QUALITY ACCOUNT 2015-16
CONTENTS Part 1 Chief Executive s statement on quality... 3 Vision, purpose, values and strategic aims... 4 Part 2 Priorities for improvement and statement of assurance... 5 2.1 Priorities for improvement 2016-17... 5 2.1.1 Continue to develop a rehabilitative model of care across all Hospice services... 5 2.1.2 Advanced Care Planning... 5 2.1.3 Increase opportunities for patient, family, staff and volunteer feedback... 5 2.1.4 To further develop reporting on patient outcome measures... 5 2.2 Achievement of priorities for improvement 2015-16... 5 2.2.1 Development of a consultant-led outpatient clinic... 5 2.2.2 Improve referral procedures to the Hospice... 5 2.2.3 Improve cross-working with other local organisations... 6 2.2.4 Introduce Patient Care Volunteers to the Hospice Inpatient Unit and Magnolia Place... 6 2.3 Statements of assurance... 6 2.3.1 Review of services... 6 2.3.2 Participation in national clinical audits... 6 2.3.3 Participation in local audits... 7 2.3.4 Research... 7 2.3.5 Quality improvement and innovation goals agreed with commissioners... 7 2.3.6 What our regulators say about the Hospice... 7 2.3.7 Data quality... 8 Part 3 Review of quality performance... 9 3.2 Board of Trustees commitment to quality... 9 3.3 Comparison of Heart of Kent Hospice over a four-year period from 2011/12 2015/16... 9 3.4 Feedback from patients and their relatives... 10 3.5 Clinical complaints... 12 3.6 What staff say about the Hospice... 12 2
Part 1 Chief Executive s statement on quality I am delighted to introduce our Quality Account for 2015-16. Heart of Kent Hospice provides specialist and individualised palliative care to the population of Maidstone, Aylesford, Tonbridge and Malling and surrounding villages. Our care is provided free of charge to nearly 1,000 patients and families each year in their homes, in nursing and care homes and in the Hospice. As an independent charity we are not part of the NHS but we work in collaboration with local NHS services. We receive a grant from the NHS which contributes to 18% of our annual costs. Heart of Kent Hospice is committed to delivering a high quality and cost-effective service to patients and their families and this report highlights the actions we have taken to improve our services in the last year and our key priorities for the coming year. The safety, experience and outcomes for our patients and their families is of utmost importance to us. Over the last year, we have strengthened our clinical governance structure and audit programme to ensure we can identify improvement areas and continue to develop our services. We actively continue to seek the views of our service users through comments cards, surveys and our service user group; this feedback enables us to ensure our service planning is patient-centred at all times. Together with our Board of Trustees, I would like to thank our team of staff and volunteers for their hard work and commitment to providing outstanding care to our patients and their families over the last year. I am responsible for overseeing 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. Sarah Pugh Chief Executive June 2016 3
Our vision, purpose, values and strategic aims Our Vision We aim for a time when end of life care and death is a positively supported experience for all Our Purpose We are here to provide skilled, high quality care to all those facing the challenge of a lifelimiting illness. We aim to optimise quality of life, enable people to live with dignity, affirm their individuality and support those closest to them during and following this most difficult of times. Our Values Are Compassionate Act with Integrity We Are Respectful Work Together Strategic Aims 4
Part 2 Priorities for improvement and statements of assurance 2.1 Priorities for improvement 2016-17 2.1.1 Continue to develop a rehabilitative model of care across all Hospice services Develop and implement a rehabilitation assessment and evaluation tool Focus on patient centred goal setting Promote an enabling, empowering approach throughout all clinical services Offer a well-being program for patients and carers to access through the Hospice outpatient centre 2.1.2 Advanced Care Planning Achieve a 100% of patients having the opportunity to discuss and record their advanced wishes Promote a culture where we support patients by understanding their likes, dislikes, preferences and wishes Wherever possible to support patients to die in the place of their choice. 2.1.3 Increase opportunities for patient, family, staff and volunteer feedback By creating open transparent opportunities for patients, carers, staff and volunteers to make comments and suggestions Adopt a learning approach from adverse comments Sharing actions from feedback ie. You said, we did.. information Audit complaints 2.1.4 Further develop reporting on patient outcome measures Audit and evaluate ipos (Integrated Palliative Care Outcome Scale) currently being used Provide monthly Key Performance Indicators set against NICE quality markers for End of Life Care 2.2 Achievement of priorities for improvement 2015-16 2.2.1 Develop a consultant-led Outpatient Clinic Outpatient Clinic room created in former family room space at Hospice Outpatient Clinic promoted to GPs through GSF meetings and consultant contact Ultrasound and ECG purchased for Outpatient Clinic and doctors trained in use 67 patients seen at Outpatient Clinic in 2015-16 2.2.2 Improve referral procedures to the Hospice Working group established to review referral procedures Direct referrals into appropriate Hospice team Duty Clinical Nurse Specialist (CNS) system introduced to facilitate efficient telephone access to expert advice for patients and healthcare professionals and triage to appropriate Hospice team 5
2.2.3 Improve cross-working with other local organisations Established regular strategic meetings with local organisations involved in palliative care to support collaborative working and improve patient outcomes Developed relationship with local private hospital to improve pathways for patients with life-limiting illnesses Quarterly meetings with SECAMB (Ambulance Service), Kent Community Healthcare Foundation Trust, IC24 and Hospice in the Weald to discuss end of life issues and understand SECAMB s End of Life Framework Attended quarterly Health and Wellbeing Kent County Council meetings, promoting integrated care and working collaboratively with Kent County Council housing and social care 2.2.4 Introduce Patient Care Volunteers to the Hospice Inpatient Unit and Magnolia Place Established training programme with passport and competencies for patient care volunteers Recruited 35 volunteers to take part in a four-weekly rolling training programme 35 volunteers trained and supporting team on Inpatient Unit by May 2016 Submitted paper to International Palliative Care Congress on Patient Care Volunteer programme to share learnings with other Hospices 2.3 Statements of assurance The following are a series of statements that all providers must include in their Quality Account. Some of these statements are not directly applicable to Hospices. 2.3.1 Review of services During 2015/16 Heart of Kent Hospice supported the commissioning priorities for West Kent CCG by providing the following services: Inpatient care Community care Outpatient centre Occupational therapy Physiotherapy Complementary therapies Pre and post bereavement counselling Chaplaincy support Funding provided by West Kent CCG represents 18% of our expenditure on charitable activities. 4m income is generated to fund our services annually, this balance is raised through gifts in a will, fundraising, events, corporate and community fundraising, grants from trusts and foundations, Hospice shops and lottery. 2.3.2 Participation in national clinical audits As a provider of specialist palliative care, Heart of Kent Hospice is not eligible to participate in any of the national clinical audits or national confidential enquiries during 2015/16. 6
2.3.3 Participation in local audits Local clinical audits were carried out at Heart of Kent Hospice in 2015-16. Internal clinical audits included: Infection Control Controlled Drug Audit Drug Incident Audit Complaints Audit Pressure Ulcer Audit Mobility & Safety Audit (Falls) DNACPR Audit FP10 prescription audit ipos Audit Out of Hours Activity Audit 2.3.4 Research No patients under the care of Heart of Kent Hospice during 2015-16 have participated in research that required approval by a research ethics committee. There were no appropriate national ethically approved research studies in palliative care, which patients under the care of Heart of Kent Hospice were asked to participate in. 2.3.5 Quality improvement and innovation goals agreed with commissioners The Hospice s income from West Kent CCG in 2015-16 was not conditional on achieving quality improvement and innovation goals through the commissioning for quality and innovation payment framework because it was received in the form of a grant. The Hospice was required to submit quarterly data to the CCG including: Number of referrals and source of referrals Ethnicity, gender and age Percentage of cancer and non-cancer patients referred Number of community contacts, new, follow up and telephone IPU bed availability and occupancy Deaths: total on IPU, at home, and number of preferred place of care who stated a preferred place of care Number of continuing care patients Number of bereavement contacts Number of incidents including drug incidents Number of day therapy places, attendance and complexity Number of complaints and comments Number of individual services referrals and contacts 2.3.6 What our regulators say about the Hospice Heart of Kent Hospice is registered with the Care Quality Commission and its current registration status is unconditional. An unannounced routine inspection took place in February 2016. Heart of Kent Hospice is proud of its excellent reputation for providing palliative care to people across Maidstone, Aylesford, Tonbridge, Malling and the surrounding villages. We are, therefore, very 7
disappointed that Heart of Kent Hospice was given an overall rating of Requires Improvement following this inspection. We are, however, delighted to have received an Outstanding rating for providing a Caring service. The Hospice was aware of most of the issues outlined in the report prior to the inspection. We had been taking steps to address these issues through an improvement plan, as CQC have highlighted in the report. CQC acknowledged that many changes were already in place but required time to embed fully across the Hospice. CQC reported that Hospice staff were attentive and kind, demonstrating dignity and respect at all times, and often performing beyond the scope of their duties. CQC spoke to patients, relatives, visitors and healthcare professionals who were all overwhelmingly positive about the service the Hospice provides. Our Outstanding rating for providing a Caring service demonstrates the commitment of Heart of Kent Hospice staff and volunteers to providing the very best care for our patients and their families. We take our responsibilities very seriously and we are confident that our ongoing plan, which has been approved by the Hospice s Board of Trustees, will resolve the issues identified. The full report can be found at http://www.cqc.org.uk/sites/default/files/new_reports/ins2-2344605978.pdf 2.3.7 Data quality In accordance with the Department of Health, Heart of Kent Hospice submits annual Minimum Data Set (MDS) returns to the National Council for Palliative Care. Heart of Kent Hospice, as a specialist palliative care provider, does not submit data information to the Hospital Episodes Statistics because we are not eligible to participate in this scheme. Heart of Kent Hospice has a dedicated Information Officer and continues to monitor its data through its monthly Clinical Management Meetings and clinical governance structure. In 2015-16 we once again successfully met the Information Governance Toolkit requirements and the annual assessment we submitted was approved. This enables us to use NHS Connecting for Health systems and services such as N3. This will enable the medical and clinical teams at the Hospice to share and access relevant patient information in a secure manner and improve the overall coordination of care. 8
Part 3 Review of quality performance 3.1 Governance structure The Hospice clinical governance structure was reviewed in 2015-16 with Clinical Management Team meetings established monthly rather than quarterly and a Patient Care Leadership Group meeting quarterly. An Audit and Research Group was also established. Trustees attend quarterly Patient Services Committee meetings which are reported to the Board. Board meetings include clinical data and Patient Services reports at each meeting. BOARD OF TRUSTEES PATIENT SERVICES COMMITTEE CLINICAL to MANAGEMENT quality TEAM HOSPICE USER GROUP PATIENT CARE LEADERSHIP GROUP AUDIT GROUP 3.2 Board of Trustees commitment to quality Representat ives from all The Board of Trustees is fully committed to the quality agenda. The Hospice has a wellestablished governance structure as outlined above with members of the Board of Services Trustees Clinical having an active role in ensuring the Hospice provides a high quality service in accordance Information with its Statement of Purpose. Officer In 2015, a Trustee visit was conducted by a member of the Board and a report provide to the Board. During the visit, the Trustee spoke to patients, their families and staff. The Board is confident that the treatment and care provided by the Hospice is of high quality and is cost effective. 3.3 Comparison of Heart of Kent Hospice over a four-year period from 2011/12 2015/16 2015/16 2014/15 2013/14 2012/13 2011/12 Inpatient unit % New patients 93 95 86 94 92 % Bed occupancy 77 62 71 71.8 70.7 % Patients discharged 30 25 19 27.3 27.1 Average LoS cancer patients 12.5 11.7 11.2 10.4 9.7 Average LoS non-cancer patient 8.1 7.6 8.3 8.9 9.3 Outpatient Centre % new patients 62 57 65 57 70 % sessions attended 68 46*** 56 94** 78 Community Palliative Care Team % new patients 75 80 76 65 67 % new patients non-cancer 32 27 23 21 17.2 Telephone calls 18,912 14,340 13,818 10,426 8,227 Total number of visits 4,741 4,184 3,996 2,701 2,272 ** Inaccurate data due to repetition in recording *** During a change process and staff recruitment issues in Magnolia Place, attendance was reduced to three days per week, the data from Quarter 3 2015 will show a significant improvement and plans to open four days a week from January 2016 9
Overall during 2015-16 the Hospice cared for 1116 patients (2014-15: 880). We cared for 579 patients who died in 2015-16 (2014-15: 639). IPU data has remained fairly static with bed occupancy slightly increased since last year. The Outpatient Centre has seen an increase in referrals in 2015-16 by 62% in 2015-16 with an increase of sessions attended by 68%. As well as collecting this data we count daily spaces used by way of complexity i.e. 1 space = ambulant self-caring patient, 2 = requiring 2 to transfer and help with toileting, 3 = patients requiring hoisting and all care. This form of scoring informs staffing levels and attendance allocation. Referrals to the Community Palliative Care Team have increased by 75% and new noncancer patients by 32%, this rise in referral numbers has been impacted on by dementia patient referrals and the Hospice broadening its scope to care for all end of life patients irrespective of their disease or illness including elderly frail patients. We have also chosen to measure our performance against the following metrics: Indicator 2015/16 2014/15 2013/14 2012/13 2011/12 Referrals to the service 801 749 628 580 IPU admissions 238 219 209 252 239 Number of complaints 1 2 0 0 2 Number of complaints 0 missing 0 0 0 upheld Number of RIDDOR 0 0 0 2 (1 staff 0 reportable incidents 1 volunteer) Number of patient 34 Data Data 34 42 accidents (slips, trips, falls) unavailable unavailable Number of patients 0 0 0 1 2 admitted with MRSA Number of patients 0 0 0 0 0 contracted MRSA whilst on IPU Number of patients 0 0 1 0 0 admitted with Clostridium difficile Number of patient contracted Clostridium difficile whilst on IPU 0 0 0 0 0 3.4 Feedback from patients and their relatives During 2015-16 the Hospice carried out patient and carer surveys in the Inpatient Unit. The aim of the survey was to: Establish the views of patients cared for within the Hospice Gain ideas, suggestions and comments on how the service could be improved Encourage user involvement 10
Below are a selection of the questions and responses from patients and carers. Questions Asked Always Most of the time The doctors explanation of your treatment and care? Were you satisfied with the attention you received from the nursing staff? How satisfied were you with your involvement in the planning of your care? Were you satisfied with the quality and choice of food available? Some of the time No answer 77% 15% 8% (1 patient) 85% 15% 77% 15% 8% (1 patient) Quality 95% Choice 85% Please rate how clean the Hospice was. 83% Excellent Did you have the opportunity to ask questions when you wanted? Were you treated with dignity and respect whilst you were in the Hospice? Quality 5% Choice 15% 17% good 60% 20% 20% 92% 8% (1 patient) Below are a selection of the questions asked and responses from patients and carers. Yes and No answers. Questions Asked Yes No No answer Do you feel respect was to your wishes? 100% While in the Hospice did you see any notices, posters or leaflets explaining how to complain about the care or treatment you received? Where you happy with the visiting arrangements at the Hospice? 39% 46% 15% 100% The Hospice also participated in the FAMCARE survey 2015, this national survey was carried out by the Association of Palliative Medicine and completed by bereaved carers. In general, most bereaved carers were satisfied with the end-of-life care provided to their family member by the specialist palliative care service. Heart of Kent Hospice results include: The way in which the palliative care team respected the patient s dignity 82.6% very satisfied, 17.3% satisfied The way in which the patient s physical needs for comfort were met 69.5% very satisfied, 17.3% satisfied Emotional support provided to family members by the palliative care team 65.2% very satisfied, 30.4% satisfied 11
Full results are available at http://apmonline.org/committees/professionalstandardscommittee/service-evaluations/ The Hospice also provides comments cards placed around the Hospice that visitors, patients, families and staff can complete. All comments are reviewed by the Chief Executive and Patient Services Director and actions logged as appropriate. Comments have been very positive about the Hospice. Our Hospice Users Group (Hugs) continues to meet regularly to provide valuable support and feedback on the work of the Hospice and in 2015-16 several new members joined the Group. 3.5 Clinical complaints Heart of Kent Hospice takes all complaints and adverse comments seriously. The Clinical Management Group oversees the management of complaints and reports to the Patient Services Committee and Governance Committee. During 2015-16, the Hospice received one complaint (from a healthcare professional) about the services provided. 3.6 What staff say about the Hospice Heart of Kent Hospice values the opinions of all its staff and volunteers and encourages a culture of open feedback. We are currently undertaking a staff survey. Heart of Kent Hospice Quality Account Feedback If you would like to comment on the content or format of the Heart of Kent Hospice Quality Account 2015-16, please submit your comments via our website at hokh.org or by email at enquiries@hokh.co.uk or to Heart of Kent Hospice s Chief Executive at this address: Heart of Kent Hospice Preston Hall Aylesford Kent ME20 7PU Website: hokh.org 12