Martlets Quality Account

Martlets Quality Account 2015-2016 Our Vision We believe a good and dignified death is everyone s entitlement. To those dying in our community, we will provide the best possible care. We will raise as much money as possible to help as many people as we can. Through our work and reputation we will remain attractive to our stakeholders and deserving of their support 1

Part 1: Statement from the Chief Executive At the Martlets the patient and their family are always at the centre of our decision making. Access to the right care at the right time is pivotal to patients experience along with earlier referral to the right services as this can empower patients and their families to make the choices that are right for them. To achieve this we also need to maintain excellent working relationships with all of our partners in the community and within the Hospital setting as we work together for the patient and their family. The quality of care delivered needs to be measurable so that we can demonstrate impact and also learn from it. This year we have engaged with OACC (Outcome Assessment and Complexity Collaborative) as a Palliative Care outcomes measurement tool. This is in its early stages of roll out however we will be able to demonstrate the outputs of the care delivered. As we expand the range of service delivered it is imperative that we appreciate the impact of the interventions delivered and ultimately received by the patient. This last year we have again focused on increasing our reach and widening access for people across Brighton and Hove and we have seen a significant growth in the number of people we support who are living through a terminal illness. The In-Patient Unit continues to see more patients with more complex needs which need the 24 hr expertise of our In-Patient service. The Palliative Care Partnership continues to grow and increase its impact as a 24 hour telephone support service along with the provision of hands on care in patients home through the Hospice at Home team working in partnership with the Community Palliative Care Team, which are the NHS team of Clinical Nurse Specialist and Consultants. This service promotes patient choice and 24 access to support and advice for patients, their families and professionals The growth in more people being cared for in their own home is significant and as we look at the national profile of Palliative and End of Life care this is reflected across all hospice care settings. Supporting family members and friends is a key part of our role at the Martlets and another area which is seeing significant growth is within our pre and post bereavement service. Underpinning all of the care provided there has to be a robust quality assurance programme to ensure the Martlets reviews, measures and evaluates all services provided which this report will evidence. Imelda Glackin Chief Executive Officer 2

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What we do well Performance in 2015-2016 Inpatient Unit In the year 2015-2016, there were 308 admissions to the in-patient unit. The average length of stay was just over 16 days. 88% of patients had a diagnosis of cancer and the remaining 12% of patients had conditions such as Motor Neurone Disease, Heart Failure and Chronic Respiratory Disease. "He wanted to be in the Martlets as he felt safe there. Patient s relative. Hospice at Home Our Hospice at Home service provides support for people in their own homes, 7 days a week. The Hospice at Home service is part of the wider Palliative Care Partnership, which along with Sussex Community NHS Foundation Trust, provides 24 hour telephone support and advice to patients, families and professionals. In the year 2015-2016, the Hospice at Home team saw a total of 349 patients for end of life care and/or respite support, making a total of 3,885 visits and 12,230 telephone calls. The care my husband had was truly exceptional the support to me and my family was outstanding. All these people gave 100% and more for him and us as a family, words are not enough - wonderful people at such a devastating time. Patient s relative. Bereavement Service Our bereavement service form part of the Patient and Family Support Team, and consists of 4 part time qualified counsellors available for one to one counselling and trained bereavement volunteers who visit people in the community. In the year 2015-2016, a total of 137 clients were seen by the bereavement service and attended 686 individual counselling sessions. I was made to feel that I could contact the Martlets at any time in the future if I felt I needed to. The Martlets Hospice gave xxxx the most dignified and caring ending, we are all so grateful to you. Patient s relative. Rehabilitation Our Specialist Physiotherapist and Specialist Occupational Therapist, along with a therapy assistant, provide rehabilitation input to patients on the ward and in the community. A multidisciplinary rehabilitation clinic runs twice weekly for patients. During 2015/2016, the rehabilitation clinic delivered 161 sessions. The majority of sessions lasted 1 hour to 1 hour 15 minutes and the average 4

number of sessions attended by each person was 5 sessions. The service is now growing and in January 2016, there were 12 sessions attended and in April 2016 there were 21 sessions attended. Patient and Family Support Team The care given to my wife was exceptional and the family will be forever grateful for the help we were given in a sad and traumatic time. Many thanks again. Patient s relative The Patient and Family support team consists of Counsellors, a Chaplain and Social Workers. The team support patients and their families on the ward and also visit people in the community, both in their own homes and care settings. The community Social Worker coordinates the community visiting volunteers who provide support to patients and families. Complementary Therapies The complementary therapy service consists of a team of 30 skilled volunteer therapists, and the service continues to expand. The type of therapies offered is continually growing and Acupuncture, Massage, Reflexology, Reiki, Shiatsu and Emotional Freedom Technique (EFT) are some of the therapies currently offered to patients and their carers or family members both on the In-Patient Unit and within Day Services. Day Services Martlets Day Services began in April 2014 and provides supportive care for patients and their carers living at home with a life limiting condition. Services include but are not confined to Clinical Nurse clinic, Acupuncture, Art Therapy, Welfare Benefits Advice clinic, various complementary therapies, Legal clinic, Rehabilitation clinic and gym, Reminiscence group, Pamper suite and our community choir. The service is continually growing and is in an ideal position to support patients and carers in the community. 5

Education The Hospice provided education and training on over 50 different study topics in the year 2015-2016. Around 1200 internal and external health professionals, other staff and volunteers attended these sessions. The training events have covered a wide range of topics including Communication Skills; Resilience and Mindfulness for Wellbeing; Bereavement and Loss; Symptom Management; Oxygen Administration; Fire Warden Training. The Hospice is very proud of the achievements of its staff and volunteers. Some of the Higher Education Qualifications gained by nursing staff include: Advanced Physical Assessment module at Masters Level Aromatherapy Level 3 Caring for Patients with Acute Conditions Complementary Therapies in Palliative Care Diploma Counselling Diploma Diabetes in Palliative Care Diploma in Management End of Life Chronic and Long Term Conditions Module End of Life Non Malignant Conditions End of Life Principles of Care Module Health Law & Ethics Module Hons Degree in Health and Social Care Hons Degree in Palliative Care Infection Control Diploma Leadership and Management Module Mental Health Qualification Mentorship Module MSC in Health Ethics NVQ Assessor Qualification Palliative Care Degree Palliative Care Module at Masters Level Reflexology Level 3 Reiki Level 2 Research Module Study Skills Module Diploma Level 6

What we have improved in 2015-2016 The following priorities were identified for the past year and achievements against these priorities are outlined below. Priority 1: Launch a discharge buddy service for patients discharged home from the In-Patient Unit who may live alone or need additional support on discharge. A discharge buddy service has been introduced in the past 12 months. The service is delivered by trained volunteers managed by the Discharge Coordinator. The service has started small however the feedback from patients has been extremely positive and has helped support patients when they have been newly discharged from the In-Patient Unit. Any expansion of this service will be as a direct result of identified need. Priority 2: Introduce outcome measures into our everyday clinical practice on the In-Patient Unit and in the community by implementing the OACC (Outcome Assessment and Complexity Collaborative) palliative care outcome measures. The OACC outcome measures have now been implemented in both the in-patient unit and the community services. It is still too early to report on these measures but when we do it is hoped that it will provide real evidence of what we are doing right to relieve patient symptoms and where we need to improve. Priority 3: Introduce a standardised and validated tool for measuring wellbeing into our Day Services to be able to demonstrate the impact these services have on patients and their carers and family members. We are still working on identifying the best tool for this although we have narrowed it down to two possible tools. We want to make sure that whatever tool we use is not too burdensome to the patient but is of use to clinicans. We plan to implement the tool in the next few months. 7

Part 2: Priorities for Improvement What we want to achieve in 2016-2017 Below we have outlined the priorities for patient safety, clinical effectiveness and patient experience we want to achieve in the coming year. Priority 1: Patient Safety We are currently reviewing the number of patient falls and looking at how we can reduce these while still supporting patients to be as independent as they wish to. How will this be achieved? The Nurse Development and Quality lead has been reviewing falls within the hospice and has looked at initiatives that have successfully been implemented elsewhere. One of the initiatives includes reviewing and reflecting with staff after a fall has occurred about what can be put in place to prevent this happening again. Priority 2: Clinical Effectiveness The use of statistical data collection and analysis can help inform our future direction to ensure that we deliver the right care to the right people and at the right time. How will this be achieved? We will recruit a data analyst who can effectively analyse the data that is collected internally and externally. Production of meaningful analysis will help inform the care and support that we deliver now and in the future. Priority 3: Patient Experience Staff feedback has identified areas within the Hospice that need refurbishment. This includes patient rooms where as well as basic redecoration there will be work done on improving the fixtures and fittings. It is important for the patient surroundings to be as pleasant as possible which will make a patient feel more comfortable. How will this be achieved? A small working party is being formed to look at what is required. Because of the pressure on beds there will be a planned process for achieving refurbishment of all patient rooms over the next 12 months. 8

Part 3: Statement of Assurance The following are statements that all providers must include in their quality account. Many of these statements are not directly applicable to specialist palliative care providers. Review of Services During 2015-2016, the Martlets supported the NHS commissioning priorities with regard to the provision of local specialist palliative care by providing: IPU services Hospice at Home services In addition the Martlets has provided the following services through charitable funding: Bereavement Support Service, including professional Counsellors and trained bereavement volunteers Rehabilitation service delivering specialist Occupational Therapy and Physiotherapy Volunteer Visiting Service Day Services for patients and carers Complementary Therapy Service Education and Training Income Generated The income generated by the NHS services reviewed in 2015-2016 includes contracts with the local Clinical Commissioning Group and represents less than one third of the total income generated by Martlets for 2015-2016. The remaining income is through charitable donations, fundraising events, Martlets lottery and trading activities. Participation in Clinical Audit During 2015-2016, the Martlets Hospice was not eligible to participate in any national clinical audits or confidential enquiries. This is because none of the national clinical audits or confidential enquiries related to specialist palliative care. Hospice Clinical Audits The Martlets Hospice has completed a number of clinical audits in 2015-2016, which form part of the annual audit programme. The monitoring and reporting of the results of these audits, as well as the implementation of recommended actions following the audits ensures that care delivery is safe and effective. The clinical audits completed for 2015-2016 can be viewed below. Process of administration of a blood transfusion Bereavement services Record keeping audit Nutritional audit Housekeeping audit Discharge audit 9

Infection control audit Prescribing Controlled Drugs on discharge Medical audits Preferred Place of Death Bereavement Follow up Contact after triage Medication audit Research The number of patients receiving NHS services provided or subcontracted by the Martlets Hospice in 2015-2016 that were recruited during that period to participate in research approved by a research ethics committee was: None. There were no appropriate, national, ethically approved research studies in palliative care in which we could participate. Use of CQUIN payment framework The Martlets Hospice income in 2015-2016 was not conditional on achieving quality improvement and innovation goals through the Commissioning for Quality and Innovation payment framework because it is a third sector organisation and as such was not eligible to participate in this scheme during the reporting period. Care Quality Commission The Martlets Hospice is required to register with the Care Quality Commission. The Martlets Hospice is required to undertake only regulated activities at the following location: Martlets Hospice, Wayfield Avenue, Hove, East Sussex, BN3 7LW. The Martlets Hospice is subject to periodic reviews by the Care Quality Commission and the last on-site inspection was December 2015. The Martlets received an overall rating of good with care being rated as outstanding. The Martlets Hospice has not participated in any special reviews or investigations by the Care Quality Commission during 2015-2016. Data Quality The Martlets Hospice did not submit records during 2015-2016 to the Secondary Users service for inclusion in the Hospital Episode Statistics. This is because the Martlets Hospice is not eligible to participate in this scheme. However, the Martlets Hospice does submit data to the Minimum Data Set (MDS) for the Specialist Palliative Care Services collected by National Council of Palliative Care on an annual basis, with the aim of providing an accurate picture of hospice and specialist palliative care service activity. Information Governance Toolkit Attainment Levels The Martlets Hospice is not required to use the NHS Information Governance Toolkit, however, as a standard for good practice we have completed the toolkit to 100% Level 2 compliance for the past five years. 10

Part 4: Quality Overview We have chosen to present an overview of Martlets Bereavement Services for 2015-2016. There were 137 clients who accessed the bereavement service. During the 12 month period there were 686 individual counselling sessions delivered by a trained and professionally accredited counsellor. 160 140 120 100 80 60 40 Female Male All 20 0 under 16 16-18 19-24 25-64 65-74 75-84 85+ not known Ages Total 11

Client Evaluation of Bereavement Counselling Service Counsellors Activity Data collected for year 2015 Summary: This evaluation remains consistent with the positive results of the previous audits, which has seen that the majority of clients who return their questionnaires report being satisfied with the service. The numbers of clients seen has fluctuated over the past few years, however this has more to do with counsellor activity in other areas of the hospice changing in response to the development of the counselling service as a whole. Response rates remain high (52%). As in 2014 higher numbers of clients refer themselves to the service in the first 3 months of their bereavement (41%). Clients report being satisfied with the number of sessions they are offered which reflects counsellors ongoing responsiveness to the needs of the individual during their often unpredictable bereavement journey. Clients are sent an evaluation feedback form approximately 2 weeks following ending of counselling - assessment sessions are included. Number of evaluations sent: 2014 2015 Evaluations 114 78 Client responses 55(48%) 41 (52.5%) Length of time post bereavement counselling taken up: 2014 2015 Up to 3 months: 29 (52%) 17 (41%) 3-6 months : 13 (24%) 12 (29 %) Over 6 months : 13 (24%) 11 (27%) (1 blank) Average number of sessions per client: Approximately 9 (Range 1-56) (this number is only an estimate based on data given by clients). Client s impressions on number of sessions received: Too many: 0 Too few: 4 About right: 36 (1blank) 12

Impressions of the counselling: To express feelings To feel listened to To explore worries or concerns To cope with loss Overall was the counselling helpful? No of Clients 0-10 (not at all very much) Average 19 10 8.9 (8.7) 9 9 4 8 5 7 1 6 1 5 2 blank 31 10 9.3 (9.3) 4 9 2 8 1 7 1 5 1 blank 25 10 9.4 (8.9) 9 9 4 8 1 6.5 2 blank 23 10 9 (8.6) 5 9 4 8 5 7 2 6 2 blank 25 10 9.3 (8.8) 7 9 5 8 2 7 1 5 1 blank 13

Rating of the service in general: No Clients Rating Scaled 0-5 (poorexcellent) Average Initial Impressions 31 5 4.5 (4.8) 7 4 1 3 1 2 1 1 Ease of access 33 5 4.7 (4.8) 6 4 2 3 Waiting times 34 5 4.6 (4.7) 4 4 2 3 1 2 Frequency of sessions 33 5 4.7 (4.6) 5 4 1 3 1 2 1 blank Environment in which counselling took place 36 5 4.8 (4.5) 3 4 1 3 1 1 Qualitative data Clients asked to add anything else about how the counselling has helped: It helped me to access my grief, understand the process I was experiencing and plan for the future, as well as to help me deal with more generalised anxiety. The counselling gave me a safe place to be open. It was the only place I could be myself and express how I was really feeling. Counselling helped me to both come to terms with my loss but also it helped me to see that I have a future as a person in my own right after losing my husband. xxxx was so wonderful, she was amazing and helped me so much through the darkest of times. Listened intently and was very kind. I think all I needed was for xxxx to unlock my feelings which she did. I have a lot of support through friends and family and did not feel the need for more appointments. 14

xxxx commented on questions 4a) to 4e): Not sure how to answer some of these questions as had very mixed views from the 1st six weeks and the 2nd six weeks. Think it was where I was at. I didn t feel the counselling helped at all until we reached what was to be the final session at 6 weeks. Something changed on this day, not sure quite what but I think I was more open. xxxx could probably say more about this. After that I found things started to change and very helpful. Since my final session I have continued to move forward. Thank you. I was very pleased I had these sessions. It gave me confidence to try to do more for myself. I realise now it s all about me and I am important too. It helped me to face up to my grief. I lost my mum suddenly and unexpectedly she was my only blood family left so without xxxx. I don t know how I would have coped with her loss. She helped me to focus on my husband and young children and friends for love and support. I truly cannot thank her or praise her enough and will always be thankful and miss her too. Nothing to improve on. It was all top class. Many, many thanks. I feel that my time with xxxx was very successful because she was extremely understanding if mine and my family s needs, and supported us at the best that she could. I am very grateful. The hospice was where my nan passed and it was hard to go back. I should have had more sessions but I had a set back and withdrew into myself so was unable to deal with arranging more appointments. This had nothing to do with xxxx who was excellent, I couldn t speak or talk to anyone. W was very helpful and introduced me to xxxx bereavement friend. xxxx has been to see me three times so far on a weekly basis at the moment. She is very kind and I feel her visits are benefitting me. xxxx helped me to face my loss and made it easier to face every day. xxxx was wonderful; kind caring, patient, supportive and open-minded. I couldn t have hoped for a better counsellor. It helped me give better support to my daughter while not leaving out my own grief. Over time I became at ease with not knowing the answers to questions that cannot be answered. xxxx was very good at following my particular resources and beliefs. My counselling helped me completely get rid of the IBS symptoms that appeared as a physical side effect of my grief. Counselling also helped me to continue and excel at my work. The counselling helped me immensely from start to finish. It is a bewildering world I entered into and the counselling helped me make sense of it as well as being my outlet. Thank you xxxx. xxxx was great, a good listener and helped me through to process what happened to my mum. She was fab at getting me to talk too as I don t find it easy. I really don t know where I d be emotional if it wasn t for xxxx. 15

The support I have received from my counsellor has been invaluable. I feel much better placed to cope with the loss of my dear partner. I m so grateful for having seen xxxx she s taught me how to cope with thoughts and to now begin to focus on the future :) xxxx really helped me to understand and accept the process of grief and to make it something I could learn to live with one day at a time. Very useful to be able to say certain things, things I have been unable to say to anyone else. xxxx was brilliant at helping me through this. xxxx provided a safe and supportive space where I could begin to grieve my son xxxx. She helped me understand that people experience grief differently and provided constructive help to manage my own loss. It has helped me cope with the loss of my wife. I never expected to be a widower at 49. I found the counselling very helpful and reassuring to get my life back to some sort of normality. Able to voice concerns aloud with a person who is not friend or family. To be listened and heard is a wonderful thing. Thank you. Not really If you feel your counselling has not helped please comment: Ref (4d) & (4e) the scores are lower because I still feel that I need help and wasn t really ready to stop. I feel totally lost and have nowhere to express my feelings. I sometimes wondered whether it would have been helpful to join a group of people in a similar situation to myself. Mum died but I never had a call to carry on counselling. Any suggestions about ways which we could improve this service: The service was excellent and much appreciated. I don t have any suggestions on making improvements, as I felt it exceeded my expectations in many ways. Absolutely brilliant service. Perhaps a follow up 3 or 6 months later to see how things have been going and any more help needed? It was difficult for me to access the sessions as I am a xxxx and unable to be at a session by 3.30pm. xxxx kindly agreed to see me at 4pm so I could access the service. Later appointments would be very useful for workers who can t leave work early. 16

No, I think it was great. Only comment would be that as xxxx only worked 2 days a week the sessions were too long between each one. Just keep it up! I would just like to add that Martlets Hospice is such an important charity. The care, support and compassion shown to me and my late partner has been so sincere, in such difficult times. I just thank all at the Martlets Hospice. Thank you so much my dad would be so happy to know that I ve been helped. The first few weeks were not very productive for me and maybe there is a way to help the person to open up earlier than I did to gain more benefit earlier. But this could be just how I responded and not others. Thank you for all the help I have received. The sessions with xxxx supported me through a very painful time, and I am very grateful for this. I feel the death of a child (at any age) is lasting in a different way to other loss. Contact with other bereaved parents in a group setting would be helpful if possible. None at all. You are all wonderful, caring and loving people. You do a job that has so much compassion. I was overwhelmed with your support. So I will always support you. All excellent! Room was fine but having to go to the hospice for counselling was extremely difficult as the associations with the building are very upsetting and hard to deal with. This did not become easier to deal with at all over the six months. The only thing I would suggest is to hope you are able to get more people like xxxx. Best wishes for the future. Bereavement counselling!! I m not sure if it was too soon, too late or just wasn t for me. xxxx showed me great empathy and support. More colourful 17

Supporting Statements As required by the regulations, this document was sent to the following organisations for comment: Brighton and Hove Clinical Commissioning Group Brighton and Hove City Council Health and Wellbeing Overview and Scrutiny Committee Brighton and Hove Healthwatch Board 18