North Devon Hospice Quality Account 2012-2013

Quality Account 2012-2013

For healthcare professionals

being there for all the family

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Contents

1.

Quality Statement

2.

Performance in 2012-2013

Clinical Service Provision

Community Specialist Palliative Care Nursing Service

Community Palliative Care Service

Hospice to Home Service

Specialist Palliative Care In-Patient Service - The Bedded Unit

Hospital based Specialist Palliative Care Service

Physiotherapy & Occupational Therapy

Consultant Outpatient Appointments & Consultant Domiciliary Visits Outpatient Treatments Supportive Care Services

Introduction by Murray Fletcher Our Values and Vision Mission Statement Clinical Governance

• • •

The Whole Family Day Hospice Complementary Therapy

Our Education

3.

Priorities for 2013-2014

The Board of Trustees’ Commitment to Quality

With Thanks

Comments and Feedback

4.

Annex

Statements of Quality Assurance from the Board of Trustees

Referral Criteria

Our Priorities 2013-2014

Crosscare

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1.

Quality Statement Dear friends, It is my pleasure to open North Devon Hospice’s fourth annual Quality Account. We produce this document in order to share our commitment to high standards, outlining our care statistics for the year and highlighting the many different ways in which we provide care to local patients and families.

But as well as the raw numbers, our Quality Account shows how we achieve our aim of providing the best possible care. It gives details about our extensive clinical audit programme, which ensures our services are always improving, as well as an outline of the future of North Devon Hospice.

We feel this is vitally important so that you, our partners in providing local healthcare, can have confidence in the quality of hospice services and in our direction for the future.

It is an exciting time for North Devon Hospice as we aim to provide even more services as close as possible to people’s homes. So I would like to thank everyone who has helped us to get to this point and who will now work with us to provide even more seamless care for local patients and families. This includes every single member of the hospice team and our many clinical partners for their outstanding commitment and effort towards our achievements over the past year.

Thank you for your continued involvement with the hospice.

Yours truly,

Murray Fletcher Medical Director and Consultant in Palliative Medicine murrayfletcher@northdevonhospice.org.uk

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Our Values and Vision Patients are at the heart of everything we do We listen to our patients, their loved ones and our healthcare partners, learning from the things that have worked well and where we can look to improve. The quality of our patients’ personal and medical experience is of the utmost importance to us and that is why the foundations of our services include ensuring patients’ safety, providing high quality care and positive experiences.

We believe in: > > > > >

Being there for all the family Recognising and treating each person as an individual The caring and clinical support that is provided The sense of safety and support the hospice brings The expertise of our professional teams.

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Mission Statement Our mission is to promote the relief of symptoms amongst people with life-limiting illnesses.

We do this through offering: > Specialist palliative care for patients with an advanced, progressive illness and

support for the adults and children who are close to the patient > Personal care to patients at the end-of-life and support to their families

at home and in other settings > Supportive care to patients who have been diagnosed with a life-limiting

illness and to the adults and children who are close to the patient > Advice, support and education provision to patients, families, communities,

organisations, and healthcare professionals who are responding to

life-limiting illness, death and loss.

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2.

Performance in 2012-2013 Clinical Governance The Clinical Governance Action Plan records all of the clinical standard setting and audit activity undertaken by the hospice. It underpins our care quality standards, enabling us to meet the Care Quality Commission’s essential standards for quality and safety. In 2012-2013 North Devon Hospice achieved 100% compliance, with no concerns following an unannounced inspection by the Care Quality Commission in February 2013.

The Clinical Governance Action Plan and relevant key performance indicators are reviewed regularly by the Care Quality Working Group and presented to the Corporate Governance Committee and the Board of Trustees.

We continue to support the Minimum Data Set Project organised by the National Council for Palliative Care and the South West Hospices Informatics Project.

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Clinical Audits:

Carers Experience Survey > Clinical Nurse Specialist Referrals Response Audit > Controlled Drugs Audit > Discharge Planning Audit (Bedded Unit) > Documentation Audit:

Peninsula Cancer Network

>

>

Safe Disposal of Sharps Audit

>

Surveys and Exercises: > Investors In People Review

Next of Kin Resuscitation Documentation

> South West Regional Hospices Audit: Falls, Medication Errors Pressure Damage

Duty Clinical Nurse Specialist Reviews > End-of-Life Re-admissions >

(NDDH Specialist Palliative Care Team)

> Carers Experience Survey > Patient Survey

Gold Standards Framework Care Home Review > Hand Hygiene Audit > Help the Hospices Pre-Bereavement Audit > Management of Malignant Hypercalcaemia > Medicines Management Audit > Palliative Care Outcome Score >

Review of On Call Services Provided by Hospices

> South West Hospices Informatics Project: Preferred Priorities for Care >

South West Hospices Informatics Project: Avoidance of Inappropriate Admission to Hospital Audit

Symptoms Audit

100% compliance awarded in 2013 for the second year running

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Clinical Service Provision During 2012-2013, 864 new patients were referred with life-limiting illnesses, including COPD, Heart Failure, Liver Failure, MND, MS and Cancer. This year marks another rise in the number of new patients from the year before, with 99 more referrals.

NO. OF NEW PATIENT REFERRALS Referrals accepted from GPs, Consultants, District Nurses and Social Services

Ages 18 - 24 7 patients

Ages 25- 49 41 patients

Ages 50 - 64 148 patients

Ages 65 - 79 366 patients

Ages 80+ 302 patients

Total number of patients : 864

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We endeavour to support people to achieve their preferred place of care.

Unsurprisingly, the majority of our patients choose to spend their final days at home, often surrounded by family and by friends. Last year, the majority of our patients died at home, in line with their wishes.

PLACE OF DEATH Other

8 patients

Care Home 69 patients

Community Hospital

At Home

45 patients

265 patients

Hospital

119 patients

North Devon Hospice 104 patients

“

“

They’ve taken a huge amount of pressure off us, you couldn’t wish for a more caring place or staff A patient speaking to the Care Quality Commission

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Community Specialist Palliative Care Nursing Service Working in partnership with GPs, District Nurses and other healthcare teams, our Community Clinical Nurse Specialists deliver care and support in the homes of our patients throughout the North Devon community. For over 29 years, it is still where the majority of our care takes place.

Last year the team conducted 5,067 patient visits and travelled over 50,000 miles to reach them.

LOCATION OF VISITS BY COMMUNITY CLINICAL NURSE SPECIALISTS Home nursing delivered in 143 locations across the catchment area.

Nursing Home 156 patient visits

Hospital & Community Hospitals 192 patient visits

Hospice 377 patient visits

Home 4,342 patient visits

Total number of patient visits : 5,067

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Community Palliative Care Service In support of patients who choose to be at home for the last stages of their illness, the Community Palliative Care Support Workers provided hands on end-of-life care to 169 patients. All of these patients achieved their preferred place of care; being cared for in their own home.

Hospice to Home Service The Hospice to Home team provides care at home for up to 72 hours, day or night, for people nearing the end of their life. This vital service has been running for one year. During 2012-2013 the service received 120 referrals; 85 had a cancer diagnosis and 35 non-cancer diagnosis. 100% of patients achieved their preferred place of care, being cared for in their own home.

“

We would like to take this moment to thank everyone for the unwavering dedication of love, kindness and care you gave to my wife in her final days. We could not have had better treatment anywhere. You are a credit to your profession and more so to your fellow people, you are something else. Although it was in desperate circumstances, it was a pleasure and a privilege to get to know you all.

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“

Husband of a patient

Performance 2012-2013 2. 2.

Performance inin 2012-2013 21/11/2013 09:28

Specialist Palliative Care In-Patient Service - The Bedded Unit The hospice’s purpose built 7 Bedded Unit provides assessment and treatment of complex symptoms, end-of-life care, and support and care to patients, their families and carers.

Last year there were 159 admissions to the Bedded Unit. Contrary to popular misconception, 96% of those admissions were for symptom management and treatment which saw a number of patients returning home to continue their journey. Only 4% of patients were admitted for end-of-life care. This is a reflection of the care and support provided in the community so that people can achieve their preferred place of care. The average length of stay was 11 days, with a range from a 1 day stay up to 48 days.

REASON FOR BEDDED UNIT ADMISSION Majority of patients are admitted for symptom management & treatment

End-of-Life 6 patients admitted

Symptom Control & Treatment 153 patients admitted

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Hospital based Specialist Palliative Care Service North Devon Hospice has a specialist team working with patients and families who are being cared for at North Devon District Hospital. They assist in the provision of support and advice for patients with life-limiting illnesses and integration of care with peers.

Physiotherapy & Occupational Therapy The hospice’s Physiotherapist and Occupational Therapist have significantly increased the number of sessions delivered during the last few years including making outpatient visits.

Physiotherapy

Inpatient Visits/Review 249 Outpatient Visits & Day Hospice 14

Total

263

Inpatient Visits/Review/

Discharge Planning 131

Outpatient Visits & Day Hospice 2

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Occupational Therapy

Total

133

2. 2.

Performance inin 2012-2013 Performance 2012-2013 21/11/2013 09:28

Consultant Outpatient Appointments & Consultant Domiciliary Visits At the request of medical professionals, patients can be reviewed by the Consultant in Palliative Medicine at the hospice, in a community hospital, or in their own home. In most cases, one of the Community Clinical Nurse Specialists is in attendance to provide ongoing support and guidance for the patient and their carers. The Consultant meets regularly with the Community Nurse Specialist Team to discuss the management of patients. At these meetings patients who would benefit from a Consultant appointment are identified.

Outpatient Treatments At the request of medical professionals, 44 outpatient treatments were managed and monitored from the Bedded Unit.

Available treatments included: > Pamidronate Infusion > Blood Transfusion/Platelets

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Supportive Care Services Supportive Care Services offer time and space for patients and their families to look at what is happening in their lives and the opportunity to explore what they need to sustain them in the most difficult of circumstances.

During 2012-2013, the team supported 2,582 individuals, including children.

NO. OF PEOPLE WHO ACCESSED SUPPORTIVE CARE SERVICES

Family Members 1,901

Patients 681

Total number of people supported: 2,582

“

“

I would like to say a massive thank you for all your help and dedication towards me, for without which, I do not think I would be here now.

A patient

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2. 2.

Performance inin 2012-2013 Performance 2012-2013 21/11/2013 09:28

Supportive Care: The Whole Family Support is available to everyone, including children, and is provided both at the hospice and across the community.

Support is offered in a variety of ways, including: > > > >

One-to-one counselling Spiritual care Self-help techniques Attending group sessions.

SUPPORT FOR THE WHOLE FAMILY The youngest person supported was 6 years old

Telephone calls 1,621 sessions

One-to-one & group sessions 2,783 sessions

Creative workshops & other special events 29 sessions

One-to-one & group sessions for the bereaved 1,605 sessions

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Supportive Care: Day Hospice Day Hospice is available to patients 3 days a week throughout the year. They spend timetable free days together at Deer Park, enjoying the gardens, the art room, entertainment, days out and delicious lunches.

Over the last year, 53 patients benefitted from coming together and belonging to a community of people who really understand the challenge of living with a life-limiting illness.

The wife of a patient

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“

“

Just to say thank you so much for all your kindness and care that you gave my husband at Day Hospice. He loved going there and so often said he felt spoilt by you all! Those days he had with you did him so much good and he enjoyed making new friends there. Will you please thank his driver, how much he helped us both he will probably never know!

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Supportive Care: Complementary Therapy Deer Park is a relaxing environment for patients and carers to receive a complementary therapy. The therapies help relieve symptoms and enhance well-being. Therapies available include aromatherapy, massage, Indian head massage, reflexology, Bowen technique and Feldenkrais method.

During the last year there has been a significant increase in the number of treatments being delivered to patients and carers. It rose from 385 in 2011-2012 to 705 therapies in 2012-2013. This rise is linked to the appointment of a Complementary Therapy Team Leader. She has recruited a team of qualified therapists who volunteer their time to deliver a range of therapies to our patients and carers, completely free of charge.

NO. OF COMPLEMENTARY THERAPY SESSIONS DELIVERED Patient Sessions 392 sessions

Carer Sessions 313 sessions

Total number of sessions : 705

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Our Education During 2012-2013, 17 student nurses and 7 Registered Nurses joined us for their training placements. Some worked alongside our team on the Bedded Unit whereas the majority worked with our Community Nurses, delivering care and support to patients at home across North Devon. We also welcomed 5 GP Registrars as well as several medical students.

Last year we delivered 25 educational sessions to our local healthcare partners, which ranged from general study days on palliative and end-of-life care to the ‘Specialist Approaches to Palliative Care and Care of the Dying’ module which contributes to the Health Studies degree from Plymouth University. To be responsive to the needs of our partners and in turn, the needs of our patients, we welcomed GPs, District Nurses, and Care Home representatives to an ‘Education Shaping Event.’ In response to this we have changed the focus of the hospice’s end-of-life care education towards delivering outreach sessions throughout the North Devon community.

In addition to the above, the Care Homes Facilitator conducted over 100 visits to nursing and residential homes in an educational capacity.

“

With regard to my work experience on the Bedded Unit, staff were very warm, friendly and inviting. Everyone was happy to talk to me and encouraged me to ask questions. I felt my presence was wanted, which is a bit of a treat for a medical student. What I really got from the experience is a gold-standard example of how medicine should be practised and how clinical teams should work together. I found it an extremely valuable placement.

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“

A medical student

Performance 2012-2013 2. 2.

Performance inin 2012-2013 21/11/2013 09:28

3.

Our Priorities for 2013-2014 > To deliver services closer to home across North Devon through our Hospice to Home initiative in order to provide more readily accessible holistic care > To undertake stakeholder engagement that will contribute to the future development of hospice services > To further develop the integration of care services >

To further develop and co-ordinate education to meet the needs of stakeholders with a particular focus on increasing the knowledge and skills of healthcare professionals in the delivery of end-of-life care as well as building relationships with Nursing and Care Homes across North Devon.

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The Board of Trustees’ Commitment to Quality North Devon Hospice’s Board of Trustees take direct responsibility for ensuring that patients and their families are given the best possible care. To do this, they ensure that our services continually improve, in a care setting with high standards.

Quality care is achieved through evidence-based audits, and at North Devon Hospice we audit regularly and thoroughly. This is to ensure we are compliant with regulatory frameworks and also so that the views and needs of our patients, their families and other healthcare professionals can be taken into account.

Outcomes of these audits are reviewed by appropriate committees of the Board.

Regular reviews are undertaken to identify any risks and aspects of safety that may impact upon our standards of care, so that they can be acted upon or prevented. We consistently review and improve the quality of our care for the benefit of those who need our services.

Statements of quality assurance from the Board of Trustees are available in the Annex.

100% compliance awarded in 2013 for the second year running

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Priorities forin 2013-2014 2.3.Performance 2012-2013 21/11/2013 09:28

With Thanks Every aspect of our care is provided completely free of charge to all who need it, offering comfort and care to those facing the most difficult of times. However, this is only possible thanks to the people of North Devon, whose generosity enables us to care for those facing life-limiting illnesses. We are ever grateful for this support, and as you can see from the details in this Quality Account, every pound donated makes a difference to the lives of local people.

There are many ways in which people can support the work of North Devon Hospice, including taking part in one of our many fundraising events or leaving a gift in their will. Please visit www.northdevonhospice.org.uk for more ideas, or call our fundraising team on 01271 344248. We would be delighted to hear from you.

Comments and Feedback If you have any comments or questions about this Quality Account, or our services in general, we are always happy to hear feedback. Please do not hesitate to contact us: Vanessa Saunders Head of Clinical Governance & Audit North Devon Hospice Deer Park, Newport, Barnstaple North Devon, EX32 0HU vanessasaunders@northdevonhospice.org.uk / 01271 344248

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4. Annex

Statements of Quality Assurance from the Board of Trustees In compliance with statutory regulations, North Devon Hospice’s Board of Trustees can confirm: 1.1 During 2012-2013 North Devon Hospice provided or sub-contracted no NHS Services directly. A grant was received from the Devon Primary Care Trust to provide palliative and end-of-life care.

1.2 During 2012-2013, no National Clinical Audits and no National Confidential Enquiries covered NHS services that North Devon Hospice provides.

1.3 The reports of fifteen clinical audits were reviewed by North Devon Hospice in 2012-2013 and North Devon Hospice will take action to continue improving the quality of healthcare provided.

1.4 The number of patients receiving NHS services provided or sub-contracted

by North Devon Hospice in 2012-2013 that were recruited during that period to participate in research approved by a research ethics committee was zero.

1.5 North Devon Hospice’s income in 2012-2013 was not conditional on achieving quality improvement and innovation goals through the Care Quality Commission.

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1.6 North Devon Hospice is required to register with the Care Quality Commission and its current registration status is active. North Devon Hospice has the following conditions on registration: to provide the regulated activities of diagnostic and screening procedures, transport services, triage and medical advice provided remotely, treatment of disease, disorder or injury with conditions, and personal care as of the 31st March 2013.

1.7 The Care Quality Commission has not taken enforcement action against North Devon Hospice during the reporting period of 2012-2013.

1.8 North Devon Hospice has not participated in any special reviews or investigations by the Care Quality Commission during the reporting period.

1.9 North Devon Hospice did not submit recordings during 2012-2013 to the Secondary Uses Service for inclusion in the Hospital Episode Statistics which are included in the latest publication data.

1.10 North Devon Hospice was not subject to the Payment by Results Clinical Coding Audit during 2012-2013 by the Audit Commission.

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Referral Criteria Community Specialist Palliative Care Nursing Service To provide a specialist palliative care community nursing service for adult patients with complex problems associated with a life-limiting illness Available to people who: - Have an advanced progressive illness/on the Gold Standards Framework - Need advice and care for pain management and other distressing symptoms - Would benefit from holistic care, with any emotional and spiritual needs being addressed

This includes: - Clinical Nurse Specialists providing advice and support to patients and families in the care setting of their choice - The hospice multi-disciplinary team sharing care, information, advice and support with other health and social care professionals

Referral: Completion of the ‘request for services’ referral form or calling 01271 344248.

Whilst healthcare professionals can request community nursing services, the patient’s GP must give their agreement on all occasions. Acceptance is reviewed during the daily (Monday to Friday) referral team meetings.

Community Palliative Care Service To provide practical nursing care and support for patients requiring palliative care and their families during the final days of their life.This service is provided to facilitate patient choice in relation to preferred place of care and reduce inappropriate hospital admission Available to people who: - Need practical care and support in the final days of life

This includes: - Practical care and support during the night for patients during their final days - Practical and emotional support during the night for carers during final days - Facilitation of ‘Just in Case’ boxes across North Devon

Referral: Via phone during office hours (Monday to Friday) by calling 01271 347247 or out of hours referrals via Devon Doctors by calling 01392 823666. Requests from all healthcare professionals. Acceptance is reviewed as soon as possible to avoid delay.

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Specialist Palliative Care In-Patient Service; the Bedded Unit To provide specialist palliative care inpatient services for adult patients who have complex problems associated with a life-limiting illness Available to people who: - Have an advanced progressive illness - Need treatment for complex pain management or other distressing symptoms - Have complex end-of-life care needs

This includes: - 24 hour care in a purpose built 7 Bedded Unit to help with the management of complex symptoms or in providing end-of-life care - Allied Healthcare Professionals providing one-to-one and group sessions - Consultant outpatient treatments and Consultant domiciliary appointments - The hospice multi-disciplinary team sharing care, information, advice and support with other health and social care professionals

Referral: Completion of the ‘request for services’ referral form. In urgent and out of hours cases, call the Duty Medical Officer direct on 01271 347214. All requests must be with the explicit agreement of the GP and/or relevant hospital Consultant. Acceptance is reviewed as soon as possible, avoiding delay for admissions.

Supportive Care Services To provide a range of supportive care services, pre and post bereavement, to patients, carers and family members, including children Available to people who: - Are over 18 and have a life-limiting illness - Or are adults or children deeply affected by that person’s illness - Or are left bereaved as a result of that person’s death

This includes: - Support groups for patients, for carers and also the bereaved - Day Hospice - ‘Look Good Feel Great’ sessions - ‘It’s Friday’ drop-in - Complementary therapies

- ‘Staying Steady’ sessions - ‘Pamper Days’ for carers - One-to-one bereavement support - Support for children and their carers - Pastoral and Spiritual Support

Referral: Completion of the ‘request for services’ referral form. Requests can be made from GPs’, Consultants, Social Services, other hospices and other agencies. Requests are considered at any point in the patient’s/family’s journey and acceptance is reviewed during the daily (Monday to Friday) referral team meetings.

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Hospital based Specialist Palliative Care Service To provide support to individuals who have cancer or any other life-limiting illness, at any stage of their journey Available to people who: - Have advanced progressive incurable disease and who agree to the referral being made

This includes: - Symptom control, including patients with distressing physical symptoms which are difficult to manage by professionals in the current care setting - End-of-life care for patients whose needs are difficult to manage by professionals in the current care setting - Complex emotional or spiritual issues related to the patient’s illness, that are being experienced by family and carers - Assessing patients for hospice admission

Referral: Via phone on 01271 311642. Referrals can be made 24/7 by medical, nursing or allied health professionals who have the agreement of the consultant team responsible for the patient’s care.

Hospice to Home Service To provide care and support for palliative patients and their carers, during the day and/or night for up to 72 hours when nearing end-of-life. This service is provided with the aim to reduce inappropriate admissions to hospital Available to people who:

- Are over 18 and have a life-limiting illness - Are known on the Gold Standards Framework register - Have a care plan and risk assessment - Require care to prevent admission to hospital or another care setting - Live in North Devon or Torridge side

This includes: - Hands on end-of-life for up to 72 hours and palliative care and support in the community - Crisis intervention to prevent unplanned admission - Skilled carers to provide round the clock care for those at end of life

Referral: Referrals taken between 8am and 8pm. Via the phone during office hours (Monday to Friday) by calling 01271 347246 or 347247. Out of hours contact via Community Nurses on 01392 823666. Requests accepted from all healthcare professionals. The service excludes routine packages of care, and does not provide respite care.

The referral forms are available online from www.northdevonhospice.org.uk and copies available by calling 01271 344248 4 . Referral Criteria Quality Account 2012-13.indd 27

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Working in the homes of our patients across the community Working with GP practices & District Nurses Working with Nursing Homes & Residential Homes Working with Hospitals & Community Hospitals North Devon Hospice Deer Park Hospice Shops

Lynton

Combe Martin

Woolacombe

Ilfracombe

N O R T H D E V O N

Braunton

Heanton

Chelfham

Barnstaple Instow

Landkey Swimbridge

Northam Abbotsham

Bideford

South Molton

Alverdiscott

Hartland Great Torrington

High Bickington

T O R R I D G E Chulmleigh

Bradworthy

Holsworthy

Shebbear Black Torrington Beaworthy

being there for all the family North Devon Hospice, Deer Park, Barnstaple, Devon EX32 0HU email: info@northdevonhospice.org.uk www.northdevonhospice.org.uk / 01271 344248 Registered charity no. 286554

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