Arthur Rank Hospice Charity 1
Quality Account 2015 - 2016 1
Quality Account
2015 - 2016
1
Arthur Rank Hospice Charity 2
Quality Account 2015 - 2016 2
Introduction
Acknowledgements
Thank you to the following Hospice staff who contributed to this Quality Account:
Liz Webb / David Burling / Kate Sibley / Ian Moyes (CCS Informatics)/ Alison Strickle
Statement from a Patient
You have all left a lasting impression on so many people who had no idea what the power
of human kindness can achieve. We will leave here this week with a spring in our step
and a huge appreciation for all that you have done for us. We shall never forget you.
I want to be cared
for and die in a place
of my choice
I want involvement
in and control over,
decisions about
my care
I want the people
who are important to
me to be supported and
involved in my care
I want access
to high quality care
given by well
trained staff
I want the right
people to know my
wishes at the
right time
I want access to
the right services when
I need them
I want support for
my physical, emotional,
social and spiritual
needs
What choices are important to me at
end of life and after my death?
Gomes, B., Higginson, I., Calanzani, et al. (2012). Preferences for place of death if faced with advanced cancer: a population
survey in England, Flanders, Germany, Italy, the Netherlands, Portugal and Spain. Annals of Oncology, 23(8), pp.2006-2015.
2
Arthur Rank Hospice Charity 3
Quality Account 2015 - 2016 3
Part 1
Introductory statement by the Chief Executive
This year has been a year of change for the
hospice. We moved from a situation where
the Arthur Rank Hospice Charity, sat alongside
and supported the services which were
delivered by Cambridgeshire Community
Services - an NHS Trust, to becoming an
‘independent hospice’ on the 1 August.
Being an independent hospice means that
the Arthur Rank Hospice Charity now has a
grant agreement from the NHS to deliver
the services, thus the staff delivering services
along with their administrative support teams
came across to the charity under a TUPE
agreement on the 1 August 2015.
As an organisation we believe that being
independent, whilst running some NHS funded
services, gives us the ability to combine NHS
funds with the funds we have generated through
donations and charitable activities, to provide
the optimum service for our patients and their
families. We have the flexibility to respond
quickly, yet thoughtfully, to the needs of our
patients as and when we see opportunities for
development or improvement.
As part of our desire to provide the very best
service the charity is building a new state-ofthe-art hospice to replace our current hospice.
Arthur Rank House is over 32 years old, it is too
small and it does not have the facilities one would
expect to see in a hospice in the 21st century.
These Quality Accounts detail the excellent
service that the Arthur Rank Hospice provides
and I can vouch for the accuracy of the
information. Furthermore it has been of
paramount importance to us, that moving to
a new hospice will not in any way diminish the
quality of care and indeed we have carried out
extensive consultation with staff, patients, families
and other stakeholders to ensure that facilities,
layout and services in the new hospice are in
keeping with our aspirations for excellence.
Just as our physical offering is developing, so
too is our mission to continuously improve
our service. For example we have, added an
additional day therapy session to our day therapy
programme, using a new model developed
by patients and staff, which is proving very
successful. We have also, using funds from
the Nursing Technology Fund, equipped our
community and Hospice at Home team, with
mobile devices which enable them to update
electronic records contemporaneously - this has
already resulted in significant time saving for the
specialist nurses and healthcare assistants.
Continuous improvement also extends to the
Board of Trustees, independence brought with
it the need for the charity trustees to increase
their level of scrutiny around clinical governance.
We do not underestimate the importance of good
clinical governance and have provided training for
Trustees and updates for staff. We have developed
a clinical governance framework which we believe
delivers a robust governance structure.
We are very proud that in the environment we
have had this year of significant change, we
have provided a seamless, quality service for our
patients. In late autumn 2016 we will move to our
new hospice and we will endeavour to ensure that
we create a very smooth transition of service to
our new premises which provides patients with a
seamless service.
We are delighted to share with you our
achievements from this year in this document.
Should you wish to find out more, please do not
hesitate to go to our website arhc.org.uk where
you will find additional information and details
plus pictures, of our new hospice.
Lynn Morgan
Chief Executive, Arthur Rank Hospice
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Arthur Rank Hospice Charity 4
Quality Account 2015 - 2016 4
Statement from the Trustees
On behalf of the Board of Trustees of the
Charity, I am pleased to endorse this Quality
Account. Originally founded over 30 years
ago, the Charity has always provided
financial and volunteer support for End of
Life Care in Cambridgeshire. The extent
of our support has grown significantly in
recent years. On 1 August 2015 the Charity
became an independent hospice and took
over responsibility for delivery of services
previously provided by Arthur Rank House,
part of Cambridgeshire Community Services
NHS Trust. So this is the first Quality Account
produced by the Charity.
As part of becoming independent, over 100
NHS staff transferred to the Charity under TUPE
arrangements - we already knew most of them
well, and were delighted to welcome them to
our team. We had consulted widely with NHS
and Charity staff as well as volunteers, and were
heartened by their tremendous enthusiasm for
this change. In particular, we were delighted that
Liz Webb, Matron at Arthur Rank House, became
Deputy Chief Executive and Director of Clinical
Services for the Charity. She is the principal
author of this Quality Account.
During 2015 the Charity also commenced
construction of a new larger purpose-build
hospice at a cost of over £10m. The existing facility
in Mill Road, Cambridge is now showing its age
and simply does not have the facilities our patients
need and expect in a modern hospice. What’s
more, it is too small given demographic changes
over the next few years as Baby Boomers age
and progressively reach their End of Life phase.
Construction is going well - on time, on budget
and to a high quality standard. We will have
moved in by the end of 2016. The new hospice will
be a hub for End of Life Care in Cambridgeshire not just an In-Patient Unit, but delivering Hospice
at Home, Day Therapy, Education, and other
vital services.
The Trustees take a long term strategic view of the
Charity’s mission. For over five years we have been
following a twin track strategy to
•
•
Become an independent hospice; and
Build a new hospice
We took the view that it was best to do both
together - you couldn’t do one without the
other. So we built up our financial reserves. And
we expanded our management team under
the leadership of our CEO Dr Lynn Morgan in
anticipation of our new responsibilities once we
became independent.
We also took steps to develop our Board of
Trustees so it was able to
•
Supervise management as it discharged its new responsibilities, particularly with regard to Clinical Governance;
•
Ensure we meet the highest standards of quality in caring for patients and supporting their family, carers and friends; and
•
Keep our strategy under review and up to date in an ever changing world
Everyone involved with the Charity can take
considerable satisfaction in what has been
accomplished in the last year or so. But we all
know there is much more to do. We are resolute
in our determination to deliver high, and ever
improving, quality standards. We look forward to
sharing next year’s Quality Accounts with you.
Stuart Evans
Chair of Trustees
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Arthur Rank Hospice Charity 5
Quality Account 2015 - 2016 5
Part 2
Priorities for improvement
The charity recognises that as a whole
our clinical services are going through a
significant period of change and associated
transition. In August 2015 we began
delivering clinical services for the first time as
a charity after transferring the NHS Clinical
team to the charity, and registered with the
CQC as a provider of healthcare. In the next
12 months we will transfer all our Cambridge
located services to a new purpose built
building. These two projects were identified
in our 5 year plan in 2010, and we believe
will result in significant improvements for
the long term provision of care for patients
within Cambridgeshire. However, we are
very clear that they are significant changes
both for ourselves as an organisation and
for our staff and patients. With that in mind
we are focusing on both direct care delivery
improvements which are detailed here as well
as progressing these two projects.
In this quality account we look back at the quality
of our services over the last 8 months since
we took on delivery of clinical care and look
forward to the next twelve months. Our Quality
Governance model is set up to ensure that
everyone who is a stakeholder in our care has a
voice; staff, patients, carers and volunteers.
The Care Board is the central conduit for planning
and decision making around quality of care and
improvements required.
The priorities for 16/17 have been planned in
collaboration with the trustee board; clinical
governance committee; care board, staff forum
and from patient feedback. Our contract
requirements with the Cambridgeshire and
Peterborough Clinical Commissioning group
underpin the work identified.
Each of our priorities for improvement link to
NHS’s five Domains of Quality:
• Domain 1: Preventing people from
dying prematurely.
• Domain 2: Enhancing quality of life for people with long-term conditions.
• Domain 3: Helping people to recover from episodes of ill health or following injury.
• Domain 4: Ensuring that people have a positive experience of care.
• Domain 5: Treating and caring for people in a safe environment and protecting them from avoidable harm.
Board of Trustees
Every 2 months
Chair Mr Stuart Evans
Administration
Clinical Governance Committee
Chronic
Neurological
Conditions
MDT
Trustees and senior management
Every 2 months
Chair Dr Alex Manning
Meds Management
Infection Control
Clinical Care Board
Staff Forum
Patient
Forum
Day
Therapy
All ARH clinical staff, education, support
services, guest attendees
4 weekly
Education
Research Group
Hospice at
Home
Hudson
Centre
Inpatient
Unit
Lymphoedema
Patient and
Family
Support
Specialist
Palliative
Care Home
Team
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Arthur Rank Hospice Charity 6
Quality Account 2015 - 2016 6
Looking forward
Priority 1
Priority 3
Updating our provision of care
according to changing guidance
and available evidence
Seeking and hearing our patient’s voices
As a provider of quality palliative and end of
life care this priority is always on our work plan
however these two elements have particular focus
for us in the coming year.
•
•
Updating of our personalised care plan for the last days of life. A document developed after the Neuberger Review will be revised in line with the NICE guidance recently published.
We plan to continue to participate in the development of the Outcome Assessment and Complexity Collaboration (OACC) project to support measurement of patient’s
outcomes. This project is well established within our in-patient ward so we will be
exploring how to use these tools within other services including Day Therapy and
our Community Services.
Priority 2
Reaching our diverse populations
•
We will review the religious and ethnic diversity of our population and further develop a strategy to widen access to all our services for both the community and within the hospice.
•
In the next 12 months as we move to the new hospice building, we will have a project in partnership with our local children’s hospice to improve young people’s transition to adult hospice care.
•
Building on our MND pathway in the next 12 months. We plan to provide the acute
trusts neurology department with MND
clinics within the new hospice building.
This will build on the work already done to support the complex care needs of the
patients and families.
•
We recognise that while we collect
feedback from our patients/carers this could be improved. A Patient Forum is being set
up which will be chaired by a volunteer. The Forum will become integrated into the business of the hospice to support and
challenge us to ensure our services are truly patient focused.
•
Additional education and training about the care needs of patients with Dementia will be introduced as a mandatory training
requirement for all clinical staff. Led by our Education team this will be available via our e-learning or face to face sessions.
Priority 4
Refining quality governance processes
•
We will revise our incident reporting system so that we are self-sufficient in this area. As a previous NHS service the clinical team use an integrated system to record and learn from any incident that takes place.
•
We will review our holistic care records to ensure that they continue to reflect best available evidence. This is part of a hospice wide implementation of System-One, which is used within Cambridgeshire by us and our community colleagues such as GPs and District Nurses. As part of being awarded money from the Nursing Technology fund the service is also introducing remote working and paper light record keeping. Our ambition is in line with the NHS plan to be paperless by 2020 as we recognise the real value to patients if their records are up to date in real time
24 hours a day seven days a week. It also facilitates our clinicians to communicate effectively with our health partners.
•
Following our transfer from the NHS last August we will now start an 18 month
programme to further review all policies/
guidance/SOPs to ensure that these are fit for the purpose of a smaller organisation; continue to meet national guidance and reflect care and compassion at the core.
•
We will revise our emergency planning protocols following our move to the
new hospice.
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Arthur Rank Hospice Charity 7
Priority 5
Quality Account 2015 - 2016 7
•
Planned and safe move to new
buildings fit for 21st Century Care
We intend to continue with the board improvement programme for Trustees in the coming year in order to ensure that the Board is as effective as it can be.
•
In Autumn 2016 we will be moving to a new purpose built 24 bedded hospice. This will involve a full review of working practices and policies to ensure that they are ‘fit for purpose’ and match the new environment.
The new hospice is a bespoke building which offers a mix of en-suite rooms for in-patients and 2 x four bedded wards to cater for individual preference.
•
•
Our risk register identifies that the space and need for capacity in the Hudson centre at Wisbech has out grown the building it
is in. With the local Clinical Commissioning
Group we are developing a project to improve
the space (with an extension and refurbishment) and working with other partners locally to have an integrated hub of hospice care. This is in its early development stages.
To support our transition as a new team - NHS and Charity, together we commissioned 10 workshops from an independent facilitator to ask staff about the culture and transparency of the organisation. The feedback in the main was that the culture is open and transparent,
but the management team are aware that we need to consolidate the new governance structures, meeting structures, and continuous improvement. Significantly we will be working on ‘closing the loop’ with all staff and supporters on what action is taken with complaints, incidents, general feedback.
•
A staff forum has been started to work on actions from workshops held earlier this year with all staff in the hospice services.
Actions to be taken are:
Priority 6
Working with our staff to achieve
excellence through transformation
As mentioned previously the senior leadership
team are very aware of the impact of the
significant changes that are taking place and are
working with all levels of staff to achieve these
changes in a positive way.
•
We will ensure that the staff are supported in the new building environment so that our current good practice comes with us and that we respond to the new environment fully by exploring new opportunities to improve practice.
•
We will seek to bring the good things from the current building so that our past reputation is maintained, but that in doing so
we do not constrain innovative opportunity.
•
We will recognise that a lot of people will be leaving difficult memories behind and we will continue to support the team with events such as a lantern walk to the new hospice, celebration and remembering events before we leave the old hospice and we will maintain continuity by events such as our annual ‘light up a life’ service.
• Communication of management and quality governance structures in
language all staff can relate too
• Back to the floor for non-clinical managers
• Clear transition plan for move to the
new building including revision of
policies and guideline
•
A resilience Development Programme Pilot, which will look at how the service supports and develops staff with positive leadership. Within our local networks we will also be seeking access to leadership development for our middle managers; supporting them in their complex roles.
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Arthur Rank Hospice Charity 8
Quality Account 2015 - 2016 8
Looking back
As a provider of healthcare services this is the first
Quality Account we have published. This section
looking back at the priorities for improvement
in 2015-16. This is therefore taken from relevant
charities objectives 15/16 and our Clinical Care
Boards work plan 2015/16 rather than last year’s
quality account.
Our plan for the future
Priority 1
•
What we wanted to achieve
Successfully market the Gold Standard Framework training and accreditation we offer
to Nursing, Care and Residential Homes
•
Achieve ‘independence’ as a hospice by entering into a grant agreement with the Cambridgeshire and Peterborough Clinical Commissioning Group (CCG) for delivery of NHS funded services at Arthur Rank Hospice
•
Work with the CCG to look at commissioning opportunities for the additional 11 beds in the new hospice
•
Develop and achieve meaningful outcomes which will best benefit our patients, their families and carers and meet the requirements of the CCG
Implement plans for delivering day therapy in a new way
•
Work with GPs, the Hudson Centre and other stakeholders in the North of the County to explore ways of enhancing the end-of-life
care offer in that locality
•
Work closely with Addenbrookes to improve patient referrals from Addenbrookes to ARHC
•
Work collaboratively with the CCG to provide a truly integrated model of end of life care in each of the new integrated care teams
•
Review patient experience of admission, discharge and transition within and to care provider, for example, home to hospice to
care home
•
What we wanted to achieve
Review our Do Not Attempt Cardiopulmonary Resuscitation policy and application within the services taking into account national and regional debate and changes
•
Oversee the building of the new hospice ensuring that it keeps on track in terms of our target finish date of October 2016,
without compromising on quality or amenities
•
Increase service wide knowledge and skills to care for patients under the Mental Capacity Act and Deprivation of Liberty (DoLs)
•
•
Continue to vigorously fundraise to raise
more of the funds needed for the build
Review knowledge and skills around nutrition and hydration in the palliative phase and when the patient is dying
•
Develop a detailed plan for equipping the
new hospice
•
Review information available to patients, families, carers and health care professionals
•
Obtain more patient and carer feedback on the care delivered and their experience of
the service
•
What we have achieved
•
We secured a five year grant from the CCG
for service delivery
•
We safely transferred all the clinical services and staff under TUPE, (Transfer of Undertaking Protection of Employment)
Our plan for the future
With the CCG and other providers of end of life
care, continue to work in an integrated way to
improve patient access and care.
Priority 2
What we have achieved
The new hospice is built and we will move in
to it in the autumn of 2016.
Safe and planned transfer of the organisation
to the new facility.
Priority 3 - Development of Service
What we wanted to achieve
8
Arthur Rank Hospice Charity 9
•
Develop systems to record patient activities in order to demonstrate value to Commissioners, and have evidence to show that we are meeting local and national standards, whilst showing that we are using donated money well, and generating income
What we have achieved
We have completed the majority of our
developments described above. Our Education
centre is about to commence training its second
cohort of Care Homes following the Gold
Standards Framework development Program.
Our systems to gather meaningful data on the
work we do is developing well. The way that we
gather patient and carer feedback is growing and
enabling us to take action appropriately.
Our plan for the future
Areas that we continue to develop include
opening the additional 11 beds at the new
building. Working with all our acute hospital
partners such as Addenbrookes and Queen
Elizabeth Hospital King’s Lynn to ensure patients
receive care in the right place and timescale.
Quality Account 2015 - 2016 9
Objective 4 - Staff Development
What we wanted to achieve
•
Actively work with staff to develop integration of the CCS NHS Trust staff that transferred to ARHC with the existing charity staff
•
•
Develop one positive culture
Develop leadership and management skills across the service; developing a truly transformational approach to care delivery and change
What we have achieved
We have transferred the NHS team into the charity.
An independent facilitator has run 10 workshops
with all staff to explore the culture and behaviour of
their previous teams; identifying what was good to
bring with them and what should be changed.
Our plan for the future
The plan now is to work with staff to maintain and
develop the positive culture that they described,
with the clear message that this is for everyone to
achieve together, ‘Achieving Excellence Through
Transformation.’
What our staff say
about Arthur Rank Hospice
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Arthur Rank Hospice Charity 10
Quality Account 2015 - 2016 10 10
Values
Mission
We will achieve our vision through the delivery
of excellent, innovative and compassionate
specialist and community based palliative care.
We will support patients with a life limiting
diagnosis to improve their quality of life, and
we will endeavour to support patients to fulfil
their choices at the end of their lives, and we will
provide timely and compassionate support to
families and carers.
Arthur Rank Hospice Charity
making every moment count
Flexible, individual and responsive focussed
specialist palliative care
Equality of service
Valuing and investing in our workforce
Integrity, compassion and professionalism
Prudence in the management of our resources
Strategic Aims
Underpinned by
financial management
Strong financial management
Strategic financial planning
Achieving financial stability with
a diverse funding income
Managing key risks
Failure to acquire the SPC contract
Failure to raise sufficient funds for
the new hospice
TUPE transfer confers
unacceptable additional costs
Staff fail to integrate
• Autonomy
• New hospice
• Maintaining excellence of care
• Smooth integration
• Good management of change
ACHIEVING EXCELLENCE
THROUGH
TRANSFORMATION
To support transition to an
autonomous organisation
Change management through transition
Communicate and consult regularly with
staff, volunteers, patients and families
Address potential attachment feelings for
Arthur Rank House
Achieve ‘buy-in’ for new ways of working
To provide an excellent experience for all patients
Achieving independence
Provision of excellent facilities fit for 21st century
To be the employer of choice
To be a highly respected centre of information, advice
and education of palliative and end of life care
Goals:
Good governance
Board direction
Executive leadership
Supportive and enabling management of staff
Performance management
Collaborative working with the
Current market analysis
Cambridgeshire population
significantly increasing
Nationally death rates are predicted to
significantly increase from 2016 onwards
Only adult hospice in Cambridgeshire
People living longer, therefore present
with co-morbidities
Increase in patients with dementia
Our strategy is to:
To achieve this we will:
Become investment ready
Strengthen our business plan
Develop new ways of working
Plan for integration and
harmonisation
Become the provider of choice for the
new prime vendor
Achieve the best facilities possible for
our patients and staff
Build a hospice which is flexible
and sustainable
Strengthen our financial base through
grants, contracts and fundraising
Arthur Rank Hospice Charity 11
Quality Account 2015 - 2016 11 11
Mandatory statements relating to the quality of NHS services provided
The following are statements that all providers are required
to include in their quality account. Many of these are not
directly applicable to Arthur Rank Hospice Charity and we
will explain this where necessary.
Review of service
During August 2015 - 31 March 2016 the Arthur Rank
Hospice provided a number of NHS services listed.
The Arthur Rank Hospice Charity has reviewed all the data
available to them on the quality of care in all of these
NHS services. The income generated by the NHS services
reviewed in August 1 2015 - March 31 2016 represents
100 per cent of the total income generated from the
provision of NHS services by the Arthur Rank Hospice
Charity for the period 1 August 2015 - 31 March 2016.
Additional services are are funded by the
Arthur Rank Hospice Charity.
Services provided
Domiciliary Specialist Palliative Care - Specialist
Palliative Care Home Team
(7 day service 9-pm)
24/7 telephone advice via the Inpatient Unit
* Chaplaincy
* Hospice at Home
* Day Therapy - Arthur Rank Site
Day Treatment - Hudson Centre, North Cambs
Hospital, Wisbech
Inpatient Unit
Outpatients -
•
•
•
•
* •
* •
•
•
* •
Medical
Nursing
Physiotherapy
Occupational therapy
Psychological support
Complementary therapy
Lymphoedema
Complex pain
Bereavement support
* These services are either wholly or largely funded
by the Arthur Rank Hospice Charity
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Quality Account 2015 - 2016 12 12
Participation in clinical audits
National Audits and National
Confidential Enquires
There are no national audits or confidential
enquiries that are applicable to the services
provided by Arthur Rank Hospice Charity. This is
because none of the current national audits or
confidential enquires are applicable to palliative
and end of life care.
Local Audits
The charity is reviewing the type and process of
clinical audit through the Clinical Care Board to
encourage wider participation in audits and to
enable more staff to understand the value of them
within the context of ‘continuous improvement’.
The first stage of this has been to quantify the
type and number of audits that we have inherited
from the NHS policies and guidance. We are now
designing a programme of clinical audit that truly
underpins our quality of care.
In the last year these audits have taken place:
•
Use of the personalised care plan in the last
few days of life (re-audit). Reviewing the
completion rate of the care plan.
•
Controlled drug standards, audits as per
requirements of holding and delivering
controlled drugs.
•
Weekly audit of drug charts on in-patient unit
and gaps identified on charts. This is to facilitate
good practice and identify swiftly when this is
not taking place.
•
Do Not Attempt Cardio Pulmonary
Resuscitation (DNAR) decisions. This audited
the use of the form in line with recent
national guidance and legal cases, particularly
communication about the decision with
patients and families.
•
Blood transfusion audit. This audit is a
requirement of our blood transfusion
standards and is completed by our ward
and the Hudson Centre.
•
Specialist Palliative Care Home team; audit
of Triage Tool. This new tool is being used
to ensure patients are seen in a timely way
within this small team.
Specialist Palliative Care Home team; audit
of weekend and bank holiday working.
This audit reviewed how many calls were
made across the seven day service and also
reviewed working practices.
•
•
•
Audit of Day Therapy Services.
•
Hand Hygiene - is completed monthly by
clinical areas as per best practice guidance.
Value of lymquol tool in assessing
lymphoedema patients
Participation in Clinical Research
There are no national studies that we are
participating in now.
Use of CQUIN Payment Framework
Arthur Rank Hospice Charity grant income from
the NHS was not conditional on achieving quality
improvement and innovation goals through
the Commissioning of Quality and Innovations
framework (CQUIN), because the grant/contract
was set by the CCG and currently does not
include these elements for us.
Arthur Rank Hospice Charity 13
Quality Account 2015 - 2016 13 13
Part 3
Review of quality performance
In this section we have presented data about our activity and our performance against our agreed
quality measures. These are for an 8 month period 1 August 2015 - 31 March 2016.
Activity
Data table for the period 1 Aug 2015 - 31 March 2016
All Patients/All Services referred Aug 2015 - Mar 2016
Inpatient Unit
274
Day Therapy
104
Hospice at Home
335
Special Palliative Care Home Team
505
Lymphoedema
84
Patient and Family Support Services
165
Pain Management
18
Complementary Therapy
106
Medical Outpatient and Domiciliary
59
Total
3300
Inpatient Services
Number of beds
12
Bed occupancy
84%
Number of patients
274
Number of discharges
275
Average duration
9.2 days
Available bed days
2928
Day Therapy - Cambridge
Number of referrals
104
Number of discharges
128
Average attendance at Day Therapy sessions 80%
Hudson Centre - Wisbech
Day Care (those who attended)
661
Treatment patients
1075
In patients on Trafford ward supported
26
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Quality Account 2015 - 2016 14 14
Hospice at Home
Number of referrals
335
Number of discharges
316
Preferred place of death achieved
93%
Episodes of care
1248
Specialist Palliative Care at Home
Number of referrals
505
Number of discharges
534
Contacts (phone etc.)
6315
Lymphoedema
Number of referrals
84
Number of discharges
99
Caseload as at Mar 31 2016
348
Number of appointments
574
Patient and Family Support
Number of referrals
165
Number of discharges
145
Contacts with patients
2427
Pain Clinic
Number of referrals
18
Number of discharges
27
Complementary Therapy
Number of referrals
106
Number of discharges
120
Medical Outpatient and Domiciliary
Number of referrals
59
Number of discharges
68
Arthur Rank Hospice Charity 15
Interventions this year that have enhanced
our activity and supported staff in the delivery
of high quality care in an environment of
increasing demand include:
•
•
•
•
•
Quality Account 2015 - 2016 15 15
Incident Type
Pressure Ulcer Grade 2
2
Pressure Ulcer on Admission Grade 3
2
Pressure Ulcer on Admission Grade 2
2
Falls in IPU - no harm
12
Falls in patient’s home - no harm
2
Falls in IPU - low harm
2
OACC Project implementation
Falls in Hudson Centre - low harm
1
Registration as Regional Gold Standards
Framework Education Site
Falls in patient’s home - low harm
1
Falls in IPU - moderate harm
3*
Medication - administration
2
Medication – dispensing (by pharmacy)
1
Medication Security
1
Monitoring and advice meds
1
Prescribing
4
Other
2
Total
33
Hospital liaison nurse
Mobile working with Nursing Technology Fund
Education facilitator role on the ward
Quality Data
To compare our incident data with other hospices
we have joined the Hospice UK Bench Marking
Project which enables us to see how we measure
against others. However we are also working
on our own data to seek improvement, whether
that is because we feel our performance is not
as good as it should be, or where we looked as
though we are reaching a good standard but still
wish to see improvement.
* One of these was a member of staff
Incidents
Incidents are recorded via an integrated incident
reporting system (DATIX). All are investigated by
the service manager and where required a full
investigation is completed using a root cause
analysis approach.
Access, Admin, Transfer, Discharge
8
Accident
28
Behavioural Issues
1
Clinical Assessment & Treatment
10
Community Issues
3
Equipment Issues
4
Infection Control
2
Information
2
Medication
11
Organisation Issues
1
Service User Issues
1
Total
71
Arthur Rank Hospice Charity 16
Quality Account 2015 - 2016 16 16
Examples of patient related incidents and actions taken
Medication
An investigation into the administration of a
drug that a patient was allergic to concluded
that action should be taken to improve
communication of patient cases to the consultant;
conduct a review of medication reconciliation
and allergies on admission; consider emergency
access to drugs. A detailed investigation using
root cause analysis methodology enabled the
team to learn from this complex incident and take
appropriate action.
Falls
All patients who are admitted to either our
in-patient ward or day therapy have a falls risk
assessment. Any risks identified are explored
and where possible care is planned to reduce
such incidents.
One fall in this period resulted in a fractured
neck of femur; which was reported through the
Clinical Commissioning Groups Serious Incident
Process and to the Care Quality Commission.
A full investigation concluded that a care plan
and risk assessment should be done for the
safety of other patients close to a confused
patient. This has been introduced and will
be monitored.
Pressure ulcers
We have low levels of pressure ulcers within our
services compared with national data. All patients
are screened on admission using the SSKIN
tool and we have a range of pressure relieving
equipment available to use with our patients.
VTE
100% of our patients were scanned for VTE risk.
Catheter acquired infection
There was one incident recorded between
August 2015 and March 2016.
Complaints, feedback and
patient experience
Since taking on delivery of Clinical Services in
August 2015, we have worked hard at significantly
improving the way we collect information from
anyone accessing our services.
There is a process that is communicated to all for
the collection and action on feedback of any sort.
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•
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Complaints Policy and process
Introduction of a Patient forum
Satisfaction Surveys
Staff Survey
Feedback forms
Complaints and concerns
In this period we have had one formal complaint
and three concerns raised.
Complaint
The family of a patient complained around the
non-availability of ice, menus for food drink and
keeping next of kin informed. We have purchased
an ice maker machine, laminated menus and
produced a communication leaflet for relatives
regarding the dying process and its impact
on relatives.
Concerns
We had a few concerns raised in the period
these were dealt with directly by our staff with
the patient or carer concerned. For example
we introduced and revised information about
admission and continue to monitor noise levels
on the inpatient unit particularly in busy periods.
Arthur Rank Hospice Charity 17
Quality Account 2015 - 2016 17 17
Compliments
This is a selection of the comments from patients and their relatives across all services:
All staff are polite and approachable they make
you feel confident that you are getting the best
care available and you are never left feeling alone.
Thank you for being such a great team.
Nice to talk to people who understand your
position and give you help where needed.
The STAFF - “they make this place” understanding and undemanding, nothing is too
much trouble. Everyone is super.
Staff put my mind at rest and this reduces
my stress level.
Discussion about my condition and treatment here
helped me make choices at Addenbrookes with
regard to my treatment.
The family are very impressed with the contact
the staff make with them regarding the
patient’s condition.
Son: Can’t fault the care. Ex-wife of patient:
Support and liaison with family very good. Holistic
approach much appreciated.
Pain sorted out by Doctors. Couldn’t wish
for any better.
Doctors and nurses very helpful in explaining
Thank you (a really big one!!!!) to the nursing
team who looked after our mum in her short
stay with you. Although her stay was short,
the care she received from you all will never
be forgotten nor will we forget the wonderful
atmosphere in this place.
That is fantastic news!! Jeannet I cannot thank you
enough for all the help and assistance you have
provided. So hopefully now we can at long last get
some support we badly need.
Dear Everyone. I am writing on behalf of my
family to thank you all most sincerely for
your very kind care and attention to my late
mother, Mrs JF, throughout her final illness. It
was through your efforts that mother was able
to die peacefully in her own home which had
always been her wish. The professionalism
shown by your wonderful carers has meant so
much to us all and we really appreciate and
thank you all very much indeed. I would be
so grateful if you could pass on our grateful
thanks to everyone involved.
Comments from husband of patient with advanced
disease: She never did anything she didn’t want to
therefore her regular attendance in Day Therapy
was a credit to the service Day Therapy offers.
Husband’s day of respite was of huge benefit to
him. Will give donation to Day Therapy and wider
service and later buy something for the new build.
Wife of in-patient ‘Can I just say that you
are all so kind, all the doctors, the nurses
and the volunteers’, you all make me feel
very welcome.
Arthur Rank Hospice Charity 18
Quality Account 2015 - 2016 18 18
Response from CCG
Cambridgeshire and Peterborough Clinical Commissioning Group welcome the first Quality Account from
Arthur Rank Hospice Charity.
The account reflects an exciting and changing time for Arthur Rank Hospice Charity. Becoming an
independent charity in August 2015, incorporating new staff from another organisation and building a
new hospice whilst holding on to all that is so highly respected.
They do not shy away from discussing the challenges but there also is a strong sense of an organisation
moving forward in partnership with staff, patients and families and a committed board. There is also a
strong sense of an organisation that understands Cambridge and Cambridgeshire and some interesting
and diverse initiatives that are being undertaken to meet the specific needs of key groups including
children in transition and patients with Motor Neurone Disease.
The review of quality performance demonstrates an organisation finding its feet in this area. What comes
across clearly is that systems and processes for monitoring and review are in place and that learning is
captured. The compliments show a committed, kind and caring workforce who are really appreciated and
only one formal complaint demonstrates that as an organisation they are quick to learn and improve the
experience of patients.
This is an excellent first report.
Response from Health Watch
Healthwatch Cambridgeshire recognises the valuable work of Arthur Rank Hospice and is pleased to
comment on the Quality Account for 2015/16. It is evident that the Hospice is highly valued by the
community and makes a significant difference to patients and families’ end of life experiences. The
Hospice’s ethos clearly places the patient and their family at the centre of their care.
Healthwatch Cambridgeshire recognises the challenge that the Hospice has experienced during the past
year and is pleased to see that change has been embraced and opportunities identified and progressed.
The extensive changes to the nature of the organisation and associated implications for staff, funding and
governance are significant. The Hospice is to be commended for continuing patient care through this
period.
The priority areas identified by the Hospice are comprehensive. Healthwatch Cambridgeshire welcomes the
commitment to diversity and hearing more patient voices and would be pleased to work with the Hospice
on the development of a Patient Forum. Transition to adulthood is indeed a challenging time to experience
serious health conditions; the commitment to closer working with the children’s hospice and improving
end of life experiences of young people and their families is therefore much needed and very welcome.
The rural isolation of many parts of the north of Cambridgeshire undoubtedly impacts on local people’s
health outcomes. It is good that the Hospice is committed to expanding its work in this area. The area is
served by a complex array of services which many people report difficult to access; integration and
simplification for patients is very much needed. End of Life support is crucial in improving life experiences
and so must be part of this integration.
Healthwatch Cambridgeshire looks forward to working with the Hospice in the coming year and wishes the
organisation every success for the move to the new building and development of vital community services.
Arthur Rank Hospice Charity 18
Quality Account 2015 - 2016 18 19
Response from Overview and Scrutiny Committee
Contact Details:
Lynn Morgan, Chief Executive
[email protected]
Liz Webb, Director of Clinical Services/DCEO
[email protected]