Quality Account

2013/14

Hospice Mission Statement

St Leonard’s Hospice is committed to caring for local people over the age of 18, regardless of sex, race, colour or creed, who have active, progressive and

advanced illnesses, their families and carers, without personal charge.

St Leonard's Hospice is a company limited by guarantee registered in England and Wales under number 1451533. Registered as a charity under number 0509294. Registered office: 185 Tadcaster Road, York YO24 1GL

Statement from the Chief Executive On behalf of the Board of Trustees and Executive Management Team it gives me great pleasure to present this first formal Quality Account for St Leonard’s Hospice. The account looks back on progress that we have made and work we have done in 2012/13 when our initial Quality Account was written, and outlines some of our key priorities for improvements to services for patients and families in 2013/14. St Leonard’s Hospice is highly respected and has an excellent reputation in the community: it has outstanding public and business support and is well regarded by the health and social care communities. The strength of St Leonard’s Hospice is ‘the team’, and together with our Board of Trustees I would like to thank the clinical and support teams for their contribution to providing excellent patient care and for ensuring that our reputation continues. “we cannot stress how nice this place is, we are really happy with the care” “the staff are absolutely super. The care is first class” Patient and family comments to CQC inspector (2013)

Once again we were given a clean bill of health and a very positive Care Quality Commission (CQC) report following an unannounced visit in October 2013. The CQC identified no shortfalls in the standard of services provided by St Leonard’s Hospice. Our patients, families and their carers are at the centre of everything we do and this is reflected in our mission statement and is a principle that is at the core of all our priorities that we have outlined for the forthcoming year. Here at St Leonard’s Hospice we have a culture of continually working to monitor and improve quality. We actively seek feedback from our patients and their families and staff are always encouraged to make suggestions and feedback to members of the Executive Team and Trustees. As partnership working with our colleagues in the Acute Trust and community and social care increases we are also looking to those areas to provide us with feedback on ways that care can be improved for patients. I am responsible for the preparation of this report and its contents. To the best of my knowledge, the information reported in this Quality Account is accurate and a fair representation of the quality of healthcare services provided by St Leonard’s Hospice. Martyn Callaghan Chief Executive

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PART ONE Looking back at what we achieved in 2012/13. 1.1 Patient Safety Priority One : Review of clinical services to ensure that current models of service provision are best for meeting the needs of patients now and in the future

A formal external review of Lymphoedema services was commissioned by the Chief Executive in partnership with other local hospices. This review identified differences in funding and operational functionality of each service and has provided some valuable evidence to feedback to Trustees and more widely the new commissioning GP’s from the Vale of York Clinical Commissioning Group (VoYCCG). No operational changes have been made to the Lymphoedema service as a result of this review, however it is anticipated that it will form the basis of discussions with commissioners and partners from the Acute Trust in relation to provision of services across the wider locality. A comprehensive review of the model of care delivery on the in-patient unit (IPU)was commissioned by the Director of Clinical services and has been undertaken and completed by a Charge Nurse from the IPU, supported by the Senior Sister. A proposal for change to the model of care delivery has been submitted to the Executive Management team and provides the foundation for one of our priorities for 2013/14. Priority Two : Review and develop a strategy for education and training A comprehensive review and restructure of the provision of mandatory training took place and has provided the basis for examination of other non-mandatory training through the Hospice. More formal working partnerships have been developed with the University of York School of Health Sciences and some joint workshops/study days are planned for 2013. 1.2 Patient Experience Priority Three: Increase engagement with service users A formal Communications Committee has been established which has focussed primarily on improving the existing Hospice website as a tool for wider communication.

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The Director of Clinical Services has met with the York Older Peoples Assembly discussing issues around advanced care planning and the work of the Hospice. St Leonard’s Hospice held it’s first Open Day in October 2012 which was very successful. Over 150 people attended and had the opportunity to meet representatives from every department within the Hospice, members of the Executive Management Team and Trustees. Visitors to the Open Day included potential patients, relatives of current patients, people who have fundraised for the Hospice and were curious about where the money went and what services were provided and also some relatives of patients who had been cared for and died within the Hospice. There were notably very few health professionals attended despite invitations going to all GP practices within the VoYCCG – this will be an area to focus on for any future open days. Priority Four: Establish multidisciplinary team (MDT) meetings for Daycare patients There are now monthly MDT meetings held within the Daycare service to identify progress, ongoing concerns and potential for discharge of patients from the service. Whilst attendance from professionals could be improved it is hoped that these meetings can become part of the wider Hospice MDT meeting in the future. The value of discussions is widely appreciated but overall there needs to be a focus on reducing the number of meetings attended by healthcare professionals’ and subsequently increasing the time available for direct patient care and support. 1.3 Clinical Effectiveness Priority Five: Patient Record System – St Leonards will implement the use of a single electronic patient record system - SystmOne Progress in this area has been made but has been slow. St Leonard’s Hospice are no longer utilising multiple databases for patient records and all admission and discharge data is now stored within SystmOne. The appointment of an IT Manager is already proving an asset in terms of identification of staff training needs, equipment requirements (including IT infrastructure) and the development of implementation plans for key areas such as the IPU. Most areas within the Hospice are now utilising SystmOne to a basic degree with some areas more advanced than others. The notable exception to this is the IPU and this is why this priority will remain in place during 2013/14.

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Priority Six: Partnership Working Progress within this area continues to be good. The Hospice is joint chair of the End Of Life Board that covers both the VoYCCG and colleagues in the Scarborough area CCG. This Board includes partners from local Acute Providers (incorporating community services), Social services and independent providers, commissioning managers from CCG’s and representatives from the Commissioning Support Unit (CSU). Colleagues from St Catherine’s Hospice in Scarborough are also in attendance and act as joint chair of the Board. The End of Life lead Nurse post has been recruited to and we are already seeing the benefits of joining up this work and having a named individual with responsibility for pulling service providers together on issues such as hospital discharge, education and training, patient transport and peer review.

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PART TWO Priorities for Improvement for 2013/14 and Statements of Assurance from the Board (as defined in regulation) The Hospice has a number of committees that are continually working towards improving the quality and safety of care for patients and the well being of staff. The Board of Trustees and Executive Management Team continue to support the development and improvement of services to ensure the care the Hospice provides evolves to meet the needs of our patients and the demands of the changing context of healthcare provision. The priorities for quality improvement we have identified for 2013/14 are outlined below. The priorities have been identified in conjunction with the Board and the Executive Management Team. They will impact directly on the priority areas identified as contributing to high quality care as defined by Lord Darzi: - patient safety - clinical effectiveness - patient experience The priorities also reflect St Leonard’s Hospice response to the Francis report (2013) and the Chief Nursing Officer for England’s Vision for Nursing and the development of a culture of compassionate care. Priorities for Improvement 2013/14 - Future Planning Outside of the six identified priorities listed below is the requirement for St Leonard’s Hospice to recruit into the vacant Medical Director and Consultant in Palliative Medicine posts. At the time of writing the report an advert is in place for two posts equating to 15 Professional Activity sessions of consultant time. This is an increase of 6 sessions from the previous post holder and reflects the changing demands of the Hospice, the need to increase community cover and the desire to develop services across other care providers and educational institutions. It is expected that the consultants will be in post in October 2013.

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2.1 Patient Safety Priority One : Implement change to the model of care delivery across the IPU to reflect a more holistic patient centred approach to care

Why was this identified as a priority ? Following a review of the model of care delivery a number of key areas for improvement were identified. These related to ward routine and specifically the role of clinical staff in delivering patient care that is of a high quality and is responsive to patient need rather than ward routine. Discussion with multi-professional staff within the clinical areas identifies that they have a desire to deliver high quality, individualised patient care. The low number of complaints and excellent reports following CQC inspections demonstrates that care is of a high standard but it would be wrong to assume that this could not be improved upon. The recently published Francis report and the Vision for Nursing set out by the Chief Nursing officer for England all provide evidence for a need to focus on getting back to basics, improving leadership at ward level through visibility and presence and improving communication. How will this priority be achieved ? 1 Communication and feedback between all clinical staff working within the IPU

will be essential to the success of this objective. 2 Senior Nursing staff (Band 7) will be required to work clinically on the IPU in the role

of nurse in charge with responsibility for shifts on a daily basis. During this time they will not be in attendance at meetings (with the exception of MDT each week) and will be responsible for supervision of nursing staff, co-ordination of workload within the IPU and monitoring, improving and maintaining standards of documentation. They will also ‘manage the change process’ and ensure that quality of care and patient safety are not compromised at anytime and that all staff are aware of their responsibilities.

3 A model of ‘primary nursing’ will be adopted with staff nurses being allocated

specific patients for whom they will have responsibility for delivering total patient care. This is a move from the existing model of ‘team nursing’ which sees staff working in teams to deliver cares based largely on a task allocation basis.

4 Changes to fundamental aspects of care delivery such as ward rounds,

medication administration and handover will also be required How will progress be monitored and reported ? Progress will be formally reported through feedback to the Executive Management Team and the Board of Trustees.

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The Hospice Governance Committee will monitor progress with work streams via the existing sub-committees as appropriate. Priority Two : Develop a competency based assessment document for staff within St Leonard’s Hospice. Why was this identified as a priority ? There is currently no general competency framework for staff to work with within the Hospice. Mentorship is in place and provides excellent support for staff new to the clinical area but with little competency based assessment except for specific skills such as managing intravenous devices, blood transfusions and catherisation. There is no formal supporting framework for staff. The Hospice has previously provided a very comprehensive package of internal education and training for staff, but assessment of skills and knowledge has not been formalised. Ensuring workforce have the required skills and knowledge to be competent and carry out care with compassion is an essential elements of the Vision for Nursing. St Leonard’s Hospice prides itself on delivering excellent care to patients and this process of competency assessment will ensure that all staff are receiving appropriate training that is effective. How will this priority be achieved ? 1 A competency framework is already available for staff working within the Acute

Trust in York (and is used for both Hospital and Community Staff Nurses). This will be used as the framework for a St Leonard’s Hospice document.

2 Mentorship of new staff and management of those staff who may find

themselves in difficulty with areas of practice such as medicines administration will follow a competency framework.

How will progress be monitored and reported ? Progress with the development of a competency document will be led by the lead Nurse for Education and monitored by the Director of Clinical Services. Implementation of the document will be supported by the senior sister and progress will be reported via Trustee reports and Executive Management Team meetings.

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2.2 Patient Experience Priority Three: Undertake a formal patient and carer experience survey Why was this identified as a priority ? Currently we continue to have very little user involvement in service development. We have systems for informing staff within the hospice when we receive feedback from patients and families. We have patient and family questionnaires that are used to obtain feedback with the results being used to make adjustments to practice and process as required however, generally the public are not directly involved with the overall development of Hospice services and vision. How will this priority be achieved ? There has been discussion within the Hospice previously relating to the development and benefits of a communications group that will involve service users in the development of strategies to improve relationships with the wider community.

1. A communication sub-group will be established to look at how we can improve communications to the general public. The scope of this group may in the future include the development of a service user forum.

How will progress be monitored and reported ? In line with current practice at St Leonards updates on work undertaken by the communication sub-committee will be discussed at the Executive Management Team meetings. Formal reports will be submitted to the Board of Trustees. Priority Four: Refurbishment of patient and family areas to enhance the patient environment Why was this identified as a priority ? A successful bid for Department of Health monies and an exceptionally good legacy income year have meant that St Leonard’s Hospice are in a position to refurbish a number of areas that will improve patient experience and enhance the environment for the enjoyment of patients and their families. How will this priority be achieved ? A Director of Development has already been identified and a firm of Architects have been appointed.

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A formal project plan will be developed and managed on a day to day basis by the St Leonard’s Hospice Site Manager. How will progress be monitored and reported ? A Scrutiny Committee (as a sub-Group of the Board) have been established and will monitor progress with the Director of Development. 2.3 Clinical Effectiveness Priority Five: Patient Record System – St Leonards will implement the use of a single electronic patient record system - SystmOne Why was this identified as a priority? Although St Leonards Hospice has made steps towards utilising a single electronic database to access and record patient level information, there are still some areas (most notably the IPU), where electronic records are poorly accessed and all documentation remains in paper form. Duplication of data inputting is common place and this impacts greatly on the workload of medical secretaries and some department leads. This priority remains largely unchanged from 2012/13. Paper documentation makes effective report writing time consuming and at times inaccurate. Nationally there has been a drive to roll out SystmOne IT system as the patient administration system of choice however for a number of reasons it was not implemented fully at St Leonards and as a result we are already behind most other hospices in its development and use. SystmOne may be used to provide data for funding in the future and is already used in some Hospices to manage patient records. It is also essential as a means of communication with other providers and professionals. As SystmOne is developed, there will be efficiency savings as processes such as referrals and discharge information are handled electronically and information will pass more quickly between service providers. Around two thirds of our local GPs are now on SystmOne, and it is currently being rolled out within the community nursing service. How will this priority be achieved ? The appointment of an Information Manager at the Hospice has provided an excellent opportunity for someone to focus on training needs analysis, implementation plans and infrastructure. High level implementations plans are already in place for the use of SystmOne across the IPU with required IT infrastructure also identified.

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The Information Manager has successfully completed a Train the Trainer course for SystmOne so will be able to train departmental staff to facilitate full usage of SystmOne in areas such as Hospice@Home, Daycare and Lymphoedema. How will progress be monitored and reported ? Progress with implementation will be monitored against the plan and reported via the Executive Management Team to Trustees via the standard reports. Priority Six: Partnership Working Why was this identified as a priority? This is an essential aspect of continuous development for the Hospice and as such remains unchanged from 2012/13. St Leonard’s Hospice already has links with a number of organisations and people within the area that benefit the patients we care for. There is a view, however that many of these links could be formalised or improved to further enhance the quality of care patients receive through continued work to develop an integrated pathway of care for patients. The VoYCCG has been established within the area and St Leonard’s Hospice are looking to develop close working relationships with this CCG’s in order to enhance end of life care. There are also number of areas relating to communication and joint working that would benefit from a more formal approach to partnership working in order to improve the strategic direction of end of life care within York and the surrounding area. How will this priority be achieved? The Hospice already links with many organisations that provide care for patients. Through continued links with the Acute Trust, other Hospices, and the newly formed VoYCCG, St Leonard’s Hospice will position itself at the forefront of service development. The Hospice is already one of a number of sites piloting the Palliative Care Funding Review and this will increase contact with other teams on both a local and national level. The Hospice will continue to be a key stakeholder on the End of Life Strategy Board and will contribute to the development and implementation of an end of life pathway for patients within the area. The Hospice will continue to part fund a Lead Nurse for End of Life Care post with the Acute Trust. Other important links outside of the clinical arena will include the continued development of the fundraising database and the development of strategies for increasing legacy and community involvement.

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Statement of Assurance From the Board The following are statements that all providers of healthcare must include in their Quality Account. Many of the statements are not directly applicable to a specialist palliative care providers and therefore explanations of what these statements mean are also given. Review of Services (Mandatory Statement) During 2012/13 St Leonard’s Hospice has provided for the NHS:

In-Patient Care Daycare services Lymphoedema services – out-patient review and treatments Family Support and Bereavement Services – pre and post bereavement support Hospice@Home services Complementary therapies

What this Means St Leonard’s Hospice is currently funded through a combination of an NHS grant and fundraising activity. The grant that is allocated from the VoYCCG represents approximately 27% of the Hospices’ total income. The value of grant received by St Leonard’s Hospice from the NHS means that the services provided are substantially funded from charitable funds. The remaining income is generated through the Hospice retail outlets, community fundraising events, lottery activity, donations and legacies. Participation In Clinical Audit (Mandatory Statement) During the year 2012/13, St Leonard’s Hospice was not eligible to participate in any national clinical audits or national confidential enquiries. What this means St Leonard’s Hospice has not been eligible to participate in any National audit or National Confidential enquiries because it is a provider of specialist palliative care. There were no audits or enquiries on a National level that examined specialist palliative care services. At the time of writing the Quality Account St Leonard’s Hospice is not intending to participate in any national confidential enquiries for the same reason. During 2013/14 St Leonard’s Hospice will continue to participate as a pilot site for the National Palliative Care Funding Review. The devolvement of the PCT structure and formation of Clinical Commissioning Groups (CCG) in April 2013 has not affected this

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participation and support continues to be provided by the project lead who is now employed by the Commissioning Support Unit. During 2013/14 St Leonard’s Hospice will undertake regular audit of all services to ensure key quality standards are met. A formal audit plan will be developed with the newly appointed Medical Director in the Autumn. Audit tools developed by Help the Hospices and supported by the Kairos electronic audit system will continue to be utilised. Results from St Leonard’s Hospice will be benchmarked against peer organisations from around the Yorkshire region. Results will be reported through the Hospice Governance structure. Previous audits relating to documentation and the use of the End of Life Pathway indicated that we fell short of the standards we expect. We will be required to improve our performance and this will be led by the senior sister and reported through the Governance structure. The End of Life Pathway has already been reviewed, revised and re-implemented as a care plan and audit of the success of that document will be undertaken in June 2013. Changes to documentation are likely over the period 2013/14 with proposed changes to the model of care delivery. Prescribing Standards Audit Monthly audit of standards of medicine prescribing indicate a high standard of documentation. Generally prescribing standards are excellent, and the audits have not identified areas for immediate concern. Research The number of patients receiving services from St Leonard’s Hospice in 2012/13 that were recruited during that period to participate in research approved by a research ethics committee was none. NHS Quality Improvement and Innovation Goals (Mandatory Statement) The grant received by St Leonard’s Hospice was not conditional on achieving quality improvement and innovation goals through the Commissioning for Quality and Innovation payment framework (CQUINS). What this means As a third sector/voluntary organisation St Leonard’s Hospice was not eligible to participate in the CQUINS payment scheme during the reporting period. We do produce activity figures for the PCT that are required as a condition of the grant received. Over a full year in-patient unit occupancy is required to average over 70%.

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The Programme of internal audit that was undertaken during the reporting period outlines quality improvement standards set within the Hospice and is submitted to the Care Quality Commission during inspection. What others say about us (Mandatory Statement) St Leonard’s Hospice employs 176 whole time equivalent members of staff across the main Hospice site and the retail outlets. During 2012/13 there were 29 staff leavers and 20 new recruits. In addition to this there are approximately 470 volunteers who give time to the various departments within the Hospice and retail outlets. “ we spoke to senior managers who were very clear about the importance of robust recruitment processes to ensure only suitable people were recruited” “This helps to protect people from harm” “we spoke to a care worker and a volunteer about their experiences when they applied for work at St Leonard’s Hospice….both described a process that was thorough and said there had been no question of them starting before the checks had been completed ” (Feedback from CQC inspector, October 2012) “we saw that the service had recently appointed some nurses who had just completed their training, we saw that these staff were employed as care workers until they provided evidence of being registered with a professional body” (Feedback from CQC inspector, October 2012)

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St Leonards Hospice is required to be registered with the Care Quality Commission (CQC). The current registration is as a provider of the following services : 1.Nursing Care

Terms of this registration relating to carrying out this regulated activity

The Registered Provider must ensure that the regulated activity nursing care is managed by an individual who is registered as a manager in respect of the activity, as carried on at or from St Leonard’s Hospice.

2. Treatment of Disease, Disorder or Injury

Terms of this registration relating to carrying out this regulated activity

The Registered Provider must ensure that the regulated activity treatment of disease, disorder or injury is managed by an individual who is registered as a manager in respect of the activity, as carried on at or from the location St Leonard’s Hospice.

3. Diagnostic and Screening Procedures

Terms of this registration relating to carrying out this regulated activity

The Registered Provider must ensure that the regulated activity diagnostic and screening procedures is managed by an individual who is registered as a manager in respect of the activity, as carried on at or from St Leonard’s Hospice.

4.Personal Care

Terms of this registration relating to carrying out this regulated activity

The Registered Provider must ensure that the regulated activity personal care is managed by an individual who is registered as a manager in respect of the activity, as carried on at or from St Leonard’s Hospice.

In addition to the terms of registration outlined above St Leonard’s Hospice can accommodate up to a maximum of 20 patients on the in-patient unit and a maximum 14 patients within the daycare unit each day.

The CQC has not taken any enforcement action against St Leonard’s Hospice during 2012/13.

St Leonard’s Hospice has not participated in any special reviews or investigations by the CQC during the reporting period 2012/13.

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St Leonard’s Hospice is subject to periodic reviews by the CQC and the last inspection was 23rd October 2012. During this inspection St Leonard’s Hospice was found to be meting the essential standards of care for the outcomes that were assessed.

The outcomes assessed during the visit were:

02 Consent to care and treatment

04 Care and welfare of people who use the service

08 Cleanliness and infection control

12 Requirements relating to workers

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Data Quality (Mandatory Statement)

St Leonard’s Hospice did not submit records during 2012/13 to the Secondary Users service for inclusion in the Hospital Episode Statistics which are included in the latest published data.

What this means

As a specialist palliative care unit St Leonard’s Hospice is not eligible to participate in submission of data to the Secondary Users Service for inclusion in the Hospital Episode Statistics.

St Leonard’s Hospice has a system in place for monitoring the quality of data through the use of the electronic information systems SystmOne and iCare.

With the patients consent we share data with other relevant health professionals to support the care of patients in the community and acute hospitals.

St Leonard’s Hospice submits a National Minimum Dataset (MDS) to the National Council for Palliative Care.

St Leonard’s Hospice provided monthly and quarterly activity data to the local Primary Care Trust but it is not yet clear if the VoYCCG will be requiring any formal data.

St Leonard’s Hospices score for 2012/13 for quality and Records Management was not assessed using the Information Governance Toolkit. This toolkit is not applicable to

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palliative care but this is an area that the Hospice are keen to develop with the lead being taken by the IT Manager.

Clinical Coding Error Rate

St Leonard’s Hospice was not subject to the payment by results clinical coding audit during 2012/13 by the Audit Commission. This is because St Leonard’s Hospice receives payment under a block grant system and not through tariff and therefore clinical coding is not relevant.

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Part Three

Review of Quality Performance

The National Council for Palliative Care (NCPC) : Minimum Data Set (MDS)

This section of the account will present the information for St Leonard’s Hospice from the NCPC minimum data set. This is the only activity data collected nationally on Hospice activity.

St Leonard’s Hospice

Inpatient Unit Services

2011/12 National Figures for 2011/12 (median)

2012/13

Total Number of patients

295 350 343

% new patients 91.5 % 90.2 % 79.0 %

% re-referred patients 2.4 % 5.1 % 4.7 %

% Occupancy 77.6 % 77.3 % 78.3 %

% patients returning home

32.9 % Not available 35 %

Average length of stay- cancer patients

18.5 days 13.4 days 17.6 days

Average length of stay – non-cancer patients

15.0 days 12.6 days 12.7 days

Note : national average figures for 2012/13 are not available at the time of writing the report

For the purpose of comparison with National figures St Leonard’s Hospice is in the category large Hospice (over

16 beds)

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The number of patients treated on the IPU has increased from 2011/12 to 2012/13 and is relatively consistent with the National median figures for 2012/13.

The numbers of patients being discharged home has increased slightly.

Whilst the average length of stay for non-cancer patients has decreased it remains higher than the National median value and this is something that St Leonard’s Hospice needs to consider in the face of changes to the funding of palliative care services and the likely introduction of a tariff based payment system.

Daycare Services

2011/12 National Figures for 2011/12 (median)

2012/13

Total number of patients

145 142 148

% new patients 67.6 % 64.1 % 61.5 %

% re-referred patients 2.8 % 2.8 % 2.7 %

% places used 59 % 57.8 % 62.2 %

% places booked but not used

31.9 % 27.7 % 24.6 %

Average length of care

102.1 days 168.1 days 77.1 days

Note : the national average figures for 2012/13 are not available at the time of writing the report

For the purpose of comparison with National figures St Leonard’s Hospice is in the category medium size

(between 126 and 179 patients)

2012/13 saw a static number of patients attending Daycare at St Leonard’s Hospice as compared to 2011/12. Overall throughout the year the number of attendances increased slightly and there was an decrease in the number of booked sessions that

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were not attended. There is however a note of caution that since January 2013 numbers have been lower and the number of patients not attending has increased.

There is a general feeling that the patients attending Daycare are more dependent and are being referred for care later in the disease process, this may be an explanation of why the number of cancelled sessions is increasing. There was a period of severe weather disruption when many patients cancelled their session due to poor road conditions and concerns about the safety of travelling.

The Hospice has also seen a decrease in the average length of care provided for patients, and this may again reflect the sense that patients are being referred later in their disease progression. Very few patients are discharged from Daycare as the model at St Leonard’s is a social daycare model however this number is increasing with the introduction of MDT meetings.

Hospice@Home Service

2011/12 National Figures for 2011/12 (median)

2012/13

Total number of patients

116 97 171

% new patients 98.3 % 90.9 % 95.9 %

Average length of care episode

Not available 28 days Not Available

Average number of visits per care episodes

4.9 5.3 Not Available

Note : the national average figures for 2012/13 are not available at the time of writing the report

For the purpose of comparison with National figures St Leonard’s Hospice is in the small category (fewer than

129 patients)

The St Leonard’s Hospice @ Home service has continued to increase service provision, however there remains scope for further development. This is due to a combination of ongoing factors that are being dealt with by senior managers from both the Hospice and the wider community services.

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There had been a trend since 2011/12 for an increase in requests for unregistered nurse support – this does not reflect the way the service was set up, however careful monitoring of referral patterns is required to ensure that the service meets patient demand and the workforce develops to reflect this.

The large variance between national data and the local average length of care episode will reflect the variance in referral criteria to Hospice @ Home services.

A lack of consistent approach to utilising SystmOne to collect activity data makes extraction of data for MDS reporting very difficult and this year we are not in a position to submit as much data as we had hoped. This situation will be improved with training and improved access for staff over the year 2013/14.

Bereavement Services

2011/12 National Figures for 2010/11 (median)

2012/13

Total service users 546 552 591

% new service users 56.2 % 65.7 % 52.8 %

Average length of support (days)

300 days 141.7 days 341.9 days

Note : the national average figures for 2011/12 are not available from the National Council for Palliative Care at

the time of writing the report

For the purpose of comparison with National figures St Leonard’s Hospice is in the category large service (more

than 300 patients)

The outstanding observation from the data presented for bereavement services continues to be the increase in average length of time we support services users and the large variance from national average (compared against 2010/11 figures) that is evident. That is a similar picture to the report from 2011/12. We currently support bereaved relatives for over twice as long as the national average.

The Bereavement Service Coordinator will be formally asked to review the activity data and consider the model in use at St Leonard’s Hospice. The model is not a counselling model but a listening one and as such is supported primarily by volunteers. It is of particular importance that the service is reviewed since bereavement services are

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currently not included in the proposed changes to palliative care funding and therefore going forward is likely to be a service funded purely by charitable donations.

Currently the service provides a luncheon club for people who are being supported that encourages people to remain in contact with their supporter up to and including the anniversary of the death of their family member. This could be one explanation for the length of support time. Another explanation may be that the service is supported by volunteers who may perhaps be more reluctant to ‘discharge’ people they are supporting, although this is purely a hypothesis and further work is clearly required in this area.

Quality markers we have chosen to measure

Complaints

In addition to the limited amount of quality data submitted as part of the minimum data set, St Leonard’s Hospice also monitors the number of complaints received by the service as a measure of quality.

During the period 2012/13 St Leonard’s Hospice received 1 written complaint that was a follow on from a single complaint to the Hospice made during the period 2010/11.

The complaint received in 2012/13 related to communication and a perceived lack of consistency with an approach to care that allegedly resulted in a delayed discharge of a patient.

The Executive Management Team considers all complaints serious and this complaint was dealt with by the Director of Clinical Services and the Senior Sister for in-patient services.

No complaints were received by the CQC in relation to the care of patients at St Leonard’s Hospice.

Communication skills training is included as part of mandatory training and permission had been received from the complainant in 2011/12 to use exerpts from a letter received to highlight how the actions and attitudes of staff impact on families. This training has been well received by staff.

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Patient Safety Indicators

In 2012/13 the following patient safety indicators were monitored and going forward into 2013/14 comparisons will be ale to be made to establish trends and areas for continued improvement:

Number of patient slips, trips and falls 59

Number of falls resulting in fracture 1

Number of patients who were admitted with pressure ulcers reportable to the CQC

1

Number of patients who develop pressure ulcers in our care

0

Number of patients who develop a healthcare acquired infection in our care

1. MRSA

2. Clostridium Difficile infection

0

0

Supporting Statement from CCG

At the time of writing this draft report there is no clear indication from CCG who would support and write in the Quality Account.