Quality Account High quality care for all

Transcription

1 Quality Account High quality care for all Reporting period: 1 st April 2013 to 31 st March 2014

2 Impact of Hospice Services 1 st April st March 2014 The impact of hospice services in our local community is identified below patients received hospice care from between 1 st April 2013 and 31 st March % of patients had a diagnosis of cancer. The hospice received 1583 new referrals (81% cancer patients). Supporting our Local Community 94% of the referrals were for pain/ symptom management. The hospice supports patients for days (median). Patients and carers score us highly in terms of outcome, experience and overall satisfaction. Patients gave the hospice an overall rating of 94.8% and carers gave an overall rating of 96.8% for the advice, care and support provided. Support provided by the 24/7 advice line prevented calls. There were 646 completed In-Patient stays. 46.2% of patients are discharged following an admission to the In-Patient Unit. It is more than twice as likely that patients receiving hospice care will be able to die at home as those end-oflife patients who were not referred to the hospice. Hospice support is reducing the percentage of patients dying in hospital by approximately 60% when compared to those end-of-life patients who were not referred to the hospice. 2

3 I give the care 10/10. I have got my dignity back. That is all I want. People think you come to die in the Hospice. But it isn t like that. We need to spread the message. We are all very much alive. The GP saw me first and then a cancer nurse and I thought it was all doom and gloom. But then I came here I am very happy with the service. Your help and support and talking to others helps me cope. It has given me a much better view on life. It is wonderful coming here and talking to everyone. I started to come here soon after my husband died. Your bereavement care helped me to move on and so I hope to stay until I am ready. I want to be here because I feel someone is caring for me. I feel more confident here, as someone is caring for me. It is like being at home. You feel one of the family here. I can t find fault. Comments from the Patients Forum 3

4 Chief Executive s Statement Together with the Board of Trustees, I would like to thank all of our staff and volunteers for their achievements over the past year. The hospice has continued to provide a high quality service and remains financially sound. We have achieved this by providing high quality, cost-effective services to our patients and their families. The 8.5 million that is raised from our local community annually is a testament to the value that the community puts on the provision of our services. The Douglas Macmillan Hospice has been a leader and innovator in the hospice movement and has a well established governance function. This has enabled the hospice to focus on the quality of the services provided. Our regulators undertook an unannounced inspection on 12 th July 2013 and assessed us as being fully compliant. This is a tribute to the hard work of every member of staff working for the Douglas Macmillan Hospice. The hospice has a culture of continuous quality monitoring, in which any shortfalls are identified and acted upon quickly. I am responsible for the preparation of this report and its contents. 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 our hospice. The safety, experience and outcomes for all our patients and their loved ones are of paramount importance to us. We continue to actively seek the views of our service users. Michelle Roberts Chief Executive 15 th May

5 Section 1 Improvement priorities Priorities for improvement Following our assessment against the essential standards of quality and safety on 12 th July 2013, the hospice was assessed as being fully compliant. The Care Quality Commission (CQC) continues to categorise the hospice as a low risk organisation. To maintain the Quality Risk Profile at this level, the hospice provides quarterly reports to the CQC. These reports are also provided to the commissioners of hospice services. In developing the strategic plan, the hospice has paid regard to the rapidly changing health and social care environment. There are two key clinical objectives that have arisen from our discussion on future strategy: To support and enable the enhancement of palliative and end of life care services for patients of all disease groups in settings appropriate to their needs and to encourage independent and supportive models of living at end of life. To have a palliative and end of life service delivery model that seeks to deliver appropriate care closer to home and encourages the development of patient choice, independence and supportive care. Within this context, and following consultation with the staff, volunteers and the Patients Forum, the DMH confirmed the top three quality improvement priorities for 2014 to 2015 to be as follows: Strategic theme: Increasing Access to a wider range of conditions The care management of frail elderly patients is a key priority area for the local health and social care economy. The number of patients classified as frail and elderly is growing. Current patterns of care are not meeting the needs of this group. Identification of patients at end of life is particularly challenging as these patients often have a number of illnesses, rather than one single life limiting illness. Estimates of numbers of frail patients in this cohort are given below: 300 highly complex patients with extensive needs 1,300 patients with a serious condition and with significant needs 3,000 patients requiring sporadic, infrequent input from healthcare services. 5

6 In 2014/15, the DMH will put in place the processes to support the initiatives within our locality. The hospice aim is to enable frail elderly patients, with complex needs, to access hospice services. The objectives of this service are to provide: an alternative care option a reduction in the number of frail elderly people attending A&E a reduction in acute admissions specialist end-of-life support. Future planning priority 1 Development of a Palliative Care Specialist Nurse-led frail elderly/dementia service This new service will enable patients within North Staffordshire to receive palliative care within their own home or in a Nursing Home. A service model will be developed and piloted in 2014/15. Future planning priority 2 Collaboration with Nursing and Residential Homes The hospice is developing a model of working with the Frail and Complex Team, which will involve working closely with Nursing Homes and Care Homes. The model will include the development of a frail/elderly/dementia PCNS team Strategic theme: Delivering care closer to home Future planning priority 3 Satellite Beds The hospice has been recognised for its award winning Community Lodges, which have illustrated the value of community-led beds. In , the hospice will explore the development of satellite beds in the community to increase the diversity of hospice services. 6

7 Progress against the improvement priorities identified for Throughout , the hospice had a number of initiatives to enable it to offer a more comprehensive service to the local community, whilst remaining within the limitations of the financial constraints at that time. All plans for improvement were identified through needs assessments of the local community and direct patient involvement. We discussed all initiatives with the hospice s Patients Forum and Carers Forum. Inevitably, progress against the quality improvement priorities for was influenced by financial constraints of the charity, delay to the grant sign-off process and by the poor weather conditions experienced over the winter months. Progress is discussed below Priority 1 To build a purpose designed unit, from which the hospice will provide an integrated therapy service and a bereavement support service. The hospice was successful in its application for a Department of Health grant to have a purpose designed out-patient unit, which will provide: More appropriate rooms with natural light and proper ventilation for all services Privacy and dignity for all patients Improved access for patients using mobility aids Improved access for patients to the exterior of the building. Due to the extreme weather conditions experienced in the winter of , building work has fallen behind schedule. Phase 1 of the building work will be completed by 31 st July 2014 and Phase 2 by 30 th September When completed, the hospice will provide the following to the local community: Phase 1 A massive improvement in the physical environment for patients attending the hospice for support. A suite for psychological therapies which maximises clients privacy, dignity and comfort. Phase 2 New rehabilitation and physiotherapy facilities to enable patients to remain independent and self supportive. A much improved facility for the treatment of complex lymphoedema. 7

8 A new out-patient consultation suite. This will improve the capacity of the out-patient services and enable patients to remain at home with our support Priority 2 To improve the ability of the In-Patient Unit to manage the increased complexity and comorbidity of patients Over the last 12 months, the hospice has increased the number of registered staff and provided administrative support-staff seven days per week. This has enabled the hospice to provide a more responsive service to patients. The In-Patient Unit is now able to admit and discharge patients on a seven day a week basis. 556 patients were admitted to the In-Patient Unit between 1 st April 2013 and 31 st March 2014, 478/556 (86.0%) patients had a diagnosis of cancer. Some patients were admitted more than once, bringing the total number of admissions to Priority 3 To develop the provision of psychological services to hospice patients The Psychological Therapist provides psychological interventions at Level 4 (NICE Guidance, 2004) for those patients/carers and family members who are experiencing complex psychological issues. The service is in high demand as psychological distress is often a prominent feature for palliative care patients and care givers. An Integrative Counsellor has been appointed to enable the Psychological Support Service to respond to patients requiring both Level 3 and Level 4 support. The Integrative Counsellor provides training to hospice staff to ensure a consistent approach is used to support patients requiring Level 2 support. A Body Image and Mindfulness group is being delivered to women who have experienced physical and emotional changes. This group is run within a local Community Hub The Integrative Counsellor provides two bereavement groups, one in the hospice and one in the community. These monthly bereavement support groups serve to connect bereaved people within the community. 8

9 Section 2 Mandated Statements Statements 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 hospices. Review of services Between 1 st April 2013 and 31 st March 2014, the DMH provided the following services: In-Patient Unit Day Therapy Unit Out Patients Hospice at Home Palliative Care Nurse specialist Service The DMH s Clinical Governance Group (CGG) is a sub-committee of the Board, which meets bimonthly. The CGG receives quality reports, which enables the group to review the quality of care provided by all clinical services. A Clinical Governance report is submitted to the Board of Trustees on a quarterly basis. Participation in clinical audits During 2013/14, the DMH was ineligible to participate in the national clinical audits and national confidential enquiries. Research The hospice is a pilot site in a national, ethically approved research project entitled Implementation and Evaluation of the Carer Support Needs Assessment Tool in Hospice Home-Care Services. The hospice has compared carer assessment and support with and without the use of a formal, validated research tool. The pilot is proceeding according to plan and was completed in November The results of the pilot will be published at the end of The research was led by Gunn Grande and Lynn Austin, University of Manchester. The hospice is involved in a local, ethically approved, qualitative research study being undertaken by Susan Walker, whose PhD is entitled Preferred Place of Death: One UK Hospice Perspective. All data for the study have been collected and the thesis is due for completion by the end of

10 To improve patient care, the hospice has continued to work with the heart failure specialist teams at UHNS and Staffordshire & Stoke on-trent Partnership with regard to provision of non-oral diuretics for heart failure patients in the community. This work won first prize in the Cardiac Care category of the Care Integration Awards Quality improvement and innovation goals agreed with our commissioners For the year 2013/14, the hospice received a grant without any specific conditions attached. What others say about us The DMH is required to register with the Care Quality Commission and its current registration status is unconditional. The Care Quality Commission has not taken any enforcement action against the DMH during 2013/14. The DMH is subject to regular inspections by the Care Quality commission. The last on-site inspection was on 12 th July 2013, at which the hospice was assessed as being fully compliant. The Quality Risk Profile of the hospice states that the hospice is low risk. Data quality In accordance with agreement with the Department of Health, the DMH submits a National Minimum Dataset (MDS) to the National Council for Palliative Care. The DMH provides the MDS report and a copy of the quarterly quality report to the local CCG. 10

11 The DMH will be taking the following actions to improve data quality: The IT Manager and the Clinical Governance Manager will continue to review the data outputs in order to improve the quality of patient data recording and reporting. Information Governance Toolkit attainment levels The Information Governance Assessment Report overall score for 1 st April st March 2014 was 67% and was graded green. Section 3 Quality overview Comparison with national minimum data set The most recent National Minimum Dataset covers the period 1 st April 2012 to 31 st March Community The hospice has a specialist community team, including a Director of Community Services, medical consultant, doctor, nurse specialists and a Hospice at Home team. As a result, patients are managed in their home environment, or alternative place of care, for as long as possible. Palliative Care Nurse Specialist A summary of the MDS data for the Community Specialist Palliative Care team is given in Table 1. Table 1 Community Specialist Palliative Care MDS data DMH National Median Data have been compared to 34 large units % New patients 1437 (62.2%) 897 (68.0%) % New patients with a non-cancer diagnosis 243 (16.9%) 142 (15.4%) Average length of care 157days 94.7 days Face to face visits per patient Telephone contacts per patient

12 The hospice sees the community team as providing a significant role in improving the quality, accessibility, flexibility and integration of palliative and end of life (EOL) care in our catchment area. The number of home visits was 4.5 per patient per annum in , which was 45% higher than the national median value of 3.1, and the number of telephone contacts was 3.4 per patient per annum, which was in accordance with the national average of 3.5. The relatively high level of face-to-face contact provided by the community PCNS service in accordance with the future of palliative and end of life (EOL) care services set out in the 2010 Demos report entitled Dying for Change. Comments from bereaved families confirm that this level of support is valued by family members. PCNS Team: Comments from bereaved relatives Your regular contact and visits were reassuring for me. Thanks to your kindness I was able to continue to care for dad at home, knowing that you were there if I needed anything at all. Just a few words to say thank you for what you did for my son. The family thought how much you cared for him was out of this world. On behalf of myself and my family I would like to say a big thank you. Thank you most sincerely for your support during mum s final weeks. Your knowledge, advice and practical support were a life-line to me and my dad. Your calm reassurance was vital in giving us the confidence to believe that we could fulfil Mum s wish to remain in the comfort and security of her own home. Thank you for the kindness, thoughtfulness, consideration and all your hard work that you all provided to ensure my mother received such fabulous care in the final months of her illness. Not only did you care for her but you also provided an enormous amount of care, consideration and support for us all at such a difficult time. 12

13 Hospice at Home A summary of the MDS data for Hospice at Home is given in Table 2. Table 2 Hospice at Home MDS data DMH National Median Data have been compared to 15 large units % New patients 470 (90.0%) 572 (88.6%) % New patients with a non-cancer diagnosis 68 (16.1%) 87 (16.1%) Average length of care 24.6 days 39.9 days The MDS data for show that the percentage of new patients seen by the Hospice at Home Service was 90.0%, which is slightly higher than the national median value of 88.3%. In accordance with the priorities of the hospice, the percentage of non-cancer patients increased to 16.1%, which was identical to the national median value. Hospice at Home: Feedback from family members My Aunt wished to die at home, with her family around her. The Hospice at Home team helped us to fulfil her wish. She died with dignity. The care was professional, compassionate and appropriate to her needs. Thank you for making it possible to keep mum at home in the last week of her life. She had the best care and I had great support during these last days. I am grateful for everything that you and the team did for her. Words cannot begin to fully express the gratitude I feel for the care given to my mother during the last week of her life by the Hospice at Home team. I am also grateful for the support given to me at such an emotional time. 13

14 On-Site Services In-Patient Unit A summary of the MDS data for the In-Patient Unit (IPU) is given in Table 3. Table 3 In-Patient Unit MDS data DMH National Median Data have been compared to 44 large units % New patients 468 (84.5%) 324 (88.1%) % New patient with a noncancer 62 (13.2%) 32 (11.5%) diagnoses % Patients returning home 45.8% 41.0% Average length of stay- cancer 12.2 days 14.7 days Average length of stay- noncancer 10.3 days 13.3 days In , the percentage of non-cancer admissions to the IPU was 13.2%, which remains higher than the national median of 11.5%. This trend is in accordance with the charity s aims to offer comprehensive specialist palliative care to all adults in North Staffordshire with progressive, advanced disease and a limited life expectancy. Since , the IPU has reduced its average length of stay (LOS) from 13.6 day to 12.2 days for cancer patients and 10.3 days for non-cancer patients, which is lower than the national median (cancer patients 14.7 days: non-cancer patients 13.3 days). The hospice is committed to supporting patients to return to their own home, or alternative place of care, as soon as their symptoms have been managed. 14

15 Effective use of the admission and discharge criteria enable the timely admission of patients needing specialist in-patient palliative care. In-Patient Unit You have all been so kind, patient and loving with me. I shall be sorry to move on but I still have a wonderful family who would take care of me. I would never feel apprehensive about having to return to your team. Feedback from a patient The entire staff treated me to a very high standard of quality care throughout my stay for which I am most grateful. A very big thank you and my very best wishes to everyone concerned. Feedback from a patient The family wishes to express our heartfelt appreciation for the kindness and excellent care our mother received during her stay at the hospice. Of course we are saddened by her death, but we are comforted knowing that she received the best care available. The sensitivity and support of all staff helped us through what was a very difficult time. Thank you to everyone for the wonderful work you do. We will never forget your kindness. Feedback from a bereaved family Thank you to all the staff for the care given to XX during his stays in the hospice and particularly during his final days. XX was very apprehensive about coming into the hospice initially but after his first stay to monitor his pain, he couldn t speak highly enough of everyone he came into contact with and happily came in for a second and third stay. I experienced his care during my visits during the day but, when I stayed overnight I was overwhelmed by the kindness shown to me also. To see the nurses in action during the night was just amazing. I cannot thank you enough. Feedback from bereaved relatives 15

16 Day Therapy Unit A summary of the MDS data for the Day Therapy Unit is given in Table 4. Table 4 Day Therapy Unit MDS data DMH National Median Data have been compared to 49 large units % New patients 143 (62.7%) 150 (65.4%) % New patient with a noncancer diagnoses Average length of attendance (days) 28 (19.6%) 28 (18.9%) days days In , the percentage of new patients attending the Day Therapy Unit was 62.7%, which was slightly lower than the national median value of 65.4% Throughout , the hospice continued to change the focus of the unit from a day hospice to a day therapy unit, with an emphasis on clinical interventions. Feedback from the Patients Forum and the Carers Forum indicates that this support is highly valued. 16

17 Day Therapy Unit: Feedback from the patients This is the only day of the week that my son feels relaxed. He knows that I am in good hands and that I will be safe all day. He doesn t need to worry about me. Whatever you want the care is there so I look forward to the next visit. You are always being looked after. The care is excellent. I have no complaints. I feel fully involved in my care. If I am worried about anything there is someone to talk to. Then they ask you ask you again on the next visit. The care received here is second to none and I wouldn t want to be anywhere else when I go, except perhaps overlooking the sea. Everyone is very respectful, all the staff care, we appreciate everything Coming here gives you value of life, it does me the world of good, I love it and the meals are wonderful All the staff are incredible and that makes DMH very special The staff make you feel like you matter, that is priceless The care is absolutely excellent. It gives me a reason to get up on a Friday morning. Everyone has my welfare at heart. I enjoy it all. I didn t think I would. We have a nice dinner. In fact everything is nice. 17

18 Out-patients A summary of the MDS data for Outpatients is given in Table 5. Table 5 Out-patients MDS data DMH National Median Data have been compared to 50 medium sized units % New patients 417 (71.2%) 255 (40.0%) % New patients with a non-cancer diagnosis % attendances with a Medical Consultant 53 (12.7%) 43 (14.4%) 5.5% 11.6% The hospice continues to develop the out-patient services to a significant extent. We have been successful in winning a Department of Health grant of 500,000, which has enabled us to build a dedicated out-patient facility. Progress has been influenced by financial constraints of the charity, delay to the grant sign-off process and by the poor weather conditions experienced over the winter months. Phase 1 will be completed by the end of July

19 Local quality measures The hospice uses the national definition of quality, which states that the following three dimensions must be present to provide a high quality service: clinical effectiveness quality care is care which is delivered according to the best evidence as to what is clinically effective in improving an individual s health outcomes. The main focus of the hospice is Domain 2 of the NHS outcomes framework: enhancing the quality of life of patients with long-term conditions. patient experience quality care is care which looks to give the individual as positive an experience of receiving and recovering from the care as possible, including being treated according to what that individual wants or needs, and with compassion, dignity and respect (Domain 4). safety quality care is care which is delivered so as to avoid all avoidable harm and risks to the individual s safety (Domain 5) In addition to the national dataset for palliative care, the following measures reflect our performance against the three quality dimensions. Clinical Effectiveness Patients receiving care from the hospice To meet the end of life needs of the local community, the hospice has accommodated a 31.5% increase in the number of patients receiving hospice care since The hospice is committed to meeting the requirements of all patients requiring our specialist support. As a consequence of this commitment, there has been a steady increase in the percentage of non-cancer patients from 8.8% year ending 31 st March 2009 to 16.9% in year ending 31 st March Table 6 & Figure 2 Number of patients receiving care from the hospice year ending March 31 st Year ending 31 st March Number of patients

20 The majority of our patients (72.8%) are aged 65 years and above. The primary care aim of 94.1% of the patients referred to us is pain and symptom management. Most of our referrals are from the hospital Clinical Nurse Specialist (34.48%) and the patients GPs (29.7%). 24/7 Advice Line A 24/7 advice line is provided 24 hours a day for 365 days of the year by a team of experienced and trained Palliative Care Nurse Specialists (PCNSs). The PCNSs are provided with the necessary training, skills and information resources needed to keep their clinical knowledge fully up-to-date. The hospice uses an electronic patient database, which means that the PCNS taking the call has direct access to the patient records of all patients known to the hospice. The hospice standard is that all calls to healthcare professionals will be responded to within 15 minutes of call receipt. Over the past 12 months, this standard was met for 95.8% of calls. Between 1 st April 2013 and 31 st March 2014, this service took 3354 calls, of which 65.9% of calls were from patients/carers. The Carers Forum has stated how invaluable this service is to them. This is supported by the fact that were prevented over the past 12 months. Supporting patient choice The percentage of hospice patients (all diagnoses) dying at home was 39.9% for the year ending 31 st March This compared to 19.1% of all deaths recorded in the End of Life PCT profile for patients living in North Staffordshire and Stoke-on-Trent (Table 7 and Figure 3). Table 7 Location of death of all patients in our local community and patients receiving hospice care EOL PCT profile Oct 2012 (n=4734) Annual (n=1338) Location Acute Hosp % Community Hosp % 56.9% Home % 19.1% Care home % 15.3% Hospice IPU % 6.5% Other 2 0.1% 2.4% 20

21 Figure 3 Location of death of all patients in our local community and patients receiving hospice care The percentage of hospice patients (all diagnoses) dying at home was 39.9% for the year ending 31 st March This compared to published figures of 19.1% given for all deaths of patients living in Staffordshire and Stoke-on-Trent. The hospice has consistent, externally verified evidence that it is more than twice as likely that patients receiving hospice care will be able to die at home as those end of life patients who are not referred to the hospice. The percentage of hospice patients (all diagnoses) dying in a hospital was 22.9% for the year ending 31 st March This compared to published figures of 56.9% for all deaths of patients living in Staffordshire and Stoke-on-Trent. The hospice has consistent, externally verified evidence that hospice support is reducing the percentage of patients dying in hospital by approximately 60% when compared to those end of life patients who were not referred to the hospice. 21

22 Patient experience Patients Forum The DMH Patients Forum continues to be a very active group, which meets and rotates the days of the meeting from Monday to Friday to maximise patient involvement. Due to the type of patient treated by the hospice, the membership of this group comprises mainly of patients from the Day Therapy Unit (although meetings are also open to in-patients and community patients). The Head of Quality and Governance, Stoke on Trent Clinical Commissioning Group, a Lay Member of the PPI and a representative of the Patients Congress attended the Patients Forum on 22 nd August. The hospice received very positive feedback. User feedback provided during the episode of care The hospice undertakes real-time monitoring which enables staff to take immediate action to address any issues raised. Of the 652 admissions to the IPU between 1 st January and 31 st December 2013, 523 (80.2%) patients were randomly selected to complete the questionnaire. Where the patient was unable to complete the questionnaire themselves, a family member or a volunteer was asked to help the patient. 233 questionnaires were completed (44.6%); the other patients were too ill to complete the questionnaire, had been admitted 22

23 previously or did not wish to complete the questionnaire. The feedback from inpatients is summarised in Table 8. These data have a confidence level of 95% and a confidence interval of 5. Table 8 Real-time monitoring of in-patient satisfaction Yes.Question (n=233) CL =95% CI=5 Have the first 3 days of your stay been satisfactory % Have you understood the reasons for your admission and what we are trying to achieve for you % Have you found the staff approachable % Have you been given the opportunity to discuss treatments % Have you expressed any concerns or issues you may have % Are we doing everything for you that you would wish us to do? % If you had a complaint about the care you are receiving, would you know what to do? % In all cases, there is documented evidence that any issues raised by the patients were dealt with immediately. Patient-Led Assessment of the Care Environment. The hospice undertook the national Patient-Led Assessment of the Care Environment (PLACE) assessment on May 22 nd. The assessment was undertaken by members of the Carers Forum. The benchmarked results were published on September 18 th

24 The hospice scored higher than the national average in all areas. The DMH has worked closely with Help the Hospices to encourage other hospices to take part in this patient-lead assessment. In 2014, Healthwatch has agreed to take part in the hospice s assessment. The team of assessors will include two members of the Carers Forum and an independent reviewer from Healthwatch. Safety A quality indicator: Prevention and management of pressure ulcers Between 1 st April 2013 and 31 st March 2014, 665 patients were admitted to the In- Patient Unit (IPU). A Waterlow score was determined for 97.7% of patients. The average Waterlow score was 22.8 with a range of 5-49 (very high risk = a score of 20), which is an indication of the frailty of the patients being cared for. 123/665 (18.5%) patients had pressure ulcers on admission. All pressure ulcers, and areas at risk of developing into a pressure ulcer, were given a grading using the EPUAP classification system. All at risk patients had a documented care plan, which includes monitoring on an ongoing basis. Preventative measures were put in place for all at risk patients, such as pressure relieving mattresses and cushions. No patient developed a Grade 3 or above pressure ulcer during their stay on the In- Patient Unit. Our participation in clinical audits National hospice-specific audit In , the DMH took part in a national audit of Hospice at Home services received by 4,800 patients across England and Wales. This piece of work was undertaken by Help the Hospices, in partnership with the National Association for Hospice at Home; the work has not been published to date. Local audit To ensure that the hospice is providing a consistently high quality service, we undertake our own clinical audits, often using national audit tools developed specifically for hospices, which have been peer reviewed and quality assessed. This allows us to monitor the quality of care being provided in a systematic way and creates a framework by which we can review this information and make improvements where needed. 24

25 Each year, the Board approves the audit schedule for the coming year. Priorities are selected in accordance with what is required by our regulators and any areas where a formal audit would inform the risk management processes within the hospice. Through the Clinical Governance report, the Board of Trustees is kept fully informed about the audit results and any identified shortfalls. Through this process, the Board receives assurance of the quality of the services provided. The following audits were completed between 1 st April 2013 and 31 st March Self-assessment by the Accountable Officer Management of controlled drugs Infection control Pain Management Management of General Medicines This audit has to be completed annually. The hospice was fully compliant with the legal requirements. This audit has to be completed annually to provide evidence to support the self assessment by the Accountable Officer. A few minor shortfalls were identified. The Board is assured that the hospice is now compliant. The CD Accountable Officer has robust monitoring processes in place. The hospice had a few minor areas of shortfall, which are being managed by the Infection Control Team. The audit highlighted problems with documentation. Continuous quality monitoring and patient feedback provided reassurance that pain is managed effectively. Documentation is being revised and the audit will be repeated in The audit identified an issue with documentation in relation to the destruction of general medicines. An audit trail was put in place with immediate effect. The hospice audit team is continuing to develop. On June 17 th, the DMH is cohosting a Regional Audit Day with St Giles Hospice. Auditors from the hospices within the West Midlands are presenting their results and sharing learnings. Psychological Support One of the Charity s aims is to offer professional advice and support to families and carers during the patient s illness and during the initial stages of bereavement. The MDS data, published for , showed that clients received 8.2 contacts. This figure was 39% higher than the national median value of 5.9 (Data compared with that of 41 medium sized unit). Between 1st April 2013 and 31 st March 2014, 211 carers received bereavement support. The majority of clients received support for less than three months. 25

26 What our staff says about the organisation The DMH values the opinions of the staff regarding the quality of the service provided. The Hospice undertakes a staff survey every 2 years to ascertain engagement levels, celebrate success and to highlight areas for improvement. Staff Survey In June and July 2013, the DMH took part in the staff survey run by Birdsong Charity Consulting on behalf of Help the Hospices. 110/275 DMH staff took part in this survey (response rate =40%). 42 Hospices participated (5,501 paid staff and volunteers). Table 9 Staff survey 2013 Category DMH Hospice Sector Average The Organisation & Communication I understand what the charity wants to achieve as an organisation 96% 91% The senior management team is effective 61% 56% I would recommend this hospice as an employer 81% 76% Morale and Work/Life Balance I feel I am making a difference 94% 89% I enjoy the work I do 95% 95% I am not concerned about my job security 59% 57% People Management I receive useful feedback on how I am performing 73% 63% I am clear about what is expected of me in my job 90% 86% my views are listened to and valued 71% 63% Development and Reward I receive sufficient training to enable me to do my job well 80% 71% there are good opportunities for personal development 69% 54% overall I am satisfied with my job 85% 80% In the current financial situation, the hospice has had to ensure that charitable funds are controlled very tightly. These tight controls have not impacted negatively on staff survey. 26

27 Table 10 Staff turnover Retirements Staff leaving Total staff employed Turnover of DMH staff 14.40% 6.20% 13.30% 14.90% 17.70% Comparison to Voluntary, Community, Not-for-Profit Sectors 16.40% 15.90% 13.10% 13.0% 15.20% Overall turnover of staff is similar to the average for the sector. The Board of Trustees commitment to quality The Board of Trustees is fully committed to the quality agenda. The hospice has a well established governance structure, with members of the Board having an active role in ensuring that the hospice provides a high quality service in accordance with its Statement of Purpose. As a way of having first-hand knowledge of what the patients think about the quality of the service provided, the Chair of Trustees has attended several meetings of the Patients Forum. Attending these meetings gives me the opportunity to listen to what can be done for the patients to improve their lives through our care and support. I encourage Trustees to attend these meetings. As the Trustees have ultimate responsibility for the governance of the hospice, this interaction with the patients provides a valuable insight into the work of the hospice and how it is perceived by the patients. The Board is confident that the treatment and care provided by the Hospice is of high quality and is cost effective. 27

28 Rating of our service by patients and carers The hospice does not ask the family and friends question but we do ask patients and carers to score the services. Table 11 Overall rating of the hospice by patients and carers Patients gave the hospice an overall rating of 94.5%; carers gave an overall rating of 96.8%. All service areas achieved over 90%. 28

29 References Care Quality Commission: Guidance about compliance Essential standards of quality and safety. Outcome 1. March Last accessed 16/04/14 ELCQuA Last accessed 16/04/14 Leadbeater, c. and Garber, J., Demos Report: Dying for Change. Demos, London. Last accessed 16/04/14 National End of Life Care Intelligence Network. EOL PCT profile October Last accessed 22/04/14. Goodridge, D. & Marr, H. 2002, "Factors associated with falls in an inpatient palliative care unit: an exploratory study", International journal of palliative nursing, vol. 8, no. 11, pp Health and Social Care Act 2012, March Last accessed 16/04/14 NICE Quality standard for end of life care for adults, November Last accessed 16/04/14 Pearse, H., Nicholson, L. & Bennett, M. 2004, "Falls in hospices: a cancer network observational study of fall rates and risk factors", Palliative medicine, vol. 18, no. 5, pp Quality in the new health system - Maintaining and improving quality from April 2013, Jan Last accessed 16/04/14 West Midlands Cancer Intelligence Unit. Where do people die? last accessed 16/04/14 Help the Hospices Commission: Future ambitions for hospice care: our mission and our opportunity: October 2013 Help the Hospices Commission: Current and Future needs for hospice care: January 2013 Commission on Improving Dignity in Care for Older People (2011) 29

30 Annex What Stoke -on-trent and North Staffordshire CCGs say about the organisation Statement for Douglas Macmillan Hospice North Staffordshire CCG and Stoke-on-Trent CCG are pleased to be asked to comment on the Douglas Macmillan Quality Account for 2013/14. The CCGs meet with the Douglas Macmillan Hospice twice annually via the Staffordshire Hospices Clinical Quality Review Meeting to monitor and seek assurance on the quality of services provided. The Quality Account covers many of the areas that are discussed at these meetings, which seek to ensure that patients receive safe, high quality care. It is noted that the hospice was visited by the Care Quality Commission in July 2013 and was assessed as compliant with the essential standards of quality and safety. The CCGs also visit the hospice and in August 2013 we were pleased to be invited to attend the Patient Forum with members from our own Patient Congress. It was impressive to see how well the hospice listened to the patients and acted upon their feedback which is reflected in the excellent patient and carer ratings. Commissioners support the continued use of real time monitoring of patient feedback to enable staff to take immediate action to address any issues raised. It was pleasing to see that the hospice scored higher than the national average in all areas of the national Patient Led Assessment of the Care Environment (PLACE) assessment. The progress made on priorities is reassuring and it is good to see that the hospice are now able to admit and discharge patients on a seven day week basis. They have identified quality improvement priorities for which address key important areas which are aligned to both health and social care priorities namely; providing care closer to home and supporting the frail elderly. To the best of the commissioner s knowledge, the information contained within this report is accurate. Received 20 th June

31 What Healthwatch says about the organisation Healthwatch Stoke-on-Trent welcomes the opportunity to comment on the Quality Account of the Douglas Macmillan Hospice. It is noted that there has been mixed progress against the priorities set for but that there have been a number of external influences which have affected the achievement of these. However, Healthwatch is pleased to see that firm deadlines for completion of the building work detailed in Priority 1 have been set and it is hoped that the opening of these new facilities will support patients and their families with much needed additional services. The extension of services through increased staffing and the 7 day a week admission and discharge service is a welcome addition to patient services. Healthwatch also welcomes the extension of Psychological Support Service which has further enhanced patient and family experience through a diverse range of activities. With the drive in the wider Staffordshire Health Economy to provide appropriate care closer to home for patients and services users, Healthwatch is pleased to note the aspirations set out in your 2014/15 Priorities which provide models of care that support this type of provision for palliative care. Received 24 th June