ACORNS CHILDREN’S HOSPICE · 2016-03-30 · Acorns has provided specialist palliative care and support to children and their families since 1988. We welcome the opportunity to demonstrate

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ACORNS CHILDREN’S HOSPICE

TRUST

QUALITY ACCOUNTS 2014 – 2015

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Table of Contents Page Number

Part one Statement from the Chief Executive

3

Enduring Principles 4

Part 2 Priorities for improvement and Statements of Assurance from the Board

6

Priority areas for Quality Improvement for 2014 -2015

7

Review of Quality Improvement Areas for 2014 -2015

9

Mandated Statements Statements of Assurance from the Board

11

Safeguarding 13

Participation in National Audits

16

Research

16

Quality Improvement and Innovation Goals agreed with Commissioners

17

What others say about us

18

Data Quality

22

Clinical Coding Error Rate

22

Part 3 Review of Quality Performance

23

The views of Acorns service users

30

Closing statement from Acorn’s Director of Care Services

41

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Part 1: CHIEF EXECUTIVE

STATEMENT

Acorns’ Quality Accounts 2014-15 is intended to provide service users, the public and those

organisations that support us financially, including the NHS, with information on the quality of

the services we deliver. This account will demonstrate how we assess the quality of those

services and ensure evidence based quality improvement on an on-going basis.

The Quality Accounts have the dual function of looking both backwards and forwards. The

narrative of the Quality Accounts will explain Acorns commitment to review its services and

this then influences the priorities for further quality improvement.

Acorns has provided specialist palliative care and support to children and their families since

1988. We welcome the opportunity to demonstrate the work of our dedicated and skilled

workforce (including volunteers), the systems we have developed over more than a quarter

of a century and to share our future priorities.

Acorns Director of Care Services was responsible for the preparation of this report and its

contents bringing together the information systems actively used across the Charity to

measure and review quality. To the best of my knowledge, the information in the Quality

Accounts is an accurate and fair representation of the quality of health care services

provided by Acorns Children’s Hospices. Quality is continually addressed at Executive level

through the Care Governance Group and at Board Level through the Care Assurance

Committee; they both meet on a quarterly basis to ensure a robust and rigorous review of

quality and the monitoring of performance.

Underpinning all our work at Acorns are Vision, Mission and Values statements which are

further guided by our enduring principles. They are respectively as follows:

VISION

Every child and young person living in our region that is life limited or life threatened and

their families should receive the specialist care and support they need.

MISSON

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To provide holistic, specialist, palliative care services to children, young people and their

families. We will deliver these services in partnership with others wherever possible,

championing the cause of palliative care for children and young people.

VALUES

Acorns is a caring, responsive and innovative charity, putting children and young people and

their families first in all our services, while embracing the diversity of our regional

communities, demonstrating professionalism, integrity and quality in all we do.

ENDURING PRINCIPLES

Staying focused on our vision, mission and values to provide an on-going sense of direction

for our Strategy;

Living within our means, especially by controlling our fixed costs;

Ensuring our voice is heeded wherever the cause of palliative care for children and young

people needs to be championed;

Working in partnership with NHS and local authority commissioners and providers, other

charities and like-minded private sector organisations; and,

Maximising sustainable statutory, retail and lottery funding, while maintaining a robust

fundraising portfolio and sufficient operational reserve.

The children and their families are central to all we do at Acorns. Ensuring our services are

responsive to needs has been the driving motivation of Acorns for 27 years. In order to

support the child and his or her family Acorns allocates a family support professional for

every family who will listen to the views of each and every individual family member. This

ensures that the support is personalised and unique to the person concerned.

Over the last 27 years we have more than trebled the number of children and families we

have been able to support developing from one hospice with a family support team

supporting families in the community in 1988 to our current three hospices, three family

support teams and a hospice at home team of nursing care staff providing outreach care in

families homes. We have achieved this while continuing to improve the quality of service

and responding to children and their families in relation to their changing needs over the last

three decades.

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It is our intention to continue to increase and expand our services by offering a clinical

outreach service and a comprehensive home volunteering service to support additional

children and families; we will continue to work closely with all our service users and wider

stakeholders to ensure this is achieved whilst maintaining the highest quality standards in

care.

David Strudley

Chief Executive

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PART 2: PRIORITIES FOR IMPROVEMENT AND STATEMENTS OF ASSURANCE FROM THE BOARD

The Board’s strategic plan for Acorns, ‘Realising the Vision 2013 - 2018,’ identified key

priorities for the development of services for the next 5 years. 2013-14 was the enabling

year; we used this opportunity to ensure we had the workforce and systems in place to

achieve our priorities. Quality is integral to any growth in, and development of, services. In

2014-15 we added additional resources and implemented the Acorns ‘Integrated Care Model

’ which involved the appointment of outreach nurse leads to support the development of

clinical support being offered to children in home and hospital. The out-reach nurses have

this year worked with colleagues from the hospice who know the children and families. We

also appointed volunteer co-ordinators who have this year developed community out-reach

volunteers supporting children and their families in the community. This year (2015-16) we

are in our third year of implementing the vision strategy and continue to work towards

achieving our offer of care to at least 1,000 children and young people a year by the end of

the decade.

There are sound and robust systems across Acorns that ensure safe high quality care.

Acorns has a Standing Operating Procedures in response to the ‘Implementation of

Controlled Drugs (Supervision on Management and Use) Regulations 2006’. Acorns has an

established Care Governance Group which internally regulates and quality assures all work

across its hospices. A Care Assurance Committee (comprising members from the Board of

Trustees) meets quarterly with the Director of Care to rigorously monitor service delivery and

quality of care services. There are also systems across the Trust which monitor and

internally regulate Information Governance and ensure compliance under the Data

Protection Act 1998 and the Human Rights Act 1998.

Acorns is registered with the Care Quality Commission (CQC) which exercises external

governance that must be met in order for Acorns to operate its services.

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PRIORITY AREAS FOR QUALITY IMPROVEMENT FOR 2015 - 16 Following consultation with the care managers and hospice leaders and using feedback from

service users, Acorns identified the following three priority areas for quality improvement in

2015-1616.

Quality Improvement Area 1

Real Time Reporting

Service user feedback is integral to ensuring Acorns services are effective and

responsive to children and their family’s needs. Acorns have used annual and

biennial satisfaction surveys and service user involvement to ensure our services are

providing the appropriate level and standards of care. Real Time Reporting supports

an interactive and timely feedback from parents and children using the service, by

utilising technology and software which enables monthly summaries of service users’

views.

The managers can then respond to any concerns or requests promptly.

This will be achieved by:

Identifying Real Time Reporting Champions at each hospice who will promote

and support this project with service users.

Reviewing questions every quarter to monitor targeted areas of hospice

services.

Outcomes from Real Time Reporting will be shared at the Acorns Research

and Development Group with outcomes and responses being available to

families via the family newsletter and the internet and to commissioners via

the impact report.

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Face to Face Service

This is a new service providing parent to parent support for families with children with

Palliative Care needs. The service will provide support at all stages of the palliative

journey from diagnosis to bereavement, empowering parents to make decisions and

choices at each stage including end of life.

This will be achieved by:

Recruiting parents with the time and skill sets to become befrienders

Providing accredited training for all befrienders

Outcomes will be evaluated by Acorns Lead Nurse for Governance & Quality

Befriender’s will receive ongoing support from Acorns Volunteer

Co-ordinators.


Expert by Experience

The Care Quality Commission (CQC) have recruited ‘Experts by Experience’ to be

part of CQC inspection teams when undertaking unannounced visits to care

providers.

Acorns senior care management undertake compliance visits across the hospices to

monitor quality. Acorns will recruit parents who use or have used the service to work

alongside the senior managers on these compliance visits as an additional

mechanism and perspective for quality assurance.

This will be achieved by:-

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Recruiting and briefing parents who have the time and skills for this role.

Undertaking a compliance visit at each of the hospices with an ‘Expert by

Experience’ as a member of the Acorns inspection team.

Producing a report on the compliance visit findings and submitting to Acorns

Board of Trustees and CQC.

Feeding back to CQC the learning of using Experts by Experience in a

children’s palliative care setting.

REVIEW OF QUALITY IMPROVEMENT AREAS FOR 2014-15


Equality Impact Assessments (EIA)

Public sector organisations are required to consider all legislated equality groups as

part of their EIA to ensure their compliance with their duties as a public body.

Acorns is not a public body, however under best practice, particularly with regard to

the Equality Act 2010 and the Together for Short Lives Diversity Toolkit, undertaking

EIA was considered to be evidence of our commitment to diversity for commissioning

purposes, when public bodies are purchasing our services, and for Care Quality

Commission inspections.

What we did:

Acorns devised and implemented an initial Impact Assessment screening template,

the organisational panel has undertaken an EIA for every care policy reviewed and

or developed this year.

What the outcome was:

Care policies have an Equality Impact Assessment where appropriate. This provides

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another governance measure to ensure Acorns services and practices are none

discriminatory and proactively support the equality of assess of services for all.

Area 3

Environment Area 3

As a result of securing funding from the Department of Health Capital Appeals Bid

we fitted out the new buildings and extensions for the three hospices. This improved

facilities Acorns is able to offer to families primarily via complimentary and


Standardising End of Life (EoL) Referral Processes

The aim was to ensure Acorns services offered a consistent and immediate

response to all EoL referrals and requests from the West Midlands area.

What we did:

Guidance for the Acorns staff was developed to support the implication of this

practice. The changes to process were further embedded in the form of workshop

discussion sessions at staff meetings.

A new EoL referral form was developed and used across all the hospices when a

referral is made.

What the outcomes was:

When a child is now referred the new system ensures that all the required

information is obtained and all the appropriate professionals in Acorns and partner

organisations are involved in the decision and planning process, thus ensuring a

more responsive and effective service at a time of crisis.

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therapeutic services. We intended to provide complementary service for an increase

of a minimum 50 children and families across the region.

What we did:

1. Acorns re-modelled the therapeutic rooms.

2. The referral processes were refined to promote increased use of

complimentary and therapeutic services.

What the outcomes was:

Over 84% of people who accessed the therapeutic service/ sessions reported they

had immediate improvements following a complimentary therapy session which

resulted in 98% stating they would recommend this service for families and friends.

STATEMENTS OF ASSURANCE FROM THE BOARD

The following are statements that all providers must include in their Quality Account. Many

of these statements are not directly applicable to specialist palliative care providers, and

therefore explanations of what these statements mean are also given.

Review of services

During 2014-15 the hospice provided the following services to the NHS:

Acorns hospices

Acorns has three ten bedded hospices strategically located across the West Midlands:

Walsall for the Black Country; Selly Oak for Birmingham and Warwickshire; and, Worcester

for the Three Counties of Worcestershire, Gloucestershire and Herefordshire. All of the

hospices include separate accommodation for families to stay with their children, if they

desire, and each is specifically designed to create a home from home environment and

atmosphere suitable for the care of children and young people with a diverse range of

needs. The hospices provide skilled paediatric palliative nursing care offering the following

services:

planned short break/ respite care and support;

emergency short break support;

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end of life care;

day care;

pain and symptom control;

medical support;

hydrotherapy, physiotherapy and complementary therapies;

access to interpreters; and,

Outreach clinical care.

Acorns family support services provided in the community and

across our hospices

Acorns also delivers care and support services to children and young people and their

families, in the community, including:

support to access End of Life Care services, including access to management of pain

symptoms and the provision of psychological, social, spiritual and practical support;

support and advice provided on a 24 hour phone basis via the hospice medical and

nursing teams;

family support team of professionals who provide support on a 24 hour basis by

phone and/or home visits;

access to physiotherapy;

advocacy - the Acorns family support team and the hospice workers work closely

with primary health care teams and the acute hospital teams as appropriate.

pre and post bereavement support by registered/experienced professionals;

sibling support by trained staff;

home volunteers, offering support and befriending;

a variety of support groups for parents, carers and grandparents;

advisory resources to families and professionals;

access to interpreters;

preparation of young people for adulthood with trained youth workers;

enable young people to transition to adult services supported by registered

professionals; and,

Face to Face service; with parents trained as befrienders supporting other parents for

time limited period.

Acorns Hospice at Home Services

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Acorns offers hospice at home services based on the same holistic principle and

incorporating all the services above, tailored to individual needs and delivered in the home.

Such services are currently provided in specific geographical areas under contract to a local

statutory body.

Reporting processes

Acorns reviews all the data available on the quality of care in all its care services.

In addition to the Care Governance Group and Trustee Care Assurance Committee quarterly

reports, the Director of Care and Head of Care Services undertake a minimum of 3 annual

unannounced visits to all sites to measure and monitor quality in service delivery. All

incidents are reviewed monthly by the Director of Care and reported to the Board directly as

necessary. Acorns also work closely with service users through the established Parent

Champions, and Young Ambassador and the newly formed Sibling Council.

All services delivered by the Hospice are funded through a combination of fundraising

activity and contracts with NHS. The NHS contracts mean that all services delivered by the

hospice are part funded by the NHS. Where NHS funding is secured this contributes up-to

30% of the costs of care of children. Therefore 70% of all care costs are funded by charitable

funds. We also benefit from having teams of skilled and trained care volunteers (over 400)

who support non personal care work across the region.

SAFEGUARDING

Acorns Children’s Hospice Trust wants a world in which children with life limiting and life

threatening conditions have the same rights and opportunities as everyone else. This

includes the rights of all children and young people to be safeguarded and protected from all

forms of abuse and neglect. Acorns are committed to maintaining a safe environment for all

the children. Acorns has a thorough and transparent child protection policy to afford all

children who receive their services maximum safeguards.

Acorns conforms to the requirements of safeguarding as referred to in the ‘Prevent Strategy’

(HM Gov 2011) and to the requirements of the Role of Accountable Emergency Officers for

Emergency Preparedness, Resilience and Response (EPRR) (NHS Operations 2012).

Statement of Intent

Acorns recognises that in protecting and safeguarding children, it is also providing a

framework for all staff which identifies and promotes best practice and minimises uncertainty

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for staff and volunteers working with children. Acorns has a robust policy which is designed

to:

Protect children

Children should be assured of good standards of care and protection from all Acorns staff,

volunteers and representatives.

Protect Acorns Staff and Volunteers

By following the guidelines and procedures everyone working within Acorns should be able

to avoid inappropriate, misguided or wrong behaviour and know what to do if they are

concerned about a child’s welfare.

Protect Acorns

The policy forms part of Acorns commitment to best practice, promotes the organisation’s

integrity and ensures compliance with the Independent Health Care Minimum Standards and

Regulations on Private Health Care.

The effective implementation of Acorns’ approach to child protection is based on and reflects

the principles recognised in UK legislation and in International Agreements, namely that:

• The welfare and protection of children is paramount whatever the circumstances.

• All children and young people, regardless of age, disability, gender, racial heritage,

religious belief and sexual orientation or identity, have the right to protection from all types

of harm and abuse.

• Recognition of the importance of working in partnership with parents, carers and other

agencies including those of diverse communities.

Safeguarding children is EVERYBODY’S responsibility; the following reinforces the specific

expectations of Acorns for the staff groups.

All care team staff are responsible for ensuring:

• They are familiar with all relevant internal policies, safeguarding and child protection

procedures, safeguarding guidance, documentation and access available training

regarding safeguarding of children and young people from Acorns.

• They contribute in a case conference or strategy meeting regarding safeguarding issues

relating to a child or young person.

The Care Management Team are responsible for:

• Ensuring all staff and volunteers receive the appropriate levels of safeguarding training.

(Every 2 years).

• Staff supervision and support is provided in accordance with the Acorns Safeguarding

Supervision Policy.

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• Ensuring that the safeguarding child protection policy, procedures and guidance are

accessible for all care teams.

• Acting in accordance to Acorns procedure when alerted to any safeguarding concerns;

reporting to statutory services and informing Acorns designated Safeguarding Officer.

Acorns Designated Safeguarding Officer (Acorns Director of Care Services) is

responsible for:

• Maintaining overall responsibility for the review of the Safeguarding and Child Protection

Policy and Procedures and Guidance for Acorns Children's Hospice.

• Chairing the Safeguarding Steering Group which monitors and reviews all safeguarding

issues across the organisation.

• Offering support, advice and consultation to the Care Management team who may be

reporting safeguarding concerns to statutory agencies.

• Ensuring the CEO and Trustee Board are informed of any safeguarding issues affecting

an Acorns child.

• Working with the Head of Training and the Safeguarding Steering Group ensuing

safeguarding training is in place across the Trust for all care staff.

• Ensuring Acorns is appropriately linked into the Safeguarding Children’s Boards across

the region.

• Receiving reports of child protection concerns or suspicions.

• Promoting an understanding of Child Protection issues within Acorns.

• Briefing management and staff on Acorns’ other procedures and legal requirements in

relation to child protection.

• Reports all safeguarding incidents occurring on Acorns premises or involving Acorns staff

to the relevant Local Authority Designated Safeguarding Officer and CCG.

• Ensures anyone with an offence is reported to the DBS.

Acorns will ensure there is clear safeguarding documentation to:

• Clarify safeguarding procedures.

• Provide specific documentation for reporting.

• Ensure support and supervision for staff involved in safeguarding situations.

• Provide information for children and young people accessing Acorns services.

• Understand what to do when managing a disclosure from a child.

Monitoring Compliance

• The Review of safeguarding training records is led by the Head of Training, the results

are reported to the safeguarding steering group and through quarterly reports to the

commisioners.

• Monitoring of safeguarding training and incidents takes place every quarter by Acorns

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regional Safeguarding Steering Group and Care Governance Group.

• Unannounced compliance visits completed by the Designated Safeguarding Officer and

Acorns Heads of Service take place annually during these visits staff are interviewed on

their awareness of the safeguarding policy and reporting procedures.

Associated documentation

• Safeguarding and child protection guidance

• Safeguarding and child protect leaflet

• Policy for Safeguarding Vulnerable Adults

• Policy for the confidentiality of records

• Policy for Good Record Keeping

• Policy for notifying local safeguarding boards – child death overview panel (CDOP) of a

clients death

• Policy for Domestic Abuse

• Policy for Managing Aggression

• Safeguarding supervision policy

• Policy for mental capacity

• Prevent Policy

• Whistle Blowing Policy

• IG Policy

PARTICIPATION IN NATIONAL AUDITS

During 2014-15 the hospice was ineligible to participate in the national clinical audit and

national confidential enquiries. This is because there were no audits or enquiries relating

specifically to specialist palliative care in 2014 -15.

RESEARCH

Acorns has not conducted any ‘Clinical Research’ which has needed favourable opinion from

a research ethics committee within the National Research Ethics Committee. We are

however able to consider working in partnership with universities in supporting research

projects which could further advance the care and services available to the children and

young people we work with. This year Acorns has developed a working relationship with the

Network Support & Palliative Care Research Nurse, from the NIHR Clinical Research

Network, West Midlands. Acorns may be approached and equally can approach this network

if there are joint areas of work identified.

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Acorns supported research with parent champion’s involvement in research undertaken from

Bournemouth University re ‘Understanding the Impact of Children’s Hospices on Parental

Relationships of Life Limited and Threatened Children and Young People’.

QUALITY IMPROVEMENT AND INNOVATION GOALS

AGREED WITH OUR COMMISSIONERS

A small proportion of Acorns income in 2014-15 was conditional on achieving

Commissioning for Quality and Innovation payment framework (CQUIN). Acorns is

committed to working with the CQUIN framework to proactively engage in quality

improvements with our commissioners.

The goals and indicators for Acorns identified by the CQUIN were as follows:

Supporting effective transition of those with life limiting /life threatening conditions

Preparing and supporting parents/ carers and young people who are going through

transition to adult services.

Support transition through young people and parent/carer workshops/forums

What has been achieved?

Four parent carer workshops were held which 29 families benefited from.

Eight groups for CYP were held with 63 children and young people attending.

Reflection and Impact of Scheme

As an organisation Acorns saw young people become more eloquent and confident in

expressing themselves and getting their needs met. Young people were prepared for

adulthood by helping to make choices, gain new experiences, understand money, transport,

explore education opportunities, learn about their conditions and what to do in an

emergency.

This work has seen the young ambassadors motivated to pass skills on to younger peers,

they reported they found mentoring new Ambassadors and speaking to other Acorns clients

rewarding and identified they want others to learn from their experiences and not make the

same mistakes. These lessons have been positive in enabling them as young disabled

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people to speak up for themselves, and will provide life skills which will help in a variety of

setting such as when they are employing and retaining their personal carers.

This year young people supported each other when one of their peers; a long standing

Ambassador died. This also led into an extremely in depth discussion on their own mortality

and future wishes for their funeral preparations.

Parents have responded well to meetings, this involved seeing new adult providers which

has supported parents to accept they will need to engage with some adult providers when

leaving Acorns. Parents have had an opportunity to hear other parent’s experiences in

relation to good care they and their son/daughter have received from adult services. This

was identified as being inspirational to other parents who were just beginning to go through

transition.

Actions taken as a result of lessons learnt:-

1. There are plans to facilitate ongoing support groups for young people particularly in

relation to mortality and the death of friends and peers.

2. There will be a short film produced by young people for young people in their role as

ambassadors.

In 2015 we are working with Birmingham CCG who wish to include a CQUIN in their

contracts. The CQUIN is focusing the outreach lead nurses using capacity available within

the hospice to provide an enhanced outreach service for children who have not engaged

with palliative care services.

WHAT OTHERS SAY ABOUT US

The hospice service is required to register with the Care Quality Commission (CQC) and the

current registration status is unconditional. The hospice service has no conditions on

registration. The CQC did not take any enforcement action against Acorns during 2014 –15.

Acorns is subject to periodic reviews by the CQC and the last on-site inspections were in

2013 and 2014 all the hospices were fully compliant. There were no inspections in 2014-15

however there is an expectation unannounced visits will take place in 2015-16.

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In 2014 two professional days were held at Acorns which was attended by 103 external

professionals. The programmes consisted of Acorns specialist professionals providing an

overview of the care and services available.

Feedback from professionals attending the Black Country and Three Counties

professional’s day September/ October 2014.

All 103 professionals across health and social care services (100%) identified they would be

extremely likely to recommend Acorns to a family.

The professionals were asked the reasons for this recommendation:

Have referred families in previously so know the difference it can make to the lives of

families-a life line to parents.

To provide better care for the families I work with due to the services offered by

Acorns Children's Hospice.

Extremely professional and valuable services available.

Positive parent feedback. All parents I have spoken to speak highly about Acorns.

I work with a lot of children with life limiting conditions and feel they would benefit

greatly from Acorns help and support.

Working as a CCN I see life limited/ life threatened children, hospice for

support/respite is always discussed, the family then decide.

As a professional I feel hospice is beneficial to the child and family from referral to

after the child’s death. And the important care and support following death.

Friendly staff, lovely hospice.

Acorns offer so much and our babies/ children and families need to be aware of the

option available to them.

I think the support offered by Acorns is fantastic and invaluable to families and

children in this area, especially the variety of support offered for the entire family.

Family recommendation and reputation.

Support for whole family. As a CCN I work closely with families.

Because Acorns offer a lot more than short breaks.

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As a social work practitioner I support children and their families and I feel that the

support that Acorns can offer is valuable.

Great feedback from children, young people and families. The link between home

and hospice to help families to stay at home and child as long as they wish.

The holistic approach of care for the whole family unit.

Fantastic service, fabulous staff.

Non-clinical environment; friendly family atmosphere, bespoke packages,

appropriately trained staff who have time and experience.

The hospice environment is something every family should have the opportunity of

using, it provides such a valuable support for all the family.

I am impressed with the site, professionalism and forward thinking I have heard

talked about today.

Welcoming with good knowledge & experience.

Acorns can offer a family who are experiencing palliative care the support they

require to make end of life care more bearable for the family by enabling them to

seek advice and support as and when they require.

It seems like a professional, beautiful and peaceful place. Extremely friendly and

supportive staff - very privileged to visit and learn about a wonderful organisation.

Acorns offers a great amount of support for families and the children throughout their

whole journey.

I have worked with a lot of families who have received care at Acorns over many

years but this is the first time I have been able to visit and learn all you can offer

families with life limiting conditions.

I plan to offer the Oncology Support Group to all our families and work with the

Birmingham CLIC team to develop this. Families who have accessed Acorns have

always given very positive feedback about their experiences.

Clearly a well-established, researched service to meet all the need of the child and

family holistically.

Holistic approach to practical care.

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The total support that puts family at centre of care programme & wonderful facilities.

More aware of holistic nature of service & how early intervention can have huge

impact on EoL care and other services available i.e. support groups and transition

work.

"Part of my job role as a palliative care nurse is to support child & family. Acorns is

an excellent support network for the child & family as well as for myself"

"because you provide care and support for family & children when they are most

vulnerable and enable them to make happy memories"

Very impressed by the service offered, the location and venue. Friendly and

understanding staff who genuinely are passionate about helping and supporting

children & families.

Been aware of your services for many years. Happy to recommend your support to

our families.

Knowing what is available how could I not?

Caring, professional - lovely environment, welcoming.

An invaluable support.

Already involved with families who access our services & Acorns so aware of brilliant

support and care Acorns offers.

Part of my role is to support the family and families I work with are always full of

praise for the role Acorns plays in their lives.

In 2014-15 Acorns received 128 of compliments from service users in relation to the care

and service provided to them and their children.

In addition to the compliments a formal system of family feedback was undertaken with a

focus on six services. The outcomes from this is available in the section; The Views of

Acorns Services Users: Family Feedback for 2014-15 (page 30).

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DATA QUALITY

Acorns did not submit records during 2014-15 to the Secondary Users Service for inclusion

in the Hospital Episode Statistics which are included in the latest published data. This is

because the hospice is not eligible to participate in this scheme.

Acorns collects and submits the following internal activity/performance data:

annual data to Together for Short Lives;

child death data to Child Death Overview Panels;

activity data via quarterly quality reports to 20 clinical commissioning groups (CCGs);

annual activity data to 20 CCGs, and;

data to evidence that Acorns meets the Key Lines of Enquiry (KLOES) standards as

identified by the Care Quality Commission.

CLINICAL CODING ERROR RATE

The hospice was not subject to the Payment by Results clinical coding audit during 2014-15

by the Audit Commission.

Part 3: REVIEW OF QUALITY PERFORMANCE

There are three tables presented in this section.

Table 1; identifies an overview on the quantity of work undertaken across Acorns in 2014 -

2015.

Table 2; identified the Quality Performance Indicators which are organised under the

KLOES identified by CQC as the indicator categories they focus on measuring and

monitoring quality and safety in services.

Table 3; highlights the clinical audits undertaken across Acorns in the last 12 months which

support the monitoring and management of clinical effectiveness.

TABLE 1

Figures for April 2014 to March 2015.

Total number of open cases at end of the 12 month period No of families actually supported at the end of the 12 month period

635 current number of children being supported 866 families being supported An additional 240 bereaved families being supported

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Total number of children supported for 2014-15

768

Total number of families supported for 2014 -15

990

Number of new patients 188

Number of referrals made – % accepted, % declined

205 referrals received 188 referrals accepted 17 declined

No of Beds Available (based on 30 beds) No of Beds Taken

10,950 7,299 (67% occupancy) (this includes day care)

Number discharged from care

133 TOTAL 65 Bereavement Support Completed 1 Child No longer meets our criteria 3 Closed service 1 Death 10 Discharged to TT 3 Left District 9 No longer able to contact family 5 no longer life threatened 15 No longer requires support 19 Transferred to Adult Service 2 Transferred to other service

Number in transition (16-18 years) 53 (52 16-17 year olds and 1 18 year old)

Number of day care episodes 1,237 (already included in above figure)

Number of episodes of care in community Over 3,623 support sessions with families in the community with an additional 7,579 phone support calls made to families. Overall support contacts: 15,529.

Number of deaths 77

Number of episodes of end of life care Number of nights provided (in special bedroom)

22 133

TABLE 2

The following Quality Performance Indicators (QPI) and Acorns Standards for quality of service

are organised under the 5 domains identified by CQC as the indicator categories to focus on

measuring and monitoring quality and safety in services;

1. ensuring care services are responsive to people’s needs;

2. ensuring services are caring;

3. ensuring services are well led;

4. ensuring services are effective; and,

5. ensuring services are safe.

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The progress of the QPIs is reported through quarterly reports by Senior Care Managers to the

Care Governance Group and presented to Care Assurance Committee for quarterly updates.

Ensuring our care services are responsive to people’s need

QPI INDICATOR Measure

1. All families and Young People receive an assessment, highlighting outcomes achieved from service intervention and or future desired outcomes, this will be reviewed annually.

100% Outcome data base, monthly data identified by each team via reports.

2 Allocated worker responsibility for YP over 16yrs of age to be transferred to the transition team when the transition team worker is undertaking the majority of support to the family.

100% Report by exception in monthly reporting system.

3 All siblings requiring 1:1 Bereavement Support will be assessed by the sibling manager and time limited support offered where appropriate.

100% Monthly report and quarterly reports

4 Communication groups in each site to improve the experience for children and families.

1 group each site

Quarterly outcome based report to care governance

5 Families with assessed need receive out-reach support from clinical teams.

20 visits per hospice per month

Monthly report and quarterly reports to care governance.

6 Out-reach nurse lead to support the increase the number of referrals

12 referrals as year


7 Increase in neonates offered a service from Acorns

Additional 6 a year


8 Teams of volunteers to work with families to meet desired outcomes in the community.

Providing support to 20 families per site


9 Recruit and train volunteer drivers/mini bus drivers and escorts to support ; siblings to access support groups support families to access to hospices for short-breaks (via transporting equipment)

3 pairs per site to support the sibling groups


10 Recruit accredited complementary therapists as volunteers

4 per site Monthly report and quarterly reports to care governance.

11 Recruit and train volunteers with necessary therapeutic skills for sib groups, role description to be shared

6 per region


12 Recruit and Train Face to Face Volunteers 12 Monthly report and quarterly reports to care governance.

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Standards

Standard INDICATOR Measure

13 Newly accepted families or families who have a child under 16 years of age to have an allocated CTW.

100% Data system identifies allocated worker per child. Concerns reported through exception reports

14 All newly accepted families will be contacted within 7 days

100% Data system Concerns reported through exception reports

15 All emergency EoL referrals to be responded in accordance with the EOL referral process guidance.

100% None compliance to be reported through the incident reporting process

16 Acorns to provide a minimum of 4 hours’ notice for any cancelled visit for hospice at home in the community.

100% Data system and exception reports when this is not the case

17 Hospice at Home Bookings All families to have a minimum of 1 weeks’ notice of planned bookings

100%

Data system and exception reports when this is not the case

18 There is an annual review of individual care plans

100% Audit

19 There is an annual programme of audits to meet CQC and organisational requirements.

100%

Reports to Care Gov. group

20 All young people aged over 14 receive an initial transition assessment/ transition review

100% Data System

21 All siblings receive an assessment and review annually highlighting outcomes achieved from service intervention and future desired outcomes

90% Data System

Ensuring our services are caring


22

Three Sibling residential bereavement groups per year to meet the highlighted outcomes from assessments and reviews

1 per Hospice

Monthly report and quarterly reports

23

24 Sibling groups per year to meet the highlighted outcomes from assessments and reviews

8 per hospice


24

BASIL meetings to support the development of sibling service utilising sibling perspectives

6 meetings a year to produce; BASIL Magazine


25

Support groups to be provided for parents and carers to meet identified outcomes

10 per hospice per year.

To be reported through quarterly reporting

26

Therapeutic bereavement group 1 per hospice per year

To be reported through quarterly reporting

Standards INDICATOR Measure

24/7 OOH Psychosocial support is available 100% OOH collated weekly via first on-call

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27 to all families.

28

All communications to children and families to be accurate, timely, respectful and confidential

100%

Record of incident, complaint or IG issue or quarterly sample feedback from family

29

Reception areas provide a safe, secure but warm welcome to the hospices

100% Audit

Ensuring our services are well led


30

Develop operational changes to shift patterns to utilize time effectively.

change in shift patterns

Full report with recommendations to be considered

31

Increase and maintain Corporate engagement as part of Community Engagement Agenda

15 groups per year per site


32

Maintain Ambassador and Champion roles Recruit and train for roles


33

Prepare young people and their families for transition into adulthood

Deliver 6 prep for adulthood events per hospice / 12 youth clubs per hospice/ 4 parent group event per hospice


34 Sibling council further developed to promote the work of the siblings and support other siblings

6 meetings a year

Sibling leaflets and resource pack for families and professionals developed


35

Records and children’s files are maintained ensuring they are confidential, accessible and stored in line with principles of information governance and CQC guidance.

100% Audits

36

All staff have an Individual Performance Review and PDP annually which feeds into the annual training plan.

90% HR records

Ensuring our care services are effective


37 2 nurse prescribers at each site 100% To be in process of being trained or operational

38 2 nurses each site each year to achieve accredited qualification in paediatric palliative

100% To be in process of being trained or operational

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care and clinical assessment skills

39 Achieve occupancy at a level that will maintain funding from CCGs

Monthly reports

Report already in place

40

Retaining a regional & national presence 2 published reports and or conference representation


41

Re- establish priorities for Lead Nurse Roles QPI’s to be developed



42 All activity codes for children’s data to be recorded in timely and in an accurate manner

100% System checks and end of year review.

Ensuring our care services are safe


43 Develop links between dependency scoring and day to day staffing to support day to day occupancy and establishment planning.

System to be in place.

Quarterly update reports

Standard INDICATOR Measure

44 All staff and volunteers attend identified core training on induction and updates as indicated in training plan.

100% L&D data base.

OUR PARTICIPATION IN CLIICAL AUDIT

To ensure that Acorns is providing a consistently high quality service, we undertake our own

clinical audits, using national audit tools, where available, developed specifically for

hospices, which have been peer reviewed and quality assessed. This allows us to monitor

the quality of care being provided in a systematic way and creates a framework by which we

can review this information and make improvements where needeEach year the Nurse

Managers and the nurses with additional responsibilities agree the audit schedule with the

Senior Nurse for Quality and Governance for the coming year, this is then reported to the

Care Governance Group. Priorities are selected in accordance with what is required by our

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regulators and any areas where a formal audit would inform the risk management processes

within the hospice.

Through the Care Governance report, the Board of Trustees is kept fully informed about the

audit results and any identified shortfalls. Through this process, the Board has received an

assurance of the quality of the services provided.

The following audits were completed between 1st April 2014 and 31st March 2015.

Clinical Audit Outcome

-Audit of transition records. Re-audit to ensure changes in documentation have

been embedded and improvements in documentation

seen. New audit planned for 2015.

Re-audit of Help the Hospice

general medication audit tool all

sites.

Medicines Management policy and procedures

reviewed and re-written to reflect the outcome of the

audit. Re-audit undertaken in all sites for 2014 to

ensure consistent good practice has been

maintained. New audit planned for 2015.

Quarterly one module of Help the

Hospices prevention and control

of infection audit tool suite all

sites.

Audits for 2014 have highlighted areas of good

practice and action plans implemented each quarter

to remedy any areas not meeting required standard

such as updating cleaning schedules. Audit of one

module at each hospice quarterly continues through

2015.

Yearly all sites external infection

control audit from SLA

Yearly audit of on-going standards shows good

practice and action plans for improvement have been

implemented. Next audits due 2015.

Quarterly Hand hygiene all sites

hospice staff audits

Quarterly audits of hand hygiene maintained to

ensure good practice is observed. Continue through

2015.

Hand hygiene hospice at home

staff audit.

Additional hand cleaning items supplied to staff back

packs for use in homes. Re-audit 2015.

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Hospice at home yearly record

keeping audit.

2014 audit showed some improved practice, with

some improvements recommended around devising

new care plans.

Hospice at home audit of medicine

charts.

2014 audit produced an action plan for staff training

updates on recording on medication charts.

Independent non-medical prescriber identified and

commenced training to improve further practice in this

area.

Resuscitation re-audit all sites Following changes to policy the audit reviewed

practice and identified further changes needed to be

made to policy and practice to reflect the use of

regional documentation around end of life plans and

resuscitation. Re-audit due 2016 following

completion of action plans.

Quarterly mattress audits all sites This continued across the sites in 2014 and actions

on replacement of covers and mattresses are on-

going continue through 2015.

Record Keeping Audit across all

sites in-house and community

teams.

Some areas of improvement identified across the

teams in 2014. Additions to audit criteria made for

2015 around consent and parent/carer signatures and

a larger sample recommended. Action Plan

developed and being implemented , re-audit due

2015

Audit of record keeping for sibling

records.

2014 Audit completed with some good practice seen,

improvements to consistency of paperwork being

implemented. New audit planned for 2015.

Pain assessment and recording

re-audit at Birmingham Hospices.

2014 Re-audit showed some improvements in

recording and assessment of pain and the use of

charts following implementation of an action plan.

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Pain assessment and recording

audit at Black Country Hospice.

2014 audit showed some improvements needed

around consistency of completing paperwork action

plan in place.

Re-audit of tissue viability

recording Black Country Hospice

2014 re-audit showed some significant improvement

on completion of paperwork and staff understanding

following training and revised paperwork.

Audit of play and activity

provision and recording across all

sites.

2014 audit produced an action plan for improving

recording of activity, co-ordination of activity and

increasing training on outcome recording of activity

undertaken.

Reception area welcoming and

friendly audit across sites.

2014 audit highlighted the need for an action plan to

ensure areas have up to date literature available, a

review of the areas to ensure they are friendly is

required and also that staff/ volunteers greet all

visitors consistently to the same standards that are

expected.

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THE VIEWS OF ACORNS SERVICES USERS

In 2014 Acorns piloted a Real Time Reporting System for seeking children, young people

and families views on services. This was in addition to the feedback postcards being

utilised. The Real Time Reporting pilot system enabled service users to complete an

electronic survey which takes only minutes to complete on a hospice iPad for by web link

using a QR code at home. This is service user friendly and has resulted in an increased

response from children and families in relation to Acorns services. The benefit of the

process being real time means Acorns is able to respond quickly to comments in addition to

providing an annual overview of service user views. This system of seeking service user

feedback is one of the quality improvement areas for 201516.

The following feedback has been collated by a combination of post card feedback and Real

Time Reporting for the following areas:

1. Hospice at Home;

2. Support Groups;

3. Family Events;

4. Complementary Therapy;

5. Hospice Care; and,

6. Young person’s satisfaction.

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CLOSING STATEMENT FROM THE DIRECTOR OF CARE

SERVICES

It is our ongoing commitment that every intervention we have with each and every child and

family is of the highest standard and quality and makes a positive difference to them.

Acorns Impact Report should be read in conjunction with Quality Accounts, the Impact

Report is available on our website which provides an annual overview on the outcomes and

impacts our services have had on our service users in the last 12 months.

Since 1988 we have been providing holistic specialist palliative care services, we are

confident in our expertise provided by our skilled workforce, however we are not complacent.

The ever changing needs of children with different conditions of varying complexities and

changing technological and nursing needs requires us to be progressive in our provision of

health and social care. We will continue to develop and scope our services working in

partnership with colleagues across the hospice movement, colleagues and professionals in

the wider NHS and Social Care statutory sectors and most importantly with our service

users.

Emma Aspinall

Director of Care

Documents

ACORNS CHILDREN’S HOSPICE · 2016-03-30 · Acorns has provided specialist palliative care and support to children and their families since 1988. We welcome the opportunity to demonstrate