North Devon Hospice Quality Account 2010-2011

Quality Account 2010-2011 for health professionals, patients and their families and carers

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Contents Quality at North Devon Hospice Introduction by Chief Executive Our Vision and Values Our Performance 2010-2011 Clinical Governance Clinical Service Provision Supportive Care Facilitating Education and Integration

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Our Priorities 2011-2012

The Board of Trustees’ Commitment to Quality With thanks

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Annex Statements of quality assurance from the Board of Trustees Our service offering for patients

Best Fundraising Event

Financial Management

Dear friends, Everything we do at North Devon Hospice aims to deliver the best care and support to our patients. On behalf of the Board of Trustees, we are delighted to present our second annual Quality Account to showcase how we continue to achieve this.

The Quality Account is both retrospective and forward thinking. It showcases the quality of healthcare services delivered in the previous year, enabling our clinicians, nurses, and support team to demonstrate their commitment to improvements. We complete the picture by identifying our priorities for the year ahead, outlining how we will continue to build on offering a quality service for our patients, their families and carers.

May I thank the staff and volunteer team at the hospice for their considerable achievements over the past year. I hope you will find the information provided in this booklet useful and we look forward to receiving your comments and feedback.

Gordon Lester Chief Executive gordonlester@northdevonhospice.org.uk

“You’re more than just my counsellor; it’s like you are with me when I leave and I hear your voice comforting me when I’m upset.” A carer

Patients are at the heart of everything we do.

The quality of their personal and medical experience is of key importance to us.

Ensuring patients’ safety, providing high quality care and positive experiences are key components of our service provision. We listen to our patients, learning from the things that have worked well and where we can look to improve.

Our mission is to promote the relief of symptoms amongst people with life-limiting illnesses. We do this through: • Specialist palliative care for patients with an advanced, progressive illness and 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 life limiting illness and the adults and children who are close to the patient • Advice, support and education provision to patients, families, communities, organisations, and healthcare professionals who are responding to life-limiting illness, death and loss 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

Quality at North Devon Hospice

Our Vision and Values

Consultant in Palliative Medicine & Medical Director

Director of Care

Community Clinical Services Manager

Community Palliative Care Manager

Bedded Unit Clinical Services Manager

Head of Supportive Care

13 Community Clinical Nurse Specialists 9.2 Fte

1 Palliative Care Co-ordinator

Senior Staff Nurse

2 Counsellors

5 Palliative Care Support Workers

11 Registered Nurses 8 Fte

1 Healer/ Counsellor 0.3 Fte

4 Medical Officers 1.4 Fte

1 Chaplain 0.8 Fte

9 Healthcare Assistants 7.5 Fte

1 Day Hospice Team Leader

Head of Clinical Governance

and Audit

Hospital Based Clinical Nurse Specialist

All of our work is supported by a diverse team of volunteers

1.6 fte

0.6 Fte

1 Healthcare Assisstant 0.6 Fte

Our hospice based Consultant in Palliative Medicine and Medical Director, Murray Fletcher, provides clinical leadership. He oversees the full range of care we provide and acts as a link between the specialist and supportive care services.

Our 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.

The Clinical Governance Action Plan and relevant key performance indicators are regularly reported to the Board of Trustees, regularly represented to the Corporate Governance Committee and reviewed monthly by the Clinical Audit Working Group.

We continue to support the Minimum Data Set Project organised by the National Council for Palliative Care.

Clinical Audits • • • • • • • • • • • • •

The Accountable Officer Controlled Drug Audits Infection Control: Hand Hygiene Audit Infection Control: Clinical Care Environmental Audit Referral Response Rate Audit Infection Control: Safe Disposal of Sharps Audit Food and Nutrition Audit Corneal Donation and Retrieval Audit Pressure Damage Audit Out of Hours Telephone Helpline Audit Complementary Therapy: Measuring the Effects of the Intervention Management and Treatment of Hypercalcaemia Audit Blood Glucose Equipment Monitoring Audit Specimens and Investigations Audit

Surveys and Exercises • • • •

Internal Staff Survey Help the Hospices: Patient Survey - Day Hospice and In-patient Unit South West Regional Hospices Audit: Falls, Medication Errors, Pressure Damage ‘Involving You’ Consultation

Our Performance 2010-2011

Clinical Governance

3 North Devon Hospice Quality Account 2010 - 2011

�Hospitals try to mend people; the hospice helps you to live.� A patient

During 2010-2011, we received 603 new patient referrals, whose ages ranged from 21 to 98 years. 88.4% of these patients had a cancer diagnosis and the remaining patients were referred with various life-limiting diagnosis, including MND, MS, Heart Failure, COPD, Liver failure, Renal Failure and Dementia. Of these 603 new patients, 318 died during 2010-2011.

In support of valuing our patients choices, we continue to support their right to die in the place of their choice and this practice is reflected in our records; showing an increase in the number of deaths at home, which includes deaths of patients in care/residential homes. Consistent with the key imperatives underpinning the National End of Life Care Strategy, we continue to monitor place of death and record Preferred Priorities for Care.

Age range of new patients 2010-2011 Total

%

Male

Female

20 - 34

4

0.66

1

3

35 - 49

30

4.98

10

20

50 - 64

123

20.4

51

72

65 - 79

259

42.95

147

112

80+

187

31.01

88

99

Total

603

297

306

Place of death

2009-2010

2010-2011

Hospice

131

109

Home

164

181

Hospital

104

100

38

49

437

439

Other inc Care & Nursing Homes

Total

Our Performance 2010-2011

Clinical Service Provision

From the purpose built facility at Deer Park, North Devon Hospice operates a 7 bed in patient Bedded Unit, providing assessment and treatment of complex symptoms, end-of-life care, support and care to patients, their families and carers.

During 2010-2011, there were 163 admissions to the Bedded Unit, with a bed occupancy running at 71%; a figure consistent with the previous 2 years performance. The average length of stay on the unit was 10.6 days, with other periods ranging up to 45 days.

Of the 163 Bedded Unit admissions, 63% of admissions were for symptom management, with 37% admissions for end-of-life care.

Outpatient Treatments At the request of medical professionals, a number of outpatient treatments can be managed and monitored from the Bedded Unit. During 2010-2011, 58 of these were conducted, including:

• Pamidronate infusions • Blood transfusions • Paracentesis/drainage Following the recruitment of two part-time allied health professional team members, 189 occupational therapy and physiotherapy reviews and visits were conducted.

Consultant Outpatient Appointments & Consultant Domiciliary Visits At the request of medical professionals, Consultant Outpatient Appointments are managed from the Bedded Unit and Consultant Domiciliary Visits are in joint attendance with a Community Clinical Nurse Specialist.

Consultant Outpatient Appointments have dropped from 25 in 2009-2010 to 20, and this decline is also shown in Consultant Domiciliary Visits from 25 to 6. The team attended regular consultations and meetings with medical professionals, ensuring interventions were managed before a patient was in a position to need a visit of this nature; showing a significant improvement in patient care.

Our Performance 2010-2011

The Bedded Unit

“They provided much needed respite for myself, and wonderful care and compassion to my mother. They were the listening ears and supportive shoulders I needed, and the kind, practical and skilled help that mum needed.�

The daughter of a patient

Working in partnership with GPs, primary healthcare teams, care homes, and the hospitals, our 13 Community Clinical Nurse Specialists continue to deliver integrated care and support to patients.

During 2010-2011 there was a notable 81.95% increase of the number of Gold Standards Framework and Multi-disciplinary Team meetings demonstrating a cohesive approach to patient care and partnership working. There were 1,331episodes where individual patients were discussed at Gold Standards Framework meetings; 499 episodes where individual patients were discussed at Multi-disciplinary Team meetings; all in attendance by the hospice Community Clinical Nurse Specialists.

With the nursing team covering the length and breadth of North Devon, from Holsworthy to Lynton, they travelled nearly 50,000 miles on their 5,417 patient visits; 59% of these visits to patients in their own homes.

Community Clinical Nurse Specialist Visits

2009-2010

2010-2011

At Home

3,026

3,081

Professional visits, not inc. GSF meetings

1,392

1,625

Hospitals

330

158

Nursing Home

180

128

Hospice

200

338

Other patient visits inc. bereavement visits

174

243

5,302

5,573

Total

Community Palliative Care Team & Hospital Based Specialist Palliative Care Team In December 2010, we welcomed the Community Palliative Care Team (seconded to the hospice for 5 years) from the Northern Devon Healthcare Trust. The 5 Community Palliative Care Support Workers provide ‘hands on’ end-of-life care for patients in their own homes or other places of choice. Since December, the team have supported 76 patients in their own homes and been there for their families and carers to provide support and guidance during difficult times.

We also welcomed the hospital based Specialist Palliative Care Service who support individuals who are experiencing cancer and any other life-limiting illness, at any stage in their journey.

Our Performance 2010-2011

Community Clinical Nurse Specialists

Supportive Care The Supportive Care team offers time and space for patients and their families to look at what is happening in their lives and the opportunity to explore what they will need to sustain them in the most difficult of circumstances.

One to One Support Everyone known to the hospice has the opportunity for one to one support and/ or is able to join the patients, carers or bereavement groups. Whether individually or within a group, those attending have the space to explore and express feelings, ideas, thoughts and concerns that may be difficult to share elsewhere. During 2010-2011, Supportive Care provided personal support in over 5,000 instances and continued to run well attended group sessions which supported 129 people.

Support for Children At school, at home, or at the hospice; one to one support is offered to children.

Children are encouraged to explore and express themselves through talking, painting, drawing or play.

‘It’s Friday’ Drop-in The Friday drop-in offers patients, carers and family members the time to relax, meet with others, enjoy the gardens, spend time in the art room, and use the opportunity for one to one support if required. The drop-in was introduced this year with positive feedback and welcomed 894 attendances.

Counselling

2009-2010

2010-2011

909

925

1,760

2,651

228

221

Support over the phone

1,381

1,674

Total

4,278

5,471

Bereavement counselling, inc groups Counselling and spiritual support, inc groups Unplanned patient/family meetings

Our Performance 2010-2011

Group sessions

Number of sessions held Attendees Attendances

Patient group

47

47

400

Carers group

28

46

289

Bereavement group

12

36

166

Total

69

129

855

NB. These figures are also included in the Counselling table

“I soon realised it was really normal to have these thoughts and emotions... and that ever yone else had them too; thank goodness for that!�

A patient

Supported by nursing staff, Day Hospice is time for patients to be together, where they can talk, laugh, be with each other and find a quiet space too if needed.

Available every Tuesday,Wednesday and Thursday throughout the year, patients can attend timetable free days to enjoy art and crafts, entertainment, occasional outings, relaxation in the gardens, and time to meet and talk with each other. Whilst our patients find benefit from going to Day Hospice, it is also an opportunity for their carers to attend a Carers group, or have some respite from their 24/7 caring role.

In 2010-2011, Day Hospice welcomed 82 patients, totalling 1,082 attendances.

‘Look Good Feel Great’ & ‘Pamper Days’ To boost morale ‘Look Good Feel Great’ is available to patients and ‘Pamper Days’ for carers. During the last year treatments included hand/foot massage, manicures, coping with hair loss, hairdressing and make-up tips.

‘Staying Steady’ Sessions Offered to patients and carers, ‘Staying Steady’ sessions teach the art of relaxation.

Learning these skills can release and reduce tension, calm the mind, improve physical balance, sleep and the ability to deal with stressful situations.

‘Benefits Surgery’ & ‘Question and Answers’ Sessions The ‘Benefits Surgery’ and ‘Question and Answers’ sessions provide opportunities for one to one and/or group discussion with invited professionals. Topics discussed included nutrition, managing at home and benefits. Patients and carers also booked individual interviews for specific advice on benefits.

Complementary Therapy Complementary therapy treatments were provided for patients and carers from the treatment rooms at Deer Park. The Complementary Therapy service included aromatherapy massage, Reiki healing, Indian head massage and reflexology.

Inherently present throughout all the Supportive Care work is an awareness of people’s pastoral and spiritual needs. The team provides a flexible presence to respond as and when the need arises, supporting people of all faiths and also of none.

Our Performance 2010-2011

Day Hospice

Facilitating Education, Training and Integration Our Staff and Volunteers All staff and volunteers attend appropriate annual training to ensure they have the skills required to maintain standards. Our compliance levels for both clinical and non-clinical statutory training remain at 98%.

As part of our on-going training development, the hospice ran its first in-house Food Safety Certificate course.

Our Wider Colleagues Early in 2011, we began procurement for the new Crosscare software to enhance patient medical records and integration with other healthcare professionals.

Our Consultant in Palliative Medicine confirmed his position as the Elective Period Supervisor for 2 medical students in the coming year.

Our Education department facilitated 8 whole study days, specifically for health and social care professionals working in end-of-life care across North Devon. In addition, working in partnership with the University of Plymouth, a specialist accredited Palliative Care course worth 20 credits was delivered.

Our Education department secured funding from NHS Devon to deliver education and training in ‘End-of-Life Care.’ This consisted of 4-part taster sessions followed by 6 whole study days; with 47 taster sessions and 3 whole study days being delivered with more to follow. All education and training was offered free of charge to health and social care professionals providing end-of-life care, in all care settings across North Devon.

Our Performance 2010-2011

“I feel that I’m living my life in full colour instead of black and white. With regards to how long my life will continue, who knows.

All I know is it’s going to be a life well lived, a life completed.”

A patient

• To undertake stakeholder engagement that will contribute to the future development of hospice services • The development of a ‘User Feedback’ strategy that will enable us to use an experienced-based design approach to deliver high quality services • To deliver services closer to home and across North Devon in order to provide more readily accessible holistic care • To further develop the integration of care services • To further develop and co-ordinate education to meet the needs of stakeholders and service users and to support the achievement of the above priorities .

Our Priorities 2011-2012

Our Priorities for 2011-2012

The Board of Trustees Commitment to Quality Our Board of Trustees take direct responsibility for ensuring consistent service improvement, whilst safeguarding high standards of care and creating an environment in which excellence in clinical care can flourish.

Quality clinical care is achieved through evidenced-based audits. These organisation wide audits ensure we are compliant with regulatory frameworks as well as taking into account the views and needs of our patients and service users.

Potential risks and aspects of safety which may impact on the standards of care we provide are regularly reviewed and acted upon. We are consistently reviewing and improving our quality of care for the benefit of our patients.

Statements of quality assurance from the Board of Trustees are available in the Annex.

Our care and support is provided to patients completely free of charge, however, it costs over ÂŁ3 million each year to provide.

With thanks to the valued support of our community, we continue to raise the much needed money to fund our care. Your donations are welcome, always appreciated and needed.

Do you have any comments or questions? We are always happy to receive feedback about our services. If you have any comments or questions about this Quality Account please do not hesitate to contact us: Vanessa Saunders Head of Clinical Governance & Audit North Devon Hospice Deer Park Barnstaple North Devon EX32 0HU vanessasaunders@northdevonhospice.org.uk / 01271 344248

Our Priorities 2011-2012

With thanks

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 2010-2011 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 2010-2011, no National Clinical Audits and no National Confidential Enquiries covered NHS services that North Devon Hospice provides.

1.3 The reports of thirteen clinical audits were reviewed by North Devon Hospice in 2010-2011 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 2010-2011 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 2010-2011 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. 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 and the treatment of disease, disorder or injury with conditions as of the 31st March 2011.

1.7 The Care Quality Commission has not taken enforcement action against North Devon Hospice during the reporting period of 2010-2011.

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 recording during 2010-2011 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 2010-2011 by the Audit Commission.

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:

This includes:

Have an advanced progressive illness

Clinical Nurse Specialists providing advice and support to patients and families in the care setting of their choice

Need advice and care for pain management and other distressing symptoms Would benefit from holistic care, with any emotional and spiritual needs being addressed

The hospice multi-disciplinary team sharing care, information, advice and support with other health and social care professionals

Access: Via completion of the ‘request for services’ 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.

Specialist Palliative Care Inpatient Service; 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:

This includes:

Have an advanced progressive illness

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

Need treatment for pain management or other distressing symptoms Need 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

Access: In urgent and out of hours cases, call the Duty Medical Officer direct on 01271 347214. Otherwise via completion of the ‘request for services’ form. 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:

This includes:

Are over 18 and have a life-limiting illness

Support groups for patients, for carers and also the bereaved

Or are adults or children deeply affected by that persons illness

Day Hospice

Or are left bereaved as a result of that persons death

‘Look Good Feel Great’ sessions ‘It’s Friday’ drop-in Complementary therapies ‘Staying Steady’ sessions ‘Pamper Days’ for carers ‘Benefits Surgery’ and ‘Question and Answers’ sessions One to one bereavement support Support for children and their carers Pastoral and Spiritual Support

Access: Via the ‘request for services’ 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.

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:

This includes:

Need practical nursing care and support in the final days of life

Practical nursing care and support during the night for patients during the final days Practical and emotional support during the night for carers during final days Facilitation of ‘Just in Case’ boxes across North Devon

Access: 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.

Hospital based Specialist Palliative Care Service To provide support to individuals who have cancer and any other life-limiting illness, at any stage of their journey Available to people who:

This includes:

Have advanced progressive incurable disease and who agree to the referral being made

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

Access: 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.

The ‘request for services’ forms are available online from www.northdevonhospice.org.uk and copies available by calling 01271 344248

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 Deer Park Hospice Shops

Woolacombe

Chelfham

Heanton

Braunton

Fremington Instow Westward Ho!

Barnstaple Landkey Swimbridge

Northam Abbotsham

Bideford

South Molton

Alverdiscott

Hartland

Great Torrington

High Bickington

Bradworthy

Chulmleigh Shebbear

Holsworthy

Black Torrington Beaworthy

Quality Account 2010-2011 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