North Devon Hospice Quality Account 2011-2012

Quality Account 2011-2012 For health professionals, patients and their families and carers

being there for all the family

Contents

1.

Quality Statement

Introduction by Murray Fletcher, Medical Director and Consultant in Palliative Medicine Our Values and Vision

2.

Performance in 2011-2012

Clinical Governance Clinical Service Provision Community Specialist Palliative Care Nursing Service Community Palliative Care Service Specialist Palliative Care In-Patient Service Outpatient Treatments Physiotherapy and Occupational Therapy Consultant Outpatient Appointments & Consultant Domiciliary Visits Hospital based Specialist Palliative Care Service Supportive Care Services Individual Support Day Hospice Complementary Therapy Education and Integration

3.

Priorities for 2012-2013

Our Priorities 2012-2013 The Board of Trustees’ Commitment to Quality With thanks

4.

Annex

Statements of quality assurance from the Board of Trustees Referral criteria

1.

Quality Statement Dear friends, It is my pleasure to open North Devon Hospice’s third Quality Account. Everything we do is focused towards delivering the best care to our patients and their families and through this document we are sharing our commitment to high standards with you.

The Quality Account outlines far more than our care statistics; it provides details about how we achieve our aim of providing the best possible care to local people. This ranges from our commitment to quality, to our diligent auditing process which ensures we continuously strive to improve our services, and an outline of the future of our service provision. During the last year we have developed our services and care provision to meet the changing needs of our patients, their families and the rural community, ensuring we make efforts to go back to our roots. This has been a significant contribution to local care services but it is still only a part of our contribution to caring for people who are affected by life-limiting illnesses.

I would like to take this opportunity to thank every single member of the team and our clinical partners for their exceptional commitment and efforts towards our achievements over the past year.

Your interest in the hospice is always welcome.

Yours truly,

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

www.northdevonhospice.org.uk . Being there for all the family

Quality Statement

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.

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 the adults and children who are close to the patients

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

families, communities, organisations, and healthcare professionals who are responding to life-limiting illness, death and loss.

- Personal care to patients at the end-of-life and support -

- Advice, support and education provision to patients,

www.northdevonhospice.org.uk . Being there for all the family

Quality Statement

2.

Performance in 2011-2012 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 2011-2012 North Devon Hospice achieved full compliance with no concerns following an unannounced inspection by the Care Quality Commission in February 2012.

The plan and relevant key performance indicators are reviewed bi-monthly by the Care Quality Working Group and regularly represented 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.

Deer Pa

rk Gar d e ns

at N o

r th D

evo nH

osp

ice

Clinical Audits

- Preferred Priorities for Care (Community Nurse Specialist Team) - Blood Transfusion Audit - Prescribing Audit - Pressure Damage Audit - Infection Control: Hand Hygiene Audit - Privacy and Dignity Audit (In-Patient Unit) - Environmental Infection Control Audit - Nutritional Audit - Care Environment Audit - Accountable Officer Controlled Drugs Audit - Safe Disposal of Sharps Audit - Sluice and Commode Cleanliness Audit - Next of Kin Documentation Audit - Education Audit - Look Good Feel Great Audit Surveys and Exercises

- Investors In People Review - Help the Hospices: Patient Survey Day Hospice and In-Patient Unit - South West Regional Hospices Audit: Falls, Medication

Errors, Pressure Damage.

“The service was managed well and provided a high standard of individualised care and support. We found that North Devon Hospice was compliant with all five outcomes we inspected.�

The Care Quality Commission

www.northdevonhospice.org.uk . Being there for all the family

Performance in 2011-2012

Clinical Service Provision During 2011- 2012, patients were referred with life-limiting illnesses, including COPD, Heart Failure, Renal Failure, Liver Failure, MND, MS and Dementia. However, 80% of patients were referred with a cancer diagnosis. There was a rise in the number of younger patients (under 24) being referred for hospice care, with an increase of nearly 2% from the previous year.

Number of Patients

New Patients 2011-2012 180 160 140 120 100 80 60 40 20 0

20/24

25-49

50-64

65-79

80+

6 14 55 161

124

Female 12 28 71 154

140

Age Range Male

In support of valuing our patients’ choices, where possible we continue to support people in the care environment of their choice. As highlighted in the 2008 Department of Health End of Life Care Strategy “there is a major mismatch between people’s preferences for where they should die and their actual place of death. Most would probably like to die at home but only around 18% do so.” Our practice is reflected in our records, which show a marked increase in the number of supported deaths at home, including a rise in deaths of patients in Care Homes.

Place of Death Number of Patient Deaths

300 250 200 150 100 50 0

Home

Hospice

Hospital

Place of Death

Other including Care Homes

2010/11

181

100 109

49

2011/12

248

106 140

78

www.northdevonhospice.org.uk . Being there for all the family

Performance in 2011-2012

Community Specialist Palliative Care Nursing Service Working in partnership with GPs, District Nurses and other healthcare teams, our 13 Community Clinical Nurse Specialists continue to deliver care and support in the homes of patients throughout the hospice catchment area.

Last year, the team travelled over 50,000 miles on their patient visits. Of the 5,058 patients they visited, 85% of these, an increase of over a third were in their own home. For over 28 years, it is still where the majority of our care takes place. “Working in partnership with other healthcare providers is fundamental. In addition to delivering integrated care, last year our Community Nursing team attended over 2,000 professional meetings and discussions for the benefit of patient care� (Murray Fletcher, Medical Director and Consultant in Palliative Medicine).

Visits by Community Nurses 4500

Number of Patients

4000 3500 3000 2500 2000 1500 1000 500 0

Home

Hospice

Hospital

Nursing Home

Location of Visit 2010/11

3081

338

158

128

2011/12

4091

603

180

184

“The nurse was a great comfort, they prepared us for the reality, I don’t know what we would have done without them.”

Keely, C ommunity

urse ice N y Hosp a D , e i g g a Nurse Specialist and M

A relative speaks to the Care Quality Commission

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 171 patients, with 98% of these patients being cared for in the place of their choice.

“You talked us through so many things, made us laugh sometimes and also were there when we cried…When she died, you showed such tenderness and sensitivity, for which we will never forget you.”

A family member whose mother was supported at home.

www.northdevonhospice.org.uk . Being there for all the family

Performance in 2011-2012

Specialist Palliative Care In-Patient Service - The Bedded Unit From a purpose built Bedded Unit at Deer Park, North Devon Hospice operates the 7 bedded unit, providing assessment and treatment of complex symptoms, end-of-life care, support and care to patients, their families and carers.

During 2011-2012, the Bedded Unit ran at a 73% occupancy rate, with the average length of stay being 10 days, with a range from 1 to 46 consecutive days. Of the 171 admissions to the Bedded Unit, 65% were for symptom management; 66 of these patients were discharged.

Reasons for Admission to the Bedded Unit

Symptom Control

114

Treatment

6

End of Life Care

51

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 significantly increased their number of sessions during the last year and extended the locations of care provision to include more contacts in the Bedded Unit, Outpatients and Day Hospice.

Physiotherapy

2010/11

2011/12

Inpatient Visits/Review 90 Outpatient & Day Hospice 0 Home Visits/Review 1

226 39 0

91

265

Occupational Therapy

2010/11

2011/12

Inpatient Visits/Review 91 Outpatient & Day Hospice N/A Home Visits/Review 7

145 10 5

98

160

www.northdevonhospice.org.uk . Being there for all the family

Performance in 2011-2012

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. Regular clinical meetings often negate the need for reviews because earlier intervention is managed before a need arises.

Outpatient Treatments At the request of medical professionals, 49 outpatient treatments were managed and monitored from the Bedded Unit.

Available treatments included:

- Pamidronate Infusion - Blood Transfusion/Platelets

“It can’t be alright but they make it as good as it can be and they are there for us.”

A patient speaks to the Care Quality Commission

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 2011-2012, the Supportive Care team supported 1,282 individuals. ‘Being there for all the family’ really is evident throughout all of this work with families, individuals and children accessing one or more services to support them in their journey.

Supportive Care 2011/12

No. of people supported

Patients Family and Carers

347 935

1282

www.northdevonhospice.org.uk . Being there for all the family

Performance in 2011-2012

Supportive Care: Individual Support Individual support is offered in a variety of ways, including:

- - - -

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

This care is available to the whole family, including children, and is provided both at the hospice and across the community.

Last year there was another rise in the amount of counselling provided and in the number of people who have received support.

Creative and special events are organised in response to people expressing a particular need. Last year ‘Something for You’ gave opportunity for patients to work with various artists to create something unique that they could leave for family and friends. ‘In the Making’ monthly workshops continue this opportunity for creative activity for patients and their families.

Individual support provided 2011 - 2012

Individual support including one to one and group sessions

2188

Bereavement support including one to one and group sessions

773

Creative workshops and other special events

1042

Supportive Care telephone calls

1619

Supportive Care: Day Hospice Supported by nursing staff, Day Hospice is time for patients to be together. Available 3 days a week throughout the year, patients can attend timetable-free days to enjoy arts and crafts, entertainment, occasional outings, relaxation in the gardens, time to meet and talk, as well as access other hospice services and support.

In 2011-2012 we welcomed 71 patients to Day Hospice. This essential service is valued by many people.

“I’ve seen things in myself and others that are truly wonderful.” A patient

Day Hospice

Number of Patients

1200 1000 800 600 400 200 0

Day Hospice Planned Attendances

Day Hospice Cancellations

2010/11

1083

459

2011/12

1003

595

www.northdevonhospice.org.uk . Being there for all the family

Performance in 2011-2012

Complementary Therapy From the treatment rooms at Deer Park, complementary therapy relieves symptoms and enhances the sense of well-being of patients and carers. These therapies include aromatherapy, massage, Reiki, Indian head massage and reflexology.

Complementary Therapy Activity

Number of Clients

350 300 250 200 150 100 50 0

Patient Complementary Therapy Sessions

Carer Complementary Therapy Sessions

Cancellations

Complementary Therapy Activity

2010/11

220

0

12

2011/12

310

75

32

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Education and Integration Awareness and education is an essential aspect of integrated hospice care and one of our key strategic objectives.

During 2011-2012, 3 medical students completed a placement on the Bedded Unit under the supervision of Murray Fletcher, Consultant in Palliative Medicine; 1 pre-reg Nursing student and 1 student with the Supportive Care team.

During 2011-2012, we delivered more than 120 training sessions and 40 study days across the community for health and social care professionals. These education opportunities expanded the knowledge base amongst professionals caring for people with life-limiting illnesses. In some cases, some professionals were accessing formal end-of-life education for the very first time.

We continue to work closely with the Northern Devon Healthcare Trust, NHS Devon, Plymouth University and other hospices to deliver our education programme and are proud to run a module on Palliative Care (HEAB 306, Specialist Approaches to Palliative Care and Care of the Dying) that contributes towards a Plymouth University Health Studies degree. Last year, in collaboration with 8 other hospices, we facilitated a ‘Train the Trainer’ programme to improve the skills and confidence of healthcare professionals. Also in partnership with other Devon hospices we developed and delivered an ‘Enhanced Communication Skills’ programme to help staff support patients and their families.

Funded by either NHS Devon or North Devon Hospice

www.northdevonhospice.org.uk . Being there for all the family

Performance in 2011-2012

3.

Priorities for 2012-2013 Our Priorities 2012-2013

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

The development of a ‘User Feedback’ strategy utilising media that will enable us to use an experience-based design approach to delivering high quality 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 EOLC as well as building relationships with Nursing and Care Homes across North Devon.

“As the commissioner of healthcare services for the population of North Devon we fully support the development of North Devon Hospice’s new ‘Hospice to Home’ service and are pleased to be able to support the establishment of this very important service. We recognise the need for specialist palliative care to be available to patients in their own homes, out of hours and North Devon Hospice is very well placed to meet these needs.” Paul Baker Head of Locality Commissioning, Urgent Care NHS Devon

The Board of Trustees’ Commitment to Quality North Devon Hospice’s Board of Trustees takes direct responsibility for ensuring that patients and their families are given the best possible care. To do this, we ensure that our services continually improve, while safeguarding our high standards of care and creating an environment in which excellence can flourish.

Quality care is achieved through evidence-based audits, and at North Devon Hospice we audit regularly and thoroughly. This is not only to ensure that we are compliant with regulatory frameworks, but 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.

North Devon Hospice met 100% compliance following an un-announced visit from the Care Quality Commission in February 2012.

100% Compliance

www.northdevonhospice.org.uk . Being there for all the family

Our Priorities in 2012-2013

With thanks North Devon Hospice would not be able to provide the care that has been highlighted in this publication without the incredible support of the local community. We provide our specialist support absolutely 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 really does make a difference to the lives of local people.

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

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

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 2011-2012 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 2011-2012, 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 2011-2012 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 in 2011-2012 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 2011-2012 was not conditional on achieving quality improvement and innovation goals through the Care Quality Commission.

www.northdevonhospice.org.uk . Being there for all the family

Annex

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 2012.

1.7 The Care Quality Commission has not taken enforcement action against North Devon Hospice during the reporting period of 2011-2012.

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 2011-2012 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 2011-2012 by the Audit Commission.

5.

Referral Criteria

being there for all the family

www.northdevonhospice.org.uk Reg Charity no. 286554

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 - 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 Available to people who: - Need practical nursing care and support in the final days of life This includes: - Practical nursing 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.

www.northdevonhospice.org.uk . Being there for all the family

Referral Criteria

Specialist Palliative Care; 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 pain management or other distressing symptoms - Need end-of-life care 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 - Discharge planning - 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 persons illness - Or are left bereaved as a result of that persons death This includes: - Support groups for patients, for carers - ‘Staying Steady’ sessions and also the bereaved - ‘Pamper Days’ for carers - Day Hospice - ‘Benefits Surgery’ and ‘Question and Answers’ sessions - ‘Look Good Feel Great’ sessions - One to one bereavement support - ‘It’s Friday’ drop-in - Support for children and their carers - Complementary therapies - Pastoral and Spiritual Support Referral: Completion of the ‘request for services’ referral form.

Requests can be made from GP’s, 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.

Hospital based Specialist Palliative Care Service

being there for all the family

www.northdevonhospice.org.uk Reg Charity no. 286554

To provide support to individuals who have cancer and 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, emotional, social or spiritual 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 patients 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 a GSF 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 and palliative care and support in the community - Crisis intervention to prevent unplanned admission - Skilled carers to provide round the clock care for up to 72 hours Referral: Referrals taken between 8am and 8pm. Via the phone during office hours (Monday

to Friday) by calling 01271 347247. Out of hours contact 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 www.northdevonhospice.org.uk . Being there for all the family

Referral Criteria

Working in the homes of our patients across the community

Combe Martin

Lynton

Ilfracombe

Working with GP practices & District Nurses Working with Nursing Homes & Residential Homes Working with Hospitals & Community Hospitals North Devon Hospice Deer Park

Woolacombe

Chelfham

Heanton

Braunton

Barnstaple

Instow

Landkey Swimbridge

Northam Abbotsham

Bideford

South Molton

Alverdiscott

Hartland

Great Torrington

High Bickington

Bradworthy

Chulmleigh Shebbear

Holsworthy

Black Torrington Beaworthy

Quality Account 2011-2012

For health professionals, patients and their families and carers

Registered charity no. 286554

www.northdevonhospice.org.uk / 01271 344248 North Devon Hospice, Deer Park, Barnstaple, Devon EX32 0HU