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Quality Account 2015 - 2016
Welcome to our Quality Account for 2015 – 16.
At St Oswald’s Hospice, we continue to strive to provide first-class, high quality, specialist care to North East adults,
children and young people with incurable conditions. We started providing our services to adults, and their families,
almost 30 years ago and since then our services have continued to grow and develop to meet the needs of our North
East community. We provide services for young people and children, have an inpatient ward, a day hospice and
outpatient clinics, which are based both onsite at our Newcastle Hospice, and offsite in satellite clinics around the
region. We rely on the kindness and generosity of our local community to help us fundraise the income needed to
sustain our high level of services. We are humbled and eternally grateful for this continued support.
To ensure we provide a quality service to our patients and their families, we have a range of ‘checking and monitoring’
methods in place. We are regulated by the Care Quality Commission (CQC) , Charity Commission and Companies House.
Our last CQC inspection (August and September 2015), we were compliant in all outcomes, with an overall rating of
’good’ and rated as ’outstanding’ for our care services. Patients and their families told the CQC that they “received an
exceptional quality of care from all the staff at the hospice,” and no recommendations for improvement were made.
We are monitored and required to provide evidence of quality service to a variety of external stakeholders including
funders, and internally, with our patients, families, staff and volunteers. We encourage all stakeholders to feedback on
their experiences. We do this with a wide range of mechanisms including patient experience questionnaires, face to face
interviews, focus groups and submissions to our ‘feedback bank’. All patient experience data, as well as comments,
complaints, compliments and suggestions from all stakeholders is collated, analysed and reported in to our ‘Clinical
Quality Group’ for action where necessary.
Our Clinical Quality Group reviews all issues relating to patient experience and providing a quality service. They take
forward any actions needed and continuously update our Compliance Register accordingly. Updates are provided to our
Council of Trustees via our Clinical Quality & Governance Committee and Council on a regular basis.
We continue to ask the ‘NHS’ Friends and Family Test to all patients, staff and volunteers. The test asks patients, staff
and volunteers if they would recommend St Oswald’s as a care provider and an employer. Results are reported to our
Council of Trustees, as part of our Balanced Scorecard and provide an additional quality assurance tool. We also ensure
staff and volunteers responses are feedback to our workforce via a range of internal communications channels.
As we embark on providing #30yearsofcare, our vision for our community and commitment to providing high quality
care across all our services remains resolute. It is at the core of our ethos. We recognise the enormous contribution our
past and present staff and volunteers have made, and continue to make as ambassadors for our work. We recognise the
important role our community plays in helping to shape and continue developing our services to make sure that, as our
Vision statement details - everyone in our region gets expert, dignified and compassionate care when they need it.
Thank you.
James Ellam, Chief Executive
Who we are
St Oswald’s Hospice provides specialist palliative care to local adults, young people and children with
life limiting conditions from across the North East of England.
Established in 1986, we have gained a local, national and international reputation for providing first
class quality care to local people.
As a charity, our vision is to provide excellence in care for those with incurable conditions, ensuring
everyone in our region gets expert, dignified and compassionate care when they need it.
See our Vision Statement and Vision 2025 objectives updates overleaf to find out how we are doing
this.
What we do
We offer a range of adult services including an inpatient unit, day hospice, outpatient services,
Lymphoedema management and outreach.
We are experts in pain and symptom management and end of life care.
We follow a team approach – including consultants, doctors, nurses, social workers, chaplaincy,
physiotherapists, occupational therapists and complementary therapists.
We look after people with a range of conditions, not just cancer. For example, Motor Neurone
Disease, Multiple Sclerosis and advanced respiratory, neurological or cardiac conditions.
We also care for children and young adults with progressive, life shortening conditions. We provide
specialist short breaks and offer end of life care.
We provide care and support to patients families and carers, following a holistic approach to our care.
Our Vision statement
Together, we will make the most of time and improve quality of life
for everyone in the North East living with an incurable condition,
and their families.
Together, with the vital support of our staff, volunteers, donors and
supporters, we will continue to develop and grow our services so
that everyone in our region gets expert, dignified and
compassionate care when they need it.
“St Oswald’s is an amazing
place filled with beautiful,
caring, considerate, funny
people. Not only do they show
the utmost care to the patients
but also their families too. Can't
thank them enough for
everything they did for our
family.”
Our Vision 2025
Our ten year Vision strategy objectives are:
• To continuously improve the quality and efficiency of the services that we provide to
our patients and their families.
• To lead the development of palliative care services within the region by working
more closely with other organisations.
• To work with staff and volunteers to deliver excellent services through our
commitment to individual development.
• To work flexibly, always seeking to maintain financial stability.
Our Vision 2025 - priorities
Our priorities below underpin our Vision 2025 objectives.
By 2025 we will aim to:
• develop a family support service for carers and bereaved adults and children
• develop a funded, community-based network of Lymphoedema services
• lead the development of a North East palliative care education centre
• create alliances with other local providers to increase access to palliative care
• open additional adult inpatient beds
• increase capacity to care for patients with a non-cancer diagnosis
• expand the children’s hospice and facilitate independent living for young adults
• ensure co-ordinated out-of-hours palliative care and advice is available across the
region
PART 2: Priorities for improvement and required statements
St Oswald’s remains committed to the continuous development of the whole service and through an active approach to patient
and stakeholder involvement keeps the service users at the heart of decision making and service improvement.
There were a significant number of strategic objectives for each directorate in 2015/16, however four objectives were highlighted:
1. To develop the Focus on Living project within Day Services increasing the amount of support we can provide in a flexible and timely manner to a
broader range of patients. Meeting this objective will be monitored via attendance figures and feedback from patients.
⇒ This objective was met. Focus on living was originally launched in January 2015 and since then we have developed and offered
several different sessions for patients and their carers including creative writing, Yoga, More Like You, silk painting, positive steps and
more. Patients are regularly asked for feedback which helps shapes future sessions. Referrals for the courses have been received
from several new community links as well as St Oswald’s Day Hospice, existing external links and the team work closely with the
Family Support Team.
2. To develop a programme of training in supporting children facing bereavement for delivery to schools, healthcare professionals and hospice
staff. Meeting this objective will be measured by the availability of the training programme.
⇒ Partially met. Training volunteers for working with bereaved children has started and will continue as a focus for 2016/17.
3. To implement outcome measure using the OACC suite of measures (Outcome Assessment Complexity Collaborative). Successful
implementation will include the ongoing monitoring of measures through monthly reports.
⇒ Partially met. Work is underway to fully implement OACC in Adult Inpatients and Day Hospice. This will continue to be a focus
for 2016/17.
4. To finalise funding arrangements for our NHS Lymphoedema service from April 2016.
⇒ Work continues on this objective and will do in to 2016/17.
PRIORITIES FOR IMPROVEMENT—key Priorities for 2015-2016
PART 2: Priorities for improvement and required statements
Review of services:
During 2015-2016 St Oswald’s Hospice provided and/ or sub-contracted two NHS services.
• Outpatient Lymphoedema Service
• Outreach Lymphoedema Service
St Oswald’s Hospice has reviewed all the data available to them on the quality of care in two of these NHS services.
In addition the Hospice has provided the following services through grants & charitable funding:
• Children’s Service
• Young Adults Transition Service
• Day Hospice
• Outpatient Clinic
• Complementary Therapy
• Physiotherapy
• Occupational Therapy
• Social Work
• Bereavement Support Team
• Chaplaincy
The income generated by the NHS services reviewed in 2014-2015 represents 30 percent of the total income generated from
the provision of NHS services by the St Oswald’s Hospice for 2014-2015.
PART 2: Priorities for improvement and required statements
Participation in clinical audits:
During 2015-2016, no national clinical audits and no national confidential enquiries covered NHS services that St Oswald’s
provides.
St Oswald’s regularly audits various elements of clinical and non-clinical practice both via internal procedures and with the
support of internal and external audit partners.
The Clinical Audit Group and the Nursing Audit Group, focus on developing audit within St Oswald’s and continuously
improving the quality of care provision.
Audits undertaken in 2015-2016 included a Senior Review Audit, Review Of Discharge Letters To GPs, Hospice Use Of Antibiot-
ics against NUTH Guidelines, OACC/shared Plan Of Care, Clinical Passports for Young Adults, Inpatient MND Admissions, Recog-
nition of Polypharmacy And Risk Of Interactions, Use Of Steroids In Palliative Care, Management Of Lymphoedema/Oedema In
Advanced Disease, Primary Thromboprophylaxis Assessment On Admission To IPU, Advice Line Audit For Children & Delirium
Concordance Review Against NICE Guidelines. Infection Control and Manual Handling Audits also form part of a regular audit
cycle.
Participation in clinical research:
The number of patients receiving NHS services provided or sub-contracted by St Oswald’s Hospice in 2014-2015 that were re-
cruited during that period to participate in research approved by a research ethics committee was zero.
Use of the CQUIN payment framework:
St Oswald’s Hospice income in 2015-2016 was conditional on achieving quality improvement and innovation goals through the
Commissioning for Quality and Innovation payment framework.
Targets achieved were as follows:
• Implementation of Intentional Rounding.
• Implementation of the 2 year Lymphoedema keyworker pathway.
Statements from the Care Quality Commission:
St Oswald’s Hospice is required to register with the Care Quality Commission (CQC) and is currently registered to carry out
regulated activities:
• Treatment of disease, disorder or injury.
• Diagnostic and screening procedures.
• Transport services, triage, medical advice provided remotely.
St Oswald’s Hospice has the following conditions on registration:
1. The registered provider must ensure that the regulated activities are managed by an individual who is registered as a
manager in respect of the activity, as carried on at or from the location St Oswald’s Hospice.
2. This regulated activity may only be carried on at or from the following locations: St Oswald’s Hospice, Regent Avenue,
Gosforth, Newcastle Upon Tyne, Tyne & Wear, NE3 1EE.
PART 2: Priorities for improvement and required statements
PART 2: Priorities for improvement and required statements
St Oswald’s has the following additional conditions:
1. The registered provider may accommodate no more than 19 service users in the adult unit at St Oswald’s Hospice.
2. The registered provider may accommodate no more than 8 service users, aged from birth to eighteen, in the children’s
unit at St Oswald’s Hospice.
The CQC has not taken enforcement action against St Oswald’s Hospice during 2015-2016.
St Oswald’s Hospice has not participated in any special reviews or investigations by the CQC during the reporting period.
Data Quality:
St Oswald’s Hospice continually works to improve the quality of information provided.
St Oswald’s Hospice did not submit records during 2015-2016 to the secondary uses service for the inclusion in the Hospital
Episode Statistics which are included in the latest published data, however St Oswald’s did continue to participate in the Na-
tional Council for Palliative Care MDS project and also a Hospice UK benchmarking project.
Information Governance Toolkit Attainment Levels
St Oswald’s Hospice Information Governance Assessment Report score overall for 2015-2016 was 74%
The information Governance Group will be taking forward the action plan from the toolkit audit over the course of 2016-2017.
The hospice was inspected by the CQC on August the 11th & September 4th,7th 2015, achieving an OUTSTANDING rating for
care & a GOOD rating overall.
PART 2: Priorities for improvement and required statements
The Information Governance and Quality Group meets bi-monthly and each meeting has a specific focus, i.e. organisational or
clinical and the membership is adjusted accordingly around a core of members who attend each meeting. We will continue to
monitor the functionality/effectiveness of the new group going forward.
Detailed below is an update on the work undertaken or initiated:
• The Information Governance Policy and Procedure was reviewed and approved in July 2015.
• Continued SystmOne development and building on the implementation of SystmOne on the Adult In-patient Unit and
the Children and Young Adults unit
• Paper light within Day Services.
• Introduction of a rolling programme of reviewing evidence submitted to the IG Toolkit in preparation for submission in
March.
• Staff Information Governance skills assessment with a 85% pass rate was introduced in 2015.
Clinical coding error rate:
St Oswald’s Hospice was not subject to the payment by results clinical coding audit during 2015-2016 by the Audit
Commission.
PART 2: Priorities for improvement and required statements
As in 2015/16, we will continue to work towards our Vision 2025 strategic objectives and related priorities. During 2016/17,
however, our highlighted priorities are:
1) To continue to develop and fully implement outcome measure using the OACC suite of measures (Outcome Assessment
Complexity Collaborative). Successful implementation will include the ongoing monitoring of measures through monthly
reports.
2) To finalise funding arrangements for our NHS Lymphoedema service from April 2016 onwards.
3) To further research and develop better collaborative working relationships with other region-wide hospices and related
organisations. The aim will be to enable improved services across the North East and increase access to high-quality
palliative care for our communities.
4) To continue research into and further develop possible education solutions such as the creation of a North East palliative
care education centre.
PRIORITIES FOR IMPROVEMENT—key Priorities for 2016-2017
PART 3: Review of performance and user involvement
During 2015 –2016, 2,280 adult patients, 54 children and 12 young adults benefited
from St Oswald’s services including:
• 411 Inpatient referrals, 243 adult inpatient admissions & 241 completed stays.
• 182 new referrals into day hospice with 133 patients attending over the course of
the year for a total of 2,193 days.
• 831 Lymphoedema referrals.
• 8,519 Lymphoedema outpatient attendances.
• 415 Lymphoedema attendances at our Shiremoor clinic.
• 392 Lymphoedema attendances at our Blaydon clinic.
• 316 Lymphoedema attendances at our Morpeth clinic.
• 1,361 Complementary Therapy sessions provided to Outpatients, Day Hospice
patients, inpatients and carers.
• Children’s & Young Adults recorded an occupancy of 94% over the year resulting
in 1,950 bed days.
We serve adult patients from Northumberland, North Tyneside, Gateshead and
Newcastle. In addition, children and young adults from Sunderland, South Tyneside
and North Durham can also access our services.
Patients are referred to us by their GP, consultant or specialist palliative care team.
Children and young adults are referred to us by health and social care pathway
co-ordinators.
R
Referrals to the hospice…an overview
R
0.8%
10.6%
2.3%
22.8%
0.1%
0.4%
1.2%
1.3%
10.8%
0.8%
46.0%
0.6%
2.4%
0.0% 10.0% 20.0% 30.0% 40.0% 50.0%
Childrens (Short Break)
Focus on Living
Lymphoedema Outreach
OP - Acupuncture
OP - Complementary Therapy
OP - Lymphoedema
Positive Steps
Referrals By Department
42.8%
17.7%
27.7%
8.9%
0.2%2.7%
0.0%5.0%
10.0%15.0%20.0%25.0%30.0%35.0%40.0%45.0%
NH
S N
ew
cast
le
Ga
tesh
ea
d C
CG
NH
S N
ort
h
Ty
ne
sid
e C
CG
NH
S
No
rth
um
be
rla
nd
CC
G
NH
S S
ou
th
Ty
ne
sid
e C
CG
NH
S S
un
de
rla
nd
CC
G
Oth
er
CC
G
Referrals (CCG)
11 7 3 10 7
487
243
319
181249
140102
45
0
100
200
300
400
500
600
Fe
ma
le
Ma
le
Fe
ma
le
Fe
ma
le
Ma
le
Fe
ma
le
Ma
le
Fe
ma
le
Ma
le
Fe
ma
le
Ma
le
Fe
ma
le
Ma
le
0 - 15 16 -
18
19 - 24 25 - 64 65 - 74 75 - 84 85+
Referrals (Gender/Age Group)
Inpatient Service
Our 15-bedded inpatient unit caters for patients needing pain and symptom control,
emergency respite, and end of life care.
Our multi-disciplinary team work together and strive to address not just a patient’s
physical needs, but their emotional and spiritual needs too.
Our aim is to ensure patients with specialist palliative care needs can improve their
quality of life; facilitate a safe and timely patient discharge or transfer to a continuing
care service, as well as provide a supportive environment at the end of life.
We also understand the impact an illness has on the whole family and offer wide
ranging support for carers.
•
“Thank you so much for
looking after my husband,
so well. He is home and
enjoying some family time
now. St Oswald's is such a
remarkable place run by
amazing people who we
now call friends.”
Last year...
• There were 242 adult inpatient admissions
last year, 125 patient discharges and 116
deaths.
• 4527 bed-days were occupied during the year,
with an average occupancy of 83%.
• Patients stayed with us for an average stay of
18 days.
• All families and carers have access to our
Family Support Unit including bereavement
support.
Inpatient Service…..discharges overview
ser-
vice.
· Pro-
vide a
major
re-
source
in pallia-
tive
care.
· Man-
age the
Hospice
effec-
tively.
For details about our 10 Year Vision for the
Hospice please see page 14.
Home
68%
Hospital
31%
Nursing Home
1%
Location Before Admission (Discharges)
Cancer
85%
Non Cancer
15%
Diagnosis Class (Discharges)
0
0
0
0.391509434
0.287735849
0.254716981
0.066037736
0 0.1 0.2 0.3 0.4 0.5
Under 16…
16 - 18
19 - 24
25 - 64
65 - 74
75 - 84
85+
Age Group (Discharges)
2014-2015 2015-2016
% Change Average Total Average Total
Admissions 17 207 20.2 243 14.8%
Percentage Occupancy 85% 83% -2%
Discharges 10 118 10.4 125 6%
Deaths 8 91 9.7 116 22%
Finished Admissions 17 209 20.2 242 14%
% Deaths 45% 48% 3%
Average Age 70 Years 66 Years -4 Years
average LOS 22 Days 18.7 Days -3 Days
minimum LOS 3 Days 1.4 Days -1.6 Days
maximum LOS 71 Days 69 Days -2 Days
Average wait 5 Days 4 Days - 1 Days
Total referrals 28 341 34 411 17%
Day Hospice
Day Hospice offers patients respite, symptom management and support during the day.
Day Hospice facilities are available from Tuesday to Friday, between 10 am and 3pm.
A visit to Day Hospice can be as busy or as relaxed as a patient wishes, with each
session tailored around their individual needs. Activities designed to enhance a
patient’s feelings of wellbeing and self esteem include: Crafts, reminiscence, music
therapy and creative writing. All meals and refreshments are provided free of charge
and transport can be provided.
Group sessions are also available including Fatigue management, exercise, relaxation
and mindfulness.
Members of our care team informally monitor a patient’s condition throughout their
time with us and report any changes or difficulties back to their GP, hospital, or
community team. During each visit, patients can benefit from the services of our
nursing team, Physio and Occupational therapists, Complementary Therapists, Social
Workers, our Chaplain and Therapeutic Activities Facilitator. Our medical team is also
available when necessary, although a patient’s GP retains overall responsibility for their
care.
“The Hospice is filled with
a lot of amazing people. The
nursing team are all very at-
tentive and committed; noth-
ing is too much trouble for
them. The professional and
technical support is great too
as I’ve had physiotherapy and
acupuncture, so all my needs
are catered to.”
Last year...
We received 182 new referrals
• There was an average of 252 Day Hospice
places booked each month, which is 75%
of our capacity.
• Average actual attendance was 73%.
Day Hospice Referrals……..an overview
“I’ve been coming here for about five years and it’s now my one day during the
week where I can get out and about. I love coming to the Hospice so that I can
go for a walk and then go to the service at the chapel. It would break my heart
if I couldn’t get here.”
Diagnosis Group Count %
Cancer - Breast 19 10%
Cancer - Digestive Organs 31 17%
Cancer - Eye, Brain & Other CNS 17 9%
Cancer - Female Genital Organs 7 4%
Cancer - Ill Defined, Unspecified 1 1%
Cancer - Lip, Oral Cavity, & Pharynx 1 1%
Cancer - Lymphoid / Haematopoietic 8 4%
Cancer - Male Genital Organs 12 7%
Cancer - Other Specified Sites 3 2%
Cancer - Respiratory & Intrathoracic 33 18%
Cancer - Urinary Tract 5 3%
Degenerative Nervous System Diseases 25 14%
Heart / Circulatory Disease 8 4%
Multiple Sclerosis 0 0%
Other Non Cancer Diagnosis 7 4%
Respiratory Diseases 5 3%
Grand Total 182 100%
43%
8%
5%
1%
14%
19%
1%
1%
7%
0% 10% 20% 30% 40% 50%
Community Palliative Care Team
District Nurse
GP
Hospice
Hospital Palliative Care Team
Internal Referral
Other Clinician
Physiotherapy
Specialist Nurse
Referral Source
Referral Source Count %
Community Palliative Care Team 78 43%
District Nurse 15 8%
GP 10 5%
Hospice 2 1%
Hospital Palliative Care Team 26 14%
Internal Referral 34 19%
Other Clinician 2 1%
Physiotherapy 2 1%
Specialist Nurse 13 7%
Grand Total 182 100%
34
29
37
18
29
1315
7
0
5
10
15
20
25
30
35
40
Female Male Female Male Female Male Female Male
25 - 64 65 - 74 75 - 84 85+
Referrals (Age Group/Gender)
Outpatient services
Our Outpatient Services for patients and their carers include:
Complementary Therapy Service
We offer a range of complementary therapies to patients and carers, on an outpatient
basis, including: Massage, Aromatherapy, Indian Head Massage, Reflexology, Reiki and
Hot Stone Therapy.
Treatments are offered alongside conventional medical care and aim to help patients
feel better physically, emotionally and psychologically.
Hypnotherapy
Clinical Hypnosis can help patients feel more in control, reduce their anxiety, raise self
esteem and build confidence. Sessions are provided by Lisa Cairns, who is qualified in
Clinical Hypnosis and has undertaken pioneering work with Northumbria University to
develop the use of hypnosis in palliative care settings, with a particular focus on
symptom management.
“I’ve always said that if I didn’t
have St Oswald’s, my life
wouldn’t be as it is now. Coming
here has helped me manage and
control my Lymphoedema so that
I could live life. By being able to
manage my condition, and
having so much support from the
Hospice, I gained so much
confidence.”
Acupuncture
Our team of physiotherapists offer acupuncture
to St Oswald’s patients. Acupuncture can be
used to relieve pain, aid relaxation, reduce
muscle tension and help manage tension and
sweats.
Focus on Living sessions
Introduced in early 2015, the aim of our ‘Focus on living’ sessions is to enable people
with life limiting, incurable conditions to feel better in themselves, by benefiting from a
range of structured, sessional activities that are tailored to their individual needs.
Sessions include ‘Positive Steps’ – a six week programme introducing the range of
St Oswald’s services and to dispel myths around hospice care, relaxation classes,
mindfulness, creative writing, fatigue management, arts and crafts, exercise and music
therapy.
Cognitive Behavioural Therapy
We offer Cognitive Behavioural Therapy (CBT) to patients who
have ongoing feelings of anxiety, low mood, anger or panic as a
result of their life limiting condition.
CBT helps our patients to change the way they think about
themselves, their situation and the future. It is designed to
help patients learn effective ways of dealing with
difficulties relating to their condition, and can help
when adjusting to and coping with pain and symptoms.
Sessions are provided to patients by Anne Pelham, one
of our Consultants and Gill Satterley, a Cognitive
Behavioural Therapist.
“Coming to the Hospice since
first being referred has 95%
improved my wellbeing. I
think I’ve taken part in
every Focus on Living class
going! Taking part in so many
different things has been
fantastic and I’ve made some
wonderful friendships.”
Outpatient activity last year...an overview
CCGMedical OP
Attendances
Complementary
Therapy OP
Attendances
Complementary
Therapy as Part
of other services
Complementary
Therapy for
Carers
CBT
Attendances Acupuncture Hypnotherapy
Positive
Steps
Focus On
Living Total
NHS North Tyneside CCG 7 39 159 29 6 11 1 17 4 273
NHS Northumberland CCG 16 145 365 58 28 15 31 41 699
NHS South Tyneside CCG 2 0 5 0 5 6 18
NHS North Durham CCG 0 20 0 0 0 12 1 33
NHS Newcastle Gateshead CCG 9 182 327 30 12 35 12 27 33 667
NHS Durham Dales, Easington & Sedgefield CCG 0 0 0 0 2 2
NHS Sunderland CCG 0 0 0 0 0 0
NHS Hartlepool and Stockton-on-Tees CCG 0 0 0 0 0 0
Other CCG 0 0 1 1 0 2
Total 34 386 857 118 53 58 28 75 85 1694
Medical OP
Attendances, 34
Complementary
Therapy OP
Attendances, 386
Complementary
Therapy as Part of
other services, 857
Complementary
Therapy for Carers,
118
CBT Attendances, 53
Acupuncture, 58
Hypnotherapy, 28
Positive Steps, 75Focus On Living, 85
Outpatient Appointments (Service)
Lymphoedema Service
Recognised as a national centre of excellence in Lymphoedema management,
St Oswald’s is the largest specialist Lymphoedema service provider in the North East.
Our senior Lymphoedema practitioners also play a leading role in clinical education in
the North East. We are working in partnership with Northumbria University to develop
accredited training modules in assessment and management of Lymphoedema.
We treat patients with cancer-related Lymphoedema, those with oedema as a
symptom of their progressive disease and patients with non-cancer related
Lymphoedema.
As we’ve provided Lymphoedema care consistently over the last 25 years, we are
specialists in our field and we regularly treat the most complex, severe cases.
A large number of patients have complicated Lymphoedema, requiring intensive
treatment and a number of review appointments – symptomatic of the specialist
service we provide.
We have Key Workers trained in-house to care for more routine cases, through to
specialist nurses for the most complex care. We also have specialist medical input
available.
All patients are cared for on a pathway approach, covering assessment, treatment and
planned review and discharge. Our pathways mirror the International Lymphoedema
Framework Best Practice Consensus Document (2006).
Referrals have increased year on year for over 10 years. As a result we’ve developed a
hub and spoke model of care, where patients with mild and uncomplicated
Lymphoedema from Gateshead, Morpeth and North Tyneside are treated in their
locality, whilst patients requiring specialist care receive treatment on site at the
Hospice. We can also provide home visits to patients who are housebound, as a result
of their condition.
Lymphoedema is an incurable , chronic, progressive and life long condition. It can
severely compromise a patient’s mobility and quality of life. It can affect their ability to
work and causes considerable anxiety and distress.
However, it can be managed effectively by:
• Early diagnosis, referral and treatment
• A treatment programme comprising one or more of: compression bandaging and/or
hosiery, skincare (simple lymphatic drainage), manual lymphatic drainage and exer-
cise
• Promotion of self care
• An integrated care plan which includes long term management
When Lymphoedema is recognised early and treatment is implemented, patients have
fewer complications, fewer hospital admissions and community nursing interventions,
the ability to self manage their condition and a better quality of life.
When Health Care Professionals are trained effectively and teams work collaboratively,
patients benefit from more effective long term management of their condition, with
the reduced risk of deterioration and further complications.
Cellulitis is a common
secondary complication
caused by Lymphoedema,
presenting in 20-30% of
cases (Vaillant 2002) and
often requiring repeated
acute admissions.
According to The NHS Insti-
tute for Innovation and Im-
provement, in 2003-2004
there were 45,522 inpatient
admissions for cellulitis
costing £87million in total.
It is estimated that for every £1
spent on Lymphoedema care,
saves the NHS £100 in acute and
community nursing costs.
4%
9%
7%
49%
1%
7%
4%
13%
1%
6%
0% 10% 20% 30% 40% 50% 60%
Community Palliative Care Team
Consultant
District Nurse
GP
Hospice
Hospital Palliative Care Team
Internal Referral
Other Clinician
Physiotherapy
Specialist Nurse
Lymphoedema Referrals (Source)
39%
17%
23%
18%
0%
3%
0% 10% 20% 30% 40% 50%
NHS Newcastle Gateshead CCG
NHS North Tyneside CCG
NHS Northumberland CCG
NHS South Tyneside CCG
NHS Sunderland CCG
Other CCG
Lymphoedema Referrals (CCG)
20
0
15
7
13
4 22
9
23
5
27
4
38
7 45
4 52
9
50
7
61
5
62
1
83
1
0
100
200
300
400
500
600
700
800
900
20
03
/04
20
04
/05
20
05
/06
20
06
/07
20
07
/08
20
08
/09
20
09
/10
20
10
/11
20
11
/12
20
12
/13
20
13
/20
14
20
14
/15
20
15
/16
Lymphoedema Referrals
0 95
4 10
84
11
79
13
40
16
36
19
39
22
60
21
92
32
59
37
34
34
53
37
25
46
684
85
58
0
73
3
10
15
13
81 2
01
3
19
35
21
09
21
86
34
36
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
20
02
/03
20
03
/04
20
04
/05
20
05
/06
20
06
/07
20
07
/08
20
08
/09
20
09
/10
20
10
/11
20
11
/12
20
12
/13
20
13
/20
14
20
14
/15
20
15
/16
Lymphoedema Attendances (including DLT/MLD)
Attendances Treatments
0
5
10
15
20
25
30
35
40
45
50
Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16
Lymphoedema Outreach Attendances
Shiremoor Outreach Blaydon Outreach
24 hour Palliative Care Telephone Advice Service
Working in conjunction with Marie Curie Cancer Care, we run Hospadvice, an out of
hours telephone advice service available for health and social care professionals caring
for adult patients from Northumberland, North of Tyne and Gateshead with palliative
care needs.
Calls are answered by one of the doctors or qualified nurses on our inpatient unit. Ho-
spadvice offers access to advice on medical, clinical and signposting options.
Last year, 327 phone calls were received from health care professionals to our adult
services palliative care advice line.
We also offer a paediatric palliative advice line, for health care professionals in the re-
gion caring for children and young people with advanced, deteriorating or progressing
conditions or are in need end of life care.
This is supported by some of our senior Palliative Care medical team in collaboration
with Dr Alison Guadagno, Consultant Paediatrician at the Great North Children’s Hospi-
tal .
Children and Young Adults Service
We provide specialist short breaks and palliative care to children and young adults,
aged from 0 to 25, with progressive, life-shortening conditions. We also provide end-of-
life care. Specialist, medically-supported care is provided, 24 hours a day, seven days a
week.
Our team of skilled staff provide residential short breaks to children and young adults
from across the region.
Up to six children and young adults can stay at any one time in our relaxed, home-from-
home environment.
Children and young adults from Northumberland, Newcastle, Gateshead, North
Tyneside, South Tyneside, Sunderland or Durham City, Chester-le-Street and
Derwentside can benefit from short breaks at St Oswald’s.
There is an assessment and referral pathway that has been agreed with health and,
social care colleagues and ourselves within each area.
We work closely with colleagues at the Great North Children’s Hospital.
Caring for children
Children staying with us can enjoy a range of
activities such as: sensory play, music therapy,
arts and crafts, baking, bowling and the cinema.
Teenagers benefit from their own living area –
complete with games consoles, wide screen TV
and PC’s.
“St Oswald’s is a family to
us. I call you our guardian
angels. Leaving our son for
a short break is a much
needed time away not
only for him but also for
our family.”
Young adults
As well as residential short breaks, we now also offer day care for young adults, two
days a week. In addition, our Young Adults Social Group remains very popular, which
offers a range of empowering activities and a chance to socialise. Young adults staying
at St Oswald’s tell us how much they value independence from their carers and the
chance to spend time with peers.
Family support
At St Oswald’s we are committed to providing services for the whole family. Our care
team offer confidential 1-1 support to parents and we also strive to bring families
together, to get to know one another and benefit from peer support.
For families wishing to stay with us, we offer four en-suite bedrooms, a bathroom and a
lounge area with kitchenette. Parents can also benefit from our free complementary
therapy service.
As we know that brothers and sisters of children with chronic conditions can feel
forgotten, we offer dedicated support for siblings too. Each year we run two ‘Sibz Days’
for brothers and sisters of children who stay with us for short breaks. Led by our care
team, Sibz Days involve sharing feelings and experiences and expressing them in
different ways – including art, crafts and music.
Children get the chance to have fun, make new friends and even play with medical
equipment that their brother or sister may use, in a safe environment.
If a child dies, at St Oswald’s, their own home or in hospital, we are also here to provide
ongoing, bereavement support to families.
“Words cannot express how important a role you all play in families lives when they
need you the most. You are a tremendous support and we have been privileged to
experience your unique skills when we needed them. Keep up the good work.”
Last year...
• 54 children and their families benefited from our Children’s Service.
• A further 12 young adults were cared for at St Oswald’s.
• 37% of children staying were aged between 0 and 3
years old.
• 654 admissions, 1,950 bed days were occupied
with a 94% occupancy rate.
• The average length of stay is 3 nights per visit for Children & 3 nights for Young Adults.
“I love the fact that St Oswald's is
like a great big security blanket
which wraps round you during
the hardest time in your life. We
will never forget the role you
played in our lives during our
son's final years.”
206 464 215 223 39851
39
101
95 0
158
0
0
100
200
300
400
500
600 Total Nights (CCG)
Young Adults Childrens
Childrens,
1557
Young
Adults, 393
Children/Young Adults Bed Nights
10
46
12
99
12
14
12
06
14
34
17
85
20
68
19
30
19
85
19
50
3.0 3.2 3.1 3.12.9 3.0
3.5
3.0 3.1 3.0
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
0
500
1000
1500
2000
2500
Children & Young Adults Occupied Nights/Avg
LOS
Carer and Bereavement Support
• Our services to carers include complementary therapy, carers drop-in sessions,
group sessions and one-to-one support.
• We also offer a range of support services to bereaved individuals and families on a
one-to-one basis and in groups.
• Our one-to-one service is available onsite, over the telephone or can be held in the
comfort of a patient or carer’s home.
• Group sessions are usually held at St Oswald’s, where you have the chance to share
feelings and experiences in a warm and welcoming setting – with others who
understand.
• We also hold ‘Ozzy Days’ for bereaved children aged from 5 to 15 whose parent,
sibling or other loved one has received care from St Oswald's.
“Thank you to everyone
who made Ozzy day so
brilliant. At this time of year it
is even more difficult for bereaved
children, bombarded with happy
family scenarios on TV and
Christmas celebrations, to cope with
their loss. Today gave mine a chance
to be with other children who have
suffered loss and share feelings,
thoughts and also laughter.”
“I know I’m fully supported
and someone is always
there with a listening ear.
I also use the
complementary therapy
service, which is lovely.
It’s fantastic to have an
hour which is just about me
having a break.”
Patient Feedback…..An Overview
Average Friends and Family Test Score 2015/2016—91%
The NHS Friends and family test score shows the proportion of patients who would strongly recommend the Hospice as a care
provider minus those who would not recommend, or who are indifferent.
New Outpatient Feedback April 2015 to March 2016
Every new patient to Day Services is sent a survey to monitor the service they received during their first encounter with St
Oswald’s. 716 patients were sent surveys and 249 responses were received. A 35% return rate. Consideration is being given to
utilising online surveys such as survey monkey to provide another opportunity for patients to respond.
♦ 99% of patients felt the nurse or therapist explained everything clearly.
♦ 96% of patients felt they left with a clear idea of their future treatment plan.
The patients gave very positive comments like ♦ “Care and service is to an exceptional standard, it is a none threatening environment. Staff are exce llent,
warm, friendly and caring”. ♦ “Altogether a marvellous organisation with superb c are and service. A very kind and reassuring experi -
ence - giving hope to patients”. ♦ “Every visit I make here is met by helpful and frie ndly staff and all treatment is explained to before hand
so that I am at ease. Well done to all staff”.
Question 18: Overall how would you rate the level of service Total % 10 163 68% 9 53 22% 8 16 7% 7 6 3% 5 2 1%
Patient Feedback…..An Overview
They also provided some suggested improvements, for which a response or action point is also given.
Feedback Action/Comment
You said...The Auxiliary Nursing Study Day was really useful, interesting and informa-tive.
We did...We're booking more events to get out and about to educate health care profes-sionals in the North East. If you would like us to visit your organisation to talk about any of our services or care, please contact us.
You said...The Kingston Park retail team are very helpful and a joy to deal with. We did...We passed on your message to Shop Manager Kenny and his team of volun-teers at our Kingston Park Warehouse. Thank you!
You said...I'd like up-to-date information for Lymphoedema patients on Facebook. We did...We post each issue of our patient newsletter Lymph Notes on Facebook and we created a Facebook tab on our page where users can access a library of back issues. We also post latest news and service developments as well as patient quotes about the service.
You said...We'd like to see more vacancies advertised on social media. We did...We promote all our paid and unpaid vacancies via Twitter as they become available, and on Facebook on a scheduled basis. We also use #VolunteerHour (Wednesdays 3-4pm) on Twitter to reach potential volunteers.
You said...The speed bumps in the Outpatient and Children’s Car park are very high and uncomfortable when passing over them.
We did...We reduced the gradient of the speed bump so that it was more comfortable for our patients when driving over them.
You said...When meals are being served on the inpatient ward they are occasionally cold by the time they make it around the entire Ward.
We did...We purchased a new hot catering trolley for serving meals. This ensures that food is kept warm for patients. However, the trolley also reduces handling and ensures that portion control is maintained as all food is plated up in the kitchen, thus reducing the time that lunches are given out. Additionally, both hot and cold food can be deliv-ered by the one trolley. This has proved so successful, that an additional trolley is cur-rently on order for Day Hospice.
You said...It would be easier to make my next Lymphoedema appointment before I leave the Hospice, rather than over the phone later.
We did...We have increased administrative staff provision on the Outpatients Reception to enable patients to make appointments before they leave.
Patient Feedback…..An Overview
Lymphoedema review patient feedback – April 2015 to March 2016
A random sample of review patients are surveyed each month from the Lymphoedema service and the results always indicate
high levels of satisfaction.
In April to March 2016 408 surveys were issued and 163 returned, a response rate of 40%, a slight increase on previous re-
sponse rates.
♦ 92% of patients felt staff explained what they were doing all of the time, 7% most of the time.
♦ 94% of patients have confidence in the staff treating tem all of the time, 6% most of the time.
♦ 80% of patients were very satisfied with their involvement in their care, 20% were satisfied.
♦ 71% of patients felt they understood the explanations about their Lymphoedema management all of the time, 26% most of
the time.
♦ 87% of patients felt they has the opportunity to ask questions regarding their treatment all of the time, 11% most of the
time.
♦ 89% of patients felt staff made every effort to meet their individual needs, 11% most of time.
♦ 97% of patients felt they are treated with courtesy all of the time, 3% most of the time.
♦ 99% of patient feel their privacy is respected all of the time, 1% most of the time.
Patients are asked to rank their anxiety about the appointment before and after attending with 0 being not anxious at all to 5
extremely anxious. As can be seen from the table below, anxiety levels decrease for the vast majority of patients.
Scale Before % After %
0 48 29% 104 65%
1 31 19% 29 18%
2 30 18% 14 9%
3 24 15% 10 6%
4 16 10% 3 2%
5 14 9% 1 1%
Grand Total 163 100% 161 100%
Patient Feedback…..An Overview
Patients gave very positive comments such as:
♦ “Excellent service thank you. Before attending the clinic my condition was in danger of being neglected and I have made
good progress. I feel this clinic has kept me out of the hospital system for residential treatment”.
♦ “The general overall service with regards to Lymphoedema education programme was so interesting. It helped me un-
derstand the condition very well”.
♦ “Every member of staff including reception, drivers and driver escorts make sure that your needs/welfare are important.
Could not have had a better team looking after me”.
♦ “I am greatly appreciative of the treatment received. The staff at St Oswald's & Shiremoor are second to none, thank you
everyone!”.
Feedback Bank
Since the launch of the feedback bank there have been 267 posts onto the Feedback, which includes any feedback received
through social media, suggestions boxes and comments books. A summary of the type of feedback is shown below, and as can
be seen the vast majority is a thank you or positive comments (56%).
Where negative comments are made, the information is forwarded immediately to the department manager and a response
requested, which is updated on the feedback survey should the individual choose to go back and look.
Type Of Feedback 2013 2014 2015 2016 Grand Total
Constructive Criticism 9 12 5 26
Negative Feedback 3 25 20 5 53
Neutral 2 3 5
Positive Feedback 18 54 37 5 114
Suggestion 17 14 3 34
Thank you 5 15 13 2 35
Grand Total 28 120 99 20 267
We campaign
St Oswald’s was founded in the 1970’s thanks to the drive and determination of our
founders, who felt so strongly that the people of the North East of England should
benefit from hospice care, that they set about campaigning for it.
Over the years, our campaigning role has involved forging partnerships and driving
forward an agenda to mainstream hospice care.
Today, we work with a number of partner agencies, most notably national associations,
Help the Hospices and Together for Short Lives, to campaign collectively with other UK
hospices and related organisations about issues affecting adults, children and young
people with life limiting conditions.
Recently, we campaigned for:
Better provision of transition services for young adults
In 2012 we devised and published a report called 'Living longer than you thought I
would' with support from Marie Curie Cancer Care Young People and Transition
Programme. The report aimed to better understand the situation, needs and
aspirations of young people with life limiting conditions who are growing into
adulthood. The publication was launched at a high visibility event in London, aimed at
government ministers and policy makers, as well as local MP’s to garner their support.
Building on this work we are also now regional lead for the ‘Transition Taskforce’. The
Taskforce is a national initiative involving agencies such as Together for Short Lives, Help
the Hospices, Marie Curie and the National Council for Palliative Care.
The aim of the Transition Taskforce is to ensure young people approaching adulthood
with life limiting conditions make the transition to adult services and live their lives as
independently as possible according to their wishes, whilst receiving the care and
support they - and their carers - need.
We continue to campaign for the needs of young people and all of our patients and
families. These form the basis of our Vision 2025 strategic objectives.
We educate
We are a leading provider of specialist palliative care education in the North East. We
have been providing first class quality care for almost thirty years and are renowned
locally, regionally and nationally for our expertise. Our role as an educator includes:
Medical Specialty Training
We offer postgraduate training for Specialty Registrars. Dr Andrew Hughes, Consultant
in Specialist Palliative Medicine oversees our doctors training programme.
Northern GP training programme
We lead the palliative care sessions Northern Deanery GP training programme. These
take place twice a month at Coach Lane campus at Northumbria University and are led
by our consultants and specialty doctors. GP colleagues from Teesside also visit
St Oswald’s for a week each Autumn to gain an overview and update in specialist
palliative care.
Student placements
Fourth year medical students undertake a six week placement twice a year, supervised
by one of our consultants.
Third year LTC students (Long term Conditions) attend teaching sessions at the Hospice
for two and a half days a week, every month from January to June each year.
Corroborative statement from Newcastle Gateshead, N orthumberland and North Tyneside Clinical Commissioning Groups (CCGs) for St Oswald’ s Hospice Quality Accounts 2015/16 The CCGs welcomes the opportunity to review and comment on St Oswald’s Hospice Quality Account for 2015/16 and would like to provide the following commentary. As commissioners, Newcastle Gateshead, Northumberland and North Tyneside Commissioning Groups (CCGs) are committed to commissioning high quality services from St Oswald’s Hospice and take seriously their responsibility to ensure that patients’ needs are met by the provision of safe, high quality services and that the views and expecta-tions of patients and the public are listened to and acted upon. The CCGs recognise that the hospice provides an important and very specific role in the North East of England and is widely respected and admired by patients, the public and healthcare staff. St Oswald’s Hospice has a strong and unique brand identity; and it is clear that the service is always looking ahead to provide ever more comprehensive care for inpatients and outpatients, as well as for people at home or other community settings. The commitment of St Oswald’s Hospice to continuous quality improvement is also very evident. The report very clearly details the progress made against the priorities for the previous 12 months and the CCGs would like to congratulate St Oswald’s Hospice on the excellent work that has been undertaken. The Focus on Living Project within day services has made excellent steps forward and this objective has been fully met. The CCGs note that the training to support services for bereaved children and also the Outcomes Assessment Complexity Collabo-rative (OACC) suite of measures are partially met and both these areas will continue to be focus in 2016/17. The se-curing of funds for the NHS Lymphoedema Services has also made important progress forward. The CCGs also note confirmation in the Quality Account that the Hospice was assessed as ‘good’ overall by the Care Quality Commission (CQC) with ‘outstanding’ for care. The CCGs would like to offer congratulations to the Board and all staff on this recognition of high quality care and services.
Corroborative statement from Newcastle Gateshead, N orthumberland and North Tyneside Clinical Commissioning Groups (CCGs) for St Oswald’ s Hospice Quality Accounts 2015/16 (cont.) It is a CQC requirement that compliance with the statutory duty of candour is evidenced by all healthcare providers and St Oswald’s Hospice must therefore ensure that records of conversations and correspondence are maintained when duty of candour has been initiated. It is noted that St Oswald’s Hospice implementation of duty of candour has not been included in this Quality Accounts statement as suggested by NHS England. The CCGs fully support the key priorities for 2016/17 and feel they are appropriate areas to target for continued improvement. The CCGs welcome the continued focus in the OACC suite of measures and also NHS Lymphoedema services; the new and refreshed look at collaborative working with other North East hospices and also wider potential educational solutions to the challenge of excellent end of life care for our patients. Finally, the CCGs would like to offer congratulations to St Oswald’s Hospice on the achievements outlined in this report which we believe accurately reflects the hospice’s commitment to delivering a high quality, patient centred services. The CCGs look forward to continuing to work in partnership with the hospice to assure the quality of services com-missioned in 2016/17.
Dr Neil Morris Chris Piercy Medical Director Executive Director of Nursing, P atient Safety & Quality For and on behalf of NHS Newcastle Gateshead Clinical Commissioning Group NHS Northumberland Clinical Commissioning Group
St Oswald’s Hospice, Regent Avenue,
Gosforth, Newcastle upon Tyne, NE3 1EE
Telephone: 0191 285 0063 Fax: 0191 246 9052
Email: [email protected] Reg Charity No. 503386
www.stoswaldsuk.org
