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PROVIDER VISIT

Location : St. Clare Hospice Trust, Hastingwood Road, Hastingwood. Essex CM 17 9JX Telephone number: 01279773702 Visiting Trustees:

(1)

Name

John Frazer (Vice Chairman)

(2)

Name

Phil Quincey (Vice Chairman)

(3)

Name

Date: 4th June 2013

Roderick Grosstephan (User representative)

Date of Last Provider Visit March 2011 Key areas this provider visit will focus on: (1)

IPU including Physio/OT (as available) and admin

(2)

Community team and admin

(3)

Fundraising

Provider Visit Report. St Clare Hospice. June 2013

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CLINICAL - (IPU, Day Therapy, Community, Bereavement) IPU Overview of clinical service:

The IPU has 8 beds and is a short stay facility which provides end of life care for patients with complex needs. Patients usually stay between 7 and 10 days. The unit accepts admissions for assessment of need, symptom control, and end of life care

Who was spoken with and the information gleaned:

IPU Doctor, 2 IPU Nurses, IPU Administrator, Director of Patient care The unit cares for patients with complex needs. Patient’s care and progress is reviewed daily and patients are involved along with clinical staff and relatives when assessing individual treatment plans

What is going well?

The team work and support between the wide range of staff in the IPU is good. Staff value being able to spend time with patients and being able to provide a proper care package for them. They appreciate the fact that St Clare is not driven by targets as is often the case in sections of the NHS. This enables good communication between staff patients and their families

Summary of patient/carer feedback

On the day of the visit one inpatient was able to be interviewed He was very satisfied with all the facilities at the hospice and described the rooms as being very comfortable. He had nothing but praise for the standard of care provided describing the nurses involved in his care as “ friendly and efficient” There were no carers available for interview on this occasion.

What are the challenges?

The complex and varied needs of the patients. Good paper-light systems allow access by all teams to patient information, but more laptops would be helpful The continued development of Hospice at home and the challenges of providing 7 day working

Suggestions of key areas to be explored following the provider visit

The vision for the IPU in the next 5 years The advice line is a positive development but highlights the difficulty when there is no staff available to provide support for patients at home during weekends. Plans for staff/nurse development

Provider Visit Report. St Clare Hospice. June 2013

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CLINICAL - (IPU, Day Therapy, Community, Bereavement) Community team: Overview of clinical service:

Who was spoken with and the information gleaned:

The community team is a team of Specialist Palliative Care nurses with administrative support. They work as an outreach team of St Clare providing support to patients and families at home and in the community. The management of the team was transferred from West Essex PCT to St Clare 2 years ago. The team works from a base in St Clare and each nurse works within a geographical area and has their own case load of patients Three members of the Community team including administrative support. The team work with and often co-ordinate the input and support from a wide range of professionals; GPs, District Nurses, Hospital Oncologists, Social Workers including family members to ensure that patients receive the highest level of palliative care possible in each individual case.

What is going well?

Summary of patient/carer feedback

What are the challenges?

The team have now been based at St Clare for 2 yrs and after the usual settling in problems have established an effective way of working. Since being based at the hospice the team have found the specialist clinical support and advice available from clinical staff at St Clare to be invaluable in their work and it has helped to provide a more co-ordinated service for patients. They also appreciate the open and supportive management they are receiving. The “clinician of the day� system has been instrumental in enabling a more responsive service to be provided. There is good overlap between Community and IPU It was not possible to interview any patients of carers who were receiving a service from the community team on this occasion

While the team are working well there is concern that there is currently a waiting list for the service. The hospice recently trialled 7 day working and while this was embraced as a positive development the main challenge for the team will be to maintain a good level of service over the extended period and particularly over weekends.

Suggestions of key areas to be explored following the provider visit

More staff will be needed when 7 day working is introduced permanently. It would be good to return the day room to patients, if that is possible during the proposed site redevelopment

Provider Visit Report. St Clare Hospice. June 2013

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NON CLINICAL AREA: Fundraising Overview of service:

The fundraising team has undergone major changes in the last year which has involved the appointment of a new Director of Fundraising and more recently a new Fund Raising Manager along with a number of other significant appointments The team is now approaching full strength.

Who was spoken with and the information gleaned:

The Fundraising Manager and four members of the Fundraising Team. From the discussions which took place It was clear that the recent appointments had substantially strengthened the Fundraising team which had undergone a fair degree of turbulence over the last two years as a result of the high number of vacancies due to staff turnover. Hopefully the recent strong appointments will herald a period of stability in the team and the more systematic approach to fundraising which is currently being promoted will pay dividends.

What is going well?

Although many of the team are new in post they are well motivated and beginning to work as a team. Staff finds management of the team open and supportive and enjoy the good working environment. All events are well supported and the challenges are going well as is the Lottery. Recent appointments have filled vacancies with staff who have the appropriate skills for the job they are being asked to do thus adding to the fundraising potential of the team.

What are the challenges?

To find ways of increasing the fundraising income for St Clare in a field which is becoming more competitive. There is competition from hospices and other charities including the big national charities in a challenging economic climate. Bringing new staff up to speed as quickly as possible and continuing the team building.

Suggestions of key areas to be explored following the provider visit

To explore other ways of raising income whilst still being able to maintain impetus on our existing big money spinners. To investigate incentives to increase sponsorship for those participating in major events run by St Clare

Provider Visit Report. St Clare Hospice. June 2013

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CLINICAL - Occupational Therapy Overview of service:

Occupational therapy provide a wide range of physical and practical help to patients in the IPU, Day Centre and the Community and provides a link to a number of other key services.

Who was spoken with and the information gleaned:

Occupational Therapist - carries out a wide range of activities both in and out of St Clare helping people adapt to their situation both physically and emotionally. It is particularly important to offer physical and practical help for patients returning home. Can be involved in guiding patients into the most helpful Day Therapy activities to suit them. Day therapy not suitable for all people, but OT can still be helpful to people

What is going well?

Day Therapy is going very well, management of the service is good and it’s a really great place to work. From patient reaction it is very clear that the therapeutic and social element of Day Therapy is very valuable

What are the challenges?

Not enough Occupational Therapists – Communications between the 3 teams (IPU, Day therapy and Community) could be better – it can be difficult to follow patients through from one team to another.

Suggestions of key areas to be explored following the provider visit

More staff would mean more people could be helped

Provider Visit Report. St Clare Hospice. June 2013

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COMMUNICATIONS AND REPUTATION Observations: look at the customer service experience, polite, courteous inter-actions/can do approach

A review of the Complaints log was undertaken; all complaints had been dealt with according to policy and procedure save for one where it was not clear whether the outcome had not been pursued or did not need to be (IPU Room 1 22/12/12).

May wish to enquire about: - team meetings, newsletters, e-mail, SharePoint, notice boards, cascade of information, are staff/volunteers aware of what is happening and mission, vision and values. During the discussions which took place during the visit it was evident that regular team meetings were taking place in the teams interviewed. Communication overall was thought to be good particularly within specific teams. However, there was some concern expressed that internal communication across the hospice could be improved in some areas.

Provider Visit Report. St Clare Hospice. June 2013

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STAFF AND VOLUNTEERS Have staff been appraised?

It was clear from discussions with staff during the visit that a system of regular appraisal was in place and being carried out

How is morale? The impression gained from this visit indicated that morale within the Hospice was generally high. Look at few pertinent policies and procedures

None looked at on this occasion although all Hospice policies are reviewed regularly by the appropriate

Are staff aware of key documents?

Not explored on this visit

Statement of Purpose

Annual Review

CQC Report

Complaints Policy/gaining feedback

Ask new staff about recruitment/ induction procedures:

committee and ratified by the full Trust Board.

The staff interviewed found the induction procedures good and were appreciative of the “open door” policy and accessibility of staff.

Provider Visit Report. St Clare Hospice. June 2013

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ENVIRONMENT Safe and secure?

The premises are secure, with Reception staffed 9 to 5, and securely locked at other times. The premises have intruder alarms.

Evidence of risk assessments

Not explored on this visit

How is privacy and dignity managed?

Not explored on this visit

Look at any specific areas of health and safety

Not looked at on this visit

Suggested areas to check •

incidents/accidents

power source

A review of the incident log was carried out and nothing untoward found; it is recognised that slips and trips are common among patients and the relevant “toolkit” is being used to help prevent/mitigate these. Standby generator tested weekly and given a good run monthly

fire plans

Not checked on this visit

Hospice vehicle schedule

Not looked at on this visit

disaster plan

Not looked at on this visit

equipment log

Not looked at on this visit

look at the website

Not looked at on this visit

look at complaints log

A review of the Complaints log was undertaken; all complaints had been dealt with according to policy and procedure save for one where it was not clear whether the outcome had not been pursued or did not need to be (IPU Room 1 22/12/12).

Provider Visit Report. St Clare Hospice. June 2013

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SUMMARY OF VISIT

The provider visit gives trustees a snapshot of the running of the hospice on a given day in specified key areas agreed by trustees prior to the visit. St Clare has been through substantial change over the last two years both in terms of staff turnover and the massive changes taking place in the health sector at this time. In spite of this the Hospice has been able to make the step change necessary to increase its strategic influence and credibility within the West Essex, East Hertfordshire health community and in so doing enable it to become a major provider of palliative care in the area. Credit is due to the senior management of the hospice for the way in which they have managed such potentially disruptive change so well. Recent appointments have strengthened the staff team at a time when the Hospice is seen to be playing an increasingly pivotal role in the area. In addition to this the Hospice was successful in its bid to the Department of Health for money earmarked for improvements to the building with particular emphasis on the Day Therapy element of the Hospice. These are all positive developments which, along with the development of 7 day working, will put pressure on management and staff and will need to be managed carefully. However, on the evidence of this visit staff are excited about the future and well motivated to rise to the challenges coming up... With the Systems and structures that are in place it should be possible to ensure staff are well supported. This will be extremely important given the large number of new members of staff and will need to be monitored carefully over the next year. The team that carried out the Provider Visit found staff to be open, friendly and well motivated. We would like to thank everyone for their patience co-operation and good humour during the visit.

Provider Visit Report. St Clare Hospice. June 2013

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RECOMMENDATIONS Although communication within the teams interviewed was good communication between different teams of the hospice could be improved •

Look at ways of improving internal communication across the various teams in the Hospice

It was good to note that most staff were able to recognize some of the Trustees and all knew who the Chairman was. However, it would be productive to increase occasions when Trustees and staff have the opportunity to meet up. •

Encourage trustees to attend occasions when there is the opportunity of meeting with staff

As Day Therapy is a significant and developing element of the holistic package of care provided by St Clare it would be useful to make Day therapy one of the main foci of the next provider visit. •

Ensure that Day Therapy is one of the main strands of the next Provider Visit

.

Signed

................................................................

John Frazer (Trustee)

Signed

................................................................

Phil Quincey (Trustee)

Signed

................................................................

Roderick Grosstephan (User Forum)

Provider Visit Report. St Clare Hospice. June 2013

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Provider report June 2013  

Written by our trustees and a member of our user involvement forum after speaking to members of staff, this is a snapshot report of St Clare...