North Devon Hospice Quality Account - 2017/2018

North Devon Hospice

Quality Account 2017/18 Make a referral as soon as a patient hears the news or call us on 01271 344248 for more information

northdevonhospice.org.uk

Contents 3 Our achievements 4 Overview of Clinical Governance 5 A look at our Patient Services 12 Priorities for 2018/2019 12 Statements of Quality Assurances 14 How to refer

Shortlisted for the National ‘Patient Safety Awards’ for improving response time to our referrals

PATIENT SAFETY AWARDS

For more information call us on 01271 344248 visit www.northdevonhospice.org.uk

Our care was rated ‘Outstanding’ by the CQC

Rachel McCarty Director of Care, Registered Manager & Accountable Officer for Controlled Drugs

Murray Fletcher Consultant in Palliative Medicine

Dear Colleagues, From the moment someone hears the news, you can make a referral to us.

Your early referrals mean that we can be there for patients and their wider family and friends for the entirety of their journey, enabling them to access a wide range of care and support.

During the last year, we have been shortlisted for the National ‘Patient Safety Awards’ for improving response time of our referrals. In addition to this, we continue to streamline our referral process. Looking to the year ahead, we are preparing to make the transition from Cross Care to Systm One. This transition is another example of our commitment to continuous improvement in working together for the benefit of local patients.

We very much look forward to working with you in the coming year.

Warm regards,

Rachel McCarty

Murray Fletcher

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About North Devon Hospice Our care and support is available to local patients and their families.

• Ongoing clinical support with our Clinical Nurse Specialists across North Devon • End of life care at home with the Hospice to Home team • In-patient care on the Bedded Unit • One to one counselling • Group counselling • Bereavement counselling • Complementary Therapies North Devon Hospice is a local charity providing specialist care to over 2,000 patients and their families each year. We care for people who are affected by a life-limiting illness; not just cancer, but other illnesses such as Motor Neurone Disease, Renal Failure, Heart Failure, COPD et al.

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

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Our achievements

PATIENT SAFETY AWARDS Shortlisted for ‘Patient Safety Awards’ for improving referral response time

Our care was rated ‘Outstanding’ by the CQC

676 the number of hospital admissions avoided

mi²

800 80 82 the number of square miles we cover across North Devon

pence in each pound raised is spent directly on patient care

% of patients achieved their preferred place of care

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Overview of Clinical Governance We strive to maintain a standard of quality through clinical audits.

We monitor our efficiency and effectiveness through quality control audits:

Clinical Audits

Learning Points

• Hand Hygiene • Medicines Management • External Infection Control and ATP Testing, Clinical Care Environment • Confidentiality • Preferred Priorities for Care • Safe Disposal of Sharps • Documentation Scanning Audit • Patient Property Documentation • Barriers to Accessing Supportive Care Services • Management of Patients’ Own Medications upon Admission and Discharge to the Bedded Unit • Documentation of Infection Risk • Monitoring the Use Of Antibiotics on Bedded Unit over 3 months • Patient Meal Feedback • Equality and Diversity • I Want Great Care • Hospice UK • Falls, Medication Errors and Pressure Damage Benchmarking • Factors Influencing Duration of Hospice-based Palliative Care Services from Referral to Death

• Supporting Patients with Swallowing Difficulties • Nursing Associates – How We Are Getting Involved • Falls Prevention • MND Special Interest Group • Anxiety Management for Palliative Care and Progressive Conditions • Potential and Possibility: Rehabilitation at End of Life • Sign Up to Safety • DOLS Update • New Diabetic End of Life Pathway • Verification of Expected Death on the Bedded Unit by Registered Nurses

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Significant Event Meeting •

•

How Can Hospice to Home Support Bedded Unit Staff Out of Hours An Example of Managing Challenging Pain at End of Life in the Home

12,575

Patients and carers receiving contact in person or on the phone

4,821 60,557 8,023

Visits made by our CNS team

Miles covered by our CNS last year Contacts with other health professionals

Clinical Nurse Specialists With a family’s permission, our nurses are able to work closely with a patient’s own GP, District Nurse and other health care professionals to ensure that the best joined up care is made available.

Our CNS team made nearly 5,000 visits during the last year, ensuring that they were providing specialist care, advice and emotional support to patients and their families in the care setting of their choice.

When my hospice nurse visits me at home I don’t feel so alone. She is there for me and I can talk to her about anything.

A patient

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149

Total patients cared for on our Bedded Unit

31

Bedded Unit

People went on to continue with care at home

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 during their final weeks and days of life. Patients are admitted to our 7 bedded unit via GP or Consultant referral, once here they are able to benefit from one to one symptom management and end of life care. Many of our patients then go on to return home with our continued support.

233 310

Avoided Hospital admissions

Total referrals to our ‘Hospice to Home’ team

9,294

Hospice to Home

Hours spent with patients at 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. This intervention not only saved the NHS thousands of pounds, but also means that many patients can achieve their preferred place of care and carers can have a valuable break at a difficult time.

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I know that I’m at the end of life stage, there is no point beating about the bush.

But being at home makes a real difference, because I wouldn’t want to be in hospital. My son and daughter both live nearby and care for me fantastically well, but they both have full-time jobs. Having this extra support and expertise takes the pressure off them, for which I’m very grateful.

A patient

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We can offer care and support for all the family. We urge all GPs to make a referral as early as possible to ensure their patients are supported in all aspects, including with their emotional health.

A counsellor

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1,222 5,966

Interactions with supportive care patients

people accessed supportive care services

1,872

Bereavement support sessions given to family members

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 • Group support sessions for carers • Group support for those who are bereaved • Complementary therapies In addition to the support offered above, we also offer a range of ‘activities’ and ‘sessions’ which we tailor to the needs of the individuals in our care at the time. During the last year these have included: • Special Events: - Film with Lunch - Picnic at Deer Park - Singing Workshop - Candlelit Dinner - BBQ - Summer Party - Quiz Party - Lantern Party - Midwinter Celebration - New Year Gathering

• Creative Groups: - Tracks of My Years - Recycled for You - My Story - Something for your Tree - Picturing Me - Fingerprints - Weaving Words • Activity/Well-being Groups: - Gardening - Seated Exercise/Hand Massage - Head to Toe - Mindfulness

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100% 773

Positive feedback from all course attendees

Healthcare professionals trained in 2017/2018

273

Nursing/Residential home staff supported with training

Education During the last year, our Education team focused on providing training for local healthcare professionals in end of life care topics.

The following were included: • Dilemmas in Palliative Care • Palliative Care and Symptom Management for People with

End-stage Dementia • Priorities of Care for the Dying Person • Human Rights • Mental Capacity Act and Advance Care Planning Discussions • Opening the Spiritual Gate • Enhanced Communication Skills • The Emotional Impact of Life-Limiting Illness • Pharmacological Approaches to Symptom Management • Practical Approaches to Symptom Relief

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I refer my patients to the hospice knowing that they can be offered another tier of care. We all work together for the good of our patients.

A physiotherapist

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Priorities for 2018/2019 Achieve funding from the NHS for our Hospice to Home service

Integrate our care model with NDHT

Increase non cancer referrals from GPs

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

1.1 During 2017-18 North Devon Hospice provided or sub-contracted no NHS services directly. A grant was received from the NEW Clinical Commissioning Group to provide palliative and end of life care.

1.2 During 2017-18, no National Clinical Audits and no National Confidential Enquiries covered NHS services that North Devon Hospice provides.

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1.3 The reports of 18 clinical audits were reviewed by North Devon Hospice in 2017-18 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 2017-18 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 2017-18 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 2017-18.

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 201718 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 2017-18 by the Adult Commission.

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Referrals: How to refer to our services 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 from initial diagnosis. It can also help to negate the volume of support related visits to GPs. We respond to all clinical referrals within 24 hours 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 and we respond within 24 hours to case referrals.

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 We provide care and support for patients at or near end of life, as a short-term intervention, to help prevent a crisis from 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.

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Where we offer our services We have been providing care for over 30 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 01271 344248 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

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

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 ÂŁ4.5m 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 Rachel McCarty by post, email or telephone: Rachel McCarty MSc, BSc, RN

Director of Care, Registered Manager & Accountable Officer for Controlled Drugs.

North Devon Hospice, Deer Park, Barnstaple, North Devon EX32 0HU 01271 347203 rachelmccarty@northdevonhospice.org.uk

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