by the wonderful comments we receive from patients and families. There has been a strong focus in the last 12 months on developing partnerships and working collaboratively to ensure patients and families receive the best care and services available. This is evidenced in the report through our work with commissioners, Macmillan, The Myriad Foundation and many others. The last year has once again seen thorough inspections of our three sites by the Care Quality Commission. The standards measured were different at each site and I am pleased to say we met them all and are therefore fully compliant. However, at St Ann’s one of our strategic goals is “striving to be the best at what we do” and therefore it is testament to the staff that we also met all our quality improvement goals and have agreed further ambitious targets for 2014/15. I am pleased to confirm that the Board of Directors has reviewed the 2013/14 Quality Account and that it is a true and accurate reflection of our performance.

Jayne Bessant Chief Executive


How we serve Greater Manchester

Who do we care for? St Ann’s Hospice cares for around 3,000 patients (over

the age of 16) and their families and carers every year who are affected by

cancer and non-cancer life limiting illnesses. We deliver care that is special

and unique to each individual person. Around a third of inpatients at St Ann’s

Hospice return home after treatment.

Where do we care? St Ann’s Hospice provides care on 3 sites and in

people’s own homes, working in partnership with acute hospitals, community

services, local authority and social care providers and voluntary organisations.


St Ann’s Purpose & Strategic Goals

Purpose To provide excellent care and support to people living with or affected by life-limiting illnesses.

Core Values Compassionate

Providing a safe, secure and a caring environment for everyone. Professional

Aspiring to be the best in everything that we do. Respectful

Treating everyone with dignity and respect. Inclusive

Recognising and accepting that everyone is different.

This year’s progress against our Strategic Goals 1. Putting patients and their carers first

St Ann’s has continued to work together with its local Clinical Commissioning Groups (CCGs) to develop monitoring tools that assess the quality and impact of services in terms of outcomes and efficiency. These measures demonstrate the importance and need for our services with our commissioners, healthcare practitioners and user groups. This year St Ann’s has initiated reporting on advanced care planning on discharge, the Family and Friends test and an electronic palliative care coordination system. Monitoring delayed discharge of patients into the community also continues from last year. It is hoped that these will help us and our commissioners to understand and develop our services.

Over the last year St Ann’s has worked hard to ensure that it achieved level two compliance for its organisational processes for Information Governance in March 2014. This will now allow St Ann’s to link in to local NHS Trust patient databases facilitating continuity of care for patients.


2. Supporting and empowering our staff and volunteers

In response to the recent national Francis report into the quality of care provided at Mid-Staffordshire NHS Trust and it’s wider recommendations, one initiative St Ann’s has developed is a training programme on the delivery of compassionate care for its health care assistant staff. The certificate in compassionate care offers non registered staff the opportunity to learn more about fundamental care principles over 6 half day sessions. Modules include, communication, practical skills, symptom control, advance care planning, and understanding more about a range of life limiting illnesses. This certificate has been added to the education programme and recruitment is underway.

Our workforce has developed significantly over the last year with the embedding into role of our newly qualified Assistant Practitioners. The addition of the new role will help to ensure that the clinical team has a skill mix that deliver the appropriate level of care to its patents and carers.

St Ann’s Lecturer-Practitioner has recently been supported by the organisation to complete a staff coaching certificate. She will now train a group of senior staff to deliver quarterly solution focused group coaching sessions to non-registered clinical staff. Within sessions non registered staff will consider issues that impact upon their role, exploring practical solutions to these issues. This opportunity offers time for reflection not currently available to non-registered clinical staff. The training of nominated facilitators will be offered over the summer with the first groups being offered towards the end of 2014.

3. Strengthening our foundations as a charitable organisation

St Ann’s continues to invest in its fundraising team, with the appointment of a number of new posts, hoping to maximise both its engagement and return from its supporters across Manchester.

We are continuing to work collaboratively with Macmillan Cancer Support who are currently investing in improving patient cancer care pathways across the south, central and north Manchester localities. Recently, St Ann’s in partnership with the University of Manchester has been commissioned to deliver a workforce skills evaluation as part of the improvement programme. The evaluation will identify skills gaps that exist in the current community workforce and provide recommendations for addressing these in the near future to improve the care and support of cancer patients and their families across Manchester.

4. Engaging with our Communities

This last year has seen the initiation of a partnership between St Ann’s and the Myriad Foundation. Volunteers from the Myriad Foundation, which is represented across Manchester, have been trained by MacMillan Cancer Support to deliver a new role as ‘My Cancer Buddy’. It is hoped that such roles will provide


additional informal and much needed support to patients who attend St Ann’s services.

St Ann’s has expanded its work with care homes across Manchester and Trafford, delivering the ‘6 Steps’ programme, empowering care homes to provide effective palliative care for their residents, often fulfilling their wishes for preferred place of care.

This last year has also seen St Ann’s trialling new ways of gaining user views by using ‘real time surveys’. Patients who have been cared for within our inpatient units have been interviewed during their stay by volunteers, gaining their views on their satisfaction with both the care they are receiving and the ward environment.

5. Looking Forward

St Ann’s increasingly adapts to the localities changing healthcare economy, reviewing service provision to ensure that we remain a leader in the delivery of specialist palliative care across Greater Manchester. We will develop priorities which:

Maximise our effectiveness by delivering care to the right patients at the right time, in the in the right setting, to best meet both their and their families needs.

Improve patient, family and community engagement and experience of our services, particularly with hard to reach cultural and social groups.

Ensure the continued safe delivery of care to our patients, by minimising the risk of avoidable harm through improvements in the monitoring of medicines management, patient falls and development of pressure ulcers.

6. Striving to be the best at what we do

St Ann’s continues to work hard to ensure that the services we provide continue to improve, delivering high quality. Work streams are prioritised by organisational need such as training and education, clinical audit, evaluation, documentation development, effective governance meetings and engagement with many service providers across the locality. This ensures that we continue to strive to do the best for our service users, be they patients, carers or professionals.

From our most recent Care Quality Commission (CQC) inspections, we continue to be fully compliant in all categories.

This is the now the third year that we are publishing an account of our service quality –‘Quality Accounts’, which is available on the NHS Choices website and on our St Ann’s Hospice website.

We continue to proactively develop our clinical data reporting dashboards. These dashboards will provide St Ann’s with detailed information with which it can interrogate, challenge and develop its own practice. The dashboards also provide a platform for systematic reporting to our local clinical commissioning groups, improving monitoring and enhancing wider understanding of our services.


Review of services

During 2013/14 St Ann’s Hospice provided the following services to palliative care patients and their carers and families from across Greater Manchester. St Ann’s services encompass the localities of Salford, Trafford, Manchester and Stockport, a total population of approximately 1.2 million people. Our services are based on 3 sites, St Ann’s Hospice Heald Green, St Ann’s Hospice Little Hulton and the Neil Cliffe Centre (based within the grounds of South Manchester University Hospital, Wythenshawe):

In-Patient Units

Daycare Services

Supportive and medical outpatient Services

Hospice at Home

Community Palliative Care Nurse Specialist Service

24 Hour Advice Line

Complementary therapy services, including an outreach service St Ann’s Hospice has reviewed all the data available to us on the quality of care in all of these services. The income generated by the NHS represented 34% of the total income required to provide the services which were delivered by St Ann’s Hospice in the reporting period of 2013/14.

Quality improvement and innovation goals with our commissioners St Ann’s works closely with its local NHS clinical commissioning consortium. Each service provided has agreed annual quality performance measures. St Ann’s NHS quality improvement and innovation goals through the Commissioning for Quality and Innovation payment framework for April 2013 to March 2014 were to: Electronic Palliative Care Coordination Systems (EPaCCS):

Throughout the last year EPaCCS has continued to be implemented across all NHS health care localities in England. The goal of EPaCCS is to improve the sharing of information between clinical professionals on their patients when relevant. It is envisaged that this will enhance the communication and continuity of care that patients with supportive and palliative care needs receive. While St Ann’s is still awaiting it’s link into locality NHS information technology (IT) systems, it has mirrored the EPaCCS systems provided by its locality NHS providers and shares information as required. St Ann’s will be fully integrated into locality EPaCCS once full IT connectivity is achieved later in 2014.


Friends and Family Test:

The Friends and Family test is now widely used across the NHS healthcare economy. St Ann’s has achieved its CQUIN target of implementing the Friends and Family test questions within its inpatient units. Over the survey period from October 2013 to March 2014, almost all respondents (86 to 100%) were extremely likely to recommend St Ann’s to their family and friends.

CQUINS for 2014/15: For 2014/15 we have agreed the following CQUINs with our commissioners. There are 3 in total and reflect both the national CQUIN agenda and that of Greater Manchester:

The Friends and Family Test, implemented throughout NHS England in 2013, will continue in St Ann’s inpatient units. For 2014/15 it will now also be rolled out to other St Ann’s services including outpatients and day therapy. We will also participate in the staff friends and family test which includes 2 questions; first would they recommend the services to friends and family and secondly would they recommend the organisation as a place to work.

Implement the Patient Safety Thermometer to measure and reduce harm from pressure ulcers: In 2014/5 St Ann’s will continue to record, investigate and report on new Pressure Ulcers (acquired 72 hours after admission) of grade 2 and above. Reports will be provided to commissioners each quarter. St Ann's will also participate in the Stockport locality Pressure Ulcer Working Group.

Survey in real time of patient's experience and expectations of St Ann's Hospice care. The survey will be based on the Better Care philosophy using 3 questions: What worked well, what didn’t work well and what would you like to see in the Future. The survey will also include a question to identify as to whether St Ann’s patients are aware of how they can make a complaint. A full report will be provided to the Commissioner each quarter.

What others say about us Care Quality Commission (CQC) St Ann’s Hospice is required to register with CQC. The CQC has the power to take enforcement action against health care providers if required and can implement special reviews or investigations. The last on-site inspections were on 10th December 2013 for our Little Hulton site and 23rd September 2013 for our Heald Green and 19th September 2013 for our Neil Cliffe Centre. As for previous years, all three sites were assessed as fully compliant.


Patient Led Assessments of the Care Environment (PLACE) PLACE puts patient assessors at the centre of the assessment process, and use the information gleaned directly from patient views to report how well a hospital or hospice is performing in the areas of privacy and dignity, cleanliness, food and general building maintenance. It focuses entirely on the care environment and does not cover clinical care provision or staff behaviours. Our last PLACE assessments were carried out in March and April 2014, the results for which will be available later in 2014. Our previous assessments were held in October 2013:

St Ann’s Hospice’s Heald Green and Little Hulton sites were assessed, and both scored above average in every category, with cleanliness at Little Hulton scoring 100%.

Rachel McMillan, Director of Clinical Services, says “PLACE is an invaluable tool as it helps us to benchmark against other healthcare providers and enables us to share best practice. I’m delighted that we’ve scored well above the national average, which is a testament to all the hard work of our staff and volunteers in ensuring that we strive to deliver the very best possible care for our patients and their families.”

PLACE Assessment Findings October 2013

National Average

St Ann’s Heald Green

St Ann’s Little Hulton

Cleanliness

95.7%

99.4%

100%

Condition, Appearance and Maintenance

88.7%

90.1%

92.0%

Privacy, Dignity and Wellbeing

88.9%

94.3%

97.4%

Food and Hydration

85.0%

95.9%

96.7


Data quality In agreement with the Department of Health, St Ann’s Hospice submits a National Minimum Dataset (MDS) to the National Council for Palliative Care. St Ann’s Hospice also provided the MDS to our local Clinical Commissioning Group across Salford, Trafford, Stockport and Manchester (previously the Primary Care Trust Consortia). NHS Number and General Medical Code Validity St Ann’s Hospice was not required to and did not submit records during 2013/14 to the Secondary Uses Service for inclusion in the Hospital Episode Statistics which are included in the latest published data. Information Governance Attainment Levels

During 2013-2014 St. Ann’s has continued to work in partnership with Dilys Jones Associates to progress towards achieving compliance with level II information governance requirements. This has now been achieved in March 2014. This gives St. Ann’s assurance that it’s systems for managing its clinical and corporate information are effective and secure. St. Ann’s is now in the process of linking into local NHS Hospital Trust information systems to

improve the continuity of care that we can provide to our patients when they transfer between St. Ann’s and NHS services. It is hoped that full connectivity to local NHS information technology systems will be achieved in 2014. Clinical coding Error Rate St Ann’s Hospice was not subject to the Payment by Results clinical coding audit during 2012/13 by the Audit Commission.


Prior to publication, St. Ann’s Quality Account has been shared with our lead locality service commissioner, Healthwatch Stockport and our local Health and Wellbeing Overview and Scrutiny Committee. Feedback has been received from both Stockport Clinical Commissioning Group and Healthwatch Stockport: NHS Stockport Clinical Commissioning Group: ‘It appears an extremely comprehensive report and I have nothing to add. It just serves to confirm to me the excellent care that St Ann’s provides.’

Dr Karen McEwan, Macmillan GP Cancer Care Commissioning Lead, NHS Stockport Clinical Commissioning Group.

Healthwatch Stockport: Healthwatch Stockport commends St Ann’s Hospice on the many areas where, through hard work and dedication quality improvements have been demonstrated.

Healthwatch Stockport suggest that the following information is included within next year’s Quality Account report:

Figures on enhanced training for non-registered clinical staff.

Identification of skill gaps in the community.

How improvements in engagement with hard to reach cultural and social groups is progressing.

Details of in-house therapies. The full Healthwatch Stockport report has been included at the end of this Quality Account report (Appendix A).


CLINICAL EFFECTIVENESS

The following pages give an overview of the quality of the clinical services provided by St Ann’s Hospice and how we strive to improve the quality of care delivered to our patients, families and carers.


Comparison with national quality measures The National Council for Palliative Care produces an annual report called the ‘National Minimum Dataset for Palliative Care’. The most recent report produced by the National Council covers the period 1st April 2012 to 31st March 2013, and compares St Ann’s Hospice with the national median values (the middle values) for all hospice services of comparable size from across the UK. St Ann’s Hospice currently has 45 beds and is one of the largest hospices in the UK.

The National Council For Palliative Care: Minimum Data Sets For Palliative Care 2011-2012

SAH 09 - 10

SAH 10-11

SAH 11-12

SAH 12-13

National Median

2012 -2013

In-Patient Unit

(N=43)

Total patients 713 658 637 608 371

% New patients 91.9 91.3 91.4 90.8 88.3

% bed Occupancy 82.7 78.0 84.4 79.1 79.1

% Patient stays ending in death

64.2 67.9 68.1 64.9 57.3

% Patients discharged

35.8 32.1 31.9 35.1 42.7

Average length of stay- cancer

17.0 17.0 19.1 19.5 14.7

Average length of stay- non-cancer

15.0 17.1 20.2 17.3 13.2

% New patients with non-cancer diagnosis

6.4 8.0 6.2 9.6 11.5

Commentary: The total number of inpatients admitted decreased slightly in 2012-13, confirming a trend observed over the last four years of reporting (a 15% decrease overall). Other parameters remain comparable.


SAH

09 - 10 SAH 10-11

SAH 11-12

SAH 12-13

National Median

2012 -2013

Day Hospice

(n=48)

Total patients 400 395 400 423 228

% New patients 77.8 78.0 78.0 76.6 65.6

% Places used 48.1 51.0 51.6 54.9 58.1

Discharges (and deaths)

357 355 356 382 198

Average length of attendances (days)

68.0 66.0 69.8 63.0 146.2

Commentary: The total number of patients attending day care increased slightly in this last reporting period, including a slight increase in the percentage of places used. Further work continues into 2014 to address the number of unused places.

SAH 09 - 10

SAH 10-11

SAH 11-12

SAH 12-13

National Median

2012 -2013

Outpatients

(n=50)

All clients 1,265 1,165 1,074 1,069 531

% New clients 40.3 38.8 44.2 43.5 39.9

% New patients with a non-cancer diagnosis

28.0 30.5 32.8 25.6 14.9

Attendances per patient

2.6 2.8 2.9 3.4 1.9

Attendances per clinic 1.6 1.6 1.5 1.5 3.2

% attendances with a Medical Consultant

11.5 9.4 8.5 10.8 10.8

Commentary: The service continues to provide a valuable service to patients and carers who are community based. It is envisaged that this service will develop over the next 12-24 months, in order to engage a larger number of patients and their carers with palliative care needs from across our local communities.

SAH 09 - 10

SAH 10-11

SAH 11-12

SAH 12-13

National Median

2012 -2013

Hospice at Home

(n=16)

Total patients 196 236 253 251 231

% New patients 93.4 89.4 87.4 90.4 90.5


8.2 12.3 13.6 18.9 16.7

% home and care home deaths

80.8 78.6 71.4 72.0 80.7

Average length of care (days)

19.6 22.3 31.7 21.6 25.5

Commentary: The proportion of non-cancer patients has more than doubled over the last for years of reporting, indicating a widening in the accessibility of the Hospice at Home Service. However, the overall number of patients accessing remains comparable.


SAH

09 - 10 SAH 10-11

SAH 11-12

SAH 12-13

National Median

2012 -2013

Community Specialist Palliative CareTeam (CSPCT)

(n=12)

Total patients 489 627 634 584 368

% New patients 76.9 76.7 71.6 75.9 74.7


14.4 12.9 15.0 15.1 15.0

Average length of care (days)

56.6 53.3 53.9 49.1 74.0

Face to face visits per patient

2.8 3.3 3.0 2.8 3.8

Telephone contacts per patient

4.1 4.8 4.4 No longer reported

n/a (4.4 in 11-12)

Telephone calls to patients (average per patient) (new for 12-13)

n/a n/a n/a 4.0 2.5

Telephone calls to carers (average per patient) (new for 12-13)

n/a n/a n/a 2.7 0.8

Telephone calls to other health care professionals (average per patient) (new for 12-13)

n/a n/a n/a 5.9 1.2

Commentary: St Ann’s CSPCT team have less face to face contact with their patient group in comparison to the national average. However, telephone contact with carers and other health care professionals is markedly greater. This may be a reflection of the increased emphasis from the CSPCT team towards a coordination of care role across their Salford locality. Next year’s report may reflect this change further having implemented an urgent response service during 2013/14.

SAH 09 - 10

SAH 10-11

SAH 11-12

SAH 12-13

National Median

2012 -2013

Bereavement Support

(n=41)

Total clients 94 149 153 150 184

% New service users 74.5 68.5 68.6 68.7 74.2

Contacts per service user

7.6 6.9 7.1 6.5 n/a

Average length of support (days)

126.0 172.6 172.4 140.0 137.0

% Discharged 50.0 65.8 69.3 65.6 57.3

Commentary: The average length of support has decreased in 2012-13 compared to previous. A higher proportion of clients are discharged per year in comparison to the national median.


Liverpool Care Pathway

Inpatient Use of the Liverpool Care Pathway

Jan – Dec 2009

Jan – Dec 2010

April 2011 – March

2012


2013

April 2013 – March 2014

Total number of inpatient deaths

483 507 460 440 446

Inpatients placed on

LCP

425 (88%)

444

(88%)

414 (90%)

392 (89%)

336 (75%)

Inpatients not placed

on LCP

58 (12%) 63 (12%) 46 (10%) 48 (11%) 110

(25%)

The Liverpool Care Pathway (LCP) documentation, has been used over the last decade by most UK based hospices, to outline the plan of care when a patient’s condition changes and indicates to the inpatient ward team that the patient is dying. In comparison to recent years, the proportion of inpatients where the LCP has been used as a plan of care has dipped markedly over the 2013-2014 reporting period. This is likely due to the recent controversy surrounding the use of the LCP in the UK. In response to national recommendations from the ‘Leadership Alliance for the Care of the Dying People, NHS England’, use of the LCP is to be phased out across England by July 2014 and replaced by an ‘individual plan of care guideline’ for each patient. Future monitoring and audit of the new guidelines are envisaged.


Clinical audit activity Quarterly meetings chaired by our lead for quality and audit with clinical and medical representation from all service areas are held 3 monthly. A rolling plan for clinical audit is agreed and reviewed. Along with internally agreed audits, St Ann’s continues to participate in the North West Regional Audit Group (NWAG) audit programme. The following is the clinical audit activity from 2013/14:

TOPIC

STATUS

Administration of Medicines

A regular audit conducted by the Practice Development Facilitators with a ward nurse. Progress on the agreed action plan from the last audit in July 2013 is facilitated through the clinical chart meeting.

Prescribing of Medicines

Audit conducted by pharmacists 3 times each year and results fed back to all doctors

Reaudit of LCP for the Dying

Final report with action plan circulated and posted on the intranet.

Low molecular weight Heparin Audit


Week 1 assessment Documentation Audit

Final report with action plan circulated and posted on the intranet

Reaudit of use of fentanyl and opioids at the end of life (NWAG)


Reaudit of antibiotic use


NWAG Reaudit of Nausea and Vomiting

Final report with action plan being agreed

Complementary Therapy Documentation

Audit commenced

Sensory Impairment Assessment on admission

Report and action plan being compiled following organisational presentation of findings


St Ann’s is participating in the Personal Excellence Pathway (PEP) scheme for medical students and which includes their involvement in audit activity which was well evaluated by the students involved. We are planning to introduce the following:

Monthly ongoing audit of Antibiotic prescribing

Monthly ongoing Medicines Safety Thermometer Audits St Ann’s contributed to the NWAG Audit Conference held on 14th February 2014 and the CSPCT Urgent response Audit was awarded 2nd prize in the poster submissions.


Spotlight on Audit

Specialist palliative care nurse independent prescribing in the community

-an audit of practice

The St Ann’s Community specialist palliative care team (CSPCT) provides advice and support to patients and carers when there are unresolved symptoms and complex psychosocial issues for patients with advanced disease. An audit was carried out to assess the current prescribing practice of the clinical nurse specialists within the CSPCT. Fifteen prescriptions from each of the 4 nurse independent prescribers were audited for quality and relevance. A total of 86 items were prescribed. When the quality of prescription writing and documentation was assessed, all standards achieved 100% compliance excepting the letter sent to the patient’s GP detailing the prescription. Only 67% were faxed within 24 hour standard set.

Medicines most commonly prescribed by the team were analgesics (50%) followed by anticipatory medicines for the care of the dying. The CSPCT case load focuses on managing patients with complex pain and symptoms towards end of life, with medicines prescribed demonstrating this. The full results of the audit and action plan were presented to the joint Salford Palliative Care multi-disciplinary team meeting and at a local palliative care conference where it promoted discussion challenging the nurse prescribing role in the community. The audit provided evidence of robust and quality prescribing by the CSPCT team, demonstrating effective and timely prescribing for patients in Salford struggling with complex pain and symptom control issues, as recommended by the NICE guidance for palliative and supportive care (2004).


24 Hour Advice Line

The Hospice’s 24 hour advice line provides telephone support for both health care professionals and patients and their carers from across Manchester (Salford, Trafford, Manchester and Stockport).

Calls to the Hospice 24 Hour Advice Line Service

24 HR ADVICE LINE CALLS

2009 – 2010

2010 – 2011




Total number of calls received

724 704 698 690 717

Source of calls

Health care professionals

364 349 372 341 372

Patients and carers

306 297 272 303 290

Other (including unknown)

54 58 54 46 55

Reason for call (more than 1 reason can be recorded)

Pain control 200 223 210 220 227

Symptom control (excluding pain)

259 270 307 265 273

Service and referral information

138 87 96 81 108

Non clinical 36 36 33 30 20

Other* 134 147 149 173 168

* Includes carer support, (e.g. advice/reassurance, support re. Liverpool Care Pathway) and information regarding external health care professionals and equipment loans The total number of calls has slightly increased from the previous year, with more calls from health care professionals observed. Types of calls remain comparable to previous years, with the majority requesting advice on both a patients’ pain and symptom control. Over thirteen calls are received each week, 40% of which are from patients and carers. Advice given may help patients to avoid unnecessary crises referral to hospital, and has the potential to enable patients to stay in their home.


Education The palliative care education team provide specialist training and development to staff working for the hospice organisation and for hospital and community colleagues wishing to increase their confidence and expertise in a range of issues relevant to palliative care. Shared learning Through the palliative care education programme staff from differing specialities and care environments are offered the opportunity to explore relevant topics together and to learn from each other. Study sessions available are advertised through a monthly palliative care education summary and also are available for those outside the organisation to book through the St Ann’s Hospice website. Most study sessions are offered twice in the year once at either hospice site. Study sessions offered in 2013;

Enhanced communication skills training (2 days)

Understanding Cancer for Clinical staff (2 days)

Understanding Cancer for non-clinical staff

Advanced Heart failure; supporting the person and their family

Advanced Liver Disease; supporting the person and their family

Advanced Renal Failure; supporting the person and their family

Non Invasive Ventilation in palliative care update

Advanced COPD; supporting the person and their family

Exploring spirituality workshop

Dementia update provided by Dementia specialist practitioner

Student Nurse Information afternoons

Introduction to point of care ultrasound (palliative care consultant led)

Reiki (Introductory course)

Reiki (Intermediate course)

Breathlessness management workshop (2 days)

Palliative Care Emergencies Commissioned courses The palliative care education team continue to offer training and development to community colleagues in partnership with the Macmillan Service and local End of Life facilitators. 6 Steps to Success Manchester and Trafford The palliative care education team continue to provide workshops and support for the yearlong end of life change management programme called the 6 Steps to Success End of Life programme. The Manchester Education has been provided since 2011 and enables care and nursing homes to establish high quality systems to ensure the resident is


afforded choice, advance care planning, comfort and an opportunity to die in their preferred place which is usually the care establishment. Trafford End of Life facilitation project As part of the 6 steps education provision to care and nursing homes in Trafford both the education and home facilitation visits are being undertaken by the hospice palliative care education team. Uptake of the programme by the homes continues to be buoyant with almost all the Trafford homes being recruited onto the programme and achieving excellent results re developing palliative care systems and developing their palliative care knowledge. Domiciliary care programme Working with Stockport Adult Social Care and the Stockport Macmillan Palliative Care Team 2 day “Comfort and Care at the End of Life” programme has been delivered to front line care workers across Stockport. 5 courses have been provided March 2013 to March 2014. End of life facilitator training The Greater Manchester Lancashire and South Cumbria Strategic Clinical Network commissioned the palliative care education team to provide 2 end of life role development 5 day courses. Both courses have been evaluated excellently by the attendees and is assisting them to make real changes in practice. Specialist learning for hospice staff Staff within the hospice have particular learning requirements linked to their roles. The palliative care team organise and deliver in collaboration with the Practice Development Facilitators specialist training to address specific hospice learning needs which are often identified at individual performance review. Updates include; Assistant Practitioner updates (Nutrition pump training, hot and cold pack training, breathlessness management training) Mentorship updates Moving and handling update sessions Advice and support for a 3 yr. clinical competency roll out working in collaboration with the Practice Development Facilitators Mandatory training workbooks have been completed. The overseeing and developing of statutory and mandatory training is now being reviewed by the non-clinical training and development manager. Student co-ordination The palliative education co-ordinator works with the clinical team to ensure an effective and supportive student experience. The co-ordinator works with the partner universities and other Practice Education facilitators. Nursing students are allocated to St Ann’s Hospice as part of their undergraduate Bachelor in Nursing placements. Students are allocated at all stages of their training. The education co-coordinator works with the clinical areas to ensure a quality learning environment awaits the student on arrival. This year the education


co-ordinator has refined the student welcome pack in line with national requirements. All students have detailed information prior to their placements. Mentorship registers are maintained and mentorship updates provided for staff in collaboration with the university link tutors. Feedback has been particularly positive about the quality of the learning experience at St Ann’s Hospice. The education co-ordinator also supports and administers clinical placement for other staff such as, art therapy students, occupational therapy students, physiotherapy students and counselling students. Transform programme Working in collaboration with the Pennine Acute End of Life Facilitators and North Manchester Macmillan Service the palliative care education team has co-ordinated a placement of senior clinical staff from the acute sector to experience the hospice clinical environment. This rotation will take place at Little Hulton in June 2014. Central Manchester and hospice renal exchange programme This programme has continued to increase in popularity and develop. Currently plans are being finalised to extend the exchange to other wards in the medical directorate at Central Manchester. In patient units specialising in gastroenterology, respiratory, haematology, are now wishing to welcome hospice staff who wish to shadow their work. Hospice staff at Heald Green will be offering a 3 day placement to staff across the directorate in an innovative skills exchange in return. Library facility All staff can access journals via Athens and books from the library facilities at Heald Green, Little Hulton and Neil Cliffe Centre. The content of the library has been upgraded and staff recommendations for new books have been incorporated. External education The education team administer and co-ordinate applications for external training to support the development of clinical staff across the organisation. Monthly summaries of expenditure and course information internal and external is provided to managers. Booking and liaison with other course providers is undertaken and recorded by the education co-ordinator.


Research & Evaluation

Workforce Modelling in UK Hospices

The project, led by St Ann’s has continued its activity throughout the last year and has now provided staffing recommendations to an additional four adult hospice units, totalling forty eight from across the UK. During 2013-2014, St Ann’s has developed the project into a new care sector, working collaboratively with six children’s hospices from across England. Dr Dai Roberts, Lead for Research & Development for St Ann’s and Dr Keith Hurst, Independent Workforce Analyst has worked in collaboration with the clinical leads for the six children’s hospices to produce an adapted evaluation tool applicable to the children’s sector. As with the adult hospice project, child dependency, nursing activity and workload and ward occupancy data is used to produce evidence based recommendations for optimal nursing staffing to ensure cost effective and high quality care is delivered. This work continues into 2014 with the addition of more children’s hospice units. A primary outcome for the project will be the generation of a new benchmark workforce dataset applicable to the children’s hospice sector.

Carer Needs Assessment Tool

The Carer Support Needs Assessment Tool (CSNAT) is an evidence based tool developed with the help of family carers to aid the assessment of carers' support needs when caring for a relative or friend at home towards the end of life. It has been designed as an approach to opening up discussions with carers about their support needs. The project is led by Professor Gunn Grande from the University of Manchester and Dr Gail Ewing form the University of Cambridge.

The Carer Assessment Study will evaluate the implementation of the Carer Support Needs Assessment Tool (CSNAT) in practice.

As part of the study, St Ann’s Hospice at Home service, is trialling the use of the CSNAT with all main carers of patients who are cared for at home by the St Ann’s service. It is hoped that CSNAT will help to identify carers that can either be addressed directly by the hospice at home team or referrals made for specialist advice and support.


St Ann’s Day Therapy and Neil Cliffe Services – Service Review and Evaluation

Summer 2013 St Ann’s initiated a review of its Day Therapy services based at its Heald Green hospice site and at its Neil Cliffe Centre. Subsequent to the supportive outpatient evaluation reported in last year’s Quality Account, user views have been gained from both services throughout early autumn 2013. Focus groups were held with patients and carers attending daycare at Heald Green and the Neil Cliffe Centre to gain their views on their experiences from attending the services and also their views on the types of support and interventions that they valued the most and would wish to see if not already offered. Subsequently, in early 2014 St Ann’s has employed a project manager to lead on the review, remodelling and development of our St Ann’s day therapy and supportive outpatient services. The reviews key aims are to expand the opportunities available for supportive care to a wider patient group, ensuring that St Ann’s reaches out to and meets the needs of as many supportive and palliative care patients and their carers as is possible. The service review will continue throughout 2014 with an anticipated completion before March 2015.


PATIENT SAFETY

Clinical Governance Committee

St Ann’s Hospice’s Clinical Governance Committee meets quarterly. The committee is chaired by a hospice Trustee, with multi-disciplinary membership from across clinical services, plus external representation from our local Clinical Commissioning Group (CCG). The committee oversees the approval of clinical policies and monitors the quality, safety and effectiveness of clinical service provision via a variety of reports and data dashboards.

Incident Reporting

An organisation wide incident / near miss reporting system was introduced in 2004 and has been reviewed 4 times in response to the feedback from its users. A quarterly report is compiled, which focuses on actions agreed in line with the learning culture.

The incident reporting form has been reviewed to reflect user suggestions raised in incident training sessions

St Ann’s is participating in the Help the Hospices Benchmarking pilot for Pressure Ulcers, Falls and Medication Incidents which was piloted between January and March 2014 and will continue for the rest of 2014

A medicine management meeting is holding its first meeting in May 2014 and will include the discussion of all medicine related incidents reported during the previous quarter. Attendance will include representation from pharmacy, medicine , quality and clinical operational managers and will also contribute to the requirements recommended in the central alert “ improving medication error reporting and learning “ received in March 2014.

Clinical Incidents with an external impact are now reported verbally to the appropriate external manager within the area involved e.g. ward or service. A copy of the quarterly summary of incidents and near misses is also copied to the Contract Manager for the Greater Manchester Commissioning Support Unit, for information.


The following summarises the type and number of incident/near miss forms received.

2010/2011 2011/2012 2012/2013 2012/2013

Total incidents & near misses

517 521 492 541

Total Clinical of these :

- medicine related

- patient falls

413

96

136

433

88

177

403

87

183

411

97

166

Total Non-clinical 104 87

48 52

Total with impact on Clinical and non-clinical services

41

78

RIDDOR reports (Reporting of Injuries, Diseases and Dangerous Occurrence Regulations)

3 6 0

1

Actions from reported incidents & near misses include:

Mobile phone guidance produced to include protection of personal information

Donation policy reviewed

Contribution to the recruitment of a pharmacy technician to support medicine management

Updated nurse call system for Heald Green Hospice included in the Hospice’s Resource and Planning ‘wish list’

Additional Hospice insurance acquired to cover staff driving vehicles not owned by the hospice.


Infection Control and Wound Care

Infection Control Data

TYPE OF INFECTION

Apr 09 – Mar 10

Apr 10 – Mar 11

Apr 11 – Mar 12

Apr 12 – Mar 13

Apr 13 – Mar 14

MRSA (localised infection and colonisation)

5

6

7

5

2

Clostridium difficile toxin positive

3

1

4

2

(hospice acquired)

2

(hospice acquired)

1 (On

admission)

2 (on

admission)

Bacteraemias (blood stream infections)

0

0

2

1

(non-MRSA)

0

Extended spectrum beta-lactamases

n/a

n/a

7

Data no longer

recorded

Data no longer

recorded

carbapenem producing coliforms and other significant organisms

-

-

-

0

0

Surveillance data for the period April 2013 – March 2014: (St Ann’s infection control reporting is informed by Public Health England). Infection/colonisation of MRSA data is collected although not a requirement under PHE standards. This was considered beneficial to the hospice because not all patients are screened on admission and it gives some insight into incidence. Information about infections/colonisation is also obtained via referring services (e.g. General Practitioners, Nursing Homes and Hospital Trusts), and management strategies for these cases can then be implemented on patient admission. This is particularly evident for cases of carbepenem producing coliforms where our laboratory surveillance data is zero for this reporting period but there have been several referrals and subsequent admission made for patients known to be colonising these organisms and are able to be managed appropriately due to the referral process. With the large increase in extended spectrum beta-lactamase (ESBL) positive specimens, surveillance of these organisms is no longer recorded as many have little impact on patient management.


The data for CDI rates reflects whether the infection originated during hospice admission, or was evident on admission which is in line with reporting to commissioners. All cases of bacteraemia are recorded not just those associated with reportable organisms such as E coli and MRSA.

Wound Care Data April 2013 – March 2014




Present on admission

(from hospital/

home/ Other)

Hospice acquired

(St Ann’s)


(from hospital/

home/ Other)

Hospice acquired

(St Ann’s)


(from hospital/

home/ Other)

Hospice acquired

(St Ann’s)

PRESSURE ULCERS

Grade I 47 29 38 23 40 23 Grade II 85 52 78 39 123 61 Grade III 19 0 14 1 13 1 Grade IV 4 1 14 0 9 0 Total: 155 82 144 63 185 85 WOUNDS (not including pressure ulcers)*

100 46 89 28 65 33

*Wounds as categorised include forms of wound associated with palliative patients’ conditions and exclude pressure ulcers. All patients on admission to our hospice receive a tissue viability risk assessment, followed by relevant preventative measures (e.g. pressure care mattresses). However, many patients who are cared for by St Ann’s Inpatient wards experience deteriorating symptoms due to the progression of their condition and poor circulation. For example, many patients are prescribed steroid medication, which increases the risk of diabetes and pressure ulcers thereafter. This is why in some cases, pressure ulcers can develop while a person is under St Ann’s care, despite preventative measures being taken. In such cases, specific management strategies are used, including the use of care plans and dressings to minimise discomfort and maximise quality of life. Rates for both pressure ulcers and other wounds have increased over 2013-2014 (approximately 30%) compared to the previous year (2012-2013). Throughout 2013-2014, St Ann’s inpatient units have worked hard, via the continued work of the hospice’s tissue viability link nurse group, to ensure that reporting of pressure ulcers and wounds is consistent across its two inpatient sites. We are now confident that this last year’s reporting figures are a true reflection of wound care rates at St Ann’s. In 2014/15, St Ann’s will be reviewing its policies, procedures and practices to ensure best practice is maintained and developed in line with the patient safety thermometer being implemented this year (page 8).


Staff Health, Absence and Turnover

2010-2011 2011 - 2012

2012 - 2013

2013 - 2014

Sickness and absence

4.6%

4.3%

5.2%

4.7%

Staff turnover (number of starters and leavers)

6.4%

10.8%

7.7%

10.2%

St Ann’s sickness and absence rates in 2013/14 are comparable to previous years. Staff turnover has increased compared to the previous year. St Ann’s continually strives to minimise its sickness and absence levels by providing a healthy and productive environment, including clear organisational values and goals, within which its workforce can be supported and cared for. In 2014/15 this will be supported by a staff survey which will include staff perceptions of working at St Ann’s. Volunteers The success of the organisation is supported by over 800 volunteers who contribute over 80,000 hours in total. They are a diverse workforce who bring new skills and experience. Examples of how our volunteers help include in our ward areas, charity shops, reception desks, bereavement support service and administration support.


PATIENT EXPERIENCE

1. Comments Scheme This scheme enables visitors, patients, volunteers and staff to make suggestions for improvement or comments they have about our services. The Lead for Quality and Audit is responsible for managing the scheme and sending comments received to the appropriate manager for consideration and a response. The responses are collated and approved at an organisational meeting and then fedback via the hospice newsletter and website along with organisational distributions of monthly summaries. A total of 154 comments or suggestions were posted in 2013/2014 Actions implemented in 2013/2014 include:

changing room door in one of our charity shops modified to improve privacy

System for ordering daily newspapers reintroduced

Improved system for storage and disposal of lost property

2. Patient/Carer Group activity The patient / Carer group meets every 2 months and has a current membership of 10 patients and 6 carers who have all had experience with services provided by St Ann’s Hospice. The group continues to provide an invaluable contribution to the ongoing development of the hospice services. During 2013/14 their views have been sought for the following:

Complementary therapy leaflet review

Counselling Leaflet

Prayers and readings at difficult times

Ideas for assuring confidentiality of patient enquiries

Timing of the display of Christmas cards

Breathlessness leaflet

Revision of the organisational comment card

CSPCT Service user questionnaire

External Involvement

The group were visited by a representative of the Macmillan Manchester Cancer Improvement Programme to discuss the opportunity for them within the user Involvement workstream.

Macmillan End of Life Factsheet

Name for Stockport’s Electronic Palliative Care Coordinated System (EPaCCS) Project


The group were visited by the Palliative Care Nurse Specialist from Salford Royal Foundation Trust to gain their views on expectations of end of life care and naming of future documentation following the removal of the LCP and the development of an information leaflet

3. Friends and Family Survey (inpatient unit) This was introduced in October 2013

Surveys handed out Oct 2013 –

March 2014

Surveys returned

Responses to question asking if they would recommend the

hospice :

147 86(58%)

81/86 ( 94%) extremely likely 4/86 ( 5%) likely 1/86 ( 1%) don’t know

As part of an agreed CQUIN this survey is going to be extended to include daycare and outpatients starting in July 2014

4. Real Time Survey Volunteers have been conducting structured 1:1 surveys of ward patients and visitors on topics including hospice cleanliness, staff attitudes, the environment , privacy and dignity and information. Their feedback has been collated and fedback through posters displayed within the Hospice and specific comments have been processed through the comment scheme. As part of an agreed CQUIN these interviews will be extended to daycare attendees. The questions are in the process of being reviewed taking into account local issues highlighted from previous findings and incorporating the NHS ‘better care philosophy’ questions which ask what went well, what did not go so well and what changes patients would suggest for the future. The overall results have been very pleasing and have also highlighted a need to improve patient’s awareness of the bedside booklet which is currently being addressed.

5. Help the Hospices Patient Survey The final report was received in November 2013 with very pleasing results. Actions agreed from the findings include the development of a complaints leaflet and increasing activities available for ward patients to participate in, which we hope will be achieved via the My Cancer Buddy project which is soon to be piloted at HG.


More information, including a poster of findings can be viewed by clicking on

the following web links:

http://www.sah.org.uk/about/results-of-patient-surveys

http://www.sah.org.uk/media/424054/day%20care_ward%20results%20poster.pdf

6. Survey of Referrers to St Ann’s Hospice Community Specialist Palliative Care Team (CSPCT) and Hospice at Home Service A questionnaire was circulated using “survey monkey” to all potential referrers to these services to gain their views and suggestions for service development. An action plan from the respective findings is currently being agreed by the Service Managers.

7. Day therapy Service Users at HG and NCC Focus groups were held to gain the views of the service users as part of a service evaluation and their views have been considered in the service developments in the process of being agreed.

Complaints & Compliments Complaints and Compliments Received 2009/2010 to 2012/2013

COMPLAINT / COMPLIMENT


2011


2012

April 2012 –March 2013

April 2013 –March

2014

Formal complaints

6

2

2 3

Informal complaints

5

3

16 7

Compliments (via letters, cards, comments cards and emails)

481

467

540 *No longer

counted

*St Ann’s continues to receive a large number of compliments on the services it provides to its patients and carers. However, St Ann’s will focus reporting on additional quality measures introduced in 2013/14.

http://www.sah.org.uk/about/results-of-patient-surveys

http://www.sah.org.uk/media/424054/day%20care_ward%20results%20poster.pdf


Complaints:

The number of formal complaints remains low for this reporting period, while the number of informal complaints which increased last year has decreased again over this last year. Looking back to the 2012-2013 period, a number of informal complaints related to changing our chapels to ‘havens’ (multi-faith areas) to encourage diversity and inclusiveness. This theme for informal complaint has not been evident over the last year, with the multi-faith worship spaces embedded in practice.

Examples of compliments received: Daycare “The most caring and genuine people I have ever had the pleasure to meet " “ The minister took an interest in my life outside the hospice as well as inside and “The Haven” offered a comfortable place for anyone of any religion to quietly spend time in “ At certain intervals my appetite worsened, but the staff made sure a tempting selection was available and not just at meal times but all the day period” Inpatients “All members of staff were angels - including housekeeping and volunteers” “ I found St Ann’s Hospice the most caring and happy surroundings I have ever stayed in – did not want to leave “ “I would be happy to end my days at St Ann’s when it comes because I know I will be taken care of with dignity” Neil Cliffe Centre “ NCC saved my sanity “

“I was in a dark tunnel and NCC gave me a hand out of it , I became so positive that people commented on the way I had changed.” “I was depressed and NCC gave me a positive mindset and the motivation to live again.”


What our staff say about the organisation

St Ann’s Hospice engages its staff in consultation in several ways:

We hold a ‘One Organisational Group’ monthly meeting which brings together staff from across all clinical and support services (catering, HR, finance, fundraising, trading company) for shared learning across the organisation.

A Staff Reps committee meets bi-monthly, representing the views of grass roots staff from across the organisation.

Regular open meetings are held with the Executive team and all staff at each site three times a year. These are backed up with more regular 1:1 ‘Directors surgeries’ to maximise staff consultation and engagement. For 2014/15 these will include an informal walkabout approach to reach more staff.

Our Chief Executive also publishes a weekly brief and staff are encouraged to contribute with updates and key messages.


What our regulators say about us

St Ann’s services are regularly reviewed by the Care Quality Commission (CQC). Further information and full reports can be obtained via the following link: http://www.cqc.org.uk/

What the CQC icons mean

All standards were being met when we inspected the service. If this

service has not had a CQC inspection since it registered with us, our

judgement may be based on our assessment of declarations and

evidence supplied by the service.

At least one standard in this area was not being met when we inspected

the service and we required improvements.

At least one standard in this area was not being met when we inspected

the service and we have taken enforcement action.

A key aspect of the inspection process is to ask our patients their views on

their care received.

http://www.cqc.org.uk/


St Ann's Hospice Heald Green St Ann's Road North, Heald Green, Cheadle, SK8 3SZ

Date of Inspection: 23 September 2013 Date of Publication: October 2013 We inspected the following standards as part of a routine inspection. This is what we found:

Care and welfare of people who use services

Safeguarding people who use services from abuse

Safety and suitability of premises

Staffing

Assessing and monitoring the quality of service provision St Ann's Hospice is an independent adult hospice. The hospice is registered for 34 inpatient beds but is currently operating on 27 beds as agreed with their commissioners. The hospice also runs a day care centre four days a week and an outpatient clinic twice a week. The hospice has an enclosed garden, a coffee shop, a small number of lounges and a small multi-faith room.

Summary of the inspection: We visited St Ann’s Hospice on 23 September 2013 at the time of our visit there were 24 in patients. At the time of our visit the manager was unavailable; the inspection was assisted by the Clinical director, Ward Manager, Training Officer and the lead for quality and audit. We saw staff caring for patients with respect and compassion. Staff were heard speaking with patients in a calm and friendly manner. We saw appropriate policies and procedures in place, staff we spoke with were aware of how to access them and the correct procedures to follow. We looked at two patients’ records which contained relevant and factual health information. Patients’ wishes and preferences were recorded and patients were included in discussions about their care and treatment. We spoke with three patients and ten relatives. One patient said “This is a wonderful place; all the staff are so kind and caring I can’t praise them enough. They make sure I am not in any pain. The food is very good and nicely presented. ” Another patient told us “The care is excellent, I am very comfortable.” A relative said “People worry about having to go into a hospice but the care here is excellent, 10 out of 10. The staff have time to talk to us and give us as much information and support we need as a

http://www.cqc.org.uk/directory/1-120031357


family”. Another relative said, “The standard of care is first class”. We spoke with four members of staff who were aware of the safeguarding procedures and had an understanding of mental capacity issues and best interests decision making. Staff told us they were well supported by management and told us that there was an open door policy and everyone was approachable. Staff meetings were held regularly, training and professional development was on-going and annual appraisals were undertaken. Any complaints were taken seriously and followed up appropriately we saw evidence that regular audits were undertaken.

St Ann's Hospice Little Hulton Peel Lane, Little Hulton, Worsley, Manchester, M28 0FE

Date of Inspection: 10 December 2013 Date of Publication: December 2013 We inspected the following standards as part of a routine inspection. This is what we found:

Respecting and involving people who use Services

Care and welfare of people who use services

Cleanliness and infection control

Safety, availability and suitability of equipment

Assessing and monitoring the quality of service provision

St Ann's Hospice is situated in the Little Hulton area of Salford, Greater Manchester and is registered as a charity. The hospice provides palliative and supportive care services to patients with life threatening illnesses. Services provided include hospice at home, day therapy and inpatient care. An extensive garden area is available for the benefit of patients and visitors. Off street car parking is available and the

location is well served by public transport routes.

Summary of the inspection:

As part of our inspection we focused on the inpatient unit at St Ann's Hospice

as well as the community based services team which provided care to people

http://www.cqc.org.uk/directory/1-120031374


in their own homes. During our inspection, patients made positive comments

about the service they received whilst at the hospice. The people we spoke

with told us they were comfortable and their pain was well managed.

Comments included; “The hospice is fantastic. Staff help me with personal

care and keep my pain under control. The staff are brilliant and the food is

fantastic” and “I have been very well looked after since I have been here. I get

treated with respect and would definitely recommend it to other people and

their families”. We looked at how patients were involved in the care they

received and if they were treated with dignity and respect my staff. One

patient told us; “Staff treat you so well here. Thankfully I can still do things for

myself but staff recognise that and allow me to have a go on my own first”. We

spent some time speaking with the lead for infection control and found the

premises were clean, tidy and odour free. We also checked equipment was fit

for purpose and available in appropriate quantities. We found equipment had

been serviced regularly and stored safely. We found there were appropriate

systems in place to monitor the quality of service provided. This included

regular auditing and the use of patient surveys which were analysed.

Neil Cliffe Centre

Wythenshawe Hospital, Southmoor Road, Manchester, Greater Manchester, M23 9LT

Date of Inspection: 19 September 2013 Date of Publication: October 2013

We inspected the following standards as part of a routine inspection. This is what we found:

Consent to care and treatment

Cooperating with other providers

Requirements relating to workers

Complaints

Records


The Neil Cliffe Centre is based at University Hospital of South Manchester and provides outpatient services to people at any stage of their illness – from diagnosis, during treatment, post treatment, at times of reoccurrence and onward. There is also a medical outpatient clinic held once a week at the centre.

Summary of the inspection: We spoke with two people on the day of inspection. Both confirmed that the staff had explained the care and treatment options to them and staff had asked for their consent. The people we spoke with were very complimentary about the staff and services provided. One person said “The care is phenomenal; I loved the place from the moment I walked in”. Another person told us “The staff are caring, professional and very thoughtful”. The people we spoke with confirmed that the centre had put them in touch with other services and gave them valuable support. One person told us “I was allocated a keyworker who devised a programme and explained everything to me”. Both people confirmed they didn’t have any need to make any complaints and felt the staff would accommodate any issues or concerns that may arise.


APPENDIX A Healthwatch Stockport response to St Ann’s Hospice Quality Account 2013/14 About Healthwatch Stockport

Healthwatch is the new independent consumer champion created to gather and represent the views of the public, patients, relatives and carers. Healthwatch plays a role at both national and local level and makes sure that the views of the public and people who use services are taken into account.

Healthwatch Stockport is a membership organisation run by volunteers with an interest in health & social care. They are supported by a team of staff to offer help to members carrying out activity on behalf of the organisation.

Healthwatch Stockport has, amongst others, the following responsibilities;

Promote and support local people to be involved in monitoring, commissioning and provision of local care services

Obtain local people’s views about their needs for and experience of local care services

Tell agencies involved in the commissioning, provision and scrutiny of care services about these views

Produce reports and make recommendations about how local health and care services could or should be improved

Introduction

Healthwatch Stockport welcomes the opportunity to comment on this Annual Quality Account (as seen in draft). We recognise that Quality Account reports are a useful tool in ensuring that NHS healthcare providers are accountable to patients and the public about the quality of service they provide. We fully support these reports as a means for providers to review their services in an open and honest manner, acknowledging where services are working well and where there is room for improvement.

We share the aspiration of making the NHS more patient-focussed and placing the patient’s experience at the heart of health and social care. An essential part of this is making sure the collective voice of the people of Stockport is heard and given due regard, particularly when decisions are being made about quality of care and changes to service delivery and provision.

Our wish is therefore that Healthwatch Stockport works with its partners in the health & social care sector to engage patients and service users effectively and to ensure that their views are listened to and acted upon. We look forward to continuing to work alongside St Ann’s Hospice to making sure that the voice and experience of patients and the public form is heard throughout the provision of services.

Healthwatch Stockport commends St Ann’s Hospice on the many areas where, through hard work and dedication quality improvements have been demonstrated.


St Ann’s Hospice Quality Account 2013/14

The Quality Account is a very well written report, which obviously has to follow a prescribed format. In the future Healthwatch Stockport would like to see a bit more information on:

Figures on enhanced training for non-registered clinical staff.

Identification of skill gaps in the community.

How improvements in engagement with hard to reach cultural and social groups is progressing.

Details of in-house therapies.

The Hospice at Home Service is well covered within the report and Healthwatch Stockport are pleased to see the Carer Needs Assessment Tool in use at the service.

The uplifting corresponding examples within the Quality Account add some colour to the prescribed format of the report, which could seem quite dry without them.

Through our working relationship, Healthwatch Stockport took part in the PLACE (Patient Led Assessments of the Care Environment), the results of which are particularly good, and congratulate St Ann’s Hospice on the results of this assessment.

The Care Quality Commission Report also brings heart to the Quality Account and appears to confirm what the community feels about St. Ann's Hospice.

We are also happy to see the number of pieces of work carried out by the hospice to collect patient feedback, from their comments scheme, to the Patient/Care Group, a variety of surveys and the Day Therapy Service Users focus groups.

Conclusion

At Healthwatch Stockport, we have previously received verbal feedback praising the service received at St Ann’s Hospice. We are glad to see the number of compliments (as reported in the Quality Account) received to the hospice far outweighs the number of complaints and that the number of informal complaints has decreased since last year’s report.

Healthwatch Stockport thanks St Ann’s Hospice for the opportunity to comment on this document and request consistency in reporting next year to enable a direct comparison of the information.

If members of the public have any queries or questions or concerns resulting from this report or annex, Healthwatch Stockport can be contacted by e-mail at [email protected], telephone on 0161 477 8479 or you can visit our website at www.healthwatchstockport.co.uk.

Healthwatch Stockport

mailto:[email protected]

http://www.healthwatchstockport.co.uk/

quality account 2013/14 - nhs · 2014-06-30 · quality account 2013 – 42014, st ann’s hospice...

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