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Quality Account 2013-2014
Contents
1. Quality Statement
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2. Performance in 2013-2014
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3. Priorities 2014-2015
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4. Statements of Quality Assurance 21 5. Referral Criteria
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Crosscare
North Devon Hospice Quality Account 2013-14
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1. Quality Statement Dear colleagues, As a healthcare professional, you play a key role in ensuring local palliative care patients and their families can access our services and support. It is because of your referrals that we cared for over 1,000 new patients during the last year. Working together and supporting people along their journey has never been more important. The landscape of palliative care across the UK is changing and in the not-so-distant future we must all be prepared for an increased need for palliative care and support services. As ever, we continue to work not only towards providing more care, but also providing more of that care closer to people’s homes. During the last year we have been planning for the new North Devon Hospice outreach centre, The Long House, which will be adjacent to the Holsworthy Medical Centre. It has been an exciting development in local palliative care provision and one that will make a significant difference to people in Holsworthy and the surrounding areas. Your interest in our work is always welcome, as is your continued support.
Kind regards,
Medical Director and Consultant in Palliative Medicine murrayfletcher@northdevonhospice.org.uk
Health Professionals Helpline 01271 347214
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for palliative care advice and information
1. Quality Statement
Murray Fletcher
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North Devon Hospice Quality Account 2013-14
Our Values and Vision We provide care and support to local people who are affected by cancer and other life-limiting illnesses. Our emphasis is offering care and support to individuals rather than just treating the illness. In all that we do, our experienced and specialist teams ensure patient safety, provide high quality care and aim to provide positive experiences for the people we meet. 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
1. Quality Statement
• The expertise of our professional teams.
being there for all the family
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www.northdevonhospice.org.uk
North Devon Hospice Quality Account 2013-14
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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 lifelimiting illness and to the adults and children who are close to the patient
Health Professionals Helpline 01271 347214
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for palliative care advice and information
1. Quality Statement
• 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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North Devon Hospice Quality Account 2013-14
2. Performance in 2013-2014 Clinical Governance Our patients’ experience and quality of care is of the utmost importance to us. We place emphasis on clinical standard setting and audit activity to ensure we meet the essential quality and safety standards outlined by the Care Quality Commission. For the 3rd year running, we have been awarded 100% compliance from the CQC, following an unannounced inspection.
being there for all the family
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www.northdevonhospice.org.uk
North Devon Hospice Quality Account 2013-14
Clinical Audits: • • • • • • •
• • • • • • • • • • •
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Learning Points:
Blood Transfusion Carers Support Needs Assessment Tool Controlled Drugs Documentation Hand Hygiene Help the Hospice: Care of the Deceased Person Infection Control Hospice to Home National Association for Hospice at Home Survey Development Questionnaire Infection Control Care Environment Just In Case Box Medicines Management Patient and Carer Focus Group Review Safe Disposal of Sharps Single Point of Access South West Hospices Informatics Project: Medication Errors, Falls and Pressure Damage South West Hospices Regional Community Palliative Care Nurse Specialist Survey South West Informatics Project: Preferred Place of Care for Dying Treatment Escalation Plan (TEP) for Residents in Care Home Preferred Priorities for Care Documentation
• • • • • •
Mesothelioma and Asbestosis ‘Letting Go’ Diabetes Update Liverpool Care Pathway: The Facts and Myths HIV and AIDS: African Perspective Conference feedback on the Management of Breathlessness
Significant Event Meetings: • • •
The Francis Report Learning from Mid-Staffordshire Berwick Report NICE Falls Guidance 2013: Recommendations and Falls Management
Journal Club: • •
Can the Liverpool Care Pathway make a recovery? Discussing Preferred Place of Care for dying
Health Professionals Helpline 01271 347214
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for palliative care advice and information
2. Performance in 2013-2014
100% compliance for the 3rd year running
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North Devon Hospice Quality Account 2013-14
Clinical Service Provision Care closer to home has been a consistent theme during the last year and one that we will echo in years to come. Through developing new services, we have been able to provide more care closer to home, supporting people to achieve their preferred place of care.
Home 247 45% Other 4 1% Hospice 118 22% Community Hospital 29 5%
2. Performance in 2013-2014
Care Home 62 11% Acute Hospital 89 16%
being there for all the family . www.northdevonhospice.org.uk
North Devon Hospice Quality Account 2013-14
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Place of death remains a key performance indicator, enabling us to ensure that, at the end of their lives, patients’ wishes are met. The majority of our patients died in their own homes, in line with their preferred place of care.
A patient’s husband
Health Professionals Helpline 01271 347214
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for palliative care advice and information
2. Performance in 2013-2014
“Thank you for your amazing care and concern for my wife and all of us. My wife died peacefully where she chose, with those she loved. We couldn’t have managed it without you”
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North Devon Hospice Quality Account 2013-14
Community Nurse Specialist Palliative Care Service The majority of our care has always taken place in people’s own homes. During this reporting period, nearly 1,000 patients were supported at home. This specialist support also extended to the patient’s family and main care-giver.
COMMUNITY NURSE SPECIALIST VISITS Quantity of Community Nurse Specialist visits (face to face)
Home 87% Hospice 7% Care Home / Nursing Home 4% Hospital 2%
2. Performance in 2013-2014
Total number of patients supported: 939
being there for all the family
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www.northdevonhospice.org.uk
North Devon Hospice Quality Account 2013-14
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Hospice to Home Service and Community Palliative Care Service Our end-of-life care services provided round-the-clock, hands-on care for patients in their own homes. These essential services may only have been in situ for over a year, but they have already made a large impact, not only to patients and their families but also on local healthcare provision. Hospice intervention has meant that 305 unnesessary admissions to hospital were avoided, which is estimated to make a cost saving to the NHS of around half a million pounds. 96% of our patients achieved their Preferred Place of Care (PPC) because of these services.
CARE CLOSER TO HOME
New Referrals Cancer Non-Cancer PPC Achieved
Hospice to Home
Community Palliative Care
Total
259 192 (74%) 67 (26%) 96%
179 133 (74%) 46 (26%) 96%
438 325 (74%) 113 (26%) 96%
Health Professionals Helpline 01271 347214
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for palliative care advice and information
2. Performance in 2013-2014
Admissions avoided across Hospice to Home and the Community Palliative Care Services: 305
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North Devon Hospice Quality Account 2013-14
The Bedded Unit The majority of urgent referrals to the Bedded Unit were met on the same day, so there was no delay in providing specialist care around the clock. In line with our history of care on the Unit, the majority of our patients were admitted for symptom management, not end-of-life care. Once these symptoms were managed, patients returned home where care was given by the hospice and our healthcare partners.
THE BEDDED UNIT Total admissions:
180
Diagnosis: 145 16
Cancer Non-Cancer
2. Performance in 2013-2014
Average length of stay: 9.4 days
“The majority of urgent requests for admissions were met on the same day� Murray Fletcher, Consultant in Palliative Medicine
being there for all the family
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www.northdevonhospice.org.uk
North Devon Hospice Quality Account 2013-14
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“When I was diagnosed, I walked through the doors of the hospice for the first time as a patient, a very frightened and isolated individual. Immediately I was enveloped with help and reassurance by every nurse, therapist, carer, member of staff and fellow patients I came into contact with� A patient
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2. Performance in 2013-2014
Health Professionals Helpline 01271 347214
for palliative care advice and information
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North Devon Hospice Quality Account 2013-14
Appointments and Treatments We conducted 18 outpatient treatments on the Bedded Unit during the reporting period. In addition to this, the Consultant in Palliative Medicine carried out 19 Consultant outpatient appointments both at Deer Park and in patients’ own homes. Our physiotherapy sessions were delivered in a number of locations to suit each patients’ needs and our occupational therapy was provided as part of the discharge planning process from the Bedded Unit.
OCCUPATIONAL THERAPY Inpatient visits/Review/ Discharge planning Outpatient/Day Hospice
135 2
Total number of sessions:
137
OUTPATIENT TREATMENTS
CONSULTANT OUTPATIENT APPOINTMENTS
2. Performance in 2013-2014
PHYSIOTHERAPY SESSIONS Outpatients Bedded Unit Home Day Hospice
29 187 26 8
Domiciliary visits Outpatient appointments
8 11
Total number of sessions:
250
Total number of appointments:
19
being there for all the family
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www.northdevonhospice.org.uk
North Devon Hospice Quality Account 2013-14
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Supportive Care Services We believe in being there for all the family and this ethos is reflected in the care and support provided to family members and carers. We have continued to support patients and their families (including children) in their homes and in schools as well as at the hospice in Barnstaple.
We believe in being there for all the family
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2. Performance in 2013-2014
Health Professionals Helpline 01271 347214
for palliative care advice and information
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North Devon Hospice Quality Account 2013-14
Supportive Care Sessions Bereavement support included offering people one to one support and also support within the comfort of a group session. Patients and their families received pre-bereavement and bereavement support in a number of ways, including complementary therapies, support groups, one-to-one sessions and by attending the ‘It’s Friday’ drop-in. Also, specific events, such as Floating Bye, were organised to support people in their grief.
“Thank you for inviting me to take part in the patients’ group. I’ve looked forward to my 2 hours on a Thursday where I can talk openly and honestly about my fears and worries” A patient
2. Performance in 2013-2014
SUPPORTIVE CARE SESSIONS PROVIDED
Bereavement support
1,569
Pre-Bereavement support
2,498
Complementary therapy
798
Special events
37
Total number of sessions provided:
being there for all the family
4,902
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www.northdevonhospice.org.uk
North Devon Hospice Quality Account 2013-14
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Day Hospice Day Hospice is available 3 days a week throughout the year. During each of those days, people spend timetable-free days together, enjoying the gardens, the art room, entertainment, delicious lunches and days out. Day Hospice provides a community environment where patients can seek support and share any worries or concerns they may have.
DAY HOSPICE Number of patients
47
Diagnosis Cancer Non-Cancer
39 8
A Day Hospice patient
Health Professionals Helpline 01271 347214
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for palliative care advice and information
2. Performance in 2013-2014
“Thank you so much for all the delicious meals you have provided at Day Hospice. I eat frozen meals all week, so you can imagine every mouthful of your lunches makes my toes curl up in anticipation, lovely jubbly. I am so grateful to you�
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North Devon Hospice Quality Account 2013-14
Complementary Therapy This year there has been another increase in the number of complementary therapy sessions provided. We continue to offer a range of treatments for patients and their carers and feedback about these sessions remains very positive. Each therapy can help to enhance well-being and relieve aches and pains.
“After my massage my headache finally went. I’d had it for 3 weeks and nothing could touch it”
2. Performance in 2013-2014
A patient
being there for all the family
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www.northdevonhospice.org.uk
North Devon Hospice Quality Account 2013-14
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Hospice Education 711 healthcare professionals attended the hospice’s free of charge education courses during the last year. By bringing palliative care topics to educational sessions, local healthcare providers have been supported and with increased skills, many have felt more confident when working with people who are affected by life-limiting illnesses. These educational courses have averaged 100% positive feedback.
Book your course online at www.northdevonhospice.org.uk
% of positive feedback post attendance at hospice education
100%
Number of health professionals who received hospice education Number of care home employees who received hospice education from our Outreach Care Home Facilitator
501
Health Professionals Helpline 01271 347214
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210
for palliative care advice and information
2. Performance in 2013-2014
HOSPICE EDUCATION SESSIONS
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North Devon Hospice Quality Account 2013-14
3. Priorities in 2014-2015 •
To deliver care closer to home across the whole of North Devon through our Hospice to Home initiative and the launch of The Long House in Holsworthy
•
To continue to engage with Commissioners, GPs, District Nurses and our other healthcare partners ensuring the development of hospice services
•
To co-ordinate education with a particular focus on increasing the knowledge and skills of healthcare professionals in the delivery of end-of-life care as well as continuing to build relationships with nursing and care homes across North Devon
•
From The Long House we seek to provide: • One-to-one support for patients and their families • Support groups for patients and carers • Complementary therapy • Bereavement support • Education sessions for the local healthcare community • A base for our local Community Nurse Specialist
To find out more about The Long House or to donate to the community appeal please visit www.northdevonhospice.org.uk or call us on 01271 347204.
being there for all the family
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www.northdevonhospice.org.uk
North Devon Hospice Quality Account 2013-14
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The Board of Trustees’ Commitment to Quality The Board of Trustees are responsible for ensuring our patients and their families are given the best possible care. Behind our patient-focused care and support are robust, evidence-based audits, standards of health and safety and standards of care which are regularly reviewed. We review the quality of our care and standards for the benefit of those who access our services. A reflection of our standards and the quality of our care was echoed in the 2014 Care Quality Commission inspection which awarded us 100% compliance for the third year running. Statements of quality assurance from the Board of Trustees are available overleaf.
“We cover one of the largest catchment areas of any hospice in the UK and constantly review the most effective way to support as many people as possible. We have launched a community appeal to raise money towards building The Long House centre in Holsworthy”
100% compliance for the 3rd year running Health Professionals Helpline 01271 347214
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for palliative care advice and information
3. Priorities in 2014-2015
Chair, Angela Webb
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North Devon Hospice Quality Account 2013-14
With Thanks It is thanks to the people of North Devon that in 2014 we celebrated our 30th Anniversary. In those 30 years we have cared for thousands of local people across North Devon’s 800 square miles. Our care has only been possible thanks to the generosity and support from the local community. We need to raise £4 million from scratch every year to continue to provide this care and support to thousands of local people. Please support the work of your local hospice by making a regular donation or remembering us in your will. For more information contact Ali Hunt, Head of Fundraising alihunt@northdevonhospice.org.uk / 01271 347206
Comments and Feedback
3. Priorities in 2014-2015
If you have any comments or questions about this Quality Account or our services in general, we are always grateful to have feedback. Please do not hesitate to contact us: Vanessa Saunders Head of Clinical Governance and Audit North Devon Hospice Deer Park, Newport, Barnstaple North Devon EX32 0HU vanessasaunders@northdevonhospice.org.uk / 01271 344248
being there for all the family
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www.northdevonhospice.org.uk
North Devon Hospice Quality Account 2013-14
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4. 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 2013-2014 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 2013-2014, no National Clinical Audits and no National Confidential Enquiries covered NHS services that North Devon Hospice provides. 1.3 The reports of eighteen clinical audits were reviewed by North Devon Hospice in 2013-2014 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 2013-2014 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 2013-2014 was not conditional on achieving quality improvement and innovation goals through the Care Quality Commission.
Health Professionals Helpline 01271 347214
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for palliative care advice and information
4. Statements of Quality Assurance
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 31st March 2014.
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North Devon Hospice Quality Account 2013-14
1.7 The Care Quality Commission has not taken enforcement action against North Devon Hospice during the reporting period of 2013-2014. 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 2013-2014 to the Secondary Uses Service for inclusion in the Hospital Episode Statistics which are included in the latest publication data.
4. Statements of Quality Assurance
1.10 North Devon Hospice was not subject to the Payment by Results Clinical Coding Audit during 2013-2014 by the Audit Commission.
being there for all the family
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www.northdevonhospice.org.uk
North Devon Hospice Quality Account 2013-14
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Referral Criteria Community Nurse Specialist Palliative Care Service To provide a specialist palliative care community nursing service for adult patients with complex problems associated with life-limiting illnesses Available to people who: • • •
Have an advanced, progressive illness or are 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 admissions 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.
Health Professionals Helpline 01271 347214
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for palliative care advice and information
5. Referral Criteria
• • •
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North Devon Hospice Quality Account 2013-14
The Bedded Unit To provide specialist palliative care in-patient services for adult patients who have complex problems associated with life-limiting illnesses 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:
5. Referral Criteria
• • • • •
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. being there for all the family
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www.northdevonhospice.org.uk
North Devon Hospice Quality Account 2013-14
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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 an 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 the 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:
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. Health Professionals Helpline 01271 347214
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for palliative care advice and information
5. Referral Criteria
- Hands on end-of-life for up to 72 hours, and palliative care and support in the community - Crisis intervention to prevent unplanned admission to hospital - Skilled carers to provide round the clock care for those at the end of life
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Working in the homes of our patients across the community
iv iat all p r fo
Combe Martin
Working with GP practices & District Nurses
Woolacombe
Working with Nursing Homes & Residential Homes Working with Hospitals & Community Hospitals
Ilfracombe
N O R T H D E V O N
Braunton
Heanton
North Devon Hospice Deer Park
Chelfham
Barnstaple
Hospice Shops
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
Lynton