2015/16. St. Michael s Hospice (North Hampshire) Quality Account

2015/16 St. Michael s Hospice (North Hampshire) Quality Account

CONTENTS Part 1 Page Chief Executive s Statement 3 Mission Statement and Vision 4 Priorities for Improvement 2016-2017 4 Review of Priorities for Improvement 2015-2016 5 Part 2 Statement of Assurance from the Board 7 Review of Services 7 Participation in Clinical Audit 7 Research 9 Implementing the Duty of Candour 9 Quality Improvement and Innovation Agreed With Our Commissioners 9 What Others Say About Us 9 Data Quality 11 Part 3 Quality Overview 13 What Our Patients Say About St. Michael s Hospice 15 What our Staff Say About The Organisation 16 What Our Regulators Say About St. Michael s Hospice 17 The Board of Trustees Commitment to Quality 17 Comments From Other Stakeholders 18 SMH Quality Account Feedback 19 Page 2 of 19

Part 1 Chief Executive s Statement Our fifth Quality Account 2015-16 demonstrates to our patients and the community we serve how we assess the quality of our services and ensure evidence based quality improvement is implemented on an on-going basis. This report reviews progress against our priorities described in last year s account and sets out some of our key quality improvements to enhance services for patients and their families in the coming year. I am pleased to report that our new community palliative care project, part of our 5 year strategy plan implementation, has had a very successful first year, further enhancing our care in the local community in collaboration with our existing Hospice at Home team. Duty of Candour has always been high on my agenda in everything we do and we further strengthened our commitment to honesty and openness, with all staff receiving training to further support them to embed this in their everyday practice. Our 2015 Friends and Family survey results reveal that 97% of respondents stated that they were either likely or extremely likely to recommend St. Michael s Hospice to their friends or family if they needed similar care or treatment, a 3% increase from 2014. However, we are not complacent and continually strive to ensure we learn and embrace ideas and feedback from all patients and families who use our services and from our staff and volunteers who work for us. All of our services can of course be accessed free of charge by anyone, irrespective of ethnicity, religion, disability or sexual orientation. Our clinical and fundraising teams continue to work hard to promote hospice care to the whole community to ensure equity of access. Finally, I would like to thank our dedicated team of staff, volunteers and supporters of the hospice. The high standards of care achieved by St. Michael s Hospice are only possible through their hard work and commitment to improve the quality of care provided. David Monkman Chief Executive May 2016 Page 3 of 19

Mission Statement St. Michael s Hospice (North Hampshire) enables people faced with a life limiting illness, their families and carers, to attain the highest possible quality of life by providing a choice of specialist care and support. Our Vision St. Michael s Hospice will endeavor to influence and lead all aspects of palliative care provision in North Hampshire. It will do this by working in partnership with all stakeholders, particularly service users, who will be actively involved in the development and delivery of services which, as far as possible, will be user lead. Priorities for Improvement 2016-2017 The hospice will continue to focus its energies to provide a service of outstanding quality and during 2016-2017 it has committed to a number of key priorities under the headings of patient safety, clinical effectiveness and patient experience. It is through listening, learning and being responsive to change that enables us to provide individualised quality driven services to the community of North Hampshire. Our targeted quality improvement priorities for 2016-2017 are: Patient Safety Priority 1: Sign up to Safety How was this Priority identified? St. Michael s Hospice Strategy identifies that high standards of clinical care will be fundamental to any service provision. In order to achieve these we have identified how a national initiative Sign up to Safety (NHS England) can help staff achieve their patient safety aspirations and care for their patients in the safest possible way. At the heart of the Sign up to Safety initiative is the philosophy of locally led, self-directed safety improvement, which staff have been discussing in recent mandatory training sessions. How will Priority 1 be achieved? A plan will be disseminated and shared with staff which will describe the actions the hospice will undertake in response to the five Sign up to Safety pledges. The plan will include a staff suggestion scheme to identify effective solutions and support ownership of any changes required. Page 4 of 19

Clinical Effectiveness Priority 2: Improving Clinical Documentation How was this Priority identified? A review of the current clinical documentation by our new Director of Patient Services in conjunction with senior clinical staff, identified that improvements could be made to the patients care planning process and communication of care and in particular would benefit from improved structuring of the documentation. How will Priority 2 be achieved? A working party has been created to examine the issues with current documentation and it will identify solutions to create a more robust, user friendly tool to enhance the quality of documentation produced, leading to improvements in the patient s care planning process. Extra support and training will be provided to relevant staff. Patient Experience Priority 3: Increasing patient feedback How was this Priority identified? The patient feedback received during 2015 was reviewed and a low response rate (n=18) from discharged patients was identified. Feedback from staff recognised that the length of the questionnaire may be a contributory factor in the response rate, although data gained was valuable. Strategies to improve feedback, including improving friends and family test feedback, have been identified and a pilot is in place. It is anticipated that the friends and families test will be provided in a range of formats, for example use of electronic and web based media, therefore increasing accessibility and uptake.. How will Priority 3 be achieved? An A5 card has been designed to make feedback easier and staff will encourage patients to complete the cards. We will make the feedback system more visual within the in-patient unit and the day service unit which will encourage relatives to discuss feedback with the patient. Depending on the pilot evaluation we will extend this system to Hospice at Home and the Community Palliative Care project. Review of Priorities for Improvement 2014 2015 Improvement Priorities Page 5 of 19

The key improvement priorities undertaken during 2014-2015 were: Priority 1: Organisational Review of Tissue Viability Provision A tissue viability specialist nurse was sourced and currently provides weekly input to support improvements in pressure ulcer prevention and care provision. New documentation was implemented and new equipment trialled and purchased. An audit was undertaken which demonstrated an overall 30% improvement in tissue viability care in IPU. A self-sustaining model has been developed which includes identification of a link nurse for tissue viability and mandatory training for all clinical staff. The Pressure Ulcer Working Party will continue to monitor care in this area via quarterly auditing, undertaken by the link nurse, to ensure progress continues. Priority 2: The North Hampshire Six Steps Education and Practice Development Programme The North Hampshire Six Steps Education and Practice Development Program is a national quality framework which has been adapted by the hospice to align with local end of life care strategy. The program aims to support local nursing and residential care homes to improve end of life care for their residents and avoid inappropriate end of life hospital admissions. This program is on track with outcomes being monitored quarterly against key performance indicators (KPIs) by North Hampshire Clinical Commissioning Group (CCG). A total of 7 care homes have been accredited and we saw a 44% decrease in hospital admissions from these homes between October 2014 and June 2015. 7 homes are currently on the program with 5 due to accredit by the end of June 2016. North Hampshire CCG have agreed to fund this initiative for another year. Priority 3: St. Michael s Community Palliative Care Project The Odiham and Alton area now have enhanced access to multidisciplinary specialist palliative care services for patients in the final phase of their life. Progress on this project is monitored against quarterly KPIs which are currently on track. The project is currently supporting 55 patients in this area. 94% of patients have achieved their preferred place of death to date. There are plans to roll out the project to the next area (Rural West) but this will be dependent on funding from the North Hampshire CCG. Part 2 Page 6 of 19

Statement of Assurance from the Board. The following are sections that all providers must incorporate in their quality account, as mandated by the NHS England. Many of these sections are not specifically applicable to specialist palliative care providers but those that are applicable are identified below. Review of Services During 2015-2016, St. Michael s Hospice supported local NHS commissioning priorities with regard to the provision of specialist palliative care by providing: In Patient Unit Services Day Care Day Service Programs Out Patient Services Hospice at Home Specialist palliative care support in the Odiham and Alton area Complementary Therapy Physiotherapy Occupational Therapy Psychological Therapy Bereavement Services Chaplaincy St. Michael s Hospice is an independent charity that provides all services without charge to patients and their families. 3.1 million income is generated to fund our services yearly. This comes from voluntary charitable donations, legacies, events, corporate and community fundraising, hospice shops and lottery. The remaining 22% of the overall service delivery is funded by the NHS via the North Hampshire CCG. Participation in Clinical Audit National Audits During 2015-2016, no national clinical audits or national confidential enquires were conducted covering the NHS services directly relating to palliative care. There has therefore been no requirement to submit cases to national audits and the percentage of the number of registered cases has therefore not been included in this document. Local Audits To ensure high quality of services, an annual clinical audit programme is carried out and a variety of audit activities are undertaken using where possible, nationally agreed hospice specific benchmarking tools. Page 7 of 19

Audit Topic Tissue Viability PLACE (Patient led Assessments of the Care Environment) Audit Outcomes Overall 30% improvement in tissue viability care in the inpatient unit. More work required in care planning & skin assessment. Overall 89% compliance. Work has since been undertaken to upgrade clinical areas. 5 Priorities of Care Holistic assessment documentation requires an evaluation. Working party currently reviewing documentation. Handwashing Audits Handwashing technique has shown an improvement from last year. Staff need reminding to wash their hands after glove removal; this is being addressed in mandatory training. Discharge from in-patient unit No evidence of failed discharges from the in-patient unit, using the readmitted within 28 days as an audit standard. Patient reported effectiveness of complementary therapy Patients perceive that the complementary therapies received seemed to have positive effects on their symptoms particularly related to anxiety, insomnia and breathing Hospice at Home out of hours activity Controlled Drug Audits (pharmacist external auditor) Health & Safety (external auditors) Infection Control (using Hospice UK audit tools) Controlled Drug Hospice UK audit tool (Accountable Officer) problems. Most call outs to the H@H team were appropriate and occurred between midnight and 6am. Further audit required with once more data available. Overall high levels of compliance noted. No Priority 1 actions were noted within the hospice. Priority 2 actions have either already been addressed or are currently being addressed. Overall result: 91% compliance, 3% improvement from 2014 audit results. Environmental upgrades in clinical areas will further enhance infection control measures. 100% compliance now achieved. In addition to the audits listed above there have been projects on: Opioid Toxicity: Nearly 90% of patients admitted to the hospice were prescribed opiate medication with several of those patients having additional risk factors for becoming opiate toxic. Toxicity can be difficult to detect as the signs and symptoms are not necessarily specific. Education sessions have been given to staff and a naloxone policy was issued to staff for guidance in managing opioid toxicity. Patient Transition through the in-patient unit: Page 8 of 19

84% admissions were for patients with cancer as their primary problem. There was an equal proportion of male and female patients with a mean age of 74 years. More patients were admitted from the community than from hospital (71% v 29%). The majority of admissions were on weekdays, but a fifth of admissions took place on a weekend or bank holiday. 90% patients are admitted within two days of request for hospice admission and 40% are admitted on the day of request. Research No NHS funded patients at St. Michael s Hospice in 2015-16 were recruited to participate in research approved by a research ethics committee. There were no national, ethically approved research studies in palliative care in which we participated during this period Implementing Duty of Candour Following the Francis Report, the Care Quality Commission has put in place a requirement for healthcare providers to be honest with patients and apologise when things go wrong and this is very much part of the open and honest culture at the hospice. This duty applies to all registered providers of both NHS and independent healthcare bodies, as well as providers of social care from 1 April 2015. At St. Michael s Hospice we take the duty of candour very seriously and we have made it a key component of our face to face mandatory training for all staff, which is refreshed yearly. The importance of duty of candour is reinforced with all staff and they have the opportunity to discuss how it is implemented in clinical practice at the hospice. All concerns and complaints are investigated and responded to with an open and honest approach. Quality Improvement and Innovation Agreed with Our Commissioners The hospice s NHS income in 2015-2016 is not conditional on achieving quality improvement and innovation goals through the Commissioning for Quality and Innovation payment framework (CQUIN Framework). We do however participate in regular contract reviews (which have a quality component) with the North Hampshire CCG as part of a combined quality assurance process. What Others Say About Us St. Michael s Hospice is registered with the Care Quality Commission (CQC) to provide the following services: Page 9 of 19

Treatment of disease, disorder or injury. Diagnostic and screening procedures. St. Michael s Hospice registration status is unconditional. The CQC last visited on the 4 th February 2014 (unannounced) and the hospice was assessed to be fully compliant against the requirements of the five measures reviewed which were: - Care and welfare of people who use services - Meeting nutritional needs - Requirements relating to workers - Supporting workers - Assessing and monitoring the quality of service provision All of the above standards were met with no areas for improvement identified. Care Quality Commission: 5 key lines of enquiry Hospice services key lines of enquiry have been developed by the CQC to make future inspections more palliative care focused. A provider information return has been submitted to the CQC and we are waiting an inspection visit. We are currently focusing on how our services meet the new inspection criteria and some examples of how we seek to comply with each key area are given below. Are they safe? A register of all reported incidents is held electronically where a summary of severity of harm and actions are kept. The Risk Management system supports lessons learnt from incidents and complaints in all departments Our Patients Falls Prevention and Management Policy (2015) includes a falls prevention risk assessment, to be completed for all relevant patients on admission. A post falls checklist to support prevention of re-occurrence is incorporated into the incident reporting form, and used by the multidisciplinary team. Are they effective? The Therapeutic Day Service, utilise specialist skills from the multidisciplinary team, who run an individualised 12 week programme. This aims to support patients with palliative care needs and encourages them to optimise their quality of life by maintaining their health and social needs Page 10 of 19

In the last few days of life, patients commence our Achieving Priorities of Care (APoC) pathway, involving patients and their families in decision making at this important time. Are they caring? Our monthly specialist multidisciplinary clinic for patients suffering with Motor Neurone disease (MND) has increased and currently supports 12 patients and their relatives. The clinic is supported by the MND Association. An in-patient MND link nurse supports patients and staff regarding complexity of needs. An early intervention befriending service was successfully piloted and is currently led by 18 volunteers serving the local community. Working closely with the Integrated Care Team and GP practice managers, the service delivers a more 'joined up' approach in supporting end of life patients. Are they responsive to people s needs? The discharge procedure ensures meetings involve both the patient and the family (as requested by the patient) at key points during discharge planning. Complex discharges can be facilitated via multi-professional and family case reviews. This is led by our Family Support Lead. In-patient unit environmental upgrades are currently in progress to improve facilities and compliance with infection control. Our VOICES survey highlighted how more relatives are staying overnight and we plan to improve our facilities to make their stay more comfortable. Are they well led? Open communication is actively promoted. A bi-monthly CEO Forum is held which staff are encouraged to attend and minutes of the meeting are shared. The Director of Patient Services has regular open door sessions and undertakes a daily walk round of the unit. Varying support strategies are available to staff. In addition to managerial supervision, staff can receive support from the Chaplin and request counselling via the Wellbeing Heath Care scheme for staff. Clinical staff also have access to group clinical supervision via an external supervisor. Part 3 Review of Quality Performance Data Quality St. Michael s Hospice (SMH) submits a National Minimum Dataset (MDS) to the National Council for Palliative Care to facilitate data comparisons across hospice services. Page 11 of 19

Minimum Data Set Tables for Palliative Care 2014 2015 (Small Units) Table 1 St. Michael s Hospice In Patient Unit In Patient Unit Currently available national median 2014/15 SMH 2014/15 SMH 2015/16 New Patients 134 187 210 % Occupancy 77% 82% 88% % Patients Non Cancer 13% 12% 13% Average Length of Stay (days) Cancer 13 13 14 Average Length of Stay (days) 11 11 10 Non Cancer Day Case Admissions 0% 5% 6% Table 2 St. Michael s Hospice Day Care Service Day Care Service Currently Available National median 2014/15 SMH 2014/15 SMH 2015/16 Total Number of Patients 78 63 75 Day Care Attendances 990 628 968 % Places Used 54% 48% 71% Table 3 St. Michael s Hospice at Home Hospice at Home Currently available national median 2014/15 SMH 2014/15 SMH 2015/16 Total Number of Patients 262 307 399 New Patients 194 263 374 % Patients with a Non Cancer 21% 25% 24% Diagnosis Average Length of Care (days) 53 33 30 % Patients Died at Home (including care homes) 77% 92% 90% Chaplaincy The chaplaincy service encompasses all parts of the hospice and works with patients, their families and friends. She provides spiritual support for those of all faiths or no faith. The Chaplain is able to conduct funeral services as required and has also provided a wedding service for patients. Page 12 of 19

We have plans to upgrade the chapel of rest during 2016 to make it a homely space to allow relatives time to say goodbye in comfort. It is hoped that by enhancing the environment this will facilitate relatives to have a more positive view of the last moments spent with the patient. Therapy Services A new Physiotherapy / OT therapeutic clinic has been commenced to support the current day service program. Patients are now being assessed and treated in this clinic prior to commencing day services, which allows earlier identification of patients needs prior to attending day services. An individualised program can then be created for each patient as part of their day service care. A new seated exercise program has been created by the team to support day service patients and patients from the in-patient unit (IPU) can also access this program. We are currently planning improvement to our lymphoedema support group by purchasing a safe low level laser unit, used to soften fibrosis which can occur as a result of severe lymphoedema or in advanced disease. This improves uptake of fluid in the initial lymphatics and helps to reduce swelling and successfully treat pain. Complementary Therapy Service St. Michael s Hospice continues to provide a range of complementary therapies for patients, their families and the bereaved to help with relaxation, symptom control and general wellbeing. We also run a home visiting service and a clinic at Odiham Cottage Hospital. This year we have provided nearly 3,500 treatments which have included Massage, Indian Head Massage, Aromatherapy, Reflexology, Reiki, Yoga (patients only), Bach Flower Remedies, Acupuncture and Deep Relaxation. Aromatherapy diffusers are now available in patient rooms to help with symptoms such as anxiety, insomnia, nausea and odour control if the patient chooses to use them. We are very fortunate to have a team of 25 volunteer therapists, assisted by 8 volunteer receptionists. Ongoing support and education is provided by the Complementary Therapy Manager who this year has also provided training to The Pink Place volunteers, as well as to care home and nursing staff both in-house and in the hospital. Additional Data In addition to the quality metrics in the national minimum data set, St. Michael s Hospice analyses additional care indicators, as shown below. Table 4 Overview of Key Governance and Activity Data Page 13 of 19

2015/16 Available (ABDs) Occupied (OBDs) Bed Occupancy (%) Clinical Governance Data 2014-2015 2015-2016 Total Number of Patients Admitted to the In Patient Unit 228 231 % of Patients Who Went Home 38% 28% Total Number of Attendances by Patients at Day Care 628 968 Total Number of Hospice at Home Visits 1517 1839 (plus 483 project) Total Number of Clinical Complaints 2 2 Total Number of Serious Patient Safety Incidents (excluding falls) Total Number of Patients Known to be Infected with MRSA on Admission to the In Patient Unit 0 0 0 0 Total Number of Patients Infected with MRSA Whilst on the In Patient Unit 0 0 Average Length of stay on In Patient Unit in Days 12.8 13.6 Table 5. Hospice UK Comparison Data on Key Quality Indicators Data Source Bed Days Patient Falls per 1000 OBDs Grade 3+ pressure ulcers per 1000 OBDs Medication Incidents per 1000 OBDs SMH HOSPICE (10 beds) AVERAGE HOSPICES (7-10 beds) AVERAGE - ALL ADULT HOSPICES 3,628 3,228 89.0 9.3 1.9 5.0 3203.5 2453.7 76.6 9.1 2.4 6.3 5430.0 4249.6 78.3 10.4 3.8 6.4 St. Michael s Hospice is committed to achieving high quality care for all of our patients and their families. We are pleased to highlight that: An 89% Bed Occupancy demonstrates that we are making good use of our beds, particularly compared to other hospices of a similar size and nationally. We will continue to look for ways to ensure optimum bed occupancy by regularly analysing our IPU activity data including our waiting list data. Page 14 of 19

Our infection rates continue to remain very low and the environmental upgrades that have occurred this year will further support the clinical staff to continue our low infection occurrences. We have had no serious untoward instances this year (excluding grade 3 pressure ulcers) and we have improved our incident risk grading this year by identifying actual harm caused by the incident to either patients or staff. We have had no severe or catastrophic incidents reported this year. Our number of complaints continues to remain low this year. We have implemented additional methodologies to gather feedback from patients and we will look to use other forms of media to further improve the quantity of patient feedback. What Our Patients Say About St. Michael s Hospice All patients discharged from the In Patient Unit are surveyed regarding their satisfaction with the units care and facilities. IPU Patient Feedback (Post Discharge) 2015 (n=18) a) While you were in St. Michael s Hospice: Did the staff involved in your care explain what they were doing? Always = 89% b) Did you have the confidence in the staff who were caring for you? Always = 100% c) Have you had the opportunity to discuss your wishes for future care if you were unable to make these decisions yourself? Yes = 93% d) How likely are you to recommend our hospice care to friends or family if they needed similar care or treatment? Extremely likely / Likely = 94% Relative Feedback VOICES Survey 2015 (n=149) Chart to Show Friends and Family Test 94% 97% Likely or Extremely Likely to Recommend SMH Likely or Extremely Likely to Recommend SMH 2014 2015 Page 15 of 19

Percentage of Relatives who Rated Care in the In Patient Unit as either Exceptional, Excellent or Good National Hospices 83% SMH Doctors 99% SMH Nurses 99% 75% 80% 85% 90% 95% 100% Note in 2015: 94% of nursing care was rated as exceptional or excellent. 93% of medical care was rated as exceptional or excellent According to relatives, the management of patient s pain has improved considerably in IPU during 2015. 72% of respondents stated that they felt the patient s pain was controlled completely all of the time. This compares to 64% who stated this in 2014. Nationally, pain being controlled completely all of the time in hospices was rated at 64%. The management of patient s pain in Hospice at Home has improved since 2014. 61% of relatives stated that pain was relieved completely all of the time in 2015 in Hospice at Home. This compares to 51% stating that pain was relieved completely in 2014. What Our Staff Say About The Organisation The last staff survey was conducted by Bird Song Charity Consulting in March 2014. A good (hospice comparable) 56% response rate was achieved. The reporting requirements for the quality account require us to report on 2 specific areas in this section: 1. Bullying and Harassment: In our last survey 94% of staff stated that they had not experienced harassment or bullying in the workplace. This compares to 89% of staff in all hospices surveyed in 2014 where staff reported no bullying or harassment. Page 16 of 19

2. Equal Opportunities for Staff: In our last survey 94% of the staff stated that they felt that St. Michael s Hospice charity treated them with fairness and respect. This compares to 92% of staff in all hospices surveyed in 2014 where staff stated that they were treated with fairness and respect. Comments from staff include: It gives me the best feeling of job satisfaction I have ever had. I find team working suits me best. I get to use all my skills over time. Working in a team that are highly motivated in providing a high standard of care to patients and their loved ones. The team care for each other and provide me with the support and inspiration to continue working here. It would be good if we improve communication and relations within and out of the organisation to improve the fantastic unity we already have and take it to the next level. What Our Regulators Say About St. Michael s Hospice See section 2.5 for the outcome of our last successful Care Quality Commission inspection. The Board of Trustees Commitment to Quality The Board of Trustees is fully committed to the delivery of high quality care to all patients and families using the hospice services. The Trustees have an active role within the hospice community and are involved in monitoring the quality of services delivered. They do this by critically appraising all quarterly activity reports on the service and they actively participate in several hospice committees, including the Clinical Governance Committee, offering their unique contribution to support new developments which enhance service delivery. Regular meetings are held by the Board Chairman and the Chief Executive, to review any current governance issues and priorities for improvement. Additionally the Chief Executive maintains a high visibility by daily walk rounds of the hospice and he has an open door policy. Open communication is further promoted by the bi-monthly CEO forum which all staff are actively encouraged to attend. The hospice has a strong responsive clinical governance and corporate framework. Its outward facing culture of continuous improvement, demonstrates its commitment to search for new ways to improve its services to patients and their families. Page 17 of 19

The Board of Trustees uses these strategies to ensure that they have a comprehensive understanding of the quality of the care provided to patients and their families. This enables them to be confident that high quality care is delivered to patients and their families in our local community. Comments from Other Stakeholders Comment from the North Hampshire Clinical Commissioning Group: In providing this response in relation to St Michael s Hospice Quality, North Hampshire CCG has taken the regular information and assurance generated through the Contract Review Meetings and other associated on-going quality assurance processes into consideration. NHCCG has reviewed the Quality Account produced by St Michael s Hospice (North Hampshire) and believe the information provided is factual and accurate. Quality Priorities NHCCG is in support of the quality priorities that were selected for 2015/16 by St Michael s Hospice. The priorities could be more detailed in terms of objectives but NHCCG will monitor progress against these priorities in contract review meetings in 2016/17. Progress on the quality priorities from 2014/15 were all regularly reported to NHCCG. The organisational review of tissue viability was an important priority in 2014/15 as there were four grade 3 pressure ulcers that were reported. Investigations into each occurrence took place and the action plans were shared with the CCG. The actions should reduce the likelihood of future reoccurrences. NHCCG will continue to fund work around the Six Steps project until June 2017. The Six Steps programme has provided valuable education to local care homes within North Hampshire. The Enhanced Hospital at Home pilot 15/16 in Rural East Hampshire demonstrated some good quality outcomes for patients and the NHCCG is currently considering a proposal from SMH to roll this out to other ICT areas. General comments This Quality Account is laid out in a readable format that is easy to understand and should provide the reader with an understanding of the work that St Michael s is doing to ensure that it provides good quality care. The document does comply with the requirements that should be included within a Quality Account. NHCCG look forward to continue working with St Michael s Hospice to keep driving continuous quality improvement for end of life care in North Hampshire. Quality Team, North Hampshire Clinical Commissioning Group Comment the General Practitioner lead North Hampshire End of Life Steering Group: North Hampshire Clinical Commissioning Group(NHCCG) commissions community and hospice palliative care provision from St Michael's Hospice(SMH).One of NHCCG's priorities is to enable people to die in their preferred place of care which is often their home or the hospice. Page 18 of 19

SMH is a vital resource to help us achieve this outcome. Hospice at home allows specialist palliative care nursing to be delivered in patient's homes supporting patients and relatives. Sometimes dying at home is not possible due to complex nursing and social needs and the inpatient unit is invaluable in this situation offering a more appropriate place of care than a general hospital. The extension of facilities at SMH has improved patient experience and also provided space to deliver valuable education events and training which improve palliative care knowledge in the local workforce as well as in the local community. As commissioners we regularly evaluate the quality of care that SMH provides. CQC inspections, patient and relative feedback and our regular meetings with both management team and clinical staff provide evidence that it provides excellent care particularly with respect to dignity and respect for patients. I believe that SMH is an essential part of palliative care provision and education in North Hampshire. Dr Charlotte Hutchings, End of Life GP Lead, North Hampshire Clinical Commissioning Group St. Michael s Hospice Quality Account Feedback If you would like to comment on the content or format of the St. Michael s Hospice Quality Account for 2015-2016, please submit your comments via the St. Michael s Hospice website or to the St. Michael s Hospice Chief Executive at this address: St. Michael s Hospice (North Hampshire) Basil de Ferranti House Aldermaston Road Basingstoke Hampshire RG24 9NB Website: www.stmichaelshospice.org.uk Page 19 of 19