Section 1
1.1 Statement from the Chief Executive
I am pleased to introduce the Quality Account for Royal Trinity Hospice 2023-2024, a fair and accurate representation of our care and support activities over the last year.
We said farewell and thank you to Adrian Williams, Chair of the Board of Trustees, in June 2023, at the end of his six-year tenure. We are delighted that Professor Suzanne Shale took up the role in July 2023, bringing personal experience of bereavement volunteering at Trinity in addition to her extensive professional expertise and insight.
In March 2024, we recruited three more members to the Board of Trustees with clinical backgrounds to enhance the oversight of our clinical services and to ensure that the highest quality standards are maintained.
We introduced our new clinical model of care across the year, delivered via our Transform programme. Our new clinical model is designed to meet our strategic objectives of supporting more people, without compromising on the quality of care and offering a more responsive and streamlined service.
We launched our new Living Well service in May 2023, offering a tailored programme of activities, appointments, and group sessions at the hospice to support patients and carers in living well.
Our new clinical hub and single point of access to the organisation, launched in September 2023, brings together our most highly skilled clinicians and administrators to coordinate care. We were also pleased to introduce the first phase of our new Rapid Response service in July 2023, which continued to expand its hours of operation throughout the year. As a result, we were able to support more people than ever.
Importantly, we also introduced our new quality outcomes framework in 2023 to allow us to better quantify the benefits that our care and support we are delivering. We have expanded how we capture and listen to people’s experiences of using our services and adopted a consistent approach to measuring clinical outcomes through core patient-centred outcome measures for palliative care (PCOMs for palliative care, previously Outcome Assessment and Complexity Collaborative/OACC). This has been done in conjunction with the rollout of the new national Patient Safety Incident Response Framework (PSIRF), including setting our patient safety priorities and agreeing our PSIRF policy and plan.
I am proud of our achievements in the last year and the hard work of our team in delivering them, allowing us to deliver even more for our beneficiaries.
We continue to be indebted to our volunteers and supporters for their generosity, enabling Royal Trinity Hospice to support local people and their loved ones at the end of their lives.
Emily Carter Chief Executive Officer
1.2 Overview of Royal Trinity Hospice
Royal Trinity Hospice provides free specialist palliative and end of life care, on our 26 bedded unit; to outpatients both in the hospice and virtually, and in people’s homes and other community settings such as care homes, hostels, and prisons.
We are commissioned by South West London Integrated Care Board (ICB), South East London ICB, and North West London ICB to deliver services on behalf of the NHS.
The past year has been one of significant change at Royal Trinity Hospice. We have transformed our clinical model of care, introduced and embedded new services and consolidated existing resources to make the best use of them. We eventually aim to increase our support to over 5,000 people every year, to meet unmet and growing demand for our services by 2027.
These changes represent positive progress against our five-year strategy and will enable us to provide quality care to more people who need us across our catchment area in the future.
We regularly measure our performance against national, local, and internal performance standards. These objective measurements demonstrate that we continue to provide safe, effective, and efficient specialist palliative care services.
1.3 Headline numbers 2023-2024
1.3
Headline numbers
2023-2024
We cared for 2,400 patients, over 6% more patients than the year before
In total, 2,843 patients, carers and family members directly received our care and support
At any one time we were caring for 650 patients
2,384 patients received care in their own homes, which is where over 85% of our patients receive their care
The Community Nursing team made 2,435 home visits, which was more than double the number of visits they made the previous year
324 patients received care in the inpatient unit
572 patients received physiotherapy, occupational therapy, complementary therapy or dietetic support in the hospice and in the community.
235 people benefited from 1,503 bereavement support sessions and 389 people attended a bereavement event
413 carers received psychosocial or spiritual support
110 patients living in Wandsworth were supported by the Royal Trinity Carers and 483 received care coordination support.
The youngest patient we cared for was 29 and the oldest was 106
97% of respondents would recommend us to friends and family if they needed similar care of support and 99% of respondents felt they were treated with dignity and respect
We must raise over £13m from fundraising and our shops this year to supplement the funds we receive from the NHS, which only account for about 26% of what it costs to run the hospice annually.
1.4 Stories of our care:
story
Four years on, the impact of Trinity’s care given to former patient How is well remembered by his surviving widow Moira.
How was a patient on Trinity’s inpatient unit in 2020, where he was visited by Moira and his two children. The importance of being able to spend time together was intensified by How’s terminal diagnosis and the limitations imposed by COVID-19.
The family described their appreciation of the help and support given by Trinity and for How’s children being able to visit and create memories.
The family has a further special connection to the hospice because of the help we gave to two people to fulfil their dream of being married. How and Moira had intended to get married at the Wandsworth Registry Office; however, changes in How’s health meant the wedding had to be quickly pulled forward. In less than 24 hours, Trinity nurses transformed the Mulberry room at the hospice into a wedding venue decorated with flowers, a wedding cake, and created a buttonhole and bouquet.
“One of the most poignant moments that I think back to was just after How has passed, and the way that one of the care staff on duty opened the window in the How’s room so that “his spirit could wander the garden” which is exactly what he would have wanted to do. I also can’t thank Fiona enough for all the help and support she offered me during our counselling sessions, even extending them when I lost my dad, while I was still receiving bereavement counselling for How and then pointing me in the direction of WAY (Widowed and Young) who offer peer to peer support. She listened to everything I was saying, understood the difficulties I was having and offered some real support suggestions. The work that you do at Royal Trinity Hospice is so important. You really do make such a difference to those in your care and to us, their families.”
and Ann
Our respite service offers 1-2 weeks respite care for patients with dementia. This offers patients a change of scene in a safe, caring environment, giving their primary carers a chance to take a break of their own from caring.
Jamie stayed in our inpatient unit (IPU), giving his wife Ann the chance to attend a family wedding in Wales. Ann had not seen some family members for ten years.
“At the wedding, when we arrived, the bride Maddie went mad – she tore across the room with a big shriek and gave me a massive hug and a good kiss.
I got to see my brother and sister for the first time since covid. I got to see a family I’ve not seen for ten years because they had moved. I got to sit at a table with my family.
Jamie was so happy with everything [at Trinity], he wasn’t ringing me every five minutes; it was me ringing him! One of the reasons he loved it so much was they gave him a shower using the wheelchair.
Before Jamie went into Trinity, he was bed bound and when I went to pick him up, the physio recommended he got out of bed.
Trinity helped arrange a new chair for the lounge and now Jamie can come into that room and watch TV or listen to his favourite, Radio Caroline – that’s thanks to Trinity.
When I went to pick Jamie up from Trinity he said, ‘could he stay a bit longer, everyone’s so nice.’“
Moira and How’s
Jamie
Section 2: Quality of care
2.1 Patient safety
Patient safety is a key domain of quality in hospice care. Quality indicators are used to demonstrate safe and harm-free care. We constantly review data from patient safety incidents across the hospice and as part of the Hospice UK Patient Safety Programme, data is submitted monthly, enabling clinical benchmarking between Trinity and other hospices across the UK.
Palliative care patients are vulnerable to and at increased risk of certain clinical incidents because of their diagnosis e.g. pressure ulcers. Both clinical and non-clinical incidents may compound the complex psychological and physical impact of their illness.
It should be noted that the incidents listed in this report include some clinical incidents recorded in the community that were noted by Trinity but did not occur under Trinity’s care. Our Quality Committee and Patient Services Committee oversee compliance with policy, and that learning has been identified and rolled out within the organisation.
Patient Safety Incident Response Framework (PSIRF)
The NHS Patient Safety Strategy was published in 2019 and describes a fundamental change in how patient safety is prioritised. The Patient Safety Incident Response Framework sets out a new approach to achieving effective learning and improvement following patient safety incidents. It aims to embed patient safety incident response within a wider system of improvement prompting a shift towards systematic safety management.
In 2023-24 we began the process of embedding PSIRF within our governance framework across all clinical areas of the hospice. We have finalised our PSIR plan and PSIR policy, which have been approved by south west London ICB.
All key roles have been allocated to relevant key staff within the hospice and training has commenced for those involved. With a programme for further implementation, we have had some early engagement events to raise awareness amongst staff and to increase familiarity with PSIRF terminology.
Following retrospective analysis of incidents in previous years Trinity’s identified patient safety priorities are:
Pressure ulcers
Falls
Medication errors
In 2024-2025, we will continue implementation of the systems based approaches to safety enshrined in PSIRF including the introduction of new patient safety learning responses and methods of improving and disseminating learning.
Analysis of Trinity safety incidents
Overall incidents and near misses: green
During 2023-24, we recorded 348 clinical incidents, 67 near misses, and 79 non-clinical incidents.
We have increased our emphasis on reviewing lessons learned and staff proactively implement changes to practice. The introduction of PSIRF will enhance and improve the way we manage incidents within the organisation and importantly the way we constantly learn from any incidents.
During 2023-24, the number of amber incidents was relatively unchanged. The clinical incidents included 1 equipment failure, 4 medication incidents, 6 falls incidents, 17 pressure ulcer incidents, and 4 other cause incidents. Analysis of these has revealed that staff continue to prioritise patient safety through reporting clinical incidents.
The incident themes of our amber events highlight the reason for choosing , pressure ulcers, falls, and medication incidents, as our patient safety priorities within PSIRF.
Analysis of Trinity safety incidents
During 2023- 24, a total of 35 non-clinical health & safety incidents were reported.
We have noted an increase in facility incidents linked to problems with our ageing infrastructure. Our priority for next year is to ensure maintenance plans for the next 5 years are robust.
During 2023-24, we noted an increase in Pressure Ulcer (PU) incident numbers for Category 1, Category 2, and Unstageable reported by staff. As a result, we have identified this as a PSIRF priority to focus on learning and improving care for patients.
We have looked at the 23 Category 2 PU incidents which were reported for patients on admission to the hospice. 21 of these were individual patients with one single Category 2 PU and two were patients with multiple Category 2 PU. The Category 3 PU occurred on the inpatient unit. Review of this incident revealed that processes and appropriate care had been in place but the patient’s preferred position in their bed contributed to the PU. The unstageable PU deteriorated from an initial Category 2 PU, and an appropriate
was
appropriate
and
against any further
Analysis of Trinity safety incidents
Medication incidents
The overall number of medication incidents has increased in 2023/24 from the previous year. On review of all the incidents, one incident of patient harm was identified. Medication incidents are one of our identified patient safety priorities. Level 2 and Level 3 medication incidents are managed appropriately by clinical staff, and interventions, remedies, and training are provided to ensure medication compliance and adherence.
Our Medication Safety Group meets monthly and reports to the Clinical Risk Management Group and the Quality Committee. The group ensures appropriate medication scrutiny and supports a range of activities to ensure medications prescribed are safe, effective, and provided by appropriately trained healthcare professionals.
Inpatient falls
We saw an increase in the number of falls being reported and near misses in comparison to 2022-23. We have therefore identified falls as a patient safety priority within PSIRF. The process of our reporting and reviewing of falls is more consistent and precise through: Training on falls incident reporting to raise awareness of reporting falls/near misses, which has improved implementation of falls/transfer care plans and lessons learned.
The introduction of EMIS as the electronic patient recording system in 2022 has allowed us to generate a new fall risk assessment with a RAG rating system (low/medium/high) and
action plan for each level to inform staff of fall management plans.
The Falls Group meets monthly, reporting to the Clinical Risk Management Group and the Quality Committee. The group looks at all aspects of falls including policies, procedures and incidents with the aim of constantly improving clinical practice and reducing the number of patient falls.
Safeguarding adults
Throughout 2023-24, we have upheld our commitment to safeguarding, ensuring that all individuals associated with the hospice are protected from harm, abuse, or neglect. Our efforts have provided a safe and supportive environment for our patients, their families, our staff, and visitors.
The safeguarding team consists of:
Board Trustee Lead, Safeguarding: Rebecca Pritchard
Executive Lead, Safeguarding: Isatta Sisay, Director of Patient Services
Designated Safeguarding Lead: Paul Sullivan, Head of Patient and Family Support
Deputy Safeguarding Leads (DDSL): the Social Workers within the Patient and Family Support team at Royal Trinity Hospice
Our Safeguarding concerns raised from April 2023 to March 2024
Themes of safeguarding concerns raised April 2023 March 2024
Of the total 49 safeguarding concerns raised by Trinity staff during this period, a notable proportion (17 concerns) were related to pressure ulcers.
Learning from safeguarding reviews
To ensure visibility and accessibility, signs advertising the team’s availability are displayed around the hospice and published on the Trinity website.
Significant training initiatives have been implemented for all staff on IPU in relation to managing and reporting of pressure ulcers.
All safeguarding alerts are reported monthly and presented to the Clinical Risk Management Group and Patient Services Committee, providing a comprehensive overview of safeguarding activity within Trinity.
Freedom to Speak Up Guardians
Freedom to Speak Up Guardians provide an additional route to support anyone to speak up about anything they may be concerned about. We have 9 Freedom to Speak up Guardians who have completed their training and are in roles to help anyone with anything they wish to raise.
The hospice submits data to the National Guardian’s Office each quarter, which includes the number of cases brought to guardians and, within very broad definitions, what the cases were about and any issues, learning or lessons from them. The information is reported to the Patient Services Committee.
The total number of cases raised by staff in 2023-24 was 4 and these included themes of worker safety, wellbeing, and bullying and harassment.
Guardians help to:
Protect patient safety and the quality of care
Improve the experiences of workers
Promote learning
By ensuring that:
Staff are supported in speaking up
Barriers are addressed
Issues raised are used as opportunities for learning and improvement
2.2 Effective care
Outcome framework
We have introduced a quality outcome framework for how we measure impact, gather feedback from those experiencing our care and gather the data that allows us to measure how well we are engaging with the communities we serve. We continue to find ways to listen to these communities and to identify any barriers to people receiving the inclusive, responsive care that they deserve.
Core patient-centred outcome measures for palliative care (PCOMs for palliative care)
For several years, hospices have been signed up to the PCOMs suite of outcome measures to describe patient status over time.
Officially the term for outcome measures in palliative care has now changed to PCOMs for Palliative Care with the core measures being the IPOS, phase of illness and the Modified Karnofsky Performance scale. The CSNAT and Barthel Index are now regarded as additional measures.
Definitions of outcome measures:
• Phase of illness (describes the distinct stage in the patient’s illness)
Modified Karnofsky Performance Scale (describes the performance status of the patient)
• IPOS (measures global symptom burden to the patient)
• Carer Support Needs Assessment Tool (CSNAT) measures support needed by those caring for the patient. NB: the original OACC suite used the Zarit Burden interview, but this has been swapped for the CSNAT in several organisations including Trinity.
• Barthel Index for activities of daily living.
When reviewing the use of the outcome measures, we found inconsistencies across clinical areas. Learning from complaints and concerns highlighted that more constant and regular use of outcome measures would improve communication between teams. In addition, outcome measures, particularly IPOS, will help us to demonstrate the impact we have on patient wellbeing and symptoms.
A PCOMs steering group has been established and meets monthly. To re-energise clinical staff in the use and importance of outcome measures, we ran a 2-week series of ‘OACCey-Cokey’ information sessions.
Our IPU patients complete an IPOS on admission, which is repeated regularly during admission. As a result of the steering group work, IPOS scores are now discussed at every inpatient interdisciplinary team meeting, and an IPOS is also completed at the point of the patient’s discharge or death. Work is currently being done to enable the extraction and analysis of IPOS scores from the electronic note system to illustrate the impact of care on the IPU.
Completing the PCOMs measures in the community forms part of the revised SOP for patient and carer assessment in Community Services.
The outcome measure questions are embedded in the new patient proforma but can also be used as a standalone assessment if required. Repeat scoring of the measures will occur at any review of patient symptoms. The SOP will also introduce the use of IPOS scoring on death or on discharge.
Mortality review
Historically, the hospice has conducted two separate mortality reviews: one for the community and one for the IPU. Both were different in their focus; the community used a structured judgement review process to review the timeliness of specific steps for patients who died before face-to-face assessment, the IPU review was more quantitative and looked at the numbers of patients who died having been referred for admission but before they were admitted. Both processes have now been reviewed, considering ongoing learning, the focus on organisational reassurance, our response to the Lucy Letby case and support for the PSIRF process.
Community mortality review
The community mortality data has been reviewed for 2022-2023 using a structured judgement case review (a total of 103 cases were reviewed).
Moving forward, the community mortality review will focus more on care given by the Community team and the phases of care being assessed will now be:
First assessment (including advance care planning documentation and demographic data collection) and initial action plan
• Ongoing care (including frequency of review and discussion at IDT)
• Communication with family
• Communication with other healthcare providers
• End of life care
• Communication after death
Of patients who died before being seen the following improvement actions have been identified and are being actioned:
• Triaging of all patients on the day the referral is received as the narrative for some cases marked ‘non-urgent’ leads to a revision of the urgency classification
• A numbered system for triage which links with a newly introduced RAG rating for all patients so the timeframe we expect to see patients in is clear
• Revision of the community service business continuity plan to highlight actions to be taken in the event of several staff members being off sick
Inpatient mortality review
Previously, the inpatient mortality review focussed on the number of patients dying following referral for admission but before being admitted. The inpatient review has now been revised and uses the structured judgement review format with phases including:
Admission and initial care in first 24 hours (including action plan, nursing assessments completed and consultant review within 24 hours of admission/48 hours if admission at weekend)
Ongoing care (including regular medical review and consultant ward rounds, one nursing entry per shift, and risk assessments completed and reviewed)
• Care during a procedure (catheter insertion, blood transfusion, syringe pump, including consent, assessment of effectiveness of interventions)
• End of life or discharge care
Communication with family (documentation and regularity)
• Assessment of care overall (including medication changes, were outcomes documented, MCA assessment and DOLs if appropriate, appropriate IDT discussion)
Use of this review has highlighted the following improvement actions which are being actioned:
• Teaching around documentation, stressing the importance of noting the effectiveness of medications
• Teaching around documentation of conversations with family members and if communication is not occurring, the reasons for this
Guidance as to how to manage communication in complex situations
Education, learning and development
In 2023-24 our first staff cohort completed our internal Management Development Programme (MDP) and Senior Leadership Development Programme for clinical and non-clinical staff within the hospice and shops.
The concept of ‘social’ learning has been the focus throughout the year, with informal learning opportunities incorporated into the Learning and Development (L&D) calendar, such as ‘learning at lunch’ sessions for all staff. This year, we have changed our mandatory learning provider to an internally managed system, Talent LMS, which was previously used for the provision of external education workshops. This has allowed us to better monitor our mandatory learning compliance rates.
In the coming year, our focus will remain on continuing and building on the initiatives launched the previous year, enabling all staff to continually develop so that their time at Trinity adds value and provides a sense of purpose.
We continue to share our education platform with other hospices, local authorities and care homes who participate in our programme to support their staff development in relation to palliative and end of life care.
During 2023-24 we further developed the engagement of care homes, local universities and unpaid carers in our catchment area in our clinical education programme.
We continue to provide nursing placements to 15 pre-registration and 1 return-to-practice student nursing placements from adult and learning disability specialities in various clinical and non-clinical settings.
One student’s feedback was that all their fears were put to rest on the first day, as they were warmly supported during their placement, and the practice assessor nurse demonstrated compassion, empathy, and knowledge about palliative and end of life care, ensuring that her learning needs were met.
In 2024-25, we aim to maintain and create new partnerships to support all our staff. We also aim to collaborate with staff to ensure that training is expanded and promoted to enhance continuing professional development (CPD). Our focus remains on updating and enhancing our portfolio of education workshops to provide better provision to healthcare professionals and, ultimately, a better experience of care for people living in our catchment area.
Clinical audit
Trinity undertakes regular audits to ensure compliance with regulations, such as health and safety, infection prevention and control, information governance, pharmacy, and organisational policies. During the past year, we undertook additional clinical audits, such as the omission of medication toolkit.
During 2023-24, the Clinical Effectiveness Committee has continued to oversee audits and quality improvement projects (QIPs). The Clinical Effectiveness Committee has previously provided oversight of research; however, this has now been separated out and is covered by the Research and Quality Committee. The Clinical Risk Management Group oversees compliance with policies and that learning has been identified and rolled out across the organisation.
The Clinical Effectiveness Committee has reviewed the audit timetable over the past year to ensure a smaller number of consistently completed projects. The current audit schedule includes:
Clinical: omitted and delayed medicines, antimicrobials, falls, nutrition and hydration, diabetes management, pressure area care, mental capacity, and steroid use.
Patient and family support: bereavement and safeguarding.
In the last year, our regular compliance checks have been:
Pharmacy: Local Intelligence Network controlled drugs report, controlled drugs monthly checks, chart screening, driver delivery (transportation of medicines between NHS Trusts and the hospice), medicines and devices enquires, pharmacy discharge information, safe dose prescribing and administration of insulin and verbal order compliance check.
Further work is in progress to embed the following clinical compliance checks: vascular devices, catheter care, hand hygiene and blood transfusions.
Clinical Audit
Clinical Audit
Omitted and delayed medicines (NPSA 09)
Falls
Bereavement
Diabetes management
May 2023
December 2023
September 2023
July 2023
Staff awareness and compliance have improved.
For reaudit in autumn 2024.
Mental capacity
January 2024
Steroid use
March 2023
Infection Prevention and Control (annually)
April 2023
Ongoing monitoring via compliance check.
Reaudit completed and being monitored by falls group.
Service evaluation. Ongoing liaison with PAFS team.
Staff education and learning with diabetes management.
All staff and patients are supported with clinical workshops around mental capacity.
Review of guidance to support staff and patients’ compliance.
Improvement of staff awareness of infection control compliance within the organisation.
Reaudit showed no concerns – for reaudit mid-late 2024.
Audit of documentation for TEP / DNACPR capacity assessments showed a lack of formal capacity assessments and use of dedicated EMIS templates. Interventions currently ongoing.
Being monitored via compliance.
Environmental management system of process and practice in situ.
• Monthly audit of hand hygiene, aseptic technique, catheter care and mattress cleanliness.
• Regular internal unannounced audits by the Head of Facilities.
The hospice Research Committee meets monthly. The committee reviews all requests for collaboration in research projects from external organisations and supports staff members with their own research projects. Research
Study title
Institution
CHELsea II University of Surrey
Study purpose
A cluster randomised trial of clinically assisted hydration in patients’ last days of life. Trinity has been randomised to be the ‘control’ arm of the study. Recruitment began in January 2023 and so far, we have recruited 18 patients. We aim to recruit 20 patients over two years.
The research team have conducted site visits to assess how well we are working within the trial protocol.
Patient recruitment for this study is ongoing.
PALLUP Study- Equipping community services to meet the palliative care needs of older people with frailty approaching the end of life; a mixed methods study
Hospice Eye Donation
Surrey University
NHS Blood and Transplant
The Modified Delphi aims to establish consensus on the core palliative care needs of severely frail elders living at home and gain insight into the shared and distinctive features of agreed palliative care needs.
We are awaiting the results which will be sent at the end of phase 4.
The purpose of this engagement is for NHSBT (National Health Service Blood and Transplant) to implement the outputs of the recently concluded three-year research study Eye Donation from Palliative and Hospice Care settings: Investigating Potential, Practice, Preference and Perceptions (EDiPPPP). The hospice will be involved in this project which aims to improve the rates of corneal donation through education and the use of an online Eye Donation Eligibility Assessment Checklist.
RUN PC project
CNS (for dissertation towards Masters in Supportive Palliative and End of Life Care)
The project aims to roll out the use of the RUN PC triage system for inpatient and community services using ADKAR service change model and assess challenges and benefits of using the triage model.
2.3 Patient experience
Our approach to listening and learning from the people who have used our services
Our patient experience of care plan sets out our ambitions to improve the patient experience of care at Trinity. It is important for the hospice to have processes in place to ensure that it seeks and responds to feedback about all the services that it provides from patients, carers, staff, and stakeholders.
We have previously experienced challenges in consistently receiving patient feedback, with low response rates from previous surveys. To address this issue, the hospice has been working on a range of different ways to make this process easier and increase the response rate.
These plans include an annual patient experience survey, next due in May 2024, a yearly carer survey, due in September 2024, and a rolling short three-question survey for anyone who uses our services.
Patient experience of care survey: survey feedback
The overall responses to our patient feedback for 2023 – 2024 were:
97% of respondents would recommend us to friends and family if they ever needed similar care or support.
99% of respondents felt that they were treated with respect and dignity.
93% of respondents felt that we responded quickly whether they needed advice or help urgently.
Patient experience surveys sent (1 April 2023 to 31 March 2024): 330; received 145. Responses were from people receiving care from any clinical service provided by the hospice.
There were two ways to complete the surveyeither by hand or electronically - and when the survey closed at the end of March 2024, a total of 145 responses were received, 44% of the patients contacted. The following 2 pages are a summary of the key questions and their responses.
Thinking about your care how often have you felt:
That your care team treats you with respect and dignity?
That your care team works well together?
That the things that are important to you are considered in planning your care?
That you have been as involved as you would like in decisions about your care and treatment?
That you have been able to talk with members of your care team as openly as you would wish?
That you have had enough opportunity to ask questions?
Thinking about your care how often have you felt:
That when you need advice or help urgently, your care team responds quickly?
Safe in your place of care?
That your care team helps you to have as much privacy as you want?
That your care team treats you as a whole person: eg: takes into account your beliefs, hopes, traditions, customs, spirituality?
That the care and support meets your emotional needs:eg: feeling low, feeling worried, feeling anxious?
That the care and support meets your physical needs eg: pain, breathlessness, fatigue, mobility
Thinking about your care, were you given:
Support to involve your family and those close to you, as much as you wish, in decisions about your care?
Support to do things that you enjoy e.g: spending time with family and friends/ reading, going outdoors?
Support to get any equipment or aids that you need e.g: oxygen, hospital bed, wheelchair?
Support to get help with practical matters e.g social benefits, wills, finances, legal matters, form filling?
Support to get help with your personal care e.g. dressing, washing, eating?
Information that you can understand about your prescribed medicines?
Information you can understand about your condition?
We are delighted that our patients’ feedback is positive, which demonstrates the encouraging outcomes we are delivering. Teams across the hospice receive regular feedback, and we respond to as many people as possible.
Lessons learned from the free text provided in the patient experience feedback forms include:
To provide clear information regarding outpatient services and encourage staff to use the information leaflets in relation to patient care.
To enhance medication discussions with patients in the community setting.
To ensure that our response times to all comments, suggestions, and complaints are managed appropriately.
Complaints and concerns
We received 8 formal complaints in 2023-24 (compared with 4 in 2022-23).
• 2 were resolved and upheld
• 4 were resolved and partially upheld.
• 2 were resolved and not upheld.
We received 27 concerns, compared to the 14 concerns in 2022-23. All were discussed with the parties involved and have been resolved and closed.
Learning outcomes from concerns and complaints this year include:
A review of our bereavement information pack for families, carers and patients has been updated offering support through the emotional impact of grief.
Our Community Nursing team has reviewed their Care at Home patient information leaflet to ensure that people and families in their own homes understand the expectations of our community services.
A guideline for communication with inpatient families to ensure staff follow hospice values when speaking to bereaved relatives and next of kin.
The protocol has been changed for Care Coordinators managing equipment collection from bereaved families.
We have encouraged the routine use of outcome measures in community assessments to ensure less apparent needs are identified.
Compliments
During 2023-24 we recorded 159 written and/or verbal compliments (compared with 131 in 2022-23). Compliments received by patients and families are anonymised and reported to the Clinical Risk Management Committee and summaries are shared with staff.
Family, carer, relative and stakeholder comments received:
“To all the staff on the ground floor, thank you so much. Your care and dedication were greatly appreciated during my mother’s week at Trinity. I will always remember the kindness shown by you all.”
“Empathetic, Caring, Kind, Loving, Supportive, and Professionalthat’s all of you. Thank you so much.”
“To the night staff at Royal Trinity Hospice. Thank you for all the care and welcoming hospitality you showed not only to our nan/mum/wife but to our whole family. Thank you for making her last days peaceful and calming.”
“The care I have received at the hospice has been so remarkable that while I am usually reasonably loquacious, I find it difficult to articulate my most profound gratitude. Thank you to everyone involved for their individual attention to my slightest need, from the individual who cleaned my room to all the nurses/doctors/therapists, etc.”
“I just want to convey my gratitude and thanks for the support provided by your team. My colleague and I encountered a highly distressing situation upon arrival at the patient’s home. Due to the significant carer distress we encountered; we requested an urgent admission for this gentleman. We appreciated the recognition of the urgency and your team’s support in admitting this gentleman.”
“Every single amazing person who came through our door brought compassion, dignity and professionalism.”
Family, carer, relative and stakeholder comments received:
“The family would like to thank all Trinity staff for the awesome and very kind care they have supplied to her. Thank you for taking care of my mum and making her journey easy. We’ll never forget what you did for Mum.”
“Trinity has provided our family with a lot of well-needed support at times we were experiencing great emotions trying to deal with our mother’s needs and wellbeing. They regularly touch in with us which is both valuable and well appreciated. Trinity has been wonderful at times when we needed additional support and advice.”
“I would like to congratulate all the staff from Trinity : the kitchen staff, the doctors, the nurses, the healthcare assistants, the receptionists, the cleaners, the volunteers, and the religious support team of everyone working at Trinity. Your kindness, your care, and your attention to detail is beyond. You have left me speechless. I have visited my dear friend every day during their stay at Trinity . Staff managed to feed and support our dear friend with grace, respect, and dignity. Our dear friend is still alive and has moved into a nursing home. Thank you very much to all of you for all your care, support, and kindness.”
“Dear everyone at Trinity. Thank you! For all the times you’ve cared for our Mum. For all the times you’ve rescued her after she skipped over the falls mat! Thank you for the skills you’ve brought, for the food, drinks, ice cream, rice puddings, for the lovely reception at the front door, for the beautiful gardens, for the attention to detail. We’re hugely grateful.”
“To all the wonderful staff at Trinity, thank you so much for taking great care of me.”
Section 3: Our review of 2023-24
Progress against priorities for improvement 2023/24
We successfully delivered the second year of activity against our five-year strategy with the goal “To expand our reach to all of the people in our community who would benefit from our services, through an inclusive and collaborative approach to delivery while maintaining outstanding quality and financial balance.”
Trinity’s 5-year objectives
1. To invest in expanding our services, workforce and facilities.
2. To strengthen our collaboration with partners, utilising innovative pathways.
3. To extend our reach across all of our diverse communities – particularly those who traditionally do not access palliative and end of life services.
4. To make the best use of our existing workforce model and facilities, utilising digital and virtual working.
5. To ensure fundraising, retail operations and NHS income match growth in activity and associated operational costs.
Objective 1
To make the best use of our existing workforce model and facilities, utilising digital and virtual working.
What we did in 2023-24
We have implemented a new impact framework to provide clearer evidence of the difference we make to the people we care for and support.
We have introduced the National Patient Safety Incident Response Framework.
We have launched our Living Well outpatient service.
We have introduced an electronic rostering system for our nursing workforce to provide a transparent and reliable staffing system.
We have improved allocation of workloads based on patient complexity and skill mix within the Community Nursing team.
We centralised service coordination and simplified the patient pathway through the launch of a Clinical Hub, ensuring a single point of access and contact, continuity of care, reduced waiting times, and freeing up more clinician time to spend with patients.
Areas for future improvement and what we will do next: plans for 2024-25
We will develop a new estates strategy, which will include a five-year maintenance plan, to ensure adequate investment is made to our aging infrastructure to reduce incidents.
We will ensure that post-death care standards are maintained and that recommendations from the recent Sir Jonathan Michael Mortuary review are embedded in operating procedures.
We will embed the Patient Safety Incident Response Framework into the organisation.
We will optimise the occupancy of the inpatient unit by proactively linking in and working collaboratively with referring clinicians.
Objective 2:
To extend our reach across all our diverse communities, particularly those who do not traditionally access palliative and end of life services.
What we did in 2023-24
We grew the Compassionate Neighbours project with over 50 community members matched with trained volunteers across our catchment area.
We have trained more staff on the unmet needs of our population, including people including people with learning disabilities, people with hearing loss and people who are religious.
We have redesigned our patient engagement program to make it easier for all patients and carers experiencing our care to share feedback.
We launched “CARES” (Contact information, age, religion, ethnicity, sexual orientation), to improve the capture of patient demographic information.
Areas for future improvement and what we will do next: plans for 2024-25
We will focus on learning and adapting our services in response to the information gathered from our community engagement activity.
We will collaborate with King George’s Hostel in Westminster on a collaborative art project which aims to improve death literacy among homeless men living in our catchment area.
We will continue to host events and activities aimed at bringing people into the hospice with a specific focus on key audiences and communities that we do not currently reach e.g. Talk & Tour, Carers Week.
We will work to improve the care experience for deaf and hard-of-hearing patients.
Objective 3:
To strengthen our collaboration with external partners utilising innovative pathways.
What we did in 2023-24
We further developed our close working relationships with our neighbouring hospices, sharing best practice and resources.
We switched on data sharing with our new patient record management system, EMIS. This has allowed us to connect our teams to the NHS spine and local GP practices ensuring more joined-up, timely working and a smoother experience of care for patients.
We strengthened our partnerships with acute hospitals, agreeing a new joint consultant post with St George’s Hospital
We continue to work in partnership with local educational institutions which include all our university partners, NHS trust hospitals, secondary care providers and international organisations. This has included palliative care units from Argentina, health and social care students from Norway, as well as a premed student from United States of America.
We expanded our educational offer to staff and local healthcare professionals.
Areas for future improvement and what we will do next: plans for 2024-25
We will grow our education workshop provision to include a wider range of topics and aim to promote these externally to broaden our reach.
We will strengthen our partnership working with care homes to provide specialist advice for individual patients via visits, remotely and support MDT members.
We will proactively engage with referring partners (hospitals, GP, district nursing) to make sure we support everyone who could benefit from our services.
We will embed and share electronic patient records with primary care providers to improve collaborative working.
Objective 4:
To invest in expanding our services, workforce, and facilities.
What we did in 2023-24
We completed phase one of our new Clinical Hub model rollout by:
• launching a Rapid Response service
• expanding our care coordination to every person we support
• launching a new dietetic service introducing art therapy
• launching an enhanced bereavement service
We delivered our Transform Programme: our new clinical model of care
Central admin team
Coordinating all care services
More virtual services
Including a virtual support service
Rapid response service
For fast response to urgent patient needs
Support complex patients and those recently discharged from hospital/hospice
Support new and existing urgent patient cases at home and transfer to/from IPU
Care coordination
Serving North and South areas of our catchment
Wellbeing services offered and outpatient hubs
Introduced into the community
Support for patients and family members. Expanded to include wellbeing services. Currently known as outpatient service
Service to support urgent transport of patients to/from the hospice IPU
A social movement to tackle loneliness and isolation. Support by volunteers Part of the PAFS service
Expanded to entire catchment area
Enhanced service which prepares internal and external HCPS to provide appropriate care
We developed a monitoring and evaluation framework to measure the performance of our new clinical model of care.
We designed and introduced the second phase of the People Plan, which includes investing in the development of our clinical workforce through education and training.
We established a Return to Practice programme linked to educational institutes with which we work in partnership to support nursing placements at Trinity.
We expanded our Palliative Care Assistant role in the community to support the community IDT of registered professionals.
Areas for future improvement and what we will do next: plans for 2024-25
We will continue working towards becoming an Employer of Choice with ongoing commitment to investing in our people through the People Plan II
We will launch a new Virtual Support Service to support complex discharges into the community.
We will expand the operational hours and reach of our Rapid Response service to a 12 hours 7 days service
Objective 5:
To ensure fundraising, retail operations and NHS income matches growth in activity and associated operational costs.
What we did in 2023-24
We continued to discuss with commissioners the urgent need to increase the proportion of our funding that comes from the NHS.
We opened two new shops in Brixton and Wimbledon.
We delivered our most successful year ever in retail with our profit growing by 7% year on year.
We launched the ‘Every Person Matters’ campaign to fund our growth strategy with the goal of raising an extra £4 million in the next 2 years.
We increased the number of people who supported us through charitable activities.
We launched the “I will” campaign to strengthen our future legacy pipeline.
We reviewed our cost base and found further opportunities to maximise value for money.
Areas for future improvement and what we will do next: plans for 2024-25
We will continue to lobby our NHS commissioners for increased statutory funding towards our core and specialised services, with a view to meeting the average funding received by other London hospices.
We aim to further increase the profit made by our retail business, through strengthening our stock pipeline and attracting new customers.
We aim to further increase the amount raised through our fundraising activity, by refining our existing activities and introducing new opportunities for our communities to support us, such as new events and further work on our legacy pipeline.
We will explore other opportunities to generate income for the hospice.
Section 4: Trinity governance and compliance
4.1 Board of Trustees
There is a 15-member Board of Trustees, which has ultimate responsibility for the governance and leadership of Royal Trinity Hospice. The Board makes strategic decisions, monitors the organisation’s performance, and ensures that it complies with its Articles of Association and applicable laws and regulations.
The Board works closely with the Chief Executive Officer and the Executive team to set our strategy and monitor performance and risk management. The Board meets quarterly and works through three board committees (People and Culture Committee, Finance and Resources Committee and Patient Services Committee) and closely with the board of the retail subsidiary.
Board of Trustees
Hospice
4.2 Care Quality Commission (CQC) regulation
Trinity serves the communities of the London Borough of Wandsworth, which makes up approximately 50% of the patient population. The remaining 50% of patients come from other surrounding London boroughs, including Lambeth, Hammersmith and Fulham, Kensington and Chelsea, Westminster, Richmond, and Merton.
Trinity has a CQC registered manager, our Director of Nursing and Quality, in post since July 2022 who coordinates any liaison with the CQC. Trinity was last inspected in August 2019, and the service was rated as ‘Outstanding’.
4.3 Data management
Trinity has been using EMIS Web as our clinical record database since October 2022. During this time, we continue to encourage GPs within our catchment to sign our data sharing agreement and enable patient record sharing within EMIS. Smartcards have now also been deployed to allow access to the patient demographic service, thereby ensuring the use of NHS numbers for unique identifiers.
We are obliged to meet the standards of the Data Security and Protection Toolkit. We completed this year’s Data Security and Protection Toolkit return by 30 June 2023, in line with the deadline.
Our Information Governance Committee ensures we consistently meet national requirements, and reviews and oversees the implementation of information governance practices, new policies, and training. In 2023, an external audit of our Data Security and Protection Toolkit and data protection practice was carried out to ensure we meet the highest standards.
Annexe 1: The Board of Trustees and Lead
Commissioner’s Statements 2021-22
The Board of Trustees is fully committed to the provision of a high-quality service at Royal Trinity Hospice. The hospice has a robust clinical and corporate governance structure, with members of the Board playing an active part in ensuring that Royal Trinity Hospice fulfils its mission, according to its charitable intentions and in ensuring that the organisation remains responsible and compliant in all areas of CQC registration, health and safety, employment law and other relevant legislation:
Signed Andrew Dillon
Chair of the Patient Services Committee, Royal Trinity Hospice
Date: June 2024
Lead Commissioner Statement
The Commissioners have reviewed Royal Trinity Hospice’s Quality Account for 2023/24 and acknowledge the high standard of care provided. They welcome the specific priorities for 2023/24 as appropriate areas for continued improvement that link with clinical commissioning priorities:
Signed Darren Jones
Director of Nursing NWL ICB
Date: June 2024
Signed Sandy Keen Head of Integrated Care for Wandsworth and Merton NHS SWL London and SE London
Date: 28 June 2024