Quality Account 2019-2020

Quality Account 2020

being there for all the family

northdevonhospice.org.uk

Dear Colleagues, Jo Dedes It is a year since I joined the fantastic team here at North Director of Care Devon Hospice. Having worked in the same role at a hospice in London, I already knew that hospice staff everywhere are dedicated, committed and compassionate. But what I found here was a real passion for improvement; an ambition to always do better; a genuine concern that we listen and learn.

During the last year we have implemented the electronic patient data system, SystmOne. We did this to help us work more closely with our primary care colleagues, facilitating communication by streamlining the referral process through the system. We hope that through this year you will really start to see the benefits of working together with the same system.

During 2019/2020 we have educated over 500 colleagues from other teams supporting them to develop their knowledge and skill in topics such as symptom management, human rights at end of life and palliative emergencies.

We have used feedback, incident reviews, audits and national guidance to shape and inform our service development and quality improvement program during 2019/2020. And we did this against the backdrop of delivering excellent care every day here at the hospice, in people’s homes, through our service based at the hospital and at our outreach centre in Holsworthy. During the last year we have mapped out a new model of care that will maximise capacity and create greater flexibility to respond to need. Because of the pandemic we have had to pause the implementation of some of the new ways of working but we have been able to implement some changes, including improved rapid response and a single point of referral.

As we look back at 2019/2020 we couldn’t have imagined that we would be facing the challenge of a global pandemic. We know that this has impacted the way we work now and possibly for the long term. It has been tough; but there has also been so much from which we can learn. Next year when I write to you I hope to tell you that we are still using technology and innovative approaches to extend our reach into the community and improve access to our services.

We work best when we work together.Your continued support of our work, the referrals you make to our services and the collaborative approach we take to support the care for our patients is what makes working at the hospice so rewarding. And it’s what helps ensure our patients and families experience the very best care that we have to offer here in North Devon.

Best wishes, Jo Dedes, Director of Care

Where can we step in to support your patients?

Our care and support is available to any local person and their families facing a terminal illness such as cancer, motor neurone disease, heart and kidney failure and COPD. All of our care is provided free of charge thanks to the generous local community who keep our services going.

We can offer support through a number of ways: - Clinical support at patient’s homes via our team of Clinical Nurse Specialists - End of life care at home through our Hospice to Home team - End of life or symptom management on our 7 Bedded Inpatient Unit - One to one bereavement and emotional counselling for family members - Group counselling and support for those caring for patients or who have lost someone - Complementary Therapies to help relieve pain and stress - A range of adaptable activities aimed at improving wellbeing, independence and quality of life for families.

- Clinical Support for those palliative patients based at North Devon District Hospital through our Clinical Nurse Specialists based there.

We understand that as healthcare professionals you are all extremely busy so we aim to support you with your own patients in the most efficient way possible.

To make a referral to us, please email us at ndh.referrals@nhs.net

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The Difference We Make Together “When we first got told Dad was going to the hospice we were very, very scared.

But within the first hour of being there we were just overwhelmed with how incredible the place was. The support was very important for all of us and it was like an extended family really. Dad was able to go outside with the grand kids and they could play in the gardens. We made some special memories at the hospice.”

Son of a patient

“From the whole of my heart I would like to thank the entire team. You will never know how much you’ve helped me and my family. I called for help and you were there. ‘Friends Forever’.”

Family member

“The Hospice to Home team started coming in twice a day and it made the biggest difference to our lives.They go above and beyond - more than what could be in any job description.They’re just fabulous. I thought the hospice was just like a hospital, but really what they do is make the whole situation easy for the whole family, by being in the home with us every single day. It’s made a huge difference.”

Daughter-in-law of a patient

“It’s wonderful to see the difference in someone after I have referred them to the hospice, it’s almost like a weight has been physically lifted from their shoulders” Local GP

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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 Page 12services, at any point throughout their journey and support from initial diagnosis. It can also help to negate the volume Howrelated to refer to our to services– of support visits GPs. use website text ‘table’ that Leo/Naomi updated last year We respond to all clinical referrals within 24 hours (Monday - Friday) and 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.

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

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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

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We provide care and support for patients at or near end of life, a short-term intervention, to help prevent a crisis from Howasto refer to our services (contd) (as above) escalating or to avoid an acute admission. The Hospice to Home service is available to patients who are identified as being in the last 3 months of life. We work closely with Devon Cares to arrange packages of care if required.

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.

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Our Achievements Clinical Nurse Specialists Last year...

3,734 visits to patients’ homes 35,795 miles covered across North Devon 9,879 contacts with patients and carers over the phone or in person to offer support

Bedded Unit Last year...

102 patients cared for on our Bedded Unit 21 patients supported to go home 5 star average rating from ‘I Want Great Care’ based on nearly 700 reviews

9,879 contacts with patients and carers

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star average rating from ‘I Want Great Care’

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Hospice to Home Last year...

306 patient referrals 5,401 visits to patient homes 8,043 hours spent with patients at home

5,401 visits to patient homes

Supportive Care Last year...

953 people received supportive care 5,531 attendances from patients or family members at one to one and group sessions 1,772 journeys organised by our team of volunteer drivers

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953 people received supportive care

Education During the last year we have trained 511 healthcare professionals. We also heavily focused on providing training for our own clinical staff to ensure that their knowledge, skills and competencies are constantly meeting the needs of our patients.

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

Overview of Clinical Audits 2019/20 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

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Statement of Quality Assurances In compliance with statutory regulations, North Devon Hospice’s Board of Trustees can confirm: 1.1 During 2019-20 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 2019-20, no National Clinical Audits and no National Confidential Enquiries covered NHS services that North Devon Hospice provides.

1.3 The reports of 19 clinical audits were reviewed by North Devon Hospice in 2019-20 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 2019-20 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 2019-20 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 2019-20.

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 2019-20 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 2019-20 by the Adult Commission.

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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.

North Devon Hospice, Deer Park, Barnstaple, North Devon EX32 0HU 01271 344248

Deer Park, Barnstaple

The Long

House,

Holsworthy

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.

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

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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 £4.7m each year to be able to provide our care and support year on year. We can only do this thanks to regular donations,

community fundraising, 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

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

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