North Devon Hospice Quality Account 2018-2019

Quality Account 2019

being there for all the family

northdevonhospice.org.uk

Contents 3 Where can we step in to support your patients?

4 ‘We didn’t think we needed the hospice but we really do’ 5 Our top achievements last year 6 Our services 12 How to refer to us

I remember the ambulance nurse said to me when we arrived with Mum, just how lucky we were to come to the hospice.

I remember thinking it was an odd thing to say at the time, but when my mum was dying at the end, I really got it. Mum was in the right place and was happy.

Nothing was too much trouble for any of the staff.

We are currently rated as ‘Good’ overall by the CQC with an ‘Outstanding’ rating for our patient care

Jo Dedes Director of Care

Dear Colleagues, I wanted to take this opportunity to introduce myself as the new Director of Patient Care for North Devon Hospice. Although I’ve relocated to the beautiful area of North Devon from St Luke’s Hospice in London, I’ve not relocated just for a life by the sea. My motivation is to ensure that people who need our services are able to both access them and receive the best care possible. As a healthcare professional, you might be regularly referring your patients to our services already and that’s great. If you’re not, I want to reach out to you and encourage you to get in touch if you have a patient facing a life limiting illness including cancer, motor neurone disease, heart and kidney failure and COPD. Even at early diagnosis stage, we are able to step in and begin the conversation, if a patient feels ready to start their journey with us.

Within the last year, we were recognised at the very highest level of innovation and quality in health care at the National Patient Safety Awards – this was a proud moment for us and shows our determination to excel in giving our patients and their loved ones the very best care. We were also accredited once again as ‘outstanding’ by the CQC for our patient care.

I very much look forward to meeting and working with you all over the coming months.

Warmest regards, Jo Dedes Director of Care

2

Where can we step in, to support your patients?

Our care and support is available to any local person and their families facing a life limiting illness including cancer, motor neurone disease, heart and kidney failure and COPD. We offer this support through a number of ways: -

- - - - - -

Clinical support at home through our team of Clinical Nurse Specialists End of life care at home through our Hospice to Home team End of life or symptom management in our Bedded Unit One to one bereavement and emotional counselling Group counselling and support Complementary Therapies A range of activities aimed at improving wellbeing, independence and quality of life

We recognise that healthcare professionals are extremely busy and we want to support you with your own patients in the most efficient way possible. To make a referral, please email us at ndh.referrals@nhs.net

3

“We didn’t think we needed the hospice, but we really do” Simon and Sarah live in Bradworthy and have been receiving support from the hospice after a scan revealed a tumour on the left side of Simon’s face, which would ultimately require nine operations as well as bouts of chemotherapy and radiotherapy.

Simon shared “We wanted to understand what support was out there and, luckily enough, we found North Devon Hospice. It’s proved tremendous for both of us. We came here not knowing what to expect. We thought it might be like sitting in a day room with a load of old people! But it’s not like that at all! It’s fun, we chat, we’re just here to have a day off and relax.”

The couple have been supported in a number of ways at the hospice’s outreach centre in Holsworthy, called The Long House.

This has included counselling sessions, complementary therapies and other activities. Sarah said, “The main thing for me is that I feel supported. If things weren’t going well I could ring here rather than having to go through the doctor. It’s good to know that you’re not in a leaky boat on your own, there are other people with you helping to bail out.”

The couple are very much living life to the full at the moment with the support of the hospice. Sarah said “After a day at the hospice, I do feel re-energised, rejuvenated. I know it’s a cliché, but I’ve had time to relax, time to talk to people, and after a day here I feel more alive and I think that’s what it’s all about really.’

You can watch Simon and Sarah’s full interview by visiting northdevonhospice.org.uk/news

4

What we achieved together

2,778

5,968 51,701

10,691

298 12,004

hospital admissions avoided where we’ve stepped in

visits made to our patients in their homes

5

supportive care sessions

referrals made to our Hospice to Home team

miles travelled across the 800 square miles we cover in North Devon

calls to patients and carers giving advice and support

Our Services Clinical Nurse Specialists Our team of Clinical Nurse Specialists support patients and their families in their own homes offering care and support to them as they go through their illness. With the vast majority of our patients choosing to be supported at home, our team of nurses can provide advice and support with: Pain and symptom control Emotional and spiritual support Practical support such as use of medication, nutrition, benefits and skin care etc.

Last year...

4,923 visits to patients’ homes 51,701 miles covered across North Devon 1,568 patients and carers supported

Bedded Unit We provide a specialist palliative care in-patient service for adults with complex problems associated with advanced progressive illnesses. This is available to patients who have complex end of life care needs and require treatment for pain management or other distressing symptoms 24 hours a day.

We always aim to provide individualised care and support, prioritising the patient and not just the illness. In all that we do, we aim to make our patients comfortable during their stay with us in their final weeks and days of life. Patients are admitted to our 7 bedded unit via a GP or Consultant referral. When under our care, they are able to benefit from one to one symptom management and end of life care. Many of our patients are able to return home after a short stay with us.

Last year...

98 patients cared for on our Bedded Unit 39 patients supported to go home 5 star satisfaction from ‘I want great care’ (based on 106 reviews)

6

Hospice to Home Our rapid response ‘Hospice to Home’ service can provide round the clock care for those who need more hands-on care and support towards the end of life. We offer personal care, practical help, psychological support and symptom control.

Thanks to the ‘Hospice to Home’ service, over 200 people avoided an unnecessary admission into hospital. These interventions not only saved the NHS thousands of pounds, but also meant many patients can achieve their preferred place of care and carers could have a valuable break at a difficult time.

Last year...

298 patient referrals 210 hospital admissions avoided 5,768 visits to patient homes

Supportive Care We continually review our supportive services to ensure we adapt to the needs of the people we support and the community. Recognising that every person is unique and has different needs is integral to the ethos of our support.

We offer - One to one support for adults and children - One to one bereavement support for adults and children - Group support sessions for patients and carers - Group support for those who are bereaved - Complementary therapies In addition to this support, we also offer a range of activities and sessions which we tailor to the needs of individuals in our care at the time. This has included running Wellbeing Sessions, dinner events, singing workshops and other creative groups. The majority of our sessions are delivered from either the Hospice in Barnstaple or at The Long House outreach centre in Holsworthy.

7

Last year...

1,184 people received supportive care 5,968 attendances for one to one and group sessions at our Hospice in Barnstaple and at The Long House outreach centre in Holsworthy 985 journeys organised by our team of volunteer drivers

Education During the last year our education department trained 725 healthcare professionals. We also focused on providing training for our own clinical staff to ensure that their knowledge, skills and competencies are up to date and meet the needs of our patients. Full and half day training for local healthcare professionals has also been provided in a variety of end of life care topics.

The following sessions were available to hospice staff as well as external health and social care staff: - -

- - - - - - -

Mental Capacity Act and advance care planning discussions Communication – basic awareness, enhanced communication skills and advanced communication training Priorities of care for the dying person Pharmacological approaches to symptom management Practical approaches to symptom management Dilemmas and emergencies in palliative care Human rights approach to end of life care Opening the spiritual gate Palliative care and symptom management for people with end stage dementia

8

Patients benefiting at hospital with new hospice nursing posts Two new hospice nurse posts have been introduced at North Devon Hospital to help improve care for end of life patients facing life limiting illnesses while in hospital.

One of our nurses, Charlie Raymont, who typically can support up to 9 patients each day at the hospital tells us “Most of the hospice’s work involves supporting patients in their own homes, but this new partnership with the hospital helps ensure seamless care for patients and their families based at the hospital at a particularly difficult point in their lives.”

Charlie added “I know how the hospice works so once we get a patient referral at the hospital with a life limiting illness we look at what they need, what they ideally want and where they want to be looked after. We evaluate their symptoms, give support to their loved ones and make a call on whether we then transfer them back home with support from our team of nurses; or evaluate whether their care needs have advanced where a transfer to our Bedded Unit at North Devon Hospice is more appropriate. So we really see ourselves as one integrated team with the hospital staff, to ultimately help improve the process for patients and their families.”

In summing up the joint partnership, Charlie said “It’s a big team effort and the staff on the wards are absolutely fantastic. We combine well together to just add that little bit of extra support for people and provide the best care we can. That’s why this partnership is really blossoming.”

9

Overview of Clinical Audits 2018/19 We strive to maintain a standard of quality through clinical audits. We monitor our efficiency and effectiveness through quality control audits: - - - - - - - - - - - - - - - - - - -

Skin Care Audit Medicine Management Audit Use of Midazolam in IPU Audit IPU Cleaning Audit IPU Mattress Audit Confidentiality Audit Controlled Drugs Audit Equality and Diversity Audit Opiates and constipation prescribing in IPU Audit Hand Hygiene Audit Infection Control Audit Referral Response Times Audit Syringe Drivers in Nursing Homes Audit Falls, medication errors and pressure damage benchmarking ‘I want great care’ monitoring Drug Errors and Incidents Trend Report Drug Errors and Incidents Staff Trend Report IPU Documentation Standards Audit Pressure Damage Report

Statement of Quality Assurances In compliance with statutory regulations, North Devon Hospice’s Board of Trustees can confirm:

1.1 During 2018-19 North Devon Hospice provided or sub-contracted no NHS services directly. A grant was received from the Devon Clinical Commissioning Group to provide palliative and end of life care.

1.2 During 2018-19, no National Clinical Audits and no National Confidential Enquiries covered NHS services that North Devon Hospice provides.

10

1.3 The reports of 19 clinical audits were reviewed by North Devon Hospice in 2018-19 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 2018-19 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 2018-19 was not conditional on achieving quality improvement and innovation goals through the Care Quality Commission.

1.6 North Devon Hospice is required to register with the Care Quality Commission and its current registration status is active.

We are active in the following areas: - Treatment of disease, disorder and injury - Personal care 1.7 The Care Quality Commission has not taken enforcement action against North Devon Hospice during the reporting period of 2018-19.

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 2018-19 to the Secondary Users 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 2018-19 by the Adult Commission.

11

Referrals:

What you can do, to make a difference to your patients Referring your patients and their family members to us early ensures that they are able to access a whole range of care and support services, at any point throughout their journey Pagediagnosis.

12 from initial It can also help to negate the volume of support related visits to GPs. How to refer to our services– use website text ‘table’ that Leo/Naomi updated last year 24 hours and We respond to all clinical referrals within supportive care referrals within 5 working days. Please call us on 01271 344248 to discuss your needs.

Clinical Nurse Specialist Service We provide a specialist palliative care community nursing service for adult patients, who have a progressive illness or are on the Gold Standards Framework Register and would benefit from symptom management, psychological assistance and holistic care with emotional or spiritual needs. The multi-disciplinary team work closely with other healthcare providers to ensure the patient is supported on an individual basis. Each patient has a named contact within the team and we respond to case referrals within 24 hours.

Agreement for CNS intervention must be received from the patients’ GP on all occasions. Contact our team on the number above.

10

12

The Bedded Unit We provide a specialist palliative care in-patient service for adults with complex problems associated with advanced progressive illnesses. This is available to patients who have complex end of life care needs and require treatment for pain management or other distressing symptoms 24 hours a day.

All requests for referral to our bedded unit must be with the explicit agreement of the GP and/or relevant hospital consultant.

In urgent and out of hours cases, call the Duty Medical Officer on 01271 347214, alternatively contact the main hospice number on 01271 344248.

Hospice to Home Service

Page 13

We provide care and support for patients at or near end of life, short-term intervention, to help prevent a crisis from Howastoa refer to our services (contd) (as above) escalating or to avoid an acute admission. This service is available to patients who are identified as being in the last 3 months of life.

Referrals can be made between 8.30am – 5pm, Monday to Friday by calling 01271 347246/7, or out of hours by calling 01392 822342. Referrals are accepted from all healthcare professionals.

Supportive Care Services We provide a range of supportive care services, pre and post bereavement to patients, carers and family members, including children. These services are available to all patients within the care of the hospice along with any adults and children who are affected by the diagnosis or have been bereaved as a result of a patient’s death.

Referrals can be made by GPs, consultants, social services, other hospices and other agencies. Please contact us on 01271 344248 to discuss how we could help.

13

13

Where we offer our services We have been providing care for 35 years. The majority of our care is provided within people’s own homes. In addition to the care and support we offer throughout the community, we have teams based at two locations in North Devon.

Our main site is based on the outskirts of Barnstaple. Our patients and families can access a wide range of care and support services, including our 7 bedded in-patient unit.

Deer Park, Barnstaple

North Devon Hospice, Deer Park, Barnstaple, North Devon EX32 0HU

The Long House is a purpose built outreach centre adjacent to Holsworthy Medical Centre. Patients and their families can access a range of supportive care services including group support, complementary therapies and one to one support.

The Long

House,

Holsworthy

15

North Devon Hospice, The Long House, Dobles Lane, Holsworthy, North Devon EX22 6GH 01271 344248

16

Thank you On behalf of every patient and family member we have supported over the last year, we thank you for your continued support of North Devon Hospice.

We rely on support from our local community to continue providing the level of care we currently offer for patients and their families. We need to raise over ÂŁ4.7m each year to be able to provide our care and support year on year. We can only do this thanks to regular donations,

fundraising, events, donations to our charity shops and gifts left to us in wills.

If you have any comments or questions about the information provided within this publication, or on our services, we would love to hear from you. Please contact Jo Dedes by post, email or telephone: Jo Dedes

Director of Care, Registered Manager & Accountable Officer for Controlled Drugs. jodedes@northdevonhospice.org.uk 01271 347203

North Devon Hospice, Deer Park, Barnstaple, Devon EX32 0HU email: info@northdevonhospice.org.uk www.northdevonhospice.org.uk / 01271 344248 Registered charity number 286554.